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Kocaoglu M, Lang SM, Ta H, Moore RA, Pednekar A. Noncontrast free-breathing ECG-gated 3D balanced steady-state free precession in congenital heart disease and aortopathy evaluation. Pediatr Radiol 2024; 54:1661-1673. [PMID: 39164501 DOI: 10.1007/s00247-024-06024-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND High-fidelity cardiac magnetic resonance (MR) imaging plays a pivotal role in the surveillance of congenital heart disease (CHD) and aortopathy. OBJECTIVE We aimed to evaluate the quality and accuracy of free breathing, ECG-gated noncontrast three-dimensional (3D) balanced steady-state free precession (bSSFP) in cases of CHDs and aortopathies using contrast-enhanced 3D bSSFP as a reference. We also used one of our routinely used non-ECG-gated 2D-single-shot (SSh) bSSFP sequence as an adjunct to noncontrast 3D bSSFP. MATERIALS AND METHODS Institutional review board approval was obtained to perform a systematic retrospective analysis of image quality and vascular measurements. Patients with CHD and aortopathy, who were undergoing clinically indicated contrast-enhanced 3D bSSFP, were prospectively identified to also undergo additional noncontrast 3D bSSFP and 2D SSh bSSFP imaging as part of a clinical quality improvement initiative aimed at reducing the use of contrast when feasible. Two readers, blinded to each other's evaluations, graded image quality on a 5-point Likert scale and performed vascular measurements in separate sessions for both 3D bSSFP images. They also reported the visibility of various mediastinal great vessels on 2D SSh bSSFP images. Raw agreement, the weighted kappa statistic, and intra-class correlation coefficients (ICCs) were computed to assess the consistency and agreement between the two readers. Comparative analysis of noncontrast and contrast-enhanced 3D bSSFP imaging was performed in adult and pediatric patients using a two-sided paired t-test and Bland-Altman analysis. A P-value < 0.05 was considered significant for all inference testing. RESULTS A total of 29 patients (17 males, median age 20.3 years, interquartile range (IQR) 12.5, age range 7-39 years), including 11 pediatric patients under the age of 18 years (6 males, median age 14.5 years, IQR 4.0, age range 7-17 years), underwent retrospective analysis. The overall image quality score for contrast-enhanced 3D bSSFP was significantly higher (P < 0.0001) than that of noncontrast 3D bSSFP for both all subjects (4.4 ± 0.2, range 4.0-4.9 vs 3.7 ± 0.4, range 3.1-4.7) and only pediatric subjects (4.3 ± 0.3, range 4.0-4.9 vs 3.6 ± 0.5, range 3.1-4.4). By combining noncontrast 3D bSSFP and 2D bSSFP, reader 1 and reader 2 rated 423 and 420 vessels diagnostic, respectively, in a total of 435 vessel segments. All landmarks showed similar mean vessel diameters without significant differences between noncontrast and contrast-enhanced 3D bSSFP MR angiography (r = 0.99, bias -0.31 mm, 95% limits of agreement -2.04 mm to 1.43 mm). CONCLUSIONS Although contrast-enhanced images had better overall image quality, an imaging protocol consisting of noncontrast 2D SSh bSSFP and 3D bSSFP whole-chest images provides diagnostically adequate image quality, and accurate vascular measurements, comparable to free-breathing contrast-enhanced 3D bSSFP in both children and adults with CHD and aortopathies.
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Affiliation(s)
- Murat Kocaoglu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Sean M Lang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hieu Ta
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ryan A Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amol Pednekar
- Department of Radiology, Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Bagherzadeh SP, Celestin BE, Santana EJ, Salerno M, Nadeau KC, Sweatt AJ, Zamanian RT, Haddad F. Novel Reference Equations for Pulmonary Artery Size and Pulsatility Using Echocardiography and Their Diagnostic Value in Pulmonary Hypertension. Chest 2024:S0012-3692(24)04615-4. [PMID: 39025204 DOI: 10.1016/j.chest.2024.06.3805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND According to the most recent pulmonary hypertension (PH) guidelines, a main pulmonary artery (MPA) diameter > 25 mm on transthoracic echocardiography supports the diagnosis of PH. However, the size of the pulmonary artery (PA) may vary according to body size, age, and cardiac phases. RESEARCH QUESTION (1) What are the reference limits for PA size on transthoracic echocardiography, considering differences in body size, sex, and age? (2) What is the diagnostic value of the PA size for classifying PH? (3) How does the selection of different reference groups (healthy volunteers vs patients referred for right heart catheterization [RHC]) influence the diagnostic OR (DOR)? STUDY DESIGN AND METHODS The study included a reference cohort of 248 healthy individuals as control patients, 693 patients with PH proven by RHC, and 156 non-PH patients proven by RHC. In the PH cohort, 300 had group 1 PH, 207 had group 2 PH, and 186 had group 3 PH. MPA and right PA diameters and areas were measured in the upper sternal short-axis and suprasternal notch views. Reference limits (5th-95th percentile) were based on absolute values and height-indexed measures. Quantile regression analysis was used to derive median and 95th quantile reference equations for the PA measures. DORs and probability diagnostic plots for PH were then determined using healthy control and non-PH cohorts. RESULTS The 95th percentile for indexed MPA diameter was 15 mm/m in diastole and 19 mm/m in systole in both sexes. Quantile regression analysis revealed a weak age effect (pseudo-R2 of 0.08-0.10 for MPA diameters). Among measures, the MPA size in diastole had the highest DOR (156.2; 95% CI, 68.3-357.5) for detection of group 1 PH. Similarly, the DORs were also high for groups 2 and 3 PH when compared with the control cohort but significantly lower compared with the non-PH cohort. INTERPRETATION This study presents novel reference limits for MPA based on height indexing and quantile regression.
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Affiliation(s)
- Shadi P Bagherzadeh
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA.
| | - Bettia E Celestin
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Sean N. Parker Center of Allergy and Asthma Research, Stanford, CA
| | - Everton J Santana
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA
| | - Michael Salerno
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA
| | - Kari C Nadeau
- Sean N. Parker Center of Allergy and Asthma Research, Stanford, CA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrew J Sweatt
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA
| | - Roham T Zamanian
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA.
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Grosso G, Tognetti R, Domenech O, Marchesotti F, Patata V, Vezzosi T. Echocardiographic reference intervals of the dimensions of the main pulmonary artery and the right pulmonary artery: a prospective study in 269 healthy dogs. J Vet Cardiol 2023; 50:29-38. [PMID: 37918089 DOI: 10.1016/j.jvc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 08/15/2023] [Accepted: 09/15/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION No data are available on the echocardiographic reference intervals (RIs) for the main pulmonary artery (MPA) and right pulmonary artery (RPA) dimensions in a large sample of dogs. Therefore, we aimed to describe the echocardiographic RIs of the MPA and RPA dimensions in normal dogs. ANIMALS, MATERIALS, AND METHODS Two hundred and sixty nine healthy dogs of different breeds, age and body weight (BW) were prospectively enrolled in this multicenter, observational study. The MPA diameter, RPA maximum diameter (RPAmax), and RPA minimum diameter (RPAmin) were measured from the right parasternal short axis view. Prediction intervals (PIs) for MPA, RPAmax and RPAmin were generated using allometric scales. Reference intervals (RI) of MPA indexed to the ascending aorta (MPA/AO), and RPAmax and RPAmin indexed to the aortic annulus (RPAmax/Aod and RPAmin/Aod), were defined. RESULTS A positive linear relationship between MPA, RPAmax, RPAmin and BW was evident after logarithmic transformation (R2 = 0.859, R2 = 0.787 and R2 = 0.725, respectively; P<0.0001). According to allometric scales, the PI for the MPA normalized for BW (MPA_N) was between 5.50 and 8.07, the PI for the RPAmax normalized for BW (RPAmax_N) was between 3.23 and 5.62, while the PI for the RPAmin normalized for BW (RPAmin_N) was between 1.62 and 3.30. The median MPA/AO was 0.92 (RI, 0.78-1.01), the median RPAmax/Aod was 0.70 (RI, 0.53-0.98) and the median RPAmin/Aod was 0.40 (RI, 0.29-0.61). DISCUSSION AND CONCLUSIONS The reported RIs of the MPA and RPA dimensions in normal dogs could increase the diagnostic accuracy of transthoracic echocardiography in the identification of pulmonary artery enlargement in dogs.
