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Sample records for left atrium area

  1. Repeatability and reproducibility of measurements obtained via two-dimensional speckle tracking echocardiography of the left atrium and time-left atrial area curve analysis in healthy dogs.

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    Osuga, Tatsuyuki; Nakamura, Kensuke; Lim, Sue Yee; Tamura, Yu; Kumara, Wickramasekara Rajapakshage Bandula; Murakami, Masahiro; Sasaki, Noboru; Morishita, Keitaro; Ohta, Hiroshi; Yamasaki, Masahiro; Takiguchi, Mitsuyoshi

    2013-06-01

    To evaluate left atrial phasic function in healthy dogs by means of 2-D speckle tracking echocardiography with time-left atrial area curve analysis and to assess repeatability and reproducibility of obtained measurements. 6 healthy Beagles. Each dog underwent echocardiography twice on different days (3 nonconsecutive examinations/d). Images were analyzed with offline software; area of the left atrium was automatically calculated in each frame throughout the cardiac cycle to derive time-left atrial area curves. Variables used to assess left atrial phasic function (total, passive, and active emptying area and emptying fractions and mean active and total emptying rates) were calculated. Agreement between variables measured via speckle tracking echocardiography and a manual tracing method was assessed with modified Bland-Altman analysis. Within-day and between-day coefficients of variation were determined. Mean ± SD total, passive, and active emptying fractions of the left atrium were 49.8 ± 3.5%, 277 ± 4.0%, and 30.5 ± 4.3%, respectively. Mean ± SD total and active emptying rates were 16.0 ± 2.5 cm(2)/s and 25.1 ± 4.9 cm(2)/s, respectively. Within-day and between-day coefficients of variation were canine patients.

  2. Malignant phyllodes tumor of the left atrium

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    Anupam Bhambhani

    2014-03-01

    Full Text Available Metastatic tumors to the heart usually involve right sided chambers. We report a rare case of malignant phyllodes tumor of breast with metastatic involvement of left atrium occurring through direct invasion from mediastinal micro-metastasis and presenting as a left atrial mass causing arrhythmia.

  3. Mechanical discordance between left atrium and left atrial appendage

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    Arash Khamooshian

    2018-01-01

    Full Text Available During standard transesophageal echocardiographic examinations in sinus rhythm (SR patients, the left atrial appendage (LAA is not routinely assessed with Doppler. Despite having a SR, it is still possible to have irregular activity in the LAA. This situation is even more important for SR patients where assessment of the left atrium is often foregone. We describe a case where we encountered this situation and briefly review how to assess the left atrium and its appendage in such a case scenario.

  4. UFO in the Left Atrium: How to Capture Metal Debris Floating in the Left Atrium.

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    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.

  5. Giant left atrium encountered during right-sided thoracentesis

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    Rashmi Advani

    Full Text Available Giant left atrium is an uncommon pathology to encounter during bedside chest ultrasound, but is an important structure to be aware of when considering thoracentesis. This cardiac structure could easily be mistaken for loculated pleural fluid. This case also supports growing evidence that expert users can safely perform thoracentesis without completely reversing therapeutic anticoagulation. Keywords: Giant left atrium, Thoracentesis, Rheumatic heart disease, Ultrasound

  6. Left Atrium Papillary Fibroelastomas: A Cause of Cerebral Emboli

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    A. G. Ciss

    2012-01-01

    Full Text Available Papillary fibroelastomas are cardiac benign tumours. Among the benign cardiac tumor, papillary fibroelastomas are reported second after myxomas. Most often diagnosed incidentally, papillary fibroelastomas may embolize to cerebral circulation. Valvular locations are predominant; location in left atrium is rare. In this paper, we present a case of papillary fibroelastoma located in left atrium with symptoms of cerebral embolization. Transoesophageal echocardiography diagnosed a mobile mass. The patient was treated with surgical resection without further embolic complication.

  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. Right superior vena cava draining into the left atrium

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    Calcagni, Giulio; Sidi, Daniel; Bonnet, Damien [University Rene Descartes-Paris 5, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, Paris (France); Batisse, Alain [Institut de Puericulture et de Perinatalogie, Paris (France); Vouhe, Pascal [University Rene Descartes-Paris 5, Department of Paediatric Cardiac Surgery, Hopital Necker-Enfants Malades, Paris (France); Ou, Phalla [University Rene Descartes-Paris 5, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, Paris (France); University Rene Descartes-Paris 5, Department of Pediatric Radiology, Hopital Necker-Enfants Malades, Paris (France)

    2008-08-15

    The right superior vena cava draining into the left atrium is a rare malformation causing cyanosis and clubbing in patients in whom no other signs of congenital heart defect are present. Diagnosis may be difficult as cyanosis may be mild and the anomaly is not always easily detectable by echocardiography. For this reason we report a 13-month-old male in whom we confirmed the clinical and echocardiographic suspicion of anomalous drainage of the right superior vena cava using multidetector CT. This allowed successful surgical reconnection of the right superior vena cava to the right atrium. (orig.)

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

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    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

  10. Validation of semi-automatic segmentation of the left atrium

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    Rettmann, M. E.; Holmes, D. R., III; Camp, J. J.; Packer, D. L.; Robb, R. A.

    2008-03-01

    Catheter ablation therapy has become increasingly popular for the treatment of left atrial fibrillation. The effect of this treatment on left atrial morphology, however, has not yet been completely quantified. Initial studies have indicated a decrease in left atrial size with a concomitant decrease in pulmonary vein diameter. In order to effectively study if catheter based therapies affect left atrial geometry, robust segmentations with minimal user interaction are required. In this work, we validate a method to semi-automatically segment the left atrium from computed-tomography scans. The first step of the technique utilizes seeded region growing to extract the entire blood pool including the four chambers of the heart, the pulmonary veins, aorta, superior vena cava, inferior vena cava, and other surrounding structures. Next, the left atrium and pulmonary veins are separated from the rest of the blood pool using an algorithm that searches for thin connections between user defined points in the volumetric data or on a surface rendering. Finally, pulmonary veins are separated from the left atrium using a three dimensional tracing tool. A single user segmented three datasets three times using both the semi-automatic technique as well as manual tracing. The user interaction time for the semi-automatic technique was approximately forty-five minutes per dataset and the manual tracing required between four and eight hours per dataset depending on the number of slices. A truth model was generated using a simple voting scheme on the repeated manual segmentations. A second user segmented each of the nine datasets using the semi-automatic technique only. Several metrics were computed to assess the agreement between the semi-automatic technique and the truth model including percent differences in left atrial volume, DICE overlap, and mean distance between the boundaries of the segmented left atria. Overall, the semi-automatic approach was demonstrated to be repeatable within

  11. Anesthetic implications of total anomalous systemic venous connection to left atrium with left isomerism

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    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.

  12. Gadofosveset trisodium-enhanced magnetic resonance angiography of the left atrium-A feasibility study

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    Wagner, Moritz, E-mail: moritz.wagner@charite.d [Department of Radiology, Charite - University Hospital, Berlin (Germany); Rief, Matthias; Asbach, Patrick [Department of Radiology, Charite - University Hospital, Berlin (Germany); Vogtmann, Thomas [Department of Cardioloy and Angiology, Charite - University Hospital, Berlin (Germany); Huppertz, Alexander [Imaging Science Institute Charite Berlin, Berlin (Germany); Beling, Mark [Department of Cardioloy and Angiology, Charite - University Hospital, Berlin (Germany); Butler, Craig [Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (Canada); Laule, Michael [Department of Cardioloy and Angiology, Charite - University Hospital, Berlin (Germany); Warmuth, Carsten; Taupitz, Matthias; Hamm, Bernd; Lembcke, Alexander [Department of Radiology, Charite - University Hospital, Berlin (Germany)

    2010-08-15

    Aim: Imaging of the left atrium is regularly performed prior to pulmonary vein isolation. The aim of the study was to evaluate the feasibility of contrast-enhanced high-resolution magnetic resonance angiography (MRA) of the left atrium using the blood-pool contrast agent gadofosveset trisodium in comparison to noncontrast MRA. Materials and methods: Twenty consecutive patients were examined by free-breathing electrocardiogram-gated whole-heart MRA (reconstructed spatial resolution, 0.7 mm x 0.6 mm x 0.8 mm) with a noncontrast T2-prepared steady state free precession sequence (T2-prep SSFP) and a gadofosveset trisodium-enhanced inversion-recovery SSFP sequence (CE IR-SSFP). Contrast-to-noise ratio (CNR) of blood in the left atrium was determined. Depiction of the left atrium was rated by two radiologists in consensus. A cardiologist segmented the MR data sets and rated depiction of the left atrium. Results: Five of 20 patients had irregular breathing patterns with navigator efficiency less than 35% and were excluded from evaluation. CNR was significantly higher for CE IR-SSFP compared with T2-prep SSFP (18.4 {+-} 5.3 vs. 11.7 {+-} 3.5, p < 0.01). Depiction of the left atrium by T2-prep SSFP was rated as good in four patients, moderate in ten patients, and poor in one patient, whereas depiction of the left atrium by CE IR-SSFP was rated as excellent in nine patients, good in four patients, and moderate in two patients. CE IR-SSFP allowed for semiautomated segmentation of the left atrium in 15 patients, whereas T2-prep SSFP allowed for segmentation only in ten patients. Conclusion: Gadofosveset trisodium-enhanced MRA of the left atrium is feasible with significantly improved image quality compared to noncontrast MRA.

  13. Catheter localization in the left atrium using an outdated anatomic reference for guidance.

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    Koolwal, Aditya B; Barbagli, Federico; Carlson, Christopher R; Liang, David H

    2009-01-01

    We present a method for registering real-time ultrasound of the left atrium to an outdated, anatomic surface mesh model, whose shape differs from that of the anatomy. Using an intracardiac echo (ICE) catheter with mounted 6DOF electromagnetic position/orientation sensor (EPS), we acquire images of the left atrium and determine where the ICE catheter must be positioned relative to the surface mesh to generate similar, "virtual" ICE images. Further, we use an affine warping model to infer how the shape of the surface mesh differs from that of the atrium. Our registration and warping algorithm allows us to display EPS-sensorized catheters inside the surface mesh, facilitating guidance for left atrial procedures. By solving for the atrium-to-mesh warping parameters, we ensure that tissue contact in the anatomy is properly displayed as tissue contact in the mesh. After considering less than thirty seconds worth of ICE data, we are able to accurately localize EPS measurements within the surface mesh, despite surface mesh warpings of up to +/-20% along and about the principal axes of the left atrium. Further, because our estimation framework is iterative and continuous, our accuracy improves as new data is acquired.

  14. Transcatheter therapy in partially abnormal pulmonary venous return with additional drainage to the left atrium.

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    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.

  15. A large tumour of the left atrium – A 10-year follow-up

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    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.

  16. Pleomorphic rhabdomyosarcoma of the left atrium mimicking myxoma

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    Tanvi Aggarwal

    2016-01-01

    Full Text Available Primary rhabdomyosarcoma (RMS of the heart is a rare malignant tumor which has poor prognosis and survival despite surgery and adjuvant chemotherapy. The preoperative diagnosis is often difficult in view of nonspecific clinicoradiological findings. This report describes a case of a 60-year-old woman who was clinically diagnosed as left atrial myxoma. A diagnosis of pleomorphic RMS was made on histopathology after excision. Our case discusses the clinicopathological features and treatment options of cardiac RMS emphasizing the fact that histopathology and immunohistochemistry are essential to confirm the diagnosis of such an aggressive malignant tumor.

  17. Unexpected traumatic rupture of left atrium mimicking aortic rupture

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    Abdallah K Alameddine

    2014-01-01

    Full Text Available Left atrial (LA rupture is rare following blunt chest injury. We describe a case of blunt LA rupture that was treated surgically. This report is intended to alert practitioners for a need of a close multiple disciplinary collaborations among them for optimal management of patients with this type of trauma; because other non-cardiac injuries involving the head, abdomen, or extremities are considered covariates for in-hospital mortality. As in the present case, the patient eventually died from associated extrathoracic injuries. The diagnosis of LA rupture is by exclusion. However, the initial radiological reading may be misinterpreted, because this injury can easily be mistaking for an aortic rupture. The final reappraisal of the chest imaging studies should be interpreted by a skilled radiologist to avoid misdiagnosis. Subtle radiological features can help distinguish aortic thoracic injury as illustrated in this patient. These factors may be useful to the practicing surgeon in deciding surgical approach.

  18. Surgical repair of an aneurysm-like fistula connecting the left main coronary artery with the right atrium.

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    Tong, Guang; Sun, Zhongchan; Zhang, Weida

    2016-08-01

    Coronary fistula is defined as an anomalous connection between a coronary artery and any of the four chambers of the heart or any of its great vessels. A coronary fistula connecting the left main coronary artery to the right atrium is the most uncommon. In the present study, we report the surgical management of a very uncommon case of an aneurysm-like fistula connecting the left main coronary artery to the right atrium in a 2-year-old boy.

  19. Quantitative description of the 3D regional mechanics of the left atrium using cardiac magnetic resonance imaging

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    Kuklik, P; Molaee, P; Ganesan, A N; Brooks, A G; Worthley, S G; Sanders, P; Podziemski, P

    2014-01-01

    The left atrium (LA) plays an important role in the maintenance of hemodynamic and electrical stability of the heart. One of the conditions altering the atrial mechanical function is atrial fibrillation (AF), leading to an increased thromboembolic risk due to impaired mechanical function. Preserving the regions of the LA that contribute the greatest to atrial mechanical function during curative strategies for AF is important. The purpose of this study is to introduce a novel method of regional assessment of mechanical function of the LA. We used cardiac MRI to reconstruct the 3D geometry of the LA in nine control and nine patients with paroxysmal atrial fibrillation (PAF). Regional mechanical function of the LA in pre-defined segments of the atrium was calculated using regional ejection fraction and wall velocity. We found significantly greater mechanical function in anterior, septal and lateral segments as opposed to roof and posterior segments, as well as a significant decrease of mechanical function in the PAF group. We suggest that in order to minimize the impact of the AF treatment on global atrial mechanical function, damage related to therapeutic intervention, such as catheter ablation, in those areas should be minimized. (paper)

  20. Computer-based automated left atrium segmentation and volumetry from ECG-gated coronary CT angiography data. Comparison with manual slice segmentation and ultrasound planimetric methods

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    Bauer, R.W.; Kraus, B.; Kerl, J.M.; Lehnert, T.; Vogl, T.J. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Bernhardt, D.; Vega-Higuera, F. [Siemens AG, Healthcare Sector, Forchheim (Germany). Computed Tomography; Ackermann, H. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Biostatistik und Mathematische Modellierung

    2010-12-15

    Purpose: Enlargement of the left atrium is a risk factor for cardiovascular or cerebrovascular events. We evaluated the performance of prototype software for fully automated segmentation and volumetry of the left atrium. Materials and Methods: In 34 retrospectively ECG-gated coronary CT angiography scans, the end-systolic (LAVsys) and end-diastolic (LAVdia) volume of the left atrium was calculated fully automatically by prototype software. Manual slice segmentation by two independent experienced radiologists served as the reference standard. Furthermore, two independent observers calculated the LAV utilizing two ultrasound planimetric methods ('area length' and 'prolate ellipse') on CTA images. Measurement periods were compared for all methods. Results: The left atrial volumes calculated with the prototype software were in excellent agreement with the results from manual slice segmentation (r = 0.97 - 0.99; p < 0.001; Bland-Altman) with excellent interobserver agreement between both radiologists (r = 0.99; p < 0.001). Ultrasound planimetric methods clearly showed a higher variation (r = 0.72 - 0.86) with moderate interobserver agreement (r = 0.51 - 0.79). The measurement period was significantly lower with the software (267 {+-} 28 sec; p < 0.001) than with ultrasound methods (431 {+-} 68 sec) or manual slice segmentation (567 {+-} 91 sec). Conclusion: The prototype software showed excellent agreement with manual slice segmentation with the least time consumption. This will facilitate the routine assessment of the LA volume from coronary CTA data and therefore risk stratification. (orig.)

  1. Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins

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    Y. van Belle (Yves); S.P. Knops (Simon); P. Janse (Petter); M. Rivero-Ayerza (Maximo); E. Jessurun; T. Szili-Torok (Tamas); L.J.L.M. Jordaens (Luc)

    2009-01-01

    textabstractIntroduction: The 28 mm cryoballoon catheter is a device used for pulmonary vein isolation (PVI). The aim of this study was to evaluate the extent of the ablation in the antral regions of the left atrium. Methods and Results: Eighteen patients with drug refractory, symptomatic,

  2. Contrast-Based 3D/2D Registration of the Left Atrium: Fast versus Consistent

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    Matthias Hoffmann

    2016-01-01

    Full Text Available For augmented fluoroscopy during cardiac ablation, a preoperatively acquired 3D model of a patient’s left atrium (LA can be registered to X-ray images recorded during a contrast agent (CA injection. An automatic registration method that works also for small amounts of CA is desired. We propose two similarity measures: The first focuses on edges of the patient anatomy. The second computes a contrast agent distribution estimate (CADE inside the 3D model and rates its consistency with the CA as seen in biplane fluoroscopic images. Moreover, temporal filtering on the obtained registration results of a sequence is applied using a Markov chain framework. Evaluation was performed on 11 well-contrasted clinical angiographic sequences and 10 additional sequences with less CA. For well-contrasted sequences, the error for all 73 frames was 7.9 ± 6.3 mm and it dropped to 4.6 ± 4.0 mm when registering to an automatically selected, well enhanced frame in each sequence. Temporal filtering reduced the error for all frames from 7.9 ± 6.3 mm to 5.7 ± 4.6 mm. The error was typically higher if less CA was used. A combination of both similarity measures outperforms a previously proposed similarity measure. The mean accuracy for well contrasted sequences is in the range of other proposed manual registration methods.

  3. Percutaneous closure of a hemodynamically significant connection between the inferior vena cava and the left atrium.

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    Wiebe, Jens; Rixe, Johannes; Nef, Holger

    2015-10-01

    A connection between the inferior vena cava (IVC) and the left atrium (LA) can occur as a rare complication after surgical atrial septum defect (ASD) repair. We demonstrate the first case of a percutaneous closure of this connection. A 67-year-old female was admitted to hospital due to exertional dyspnea. A history of a surgical ASD repair in 1960 and 1966 with a residual shunt was already known. Transesophageal echocardiography and a CT scan revealed a hemodynamically significant drainage of the IVC into the LA. This connection was successfully closed percutaneously with an AMPLATEZR Duct Occluder I (St. Jude Medical, St. Paul, MN). Post-procedural CT-scan and transthoracic echocardiography demonstrated a stable position and there was also no evidence of a residual shunt. The patient reported a significant reduction of exertional dyspnea. Percutaneous closure of an IVC to LA connection in this case was safe and feasible. The decision about which device is optimal must be made on an individual basis. © 2015 Wiley Periodicals, Inc.

  4. Hemangioma intra-atrial esquerdo Capillary-type cardiac hemangioma, in the left atrium

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    Adalberto Freire Sobrinho

    2005-12-01

    Full Text Available É apresentado o caso de paciente de 49 anos, sexo feminino, com ecocardiograma e cateterismo cardíaco mostrando massa intra-atrial esquerda, sugerindo mixoma, encaminhada para avaliação cardiológica devido à dispnéia. A paciente era ainda portadora de hepatoesplenomegalia esquistossomótica. Após preparo pré-operatório, que incluiu assistência hematológica, a paciente foi submetida a tratamento cirúrgico, com auxílio de circulação extracorpórea. Apresentou sangramento aumentado no pós-operatório imediato, melhorando após transfusão de plaquetas. O estudo anatomopatológico revelou tratar-se de hemangioma capilar benigno.A 49-year-old woman, whose echocardiography and hemodynamic study showed a mass in the left atrium suggestive of myxoma, was referred for cardiological evaluation because of dyspnea. She also had schistosomotic hepatosplenomegaly. After a preoperative evaluation with hematological assistance, the patient underwent surgery using a cardiopulmonary bypass. She suffered a hemorrhage in the immediate post-operative period, which improved after platelet transfusion. The histopathologic study showed a capillary-type cardiac hemangioma.

  5. [Value of two left atrium and pulmonary vein stereoscopic imaging reconstruction methods on guiding radiofrequency ablation for atrial fibrillation].

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    Tian, Y; Zhou, S; Yin, Y H; Zheng, Y X; Wang, R P; Liu, X Q; Liu, Z Q; Liu, Q F; Liu, W; Pang, J; Jiang, Z; Tian, L H; Huang, J; Yang, L

    2017-11-24

    Objective: To compare the value of two 3D imaging reconstruction methods for left atria and pulmonary vein on guiding the catheter ablation for atrial fibrillation (AF). Methods: From January 2014 to January 2017, a total of 100 drug refractory paroxysmal AF patients were divided into left atria direct angiography group ( n =50), and indirect angiography group ( n =50). 3D CARTO system was applied for mapping and guiding the ablation procedure. Patients assigned to direct angiography group were treated as follows: intraoperative puncture of atrial septum, inject contrast agent directly into the left atrium, conduct left atrial and pulmonary venous rotation angiography, reconstruct three-dimensional image, integrate the image into real-time X-ray system to facilitate circumferential pulmonary vein isolation. Patients assigned into the indirect angiography group were treated as follows: inject contrast agent through the right ventricle, conduct delayed rotation angiography of the left atria and pulmonary vein to guide circumferential pulmonary vein fixation and ablation. The left atrial and pulmonary venous image acquisition, the operation and X-ray exposure time, the success rate and the incidence of complication of the two groups were compared. The patients were followed up for 3-6 months. Results: General clinical characteristics of the two groups were similar(all P >0.05). Ablation was successful in all 100 patients. The operation time[(112.0±21.4)min vs. (134.0±24.3)min]and X-ray exposure time((10.7±4.7)min vs. (15.8±5.2)min)were significantly lower in direct angiography group than in indirect angiography group (both P guide the radiofrequency catheter ablation of paroxysmal atrial fibrillation by reconstruction 3D image of left atrium and pulmonary vein. Compared with indirect angiography group, direct angiography group can improve the imaging quality of left atrium and pulmonary vein, decrease the X-ray exposure time of the ablation procedure.

  6. Pain perception during esophageal warming due to radiofrequency catheter ablation in the left atrium.

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    Galeazzi, Marco; Ficili, Sabina; Dottori, Serena; Elian, Mohamed Abdelkader; Pasceri, Vincenzo; Venditti, Franco; Russo, Maurizio; Lavalle, Carlo; Pandozi, Angela; Pandozi, Claudio; Santini, Massimo

    2010-03-01

    We investigated the relationship among esophageal warming, pain perception, and the site of radiofrequency (RF) delivery in the left atrium (LA) during the course of catheter ablation of atrial fibrillation. Such a procedure in awake patients is often linked to the development of visceral pain and esophageal warming. As a consequence, potentially dangerous complications have been described. Twenty patients undergoing RF ablation in the LA were studied. An esophageal probe (EP) capable of measuring endoesophageal temperature (ET) was positioned before starting the procedure. The relative position of the EP and the tip of the ablator were evaluated through fluoroscopy imaging before starting each RF delivery, during which the highest value of the temperature was collected. After RF withdrawal, the patients were asked to define the intensity of the experienced pain by using a score index ranging from 0 (no pain) to 4 (pain requiring immediate RF interruption). The mean ET value during ablation was 39.59 +/- 4.71 degrees C. The EP proximity to the ablator's tip showed a high correlation with the development of the highest ET values (Spearman's rank correlation coefficient r = 0.49, confidence interval (CI) 0.55-0.41). Moreover, the highest values of pain intensity were reported when the RF was delivered to the atrial zones close to the EP projection (r = 0.50, CI 0.55-0.42) and when the highest ET levels were reached (r = 0.38, CI 0.30-0.45). Pain perception in LA ablation is significantly related to esophageal warming and is higher when the RF is delivered near the esophagus. It seems advisable to perform ET monitoring in sedated patients to avoid short- and long-term jeopardizing of the esophageal wall.

  7. 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

  8. Daylighting and Cooling of Atrium Buildings in Warm Climates: Impact of the Top-Fenestration and Wall Mass Area.

    Science.gov (United States)

    Atif, Morad Rachid

    1992-01-01

    Sun-lighting and daylighting contribute greatly to the aesthetic value of an atrium. However, today's atria are often found either over-lit with extensive cooling loads, or under-lit requiring increased artificial lighting loads. The increase of the top-glazing area increases the cooling loads and decreases the lighting loads. The increase of the mass in the atrium walls decreases the maximum atrium temperature and the cooling loads. Furthermore, the mass distribution and its reflectance affect the lighting levels at the atrium floor. The purpose of this study is to investigate the simultaneous impact of the top-fenestration and the mass and reflectance of atrium walls on the cooling and daylighting performance of atria in warm climates. It attempts to determine the optimum top-fenestration for efficient daylighting and low cooling loads. The daylighting performance was evaluated through illumination measurements in physical models in a sky simulator. The cooling performance was evaluated using the software TRNSYS 13.1. Two types of top-fenestration were tested: horizontal and vertical south-facing, each with three alternate areas. The variations of the atrium walls included materials (standard frame and heavyweight concrete) and percentage and reflectance of the solid area. Two and four-story atria were considered, each with square and linear configuration. The performance was evaluated for three warm climates. The optimum top-fenestration for efficient daylighting was determined. The daylighting prediction algorithm was extended to include the effective reflectance of the atrium walls. The increase of mass in the atrium walls significantly decreased the atrium temperature range, the maximum atrium temperature, and the cooling loads. This impact decreased from horizontal to vertical south-facing top-glazing. The vertical south-facing top-glazing and, to a lesser degree, the reduction of the glazed atrium cover by 50% had more cooling benefits than increasing the

  9. A fast slam approach to freehand 3-d ultrasound reconstruction for catheter ablation guidance in the left atrium.

    Science.gov (United States)

    Koolwal, Aditya B; Barbagli, Federico; Carlson, Christopher R; Liang, David H

    2011-12-01

    We present a method for real-time, freehand 3D ultrasound (3D-US) reconstruction of moving anatomy, with specific application towards guiding the catheter ablation procedure in the left atrium. Using an intracardiac echo (ICE) catheter with a pose (position/orientation) sensor mounted to its tip, we continually mosaic 2D-ICE images of a left atrium phantom model to form a 3D-US volume. Our mosaicing strategy employs a probabilistic framework based on simultaneous localization and mapping (SLAM), a technique commonly used in mobile robotics for creating maps of unexplored environments. The measured ICE catheter tip pose provides an initial estimate for compounding 2D-ICE image data into the 3D-US volume. However, we simultaneously consider the overlap-consistency shared between 2D-ICE images and the 3D-US volume, computing a "corrected" tip pose if need be to ensure spatially-consistent reconstruction. This allows us to compensate for anatomic movement and sensor drift that would otherwise cause motion artifacts in the 3D-US volume. Our approach incorporates 2D-ICE data immediately after acquisition, allowing us to continuously update the registration parameters linking sensor coordinates to 3D-US coordinates. This, in turn, enables real-time localization and display of sensorized therapeutic catheters within the 3D-US volume for facilitating procedural guidance. Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  10. Preventive AF ablation in patients with mitral valve lesion and left atrium enlargement: 3-month follow-up results

    Directory of Open Access Journals (Sweden)

    A. V. Bogachev-Prokophiev

    2017-07-01

    Full Text Available Aim. Persistence or appearance of atrial fibrillation (AF after mitral valve surgery significantly reduces the number of excellent and good results in the long-term period. AF leads to heart failure and pulmonary hypertension and increases the risk of thromboembolic events and stroke. Drug strategies for prevention of new-onset AF in the postoperative period are well developed, while invasive methods are still under development and clinical trials. This study aims to evaluate the safety and efficacy of surgical prevention of atrial fibrillation in patients with left atrium enlargement and mitral valve (MV lesion at 3-month follow-up.Methods. Forty patients operated in our clinic over a period of 2015–2017 were included in the study. All patients had MV lesion and left atrial dilatation greater than 60 mm. All patients had a sinus rhythm at the time of the operation and no documented AF in the history. The mean age of the patients was 48.9±10.1 (23-69 years. All patients had indications for mitral valve surgery and were randomized into two groups. The first group included patients who underwent a concomitant preventive ablation procedure (n = 20. The second group included patients with isolated MV surgery (n = 20. Complications and heart rhythm were evaluated within 3 months after surgery.Results. Patients who underwent preventive ablation within 3 months after the surgery did not differ significantly in the number of complications as compared with the control. In the group of patients with preventive ablation, a higher freedom from AF in comparison with the group of patients with isolated MV surgery was observed: 95 vs. 40%, respectively. Conclusion. Preventive atrial fibrillation ablation in patients with mitral valve lesion and left atrium enlargement is a safe and effective procedure. Preventive ablation reduces the risk of atrial fibrillation by 1.6 times within 3-month follow-up.Received 24 April 2017. Accepted 28 June 2017.Funding: The

  11. 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

    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...

  12. A Combined Random Forests and Active Contour Model Approach for Fully Automatic Segmentation of the Left Atrium in Volumetric MRI

    Directory of Open Access Journals (Sweden)

    Chao Ma

    2017-01-01

    Full Text Available Segmentation of the left atrium (LA from cardiac magnetic resonance imaging (MRI datasets is of great importance for image guided atrial fibrillation ablation, LA fibrosis quantification, and cardiac biophysical modelling. However, automated LA segmentation from cardiac MRI is challenging due to limited image resolution, considerable variability in anatomical structures across subjects, and dynamic motion of the heart. In this work, we propose a combined random forests (RFs and active contour model (ACM approach for fully automatic segmentation of the LA from cardiac volumetric MRI. Specifically, we employ the RFs within an autocontext scheme to effectively integrate contextual and appearance information from multisource images together for LA shape inferring. The inferred shape is then incorporated into a volume-scalable ACM for further improving the segmentation accuracy. We validated the proposed method on the cardiac volumetric MRI datasets from the STACOM 2013 and HVSMR 2016 databases and showed that it outperforms other latest automated LA segmentation methods. Validation metrics, average Dice coefficient (DC and average surface-to-surface distance (S2S, were computed as 0.9227±0.0598 and 1.14±1.205 mm, versus those of 0.6222–0.878 and 1.34–8.72 mm, obtained by other methods, respectively.

  13. A case of a resected benign myxoma-like hemorrhagic cyst, which later recurred as undifferentiated pleomorphic sarcoma in the left atrium.

    Science.gov (United States)

    Kim, Eunju; Choi, Seo-Won; Min, Daniel; Kim, Sang Hoon; Yang, Woo-In; Moon, Jae Youn; Sung, Jung Hoon; Kim, In Jai; Lim, Sang-Wook; Cha, Dong-Hun; Moon, Byung; Cho, Sang-Ho; Kim, Won-Jang

    2017-04-01

    An intracardiac cystic mass is a rare type of mass found in the left atrium. The differential diagnosis of an intracardiac cystic mass includes hydatid cysts, bronchogenic cysts, intracardiac varices, and hemorrhages in some tumor types, including myxoma. We present the case of a 68-year-old woman who presented with episodic dyspnea. Transthoracic echocardiography (TTE) revealed the presence of a left atrial mass mimicking myxoma. However, in postoperative findings, it was determined that the mass was actually a hemorrhagic cyst. Eighteen months later, the patient presented with recurrent exertional dyspnea and TTE revealed the recurrence of a left atrial mass. Computed tomography showed that the mass extended into the right atrium, inferior vena cava, and coronary sinus. After re-operation, the final histological diagnosis was determined to be an undifferentiated pleomorphic sarcoma in the left atrium. An intracardiac hemorrhagic cyst was suspected during the operation of a benign-looking LA mass. As such, we recommend that other rare etiologies be considered and more biopsies be performed when possible.

  14. 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.

  15. Impact of ECG gating in contrast-enhanced MR angiography for the assessment of the pulmonary veins and the left atrium anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Katoh, M.; Buecker, A.; Muehlenbruch, G.; Guenther, R.W.; Spuentrup, E. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum RWTH Aachen (Germany); Schauerte, P. [Medizinische Klinik 1, Universitaetsklinikum RWTH Aachen (Germany)

    2006-02-15

    Purpose: Implementation of ECG gating in contrast-enhanced MR angiography (ceMRA) for improved visualization of the pulmonary veins, the left atrium, and the thoracic vessels. Materials and Methods: CeMRA was performed on twelve patients with a history of recurrent atrial fibrillation for the purpose of an intra-individual comparison with and without ECG gating on a 1.5 Tesla MR system (Gyroscan Intera, Philips Medical Systems, Best, NL). Objective image quality parameters such as the signal-to-noise ratio (SNR) of the blood and the contrast-to-noise ratio (CNR) between the blood and myocardium or lung parenchyma were analyzed. The contour sharpness of the pulmonary veins, left atrium, ascending aorta, and pulmonary trunk was also measured. In addition, the artifact level was subjectively assessed by two observers blinded with respect to the sequence parameters. Statistically significant differences (p<0.05) between the procedures were analyzed using the Wilcoxon test and Pearson Chi-square test. Results: The use of ECG gating in ceMRA significantly reduced artifacts caused by cardiac motion and vessel pulsation. This in turn lead to a significant increase in the contour sharpness of the left atrium and the thoracic vessels. In addition, higher SNR and CNR were found using ECG-gated ceMRA compared to standard ceMRA. Conclusion: The use of ECG gating in ceMRA results in artifact-free and sharper delineation of the structures of the heart and thoracic vessels. (orig.)

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

    DEFF Research Database (Denmark)

    Huo, Yan; Gaspar, Thomas; Pohl, Matthias

    2017-01-01

    Aims: 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. Methods and results: Consecutive patients who underwent...... was present in 58 out of 292 patients with paroxysmal and 134 out of 247 persistent AF (P 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...... of LVZ. Conclusion: 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...

  17. Mixoma gigante em átrio esquerdo: relato de caso Giant myxoma in the left atrium: case report

    Directory of Open Access Journals (Sweden)

    Marcos de Paula Vale

    2008-06-01

    Full Text Available Paciente de 63 anos, sexo feminino, com história de dispnéia, palpitação e precordialgia foi submetida a avaliação cardiológica. Ao exame físico mostrava-se sem anormalidades. O ecocardiograma mostrou grande massa em átrio esquerdo, sugerindo mixoma; confirmado pela tomografia e cateterismo. A paciente foi submetida a tratamento cirúrgico, com boa evolução pós-operatória. O estudo anatomopatológico confirmou o diagnóstico de mixoma. Neste artigo é apresentada revisão bibliográfica, bem como comentários enfatizando-se a dificuldade diagnóstica baseada nos sinais e sintomas, assim como o desenvolvimento de derrame pleural bilateral no pós-operatório, possivelmente relacionado ao mixoma.In this study is reported the case of a 63-year-old-woman with history of dyspnea, palpitations, and precordial pain who underwent cardiologic evaluation. The physical examination did not reveal abnormalities. The echocardiogram showed great mass in the left atrium, suggesting myxoma which was confirmed by tomography and catheterization. The patient underwent surgical treatment with a good postoperative evolution. The diagnosis of myxoma was confirmed by histopathologic study. In this study is included a bibliographic review and a comment emphasizing the diagnostic difficulty based on signs and symptoms, as well as the details about the development of bilateral pleural effusion possibly related to the myxoma.

  18. Thromboembolic risk in atrial fibrillation: association between left atrium mechanics and risk scores. A study based on 3D wall-motion tracking technology.

    Science.gov (United States)

    Islas, Fabián; Olmos, Carmen; Vieira, Catarina; De Agustín, José A; Marcos-Alberca, Pedro; Saltijeral, Adriana; Almería, Carlos; Rodrigo, José L; García Fernández, Miguel A; Macaya, Carlos; Pérez de Isla, Leopoldo

    2015-04-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a significantly high risk of stroke and systemic embolism. The aim of our study was to assess the association between left atrium (LA) mechanics measured by 3D wall-motion tracking (3DWMT) technology and the most common thromboembolic risk scores (CHADS2, CHA2DS2-VASc). A total of 101 consecutive patients with permanent AF referred were included. Conventional bidimensional (2D) LA parameters, and LA mechanics by means of 3DWMT were studied. Association between LA 2D and 3DWMT parameters and both risk scores was evaluated as well as its correlation with every component of the score individually. Mean age was 78 ± 10 years. Mean CHADS2 was 2.7 ± 1.3 and mean CHA2DS2-VASc was 4.4 ± 1.7. Values of 2D and 3DWTM LA parameters were: 2D area 26.4 ± 9.7 cm(2) , 2D volume index 49.4 ± 10.1 mL/m(2) , 3DWMT left atrial emptying fraction (LAEF) 15.9 ± 8.4%, longitudinal strain 9.1 ± 4.5% and area strain 14.9 ± 8.8%. Linear regression analysis showed statistically significant correlation between LA longitudinal strain and LAEF with CHADS2 and CHA2DS2-VASc scores. For each 10% variation in longitudinal strain, CHADS2 and CHA2DS2-VASc scores change in 0.7 and 0.8 points, respectively. Left atrial longitudinal strain and emptying fraction assessed by 3D WMT technology have correlation with both CHADS2 and CHA2DS2-VASc scores. Each 10% of variation in longitudinal strain represents a 0.7 and 0.8 points change in those risk scores. LA mechanics evaluation might provide additional value to risk scores and could be considered to be a predictor of stroke in patients with AF. © 2014, Wiley Periodicals, Inc.

  19. Left atrium volume index is influenced by aortic stiffness and central pulse pressure in type 2 diabetes mellitus patients: a hemodynamic and echocardiographic study.

    Science.gov (United States)

    Zapolski, Tomasz; Wysokiński, Andrzej

    2013-03-04

    Left atrial volume index (LAVI) has recently emerged as a useful biomarker for risk stratification and risk monitoring in many clinical settings. Many hemodynamic factors such as preload and afterload have an effect on evaluating left atrium function. This study was performed to investigate the relationship between LAVI and aortic stiffness index (ASI) and selected markers characterizing hemodynamic state in patients with type 2 diabetes mellitus (DM2). The study population consisted of 100 patients (56 men, 44 women), 67.2 (±10.9) years old DM2, scheduled for routine coronary angiography. Standard transthoracic echocardiography was used to measure parameters needed for calculation of LAVI and ASI. During invasive procedures, central pulse pressure (CPP) in the ascendens aorta and left ventricle end-diastolic pressure (LVEDP) were recorded. Selected laboratory parameters were obtained, including lipidogram, serum uric acid, hs-CRP, fibrinogen, cTnT, myoglobin, BNP, HbA1C, creatinine, and GFR. Both LAVI and ASI were greater and CPP and LVEDP were markedly elevated in DM2 patients compared to controls. The independent predictors of LAVI were ASI (ß=0.331; p=0.011), CPP (ß=0.312; p=0.020), LVEDP (ß=0.381; p=0.006), HbA1C (ß=0.379; p=0.008), and BNP (ß=0,423; pDM2 patients.

  20. The Abundance of Epicardial Adipose Tissue Surrounding Left Atrium Is Associated With the Occurrence of Stroke in Patients With Atrial Fibrillation

    Science.gov (United States)

    Tsao, Hsuan-Ming; Hu, Wei-Chih; Tsai, Ping-Huang; Lee, Chao-Lin; Liu, Fang-Chun; Wang, Hsueh-Han; Lo, Li-Wei; Chang, Shih-Lin; Chao, Tze-Fan; Chen, Shih-Ann

    2016-01-01

    Abstract Epicardial adipose tissue (EAT) is positively associated with risk factors for cardiovascular disease, but the role of EAT in the development of atrial fibrillation (AF)-related stroke and its association with the anatomical and functional remodeling of the left atrium (LA) have not been elucidated. This was a comparative cross-sectional study. Twenty-seven patients with paroxysmal or persistent AF and cardioembolic stroke were selected and compared with 68 age- and sex-matched AF patients without stroke. In addition, 20 controls without a history of AF or stroke were included. The periatrial EAT and the structural and functional properties of the LA and left ventricle were evaluated using contrast-enhanced 64-slice multidetector computed tomography during sinus rhythm. Total EAT around the LA was significantly increased across the groups (control vs AF vs AF-related stroke, P EAT had a negative correlation with the dynamic function of the LA, LAA, and the HU ratio. After a multivariate analysis, increased EAT (P EAT was increased and was correlated with atrial dysfunction in patients with AF-related stroke. Hence, EAT assessment may potentially offer an incremental value for grading the risk of cardioembolic stroke in patients with AF. PMID:27057876

  1. Routine18F-FDG PET/CT does not detect inflammation in the left atrium in patients with atrial fibrillation.

    Science.gov (United States)

    Lange, Philipp S; Avramovic, Nemanja; Frommeyer, Gerrit; Wasmer, Kristina; Pott, Christian; Eckardt, Lars; Wenning, Christian

    2017-08-01

    Increasing evidence supports a role of inflammation in the development of atrial fibrillation (AF). However, direct evidence of persistent inflammatory activity in the atria of AF patients is scarce. In this study, we used 18-Fluor-Deoxyglucose positron emission tomography computed tomography ( 18 F-FDG PET/CT) to determine atrial inflammation in patients with and without AF. Retrospectively, 18 F-FDG PET/CT scans were analyzed. 37 patients with a history of AF were compared to an age and sex matched control group with no history of AF. Standardized uptake values were obtained in the atrial walls, in the left ventricular wall, and in the right ventricular blood pool, respectively. Target to background ratios (TBR) were determined in the atrial and left ventricular walls and compared between the two groups. TBR values of the left atrial wall were slightly but not significantly higher in patients with AF (1.21 ± 0.27) compared to those without AF (1.14 ± 0.29; p = 0.85). Likewise, a weak but not significant difference was observed in signal intensities in the right atrial wall between patients in the AF (1.14 ± 0.45) and the control group (0.96 ± 0.2; p = 0.41). TBR values of the left ventricular myocardium did not differ between the groups; no significant correlation was found between the TBR in the left and right atrial wall and blood glucose levels. 18 F-FDG PET/CT performed under routine conditions did not detect a significant difference in inflammatory activity in the left or right atrium between patients with and without AF. Contrary to previous reports, these results therefore do not clearly support a role for ongoing atrial inflammation in patients with AF. Prospective clinical studies using myocardial glucose uptake suppression strategies may be helpful to clarify these issues.

  2. 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...... AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents...... of AF before or after their echocardiographic examination. Patients in the paroxysmal AF group were significantly older and had higher CHA2DS2-VASc score than patients without paroxysmal AF (p

  3. Rotational X-ray angiography: a method for intra-operative volume imaging of the left-atrium and pulmonary veins for atrial fibrillation ablation guidance

    Science.gov (United States)

    Manzke, R.; Zagorchev, L.; d'Avila, A.; Thiagalingam, A.; Reddy, V. Y.; Chan, R. C.

    2007-03-01

    Catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation in cardiac electrophysiology (EP) are complex and require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present an application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. Depending on the heart size a single or two selective contrastenhanced rotational acquisitions are performed and CT-like volumes are reconstructed with 3D filtered back projection. In case of dual injection, the two volumes depicting the left and right portions of the LAPV are registered and fused. The data sets are visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with preacquired imaging data and can be of sufficient quality for intra-operative guidance.

  4. 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.

  5. Atrium-driven mitral annulus motion velocity reflects global left ventricular function and pulmonary congestion during acute biventricular pacing.

    Science.gov (United States)

    Frielingsdorf, Jürgen; Schmidt, Christoph; Debrunner, Marianne; Tavakoli, Reza; Genoni, Michele; Straumann, Edwin; Bertel, Osmund; Naegeli, Barbara

    2008-03-01

    The short-term effect of acute biventricular pacing on cardiac function in patients with chronic heart failure undergoing heart surgery is widely unknown. The present study was designed to determine whether mitral annular tissue Doppler imaging (TDI) is useful to predict acute changes in global systolic function determined by the continuous cardiac output method that was measured postoperatively during various pacing configurations in patients with depressed left ventricular (LV) function. TDI peak velocities of systolic (Sm), early diastolic (Em), and late diastolic (Am) mitral annular motion waves were measured in 17 patients (age 67 +/- 8 years, 10 male) with depressed LV systolic function (LV ejection fraction 120 ms undergoing temporary epicardial biventricular pacing after aortocoronary bypass and valve surgery. TDI velocities, QRS duration on surface electrocardiogram, cardiac index (CI), right atrial pressure, pulmonary artery pressure, and pulmonary capillary wedge (PCW) pressure were measured simultaneously during various pacing configurations (right atrial-biventricular, right atrial-LV, right atrial-right ventricular, atrial inhibited, and no pacing). Univariate linear regression analysis showed a good correlation between Am and CI (r = 0.53, P = .0001) determined in all pacing modes, a weak correlation between Sm and CI (r = 0.31, P = .017), and no correlation between Em and CI (r = 0.21, P = .074). Am > 6 cm/s predicted a CI of 2.5 L/min/m(2) or more with a sensitivity of 95% and a specificity of 30%. All TDI values correlated negatively with PCW (r = -0.53, P = .0001 for Sm; r = -0.34, P = .01 for Em; r = -0.50, P = .0001 for Am). Am greater than 6 cm/s predicted a PCW of 16 mm Hg or less with a specificity of 100% and a sensitivity of 34%. Mean values of TDI velocities and hemodynamic parameters were not significantly different between each pacing configuration. Peak Am mitral annular velocity correlates well with CI and PCW, respectively, thus

  6. 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

  7. Volumetric and functional assessment of the left atrium in young competitive athletes without left ventricular hypertrophy: the MAGYAR-Sport Study.

    Science.gov (United States)

    Nemes, Attila; Domsik, Péter; Kalapos, Anita; Orosz, Andrea; Oszlánczi, Mónika; Török, László; Balogh, László; Márton, János; Forster, Tamás; Lengyel, Csaba

    2017-06-01

    Left atrial (LA) remodeling may be regarded as a physiologic adaptation to exercise conditioning. Three-dimensional speckle tracking echocardiography (3DSTE) is a new promising tool for volumetric and functional characterization of the LA. The present study was undertaken to assess adaptive changes in LA volumes and functional properties respecting cardiac cycle in young competitive athletes without left ventricular hypertrophy (LVH) by detailed 3DSTE assessment. The study group consisted of 20 young elite basketball and handball players (mean age: 28.1±10.1 years, 8 men) without LVH, their results were compared to 23 age- and gender-matched non-sportive healthy controls (mean age: 31.7±8.5 years, 11 men. All subjects had undergone standard transthoracic two-dimensional Doppler echocardiographic study with 3DSTE. Increased systolic maximum (66.5±13.6 mL vs. 38.5±8.6 mL, Pglobal (21.1±7.7% vs. 27.6±9.9%, P=0.02) and mean segmental (26.1±7.1% vs. 35.7±12.0%, P=0.003) peak LA strains proved to be significantly reduced in athletes as compared to controls. 3DSTE-derived increased cyclic LA volumes and specific alterations in LA functional properties could be demonstrated in young competing athletes which is most likely a physiologic consequence of a global cardiac adaptation to intensive and chronic training.

  8. Circumferential lesion formation around the pulmonary veins in the left atrium with focused ultrasound using a 2D-array endoesophageal device: a numerical study

    Energy Technology Data Exchange (ETDEWEB)

    Pichardo, Samuel; Hynynen, Kullervo [Imaging Research-Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room C713, Toronto, ON M4N 3M5 (Canada)

    2007-08-21

    Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia affecting humans. The electrical isolation by ablation of the pulmonary veins (PVs) in the left atrium (LA) of the heart has been proven as an effective cure of AF. The ablation consists mainly in the formation of a localized circumferential thermal coagulation of the cardiac tissue surrounding the PVs. In the present numerical study, the feasibility of producing the required circumferential lesion with an endoesophageal ultrasound probe is investigated. The probe operates at 1 MHz and consists of a 2D array with enough elements (114 x 20) to steer the acoustic field electronically in a volume comparable to the LA. Realistic anatomical conditions of the thorax were considered from the segmentation of histological images of the thorax. The cardiac muscle and the blood-filled cavities in the heart were identified and considered in the sound propagation and thermal models. The influence of different conditions of the thermal sinking in the LA chamber was also studied. The circumferential ablation of the PVs was achieved by the sum of individual lesions induced with the proposed device. Different scenarios of lesion formation were considered where ultrasound exposures (1, 2, 5 and 10 s) were combined with maximal peak temperatures (60, 70 and 80 {sup 0}C). The results of this numerical study allowed identifying the limits and best conditions for controlled lesion formation in the LA using the proposed device. A controlled situation for the lesion formation surrounding the PVs was obtained when the targets were located within a distance from the device in the range of 26 {+-} 7 mm. When combined with a maximal temperature of 70 {sup 0}C and an exposure time between 5 and 10 s, this distance ensured preservation of the esophageal structures, controlled lesion formation and delivery of an acoustic intensity at the transducer surface that is compatible with existing materials. With a peak

  9. A cooled intraesophageal balloon to prevent thermal injury during endocardial surgical radiofrequency ablation of the left atrium: a finite element study

    Energy Technology Data Exchange (ETDEWEB)

    Berjano, Enrique J [Center for Research and Innovation on Bioengineering, Valencia Polytechnic University, Camino de Vera s/n, 46022 Valencia (Spain); Hornero, Fernando [Cardiac Surgery Department, Valencia University General Hospital, Avd Tres Cruces s/n, 46014, Valencia (Spain)

    2005-10-21

    Recent clinical studies on intraoperative monopolar radiofrequency ablation of atrial fibrillation have reported some cases of injury to the esophagus. The aim of this study was to perform computer simulations using three-dimensional finite element models in order to investigate the feasibility of a cooled intraesophageal balloon appropriately placed to prevent injury. The models included atrial tissue and a fragment of esophagus and lung linked by connective tissue. The lesion depth in the esophagus was assessed using a 50 deg. C isotherm and expressed as a percentage of thickness of the esophageal wall. The results are as follows: (1) chilling the esophagus by means of a cooled balloon placed in the lumen minimizes the lesion in the esophageal wall compared to the cases in which no balloon is used (a collapsed esophagus) and with a non-cooled balloon; (2) the temperature of the cooling fluid has a more significant effect on the minimization of the lesion than the rate of cooling (the thermal transfer coefficient for forced convection); and (3) pre-cooling periods previous to RF ablation do not represent a significant improvement. Finally, the results also suggest that the use of a cooled balloon could affect the transmurality of the atrial lesion, especially in the cases where the atrium is of considerable thickness. (note)

  10. Antenatal and postnatal sonographic imaging findings of a single ventricle presenting as double outlet right ventricle with rudimentary left ventricle and single atrium

    Directory of Open Access Journals (Sweden)

    Donboklang Lynser

    2015-11-01

    Full Text Available Congenital heart disease is a major cause of morbidity and mortality. Single ventricle is a rare finding and usually of left ventricular morphology. We present here interesting antenatal and postnatal echocardiographic findings of a baby having a rare single ventricle of right ventricular morphology with double outlet. Antenatally we saw a large ventricular septal defect indistinguishable from a single ventricle with left to right ventricular ratio of 1:1. Postnatally we saw a single ventricle having the outlets for both the main pulmonary artery and aortic root. The left ventricle is collapse with a rudimentary morphology possibly due to changes in hemodynamics after birth and absent of outlet from it.

  11. Preferential streaming of the ductus venosus toward the right atrium is associated with a worse outcome despite a higher rate of invasive procedures in human fetuses with left diaphragmatic hernia.

    Science.gov (United States)

    Stressig, R; Fimmers, R; Schaible, T; Degenhardt, J; Axt-Fliedner, R; Gembruch, U; Kohl, T

    2013-12-01

    Preferential streaming of the ductus venosus (DV) toward the right atrium has been observed in fetuses with left diaphragmatic hernia (LDH). The purpose of this retrospective study was to compare survival rates to discharge between a group with preferential streaming of the DV toward the right heart and a group in which this abnormal flow pattern was not present. We retrospectively searched our patient records for fetuses with LDH in whom liver position, DV streaming and postnatal outcome information was available. 55 cases were found and divided into two groups: Group I fetuses exhibited abnormal DV streaming toward the right side of the heart; group II fetuses did not. Various prognostic and outcome parameters were compared. 62 % of group I fetuses and 88 % of group II fetuses survived to discharge (p = 0.032). Fetoscopic tracheal balloon occlusion (FETO) was performed in 66 % of group I fetuses and 23 % of group II fetuses (p = 0.003). Postnatal ECMO therapy was performed in 55 % of group I fetuses and 23 % of group II infants (p = 0.025). Moderate to severe chronic lung disease in survivors was observed in 56 % of the survivors of group I and 9 % of the survivors of group II (p = 0.002). Preferential streaming of the DV toward the right heart in human fetuses with left-sided diaphragmatic hernia was associated with a poorer postnatal outcome despite a higher rate of invasive pre- and postnatal procedures compared to fetuses without this flow abnormality. Specifically, abnormal DV streaming was found to be an independent predictor for FETO. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Serum levels of NT- pro ANP, BNP, NT-pro BNP and function of the left atrium in patients with heart failure and preserved ejection fraction after myocardial infarction

    Science.gov (United States)

    Shurupov, V.; Suslova, T.; Ryabov, V.

    2015-11-01

    The objective of our study was to evaluate the levels of natriuretic peptides in patients (pts) with heart failure with preserved ejection fraction (HFpEF) in 12 month after ST elevation myocardial infarction (STEMI) with a focus on the function of left atrium (LA) and left ventricular (LV) filling pressure. 55 pts were included in the study. 6-minute walk test was performed. Echo exam was performed by the diagnostic system VIVID 7. BNP in whole blood was determined using the Triage ® Meter BNP test. The serum levels of NT-pro BNP, NT-pro ANP («Biomedica», Austria) were determined in blood samples by enzyme-linked immune-sorbent assay (ELISA). LA volume index were differences (16.03±3.39 ml/m2; 25.36±8.26 ml/m2; 29.41±9.46 ml/m2 accordingly I, II, III class) depending on severity of HF. Well as E/E' ratio were differences (7.5±1.4; 9.8±5.1; 13.5±7.6 accordingly I, II, III class) depending on severity of HF. The LA volume index correlated with levels of NT-pro ANP (R=0.29; p=0.04), levels of NT-pro BNP (R=0.37; p=0.01), levels of BNP (R=0.51; p=0.0001). The LV filling pressure correlated with levels of NT-pro ANP (R=0.45; p=0.002), levels of NT-pro BNP (R=0.49; p=0.001), levels of BNP (R=0.37; p=0.01).

  13. Mechanical and substrate abnormalities of the left atrium assessed by 3-dimensional speckle-tracking echocardiography and electroanatomic mapping system in patients with paroxysmal atrial fibrillation.

