Early changes in left ventricular size and function after correction of left ventricular volume overload.
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Adult↗
Biomedical subjects
J B Bingham
Publications and source records attributed to J B Bingham.
Right Ventricular function in aortic and mitral valve disease.
Radionuclide ventriculography of the right heart was performed in 56 patients within two weeks of cardiac catheterization using a gated first-pass technique. Thirteen patient served as normal controls, and 43 patients had severe aortic or mitral valve disease or both, 35 of whom subsequently underwent valve surgery. Right ventricular ejection fraction (RVEF) and the presence of central venous reflux was determined and related to catheterization findings. In normal patients, RVEF was 60 plus or minus 7 percent (mean plus or minus 1 SD). In patients with valvular disease, the RVEF was below the normal range in only 2/14 (14 per cent) when right ventricular peak systolic pressures were less than 50 mm Hg, compared with 16/29 (55 percent) with an RVEF below normal when right ventricular peak systolic pressures greater than 50 mm Hg (P less than .05). In contrast, there was no relation of right ventricular ejection fraction to ventricular filling pressure in valvular heart disease patients. There was no difference in early postoperative course in patients with normal or reduced ejection fraction. Central venous systolic reflux was not presented in normal patients, but was present in 3/12 (25 percent) and 22/25 (88 percent); P less than 0.1) of patients with right ventricular systolic pressures below and above 55 mm Hg, respectively, including all ten patients with documented tricuspid regurgitation. Radionuclide assessment of right ventricular function in patients with aortic or mitral valve disease or both provides information that cannot be inferred from right-sided pressure measurements.
Adult↗
Cardiac nuclear imaging: principles, instrumentation and pitfalls.
The requirements for cardiac imaging with nuclear techniques are: (1) a radiolabeled tracer that is distributed in proportion to the function under investigation; (2) a collimator to allow photons arising only from specific areas of the heart to interact with the imaging device; (3) an imaging device to convert the gamma photon energy into an electrical signal that can be processed and displayed; and (4) a computer to record the information and permit quantification and optimal display of the data. One characteristic of nuclear imaging techniques is the requirement of averaging of a number of cardiac cycles to provide data for interpretation, whereas th information recorded with nuclear probes can be analyzed on a beat by beat basis. The data can be reviewed both visually and quantitatively. Semiautomatic methods of measuring ejection fraction, which correlate well with data from cardiac catheterization, have been in clinical use for several years. However, these techniques are not capable of correctly analyzing the data from all patients. Particular errors occur with gating, tracking the edge of the ventricle or in the selection of a background area, which may result in the calculation of an erroneous election fraction. In the future, short-lived radiopharmaceutical agents will result in a lower radiation burden to patients and higher quality studies in a shorter period of time, and tomographic techniques should provide new insights into the structure and function of the heart.
Heart Ventricles↗
Scintigraphic evaluation of left ventricular aneurysm.
Gated cardiac blood pool scintigraphy is a noninvasive method to assess regional and global left ventricular function in the patient with suspected true or false left ventricular aneurysm after a myocardial infarction. The procedure is easy to perform and provides reproducible, high resolution images that can accurately distinguish from diffuse contractile abnormalities often present after myocardial infarction. An overall accuracy rate of 96 percent for detection of left ventricular aneurysm can be obtained with gated cardiac blood pool scintigraphy as compared with contrast left ventriculography. The procedure also permits assessment of functional reserve of the noninvolved myocardium and thus can provide valuable information on whether enough viable myocardium will remain after aneurysmectomy. The addition of thallium-201 myocardial perfusion scintigraphy may aid in the separation of viable from scarred myocardium at the edge of the aneurysm. Both radionuclide techniques are well suited for screening the patient after infarction with persistent congestive heart failure, malignant arrhythmia or systemic emboli in whom a left ventricular aneurysm may have developed.
Cardiomyopathies↗
Influence of coronary artery disease on pulmonary uptake of thallium-201.
