Double-chambered left ventricle with a thrombus in an asymptomatic patient:A case report

BACKGROUND Double-chambered left ventricle(DCLV)is an extremely rare congenital disease in which the left ventricle(LV)is divided by abnormal muscle tissue.Due to its rarity,there is a lack of data on the disease,including its diagnosis,treatment,and prognosis.Accordingly,we report a case in which DCLV was diagnosed and followed up.CASE SUMMARY A 45-year-old man presented to our hospital due to abnormal findings on an electrocardiogram recorded during a health check.He had no specific cardiac symptoms,comorbidities or relevant past medical history.Echocardiography revealed that the LV was divided into two by muscle fibers.There were no findings of ischemia on coronary angiography and coronary computed tomography angiography performed to exclude differential diagnoses.After comprehensive analysis of the images,DCLV was diagnosed.As it seemed to be asymptomatic DCLV,we decided the patient was to be observed without administering any medication.However,follow-up echocardiography revealed a thrombus in the accessory chamber(AC).Anticoagulant medication was initiated,the thrombus resolved,and the patient is currently undergoing follow-up without any specific symptoms.CONCLUSION Asymptomatic,uncomplicated DCLV was diagnosed through multimodal imaging;however,a thrombus in the AC occurred during the follow-up.The findings highlight that multimodal imaging is essential in diagnosing DCLV,and that anticoagulation is important in its management.

An Interpretable CNN for the Segmentation of the Left Ventricle in Cardiac MRI by Real-Time Visualization

The interpretability of deep learning models has emerged as a compelling area in artificial intelligence research.The safety criteria for medical imaging are highly stringent,and models are required for an explanation.However,existing convolutional neural network solutions for left ventricular segmentation are viewed in terms of inputs and outputs.Thus,the interpretability of CNNs has come into the spotlight.Since medical imaging data are limited,many methods to fine-tune medical imaging models that are popular in transfer models have been built using massive public Image Net datasets by the transfer learning method.Unfortunately,this generates many unreliable parameters and makes it difficult to generate plausible explanations from these models.In this study,we trained from scratch rather than relying on transfer learning,creating a novel interpretable approach for autonomously segmenting the left ventricle with a cardiac MRI.Our enhanced GPU training system implemented interpretable global average pooling for graphics using deep learning.The deep learning tasks were simplified.Simplification included data management,neural network architecture,and training.Our system monitored and analyzed the gradient changes of different layers with dynamic visualizations in real-time and selected the optimal deployment model.Our results demonstrated that the proposed method was feasible and efficient:the Dice coefficient reached 94.48%,and the accuracy reached 99.7%.It was found that no current transfer learning models could perform comparably to the ImageNet transfer learning architectures.This model is lightweight and more convenient to deploy on mobile devices than transfer learning models.

Value of clinical applications of differential pressure and relative pressure imaging in the left ventricle

Regional pressure differences between sites within the left ventricular cavity have long been identified,and the potential clinical value of diastolic and systolic intraventricular pressure differences(IVPDs)is of increasing interest.This study concluded that the IVPD plays an important role in ventricular filling and emptying and is a reliable indicator of ventricular relaxation,elastic recoil,diastolic pumping,and effective left ventricular filling.Relative pressure imaging,as a novel and potentially clinically applicable measure of left IVPDs,enables early and more comprehensive identification of the temporal and spatial characteristics of IVPD.In the future,as research related to relative pressure imaging continues,this measurement method has the possibility to become more refined and serve as an additional clinical aid that can replace the gold standard cardiac catheterization technique for the diagnosis of diastolic dysfunction.

Inadvertent Lead Malposition in the Left Ventricle during Permanent Ventricular Pacing about One Case

Inadvertent Lead Malposition in Left Ventricle is a rare and underdiagnosed incident, which may occur during implantation of cardiac electronic devices and may remain asymptomatic. We reported the case of a 71-year-old man who was implanted with a ventricular single-chamber pacemaker for a slow atrial fibrillation with syncope and whose routine transthoracic echocardiography 23 months after implantation displayed a malposition of the pacemaker lead into the Left Ventricle through a patent foramen oval. The patient was asymptomatic. The electrocardiogram showed right bundle branch block QRS-paced morphology with a positive QRS pattern in V1, a median paced QRS axis on the frontal plane at -120°, a Precordial transition on V5. At the lateral Chest X-ray the lead curved backwards to the spine. Given the age of this old patient who already received oral anticoagulant for Atrial Fibrillation and the Lead malposition discovered 23 months after pacemaker’s implantation, we decided to maintain the lead in LV and continue anticoagulation.

