Chaowu Yan

Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults

Background: Surgical closure of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension in adults carries higher risk than in children. Objectives: To investigate the application of self-expandable occluders for transcatheter closure of PDA associated with severe pulmonary arterial hypertension in adults, and the assessment of immediate and short-term results. Methods: 29 adult patients (6 men, 23 women) underwent attempted transcatheter closure of PDA at a mean (standard deviation (SD)) age of 31.1 (11.4) years (range 18–58 years) and a mean (SD) weight of 54.1 (7.1) kg (range 42–71 kg). On the basis of haemodynamic and clinical data obtained before and after trial occlusion, the final duct occlusion was determined and carried out. Radiographs of the chest, electrocardiograms and echocardiograms were used for follow-up evaluation of the treatment within 1 day, 1 month and 3–6 months after successful closure. Results: 20 of the 29 patients had successful occlusion (group 1), and 9 patients failed (named group 2). In group 1, in which occlusion was successful, mean (SD) pulmonary arterial pressures decreased markedly after trial occlusion: 78 (19.3) mm Hg (range 50–125 mm Hg) before occlusion and 41 (13.8) mm Hg (range 23–77 mm Hg) after occlusion. Systemic arterial oxygen saturation was found to be >90% in 19 patients and <90% in the remaining patient before inhalation of oxygen, and >95% during inhalation of oxygen or after occlusion in all 20 patients. In group 2, the occlusion was not successful, because in two patients the device was not available; another two patients showed worsening of symptoms. The other five patients showed increased pulmonary arterial pressures after trial closure; their mean (SD) pulmonary arterial pressures increased by 10.3 (6) mm Hg (4–16 mm Hg) after trial occlusion, and systemic arterial oxygen saturation was 85.5% (2.6%) (range 82.6–88%) before inhalation of oxygen and 94.7% (1.7%) (range 90.7–99.1%) during inhalation of oxygen. In group 1, the dimensions of the left atrium, left ventricle and pulmonary artery increased considerably in 3–6-months of follow-up compared with those of preocclusion. Conclusions: Transcatheter closure is an effective treatment for adults with PDA associated with reversible severe pulmonary arterial hypertension. Further research is needed for the evaluation of long-term results.

The relative atrial volume ratio and late gadolinium enhancement provide additive information to differentiate constrictive pericarditis from restrictive cardiomyopathy

BackgroundThe differentiation of constrictive pericarditis (CP) from restrictive cariomyopathy (RCM) is often difficult. This study sought to determine the clinical utility of cardiovascular magnetic resonance imaging (CMR) for differentiating both these disorders.MethodsTwenty-three patients with surgically documented CP, 22 patients with RCM and 25 normal subjects were included in the study. CMR yielded information about cardiac morphology, function and tissue characteristics. The left (LA) and right atrial (RA) volume was calculated using the area-length method. The relative atrial volume ratio (RAR) was defined as the LA volume divided by RA volume. Receiver operating characteristic curve analysis was used to test the ability of different variables in differentiating CP from RCM.ResultsThe maximal pericardial thickness in CP patients was significantly larger than in normal subjects and RCM patients. The RA volume index in RCM patients (90.5 ± 35.3 mL/m2) was significantly larger than in CP patients (71.4 ± 15.7 mL/m2, p = 0.006) and normal subjects (38.1 ± 9.0 mL/m2, p < 0.001). The LA volume index in RCM (96.0 ± 37.0 mL/m2) and CP patients (105.6 ± 25.1 mL/m2) was significantly larger than in normal subjects (39.5 ± 9.5 mL/m2, p < 0.001 for all). The RAR in CP patients (1.50 ± 0.29) was significantly larger than in RCM patients (1.12 ± 0.33, p < 0.001) and normal subjects (1.06 ± 0.20, p < 0.001). There were no differences between RCM patients and normal subjects in the RAR (p = 0.452). At a cut-off value of 1.32 for the RAR, the sensitivity was 82.6%, and the specificity was 86.4% in the detection of CP. Septal bounce was identified in 95.7% CP patients, in none of RCM patients and normal subjects. Late gadolinium enhancement (LGE) was present in 31.8% RCM patients and absence in all CP patients and normal subjects.ConclusionsCMR with LGE and RAR can facilitate differentiation of CP from RCM.

Comparison of 99mTc-MIBI SPECT/18F-FDG PET Imaging and Cardiac Magnetic Resonance Imaging in Patients With Idiopathic Dilated Cardiomyopathy: Assessment of Cardiac Function and Myocardial Injury.

