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  1. Left atrial appendage occlusion

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    Ahmad Mirdamadi

    2013-01-01

    Full Text Available Left atrial appendage (LAA occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC, it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC and mitral valve replacement (MVR too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.

  2. Left Atrial Decompression by Percutaneous Left Atrial Venting Cannula Insertion during Venoarterial Extracorporeal Membrane Oxygenation Support

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    Ha Eun Kim

    2016-06-01

    Full Text Available Patients with venoarterial extracorporeal membrane oxygenation (ECMO frequently suffer from pulmonary edema due to left ventricular dysfunction that accompanies left heart dilatation, which is caused by left atrial hypertension. The problem can be resolved by left atrium (LA decompression. We performed a successful percutaneous LA decompression with an atrial septostomy and placement of an LA venting cannula in a 38-month-old child treated with venoarterial ECMO for acute myocarditis.

  3. Occlusion of left atrial appendage in patients with atrial fibrillation

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    О. Н. Ганеева

    2015-10-01

    Full Text Available The article reviews a new method of prophylaxis of thromboembolitic complications, specifically occlusion of left atrial appendage, in patients with atrial fibrillation. Indications and contraindications for the procedure, as well as a step-by-step process of the intervention itself are described. Special emphasis is placed on the up-to-date evidence and the review of clinical trials.

  4. Left ventricular filling under elevated left atrial pressure

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    Gaddam, Manikantam; Samaee, Milad; Santhanakrishnan, Arvind

    2017-11-01

    Left atrial pressure (LAP) is elevated in diastolic dysfunction, where left ventricular (LV) filling is impaired due to increase in ventricular stiffness. The impact of increasing LAP and LV stiffness on intraventricular filling hemodynamics remains unclear. We conducted particle image velocimetry and hemodynamics measurements in a left heart simulator (LHS) under increasing LAP and LV stiffness at a heart rate of 70 bpm. The LHS consisted of a flexible-walled LV physical model fitted within a fluid-filled chamber. LV wall motion was generated by a piston pump that imparted pressure fluctuations in the chamber. Resistance and compliance elements in the flow loop were adjusted to obtain bulk physiological hemodynamics in the least stiff LV model. Two LV models of increasing stiffness were subsequently tested under unchanged loop settings. LAP was varied between 5-20 mm Hg for each LV model, by adjusting fluid level in a reservoir upstream of the LV. For constant LV stiffness, increasing LAP lowered cardiac output (CO), while ejection fraction (EF) and E/A ratio were increased. For constant LAP, increasing LV stiffness lowered CO and EF, and increased E/A ratio. The implications of these altered hemodynamics on intraventricular filling vortex characteristics will be presented.

  5. Echocardiographic study of left atrial myxoma

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    Dalal J

    1979-01-01

    Full Text Available Four cases of left atrial myxoma were diagnosed pre-operatively by echocardiography. All cases showed characteristic echocardio-graphic features of variegated shadows behind the mitral valve in diastole and within the left atrium in systole. In two cases the my-xomas were surgically removed and confirmed on histology. In one case the post-operative echocardiogram showed complete dis-appearance of the abnormal shadows. Echocardiography is the most reliable method today for the diagnosis of a myxoma.

  6. Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

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    Chinali, M.; Simone, G. de; Wachtell, K.

    2008-01-01

    In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial...... systolic force and left ventricular geometry and function have not been investigated in high-risk hypertrophic hypertensive patients. Participants in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy without prevalent cardiovascular disease or atrial fibrillation (n...... = 567) underwent standard Doppler echocardiography. Left atrial systolic force was obtained from the mitral orifice area and Doppler mitral peak A velocity. Patients were divided into groups with normal or increased left atrial systolic force (>14.33 kdyn). Left atrial systolic force was high in 297...

  7. Anatomic relationship between left coronary artery and left atrium in patients undergoing atrial fibrillation ablation.

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    Anselmino, Matteo; Torri, Federica; Ferraris, Federico; Calò, Leonardo; Castagno, Davide; Gili, Sebastiano; Rovera, Chiara; Giustetto, Carla; Gaita, Fiorenzo

    2017-07-01

    Atrial fibrillation transcatheter ablation (TCA) is, within available atrial fibrillation rhythm control strategies, one of the most effective. To potentially improve ablation outcome in case of recurrent atrial fibrillation after a first procedure or in presence of structural myocardial disease, isolation of the pulmonary veins may be associated with extensive lesions within the left atrium. To avoid rare, but potentially life-threatening, complications, thorough knowledge and assessment of left atrium anatomy and its relation to structures in close proximity are, therefore, mandatory. Aim of the present study is to describe, by cardiac computed tomography, the anatomic relationship between aortic root, left coronary artery and left atrium in patients undergoing atrial fibrillation TCA. The cardiac computed tomography scan of 21 patients affected by atrial fibrillation was elaborated to segment left atrium, aortic root and left coronary artery from the surrounding structures and the following distances measured: left atrium and aortic root; left atrium roof and aortic root; left main coronary artery and left atrium; circumflex artery and left atrium appendage; and circumflex artery and mitral valve annulus. Above all, the median distance between left atrium and aortic root (1.9, 1.5-2.1 mm), and between circumflex artery and left atrium appendage ostium (3.0, 2.1-3.4 mm) were minimal (≤3 mm). None of measured distances significantly varied between patients presenting paroxysmal versus persistent atrial fibrillation. The anatomic relationship between left atrium and coronary arteries is extremely relevant when performing atrial fibrillation TCA by extensive lesions. Therefore, at least in the latter case, preablation imaging should be recommended to avoid rare, but potentially life-threatening, complications with the aim of an as well tolerated as possible procedure.

  8. Mapping of the left-sided phrenic nerve course in patients undergoing left atrial catheter ablations.

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    Huemer, Martin; Wutzler, Alexander; Parwani, Abdul S; Attanasio, Philipp; Haverkamp, Wilhelm; Boldt, Leif-Hendrik

    2014-09-01

    Catheter ablation of atrial fibrillation has been associated with left-sided phrenic nerve palsy. Knowledge of the individual left phrenic nerve course therefore is essential to prevent nerve injury. The aim of this study was to test the feasibility of an intraprocedural pace mapping and reconstruction of the left phrenic nerve course and to characterize which anatomical areas are affected. In patients undergoing left atrial catheter ablation, a three-dimensional map of the left atrial anatomical structures was created. The left-sided phrenic nerve course was determined by high-output pace mapping and reconstructed in the map. In this study, 40 patients with atrial fibrillation or atrial tachycardias were included. Left phrenic nerve capture was observed in 23 (57.5%) patients. Phrenic nerve was captured in 22 (55%) patients inside the left atrial appendage, in 22 (55%) in distal parts, in 21 (53%) in medial parts, and in two (5%) in ostial parts of the appendage. In three (7.5%) patients, capture was found in the distal coronary sinus and in one (2.5%) patient in the left atrium near the left atrial appendage ostium. Ablation target was changed due to direct spatial relationship to the phrenic nerve in three (7.5%) patients. No phrenic nerve palsy was observed. Left-sided phrenic nerve capture was found inside and around the left atrial appendage in the majority of patients and additionally in the distal coronary sinus. Phrenic nerve mapping and reconstruction can easily be performed and should be considered prior catheter ablations in potential affected areas. ©2014 Wiley Periodicals, Inc.

  9. Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation.

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    Demirçelik, Muhammed Bora; Çetin, Mustafa; Çiçekcioğlu, Hülya; Uçar, Özgül; Duran, Mustafa

    2014-05-01

    We aimed to investigate effects of left ventricular diastolic dysfunction on left atrial appendage functions, spontaneous echo contrast and thrombus formation in patients with nonvalvular atrial fibrillation. In 58 patients with chronic nonvalvular atrial fibrilation and preserved left ventricular systolic function, left atrial appendage functions, left atrial spontaneous echo contrast grading and left ventricular diastolic functions were evaluated using transthoracic and transoesophageal echocardiogram. Patients divided in two groups: Group D (n=30): Patients with diastolic dysfunction, Group N (n=28): Patients without diastolic dysfunction. Categorical variables in two groups were evaluated with Pearson's chi-square or Fisher's exact test. The significance of the lineer correlation between the degree of spontaneous echo contrast (SEC) and clinical measurements was evaluated with Spearman's correlation analysis. Peak pulmonary vein D velocity of the Group D was significantly higher than the Group N (p=0.006). However, left atrial appendage emptying velocity, left atrial appendage lateral wall velocity, peak pulmonary vein S, pulmonary vein S/D ratio were found to be significantly lower in Group D (p=0.028, patrial appendage emptying, filling, pulmonary vein S/D levels and lateral wall velocities respectively (r=-0.438, r=-0.328, r=-0.233, r=-0.447). Left atrial appendage emptying, filling, pulmonary vein S/D levels and lateral wall velocities were significantly lower in SEC 2-3-4 than SEC 1 (p=0.003, p=0.029, patrial fibrillation and preserved left ventricular ejection fraction, left atrial appendage functions are decreased in patients with left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction may constitute a potential risk for formation of thrombus and stroke.

  10. Assessment of left atrial volume and function

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    Kühl, J Tobias; Lønborg, Jacob; Fuchs, Andreas

    2012-01-01

    dynamic LA volume changes. Conversely, cardiac magnetic resonance imaging (CMR) and multi-slice computed tomography (MSCT) appears more appropriate for such measures. We sought to determine the relationship between LA size assessed with TTE and LA size and function assessed with CMR and MSCT. Fifty......-four patients were examined 3 months post myocardial infarction with echocardiography, CMR and MSCT. Left atrial volumes and LA reservoir function were assessed by TTE. LA time-volume curves were determined and LA reservoir function (cyclic change and fractional change), passive emptying function (reservoir...... between CMR and MSCT, with a small to moderate bias in LA(max) (4.9 ± 10.4 ml), CC (3.1 ± 9.1 ml) and reservoir volume (3.4 ± 9.1 ml). TTE underestimates LA(max) with up to 32% compared with CMR and MSCT (P ...

  11. Percutaneous left atrial appendage closure for stroke prevention

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    De Backer, Ole; Loupis, Anastasia M; Ihlemann, Nikolaj

    2014-01-01

    INTRODUCTION: In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alt...

  12. Transient left atrial dysfunction is a feature of Takotsubo syndrome

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    Stiermaier, Thomas; Graf, Tobias; Möller, Christian

    2017-01-01

    BACKGROUND: Takotsubo syndrome (TTS) is characterized by a transient left and/or right ventricular dysfunction as a consequence of a distinctive pattern of regional wall motion abnormalities. However, a systematic evaluation of the left atrial (LA) function in patients with TTS is lacking. The ai...

  13. Incisional left atrial isolation for ablation of atrial fibrillation in mitral valve surgery.

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    Graffigna, Angelo; Branzoli, Stefano; Sinelli, Stefano; Vigano, Mario

    2009-01-01

    The renewed interest in surgical techniques for atrial fibrillation (AF) limited to the left atrium has risen the importance of the original technique of left atrial isolation by means of surgical incision. Transmurality of lesions and cost containment are strong elements to be appreciated in this technique.

  14. [Left versus bi-atrial radiofrequency ablation in the treatment of atrial fibrillation].

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    Wang, Jian-Gang; Meng, Xu; Li, Hui

    2008-11-25

    To evaluate the effectiveness of radiofrequency modified maze operation for the treatment of atrial fibrillation (AF) and compare the results of the left versus bi-atrial procedures. 305 patients of organic heart disease combined with AF, 117 males and 188 females, aged (53 +/- 10), that underwent cardiac valve operation (n = 293) and/or coronary artery bypass graft surgery (n = 14), received concomitant atrial fibrillation, bi-atrial (n = 160) or left atrial (n = 145) with a mean duration of (36 +/- 43) months. Follow-up was conducted for (28 +/- 5) (3 - 42) months. Thirteen patients (4.3%) died postoperatively: 7 died of multisystem and organ failure, 3 of low cardiac output, 1 of rupture of left ventricle, 1 of arrhythmia, and 1 of sudden death. During the follow-up, 1 patient died of heart failure, 1 of encephalorrhagia and 1 of unknown reason in the bi-atrial group. At the end of the procedure 223 patients (73.1%) had sinus rhythm, with a sinus rhythm rate of 66.9% (107/160) in the bi-atrial group, significant lower than that in the left atrial group (80.0%, 116/145, P bi-atrial group was 80.0%, not significantly different from that of the left atrial group (81.9%, P > 0.05). The Kaplan-Meier survival analysis showed there was no significant difference in the AF rhythm rate between these 2 groups (P = 0.33). Logistic regression analysis showed that the left atrial diameter of >/= 80 mm was an independent predictor of AF recurrence. Both the left and bi-atrial procedures are successful in terms of restoring sinus rhythm. Left atrial ablation in severe cases and where the incision of right atrium is not needed is a reasonable choice.

  15. Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

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    Simone Nascimento dos Santos

    2014-12-01

    Full Text Available Background: Left ventricular (LV diastolic dysfunction is associated with new-onset atrial fibrillation (AF, and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. Objective: To evaluate the impact of AF ablation on estimated LV filling pressure. Methods: A total of 141 patients underwent radiofrequency (RF ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind, and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e' were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. Results: One hundred seventeen patients (82.9% were free of AF during the follow-up (average, 18 ± 5 months. LAVind reduced in the successful group (30.2 mL/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001 compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, p = ns. Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001 but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns. The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001. Conclusion: Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

  16. Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

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    Santos, Simone Nascimento dos, E-mail: simonens@cardiol.br [Instituto Brasília de Arritmia- Universidade de Brasília, DF (Brazil); Faculdade de Medicina (UnB), Brasília, DF (Brazil); Henz, Benhur Davi; Zanatta, André Rodrigues; Barreto, José Roberto; Loureiro, Kelly Bianca; Novakoski, Clarissa; Santos, Marcus Vinícius Nascimento dos; Giuseppin, Fabio F.; Oliveira, Edna Maria; Leite, Luiz Roberto [Instituto Brasília de Arritmia- Universidade de Brasília, DF (Brazil)

    2014-12-15

    Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. To evaluate the impact of AF ablation on estimated LV filling pressure. A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m{sup 2} ± 10.6 mL/m{sup 2} to 22.6 mL/m{sup 2} ± 1.1 mL/m{sup 2}, p < 0.001) compared to the non-successful group (37.7 mL/m{sup 2} ± 14.3 mL/m{sup 2} to 37.5 mL/m{sup 2} ± 14.5 mL/m{sup 2}, p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

  17. Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

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    Santos, Simone Nascimento dos; Henz, Benhur Davi; Zanatta, André Rodrigues; Barreto, José Roberto; Loureiro, Kelly Bianca; Novakoski, Clarissa; Santos, Marcus Vinícius Nascimento dos; Giuseppin, Fabio F.; Oliveira, Edna Maria; Leite, Luiz Roberto

    2014-01-01

    Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. To evaluate the impact of AF ablation on estimated LV filling pressure. A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m 2 ± 10.6 mL/m 2 to 22.6 mL/m 2 ± 1.1 mL/m 2 , p < 0.001) compared to the non-successful group (37.7 mL/m 2 ± 14.3 mL/m 2 to 37.5 mL/m 2 ± 14.5 mL/m 2 , p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure

  18. Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial Fibrillation

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    Merih Cibis

    2017-12-01

    Full Text Available Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored.Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2–3 h (Time-1 and 4 weeks (Time-2 following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed.Results: From Time-1 to Time-2: Heart rate decreased (61 ± 7 vs. 56 ± 8 bpm, p = 0.01; Maximum change in left atrial volume increased (8 ± 4 vs. 22 ± 15%, p = 0.009; The duration of stasis (68 ± 11 vs. 57 ± 8%, p = 0.002 and the volume of stasis (14 ± 9 vs. 9 ± 7%, p = 0.04 decreased; Thrombin-antithrombin complex (TAT decreased (5.2 ± 3.3 vs. 3.3 ± 2.2 μg/L, p = 0.008. A significant correlation was found between TAT and the volume of stasis (r2 = 0.69, p < 0.001 at Time-1 and between TAT and the duration of stasis (r2 = 0.34, p = 0.04 at Time-2.Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation

  19. Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial Fibrillation

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    Cibis, Merih; Lindahl, Tomas L.; Ebbers, Tino; Karlsson, Lars O.; Carlhäll, Carl-Johan

    2017-01-01

    Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR) enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored. Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2–3 h (Time-1) and 4 weeks (Time-2) following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed. Results: From Time-1 to Time-2: Heart rate decreased (61 ± 7 vs. 56 ± 8 bpm, p = 0.01); Maximum change in left atrial volume increased (8 ± 4 vs. 22 ± 15%, p = 0.009); The duration of stasis (68 ± 11 vs. 57 ± 8%, p = 0.002) and the volume of stasis (14 ± 9 vs. 9 ± 7%, p = 0.04) decreased; Thrombin-antithrombin complex (TAT) decreased (5.2 ± 3.3 vs. 3.3 ± 2.2 μg/L, p = 0.008). A significant correlation was found between TAT and the volume of stasis (r2 = 0.69, p < 0.001) at Time-1 and between TAT and the duration of stasis (r2 = 0.34, p = 0.04) at Time-2. Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation related

  20. Left atrial isolation associated with mitral valve operations.

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    Graffigna, A; Pagani, F; Minzioni, G; Salerno, J; Viganò, M

    1992-12-01

    Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent mitral valve operations. From May 1989 to September 1991, 62 patients underwent mitral valve operations (group I); 19, mitral valve operations and DeVega tricuspid annuloplasty (group II); 15, mitral and aortic operations (group III); and 4, mitral and aortic operations and DeVega tricuspid annuloplasty (group IV). Left atrial isolation was performed, prolonging the usual left paraseptal atriotomy toward the left fibrous trigone anteriorly and the posteromedial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesions were placed at the edges to ensure complete electrophysiological isolation of the left atrium. Operative mortality accounted for 3 patients (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (group I, 80.7%; group II, 68.5%; group III, 86.7%; group IV, 75%; p = not significant). Three late deaths (3.1%) were registered. Long-term results show persistence of sinus rhythm in 71% of group I, 61.2% of group II, 85.8% of group III, and 100% of group IV. The unique risk factor for late recurrence of atrial fibrillation was found to be preoperative atrial fibrillation longer than 6 months. Due to the satisfactory success rate in recovering sinus rhythm, we suggest performing left atrial isolation in patients with chronic atrial fibrillation undergoing valvular operations.

  1. Atorvastatin can ameliorate left atrial stunning induced by radiofrequency ablation for atrial fibrillation.

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    Xie, Ruiqin; Yang, Yingtao; Cui, Wei; Yin, Hongning; Zheng, Hongmei; Zhang, Jidong; You, Ling

    2017-09-01

    The objective of this study was to study the functional changes of the left atrium after radiofrequency ablation treatment for atrial fibrillation and the therapeutic effect of atorvastatin. Fifty-eight patients undergoing radiofrequency ablation for atrial fibrillation were randomly divided into non-atorvastatin group and atorvastatin group. Patients in the atorvastatin group were treated with atorvastatin 20 mg p.o. per night in addition to the conventional treatment of atrial fibrillation; patients in the non-atorvastatin group received conventional treatment of atrial fibrillation only. Echocardiography was performed before radiofrequency ablation operation and 1 week, 2 weeks, 3 weeks, and 4 weeks after operation. Two-dimensional ultrasound speckle tracking imaging system was used to measure the structural indexes of the left atrium. Results indicated that there was no significant change for indexes representing the structural status of the left atrium within a month after radiofrequency ablation (P > 0.05); however, there were significant changes for indexes representing the functional status of the left atrium. There were also significant changes in indexes reflecting left atrial strain status: the S and SRs of atorvastatin group were higher than those of non-atorvastatin group (P atorvastatin could improve left atrial function and shorten the duration of atrial stunning after radiofrequency ablation of atrial fibrillation.

  2. The left atrial catheter: its uses and complications.

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    Leitman, B S; Naidich, D P; McGuinness, G; McCauley, D I

    1992-11-01

    The authors describe the radiographic appearance of the left atrial catheter, a widely used postsurgical intracardiac device. Recognition of the characteristic appearance of this catheter should be of value in detection of potential complications, including line fracture with resultant retention and/or embolization, infection, prosthetic valve dysfunction, and even cardiac tamponade.

  3. Left atrial thrombus following bilobectomy: a case report

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    Kaya Ugur

    2010-02-01

    Full Text Available Abstract Introduction Left atrial free floating ball thrombus is a relatively rare event, especially without mitral valve disease. Case presentation A 61-year-old Turkish man was admitted to our hospital with a thrombus mass in his left atrium. Five months earlier, he had undergone right bilobectomy and superior bronchoplasty due to squamous cell carcinoma in the lung. The patient had no evidence of cardiac disease except atrial fibrillation and there were no defined embolizations. The thrombus mass was surgically removed. The patient was discharged from hospital on the sixth postoperative day. Conclusion Surgery with cardiopulmonary bypass is a safe method for treatment. The patient should be medicated with warfarin, especially in the presence of atrial fibrillation.

  4. Left atrial size and function as predictors of new-onset of atrial fibrillation in patients with asymptomatic aortic stenosis

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    Bang, Casper Niels Furbo; Dalsgaard, Morten; Greve, Anders

    2013-01-01

    Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS).......Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS)....

  5. Speckle tracking analysis: a new tool for left atrial function analysis in systemic hypertension: an overview.

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    Cameli, Matteo; Ciccone, Marco M; Maiello, Maria; Modesti, Pietro A; Muiesan, Maria L; Scicchitano, Pietro; Novo, Salvatore; Palmiero, Pasquale; Saba, Pier S; Pedrinelli, Roberto

    2016-05-01

    Speckle tracking echocardiography (STE) is an imaging technique applied to the analysis of left atrial function. STE provides a non-Doppler, angle-independent and objective quantification of left atrial myocardial deformation. Data regarding feasibility, accuracy and clinical applications of left atrial strain are rapidly gathering. This review describes the fundamental concepts of left atrial STE, illustrates its pathophysiological background and discusses its emerging role in systemic arterial hypertension.

  6. The Prognostic Value of Left Atrial Peak Reservoir Strain in Acute Myocardial Infarction Is Dependent on Left Ventricular Longitudinal Function and Left Atrial Size

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    Ersbøll, Mads; Andersen, Mads J; Valeur, Nana

    2013-01-01

    of PALS and left ventricular longitudinal strain (global longitudinal strain) in large-scale populations in regard to prognosis. METHODS AND RESULTS: We prospectively included 843 patients (mean age 62.1+/-11.8; 74% male) with acute myocardial infarction and measured global longitudinal strain, left......BACKGROUND: Peak atrial longitudinal strain (PALS) during the reservoir phase has been proposed as a measure of left atrium function in a range of cardiac conditions, with the potential for added pathophysiological insight and prognostic value. However, no studies have assessed the interrelation...

  7. Management of left atrial myxomas at civil hospital, Karachi

    International Nuclear Information System (INIS)

    Iqbal, M.I.; Khan, A.B.; Aftab, S.; Mahmood, S.A.

    2008-01-01

    To study the outcome of the management of left atrial myxoma. The diagnosis was made according to clinical presentation and echocardiographic examinations. Tumour excised under cardiopulmonary bypass using aortic and bicaval cannulation and moderate hypothermia. Variables noted were surgical approach, pathological findings and complications after surgery. Of the 12 cases, six were male and six female, with a mean age of 33.67+-6.05 years. Fatigue and fever were the most common general symptoms, and dyspnoea the most common cardiologic symptom. The pedunculated atrial tumours were excised by trans-septal approach; tumour size ranged between 1.5x1x0.7 cms to 9x8x6 cms and weight 3-140 gms. Histopathology confirmed the tumours as atrial myxomas. One patient died of cerebrovascular accident on the 3rd postoperative day. So far, there has been no recurrence of the tumours. Surgical treatment with wide excision of left atrial myxomas by trans-septal approach is a suitable approach with negligible chances of recurrence. (author)

  8. Left atrial size in patients with cryptogenic stroke as a predictor of occurrence of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Antonio Cruz Culebras

    2017-04-01

    Full Text Available Objective: To determine whether the left atrial size can predict the development of atrial fibrillation (AF in patients with embolic stroke of undetermined source (ESUS. Methods: Patients with ischemic stroke were included prospectively (January 2015-July 2015 when ESUS was suspected. Clinical and cardiac imaging data were recorded. Patients with cardiac failure were excluded. Results: a total of 55 patients were included. Medium age was 71 years. The proportion of patients who developed AF during the follow-up (1 year was 23, 63%. 10 % of patients did not have any vascular risk factor. Basal ECG was normal in 98% of cases. The left atrial size volume was 36, 08 ml in patients who developed AF and 27, 14 ml in patients who did not. Conclusions: In patients with ESUS, left atrial size dimensions do not predict the occurrence of AF.

  9. LEFT ATRIAL FUNCTION: MODERN ASSESSMENT METHODS AND CLINICAL SIGNIFICANCE

    Directory of Open Access Journals (Sweden)

    E. N. Pavlyukova

    2017-01-01

    Full Text Available Assessment of the left atrial (LA function is important aspect of comprehensive cardiovascular system estimation. Many cardiac diseases make an impact to LA work either by direct affect on myocardium or hemodynamic condition changing. It is considered, LA and left ventricle diastolic pressure is interrelated, thus without mitral valve disease LA expanding is a sign of LV filling pressure augmentation. Examination of LA size and function by analysis of atrial reservoir, conduit, and booster pump can predict cardiovascular outcomes in patients with cardiomyopathy, ischemic heart disease and valvular heart disease. The last two decades gave new technologies to accurate and comprehensive LA mechanics estimation, in the first place related to tissue Doppler imaging. Atrial strain and strain rate obtained using two-dimensional speckle-tracking echocardiography have proved to be feasible and reproducible techniques to evaluate LA mechanics.In physiological settings, LA is a highly expandable chamber with relatively low pressures. However in the presence of acute and chronic injury, LA wall stretches. LA stretching is a hallmark of structure changing with myocardial fibrosis and has influence on LA strain and strain rate. LA strain estimation could be useful in the prediction of sinus rhythm restoration and maintenance after cardioversion and catheter ablation. Low values of global longitudinal LA strain indicate irreversible LA remodeling and are related to the atrial fibrillation progression from paroxysmal to permanent forms. The most interesting in these circumstances is the potential contribution of echocardiography to thromboembolic risk stratification in atrial fibrillation and invasive procedures such as atrial ablation. Therefore, at present, the main task is to understand the ways of clinical application of data  obtained during the LA study.

  10. Case of right atrial myxoma with right to left shunt

    Energy Technology Data Exchange (ETDEWEB)

    Nakai, Kenji; Suzuki, Tomoyuki; Ohzeki, Tetsuro (Iwate Medical Coll., Morioka (Japan). School of Medicine)

    1982-12-01

    A case of 49-year-old woman with right atrial myxoma resulting to right to left shunt, diagnosed by cardiac pool isotope image, was reported. She was admitted to our clinic because of progressive shortness of breath. At admission lip cyanosis was noted. Laboratory data included polycythemia, low O/sub 2/ saturation (89%) and high erythrocyte sedimentation rate (65 mm/1 h). Chest x-p showed slight right atrial enlargement, but no pulmonary congestion. The electrocardiogram showed sinus regular rhythm with biphasic p wave in leads II, III, aVf. Although 1st heart sound at the apex was splited, no heart murmur was heard. In usual echocardiographic approach, no abnormal echogram was obtained in the right ventricular region. Lung perfusion scintiscan with Tc-99 m-MAA showed visualization of thyroid gland and kidney, which suggested intracardiac right-to-left shunt. Cardiac pool image with Tc-99m-HSA revealed large photo-deficient area in the right atrium and early visualization of aortic arch. Computor tomography showed large round low density region 8 x 7 cm in size. Based on their findings, this patient was diagnosed as right atrial tumor. At operation a large tumor (diameter 8 x 7 x 7 cm, weight 160g) filled the lower part of the right atrium and was adherent to the anterolateral wall in the right atrium. As a cause of R-L shunt, streched foramen ovale (5 x 10 mm) was found. Tumor histology was typical of atrial myxoma. Post-operative gated cardiac isotope image showed no evidence of residual atrial tumor. Cardiac blood pool isotope imaging was a method for the noninvasive detection and assessment of right atrial myxoma.

  11. Early changes in left atrial volume after acute myocardial infarction

    DEFF Research Database (Denmark)

    Bakkestrom, R.; Andersen, Mads J; Ersboll, M.

    2016-01-01

    . The objective was to assess changes in LA volume early after MI in patients with diastolic dysfunction and the relation to invasive hemodynamics and natriuretic peptides. Methods: 62 patients with left ventricle ejection fraction (LVEF) >= 45%, diastolic E/e' > 8 and LA volume index >34 ml/m(2) within 48 h......Background: Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise...... of MI were enrolled. After 1 and 4 months blood sampling, echocardiography and right heart catheterization were performed during exercise test. Results: LA remodeling was considered in patients with a change from mild (35-41 ml/m(2)), to severe (>48ml/m(2)) dilatation after 4 months (Found in 22...

  12. Plain chest PA evaluation of left atrial thrombosis in mitral valvular disease

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Yeon Myung; Park, Jae Hyung; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1984-09-15

    Conventional posteroanterior chest radiographs of 73 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the absence of the convexity of the left lower mid cardiac border (left atrial segment) and to the relation with duration of illness, atrial fibrillation, pulmonary capillary wedge pressure (PCWP) as well as surgical findings. The results obtained are as follows: 1. The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in eleven (64.7%) of 17 patients who had left atrial thrombosis and in six (10.7%) of 56 patients who did not have thrombosis (false positive diagnosis). Six (35.5%) of the 17 patients who had left atrial thrombosis did not this findings on radiographs (false positive diagnosis). Six (35.3%) of the 17 patients who had left atrial thrombosis did not show this finding on radiographs (false positive diagnosis). Therefore, the accuracy in the diagnosis of thrombosis of left atrium wa 64.7% (eleven of seventeen) for patients who had thrombosis of left atrium. 2. The atrial fibrillation was observed in sixteen (94.1%)of 17 patients who had left atrial thrombosis. So, correlation between the presence of left atrial thrombosis and atrial fibrillation wa evident. But there was no correlation between the duration of illness of the PCWP of patients and the presence of left atrial thrombosis.

  13. Plain chest PA evaluation of left atrial thrombosis in mitral valvular disease

    International Nuclear Information System (INIS)

    Choo, Yeon Myung; Park, Jae Hyung; Han, Man Chung

    1984-01-01

    Conventional posteroanterior chest radiographs of 73 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the absence of the convexity of the left lower mid cardiac border (left atrial segment) and to the relation with duration of illness, atrial fibrillation, pulmonary capillary wedge pressure (PCWP) as well as surgical findings. The results obtained are as follows: 1. The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in eleven (64.7%) of 17 patients who had left atrial thrombosis and in six (10.7%) of 56 patients who did not have thrombosis (false positive diagnosis). Six (35.5%) of the 17 patients who had left atrial thrombosis did not this findings on radiographs (false positive diagnosis). Six (35.3%) of the 17 patients who had left atrial thrombosis did not show this finding on radiographs (false positive diagnosis). Therefore, the accuracy in the diagnosis of thrombosis of left atrium wa 64.7% (eleven of seventeen) for patients who had thrombosis of left atrium. 2. The atrial fibrillation was observed in sixteen (94.1%)of 17 patients who had left atrial thrombosis. So, correlation between the presence of left atrial thrombosis and atrial fibrillation wa evident. But there was no correlation between the duration of illness of the PCWP of patients and the presence of left atrial thrombosis.

  14. Relationship of left atrial enlargement to persistence or development of ECG left ventricular hypertrophy in hypertensive patients: implications for the development of new atrial fibrillation

    DEFF Research Database (Denmark)

    Okin, Peter M; Gerdts, Eva; Wachtell, Kristian

    2010-01-01

    Persistence and development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria are associated with an increased risk of atrial fibrillation compared with regression or continued absence of LVH. We postulated that this association might be in part mediated via greater left atrial...... enlargement (LAE) in patients with new and persistent ECG LVH....

  15. Effects of sedation on echocardiographic variables of left atrial and left ventricular function in healthy cats.

    Science.gov (United States)

    Ward, Jessica L; Schober, Karsten E; Fuentes, Virginia Luis; Bonagura, John D

    2012-10-01

    Although sedation is frequently used to facilitate patient compliance in feline echocardiography, the effects of sedative drugs on echocardiographic variables have been poorly documented. This study investigated the effects of two sedation protocols on echocardiographic indices in healthy cats, with special emphasis on the assessment of left atrial size and function, as well as left ventricular diastolic performance. Seven cats underwent echocardiography (transthoracic two-dimensional, spectral Doppler, color flow Doppler and tissue Doppler imaging) before and after sedation with both acepromazine (0.1 mg/kg IM) and butorphanol (0.25 mg/kg IM), or acepromazine (0.1 mg/kg IM), butorphanol (0.25 mg/kg IM) and ketamine (1.5 mg/kg IV). Heart rate increased significantly following acepromazine/butorphanol/ketamine (mean±SD of increase, 40±26 beats/min) and non-invasive systolic blood pressure decreased significantly following acepromazine/butorphanol (mean±SD of decrease, 12±19 mmHg). The majority of echocardiographic variables were not significantly different after sedation compared with baseline values. Both sedation protocols resulted in mildly decreased left ventricular end-diastolic dimension and mildly increased left ventricular end-diastolic wall thickness. This study therefore failed to demonstrate clinically meaningful effects of these sedation protocols on echocardiographic measurements, suggesting that sedation with acepromazine, butorphanol and/or ketamine can be used to facilitate echocardiography in healthy cats.

  16. Left atrial spindle cell sarcoma – Case report

    Directory of Open Access Journals (Sweden)

    Nihar Mehta

    2012-07-01

    Full Text Available Primary spindle cell sarcoma of the left atrium is an extremely rare tumour. Surgical excision is the mainstay of treatment since it responds poorly to chemotherapy or radiotherapy. In spite of all the treatment, the prognosis remains poor due to inadvertent delay in diagnosis, few therapeutic options and propensity to metastasize. We present a 47-year-old male who underwent a surgical excision of a left atrial mass in February 2010. It was proved to be a high-grade spindle cell sarcoma on histopathology. He presented again in October 2010 with recurrence of the tumour for which he was re-operated. However, the tumour recurred again within one month, to which the patient succumbed.

  17. Left Atrial Systolic Force in Asymptomatic Aortic Stenosis

    DEFF Research Database (Denmark)

    Cioffi, Giovanni; Cramariuc, Dana; Dalsgaard, Morten

    2011-01-01

    LASF in the total study population was 21 ± 14 kdynes/cm(2) . The determinants of LASF were higher age, heart rate, body mass index, systolic blood pressure, left ventricular (LV) mass, mitral peak early velocity, maximal LA volume, and longer mitral deceleration time (multiple R(2) = 0.37, P ...Background: There is a limited knowledge about left atrial (LA) systolic force (LASF) and its key determinants in patients with asymptomatic mild-moderate aortic stenosis (AS). Methods: We used baseline clinic and echocardiographic data from 1,566 patients recruited in the simvastatin ezetimibe...... in aortic stenosis study evaluating the effect of placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic AS. The LASF was calculated by Manning's method. Low and high LASF were defined as 95th percentile of the distribution within the study population, respectively. Results: Mean...

  18. Hemostasis of Left Atrial Appendage Bleed With Lariat Device

    Directory of Open Access Journals (Sweden)

    Amena Hussain, MD

    2014-09-01

    Full Text Available New devices designed for minimally invasive closure of the left atrial appendage (LAA may be a viable alternative for patients in whom anticoagulation is considered high risk. The Lariat (Sentreheart, Redwood City, CA, which is currently FDA-approved for percutaneous closure of tissue, requires both trans-septal puncture and epicardial access. However it requires no anticoagulation after the procedure. Here we describe a case of effusion and tamponade during a Lariat procedure with successful completion of the case and resolution of the effusion.

  19. Left atrial appendage occlusion for stroke prevention in atrial fibrillation in Europe

    DEFF Research Database (Denmark)

    Lip, Gregory Y.H.; Dagres, Nikolaos; Proclemer, Alessandro

    2013-01-01

    The purpose of this EP wire survey was to assess clinical practice in relation to the use of left atrial appendage occlusion (LAAO) devices for stroke prevention in atrial fibrillation (AF) among members of the European Heart Rhythm Association research network. The average number of performed LA...... are most often performed by interventional cardiologists. Experience varied widely, and this was reflected in the wide range of thromboembolic and procedural (tamponade, bleeding) complications reported by the respondents to this EP wire survey....

  20. Left atrial strain: a new parameter for assessment of left ventricular filling pressure.

    Science.gov (United States)

    Cameli, Matteo; Mandoli, Giulia Elena; Loiacono, Ferdinando; Dini, Frank Lloyd; Henein, Michael; Mondillo, Sergio

    2016-01-01

    In order to obtain accurate diagnosis, treatment and prognostication in many cardiac conditions, there is a need for assessment of left ventricular (LV) filling pressure. While systole depends on ejection function of LV, diastole and its disturbances influence filling function and pressures. The commonest condition that represents the latter is heart failure with preserved ejection fraction in which LV ejection is maintained, but diastole is disturbed and hence filling pressures are raised. Significant diastolic dysfunction results in raised LV end-diastolic pressure, mean left atrial (LA) pressure and pulmonary capillary wedge pressure, all referred to as LV filling pressures. Left and right heart catheterization has traditionally been used as the gold standard investigation for assessing these pressures. More recently, Doppler echocardiography has taken over such application because of its noninvasive nature and for being patient friendly. A number of indices are used to achieve accurate assessment of filling pressures including: LV pulsed-wave filling velocities (E/A ratio, E wave deceleration time), pulmonary venous flow (S wave and D wave), tissue Doppler imaging (E' wave and E/E' ratio) and LA volume index. LA longitudinal strain derived from speckle tracking echocardiography (STE) is also sensitive in estimating intracavitary pressures. It is angle-independent, thus overcomes Doppler limitations and provides highly reproducible measures of LA deformation. This review examines the application of various Doppler echocardiographic techniques in assessing LV filling pressures, in particular the emerging role of STE in assessing LA pressures in various conditions, e.g., HF, arterial hypertension and atrial fibrillation.

  1. The effect of percutaneous transcatheter occlusion of left atrial appendage on left atrium and adjacent anatomic structure in canine

    International Nuclear Information System (INIS)

    Yang Zhihong; Wu Hong; Qin Yongwen; Hu Jianqiang; Ding Zhongru; Liu Zongjun; Liu Biao; Zheng Xing

    2009-01-01

    Objective: To observe the effect of percutaneous transcatheter occlusion of left atrial appendage (LAA) with a new self-manufactured LAA occluder on left atrium and adjacent anatomic structure in canine. Methods: A new self-manufactured LAA occluder was implanted into the LAA through a transseptal catheter in 20 dogs. Before and after the procedure, the experimental dogs were anaesthetized and examined by transthoracic echocardiography (TTE) to measure the diameter and the volume of the left atrium, the left superior pulmonary vein flow velocity and the left atrioventricular valve flow velocity separately. The contrast radiography of the LAA and the left coronary arteriography were performed. Results: The new LAA occluder was implanted successfully in 14 dogs. No obvious changes in the diameter and the volume of the left atrium, in left superior pulmonary vein flow velocity and in left atrioventricular valve flow velocity were found. On arteriography, left circumflex artery was normally displayed after the procedure. No migration of the occluder was seen on TTE and angiography after procedure. Conclusion: Percutaneous transcatheter occlusion of left atrial appendage with a new self-manufactured LAA occluder has no obvious effect on left atrium and adjacent anatomic structure in experimental canine, which indicates that the new-type device is a safe and feasible occluder for LAA. (authors)

  2. Left Atrial Linear Ablation of Paroxysmal Atrial Fibrillation Guided by Three-dimensional Electroanatomical System

    DEFF Research Database (Denmark)

    Zhang, Dai-Fu; Li, Ying; Qi, Wei-Gang

    2005-01-01

    Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D...... electroanatomic LA mapping, and all pulmonary vein ostia were marked under the help of pulmonary veins angiography on the 3D map. Radiofrequency (RF) energy was delivered to create continuous linear lesions encircling the pulmonary veins, it was delivered with a target temperature of 43¿, a maximal power limit...

  3. [Left atrial electric isolation in the treatment of atrial fibrillation secondary to rheumatic valvular disease].

    Science.gov (United States)

    Graffigna, A; Pagani, F; Minzioni, G; Salerno, J; Viganò, M

    1992-08-01

    Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent valve surgery. From May 1989 to September 1991, 62 patients underwent mitral valve surgery (Group I), 19 underwent mitral valve surgery and DeVega tricuspid annuloplasty (Group II), 15 underwent mitral and aortic surgery (Group III), and 4 patients underwent mitral and aortic surgery and DeVega tricuspid annuloplasty (Group IV). Left atrial isolation was performed prolonging the usual left paraseptal atriotomy towards the left fibrous trigone anteriorly, and the postero-medial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesion were placed at the edges to ensure complete electrophysiological isolation of the left atrium. Operative mortality accounted for 3 cases (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (Group I: 80.7%; Group II: 68.5%; Group III 86.7%, Group IV 75% - p = N.S.). Three cases of late mortality (3.1%) were registered. long-term results showed persistence of SR in 71% of Group I, 61.2% of Group II, 85.8% of Group III, and 100% of Group IV. The unique risk factor for late recurrency of atrial fibrillation was found to be a duration of preoperative AF longer than 6 months. Due to the high success rate in recovering the sinus rhythm, we suggest left atrial isolation in patients with chronic atrial fibrillation undergoing valvular surgery.

  4. Left atrial function in heart failure with impaired and preserved ejection fraction.

    Science.gov (United States)

    Fang, Fang; Lee, Alex Pui-Wai; Yu, Cheuk-Man

    2014-09-01

    Left atrial structural and functional changes in heart failure are relatively ignored parts of cardiac assessment. This review illustrates the pathophysiological and functional changes in left atrium in heart failure as well as their prognostic value. Heart failure can be divided into those with systolic dysfunction and heart failure with preserved ejection fraction (HFPEF). Left atrial enlargement and dysfunction commonly occur in systolic heart failure, in particular, in idiopathic dilated cardiomyopathy. Atrial enlargement and dysfunction also carry important prognostic value in systolic heart failure, independently of known parameters such as left ventricular ejection fraction. In HFPEF, there is evidence of left atrial enlargement, impaired atrial compliance, and reduction of atrial pump function. This occurs not only at rest but also during exercise, indicating significant impairment of atrial contractile reserve. Furthermore, atrial dyssynchrony is common in HFPEF. These factors further contribute to the development of new onset or progression of atrial arrhythmias, in particular, atrial fibrillation. Left atrial function is an integral part of cardiac function and its structural and functional changes in heart failure are common. As changes of left atrial structure and function have different clinical implications in systolic heart failure and HFPEF, routine assessment is warranted.

  5. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion

    DEFF Research Database (Denmark)

    Osmanagic, Armin; Möller, Sören; Osmanagic, Azra

    2016-01-01

    BACKGROUND: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atri...

  6. ABO blood groups: A risk factor for left atrial and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Fu, Yuan; Li, Kuibao; Yang, Xinchun

    2017-08-01

    Previous studies have identified ABO blood groups as predictors of thromboembolic diseases. In patients with atrial fibrillation (AF), however, potential association between ABO blood groups and the risk of left atrial (LA) and/or left atrial appendage (LAA) thrombogenic milieu (TM) has not been established. This is a retrospective case-control study that included 125 consecutive patients with non-valvular atrial fibrillation (NVAF) plus TM, as evidenced by transesophageal echocardiography (TEE) during a period from1 January 2010 to 31 December 2016. The controls were selected randomly from 1072 NVAF without TM at a 1:2 ratio. Potential association between ABO blood groups and TM was analyzed using multivariate logistic regression analysis. The risk of TM was higher in patients with blood group A (33.6% vs. 20.2% in non-A blood groups, P=0.005). After adjusting for age, sex, oral anticoagulant use, AF type and duration, and relevant functional measures (e.g., NT-pro BNP level, left atrium diameter, and left ventricular ejection fraction), blood group A remained associated with an increased risk of TM (OR=2.99, 95% CI 1.4-6.388, P=0.005). Blood group A is an independent risk factor for TM in NVAF patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. [Left atrial function and left atrial appendage flow velocity in hypertrophic cardiomyopathy: comparison of patients with and without paroxysmal atrial fibrillation].

    Science.gov (United States)

    Akasaka, K; Kawashima, E; Shiokoshi, T; Ishii, Y; Hasebe, N; Kikuchi, K

    1998-07-01

    The involvement of left atrial (LA) appendage flow velocity in reduced left atrial function was investigated in 24 patients with hypertrophic cardiomyopathy, who retained sinus rhythm at the examination. Patients were divided into 11 with a history of paroxysmal atrial fibrillation [PAf(+)] and 13 without such history [PAf(-)]. Transthoracic echocardiography was performed to evaluate LA fractional shortening (LA%FS) and mean velocity of circumferential LA fiber shortening (LAmVcf), as contractile functions of the left atrium at the phase of active atrial contraction. Transesophageal echocardiographic Doppler examination was performed in all patients to measure the LA appendage velocity. In all patients, significant positive correlations were observed between the LA appendage velocity and LA%FS (r = 0.50, p fibrillation were significantly lower than in those without (0.84 +/- 0.15 vs 1.28 +/- 0.37 circ/sec, 44 +/- 12 vs 65 +/- 20 cm/sec, both p fibrillation. These results indicate that there is a close relationship between LA appendage velocity and LA contractile function in patients with hypertrophic cardiomyopathy with paroxysmal atrial fibrilation, and these patients have potential risk of cerebral infarction.

  8. Effect of Left Ventricular Outflow Tract Obstruction on Left Atrial Mechanics in Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Lynne K. Williams

    2015-01-01

    Full Text Available Left atrial (LA volumes are known to be increased in hypertrophic cardiomyopathy (HCM and are a predictor of adverse outcome. In addition, LA function is impaired and is presumed to be due to left ventricular (LV diastolic dysfunction as a result of hypertrophy and myocardial fibrosis. In the current study, we assess the incremental effect of outflow tract obstruction (and concomitant mitral regurgitation on LA function as assessed by LA strain. Patients with HCM (50 obstructive, 50 nonobstructive were compared to 50 normal controls. A subset of obstructive patients who had undergone septal myectomy was also studied. Utilising feature-tracking software applied to cardiovascular magnetic resonance images, LA volumes and functional parameters were calculated. LA volumes were significantly elevated and LA ejection fraction and strain were significantly reduced in patients with HCM compared with controls and were significantly more affected in patients with obstruction. LA volumes and function were significantly improved after septal myectomy. LVOT obstruction and mitral regurgitation appear to further impair LA mechanics. Septal myectomy results in a significant reduction in LA volumes, paralleled by an improvement in function.

  9. Left Atrial Mechanical Function and Global Strain in Hypertrophic Cardiomyopathy.

    Directory of Open Access Journals (Sweden)

    Kyung-Jin Kim

    Full Text Available Atrial fibrillation is the most common arrhythmia and is associated with adverse outcomes in hypertrophic cardiomyopathy (HCM. Although left atrial (LA remodeling and dysfunction are known to associate with the development of atrial fibrillation in HCM, the changes of the LA in HCM patients remain unclear. This study aimed to evaluate the changes in LA size and mechanical function in HCM patients compared to control subjects and to determine the characteristics of HCM associated with LA remodeling and dysfunction.Seventy-nine HCM patients (mean age, 54 ± 11 years; 76% were men were compared to 79 age- and sex-matched controls (mean age, 54 ± 11 years; 76% were men and 20 young healthy controls (mean age, 33 ± 5 years; 45% were men. The LA diameter, volume, and mechanical function, including global strain (ε, were evaluated by 2D-speckle tracking echocardiography. The phenotype of HCM, maximal left ventricular (LV wall thickness, LV mass, and presence and extent of late gadolinium enhancement (LGE were evaluated with cardiac magnetic resonance imaging.HCM patients showed increased LA volume index, impaired reservoir function, and decreased LA ε compared to the control subjects. When we divided the HCM group according to a maximal LA volume index (LAVImax of 38.7 ml/m2 or LA ε of 21%, no significant differences in the HCM phenotype and maximal LV wall thickness were observed for patients with LAVImax >38.7 ml/m2 or LA ε ≤21%. Conversely, the LV mass index was significantly higher both in patients with maximal LA volume index >38.7 ml/m2 and with LA ε ≤21% and was independently associated with LAVImax and LA ε. Although the LGE extent was increased in patients with LA ε ≤21%, it was not independently associated with either LAVImax or LA ε.HCM patients showed progressed LA remodeling and dysfunction; the determinant of LA remodeling and dysfunction was LV mass index rather than LV myocardial fibrosis by LGE-magnetic resonance

  10. Detection and evaluation of left atrial myxoma by gated radionuclide imaging

    International Nuclear Information System (INIS)

    Sugihara, Hiroki; Adachi, Haruhiko; Nakagawa, Hiroaki

    1985-01-01

    Radionuclide imaging plays an important role in diagnosising left atrial myxoma (LAM). We discussed diagnostic value of Fourier analysis with phase image and evaluated left ventricular filling function using indices such as 1/3 Filling Fraction, Rapid Filling Fraction and Peak Filling Rate derived from left ventricular volume curve. Equillibrium radionuclide angiocardiography was performed in 6 LAM patients. Phase delay in the basal portion of the left ventricle was shown in 5 of 6 LAM patients, and standard deviation of left ventricular phase was larger than these of controls. Left ventricular filling disturbance was suggested in 5 of 6 LAM patients. After surgical remove of myxoma phase delay was disappeared and standard deviation was normalized. And left ventricular filling was improved. We concluded that the phase image of Fourier analysis revealed a left atrial mass prolapsing in the left ventricule during the diastole, and that diastolic indices were useful for left ventricular filling disturbance due to LAM. (author)

  11. Association Between Left Atrial Compression And Atrial Fibrillation: A Case Presentation And A Short Review Of Literature.

    Science.gov (United States)

    Ahmed, Niloy; Carlos, Morales-Mangual; Moshe, Gunsburg; Yitzhak, Rosen

    2016-01-01

    This case report describes a patient who developed palpitations and chest pain and was found to be in atrial fibrillation, which was likely due to the presence of an extra-cardiac mass. This was compressing the left atrium. The mass was related to small cell carcinoma, which decreased significantly in size after chemotherapy. Resolution of the atrial fibrillation correlated temporally with reduction in the size of the mass and alleviation of the left atrial compression.

  12. The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Wachtell, K.; Devereux, R.B.; Lyle, P.A.

    2008-01-01

    was superior to atenolol-based treatment for reducing new-onset AF and complications, especially stroke, associated with new-onset or pre-existing AF. Potential mechanisms of AF prevention by angiotensin receptor blockade supported by LIFE results include greater reduction in left atrial size and LV......The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study provided extensive data on predisposing factors, consequences, and prevention of atrial fibrillation (AF) in patients with hypertension and left ventricular (LV) hypertrophy. Randomized losartan-based treatment...... hypertrophy. Differential effects of antihypertensive treatment on the left atrium and left ventricle may help prevent AF and reduce risk of stroke associated with hypertensive heart disease Udgivelsesdato: 2008/12...

  13. Left atrial accessory appendages, diverticula, and left-sided septal pouch in multi-slice computed tomography. Association with atrial fibrillation and cerebrovascular accidents.

    Science.gov (United States)

    Hołda, Mateusz K; Koziej, Mateusz; Wszołek, Karolina; Pawlik, Wiesław; Krawczyk-Ożóg, Agata; Sorysz, Danuta; Łoboda, Piotr; Kuźma, Katarzyna; Kuniewicz, Marcin; Lelakowski, Jacek; Dudek, Dariusz; Klimek-Piotrowska, Wiesława

    2017-10-01

    The aim of this study is to provide a morphometric description of the left-sided septal pouch (LSSP), left atrial accessory appendages, and diverticula using cardiac multi-slice computed tomography (MSCT) and to compare results between patient subgroups. Two hundred and ninety four patients (42.9% females) with a mean of 69.4±13.1years of age were investigated using MSCT. The presence of the LSSP, left atrial accessory appendages, and diverticula was evaluated. Multiple logistic regression analysis was performed to check whether the presence of additional left atrial structures is associated with increased risk of atrial fibrillation and cerebrovascular accidents. At least one additional left atrial structure was present in 51.7% of patients. A single LSSP, left atrial diverticulum, and accessory appendage were present in 35.7%, 16.0%, and 4.1% of patients, respectively. After adjusting for other risk factors via multiple logistic regression, patients with LSSP are more likely to have atrial fibrillation (OR=2.00, 95% CI=1.14-3.48, p=0.01). The presence of a LSSP was found to be associated with an increased risk of transient ischemic attack using multiple logistic regression analysis after adjustment for other risk factors (OR=3.88, 95% CI=1.10-13.69, p=0.03). In conclusion LSSPs, accessory appendages, and diverticula are highly prevalent anatomic structures within the left atrium, which could be easily identified by MSCT. The presence of LSSP is associated with increased risk for atrial fibrillation and transient ischemic attack. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Assessment of left atrial volume and function in patients with permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Agner, Bue F Ross; Kühl, Jørgen Tobias; Linde, Jesper James

    2014-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with substantial morbidity and mortality. AF is associated with enlargement of the left atrium (LA), and the LA volume has important prognostic implications for the disease. The objective of the study was to determine how...... measurements of LA volume and function obtained by transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR), and 320-slice multi-detector computed tomography (MDCT) correlate in patients with permanent AF....

  15. Left atrial appendage closure: a new technique for clinical practice.

    Science.gov (United States)

    John Camm, A; Colombo, Antonio; Corbucci, Giorgio; Padeletti, Luigi

    2014-03-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is associated with increased risk for stroke mainly due to cardiac embolism from the left atrial appendage (LAA). Occlusion of the LAA by means of a device represents a valid alternative to oral anticoagulation, mainly in patients who cannot tolerate this therapy because of a high bleeding risk. Recent data on the endocardial device WATCHMAN show encouraging results for this patient population in terms of stroke risk reduction compared to the expected rate as well as in terms of implant success. This article reviews all relevant publications related to the main surgical and transcatheter devices used for LAA closure (LAAC). PROTECT-AF, the first prospective randomized trial conducted on this technique, showed that LAA occlusion using the WATCHMAN was noninferior to warfarin for a combined end-point in patients with nonvalvular AF. There is a lack of large-scale randomized trials on long-term stroke risk in patients submitted to LAAC. Most studies are relatively small and focus on the comparison of different surgical techniques with regard to complete/incomplete closure success. More recently, PROTECT-AF long-term results (4-year follow-up) demonstrated that LAAC was statistically superior to warfarin in terms of efficacy. This review concludes that it is now appropriate to consider these techniques for patients with AF who are at high risk for stroke for whom effective conventional or novel anticoagulant therapy is not available or who present problems in managing drug treatment. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  16. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    International Nuclear Information System (INIS)

    Murdoch, Dale; McAulay, Laura; Walters, Darren L.

    2014-01-01

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy

  17. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Murdoch, Dale, E-mail: dale_murdoch@health.qld.gov.au [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia); McAulay, Laura [The Prince Charles Hospital, Brisbane (Australia); Walters, Darren L. [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia)

    2014-11-15

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.

  18. Left atrial low-voltage areas predict atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation.

    Science.gov (United States)

    Masuda, Masaharu; Fujita, Masashi; Iida, Osamu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Tsujimura, Takuya; Matsuda, Yasuhiro; Okuno, Shota; Ohashi, Takuya; Tsuji, Aki; Mano, Toshiaki

    2018-04-15

    Association between the presence of left atrial low-voltage areas and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been shown mainly in persistent AF patients. We sought to compare the AF recurrence rate in paroxysmal AF patients with and without left atrial low-voltage areas. This prospective observational study included 147 consecutive patients undergoing initial ablation for paroxysmal AF. Voltage mapping was performed after PVI during sinus rhythm, and low-voltage areas were defined as regions where bipolar peak-to-peak voltage was low-voltage areas after PVI were observed in 22 (15%) patients. Patients with low-voltage areas were significantly older (72±6 vs. 66±10, plow-voltage areas than without (36% vs. 6%, pLow-voltage areas were independently associated with AF recurrence even after adjustment for the other related factors (Hazard ratio, 5.89; 95% confidence interval, 2.16 to 16.0, p=0.001). The presence of left atrial low-voltage areas after PVI predicts AF recurrence in patients with paroxysmal AF as well as in patients with persistent AF. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. The Relationship between Left Atrial Mechanical Function and Functional Capacity in Mitral Stenosis

    Directory of Open Access Journals (Sweden)

    Mücahit Yetim

    2013-11-01

    Full Text Available Aim: In this study, left atrial functions of patients with rheumatic mitral stenosis and sinus rhythm, which was determined by transthorasic echocardiography, was compared with those of healhty subjects and the association of left atrial functions with functional capacity was investigated in subgroup analyses.   Material and methods: 32 patients with isolated rheumatic mitral stenosis (median age was 39.1±11  (group 1 and 20 patients in the control group ( median age was 37±8,2 (group 2 were enrolled to study. The average mitral valve area of patients was 1.1±0,3 cm2. When patients were divided according to New York Heart Association (NYHA classification ; 16 patients were NYHA 2 (Grup A and 16 patients were NYHA 3 (Grup B. There were not any asymptomatic patients and no patients were NYHA 4. Left atrium diameters, left atrium volume, left atrium fractional area change and left atrium ejection fractions  of patients in these groups were calculated.   Results: The demographic characteristics of patients is shown in table 1. Left atrium ejection fraction (LAEF and left atrium fractional area change (LAFAC that were determined echocardiographycally were significantly lower in patients with mitral stenosis (32 ± 5, 44 ± 3; p<0.001- 25 ± 11, 32 ± 6; p< 0.02.  When patients were divided according to New York Heart Association (NYHA classification ; 16 patients were NYHA 2 (Grup A and 16 patients were NYHA 3 (Grup B. There were not any asymptomatic patients and no patients were NYHA 4. The clinical and echocardiographic data of patients are shown in table 2. Despite of similar mitral valve area and average mitral gradient ,systolic pulmonary artery pressure was found to be higher in symptomatic group. But there was no difference between left atrial functions of the two groups.   Discussion: In this study we have shown that left atrial functions determined echocardiographically  can decline in patients with mitral stenosis but the

  20. Left atrial appendage thrombosis during therapy with rivaroxaban in elective cardioversion for permanent atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Walter Serra

    2015-09-01

    Full Text Available Electric external cardioversion (EEC for permanent atrial fibrillation (AF carries a risk of thromboembolic events (TE. The use of transesophageal echocardiography (TEE to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned. Therapeutic anticoagulation with novel oral anticoagulants (NOAC is recommended for 3 to 4 weeks before and an anticoagulation life-long therapy is recommended after EEC to reduce TE, in patients with high CHA2DS2-VASc score; however, only few data are currently available about safety of shortterm anticoagulation with NOAC in the setting of EEC. Patients with increased risk of thromboembolism have not been adequately studied and the monitoring of anticoagulant effects can also have important benefits in case of drug interactions. We report a case of a 68-year old man with AF from September 2014. Moderate depression of global left ventricular systolic function was detected by echocardiographic exam. On the basis of a high thromboembolic risk, an anticoagulant therapy with rivaroxaban, at the dose of 20 mg/day, was started. TEE showed a thrombus in the left atrial appendage. This case demonstrates the utility of performing TEE prior than EEC in patients with hypokinetic cardiomyopathy other than AF in therapy with NOAC. We underline the presence of significant pharmacodynamic interference of rivaroxaban with other drugs such as oxcarbazepine.

  1. Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Bhupesh Kumar

    2014-01-01

    Full Text Available Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

  2. Spatial Relation Between Left Atrial Anatomical Contact Areas and Circular Activation in Persistent Atrial Fibrillation.

    Science.gov (United States)

    Nakahara, Shiro; Yamaguchi, Takanori; Hori, Yuichi; Anjo, Naofumi; Hayashi, Akiko; Kobayashi, Sayuki; Komatsu, Takaaki; Sakai, Yoshihiko; Fukui, Akira; Tsuchiya, Takeshi; Taguchi, Isao

    2016-05-01

    Atrial low-voltage zones (LVZs) may be related to maintenance of atrial fibrillation (AF). The influence of left atrial (LA) contact areas (CoAs) on reentrant or rotor-like sources maintaining AF has not been investigated. Forty patients with persistent AF (PsAF) were analyzed. Three representative CoA regions in the LA (ascending aorta: anterior wall; descending aorta: left inferior pulmonary vein; and vertebrae: posterior wall) were visualized by enhanced CT. Using circular catheters, the LVZs (80% of the mean AF cycle length. A pivot was defined as the core of the localized circular activation. Anterior (39/40 patients, 98%), left pulmonary vein antrum (27/40, 68%), and posterior (19/40, 48%) CoAs were identified, and 80% (68/85) of those sites were overlapped by or close (<3 mm) to LVZs. Thirty-six (90%) patients demonstrated circular activation (3.1±1.7 sites/patients) along with significantly higher organized dominant frequencies (6.3 ± 0.5 Hz, regularity-index: 0.26 [0.23-0.41]) within the LA, and the average electrogram amplitude of those pivots was 0.30 mV (0.18-0.52). Of those sites, 55% (66/120) were located at or close to CoA regions. Catheter ablation including of LVZs neighboring CoAs terminated AF in 9 (23%) patients. External anatomical structures contacting the LA may be related to unique conduction properties in diseased myocardium necessary for PsAF maintenance. © 2016 Wiley Periodicals, Inc.

  3. Left atrial appendage obliteration in atrial fibrillation patients undergoing bioprosthetic mitral valve replacement.

    Science.gov (United States)

    Min, X P; Zhu, T Y; Han, J; Li, Y; Meng, X

    2016-02-01

    Left atrial appendage (LAA) obliteration is a proven stroke-preventive measure for patients with nonvalvular atrial fibrillation (AF). However, the efficacy of LAA obliteration for patients with AF after bioprosthetic mitral valve replacement (MVR) remains unclear. This study aimed to estimate the efficacy of LAA obliteration in preventing embolism and to investigate the predictors of thromboembolism after bioprosthetic MVR. We retrospectively studied 173 AF subjects with bioprosthetic MVR; among them, 81 subjects underwent LAA obliteration using an endocardial running suture method. The main outcome measure was the occurrence of thrombosis events (TEs). The mean follow-up time was 40 ± 17 months. AF rhythm was observed in 136 patients postoperatively. The incidence rate of TEs was 13.97 % for postoperative AF subjects; a dilated left atrium (LA; > 49.5 mm) was identified as an independent risk factor of TEs (OR = 10.619, 95 % CI = 2.754-40.94, p = 0.001). For postoperative AF patients with or without LAA, the incidence rate of TEs was 15.8 % (9/57) and 12.7 % (10/79; p = 0.603), respectively. The incidence rate of TEs was 2.7 % (1/36) and 4.2 % (2/48) for the subgroup patients with a left atrial diameter of  49.5 mm (p = 0.346). Surgical LAA obliteration in patients with valvular AF undergoing bioprosthetic MVR did not reduce TEs, even when the CHA2DS2-VASc score (a score for estimating the risk of stroke in AF) was ≥ 2 points.

  4. Left Atrial Appendage Closure in Atrial Fibrillation: A World without Anticoagulation?

    Directory of Open Access Journals (Sweden)

    Tahmeed Contractor

    2011-01-01

    Full Text Available Atrial Fibrillation (AF is a common arrhythmia with an incidence that is as high as 10% in the elderly population. Given the large proportion of strokes caused by AF as well as the associated morbidity and mortality, reducing stroke burden is the most important part of AF management. While warfarin significantly reduces the risk of AF-related stroke, perceived bleeding risks and compliance limit its widespread use in the high-risk AF population. The left atrial appendage is believed to be the “culprit” for thrombogenesis in nonvalvular AF and is a new therapeutic target for stroke prevention. The purpose of this review is to explore the evolving field of percutaneous LAA occlusion. After briefly highlighting the risk of stroke with AF, problems with warfarin, and the role of the LAA in clot formation, this article discusses the feasibility and efficacy of various devices which have been developed for percutaneous LAA occlusion.

  5. The left atrio-vertebral ratio. A new simple means for assessing left atrial enlargement on computed tomography

    International Nuclear Information System (INIS)

    Montillet, Marie; Tasu, Jean-Pierre; Baque-Juston, Marie; Bertrand, Sandra; Berthier, Frederic; Zarqane, Naima; Brunner, Philippe

    2018-01-01

    The purpose of this study is to describe a new method to quickly estimate left atrial enlargement (LAE) on Computed Tomography. Left atrial (LA) volume was assessed with a 3D-threshold Hounsfield unit detection technique, including left atrial appendage and excluding pulmonary venous confluence, in 201 patients with ECG-gated 128-slice dual-source CT and indexed to body surface area. LA and vertebral axial diameter and area were measured at the bottom level of the right inferior pulmonary vein ostium. Ratio of LA diameter and surface on vertebra (LAVD and LAVA) were compared to LA volume. In accordance with the literature, a cutoff value of 78 ml/m 2 was chosen for maximal normal LA volume. 18% of LA was enlarged. The best cutoff values for LAE assessment were 2.5 for LAVD (AUC: 0.65; 95% CI: 0.58-0.73; sensitivity: 57%; specificity: 71%), and 3 for LAVA (AUC: 0.78; 95% CI: 0.72-0.84; sensitivity: 67%; specificity: 79%), with higher accuracy for LAVA (P=0.015). Inter-observer and intra-observer variability were either good or excellent for LAVD and LAVA (respective intraclass coefficients: 0.792 and 0.910; 0.912 and 0.937). A left atrium area superior to three times the vertebral area indicates LAE with high specificity. (orig.)

  6. The left atrio-vertebral ratio. A new simple means for assessing left atrial enlargement on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Montillet, Marie; Tasu, Jean-Pierre [Centre Hospitalier Universitaire de Poitiers, Poitiers (France); Baque-Juston, Marie; Bertrand, Sandra; Berthier, Frederic; Zarqane, Naima; Brunner, Philippe [Hopital Princesse Grace, Monaco (Monaco)

    2018-03-15

    The purpose of this study is to describe a new method to quickly estimate left atrial enlargement (LAE) on Computed Tomography. Left atrial (LA) volume was assessed with a 3D-threshold Hounsfield unit detection technique, including left atrial appendage and excluding pulmonary venous confluence, in 201 patients with ECG-gated 128-slice dual-source CT and indexed to body surface area. LA and vertebral axial diameter and area were measured at the bottom level of the right inferior pulmonary vein ostium. Ratio of LA diameter and surface on vertebra (LAVD and LAVA) were compared to LA volume. In accordance with the literature, a cutoff value of 78 ml/m{sup 2} was chosen for maximal normal LA volume. 18% of LA was enlarged. The best cutoff values for LAE assessment were 2.5 for LAVD (AUC: 0.65; 95% CI: 0.58-0.73; sensitivity: 57%; specificity: 71%), and 3 for LAVA (AUC: 0.78; 95% CI: 0.72-0.84; sensitivity: 67%; specificity: 79%), with higher accuracy for LAVA (P=0.015). Inter-observer and intra-observer variability were either good or excellent for LAVD and LAVA (respective intraclass coefficients: 0.792 and 0.910; 0.912 and 0.937). A left atrium area superior to three times the vertebral area indicates LAE with high specificity. (orig.)

  7. Atrial conduction times and left atrial mechanical functions and their relation with diastolic function in prediabetic patients.

    Science.gov (United States)

    Gudul, Naile Eris; Karabag, Turgut; Sayin, Muhammet Rasit; Bayraktaroglu, Taner; Aydin, Mustafa

    2017-03-01

    The aim of this study was to investigate atrial conduction times and left atrial mechanical functions, the noninvasive predictors of atrial fibrillation, in prediabetic patients with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Study included 59 patients (23 males, 36 females; mean age 52.5 ± 10.6 years) diagnosed with IFG or IGT by the American Diabetes Association criteria, and 43 healthy adults (22 males, 21 females; mean age 48.5 ± 12.1 years). Conventional and tissue Doppler echocardiography were performed. The electromechanical delay parameters were measured from the onset of the P wave on the surface electrocardiogram to the onset of the atrial systolic wave on tissue Doppler imaging from septum, lateral, and right ventricular annuli. The left atrial volumes were calculated by the disk method. Left atrial mechanical functions were calculated. The mitral E/A and E'/A' ratios measured from the lateral and septal annuli were significantly lower in the prediabetics compared to the controls. The interatrial and left atrial electromechanical delay were significantly longer in prediabetic group compared to the controls. Left atrial active emptying volume (LAAEV) and fraction (LAAEF) were significantly higher in the prediabetics than the controls. LAAEV and LAAEF were significantly correlated with E/A, lateral and septal E'/A'. In the prediabetic patients, the atrial conduction times and P wave dispersion on surface electrocardiographic were longer before the development of overt diabetes. In addition, the left atrial mechanical functions were impaired secondary to a deterioration in the diastolic functions in the prediabetic patients.

  8. Etiologic significance of enlargement of the left atrial appendage in adults

    International Nuclear Information System (INIS)

    Green, C.E.; Kelley, M.J.; Higgins, C.B.

    1982-01-01

    Fifty-one patients were divided into two groups: 20 patients with proven rheumatic mitral valve disease (RMVD) and 31 patients with left atrial enlargement (LAE) of a nonrheumatic etiology. The latter group included patients with ischemic papillary muscle dysfunction, mitral valve prolapse, and congestive cardiomyopathy. Radiographic studies showed that enlargement of the left atrial appendage (LAAE) was present in 18 of 20 rheumatics but in only one of 31 nonrheumatics. There was no direct relationship between enlargement of the LAA and radiographic or echocardiographic left atrial size, degree of pulmonary venous hypertension (PVH), or presence of atrial fibrillation. It is postulated that rheumatic influammation of the LAA allows it to dilate out of proportion to the body of the left atrium. In the adult patient with radiographic findings of PVH, LAAE is a valuable and specific radiographic sign of rheumatic mitral valve disease

  9. Pulmonary artery-to-left atrial fistula discovered after the closure of atrial septal defect: A rare clinical scenario

    Directory of Open Access Journals (Sweden)

    Akshay Chauhan

    2018-01-01

    Full Text Available A case of the right pulmonary artery-to- left atrial fistula with atrial septal defect (ASD is presented. The fistula was detected after the patient developed desaturation following surgical closure of the ASD. It was managed with a transcatheter (trans-RPA route closure of the fistula using a 12-mm Amplatzer ventricular septal defect closure device.