    Science.gov (United States)

    Watanabe, Yoshikazu; Nakano, Yukiko; Hidaka, Takayuki; Oda, Noboru; Kajihara, Kenta; Tokuyama, Takehito; Uchimura, Yuko; Sairaku, Akinori; Motoda, Chikaaki; Fujiwara, Mai; Kawazoe, Hiroshi; Matsumura, Hiroya; Kihara, Yasuki

    2015-03-01

    Left atrial (LA) remodeling progresses to electrical remodeling, contractile remodeling, and subsequently structural remodeling. Little is known about the relationship between LA electrical and anatomical remodeling and LA mechanical function. We aimed to clarify the relationship between LA mechanical function using 3-dimensional speckle-tracking echocardiography (3D-STE) and LA electrical remodeling using an electroanatomic mapping system (CARTO 3) and to estimate atrial fibrillation (AF) substrate in patients with paroxysmal AF (PAF). A total of 52 patients with PAF (41 (79%) men; mean age 61 ± 11 years) undergoing their initial pulmonary vein isolation (PVI) were examined. The standard deviation of the time to peak strain in each LA segment (%SD-TPS) was analyzed as an index of LA dyssynchrony using 3D-STE before PVI. Contact LA bipolar voltage and activation maps were constructed during sinus rhythm before PVI using CARTO 3. The LA total activation time was measured and low-voltage zones (LVZs) were determined with a local bipolar electrogram amplitude of <0.5 mV. The patients were divided into those with an LVZ (LVZ group; n = 23) and those without an LVZ (non-LVZ group; n = 29). The %SD-TPS was significantly higher (14.1 ± 5.7 vs 8.0 ± 5.1; P=.0002) in the LVZ group than in the non-LVZ group and was an independent determinant of the LVZ (odds ratio 1.21; 95% confidence interval 1.04-1.49; P=.01). In addition, the LA total activation time was weakly correlated with the %SD-TPS. LA dyssynchrony and conduction delay exist in patients with PAF. The 3D-STE enabled noninvasive estimation of LA electrical remodeling and AF substrate. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  14. Acesso transeptal vertical ampliado em reoperações valvares mitrais com átrio esquerdo pequeno Extended vertical transseptal approach in mitral valve reoperation with a small left atrium

    Directory of Open Access Journals (Sweden)

    Walter Vosgrau Fagundes

    2004-03-01

    Full Text Available OBJETIVO: Avaliar a abordagem transeptal vertical ampliada em reoperações da valva mitral com átrio esquerdo pequeno. MÉTODO: De janeiro de 2001 a dezembro de 2002, 15 pacientes portadores de doença valvar mitral com indicação de reintervenção cirúrgica, átrio esquerdo pequeno (menor ou igual a 4,0 cm e fibrilação atrial crônica, foram submetidos à abordagem transeptal vertical ampliada da valva mitral. Nove pacientes (pt eram do sexo feminino. A idade variou de 22 a 48 anos. As indicações cirúrgicas foram: disfunção de prótese mitral (seis pt; insuficiência mitral (cinco pt e dupla lesão mitral (quatro pt. Três pacientes apresentavam insuficiência aórtica associada e um pt, insuficiência tricúspide. Nove (60% pacientes encontravam-se em ICC CF III da NYHA e seis (40%, em CF IV. RESULTADOS: A exposição do aparelho valvar mitral foi excelente. O tempo de circulação extracorpórea variou de 65 a 150 min (média = 95min. Foram implantadas próteses em todos os pacientes (15 mitrais, três aórticas e um tricúspide. A mortalidade hospitalar foi de 6,7%, com um óbito devido a baixo débito cardíaco e falência de múltiplos órgãos. Um (6,7% paciente apresentou broncopneumonia na fase hospitalar. Dez pacientes permaneceram com fibrilação atrial, três pt reverteram para ritmo sinusal e um evoluiu com ritmo juncional. A permanência hospitalar média foi de 8,2 dias. Doze (85,7% pacientes encontram-se em CF I e dois (14,3% em CF II. A curva atuarial de sobrevida é de 92,5 % em 22 meses de seguimento. CONCLUSÃO: A técnica cirúrgica empregada proporciona excelente visibilização do aparelho valvar mitral, com baixo índice de complicações.OBJECTIVE: To evaluate the efficacy of the extended vertical transseptal approach in mitral valve reoperation with a small left atrium. METHOD: From January 2001 to December 2002, 15 patients with previous mitral operations, small left atrium and atrial fibrillation

  15. [The application of Atricure bipolar radiofrequency system in ablation of different parts and different times of pig heart atrium and the analysis of transmural lesions].

    Science.gov (United States)

    Liu, Pei-sheng; Chen, Xin; Liu, Ming

    2010-12-15

    To analyze the transmural lesions of different parts of the pig heart atrium received different times of ablation applied with Atricure bipolar radiofrequency system. Six fresh (ex vivo timepig hearts with atrium preserved intact were used as the experimental objects and experimental groups were divided according to the ablation position. The Atricure bipolar radiofrequency system was applied in the ablation of the parts of the atrium, such as posterior wall of left atrium, anterior wall of left atrium, anterior wall of right atrium and posterior wall of left atrium close to mitral posterior ring. Ablate the position of the atrium lengthened about 2.0 cm with the same thickness with an interval of 0.5 cm for 4 times respectively, also recording the time of every ablation. For each part and each time of ablation, the ablated atrial tissue was preserved with 4% formaldehyde and 5% glutaraldehyde, and was sent for observation under light microscope and transmission electron microscope. The ablation time and lesion were analyzed statistically. In the same position of the atrium, ablation time decreased with the times of the ablation, in different position of the atrium with same time of ablation, time showed a positive proportion with the thickness of the atrium. Atricure bipolar radiofrequency system is very safe and efficient, also convenient for manipulation. With regard to the relatively thinner part of the atrium, such as posterior wall and anterior wall of left atrium, at least two times of ablation can ensure transmural lesion of the atrial tissue, but to the position of the atrium such as anterior wall of right atrium and posterior wall of left atrium close to mitral posterior ring, 3 to 4 times of ablation can ensure transmural lesion of the atrial tissue.

  16. Anomalía del retorno venoso sistémico Drenaje anómalo de la vena cava superior derecha a la aurícula izquierda: Revisión de la literatura y reporte de caso Anomalous systemic venous return. Anomalous drainage of the right superior vena cava into the left atrium: Review of literature and case report

    Directory of Open Access Journals (Sweden)

    Ríos Giovanny

    2012-06-01

    Full Text Available La anomalía total del retorno venoso sistémico tiene gran variedad de presentaciones; sin embargo, la patología de más baja frecuencia es el drenaje de vena cava superior derecha a la aurícula izquierda, hecho de peso para que en el mundo se reporten pocos casos. En la Fundación Clínica Abood Shaio se trató el caso de una paciente de seis años de edad con drenaje venoso total de cava superior derecha a la aurícula izquierda, mediante la técnica de movilización de cava superior y anastomosis cavo-atrial, y se obtuvieron buenos resultados. El caso es mención corresponde al número 21 en la literatura mundial.Total anomalous systemic venous return has a variety of presentations, being the drainage of right superior vena cava into the left atrium a low frequency condition. There are few reported cases in the world. In Shaio Clinic Foundation we have handled a case of total venous drainage of the right superior vena cava into the left atrium in a 6-year old girl, using the superior vena cava mobilization technique and cavo-atrial anastomosis, with good results. This case is reported as case number 21 in the world.

  17. Clarifying the atrioventricular junctional anatomy in the setting of double outlet right atrium

    Science.gov (United States)

    Gupta, Saurabh Kumar; Gupta, Anunay; Ramakrishnan, Sivasubramanian; Anderson, Robert H

    2015-01-01

    Double outlet atrium is a rare cardiac anomaly wherein one of the atriums, most frequently the right atrium, opens into both the ventricles. Although seen more commonly in the setting of atrioventricular septal defect, this arrangement can also be found when one of the atrioventricular connections is atretic due to absence of the atrioventricular connection and the other atrioventricular valve straddles the muscular ventricular septum. It is the specific anatomy and connections of the atrioventricular junction that clarifies the situation and distinguishes between these two types of double outlet atrium. In this report, we present a case of double outlet right atrium co-existing with the absence of left atrioventricular connection. We then discuss the morphologic aspects of this interesting anomaly. PMID:26556972

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

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    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

  19. EXAMINATION OF ELECTROPHYSIOLOGICAL PARAMETERS OF THE ATRIUMS IN PATIENTS WITH LONG-TERM PERSISTENT FORM OF ATRIAL FIBRILLATION AND VALVULAR HEART DISEASE

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    A. A. Kulikov

    2017-01-01

    Full Text Available The study objective is to examine electrophysiological parameters of atrial myocardium, characteristics of atrioventricular conduction, and potential factors affecting recurrent atrial fibrillation (AF in patients with persistent and long-term persistent forms of AF prior to the Labirynth IIIB surgery with single-step correction of valvular heart disease.Materials and methods. The study included 100 adults (48 men, 52 women with persistent and long-term persistent forms of AF and different valvular heart diseases. Mean patient age was 59 years. Mean AF duration was 4 years. All patients were prescribed antiarrhythmic therapy but it proved ineffective. In 15 % of patients, restoration of the sinus rhythm was attempted through electrical cardioversion but long-term control of the sinus rhythm wasn’t achieved. All patients were diagnosed with organic pathology of the mitral valve. Also, in 80 % of patients, relative insufficiency of the tricuspid valve was detected. Chronic heart failure functional class per NYHA was III. Size of the left atrium was 5 cm, mean left ventricular ejection fraction was 61 %. All patients underwent electrical cardioversion. After successful restoration of the sinus rhythm, endocardial electrophysiology study (EES of the heart was performed. Then, correction of valvular pathologies and the Labyrinth IIIB surgery were performed. Results. Examination of refractoriness of different parts of the atriums has shown that effective refractory period (ERP of the atrioventricular node was minimal compared to other parts of the atriums. Maximal ERP duration was observed in the upper part of the right atrium. Therefore, in patients with long history of AF, heterogeneity of atrial myocardium ERP duration is observed. In 17 % of patients, atrial vulnerability was detected. The area of atrial vulnerability was always associated with ERP. Its duration in patients with atrial vulnerability was significantly higher.Conclusion. Long

  20. Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report.

    Science.gov (United States)

    Pollert, Lukas; Prikrylova, Zuzana; Berousek, Jan; Mosna, Frantisek; Lischke, Robert

    2016-01-01

    Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk. This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day. According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks associated with thrombolysis and arteriovenous ECMO support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.

  1. Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report

    Directory of Open Access Journals (Sweden)

    Pollert L

    2016-06-01

    Full Text Available Lukas Pollert,1 Zuzana Prikrylova,1 Jan Berousek,1 Frantisek Mosna,1 Robert Lischke2 1Department of Anaesthesiology and Intensive Care, 2nd Faculty of Medicine, 23rd Surgical Department, 1st Faculty of Medicine, Charles University in Prague and Motol University Hospital, Praha, Czech Republic Background: Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk.Case presentation: This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day.Conclusion: According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks

  2. The assessment of left atrial function in hypertrophic cardiomyopathy using an ultrafast computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Karikomi, Masahito (Chiba Univ. (Japan). School of Medicine)

    1994-06-01

    Ultrafast computed tomography was performed in 22 patients with hypertrophic cardiomyopathy (HCM) and 8 normal subjects to evaluate left atrial function. The area-time curve of the left atrium was obtained from the long axial view and analyzed. The diminishing fraction of the left atrial area from passive atrial emptying to atrial diastasis in HCM was significantly less than that in normal subjects (17.4[+-]6.3% vs 23.0[+-]6.8%, p<0.05). The maximum area, filling fraction, time to peak diminishing rate, peak diminishing rate, time to 50% of peak diminishing rate, and diminishing fraction at the time of peak diminishing rate in HCM did not differ significantly from those in normal subjects. No indices differed between symptomatic patients with HCM and asymptomatic patients with HCM. In conclusion, the contraction of the left atrium is increased and a compensatory mechanism is at work in response to the impairment of left ventricular early diastolic filling, which does not affect the conduit function of the left atrium. It is suggested that the left atrial function in HCM may well be altered before symptom is present. (author).

  3. Enlarged Right Atrium Falsely Interpreted as a Mediastinal Mass: A Case Report

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    Farid Zand

    2015-09-01

    Full Text Available Right atrial dilation due to left heart disease is a common complication among adults. The present review aimed to describe a case of massively dilated right atrium in a female patient presenting with valvular heart disease and no atrial fibrillation. The results of chest X-ray revealed a large opacity filling the lower right hemithorax, falsely interpreted as a mediastinal mass. During the transesophageal echocardiography, severe enlargement of the right atrium was detected, and open mitral and tricuspid valve replacements were performed successfully.

  4. [Recurrent left atrial myxoma].

    Science.gov (United States)

    Moreno Martínez, Francisco L; Lagomasino Hidalgo, Alvaro; Mirabal Rodríguez, Roger; López Bermúdez, Félix H; López Bernal, Omaida J

    2003-01-01

    Primary cardiac tumors are rare. Mixomas are the most common among them; 75% are located in the left atrium, 20% in the right atrium, and the rest in the ventricles. The seldom appear in atrio-ventricular valves. Recidivant mixoma are also rare, appearing in 1-5% of all patients that have undergone surgical treatment of a mixoma. In this paper we present our experience with a female patient, who 8 years after having been operated of a left atrial mixoma, began with symptoms of mild heart failure. Transthoracic echocardiography revealed recurrence of the tumor, and was therefore subjected to a second open-heart surgery from which she recovered without complications.

  5. 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

  6. Borders of left gastric lymph node area in 124 patients with esophageal and gastric cardia carcinoma

    International Nuclear Information System (INIS)

    Qian Pudong; Guo Yesong; Li Jianzhong; Wang Yufen; Feng Chunwei; Lv Hong; Fei Wenlong

    2006-01-01

    Objective: To measure and define the distribution of left gastric lymph nodes. Methods: From Jan. 2004 to Apr. 2005, silver clips were set around the root of the left gastric artery in 124 patients with esophageal and gastric cardia carcinoma, X-ray films at 0 degree and 90 degree simulator gantry in the radio- therapeutic position were taken. Then, the data of the superior, lower, left, right, anterior and posterior bor- der in each patient was recorded. With SAS 8.02 software, data of minimum area which covered the left gastric lymph node in different incidences were obtained. Results: According to the analysis of Shapiro-Wilk, Kolmogorov-Smimov, Cramervon Mises and Anderson-Darling tests, each border' was of normal distribution, with equal frequency in the male and female, despite the actual results in different genders. Pearson Correlation Coefficients analysis did not suggest a significant relationship between the border and height, weight and size of vertebrae, which formed the minimum area covering the left gastric area at frequency of 100%, 95%, 90% and 85%, which were drawn out through the calculation. Conclusions: Aiming at completely identifying the normal distribution of the left gastric lymph node, more patients are required to be in the pool. For the time being, location in the left gastric area can be obtained from details of the results in the present study. (authors)

  7. Individual structural differences in left inferior parietal area are associated with schoolchildrens’ arithmetic scores

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    Yongxin eLi

    2013-12-01

    Full Text Available Arithmetic skill is of critical importance for academic achievement, professional success and everyday life, and childhood is the key period to acquire this skill. Neuroimaging studies have identified that left parietal regions are a key neural substrate for representing arithmetic skill. Although the relationship between functional brain activity in left parietal regions and arithmetic skill has been studied in detail, it remains unclear about the relationship between arithmetic achievement and structural properties in left inferior parietal area in schoolchildren. The current study employed a combination of voxel-based morphometry (VBM for high-resolution T1-weighted images and fiber tracking on diffusion tensor imaging (DTI to examine the relationship between structural properties in the inferior parietal area and arithmetic achievement in 10-year-old schoolchildren. VBM of the T1-weighted images revealed that individual differences in arithmetic scores were significantly and positively correlated with the grey matter (GM volume in the left intraparietal sulcus (IPS. Fiber tracking analysis revealed that the forceps major, left superior longitudinal fasciculus (SLF, bilateral inferior longitudinal fasciculus (ILF and inferior fronto-occipital fasciculus (IFOF were the primary pathways connecting the left IPS with other brain areas. Furthermore, the regression analysis of the probabilistic pathways revealed a significant and positive correlation between the fractional anisotropy (FA values in the left SLF, ILF and bilateral IFOF and arithmetic scores. The brain structure-behavior correlation analyses indicated that the GM volumes in the left IPS and the FA values in the tract pathways connecting left IPS were both related to children’s arithmetic achievement. The present findings provide evidence that individual structural differences in the left IPS are associated with arithmetic scores in schoolchildren.

  8. Serpentinous structure in the right atrium

    Directory of Open Access Journals (Sweden)

    Monish S Raut

    2017-01-01

    Full Text Available Thin, slender, filament like structure is common finding in right atrium echocardiographically. These structures generally represent embryological remnants like thebasian valve, eustachian valve and chiari network. Apart from these variants, they can also be initial finding of thrombotic process specially in the presence of central venous catheter. Early detection and removing the catheter can prevent further thromboembolism in such cases.

  9. New Engineering Principles in Atrium Smoke Management

    DEFF Research Database (Denmark)

    Valkvist, Morten Birk Sabroe

    A typical atrium smoke management setup was divided into characteristic flow regions; axisymmetric plume, ceiling jet/approach flow, rotation region and spill plume. A grid convergence study was conducted on each of the flow regions in order to determine the non-dimensional grid resolution required...

  10. Spectroscopic photoacoustic imaging of radiofrequency ablation in the left atrium

    NARCIS (Netherlands)

    S. Iskander-Rizk (Sophinese); P. Kruizinga (Pieter); A.F.W. van der Steen (Ton); G. van Soest (Gijs)

    2018-01-01

    textabstractCatheter-based radiofrequency ablation for atrial fibrillation has long-term success in 60-70% of cases. A better assessment of lesion quality, depth, and continuity could improve the procedure’s outcome. We investigate here photoacoustic contrast between ablated and healthy atrial-wall

  11. Investigating atrium in hot and humid climate and providing ...

    African Journals Online (AJOL)

    Atrium has thermal comfort space since the old time by two methods of greenhouse effect and chimney effect. Now these questions are raised: What impact does atrium have in terms of performance in reducing energy consumption in buildings and how is the performance of atrium in the hot and humid climate, and how it ...

  12. The role of the left Brodmann's areas 44 and 45 in reading words and pseudowords

    OpenAIRE

    Heim, S.; Alter, K.; Ischebeck, A.; Amunts, K.; Eickhoff, S.; Mohlberg, H.; Zilles, K.; von Cramon, D.; Friederici, A.

    2005-01-01

    In this functional magnetic resonance imaging (fMRI) study, we investigated the influence of two task (lexical decision, LDT; phonological decision, PDT) on activation in Broca's region (left Brodmann's areas [BA] 44 and 45) during the processing of visually presented words and pseudowords. Reaction times were longer for pseudowords than words in LDT but did not differ in PDT. By combining the fMRI data with cytoarchitectonic anatomical probability maps, we demonstrated that the left BA 44 an...

  13. Increased FDG uptake in the wall of the right atrium in people who participated in a cancer screening program with whole-body PET

    International Nuclear Information System (INIS)

    Fujii, Hirofumi; Ide, Michiru; Yasuda, Seiei; Takahashi, Wakoh; Shohtsu, Akira; Kubo, Atsushi

    1999-01-01

    The purpose of this study was to evaluate the characteristics of patients who showed increased FDG uptake in the wall of the right atrium. We have encountered 10 patients with increased activity in the wall of the right atrium among a total of 2,367 examinees who participated in our cancer screening program with whole-body PET. The mean age of these examinees was 62.9 yr, higher than that of the total population. All suffered from cardiac disorders, especially atrial fibrillation. FDG accumulated almost exclusively in the wall of the right atrium, whereas only slight activity was seen in the wall of the left atrium. Although the average size of the right atria was significantly enlarged, left atria were more severely dilated than right ones. Therefore overload does not seem to account for the FDG accumulation in the wall of the right atrium. In conclusion, the increased activity in the wall of the right atrium was a rare finding that was made in older people who suffered from cardiac disease. Although the mechanism of induction of the high metabolic state of glucose in the wall of the right atrium remains unclear, this unusual activity would be another false positive finding in cancer screening with whole-body FDG PET. (author)

  14. Cor triatriatum or divided atriums: which approach provides the better understanding?

    Science.gov (United States)

    Bharucha, Tara; Spicer, Diane E; Mohun, Timothy J; Black, David; Henry, G William; Anderson, Robert H

    2015-02-01

    It is frequent, in the current era, to encounter congenital cardiac malformations described in terms of "cor triatriatum". But can hearts be truly found with three atrial chambers? The morphological method, emphasised by Van Praagh et al, states that structures within the heart should be defined on the basis of their most constant components. In the atrial chambers, it is the appendages that are the most constant components, and to the best of our knowledge, hearts can only possess two appendages, which can be of either right or left morphology. The hearts described on the basis of "cor triatriatum", nonetheless, can also be analysed on the basis of division of either the morphologically right or the morphologically left atriums. In this review, we provide a description of cardiac embryology, showing how each of the atrial chambers possesses part of the embryological body, along with an appendage, a vestibule, a venous component, and a septum that separates them. We then show how it is, indeed, the case that the hearts described in terms of "cor triatriatum" can be readily understood on the basis of division of these atrial components. In the right atrium, it is the venous valves that divide the chamber. In the left atrium, it is harder to provide an explanation for the shelf that produces atrial division. We also contrast the classic examples of the divided atrial chambers with the vestibular shelf that produces supravalvar stenosis in the morphologically left atrium, showing that this form of obstruction needs to be distinguished from the fibrous shelves producing intravalvar obstruction.

  15. To leave an area after disaster: how evacuees from the WTC buildings left the WTC area following the attacks.

    Science.gov (United States)

    Zimmerman, Rae; Sherman, Martin F

    2011-05-01

    How people leave a devastated area after a disaster is critical to understanding their ability to cope with risks they face while evacuating. Knowledge of their needs for communications about these risks is particularly crucial in planning for emergency responses. A convenience sample of 1,444 persons who survived the World Trade Center (WTC) attacks on September 11, 2001 were surveyed to ascertain their initial and ultimate destinations once they had left the buildings, how they arrived there, the role of types of obstacles they encountered, and the need for information and the seeking of other people as potential factors in influencing the process of leaving immediately. This survey was part of a larger, original survey. Results showed differences in how people traveled by mode to initial and ultimate destinations, how immediately they left the area, and factors associated with when they left. How they traveled and when they left were associated with where people lived, their tendency in times of stress to seek out other people including who they knew in the immediate area (e.g., co-workers or friends), the physical conditions surrounding them, and the importance to some of waiting for more information. Many people indicated they did not leave immediately because they had no information about where to go or what services would be available to them. Perceptions and communications about risks they were facing were reflected in the choices they considered in how and when to leave the area. These findings have numerous ramifications for understanding and guiding personal behavior in catastrophic situations. © 2010 Society for Risk Analysis.

  16. Mediastinal lymphoma eroding the right atrium

    International Nuclear Information System (INIS)

    Saeed, S.; Mangi, S.A.; Ahmad, R.; Rashid, A.

    2013-01-01

    Primary cardiac tumours are an uncommon cause of intra-cardiac mass. Most common intra-cardiac mass is thrombus followed by infiltrating secondary cardiac tumours. These secondary tumours are more likely to invade the cardiac chambers when they arise from close vicinity of the heart. We report an unusual case of mediastinal lymphoma in a 55 years old lady presenting as an intra-cardiac mass in the right atrium, which was detected by a transthoracic echocardiogram and later confirmed with more specific modalities. (author)

  17. Functional MRI evaluation of supplementary motor area language dominance in right- and left-handed subjects.

    Science.gov (United States)

    Dalacorte, Amauri; Portuguez, Mirna Wetters; Maurer das Neves, Carlos Magno; Anes, Maurício; Dacosta, Jaderson Costa

    2012-01-01

    Functional magnetic resonance imaging (fMRI) is a non-invasive brain imaging technique widely used in the evaluation of the brain function that provides images with high temporal and spatial resolution. Investigation of the supplementary motor area (SMA) function is critical in the pre-surgical evaluation of neurological patients, since marked individual differences and complex overlapping with adjacent cortical areas exist, and it is important to spare the SMA from lesions when adjacent cortical tissue is surgically removed. We used fMRI to assess the activity of SMA in six right-handed and six left-handed healthy volunteers when a task requiring silent repetition of a series of words was given. Brain activation areas in each of the subjects were localized according to the standard Talairach coordinate space, and the individual voxels for each map were compared after 3D sagittal images were created and SMA was delimited. Quantitative analysis of hemispheric and bilateral SMA activation was described as mean ± standard deviation of hot points/total points. The results show that the language task induced bilateral SMA activation. Left SMA activation was significantly higher than right SMA activation in both right-handed and left-handed subjects.

  18. The role of left supplementary motor area in grip force scaling.

    Directory of Open Access Journals (Sweden)

    Olivier White

    Full Text Available Skilled tool use and object manipulation critically relies on the ability to scale anticipatorily the grip force (GF in relation to object dynamics. This predictive behaviour entails that the nervous system is able to store, and then select, the appropriate internal representation of common object dynamics, allowing GF to be applied in parallel with the arm motor commands. Although psychophysical studies have provided strong evidence supporting the existence of internal representations of object dynamics, known as "internal models", their neural correlates are still debated. Because functional neuroimaging studies have repeatedly designated the supplementary motor area (SMA as a possible candidate involved in internal model implementation, we used repetitive transcranial magnetic stimulation (rTMS to interfere with the normal functioning of left or right SMA in healthy participants performing a grip-lift task with either hand. TMS applied over the left, but not right, SMA yielded an increase in both GF and GF rate, irrespective of the hand used to perform the task, and only when TMS was delivered 130-180 ms before the fingers contacted the object. We also found that both left and right SMA rTMS led to a decrease in preload phase durations for contralateral hand movements. The present study suggests that left SMA is a crucial node in the network processing the internal representation of object dynamics although further experiments are required to rule out that TMS does not affect the GF gain. The present finding also further substantiates the left hemisphere dominance in scaling GF.

  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. Comparison of four echocardiographic methods to determine left atrial size in dogs

    DEFF Research Database (Denmark)

    Höllmer, Miriam; Willesen, Jakob; Tolver, Anders

    2016-01-01

    breeds, 88 healthy dogs and 88 dogs with myxomatous mitral valve disease of different disease severity. METHODS: The left apical four- and two-chamber views were used to measure LA volumes. The right parasternal short-axis view at the level of the heart base was used to measure the LA/Ao ratio. RESULTS......OBJECTIVES: To compare a linear and three volume-based two-dimensional echocardiographic methods for measuring LA size: left atrium to aorta ratio (LA/Ao ratio), biplane area-length, biplane modified Simpson and monoplane area-length. ANIMALS: One hundred seventy-six client-owned dogs of different...

  1. Left posterior-dorsal area 44 couples with parietal areas to promote speech fluency, while right area 44 activity promotes the stopping of motor responses.

    Science.gov (United States)

    Neef, Nicole E; Bütfering, Christoph; Anwander, Alfred; Friederici, Angela D; Paulus, Walter; Sommer, Martin

    2016-11-15

    Area 44 is a cytoarchitectonically distinct portion of Broca's region. Parallel and overlapping large-scale networks couple with this region thereby orchestrating heterogeneous language, cognitive, and motor functions. In the context of stuttering, area 44 frequently comes into focus because structural and physiological irregularities affect developmental trajectories, stuttering severity, persistency, and etiology. A remarkable phenomenon accompanying stuttering is the preserved ability to sing. Speaking and singing are connatural behaviours recruiting largely overlapping brain networks including left and right area 44. Analysing which potential subregions of area 44 are malfunctioning in adults who stutter, and what effectively suppresses stuttering during singing, may provide a better understanding of the coordination and reorganization of large-scale brain networks dedicated to speaking and singing in general. We used fMRI to investigate functionally distinct subregions of area 44 during imagery of speaking and imaginary of humming a melody in 15 dextral males who stutter and 17 matched control participants. Our results are fourfold. First, stuttering was specifically linked to a reduced activation of left posterior-dorsal area 44, a subregion that is involved in speech production, including phonological word processing, pitch processing, working memory processes, sequencing, motor planning, pseudoword learning, and action inhibition. Second, functional coupling between left posterior area 44 and left inferior parietal lobule was deficient in stuttering. Third, despite the preserved ability to sing, males who stutter showed bilaterally a reduced activation of area 44 when imagine humming a melody, suggesting that this fluency-enhancing condition seems to bypass posterior-dorsal area 44 to achieve fluency. Fourth, time courses of the posterior subregions in area 44 showed delayed peak activations in the right hemisphere in both groups, possibly signaling the

  2. Perturbation of the left inferior frontal gyrus triggers adaptive plasticity in the right homologous area during speech production

    DEFF Research Database (Denmark)

    Hartwigsen, Gesa; Saur, Dorothee; Price, Cathy J

    2013-01-01

    The role of the right hemisphere in aphasia recovery after left hemisphere damage remains unclear. Increased activation of the right hemisphere has been observed after left hemisphere damage. This may simply reflect a release from transcallosal inhibition that does not contribute to language...... hemisphere lesion. Our findings lend further support to the notion that increased activation of homologous right hemisphere areas supports aphasia recovery after left hemisphere damage....

  3. Structural and molecular pathology of the atrium in boxer arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Vila, J; Pariaut, R; Moïse, N S; Oxford, E M; Fox, P R; Reynolds, C A; Saelinger, C

    2017-02-01

    To investigate the expression and distribution of desmosomal and gap junction proteins of the intercalated disc in the atria of boxers with arrhythmogenic right ventricular cardiomyopathy (ARVC). Nineteen control dogs and 13 boxers with histopathologically confirmed ARVC. Right and left atrial samples were examined using immunofluorescence and Western blots. The intercalated disc proteins investigated included total and phosphorylated connexin43 (Cx43 and pCx43), connexin45, connexin40, plakoglobin, plakophilin-2, desmoplakin, and N-cadherin. Histopathological changes characteristic of ARVC were present in the left or right atrium of 12 out of 13 boxers and were absent in all control dogs. When compared to the 19 control dogs, immunofluorescence analysis revealed a decrease in signal intensity for pCx43 and plakoglobin in the left (p = 0.03 and p = 0.014, respectively) and right atrium (p = 0.015 and p = 0.002, respectively) of affected boxers. Connexin43 and pCx43 Western blot band density was significantly decreased in the left (p = 0.025 and p = 0.027, respectively) and right atrium (p = 0.001 and p = 0.044, respectively) of affected boxers. Altered intercalated disc and gap junction proteins were identified in atrial myocardium of ARVC boxers, supporting atrial involvement as part of this disorder. Reduction in pCx43 in conjunction with histological changes could represent the substrate for atrial arrhythmias associated with ARVC. Furthermore, these findings detected in boxer dogs, lend support for the broader term, arrhythmogenic cardiomyopathy, as preferred nomenclature used to describe this disease in humans. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Case Report: Giant Right Atrium in Rheumatic Mitral Disease

    Directory of Open Access Journals (Sweden)

    Deniz Demir

    2014-06-01

    Full Text Available Dilation and hypertrophy of the atria occur in patients with valvular heart disease especially in mitral regurgitation, mitral stenosis or tricuspid abnormalities. Dilatation of the atriums which occurs slowly in time, becomes evident with ritim disturbances and embolic events. We report a case of an unusual giant right atrium in context of rheumatic mitral stenosis, mitral regurgitation, pulmonar hypertansion and severe tricuspid regurgitation in a 40-year-old man who underwent succesfull operations as mitral valve replacement, Maze-IV radiofrequency ablation, right atrium atrioplasty and De Vega anuloplasty. [J Contemp Med 2014; 4(2.000: 98-102

  5. Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris.

    Science.gov (United States)

    Li, Yi-Fan; Li, Wei-Hong; Li, Zhao-Ping; Feng, Xin-Heng; Xu, Wei-Xian; Chen, Shao-Min; Gao, Wei

    2016-08-01

    The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index (LAAI) has predictive value for prognosis in patients with unstable angina pectoris (UAP). This study was aimed to assess the association between LAAI and outcomes in UAP patients. We enrolled a total of 391 in-hospital patients diagnosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of adverse cardiovascular (CV) events, including hospital readmission for angina pectoris, acute myocardial infarction (AMI), congestive heart failure (CHF), stroke and all-cause mortality. During a mean follow-up time of 26.3 ± 8.6 months, 98 adverse CV events occurred (84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality). In a multivariate Cox model, LAAI [OR: 1.140, 95% CI: 1.016-1.279, P = 0.026], diastolic blood pressure (OR: 0.976, 95% CI: 0.956-0.996, P = 0.020) and pulse pressure (OR: 1.020, 95% CI: 1.007-1.034, P = 0.004) were independent predictors for adverse CV events in UAP patients. LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.

  6. Inflammatory Myofibroblastic Tumor of the Right Atrium

    Directory of Open Access Journals (Sweden)

    Neerod K. Jha

    2010-01-01

    Full Text Available Cardiac inflammatory myofibroblastic tumor (IMT is a rare entity and is associated with distinct clinical, pathological and molecular features. The clinical behavior, natural history, biological potential, management and prognosis of such tumors are unclear. We present herewith an adolescent girl who presented with similar entity involving the junction of the right atrium and the inferior vena cava (IVC in association with thrombocytosis and IVC thrombosis leading to obstruction of blood flow. Diagnostic tools included imaging and immuno-histopathology studies. Surgical management included resection of the tumor and thrombo-embolectomy of the IVC under cardiopulmonary bypass. This case is unique due to association of complete obstruction of IVC caused by the strategic location of the tumor, thrombosis of vena cava and association of thrombocytosis. These features have not been reported yet in relation to the cardiac IMT. This report will help in better understanding and management of similar cases in terms of planning cannulation of femoral veins or application of total hypothermic circulatory arrest during cardiopulmonary bypass and prompt us to look for recurrence or metastasis during follow up using echocardiography and laboratory investigations. The possibility of IMT should be kept in the differential diagnosis of cardiac tumors especially in children and adolescents.

  7. Greater pre-stimulus effective connectivity from the left inferior frontal area to other areas is associated with better phonological decoding in dyslexic readers

    Directory of Open Access Journals (Sweden)

    Richard E Frye

    2010-12-01

    Full Text Available Functional neuroimaging studies suggest that neural networks that subserve reading are organized differently in dyslexic readers (DRs and typical readers (TRs, yet the hierarchical structure of these networks has not been well studied. We used Granger Causality (GC to examine the effective connectivity of the preparatory network that occurs prior to viewing a non-word stimulus that requires phonological decoding in 7 DRs and 10 TRs who were young adults. The neuromagnetic activity that occurred 500 ms prior to each rhyme trial was analyzed from sensors overlying the left and right inferior frontal areas (IFA, temporoparietal areas (TPA, and ventral occipitotemporal areas (VOTA within the low, medium, and high beta and gamma sub-bands. A mixed-model analysis determined whether connectivity to or from the left and right IFAs differed across connectivity direction (into vs. out of the IFAs, brain areas, reading group, and/or performance. Results indicated that greater connectivity in the low beta sub-band from the left IFA to other cortical areas was significantly related to better non-word rhyme discrimination in DRs but not TRs. This suggests that the left IFA is an important cortical area involved in compensating for poor phonological function in DRs. We suggest that the left IFA activates a wider-than usual network prior to each trial in the service of supporting otherwise effortful phonological decoding in DRs. The fact that the left IFA provides top-down activation to both posterior left hemispheres areas used by typical readers for phonological decoding and homologous right hemisphere areas is discussed. In contrast, within the high gamma sub-band, better performance was associated with decreased connectivity between the left IFA and other brain areas, in both reading groups. Overly strong gamma connectivity during the pre-stimulus period may interfere with subsequent transient activation and deactivation of sub-networks once the non

  8. Electroencephalographic (eeg coherence between visual and motor areas of the left and the right brain hemisphere while performing visuomotor task with the right and the left hand

    Directory of Open Access Journals (Sweden)

    Simon Brežan

    2007-09-01

    Full Text Available Background: Unilateral limb movements are based on the activation of contralateral primary motor cortex and the bilateral activation of premotor cortices. Performance of a visuomotor task requires a visuomotor integration between motor and visual cortical areas. The functional integration (»binding« of different brain areas, is probably mediated by the synchronous neuronal oscillatory activity, which can be determined by electroencephalographic (EEG coherence analysis. We introduced a new method of coherence analysis and compared coherence and power spectra in the left and right hemisphere for the right vs. left hand visuomotor task, hypothesizing that the increase in coherence and decrease in power spectra while performing the task would be greater in the contralateral hemisphere.Methods: We analyzed 6 healthy subjects and recorded their electroencephalogram during visuomotor task with the right or the left hand. For data analysis, a special Matlab computer programme was designed. The results were statistically analysed by a two-way analysis of variance, one-way analysis of variance and post-hoc t-tests with Bonferroni correction.Results: We demonstrated a significant increase in coherence (p < 0.05 for the visuomotor task compared to control tasks in alpha (8–13 Hz in beta 1 (13–20 Hz frequency bands between visual and motor electrodes. There were no significant differences in coherence nor power spectra depending on the hand used. The changes of coherence and power spectra between both hemispheres were symmetrical.Conclusions: In previous studies, a specific increase of coherence and decrease of power spectra for the visuomotor task was found, but we found no conclusive asymmetries when performing the task with right vs. left hand. This could be explained in a way that increases in coherence and decreases of power spectra reflect symmetrical activation and cooperation between more complex visual and motor brain areas.

  9. Structural changes in left fusiform areas and associated fiber connections in children with abacus training: Evidence from morphometry and tractography

    Directory of Open Access Journals (Sweden)

    Yongxin eLi

    2013-07-01

    Full Text Available Evidence supports the notion that the fusiform gyrus (FG, as an integral part of the ventral occipitotemporal junction, is involved widely in cognitive processes as perceiving faces, objects, places or words, and this region also might represent the visual form of an abacus in the abacus-based mental calculation process. The current study uses a combined voxel-based morphometry (VBM and diffusion tensor imaging (DTI analysis to test whether long-term abacus training could induce structural changes in the left FG and in the white matter (WM tracts distribution connecting with this region in school children. We found that, abacus-trained children exhibited significant smaller grey matter (GM volume than controls in the left FG. And the connectivity mapping identified left forceps major as a key pathway connecting left FG with other brain areas in the trained group, but not in the controls. Furthermore, mean fractional anisotropy (FA values within left forceps major were significantly increased in the trained group. Interestingly, a significant negative correlation was found in the trained group between the GM volume in left FG and the mean FA value in left forceps major, suggesting an inverse effect of the reported GM and WM structural changes. In the control group, a positive correlation between left FG GM volume and tract FA was found as well. This analysis visualized the group level differences in GM volume, FA and fiber tract between the abacus-trained children and the controls, and provided the first evidence that GM volume change in the left FG is intimately linked with the micro-structural properties of the left forceps major tracts. The present results demonstrate the structural changes in the left FG from the intracortical GM to the subcortical WM regions and provide insights into the neural mechanism of structural plasticity induced by abacus training.

  10. Structural changes in left fusiform areas and associated fiber connections in children with abacus training: evidence from morphometry and tractography.

    Science.gov (United States)

    Li, Yongxin; Wang, Yunqi; Hu, Yuzheng; Liang, Yurong; Chen, Feiyan

    2013-01-01

    Evidence supports the notion that the fusiform gyrus (FG), as an integral part of the ventral occipitotemporal junction, is involved widely in cognitive processes as perceiving faces, objects, places or words, and this region also might represent the visual form of an abacus in the abacus-based mental calculation process. The current study uses a combined voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) analysis to test whether long-term abacus training could induce structural changes in the left FG and in the white matter (WM) tracts distribution connecting with this region in school children. We found that, abacus-trained children exhibited significant smaller gray matter (GM) volume than controls in the left FG. And the connectivity mapping identified left forceps major as a key pathway connecting left FG with other brain areas in the trained group, but not in the controls. Furthermore, mean fractional anisotropy (FA) values within left forceps major were significantly increased in the trained group. Interestingly, a significant negative correlation was found in the trained group between the GM volume in left FG and the mean FA value in left forceps major, suggesting an inverse effect of the reported GM and WM structural changes. In the control group, a positive correlation between left FG GM volume and tract FA was found as well. This analysis visualized the group level differences in GM volume, FA and fiber tract between the abacus-trained children and the controls, and provided the first evidence that GM volume change in the left FG is intimately linked with the micro-structural properties of the left forceps major tracts. The present results demonstrate the structural changes in the left FG from the intracortical GM to the subcortical WM regions and provide insights into the neural mechanism of structural plasticity induced by abacus training.

  11. The association between atrium electromechanical interval and pericardial fat.

    Directory of Open Access Journals (Sweden)

    Tze-Fan Chao

    Full Text Available OBJECTIVES: Pericardial fat (PCF may induce local inflammation and subsequent structural remodeling of the left atrium (LA. However, the adverse effects of PCF on LA are difficult to be evaluated and quantified. The atrial electromechanical interval determined by transthoracic echocardiogram was shown to be a convenient parameter which can reflect the process of LA remodeling. The goal of the present study was to investigate the association between the electromechanical interval and PCF. METHODS AND RESULTS: A total of 337 patients with mean age of 51.9 ± 9.0 years were enrolled. The electromechanical interval (PA-PDI defined as the time interval from the initiation of the P wave deflection to the peak of the mitral inflow A wave on the pulse wave Doppler imaging was measured for every patient. The amount of PCF was determined by multi-detector computed tomography. The PA-PDI interval was significantly correlated with the amount of PCF (r = 0.641, p value <0.001. Graded prolongation of PA-PDI interval was observed across 3 groups of patients divided according to the tertile values of PCF. The AUC for the PA-PDI interval in predicting an increased amount of PCF (third tertile was 0.796. At a cutoff value of 130 ms identified by the ROC curve, the sensitivity and specificity of PA-PDI interval in identifying patients with a highest tertile of PCF were 63.4% and 85.3%, respectively. CONCLUSIONS: The PA-PDI intervals were longer in patients with an increased amount of PCF. It may be a useful parameter to represent the degree of PCF-related atrial remodeling.

  12. Researching for sustained translation from site cluster permeability into building courtyard and interior atrium

    Science.gov (United States)

    Teddy Badai Samodra, FX; Defiana, Ima; Setyawan, Wahyu

    2018-03-01

    Many previous types of research have discussed the permeability of site cluster. Because of interaction and interconnected attribute, it will be better that there is its translation into lower context such as building and interior scale. In this paper, the sustainability design performance of both similar designs of courtyard and atrium are investigated continuing the recommendation of site space permeability. By researching related literature review and study through Ecotect Analysis and Ansys Fluent simulations, the pattern transformation and optimum courtyard and atrium design could comply the requirement. The results highlighted that the air movement from the site could be translated at the minimum of 50% higher to the building and indoor environment. Thus, it has potency for energy efficiency when grid, loop, and cul-de-sac site clusters, with 25% of ground coverage, have connectivity with building courtyard compared to the atrium. Energy saving is higher when using low thermal transmittance of transparent material and its lower area percentages for the courtyard walls. In general, it was more energy efficient option as part of a low rise building, while the courtyard building performed better with increasing irregular building height more than 90% of the difference.

  13. Pre-surgical evaluation of the cerebral tumor in the left language related areas by functional MRI

    International Nuclear Information System (INIS)

    Zou Zhitong; Ma Lin; Weng Xuchu

    2010-01-01

    Objective: To evaluate the application of combination of BOLD-fMRI and diffusion tensor tractography (DTT) in pre-operative evaluation of cerebral tumors located at the left language related areas. Methods: A non-vocal button pressing semantic judging paradigm was developed and validated in 10 right-handed volunteers at 3 T. After validation, this protocol combined with DTI were applied to 15 patients with left cerebral tumor prior to surgical resection, and 3 of them had aphasia. fMRI data analysis was on subject-specific basis by one-sampled t-test. The distance from the tumor to Broca area and pre-central 'hand-knot' area were measured separately. Functional language laterality index (LI) was calculated by taking out Broca area and Wernicke area. Three dimensional architecture of frontal lobe white matter fibers, especially arcuate fasciculus, were visualized using diffusion tensor tractography on Volume-one software. The images demonstrating relationship among tumor, language activation areas and white matter fibers were reviewed by neurosurgeons as part of pre-operative planning. One year after the operation, patients were followed up with MRI and language function test. Results: The non-vocal semantic judging paradigm successfully detect Broca area, Wernicke area and pre-central 'hand-knot' area. In 12 of 15 patients, the relationship of Broca area and pre-central motor area to the left brain tumor in language related areas was identified, which make the pre-operative neurosurgical plan applicable to minimize the disruption of language and motor. 8 patients had the left language dominant hemisphere, 3 patients with the right language dominant hemisphere and 1 patient with bilateral dominance. The other 3 patients' fMRI data were corrupted by patients' motion. Diffusion tensor images were corrupted by motion in 1 patient but demonstrated the impact of tumor on left accouter fasciculus in 14 patients. Diffusion tensor tractography showed disruption of left

  14. Daylighting in linear atrium buildings at high latitudes

    Energy Technology Data Exchange (ETDEWEB)

    Matusiak, Barbara

    1998-12-31

    This thesis proposes new criteria for visual comfort based on knowledge of visual perception and a method for estimating the modelling ability of light by using inter-reflection calculations. Simplified calculations are presented for the daylight factor in linear building structures, using the projected solid angle principle, for uniform sky and for CIE overcast sky conditions. The calculations are compared with experimental results. Simple diagrams are created based on calculations of the mean daylight factor in rooms adjacent to a narrow street. These diagrams and presented formulas and tables can be used as a simple design tool. Daylighting strategies for linear atrium buildings at high latitudes are developed and examined. These strategies are divided into three groups: (1) the atrium space and facades as light conductor/reflector, (2) the glass roof as a light conductor, and (3) light reflectors on the neighbouring roof. The atrium space and facade strategies are subdivided into passive and active. The strategies connected to the glazed roof includes different configurations of glazing: horizontal, single pitched, double pitched, and the use of laser cut panels and prismatic panels in the glazed roof. The shapes of reflectors on the neighbouring roof are a flat reflector, a parabolic reflector and a parabolic concentrator. Strategies from all three groups are examined on a physical model of scale 1:20 in the artificial sky of mirror box type. Simulations with artificial sun have also been done. The results from model studies are compared with computer simulations. All the active daylighting systems designed for use in the atrium space or on the atrium facades have a huge potential for use in atrium buildings. From the strategies connected with the glazed roof the negatively sloped glass is found to be the best alternative for glazed roofs at high latitudes. Among the roof reflectors, the flat one performs best. 82 refs., 122 figs., 27 tabs.

  15. Comparison of neurodegeneration between right and left hippocampus area in rats

    Directory of Open Access Journals (Sweden)

    Arezo Nahavandi

    2015-02-01

    Conclusion: Our study showed different manifestations of depression after UCMS. It showed that UCMS could lead to mental depression. This study showed that the right hippocampus was more sensitive to stress than the left hippocampus. In fact, UCMS resulted in depression. The study showed that the right hippocampus was more sensitive to stress than the left hippocampus. Therefore, the main function of the right hemisphere, which is adaptation to the new environment, is disturbed more.

  16. The Left Atrio-Vertebral Ratio: a new simple means for assessing left atrial enlargement on Computed Tomography.

    Science.gov (United States)

    Montillet, Marie; Baqué-Juston, Marie; Tasu, Jean-Pierre; Bertrand, Sandra; Berthier, Frédéric; Zarqane, Naïma; Brunner, Philippe

    2018-03-01

    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. • Left atrial enlargement is a frequent condition associated with poor cardiac outcome. • Left atrial enlargement is highly time-consuming to diagnose on CT. • The left atrio-vertebral ratio quickly assesses left atrial enlargement. • A left atrial area > three times vertebral area is highly specific.

  17. Antiarrhythmic Mechanisms of SK Channel Inhibition in the Rat Atrium

    DEFF Research Database (Denmark)

    Skibsbye, Lasse; Wang, Xiaodong; Axelsen, Lene Nygaard

    2015-01-01

    -clamping and two-electrode voltage-clamp was used to access INa and IK,ACh respectively. RESULTS: The SK channel inhibitor N-(pyridin-2-yl)-4-(pyridin-2-yl)thiazol-2-amine (ICA) exhibited antiarrhythmic effects. ICA prevented electrically induced runs of atrial fibrillation in the isolated right atrium and induced...

  18. Massively dilated right atrium masquerading as a mediastinal tumor

    Directory of Open Access Journals (Sweden)

    Thomas Schroeter

    2011-04-01

    Full Text Available Severe tricuspid valve insufficiency causes right atrial dilatation, venous congestion, and reduced atrial contractility, and may eventually lead to right heart failure. We report a case of a patient with severe tricuspid valve insufficiency, right heart failure, and a massively dilated right atrium. The enormously dilated atrium compressed the right lung, resulting in a radiographic appearance of a mediastinal tumor. Tricuspid valve repair and reduction of the right atrium was performed. Follow up examination revealed improvement of liver function, reduced peripheral edema and improved New York Heart Association (NYHA class. The reduction of the atrial size and repair of the tricuspid valve resulted in a restoration of the conduit and reservoir function of the right atrium. Given the chronicity of the disease process and the long-standing atrial fibrillation, there is no impact of this operation on right atrial contraction. In combination with the reconstruction of the tricuspid valve, the reduction atrioplasty will reduce the risk of thrombembolic events and preserve the right ventricular function.

  19. Atrial fibrillation: effects beyond the atrium?

    Science.gov (United States)

    Wijesurendra, Rohan S; Casadei, Barbara

    2015-03-01

    Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and an estimated two-fold increase in premature death. Efforts to increase our understanding of AF and its complications have focused on unravelling the mechanisms of electrical and structural remodelling of the atrial myocardium. Yet, it is increasingly recognized that AF is more than an atrial disease, being associated with systemic inflammation, endothelial dysfunction, and adverse effects on the structure and function of the left ventricular myocardium that may be prognostically important. Here, we review the molecular and in vivo evidence that underpins current knowledge regarding the effects of human or experimental AF on the ventricular myocardium. Potential mechanisms are explored including diffuse ventricular fibrosis, focal myocardial scarring, and impaired myocardial perfusion and perfusion reserve. The complex relationship between AF, systemic inflammation, as well as endothelial/microvascular dysfunction and the effects of AF on ventricular calcium handling and oxidative stress are also addressed. Finally, consideration is given to the clinical implications of these observations and concepts, with particular reference to rate vs. rhythm control. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  20. Importance of the left auditory areas in chord discrimination in music experts as demonstrated by MEG.

    Science.gov (United States)

    Tervaniemi, Mari; Sannemann, Christian; Noyranen, Maiju; Salonen, Johanna; Pihko, Elina

    2011-08-01

    The brain basis behind musical competence in its various forms is not yet known. To determine the pattern of hemispheric lateralization during sound-change discrimination, we recorded the magnetic counterpart of the electrical mismatch negativity (MMNm) responses in professional musicians, musical participants (with high scores in the musicality tests but without professional training in music) and non-musicians. While watching a silenced video, they were presented with short sounds with frequency and duration deviants and C major chords with C minor chords as deviants. MMNm to chord deviants was stronger in both musicians and musical participants than in non-musicians, particularly in their left hemisphere. No group differences were obtained in the MMNm strength in the right hemisphere in any of the conditions or in the left hemisphere in the case of frequency or duration deviants. Thus, in addition to professional training in music, musical aptitude (combined with lower-level musical training) is also reflected in brain functioning related to sound discrimination. The present magnetoencephalographic evidence therefore indicates that the sound discrimination abilities may be differentially distributed in the brain in musically competent and naïve participants, especially in a musical context established by chord stimuli: the higher forms of musical competence engage both auditory cortices in an integrative manner. © 2011 The Authors. European Journal of Neuroscience © 2011 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

  1. Early morphogenesis of the sinuatrial region of the chick heart: a contribution to the understanding of the pathogenesis of direct pulmonary venous connections to the right atrium and atrial septal defects in hearts with right isomerism of the atrial appendages.

    Science.gov (United States)

    Männer, Jörg; Merkel, Nico

    2007-02-01

    The morphogenesis of the sinuatrial region of embryonic hearts is still not well understood. Current matters of dispute are the topogenesis of the future pulmonary vein orifice and the topogenesis of the primary atrial septum. We analyzed the development of the sinuatrial region in chick embryos ranging from Hamburger and Hamilton (HH) stage 14 to 25. Our study disclosed three features of sinuatrial development. First, the primitive atrium of the HH stage 16 chick embryo heart has a separate inflow component. This inflow component takes up the mouth of the confluence of the systemic veins (sinus venosus) as well as the future mouth of the common pulmonary vein (pulmonary pit). The left portion of the atrial inflow component becomes incorporated into the left atrium and its right portion becomes incorporated into the right atrium. Rightward growth of the sinuatrial fold separates the sinus venosus from the left atrium. Second, the pulmonary pit originally forms as a bilaterally paired structure. Its left and right portions are connected to the left and right portions of the atrial inflow component, respectively. Normally, only the left portion of the pulmonary pit deepens to form the common pulmonary vein orifice, whereas the right portion disappears. Third, the primary atrial septum of the chick heart is not formed at the original midline of the embryonic heart, but is formed to the left of the original midline. This finding is in accord with molecular data suggesting that the primary atrial septum derives from the left heart-forming field. Our findings shed new light on the pathogenesis of direct pulmonary venous connections to the right atrium and atrial septal defects in hearts with right isomerism of the atrial appendages.

  2. EFFECTS OF AEROBIC TRAINING ON THE CARDIOMYOCYTES OF THE RIGHT ATRIUM OF MICE

    Directory of Open Access Journals (Sweden)

    Vanessa Gonçalves Coutinho de Oliveira

    Full Text Available ABSTRACT Introduction: Polypeptide hormones (natriuretic peptides, NPs are secreted by the cardiac atria and play an important role in the regulation of blood pressure. Objective: To evaluate the effects of aerobic training on the secretory apparatus of NPs in cardiomyocytes of the right atrium. Methods: Nine-month-old mice were divided in two groups (n=10: control group (CG and trained group (TG. The training protocol was performed on a motor treadmill for 8 weeks. Systolic blood pressure was measured at the beginning of the experiment (9 months of age and at moment of the sacrifice (11 months of age. Electron micrographs were used to quantify the following variables: the quantitative density and area of NP granules, the relative volumes of the mitochondria, endoplasmic reticulum, and Golgi complex and the relative volume of euchromatin in the nucleus and the number of pores per 10 µm of the nuclear membrane. The results were compared by Student's t test (p< 0.05. Results: The cardiomyocytes obtained from TG mice showed increased density and sectional area of secretory granules of NP, higher relative volume of endoplasmic reticulum, mitochondria, and Golgi complex compared with the CG mice. Furthermore, the quantitative density of nuclear pores and the relative volume of euchromatin in the nucleus were significantly higher compared with the CG mice. Conclusion: Aerobic training caused hypertrophy of the secretory apparatus in the cardiomyocytes of right atrium, which could explain the intense synthesis of natriuretic peptides in trained mice with respect to the untrained mice.

  3. Influence of hypertensive left ventricular hypertrophy on detection of ischemic area with exercise thallium-201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Toyama, Takuji; Nishimura, Tsunehiko; Uehara, Toshiisa

    1992-01-01

    Sixty-four patients with single left anterior descending artery disease having effort angina (group A: 40 patients with hypertrophic hypertension, group B: 10 patients with hypertrophic hypertension, group C: 14 patients with non-hypertrophic hypertension) were assessed to determine the influence of hypertensive left ventricular (LV) hypertrophy on detection of ischemic area. The criterion of hypertrophy by two-dimensional echocardiography was >12 mm in the wall thickness of interventricular septal or posterior wall. Population in Group B might show low detectability in ischemic area by 201 Tl myocardial scintigraphy (positive thallium rate 60%, defect score 2.7±3.6), and high lung thallium uptake and high frequence of ECG positive among three groups. In semiquantitative analysis, the washout rate of the posterolateral wall and %RD (delayed %uptake-initial %uptake) of the septal wall in patients with Group B were lowest among three groups. However, the washout rate in the septal wall against the posterior wall, and the initial %uptake and the delayed %uptake of the septal wall were not significantly different among three groups. We could conclude that the decreased washout rate in nonischemic area with hypertensive LV hypertrophy might make the ischemic area masked. (author)

  4. Successful surgical osteoplasty of the left main coronary artery with concomitant mitral valve replacement and tricuspid annuloplasty

    Directory of Open Access Journals (Sweden)

    Ujjwal Kumar Chowdhury

    2017-01-01

    Full Text Available A 50-year-old woman with rheumatic heart disease, mitral stenosis, and critical isolated left main ostial stenosis was successfully treated by mitral valve replacement, tricuspid annuloplasty, and surgery of left main osteoplasty and is reported for its rarity. Notable clinical findings included an intermittently irregular pulse, blood pressure of 100/70 mmHg, cardiomegaly, a diastolic precordial thrill, a mid-diastolic murmur without presystolic accentuation that was loudest at the mitral area. Chest radiograph revealed cardiomegaly with a cardiothoracic ratio of 0.7 due to enlarged right atrium, right ventricle with a straightened left heart border and evidence of pulmonary hypertension. The investigation shows that surgical reconstruction of the left main coronary artery is safe and effective for the treatment.

