671 research outputs found

    Central Cardiovascular Anatomy and Function in Crocodilia

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    Abstract: Among the vertebrates, crocodilians have the most complex anatomy of the heart and outflow channels. Their cardiovascular anatomy may also be the most func­tionally sophisticated, combining as it does the best features of both reptilian and mammalian (and avian) systems. The puzzlingly complex "plumbing" of crocodilians has fascinated ana­tomists and physiologists for a very long time, the first paper being that by Panizza (1833). Gradually, with the application of successive techniques of investigation as they became available, its functional significance has become reasonably clear, and the complexity is now revealed as a cardiovascular system of considerable elegance. In this paper I will review the main anatomical features of the heart and outflow channels, discuss what is known about the way they work, and speculate about the probable functional significance

    3D Printing Cardiovascular Anatomy: A Single-Centre Experience

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    This chapter presents the experience of the cardiac engineering team within the Centre for Cardiovascular Imaging at Great Ormond Street Hospital for Children (London, UK) in using three-dimensional (3D) printing technology. 3D models can serve different functions towards implementing a patient-specific approach for studying and potentially treating congenital heart disease (CHD). In order to showcase different potential applications, this chapter discusses not only clinical case studies and engineering experiments but also the potential for translation through patients and public involvement and engagement (PPI/E)

    Interdisciplinarity and patient engagement:new representations of cardiovascular anatomy

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    Background: This article presents and discusses the genesis, making and public presentation of two artworks by British artist Sofie Layton, namely Blueprints and The Bud, which explore the anatomy of the heart infusing it with experiential and narrative elements. Methods: Artist-led workshops with a range of audiences (cardiac patients, medical staff, medical students, creative professionals, and patient relatives) led to explore narratives and imagery that, in turn, was re-presented in artworks exploring the complexity of the cardiovascular system. Results: While positioning themselves in a long tradition of artistic representations of the heart, often purely anatomical or autobiographical, these artworks stem from a process of patient involvement and participation. Integral to the pieces is an interdisciplinary approach, which is central to arts-and-health collaborations. Conclusions: At a time in which the role of the arts in improving health and wellbeing is increasingly recognised and supported by evidence, these artworks offer an opportunity to reflect not only on ways of representing cardiovascular anatomy, but also on its experiential value and on the important of patient engagement and involvement

    Interrupted Aortic Arch in an Adult

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    Interrupted aortic arch (IAA) is a rare congenital abnormality with only a few cases reported in adults. It is defined as complete loss of continuity between the ascending and descending portions of the aorta, and is usually associated with other cardiac defects. The diagnosis in adults should be suspected in the presence of refractory hypertension, a careful physical examination being crucial to early diagnosis. Magnetic resonance angiography (MRA) techniques can accurately characterize cardiovascular anatomy, and also provide information regarding heart chamber and valve function

    Feasibility of non-gated dynamic fetal cardiac MRI for identification of fetal cardiovascular anatomy

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    INTRODUCTION To evaluate the feasibility of identifying the fetal cardiac and thoracic vascular structures with non-gated dynamic balanced steady-state free precession (SSFP) MRI sequences. METHODS We retrospectively assessed the visibility of cardiovascular anatomy in 60 fetuses without suspicion of congenital heart defect. Non-gated dynamic balanced SSFP sequences were acquired in three anatomic planes of the fetal thorax. The images were analyzed following a segmental approach in consensus reading by an experienced pediatric cardiologist and radiologist. An imaging score was defined by giving one point to each visualized structure, yielding a maximum score of 21 points. Image quality was rated from 0 (poor) to 2 (excellent). The influence of gestational age (GA), field strength, placenta position, and maternal panniculus on image quality and imaging score were tested. RESULTS 30 scans were performed at 1.5T, 30 at 3T. Heart position, atria and ventricles could be seen in all 60 fetuses. Basic diagnosis (>12 points) was achieved in 54 cases. The mean imaging score was 16.8+/-3.8. Maternal panniculus (r=-0.3; p=0.015) and gestational age (r=0.6; p<0.001) correlated with imaging score. Field strength influenced image quality, with 1.5T being better than 3T images (p=0.012). Imaging score or quality were independent of placenta position. DISCUSSION/CONCLUSION Fetal cardiac MRI with non-gated SSFP sequences enables recognition of basic cardiovascular anatomy