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Affiliation(s)
- G Grosso
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy.
| | - R Tognetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy
| | - O Domenech
- Department of Cardiology, Anicura Istituto Veterinario Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy
| | - F Marchesotti
- Department of Cardiology, Anicura Istituto Veterinario Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy
| | - V Patata
- Department of Cardiology, Anicura Istituto Veterinario Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy
| | - T Vezzosi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy
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Sedhom R, Megaly M, Elbadawi A, Yassa G, Weinberg I, Gulati M, Elgendy IY. Sex Differences in Management and Outcomes Among Patients With High-Risk Pulmonary Embolism: A Nationwide Analysis. Mayo Clin Proc 2022; 97:1872-1882. [PMID: 36202496 DOI: 10.1016/j.mayocp.2022.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the sex differences in management and outcomes among patients with high-risk acute pulmonary embolism (PE). PATIENTS AND METHODS The Nationwide Readmissions Database was used to identify hospitalizations with high-risk PE from January 1, 2016, to December 31, 2018. Differences in use of advanced therapies, in-hospital mortality, and bleeding events were compared between men and women. RESULTS A total of 125,901 weighted hospitalizations with high-risk PE were identified during the study period; 46.3% were women (n=58,253). Women were older and had a higher prevalence of several comorbidities and risk factors of PE such as morbid obesity, diabetes mellitus, chronic pulmonary disease, heart failure, and metastatic cancer. Systemic thrombolysis and catheter-directed interventions were more commonly used among women; however, mechanical circulatory support was less frequently used. In-hospital mortality was higher among women in the unadjusted analysis (30.7% vs 27.8%, P<.001) and after propensity score matching (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.08 to 1.25; P<.001), whereas the rates of intracranial hemorrhage and non-intracranial hemorrhage were not different. On multivariate regression analysis, female sex (OR, 1.18; 95% CI, 1.15 to 1.21; P<.001) was independently associated with increased odds of in-hospital mortality. CONCLUSION In this contemporary observational cohort of patients admitted with high-risk PE, women had higher rates of in-hospital mortality despite receiving advanced therapies more frequently, whereas the rate of major bleeding events was not different from men. Efforts are needed to minimize the excess mortality observed among women.
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Affiliation(s)
- Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Ayman Elbadawi
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - George Yassa
- Department of Medicine, Ascension Macomb-Oakland Hospital, Warren, MI, USA
| | - Ido Weinberg
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona-College of Medicine, Phoenix, AZ, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
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Tsarova K, Morgan AE, Melendres-Groves L, Ibrahim MM, Ma CL, Pan IZ, Hatton ND, Beck EM, Ferrel MN, Selzman CH, Ingram D, Alamri AK, Ratcliffe MB, Wilson BD, Ryan JJ. Imaging in Pulmonary Vascular Disease-Understanding Right Ventricle-Pulmonary Artery Coupling. Compr Physiol 2022; 12:3705-3730. [PMID: 35950653 DOI: 10.1002/cphy.c210017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The right ventricle (RV) and pulmonary arterial (PA) tree are inextricably linked, continually transferring energy back and forth in a process known as RV-PA coupling. Healthy organisms maintain this relationship in optimal balance by modulating RV contractility, pulmonary vascular resistance, and compliance to sustain RV-PA coupling through life's many physiologic challenges. Early in states of adaptation to cardiovascular disease-for example, in diastolic heart failure-RV-PA coupling is maintained via a multitude of cellular and mechanical transformations. However, with disease progression, these compensatory mechanisms fail and become maladaptive, leading to the often-fatal state of "uncoupling." Noninvasive imaging modalities, including echocardiography, magnetic resonance imaging, and computed tomography, allow us deeper insight into the state of coupling for an individual patient, providing for prognostication and potential intervention before uncoupling occurs. In this review, we discuss the physiologic foundations of RV-PA coupling, elaborate on the imaging techniques to qualify and quantify it, and correlate these fundamental principles with clinical scenarios in health and disease. © 2022 American Physiological Society. Compr Physiol 12: 1-26, 2022.
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Affiliation(s)
- Katsiaryna Tsarova
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ashley E Morgan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Lana Melendres-Groves
- Division of Pulmonary and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Majd M Ibrahim
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christy L Ma
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Irene Z Pan
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
| | - Nathan D Hatton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Emily M Beck
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Meganne N Ferrel
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Dominique Ingram
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ayedh K Alamri
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Brent D Wilson
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Anesthetic Management During Lung Transplantation - What's New in 2021? Thorac Surg Clin 2022; 32:175-184. [PMID: 35512936 DOI: 10.1016/j.thorsurg.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As outcomes of lung transplantation (LTx) are improving transplant centers are pushing boundaries. There has been a steady increase in the medical complexity of lung transplant candidates. Many transplant centers are listing older patients with comorbidities, and there has been a steady rise in the number of candidates supported with extracorporeal membrane oxygenation (ECMO) as a bridge to transplantation. There has been a growing appreciation of the importance intraoperative management of potentially modifiable risk factors has on postoperative outcomes. Evidence suggests that LTx even in high-risk patients requiring perioperative ECMO can offer excellent results. This article outlines the current state-of-the-art intraoperative management of LTx.
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Lozano-Carrillo LC, Hernández-Garate YAK, Quiroga-Garza A, Elizondo-Omaña RE, Guzman-Lopez S. Letter to the Editor concerning: pulmonary artery trunk enlargement on admission as a predictor of mortality in in-hospital patients with COVID-19. Jpn J Radiol 2022; 40:334-335. [PMID: 34264419 PMCID: PMC8280626 DOI: 10.1007/s11604-021-01170-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Luis Carlos Lozano-Carrillo
- School of Medicine, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Eduardo Aguirre Pequeño s/n, Col. Mitras Centro, 64460, Monterrey, Nuevo León, México
| | - Yenitzeh Ana Karen Hernández-Garate
- School of Medicine, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Eduardo Aguirre Pequeño s/n, Col. Mitras Centro, 64460, Monterrey, Nuevo León, México
| | - Alejandro Quiroga-Garza
- School of Medicine, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Eduardo Aguirre Pequeño s/n, Col. Mitras Centro, 64460, Monterrey, Nuevo León, México
| | - Rodrigo Enrique Elizondo-Omaña
- School of Medicine, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Eduardo Aguirre Pequeño s/n, Col. Mitras Centro, 64460, Monterrey, Nuevo León, México
| | - Santos Guzman-Lopez
- School of Medicine, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Eduardo Aguirre Pequeño s/n, Col. Mitras Centro, 64460, Monterrey, Nuevo León, México.