  5. Areas of Left Perisylvian Cortex Mediate Auditory-Verbal Short-Term Memory

    Science.gov (United States)

    Koenigs, Michael; Acheson, Daniel J.; Barbey, Aron K.; Solomon, Jeffrey; Postle, Bradley R.; Grafman, Jordan

    2011-01-01

    A contentious issue in memory research is whether verbal short-term memory (STM) depends on a neural system specifically dedicated to the temporary maintenance of information, or instead relies on the same brain areas subserving the comprehension and production of language. In this study, we examined a large sample of adults with acquired brain…

  6. The hemodynamic response to dopamine and nitroprusside following right atrium-pulmonary artery bypass (Fontan procedure).

    Science.gov (United States)

    Williams, D B; Kiernan, P D; Schaff, H V; Marsh, H M; Danielson, G K

    1982-07-01

    Cardiac output is critically dependent upon pulmonary vascular resistance after right atrium-pulmonary artery bypass (Fontan procedure), since there is no pulmonary ventricle in the circulation. Inotropic agents, including dopamine, may increase pulmonary vascular resistance and, therefore, might have an adverse effect on cardiac output. The present study determined the hemodynamic responses to dopamine and nitroprusside of 9 patients following right atrium-pulmonary artery bypass. Particular attention was given to effects on cardiac output (CI), pulmonary vascular resistance, and right atrial pressure (RAP). Baseline hemodynamic data were measured without drugs, with dopamine at 7.5 micrograms/kg/min, with sodium nitroprusside up to 5.0 micrograms/kg/min, and with a combination of dopamine, 7.5 micrograms/kg/min, and sodium nitroprusside, 1.0 micrograms/kg/min. Right and left atrial pressures (LAP), mean arterial blood pressure (BP), heart rate (HR), and CI were measured. Stroke volume index and pulmonary arteriolar resistance index were calculated. The increase in CI from baseline (1.98 +/- 0.86 liters per minute) was significant for infusions of dopamine (2.75 +/- 1.05, p less than 0.001), sodium nitroprusside (2.57 +/- 0.78, p less than 0.001), and both drugs (2.74 +/- 0.84, p less than 0.001). The increased CI was achieved primarily by a significant increase in HR with dopamine and by an increase in stroke volume index with sodium nitroprusside. With a similar increment in CI, the RAP was significantly decreased from baseline (21 +/- 4 torr) with sodium nitroprusside (15 +/- 3, p less than 0.001) but was unchanged with dopamine. Pulmonary arteriolar resistance index decreased significantly from baseline (375 +/- 230 dynes sec cm-5/m2) with sodium nitroprusside (169 +/- 132, p less than 0.001), and, interestingly, with dopamine as well (273 +/- 165, p less than 0.05). Both dopamine and sodium nitroprusside in these dosages have favorable effects on CI and

  7. T-wave area predicts response to cardiac resynchronization therapy in patients with left bundle branch block.

    Science.gov (United States)

    Engels, Elien B; Végh, Eszter M; Van Deursen, Caroline J M; Vernooy, Kevin; Singh, Jagmeet P; Prinzen, Frits W

    2015-02-01

    Chronic heart failure patients with a left ventricular (LV) conduction delay, mostly due to left bundle branch block (LBBB), generally derive benefit from cardiac resynchronization therapy (CRT). However, 30-50% of patients do not show a clear response to CRT. We investigated whether T-wave analysis of the ECG can improve patient selection. The study population comprised 244 CRT recipients with baseline 12-lead electrocardiogram recordings. Echocardiographic response after 6-month CRT was defined as a ≥5% increase in LV ejection fraction (LVEF). Vectorcardiograms (VCGs) were constructed from the measured 12-lead ECGs using an adapted Kors algorithm on digitized ECGs. Logistic regression models indicated repolarization variables as good predictors of CRT response. The VCG-derived T-wave area predicted CRT response (odds ratio [OR] per 10 μVs increase 1.172 [P < 0.001]) even better than QRS-wave area (OR = 1.116 [P = 0.001]). T-wave area had especially predictive value in the LBBB patient group (OR = 2.77 in LBBB vs. 1.09 in non-LBBB). This predictive value persisted after adjustment of multiple covariates, such as gender, ischemia, age, hypertension, coronary artery bypass graft, and the usage of diuretics and β-blockers. In LBBB patients, the increase in LVEF was 6.1 ± 9.7% and 11.3 ± 9.1% in patients with T-wave area below and above the median value, respectively (P < 0.01). In patients with LBBB morphology of the QRS complex, a larger baseline T-wave area is an important independent predictor of LVEF increase following CRT. © 2014 Wiley Periodicals, Inc.

  8. High-Frequency Electroencephalographic Activity in Left Temporal Area Is Associated with Pleasant Emotion Induced by Video Clips

    Directory of Open Access Journals (Sweden)

    Jukka Kortelainen

    2015-01-01

    Full Text Available Recent findings suggest that specific neural correlates for the key elements of basic emotions do exist and can be identified by neuroimaging techniques. In this paper, electroencephalogram (EEG is used to explore the markers for video-induced emotions. The problem is approached from a classifier perspective: the features that perform best in classifying person’s valence and arousal while watching video clips with audiovisual emotional content are searched from a large feature set constructed from the EEG spectral powers of single channels as well as power differences between specific channel pairs. The feature selection is carried out using a sequential forward floating search method and is done separately for the classification of valence and arousal, both derived from the emotional keyword that the subject had chosen after seeing the clips. The proposed classifier-based approach reveals a clear association between the increased high-frequency (15–32 Hz activity in the left temporal area and the clips described as “pleasant” in the valence and “medium arousal” in the arousal scale. These clips represent the emotional keywords amusement and joy/happiness. The finding suggests the occurrence of a specific neural activation during video-induced pleasant emotion and the possibility to detect this from the left temporal area using EEG.

  9. Primary malignant fibrous histiocytoma involving the left pulmonary vein presenting as a left atrial tumor

    Directory of Open Access Journals (Sweden)

    Saikat Bandyopadhyay

    2013-01-01

    Full Text Available A 35-year-old woman presented with 4 months history of progressively increasing intermittent dyspnea and hemoptysis. Transthoracic echocardiography revealed a loculated mass in the left atrium (LA. A provisional diagnosis of LA myxoma was made. Intraoperatively the tumor was found extending into and closely adherent to the left pulmonary vein and could not be completely cleared off from the pulmonary venous wall. The histopathological examination of the tumor revealed it to be a myxoid malignant fibrous histiocytoma.

  10. Right coronary fistula and aneurysm draining to the right atrium.

    Science.gov (United States)

    Pesonen, Erkki; Hochbergs, Peter

    2009-09-01

    In a 3-year-old boy, a continuous heart murmur was heard. The echocardiogram showed a dilated right coronary artery suggesting the existence of a coronary fistula. A more detailed echocardiogram when the patient was sedated revealed a fistula leading to a large aneurysm and further to the right atrium. The accidental dissection and thrombosis during the interventional heart catheterization resulted in a closure of the fistula. A continuous heart murmur and a dilated coronary artery are the hallmarks of coronary fistula. Anatomic details of coronary fistula might be possible to see in an echocardiogram. Interventional heart catheterization is usually an adequate treatment option.

  11. Analysis and prediction of daylighting and energy performance in atrium spaces using daylight-linked lighting controls

    International Nuclear Information System (INIS)

    Chow, Stanley K.H.; Li, Danny H.W.; Lee, Eric W.M.; Lam, Joseph C.

    2013-01-01

    Highlights: ► Daylight-linked lighting control and energy performance for atrium is studied. ► Field measurement of automatic dimming control shows 93% energy saving. ► Field measurement of manual on–off control shows 95% energy saving. ► Atrium illuminance is correlated with daylight factor for energy saving prediction. - Abstract: In subtropical Hong Kong, a certain amount of electricity is used to create visually comfortable interior spaces through electric lighting, which is the second major electricity-consuming item in commercial buildings, accounting for 20–30% of total electricity use. The burning of fossil fuels for electricity generation has many adverse effects on the environment. Daylighting is an important and useful strategy for enhancing visual comfort and reducing the need for the electricity consumed by light fittings. The rational use of daylight through tools such as photoelectric lighting controls can effectively reduce buildings’ electricity consumption and the related pollutants and greenhouse gas emissions. Daylighting design techniques are often best demonstrated via field measurements that provide reliable operational and energy performance data for establishing design guidelines. An atrium provides an environmentally controlled indoor public space that introduces daylight into the hearts of large buildings. In circulation areas such as corridors, people expect the way ahead to be sufficiently lit and daylight-linked lighting controls can deliver excellent energy savings. This paper presents the daylighting and energy performance of an atrium space using daylight-linked lighting controls. The cost, energy and environmental issues related to various daylight illuminances are estimated and design implications are discussed

  12. Simulation of Left Atrial Function Using a Multi-Scale Model of the Cardiovascular System

    Science.gov (United States)

    Pironet, Antoine; Dauby, Pierre C.; Paeme, Sabine; Kosta, Sarah; Chase, J. Geoffrey; Desaive, Thomas

    2013-01-01

    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. PMID:23755183

  13. 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.

  14. Comparison of left and right ventricular volume measurement using the Simpson's method and the area length method

    International Nuclear Information System (INIS)

    Hergan, Klaus; Schuster, Antonius; Fruehwald, Julia; Mair, Michael; Burger, Ralph; Toepker, Michael

    2008-01-01

    Purpose: To compare ventricular volume measurement using a volumetric approach in the three standard cardiac planes and ventricular volume estimation by a geometrical model, the Area-Length method (ALM). Materials and methods: Fifty-six healthy volunteers were examined (27 males, 29 females) on a 1.5 T MR-unit with ECG-triggered steady state free precision (SSFP) Cine-MR sequences and parallel image acquisition. Multiple slices in standardized planes including the short-axis view (sa), 4-chamber view (4ch), left and right 2-chamber views (2ch) were used to cover the whole heart. End-systolic and end-diastolic ventricular volumes (EDV, ESV), stroke volume (SV), and ejection fraction (EF) were calculated with Simpson's rule in all planes and with ALM in the 2ch and 4ch planes. Global function parameters measured in the sa plane were compared with those obtained in the other imaging planes. Results: A very good correlation is observed when comparing functional parameters calculated with Simpson's rule in all imaging planes: for instance, the mean EDV/ESV of the left and right ventricle of the female population group measured in sa, 4ch, and 2ch: left ventricle EDV/ESV 114.3/44.4, 120.9/46.5, and 117.7/45.3 ml; right ventricle EDV/ESV 106.6/46.0, 101.2/41.1, and 103.5/43.0 ml. Functional parameters of the left ventricle calculated with ALM in 2ch and 4ch correlate to parameters obtained in sa with Simpson's rule in the range of 5-10%: for instance, the EDV/ESV of the left ventricle of the male population group measured in the sa, 4ch, and 2ch: 160.3/63.5, 163.1/59.0, and 167.0/65.7 ml. Functional parameters of the right ventricle measured with ALM in 4ch are 40-50% lower and calculated in 2ch almost double as high as compared with the parameters obtained in sa with Simpson's rule: for instance, male right ventricular EDV/ESV measured in sa, 4ch, and 2ch: 153.4/68.1, 97.5/34.5, and 280.2/123.2 ml. The EF correlates for all imaging planes measured with the Simpson's rule

  15. Comparison of left and right ventricular volume measurement using the Simpson's method and the area length method

    Energy Technology Data Exchange (ETDEWEB)

    Hergan, Klaus [Department of Radiology, Paracelsus Medical University Salzburg (Austria)], E-mail: k.hergan@salk.at; Schuster, Antonius [Department of Radiology, LKH Feldkirch (Austria); Fruehwald, Julia [Department of Radiology, Medical University Vienna (Austria); Mair, Michael; Burger, Ralph; Toepker, Michael [Department of Radiology, LKH Feldkirch (Austria)

    2008-02-15

    Purpose: To compare ventricular volume measurement using a volumetric approach in the three standard cardiac planes and ventricular volume estimation by a geometrical model, the Area-Length method (ALM). Materials and methods: Fifty-six healthy volunteers were examined (27 males, 29 females) on a 1.5 T MR-unit with ECG-triggered steady state free precision (SSFP) Cine-MR sequences and parallel image acquisition. Multiple slices in standardized planes including the short-axis view (sa), 4-chamber view (4ch), left and right 2-chamber views (2ch) were used to cover the whole heart. End-systolic and end-diastolic ventricular volumes (EDV, ESV), stroke volume (SV), and ejection fraction (EF) were calculated with Simpson's rule in all planes and with ALM in the 2ch and 4ch planes. Global function parameters measured in the sa plane were compared with those obtained in the other imaging planes. Results: A very good correlation is observed when comparing functional parameters calculated with Simpson's rule in all imaging planes: for instance, the mean EDV/ESV of the left and right ventricle of the female population group measured in sa, 4ch, and 2ch: left ventricle EDV/ESV 114.3/44.4, 120.9/46.5, and 117.7/45.3 ml; right ventricle EDV/ESV 106.6/46.0, 101.2/41.1, and 103.5/43.0 ml. Functional parameters of the left ventricle calculated with ALM in 2ch and 4ch correlate to parameters obtained in sa with Simpson's rule in the range of 5-10%: for instance, the EDV/ESV of the left ventricle of the male population group measured in the sa, 4ch, and 2ch: 160.3/63.5, 163.1/59.0, and 167.0/65.7 ml. Functional parameters of the right ventricle measured with ALM in 4ch are 40-50% lower and calculated in 2ch almost double as high as compared with the parameters obtained in sa with Simpson's rule: for instance, male right ventricular EDV/ESV measured in sa, 4ch, and 2ch: 153.4/68.1, 97.5/34.5, and 280.2/123.2 ml. The EF correlates for all imaging planes measured

  16. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size

    DEFF Research Database (Denmark)

    Ersboll, M; Andersen, Mads Jønsson; Valeur, N.

    2013-01-01

    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 ...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    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 ...

  18. Gastric bare area and left adrenal gland involvement on abdominal computed tomography and their prognostic value in acute pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Zaiyi [Guangdong Provincial People' s Hospital, Department of Radiology, Guangzhou, Guangdong Province (China); Sichuan University, Department of Radiology, West China Hospital, Chengdu, Sichuan Province (China); Yan, Zhihan [Wenzhou Medical College, Department of Radiology, Second Affiliated Hospital, Wenzhou, Zhejiang Province (China); Min, Pengqiu [Sichuan University, Department of Radiology, West China Hospital, Chengdu, Sichuan Province (China); Liang, Changhong [Guangdong Provincial People' s Hospital, Department of Radiology, Guangzhou, Guangdong Province (China); Wang, Ying [Sun Yatsen University, Department of Medical Ultrasonics, First Affiliated Hospital, Guangzhou, Guangdong Province (China)

    2008-08-15

    To demonstrate the CT manifestations of gastric bare area involvement (GBAI) and left adrenal gland involvement (LAGI) in acute pancreatitis (AP) and evaluate their prognostic value. From January 2003 to December 2006, CT examinations of 116 patients with AP were retrospectively reviewed. There were 34 (29.3%) patients with GBAI showing haziness and streaky density or fluid collection in the gastric bare area, and 18 (15.5%) with LAGI showing deformity and hypoattenuation of left adrenal gland. The mean duration of hospital stay in patients with GBAI and LAGI was longer than that of patients without (P<0.001). The sensitivity and specificity of GBAI for predicting complications were 43.3% (0.31, 0.55) and 89.8% (0.81, 0.98), respectively; and 83.3% (0.36, 1.00) and 73.6% (0.65, 0.82) for predicting mortality. A patient with GBAI was 6.7 (2.4, 19.1) and 14.0 (1.6, 124.6) times more likely to have complications and die than was a patient without. The sensitivity and specificity of LAGI for predicting complications were 23.9% (0.14, 0.34) and 95.9% (0.86, 0.99), respectively, and 66.7% (0.22, 0.96) and 87.3% (0.81, 0.94) for predicting mortality. A patient with LAGI was 7.4 (1.6, 33.8) and 13.7 (2.3, 81.9) times more likely to have complications and die than was a patient without. Our results showed that GBAI and LAGI were characteristic CT findings in AP and could serve as useful prognostic indicators for this disease. (orig.)

  19. Controversies over the mechanisms underlying the crucial role of the left fronto-parietal areas in the representation of tools

    Directory of Open Access Journals (Sweden)

    Guido eGainotti

    2013-10-01

    Full Text Available Anatomo-clinical and neuroimaging data show that the left fronto-parietal areas play an important role in representing tools. As manipulation is an important source of knowledge about tools, it has been assumed that motor activity explains the link between tool knowledge and the left fronto-parietal areas. However, controversies exist over the exact mechanisms underlying this relationship. According to a strong version of the ‘embodied cognition theory’, activation of a tool concept necessarily involves re-enactment of the corresponding kind of action. Impairment of the ability to use tools should, therefore, lead to impairment of tool knowledge. Both the ‘domains of knowledge hypothesis’ and the ‘sensory-motor model of conceptual knowledge’ refute the strong version of the ‘embodied cognition hypothesis’ but acknowledge that manipulation and other action schemata play an important role in our knowledge of tools. The basic difference between these two models is that the former is based on an innatist model and the latter holds that the brain’s organization of categories is experience dependent. Data supporting and arguing against each of these models are briefly reviewed. In particular, the following lines of research, which argue against the innate nature of the brain’s categorical organization, are discussed: (1 the observation that in patients with category-specific disorders the semantic impairment does not respect the boundaries between biological entities and artefact items; (2 data showing that experience-driven neuroplasticity in musicians is not confined to alterations of perceptual and motor maps but also leads to the establishment of higher-level semantic representations for musical instruments; (3 results of experiments using previously unfamiliar materials showing that the history of our sensory-motor experience with an object significantly affects its neural representation.

  20. Common Atrium with Unusual Electrocardiogram in Ellis-van Creveld Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Amit Kumar

    2015-01-01

    This report describes a case of common atrium with unusual electrocardiographic findings in a patient with EVC syndrome. This 17-year-old male of Indian origin born of a consanguineous marriage had short stature, genu valgum, polydactyly, gingival hypertrophy, multiple frenula, common atrium, and right axis deviation of QRS with clockwise depolarization in electrocardiogram.

  1. Plant Atrium System for Food Production in NASA's Deep Space Habitat Tests

    Science.gov (United States)

    Massa, Gioia D.; Simpson, Morgan; Wheeler, Raymond M.; Newsham, Gerald; Stutte, Gary W.

    2013-01-01

    In preparation for future human exploration missions to space, NASA evaluates habitat concepts to assess integration issues, power requirements, crew operations, technology, and system performance. The concept of a Food Production System utilizes fresh foods, such as vegetables and small fruits, harvested on a continuous basis, to improve the crew's diet and quality of life. The system would need to fit conveniently into the habitat and not interfere with other components or operations. To test this concept, a plant growing "atrium" was designed to surround the lift between the lower and upper modules of the Deep Space Habitat and deployed at NASA Desert Research and Technology Studies (DRATS) test site in 2011 and at NASA Johnson Space Center in 2012. With this approach, no-utilized volume provided an area for vegetable growth. For the 2011 test, mizuna, lettuce, basil, radish and sweetpotato plants were grown in trays using commercially available red I blue LED light fixtures. Seedlings were transplanted into the atrium and cared for by the. crew. Plants were then harvested two weeks later following completion of the test. In 2012, mizuna, lettuce, and radish plants were grown similarly but under flat panel banks of white LEDs. In 2012, the crew went through plant harvesting, including sanitizing tlie leafy greens and radishes, which were then consumed. Each test demonstrated successful production of vegetables within a functional hab module. The round red I blue LEDs for the 2011 test lighting cast a purple light in the hab, and were less uniformly distributed over the plant trays. The white LED panels provided broad spectrum light with more uniform distribution. Post-test questionnaires showed that the crew enjoyed tending and consuming the plants and that the white LED light in 2012 provided welcome extra light for the main HAB AREA.

  2. Left atrium in cardiac resynchronization therapy: Active participant or innocent bystander

    Directory of Open Access Journals (Sweden)

    Haitham A. Badran

    2017-10-01

    Conclusions: CRT induces LA anatomic, electrical, and structural reverse remodeling that could be assessed by conventional 2D echocardiography and 2D (ɛ strain imaging. LA dimension and volumes were independent predictors of response to CRT and can help in selection of candidates for it.

  3. Idiopathic Pulmonary Vein Thrombus Extending into Left Atrium: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Muhammad Asim Rana

    2016-01-01

    Full Text Available Pulmonary vein thrombosis (PVT is rather an uncommon condition which presents nonspecifically and is usually associated with lung malignancy and major pulmonary surgery. Rarely could no cause be found. It causes increased pulmonary venous pressure leading to pulmonary arterial vasoconstriction and subsequent pulmonary arterial hypertension and subsequently can cause cor pulmonale if not addressed in timely fashion. Other associated complications like peripheral embolization and stroke have also been reported. This case emphasizes the importance of maintaining high index of clinical suspicion especially when CT pulmonary angiogram is negative for pulmonary embolism.

  4. Cerebral embolism complicating left atrial myxoma: a case report.

    Science.gov (United States)

    Ihsen, Zairi; Hela, Mssaad; Khadija, Mzoughi; Zouhayer, Jnifene

    2016-01-01

    Cardiac myxoma are the most common benign primary cardiac tumors that can lead to many complications as described in literature. Here we report the case of a boy aged 11 that was referred for etiological diagnosis of ischemic stroke. Transthoracic echocardiography reveals a myxoma in the left atrium. Patient was referred to surgery. The diagnosis was confirmed and the mass was completely resected.

  5. Left atrial calcification in a hemodialysis patient with cor triatriatum.

    Science.gov (United States)

    Peces, R; Pobes, A; Rodriguez, M; Simarro, C; Iglesias, G; Simarro, E

    2000-05-01

    Myocardial calcification is a rare manifestation of abnormal calcium metabolism seen in some patients with chronic renal failure. This report describes the transesophageal echocardiographic and spiral computed tomography (CT) findings in a young hemodialysis female with severe secondary hyperparathyroidism. These findings included calcification of the multiperforated membrane of a cor triatriatum and the wall of the left atrium.

  6. Diffuse Gallium-67 Accumulation in the Left Atrial Wall Detected Using SPECT/CT Fusion Images

    Directory of Open Access Journals (Sweden)

    Kohei Kotani

    2016-01-01

    Full Text Available Gallium-67 scintigraphy is useful for detecting active inflammation. We show a 66-year-old female patient with atrial fibrillation and diffuse thickening of the left atrial wall due to acute myocarditis, who presented diffuse abnormal accumulation of gallium-67 in the left atrium on single photon emission computed tomography/computed tomography (SPECT/CT fusion images. In the second gallium-67 scan 2 months after the first scintigraphy, the abnormal accumulation in the heart was no longer visible. Gallium-67 SPECT/CT images helped understanding the disease condition that temporary inflammation in the left atrium caused atrial fibrillation.

  7. Heart failure due to giant left atrial myxoma: a case report

    Directory of Open Access Journals (Sweden)

    Giuston Mendoza-Chuctaya

    2016-04-01

    Full Text Available Myxomas are frequent cardiac tumors that are mostly located in the left atrium. Their signs and symptoms are very varied and nonspecific, and depend on their behavior. We report the case of a 41-year-old female patient with a disease period of approximately 3 months, and a clinical picture suggesting heart failure characterized by respiratory difficulty at rest, chest pain, general malaise and edema on lower limbs. The EKG suggested left atrial growth, where transthoracic echocardiography was a key test for the diagnosis of a myxoma filling the entire left atrium, which was later excised by surgery and confirmed by pathological anatomy

  8. Changes in regional cerebral blood flow in the right cortex homologous to left language areas are directly affected by left hemispheric damage in aphasic stroke patients: evaluation by Tc-ECD SPECT and novel analytic software.

    Science.gov (United States)

    Uruma, G; Kakuda, W; Abo, M

    2010-03-01

    The objective of this study was to clarify the influence of regional cerebral blood flow (rCBF) changes in language-relevant areas of the dominant hemisphere on rCBF in each region in the non-dominant hemisphere in post-stroke aphasic patients. The study subjects were 27 aphasic patients who suffered their first symptomatic stroke in the left hemisphere. In each subject, we measured rCBF by means of 99mTc-ethylcysteinate dimmer single photon emission computed tomography (SPECT). The SPECT images were analyzed by the statistical imaging analysis programs easy Z-score Imaging System (eZIS) and voxel-based stereotactic extraction estimation (vbSEE). Segmented into Brodmann Area (BA) levels, Regions of Interest (ROIs) were set in language-relevant areas bilaterally, and changes in the relative rCBF as average negative and positive Z-values were computed fully automatically. To assess the relationship between rCBF changes of each ROIs in the left and right hemispheres, the Spearman ranked correlation analysis and stepwise multiple regression analysis were applied. Globally, a negative and asymmetric influence of rCBF changes in the language-relevant areas of the dominant hemisphere on the right hemisphere was found. The rCBF decrease in left BA22 significantly influenced the rCBF increase in right BA39, BA40, BA44 and BA45. The results suggested that the chronic increase in rCBF in the right language-relevant areas is due at least in part to reduction in the trancallosal inhibitory activity of the language-dominant left hemisphere caused by the stroke lesion itself and that these relationships are not always symmetric.

  9. Overlay Technique for Transcatheter Left Atrial Appendage Closure.

    Science.gov (United States)

    Li, Shuang; Zhu, Mengyun; Lu, Yunlan; Tang, Kai; Zhao, Dongdong; Chen, Wei; Xu, Yawei

    2015-08-01

    The Overlay technique is popular in peripheral artery interventions, but not in coronary or cardiac structural procedures. We present an initial experience using three-episode overlays during a transcatheter left atrial appendage closure. The first overlay was applied to facilitate advancement of the delivery sheath into left atrium. The second overlay was used to navigate the advancement of prepped delivery system containing the compressed occluder into its optimal position in the left atrium. The third overlay facilitated the real-time deployment of the closure device. This case report demonstrates the effectiveness of the overlay technique in facilitating each step of the transcatheter left atrial appendage closure. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  10. [Left ventricular hypertrophy in black African subjects with artery hypertension: Results of a cross-sectional survey conducted in semi-rural area in Senegal].

    Science.gov (United States)

    Mbaye, A; Dodo, B; Ngaïde, A A; Sy, N F; Babaka, K; Mingou, J S; Faye, M; Niang, K; Sarr, S A; Dioum, M; Bodian, M; Ndiaye, M B; Kane, A D; Ndour-Mbaye, M; Diao, M; Diack, B; Kane, M; Diagne-Sow, D; Thiaw, I; Kane, A

    2017-09-01

    To assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area. According to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P<0.05. We examined 1411 subjects aged on average of 48.5±12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men (P=0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female (P=0.0001; P=0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height 2.7 . LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index (P<0.0001) and the grade 3 of hypertension (P=0.003). Although rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Pulmonary vein tumor thrombosis and left atrial extension in lung carcinoma.

    Science.gov (United States)

    Koo, B C; Woldenberg, L S; Kim, K T

    1984-10-01

    A case of lung carcinoma extending into left atrium through a pulmonary vein and mimicking left atrial myxoma is presented. The localized enlargement of a pulmonary vein is seen as a possible CT sign of pulmonary vein tumor thrombosis. Computed tomography (CT) and echocardiography are complementary in the correct diagnosis of this condition.

  12. [Surface ECG characteristics of right and left atrial flutter].

    Science.gov (United States)

    Rostock, Thomas; Konrad, Torsten; Sonnenschein, Sebastian; Mollnau, Hanke; Ocete, Blanca Quesada; Bock, Karsten; Spittler, Raphael; Huber, Carola; Theis, Cathrin

    2015-09-01

    Atrial tachycardia in virtually all areas of both atria has become more important in the clinical management of patients with previous complex atrial fibrillation ablation. Accurate interpretation of surface electrocardiogram (ECG) characteristics is of paramount importance to localize the origin of atrial tachycardia, particularly for planning interventional treatment. This article highlights the ECG features of different types of right and left atrial tachycardia. Typical right atrial flutter through the cavotricuspid isthmus conducts septally in a cranial direction and demonstrates sawtooth-like flutter waves which start negative in II, III and aVF and then show a steep slope upwards to the isoelectric line. The flutter rate typically ranges between 240-250 beats/min. In contrast, right atrial flutter in a clockwise rotation, flutter around the vena cava inferior or superior and around a scar (e.g. after cardiac surgery) show positive or biphasic flutter waves (lower or upper loop reentry). Left atrial flutter waves (e.g. around the mitral valve or around the pulmonary veins) are very heterogeneous and are typically positive in V1 as the left atrium is located in the posterior mediastinum. Specific knowledge of flutter wave morphology in surface ECG facilitates planning and performance of the ablation strategy.

  13. Echocardiographic study of left atrial myxoma

    Directory of Open Access Journals (Sweden)

    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.

  14. Homeostatic Left Heart integration and disintegration links atrio-ventricular covariation's dyshomeostasis in Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Piras, Paolo; Torromeo, Concetta; Evangelista, Antonietta; Gabriele, Stefano; Esposito, Giuseppe; Nardinocchi, Paola; Teresi, Luciano; Madeo, Andrea; Schiariti, Michele; Varano, Valerio; Puddu, Paolo Emilio

    2017-07-24

    Left ventricle and left atrium are and have been practically always analyzed separately in common clinically and non-clinically oriented cardiovascular investigations. Both classic and speckle tracking echocardiographic data contributed to the knowledge about deformational impairments occurring in systo-diastolic differences. Recently new trajectory based approaches allowed a greater awareness about the entire left ventricle or left atrium revolution and on their deficiencies that take place in presence of hypertrophic cardiomyopathy. However, surprisingly, the concomitant function of the two left heart chambers has not been analyzed for their geometrical/mechanical relationship. For the first time we study here, by acquiring left ventricle and left atrial geometries on the same heartbeat, the trajectory attributes of the entire left heart treated as a whole shape and the shape covariation of its two subunits. We contrasted healthy subjects with patients affected by hypertrophic cardiomyopathy. We found impaired left heart trajectory mainly in terms of orientation and size. More importantly, we found profound differences in the direction of morphological covariation of left ventricle and left atrium. These findings open to new perspectives in pathophysiological evaluation of different diseases by allowing the appreciation of concomitant functioning of both left heart whole geometry and of its two chambers.

  15. Malignant inferior vena cava obstruction involving right atrium. Palliative treatment with self expandable metallic stent

    International Nuclear Information System (INIS)

    Shao Guoliang; Wang Jianhua; Zhou Kangrong; Yan Zhiping

    2001-01-01

    Objective: To investigate the safety and efficacy of placement of self-expandable metallic stent within right atrium and inferior vena cava (ICV) in patients with malignant ICV obstruction involving right atrium. Methods: There were 5 male patients with advanced hepatocellular carcinoma, aged from 42 to 65 years (mean 56.3 years). The malignancies invaded right atrium and ICV simultaneously, and caused obstruction of ICV. These patients presented symptoms and signs of obstruction of ICV such as hepatomegaly, ascites, edema of lower extremities. 'Z' type stainless steel stents (7.5-10.0 cm in length and 2.5 cm in diameter) were selected for these patients. Part (1.0-3.0 cm in length) of stent was placed in right atrium and the rest was in ICV. Results: All of stents were placed successfully and obstructed ICV reopened. The symptoms of obstruction of ICV relieved or disappeared. There were no recurrence of symptoms of obstruction of ICV and any cardiac complication related to placement of stents in follow-up period (67-188 days). Conclusion: Placement of self-expandable metallic stent within right atrium and ICV in treatment of patients with malignant ICV obstruction involving right atrium is one of the safe and effective methods

  16. [A case of combined sensation disturbance and clumsiness of the left hand caused by an infarction localized to brodmann areas 1 and 2].

    Science.gov (United States)

    Kutoku, Yumiko; Hagiwara, Hiroki; Ichikawa, Yaeko; Takeda, Katsuhiko; Sunada, Yoshihide

    2007-04-01

    A 70-year-old woman was admitted to our hospital with a complaint of numbness and clumsiness of the left hand. On physical examination 23 days after the onset of cerebral infarction, she showed no apparent muscle weakness. Although her elementary somatosensory function was mostly intact with a minimal joint position sensation disturbance, she showed disturbances in tactile recognition, two-point discrimination, and weight perception. She also had difficulty in discrete finger movement of her left hand, especially when her eyes were closed. Brain MRI disclosed a small infarction localized to Brodmann areas 1 and 2 in the right postcentral gyrus. In the left median nerve short-latency somatosensory evoked potentials (s-SEPs), the N20 potential was normally evoked. This finding also indicated that the area 3b was preserved. The sensory symptoms observed in this patient were compatible with the hierarchical somatosensory processing model in the postcentral gyrus proposed by Iwamura et al, in which the elementary sensation recognized in area 3 is transferred to areas 1 and 2, and then processed to discriminative sensation. The disturbed discrete finger movement in this patient probably resulted from impaired tactile recognition which could be compensated for by visual information.

  17. Simultaneous Epicardial and Noncontact Endocardial Mapping of the Canine Right Atrium: Simulation and Experiment

    Science.gov (United States)

    Sabouri, Sepideh; Matene, Elhacene; Vinet, Alain; Richer, Louis-Philippe; Cardinal, René; Armour, J. Andrew; Pagé, Pierre; Kus, Teresa; Jacquemet, Vincent

    2014-01-01

    Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes), noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter), and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression), activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa), a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments) and 0.96 (simulation) between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments) and 0.92 (simulation) between ATa values. Despite distance (balloon-atrial wall) and dimension reduction (64 electrodes), some information about atrial repolarization remained present in noncontact signals. PMID:24598778

  18. Simultaneous epicardial and noncontact endocardial mapping of the canine right atrium: simulation and experiment.

    Directory of Open Access Journals (Sweden)

    Sepideh Sabouri

    Full Text Available Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes, noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter, and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression, activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa, a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments and 0.96 (simulation between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments and 0.92 (simulation between ATa values. Despite distance (balloon-atrial wall and dimension reduction (64 electrodes, some information about atrial repolarization remained present in noncontact signals.

  19. Simultaneous epicardial and noncontact endocardial mapping of the canine right atrium: simulation and experiment.

    Science.gov (United States)

    Sabouri, Sepideh; Matene, Elhacene; Vinet, Alain; Richer, Louis-Philippe; Cardinal, René; Armour, J Andrew; Pagé, Pierre; Kus, Teresa; Jacquemet, Vincent

    2014-01-01

    Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes), noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter), and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression), activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa), a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments) and 0.96 (simulation) between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments) and 0.92 (simulation) between ATa values. Despite distance (balloon-atrial wall) and dimension reduction (64 electrodes), some information about atrial repolarization remained present in noncontact signals.

  20. 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...

  1. Left Atrial trajectory impairment in Hypertrophic Cardiomyopathy disclosed by Geometric Morphometrics and Parallel Transport

    Science.gov (United States)

    Piras, Paolo; Torromeo, Concetta; Re, Federica; Evangelista, Antonietta; Gabriele, Stefano; Esposito, Giuseppe; Nardinocchi, Paola; Teresi, Luciano; Madeo, Andrea; Chialastri, Claudia; Schiariti, Michele; Varano, Valerio; Uguccioni, Massimo; Puddu, Paolo E.

    2016-10-01

    The analysis of full Left Atrium (LA) deformation and whole LA deformational trajectory in time has been poorly investigated and, to the best of our knowledge, seldom discussed in patients with Hypertrophic Cardiomyopathy. Therefore, we considered 22 patients with Hypertrophic Cardiomyopathy (HCM) and 46 healthy subjects, investigated them by three-dimensional Speckle Tracking Echocardiography, and studied the derived landmark clouds via Geometric Morphometrics with Parallel Transport. Trajectory shape and trajectory size were different in Controls versus HCM and their classification powers had high AUC (Area Under the Receiving Operator Characteristic Curve) and accuracy. The two trajectories were much different at the transition between LA conduit and booster pump functions. Full shape and deformation analyses with trajectory analysis enabled a straightforward perception of pathophysiological consequences of HCM condition on LA functioning. It might be worthwhile to apply these techniques to look for novel pathophysiological approaches that may better define atrio-ventricular interaction.

  2. Four-dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis.

    Science.gov (United States)

    Deng, Yan; Peng, Long; Liu, Yuan-Yuan; Yin, Li-Xue; Li, Chun-Mei; Wang, Yi; Rao, Li

    2017-09-01

    The aim of this prospective study was to assess the diagnosis value of four-dimensional echocardiography area strain (AS) combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis. Based on treadmill exercise load status, two-dimensional conventional echocardiography and four-dimensional echocardiography area strain were performed on patients suspected coronary artery disease before coronary angiogram. Thirty patients (case group) with mild left anterior descending coronary artery stenosis (stenosis coronary artery stenosis according to the coronary angiogram results were prospectively enrolled. All the patients had no left ventricular regional wall motion abnormality in two-dimensional echocardiography at rest and exercise stress. There was no significant difference in the 16 segmental systolic peak AS at rest between two groups. After exercise stress, the peak systolic AS rest-stress at mid anterior wall (-7.00%±10.90% vs 2.80%±23.69%) and mid anterolateral wall (-4.40%±18.81% vs 8.80%±19.16%) were decreased, while increased at basal inferolateral wall (14.00%±19.27% vs -5.60%±15.94%) in case group compared with control group (Pcoronary artery stenosis, the area strain was decreased at involved segments, while compensatory increased at noninvolved segments after exercise stress. Four-dimensional echocardiography area strain combined with exercise stress echocardiography could sensitively find left ventricular regional systolic function abnormality in patients with mild single vessel coronary artery stenosis, and locate stenosis coronary artery accordingly. © 2017, Wiley Periodicals, Inc.

  3. Isolated tear in left atrial appendage due to blunt trauma chest: A rare case report

    OpenAIRE

    Salooja, Manpreet S.; Singla, Manender; Srivastava, Anupam; Mukherjee, Kishore C.

    2013-01-01

    Blunt traumatic cardiac rupture is associated with a high mortality rate. Motor vehicle accidents account for most cardiac ruptures, but crush injury is relatively rare. We describe a case of a 72-year-old man who had the left atrial appendage ruptured through blunt trauma due to a fall from scooter. Simple suture repair of the atrial appendage was achieved after clamping the base of the left atrium to control the bleeding. He recovered without complication. Traumatic injury to left atrial ap...

  4. Asymmetric oculomotor apraxia, optic ataxia, and simultanagnosia with right hemispatial neglect from a predominantly left-sided lesion of the parieto-occipital area.

    Science.gov (United States)

    Sakurai, Yasuhisa; Fujimoto, Masanori; Hamada, Kensuke; Sugimoto, Izumi

    2018-01-01

    Bálint's syndrome involves bilateral damage to the parieto-occipital area. The extent of the effect of unilateral damage on the Bálint's triad (oculomotor apraxia, optic ataxia, and simultanagnosia) remains unknown. We examined a 63-year-old, right-handed woman who developed right hemianopia, oculomotor apraxia, optic ataxia, simultanagnosia, and hemispatial neglect (HSN) for the right after a cerebral infarction, with detailed neuropsychological tests, magnetic resonance imaging, and single photon emission computed tomography (SPECT). Neuropsychological examination showed that oculomotor apraxia, optic ataxia, and simultanagnosia were more pronounced in the right hemi-space, probably due to the limited eye movement in the right visual field, whereas HSN was restricted to the right hemi-space. Diffusion-weighted MR images revealed hyperintensity in the left parieto-temporo-occipital region, and several spotty areas of the bilateral frontal and parietal subcortical regions. SPECT revealed hypoperfusion in the left parieto-occipital region and frontal operculum and small areas of the right superior parietal lobule. The case suggests that asymmetric (more pronounced in the right hemi-space) oculomotor apraxia, optic ataxia, and simultanagnosia occur in an extensive lesion of the left parieto-occipital cortices. Although HSN is not a prerequisite for simultanagnosia, the coexistence of HSN aggravates simultanagnosia in the hemi-space opposite the lesion.

  5. Systematic analysis of gene expression differences between left and right atria in different mouse strains and in human atrial tissue.

    Directory of Open Access Journals (Sweden)

    Peter C Kahr

    Full Text Available BACKGROUND: Normal development of the atria requires left-right differentiation during embryonic development. Reduced expression of Pitx2c (paired-like homeodomain transcription factor 2, isoform c, a key regulator of left-right asymmetry, has recently been linked to atrial fibrillation. We therefore systematically studied the molecular composition of left and right atrial tissue in adult murine and human atria. METHODS: We compared left and right atrial gene expression in healthy, adult mice of different strains and ages by employing whole genome array analyses on freshly frozen atrial tissue. Selected genes with enriched expression in either atrium were validated by RT-qPCR and Western blot in further animals and in shock-frozen left and right atrial appendages of patients undergoing open heart surgery. RESULTS: We identified 77 genes with preferential expression in one atrium that were common in all strains and age groups analysed. Independent of strain and age, Pitx2c was the gene with the highest enrichment in left atrium, while Bmp10, a member of the TGFβ family, showed highest enrichment in right atrium. These differences were validated by RT-qPCR in murine and human tissue. Western blot showed a 2-fold left-right concentration gradient in PITX2 protein in adult human atria. Several of the genes and gene groups enriched in left atria have a known biological role for maintenance of healthy physiology, specifically the prevention of atrial pathologies involved in atrial fibrillation, including membrane electrophysiology, metabolic cellular function, and regulation of inflammatory processes. Comparison of the array datasets with published array analyses in heterozygous Pitx2c(+/- atria suggested that approximately half of the genes with left-sided enrichment are regulated by Pitx2c. CONCLUSIONS: Our study reveals systematic differences between left and right atrial gene expression and supports the hypothesis that Pitx2c has a functional

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

    Science.gov (United States)

    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 radiofrequency ablation of atrial fibrillation.

  7. Anomlus pulmonary venous return aaccompanied by normal superior pulmonary veins in the left upper lobe: A case report

    International Nuclear Information System (INIS)

    Kim, Dong Eon; Kang, Min Jin; Lee, Ji Hae; Bae, Kyung Eun; Kim, Jae Hyung; Kang, Tae Kyung; Kim, Soung Hee; Kim, Ji Young; Jeong, Myeong Ja; Kim, Soo Hyun

    2017-01-01

    Partial anomalous pulmonary venous return is a rare congenital pulmonary venous anomaly, in which some of the pulmonary veins drain into the systemic circulation rather than the left atrium. Many variants of partial anomalous pulmonary venous return have been reported. We present a rare type of partial anomalous pulmonary venous return in which the anomalous left upper lobe pulmonary vein drained into the left innominate vein via the vertical vein, accompanying the left upper lobe pulmonary vein in the normal location

  8. Anomlus pulmonary venous return aaccompanied by normal superior pulmonary veins in the left upper lobe: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Eon; Kang, Min Jin; Lee, Ji Hae; Bae, Kyung Eun; Kim, Jae Hyung; Kang, Tae Kyung; Kim, Soung Hee; Kim, Ji Young; Jeong, Myeong Ja; Kim, Soo Hyun [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2017-08-15

    Partial anomalous pulmonary venous return is a rare congenital pulmonary venous anomaly, in which some of the pulmonary veins drain into the systemic circulation rather than the left atrium. Many variants of partial anomalous pulmonary venous return have been reported. We present a rare type of partial anomalous pulmonary venous return in which the anomalous left upper lobe pulmonary vein drained into the left innominate vein via the vertical vein, accompanying the left upper lobe pulmonary vein in the normal location.

  9. Investigation on Smoke Movement and Smoke Control for Atrium in Green and Sustainable Buildings

    DEFF Research Database (Denmark)

    Fang, Lui; Nielsen, Peter V.; Brohus, Henrik

    exhaust effectiveness; atrium smoke filling process and its time constant; pre-stratification and detection ; airflow for smoke control between the atrium and communicating space; sprinkler effect, etc. This report was written as a work report of my stay at the department of civil engineering of Aalborg...... conservation into account. Architectural and building design, electrical and mechanical systems, and building management have to be upgraded. However, there are problems in dealing with fire safety, especially in complying with the existing prescriptive fire codes. A hot argument is that smoke control system...... such as axisymmetric plume, wall plume, corner plume and balcony spill plume in this report. As many large space buildings such as cinema, sports arenas containing the sloping floor are designed to meet the function and aesthetic requirement. The smoke movement in atrium with sloping floor is also discussed...

  10. Atrium-specific ion channels in the zebrafish-A role of Iin atrial repolarization

    DEFF Research Database (Denmark)

    Skarsfeldt, M A; Bomholtz, S H; Lundegaard, P R

    2018-01-01

    reaction, we assessed the expression level of atrium-specific potassium channels. The functional role of these channels was studied by patch clamp experiments on isolated atrial and ventricular cardiomyocytes and by optical mapping of explanted adult zebrafish hearts. Finally, surface ECGs were recorded...... to establish possible in vivo roles of atrial ion channels. RESULTS: In isolated adult zebrafish hearts, we identified the expression of kcnk3, kcnk9, kcnn1, kcnn2, kcnn3, kcnj3 and kcnj5, the genes that encode the atrium-specific K2P, KCa2.x and Kir3.1/4 (KACh) ion channels. The electrophysiological data...... indicate that the acetylcholine-activated inward-rectifying current, IKACh,plays a major role in the zebrafish atrium, whereas K2P3.1/9.1 and KCa2.x channels do not appear to be involved in regulating the action potential in the zebrafish heart. CONCLUSION: We demonstrate that the acetylcholine...

  11. The Linguistic and Cultural Interpretation of Dissonant Heritage: the ATRIUM Cultural Route

    Directory of Open Access Journals (Sweden)

    Sandra Nauert

    2017-06-01

    Full Text Available The European Cultural Route ATRIUM (Architecture of Totalitarian Regimes in Europe's Urban Memory deals with dissonant heritage, referring to a contrast of meaning and value systems between the past and the present. The route will be examined within the framework of a set of communication strategies for cultural routes. This short paper will look at some linguistic aspects related to the ATRIUM route and its ‘dissonant heritage’. By analysing some examples of existing promotional approaches related to this particular heritage, it will outline some considerations for a communicative strategy appropriate to the overall narrative structure of the ATRIUM cultural route, with special regard to a bottom-up constructivist approach.

  12. 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.

  13. Left atrial strain: a new predictor of thrombotic risk and successful electrical cardioversion

    Directory of Open Access Journals (Sweden)

    Cátia Costa

    2016-06-01

    Full Text Available Background: Left atrial deformation (LAD parameters are new markers of atrial structural remodelling that seem to be affected in atrial fibrillation (AF and atrial flutter (AFL. This study aimed to determine whether LAD can identify patients with a higher risk of thrombosis and unsuccessful electrical cardioversion (ECV. Methods: Retrospective study including 56 patients with AF or AFL undergoing ECV, with previous transthoracic (TTE and transoesophageal echocardiography (TEE studies. Echocardiographic parameters analysed were as follows: left ventricle function, left atrium (LA dimensions, LAD parameters (positive and negative strain peaks, left atrial appendage (LAA filling and emptying velocities and the presence of thrombi. Strain values were analysed according to thrombotic risk and success of ECV. Results: Lower mean values of peak-positive strain (PPS in patients with prothrombotic velocities (<25 cm/s and a higher incidence of thrombi in LAA were observed compared with those with normal velocities. Multivariate analysis revealed PPS normalised by LA maximum volume indexed by body surface area (BSA to be associated with prothrombotic risk (odds ratio 0.000 (95% CI: 0.000–0.243, P 0.017, regardless of CHADs2VASC score. Peak-negative strain normalised by LA volumes indexed by BSA were associated with unsuccessful ECV. Conclusions: Atrial deformation parameters identify AF and AFL patients with a high risk of thrombosis and unsuccessful ECV. Therefore, these new parameters should be included in anticoagulation management and rhythm vs rate control strategies.

  14. Smoke Movement in an Atrium with a Fire with Low Rate of Heat Release

    DEFF Research Database (Denmark)

    Nielsen, Peter V.; Brohus, Henrik; Petersen, A. J.

    2008-01-01

    Results from small-scale experiments on smoke movement in an atrium are given, both with and without a vertical temperature gradient, and expressions for the smoke movement are developed on the basis of these experiments. Comparisons with a general analytical expression used for calculating...... the height to the location of the smoke layer are given. Furthermore, the paper discusses the air movement in a typical atrium exposed to different internal and external heat loads to elaborate on the use of the "flow element" expressions developed for smoke movement from a fire with a low rate of heat...

  15. Focal FDG Activity in the Region of Right Atrium: Coregistered CT Identifies Three Benign Etiologies.

    Science.gov (United States)

    Meka, Murali; Depuey, E Gordon; Bhargava, Peeyush

    2008-01-01

    We present the whole body FDG PET-CT images on 3 different patients with benign focal activity in the region of the right atrium. Co-registered CT correctly identified the cause of focal FDG activity as: right atrial appendage, lipomatous hypertrophy of the interatrial septum, and catheter-related activity. Although all these have been reported separately in the literature, we are presenting them together to emphasize the importance of recognizing the benign causes of FDG uptake in the region of right atrium and the role of co-registered CT in improving the accuracy and specificity of the FDG PET.

  16. Quantification of aortic valve area and left ventricular muscle mass in healthy subjects and patients with symptomatic aortic valve stenosis by MRI.

    Science.gov (United States)

    Haimerl, J; Freitag-Krikovic, A; Rauch, A; Sauer, E

    2005-03-01

    MRI allows visualization and planimetry of the aortic valve orifice and accurate determination of left ventricular muscle mass, which are important parameters in aortic stenosis. In contrast to invasive methods, MRI planimetry of the aortic valve area (AVA) is flow independent. AVA is usually indexed to body surface area. Left ventricular muscle mass is dependent on weight and height in healthy individuals. We studied AVA, left ventricular muscle mass (LMM) and ejection fraction (EF) in 100 healthy individuals and in patients with symptomatic aortic valve stenosis (AS). All were examined by MRI (1.5 Tesla Siemens Sonate) and the AVA was visualized in segmented 2D flash sequences and planimetry of the performed AVA was manually. The aortic valve area in healthy individuals was 3.9+/-0.7 cm(2), and the LMM was 99+/-27 g. In a correlation analysis, the strongest correlation of AVA was to height (r=0.75, pvalve stenosis, AVA was 1.0+/-0.35 cm(2), in correlation to cath lab r=0.72, and LMM was 172+/-56 g. We compared the AS patients results with the data of the healthy subjects, where the reduction of the AVA was 28+/-10% of the expected normal value, while LMM was 42% higher in patients with AS. There was no correlation to height, weight or BSA in patients with AS. With cardiac MRI, planimetry of AVA for normal subjects and patients with AS offered a simple, fast and non-invasive method to quantify AVA. In addition LMM and EF could be determined. The strong correlation between height and AVA documented in normal subjects offered the opportunity to integrate this relation between expected valve area and definitive orifice in determining the disease of the aortic valve for the individual patient. With diagnostic MRI in patients with AS, invasive measurements of the systolic transvalvular gradient does not seem to be necessary.

  17. Atlas-Based Mosaicing of Left Atrial 3-D Transesophageal Echocardiography Images

    NARCIS (Netherlands)

    Mulder, Harriët W.; van Stralen, Marijn; Ren, Ben; Haak, Alexander; Viergever, Max A.; Bosch, Johan G.; Pluim, JPW

    Transesophageal echocardiography (TEE) is a promising imaging modality used to guide cardiac interventions, such as catheter ablation for the treatment of cardiac arrhythmias. These procedures rely on good visualization of the left atrium and pulmonary veins. To visualize these structures in a

  18. a case of persistent left superior vena cava detected by post-contrast CT scan

    International Nuclear Information System (INIS)

    Sasaki, Fumio; Koga, Sukehiko; Takeuchi, Akira; Hattori, Yoshinobu; Ino, Akio

    1983-01-01

    A case of persistent left superior vena cava and large anastomosis between double superior vena cava was incidentally detected by post-contrast CT scans. This abnormal vein did not connect to the right atrium via coronary sinus. The usefulness for the diagnosis of post-contrast CT scans and RI venography should be emphasized. (author)

  19. “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.

  20. Rupture of sinus of Valsalva aneurysm into both right atrium and ...

    African Journals Online (AJOL)

    A young man had a congenital sinus of Valsalva aneurysm originating from the right coronary sinus, complicated by fistulas draining into both right atrium and right ventricle, as well as a congenitally abnormal aortic valve with mild aortic insufficiency. His dramatic clinical presentation, with the sudden appearance of severe ...

  1. Anomalous muscle bundle in the right atrium; Implication to trans atrial device closure

    Directory of Open Access Journals (Sweden)

    Saji Philip

    2017-09-01

    Full Text Available Intracavitary muscle bands or aberrant bands have been well described in all four chambers of the heart but rarely seen thick muscular band crossing right atrium. We report a case of devisable secundum atrial septal defect with an intra-atrial anomalous muscular band, crossing right atrial wall to the rim of the secundum atrial septal defect warranting surgical closure.

  2. Optimisation of Heating Energy Demand and Thermal Comfort of a Courtyard-Atrium Dwelling

    NARCIS (Netherlands)

    Taleghani, M.; Tenpierik, M.; Dobbelsteen, A.

    2013-01-01

    In the light of energy reduction, transitional spaces are recognised as ways to receive natural light and fresh air. This paper analyses the effects of courtyard and atrium as two types of transitional spaces on heating demand and thermal comfort of a Dutch low-rise dwelling, at current and future

  3. Thrombus Development on a Transseptal Sheath in the Right Atrium Before Electrical Pulmonary Vein Isolation

    Directory of Open Access Journals (Sweden)

    Nieves Romero-Rodriguez

    2008-02-01

    Full Text Available We describe the case of a patient who developed a thrombus on the transseptal sheath in the right atrium before transseptal puncture for circumferential pulmonary vein isolation for paroxysmal atrial fibrillation treatment. The use of intracardiac echocardiography allowed to its identification and probably prevented the patient from suffering a serious thromboembolic complication.

  4. [Surgical treatment for pseudoaneurysm of the sinus of valsalva ruptured into the right atrium after mycotic right coronary artery aneurysm repair;report of a case].

    Science.gov (United States)

    Hirai, Hidekazu; Sasaki, Yasuyuki; Hosono, Mitsuharu; Bito, Yasuyuki; Nakahira, Atsushi; Suehiro, Yasuo; Kaku, Daisuke; Miyabe, Makoto; Suehiro, Shigefumi

    2015-02-01

    A 67-year-old man was admitted to our hospital by ambulance after syncope due to complete A-V block. He had received surgical treatment for mycotic aneurysm of the right coronary artery 3 months before, with patch plasty of the right sinus of Valsalva and bypass grafting to the right coronary artery (RCA) as well as the left anterior descending branch. Computed tomography revealed pseudoaneurysm of the right Valsalva sinus of about 8 cm in diameter and a shunt flow to the right atrium. The previous bypass graft to RCA had been occluded due to compression by the aneurysm. As he was in a shock state, emergency operation was performed. Cardiopulmonary bypass was first established, and after the rectal temperature reached to 26 degrees centigrade, the chest was opened. The pseudoaneurysm burst out when the sternum was re-opened. Under circulatory arrest, the ascending aorta was clamped, and then the circulation was resumed. The previous bovine pericardium patch repairing the Valsalva sinus was detached due to infection, and mural thrombus and pus were observed in the aneurysm. At the bottom of the aneurysm, a fistula connected to the right atrium was found. Debridement around the aneurysm was performed as much as possible. The defect of the Valsalva sinus was repaired with a Dacron patch immersed in gentian violet. The postoperative course was uneventful without any recurrence of infection.

  5. Numerical investigations of buoyancy-driven natural ventilation in a simple three-storey atrium building and thermal comfort evaluation

    International Nuclear Information System (INIS)

    Hussain, Shafqat; Oosthuizen, Patrick H.

