Congenital ventricular aneurysm is a very rare cardiac anomaly.A diagnosis can be made during the prenatal period using fetal echocardiography.This study presents a very rare apically located left ventricular aneurysm...Congenital ventricular aneurysm is a very rare cardiac anomaly.A diagnosis can be made during the prenatal period using fetal echocardiography.This study presents a very rare apically located left ventricular aneurysm case,and the relevant literature was reviewed and discussed.In this case,a 35-year-old,gravida 2,parity 1 preg-nant woman at 24 weeks of gestation,displayed a wide aneurysmal image in the left ventricular apical wall on fetal echocardiography.There was a 1.79 mm muscular ventricular septal defect at the apical region of the interven-tricular septum.In the course of the color Doppler ultrasonography examination,an aberrantfibrous band within the left ventricle and consequent turbulentflow during systole were observed.The baby,born via cesarean section at 37 weeks of gestation,is now in its postnatal seventh month.However,during echocardiographic follow-ups,changes have been observed,including mild to moderate mitral insufficiency and a decrease in systolic function.Despite thesefindings,the clinical condition remains asymptomatic.It is of great importance to use a multidis-ciplinary approach in managing these rare cases that could lead to potential adverse outcomes during the antena-tal or postnatal periods.展开更多
Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM ...Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM may present with an intraventricular or LV outflow tract obstruction,diastolic dysfunction,myocardial fibrosis and/or ventricular arrhythmias.Differentiating HCM from other diseases associated with LV hypertrophy,such as hypertension,aortic stenosis,or LV non-compaction(LVNC),can at times be challenging.LVNC is defined by excessive LV trabeculation and deep recesses between trabeculae,often accompanied by increased LV myocardial mass.Previous studies indicate that the LVNC phenotype may be observed in up to 5%of the general population;however,in most cases,it is a benign finding with no impact on clinical outcomes.Nevertheless,LVNC can occasionally lead to LV systolic dysfunction,manifesting as a phenotype of dilated or non-dilated left ventricular cardiomyopathy,with an increased risk of thrombus formation and arterial embolism.In extreme cases,where LVNC is associated with a very thickened LV wall,it can even mimic HCM.There is growing evidence of an overlap between HCM and LVNC,including similar genetic mutations and clinical presentations.This raises the question of whether HCM and LVNC represent different phenotypes of the same disease or are,in fact,two distinct entities.展开更多
BACKGROUND Double-chambered left ventricle(DCLV)is an extremely rare congenital disease in which the left ventricle(LV)is divided by abnormal muscle tissue.Due to its rarity,there is a lack of data on the disease,incl...BACKGROUND Double-chambered left ventricle(DCLV)is an extremely rare congenital disease in which the left ventricle(LV)is divided by abnormal muscle tissue.Due to its rarity,there is a lack of data on the disease,including its diagnosis,treatment,and prognosis.Accordingly,we report a case in which DCLV was diagnosed and followed up.CASE SUMMARY A 45-year-old man presented to our hospital due to abnormal findings on an electrocardiogram recorded during a health check.He had no specific cardiac symptoms,comorbidities or relevant past medical history.Echocardiography revealed that the LV was divided into two by muscle fibers.There were no findings of ischemia on coronary angiography and coronary computed tomography angiography performed to exclude differential diagnoses.After comprehensive analysis of the images,DCLV was diagnosed.As it seemed to be asymptomatic DCLV,we decided the patient was to be observed without administering any medication.However,follow-up echocardiography revealed a thrombus in the accessory chamber(AC).Anticoagulant medication was initiated,the thrombus resolved,and the patient is currently undergoing follow-up without any specific symptoms.CONCLUSION Asymptomatic,uncomplicated DCLV was diagnosed through multimodal imaging;however,a thrombus in the AC occurred during the follow-up.The findings highlight that multimodal imaging is essential in diagnosing DCLV,and that anticoagulation is important in its management.展开更多
The interpretability of deep learning models has emerged as a compelling area in artificial intelligence research.The safety criteria for medical imaging are highly stringent,and models are required for an explanation...The interpretability of deep learning models has emerged as a compelling area in artificial intelligence research.The safety criteria for medical imaging are highly stringent,and models are required for an explanation.However,existing convolutional neural network solutions for left ventricular segmentation are viewed in terms of inputs and outputs.Thus,the interpretability of CNNs has come into the spotlight.Since medical imaging data are limited,many methods to fine-tune medical imaging models that are popular in transfer models have been built using massive public Image Net datasets by the transfer learning method.Unfortunately,this generates many unreliable parameters and makes it difficult to generate plausible explanations from these models.In this study,we trained from scratch rather than relying on transfer learning,creating a novel interpretable approach for autonomously segmenting the left ventricle with a cardiac MRI.Our enhanced GPU training system implemented interpretable global average pooling for graphics using deep learning.The deep learning tasks were simplified.Simplification included data management,neural network architecture,and training.Our system monitored and analyzed the gradient changes of different layers with dynamic visualizations in real-time and selected the optimal deployment model.Our results demonstrated that the proposed method was feasible and efficient:the Dice coefficient reached 94.48%,and the accuracy reached 99.7%.It was found that no current transfer learning models could perform comparably to the ImageNet transfer learning architectures.This model is lightweight and more convenient to deploy on mobile devices than transfer learning models.展开更多
BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true a...BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true apex is occupied by the right ventricle.Due to the rarity of the disease,just a few case reports and limited case series have been published in the field.AIM To analysing the so far 37 reported ILVAH cases worldwide.METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13,2022.RESULTS The majority of cases reported occurred in males(52.7%).Mean age at diagnosis was 26.1±19.6 years.More than a third of the patients were asymptomatic(35.1%).The most usual clinical presentation was breathlessness(40.5%).The most commonly detected electrocardiogram changes were T wave abnormalities(29.7%)and right axis deviation with poor R wave progression(24.3%).Atrial fibrillation/flutter was detected in 24.3%.Echocardiography was performed in 97.3%of cases and cardiac MRI in 91.9%of cases.Ejection fraction was reduced in more than a half of patients(56.7%).An associated congenital heart disease was found in 16.2%.Heart failure therapy was administered in 35.1%of patients.The outcome was favorable in the vast majority of patients,with just one death.CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course,ranging from benign until the elderly to sudden death during adolescence.展开更多
The automatic localization of the left ventricle(LV)in short-axis magnetic resonance(MR)images is a required step to process cardiac images using convolutional neural networks for the extraction of a region of interes...The automatic localization of the left ventricle(LV)in short-axis magnetic resonance(MR)images is a required step to process cardiac images using convolutional neural networks for the extraction of a region of interest(ROI).The precise extraction of the LV’s ROI from cardiac MRI images is crucial for detecting heart disorders via cardiac segmentation or registration.Nevertheless,this task appears to be intricate due to the diversities in the size and shape of the LV and the scattering of surrounding tissues across different slices.Thus,this study proposed a region-based convolutional network(Faster R-CNN)for the LV localization from short-axis cardiac MRI images using a region proposal network(RPN)integrated with deep feature classification and regression.Themodel was trained using images with corresponding bounding boxes(labels)around the LV,and various experiments were applied to select the appropriate layers and set the suitable hyper-parameters.The experimental findings showthat the proposed modelwas adequate,with accuracy,precision,recall,and F1 score values of 0.91,0.94,0.95,and 0.95,respectively.This model also allows the cropping of the detected area of LV,which is vital in reducing the computational cost and time during segmentation and classification procedures.Therefore,itwould be an ideal model and clinically applicable for diagnosing cardiac diseases.展开更多
Regional pressure differences between sites within the left ventricular cavity have long been identified,and the potential clinical value of diastolic and systolic intraventricular pressure differences(IVPDs)is of inc...Regional pressure differences between sites within the left ventricular cavity have long been identified,and the potential clinical value of diastolic and systolic intraventricular pressure differences(IVPDs)is of increasing interest.This study concluded that the IVPD plays an important role in ventricular filling and emptying and is a reliable indicator of ventricular relaxation,elastic recoil,diastolic pumping,and effective left ventricular filling.Relative pressure imaging,as a novel and potentially clinically applicable measure of left IVPDs,enables early and more comprehensive identification of the temporal and spatial characteristics of IVPD.In the future,as research related to relative pressure imaging continues,this measurement method has the possibility to become more refined and serve as an additional clinical aid that can replace the gold standard cardiac catheterization technique for the diagnosis of diastolic dysfunction.展开更多
Inadvertent Lead Malposition in Left Ventricle is a rare and underdiagnosed incident, which may occur during implantation of cardiac electronic devices and may remain asymptomatic. We reported the case of a 71-year-ol...Inadvertent Lead Malposition in Left Ventricle is a rare and underdiagnosed incident, which may occur during implantation of cardiac electronic devices and may remain asymptomatic. We reported the case of a 71-year-old man who was implanted with a ventricular single-chamber pacemaker for a slow atrial fibrillation with syncope and whose routine transthoracic echocardiography 23 months after implantation displayed a malposition of the pacemaker lead into the Left Ventricle through a patent foramen oval. The patient was asymptomatic. The electrocardiogram showed right bundle branch block QRS-paced morphology with a positive QRS pattern in V1, a median paced QRS axis on the frontal plane at -120°, a Precordial transition on V5. At the lateral Chest X-ray the lead curved backwards to the spine. Given the age of this old patient who already received oral anticoagulant for Atrial Fibrillation and the Lead malposition discovered 23 months after pacemaker’s implantation, we decided to maintain the lead in LV and continue anticoagulation.展开更多