Concordant Atrioventricular Connection to L-Looped Ventricles with the Left Ventricle on Top of the Right Ventricle in Situs Solitus:A Case Report with 3D Modelling and Printing

We report the case of a rare complex cardiac anomaly involving situs solitus,concordant atrioventricular connection with left-hand ventricular topology,and L-looped ventricles.The ventricles had a superior-inferior relationship with an inferiorly located right ventricle,which had a double outlet with far posteriorly located great arteries.The left atrium was elongated,with juxta-positioned atrial appendages on the right side.The 3D-printed model using a computed tomography scan taken on the fourth day of birth demonstrated the anatomy clearly and helped us decide on the surgical management.

A NUMERICAL MODEL OF LEFT VENTRICLE AND AORTIC VALVE FUNCTION OF ITS AFTERLOAD(Ⅰ)

Due to the study of the function of heart and aoritic valve, we set up a physicalmodel of left ventricle, aortic valve and afterload and derive theoretical equation of each part from the model. Then we calculate the hasic equations within phystology and impair parameters. Bwsed on this, we will discus fully in the next paper the effectofleyt ventricular afterloadon valve opining, ejection and valve Jumction .etc

Hypertrophic cardiomyopathy and left ventricular non-compaction:Distinct diseases or variant phenotypes of a single condition?

Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM may present with an intraventricular or LV outflow tract obstruction,diastolic dysfunction,myocardial fibrosis and/or ventricular arrhythmias.Differentiating HCM from other diseases associated with LV hypertrophy,such as hypertension,aortic stenosis,or LV non-compaction(LVNC),can at times be challenging.LVNC is defined by excessive LV trabeculation and deep recesses between trabeculae,often accompanied by increased LV myocardial mass.Previous studies indicate that the LVNC phenotype may be observed in up to 5%of the general population;however,in most cases,it is a benign finding with no impact on clinical outcomes.Nevertheless,LVNC can occasionally lead to LV systolic dysfunction,manifesting as a phenotype of dilated or non-dilated left ventricular cardiomyopathy,with an increased risk of thrombus formation and arterial embolism.In extreme cases,where LVNC is associated with a very thickened LV wall,it can even mimic HCM.There is growing evidence of an overlap between HCM and LVNC,including similar genetic mutations and clinical presentations.This raises the question of whether HCM and LVNC represent different phenotypes of the same disease or are,in fact,two distinct entities.