    Echocardiography curriculum development for physician assistants using entrustable professional activities

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    BACKGROUND: With the projected increase of cardiovascular disease in the aging population, a higher demand for echocardiography use is predicted. However, there is a shortage in the supply of cardiologists, to the point that a 2009 American College of Cardiology survey report called it a "cardiology workforce crisis". The report also recommends a more aggressive use of PAs and NPs as one of the solutions to fill the shortage. Currently, echocardiography is not routinely included in the scope of practice for PAs in cardiology. While PAs attain strong basic science knowledge and clinical training experience in PA school, they typically do not receive additional formal postgraduate training. PAs have limited training opportunities to train in echocardiography and receive certification of recognition, but a formally standardized training program and certifying examination geared specifically for PAs are yet to be developed. This study seeks to develop a pilot curriculum in training echocardiography which can be standardized for utilization across various regions and medical subspecialties. The curriculum draws on the concept of Entrustable Professional Activities (EPA), which is being actively used in graduate medical education. HYPOTHESIS: After participating in the proposed pilot curriculum which involves online didactic learning and supervised hands-on clinical training, trained PAs will be able to reach proficiency in echocardiography operation and interpretation at level 4 supervision according to the EPA guidelines. METHODS: This study proposes a pilot curriculum with framework based on the EPA titled ‚Äúperforming and interpreting echocardiography‚ÄĚ by PAs. The curriculum involves didactic and clinical training in echocardiography, with the goal to achieve mastery of level 4 supervision (minimal supervision). 2 subjects will be recruited from a teaching medical institution in the Greater Boston area with an IAC accredited echocardiography laboratory. After the 12-month training, participants will take ASCeXAM/ReASCE Online Practice Exam Simulation offered by the ASE. Upon 1) achievement of individualized EPAs as assessed by supervisor, and 2) simulation exam score of >80%, participants will earn a STAR in echocardiography. CONCLUSION: The study is the first step to establishing an effective training curriculum that will eventually be a basis for creating a certifying exam in echocardiography, designed specifically for PAs. As this study merely suggests a new curriculum, future studies should focus on identifying strengths and weaknesses of the curriculum after implementation and expansion to multiple sites, and gather data to use for continual improvement of the training curriculum

    Dysphagia in an adult tetralogy of fallot with double aortic arch

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    Double aortic arch (DAA) is a common vascular ring. It may occur in isolation or coexist with various types of congenital heart disease . The anomaly usually presents in early infancy. This reports a 23yr old male presenting with dysphagia, who was found to have a double aortic arch and tetralogy of Fallot .Both lesions were successfully corrected surgically.peer-reviewe

    Research in Progress

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    Updates on research conducted by the Boston University School of Medicin

    GridNet with automatic shape prior registration for automatic MRI cardiac segmentation

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    In this paper, we propose a fully automatic MRI cardiac segmentation method based on a novel deep convolutional neural network (CNN) designed for the 2017 ACDC MICCAI challenge. The novelty of our network comes with its embedded shape prior and its loss function tailored to the cardiac anatomy. Our model includes a cardiac centerof-mass regression module which allows for an automatic shape prior registration. Also, since our method processes raw MR images without any manual preprocessing and/or image cropping, our CNN learns both high-level features (useful to distinguish the heart from other organs with a similar shape) and low-level features (useful to get accurate segmentation results). Those features are learned with a multi-resolution conv-deconv "grid" architecture which can be seen as an extension of the U-Net. Experimental results reveal that our method can segment the left and right ventricles as well as the myocardium from a 3D MRI cardiac volume in 0.4 second with an average Dice coefficient of 0.90 and an average Hausdorff distance of 10.4 mm.Comment: 8 pages, 1 tables, 2 figure
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