Summary： Intraventricular hydrodynamics is considered an important component of cardiac function assessment. Vector flow mapping （VFM） is a novel flow visualization method to describe cardiac pathophysiological con...Summary： Intraventricular hydrodynamics is considered an important component of cardiac function assessment. Vector flow mapping （VFM） is a novel flow visualization method to describe cardiac pathophysiological condition. This study examined use of new VFM and flow field for assessment of left ventricular （LV） systolic hemodynamics in patients with simple hyperthyroidism （HT）. Thirty-seven simple HT patients were enrolled as HT group, and 38 gender- and age-matched healthy volunteers as control group. VFM model was used to analyze LV flow field at LV apical long-axis view. The follow- ing flow parameters were measured, including peak systolic velocity （Vs）, peak systolic flow （Fs）, total systolic negative flow （SQ） in LV basal, middle and apical level, velocity gradient from the apex to the aortic valve （AV）, and velocity according to half distance （V1/2）. The velocity vector in the LV cavity, stream line and vortex distribution in the two groups were observed. The results showed that there were no significant differences in the conventional parameters such as left ventricular ejection fraction （LVEF）, left ventricular end-diastolic diameter （LVEDD） and left atrium diameter （LAD） between HT group and control group （P〉0.05）. Compared with the control group, a brighter flow and more vortexes were detected in HT group. Non-uniform distribution occurred in the LV flow field, and the stream lines were discontinuous in HT group. The values of Vs and Fs in three levels, SQ in middle and basal levels, AV and V1/2 were higher in HT group than in control group （P〈0.01）. AV was positively correlated with serum free thyroxin （FT4） （r=0.48, P〈0.01）. Stepwise multiple regression analysis showed that LVEDD, FT4, and body surface area （BSA） were the influence factors of △V. The unstable left ventricular sys- tolic hydrodynamics increased in a compensatory manner in simple PIT patients. The present study in- dicated that VFM may be used for early detection of abnormal ventricle contraction in clinical settings.展开更多
Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enc...Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.展开更多
Objective:To establish a quantitative evaluation of the left ventricle's systolic function in patients with chronic kidney failure(CKF)by three-dimensional speckle-tracking echocardiography.Methods:Two-dimensional...Objective:To establish a quantitative evaluation of the left ventricle's systolic function in patients with chronic kidney failure(CKF)by three-dimensional speckle-tracking echocardiography.Methods:Two-dimensional and three-dimensional transthoracic echocardiography was performed on 30 patients with CKF.The ejection fraction,mass and global peak longitudinal strain,global circumferential strain,global area strain,and global radial strain of the left ventricle were calculated.Results:The ejection fraction,mass and global peak longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS),and global radial strain(GRS)in the CKF group were significantly lower than those in the control group.Simultaneously,the GLS,GCS,GAS and GRS were well correlated with the ejection fraction.For patients with normal ejection fraction in the CKF group,the GLS,GCS,GAS and GRS were lower than those in the control group,while the left ventricular mass was significantly higher in CKF patients than in the control group.For patients with hypertension in the CKF group,ejection fraction,GLS,GCS,GAS and GRS calculated using three-dimensional echocardiography were significantly lower than those in patients with normal blood pressure;however,the myocardial mass was higher.Conclusions:The parameters(GLS,GCS,GAS and GRS)calculated using three-dimensional speckle-tracking software were lower in the CKF group.Simultaneously,the left ventricular mass was higher in CFK patients than in the control group,thus showing that the myocardial contraction function was impaired and that myocardial remodeling had occurred.展开更多
A 72-year-old elderly male smoker with a known history of hypertension presented with a six day history of chest pain. His blood pressure at presentation was 110/70 mmHg and there was no audible murmur. ECG showed Q w...A 72-year-old elderly male smoker with a known history of hypertension presented with a six day history of chest pain. His blood pressure at presentation was 110/70 mmHg and there was no audible murmur. ECG showed Q waves in the inferior leads （Figure IA） and troponin level was elevated （14 /.tg/L）.展开更多
The cardiovascular system with a lumped parameter model is treated, in which the Starling model is used to simulate left ventricle and the four-element Burattini & Gnudi model is used in the description of...The cardiovascular system with a lumped parameter model is treated, in which the Starling model is used to simulate left ventricle and the four-element Burattini & Gnudi model is used in the description of arterial system. Moreover, the feedback action of arterial pressure on cardiac cycle is taken into account. The phenomenon of mechanical periodicity (MP) of end diastolic volume (EDV) of left ventricle is successfully simulated by solving a series of one-dimensional discrete nonlinear dynamical equations. The effects of cardiovascular parameters on MP is also discussed.展开更多
This paper shows the blood flow control （FwC） performance to adjust rotational speed of an ICBP （implantable centrifugal blood pump） in order to provide an adequate flow to left ventricle in different patient cond...This paper shows the blood flow control （FwC） performance to adjust rotational speed of an ICBP （implantable centrifugal blood pump） in order to provide an adequate flow to left ventricle in different patient conditions. ICBP is a totally implantable LVAD （left ventricular assist device） with ceramic bearings developed for long term circulatory assistance. FwC uses PI （proportional-integral） control to adjust rotational speed in order to provide blood flow. FwC does not use sensor for feedback, as there is an estimation system to provide blood flow measurement. Control strategy has being studied in a HCS （hybrid cardiovascular simulator） as a tool that allows the physical connection of ICBP during evaluation. In addition, HCS allows changes of some cardiovascular parameters in order to simulate specific heart disease： ejection fraction （10-25%） and heart rate （50-110 bpm）. FwC was able to adjust blood flow with steady error less than 2%. Results demonstrated that FwC is adequate to LVAD control irL different left ventricle failure conditions.展开更多