    2013-01-01

    The numerical investigations of buoyancy-driven natural ventilation and thermal comfort evaluation in a simple three-storey atrium building as a part of the passive ventilation strategy was undertaken using a validated Computational Fluid Dynamic (CFD) model. The Reynolds Averaged Navier–Stokes (RANS) modeling approach with the SST-k–ω turbulence model and the discrete transfer radiation model (DTRM) was used for the numerical investigations. The steady-state governing equations were solved using a commercial solver FLUENT©. Various flow situations of the buoyancy-driven natural ventilation in the building during day and night time were examined. The numerical results obtained for the airflow rates, airflow patterns and temperature distributions inside the building are presented in this paper. Using the numerical results, the well-known thermal comfort indices PMV (predicted mean vote) and PPD (predicted percentage of dissatisfied) were calculated for the evaluation of the thermal comfort conditions in the occupied regions of the building. It was noticed that thermal conditions prevailing in the occupied areas of the building as a result of using the buoyancy-driven ventilation were mostly in comfort zone. From the study of the night time ventilation, it was found that hot water (80 °C) circulation (heated by solar collectors during daytime) along the chimney walls during night time and heat sources present in the building can be useful in inducing night ventilation airflows in the building as a part of the passive ventilation strategy. -- Highlights: • A simple three-storey atrium building. • Numerical modeling of buoyancy-driven ventilation flow in the building. • Effect of solar intensity and geographical location on ventilation. • CFD predictions were used to calculate thermal comfort indices. • Evaluation of thermal comfort conditions for the occupants

  6. Echocardiographic assessment of left atrial size in patients with end-stage renal disease.

    Science.gov (United States)

    Koçinaj, Dardan; Gashi, Masar; Berisha, Merita; Koçinaj, Allma; Ramadani, Naser; Korça, Hajrije

    2009-01-01

    Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease, silent myocardial ischaemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, annular mitral and aortic valve calcification, and enlargement of the left atrium, than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels. In this study, we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease. We analysed data from 123 patients who were on regular haemodialysis, by means of traditional transthoracic echocardiographic examination. The usual statistical parameters, correlations and the Student's t-test were performed, with levels of significance of p < 0.01 and p < 0.05. The most presented age group was 60 to 69 years old, with a predomination of females (56.1%). We found dilated left atrium in 26.02% of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium. Evaluation of left atrial size should be determined by several different measurements, and left atrial enlargement should be seen as a risk factor for advancing disease.

  7. Kids in the atrium: comparing architectural intentions and children's experiences in a pediatric hospital lobby.

    Science.gov (United States)

    Adams, Annmarie; Theodore, David; Goldenberg, Ellie; McLaren, Coralee; McKeever, Patricia

    2010-03-01

    The study reported here adopts an interdisciplinary focus to elicit children's views about hospital environments. Based at the Hospital for Sick Children (SickKids), Toronto, the research explores the ways in which designers and patients understand and use the eight-storey lobby, The Atrium, a monumental addition constructed in 1993. It is a public place that never closes; hundreds of children pass through the namesake atrium every day. Combining methodological approaches from architectural history and health sociology, the intentions and uses of central features of the hospital atrium are examined. Data were collected from observations, focused interviews, and textual and visual documents. We locate the contemporary atrium in a historical context of building typologies rarely connected to hospital design, such as shopping malls, hotels and airports. We link the design of these multi-storey, glass-roofed spaces to other urban experiences especially consumption as normalizing forces in the everyday lives of Canadian children. Seeking to uncover children's self-identified, self-articulated place within contemporary pediatric hospitals, we assess how the atrium--by providing important, but difficult-to-measure functions such as comfort, socialization, interface, wayfinding, contact with nature and diurnal rhythms, and respite from adjacent medicalized spaces--contributes to the well-being of young patients. We used theoretical underpinnings from architecture and humanistic geography, and participatory methods advocated by child researchers and theorists. Our findings begin to address the significant gap in understanding about the relationship between the perceptions of children and the settings where their healthcare occurs. The study also underlines children's potential to serve as agents of architectural knowledge, reporting on and recording their observations of hospital architecture with remarkable sophistication. 2009 Elsevier Ltd. All rights reserved.

  8. Thoracic aortic stent-graft placement combined with left subclavian artery 'chimney operation': therapeutic analysis of 15 cases with insufficient proximal anchor area

    International Nuclear Information System (INIS)

    Liu Jiayi; Huang Lianjun; Fan Zhanming; Zhang Zhaoqi

    2012-01-01

    Objective: To discuss the strategies for the management of insufficient proximal anchoring area during the performance of transluminal stent-graft placement (TSGP), and to evaluate the feasibility of intentional coverage of the left subclavian artery (LSA) together with left subclavian artery stent-graft placement by using 'chimney operation' technique. Methods: A total of 15 patients with thoracic aortic diseases complicated by insufficient proximal anchoring area, who were encountered in authors' hospital during the period from Dec. 2009 to April 2011, were enrolled in this study. The clinical data were retrospectively analyzed. The thoracic aortic diseases included aortic dissection (n=6), aortic pseudoaneurysm (n=1), aortic aneurysm (n=4) and penetrating ulcer (n=4). Of the 15 patients, the distance between the lesion and LSA anchoring site 15 mm in 2. TSGP was carried out. The ostium of LSA was intentionally and completely covered by thoracic aortic stent-graft and left subclavian artery stent-graft placement was subsequently performed. The patients were kept under observation for symptoms of cerebral and upper limb ischemia. The postoperative complications such as endoleak and the patency of LSA were assessed with angiography. Results: Thoracic aortic stent-graft placement was successfully carried out in all 15 patients. In addition, one 'chimney' stent was properly implanted in LSA in each patient. After the procedure, no complications of nervous system or severe ischemia of upper extremity occurred. Follow-up examinations performed between 5 days to 3 months after the treatment revealed that the aortic stent-graft remained in stable condition and no type Ⅰ endoleak occurred, meanwhile the blood flow in 'chimney' stent was unobstructed. Conclusion: Intentional LSA coverage with 'chimney operation' can expand the applicability of TSGP with high tolerability. It is especially useful for patients with left vertebral artery blood supply dominance or with

  9. Left Atrial Thrombus Causing Stroke and Syncope: Does Size Matters?

    Directory of Open Access Journals (Sweden)

    Surender Deora

    2014-01-01

    Full Text Available Left atrium thrombus is seen in patients with rheumatic heart disease, severe mitral stenosis and/or atrial fibrillation, but is usually immobile and located in left atrial appendage. Freely mobile thrombus is rarely seen, and the size may vary from few millimeters to centimeters. The clinical presentation varies from presyncope or syncope in a small well organized thrombus to transient ischemic attacks or stroke in large poorly organized thrombus. Management includes urgent surgical removal of thrombus with underlying valvular correction and anticoagulation.

  10. Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality.

    Science.gov (United States)

    Oz, Ibrahim Ilker; Altınsoy, Bülent; Serifoglu, Ismail; Sayın, Rasit; Buyukuysal, Mustafa Cagatay; Erboy, Fatma; Akduman, Ece Isin

    2015-12-01

    The aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE. This retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A review of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography. There were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (prights reserved.

  11. Aqueous leaf extract of Averrhoa carambola L. (Oxalidaceae reduces both the inotropic effect of BAY K 8644 on the guinea pig atrium and the calcium current on GH3cells

    Directory of Open Access Journals (Sweden)

    Carla M. L. Vasconcelos

    Full Text Available It was previously showed that aqueous leaf extract (AqEx of Averrhoa carambola depresses the guinea pig atrial inotropism. Therefore, experiments were carried out on guinea pig left atrium and on pituitary GH3 cells in order to evaluate the effect of AqEx on the cellular calcium influx. The atrium was mounted in an organ chamber (5 mL, Tyrode, 27 ± 0.1 ºC, 95 % O2, 5 % CO2, stretched to 10 mN, and paced at 2 Hz (0.5 ms, 400 V and GH3 cells were submitted to a whole cell voltage clamp configuration. In the atrium, the AqEx (1500 µg/mL shifted to the right the concentration-effect curve of the positive inotropic effect produced by (± BAY K 8644, an L-type calcium channel agonist. The AqEx increased EC50 (concentration required to promote 50% of the maximum effect of the inotropic effect of BAY K 8644 from 7.8 ± 0.38 to 115.1 ± 0.44 nM (N = 3; p < 0.05. In GH3 cells assayed with 500 µg/mL of AqEx, the L-type calcium inward current declined 30 % (from 282 to 190 pA. Nevertheless, the extract did not change the voltage correspondent to the peak current. These data suggest that, at least in part, the negative inotropic effect of AqEx on the guinea pig atrium is due to a reduction of the L-type calcium current.

  12. The Left Superior Longitudinal Fasciculus within the Primary Sensory Area of Inferior Parietal Lobe Plays a Role in Dysgraphia of Kana Omission within Sentences

    Directory of Open Access Journals (Sweden)

    Nobusada Shinoura

    2012-01-01

    Full Text Available Functional neurological changes after surgery combined with diffusion tensor imaging (DTI tractography can directly provide evidence of anatomical localization of brain function. Using these techniques, a patient with dysgraphia before surgery was analyzed at our hospital in 2011. The patient showed omission of kana within sentences before surgery, which improved after surgery. The brain tumor was relatively small and was located within the primary sensory area (S1 of the inferior parietal lobe (IPL. DTI tractography before surgery revealed compression of the branch of the superior longitudinal fasciculus (SLF by the brain tumor. These results suggest that the left SLF within the S1 of IPL plays a role in the development of dysgraphia of kana omission within sentences.

  13. Right lower limb apraxia in a patient with left supplementary motor area infarction: intactness of the corticospinal tract confirmed by transcranial magnetic stimulation

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    Min Cheol Chang

    2015-01-01

    Full Text Available We reported a 50-year-old female patient with left supplementary motor area infarction who presented right lower limb apraxia and investigated the possible causes using transcranial magnetic stimulation. The patient was able to walk and climb stairs spontaneously without any assistance at 3 weeks after onset. However, she was unable to intentionally move her right lower limb although she understood what she supposed to do. The motor evoked potential evoked by transcranial magnetic stimulation from the right lower limb was within the normal range, indicating that the corticospinal tract innervating the right lower limb was uninjured. Thus, we thought that her motor dysfunction was not induced by motor weakness, and confirmed her symptoms as apraxia. In addition, these results also suggest that transcranial magnetic stimulation is helpful for diagnosing apraxia.

  14. Angiosarcoma of the Right Atrium Presenting as Syncope and Hemorrhagic Pericardial Tamponade

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    V. G. Sams

    2012-01-01

    Full Text Available Angiosarcoma of the heart is a rare malignancy that can present in many ways. It is an important diagnosis to consider in patients presenting with otherwise unexplained tamponade-type symptoms. Here we present a case of a young male who presented with hemorrhagic tamponade and underwent resection of a large angiosarcoma of the right atrium. In this case, we describe the rare presentation of angiosarcoma with its diagnostic approaches, hospital course, clinical management, and discussion.

  15. Renal Angiomyolipoma with Fatty Thrombus Extending to the Right Atrium: An Exceptional Presentation

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    Yassine Nouira

    2013-01-01

    Full Text Available This paper reports the case of 34-year-old woman who presented with bilateral renal angiomyolipomas (AMLs. On the right side, there was a large AML with a fatty thrombus extending to the right atrium. The treatment consisted of right nephrectomy and complete thrombectomy with extracorporeal circulation and right atriotomy. Postoperatively, the patient was septic and died on postoperative day 7 because of septic shock.

  16. Il patrimonio scomodo del Novecento europeo nel progetto Atrium a Forlì

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    Elena Pirazzoli

    2013-09-01

    Full Text Available Il Novecento ha lasciato tracce difficili nelle città d'Europa. I regimi che si sono succeduti hanno trasformato urbanisticamente e architettonicamente l'intero territorio e oggi è complesso relazionarsi con questi segni. Il progetto europeo Atrium - Architecture of Totalitarian Regimes in Urban Managements si propone di valorizzare, con attenta cura e senza intenti mistificatori, proprio il “patrimonio scomodo” di 11 paesi dell'Europa del sud.

  17. Atypical leiomyoma arising in a hepatic vein with extension into the inferior vena cava and right atrium

    International Nuclear Information System (INIS)

    Dunlap, H.J.; Udjus, K.

    1990-01-01

    We report an atypical leiomyoma arising in a hepatic vein and extending into the inferior vena cava and right atrium in a fourteen year old boy. US, CT and MRI facilitated diagnosis and removal of this tumor. (orig.)

  18. Hydatid Cyst of Right Atrium: A Case Report

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    Maral Mokhtari

    2015-06-01

    Full Text Available Cardiac hydatid cyst is rare and usually occurs in the setting of disseminated disease. Herein, we reported a case of isolated right atrial hydatid cyst misdiagnosed clinically as a tumor. A 65-year-old woman diagnosed as having large right atrial mass suspected of malignancy underwent resection of the cardiac mass. Histopathological examination showed laminated membrane and protoscolices of Echinococcus Granulosus. However, all other work-ups failed to document systemic diseases. Therefore, isolated cardiac hydatid cyst was diagnosed. Hydatid cysts should be considered in differential diagnosis of any cardiac mass, especially in endemic areas.

  19. Body surface localization of left and right atrial high-frequency rotors in atrial fibrillation patients: a clinical-computational study.

    Science.gov (United States)

    Rodrigo, Miguel; Guillem, María S; Climent, Andreu M; Pedrón-Torrecilla, Jorge; Liberos, Alejandro; Millet, José; Fernández-Avilés, Francisco; Atienza, Felipe; Berenfeld, Omer

    2014-09-01

    Ablation is an effective therapy in patients with atrial fibrillation (AF) in which an electrical driver can be identified. The aim of this study was to present and discuss a novel and strictly noninvasive approach to map and identify atrial regions responsible for AF perpetuation. Surface potential recordings of 14 patients with AF were recorded using a 67-lead recording system. Singularity points (SPs) were identified in surface phase maps after band-pass filtering at the highest dominant frequency (HDF). Mathematical models of combined atria and torso were constructed and used to investigate the ability of surface phase maps to estimate rotor activity in the atrial wall. The simulations show that surface SPs originate at atrial SPs, but not all atrial SPs are reflected at the surface. Stable SPs were found in AF signals during 8.3% ± 5.7% vs. 73.1% ± 16.8% of the time in unfiltered vs. HDF-filtered patient data, respectively (P surface HDF rotors by reducing the effect of the atrial electrical activity occurring at different frequencies. Torso surface SPs representing HDF rotors during AF were reflected at specific areas corresponding to the fastest atrial location. Phase analysis of surface potential signals after HDF filtering during AF shows reentrant drivers localized to either the left atrium or the right atrium, helping in localizing ablation targets. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  20. The utility of atrial pacing for identifying the electrical breakthrough sites between the left atrium and pulmonary veins

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    Shinya Sugiura, MD

    2017-04-01

    Conclusions: This pacing method may help to identify whether EBSs are located in the anterior Lt.PVs. Improved recognition of EBSs through pacing from different sites would be helpful for achieving PV isolation.

  1. Detection of left atrial thrombus by intracardiac echocardiography in patients undergoing ablation of atrial fibrillation.

    Science.gov (United States)

    Sriram, Chenni S; Banchs, Javier E; Moukabary, Talal; Moradkhan, Raman; Gonzalez, Mario D

    2015-09-01

    The role of intracardiac echocardiography (ICE) to detect thrombus within left atrium (LA) before atrial fibrillation (AF) ablation despite a recent transesophageal echocardiogram (TEE) is not well defined. We examined the prevalence of LA/left atrial appendage (LAA) thrombus using ICE immediately prior to AF ablation in patients in whom anticoagulation was not withheld. We analyzed 122 consecutive patients (62.6 ± 10.8 years, 90 males, CHA(2)DS(2) -VASc score 2.4 ± 1.5, persistent AF 29.5 %) who underwent an ICE-guided AF ablation 1 day after a negative (n = 120) or inconclusive (n = 2) TEE for LA thrombus. LA was imaged with ICE from the right atrium, coronary sinus, and right ventricular inflow tract (RVIT). ICE and TEE images were compared for LAA area, thrombus, and spontaneous echo contrast (SEC). LAA was adequately visualized in 99 and 100 % of patients with TEE and ICE, respectively. RVIT was the best ICE view for LAA visualization. The LAA 2-D-area measured by TEE was 4.9 ± 0.5 vs. 5 ± 0.5 cm(2) by ICE (P = NS). ICE identified a thrombus in seven patients with a previous negative TEE, leading to cancellation of ablation. It ruled out a thrombus in two patients with an inconclusive TEE. Thrombi were found in the LAA (n = 4), atrial septum (n = 2), and left superior pulmonary vein (n = 1). SEC during TEE was more frequent in patients with thrombus on ICE than those without (85.7 vs. 17.4 %; p = 0.03; positive predictive value 23.1 %, negative predictive value 98.9 %). The results of our staged imaging approach suggest that ICE has a complimentary value in re-screening the LA/LAA for thrombus after a recent negative or equivocal TEE. The presence of SEC during TEE increases the probability of finding a thrombus with ICE, which could potentially be dislodged during catheter manipulation.

  2. Granger Causality and Jensen–Shannon Divergence to Determine Dominant Atrial Area in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Raquel Cervigón

    2018-01-01

    Full Text Available Atrial fibrillation (AF is already the most commonly occurring arrhythmia. Catheter pulmonary vein ablation has emerged as a treatment that is able to make the arrhythmia disappear; nevertheless, recurrence to arrhythmia is very frequent. In this study, it is proposed to perform an analysis of the electrical signals recorded from bipolar catheters at three locations, pulmonary veins and the right and left atria, before to and during the ablation procedure. Principal Component Analysis (PCA was applied to reduce data dimension and Granger causality and divergence techniques were applied to analyse connectivity along the atria, in three main regions: pulmonary veins, left atrium (LA and right atrium (RA. The results showed that, before the procedure, patients with recurrence in the arrhythmia had greater connectivity between atrial areas. Moreover, during the ablation procedure, in patients with recurrence in the arrhythmial both atria were more connected than in patients that maintained sinus rhythms. These results can be helpful for procedures designing to end AF.

  3. Fixed volume particle trace emission for the analysis of left atrial blood flow using 4D Flow MRI.

    Science.gov (United States)

    Gaeta, Stephen; Dyverfeldt, Petter; Eriksson, Jonatan; Carlhäll, Carl-Johan; Ebbers, Tino; Bolger, Ann F

    2018-04-01

    4D Flow MRI has been used to quantify normal and deranged left ventricular blood flow characteristics on the basis of functionally distinct flow components. However, the application of this technique to the atria is challenging due to the presence of continuous inflow. This continuous inflow necessitates plane-based emission of particle traces from the inlet veins, leading to particles that represents different amounts of blood, and related quantification errors. The purpose of this study was to develop a novel fixed-volume approach for particle tracing and employ this method to develop quantitative analysis of 4D blood flow characteristics in the left atrium. 4D Flow MRI data were acquired during free-breathing using a navigator-gated gradient-echo sequence in three volunteers at 1.5T. Fixed-volume particle traces emitted from the pulmonary veins were used to visualize left atrial blood flow and to quantitatively separate the flow into two functionally distinct flow components: Direct flow=particle traces that enter and leave the atrium in one heartbeat, Retained flow=particle traces that enter the atrium and remains there for one cardiac cycle. Flow visualization based on fixed-volume traces revealed that, beginning in early ventricular systole, flow enters the atrium and engages with residual blood volume to form a vortex. In early diastole during early ventricular filling, the organized vortical flow is extinguished, followed by formation of a second transient atrial vortex. Finally, in late diastole during atrial contraction, a second acceleration of blood into the ventricle is seen. The direct and retained left atrial flow components were between 44 and 57% and 43-56% of the stroke volume, respectively. In conclusion, fixed-volume particle tracing permits separation of left atrial blood flow into different components based on the transit of blood through the atrium. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. 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.

  5. Comparison of left ventricular outflow geometry and aortic valve area in patients with aortic stenosis by 2-dimensional versus 3-dimensional echocardiography.

    Science.gov (United States)

    Saitoh, Takeji; Shiota, Maiko; Izumo, Masaki; Gurudevan, Swaminatha V; Tolstrup, Kirsten; Siegel, Robert J; Shiota, Takahiro

    2012-06-01

    The present study sought to elucidate the geometry of the left ventricular outflow tract (LVOT) in patients with aortic stenosis and its effect on the accuracy of the continuity equation-based aortic valve area (AVA) estimation. Real-time 3-dimensional transesophageal echocardiography (RT3D-TEE) provides high-resolution images of LVOT in patients with aortic stenosis. Thus, AVA is derived reliably with the continuity equation. Forty patients with aortic stenosis who underwent 2-dimensional transthoracic echocardiography (2D-TTE), 2-dimensional transesophageal echocardiography (2D-TEE), and RT3D-TEE were studied. In 2D-TTE and 2D-TEE, the LVOT areas were calculated as π × (LVOT dimension/2)(2). In RT3D-TEE, the LVOT areas and ellipticity ([diameter of the anteroposterior axis]/[diameter of the medial-lateral axis]) were evaluated by planimetry. The AVA is then determined using planimetry and the continuity equation method. LVOT shape was found to be elliptical (ellipticity of 0.80 ± 0.08). Accordingly, the LVOT areas measured by 2D-TTE (median 3.7 cm(2), interquartile range 3.1 to 4.1) and 2D-TEE (median 3.7 cm(2), interquartile range 3.1 to 4.0) were smaller than those by 3D-TEE (median 4.6 cm(2), interquartile range 3.9 to 5.3; p interquartile range 0.79 to 1.3, p interquartile range 0.64 to 0.94) and 2D-TEE (median 0.76 cm(2), interquartile range 0.62 to 0.95). Additionally, the continuity equation-based AVA by RT3D-TEE was consistent with the planimetry method. In conclusion, RT3D-TEE might allow more accurate evaluation of the elliptical LVOT geometry and continuity equation-based AVA in patients with aortic stenosis than 2D-TTE and 2D-TEE. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Latest generation of unipolar and bipolar steroid eluting leads: long-term comparison of electrical performance in atrium and ventricles.

    Science.gov (United States)

    Cornacchia, D; Fabbri, M; Puglisi, A; Moracchini, P; Bernasconi, M; Nastasi, M; Menozzi, C; Mascioli, G; Marotta, T; de Seta, F

    2000-07-01

    One hundred and seventy-three patients, mean age 74 years permanently paced with 123 atrial (53 unipolar, 70 bipolar) and 143 ventricular (73 unipolar, 70 bipolar) pacing leads were included in this study. The pacing leads were recent generation low surface area steroid eluting leads from one manufacturer: leads with silicone and polyurethane insulation were studied, and they were combined with generations of one pacemaker family from the same manufacturer permitting identical measurements to be made over a follow-up of 2 years. Pacing threshold was measured using pulse duration at a fixed voltage of 1.5 V: peak to peak P and R wave amplitude and pacing impedance at 2.5 V and 0.5 ms were all measured using the manufacturer's standard programmer. Although many significant differences, in the parameters measures, existed between atrium and ventricle and unipolar and bipolar configurations, none was felt to be of clinical significance. These data permit the physician to choose the lead type with regard to sensing performance and long-term lead integrity.

  7. Study on the Status of Health Service Utilization among Caregivers of Left-Behind Children in Poor Rural Areas of Hunan Province: A Baseline Survey.

    Science.gov (United States)

    Ji, Meimei; Zhang, Yefu; Zou, Jiaojiao; Yuan, Tong; Tang, Amber; Deng, Jing; Yang, Lina; Li, Mingzhi; Chen, Jihua; Qin, Hong; Lin, Qian

    2017-08-12

    The caregivers of left-behind children (CLBC) in China's poor, rural areas are mostly elderly and women. Their health status and access to health services have not been previously characterized. This study aims to explore the status of CLBC in terms of their health service utilization and to provide a scientific basis for guiding effective implementation of health policy in rural Hunan. Random cluster sampling was used to survey CLBC in two rural counties. Face-to-face interviews and questionnaires were used to collect data, including socioeconomic status and health service utilization. The two-week prevalence rate was used to reflect health service needs, while the two-week visiting rate, annual hospitalization rate and participation in basic public health services were used to evaluate health service utilization. Of the 518 respondents in the study, 95.9% were farmers and 88.4% were over 40 years old. The two-week prevalence rate was 36.1%. Furthermore, 40.1% of ill caregivers' activities were partly restricted by illness and 3.7% needed to be on bed rest. The two-week visiting rate was 21.0%. The main reasons for not seeing a doctor were "self-medication" (39.1%) or "financial difficulties" (32.6%). The annual hospitalization rate of the CLBC was 22.6% and the non-hospitalization rate of those who needed hospitalization was 41.5%. "Lack of time" (22.3%) and "financial difficulties" (50.5%) were the major factors affecting the utilization of hospitalization services. In terms of participation in basic public health services, only 35.1% CLBC clearly knew that township hospitals have established health records for them. Only 50.6% of caregivers received free health examinations in village clinics or township hospitals and 81.3% of the caregivers did not participate in health education or lectures organized by local health institutions in 2014. The utilization rate of health services was extremely low, which may affect the quality of care for left-behind children

  8. Left atrio-vertebral ratio: A new computed-tomography measurement to identify left atrial dilation.

    Science.gov (United States)

    Baque-Juston, Marie; Volondat, Manuelle; Fontas, Eric; Roger, Coralie; Brunner, Philippe; Padovani, Bernard; Chevallier, Patrick

    2016-01-01

    Left cardiac chambers dilation, interstitial lung changes and pleural effusions are the characteristics of cardiogenic pulmonary oedema on computed tomography (CT) of the chest but mensuration of the left atrial size is not routinely performed. Cardiac chambers normal dimensions are known to be proportional to the patient's build and anthropomorphic data but adjustment of chambers dimensions to available elements seen on the axial CT images has never been evaluated before. Our objective was to use data easily available on axial images to directly scale the left atrium. We chose to divide the left atrial diameter by the thoracic vertebral diameter, using the latter as a body-mass indicator. As a preliminary study, we aimed to evaluate the range of values of this left atrio-vertebral ratio (LAVR) by comparing patients suffering from cardiogenic pulmonary oedema with patients free of cardiac disease. We hypothesized that if the difference of values in these two populations of patients was significant enough, this ratio would be relevant and could be used as a quick criterion in different clinical situations. Two radiologists reviewed CT scans of 32 of patients free of cardiac disease and 40 patients in acute cardiac failure. The maximum diameter of the left atrium at the level of the right inferior pulmonary vein was divided by the vertebral transverse diameter to generate a left atrio-vertebral ratio. Receiver operating characteristic curves identified the threshold associated with pulmonary oedema. The mean LAVR was 1.85 ± 0.27 in asymptomatic patients and 2.48 ± 0.35 in patients with pulmonary oedema. A LAVR of 2.1 yielded 85% sensitivity and 88% specificity for the diagnosis of cardiogenic pulmonary oedema. LAVR is a simple new measure directly scaling the left atrial diameter to the anthropomorphic characteristics of the patient. In our series, a ratio above 2.1 is strongly associated with cardiogenic pulmonary oedema indirectly suggesting left atrial dilation

  9. Pacing Lead-Induced Granuloma in the Atrium: A Foreign Body Reaction to Polyurethane

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    Shinagawa Yoko

    2013-01-01

    Full Text Available We described a case of an 82-year-old male who presented with a granuloma entrapping the polyurethane-coated pacing lead at the site of contact on the atrium. He had been paced for 8 years without symptoms or signs suggestive of an allergic reaction to the pacemaker system and died from thrombosis of the superior mesenteric artery and heart failure. A histological examination of the nodule showed an incidental granuloma with multinucleated giant cells. No granuloma was found in the heart or the lung.

  10. Extension of adrenocortical carcinoma into the right atrium – echocardiographic diagnosis: A case report

    Directory of Open Access Journals (Sweden)

    Rozenman Yoseph

    2003-05-01

    Full Text Available Abstract Background Adrenocortical carcinoma is a rare, highly malignant tumor. Cardiac involvement of the tumor is very rare. Echocardiography facilitates the evaluation of the cardiac involvement of the tumor. Case Presentation We describe a patient with an adrenal tumor. Transthoracic echo showed its extension into the right atrium. Accordingly, a combined abdominal and cardiac operation was performed, monitored by transesophageal echocardiography. Conclusion This case highlights the importance of echocardiography in revealing the cardiac involvement by this tumor and in planning the operative procedure.

  11. Isolated left-sided partial anomalous pulmonary venous connection in a child.

    Science.gov (United States)

    Onan, İsmihan Selen; Sen, Onur; Gökalp, Selman; Onan, Burak

    2017-09-01

    Isolated left-sided partial anomalous pulmonary venous connection with intact interatrial septum is a rare diagnosis in childhood. In these cases, a vertical vein drains the left upper pulmonary lobe into the brachiocephalic vein and finally to the right atrium. Surgical treatment is performed to prevent right ventricular failure and pulmonary artery disease in advanced age. In this report, the rare entity of isolated left-sided anomalous pulmonary venous connection in a 14-year-old girl and successful minimally invasive surgery without cardiopulmonary bypass are described.

  12. Left atrial myxoma complicated with multi-system embolization.

    Science.gov (United States)

    Zhang, Ren-Dan; Zeng, Zhi-Huan; Zheng, Jian-Yi; Li, Tu-Di; Zhao, Yan-Qun; Liu, Yu-Hong; Yao, Yu-Si

    2017-09-05

    Atrial myxoma accounts for approximately 50% of all cardiac tumors. The majority of myxomas are located in the left atrium and present variable clinical manifestation. A young man was transferred to our hospital with sudden onset of resting pain, pallor and numb in right leg. An atrial mobile mass was detected by transthoracic echocardiography. Anticoagulant and antithrombotic therapy were administered, a timely surgery was performed and the mass was confirmed as a myxoma. The patient did not discharge any discomfort post-operation. For patients with atrial myxoma, early diagnosis is essential, anticoagulant or antithrombotic therapy and surgery have a great importance to prevent further embolism.

  13. Left atrial rupture due to blunt thoracic trauma.

    Science.gov (United States)

    Akar, İlker; İnce, İlker; Aslan, Cemal; Çeber, Mehmet; Kaya, İlker

    2015-07-01

    Blunt traumatic cardiac rupture is rare and associated with high mortality. The most popular theory of cardiac rupture after blunt thoracic trauma is rapid deceleration with disruption of the atria from their connections to the vena cava and pulmonary veins. In cases with both massive hemothorax and hemopericardium, injury can usually originate from the heart and/or major vessels. Surgical approach through the median sternotomy can provide convenience to repair the defect. In this article, successful treatment with median sternotomy of a 33-year-old male case with a rupture of the left atrium after blunt thoracic trauma was reported.

  14. Left ventricular mass regression is independent of gradient drop and effective orifice area after aortic valve replacement with a porcine bioprosthesis.

    Science.gov (United States)

    Sádaba, Justo Rafael; Herregods, Marie-Christine; Bogaert, Jan; Harringer, Wolfgang; Gerosa, Gino

    2012-11-01

    The question of whether left ventricular mass (LVM) regression following aortic valve replacement (AVR) is affected by the prosthesis indexed effective orifice area (IEOA) and transprosthetic gradient has not been fully elucidated. Data from a prospective, core-laboratory-reviewed echocardiography and magnetic resonance imaging (MRI) study was used to determine if the degree of LVM regression following AVR with two types of porcine bioprosthesis in patients suffering from predominant aortic valve stenosis (AS) was related to the prosthesis IEOA and transprosthetic gradient. Over a two-year period, 149 patients enrolled at eight centers received either an Epic or an Epic Supra aortic bioprosthesis (St. Jude Medical, MN, USA). Preoperative valve dysfunction was pure AS in 54 patients (36%) and mixed valve disease (primarily stenosis) in 95 patients (64%). LVM was determined preoperatively and at six months postoperatively, using MRI. The prosthesis IEOA and transprosthetic gradient were calculated at six months by means of echocardiography. Data were available for 111 patients at both enrolment and six months postoperatively. The LVM at enrolment and at follow up was 154.96 +/- 42.50 g and 114.83 +/- 29.20 g, respectively (p regression methods, showed LVM regression to be independent of the mean systolic pressure gradient, peak systolic pressure and prosthesis IEOA at six months (p = 0.53, 0.43, and 0.15, respectively). At six months after AVR with a porcine bioprosthesis to treat AS, there was a significant LVM regression that was independent of the prosthesis IEOA and the mean systolic pressure gradient and peak systolic pressure.

  15. Computational prediction of proarrhythmogenic effect of the V241F KCNQ1 mutation in human atrium.

    Science.gov (United States)

    Imaniastuti, Riski; Lee, Hyun Seung; Kim, Nari; Youm, Jae Boum; Shim, Eun Bo; Lim, Ki Moo

    2014-09-01

    Genetic factors play an important role in the pathogenesis of atrial flutter (AF). Although mutation in KCNQ1 has been widely correlated with AF, the mechanism by which mutation promotes AF remains poorly understood. The purpose of this study was to investigate the proarrhythmic effect of V241F KCNQ1 mutation in human atrium using the electrophysiological model of human atrium. Using 2D and 3D cardiac electrophysiological models that incorporate the Courtemanche human atrial model, we simulated electrical conduction through atrial tissue and compared spiral wave dynamics under the wild-type and V241F KCNQ1 conditions. In 2D and 3D simulation, V241F KCNQ1 showed a stable and persistent wave without spiral break-up, whereas the wild-type wave was less stable, resulting in early self-termination. According to the results, we concluded that compared to the wild type, the electrical activity of the V241F KCNQ1 mutation is more likely to sustain spiral wave. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. [Endoscopic approach to ventricular atrium for biopsy of pineal region tumour: case report].

    Science.gov (United States)

    Hernández-León, Odalys; Rodríguez-Villalonga, Olga Lidia; Pérez-Nogueira, Frank Reinaldo; Guillén-Cánovas, Evelio José; Alvarez-Toledo, Nilo; Lemus-Saraceni, Agustín

    2014-01-01

    The usual endoscopic approach in the management of pineal region tumours consists of inserting the scope into the frontal horn of the lateral ventricle and advancing it through the foramen of Monro into the third ventricle. We report the case of a patient with a pineal tumour on whom we used an endoscopic approach through the ventricular atrium to obtain a biopsy by opening the choroidal fissure. This young 25-year-old man presented with headache and double vision. Papilloedema and Parinaud's syndrome were found on physical examination. Cranial magnetic resonance revealed a pineal mass and hydrocephalus. We initially performed a third ventriculostomy and a tumour biopsy through a frontal burr hole. The tissue sample was not useful for pathological diagnosis and we decided to perform a second endoscopic biopsy. The endoscopic approach to pineal region masses, reaching the ventricular atrium through a parietal burr hole and opening the choroidal fissure, makes it possible to take a biopsy using a single endoscopic approach without needing to cross other ventricular structures. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  17. Computer Simulation Investigation on the Effect of Channelled and Unchannelled Screens on Smoke Contamination in Atriums Upper Balconies

    Directory of Open Access Journals (Sweden)

    Nasif Mohammad Shakir

    2014-07-01

    Full Text Available This paper performed the effect of installing channel screen on smoke contamination in the presence of 0.5 m deep down stand in a fire compartment. The results are then compared with smoke contamination occurrence when the channel screens were removed. The results showed that there will be 96% increase in upper balconies smoke contamination in an atrium when no channel screens at fire compartment opening are used. This work provides new correlation obtained from numerical study which can predict the smoke contamination height in upper balconies of the atrium in the presence of 0.5 m down stand and no channel screens. The proposed correlation will be useful design tool for building designer to design safe shopping malls (atrium.

  18. 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....

  19. Autosynchronized systolic unloading during left ventricular assist with a centrifugal pump.

    Science.gov (United States)

    Kono, Satoshi; Nishimura, Kazunobu; Nishina, Takeshi; Yuasa, Sadatoshi; Ueyama, Koji; Hamada, Chikuma; Akamatsu, Teruaki; Komeda, Masashi

    2003-02-01

    The purpose of this study was to investigate how the inflow cannulation site of the left ventricular assist system with a centrifugal pump would influence cardiac function on failing heart models. In 10 sheep, a left ventricular assist system was instituted by an outflow cannula in the descending aorta, two inflow cannulas in the left atrium and the left ventricle, and connecting those cannulas to a magnetically suspended centrifugal pump. A conductance catheter and a tipped micromanometer for monitoring the pressure-volume loop were also inserted into the left ventricle. Myocardial oxygen consumption was directly measured. Heart failure was induced by injection of microspheres into the left main coronary artery. The assist rate was varied from 0% to 100% at each inflow cannulation site. The pump flow with left ventricular cannulation increased during the systolic phase and decreased during the diastolic phase, whereas it was constant with left atrial cannulation. Ejection fraction with left atrial cannulation decreased as the assist rate increased, whereas that with left ventricular cannulation was maintained up to 75% assist. The external work with left atrial cannulation decreased gradually as the assist rate increased, whereas the external work with left ventricular cannulation did not decrease until the assist rate reached 75%. The myocardial oxygen consumption in both cannulations decreased proportionally as the assist rate increased; they were significantly less with left ventricular cannulation at the 100% assist rate than with left atrial cannulation. Left ventricular cannulation during left ventricular assistance maintains ejection fraction and effectively reduces oxygen consumption.

  20. Numerical investigation on the effect of balcony open and solid upstand on smoke contamination in atrium balconies

    Science.gov (United States)

    Mutafi, M. A.; Nasif, M. S.; Pao, W.; Ismail, F. B.

    2017-10-01

    Atrium is a modern architectural design of buildings that has an open space at the middle and contains several floors. In atrium structure the smoke due to fire can easily flow through the open spaces and causes smoke contamination. CFD simulation using fire dynamic simulator (FDS) software is conducted in this work, to investigate the effect of balcony open upstand on smoke contamination in atrium’s balconies and compare it with balconies with solid upstand. It was found that in case of open upstand, the smoke contamination occurrence decreased inside the balcony comparing with balconies with solid upstand.

  1. Blood pressure levels, left ventricular mass and function are correlated with left atrial volume in mild to moderate hypertensive patients.

    Science.gov (United States)

    Milan, A; Caserta, M A; Dematteis, A; Naso, D; Pertusio, A; Magnino, C; Puglisi, E; Rabbia, F; Pandian, N G; Mulatero, P; Veglio, F

    2009-11-01

    Arterial hypertension is associated with an increased risk of atrial fibrillation (AF), and leads to a pronounced increase in morbidity and mortality. Left atrial volume (LAV) is an important prognostic marker in the older populations. The aim of our study was to identify the clinical and echocardiographic determinants of LAV in middle-aged (R(2)=0.19, P<0.001) and LAV were increased in essential hypertensive patients with left ventricular hypertrophy (LVH), and patients with enlarged LAV showed lower systolic and diastolic function and an increased LVMI. The LAVi is dependent on blood pressure levels and anthropometric variables (age and BMI). Further structural (LVMI) and functional (systolic and diastolic) variables are related to the LAVi; LVMI is the most important variable associated with LAV in mild to moderate essential hypertensive adult patients. These findings highlight the importance of left atrium evaluation in adult, relatively young, essential hypertensive patients.

  2. A novel innominate vein-to-common atrium fenestration at Fontan completion.

    Science.gov (United States)

    Mir, Thomas S; Arndt, Florian; von Samson, Patrick; Philipp, Lisa; Schnegg, Clivia; Mueller, Götz; Dodge-Khatami, Ali

    2010-05-01

    With the hypothesis of low thromboembolic risk and higher late postoperative spontaneous closure, a new fenestration technique during extracardiac total cavopulmonary connection was attempted. From 2008 to 2009, 14 consecutive patients received an innominate vein-common atrium 5-mm Gore-Tex (W.L. Gore and Associates, Flagstaff, AZ) graft fenestration. Monitoring was performed by contrast bubble echocardiography at hospital discharge and up to 6 months postoperatively. The technique proved safe and reproducible, did not add to surgical difficulty or time, and provided reliable fenestration of up to at least 3 weeks, with a high rate of spontaneous closure during intermediate follow-up. Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. A сase of obstruction of SVC-right atrium appendage anastomosis after procedure Warden

    Directory of Open Access Journals (Sweden)

    Е. А. Связов

    2017-04-01

    Full Text Available The analysis of a 6-year patient’s medical history after correction of congenital heart disease (partial anomalous drainage of the right superior pulmonary vein into the superior vena cava complicated by obstruction of the anastomosis between the SVC and the appendage right atrium is presented. The article discusses the stages of diagnosis and patient management features, as well as the choice of treatment.Received 12 December 2016. Accepted 14 February 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Svyazov E.A.: data analysis, article writing and editing. Podoksenov A.U.: article editing. Varvarenko V.I.: implantation of the stent-graft in superior vena cava.Martsinkevich G.I.: echocardiographic examination of the patient before and after endograft implantation, article editing. Krivoshchyokov E.V.: organizational work and referral of the patient to endovascular treatment, article editing.

  4. ARE LEFT HANDED SURGEONS LEFT OUT?

    OpenAIRE

    SriKamkshi Kothandaraman; Balasubramanian Thiagarajan

    2012-01-01

    Being a left-handed surgeon, more specifically a left-handed ENT surgeon, presents a unique pattern of difficulties.This article is an overview of left-handedness and a personal account of the specific difficulties a left-handed ENT surgeon faces.

  5. Persistent left superior vena cava with absent right superior vena cava: image findings

    International Nuclear Information System (INIS)

    Araujo Junior, Cyrillo Rodrigues de; Carvalho, Tarcisio Nunes; Fraguas Filho, Sergio Roberto; Costa, Marlos Augusto Bitencourt; Jacob, Beatriz Mahmud; Machado, Marcio Martins; Teixeira, Kim-Ir-Sen Santos; Ximenes, Carlos Alberto

    2003-01-01

    Persistent left superior vena cava absent right superior vena cava is a rare anomaly, with less than 150 cases reported in the literature. Congenitally persistent left superior vena cava is the most common variant of systemic venous return to the heart, resulting embryologically from failure of the left anterior cardinal vein to become obliterated. Its incidence varies from 0.3% in patients with otherwise normal heart to 4.3% in patients with congenital heart disease. In the majority of the patients, a right superior vena cava is present as well, but rarely the right anterior cardinal vein degenerates resulting in the absence of the normal right superior vena cava. The blood from the right side is carried by the persistent left superior vena cava to the right atrium through the coronary sinus. We report the case of a patient with a persistent left superior vena cava and absence of right superior vena cava identified by chance during a chest radiograph and computed tomography examination for investigation of chronic pulmonary obstructive disease. The patient had no congenital heart disease and the blood from the right side was drained by the persistent left superior vena cava into the right atrium through the coronary sinus. (author)

  6. Sudden onset congestive heart failure with a continuous murmur: ruptured sinus of Valsalva aneurysm complicated by anomalous origin of the left coronary artery.

    Science.gov (United States)

    Seto, Arnold H; Hermer, Alan; Kern, Morton

    2008-01-01

    Ruptured sinus of Valsalva aneurysm is an unusual cause for congestive heart failure, and anomalous coronary arteries have rarely been found in association. A 47-year-old man developed sudden onset heart failure due to a ruptured noncoronary sinus of Valsalva fistula to the right atrium. Coronary angiography revealed an anomalous left coronary artery arising from the right coronary sinus, limiting percutaneous options for repair. We review the incidence, complications, and management of sinus of Valsalva aneurysms and anomalous left coronary arteries.

  7. A Giant Left Atrial Myxoma Neovascularized from the Right Coronary Artery

    Directory of Open Access Journals (Sweden)

    Demet Menekse Gerede

    2015-01-01

    Full Text Available Myxomas are benign and the most common tumors of the cardiac muscle (Reynen, 1995. They are predominantly located in the left atrium. Clinical manifestations may vary according to the localization and the size of the myxoma. On the other hand, imaging of a myxoma by contrast dye during coronary angiography is a rare sign, which displays the vascular supply of the tumor. Here, we report the case of a 51-year-old man presenting with presyncope and palpitations due to a giant left atrial myxoma having its vascular supply from the right coronary artery (RCA.

  8. Left atrial appendage occlusion

    Directory of Open Access Journals (Sweden)

    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.

  9. Atrial myocardium derives from the posterior region of the second heart field, which acquires left-right identity as Pitx2c is expressed.

    Science.gov (United States)

    Galli, Daniela; Domínguez, Jorge N; Zaffran, Stephane; Munk, Andrew; Brown, Nigel A; Buckingham, Margaret E

    2008-03-01

    Splanchnic mesoderm in the region described as the second heart field (SHF) is marked by Islet1 expression in the mouse embryo. The anterior part of this region expresses a number of markers, including Fgf10, and the contribution of these cells to outflow tract and right ventricular myocardium has been established. We now show that the posterior region also has myocardial potential, giving rise specifically to differentiated cells of the atria. This conclusion is based on explant experiments using endogenous and transgenic markers and on DiI labelling, followed by embryo culture. Progenitor cells in the right or left posterior SHF contribute to the right or left common atrium, respectively. Explant experiments with transgenic embryos, in which the transgene marks the right atrium, show that atrial progenitor cells acquire right-left identity between the 4- and 6-somite stages, at the time when Pitx2c is first expressed. Manipulation of Pitx2c, by gain- and loss-of-function, shows that it represses the transgenic marker of right atrial identity. A repressive effect is also seen on the proliferation of cells in the left sinus venosus and in cultured explants from the left side of the posterior SHF. This report provides new insights into the contribution of the SHF to atrial myocardium and the effect of Pitx2c on the formation of the left atrium.

  10. Rapid growth of left atrial myxoma after radiofrequency ablation.

    Science.gov (United States)

    Rubio Alvarez, José; Martinez de Alegria, Anxo; Sierra Quiroga, Juan; Adrio Nazar, Belen; Rubio Taboada, Carola; Martinez Comendador, José Manuel

    2013-01-01

    Atrial myxoma is the most common benign tumor of the heart, but its appearance after radiofrequency ablation is very rare. We report a case in which an asymptomatic, rapidly growing cardiac myxoma arose in the left atrium after radiofrequency ablation. Two months after the procedure, cardiovascular magnetic resonance, performed to evaluate the right ventricular anatomy, revealed a 10 × 10-mm mass (assumed to be a thrombus) attached to the patient's left atrial septum. Three months later, transthoracic echocardiography revealed a larger mass, and the patient was diagnosed with myxoma. Two days later, a 20 × 20-mm myxoma weighing 37 g was excised. To our knowledge, the appearance of an atrial myxoma after radiofrequency ablation has been reported only once before. Whether tumor development is related to such ablation or is merely a coincidence is uncertain, but myxomas have developed after other instances of cardiac trauma.

  11. 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.

  12. Functional mapping of left parietal areas involved in simple addition and multiplication. A single-case study of qualitative analysis of errors.

    Science.gov (United States)

    Della Puppa, Alessandro; De Pellegrin, Serena; Salillas, Elena; Grego, Alberto; Lazzarini, Anna; Vallesi, Antonino; Saladini, Marina; Semenza, Carlo

    2015-09-01

    All electrostimulation studies on arithmetic have so far solely reported general errors. Nonetheless, a classification of the errors during stimulation can inform us about underlying arithmetic processes. The present electrostimulation study was performed in a case of left parietal glioma. The patient's erroneous responses suggested that calculation was mainly applied for addition and a combination of retrieval and calculation was mainly applied for multiplication. The findings of the present single-case study encourage follow up with further data collection with the same paradigm. © 2014 The British Psychological Society.

  13. 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.

  14. South-east frontier of the Russian Empire and the processes on the division of the Ural River left bank area between Kirghiz-Kaysaks and Ural Cossacks in the second half of the XIX century

    Directory of Open Access Journals (Sweden)

    Alexey I. Kortunov

    2015-03-01

    Full Text Available The article highlights the issue related to the peculiarities of formation of the south-east frontier of the Russian Empire and with the process on separation of the border areas of the Orenburg line (in particular of the Ural River left bank area between Kirghiz-Kaysaks and Ural Cossacks in the second half of XIX century. The author pays particular attention to the problem of the resolution of disputes between the Ural Cossacks and Kirghiz-Kaysaks by local and central authorities.

  15. Image-based flow modeling in a two-chamber model of the left heart

    Science.gov (United States)

    Vedula, Vijay; Seo, Jung-Hee; Shoele, Kourosh; George, Richard; Younes, Laurent; Mittal, Rajat

    2014-11-01

    Computational modeling of cardiac flows has been an active topic of discussion over the past decade. Modeling approaches have been consistently improved by inclusion of additional complexities and these continue to provide new insights into the dynamics of blood flow in health and disease. The vast majority of cardiac models have been single-chamber models, which have typically focused on the left or right ventricles, and in these models, the atria are modeled in highly simplistic ways. However, the left atrium acts as a mixing chamber and works with the left ventricle in a highly coordinated fashion to move the blood from the pulmonary veins to the aorta. The flow dynamics associated with this two-chamber interaction is not well understood. In addition, the flow in the left atrium has by itself significant clinical implications and our understanding of this is far less than that of the left ventricle. In the current study, we use 4D CT to create a physiological heart model that is functionally normal and use an experimentally validated sharp-interface immersed boundary flow solver to explore the atrio-ventricular interaction and develop insights into some of the questions addressed above. This research is supported by the U.S. National Science Foundation through NSF Grants IOS-1124804 and IIS-1344772. Computational resources are provided in part through the NSF XSEDE grants TG-CTS100002 and TG-CTS130064.

  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. Condrossarcoma mixóide de átrio direito Right atrium myxoid chondrosarcoma

    Directory of Open Access Journals (Sweden)

    Cláudio Ribeiro da Cunha

    2008-03-01

    Full Text Available Relatamos o caso de uma paciente de 46 anos, cor branca, hipertensa há 20 anos, com suspeita de endocardite infecciosa. Foi realizado ecocardiograma transtorácico, o qual levou à hipótese de mixoma de átrio direito. A paciente foi submetida à cirurgia, observando-se massa tumoral de aspecto muco-gelatinoso friável. A massa foi submetida a congelação para exame anatomopatológico, com laudo sugestivo de tumor maligno mesenquimal. Foi realizado exame imunohistoquímico compatível com condrossarcoma mixóide. A paciente evoluiu com remissão espontânea do quadro após ressecção completa da neoplasia. Realizou acompanhamento ambulatorial por 14 meses, sem apresentar sinais de recidiva do tumor.We report a case of a 46 years-old woman, Caucasian, with hypertension and a primary dianosis of infectious endocarditis. A transthoracic echocardiogram was performed suggesting right atrium myxoma. The patient was submitted to surgery, which found a tumor mass with a jelly-like exterior. The mass was sent to anatomo-pathological analysis which diagnosed a myxoid chondrosarcoma tumor. After surgical resection, the patient achieved complete recovery with no signs of recidivation after 14 months.

  18. Hepatic vein and inferior vena caval thrombus extending into the right atrium: A rare complication of amoebic liver abscess

    International Nuclear Information System (INIS)

    Rehman, S.; Alvi, A.R.

    2010-01-01

    Amoebic liver abscess is an endemic in developing countries but few cases of associated vascular complications have been reported. The authors report a very rare vascular complication of hepatic veins and inferior vena caval (IVC) thrombosis extending into the right atrium in a young male with large amoebic liver abscess. Optimal result was achieved with early diagnosis on CT scan, percutaneous drainage of abscess, intravenous metronidazole, peri-operative anticoagulation, sternotomy and thrombectomy. (author)

  19. An impact of tectonic structures on the groundwater circulation and losses from surface accumulation in the area of the left bank of Lazići dam on the Tara MTS

    Directory of Open Access Journals (Sweden)

    Jemcov Igor R.

    2017-01-01

    Full Text Available The process of water leakage determination in the area of water accumulation and left bank of the Lazići dam requires extensive application of different methods: very detailed monitoring data, tracing, structural and tectonic investigations, etc. Obtained results of water losses from the reservoir indicate a tendency for further increases. According to the applied analyses, two zones at the narrow zone of the grout curtain, characterized by different hydraulic mechanisms were detected. Additionally, the general direction of water leakage from the reservoir was detected. An important conclusion is that in such hydraulically intense conditions leakage is unstoppable, but can be partially controlled or slowed down.

  20. 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.

  1. 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

  2. Persistent left superior vena cava leads to catheter malposition during PICC Port placement.

    Science.gov (United States)

    Konstantinou, Evangelos A; Mariolis Sapsakos, Theodoros D; Katsoulas, Theodoros A; Velecheris, Dimitrios; Tsitsimelis, Dimitrios; Bonatsos, Gerasimos

    2016-03-09

    We present a case of peripherally inserted central catheter (PICC) port placement where the catheter had been malpositioned to the persistent left superior vena cava. Despite the obvious elevation of the P-wave signaling proximity of the catheter tip to the sinus node, the catheter was not in the desired location within the superior vena cava or the right atrium, because of the presence of a persistent left superior vena cava. Computed tomography was used in order to locate the catheter. The catheter was located in the persistent left superior vena cava. Malpositioning of the catheter in the persistent left superior vena cava occurs in 0.3%-0.5% of patients. The catheter was subsequently removed.

  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

    Full Text Available Objective: to study the main components of the formation of impaired left ventricular diastolic filling in adolescents with myocardial pathology. Materials and methods. The study involved 110 adolescents with myocardial pathology aged 13–18 years, of which 40 — with heart rhythm disorder, 40 — with dysplastic cardiomyopathy, 30 — with primary hypertension. Morphological and functional parameters of the heart were studied using ultrasound according to standard procedure. Left ventricular diastolic function has been studied in the pulsed wave Doppler mode with transmitral flow mapping from the apical access of four-chambered heart. For an adequate assessment of left ventricular diastolic function and detection of its earliest disorders, adolescents underwent tests with isometric exercise. Based on these results, adolescents were divided in terms of the E/A ratio. In order to identify common latent factors that explain the correlation between indicators, we have used the factor analysis, namely, the principal component analysis. All statistical procedures were performed using application packages Statgraphics Centurion. Results. On the initial stages of formation of diastolic dysfunction of the left ventricular myocardium in adolescents, a significant role is played by a number of factors, which can be conditionally defined as the geometric, functional and neurohumoral factors consistently included in the pathological process. Thus, during the formation of left ventricular diastolic dysfunction type 1, the number one is neurohumoral factor, namely, the activation of the sympathoadrenal system, then peripheral vascular tone is being involved in the pathological process, and, consequently, a geometric factor — changing the sizes of the left atrium. In the formation of left ventricular diastolic dysfunction type 2, the process consistently involves the renin-angiotensin system, namely, renin, a functional factor is presented by the indices

  4. Comparison of left atrial size and function in hypertrophic cardiomyopathy and in Fabry disease with left ventricular hypertrophy.

    Science.gov (United States)

    Saccheri, María Cristina; Cianciulli, Tomás Francisco; Challapa Licidio, Wilde; Lax, Jorge A; Beck, Martín A; Morita, Luis A; Gagliardi, Juan A

    2018-02-19

    Fabry disease (FD) and hypertrophic cardiomyopathy (HCM) are two diseases with a different pathophysiology, both cause left ventricular hypertrophy (LVH) and myocardial fibrosis. Although remodeling and systolic dysfunction of the left atrium (LA) are associated with atrial fibrillation and stroke in HCM, changes in the size and function of the LA have not been well studied in FD with LVH. The following groups were studied prospectively, and their respective findings compared: 19 patients with non-obstructive HCM (Group I), 20 patients with a diagnosis of Fabry cardiomyopathy (Group II), and 20 normal subjects matched for sex and age (Group III). Left ventricular mass index was measured using Devereux' formula, left atrial volume with Simpson's biplane method and left atrial mechanical function, including strain and strain rate, was measured using the speckle tracking technique. Strain and strain rate of the reservoir were measured during the three phases: reservoir (SR S), passive conduit (SR E) and atrial contraction (SR A). Patients with HCM had a larger left atrial volume than patients with FD (48.16 ± 14.3 mL/m 2 vs 38.9 ± 14.9 mL/m 2 respectively, P cardiomyopathy, affecting the three phasic functions of the LA. Although in patients with HCM left atrial volume is larger than in patients with FD, both disorders exhibit severe decrease in left atrial function. These findings should be considered, given the potentially serious complications that can occur with the two diseases. © 2018 Wiley Periodicals, Inc.