An increased pulmonary thallium-201 concentration has been observed in exercise stress thallium perfusion imaging in patients with coronary artery disease. To understand the cause of this lung uptake, studies were performed in experimental animals and in patients undergoing stress thallium perfusion imaging. The extraction fraction of thallium-201 by the lungs was measured in a group of eight dogs using a dual isotope technique. Basal thallium-201 extraction fraction at rest was 0.09 +/- 0.009. After administration of isoproterenol, it decreased to 0.06 +/- 0.02 (difference not significant). After balloon obstruction of the left atrium (which increased mean left atrial pressure and pulmonary transit time) and after administration of acetylcholine as a bolus injection (which prolonged pulmonary transit time only) it increased to 0.19 +/- 0.02 (p < 0.01). Lung thallium-201 activity was measured in 86 patients who had undergone cardiac catheterization and stress-redistribution myocardial perfusion imaging. The initial/final lung activity ratio was 1.41 +/- 0.03 in patients with no significant coronary artery disease, 1.52 +/- 0.03 (difference not significant) in patients with single vessel coronary disease, 1.60 +/- 0.05 (p < 0.05) in those with two vessel disease and 1.59 +/- 0.05 (p < 0.05) in those with triple vessel disease. Quantitation of lung activity in 30 of these patients indicated that the increased ratio in patients with multivessel coronary artery disease was due to a transient absolute increase in the thallium-201 concentration immediately after maximal exercise. The data imply that increased pulmonary concentration of thallium-201 during exercise is a consequence of left ventricular failure.
Adult↗
Right atrial enlargement--cardiac imaging.
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Cardiomegaly↗
Of linens and laces--the eighth anniversary of the gated blood pool scan.
Evaluation of ventricular performance is essential in the diagnosis and long-term management of patients with heart disease. This can be most easily performed clinically using simple tools. When more definitive objective assessment of cardiac function is indicated, the equilibrium gated blood pool study provides reliable angiographic evaluation of the heart. It will continue as a mainstay in the armamentarium of cardiology.
Cardiac Output↗
Nuclear medicine applications to the study of coronary artery disease.
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Cardiac Output↗
Use of 99Tcm-DMSA as a static renal imaging agent.
The use of 99Tcm-labelled DMSA as a static renal imaging agent has been analyzed semi-quantitatively in 366 patients. Study with this agent proved to be of most value in patients with equivocal space-occupying lesions of the kidney, provided useful information in various destructive diseases of the kidney when used for determining divided renal function but was of little value in chronic renal failure. In 33 patients, the uptake of 99Tcm-DMSA at 3 h as a measure of divided renal function was compared with the uptake of 99Tcm-DTPA from 30 to 150 sec following injection and was found to correlate well. In a series of 7 dogs with induced unilateral renal impairment, divided function determined with 99Tcm-DMSA was found to correlate well with results obtained using 51Cr-EDTA.
Animals↗
The appearances of renal transplant lymphocoeles during dynamic renal scintigraphy.
Eight patients are described in whom transplant lymphocoeles were drained. All had 99Tcm-DTPA dynamic renal scintigrams performed pre-operatively; five showed features of obstruction. Photon deficient areas on the scintigrams and bladder deformities were of particular value in detecting lymphocoeles.
Adolescent↗
An evaluation of the use of 99Tcm-dimercaptosuccinic acid (DMSA) as a static renal imaging agent.
The clinical value of 99Tcm-dimercaptosuccinic acid, utilized as a static renal imaging agent, has been analysed in 366 patients. It proved to be diagnostically most useful in space occupying lesions of the kidney when equivocal on IVU and provided useful additional information when used in the determination of divided renal function or the distribution of intrarenal function. Its use is contraindicated in the determination of divided renal function in obstructed kidneys because of accumulation of significant amounts of DMSA that are excreted by glomerular filtration. When DMSA uptake at three hours after injection is compared with 99Tcm-DPTA uptake from 90 to 150 seconds after bolus injection, there is a good correlation between the two methods of determination of divided renal function.
Humans↗
Heterotopic pancreas as lead point in intussusception: new variant of vitellointestinal tract malformation.
Two cases of intussusception are reported with heterotopic pancreatic tissue attached to and draining into the ileum. The first patient, a boy aged 16 months, presented with ileoileal intussusception. The diagnosis was confirmed on ultrasound scan. Laparotomy and resection were performed. A 12-mm nodule of heterotopic pancreatic tissue was identified in the ileal serosa at the apex of the intussusceptum, fully formed with acinar tissue, islets, and draining duct. The second patient, also a boy aged 16 months, presented with obstructed ileocolic intussusception in which the lead point at surgery resembled a Meckel's diverticulum. Histopathology revealed a similar 10-mm nodule of fully formed pancreatic tissue in the ileal serosal tissues, with some acinar tissue extending through the wall of the intestine alongside ductal structures. In both cases there was ectopic gastric mucosa either in the distal part of the draining duct or in the small intestine itself at the opening. Heterotopic pancreas is a rare cause of intussusception. We propose that this lesion is of vitellointestinal tract origin, conceptually similar to a Meckel's diverticulum but without a diverticulum as such. Heterotopic pancreatic tissue occurring alone is more common in the proximal small intestine, duodenum, and stomach than in the ileum, and it is often asymptomatic.
Choristoma↗