Due to the study of the function of heart and aoritic valve, we set up a physicalmodel of left ventricle, aortic valve and afterload and derive theoretical equation of each part from the model. Then we calculate the h...Due to the study of the function of heart and aoritic valve, we set up a physicalmodel of left ventricle, aortic valve and afterload and derive theoretical equation of each part from the model. Then we calculate the hasic equations within phystology and impair parameters. Bwsed on this, we will discus fully in the next paper the effectofleyt ventricular afterloadon valve opining, ejection and valve Jumction .etc展开更多
Maternal protein restriction may be a risk factor for cardiovascular disorders in adulthood. The RAS (renin-angiotensin-system) plays a pivotal role in cardiac remodeling. Components of the RAS, including angiotensin ...Maternal protein restriction may be a risk factor for cardiovascular disorders in adulthood. The RAS (renin-angiotensin-system) plays a pivotal role in cardiac remodeling. Components of the RAS, including angiotensin II (AngII) and its receptors type 1 (AT1R) and 2 (AT2R) are expressed in the heart. This study investigates whether gestational protein restriction alters the expression and localization of AT1R and AT2R and RAS signaling pathway proteins in parallel with left ventricle hypertrophy and systemic hypertension in male offspring. Dams were kept on normal (NP, 17% protein) or low (LP, 6% protein) protein diet during pregnancy. Systolic blood pressure (SBP) of male offspring was measured from the 8th to 16th week and left ventricles of 16-wk-old rats were processed for histology, morphometric, immunoblotting and immunohistochemistry. LP offspring showed a significant reduction in birth body weight and SBP increased significantly from the 8th week. Left ventricle mass and cardiomyocytes area were also significantly higher in LP animals. Widespread perivascular fibrosis was not detected in the heart tissue. Analysis by immunoblotting and immunohistochemistry demonstrated a significant enhance in cardiomyocyte expression of AT1R and ERK1 in LP offspring. Expression of PI3K in LP was significantly reduced in cardiomyocytes and in the intramural coronary wall, while AT2R expression was unchanged in the NP group. We also found reduced LP expression of JAK2 and STAT3. In conclusion, our data also suggest that changes in the RAS may play a role in the ventricular growth through upregulation of the AT1-mediated ERK1/2 response, despite unchanged AT2R expression.展开更多
We describe a rare case of a 60-year-old woman suffering from intramyocardial dissection and left ventricular aneurysm secondary to acute myocardial infarction. A rare form of ventricular septal rupture resulted from ...We describe a rare case of a 60-year-old woman suffering from intramyocardial dissection and left ventricular aneurysm secondary to acute myocardial infarction. A rare form of ventricular septal rupture resulted from intramyocardial dissection deterioration, which was iden- tified during echocardiographic follow-up. Surgical repair under beating-heart cardiopulmonary bypass was successful.展开更多
Objective: To explore the clinical efficacy of Xuefu Zhuyu (血府逐瘀, XFZY) oral liquid combined with western medicine (WM) in reversing left ventricle remodeling (LVR) after acute myocardial infarction (AMI) in patie...Objective: To explore the clinical efficacy of Xuefu Zhuyu (血府逐瘀, XFZY) oral liquid combined with western medicine (WM) in reversing left ventricle remodeling (LVR) after acute myocardial infarction (AMI) in patients and its therapeutic mechanism. Methods: Sixty patients conforming to criteria were divided into the treated group and WM control group with randomly stratified method. Thirty cases were assigned to each group, they were given XFZY + WM + general treatment and WM + general treatment respectively. Color Doppler ultrasonography was used to study the changes of LVR before and after treatment. Results: In both groups, before and after treatment the P value of such parameters as the changes of their left diastolic volume (LDV), left systolic volume (LSV), left ventricle ejection fraction (EF) was <0.05, suggesting that the difference of various parameters was significantly different; but when compared with the results of the 12th week after medications, the change of LDV, LSV, EF showed that the LDV, LSV of the treated group were lower than that of the control group, the EF of the treated group was higher than that of the control group, and the P value of various groups was all <0.05, suggesting that the different data of various groups showed significant difference. Conclusion: Conventional WM treatment and XFZY combined with WM could both, in treating AMI, effectively reverse the patients' LVR; yet the use of integrative Chinese and western medicine on reversing patients LVR showed even better results than that of simple WM treatment.展开更多
<strong>Background: </strong><span style="font-family:Verdana;">Speckle tracking echocardiography using average global strain and strain</span><b><span style="font-famil...<strong>Background: </strong><span style="font-family:Verdana;">Speckle tracking echocardiography using average global strain and strain</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">rate (SR) parameters for early detection of high risk patients with coronary artery disease (CAD) has gained a substantial clinical interest. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> Assessment of the diagnostic accuracy of strain imaging of the left ventricle in detection of obstructive coronary artery disease. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> One hundred patients were enrolled</span><span style="font-family:Verdana;">. </span><span style="font-family:Verdana;">They were divided into 3 groups</span><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">Group I (n = 40 patients) presented with ST segment elevation myocardial infarction (STEMI), Group II (n = 40 patients) presented with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and Group</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">III </span><span style="font-family:Verdana;">(n = 20 patients) with normal coronary angiography served as a control group. All patients were subjected to 2D speckle tracking echocardiography (2D STE) to assess LV longitudinal strain and strain rate (SR). Sensitivity, specificity and diagnostic accuracy of 2D STE in prediction of CAD and its severity using Gensini score were assessed. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The mean age for Group I, II and III was 52.20 ± 11.83, 51.97 ± 14.53 and 52.75 ± 10.75 respectively. LV average global systolic strain (AGS) was significantly lower in group I and II when compared to group III. AGS and average global systolic SR showed significant direct correlation with Gensini score. The diagnostic accuracy of 2D STE in prediction of significant LAD stenosis was 92.5%, and it was 89.5% in prediction of 3 vessels CAD. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Strain imaging using 2D STE can predict the territory and severity of CAD with high diagnostic accuracy</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">and can be used as a simple noninvasive diagnostic tool to identify high risk CAD patients.</span>展开更多
