H.-P. Dübel

Head-to-Head Comparison of Left Ventricular Function Assessment with 64-Row Computed Tomography, Biplane Left Cineventriculography, and Both 2- and 3-Dimensional Transthoracic Echocardiography Comparison With Magnetic Resonance Imaging as the Reference Standard

OBJECTIVESnThis study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI).nnnBACKGROUNDnCardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients.nnnMETHODSnA total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed.nnnRESULTSnFor the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58).nnnCONCLUSIONSn64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.

Multislice computed tomography: angiographic emulation versus standard assessment for detection of coronary stenoses

The present study investigated angiographic emulation of multislice computed tomography (MSCT) (catheter-like visualization) as an alternative approach of analyzing and visualizing findings in comparison with standard assessment. Thirty patients (120 coronary arteries) were randomly selected from 90 prospectively investigated patients with suspected coronary artery disease who underwent MSCT (16-slice scanner, 0.5xa0mm collimation, 400xa0ms rotation time) prior to conventional coronary angiography for comparison of both approaches. Sensitivity and specificity of angiographic emulation [81% (26/32) and 93% (82/88)] were not significantly different from those of standard assessment [88% (28/32) and 99% (87/88)], while the per-case analysis time was significantly shorter for angiographic emulation than for standard assessment (3.4u2009±u20091.5 vs 7.0u2009±u20092.5xa0min, Pu2009<u20090.001). Both interventional and referring cardiologists preferred angiographic emulation over standard curved multiplanar reformations of MSCT coronary angiography for illustration, mainly because of improved overall lucidity and depiction of sidebranches (Pu2009<u20090.001). In conclusion, angiographic emulation of MSCT reduces analysis time, yields a diagnostic accuracy comparable to that of standard assessment, and is preferred by cardiologists for visualization of results.

Koronaranomalie und koronare Herzkrankheit : Ein Fallbericht

We report on a 60 year old man with coronary artery disease and coronary artery anomaly. In this patient a reopening of the occluded right coronary artery was performed and a stenosis of the circumflex artery was successfully dilated. Wir berichten über einen Patienten mit koronarer Herzkrankheit und Koronaranomalie. Ein Verschluss der rechten Kranzarterie wurde rekanalisiert und in einer zweiten Sitzung eine Stenose des Ramus circumflexus dilatiert.

Linksatriales Myxom: zweites Rezidiv 20 Jahre nach der ersten Operation

We report about a 52-year old woman, who underwent a resection of a left atrial myxoma 20 years ago. Twelve years later she suffered from exertional dyspnea. Echocardiography revealed a recurrent myxoma. This was resected. Eight years later the woman suffered from disturbances of heart rhythm and from angina pectoris. The coronary arteries were normal, but a recurrent left atrial myxoma was found and operated. We conclude a long-term follow-up is inevitable in patients after the resection of a myxoma.We report about a 52-year old woman, who underwent a resection of a left atrial myxoma 20 years ago. Twelve years later she suffered from exertional dyspnoe. Echocardiography revealed a recurrent myxoma. This was resected. Eight years later the woman suffered from disturbances of heart rhythm and from angina pectoris. The coronary arteries were normal, but a recurrent left atrial myxoma was found and operated. We conclude a long-term follow-up is inevitable in patients after the resection of a myxoma. Bei einer 52-jährigen Frau war vor 20 Jahren ein linksatriales Myxom entfernt worden. 12 Jahre danach litt sie unter Belastungsdyspnoe. Echokardiographisch fand sich ein Rezidiv, welches reseziert wurde. 8 Jahre später klagt die Patientin über Herzrhythmusstörungen und Angina pectoris. Die Herzkranzarterien waren unauffällig, jedoch wurde erneut ein Rezidiv im linken Vorhof diagnostiziert und operativ entfernt. Wir schlussfolgern, dass Patienten nach Entfernung eines Myxoms langfristig kontrolliert werden sollten.

Atypical vessels as an early sign of intracardiac myxoma

We report on a woman with previously unknown left atrial myxoma, who underwent percutaneous coronary intervention. 45 months after the initial coronary angiography, echocardiography demonstrated a large atrial myxoma, which was not seen echocardiographically before. The retrospective analysis of the pre-intervention coronary angiography revealed atypical vessels in the atrial septum, which are interpreted as early signs of myxoma.

[Left atrial myxoma: second recurrence 20 years after the first operation].