  10. Does Left Atrial Volume and Pulmonary Venous Anatomy Predict the Outcome of Catheter Ablation of Atrial Fibrillation ?

    NARCIS (Netherlands)

    Hof, Irene; Chilukuri, Karuna; Arbab-Zadeh, Armin; Scherr, Daniel; Dalal, Darshan; Nazarian, Saman; Henrikson, Charles; Spragg, David; Berger, Ronald; Marine, Joseph; Calkins, Hugh

    Introduction: Preprocedural factors may be helpful in selecting patients with atrial fibrillation (AF) for treatment with catheter ablation and in making an assumption regarding their prognosis. The aims of this study were to investigate whether left atrial (LA) volume and pulmonary venous (PV)

  11. Plasmacytoid lymphoma within a left atrial myxoma: a rare coincidental dual pathology.

    Science.gov (United States)

    White, Ralph W; Hirst, Natalie A; Edward, Sara; Nair, Unnikrishnan R

    2010-01-01

    Primary malignant cardiac neoplasms are extremely rare. The occurrence of a malignant lymphoid tumour within a left atrial myxoma is highly atypical, with only one such case previously reported. Here, we describe a patient who presented with symptoms and signs of a left atrial myxoma. Subsequent specimen histology demonstrated the presence of lymphoma within the myxoma. We discuss the importance of histological diagnosis in order to best direct treatment and prognosis of such cases.

  12. Effect of mitral regurgitation on cerebrovascular accidents in patients with atrial fibrillation and left atrial thrombus.

    Science.gov (United States)

    Nair, Chandra K; Aronow, Wilbert S; Shen, Xuedong; Anand, Kishlay; Holmberg, Mark J; Esterbrooks, Dennis J

    2009-11-01

    The effect of mitral regurgitation (MR) on the incidence of new cerebrovascular accidents (CVA) and mortality in patients with atrial fibrillation (AF) and left atrial thrombus (LAT) is unknown. To investigate the effect of MR in patients with AF and LAT on new CVA and mortality. Eighty nine consecutive patients, mean age 71 years, with AF and LAT documented by transesophageal echocardiography were investigated to determine the prevalence and severity of MR and the association of the severity of MR with new cerebrovascular accidents (CVA) and mortality at 34-mo follow-up. Of 89 patients, 1 + MR was present in 23 patients (26%), 2 + MR in 44 patients (50%), 3 + MR in 17 patients (19%), and 4 + MR in 3 patients (4%). Mean follow-up was 34 +/- 28 mo. The Cox proportional hazards model showed that the severity of increased MR did not significantly increase new CVA or mortality at 34-mo follow-up. The only variable predictive of mortality was left ventricular ejection fraction (LVEF), and with every unit increase in LVEF, the risk decreased by 3%. MR occurred in 87 of 89 patients (98%) with AF and LAT. There was no association between the severity of MR and the incidence of CVA or mortality.

  13. Multimodality Cardiac Imaging for the Assessment of Left Atrial Function and the Association With Atrial Arrhythmias

    DEFF Research Database (Denmark)

    Olsen, Flemming Javier; Bertelsen, Litten; de Knegt, Martina Chantal

    2016-01-01

    Several cardiac imaging modalities are able to visualize the left atrium (LA) and, therefore, allow for quantification of both structural and functional properties of this cardiac chamber. In echocardiography, only the maximal LA volume is included in the assessment of diastolic function at the c......Several cardiac imaging modalities are able to visualize the left atrium (LA) and, therefore, allow for quantification of both structural and functional properties of this cardiac chamber. In echocardiography, only the maximal LA volume is included in the assessment of diastolic function...... atrial fibrillation, which will be a point of focus in this review. Pivotal cardiac magnetic resonance imaging studies have revealed high correlation between LA fibrosis and risk of atrial fibrillation recurrence after catheter ablation, and subsequent multimodality imaging studies have uncovered...... an inverse relationship between LA reservoir function and degree of LA fibrosis. This has sparked an increased interest into the application of advanced imaging modalities, including both speckle tracking echocardiography and tissue tracking by cardiac magnetic resonance imaging. Even though increasing...

  14. Correlation of right atrial appendage velocity with left atrial appendage velocity and brain natriuretic Peptide.

    Science.gov (United States)

    Kim, Bu-Kyung; Heo, Jung-Ho; Lee, Jae-Woo; Kim, Hyun-Soo; Choi, Byung-Joo; Cha, Tae-Joon

    2012-03-01

    Left atrial appendage (LAA) anatomy and function have been well characterized both in healthy and diseased people, whereas relatively little attention has been focused on the right atrial appendage (RAA). We sought to evaluate RAA flow velocity and to compare these parameters with LAA indices and with a study of biomarkers, such as brain natriuretic peptide, among patients with sinus rhythm (SR) and atrial fibrillation (AF). In a series of 79 consecutive patients referred for transesophageal echocardiography, 43 patients (23 with AF and 20 controls) were evaluated. AF was associated with a decrease in flow velocity for both LAA and RAA [LAA velocity-SR vs. AF: 61 ± 22 vs. 29 ± 18 m/sec (p vs. AF: 46 ± 20 vs. 19 ± 8 m/sec (p brain natriuretic peptide (BNP). AF was associated with decreased RAA and LAA flow velocities. RAA velocity was found to be positively correlated with LAA velocity and negatively correlated with BNP. The plasma BNP concentration may serve as a determinant of LAA and RAA functions.

  15. Rare Chronic Gastric Volvulus Associated with Left Atrial and Mediastinal Compression

    OpenAIRE

    Shriki, Jabi E.; Nguyen, Khanh; Rozo, Juan Carlos; Reul, George J.; Mortazavi, Ali

    2002-01-01

    We report a case of chronic gastric volvulus associated with left atrial compression in a 75-year-old woman who presented with chest pain, shortness of breath, and hypotension after elective hemiarthroplasty of the left hip. The patient's medical history included a paraesophageal hernia and gastric volvulus diagnosed in 1997 but left untreated. The present diagnosis of gastric volvulus was made on the basis of a chest radiograph and subsequent computed tomography. Echocardiography showed the ...

  16. Inadvertent puncture of the aortic noncoronary cusp during postoperative left atrial tachycardia ablation

    Directory of Open Access Journals (Sweden)

    Dursun Aras, MD

    2015-08-01

    Full Text Available Transseptal catheterization has become part of the interventional electrophysiologist׳s technical armamentarium since the development of left atrial catheter ablation and percutaneous technologies for treating mitral and aortic valve disease. Although frequently performed, the procedure׳s most feared complication is aortic root penetration. Focal atrial tachycardia has been described as the most common late sequela of surgical valve replacements. We present a complicated case involving the inadvertent delivery of an 8 French sheath across the noncoronary cusp during radiofrequency catheter ablation for left atrial tachycardia originating from the mitral annulus in a patient with prior mitral valve replacement.

  17. Changes in left atrial deformation in hypertrophic cardiomyopathy: Evaluation by vector velocity imaging

    Directory of Open Access Journals (Sweden)

    Hala Mahfouz Badran

    2012-12-01

    Full Text Available Objectives: Hypertrophic cardiomyopathy (HCM represents a generalized myopathic process affecting both ventricular and atrial myocardium. We assessed the global and regional left atrial (LA function and its relation to left ventricular (LV mechanics and clinical status in patients with HCM using Vector Velocity Imaging (VVI. Methods: VVI of the LA and LV was acquired from apical four- and two-chamber views of 108 HCM patients (age 40±19years, 56.5% men and 33 healthy subjects, all had normal LV systolic function. The LA subendocardium was traced to obtain atrial volumes, ejection fraction, velocities, and strain (ɛ/strain rate (SR measurements. Results: Left atrial reservoir (ɛsys,SRsys and conduit (early diastolic SRe function were significantly reduced in HCM compared to controls (P-1.8s-1 was 81% sensitive and 30% specific, SRa>-1.5s-1 was 73% sensitive and 40% specific. By multivariate analysis global LVɛsys and LV septal thickness are independent predictors for LAɛsys, while end systolic diameter is the only independent predictor for SRsys, P<.001. Conclusion: Left atrial reservoir and conduit function as measured by VVI were significantly impaired while contractile function was preserved among HCM patients. Left atrial deformation was greatly influenced by LV mechanics and correlated to severity of phenotype.

  18. Changes in left atrial deformation in hypertrophic cardiomyopathy: Evaluation by vector velocity imaging

    Science.gov (United States)

    Badran, Hala Mahfouz; Soltan, Ghada; Hassan, Hesham; Nazmy, Ahmed; Faheem, Naglaa; Saadan, Haythem; Yacoub, Magdi H.

    2012-01-01

    Abstract: Objectives: Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. We assessed the global and regional left atrial (LA) function and its relation to left ventricular (LV) mechanics and clinical status in patients with HCM using Vector Velocity Imaging (VVI). Methods: VVI of the LA and LV was acquired from apical four- and two-chamber views of 108 HCM patients (age 40 ± 19years, 56.5% men) and 33 healthy subjects, all had normal LV systolic function. The LA subendocardium was traced to obtain atrial volumes, ejection fraction, velocities, and strain (ϵ)/strain rate (SR) measurements. Results: Left atrial reservoir (ϵsys,SRsys) and conduit (early diastolic SRe) function were significantly reduced in HCM compared to controls (P  − 1.8s− 1 was 81% sensitive and 30% specific, SRa> − 1.5s− 1 was 73% sensitive and 40% specific. By multivariate analysis global LVϵsys and LV septal thickness are independent predictors for LAϵsys, while end systolic diameter is the only independent predictor for SRsys, P < .001. Conclusion: Left atrial reservoir and conduit function as measured by VVI were significantly impaired while contractile function was preserved among HCM patients. Left atrial deformation was greatly influenced by LV mechanics and correlated to severity of phenotype. PMID:24688992

  19. Validation of Left Atrial Volume Estimation by Left Atrial Diameter from the Parasternal Long-Axis View.

    Science.gov (United States)

    Canciello, Grazia; de Simone, Giovanni; Izzo, Raffaele; Giamundo, Alessandra; Pacelli, Filomena; Mancusi, Costantino; Galderisi, Maurizio; Trimarco, Bruno; Losi, Maria-Angela

    2017-03-01

    Measurement of left atrial (LA) volume (LAV) is recommended for quantification of LA size. Only LA anteroposterior diameter (LAd) is available in a number of large cohorts, trials, or registries. The aim of this study was to evaluate whether LAV may be reasonably estimated from LAd. One hundred forty consecutive patients referred to our outpatient clinics were prospectively enrolled to measure LAd from the long-axis view on two-dimensional echocardiography. LA orthogonal dimensions were also taken from apical four- and two-chamber views. LAV was measured using the Simpson, area-length, and ellipsoid (LAV e ) methods. The first 70 patients were the learning series and the last 70 the testing series (TeS). In the learning series, best-fitting regression analysis of LAV-LAd was run using all LAV methods, and the highest values of F were chosen among the regression equations. In the TeS, the best-fitting regressions were used to estimate LAV from LAd. In the learning series, the best-fitting regression was linear for the Spearman method (r 2  = 0.62, F = 111.85, P = .0001) and area-length method (r 2  = 0.62, F = 112.24, P = .0001) and powered for the LAV e method (r 2  = 0.81, F = 288.41, P = .0001). In the TeS, the r 2 value for LAV prediction was substantially better using the LAV e method (r 2  = 0.89) than the Simpson (r 2  = 0.72) or area-length (r 2  = 0.70) method, as was the intraclass correlation (ρ = 0.96 vs ρ = 0.89 and ρ = 0.89, respectively). In the TeS, the sensitivity and specificity of LA dilatation by the estimated LAV e method were 87% and 90%, respectively. LAV can be estimated from LAd using a nonlinear equation with an elliptical model. The proposed method may be used in retrospective analysis of existing data sets in which determination of LAV was not programmed. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  20. Psoriasis is associated with subsequent atrial fibrillation in hypertensive patients with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Bang, Casper N; Okin, Peter M; Køber, Lars

    2014-01-01

    BACKGROUND: Inflammation contributes to the pathogenesis of psoriasis as well as atrial fibrillation. The impact of psoriasis and its association with new-onset atrial fibrillation was assessed in hypertensive patients with left ventricular hypertrophy (LVH). METHODS: The predictive value...... or developed psoriasis and new-onset atrial fibrillation occurred in 506 patients (7.1%) during a mean follow-up of 4.7 ± 1.1 years. At baseline, the psoriasis patients were younger (65 ± 7 vs. 67 ± 7 years) and had less left ventricle hypertrophy by ECG Sokolow-Lyon voltage (27.6 ± 9.7 vs. 30.1 ± 10.4 mm...... of baseline or incident psoriasis for new-onset atrial fibrillation was evaluated in 7099 hypertensive patients with electrocardiographic LVH with no history of atrial fibrillation or other cardiovascular disease, in sinus rhythm on their baseline electrocardiogram. RESULTS: A total of 154 patients (2.2%) had...

  1. Catheter Ablation of Ectopic Atrial Tachycardia Originating from the Left Atrial Appendage using CARTOMERGE® System

    Directory of Open Access Journals (Sweden)

    Masahiko Goya, MD

    2008-01-01

    Full Text Available A 70-year-old woman was referred because of drug resistant and daily incessant palpitation attack. She had undergone two previous unsuccessful radiofrequency catheter ablations at another hospital. The physical examination, chest X-ray, and echocardiogram were all normal. The 12-lead ECG during tachycardia showed narrow QRS, short PR tachycardia and negative polarity of the P wave in leads I and aVL (Fig. 1A. The ECG monitor showed incessant tachycardia with warming-up phenomenon. Three dimensional electroanatomical map integrated with CT imaging (CARTOMERGE®, Biosense Webster Inc. clearly revealed the radial activation pattern originating from the basalo-postero-inferior aspect of the left atrial appendage. Radiofrequency energy application at this site eliminated tachycardia permanently.

  2. Thickening of the left atrial wall shortly after radiofrequency ablation predicts early recurrence of atrial fibrillation

    International Nuclear Information System (INIS)

    Yokokawa, Miki; Koyama, Keiko; Ino, Toshihiko; Naito, Shigeto; Oshima, Shigeru; Taniguchi, Koichi; Tada, Hiroshi

    2010-01-01

    Inflammatory responses following atrial fibrillation (AF) ablation may aggravate arrhythmogenic activity and cause an early recurrence of AF (ERAF). In 56 patients who underwent circumferential pulmonary vein ablation (CPVA) for paroxysmal AF, cardiovascular magnetic resonance imaging (CMRI) was evaluated in 5 subdivided left atrial (LA) regions before the CPVA and at 1 day and 1 month after. At a mean of 7±10 days after the CPVA, 23 patients (41%) developed 1 or more episodes of AF (ERAF group), while 33 patients (59%) remained free from AF during the first month of follow up (no-ERAF group). LA wall thickness increased 1 day after the CPVA in both groups, as demonstrated by high T2-weighted signal. The LA roof thickness and its increase, however, were greater in the ERAF group than in the no-ERAF group (P<0.05). Regions of delayed enhancement (DE) were also frequently detected in both groups, but the total number of DE regions did not differ between the 2 groups. The thickening of the LA wall associated with a high T2-weighted signal resolved within 1 month. No significant difference between the 2 groups was found in any of the CMRI parameters before or 1 month after CPVA. Thickening of the LA roof shortly after CPVA may predict an ERAF. (author)

  3. Left atrial leiomyosarcoma as cause of heart failure

    International Nuclear Information System (INIS)

    Valdes Martin, Alexander

    2012-01-01

    The case of a 26 year-old patient with diagnosis of heart failure and presence of a mobile echogenic mass without calcification attached to the posterolateral area of the left atrium was reported. She underwent surgery and tissue examination evidenced a high-grade heart leiomyosarcoma. Postoperative course was satisfactory and her clinical state was rigorously monitored by oncology and heart specialists in the institution

  4. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study.

    Science.gov (United States)

    Sugimoto, Tadafumi; Robinet, Sébastien; Dulgheru, Raluca; Bernard, Anne; Ilardi, Federica; Contu, Laura; Addetia, Karima; Caballero, Luis; Kacharava, George; Athanassopoulos, George D; Barone, Daniele; Baroni, Monica; Cardim, Nuno; Hagendorff, Andreas; Hristova, Krasimira; Lopez, Teresa; de la Morena, Gonzalo; Popescu, Bogdan A; Penicka, Martin; Ozyigit, Tolga; Rodrigo Carbonero, Jose David; van de Veire, Nico; Von Bardeleben, Ralph Stephan; Vinereanu, Dragos; Zamorano, Jose Luis; Go, Yun Yun; Marchetta, Stella; Nchimi, Alain; Rosca, Monica; Calin, Andreea; Moonen, Marie; Cimino, Sara; Magne, Julien; Cosyns, Bernard; Galli, Elena; Donal, Erwan; Habib, Gilbert; Esposito, Roberta; Galderisi, Maurizio; Badano, Luigi P; Lang, Roberto M; Lancellotti, Patrizio

    2018-02-23

    To obtain the normal ranges for echocardiographic measurements of left atrial (LA) function from a large group of healthy volunteers accounting for age and gender. A total of 371 (median age 45 years) healthy subjects were enrolled at 22 collaborating institutions collaborating in the Normal Reference Ranges for Echocardiography (NORRE) study of the European Association of Cardiovascular Imaging (EACVI). Left atrial data sets were analysed with a vendor-independent software (VIS) package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire data sets. The lowest expected values of LA function were 26.1%, 48.7%, and 41.4% for left atrial strain (LAS), 2D left atrial emptying fraction (LAEF), and 3D LAEF (reservoir function); 7.7%, 24.2%, and -0.53/s for LAS-active, LAEF-active, and LA strain rate during LA contraction (SRa) (pump function) and 12.0% and 21.6% for LAS-passive and LAEF-passive (conduit function). Left atrial reservoir and conduit function were decreased with age while pump function was increased. All indices of reservoir function and all LA strains had no difference in both gender and vendor. However, inter-vendor differences were observed in LA SRa despite the use of VIS. The NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.

  5. Percutaneous closure of the left atrial appendage in patients with diabetes mellitus.

    Science.gov (United States)

    Azizy, Obayda; Rammos, Christos; Lehmann, Nils; Rassaf, Tienush; Kälsch, Hagen

    2017-09-01

    Left atrial appendage closure is a preventive treatment of atrial fibrillation-related thrombo-embolism. Patients with diabetes mellitus have increased risk for a negative outcome in percutaneous cardiac interventions. We assessed whether percutaneous left atrial appendage closure is safe and effective in patients with diabetes mellitus. We included 78 patients (mean age of 74.4 ± 8.3 years) with indication for left atrial appendage closure in an open-label observational single-centre study. Patients with diabetes mellitus ( n = 31) were at higher thrombo-embolic and bleeding risk (CHA 2 DS 2 -VASc: 4.5 ± 0.9, HAS-BLED: 4.7 ± 0.7) compared to patients without diabetes mellitus ( n = 47, CHA 2 DS 2 -VASc: 3.5 ± 1.0, HAS-BLED: 4.1 ± 0.8; p diabetes mellitus (Euro II-Score: 6.6 ± 3.7 vs 3.9 ± 1.9, p diabetes mellitus had no events ( p = 0.672). Follow-up of 6 months revealed no bleeding complication in both groups. No stroke occurred in follow-up, and left atrial appendage flow velocity reduction (55.6 ± 38.6 vs 51.4 ± 19.1 cm/s, p = 0.474) and rate of postinterventional leakage in the left atrial appendage were comparable (0% vs 2.1%, p = 0.672). Despite patients with diabetes mellitus are high-risk patients, the outcome of percutaneous left atrial appendage closure is similar to patients without diabetes mellitus.

  6. Clinical impact of quantitative left atrial vortex flow analysis in patients with atrial fibrillation: a comparison with invasive left atrial voltage mapping.

    Science.gov (United States)

    Lee, Jung Myung; Hong, Geu-Ru; Pak, Hui-Nam; Shim, Chi Young; Houle, Helene; Vannan, Mani A; Kim, Minji; Chung, Namsik

    2015-08-01

    Recently, left atrial (LA) vortex flow analysis using contrast transesophageal echocardiography (TEE) has been shown to be feasible and has demonstrated significant differences in vortex flow morphology and pulsatility between normal subjects and patients with atrial fibrillation (AF). However, the relationship between LA vortex flow and electrophysiological properties and the clinical significance of LA vortex flow are unknown. The aims of this study were (1) to compare LA vortex flow parameters with LA voltage and (2) to assess the predictive value of LA vortex flow parameters for the recurrence of AF after radiofrequency catheter ablation (RFCA). Thirty-nine patients with symptomatic non-valvular AF underwent contrast TEE before undergoing RFCA for AF. Quantitative LA vortex flow parameters were analyzed by Omega flow (Siemens Medical Solution, Mountain View, CA, USA). The morphology and pulsatility of LA vortex flow were compared with electrophysiologic parameters that were measured invasively. Hemodynamic, electrophysiological, and vortex flow parameters were compared between patients with and without early recurrence of AF after RFCA. Morphologic parameters, including LA vortex depth, length, width, and sphericity index were not associated with LA voltage or hemodynamic parameters. The relative strength (RS), which represents the pulsatility power of LA, was positively correlated with LA voltage (R = 0.53, p = 0.01) and LA appendage flow velocity (R = 0.73, p vortex flow analysis, especially RS, correlated well with LA voltage. Decreased pulsatility strength in the LA was associated with recurrent AF. LA vortex may have incremental value in predicting the recurrence of AF.

  7. Significant correlation of P-wave parameters with left atrial volume index and left ventricular diastolic function.

    Science.gov (United States)

    Tsai, Wei-Chung; Lee, Kun-Tai; Wu, Ming-Tsang; Chu, Chih-Sheng; Lin, Tsung-Hsien; Hsu, Po-Chao; Su, Ho-Ming; Voon, Wen-Chol; Lai, Wen-Ter; Sheu, Sheng-Hsiung

    2013-07-01

    The 12-lead electrocardiogram (ECG) is a commonly used tool to access left atrial enlargement, which is a marker of left ventricular diastolic dysfunction (LVDD). The aim of this study was to evaluate any association of the P-wave measurements in ECG with left atrial volume (LAV) index and LVDD. This study enrolled 270 patients. In this study, 4 ECG P-wave parameters corrected by heart rate, that is, corrected P-wave maximum duration (PWdurMaxC), corrected P-wave dispersion (PWdisperC), corrected P-wave area (PWareaC) and corrected mean P-wave duration (meanPWdurC), were measured. LAV and left ventricular diastolic parameters were measured from echocardiography. LVDD was defined as a pseudonormal or restrictive mitral inflow pattern. The 4 P-wave parameters were significantly correlated with the LAV index after adjusting for age, sex, diabetes, hypertension, coronary artery disease, body mass index and diastolic blood pressure in multivariate analysis. The standardized β coefficients of PWdurMaxC, PWdisperC, meanPWdurC and PWareaC were 0.338, 0.298, 0.215 and 0.296, respectively. The 4 P-wave parameters were also significantly correlated with LVDD after multivariate logistic regression analysis. The odds ratios (95% confidence intervals) of PWdurMaxC, PWdisperC, meanPWdurC and PWareaC were 1.03 (1.01-1.04), 1.02 (1.04-1.04), 1.04 (1.02-1.07) and 1.01 (1.00-1.02), respectively. This study demonstrated that PWdurMaxC, PWdisperC, meanPWdurC and PWareaC were important determinants of the LAV index and LVDD. Therefore, screening patients by means of the 12-lead ECG may be helpful in identifying a high-risk group of increased LAV index and LVDD.

  8. Obese Hypertensive Men Have Lower Circulating Proatrial Natriuretic Peptide Concentrations Despite Greater Left Atrial Size

    DEFF Research Database (Denmark)

    Asferg, Camilla L; Andersen, Ulrik B; Linneberg, Allan

    2018-01-01

    BACKGROUND: Obese persons have lower circulating natriuretic peptide (NP) concentrations. It has been proposed that this natriuretic handicap plays a role in obesity-related hypertension. In contrast, hypertensive patients with left atrial enlargement have higher circulating NP concentrations....... On this background, we investigated whether obese hypertensive men could have lower circulating NP concentrations despite evidence of pressure-induced greater left atrial size. METHODS: We examined 98 obese men (body mass index [BMI] ≥ 30.0 kg/m2) and 27 lean normotensive men (BMI 20.0-24.9 kg/m2). All men were...... using echocardiography, and we measured fasting serum concentrations of midregional proatrial NP (MR-proANP). RESULTS: Of the 98 obese men, 62 had hypertension and 36 were normotensive. The obese hypertensive men had greater left atrial size (mean ± SD: 28.7 ± 6.0 ml/m2) compared with the lean...

  9. Unusual case of left atrial myxoma with gastroesophageal junction adenocarcinoma.

    Science.gov (United States)

    Singh, Narinder Pal; Nagpal, Swapan Deep Singh; Goel, Arun Kumar; Dhingra, Bhupendra Kr

    2018-02-01

    Cardiac myxomas are rare tumors. Esophageal adenocarcinomas are common tumors of the gastrointestinal tract. Simultaneous occurrence of these tumors has not been reported. A 52-year-old gentleman presented to our hospital with dysphagia and was diagnosed with esophageal adenocarcinoma. Routine echocardiography discovered a cardiac tumor in the left atrium. The cardiac tumor was surgically removed and biopsy confirmed a myxoma. We removed the cardiac tumor as the first step and then initiated neoadjuvant chemotherapy. It is ideal to constitute a multidisciplinary team to decide on the course of treatment in such cases.

  10. Magnetic resonance imaging and angiography of the brain in embolic left atrial myxoma

    International Nuclear Information System (INIS)

    Marazuela, M.; Yebra, M.; Diego, J.; Durantez, A.; Garcia-Merino, A.; Brasa, J.M.

    1989-01-01

    A case of left atrial myxoma presenting exclusively with neurological symptoms, studies with magnetic resonance imaging (MRI) combined with cerebral angiography and computed tomography (CT) is reported. Typical angiographic findings suggested the diagnosis of myxoma. MRI showed multiple ischemic lesions disseminated throughout the entire brain, some of which had been clinically asymptomatic. Because of its sensitivity in identifying small cerebral infarcts, MRI should prove in the future to be a first-choice technique in the evaluation of the presence of an extent of cerebral involvement in embolic left atrial myxoma. (orig.)

  11. Brain ischemia as initial sign of a left atrial myxoma Report of one case

    International Nuclear Information System (INIS)

    Osio, Luis F; Velasquez, Jorge E; Tobon, Gabriel J; Posada, Gloria; Contreras, Eduardo; Sanchez, Jairo; Gutierrez, Javier

    2008-01-01

    Primary heart tumors are rare; 75% of them are benign and almost half of the benign ones are myxomas that in most cases are located in the left cavities. Clinical manifestations of myxomas depend on its localization site. Nevertheless, it is accepted that brain ischemia is the initial clinical manifestation in a third of atrial myxomas. The case of a 65 years ald male patient in whom the first clinical manifestation of an atrial myxoma was an ischemic cerebrovascular event, is presented

  12. Left atrial appendage function in prediction of paroxysmal atrial fibrilation in patients with untreated hypertension.

    Science.gov (United States)

    Tenekecioglu, Erhan; Agca, Fahriye Vatansever; Karaagac, Kemal; Ozluk, Ozlem Arican; Peker, Tezcan; Kuzeytemiz, Mustafa; Senturk, Muhammed; Yılmaz, Mustafa

    2014-01-01

    Abstract The onset of AF results in a significant increase in mortality rates and morbidity in hypertensive patients and this rhythm disorder exposes patients to a significantly increased risk of cerebral or peripheral embolisms. Tissue Doppler imaging was found to be useful in early detection of myocardial dysfunction in several diseases. It was shown that tissue Doppler analysis of the walls of the left atrial appendage (LAA) can give accurate information about the function of the LAA in hypertensive patients. In this study, we aimed to investigate and identify the specific predictive parameters for the onset of AF in patients with hypertension with tissue Doppler imaging of LAA. We studied age and sex matched 57 untreated hypertensive patients with paroxysmal atrial fibrillation (PAF) and 27 untreated hypertensive subjects without PAF. With transthoracic echocardiography, diastolic mitral A-velocity and LA maximal volume index which reflects reservoir function of left atrium was measured, with transesophageal echocardiography, LAA emptying velocity (LAA-PW D2) and tissue Doppler contracting velocity of LAA (LAA-TDI-D2) were measured. LA maximal volume index of the groups (22.28 ± 3.59 mL/m(2) in Group 1 versus 20.37 ± 3.97 mL/m(2) in Group 2, p = 0.07) and diastolic mitral A-velocity [0.93 (0.59-1.84) m/s in patients with PAF versus 0.90 (0.62-1.76) m/s in patients without PAF, p = 0.26] was not significantly different between study groups, during TEE, LAA-PW D2 (0.31 ± 0.04 m/s in Group 1 versus 0.33 ± 0.03 m/s in Group 2, p = 0.034) and LAA-TDI-D2 (0.18 ± 0.04 m/s in Group 1 versus 0.21 ± 0.05 m/s in Group 2, p = 0.014) were significantly decreased in Group 1. In this study, we found that in hypertensive PAF patients despite normal global LA functions, LAA contracting function was deteriorated. Tissue Doppler analysis of LAA is clinically usefull approach to detect the risk of developing PAF in

  13. Left atrial appendage: morphology and function in patients with paroxysmal and persistent atrial fibrillation.

    Science.gov (United States)

    Park, Hwan-Cheol; Shin, Jinho; Ban, Ji-Eun; Choi, Jong-Il; Park, Sang-Weon; Kim, Young-Hoon

    2013-04-01

    The anatomical and functional characteristics of the left atrial appendage (LAA) and its relationships with anatomical remodeling and ischemic stroke in patients with atrial fibrillation (AF) have not been clearly established. The purpose of this study was to determine whether functional and morphological features of the LAA independently predict clinical outcome and stroke in patients with AF who underwent catheter ablation (CA). Two hundred sixty-four patients with AF, including 176 with paroxysmal AF (PAF, 54.0 ± 11.4 years old, M:F = 138:38) and 88 with persistent AF (PeAF, 56.4 ± 9.6 years old, M:F = 74:14) were studied. Of these patients, 31 (11.7 %) had a history of stroke/TIA (transient ischemic attack). The LA and LAA volumes were 124.0 ± 42.4 and 24.9 ± 4.3 ml in PeAF, these values were greater than those in PAF (81.2 ± 24.8 ml and 21.2 ± 5.1 ml, P stroke, stroke patients had larger LA volume (106.9 ± 23.0 vs. 94.0 ± 38.9 ml, P = 0.004) and had lower LAA EF (50.0 ± 11.0 vs. 65.7 ± 13.4 %, P stroke were age (P = 0.002) and LAA EF (P stroke/TIA and recurrence of AF after CA in paroxysmal AF patients. Further large scaled prospective study is required for validation.

  14. Left atrial appendage morphology in patients with suspected cardiogenic stroke without known atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Miika Korhonen

    Full Text Available The left atrial appendage (LAA is the typical origin for intracardiac thrombus formation. Whether LAA morphology is associated with increased stroke/TIA risk is controversial and, if it does, which morphological type most predisposes to thrombus formation. We assessed LAA morphology in stroke patients with cryptogenic or suspected cardiogenic etiology and in age- and gender-matched healthy controls. LAA morphology and volume were analyzed by cardiac computed tomography in 111 patients (74 males; mean age 60 ± 11 years with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology other than known atrial fibrillation (AF. A subgroup of 40 patients was compared to an age- and gender-matched control group of 40 healthy individuals (21 males in each; mean age 54 ± 9 years. LAA was classified into four morphology types (Cactus, ChickenWing, WindSock, CauliFlower modified with a quantitative qualifier. The proportions of LAA morphology types in the main stroke group, matched stroke subgroup, and control group were as follows: Cactus (9.0%, 5.0%, 20.0%, ChickenWing (23.4%, 37.5%, 10.0%, WindSock (47.7%, 35.0%, 67.5%, and CauliFlower (19.8%, 22.5%, 2.5%. The distribution of morphology types differed significantly (P<0.001 between the matched stroke subgroup and control group. The proportion of single-lobed LAA was significantly higher (P<0.001 in the matched stroke subgroup (55% than the control group (6%. LAA volumes were significantly larger (P<0.001 in both stroke study groups compared to controls patients. To conclude, LAA morphology differed significantly between stroke patients and controls, and single-lobed LAAs were overrepresented and LAA volume was larger in patients with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology.

  15. Clinical application of percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis and left atrial thrombi

    International Nuclear Information System (INIS)

    Chen Junzhu; Zhang Furong; Tao Qianmin; Cheng Guanchang; Zheng Liangrong; Zhu Jianhua

    2002-01-01

    Objective: To evaluate safety and effect of percutaneous balloon mitral valvuloplasty (PBMV) for patients with rheumatic mitral stenosis and left atrial thrombi. Methods: PBMV was performed in 27 patients with rheumatic mitral stenosis and left atrial thrombi. 19 cases of left atrial fresh thrombi revealed by trans-esophageal echocardiography (TEE) received warfarin orally for 3-6 months before PBMV. Results: PBMV was successful in all cases of mitral stenosis and left atrial thrombi. Left atrial fresh thrombi was completely resolved in 9 cases and became smaller chronic organized thrombi in 10 cases after warfarin anticoagulation treatment among 19 cases of left atrial fresh thrombi revealed by TEE. In 5 cases of left atrial chronic organized thrombi shown only transthoracic echocardiography and without anticoagulation treatment, one case had cerebral embolism. No complication occurred in other cases. Conclusions: The study showed that patients with rheumatic mitral stenosis and atrial fibrillation should have routine TEE. PBMV for rheumatic mitral stenosis with left atrial thrombi after anticoagulation treatment is safe and effective

  16. Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

    Directory of Open Access Journals (Sweden)

    Król Wojciech

    2016-12-01

    Full Text Available Enlargement of the left atrium is perceived as a part of athlete’s heart syndrome, despite the lack of evidence. So far, left atrial size has not been assessed in the context of exercise capacity. The hypothesis of the present study was that LA enlargement in athletes was physiological and fitness-related condition. In addition, we tried to assess the feasibility and normal values of left atrial strain parameters and their relationship with other signs of athlete’s heart. The study group consisted of 114 international-level rowers (17.5 ± 1.5 years old; 46.5% women. All participants underwent a cardio-pulmonary exercise test and resting transthoracic echocardiography. Beside standard echocardiographic measurements, two dimensional speckle tracking echocardiography was used to assess average peak atrial longitudinal strain, peak atrial contraction strain and early left atrial diastolic longitudinal strain. Mild, moderate and severe left atrial enlargement was present in 27.2°%, 11.4% and 4.4% athletes, respectively. There were no significant differences between subgroups with different range of left atrial enlargement in any of echocardiographic parameters of the left ventricle diastolic function, filling pressure or hypertrophy. A significant correlation was found between the left atrial volume index and maximal aerobic capacity (R > 0.3; p < 0.001. Left atrial strain parameters were independent of atrial size, left ventricle hypertrophy and left ventricle filling pressure. Decreased peak atrial longitudinal strain was observed in 4 individuals (3.5%. We concluded that LA enlargement was common in healthy, young athletes participating in endurance sport disciplines with a high level of static exertion and was strictly correlated with exercise capacity, therefore, could be perceived as another sign of athlete’s heart.

  17. Left Atrial Size and Function in a Canine Model of Chronic Atrial Fibrillation and Heart Failure

    Science.gov (United States)

    Goldberg, Adam; Kusunose, Kenya; Qamruddin, Salima; Rodriguez, L. Leonardo; Mazgalev, Todor N.; Griffin, Brian P.; Van Wagoner, David R.; Zhang, Youhua; Popović, Zoran B.

    2016-01-01

    Background Our aim was to assess how atrial fibrillation (AF) induction, chronicity, and RR interval irregularity affect left atrial (LA) function and size in the setting of underlying heart failure (HF), and to determine whether AF effects can be mitigated by vagal nerve stimulation (VNS). Methods HF was induced by 4-weeks of rapid ventricular pacing in 24 dogs. Subsequently, AF was induced and maintained by atrial pacing at 600 bpm. Dogs were randomized into control (n = 9) and VNS (n = 15) groups. In the VNS group, atrioventricular node fat pad stimulation (310 μs, 20 Hz, 3–7 mA) was delivered continuously for 6 months. LA volume and LA strain data were calculated from bi-weekly echocardiograms. Results RR intervals decreased with HF in both groups (p = 0.001), and decreased further during AF in control group (p = 0.014), with a non-significant increase in the VNS group during AF. LA size increased with HF (p<0.0001), with no additional increase during AF. LA strain decreased with HF (p = 0.025) and further decreased after induction of AF (p = 0.0001). LA strain decreased less (p = 0.001) in the VNS than in the control group. Beat-by-beat analysis showed a curvilinear increase of LA strain with longer preceding RR interval, (r = 0.45, p <0.0001) with LA strain 1.1% higher (p = 0.02) in the VNS-treated animals, independent of preceding RR interval duration. The curvilinear relationship between ratio of preceding and pre-preceding RR intervals, and subsequent LA strain was weaker, (r = 0.28, p = 0.001). However, VNS-treated animals again had higher LA strain (by 2.2%, p = 0.002) independently of the ratio of preceding and pre-preceding RR intervals. Conclusions In the underlying presence of pacing-induced HF, AF decreased LA strain, with little impact on LA size. LA strain depends on the preceding RR interval duration. PMID:26771573

  18. Simulation of left atrial function using a multi-scale model of the cardiovascular system.

    Directory of Open Access Journals (Sweden)

    Antoine Pironet

    Full Text Available During a full cardiac cycle, the left atrium successively behaves as a reservoir, a conduit and a pump. This complex behavior makes it unrealistic to apply the time-varying elastance theory to characterize the left atrium, first, because this theory has known limitations, and second, because it is still uncertain whether the load independence hypothesis holds. In this study, we aim to bypass this uncertainty by relying on another kind of mathematical model of the cardiac chambers. In the present work, we describe both the left atrium and the left ventricle with a multi-scale model. The multi-scale property of this model comes from the fact that pressure inside a cardiac chamber is derived from a model of the sarcomere behavior. Macroscopic model parameters are identified from reference dog hemodynamic data. The multi-scale model of the cardiovascular system including the left atrium is then simulated to show that the physiological roles of the left atrium are correctly reproduced. This include a biphasic pressure wave and an eight-shaped pressure-volume loop. We also test the validity of our model in non basal conditions by reproducing a preload reduction experiment by inferior vena cava occlusion with the model. We compute the variation of eight indices before and after this experiment and obtain the same variation as experimentally observed for seven out of the eight indices. In summary, the multi-scale mathematical model presented in this work is able to correctly account for the three roles of the left atrium and also exhibits a realistic left atrial pressure-volume loop. Furthermore, the model has been previously presented and validated for the left ventricle. This makes it a proper alternative to the time-varying elastance theory if the focus is set on precisely representing the left atrial and left ventricular behaviors.

  19. Epidemiological study of dilated cardiomyopathy from eastern India with special reference to left atrial size

    Directory of Open Access Journals (Sweden)

    Rudrajit Paul, Saumen Nandi, Pradip K Sinha

    2014-07-01

    Full Text Available Dilated cardiomyopathy (DCM is a common cause of emergency visit in our country. The disease is often misdiagnosed and mistreated. There are very few studies on DCM from India. We undertook a small study on DCM patients from Eastern India to find the demographic and echocardiographic characteristics. Patients and methods: We under took this study in a tertiary care Medical College of Eastern India. All patients coming to the emergency with dyspnea were evaluated for cardiac dysfunction. Emergency echocardiography was done to diagnose dilated cardiomyopathy. Patients with DCM were then evaluated as per protocol. After stabilization, echocardiography was repeated to note the study parameters like left atrial diameter. Standard statistical tests were used. Results: we had a total of 70 patients in our study with a male: female ratio of 43:27. Most patients were aged over 40 years. Patients with COPD, history of radiation, malignancy or drug abuse were excluded. Most patients (47% were on NYHA stage 3 at the time of presentation. In our patient cohort, 24% were alcoholic and 46% were smokers. Atrial fibrillation was present in 15.7% of the patients and right and left bundle branch block had been present in 8 and 15 patients respectively. In echocardiography, increased left atrial (LA size (>40 mm was found in 45 patients. Many patients had valvular regurgitation, mitral, aortic or tricuspid. LA size was positively correlated with left ventricular systolic diameter (r=0.403 and negatively correlated with ejection fraction (r= -0.23. Analysis and conclusion: different ECG abnormalities like bundle branch block and arrhythmias like atrial fibrillation are quite common in DCM. In echocardiography, left atrial size is an important prognostic marker and correlates with left ventricular function.

  20. Assessment of blood stasis in left-atrial appendage with electron-beam CT: filling delay in atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Nakanishi, Tadashi [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan); Hamada, Seiki [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan); Takamiya, Makoto [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan); Kuribayashi, Sachio [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan); Naito, Hiroaki [Biomedical Research Center, Osaka Univ. School of Medicine, Suita (Japan)

    1994-10-01

    The left-atrial appendage (LAA) is the most frequent site of thrombus formation. The most probable reason is its anatomical structure and blood stasis. We hypothesized that peak time delay should occur in the LAA with stagnant blood flow. We measured peak time delay in LAA against left atrium with the flow-mode study of electron-beam CT for 49 patients (including 23 patients with atrial fibrillation [AF]). Volume-mode scannings were also performed to detect intracardiac thrombi. Patients with atrial fibrillation showed a larger value than those with sinus rhythm. Some AF patients with no filling of contrast media into the LAA and/or thrombus showed a larger value than the others. The value obtained by the flow-mode study might have the potential by the flow-mode study might have the potential to assess blood stasis and to predict the jeopardized state in the LAA. (orig.)

  1. Assessment of blood stasis in left-atrial appendage with electron-beam CT: filling delay in atrial fibrillation

    International Nuclear Information System (INIS)

    Nakanishi, Tadashi; Hamada, Seiki; Takamiya, Makoto; Kuribayashi, Sachio; Naito, Hiroaki

    1994-01-01

    The left-atrial appendage (LAA) is the most frequent site of thrombus formation. The most probable reason is its anatomical structure and blood stasis. We hypothesized that peak time delay should occur in the LAA with stagnant blood flow. We measured peak time delay in LAA against left atrium with the flow-mode study of electron-beam CT for 49 patients (including 23 patients with atrial fibrillation [AF]). Volume-mode scannings were also performed to detect intracardiac thrombi. Patients with atrial fibrillation showed a larger value than those with sinus rhythm. Some AF patients with no filling of contrast media into the LAA and/or thrombus showed a larger value than the others. The value obtained by the flow-mode study might have the potential by the flow-mode study might have the potential to assess blood stasis and to predict the jeopardized state in the LAA. (orig.)

  2. Left atrial remodelling in patients with myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALIANT Echo study

    DEFF Research Database (Denmark)

    Meris, Alessandra; Amigoni, Maria; Uno, Hajime

    2009-01-01

    AIMS: To assess the relationship between left atrial (LA) size and outcome after high-risk myocardial infarction (MI) and to study dynamic changes in LA size during long-term follow-up. METHODS AND RESULTS: The VALIANT Echocardiography study prospectively enrolled 610 patients with left ventricul...

  3. Left atrial and left ventricular diastolic function after the maze procedure for atrial fibrillation in mitral valve disease: degenerative versus rheumatic.

    Science.gov (United States)

    Kim, Hwan Wook; Moon, Mi Hyoung; Jo, Keon Hyun; Song, Hyun; Lee, Jae Won

    2015-02-01

    The present study was aimed to compare the left atrial and left ventricular diastolic functions amongst the rheumatic and degenerative mitral valve disease patients in atrial fibrillation who reverted to normal sinus rhythm following Cox-maze procedure. We prospectively investigated the left atrial and left ventricular function with Doppler echocardiography, by dividing into the rheumatic (N = 105) and the degenerative group (N = 47). Over the follow-up period (mean: 4.4 ± 1.2 years in the rheumatic group, 4.8 ± 1.3 years in the degenerative group), the rheumatic group showed statistically significant decrease in A' velocity and E' velocity, on contrary to degenerative group (A' velocity: mean decrease of 0.43 ± 0.13 cm/s in the rheumatic group, mean increase of 0.57 ± 0.11 cm/s in the degenerative group, p = 0.029, E' velocity: mean decrease of 0.23 ± 0.17 cm/s in the rheumatic group, mean increase of 0.21 ± 0.15 cm/s in the degenerative group, p = 0.031). In addition, the rheumatic group showed statistically significant increase in E/E' ratio than the degenerative group (mean increase of 4.49 ± 1.98 in the rheumatic group, mean increase of 1.74 ± 1.52 in the degenerative group, p = 0.047). Despite successful sinus rhythm restoration, the progressive loss of LA function as well as LV diastolic function is more prominent in the rheumatic group than the degenerative group. Therefore, differentiated strategies for postoperative surveillance are needed according to the pathology of mitral valve disease.

  4. Early Heparin Administration Reduces Risk for Left Atrial Thrombus Formation during Atrial Fibrillation Ablation Procedures

    Directory of Open Access Journals (Sweden)

    Stefan Asbach

    2011-01-01

    Full Text Available Objective. Despite the use of anticoagulation during left atrial (LA ablation procedures, ischemic cerebrovascular accidents (CVAs are recognized as a serious complication. Heparin is usually given after safe transseptal access has been obtained, resulting in a short unprotected dwell time of catheters within the LA, which may account for CVAs. We investigated the frequency of CVAs and LA thrombus formation as detected by intracardiac ultrasound (ICE depending on the timing of heparin administration. Methods and Results. Sixty LA ablation procedures with the use of ICE were performed in 55 patients. Patients were grouped by heparin administration after (Group I, =13 and before (Group II, =47 transseptal access. Group I patients were younger (56.6±13.7 versus 65.9±9.9 years, =.01; other clinical and echocardiographic characteristics did not differ between groups. Early thrombus formation was observed in 2 (15.4% of group I patients as compared to 0% of group II patients (=.04. One CVA (2.1% occurred in one group II patient without prior thrombus detection, and none occurred in group I patients (=ns. Conclusion. Early administration of heparin reduces the risk of early intracardiac thrombus formation during LA ablation procedures. This did not result in reduced rate of CVAs.

  5. Left atrial ejection force predicts the outcome after catheter ablation for paroxysmal atrial fibrillation.

    Science.gov (United States)

    Kishima, Hideyuki; Mine, Takanao; Takahashi, Satoshi; Ashida, Kenki; Ishihara, Masaharu; Masuyama, Tohru

    2018-02-01

    Left atrium (LA) systolic dysfunction is observed in the early stages of atrial fibrillation (AF) prior to LA anatomical change. We investigated whether LA systolic dysfunction predicts recurrent AF after catheter ablation (CA) in patients with paroxysmal AF. We studied 106 patients who underwent CA for paroxysmal AF. LA systolic function was assessed with the LA emptying volume = Maximum LA volume (LAV max ) - Minimum LA volume (LAV min ), LA emptying fraction = [(LAV max - LAV min )/LAV max ] × 100, and LA ejection force calculated with Manning's method [LA ejection force = (0.5 × ρ × mitral valve area × A 2 )], where ρ is the blood density and A is the late-diastolic mitral inflow velocity. Recurrent AF was detected in 35/106 (33%) during 14.6 ± 9.1 months. Univariate analysis revealed reduced LA ejection force, decreased LA emptying fraction, larger LA diameter, and elevated brain natriuretic peptide as significant variables. On multivariate analysis, reduced LA ejection force and larger LA diameter were independently associated with recurrent AF. Moreover, patients with reduced LA ejection force and larger LA diameter had a higher risk of recurrent AF than preserved LA ejection force (log-rank P = 0.0004). Reduced LA ejection force and larger LA diameter were associated with poor outcome after CA for paroxysmal AF, and could be a new index to predict recurrent AF. © 2017 Wiley Periodicals, Inc.

  6. The imaging features of neurologic complications of left atrial myxomas

    International Nuclear Information System (INIS)

    Liao, Wei-Hua; Ramkalawan, Divya; Liu, Jian-Ling; Shi, Wei; Zee, Chi-Shing; Yang, Xiao-Su; Li, Guo-Liang; Li, Jing; Wang, Xiao-Yi

    2015-01-01

    Background: Neurologic complications may be the first symptoms of atrial myxomas. Understanding the imaging features of neurologic complications of atrial myxomas can be helpful for the prompt diagnosis. Objective: To identify neuroimaging features for patients with neurologic complications attributed to atrial myxoma. Methods: We retrospectively reviewed the medical records of 103 patients with pathologically confirmed atrial myxoma at Xiangya Hospital from January 2009 to January 2014. The neuroimaging data for patients with neurologic complications were analyzed. Results: Eight patients with atrial myxomas (7.77%) presented with neurologic manifestations, which constituted the initial symptoms for seven patients (87.5%). Neuroimaging showed five cases of cerebral infarctions and three cases of aneurysms. The main patterns of the infarctions were multiplicity (100.0%) and involvement of the middle cerebral artery territory (80.0%). The aneurysms were fusiform in shape, multiple in number (100.0%) and located in the distal middle cerebral artery (100.0%). More specifically, high-density in the vicinity of the aneurysms was observed on CT for two patients (66.7%), and homogenous enhancement surrounding the aneurysms was detected in the enhanced imaging for two patients (66.7%). Conclusion: Neurologic complications secondary to atrial myxoma consist of cerebral infarctions and aneurysms, which show certain characteristic features in neuroimaging. Echocardiography should be performed in patients with multiple cerebral infarctions, and multiple aneurysms, especially when aneurysms are distal in location. More importantly, greater attention should be paid to the imaging changes surrounding the aneurysms when myxomatous aneurysms are suspected and these are going to be the relevant features in our article

  7. The imaging features of neurologic complications of left atrial myxomas

    Energy Technology Data Exchange (ETDEWEB)

    Liao, Wei-Hua; Ramkalawan, Divya; Liu, Jian-Ling; Shi, Wei [Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan (China); Zee, Chi-Shing [Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033 (United States); Yang, Xiao-Su; Li, Guo-Liang; Li, Jing [Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, Hunan (China); Wang, Xiao-Yi, E-mail: cjr.wangxiaoyi@vip.163.com [Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan (China)

    2015-05-15

    Background: Neurologic complications may be the first symptoms of atrial myxomas. Understanding the imaging features of neurologic complications of atrial myxomas can be helpful for the prompt diagnosis. Objective: To identify neuroimaging features for patients with neurologic complications attributed to atrial myxoma. Methods: We retrospectively reviewed the medical records of 103 patients with pathologically confirmed atrial myxoma at Xiangya Hospital from January 2009 to January 2014. The neuroimaging data for patients with neurologic complications were analyzed. Results: Eight patients with atrial myxomas (7.77%) presented with neurologic manifestations, which constituted the initial symptoms for seven patients (87.5%). Neuroimaging showed five cases of cerebral infarctions and three cases of aneurysms. The main patterns of the infarctions were multiplicity (100.0%) and involvement of the middle cerebral artery territory (80.0%). The aneurysms were fusiform in shape, multiple in number (100.0%) and located in the distal middle cerebral artery (100.0%). More specifically, high-density in the vicinity of the aneurysms was observed on CT for two patients (66.7%), and homogenous enhancement surrounding the aneurysms was detected in the enhanced imaging for two patients (66.7%). Conclusion: Neurologic complications secondary to atrial myxoma consist of cerebral infarctions and aneurysms, which show certain characteristic features in neuroimaging. Echocardiography should be performed in patients with multiple cerebral infarctions, and multiple aneurysms, especially when aneurysms are distal in location. More importantly, greater attention should be paid to the imaging changes surrounding the aneurysms when myxomatous aneurysms are suspected and these are going to be the relevant features in our article.

  8. Cine MR imaging in mitral valve prolapse; Study on mitral regurgitation and left atrial volume

    Energy Technology Data Exchange (ETDEWEB)

    Kumai, Toshihiko [Chiba Univ. (Japan). School of Medicine

    1993-02-01

    This study was undertaken to assess the ability of cine MR imaging to evaluate the direction, timing, and severity of mitral regurgitation in patients with mitral valve prolapse (MVP). The population of this study was 33 patients with MVP diagnosed by two-dimensional echocardiography and 10 patients with rheumatic mitral valve disease (MSR) for comparison. 7 patients with MVP and 5 with MSR had atrial fibrillation and/or history of congestive heart failure as complications. Mitral regurgitation was graded for severity by color Doppler flow imaging in all patients. Direction and size of systolic flow void in the left atrium were analyzed by contiguous multilevel cine MR images and the maximum volumes of flow void and left atrium were measured. Although flow void was found at the center of the left atrium in most of MSR, it was often directed along the postero-caudal atrial wall in anterior leaflet prolapse and along the anterocranial atrial wall in posterior leaflet prolapse. In MVP, the maximum volume of flow void was often seen in late systole. The maximum volume of flow void and that of left atrium were significantly larger in patients with atrial fibrillation and/or history of congestive heart failure. The length and volume of flow void were increased with clinical severity and degree of regurgitation determined by color Doppler flow imaging. Thus cine MR imaging provides a useful means for detection and semiquantitative evaluation of mitral regurgitation in subjects with MVP. (author).

  9. Predictors and prognostic value of left atrial remodelling after acute myocardial infarction

    DEFF Research Database (Denmark)

    Kyhl, Kasper; Vejlstrup, Niels; Lønborg, Jacob

    2015-01-01

    PURPOSE: Left atrial (LA) volume is a strong prognostic predictor in patients following ST-segment elevation myocardial infarction (STEMI). However, the change in LA volume over time (LA remodelling) following STEMI has been scarcely studied. We sought to identify predictors for LA remodelling an...

  10. A case of anemia with left atrial myxoma suspected as late effect of an atomic bomb

    International Nuclear Information System (INIS)

    Sugahara, Hiroko; Aosaki, Noboru; Kurita, Akira

    1980-01-01

    A 43 years old housewife with a history of exposure to an atomic bomb at 8 years old, recently developed anemia and palpitation. The laboratory data showed accelerated ESR, anemia (Hb 10.0 g/dl), and hyper γ-globulinemia. Despite the suspicion of late effect of atomic radiation, further examinations confirmed the diagnosis of left atrial myxoma. The echocardiographic studies revealed the decrease of diastolic descent rate, and multiple echos reflected from the tumor within the mitral orifice during diastole. Cardiac catheterization demonstrated remarkably high value of PCWP (V-wave 38 mmHg) and space filling defect moving from left atrium to left ventricle by cineangiography. Phonecardiographic studies were similar to mitral stenosis. After left atrial myxoma was removed, her symptoms and laboratory data including all noninvasive findings were improved. Therefore we suspected that her symptoms was related with left atrial myxoma rather than the late effect of atomic bomb exposure. We have discussed its significance and usefulness of noninvasive diagnostic approaches as well as whole body computed tomography in heart tumor. (author)

  11. [Quantitative Measurements on the Blood Flow Fields of Left Atrial Appendage using Vector Flow Mapping in Patients with Nonvalvular Atrial Fibrillation].

    Science.gov (United States)

    Cai, Yu-Yan; Wei, Xin; Zhang, Xiao-Ling; Liu, Gu-Yue; Li, Xi; Tang, Hong

    2018-01-01

    To quantify the hemodynamic characteristics of patients with nonvalvular atrial fibrillation. Twenty patients with paroxysmal atrial fibrillation and 15 patients with persistent atrial fibrillation enrolled in this study,while 12 patients with sinus rhythms served as controls. The hemodynamic characteristics of the patients in left atrial appendage were measured by transesophageal echocardiography (TEE) and vector flow mapping (VFM) using indicators such as vectors,vortex and energy loss (EL). ① Significant differences appeared between the patients with atrial fibrillation and the controls in heart rate,size of left atrium,size of left atrial appendage (LAA),and velocities of LAA filling and emptying. ② Regular vectors in LAA in early systole and late diastole were found in the patients with paroxysmal atrial fibrillation and the controls; whereas,irregular vectors with direction alternating were visualized in the whole cardiac cycle in the patients with persistent atrial fibrillation. ③ Small vortexes were observed at the opening of the left atrial appendage in late diastole in the patients with paroxysmal atrial fibrillation and the controls. ④ Peak EL values occurred in early systole and late diastole in the patients with paroxysmal atrial fibrillation and the controls. But the patients with persistent atrial fibrillation had increased EL values over the whole cardiac cycle. VFM can visualize and quantify the hemodynamics of LAA in patients with different heart rhythms. It may provide a new method for assessing atrial fibrillation. CopyrightCopyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).

  12. Paroxysmal postprandial atrial fibrilation suppressed by laparoscopic repair of a giant paraesophageal hernia compressing the left atrium.

    Science.gov (United States)

    Cristian, Daniel A; Constantin, Alin S; Barbu, Mariana; Spătaru, Dan; Burcoș, Traean; Grama, Florin A

    2015-03-01

    We present the case of a patient with a giant paraesophageal hernia associated with paroxysmal postprandial atrial fibrillation that was suppressed after surgery. The imaging investigations showed the intrathoracic displacement of a large part of the stomach, which pushed the left atrial wall causing atrial fibrillation. The laparoscopic surgical repair acted as sole treatment for this condition.

  13. Left-to-Right Atrial Inward Rectifier Potassium Current Gradients in Patients With Paroxysmal Versus Chronic Atrial Fibrillation

    Science.gov (United States)

    Voigt, Niels; Trausch, Anne; Knaut, Michael; Matschke, Klaus; Varró, András; Van Wagoner, David R.; Nattel, Stanley; Ravens, Ursula; Dobrev, Dobromir

    2018-01-01

    Background Recent evidence suggests that atrial fibrillation (AF) is maintained by high-frequency reentrant sources with a left-to-right–dominant frequency gradient, particularly in patients with paroxysmal AF (pAF). Unequal left-to-right distribution of inward rectifier K+ currents has been suggested to underlie this dominant frequency gradient, but this hypothesis has never been tested in humans. Methods and Results Currents were measured with whole-cell voltage-clamp in cardiomyocytes from right atrial (RA) and left (LA) atrial appendages of patients in sinus rhythm (SR) and patients with AF undergoing cardiac surgery. Western blot was used to quantify protein expression of IK1 (Kir2.1 and Kir2.3) and IK,ACh (Kir3.1 and Kir3.4) subunits. Basal current was ≈2-fold larger in chronic AF (cAF) versus SR patients, without RA-LA differences. In pAF, basal current was ≈2-fold larger in LA versus RA, indicating a left-to-right atrial gradient. In both atria, Kir2.1 expression was ≈2-fold greater in cAF but comparable in pAF versus SR. Kir2.3 levels were unchanged in cAF and RA-pAF but showed a 51% decrease in LA-pAF. In SR, carbachol-activated (2 μmol/L) IK,ACh was 70% larger in RA versus LA. This right-to-left atrial gradient was decreased in pAF and cAF caused by reduced IK,ACh in RA only. Similarly, in SR, Kir3.1 and Kir3.4 proteins were greater in RA versus LA and decreased in RA of pAF and cAF. Kir3.1 and Kir3.4 expression was unchanged in LA of pAF and cAF. Conclusions Our results support the hypothesis that a left-to-right gradient in inward rectifier background current contributes to high-frequency sources in LA that maintain pAF. These findings have potentially important implications for development of atrial-selective therapeutic approaches. PMID:20657029

  14. The influence of right ventricular apical pacing on left atrial volume in patients with normal left ventricular function

    Directory of Open Access Journals (Sweden)

    AR Moaref1

    2008-03-01

    Full Text Available Background: Right ventricular apical (RVA pacing has been reported to induce several deleterious effects particularly in the presence of structural heart disease but can also involve patients with normal left ventricular (LV function. Left atrial (LA enlargement is one of these effects, but the majority of studies have measured LA dimension rather than volume.Objective: The present prospective study was designed to assess the effect of RVA pacing on LA volume in patients with normal LV function.Patients and Methods: The study comprised 41 consecutive patients with LV ejection fraction ≥ 45% and LV end diastolic dimension ≤ 56 mm who underwent single-or dual- chamber pacemaker implantation in RVA and followed for LA volume measurement and pacemaker analysis at least during the ensuing 4.2 months. Results: In all, 21 patients were excluded from the study due to five spontaneous wide QRS complex (≥120msec, one recent acute coronary syndrome,one significant valvular heart disease, three pacing frequency <90%, eight death or losing follow up in three cases. In remaining 20 patients, LA volume ragned from 21 to 54 mm3 with mean of 37.3±9.7 mm3 prior to pacemaker implantation that increased to 31 to 103 mm3 (54.3±17.0 during follow-up (P<0.001.Conclusion: RVA pacing might lead to an increase in LA volume even in patients with normal LV function.

  15. LEFT ATRIAL FIBROSIS IN PATIENTS WITH ATRIAL FIBRILLATION ACCORDING TO MAGNETIC RESONANCE IMAGING WITH LATE GADOLINIUM ENHANCEMENT

    Directory of Open Access Journals (Sweden)

    O. V. Stukalova

    2015-01-01

    Full Text Available Rationale: Atrial fibrillation (AF is the most common type of arrhythmia. Left atrial abnormalities in AF require further investigation.Aim: To evaluate characteristics of myocardial structure of the left atrium by magnetic resonance imaging (MRI with delayed contrast enhancement in patients with AF associated with essential hypertension (EH, in those without any cardiovascular disorders, and in patients with AF after cryoablation of the pulmonary artery orifice.Materials and methods: The study enrolled 53 patients with AF (mean age 56 years. Twenty eight of them had AF without any associated cardiovascular disorders (lone AF, or LAF group, 25 patients had AF related to EH (AF + EH group. Three patients had undergone anti-arrhythmic intervention. Cardiac MRI was performed in all patients with high resolution late gadolinium enhancement (LGE at 15–20 min after i.v. gadoversetamide (0.15 mmol/kg. For LGE MRI, we used a novel high resolution inversion recovery (inversion times 290–340 ms magnetic resonance pulse sequence with isotropic voxel (size 1.25 . 1.25 .2.5 mm and fat saturation. Left atrium walls were segmented semi-automatically on the LGE images. Left atrium fibrosis quantification was performed with the original software LGE Heart Analyzer, developed in Russian Cardiology Research and Production Complex (Moscow.Results: Left atrium fibrosis (mean, 9 [1.7; 18] % was found both in patients with AF + EH and with lone AF. There was a trend towards more significant left atrial fibrosis in the group of AF + EH, compared to that in the lone AF group (10.972 [6.98; 19.366] % vs 4.37 [0.893; 18.575] %, respectively, p = 0.1. The extent of left atrium fibrosis correlated with left atrium dilatation (r = 0.37, p < 0.001 and with the decreased ejection fraction (r = -0.4, р < 0.001. The patients who had undergone an antiarrhythmic intervention, demonstrated formation of intensive LGE zones in the ablation areas.Conclusion: Quantification of

  16. LEFT-VENTRICULAR BEAT-TO-BEAT PERFORMANCE IN ATRIAL-FIBRILLATION - CONTRIBUTION OF FRANK-STARLING MECHANISM AFTER SHORT RATHER THAN LONG RR INTERVALS

    NARCIS (Netherlands)

    GOSSELINK, ATM; BLANKSMA, PK; CRIJNS, HJGM; VANGELDER, IC; DEKAM, PJ; HILLEGE, HL; NIEMEIJER, MG; LIE, KI; MEIJLER, FL

    1995-01-01

    Objectives. This study sought to evaluate control mechanisms of the varying left ventricular performance in atrial fibrillation. Background. Atrial fibrillation is characterized by a randomly irregular ventricular response, resulting in continuous variation in left ventricular beat-to-beat

  17. Left ventricular beat-to-beat performance in atrial fibrillation: Contribution of Frank-Starling mechanism after short rather than long intervals

    NARCIS (Netherlands)

    Gosselink, A.T.M.; Blanksma, P.K.; Crijns, H.J.G.M.; Gelder, I.C. van; Kam, P.J. de; Hillege, H.L.; Niemeijer, M.G.; Lie, K.I.; Meijler, F.L.

    1995-01-01

    This study sought to evaluate control mechanisms of the varying left ventricular performance in atrial fibrillation. Atrial fibrillation is characterized by a randomly irregular ventricular response, resulting in continuous variation in left ventricular beat-to-beat mechanical behavior and

  18. Brain Abscess Associated with Isolated Left Superior Vena Cava Draining into the Left Atrium in the Absence of Coronary Sinus and Atrial Septal Defect

    International Nuclear Information System (INIS)

    Erol, Ilknur; Cetin, I. Ilker; Alehan, Fuesun; Varan, Birguel; Ozkan, Sueleyman; Agildere, A. Muhtesem; Tokel, Kursad

    2006-01-01

    A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported

  19. Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Syuichi Tetsuka

    2015-01-01

    Full Text Available A 21-year-old woman developed left hemiparesis during work and was hospitalized. Her National Institutes of Health Stroke Scale score was 4. Hyperintense areas in the left basal ganglia, corona radiata, and cortex of the temporal lobe were found by brain diffusion-weighted magnetic resonance imaging, indicating acute cerebral infarction. Echocardiography showed a giant mass of diameter 7 × 4 cm in the left atrium. Therefore, she was diagnosed with cerebral embolism due to a left atrial myxoma. Currently, thrombolytic therapy may continue to be effective because the embolic source may be composed of tumor tissue itself. In case of atrial myxoma, we considered that the use of tPA as emergency treatment in all patients with infarction by atrial myxoma may be questioned. Thus, cardiac tumor extraction was performed the next day after hospitalization without thrombolytic therapy. The excised myxoma measured 7 × 6 × 4 cm. The patient recovered and her neurological symptoms also improved. Furthermore, her National Institutes of Health Stroke Scale score improved to 0. Thirteen days after admission, the patient was discharged from our hospital. Cardiac myxoma is often associated with a high risk of embolic episodes, which emphasizes the need for prompt surgical excision as soon as the diagnosis is confirmed.

  20. Right and Left Ventricular Volumes in Atrial Septal Defect Studied by Radiocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Ivancevic, D. [Radioisotope Department, Internal Clinic, Rebro, Zagreb, Yugoslavia (Croatia); Vernejoul, P. de; Kellershohn, C. [CEA, Service Hospitalier Frederic Joliot, Departement de Biologie, Orsay (France)

    1971-02-15

    Radiocardiography with radioiodinated ({sup 131}I) human serum albumin and barium ({sup 137m}Ba) solution injected into the right subclavian vein has been performed in a group of 43 patients with atrial septal defect and left-to-right shunt. Data on the output and ejection index of each ventricle are essential for the estimation of the diastolic and residual volumes of the right and left ventricle. The systemic flow was therefore calculated according to Veall's formula and the pulmonary flow and the shunt How were determined using the method of de Vernejoul and co-workers. The formulas for the calculation of ventricular volumes were modified. The results show that many cases of atrial septal defect have an enlarged right ventricle whereas the left ventricle remains normal or is diminished. These changes correlate well with the amount of the shunt flow. In both ventricles the ventricular volumes show a good correlation with the stroke volumes. For the regulation of the pulmonary blood volume the right ventricle seems to be more important than the left ventricle. The operative closure of atrial septal defect (in 14 patients) has normalized the size of ventricular volumes. (author)

  1. Small atrial septal defect associated with heart failure in an infant with a marginal left ventricle

    Directory of Open Access Journals (Sweden)

    Sandra D.K. Kingma

    2012-07-01

    Full Text Available Atrial septal defect (ASD is usually asymptomatic in infancy, unless pulmonary hypertension or severe co-morbidity is present. We report a case of a 4-week-old infant with moderate- sized ASD, small patent ductus arteriosus (PDA, and a borderline sized left ventricle that developed heart failure. Despite the relatively small diameter of the ASD, this defect influenced the mechanism of heart failure significantly. After surgical closure of both PDA and ASD, the signs of pulmonary hypertension resolved and the patient developed a normal sized left ventricle. This report illustrates that the presence of a small ASD in combination with a marginal left ventricle may result in inadequate left ventricular filling, pulmonary hypertension and heart failure.

  2. A Case of Atrial Tachycardia Circulating around a Left Atrial Roof Scar with Diabetes Mellitus and Renal Failure on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Naoko Hijioka

    2016-01-01

    Full Text Available Introduction. Little is known about the effects of volume change by hemodialysis (HD and mechanical stress caused by an anatomical structure being in contact with the left atrium on the progression of atrial remodeling. We experienced a case of atrial tachycardia (AT in a patient who had left atrial (LA scarring at the LA roof and a low-voltage area with slow conduction around the LA scar as components of AT circuit. Here, we present the conceivable hypothesis of the LA scar and the low-voltage area formation. Our concept can be useful in developing a strategy for ablation in a patient with chronic renal failure (CRF on HD. Case Report. A 65-year-old man with CRF on HD was referred for AT ablation. Three-dimensional electroanatomical mapping revealed that the AT conducted around an LA scar in a counterclockwise fashion. There was a slow conduction area at the superior side of the LA scar, where the AT was terminated during the ablation. Computed tomography indicated a close relationship between the LA and the anatomical structures (ascending aorta and pulmonary artery. Conclusion. Volume change by HD and close contact of anatomical structures to the LA can promote atrial remodeling, resulting in AT occurrence.

