Preoperative three-dimensional reconstruction of the heart and great vessels in patients with congenital heart disease. Technique and initial results.

Magnetic resonance images have been obtained preoperatively in six patients with congenital heart disease. Contiguous sequences of electrocardiogram-triggered spin-echo images have been reconstructed in three-dimensional form to define the size and anatomic relationships to the great vessels and internal cardiac structures. Findings of magnetic resonance imaging were corroborated by angiographic and sector-scan echocardiographic studies and at operation.

Three-dimensional magnetic resonance imaging of congenital heart disease.

Three-dimensional surface reconstruction images of the heart and great vessels have been produced from contiguous sequences of EKG-triggered MRI scans in more than 35 patients with congenital heart disease and 5 normal subjects. The scan data was semiautomatically processed to separate the epi- and endocardial surfaces and to define the outlines of the enclosed blood volumes on a slice by slice basis. Surface reconstruction images aid communication with clinicians, establish the size and location of intracardiac defects, and image the pulmonary venous drainage.

Noninvasive three-dimensional reconstruction of the heart and great vessels by ECG-gated magnetic resonance imaging: a new diagnostic modality.

We have developed a new method of computer image processing that allows true three-dimensional (3-D) images of the heart and great vessels to be reconstructed from standard ECG-gated two-dimensional magnetic resonance (MR) images. Contiguous 5-mm thick MR images of the thorax from the level of the cardiac apex to the aortic arch were obtained in 4 normal volunteers and 3 patients with congenital heart disease: 1 with pseudotruncus arteriosus and 1 with a ventricular septal defect, each with Eisenmenger's complex, and 1 with aortic coarctation. Each image could be obtained at up to seven different intervals throughout the cardiac cycle with ECG gating.

Our experience in the removal of intravitreal and subretinal cysticerci.

Ocular cysticercosis is a rather infrequent entity even in developing countries. Several treatments have been proposed depending on the location of the organism within the eye. Three cases are described, emphasizing treatment of a subretinal cysticercus with sclerotomy instead of photocoagulation.

Assessment of a physical training program in patients with myocardial infarction in a tropical country.

Twenty-five myocardial infarction patients, included in a comprehensive cardiac rehabilitation programme, were studied in order to assess the physical training effects upon several physiological parameters in a country with a tropical climate. Training consisted of three-times weekly supervised sessions with running, under telemetric control, accomplished continuously, during thirty minutes at 120 m/min as mean speed. Symptom-limited exercise stress testing was initially performed and repeated after three months of training.

Congenital arteriovenous malformations between brachiocephalic arteries and systemic veins.

Three patients under two years of age are described with unusual fistulas involving the brachiocephalic arteries and the innominate vein or the superior vena cava. Two patients were asymptomatic, and one newborn was cyanotic and in congestive failure. This unusual presentation has only rarely been reported in thoracic arteriovenous malformations.

Angiographically occult vascular malformations in childhood.

Five infants and children with angiographically occult vascular malformations of the brain detected by computed tomography (CT) are presented. Four malformations were located in the cerebral hemisphere, and one was in the brain stem. CT demonstrated high density lesions with little or no enhancement after infusion of the contrast material.

Mediastinal vessels: postoperative evaluation with MR imaging.

The mediastinal vessels in 27 patients who had previously undergone vascular surgery were evaluated with use of magnetic resonance (MR) imaging for patency and the presence of stenosis. Thirty-six postoperative vessels or shunts were studied, including 11 aortas after coarctation or stenosis repair, 18 systemic-pulmonary shunts, four pulmonary artery or vein repairs, and three spiral vein grafts. Angiographic (n = 21), direct surgical (n = 1), contrast material-enhanced computed tomography (n = 1), or clinical (n = 13) findings were correlated with the MR findings.

Duplication of the inferior vena cava in thromboembolic disease.

Recurrent pulmonary embolism from the lower extremities or pelvis, despite anticoagulation, often requires interruption of the inferior vena cava (IVC). We report two patients in whom interruption of the IVC failed to ameliorate symptoms. Both patients demonstrated a previously unrecognized duplication of the IVC.

Magnetic resonance imaging of spiral vein graft bypass of superior vena cava in fibrosing mediastinitis.

Magnetic resonance imaging (MRI) was used for postoperative evaluation of spiral vein grafts in three patients with fibrosing mediastinitis who had undergone bypass of the superior vena cava (SVC) for SVC syndrome. The MRI images, obtained without ECG triggering, were compared retrospectively with postoperative bilateral arm venograms. Patent grafts were identified by MRI in all patients.

Ytterbium-DTPA. A potential intravascular contrast agent.

Ytterbium-DTPA was evaluated as a potential intravascular contrast agent. Ytterbium-DTPA was synthesized from ytterbium oxide and diethylene triamine penta-acetic acid (DTPA). CT scans of increasing concentrations of ytterbium and iodine showed that at 125 kVp, ytterbium was denser than an equal concentration of iodine.

Oblique magnetic resonance imaging of the cardiovascular system.

This exhibit demonstrates that cardiac anatomy can be imaged by MRI in oblique planes that are equivalent to views obtained radiographically or at angiocardiography. These MR images may be obtained either by simple patient positioning or by electronic rotation of the imaging axis. The advantages of this technique include its simplicity and its ability to show detailed anatomy noninvasively.

The thoracic aorta studied by MR imaging.

Thirty-three patients with a variety of disorders of the thoracic aorta (aneurysm, dissection, Marfan syndrome, coarctation/pseudocoarctation, L-transposition, and Takayasu disease) were evaluated with magnetic resonance (MR) imaging. MR imaging delineated the presence and extent of thoracic aortic aneurysms and showed the relationship of the aneurysm to arch vessels; it also demonstrated intimal flaps and individual lumina in types A and B aortic dissection. Dilation of the ascending aorta in Marfan syndrome and focal narrowing of the aorta in coarctation were well visualized.

Diagnosis of congenital absence of left pericardium by MR imaging.

Congenital absence of the pericardium, whether partial or total, is a rare abnormality. It can be very difficult to diagnose clinically as well as to confirm radiographically. Plain film fluoroscopy and CT have been shown to be of value in differentiating this entity from others with similar findings.

Oblique views of the heart by magnetic resonance imaging.

We describe a simple method that uses patient positioning to obtain oblique views of the human heart by magnetic resonance (MR) imaging. These views provide MR images that directly correlate with conventional anterior or posterior oblique radiography.

Digital subtraction angiography of the coronary arteries.

The application of digital coronary arteriography in the evaluation of patients with known or suspected coronary artery disease is considered. Digital imaging of coronary arteries and bypass grafts can augment 35-mm cineangiography and may eventually replace film for coronary arteriography. The clinical efficacy of both selective and nonselective digital coronary arteriography is not yet established, however, a number of advantages over 35 mm cine have now been delineated including high contrast sensitivity image subtraction and digital image processing.

[Experience with the use of an external fixator in patients with multiple injuries].

The authors report on experiences with fixateur extern according to Raoul Hoffmann in 110 open fractures of second-degree and third-degree severity. The patient material comprised 90 patients, of which a total of 71 (79 per cent) had polytraumas. It was shown that good results can be expected if fixateur extern is applied immediately.

NMR imaging of pulmonary arteriovenous fistulae .

The nuclear magnetic resonance (NMR) imaging of pulmonary arteriovenous fistulae is reported, and the value of NMR in separating vascular from nonvascular lesions in the lung and mediastinum is discussed.