Comportamiento mecánico ante la sobrexpansión de stents de cromo-cobalto comparados con stents de acero inoxidable, implantados en la aorta abdominal de conejos hipercolesterolémicos

Introducción: La fisiopatología de la disfunción diastólica del ventrículo izquierdo incluye alteraciones de la relajación ventricular, rigidez elástica pasiva o una combinación de ambos mecanismos. Mediante el eco-Doppler es posible evaluar parámetros relacionados con la relajación ventricular, pero no de la rigidez elástica pasiva. El estrés parietal diastólico evalúa la rigidez elástica pasiva a través de la disminución de la compresión del miocardio al final de la diástole. Objetivo: Evaluar la rigidez elástica pasiva mediante el estrés parietal diastólico en pacientes con estenosis aórtica grave con fracción de eyección preservada y su relación con la presencia de insuficiencia cardíaca grado III-IV. Material y métodos: Se estudiaron 76 pacientes (edad promedio 67 ± 11 años) portadores de estenosis aórtica grave (índice de área valvular aórtica <0,6 cm2/m2) y fracción de eyección mayor o igual al 50%. El estrés parietal diastólico fue calculado como: (espesor sistólico de pared posterior – espesor diastólico) / espesor sistólico en modo M. Se calculó por métodos no invasivos la relación E/e´, presión de fin de diástole y presión de fin de diástole / volumen de fin de diástole. Los pacientes fueron ordenados en 2 grupos: Grupo 1: insuficiencia cardíaca grado III - IV (n = 5 pacientes) y Grupo 2: sin insuficiencia cardíaca (n = 71 pacientes). Resultados: Los pacientes del grupo 1 presentaron mayor alteración de la rigidez elástica pasiva evidenciada por disminución del estrés parietal diastólico (0,23 ± 0,05 vs. 0,30 ± 0,06 p < 0,01), mayor incremento de E/e´ (20 ± 7 vs. 14 ± 8 p < 0,05), presión de fin de diástole y presión de fin de diástole / volumen de fin de diástole. Conclusión: El estrés parietal diastólico permitiría objetivar alteraciones de la rigidez elástica pasiva en pacientes con estenosis aórtica grave, fracción de eyección preservada e insuficiencia cardíaca que no pueden ser evaluadas mediante los parámetros de función diastólica habituales.Objectives: The aim of this study was to analyze the behavior to overexpansion of cobalt chromium stents compared with stainlesssteel stents.Methods: Twenty New Zealand rabbits were used, fed with a diet supplemented with 1% cholesterol. Animals were divided into twogroups. Group 1 (n=10) received 3.0 mm cobalt chromium stents overexpanded at 20 atmospheres and group 2 (n=10) 3.5 mm stentsdeployed at 10 atmospheres. These stents were compared with a previous series of 20 animals with stainless steel stents, dividedinto the same two groups. A third group with conventional diet was used as control. Intravascular ultrasound (IVUS) was performedto assess the degree of elastic recoil and also the degree of symmetry using ?intertrust angles?.Results: In group 1 of cobalt chromium stents, mean elastic recoil was 0.11±0.13 mm, (3.21% recoil) and in group 2 this was0.3±0.12 mm, (8.26% recoil) (p=0.002). In group 1 of stainless steel stents mean elastic recoil was 0.28±0.18 mm (8.21% recoil) andin group 2 this was 0.10±0.11 mm (2.79% recoil) (p <0.001).Conclusions: In cobalt chromium stents, elastic recoil was lower in overexpanded stents, whereas in stainless steel stents, elasticrecoil was higher in overexpanded stents. No differences in symmetry were observed between the different groups.Fil: Fernandez, Alejandro. Hospital Italiano; ArgentinaFil: Mele, Esteban. Hospital Italiano; ArgentinaFil: Renou, Sandra Judith. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patológica; ArgentinaFil: Olmedo, Daniel Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patológica; ArgentinaFil: Berrocal, Daniel. Hospital Italiano; ArgentinaFil: Gelpi, Ricardo Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patológica; Argentin

Deep motion tracking from multiview angiographic image sequences for synchronization of cardiac phases

In the diagnosis and interventional treatment of coronary artery disease, the 3D+time reconstruction of the coronary artery on the basis of x-ray angiographic image sequences can provide dynamic structural information. The synchronization of cardiac phases in the sequences is essential for minimizing the influence of cardiorespiratory motion and realizing precise 3D+time reconstruction. Key points are initially extracted from the first image of a sequence. Matching grid points between consecutive images in the sequence are extracted by a multi-layer matching strategy. Then deep motion tracking (DMT) of key points is achieved by local deformation based on the neighboring grid points of key points. The local deformation is optimized by the Random sample consensus (RANSAC) algorithm. Then, a simple harmonic motion (SHM) model is utilized to distinguish cardiac motion from other motion sources (e.g. respiratory, patient movement, etc). Next, the signal which is composed of cardiac motions is filtered by a band-pass filter to reconstruct the cardiac phases. Finally, the synchronization of cardiac phases from different imaging angles is realized by a piece-wise linear transformation. The proposed method was evaluated using clinical x-ray angiographic image sequences from 13 patients. 85% matching points can be accurately computed by the DMT method. The mean peak temporal distance (MPTD) between the reconstructed cardiac phases and the electrocardiograph signal is 0.027 s. The correlation between the cardiac phases of the same patient is over 89%. Compared with three other state-of-the-art methods, the proposed method accurately reconstructs and synchronizes the cardiac phases from different sequences of the same patient. The proposed DMT method is robust and highly effective in synchronizing cardiac phases of angiographic image sequences captured from different imaging angles