We report about a 52-year old woman, who underwent a resection of a left atrial myxoma 20 years ago. Twelve years later she suffered from exertional dyspnea. Echocardiography revealed a recurrent myxoma. This was resected. Eight years later the woman suffered from disturbances of heart rhythm and from angina pectoris. The coronary arteries were normal, but a recurrent left atrial myxoma was found and operated. We conclude a long-term follow-up is inevitable in patients after the resection of a myxoma.We report about a 52-year old woman, who underwent a resection of a left atrial myxoma 20 years ago. Twelve years later she suffered from exertional dyspnoe. Echocardiography revealed a recurrent myxoma. This was resected. Eight years later the woman suffered from disturbances of heart rhythm and from angina pectoris. The coronary arteries were normal, but a recurrent left atrial myxoma was found and operated. We conclude a long-term follow-up is inevitable in patients after the resection of a myxoma. Bei einer 52-jährigen Frau war vor 20 Jahren ein linksatriales Myxom entfernt worden. 12 Jahre danach litt sie unter Belastungsdyspnoe. Echokardiographisch fand sich ein Rezidiv, welches reseziert wurde. 8 Jahre später klagt die Patientin über Herzrhythmusstörungen und Angina pectoris. Die Herzkranzarterien waren unauffällig, jedoch wurde erneut ein Rezidiv im linken Vorhof diagnostiziert und operativ entfernt. Wir schlussfolgern, dass Patienten nach Entfernung eines Myxoms langfristig kontrolliert werden sollten.

Verbindung zwischen nichtstenosierten Herzkranzarterien

This is the report of a rare intercoronary communication between the right and the circumflex artery. Beschrieben wird eine seltene, kaliberkräftige Verbindung zwischen rechter Kranzarterie und Ramus circumflexus.

Linksatriales Myxom: zweites Rezidiv 20 Jahre nach der ersten Operation@@@Left atrial myxoma: second recurrence 20 years after the first operation

We report about a 52-year old woman, who underwent a resection of a left atrial myxoma 20 years ago. Twelve years later she suffered from exertional dyspnea. Echocardiography revealed a recurrent myxoma. This was resected. Eight years later the woman suffered from disturbances of heart rhythm and from angina pectoris. The coronary arteries were normal, but a recurrent left atrial myxoma was found and operated. We conclude a long-term follow-up is inevitable in patients after the resection of a myxoma.We report about a 52-year old woman, who underwent a resection of a left atrial myxoma 20 years ago. Twelve years later she suffered from exertional dyspnoe. Echocardiography revealed a recurrent myxoma. This was resected. Eight years later the woman suffered from disturbances of heart rhythm and from angina pectoris. The coronary arteries were normal, but a recurrent left atrial myxoma was found and operated. We conclude a long-term follow-up is inevitable in patients after the resection of a myxoma. Bei einer 52-jährigen Frau war vor 20 Jahren ein linksatriales Myxom entfernt worden. 12 Jahre danach litt sie unter Belastungsdyspnoe. Echokardiographisch fand sich ein Rezidiv, welches reseziert wurde. 8 Jahre später klagt die Patientin über Herzrhythmusstörungen und Angina pectoris. Die Herzkranzarterien waren unauffällig, jedoch wurde erneut ein Rezidiv im linken Vorhof diagnostiziert und operativ entfernt. Wir schlussfolgern, dass Patienten nach Entfernung eines Myxoms langfristig kontrolliert werden sollten.

Left ventricular pseudoaneurysm after mitral valve replacement

We report about a woman with a rare complication after mitral valve replacement 24 years ago. The patient had a massive hemorrhage some hours after operation. We performed invasive diagnostics because of an increasing pressure gradient across the prosthesis and revealed a left ventricular pseudoaneurysm. Before the planned reoperation the patient died suddenly. As the cause of death, we assumed a rupture of the pseudoaneurysm. Wir berichten über eine Patientin mit einer seltenen Komplikation nach Mitralklappersatz vor 24 Jahren. Einige Stunden nach der Operation erlitt die Patientin eine massive Nachblutung. Bei der invasiven Diagnostik wegen eines zunehmenden Druckgradienten an der Klappenprothese fanden wir ein von der linken Kammer ausgehendes Pseudoaneurysma. Kurz vor der geplanten Reoperation verstarb die Patientin. Wir vermuten als Todesursache eine Ruptur des Pseudoaneurysma.

Linksventrikuläres Pseudoaneurysma nach Mitralklappenersatz

We report about a woman with a rare complication after mitral valve replacement 24 years ago. The patient had a massive hemorrhage some hours after operation. We performed invasive diagnostics because of an increasing pressure gradient across the prosthesis and revealed a left ventricular pseudoaneurysm. Before the planned reoperation the patient died suddenly. As the cause of death, we assumed a rupture of the pseudoaneurysm. Wir berichten über eine Patientin mit einer seltenen Komplikation nach Mitralklappersatz vor 24 Jahren. Einige Stunden nach der Operation erlitt die Patientin eine massive Nachblutung. Bei der invasiven Diagnostik wegen eines zunehmenden Druckgradienten an der Klappenprothese fanden wir ein von der linken Kammer ausgehendes Pseudoaneurysma. Kurz vor der geplanten Reoperation verstarb die Patientin. Wir vermuten als Todesursache eine Ruptur des Pseudoaneurysma.