Mathematical three-dimensional solid modeling of biventricular geometry

The characterization of regional myocardial stress distribution has been limited by the use of idealized mathematical representations of biventricular geometry. State-of-the-art computer-aided design and engineering (CAD/CAE) techniques can be used to create complete, unambiguous mathematical representations (solid models) of complex object geometry that are suitable for a variety of applications, including stress-strain analyses. We have used advanced CAD/CAE software to create a 3-D solid model of the biventricular unit using planar geometric data extracted from anex vivo canine heart. Volumetric analysis revealed global volume errors of 4.7%, −1.3%, −1.6%, and −1.1% for the left ventricular cavity, right ventricular cavity, myocardial wall, and total enclosed volumes, respectively. Model errors for 34 in-plane area and circumference determinations (mean ±SD) were 5.3±6.7% and 3.8±2.7%. Error analysis suggested that model volume errors may be due to operator variability. These results demonstrate that solid modeling of theex vivo biventricular unit yields an accurate mathematical representation of myocardial geometry which is suitable for meshing and subsequent finite element analysis. The use of CAD/CAE solid modeling in the representation of biventricular geometry may thereby facilitate the characterization of regional myocardial stress distribution.     

Changes in the incidence and duration of ventricular fibrillation in dependence on the extraneuronal accumulation of isoprenaline in the perfused rat heart

Summary The relationship between the accumulation of isoprenaline and the incidence and duration of ventricular fibrillation was investigated in the perfused rat heart. Isolated rat hearts were perfused with ³H-isoprenaline (1 mol/l) for 30 min at a constant flow rate of 6.5 ml/min at a temperature between 40 and 41° C. Electrocardiograms were recorded during the perfusion period and the isoprenaline content of the tissue was measured after the perfusion. The accumulation of isoprenaline was significantly increased and the duration of ventricular fibrillation was significantly prolonged by the presence of tropolone (100 mol/l). When extraneuronal uptake inhibitors such as normetanephrine (100 mol/l), 3-O-methylisoprenaline (100 mol/l) or phenoxybenzamine (1 mol/l) were added to the perfusion fluid containing ³H-isoprenaline (1 mol/l) and tropolone (100 mol/l), the accumulation of isoprenaline was sifnificantly decreased, the incidence of ventricular fibrillation was significantly reduced and the duration of ventricular fibrillation was significantly shortened. There was a significant correlation for dependence of duration of ventricular fibrillation on the isoprenaline content of rat hearts perfused with various extraneuronal uptake inhibitors in the presence of tropolone (correlation coefficient [r]=0.62, P<0.001).These results indicate that the accumulation of isoprenaline in perfused rat hearts relates to the occurrence and duration of ventricular fibrillation.This study was supported in part by a Grant-in-Aid for Scientific Research (59570980) from the Ministry of Education, Science and Culture, Japan     

Measurement of left-ventricular volumes using an internal standard

When performing equilibrium radionuclide angiocardiography with two successive acquisition views, absolute left-ventricular volumes can be calculated using an internal standard generated by a computer in the left-ventricular cavity. The method is based on the computed ratio of maximum to global activity in the 40°-left-anterior-oblique view after background correction and on the measured depth of the left ventricle in almost-orthogonal, 30°-left-posterior-oblique Fourier first-harmonic images. The method does not require blood sampling or correction for self attenuation. The intra- and interobserver reproducibility is excellent, even in patients with severe impairment of the ventricular-contractility pattern. When compared with a classical method requiring venous-blood counting and an attenuation correction factor, the accuracy of the internalstandard method was fairly good, with a regression coefficient of 0.90.     

Ventricular tachycardia as a complication of annular subvalvular ventricular aneurysm in a Caucasian woman

A Caucasian female patient with repetitive attacks of ventriculartachycardia and fibrillation caused by annular submitral leftventricular aneurysm is reported. During a follow-up periodof six years after aneurysmectomy, the patient remained symptom-free.     