Objective The aim of this study is to evaluate the agreement between myocardial 18F-FDG PET imaging and cardiac magnetic resonance imaging (cMRI) in assessing cardiac function and relationship of cMRI late gadolinium enhancement (cMRI-LGE) and myocardial perfusion/metabolism pattern in patients with idiopathic dilated cardiomyopathy (IDCM). Methods Forty-two consecutive patients diagnosed with IDCM were enrolled. All patients underwent 99mTc-MIBI SPECT, gated 18F-FDG PET imaging, and cMRI within 3–7 days. Cardiac function parameters were calculated using PET and cMRI. The segments analysis was performed using a 17-segment model. Patterns of perfusion/metabolism were classified as normal, mismatch, mild-to-moderate match, and severe match, and cMRI-LGE was classified into 3 categories (non-LGE, mid-wall LGE, and transmural LGE). Results The correlation between gated PET and cMRI was excellent for end-diastolic volume (EDV; r = 0.948, P < 0.001), end-systolic volume (ESV; r = 0.939, P < 0.001), and left ventricular ejection fraction (LVEF; r = 0.685, P < 0.001). EDV and ESV were underestimated, whereas LVEF was slightly overestimated by gated PET in comparison to cMRI. Perfusion/metabolism patterns varied in 3 different categories of non-LGE, mid-wall LGE, and transmural LGE (&khgr;2 = 14.276, P < 0.001). Also, 71.0% (44/62) segments with mid-wall LGE had normal perfusion/metabolism patterns, and 75.9% (63/83) perfusion/metabolism mismatch segments were shown as non-LGE. The incidence of LGE was significantly higher in segments with severe match than the other 3 segment groups (&khgr;2 = 112.53, P < 0.001). Conclusion There is an excellent agreement between gated PET and cMRI in assessment of cardiac function. LGE-cMRI is much more sensitive in detecting moderate fibrosis, while PET could detect more impaired but viable myocardium. Combining the 2 imaging modalities is useful for providing more comprehensive evaluations of myocardial injury in patients with IDCM.

Comparison of cardiac magnetic resonance imaging features of isolated left ventricular non-compaction in adults versus dilated cardiomyopathy in adults

AIM To compare cardiac magnetic resonance imaging (MRI) features between isolated left ventricular non-compaction (IVNC) and dilated cardiomyopathy (DCM) in adults. MATERIALS AND METHODS A consecutive series of 50 patients with IVNC from a single institution were reviewed. During the same period, 50 patients with DCM who had prominent trabeculations, who were matched for age, gender, and body surface area, were prospectively included. Left ventricular (LV) morphology and function were assessed using cardiac MRI. RESULTS Compared with patients with DCM, patients with IVNC had a significantly lower LV sphericity index and end-diastolic volume index (LVEDVI) and a greater LV ejection fraction (LVEF), number of trabeculated segments, and ratio of non-compacted to compacted myocardium (NC/C ratio). There were no significant differences in stroke volume index, cardiac output, and cardiac index between the two patient groups. In patients with IVNC, the number of trabeculated segments and the NC/C ratio correlated positively with LVEDVI (r=0.626 and r=0.559, respectively) and negatively with LVEF (r=-0.647 and r=-0.521, respectively, p<0.001 for all). In patients with DCM, the number of non-compacted segments and the NC/C ratio had no correlation with either the LVEDVI (r=-0.082 and r=-0.135, respectively) or the LVEF (r=0.097 and r=0.205, respectively). CONCLUSION There are demonstrable morphological and functional differences between IVNC and DCM at LV assessment using cardiac MRI. The occurrence of trabeculated myocardium might be due to a different pathophysiological mechanism.

Three-dimensional printing assisted transcatheter closure of atrial septal defect with deficient posterior-inferior rim

Though successful transcatheter closure has been reported in secundum atrial septal defect (ASD) with deficient posterior–inferior rim, it is still difficult to screen the appropriate candidates. Three‐dimensional printing (3DP) makes in vitro trial occlusion possible, and might provide a feasible method in the prediction of successful closure.

Viable apical aneurysms of left ventricle in hypertrophic cardiomyopathy

Background The formation of left ventricular apical aneurysm (LVAA) is a distinctive subset in hypertrophic cardiomyopathy (HCM), however, it is still unknown about myocardial viability of LVAAs in these patients. Objectives The study was carried out to assess the myocardial viability of LVAAs in HCM patients. Methods Of 510 HCM patients, 21 (4.1%, 17 M/4 F) were identified as HCM with LVAAs. Coronary artery disease was ruled out by selective coronary angiography or coronary computed tomography angiography (CTA). Myocardial viability of LVAAs was assessed by single photon emission computed tomography (SPECT), positron emission tomography (PET) and delayed-enhancement magnetic resonance imaging. Results Viable LVAAs were identified in 8 HCM patients and nonviable LVAAs presented in the other 13 patients. Left ventricular obstruction presented in 15 patients, including 3 patients with mid-ventricular obstruction. In all LVAAs, the aneurysmal wall was thin (<5.5 mm) and the maximum thickness of left ventricular segments was 20.5±4.6 mm. The left ventricular ejection fraction (LVEF) was higher in viable group than that in nonviable group, (69.1±6.8)% vs (58.4±11.9)%, p=0.03. In the two groups, there were no significant differences in age, left ventricular end diastolic dimension (LVED), maximum thickness, left atrial dimension, maximum dimension of LVAA and time of follow up. In nonviable group, mural thrombus presented in 3 patients and pericardiac effusion occurred in 2 patients. Transaortic septal myectomy and septal alcohol ablation were performed in 3 patients, respectively. In the 1.7±0.9 years follow up, no adverse events occurred in viable group. In particular, a case of complete transition from viable to nonviable LVAA was recorded. In nonviable group (1.7±0.7 years follow up), emergence or progression of congestive heart failure occurred in 5 patients, ventricular tachycardia in 3 patients. Conclusions Viable LVAAs existed in a small proportion of HCM patients, and might develop into nonviable LVAAs. This finding warranted further investigations to reassess the mechanism, treatment considerations and prognosis of the disease.