  3. Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency-catheter ablation: Comparison of a manual and automated 3D volume segmentation method

    International Nuclear Information System (INIS)

    Wolf, Florian; Ourednicek, Petr; Loewe, Christian; Richter, Bernhard; Goessinger, Heinz David; Gwechenberger, Marianne; Plank, Christina; Schernthaner, Ruediger Egbert; Toepker, Michael; Lammer, Johannes; Feuchtner, Gudrun M.

    2010-01-01

    Introduction: The purpose of this study was to compare a manual and automated 3D volume segmentation tool for evaluation of left atrial (LA) function by 64-slice multidetector-CT (MDCT). Methods and materials: In 33 patients with paroxysmal atrial fibrillation a MDCT scan was performed before radiofrequency-catheter ablation. Atrial function (minimal volume (LAmin), maximal volume (LAmax), stroke volume (SV), ejection fraction (EF)) was evaluated by two readers using a manual and an automatic tool and measurement time was evaluated. Results: Automated LA volume segmentation failed in one patient due to low LA enhancement (103HU). Mean LAmax, LAmin, SV and EF were 127.7 ml, 93 ml, 34.7 ml, 27.1% by the automated, and 122.7 ml, 89.9 ml, 32.8 ml, 26.3% by the manual method with no significant difference (p > 0.05) and high Pearsons correlation coefficients (r = 0.94, r = 0.94, r = 0.82 and r = 0.85, p < 0.0001), respectively. The automated method was significantly faster (p < 0.001). Interobserver variability was low for both methods with Pearson's correlation coefficients between 0.98 and 0.99 (p < 0.0001). Conclusions: Evaluation of LA volume and function with 64-slice MDCT is feasible with a very low interobserver variability. The automatic method is as accurate as the manual method but significantly less time consuming permitting a routine use in clinical practice before RF-catheter ablation.

  4. The clot thickens: an incompletely ligated left  atrial appendage

    Directory of Open Access Journals (Sweden)

    Merrill Thomas

    2018-05-01

    Full Text Available Our patient presented with known mechanical mitral valve endocarditis documented by 2D transesophageal echocardiogram (TOE from a recent hospitalization at an outside facility. On admission to our center, there was no prior knowledge of an incompletely ligated left atrial appendage (LAA according to patient- or family-reported history, review of outside records or the outside facility’s 2D TOE report. A 3D TOE performed at our center to assess her pathology, since a month had passed from her prior hospitalization, revealed a LAA ligation with evidence of communication to the left atrium and with clot present in the appendage. This case report highlights the common finding of incomplete closure of the LAA following surgical ligation, thus making it inadequate for stroke prevention in patients with atrial fibrillation, and that 3D TOE plays a valuable role in assessing the durability of LAA ligation.

  5. Rotational Angiography Based Three-Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture.

    Science.gov (United States)

    Koektuerk, Buelent; Yorgun, Hikmet; Koektuerk, Oezlem; Turan, Cem H; Gorr, Eduard; Horlitz, Marc; Turan, Ramazan G

    2016-02-01

    Rotational angiography is a well-known method for the three-dimensional (3-D) reconstruction of left atrium and pulmonary veins during left-sided atrial arrhythmia ablation procedures. In our study, we aimed to review our experience in transseptal puncture (TSP) using 3-D rotational angiography. We included a total of 271 patients who underwent atrial fibrillation ablation using cryoballoon. Rotational angiography was performed to get the three-dimensional left atrial and pulmonary vein reconstructions using cardiac C-arm computed tomography. The image reconstruction was made using the DynaCT Cardiac software (Siemens, Erlangen, Germany). The mean age of the study population was 61 ± 10 years. The indications for left atrial arrhythmia ablation were paroxysmal AF in 140 patients (52%) and persistent AF patients in 131 (48%) patients. The success rate of TSP using only rotational guidance was (264/271 patients, 97.4%). In the remaining seven patients, transesophageal guidance was used after the initial attempt due to thick interatrial septum in five patients and difficult TSP due to abnormal anatomy and mild pericardial effusion in the remaining two patients. Mean fluoroscopy dosage of the rotational angiography was 4896.4 ± 825.3 μGym(2). The mean time beginning from femoral vein puncture to TSP was 12.3 ± 5.5 min. TSP guided by rotational angiography is a safe and effective method. Our results indicate that integration of rotational angiographic images into the real-time fluoroscopy can guide the TSP during the procedure. © 2015 John Wiley & Sons Ltd.

  6. Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus

    Directory of Open Access Journals (Sweden)

    Preetham R Muskula

    2017-04-01

    Full Text Available An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4. Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7. The patient underwent resection of the massive left atrial thrombus (Fig. 2D but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2. This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement.

  7. Comparison of biatrial and left atrial radiofrequency ablation in patients with heart valves diseases

    Directory of Open Access Journals (Sweden)

    А. В. Богачев-прокофьев

    2015-10-01

    Full Text Available We analysed results of left atrial and biatrial anatomic scheme of radiofrequency (RF ablation of the atria in patients with valvular heart. From 2007 to 2011, RF ablation procedure performed 283 patients with atrial fibrillation and heart valve disease. Patients were divided into two groups - group I performed a complete circuit biatrial procedure (procedure maze IV - 131 patients, in group II only ablation of the left atrium -152 patients. Most of the patients had long-term persistent AF. The main problem of early postoperative period is dysfunction of pacemaker complex, which observed in 64.9% and 50.7% patients for group I and II, respectively (p = 0.031. Permanent dysfunction of pacemaker complex required implantation of permanent pacemaker (9.2% and 4.6% of cases for group I and II, respectively, p = 0,023. Predictors of dysfunction of the pacemaker complex were biatrial execution method and duration of AF. Freedom from AF and AT during 36 months after surgery was 80.4% for patients in group I and 78.5% for patients in group II, with no statistically significant difference (log-rank test, p = 0.621. Atrial transport function has not revealed that the active fraction of the right atrium was 29.8% higher than in group II in the early postoperative phase and by 17.9% in the long term, with no difference between groups for the left atrium has been received.

  8. Impact of congestive heart failure and left ventricular systolic function on the prognostic significance of atrial fibrillation and atrial flutter following acute myocardial infarction

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Bagger, Henning; Køber, Lars

    2005-01-01

    fibrillation in acute myocardial infarction patients that might explain previous discrepancies. METHODS: The study population was 6676 patients consecutively admitted to hospital with acute myocardial infarction. Information on the presence of atrial fibrillation/flutter, left ventricular systolic function......BACKGROUND: Reports on the prognostic importance of atrial fibrillation following myocardial infarction have provided considerable variation in results. Thus, this study examined the impact of left ventricular systolic function and congestive heart failure on the prognostic importance of atrial...... and congestive heart failure were prospectively collected. Mortality was followed for 5 years. RESULTS: In patients with left ventricular ejection fraction

  9. Long-term survival of quiescent left atrial myxoma in an elderly patient.

    Science.gov (United States)

    Kay, Jay F L; Chow, Wing Hing

    2002-01-01

    Left atrial myxoma, if left untreated, is inexorably progressive and usually fatal. The classical management of this disease is prompt surgical removal. However, there may be exceptions to this traditional dogma. The authors report an 85-year-old man who presented with features of chronic obstructive airway disease and congestive heart failure 15 years previously. Auscultation of the heart showed a pansystolic murmur. Two-dimensional echocardiography revealed a nonobstructive, calcified, and well circumscribed mass in the left atrium, with a pedicle attached to the interatrial septum. Because the patient refused high-risk cardiac surgery related to his comorbidity, he was managed medically with a bronchodilator, diuretics, and digoxin. There have been no features of embolism or intracardiac obstruction, and serial echocardiography demonstrates no disease progression over this long period of time. This case illustrates that calcified left atrial myxoma may exhibit a quiescent phase. Tumor calcification, slow growth potential, and the absence of intracardiac obstruction may correlate with a better outcome in the elderly patient. (c)2002 CVRR, Inc.

  10. Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry.

    Science.gov (United States)

    Leung, Melissa; van Rosendael, Philippe J; Abou, Rachid; Ajmone Marsan, Nina; Leung, Dominic Y; Delgado, Victoria; Bax, Jeroen J

    2018-04-21

    Atrial fibrillation (AF) is an independent risk factor for ischaemic stroke. The CHA2DS2-VASc is the most widely used risk stratification model; however, echocardiographic refinement may be useful, particularly in low risk AF patients. The present study examined the association between advanced echocardiographic parameters and ischaemic stroke, independent of CHA2DS2-VASc score. One thousand, three hundred and sixty-one patients (mean age 65±12 years, 74% males) with first diagnosis of AF and baseline transthoracic echocardiogram were followed by chart review for the occurrence of stroke over a mean of 7.9 years. Left atrial (LA) volumes, LA reservoir strain, P-wave to A' duration on tissue Doppler imaging (PA-TDI, reflecting total atrial conduction time), and left ventricular (LV) global longitudinal strain (GLS) were evaluated in patients with and without stroke. The independent association of these echocardiographic parameters with the occurrence of ischaemic stroke was evaluated with Cox proportional hazard models. One-hundred patients (7%) developed an ischaemic stroke, representing an annualized stroke rate of 0.9%. The incident stroke rate in the year following the first diagnosis of AF was 2.6% in the entire population and higher than the remainder of the follow-up period. Left atrial reservoir (14.5% vs. 18.9%, P = 0.005) and conduit strains were reduced (10.5% vs. 13.5%, P = 0.013), and PA-TDI lengthened (166 ms vs. 141 ms, P Left atrial reservoir strain and PA-TDI were independently associated with risk of stroke in a model including CHA2DS2-VASc score, age, and anticoagulant use. The assessment of LA reservoir strain and PA-TDI on echocardiography after initial CHA2DS2-VASc scoring provides additional risk stratification for stroke and may be useful to guide decisions regarding anticoagulation for patients upon first diagnosis of AF.

  11. In-treatment reduced left atrial diameter during antihypertensive treatment is associated with reduced new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy: The LIFE Study

    DEFF Research Database (Denmark)

    Wachtell, Kristian; Gerdts, Eva; Aurigemma, Gerard P

    2010-01-01

    It is unclear whether improvement of left atrial (LA) and ventricular (LV) structure results in reduction in new-onset atrial fibrillation (AF). The aim of the present study was to examine whether changes in-treatment LA diameter were related to changes in risk of new-onset AF....

  12. Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Jing; Yang, Zhi-Gang; Xu, Hua-Yan; Shi, Ke; Long, Qi-Hua [Sichuan University, Department of Radiology, West China Hospital, Chengdu, Sichuan (China); Guo, Ying-Kun [Sichuan University, Department of Radiology, West China Second University Hospital, Chengdu (China)

    2017-02-15

    To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT. Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed. In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293). PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy. (orig.)

  13. Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT

    International Nuclear Information System (INIS)

    Chen, Jing; Yang, Zhi-Gang; Xu, Hua-Yan; Shi, Ke; Long, Qi-Hua; Guo, Ying-Kun

    2017-01-01

    To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT. Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed. In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293). PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy. (orig.)

  14. The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction.

    Science.gov (United States)

    Beltrami, Matteo; Palazzuoli, Alberto; Padeletti, Luigi; Cerbai, Elisabetta; Coiro, Stefano; Emdin, Michele; Marcucci, Rossella; Morrone, Doralisa; Cameli, Matteo; Savino, Ketty; Pedrinelli, Roberto; Ambrosio, Giuseppe

    2018-02-01

    Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools. The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed. In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk. Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies. © 2017 John Wiley & Sons Ltd.

  15. Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency-catheter ablation: Comparison of a manual and automated 3D volume segmentation method

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, Florian, E-mail: florian.wolf@meduniwien.ac.a [Department of Radiology, Medical University of Vienna, Vienna (Austria); Ourednicek, Petr [Philips Medical Systems, Prague (Czech Republic); Loewe, Christian [Department of Radiology, Medical University of Vienna, Vienna (Austria); Richter, Bernhard; Goessinger, Heinz David; Gwechenberger, Marianne [Department of Cardiology, Medical University of Vienna, Vienna (Austria); Plank, Christina; Schernthaner, Ruediger Egbert; Toepker, Michael; Lammer, Johannes [Department of Radiology, Medical University of Vienna, Vienna (Austria); Feuchtner, Gudrun M. [Department of Radiology, Innsbruck Medical University, Innsbruck (Austria); Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland)

    2010-08-15

    Introduction: The purpose of this study was to compare a manual and automated 3D volume segmentation tool for evaluation of left atrial (LA) function by 64-slice multidetector-CT (MDCT). Methods and materials: In 33 patients with paroxysmal atrial fibrillation a MDCT scan was performed before radiofrequency-catheter ablation. Atrial function (minimal volume (LAmin), maximal volume (LAmax), stroke volume (SV), ejection fraction (EF)) was evaluated by two readers using a manual and an automatic tool and measurement time was evaluated. Results: Automated LA volume segmentation failed in one patient due to low LA enhancement (103HU). Mean LAmax, LAmin, SV and EF were 127.7 ml, 93 ml, 34.7 ml, 27.1% by the automated, and 122.7 ml, 89.9 ml, 32.8 ml, 26.3% by the manual method with no significant difference (p > 0.05) and high Pearsons correlation coefficients (r = 0.94, r = 0.94, r = 0.82 and r = 0.85, p < 0.0001), respectively. The automated method was significantly faster (p < 0.001). Interobserver variability was low for both methods with Pearson's correlation coefficients between 0.98 and 0.99 (p < 0.0001). Conclusions: Evaluation of LA volume and function with 64-slice MDCT is feasible with a very low interobserver variability. The automatic method is as accurate as the manual method but significantly less time consuming permitting a routine use in clinical practice before RF-catheter ablation.

  16. Left atrial leiomyosarcoma as cause of heart failure; Leiomiosarcoma atrial izquierdo como causa de insuficiencia cardiaca

    Energy Technology Data Exchange (ETDEWEB)

    Valdes Martin, Alexander [Instituto de Cardiologia y Cirugia Cardiovascular, La Habana (Cuba)

    2012-07-01

    The case of a 26 year-old patient with diagnosis of heart failure and presence of a mobile echogenic mass without calcification attached to the posterolateral area of the left atrium was reported. She underwent surgery and tissue examination evidenced a high-grade heart leiomyosarcoma. Postoperative course was satisfactory and her clinical state was rigorously monitored by oncology and heart specialists in the institution.

  17. Beat-to-beat left ventricular performance in atrial fibrillation: radionuclide assessment with the computerized nuclear probe

    International Nuclear Information System (INIS)

    Schneider, J.; Berger, H.J.; Sands, M.J.; Lachman, A.B.; Zaret, B.L.

    1983-01-01

    There is wide beat-to-beat variability in cycle length and left ventricular performance in patients with atrial fibrillation. In this study, left ventricular ejection fraction and relative left ventricular volumes were evaluated on a beat-to-beat basis with the computerized nuclear probe, an instrument with sufficiently high sensitivity to allow continuous evaluation of the radionuclide time-activity curve. Of 18 patients with atrial fibrillation, 5 had mitral stenosis, 6 had mitral regurgitation, and 7 had coronary artery disease. Fifty consecutive beats were analyzed in each patient. The mean left ventricular ejection fraction ranged from 17 to 51%. There was substantial beat-to-beat variation in cycle length and left ventricular ejection fraction in all patients, including those with marked left ventricular dysfunction. In 14 patients who also underwent multiple gated cardiac blood pool imaging, there was an excellent correlation between mean ejection fraction derived from the nuclear probe and gated ejection fraction obtained by gamma camera imaging (r . 0.90). Based on beat-to-beat analysis, left ventricular function was dependent on relative end-diastolic volume and multiple preceding cycle lengths, but not preceding end-systolic volumes. This study demonstrates that a single value for left ventricular ejection fraction does not adequately characterize left ventricular function in patients with atrial fibrillation. Furthermore, both the mean beat-to-beat and the gated ejection fraction may underestimate left ventricular performance at rest in such patients

  18. [Comparison of ablation of left-sided accessory pathway by atrial septal and retrograde arterial approach].

    Science.gov (United States)

    Zhu, J G; Bao, Z Y; Gu, X

    2017-03-07

    Objective: To compare the advantages and disadvantages of radiofrequency ablation of left-sided accessory pathways by via atrial septal approach with retrograde through aortic approach. Methods: A total of 184 patients of left-side accessory pathways were treated in Taizhou People's Hospital and the Subei People's Hospital from March 2012 to August 2015.A total of 103 cases were treated by aortic retrograde approach as through arterial group, 81 cases were treated by punctured atrial septal to left atrial for mapping and ablation as through atrial septal group.Comparison of ablation procedure time, total and pathways of different parts(subgroup) at instant success and relapse rates, safety (serious complications), and statistics other complications in operation and postoperative. Results: Through arterial group and through atrial septal group were no significant difference ( P >0.05) in the ablation procedure time((25±18 ) vs (22±15)min ), instant success(98.1% vs 97.5%) and relapse rates(1.0% vs 1.2%), security(1 vs 0 case). There was no statistical difference in septal part subgroups (all P >0.05) in the ablation procedure time((22±18)vs (25±19)min), instant success(91.7% vs 89.9 %) and relapse rates(0 vs 11.1%); posterior wall subgroup had no statistical difference in the ablation procedure time((18±15)vs (16±12)min), instant success(100% vs 100 %) and relapse rates(0 vs 0)(all P >0.05); side wall subgroup had no statistical difference in the ablation procedure time((29±20)vs (21±18) min), instant success (98.3% vs 98.1%)and relapse rates(1.7% vs 0%)(all P >0.05). Conclusion: Ablation of left-sided accessory pathways by transseptal approach and transaortic approach has no statistical difference in the procedure time, instant success and relapse rates, security.In a particular case, there is a certain complementarity between the two methods.

  19. Use of computed tomography to identify atrial fibrillation associated differences in left atrial wall thickness and density.

    Science.gov (United States)

    Dewland, Thomas A; Wintermark, Max; Vaysman, Anna; Smith, Lisa M; Tong, Elizabeth; Vittinghoff, Eric; Marcus, Gregory M

    2013-01-01

    Left atrial (LA) tissue characteristics may play an important role in atrial fibrillation (AF) induction and perpetuation. Although frequently used in clinical practice, computed tomography (CT) has not been employed to describe differences in LA wall properties between AF patients and controls. We sought to noninvasively characterize AF-associated differences in LA tissue using CT. CT images of the LA were obtained in 98 consecutive patients undergoing AF ablation and in 89 controls. A custom software algorithm was used to measure wall thickness and density in four prespecified regions of the LA. On average, LA walls were thinner (-15.5%, 95% confidence interval [CI] -23.2 to -7.8%, P identified significant thinning of the LA wall and regional alterations in tissue density in patients with a history of AF. These findings suggest differences in LA tissue composition can be noninvasively identified and quantified using CT. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  20. Left atrial appendage thrombus with resulting stroke post-RF ablation for atrial fibrillation in a patient on dabigatran.

    LENUS (Irish Health Repository)

    Lobo, R

    2015-11-01

    Dabigatran etexilate is licensed for use in prevention of deep venous thromboembolism and in prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). It has also been used in patients for other indications as a substitute for warfarin therapy because it requires no monitoring; one group being patients undergoing radiofrequency (RF), ablation for AF, although there have been no consensus guidelines with regards to dosage and timing of dose. We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation.

  1. Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, University Medical Center Utrecht (Netherlands); Vliegenthart, Rozemarijn [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); University of Groningen/University Medical Center Groningen, Center for Medical Imaging − North East Netherlands, Department of Radiology, Groningen (Netherlands); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Nance, John W. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Bamberg, Fabian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen (Germany); Abro, Joseph A. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Carr, Christine M. [Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Litwin, Sheldon E. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); and others

    2017-01-15

    Highlights: • LV mass and LA diameter are independent prognostic factor for composite MACE. • LV mass and LA diameter were not significant prognostic factors for MACE in African Americans. • Assessment of LV mass by CT may have a role in the management of patients. - Abstract: Purpose: To determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures. Materials and methods: This retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis. Results: 225 subjects (age, 56.2 ± 11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01–1.13 per mm) and LV mass (HR:1.05, 95%CI:1.00–1.10 per g) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE. Conclusion: CT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and

  2. Cost-effectiveness analysis of left atrial appendage occlusion compared with pharmacological strategies for stroke prevention in atrial fibrillation.

    Science.gov (United States)

    Lee, Vivian Wing-Yan; Tsai, Ronald Bing-Ching; Chow, Ines Hang-Iao; Yan, Bryan Ping-Yen; Kaya, Mehmet Gungor; Park, Jai-Wun; Lam, Yat-Yin

    2016-08-31

    Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF. A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban. Outcome measures included quality-adjusted life years (QALYs), lifetime costs and incremental cost-effectiveness ratios (ICERs). Base-case data were derived from ACTIVE, RE-LY, ARISTOTLE, ROCKET-AF, PROTECT-AF and PREVAIL trials. One-way sensitivity analysis varied by CHADS2 score, HAS-BLED score, time horizons, and LAAO costs; and probabilistic sensitivity analysis using 10,000 Monte Carlo simulations was conducted to assess parameter uncertainty. LAAO was considered cost-effective compared with aspirin, clopidogrel plus aspirin, and warfarin, with ICER of US$5,115, $2,447, and $6,298 per QALY gained, respectively. LAAO was dominant (i.e. less costly but more effective) compared to other strategies. Sensitivity analysis demonstrated favorable ICERs of LAAO against other strategies in varied CHADS2 score, HAS-BLED score, time horizons (5 to 15 years) and LAAO costs. LAAO was cost-effective in 86.24 % of 10,000 simulations using a threshold of US$50,000/QALY. Transcatheter LAAO is cost-effective for prevention of stroke in NVAF compared with 7 pharmacological strategies. The transcatheter left atrial appendage occlusion (LAAO) is considered cost-effective against the standard 7 oral pharmacological strategies including acetylsalicylic acid (ASA) alone, clopidogrel plus ASA, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban for stroke prophylaxis in non-valvular atrial fibrillation management.

  3. Left atrial appendage closure: Six reasons why I wouldn't choose a percutaneous closure for my appendage.

    Science.gov (United States)

    Ferlini, Marco; Rossini, Roberta

    2018-01-15

    Left atrial appendage has been shown as a primary source of thrombi in patients with non-valvular atrial fibrillation (AF). Non vitamin k oral anticoagulants (NOAC) have been shown to be safe and effective in the prevention of embolic complications. Current guidelines on AF state that percutaneous left atrial appendage closure (LAAC) might be considered in patients with contraindication to long term oral anticoagulant therapy (OAC). An overview of the main trials on NOAC and LAAC is provided. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. LEFT ATRIAL APPENDAGE CLOSURE AS AN ALTERNATIVE TO WARFARIN FOR STROKE PREVENTION IN ATRIAL FIBRILLATION: A PATIENT¬LEVEL META¬ANALYSIS

    Directory of Open Access Journals (Sweden)

    2015-01-01

    Full Text Available Holmes D.R. Jr, Doshi S.K., Kar S., et al. Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient­Level Meta­Analysis // J. Am. Coll. Cardiol. – 2015. – Vol. 65. – P. 2614–2623.

  5. Left ventricular outflow tract to left atrial communication secondary to rupture of mitral-aortic intervalvular fibrosa in infective endocarditis: diagnosis by transesophageal echocardiography and color flow imaging.

    Science.gov (United States)

    Bansal, R C; Graham, B M; Jutzy, K R; Shakudo, M; Shah, P M

    1990-02-01

    Infection of the mitral-aortic intervalvular fibrosa occurs most commonly in association with infective endocarditis of the aortic valve. Infection of the aortic valve results in a regurgitant jet that presumably strikes this subaortic interannular zone of fibrous tissue and produces a secondary site of infection. Infection of this interannular zone then leads to the formation of subaortic abscess or pseudoaneurysm of the left ventricular outflow tract. This infected zone of mitral-aortic intervalvular fibrosa or subaortic aneurysm can subsequently rupture into the left atrium with systolic ejection of blood from the left ventricular outflow tract to the left atrium. This report describes the echocardiographic findings in three patients with pathologically proved left ventricular outflow tract to left atrial communication. Precise preoperative diagnosis is important, and this lesion should be differentiated from ruptured aneurysm of the sinus of Valsalva and perforation of the anterior mitral leaflet. Transthoracic echocardiography using color flow imaging and conventional Doppler techniques may show an eccentric mitral regurgitation type of signal in the left atrium originating from the region of the left ventricular outflow tract. However, transesophageal echocardiography provides an accurate preoperative diagnosis and should be used intraoperatively during repair of such lesions.

  6. Left atrial appendage myxofibrosarcoma: A rare masquerader of myxoma and thrombus-"all that glitters is not gold".

    Science.gov (United States)

    Khan, Muhammad Shoaib; Reddy, Sahadev; Lombardi, Richard; Isabel, Pitti; Mcgregor, Walter E; Tang, Bang; Gabriel, George; Biederman, Robert W

    2018-02-01

    Left atrial appendage mass can occasionally pose a serious challenge to physicians to identify the nature of the mass with the aid of imaging techniques. We present a case of 67-year-old man, who was evaluated for suspected left atria myxoma. Transesophageal echocardiography revealed a heterogeneous density originating from left atrial appendage, thought to be most consistent with a myxoma. Cardiac magnetic resonance imaging, uncharacteristically, gave an equivocal picture, suggesting the mass to be a myxoma on initial imaging and a thrombus with evidence of liquefaction necrosis following postcontrast enhancement. Surprisingly, histopathology of the mass following its surgical excision yielded a rare diagnosis of myxofibrosarcoma. © 2017, Wiley Periodicals, Inc.

  7. Clinical study on left atrial thrombi. Comparative study between echocardiography and CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Shimada, E; Asano, H; Kurasawa, T; Mitsumoto, K; Yamane, Y [Tokyo Kosei-Nenkin Hospital (Japan)

    1981-09-01

    We studied left atrial thrombi (LAT) by both echocardiography and computed tomography (CT) and compared the features of the 2 methods. A total of 15 patients with mitral stenosis complicated by atrial fibrillation were selected as the subjects. LAT were noted on the M-mode echocardiograms in 2 patients including a questionably positive one, on the two-dimensional echocardiograms in 5, and on the CT scans in 6 of 15. The history of thromboembolism was rather frequent and was found in 7 of 15 patients. However, LAT was found in only 3 of these on the CT scans. A shaggy or fuzzy pattern on the M-mode echocardiogram cannot be regarded as representing thrombi, while a laminar pattern undoubtedly represented thrombi. Two-dimensional echocardiography has considerably contributed to the improved detection rate of LAT. For the characteristic properties of ultrasound beams, however, it was impossible to investigate the entire left atrium. The detection of the thrombi in the appendage was especially difficult. However, computed tomography, permitting transverse cross-sectional tomography, was capable of sectioning the heart even in the presence of air and bones. The measurement of CT values was suggestive of the properties of the substance or substances involved, and also allowed the presumption as to whether the thrombus has been fibrosed. Furthermore, it was possible to estimate more accurately as well as 3-dimensionally the location, shape and dimensions of the thrombi by the reconstruction of the heart according to the CT values. It was concluded that echocardiography and computed tomography are the mutual aid to further improvement in the detection rate of left atrial thrombi.

  8. Outcomes following the Kawashima procedure for single-ventricle palliation in left atrial isomerism.

    Science.gov (United States)

    Vollebregt, Anne; Pushparajah, Kuberan; Rizvi, Maleeha; Hoschtitzky, Andreas; Anderson, David; Austin, Conal; Tibby, Shane M; Simpson, John

    2012-03-01

    Patients with left atrial isomerism and interrupted inferior vena cava palliated with a superior cavopulmonary connection or Kawashima procedure (KP) have a high incidence of developing pulmonary arteriovenous malformations. The necessity for hepatic vein redirection (HVR) and its timing remains a controversy. We aimed to assess the clinical outcome of patients with left atrial isomerism following a KP. The main end points were death, requirement for HVR and the impact of HVR on oxygen saturation. Retrospective review of 21 patients with a diagnosis of left atrial isomerism, interruption of the inferior vena cava and single-ventricle physiology managed with a KP at a single centre between January 1990 and March 2010. Twenty-one patients had a KP, with 12 subsequently undergoing HVR. There was relatively a constant monthly decrement in the proportion of patients who were free from death or HVR up until 60 months following the KP, with a dramatic increase in the hazard after this time. The Cox proportional hazards regression model demonstrated a reduced early risk for HVR or death in patients who underwent pulmonary artery banding versus arterial shunt as the primary procedure (hazard ratio: 0.10; P = 0.01), and an increased risk with bilateral superior vena cavas (SVCs) (hazard ratio: 3.4; P = 0.04) and age at KP (hazard ratio: 1.02 per month increase in age at KP; P = 0.02). HVR mortality was relatively high with 3 of 12 patients dying in the early postoperative period with profound cyanosis. The timing of HVR after the KP did not influence the postoperative rate of increase in oxygen saturation. These findings confirm that the majority of patients who undergo a KP will require HVR. Patients who are older at the time of the KP or having an initial arterial shunt or bilateral SVCs are at higher risk of HVR or death. The relatively high mortality at HVR was characterized by severe postoperative cyanosis.

  9. Infective Endocarditis of the Left Main to Right Atrial Coronary Cameral Fistula

    Science.gov (United States)

    Mishra, Ramesh Chandra; Barik, Ramachandra; Patnaik, Amar Narayana

    2016-01-01

    A 7-year-old female child presented with pyrexia of unknown origin. She had received an empirical regimen of antibiotic for possible endocarditis. Evaluation included multiple imaging supports and blood culture. She had left main coronary artery to right atrium coronary cameral fistula, restricted patent ductus arteriosus, vegetation at the right atrial exit of fistula and negative blood culture. Ongoing fever more than 2 weeks, oscillating vegetation in the echo and histopathological evidence of healing vegetation suggested definite diagnosis of infective endocarditis. She was treated successfully by surgical closure of fistula from the right atrial approach. Device closure in this case would have resulted in a large residual cul-de-sac with or without tiny residual high-velocity jets, either being a threat for future enlargement, rupture of the residual aneurysmal sac, thromboembolism, prolonged anticoagulation, and infective endocarditis. PMID:28465978

  10. Left atrial mass 16 years after radiation therapy for mediastinal neuroblastoma

    International Nuclear Information System (INIS)

    Ensing, G.J.; Driscoll, D.J.; Smithson, W.A.

    1987-01-01

    Tumors involving the heart during childhood are rare. However, neuroblastoma, a common pediatric malignancy, has been described to involve the cardiovascular system in 3%-12% of patients dying with this tumor. Rarely is such involvement diagnosed ante mortem and never, to our knowledge, has a benign cardiac tumor been reported to present in childhood after successful eradication of neuroblastoma. We describe the identification and surgical resection of a nodular, hypertrophied, calcified, pedunculated left atrial mass in a 16-year-old boy who was complaining of exercise-associated presyncope and headaches 16 years after irradiation and chemotherapy for mediastinal neuroblastoma

  11. Case Report of a Left Atrial Myxoma Associated with Carney%u2019s Syndrome

    Directory of Open Access Journals (Sweden)

    Anil Ozen

    2016-05-01

    Full Text Available Primary cardiac neoplasms are very rare as compared to metastatic tumors. 70% to 80% of them are benign myxomas. Complications of myxomas include cyst and microabscess formation, embolization, syncope and sudden death. Rarely, cardiac myxomas are associated with primary nodular adrenal cortical disease, mammary fibroadenomas, testicular tumors or pitiutary adenomas with gigantism or acromegaly known as Carney%u2019s syndrome. We present a patient with a left atrial myxoma who underwent reoperation associated with Carney%u2019s syndrome.

  12. Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Angela S. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); National Heart Centre Singapore, Singapore (Singapore); Murthy, Venkatesh L.; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Wu, Justina [Brigham and Women' s Hospital, Division of Cardiology, Department of Medicine, and the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Dorbala, Sharmila [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Department of Radiology and the Division of Cardiology, Noninvasive Cardiovascular Imaging Section, Boston, MA (United States)

    2015-09-15

    Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical {sup 82}Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function. (orig.)

  13. 5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials.

    Science.gov (United States)

    Reddy, Vivek Y; Doshi, Shephal K; Kar, Saibal; Gibson, Douglas N; Price, Matthew J; Huber, Kenneth; Horton, Rodney P; Buchbinder, Maurice; Neuzil, Petr; Gordon, Nicole T; Holmes, David R

    2017-12-19

    The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low. The warfarin cohort experienced an unexpectedly low ischemic stroke rate, rendering the efficacy endpoints inconclusive. However, these outcomes were based on relatively few patients followed for a relatively short time. The final results of the PREVAIL trial, both alone and as part of a patient-level meta-analysis with the PROTECT AF trial, are reported with patients in both trials followed for 5 years. PREVAIL and PROTECT AF are prospective randomized clinical trials with patients randomized 2:1 to LAAC or warfarin; together, they enrolled 1,114 patients for 4,343 patient-years. Analyses are by intention-to-treat, and rates are events per 100 patient-years. For the PREVAIL trial, the first composite coprimary endpoint of stroke, systemic embolism (SE), or cardiovascular/unexplained death did not achieve noninferiority (posterior probability for noninferiority = 88.4%), whereas the second coprimary endpoint of post-procedure ischemic stroke/SE did achieve noninferiority (posterior probability for noninferiority = 97.5%); the warfarin arm maintained an unusually low ischemic stroke rate (0.73%). In the meta-analysis, the composite endpoint was similar between groups (hazard ratio [HR]: 0.820; p = 0.27), as were all-stroke/SE (HR: 0.961; p = 0.87). The ischemic stroke/SE rate was numerically higher with LAAC, but this difference did not reach statistical significance (HR: 1.71; p = 0.080). However, differences in

  14. The incidence and characteristics of supraventricular tachycardia in left atrial isomerism: a high incidence of atrial fibrillation in young patients.

    Science.gov (United States)

    Miyazaki, Aya; Sakaguchi, Heima; Ohuchi, Hideo; Yamamoto, Tetsuya; Igarashi, Takehiro; Negishi, Jun; Toyota, Naoki; Kagisaki, Koji; Yagihara, Toshikatsu; Yamada, Osamu

    2013-06-20

    In left atrial isomerism (LAI), both atria show left atrial morphology. Although bradyarrhythmias are frequent and highly complex in LAI patients, previous studies have reported a low incidence of supraventricular tachycardia (SVT). To evaluate the incidence and characteristics of SVT in LAI, we retrospectively evaluated the clinical characteristics of SVTs in 83 patients with LAI (age at last follow-up, 15.3±10.5 years). There were 27 SVTs in 19 patients (23%), including nine episodes of atrial fibrillation (AF) and eight non-reentrant SVTs. Sixteen of the 19 patients with SVT had histories of atriotomy, but the three patients with AF or non-reentrant tachycardia had no history of atriotomy. The rates of freedom from SVT were 66% and 59% at ages of 20 and 30 years, respectively; the corresponding rates for freedom from AF were 89% and 74%. In multivariate analysis, the predictors of SVT were age (OR, 1.14; 95% CI, 1.06-1.26; p=0.003) and sinus node dysfunction (SND) (OR, 3.88; 95% CI, 1.57-13.34; p=0.01). In patients with LAI, SVTs are common, and AF and non-reentrant SVTs are the major type of SVTs. The incidence of AF was high in young patients with LAI. The lack of anatomical barriers in the atria that allow the formation of macro-reentrant circuits may account for the higher incidence of AF and non-reentrant SVT than macro-reentrant tachycardia. Moreover, the increasing prevalence of SND with age should contribute to a higher incidence of SVT. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  15. Characteristics of complex fractionated atrial electrogram in the electroanatomically remodeled left atrium of patients with atrial fibrillation

    International Nuclear Information System (INIS)

    Park, Jae-Hyung; Kim, Jong-Youn; Park, Sang-Weon

    2010-01-01

    Complex fractionated atrial electrogram (CFAE) guided ablation is effective in some patients with persistent atrial fibrillation (PeAF), but the pattern of CFAE may be different in the remodeled left atrium (LA). In 100 AF patients (83 males, 55.0±10.6 years old) with AF (51 paroxysmal AF (PAF), 49 PeAF) who underwent catheter ablation, CFAE cycle length (CL) and distribution (NavX 3D map) were compared according to the LA volume (3D-CT) and endocardial voltage (during high right atrial pacing 500-ms (Vol PACE ) and AF (Vol AF ; NavX). The mean CFAE-CL was longer (P=0.003) and the % area CFAE was smaller (P=0.006) in patients with LA ≥125 ml than those with PACE AF PACE <1.7 mV than those with ≥1.7 mV (P=0.006). The incidence of septal CFAE was consistently high, regardless of the degree of LA remodeling. In the AF patients with an electroanatomically remodeled LA, the % area of CFAE was smaller and mean CFAE-CL was longer than in those with a less remodeled LA. However, the majority of CFAE are consistently positioned on the septum in the remodeled LA. (author)

  16. Beat-to-beat assessment of left ventricular ejection in atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Benjelloun, H; Brochier, M; Itti, R; Philippe, L; Lorgeron, J M

    1983-05-01

    Beat-to-beat left ventricular ejection was evaluated in a group of 20 patients with chronic atrial fibrillation using a computerized single probe detector. The reference group consisted of 10 patients with sinus rhythm. For each patient 30 successive cardiac cycles were analyzed and the relative variations of four parameters were assessed: R-R interval, diastolic and systolic time intervals, and ejection amplitude, corresponding to the left ventricular stroke volume. The mean variations were respectively 3.4%, 10.4%, 8.4%, and 11.8% in patients with sinus rhythm, and 21.9%, 37.9%, 10.6% and 30.5% in patients with artrial fibrillation. This demonstrates that changes in ejection are mainly related to the duration of the filling phase, with nearly constant systolic times. Correlations between R-R intervals and systolic ejection amplitudes were highly significant (P<0.001) in patients with atrial fibrillation in 85% of cases. This information complements the average ejection fraction obtained from multiple cycle superimposition.

  17. Left atrial appendages from adult hearts contain a reservoir of diverse cardiac progenitor cells.

    Directory of Open Access Journals (Sweden)

    Jussi V Leinonen

    Full Text Available There is strong evidence supporting the claim that endogenous cardiac progenitor cells (CPCs are key players in cardiac regeneration, but the anatomic source and phenotype of the master cardiac progenitors remains uncertain. Our aim was to investigate the different cardiac stem cell populations in the left atrial appendage (LAA and their fates.We investigated the CPC content and profile of adult murine LAAs using immunohistochemistry and flow cytometry. We demonstrate that the LAA contains a large number of CPCs relative to other areas of the heart, representing over 20% of the total cell number. We grew two distinct CPC populations from the LAA by varying the degree of proteolysis. These differed by their histological location, surface marker profiles and growth dynamics. Specifically, CD45(pos cells grew with milder proteolysis, while CD45(neg cells grew mainly with more intense proteolysis. Both cell types could be induced to differentiate into cells with cardiomyocyte markers and organelles, albeit by different protocols. Many CD45(pos cells expressed CD45 initially and rapidly lost its expression while differentiating.Our results demonstrate that the left atrial appendage plays a role as a reservoir of multiple types of progenitor cells in murine adult hearts. Two different types of CPCs were isolated, differing in their epicardial-myocardial localization. Considering studies demonstrating layer-specific origins of different cardiac progenitor cells, our findings may shed light on possible pathways to study and utilize the diversity of endogenous progenitor cells in the adult heart.

  18. Beat-to-beat assessment of left ventricular ejection in atrial fibrillation

    International Nuclear Information System (INIS)

    Benjelloun, H.; Brochier, M.; Itti, R.; Philippe, L.; Lorgeron, J.M.

    1983-01-01

    Beat-to-beat left ventricular ejection was evaluated in a group of 20 patients with chronic atrial fibrillation using a computerized single probe detector. The reference group consisted of 10 patients with sinus rhythm. For each patient 30 successive cardiac cycles were analyzed and the relative variations of four parameters were assessed: R-R interval, diastolic and systolic time intervals, and ejection amplitude, corresponding to the left ventricular stroke volume. The mean variations were respectively 3.4%, 10.4%, 8.4%, and 11.8% in patients with sinus rhythm, and 21.9%, 37.9%, 10.6% and 30.5% in patients with artrial fibrillation. This demonstrates that changes in ejection are mainly related to the duration of the filling phase, with nearly constant systolic times. Correlations between R-R intervals and systolic ejection amplitudes were highly significant (P<0.001) in patients with atrial fibrillation in 85% of cases. This information complements the average ejection fraction obtained from multiple cycle superimposition. (orig.)

  19. Excessive interatrial adiposity is associated with left atrial remodeling, augmented contractile performance in asymptomatic population

    Directory of Open Access Journals (Sweden)

    Yau-Huei Lai

    2016-05-01

    Full Text Available Purpose: Pericardial adipose tissue had been shown to exert local effects on adjacent cardiac structures. Data regarding the mechanistic link between such measures and left atrial (LA structural/functional remodeling, a clinical hallmark of early stage heart failure (HF and atrial fibrillation (AF incidence, in asymptomatic population remain largely unexplored. Methods: This retrospective analysis includes 356 subjects free from significant valvular disorders, atrial fibrillation, or clinical HF. Regional adipose tissue including pericardial and periaortic fat volumes, interatrial septal (IAS, and left atrioventricular groove (AVG fat thickness were all measured by multidetector computed tomography (MDCT (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA. We measured LA volumes, booster performance, reservoir capacity as well as conduit function, and analyzed their association with adiposity measures. Results: All four adiposity measures were positively associated with greater LA volumes (all P < 0.05, while IAS and AVG fat were also related to larger LA kinetic energy and worse reservoir capacity (both P < 0.01. In multivariate models, IAS fat thickness remained independently associated with larger LA volumes, increased LA kinetic energy and ejection force (β-coef: 0.17 & 0.15, both P < 0.05, and impaired LA reservoir and conduit function (β-coef: −0.20 & −0.12, both P < 0.05 after adjusting for clinical variables. Conclusion: Accumulated visceral adiposity, especially interatrial fat depots, was associated with certain LA structural/functional remodeling characterized by impaired LA reservoir and conduit function though augmented kinetic energy and ejection performance. Our data suggested that interatrial fat burden may be associated with certain detrimental LA functions with compensatory LA adaptation in an asymptomatic population.

  20. Percutaneous left atrial appendage occlusion for stroke prevention in atrial fibrillation

    DEFF Research Database (Denmark)

    De Backer, O; Arnous, S; Ihlemann, N

    2014-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. One of its most devastating complications is the development of thromboembolism leading to fatal or disabling stroke. Oral anticoagulation (OAC, warfarin) is the standard treatment for strok...

  1. Characteristics of Left Atrial Deformation Parameters and Their Prognostic Impact in Patients with Pathological Left Ventricular Hypertrophy: Analysis by Speckle Tracking Echocardiography.

    Science.gov (United States)

    Iio, Chiharuko; Inoue, Katsuji; Nishimura, Kazuhisa; Fujii, Akira; Nagai, Takayuki; Suzuki, Jun; Okura, Takafumi; Higaki, Jitsuo; Ogimoto, Akiyoshi

    2015-12-01

    The pathological process of left ventricular (LV) hypertrophy is associated with left atrial (LA) remodeling. This study was aimed to evaluate the prognostic value of LA strain parameters in patients with pathological LV hypertrophy. This study included 95 patients with hypertensive heart disease (HHD: n = 24), hypertrophic cardiomyopathy (HCM: n = 56), cardiac amyloidosis (CA: n = 15), and control subjects (n = 20). We used two-dimensional speckle tracking echocardiography (STE) to analyze LA global strain. LA electromechanical conduction time (EMT) at the septal (EMT-septal) and lateral wall (EMT-lateral), and their time difference (EMT-diff) were calculated. The incidence of cardiac death and heart failure hospitalization was defined as major cardiac events and that of atrial fibrillation as secondary outcome. Left atrial volume index was increased and LA booster strain was decreased in the HCM and CA groups compared with the HHD group. EMT-lateral was increased in the diseased groups compared with the control. EMT-diff was prolonged in the CA group compared with the HCM group. During the follow-up period (mean 3.4 years), major cardiac events and atrial fibrillation occurred in 17 and 13 patients, respectively. The occurrence of atrial fibrillation was associated with CA etiology, E/e', LA volume index, LAa, and EMT-lateral. The incidence of major cardiac events was independently correlated with LA volume index and EMT-diff in multivariate analysis. This study suggested that the EMT-diff could discriminate patients with a high risk of cardiac events among patients with pathological LV hypertrophy. © 2015, Wiley Periodicals, Inc.

  2. Increased pulse pressure is associated with left atrial enlargement in resistant hypertensive patients.

    Science.gov (United States)

    Armario, Pedro; Oliveras, Anna; Hernández-Del-Rey, Raquel; Suárez, Carmen; Martell, Nieves; Ruilope, Luis M; De La Sierra, Alejandro

    2013-02-01

    Resistant hypertension (RH) is frequently associated with a high prevalence of target organ damage, which impairs the prognosis of these patients. Considering cardiac alterations in RH, most attention has been devoted to left ventricular hypertrophy (LVH), but data concerning left atrial enlargement (LAE) is less known. This cross-sectional study assessed the factors associated with LAE, with special focus on blood pressure (BP) estimates obtained by ambulatory blood pressure monitoring (ABPM), in 250 patients with RH, aged 64 ± 11 years. LAE and LVH were observed in 10.0% (95% CI 6.3-13.7) and 57.1% (95% CI 50.8-63.5) of patients, respectively. Compared with patients with normal atrium size, those exhibiting LAE were older, more frequently women, had elevated pulse pressure (PP) measured both at the office and by ABPM, and showed higher prevalence of LVH (83% vs 54%; p = 0.016). In a logistic regression analysis, adjusting for age, gender, body mass index, left ventricular mass index and BP pressure estimates, night-time PP was independently associated with LAE (OR for 5 mmHg = 1.28, 95% CI 1.24-1.32; p = 0.001). In conclusion, besides classical determinants of LAE, such as age and LVH, an elevated night-time PP was independently associated with LAE in patients with RH.

  3. Relationship of carotid arterial functional and structural changes to left atrial volume in untreated hypertension.

    Science.gov (United States)

    Jaroch, Joanna; Rzyczkowska, Barbara; Bociąga, Zbigniew; Vriz, Olga; Driussi, Caterina; Loboz-Rudnicka, Maria; Dudek, Krzysztof; Łoboz-Grudzień, Krystyna

    2016-04-01

    The contribution of arterial functional and structural changes to left ventricular (LV) diastolic dysfunction has been the area of recent research. There are some studies on the relationship between arterial stiffness (a.s.) and left atrial (LA) remodelling as a marker of diastolic burden. Little is known about the association of arterial structural changes and LA remodelling in hypertension (H). The aim of this study was to examine the relationship between carotid a.s. and intima-media thickness (IMT) and LA volume in subjects with H. The study included 245 previously untreated hypertensives (166 women and 79 men, mean age 53.7 ± 11.8 years). Each patient was subjected to echocardiography with measurement of LA volume, evaluation of left ventricular hypertrophy (LVH) and LV systolic/diastolic function indices, integrated assessment of carotid IMT and echo-tracking of a.s. and wave reflection parameters. Univariate regression analysis revealed significant correlations between indexed LA volume and selected clinical characteristics, echocardiographic indices of LVH and LV diastolic/systolic function and a.s./wave reflection parameters. The following parameters were identified as independent determinants of indexed LA volume on multivariate regression analysis: diastolic blood pressure (beta = -0.229, P arterial stiffness but not intima-media thickness and LA volume in patients with untreated hypertension.

  4. Association Between Local Bipolar Voltage and Conduction Gap Along the Left Atrial Linear Ablation Lesion in Patients With Atrial Fibrillation.

    Science.gov (United States)

    Masuda, Masaharu; Fujita, Masashi; Iida, Osamu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Sunaga, Akihiro; Tsujimura, Takuya; Matsuda, Yasuhiro; Mano, Toshiaki

    2017-08-01

    A bipolar voltage reflects a thick musculature where formation of a transmural lesion may be hard to achieve. The purpose of this study was to explore the association between local bipolar voltage and conduction gap in patients with persistent atrial fibrillation (AF) who underwent atrial roof or septal linear ablation. This prospective observational study included 42 and 36 consecutive patients with persistent AF who underwent roof or septal linear ablations, respectively. After pulmonary vein isolation, left atrial linear ablations were performed, and conduction gap sites were identified and ablated after first-touch radiofrequency application. Conduction gap(s) after the first-touch roof and septal linear ablation were observed in 13 (32%) and 19 patients (53%), respectively. Roof and septal area voltages were higher in patients with conduction gap(s) than in those without (roof, 1.23 ± 0.77 vs 0.73 ± 0.42 mV, p = 0.010; septal, 0.96 ± 0.43 vs 0.54 ± 0.18 mV, p = 0.001). Trisected regional analyses revealed that the voltage was higher at the region with a conduction gap than at the region without. Complete conduction block across the roof and septal lines was not achieved in 3 (7%) and 6 patients (17%), respectively. Patients in whom a linear conduction block could not be achieved demonstrated higher ablation area voltage than those with a successful conduction block (roof, 1.91 ± 0.74 vs 0.81 ± 0.51 mV, p = 0.001; septal, 1.15 ± 0.56 vs 0.69 ± 0.31 mV, p = 0.006). In conclusion, a high regional bipolar voltage predicts failure to achieve conduction block after left atrial roof or septal linear ablation. In addition, the conduction gap was located at the preserved voltage area. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Rationale and Design of the Reduce Elevated Left Atrial Pressure in Patients With Heart Failure (Reduce LAP-HF) Trial

    DEFF Research Database (Denmark)

    Hasenfuss, Gerd; Gustafsson, Finn; Kaye, David

    2015-01-01

    OBJECTIVE: Heart failure with preserved ejection fraction (HFpEF) is characterized by elevated left atrial pressure during rest and/or exercise. The Reduce LAP-HF (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) trial will evaluate the safety and performance of the Interatrial...... Shunt Device (IASD) System II, designed to directly reduce elevated left atrial pressure, in patients with HFpEF. METHODS: The Reduce LAP-HF Trial is a prospective, nonrandomized, open-label trial to evaluate a novel device that creates a small permanent shunt at the level of the atria. A minimum of 60...... patients with ejection fraction ≥40% and New York Heart Association functional class III or IV heart failure with a pulmonary capillary wedge pressure (PCWP) ≥15 mm Hg at rest or ≥25 mm Hg during supine bike exercise will be implanted with an IASD System II, and followed for 6 months to assess the primary...

  6. Accessory left atrial diverticulae: contractile properties depicted with 64-slice cine-cardiac CT.

    LENUS (Irish Health Repository)

    Killeen, Ronan P

    2012-02-01

    To assess the contractility of accessory left atrial appendages (LAAs) using multiphasic cardiac CT. We retrospectively analyzed the presence, location, size and contractile properties of accessory LAAs using multiphasic cardiac 64-slice CT in 102 consecutive patients (63 males, 39 females, mean age 57). Multiplanar reformats were used to create image planes in axial oblique, sagittal oblique and coronal oblique planes. For all appendages with an orifice diameter >or= 10 mm, axial and sagittal diameters and appendage volumes were recorded in atrial diastole and systole. Regression analysis was performed to assess which imaging appearances best predicted accessory appendage contractility. Twenty-three (23%) patients demonstrated an accessory LAA, all identified along the anterior LA wall. Dimensions for axial oblique (AOD) and sagittal oblique (SOD) diameters and sagittal oblique length (SOL) were 6.3-19, 3.4-20 and 5-21 mm, respectively. All appendages (>or=10 mm) demonstrated significant contraction during atrial systole (greatest diameter reduction was AOD [3.8 mm, 27%]). Significant correlations were noted between AOD-contraction and AOD (R = 0.57, P < 0.05) and SOD-contraction and AOD, SOD and SOL (R = 0.6, P < 0.05). Mean diverticulum volume in atrial diastole was 468.4 +\\/- 493 mm(3) and in systole was 171.2 +\\/- 122 mm(3), indicating a mean change in volume of 297.2 +\\/- 390 mm(3), P < 0.0001. Stepwise multiple regression analysis revealed SOL to be the strongest independent predictor of appendage contractility (R(2) = 0.86, P < 0.0001) followed by SOD (R(2) = 0.91, P < 0.0001). Accessory LAAs show significant contractile properties on cardiac CT. Those accessory LAAs with a large sagittal height or depth should be evaluated for contractile properties, and if present should be examined for ectopic activity during electrophysiological studies.

  7. Computational Fluid Dynamic Analysis of the Left Atrial Appendage to Predict Thrombosis Risk

    Directory of Open Access Journals (Sweden)

    Giorgia Maria Bosi

    2018-04-01

    Full Text Available During Atrial Fibrillation (AF more than 90% of the left atrial thrombi responsible for thromboembolic events originate in the left atrial appendage (LAA, a complex small sac protruding from the left atrium (LA. Current available treatments to prevent thromboembolic events are oral anticoagulation, surgical LAA exclusion, or percutaneous LAA occlusion. However, the mechanism behind thrombus formation in the LAA is poorly understood. The aim of this work is to analyse the hemodynamic behaviour in four typical LAA morphologies - “Chicken wing”, “Cactus”, “Windsock” and “Cauliflower” - to identify potential relationships between the different shapes and the risk of thrombotic events. Computerised tomography (CT images from four patients with no LA pathology were segmented to derive the 3D anatomical shape of LAA and LA. Computational Fluid Dynamic (CFD analyses based on the patient-specific anatomies were carried out imposing both healthy and AF flow conditions. Velocity and shear strain rate (SSR were analysed for all cases. Residence time in the different LAA regions was estimated with a virtual contrast agent washing out. CFD results indicate that both velocity and SSR decrease along the LAA, from the ostium to the tip, at each instant in the cardiac cycle, thus making the LAA tip more prone to fluid stagnation, and therefore to thrombus formation. Velocity and SSR also decrease from normal to AF conditions. After four cardiac cycles, the lowest washout of contrast agent was observed for the Cauliflower morphology (3.27% of residual contrast in AF, and the highest for the Windsock (0.56% of residual contrast in AF. This suggests that the former is expected to be associated with a higher risk of thrombosis, in agreement with clinical reports in the literature. The presented computational models highlight the major role played by the LAA morphology on the hemodynamics, both in normal and AF conditions, revealing the potential

  8. [New technology for prevention of embolic events in atrial fibrillation: a systematic review on percutaneous endovascular left atrial appendage closure].

    Science.gov (United States)

    Danna, Paolo; Sagone, Antonio; Proietti, Riccardo; Arensi, Andrea; Viecca, Maurizio; Santangeli, Pasquale; Di Biase, Luigi; Natale, Andrea

    2012-09-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia. The mortality rate of patients with AF is doubled as compared to non-fibrillating controls. The most relevant complication of AF is a major increase in the risk of stroke. The gold standard in reducing cerebrovascular events in AF is warfarin therapy, which is not free from contraindications and limitations. The left atrial appendage (LAA) is the main source of emboli causing stroke in AF. LAA closure is a seducing approach to stroke risk reduction in AF without anticoagulation. Since 1949, heart surgeons have performed LAA closure or amputation in patients with AF. Percutaneous endovascular LAA closure is a new, less invasive, technique to reach the goal. Several devices have been used to perform this intervention, and the results of published trials are encouraging in terms of effectiveness and relative safety of this attractive technique. In this review we examine the published trials and data on percutaneous LAA closure, with particular attention to the risks and benefits of this procedure.

  9. Percutaneous left atrial appendage occlusion in atrial fibrillation patients with a contraindication to oral anticoagulation: a focused review.

    Science.gov (United States)

    Nishimura, Marin; Sab, Shiv; Reeves, Ryan R; Hsu, Jonathan C

    2017-12-08

    Stroke is the most feared complication of atrial fibrillation (AF). Although oral anticoagulation with non-vitamin K antagonist and non-vitamin K antagonist oral anticoagulants (NOACs) have been established to significantly reduce risk of stroke, real-world use of these agents are often suboptimal due to concerns for adverse events including bleeding from both patients and clinicians. Particularly in patients with previous serious bleeding, oral anticoagulation may be contraindicated. Left atrial appendage occlusion (LAAO), mechanically targeting the source of most of the thrombi in AF, holds an immense potential as an alternative to OAC in management of stroke prophylaxis. In this focused review, we describe the available evidence of various LAAO devices, detailing data regarding their use in patients with a contraindication for oral anticoagulation. Although some questions of safety and appropriate use of these new devices in patients who cannot tolerate anticoagulation remain, LAAO devices offer a significant step forward in the management of patients with AF, including those patients who may not be able to be prescribed OAC at all. Future studies involving patients fully contraindicated to OAC are warranted in the era of LAAO devices for stroke risk reduction. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  10. Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity.

    Science.gov (United States)

    Koh, Angela S; Murthy, Venkatesh L; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Wu, Justina; Di Carli, Marcelo F; Dorbala, Sharmila

    2015-09-01

    Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical (82)Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function.

  11. Left atrial dysfunction in patients with patent foramen ovale and atrial septal aneurysm: an alternative concurrent mechanism for arterial embolism?

    Science.gov (United States)

    Rigatelli, Gianluca; Aggio, Silvio; Cardaioli, Paolo; Braggion, Gabriele; Giordan, Massimo; Dell'avvocata, Fabio; Chinaglia, Mauro; Rigatelli, Giorgio; Roncon, Loris; Chen, Jack P

    2009-07-01

    We postulate that, in patients with large patent foramen ovales (PFO) and atrial septal aneurysms (ASA), left atrial (LA) dysfunction simulating "atrial fibrillation (AF)-like" pathophysiology might represent an alternate mechanism in the promotion of arterial embolism. Despite prior reports concerning paradoxical embolism through a PFO, the magnitude of this phenomenon as a risk factor for stroke remains undefined, because deep venous thrombosis is infrequently detected in such patients. To test our hypothesis, we prospectively enrolled 98 consecutive patients with previous stroke (mean age 37 +/- 12.5 years, 58 women) referred to our center for catheter-based PFO closure. Baseline values of LA passive and active emptying, LA conduit function, LA ejection fraction, and spontaneous echocontrast (SEC) in the LA and LA appendage were compared with those of 50 AF patients as well as a sex/age/cardiac risk-matched population of 70 healthy control subjects. Pre-closure PFO subjects demonstrated significantly greater reservoir function as well as passive and active emptying, with significantly reduced conduit function and LA ejection fraction, when compared with AF and control patients. Furthermore, in PFO patients, 66.3% (65 of 98) had moderate-to-severe ASA and basal shunt; SEC was observed in 52% of PFO plus ASA patients before closure. Multivariate stepwise logistic regression revealed moderate-to-severe ASA (odds ratio: 9.4, 95% confidence interval: 7.0 to 23.2, p < 0.001) as the most powerful predictor of LA dysfunction. After closure, all LA parameters normalized to the levels of control subjects: no SEC, device-related thrombosis, or aortic erosion were observed on follow-up echocardiography. This study suggests that moderate-to-severe ASA might be associated with LA dysfunction in patients with PFO. The resultant similarities to the pathophysiology of AF might represent an additional contributing mechanism for arterial embolism in such patients.

  12. Percutaneous Occlusion of the Left Atrial Appendage with the Watchman Device in an Active Duty Sailor with Atrial Fibrillation and Recurrent Thromboembolism Despite Appropriate Use of Oral Anticoagulation.

    Science.gov (United States)

    Cox, Justin M; Choi, Anthony J; Oakley, Luke S; Francisco, Gregory M; Nayak, Keshav R

    2018-05-23

    Atrial fibrillation is the most common significant cardiac arrhythmia and is associated with a five-fold increased risk of stroke from thromboembolism. Over 94% of these emboli arise from the left atrial appendage. Systemic embolic phenomena are rare, accounting for less than 1 out of 10 of all embolic events, but have a similar prevention strategy. Anticoagulation significantly reduces the risk of these events, and thus forms the cornerstone of therapy for most patients with atrial fibrillation. Left atrial appendage occlusion with the Watchman device is a recently approved alternative for stroke prevention in selected patients. We present a case of an active duty U.S. Navy sailor at low risk for thromboembolism who nonetheless suffered recurrent thromboembolic events despite appropriate anticoagulation, and thus underwent Watchman implantation. The therapy in this case will ideally provide a lifetime of protection from recurrent systemic embolization while allowing the patient to continue his active duty military career without restriction due to oral anticoagulation.

  13. Left atrial volume and function in dogs with naturally occurring myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Höllmer, M.; Willesen, J. L.; Tolver, A.

    2017-01-01

    stroke volume increased, whereas LA reservoir and contractile function decreased with increasing disease severity. A maximal LA volume heart failure in dogs with chronic MMVD with a sensitivity of 96% and a specificity of 100......%. An active LA emptying fraction heart failure in dogs with chronic MMVD with a sensitivity of 77% and a specificity of 89% and a sensitivity of 82% and a specificity of 82%, respectively. CONCLUSION: Dogs with MMVD appear to have larger LA...... of cardiac compensation. Left atrial function in dogs with naturally occurring MMVD remains largely unexplored. The objective of this study was to evaluate LA volume and function in dogs with naturally occurring MMVD. ANIMALS: This prospective study included 205 client-owned dogs of different breeds, 114...

  14. Evaluation of single right atrial volume and function with magnetic resonance imaging in children with hypoplastic left heart

    Energy Technology Data Exchange (ETDEWEB)

    Vijarnsorn, Chodchanok [University of Alberta, Faculty of Medicine and Dentistry, Stollery Children' s Hospital, Edmonton, AB (Canada); Mahidol University, Siriraj Hospital, Bangkok (Thailand); Myers, Kimberley; Patton, David J. [Alberta Children' s Hospital, Section of Pediatric Cardiology, Department of Pediatrics, Department of Pediatrics, Calgary, AB (Canada); Noga, Michelle; Crawley, Cinzia; Tham, Edythe [University of Alberta, Faculty of Medicine and Dentistry, Stollery Children' s Hospital, Edmonton, AB (Canada)

    2016-06-15

    Standardized methods to evaluate atrial properties in single ventricles are lacking. To determine the feasibility of quantifying right atrial volumes and function in hypoplastic left heart using MRI. We studied 15 infants with hypoplastic left heart prior to Glenn surgery (mean age 4.2 months [standard deviation 0.3]) who underwent cardiac MRI with evaluation of atrial volumes and emptying fraction using monoplane two-chamber, monoplane four-chamber, and biplane methods, all of which were compared to the atrial short-axial oblique stack method. We compared atrial end-diastolic volume, end-systolic volume and emptying fraction among these methods. We analyzed reproducibility of the methods using Bland-Altman plots. Both four-chamber and biplane methods showed high correlations for atrial end-diastolic volume (r = 0.7 and r = 0.8, respectively; P < 0.01) and end-systolic volume (r = 0.8 and r = 0.9, respectively; P < 0.01) with small mean differences (-0.2 ± 2.9 standard deviation [SD] ml and -0.8 ± 1.6 ml, respectively, for atrial end-diastolic volume and -0.8 ± 1.5 ml and -0.9 ± 0.9 ml, respectively, for atrial end-systolic volume). The short-axial oblique method was the most reproducible, followed by the four-chamber method. MRI assessment of atrial volume and function is feasible in hypoplastic left heart and might provide further insight into single-ventricle mechanics. (orig.)

  15. The effect of activation rate on left atrial bipolar voltage in patients with paroxysmal atrial fibrillation.

    Science.gov (United States)

    Williams, Steven E; Linton, Nick; O'Neill, Louisa; Harrison, James; Whitaker, John; Mukherjee, Rahul; Rinaldi, Christopher A; Gill, Jaswinder; Niederer, Steven; Wright, Matthew; O'Neill, Mark

    2017-09-01

    Bipolar voltage is used during electroanatomic mapping to define abnormal myocardium, but the effect of activation rate on bipolar voltage is not known. We hypothesized that bipolar voltage may change in response to activation rate. By examining corresponding unipolar signals we sought to determine the mechanisms of such changes. LA extrastimulus mapping was performed during CS pacing in 10 patients undergoing first time paroxysmal atrial fibrillation ablation. Bipolar and unipolar electrograms were recorded using a PentaRay catheter (4-4-4 spacing) and indifferent IVC electrode, respectively. An S1S2 pacing protocol was delivered with extrastimulus coupling interval reducing from 350 to 200 milliseconds. At each recording site (119 ± 37 per LA), bipolar peak-to-peak voltage, unipolar peak to peak voltage and activation delay between unipole pairs was measured. Four patterns of bipolar voltage/extrastimulus coupling interval curves were seen: voltage attenuation with plateau voltage >1 mV (48 ± 15%) or voltage unaffected by coupling interval with plateau voltage >1 mV (17 ± 10%) or voltage attenuation were associated with significantly greater unipolar voltage attenuation at low (25 ± 28 mV/s vs. 9 ± 11 mV/s) and high (23 ± 29 mV/s vs. 6 ± 12 mV/s) plateau voltage sites (P voltage attenuation (P = 0.026). Bipolar electrogram voltage is dependent on activation rate at a significant proportion of sites. Changes in unipolar voltage and timing underlie these effects. These observations have important implications for use of voltage mapping to delineate abnormal atrial substrate. © 2017 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals, Inc.

  16. Assessment of the effect of left atrial cryoablation enhanced by ganglionated plexi ablation in the treatment of atrial fibrillation in patients undergoing open heart surgery.

    Science.gov (United States)

    Bárta, Jiří; Brát, Radim

    2017-08-17

    The aim of our study was to investigate, whether enhancement of left atrial cryoablation by ablation of the autonomic nervous system of left atrium leads to influencing the outcomes of surgical treatment of atrial fibrillation in patients with structural heart disease undergoing open-heart surgery. The observed patient file consisted of 100 patients, who have undergone a combined open-heart surgery at our department between July 2012 and December 2014. The patients were indicated for the surgical procedure due to structural heart disease, and suffered from paroxysmal, persistent, or long-standing persistent atrial fibrillation. In all cases, left atrial cryoablation was performed in the extent of isolation of pulmonary veins, box lesion, connecting lesion with mitral annulus, amputation of the left atrial appendage and connecting lesion of the appendage base with left pulmonary veins. Furthermore, 35 of the patients underwent mapping and radiofrequency ablation of ganglionated plexi, together with discision and ablation of the ligament of Marshall (Group GP). A control group was consisted of 65 patients without ganglionated plexi intervention (Group LA). The main primary outcome was establishment and duration of sinus rhythm in the course of one-year follow-up. Evaluation of the number of patients with a normal sinus rhythm in per cent has shown comparable values in both groups (Group GP - 93.75%, Group LA - 86.67%, p = 0.485); comparable results were also observed in patients with normal sinus rhythm without anti-arrhythmic treatment in the 12th month (Group GP - 50%, Group LA - 47%, p = 0.306). We have not observed any relation between the recurrence of atrial fibrillation and the presence of a mitral valve surgery, or between the presence of a mitral and tricuspid valves surgery and between the left atrial diameter > 50 mm. Enhancement of left atrial cryoablation by gangionated plexi ablation did not influence the outcomes of surgical ablation due to

  17. Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function

    DEFF Research Database (Denmark)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne Krarup; Høst, Nis

    2016-01-01

    Twenty-five to 35 percentage of stroke cases are cryptogenic, and it has been demonstrated that paroxysmal atrial fibrillation (AF) is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal...... with paroxysmal AF. However, the atrial measurements evaluating LA function (min LA volume and LA emptying fraction) were significantly different (LA emptying fraction: 45% ± 10% vs 50% ± 10%, p = 0.004; minimal LA volume: 30.2 ml ± 17.3 ml vs 24 ml ± 10 ml, p = 0.035 in patients with paroxysmal AF, even after...

  18. Electron-beam computed tomography findings of left atrial appendage in patients with cardiogenic cerebral embolism

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, Makiko; Takahashi, Satoshi; Yonezawa, Hisashi [Iwate Medical Univ., Morioka (Japan). School of Medicine

    2002-04-01

    We studied electron-beam computed tomography (EBCT) findings in the left atrial appendage of 72 patients with cerebral embolism [27 in the acute phase (<48 hours) and 45 in the chronic phase], 9 cases with nonvalvular atrial fibrillation (NVAF) but without stroke, and 13 controls. EBCT was performed in the early (during injection of contrast medium), late-1 (5 min after injection), and-2 (10 min after injection) phases. In the acute phase patients, 41% showed filling defect (FD) in the early phase alone (FDE), 15% showed FD until late phase-1 (FDL-1), and 15% showed FD until late phase-2 (FDL-2). The chronic phase patients showed FDE in 33% of cases, FDL-1 in 8% and FDL-2 11%. Only FDE was observed in 44% in NVAF cases without stroke. No FDs were observed in controls. Flow velocity in the appendage measured by transesophageal echocardiography was 23{+-}10 cm/sec in 21 FDE cases, 14{+-}3 cm/sec in 3 FDL-1 cases, 29{+-}23 cm/sec in 4 FDL-2 cases, significantly lower in comparison with 58{+-}25 cm/s in the 23 cases with no FD. FDL-1 and -2 suggested severe stasis or presence of thrombus in the appendage, which indicated high risk of embolism slower the movement of MES through the sample volume. (author)

  19. Electron-beam computed tomography findings of left atrial appendage in patients with cardiogenic cerebral embolism

    International Nuclear Information System (INIS)

    Okamoto, Makiko; Takahashi, Satoshi; Yonezawa, Hisashi

    2002-01-01

    We studied electron-beam computed tomography (EBCT) findings in the left atrial appendage of 72 patients with cerebral embolism [27 in the acute phase (<48 hours) and 45 in the chronic phase], 9 cases with nonvalvular atrial fibrillation (NVAF) but without stroke, and 13 controls. EBCT was performed in the early (during injection of contrast medium), late-1 (5 min after injection), and-2 (10 min after injection) phases. In the acute phase patients, 41% showed filling defect (FD) in the early phase alone (FDE), 15% showed FD until late phase-1 (FDL-1), and 15% showed FD until late phase-2 (FDL-2). The chronic phase patients showed FDE in 33% of cases, FDL-1 in 8% and FDL-2 11%. Only FDE was observed in 44% in NVAF cases without stroke. No FDs were observed in controls. Flow velocity in the appendage measured by transesophageal echocardiography was 23±10 cm/sec in 21 FDE cases, 14±3 cm/sec in 3 FDL-1 cases, 29±23 cm/sec in 4 FDL-2 cases, significantly lower in comparison with 58±25 cm/s in the 23 cases with no FD. FDL-1 and -2 suggested severe stasis or presence of thrombus in the appendage, which indicated high risk of embolism slower the movement of MES through the sample volume. (author)

  20. ST-segment elevation and ventricular fibrillation shortly after transseptal puncture for left atrial catheter ablation

    Directory of Open Access Journals (Sweden)

    Daisuke Ishigaki, MD

    2013-10-01

    Full Text Available A 47-year-old man with drug-resistant paroxysmal atrial fibrillation underwent left atrial (LA catheter ablation. After sheaths were inserted into the LA using the Brockenbrough method, he complained of angina and developed ST-segment elevation in the II, III, aVF, V5, and V6 leads. Ventricular fibrillation (VF occurred followed by ventricular tachycardia. The VF was successfully treated with direct current shock. Coronary angiography with isosorbide dinitrate showed neither spasm nor embolism in the coronary artery. The chest pain disappeared after 6 min with resolution of the ST-segment elevation. A summarized review of ST-segment elevation associated with transseptal puncture disclosed that ST-segment elevation is often found in inferior leads (87.5%, while concomitant bradyarrhythmia has been reported in 43.8% of patients. Our patient is the first recorded case with potentially lethal tachyarrhythmia. Although ST-segment elevation and VF is a rare complication associated with transseptal puncture, awareness of this complication is important.