Aortic arch tortuosity with PHACE syndrome : a rare case scenario

PHACE syndrome is a rare neurocutaneous disorder characterised by an association of infantile haemangiomas with structural anomalies of brain, cerebral vasculature, eye, aorta and chest wall.1 Coarctation of aorta (COA) is most the common cardiac anomaly reported in PHACE syndrome. COA or interrupted aortic arch in PHACE is unique and complex both in location and character compared to the typical coarctation anatomy. Arterial tortuosity of the cerebral vasculature has been well described in literature in PHACE syndrome. We present a rare case of tortuous aortic arch continuing as descending aorta in an infant with PHACE syndrome.peer-reviewe

Coronary angiography enhancement for visualization

High quality visualization on X-ray angiograms is of great significance both for the diagnosis of vessel abnormalities and for coronary interventions. Algorithms for improving the visualization of detailed vascular structures without significantly increasing image noise are currently demanded in the market. A new algorithm called stick-guided lateral inhibition (SGLI) is presented for increasing the visibility of coronary vascular structures. A validation study was set up to compare the SGLI algorithm with the conventional unsharp masking (UM) algorithm on 20 still frames of coronary angiographic images. Ten experienced QCA analysts and nine cardiologists from various centers participated in the validation. Sample scoring value (SSV) and observer agreement value (OAV) were defined to evaluate the validation result, in terms of enhancing performance and observer agreement, respectively. The mean of SSV was concluded to be 77.1 ± 11.9%, indicating that the SGLI algorithm performed significantly better than the UM algorithm (P-value < 0.001). The mean of the OAV was concluded to be 70.3%, indicating that the average agreement with respect to a senior cardiologist was 70.3%. In conclusion, this validation study clearly demonstrates the superiority of the SGLI algorithm in the visualization of coronary arteries from X-ray angiograms

Quantification of fractional flow reserve based on angiographic image data

Coronary angiography provides excellent visualization of coronary arteries, but has limitations in assessing the clinical significance of a coronary stenosis. Fractional flow reserve (FFR) has been shown to be reliable in discerning stenoses responsible for inducible ischemia. The purpose of this study is to validate a technique for FFR quantification using angiographic image data. The study was carried out on 10 anesthetized, closed-chest swine using angioplasty balloon catheters to produce partial occlusion. Angiography based FFR was calculated from an angiographically measured ratio of coronary blood flow to arterial lumen volume. Pressure-based FFR was measured from a ratio of distal coronary pressure to aortic pressure. Pressure-wire measurements of FFR (FFRP) correlated linearly with angiographic volume-derived measurements of FFR (FFRV) according to the equation: FFRP = 0.41 FFRV + 0.52 (P-value < 0.001). The correlation coefficient and standard error of estimate were 0.85 and 0.07, respectively. This is the first study to provide an angiographic method to quantify FFR in swine. Angiographic FFR can potentially provide an assessment of the physiological severity of a coronary stenosis during routine diagnostic cardiac catheterization without a need to cross a stenosis with a pressure-wire

Characterization and Normal Measurements of the Left Ventricular Outflow Tract by ECG-gated Cardiac CT: Implications for Disorders of the Outflow Tract and Aortic Valve.

RATIONALE AND OBJECTIVES: Studies suggest that electrocardiographically gated coronary computed tomographic angiography provides a clear definition of the left ventricular outflow tract (LVOT), and normal LVOT morphology may not be round, as assumed when the continuity equation is applied during echocardiography. The aims of this study were to demonstrate the morphology of the LVOT on coronary computed tomographic angiography and to establish normal values for LVOT measurements. MATERIALS AND METHODS: Two independent readers retrospectively measured anterior-posterior (AP) and transverse diameters of the LVOT and performed LVOT planimetry on coronary computed tomographic angiographic studies of 106 consecutive patients with normal aortic valves. RESULTS: Excellent interobserver agreement was observed for all measurements (r = 0.78-0.94). The LVOT was ovoid, with a larger transverse diameter than AP diameter during diastole and systole (P \u3c .001). However, the ratio of AP diameter to transverse diameter was closer to 1.0 during systole (P \u3c .001). Mean indexed LVOT area was minimally larger in systole than in diastole (P = .01-.04) and was larger in men than in women during diastole (P ≤ .001) and systole (P ≤ .01). Mean LVOT area indexed to body surface area was 2.3 ± 0.5 cm(2)/m(2) in women and 2.6 ± 0.7 cm(2)/m(2) in men. LVOT area demonstrated significant correlation with aortic root diameter. CONCLUSIONS: The normal LVOT is ovoid in shape. LVOT is more circular during systole, but the AP diameter remains smaller than the transverse diameter throughout the cardiac cycle. The oval shape of the LVOT has important implications when LVOT area is calculated from LVOT diameters. Normal LVOT area values established in this study should facilitate diagnosis of the fixed component of LVOT obstruction