From Clinical Clues to Final Diagnosis: The Return of Detective Work to Clinical Medicine in Cardiac Amyloidosis.

Cardiac amyloidosis is frequently misdiagnosed, denying patients the opportunity for timely and appropriate management of the disease. The purpose of this review and case studies is to raise awareness of the diagnostic "red flags" associated with cardiac amyloidosis and the currently available non-invasive strategies for diagnosis. The review focuses on the identification of one of the two main types of cardiac amyloidosis, transthyretin amyloid cardiomyopathy, and non-invasive tools to distinguish this from light-chain amyloidosis.

Medical three-dimensional printing opens up new opportunities in cardiology and cardiac surgery.

Advanced percutaneous and surgical procedures in structural and congenital heart disease require precise pre-procedural planning and continuous quality control. Although current imaging modalities and post-processing software assists with peri-procedural guidance, their capabilities for spatial conceptualization remain limited in two- and three-dimensional representations. In contrast, 3D printing offers not only improved visualization for procedural planning, but provides substantial information on the accuracy of surgical reconstruction and device implantations.

Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator.

Background: The presence of a cardiovascular implantable electronic device has long been a contraindication for the performance of magnetic resonance imaging (MRI). We established a prospective registry to determine the risks associated with MRI at a magnetic field strength of 1.5 tesla for patients who had a pacemaker or implantable cardioverter-defibrillator (ICD) that was "non-MRI-conditional" (i.

Design and Evolution of the Asporto Heart Preservation Device.

The Asporto Heart Preservation Device is a system providing perfusion of cardioplegia to the donor heart using a computer-controlled peristaltic pump in a thermoelectrically cooled and insulated container. In 1998, a user interface was developed at the University of Minnesota consisting of a touch screen and battery-backed microcontroller. Power was supplied by a 120 VAC to 12 VDC converter.

Evaluation of self-contained PACS viewers on CD-ROM.

Providing patients and clinicians with self-contained PACS viewer on CD format is a common and necessary tool to share vital imaging data. However, to be useful, this tool should be reliable, robust, and convenient. Numerous PACS viewer options are available, often without empirical data to guide in choosing one for routine use.

Left ventricular diverticulum: how we do it.

Left ventricular diverticulum is an extremely rare anomaly, especially in the absence of other findings, and as such it has been rarely imaged, rarely seen intraoperatively, and has no standardized management algorithm. We report our suggested imaging and management in the context of previous management philosophies.

Benefit of 3D volume rendered CT scans in the diagnosis and treatment of cardiac anomalies: a report of 3 cases.

3D volume rendered computed tomography (3D-CT) produces detailed, three-dimensional models that can be rotated and viewed in any orientation to provide a more natural and functional view of the patient's anatomy. This technology is especially beneficial in diagnosing and repairing cardiovascular anomalies. Three cases are presented where 3D-CT was used to diagnose and plan a course of treatment for patients with cardiac anomalies.

Transmural atrial fibrosis after epicardial and endocardial argon-powered CryoMaze ablation.

Background: The CryoMaze procedure is usually limited to endocardial ablation under cardio-pulmonary bypass. Epicardial ablation is considered inferior as endocardial islets of atrial tissue could theoretically remain viable, protected from cryoinjury by epicardial fat and endocardial circulating warm blood. Novel argon-powered cryoprobes with lower ablation temperatures have recently become available.

Evaluation of aortic root and valve calcifications by multi-detector computed tomography.

Background And Aim Of The Study: In percutaneous aortic valve replacement (AVR), whilst calcifications are used as landmarks in fluoroscopic placement of the stent, they may also complicate stent placement. In response to this problem, the study aim was to examine severe aortic root calcification by using multi-detector computed tomography (MDCT), to better understand the pathology complicating percutaneous valve placement.

Methods: In 33 patients with severe aortic stenosis and scheduled for surgery, the 'inner orifice' and 'outer fibrous' annulus diameter and area (with and without calcification) were measured, in addition to the distances of the calcifications and coronary ostia from the annulus, using by ECG-gated 64-slice MDCT.

Perfusion preservation of the donor heart: basic science to pre-clinical.

As a consequence of technology improvements and refinement, perfusion of the donor heart has moved from the research laboratory to clinical studies. Multiple investigators are currently leading pre-clinical trials of devices using perfusion preservation, and one device is now in European clinical trials. One major problem with the donor heart is the high metabolism relative to other organs, and depletion of ATP leads rapidly to acidosis and necrosis of the myocardium.

Achievement of feeding milestones after primary repair of long-gap esophageal atresia.

Objectives: To determine the pattern of feeding milestones following primary repair of long-gap esophageal atresia (EA).

Method: A questionnaire based upon well established feeding milestones was used. Children after long-gap EA repair, n=40, were compared from after primary repair to healthy children from birth, n=102.

Intermittent antegrade cardioplegia: isolated heart preservation with the Asporto heart preservation device.

Background: A major problem in procurement of donor hearts is the limited time a donor heart remains viable. After cardiectomy, ischemic hypoxia is the main cause of donor heart degradation. The global myocardial ischemia causes a cascade of oxygen radical formation that cumulates in an elevation in hydrogen ions (decrease in pH), irreversible cellular injury, and potential microvascular changes in perfusion.

Development of a sheep model of atrial fibrillation for preclinical prosthetic valve testing.

Currently, prosthetic heart valve testing is performed on animal models with no underlying cardiovascular pathologies. Unfortunately, unforeseen adverse events may occur when heart valves tested in animals in normal sinus rhythm are implanted in patients suffering from arrhythmias. For example, the Medtronic Parallel valve functioned well in pre-clinical testing, but a high rate of thromboembolic complications appeared when the valve was placed in patients with atrial fibrillation (AF).

Administration of tauroursodeoxycholic acid (TUDCA) reduces apoptosis following myocardial infarction in rat.

Black bear bile has been used in traditional Chinese medicine to treat liver and eye related illnesses for centuries. A major constituent of bile is ursodeoxycholic acid (UDCA). Recent analysis of the cellular effects of UDCA and its taurine conjugate tauroursodeoxycholic acid (TUDCA) have demonstrated their antiapoptotic properties through regulation of Bcl-2 family and survival signaling proteins (Bax, Bad, phosphatidylinositol-3-kinase).

A comparison of myocardial perfusion and rejection in cardiac transplant patients.

Introduction: Although histological evaluation of the cardiac tissue is the current gold standard for evaluation of rejection, we hypothesized that cardiac perfusion MRI is a safe non-invasive method that correlates tissue blood flow changes with biopsy proven rejection in the cardiac transplant patient.

Materials And Methods: In a retrospective study from 1984-2001, 83 patients underwent 135 MR Gd-DTPA imaging studies. In 8 patients (9%), biopsies graded 2 or higher (by ISHLT criteria) provided evidence of rejection.