  1. A novel device for the occlusion of left atrial appendage: an experimental study in canine models

    International Nuclear Information System (INIS)

    Yang Zhihong; Qin Yongwen; Wu Hong; Hu Jianqiang; Wang Shengqiang; Ding Zhongru; Liu Zongjun

    2011-01-01

    Objective: To evaluate the feasibility, safety and biocompatibility of a novel device designed by the authors for the occlusion of left atrial appendage (LAA) in canine models. Methods: The occlusion of LAA was performed in 20 experimental dogs by using a novel LAA occluder, which was delivered to the LAA through a transseptal catheter. During the period of 2 weeks to 6 months after the procedure, the dogs were kept under observation for the device healing, migration, perforation and the formation of thrombus. Both scanning electron microscope (SEM) and transmission electron microscope (TEM) were used to examine the endothelial growth on the surface of the occluder and the structure of the endothelial cells. Results: Of the total 20 dogs, the novel device was successfully implanted in 14. The LAA was occluded completely in 13 dogs. No mobile thrombi caused by the implantation procedure were observed. Endothelialization of the atrium-facing surface was observed at one month after the procedure, and the surface was completely covered with endothelial cells at 3 months after the treatment, which was confirmed by gross, histological and SEM examinations. TEM examination showed that the structure of endothelial cells, the mitochondrion and sarcomere of atrial cardiocyte were all normal. Gross and light microscopic examination of the kidney, lung spleen and liver showed that there was no evidence of embolism or infarction. Conclusion: The novel device is safe and feasible for the occlusion of the LAA in experimental dogs. Further study is needed to observe its long-term safety. (authors)

  2. Velocity encoded cardiovascular magnetic resonance to assess left atrial appendage emptying

    Directory of Open Access Journals (Sweden)

    Muellerleile Kai

    2012-06-01

    Full Text Available Abstract Background The presence of impaired left atrial appendage (LAA function identifies patients who are prone to thrombus formation in the LAA and therefore being at high risk for subsequent cardioembolic stroke. LAA function is typically assessed by measurements of LAA emptying velocities using transesophageal echocardiography (TEE in clinical routine. This study aimed at evaluating the feasibility of assessing LAA emptying by velocity encoded (VENC cardiovascular magnetic resonance (CMR. Methods This study included 30 patients with sinus rhythm (n = 18 or atrial fibrillation (n = 12. VENC-CMR velocity measurements were performed perpendicular to the orifice of the LAA. Peak velocities were measured of passive diastolic LAA emptying (e-wave in all patients. Peak velocities of active, late-diastolic LAA emptying (a-wave were assessed in patients with sinus rhythm. Correlation and agreement was analyzed between VENC-CMR and TEE measurements of e- and a-wave peak velocities. Results A significant correlation and good agreement was found between VENC-CMR and TEE measurements of maximal e-wave velocities (r = 0.61, P  Conclusions The assessment of active and passive LAA emptying by VENC-CMR is feasible. Further evaluation is required of potential future clinical applications such as risk stratification for cardioembolic stroke.

  3. Left Atrial Appendage Closure Device With Delivery System: A Health Technology Assessment

    Science.gov (United States)

    Nevis, Immaculate; Falk, Lindsey; Wells, David; Higgins, Caroline

    2017-01-01

    Background Atrial fibrillation is a common cardiac arrhythmia, and 15% to 20% of those who have experienced stroke have atrial fibrillation. Treatment options to prevent stroke in people with atrial fibrillation include pharmacological agents such as novel oral anticoagulants or nonpharmacological devices such as the left atrial appendage closure device with delivery system (LAAC device). The objectives of this health technology assessment were to assess the clinical effectiveness and cost-effectiveness of the LAAC device versus novel oral anticoagulants in patients without contraindications to oral anticoagulants and versus antiplatelet agents in patients with contraindications to oral anticoagulants. Methods We performed a systematic review and network meta-analysis. We also conducted an economic literature review, economic evaluation, and budget impact analysis to assess the cost-effectiveness and budget impact of the LAAC device compared with novel oral anticoagulants and oral antiplatelet agents (e.g., aspirin). We also spoke with patients to better understand their preferences, perspectives, and values. Results Seven randomized controlled studies met the inclusion criteria for indirect comparison. Five studies assessed the effectiveness of novel oral anticoagulants versus warfarin, and two studies compared the LAAC device with warfarin. No studies were identified that compared the LAAC device with aspirin in patients in whom oral anticoagulants were contraindicated. Using the random effects model, we found that the LAAC device was comparable to novel oral anticoagulants in reducing stroke (odds ratio [OR] 0.85; credible interval [Cr.I] 0.63–1.05). Similarly, the reduction in the risk of all-cause mortality was comparable between the LAAC device and novel oral anticoagulants (OR 0.71; Cr.I 0.49–1.22). The LAAC device was found to be superior to novel oral anticoagulants in preventing hemorrhagic stroke (OR 0.45; Cr.I 0.29–0.79), whereas novel oral

  4. Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity.

    Science.gov (United States)

    Fernandes-Cardoso, A; Santos-Furtado, M; Grindler, J; Ferreira, L A; Andrade, J L; Santo, M A

    2017-08-01

    Epicardial fat (EF) is increased in obesity and has important interactions with atrial and ventricular myocardium. Most of the evidence in this scenario can be confused by the presence of comorbidities such as hypertension, diabetes and dyslipidemia, which are very common in this population. The influence of EF on atrial remodeling and cardiac function demands further investigation on morbidly obese without these comorbidities. We prospectively recruited 20 metabolically healthy morbidly obese and 20 normo-weights controls. The maximum P-wave duration (PWD) was analyzed by 12-lead electrocardiogram. Left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and EF thickness (EFT) were evaluated by two-dimensional echocardiography. The mean of maximum PWD and LAD were significantly larger in the obese group as compared to the control group: 109.55 ± 11.52 ms × 89.38 ± 11.19 ms and 36.12 ± 3.46 mm × 31.45 ± 2.64 mm, (p function. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  5. Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors

    Directory of Open Access Journals (Sweden)

    Deirdre M Mooney

    2015-10-01

    Full Text Available Heart failure (HF is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension.

  6. Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors.

    Science.gov (United States)

    Mooney, Deirdre M; Fung, Erik; Doshi, Rahul N; Shavelle, David M

    2015-01-01

    Heart failure (HF) is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF) can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension.

  7. Relation of Left Atrial Size, Cardiac Morphology, and Clinical Outcome in Asymptomatic Aortic Stenosis

    DEFF Research Database (Denmark)

    Christensen, Nicolaj Lyhne; Dahl, Jordi; Carter-Storch, Rasmus

    2017-01-01

    characterized by higher LV mass index (73 ± 17 g/m² vs. 66 ± 16 g/m² , p=0.03), increased right ventricle (70 ± 14 ml/m² vs. 63 ± 12 ml/m², p=0.01) and LV end-diastolic volume index (84 ± 18 ml/m² vs. 77 ± 16 ml/m², p=0.05), and higher brain natriuretic peptide (BNP). No difference in late enhancement was seen......Left atrial (LA) dilatation in asymptomatic severe aortic stenosis (AS) may be an indicator of advanced disease. The aim was to investigate the association between LA volume index (LAVi) and left ventricular (LV) morphology assessed with cardiac magnetic resonance imaging (cMRI), and to assess...... underwent echocardiography, cMRI, exercise test, and patients were followed for the composite endpoint of death, readmission or aortic valve replacement. AVA index was similar (0.45 ± 0.08 cm² /m² vs. 0.45 ± 0.09 cm², p=0.85) in patients with a dilated and normal LA. On cMRI patients with dilated LA were...

  8. Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Stefania Scarsoglio

    2016-07-01

    Full Text Available Background: Although atrial fibrillation (AF, a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. Methods: We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of the four heart chambers, together with the systemic and pulmonary circulation. The AF modelling involves: (i irregular, uncorrelated and faster heart rate; (ii atrial contractility dysfunction. Three different grades of severity (mild, moderate, severe were analyzed for each of the four valvulopathies (AS, aortic stenosis, MS, mitral stenosis, AR, aortic regurgitation, MR, mitral regurgitation, by varying–through the valve opening angle–the valve area. Results: Regurgitation was hemodynamically more relevant than stenosis, as the latter led to inefficient cardiac flow, while the former introduced more drastic fluid dynamics variation. Moreover, mitral valvulopathies were more significant than aortic ones. In case of aortic valve diseases, proper mitral functioning damps out changes at atrial and pulmonary levels. In the case of mitral valvulopathy, the mitral valve lost its regulating capability, thus hemodynamic variations almost equally affected regions upstream and downstream of the valve. In particular, the present study revealed that both mitral and aortic regurgitation strongly affect hemodynamics, followed by mitral stenosis, while aortic stenosis has the least impact among the analyzed valvular diseases. Discussion: The proposed approach can provide new mechanistic insights as to which valvular pathologies merit more aggressive

  9. Radionuclide analysis of right and left ventricular response to exercise in patients with atrial and ventricular septal defects

    International Nuclear Information System (INIS)

    Peter, C.A.; Bowyer, K.; Jones, R.H.

    1983-01-01

    In patients with ventricular or atrial septal defect, the ventricle which is chronically volume overloaded might not appropriately respond to increased demand for an augmentation in output and thereby might limit total cardiac function. In this study we simultaneously measured right and left ventricular response to exercise in 10 normal individuals, 10 patients with ventricular septal defect (VSD), and 10 patients with atrial septal defect (ASD). The normal subjects increased both right and left ventricular ejection fraction, end-diastolic volume, and stroke volume to achieve a higher cardiac output during exercise. Patients with VSD failed to increase right ventricular ejection fraction, but increased right ventricular end-diastolic volume and stroke volume. Left ventricular end-diastolic volume did not increase in these patients but ejection fraction, stroke volume, and forward left ventricular output achieved during exercise were comparable to the response observed in healthy subjects. In the patients with ASD, no rest-to-exercise change occurred in either right ventricular ejection fraction, end-diastolic volume, or stroke volume. In addition, left ventricular end-diastolic volume failed to increase, and despite an increase in ejection fraction, left ventricular stroke volume remained unchanged from rest to exercise. Therefore, cardiac output was augmented only by the heart rate increase in these patients. Right ventricular function appeared to be the major determinant of total cardiac output during exercise in patients with cardiac septal defects and left-to-right shunt

  10. Percutaneous closure of the left atrial appendage with Watchman device: An option for patients with atrial fibrilation and high risk of bleeding with anticoagulation

    Directory of Open Access Journals (Sweden)

    Sénior, Juan

    2015-07-01

    Full Text Available Atrial fibrillation is the most common arrhythmia found in clinical practice, with a population prevalence of 1% to 2%. Anticoagulation remains a fundamental part of treatment for the prevention of cerebrovascular events (stroke, but it is contraindicated in approximately 20% of patients. We report a case of non-valvular atrial fibrillation with high-risk score for stroke, a history of intracerebral bleeding, and very high risk of bleeding with long-term anticoagulation. Percutaneous closure of the left atrial appendage with the Watchman device was performed successfully without complications.

  11. Left Ventricular Systolic Function Assessed by Global Longitudinal Strain is Impaired in Atrial Fibrillation Compared to Sinus Rhythm

    DEFF Research Database (Denmark)

    Agner, Bue Fridolin Ross; Katz, Michael G; Williams, Zachary R

    2018-01-01

    Background: Atrial fibrillation (AF) is the most common aberrant cardiac arrhythmia. Many AF patients present with symptoms of dyspnea and fatigue, but have normal left ventricular ejection fraction (LVEF). Purpose: To determine the reproducibility of measurements of global longitudinal strain (GLS...

  12. Left atrial appendage segmentation and quantitative assisted diagnosis of atrial fibrillation based on fusion of temporal-spatial information.

    Science.gov (United States)

    Jin, Cheng; Feng, Jianjiang; Wang, Lei; Yu, Heng; Liu, Jiang; Lu, Jiwen; Zhou, Jie

    2018-05-01

    In this paper, we present an approach for left atrial appendage (LAA) multi-phase fast segmentation and quantitative assisted diagnosis of atrial fibrillation (AF) based on 4D-CT data. We take full advantage of the temporal dimension information to segment the living, flailed LAA based on a parametric max-flow method and graph-cut approach to build 3-D model of each phase. To assist the diagnosis of AF, we calculate the volumes of 3-D models, and then generate a "volume-phase" curve to calculate the important dynamic metrics: ejection fraction, filling flux, and emptying flux of the LAA's blood by volume. This approach demonstrates more precise results than the conventional approaches that calculate metrics by area, and allows for the quick analysis of LAA-volume pattern changes of in a cardiac cycle. It may also provide insight into the individual differences in the lesions of the LAA. Furthermore, we apply support vector machines (SVMs) to achieve a quantitative auto-diagnosis of the AF by exploiting seven features from volume change ratios of the LAA, and perform multivariate logistic regression analysis for the risk of LAA thrombosis. The 100 cases utilized in this research were taken from the Philips 256-iCT. The experimental results demonstrate that our approach can construct the 3-D LAA geometries robustly compared to manual annotations, and reasonably infer that the LAA undergoes filling, emptying and re-filling, re-emptying in a cardiac cycle. This research provides a potential for exploring various physiological functions of the LAA and quantitatively estimating the risk of stroke in patients with AF. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. Total and interatrial epicardial adipose tissues are independently associated with left atrial remodeling in patients with atrial fibrillation.

    Science.gov (United States)

    Shin, Seung Yong; Yong, Hwan Seok; Lim, Hong Euy; Na, Jin Oh; Choi, Cheol Ung; Choi, Jong Il; Kim, Seong Hwan; Kim, Jin Won; Kim, Eung Ju; Park, Sang Weon; Rha, Seung-Woon; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Kim, Young-Hoon

    2011-06-01

    As epicardial adipose tissue (EAT) is a metabolically active visceral fat, potential interaction between EAT and myocardium is strongly suggested. The aims of this study were to determine whether the amount and regional distribution of EAT are related to the chronicity of atrial fibrillation (AF) and left atrial (LA) remodeling. This study consisted of 40 subjects with paroxysmal AF (PAF) and 40 with persistent AF (PeAF). Eighty subjects with no history of AF were enrolled as controls. Total volume of EAT (EAT(total)), regional thickness of EAT, and LA volume (LAV) were measured by multislice computed tomography. In the AF group, blood samples were drawn from coronary sinus for analysis of inflammatory cytokines including adiponectin. Compared with controls, AF subjects had larger LAV, EAT(total), and the thicknesses of periatrial EAT including interatrial septum (IAS). However, the thicknesses of periventricular EAT were not different between the groups. The PeAF subjects had larger LAV, EAT(total), and periatrial EAT thicknesses, higher levels of inflammatory cytokines, and lower level of adiponectin than did the PAF subjects. Adiponection level was significantly associated with EAT(total) and IAS thickness. Multivariate analysis revealed that EAT(total) (P = 0.004) and IAS thickness (P = 0.016) were independently associated with LAV. EAT(total) and thickness of periatrial EAT were significantly larger in AF subjects compared to those of the matched controls and were closely related to the chronicity of AF. Moreover, EAT(total) and IAS thickness were independently associated with LAV in subjects with AF. © 2011 Wiley Periodicals, Inc.

  14. A Left Atrial Myxoma Case with a History of Stroke on whom a Coronary Bypass Surgery was Performed

    Directory of Open Access Journals (Sweden)

    Cihangir Kaymaz

    2009-12-01

    Full Text Available Cardiac myxomas are the most frequently encountered benign cardiac tumors in adult groups. Patients with myxoma may suffer from variety of clinical features. A patient who had suffered from stroke a yearago came to our hospital with a chest pain complaint. In the echocardiography of the patient suffering from acute coronary syndrome, left ventricular disfunction and left atrial mass was determined. In the coronary angiography, LAD and Cx critical stenosis, and an abnormal feeding artery which roots from Cxperformed was observed. LIMA-AD, Ao-RCA bypass and mass exision withleft atriotomy was made. Cardiac tumor embolism which makes up a rare cause of cerebral embolies should be considered especiallyin patients with sinus rhythm. In the coronary angiography the feeding artery of the myxoma was shown. A patient who has underwent coronary bypass operation and left atrial myxoma exision has beenpresented as a case.

  15. Assessment of left atrial volume and function: a comparative study between echocardiography, magnetic resonance imaging and multi slice computed tomography.

    Science.gov (United States)

    Kühl, J Tobias; Lønborg, Jacob; Fuchs, Andreas; Andersen, Mads J; Vejlstrup, Niels; Kelbæk, Henning; Engstrøm, Thomas; Møller, Jacob E; Kofoed, Klaus F

    2012-06-01

    Measurement of left atrial (LA) maximal volume (LA(max)) using two-dimensional transthoracic echocardiography (TTE) provides prognostic information in several cardiac diseases. However, the relationship between LA(max) and LA function is poorly understood and TTE is less well suited for measuring dynamic LA volume changes. Conversely, cardiac magnetic resonance imaging (CMR) and multi-slice computed tomography (MSCT) appears more appropriate for such measures. We sought to determine the relationship between LA size assessed with TTE and LA size and function assessed with CMR and MSCT. Fifty-four patients were examined 3 months post myocardial infarction with echocardiography, CMR and MSCT. Left atrial volumes and LA reservoir function were assessed by TTE. LA time-volume curves were determined and LA reservoir function (cyclic change and fractional change), passive emptying function (reservoir volume) and pump function (left atrial ejection fraction-LAEF) were derived using CMR and MSCT. Left atrial fractional change and left atrial ejection fraction (LAEF) determined with CMR and MSCT were unrelated to LA(max) enlargement by echocardiography (P = NS). There was an overall good agreement between CMR and MSCT, with a small to moderate bias in LA(max) (4.9 ± 10.4 ml), CC (3.1 ± 9.1 ml) and reservoir volume (3.4 ± 9.1 ml). TTE underestimates LA(max) with up to 32% compared with CMR and MSCT (P fractional change and LAEF is not significantly related to LA(max) measured by TTE. TTE systematically underestimated LA volumes, whereas there are good agreements between MSCT and CMR for volumetric and functional properties.

  16. Angiotensin converting enzyme 2 activity and human atrial fibrillation: increased plasma angiotensin converting enzyme 2 activity is associated with atrial fibrillation and more advanced left atrial structural remodelling.

    Science.gov (United States)

    Walters, Tomos E; Kalman, Jonathan M; Patel, Sheila K; Mearns, Megan; Velkoska, Elena; Burrell, Louise M

    2017-08-01

    Angiotensin converting enzyme 2 (ACE2) is an integral membrane protein whose main action is to degrade angiotensin II. Plasma ACE2 activity is increased in various cardiovascular diseases. We aimed to determine the relationship between plasma ACE2 activity and human atrial fibrillation (AF), and in particular its relationship to left atrial (LA) structural remodelling. One hundred and three participants from a tertiary arrhythmia centre, including 58 with paroxysmal AF (PAF), 20 with persistent AF (PersAF), and 25 controls, underwent clinical evaluation, echocardiographic analysis, and measurement of plasma ACE2 activity. A subgroup of 20 participants underwent invasive LA electroanatomic mapping. Plasma ACE2 activity levels were increased in AF [control 13.3 (9.5-22.3) pmol/min/mL; PAF 16.9 (9.7-27.3) pmol/min/mL; PersAF 22.8 (13.7-33.4) pmol/min/mL, P = 0.006]. Elevated plasma ACE2 was associated with older age, male gender, hypertension and vascular disease, elevated left ventricular (LV) mass, impaired LV diastolic function and advanced atrial disease (P < 0.05 for all). Independent predictors of elevated plasma ACE2 activity were AF (P = 0.04) and vascular disease (P < 0.01). There was a significant relationship between elevated ACE2 activity and low mean LA bipolar voltage (adjusted R2 = 0.22, P = 0.03), a high proportion of complex fractionated electrograms (R2 = 0.32, P = 0.009) and a long LA activation time (R2 = 0.20, P = 0.04). Plasma ACE2 activity is elevated in human AF. Both AF and vascular disease predict elevated plasma ACE2 activity, and elevated plasma ACE2 is significantly associated with more advanced LA structural remodelling. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  17. Ticagrelor, but not clopidogrel active metabolite, displays antithrombotic properties in the left atrial endocardium.

    Science.gov (United States)

    Reiner, Martin F; Breitenstein, Alexander; Holy, Erik W; Glanzmann, Martina; Amstalden, Heidi; Stämpfli, Simon F; Bonetti, Nicole R; Falk, Volkmar; Keller, Stephan; Savarese, Gianluigi; Benussi, Stefano; Maisano, Francesco; Lüscher, Thomas F; Beer, Jürg H; Steffel, Jan; Camici, Giovanni G

    2017-03-21

    Oral anticoagulation is considered standard therapy for stroke prevention in atrial fibrillation (AF). Endocardial activation triggers expression of pro-thrombotic mediators including tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1), and contributes to thrombus formation in the left atrial appendage (LAA) of AF patients. Recently, pleiotropic effects of specific P2Y12 receptor antagonists were demonstrated; however, whether these drugs possess antithrombotic effects on LAA endocardial cells currently remains unknown. LAA were obtained from 14 patients with known AF undergoing elective cardiac surgery including LAA removal at the University Hospital Zurich. LAA endocardial cells were isolated and pre-incubated with ticagrelor (10-7, 10-6, 10-5M) or clopidogrel active metabolite (CAM) (1.5 × 10-8, 1.5 × 10-7, 1.5 × 10-6 M) before stimulation with tumour necrosis factor-alpha (TNF-α) (10 ng/mL). Finally, TF and PAI-1 expression and activity were analysed. Ticagrelor, unlike CAM, concentration dependently decreased TNF-α-induced TF expression and TF activity in LAA endocardial cells. Further, ticagrelor, but not CAM reduced PAI-1 expression and enzyme activity in TNF-α-stimulated LAA endocardial cells. In contrast, TF pathway inhibitor (TFPI) remained unaffected by both dugs. Ticagrelor, but not CAM, reduces expression and activity of TF and PAI-1 in LAA endocardial cells isolated from patients with AF, indicating possible local antithrombotic effects. Such pleiotropic properties of ticagrelor may contribute to a reduction in thromboembolic complications in patients with AF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  18. Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy.

    Science.gov (United States)

    Yalçin, Fatih; El-Amrousy, Mahmoud; Müderrisoğlu, Haldun; Korkmaz, Mehmet; Flachskampf, Frank; Tuzcu, Murat; Garcia, Mario G; Thomas, James D

    2002-01-01

    Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (pLA pressure were correlated with changes in S/D (r=0.57, pLA pressure-volume relationship were also correlated with changes in S/D (r=0.52, pLA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.

  19. Atrial Fibrillation associated chromosome 4q25 variants are not associated with PITX2c expression in human adult left atrial appendages.

    Directory of Open Access Journals (Sweden)

    Shamone R Gore-Panter

    Full Text Available Atrial Fibrillation (AF, the most common sustained arrhythmia, has a strong genetic component, but the mechanism by which common genetic variants lead to increased AF susceptibility is unknown. Genome-wide association studies (GWAS have identified that the single nucleotide polymorphisms (SNPs most strongly associated with AF are located on chromosome 4q25 in an intergenic region distal to the PITX2 gene. Our objective was to determine whether the AF-associated SNPs on chromosome 4q25 were associated with PITX2c expression in adult human left atrial appendages. Analysis of a lone AF GWAS identified four independent AF risk SNPs at chromosome 4q25. Human adult left atrial appendage tissue was obtained from 239 subjects of European Ancestry and used for SNP analysis of genomic DNA and determination of PITX2c RNA expression levels by quantitative PCR. Subjects were divided into three groups based on their history of AF and pre-operative rhythm. AF rhythm subjects had higher PITX2c expression than those with history of AF but in sinus rhythm. PITX2c expression was not associated with the AF risk SNPs in human adult left atrial appendages in all subjects combined or in each of the three subgroups. However, we identified seven SNPs modestly associated with PITX2c expression located in the introns of the ENPEP gene, ∼54 kb proximal to PITX2. PITX2c expression in human adult left atrial appendages is not associated with the chromosome 4q25 AF risk SNPs; thus, the mechanism by which these SNPs are associated with AF remains enigmatic.

  20. Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach

    DEFF Research Database (Denmark)

    Lukac, Peter; Hjortdal, Vibeke E; Pedersen, Anders K

    2006-01-01

    retrospectively evaluated. The surgeons used either the superior transseptal (group A) or left atrial approach (group B). The risk of pacemaker implantation associated with the superior transseptal approach as compared with the left atrial approach was estimated using the multivariate Cox regression analysis...... to adjust for possible confounders. RESULTS: We included 577 patients, 150 in group A and 427 in group B. Forty-four patients had a pacemaker implanted after the surgery; 17 in group A and 27 in group B (p = 0.010). The superior transseptal approach was an independent risk factor of pacemaker implantation...... in multivariate analysis (hazard ratio 2.2 [1.2 to 4.1], p = 0.014). Nineteen patients had a pacemaker implanted because of sinus node dysfunction; 9 in group A and 10 in group B (p = 0.017). Group A was an independent predictor of pacemaker implantation because of sinus node dysfunction in bivariate analyses...

  1. Left atrial passive emptying function is preserved in patients with permanent atrial fibrillation--a 320-slice multidetector computed tomography study

    DEFF Research Database (Denmark)

    Agner, Bue Fridolin Ross; Kühl, Jørgen Tobias; Kofoed, Klaus Fuglsang

    2014-01-01

    OBJECTIVE: Left atrial (LA) mechanical function is thought to be virtually inexistent in patients with permanent atrial fibrillation (AF). Due to recent advances in multidetector computed tomography (MDCT) technology, it is now possible to acquire images of the entire heart in a single heartbeat....... The objective of this study was to compare individual components of LA function assessed by MDCT in patients with permanent AF and patients in sinus rhythm (SR). METHODS: 320-slice MDCT was performed in 30 patients with permanent AF. Measurements of LA volumes during the cardiac cycle were compared to 30......; 71 vs. 30 ml/m(2), p permanent AF have significantly increased LA volumes throughout the cardiac...

  2. Computed tomography measurement of the left atrial appendage for optimal sizing of the Watchman device.

    Science.gov (United States)

    Xu, Bo; Betancor, Jorge; Sato, Kimi; Harb, Serge; Abdur Rehman, Karim; Patel, Kunal; Kumar, Arnav; Cremer, Paul C; Jaber, Wael; Rodriguez, L Leonardo; Schoenhagen, Paul; Wazni, Oussama

    Percutaneous left atrial appendage (LAA) occlusion is an emerging treatment option for patients with non-valvular atrial fibrillation who cannot tolerate oral anticoagulation. The Watchman device (Boston Scientific Corporation, Natick, MA, USA) is deployed at the ostium of the LAA, and an appropriately sized device is critical for successful occlusion. However, standardized imaging protocols for device sizing have not been established. We investigated the clinical utility of a standardized imaging protocol, with pre-procedural multi-detector cardiac computed tomography (MDCT), and intra-procedural transesophageal echocardiography (TEE), for Watchman device sizing. Patients who underwent Watchman device implantation between 2010 and 2016 at our center, and who had pre-procedural MDCT and intra-procedural TEE were included. MDCT measurements (CTmax, CTmin, CTmean), and TEE measurement (TEEmax) of the LAA ostium were determined for each case, and correlated with the final size of the Watchman device implanted. Demographic data and clinical outcomes were collected. The study included 80 patients (mean age: 75 ± 9.6 years; male: 68%; mean CHA2DS2-VASc score: 4.5 ± 1.4). CTmax of the LAA ostium correlated strongly with the final deployed Watchman device size (Spearman's rho: 0.81, p < 0.001), while TEEmax of the LAA ostium showed only moderate correlation with the final deployed Watchman device size (Spearman's rho: 0.61, p < 0.001). Implantation success rate was 100%. At a mean duration of follow-up of 197 days, there were no device-related complications (device embolization, cardiac perforation and pericardial tamponade). At follow-up, the vast majority of patients (76 patients; 95%) had either no or trivial (≤3 mm) residual peri-device leak on TEE. A standardized imaging protocol for assessment of Watchman device implantation incorporating pre-procedural MDCT and intra-procedural TEE, was associated with excellent procedural outcomes at a mean duration

  3. Left and right atrial feature tracking in acute myocarditis: A feasibility study

    International Nuclear Information System (INIS)

    Dick, Anastasia; Schmidt, Björn; Michels, Guido; Bunck, Alexander C.; Maintz, David; Baeßler, Bettina

    2017-01-01

    Purpose: The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. Methods: CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [ε s ], peak positive SR [SR s ]), conduit function (passive strain [ε e ], peak early negative SR [SR e ]) and booster pump function (active strain [ε a ], peak late negative SR [SR a ]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV). Results: FT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA ε s : 32 ± 17 vs. 46 ± 13, p = 0.019; LA SR s : 1.5 ± 0.5 vs. 1.8 ± 0.5, p = 0.117; LA SR e : −1.3 ± 0.5 vs. −1.9 ± 0.5, p < 0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SR e proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SR e with a cut-off of −1.6 s −1 resulted in a diagnostic sensitivity of 83% and a specificity of 80%. Changes in RA phasic function parameters

  4. Prognostic value of left atrial size and function in adults with tetralogy of Fallot.

    Science.gov (United States)

    Baggen, Vivan J M; Schut, Anne-Rose W; Cuypers, Judith A A E; Witsenburg, Maarten; Boersma, Eric; van den Bosch, Annemien E; Roos-Hesselink, Jolien W

    2017-06-01

    Left atrial (LA) size predicts cardiovascular outcome in chronic heart failure. Its prognostic value in adults with repaired tetralogy of Fallot (ToF) is unknown. This study therefore investigated the association of LA size and function with cardiovascular events in adults with ToF. Clinically stable adults with ToF who visited the outpatient clinic between 2011 and 2013 underwent echocardiography and were prospectively followed for the occurrence of death, heart failure, hospitalizations, arrhythmia, thromboembolic events, and re-interventions. LA maximal, minimal and pre-A wave volume, area and length were measured on the apical four-chamber view. Total, passive and active emptying fractions were calculated. In total, 134 patients were included (median age 35 [IQR 29-45] years, 65% male, 91% NYHA I). Median follow-up was 40 [IQR 32-47] months. Patients with a dilated LA (≥34mL/m 2 , 43%) were at higher risk of cardiovascular events (n=33, adjusted HR 2.48 [1.09-5.62], P=0.030). Analysis of LA volumes as continuous variables yielded similar conclusions. In addition, LA length (adjusted HR 2.49 [1.51-4.09], P<0.001), total emptying fraction (adjusted HR 0.96 [0.93-0.99], P=0.008), and active emptying fraction (adjusted HR 0.92 [0.87-0.96], P=0.001) were significantly associated with cardiovascular events. Standardized HRs indicated that LA length was the strongest prognostic marker. In addition, none of the patients with a normally sized LA died or developed heart failure. LA size and function can provide relevant prognostic information in clinically stable adults with repaired ToF. Especially LA length may be a valuable additional tool in the risk stratification of these patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Evaluation of Left Atrial Volumes Using Multidetector Computed Tomography: Comparison with Echocardiography

    International Nuclear Information System (INIS)

    Gweon, Hye Mi; Kim, Sang Jin; Kim, Tae Hoon; Lee, Sang Min; Hong, Yoo Jin; Rim, Se Joong

    2010-01-01

    To prospectively assess the relationship between the two different measurement methods for the evaluation of left atrial (LA) volume using cardiac multidetector computed tomography (MDCT) and to compare the results between cardiac MDCT and echocardiography. Thirty-five patients (20 men, 15 women; mean age, 60 years) underwent cardiac MDCT angiography for coronary artery disease. The LA volumes were measured using two different methods: the two dimensional (2D) length-based (LB) method measured along the three-orthogonal planes of the LA and the 3D volumetric threshold-based (VTB) method measured according to the threshold 3D segmentation of the LA. The results obtained by cardiac MDCT were compared with those obtained by echocardiography. The LA end-systolic and end-diastolic volumes (LAESV and LAEDV) measured by the 2D-LB method correlated well with those measured by the 3DVTB method using cardiac MDCT (r = 0.763, r = 0.786, p = 0.001). However, there was a significant difference in the LAESVs between the two measurement methods using cardiac MDCT (p < 0.05). The LAESV measured by cardiac MDCT correlated well with measurements by echocardiography (r = 0.864, p = 0.001), however with a significant difference (p < 0.01) in their volumes. The cardiac MDCT overestimated the LAESV by 22% compared to measurements by echocardiography. A significant correlation was found between the two different measurement methods for evaluating LA volumes by cardiac MDCT. Further, cardiac MDCT correlates well with echocardiography in evaluating the LA volume. However, there are significant differences in the LAESV between the two measurement methods using cardiac MDCT and between cardiac MDCT and echocardiography

  6. Preoperative atrial fibrillation increases risk of thromboembolic events after left ventricular assist device implantation.

    Science.gov (United States)

    Stulak, John M; Deo, Salil; Schirger, John; Aaronson, Keith D; Park, Soon J; Joyce, Lyle D; Daly, Richard C; Pagani, Francis D

    2013-12-01

    Because no series has specifically analyzed the impact of preoperative atrial fibrillation (AF) on patients already at higher risk of thromboembolism after implantation of a left ventricular assist device (LVAD), we review our experience with these patients. Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous flow LVAD at University of Michigan Hospital and Mayo Clinic. Median age at implant was 60 years (range, 18 to 79 years). Preoperative AF was present in 120 patients (31%). Outcomes were analyzed for the association of preoperative AF and postoperative thromboembolic (TE) events defined as stroke, transient ischemic attack, hemolysis, or pump thrombosis. Thromboembolic events occurring within the first 30 days were not counted. One hundred thirty-eight TEs events occurred in 97/389 patients (25%) for an event rate of 0.31 TE events/patient-years of support. Freedom from a TE event in patients with preoperative AF was 62% at 1 year and 46% at 2 years compared with 79% and 72% at 1 and 2 years, respectively, in patients without preoperative AF (p < 0.001). Median survival was 10 months (maximum 7.2 years, total 439 patient-years). Preoperative AF did not decrease late survival at 1 and 2 years after LVAD implant (preop AF: 85% and 70% versus no preop AF: 82% and 70%, respectively; p = 0.55). Patients with preoperative AF have a lower freedom from TE events after LVAD implant. While overall late survival was not significantly reduced in these patients, refinement in anticoagulation strategies after VAD implant may be required. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Left Atrial Volume Index and Prediction of Events in Acute Coronary Syndrome: Solar Registry

    Directory of Open Access Journals (Sweden)

    Jose Alves Secundo Junior

    2014-10-01

    Full Text Available Background: According to some international studies, patients with acute coronary syndrome (ACS and increased left atrial volume index (LAVI have worse long-term prognosis. However, national Brazilian studies confirming this prediction are still lacking. Objective: To evaluate LAVI as a predictor of major cardiovascular events (MCE in patients with ACS during a 365-day follow-up. Methods: Prospective cohort of 171 patients diagnosed with ACS whose LAVI was calculated within 48 hours after hospital admission. According to LAVI, two groups were categorized: normal LAVI (≤ 32 mL/m2 and increased LAVI (> 32 mL/m2. Both groups were compared regarding clinical and echocardiographic characteristics, in- and out-of-hospital outcomes, and occurrence of ECM in up to 365 days. Results: Increased LAVI was observed in 78 patients (45%, and was associated with older age, higher body mass index, hypertension, history of myocardial infarction and previous angioplasty, and lower creatinine clearance and ejection fraction. During hospitalization, acute pulmonary edema was more frequent in patients with increased LAVI (14.1% vs. 4.3%, p = 0.024. After discharge, the occurrence of combined outcome for MCE was higher (p = 0.001 in the group with increased LAVI (26% as compared to the normal LAVI group (7% [RR (95% CI = 3.46 (1.54-7.73 vs. 0.80 (0.69-0.92]. After Cox regression, increased LAVI increased the probability of MCE (HR = 3.08, 95% CI = 1.28-7.40, p = 0.012. Conclusion: Increased LAVI is an important predictor of MCE in a one-year follow-up.

  8. Exchanging Catheters Over a Single Transseptal Sheath During Left Atrial Ablation is Associated with a Higher Risk for Silent Cerebral Events

    Directory of Open Access Journals (Sweden)

    Thomas Deneke, MD

    2014-09-01

    Conclusions: Exchanging catheters over a single transseptal access to perform left atrial ablation is associated with a significantly higher incidence of SCE compared to an ablation technique using different transseptal accesses for therapeutic and diagnostic catheters.

  9. Evaluation of left ventricular function in patients with atrial fibrillation by ECG gated blood pool scintigraphy. Analysis of left ventricular filling and function curve

    Energy Technology Data Exchange (ETDEWEB)

    Inagaki, Suetsugu; Adachi, Haruhiko; Sugihara, Hiroki

    1985-12-01

    ECG gated blood pool scintigraphy (EGBP) is not always valid for the patients with atrial fibrillation (AF), since they have wide variability in cardiac cycle length (CL). To evaluate the left ventricular (LV) function during AF by EGBP, we devised a new processing algorithm to construct multiple gated images discriminated by preceding R-R interval (PRR) from the data acquired in list mode. 18 patients with AF were studied as to; 1) How affect the PRR on cardiac indices such as EF, TES, PER or TPER, 2) Comparison with conventional method getting all CL data, 3) LV filling curves derived by plotting EDV against PRR, 4) The slope and position of LV function curves (LVFC) derived by plotting SV against EDV. In most cases, EF, PER and TES were increased with longer PRR, and those by conventional method nearly corresponded to the average values obtained by our new method. Impairment of ventricular filling was demonstrated in the cases of mitral stenosis and constrictive pericarditis. LVFC of CHF group was situated at right and downward to controls, and left and upward shift was observed after treatment. The slope of LVFC was reduced in relation to the progression of NYHA's functional class. In conclusion, this new algorithm processing irregular CL enables LV filling and function curves to draw, which are useful in the evaluation of cardiac performance in the subjects with AF.

  10. Left ventricular ejection fraction and left atrium diameter related to new-onset atrial fibrillation following acute myocardial infarction: a systematic review and meta-analysis.

    Science.gov (United States)

    Zeng, Rui-Xiang; Chen, Mao-Sheng; Lian, Bao-Tao; Liao, Peng-Da; Zhang, Min-Zhou

    2017-10-06

    New-onset atrial fibrillation (NOAF) occurs frequently in patients with acute myocardial infarction (AMI), and is associated with increased subsequent cardiovascular mortality. However, only a few studies directly evaluated the relationship of left ventricular ejection fraction (LVEF) or left atrium diameter (LAD) and NOAF following AMI. MEDLINE ® , EMBASE ® and the Cochrane Library were carried out to find studies until January 2017. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate the value of LVEF and LAD in the prediction of NOAF after AMI. We performed sensitivity analyses to explore the potential sources of heterogeneity. Statistical analyses were carried out using the Revman 5.3. We included 10 qualifying studies comprising a total of 708 patients with NOAF and 6785 controls. Overall, decreased LVEF and increased LAD levels had a significant positive association with NOAF in patients with AMI. The MD in the LVEF levels between the patients with and those without NOAF was -4.91 units (95% Cl: -5.70 to -4.12), test for overall effect z-score = 12.18 ( p < 0.00001, I 2 = 35%). Moreover, in a subgroup analysis, the MD for LAD and NOAF was 2.55 units (95% Cl: 1.91 to 3.19), test for overall effect z-score = 7.80 ( p < 0.00001, I 2 = 57%). Our meta-analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI.

  11. Associations of electrocardiographic P-wave characteristics with left atrial function, and diffuse left ventricular fibrosis defined by cardiac magnetic resonance: The PRIMERI Study.

    Science.gov (United States)

    Tiffany Win, Theingi; Ambale Venkatesh, Bharath; Volpe, Gustavo J; Mewton, Nathan; Rizzi, Patricia; Sharma, Ravi K; Strauss, David G; Lima, Joao A; Tereshchenko, Larisa G

    2015-01-01

    Abnormal P-terminal force in lead V1 (PTFV1) is associated with an increased risk of heart failure, stroke, atrial fibrillation, and death. Our goal was to explore associations of left ventricular (LV) diffuse fibrosis with left atrial (LA) function and electrocardiographic (ECG) measures of LA electrical activity. Patients without atrial fibrillation (n = 91; mean age 59.5 years; 61.5% men; 65.9% white) with structural heart disease (spatial QRS-T angle ≥105° and/or Selvester QRS score ≥5 on ECG) but LV ejection fraction >35% underwent clinical evaluation, cardiac magnetic resonance, and resting ECG. LA function indices were obtained by multimodality tissue tracking using 2- and 4-chamber long-axis images. T1 mapping and late gadolinium enhancement were used to assess diffuse LV fibrosis and presence of scar. P-prime in V1 amplitude (PPaV1) and duration (PPdV1), averaged P-wave-duration, PR interval, and P-wave axis were automatically measured using 12 SLTM algorithm. PTFV1 was calculated as a product of PPaV1 and PPdV1. In linear regression after adjustment for demographic characteristics, body mass index, maximum LA volume index, presence of scar, and LV mass index, each decile increase in LV interstitial fibrosis was associated with 0.76 mV*ms increase in negative abnormal PTFV1 (95% confidence interval [CI] -1.42 to -0.09; P = .025), 15.3 ms prolongation of PPdV1 (95% CI 6.9 to 23.8; P = .001) and 5.4 ms prolongation of averaged P-duration (95% CI 0.9-10.0; P = .020). LV fibrosis did not affect LA function. PPaV1 and PTFV1 were associated with an increase in LA volumes and decrease in LA emptying fraction and LA reservoir function. LV interstitial fibrosis is associated with abnormal PTFV1, prolonged PPdV1, and P-duration, but does not affect LA function. Copyright © 2015 Heart Rhythm Society. All rights reserved.

  12. Diastolic dysfunction predicts new-onset atrial fibrillation and cardiovascular events in patients with acute myocardial infarction and depressed left ventricular systolic function: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jons, Christian; Joergensen, Rikke Moerch; Hassager, Christian

    2010-01-01

    The aim of this study was to investigate the association between diastolic dysfunction and long-term occurrence of new-onset atrial fibrillation (AF) and cardiac events in patients with acute myocardial infarction (AMI) and left ventricular (LV) systolic dysfunction.......The aim of this study was to investigate the association between diastolic dysfunction and long-term occurrence of new-onset atrial fibrillation (AF) and cardiac events in patients with acute myocardial infarction (AMI) and left ventricular (LV) systolic dysfunction....

  13. Effect of preload reduction by hemodialysis on left atrial volume and echocardiographic Doppler parameters in patients with end-stage renal disease.

    Science.gov (United States)

    Barberato, Silvio H; Mantilla, Diego E V; Misocami, M Arcio; Gonçalves, Simone M; Bignelli, Alexandre T; Riella, Miguel C; Pecoits-Filho, Roberto

    2004-11-01

    Left atrial (LA) volume has been proposed as a less preload-dependent parameter of diastolic function than Doppler mitral inflow. We hypothesize that in the absence of mitral regurgitation and atrial fibrilation, LA enlargement could be a more practical (and relatively preload-independent) method for the evaluation of left ventricular diastolic function. The aim of the present study was to determine the effects of preload reduction by hemodialysis on LA volume.

  14. Left and right atrial feature tracking in acute myocarditis: A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Dick, Anastasia, E-mail: anastasia-dick@web.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Schmidt, Björn, E-mail: bjoernschmidt1989@gmx.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Michels, Guido, E-mail: guido.michels@uk-koeln.de [Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Bunck, Alexander C., E-mail: alexander.bunck@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Maintz, David, E-mail: david.maintz@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Baeßler, Bettina, E-mail: bettina.baessler@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany)

    2017-04-15

    Purpose: The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. Methods: CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [ε{sub s}], peak positive SR [SR{sub s}]), conduit function (passive strain [ε{sub e}], peak early negative SR [SR{sub e}]) and booster pump function (active strain [ε{sub a}], peak late negative SR [SR{sub a}]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV). Results: FT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA ε{sub s}: 32 ± 17 vs. 46 ± 13, p = 0.019; LA SR{sub s}: 1.5 ± 0.5 vs. 1.8 ± 0.5, p = 0.117; LA SR{sub e}: −1.3 ± 0.5 vs. −1.9 ± 0.5, p < 0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SR{sub e} proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SR{sub e} with a cut-off of −1.6 s{sup −1} resulted in a diagnostic sensitivity of 83% and a specificity of

  15. Percutaneous left atrial appendage occlusion: Effect of device positioning on outcome.

    Science.gov (United States)

    Wolfrum, Mathias; Attinger-Toller, Adrian; Shakir, Samera; Gloekler, Steffen; Seifert, Burkhardt; Moschovitis, Aris; Khattab, Ahmed; Maisano, Francesco; Meier, Bernhard; Nietlispach, Fabian

    2016-10-01

    The study in patients with percutaneous left atrial appendage (LAA) occlusion investigates clinical outcomes according to the position of the Amplatzer Cardiac Plug (ACP) disc. The ACP consists of a disc and an anchoring lobe. The disc is meant to cover the ostium of the LAA, but frequently retracts partially or completely into the neck of the LAA. It is not known whether a retracted disc affects outcome. Outcomes of 169 consecutive patients (age 73.1 ± 10.4 years; 76% male) with successful LAA closure were analyzed according to the position of the ACP disc: group A had complete coverage of the LAA ostium; in group B the disc prolapsed partially or completely into the LAA-neck. Transesophageal echocardiography was performed 1-6 months after ACP implantation. The safety endpoint was the composite of clinically significant pericardial effusion, device embolization, procedure-related stroke/transient ischemic attack (TIA), major bleeding, or device thrombus. The efficacy endpoint was the composite of death, neurological events (ischemic and hemorrhagic stroke, TIA), or systemic embolism during follow-up. Group A comprised 76 patients (age 73.0 ± 9.9 years; 74% male) and group B 93 patients (age 73.3 ± 10.9 years; 79% male). Mean CHA 2 DS 2 -Vasc score and HASBLED score were 4.2 ± 1.7 (group A 4.3 ± 1.6; group B 4.2 ± 1.8) and 2.9 ± 1.1 (group A 2.9 ± 1.0; group B 3.0 ± 1.2), respectively. Mean follow-up of the study population was 13.0 ± 10.4 months. Overall, the composite safety and efficacy endpoints occurred in 20 (12%) and 6 patients (4%), respectively. There was no significant difference between groups A and B in the occurrence of the safety endpoint (13% vs. 11%, P = 0.64), or the efficacy endpoint (4% vs. 3%, P = 1.0). No evidence for a difference in the occurrence of the safety and efficacy endpoint was found between patients with complete vs. incomplete ACP disc coverage of the LAA ostium. The risk of

  16. Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation.

    Science.gov (United States)

    Huo, Yan; Gaspar, Thomas; Pohl, Matthias; Sitzy, Judith; Richter, Utz; Neudeck, Sebastian; Mayer, Julia; Kronborg, Mads Brix; Piorkowski, Christopher

    2017-06-10

    To describe the extent and distribution of low voltage zones (LVZ) in a large cohort of patients undergoing ablation for paroxysmal and persistent atrial fibrillation (AF), and to explore baseline predictors of LVZ in these patients. Consecutive patients who underwent a bipolar voltage map guided AF ablation, were enrolled. Voltage maps were conducted for each patient using 3-dimensional electroanatomical mapping system and LVZ were defined as areas of bipolar voltage voltage zones was present in 58 out of 292 patients with paroxysmal and 134 out of 247 persistent AF (P < 0.001). The area of LVZ was larger in patients with persistent as compare to paroxysmal AF, 5 cm2 (IQR 3-18.6) vs. 12.1 cm2 (IQR 3.6-28.5), P = 0.026, respectively. In the multivariate analysis age (OR 1.07, 95%CI 1.05-1.10, P < 0.001), female gender (OR 2.18, 95%CI 1.38-3.43, P = 0.001), sinoatrial node dysfunction (OR 3.90, 95%CI 1.24-12.21, P = 0.020), larger surface area of left atrium pr. cm2 (OR 1.01, 95%CI 1.00-1.02, P = 0.016), and persistent AF (OR 5.03, 95%CI 3.20-7.90, P<0.001) were associated with presence of LVZ. In a large cohort of patients undergoing ablation for AF, the prevalence of LVZ was higher and LVZ areas larger in patients with persistent as compared with paroxysmal AF. The most frequent localization of LVZ was anterior wall, septum and posterior wall. Presence of LVZ was associated with higher age, female gender, larger LA surface area, and sinoatrial node dysfunction. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  17. Noninvasive assessment of left atrial maximum dP/dt by a combination of transmitral and pulmonary venous flow.

    Science.gov (United States)

    Nakatani, S; Garcia, M J; Firstenberg, M S; Rodriguez, L; Grimm, R A; Greenberg, N L; McCarthy, P M; Vandervoort, P M; Thomas, J D

    1999-09-01

    The study assessed whether hemodynamic parameters of left atrial (LA) systolic function could be estimated noninvasively using Doppler echocardiography. Left atrial systolic function is an important aspect of cardiac function. Doppler echocardiography can measure changes in LA volume, but has not been shown to relate to hemodynamic parameters such as the maximal value of the first derivative of the pressure (LA dP/dt(max)). Eighteen patients in sinus rhythm were studied immediately before and after open heart surgery using simultaneous LA pressure measurements and intraoperative transesophageal echocardiography. Left atrial pressure was measured with a micromanometer catheter, and LA dP/dt(max) during atrial contraction was obtained. Transmitral and pulmonary venous flow were recorded by pulsed Doppler echocardiography. Peak velocity, and mean acceleration and deceleration, and the time-velocity integral of each flow during atrial contraction was measured. The initial eight patients served as the study group to derive a multilinear regression equation to estimate LA dP/dt(max) from Doppler parameters, and the latter 10 patients served as the test group to validate the equation. A previously validated numeric model was used to confirm these results. In the study group, LA dP/dt(max) showed a linear relation with LA pressure before atrial contraction (r = 0.80, p LA. Among transmitral flow parameters, mean acceleration showed the strongest correlation with LA dP/dt(max) (r = 0.78, p LA dP/dt(max) with an r2 > 0.30. By stepwise and multiple linear regression analysis, LA dP/dt(max) was best described as follows: LA dP/dt(max) = 0.1 M-AC +/- 1.8 P-V - 4.1; r = 0.88, p LA dP/dt(max) correlated well (r = 0.90, p LA dP/dt(max) predicted by the above equation with r = 0.94. A combination of transmitral and pulmonary venous flow parameters can provide a hemodynamic assessment of LA systolic function.

  18. Left atrial volume assessment in atrial fibrillation using multimodality imaging: a comparison of echocardiography, invasive three-dimensional CARTO and cardiac magnetic resonance imaging.

    Science.gov (United States)

    Rabbat, Mark G; Wilber, David; Thomas, Kevin; Malick, Owais; Bashir, Atif; Agrawal, Anoop; Biswas, Santanu; Sanagala, Thriveni; Syed, Mushabbar A

    2015-06-01

    Left atrial size in atrial fibrillation is a strong predictor of successful ablation and cardiovascular events. Cardiac magnetic resonance multislice method (CMR-MSM) is the current gold standard for left atrial volume (LAV) assessment but is time consuming. We investigated whether LAV with more rapid area-length method by echocardiography (Echo-AL) or cardiac magnetic resonance (CMR-AL) and invasive measurement by 3D-CARTO mapping during ablation correlate with the CMR-MSM. We studied 250 consecutive patients prior to atrial fibrillation ablation. CMR images were acquired on 3T scanner to measure LAV by MSM and biplane area-length method. Standard echocardiography views were used to calculate LAV by biplane area-length method. LAV during ablation was measured by 3D-CARTO mapping. LAV was compared using intra-class correlation (ICC), Pearson's correlation and Bland-Altman plots. CMR-MSM was used as the reference standard. Mean LAV using CMR-MSM was 112.7 ± 36.7 ml. CMR-AL method overestimated LAV by 13.3 ± 21.8 ml (11.2%, p atrial fibrillation. CMR-AL and 3D-CARTO correlated and agreed well with CMR-MSM (r = 0.87 and 0.74, ICC = 0.80 and 0.77 respectively). However, Echo-AL had poor correlation and agreement with CMR-MSM (r = 0.66 and ICC = 0.48). Bland-Altman plots confirmed these findings. CMR-AL method may be used as an alternative to CMR-MSM, as it is non-invasive, rapid, and correlates well with CMR-MSM. LAV by different modalities should not be used interchangeably.

  19. New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial.

    Science.gov (United States)

    Kosmidou, Ioanna; Chen, Shmuel; Kappetein, A Pieter; Serruys, Patrick W; Gersh, Bernard J; Puskas, John D; Kandzari, David E; Taggart, David P; Morice, Marie-Claude; Buszman, Paweł E; Bochenek, Andrzej; Schampaert, Erick; Pagé, Pierre; Sabik, Joseph F; McAndrew, Thomas; Redfors, Björn; Ben-Yehuda, Ori; Stone, Gregg W

    2018-02-20

    There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes. In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. Among 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Assessment of left ventricular function in patients with atrial fibrillation by left ventricular filling and function curves determined by ECG gated blood pool scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Inagaki, Suetsugu

    1986-06-01

    Accurate cardiac function in patients with atrial fibrillation (Af) is difficult to assess, since a wide fluctuation of cardiac cycle makes the ventricular hemodynamics variable. Although ECG gated blood pool scintigraphy (EGBPS) is useful to evaluate left ventricular (LV) function, a conventional EGBPS might have a problem in applying to Af. Therefore, a new processing algorithm was devised to make multiple gated images discriminated by preceding R-R intervals (PRR), and LV filling and function curves were obtained in 62 patients with Af to evaluate LV function. LV filling curve, obtained by plotting end-diastolic volume (EDV) againt PRR, demonstrated that the blood filling was impaired in mitral stenosis and constrictive pericarditis, but recovered after mitral commissurotomy. LV function curve, by plotting stroke volume (SV) againt EDV, was quantitatively analysed by the indices such as Slope and Position. Both indices reduced significantly in heart failure. When compared among underlying diseases individually, the indices decreased in the following order; lone Af, hyperthyroidism, senile Af, hypertension, mitral valve disease, ischemic heart disease, dilated cardiomyopathy and aortic regurgitation. After the treatment with digitalis and/or diuretics, left and upward shift of function curve was observed. The rise in heart rate by atropine infusion made Slope and Position unchanged, and which implied that function curve was little influenced by heart rate per se. The rise in systolic blood pressure by angiotensin-II infusion caused shifts in function curve to rightward and downward. Downward shift, mostly seen in patients with gentler slope in control state, may imply afterload mismatch due to a decrease in preload reserve. (J.P.N.).

  1. Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain

    Energy Technology Data Exchange (ETDEWEB)

    Shang, Quanliang [University of Nebraska College of Medicine and Children' s Hospital and Medical Center, Division of Pediatric Cardiology, Omaha, NE (United States); Central South University, Department of Radiology, Second Xiangya Hospital, Changsha, Hunan Province (China); Sarikouch, Samir; Beerbaum, Philipp [Hannover Medical School, Hannover (Germany); Patel, Shivani; Danford, David A.; Kutty, Shelby [University of Nebraska College of Medicine and Children' s Hospital and Medical Center, Division of Pediatric Cardiology, Omaha, NE (United States); Schuster, Andreas [Department of Cardiology and Pneumonology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Goettingen (Germany); Steinmetz, Michael [Department of Pediatric Cardiology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Goettingen (Germany); Ou, Phalla [University Paris Diderot, Department of Radiology, Hospital Bichat, APHP, Paris (France)

    2017-01-15

    In patients with repaired coarctation of aorta (CoA), we assessed ventriculo-vascular characteristics using CMR-derived aortic area strain (AAS), left atrial (LA) and left ventricular (LV) longitudinal and circumferential strain (LS, CS). Seventy-five subjects including 50 with repaired CoA divided into hypertensive (n = 25), normotensive (n = 25) and 25 controls were studied. AAS was measured at 3 levels: ascending aorta, proximal descending and descending aorta. LA and LV LS were measured using CMR-feature tracking. LA and LV end-diastolic volumes, ejection fraction (EF) and mass were measured. Mean patient age was 19.7 ± 6.7 and controls 23 ± 15 (years). All strains (LA, LV, ascending and descending aortic) were lower in CoA subgroups compared to controls except the AAS at diaphragm, which was not different. Comparisons between hypertensive and normotensive CoA showed no differences in LV mass, LV volumetric indices, and LA and LV strain indices; however, ascending AAS was lower in hypertensive subgroup (p = 0.02). Ascending AAS was correlated with LV mass (r = -0.4, p = 0.005), LVEF (r = -0.4, p = 0.004), systolic blood pressure (r = -0.5, p = 0.0001) and LVLS (r = 0.5, p = 0.001). Ascending AAS correlated with LV mass, EF and LVLS. In hypertensive CoA, ascending AAS was reduced compared to normotensive CoA and controls, indicating vascular remodelling differences influenced by ongoing hypertension. (orig.)

  2. Left atrial volume index as a predictor for persistent left ventricular dysfunction after aortic valve surgery in patients with chronic aortic regurgitation: the role of early postoperative echocardiography.

    Science.gov (United States)

    Cho, In-Jeong; Chang, Hyuk-Jae; Hong, Geu-Ru; Heo, Ran; Sung, Ji Min; Lee, Sang-Eun; Chang, Byung-Chul; Shim, Chi Young; Ha, Jong-Won; Chung, Namsik

    2015-06-01

    This study aimed to explore whether echocardiographic measurements during the early postoperative period can predict persistent left ventricular systolic dysfunction (LVSD) after aortic valve surgery in patients with chronic aortic regurgitation (AR). We prospectively recruited 54 patients (59 ± 12 years) with isolated chronic severe AR who subsequently underwent aortic valve surgery. Standard transthoracic echocardiography was performed before the operation, during the early postoperative period (≤2 weeks), and then 1 year after the surgery. Twelve patients with preoperative LVSD demonstrated LVSD at early after the surgery. Of the 42 patients without LVSD at preoperative echocardiography, 15 patients (36%) developed early postoperative LVSD after surgical correction. All 27 patients without LVSD at early postoperative echocardiography maintained LV function at 1 year after surgery. In the other 27 patients with postoperative LVSD, 17 patients recovered from LVSD and 10 patients did not at 1 year after surgery. Multiple logistic analysis demonstrated that postoperative left atrial volume index (LAVI) was the only independent predictor for persistent LVSD at 1 year after surgery in patients with postoperative LVSD (OR 1.180, 95% CI, 1.003-1.390, P = 0.046). The optimal LAVI cutoff value (>34.9 mL/m(2) ) had a sensitivity of 80% and a specificity of 88% for the prediction of persistent LVSD. Prevalence of early postoperative LVSD was relatively high, even in the patients without LVSD at preoperative echocardiography. Postoperative LAVI could be useful to predict persistent LVSD after aortic valve surgery in patients with early postoperative LVSD. © 2014, Wiley Periodicals, Inc.

  3. Association of pulse pressure with new-onset atrial fibrillation in patients with hypertension and left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Larstorp, Anne Cecilie K; Ariansen, Inger; Gjesdal, Knut

    2012-01-01

    , and mean arterial pressure. When evaluated in the same model, the predictive effect of systolic and diastolic blood pressures together was similar to that of PP. In this population of patients with hypertension and left ventricular hypertrophy, PP was the strongest single blood pressure predictor of new......Previous studies have found pulse pressure (PP), a marker of arterial stiffness, to be an independent predictor of atrial fibrillation (AF) in general and hypertensive populations. We examined whether PP predicted new-onset AF in comparison with other blood pressure components in the Losartan...... Intervention For Endpoint reduction in hypertension study, a double-blind, randomized (losartan versus atenolol), parallel-group study, including 9193 patients with hypertension and electrocardiographic left ventricular hypertrophy. In 8810 patients with neither a history of AF nor AF at baseline, Minnesota...

  4. Isolated persistent left-sided superior vena cava, giant coronary sinus, atrial tachycardia and heart failure in a child

    Directory of Open Access Journals (Sweden)

    Nagaraja Moorthy

    2013-09-01

    Full Text Available Persistence of a left-sided superior vena cava (PLSVC with absent right superior vena cava (isolated PLSVC is a very rare venous malformation and commonly associated with congenital heart disease or alterations of the cardiac situs. We describe an unusual case of a young boy presenting with persistent atrial tachycardia and congestive heart failure. He was detected to have unexplained grossly dilated right atrium, right ventricle with systolic dysfunction and a giant coronary sinus (CS. The dilated CS closely mimicked a pseudo cor-triatriatum on echocardiography. Contrast echocardiography from both arms revealed opacification of the CS before the right atrium. Bilateral upper limb venography confirmed the presence of absent right SVC and isolated persistent left SVC draining into the giant coronary sinus.

  5. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction

    DEFF Research Database (Denmark)

    Pedersen, O D; Bagger, H; Køber, Lars Valeur

    1999-01-01

    in patients with reduced left ventricular function secondary to acute myocardial infarction. The patients in this study were those who qualified for inclusion into the TRAndolapril Cardiac Evaluation (TRACE) study, a randomized double-blind placebo-controlled study and who had sinus rhythm on the ECG obtained...... at randomization. Patients who fulfilled the criteria for inclusion were randomized to treatment with the ACE inhibitor trandolapril or placebo and were followed up for 2 to 4 years. Development and time to occurrence of atrial fibrillation in one 12-lead ECG recorded at the outpatient visits was the primary end...

  6. Quantification of left to right shunts in adults with atrial septal defects of secundum type, using radionuclide technique

    International Nuclear Information System (INIS)

    Sire, S.; Rootwelt, K.; Mangschau, A.

    1991-01-01

    Quantification of left to right shunt was carried out in 15 adult patients with a suspected ostium secundum atrial septal defect (ASD II). Radionuclide shunt quantitation correlated well with the results of righ heart catheterization. The radionuclide technique failed in two patients for technical reasons, but revealed no false negative or false positive results when technically satisfactory. The diagnosis was confirmed at operation. It is concluded that the radionuclide technique is a useful and reliable method which can also be used at follow-up after surgery in patients with artrial septal defects of secundum type. 20 refs., 3 figs., 1 tab

  7. Occult left atrial ball-like thrombus in a patient referred for surgical removal of suspected cerebellum tumor

    International Nuclear Information System (INIS)

    Możeńska, Olga; Kalińska, Irena; Brodowski, Karol; Walecki, Jerzy; Kosior, Dariusz A.

    2014-01-01

    Atrial fibrillation and related cardio-embolic cerebrovascular accidents are two well-defined major healthcare problems worldwide. It has been approximated that 2.2 million people in America and 4.5 million in European Union have paroxysmal or persistent atrial fibrillation. And atrial fibrillation itself is an independent long-term risk factor of stroke. We present a case of patient referred to our center for surgical removal of suspected cerebellum tumor, a case that had a rather unexpected ending. A 58-year-old male patient with a history of atrial fibrillation, congestive heart failure (NYHA II/III), stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with vertigo, headaches, mainly during physical activity and increased tiredness. Performed computer tomography revealed two lesions in the cerebellum and in the left lateral chamber. The diagnosis of a proliferative disease of the cerebellum was established and patient was referred to the Neurosurgical Department. Fortunately, before the operation the echocardiography was performed, which revealed two lesions in left atrium. The decision of the Heart Team was to refer the patient for an open-heart surgery, in which two thrombi were removed. Neurosurgeons decided to withdraw from further surgery and proceed with head MRI and conservative treatment, deciding that the lesion in the cerebellum was most likely an ischemic area. Looking at the brain lesion should always be done from the whole patient’s perspective. And using mutlimodality imaging may lead to appropriate diagnosis, correct course of therapeutic action and unexpected ending of a rather non-extraordinary case

  8. “Anomalous right pulmonary artery left atrial fistula”: Growth in vain

    Directory of Open Access Journals (Sweden)

    Vishal Kumar Jain

    2015-12-01

    Full Text Available We report a case of direct communication between the right pulmonary artery and the left atrium; a rare cause of central cyanosis in 10 year old boy, emphasizing the role of multislice computed tomography scanner in delineating the complex vascular abnormality over more invasive conventional angiography.

  9. Usefulness of left ventricular speckle tracking echocardiography and novel measures of left atrial structure and function in diagnosing paroxysmal atrial fibrillation in ischemic stroke and transient ischemic attack patients.

    Science.gov (United States)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne; Høst, Nis; Mahmoud, Masti Mahdy; Ovesen, Christian; Olsen, Flemming Javier; Jensen, Jan Skov; Biering-Sørensen, Tor

    2017-12-01

    Asymptomatic paroxysmal atrial fibrillation (PAF) is often assumed to be the cause of cryptogenic ischemic strokes (IS) and transient ischemic attacks (TIA). We examined the usefulness of measures obtained by 2D speckle tracking echocardiography and novel left atrial measurements, in the diagnosis of PAF in patients with IS and TIA. We retrospectively included 205 patients who after acute IS or TIA underwent an echocardiogram in sinus rhythm. Patients were designated as PAF-patients if they had one or more reported incidents of AF before or after their echocardiographic examination. None of the conventional echocardiographic parameters were significantly associated with PAF. Of the speckle tracking measurements, only early diastolic strain rate (0.7±0.2 s -1 vs. 0.8±0.3 s -1 , p = 0.048) and global longitudinal displacement (GLD) (3.15 ± 1.40 mm vs. 3.87 ± 1.56 mm, p = 0.007) proved significantly different. Of the left atrial parameters both minimal and maximal left atrium volume divided by left ventricular length (min LAV/LVL and max LAV/LVL, respectively) were significantly impaired (min LAV/LVL: 3.7 ± 2.1 cm 2 vs. 2.8 ± 1.11 cm 2 , p = 0.012; max LAV/LVL: 6.6 ± 3.1 cm 2 vs. 5.6 ± 1.7 cm 2 , p = 0.012). GLD, min max LAV/LVL proved significant after adjustment for age, gender, CHA 2 DS 2 -VASc and NIHSS. By combining information regarding age, GLD, min and max LAV/LVL the diagnostic accuracy of PAF improved, resulting in a significantly increased area under the curve (p = 0.037). In patients with IS and TIA GLD, min and max LAV/LVL were independently associated with the presence of PAF.

  10. Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results From PROTECT AF Versus PREVAIL.

    Science.gov (United States)

    Freeman, James V; Hutton, David W; Barnes, Geoffrey D; Zhu, Ruo P; Owens, Douglas K; Garber, Alan M; Go, Alan S; Hlatky, Mark A; Heidenreich, Paul A; Wang, Paul J; Al-Ahmad, Amin; Turakhia, Mintu P

    2016-06-01

    Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost effectiveness compared with anticoagulation has not been evaluated using all available contemporary trial data. We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation (PROTECT AF) and Prospective Randomized Evaluation of the Watchman LAA Closure Device in Patients With Atrial Fibrillation (PREVAIL) randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios compared with warfarin and dabigatran were $20 486 and $23 422 per quality-adjusted life year, respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 quality-adjusted life years, respectively) and more costly. At a willingness-to-pay threshold of $50 000 per quality-adjusted life year, LAA closure was cost effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer-term trial results and postmarketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical

  11. Left atrial volume index is an independent predictor of hypertensive response to exercise in patients with hypertension.

    Science.gov (United States)

    Lee, Sang-Eun; Youn, Jong-Chan; Lee, Hye Sun; Park, Sungha; Lee, Sang-Hak; Cho, In-Jeong; Shim, Chi Young; Hong, Geu-Ru; Choi, Donghoon; Kang, Seok-Min

    2015-02-01

    A hypertensive response to exercise (HRE) is known to be associated with higher risk of heart failure and future cardiovascular events in patients with hypertension. Left atrial volume index (LAVI) is associated with the diastolic dysfunction, indicating exercise intolerance. Therefore, we investigated whether LAVI is relevant to HRE during cardiopulmonary exercise test (CPET). We studied 118 consecutive hypertensive patients (61 men, 57±11 years) and 45 normotensive control subjects (16 men, 54±8 years). Clinical characteristics, CPET, echocardiographic and laboratory findings were assessed at the time of enrollment. HRE was defined as maximum systolic blood pressure (SBP)⩾210 mm Hg in men and ⩾190 mm Hg in women. HRE was more prevalent in hypertensive patients compared with normotensive control subjects (50.8% vs. 20.0%, PHRE in normotensive control subjects, as were baseline SBP and LAVI in hypertensive group. In multivariate analysis, LAVI was found to be an independent predictor of HRE in hypertensive patients (P=0.020) but not in normotensive control subjects (P=0.936) when controlled for age, sex, body mass index and peak oxygen consumption. Higher LAVI, reflecting the duration and severity of increased left atrial pressure is independently associated with HRE in hypertensive patients, but not in normotensive control subjects.

