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CORAZZA IVAN, PINARDI CHIARA, MANCO LUIGI, BIANCHINI DAVID, CERCENELLI LAURA, MARCELLI EMANUELA, ZANNOLI ROMANO. BIOMECHANICAL APPROACH TO THE CLINICAL TREATMENT OF PULMONARY ARTERIAL HYPERTENSION. J MECH MED BIOL 2013. [DOI: 10.1142/s0219519413400058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Negative clinical trend of severe pulmonary arterial hypertension (PAH) is due to right ventricular chamber dilatation and consequent dysfunction. On a biomechanical basis the clinical evolution is associated to a progressive mismatching of the artero-ventricular junction and a possible mechanical intervention may be foreseen. This paper demonstrates how the progressive right ventricular dysfunction, in terms of biochemical–mechanical efficiency, is related to the stress–strain curve of the pulmonary artery, simulated by superimposing different elastance tubes in a cardiovascular mock. Applying the experimental signals to an "ideal" normal and dilated ventricle, it was demonstrated that the very high pulmonary elastance at high pressure is the prime cause of a sharp efficiency drop, in comparison with an aortic similar condition. This evidence supports the proposal of mechanical interventions to reduce pulmonary arterial elastance to improve the artero-ventricular matching, increase the reduced ventricular efficiency and change the negative trend of the illness.
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Affiliation(s)
- IVAN CORAZZA
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna Via Massarenti, 9, 40138 Bologna, Italy
| | - CHIARA PINARDI
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna Via Massarenti, 9, 40138 Bologna, Italy
| | - LUIGI MANCO
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna Via Massarenti, 9, 40138 Bologna, Italy
| | - DAVID BIANCHINI
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna Via Massarenti, 9, 40138 Bologna, Italy
| | - LAURA CERCENELLI
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna Via Massarenti, 9, 40138 Bologna, Italy
| | - EMANUELA MARCELLI
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna Via Massarenti, 9, 40138 Bologna, Italy
| | - ROMANO ZANNOLI
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna Via Massarenti, 9, 40138 Bologna, Italy
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Niwa K, Uchishiba M, Aotsuka H, Tateno S, Tobita K, Niimi H, Matsuo K, Fujiwara T. Systematic diagnostic method using magnetic resonance imaging to analyze viscero-bronchial-cardiovascular anomalies in pediatric patients with congenital heart disease. Int J Angiol 2011. [DOI: 10.1007/bf02043643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Gutberlet M, Hoffmann J, Künzel E, Fleischer A, Sarikouch S, Beerbaum P, Lehmkuhl L, Andres C, Lurz P, Kostelka M, Abdul-Khaliq H, Dähnert I, Grothoff M. Prä- und Postoperative Bildgebung bei Patienten mit Transposition der großen Gefäße. Radiologe 2010; 51:15-22. [DOI: 10.1007/s00117-010-1996-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lembcke A, Koch C, Dohmen PM, Rutsch W, Abbara S, Krug LD, Muehler MR, Rogalla P. Electrocardiographic-Gated Multislice Computed Tomography for Visualization of Cardiac Morphology in Congenitally Corrected Transposition of the Great Arteries. J Comput Assist Tomogr 2005; 29:234-7. [PMID: 15772544 DOI: 10.1097/01.rct.0000156198.02741.c0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of congenitally corrected transposition of the great arteries in a 64-old-woman is presented. Diagnosis was missed by invasive angiocardiography. Electrocardiographic-gated multislice computed tomography not only demonstrated switching of the aortic root and pulmonary trunk but clearly identified fine morphologic details of the cardiac chambers, including the atypical coronary artery pattern.
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Affiliation(s)
- Alexander Lembcke
- Department of Radiology, Charité-University of Medicine, Berlin Medical School of the Free University and Humboldt University, Berlin, Germany.
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5
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Boxt LM. Magnetic resonance and computed tomographic evaluation of congenital heart disease. J Magn Reson Imaging 2004; 19:827-47. [PMID: 15170787 DOI: 10.1002/jmri.20077] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Magnetic resonance imaging (MRI) and contrast-enhanced computed tomography (CT) provide noninvasive visualization of morphologic changes in pediatric and adult patients with congenital heart disease, as well as the functional changes caused by the underlying morphologic abnormalities. Clinical experience with MRI is richer than that with fast CT, but CT appears to provide accurate and high-quality imagery for diagnosis. The two modalities may be complementary. That is, intracardiac anatomy is so well depicted by MRI, and CT provides exquisite images of the great vessels. Furthermore, in adult patients, MR and CT are helpful in demonstrating and quantitating physiologic changes superimposed by acquired cardiovascular disease on the underlying congenital malformations. Using MRI, spin echo acquisitions provide the image data for evaluation of morphologic changes, and gradient reversal techniques add functional and flow data to complement morphologic changes. Contrast-enhanced electrocardiographic (ECG)-gated multidetector and electron beam CT examination provide morphologic information and may be used as a data set for off-line functional quantitation.