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Sekaran NK, Whisenant B. Pulmonary Artery Dilation: A Simple Measurement Informing Better Care. JACC Cardiovasc Interv 2021; 14:2570-2571. [PMID: 34774476 DOI: 10.1016/j.jcin.2021.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 10/19/2022]
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Cerne JW, Pathrose A, Gordon DZ, Sarnari R, Veer M, Blaisdell J, Allen BD, Avery R, Markl M, Ragin A, Carr JC. Evaluation of Pulmonary Hypertension Using 4D Flow MRI. J Magn Reson Imaging 2021; 56:234-245. [PMID: 34694050 DOI: 10.1002/jmri.27967] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is becoming an alternative to right heart catheterization (RHC) for evaluating pulmonary hypertension (PH). A need exists to further evaluate cardiac MRI's ability to characterize PH. PURPOSE To evaluate the potential for four-dimensional (4D) flow MRI-derived pulmonary artery velocities to characterize PH. STUDY TYPE Prospective case-control. POPULATION Fifty-four PH patients (56% female); 25 controls (36% female). FIELD STRENGTH/SEQUENCE 1.5 T; gradient recalled echo 4D flow and balanced steady-state free precession cardiac cine. ASSESSMENT RHC was used to derive patients' pulmonary vascular resistance (PVR). 4D flow measured blood velocities at the main, left, and right pulmonary arteries (MPA, LPA, and RPA); cine measured ejection fraction, end diastolic, and end systolic volumes (EF, EDV, and ESV). EDV and ESV were normalized (indexed) to body surface area (ESVI and EDVI). Parameters were evaluated between, and within, PH subgroups: pulmonary arterial hypertension (PAH); PH due to left heart disease (PH-LHD)/chronic lung disease (PH-CLD)/or chronic thrombo-emboli (CTE-PH). STATISTICAL TESTS Analysis of variance and Kruskal-Wallis tests compared parameters between subgroups. Pearson's r assessed velocity, PVR, and volume correlations. Significance definition: P < 0.05. RESULTS PAH peak and mean velocities were significantly lower than in controls at the LPA (36 ± 12 cm/second and 20 ± 4 cm/second vs. 59 ± 15 cm/second and 32 ± 9 cm/second). At the RPA, mean velocities were significantly lower in PAH vs. controls (27 ± 6 cm/second vs. 40 ± 9 cm/second). Peak velocities significantly correlated with right ventricular EF at the MPA (r = 0.286), RPA (r = 0.400), and LPA (r = 0.401). Peak velocity significantly correlated with right ventricular ESVI at the RPA (r = -0.355) and LPA (r = -0.316). Significant correlations between peak velocities and PVR were moderate at the LPA in PAH (r = -0.641) and in PH-LHD (r = -0.606) patients, and at the MPA in PH-CLD (r = -0.728). CTE-PH showed non-significant correlations between peak velocity and PVR at all locations. DATA CONCLUSION Preliminary findings suggest 4D flow can identify PAH and track PVR changes. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- John W Cerne
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Daniel Z Gordon
- Department of Infectious Diseases, Northwestern University, Chicago, Illinois, USA
| | - Roberto Sarnari
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Manik Veer
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Julie Blaisdell
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Ann Ragin
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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Branch Pulmonary Artery Regurgitation in Repaired Tetralogy of Fallot: Correlation with Pulmonary Artery Morphology, Distensibility, and Right Ventricular Function. Tomography 2021; 7:412-423. [PMID: 34564298 PMCID: PMC8482212 DOI: 10.3390/tomography7030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/03/2021] [Accepted: 08/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The aim was to determine the effect of pulmonary artery (PA) morphology on the branch pulmonary artery-regurgitation fraction (BPA-RF), the relationship of pulmonary insufficiency (PI) to BPA-RF and PA-distensibility, and factors (BPA-RF and PA-distensibility) associated with right ventricular function (RVF) in repaired tetralogy of Fallot (rTOF). Methods: A total of 182 rTOF patients (median age 17.1 years) were analyzed for length, angle of PA, BPA-RF, PI, and PA-distensibility, using magnetic resonance imaging. Results: The left PA had a significant greater RF than the right PA (median (interquartile range)): LPA 43.1% (32.6–51.5) and RPA 35.2% (24.7–44.7), p < 0.001. The LPA was shorter with a narrower angle than the RPA (p < 0.001). The anatomy of the branch-PA was not a factor for the greater LPA-RF (odds ratio, 95% confidence interval: CI, p-value): length 0.44 (0.95–2.00), p = 0.28; angle 0.63 (0.13–2.99), p = 0.56. There was a strong positive correlation between PI and BPA-RF-coefficients (95% CI), p-value: LPA 0.78% (0.70–0.86), p < 0.001; RPA 0.78% (0.71–0.84), p < 0.001 and between BPA-RF and distensibility-coefficients (95%CI), p-value: LPA 0.73% (0.37–1.09), p < 0.001; RPA 1.63% (1.22–2.03), p < 0.001, respectively. The adjusted BPA-RF did not predict RVF, RPA (p = 0.434), LPA (p = 0.268). Conclusions: PA morphology is not a significant factor for the differential BPA-RF. The vascular wall in rTOF patients responds to chronic increased intravascular volume by increasing distensibility. BPA-RF is not a determinant of RVF.
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Pulmonary Artery Size Measurements: A Comparison Study Between Electrocardiogram-Gated and Nonelectrocardiogram-Gated Computed Tomography. J Comput Assist Tomogr 2021; 45:415-420. [PMID: 33797443 DOI: 10.1097/rct.0000000000001144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine the difference and correlation in pulmonary artery (PA) size when measured from the electrocardiogram (ECG)-gated computed tomography (CT) and non-ECG-gated CT. METHODS In the retrospective study, 279 patients who underwent both ECG-gated CT and non-ECG-gated CT were enrolled. Maximum and minimum diameters of main pulmonary artery (MPA), right pulmonary artery (RPA), and ascending aorta (AAO) were measured, whereas mean diameters of MPA and RPA were obtained. The same PA size parameters were also measured on non-ECG-gated CT. RESULTS There was a significant difference in maximum and minimum PA diameters between ECG-gated CT and non-ECG-gated CT, whereas mean PA diameters showed no statistically difference. The PA parameters showed a strong positive correlation between these 2 examinations. CONCLUSIONS The PA size was different between ECG-gated CT and non-ECG-gated CT, whereas the PA size parameters on non-ECG-gated CT could be used to predict those with ECG-gated CT, which allow for confident prediction of pulmonary hypertension and guide further surgical intervention.
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12
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Cao Y, Geng C, Li Y, Zhang Y. In situ Pulmonary Artery Thrombosis: A Previously Overlooked Disease. Front Pharmacol 2021; 12:671589. [PMID: 34305592 PMCID: PMC8296465 DOI: 10.3389/fphar.2021.671589] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/28/2021] [Indexed: 12/30/2022] Open
Abstract
Pulmonary thromboembolism (PTE) is the third leading cause of death in cardiovascular diseases. PTE is believed to be caused by thrombi detached from deep veins of lower extremities. The thrombi travel with systemic circulation to the lung and block pulmonary arteries, leading to sudden disruption of hemodynamics and blood gas exchange. However, this concept has recently been challenged by accumulating evidence demonstrating that de novo thrombosis may be formed in pulmonary arteries without deep venous thrombosis. On the other hand, chronic thromboembolic pulmonary hypertension (CTEPH), a subtype of pulmonary hypertension, could have different pathogenesis than traditional PTE. Therefore, this article summarized and compared the risk factors, the common and specific pathogenic mechanisms underlying PTE, in situ pulmonary artery thrombosis, and CTEPH at molecular and cellular levels, and suggested the therapeutic strategies to these diseases, aiming to facilitate understanding of pathogenesis, differential diagnosis, and precision therapeutics of the three pulmonary artery thrombotic diseases.