  5. Evaluation of left atrial functions in children with chronic renal failure.

    Science.gov (United States)

    Demirpençe, Savaş; Güven, Barış; Meşe, Timur; Serdaroğlu, Erkin; Yılmazer, Murat Muhtar; Firuzan, Esin; Tavlı, Vedide

    2014-05-01

    One-quarter of deaths in children with chronic renal failure is due to cardiovascular complications. Conventional echocardiographic methods are insufficient for evaluating systolic functions in children with chronic renal failure. The aim of the present study was to investigate cardiac functions in children with chronic renal failure by evaluating left atrial volume and functions. The present cross-sectional observational study included 44 children undergoing dialysis, 16 children with chronic renal failure but not yet on dialysis, and 20 healthy control subjects. Transthoracic echocardiography was performed for all children. Variables regarding to left ventricle and atrium (left atrial systolic force, left atrial systolic force index, left atrial volume, left ventricular mass index, and relative wall thickness) were measured using two-dimensional and M-mode echocardiography. Left atrial systolic force index was negatively correlated with systolic blood pressure and left ventricular mass (p=0.01, r=0.266 and p=0.02, r=0.347, respectively). However, it was positively correlated with both early and late diastolic mitral inflow velocity (r=0.518, p=0.001 and r=0.828, p=0.001, respectively). There were no significant difference among the groups in terms of left atrial systolic force index and left atrial volume. However, left atrial systolic force index was higher in children with chronic renal failure but not yet on dialysis. Left atrial systolic force was negatively correlated with systolic blood pressure and left ventricular mass. These findings suggested that evaluating left atrial systolic force and left atrial volume were useful to determine diastolic dysfunction and the necessity of dialysis in patient with chronic renal failure.

  6. [Determination of residual mass in left ventricle by intraoperative transesophageal echocardiography after a giant and floating left atrial myxoma resection].

    Science.gov (United States)

    Kavakli, Ali Sait; Kavrut Ozturk, Nilgun

    2017-12-20

    Atrial myxoma is a benign tumor of the heart that occurs primarily in the left atrium. Floating or large left atrial myxomas frequently cause functional mitral stenosis, may also affect mitral valve structure and flow, and lead to mitral regurgitation. Systemic embolization occurs in around 30% of cases either from tumor fragmentation or complete tumor detachment hence it should be removed as soon as it is detected. Intraoperative transesophageal echocardiography has a vital importance in the surgery. After resection of myxoma, intraoperative transesophageal echocardiography must be performed to rule out residual mass. The case here reported is of a 48-year old female, who presented with giant and floating left atrial myxoma. Residue mass was detected with intraoperative transesophageal echocardiography in the left ventricle after the resection of myxoma. Subsequently, the residue mass was successfully removed. Complete resection must be required to prevent possible complications such as recurrence, embolization in atrial myxomas. Transesophageal echocardiography performed intraoperatively is vital importance to confirm that the myxoma is completely resected. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. Pitx2 prevents susceptibility to atrial arrhythmias by inhibiting left-sided pacemaker specification.

    Science.gov (United States)

    Wang, Jun; Klysik, Elzbieta; Sood, Subeena; Johnson, Randy L; Wehrens, Xander H T; Martin, James F

    2010-05-25

    Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, often coexists with the related arrhythmia atrial flutter (AFL). Limitations in effectiveness and safety of current therapies make an understanding of the molecular mechanism underlying AF more urgent. Genome-wide association studies implicated a region of human chromosome 4q25 in familial AF and AFL, approximately 150 kb distal to the Pitx2 homeobox gene, a developmental left-right asymmetry (LRA) gene. To investigate the significance of the 4q25 variants, we used mouse models to investigate Pitx2 in atrial arrhythmogenesis directly. When challenged by programmed stimulation, Pitx2(null+/-) adult mice had atrial arrhythmias, including AFL and atrial tachycardia, indicating that Pitx2 haploinsufficiency predisposes to atrial arrhythmias. Microarray and in situ studies indicated that Pitx2 suppresses sinoatrial node (SAN)-specific gene expression, including Shox2, in the left atrium of embryos and young adults. In vivo ChIP and transfection experiments indicated that Pitx2 directly bound Shox2 in vivo, supporting the notion that Pitx2 directly inhibits the SAN-specific genetic program in left atrium. Our findings implicate Pitx2 and Pitx2-mediated LRA-signaling pathways in prevention of atrial arrhythmias.

  8. 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.

  9. A Case of Left Atrial Myxoma Whose Initial Symptom Was Finger Ischemic Symptom.

    Science.gov (United States)

    Yamashita, Maho; Eguchi, Kazuo; Ogawa, Masaya; Takahashi, Kan; Nagai, Michiaki; Shimpo, Masahisa; Misawa, Yoshio; Kario, Kazuomi

    2018-01-01

    We experienced a 45-year-old Japanese man who was transferred to our hospital complaining of acute onset of pain and pallor in the right lower limb. Two years earlier, he had complained of repetitive pain at rest and pallor in the left third and fourth fingers. The physical exam and angiography demonstrated occlusion of finger arteries, however we could not reach final diagnosis. Acute arterial occlusive disease in the right lower limb was suspected. Transthoracic echocardiography demonstrated a gross tumor in the left atrium, which suggested left atrial myxoma. An emergency tumorectomy was successfully conducted. Pathologically, the fragile tumor and resultant thrombosis could have caused the patient's peripheral circulatory failure at least two years prior to this episode. A rigorous systemic survey is important even when the ischemic symptom is localized in peripheral circulation.

  10. Types of Diastolic Dysfunction of the Left Ventricle in Adolescents with Myocardial Pathology

    Directory of Open Access Journals (Sweden)

    L.F. Bogmat

    2014-05-01

    Full Text Available In adolescents with myocardial pathology during isometric tests we detected three types of diastolic dysfunction of the left ventricle (LV of the heart, depending on E/A ratio. The most pronounced signs of diastolic filling disorders were detected in the third group of patients, as evidenced: by a tendency to increase isovolumic relaxation time, a significant increase of slowing down time of the first phase of left ventricular filling, reduced LV filling rate both in the first phase of the passive filling and the second phase of active LV filling, increasing E/A ratio of more than 2, significant dilation of the left atrium, as well as positive increase in diastolic reserve that confirms deeper diastolic dysfunction in these adolescents compared with other subgroups.

  11. A Large Left Ventricle Myxoma: Presenting with Epigastric Pain and Weight Loss

    Directory of Open Access Journals (Sweden)

    Solmaz Fakhari

    2016-01-01

    Full Text Available Cardiac myxomas are the most common benign tumors found in the heart. They usually appear in the left atrium. Those originating from the left ventricle (LV are rare. Although clinical presentation may vary, dyspnea and embolism are the most commonly reported symptoms. In the present case study, a 27-year-old woman with a large myxoma originating from the left ventricular free wall is studied. She had atypical complaints, mainly epigastric discomfort, nausea, vomiting, and anorexia. She was hospitalized for acute abdomen, but subsequent investigations revealed a large myxoma that fully filled the LV and severely compromised the flow of the aortic and mitral valves. After successful emergency tumor resection, all symptoms disappeared. The uncommon presentation caused by these tumors is discussed in this study.

  12. [Research on child neglect situation and influential factors of left-behind children and living-with-parents children aged 6-17 year-old in rural areas of two provinces, western China].

    Science.gov (United States)

    Zhong, Yin; Zhong, Zhaohui; Pan, Jianping; Li, Qunying; Zhong, Yun; Sun, Haoling

    2015-10-01

    To investigate the situation and the influential factors of child neglect between left-behind children and living-with-parents children aged 6-17 years in the rural areas in western China. Students were randomly selected according to the principle of multi-stage stratified cluster sampling and they were from three cities in Shanxi and four districts in Chongqing. Among the 4,131 children, there were 1,874 students in the 6-11 years group and the left-behind children accounted for 50.21% (941/1,874) in this group. There were 2,257 students in the 12-17 years old group and the left-behind children accounted for 53.35% (1,204/2,257) in this group. The questionnaire named "Evaluation on Neglect for Elementary and Secondary School Students Aged 6-17 Years in Rural Areas in China" was used in the field investigation. The students' neglect frequency was described by neglect rate and the factors affecting students' neglect were analyzed by means of binary logistic regression. In the 6-11 years old group, the neglect rates of left-behind children and living-with-parents children were 63.03% (474/752) and 43.87% (347/791), respectively (χ2=58.86, Pchildren and living-with-parents children were 60.64% (627/1 034) and 53.57% (495/924), respectively (χ2=9.96, Pchildren, compared to the factors about boys, younger mother (≤40 years old), presence of parents' income reduction within the last year and nuclear family, the factors about girls, elder mother (41-49 years), absence of parents' income reduction within the last year and three-generation family or single-parent family were associated with lower neglect risk, and OR values were 0.67, 0.68, 0.70, 0.73, and 0.43 (Pchildren, the factors about other nationalities, non-only child, no separate room at home, and non-resident children were associated with high neglect risk, and OR values were 1.85, 1.34, 1.46, and 1.32 (Pchildren and parents as well as good relationship between parents, fair or poor relationship was associated

  13. 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

  14. Plain radiographic diagnosis of thrombosis of left atrial appendage in mitral valve disease

    International Nuclear Information System (INIS)

    Matsuyama, S.; Watabe, T.; Kuribayashi, S.

    1983-01-01

    Conventional posteroanterior chest radiographs of 42 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the presence or absence of the convexity of the left lower midcardiac border (left artrial segment). The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in six (60%) of 10 patients who had left atrial thrombosis, and in three (9%) of 32 patients who did not have thrombosis (false positive diagnosis). Four of the 10 patients who had left atrial thrombosis did not show this finding on the radiographs (false negative diagnosis). One of these four had a thrombus only against the posterior wall of the body of the left atrium. Therefore, the accuracy in the diagnosis of thrombosis of the left atrial appendage was 66.7% (six of nine) for patients who had thrombosis of the appendage. Standard chest radiographs are important in the evaluation of the patient with thrombosis of the left atrial appendage

  15. [Ischemic stroke induced by a left atrial myxoma].

    Science.gov (United States)

    Hatayama, Sayaka; Ogata, Toshiyasu; Okawa, Masakazu; Higashi, Toshio; Inoue, Tooru; Takano, Koichi; Minematsu, Noritoshi; Tashiro, Tadashi; Sakata, Noriyuki

    2012-10-01

    We reported a case of ischemic stroke induced by a left atrial myxoma. A 76-year-old man was found unconscious and transferred to the emergency ward in our hospital. He experienced consciousness disturbance, motor dominant aphasia, and severe right hemiparesis. His neurological and radiological findings indicated that he had ischemic stroke and was eligible to undergo intravenous thrombolysis. Alteplase was administrated 155 min after the onset of stroke. Intracerebral hemorrhage was not seen 24h after thrombolysis. A tumor in the left atrium was detected on transthoracic echocardiography, and this finding suggested that the tumor was a myxoma. Although cardiac surgery was scheduled, hemorrhagic transformation was found on day 11, which made us postpone the surgery. After the hemorrhage was disappeared, the tumor was resected by open-heart surgery and it was confirmed to be a myxoma. Neither his neurological symptom nor intracerebral hemorrhage was not deteriorated after the operation. Thrombolytic treatment seemed a safe option for ischemic stroke caused by left atrial myxoma. However, we should carefully monitor the extent of anticoagulation therapy because hemorrhagic transformation might alter the timing of surgery for tumor resection.

  16. A Novel Mapping System for Panoramic Mapping of the Left Atrium: Application to Detect and Characterize Localized Sources Maintaining Atrial Fibrillation.

    Science.gov (United States)

    Honarbakhsh, Shohreh; Schilling, Richard J; Dhillon, Gurpreet; Ullah, Waqas; Keating, Emily; Providencia, Rui; Chow, Anthony; Earley, Mark J; Hunter, Ross J

    2018-01-01

    This study sought to use a novel panoramic mapping system (CARTOFINDER) to detect and characterize drivers in persistent atrial fibrillation (AF). Mechanisms sustaining persistent AF remain uncertain. Patients undergoing catheter ablation for persistent AF were included. A 64-pole basket catheter was used to acquire unipolar signals, which were processed by the mapping system to generate wavefront propagation maps. The system was used to identify and characterize potential drivers in AF pre- and post-pulmonary vein (PV) isolation. The effect of ablation on drivers identified post-PV isolation was assessed. Twenty patients were included in the study with 112 CARTOFINDER maps created. Potential drivers were mapped in 19 of 20 patients with AF (damage to the basket and noise on electrograms was present in 1 patient). Thirty potential drivers were identified all of which were transient but repetitive; 19 were rotational and 11 focal. Twenty-six drivers were ablated with a predefined response in 22 of 26 drivers: AF terminated with 12 and cycle length slowed (≥30 ms) with 10. Drivers with rotational activation were predominantly mapped to sites of low-voltage zones (81.8%). PV isolation had no remarkable impact on the cycle length at the driver sites (138.4 ± 14.3 ms pre-PV isolation vs. 137.2 ± 15.2 ms post-PV isolation) and drivers that had also been identified on pre-PV isolation maps were more commonly associated with AF termination. Drivers were identified in almost all patients in the form of intermittent but repetitive focal or rotational activation patterns. The mechanistic importance of these phenomena was confirmed by the response to ablation.

  17. Enlargement of the left atrium is associated with increased infiltration of immune cells in patients with atrial fibrillation who had undergone surgery

    Directory of Open Access Journals (Sweden)

    Takeshi Yamashita, MD

    2015-04-01

    Conclusions: In the patients with AF, LA enlargement was associated not only with the increase in the extent of interstitial fibrosis but also with the changes in the LA component cells, including an increase in number of immune cells resident in tissues.

  18. Crude extract and purified components isolated from the stems of Tinospora crispa exhibit positive inotropic effects on the isolated left atrium of rats

    DEFF Research Database (Denmark)

    Praman, Siwaporn; Mulvany, Michael J.; Williams, David E.

    2013-01-01

    -butanol soluble material was concentrated and dried under reduced pressure and lyophilized to obtain a crude powder (Tinospora crispa extract). The active components of Tinospora crispa extract were separated by column chromatography and preparative HPLC. The effects and mechanisms of the n-butanol extract...

  19. Health allowance for improving the nutritional status and development of 3-5-year-old left-behind children in poor rural areas of China: study protocol for a cluster randomised trial.

    Science.gov (United States)

    Lin, Qian; Adab, Peymané; Hemming, Karla; Yang, Lina; Qin, Hong; Li, Mingzhi; Deng, Jing; Shi, Jingcheng; Chen, Jihua

    2015-08-18

    Left-behind children (LBC) are recognised as a new social group in China. LBC are young children who are abandoned in rural villages whilst their parents travel to distant urban centres for employment (a new generation of migrant workers). Following the rapid growth in the number of migrant workers, the LBC population is also rapidly increasing. These children are usually left to be raised by elderly grandparents, a single parent, or sometimes distant relatives or neighbours who have limited resources, tend to have a poor education and sometimes are in frail health. Over 40 % of the 61 million LBC in China who are under 5 years old are undernourished, which affects their long-term health and abilities. An intervention that combines a conditional cash transfer (CCT) with nutrition education offers a potential solution. A cluster randomised controlled trial design will be used to allocate 40 villages to the intervention arm (20 villages) or control arm (20 villages). The caregivers and all of the 3-5-year-old LBC will be the target population. Caregivers in the intervention arm will receive a cash allowance conditional on attending nutrition education sessions, ensuring that the LBC will use basic public health services over a 12-month period. At the baseline, midterm (month 6) and end (month 12) of the intervention period, evaluations will be conducted in all 40 villages. Multilevel generalised linear models will be used to analyse the impact of the intervention on nutrition status and other outcomes, adjusting for baseline levels using an analysis of covariance approach. The cost of the intervention will also be estimated. If found to be cost-effective, the findings will inform the development of a sustainable model to improve nutrition status among LBC in rural areas of China. Chinese Trial Register (ChiCTR) identifier: CTXY-140003-2 . Registered on 19 Aug 2014.

  20. Areas of Active Tectonic Uplift Are Sensitive to Small Changes in Fold Orientations within a Broad Zone of Left-lateral Transpression and Shearing, Dominican Republic and Haiti (Hispaniola)

    Science.gov (United States)

    Ambrosius, I.; Mann, P.

    2014-12-01

    Previous GPS studies have shown that the island of Hispaniola is a 250 km-wide zone of active, east-west, left-lateral shearing along two major strike-slip zones: the Septentrional-Oriente fault zone through the northern part of the island and the Enriquillo-Plantain Garden fault zone (EPGFZ) through the southern part of the island. The total interplate rate distributed on both faults is 21 mm/yr. Using a high-resolution DEM, we constructed fluvial channel profiles across transpression-related folds of late Miocene to recent age in the area of central and southern Dominican Republic and Haiti to determine controls of areas of relatively high, moderate, and slow uplift inferred from fluvial channel profiles. Fold axes in this area extend for 50-150 km and exhibit two different trends: 1) folds that occupy the area of the Sierra de Neiba-Chaine des Matheux north of the Enriquillo-Cul-de-Sac Valley and EPGFZ and folds that occupy the area of the Sierra de Bahoruco-Massif de la Selle all exhibit more east-west fold axes trending 110; 2) folds that occupy the area northwest of the EPGFZ in the western Chaine des Matheux and Sierra de Neiba all exhibit fold axes with more northwest trends of 125. River channel profiles show that the second group of more northwesterly-trending fold axes show relatively higher rates of tectonic uplift based on their convex-upward river profiles. Our interpretation for regional variations in river profiles and inferred uplift is that uplift is more pronounced on fold axes trending 15 degrees more to the northwest because their axes are more oblique to the interplate direction of east-west shearing. Longterm uplift rates previously measured from a stairstep of late Quaternary coral terraces at the plunging nose of the westernmost Chaine des Matheux have been previously shown to be occurring at a rate of 0.19 mm/yr. Onland exposures of Holocene corals are found only on one locality within the southern area of folds 30 km west of the epicenter

  1. A rare case of classical Hodgkin's lymphoma in the setting of a newly diagnosed left atrial myxoma

    Science.gov (United States)

    Bolanos, Alexander Javier; Dibu, George; Burke, Floyd W; Klodell, Charles T; Li, Ying; Rand, Kenneth H; Lucas, Alexandra Rose

    2015-01-01

    We report a rare case of left atrial myxoma with concomitant classical Hodgkin's lymphoma in a 36-year-old woman with a non-significant medical history and 4 months of progressively worsening palpitations, dyspnoea on exertion, chest discomfort and fatigue. Outpatient echocardiography revealed functional mitral valve stenosis as a result of a large left atrial cardiac mass. Preoperative thoracic imaging revealed an anterior mediastinal mass with associated lymphadenopathy. The patient underwent successful resection of the anterior mediastinal mass and left atrial mass. Surgical pathology revealed myxoma in the left atrium and classical Hodgkin's lymphoma in the anterior mediastinum. Thus the patient was diagnosed with early-stage classical Hodgkin's lymphoma. This clinical vignette emphasises the importance of a comprehensive diagnostic evaluation in the setting of a newly discovered atrial tumour. PMID:26516250

  2. 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.

  3. 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

  4. The effect of aerobic continuous training and detraining on left ventricular structure and function in male students

    Directory of Open Access Journals (Sweden)

    Mahdiabadi Javad

    2017-04-01

    Full Text Available Purpose. Regular exercise training induces cardiac physiological hypertrophy. The aim of this study was to determine the effect of aerobic continuous training and a detraining period on left ventricular structure and function in non-athlete healthy men. Material. Ten untrained healthy male students (aged 18-22 years were volunteered and participated in countryside continuous jogging programme (3days/week, at 70% of Maximum Heart Rate for 45 min, 8-weeks and four weeks detraining afterwards. M-mode, 2-dimensional, colour and Doppler transthoracic echocardiography were performed, during resting conditions, before and after the training and after detraining period. Results. Using t-test, we found significant difference in end systolic diameter and the posterior wall thickness, percentage shortening and ejection fraction after eight weeks training compared to before training. It was found no significant difference in end diastolic diameter, interventricular septum thickness, left atrium diameter, aortic root diameter, heart rate, systolic and diastolic blood pressures. Following four weeks detraining after training, compared with eight weeks of training was a significant difference in end diastolic diameter, percentage shortening and ejection fraction and no significant difference in end systolic diameter, posterior wall thickness, interventricular septum thickness, left atrium diameter, aortic root diameter, heart rate, systolic and diastolic blood pressures. Conclusions. In general, eight-week aerobic continuous training and a detraining period can affect left ventricular structure and function.

  5. 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...

  6. Effects of trypan blue on the action of adrenergic agonists in the guinea-pig isolated atrium.

    Science.gov (United States)

    Mahmoudian, M; Ziai, S A

    1998-01-01

    It has been reported that trypan blue, a diazo dye with polyamphipathic structure, can inhibit the coupling of receptors to G-proteins. The present study was carried out to investigate the effect of trypan blue on the actions of adrenoceptor agonists in the guinea-pig atrium. Trypan blue (10 and 100 microM) antagonized the positive inotropic effects of isoprenaline and dobutamine by shifting their concentration-response curves to the right. With the selective beta 2-adrenoceptor agonist, salbutamol, there was a reduction of response in the presence of trypan blue. Therefore, we concluded that trypan blue diminish the response to beta-adrenoceptor agonists possibly via decoupling receptors from Gs. Trypan blue and similar agents, due to their unique mode of action, can be used as tools for the investigation of the mechanism of receptor-G protein coupling in the whole tissue preparation.

  7. Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    Chun Sung Byun

    Full Text Available Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.

  8. A successful insertion of PICC in patient with cardiac angiosarcoma and neoplasty of right atrium and pacemaker: A case report.

    Science.gov (United States)

    Liu, Bing; Sun, Wenyan; Wang, Kai

    2017-12-01

    Primary cardiac angiosarcoma is a rare tumor and the common treatment is surgical resection followed by chemotherapy. Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate especially in patient with abnormal anatomy structure. Reports about PICCs being placed in patient who had suffered from the cardiac angiosarcoma and neoplasty of right atrium with an ipsilateral cardiac permanent pacemaker are rarely.After patient's informed consent, we present a case of the successful insertion of PICC into a patient with the ipsilateral cardiac disease with a pacemaker placement, which has not been previously reported. This report highlights PICC could be used in patient with cardiac disease with a pacemaker placement for chemotherapy. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  9. A successful insertion of PICC in patient with cardiac angiosarcoma and neoplasty of right atrium and pacemaker

    Science.gov (United States)

    Liu, Bing; Sun, Wenyan; Wang, Kai

    2017-01-01

    Abstract Introduction: Primary cardiac angiosarcoma is a rare tumor and the common treatment is surgical resection followed by chemotherapy. Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate especially in patient with abnormal anatomy structure. Reports about PICCs being placed in patient who had suffered from the cardiac angiosarcoma and neoplasty of right atrium with an ipsilateral cardiac permanent pacemaker are rarely. After patient's informed consent, we present a case of the successful insertion of PICC into a patient with the ipsilateral cardiac disease with a pacemaker placement, which has not been previously reported. Conclusions: This report highlights PICC could be used in patient with cardiac disease with a pacemaker placement for chemotherapy. PMID:29390474

  10. 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.

  11. A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium: Towards safer, imaging-guided, tailored cortico-leucotomies.

    Science.gov (United States)

    Frati, Alessandro; Pesce, Alessandro; D'Andrea, Giancarlo; Fraschetti, Flavia; Salvati, Maurizio; Cimatti, Marco; Esposito, Vincenzo; Raco, Antonino

    2018-04-01

    The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard "anatomical" approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and "tailored" cortico-leucotomy for an optimal exposure of the lesion. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Left atrial volume index

    DEFF Research Database (Denmark)

    Poulsen, Mikael K; Dahl, Jordi S; Henriksen, Jan Erik

    2013-01-01

    To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease.......To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease....

  13. 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.

  14. Tomato (Lycopersicon esculentum) Supplementation Induces Changes in Cardiac miRNA Expression, Reduces Oxidative Stress and Left Ventricular Mass, and Improves Diastolic Function.

    Science.gov (United States)

    Pereira, Bruna L B; Arruda, Fernanda C O; Reis, Patrícia P; Felix, Tainara F; Santos, Priscila P; Rafacho, Bruna P; Gonçalves, Andrea F; Claro, Renan T; Azevedo, Paula S; Polegato, Bertha F; Okoshi, Katashi; Fernandes, Ana A H; Paiva, Sergio A R; Zornoff, Leonardo A M; Minicucci, Marcos F

    2015-11-19

    The aim of this study was to evaluate the effects of tomato supplementation on the normal rat heart and the role of oxidative stress in this scenario. Male Wistar rats were assigned to two groups: a control group (C; n = 16), in which animals received a control diet + 0.5 mL of corn oil/kg body weight/day, and a tomato group (T; n = 16), in which animals received a control diet supplemented with tomato +0.5 mL of corn oil/kg body weight/day. After three months, morphological, functional, and biochemical analyses were performed. Animals supplemented with tomato had a smaller left atrium diameter and myocyte cross-sectional area (CSA) compared to the control group (C group: 474 (415-539); T group: 273 (258-297) µm²; p = 0.004). Diastolic function was improved in rats supplemented with tomato. In addition, lipid hydroperoxide was lower (C group: 267 ± 46.7; T group: 219 ± 23.0 nmol/g; p = 0.039) in the myocardium of rats supplemented with tomato. Tomato intake was also associated with up-regulation of miR-107 and miR-486 and down-regulation of miR-350 and miR-872. In conclusion, tomato supplementation induces changes in miRNA expression and reduces oxidative stress. In addition, these alterations may be responsible for CSA reduction and diastolic function improvement.

  15. Tomato (Lycopersicon esculentum Supplementation Induces Changes in Cardiac miRNA Expression, Reduces Oxidative Stress and Left Ventricular Mass, and Improves Diastolic Function

    Directory of Open Access Journals (Sweden)

    Bruna L. B. Pereira

    2015-11-01

    Full Text Available The aim of this study was to evaluate the effects of tomato supplementation on the normal rat heart and the role of oxidative stress in this scenario. Male Wistar rats were assigned to two groups: a control group (C; n = 16, in which animals received a control diet + 0.5 mL of corn oil/kg body weight/day, and a tomato group (T; n = 16, in which animals received a control diet supplemented with tomato +0.5 mL of corn oil/kg body weight/day. After three months, morphological, functional, and biochemical analyses were performed. Animals supplemented with tomato had a smaller left atrium diameter and myocyte cross-sectional area (CSA compared to the control group (C group: 474 (415–539; T group: 273 (258–297 µm2; p = 0.004. Diastolic function was improved in rats supplemented with tomato. In addition, lipid hydroperoxide was lower (C group: 267 ± 46.7; T group: 219 ± 23.0 nmol/g; p = 0.039 in the myocardium of rats supplemented with tomato. Tomato intake was also associated with up-regulation of miR-107 and miR-486 and down-regulation of miR-350 and miR-872. In conclusion, tomato supplementation induces changes in miRNA expression and reduces oxidative stress. In addition, these alterations may be responsible for CSA reduction and diastolic function improvement.

  16. Reduction in left supplementary motor area grey matter in adult female fibromyalgia sufferers with marked fatigue and without affective disorder: a pilot controlled 3-T magnetic resonance imaging voxel-based morphometry study.

    Science.gov (United States)

    Puri, B K; Agour, M; Gunatilake, K Dr; Fernando, K Ac; Gurusinghe, A I; Treasaden, I H

    2010-01-01

    This study aimed to test the hypothesis that structural grey matter brain changes might occur in the chronic intractable pain disorder fibromyalgia when this is associated with marked fatigue in the absence of a DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision) diagnosis of affective disorder. High-resolution 3-T cerebral magnetic resonance imaging scans were acquired in 10 female, right-handed, non-smoking, white Caucasian subjects: five patients with fibromyalgia associated with marked fatigue and five age-matched healthy women. Voxel-wise generalized linear modelling of the processed neuroanatomical data using permutation-based non-parametric testing, forming clusters at t > 2.3 and testing clusters for significance at P fibromyalgia and marked fatigue in the left supplementary motor area. This brain region plays an important role in cognitive or executive control and in the translation of painful cognition; these functions are impaired in fibromyalgia associated with marked fatigue.

  17. Anatomy and Physiology of Left Ventricular Suction Induced by Rotary Blood Pumps.

    Science.gov (United States)

    Salamonsen, Robert Francis; Lim, Einly; Moloney, John; Lovell, Nigel Hamilton; Rosenfeldt, Franklin L

    2015-08-01

    This study in five large greyhound dogs implanted with a VentrAssist left ventricular assist device focused on identification of the precise site and physiological changes induced by or underlying the complication of left ventricular suction. Pressure sensors were placed in left and right atria, proximal and distal left ventricle, and proximal aorta while dual perivascular and tubing ultrasonic flow meters measured blood flow in the aortic root and pump outlet cannula. When suction occurred, end-systolic pressure gradients between proximal and distal regions of the left ventricle on the order of 40-160 mm Hg indicated an occlusive process of variable intensity in the distal ventricle. A variable negative flow difference between end systole and end diastole (0.5-3.4 L/min) was observed. This was presumably mediated by variable apposition of the free and septal walls of the ventricle at the pump inlet cannula orifice which lasted approximately 100 ms. This apposition, by inducing an end-systolic flow deficit, terminated the suction process by relieving the imbalance between pump requirement and delivery from the right ventricle. Immediately preceding this event, however, unnaturally low end-systolic pressures occurred in the left atrium and proximal left ventricle which in four dogs lasted for 80-120 ms. In one dog, however, this collapse progressed to a new level and remained at approximately -5 mm Hg across four heart beats at which point suction was relieved by manual reduction in pump speed. Because these pressures were associated with a pulmonary capillary wedge pressure of -5 mm Hg as well, they indicate total collapse of the entire pulmonary venous system, left atrium, and left ventricle which persisted until pump flow requirement was relieved by reducing pump speed. We suggest that this collapse caused the whole vascular region from pulmonary capillaries to distal left ventricle to behave as a Starling resistance which further reduced right

  18. Radionuclide detection and differential diagnosis of left-to-right cardiac shunts by analysis of time-activity curves

    International Nuclear Information System (INIS)

    Kim, Ok-Hwa

    1986-01-01

    The noninvasive nature of the radionuclide angiocardiography provided a useful approach for the evaluation of left-to-right cardiac shunts (LRCS). While the qualitative information can be obtained by inspection of serial radionuclide angiocardiograms, the quantitative information of radionuclide angiocardiography can be obtained by the analysis of time-activity curves using advanced computer system. The count ratios method and pulmonary-to-systemic flow ratio (QP/QS) by gamma variate fit method were used to evaluate the accuracy of detection and localization of LRCS. One hundred and ten time-activity curves were analyzed. There were 46 LRCS (atrial septal defects 11, ventricular septal defects 22, patent ductus arteriosus 13) and 64 normal subjects. By computer analysis of time-activity histograms of the right atrium, ventricle and the lungs separately, the count ratios modified by adding the mean cardiac transit time were calculated in each anatomic site. In normal subjects the mean count ratios in the right atrium, ventricle and lungs were 0.24 on average. In atrial septal defects, the count ratios were high in the right atrium, ventricle and lungs, whereas in ventricular septal defects the count ratios were higher only in the right ventricle and lungs. Patent ductus arteriosus showed normal count ratios in the heart but high count ratios were obtained in the lungs. Thus, this count ratios method could be separated normal from those with intracardiac or extracardiac shunts, and moreover, with this method the localization of the shunts level was possible in LRCS. Another method that could differentiate the intracardiac shunts from extracardiac shunts was measuring QP/QS in the left and right lungs. In patent ductus arteriosus, the left lung QP/QS was hight than those of the right lung, whereas in atrial septal defects and ventricular septal defects QP/QS ratios were equal in both lungs. (J.P.N.)

  19. What is left behind when the lights go off? Comparing the abundance and composition of litter in urban areas with different intensity of nightlife use in Mar del Plata, Argentina.

    Science.gov (United States)

    Becherucci, Maria Eugenia; Seco Pon, Juan Pablo

    2014-08-01

    Nightlife activities represents an important source of urban litter; the latter often being left behind or abandoned in public places and streets. Mar del Plata is a very important city on the Atlantic coast of Argentina and is the main tourism destination in the South Atlantic region of South America. However, few studies on urban litter related to nightlife activities have been conducted in the area. Here we assessed (i) the abundance and composition of litter, and (ii) the spatial and temporal variations of its abundance, diversity, richness and evenness in urbanized areas with different intensity of nightlife activities from April 2008 to March 2009. An overall of 13,503 items were counted. Around 92% of the total litter was comprised by cigarette butts, papers and plastics. We found significant spatial differences in the abundance of litter between sampling sites, with the greatest amounts of litter at the Alem site followed by the Hipólito site (both with an intensive nightlife activity) compared with the Chauvin site (a quiet high-income neighborhood). The composition of litter of the Alem and the Hipólito sites was relatively similar and both sites differ with respect to the Chauvin site. Cigarette butts, papers, and plastics were the items that contributed most to the dissimilarity between sampling sites. The diversity of litter was the single community parameter that significantly differed from the other seasons. We discussed the potential effect of nightlife activities on the amounts and quality of urban litter in the city of Mar del Plata. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. 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

    2017-12-28

    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.

  1. 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 ...

  2. Assessment of left and right ventricular parameters in healthy Korean volunteers using cardiac magnetic resonance imaging: change in ventricular volume and function based on age, gender and body surface area.

    Science.gov (United States)

    Chang, Sung-A; Choe, Yeon Hyeon; Jang, Shin Yi; Kim, Sung Mok; Lee, Sang-Chol; Oh, Jae K

    2012-12-01

    The clinical utility of cardiac magnetic resonance imaging (CMR) is growing and is being used predominantly as a means of measuring ventricular function. The normal reference range of ventricular function may vary based on age, sex and ethnicity. At present, most CMR reference values for healthy individuals have been reported from Western countries. The intent of this study was to investigate the normal CMR reference range for left ventricular (LV) and right ventricular (RV) parameters in healthy Koreans. Healthy volunteers between the ages of 20-70 years without any history of cardiovascular disease or associated risk factors were prospectively recruited to be a part of this study. A total of 124 patients were recruited for this study. Steady-state free precession pulse sequences were used to obtain the cine images for LV and RV volume analysis. All parameters were analyzed based on age and gender, and normalized to body surface area (BSA). LV volume, mass and cardiac output were significantly greater in males than in females. However, all of these parameters which are associated with BSA and gender differences disappeared when corrected for BSA. RV volume was less in females even after the data was normalized for BSA. LV and RV volumes normalized for BSA gradually decreased with greater age, whereas the ejection fraction increased with age, thus maintaining the stroke volume index and cardiac index. LV and RV volumes, mass and function values for a healthy population largely depend on BSA and should be evaluated after normalization by BSA. LV parameters show no difference based on gender, but RV volume is less in the female. Greater age is associated with less ventricular volume, suggesting the possibility of volume sensitivity in the elderly.

  3. Right to Left Ventricular Diameter Ratio ≥0.42 is the Warning Flag for Suspecting Atrial Septal Defect in Preschool Children: Age- and Body Surface Area-Related Reference Values Determined by M-Mode Echocardiography.

    Science.gov (United States)

    Hashimoto, Ikuo; Watanabe, Kazuhiro; Ichida, Fukiko

    2016-04-01

    It is not always easy to observe and screen atrial septal defects (ASD) using echocardiography. In addition, there are no established echocardiographic reference indices for screening patients with ASDs. We retrospectively reviewed our database and recruited 151 isolated ASD patients and 2769 healthy subjects. In total, 307 echocardiographic studies were performed for ASD patients. Surgical repairs were done in 75 of the ASD patients. The ratio of right to left ventricular end-diastolic dimensions (RVD/LVD), which was determined by M-mode echocardiography, was used as an index of RV dilatation. After obtaining age- and body surface area (BSA)-related RVD/LVD nomograms in healthy subjects, we calculated the z-scores of RVD/LVD for all subjects and obtained the optimal cut-off values to differentiate patients with ASD from healthy subjects. The optimal cut-off values were high in neonates and gradually decreased with an increase in the age and BSA, but were almost constant in children aged >4 years or whose BSA was >0.65 m(2). The cut-off values of RVD/LVD for suspected ASD were ≥0.42 in children aged >4 years or those whose BSA was >0.65 m(2). Those for an ASD operation were ≥0.46 in those whose BSA > 0.65 m(2). The RVD/LVD determined by M-mode echocardiography is a useful index to evaluate RV dilatation in patients with ASDs. The RVD/LVD ≥ 0.42 is the warning flag for suspecting ASD in preschool children and that ≥0.46 may be a clinical important sign to determine ASD operation.

  4. Postreperfusion myocardial technetium-99m-sestamibi defect corresponds to area at risk

    Energy Technology Data Exchange (ETDEWEB)

    Poulsen, Runa Hyldgaard, E-mail: runa.poulsen@ki.au.dk [Clinical Institute, Aarhus University, DK-8000 Aarhus C (Denmark); Botker, Hans Erik [Department of Cardiology, Aarhus University Hospital, Skejby (Denmark); Rehling, Michael [Department of Nuclear Medicine, Aarhus University Hospital, Skejby (Denmark)

    2011-08-15

    Introduction: Technetium-99m-sestamibi (MIBI) is the most frequently used myocardial perfusion tracer in patients with ischemic heart disease. In patients with acute ST-elevation myocardial infarction, we previously found that the defect in myocardial MIBI uptake was the same in patients injected with MIBI before primary angioplasty and in patients injected immediately after successful treatment. Thus, reperfusion may not be followed by increased uptake of MIBI. Instead, the MIBI defect after reperfusion may reflect the area at risk (AAR) defined by MIBI injected before treatment. We intended to investigate whether myocardial imaging with MIBI administered after reperfusion reflects myocardial perfusion or rather the ischemic AAR. Methods: In 12 pigs, left anterior descending coronary artery was totally occluded for 45 min with an angioplasty balloon. After a 2-h reperfusion, MIBI was injected intravenously, and {sup 153}Gd-microspheres were injected in left atrium. AAR and infarct size (IS) were determined by histochemical staining. MIBI and microsphere distribution were evaluated by counting the sliced left ventricle on a gamma camera. Defects were defined as uptake less than 45% of maximum uptake. Results: The mean{+-}S.D. defect size as a fraction of left ventricle was for MIBI 21%{+-}5.5%, AAR 25%{+-}6.3%, IS 13%{+-}3.9% and microspheres defect size 7.3%{+-}5.5%. MIBI defect size overestimated IS (P=.0005) and microspheres defect size (P=.0001), but it was not significantly different from AAR (P=.30). Conclusion: In a porcine model of myocardial infarction after 45 min of ischemia, MIBI administered 120 min after reperfusion delineates AAR.

  5. Left-Handed Children--Are They Losing Out?

    Science.gov (United States)

    Milsom, Lauren

    1995-01-01

    Discusses difficulties faced by left-handed children in everyday schoolwork. Highlights include right-handed bias of toys, clothing, and tools; the need for guidance in handwriting; problem areas including domestic science, arts and crafts, and metal and woodwork; left-hand advantages in sports and creative arts; and the European Left-Handers Club…

  6. Right atrium positioning for exposure of right pulmonary veins during off-pump atrial fibrillation ablation.

    Science.gov (United States)

    Suwalski, Grzegorz; Emery, Robert; Mróz, Jakub; Kaczejko, Kamil; Gryszko, Leszek; Cwetsch, Andrzej; Skrobowski, Andrzej

    2017-06-01

    Concomitant surgical ablation of atrial fibrillation (AF) is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable haemodynamic conditions is crucial for proper completion of the ablation procedure. This study evaluates the safety and feasibility of right atrial positioning using a suction-based cardiac positioner as opposed to compressive manoeuvres for exposure during off-pump surgical ablation for AF. Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins. Safety and feasibility end points were analysed intraoperatively and in the early postoperative course. In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of ganglionated plexi and conduction block assessment. In all patients, this entire right-sided ablation procedure was completed with a single exposure manoeuvre. Feasibility end points were achieved in all study patients. This report documents the safety and feasibility of right atrial exposure using a suction-based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable haemodynamic conditions and optimal visualization of the right pulmonary veins. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  7. Architecture of fibrin network inside thrombotic material obtained from the right atrium and pulmonary arteries: flow and location matter.

    Science.gov (United States)

    Mazur, Piotr; Sobczyński, Robert; Ząbczyk, Michał; Babiarczyk, Paulina; Sadowski, Jerzy; Undas, Anetta

    2013-01-01

    Pulmonary embolectomy is a treatment option in selected patients with high-risk pulmonary embolism (PE). Efficiency of thrombus degradation in PE largely depends on the architecture of its fibrin network, however little is known about its determinants. We present the case of a 56-year-old woman with high-risk PE and proximal deep-vein thrombosis, whose thrombotic material removed during embolectomy from the right atrium and pulmonary (lobar and segmental) arteries has been studied using scanning electron microscopy (SEM). SEM images showed that distally located thrombi are richer in densely-packed fibrin fibers and contain more white cells and less erythrocytes than the proximal ones and the atrial thrombus. Fibrin fibers alignment along the flow vector was observed in the thrombi removed from high-velocity flow pulmonary arteries, and not in the atrial thrombus. The content of denser fibrin network and platelet aggregates was increased in segmental thromboemboli. Our findings describe the relation between thrombus architecture and location, and might help to elucidate thrombus resistance to anticoagulant therapy in some PE patients.

  8. Adrenocortical carcinoma with extension to the inferior vena cava and right atrium: 20-month-old girl with TP53 mutation

    Directory of Open Access Journals (Sweden)

    Terry L. Levin, MD

    2015-01-01

    Full Text Available A 20-month-old female presented with respiratory distress and a right adrenal mass extending into the inferior vena cava and right atrium. The mass was initially thought to be neuroblastoma. Pathology later revealed adrenocortical carcinoma. Inferior vena cava extension is far more common in adrenocortical carcinoma than neuroblastoma, and its presence should prompt clinical and laboratory evaluation for an adrenocortical tumor. The genetic findings in TP53 associated with this disease are discussed.

  9. 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.

  10. Giant congenital aneurysm of the appendix of the left auricle; an entity potentially lethal

    International Nuclear Information System (INIS)

    Perafan, Sergio; Ascione, Giovanny; Parra, Luis E; Jimenez, Luz S

    2004-01-01

    The case of a 22 years old female patient who at 16 years of age suffered a closed thoracic trauma during a car accident is reported. She underwent surgery under extra corporeal circulation with femoro-femoral cannulation with the diagnosis of rupture of the left atrium. a large aneurysm of the left auricle without evidence of heart trauma, pericardial leakage or hemo pericardium, was found. The surgeon decided not to perform surgery on the aneurysm and to withdraw the extra corporeal circulation, proceeding to suture the patient, who was released with the recommendation of performing additional studies in order to consider the handling of the aneurysm. Six years later she is sent to our institution with the diagnosis of cerebral embolism with left hemiparesis, and a giant partially thrombosed left auricle aneurysm. With a diagnosis of an embolizing partially thrombosed aneurysm of the left auricle she underwent surgery under extracorporeal circulation in order to resect it. The case with the intraoperative findings and the surgical technique are described. Different manifestations and expressions of this potentially lethal rare entity are detailed, concluding that it is imperative to resect surgically the aneurysm once it has been diagnosed

  11. Size of Left Cardiac Chambers Correlates with Cerebral Microembolic Load in Open Heart Operations

    Directory of Open Access Journals (Sweden)

    Elena Z. Golukhova

    2010-01-01

    Full Text Available Background. Microemboli are a widely recognized etiological factor of cerebral complications in cardiac surgery patients. The present study was aimed to determine if size of left cardiac chambers relates to cerebral microembolic load in open heart operations. Methods. Thirty patients participated in the study. Echocardiography was performed in 2-3 days before surgery. A transcranial Doppler system was used for registering intraoperative microemboli. Results. Preoperative left atrium and left ventricular end-systolic and end-diastolic sizes significantly correlated with intraoperative microembolic load (s=0.48, 0.57 and 0.53, s≺.01, resp.. The associations between left ventricular diameters and number of cerebral microemboli remained significant when cardiopulmonary bypass time was included as a covariate into the analysis. Conclusions. The present results demonstrate that increased size of left heart chambers is an influential risk factor for elevated cerebral microembolic load during open heart operations. Mini-invasive surgery and carbon dioxide insufflation into wound cavity may be considered as neuroprotective approaches in patients with high risk of cerebral microembolism.

  12. Slow-fast Form of Atrioventricular Nodal Reentrant Tachycardia with Unusual Retrograde Activation in the Right Atrium —Possible Conduction Disturbance across the Tendon of Todaro Related to the Genesis of Positive Component of Biphasic Retrograde P Wave—

    Directory of Open Access Journals (Sweden)

    Kazuya Ishibashi, MD

    2006-01-01

    Full Text Available We report a rare case of slow-fast form of atrioventricular nodal reentrant tachycardia with delayed activation in the low septal right atrium (His bundle area. During supraventricular tachycardia (SVT, electrocardiogram showed “pseudo-positive P waves” in II, III, and aVF leads. SVT was induced by atrial extrastimulus with marked AH prolongation (i.e., jump phenomenon. Ventricular pacing showed a decremental retrograde conduction without jump phenomenon. Double atrial potentials were observed in the His bundle area during SVT and during ventricular pacing. The first electrogram of these split potentials, which was the earliest activation during SVT and during ventricular pacing, showed a dull and small deflection, whereas the second electrogram was sharp and clear. The interval of these discrete potentials was 70 msec during SVT. After a standard slow pathway ablation, SVT could never be induced by any programmed stimuli. It was concluded that in this case, the conduction disturbance across the tendon of Todaro was likely to cause the delayed atrial activation in the His bundle area, which created the pseudo-positive (biphasic. retrograde P wave.

  13. The effect of 8-week aerobic interval training and a detraining period on left ventricular structure and function in non-athlete healthy men

    Directory of Open Access Journals (Sweden)

    Abbasali Gaeini

    2012-02-01

    Full Text Available Background: Exercise plays an important role to improve cardiovascular performance. The purpose of this study was to determine the effect 8wk of aerobic cyclic training and a detraining period on left ventricular structure and function in non-athlete healthy men.Materials and Method: In this research, ten male non-athlete students were volunteered and participated in a 8- week running program (3days/week, at 70% of Maximum Heart Rate and 4 weeks detraining afterwards. In each session, cyclic running was done in 5 nine-minute stages and there was a four-minute inactive rest among them.Results: Using echocardiography, there was a significant difference in interventricular septal thickness, percent of rapid shortening and percent of ejection fraction after 8 weeks training compared to before training. It was found no significant difference end-diastolic and end-systolic dimensions, posterior wall thickness, left atrium diameter, aortic root thickness, heart rate, systolic and diastolic blood pressures. There was a significant difference in end-systolic dimension, intervntricular septal thickness, left atrium diameter, percent of rapid shortening and ejection fraction following 4-week detraining after training compared to 8-week.Conclusion: Eight-week aerobic cyclic training and a detraining period can effect on left ventricle structure and function

  14. Hypoplastic left heart syndrome

    Directory of Open Access Journals (Sweden)

    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

  15. 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.

  16. Macro- and micromechanical remodelling in the fish atrium is associated with regulation of collagen 1 alpha 3 chain expression.

    Science.gov (United States)

    Keen, Adam N; Fenna, Andrew J; McConnell, James C; Sherratt, Michael J; Gardner, Peter; Shiels, Holly A

    2018-03-28

    Numerous pathologies lead to remodelling of the mammalian ventricle, often associated with fibrosis. Recent work in fish has shown that fibrotic remodelling of the ventricle is 'reversible', changing seasonally as temperature-induced changes in blood viscosity alter haemodynamic load on the heart. The atrial response to varying haemodynamic load is less understood in mammals and completely unexplored in non-mammalian vertebrates. To investigate atrial remodelling, rainbow trout were chronically cooled (from 10 ± 1 to 5 ± 1 °C) and chronically warmed (from 10 ± 1 to 18 ± 1 °C) for a minimum of 8 weeks. We assessed the functional effects on compliance using ex vivo heart preparations and atomic force microscopy nano-indentation and found chronic cold increased passive stiffness of the whole atrium and micromechanical stiffness of tissue sections. We then performed histological, biochemical and molecular assays to probe the mechanisms underlying functional remodelling of the atrial tissue. We found cooling resulted in collagen deposition which was associated with an upregulation of collagen-promoting genes, including the fish-specific collagen I alpha 3 chain, and a reduction in gelatinase activity of collagen-degrading matrix metalloproteinases (MMPs). Finally, we found that cooling reduced mRNA expression of cardiac growth factors and hypertrophic markers. Following long-term warming, there was an opposing response to that seen with cooling; however, these changes were more moderate. Our findings suggest that chronic cooling causes atrial dilation and increased myocardial stiffness in trout atria analogous to pathological states defined by changes in preload or afterload of the mammalian atria. The reversal of this phenotype following chronic warming is particularly interesting as it suggests that typically pathological features of mammalian atrial remodelling may oscillate seasonally in the fish, revealing a more dynamic and plastic atrial

  17. 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.

  18. Fully automated left ventricular contour detection for gated radionuclide angiography, (1)

    International Nuclear Information System (INIS)

    Hosoba, Minoru; Wani, Hidenobu; Hiroe, Michiaki; Kusakabe, Kiyoko.

    1984-01-01

    A fully automated practical method has been developed to detect the left ventricular (LV) contour from gated pool images. Ejection fraction and volume curve can be computed accurately without operater variance. The characteristics of the method are summarized as follows: 1. Optimal design of the filter that works on Fourier domain, can be achieved to improve the signal to noise ratio. 2. New algorithm which use the cosine and sine transform images has been developed for the separating ventricle from atrium and defining center of LV. 3. Contrast enhancement by optimized square filter. 4. Radial profiles are generated from the center of LV and smoothed by fourth order Fourier series approximation. The crossing point with local threshold value searched from the center of the LV is defined as edge. 5. LV contour is obtained by conecting all the edge points defined on radial profiles by fitting them to Fourier function. (author)

  19. Left atrial deformation: Useful index for early detection of cardiac damage in chronic mitral regurgitation.

    Science.gov (United States)

    Cameli, M; Incampo, E; Mondillo, S

    2017-12-01

    In chronic mitral regurgitation (MR) left atrium is one of the first cardiac structures that is involved in remodeling and ultrastructural changes for a progressive volume overload. Severe left atrial (LA) dilation on echocardiography and new onset of atrial fibrillation in asymptomatic patients with preserved Left Ventricular (LV) function, appeared as a Class IIb recommendation for consideration for surgical mitral valve repair in the actual guidelines. However, before atrial dilatation and dysfunction, several ultrastructural changes appear in the atrial muscle tissue that are difficult to identify with the standard echocardiography. Speckle tracking echocardiography (STE) can analyze LA function: it has been showed that it can indirectly identify structural tissue modifications from excessive atrial effort in the early stages of MR up to the full depression of atrial function in the late stages where there are advanced ultrastructural alterations. This review aims to summarize current knowledge on the role of atrial strain identifying early structural alterations of the atrial tissue in the rising stages of MR considering that Left Atrial Peak Longitudinal Strain (PALS) considered useful parameter for a more extensive evaluation of MR patients.

  20. 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.

  1. Exercise and cardiovascular outcomes in hypertensive patients in relation to structure and function of left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Boman, Kurt; Gerdts, Eva; Wachtell, Kristian

    2009-01-01

    (P = 0.016); and larger left atrium (P = 0.006). Systolic variables did not differ. In Cox regression analysis, physically active compared with sedentary patients had lower risk of primary composite endpoint [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.26-0.68, P cardiovascular......BACKGROUND: Exercise lowers blood pressure and improves cardiovascular function, but little is known about whether exercise impacts cardiovascular morbidity and mortality independent of left ventricular hypertrophy (LVH) and LV geometry. DESIGN: Observational analysis of prospectively obtained...... (never exercise), intermediate (30 min twice/week). During 4.8-year follow-up, 105 patients suffered the primary composite endpoint of myocardial infarction (MI), stroke, or cardiovascular death. MI occurred in 39, stroke in 60, and cardiovascular death in 33 patients. RESULTS: Sedentary individuals (n...

  2. 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.

  3. Indexed left atrial volume predicts the recurrence of non-valvular atrial fibrillation after successful cardioversion.

    Science.gov (United States)

    Marchese, Procolo; Bursi, Francesca; Delle Donne, Grazia; Malavasi, Vincenzo; Casali, Edoardo; Barbieri, Andrea; Melandri, Francesco; Modena, Maria Grazia

    2011-03-01

    Atrial fibrillation (AFib) induces remodelling of the left atrium (LA). Indexed LA volume (iLAV) as more accurate measure of LA size has not been evaluated as predictor of recurrence of AFib after cardioversion. We identified 411 adults (mean age 64.1 ± 11.4 years, 34.5% women) who underwent successful cardioversion and with no history of other atrial arrhythmia, stroke, congenital heart disease, valvular dysfunction, surgery, thyroid dysfunction, acute or chronic inflammatory disease, and pacemaker. All echocardiographic data were retrieved from the laboratory database. iLAV was measured off-line using Simpson's method. Clinical characteristics and recurrence of clinical AFib were determined by review of medical records. Patients with scheduled follow-up of at least 6 months were included. About 250 patients (60.8%) developed AFib recurrence after a median (25th-75th percentile) follow-up of 345.0 (210.0-540.0) days. Patients with AFib recurrence had significantly greater iLAV than patients without AFib recurrence (39.7 ± 8.4 vs. 31.4 ± 4.6, P < 0.001). Each mL/m(2) increase in iLAV was associated with a 30% increased risk of AFib recurrence [odds ratio (OR) 1.30, confidence interval (CI) 1.23-1.38, P < 0.001]. In a multivariable model, each mL/m(2) increase in iLAV was independently associated with a 21% increase in the risk of AFib recurrence (OR 1.21, CI 1.11-1.30, P < 0.001). The areas under receiver operating characteristic curves, generated to compare LA diameter and iLAV as predictors of AFib recurrence, were 0.59 ± 0.3 and 0.85 ± 0.2, respectively (P < 0.001). The present study is the first to show that larger iLAV before cardioversion, as a more accurate measure of LA remodelling than LA diameter, is strongly and independently associated with higher risks of AFib recurrence.

  4. Mixoma atrial esquerdo múltiplo: relato de caso Multiple left atrial myxoma: case report

    Directory of Open Access Journals (Sweden)

    José Carlos Dorsa Vieira Pontes

    2011-09-01

    Full Text Available Os tumores primários cardíacos são infrequentes, apresentando incidência entre 0,001% a 0,2%, com características histológicas benignas em 75% dos casos. Os mixomas correspondem a aproximadamente 50% dessas neoplasias. Quanto à localização, 75 a 80% dos mixomas estão no átrio esquerdo, 18% no átrio direito, e mais raramente nos ventrículos. Relatamos o caso de um paciente em classe funcional (CF IV New York Heart Association (NYHA e diagnóstico anatomopatológico pós-operatório de mixoma multilobular originário na parede posterior atrial esquerda. À avaliação clínica no 3º mês pós-operatório se encontrava em CF I NYHA e a ecocardiográfica com ausência de massas intracardíacas.Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprising benign histological characteristics in 75% of these cases. Myxomas account for approximately 50% of these neoplasms. As regards location, 75-80% of myxomas are in the left atrium, 18% in the right atrium, and more rarely in the ventricles. We report a case of a patient in functional class (FC IV New York Heart Association (NYHA and postoperative histological diagnosis of multilobular myxoma originating in the posterior left atrial wall. Clinical evaluation 3 months after surgery suggested NYHA functional class I and echocardiographic absence of intracardiac masses.