Dopamine in the conscious dog with chronic heart-block

Summary The chronotropic effects of dopamine were studied in the conscious dog with chronic A-V block. Dopamine at 12.5–200 g/kg and 12.5–50 g/kg/min lowered atrial rate independently of dose. After blockade of muscarine receptors or alpha-adrenoceptors, it raised atrial rate. After blockade of dopamine receptors, dopamine still lowered atrial rate, and did so dose-relatedly after blockade of beta-adrenoceptors. It raised ventricular rate, and at high doses also induced ventricular rhythm disorders. Blockade of muscarine receptors enhanced the ventricular cardioaccelerator effect of dopamine (P<0.025) at 100 g/kg, while blockade of alpha-adrenoceptors reduced it (P<0.05). Blockade of dopamine receptors did not modify this effect, but blockade of beta-adrenoceptors reversed it. Dopamine at 25–200 g/kg raised mean blood pressure. This effect was enhanced by blockade of muscarine receptors, reversed by blockade of alpha-adrenoceptors, and was unaffected by blockade of beta-adrenoceptors or dopamine receptors. These results show that the atrial cardiomoderator effect of dopamine is a vagal reflex response to its hypertensive action, and that it is limited by its direct beta-adrenergic stimulating action. They also show that the ventricular cardioaccelerator effect of dopamine is attenuated by a reflex vagal depressor effect consequent to the induced hypertension. No evidence was found for the existence of positive chronotropic dopamine receptors in either atria or ventricles.A preliminary report of these findings was presented at the Symposium on Peripheral Dopaminergic Receptors, July 1978, in Strasbourg, France (Boucher et al. 1979b)     

急性心肌梗塞Q－T离散度分析－－附68例临床报告

目的：探讨急性心肌梗塞（AMI）患首次心电图Q－T离散度（Q－Td)及Q－Tc离散度（Q－Tcd）与严重室性心律失常发生的关系,对预后进行评估。方法：对68例AMI患首次心电图Q－Td及Q－Tcd进行测定。结果：18例AMI并室速室颤组患Q－Td,Q－Tcd显高于50例非室速室颤组患;结论：AMI患Q－Td及Q－Tcd值增大,室速室颤发生率增加,两呈正相关关系,易发生心源性猝死。故Q－Td及Q－Tcd可作为AMI病情危重预后差的标志,对判断预后有重要临床意义。     

肺静脉血流频谱评价高血压患者的左心室舒张功能

目的　探讨肺静脉血流频谱评价高血压患者左心室舒张功能的价值。　方法　选择 3 0例无心脏疾患者、3 0例高血压无左心房扩大者 ,2 5例高血压左心房扩大者共 85例为研究对象 ,用多普勒超声心动图检测各组肺静脉血流频谱 (PVFP)和二尖瓣血流频谱 (MVFP)参数并做比较。　结果　与正常对照组比较 ,高血压无左房扩大组PVFP中S峰速度加快 ,D峰速度减慢 ,S/D >1 ,AR峰明显加快 ,两组之间有明显差异 (P <0 .0 1 ) ;MVFP中E峰降低 ,A峰增加 ,E峰减速时间 (EDT)延长 ,E/A <1。与正常组对照 ,高血压左心房扩大组PVFP中的S峰降低 ,D峰降低 ,S/D <1 ,但AR峰明显的加速 ,两组之间也有明显的差异 (P <0 .0 1 ) ;MVFP中E峰、A峰、E/A比值和EDT两组近似 (P >0 .0 5 )。　结论　肺静脉血流频谱结合二尖瓣血流频谱能较全面地评价高血压患者的左心室舒张功能。     

