PubMed · 7754963
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N Danchin. 1995. Interventricular septum and right ventricular function.. https://doi.org/10.1016/0002-8703(95)90418-2
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To assess the accuracy of automatic extraction of the left ventricular inner contour on contrast-enhanced ultrafast cine magnetic resonance (MR) images, we compared the values obtained by this method with those obtained using intravenous digital subtraction left ventriculography. High-quality single breath-hold contrast-enhanced ultrafast cine MR images were obtained in all cardiac phases on horizontal and vertical long axis sections of the left ventricle. For ultrafast cine MR imaging, a phase-rewind gradient-echo (rewind-SMASH) sequence was used. Automatic extraction of the left ventricular inner contour on contrast-enhanced ultrafast cine MR images was performed in all cardiac phases. High-quality left ventricular images of the horizontal long axis section were obtained in 127 of 160 patients (79%). The automatic extraction of the left ventricular contour was easily performed on high-quality images with very short processing time (4 s/frame). The values for left ventricular volumes obtained with the automatic extraction method on contrast-enhanced ultrafast cine MR imaging were correlated well with those obtained with the manual extraction method and IV-DSA in high quality cardiac images. The biplane modified Simpson's method using automatic extraction is an accurate and highly reproducible method for evaluating left ventricular volumes.
This study reports hemodynamic, electrophysiologic, and clinical results in 171 patients (157 men and 14 women, mean age 57 +/- 8 years) 1 year after endoventricular circular patch repair and coronary grafting for postinfarction left ventricular dyskinetic or akinetic aneurysm. All patients had hemodynamic and electrophysiologic study before the operation and early and 1 year after the operation. The vast majority of aneurysms were anterior (n = 166), with a mean delay from infarction of 43 +/- 50 months. Fifty-two percent of patients were in New York Heart Association class III or IV, and preoperative ejection fraction was less than 40% in the majority of them (75%). Preoperative clinical ventricular tachycardia was present in 25 patients and was inducible in 59 patients. All patients had endoventricular circular patch repair with a synthetic (n = 99) or autologous patch (n = 72); 96% had associated coronary grafting with a mean number of bypass grafts of 1.9 +/- 0.9. Results at 1 year demonstrated a significant increase in ejection fraction (from 36% +/- 13% to 46% +/- 12% (p < 0.0001) and a significant reduction in ventricular volumes (end-diastolic volume index from 116 +/- 5 to 94 +/- 29 ml/m2 and end-systolic volume index from 77 +/- 45 to 53 +/- 25 ml/m2, p < 0.0001). New York Heart Association functional classification was significantly improved (2.6 +/- 0.9 vs 1.4 +/- 0.6, p < 0.0001) and ventricular tachycardias were almost suppressed (no documented clinical ventricular tachycardias and 8% incidence of inducible ventricular tachycardias after 1 year, chi 2 < 0.001). Patients who benefit most from the operation are those with more severe preoperative left ventricular dysfunction (i.e., ejection fraction < 30%), more frequent ventricular arrhythmias, and larger ventricular volumes. At regression analysis, critical disease of the right coronary artery was the only independent predictor of unsatisfactory pump improvement (as evaluated by postoperative increase of ejection fraction < 10 absolute points). In conclusion, in our large series of patients operated on by one surgical team between 1988 and 1993, who were studied hemodynamically both before and after the operation, endoventricular circular patch repair of left ventricular aneurysm associated with coronary grafting definitely improves left ventricular pump function and clinical status 1 year after the operation.
The technique of tomographic 3D-echocardiographic reconstructions allows, beside the morphological description of cardiac structures, a left ventricular quantification concerning the diagnosis of the coronary heart disease. The advantage of the tomographic 3D-reconstruction and tomographic quantification is that the left ventricular volume is determined directly by manual planimetry during the whole heart cycle and will not be approximated by geographical algorithms as used for 2D-techniques and alternative 3D-techniques. We worked with the Echoscan reconstruction unit (TomTec) equipped with a pentium-processor and a 64 RAM memory for the acquisition and digitalization of a 3D-echocardiographic image data set (Figures 2a and 2b). Automatic image acquisition is performed using a unit existing of a common ultrasound transducer and a special rotational motor device. All the examinations described in this publication are performed by a transthoracic approach. Examining asymmetric model hearts with aneurysm an experimental study sustentiated the high accuracy of determining asymmetric ventricle volumes (mean of difference [3D--true dimensions] = 0.91 ml; SD of differences = +/- 6.17 ml) and aneurysm volume (mean of difference = 0.43 ml; SD of difference = +/- 2.14 ml). Also high reproducibility of 2 repeated 3D-measurements was documented (ventricular volumetry: mean of difference = -0.09 ml; SD of difference = 3.15 ml. Aneurysm volumetry: mean of difference = 0.24 ml; SD of difference = 0.17 ml). The principle of quantification by tomographic planimetry is usable the same way in vivo (Figures 3 and 4).(ABSTRACT TRUNCATED AT 250 WORDS)