  5. Left Ventricular Pseudoaneurysm Perceived as a Left Lung Mass

    Directory of Open Access Journals (Sweden)

    Ugur Gocen

    2013-02-01

    Full Text Available Left ventricular pseudo-aneurysm is a rare complication of aneurysmectomy. We present a case of surgically-treated left ventricular pseudo-aneurysm which was diagnosed three years after coronary artery bypass grafting and left ventricular aneurysmectomy. The presenting symptoms, diagnostic evaluation and surgical repair are described. [Cukurova Med J 2013; 38(1.000: 123-125

  6. Abnormal positioning of multiple abdominal organs with anomalous direct drainage of hepatic vein into the right atrium in a post operative omphalocele patient: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Su Jeong; Cho, Bum Sang; Kim, Sung Jin; Lee, Seung Young; Kang, Min Ho; Yi, Kyung Sik [Chungbuk National Univ. Hospital, Cheongju (Korea, Republic of)

    2012-10-15

    An omphalocele is a rare congenital anomaly in which the infant's intestines protrude through the navel. Additional anomalies that are associated with omphalocele remain present in as many as 50% of cases, and these anomalies vary greatly from patient to patient. However, the persistent anomalies or abnormal position of the abdominal organs in post operative omphalocele patients have not reported previously. Herein, we report the case of an omphalocele patient with abnormal positioning of the liver, spleen and both kidneys, as well as abnormal drainage of the hepatic vein into the right atrium, which was found during a routine, postoperative follow-up computed tomography scan.

  7. Cardiac Aspergilloma: A Rare Case of a Cardiac Mass Involving the Native Tricuspid Valve, Right Atrium, and Right Ventricle in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Christina S. Chen-Milhone

    2018-01-01

    Full Text Available Aspergillus can cause devastating opportunistic infections in immunocompromised patients. Rarely does this fungus invade the heart, and when it does, survival is especially poor despite optimal medical and surgical treatment. We report a case of cardiac aspergilloma with involvement of the tricuspid valve and both the right atrium and ventricle found on a transthoracic echocardiogram in an immunocompromised patient after developing atrial fibrillation with rapid ventricular rate. The findings from this case suggest that early clinical suspicion is critical in early diagnosis and thus early treatment.

  8. Computational Analysis of Pumping Efficacy of a Left Ventricular Assist Device according to Cannulation Site in Heart Failure with Valvular Regurgitation.

    Science.gov (United States)

    Heikhmakhtiar, Aulia Khamas; Lim, Ki Moo

    2016-01-01

    Mitral valve regurgitation (MR) causes blood to flow in two directions during contraction of the left ventricle (LV), that is, forward into the aorta and backward into the left atrium (LA). In aortic valve regurgitation (AR), leakage occurs from the aorta into the LV during diastole. Our objective is to analyze the contribution of a left ventricular assist device (LVAD) to MR and AR for the following two different cannulation sites: from the LA to the aorta (LAAO) and from the LV to the aorta (LVAO). Using a computational method, we simulated three ventricular conditions (normal [HF without valvular regurgitation], 5% MR, and 5% AR) in three groups (control [no LVAD], LAAO, and LVAO). The results showed that LVAD with LAAO cannulation is appropriate for recovery of the MR heart, and the LVAD with LVAO cannulation is appropriate for treating the AR heart.

  9. 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...... critics, and not least by feminists. The aim of this paper is to point out the position Freud took toward his patient. Dora stands out as the one case among Freud’s 5 great case stories that has a female protagonist, and reading the case it becomes clear that Freud stumbled because of an unresolved...... 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...

  10. Anatomicosurgical segmentectomy of the left ventricle for systematized partial resection of the heart: an experimental study

    Directory of Open Access Journals (Sweden)

    Liberato John Alphonse DI DIO

    1998-10-01

    Full Text Available A surgical experimental investigation is being carried out in an attempt to provide a viable alternative to the current approaches to cardiac resection of the left ventricular myocardium in cases of cardiomyopathies with dilated ventricle. The experiments are based upon the presence of anatomicosurgical segments in the dog's heart similar to those existing in the atria and ventricles of humans. So far three mongrel dogs (weight 15 kg were submitted to cardiac catheterism to evaluate the anatomy of the coronary arteries and their branches, the function and cavity of the left ventricle (LV. A lateral thoracotomy on the left side was performed to expose the heart. Cardiopulmonary bypass (CPB of each animal was established through the right atrium and the femoral artery (4 mg/kg Heparin, at 32°C, intermittent aorta cross-clamping. The left marginal artery and veins were ligated, causing an area of acute myocardial infarction, showing well-defined sharp limits. Such an area was then resected and the left ventricle was reconstructed. The animals were weaned from CPB, one dog having remained in a stable condition during a 7-day period of observation. The second was sacrificed after 4-day period of observation and the third dog died four hours after CPB owing to an excessive reduction of the LV chamber related to an anatomical variation. Pre and post operation transthoracic echocardiograms were obtained after undergoing cardiac catheterism. The echocardiogram revealed discrete mitral insufficiency, reduction of the diameter of the left ventricle with approximation of the papillary muscles, a dysfunction and an impressive reduction of the cavity of the left ventricle. Peri-sutural areas of infarction were not observed. The orientation given by the anatomicosurgical segmentation of the coronary circulation is an important alternative to the present surgical treatment of cardiomyopathies with dilated ventricle.Uma investigação experimental cir

  11. 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

  12. Negative inotropic effect of carbachol and interaction between acetylcholine receptor-operated potassium channel (K.ACh channel) and GTP binding protein in mouse isolated atrium--a novel methodological trial.

    Science.gov (United States)

    Okada, Muneyoshi; Noma, Chihiro; Yamawaki, Hideyuki; Hara, Yukio

    2013-01-01

    Interaction between acetylcholine receptor-operated potassium channel (K.ACh channel) and GTP binding protein was examined by an immunoprecipitation-Western blotting system in mouse isolated atrium. The carbachol-induced negative inotropic action in indomethacin-pretreated mouse atrium was significantly inhibited by a K.ACh channel blocker, tertiapin or atropine. Kir3.1 K.ACh channel (Kir3.1) was immunoprecipitated with a mouse anti-Kir3.1 antibody. Coprecipitating Gβ with Kir3.1, detected by Western blotting, was significantly augmented by carbachol. Atropine, but not tertiapin, significantly inhibited the carbachol-induced coprecipitating Gβ with Kir3.1. The data indicate that immunoprecipitation with Kir3.1 and Western blotting of Gβ system is a useful method for assessing interaction between K.ACh channel and GTP binding protein in mouse atrium.

  13. Left Atrial Appendage: Physiology, Pathology, and Role as a Therapeutic Target

    Directory of Open Access Journals (Sweden)

    Damiano Regazzoli

    2015-01-01

    Full Text Available Atrial fibrillation (AF is the most common clinically relevant cardiac arrhythmia. AF poses patients at increased risk of thromboembolism, in particular ischemic stroke. The CHADS2 and CHA2DS2-VASc scores are useful in the assessment of thromboembolic risk in nonvalvular AF and are utilized in decision-making about treatment with oral anticoagulation (OAC. However, OAC is underutilized due to poor patient compliance and contraindications, especially major bleedings. The Virchow triad synthesizes the pathogenesis of thrombogenesis in AF: endocardial dysfunction, abnormal blood stasis, and altered hemostasis. This is especially prominent in the left atrial appendage (LAA, where the low flow reaches its minimum. The LAA is the remnant of the embryonic left atrium, with a complex and variable morphology predisposing to stasis, especially during AF. In patients with nonvalvular AF, 90% of thrombi are located in the LAA. So, left atrial appendage occlusion could be an interesting and effective procedure in thromboembolism prevention in AF. After exclusion of LAA as an embolic source, the remaining risk of thromboembolism does not longer justify the use of oral anticoagulants. Various surgical and catheter-based methods have been developed to exclude the LAA. This paper reviews the physiological and pathophysiological role of the LAA and catheter-based methods of LAA exclusion.

  14. LEFT VENTRICULAR NON-COMPACTION: AN EXAMPLE OF A RARE DISEASE IN CLINICAL PRACTICE

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    O. V. Gaysyonok

    2017-01-01

    Full Text Available Objective: to describe the clinical case of a rare heart disease – left ventricular non-compaction.Materials and methods. Patient G., 1948, was hospitalized in connection with complaints of fluctuations in blood pressure, heart failure, discomfort in the heart, dizziness, headaches. The patient underwent the following general examination: general and biochemical blood tests, electrocardiography, Holter ECG monitoring, treadmill test, echocardiography, color duplex scanning of neck vessels, ultrasound of the thyroid and kidneys, chest X-ray.Results. Based on the history, complaints, clinical picture of the disease, objective and instrumental examination data, a clinical diagnosis was made: left ventricular non-compaction. One of the main diagnostic methods that allowed to verify the diagnosis was echocardiographic study: the structure of the myocardium of the lower-apical section of a two-layered one, with the presence of a noncompact layer (with intertabercular breaks, in relation to the compact as 2:1; a small extension of the left atrium; small hypokinesia in the lower-upper segment of the LV, without a decrease in the LVEF (PV = 73 %.Conclusion. This clinical case is interesting because the disease, concealed under the guise of rheumacarditis in an era when ultrasonic methods of examining the heart were not available in clinical practice, has now been diagnosed in the conduct of a reference echocardiographic study. Despite the fact that this disease belongs to rare nosology, it can occur in any age group and can often be asymptomatic.

  15. Experimental Assessment of the Hydraulics of a Miniature Axial-Flow Left Ventricular Assist Device

    Science.gov (United States)

    Smith, P. Alex; Cohn, William; Metcalfe, Ralph

    2017-11-01

    A minimally invasive partial-support left ventricular assist device (LVAD) has been proposed with a flow path from the left atrium to the arterial system to reduce left ventricular stroke work. In LVAD design, peak and average efficiency must be balanced over the operating range to reduce blood trauma. Axial flow pumps have many geometric parameters. Until recently, testing all these parameters was impractical, but modern 3D printing technology enables multi-parameter studies. Following theoretical design, experimental hydraulic evaluation in steady state conditions examines pressure, flow, pressure-flow gradient, efficiency, torque, and axial force as output parameters. Preliminary results suggest that impeller blades and stator vanes with higher inlet angles than recommended by mean line theory (MLT) produce flatter gradients and broader efficiency curves, increasing compatibility with heart physiology. These blades also produce less axial force, which reduces bearing load. However, they require slightly higher torque, which is more demanding of the motor. MLT is a low order, empirical model developed on large pumps. It does not account for the significant viscous losses in small pumps like LVADs. This emphasizes the importance of experimental testing for hydraulic design. Roderick D MacDonald Research Fund.

  16. [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.

  17. Evaluation of aspirin therapy on intracardiac thrombi using indium-111-oxine platelet scintigraphy, two-dimentional echocardiography and left ventriculography

    International Nuclear Information System (INIS)

    Shibuya, Masanori; Irino, Tadayoshi; Yoshioka, Toshiharu; Sugimoto, Tsuyoshi; Tsuji, Kazuo; Naka, Masashi; Arai, Hidekazu.

    1984-01-01

    Left ventriculography (LVG), two-dimensional echocardiography (2-DE) and indium-111-oxine platelet scintigraphy were performed in five patients with intracardiac thrombi. Thrombi were visible in 7 sites (5 in the ventricle and 2 in the atrium) by platelet scintigraphy, in 4 sites (3 in the ventricle and 1 in the atrium) by 2-DE, and in 4 sites (4 in the ventricle) by LVG. When aspirin was administered to the patients, platelet scintigraphy had become negative for thrombi in 5 sites and false-negative for them in 2 sites. However, thrombi were detected in 6 sites after the withdrawal of aspirin. On the other hand, thrombi were detected in 4 sites by 2-DE, irrespective of the administration of aspirin. Indium-111-oxine platelet scintigraphy has proved to not only have higher sensitivity for detecting thrombi but also to be capable of observing the coagulation status of platelets on the thrombi. It is therefore considered very helpful in assessing anticoagulation therapy. (Namekawa, K)

  18. Myxoma of the Left Ventricle

    Science.gov (United States)

    Novoa, José; Delgado, Antonio; Alonso, Ana

    2014-01-01

    This report concerns a 69-year-old woman who presented with an asymptomatic myxoma in the left ventricle. The tumor was successfully excised. We provide a very brief review of 72 other published cases of surgically treated left ventricular myxoma. PMID:25120392

  19. Left ventricular hypertrophy in athletes.

    Science.gov (United States)

    Douglas, P S; O'Toole, M L; Katz, S E; Ginsburg, G S; Hiller, W D; Laird, R H

    1997-11-15

    Left ventricular wall thickness >1.3 cm, septal-to-posterior wall ratios > 1.5, diastolic left ventricular size >6.0 cm, and eccentric or concentric remodeling are rare in athletes. Values outside of these cutoffs in an athlete of any age probably represent a pathologic state.

  20. The Left-Handed Writer.

    Science.gov (United States)

    Bloodsworth, James Gaston

    Contrary to the beliefs of many, right-handedness is not a single factor existing in almost all people, with a few exceptions termed left-handed: neither extreme exists independently of the other. During the first 4 years of life there is a period of fluctuation between right and left-handed dominance. Statistics and findings vary in determining…

  1. Two Lefts in Latin America?

    DEFF Research Database (Denmark)

    Christensen, Steen Fryba

    In this working paper I list five researchers' categorizations of the Latin American left in power (april 2006) in a schematic form. The most important criteria for the categorizations are given.......In this working paper I list five researchers' categorizations of the Latin American left in power (april 2006) in a schematic form. The most important criteria for the categorizations are given....

  2. A Giant Left Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Medhat F. Zaher

    2014-01-01

    Full Text Available Atrial myxomas are the most common primary cardiac tumors. Patients with left atrial myxomas generally present with mechanical obstruction of blood flow, systemic embolization, and constitutional symptoms. We present a case of an unusually large left atrial myxoma discovered incidentally in a patient with longstanding dyspnea being managed as bronchial asthma.

  3. 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. .

  4. Left ventricular wall stress compendium.

    Science.gov (United States)

    Zhong, L; Ghista, D N; Tan, R S

    2012-01-01

    Left ventricular (LV) wall stress has intrigued scientists and cardiologists since the time of Lame and Laplace in 1800s. The left ventricle is an intriguing organ structure, whose intrinsic design enables it to fill and contract. The development of wall stress is intriguing to cardiologists and biomedical engineers. The role of left ventricle wall stress in cardiac perfusion and pumping as well as in cardiac pathophysiology is a relatively unexplored phenomenon. But even for us to assess this role, we first need accurate determination of in vivo wall stress. However, at this point, 150 years after Lame estimated left ventricle wall stress using the elasticity theory, we are still in the exploratory stage of (i) developing left ventricle models that properly represent left ventricle anatomy and physiology and (ii) obtaining data on left ventricle dynamics. In this paper, we are responding to the need for a comprehensive survey of left ventricle wall stress models, their mechanics, stress computation and results. We have provided herein a compendium of major type of wall stress models: thin-wall models based on the Laplace law, thick-wall shell models, elasticity theory model, thick-wall large deformation models and finite element models. We have compared the mean stress values of these models as well as the variation of stress across the wall. All of the thin-wall and thick-wall shell models are based on idealised ellipsoidal and spherical geometries. However, the elasticity model's shape can vary through the cycle, to simulate the more ellipsoidal shape of the left ventricle in the systolic phase. The finite element models have more representative geometries, but are generally based on animal data, which limits their medical relevance. This paper can enable readers to obtain a comprehensive perspective of left ventricle wall stress models, of how to employ them to determine wall stresses, and be cognizant of the assumptions involved in the use of specific models.

  5. Isolated right atrial appendage (RAA) rupture in blunt trauma--a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness.

    Science.gov (United States)

    Figueiredo, Adoniram M; Poggetti, Renato S; Quintavalle, Fabio G; Fontes, Belchor; Dalva, Moise; Younes, Riad N; Jatene, Fabio B; Birolini, Dario

    2007-02-15

    Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA) is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study. The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. The comparison of the data showed that wall thickness of the RAA (0.53 +/- 0.33 mm) was significantly thinner than that of RA (1.11 +/- 0.42 mm) (p < 0.05). In all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture. Thus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma.

  6. Isolated right atrial appendage (RAA rupture in blunt trauma – a case report and an anatomic study comparing RAA and right atrium (RA wall thickness

    Directory of Open Access Journals (Sweden)

    Jatene Fabio B

    2007-02-01

    Full Text Available Abstract Background Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. Objective To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA and RAA wall thickness in a necropsy study. Methods The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. Result The comparison of the data showed that wall thickness of the RAA (0.53 ± 0.33 mm was significantly thinner than that of RA (1.11 ± 0.42 mm (p Comments In all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture. Conclusion Thus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma.

  7. Isolated right atrial appendage (RAA) rupture in blunt trauma – a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness

    Science.gov (United States)

    Figueiredo, Adoniram M; Poggetti, Renato S; Quintavalle, Fabio G; Fontes, Belchor; Dalva, Moise; Younes, Riad N; Jatene, Fabio B; Birolini, Dario

    2007-01-01

    Background Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA) is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. Objective To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study. Methods The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. Result The comparison of the data showed that wall thickness of the RAA (0.53 ± 0.33 mm) was significantly thinner than that of RA (1.11 ± 0.42 mm) (p < 0.05). Comments In all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture. Conclusion Thus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma. PMID:17302990

  8. Arrhythmias are not to blame for all cardiac syncope patients: left atrial myxoma causing syncope in a middle-aged man.

    Science.gov (United States)

    Rajani, Ali Raza; Muaz, Reem Naif; Govindaswamy, Pushpa Rani; Mian, Muhammad Hamid

    2015-04-15

    A 47-year-old man presented with a history of syncope that lasted for 3 min and was not accompanied by jerky movement of limbs or incontinence. After regaining consciousness, he felt generalised weakness. There was no history of chest pain or palpitation. ECG showed normal sinus rhythm. All blood investigations were normal. Transthoracic echocardiography showed a large multilobulated echo dense mass in the left atrium. The mass was prolapsing through the mitral valve during diastole. Transoesophageal echocardiography verified these findings and also showed the stalk of the mass attached to the interatrial septum near the fossa ovalis. The mass was highly suggestive of myxoma. The patient underwent surgical resection of the mass and histopathology confirmed the diagnosis of left atrial myxoma. 2015 BMJ Publishing Group Ltd.

  9. Left atrial and ventricular function during dobutamine and glycopyrrolate stress in healthy young and elderly as evaluated by cardiac magnetic resonance

    DEFF Research Database (Denmark)

    Ahtarovski, Kiril A; Iversen, Kasper K; Lønborg, Jacob T

    2012-01-01

    The aim of this study is to describe phasic volume changes of the left atrium (LA) in healthy young and elderly subjects at rest and during pharmacological stress (PS). LA maximum size is related to cardiovascular mortality. LA has passive, active, and conduit function for left ventricular (LV......) filling. We hypothesized that changes in LV compliance from normal aging are reflected in LA volume changes and that PS will augment these differences. We enrolled twenty young (20-30 yr) and twenty elderly (60-70 yr) healthy subjects and measured their LV and LA volumes by cardiac magnetic resonance...... imaging at rest and during dobutamine and glycopyrrolate stress. We identified LA minimum, maximum, and middiastolic volumes and the volume before atrial contraction. LA emptying volumes were calculated as LA passive and active emptying volumes and LA conduit volume. We also calculated LV peak filling...

  10. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking

    Directory of Open Access Journals (Sweden)

    Lisi Matteo

    2009-02-01

    Full Text Available Abstract Background The role of speckle tracking in the assessment of left atrial (LA deformation dynamics is not established. We sought to determine the feasibility and reference ranges of LA longitudinal strain indices measured by speckle tracking in a population of normal subjects. Methods In 60 healthy individuals, peak atrial longitudinal strain (PALS and time to peak longitudinal strain (TPLS were measured using a 12-segment model for the left atrium. Values were obtained by averaging all segments (global PALS and TPLS and by separately averaging segments measured in the two apical views (4- and 2-chamber average PALS and TPLS. Results Adequate tracking quality was achieved in 97% of segments analyzed. Inter and intra-observer variability coefficients of measurements ranged between 2.9% and 5.4%. Global PALS was 42.2 ± 6.1% (5–95° percentile range 32.2–53.2%, and global TPLS was 368 ± 30 ms (5–95° percentile range 323–430 ms. The 2-chamber average PALS was slightly higher than the 4-chamber average PALS (44.3 ± 6.0% vs 40.1 ± 7.9%, p Conclusion Speckle tracking is a feasible technique for the assessment of longitudinal myocardial LA deformation. Reference ranges of strain indices were reported.

  11. Thrombus-in-Transit Entrapped in a Partially Ligated Left Atrial Appendage

    Directory of Open Access Journals (Sweden)

    Farideh Roshanali

    2015-10-01

    Full Text Available A 54-year-old man referred to our center with Barlow’s disease and severe mitral regurgitation. He had atrial fibrillation (AF rhythm, with a mildly enlarged left atrium (LA. Transesophageal echocardiography (TEE showed no clot in the LA and LA appendage; there was only mild spontaneous echo contrast in the LA appendage. The patient underwent mitral valve repair and the Maze operation, during which the LA appendage was ligated with the double suture technique. He was discharged from the hospital in good condition and in sinus rhythm. He was recommended Warfarin and PT control.One month later, he returned with the complaint of vision loss twice in the left eye each time for a few seconds. The AF rhythm had returned.TEE demonstrated a fresh and mobile thrombus entrapped in the LA appendage with a small portion in the LA (Figures 1 and 2. Laboratory tests showed therapeutic international normalized ratio (INR. The patient refused re- operation.  Plavix was added to his medication, and he was discharged.

  12. 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.)

  13. Segmentation of Fetal Left Ventricle in Echocardiographic Sequences Based on Dynamic Convolutional Neural Networks.

    Science.gov (United States)

    Yu, Li; Guo, Yi; Wang, Yuanyuan; Yu, Jinhua; Chen, Ping

    2017-08-01

    Segmentation of fetal left ventricle (LV) in echocardiographic sequences is important for further quantitative analysis of fetal cardiac function. However, image gross inhomogeneities and fetal random movements make the segmentation a challenging problem. In this paper, a dynamic convolutional neural networks (CNN) based on multiscale information and fine-tuning is proposed for fetal LV segmentation. The CNN is pretrained by amount of labeled training data. In the segmentation, the first frame of each echocardiographic sequence is delineated manually. The dynamic CNN is fine-tuned by deep tuning with the first frame and shallow tuning with the rest of frames, respectively, to adapt to the individual fetus. Additionally, to separate the connection region between LV and left atrium (LA), a matching approach, which consists of block matching and line matching, is used for mitral valve (MV) base points tracking. Advantages of our proposed method are compared with an active contour model (ACM), a dynamical appearance model (DAM), and a fixed multiscale CNN method. Experimental results in 51 echocardiographic sequences show that the segmentation results agree well with the ground truth, especially in the cases with leakage, blurry boundaries, and subject-to-subject variations. The CNN architecture can be simple, and the dynamic fine-tuning is efficient.

  14. 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.

  15. 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...

  16. Dabigatran for left ventricular thrombus

    Directory of Open Access Journals (Sweden)

    Satishkumar Kolekar

    2015-09-01

    Dabigatran is a reversible direct thrombin inhibitor and currently approved for the prevention of thromboembolic episodes in non-valvar atrial fibrillation. This case demonstrates possible thrombolytic properties of dabigatran in resolution of left ventricular thrombus.

  17. Left ventricular noncompaction in a patient presenting with a left ventricular failure

    Directory of Open Access Journals (Sweden)

    Ristić-Anđelkov Anđelka

    2018-01-01

    Full Text Available Introduction. Left ventricular noncompaction (LVNC is a congenital disorder characterised by prominent trabeculations in the left ventricular myocardium. This heart condition very often goes completely undetected, or is mistaken for hypertrophic cardiomyopathy or coronary disease. Case report. A middle-aged female with a positive family history of coronary disease was admitted with chest pain, electrocardiography (ECG changes in the area of the inferolateral wall and elevation in cardiac specific enzymes. Initially, she was suspected of having acute coronary syndrome. However, in the left ventricular apex, especially alongside the lateral and inferior walls, cardiac ultrasound visualised hypertrabeculation with multiple trabeculae projecting inside the left ventricular cavity. A short-axis view of the heart above the papillary muscles revealed the presence of two layers of the myocardium: a compacted homogeneous layer adjacent to the epicardium and a spongy layer with trabeculae and sinusoids under the endocardium. The thickness ratio between the two layers was 2.2:1. The same abnormalities were corroborated by multislice computed tomography (MSCT of the heart. Conclusion. Left ventricular noncompaction is a rare, usually hereditary cardiomyopathy, which should be considered as a possibility in patients with myocardial hypertrophy. It is very often mistaken for coronary disease owing to ECG changes and elevated cardiac specific enzymes associated with myocardial hypertrophy and heart failure.

  18. 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

  19. 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)

  20. Left Main Coronary Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Hossein Doustkami

    2016-07-01

    Full Text Available Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic.

  1. 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.

  2. 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.

  3. Predictors for cardiac resynchronization therapy response: the importance of QRS morphology and left ventricular lead position.

    Science.gov (United States)

    Lin, Haiyan; Zhou, Ying; Xu, Geng

    2014-01-01

    Although cardiac resynchronization therapy (CRT) is a well-established treatment for a subset of patients with chronic heart failure, a considerable proportion of eligible patients still fail to benefit from this treatment. The aim of this study was to identify potential independent predictors for being a responder to CRT. A single-center, retrospective analysis was conducted in 193 consecutive patients with heart failure and wide QRS complex who successfully underwent CRT device implantation from January 2006 to October 2012. Clinical characteristics, left ventricular lead position (LV-Ps), electrocardiography and echocardiography were evaluated before and 12 months after CRT. Response to CRT was defined as an absolute increase of ≥ 5% in left ventricular ejection fraction (LVEF) compared with baseline at 12 months after CRT implantation without heart failure rehospitalization or any cause of death. There were 132 responders (68%) and 61 nonresponders (32%). By univariate logistic analysis, the presence of non-left bundle branch block (non-LBBB) and QRS duration, chronic atrial fibrillation (AF), history of ventricular tachycardia (VT), degree of tricuspid regurgitation and left atrium dimension (LAD) at baseline, ΔQRS duration, and LV-Ps were associated with predicting a response to CRT. However, on multivariate analysis, only optimal LV-Ps and presence of non-LBBB remained independently predictive for a CRT response, with an odds ratio of 2.53 (95% confidence interval [CI]: 1.13-5.66, P = 0.023), 0.15(95% CI: 0.05-0.45, P = 0.001), respectively. Kaplan-Meier analysis revealed that patients with nonoptimal LV-Ps or non-LBBB morphology had a significantly higher rate of mortality or heart failure rehospitalization as compared with those with optimal LV-Ps or LBBB morphology (P < 0.05).

  4. Non-invasive quick diagnosis of cardiovascular problems from visible and invisible abnormal changes with increased cardiac troponin I appearing on cardiovascular representation areas of the eyebrows, left upper lip, etc. of the face & hands: beneficial manual stimulation of hands for acute anginal chest pain, and important factors in safe, effective treatment.

    Science.gov (United States)

    Omura, Yoshiaki; Jones, Marilyn K; Duvvi, Harsha; Shimotsuura, Yasuhiro; Ohki, Motomu; Rodriques, Aaron

    2014-01-01

    Our previous study indicated that there are at least 7 cardiovascular representation areas on the face, including the "Eyebrows", both sides of the "Nose", "Lelt Upper Lip" and the "Outside of the corner of both sides of the mouth," in addition to 2 areas in each hand. When there are cardiovascular problems, some of the heart representation areas of these areas often show the following changes: 1) Most distinctive visible changes such as the initial whitening with or without long white hair, then hair loss and complete disappearance of the hairs of the heart representation area of "Eyebrows" 2) Invisible biochemical changes that happen in heart representation areas at the "Left Upper Lips", 3) "Nose" below eye level as well as 4) "3rd segment of Middle Finger of Hands." Most distinctive visible & invisible changes are found in heart representation areas on the "Eyebrow", located nearest to the midline of face, where the color of the hairs becomes white compared with the rest of the Eyebrow. Then the cardiovascular problem advances, and hair starts disappearing. When there are no hairs at the heart representation areas of the Eyebrow, usually Cardiac Troponin I is increased to a very serious, abnormal high value. Most of the cardiovascular representation areas of the face show, regardless of presence or absence of visible change. When there is a cardiovascular problem, not only simple Bi-Digital O-Ring Test can detect without using any instrument in several minutes but also, corresponding biochemical changes of abnormally increased Cardiac Troponin I level can often be detected non-invasively from these Organ Representation Areas of Face & Hands, although changes in Eyebrows, L-Upper Lip & 3rd segment of middle fingers are clinically the most reliable changes & easy to identify the locations. Manual Stimulation of Hand's heart representation areas often eliminated acute anginal chest pain before medical help became available. Important factors for safe, effective

  5. 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)

  6. Longitudinal strain predicts left ventricular mass regression after aortic valve replacement for severe aortic stenosis and preserved left ventricular function.

    Science.gov (United States)

    Gelsomino, Sandro; Lucà, Fabiana; Parise, Orlando; Lorusso, Roberto; Rao, Carmelo Massimiliano; Vizzardi, Enrico; Gensini, Gian Franco; Maessen, Jos G

    2013-11-01

    We explored the influence of global longitudinal strain (GLS) measured with two-dimensional speckle-tracking echocardiography on left ventricular mass regression (LVMR) in patients with pure aortic stenosis (AS) and normal left ventricular function undergoing aortic valve replacement (AVR). The study population included 83 patients with severe AS (aortic valve area regression (all P regression in patients with pure AS undergoing AVR. Our findings must be confirmed by further larger studies.

  7. Negative inotropic and chronotropic effects on the guinea pig atrium of extracts obtained from Averrhoa carambola L. leaves

    Directory of Open Access Journals (Sweden)

    Vasconcelos C.M.L.

    2005-01-01

    Full Text Available It has been reported that star fruit can lead to a fatal outcome in uremic patients. The intoxication syndrome consists of hiccups, mental confusion, dizziness, and vomiting. On the other hand, folk medicine uses teas and infusions of carambola leaves to treat headache, vomiting, cough, insomnia, and diabetes. This motivated us to determine if Averrhoa carambola can act on the contractility and automaticity of the guinea pig heart. We measured the atrial isometric force in stimulated left atria and determined the chronotropic changes in spontaneously beating right atria. The carambola leaf extracts (1.5 mg/ml abolished the contractile force in a concentration-dependent manner. Among the crude, methanolic, ethanolic, aqueous, and acetic extracts, the aqueous one was the most potent (EC50 = 520 ± 94 µg/ml; flavonoids and tannins are the main constituents; Na+ and K+ contents in 1.0 mg/ml of aqueous extract were 0.12 ± 0.016 and 1.19 ± 0.15 mM, respectively. The aqueous extract abolished the positive Bowditch staircase phenomenon and reduced the inotropic response to CaCl2 (0.17-8.22 mM, events that are dependent on the cellular Ca2+ inward current. The adrenergic, muscarinic or opioid membrane receptors do not seem to participate in the mechanism of action of the cardioactive substance(s. In spontaneously beating atria, the aqueous extract promoted a negative chronotropic effect that was antagonized by 0.1 µM isoproterenol bitartrate. With this agonist, the EC50 of the aqueous extract increased from 133 ± 58 to 650 ± 100 µg/ml. These data regarding the effect of A. carambola on guinea pig atrial contractility and automaticity indicate an L-type Ca2+ channel blockade.

  8. Left Activism, Succour and Selfhood

    DEFF Research Database (Denmark)

    Hughes, Celia Penelope

    2014-01-01

    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...

  9. Left atrial dilatation in systolic heart failure: a marker of poor prognosis, not just a buffer between the left ventricle and pulmonary circulation.

    Science.gov (United States)

    Rossi, A; Dini, F L; Agricola, E; Faggiano, P; Benfari, G; Temporelli, P L; Cucco, C; Scelsi, L; Vassanelli, C; Ghio, S

    2018-02-23

    The relation between systolic pulmonary pressure (sPAP) and left atrium in patients with heart failure (HF) is unclear. Diastolic dysfunction, expressed as restrictive mitral filling pattern (RMP), and functional mitral regurgitation (FMR) are associated with both LA enlargement and increased sPAP. We aimed to evaluate whether atrial dilation might modulate the consequences of RMP and FMR on the pulmonary circulation of patients with HF with reduced ejection fraction (HFrEF). 1256 HFrEF patients were retrospectively recruited in four Italian centers. Left ventricular (LVD) and atrial (LAD) diameters were measure by m-mode, and EF were measured. RMP was defined as E-wave deceleration time lower than 140 ms. FMR was quantitatively measured. sPAP was evaluated based on maximal tricuspid regurgitant velocity and estimated right atrial pressure. Final study population was formed by 1005 patients because of unavailability of sPAP in 252 patients. Mean EF was 33 ± 3, 35% had RMP, 67% had mild, and 26% moderate-to-severe FMR. 69% of patients had increased sPAP. A significant association was observed between sPAP and EF, RMP, FMR, and LAD (p < 0.0001 for all). At multivariate analysis, LAD was positively associated with sPAP (p < 0.0001) independently of EF, RMP, and FMR. Analogously, LAD (p < 0.05) was associated with more severe symptoms and worse prognosis after adjustment for LV function and FMR. LA dilation was positively associated with sPAP independently of EF, RMP, and FMR. This highlights that LA size should be considered a marker of the severity of the disease.

  10. Left ventricular diastolic performance of left ventricular hypertrophy

    Energy Technology Data Exchange (ETDEWEB)

    Ikezono, Tohru; Ozaki, Masaharu; Yamagishi, Takashi; Shimizu, Tatsuro; Furutani, Yuji; Kusukawa, Reizo

    1987-02-01

    To study left ventricular diastolic performance in different forms of left ventricular hypertrophy, ECG gated cardiac blood pool scan was performed in 11 patients with hypertrophic nonobstructive cardiomyopathy (HCM) and in 19 patients with hypertension (HT), and left ventricular volume curve (LVVC) was analyzed and compared with those of 13 normal subjects (N). Ejection fraction (EF) and early filling volume ratio (the ratio of volume increment of 100 msec later than the zero point in the first derivative of LVVC to the end diastolic volume) (%EFV) were computed from LVVC. Peak ejection rate (PER) and peak filling rate (PFR) were obtained from the first derivative of LVVC. Peak ejection acceleration (PEA) and peak filling acceleration (PFA) were calculated from the second derivative of LVVC. EF, PER and PEA did not show any difference between these 3 groups. PFR was lower in HT (2.6 +- 0.5) compared with those in HCM (3.0 +- 0.5) (p < 0.05) and in N (3.4 +- 0.5) (p < 0.001), but the %EFV in HCM (4.9 +- 1.8) was lower than those in HT (6.9 +- 1.9) (p < 0.01) and in N (11.4 +- 1.4) (p < 0.001). Moreover, PFA in HCM (27.9 +- 7.2) was increased than those in HT (20.2 +- 5.4) (p < 0.01) with no differences between HCM and N (29.4 +- 8.1). Significant correlation was observed between PFR and PFA (Y = 0.06X + 1.4. r = 0.856. p < 0.001). These result indicate that, in HCM, reduced increase in early left ventricular volume is compensated by a greater filling acceleration. In contrast, there is no compensation by filling acceleration in HT.

  11. Increased cardiac alpha-myosin heavy chain in left atria and decreased myocardial insulin-like growth factor (Igf-I) expression accompany low heart rate in hibernating grizzly bears.

    Science.gov (United States)

    Barrows, N D; Nelson, O L; Robbins, C T; Rourke, B C

    2011-01-01

    Grizzly bears (Ursus arctos horribilis) tolerate extended periods of extremely low heart rate during hibernation without developing congestive heart failure or cardiac chamber dilation. Left ventricular atrophy and decreased left ventricular compliance have been reported in this species during hibernation. We evaluated the myocardial response to significantly reduced heart rate during hibernation by measuring relative myosin heavy-chain (MyHC) isoform expression and expression of a set of genes important to muscle plasticity and mass regulation in the left atria and left ventricles of active and hibernating bears. We supplemented these data with measurements of systolic and diastolic function via echocardiography in unanesthetized grizzly bears. Atrial strain imaging revealed decreased atrial contractility, decreased expansion/reservoir function (increased atrial stiffness), and decreased passive-filling function (increased ventricular stiffness) in hibernating bears. Relative MyHC-α protein expression increased significantly in the atrium during hibernation. The left ventricle expressed 100% MyHC-β protein in both groups. Insulin-like growth factor (IGF-I) mRNA expression was reduced by ∼50% in both chambers during hibernation, consistent with the ventricular atrophy observed in these bears. Interestingly, mRNA expression of the atrophy-related ubiquitin ligases Muscle Atrophy F-box (MAFBx) and Muscle Ring Finger 1 did not increase, nor did expression of myostatin or hypoxia-inducible factor 1α (HIF-1α). We report atrium-specific decreases of 40% and 50%, respectively, in MAFBx and creatine kinase mRNA expression during hibernation. Decreased creatine kinase expression is consistent with lowered energy requirements and could relate to reduced atrial emptying function during hibernation. Taken together with our hemodynamic assessment, these data suggest a potential downregulation of atrial chamber function during hibernation to prevent fatigue and dilation

  12. Medline Plus

    Full Text Available ... The four chambers of the heart are the right atrium, the right ventricle, the left atrium, and the left ventricle. ... which bring blood from the body to the right atrium, the pulmonary artery, which transports blood from ...

  13. Detailed anatomy of a left accessory aberrant colic artery.

    Science.gov (United States)

    Rusu, M C; Vlad, M; Voinea, L M; Curcă, G C; Sişu, A M

    2008-10-01

    In an aged human female cadaver a left accessory aberrant colic artery (LAACA) was observed and studied. It originated from the superior mesenteric artery at 3 cm proximal to the middle colic artery, at the inferior border of pancreas, passing over Treitz's muscle and continued covered by the superior duodenal fold where it crossed the inferior mesenteric vein. Further, it continued with a satellite vein anterior to the left renal vein and the anterior branch of the renal artery. The LAACA divided into an ascending branch and a descending one, anastomosed with the middle colic and proper left colic arteries; between its two primary branches and the splenic flexure of colon, a hypovascular area was observed. The surgical relevance of the LAACA detailed anatomy mainly relates to specific procedures performed in left colectomies and nephrectomies.

  14. Producing The New Regressive Left

    DEFF Research Database (Denmark)

    Crone, Christine

    This thesis is the first comprehensive research work conducted on the Beirut based TV station, an important representative of the post-2011 generation of Arab satellite news media. The launch of al-Mayadeen in June 2012 was closely linked to the political developments across the Arab world...... 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...

  15. Left Ventricular Hypertrophy Evaluation in Obese Hypertensive Patients: Effect of Left Ventricular Mass Index Criteria

    Directory of Open Access Journals (Sweden)

    Eduardo Cantoni Rosa

    2002-04-01

    Full Text Available PURPOSE: To evaluate left ventricular mass (LVM index in hypertensive and normotensive obese individuals. METHODS: Using M mode echocardiography, 544 essential hypertensive and 106 normotensive patients were evaluated, and LVM was indexed for body surface area (LVM/BSA and for height² (LVM/h². The 2 indexes were then compared in both populations, in subgroups stratified according to body mass index (BMI: or = 30kg/m². RESULTS: The BSA index does not allow identification of significant differences between BMI subgroups. Indexing by height² provides significantly increased values for high BMI subgroups in normotensive and hypertensive populations. CONCLUSION: Left ventricular hypertrophy (LVH has been underestimated in the obese with the use of LVM/BSA because this index considers obesity as a physiological variable. Indexing by height² allows differences between BMI subgroups to become apparent and seems to be more appropriate for detecting LVH in obese populations.

  16. From the Left to the Right: How the Brain Compensates Progressive Loss of Language Function

    Science.gov (United States)

    Thiel, Alexander; Habedank, Birgit; Herholz, Karl; Kessler, Josef; Winhuisen, Lutz; Haupt, Walter F.; Heiss, Wolf-Dieter

    2006-01-01

    In normal right-handed subjects language production usually is a function of the left brain hemisphere. Patients with aphasia following brain damage to the left hemisphere have a considerable potential to compensate for the loss of this function. Sometimes, but not always, areas of the right hemisphere which are homologous to language areas of the…

  17. 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...

  18. A case with double-chambered right ventricle and left ventricular-right atrial communication (Gerbode defect): potential pitfall for Eisenmenger syndrome.

    Science.gov (United States)

    Gur, Demet Ozkaramanli; Gur, Ozcan; Goksuluk, Huseyin; Oral, Dervis

    2012-09-01

    The ventricular septal defect (VSD) can rarely be associated with other malformations such as double-chambered right ventricle (DCRV) in which hypertrophied muscle bundles divide the right ventricle into two chambers causing progressive obstruction (Mao et al., Asia Pac J Thorac Cardiovasc Surg 5:14-17, 1996). Most VSDs close spontaneously by apposition of the tricuspid leaflets, but the process is rarely disrupted, resulting in communication between left ventricle and right atrium called Gerbode defect [Cho et al., J Cardiovasc Ultrasound 19(3):148-151, 2011]. Hence, the Gerbode defect involves potential misinterpretation of its high-velocity shunt as pulmonary hypertension. Here we present a case with DCRV and Gerbode defect initially misdiagnosed to have Eisenmenger syndrome.

  19. Role of surface electrocardiogram precordial leads in localizing different anatomic sites of ectopic atrial tachycardia arising from lower right atrium in pediatric population.

    Science.gov (United States)

    Allam, Lamyaa Elsayed; Ahmed, Rania Samir; Ghanem, Mazen Tawfik

    2018-01-01

    The study was designed to examine P wave morphology (PWM) in precordial leads (V 1 -V 6 ) during ectopic atrial tachycardia (EAT) originating from low right atrium (RA) to identify the anatomic sites of these foci in children. Twenty-three consecutive pediatric patients (56% females, mean age 8.5 ± 2.5) with EAT originating from the low RA underwent detailed atrial endocardial activation mapping and radiofrequency ablation. PWM during EAT was analyzed using standard 12-lead ECG in relation to successful ablation sites in RA. Ectopic atrial tachycardia originated from coronary sinus ostium (CSo) in 12 patients, nonseptal tricuspid annulus (TA) in five, lower crista terminalis (CT) in three and lower free wall in three. In lead V 1 , PWM showed a positive pattern during EAT originating from CSo (8/12) [91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), 100% negative predictive value (NPV)]. A negative pattern was observed in EAT originating from lower free wall (1/3) and nonseptal TA (5/5) [50% sensitivity, 100% specificity, 100% PPV, 75% NPV], while isoelectric pattern was in EAT originating from lower CT (3/3) [100% sensitivity, 100% specificity, 100% PPV, 100% NPV]. In leads V 3 -V 6 , PWM showed a negative pattern in at least two consecutive leads during EAT from CSo (12/12), nonseptal TA (5/5) and lower free wall (3/3) while it was positive in EAT originating from lower CT (3/3) [100% sensitivity, 95% specificity, 75% PPV and 100% NPV]. P wave morphology in precordial leads can help differentiate the anatomic sites of EAT from lower RA with high PPVs and NPVs. © 2017 Wiley Periodicals, Inc.

  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. 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

  2. Preliminary design of the internal geometry in a minimally invasive left ventricular assist device under pulsatile-flow conditions.

    Science.gov (United States)

    Smith, P Alex; Wang, Yaxin; Metcalfe, Ralph W; Sampaio, Luiz C; Timms, Daniel L; Cohn, William E; Frazier, O H

    2018-03-01

    A minimally invasive, partial-assist, intra-atrial blood pump has been proposed, which would unload the left ventricle with a flow path from the left atrium to the arterial system. Flow modulation is a common strategy for ensuring washout in the pump, but it can increase power consumption because it is typically achieved through motor-speed variation. However, if a pump's performance curve had the proper gradient, flow modulation could be realized passively. To achieve this goal, we propose a pump performance operating curve as an alternative to the more standard operating point. Mean-line theory was employed to generate an initial set of geometries that were then tested on a hydraulic test rig at ~20,000 r/min. Experimental results show that the intra-atrial blood pump performed below the operating region; however, it was determined that smaller hub diameter and longer chord length bring the performance of the intra-atrial blood pump device closer to the operating curve. We found that it is possible to shape the pump performance curve for specifically targeted gradients over the operating region through geometric variations inside the pump.

  3. Considerations in cardio-oncology: Multiple mobile left-sided cardiac thrombi in chemotherapy-induced cardiomyopathy.

    Science.gov (United States)

    Minamishima, Toshinori; Matsushita, Kenichi; Morikubo, Hiromu; Isaka, Aoi; Matsushita, Noriko; Endo, Hidehito; Kubota, Hiroshi; Sakata, Konomi; Satoh, Toru; Yoshino, Hideaki

    2017-07-01

    With advances in cancer chemotherapy, the importance of the new clinical discipline of cardio-oncology, which is concerned with the cardiac effects of chemotherapy, is increasing. Herein we describe the case of a 48-year-old woman with a history of breast cancer who presented with symptoms of heart failure due to chemotherapy-induced cardiomyopathy. Treatment for the patient's breast cancer had included surgery and chemotherapy with anthracyclines and trastuzumab. Echocardiography revealed multiple mobile thrombi in the left ventricle and atrium. In addition, brain magnetic resonance imaging revealed small acute cerebral infarctions due to embolization. Given the high risk of re-embolization, surgical thrombectomy was performed. Thus far, there are no standardized therapeutic guidelines for left-sided cardiac thrombi and the optimal treatment remains contentious. Although this patient was managed successfully with surgical thrombectomy, patients should be managed individually, taking into consideration embolization, bleeding, and surgical risks. With further improvements in cancer chemotherapy, there may be an increase in the incidence of complications such as multiple cardiac thrombi. From the cardio-oncology standpoint, we propose close interactions between cardiologists and oncologists for the optimal care of cancer patients. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  4. Syndrome of hypoplasic left ventricle, Description of a clinical case with survival after carrying out of Norwood technique

    International Nuclear Information System (INIS)

    Velasco B, Ana M; Lince V, Rafael; Zapata S, Jorge A and others

    2003-01-01

    A clinical case of a 72 hours newborn patient admitted to the pediatric intensive care unit for reduced cardiac output syndrome showing anuria, metabolic acidosis and respiratory distress, is reported. Mechanical ventilation, inotropic support and continuous prostaglandin e1 infusion were initiated. The echocardiogram showed hypoplasia of the left ventricle. The Norwood procedure stage i under extracorporeal circulation with deep hypothermia and circulatory arrest, was performed at the 6th day of life. During the early postoperative period, the patient developed hypoxaemia and pulmonary hypertension, which improved with controlled hyperventilation and vasodilatation therapy. Other complications were clinical sepsis and abstinence syndrome, which resolved with medical management. The patient was extubated on the sixth postoperative day. Subsequent echocardiograms showed tricuspid valve regurgitation, right ventricular dysfunction with dilation and an organized thrombus in the left atrium. These improved with diuretics, dopamine, milrinone and heparin. The patient was discharged after 32 days of the surgery without signs of congestive heart failure. This case is important, given the high mortality rate of this pathology. The Norwood procedure proved to be a palliative strategy versus the ortotopic cardiac transplant in newborns, because of the difficulty in finding donators at this age and the immunosuppressive therapy complications. This represents a great advance in the Colombian pediatric cardiology because until recent years these patients did not have any other surgical alternative

  5. [Biatrial vs. isolated left atrial cryoablation for the treatment of long-lasting permanent atrial fibrillation. Midterm recurrence rate].

    Science.gov (United States)

    Gualis, Javier; Castaño, Mario; Martínez-Comendador, Jose Manuel; Marcos, Jose Miguel; Martín, Carlos; Estévez-Loureiro, Rodrigo; Gómez-Plana, Jesús; Martín, Elio; Otero, Javier

    2016-01-01

    The long-term results of cryomaze in patients with longstanding persistent atrial fibrillation during concomitant surgical procedures are still uncertain. Between 2006 and 2011, 150 consecutive patients with associated long-lasting permanent atrial fibrillation and associated heart disease underwent heart surgery were treated by biatrial Cox-Maze (63 patients) or by isolated endocardial or epicardial left atrial cryoablation (83 patients) concomitantly. The results at 3 years in these groups were compared with clinical monitoring, electrocardiography, 24-hour Holter, and echocardiography with measurement of the transmitral A wave at 1, 6 and 12 months and annually thereafter in all patients. Patients undergoing Cox-Maze IV ablation presented rates of freedom from atrial fibrillation of 97, 94, 89, 80 and 54% at 1, 6, 12, 24 and 36 months, respectively. In the 12-month follow-up, these differences were significant (p<.05). The independent risk factors of atrial fibrillation recurrence was isolated ablation of left atrium. Atrial fibrillation by cryothermia ablation had a high success rate before 2 years postoperatively. Recurrence of atrial fibrillation increased thereafter regardless of the technique used, although it was more intense and developed earlier in cases of monoatrial ablation. For the treatment of other long-lasting permanent atrial fibrillation cardiac surgery-associated pathology, an aggressive biatrial treatment with Cox maze ablation should be performed. Copyright © 2015 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  6. Blood pressure control and left ventricular hypertrophy in ...

    African Journals Online (AJOL)

    surface area (BSA). When LVM was indexed to height, left ventricular hypertrophy was found in none of the subjects of the normotensive group, while it was found present in 43 (22.4%) and 14 (24.1%) subjects of the uncontrolled and controlled hypertensive groups, respectively. Significant difference in the prevalence of ...

  7. The role of left posterior inferior temporal cortex in spelling.

    Science.gov (United States)

    Rapcsak, Steven Z; Beeson, Pélagie M

    2004-06-22

    To determine whether damage to left posterior inferior temporal cortex (PITC) is associated with agraphia and to characterize the nature of the spelling impairment. Left angular gyrus may play a critical role in spelling. However, this traditional view is challenged by reports of agraphia after left temporo-occipital lesions and by functional imaging studies demonstrating activation of left PITC during writing in normal individuals. Patients with focal damage to the left temporo-occipital cortex and normal control subjects were administered a comprehensive spelling battery that included regular words, irregular words, and nonwords as stimuli. Although patients performed worse than control subjects in all experimental conditions, the spelling deficit was particularly severe for irregular words, whereas regular word and nonword spelling were less impaired. Additional analyses indicated that orthographic regularity and word frequency had a much more pronounced effect on spelling accuracy in patients compared with control subjects. Most errors on irregular words were phonologically plausible, consistent with reliance on a sublexical phonologic spelling strategy (i.e., phoneme-grapheme conversion). Overall, the spelling impairment of the patients showed the characteristic profile of lexical agraphia. Lesion analyses indicated that the damage in the majority of patients encompassed an area within the left PITC (BA 37/20) where the authors previously obtained evidence of activation in a functional imaging study of writing in normal participants. The behavioral and neuroanatomic observations in the patients are consistent with functional imaging studies of writing in neurologically intact individuals and provide converging evidence for the role of left PITC in spelling. Together, these findings implicate left PITC as a possible neural substrate of the putative orthographic lexicon that contains stored memory representations for the written forms of familiar words.

  8. ODEs: is there anything left to do

    Energy Technology Data Exchange (ETDEWEB)

    Gear, C.W.

    1979-10-01

    Two decades ago many people thought that there was very little left to occupy the researcher in the numerical initial-value problem for ordinary differential equations, but there has since been an enormous increase in the effort devoted to this problem and related software. The question is whether everything is finally done so that more difficult areas can be studied. The development of numerical solution techniques is examined from the identification of a problem to the never-final preparation of automatic codes for the solution of classes of similar problems. A number of ODE problems that are only a part of the way along this path of development are discussed. These problems include ones with highly oscillatory solutions, ones with frequent discontinuities, and ones in which very little accuracy is needed (and which should be integrated at low cost). 4 figures.

  9. Semantic dementia and the left and right temporal lobes.

    Science.gov (United States)

    Snowden, Julie S; Harris, Jennifer M; Thompson, Jennifer C; Kobylecki, Christopher; Jones, Matthew; Richardson, Anna M; Neary, David

    2017-08-31

    Semantic dementia, a circumscribed disorder of semantic knowledge, provides a unique model for understanding the neural basis for semantic representation. The study addressed areas of contention: the relative roles of the left and right temporal lobe, the contribution of anterior versus posterior temporal cortex and the status of the anterior temporal lobes as amodal hub. Naming and word comprehension was examined in 41 semantic dementia patients, 31 with left-predominant and 10 right-predominant atrophy. In keeping with expectation, naming and comprehension were significantly poorer in left-predominant patients. Structural magnetic resonance image analysis, using a visual rating scale, showed strong inverse correlations between naming scores and severity of both left anterior and posterior temporal lobe atrophy. By contrast, comprehension performance was more strongly correlated with left posterior temporal atrophy. Analysis of naming errors revealed a correlation between anterior temporal atrophy and associative/functional descriptive responses, implying availability of semantic information. By contrast, 'don't know' responses, indicative of loss of semantic knowledge, were linked to left posterior temporal lobe atrophy. Semantic errors, the hallmark of semantic dementia, were linked to right hemisphere atrophy, especially the right posterior temporal lobe. Matched visual-verbal tasks (famous face and name identification, Pyramids and Palm trees pictures and words, animal knowledge from 3-D models and animal names) administered to nine patients elicited variable correspondence between performance on nonverbal and verbal versions of the task. Marked performance dissociations were demonstrated in some patients: poorer understanding of names/words in left-predominant patients and of faces/pictures/models in right-predominant cases. The findings are compatible with the notion of the anterior temporal lobes as areas of convergence, but are less easily accommodated

  10. The left atrial septal pouch as a risk factor for stroke: A systematic review.

    Science.gov (United States)

    Strachinaru, Mihai; Castro-Rodriguez, Jose; Verbeet, Thierry; Gazagnes, Marie-Dominique

    2017-04-01

    The left atrial septal pouch (LASP) is formed by incomplete fusion of the septum primum and septum secundum, leaving a cavity open towards the left atrium, but without interatrial shunting. There is no recommendation concerning strategy in the presence of a LASP, especially in the setting of stroke. The aim of this review was to determine whether the LASP could be incriminated as the aetiology of a stroke. We included all pertinent publications on the subject, and calculated hazard ratios for ischaemic stroke and cryptogenic stroke. There were only five case-control studies concerning the LASP, involving 516 stroke patients and 779 controls. Overall LASP prevalence was 21%, with a slightly higher prevalence in the cryptogenic stroke group (26%), but this difference was not statistically significant (P=0.27). In a random-effects meta-analysis, there was no difference between controls and patients with ischaemic stroke (hazard ratio 1.20, 95% confidence interval 0.96-1.53; P=0.14). Cryptogenic stroke appeared more frequently in patients with LASP (hazard ratio 1.53, 95% confidence interval 1.07-2.24; P=0.02), but this was driven by only one severely underpowered study. The published case reports demonstrated that thrombus formation inside the pouch can occur in the presence of major predisposing factors. The LASP can be a site for thrombus formation, leading to embolic events, but its presence does not correlate with an increased incidence of stroke. Associated factors should be taken into consideration in the setting of stroke. Further studies are necessary to validate a possible relationship with cryptogenic stroke. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Right and left ventricular ejection fraction at rest and during exercise assessed with radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Dahlstroem, J.A.