  12. Left atrial appendage occlusion with Amplatzer Cardio Plug is an acceptable therapeutic option for prevention of stroke recurrence in patients with non-valvular atrial fibrillation and contraindication or failure of oral anticoagulation with acenocumarol

    OpenAIRE

    Hawkes, Maximiliano A.; Pertierra, Lucía; Rodriguez-Lucci, Federico; Pujol-Lereis, Virginia A.; Ameriso, Sebastián F.

    2016-01-01

    ABSTRACT Left atrial appendage occlusion (LAAO) appears as a therapeutic option for some atrial fibrillation patients not suitable for oral anticoagulation because an increased hemorrhagic risk or recurrent ischemic events despite anticoagulant treatment. Methods Report of consecutive atrial fibrillation patients treated with LAAO with Amplatzer Cardio Plug because contraindication or failure of oral anticoagulation with acenocumarol. CHA2DS2VASC, HAS-BLED, NIHSS, mRS, procedural complicati...

  13. Left ventricular dysfunction in repaired tetralogy of Fallot: incidence and impact on atrial arrhythmias at long term-follow up.

    Science.gov (United States)

    Ait Ali, Lamia; Trocchio, GianLuca; Crepaz, Roberto; Stuefer, Josef; Stagnaro, Nicola; Siciliano, Valeria; Molinaro, Sabrina; Sicari, Rosa; Festa, Pierluigi

    2016-09-01

    Left ventricle (LV) systolic dysfunction in repaired tetralogy of Fallot (TOF) has been identified as a risk factor for functional status and adverse outcome. The aims of this cross-sectional followed by a prospective study were: (1) to evaluate the prevalence of LV systolic dysfunction in a large cohort of adults with repaired tetralogy of Fallot, (2) to test the relationship between LV systolic dysfunction and other known risk factors and (3) to evaluate the impact of LV systolic dysfunction on adverse cardiac events. In a multicenter study, 237 adults repaired TOF (58 % males, age 30 ± 10 years) were evaluated by cardiac magnetic resonance (CMR). Demographics, surgical history, ECG, Echo-Color Doppler and follow-up data were recorded. LV was dilated (Z value >2) in 16 patients (6 %), however 56 patients (23.6 %) had a reduced LV systolic function left ventricle ejection fraction (LVEF) (Z value <-2). Patients with LV systolic dysfunction were mainly males (82 %), had reduced right ventricle ejection fraction (RVEF), and higher right and left Late Gadolinium Enhanced scores. In a multivariate regression analysis male gender and RVEF resulted to be independent factors associated to LV systolic dysfunction. Atrial arrhythmias were the main adverse cardiac event at the follow-up and were associated to higher biventricular volumes and lower biventricular ejection fraction (EF); however multivariable analysis identified age, right ventricle end-diastolic volume (RVEDVi) and tricuspid regurgitation as independents factors associated to atrial arrhythmias. At long term follow-up at least ¼ of repaired TOF has LV dysfunction. Lower LVEF is associated to male gender and lower RVEF.

  14. Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial.

    Science.gov (United States)

    Belgaid, Djouhar Roufeida; Khan, Zara; Zaidi, Mariam; Hobbs, Adrian

    2016-09-15

    Assessing the safety and effectiveness of left atrial appendage (LAA) (pouch found in the upper chambers of the heart) occlusion, using the Watchman device compared to long term warfarin therapy (drug that reduces clot formation), in preventing the risk of stroke in patients with atrial fibrillation (most common type of irregular heart beat). 90% of strokes in atrial fibrillation arise from clots forming in this pouch. By mechanically blocking it using the device less clots are suggested to be formed. This is an alternative to taking warfarin especially in patients who cannot take it. 50 sites in the United States enrolled 407 participants. After being randomly allocated, the device group had 269 participants and warfarin group (comparator)had 138 participants. Patients with atrial fibrillation and at high risk of stroke were randomly allocated a group after they were deemed eligible. Patients in the device group had to take warfarin and aspirin for 45days till the complete closure of the LAA. The oral anticoagulant was followed by dual antiplatelet therapy until 6months and then ASA. Patients in the warfarin group have to take it for life and were continually monitored. The study ran for 26months. The trial assessed the rate of adverse events using three endpoints: The PREVAIL trial was not designed to show superiority, but non-inferiority. It met the safety endpoint and one efficacy endpoint for the watchman device compared to long term warfarin for overall efficacy of the device. The results established that LAA occlusion is not worse than warfarin intake for the prevention of stroke more than 1week after randomization. Compared to previous trials, the safety of the device has also improved. LAA occlusion is a reasonable alternative to chronic warfarin therapy in stroke prevention for patients with atrial fibrillation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Fully automatic segmentation of left atrium and pulmonary veins in late gadolinium-enhanced MRI: Towards objective atrial scar assessment.

    Science.gov (United States)

    Tao, Qian; Ipek, Esra Gucuk; Shahzad, Rahil; Berendsen, Floris F; Nazarian, Saman; van der Geest, Rob J

    2016-08-01

    To realize objective atrial scar assessment, this study aimed to develop a fully automatic method to segment the left atrium (LA) and pulmonary veins (PV) from late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI). The extent and distribution of atrial scar, visualized by LGE-MRI, provides important information for clinical treatment of atrial fibrillation (AF) patients. Forty-six AF patients (age 62 ± 8, 14 female) who underwent cardiac MRI prior to RF ablation were included. A contrast-enhanced MR angiography (MRA) sequence was acquired for anatomy assessment followed by an LGE sequence for LA scar assessment. A fully automatic segmentation method was proposed consisting of two stages: 1) global segmentation by multiatlas registration; and 2) local refinement by 3D level-set. These automatic segmentation results were compared with manual segmentation. The LA and PVs were automatically segmented in all subjects. Compared with manual segmentation, the method yielded a surface-to-surface distance of 1.49 ± 0.65 mm in the LA region when using both MRA and LGE, and 1.80 ± 0.93 mm when using LGE alone (P automatic and manual segmentation was comparable to the interobserver difference (P = 0.8 in LA region and P = 0.7 in PV region). We developed a fully automatic method for LA and PV segmentation from LGE-MRI, with comparable performance to a human observer. Inclusion of an MRA sequence further improves the segmentation accuracy. The method leads to automatic generation of a patient-specific model, and potentially enables objective atrial scar assessment for AF patients. J. Magn. Reson. Imaging 2016;44:346-354. © 2016 Wiley Periodicals, Inc.

  16. Left atrial dysfunction in type 2 diabetes mellitus: insights from cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Graca, Bruno; Donato, Paulo; Caseiro-Alves, Filipe [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Medical Imaging Department, Coimbra (Portugal); Joao Ferreira, Maria [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Cardiology Department, Coimbra (Portugal); Gomes, Leonor [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Endocrinology Department, Coimbra (Portugal); Castelo-Branco, Miguel [University of Coimbra, Faculty of Medicine, Coimbra (Portugal)

    2014-11-15

    The left atrium (LA) modulates left ventricular filling through reservoir, conduit and booster pump functions. Only limited data exist on LA involvement in type 2 diabetes mellitus (DM2). This study sought to assess LA function in asymptomatic DM2 with cardiac MRI. We hypothesized that cardiac MRI can detect LA dysfunction in asymptomatic DM2. Forty-five patients with asymptomatic DM2 and 24 normoglycaemic controls were studied. MRI cine imaging was performed to measure LA maximal and minimal volumes. A flow-sensitive phase-contrast gradient-echo sequence was used for flow measurements perpendicular to the orifice of the mitral valve, to quantify active LA stroke volume. LA total, passive and active emptying volumes and fractions were calculated. LA reservoir function, namely LA total ejection fraction, was significantly greater in controls compared to patients with DM2 (62.2 ± 5.2 vs 57.0 ± 7.6 %, P = 0.004). LA passive ejection fraction was also greater in the controls (26.2 ± 9.5 vs 16.1 ± 11.0 %, P < 0.001). Regarding parameters of LA booster pump function, LA active ejection fraction was not significantly different between groups. DM2 was demonstrated to be an independent determinant of LA function. Cardiac MRI enables the detection of LA dysfunction in asymptomatic DM2, characterized by a reduction in LA reservoir and conduit functions. (orig.)

  17. Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

    Directory of Open Access Journals (Sweden)

    Machado Cristiano V

    2011-06-01

    Full Text Available Abstract Background Left ventricular ejection fraction (LVEF has been considered a major determinant of early outcome in acute myocardial infarction (AMI. Myocardial performance index (MPI has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF specifically in patients with a first isolated ST-elevation AMI. Methods Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF. Results Early in-hospital CHF occurred in 29 (31% of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p Conclusion For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.

  18. The application and value of 64 multislice spiral CT of left atrium and pulmonary vein in radio-frequency ablation of atrial fibrillation

    International Nuclear Information System (INIS)

    Guo Xi; Lv Biao; Zhang Zhaoqi; Zhao Yike; Jiang Hong; Ma Changsheng; Yu Ronghui; Wang Xue; Cao Hainian

    2008-01-01

    Objective: Analyzing the left atrium and pulmonary vein morphologically by 64 multislice spiral CT (MSCT) scan to guide the catheter ablation of Atrial fibrillation. Methods: Two hundred and thirty-two patients (146 cases in atrial fibrillation group and 86 cases in control group) received 64 MSCT examination of the left atrium and pulmonary vein. The incidence of anatomical variation of pulmonary vein was compared between atrial fibrillation group and control group. For each group, the anatomical morphology of every pulmonary vein and the auricle of left atrium was analyzed, the diameter of the orifice of each pulmonary vein and the size of left atrium were measured. Results: Sixty-four MSCT of left atrium and pulmonary vein could demonstrate detailed connecting type between left atrium and pulmonary veins and the possible anatomical variation. Anatomical variation of pulmonary vein in this study accounted for 16.8% (39/232) of total sample. For both groups, orifices of pulmonary veins appeared oval and their superoinferior diameters were larger than their anteroposterior diameters. There was significant difference in the inner diameter of left atrium between atrial fibrillation group and control group [atrial fibrillation group: (39.47 ± 8.98) mm, control group: (36.94±5.49) mm, P=0.02], while there was no difference in the diameters of orifices of pulmonary veins between two groups [superoinferior diameters of pulmonary veins in atrial fibrillation group: left-up (18.15±1.35) mm, left-down (16.96±1.18) mm, right-up (17.50±1.12) mm, fight-down (17.65±0.94) mm, superoinferior diameters of pulmonary veins in control group: left-up (18.07±0.94) mm, left-down (17.50±0.57) mm, right-up (18.03±1.02) mm, fight-down (17.94±0.76) mm, the corresponding P>0.05, respectively, anteroposterior diameters of pulmonary veins in atrial fibrillation group: left-up (12.26±1.89) mm, left-down (11.96±0.61) mm, right-up (12.32± 1.08) mm, fight-down (12.39±0.95) mm

  19. Predicting Peri-Device Leakage of Left Atrial Appendage Device Closure Using Novel Three-Dimensional Geometric CT Analysis.

    Science.gov (United States)

    Chung, Hyemoon; Jeon, Byunghwan; Chang, Hyuk-Jae; Han, Dongjin; Shim, Hackjoon; Cho, In Jeong; Shim, Chi Young; Hong, Geu-Ru; Kim, Jung-Sun; Jang, Yangsoo; Chung, Namsik

    2015-12-01

    After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incomplete occlusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAA orifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiac computerized tomography (CT) using a novel 3D analysis system. We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakage as the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients without peri-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles θ and φ were defined between the IAS plane and the line, linking the LAA orifice center and foramen ovale. Group 2 exhibited significantly better left atrial (LA) function than group 1 (p = 0.031). Pre-procedural θ was also larger in this group (41.9° vs. 52.3°, p = 0.019). The LAA cauliflower-type morphology was more common in group 2. Overall, the patients' LA reserve significantly decreased after the procedure (21.7 mm(3) vs. 17.8 mm(3), p = 0.035). However, we observed no significant interval changes in pre- and post-procedural values of θ and φ in either group (all p > 0.05). Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakage after LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidates for LAA device closure.

  20. A stochastic approach for automatic registration and fusion of left atrial electroanatomic maps with 3D CT anatomical images

    International Nuclear Information System (INIS)

    Cristoforetti, Alessandro; Mase, Michela; Faes, Luca; Centonze, Maurizio; Greco, Maurizio Del; Antolini, Renzo; Nollo, Giandomenico; Ravelli, Flavia

    2007-01-01

    The integration of electroanatomic maps with highly resolved computed tomography cardiac images plays an important role in the successful planning of the ablation procedure of arrhythmias. In this paper, we present and validate a fully-automated strategy for the registration and fusion of sparse, atrial endocardial electroanatomic maps (CARTO maps) with detailed left atrial (LA) anatomical reconstructions segmented from a pre-procedural MDCT scan. Registration is accomplished by a parameterized geometric transformation of the CARTO points and by a stochastic search of the best parameter set which minimizes the misalignment between transformed CARTO points and the LA surface. The subsequent fusion of electrophysiological information on the registered CT atrium is obtained through radial basis function interpolation. The algorithm is validated by simulation and by real data from 14 patients referred to CT imaging prior to the ablation procedure. Results are presented, which show the validity of the algorithmic scheme as well as the accuracy and reproducibility of the integration process. The obtained results encourage the application of the integration method in post-intervention ablation assessment and basic AF research and suggest the development for real-time applications in catheter guiding during ablation intervention

  1. [Stroke. are there any difference between patients with or without patent foramen ovale in left atrial appendage systolic function?].

    Science.gov (United States)

    Contreras, Alejandro E; Perrote, Federico; Concari, Ignacio; Brenna, Eduardo J; Lucero, Cecilia

    2012-01-01

    The aim of this study was to evaluate the systolic function of the left atrial appendage (LAA) in a group with and without patent foramen ovale (PFO) who suffered ischemic cerebrovascular events. Between September 2010 and October 2011, 17 patients were referred for transesophageal echocardiography (TEE) after suffering a stroke. PFO was defined as the passage of at least one bubble through atrial septum with bubble test. We compared systolic velocity in the appendage between patients with and without PFO and a control group. Were 8 women and 9 men, mean age 54.1 ± 19.5 years and 8 patients were under 55 years of age. All patients had suffered a ischemic cerebrovascular events, 41.2% had stroke, 52.9% transient ischemic attack and amaurosis fugax 5.9%. In the assessment of TEE, 11.8% had atrial septal aneurysm and 35.3% PFO. Mean LAA systolic velocity was 66.3 ± 20.3 cm / sec. There was no difference in systolic velocity of the LAA between patients with and without PFO (67.5 ± 11.8 cm / sec vs 65.7 ± 24.3 cm / sec respectively, p = 0.87). The control group of 8 patients, 5 women and 3 men, mean age 39.5 ± 18 years, had a LAA systolic velocity of 77.6 ± 28.9 cm / sec, no significant differences with ischemic patients. There were no differences in systolic function of the LAA between patients with and without PFO with ischemic cerebrovascular event.

  2. Epicardial clip occlusion of the left atrial appendage during cardiac surgery provides optimal surgical results and long-term stability.

    Science.gov (United States)

    Kurfirst, Vojtech; Mokrácek, Aleš; Canádyová, Júlia; Frána, Radim; Zeman, Petr

    2017-07-01

    Occlusion of the left atrial appendage (LAA) has become an integral and important part of the surgical treatment of atrial fibrillation. Different methods of surgical occlusion of the LAA have been associated with varying levels of short- and long-term success for closure. The purpose of this study was to evaluate long-term results of epicardial placement and endocardial occlusion in patients undergoing cardiac operative procedures. A total of 101 patients (average age 65.7 years) undergoing cardiac operative procedures with the epicardial AtriClip Exclusion System of the LAA were enrolled in the study. The AtriClip was placed via a sternotomy or a thoracotomy or from a thoracoscopic approach. Postoperative variables, such as thromboembolic events, clip stability and endocardial leakage around the device, were examined by transoesophageal echocardiography (TEE) and/or computed tomography. Perioperative clip implantation was achieved in 98% of patients. TEE and/or computed tomography conducted during the follow-up period, comprising 1873 patient-months with a mean duration of 18 ± 11 months, revealed no clip migration, no leakage around the device and no clot formation near the remnant cul-de-sac. During the follow-up period, 4 of the cardiac patients experienced transitory ischaemic attacks, whereas no patient experienced a cerebrovascular attack. The Epicardial AtriClip Exclusion System of the LAA appears to be a feasable and safe operative method with a high success rate. Long-term follow-up confirmed clip stability, complete occlussion of the LAA and absence of any atrial fibrilation-related thromboembolic events. These results need to be confirmed by a larger, multicentre study. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  3. Anatomical analysis of incidental left atrial diverticula in patients with suspected coronary artery disease using 64-channel multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Shin, S.Y. [Department of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of); Kwon, S.H., E-mail: Kwon98@khu.ac.kr [Department of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of); Oh, J.H. [Department of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2011-10-15

    Aim: To describe and evaluate anatomical characterizations of incidental left atrial (LA) diverticula in patients with suspected coronary artery disease using 64-channel multidetector computed tomography (MDCT). Materials and methods: From October 2008 to June 2009, 2059 patients with suspected coronary artery disease underwent electrocardiogram-gated 64-channel MDCT. Five hundred and thirty-two LA diverticula were identified in 377 patients (18.3%, male to female ratio: 216:161, mean age 59 {+-} 10.89 years, range from 20 to 91 years). Two radiologists retrospectively analysed the number (single or multiple), size (diameter and length), shape (cystiform or tubiform), surface (smooth or irregular), and location (right or mid or left/upper or lower/lateral or posterior). If the length/diameter was <1.5, the diverticular shape was considered to be cystiform. Results: Among 532 LA diverticula, single (270/532, 51.1%), cystiform (411/532, 77.3%), and smooth (332/532, 62.4%) diverticula were found. The right upper region (255/532, 47.9%) was the most common location, followed by the left lateral area (172/532, 32.3%). The average diameter was 4.7 {+-} 2 mm (range from 1-19 mm), and the average length was 4.7 {+-} 2.1 mm (range 1-13 mm). The average ratio of length to diameter was 1.15 (range 0.25-1.45). The average number of diverticula was 2 {+-} 1.06 (range 1-5). Conclusion: Incidental LA diverticulum is not an uncommon finding in patients with suspected coronary artery disease. MDCT can provide anatomical details of LA diverticula. However, further studies are needed to determine their clinical significance.

  4. Prognostic value of left atrial function in systemic light-chain amyloidosis: a cardiac magnetic resonance study.

    Science.gov (United States)

    Mohty, Dania; Boulogne, Cyrille; Magne, Julien; Varroud-Vial, Nicolas; Martin, Sylvain; Ettaif, Hind; Fadel, Bahaa M; Bridoux, Frank; Aboyans, Victor; Damy, Thibaud; Jaccard, Arnaud

    2016-09-01

    Cardiac involvement in systemic light-chain amyloidosis (AL) imparts an adverse impact on outcome. The left atrium (LA), by virtue of its anatomical location and muscular wall, is commonly affected by the amyloid process. Although LA infiltration by amyloid fibrils leads to a reduction in its pump function, the infiltration of the left ventricular (LV) myocardium results in diastolic dysfunction with subsequent increase in filling pressures and LA enlargement. Even though left atrial volume (LAV) is an independent prognostic marker in many cardiomyopathies, its value in amyloid heart disease remains to be determined. In addition, few data are available as to the prognostic value of LA function in systemic AL. Using cardiac magnetic resonance (CMR), the current study aims to assess the prognostic significance of the maximal LAV and total LA emptying fraction (LAEF) in patients with AL. Fifty-four consecutive patients (age 66 ± 10 years, 59% males) with confirmed systemic AL and mean LV ejection fraction of 60 ± 12% underwent CMR. As compared with patients with no or minimal cardiac involvement (Mayo Clinic [MC] stage I), those at moderate and high risk (MC stages II and III) had significantly larger indexed maximal LAV (36 ± 15 vs. 46 ± 13 vs. 52 ± 19 mL/m(2), P = 0.03) and indexed minimal LAV (20 ± 6 vs. 34 ± 11 vs. 44 ± 17 mL/m(2), P 16% (37 ± 11 vs. 94 ± 4%, P = 0.001). In multivariate analysis, lower LAEF remained independently associated with a higher risk of 2-year mortality (HR = 1.08 per 1% decrease, 95% CI: 1.02-1.15, P = 0.003). In patients with systemic AL, LAEF as assessed by CMR is associated with NYHA functional class, MC stage, myocardial LGE and 2-year mortality. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  5. Incidence of atrial fibrillation in patients with either heart failure or acute myocardial infarction and left ventricular dysfunction: a cohort study

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle D; Pedersen, Ole D; Køber, Lars

    2011-01-01

    We examined the incidence of new-onset atrial fibrillation in patients with left ventricular dysfunction. Patients either had a recent myocardial infarction (with or without clinical heart failure) or symptomatic heart failure (without a recent MI). Patients were with and without treatment...

  6. Autonomic dysfunction and new-onset atrial fibrillation in patients with left ventricular systolic dysfunction after acute myocardial infarction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jøns, Christian; Raatikainen, Pekka; Gang, Uffe J

    2010-01-01

    Atrial fibrillation (AF) increases morbidity and mortality in patients with previous myocardial infarction and left ventricular systolic dysfunction. The purpose of this study was to identify patients with a high risk for new-onset AF in this population using invasive and noninvasive...

  7. Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction

    DEFF Research Database (Denmark)

    Køber, Lars; Swedberg, Karl; McMurray, John J V

    2006-01-01

    AIMS: To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). MET...

  8. The Impact of Atrial Left-to-Right Shunt on Pulmonary Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

    Directory of Open Access Journals (Sweden)

    Eui Kyung Choi

    2015-10-01

    Conclusion: The presence of an atrial left-to-right shunt was associated with PH in preterm infants with moderate or severe BPD. Close follow up is needed for infants with interatrial shunts, and a more tailored prognostic evaluation and treatment are recommended.

  9. Detection of left atrial thrombus in patients with mitral stenosis and atrial fibrillation: retrospective comparison of two-phase computed tomography, transoesophageal echocardiography and surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Bo Hwa; Ko, Sung Min [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Radiology, Research Institute of Medical Science, Seoul (Korea, Republic of); Hwang, Hweung Kon [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Cardiology, Seoul (Korea, Republic of); Song, Meong Gun; Shin, Je Kyoun [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Thoracic surgery, Seoul (Korea, Republic of); Kang, Woon Seok; Kim, Tae-Yop [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Anesthesiology, Seoul (Korea, Republic of)

    2013-11-15

    This retrospective study aims to assess the accuracy of two-phase computed tomography (CT) and transoesophageal echocardiography (TEE) for the detection of left atrial (LA) thrombus in patients with mitral stenosis (MS) and atrial fibrillation (AF), by using intraoperative findings as the reference standard. Preoperative two-phase CT and intraoperative TEE were performed in 106 patients with MS and AF. The ratio (LAA/AA{sub L}) of Hounsfield units (HU) in the LA appendage (LAA) to the ascending aorta (AA) was calculated on the late-phase CT image. LA echodense masses on TEE and LA filling defects on two-phase CT were observed in 29 and 39 patients, respectively. Thirty-five LA thrombi were identified at surgery in 27 patients. Compared with the intraoperative findings, per-patient sensitivity, specificity, positive and negative predictive values of two-phase CT were 100 %, 85 %, 69 % and 100 %, and those by using TEE were 93 %, 95 %, 86 % and 97 % in detecting LAA thrombus. After adopting the cut-off value of 0.5 for the LAA/AA{sub L} HU ratio, the specificity and positive predictive value of two-phase CT were increased to 96 % and 90 %, respectively. Two-phase CT with a cut-off value of LAA/AA{sub L} HU ratio of 0.5 provides high performance for the detection of LAA thrombus. (orig.)

  10. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Ono Koji

    2012-12-01

    Full Text Available Abstract Background The aim of this study was to define the independent determinants of left atrial appendage (LAA thrombus among various echocardiographic parameters measured by Velocity Vector Imaging (VVI in patients with nonvalvular atrial fibrillation (AF receiving warfarin, particularly in patients with a low CHADS2 score. Methods LAA emptying fraction (EF and LAA peak longitudinal strain were measured by VVI using transesophageal echocardiography in 260 consecutive patients with nonvalvular persistent AF receiving warfarin. The patients were divided into two groups according to the presence (n=43 or absence (n=217 of LAA thrombus. Moreover, the patients within each group were further divided into subgroups according to a CHADS2 score ≤1. Results Multivariate logistic regression analysis showed that LAAEF was an independent determinant of LAA thrombus in the subgroup of 140 with a low CHADS2 score. Receiver operating characteristics curve analysis showed that an LAAEF of 21% was the optimal cutoff value for predicting LAA thrombus. Conclusions LAA thrombus formation depended on LAA contractility. AF patients with reduced LAA contractile fraction (LAAEF ≤21% require strong anticoagulant therapy to avoid thromboembolic events regardless of a low CHADS2 score (≤1.

  11. Effect of the Size of the Left Atrium on Sustained Sinus Rhythm in Patients Undergoing Mitral Valve Surgery and Concomitant Bipolar Radiofrequency Ablation for Atrial Fibrillation.

    Science.gov (United States)

    Avdagić, Harun; Sijerčić Avdagić, Selma; Pirić Avdagić, Melika; Antonič, Miha

    2017-12-01

    Atrial fibrillation is associated with systemic embolization and complications due to anticoagulant therapy. Radiofrequency ablation has been established as an effective and safe method for the treatment of atrial fibrillation. The aim of this study was to evaluate the effect of the size of the left atrium on the outcome of surgical radiofrequency ablation. Forty patients scheduled for elective mitral valve surgery and radiofrequency ablation were enrolled in the study. Group 1 consisted of patients with a left atrium diameter ≤5 cm and group 2 of patients with left atrium diameter >5 cm. The primary endpoint of the study was stable sinus rhythm 6 months postoperatively. At 6 months postoperatively, sinus rhythm was present in significantly more group 1 patients as compared with group 2 patients, i.e. 15 (75%) vs. 8 (40%), p=0.025. Multivariate analysis proved the size of the left atrium to be an independent predictor of the radiofrequency ablation outcome. Accordingly, the size of the left atrium was demonstrated to be an important predictor of the outcome of radiofrequency ablation for atrial fibrillation. A lower cut-off value of surgical reduction of the atria than previously reported should be considered in order to improve the radiofrequency ablation outcome.

  12. Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure

    DEFF Research Database (Denmark)

    Søndergaard, Lars; Reddy, Vivek; Kaye, David

    2014-01-01

    BACKGROUND: Heart failure with preserved or mildly reduced ejection fraction (HFpEF) is common and, to date, therapeutic options are limited. Increased left atrial pressure is a key contributor to the symptoms associated with HFpEF, particularly during physical activity. We report the 30-day...... outcome of patients treated with a novel device intended to lower left atrial pressure by creating an 8 mm permanent shunt in the atrial septum. METHODS AND RESULTS: Eleven patients were enrolled in the pilot trial. Key inclusion criteria were: EF >45%; baseline PCWP ≥15 mmHg (rest), or ≥ 25 mm...... patients, one class in five patients, and worsened by one class in one patient. No patient developed pulmonary hypertension. Two serious adverse events occurred; heart failure re-hospitalization, and implant malposition successfully treated with a new device. CONCLUSION: Contemporary management of HFp...

  13. Efficiency evaluation of treatment of atrial rhythm disorders on the left ventricular function

    International Nuclear Information System (INIS)

    Alberini, J.L.; Mansour, H.; Victor, F.; De Place, C.; Carre, F.; Daubert, J.C.; Borguet, P.

    1997-01-01

    The goal of this prospective study was to evaluate the development and evolution of the LV function after treatment of atrial arrhythmias, evolving for at least three months, associated to an alteration of the LV function. Twelve patients (61.3 ± 13.9 years) were divided into two groups: Gr1 - treatment by cardio-version or radiofrequency; Gr2 - pharmacological treatment or ablation of atrial-ventricular junction and implantation of a cardiac pacemaker. An examination including ECG, Holter, test-to-effort, echocardiography, cavitary angio-scintigraphy was effectuated 48 h and 6 weeks after reduction. A net clinic amelioration was observed in the evolution, confirmed by results of the echocardiographic and angio-scintigraphic examinations (with a correlation coefficient of 0.87). In exchange, between the two examinations, there is no significant difference for the test-to-effort with medium or maximal cardiac frequencies and the diameters or tele-diastolic and tele-systolic volumes for echography. After the multi-variable analysis the initial angio-scintigraphic measurement of the LV function is a good predictive factor in ameliorating the LV function in patients maintained in sinusal rhythm. In conclusion, the angio-scintigraphy permits predicting the treatment efficiency of the atrial arrhythmias on the LV function

  14. Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion.

    Science.gov (United States)

    Bauer, Anna; Khalil, Markus; Lüdemann, Monika; Bauer, Jürgen; Esmaeili, Anoosh; De-Rosa, Roberta; Voelkel, Norbert F; Akintuerk, Hakan; Schranz, Dietmar

    2018-04-16

    Left atrial decompression is considered in patients with symptomatic heart failure with preserved ejection fraction (HFpEF). We aimed to evaluate the feasibility and efficacy of transcatheter generation of a restrictive atrial septum communication to manage HFpEF from infancy to adulthood with cardiomyopathy and congenital heart defect. From June 2009 to December 2016, 24 patients (50% with an age less than 16 years) with HFpEF were palliated; NYHA-/Ross class IV (n = 10); median systemic ventricular ejection fraction 64 (range 35-78) %. Cardiomyopathy was classified as a restrictive (n = 4) or hypertrophic (n = 2). (75% related to congenital heart defects) Three patients had a systemic right ventricle; in the majority of patients, HFpEF was associated to complex congenital heart defects (n = 18). Mean pulmonary arterial pressures (PAP systolic/diastolic) were 56/28 (± 24/13), left atrial pressures (LAP, v-, a-wave, mean) 26/25/20 (± 7/10/6). Trans-septal puncture was used in 22 patients; foramen ovale dilatation in 2 patients. Median balloon size was 12 (range 6-18) mm; procedure time including diagnostic measures 125 (83-221) min. No procedural death or complications were observed. Mean LA-pressures decreased significantly to 19/19/15 ± 6/8/5 mmHg (p = 0.05); median brain natriuretic peptide (BNP) decreased from 392 (range 93-4401) pg/ml median BNP to 314 (range 61-1544) pg/ml (p = 0.05). Three patients died; one patient received orthotopic heart and one patient a heart-lung transplantation. No patient required so far an assist device. Clinical improvement occurred in all patients, in some after additional surgical or interventional approach. Transcatheter LA decompression is an age-independent, effective palliation treating patients with HFpEF.

  15. The Value of 3D Printing Models of Left Atrial Appendage Using Real-Time 3D Transesophageal Echocardiographic Data in Left Atrial Appendage Occlusion: Applications toward an Era of Truly Personalized Medicine.

    Science.gov (United States)

    Liu, Peng; Liu, Rijing; Zhang, Yan; Liu, Yingfeng; Tang, Xiaoming; Cheng, Yanzhen

    The objective of this study was to assess the clinical feasibility of generating 3D printing models of left atrial appendage (LAA) using real-time 3D transesophageal echocardiogram (TEE) data for preoperative reference of LAA occlusion. Percutaneous LAA occlusion can effectively prevent patients with atrial fibrillation from stroke. However, the anatomical structure of LAA is so complicated that adequate information of its structure is essential for successful LAA occlusion. Emerging 3D printing technology has the demonstrated potential to structure more accurately than conventional imaging modalities by creating tangible patient-specific models. Typically, 3D printing data sets are acquired from CT and MRI, which may involve intravenous contrast, sedation, and ionizing radiation. It has been reported that 3D models of LAA were successfully created by the data acquired from CT. However, 3D printing of the LAA using real-time 3D TEE data has not yet been explored. Acquisition of 3D transesophageal echocardiographic data from 8 patients with atrial fibrillation was performed using the Philips EPIQ7 ultrasound system. Raw echocardiographic image data were opened in Philips QLAB and converted to 'Cartesian DICOM' format and imported into Mimics® software to create 3D models of LAA, which were printed using a rubber-like material. The printed 3D models were then used for preoperative reference and procedural simulation in LAA occlusion. We successfully printed LAAs of 8 patients. Each LAA costs approximately CNY 800-1,000 and the total process takes 16-17 h. Seven of the 8 Watchman devices predicted by preprocedural 2D TEE images were of the same sizes as those placed in the real operation. Interestingly, 3D printing models were highly reflective of the shape and size of LAAs, and all device sizes predicted by the 3D printing model were fully consistent with those placed in the real operation. Also, the 3D printed model could predict operating difficulty and the

  16. An elusive persistent left superior vena cava draining into left atrium

    NARCIS (Netherlands)

    A. Soward; F.J. ten Cate (Folkert); P.M. Fioretti (Paolo); P.W.J.C. Serruys (Patrick); J.R.T.C. Roelandt (Jos)

    1986-01-01

    textabstractA case report of a persistent left superior vena cava draining into left atrium with a fibromuscular left ventricular outflow tract obstruction and a small atrial septal defect. The anomalous vessel escaped detection during two right and left heart catheterizations from the right arm and

  17. 3D patient-specific models for left atrium characterization to support ablation in atrial fibrillation patients.

    Science.gov (United States)

    Valinoti, Maddalena; Fabbri, Claudio; Turco, Dario; Mantovan, Roberto; Pasini, Antonio; Corsi, Cristiana

    2018-01-01

    Radiofrequency ablation (RFA) is an important and promising therapy for atrial fibrillation (AF) patients. Optimization of patient selection and the availability of an accurate anatomical guide could improve RFA success rate. In this study we propose a unified, fully automated approach to build a 3D patient-specific left atrium (LA) model including pulmonary veins (PVs) in order to provide an accurate anatomical guide during RFA and without PVs in order to characterize LA volumetry and support patient selection for AF ablation. Magnetic resonance data from twenty-six patients referred for AF RFA were processed applying an edge-based level set approach guided by a phase-based edge detector to obtain the 3D LA model with PVs. An automated technique based on the shape diameter function was designed and applied to remove PVs and compute LA volume. 3D LA models were qualitatively compared with 3D LA surfaces acquired during the ablation procedure. An expert radiologist manually traced the LA on MR images twice. LA surfaces from the automatic approach and manual tracing were compared by mean surface-to-surface distance. In addition, LA volumes were compared with volumes from manual segmentation by linear and Bland-Altman analyses. Qualitative comparison of 3D LA models showed several inaccuracies, in particular PVs reconstruction was not accurate and left atrial appendage was missing in the model obtained during RFA procedure. LA surfaces were very similar (mean surface-to-surface distance: 2.3±0.7mm). LA volumes were in excellent agreement (y=1.03x-1.4, r=0.99, bias=-1.37ml (-1.43%) SD=2.16ml (2.3%), mean percentage difference=1.3%±2.1%). Results showed the proposed 3D patient-specific LA model with PVs is able to better describe LA anatomy compared to models derived from the navigation system, thus potentially improving electrograms and voltage information location and reducing fluoroscopic time during RFA. Quantitative assessment of LA volume derived from our 3D LA

  18. Mechanical dyssynchrony of the left atrium during sinus rhythm is associated with history of stroke in patients with atrial fibrillation.

    Science.gov (United States)

    Ciuffo, Luisa; Inoue, Yuko Y; Tao, Susumu; Gucuk Ipek, Esra; Balouch, Muhammad; Lima, Joao A C; Nazarian, Saman; Spragg, David D; Marine, Joseph E; Berger, Ronald D; Calkins, Hugh; Ashikaga, Hiroshi

    2018-04-01

    We sought to evaluate the relationship between left atrial (LA) mechanical dyssynchrony and history of stroke or transient ischaemic attack (TIA) in patients with atrial fibrillation (AF). We hypothesized that mechanical dyssynchrony of the LA is associated with history of stroke/TIA independent of LA function and Cardiac failure, Hypertension, Age, Diabetes, Stroke/transient ischaemic attack (TIA), VAscular disease, and Sex category (CHA2DS2-VASc) score in patients with AF. We conducted a cross-sectional study of 246 patients with a history of AF (59 ± 10 years, 29% female, 26% non-paroxysmal AF) referred for catheter ablation to treat drug-refractory AF who underwent preablation cardiac magnetic resonance (CMR) in sinus rhythm. Using tissue-tracking CMR, we measured the LA longitudinal strain and strain rate in each of 12 equal-length segments in two- and four-chamber views. We defined indices of LA mechanical dyssynchrony, including the standard deviation of the time to the peak longitudinal strain (SD-TPS). Patients with a prior history of stroke or TIA (n = 23) had significantly higher SD-TPS than those without (n = 223) (39.9 vs. 23.4 ms, P stroke/TIA after adjusting for the CHA2DS2-VASc score, LA minimum index volume, and the peak LA longitudinal strain (P stroke/TIA more accurately than CHA2DS2-VASc score alone (c-statistics: 0.82 vs. 0.75, P stroke/TIA in patients with AF.

  19. Comparative effects of amlodipine and benazepril on left atrial pressure in dogs with experimentally-induced mitral valve regurgitation.

    Science.gov (United States)

    Suzuki, Shuji; Fukushima, Ryuji; Ishikawa, Taisuke; Yamamoto, Yuta; Hamabe, Lina; Kim, Soomin; Yoshiyuki, Rieko; Machida, Noboru; Tanaka, Ryou

    2012-09-18

    One of the purposes of treatment for dogs with mitral regurgitation (MR) is lowering left atrial pressure (LAP). There has been few study of the amlodipine in dogs with MR and amlodipine's effect on LAP has not been fully evaluated in a quantitative manner because of difficulties in directly measuring LAP. The objective of our study was to compare the short-term effects of amlodipine (0.2 mg/kg PO q12h) vs benazepril (0.5 mg/kg PO q12h), on LAP and echocardiographic parameters in five beagle dogs with experimentally-induced MR. LAP of eight dogs that has own control were measured using radiotelemetry system at baseline and again on days 1, 2, 3, 4, 5, 6, 7 of the drug administration. Mean LAP decreased significantly after amlodipine (11.20 ± 4.19 mmHg vs 14.61 ± 3.81 mmHg at baseline, p benazepril treatment (13.19 ± 3.47 mmHg, p > .05). LAP was lower after 7 days of amlodipine treatment than after 7 days of benazepril treatment. Significant reduction was seen for the first time 4 days after the administration amlodipine. The rate of the maximal area of the regurgitant jet signals to the left atrium area (ARJ/LAA) of the amlodipine treatment was significantly lower (p benazepril treatment. Although this study did not focus on adverse effects, amlodipine may be an effective drug for helping the patients with acute onset of severe MR, such as rupture of chordae tendinae or end stage patients were the LAP is likely to be elevated. Additional studies in clinical patients with degenerative mitral valve disease and acute chordal rupture are warranted because the blood-pressure lowering effects of amlodipine can decrease renal perfusion and this can further activate the RAAS.

  20. Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study.

    Science.gov (United States)

    Park-Hansen, Jesper; Holme, Susanne J V; Irmukhamedov, Akhmadjon; Carranza, Christian L; Greve, Anders M; Al-Farra, Gina; Riis, Robert G C; Nilsson, Brian; Clausen, Johan S R; Nørskov, Anne S; Kruuse, Christina R; Rostrup, Egill; Dominguez, Helena

    2018-05-23

    Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by left atrial appendage closure with surgery (LAACS). However, the protective effect of LAACS on the risk of cerebral ischemia following cardiac surgery remains controversial. We have studied whether LAACS in addition to open heart surgery protects against post-operative ischemic brain injury regardless of a previous AF diagnosis. One hundred eighty-seven patients scheduled for open heart surgery were enrolled in a prospective, open-label clinical trial and randomized to concomitant LAACS vs. standard care. Randomization was stratified by usage of oral anticoagulation (OAC) planned to last at least 3 months after surgery. The primary endpoint was a composite of post-operative symptomatic ischemic stroke, transient ischemic attack or imaging findings of silent cerebral ischemic (SCI) lesions. During a mean follow-up of 3.7 years, 14 (16%) primary events occurred among patients receiving standard surgery vs. 5 (5%) in the group randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1-0.8, p = 0.02). In per protocol analysis (n = 141), 14 (18%) primary events occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1-1.0, p = 0.05). In a real-world setting, LAACS in addition to elective open-heart surgery was associated with lower risk of post-operative ischemic brain injury. The protective effect was not conditional on AF/OAC status at baseline. LAACS study, clinicaltrials.gov NCT02378116 , March 4th 2015, retrospectively registered.

  1. Low Left Atrial Compliance Contributes to the Clinical Recurrence of Atrial Fibrillation after Catheter Ablation in Patients with Structurally and Functionally Normal Heart.

    Science.gov (United States)

    Park, Junbeom; Yang, Pil-sung; Kim, Tae-Hoon; Uhm, Jae-Sun; Kim, Joung-Youn; Joung, Boyoung; Lee, Moon-Hyoung; Hwang, Chun; Pak, Hui-Nam

    2015-01-01

    Stiff left atrial (LA) syndrome was initially reported in post-cardiac surgery patients and known to be associated with low LA compliance. We investigated the physiological and clinical implications of LA compliance by estimating LA pulse pressure (LApp) among patients with atrial fibrillation (AF) and structurally and functionally normal heart. Among 1038 consecutive patients with LA pressure measurements before AF ablation, we included 334 patients with structurally and functionally normal heart (81.7% male, 54.1±10.6 years, 77.0% paroxysmal AF) after excluding those with hypertension, diabetes, and previous ablation or cardiac surgery. We measured LApp (peak-nadir LA pressure) at the beginning of the ablation procedure and compared the values with clinical parameters and the AF recurrence rate. AF patients with normal heart were younger and more frequently male and had paroxysmal AF, a lower body mass index, and a lower LApp compared to others (all p<0.05). Based on the median value, the low LA compliance group (LApp≥13 mmHg) had a smaller LA volume index and lower LA voltage (all p<0.05) compared to the high LA compliance group. During a mean follow-up of 16.7±11.8 months, low LA compliance was independently associated with two fold-higher risk of clinical AF recurrence (HR:2.202; 95%CI:1.077-4.503; p = 0.031). Low LA compliance, as determined by an elevated LApp, was associated with a smaller LA volume index and lower LA voltage and independently associated with higher clinical recurrence after catheter ablation in AF patients with structurally and functionally normal heart.

  2. Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: a systematic review and network meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Hanif, Hasib; Belley-Cote, Emilie P; Alotaibi, Abdullah; Dvirnik, Nazari; Neupane, Binod; Beyene, Joseph; Eikelboom, John W; Holmes, David; Whitlock, Richard P

    2018-02-01

    Atrial fibrillation (AF) is one of the leading causes of stroke. Risks associated with oral anticoagulation (OAC) limit adherence to recommended therapy. Left atrial appendage (LAA) occlusion is a treatment alternative in patients with AF. We performed a network meta-analysis (NMA) of randomized trials evaluating the efficacy of LAA occlusion compared with oral anticoagulant, antiplatelet, and placebo for stroke prevention. We also assessed the impact of LAA occlusion on mortality, major bleeding, and operative time. We searched MEDLINE, EMBASE, PubMed, and Cochrane Library for randomized trials comparing percutaneous or surgical LAA occlusion with standard of care in AF patients. Conventional meta-analysis found no difference between groups for stroke (5 trials, 1285 patients;RR 0.78, 95% CI 0.47-1.29), and a significant reduction in mortality (5 trials, 1285 patients; RR 0.71, 95% CI 0.51-0.99) favouring LAA occlusion. NMA demonstrated a trend towards reduction in stroke (OR 0.84, 95% CrI 0.47-1.55) and mortality (OR 0.69, 95% CrI 0.44-1.10) for LAA occlusion versus warfarin, but no statistically significant effect. Statistical ranking curves placed LAA occlusion as the most efficacious treatment on the outcomes of stroke and mortality when compared to warfarin, aspirin, or placebo. No significant differences between groups were seen in major bleeding or operative time for surgical trials. The overall quality of the evidence was low as assessed by GRADE. LAA occlusion appears to preserve the benefits of OAC therapy for stroke prevention in patients with AF, but the current evidence is of low quality.

  3. Assessment of normal left atrial appendage anatomy and function over gender and ages by dynamic cardiac CT

    International Nuclear Information System (INIS)

    Boucebci, Samy; Velasco, Stephane; Duboe, Pier-Olivier; Tasu, Jean-Pierre; Pambrun, Thomas; Ingrand, Pierre

    2016-01-01

    The aim of this study was to evaluate variations in anatomy and function according to age and gender using cardiac computed tomography (CT) in a large prospective cohort of healthy patients. The left atrial appendage (LAA) is considered the most frequent site of intracardiac thrombus formation. However, variations in normal in vivo anatomy and function according to age and gender remain largely unknown. Three-dimensional (3D) cardiac reconstructions of the LAA were performed from CT scans of 193 consecutive patients. Parameters measured included LAA number of lobes, anatomical position of the LAA tip, angulation measured between the proximal and distal portions, minimum (iVol min ) and maximum (iVol max ) volumes indexed to body surface area (BSA), and ejection fraction (LAAEF). Relationship with age was assessed for each parameter. We found that men had longer and wider LAAs. The iVol min and iVol max increased by 0.23 and 0.19 ml per decade, respectively, while LAAEF decreased by 2 % per decade in both sexes. Although LAA volumes increase, LAAEF decreases with age in both sexes. (orig.)

  4. Assessment of normal left atrial appendage anatomy and function over gender and ages by dynamic cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Boucebci, Samy; Velasco, Stephane; Duboe, Pier-Olivier; Tasu, Jean-Pierre [University of Poitiers, University Hospital, Department of Radiology, Poitiers (France); Pambrun, Thomas [University of Poitiers, University Hospital, Department of Cardiology, Poitiers (France); Ingrand, Pierre [University of Poitiers, University Institute of Public Health, Poitiers (France)

    2016-05-15

    The aim of this study was to evaluate variations in anatomy and function according to age and gender using cardiac computed tomography (CT) in a large prospective cohort of healthy patients. The left atrial appendage (LAA) is considered the most frequent site of intracardiac thrombus formation. However, variations in normal in vivo anatomy and function according to age and gender remain largely unknown. Three-dimensional (3D) cardiac reconstructions of the LAA were performed from CT scans of 193 consecutive patients. Parameters measured included LAA number of lobes, anatomical position of the LAA tip, angulation measured between the proximal and distal portions, minimum (iVol{sub min}) and maximum (iVol{sub max}) volumes indexed to body surface area (BSA), and ejection fraction (LAAEF). Relationship with age was assessed for each parameter. We found that men had longer and wider LAAs. The iVol{sub min} and iVol{sub max} increased by 0.23 and 0.19 ml per decade, respectively, while LAAEF decreased by 2 % per decade in both sexes. Although LAA volumes increase, LAAEF decreases with age in both sexes. (orig.)

  5. Thallium pulmonary scintigraphy. Relationship to pulmonary fluid volumes during left atrial hypertension and the acute release of pressure

    International Nuclear Information System (INIS)

    Slutsky, R.A.

    1984-01-01

    To evaluate the relationship between thallium-201 lung activity and pulmonary fluid volumes, we compared thallium pulmonary scintigrams with measures of intravascular (PBV), extravascular (EVLW) and total lung water (TLW) during gradual left atrial (LA) hypertension and then serially after the acute release of pressure. The study group was composed of nine mongrel dogs who were each studied at seven levels of elevated LA pressure, and then every 15 minutes for 2 hours after the acute release of pressure. During LA pressure (congestion phase) elevation, lung counts (normalized for myocardial activity), correlated best with TLW (r . .91), rather than PBV (r . .84) or EVLW (r . .81). After the release of pressure (recovery phase), lung counts correlated well with EVLW (r . .92) and TLW (r . .82), but not with PBV (r . .28). Postmortem lung counts from 197 separate lung sections correlated well with the corresponding wet weight/dry weight ratio from that section (r . .81). Thus, we conclude that changes in pulmonary thallium emissions during cardiogenic pulmonary edema relate to corresponding changes in pulmonary fluid volumes. During congestion, the confounding effects of nonlinear increases in EVLW and PBV make thallium emissions more a marker of TLW than either the intravascular or extravascular pulmonary fluid compartment. After pressure release, PBV immediately returns to normal, at which time EVLW and pulmonary emissions correlate closely. These latter data, more applicable to postexercise stress thallium data, lend support to the hypothesis that elevated pulmonary emissions during postexercise thallium scintigrams reflect elevations in EVLW that develop during exercise

  6. Contrast-enhanced CMR in patients after percutaneous closure of the left atrial appendage: A pilot study

    Directory of Open Access Journals (Sweden)

    Petersen Steffen E

    2011-07-01

    Full Text Available Abstract Background To evaluate the feasibility and value of first-pass contrast-enhanced dynamic and post-contrast 3D CMR in patients after transcatheter occlusion of left atrial appendage (LAA to identify incorrect placement and persistent leaks. Methods 7 patients with different occluder systems (n = 4 PLAATO; n = 2 Watchman; n = 1 ACP underwent 2 contrast-enhanced (Gd-DOTA CMR sequences (2D TrueFISP first-pass perfusion and 3D-TurboFLASH to assess localization, artifact size and potential leaks of the devices. Perfusion CMR was analyzed visually and semi-quantitatively to identify potential leaks. Results All occluders were positioned within the LAA. The ACP occluder presented the most extensive artifact size. Visual assessment revealed a residual perfusion of the LAA apex in 4 cases using first-pass perfusion and 3D-TurboFLASH indicating a suboptimal LAA occlusion. By assessing signal-to-time-curves the cases with a visually detected leak showed a 9-fold higher signal-peak in the LAA apex (567 ± 120% increase from baseline signal than those without a leak (61 ± 22%; p Conclusion This CMR pilot study provides valuable non-invasive information in patients after transcatheter occlusion of the LAA to identify correct placement and potential leaks. We recommend incorporating CMR in future clinical studies to evaluate new device types.

  7. Measurement of left atrial volume by 2D and 3D non-contrast computed tomography compared with cardiac magnetic resonance imaging

    DEFF Research Database (Denmark)

    Fredgart, Maise Høigaard; Carter-Storch, Rasmus; Møller, Jacob Eifer

    2018-01-01

    Background: Cardiac magnetic resonance imaging (MRI) is considered the gold standard for assessment of left atrial (LA) volume. We assessed the feasibility of evaluating LA volume using 3D non-contrast computed tomography (NCCT). Furthermore, since manual tracing of LA volume is time consuming, we...... evaluated the accuracy of the LA area using 2D NCCT imaging for LA volume assessment. Methods: MRI and NCCT imaging were performed in 69 patients before and one year after aortic valve replacement. In 3D MRI and 3D NCCT, each slice was manually traced, excluding the pulmonary veins and atrial appendage...

  8. Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions: the ALINE study.

    Science.gov (United States)

    Wolf, Michael; El Haddad, Milad; Fedida, Joël; Taghji, Philippe; Van Beeumen, Katarina; Strisciuglio, Teresa; De Pooter, Jan; Lepièce, Caroline; Vandekerckhove, Yves; Tavernier, René; Duytschaever, Mattias; Knecht, Sébastien

    2018-01-08

    Achieving block across linear lesions is challenging. We prospectively evaluated radiofrequency (RF) linear ablation at the roof and mitral isthmus (MI) using point-by-point contiguous and optimized RF lesions. Forty-one consecutive patients with symptomatic persistent AF underwent stepwise contact force (CF)-guided catheter ablation during ongoing AF. A single linear set of RF lesions was delivered at the roof and posterior MI according to the 'Atrial LINEar' (ALINE) criteria, i.e. point-by-point RF delivery (up to 35 W) respecting strict criteria of contiguity (inter-lesion distance ≤ 6 mm) and indirect lesion depth assessment (ablation index ≥550). We assessed the incidence of bidirectional block across both lines only after restoration of sinus rhythm. After a median RF time of 7 min [interquartile range (IQR) 5-9], first-pass block across roof lines was observed in 38 of 41 (93%) patients. Final bidirectional roof block was achieved in 40 of 41 (98%) patients. First-pass block was observed in 8 of 35 (23%) MI lines, after a median RF time of 8 min (IQR 7-12). Additional endo- and epicardial (54% of patients) RF applications resulted in final bidirectional MI block in 28 of 35 (80%) patients. During a median follow-up of 396 (IQR 310-442) days, 12 patients underwent repeat procedures, with conduction recovery in 4 of 12 and 5 of 10 previously blocked roof lines and MI lines, respectively. No complications occurred. Anatomical linear ablation using contiguous and optimized RF lesions results in a high rate of first-pass block at the roof but not at the MI. Due to its complex 3D architecture, the MI frequently requires additional endo- and epicardial RF lesions to be blocked. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.

  9. Left atrial volume and function in patients following ST elevation myocardial infarction and the association with clinical outcome

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Engstrøm, Thomas; Møller, Jacob Eifer

    2013-01-01

    The left atrium (LA) transfers blood to the left ventricle in a complex manner. LA function is characterized by passive emptying (LA passive fraction), active emptying (LA ejection fraction), and total emptying (LA fractional change). Despite this complexity, the clinical relevance of the LA is b...... function in patients following ST elevation myocardial infarction (STEMI)....

  10. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    Energy Technology Data Exchange (ETDEWEB)

    Rettmann, Maryam E., E-mail: rettmann.maryam@mayo.edu; Holmes, David R.; Camp, Jon J.; Cameron, Bruce M.; Robb, Richard A. [Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Kwartowitz, David M. [Department of Bioengineering, Clemson University, Clemson, South Carolina 29634 (United States); Gunawan, Mia [Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington D.C. 20057 (United States); Johnson, Susan B.; Packer, Douglas L. [Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905 (United States); Dalegrave, Charles [Clinical Cardiac Electrophysiology, Cardiology Division Hospital Sao Paulo, Federal University of Sao Paulo, 04024-002 Brazil (Brazil); Kolasa, Mark W. [David Grant Medical Center, Fairfield, California 94535 (United States)

    2014-02-15

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved

  11. Comparative effects of amlodipine and benazepril on Left Atrial Pressure in Dogs with experimentally-induced Mitral Valve Regurgitation

    Directory of Open Access Journals (Sweden)

    Suzuki Shuji

    2012-09-01

    Full Text Available Abstract Background One of the purposes of treatment for dogs with mitral regurgitation (MR is lowering left atrial pressure (LAP. There has been few study of the amlodipine in dogs with MR and amlodipine’s effect on LAP has not been fully evaluated in a quantitative manner because of difficulties in directly measuring LAP. The objective of our study was to compare the short-term effects of amlodipine (0.2 mg/kg PO q12h vs benazepril (0.5 mg/kg PO q12h, on LAP and echocardiographic parameters in five beagle dogs with experimentally-induced MR. LAP of eight dogs that has own control were measured using radiotelemetry system at baseline and again on days 1, 2, 3, 4, 5, 6, 7 of the drug administration. Results Mean LAP decreased significantly after amlodipine (11.20 ± 4.19 mmHg vs 14.61 ± 3.81 mmHg at baseline, p  .05. LAP was lower after 7 days of amlodipine treatment than after 7 days of benazepril treatment. Significant reduction was seen for the first time 4 days after the administration amlodipine. The rate of the maximal area of the regurgitant jet signals to the left atrium area (ARJ/LAA of the amlodipine treatment was significantly lower (p  Conclusions LAP was significantly decreased after amlodipine treatment in dogs with surgically-induced MR but not after benazepril treatment. Although this study did not focus on adverse effects, amlodipine may be an effective drug for helping the patients with acute onset of severe MR, such as rupture of chordae tendinae or end stage patients were the LAP is likely to be elevated. Additional studies in clinical patients with degenerative mitral valve disease and acute chordal rupture are warranted because the blood-pressure lowering effects of amlodipine can decrease renal perfusion and this can further activate the RAAS.

  12. Left septal atrial tachycardia after open-heart surgery: relevance to surgical approach, anatomical and electrophysiological characteristics associated with catheter ablation, and procedural outcomes.

    Science.gov (United States)

    Adachi, Toru; Yoshida, Kentaro; Takeyasu, Noriyuki; Masuda, Keita; Sekiguchi, Yukio; Sato, Akira; Tada, Hiroshi; Nogami, Akihiko; Aonuma, Kazutaka

    2015-02-01

    Septal atrial tachycardia (AT) can occur in patients without structural heart disease and in patients with previous catheter ablation of atrial fibrillation. We aimed to assess septal AT that occurs after open-heart surgery. This study comprised 20 consecutive patients undergoing catheter ablation of macroreentrant AT after open-heart surgery. Relevance to surgical approach, mechanisms, anatomic and electrophysiological characteristics, and outcomes were assessed. Septal AT was identified in 7 patients who had all undergone mitral valve surgery. All septal ATs were localized in the left atrial septum, whereas 10 of 13 nonseptal ATs originated from the right atrium. Patients with left septal AT had a thicker fossa ovalis (median, 4.0; 25th-75th percentile, 3.6-4.2 versus 2.3; 1.6-2.6 mm; P=0.006) and broader area of low voltage (open-heart surgery was characterized by a thicker septum, more scar burden in the septum, and repeated prolongations of the tachycardia cycle length during ablation. Such an arrhythmogenic substrate may interfere with transmural lesion formation by ablation and may account for higher likelihood of recurrence of left septal AT. © 2014 American Heart Association, Inc.

  13. Diagnostic accuracy of electrocardiographic P wave related parameters in the assessment of left atrial size in dogs with degenerative mitral valve disease.

    Science.gov (United States)

    Soto-Bustos, Ángel; Caro-Vadillo, Alicia; Martínez-DE-Merlo, Elena; Alonso-Alegre, Elisa González

    2017-10-07

    The purpose of this research was to compare the accuracy of newly described P wave-related parameters (P wave area, Macruz index and mean electrical axis) with classical P wave-related parameters (voltage and duration of P wave) for the assessment of left atrial (LA) size in dogs with degenerative mitral valve disease. One hundred forty-six dogs (37 healthy control dogs and 109 dogs with degenerative mitral valve disease) were prospectively studied. Two-dimensional echocardiography examinations and a 6-lead ECG were performed prospectively in all dogs. Echocardiography parameters, including determination of the ratios LA diameter/aortic root diameter and LA area/aortic root area, were compared to P wave-related parameters: P wave area, Macruz index, mean electrical axis voltage and duration of P wave. The results showed that P wave-related parameters (classical and newly described) had low sensitivity (range=52.3 to 77%; median=60%) and low to moderate specificity (range=47.2 to 82.5%; median 56.3%) for the prediction of left atrial enlargement. The areas under the curve of P wave-related parameters were moderate to low due to poor sensitivity. In conclusion, newly P wave-related parameters do not increase the diagnostic capacity of ECG as a predictor of left atrial enlargement in dogs with degenerative mitral valve disease.

  14. Decreases in left atrial compliance during early-stage exercise are related to exercise intolerance in asymptomatic significant mitral stenosis.

    Science.gov (United States)

    Jung, Mi-Hyang; Jung, Hae Ok; Lee, Jung-Won; Youn, Ho-Joong

    2017-11-01

    Doppler-driven net atrioventricular compliance (C n ), which represents left atrial (LA) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (MS). We hypothesized that decreases in C n during early-stage exercise underlie exercise intolerance in patients with MS. Thirty-three asymptomatic patients with significant MS (valve area 1.24 ± 0.16 cm 2 ) underwent resting and bicycle exercise echocardiography. LA compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise-intolerance group (n = 22) and an exercise-tolerance group (n = 11). Moreover, "50 W" was defined as an early exercise stage. Although the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative C n decrease at 50 W (expressed as a percentage of the resting C n ) was significantly greater in the exercise-intolerance group (70.3 ± 15.4% vs 49.7 ± 9.7%, P intolerance group (P = .0005). Furthermore, differences in the trends in this parameter were observed between the two groups (P intolerance (adjusted OR 1.105, 95% CI 1.030-1.184) after adjustment for other conventional parameters. Decreases in C n during early-stage exercise are an important mechanism underlying exercise intolerance in MS. © 2017, Wiley Periodicals, Inc.

  15. Optimal Analysis of Left Atrial Strain by Speckle Tracking Echocardiography: P-wave versus R-wave Trigger.

    Science.gov (United States)

    Hayashi, Shuji; Yamada, Hirotsugu; Bando, Mika; Saijo, Yoshihito; Nishio, Susumu; Hirata, Yukina; Klein, Allan L; Sata, Masataka

    2015-08-01

    Left atrial (LA) strain analysis using speckle tracking echocardiography is useful for assessing LA function. However, there is no established procedure for this method. Most investigators have determined the electrocardiographic R-wave peak as the starting point for LA strain analysis. To test our hypothesis that P-wave onset should be used as the starting point, we measured LA strain using 2 different starting points and compared the strain values with the corresponding LA volume indices obtained by three-dimensional (3D) echocardiography. We enrolled 78 subjects (61 ± 17 years, 25 males) with and without various cardiac diseases in this study and assessed global longitudinal LA strain by two-dimensional speckle tracking strain echocardiography using EchoPac software. We used either R-wave peak or P-wave onset as the starting point for determining LA strains during the reservoir (Rres, Pres), conduit (Rcon, Pcon), and booster pump (Rpump, Ppump) phases. We determined the maximum, minimum, and preatrial contraction LA volumes, and calculated the LA total, passive, and active emptying fractions using 3D echocardiography. The correlation between Pres and LA total emptying fraction was better than the correlation between Rres and LA total emptying fraction (r = 0.458 vs. 0.308, P = 0.026). Pcon and Ppump exhibited better correlation with the corresponding 3D echocardiographic parameters than Rcon (r = 0.560 vs. 0.479, P = 0.133) and Rpump (r = 0.577 vs. 0.345, P = 0.003), respectively. LA strain in any phase should be analyzed using P-wave onset as the starting point rather than R-wave peak. © 2014, Wiley Periodicals, Inc.

  16. Relationship of CHA2DS2-VASc and CHADS2 score to left atrial remodeling detected by velocity vector imaging in patients with atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Yihui Li

    Full Text Available BACKGROUND: The CHADS2/CHA2DS2-VASc scores are used to predict thrombo-embolic/stroke in patients with nonvalvular atrial fibrillation (AF. Nevertheless, limited data are available regarding the association between these risk stratification for stroke and left atrial (LA remodeling status of AF patients. The purpose of this study was to explore the association between these scores and LA remodeling status assessed quantificationally by echocardiography in AF patients. METHODS: One hundred AF patients were divided into 3 groups based on the CHA2DS2-VASc/CHADS2 score: the score of 0 (low stroke risk, the score of 1 (moderate stroke risk and the score of ≥2 (high stroke risk. All patients were performed through conventional and velocity vector imaging echocardiography. Echocardiographic parameters: maximum LA volume index (LAVImax, LA total emptying fraction (LAEFt and LA mean strain were obtained to assess quantificationally LA remodeling status. RESULTS: On categorizing with CHA2DS2-VASc, the score of 1 group showed augment in LAVImax and attenuation in LA mean strain derived from VVI, compared with the score of 0 group (LAVImax: 40.27±21.91 vs. 26.79±7.87, p=0.002; LA mean strain: 15.18±6.36 vs. 22±8.54, p=0.001. On categorizing with the CHADS2 score, similar trends were seen between the score of ≥2 and 1 groups (LAVImax: 43.72±13.77 vs. 31.41±9.50, p<0.001; LA mean strain: 11.01±5.31 vs. 18.63±7.00, p<0.001. With multivariate logistic regression, LAVImax (odds ratio: 0.92 , 95% C=I: 0.85 to 0.98, p= 0.01 and LA mean strain reflecting LA remodeling (odds ratio: 1.10, 95% CI: 1.02 to 1.19, p=0.01 were strongly predictive of the CHA2DS2-VASc score of 0. CONCLUSIONS: The superiority of the CHADS2 score may lay in identifying LA remodeling of AF patients with high stroke risk. Whereas, the CHA2DS2-VASc score was better than the CHADS2 score at identifying LA remodeling of AF patients presenting low stroke risk.

  17. MDCT Evaluation of Left Atrium and Pulmonary Vein in the Patients with Atrial Fibrillation: Comparison with the Non-Atrial Fibrillation Group

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Jung; Choi, Eun Jeong; Ham, Soo Yeon; Oh, Yu Whan; Kim, Young Hoon [Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Yong, Hwan Seok [Korea University Guro Hospital, Seoul (Korea, Republic of); Yang, Kyung Sook [Korea University, Seoul (Korea, Republic of)

    2011-02-15

    The anatomy of the left atrium (LA) and the pulmonary veins (PVs) is important in planning and performing successful electrophysiologic ablation (EPA) for atrial fibrillation (Afib) patients. The authors estimated the findings of LA and PVs of Afib patients by MDCT, and compared these with the findings of LA and PVs of the non- Afib group using coronary CT angiography (CCTA). From September, 2009 to February, 2010, 91 Afib patients underwent PVCT (male: female = 72:19, mean age = 55.0-years-old) before EPA. At same time, 90 patients underwent CCTA (male: female = 73:17, mean age = 59.1- years-old). Two radiologists reviewed and analyzed all axial and 3D images of LA and PVs retrospectively with consensus. The average LA volumes of the Afib group(100.49 mm3) was larger than that of the non-Afib group (78.38 mm3) (p<0.05). The average lengths of the LA right wall in the Afib group (40.25 mm) was longer than that of the non-Afib group (37.3 mm) (p<0.05). The average distances between the PV ostium and first segmental bifurcation of the Lt superior PV (LSPV) and the RSPV were shorter in the Afib group (LSPV, 19.38 mm: RSPV, 11.49 mm) than in the non-Afib group (LSPV, 23.23 mm: RSPV, 14.25 mm) (p<0.05). There were higher incidences of anomalous branches such as ostial, accessory branches, or common ostia in the Afib group versus the non-Afib group (p<0.05). In Afib group, variable parameters of LA and PVs were obtained and estimated by MDCT, and there was statistically significant difference in the parameters of LA and PVs between Afib and non-Afib groups

  18. MDCT Evaluation of Left Atrium and Pulmonary Vein in the Patients with Atrial Fibrillation: Comparison with the Non-Atrial Fibrillation Group

    International Nuclear Information System (INIS)

    Kim, Won Jung; Choi, Eun Jeong; Ham, Soo Yeon; Oh, Yu Whan; Kim, Young Hoon; Yong, Hwan Seok; Yang, Kyung Sook

    2011-01-01

    The anatomy of the left atrium (LA) and the pulmonary veins (PVs) is important in planning and performing successful electrophysiologic ablation (EPA) for atrial fibrillation (Afib) patients. The authors estimated the findings of LA and PVs of Afib patients by MDCT, and compared these with the findings of LA and PVs of the non- Afib group using coronary CT angiography (CCTA). From September, 2009 to February, 2010, 91 Afib patients underwent PVCT (male: female = 72:19, mean age = 55.0-years-old) before EPA. At same time, 90 patients underwent CCTA (male: female = 73:17, mean age = 59.1- years-old). Two radiologists reviewed and analyzed all axial and 3D images of LA and PVs retrospectively with consensus. The average LA volumes of the Afib group(100.49 mm3) was larger than that of the non-Afib group (78.38 mm3) (p<0.05). The average lengths of the LA right wall in the Afib group (40.25 mm) was longer than that of the non-Afib group (37.3 mm) (p<0.05). The average distances between the PV ostium and first segmental bifurcation of the Lt superior PV (LSPV) and the RSPV were shorter in the Afib group (LSPV, 19.38 mm: RSPV, 11.49 mm) than in the non-Afib group (LSPV, 23.23 mm: RSPV, 14.25 mm) (p<0.05). There were higher incidences of anomalous branches such as ostial, accessory branches, or common ostia in the Afib group versus the non-Afib group (p<0.05). In Afib group, variable parameters of LA and PVs were obtained and estimated by MDCT, and there was statistically significant difference in the parameters of LA and PVs between Afib and non-Afib groups

  19. Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results from PROTECT AF vs. PREVAIL

    Science.gov (United States)

    Freeman, James V.; Hutton, David W.; Barnes, Geoffrey D.; Zhu, Ruo P.; Owens, Douglas K.; Garber, Alan M.; Go, Alan S.; Hlatky, Mark A.; Heidenreich, Paul A.; Wang, Paul J.; Al-Ahmad, Amin; Turakhia, Mintu P.

    2016-01-01

    Background Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost-effectiveness compared to anticoagulation has not been evaluated using all available contemporary trial data. Methods and Results We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost-effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of PROTECT AF and PREVAIL randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios (ICER) compared to warfarin and dabigatran were $20,486 and $23,422 per quality adjusted life year (QALY), respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 QALYs, respectively) and more costly. At a willingness-to-pay-threshold of $50,000 per QALY, LAA closure was cost-effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Conclusions Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost-effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer term trial results and post-marketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical practice. PMID:27307517

  20. Limb ischemia, an alarm signal to a thromboembolic cascade - renal infarction and nephrectomy followed by surgical suppression of the left atrial appendage.

