High-resolution myocardial perfusion imaging at 3 T: comparison to 1.5 T in healthy volunteers

The purpose of this study was to evaluate high-resolution (HR) myocardial first-pass perfusion in healthy volunteers at 3 T compared to a typical clinical imaging protocol at 1.5 T, with respect to overall image quality and the presence of subendocardial dark rim artifacts. Myocardial first-pass rest perfusion studies were performed at both field strengths using a T1-weighted saturation-recovery segmented k-space gradient-echo sequence combined with parallel imaging (Gd-DTPA 0.05 mmol/kg). Twenty-six healthy volunteers underwent (1) a HR perfusion scan at 3 T(pixel size 3.78 mm(2)) and (2) a standard perfusion approach at 1.5 T(pixel size 9.86 mm(2)). The contrast enhancement ratio (CER) and overall image quality (4-point grading scale: 4: excellent; 1: non-diagnostic) were assessed, and a semiquantitative analysis of dark rim artifacts was performed for all studies. CER was slightly higher (1.31 +/- 0.32 vs. 1.14 +/- 0.34; p<0.01), overall image quality was significantly improved (3.03 +/- 0.43 vs. 2.37 +/- 0.39; p<0.01), and the number of dark rim artifacts (139 +/- 2.09 vs. 243 +/- 2.33; p<0.01) was significantly reduced for HR perfusion imaging at 3 T compared to the standard approach at 1.5 T. HR myocardial rest perfusion at 3 T is superior to the typical clinical perfusion protocol performed at 1.5 T with respect to the overall image quality and presence of subendocardial dark rim artifacts.

Intrapericardial teratoma in the newborn--3D-echocardiography and course of disease

Intrapericardial teratoma is a rare tumour which may become life threatening when it causes mediastinal compression. Early sonographic detection and careful evaluation is necessary for further management. In this paper, we present a case with a large intrapericardial teratoma diagnosed in utero (25 + 0 weeks). After birth, 3D-echocardiography was particularly helpful in obtaining a comprehensive view of the three-dimensional structure of this complex tumour, in order to determine tumour extension and attachment before surgical excision. This case illustrates the opportunities which new, noninvasive echocardiographic tools create to aid therapeutic management and surgical therapy of critically ill patients.

Impact of Pressure Recovery in the Evaluation of the Omnicarbon™ Tilting Disc Valve

BACKGROUND

Pressure recovery is not taken into account when calculating trans-prosthetic gradients after mechanical valve replacement using Doppler echocardiography. This may lead to underestimation of valvular performance.

METHODS

Simultaneous measurement of Doppler and direct trans-prosthetic gradients was performed in a circulatory mock loop simulator with physiologic parameters at different heart rates and cardiac outputs for small-sized aortic Omnicarbon tilting disc valves (19 - 21 mm).

RESULTS

In all adjustments the Doppler gradient significantly overestimated the net transvalvular gradient. The amount of pressure recovery averaged 59.3 %.

CONCLUSIONS

Doppler echocardiography does not allow for pressure recovery, which is a significant phenomenon in the hemodynamic function of the Omnicarbon tilting disc valve. Valve performance is much better than expected from Doppler gradients.

Ruptured sinus of Valsalva aneurysm in two patients with subarterial ventricular septal defect

Rupture of a sinus of Valsalva aneurysm (SVA) is a rare, but life-threatening, event and requires immediate recognition and intervention. We present two previously healthy and physically active patients who were 12 and 33 years of age when rupture of a right coronary SVA into the right ventricle occurred. A subarterial ventricular septal defect (VSD) was detectable in both patients. Cardiac surgery involved VSD closure as well as reconstruction of the aortic valve. Considering complications of subarterial VSD, such as aortic cusp prolapse, aortic insufficiency or SVA, we suggest close follow-up and surgical closure of the VSD in case of any aortic valve deformity.

[How I treat...fibroproliferative scars]

Following a skin injury like burn, surgery or a trauma, fibroproliferatives scars are responsible of cosmetic, psychologic and symptomatic disorders. Keloids are benign and occur secondary to an imbalance between the synthesis of extracellular matrix and its degradation. There is a lot of therapeutic modalities available. Despite this, recurrence and sometimes increasing lesions are the major complications. Surgery with adjuvant therapy like steroids injections, radiotherapy, silicone materials seems today the best therapeutic choice. A best physiopatholgy's comprehension is at the base of new treatments, but their efficacity still need to be demonstrate in larger studies.