Liver cirrhosis and left ventricle diastolic dysfunction: Systematic review

BACKGROUND Liver cirrhosis is a chronic hepatic disease which is associated with cardiovascular abnormalities.Hyperdynamic circulation in liver cirrhosis causes functional and structural cardiac alterations.The prevalence of left ventricle diastolic dysfunction(LVDD)in cirrhotic patients ranges from 25.7%to as high as 81.4%as reported in different studies.In several studies the severity of diastolic dysfunction(DD)correlated with a degree of liver failure and the rate of dysfunction was higher in patients with decompensated cirrhosis compared with compensated.Future directions of comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis for these patients.AIM To clarify the correlation between the severity of liver cirrhosis and left ventricle diastolic dysfunction in the existing literature.METHODS Through January and February of 2019 at Vilnius University we conducted a systematic review of the global existing literature on the prevalence of left ventricle diastolic dysfunction in patients with liver cirrhosis.We searched for articles in PubMed,Medline and Web of science databases.Articles were selected by using adequate inclusion and exclusion criteria.Our interest was the outcome of likely correlation between the severity of cirrhosis[evaluated by Child-Pugh classes,Model For End-Stage Liver Disease(MELD)scores]and left ventricle diastolic dysfunction[classified according to American Society of Echocardiography(ASE)guidelines(2009,2016)],as well as relative risk of dysfunction in cirrhotic patients.Subgroup analyses were performed to evaluate the ratio and grades of left ventricle diastolic dysfunction with respect to cirrhosis severity.RESULTS A total of 1149 articles and abstracts met the initial search criteria.Sixteen articles which met the predefined eligibility criteria were included in the final analysis.Overall,1067 patients(out of them 723 men)with liver cirrhosis were evaluated for left ventricle diastolic dysfunction.In our systemic analysis we have found that 51.2%of cirrhotic patients had left ventricle diastolic dysfunction diagnosed and the grade 1 was the most prevalent(59.2%,P<0.001)among them,the grade 3 had been rarely diagnosed-only 5.1%.The data about the prevalence of diastolic dysfunction in cirrhotic patients depending on Child-Pugh Classes was available from 5 studies(365 patients overall)and only in 1 research diastolic dysfunction was found being associated with severity of liver cirrhosis(P<0.005).We established that diastolic dysfunction was diagnosed in 44.6%of Child-Pugh A class patients,in 62%of Child B class and in 63.3%of Child C patients(P=0.028).The proportion of patients with higher diastolic dysfunction grades increases in more severe cirrhosis presentation(P<0.001).There was no difference between mean MELD scores in patients with and without diastolic dysfunction and in different diastolic dysfunction groups.In all studies diastolic dysfunction was more frequent in patients with ascites.CONCLUSION This systemic analysis suggests that left ventricle diastolic dysfunction is an attribute of liver cirrhosis which has not received sufficient attention from clinicians so far.Future suggestions of a comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis for these patients and give hint for better understanding of the left ventricle diastolic dysfunction pathogenesis in liver cirrhosis.

Left to Right Extracardial Shunt to Control Hemorrhage of Ascending Aorta and Left Ventricle: A Report of 3 Cases

Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.

NONLINEAR DYNAMICS MODFLING OF MECHANICAL PERIODICITY OF END DIASTOLIC VOLUME OF LEFT VENTRICLE

The cardiovascular system with a lumped parameter model is treated, in which the Starling model is used to simulate left ventricle and the four-element Burattini & Gnudi model is used in the description of arterial system. Moreover, the feedback action of arterial pressure on cardiac cycle is taken into account. The phenomenon of mechanical periodicity (MP) of end diastolic volume (EDV) of left ventricle is successfully simulated by solving a series of one-dimensional discrete nonlinear dynamical equations. The effects of cardiovascular parameters on MP is also discussed.

Patient-Specific Echo-Based Fluid-Structure Interaction Modeling Study of Blood Flow in the Left Ventricle with Infarction and Hypertension

Understanding cardiac blood flow behaviors is of importance for cardiovascular research and clinical assessment of ventricle functions.Patient-specific Echo-based left ventricle(LV)fluid-structure interaction(FSI)models were introduced to perform ventricle mechanical analysis,investigate flow behaviors,and evaluate the impact of myocardial infarction(MI)and hypertension on blood flow in the LV.Echo image data were acquired from 3 patients with consent obtained:one healthy volunteer(P1),one hypertension patient(P2),and one patient who had an inferior and posterior myocardial infarction(P3).The nonlinear Mooney-Rivlin model was used for ventricle tissue with material parameter values chosen to match echo-measure LV volume data.Using the healthy case as baseline,LV with MI had lower peak flow velocity(30%lower at beginejection)and hypertension LV had higher peak flow velocity(16%higher at begin-filling).The vortex area(defined as the area with vorticity>0)for P3 was 19%smaller than that of P1.The vortex area for P2 was 12%smaller than that of P1.At peak of filling,the maximum flow shear stress(FSS)for P2 and P3 were 390%higher and 63%lower than that of P1,respectively.Meanwhile,LV stress and strain of P2 were 41%and 15%higher than those of P1,respectively.LV stress and strain of P3 were 36%and 42%lower than those of P1,respectively.In conclusion,FSI models could provide both flow and structural stress/strain information which would serve as the base for further cardiovascular investigations related to disease initiation,progression,and treatment strategy selections.Large-scale studies are needed to validate our findings.

