Shiliang Jiang

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.

A pilot trial of autologous bone marrow mononuclear cell transplantation through grafting artery: A sub-study focused on segmental left ventricular function recovery and scar reduction

BACKGROUNDnOur preliminary study suggested that patients with chronic myocardial infarction (MI) and heart failure could potentially benefit from CABG combined with aBM-MNC by improving global left ventricular (LV) function. The purpose of this sub-study was to quantitatively evaluate the effectiveness of aBM-MNC transplantation during CABG in patients with chronic MI by intensively analyzing the global and segmental LV function, the scar, and the relationships between the function recovery and the scar transmural extent.nnnMETHODSnA randomized, double-blinded, placebo-controlled study was performed in 50 patients with chronic MI. The patients were randomly allocated into CABG with stem cell transplantation (group A) and CABG only (group B) groups. CMR assessments of global and segmental left ventricular function and scar tissue were performed before surgery and repeated at 12 months after CABG and aBM-MNC transplantation.nnnRESULTSnThe left ventricular ejection fraction (LVEF) improved by 13.5% and 8.0% in group A and B respectively (P=0.04). Segmental analysis of regional LV function recovery indicated that more improvement in contractility was found in group A within the same degree of the infarct transmurality (P=0.017) and showed a predominant interaction in the most severely affected segments (76-100%, P=0.016). Decrease in infarct size between the two groups did not reach statistical difference (9.4% vs. 6.0%, P=0.100).nnnCONCLUSIONSnCMR assessments revealed reversed ventricular remodeling and improved systolic function and scar reduction in patients who underwent aBM-MNC transplantation during CABG. And the conjunctional use of CABG and stem cell therapy could improve the left ventricular function in patients with chronic MI.

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

AIMnTo compare cardiac magnetic resonance imaging (MRI) features between isolated left ventricular non-compaction (IVNC) and dilated cardiomyopathy (DCM) in adults.nnnMATERIALS AND METHODSnA 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.nnnRESULTSnCompared 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).nnnCONCLUSIONnThere 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.

Cardiac magnetic resonance imaging characteristics of isolated left ventricular noncompaction in a Chinese adult Han population

To analyze cardiac magnetic resonance imaging (CMR) characteristics in patients with isolated left ventricular noncompaction (IVNC) and assess its value in the diagnosis of IVNC in a Chinese adult Han population. We collected a consecutive series of 30 patients with IVNC from January 1, 2007, to December 31, 2008. During the same period, we prospectively included patients drawn from groups given a potential differential diagnosis for IVNC. All magnetic resonance images were analyzed using 17-segment model. Left ventricular ejection fraction was significantly lower for patients with DCM (16.2xa0±xa05.2%, Pxa0<xa00.001) and higher in AR (47.6xa0±xa016.2%, Pxa0=xa00.009), AS (54.6xa0±xa021.1%, Pxa0=xa00.001) and HHD (62.4xa0±xa06.8%, Pxa0<xa00.001) compared with IVNC (33.0xa0±xa014.1%). The two-layered structure was most frequently seen at the apical segments, followed by the mid-cavity and basal segments in patients with INVC. The anterior and lateral walls were more commonly involved in patients with IVNC. The number of noncompacted segments and end-diastolic ratio of non-compacted to compacted myocardium (NC/C ratio) was greater in patients with IVNC than in other five groups. The end-diastolic NC/C ratio of >2.5 had 96.4% sensitivity and 97.4% specificity for identifying patients with IVNC. CMR provides an accurate and reliable evaluation of the localization and extent of noncompacted myocardium at end-diastole. The end-diastolic NC/C ratio of >2.5 had high diagnostic accuracy for IVNC in a Chinese adult Han population.

Cardiac magnetic resonance imaging in arrhythmogenic right ventricular cardiomyopathy: correlation to the QRS dispersion.

The aim of the study was to evaluate the relationship between the presence of right ventricular abnormalities detected by cardiac magnetic resonance (CMR) and QRS dispersion, the strongest independent predictor of sudden death in ARVC. A consecutive series of 40 patients from a single institution were recruited with a clinical diagnosis of ARVC based on the diagnostic criteria. All patients underwent systematic clinical evaluation, including history and examination, electrocardiography, 24-h Holter monitor, chest radiography, echocardiography and CMR examination and were divided into two groups according to the QRS dispersion: group I, QRS dispersion ≥40 ms; group II, QRS dispersion <40 ms. The relationship between the characteristic parameters of CMR image and QRS dispersion were analyzed in two groups. There were significant differences in QRS dispersion (57±14 ms vs. 26±11 ms), right ventricular end-diastolic diameter (57±10 mm vs. 48±11 mm, P=.012), right ventricular end-systolic diameter (52±10 mm vs. 44±11 mm, P=.010), right ventricular end-diastolic volume (260±105 ml vs. 180±66 ml, P=.006), right ventricular end-systolic volume (222±98 ml vs. 148±61 ml, P=.006) and myocardial fibrosis detection rate (74% vs. 38%, P=.024) between two groups. For all patients with ARVC, QRS dispersion and right ventricular end-diastolic volume (r=0.66, P<.001), right ventricular end-systolic volume (r=0.67, P<.001), right ventricular outflow tract area (r=0.68, P<.001) showed a moderate positive correlation. Right ventricular outflow tract area, right ventricular end-diastolic volume and end-systolic volume detected by CMR in patients with ARVC were positively correlated to the extent of QRS dispersion (≥40 ms), the strongest independent predictor of sudden cardiac death.