    1982-01-01

    Right (RVEF) and left ventricular ejection fraction (LVEF) assessed with radionuclide angiocardiography were compared to simultaneously obtained catheterization results at rest and during exercise in patients with pulmonary hypertension and ischemic heart disease. Blood pool imaging was performed with red blood cells (RBC) labelled with 99 Tcsup(m) in vivo as this method gave more stable 99 Tcsup(m) levels in blood compared to 99 Tcsup(m)-labelled human serum albumin and because it was more convenient than labelling RBC in vitro. RVEF measured with first pass (FP) technique and equilibrium (EQ) technique correlated well at rest, r = 0.86, and during exercise, r = 0.91. The FP technique had the best reproducibility and reference values at rest were 49+-5 per cent increasing with exercise. When 99 Tcsup(m) and 133 Xe were compared to assess RVEF with FP technique, the correlation was good, r = 0.88. LVEF assessed with EQ technique and a fixed end-diastolic region of interest was very reproducible at rest and during exercise; reference values at rest were 56+-8 per cent increasing with exercise. In 10 patients with pulmonary hypertension significant negative correlations were found between RVEF assessed with FP technique and pressures in pulmonary artery and right atrium. Abnormal RVEF was found in all patients with right ventricular disfunction. In 22 patients with recent myocardial infarction measurements of LVEF detected left ventricular disfunction better than did measurement of pulmonary artery diastolic pressure. During effort angina in another 10 patients all had abnormal LVEF and abnormal hemodynamics. By combining ejection fraction and stroke volume, ventricular volumes were calculated at rest and during exercise. (author)

  12. Distinctive left-sided distribution of adrenergic-derived cells in the adult mouse heart.

    Directory of Open Access Journals (Sweden)

    Kingsley Osuala

    Full Text Available Adrenaline and noradrenaline are produced within the heart from neuronal and non-neuronal sources. These adrenergic hormones have profound effects on cardiovascular development and function, yet relatively little information is available about the specific tissue distribution of adrenergic cells within the adult heart. The purpose of the present study was to define the anatomical localization of cells derived from an adrenergic lineage within the adult heart. To accomplish this, we performed genetic fate-mapping experiments where mice with the cre-recombinase (Cre gene inserted into the phenylethanolamine-n-methyltransferase (Pnmt locus were cross-mated with homozygous Rosa26 reporter (R26R mice. Because Pnmt serves as a marker gene for adrenergic cells, offspring from these matings express the β-galactosidase (βGAL reporter gene in cells of an adrenergic lineage. βGAL expression was found throughout the adult mouse heart, but was predominantly (89% located in the left atrium (LA and ventricle (LV (p<0.001 compared to RA and RV, where many of these cells appeared to have cardiomyocyte-like morphological and structural characteristics. The staining pattern in the LA was diffuse, but the LV free wall displayed intermittent non-random staining that extended from the apex to the base of the heart, including heavy staining of the anterior papillary muscle along its perimeter. Three-dimensional computer-aided reconstruction of XGAL+ staining revealed distribution throughout the LA and LV, with specific finger-like projections apparent near the mid and apical regions of the LV free wall. These data indicate that adrenergic-derived cells display distinctive left-sided distribution patterns in the adult mouse heart.

  13. Echocardiographic assessment of inappropriate left ventricular mass and left ventricular hypertrophy in patients with diastolic dysfunction

    Directory of Open Access Journals (Sweden)

    Hasan Shemirani

    2012-01-01

    Full Text Available Background: early diagnosis of left ventricular mass (LVM inappropriateness and left ventricular hypertrophy (LVH can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM. Materials and Methods: one hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E/late diastolic peak velocity (A, deceleration time (DT, and E/early mitral annulus velocity (E′ were measured. Results: the mean systolic and diastolic blood pressure at the patients′ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (P 0.05. Spearman′s Rank test was used to test the correlation between diastolic dysfunction and LV mass (P = 0.025. Conclusion: LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.

  14. Left-handed Children in Singapore.

    Science.gov (United States)

    Gan, Linda

    1998-01-01

    Used teacher questionnaires to examine incidence of left-handedness in nearly 2,800 Singaporean children, racial differences in this left-handed population, and educational provisions in preschool and primary school. Findings indicated that 7.5% of preschoolers and 6.3% of primary children were left-handed, with a higher proportion being Chinese…

  15. The Left-Handed: "Their Sinister" History.

    Science.gov (United States)

    Costas, Elaine Fowler

    The history of left-handedness can provide teachers and parents a better understanding of left-handed children and give those children more pride in their difference. No child should be made to feel that he or she is abnormal because of using the left hand, although some specific instruction for these students is necessary in handwriting. Many…

  16. 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.

  17. Reorganization of the Cerebro-Cerebellar Network of Language Production in Patients with Congenital Left-Hemispheric Brain Lesions

    Science.gov (United States)

    Lidzba, K.; Wilke, M.; Staudt, M.; Krageloh-Mann, I.; Grodd, W.

    2008-01-01

    Patients with congenital lesions of the left cerebral hemisphere may reorganize language functions into the right hemisphere. In these patients, language production is represented homotopically to the left-hemispheric language areas. We studied cerebellar activation in five patients with congenital lesions of the left cerebral hemisphere to assess…

  18. Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease

    Directory of Open Access Journals (Sweden)

    Perez Amanda Arantes

    2003-01-01

    Full Text Available OBJECTIVE: To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease. METHODS: A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter. RESULTS: The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23 and left ventricular diastolic diameter (r=0.30. The area calculated under the ROC curve was 0.734. CONCLUSION: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated.

  19. Right ventricular dysfunction affects survival after surgical left ventricular restoration.

    Science.gov (United States)

    Couperus, Lotte E; Delgado, Victoria; Palmen, Meindert; van Vessem, Marieke E; Braun, Jerry; Fiocco, Marta; Tops, Laurens F; Verwey, Harriëtte F; Klautz, Robert J M; Schalij, Martin J; Beeres, Saskia L M A

    2017-04-01

    Several clinical and left ventricular parameters have been associated with prognosis after surgical left ventricular restoration in patients with ischemic heart failure. The aim of this study was to determine the prognostic value of right ventricular function. A total of 139 patients with ischemic heart failure (62 ± 10 years; 79% were male; left ventricular ejection fraction 27% ± 7%) underwent surgical left ventricular restoration. Biventricular function was assessed with echocardiography before surgery. The independent association between all-cause mortality and right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain was assessed. The additive effect of multiple impaired right ventricular parameters on mortality also was assessed. Baseline right ventricular fractional area change was 42% ± 9%, tricuspid annular plane systolic excursion was 18 ± 3 mm, and right ventricular longitudinal peak systolic strain was -24% ± 7%. Within 30 days after surgery, 15 patients died. Right ventricular fractional area change (hazard ratio, 0.93; 95% confidence interval, 0.88-0.98; P right ventricular longitudinal peak systolic strain (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26; P Right ventricular function was impaired in 21%, 20%, and 27% of patients on the basis of right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain, respectively. Any echocardiographic parameter of right ventricular dysfunction was present in 39% of patients. The coexistence of several impaired right ventricular parameters per patient was independently associated with increased 30-day mortality (hazard ratio, 2.83; 95% confidence interval, 1.64-4.87, P right ventricular systolic dysfunction is independently associated with increased mortality in patients with ischemic heart failure undergoing surgical left

  20. Aphasia following left thalamic hemorrhage. A study by Western Aphasia Battery and single photon emission CT

    Energy Technology Data Exchange (ETDEWEB)

    Makishita, Hideo; Miyasaka, Motomaro; Tanizaki, Yoshio; Yanagisawa, Nobuo; Sugishita, Morihiro

    1984-07-01

    A report is given of 7 patients with left thalamic hemorrhage in the chronic stage (from 1.5 months to 4.5 months) in which language disorders were examined by Western Aphasia Battery (WAB) and cerebral blood flow was measured 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 the left temporooccipital region and low blood flow at the left thalamus. In one of the two patients classified as anomic aphasia, emission CT showed slight low flow area at the temporo-occipital region similar to the case with transcortical sensory aphasia. In another case with anomic aphasia there was a 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. In all of the 3 patients without aphasia, emission CT showed low flow region restricted to the left thalamus.

  1. Compression syndrome of the left renal vein

    Energy Technology Data Exchange (ETDEWEB)

    Justich, E.

    1982-04-01

    Severe compression of the left renal vein produces a pressure gradient between it and the inferior vena cava and results in changes in haemodynamics. The cause of the narrowing is usually the aorta, less commonly the superior mesenteric artery. Compression of the left renal vein may be responsible for a number of abnormalities such as primary varicoceles, primary varices of the ovarian, renal, pelvic and ureteric veins on the left, the more frequent occurrence of unilateral renal vein thrombosis on the left and the development of renovascular hypertension. One hundred and twenty-three selective phlebograms of the left renal vein and CT examinations of this structure in a further 87 patients acting as a control group were carried out. The significance of compression of the left renal vein as an aetiological factor in the development of the above mentioned abnormalities is discussed.

  2. 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.

  3. Independence of intrapericardial right and left ventricular performance in septic pulmonary hypertension

    International Nuclear Information System (INIS)

    Boeck, J.C.; Eichstaedt, H.; Barker, B.C.; Lewis, F.R.; Lim, A.D.; Pollycove, M.

    1990-01-01

    To study the effect of septic pulmonary hypertension on right/left ventricular intrapericardial interactions thirteen trauma patients, seven septic and six nonseptic controls, were compared. Ventricular volumes were derived from firstpass or gated equilibrium radionuclide angiocardiography, and related to body surface area. Systemic and pulmonary pressures were measured invasively. Pulmonary arterial pressure was significantly increased in the sepsis group. Although right ventricular end-diastolic volumes were higher in sepsis, left ventricular end-diastolic volumes were not decreased. In terms of intrapericardial right/left ventricular interactions these results indicate that the right and left ventricles operate independently in septic pulmonary hypertension. (orig.) [de

  4. Multiplicativity of left centralizers forcing additivity

    Directory of Open Access Journals (Sweden)

    Mohammad Sayed Tammam El-Sayiad

    2014-01-01

    Full Text Available A multiplicative left centralizer for an associative ring R is a map satisfying T(xy = T\\(xy for all x,y in R. T is not assumed to be additive. In this paper we deal with the additivity of the multiplicative left centralizers in a ring which contains an idempotent element. Specially, we study additivity for multiplicative left centralizers in prime and semiprime rings which contain an idempotent element.

  5. Anarchy, socialism and a Darwinian left.

    Science.gov (United States)

    Clarke, Ellen

    2006-03-01

    In A Darwinian left Peter Singer aims to reconcile Darwinian theory with left wing politics, using evolutionary game theory and in particular a model proposed by Robert Axelrod, which shows that cooperation can be an evolutionarily successful strategy. In this paper I will show that whilst Axelrod's model can give support to a kind of left wing politics, it is not the kind that Singer himself envisages. In fact, it is shown that there are insurmountable problems for the idea of increasing Axelrodian cooperation within a welfare state. My surprising conclusion will be that a Darwinian left worthy of the name would be anarchistic.

  6. 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...... 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...

  7. A functional MRI study of language networks in left medial temporal lobe epilepsy

    International Nuclear Information System (INIS)

    Yu Aihong; Wang Xiaoyi; Xu Guoqing; Li Yongjie; Qin Wen; Li Kuncheng; Wang, Yuping

    2011-01-01

    Purpose: The purpose of this study was to investigate the abnormality of language networks in left medial temporal lobe epilepsy (MTLE) using fMRI. Materials and methods: Eight patients with left MTLE and 15 healthy subjects were evaluated. An auditory semantic judgment (AJ) paradigm was used. The fMRI data were collected on a 3T MR system and analyzed by AFNI (analysis of functional neuroimages) to generate the activation map. Results: Behavioral data showed that the reaction time of the left MTLE patients was significantly longer than that of controls on the AJ task (t = -3.396, P < 0.05). The left MTLE patients also exhibited diffusively decreased activation in the AJ task. Right hemisphere dominance of Broca's and Wernicke's areas was demonstrated in left MTLE patients. Conclusions: Long-term activation of spikes in left MTLE patients results in language impairment, which is associated with an abnormality of the brain neural network.

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

    DEFF Research Database (Denmark)

    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...... with larger left ventricular diameter and higher left ventricular mass index (both P hypertrophy was greater (84 vs. 64%; P ..., transmitral peak E velocities and peak A velocities; and lower E/A ratio (all P hypertrophy, but normal left ventricular chamber systolic function with increased...

  9. Mixoma em átrio esquerdo associado a doença arterial coronariana obstrutiva Left atrial myxoma associated with obstructive coronary artery disease

    Directory of Open Access Journals (Sweden)

    Ronaldo Altenburg Odebrecht Curi Gismondi

    2007-01-01

    Full Text Available Descrevemos o caso de um paciente de 67 anos, portador de doença arterial coronariana obstrutiva, o qual, em avaliação pré-operatória para cirurgia de herniorrafia inguinal, realizou ecocardiograma demonstrando um volumoso tumor em átrio esquerdo, móvel, não-obstrutivo, com pedículo proveniente da veia pulmonar superior direita. O paciente realizou cineangiocoronariografia com ventriculografia esquerda, evidenciando lesão obstrutiva grave em terço médio da artéria descendente anterior, moderada em terço proximal da artéria circunflexa, no local de saída do primeiro ramo marginal, e coronária direita com lesão não-obstrutiva em terço distal. Havia, ainda, disfunção ventricular esquerda moderada. O paciente foi então submetido a cirurgia para retirada do tumor e revascularização do miocárdio. O exame histopatológico mostrou tratar-se de um mixoma.We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.

  10. 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...

  11. Left ventricular hypertrophy, geometric patterns and clinical ...

    African Journals Online (AJOL)

    Background: Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Methods: One hundred and eighty eight ...

  12. Leptogenesis with left-right domain walls

    Indian Academy of Sciences (India)

    the scale of left-right symmetry breaking. Keywords. Leptogenesis; baryogenesis; domain walls; left-right symmetry. PACS Nos 12.10.Dm; 98.80.Cq; 98.80.Ft. Explaining the observed baryon asymmetry of the Universe within the framework of gauge theories and the standard Big Bang cosmology remains an open problem.

  13. On establishing coreference in Left Dislocation constructions ...

    African Journals Online (AJOL)

    The phenomenon of left dislocation (LD) has received relatively little attention in the generative literature. In Government & Binding theory and early versions of Minimalist Syntax, the left-dislocated expression is conventionally taken to be base-generated in its sentence-initial surface position and the resumptive pronoun in ...

  14. A new clinical sign probably associated to left hemiplegia with left hemineglect syndrome: the crossed legs.

    Science.gov (United States)

    Bazan, Rodrigo; Fernandes, Thiago; Braga, Gabriel; Luvizutto, Gustavo; Resende, Luiz

    2014-06-01

    To describe a new clinical sign associated with left unilateral neglect syndrome (UNS) in patients with ischemic stroke. Head computed tomography (CT) and National Institute of Health Stroke Scale were obtained in 150 patients with ischemic stroke. Those with right cerebral vascular lesions, left hemiplegia and right leg persistently crossed over the left were submitted to specific tests for UNS. The tests were also applied to 30 patients with right cerebral vascular lesions, left hemiplegia but without crossed legs. From 9 patients with persistent tendency to cross the right leg over the left, UNS was detected in 8. One patient died before the clinical tests were applied. Of the 30 patients without the crossed legs, 20 had normal clinical tests for UNS and 10 had minimal alterations, not sufficient for the diagnosis of UNS. The right leg crossed over the left may represent a new neurological semiotic sign associated with left hemiplegia and left UNS.

  15. Famous People Knowledge and the Right and Left Temporal Lobes

    Science.gov (United States)

    Snowden, Julie S.; Thompson, Jennifer C.; Neary, David

    2012-01-01

    It is generally accepted that the anterior temporal lobes support knowledge of famous people. The specific roles of the right and left temporal lobe remain a subject of debate, with some studies suggesting differential roles based on modality (visual versus verbal information) and others category (person knowledge versus general semantics). The present study re-examined performance of semantic dementia patients with predominantly right and predominantly left temporal lobe atrophy on famous face, famous name and general semantic tasks, with the specific aim of testing the hypothesis that the right temporal lobe has a privileged role for person knowledge and the left temporal lobe for general semantic knowledge. Comparisons of performance rankings across tasks showed no evidence to support this hypothesis. By contrast, there was robust evidence from naming, identification and familiarity measures for modality effects: right-sided atrophy being associated with relatively greater impairment for faces and visual tasks and left-sided atrophy for names and verbal tasks. A double dissociation in test scores in two patients reinforced these findings. The data present a challenge for the influential ‘semantic hub’ model, which views the anterior temporal lobes as an area of convergence in which semantic information is represented in amodal form. PMID:22207421

  16. 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.

  17. Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard

    2016-01-01

    PURPOSE: To assess the acute effect of triggered left ventricular pacing (tLVp) on left ventricular performance and contraction pattern in patients with heart failure, left bundle branch block (LBBB), and cardiac resynchronization therapy (CRT). METHODS: Twenty-three patients with pre-implant QRS...... complex >150 ms, QRS complex narrowing under CRT, and sinus rhythm were included ≥3 months after CRT implantation. Echocardiographic assessment of left ventricular ejection fraction (LVEF), global peak systolic longitudinal strain (GLS), and contraction pattern by 2D strain was performed during intrinsic......V pacing. CONCLUSIONS: The acute effect of tLVp on LV systolic function and contraction pattern is significantly lower than the effect of BiV pacing and not different from intrinsic conduction in patients with LBBB and CRT....

  18. [Vectorcardiographic manifestations of left intraventricular conduction disorders].

    Science.gov (United States)

    de Micheli, A; Medrano, G A

    1979-01-01

    Both, the vectorcardiographic changes produced by the various degrees of left bundle branch block and these observed with the different types of left distal block, are described. When a "wave jumping" phenomenon exists, the vectorcardiographic changes are more characteristic in the horizontal plane than in the frontal plane and can be interpreted satisfactorily in basis of the ventricular activation sequence. The normal counterclockwise rotation of the horizontal vectorcardiogram persists in the presence of left bundle branch block of slight and moderate degrees, since the electromotive forces of the free left ventricular wall are still predominant. In the majority of intermediate degree blocks, the middle portion of the RH loop develops with a clockwise rotation and general aspect with a clockwise rotation and the general aspect of the ventricular loop resembles an eight figure. This is due to the electromotive forces originated by the delayed depolarization of the left septal mass that starts to predominate. With advanced degrees of block, the largest portion of the RH loop shows a clockwise rotation, as well as marked notchings and slurrings. The initial anterior portion of the horizontal vectorcardiogram does not disappear, but is situated to the left of the anterior-posterior axis with a counterclockwise rotation (first right septal vector). Otherwise, the direct electrical sign of left distal block emphasized: evidence of delayed activation in a limited zone of the homolateral ventricle. This local delay gives rise to an asynchronism of the activation phenomenon between the upper and lower regions of the ventricle. The diagnosis of left bifascicular block is based essentially on the evidence of unequal delay of the activation sequence in the basal regions and in the inferior ones of the homolateral ventricle and also on the frequent persistence of the first left septal vector.

  19. Ventricular Energetics in Pediatric Left Ventricular Assist Device Patients: A Retrospective Clinical Study.

    Science.gov (United States)

    Di Molfetta, Arianna; Ferrari, Gianfranco; Iacobelli, Roberta; Filippelli, Sergio; Di Chiara, Luca; Guccione, Paolo; Amodeo, Antonio

    The aim of this study is to estimate the trend of right and left energetic parameters in left ventricular assist device (LVAD) pediatric patients. Echocardiographic data were retrospectively collected at the baseline, in the acute phase after and at the monthly follow-ups till the LVAD explantation to estimate left and right ventricular energetic parameters. A significant relationship between the left and right ventricular energetic parameter trends was found along all the study period. Left ventricular end-systolic pressure-volume relationship improved till the follow-up of 2 months and then progressively decreases. Left arteroventricular coupling decreases after the LVAD, and right arteroventricular coupling decreases at the short-term follow-up. Left ventricular external work, potential energy, and pressure-volume area decrease at the short-term follow-up and then increase progressively. Right ventricular external work, potential energy, and pressure-volume area increase after the LVAD implantation. Left (right) cardiac mechanical efficiency is improved (worsened) by the LVAD. Energetic variables show that the LVAD benefits could decrease over time. A continuous and patient tailored LVAD setting could contribute to prolong LVAD benefits. The introduction of energetic parameters could lead to a more complete evaluation of LVAD patients' outcome which is a multiparametric process.

  20. Are there excitability changes in the hand motor cortex during speech in left-handed subjects?

    Science.gov (United States)

    Tokimura, Hiroshi; Tokimura, Yoshika; Arita, Kazunori

    2012-01-01

    Hemispheric dominance was investigated in left-handed subjects using single transcranial magnetic stimulation to assess the possible effect of forced change in the dominant hand. Single transcranial magnetic stimuli were delivered randomly over the hand area of the left or right motor cortex of 8 Japanese self-declared left-handed adult volunteers. Electromyographic responses were recorded in the relaxed first dorsal interosseous muscle while the subjects read aloud. Laterality quotient calculated by the Edinburgh Inventory ranged from -100 to -5.26 and laterality index calculated from motor evoked potentials ranged from -86.2 to 38.8. There was no significant correlation between laterality quotient and laterality index. Mean data values across all 8 subjects indicated significant increases only in the left hand. Our ratio analysis of facilitation of the hand motor potentials showed that 2 each of the 8 self-declared left-handers were right- and left-hand dominant and the other 4 were bilateral-hand dominant. Speech dominancy was localized primarily in the right cerebral hemisphere in left-handed subjects, but some individuals exhibited bilateral or left dominance, possibly attributable to the forced change of hand preference for writing in childhood. Our findings suggest changes in the connections between the speech and hand motor areas.

  1. The effects of left and right monocular viewing on hemispheric activation.

    Science.gov (United States)

    Wang, Chao; Burtis, D Brandon; Ding, Mingzhou; Mo, Jue; Williamson, John B; Heilman, Kenneth M

    2018-03-01

    Prior research has revealed that whereas activation of the left hemisphere primarily increases the activity of the parasympathetic division of the autonomic nervous system, right-hemisphere activation increases the activity of the sympathetic division. In addition, each hemisphere primarily receives retinocollicular projections from the contralateral eye. A prior study reported that pupillary dilation was greater with left- than with right-eye monocular viewing. The goal of this study was to test the alternative hypotheses that this asymmetric pupil dilation with left-eye viewing was induced by activation of the right-hemispheric-mediated sympathetic activity, versus a reduction of left-hemisphere-mediated parasympathetic activity. Thus, this study was designed to learn whether there are changes in hemispheric activation, as measured by alteration of spontaneous alpha activity, during right versus left monocular viewing. High-density electroencephalography (EEG) was recorded from healthy participants viewing a crosshair with their right, left, or both eyes. There was a significantly less alpha power over the right hemisphere's parietal-occipital area with left and binocular viewing than with right-eye monocular viewing. The greater relative reduction of right-hemisphere alpha activity during left than during right monocular viewing provides further evidence that left-eye viewing induces greater increase in right-hemisphere activation than does right-eye viewing.

  2. Impairment of language is related to left parieto-temporal glucose metabolism in aphasic stroke patients.

    Science.gov (United States)

    Karbe, H; Szelies, B; Herholz, K; Heiss, W D

    1990-02-01

    Twenty-six aphasic patients who had an ischaemic infarct in the territory of the left middle cerebral artery (MCA) were investigated. Cranial computed tomography (CT) showed various lesion sites: infarcts restricted to cortical structures in 12 patients, combined cortical and subcortical infarcts in 7 and isolated subcortical infarcts sparing the left cortex in another 7 cases. 18F-2-fluoro-2-deoxyglucose positron emission tomography revealed remote hypometabolism of the left convexity cortex and of the left basal ganglia, which was extended further than the morphological infarct zone in all cases. Types and degrees of aphasia were classified using the Aachener Aphasie Test (AAT): 10 patients had global aphasia, 2 Broca's, 5 Wernicke's, and 5 amnesic aphasia. Four patients suffered from minimal or residual aphasic symptoms. The AAT results were compared with the regional cerebral metabolic rates of glucose of the left hemisphere. Irrespective of the infarct location all five AAT subtests (Token test, repetition, written language, confrontation naming, auditory and reading comprehension) were closely correlated among each other and with left parieto-temporal metabolic rates, whereas left frontal and left basal ganglia metabolism showed no significant correlation. The close relation between left temporo-parietal functional activity and all five AAT subtests suggests that the different aspects of aphasia tested by AAT can be related to a common disorder of language processing in those areas.

  3. Body-specific representations of action verbs: neural evidence from right- and left-handers.

    Science.gov (United States)

    Willems, Roel M; Hagoort, Peter; Casasanto, Daniel

    2010-01-01

    According to theories of embodied cognition, understanding a verb like throw involves unconsciously simulating the action of throwing, using areas of the brain that support motor planning. If understanding action words involves mentally simulating one's own actions, then the neurocognitive representation of word meanings should differ for people with different kinds of bodies, who perform actions in systematically different ways. In a test of the body-specificity hypothesis, we used functional magnetic resonance imaging to compare premotor activity correlated with action verb understanding in right- and left-handers. Right-handers preferentially activated the left premotor cortex during lexical decisions on manual-action verbs (compared with nonmanual-action verbs), whereas left-handers preferentially activated right premotor areas. This finding helps refine theories of embodied semantics, suggesting that implicit mental simulation during language processing is body specific: Right- and left-handers, who perform actions differently, use correspondingly different areas of the brain for representing action verb meanings.

  4. Ressecção de mixoma ventricular esquerdo após acidente vascular cerebral embólico Resection of left ventricular myxoma after embolic stroke

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Ferraz de Arruda

    2008-12-01

    Full Text Available Mixoma cardíaco é o tumor primário mais comum do coração. Sua principal localização é no átrio esquerdo, mas pode surgir em qualquer câmara cardíaca. Os sintomas clínicos são variáveis, mas dispnéia e embolia são os mais freqüentes. Relatamos o caso de um jovem com acidente vascular cerebral isquêmico embólico causado por um grande mixoma no ventrículo esquerdo. O paciente foi submetido a cirurgia três semanas após o acidente vascular cerebral. O tumor foi ressecado com cuidado, sem fragmentar. O tratamento cirúrgico foi eficaz. Enfatizamos a raridade da presente localização, juntamente com uma revisão da literatura atual.Cardiac myxoma is the most common primary tumor of the heart. The tumor is located mainly in the left atrium but can arise from any heart chamber. Clinical symptoms are variable but dyspnea and embolism are the most frequent. We report a case of a young man that had embolic ischemic stroke caused by a large left ventricular myxoma. The patient underwent surgery three weeks after the stroke. The tumor was carefully resected without fragmentation. Surgical treatment was effective. We emphasize the rarity of this location together with a review of the current literature.

  5. Effect of Left Atrial Ablation Process and Strategy on Microemboli Formation During Irrigated Radiofrequency Catheter Ablation in an In Vivo Model.

    Science.gov (United States)

    Takami, Mitsuru; Lehmann, H Immo; Parker, Kay D; Welker, Kirk M; Johnson, Susan B; Packer, Douglas L

    2016-01-01

    Formation of microemboli during catheter ablation has been suggested as a cause for asymptomatic cerebral emboli. However, it is unknown which part of the process and ablation setting/strategy is most strongly related to this occurrence. A total of 27 pigs were used. Catheter/sheath manipulations in left atrium were performed in 25 of 27 pigs outfitted with microemboli monitoring systems. Ablations using open-irrigated radiofrequency catheters were performed in 18 of 25 pigs. Two of 27 pigs did not undergo left atrial procedures and were injected with microembolic materials in the carotid artery to serve as positive controls. In total, 334 sheath/catheter manipulations (transseptal puncture, sheath flushing, catheter insertion, pulmonary vein venography, and sheath exchange) and 333 radiofrequency applications (power setting, 30/50 W; point-by-point/drag ablations) were analyzed. High microbubble volume in the extracorporeal circulation loop and a high number of microembolic signals in carotid artery were observed during sheath/catheter manipulations especially in saline/contrast injections at fast speed and ablations with steam pop. Fast sheath flushing produced significantly higher microbubble volume than slow sheath flushing (median, 12 200 versus 121 nL; Pdrag ablations, and steam pop. Brain magnetic resonance imaging showed positive-embolic lesions in control pigs. Formation of microbubbles was the greatest during fast saline/contrast injections and steam pops, whereas high-power radiofrequency applications, drag ablations, and steam pops produced most of the microparticles. © 2016 American Heart Association, Inc.

  6. Doble dosis de estreptocinasa en tromboembolismo pulmonar masivo con trombo flotante libre en la aurícula derecha Double conventional doses of streptokinase in a massive pulmonary thromboembolism with a free-floating thrombus in the right atrium

    Directory of Open Access Journals (Sweden)

    Eduardo A. Sampó

    2004-06-01

    Full Text Available Presentamos el caso de una paciente con tromboembolismo pulmonar grave, disfunción ventricular derecha y shock sostenido, con altos requerimientos de drogas vasoactivas, con un trombo flotante en aurícula derecha, cuya situación hemodinámica y clínica, así como la imagen ecocardiográfica fueron resueltas mediante la infusión endovenosa de dos dosis completas de estreptocinasa, separadas por un intervalo de 72 horas.We present a case of severe thromboembolism, with right ventricular dysfunction, high vasoactive drug requirements, sustained shock and a free-floating thrombus in right atrium. Hemodynamic and clinical picture as well as the echocardiographic image were solved after intravenous infusions of two complete doses of streptokinase, separated by an interval of 72 hours.

  7. Beware the left-sided gallbladder

    African Journals Online (AJOL)

    %, and is defined as a gallbladder located to the left of the ligamentum teres and the falciform ligament.1 LSGB was first described by Hochstetter in 1886, and its identification is important because of the numerous and potentially hazardous.

  8. 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)

  9. Electrocardiographic features suggestive of a left. ventricular ...

    African Journals Online (AJOL)

    Abstract. Electrocardiographic features suggestive of a transmural anterior myocardial infarction with resultant left ventricular aneurysm formation were found in a 22-year-old man who had sustained a ballistic missile injury to his chest.

  10. Automatic left-atrial segmentation from cardiac 3D ultrasound: a dual-chamber model-based approach

    Science.gov (United States)

    Almeida, Nuno; Sarvari, Sebastian I.; Orderud, Fredrik; Gérard, Olivier; D'hooge, Jan; Samset, Eigil

    2016-04-01

    In this paper, we present an automatic solution for segmentation and quantification of the left atrium (LA) from 3D cardiac ultrasound. A model-based framework is applied, making use of (deformable) active surfaces to model the endocardial surfaces of cardiac chambers, allowing incorporation of a priori anatomical information in a simple fashion. A dual-chamber model (LA and left ventricle) is used to detect and track the atrio-ventricular (AV) plane, without any user input. Both chambers are represented by parametric surfaces and a Kalman filter is used to fit the model to the position of the endocardial walls detected in the image, providing accurate detection and tracking during the whole cardiac cycle. This framework was tested in 20 transthoracic cardiac ultrasound volumetric recordings of healthy volunteers, and evaluated using manual traces of a clinical expert as a reference. The 3D meshes obtained with the automatic method were close to the reference contours at all cardiac phases (mean distance of 0.03+/-0.6 mm). The AV plane was detected with an accuracy of -0.6+/-1.0 mm. The LA volumes assessed automatically were also in agreement with the reference (mean +/-1.96 SD): 0.4+/-5.3 ml, 2.1+/-12.6 ml, and 1.5+/-7.8 ml at end-diastolic, end-systolic and pre-atrial-contraction frames, respectively. This study shows that the proposed method can be used for automatic volumetric assessment of the LA, considerably reducing the analysis time and effort when compared to manual analysis.

  11. No Child Left Inside Week: Pilot Program

    OpenAIRE

    Clark, Jamie C.

    2013-01-01

    This program evaluation assessed the feasibility and effectiveness of a free No Child Left Inside (NCLI) week-long outdoor program to coincide with the Utah state-designated No Child Left Inside Week. The pilot program was implemented at the community level in Cache Valley, Utah, in 2012. Families attended eleven activities throughout the week that included hands-on experience and participation. A community BioBlitz was also planned as a conclusion to the week. Survey results demonstrate incr...

  12. Drilling simulated temporal bones with left-handed tools: a left-hander's right?

    Science.gov (United States)

    Torgerson, Cory S; Brydges, Ryan; Chen, Joseph M; Dubrowski, Adam

    2007-11-01

    Left-handed trainees can be at a disadvantage in the surgical environment because of a right-handed bias. The effectiveness of teaching left-handed trainees to use an otologic drill designed for their dominant hand versus the conventional right-handed drill was examined. Novice medical students were recruited from the university community. Twenty-four subjects were left-handed, and 12 were right-handed. Eight left-handed surgeons also participated. A randomized controlled trial was conducted to compare the performance of left-handed trainees using novel left-handed drills to that of left-handed trainees using right-handed tools and to that of right-handed trainees using right-handed tools. The evaluation consisted of 3 phases: pretest, skill acquisition, and 2 post-tests. The measurement tools included expert assessment of performance, and subjective and objective final product analyses. An initial construct validity phase was conducted in which validity of the assessment tools was ensured. Both the left-handers using left-handed tools and the right-handers using right-handed tools significantly outperformed the left-handers using right-handed tools at pretest, immediate posttest, and delayed posttest. All participants improved their performance as a function of practice. The left-handed trainees learned bone drilling better with tools designed for the left hand. These tools may be incorporated into residency training programs for the development of surgical technical skills. Future studies should assess skill transfer between the left-handed and right-handed drills.

  13. Low-frequency transcranial magnetic stimulation over left dorsal premotor cortex improves the dynamic control of visuospatially cued actions

    DEFF Research Database (Denmark)

    Ward, Nick S; Bestmann, Sven; Hartwigsen, Gesa

    2010-01-01

    Left rostral dorsal premotor cortex (rPMd) and supramarginal gyrus (SMG) have been implicated in the dynamic control of actions. In 12 right-handed healthy individuals, we applied 30 min of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) over left rPMd to investigate...... the involvement of left rPMd and SMG in the rapid adjustment of actions guided by visuospatial cues. After rTMS, subjects underwent functional magnetic resonance imaging while making spatially congruent button presses with the right or left index finger in response to a left- or right-sided target. Subjects were...... responses in invalidly cued trials. After real rTMS, task-related activity of the stimulated left rPMd showed increased task-related coupling with activity in ipsilateral SMG and the adjacent anterior intraparietal area (AIP). Individuals who showed a stronger increase in left-hemispheric premotor...

  14. Transmural distribution of myocardial infarction: difference between the right and left ventricles in a canine model

    International Nuclear Information System (INIS)

    Ohzono, K.; Koyanagi, S.; Urabe, Y.; Harasawa, Y.; Tomoike, H.; Nakamura, M.

    1986-01-01

    The evolution of myocardial infarction 24 hours after ligating both the right coronary artery and the obtuse marginal branch of the left circumflex coronary artery was examined in 33 anesthetized dogs. Postmortem coronary angiography and a tracer microsphere technique were used to determine risk areas and their collateral blood flows, respectively. The mean weight of the risk areas was 11.3 +/- 0.5 g (mean +/- SEM) in the right ventricle and 10.5 +/- 0.9 g in the left ventricle (NS). The weight of infarcted tissue was 5.7 +/- 0.7 g in the right ventricle and 5.2 +/- 0.9 g in the left ventricle (NS). In both ventricles, infarct weight was linearly related to risk area size, and the percent of risk area necrosis was inversely correlated with the extent of collateral flow at 24 hours of coronary ligation, defined as the mean myocardial blood flow inside the central risk area. Ratios of infarct to risk area between the subendocardial and subepicardial layers were 0.76 +/- 0.06 and 0.28 +/- 0.05 in the right and left ventricles, respectively (p less than 0.01, between ventricles, n = 31), which coincided well with subendocardial-to-subepicardial-flow ratios at 24 hours, ie, 0.86 +/- 0.04 in the right ventricle and 0.32 +/- 0.06 in the left ventricle (p less than 0.01). The regional distribution of myocardial infarction correlated well with flow distribution inside the risk area; the slope of these relations was similar between the subendocardium and subepicardium in the right ventricle, whereas in the left ventricle it was larger in the subendocardium than in the subepicardium. Thus, in the dog, the inherent change in the regional distribution of coronary collateral blood flow is an important modifier in the evolution of myocardial infarction, especially in the left ventricle

  15. Left Vocal Cord Paralysis Detected by PET/CT in a Case of Lung Cancer

    Directory of Open Access Journals (Sweden)

    Ali Ozan Oner

    2015-01-01

    Full Text Available We report a patient with lung cancer. The first PET/CT imaging revealed hypermetabolic mass in the left aortopulmonary region and hypermetabolic nodule in the anterior segment of the upper lobe of the left lung. After completing chemotherapy and radiotherapy against the primary mass in the left lung, the patient underwent a second PET/CT examination for evaluation of treatment response. This test demonstrated, compared with the first PET/CT, an increase in the size and metabolic activity of the primary mass in the left lung in addition to multiple, pathologic-sized, hypermetabolic metastatic lymph nodes as well as multiple metastatic sclerotic areas in bones. These findings were interpreted as progressive disease. In addition, an asymmetrical FDG uptake was noticed at the level of right vocal cord. During follow-up, a laryngoscopy was performed, which demonstrated left vocal cord paralysis with no apparent mass. Thus, we attributed the paralytic appearance of the left vocal cord to infiltration of the left recurrent laryngeal nerve by the primary mass located in the apical region of the left lung. In conclusion, the knowledge of this pitfall is important to avoid false-positive PET results.

  16. Multiple cavities in myocardium of left ventricle after irradiation therapy for breast cancer. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Miyake, Shinobu; Kato, Hiroshi; Koizumi, Katsumi [Nishi-Kobe Medical Center (Japan)] (and others)

    1999-09-01

    A 68-year-old woman was admitted to our hospital with congestive heart failure. She had been diagnosed with hypertrophic cardiomyopathy 12 years ago in another hospital. She had received irradiation therapy for left breast cancer 33 years ago after resection of her left breast. Echocardiography revealed left ventricular hypertrophy and wall motion hypokinesis, and multiple cavities in the myocardium of the left ventricle, interventricular septum, and anterior wall. Some cavities were observed to connect to the left ventricular cavity and Doppler echocardiography showed slow velocity flows in them different from that of the coronary artery. The pathologic diagnosis was severe sclerosis of the left coronary artery, especially the left descending artery and its branch, which was the area with irradiation. Histopathology revealed sclerotic changes of the coronary artery causing acute and chronic myocardial infarction, and incomplete regeneration and hypertrophy of cardiac cells. There was no sign of hypertrophic cardiomyopathy. Myocardial degeneration and deciduation were present next to the cavities connected to left ventricle-like fistulas. (author)

  17. Involvement of the Left Supramarginal Gyrus in Manipulation Judgment Tasks: Contributions to Theories of Tool Use.

    Science.gov (United States)

    Lesourd, Mathieu; Osiurak, François; Navarro, Jordan; Reynaud, Emanuelle

    2017-09-01

    Two theories of tool use, namely the gesture engram and the technical reasoning theories, make distinct predictions about the involvement of the left inferior parietal lobe (IPL) in manipulation judgement tasks. The objective here is to test these alternative predictions based on previous studies on manipulation judgment tasks using transcranial magnetic stimulations (TMS) targeting the left supramarginal gyrus (SMG). We review recent TMS studies on manipulation judgement tasks and confront these data with predictions made by both tool use theories. The left SMG is a highly intertwined region, organized following several functionally distinct areas and TMS may have disrupted a cortical network involved in the ability to use tools rather than only one functional area supporting manipulation knowledge. Moreover, manipulation judgement tasks may be impaired following virtual lesions outside the IPL. These data are more in line with the technical reasoning hypothesis, which assumes that the left IPL does not store manipulation knowledge per se. (JINS, 2017, 23, 685-691).

  18. Simultaneous occurrence of a large asymptomatic prolapsing left atrial myxoma with a cutaneous squamous cell carcinoma.

    Science.gov (United States)

    Iltumur, Kenan; Demir, Tolga; Ariturk, Zuhal; Toprak, Nizamettin; Oto, Oztekin

    2015-02-27

    Synchronous myxoma of the heart and other malignancies are extremely rare. We report a case of a 64-year-old man who had a large left atrial myxoma that obstructed the mitral valve, as well as an unrelated, coexistent cutaneous squamous cell carcinoma in the sacral area. During the preoperative evaluation for non-cardiac surgery, the tumor was diagnosed coincidentally by echocardiographic examination. Echocardiography findings were consistent with a large left atrial myxoma originating from the posterior wall and prolapsing into the left ventricular cavity through the mitral valve, causing mitral stenosis. The mass was successfully completely excised. Histologic examination of the mass confirmed the diagnosis of cardiac myxoma. We report a casual echocardiographic finding of a left atrial myxoma that obstructed the mitral valve outflow tract, and an unrelated, synchronous cutaneous squamous cell carcinoma in the sacral area.

  19. Left Right Patterning, Evolution and Cardiac Development

    Directory of Open Access Journals (Sweden)

    Iain M. Dykes

    2014-04-01

    Full Text Available 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.

  20. Left behind radiological investigations: An inherent problem

    Directory of Open Access Journals (Sweden)

    Giridhar A Govindswamy

    2011-01-01

    Full Text Available Objectives: To assess the number of investigations left behind by patients in radiology department, their cost, and the possible methods of reducing the problem. Materials and Methods: A total of 1424 radiographs, 160 computed tomography (CT scans, 300 ultrasonography (USG reports, and 46 Doppler reports were left behind by patients in one financial year. The total cost of these left behind investigations was calculated and the reports were categorized into normal and abnormal for each modality. Results: Of the radiographs left behind 658 were abnormal, with 211 among these being radiographs of postoperative patients. Thirty-seven percent of CT scans had positive findings. Sixty-eight percent of USG reports had positive findings while 46% of Doppler reports were abnormal. Conclusion: We believe that the cost and number of these left behind investigations over a period of time would definitely be significant for the health care system in a developing country. It is time to think of the possible reasons and methods for containing this problem.

  1. Left atrial laceration with epicardial ligation device.

    Science.gov (United States)

    Keating, Vincent P; Kolibash, Christopher P; Khandheria, Bijoy K; Bajwa, Tanvir; Sra, Jasbir; Kress, David C

    2014-01-01

    Many new devices and techniques are being developed to attempt a reduction in embolic stroke risk for patients with atrial fibrillation who are either unable or unwilling to maintain long-term anticoagulation. One of these new devices (LARIAT®, SentreHEART Inc., Redwood City, California, USA) employs delivery of an epicardial suture to ligate the left atrial appendage after percutaneous pericardial and transseptal access. This series presents three clinical cases that demonstrate a serious and recurrent complication of left atrial laceration and cardiac tamponade shortly following delivery of an epicardial suture ligation to the left atrial appendage. Three clinical cases are described in detail with pre- and postprocedure angiography and echocardiography as well as illustrations reflecting the surgeon's findings on direct visualization of the left atrial lacerations postligation. Potential hypotheses of each injury are examined in light of the case timelines and findings at sternotomy. There was no suggestion that tamponade was related to pericardial or transseptal access, but rather a complication with device delivery. These three patients quickly progressed to clinical cardiac tamponade despite attempted drainage, stressing the importance of cardiovascular surgery backup, including a cardiopulmonary bypass pump, when delivering novel, percutaneous ligation devices for the left atrial appendage.

  2. Descriptive anatomy of Heschl?s gyri in 430 healthy volunteers, including 198 left-handers

    OpenAIRE

    Marie, D.; Jobard, G.; Crivello, F.; Perchey, G.; Petit, L.; Mellet, E.; Joliot, M.; Zago, L.; Mazoyer, B.; Tzourio-Mazoyer, N.

    2013-01-01

    This study describes the gyrification patterns and surface areas of Heschl?s gyrus (HG) in 430 healthy volunteers mapped with magnetic resonance imaging. Among the 232 right-handers, we found a large occurrence of duplication (64?%), especially on the right (49 vs. 37?% on the left). Partial duplication was twice more frequent on the left than complete duplication. On the opposite, in the right hemisphere, complete duplication was 10?% more frequent than partial duplication. The most frequent...

  3. 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.

  4. 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.)

  5. “Getting the Left Right”

    DEFF Research Database (Denmark)

    Klinke, Marianne E.; Zahavi, Dan; Hjaltason, Haukur

    2015-01-01

    experience was captured in the overarching theme, “getting the left right,” which encompasses the two subthemes of (a) surreal awareness of the left and (b) emergence of a different world. Patients had unclear perceptions of their own body and surroundings, their attention was brittle, and they encountered...... bewildering reactions from other people. They simultaneously pursued the ineffable neglected space and searched for coherence. The vulnerability, loss, and conflicting perceptions that patients with neglect face should be acknowledged and alleviation sought. Facilitating methods should provide additional...

  6. 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...

  7. Left paraduodenal hernias; Hernias paraduodenales izquierdas

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Negrete, L.; Garcia-Lozano, J.; Sanchez, J. L.; Tejeiro, A.; Sala, J. [Hospital Valle del Nalon. Riano-Sama. Asturias (Spain)

    2002-07-01

    We report two cases of left paraduodenal internal hernias located in the fossa of Landzert that were diagnosed by CT. Internal hernias are an infrequent cause of acute abdomen, due to the intestinal sub occlusion they produce. Left paraduodenal hernias are responsible for about 50% of internal hernias. CT makes it possible to demonstrate the group of herniated loops between the stomach, fourth segment of the duodenum, descending colon, and tail of the pancreas. The identification of the loops in an atypical position together with displaced blood vessels (mesenteric vessels) and colon gives concerns on them a typical radiological semiology that makes them easily identifiable. (Author) 9 refs.

  8. 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.

  9. Transient Beneficial Effects of Excitatory Theta Burst Stimulation in a Patient with Phonological Agraphia after Left Supramarginal Gyrus Infarction

    Science.gov (United States)

    Nardone, Raffaele; De Blasi, Pierpaolo; Zuccoli, Giulio; Tezzon, Frediano; Golaszewski, Stefan; Trinka, Eugen

    2012-01-01

    We report a patient showing isolated phonological agraphia after an ischemic stroke involving the left supramarginal gyrus (SMG). In this patient, we investigated the effects of focal repetitive transcranial magnetic stimulation (rTMS) given as theta burst stimulation (TBS) over the left SMG, corresponding to the Brodmann area (BA) 40. The patient…

  10. Impact of aortic prosthesis-patient mismatch on left ventricular mass regression.

    Science.gov (United States)

    Alassal, Mohamed A; Ibrahim, Bedir M; Elsadeck, Nabil

    2014-06-01

    Prostheses used for aortic valve replacement may be small in relation to body size, causing prosthesis-patient mismatch and delaying left ventricular mass regression. This study examined the effect of prosthesis-patient mismatch on regression of left ventricular mass after aortic valve replacement. We prospectively studied 96 patients undergoing aortic valve replacement between 2007 and 2012. Mean and peak gradients and indexed effective orifice area were measured by transthoracic echocardiography at 3 and 6 months postoperatively. Patient-prosthesis mismatch was defined as indexed effective orifice area ≤0.85 cm(2)·m(-2). Moderate prosthesis-patient mismatch was present in 25% of patients. There were no significant differences in demographic and operative data between patients with and without prosthesis-patient mismatch. Left ventricular dimensions, posterior wall thickness, transvalvular gradients, and left ventricular mass decreased significantly after aortic valve replacement in both groups. The interventricular septal diameter and left ventricular mass index regression, and left ventricular ejection fraction were better in patients without prosthesis-patient mismatch. There was a significant positive correlation between the postoperative indexed effective orifice area of each valve prosthesis and the rate of left ventricular mass regression. Prosthesis-patient mismatch leads to higher transprosthetic gradients and impaired left ventricular mass regression. A small-sized valve prosthesis does not necessarily result in prosthesis-patient mismatch, and may be perfectly adequate in patient with small body size. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  11. 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

  12. Left ventricular mass: Myxoma or thrombus?

    Directory of Open Access Journals (Sweden)

    Monish S Raut

    2015-01-01

    Full Text Available Patient with embolic episode should always be evaluated for cardiac mass. Mass in left ventricular can be a myxoma or thrombus even in a normal functioning heart . In either case, mobile mass with embolic potential should be surgically resected.

  13. Left atrial myxoma with biventricular dysfunction

    Directory of Open Access Journals (Sweden)

    Monish S. Raut

    2016-09-01

    Full Text Available Occurrence of left atrial myxoma with severe ventricular dysfunction without any obstructive coronary artery disease, as presented in our case, is very rare. It may be due to undiagnosed concomitant dilated cardiomyopathy or unknown cardiodepressant effect of myxoma which warrants further research.

  14. Left atrial myxoma with biventricular dysfunction.

    Science.gov (United States)

    Raut, Monish S; Shad, Sujay; Maheshwari, Arun

    2016-09-01

    Occurrence of left atrial myxoma with severe ventricular dysfunction without any obstructive coronary artery disease, as presented in our case, is very rare. It may be due to undiagnosed concomitant dilated cardiomyopathy or unknown cardiodepressant effect of myxoma which warrants further research. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  15. Vergisson 4: a left-handed Neandertal.

    Science.gov (United States)

    Condemi, Silvana; Monge, Janet; Quertelet, Sylvain; Frayer, David W; Combier, Jean

    2017-01-01

    Handedness is an important marker for lateralization of humans in the modern and fossil record. For the most part, Neandertals and their ancestors are strongly right-handed. We describe a single tooth from a Neandertal level at Vergisson 4 (Vg 4-83). This left upper central incisor shows all the features typical of Neandertal incisors. It also exhibits a predominance of left-handed striations. Striations on the incisor's labial surface were mapped at 20x magnification using Photoshop. Angulations of the striations were determined from their deviation from the maximum mesio-distal line and were analyzed using NIH's freeware, Image J. Of the 60 labial surface striations, Vg 4-83 shows a strong predominance of left-handed striations (46; 76.7%), which are statistically significantly different (p handed striations. The identification of another left-handed Neandertal adds to our understanding about handedness variation in this fossil hominin. Given the high frequency of right-handed Neandertals, the 90: 10 modern ratio is still preserved in this group. © 2016 Wiley Periodicals, Inc.

  16. Electrocardiographic features suggestive of a left. ventricular ...

    African Journals Online (AJOL)

    1983-01-01

    Jan 1, 1983 ... sniper with an Armourlite assault rifle in Ireland. He had received a single bullet injury to the left ... His history negated any cardiovascular impairment, angina or limitation in effort tolerance. He plays ... In view of the patient's age, history and the cardiovascular findings, we would like to postulate that the ...

  17. Radiative left-right Dirac neutrino mass

    Science.gov (United States)

    Ma, Ernest; Sarkar, Utpal

    2018-01-01

    We consider the conventional left-right gauge extension of the standard model of quarks and leptons without a scalar bidoublet. We study systematically how one-loop radiative Dirac neutrino masses may be obtained. In addition to two well-known cases from almost 30 years ago, we find two new scenarios with verifiable predictions.

  18. Giant melanoma of the left thumb

    NARCIS (Netherlands)

    Zeebregts, CJAM; Schraffordt Koops, H.

    A 74-year-old female patient is described with a giant melanoma of the left thenar and concomitant bilateral pulmonary metastases. Palliative treatment consisted of a two-staged procedure in order to save the limb from amputation. Firstly, perfusion with gamma-interferon, tumour necrosis

  19. Submitral Left Ventricular Aneurysm Associated with Thrombus

    African Journals Online (AJOL)

    2018-01-01

    Jan 1, 2018 ... She was given drugs for management of heart failure and ... treatment abroad. KEYWORDS: Ethiopia, heart failure, submitral aneurysm, thrombus. INTRODUCTION. Submitral left ventricle aneurysm is a rare cardiovascular disorder worldwide, but ... grade 2 pulmonary edema, and bilateral pleural effusion.

  20. Left-Right Symmetry at LHC

    CERN Document Server

    Maiezza, Alessio; Nesti, Fabrizio; Senjanovic, Goran

    2010-01-01

    We revisit the issue of the limit on the scale of Left-Right symmetry breaking. We focus on the minimal SU(2)_L x SU(2)_R x U(1)_B-L gauge theory with the seesaw mechanism and discuss the two possibilities of defining Left-Right symmetry as parity or charge conjugation. In the commonly adopted case of parity, we perform a complete numerical study of the quark mass matrices and the associated left and right mixing matrices without any assumptions usually made in the literature about the ratio of vacuum expectation values. We find that the usual lower limit on the mass of the right-handed gauge boson from the K mass difference, M_WR>2.5TeV, is subject to a possible small reduction due to the difference between right and left Cabibbo angles. In the case of charge conjugation the limit on M_WR is somewhat more robust. However, the more severe bounds from CP-violating observables are absent in this case. In fact, the free phases can also resolve the present mild discrepancy between the Standard Model and CP-violat...

  1. Left Dislocation: a typological overview | Westbury | Stellenbosch ...

    African Journals Online (AJOL)

    The Left Dislocation construction is a typologically universal phenomenon that has received detailed analysis, from both formal and functional perspectives, in a number of genetically and areally diverse languages. The present paper aims to provide a general overview of this cross-linguistic research with a concentration ...

  2. 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

  3. Left Ventricular Thrombus among patients undergoing Transthoracic ...

    African Journals Online (AJOL)

    Objective: Left Ventricular Thrombus (LVT) is a well recognized complication of various cardiac conditions, particularly following an acute anterior myocardial infarction and in those with systolic congestive heart failure. Transthoracic echocardiography (TTE) remains the most common imaging modality to make the diagnosis ...

  4. Modern Democratic Left and Economic Crisis

    Directory of Open Access Journals (Sweden)

    Dubravko Radošević

    2011-01-01

    Full Text Available Political left, notably social democracy, implies acceptance of market economy and parliamentary democracy, as a political framework within which the interests of large sections of the population could be preserved. Does the modern political left have a chance to revive, after the global economic crisis? We believe it does. The core idea of social democracy is the idea of equality. It is the growing inequality that could help the return of social democracy. In Croatia, during transition, there was predominantly the process of neoliberalization, and the democratic left accepted a neoliberal economic agenda. Currently Croatia has a structural economic problem and deep recession. Due to the global crisis, the democratic left in Croatia should abandon economic neoliberalism. Macroeconomic policy decision-makers in Croatia should reject orthodox policies, and it is necessary to implement heterodox economic policies. There is an urgent need to achieve a new (postKeynesian consensus, a new combination of post-Keynesian economics and social democracy

  5. 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

  6. Reorganization of syntactic processing following left-hemisphere brain damage: does right-hemisphere activity preserve function?

    Science.gov (United States)

    Tyler, Lorraine K; Wright, Paul; Randall, Billi; Marslen-Wilson, William D; Stamatakis, Emmanuel A

    2010-11-01

    The extent to which the human brain shows evidence of functional plasticity across the lifespan has been addressed in the context of pathological brain changes and, more recently, of the changes that take place during healthy ageing. Here we examine the potential for plasticity by asking whether a strongly left-lateralized system can successfully reorganize to the right-hemisphere following left-hemisphere brain damage. To do this, we focus on syntax, a key linguistic function considered to be strongly left-lateralized, combining measures of tissue integrity, neural activation and behavioural performance. In a functional neuroimaging study participants heard spoken sentences that differentially loaded on syntactic and semantic information. While healthy controls activated a left-hemisphere network of correlated activity including Brodmann areas 45/47 and posterior middle temporal gyrus during syntactic processing, patients activated Brodmann areas 45/47 bilaterally and right middle temporal gyrus. However, voxel-based morphometry analyses showed that only tissue integrity in left Brodmann areas 45/47 was correlated with activity and performance; poor tissue integrity in left Brodmann area 45 was associated with reduced functional activity and increased syntactic deficits. Activity in the right-hemisphere was not correlated with damage in the left-hemisphere or with performance. Reduced neural integrity in the left-hemisphere through brain damage or healthy ageing results in increased right-hemisphere activation in homologous regions to those left-hemisphere regions typically involved in the young. However, these regions do not support the same linguistic functions as those in the left-hemisphere and only indirectly contribute to preserved syntactic capacity. This establishes the unique role of the left hemisphere in syntax, a core component in human language.

  7. 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.

  8. 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

  9. Assessment of stiffness of the hypertrophied left ventricle of bicyclists using left ventricular inflow Doppler velocimetry.