Clinical Study on Preventing and Treating Left Ventricle Remodeling after Acute Myocardial Infarction with Integrative Chinese and Western Medicine

Objective: To explore the clinical efficacy of Xuefu Zhuyu (血府逐瘀, XFZY) oral liquid combined with western medicine (WM) in reversing left ventricle remodeling (LVR) after acute myocardial infarction (AMI) in patients and its therapeutic mechanism. Methods: Sixty patients conforming to criteria were divided into the treated group and WM control group with randomly stratified method. Thirty cases were assigned to each group, they were given XFZY + WM + general treatment and WM + general treatment respectively. Color Doppler ultrasonography was used to study the changes of LVR before and after treatment. Results: In both groups, before and after treatment the P value of such parameters as the changes of their left diastolic volume (LDV), left systolic volume (LSV), left ventricle ejection fraction (EF) was <0.05, suggesting that the difference of various parameters was significantly different; but when compared with the results of the 12th week after medications, the change of LDV, LSV, EF showed that the LDV, LSV of the treated group were lower than that of the control group, the EF of the treated group was higher than that of the control group, and the P value of various groups was all <0.05, suggesting that the different data of various groups showed significant difference. Conclusion: Conventional WM treatment and XFZY combined with WM could both, in treating AMI, effectively reverse the patients' LVR; yet the use of integrative Chinese and western medicine on reversing patients LVR showed even better results than that of simple WM treatment.

Effect of gestational protein restriction on left ventricle hypertrophy and heart angiotensin II signaling pathway in adult offspring rats

Maternal protein restriction may be a risk factor for cardiovascular disorders in adulthood. The RAS (renin-angiotensin-system) plays a pivotal role in cardiac remodeling. Components of the RAS, including angiotensin II (AngII) and its receptors type 1 (AT1R) and 2 (AT2R) are expressed in the heart. This study investigates whether gestational protein restriction alters the expression and localization of AT1R and AT2R and RAS signaling pathway proteins in parallel with left ventricle hypertrophy and systemic hypertension in male offspring. Dams were kept on normal (NP, 17% protein) or low (LP, 6% protein) protein diet during pregnancy. Systolic blood pressure (SBP) of male offspring was measured from the 8th to 16th week and left ventricles of 16-wk-old rats were processed for histology, morphometric, immunoblotting and immunohistochemistry. LP offspring showed a significant reduction in birth body weight and SBP increased significantly from the 8th week. Left ventricle mass and cardiomyocytes area were also significantly higher in LP animals. Widespread perivascular fibrosis was not detected in the heart tissue. Analysis by immunoblotting and immunohistochemistry demonstrated a significant enhance in cardiomyocyte expression of AT1R and ERK1 in LP offspring. Expression of PI3K in LP was significantly reduced in cardiomyocytes and in the intramural coronary wall, while AT2R expression was unchanged in the NP group. We also found reduced LP expression of JAK2 and STAT3. In conclusion, our data also suggest that changes in the RAS may play a role in the ventricular growth through upregulation of the AT1-mediated ERK1/2 response, despite unchanged AT2R expression.

Transcatheter Decompression of the Left Atrium in an Adolescent with a Double Inlet Left Ventricle, Severe Parachute Mitral Valve Stenosis and Pulmonary Hypertension

A 17-year-old adolescent with non-operated double inlet left-ventricle and severe stenosed parachute mitral valve is reported. He was admitted with repetitive syncope related to intermittent atrial fibrillation. Life-threatening syncope combined with pre- and post-capillary pulmonary hypertension together with his single ventricle pathophysiology led to the decision for left atrial decompression by percutaneous static atrial septum ballooning after transseptal needle perforation. Aiming to create a restrictive atrial septum defect, unloading of the left atrium without disturbing the balanced hemodynamics was directed for a long-term palliation or as a basis for a further surgical follow-up approach.