Thrombi represent the most frequently found intracardiac masses. Left ventricular thrombus (LVT) is an important complication in patients with ischemic heart diseases and in those with dilated cardiomyopathy and systo...Thrombi represent the most frequently found intracardiac masses. Left ventricular thrombus (LVT) is an important complication in patients with ischemic heart diseases and in those with dilated cardiomyopathy and systolic heart failure. The diagnosis of left ventricular thrombus remains important since anticoagulation will reduce the risk of systemic embolization and stroke. Despite advances in other imaging modalities, echocardiography remains the most important tool for diagnosis and risk stratification in patients predisposed to develop left ventricular thrombi. Mural thrombi formed on the left ventricular endocardium and horseshoe-shaped in chronic dilated cardiomyopathy, masquerading as left ventricular endomyocardial fibrosis was diagnosed by transthoracic 2D echocardiographic imaging in a 38 years old middle aged man. Background of this case highlighted the pathophysiology, high risk echocardiographic features and the role of anticoagulant therapy in LV thrombus with dilated cardiomyopathy.展开更多
文摘Congenital ventricular aneurysm is a very rare cardiac anomaly.A diagnosis can be made during the prenatal period using fetal echocardiography.This study presents a very rare apically located left ventricular aneurysm case,and the relevant literature was reviewed and discussed.In this case,a 35-year-old,gravida 2,parity 1 preg-nant woman at 24 weeks of gestation,displayed a wide aneurysmal image in the left ventricular apical wall on fetal echocardiography.There was a 1.79 mm muscular ventricular septal defect at the apical region of the interven-tricular septum.In the course of the color Doppler ultrasonography examination,an aberrantfibrous band within the left ventricle and consequent turbulentflow during systole were observed.The baby,born via cesarean section at 37 weeks of gestation,is now in its postnatal seventh month.However,during echocardiographic follow-ups,changes have been observed,including mild to moderate mitral insufficiency and a decrease in systolic function.Despite thesefindings,the clinical condition remains asymptomatic.It is of great importance to use a multidis-ciplinary approach in managing these rare cases that could lead to potential adverse outcomes during the antena-tal or postnatal periods.
基金Supported by The Department of Scientific Research and Structural Funds of Medical College,Jagiellonian University,No.N41/DBS/000594.
文摘Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM may present with an intraventricular or LV outflow tract obstruction,diastolic dysfunction,myocardial fibrosis and/or ventricular arrhythmias.Differentiating HCM from other diseases associated with LV hypertrophy,such as hypertension,aortic stenosis,or LV non-compaction(LVNC),can at times be challenging.LVNC is defined by excessive LV trabeculation and deep recesses between trabeculae,often accompanied by increased LV myocardial mass.Previous studies indicate that the LVNC phenotype may be observed in up to 5%of the general population;however,in most cases,it is a benign finding with no impact on clinical outcomes.Nevertheless,LVNC can occasionally lead to LV systolic dysfunction,manifesting as a phenotype of dilated or non-dilated left ventricular cardiomyopathy,with an increased risk of thrombus formation and arterial embolism.In extreme cases,where LVNC is associated with a very thickened LV wall,it can even mimic HCM.There is growing evidence of an overlap between HCM and LVNC,including similar genetic mutations and clinical presentations.This raises the question of whether HCM and LVNC represent different phenotypes of the same disease or are,in fact,two distinct entities.
文摘BACKGROUND Double-chambered left ventricle(DCLV)is an extremely rare congenital disease in which the left ventricle(LV)is divided by abnormal muscle tissue.Due to its rarity,there is a lack of data on the disease,including its diagnosis,treatment,and prognosis.Accordingly,we report a case in which DCLV was diagnosed and followed up.CASE SUMMARY A 45-year-old man presented to our hospital due to abnormal findings on an electrocardiogram recorded during a health check.He had no specific cardiac symptoms,comorbidities or relevant past medical history.Echocardiography revealed that the LV was divided into two by muscle fibers.There were no findings of ischemia on coronary angiography and coronary computed tomography angiography performed to exclude differential diagnoses.After comprehensive analysis of the images,DCLV was diagnosed.As it seemed to be asymptomatic DCLV,we decided the patient was to be observed without administering any medication.However,follow-up echocardiography revealed a thrombus in the accessory chamber(AC).Anticoagulant medication was initiated,the thrombus resolved,and the patient is currently undergoing follow-up without any specific symptoms.CONCLUSION Asymptomatic,uncomplicated DCLV was diagnosed through multimodal imaging;however,a thrombus in the AC occurred during the follow-up.The findings highlight that multimodal imaging is essential in diagnosing DCLV,and that anticoagulation is important in its management.
基金The National Natural Science Foundation of China (62176048)provided funding for this research.