    Science.gov (United States)

    Fagard, R; Van den Broeke, C; Bielen, E; Vanhees, L; Amery, A

    1987-06-01

    Sixteen male bicyclists and 16 control subjects were studied to assess whether the left ventricular hypertrophy of athletes is associated with changes in diastolic left ventricular function. The cyclists had a larger left ventricular internal diameter on echocardiography (55.2 versus 47.9 mm; p less than 0.001) and a disproportionate increase in wall thickness relative to the internal diameter (0.48 versus 0.41; p less than 0.01), indicating a mixed eccentric-concentric type of hypertrophy. Left ventricular inflow Doppler velocimetry showed similar results in athletes and control subjects for peak flow velocities in the atrial contraction phase (30 versus 32 cm/s; p = NS) and in the early diastolic rapid filling phase (71 versus 67 cm/s; p = NS). The similar ratio of both velocities, that is, 0.43 in the cyclists and 0.49 in the control subjects, suggests that left ventricular distensibility is unaltered in cyclists. It is concluded that the left ventricular hypertrophy observed in cyclists is not associated with changes in ventricular stiffness, as estimated from left ventricular inflow Doppler velocimetry.

  10. PICTORIAL ESSAY Is anomalous origin of the left vertebral artery ...

    African Journals Online (AJOL)

    The incidence of anomalous origin of the left vertebral artery from the aortic arch ranges between 1% and 5.8%.1,2 This anomaly has important implications for thoracic surgery and interventional procedures. The left vertebral artery may originate from: • the left common carotid artery. • the root of the left subclavian artery ...

  11. Deficit in complex sequence processing after a virtual lesion of left BA45.

    Directory of Open Access Journals (Sweden)

    Emeline Clerget

    Full Text Available Although the contribution of Broca's area to motor cognition is generally accepted, its exact role remains controversial. A previous functional imaging study has suggested that Broca's area implements hierarchically organised motor behaviours and, in particular, that its anterior (Brodmann area 45, BA45 and posterior (BA44 parts process, respectively, higher and lower-level hierarchical elements. This function of Broca's area could generalize to other cognitive functions, including language. However, because of the correlative nature of functional imaging data, the causal relationship between Broca's region activation and its behavioural significance cannot be ascertained. To circumvent this limitation, we used on-line repetitive transcranial magnetic stimulation to disrupt neuronal processing in left BA45, left BA44 or left dorsal premotor cortex, three areas that have been shown to exhibit a phasic activation when participants performed hierarchically organised motor behaviours. The experiment was conducted in healthy volunteers performing the same two key-press sequences as those used in a previous imaging study, and which differed in terms of hierarchical organisation. The performance of the lower-order hierarchical task (Experiment #1 was unaffected by magnetic stimulation. In contrast, in the higher-order hierarchical task (Experiment #2, "superordinate" task, we found that a virtual lesion of the anterior part of Broca's area (left BA45 delayed the processing of the cue initiating the sequence in an effector-independent way. Interestingly, in this task, the initiation cue only informed the subjects about the rules to be applied to produce the appropriate response but did not allow them to anticipate the entire motor sequence. A second important finding was a RT decrease following left PMd virtual lesions in the superordinate task, a result compatible with the view that PMd plays a critical role in impulse control. The present study

  12. 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.

  13. Radiofrequency Atrial Fibrillation Ablation Technique in Patients with Mitral Valve Surgery and Left Atrial Reduction Procedures

    Directory of Open Access Journals (Sweden)

    Pouya Nezafati1

    2015-10-01

    Full Text Available Background: About half of all patients who undergo mitral valve surgery suffer from atrial fibrillation (AF. Cox described the surgical cut-and-sew Maze procedure, which is an effective surgical method but has some complications. This study was designed to evaluate the efficacy of a substitution method of radiofrequency ablation (RFA for patients undergoing mitral valve surgery with AF.Methods: We evaluated 50 patients, comprising 40 men and 10 women at a mean age of 61.8 ± 7.5 years, who underwent mitral valve surgery with RFA between March 2010 and August 2013. All the patients had permanent AF with an enlarged left atrium (LA. The first indication for surgery was underlying organic lesions. Mitral valve replacement or repair was performed in the patients as a single procedure or in combination with aortic valve replacement or coronary artery bypass grafting. Radiofrequency energy was used to create continuous endocardial lesions mimicking most incisions and sutures. We evaluated the pre- and postoperative LA size, duration of aortic cross-clamping, cardiopulmonary bypass time, intensive care unit stay, and total hospital stay.Results: The mean preoperative and postoperative LA sizes were 7.5 ± 1.4 cm and 4.3 ± 0.7 cm (p value = 0.0001, respectively. The mean cardiopulmonary bypass time and the aortic cross-clamping time were 134.3 ± 33.7 minand 109.0 ± 28.4 min, respectively. The average stay at the intensive care unit was 2.1 ± 1.2 days, and the total hospital stay was 8.3 ± 2.4 days. Rebleeding was the only complication, found in one patient. There was no early or late mortality. Eighty-two percent of the patients were discharged in normal sinus rhythm. Five other patients had normal sinus rhythm at 6months' follow-up, and the remaining 4 patients did not have a normal sinus rhythm after 6 months.Conclusion: Radiofrequency ablation, combined with LA reduction, is an effective option for the treatment of permanent AF concomitant with

  14. 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

  15. Acute impact of pacing at different cardiac sites on left ventricular rotation and twist in dogs.

    Directory of Open Access Journals (Sweden)

    Zhi-Wen Zhou

    Full Text Available We evaluated the acute impact of different cardiac pacing sites on two-dimensional speckle-tracking echocardiography (STE derived left ventricular (LV rotation and twist in healthy dogs.Twelve dogs were used in this study. The steerable pacing electrodes were positioned into right heart through the superior or inferior vena cava, into LV through aorta across the aortic valve. The steerable pacing electrodes were positioned individually in the right atrium (RA, right ventricular apex (RVA, RV outflow tract (RVOT, His bundle (HB, LV apex (LVA and LV high septum (LVS, individual pacing mode was applied at 10 minutes interval for at least 5 minutes from each position under fluoroscopy and ultrasound guidance and at stabilized hemodynamic conditions. LV short-axis images at the apical and basal levels were obtained during sinus rhythm and pacing. Offline STE analysis was performed. Rotation, twist, time to peak rotation (TPR, time to peak twist (TPT, and apical-basal rotation delay (rotational synchronization index, RSI values were compared at various conditions. LV pressure was monitored simultaneously.Anesthetic death occurred in 1 dog, and another dog was excluded because of bad imaging quality. Data from 10 dogs were analyzed. RVA, RVOT, HB, LVA, LVS, RARV (RA+RVA pacing resulted in significantly reduced apical and basal rotation and twist, significantly prolonged apical TPR, TPT and RSI compared to pre-pacing and RA pacing (all P<0.05. The apical and basal rotation and twist values were significantly higher during HB pacing than during pacing at ventricular sites (all P<0.05, except basal rotation at RVA pacing. The apical TPR during HB pacing was significantly shorter than during RVOT and RVA pacing (both P<0.05. The LV end systolic pressure (LVESP was significantly lower during ventricular pacing than during pre-pacing and RA pacing.Our results show that RA and HB pacing results in less acute reduction on LV twist, rotation and LVESP compared

  16. Protected areas in mountains

    Directory of Open Access Journals (Sweden)

    Hamilton, L. S.

    2006-12-01

    Full Text Available

    left">The importance of a global Protected Areas Network in sustaining appropriate mountain development is presented in this paper. Present status of the world’s “official” Protected Areas in the UN List, and the proportion that are in mountain areas, and including international designations (World Heritage and Biosphere Reserves. Current and future challenges in the management of these special areas are also commented.



    left">El autor destaca la importancia de una Red Mundial de Espacios Protegidos para el desarrollo sostenible de las montañas. Comenta luego el estatus actual de las Áreas Protegidas “oficiales” del Mundo en la Lista de las Naciones Unidas y qué proporción de ellas forma parte de las montañas, sin olvidar las figuras internacionales de protección como Patrimonio de la Humanidad y Reservas de Biosfera. Para terminar, se discuten los problemas de gestión actuales y futuros de estas áreas tan especiales

  17. Raised preoperative international normalised ratio (INR) identifies patients at high risk of perioperative death after simultaneous renal and cardiac surgery for tumours involving the peri-diaphragmatic inferior vena cava and right atrium.

    Science.gov (United States)

    O'Brien, Tim; Fernando, Archie; Thomas, Kay; Van Hemelrijck, Mieke; Bailey, Craig; Austin, Conal

    2017-03-01

    To identify preoperative factors that predict 30-day mortality in patients undergoing simultaneous cardiac and renal surgery for urological tumours involving the peri-diaphragmatic vena cava and right atrium- The ability to predict mortality and therefore avoid surgery in those patients likely to die would be valuable. We retrospectively reviewed perioperative outcomes in patients managed between December 2007 and January 2016 by a single team. The relationships of outcome measurements were analysed using Fisher's exact and Mann-Whitney U-tests. Of the 46 patients identified, 41 (89%) underwent surgery (20 males and 21 females). The median (range) age was 65 (17-95) years. Histology confirmed 37 renal cell cancers, one adrenal cancer, two primitive neuroectodermal tumours, and one leiomyosarcoma. The overall 30-day mortality rate was 7% (three of 41 patients). The international normalised ratio (INR), age, and estimated glomerular filtration rate (eGFR) correlated significantly with 30-day mortality. The mortality rate was high in patients with an INR ≥1.5 and 70 years) and of significant post-operative complications in younger patients (International © 2016 BJU International Published by John Wiley & Sons Ltd.

  18. 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.

  19. 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.

  20. Left ventricular non-compaction cardiomyopathy and left ventricular assist device: a word of caution.

    Science.gov (United States)

    Kornberger, A; Stock, U A; Risteski, P; Beiras Fernandez, A

    2016-07-15

    In patients with left ventricular non-compaction (LVNC), implantation of a left ventricular assist device (LVAD) may be performed as a bridge to transplantation. In this respect, the particular characteristics of the left ventricular myocardium may represent a challenge. We report a patient with LVNC who required urgent heart transplantation for inflow cannula obstruction nine months after receiving a LVAD. LVAD parameters, echocardiography and examination of the explanted heart suggested changes of left ventricular configuration brought about by LVAD support as the most likely cause of inflow cannula obstruction. We conclude that changes experienced by non-compacted myocardium during LVAD support may give rise to inflow cannula obstruction and flow reduction. Presence of LVNC mandates tight surveillance for changes in LV configuration and LVAD flow characteristics and may justify urgent transplantation listing status.

  1. [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.

  2. Left-right symmetric electroweak models

    International Nuclear Information System (INIS)

    Olness, F.I.

    1989-10-01

    We present a critical analysis of the spontaneous symmetry breaking and the Higgs sector of the conventional SU(2) L circle-times SU(2) R circle-times U(1) B-L left-right symmetric theory involving bi-doublet and triplet Higgs fields. We examine the phenomenological constraints imposed on the minimization of the Higgs potential arising from experimental observations, and explore the resulting consequences including the problem of ''fine- tuning'' arising from the hierarchy of mass scales involved. We show that it is non-trivial to satisfy all of these constraints. We contrast the benefits of this general class left-right models against the required ''fine-tuning'' necessary to force the phenomenology to conform to experimental fact. 17 refs., 1 fig

  3. 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.

  4. Intra-procedure Visualization of the Esophagus using Interventional C-arm CT as Guidance for Left Atrial Radiofrequency Ablation

    Science.gov (United States)

    Tognolini, Alessia; Al-Ahmad, Amin; Wang, Paul J.; Hsia, Henry H.; Herfkens, Robert J.; Girard, Erin; Moore, Teri; Fahrig, Rebecca

    2011-01-01

    Rational and Objectives During radiofrequency catheter ablation (RFCA) for atrial fibrillation, the esophagus is at risk for thermal injury. In this study we compared using C-arm CT to clinical CT, without administration of oral contrast, to visualize the esophagus and its relationship to the left atrium (LA) and the ostia of the pulmonary veins (PV) during the RF ablation procedure. Materials and Methods Sixteen subjects underwent both cardiac clinical CT and C-arm CT. CT scans were obtained on a multi-detector CT using a standard ECG-gated protocol. C-arm CT scans were obtained using either a multi-sweep protocol with retrospective ECG-gating or a non-gated single-sweep protocol. C-arm CT and CT scans were analyzed in a random order and then compared for the following criteria: a) visualization of the esophagus (yes/no), b) relationship of esophagus position to the 4 PVs, and c) direct contact or absence of a fat pad between the esophagus and PV antrum. Results a) The esophagus was identified in all C-arm CT and CT scans. In 4 cases, orthogonal planes were needed on C-arm CT (inferior PV level); b) In 6 patients, the esophagus location on C-arm CT was different from CT; c) Direct contact was reported in 19/64 (30%) of the segments examined on CT vs. 26/64 (41%) on C-arm CT. In 5/64 segments (8%), C-arm CT overestimated a direct contact of the esophagus to the LA. Conclusion C-arm CT image quality without administration of oral contrast agents was shown to be sufficient for visualization of the esophagus location during an RFCA procedure for atrial fibrillation. PMID:21440465

  5. 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.

  6. 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....

  7. Coronary Anomalies: Left Main Coronary Artery Aneurysm

    OpenAIRE

    Varda, Rajsekhar; Chitimilla, Santosh Kumar; Lalani, Aslam

    2012-01-01

    Coronary artery aneurysm is one of the rarest anomalies that we see in our medical practice and they are mostly associated with obstructive lesions due to atherosclerotic changes. Management of these aneurysm patients (conservative or surgical repair) usually depends on obstructive lesions and associated symptoms. We are presenting a case of left main aneurysm measuring around 1 4 × 2 8  mm with other obstructive leisons. It was treated with surgical repair in view of obstructive lesions and ...

  8. Coronary Anomalies: Left Main Coronary Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Rajsekhar Varda

    2012-01-01

    Full Text Available Coronary artery aneurysm is one of the rarest anomalies that we see in our medical practice and they are mostly associated with obstructive lesions due to atherosclerotic changes. Management of these aneurysm patients (conservative or surgical repair usually depends on obstructive lesions and associated symptoms. We are presenting a case of left main aneurysm measuring around 14×28 mm with other obstructive leisons. It was treated with surgical repair in view of obstructive lesions and symptoms.

  9. Implantation of left ventricular assist device in a patient with left ventricular non-compaction.

    Science.gov (United States)

    Balsara, Keki R; Bierhals, Andrew; Vader, Justin; Pasque, Michael K; Itoh, Aki

    2017-02-01

    Left ventricular noncompaction (LVNC) may result in systolic left ventricular (LV) failure resulting in the need for heart transplantation. LV assist devices (LVAD) have been used to bridge these patients to transplantation; however, the extensive trabeculations found in these patients predispose them to thromboembolic events and pump thrombosis. We describe a patient with LVNC in whom an aggressive surgical approach was used to debride the LV cavity of trabeculations to successfully implant an LVAD. © 2017 Wiley Periodicals, Inc.

  10. Pulmonary Hypertension secondary to Left Heart Disease.

    Science.gov (United States)

    Kabbach, Ghazal; Mukherjee, Debabrata

    2017-09-12

    Pulmonary hypertension (PH) related to left heart disease (LHD) is the most common form of PH, accounting for more than two third of all PH cases. The hemodynamic abnormalities seen in PH-LHD are complex, and there are currently minimal evidence-based recommendations for the management of PH-LHD. While it is accepted that PH in the context of left heart disease is a marker of worse prognosis, it remains unclear whether its primary treatment is beneficial or harmful. In this article, we discuss the prevalence and significance of PH in patients with heart failure (HF) with reduced ejection fraction (HFrEF) as well as HF with preserved ejection fraction (HFpEF), and those with valvular heart disease and provide insights into the complex pathophysiology of cardiopulmonary interrelationship in individuals with PH due to left heart disease. Furthermore, we provide a framework for diagnostic testing and an approach to optimal management of these complex patients based on current European Society of Cardiology (ESC) guidelines. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  11. Anomalous Origin of Left Circumflex Artery

    Science.gov (United States)

    Çitaku, Hajdin; Kamberi, Lulzim; Gorani, Daut; Koçinaj, Dardan; Krasniqi, Xhevdet

    2015-01-01

    Introduction: The coronary anatomic variation of the left circumflex artery (LCx) is considered as the most common anatomic variation with a separate ostium from the right sinus, and very unusual variation as a proximal branch of right coronary artery (RCA). Case report: We report two cases, the first case is a 64-year-old man with chest pain and with history of hypertension, obesity, dyslipidemia and current smoker, and the second case is a 67-year-old who presented to the emergency department with chest pain and with a past medical history of arterial hypertension and type 2 diabetes mellitus. In the coronarography of the first case is detected an ectopic left circumflex coronary artery from the right coronary sinus with stenotic changes in RCA and LCx. The second case in the coronary angiography revealed an ectopic left circumflex coronary artery from the proximal part of the right coronary artery with stenotic changes in LAD, RCA and LCx. Based on guidelines for revascularization our patients successfully underwent treatment procedures. We present two cases that because of the atherosclerotic coronary artery disease leads to the need of coronarography find out the presence of coronary artery anomalies. Conclusion: During the coronarography we should think about coronary artery anomaly or missing artery knowing that type of these anomalies, considering that may be a contributing factor in the development of the atherosclerosis determines the method of the treatment. PMID:26843740

  12. 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.

  13. 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.

  14. Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke

    Science.gov (United States)

    Xing, Shihui; Lacey, Elizabeth H.; Skipper-Kallal, Laura M.; Jiang, Xiong; Harris-Love, Michelle L.; Zeng, Jinsheng

    2016-01-01

    The neural mechanisms underlying recovery of language after left hemisphere stroke remain elusive. Although older evidence suggested that right hemisphere language homologues compensate for damage in left hemisphere language areas, the current prevailing theory suggests that right hemisphere engagement is ineffective or even maladaptive. Using a novel combination of support vector regression-based lesion-symptom mapping and voxel-based morphometry, we aimed to determine whether local grey matter volume in the right hemisphere independently contributes to aphasia outcomes after chronic left hemisphere stroke. Thirty-two left hemisphere stroke survivors with aphasia underwent language assessment with the Western Aphasia Battery-Revised and tests of other cognitive domains. High-resolution T1-weighted images were obtained in aphasia patients and 30 demographically matched healthy controls. Support vector regression-based multivariate lesion-symptom mapping was used to identify critical language areas in the left hemisphere and then to quantify each stroke survivor’s lesion burden in these areas. After controlling for these direct effects of the stroke on language, voxel-based morphometry was then used to determine whether local grey matter volumes in the right hemisphere explained additional variance in language outcomes. In brain areas in which grey matter volumes related to language outcomes, we then compared grey matter volumes in patients and healthy controls to assess post-stroke plasticity. Lesion–symptom mapping showed that specific left hemisphere regions related to different language abilities. After controlling for lesion burden in these areas, lesion size, and demographic factors, grey matter volumes in parts of the right temporoparietal cortex positively related to spontaneous speech, naming, and repetition scores. Examining whether domain general cognitive functions might explain these relationships, partial correlations demonstrated that grey matter

  15. Ipsilesional deficit of selective attention in left homonymous hemianopia and left unilateral spatial neglect.

    Science.gov (United States)

    Chokron, Sylvie; Peyrin, Carole; Perez, Céline

    2018-03-15

    Patients with homonymous hemianopia may present a subtle ipsilesional deficit, recently referred to as 'sightblindness' in addition to the contralesional visual field defect. We recently demonstrated that this deficit could be worse in right brain-damaged patients with left hemianopia than in left brain-damaged patients with right hemianopia, confirming right hemisphere dominance for visuo-spatial and attentional capacities. In the present study we investigate whether this ipsilesional deficit could be attentional in nature and to what extent it is comparable in right brain-damaged (RBD) patients with left hemianopia and in RBD patients with left neglect. The study was also conducted in RBD patients with neither left hemianopia nor left neglect signs in order to test if a right hemisphere lesion per se could be responsible for subtle ipsilesional attentional deficit. To reach this aim, we tested selective attentional capacities in both visual fields of 10 right brain-damaged patients with left neglect (LN), 8 right brain-damaged patients with left homonymous hemianopia (LHH), 8 right brain-damaged patients with no signs of left neglect or left hemianopia (RBD controls), and 17 healthy age-matched participants (Normal controls). A lateralized letter-detection task was used to test if right-brain damaged patients with LN or LH may present a deficit of selective attention in their right, ipsilesional visual field, in comparison to Normal and RBD controls. Participants were asked to detect a target letter in either a single large stimulus (low attentional load) or a small stimulus surrounded by flankers (high attentional load). Stimuli were displayed either in the left or in the right visual field. Accuracy and reaction times were recorded. Results on accuracy showed that both LN and LH patients exhibited lower correct responses than Normal controls in their ipsilesional right visual field, suggesting an attentional deficit in their ipsilesional, supposed healthy

  16. Left Ventricular Non-compaction Cardiomyopathy - A Case Report

    Directory of Open Access Journals (Sweden)

    Timea Szakacs Xantus

    2015-06-01

    Full Text Available Background: Left non-compaction cardiomyopathy (LVNC or “spongy myocardium” is a relatively rare primary genetic cardiomyopathy, characterized by prominent wall trabeculations and intertrabecular recesses which communicate with the ventricular cavity. It appears in isolated form or coexists with other congenital heart diseases and/or systemic abnormalities. Material and method: A 28-year-old woman was admitted with exertional dyspnoea, palpitations, non-specific chest pain and progressive fatigue on exertion. In her family history sudden cardiac-related deaths at young age are present. Cardiovascular system examination revealed tachycardia, intermittent extrabeats. The rest EKG showed sinusal tachycardia (105 bpm, negative T-waves in DII, DIII, aVF, V4-V6. Consecutive 24 hours Holter EKG monitoring revealed nonsustained ventricular tachycardia, paroxysmal atrial fibrillation, isolated ventricular extrasystoles. Echocardiography showed left ventricular systolic dysfunction (LVEF:30-35%, slight LV enlargement, normal right ventricle and small left ventricle (LV trabeculae in the apical area. Cardiac MRI demonstrated dilated LV and the presence of the trabeculations of LV walls suggestive for non-compaction cardiomyopathy. A combined treatment for heart failure and cardiac arrhythmias was initiated with good clinical results. Patient was scheduled for an implantable cardioverter defibrillator “life-saving”. Conclusions: The symptoms of heart failure and cardiac arrhythmias should be considered important in apparently healthy young patients. Besides intensive medical treatment is indicated the implantation of an ICD “life-saving” and in advanced cases heart transplantation. Even if the electrocardiographic findings are non specific for noncompaction, a complete diagnostic evaluation is important, including sophisticated imaging techniques, a screening of first-degree relatives, and an extensive clinical, and genetic appreciation by a

  17. Science in the Making: Right Hand, Left Hand. III: Estimating historical rates of left-handedness.

    Science.gov (United States)

    McManus, I C; Moore, James; Freegard, Matthew; Rawles, Richard

    2010-01-01

    The BBC television programme Right Hand, Left Hand, broadcast in August 1953, used a postal questionnaire to ask viewers about their handedness. Respondents were born between 1864 and 1948, and in principle therefore the study provides information on rates of left-handedness in those born in the nineteenth century, a group for which few data are otherwise available. A total of 6,549 responses were received, with an overall rate of left-handedness of 15.2%, which is substantially above that expected for a cohort born in the nineteenth and early twentieth centuries. Left-handers are likely to respond preferentially to surveys about handedness, and the extent of over-response can be estimated in modern control data obtained from a handedness website, from the 1953 BBC data, and from Crichton-Browne's 1907 survey, in which there was also a response bias. Response bias appears to have been growing, being relatively greater in the most modern studies. In the 1953 data there is also evidence that left-handers were more common among later rather than early responders, suggesting that left-handers may have been specifically recruited into the study, perhaps by other left-handers who had responded earlier. In the present study the estimated rate of bias was used to correct the nineteenth-century BBC data, which was then combined with other available data as a mixture of two constrained Weibull functions, to obtain an overall estimate of handedness rates in the nineteenth century. The best estimates are that left-handedness was at its nadir of about 3% for those born between about 1880 and 1900. Extrapolating backwards, the rate of left-handedness in the eighteenth century was probably about 10%, with the decline beginning in about 1780, and reaching around 7% in about 1830, although inevitably there are many uncertainties in those estimates. What does seem indisputable is that rates of left-handedness fell during most of the nineteenth century, only subsequently to rise in

  18. 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

  19. Fluid loading and norepinephrine infusion mask the left ventricular preload decrease induced by pleural effusion

    DEFF Research Database (Denmark)

    Wemmelund, Kristian Borup; Ringgård, Viktor Kromann; Vistisen, Simon Tilma

    2017-01-01

    BACKGROUND: Pleural effusion (PLE) may lead to low blood pressure and reduced cardiac output. Low blood pressure and reduced cardiac output are often treated with fluid loading and vasopressors. This study aimed to determine the impact of fluid loading and norepinephrine infusion on physiologic......, n = 12), norepinephrine infusion (0.01, 0.03, 0.05, 0.1, 0.2 and 0.3 μg/kg/min (15 min each, n = 12)) or control (n = 6). Main outcome was left ventricular preload measured as left ventricular end-diastolic area. Secondary endpoints included contractility and afterload as well as global measures...... of circulation. All endpoints were assessed with echocardiography and invasive pressure-flow measurements. RESULTS: PLE decreased left ventricular end-diastolic area, mean arterial pressure and cardiac output (p values infusion (0.05 μg/kg/min) restored...

  20. Assessment of Left Ventricular Mechanics in Patients with Ischemic Heart Disease

    Directory of Open Access Journals (Sweden)

    Gladkikh Natalia

    2016-01-01

    Full Text Available The paper presents new ultrasound technology for assessment of left ventricular (LV strain in the longitudinal, radial, and circumferential directions and the LV area strain at rest and during dobutamine stressechocardiography in patients with intermediate pretest probability of ischemic heart disease (IHD. Analysis was performed for the first time using real-time three-dimensional echocardiography (4D Strain. It was shown that in patients with single-artery left anterior descending artery (LAD and left circumflex coronary artery (LCX stenosis of 50% and more, the decreases in the global LV strain in the longitudinal, radial, and circumferential directions as well as in the LV strain area were observed at peak dobutamine stress in 4D Strain mode. Assessment of global LV strain in 4D Strain mode during dobutamine test had low sensitivity, specificity, and diagnostic accuracy in diagnosing single-vessel coronary artery disease.

  1. 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.

  2. Quantitation of left ventricular asynchrony on radionuclide angiography phase images

    International Nuclear Information System (INIS)

    Alfano, B.; Betocchi, S.; Pace, L.; Perrone-Filardi, P.; Chiariello, M.; Salvatore, M.; Naples Univ.

    1990-01-01

    Quantitation of left ventricular (LV) asynchrony is relevant in clinical cardiology, as well as in evaluating LV mechanical properties. Radionuclide angiography (RA) phase images are extensively used, and asynchrony is usually assessed by computing the standard deviation of phase angle distribution (SD). However, SD is dependent on count statistics and does not take into account the spatial distribution of asynchrony. In this study a new index to evaluate asynchrony on phase images is presented (differential uniformity parameter, DUP). DUP is based on the frequency analysis of phase images. Diagnostic accuracy and reproducibility of either SD or DUP were tested. Reproducibility was evaluated in 15 patients studied by RA twice within a few minutes. DUP showed a better reproducibility than SD. Diagnostic accuracy was estimated in 84 patients, divided into four subgroups on the basis of coronary arteriography and contrast ventriculogrpahy findings: (a) 25 control subjects, (b) 16 patients with coronary artery disease (CAD) and normal LV wall motion, (c) 23 patients with CAD and LV hypokinesia and (d) 20 patients with CAD and LV dyskinesia. Relative diagnostic ability was assessed by comparing the areas under receiver-operating characteristic curves. DUP's area was larger than SD's when group D was tested against all the other groups (DUP's area=87%±5%, SD's area=76%±7%; P<0.01). Thus, our study indicates that DUP is more reproducible and more accurate than SD in identifying patients with CAD and LV dyskinesia. (orig.)

  3. Garner-Interference in left-handed awkward grasping.

    Science.gov (United States)

    Eloka, Owino; Feuerhake, Felix; Janczyk, Markus; Franz, Volker H

    2015-07-01

    The Perception-Action Model (PAM) claims to provide a coherent interpretation of data from all areas of the visual neurosciences, most notably data from neuropsychological patients and from behavioral experiments in healthy people. Here, we tested two claims that are part of the core version of the PAM: (a) certain actions (natural, highly practiced, and right-handed) are controlled by the dorsal vision for action pathway, while other actions (awkward, unpracticed, or left-handed) are controlled by the ventral vision for perception pathway. (b) Only the dorsal pathway operates in an analytical fashion, being able to selectively focus on the task-relevant dimension of an object (Ganel and Goodale, Nature 426(6967):664-667, 2003). We show that one of these claims must be wrong: using the same test for analytical processing as Ganel and Goodale (2003), we found that even an action that should clearly be ventral (left-handed awkward grasping) shows analytical processing just as a dorsal task does (right-handed natural precision grasping). These results are at odds with the PAM and point to an inconsistency of the model.

  4. 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 

    Medline Plus

    Full Text Available ... valve into the pulmonary artery. The blood then travels to the lungs, where it receives oxygen. Next, ... of the lungs via the pulmonary veins, and travels to the left atrium. From the left atrium, ...

  5. 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

  6. Ultrasound diagnosis of pulmonary sling with proximal stenosis of left pulmonary artery and patent arterial duct

    Directory of Open Access Journals (Sweden)

    Wojciech Mądry

    2013-03-01

    Full Text Available Authors discuss methods of echocardiographic diagnosis of the pulmonary sling with stenosis and hypoplasia of the left pulmonary artery and patent arterial duct with massive left‑to‑right shunt, based on a case of the newborn with resistant to treatment heart failure, with initial diagnosis of patent ductus arteriosus, referred to surgical treatment. The optimal echocardiographic views permitting establish diagnosis of the pulmonary sling were suggested. The special attention was paid to high parasternal and suprasternal views visualizing vessels of the upper mediastinum as well as characteristic differences between the normal and pathologic picture. The typical features of the echocardiogram suggesting pulmonary sling, like the lack of the left pulmonary artery in its expected position, and the abnormal branching pattern of the right pulmonary artery were indicated. The greatest diagnostic difficulties in visualization of the abnormal route of the left pulmonary artery were related to the presence of air‑containing tissues, like lungs and central airways between the ultrasound probe and area of interest. The other was the masking influence of the large patent arterial duct, that may mimic the left pulmonary artery arising from the pulmonary trunk. The other entities requiring differentiation with sling, like aplasia of the left lung, the direct or indirect aortic origin of the left pulmonary artery, were discussed. The role of other visualization technics, like computed 3D tomography, and magnetic nuclear resonance, as well as direct visualization of central airways with bronchoscopy in establishing precise diagnosis were stressed.

  7. Computational Fluid Dynamics Analysis of the Effect of Plaques in the Left Coronary Artery

    Science.gov (United States)

    Chaichana, Thanapong; Sun, Zhonghua; Jewkes, James

    2012-01-01

    This study was to investigate the hemodynamic effect of simulated plaques in left coronary artery models, which were generated from a sample patient's data. Plaques were simulated and placed at the left main stem and the left anterior descending (LAD) to produce at least 60% coronary stenosis. Computational fluid dynamics analysis was performed to simulate realistic physiological conditions that reflect the in vivo cardiac hemodynamics, and comparison of wall shear stress (WSS) between Newtonian and non-Newtonian fluid models was performed. The pressure gradient (PSG) and flow velocities in the left coronary artery were measured and compared in the left coronary models with and without presence of plaques during cardiac cycle. Our results showed that the highest PSG was observed in stenotic regions caused by the plaques. Low flow velocity areas were found at postplaque locations in the left circumflex, LAD, and bifurcation. WSS at the stenotic locations was similar between the non-Newtonian and Newtonian models although some more details were observed with non-Newtonian model. There is a direct correlation between coronary plaques and subsequent hemodynamic changes, based on the simulation of plaques in the realistic coronary models. PMID:22400051

  8. Doubling left syntactic positions in Danish

    DEFF Research Database (Denmark)

    Jørgensen, Henrik

    2016-01-01

    This paper deals with the doubling of left syntactic positions in Danish. Such doublings consist of a referential element: a NP or a clause, and an anaphoric element, an unstressed personal pronoun or an unstressed resumptive adverb. In main clauses, the CP-spec position may double in this way, w...... in the analysis of a broadcasted public speech (sect. 5). In earlier versions of Danish, as shown in sect. 4, the construction is both more frequent in writing and also seems almost obligatory....

  9. 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.

  10. Anomalous Origin of Left Circumflex Artery

    OpenAIRE

    ?itaku, Hajdin; Kamberi, Lulzim; Gorani, Daut; Ko?inaj, Dardan; Krasniqi, Xhevdet

    2015-01-01

    Introduction: The coronary anatomic variation of the left circumflex artery (LCx) is considered as the most common anatomic variation with a separate ostium from the right sinus, and very unusual variation as a proximal branch of right coronary artery (RCA). Case report: We report two cases, the first case is a 64-year-old man with chest pain and with history of hypertension, obesity, dyslipidemia and current smoker, and the second case is a 67-year-old who presented to the emergency departme...

  11. The children left to stand alone | Roalkvam | African Journal of AIDS ...

    African Journals Online (AJOL)

    Drawing upon ethnographic fieldwork in Seke, a semi-rural area outside Harare, Zimbabwe, this paper explores the social mechanism behind the seeming invisibility of children left on their own and how this form of 'invisibility' challenges established notions of childhood, parenthood, kinship, and community. It argues that ...

  12. BOLD Response to Motion Verbs in Left Posterior Middle Temporal Gyrus during Story Comprehension

    Science.gov (United States)

    Wallentin, Mikkel; Nielsen, Andreas Hojlund; Vuust, Peter; Dohn, Anders; Roepstorff, Andreas; Lund, Torben Ellegaard

    2011-01-01

    A primary focus within neuroimaging research on language comprehension is on the distribution of semantic knowledge in the brain. Studies have shown that the left posterior middle temporal gyrus (LPMT), a region just anterior to area MT/V5, is important for the processing of complex action knowledge. It has also been found that motion verbs cause…

  13. BOLD response to motion verbs in left posterior middle temporal gyrus during story comprehension

    DEFF Research Database (Denmark)

    Wallentin, Mikkel; Nielsen, Andreas Højlund; Vuust, Peter

    2011-01-01

    A primary focus within neuroimaging research on language comprehension is on the distribution of semantic knowledge in the brain. Studies have shown that the left posterior middle temporal gyrus (LPMT), a region just anterior to area MT/V5, is important for the processing of complex action...

  14. Hydatid Cyst of the Left Thigh: A case report | Abebe | East and ...

    African Journals Online (AJOL)

    A 25-year old female patient from Gurage zone rural area, a shepherd by occupation presented with a with a cystic swelling of the left thigh which had been gradually increasing in size and became painful. She reported having been taking unboiled pond water from the pond the sheep and other domestic animals used to ...

  15. Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients

    Directory of Open Access Journals (Sweden)

    James Anaissie

    2016-01-01

    Full Text Available Background. Transesophageal echocardiogram (TEE is superior to transthoracic echocardiogram (TTE in detecting left atrial thrombus (LAT, a risk factor for stroke, but is costly and invasive, carrying a higher risk for complications. Aims. To determine the utility of using left atrial enlargement (LAE on TTE to predict LAT on TEE. Methods. AIS patients who presented in 06/2008–7/2013 and underwent both TTE and TEE were identified from our prospective stroke registry. Analysis consisted of multivariate logistic regression with propensity score adjustment and receiver operating characteristic (ROC area under the curve (AUC analyses. Results. 219 AIS patients underwent both TTE and TEE. LAE on TTE was detected in 113 (51.6% of AIS patients. Patients with LAE on TTE had higher proportion of LAT on TEE (8.4% versus 1.0%, p=0.018. LAE on TTE predicted increased odds of LAT on TEE (OR=8.83, 95% CI 1.04–74.83, p=0.046. The sensitivity and specificity for LAT on TEE by LAE on TEE were 88.89% and 52.20%, respectively (AUC=0.7054, 95% CI 0.5906–0.8202. Conclusions. LAE on TTE can predict LAT detected on TEE in nearly 90% of patients. This demonstrates the utility of LAE on TTE as a potential screening tool for LAT, potentially limiting unneeded costs and complications associated with TEE.

  16. Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients.

    Science.gov (United States)

    Anaissie, James; Monlezun, Dominique; Seelochan, A; Siegler, James E; Chavez-Keatts, Maria; Tiu, Jonathan; Pineda, Denise; George, Alexander; Shaban, Amir; Abi Rafeh, Nidal; Schluter, Laurie; Martin-Schild, Sheryl; El Khoury, Ramy

    2016-01-01

    Background. Transesophageal echocardiogram (TEE) is superior to transthoracic echocardiogram (TTE) in detecting left atrial thrombus (LAT), a risk factor for stroke, but is costly and invasive, carrying a higher risk for complications. Aims. To determine the utility of using left atrial enlargement (LAE) on TTE to predict LAT on TEE. Methods. AIS patients who presented in 06/2008-7/2013 and underwent both TTE and TEE were identified from our prospective stroke registry. Analysis consisted of multivariate logistic regression with propensity score adjustment and receiver operating characteristic (ROC) area under the curve (AUC) analyses. Results. 219 AIS patients underwent both TTE and TEE. LAE on TTE was detected in 113 (51.6%) of AIS patients. Patients with LAE on TTE had higher proportion of LAT on TEE (8.4% versus 1.0%, p = 0.018). LAE on TTE predicted increased odds of LAT on TEE (OR = 8.83, 95% CI 1.04-74.83, p = 0.046). The sensitivity and specificity for LAT on TEE by LAE on TEE were 88.89% and 52.20%, respectively (AUC = 0.7054, 95% CI 0.5906-0.8202). Conclusions. LAE on TTE can predict LAT detected on TEE in nearly 90% of patients. This demonstrates the utility of LAE on TTE as a potential screening tool for LAT, potentially limiting unneeded costs and complications associated with TEE.

  17. Multiple Coronary Artery Microfistulas Associated with Apical Hypertrophic Cardiomyopathy: Left and Right Coronary Artery to the Left Ventricle

    Directory of Open Access Journals (Sweden)

    Jeong-Woo Choi

    2015-01-01

    Full Text Available A 76-year-old woman underwent coronary angiography for chest pain. On the coronary angiogram, no significant coronary artery atherosclerotic stenosis was observed. Multiple coronary artery microfistulas, draining from the left anterior descending artery to the left ventricle and from the posterior descending artery of the right coronary artery to the left ventricle, were observed. Apical wall thickening and fistula flow from the left anterior descending artery were demonstrated by using transthoracic echocardiography. We describe a rare case of multiple coronary artery microfistulas from the left and right coronary artery to the left ventricle combined with apical hypertrophic cardiomyopathy.

  18. Is there anything left for the next generation of leaders?

    Science.gov (United States)

    Volpe, Anthony

    2004-01-01

    Dean Arthur A. Dugoni is celebrated as the "dean of deans" or American dental schools. His service as a practitioner, rich network of relationships, recognition of emerging opportunities, respectful treatment of all, and ability to make people care and promote loyalty are identified. Significant issues remain for future leadership to address: dental caries is on the rebound, insurance is inadequate to provide needed coverage, prevention must be strengthened, education struggles with too few teachers and high tuition, the mobility of dentists is unrealistically restricted, and the pool of retired dentists who want to donate their services is hobbled by regulations. The ADA can take the leadership in some of these areas, but there is much left to be done by the next generation of individual leaders in the mold of Dean Dugoni.

  19. Severe personality changes after unilateral left paramedian thalamic infarct.

    Science.gov (United States)

    Fukutake, Toshio; Akada, Koichi; Ito, Shoichi; Okuda, Tomoko; Ueki, Yoshihiro

    2002-01-01

    Personality changes are not uncommon after paramedian thalamic infarction, but usually bilateral or relatively large lesions, often complicated by other neurological or neuropsychological deficits, are present. 'Pure' cases of unilateral lesions are extremely rare. We report that a right-handed, 48-year-old man, who was hypertensive and diabetic but had no prior psychiatric history, developed severe personality changes and a frontal-like syndrome after recovery from acute-onset impairment of consciousness at the age of 43. Other neurological and neuropsychological disturbances, especially verbal and visual amnesia, were unremarkable. MRI showed a very small infarct in the left paramedian area of the thalamus, mainly involving the dorsomedial nucleus. Copyright 2002 S. Karger AG, Basel

  1. Representation of Semantic Similarity in the Left Intraparietal Sulcus: Functional Magnetic Resonance Imaging Evidence

    Directory of Open Access Journals (Sweden)

    Veerle Neyens

    2017-08-01

    Full Text Available According to a recent study, semantic similarity between concrete entities correlates with the similarity of activity patterns in left middle IPS during category naming. We examined the replicability of this effect under passive viewing conditions, the potential role of visuoperceptual similarity, where the effect is situated compared to regions that have been previously implicated in visuospatial attention, and how it compares to effects of object identity and location. Forty-six subjects participated. Subjects passively viewed pictures from two categories, musical instruments and vehicles. Semantic similarity between entities was estimated based on a concept-feature matrix obtained in more than 1,000 subjects. Visuoperceptual similarity was modeled based on the HMAX model, the AlexNet deep convolutional learning model, and thirdly, based on subjective visuoperceptual similarity ratings. Among the IPS regions examined, only left middle IPS showed a semantic similarity effect. The effect was significant in hIP1, hIP2, and hIP3. Visuoperceptual similarity did not correlate with similarity of activity patterns in left middle IPS. The semantic similarity effect in left middle IPS was significantly stronger than in the right middle IPS and also stronger than in the left or right posterior IPS. The semantic similarity effect was similar to that seen in the angular gyrus. Object identity effects were much more widespread across nearly all parietal areas examined. Location effects were relatively specific for posterior IPS and area 7 bilaterally. To conclude, the current findings replicate the semantic similarity effect in left middle IPS under passive viewing conditions, and demonstrate its anatomical specificity within a cytoarchitectonic reference frame. We propose that the semantic similarity effect in left middle IPS reflects the transient uploading of semantic representations in working memory.

  2. 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.

  3. Value of transient dilation of the left ventricular cavity on stress thallium scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Sugihara, Hiroki; Shiga, Kouji; Umamoto, Ikuo (Kyoto Prefectural Univ. of Medicine (Japan)) (and others)

    1991-02-01

    This study was undertaken to evaluate the value of transient dilation of the left ventricular cavity on stress thallium scintigraphy in 80 patients with ischemic heart disease (IHD) and 50 with hypertrophic cardiomyopathy (HCM). Twenty persons without either coronary artery stenosis or heart disease were served as controls. Areas surrounded by maximum count points on the line of each 10deg on the short axis slice through the mid-cavity of the left ventricle were obtained at 10 minutes and at 3 hours after exercise. Transient dilation index (TDI) was obtained by dividing the area on early image by that on delayed image. TDI was significantly higher in patients with two or three vessel disease in the IHD group than the control group. High TDI was observed in 8% for one vessel disease, 40% for two vessel disease, and 80% for three vessel disease, contributing to the detection of multivessel IHD. In the HCM group of 80 patients, 24 (48%) had high TDI which was frequently associated with a history of chest pain and positive ECG findings at exercise. When these 24 HCM patients underwent exercise blood pool scintiscanning, left ventricular enddiastolic volume was similar before and at 10 minutes after exercise. These findings suggest that transient dilation of the left ventricular cavity after exercise may reflect subendocardial ischemia in both IHD and HCM. TDI would become a useful indicator for transient dilation of the left ventricular cavity. (N.K.).

  4. Comparison of scholastic performances of left handed and right handed students.

    Science.gov (United States)

    Sharma, R B; Goyal, M; Singh, J

    1993-10-01

    An attempt was made to compare the scholastic performance among left and right handed students. Both academic and extra curricular areas were studied among 3608 students from 6th to 12th class, from 10 schools in a rural subdivision of north east Rajasthan. General incidence of left handedness was 8.6% among students, higher in females (12.4%) as compared to males (8.1%). Right handed students performed better in aggregate as well as in individual academic areas (p performers as far as sports and games area was concerned, while right handed students tended to be average performers. Overall handedness affected both the academic and extra-curricular activities except behavior and discipline area (p > 0.05).

  5. Normal pulmonary veins anatomy is associated with better AF-free survival after cryoablation as compared to atypical anatomy with common left pulmonary vein.

    Science.gov (United States)

    Kubala, Maciej; Hermida, Jean-Sylvain; Nadji, Georges; Quenum, Serge; Traulle, Sarah; Jarry, Geneviève

    2011-07-01

    Pulmonary vein cryoablation (PVC) is a new approach in the treatment of recurrent atrial fibrillation (AF). Computed tomography (CT) can be used to evaluate the left atrium anatomy and PVs dimensions to facilitate the procedure. In radiofrequency procedures, some anatomic variants such as common left (CLPV) or right (CRPV) PV were reported as factors associated with technical procedure difficulties and potential long-term complications. We hypothesized that the absence of CLPV as determined by CT would predict better AF-free survival after PVC. We included 118 consecutive patients (mean age 56 ± 10 years; 77% males) with drug refractory paroxysmal (72%)/persistent (28%) AF, with more than 6 months follow-up, who underwent PVC. On CT scanning images performed within 1 month prior to ablation, we evaluated PV anatomic patterns: presence of CLPV or CRPV. Each patient was evaluated by 24-hour Holter monitoring within 1 and 3 months and all patients were periodically evaluated at 1, 3, and 6 months, and every 6 months thereafter. Patients were asked to record their 12-lead electrocardiogram whenever they experienced symptoms suggestive of AF. Recurrence was defined as AF that lasted at least 30 seconds. CLPV was present in 30 (25%) patients and no patients with CRPV were identified. At the end of the 13 months follow-up, patients with normal PVs had significantly better AF-free survival compared to patients with CLPV (67% vs 50%, P = 0.02). The difference was present in patients with paroxysmal AF (P = 0.008) but not in patients with persistent AF (P = 0.92). In patients undergoing cryoballoon PV isolation for AF, the presence of normal PVs pattern is associated with better AF-free survival as compared to atypical PV anatomy with CLPV, particularly in patients with paroxysmal AF. ©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.

  6. Emission computer tomography of the left ventricle

    Energy Technology Data Exchange (ETDEWEB)

    Semmler, W.; Felix, R.; Calder, D.; Golde, G.; Botsch, H.

    1983-10-01

    Tomographic studies and time-dependent tomograms on phantoms and patients were carried out using a 7-pinhole collimator in order to study the clinical value of ECG-triggered tomographic radionuclid ventriculography. A suitable computer programme has been developed. The results have shown that it is possible to evaluate local contraction abnormalities by this method. Using a left oblique position of the collimator (LAO (45/sup 0/) - cranial (15/sup 0/)), emission computer tomography is aligned with the longitudinal axis for the heart. In this way, a single projection is sufficient to show the montility of the anterior and posterior walls and of the septum. Hypokinesis, akinesis or dyskinesis can be recognised visually. The localisation and extent of the defect can be determined through the 7-pinhole collimator. Reconstructed images of the triggered radionuclide scintigrams show excellent marginal definition. In the RAO projection the left ventricle can be seen without superimposition and images obtained which equal those of a first-pass technique.

  7. Left hepatectomy after right paramedian sectoriectomy.

    Science.gov (United States)

    Takamoto, Takeshi; Hashimoto, Takuya; Makuuchi, Masatoshi

    2017-12-01

    Repeat hepatectomy is beneficial for selected patients with recurrence of liver malignancies. However, the operative procedure becomes technically demanding when the previous hepatectomy was complex, with hepatic veins and stump of portal pedicles exposed on the liver transection surface. We performed left hepatectomy after right paramedian sectoriectomy (RPMS) for three patients. Here, we describe our surgical technique and the postoperative outcomes achieved. This procedure allowed for safe adhesiolysis between the middle and right hepatic veins by following a fibrous plane. The mean operative time was 8.7 h, including 4.9 h of adhesiolysis. The mean remnant liver volume (right lateral sector and the caudate lobe) was calculated as 704 ml, being 62% of total liver volume. There was no postoperative liver failure or mortality. In conclusion, left hepatectomy after RPMS is a feasible procedure for patients with sufficient remnant liver volume, even though the middle and right hepatic veins run side by side after liver regeneration.

  8. Reversal of left ventricular hypertrophy by propranolol in ...

    African Journals Online (AJOL)

    Background: Hypertension contributes significantly to the development of left ventricular hypertrophy. Left ventricular hypertrophy is associated with increased incidence of sudden cardiac death. Recognition and management of hypertension is, therefore, imperative. Objective: To establish whether propranolol can reverse ...

  9. 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.

  10. 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.

  11. Visualisation of the left superior intercostal vein in MR

    International Nuclear Information System (INIS)

    Medrea, M.; Meydam, K.; Schmitt, W.

    1987-01-01

    A retrospective study of 56 MRT chest examinations showed the left intercostal vein in its horizontal trajectory in 3 patients with left mediastinal masses compressing the superior vena cava. In 2 patients the posterior trajectory of the horizontal segment was clearly visualised. In the third case the anterior part, namely the insertion of the left superior intercostal vein into the left brachiocephalic trunk, was demonstrated. (orig.) [de

  12. Assessment of early diastolic intraventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot.

    Science.gov (United States)

    Kobayashi, Maki; Takahashi, Ken; Yamada, Mariko; Yazaki, Kana; Matsui, Kotoko; Tanaka, Noboru; Shigemitsu, Sachie; Akimoto, Katsumi; Kishiro, Masahiko; Nakanishi, Keisuke; Kawasaki, Shiori; Nii, Masaki; Itatani, Keiichi; Shimizu, Toshiaki

    2017-11-01

    Assessment of left ventricular (LV) dysfunction is vital in patients with repaired tetralogy of Fallot (rTOF). The early diastolic intraventricular pressure gradient (IVPG) in the LV plays an important role in diastolic function. IVPG is calculated as the intraventricular pressure difference divided by the LV length, which allows to account for differences in LV size and therefore calculate IVPG in children. We aimed to investigate the mechanisms of LV diastolic dysfunction by measuring mid-to-apical IVPG as an indicator of the active suction force sucking blood from the left atrium into the LV. We included 38 rTOF patients and 101 healthy controls. The study population was stratified based on age group into children (4-9 years), adolescents (10-15 years), and adults (16-40 years). IVPGs were calculated based on mitral inflow measurements obtained using color M-mode Doppler echocardiography. Although total IVPGs did not differ between rTOF patients and controls, mid-to-apical IVPGs in adolescents and adults were smaller among rTOF patients than among controls (0.15 ± 0.05 vs. 0.21 ± 0.06 mmHg/cm, p < 0.05; 0.09 ± 0.07 vs. 0.17 ± 0.05 mmHg/cm, p < 0.001; respectively). Additionally, only mid-to-apical IVPG correlated linearly with peak circumferential strain (ρ = 0.217, p = 0.011), longitudinal strain (ρ = -0.231, p = 0.006), torsion (ρ = -0.200, p = 0.018), and untwisting rate in early diastole (ρ = -0.233, p = 0.006). In rTOF, the mechanisms underlying diastolic dysfunction involve reduced active suction force, which correlates with reduced LV deformation in all directions.

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

    Science.gov (United States)

    Rettmann, Maryam E; Holmes, David R; Kwartowitz, David M; Gunawan, Mia; Johnson, Susan B; Camp, Jon J; Cameron, Bruce M; Dalegrave, Charles; Kolasa, Mark W; Packer, Douglas L; Robb, Richard A

    2014-02-01

    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. 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 dynamic in 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. The phantom simulation studies demonstrated that combined landmark and surface-based registration improved landmark-only registration

  14. 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

  15. Parental Absence Accompanies Worse Academic Achievements: Evidence Based upon a Sample of Left-Behind Children in Rural China

    Directory of Open Access Journals (Sweden)

    Mingchen Fu

    2017-08-01

    Full Text Available In China, with the rapid urbanization and large amount of labor force migrating from rural-to-urban areas, an enormous number of children living in rural China are in the absence of parental care. The objective of the study was to investigate the academic performance of left-behind children under various statuses of parental absence. We investigated 3,076 children (1,761 non-left-behind and 1,315 left-behind regarding their academic achievement in different subjects. We found that children with different status of parental absence would perform differently on Chinese, mathematics, and English learning. In addition, left-behind children would be significantly more likely to get low scores in academic examinations as compared with non-left-behind children. Strengths and limitations of the study are discussed.

  16. Vortex Flow in the Right Atrium Surrogates Supraventricular Arrhythmia and Thrombus After Atriopulmonary Connection-Type Fontan Operation: Vortex Flow Analysis Using Conventional Cine Magnetic Resonance Imaging.

    Science.gov (United States)

    Shiina, Yumi; Inai, Kei; Takahashi, Tatsunori; Shimomiya, Yamato; Ishizaki, Umiko; Fukushima, Kenji; Nagao, Michinobu

    2018-02-01

    We developed a novel imaging technique, designated as vortex flow (VF) mapping, which presents a vortex flow visually on conventional two-dimensional (2D) cine MRI. Using it, we assessed circumferential VF patterns and influences on RA thrombus and supraventricular tachycardia (SVT) in AP connection-type Fontan circulation. Retrospectively, we enrolled 27 consecutive patients (25.1 ± 9.2 years) and 7 age-matched controls who underwent cardiac MRI. Conventional cine images acquired using a 1.5-Tesla scanner were scanned for axial and coronal cross section of the RA. We developed "vortex flow mapping" to demonstrate the ratio of the circumferential voxel movement at each phase to the total movement throughout a cardiac cycle towards the RA center. The maximum ratio was used as a magnitude of vortex flow (MVF%) in RA cine imaging. We also measured percentages of strong and weak VF areas (VFA%). Furthermore, in 10 out of 27, we compared VF between previous CMR (3.8 ± 1.5 years ago) and latest CMR. Of the patients, 15 had cardiovascular complications (Group A); 12 did not (Group B). A transaxial image showed that strong VFA% in Group A was significantly smaller than that in Group B or controls. A coronal view revealed that strong VFA% was also smaller, and weak VFA% was larger in Group A than in Group B or controls (P < 0.05, and P < 0.05). Maximum MVF% in Group A was significantly smaller than in other groups (P < 0.001). Univariate logistic analyses revealed weak VFA% on a coronal image, and serum total bilirubin level as factors affecting cardiovascular complications (Odds ratio 1.14 and 66.1, 95% CI 1.004-1.30 and 1.59-2755.6, P values < 0.05 and < 0.05, respectively). Compared to the previous CMR, smaller maximum VMF%, smaller strong VFA%, and larger weak VFA% were identified in the latest CMR. Circumferentially weak VFA% on a coronal image can be one surrogate marker of SVT and thrombus in AP connection-type Fontan circulation. This simple VF

  17. Branching patterns of left coronary artery among North Indians ...

    African Journals Online (AJOL)

    The left coronary artery displays variations in pattern, number and distribution of its branches. These variations influence the manifestation and extent of the coronary artery disease affecting the left main branch. A total of 100 North Indian cadaveric hearts were dissected to observe the main trunk of the left coronary artery.

  18. Learning Conflict Among Mixed-Dominance Left-Handed Individuals.

    Science.gov (United States)

    Blai, Boris, Jr.

    This study investigates the hypothesis that it is mixed-dominance among left handers (i.e. left handedness and right eye and/or foot dominance), that is related to academic learning difficulties among such individuals, rather than the generally held notion that their difficulties stem from the fact that they are left handers in a "right handed…

  19. Spatial Deficit in Familial Left-Handed Children.

    Science.gov (United States)

    And Others; Eme, Robert

    1978-01-01

    The study evaluated the hypothesis that familial left-handed children, who presumably have bilateral representation of language ability, should show an impairment in spatial abiblity on 44 children (22 right handed, 11 familial left handed, and 11 nonfamilial left handed) whose average age was 8 years old. (Author/PHR)

  20. Left-Handed Students: A Forgotten Minority. Fastback 399.

    Science.gov (United States)

    Kelly, Evelyn B.

    This fastback, a booklet bound "left-handed," is designed to help educators become aware of the problems faced by left-handed students in school and to suggest ways that many of the problems might be solved. Following an introduction discussing a personal experience with left-handedness, the booklet continues with a brief history of the treatment…