    Science.gov (United States)

    Caraşca, Cosmin; Borda, Angela; Incze, Alexandru; Caraşca, Emilian; Frigy, Attila; Suciu, HoraŢiu

    2016-01-01

    We present the case of a 55-year-old male with mild hypertension and brief episodes of paroxysmal self-limiting atrial fibrillation (AF) since 2010. Despite a small cardioembolic risk score, CHA2DS2-Vasc=1 (Congestive heart failure, Hypertension, Age=75, Diabetes melitus, prior Stroke), the patient is effectively anticoagulated using acenocumarol. In December 2014, he showed signs of plantar transitory ischemia, for which he did not address the doctor. In early January 2015, he urgently presented at the hospital with left renal pain, caused by a renal infarction, diagnosed by computed tomography (CT) angiography. Left nephrectomy was performed with pathological confirmation. He was discharged with effective anticoagulation treatment. Within the next two weeks, he suffered a transitory ischemic event and a stroke, associated with right sided hemiparesis. On admission, AF was found and converted to sinus rhythm with effective anticoagulation - international normalized ratio (INR) of 2.12. Transthoracic echocardiography detected no pathological findings. Transesophageal echocardiography showed an expended left atrial appendage (LAA) with a slow blood flow (0.2 m÷s) and spontaneous echocontrast. Considering these clinical circumstances, surgical LAA suppression was decided on as a last therapeutic resort. Postoperative evolution was favorable; the patient is still free of ischemic events, one year post-intervention. Some morphological and hemodynamic characteristics of LAA may add additional thromboembolic risk factors, not included in scores. Removing them by surgical LAA suppression may decrease the risk of cardioembolic events. Intraoperative presence of thrombus makes it an indisputable proof.

  1. VARIATION IN THE OPENINGS (OSTIA OF LEFT PULMONARY VEINS INTO THE LEFT ATRIUM: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sesi

    2015-03-01

    Full Text Available During early embryonic development, absorption of pulmonary venous network by the left primitive atrial chamber results in opening of four pulmonary veins which drain independently into its chamber. The extent of absorption and hence, the number of pulmon ary veins which open into the left atrium, may vary. Here we report a variation in the opening of the Left upper (superior pulmonary vein into the Left atrium. A total of six openings observed

  2. 111In-labeled platelet scintigraphy and two-dimensional echocardiography for detection of left atrial appendage thrombi. Studies in a new canine model

    International Nuclear Information System (INIS)

    Vandenberg, B.F.; Seabold, J.E.; Conrad, G.R.; Kieso, R.; Johnson, J.; Fox-Eastham, K.; Ponto, J.; Bruch, P.; Kerber, R.E.

    1988-01-01

    111In-labeled platelet scintigraphy and two-dimensional echocardiography were performed in 40 dogs to determine the ability of the two techniques to detect left atrial appendage thrombi. Thrombi were induced in 33 dogs that were classified into two groups, acute or chronic, according to the time of labeled-platelet injection after thrombus induction. In the acute group (17 dogs), platelets were injected 24 hours after thrombus induction. In the chronic group (16 dogs), platelets were injected 4-8 days after thrombus induction. Sham thoracotomies were performed on seven additional control dogs who did not receive thrombin injections. Analog and blood pool-corrected 111In-labeled platelet scintigraphy images were obtained 4-72 hours later. Closed-chest two-dimensional echocardiography was performed before thoracotomy and repeated at the time of scintigraphy. The location and size of each thrombus were verified at autopsy. Two-dimensional echocardiography detected three of 17 acute (mean volume, 1.2 +/- 1.0 cc) and three of 10 chronic (mean volume, 0.4 +/- 0.3 cc; p less than 0.025) left atrial appendage thrombi. 111In-labeled platelet scintigraphy detected all 17 acute thrombi but only two of 10 chronic thrombi. The measured radioactivity levels of the excised thrombi were 1,949 +/- 1,665 cpm/clot/dose in group 1 and 228 +/- 213 cpm/clot/dose in group 2 (p less than 0.005). In this model, 111In-labeled platelet scintigraphy was able to detect acute left atrial appendage thrombi that could not be identified by two-dimensional echocardiography. Both techniques showed poor sensitivity for detection of chronic thrombi. The decline in sensitivity of 111In-labeled platelet scintigraphy for detection of older thrombi is probably due to diminished labeled-platelet incorporation

  3. Three-dimensional speckle tracking echocardiography allows detailed evaluation of left atrial function in hypertrophic cardiomyopathy--insights from the MAGYAR-Path Study.

    Science.gov (United States)

    Domsik, Péter; Kalapos, Anita; Chadaide, Számi; Sepp, Róbert; Hausinger, Péter; Forster, Tamás; Nemes, Attila

    2014-11-01

    Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. Reduced left atrial (LA) function was demonstrated in HCM by different methods. Three-dimensional (3D) speckle tracking echocardiography (STE) has just been introduced for the evaluation of LA. This study was designed to compare 3DSTE-derived LA volumetric and strain parameters in HCM with healthy controls. The study comprised 23 consecutive HCM patients (mean age: 48.5 ± 15.1 years, 14 men). Their results were compared to 23 age- and gender-matched healthy controls. Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all cases. Calculated LA maximum (66.4 ± 20.4 mL vs. 36.0 ± 6.1 mL, P echocardiography allows detailed evaluation of LA (dys) function in HCM by volumetric and strain measurements. © 2014, Wiley Periodicals, Inc.

  4. The New 3D Printed Left Atrial Appendage Closure with a Novel Holdfast Device: A Pre-Clinical Feasibility Animal Study.

    Directory of Open Access Journals (Sweden)

    M Brzeziński

    Full Text Available Many patients undergoing cardiac surgery have risk factors for both atrial fibrillation (AF and stroke. The left atrial appendage (LAA is the primary site for thrombi formation. The most severe complication of emboli derived from LAA is stroke, which is associated with a 12-month mortality rate of 38% and a 12-month recurrence rate of 17%. The most common form of treatment for atrial fibrillation and stroke prevention is the pharmacological therapy with anticoagulants. Nonetheless this form of therapy is associated with high risk of major bleeding. Therefore LAA occlusion devices should be tested for their ability to reduce future cerebral ischemic events in patients with high-risk of haemorrhage.The aim of this study was to evaluate the safety and feasibility of a novel left atrial appendage exclusion device with a minimally invasive introducer in a swine model.A completely novel LAA device, which is composed of two tubes connected together using a specially created bail, was designed using finite element modelling (FEM to obtain an optimal support force of 36 N at the closure line. The monolithic form of the occluder was obtained by using additive manufacturing of granular PA2200 powder with the technology of selective laser sintering (SLS. Fifteen swine were included in the feasibility tests, with 10 animals undergoing fourteen days of follow-up and 5 animals undergoing long-term observation of 3 months. For one animal, the follow-up was further prolonged to 6 months. The device was placed via minithoracotomy. After the observation period, all of the animals were euthanized, and their hearts were tested for LAA closure and local inflammatory and tissue response.After the defined observation period, all fifteen hearts were explanted. In all cases the full closure of the LAA was achieved. The macroscopic and microscopic evaluation of the explanted hearts showed that all devices were securely integrated in the surrounding tissues. No

  5. Oclusão do apêndice atrial esquerdo com o Amplatzer Cardiac Plug em pacientes com fibrilação atrial Left atrial appendage closure with the Amplatzer Cardiac Plug in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Ênio Eduardo Guérios

    2012-06-01

    Full Text Available FUNDAMENTO: A oclusão percutânea do apêndice atrial esquerdo (OAAE surgiu como alternativa à anticoagulação oral (AO para prevenção do acidente vascular cerebral (AVC em pacientes com fibrilação atrial não-valvular (FANV. OBJETIVO: Relatar os resultados imediatos e o seguimento clínico de pacientes submetidos a OAAE com o Amplatzer Cardiac Plug (ACP em um único centro de referência. MÉTODOS: Oitenta e seis pacientes consecutivos com FANV, contra-indicação à AO e escore CHADS2= 2,6±1,2 foram submetidos a OAAE com implante de ACP. Realizou-se seguimento clínico e ecocardiográfico no mínimo 4 meses após o implante. RESULTADOS: Todos os implantes foram guiados apenas por angiografia. O sucesso do procedimento foi de 99% (1 insucesso por tamponamento cardíaco e consequente suspensão da OAAE. Houve 4 complicações maiores (o tamponamento já referido, 2 AVCs transitórios e uma embolização com retirada percutânea da prótese e duas menores (um derrame pericárdico sem tamponamento e uma pequena comunicação interatrial evidenciada no seguimento. Houve 1 óbito hospitalar após 6 dias, não relacionado à intervenção. Todos os outros pacientes receberam alta sem AO. Após seguimento de 25,9 pacientes-ano (69 pacientes não houve AVCs nem embolizações tardias de próteses. O AAE estava completamente ocluído em 97% dos casos. Seis pacientes apresentaram evidência de trombo sobre a prótese, que desapareceram após reinstituição de AO por 3 meses. CONCLUSÃO: OAAE se associa a um alto índice de sucesso, um índice aceitável de complicações e resultados promissores a médio prazo, podendo ser considerada uma alternativa válida à OA na prevenção do AVC em pacientes com FANV.BACKGROUND: Percutaneous left atrial appendage closure (LAAC has emerged as an alternative to oral anticoagulation (OA for prevention of thromboembolic stroke in patients with non-valvular atrial fibrillation (NVAF. OBJECTIVE: To describe the

  6. Oclusão percutânea do apêndice atrial esquerdo com o Amplatzer Cardiac PlugTM na fibrilação atrial Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Márcio José Montenegro

    2012-02-01

    , anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation. Objective: To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation. Methods: We report our initial experience with Amplatzer Cardiac PlugTM (St. Jude Medical Inc., Saint Paul, Estados Unidos in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months. Results: In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up. Conclusion: Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.

  7. Left heart ventricular angiography

    Science.gov (United States)

    ... blood vessels. These x-ray pictures create a "movie" of the left ventricle as it contracts rhythmically. ... 22578925 www.ncbi.nlm.nih.gov/pubmed/22578925 . Review Date 9/26/2016 Updated by: Michael A. ...

  8. Left heart catheterization

    Science.gov (United States)

    Catheterization - left heart ... to help guide the catheters up into your heart and arteries. Dye (sometimes called "contrast") will be ... in the blood vessels that lead to your heart. The catheter is then moved through the aortic ...

  9. Coronary artery disease, left ventricular hypertrophy and diastolic dysfunction are associated with stroke in patients affected by persistent non-valvular atrial fibrillation: a case-control study

    Directory of Open Access Journals (Sweden)

    Andrea Passantino

    2009-04-01

    Full Text Available Persistent non-valvular atrial fibrillation (NVAF is associated with an increased risk of cardiovascular events such as stroke, and its rate is expected to rise because of the ageing population. The absolute rate of stroke depends on age and comorbidity. Risk stratification for stroke in patients with NVAF derives from populations enrolled in randomized clinical trials. However, participants in clinical trials are often not representative of the general population. Many stroke risk stratification scores have been used, but they do not include transthoracic echocardiogram (TTE, pulsate wave Doppler (PWD and tissue Doppler imaging (TDI, simple and non-invasive diagnostic tools. The role of TTE, PWD and TDI findings has not been previously determined. Our study goal was to determine the association between TTE and PWD findings and stroke prevalence in a population of NVAF prone outpatients. Patients were divided into two groups: P for stroke prone and F for stroke free. There were no statistically significant differences between the two groups concerning cardiovascular risk factors, age (p=0.2, sex (p=0.2, smoking (p=0.3, diabetes (p=0.1 and hypercholesterolemia (p=0.2; hypertension was statistically significant (p less than 0.001. There were statistically significant differences concerning coronary artery disease, previous acute myocardial infarction (AMI (p less than 0.05 and non- AMI coronaropathy (p less than 0.04, a higher rate being in the P group. Concerning echo-Doppler findings, a higher statistically significant rate of left ventricular hypertrophy (LVH (p less than  0.05 and left ventricular diastolic dysfunction (p less than 0.001 was found in the P group and dilated left atrium (p Isquemia cerebral como manifestación inicial de un mixoma atrial izquierdo: Reporte de un caso Brain ischemia as initial sign of a left atrial myxoma: Report of one case

    Directory of Open Access Journals (Sweden)

    Luis F Osio

    2008-04-01

    Full Text Available Los tumores primarios del corazón son raros; 75% de éstos son benignos y cerca de la mitad de los benignos son mixomas que, en la mayoría de los casos, se encuentran en las cavidades izquierdas. Las manifestaciones clínicas de los mixomas dependen del sitio de localización del tumor. Sin embargo, se afirma que la isquemia cerebral es la manifestación clínica inicial en un tercio de los mixomas atriales. Se presenta el caso de un paciente de género masculino, de 65 años de edad, en quien la primera manifestación clínica de mixoma atrial fue un evento cerebral vascular isquémico.Primary heart tumors are rare; 75% of them are benign and almost half of the benign ones are mixomas that in most cases are located in the left cavities. Clinical manifestations of myxomas depend on its localization site. Nevertheless, it is accepted that brain ischemia is the initial clinical manifestation in a third of atrial myxomas. The case of a 65 years old male patient in whom the first clinical manifestation of an atrial myxoma was an ischemic cerebrovascular event, is presented.

  10. Higher levels of serum fibrin-monomer reflect hypercoagulable state and thrombus formation in the left atrial appendage in patients with acute ischemic stroke.

    Science.gov (United States)

    Okuyama, Hidenobu; Hirono, Osamu; Liu, Ling; Takeishi, Yasuchika; Kayama, Takamasa; Kubota, Isao

    2006-08-01

    It is sometimes difficult to make a diagnosis of cardioembolic stroke in the stroke care unit, because of the splashing and vanishing of the intracardiac source of the emboli on transesophageal echocardiography. Serum fibrin-monomer (FM) is a new marker for coagulation activity that is useful for identifying older individuals at increased risk of ischemic stroke. Two hundred and four patients with acute ischemic stroke were examined for serum coagulation and fibrinolytic activity on admission, and underwent transesophageal echocardiography within 7 days of onset. Serum levels of FM was significantly higher in patients with left atrial appendage (LAA) thrombus formation (n=24) than in those with no thrombus (88+/-52 vs 14+/-9 microg/ml, pvs 8+/-5 microg/ml, pstroke.

  11. No Community Left Behind

    Science.gov (United States)

    Schlechty, Phillip C.

    2008-01-01

    The debate over the reauthorization of No Child Left Behind (NCLB) generally overlooks--or looks past--what may be the most fundamental flaw in that legislation. As the law is now written, decisions regarding what the young should know and be able to do are removed from the hands of parents and local community leaders and turned over to officials…

  12. The Children Left Behind

    Science.gov (United States)

    Gillard, Sarah A.; Gillard, Sharlett

    2012-01-01

    This article explores some of the deficits in our educational system in regard to non-hearing students. It has become agonizingly clear that non-hearing students are being left out of the gallant sweep to enrich our children's educations. The big five areas of literacy, at best, present unique challenges for non-hearing students and, in some…

  13. Traumatic tricuspid regurgitation and right-to-left intra-atrial shunt--an unusual complication of a horse-kick.

    LENUS (Irish Health Repository)

    Byrne, R A

    2010-02-01

    A 63-year-old male presented with sudden onset chest pain and dyspnoea following a kick to the praecordium while gelding a horse. Transthoracic echocardiography showed evidence of flail tricuspid valve leaflets, severe tricuspid regurgitation and a widely patent foramen ovale with a right-to-left shunt. Due to progressive severe systemic hypoxemia the patient underwent emergent surgical intervention. Operative findings confirmed rupture of the anterior and septal tricuspid valve papillary muscles. Successful papillary muscle reattachment was performed in association with tricuspid annuloplasty and suture closure of his patent foramen ovale. Disruption of the tricuspid valve is well described as consequence of blunt trauma to the chest wall and is often well tolerated, coming to light many years post injury. Valve disruption due to rupture at the papillary muscle level, however, typically results in greater severity of tricuspid regurgitation and the abrupt rise in right intra-atrial pressure may lead to a right-to-left shunt across a patent foramen ovale. Where hemodynamic compromise ensues, prompt surgical intervention is mandated.

  14. Left Atrial Deformation Analysis in Patients with Corrected Tetralogy of Fallot by 3D Speckle-Tracking Echocardiography (from the MAGYAR-Path Study

    Directory of Open Access Journals (Sweden)

    Kálmán Havasi

    Full Text Available Abstract Background: Three-dimensional (3D echocardiography coupled with speckle-tracking echocardiographic (STE capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF. Objectives: To compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls. Methods: The study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years. They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men. Results: Increased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls. Conclusions: Significant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair.

  15. Left Atrial Deformation Analysis in Patients with Corrected Tetralogy of Fallot by 3D Speckle-Tracking Echocardiography (from the MAGYAR-Path Study)

    Science.gov (United States)

    Havasi, Kálmán; Domsik, Péter; Kalapos, Anita; McGhie, Jackie S.; Roos-Hesselink, Jolien W.; Forster, Tamás; Nemes, Attila

    2017-01-01

    Background Three-dimensional (3D) echocardiography coupled with speckle-tracking echocardiographic (STE) capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA) volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF). Objectives To compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls. Methods The study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years). They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men). Results Increased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls. Conclusions Significant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair. PMID:28327874

  16. Comparison of determinations of left atrial volume by the biplane area-length and Simpson's methods using 64-slice computed tomography

    International Nuclear Information System (INIS)

    Takagi, Yasuhiro; Ehara, Shoichi; Okuyama, Takuhiro

    2009-01-01

    There is increasing evidence that left atrial (LA) size is an important predictor of adverse cardiovascular outcomes such as atrial fibrillation, stroke, and congestive heart failure. The aim of this study was to determine whether there is a difference in results of quantification of LA volume by the area-length and Simpson's methods using multislice computed tomography (MSCT). The study population consisted of 51 patients with sinus rhythm (sinus group) and 20 patients with atrial fibrillation (af group) clinically indicated for MSCT angiography for evaluation of coronary arteries. Maximum LA volume, obtained at end-systole from the phase immediately preceding mitral valve opening, was measured using the area-length and Simpson's methods. In the sinus group, the mean LA volumes, indexed to body surface area, were 48.4±17.9 ml/m 2 with the area-length method and 48.3±17.0 ml/m 2 with the Simpson's method. In the af group, the mean indexed LA volumes with the area-length method and the Simposon's method were 91.5±47.5 ml/m 2 and 90.3±45.9 ml/m 2 , respectively. LA volumes calculated by the area-length method exhibited a strong linear relationship and agreement with those calculated using Simpson's method in both the groups (sinus group: r=0.99, P<0.0001, af group: r=0.99, P<0.0001). The area-length method is a simple and reproducible means of assessment of LA volume. Standardization of LA volume assessment using MSCT is important for serial follow-up and meaningful communication of results of testing among institutions and physicians. (author)

  17. Hypoplastic left heart syndrome

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    Thiagarajan Ravi

    2007-05-01

    Full Text Available Abstract Hypoplastic left heart syndrome(HLHS refers to the abnormal development of the left-sided cardiac structures, resulting in obstruction to blood flow from the left ventricular outflow tract. In addition, the syndrome includes underdevelopment of the left ventricle, aorta, and aortic arch, as well as mitral atresia or stenosis. HLHS has been reported to occur in approximately 0.016 to 0.036% of all live births. Newborn infants with the condition generally are born at full term and initially appear healthy. As the arterial duct closes, the systemic perfusion becomes decreased, resulting in hypoxemia, acidosis, and shock. Usually, no heart murmur, or a non-specific heart murmur, may be detected. The second heart sound is loud and single because of aortic atresia. Often the liver is enlarged secondary to congestive heart failure. The embryologic cause of the disease, as in the case of most congenital cardiac defects, is not fully known. The most useful diagnostic modality is the echocardiogram. The syndrome can be diagnosed by fetal echocardiography between 18 and 22 weeks of gestation. Differential diagnosis includes other left-sided obstructive lesions where the systemic circulation is dependent on ductal flow (critical aortic stenosis, coarctation of the aorta, interrupted aortic arch. Children with the syndrome require surgery as neonates, as they have duct-dependent systemic circulation. Currently, there are two major modalities, primary cardiac transplantation or a series of staged functionally univentricular palliations. The treatment chosen is dependent on the preference of the institution, its experience, and also preference. Although survival following initial surgical intervention has improved significantly over the last 20 years, significant mortality and morbidity are present for both surgical strategies. As a result pediatric cardiologists continue to be challenged by discussions with families regarding initial decision

  18. Presence of left atrial diverticula, accessory appendages, and normal variant pulmonary venous anatomy diagnosed using MDCT and adverse outcomes following radiofrequency catheter ablation therapy in patients with drug-refractory atrial fibrillation: An exploratory study

    International Nuclear Information System (INIS)

    Patel, S.N.; French, A.; Mathias, H.; Lyen, S.; Hamilton, M.C.K.; Manghat, N.E.

    2013-01-01

    Aim: To determine the frequency of normal variation left atrial anatomy (NVLAA) (diverticula, accessory appendages) and normal variation pulmonary venous anatomy (NVPVA) in patients with atrial fibrillation (AF), and to determine whether the presence of these entities is associated with an increased recurrence of atrial arrhythmias following radiofrequency catheter ablation (RFCA). Materials and methods: All cardiac MDCT images performed prior to RFCA between November 2009 and May 2011 in patients with drug-refractory AF were retrospectively evaluated. The presence, type, and location of NVLAA and NVPVA, and outcome of RFCA were recorded. Success was defined as restoration of sinus rhythm. Results: Forty-six consecutive patients with a mean age of 59.8 (±9.7) years (76.1% male) underwent cardiac MDCT for anatomical planning prior to RFCA procedures. Fourteen (30.4%) patients had NVLAA, 35% of patients had NVPVA. Thirty (65%) patients had successful RFCA: 57% of these had a NVLAA, 67% had NVPVA. Sixteen (35%) patients had unsuccessful RFCA: 63% of these had a NVLAA, 56% had NVPVA. There was no significant association between the presence of NVLAA (p = 0.699), NVPVA (p = 0.197), or “NVLAA in the presence of normal pulmonary venous anatomy” (p = 0.589) and the outcome of RFCA. Conclusion: The presence of NVLAA and NVPVA appears unrelated to adverse outcome in patients undergoing RFCA for the treatment of drug-refractory AF

  19. Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience.

    Science.gov (United States)

    Faustino, Ana; Paiva, Luís; Providência, Rui; Trigo, Joana; Botelho, Ana; Costa, Marco; Leitão-Marques, António

    2013-06-01

    In non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism. To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed. Patients with non-valvular atrial fibrillation and CHADS2 score ≥2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique. After the procedure, dual antiplatelet therapy was maintained for one month, followed by single antiplatelet therapy indefinitely. Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography. The procedure was performed in 22 of the 23 selected patients (95.7%), mean age 70±9 years, CHADS2 score 3.2±0.9 and CHA2DS2-VASC score 4.7±1.4. Intraprocedural device replacement was necessary only in the first patient, due to oversizing. The following periprocedural complications were observed: one femoral pseudoaneurysm, three femoral hematomas and two minor oropharyngeal bleeds, resolved by local hemostatic measures. During a 12±8 month follow-up a mild peri-device flow and a thrombus adhering to the device, resolved under with enoxaparin therapy, were identified. The rate of transient ischemic attack (TIA)/stroke was lower than expected according to the CHADS2 score (0 vs. 6.7±2.2%). In our initial experience, this procedure proved to be a feasible, safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option. Only relatively minor complications were observed, with a lower than expected TIA/stroke rate. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Left Ventricular Assist Devices

    Directory of Open Access Journals (Sweden)

    Khuansiri Narajeenron

    2017-04-01

    Full Text Available Audience: The audience for this classic team-based learning (cTBL session is emergency medicine residents, faculty, and students; although this topic is applicable to internal medicine and family medicine residents. Introduction: A left ventricular assist device (LVAD is a mechanical circulatory support device that can be placed in critically-ill patients who have poor left ventricular function. After LVAD implantation, patients have improved quality of life.1 The number of LVAD patients worldwide continues to rise. Left-ventricular assist device patients may present to the emergency department (ED with severe, life-threatening conditions. It is essential that emergency physicians have a good understanding of LVADs and their complications. Objectives: Upon completion of this cTBL module, the learner will be able to: 1 Properly assess LVAD patients’ circulatory status; 2 appropriately resuscitate LVAD patients; 3 identify common LVAD complications; 4 evaluate and appropriately manage patients with LVAD malfunctions. Method: The method for this didactic session is cTBL.

  2. Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history

    DEFF Research Database (Denmark)

    Park-Hansen, Jesper; Holme, Susanne J V; Irmukhamedov, Akhmadjon

    2018-01-01

    BACKGROUND: Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by l...

  3. The impact of the CartoSound® image directly acquired from the left atrium for integration in atrial fibrillation ablation.

    Science.gov (United States)

    Kaseno, Kenichi; Hisazaki, Kaori; Nakamura, Kohki; Ikeda, Etsuko; Hasegawa, Kanae; Aoyama, Daisetsu; Shiomi, Yuichiro; Ikeda, Hiroyuki; Morishita, Tetsuji; Ishida, Kentaro; Amaya, Naoki; Uzui, Hiroyasu; Tada, Hiroshi

    2018-04-14

    Intracardiac echocardiographic (ICE) imaging might be useful for integrating three-dimensional computed tomographic (CT) images for left atrial (LA) catheter navigation during atrial fibrillation (AF) ablation. However, the optimal CT image integration method using ICE has not been established. This study included 52 AF patients who underwent successful circumferential pulmonary vein isolation (CPVI). In all patients, CT image integration was performed after the CPVI with the following two methods: (1) using ICE images of the LA derived from the right atrium and right ventricular outflow tract (RA-merge) and (2) using ICE images of the LA directly derived from the LA added to the image for the RA-merge (LA-merge). The accuracy of these two methods was assessed by the distances between the integrated CT image and ICE image (ICE-to-CT distance), and between the CT image and actual ablated sites for the CPVI (CT-to-ABL distance). The mean ICE-to-CT distance was comparable between the two methods (RA-merge = 1.6 ± 0.5 mm, LA-merge = 1.7 ± 0.4 mm; p = 0.33). However, the mean CT-to-ABL distance was shorter for the LA-merge (2.1 ± 0.6 mm) than RA-merge (2.5 ± 0.8 mm; p imaging, and whereas the greatest CT-to-ABL distance was observed at the roof portion of the left superior PV (3.7 ± 2.8 mm) after the RA-merge, it improved to 2.6 ± 1.9 mm after the LA-merge (p images of the LA directly acquired from the LA might lead to a greater accuracy of the CT image integration for the CVPI.

  4. Left regular bands of groups of left quotients

    International Nuclear Information System (INIS)

    El-Qallali, A.

    1988-10-01

    A semigroup S which has a left regular band of groups as a semigroup of left quotients is shown to be the semigroup which is a left regular band of right reversible cancellative semigroups. An alternative characterization is provided by using spinned products. These results are applied to the case where S is a superabundant whose set of idempotents forms a left normal band. (author). 13 refs

  5. Assessment of left atrial appendage function by transthoracic pulsed Doppler echocardiography: Comparing against transesophageal interrogation and predicting echocardiographic risk factors for stroke.

    Science.gov (United States)

    Wai, Shin Hnin; Kyu, Kyu; Galupo, Mary Joyce; Songco, Geronica G; Kong, William K F; Lee, Chi Hang; Yeo, Tiong Cheng; Poh, Kian Keong

    2017-10-01

    Transesophageal echocardiographic (TEE) findings of left atrial appendage (LAA) thrombus, spontaneous echo contrast (SEC), and LAA dysfunction are established risk factors of cardioembolic stroke. The semi-invasive nature of TEE limits its utility as a routine risk stratification tool. We aim to correlate TEE and transthoracic echocardiography (TTE) pulsed Doppler measurements of LAA flow velocities and use TTE measurements to predict TEE findings. We prospectively measured pulsed Doppler LAA flow velocities in 103 consecutive patients on TEE and TTE. There was a strong correlation between TEE and TTE LAA emptying velocity (LAA E) (r = .88, P < .001) and a moderate correlation between LAA filling velocities (r = .50, P < .001). TTE LAA E predicted the presence of thrombus or SEC independent of atrial fibrillation (AF). To predict the presence of thrombus or SEC, the optimal TTE LAA E cutoff was ≤30 cm/s in all patients (75% sensitive, 90% specific) and ≤31 cm/s in AF patients (80% sensitive, 79% specific). To predict LAA dysfunction (TEE E ≤ 20 cm/s), the optimal TTE LAA E cutoff was ≤27 cm/s (100% sensitive, 89% specific in all patients and 100% sensitive, 74% specific in AF patients). TTE assessment of LAA function is feasible and correlates well with the more invasive TEE method. It predicts the presence of thrombus, SEC, and LAA dysfunction on TEE. TTE LAA assessment has incremental value in thromboembolic risk stratification and should be utilized more frequently. © 2017, Wiley Periodicals, Inc.

  6. Frequency of left atrial thrombus detected by transesophageal echocardiography in patients of tight mitral stenosis having negative trans-thoracic echocardiography at gulab devi cardiac complex

    International Nuclear Information System (INIS)

    Fayyaz, A.; Iqbal, M.W.

    2014-01-01

    Introduction: Patients with mitral stenosis (MS) having atrial fibrillation (AF) are more prone to develop left atrial (LA) thrombus. Systemic embolism, related to LA thrombus is a well-known risk of Percutaneous Mitral Balloon Valvotomy (PMBV) of the mitral valve. Therefore presence of LA thrombus is a contraindication to PMBV. Objective: Objective of this study was to detect the frequency of LA thrombus by transesophageal echocardiography (TEE) in patients of tight MS in whom transthoracic echocardiography (TTE) could not detect any LA thrombus. Patients and Methods: In this cross sectional study, we took 100 indoor patients with tight MS on non-probability consecutive sampling. Data was collected after meeting inclusion criteria. Patients were taken in this study after acquiring written informed consent. Symptoms were inquired from all patients and functional status was assessed by New York Heart Association class. Unstable patients were medically managed before the procedure. TEE was done on the same day before undergoing PMBV to look for clot in LA. Results: The mean age of the patients was 32.20 years and SD was 11.3 years. There were 36(36%) male patients and 64(64%) female patients. LA thrombus was present in 40% of patients on TEE out of which 19 were male patients (52.77%) and 21 were female patients (32.81%). Conclusion: Patients with mitral stenosis having AF are more prone to develop LA thrombus. In this study, the frequency of LA thrombus was 40% recorded, which is high. Due to the potential risk of embolization, it is strongly recommended to perform TEE in patients with normal TTE study before undergoing PMBV. The presence of a LA thrombus should be considered a contraindication to the PMBV of the mitral valve. (author)

  7. Changes in Serum NT-Pro BNP and Left Atrial BNP Levels after Percutaneous Transvenous Mitral Commissurotomy in Sinus Rhythm Versus Atrial Firilation

    Directory of Open Access Journals (Sweden)

    Leili Pourafkari

    2014-10-01

    Full Text Available Introduction: Natriuretic peptides are secreted from the heart in response to increased wall stress. Their levels are expected to be increased in patients with mitral stenosis (MS due tohigh left atrium (LA pressure and pulmonary artery pressure (PAP. Percutaneous transvenousmitral commissurotomy (PTMC if successful is pursued by a rapid decrease in LA pressure andsubsequent decrease in pulmonary artery pressure. The concurrent changes in natriuretic peptidelevels could be affected with heart rhythm.Methods: Forty five patients with severe rheumatic MS undergoing PTMC were enrolled. Weevaluated the serum NT-Pro BNP levels before and 24 hours after PTMC. BNP levels were alsomeasured from the blood samples obtained from LA before and 20 minutes after the procedure.Changes in biomarkers were assessed based on heart rhythm and success of the procedure.Results: While serum NT-Pro BNP levels showed significant decrease 24 hours after theprocedure (P= 0.04, BNP levels taken 20 minutes after PTMC from LA were similar to theirbaseline concentrations (P= 0.26. NT-Pro BNP levels decreased 51.7±182.86 pg/ml for SR and123.4±520 pg/ml for AF (P= 0.68.Conclusion: Immediate changes in BNP levels did not predict the success of procedure probablydue to the additional balloon inflation attempts in LA in several patients and half-life of BNP. BNPlevels obtained later may be of more value considering the half-life of this marker. Heart rhythmwas not found to influence the changes in biomarker levels. BNP and NT-pro BNP changes werenot found to predict success of the procedure.

  8. Why Dora Left

    DEFF Research Database (Denmark)

    Gammelgård, Judy

    2017-01-01

    The question of why Dora left her treatment before it was brought to a satisfactory end and the equally important question of why Freud chose to publish this problematic and fragmentary story have both been dealt with at great length by Freud’s successors. Dora has been read by analysts, literary...... problem toward femininity, both Dora’s and his own. In Dora, it is argued, Freud took a new stance toward the object of his investigation, speaking from the position of the master. Freud presents himself as the one who knows, in great contrast to the position he takes when unraveling the dream. Here he...

  9. Neutrosophic Left Almost Semigroup

    Directory of Open Access Journals (Sweden)

    Mumtaz Ali

    2014-06-01

    Full Text Available In this paper we extend the theory of neutrosophy to study left almost semigroup shortly LAsemigroup. We generalize the concepts of LA-semigroup to form that for neutrosophic LA-semigroup. We also extend the ideal theory of LA-semigroup to neutrosophy and discuss different kinds of neutrosophic ideals. We also find some new type of neutrosophic ideal which is related to the strong or pure part of neutrosophy. We have given many examples to illustrate the theory of neutrosophic LA-semigroup and display many properties of neutrosophic LA-semigroup in this paper.

  10. Adverse effects of permanent atrial fibrillation on heart failure in patients with preserved left ventricular function and chronic right apical pacing for complete heart block.

    Science.gov (United States)

    Lampe, Brigitte; Hammerstingl, Christoph; Schwab, Jörg Otto; Mellert, Fritz; Stoffel-Wagner, Birgit; Grigull, Andreas; Fimmers, Rolf; Maisch, Bernhard; Nickenig, Georg; Lewalter, Thorsten; Yang, Alexander

    2012-10-01

    The impact of atrial fibrillation (AF) on heart failure (HF) was evaluated in patients with preserved left ventricular (LV) function and long-term right ventricular (RV) pacing for complete heart block. Clinical, echocardiographic, and laboratory parameters of HF were assessed in 35 patients with established AF who had undergone ablation of the atrioventricular node and pacemaker implantation (Group A) and 31 patients who received dual-chamber pacing for spontaneous complete heart block (Group B). During a follow-up period of 12.7 ± 7.5 years, New York Heart Association (NYHA) functional class increased from 1.3 ± 0.5 to 2.1 ± 0.6 (p Left ventricular ejection fraction (LVEF) decreased from 59.7 ± 5.1 to 53.0 ± 8.2 (p function were moderately depressed in Group A compared with those in Group B: NYHA class 2.1 ± 0.6 versus 1.6 ± 0.7, p = 0.001; LVEF 53.0 ± 8.2 versus 56.9 ± 7.0 %, p brain natriuretic peptide (NT-proBNP) 1116.8 ± 883.9 versus 622.9 ± 1059.4 pg/ml, p 10 %, increasing NYHA class ≥1, and NT-proBNP levels >1,000 pg/ml. Permanent AF was associated with adverse effects on LV function and symptoms of HF in patients with long-term RV pacing for complete heart block, and appears to play an important role in the development of HF in this specific patient cohort.

  11. Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation.

    Science.gov (United States)

    Mohanty, Sanghamitra; Mohanty, Prasant; Di Biase, Luigi; Trivedi, Chintan; Morris, Eli Hamilton; Gianni, Carola; Santangeli, Pasquale; Bai, Rong; Sanchez, Javier E; Hranitzky, Patrick; Gallinghouse, G Joseph; Al-Ahmad, Amin; Horton, Rodney P; Hongo, Richard; Beheiry, Salwa; Elayi, Claude S; Lakkireddy, Dhanunjaya; Madhu Reddy, Yaruva; Viles Gonzalez, Juan F; Burkhardt, J David; Natale, Andrea

    2017-11-01

    Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI+ ablation of the non-PV triggers. Totally, 177 consecutive patients with PAF and severe LA scarring were included. Patients underwent PVAI only (n = 45, Group 1), PVAI+ scar homogenization (n = 66, Group 2) or PVAI+ ablation of non-PV triggers (n = 66, Group 3) based on operator's choice. Baseline characteristics were similar across the groups. After first procedure, all patients were followed-up for a minimum of 2 years. The success rate at the end of the follow-up was 18% (8 pts), 21% (14 pts), and 61% (40 pts) in Groups 1, 2, and 3, respectively. Cumulative probability of AF-free survival was significantly higher in Group 3 (overall log-rank P homogenization. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.

  12. Evaluation of left ventricular function in patients with atrial fibrillation by ECG gated blood pool scintigraphy. Using frame count normalization method

    Energy Technology Data Exchange (ETDEWEB)

    Akanabe, Hiroshi; Oshima, Motoo; Sakuma, Sadayuki

    1988-07-01

    The assumption necessary to perform ECG gated blood pool scintigraphy (EGBPS) are seemingly not valid for patients with atrial fibrillation (af), since they have wide variability in cardiac cycle length. The data were acquired in frame mode within the limits of mean heart rate of fix the first diastolic volume, and were calculated by frame count normalization (FCN) method to correct total counts in each frame. EGBPS were performed twelve patients with af, who were operated against valvular disease. The data acquired within mean heart rate +-10 % in frame mode were divided to 32 frames, and calculated total frame counts. With FCN method total frame counts from at 22nd to 32nd frame were multiplied to be equal to the average of total frame counts. FCN method could correct total frame counts at the latter frames. And there was good correlation between left ventricular ejection fraction calculated from scintigraphy and that from contrast cineangiography. Thus EGBPS with FCN method may be allow estimation of cardiac function even in subjects with af.

  13. The role of Multidetector CT in the evaluation of the left atrium and pulmonary veins anatomy before and after radio-frequency catheter ablation for atrial fibrillation. Preliminary results and work in progress.Technical note

    International Nuclear Information System (INIS)

    Centoze, Maurizio; Della Sala, Sabino Walter; Dalla Palma, Francesco; Del Greco, Maurizio; Marini, Massimiliano; Nollo, Giandomenico; Ravelli, Flavia

    2005-01-01

    Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial al fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this parer is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward [it

  14. Total agenesis of the left pericardium

    Directory of Open Access Journals (Sweden)

    J. Glauco Lobo Fº

    1999-09-01

    Full Text Available This is the report of a 46-year-old patient with the preoperative diagnosis of an atrial septal defect (ASD of the ostium secudum type. After sternectomy, partial agenesis of the left pericardium was diagnosed. It is our opinion that, if the radiographic picture is suggestive of this entity, a clinical search for cardiopulmonary anomalies should be performed, because the majority of these associated anomalies can and should be surgically corrected.

  15. Non-compact left ventricle/hypertrabeculated left ventricle

    International Nuclear Information System (INIS)

    Restrepo, Gustavo; Castano, Rafael; Marmol, Alejandro

    2005-01-01

    Non-compact left ventricle/hypertrabeculated left ventricle is a myocardiopatie produced by an arrest of the normal left ventricular compaction process during the early embryogenesis. It is associated to cardiac anomalies (congenital cardiopaties) as well as to extracardial conditions (neurological, facial, hematologic, cutaneous, skeletal and endocrinological anomalies). This entity is frequently unnoticed, being diagnosed only in centers with great experience in the diagnosis and treatment of myocardiopathies. Many cases of non-compact left ventricle have been initially misdiagnosed as hypertrophic myocardiopatie, endocardial fibroelastosis, dilated cardiomyopatie, restrictive cardiomyopathy and endocardial fibrosis. It is reported the case of a 74 years old man with a history of chronic arterial hypertension and diabetes mellitus, prechordial chest pain and mild dyspnoea. An echocardiogram showed signs of non-compact left ventricle with prominent trabeculations and deep inter-trabecular recesses involving left ventricular apical segment and extending to the lateral and inferior walls. Literature on this topic is reviewed

  16. Comparative efficacy of amiodarone with ivabradin combination or amiodarone with bisoprolol combination in the prevention of atrial fibrillation recurrence in pa- tients with left ventricular diastolic dysfunction

    Directory of Open Access Journals (Sweden)

    K. G. Adamyan

    2015-01-01

    Full Text Available Aim. To study the efficacy of use of amiodarone with ivabradine combination or amiodarone with bisoprolol combination in the prevention of atrial fibrillation (AF recurrence in patients (pts with left ventricular diastolic dysfunction (LVDD after conversion to sinus rhythm. Material and methods. 65 patients (40 males, 25 females aged 53±8 years with persistent AF and LVDD were included into the study and randomized into 3 groups to receive ivabradine and amiodarone (22 pts, bisoprolol and amiodarone (22 pts or amiodarone alone (21 pts. Left atrium (LA volume indices, LA longitudinal strain rate (LASR in systole, LV mass index, mean heart rate (HR, 24-hour HR variability and the incidence of AF by 96 h ECG monitoring were measured after the titration period, and after 3 and 6 months of follow-up. Results. After 6 months of follow-up group 1 revealed significantly lower maximum LA volume index (21.3±2.4 vs 25.2±3.0 and 28.7±3.6 ml/m2 in the 2nd and control groups, respectively, P-wave LA volume index (15.3±3.5 versus 18.1±3.8 and 20.4±4.0 ml/m2 in the 2nd and control groups, respectively, and LA systolic volume index (7.3±1.2 versus 9.4±1.6 and 9.6±1.7 ml/m2 in 2nd and control groups, respectively. The incidence of side effects in group 1 was significantly less than that in group 2 and was not different compared with control group. Conclusion. Ivabradine and amiodarone combination provides better prevention of AF recurrence and less side-effects in pts with LVDD and persistent AF after sinus rhythm restoration as compared with bisoprolol and amiodarone combination, it also reduces LA maximum, conduit and systolic volumes, and increases LASR.

  17. [Left-handedness and health].

    Science.gov (United States)

    Milenković, Sanja; Belojević, Goran; Kocijancić, Radojka

    2010-01-01

    Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome), developmental disorders (autism, dislexia and sttutering) and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about "anomalous" cerebral domination, as a consequence of hormonal disbalance.

  18. Left ventricular systolic function in sickle cell anaemia: an ...

    African Journals Online (AJOL)

    42) and 24.17 ± 4.39 ... Aortic root diameter (Ao), left atrial dimension (LAD), left ventricu- ... Key: *Statistically significant, a= Chi-square, SCA= sickle cell anaemia, SD= standard deviation. ..... of fluctuations in response to changes in sympathetic.

  19. Effect of exercise on circulating atrial natriuretic peptide and left ventricular ejection fraction in healthy persons and patients with coronary artery disease

    International Nuclear Information System (INIS)

    Nakamura, Tetsuya; Ichikawa, Shuichi; Sakamaki, Tetsuo; Suzuki, Tadashi; Iizuka, Toshio; Yagi, Atsuko; Kurashina, Toshiaki; Kumakura, Hisao; Murata, Kazuhiko

    1988-01-01

    Radionuclide angiographic measurements of left ventricular ejection fraction were performed at rest and during exercise in 10 normal persons and 11 patients with coronary artery disease. Exercise was continued on a supine bicycle exercise table up to a symptom-limited maximum. Plasma levels of atrial natriuretic peptide (ANP) were also determined at rest and during exercise. Ejection fraction in the normal volunteers was 59±3% (mean±SEM) at rest and increased significantly (p<0.01) to 69±3% during exercise. Ejection fraction in the patients was 47±5% at rest and did not change significantly during exercise (51±7%). Plasma ANP in the normals rose significantly (p<0.01) from 62±16 pg/ml at rest to 454±94 pg/ml during exercise. Plasma ANP in the patients also rose significantly (p<0.01) from 231±102 pg/ml to 794±170 pg/ml. The response of plasma ANP to exercise was enhanced significantly (p<0.05) in the patients as compared with the normals in relation to ejection fraction by analysis of covariance. In both the normals and the patients, plasma ANP was inversely and significantly correlated with ejection fraction during exercise (r=0.46, p<0.05, n=21), however, not at rest. Because it has been reported that plasma ANP is correlated positively with pulmonary artery wedge pressure, the estimation of plasma ANP during an exercise stress test might be used for the evaluation of cardiac reserve in coronary artery disease. (author)

  20. - LAA Occluder View for post-implantation Evaluation (LOVE) - standardized imaging proposal evaluating implanted left atrial appendage occlusion devices by cardiac computed tomography

    International Nuclear Information System (INIS)

    Behnes, Michael; Akin, Ibrahim; Sartorius, Benjamin; Fastner, Christian; El-Battrawy, Ibrahim; Borggrefe, Martin; Haubenreisser, Holger; Meyer, Mathias; Schoenberg, Stefan O.; Henzler, Thomas

    2016-01-01

    A standardized imaging proposal evaluating implanted left atrial appendage (LAA) occlusion devices by cardiac computed tomography angiography (cCTA) has never been investigated. cCTA datasets were acquired on a 3 rd generation dual-source CT system and reconstructed with a slice thickness of 0.5 mm. An interdisciplinary evaluation was performed by two interventional cardiologists and one radiologist on a 3D multi-planar workstation. A standardized multi-planar reconstruction algorithm was developed in order to assess relevant clinical aspects of implanted LAA occlusion devices being outlined within a pictorial essay. The following clinical aspects of implanted LAA occlusion devices were evaluated within the most appropriate cCTA multi-planar reconstruction: (1) topography to neighboring structures, (2) peri-device leaks, (3) coverage of LAA lobes, (4) indirect signs of neo-endothelialization. These are illustrated within concise CT imaging examples emphasizing the potential value of the proposed cCTA imaging algorithm: Starting from anatomical cCTA planes and stepwise angulation planes perpendicular to the base of the LAA devices generates an optimal LAA Occluder View for post-implantation Evaluation (LOVE). Aligned true axial, sagittal and coronal LOVE planes offer a standardized and detailed evaluation of LAA occlusion devices after percutaneous implantation. This pictorial essay presents a standardized imaging proposal by cCTA using multi-planar reconstructions that enables systematical follow-up and comparison of patients after LAA occlusion device implantation. The online version of this article (doi:10.1186/s12880-016-0127-y) contains supplementary material, which is available to authorized users

  1. Multimodal Examination of Atrial Fibrillation Substrate: Correlation of Left Atrial Bipolar Voltage Using Multi-Electrode Fast Automated Mapping, Point-by-Point Mapping, and Magnetic Resonance Image Intensity Ratio.

    Science.gov (United States)

    Zghaib, Tarek; Keramati, Ali; Chrispin, Jonathan; Huang, Dong; Balouch, Muhammad A; Ciuffo, Luisa; Berger, Ronald D; Marine, Joseph E; Ashikaga, Hiroshi; Calkins, Hugh; Nazarian, Saman; Spragg, David D

    2018-01-01

    Bipolar voltage mapping, as part of atrial fibrillation (AF) ablation, is traditionally performed in a point-by-point (PBP) approach using single-tip ablation catheters. Alternative techniques for fibrosis-delineation include fast-anatomical mapping (FAM) with multi-electrode circular catheters, and late gadolinium-enhanced magnetic-resonance imaging (LGE-MRI). The correlation between PBP, FAM, and LGE-MRI fibrosis assessment is unknown. In this study, we examined AF substrate using different modalities (PBP, FAM, and LGE-MRI mapping) in patients presenting for an AF ablation. LGE-MRI was performed pre-ablation in 26 patients (73% males, age 63±8years). Local image-intensity ratio (IIR) was used to normalize myocardial intensities. PBP- and FAM-voltage maps were acquired, in sinus rhythm, prior to ablation and co-registered to LGE-MRI. Mean bipolar voltage for all 19,087 FAM voltage points was 0.88±1.27mV and average IIR was 1.08±0.18. In an adjusted mixed-effects model, each unit increase in local IIR was associated with 57% decrease in bipolar voltage (p0.74 corresponded to bipolar voltage voltage was significantly associated with log-PBP bipolar voltage (ß=0.36, pvoltages, FAM-mapping distribution was shifted to the left compared to PBP-mapping; at intermediate voltages, FAM and PBP voltages were overlapping; and at high voltages, FAM exceeded PBP-voltages. LGE-MRI, FAM and PBP-mapping show good correlation in delineating electro-anatomical AF substrate. Each approach has fundamental technical characteristics, the awareness of which allows proper assessment of atrial fibrosis.

  2. Cirurgia cardíaca de emergência para ressecção de mixoma atrial esquerdo Cardiac surgery of emergency for resection of left atrial myxoma

    Directory of Open Access Journals (Sweden)

    Antônio Augusto Ramalho Motta

    2008-06-01

    Full Text Available É descrito caso de paciente do sexo feminino que apresentava manifestações pulmonares e sistêmicas inespecíficas há vários meses, as quais resultaram em várias internações hospitalares com a hipótese diagnóstica de fibrose pulmonar. Estudo ecocardiográfico evidenciou a presença de grande mixoma pediculado no átrio esquerdo, que prolapsava, através da valva mitral, para o ventrículo esquerdo. Em condições clínicas bastante desfavoráveis, a paciente foi encaminhada ao nosso Serviço para tratamento cirúrgico, evoluindo durante o preparo pré-operatório com edema agudo pulmonar e instabilidade hemodinâmica, sendo submetida a cirurgia de emergência, com sucesso, para ressecção da tumoração. A paciente encontra-se assintomática.We report case of a female patient who during months presented pulmonary manifestation associated with nonspecific systemic symptoms resulting in several hospitalizations with the diagnostic hypothesis of pulmonary fibrosis. The echocardiographic study showed a great pedunculated left atrial myxoma prolapsing through the mitral valve for the left ventricle. In quite unfavorable clinical conditions the patient was sent to our Service for surgical treatment, evolving during the preparation for surgery with acute pulmonary edema and hemodinamic instability being submitted to a successfully surgery of emergency for resection of the tumor. The patient is asymptomatic.

  3. Cardiac resynchronization therapy with His bundle pacing as a method of treatment of chronic heart failure in patients with permanent atrial fibrillation and left bundle branch block.

    Science.gov (United States)

    Boczar, Krzysztof; Sławuta, Agnieszka; Ząbek, Andrzej; Dębski, Maciej; Gajek, Jacek; Lelakowski, Jacek; Małecka, Barbara

    CRT is a therapeutic option for patients with heart failure, sinus rhythm, prolonged QRS complex duration and reduced ejection fraction. We present a case of 71-year-old woman with dilated cardiomyopathy, NYHA functional class III and AF. We implanted CRT combined with direct His-bundle pacing. The indication for such a therapy was a left bundle branch block with a QRS complex of 178ms and a left ventricular EF of 15%, left ventricular end-diastolic diameter (LVEDD) of 75mm. After 8months of follow-up the LVEDD was 60mm with EF 35-40%. Copyright © 2017. Published by Elsevier Inc.

  4. Left Right Patterning, Evolution and Cardiac Development

    Science.gov (United States)

    Dykes, Iain M.

    2018-01-01

    Many aspects of heart development are determined by the left right axis and as a result several congenital diseases have their origins in aberrant left-right patterning. Establishment of this axis occurs early in embryogenesis before formation of the linear heart tube yet impacts upon much later morphogenetic events. In this review I discuss the differing mechanisms by which left-right polarity is achieved in the mouse and chick embryos and comment on the evolution of this system. I then discus three major classes of cardiovascular defect associated with aberrant left-right patterning seen in mouse mutants and human disease. I describe phenotypes associated with the determination of atrial identity and venous connections, looping morphogenesis of the heart tube and finally the asymmetric remodelling of the embryonic branchial arch arterial system to form the leftward looped arch of aorta and associated great arteries. Where appropriate, I consider left right patterning defects from an evolutionary perspective, demonstrating how developmental processes have been modified in species over time and illustrating how comparative embryology can aide in our understanding of congenital heart disease. PMID:29755990

  5. Left-handedness and health

    Directory of Open Access Journals (Sweden)

    Milenković Sanja

    2010-01-01

    Full Text Available Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome, developmental disorders (autism, dislexia and sttutering and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about 'anomalous' cerebral domination, as a consequence of hormonal disbalance. .

  6. Long-term fate of left atrial thrombi and incidence of cerebral embolism under continuous anticoagulation therapy; MR-tomographische Evaluation der Inzidenz zerebraler Embolien bei Patienten mit Vorhofflimmern und linksatrialen Thromben

    Energy Technology Data Exchange (ETDEWEB)

    Strach, K.; Meyer, C.; Hackenbroch, M.; Schild, H.; Sommer, T. [Radiologische Universitaetsklinik Bonn (Germany); Tiemann, K. [Medizinische Universitaetsklinik und Poliklinik II, Bonn (Germany); Haase, J. [Klinik Rotes Kreuz, Frankfurt/Main (Germany); Pizulli, L. [Petruskrankenhaus, Bonn (Germany); Omran, H. [St. Marien-Hospital, Bonn (Germany)

    2005-12-15

    Purpose: Patients (pts.) with atrial fibrillation (AF) and atrial thrombi are known to have an increased risk for cerebral embolism. However, little is known about the clinical course of atrial thrombi and the incidence of cerebral embolism in those patients during anticoagulation therapy. The high sensitivity of MR imaging (MRI) including diffusion-weighted imaging (DWI) suggests that this technique could provide an improved estimate of cerebral embolism associated with the presence of left atrial thrombi. The aims of this prospective study were to evaluate (1) the prevalence of clinically silent and apparent cerebral embolism in pts. with newly diagnosed AF and atrial thrombi using MRI/DWI, (2) the long-term fate of atrial thrombi under continued anticoagulation therapy and (3) the incidence of cerebral embolism during a follow-up period of 12 months with continuous anticoagulation therapy. Materials and methods: The study group consisted of 32 pts. with (1) newly diagnosed AF and evidence of left atrial (LA) thrombi detected by TEE and (2) a new start of anticoagulation therapy [International Normalized Ratio (INR) 2.0-3.0]. 19 pts. with (1) newly diagnosed AF and no evidence of atrial thrombi and (2) an equivalent anticoagulation regimen served as the control group. In both groups (a) MRI/DWI studies of the brain (weeks 0, 4, 8, 12, 20, 28, 36, 44, and 52), (b) transesophageal echocardiographic studies (TEE) for assessment of LA-Thrombi (weeks 0 and 52) and (c) clinical neurological assessments (weeks 0, 20 and 52) were performed. Results: In the study group (AF and LA-Thrombi) 11 out of 32 pts. (34%) displayed signs of acute (n=8) or chronic (n=3) cerebral embolism in the initial MRI studies. In 4 out of 32 pts.(13%), MRI/DWI depicted new or additional cerebral emboli (n=12) during the follow-up period despite continuous anticoagulation therapy. 2 (n=2/4; 50%) of these patients had clinically apparent neurological deficits. In the control group 1 out of 19 pts

  7. CT based 3D printing is superior to transesophageal echocardiography for pre-procedure planning in left atrial appendage device closure.

    Science.gov (United States)

    Obasare, Edinrin; Mainigi, Sumeet K; Morris, D Lynn; Slipczuk, Leandro; Goykhman, Igor; Friend, Evan; Ziccardi, Mary Rodriguez; Pressman, Gregg S

    2018-05-01

    Accurate assessment of the left atrial appendage (LAA) is important for pre-procedure planning when utilizing device closure for stroke reduction. Sizing is traditionally done with transesophageal echocardiography (TEE) but this is not always precise. Three-dimensional (3D) printing of the LAA may be more accurate. 24 patients underwent Watchman device (WD) implantation (71 ± 11 years, 42% female). All had complete 2-dimensional TEE. Fourteen also had cardiac computed tomography (CCT) with 3D printing to produce a latex model of the LAA for pre-procedure planning. Device implantation was unsuccessful in 2 cases (one with and one without a 3D model). The model correlated perfectly with implanted device size (R 2  = 1; p < 0.001), while TEE-predicted size showed inferior correlation (R 2  = 0.34; 95% CI 0.23-0.98, p = 0.03). Fisher's exact test showed the model better predicted final WD size than TEE (100 vs. 60%, p = 0.02). Use of the model was associated with reduced procedure time (70 ± 20 vs. 107 ± 53 min, p = 0.03), anesthesia time (134 ± 31 vs. 182 ± 61 min, p = 0.03), and fluoroscopy time (11 ± 4 vs. 20 ± 13 min, p = 0.02). Absence of peri-device leak was also more likely when the model was used (92 vs. 56%, p = 0.04). There were trends towards reduced trans-septal puncture to catheter removal time (50 ± 20 vs. 73 ± 36 min, p = 0.07), number of device deployments (1.3 ± 0.5 vs. 2.0 ± 1.2, p = 0.08), and number of devices used (1.3 ± 0.5 vs. 1.9 ± 0.9, p = 0.07). Patient specific models of the LAA improve precision in closure device sizing. Use of the printed model allowed rapid and intuitive location of the best landing zone for the device.

  8. UFO in the Left Atrium: How to Capture Metal Debris Floating in the Left Atrium.

    Science.gov (United States)

    Fassini, Gaetano; Moltrasio, Massimo; Conti, Sergio; Biagioli, Viviana; Tondo, Claudio

    2016-06-01

    Electrophysiology procedures involving left atrium navigation are becoming more frequent, mostly due to the increase of atrial fibrillation ablation. Mapping catheters of different shapes and size as well as dedicated sheaths are mandatory tools for the accomplishment of procedural end point. Therefore, technical issues are expected, usually unrelated to significant risk. However, any accidental intra-atrial device loss of integrity implies a risk of cerebrovascular embolization. The lack of clear evidence on how to manage these events and the need for a quick solution complicate the scenario. We report an empirical solution in the case of debris floating in the left atrium. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  9. Left bundle-branch block

    DEFF Research Database (Denmark)

    Risum, Niels; Strauss, David; Sogaard, Peter

    2013-01-01

    The relationship between myocardial electrical activation by electrocardiogram (ECG) and mechanical contraction by echocardiography in left bundle-branch block (LBBB) has never been clearly demonstrated. New strict criteria for LBBB based on a fundamental understanding of physiology have recently...

  10. Producing The New Regressive Left

    DEFF Research Database (Denmark)

    Crone, Christine

    members, this thesis investigates a growing political trend and ideological discourse in the Arab world that I have called The New Regressive Left. On the premise that a media outlet can function as a forum for ideology production, the thesis argues that an analysis of this material can help to trace...... the contexture of The New Regressive Left. If the first part of the thesis lays out the theoretical approach and draws the contextual framework, through an exploration of the surrounding Arab media-and ideoscapes, the second part is an analytical investigation of the discourse that permeates the programmes aired...... becomes clear from the analytical chapters is the emergence of the new cross-ideological alliance of The New Regressive Left. This emerging coalition between Shia Muslims, religious minorities, parts of the Arab Left, secular cultural producers, and the remnants of the political,strategic resistance...

  11. Left main percutaneous coronary intervention.

    Science.gov (United States)

    Teirstein, Paul S; Price, Matthew J

    2012-10-23

    The introduction of drug-eluting stents and advances in catheter techniques have led to increasing acceptance of percutaneous coronary intervention (PCI) as a viable alternative to coronary artery bypass graft (CABG) for unprotected left main disease. Current guidelines state that it is reasonable to consider unprotected left main PCI in patients with low to intermediate anatomic complexity who are at increased surgical risk. Data from randomized trials involving patients who are candidates for either treatment strategy provide novel insight into the relative safety and efficacy of PCI for this lesion subset. Herein, we review the current data comparing PCI with CABG for left main disease, summarize recent guideline recommendations, and provide an update on technical considerations that may optimize clinical outcomes in left main PCI. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Left ventricular apical ballooning syndrome

    International Nuclear Information System (INIS)

    Rahman, N.; Tai, J.; Soofi, A.

    2007-01-01

    The transient left ventricular apical ballooning syndrome, also known as Takotsubo cardiomyopathy, is characterized by transient left ventricular dysfunction in the absence of obstructive epicardial coronary disease. Although the syndrome has been reported in Japan since 1990, it is rare in other regions. Rapid recognition of the syndrome can modify the diagnostic and therapeutic attitude i.e. avoiding thrombolysis and performing catheterization in the acute phase. (author)

  13. Apraxia in left-handers.

    Science.gov (United States)

    Goldenberg, Georg

    2013-08-01

    In typical right-handed patients both apraxia and aphasia are caused by damage to the left hemisphere, which also controls the dominant right hand. In left-handed subjects the lateralities of language and of control of the dominant hand can dissociate. This permits disentangling the association of apraxia with aphasia from that with handedness. Pantomime of tool use, actual tool use and imitation of meaningless hand and finger postures were examined in 50 consecutive left-handed subjects with unilateral hemisphere lesions. There were three aphasic patients with pervasive apraxia caused by left-sided lesions. As the dominant hand is controlled by the right hemisphere, they constitute dissociations of apraxia from handedness. Conversely there were also three patients with pervasive apraxia caused by right brain lesions without aphasia. They constitute dissociations of apraxia from aphasia. Across the whole group of patients dissociations from handedness and from aphasia were observed for all manifestations of apraxia, but their frequency depended on the type of apraxia. Defective pantomime and defective tool use occurred rarely without aphasia, whereas defective imitation of hand, but not finger, postures was more frequent after right than left brain damage. The higher incidence of defective imitation of hand postures in right brain damage was mainly due to patients who had also hemi-neglect. This interaction alerts to the possibility that the association of right hemisphere damage with apraxia has to do with spatial aptitudes of the right hemisphere rather than with its control of the dominant left hand. Comparison with data from right-handed patients showed no differences between the severity of apraxia for imitation of hand or finger postures, but impairment on pantomime of tool use was milder in apraxic left-handers than in apraxic right-handers. This alleviation of the severity of apraxia corresponded with a similar alleviation of the severity of aphasia as

  14. Right colon cancer: Left behind.

    Science.gov (United States)

    Gervaz, P; Usel, M; Rapiti, E; Chappuis, P; Neyroud-Kaspar, I; Bouchardy, C

    2016-09-01

    Prognosis of colon cancer (CC) has steadily improved during the past three decades. This trend, however, may vary according to proximal (right) or distal (left) tumor location. We studied if improvement in survival was greater for left than for right CC. We included all CC recorded at the Geneva population-based registry between 1980 and 2006. We compared patients, tumor and treatment characteristics between left and right CC by logistic regression and compared CC specific survival by Cox models taking into account putative confounders. We also compared changes in survival between CC location in early and late years of observation. Among the 3396 CC patients, 1334 (39%) had right-sided and 2062 (61%) left-sided tumors. In the early 1980s, 5-year specific survival was identical for right and left CCs (49% vs. 48%). During the study period, a dramatic improvement in survival was observed for patients with left-sided cancers (Hazard ratio [HR]: 0.42, 95% confidence interval [CI]: 0.29-0.62, p colon cancer patients, those with right-sided lesions have by far the worse prognosis. Change of strategic management in this subgroup is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Pitx2 expression defines a left cardiac lineage of cells: evidence for atrial and ventricular molecular isomerism in the iv/iv mice

    NARCIS (Netherlands)

    Campione, M.; Ros, M. A.; Icardo, J. M.; Piedra, E.; Christoffels, V. M.; Schweickert, A.; Blum, M.; Franco, D.; Moorman, A. F.

    2001-01-01

    The homeobox gene Pitx2 has been characterized as a mediator of left-right signaling in heart, gut, and lung morphogenesis. However, the relationship between the developmental role of Pitx2 and its expression pattern at the organ level has not been explored. In this study we focus on the role of

  16. Aphasia following left thalamic hemorrhage

    International Nuclear Information System (INIS)

    Makishita, Hideo; Miyasaka, Motomaro; Tanizaki, Yoshio; Yanagisawa, Nobuo; Sugishita, Morihiro.

    1984-01-01

    We reported 7 patients with left thalamic hemorrhage in the chronic stage (from 1.5 months to 4.5 months), and described language disorders examined by Western Aphasia Battery (WAB) and measured cerebral blood flow by single photon emission CT. Examination of language by WAB revealed 4 aphasics out of 7 cases, and 3 patients had no language deficit. The patient with Wernicke's aphasia showed low density area only in the left posterior thalamus in X-ray CT, and revealed severe low blood flow area extending to left temporal lobe in emission CT. In the case with transcortical sensory aphasia, although X-ray CT showed no obvious low density area, emission CT revealed moderate low flow area in watershed area that involved the territory between posterior cerebral and middle cerebral arteries in the left temporooccipital region in addition to low blood flow at the left thalamus. In one of the two patients classified as anomic aphasia, whose score of repetition (8.4) was higher than that of comprehension (7.4), emission CT showed slight low flow area at the temporo-occipital region similarly as the case with transcortical sensory aphasia. In another case with anomic aphasia, scored 9 on both fluensy and comprehension subtests and 10 on repetition, there was wide low density area all over the left thalamus and midline shift to the right in X-ray CT, and emission CT showed severe low blood flow in the same region spreading widely toward the cerebral surface. On the other hand, in all of the 3 patients without aphasia, emission CT showed low flow region restricted to the left thalamus. (J.P.N.)

  17. Left ventricular function in right ventricular overload

    International Nuclear Information System (INIS)

    Iwanaga, Shiro; Handa, Shunnosuke; Abe, Sumihisa; Onishi, Shohei; Nakamura, Yoshiro; Kunieda, Etsuo; Ogawa, Koichi; Kubo, Atsushi

    1989-01-01

    This study clarified regional and global functions of the distorted left ventricle due to right ventricular overload by gated radionuclide ventriculography (RNV). Cardiac catheterization and RNV were performed in 13 cases of atrial septal defect (ASD), 13 of pure mitral stenosis (MS), 10 of primary pulmonary hypertension (PPH), and 10 of normal subjects (NL). Right ventricular systolic pressure (RVSP) was 32.9±13.9, 45.0±12.2, 88.3±17.1, and 21.2±4.5 mmHg, respectively. The end-systolic LAO view of the left ventricle was halved into septal and free-wall sides. The end-diastolic halves were determined in the same plane. Ejection fractions of the global left ventricle (LVEF), global right ventricle (RVEF), the septal half of the left ventricle (SEPEF), and the free-wall half of the left ventricle (FWEF) were obtained. LVEF was 56.8±9.8% in NL, 52.8±10.5% in ASD, and 49.5±12.9% in PPH. In MS, LVEF (47.0±13.0%) was smaller than those in the other groups. RVEF was 37.0±5.2% in NL, 43.7±15.5% in ASD, and 32.8±11.5% in MS. In PPH, RVEF (25.0±10.6%) was smaller than those in the other groups. SEPEF was smaller in ASD (42.5±13.2%), MS (40.4±13.1%), PPH (40.5±12.5%) than in NL (53.5±8.5%). Systolic function of the septal half of the left ventricle was disturbed by right ventricular overload. RVEF (r=-0.35, p<0.05) and SEPEF (r=-0.51, p<0.01) had negative correlations with RVSP. As RVSP rose, systolic function of the septal half of the left ventricle was more severely disturbed. FWEF was the same among the four groups; NL (57.0±12.6%), ASD (48.6±15.2%), MS (50.5±12.0%), and PPH (51.1±12.3%). There was a good correlation between SEPEF and LVEF in NL (r=0.81), although in PPH this correlation was poor (r=0.64). These data showed that the distorted left ventricular due to right ventricular overload maintains its global function with preserved function of the free-wall side. (J.P.N.)

  18. Three-dimensional rotational angiography of the left atrium and the oesophagus: the short-term mobility of the oesophagus and the stability of the fused three-dimensional model of the left atrium and the oesophagus during catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Starek, Zdenek; Lehar, Frantisek; Jez, Jiri; Scurek, Martin; Wolf, Jiri; Kulik, Tomas; Zbankova, Alena; Novak, Miroslav

    2017-08-01

    The objective of this study was to evaluate the mobility of the oesophagus and the stability of the three-dimensional (3D) model of the oesophagus using 3D rotational angiography (3DRA) of the left atrium (LA) and the oesophagus, fused with live fluoroscopy during catheter ablation for atrial fibrillation. From March 2015 to September 2015, 3DRA of the LA and the oesophagus was performed in 33 patients before catheter ablation for atrial fibrillation. Control contrast oesophagography was performed every 30 min. The positions of the oesophagograms and the 3D model of the LA and the oesophagus were repeatedly measured and compared with the spine. The average shift of the oesophagus ranged from 2.7 ± 2.2 to 5.0 ± 3.5 mm. The average real-time oesophageal shift ranged from 2.7 ± 2.2 to 3.8 ± 3.4 mm. No significant shift was detected until the 90th minute of the procedure. The average shift of the 3D model of the LA and the oesophagus ranged from 1.4 ± 1.8 to 3.3 ± 3.0 mm (right-left direction) and from 0.9 ± 1.2 to 2.2 ± 1.3 mm (craniocaudal direction). During the 2 h procedure, there were no significant shifts of the model. During catheter ablation for atrial fibrillation, there is no significant change in the position of the oesophagus until the 90th minute of the procedure and no significant shift in the 3D model of the LA and the oesophagus. The 3D model of the oesophagus reliably depicts the position of the oesophagus during the entire procedure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  19. Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients

    DEFF Research Database (Denmark)

    Bang, Casper; Gerdts, Eva; Aurigemma, Gerard P

    2013-01-01

    Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation...... [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients....

  20. Influence of heart rhythm, breathing and arm position during computed tomography scanning on the registration accuracy of electro anatomical map (EAM) images, left atrium three-dimensional computed tomography angiography images, and fluoroscopy time during ablation to treat atrial fibrillation

    International Nuclear Information System (INIS)

    Chono, Taiki; Shimoshige, Shinya; Yoshikawa, Kenta; Mizonobe, Kazuhusa; Ogura, Keishi

    2013-01-01

    In CARTOMERGE for treatment of atrial fibrillation (AF) by ablation, by integrating electro anatomical map (EAM) and left atrium three-dimensional computed tomography angiography (3D-CTA) images, identification of the ablation points is simplified and the procedure can be made carried out more rapidly. However, the influence that heart rhythm, breathing and arm position during CT scanning have on registration accuracy and fluoroscopy time is not clear. To clarify the influence on registration accuracy and fluoroscopy time of heart rhythm, breathing and arm position during CT scanning. The patients were CT-scanned during both sinus rhythm (SR) and AF in each study subject. We evaluated the registration accuracy of images reconstructed between the cardiac cycle and assessed the registration accuracy and fluoroscopy time of images obtained during inspiratory breath-hold, expiratory breath-hold and up and down position of the arm. Although the registration accuracy of the EAM image and left atrium 3D-CTA image showed a significant difference during SR, no significant difference was seen during AF. Expiratory breath-hold and down position of the arm resulted in the highest registration accuracy and the shortest fluoroscopy time. However, arm position had no significant effect on registration accuracy. Heart rhythm and breathing during CT scanning have a significant effect on the registration accuracy of EAM images, left atrium 3D-CTA images, and fluoroscopy time. (author)

  1. ''Natural'' left-right symmetry

    International Nuclear Information System (INIS)

    Mohapatra, R.N.; Pati, J.C.