文摘The interpretability of deep learning models has emerged as a compelling area in artificial intelligence research.The safety criteria for medical imaging are highly stringent,and models are required for an explanation.However,existing convolutional neural network solutions for left ventricular segmentation are viewed in terms of inputs and outputs.Thus,the interpretability of CNNs has come into the spotlight.Since medical imaging data are limited,many methods to fine-tune medical imaging models that are popular in transfer models have been built using massive public Image Net datasets by the transfer learning method.Unfortunately,this generates many unreliable parameters and makes it difficult to generate plausible explanations from these models.In this study,we trained from scratch rather than relying on transfer learning,creating a novel interpretable approach for autonomously segmenting the left ventricle with a cardiac MRI.Our enhanced GPU training system implemented interpretable global average pooling for graphics using deep learning.The deep learning tasks were simplified.Simplification included data management,neural network architecture,and training.Our system monitored and analyzed the gradient changes of different layers with dynamic visualizations in real-time and selected the optimal deployment model.Our results demonstrated that the proposed method was feasible and efficient:the Dice coefficient reached 94.48%,and the accuracy reached 99.7%.It was found that no current transfer learning models could perform comparably to the ImageNet transfer learning architectures.This model is lightweight and more convenient to deploy on mobile devices than transfer learning models.
文摘BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true apex is occupied by the right ventricle.Due to the rarity of the disease,just a few case reports and limited case series have been published in the field.AIM To analysing the so far 37 reported ILVAH cases worldwide.METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13,2022.RESULTS The majority of cases reported occurred in males(52.7%).Mean age at diagnosis was 26.1±19.6 years.More than a third of the patients were asymptomatic(35.1%).The most usual clinical presentation was breathlessness(40.5%).The most commonly detected electrocardiogram changes were T wave abnormalities(29.7%)and right axis deviation with poor R wave progression(24.3%).Atrial fibrillation/flutter was detected in 24.3%.Echocardiography was performed in 97.3%of cases and cardiac MRI in 91.9%of cases.Ejection fraction was reduced in more than a half of patients(56.7%).An associated congenital heart disease was found in 16.2%.Heart failure therapy was administered in 35.1%of patients.The outcome was favorable in the vast majority of patients,with just one death.CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course,ranging from benign until the elderly to sudden death during adolescence.
基金supported by the Ministry of Higher Education(MOHE)through the Fundamental Research Grant Scheme(FRGS)(FRGS/1/2020/TK0/UTHM/02/16)the Universiti Tun Hussein Onn Malaysia(UTHM)through an FRGS Research Grant(Vot K304).
文摘The automatic localization of the left ventricle(LV)in short-axis magnetic resonance(MR)images is a required step to process cardiac images using convolutional neural networks for the extraction of a region of interest(ROI).The precise extraction of the LV’s ROI from cardiac MRI images is crucial for detecting heart disorders via cardiac segmentation or registration.Nevertheless,this task appears to be intricate due to the diversities in the size and shape of the LV and the scattering of surrounding tissues across different slices.Thus,this study proposed a region-based convolutional network(Faster R-CNN)for the LV localization from short-axis cardiac MRI images using a region proposal network(RPN)integrated with deep feature classification and regression.Themodel was trained using images with corresponding bounding boxes(labels)around the LV,and various experiments were applied to select the appropriate layers and set the suitable hyper-parameters.The experimental findings showthat the proposed modelwas adequate,with accuracy,precision,recall,and F1 score values of 0.91,0.94,0.95,and 0.95,respectively.This model also allows the cropping of the detected area of LV,which is vital in reducing the computational cost and time during segmentation and classification procedures.Therefore,itwould be an ideal model and clinically applicable for diagnosing cardiac diseases.
文摘Regional pressure differences between sites within the left ventricular cavity have long been identified,and the potential clinical value of diastolic and systolic intraventricular pressure differences(IVPDs)is of increasing interest.This study concluded that the IVPD plays an important role in ventricular filling and emptying and is a reliable indicator of ventricular relaxation,elastic recoil,diastolic pumping,and effective left ventricular filling.Relative pressure imaging,as a novel and potentially clinically applicable measure of left IVPDs,enables early and more comprehensive identification of the temporal and spatial characteristics of IVPD.In the future,as research related to relative pressure imaging continues,this measurement method has the possibility to become more refined and serve as an additional clinical aid that can replace the gold standard cardiac catheterization technique for the diagnosis of diastolic dysfunction.
文摘Inadvertent Lead Malposition in Left Ventricle is a rare and underdiagnosed incident, which may occur during implantation of cardiac electronic devices and may remain asymptomatic. We reported the case of a 71-year-old man who was implanted with a ventricular single-chamber pacemaker for a slow atrial fibrillation with syncope and whose routine transthoracic echocardiography 23 months after implantation displayed a malposition of the pacemaker lead into the Left Ventricle through a patent foramen oval. The patient was asymptomatic. The electrocardiogram showed right bundle branch block QRS-paced morphology with a positive QRS pattern in V1, a median paced QRS axis on the frontal plane at -120°, a Precordial transition on V5. At the lateral Chest X-ray the lead curved backwards to the spine. Given the age of this old patient who already received oral anticoagulant for Atrial Fibrillation and the Lead malposition discovered 23 months after pacemaker’s implantation, we decided to maintain the lead in LV and continue anticoagulation.