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Affiliation(s)
- Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Chao Geng
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yahong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yan Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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13
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Kauhanen SP, Liimatainen T, Korhonen M, Parkkonen J, Vienonen J, Vanninen R, Hedman M. Pulmonary Artery Dilatation Is a Common Finding in a Coronary Artery CT Angiography Population. In Vivo 2021; 35:2177-2185. [PMID: 34182495 DOI: 10.21873/invivo.12489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIM Dilatation of the main pulmonary artery (mPA) is a common incidental finding in chest imaging and often leads to consultation. The aim of this study was to determine the prevalence of mPA dilatation in a coronary artery CT angiography (CCTA) population. PATIENTS AND METHODS The study investigated 985 consecutive patients scheduled for diagnostic CCTA. The transverse axial diameter of the mPA was measured. The prevalence of mPA dilatation was estimated using different reference values (Framingham Heart Study: 28.9 mm for males and 26.9 mm for females, Bozlar: 29.5 mm for both genders and Karazincir: 32.6 mm for males and 31.9 mm for females). RESULTS The patient mean age was 53.0±9.7 years (66.5% were women). Body surface area (BSA) correlated moderately with the mPA diameter (r=0.423, p<0.001). The prevalence of mPA dilatation varied from 5.9% (Karazincir) to 33.7% (Framingham Heart Study) in the overall study population. CONCLUSION The prevalence of mPA dilatation is high in a CCTA patient population when using a cut-off value from the Framingham Heart Study.
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Affiliation(s)
- S Petteri Kauhanen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland; .,Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Kuopio, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Kuopio, Finland
| | - Johannes Parkkonen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Juska Vienonen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Kuopio, Finland.,Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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14
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Voges I, Boll C, Caliebe A, Gabbert D, Uebing A, Krupickova S. Reference Values for Ventricular Volumes and Pulmonary Artery Dimensions in Pediatric Patients with Transposition of the Great Arteries After Arterial Switch Operation. J Magn Reson Imaging 2021; 54:1233-1245. [PMID: 33749058 DOI: 10.1002/jmri.27602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary artery (PA) anatomy in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) with Lecompte manoeuvre is different compared to healthy subjects, and stenoses of the PA are common. Magnetic resonance imaging (MRI) is an excellent imaging modality to assess PA anatomy in TGA patients. However, disease-specific reference values for PA size are scarce. PURPOSE To establish disease-specific reference ranges for PA dimensions and for biventricular volumes and mass. STUDY TYPE Retrospective. SUBJECTS A total of 69 pediatric patients with TGA after ASO (median age 12.6 years; range 5-17.8 years; 13 females and 56 males). FIELD STRENGTH/SEQUENCE 3.0 T, steady-state free precession (SSFP) and gradient echo cine sequences and four-dimensional time-resolved magnetic resonance angiography with keyhole. ASSESSMENT Right and left PA (RPA, LPA) were each measured at three locations during its course around the aorta. Ventricular volumes, mass, and ejection fraction were measured from a stack of short axis cine images. STATISTICAL TESTS The lambda-mu-sigma (LMS) method of Cole and Green, univariate and multivariate linear models, and t-test. RESULTS Centile graphs and tables for PA dimensions, biventricular volumes, mass, and ejection fraction were created. Univariate linear analysis showed significant associations (P < 0.05) between body surface area (BSA), height, and weight with systolic MPA and RPA diameter. In multivariate linear analysis, only BSA remained a strong predictor for main PA and RPA diameters. For biventricular volumes, the univariate linear model revealed a strong influence of BSA, height, weight, and age (all P < 0.05). On multivariate linear analysis, only body height remained associated. DATA CONCLUSION Uni- and multivariate linear analyses showed a strong association between BSA and PA diameters, as well as between height and biventricular volumes, and therefore, centile tables and graphs are presented accordingly. Our data may improve MR image interpretation and may serve as a reference in future studies. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Christien Boll
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Amke Caliebe
- Department for Medical Informatics and Statistics, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Dominik Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Sylvia Krupickova
- Department of Pediatric Cardiology and CMR Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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15
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Kawel-Boehm N, Hetzel SJ, Ambale-Venkatesh B, Captur G, Francois CJ, Jerosch-Herold M, Salerno M, Teague SD, Valsangiacomo-Buechel E, van der Geest RJ, Bluemke DA. Reference ranges ("normal values") for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update. J Cardiovasc Magn Reson 2020; 22:87. [PMID: 33308262 PMCID: PMC7734766 DOI: 10.1186/s12968-020-00683-3] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) enables assessment and quantification of morphological and functional parameters of the heart, including chamber size and function, diameters of the aorta and pulmonary arteries, flow and myocardial relaxation times. Knowledge of reference ranges ("normal values") for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. Compared to the previous version of this review published in 2015, we present updated and expanded reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques. Further, databases and references for deep learning methods are included.
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Affiliation(s)
- Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland
- Institute for Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, InselspitalBern, Switzerland
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI, 53726, USA
| | - Bharath Ambale-Venkatesh
- Department of Radiology, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Gabriella Captur
- MRC Unit of Lifelong Health and Ageing At UCL, 5-19 Torrington Place, Fitzrovia, London, WC1E 7HB, UK
- Inherited Heart Muscle Conditions Clinic, Royal Free Hospital NHS Foundation Trust, Hampstead, London, NW3 2QG, UK
| | - Christopher J Francois
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Salerno
- Cardiovascular Division, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Shawn D Teague
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA
| | - Emanuela Valsangiacomo-Buechel
- Division of Paediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
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16
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Li Z, Leng S, Halaweish AF, Yu Z, Yu L, Ritman EL, McCollough CH. Overcoming calcium blooming and improving the quantification accuracy of percent area luminal stenosis by material decomposition of multi-energy computed tomography datasets. J Med Imaging (Bellingham) 2020; 7:053501. [PMID: 33033732 DOI: 10.1117/1.jmi.7.5.053501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 09/04/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: Conventional stenosis quantification from single-energy computed tomography (SECT) images relies on segmentation of lumen boundaries, which suffers from partial volume averaging and calcium blooming effects. We present and evaluate a method for quantifying percent area stenosis using multienergy CT (MECT) images. Approach: We utilize material decomposition of MECT images to measure stenosis based on the ratio of iodine mass between vessel locations with and without a stenosis, thereby eliminating the requirement for segmentation of iodinated lumen. The method was first assessed using simulated MECT images created with different spatial resolutions. To experimentally assess this method, four phantoms with different stenosis severity (30% to 51%), vessel diameters (5.5 to 14 mm), and calcification densities (700 to 1100 mgHA / cc ) were fabricated. Conventional SECT images were acquired using a commercial CT system and were analyzed with commercial software. MECT images were acquired using a commercial dual-energy CT (DECT) system and also from a research photon-counting detector CT (PCD-CT) system. Three-material-decomposition was performed on MECT data, and iodine density maps were used to quantify stenosis. Clinical radiation doses were used for all data acquisitions. Results: Computer simulation verified that this method reduced partial volume and blooming effects, resulting in consistent stenosis measurements. Phantom experiments showed accurate and reproducible stenosis measurements from MECT images. For DECT and two-threshold PCD-CT images, the estimation errors were 4.0% to 7.0%, 2.0% to 9.0%, 10.0% to 18.0%, and - 1.0 % to - 5.0 % (ground truth: 51%, 51%, 51%, and 30%). For four-threshold PCD-CT images, the errors were 1.0% to 3.0%, 4.0% to 6.0%, - 1.0 % to 9.0%, and 0.0% to 6.0%. Errors using SECT were much larger, ranging from 4.4% to 46%, and were especially worse in the presence of dense calcifications. Conclusions: The proposed approach was shown to be insensitive to acquisition parameters, demonstrating the potential to improve the accuracy and precision of stenosis measurements in clinical practice.