    1975-01-01

    It is remarked that left-right symmetry of the starting gauge interactions is retained as a ''natural'' symmetry if it is broken in no way except possibly by mass terms in the Lagrangian. The implications of this result for the unification of coupling constants and for parity nonconservation at low and high energies are stressed

  2. Primary left ventricular hydatid cyst in a child: case report

    International Nuclear Information System (INIS)

    Turkvatan, A.; Yelgec, N.S.; Calikoglu, U.; Olcer, T.

    2000-01-01

    The most common cause of echinococcosis in humans is Echinococcus granulosus. Although hydatid cyst is most frequently localized in liver (more than 65% of cases) and lung (25%) by means of portal and systemic circulation, it may involve other tissues and organs. Cardiac hydatid cysts account for only 0.5%-2% of all hydatid cysts, even in endemic areas. Of all cardiac hydatid cysts, the left ventricle accounts for 60%, right ventricle 10%, pericardium 7%, pulmonary artery 6%, left atrial appendage 6%, and interventricular septum 4%. We report the case of a myocardial hydatid cyst of the left ventricle in a 9-year-old boy. (author)

  3. Primary left ventricular hydatid cyst in a child: case report

    Energy Technology Data Exchange (ETDEWEB)

    Turkvatan, A. [Turkiye Yuksek Ihtisas Hospital, Dept. of Radiology, Ankara (Turkey); Yelgec, N.S. [Turkiye Yuksek Ihtisas Hospital, Dept. of Cardiology, Ankara (Turkey); Calikoglu, U.; Olcer, T. [Turkiye Yuksek Ihtisas Hospital, Dept. of Radiology, Ankara (Turkey)

    2000-12-01

    The most common cause of echinococcosis in humans is Echinococcus granulosus. Although hydatid cyst is most frequently localized in liver (more than 65% of cases) and lung (25%) by means of portal and systemic circulation, it may involve other tissues and organs. Cardiac hydatid cysts account for only 0.5%-2% of all hydatid cysts, even in endemic areas. Of all cardiac hydatid cysts, the left ventricle accounts for 60%, right ventricle 10%, pericardium 7%, pulmonary artery 6%, left atrial appendage 6%, and interventricular septum 4%. We report the case of a myocardial hydatid cyst of the left ventricle in a 9-year-old boy. (author)

  4. Migration of a Central Venous Catheter in a Hemodialysis Patient Resulted in Left Atrial Perforation and Thrombus Formation Requiring Open Heart Surgery.

    Science.gov (United States)

    Wong, Kevin; Marks, Barry A; Qureshi, Anwer; Stemm, Joseph J

    2016-07-01

    Central venous catheterization is widely used in patients on hemodialysis. A rare complication associated with the clinical use of central venous catheters is perforation of the heart or major vessels. We report a case of inadvertent perforation of the left atrium and thrombosis after the placement of a hemodialysis catheter in the right internal jugular vein. In such cases, surgical removal of the central venous catheter from perforation sites in the heart and vessel walls poses anesthetic challenges because of the high risk of pneumothorax, hemorrhage, arrhythmias, thrombosis, and death.

  5. The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jons, Christian; Jacobsen, Uffe G; Joergensen, Rikke Moerch

    2011-01-01

    The incidence and risk associated with new-onset atrial fibrillation (AF) occurring after discharge in patients with acute myocardial infarction (MI) remains unknown.......The incidence and risk associated with new-onset atrial fibrillation (AF) occurring after discharge in patients with acute myocardial infarction (MI) remains unknown....

  6. Generalised left ventricular dysfunction after traumatic right coronary ...

    African Journals Online (AJOL)

    A patient with traumatic right coronary artery to right atrial fistula, which was repaired by direct closure and aortocoronary saphenous vein bypass grafting, is described. Cardiac catheterisation and selective cine angiocardiography were performed pre- and postoperatively, and left ventricular (LV) function was studied in ...

  7. Left Activism, Succour and Selfhood

    DEFF Research Database (Denmark)

    Hughes, Celia Penelope

    2014-01-01

    At the height of mass activity on the Left, the ascendancy of the women's liberation movement (WLM), and the beginnings of real social and personal change for men and women, the 1970s are increasingly seen as the decade when sixties permissiveness began to be truly felt in Britain. This article...... draws upon a personal archive of correspondence from this turbulent decade, between two revolutionary women, Di Parkin and Annie Howells. It argues that the women's letters form an important contribution to new understandings about the construction of the post-war gendered self. The letters represent...... an interchange of motherhood, domesticity, far-left politics, and close female friendship. The article will show how the women's epistolary friendship offers intimate insight into female self-fashioning at a breakthrough social and political moment in 1970s Britain. As they reflected on some of the key political...

  8. Time left in the mouse.

    Science.gov (United States)

    Cordes, Sara; King, Adam Philip; Gallistel, C R

    2007-02-22

    Evidence suggests that the online combination of non-verbal magnitudes (durations, numerosities) is central to learning in both human and non-human animals [Gallistel, C.R., 1990. The Organization of Learning. MIT Press, Cambridge, MA]. The molecular basis of these computations, however, is an open question at this point. The current study provides the first direct test of temporal subtraction in a species in which the genetic code is available. In two experiments, mice were run in an adaptation of Gibbon and Church's [Gibbon, J., Church, R.M., 1981. Time left: linear versus logarithmic subjective time. J. Exp. Anal. Behav. 7, 87-107] time left paradigm in order to characterize typical responding in this task. Both experiments suggest that mice engaged in online subtraction of temporal values, although the generalization of a learned response rule to novel stimulus values resulted in slightly less systematic responding. Potential explanations for this pattern of results are discussed.

  9. Polycythemia vera presenting with left hemichoreiform movements

    International Nuclear Information System (INIS)

    Mori, Tamiharu; Shimomura, Chikako; Ishibashi, Hiroshi; Tsujihata, Mitsuhiro; Nagataki, Shigenobu.

    1985-01-01

    A 65-year-old man developed abruptly choreiform movements involving the left face, arm and leg one day prior to admission. Physical examination revealed red face and palms, hyperemic conjunctivae and atrial fibrillations. Blood pressure was 168/90. Spleen was not palpable. Hemichoreiform movements of the left face and limbs were observed. There was no other neurological abnormalities. Laboratory studies showed RBC 880x10 4 , Hb 22.4g/dl, Hct 63%, WBC 8,100, platelets 22.9x10 4 , ESR 0mm/hr, RBC oxygen saturation 97%, serum iron 67 μg/dl, LDH 593 units, uric acid 14mg/dl, and erythropoietine (HI method) 19mIU/ml (normal 28-88). Bone marrow showed myeloid nucleated cell count 38.6x10 4 . ECG showed atrial fibrillations. Chest X-ray and scintigrams of liver and spleen were normal. CSF was normal. Brain CT scan on admission disclosed a low density area in right caudate nucleus. The choreiform movements were rapidly mitigated by venesection and by oral administration of haloperidol(3mg daily). There weeks after discontinuing haloperidol, the hemichorea returned. The routine hematology showed RBC 870x10 4 , Hb 19.8g/dl, Hct 62%, WBC 10,200, and plateret 37.4x10 4 . Another venesection reduced the chorea. Pipobroman was administered to control the polycythemia vera. He has been free of choreic movements thereafter. Choreiform movement is rarely observed in polycythemia vera. The pathogenesis is still unknown. The venous congestion, however, may play a role in this case because the choreic movements disappeared by venesection. (author)

  10. Radionuclide assessment of left ventricular diastolic function in patients with mitral stenosis before and after percutaneous transvenous mitral commissurotomy; Use of list mode method in patients with atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Seishi; Iwasaka, Toshiji; Kimura, Yutaka; Ohkubo, Naohiko; Matsuura, Takashi; Inada, Mitsuo; Shiraishi, Tomokuni [Kansai Medical School, Moriguchi, Osaka (Japan)

    1991-07-01

    To evaluate the effect of percutaneous transvenous mitral commissurotomy (PTMC), equilibrium radionuclide angiocardiography was performed in eight patients with mitral stenosis who had atrial fibrillation. Accurate cardiac function in patients with atrial fibrillation is difficult to assess, since the wide fluctation of cardiac cycle makes the ventricular hemodynamics variable. A new processing algorhythm was devised to make multiple gated images discriminated from a heart rate distribution histogram. We obtained about 1,000 beats data by list mode acquisition, and processed a heart rate distribution histogram. The data in the area {+-}5% of the most frequent heart rate were converted into frame mode and a representative time activity curve was derived. Mitral valve area calculated by echocardiography increased from 1.3{+-}0.5 to 2.0{+-}0.6 (cm{sup 2}) significantly (p<0.01). The mean transmitral pressure gradient measured by catheterization decreased from 12.4{+-}5.9 to 4.9{+-}3.7 (mmHg) significantly (p<0.01) and the clinical symptoms improved in all patients. The change in left ventricular ejection fraction from 43{+-}9 to 48{+-}13 (%) was not statistically significant, but peak filling rate (PFR) derived from the time activity curve increased from 1.5{+-}0.3 to 2.0{+-}0.4 (EDV/sec) significantly (p<0.01). Thus PFR is a noninvasive parameter that can evaluate the effect of PTMC. (author).

  11. Left cardiac isomerism in the Sonic hedgehog null mouse.

    Science.gov (United States)

    Hildreth, Victoria; Webb, Sandra; Chaudhry, Bill; Peat, Jonathan D; Phillips, Helen M; Brown, Nigel; Anderson, Robert H; Henderson, Deborah J

    2009-06-01

    Sonic hedgehog (Shh) is a secreted morphogen necessary for the production of sidedness in the developing embryo. In this study, we describe the morphology of the atrial chambers and atrioventricular junctions of the Shh null mouse heart. We demonstrate that the essential phenotypic feature is isomerism of the left atrial appendages, in combination with an atrioventricular septal defect and a common atrioventricular junction. These malformations are known to be frequent in humans with left isomerism. To confirm the presence of left isomerism, we show that Pitx2c, a recognized determinant of morphological leftness, is expressed in the Shh null mutants on both the right and left sides of the inflow region, and on both sides of the solitary arterial trunk exiting from the heart. It has been established that derivatives of the second heart field expressing Isl1 are asymmetrically distributed in the developing normal heart. We now show that this population is reduced in the hearts from the Shh null mutants, likely contributing to the defects. To distinguish the consequences of reduced contributions from the second heart field from those of left-right patterning disturbance, we disrupted the movement of second heart field cells into the heart by expressing dominant-negative Rho kinase in the population of cells expressing Isl1. This resulted in absence of the vestibular spine, and presence of atrioventricular septal defects closely resembling those seen in the hearts from the Shh null mutants. The primary atrial septum, however, was well formed, and there was no evidence of isomerism of the atrial appendages, suggesting that these features do not relate to disruption of the contributions made by the second heart field. We demonstrate, therefore, that the Shh null mouse is a model of isomerism of the left atrial appendages, and show that the recognized associated malformations found at the venous pole of the heart in the setting of left isomerism are likely to arise from

  12. Rebuilding the US Health Left

    Directory of Open Access Journals (Sweden)

    Victor W. Sidel, MD

    2010-02-01

    Full Text Available With this issue Social Medicine begins a series of invited papers on the topic: “Rebuilding the US Health Left.” In this editorial we will outline our vision for this series. We undertake this project aware that our good friend and mentor, Dr. Walter Lear, one of the leading health activists of the 20th century, lies critically ill. Walter was the creator and custodian of the US Health Left Archives, a collection that is now with the University of Pennsylvania library. The collection reminds us of the important role left health care workers played in US history throughout the 20th century. They advocated for a national health program (Committee on the Costs of Medical Care, Physicians Forum, Medical Care Section/APHA, HealthPAC, Physicians for a National Health Program, National Physicians Alliance, provided international solidarity (American Soviet Medical Society, international brigades during the Spanish Civil War, Central American Solidarity Movement, Committee to Help Chilean Health Workers, Doctors for Global Health, traced the connections between disease and social class (Sigerist Circle, Spirit of 1848, APHA, fought for workers’ health (Councils for Occupational Safety and Health; Occupational Health and Safety Section, APHA participated in anti-war movements (Medical Committee for Human Rights, Physicians for Social Responsibility, International Physicians for the Prevention of Nuclear War, created new models of health care delivery (Health Cooperatives, Prepaid Health Maintenance Organizations, Community Health Centers, National Health Service Corps, Free Clinics, were central to the struggle for women’s rights (Planned Parenthood, Physicians for Reproductive Choice and Health, supported the civil rights movement both in medicine and in the broader society (National Medical Association, Medical Committee for Human Rights, played key roles in the movement for gay rights (ACT-UP, Gay & Lesbian Medical Association, Lesbian, Gay

  13. ["Habitual" left branch block alternating with 2 "disguised" bracnch block].

    Science.gov (United States)

    Lévy, S; Jullien, G; Mathieu, P; Mostefa, S; Gérard, R

    1976-10-01

    Two cases of alternating left bundle branch block and "masquerading block" (with left bundle branch morphology in the stnadard leads and right bundle branch block morphology in the precordial leads) were studied by serial tracings and his bundle electrocardiography. In case 1 "the masquerading" block was associated with a first degree AV block related to a prolongation of HV interval. This case is to our knowledge the first cas of alternating bundle branch block in which his bundle activity was recorded in man. In case 2, the patient had atrial fibrilation and His bundle recordings were performed while differents degrees of left bundle branch block were present: The mechanism of the alternation and the concept of "masquerading" block are discussed. It is suggested that this type of block represents a right bundle branch block associated with severe lesions of the "left system".

  14. Impact of alcohol habits and smoking on the risk of new-onset atrial fibrillation in hypertensive patients with ECG left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Ariansen, Inger; Reims, Henrik M; Gjesdal, Knut

    2012-01-01

    The incidence of new-onset atrial fibrillation (AF) is increased by uncontrolled hypertension, and antihypertensive treatment reduces new-onset AF. However, it is unclear whether alcohol intake and smoking influence the risk of new-onset AF during antihypertensive treatment....

  15. Flavoured Dark Matter moving left

    Science.gov (United States)

    Blanke, Monika; Das, Satrajit; Kast, Simon

    2018-02-01

    We investigate the phenomenology of a simplified model of flavoured Dark Matter (DM), with a dark fermionic flavour triplet coupling to the left-handed SU(2) L quark doublets via a scalar mediator. The DM-quark coupling matrix is assumed to constitute the only new source of flavour and CP violation, following the hypothesis of Dark Minimal Flavour Violation. We analyse the constraints from LHC searches, from meson mixing data in the K, D, and B d,s meson systems, from thermal DM freeze-out, and from direct detection experiments. Our combined analysis shows that while the experimental constraints are similar to the DMFV models with DM coupling to right-handed quarks, the multitude of couplings between DM and the SM quark sector resulting from the SU(2) L structure implies a richer phenomenology and significantly alters the resulting impact on the viable parameter space.

  16. Defeito do anel fibroso mitral posterior com aneurisma de átrio esquerdo e insuficiência mitral: tratamento cirúrgico com sucesso Defect of the posterior mitral fibrous ring with left atrial aneurysm and mitral insufficiency: successful surgical treatment

    Directory of Open Access Journals (Sweden)

    Ronaldo Machado BUENO

    1999-10-01

    Full Text Available Aneurismas em átrio esquerdo são pouco comuns, podendo ocorrer na aurícula ou na parede do átrio esquerdo. Freqüentemente, são assintomáticos, podendo ocorrer arritmias, fenômenos tromboembólicos ou insuficiência cardíaca como complicação da sua evolução. Apresentamos paciente de 39 anos, do sexo feminino, com defeito do anel posterior da valva mitral levando a grande dilatação aneurismática da parede posterior do átrio esquerdo com insuficiência mitral. O diagnóstico foi feito pela radiografia de tórax (abaulamento de silhueta cardíaca esquerda e ecocardiograma (grande aneurisma do átrio esquerdo posteriormente à parede posterior do ventrículo esquerdo com insuficiência mitral. O estudo hemodinâmico sugeriu pseudo-aneurisma de ventrículo esquerdo. Submetida a tratamento cirúrgico com auxílio da circulação extracorpórea, realizou-se anuloplastia mitral e exclusão do aneurisma com reconstrução do assoalho do átrio esquerdo com retalho de pericárdio bovino. A paciente apresentou boa evolução pós-operatória, recebendo alta hospitalar no oitavo dia em boas condições clínicas.Atrial aneurysm is a rare condition and can be found on the atrial appendage or on the atrial wall. Most patients are asymptomatic, but arrhythmias, thromboembolism, and heart failure are common complications. We present a 39 years old female patient with posterior mitral ring defect causing a great aneurysm of the left posterior atrial wall with mitral insufficiency. The diagnosis was achieved by chest roentgenogram (marked prominence of the upper left heart border and echocardiography (great left atrial aneurysm behind the left posterior ventricular wall with mitral insufficiency. Left ventricular cineangiogram suggested the presence of a false aneurysm of the left ventricle. The patient subsequently underwent surgical treatment with cardiopulmonary bypass. Posterior mitral valve annuloplasty was performed with aneurysm exclusion

  17. Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension

    International Nuclear Information System (INIS)

    Sultana, R.; Sultana, N.; Rashid, A.; Rasheed, S.Z.; Ahmed, M.; Ishaq, M.; Samad, A.

    2010-01-01

    Background: Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. Methods: In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 (31.2%) men and 344 (69%) women >30 years of age in the study. Among them 177 (35.4%) were diabetic, 224 (45%) were dyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Mean systolic BP (SBP) was 180 +- 20 mm Hg and diastolic BP (DBP) was 95 +- 12 in male and female patients. Left ventricular mass index (LVMI) was 119.2 +- 30 2 2gm/m in male while 103 +- 22 gm/m in female patients. Palpitation was seen in 126 (25%) male and 299 (59.8%) female patients. Atrial fibrillation was noted in 108 (21.6%) male and 125 (25%) female patients, 30 (6%) male and 82 (16.4%) female patients had atrial flutter. Ventricular tachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoring showed significant premature ventricular contractions (PVC'S) in 109 (21.8%) male and 128 (25.69%) female patients while Holter showed atrial arrhythmias (APC'S) in 89 (17.8%) males and 119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) with CAD male and 225 (45%) without CAD while 47 (9.4%) females presented with CAD and 109 (21.8%) without CAD. Conclusion: A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH. (author)

  18. Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Sultana, R; Sultana, N; Rashid, A; Rasheed, S Z; Ahmed, M; Ishaq, M; Samad, A [Karachi Institute of Heart Diseases, Karachi (Pakistan)

    2010-10-15

    Background: Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. Methods: In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 (31.2%) men and 344 (69%) women >30 years of age in the study. Among them 177 (35.4%) were diabetic, 224 (45%) were dyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Mean systolic BP (SBP) was 180 +- 20 mm Hg and diastolic BP (DBP) was 95 +- 12 in male and female patients. Left ventricular mass index (LVMI) was 119.2 +- 30 2 2gm/m in male while 103 +- 22 gm/m in female patients. Palpitation was seen in 126 (25%) male and 299 (59.8%) female patients. Atrial fibrillation was noted in 108 (21.6%) male and 125 (25%) female patients, 30 (6%) male and 82 (16.4%) female patients had atrial flutter. Ventricular tachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoring showed significant premature ventricular contractions (PVC'S) in 109 (21.8%) male and 128 (25.69%) female patients while Holter showed atrial arrhythmias (APC'S) in 89 (17.8%) males and 119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) with CAD male and 225 (45%) without CAD while 47 (9.4%) females presented with CAD and 109 (21.8%) without CAD. Conclusion: A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH. (author)

  19. Value of Combining Left Atrial Diameter and Amino-terminal Pro-brain Natriuretic Peptide to the CHA2DS2-VASc Score for Predicting Stroke and Death in Patients with Sick Sinus Syndrome after Pacemaker Implantation.

    Science.gov (United States)

    Mo, Bin-Feng; Lu, Qiu-Fen; Lu, Shang-Biao; Xie, Yu-Quan; Feng, Xiang-Fei; Li, Yi-Gang

    2017-08-20

    The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation (AF). We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome (SSS) after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter (LAD) and amino-terminal pro-brain natriuretic peptide (NT-proBNP). A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data (stroke and death) were collected by pacemaker follow-up visits and telephonic follow-up until December 31, 2015. During 2151 person-years of follow-up, 46 patients (9.6%) suffered stroke and 52 (10.8%) died. The CHA2DS2-VASc score showed a significant association with the development of stroke (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20-1.75, Ppacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.

  20. Echocardiographic assessment of fetal left ventricular function in hypertensive disorder of pregnancy

    International Nuclear Information System (INIS)

    Liu Xiaozhen; Liu Shaozhong

    2011-01-01

    Objective: To investigate fetal left ventricular function in hypertensive disorder of pregnancy (HDP). Methods: Fetuses of hypertensive (84) and normotensive (147) mothers were enrolled in this study. The fetal left ventricular ejection fractions, E/A ratios of mitral valves, left atrial shortening fractions and Tei indexes of the two groups were measured on fetal echocardiography. Results: The left ventricular ejection fractions (P=0.040), E/A ratios of the mitral valves (P=0.042) and the left atrial shortening fractions (P=0.036) in fetuses of HDP were significantly smaller than those of the normal group whereas the Tei indexes (P=0.030) were significantly larger than those of the normal group. Conclusion: The hypertensive disorder of pregnancy may cause decreased systolic, diastolic and global function of the fetal left ventricle. (authors)

  1. Right heart function in impaired left ventricular diastolic function: 2D speckle tracking echocardiography-based and Doppler tissue imaging-based analysis of right atrial and ventricular function.

    Science.gov (United States)

    Brand, Anna; Bathe, Marny; Oertelt-Prigione, Sabine; Seeland, Ute; Rücke, Mirjam; Regitz-Zagrosek, Vera; Stangl, Karl; Knebel, Fabian; Stangl, Verena; Dreger, Henryk

    2018-01-01

    The aim of our study was to describe right atrial (RA) and right ventricular (RV) function, assessed by Doppler tissue imaging and 2D speckle tracking echocardiography (2DSTE), in women with signs of early impaired left ventricular diastolic function (DD). In a cross-sectional trial, standard parameters of diastolic and right heart function were investigated in 438 women of the Berlin Female Risk Evaluation (BEFRI) study. In a subset of women, average peak systolic RA strain (RAS), as well as the average peak systolic RV strain of the free wall (RVS free wall) and of all RV segments (average RV strain; RVS Avg), was analyzed using 2DSTE. Compared to women with normal diastolic function (DD0), RAS, RVS free wall and RVS Avg were significantly reduced in DD (43.1% ± 11.9%, -26.7% ± 5.6%, and -23.3% ± 3.5% in DD0; vs 35.1% ± 10.4%, -23.9% ± 5.5%, and -20.6% ± 3.8% in DD; P right heart function is significantly altered in DD. DTI as well as 2DSTE constitute sensitive echocardiographic tools that enable the diagnosis of impaired right heart mechanics in early-staged DD. © 2017 Wiley Periodicals, Inc.

  2. Left ventricular diastolic function is associated with symptom status in severe aortic valve stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Christensen, Nicolaj L; Videbæk, Lars

    2014-01-01

    atrial volume index, and deceleration time were still associated with the presence of symptoms. CONCLUSIONS: The present study demonstrates that symptomatic status in severe AS is associated with impaired diastolic function, LV hypertrophy, concentric remodeling, and left atrial dilatation when corrected...... function, and left atrial dilatation compared with asymptomatic patients. METHODS AND RESULTS: In a retrospective descriptive study, we compared clinical characteristics and echocardiographic parameters in 99 symptomatic and 139 asymptomatic patients with severe AS and LV ejection fraction ≥50.......001), and had a lower prevalence of hypertension (73% versus 40%; Ptime (199±58 versus...

  3. Left Paraduodenal Hernia: An Autopsy Case

    DEFF Research Database (Denmark)

    Omland, Silje Haukali; Hougen, Hans Petter

    2011-01-01

    We present a case of a left paraduodenal hernia diagnosed at autopsy. A left paraduodenal hernia is an internal hernia of congenital origin due to the abnormal rotation of the midgut during embryonic development. Internal hernias are a rare cause of intestinal obstruction, with the paraduodenal...

  4. Basal cell carcinoma on the left cheek

    International Nuclear Information System (INIS)

    Jancar, B.

    2007-01-01

    A 91-year-old female patient was treated with irradiation for histologically confirmed basal cell carcinoma on the left cheek. The tumour, measuring 3 x 3 cm, with the depth of 2 cm, was extending up to the lower lid of the left eye. (author)

  5. Pure Left Neglect for Arabic Numerals

    Science.gov (United States)

    Priftis, Konstantinos; Albanese, Silvia; Meneghello, Francesca; Pitteri, Marco

    2013-01-01

    Arabic numerals are diffused and language-free representations of number magnitude. To be effectively processed, the digits composing Arabic numerals must be spatially arranged along a left-to-right axis. We studied one patient (AK) to show that left neglect, after right hemisphere damage, can selectively impair the computation of the spatial…

  6. Congenital Absence of Left Circumflex Coronary Artery

    Directory of Open Access Journals (Sweden)

    Zahra Ansari

    2009-09-01

    Full Text Available Congenital absence of left circumflex artery is a rare congenitalanomaly of the coronary arteries. The prevalence of theanomaly in different studies ranges from 0.6% to 1.3%. Ofthese, 80% are benign and asymptomatic and 20% are clinicallyimportant. We report a 56-year-old man presented withacute resting chest pain who was diagnosed as having acuteanterolateral infarction accompanied by electrocardiographicchanges and elevated cardiac enzymes. Coronary angiographyin different views was conducted, however, no left circumflexartery was found. The territory supplied by the artery had beenperfused by the super dominant right coronary artery. Therewas no left circumflex coronary artery with anomalous origin.Sever stenosis of left anterior ascending artery superimposedto the absent left circumflex artery was presented as acute anterolateralinfarction. Although absence of the artery is mostlyconsidered as a benign condition, atherosclerotic lesions maybe more important in such cases because of diminished compensatingmechanisms.

  7. Repair of aorto-left ventricular tunnel arising from the left sinus of valsalva.

    Science.gov (United States)

    Nezafati, Mohammad Hassan; Maleki, Mahmood Hosseinzadeh; Javan, Hadi; Zirak, Nahid

    2010-05-01

    Aortico-left ventricular tunnel (ALVT) is a rare congenital cardiac defect that bypasses the aortic valve via a para-valvular connection from the left ventricle to the aorta. In most cases, the tunnel arises from the right aortic sinus. In this case report, we are presenting a case of ALVT, of which the aortic orifice arose from the left aortic sinus, requiring special attention to avoid the left coronary artery injury at the time of surgical repair.

  8. TMS over the Left Angular Gyrus Impairs the Ability to Discriminate Left from Right

    Science.gov (United States)

    Hirnstein, Marco; Bayer, Ulrike; Ellison, Amanda; Hausmann, Markus

    2011-01-01

    The underlying cognitive and neural mechanisms of the ability to discriminate left from right are hardly explored. Clinical studies from patients with impairments of left-right discrimination (LRD) and neuroimaging data suggest that the left angular gyrus is particularly involved in LRD. Moreover, it is argued that the often reported sex…

  9. Noninvasive quantification of left-to-right shunt by phase contrast magnetic resonance imaging in secundum atrial septal defect: the effects of breath holding and comparison with invasive oximetry.

    Science.gov (United States)

    Yamasaki, Yuzo; Kawanami, Satoshi; Kamitani, Takeshi; Sagiyama, Koji; Sakamoto, Ichiro; Hiasa, Ken-Ichi; Yabuuchi, Hidetake; Nagao, Michinobu; Honda, Hiroshi

    2018-01-16

    To investigate the effect of breath-holding on left-to-right shunts in patients with a secundum atrial septal defect (ASD). Thirty-five consecutive patients with secundum ASDs underwent right heart catheterization and invasive oximetry. Phase-contrast magnetic resonance imaging (MRI) was performed for the main pulmonary artery and ascending aorta. All measurements were obtained during free breathing (FB) (quiet breathing; no breath-hold), expiratory breath-hold (EBH), and inspiratory breath-hold (IBH). Pulmonary circulation flow (Qp) and systemic circulation flow (Qs) were calculated by multiplying the heart rate by the stroke volume. Measurements during FB, EBH, and IBH were compared, and the differences compared to invasive oximetry were evaluated. There were significant differences among the measurements during FB, EBH, and IBH for Qp (FB, 7.70 ± 2.68; EBH, 7.18 ± 2.34; IBH, 6.88 ± 2.51 l/min); however, no significant difference was found for Qs (FB, 3.44 ± 0.74; EBH, 3.40 ± 0.83; IBH, 3.40 ± 0.86 l/min). There were significant differences among the measurements during FB, EBH, and IBH for Qp/Qs (FB, 2.38 ± 1.12; EBH, 2.24 ± 0.95; IBH, 2.14 ± 0.97). Qp/Qs during FB and EBH correlated better with Qp/Qs measured by invasive oximetry than did IBH. The limit of agreement was smaller for EBH than for FB and IBH. In patients with secundum ASDs, Qp/Qs significantly decreased with breath-holding. The accuracy of the Qp/Qs measurement by MRI compared with invasive oximetry during EBH was higher than during FB and IBH.

  10. Simplified single plane echocardiography is comparable to conventional biplane two-dimensional echocardiography in the evaluation of left atrial volume: a study validated by three-dimensional echocardiography in 143 individuals.

    Science.gov (United States)

    Vieira-Filho, Normando G; Mancuso, Frederico J N; Oliveira, Wercules A A; Gil, Manuel A; Fischer, Cláudio H; Moises, Valdir A; Campos, Orlando

    2014-03-01

    The left atrial volume index (LAVI) is a biomarker of diastolic dysfunction and a predictor of cardiovascular events. Three-dimensional echocardiography (3DE) is highly accurate for LAVI measurements but is not widely available. Furthermore, biplane two-dimensional echocardiography (B2DE) may occasionally not be feasible due to a suboptimal two-chamber apical view. Simplified single plane two-dimensional echocardiography (S2DE) could overcome these limitations. We aimed to compare the reliability of S2DE with other validated echocardiographic methods in the measurement of the LAVI. We examined 143 individuals (54 ± 13 years old; 112 with heart disease and 31 healthy volunteers; all with sinus rhythm, with a wide range of LAVI). The results for all the individuals were compared with B2DE-derived LAVIs and validated using 3DE. The LAVIs, as determined using S2DE (32.7 ± 13.1 mL/m(2)), B2DE (31.9 ± 12.7 mL/m(2)), and 3DE (33.1 ± 13.4 mL/m(2)), were not significantly different from each other (P = 0.85). The S2DE-derived LAVIs correlated significantly with those obtained using both B2DE (r = 0.98; P < 0.001) and 3DE (r = 0.93; P < 0.001). The mean difference between the S2DE and B2DE measurements was <1.0 mL/m(2). Using the American Society of Echocardiography criteria for grading LAVI enlargement (normal, mild, moderate, severe), we observed an excellent agreement between the S2DE- and B2DE-derived classifications (κ = 0.89; P < 0.001). S2DE is a simple, rapid, and reliable method for LAVI measurement that may expand the use of this important biomarker in routine echocardiographic practice. © 2013, Wiley Periodicals, Inc.

  11. Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation: 1-Year follow-up outcome data of the EWOLUTION trial.

    Science.gov (United States)

    Boersma, Lucas V; Ince, Hueseyin; Kische, Stephan; Pokushalov, Evgeny; Schmitz, Thomas; Schmidt, Boris; Gori, Tommaso; Meincke, Felix; Protopopov, Alexey Vladimir; Betts, Timothy; Foley, David; Sievert, Horst; Mazzone, Patrizio; De Potter, Tom; Vireca, Elisa; Stein, Kenneth; Bergmann, Martin W

    2017-09-01

    Left atrial appendage (LAA) occlusion with WATCHMAN has emerged as viable alternative to vitamin K antagonists in randomized controlled trials. EWOLUTION was designed to provide data in routine practice from a prospective multicenter registry. A total of 1025 patients scheduled for a WATCHMAN implant were prospectively and sequentially enrolled at 47 centers. Indication for LAA closure was based on European Society of Cardiology guidelines. Follow-up and transesophageal echocardiography (TEE) were performed per local practice. The baseline CHA 2 DS 2 -VASc score was 4.5 ± 1.6; the mean age was 73.4 ± 9 years; previous transient ischemic attack/ischemic stroke was present in 312 (30.5%), 155 (15.1%) had previous hemorrhagic stroke, and 320 (31.3%) had a history of major bleeding; and 750 (73%) were deemed unsuitable for oral anticoagulation therapy. WATCHMAN implant succeeded in 1005 (98.5%) of patients, without leaks >5 mm in 1002 (99.7%) with at least 1 TEE follow-up in 875 patients (87%). Antiplatelet therapy was used in 784 (83%), while vitamin K antagonists were used in only 75 (8%). At 1 year, mortality was 98 (9.8%), reflecting the advanced age and comorbidities in this population. Device thrombus was observed in 28 patients at routine TEE (3.7%) and was not correlated with the drug regimen (P = .14). Ischemic stroke rate was 1.1% (relative risk 84% vs estimated historical data); the major bleeding rate was 2.6% and was predominantly (2.3%) nonprocedure/device related. LAA closure with the WATCHMAN device has a high implant and sealing success. This method of stroke risk reduction appears to be safe and effective with an ischemic stroke rate as low as 1.1%, even though 73% of patients had a contraindication to and were not using oral anticoagulation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Social aspects of left-handedness

    Directory of Open Access Journals (Sweden)

    Belojević Goran

    2010-01-01

    Full Text Available Throughout human history left-handedness has been considered as sinful. It has been associated with the devil, weakness, female gender, unhealthiness, evil, something that has to be turned to a “good” - right side by force. Left-handedness is being more and more acceptable at rational level, but in everyday life it is still considered to be unusual if someone writes with the left hand. Lessening of the number of lefthanders is associated with ageing. There are about 13% lefthanders among people in twenties and less than 1% lefthanders among those in eighties. This finding may be explaned with more pronounced socio-cultural pressure on left-handed people in the past, compared to nowadays. On the other hand, this may also support the hypothesis about a reduced life span of lefthanded people. With cross-exercising of left-handedness, certain typical characteristics and behavioral patterns appear in these people. This was a sort of provoked behavior and an attack on the integrity of an emotional attitude toward oneself. Stuttering may also appear as a consequence of unsuccessful cross-exercising of left-handedness. The hypothesis about left-handedness as an advantage is supported with the reports about relatively more lefthanders in some specific groups such as: mathematicians, sculptors, architects, painters, musicians, actors, tennis players, as well as famous army commanders and rulers.

  13. Quantitative description of the regional mechanics of the left atria by electroanatomical mapping

    International Nuclear Information System (INIS)

    Kuklik, Pawel; Molaee, Payman; Brooks, Anthony G; John, Bobby; Worthley, Stephen G; Sanders, Prashanthan

    2010-01-01

    The left atrium is a complex chamber, which plays an integral role in the maintenance of physiologic hemodynamic and electrical stability of the heart and is involved in many disease states, most commonly atrial fibrillation. Preserving regions of the left atrium that contribute the greatest to atrial mechanical function during curative strategies for atrial fibrillation are important. We present here a new application of the CARTO electroanatomical mapping system in the assessment of the left atria mechanical function. Electroanatomical data were collected in course of the electrophysiological procedure in 11 control patients and 12 patients with paroxysmal atrial fibrillation. The three-dimensional geometry of the left atria was reconstructed in 10 ms intervals and segmented into distinct regions. For each segment, a regional ejection fraction was calculated. We found that anterior, septal and lateral segments have significantly greater regional ejection fraction than atria roof, inferior and posterior segments. Therefore, we hypothesize that in order to minimize the impact on atrial mechanical function, an important determinant of thromboembolic risk, damage should be minimized to these atrial regions

  14. Introduction to left-right symmetric models

    International Nuclear Information System (INIS)

    Grimus, W.

    1993-01-01

    We motivate left-right symmetric models by the possibility of spontaneous parity breaking. Then we describe the multiplets and the Lagrangian of such models. Finally we discuss lower bounds on the right-handed scale. (author)

  15. Left ventricular hypertrophy: virtuous intentions, malign consequences.

    Science.gov (United States)

    Pokharel, Saraswati; Sharma, Umesh C; Pinto, Yigal M

    2003-06-01

    Left ventricular hypertrophy (LVH) is currently the focus of intense cardiovascular research, with the resultant rapid evolution of novel concepts relating to its exceedingly complex pathophysiology. In addition to the alterations in signal transduction and disturbances in Ca(2+) homeostasis, there are structural changes in myofilaments, disorganization of the cytoskeletal framework and increased collagen synthesis. LVH is associated with progressive left ventricular remodeling that culminates to heart failure. The modern treatment of left ventricular hypertrophy is now largely based on the hypothesis that neuroendocrine activation is important in the progression of the disease and inhibition of neurohormones is likely to have long-term benefit with regard to morbidity and mortality. Drugs specifically designed to unload the left ventricle, such as diuretics and vasodilators, appears to be less effective in reducing LV mass and improving prognosis. Thus, the evolution of treatment for LVH itself has provided much enlightenment for our understanding of the fundamental biology of the disorder.

  16. Quantum levitation by left-handed metamaterials

    Energy Technology Data Exchange (ETDEWEB)

    Leonhardt, Ulf; Philbin, Thomas G [School of Physics and Astronomy, University of St Andrews, North Haugh, St Andrews KY16 9SS (United Kingdom)

    2007-08-15

    Left-handed metamaterials make perfect lenses that image classical electromagnetic fields with significantly higher resolution than the diffraction limit. Here, we consider the quantum physics of such devices. We show that the Casimir force of two conducting plates may turn from attraction to repulsion if a perfect lens is sandwiched between them. For optical left-handed metamaterials, this repulsive force of the quantum vacuum may levitate ultra-thin mirrors.

  17. Quantum levitation by left-handed metamaterials

    International Nuclear Information System (INIS)

    Leonhardt, Ulf; Philbin, Thomas G

    2007-01-01

    Left-handed metamaterials make perfect lenses that image classical electromagnetic fields with significantly higher resolution than the diffraction limit. Here, we consider the quantum physics of such devices. We show that the Casimir force of two conducting plates may turn from attraction to repulsion if a perfect lens is sandwiched between them. For optical left-handed metamaterials, this repulsive force of the quantum vacuum may levitate ultra-thin mirrors

  18. Assessment of left ventricular global function

    International Nuclear Information System (INIS)

    Breuel, H.-P.; Baehre, M.

    1985-01-01

    Radionuclide ventriculography (RNV), i.e. noninvasive evaluation of left venticular performance following the application of radionuclides has had a major impact on many aspects of cardiology and has proven its clinical value and reliability in the last few years. This article deals mainly with the changes in global left ventricular function. The clinical applications of RNV for coronary artery diseases and valvular heart diseases are described. (Auth.)

  19. Aetiological factors in left-handedness

    Directory of Open Access Journals (Sweden)

    Milenković Sanja M.

    2005-01-01

    Full Text Available Lateralisation associates the extremities and senses of one side of the body, which are connected by afferent and efferent pathways, with the primary motor and sensory areas of the hemisphere on the opposite side. Dominant laterality denotes the appearance of a dominant extremity or sense in the performance of complex psychomotor activities. Laterality is manifested both as right-handedness or left-handedness, which are functionally equivalent and symmetrical in the performance of activities. Right-handedness is significantly more common than left-handedness. Genetic theory is most widely accepted in explaining the onset of lateralisation. According to this theory, the models of brain organisation asymmetry (anatomical, functional, and biochemical are strongly, genetically determined. However, the inability to clearly demonstrate the association between genetic factors and left-handedness has led researchers to investigate the effects of the environment on left-handedness. Of particular interest are the intrauterine environment and the factors influencing foetal development, of which hormones and ultrasound exposure are the most significant. It has been estimated that an extra five cases of nonright-handed lateralisation can be expected in every 100 males who were exposed to ultrasound in utero compared to those who were not. Socio-cultural pressure on left-handed individuals was much more severe in the past, which is confirmed by scientific findings that left-handedness is present in 13% of individuals in their twenties, while in less than 1% of individuals in their eighties.

  20. New strict left bundle branch block criteria reflect left ventricular activation differences

    DEFF Research Database (Denmark)

    Emerek, Kasper Janus Grønn; Risum, Niels; Hjortshøj, Søren Pihlkjær

    2015-01-01

    AIMS: Pacing lead electrical delays and strict left bundle branch block (LBBB) criteria were assessed against cardiac resynchronization therapy (CRT) outcome. METHODS: Forty-nine patients with LBBB and QRS duration >130 milliseconds underwent CRT-implantation. Sensed right ventricular to left ven....... CONCLUSION: Interventricular electrical delay predicts left ventricular remodeling after CRT and new, strict ECG criteria of LBBB are superior in predicting remodeling.......AIMS: Pacing lead electrical delays and strict left bundle branch block (LBBB) criteria were assessed against cardiac resynchronization therapy (CRT) outcome. METHODS: Forty-nine patients with LBBB and QRS duration >130 milliseconds underwent CRT-implantation. Sensed right ventricular to left...... ventricular electrical delay (RV-LV-IED) was measured. Response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume. RESULTS: Eighteen of 20 (90%) patients with non-ischemic dilated cardiomyopathy (DCM) and 18 of 29 (62%) with ischemic heart disease (IHD) responded to CRT, p

  1. Effect of changes in contractility on the index of myocardial performance in the dysfunctional left ventricle

    Directory of Open Access Journals (Sweden)

    Lavine Steven J

    2006-11-01

    Full Text Available Abstract Background The index of myocardial performance has prognostic power in patients with cardiomyopathy and following myocardial infarction. As the index of myocardial performance has been shown to be preload and afterload dependent, the effect of altering contractility on IMP and its components with left ventricular dysfunction has been incompletely delineated. Methods Chronic left ventricular dysfunction was induced in 10 canines using coronary microsphere embolization. Each dog was instrumented and imaged with 2D echo and Doppler. At the same atrially paced rate, contractility was increased with a dobutamine infusion and then following 4 weeks of oral digoxin. Results With chronic left ventricular dysfunction, a reduced left ventricular ejection fraction (42 ± 3%, p Conclusion Increased inotropy with digoxin and dobutamine reduced the index of myocardial performance in dogs with left ventricular dysfunction. Shortened isovolumic contraction time, increased diastolic filling period, and reduced left ventricular end diastolic pressure with digoxin may provide insight into its efficacy in heart failure.

  2. Left ventricular approach for recording His bundle potential in man.

    Science.gov (United States)

    Lee, Y S; Lien, W P

    1975-06-01

    The electrical potentials of the His bundle (HB) were recorded from the left ventricular endocardial surface in 28 patients ranging from 16 to 63 years of age. In 14 of the patients the left bundle branch (LB) potentials were also obtained. Placement of a bipolar electrode catheter tip toward the interventricular septum, right at and also 1 to 2 cm below the aortic valve, resulted in stable recordings of both potentials in successive cardiac cycles even at performing atrial or HB pacing from the right heart. The following intervals were measured in milliseconds (msec): P-A, A-H, H, H-V, LB, and LB-V. The average values in 12 patients (average age 26 plus or minus 7 years and average heart rate 90 plus or minus 16 beats per minute) with normal A-V conduction were as follows: P-A 28 plus or minus 7, A-H 76 plus or minus 16, H 19 plus or minus 3 and H-V 45 plus or minus 6 msec. The average values for LB and LB-V in 10 of these 12 patients were 15 plus or minus 3 and 25 plus or minus 3 msec respectively. Validation of the His bundle electrogram (HBE) from the left ventricular endocardial surface was based on simultaneous recordings of the intracardiac electrograms from both left and right sides of the heart in 18 patients. The individual average values for the intervals obtained from both sides of the heart in these patients were statistically not different, except that the H potential was slightly longer in duration fr m the left heart (P equals 0.05). Among these, 16 showed simultaneous onset of the H potentials, and the LB-V and RB-V conduction times from comparable points were almost the same. Indications for the left sided electro-physiologic studies include the following situations: (a) inability to record H from the right of the heart; (b) giant right atrium; and (c) possibly during atrial fibrillation.

  3. Factors of Formation of Various Types of Left Ventricular Diastolic Filling in Adolescents with Myocardium Pathology

    Directory of Open Access Journals (Sweden)

    L.F. Bogmat

    2016-08-01

    of general peripheral vascular resistance and cardiac output, and geometric one includes left atrial diameter and the left ventricular end-diastolic size. Formation of left ventricular diastolic dysfunction type 3 is influenced by such components of the neurohormonal system, as renin and angiotensin-II, then the process subsequently includes peripheral vascular tone and a geometric factor in the form of left atrial diameter and left ventricular end-diastolic size. Thus, in the initial stages of left ventricular diastolic dysfunction in adolescents with myocardial pathology, a significant role is played by the sympathoadrenal system, peripheral vascular tone and left atrial function, and then sequentially the renin-angiotensin system is being involved, which causes an increase in myocardial stiffness and, as a result, the inclusion in the pathological process not only of the left atrium, but also the structure (end-diastolic volume and function of the left ventricle (stroke volume.

  4. What is Beyond Right/Left?

    DEFF Research Database (Denmark)

    Dyrberg, Torben Bech

    2009-01-01

    The article looks at New Labour's move beyond right/left in the mid/late 1990s, which is an occasion to spell out the nature of right/left and what it means for democracy. In contrast to both defenders and critics of this move I argue in the first part that right/left is not an empty label bound up...... with the cleavage-lines of industrial society, but that it is an orientational metaphor which is articulated with others-in/out, up/down and front/back-and that we are in the process of moving beyond the industrial society right/left prototype. The second part looks at where New Labour is heading when moving beyond...... right/left. I argue that the new hegemonic orientation is that of front/back, which designs political renewal as a response to the social changes cutting across the outdated lines of contestation of partisan politics. The democratic problem of this move lies in squeezing politics between technocratic...

  5. [Multiple coronary fistulas to the left ventricle. An unusual cause of myocardial ischemia].

    Science.gov (United States)

    Piovaccari, G; Melandri, G; Marzocchi, A; Scarfoglio, D; Sanguinetti, M; Magnani, B

    1989-04-01

    Diffuse communications between the left coronary artery and the left ventricular cavity were found in a 54-years-old man presenting with angina pectoris and reversible ischemia documented on stress Thallium scintigraphy. During atrial pacing the patient experienced chest pain which was accompanied by lactate production. Atenolol, but not nifedipine, did ameliorate the symptoms. The anatomical types and the embriogenesis of coronary microfistulas along with possible mechanisms of ischemia are discussed.

  6. Grammatical distinctions in the left frontal cortex.

    Science.gov (United States)

    Shapiro, K A; Pascual-Leone, A; Mottaghy, F M; Gangitano, M; Caramazza, A

    2001-08-15

    Selective deficits in producing verbs relative to nouns in speech are well documented in neuropsychology and have been associated with left hemisphere frontal cortical lesions resulting from stroke and other neurological disorders. The basis for these impairments is unresolved: Do they arise because of differences in the way grammatical categories of words are organized in the brain, or because of differences in the neural representation of actions and objects? We used repetitive transcranial magnetic stimulation (rTMS) to suppress the excitability of a portion of left prefrontal cortex and to assess its role in producing nouns and verbs. In one experiment subjects generated real words; in a second, they produced pseudowords as nouns or verbs. In both experiments, response latencies increased for verbs but were unaffected for nouns following rTMS. These results demonstrate that grammatical categories have a neuroanatomical basis and that the left prefrontal cortex is selectively engaged in processing verbs as grammatical objects.

  7. Left-Wing Extremism: The Current Threat

    Energy Technology Data Exchange (ETDEWEB)

    Karl A. Seger

    2001-04-30

    Left-wing extremism is ''alive and well'' both in the US and internationally. Although the current domestic terrorist threat within the U. S. is focused on right-wing extremists, left-wing extremists are also active and have several objectives. Leftist extremists also pose an espionage threat to U.S. interests. While the threat to the U.S. government from leftist extremists has decreased in the past decade, it has not disappeared. There are individuals and organizations within the U.S. who maintain the same ideology that resulted in the growth of left-wing terrorism in this country in the 1970s and 1980s. Some of the leaders from that era are still communicating from Cuba with their followers in the U.S., and new leaders and groups are emerging.

  8. Clustered survival data with left-truncation

    DEFF Research Database (Denmark)

    Eriksson, Frank; Martinussen, Torben; Scheike, Thomas H.

    2015-01-01

    Left-truncation occurs frequently in survival studies, and it is well known how to deal with this for univariate survival times. However, there are few results on how to estimate dependence parameters and regression effects in semiparametric models for clustered survival data with delayed entry....... Surprisingly, existing methods only deal with special cases. In this paper, we clarify different kinds of left-truncation and suggest estimators for semiparametric survival models under specific truncation schemes. The large-sample properties of the estimators are established. Small-sample properties...

  9. Left ventricular performance during psychological stress

    International Nuclear Information System (INIS)

    Young, D.Z.; Massachusetts General Hospital, Boston; Dimsdale, J.E.; Moore, R.H.; Barlai-Kovach, M.; Newell, J.B.; McKusick, K.A.; Boucher, C.A.; Fifer, M.A.; Strauss, H.W.

    1989-01-01

    Left ventricular ejection fraction, systolic blood pressure and plasma norepinephrine were measured in six normotensive and six mildly hypertensive subjects during rest and psychological stress. Compared with rest, 8 of the 12 subjects developed significant changes in ejection fraction (increase in 6, decrease in 2); 10 of 12 subjects developed significant elevations of plasma norepinephrine; and all developed significant increases in systolic blood pressure. When the stress effects were examined for the total group, as opposed to within subjects, there were significant increases in plasma norepinephrine and systolic blood pressure but, interestingly, mean ejection fraction and stroke volume remained unchanged, implying stress led to increased left ventricular contractility. (orig.)

  10. Aortic atresia with normal sized left ventricle

    Directory of Open Access Journals (Sweden)

    Priya Jagia

    2016-01-01

    Full Text Available Aortic atresia with an associated ventricular septal defect and adequate sized left ventricle is extremely rare. We present two cases in which an alternate diagnosis was suggested on echocardiography because the hypoplastic aortic trunk was missed due to its small caliber. The final diagnosis was, however, clinched on dual source computed tomography, which not only showed the thin aortic trunk but also clearly depicted the coronary artery origins from the hypoplastic aortic root. To the best of our knowledge, use of multi-detector computed tomography in aortic atresia with well developed left ventricle has not been reported in literature till date.

  11. Left brain, right brain: facts and fantasies.

    Science.gov (United States)

    Corballis, Michael C

    2014-01-01

    Handedness and brain asymmetry are widely regarded as unique to humans, and associated with complementary functions such as a left-brain specialization for language and logic and a right-brain specialization for creativity and intuition. In fact, asymmetries are widespread among animals, and support the gradual evolution of asymmetrical functions such as language and tool use. Handedness and brain asymmetry are inborn and under partial genetic control, although the gene or genes responsible are not well established. Cognitive and emotional difficulties are sometimes associated with departures from the "norm" of right-handedness and left-brain language dominance, more often with the absence of these asymmetries than their reversal.

  12. Left ventricular assist device implantation via left thoracotomy: alternative to repeat sternotomy.

    Science.gov (United States)

    Pierson, Richard N; Howser, Renee; Donaldson, Terri; Merrill, Walter H; Dignan, Rebecca J; Drinkwater, Davis C; Christian, Karla G; Butler, Javed; Chomsky, Don; Wilson, John R; Clark, Rick; Davis, Stacy F

    2002-03-01

    Repeat sternotomy for left ventricular assist device insertion may result in injury to the right heart or patent coronary grafts, complicating intraoperative and postoperative management. In 4 critically ill patients, left thoracotomy was used as an alternative to repeat sternotomy. Anastomosis of the outflow conduit to the descending thoracic aorta provided satisfactory hemodynamic support.

  13. Thallium-201 scintigraphy in complete left bundle branch block

    Energy Technology Data Exchange (ETDEWEB)

    Hirzel, H.O.; Senn, M.; Nuesch, K.; Buettner, C.; Pfeiffer, A.; Hess, O.M.; Krayenbuehl, H.P.

    1984-03-01

    Nineteen symptomatic patients with left bundle branch block (LBBB) were examined by thallium-201 (TI-201) exercise scintigraphy and selective coronary arteriography. All elicited significant anteroseptal perfusion defects in the exercise scintigrams, but in only 4 was coronary artery disease (CAD) involving the left anterior descending coronary artery present. To further elucidate the effect of LBBB on septal TI-201 uptake in the absence of CAD, TI-201 scintigrams combined with regional myocardial blood flow measurements using radioactive microspheres were carried out in 7 dogs during right atrial and right ventricular pacing (LBBB in the ECG) at similar heart rates. During right atrial pacing, TI-201 uptake was homogeneous in the entire left ventricle, as were tissue flows. During right ventricular pacing, TI-201 activity was reduced to 69% of maximal TI-201 activity within the septum, whereas it averaged 90% in the lateral wall (p less than 0.05) in 6 dogs. Correspondingly, regional myocardial blood flow was lower within the septum as compared with that in the lateral wall, averaging 89 and 120 ml/min/100 g, respectively (p less than 0.005). In 1 dog, normal TI-201 distribution and tissue flows were found in both studies. Thus, symptomatic patients with LBBB may elicit abnormal TI-201 exercise scintigrams, suggesting anteroseptal ischemia despite normal coronary arteries. The electrical induction of LBBB in dogs results, in most instances, in a comparable reduction in septal TI-201 uptake associated with diminished septal blood flow. Therefore, exercise-induced septal perfusion defects in the presence of LBBB do not necessarily indicate CAD even in symptomatic patients, but may reflect functional ischemia due to asynchronous septal contraction.

  14. Left-forbidding cooperating distributed grammar systems

    Czech Academy of Sciences Publication Activity Database

    Goldefus, F.; Masopust, Tomáš; Meduna, A.

    2010-01-01

    Roč. 411, 40-42 (2010), s. 3661-3667 ISSN 0304-3975 Institutional research plan: CEZ:AV0Z10190503 Keywords : cooperating distributed grammar system * cooperating derivation mode * left-forbidding grammar * generative power * descriptional complexity Subject RIV: BA - General Mathematics Impact factor: 0.838, year: 2010 http://www.sciencedirect.com/science/article/pii/S0304397510003440

  15. Magnetization of left-handed metamaterials

    International Nuclear Information System (INIS)

    Kourakis, I; Shukla, P K

    2006-01-01

    We propose a possible mechanism for the generation of magnetic fields in negative refraction index composite metamaterials. Considering the propagation of a high-frequency modulated amplitude electric field in a left-handed material (LHM), we show that the ponderomotive interaction between the field and low-frequency potential distributions leads to spontaneous generation of magnetic fields, whose form and properties are discussed

  16. Beware the left-sided gallbladder

    African Journals Online (AJOL)

    An abdominal ultrasound scan showed multiple stones in the gallbladder with no evidence of acute cholecystitis and a common bile duct (CBD) diameter of 4 mm. Owing to the atypical nature of her pain, a computed tomography (CT) scan was requested which showed a left-sided gallbladder containing gallstones (Fig. 1).

  17. Laughter-induced left bundle branch block.

    Science.gov (United States)

    Chow, Grant V; Desai, Dipan; Spragg, David D; Zakaria, Sammy

    2012-10-01

    We present the case of a patient with ischemic heart disease and intermittent left bundle branch block, reproducibly induced by laughter. Following treatment of ischemia with successful deployment of a drug-eluting stent, no further episodes of inducible LBBB were seen. Transient ischemia, exacerbated by elevated intrathoracic pressure during laughter, may have contributed to onset of this phenomenon. © 2012 Wiley Periodicals, Inc.

  18. Left-right subtraction of brain CT

    International Nuclear Information System (INIS)

    Ishiguchi, Tsuneo; Sakuma, Sadayuki

    1986-01-01

    A new image-processing method to obtain a left-right subtraction image of CT was designed for the automated detection of abnormalities in brain CT. An original CT image was divided in two by a centerline. Then the right half of the image was subtracted from the left half by calculating the absorption value of the pixels on the symmetrical positions against the centerline. The mean and the standard deviation of the absorption value of the pixels in the subtraction image were used as parameters for analysis, and the detectability of abnormal CT findings was evaluated in 100 cases - 50 cases each with normal and abnormal CT. The presence of abnormalities could be diagnosed with a sensitivity of 86 %, a specificity of 90 %, and an overall accuracy of 88 % when the borderline of these parameters between normal and abnormal CT was set at the mean + 2SD in the normal group. As a further analysis, the CT image was subdivided into several areas from a functional or anatomical viewpoint, such as cerebral vascular territories, and the left-right subtraction image of each area was obtained. The possibilities of diagnosing the location of an abnormality and of detecting smaller lesions with this method were shown. Left-right subtraction was considered to be a useful method for the detection of asymmetric abnormalities in the automated diagnosis of brain CT. (author)

  19. Left ventricular hypertrophy : virtuous intentions, malign consequences

    NARCIS (Netherlands)

    Pokharel, S; Sharma, UC; Pinto, YM

    Left ventricular hypertrophy (LVH) is currently the focus of intense cardiovascular research, with the resultant rapid evolution of novel concepts relating to its exceedingly complex pathophysiology. In addition to the alterations in signal transduction and disturbances in Ca2+ homeostasis, there

  20. Left ventricular hypertrophy: virtuous intentions, malign consequences

    NARCIS (Netherlands)

    Pokharel, Saraswati; Sharma, Umesh C.; Pinto, Yigal M.

    2003-01-01

    Left ventricular hypertrophy (LVH) is currently the focus of intense cardiovascular research, with the resultant rapid evolution of novel concepts relating to its exceedingly complex pathophysiology. In addition to the alterations in signal transduction and disturbances in Ca(2+) homeostasis, there

  1. Left-sided portal hypertension revisited

    Directory of Open Access Journals (Sweden)

    Antonio Manenti

    2016-12-01

    Conclusions: In every case of left-sided portal hypertension, upper digestive endoscopy and close follow-up are recommended. Besides, computed tomography can demonstrate particular conditions directly favoring gastroesophageal varices, and aid in selection of the appropriate therapeutic decisions. [Arch Clin Exp Surg 2016; 5(4.000: 211-215

  2. Spectral Doppler interrogation of the patent foramen ovale-a window to left heart hemodynamics.

    Science.gov (United States)

    Fadel, Bahaa M; Husain, Aysha; Bakarman, Hatem; Dahdouh, Ziad; Salvo, Giovanni Di; Mohty, Dania

    2015-02-01

    Spectral Doppler interrogation of flow across a patent foramen ovale (PFO) allows recording of the instantaneous pressure gradient between left and right atrium (RA). The assessment of RA pressure using the size and collapsibility of the inferior vena cava would thus allow estimation of left atrial (LA) pressure. In this article, we illustrate the value of spectral Doppler interrogation of flow across the PFO by transthoracic echocardiography as a novel and simple tool for the assessment of LA pressure and left cardiac hemodynamics in addition to the conventional noninvasive parameters. © 2014, Wiley Periodicals, Inc.

  3. Persistent Left Superior Vena Cava Associated with Hemiazygos Vein Draining in It and Absence of Left Brachiocephalic Vein, in a Patient with Congenital Heart Defect

    Directory of Open Access Journals (Sweden)

    Opincariu Diana

    2016-09-01

    Full Text Available Persistent left superior vena cava is an anomalous vein that derives from a malfunction of obliteration of the left common cardinal vein during intrauterine life. The diagnosis can be suggested by a dilated coronary sinus as seen in echocardiography, or other imagistic methods. Due to the lack of hemodynamic impairment, and consequently with few or no symptoms, this vascular anomaly is frequently discovered incidentally. In this brief report we present the case of a 35-year-old male known with a complex congenital cardiovascular malformation that included atrial septum defect, persistent left superior vena cava and anomalous right pulmonary vein drainage in the PLSVC, diagnosed with sinoatrial block that required pacemaker implantation. Due to the patient’s medical history, investigations to decide the best approach needed for pacemaker implantation were performed, including a thoracic CT that incidentally found additional anomalies — the hemiazygos vein draining in PLSVC and the lack of the left brachiocephalic vein.

  4. Left ventricular function in chronic aortic regurgitation

    International Nuclear Information System (INIS)

    Iskandrian, A.S.; Hakki, A.H.; Manno, B.; Amenta, A.; Kane, S.A.

    1983-01-01

    Left ventricular performance was determined in 42 patients with moderate or severe aortic regurgitation during upright exercise by measuring left ventricular ejection fraction and volume with radionuclide ventriculography. Classification of the patients according to exercise tolerance showed that patients with normal exercise tolerance (greater than or equal to 7.0 minutes) had a significantly higher ejection fraction at rest (probability [p] . 0.02) and during exercise (p . 0.0002), higher cardiac index at exercise (p . 0.0008) and lower exercise end-systolic volume (p . 0.01) than did patients with limited exercise tolerance. Similar significant differences were noted in younger patients compared with older patients in ejection fraction at rest and exercise (both p . 0.001) and cardiac index at rest (p . 0.03) and exercise (p . 0.0005). The end-diastolic volume decreased during exercise in 60% of the patients. The patients with a decrease in volume were significantly younger and had better exercise tolerance and a larger end-diastolic volume at rest than did patients who showed an increase in volume. The mean corrected left ventricular end-diastolic radius/wall thickness ratio was significantly greater in patients with abnormal than in those with normal exercise reserve (mean +/- standard deviation 476 +/- 146 versus 377 +/- 92 mm Hg, p less than 0.05). Thus, in patients with chronic aortic regurgitation: 1) left ventricular systolic function during exercise was related to age, exercise tolerance and corrected left ventricular end-diastolic radius/wall thickness ratio, and 2) the end-diastolic volume decreased during exercise, especially in younger patients and patients with normal exercise tolerance or a large volume at rest

  5. Mitral Annulus Myxoma Extending into Left Atrium and Left Ventricle with Severe Mitral Regurgitation as a Pre-Operative Finding, a Rarity

    Directory of Open Access Journals (Sweden)

    Hamza Abdur Rahim Khan

    2017-06-01

    Full Text Available Cardiac tumors constitute 0.2% of all tumors. Primary cardiac tumors occur infrequently with an incidence of 0.0017-0.19% as shown by autopsies performed in non-selected populations. Among these tumors, cardiac myxomas are most commonly encountered, with left atrial myxomas being more prevalent than right atrial ones. The classic triad of symptoms, of which at least one is present in a patient with atrial myxoma, are obstructive traits including dyspnea and syncope, constitutional symptoms such as fever and anorexia, and thromboembolic events. Surgical resection confers almost definitive treatment with recurrence rates being as low as 3%. A 50-year-old woman referred to the Emergency Unit with a sudden episode of chest heaviness and shortness of breath. There was no significant physical examination finding and all routine lab investigations were normal. She underwent an angiography that revealed tight left anterior descending artery stenosis. An angioplasty was also performed, but she had an episode of presyncope immediately. Then, echocardiogram was performed that showed a large left atrial myxoma causing severe mitral regurgitation. Thus, urgent open heart surgery was planned. The myxoma was identified and excised, the mitral annulus resolved, and normal flow was restored. The patient was then discharged home and followed up for 2 months with no complaints. In the current study, we reported a rare case where mitral regurgitation was caused by a left atrial myxoma. Our report highlighted the diverse clinical spectrum of myxoma and emphasized the need for early echocardiographic diagnosis to aid in identification of myxoma followed by early surgical intervention.

  6. Left bronchial artery arising from a replaced left hepatic artery in a patient with massive hemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Khil, Eun Kyung; Lee, Jae Myung [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2015-09-15

    A 70-year-old man with a 3-year history of bronchiectasis presented with massive hemoptysis that had lasted for 3 days. In our attempt to perform bronchial artery embolization, upper abdominal angiography was required to locate the left bronchial artery, which in this case was of anomalous origin, arising from a replaced left hepatic artery, which arose from the left gastric artery-a very unusual anatomical variant. We performed embolization with polyvinyl alcohol particles, and the patient's symptoms resolved completely, with no additional complications after conservative treatment.

  7. Evaluation of left ventricular function by cardiac CT

    International Nuclear Information System (INIS)

    Naito, Hiroaki; Kozuka, Takahiro

    1982-01-01

    Left ventricular function was evaluated by CT, which was compared with the data of left ventriculography for various cardiac diseases. The end diastolic volume of the left ventricle can be readily computed from CT, with a satisfactory correlation with that of left ventriculography (r = 0.95). The left ventricular ejection fraction, calculated from the areal ratio of the left ventricular lumen in end-diastolic imaging to that in end-sytolic imaging, also roughly reflects left ventricular contractile function, but shows correlation with left ventriculography by only r = 0.79. Although the cardiac output is not sensitive for functional evaluation, it can be directly calculated by means of dynamic scanning and shows a satisfactory correlation with the ear piece pigment dilution (r = 0.85). Evaluation of left ventricular function by CT shows a high precision in comparison with left ventriculography, but still lacks temporal resolving power. (Chiba, N.)

  8. Dyscalculia, Dysgraphia, and Left-Right Confusion from a Left Posterior Peri-Insular Infarct

    Directory of Open Access Journals (Sweden)

    S. Bhattacharyya

    2014-01-01

    Full Text Available The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation.

  9. Dyscalculia, dysgraphia, and left-right confusion from a left posterior peri-insular infarct.

    Science.gov (United States)

    Bhattacharyya, S; Cai, X; Klein, J P

    2014-01-01

    The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI) showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation.

  10. Minimal Left-Right Symmetric Dark Matter.

    Science.gov (United States)

    Heeck, Julian; Patra, Sudhanwa

    2015-09-18

    We show that left-right symmetric models can easily accommodate stable TeV-scale dark matter particles without the need for an ad hoc stabilizing symmetry. The stability of a newly introduced multiplet either arises accidentally as in the minimal dark matter framework or comes courtesy of the remaining unbroken Z_{2} subgroup of B-L. Only one new parameter is introduced: the mass of the new multiplet. As minimal examples, we study left-right fermion triplets and quintuplets and show that they can form viable two-component dark matter. This approach is, in particular, valid for SU(2)×SU(2)×U(1) models that explain the recent diboson excess at ATLAS in terms of a new charged gauge boson of mass 2 TeV.

  11. [Left postpneumonectomy syndrome: early endoscopic treatment].

    Science.gov (United States)

    Rombolá, Carlos A; León Atance, Pablo; Honguero Martínez, Antonio Francisco; Rueda Martínez, Juan Luis; Núñez Ares, Ana; Vizcaya Sánchez, Manuel

    2009-12-01

    Postpneumonectomy syndrome is characterized by postoperative bronchial obstruction caused by mediastinal shift. The syndrome is well documented in the medical literature as a late complication of right pneumonectomy; however, it rarely occurs following resection of the left lung, and only 10 cases have been published. The pathophysiology, clinical manifestations, prognosis, and treatment are similar for both sides of the lung. We present the case of an adult patient who underwent left pneumonectomy and developed postpneumonectomy syndrome 15 months later. Stenosis of the intermediate bronchus occurred between the vertebral body and the right pulmonary artery. Endoscopic treatment with a self-expanding metal stent was successful, and complete remission was observed over the 6 months of follow-up.

  12. A constrained supersymmetric left-right model

    Energy Technology Data Exchange (ETDEWEB)

    Hirsch, Martin [AHEP Group, Instituto de Física Corpuscular - C.S.I.C./Universitat de València, Edificio de Institutos de Paterna, Apartado 22085, E-46071 València (Spain); Krauss, Manuel E. [Bethe Center for Theoretical Physics & Physikalisches Institut der Universität Bonn, Nussallee 12, 53115 Bonn (Germany); Institut für Theoretische Physik und Astronomie, Universität Würzburg,Emil-Hilb-Weg 22, 97074 Wuerzburg (Germany); Opferkuch, Toby [Bethe Center for Theoretical Physics & Physikalisches Institut der Universität Bonn, Nussallee 12, 53115 Bonn (Germany); Porod, Werner [Institut für Theoretische Physik und Astronomie, Universität Würzburg,Emil-Hilb-Weg 22, 97074 Wuerzburg (Germany); Staub, Florian [Theory Division, CERN,1211 Geneva 23 (Switzerland)

    2016-03-02

    We present a supersymmetric left-right model which predicts gauge coupling unification close to the string scale and extra vector bosons at the TeV scale. The subtleties in constructing a model which is in agreement with the measured quark masses and mixing for such a low left-right breaking scale are discussed. It is shown that in the constrained version of this model radiative breaking of the gauge symmetries is possible and a SM-like Higgs is obtained. Additional CP-even scalars of a similar mass or even much lighter are possible. The expected mass hierarchies for the supersymmetric states differ clearly from those of the constrained MSSM. In particular, the lightest down-type squark, which is a mixture of the sbottom and extra vector-like states, is always lighter than the stop. We also comment on the model’s capability to explain current anomalies observed at the LHC.

  13. Left brain, right brain: facts and fantasies.

    Directory of Open Access Journals (Sweden)

    Michael C Corballis

    2014-01-01

    Full Text Available Handedness and brain asymmetry are widely regarded as unique to humans, and associated with complementary functions such as a left-brain specialization for language and logic and a right-brain specialization for creativity and intuition. In fact, asymmetries are widespread among animals, and support the gradual evolution of asymmetrical functions such as language and tool use. Handedness and brain asymmetry are inborn and under partial genetic control, although the gene or genes responsible are not well established. Cognitive and emotional difficulties are sometimes associated with departures from the "norm" of right-handedness and left-brain language dominance, more often with the absence of these asymmetries than their reversal.