基金supported by Independent Innovation Fund of Huazhong University of Science and Technology for Clinical Skills,China(No.2015-01-18-53028)
文摘Summary： Intraventricular hydrodynamics is considered an important component of cardiac function assessment. Vector flow mapping （VFM） is a novel flow visualization method to describe cardiac pathophysiological condition. This study examined use of new VFM and flow field for assessment of left ventricular （LV） systolic hemodynamics in patients with simple hyperthyroidism （HT）. Thirty-seven simple HT patients were enrolled as HT group, and 38 gender- and age-matched healthy volunteers as control group. VFM model was used to analyze LV flow field at LV apical long-axis view. The follow- ing flow parameters were measured, including peak systolic velocity （Vs）, peak systolic flow （Fs）, total systolic negative flow （SQ） in LV basal, middle and apical level, velocity gradient from the apex to the aortic valve （AV）, and velocity according to half distance （V1/2）. The velocity vector in the LV cavity, stream line and vortex distribution in the two groups were observed. The results showed that there were no significant differences in the conventional parameters such as left ventricular ejection fraction （LVEF）, left ventricular end-diastolic diameter （LVEDD） and left atrium diameter （LAD） between HT group and control group （P〉0.05）. Compared with the control group, a brighter flow and more vortexes were detected in HT group. Non-uniform distribution occurred in the LV flow field, and the stream lines were discontinuous in HT group. The values of Vs and Fs in three levels, SQ in middle and basal levels, AV and V1/2 were higher in HT group than in control group （P〈0.01）. AV was positively correlated with serum free thyroxin （FT4） （r=0.48, P〈0.01）. Stepwise multiple regression analysis showed that LVEDD, FT4, and body surface area （BSA） were the influence factors of △V. The unstable left ventricular sys- tolic hydrodynamics increased in a compensatory manner in simple PIT patients. The present study in- dicated that VFM may be used for early detection of abnormal ventricle contraction in clinical settings.
文摘Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.
基金supported by grants from the Science and Technology Department of the Hubei Province Foundation(No.2019CFC895)2016 Wuhan Young and Middle-Aged Talent Plan Foundation.
文摘Objective:To establish a quantitative evaluation of the left ventricle's systolic function in patients with chronic kidney failure(CKF)by three-dimensional speckle-tracking echocardiography.Methods:Two-dimensional and three-dimensional transthoracic echocardiography was performed on 30 patients with CKF.The ejection fraction,mass and global peak longitudinal strain,global circumferential strain,global area strain,and global radial strain of the left ventricle were calculated.Results:The ejection fraction,mass and global peak longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS),and global radial strain(GRS)in the CKF group were significantly lower than those in the control group.Simultaneously,the GLS,GCS,GAS and GRS were well correlated with the ejection fraction.For patients with normal ejection fraction in the CKF group,the GLS,GCS,GAS and GRS were lower than those in the control group,while the left ventricular mass was significantly higher in CKF patients than in the control group.For patients with hypertension in the CKF group,ejection fraction,GLS,GCS,GAS and GRS calculated using three-dimensional echocardiography were significantly lower than those in patients with normal blood pressure;however,the myocardial mass was higher.Conclusions:The parameters(GLS,GCS,GAS and GRS)calculated using three-dimensional speckle-tracking software were lower in the CKF group.Simultaneously,the left ventricular mass was higher in CFK patients than in the control group,thus showing that the myocardial contraction function was impaired and that myocardial remodeling had occurred.
文摘A 72-year-old elderly male smoker with a known history of hypertension presented with a six day history of chest pain. His blood pressure at presentation was 110/70 mmHg and there was no audible murmur. ECG showed Q waves in the inferior leads （Figure IA） and troponin level was elevated （14 /.tg/L）.
文摘The cardiovascular system with a lumped parameter model is treated, in which the Starling model is used to simulate left ventricle and the four-element Burattini & Gnudi model is used in the description of arterial system. Moreover, the feedback action of arterial pressure on cardiac cycle is taken into account. The phenomenon of mechanical periodicity (MP) of end diastolic volume (EDV) of left ventricle is successfully simulated by solving a series of one-dimensional discrete nonlinear dynamical equations. The effects of cardiovascular parameters on MP is also discussed.
文摘This paper shows the blood flow control （FwC） performance to adjust rotational speed of an ICBP （implantable centrifugal blood pump） in order to provide an adequate flow to left ventricle in different patient conditions. ICBP is a totally implantable LVAD （left ventricular assist device） with ceramic bearings developed for long term circulatory assistance. FwC uses PI （proportional-integral） control to adjust rotational speed in order to provide blood flow. FwC does not use sensor for feedback, as there is an estimation system to provide blood flow measurement. Control strategy has being studied in a HCS （hybrid cardiovascular simulator） as a tool that allows the physical connection of ICBP during evaluation. In addition, HCS allows changes of some cardiovascular parameters in order to simulate specific heart disease： ejection fraction （10-25%） and heart rate （50-110 bpm）. FwC was able to adjust blood flow with steady error less than 2%. Results demonstrated that FwC is adequate to LVAD control irL different left ventricle failure conditions.
