Coregistered MR imaging myocardial viability maps and multi-detector row CT coronary angiography displays for surgical revascularization planning: initial experience

PURPOSE: To evaluate assignment of left ventricular (LV) myocardial segments to coronary arterial territories by using coregistered magnetic resonance (MR) imaging and multi-detector row computed tomography (CT) displays; to assess the accuracy of coregistered displays in determining the distribution of clinically important coronary artery disease (CAD) and regional effect of CAD on LV myocardium in patients with chronic ischemic heart disease (CIHD); and to determine the utility of coregistered displays in optimizing surgical revascularization planning. MATERIALS AND METHODS: This study was HIPAA compliant and was approved by the local Institutional Review Board, with waiver of informed consent. Twenty-six patients (19 men, seven women; age, 56 years +/- 12 [+/- standard deviation]) with CIHD underwent MR imaging assessment of myocardial viability and multi-detector row CT assessment of CAD on the same day. For coregistration, a population-based LV model was fit to each data set separately; models were then registered spatially. For data analysis, correspondence between coregistered displays and the 17-segment LV model for assessment of CIHD was evaluated, accuracy of using coregistered displays to evaluate the extent of CAD and myocardial disease was assessed, and utility of coregistered displays in optimizing surgical revascularization planning was determined. RESULTS: Coronary assignment for coregistered displays and the 17-segment LV model differed in 17% of myocardial segments. For the majority of patients, three segments (midanterolateral [62%], apical lateral [73%], and apical inferior [58%]) were discordant. Segments were supplied by the left anterior descending artery, a diagonal branch, or a ramus intermedius with diagonal distribution in all but one case. Coregistered displays were deemed concordant with selective coronary angiography and alternate myocardial imaging in all cases. Overall, surgical planning was potentially enhanced in 83% of cases because, compared with alternate imaging modalities, coregistered displays were believed to demonstrate the relationship between coronary arteries and underlying myocardial tissue more definitively and efficiently (for patients in whom surgery was performed) or more correctly and comprehensively (for a presumably better-tailored surgery). CONCLUSION: Assessment of CIHD can be improved by using coregistered displays that directly relate the condition of LV myocardium to the anatomy of the coronary arteries in individual patients.     

The ultimate development of mitral valve endocarditis: atrioventricular separation, atrioventricular groove abscess and hemorrhagic pericarditis

A 52-year-old non-insulin-dependent diabetic man presented with cerebral emboli and mitral valve endocarditis with posterior leaflet vegetations and perforation. Surgical intervention demonstrated hemorrhagic pericarditis and an atrioventricular groove abscess. Extensive debridement of the pericardium, valve and abscess cavities, reconstruction of the mitral annulus with a patch of fresh autologous pericardium, and mitral valve replacement with a pericardial bioprosthesis was performed. The chest was left open. Postoperatively, the patient required dialysis and prolonged mechanical ventilation, but recovered well without recurrent endocarditis and was discharged home after 40 days.     

Characteristics and outcomes of patients with postoperative cardiovascular pseudoaneurysms

Background

Data regarding long-term outcomes in cardiovascular pseudoaneurysms are sparse. In patients with prior cardiovascular surgery, we sought to assess characteristics and outcomes in patients with cardiovascular pseudoaneurysms (excluding ischemic left ventricular pseudoaneurysms).

Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer

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Single Layer Broadband Anti-Reflective Coatings for Plastic Substrates Produced by Full Wafer and Roll-to-Roll Step-and-Flash Nano-Imprint Lithography

Anti-reflective coatings (ARCs) are used to lower the reflection of light on the surface of a substrate. Here, we demonstrate that the two main drawbacks of moth eye-structured ARCs—i.e., the lack of suitable coating materials and a process for large area, high volume applications—can be largely eliminated, paving the way for cost-efficient and large-scale production of durable moth eye-structured ARCs on polymer substrates. We prepared moth eye coatings on polymethylmethacrylate (PMMA) and polycarbonate using wafer-by-wafer step-and-flash nano-imprint lithography (NIL). The reduction in reflection in the visible field achieved with these coatings was 3.5% and 4.0%, respectively. The adhesion of the coating to both substrates was good. The moth eye coating on PMMA demonstrated good performance in three prototypical accelerated ageing tests. The pencil hardness of the moth eye coatings on both substrates was <4B, which is less than required for most applications and needs further optimization. Additionally, we developed a roll-to-roll UV NIL pilot scale process and produced moth eye coatings on polyethylene terephthalate (PET) at line speeds up to two meters per minute. The resulting coatings showed a good replication of the moth eye structures and, consequently, a lowering in reflection of the coated PET of 3.0%.