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Affiliation(s)
- Zhoubo Li
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States.,Mayo Graduate School, Biomedical Engineering and Physiology Graduate Program, Rochester, Minnesota, United States
| | - Shuai Leng
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Ahmed F Halaweish
- Siemens Healthcare-Imaging and Therapy Systems, Malvern, Pennsylvania, United States
| | - Zhicong Yu
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Lifeng Yu
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Erik L Ritman
- Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester, Minnesota, United States
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17
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Wenzl FA, Miljkovic SS, Dabestani PJ, Kessler JJ, Kotaru TR, Kalamchi LD, Aurit SJ, Asensio JA. A systematic review and individual patient data meta-analysis of heart failure as a rare complication of traumatic arteriovenous fistulas. J Vasc Surg 2020; 73:1087-1094.e8. [PMID: 33002586 DOI: 10.1016/j.jvs.2020.08.138] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Traumatic arteriovenous fistulas (AVFs) are rare. The vast majority occur secondary to penetrating injuries. High-output cardiac failure is a well-recognized serious complication of AVFs, associated with high morbidity and mortality. The objective of the present study was to identify predictors of heart failure (HF) in patients with traumatic AVF. METHODS Both PubMed/MEDLINE (Ovid) and CINAHL were searched (up to June 2019) for studies reporting individual patient data on the clinical and demographic characteristics of patients with AVF secondary to penetrating trauma. Exclusion criteria were age <18 years, no specification of symptoms, a cranial, spinal, or cardiac AVF location, and an iatrogenic mechanism of injury. The present study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. RESULTS A total of 274 AVF patients from 15 case series and 177 case reports were included. The median age at presentation was 32 years (interquartile range, 24-43 years), 90% were men. The most frequent mechanisms of injury were stab wounds (43%) and gunshot wounds (32%). The AVF location was the abdomen (n = 86; 31%), lower limb (n = 79; 29%), neck (n = 61; 22%), thorax (n = 38; 14%), and upper limb (n = 10; 4%). Of the 274 patients, 35 (13%) had presented with HF and 239 (87%) with other symptoms. The risk of HF increased with an increased feeding artery diameter (P < .001). On univariate analysis, HF was significantly associated with a longer median time from injury to presentation with AVF (11.2 years vs 0.1 years; P < .001), older median age at presentation (43 years vs 31 years; P = .002), involvement of a large feeding artery (ie, aorta, pulmonary artery, subclavian artery, external iliac artery; 40% vs 13%; P < .001), shrapnel injuries (11% vs 2%; P = .011), and injuries to the trunk or lower limb (94% vs 71%; P = .004). After adjusting for clinical and demographic patient characteristics, involvement of a large feeding artery (odds ratio, 3.25; 95% confidence interval, 1.26-8.42; P = .015) and every 6 years of delay to presentation (odds ratio, 1.30; 95% confidence interval, 1.03-1.63; P = .026) remained independent predictors for HF. CONCLUSIONS HF occurs in a small but important fraction of traumatic AVF patients and develops after highly variable latency periods. Large feeding arteries and delayed presentation independently predicted HF in this cohort.
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Affiliation(s)
- Florian A Wenzl
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | | | - John J Kessler
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb
| | - Tharun R Kotaru
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb
| | - Louay D Kalamchi
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb
| | - Sarah J Aurit
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb
| | - Juan A Asensio
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb.
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18
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Computed Tomography Angiography-Based Pulmonary Artery Volumetry as a Diagnostic Tool for Pulmonary Hypertension. J Comput Assist Tomogr 2020; 44:681-686. [PMID: 32842064 DOI: 10.1097/rct.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We evaluated use of three-dimensional pulmonary artery volumes derived from computed tomography pulmonary angiography (CTPA) in a group with pulmonary hypertension (PH) compared with healthy controls as a tool for the diagnosis of PH. METHODS Retrospective analysis was performed of 40 CTPA scans obtained within 90 days of right heart catheterization demonstrating PH. The CTPA scans of 40 age- and sex-matched patients without cardiopulmonary disease were used as comparison. Diameters and volumes of the pulmonary arteries were compared. RESULTS Adjusted total volume of the main, right, and left proximal pulmonary arteries (PAvol) demonstrated area under the curve of 0.918 (95% confidence interval, 0.860-0.975) for detection of PH, comparable to main pulmonary artery diameter measurement. Area under the curve values for PAvol were higher in subgroups divided by sex and PH severity. CONCLUSIONS Volumetric analysis of the proximal pulmonary arteries using CTPA is a promising diagnostic tool for PH in a real-world cohort.
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19
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Dong M, Yang W, Tamaresis JS, Chan FP, Zucker EJ, Kumar S, Rabinovitch M, Marsden AL, Feinstein JA. Image-based scaling laws for somatic growth and pulmonary artery morphometry from infancy to adulthood. Am J Physiol Heart Circ Physiol 2020; 319:H432-H442. [PMID: 32618514 DOI: 10.1152/ajpheart.00123.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary artery (PA) morphometry has been extensively explored in adults, with particular focus on intra-acinar arteries. However, scaling law relationships for length and diameter of extensive preacinar PAs by age have not been previously reported for in vivo human data. To understand preacinar PA growth spanning children to adults, we performed morphometric analyses of all PAs visible in the computed tomography (CT) and magnetic resonance (MR) images from a healthy subject cohort [n = 16; age: 1-51 yr; body surface area (BSA): 0.49-2.01 m2]. Subject-specific anatomic PA models were constructed from CT and MR images, and morphometric information-diameter, length, tortuosity, bifurcation angle, and connectivity-was extracted and sorted into diameter-defined Strahler orders. Validation of Murray's law, describing optimal scaling exponents of radii for branching vessels, was performed to determine how closely PAs conform to this classical relationship. Using regression analyses of vessel diameters and lengths against orders and patient metrics (BSA, age, height), we found that diameters increased exponentially with order and allometrically with patient metrics. Length increased allometrically with patient metrics, albeit weakly. The average tortuosity index of all vessels was 0.026 ± 0.024, average bifurcation angle was 28.2 ± 15.1°, and average Murray's law exponent was 2.92 ± 1.07. We report a set of scaling laws for vessel diameter and length, along with other morphometric information. These provide an initial understanding of healthy structural preacinar PA development with age, which can be used for computational modeling studies and comparison with diseased PA anatomy.NEW & NOTEWORTHY Pulmonary artery (PA) morphometry studies to date have focused primarily on large arteries and intra-acinar arteries in either adults or children, neglecting preacinar arteries in both populations. Our study is the first to quantify in vivo preacinar PA morphometry changes spanning infants to adults. For preacinar arteries > 1 mm in diameter, we identify scaling laws for vessel diameters and lengths with patient metrics of growth and establish a healthy PA morphometry baseline for most preacinar PAs.
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Affiliation(s)
- Melody Dong
- Department of Bioengineering, Stanford University, Stanford, California
| | - Weiguang Yang
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - John S Tamaresis
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Frandics P Chan
- Department of Radiology, Stanford University, Stanford, California
| | - Evan J Zucker
- Department of Radiology, Stanford University, Stanford, California
| | - Sahana Kumar
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Marlene Rabinovitch
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Jeffrey A Feinstein
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Pediatrics-Cardiology, Stanford University, Stanford, California
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20
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Sarıkaya Y, Arslan S, Taydaş O, Erarslan Y, Arıyürek OM. Axial pulmonary trunk diameter variations during the cardiac cycle. Surg Radiol Anat 2020; 42:1279-1285. [PMID: 32405785 DOI: 10.1007/s00276-020-02493-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies have shown a correlation between axial pulmonary trunk diameter (PTD) on chest computed tomography (CT) and pulmonary artery pressure. However, it is not known whether the PTD slices measured on chest CT have been recorded during the systolic or diastolic phase. The aim of this study was to demonstrate the variations in PTD during the cardiac cycle by measuring coronary CT angiography (CCTA) images. METHODS A retrospective analysis was made of 101 patients who underwent CCTA for coronary artery disease assessment. CCTA images were reconstructed during a full cardiac cycle and measurements were taken of the systolic and diastolic PTD and ascending aorta diameter (AAD) from the same slice by two independent observers. RESULTS Inter-observer agreement was excellent (intraclass correlation coefficient = 0.99) for all CT measurements. The mean systolic PTD of all patients was 26.3 ± 3.6 mm and the mean diastolic PTD was 22.8 ± 3.2 mm (p < 0.001). The mean difference between systole and diastole was found to be 3.5 ± 1.2 mm for PTD, 1.2 ± 0.7 mm for AAD, and 0.1 ± 0.04 for the PTD/AAD ratio (p values < 0.001). There was no statistical significance of PTD variations according to gender, age, height, weight, body mass index, and body surface area. CONCLUSION When an increased PTD is detected in a chest CT compared to normal limits or a previous CT scan, this may be the result of the variation in PTD due to the cardiac cycle.