The evaluation of intracranial bypass patency in neurosurgical practice

BackgroundThe patency of cranial bypasses must be carefully evaluated during and after the microsurgical procedure. Although, several imaging techniques are used to evaluate the patency of bypasses, their findings are sometimes difficult to interpret.PurposeThe goal of this study was to assess the consistency of different diagnostic modalities for evaluating intracranial bypass patency.Patients and methodThis prospective study included 19 consecutive patients treated with EC-IC or IC-IC bypass for MoyaMoya disease (MMD) or complex/giant aneurysms between June 2016 and June 2018. In the early postoperative period (< 7 days), all patients had transcranial Doppler (TCD), CT angiography (CTA) and MRA to demonstrate patency of anastomoses and to confirm exclusion of the aneurysm. When findings of anastomosis patency differed between these techniques, conventional angiography was performed.ResultsAll anastomoses were patent on indocyanine green videoangiography at the end of microsurgical procedure. The results of noninvasive postoperative exams were consistent to demonstrate the patency of anastomoses in 13 patients. In 4 patients, a discrepancy in patency of anastomoses arose between TCD, CTA and MRI in the early postoperative period. In 2 other patients, the interpretation of bypass patency remained inconclusive before the decision to occlude the aneurysm. In these 6 patients, a significant edema was noted in 2 cases, a postoperative subdural hematoma in 1 case, a low flow in the anastomosis in 1 case and vasospasm in 2 cases. The anastomosis was patent on the conventional angiography in five patients.ConclusionNoninvasive imaging techniques provide useful data about the patency but their findings should be carefully interpreted due to local anatomical, physiological, and pathological factors. In case of discrepant findings, conventional angiography including supraselective catheterization of the donor vessel is suggested.     

Left ventricular mass index and ventricular contractility improvement in patients with severe obesity following rapid weight loss after bariatric surgery

BackgroundObesity is a well-known risk factor for heart disease, resulting in a broad spectrum of cardiovascular changes. Left ventricular mass (LVM) and contractility are recognized markers of cardiac function.ObjectivesTo determine the changes of LVM and contractility after bariatric surgery (BaS).SettingUniversity hospital, United StatesMethodsTo determine the cardiac changes in ventricular mass, ventricular contractility, and left ventricular shortening fraction (LVSF), we retrospectively reviewed the 2-dimensional echocardiographic parameters of patients with obesity who underwent BaS at our institution. We compared these results before and after BaS.ResultsA total of 40 patients met the inclusion criteria. The majority were females (57.5%; n = 23), with an average age of 63.5 ± 12.1. The excess body mass index (BMI) lost at 12 months was 48.9 ± 28.9%. The percent total weight loss after BaS was 16.46 ± 9.9%. The left ventricular mass was 234.9 ± 88.1 grams before and 181.5 ± 52.7 grams after BaS (P = .002). The LVM index was 101.3 ± 38.3 g/m² before versus 86.7 ± 26.6 g/m² after BaS (P = .005). The LVSF was 31% ± 8.8% before and 36.3% ± 8.2% after BaS (P = .007). We found a good correlation between the decrease in LVM index and the BMI after BaS (P = .03).ConclusionRapid weight loss results in a decrease of the LVM index, as well as improvement in the left ventricular muscle contractility. Our results suggest that there is left ventricular remodeling and an improvement of heart dynamics following bariatric surgery. Further studies are needed to better assess these findings.     

使用自相关和时间序列检测的方法检测心室纤颤信号

心室纤颤信号必须准确而及时地识别,如果不使用除颤器及时进行除颤,病人会迅速死亡。另一方面,如果心室纤颤信号没有发生,而误判为心室纤颤信号,给予电击,则病人的心脏受到不应有的损伤,这也属于严重的医疗事故。因此快速与准确的识别显得十分重要。自70年代以来,世界上许多科学家都在探讨各种方法,以期望使用计算机自动识别心室纤颤信号,但均因达不到实时判别的要求或准确率不够高而不能用于自动除颤器检测的设计方案。本文介绍了一种准确率高而又较简易的快速识别法。这一方法是取一秒心电信号,进行有限长度离散信号的自相关,然后对该自相关函数作零切割,让自相关函数变成一串二进制脉冲串,接着以一秒信号的脉冲串数作为特征参数,设计分类器。经证明,心室纤颤信号(VF信号)(Ventricular Fibrillation)和心动过速信号(VT信号)(Ventricular Tachycar-dia)的特征参数均属于高斯分布。因此可用Wald时间序列检测方法对VF信号和VT信号分类。这个算法可用于计算机进行实时处理和分析,同时此法与取样率无关,适用于各种取样系统,是一个较理想的方法。