  14. Relation of osteoprotegerin in severe aortic valve stenosis to postoperative outcome and left ventricular function

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbæk, Lars; Poulsen, Mikael K

    2013-01-01

    Osteoprotegerin (OPG) is a member of the tumor necrosis factor receptor superfamily and is known to be among the mediators of the calcification process that has been shown to increase in patients with aortic stenosis (AS). The aim of this study was to characterize the association of OPG with left......, 41 patients died of a presumed cardiovascular cause or remained in New York Heart Association functional class III or IV. The risk of a poor postoperative outcome after AVR increased with increasing OPG tertiles (15% vs 33% vs 51%, p = 0.002). In a multivariate model containing age, ejection fraction......, N-terminal pro-brain natriuretic peptide and left atrial volume index, OPG was still significantly associated with postoperative outcome. In addition, OPG levels associated with cardiovascular mortality during follow-up. In conclusion, OPG is associated with LV and left atrial remodeling in patients...

  15. A disappearing left-sided neck mass.

    Science.gov (United States)

    Lutwak, Nancy; Dill, Curt

    2012-07-04

    The patient was a 48-year-old man who presented to the emergency department with complaints of a left-sided painful neck mass, which changed in size relative to ingestion of meals. He denied voice change, fever, chills, weight loss, dysphagia and hoarseness. Physical examination was unremarkable. CT scan demonstrated a 3.9 mm calculus of the submandibular gland duct. Therapeutic sialendocopy was successfully performed.

  16. The New Arab Left and 1967

    DEFF Research Database (Denmark)

    Haugbølle, Sune

    2017-01-01

    In Arab political culture, the Naksa of 1967 had a number of watershed effects. Scholars have paid a lot of attention to the decline of secular Arab nationalism and the concurrent rise of Islamism. Much less research has been done on the way 1967 spurred radical left organizations, also known as ...... moment that followed. This moment has had a lasting impact on Arab political culture and is being re-interpreted in interesting ways today by Arab revolutionaries post-2011....

  17. Aortic atresia with normal sized left ventricle

    OpenAIRE

    Priya Jagia; Arun Sharma; Saurabh K Gupta; Munish Guleria

    2016-01-01

    Aortic atresia with an associated ventricular septal defect and adequate sized left ventricle is extremely rare. We present two cases in which an alternate diagnosis was suggested on echocardiography because the hypoplastic aortic trunk was missed due to its small caliber. The final diagnosis was, however, clinched on dual source computed tomography, which not only showed the thin aortic trunk but also clearly depicted the coronary artery origins from the hypoplastic aortic root. To the best ...

  18. Clustering Of Left Ventricular Wall Motion Patterns

    Science.gov (United States)

    Bjelogrlic, Z.; Jakopin, J.; Gyergyek, L.

    1982-11-01

    A method for detection of wall regions with similar motion was presented. A model based on local direction information was used to measure the left ventricular wall motion from cineangiographic sequence. Three time functions were used to define segmental motion patterns: distance of a ventricular contour segment from the mean contour, the velocity of a segment and its acceleration. Motion patterns were clustered by the UPGMA algorithm and by an algorithm based on K-nearest neighboor classification rule.

  19. The role of Multidetector CT in the evaluation of the left atrium and pulmonary veins anatomy before and after radio-frequency catheter ablation for atrial fibrillation. Preliminary results and work in progress.Technical note; Il ruolo della TC Multidetettore nella valutazione anatomica dell'atrio sinistro e delle vene polmonari prima e dopo ablazione percutanea con radiofrequenza della fibrillazione atriale. Risultati preliminari e work in progress

    Energy Technology Data Exchange (ETDEWEB)

    Centoze, Maurizio; Della Sala, Sabino Walter; Dalla Palma, Francesco [Azienda Provinciale per i servizi sanitari, Trento (Italy). Dipartimento di radiodiagnostica; Del Greco, Maurizio; Marini, Massimiliano [Ospedale S. Chiara, Trento (Italy). U.O. di cardiologia; Nollo, Giandomenico; Ravelli, Flavia [Trento Univ., Trento (Italy). Dipartimento di fisica

    2005-07-15

    Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial al fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this parer is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward. [Italian] La ablazione percutanea con radiofrequenza (RFCA) del tratto distale delle vene polmonari nella fibrillazione atriale, che non risponde al trattamento farmacologico e alla cardioversione elettrica, e una procedura in grande sviluppo. Il successo del trattamento dipende dalla comprensione della complessa anatomia delle vene polmonari e dell'atrio sinistro. Lo scopo di questo articolo e illustrare gli aspetti tecnici fondamentali che caratterizzano lo studio di questa regione anatomica con TC spirale multidetettore prima e dopo RFCA. Particolare risalto e stato rivolto alle tecniche di post-processing 3D estremamente utili nella pianificazione della procedura di ablazione.

  20. Implantation of a HeartMate II left ventricular assist device via left thoracotomy.

    Science.gov (United States)

    Cho, Yang Hyun; Deo, Salil V; Schirger, John A; Pereira, Naveen L; Stulak, John M; Park, Soon J

    2012-11-01

    Left thoracotomy was used as an approach for the implantation of pulsatile ventricular assist devices. Avoiding the standard approach of median sternotomy is attractive in patients undergoing complicated redo cardiac surgery, especially with prior mediastinal radiation. We report a case of the use of left thoracotomy for the implantation of the HeartMate II axial-flow pump. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Left hemisphere regions are critical for language in the face of early left focal brain injury

    OpenAIRE

    Raja Beharelle, Anjali; Dick, Anthony Steven; Josse, Goulven; Solodkin, Ana; Huttenlocher, Peter R.; Levine, Susan C.; Small, Steven L.

    2010-01-01

    A predominant theory regarding early stroke and its effect on language development, is that early left hemisphere lesions trigger compensatory processes that allow the right hemisphere to assume dominant language functions, and this is thought to underlie the near normal language development observed after early stroke. To test this theory, we used functional magnetic resonance imaging to examine brain activity during category fluency in participants who had sustained pre- or perinatal left h...

  2. Pulmonary hypertension due to left heart disease.

    Science.gov (United States)

    Berthelot, Emmanuelle; Bailly, Minh Tam; Hatimi, Safwane El; Robard, Ingrid; Rezgui, Hatem; Bouchachi, Amir; Montani, David; Sitbon, Olivier; Chemla, Denis; Assayag, Patrick

    Pulmonary hypertension due to left heart disease, also known as group 2 pulmonary hypertension according to the European Society of Cardiology/European Respiratory Society classification, is the most common cause of pulmonary hypertension. In patients with left heart disease, the development of pulmonary hypertension favours right heart dysfunction, which has a major impact on disease severity and outcome. Over the past few years, this condition has been considered more frequently. However, epidemiological studies of group 2 pulmonary hypertension are less exhaustive than studies of other causes of pulmonary hypertension. In group 2 patients, pulmonary hypertension may be caused by an isolated increase in left-sided filling pressures or by a combination of this condition with increased pulmonary vascular resistance, with an abnormally high pressure gradient between arteries and pulmonary veins. A better understanding of the conditions underlying pulmonary hypertension is of key importance to establish a comprehensive diagnosis, leading to an adapted treatment to reduce heart failure morbidity and mortality. In this review, epidemiology, mechanisms and diagnostic approaches are reviewed; then, treatment options and future approaches are considered. Copyright © 2017. Published by Elsevier Masson SAS.

  3. Left-Deviating Prism Adaptation in Left Neglect Patient: Reflexions on a Negative Result

    Directory of Open Access Journals (Sweden)

    Jacques Luauté

    2012-01-01

    Full Text Available Adaptation to right-deviating prisms is a promising intervention for the rehabilitation of patients with left spatial neglect. In order to test the lateral specificity of prism adaptation on left neglect, the present study evaluated the effect of left-deviating prism on straight-ahead pointing movements and on several classical neuropsychological tests in a group of five right brain-damaged patients with left spatial neglect. A group of healthy subjects was also included for comparison purposes. After a single session of exposing simple manual pointing to left-deviating prisms, contrary to healthy controls, none of the patients showed a reliable change of the straight-ahead pointing movement in the dark. No significant modification of attentional paper-and-pencil tasks was either observed immediately or 2 hours after prism adaptation. These results suggest that the therapeutic effect of prism adaptation on left spatial neglect relies on a specific lateralized mechanism. Evidence for a directional effect for prism adaptation both in terms of the side of the visuomanual adaptation and therefore possibly in terms of the side of brain affected by the stimulation is discussed.

  4. Evaluation of left ventricular function by nuclear stethoscope

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, T [National Cardiovascular Center, Suita, Osaka (Japan)

    1981-03-01

    The Nuclear Stethoscope (N.S.) is a unique cardiac probe system that provides a precise, rapid, noninvasive method to directly quantify ventricular functions at the bedside or actual beat-to-beat or composite beat basis. The accuracy and validity of N.S. were studied in 42 patients with cardiac diseases in comparison with camera-computer EF. The N.S. EF was well correlated with camera-computer EF (r = 0.82). In this study, clinical application of N.S. was as follows. 1. Beat-to-beat left ventricular volume response for evaluation of arrythmia (atrial fibrillation, premature ventricular conduction, bigemy et al.) 2. exercise study by handgrip and ergometer. EF is an extremely sensitive indicator to discriminate coronary arteries diseases from normal subjects.

  5. Evaluation of left ventricular function by nuclear stethoscope

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko

    1981-01-01

    The Nuclear Stethoscope (N.S.) is a unique cardiac probe system that provides a precise, rapid, noninvasive method to directly quantify ventricular functions at the bedside or actual beat-to-beat or composite beat basis. The accuracy and validity of N.S. were studied in 42 patients with cardiac diseases in comparison with camera-computer EF. The N.S. EF was well correlated with camera-computer EF (r = 0.82). In this study, clinical application of N.S. was as follows. 1. Beat-to-beat left ventricular volume response for evaluation of arrythmia (atrial fibrillation, premature ventricular conduction, bigemy et al.) 2. exercise study by handgrip and ergometer. EF is an extremely sensitive indicator to discriminate coronary arteries diseases from normal subjects. (author)

  6. Polycythemia vera presenting with left hemichoreiform movements. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Tamiharu; Shimomura, Chikako; Ishibashi, Hiroshi; Tsujihata, Mitsuhiro; Nagataki, Shigenobu

    1985-01-01

    A 65-year-old man developed abruptly choreiform movements involving the left face, arm and leg one day prior to admission. Physical examination revealed red face and palms, hyperemic conjunctivae and atrial fibrillations. Blood pressure was 168/90. Spleen was not palpable. Hemichoreiform movements of the left face and limbs were observed. There was no other neurological abnormalities. Laboratory studies showed RBC 880 x 10U, Hb 22.4g/dl, Hct 63%, WBC 8,100, platelets 22.9 x 10U, ESR 0mm/hr, RBC oxygen saturation 97%, serum iron 67 g/dl, LDH 593 units, uric acid 14mg/dl, and erythropoietine (HI method) 19mIU/ml (normal 28-88). Bone marrow showed myeloid nucleated cell count 38.6 x 10U. ECG showed atrial fibrillations. Chest X-ray and scintigrams of liver and spleen were normal. CSF was normal. Brain CT scan on admission disclosed a low density area in right caudate nucleus. The choreiform movements were rapidly mitigated by venesection and by oral administration of haloperidol(3mg daily). There weeks after discontinuing haloperidol, the hemichorea returned. The routine hematology showed RBC 870 x 10U, Hb 19.8g/dl, Hct 62%, WBC 10,200, and plateret 37.4 x 10U. Another venesection reduced the chorea. Pipobroman was administered to control the polycythemia vera. He has been free of choreic movements thereafter. Choreiform movement is rarely observed in polycythemia vera. The pathogenesis is still unknown. The venous congestion, however, may play a role in this case because the choreic movements disappeared by venesection. (author).

  7. Wolff-Parkinson-White syndrome type B and left bundle-branch block: electrophysiologic and radionuclide study

    Energy Technology Data Exchange (ETDEWEB)

    Rakovec, P.; Kranjec, I.; Fettich, J.J.; Jakopin, J.; Fidler, V.; Turk, J.

    1985-01-01

    Coinciding left bundle-branch block and Wolff-Parkinson-White syndrome type B, a very rare electrocardiographic occurrence, was found in a patient with dilated cardiomyopathy. Electrophysiologic study revealed eccentric retrograde atrial activation during ventricular pacing, suggesting right-sided accessory pathway. At programmed atrial pacing, effective refractory period of the accessory pathway was 310 ms; at shorter pacing coupling intervals, normal atrioventricular conduction with left bundle-branch block was seen. Left bundle-branch block was seen also with His bundle pacing. Radionuclide phase imaging demonstrated right ventricular phase advance and left ventricular phase delay; both right and left ventricular phase images revealed broad phase distribution histograms. Combined electrophysiologic and radionuclide investigations are useful to disclose complex conduction abnormalities and their mechanical correlates.

  8. Wolff-Parkinson-White syndrome type B and left bundle-branch block: electrophysiologic and radionuclide study

    International Nuclear Information System (INIS)

    Rakovec, P.; Kranjec, I.; Fettich, J.J.; Jakopin, J.; Fidler, V.; Turk, J.

    1985-01-01

    Coinciding left bundle-branch block and Wolff-Parkinson-White syndrome type B, a very rare electrocardiographic occurrence, was found in a patient with dilated cardiomyopathy. Electrophysiologic study revealed eccentric retrograde atrial activation during ventricular pacing, suggesting right-sided accessory pathway. At programmed atrial pacing, effective refractory period of the accessory pathway was 310 ms; at shorter pacing coupling intervals, normal atrioventricular conduction with left bundle-branch block was seen. Left bundle-branch block was seen also with His bundle pacing. Radionuclide phase imaging demonstrated right ventricular phase advance and left ventricular phase delay; both right and left ventricular phase images revealed broad phase distribution histograms. Combined electrophysiologic and radionuclide investigations are useful to disclose complex conduction abnormalities and their mechanical correlates

  9. Clinical psychomotor skills among left and right handed medical students: are the left-handed medical students left out?

    Science.gov (United States)

    Alnassar, Sami; Alrashoudi, Aljoharah Nasser; Alaqeel, Mody; Alotaibi, Hala; Alkahel, Alanoud; Hajjar, Waseem; Al-Shaikh, Ghadeer; Alsaif, Abdulaziz; Haque, Shafiul; Meo, Sultan Ayoub

    2016-03-22

    There is a growing perception that the left handed (LH) medical students are facing difficulties while performing the clinical tasks that involve psychomotor skill, although the evidence is very limited and diverse. The present study aimed to evaluate the clinical psychomotor skills among Right-handed (RH) and left-handed (LH) medical students. For this study, 54 (27 left handed and 27 right handed) first year medical students were selected. They were trained for different clinical psychomotor skills including suturing, laparoscopy, intravenous cannulation and urinary catheterization under the supervision of certified instructors. All students were evaluated for psychomotor skills by different instructors. The comparative performance of the students was measured by using a global rating scale, each selected criteria was allotted 5-points score with the total score of 25. There were no significant differences in the performance of psychomotor skills among LH and RH medical students. The global rating score obtained by medical students in suturing techniques was: LH 15.89 ± 2.88, RH 16.15 ± 2.75 (p = 0.737), cannulation techniques LH 20.44 ± 2.81, RH 20.70 ± 2.56 (p = 0.725), urinary catheterization LH 4.33 ± 0.96 RH 4.11 ± 1.05 (p = 0.421). For laparoscopic skills total peg transfer time was shorter among LH medical students compared to RH medical students (LH 129.85 ± 80.87 s vs RH 135.52 ± 104.81 s) (p = 0.825). However, both RH and LH students completed their procedure within the stipulated time. Among LH and RH medical students no significant difference was observed in performing the common surgical psychomotor skills. Surgical skills for LH or RH might not be a result of innate dexterity but rather the academic environment in which they are trained and assessed. Early laterality-related mentoring in medical schools as well as during the clinical residency might reduce the inconveniences faced by the left

  10. The New Left in the European Democracies: The Case of the German Radical Left

    Directory of Open Access Journals (Sweden)

    Marco Damiani

    2015-03-01

    Full Text Available The new form of the social and political conflict cannot be explained by the traditional categories of right and left, but it articulates to them on two plans, that of the establishment, intended like plan of the structured political conflict from the traditional actors, and that of the anti-establishment, in which new representations of politics emerge. The New Left is characterized by type of intermittent participation and new perspectives on mobilization inside the parties and the social movements. This type of parties differs moreover from the traditional ones left of the socialist and social democratic left in not arranging of organizations collaterals placed under the direction of the leadership of the same party. The mobilization that spontaneously assumes not conventional forms of active participation of the citizens, or is primed by the action of an associative network of which the same parties take part, than however does not monopo-lize the collective action. In this regard, the attention will be dedicated to the study of Die Linke: an anti-establishment party of the non-socialist German left-wing, heir to the communist tradition. The choice was affected to the German model because: 1 Germany is a country with a strong social democratic tradition, but 25 years after the fall of the Berlin Wall the German political system identifies a new antagonist political party; 2 Die Linke represents an interesting case in the political landscape of the European radical left because is a one-party that gives up at the federation of parties to try to unify the political parties of German radical left-wing.

  11. Left ventricular heart failure and pulmonary hypertension†

    Science.gov (United States)

    Rosenkranz, Stephan; Gibbs, J. Simon R.; Wachter, Rolf; De Marco, Teresa; Vonk-Noordegraaf, Anton; Vachiéry, Jean-Luc

    2016-01-01

    Abstract In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequent and have important impact on disease progression, morbidity, and mortality, and therefore warrant clinical attention. Pulmonary hypertension related to left heart disease (LHD) by far represents the most common form of PH, accounting for 65–80% of cases. The proper distinction between pulmonary arterial hypertension and PH-LHD may be challenging, yet it has direct therapeutic consequences. Despite recent advances in the pathophysiological understanding and clinical assessment, and adjustments in the haemodynamic definitions and classification of PH-LHD, the haemodynamic interrelations in combined post- and pre-capillary PH are complex, definitions and prognostic significance of haemodynamic variables characterizing the degree of pre-capillary PH in LHD remain suboptimal, and there are currently no evidence-based recommendations for the management of PH-LHD. Here, we highlight the prevalence and significance of PH and RV dysfunction in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), and provide insights into the complex pathophysiology of cardiopulmonary interaction in LHD, which may lead to the evolution from a ‘left ventricular phenotype’ to a ‘right ventricular phenotype’ across the natural history of HF. Furthermore, we propose to better define the individual phenotype of PH by integrating the clinical context, non-invasive assessment, and invasive haemodynamic variables in a structured diagnostic work-up. Finally, we challenge current definitions and diagnostic short falls, and discuss gaps in evidence, therapeutic options and the necessity for future developments in this context. PMID:26508169

  12. Sympathetic stimulation alters left ventricular relaxation and chamber size.

    Science.gov (United States)

    Burwash, I G; Morgan, D E; Koilpillai, C J; Blackmore, G L; Johnstone, D E; Armour, J A

    1993-01-01

    Alterations in left ventricular (LV) contractility, relaxation, and chamber dimensions induced by efferent sympathetic nerve stimulation were investigated in nine anesthetized open-chest dogs in sinus rhythm. Supramaximal stimulation of acutely decentralized left stellate ganglia augmented heart rate, LV systolic pressure, and rate of LV pressure rise (maximum +dP/dt, 1,809 +/- 191 to 6,304 +/- 725 mmHg/s) and fall (maximum -dP/dt, -2,392 +/- 230 to -4,458 +/- 482 mmHg/s). It also reduced the time constant of isovolumic relaxation, tau (36.5 +/- 4.8 to 14.9 +/- 1.1 ms). Simultaneous two-dimensional echocardiography recorded reductions in end-diastolic and end-systolic LV cross-sectional chamber areas (23 and 31%, respectively), an increase in area ejection fraction (32%), and increases in end-diastolic and end-systolic wall thicknesses (14 and 13%, respectively). End-systolic and end-diastolic wall stresses were unchanged by stellate ganglion stimulation (98 +/- 12 to 95 +/- 9 dyn x 10(3)/cm2; 6.4 +/- 2.4 to 2.4 +/- 0.3 dyn x 10(3)/cm2, respectively). Atrial pacing to similar heart rates did not alter monitored indexes of contractility. Dobutamine and isoproterenol induced changes similar to those resulting from sympathetic neuronal stimulation. These data indicate that when the efferent sympathetic nervous system increases left ventricular contractility and relaxation, concomitant reductions in systolic and diastolic dimensions of that chamber occur that are associated with increasing wall thickness such that LV wall stress changes are minimized.

  13. Preoperative left ventricular ejection fraction and left atrium reverse remodeling after mitral regurgitation surgery.

    Science.gov (United States)

    Machado, Lucia R; Meneghelo, Zilda M; Le Bihan, David C S; Barretto, Rodrigo B M; Carvalho, Antonio C; Moises, Valdir A

    2014-11-06

    Left atrium enlargement has been associated with cardiac events in patients with mitral regurgitation (MR). Left atrium reverse remodeling (LARR) occur after surgical correction of MR, but the preoperative predictors of this phenomenon are not well known. It is therefore important to identify preoperative predictors for postoperative LARR. We enrolled 62 patients with chronic severe MR (prolapse or flail leaflet) who underwent successful mitral valve surgery (repair or replacement); all with pre- and postoperative echocardiography. LARR was defined as a reduction in left atrium volume index (LAVI) of ≥ 25%. Stepwise multiple regression analysis was used to identify independent predictors of LARR. LARR occurred in 46 patients (74.2%), with the mean LAVI decreasing from 85.5 mL/m2 to 49.7 mL/m2 (p <0.001). These patients had a smaller preoperative left ventricular systolic volume (p =0.022) and a higher left ventricular ejection fraction (LVEF) (p =0.034). LVEF was identified as the only preoperative variable significantly associated with LARR (odds ratio, 1.086; 95% confidence interval, 1.002-1.178). A LVEF cutoff value of 63.5% identified patients with LARR of ≥ 25% with a sensitivity of 71.7% and a specificity of 56.3%. LARR occurs frequently after mitral valve surgery and is associated with preoperative LVEF higher than 63.5%.

  14. Photonic-resonant left-handed medium

    International Nuclear Information System (INIS)

    Shen Jianqi

    2006-01-01

    A new scheme to realize simultaneously negative permittivity and permeability in a coherent atomic vapor medium (photonic-resonant material) via a coherent driving mechanism is suggested. It is verified that the atomic system coherently driven by a strong optical field will give rise to a negative refractive index in certain probe frequency ranges. One of the most remarkable features of the present scheme is such that a slab fabricated by the left-handed vapor medium is an ideal candidate for designing perfect lenses since the photonic-resonant atomic vapor cannot only exhibit an isotropic negative refractive index, but also provide a good impedance match at the air-medium interfaces

  15. Mycobacterium chimaera left ventricular assist device infections.

    Science.gov (United States)

    Balsam, Leora B; Louie, Eddie; Hill, Fred; Levine, Jamie; Phillips, Michael S

    2017-06-01

    A global outbreak of invasive Mycobacterium chimaera infections after cardiac surgery has recently been linked to bioaerosols from contaminated heater-cooler units. The majority of cases have occurred after valvular surgery or aortic graft surgery and nearly half have resulted in death. To date, infections in patients with left ventricular assist devices (LVADs) have not been characterized in the literature. We report two cases of device-associated M. chimaera infection in patients with continuous-flow LVADs and describe challenges related to diagnosis and management in this population. © 2017 Wiley Periodicals, Inc.

  16. Functional β2-adrenoceptors in rat left atria: effect of foot-shock stress.

    Science.gov (United States)

    Moura, André Luiz de; Hyslop, Stephen; Grassi-Kassisse, Dora M; Spadari, Regina C

    2017-09-01

    Altered sensitivity to the chronotropic effect of catecholamines and a reduction in the β 1 /β 2 -adrenoceptor ratio have previously been reported in right atria of stressed rats, human failing heart, and aging. In this report, we investigated whether left atrial inotropism was affected by foot-shock stress. Male rats were submitted to 3 foot-shock sessions and the left atrial inotropic response, adenylyl cyclase activity, and β-adrenoceptor expression were investigated. Left atria of stressed rats were supersensitive to isoprenaline when compared with control rats and this effect was abolished by ICI118,551, a selective β 2 -receptor antagonist. Schild plot slopes for the antagonism between CGP20712A (a selective β 1 -receptor antagonist) and isoprenaline differed from unity in atria of stressed but not control rats. Atrial sensitivity to norepinephrine, as well as basal and forskolin- or isoprenaline-stimulated adenylyl cyclase activities were not altered by stress. The effect of isoprenaline on adenylyl cyclase stimulation was partially blocked by ICI118,551 in atrial membranes of stressed rats. These findings indicate that foot-shock stress equally affects inotropism and chronotropism and that β 2 -adrenoceptor upregulation contributes to the enhanced inotropic response to isoprenaline.

  17. Use of the Amplatzer ASD Occluder for Closing a Persistent Left Vertical Vein

    International Nuclear Information System (INIS)

    Zanchetta, Mario; Zennaro, Marco; Zecchel, Roberto; Mancuso, Daniela; Pedon, Luigi

    2009-01-01

    We report the case of a very large anomalous connection of the veins draining the upper lobe of the left lung to both the left-sided vertical vein and the left atrium, associated with mild rheumatic mitral valve stenosis, in which the atrial septum was intact and the remaining venous system, including the coronary sinus, was otherwise normal (a variant of Lutembacher's syndrome). In order to abolish the left-to-right shunting, a transcatheter approach to close this venous structure was successfully attempted using an Amplatzer ASD Occluder device. The technical aspects and the alternative options of performing a procedure with a device for a purpose outside the scope of its approved label are discussed.

  18. Heart Failure with Transient Left Bundle Branch Block in the Setting of Left Coronary Fistula

    Directory of Open Access Journals (Sweden)

    Stephen P. Juraschek

    2011-01-01

    Full Text Available Coronary arterial fistulas are rare communications between vessels or chambers of the heart. Although cardiac symptoms associated with fistulas are well described, fistulas are seldom considered in the differential diagnosis of acute myocardial ischemia. We describe the case of a 64-year-old man who presented with left shoulder pain, signs of heart failure, and a new left bundle branch block (LBBB. Cardiac catheterization revealed a small left anterior descending (LAD-to-pulmonary artery (PA fistula. Diuresis led to subjective improvement of the patient's symptoms and within several days the LBBB resolved. We hypothesize that the coronary fistula in this patient contributed to transient ischemia of the LAD territory through a coronary steal mechanism. We elected to observe rather than repair the fistula, as his symptoms and ECG changes resolved with treatment of his heart failure.

  19. Coronary artery to left ventricle fistula

    Directory of Open Access Journals (Sweden)

    Kumar Vivek

    2005-11-01

    Full Text Available Abstract Background Coronary cameral fistulas are an uncommon entity, the etiology of which may be congenital or traumatic. They involve abnormal termination of a coronary artery, usually the right coronary, into a cardiac chamber, usually the right ventricle. Case Presentation We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up an abnormal flow traversing the septum into the left ventricle was identified and Doppler interrogation demonstrated a continuous flow, with a predominantly diastolic component, consistent with coronary arterial flow. Conclusion The literature on coronary cameral fistulas is reviewed and the etiology of the diagnostic findings discussed. In our patient, a coronary artery to left ventricle fistula was the most likely explanation secondary to trauma to the septal perforator artery during myectomy. Since the patient was asymptomatic at the time of diagnosis no intervention was recommended and has done well on follow-up.

  20. Nonlinear left-handed transmission line metamaterials

    International Nuclear Information System (INIS)

    Kozyrev, A B; Weide, D W van der

    2008-01-01

    Metamaterials, exhibiting simultaneously negative permittivity ε and permeability μ, more commonly referred to as left-handed metamaterials (LHMs) and also known as negative-index materials, have received substantial attention in the scientific and engineering communities [1]. Most studies of LHMs (and electromagnetic metamaterials in general) have been in the linear regime of wave propagation and have already inspired new types of microwave circuits and devices. The results of these studies have already been the subject of numerous reviews and books. This review covers a less explored but rapidly developing area of investigation involving media that combine nonlinearity (dependence of the permittivity and permeability on the magnitude of the propagating field) with the anomalous dispersion exhibited by LHM. The nonlinear phenomena in such media will be considered on the example of a model system: the nonlinear left-handed transmission line. These nonlinear phenomena include parametric generation and amplification, harmonic and subharmonic generation as well as modulational instabilities and envelope solitons. (topical review)

  1. Rare occurrence of the left maxillary horizontal third molar impaction ...

    African Journals Online (AJOL)

    Rare occurrence of the left maxillary horizontal third molar impaction, the right maxillary third molar vertical impaction and the left mandibular third molar vertical impaction with inferior alveolar nerve proximity in a 30 year old female: a case report.

  2. challenges left-handed students face in kenyan girls' secondary

    African Journals Online (AJOL)

    IICBA01

    Previous research on left-handedness has mainly taken place in developed countries. This ... participants were five left-handed science students and their respective subject teachers from a ... Qualitative data was collected through classroom.

  3. Behavioral evidence for left-hemisphere specialization of motor planning

    NARCIS (Netherlands)

    Janssen, L.; Meulenbroek, R.G.; Steenbergen, B.

    2011-01-01

    Recent studies suggest that the left hemisphere is dominant for the planning of motor actions. This left-hemisphere specialization hypothesis was proposed in various lines of research, including patient studies, motor imagery studies, and studies involving neurophysiological techniques. However,

  4. Incidental retroaortic left innominate vein in adult patient

    Directory of Open Access Journals (Sweden)

    Alexandre Semionov, MD, PhD

    2017-09-01

    Full Text Available Retro-aortic left innominate vein is a rare vascular abnormality, usually associated with congenital heart disease. Here we report a case of isolated retro-aortic left innominate vein in an adult female.

  5. Anesthetic implications of total anomalous systemic venous connection to left atrium with left isomerism

    Directory of Open Access Journals (Sweden)

    Parimala Prasanna Simha

    2012-01-01

    Full Text Available Total anomalous systemic venous connection (TASVC to the left atrium (LA is a rare congenital anomaly. An 11-year-old girl presented with complaints of palpitations and cyanosis. TASVC with left isomerism and noncompaction of LV was diagnosed after contrast echocardiogram and computed tomography angiogram. The knowledge of anatomy and pathophysiology is essential for the successful management of these cases. Anesthetic concerns in this case were polycythemia, paradoxical embolism and rhythm abnormalities. The patient was successfully operated by rerouting the systemic venous connection to the right atrium.

  6. Transcatheter therapy in partially abnormal pulmonary venous return with additional drainage to the left atrium.

    Science.gov (United States)

    Luciano, Debora; Laux, Daniela; Boudjemline, Younes; Hascoët, Sébastien; Lusson, Jean-René; Sorensen, Clio; Ovaert, Caroline; Kreitmann, Bernard; Van Praagh, Richard; Fraisse, Alain

    2013-12-10

    A persistent anastomosis between the pulmonary veins that connect with the left atrium and the systemic vein that drains into the right atrium has occasionally been reported. We report characteristics and transcatheter therapy in partially abnormal pulmonary venous return with additional drainage to the left atrium. We retrospectively studied such patients in 5 institutions. Ten patients (6 girls) presented at a median age of 8 (0.1 to 54) years with 2 anatomic types: 8 vertical vein types with drainage of the left upper lobe to the innominate vein via a large vertical vein (left superior cardinal vein) and to the left atrium via the left upper pulmonary vein; and 2 scimitar vein (SV) types with drainage of the right middle and lower pulmonary veins into the inferior vena cava and to the left atrium via an anomalous connecting vein. Associated malformations were aortic coarctation (n=2) and secundum atrial septal defects (n=3). Two patients of the vertical vein type were operated. Transcatheter occlusion of the abnormal pulmonary venous return was performed in 7 cases, associated with occlusion of systemic arterial supply (n=2), secundum atrial septal closure (n=2), left upper pulmonary vein stenosis stenting (n=1), and coarctation stenting (n=1). Including previously published cases, 18 patients (13 vertical veins and 5 scimitar veins) underwent transcatheter repair. Patients over 40 years of age tend to be symptomatic at presentation (p=0.056). In partially abnormal pulmonary venous return with dual drainage, transcatheter therapy can be offered in the majority of patients. © 2013.

  7. A Right Brain/Left Brain Model of Acting.

    Science.gov (United States)

    Bowlen, Clark

    Using current right brain/left brain research, this paper develops a model that explains acting's underlying quality--the actor is both himself and the character. Part 1 presents (1) the background of the right brain/left brain theory, (2) studies showing that propositional communication is a left hemisphere function while affective communication…

  8. Left Ventricular Geometry In Nigerians With Type II Diabetes Mellitus ...

    African Journals Online (AJOL)

    Background: Left ventricular hypertrophy is independently associated with increased incidence of cardiovascular disease, cardiovascular and all cause mortality. In a relatively healthy hypertensive adult population, type II diabetes is associated with higher left ventricular mass, concentric left ventricular geometry and lower ...

  9. Biomass fuel smoke exposure was associated with adverse cardiac remodeling and left ventricular dysfunction in Peru.

    Science.gov (United States)

    Burroughs Peña, M S; Velazquez, E J; Rivera, J D; Alenezi, F; Wong, C; Grigsby, M; Davila-Roman, V G; Gilman, R H; Miranda, J J; Checkley, W

    2017-07-01

    While household air pollution from biomass fuel combustion has been linked to cardiovascular disease, the effects on cardiac structure and function have not been well described. We sought to determine the association between biomass fuel smoke exposure and cardiac structure and function by transthoracic echocardiography. We identified a random sample of urban and rural residents living in the high-altitude region of Puno, Peru. Daily biomass fuel use was self-reported. Participants underwent transthoracic echocardiography. Multivariable linear regression was used to examine the relationship of biomass fuel use with echocardiographic measures of cardiac structure and function, adjusting for age, sex, height, body mass index, diabetes, physical activity, and tobacco use. One hundred and eighty-seven participants (80 biomass fuel users and 107 non-users) were included in this analysis (mean age 59 years, 58% women). After adjustment, daily exposure to biomass fuel smoke was associated with increased left ventricular internal diastolic diameter (P=.004), left atrial diameter (P=.03), left atrial area (four-chamber) (P=.004) and (two-chamber) (P=.03), septal E' (P=.006), and lateral E' (P=.04). Exposure to biomass fuel smoke was also associated with worse global longitudinal strain in the two-chamber view (P=.01). Daily biomass fuel use was associated with increased left ventricular size and decreased left ventricular systolic function by global longitudinal strain. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Accessory left gastric artery: angiographic anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Soo; Lim, Hyung Guhn; Kim, Hong Soo; Jeon, Doo Sung [Presbyterian Medical Center, Chunju (Korea, Republic of); Chung, Jin Wook; Park, Jae Hyung [College of Medicine and the Institute of Radiation Medicine, Seoul National University, Seoul (Korea, Republic of); Song, Soon Young [Myongji Hospital, College of Medicine, Kwandong University, Seoul (Korea, Republic of)

    2000-09-01

    To evaluate the angiographic anatomy of the accessory left gastric artery (accLGA). We evaluated the angiographic findings of the accLGA in 50 patients (Angiostar; Siemens, Erlangen, Germany). Performing celiac and selective angiography in 50 and 34 patients, respectively. By means of celiac angiography, (1) site of origin, (2) anatomical course, (3) diameter, (4) degree of tortuosity, and (5) distal tapering were evaluated, while selective angiography was used to determine (1) arterial branching, (2) area of blood supply, and (3) patterns of gastric wall stain. Celiac angiography showed that the accLGA arose from the left hepatic artery (LHA) in 45 cases (90%) and from the proper hepatic artery in five (10%). If the accLGA arose from the LHA, its origin entirely depended on the branching pattern of the latter. It always arose from the lateral branch of the LHA furthest to the left and uppermost, and proximal to its umbilical point. The most common anatomical course of the accLGA, seen in 27 cases (54%), was between the S2 and S3 segmental branch. The diameter and degree of tortuosity of the accLGA were similar to those of adjacent intrahepatic branches in 21 (42%) and 33 cases (66%), respectively. The degree of tapering was less than that of adjacent intrahepatic vessel in 28 (56%). Selective angiography demonstrated esophageal branching of the acc LGA in 27 cases (79%), inferior phrenic arterial branching in three (9%), a mediastinal branch in one (3%), and hypervascularity of the lung in one (3%). In 15 cases (44%), bifurcation of the accLGA was recognized. The vascular territory of the accLGA was the gastric fundus together with the distal esophagus in 21 cases (62%), mainly the gastric fundus in six (18%), and mainly the distal esophagus in four (12%). The pattern of gastric mucosal stain was curvilinear wall in 31 cases (91%) and nodular in three (9%). A knowledge of the angiographic anatomy of the accLGA facilitates accurate recognition of this artery on

  11. Isolated left ventricular non-compaction cardiomyopathy associated with polymorphous ventricular tachycardia mimicking torsades de pointes

    Directory of Open Access Journals (Sweden)

    Oana Dickinson

    2013-02-01

    Full Text Available Left ventricular non-compaction (LVNC cardiomyopathy is a rare congenital disorder, classified by the American Heart Association as a primary genetic cardiomyopathy and characterized by multiple trabeculations within the left ventricle. LVNC cardiomyopathy has been associated with 3 major clinical manifestations: heart failure, atrial and ventricular arrhythmias and thromboembolic events, including stroke. In this case report, we describe a female patient with apparently isolated LVNC in whom pause-dependent polymorphic ventricular tachycardia suggesting torsades de pointes occurred in the presence of a normal QT interval.

  12. Measurement and comparison of left ventricular ejection fraction utilizing first transit and gated scintiangiography

    International Nuclear Information System (INIS)

    Fletcher, J.W.; Herbig, F.K.; Daly, J.L.; Walter, K.E.

    1975-01-01

    Paired serial radionuclide scans were used for determinations of left ventricular ejection fraction (LVEF) in open chest dogs with constant cardiac output and varying ventricular rates following the left atrial injection of 99m-Tc human serum albumin. Values of LVEF obtained by first transit (high frequency) data analysis and ECG-gated scintiphotography were obtained over a wide range of ventricular rate and stroke volume. The results of this study show no significant difference in LVEF as determined by both of these methods of data acquisition and analysis and demonstrate the feasibility of rapid serial determination of LVEF by radioisotope techniques

  13. Related anomalies of origin of left vertebral and left inferior thyroid arteries

    International Nuclear Information System (INIS)

    Sartor, K.; Freckmann, N.; Boeker, D.K.; Allgemeines Krankenhaus Altona, Hamburg

    1981-01-01

    The known rare occurrence of related anomalies of origin of vertebral and inferior thyroid arteries appears not to be documented in the angiographic literature. Three cases with manifestation on the left side are presented. Embryology is discussed briefly. Knowledge of such anomalies is of importance to surgeons as well as angiographers. (orig.) [de

  14. Visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy

    Directory of Open Access Journals (Sweden)

    Yasushi Mizukami

    2017-10-01

    Full Text Available Abstract Background Pulmonary visceral subpleural hematoma is rare. We report visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy. This very rare case was difficult to distinguish from thoracic abscess. Case presentation A 68-year-old man with hypertension had undergone video-assisted thoracoscopic left upper division segmentectomy for suspected lung carcinoma. Deep vein thrombosis of the lower leg was identified and edoxaban, a so-called novel oral anticoagulant, was started on postoperative day 7. The chest drainage tube was removed on postoperative day 12 because of persistent air leakage, but fever appeared the same day. Computed tomography revealed a cavity with mixed air and fluid, so antibiotics were started on suspicion of abscess. Computed tomography-guided drainage was attempted, but proved unsuccessful. Fever continued and surgical investigation was therefore performed. Visceral subpleural hematoma was identified under the diaphragmatic surface of the left basal lung. We excised the pleura, then performed drainage and applied running sutures. The parenchyma and visceral pleura were covered with polyglycolic acid sheet and fibrin glue. Edoxaban was restarted on postoperative day 12 of video-assisted thoracoscopic surgery and no recurrence of hematoma has been revealed. Conclusions Visceral subpleural hematoma after thoracic surgery is extremely rare. Furthermore, correct diagnosis was difficult and surgery offered a good diagnostic and therapeutic procedure.

  15. Count-based left ventricular volume determination utilizing a left posterior oblique view for attenuation correction

    International Nuclear Information System (INIS)

    Rabinovitch, M.A.; Kalff, V.; Koral, K.

    1984-01-01

    This study aimed to determine the inherent error of the left ventricular volume measurement from the gated equilibrium blood pool scintigram utilizing the count-based technique. The study population consisted of 26 patients who had undergone biplane contrast ventriculography. The patients were imaged with a parallel-hole collimator in the left anterior oblique position showing the septum to best advantage. A reference blood sample was counted and radionuclide volumes calculated without correction for attenuation. Attenuation corrected volumes were derived with the factor 1/e/sup -/+d/, where d = distance from skin marker to center of the left ventricle in the orthogonal left posterior oblique view and μ = linear attenuation coefficient. A series of μ values from 0.08 to 0.15 cm -1 was evaluated. The tightest 95% confidence limits achieved for an end-diastolic 150-ml ventricle were +/- 44ml, and for an end-systolic 75-ml ventricle +/- 32 ml. In view of the magnitude of inherent error, the count-based volume measurement may be more suitable for group analyses and in cases in which an individual patient serves as his own control

  16. Left Hemisphere Regions Are Critical for Language in the Face of Early Left Focal Brain Injury

    Science.gov (United States)

    Beharelle, Anjali Raja; Dick, Anthony Steven; Josse, Goulven; Solodkin, Ana; Huttenlocher, Peter R.; Levine, Susan C.; Small, Steven L.

    2010-01-01

    A predominant theory regarding early stroke and its effect on language development, is that early left hemisphere lesions trigger compensatory processes that allow the right hemisphere to assume dominant language functions, and this is thought to underlie the near normal language development observed after early stroke. To test this theory, we…

  17. LEFT RENAL TUMOR: A RARE CADAVERIC FINDINGS

    Directory of Open Access Journals (Sweden)

    Siva Prasad

    2015-08-01

    Full Text Available A benign tumour is a non - cancerous growth that does not spread (metastasize to other parts of the body and is not usually life - threatening. Many researchers believe that most of the following types of kidney tumours are benign. However, others feel that some of these tumours have the potential to develop into renal cell carcinoma. There are no diagnostic tests that can confirm if a benign tumour has the potential to become cancerous. Benign tumours are sometimes found along with renal cell carcinoma when a removed kidney is examined by a pathologist. For these reasons, benign kidney tumours are treated like malignant tumours. In this case we have observed a male cadaver with a large tumour in the left kidney during our routine dissections of undergraduates .

  18. Rectal volvulus following laparoscopic left hemicolectomy

    Science.gov (United States)

    Sutton, Paul Anthony; Lee, Han Sian; Din, Islah; Vimalachandran, Dale

    2013-01-01

    A 60-year-old lady with a history of Dukes B2 (T3N0M0) colorectal cancer presented some 2 years following a laparoscopic left hemicolectomy with a 4-day history of absolute constipation. A plain radiograph demonstrated large bowel obstruction, and subsequent CT of the abdomen showed the level of the obstruction to be at the rectum. Initially the aetiology was believed to be recurrence at the site of the anastomosis; however, subsequent review of the imaging and indeed endoscopic examination of the rectum showed it to be volvulus. This was initially treated with endoscopic decompression and later by the insertion of a flatus tube to good effect. The patient was discharged 3 days later with no recurrence of her symptoms at 2 months. PMID:23608861

  19. Gated SPECT evaluation of myocardial perfusion defects and left ventricular function in chronic atrial fibrillation (CAF) patients - a prevalence study between a General Hospital (GH) and a referral Cardiology Hospital (CH)

    International Nuclear Information System (INIS)

    Rocha, G.; Guimaraes, M.; Marroni, B.; Zagoury, E.; Sprinz, C.; Andrea, S.; Louzada, A.; Ludwig, R.; Graef, C.

    2002-01-01

    Aims: to evaluate myocardial perfusion defects (MPD) prevalence and left ventricular function in CAF patients from a distinct referral basis (a GH and CH populations). Materials and Methods: a retrospective cross-sectional survey including 171 CAF (43 from GH and 128 from CH) and 5415 control patients (2222 from GH and 3193 from CH) submitted to rest/stress myocardial perfusion gated SPECT with Tc99m-MIBI. The following items were collected from CAF patients: the percentage of patients with MPD, the type (fixed, reversible or mixed) and number of segments with MPD and left ventricular ejection fraction (LVEF). The control patients percentage of MPD, their type and number were also collected. Results: CAF from GH and CH were not significantly different in the number of patients with MPD, mean number of segments affected, and LVEF. In GH patients, the CAF group had more segments with MPD (2,4x1,6 p<0,01) and lower LVEF (37%x52% p<0,01) than control group. CAF patients from CH also showed lower LVEF (40%x58% p<0,01) and more fixed MPD (40%x18% p<0,01) than their control group population. Conclusion: our data showed similar prevalence of MPD and reduced LVEF values between CAF patients from a GH and referral CH. The CAF group from CH seemed to have more fixed MPD perhaps reflecting more severe coronary artery disease population or referral bias. The data appears to support the evaluation of myocardial ischemia as a part of CAF possible etiologies. Caution is advised in LVEF evaluation of CAF patients due to increased variability of R-R interval

  20. Comunicação interatrial do tipo seio coronário, comunicação interventricular e ausência de veia cava superior esquerda Coronary sinus atrial septal defect and ventricular septal defect with no left superior vena cava

    Directory of Open Access Journals (Sweden)

    Fábio Alves Almeida

    1998-10-01

    Full Text Available Relatamos um caso raro de um paciente de 21 meses, portador de comunicação interatrial do tipo seio coronário, associada a comunicação interventricular perimembranosa, e ausência de veia cava superior esquerda. O diagnóstico foi realizado através da ecocardiografia e confirmado pela angiografia. O paciente foi operado sem intercorrências, ambos os defeitos foram fechados com patch de pericárdio bovino e o fluxo das veias coronárias ficou direcionado para o átrio esquerdo. Um ecocardiograma mostrou ausência de shunt residual através dos defeitos.We report a rare case of a 21 month old child with a coronary sinus atrial septal defect associated with perimembranous ventricular septal defect and no left superior vena cava. The diagnosis was made by transthoracic echocardiogram and confirmed by angiography. The patient was operated on uneventfully, both defects were closed with bovine pericardial patches and the flow from the coronary veins was directed towards the left atrium. An echocardiogram revealed complete closure of both defects.

  1. VACTERL association with double-chambered left ventricle: A rare occurrence

    Directory of Open Access Journals (Sweden)

    Abdulla Al-Farqani

    2013-01-01

    Full Text Available VACTERL association is a non-random association of birth defects of unknown etiology derived from structures of embryonic mesoderm. The common cardiac defects seen with VACTERL association are ventricular septal defects, atrial septal defects, and tetralogy of Fallot. We present a 2-year-old child with VACTERL association in whom we detected double-chambered left ventricle on transthoracic echocardiography.

  2. What's Left of the Left-Right Dimension? Why the Economic Policy Positions of Europeans Do Not Fit the Left-Right Dimension.

    Science.gov (United States)

    Otjes, Simon

    2018-01-01

    In political science the economic left-right dimension plays a central role. A growing body of evidence shows that the economic policy preferences of a large segment of citizens do not scale sufficiently. Using Mokken scale analysis, this study determines the causes of this phenomenon. Differences in the extent to which the economic policy preferences of citizens fit the left-right dimension can be explained in terms of the interaction between individual level and political system-level variables: citizens who spend more attention to politicians with views that conform to the left-right dimension, have views that conform to the left-right dimension. There is also a role for the legacy of communist dictatorship: citizens who were socialised in democratic countries have views that fit the left-right dimension better than those socialised during communism.

  3. Phase image characterization of ventricular contraction in left anterior hemiblock

    International Nuclear Information System (INIS)

    Ono, Akifumi; Mizuno, Haruyoshi; Tahara, Yorio; Ishikawa, Kyozo

    1991-01-01

    We investigated whether or not left anterior hemiblock is present in patients with left axis deviation using first-harmonic Fourier analysis of gated blood-pool images. Gated blood-pool images were taken in 50 patients without contraction abnormality. They included 14 normal subjects, 8 patients with right bundle branch block (RBBB), 20 with left axis deviation (LAD) and 8 with both RBBB and LAD (RBBB+LAD). ECG gated blood-pool scans were acquired in the anterior and 'best septal' left anterior oblique projections. First, the phase images were displayed cinematically as a continuous-loop movie. Next, for quantitative analysis of the phase image, the whole left ventricular and left ventricular high lateral regions of interest were drawn. The 'regional phase shift' (RPS) was then defined as {RPS=A-a} where 'A' is the mean value of the whole left ventricular phase angles and 'a' is that of phase angles in the high lateral region. The left ventricular phase changes and the RPSs in the RBBB and LAD groups were similar to those in the normal group. In the RBBB+LAD group, the latest phase changes occurred in the high anterolateral region. The RPSs of this group were significantly lower than those in the other 3 groups (p<0.01). These data suggest that left anterior hemiblock might coexist with RBBB in patients with RBBB+LAD, whereas left anterior hemiblock might not exist in the majority of patients with LAD alone. (author)

  4. [Surgical angioplasty of the left main coronary artery].

    Science.gov (United States)

    Vranes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Velimirović, Dusan; Djukić, Petar

    2010-01-01

    The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

  5. Left hand polydactyly: a case report.

    Science.gov (United States)

    Mumoli, Nicola; Gandini, Daniele; Wamala, Edris Kalanzi; Cei, Marco

    2008-11-24

    Polydactyly is a congenital anomaly with a wide range of manifestations that occurs in many forms, ranging from varying degrees of mere splitting to completely duplicated thumb. When duplication occurs alone, it is usually unilateral and sporadic. In this case report we describe an otherwise healthy 19-year-old woman of Tibetan heritage with isolated left hand preaxial polydactyly. She experienced working related difficulties in her daily yak's milking. She subsequently underwent surgical correction, and the over number thumb was removed with associated meticulous skeletal and soft tissue reconstruction. Polydactyly is the most common congenital digital anomaly of the hand and foot. It can occur in isolation or as part of a syndrome. Surgery is necessary to create a single, functioning thumb and is indicated to improve cosmesis. Skin, nail, bone, ligament, and musculoskeletal elements must be combined to reconstruct an optimal digit. In this case (Tibetan society is almost exclusively a sheep-breeding one) surgery was necessary to leave a single, functioning thumb for her work as yak milkmaid.

  6. Left-right symmetric superstring supergravitation

    International Nuclear Information System (INIS)

    Burova, M.V.; Ter-Martirosyan, K.E.

    1988-01-01

    A left-right (L-R) symmetric model of four-dimensional supergravitation with a SO(10) gauge group obtained as the low-energy limit is superstring theory is considered. The spectrum of the gauge fields and their interactions are in agreement with the Weinberg-Salam theory. In addition, the model includes heavy W R ± and Z μ ' bosons. Beside the N g =3 generations of the 16-plets the SO(10) model includes the fragments of such generations which play the role of Higgs particles and also scalar chiral filds, the number of which exceeds by one the number of generations. As a result the neutrinos of each generation obtain a stable small Majorana mass. It is shown that the scalar field potential leads to spontaneous violation of the SU(2) R group and L-R symmetry and at low energies the standard Weinberg-Salam theory appears. However, reasonable values of X bosons masses M x and sun 2 Θ W (Θ W is the Weinberg angle) can be obtained in the model only in the case of high mass scale M R ∼10 10 -10 12 GeV of the right group SU(2) R violation

  7. Endocarditis in left ventricular assist device

    Science.gov (United States)

    Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Sikachi, Rutuja R; Agrawal, Abhinav

    2016-01-01

    Summary Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality. Currently, there are few retrospective studies and case reports reporting the same. In our review, we found the most common cause of endocarditis in LVAD was due to bacteria. Both bacterial and fungal endocarditis were associated with high morbidity and mortality. In this review we will be discussing the risk factors, organisms involved, diagnostic tests, management strategies, complications, and outcomes in patients who developed endocarditis secondary to LVAD placement. PMID:27672540

  8. Left ventricular noncompaction: Clinical-echocardiographic study

    Directory of Open Access Journals (Sweden)

    Nikolić Aleksandra

    2012-01-01

    Full Text Available Background/Aim. Left ventricular noncompaction (LVNC is a disorder in endomyocardial morphogenesis, seen either isolated (in the absence of other cardiac anomalies or in association with congenital heart disease and some neuromuscular diseases. Intrauterine arrest of the compaction of myocardial fibers is postulated to be the reason of LVNC. Recognition of this condition is extremely important due to its high mortality and morbidity that lead to progressive heart failure, ventricular arrhythmias and thromboembolic events. The aim of this study was to determine the prevalence and clinical presentation of LVNC among consecutive outpatients according to clinical and echocardiographyic findings. Methode. A total of 3,854 consecutive patients examined at the Institute for Cardiovascular Diseases within a period January 2006 - January 2007 were included in the study. All the patients underwent echocardiographic examination using the same equipment (Vivid 7, GE Medical System. Echocardiographic parameters and clinical presentation in patients with echocardiographic criteria for LVNC were analyzed. Results. Analyzing 3,854 consecutive outpatients, using two-dimensional Color Doppler echocardiography from January 2006 to January 2007, 12 patients met the criteria for LVNC. Seven of them were male. The mean age at diagnosis was 45 ± 15 years. Analyzing clinical manifestation of LVNC it was found that seven patients had signs of heart failure, six had arrhythmias with no embolic events. Conclusion. Our results suggest that the real prevalence of LVNC may be higher than expected. New studies have to be done to solve this problem.

  9. Validation of geometric measurements of the left atrium and pulmonary veins for analysis of reverse structural remodeling following ablation therapy

    Science.gov (United States)

    Rettmann, M. E.; Holmes, D. R., III; Gunawan, M. S.; Ge, X.; Karwoski, R. A.; Breen, J. F.; Packer, D. L.; Robb, R. A.

    2012-03-01

    Geometric analysis of the left atrium and pulmonary veins is important for studying reverse structural remodeling following cardiac ablation therapy. It has been shown that the left atrium decreases in volume and the pulmonary vein ostia decrease in diameter following ablation therapy. Most analysis techniques, however, require laborious manual tracing of image cross-sections. Pulmonary vein diameters are typically measured at the junction between the left atrium and pulmonary veins, called the pulmonary vein ostia, with manually drawn lines on volume renderings or on image cross-sections. In this work, we describe a technique for making semi-automatic measurements of the left atrium and pulmonary vein ostial diameters from high resolution CT scans and multi-phase datasets. The left atrium and pulmonary veins are segmented from a CT volume using a 3D volume approach and cut planes are interactively positioned to separate the pulmonary veins from the body of the left atrium. The cut plane is also used to compute the pulmonary vein ostial diameter. Validation experiments are presented which demonstrate the ability to repeatedly measure left atrial volume and pulmonary vein diameters from high resolution CT scans, as well as the feasibility of this approach for analyzing dynamic, multi-phase datasets. In the high resolution CT scans the left atrial volume measurements show high repeatability with approximately 4% intra-rater repeatability and 8% inter-rater repeatability. Intra- and inter-rater repeatability for pulmonary vein diameter measurements range from approximately 2 to 4 mm. For the multi-phase CT datasets, differences in left atrial volumes between a standard slice-by-slice approach and the proposed 3D volume approach are small, with percent differences on the order of 3% to 6%.

  10. Isolated persistent left superior vena cava: A case report and its clinical implications

    Directory of Open Access Journals (Sweden)

    Samarjit Bisoyi

    2017-01-01

    Full Text Available The venous anomaly of a persistent left superior vena cava (PLSVC affects 0.3%-0.5% of the general population. PLSVC with absent right superior vena cava, also termed as "isolated PLSVC," is an extremely rare venous anomaly. Almost half of the patients with isolated PLSVC have cardiac anomalies in the form of atrial septal defect, endocardial cushion defects, or tetralogy of Fallot. Isolated PLSVC is usually innocuous. Its discovery, however, has important clinical implications. It can pose clinical difficulties with central venous access, cardiothoracic surgeries, and pacemaker implantation. When it drains to the left atrium, it may create a right to left shunt. In this case report, we present the incidental finding of isolated PLSVC in a patient who underwent aortic valve replacement. Awareness about this condition and its variations is important to avoid complications.

  11. A large tumour of the left atrium – A 10-year follow-up

    Directory of Open Access Journals (Sweden)

    Agnieszka M. Łebek-Szatańska

    2016-11-01

    Full Text Available Benign myxomas are the most common primary tumors in the left atrium of the heart, and they usually require urgent operative management. However, with the constant aging of the population and treatment of patients with severe concomitant diseases, an interesting question is the efficacy of the conservative approach. We present a case of a 75-year-old woman who was previously diagnosed with a left atrial myxoma, underwent an operation to resect it and then developed a recurrent tumor at the site of resection, which was found by control echocardiography 1.5 years later. She has been observed for over 10 years, as she repeatedly refused reoperation. In the setting of this example of a relatively favorable clinical course of left atrium myxoma, we discuss the current knowledge about the natural history of these tumors and the role of echocardiography in predicting their growth and complications.

  12. Persistent left superior vena cava: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Verma Gita

    2008-10-01

    Full Text Available Abstract Persistent left superior vena cava is rare but important congenital vascular anomaly. It results when the left superior cardinal vein caudal to the innominate vein fails to regress. It is most commonly observed in isolation but can be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. The presence of PLSVC can render access to the right side of heart challenging via the left subclavian approach, which is a common site of access utilized when placing pacemakers and Swan-Ganz catheters. Incidental notation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by saline contrast echocardiography.

  13. Isolated Left Pulmonary Artery Agenesis: A Case Report

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    Tansel Ansal Balcı

    2012-08-01

    Full Text Available Unilateral pulmonary artery agenesis without any cardiovascular malformation is a rare anomaly. We present the imaging findings of a patient who was diagnosed as isolated left pulmonary artery agenesis. A 27-year-old female patient was admitted to our hospital due to dyspnea during exercise for five years. Chest X-ray revealed minimally small left pulmonary hilum and left lung. She was admitted to our clinic with the suspicion of pulmonary artery pathology. Absent perfusion of the left lung with normal ventilation was visualized on scintigraphy. MDCT angiography of pulmonary arteries showed absent left main pulmonary artery with systemic collaterals around left hemithorax. Pulmonary artery agenesis can be asymptomatic and isolated until adulthood. Both scintigraphy and CT angiography images of pulmonary artery agenesis of a patient are rare in the literature. Pulmonary ventilation- perfusion scintigraphy can be used not only for pulmonary embolism but also pathologies involving pulmonary artery and its branches. (MIRT 2012;21:80-83

  14. Evaluation of left cardiac function by exercise in hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Konishi, Tokuji; Horayama, Norihisa; Hamada, Masayuki; Nakano, Takeshi; Takezawa, Hideo

    1981-01-01

    Left ventricular systolic and diastolic features at rest and exercise in hypertrophic cardiomyopathy were evaluated by Fourier analysis of blood pool scintigraphy (intracorporeal labelling with sup(99m)Tc-RBC). In the normal group (17 subjects), the left ventricular ejection fraction showed a linear increase, but no abnormality of regional ventricular wall motion, by multistage exercises. The hypertrophic cardiomyopathy group showed higher left ventricular ejection fractions at rest than those of the normal group, and in the HCM group (non-obstructive, from morphological features; 7 cases) the left ventricular ejection fraction did not increase any more when it reached a certain plateau in accordance with increased stress. In the HOCM (obstructive; 5 cases), the left ventricular ejection fraction showed a decreasing tendency as the stress was increased and also showed contractile abnormalities from the left ventricular center to the apex. Fourier analysis was effective for the evaluation of these changes. (Chiba, N.)

  15. Ruptured Sinus of Valsalva Aneurysm into the Left Atrium with Multiple Fistulous Communications: A Rare Cause of Heart Failure

    Directory of Open Access Journals (Sweden)

    Yashwant Agrawal

    2015-01-01

    Full Text Available Ruptured noncoronary sinus of valsalva aneurysm with fistulous connections to multiple cardiac chambers has not been reported previously. We report a 66-year-old man who presented with worsening cough and exertional dyspnea. Transesophageal echocardiogram confirmed a large aneurysm involving the noncoronary cusp of the aortic sinus with aneurysmal extension to the left atrium. There were also two fistulous communications with the left atrium and one small fistulous connection with the right atrium. Open-heart surgery with aortic root replacement and reimplantation of coronary arteries along with primary closure and repair of aorta to the left atrial fistula was performed.

  16. Left Sided Amyand's Hernia, A Rare Occurance: A Case Report.

    Science.gov (United States)

    Ravishankaran, Praveen; Mohan, G; Srinivasan, A; Ravindran, G; Ramalingam, A

    2013-06-01

    This is a case report about a 35 year old man admitted with complains of obstructed left sided inguinal hernia. On exploration of the left inguinal canal to our surprise a normal appendix was found in addition to a gangrenous omentum. Resection of the gangrenous omentum was done. Appendectomy was done. This case is reported for its rare occurance as only three such cases of left sided amyand's hernia has been reported so far in literature[4-6].

  17. On left (θ,ϕ-derivations in BCI-algebras

    Directory of Open Access Journals (Sweden)

    G. Muhiuddin

    2014-07-01

    Full Text Available The notion of (regular left (θ,ϕ-derivations of a BCI-algebra is introduced, some useful examples are discussed, and related properties are investigated. Conditions for a left (θ,ϕ-derivation to be regular are provided. The concepts of a d(θ,ϕ-invariant left (θ,ϕ-derivation and θ-ideal are introduced, and their relations are discussed. Furthermore, some more interesting results are established.

  18. Total anomalous systemic venous drainage in left heterotaxy syndrome.

    Science.gov (United States)

    Khandenahally, Ravindranath S; Deora, Surender; Math, Ravi S

    2013-04-01

    Total anomalous systemic venous drainage is an extremely rare congenital heart defect. In this study we describe an 11-year-old girl who presented with a history of fatigue and central cyanosis that she had had since early childhood with unremarkable precordial examination results. Investigations revealed left heterotaxy with all systemic venous drainage to the left-sided atrium with non-compaction of the left ventricle.

  19. Accessory hepatic lobe simulating a left hemidiaphragmatic tumor

    International Nuclear Information System (INIS)

    Kuroiwa, Toshiro; Hirata, Hitoshi; Iwashita, Akinori; Yasumori, Kotaro; Mogami, Hiroshi; Teraoka, Hiroaki

    1984-01-01

    A 72-year-old woman with a 20-year history of neuralgia was confirmed at surgery to have a tumor in the left hemidiaphragmatic region which was connected with the left lobe of the liver. Reassessment of radiological diagnosis after surgery revealed that hepatobiliary scintigraphy and computed tomography using left anterior oblique scanning are useful in differentiating the accessory hepatic lobe of the liver from a tumor and in confirming the diagnosis, respectively. (Namekawa, K.)

  20. Fallopian Tube Herniation through Left Sided Abdominal Drain Site.

    Science.gov (United States)

    Hussain, Khalid; Masood, Jovaria

    2016-06-01

    Intra-abdominal drains have been used since long to prevent intra-abdominal collection, and detect any anastomotic leaks. We report a case of left sided fallopian tube herniation from a left lower abdominal drain site in a 27-year female who underwent caesarian section for breach presentation. Several complications related to drain usage has been described but left sided fallopian tube prolapse through drain site has not been reported in literature.

  1. Detection of left ventricular thrombi by computerised tomography

    International Nuclear Information System (INIS)

    Nair, C.K.; Sketch, M.H.; Mahoney, P.D.; Lynch, J.D.; Mooss, A.N.; Kenney, N.P.

    1981-01-01

    Sixteen patients suspected of having left ventricular mural thrombi were studied. All had suffered transmural myocardial infarction. Fifteen patients had a ventricular aneurysm. One had had systemic emboli. The mean length of time between the myocardial infarction and the study was 14.8 months, with a range of one month to 79 months. All patients underwent computerised tomography of the heart, M-mode echocardiography (M-mode), and two-dimensional echocardiography (2-D). Eight patients underwent left ventricular cineangiography. Five patients had surgical confirmation. Computerised tomography, two-dimensional, and M-mode echocardiography predicted left ventricular mural thrombi in 10, eight, and one of the 16 patients, respectively. Left ventricular cineangiography predicted left ventricular mural thrombi in four out of eight patients. Computerised tomography and left ventricular cineangiography correctly predicted the presence or absence of left ventricular thrombi in all five patients who underwent operation. In the same group, however, two-dimensional and M-mode echocardiography failed to predict the presence of thrombi in one and three patients, respectively. Among the 11 patients without surgical confirmation, one, in whom no left ventricular thrombi were shown by M-mode and two-dimensional echocardiography, was found to have thrombi on computerised tomography. In another, two-dimensional echocardiography was positive but this finding was not confirmed either by computerised tomography or by left ventricular angiography. (author)

  2. Current status of ultrafast CT to evaluate the left ventricle

    International Nuclear Information System (INIS)

    MacMillan, R.M.; Rees, M.R.; Maranhao, V.

    1987-01-01

    Contrast-enhanced ultrafast CT with the cine mode can enable reliable assessment of left ventricular mass and function. Two oblique planar views, the long axis and short axis, are required. Right and left ventricular end-diastolic volumes, end-systolic volumes, stroke volume and ejection fraction, left ventricular segmental wall motion, and left ventricular mass can be measured. This exhibit emphasizes the methods and pitfalls in acquiring this information. Results from the authors' studies thus far to validate these measurements against reference standards are reviewed

  3. Extreme premature with persistent left superior vena cava.

    Science.gov (United States)

    Aboitiz-Rivera, Carlos Manuel; Blachman-Braun, Ruben; Parra-Pérez, Mariana Yazmin

    2017-10-01

    Persistent left superior vena cava (PLSVC) is a congenital anomaly, that results when there is an absence of the normal regression of the left common precardinal vein during embryogenesis. Usually, this anomaly remains asymptomatic, however, when the PLSVC drains into the left atrium this could lead to a right-to-left shunt. Additionally, this can result in inadvertent delivery of air or thrombus into the systemic circulation with potential neurologic, cardiac and renal complications. In this article, we present a case of an extreme premature Mexican newborn in which the diagnosis was made after placement of a percutaneous central venues catheter.

  4. Cardiac dynamic magnetic resonance of a giant lung carcinoma invading the left atrium : do not let the imaging fool you

    NARCIS (Netherlands)

    Pozzoli, Alberto; Klinkenberg, Theo J.; De Maat, Gijs E.; Mariani, Massimo A.

    This study aimed to report on a non-small-cell lung cancer (NSCLC) originating from the right lung lower lobe and circulatory extension into the left atrium. Atrial involvement is an uncommon feature of advanced NSCLC, occurring in up to 10% of patients with bronchogenic carcinoma. In this case, the

  5. Left-handedness and language lateralization in children.

    Science.gov (United States)

    Szaflarski, Jerzy P; Rajagopal, Akila; Altaye, Mekibib; Byars, Anna W; Jacola, Lisa; Schmithorst, Vincent J; Schapiro, Mark B; Plante, Elena; Holland, Scott K

    2012-01-18

    This fMRI study investigated the development of language lateralization in left- and righthanded children between 5 and 18 years of age. Twenty-seven left-handed children (17 boys, 10 girls) and 54 age- and gender-matched right-handed children were included. We used functional MRI at 3T and a verb generation task to measure hemispheric language dominance based on either frontal or temporo-parietal regions of interest (ROIs) defined for the entire group and applied on an individual basis. Based on the frontal ROI, in the left-handed group, 23 participants (85%) demonstrated left-hemispheric language lateralization, 3 (11%) demonstrated symmetric activation, and 1 (4%) demonstrated right-hemispheric lateralization. In contrast, 50 (93%) of the right-handed children showed left-hemispheric lateralization and 3 (6%) demonstrated a symmetric activation pattern, while one (2%) demonstrated a right-hemispheric lateralization. The corresponding values for the temporo-parietal ROI for the left-handed children were 18 (67%) left-dominant, 6 (22%) symmetric, 3 (11%) right-dominant and for the right-handed children 49 (91%), 4 (7%), 1 (2%), respectively. Left-hemispheric language lateralization increased with age in both groups but somewhat different lateralization trajectories were observed in girls when compared to boys. The incidence of atypical language lateralization in left-handed children in this study was similar to that reported in adults. We also found similar rates of increase in left-hemispheric language lateralization with age between groups (i.e., independent of handedness) indicating the presence of similar mechanisms for language lateralization in left- and right-handed children. Copyright © 2011 Elsevier B.V. All rights reserved.

  6. Bronchial compression by an enlarged left atrium in infants; a cause of hypovascularity of the left lung

    Energy Technology Data Exchange (ETDEWEB)

    Corr, L.; Hallidie-Smith, K.A.; McCarthy, P.A.; Lavender, J.P.

    1988-09-01

    In three infants seen recently at our institution we noted signs of compression of the left main bronchus associated with enlarged left atria. None of our cases demonstrated the more usual signs of hyperinflation which are a hyperlucent lung field, depressed hemidiaphragm and mediastinal shift away from the affected side. In addition, hypoperfusion of the left lung was noted in each case. We believe that bronchial compression due to an enlarged left atrium, with consequent hypoxic vasoconstriction is a clinically significant entity, which is not well described and may be unappreciated in infants in whom the typical signs of hyperinflation are absent.

  7. Left ventricular function in hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Takahashi, Hiromi; Yamaguchi, Ryutaro; Ifuku, Masayasu

    1985-01-01

    The present study was to investigate of left ventricular (LV) function during exercise in 26 patients with hypertrophic cardiomyopathy(HCM) usingTc-99m equilibrium angiocardiography, and to elucidate the mechanism of impaired functional reserve during exercise. In patients with HCM, LV ejection fraction decreased from 65 ± 8 (mean ± SD) % at rest to 59 ± 18 % at peak exercise, in contrast to an increase among controls (from 56 ± 9 % to 64 ± 9 %). As compared with resting values, cardiac output increased to 168 ± 24 % at