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Affiliation(s)
- Lawrence M Boxt
- Division of Cardiovascular Imaging, Department of Radiology, Beth Israel Medical Center, New York, New York 10003, USA.
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Abstract
MR examination of patients with congenital heart disease is a useful means of explicitly demonstrating chamber morphology and, in particular, morphologic changes caused by physiologic changes brought on by particular defects. Use of MR techniques allows characterization of chamber morphology for determination of cardiac connections and great artery relationships. The high-contrast resolution of spin echo acquisition provides important morphologic detail. Cine gradient echo techniques complement spin echo acquisition by providing functional and flow information. Although MR examination complements echocardiographic investigation in pediatric and adult patients, is may be useful for replacing angiocardiography, shortening examination time, and decreasing morbidity in diagnostic workups of these patients.
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Affiliation(s)
- Lawrence M Boxt
- Department of Radiology, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003, USA.
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Choi BW, Park YH, Choi JY, Choi BI, Kim MJ, Ryu SJ, Lee JK, Sul JH, Lee SK, Cho BK, Choe KO. Using electron beam CT to evaluate conotruncal anomalies in pediatric and adult patients. AJR Am J Roentgenol 2001; 177:1045-9. [PMID: 11641166 DOI: 10.2214/ajr.177.5.1771045] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- B W Choi
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemoon-gu, Seoul 120-752, Korea
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Schmidt M, Theissen P, Moka D, Voth E, Schmitter HT, Schicha H. Tc-99m MIBI SPECT correlated with magnetic resonance imaging for cardiac evaluation of a patient with congenitally corrected transposition of the great arteries (L-TGA). Clin Nucl Med 2001; 26:714-5. [PMID: 11452185 DOI: 10.1097/00003072-200108000-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Schmidt
- Klinik and Poliklinik für Nuklearmedizin der Universität zu Köln, Cologne, Germany.
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Schmidt M, Theissen P, Deutsch HJ, Dederichs B, Franzen D, Erdmann E, Schicha H. Congenitally corrected transposition of the great arteries (L-TGA) with situs inversus totalis in adulthood: findings with magnetic resonance imaging. Magn Reson Imaging 2000; 18:417-22. [PMID: 10788719 DOI: 10.1016/s0730-725x(00)00120-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diagnosis of congenitally corrected transposition of the great arteries (L-TGA) with situs inversus totalis in two adult patients was made by magnetic resonance imaging (MRI). Visualization of the complete anatomy and quantification of ventricular function was possible. Relevant concomitant disease such as perimembraneous ventricular septal defect, atrial secundum septal defect, tricuspid regurgitation, valvular pulmonic stenosis, and pulmonary artery dilatation were clearly depicted by MRI using standard spin-echo and gradient-echo techniques. Findings were confirmed by cardiac catheterization in both patients. In this rare and complex congenital cardiac anomaly, MRI is an excellent imaging modality as echocardiography may be difficult to interpret due to restricted imaging windows. MRI may help in the decision about the necessity to undergo further invasive evaluation and may help to make cardiac catheterization a straightforward procedure.
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Affiliation(s)
- M Schmidt
- Klinik und Poliklinik für Nuklearmedizin der Universität zu Köln, Cologne, Germany.
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Affiliation(s)
- G P Reddy
- Department of Radiology, University of California San Francisco 94143-0628, USA
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12
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TELLTALE SIGNS OF CONGENITAL HEART DISEASE. Radiol Clin North Am 1993. [DOI: 10.1016/s0033-8389(22)02606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ikeda U, Furuse M, Suzuki O, Kimura K, Sekiguchi H, Shimada K. Long-term survival in aged patients with corrected transposition of the great arteries. Chest 1992; 101:1382-5. [PMID: 1582301 DOI: 10.1378/chest.101.5.1382] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Corrected transposition of the great arteries is a rare condition, and few patients with this abnormality survive past 50 years of age because of associated congenital defects or the subsequent development of atrioventricular valvular insufficiency or heart block or both. We describe four men with uncomplicated C-TGA. Our patients are of interest for the following reasons: (a) their condition is very rare; (b) the diagnosis of C-TGA traditionally has been verified through invasive cardiac catheterization procedures; however, in our latest two patients, recently developed noninvasive diagnostic techniques played the decisive role in the diagnosis of C-TGA; (c) in these modalities, they presented as a "natural experimental model" that the right ventricle submitted to a high systemic pressure load is capable of increasing muscle mass over long-term adaptation. Our four patients illustrate that patients with C-TGA, even with the associated cardiac anomalies, may live a normal life span with proper management.
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Affiliation(s)
- U Ikeda
- Department of Cardiology, Jichi Medical School, Tochigi, Japan
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Gross GW, Steiner RM. Radiographic Manifestations of Congenital Heart Disease in the Adult Patient. Radiol Clin North Am 1991. [DOI: 10.1016/s0033-8389(22)02699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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