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Affiliation(s)
- Yasin Sarıkaya
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
| | - Sevtap Arslan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Onur Taydaş
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Yasin Erarslan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Orhan Macit Arıyürek
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
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21
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Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update : Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson 2020; 22:19. [PMID: 32160925 PMCID: PMC7066763 DOI: 10.1186/s12968-020-00610-6] [Citation(s) in RCA: 472] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/17/2020] [Indexed: 01/04/2023] Open
Abstract
With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post-Processing of the Society for Cardiovascular Magnetic Resonance (SCMR). The aim of the Task Force is to recommend requirements and standards for image interpretation and post-processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate. It is an update of the original recommendations published 2013.
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Affiliation(s)
- Jeanette Schulz-Menger
- Department of Cardiology and Nephrology, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Jens Bremerich
- Department of Radiology of the University Hospital Basel, Basel, Switzerland
| | - Scott D Flamm
- Imaging, and Heart and Vascular Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Fogel
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, QC, Canada
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, and Departments of Medicine and Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Sven Plein
- Leeds Institute for Genetics Health and Therapeutics & Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site RheinMain, University Hospital Frankfurt, Frankfurt am Main, Germany
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Abrams BA, Melnyk V, Allen WL, Subramaniam K, Scott CD, Mitchell JD, Seres T, Martin AK. TEE for Lung Transplantation: A Case Series and Discussion of Vascular Complications. J Cardiothorac Vasc Anesth 2020; 34:733-740. [DOI: 10.1053/j.jvca.2019.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/04/2019] [Indexed: 11/11/2022]
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Olivieri LJ, Jiang J, Hamann K, Loke YH, Campbell-Washburn A, Xue H, McCarter R, Cross R. Normal right and left ventricular volumes prospectively obtained from cardiovascular magnetic resonance in awake, healthy, 0- 12 year old children. J Cardiovasc Magn Reson 2020; 22:11. [PMID: 32013998 PMCID: PMC6998283 DOI: 10.1186/s12968-020-0602-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/13/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Pediatric z scores are necessary to describe size and structure of the heart in growing children, however, development of an accurate z score calculator requires robust normal datasets, which are difficult to obtain with cardiovascular magnetic resonance (CMR) in children. Motion-corrected (MOCO) cines from re-binned, reconstructed real-time cine offer a free-breathing, rapid acquisition resulting in cines with high spatial and temporal resolution. In combination with child-friendly positioning and entertainment, MOCO cine technique allows for rapid cine volumetry in patients of all ages without sedation. Thus, our aim was to prospectively enroll normal infants and children birth-12 years for creation and validation of a z score calculator describing normal right ventricular (RV) and left ventricular (LV) size. METHODS With IRB approval and consent/assent, 149 normal children successfully underwent a brief noncontrast CMR on a 1.5 T scanner including MOCO cines in the short axis, and RV and LV volumes were measured. 20% of scans were re-measured for interobserver variability analyses. A general linear modeling (GLM) framework was employed to identify and properly represent the relationship between CMR-based assessments and anthropometric data. Scatter plots of model fit and Akaike's information criteria (AIC) results were used to guide the choice among alternative models. RESULTS A total of 149 subjects aged 22 days-12 years (average 5.1 ± 3.6 years), with body surface area (BSA) range 0.21-1.63 m2 (average 0.8 ± 0.35 m2) were scanned. All ICC values were > 95%, reflecting excellent agreement between raters. The model that provided the best fit of volume measure to the data included BSA with higher order effects and gender as independent variables. Compared with earlier z score models, there is important additional growth inflection in early toddlerhood with similar z score prediction in later childhood. CONCLUSIONS Free-breathing, MOCO cines allow for accurate, reliable RV and LV volumetry in a wide range of infants and children while awake. Equations predicting fit between LV and RV normal values and BSA are reported herein for purposes of creating z scores. TRIAL REGISTRATION clinicaltrials.gov NCT02892136, Registered 7/21/2016.
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Affiliation(s)
- Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Jiji Jiang
- Children's Research Institute, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, USA
| | - Karin Hamann
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | | | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert McCarter
- Children's Research Institute, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, USA
| | - Russell Cross
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
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Pennig L, Wagner A, Weiss K, Lennartz S, Grunz JP, Maintz D, Laukamp KR, Hickethier T, Naehle CP, Bunck AC, Doerner J. Imaging of the pulmonary vasculature in congenital heart disease without gadolinium contrast: Intraindividual comparison of a novel Compressed SENSE accelerated 3D modified REACT with 4D contrast-enhanced magnetic resonance angiography. J Cardiovasc Magn Reson 2020; 22:8. [PMID: 31969137 PMCID: PMC6977250 DOI: 10.1186/s12968-019-0591-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with Congenital heart disease (CHD) require repetitive imaging of the pulmonary vasculature throughout their life. In this study, we compared a novel Compressed SENSE accelerated (factor 9) electrocardiogram (ECG)- and respiratory-triggered 3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT-non-contrast-enhanced magnetic resonance angiography (modified REACT-non-CE-MRA)) with standard non-ECG-triggered time-resolved 4D CE-MRA for imaging of the pulmonary arteries and veins in patients with CHD. METHODS This retrospective analysis of 25 patients (June 2018-April 2019) with known or suspected CHD was independently conducted by two radiologists executing measurements on modified REACT-non-CE-MRA and 4D CE-MRA on seven dedicated points (inner edge): Main pulmonary artery (MPA), right and left pulmonary artery, right superior and inferior pulmonary vein, left superior (LSPV) and inferior pulmonary vein. Image quality for arteries and veins was evaluated on a four-point scale in consensus. RESULTS Twenty-three of the 25 included patients presented a CHD. There was a high interobserver agreement for both methods of imaging at the pulmonary arteries (ICC ≥ 0.96); at the pulmonary veins, modified REACT-non-CE-MRA showed a slightly higher agreement, pronounced at LSPV (ICC 0.946 vs. 0.895). Measurements in 4D CE-MRA showed higher diameter values compared to modified REACT-non-CE-MRA, at the pulmonary arteries reaching significant difference (e.g. MPA: mean 0.408 mm, p = 0.002). Modified REACT-non-CE-MRA (average acquisition time 07:01 ± 02:44 min) showed significant better image quality than 4D CE-MRA at the pulmonary arteries (3.84 vs. 3.32, p < 0.001) and veins (3.32 vs. 2.72, p = 0.015). CONCLUSIONS Compressed SENSE accelerated (factor 9) ECG- and respiratory-triggered 3D modified REACT-non-CE-MRA allows for reliable and fast imaging of the pulmonary arteries and veins with higher image quality and slightly higher interobserver agreement than 4D CE-MRA without contrast agent and associated disadvantages. Therefore, it represents a clinically suitable technique for patients requiring repetitive imaging of the pulmonary vasculature, e.g. patients with CHD.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | | | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931 Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Tilman Hickethier
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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Pulmonary Hypertension Parameters Assessment by Electrocardiographically Gated Computed Tomography. J Thorac Imaging 2019; 34:329-337. [DOI: 10.1097/rti.0000000000000359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Systematic review of civilian intravascular ballistic embolism reports during the last 30 years. J Vasc Surg 2019; 70:298-306.e6. [PMID: 30922763 DOI: 10.1016/j.jvs.2019.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/01/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intravascular ballistic embolization is a rare complication of missile injury. Because of its rarity, much remains to be known about its presentation, pathophysiology, complications, and management. In this study, we analyze case reports of ballistic embolization in the last 30 years and available cases from our institution to determine the likely patient, the nature of the embolization, the possible complications, and a general management strategy. METHODS A PubMed search was performed in search of missile embolization cases from 1988 to 2018 in the English language, including only cases of intravascular emboli. Cases resulting from combat and explosive devices were excluded. In addition, five cases from our institution were included in the analysis. RESULTS A total of 261 cases were analyzed. The most common presentation was that of a young man (reflecting the demographics of those sustaining gunshot wound injuries) with injury to the anterior torso from a single gunshot wound. Venous entry was most common, most often through large-caliber vessels. There was roughly equal involvement of the right and left circulation. Left circulation emboli were frequently symptomatic, with ischemia being the most frequent sequela. In contrast, a right circulation embolus was rarely associated with significant complications. CONCLUSIONS Despite its rarity, ballistic embolization should be considered in gunshot injury with known large-vessel injury when an exit wound is not identified. In particular, signs of ischemia distant from the injury site warrant timely investigation to maximize tissue salvageability. We present a management strategy model for consideration.