GW24-e3669 Transcatheter closure of coronary artery fistulae: Initial human experience with the amplatzer duct occluder II

Objectives Transcatheter device closure is an alternative treatment for selective patients with coronary artery fistulae (CAF). Currently available technology is limited for closure of CAF with tortuous coronary artery to the drainage. The purpose of this study was to evaluate the technical feasibility, safety, and efficacy of the new device Amplatzer duct occluder II (ADO II) for closure of coronary artery fistula (CAF). Methods From April 1, 2011 to July 15, 2012, 5 patients (3 males, 2 females) aged from 3 years to 27 years (median age 5 years) underwent CAF closure with the ADO II. We evaluated early and short-term results. Results The devices (ADO II) were deployed via the femoral vein (3 cases), brachial artery (1 case) and radial artery (1 case). There were no complications during the procedures. Median fluoroscopy and procedural times were 20 and 39 min, respectively. Immediate trivial and mild residual shunt was present in one patient, respectively, but disappeared 24 hours after the procedure, and there was no recanalisation at a median follow-up of 6 months. Conclusions The new device ADO II was safely deployed with complete resolution of the CAF shunt with tortuous coronary artery to the drainage. The reduced sheath sizes and softer shape of this device allows for venous or arterial approach. The ADO II might be a preferable alternative for closure of small- tortuous CAFs.

MYOCARDIAL FAT DEPOSITION IN DILATED CARDIOMYOPATHY–ASSESSMENT BY USING MR WATER-FAT SEPARATION IMAGING

Objectives To prospectively investigate the prevalence of fat deposition in dilated cardiomyopathy (DCM) by fat-water separation imaging. An auxiliary aim was to determine the relationship between LV fat deposition and characteristic myocardial fibrosis, as well as cardiac functional parameters. Methods Forty-eight patients with DCM were scanned on a 1.5 T MR scanner (MAGNETOM Avanto, Siemens, Germany) after written informed consent was obtained. The MR scan protocols included a series of short-axis LV cine imaging for functional analysis, fat-water separation imaging using VARPRO, and late gadolinium enhanced (LGE) imaging for fibrosis. Fat-water separation imaging was covered the entire LV myocardium. Fat deposition and fibrosis location were compared to the scar regions on LGE images using 17-segment model. Statistical comparisons of LV global functional parameters, fibrosis volumes, and fat deposition were carried out using the Pearson correlation, student t test and multiple regressions. Results A fat deposition prevalence of 29.2% (14/48) was found in areas of DCM. The patients with fat deposition had larger myocardial fibrosis (27.0±15.1u2005cm3 vs 12.8±6.1u2005cm3; p<0.01), larger LVEDV (267.8±48.8u2005ml vs 201.6±46.5, p<0.01) and decreased LV ejection fraction (19.5%±8.4 vs 29.0%±12.1; p<0.01). The volume of fat deposition was correlated with scar volume, LV ejection fraction, LV end-diastolic volume index, and LV end-systolic volume index. Conclusions Fat deposition is quite a common phenomenon in DCM. And it is associated with DCM characteristics such as fibrosis volume and LV function.

EFFECTS OF AUTOLOGOUS BONE MARROW MONONUCLEAR CELLS TRANSPLANTATION VIA CORONARY ARTERY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION ASSESSED BY MRI

Objectives The aim of this study was to use an ‘one-stop’ non-invasive imaging examination-MRI to evaluate the feasibility and safety of aBM-MNC transplantation in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention. Methods We did a randomised, double-blind, placebo-controlled study in 60 patients (male=43, female=17, age 52.18±4.98u2005years) with AMI. The patients were randomly divided into 2 groups (group A: PCI+ aBM-MNC, group B: PCI only). Preoperative global left ventricular functions and scar tissue were measured by MRI. The therapeutic effects were assessed by MRI 6-month after aBM-MNC transplantation. Results ALL the patients were treated without major complications. There is no evidence of new ventricular arrhythmia or neoplasia. The LVEF was improved 28.5% in group A, while 18.4% in group B (p<0.01), LVEDV/m2 and LVESV/m2 were decreased by 21.15±3.96u2005ml/m2 and 27.14±4.48, respectively, which were significantly different from that in group B (5.85±6.18u2005ml (p=0.08) and 9.18±4.84 (p=0.04)). The cardiac output (CO), cardiac index (CI) and cardiac mass (CM) didnt show significant difference between the two groups. Compared with group B, aBM-MNC group was associated with no significant reduction in myocardial infarct size (15.3% vs 12.7%, p=0.51). Conclusions Comprehensive in vivo CMR reveals reversed remodelling and improved systolic function and scar characteristics after aBM-MNC transplantation. PCI+aBM-MNC transplantation can lead to comparable improvements of left ventricle in acute myocardial infraction.