文摘Due to the study of the function of heart and aoritic valve, we set up a physicalmodel of left ventricle, aortic valve and afterload and derive theoretical equation of each part from the model. Then we calculate the hasic equations within phystology and impair parameters. Bwsed on this, we will discus fully in the next paper the effectofleyt ventricular afterloadon valve opining, ejection and valve Jumction .etc
基金Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (Proc. 05/54362-4 and 10/52696-0)
文摘Maternal protein restriction may be a risk factor for cardiovascular disorders in adulthood. The RAS (renin-angiotensin-system) plays a pivotal role in cardiac remodeling. Components of the RAS, including angiotensin II (AngII) and its receptors type 1 (AT1R) and 2 (AT2R) are expressed in the heart. This study investigates whether gestational protein restriction alters the expression and localization of AT1R and AT2R and RAS signaling pathway proteins in parallel with left ventricle hypertrophy and systemic hypertension in male offspring. Dams were kept on normal (NP, 17% protein) or low (LP, 6% protein) protein diet during pregnancy. Systolic blood pressure (SBP) of male offspring was measured from the 8th to 16th week and left ventricles of 16-wk-old rats were processed for histology, morphometric, immunoblotting and immunohistochemistry. LP offspring showed a significant reduction in birth body weight and SBP increased significantly from the 8th week. Left ventricle mass and cardiomyocytes area were also significantly higher in LP animals. Widespread perivascular fibrosis was not detected in the heart tissue. Analysis by immunoblotting and immunohistochemistry demonstrated a significant enhance in cardiomyocyte expression of AT1R and ERK1 in LP offspring. Expression of PI3K in LP was significantly reduced in cardiomyocytes and in the intramural coronary wall, while AT2R expression was unchanged in the NP group. We also found reduced LP expression of JAK2 and STAT3. In conclusion, our data also suggest that changes in the RAS may play a role in the ventricular growth through upregulation of the AT1-mediated ERK1/2 response, despite unchanged AT2R expression.
文摘We describe a rare case of a 60-year-old woman suffering from intramyocardial dissection and left ventricular aneurysm secondary to acute myocardial infarction. A rare form of ventricular septal rupture resulted from intramyocardial dissection deterioration, which was iden- tified during echocardiographic follow-up. Surgical repair under beating-heart cardiopulmonary bypass was successful.
文摘Objective: To explore the clinical efficacy of Xuefu Zhuyu (血府逐瘀, XFZY) oral liquid combined with western medicine (WM) in reversing left ventricle remodeling (LVR) after acute myocardial infarction (AMI) in patients and its therapeutic mechanism. Methods: Sixty patients conforming to criteria were divided into the treated group and WM control group with randomly stratified method. Thirty cases were assigned to each group, they were given XFZY + WM + general treatment and WM + general treatment respectively. Color Doppler ultrasonography was used to study the changes of LVR before and after treatment. Results: In both groups, before and after treatment the P value of such parameters as the changes of their left diastolic volume (LDV), left systolic volume (LSV), left ventricle ejection fraction (EF) was <0.05, suggesting that the difference of various parameters was significantly different; but when compared with the results of the 12th week after medications, the change of LDV, LSV, EF showed that the LDV, LSV of the treated group were lower than that of the control group, the EF of the treated group was higher than that of the control group, and the P value of various groups was all <0.05, suggesting that the different data of various groups showed significant difference. Conclusion: Conventional WM treatment and XFZY combined with WM could both, in treating AMI, effectively reverse the patients' LVR; yet the use of integrative Chinese and western medicine on reversing patients LVR showed even better results than that of simple WM treatment.
文摘<strong>Background: </strong><span style="font-family:Verdana;">Speckle tracking echocardiography using average global strain and strain</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">rate (SR) parameters for early detection of high risk patients with coronary artery disease (CAD) has gained a substantial clinical interest. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> Assessment of the diagnostic accuracy of strain imaging of the left ventricle in detection of obstructive coronary artery disease. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> One hundred patients were enrolled</span><span style="font-family:Verdana;">. </span><span style="font-family:Verdana;">They were divided into 3 groups</span><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">Group I (n = 40 patients) presented with ST segment elevation myocardial infarction (STEMI), Group II (n = 40 patients) presented with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and Group</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">III </span><span style="font-family:Verdana;">(n = 20 patients) with normal coronary angiography served as a control group. All patients were subjected to 2D speckle tracking echocardiography (2D STE) to assess LV longitudinal strain and strain rate (SR). Sensitivity, specificity and diagnostic accuracy of 2D STE in prediction of CAD and its severity using Gensini score were assessed. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The mean age for Group I, II and III was 52.20 ± 11.83, 51.97 ± 14.53 and 52.75 ± 10.75 respectively. LV average global systolic strain (AGS) was significantly lower in group I and II when compared to group III. AGS and average global systolic SR showed significant direct correlation with Gensini score. The diagnostic accuracy of 2D STE in prediction of significant LAD stenosis was 92.5%, and it was 89.5% in prediction of 3 vessels CAD. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Strain imaging using 2D STE can predict the territory and severity of CAD with high diagnostic accuracy</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">and can be used as a simple noninvasive diagnostic tool to identify high risk CAD patients.</span>
文摘Thrombi represent the most frequently found intracardiac masses. Left ventricular thrombus (LVT) is an important complication in patients with ischemic heart diseases and in those with dilated cardiomyopathy and systolic heart failure. The diagnosis of left ventricular thrombus remains important since anticoagulation will reduce the risk of systemic embolization and stroke. Despite advances in other imaging modalities, echocardiography remains the most important tool for diagnosis and risk stratification in patients predisposed to develop left ventricular thrombi. Mural thrombi formed on the left ventricular endocardium and horseshoe-shaped in chronic dilated cardiomyopathy, masquerading as left ventricular endomyocardial fibrosis was diagnosed by transthoracic 2D echocardiographic imaging in a 38 years old middle aged man. Background of this case highlighted the pathophysiology, high risk echocardiographic features and the role of anticoagulant therapy in LV thrombus with dilated cardiomyopathy.