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Manning WJ. Journal of Cardiovascular Magnetic Resonance 2017. J Cardiovasc Magn Reson 2018; 20:89. [PMID: 30593280 PMCID: PMC6309095 DOI: 10.1186/s12968-018-0518-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023] Open
Abstract
There were 106 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 92 original research papers, 3 reviews, 9 technical notes, and 1 Position paper, 1 erratum and 1 correction. The volume was similar to 2016 despite an increase in manuscript submissions to 405 and thus reflects a slight decrease in the acceptance rate to 26.7%. The quality of the submissions continues to be high. The 2017 JCMR Impact Factor (which is published in June 2018) was minimally lower at 5.46 (vs. 5.71 for 2016; as published in June 2017), which is the second highest impact factor ever recorded for JCMR. The 2017 impact factor means that an average, each JCMR paper that were published in 2015 and 2016 was cited 5.46 times in 2017.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in continuus fashion and in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or theme, so that readers can view areas of interest in a single article in relation to each other and other contemporary JCMR articles. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, I have elected to use this format to convey information regarding the editorial process to the readership.I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your very best, high quality manuscripts to JCMR for consideration. I thank our very dedicated Associate Editors, Guest Editors, and Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the forefront journal of our field. And finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 3rd year as your editor-in-chief. It has been a tremendous learning experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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Alsaied T, Sleeper LA, Masci M, Ghelani SJ, Azcue N, Geva T, Powell AJ, Rathod RH. Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity. J Cardiovasc Magn Reson 2018; 20:85. [PMID: 30558626 PMCID: PMC6296022 DOI: 10.1186/s12968-018-0505-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/09/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Maldistribution of pulmonary artery blood flow (MPBF) is a potential complication in patients who have undergone single ventricle palliation culminating in the Fontan procedure. Cardiovascular magnetic resonance (CMR) is the best modality that can evaluate MPBF in this population. The purpose of this study is to identify the prevalence and associations of MPBF and to determine the impact of MPBF on exercise capacity after the Fontan operation. METHODS This retrospective single-center study included all patients after Fontan operation who had maximal cardiopulmonary exercise test (CPET) and CMR with flow measurements of the branch pulmonary arteries. MPBF was defined as > 20% difference in branch pulmonary artery flow. Exercise capacity was measured as percent of predicted oxygen consumption at peak exercise (% predicted VO2). Linear and logistic regression models were used to determine univariate and multivariable predictors of exercise capacity and correlates of MPBF, respectively. RESULTS A total of 147 patients who had CMR between 1999 and 2017 were included (median age at CMR 21.8 years [interquartile range (IQR) 16.5-30.6]) and the median time between CMR and CPET was 2.8 months [IQR 0-13.8]. Fifty-three patients (36%) had MPBF (95% CI 29-45%). The mean % predicted VO2 was 63 ± 16%. Patients with MPBF had lower mean % predicted VO2 compared to patients without MPBF (60 ± 14% versus 65 ± 16%, p = 0.04). On multivariable analysis, a lower % predicted VO2 was independently associated with longer time since Fontan, higher ventricular mass-to-volume ratio, and MPBF. On multivariable analysis, only compression of the branch pulmonary arteries by the ascending aorta or aortic root was associated with MPBF (OR 6.5, 95% CI 5.6-7.4, p < 0.001). CONCLUSION In patients after the Fontan operation, MPBF is common and is independently associated with lower exercise capacity. MPBF was most likely to be caused by pulmonary artery compression by the aortic root or the ascending aorta. This study identifies MPBF as an important risk factor and as a potential target for therapeutic interventions in this fragile patient population.
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Affiliation(s)
- Tarek Alsaied
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Marco Masci
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Sunil J. Ghelani
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Nina Azcue
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Rahul H. Rathod
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
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Prevalence and prognostic significance of pulmonary artery aneurysms in adults with congenital heart disease. Int J Cardiol 2018; 270:120-125. [PMID: 29891239 DOI: 10.1016/j.ijcard.2018.05.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/02/2018] [Accepted: 05/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prevalence and prognostic significance of pulmonary artery (PA) dilatation in congenital heart disease (CHD) have never been studied systematically. METHODS Chest X-rays of 1192 consecutive adults with CHD were reviewed. Major diameter of the PA was determined by imaging techniques in those with PA dilatation. A value >29 mm was considered abnormal. Data on anatomy, hemodynamics, residual lesions and outcomes were retrospectively collected. RESULTS Overall prevalence of PA dilatation was 18%. A minority of patients (5.5%) reached 40 mm (aneurysm; PAA) and 1.8% exceeded 50 mm. The most common PAA underlying malformations were pulmonary stenosis (21%), and shunts (55%). Significantly larger diameters were observed in hypertensive shunts (40 mm; IQR 36.7-45 mm vs. 34 mm; IQR 32-36 mm) (p < 0.0001). However, the largest diameters were found in cono-truncal anomalies. There was no significant correlation between PA dimensions and systolic pulmonary pressure (r = -0.196), trans-pulmonary gradient (r = -0.203), pulmonary regurgitation (PR) (r = 0.071) or magnitude of shunt (r = 0.137) (p > 0.05 for all). Over follow-up, 1 sudden death (SD) occurred in one Eisenmenger patient. Complications included coronary (3), recurrent laryngeal nerve (1) and airway (1) compressions, progressive PR (1), and PA thrombosis (1). Coronary compression and SD were strongly associated (univariate analysis) with pulmonary hypertension (120 vs. 55 mm Hg; p = 0.002) but not with extreme PA dilatation (range: 40-65 mm). CONCLUSIONS PA dilatation in CHD is common but only a small percentage of patients have PAA. Clinical impact on outcomes is low. Complications occurred almost exclusively in patients with pulmonary hypertension whereas PA diameter alone was not associated with adverse outcomes.
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Abstract
RATIONALE A hemodynamic relationship of pulmonary artery pressure (PAP) to pulmonary acceleration time (PAcT) has not yet been explicitly presented. OBJECTIVE We employed a logistic-based systolic model with a subtle modification for pulmonary circulation and provided a logical ground for the relationship between systolic PAP and PAcT using transthoracic echocardiography. Additionally, the logistic-based PAP estimation equation was deduced from the model to relate systolic PAP and PAcT. METHODS AND RESULTS This equation was statistically tested in comparison to existing PAP estimation equations. Results showed that the logistic-based PAP estimation equation was at least as accurate as previous equations with respect to previously published mean PAP versus PAcT values. After the subtle pulmonary modification of the model, the pulmonary blood flow velocity and pressure not only well reflected the underlying pulmonary circulation physiology, but could also be presented in harmony with systemic circulation physiology. CONCLUSIONS A future clinical study with actual systolic PAP versus PAcT measurements is needed to test the application of the logistic-based PAP estimation equation.
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Affiliation(s)
- Hyunsuk Frank Roh
- Department of Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, South Korea.
| | - Jung Mogg Kim
- Department of Microbiology and Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, South Korea.
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Manning WJ. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston. J Cardiovasc Magn Reson 2017; 19:108. [PMID: 29284487 PMCID: PMC5747150 DOI: 10.1186/s12968-017-0423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2016, the JCMR published 93 manuscripts, including 80 research papers, 6 reviews, 5 technical notes, 1 protocol, and 1 case report. The number of manuscripts published was similar to 2015 though with a 12% increase in manuscript submissions to an all-time high of 369. This reflects a decrease in the overall acceptance rate to <25% (excluding solicited reviews). The quality of submissions to JCMR continues to be high. The 2016 JCMR Impact Factor (which is published in June 2016 by Thomson Reuters) was steady at 5.601 (vs. 5.71 for 2015; as published in June 2016), which is the second highest impact factor ever recorded for JCMR. The 2016 impact factor means that the JCMR papers that were published in 2014 and 2015 were on-average cited 5.71 times in 2016.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in the order that they are accepted with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes with previously published JCMR papers to guide continuity of thought in the journal. In addition, I have elected to open this publication with information for the readership regarding the transition of the JCMR editorial office to the Beth Israel Deaconess Medical Center, Boston and the editorial process.Though there is an author publication charge (APC) associated with open-access to cover the publisher's expenses, this format provides a much wider distribution/availability of the author's work and greater manuscript citation. For SCMR members, there is a substantial discount in the APC. I hope that you will continue to send your high quality manuscripts to JCMR for consideration. Importantly, I also ask that you consider referencing recent JCMR publications in your submissions to the JCMR and elsewhere as these contribute to our impact factor. I also thank our dedicated Associate Editors, Guest Editors, and reviewers for their many efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the leading publication in our field.
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Affiliation(s)
- Warren J Manning
- From the Journal of Cardiovascular Magnetic Resonance Editorial Office and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Mijacika T, Kyhl K, Frestad D, Otto Barak F, Drvis I, Secher NH, Dujic Z, Lav Madsen P. Effect of pulmonary hyperinflation on central blood volume: An MRI study. Respir Physiol Neurobiol 2017; 243:92-96. [PMID: 28583413 DOI: 10.1016/j.resp.2017.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/31/2017] [Indexed: 11/25/2022]
Abstract
Pulmonary hyperinflation attained by glossopharyngeal insufflation (GPI) challenges the circulation by compressing the heart and pulmonary vasculature. Our aim was to determine the amount of blood translocated from the central blood volume during GPI. Cardiac output and cardiac chamber volumes were assessed by magnetic resonance imaging in twelve breath-hold divers at rest and during apnea with GPI. Pulmonary blood volume was determined from pulmonary blood flow and transit times for gadolinium during first-pass perfusion after intravenous injection. During GPI, the lung volume increased by 0.8±0.6L (11±7%) above the total lung capacity. All cardiac chambers decreased in volume and despite a heart rate increase of 24±29 bpm (39±50%), pulmonary blood flow decreased by 2783±1820mL (43±20%). The pulmonary transit time remained unchanged at 7.5±2.2s and pulmonary blood volume decreased by 354±176mL (47±15%). In total, central blood volume decreased by 532±248mL (46±14%). Voluntary pulmonary hyperinflation leads to ∼50% decrease in pulmonary and central blood volume.
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Affiliation(s)
- Tanja Mijacika
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia
| | - Kasper Kyhl
- The Cardiac MRI group, Dept. Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Daria Frestad
- Dept. of Cardiology, Copenhagen University Hospital, Hvidovre, University of Copenhagen, Denmark
| | - F Otto Barak
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia; Dept. of Physiology, Faculty of Medicine, University of Novi Sad, Serbia
| | - Ivan Drvis
- University of Zagreb Faculty of Kinesiology, Croatia
| | - Niels H Secher
- Dept. of Anesthesiology, The Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Zeljko Dujic
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia.
| | - Per Lav Madsen
- Dept. of Cardiology, Copenhagen University Hospital, Herlev, University of Copenhagen, Denmark
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杨 帆, 李 东, 杨 振, 张 璋, 王 丹, 于 铁. [Measurements of Pulmonary Artery Size for Assessment of Pulmonary Hypertension by Cardiovascular Magnetic Resonance and Clinical Application]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:93-99. [PMID: 28228220 PMCID: PMC5972974 DOI: 10.3779/j.issn.1009-3419.2017.02.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/20/2017] [Accepted: 01/27/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) often leads to dilatation of main pulmonary artery (MPA). MPA measurements can be used to predict PH. This aim of this study is to investigate power of MPA vessel indices, which are acquired from cardiovascular magnetic resonance, to evaluate PH. METHODS Cardiovascular-magnetic-resonance-determined parameters of MPA were acquired and calculated in 83 PH patients, whose diagnosis were confirmed with right heart catheterization and 49 healthy volunteers; these parameters included MPA diameter (DPA), ratio of DPA and ascending aorta diameter (DPA/DAo), max mean diameter (MDmax), min mean diameter (MDmin), fraction transverse diameter (fTD), fraction longitudinal diameter (fLD), and distensibility. RESULTS Compared with control group, DPA, DPA/DAo, MDmax, and MDmin were significantly higher in patients with PH (P<0.001); fTD, fLD, and distensibility significantly decreased (P<0.001). fTD was lesser than fLD in control group (P<0.001), whereas difference was not observed in PH (P=0.305). MPA indices were significantly correlated with mean pulmonary arterial pressure (mPAP) (P<0.05), and strongest correlation was observed for DPA/DAo (r=0.534, P<0.001). By receiver operating characteristic analysis, MDmin>28.4 mm, and MDmax>32.4 mm (area under the curve, AUC=0.979, 0.981) showed best performance in predicting PH, yielding highest specificity at 100%. CONCLUSIONS Noninvasive cardiovascular-magnetic-resonance-derived MPA measurements provide excellent and practical reference in clinical settings for detecting PH.
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Affiliation(s)
- 帆 杨
- 300052 天津,天津医科大学总医院放射科Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 东 李
- 300052 天津,天津医科大学总医院放射科Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 振文 杨
- 300052 天津,天津医科大学总医院心内科Department of Cardiovascular Disease, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 璋 张
- 300052 天津,天津医科大学总医院放射科Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 丹 王
- 300052 天津,天津医科大学总医院放射科Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - 铁链 于
- 300052 天津,天津医科大学总医院放射科Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Maagaard M, Heiberg J, Asschenfeldt B, Ringgaard S, Hjortdal VE. Does functional capacity depend on the size of the shunt? A prospective, cohort study of adults with small, unrepaired ventricular septal defects†. Eur J Cardiothorac Surg 2017; 51:722-727. [DOI: 10.1093/ejcts/ezw420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/18/2016] [Indexed: 11/13/2022] Open
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