Deep Inspiration Breath Hold Reduces Dose to the Left Ventricle and Proximal Left Anterior Descending Artery during Radiotherapy for Left-Sided Breast Cancers

The purpose of this study was to analyze motion of the left anterior descending coronary artery (LAD) and left ventricle during normal breathing and deep inspiration breath hold (DIBH). This is a dosimetric study utilizing free-breathing and static DIBH scans from eleven patients treated with radiotherapy for breast cancer. The anterior-posterior displacement along the length of the LAD was measured in each respiratory phase. Standard treatment plans targeting the whole breast without treatment of the internal mammary lymph nodes were generated and dose to the LAD and LV calculated. Non-uniform movement of the LAD during respiratory maneuvers with the proximal third exhibiting the greatest displacement was observed. In DIBH compared to end-expiration (EP), the mean posterior displacement of the proximal 1/3 of the LAD was 8.99 mm, the middle 1/3 of the artery was 6.37 mm, and the distal 1/3 was 3.27 mm. In end-inspiration (IP) compared to end-expiration the mean posterior displacements of the proximal 1/3 of the LAD was 2.08 mm, the middle 1/3 of the artery was 0.91 mm, and the distal 1/3 was 0.97 mm. Mean doses to the LAD using tangential treatment fields and a prescribed dose of 50.4 Gy were 11.32 Gy in EP, 8.98 Gy in IP, and 3.50 Gy in DIBH. Mean doses to the LV were 2.38 Gy in EP, 2.31 Gy in IP, and 1.24 Gy in DIBH. In conclusion, inspiration and especially DIBH, cause a displacement of the origin and proximal 2/3 of the LAD away from the chest wall, resulting in sparing of the most critical segment of the artery during tangential radiotherapy.

Assessment of the Left Ventricle Wall Motion Using Tagged Magnetic Resonance Imaging Data (tMRI)

In this paper, the Radial Strain (RS) and Strain Rate (SR) was calculated using tagged MRI (tMRI) data. Using tagged magnetic resonance imaging (tMRI), the left ventricle short axis of five healthy adults (three men and two women) and four healthy male rats was imaged during diastolic and systolic phases on the mid-ventricle level. The RS and radial SR of the left ventricle were calculated at the mid-ventricular level of the cardiac cycle. The peak RS for rat and human heart was found to be 46.8 ± 0.68 and 40.7 ± 1.44, respectively, and it occurred at 40% of the cardiac cycle for both human and rat hearts. The peak systolic and diastolic radial SR for human heart was 1.10 ± 0.08 s- 1 and - 1.78 ± 0.02 s- 1, respectively, while it was 4.25 ± 0.02 s- 1 and - 5.16 ± 0.23 s- 1, respectively for rat heart. The results show that tMRI data can be used to characterize the cardiac function during systolic and diastolic phases of the cardiac cycle, and as a result, it can be used to evaluate the cardiac motion by calculating its RS and radial SR at different locations of the cardiac wall during both diastolic and systolic phases. This study also approves the validity of the tagged MRI data to accurately describe the radial cardiac motion.

Diagnostic Accuracy of Strain Imaging of the Left Ventricle in Detection of Obstructive Coronary Artery Disease

Background: Speckle tracking echocardiography using average global strain and strain rate (SR) parameters for early detection of high risk patients with coronary artery disease (CAD) has gained a substantial clinical interest. Objective: Assessment of the diagnostic accuracy of strain imaging of the left ventricle in detection of obstructive coronary artery disease. Methods: One hundred patients were enrolled. They were divided into 3 groups: Group I (n = 40 patients) presented with ST segment elevation myocardial infarction (STEMI), Group II (n = 40 patients) presented with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and Group III (n = 20 patients) with normal coronary angiography served as a control group. All patients were subjected to 2D speckle tracking echocardiography (2D STE) to assess LV longitudinal strain and strain rate (SR). Sensitivity, specificity and diagnostic accuracy of 2D STE in prediction of CAD and its severity using Gensini score were assessed. Results: The mean age for Group I, II and III was 52.20 ± 11.83, 51.97 ± 14.53 and 52.75 ± 10.75 respectively. LV average global systolic strain (AGS) was significantly lower in group I and II when compared to group III. AGS and average global systolic SR showed significant direct correlation with Gensini score. The diagnostic accuracy of 2D STE in prediction of significant LAD stenosis was 92.5%, and it was 89.5% in prediction of 3 vessels CAD. Conclusion: Strain imaging using 2D STE can predict the territory and severity of CAD with high diagnostic accuracy and can be used as a simple noninvasive diagnostic tool to identify high risk CAD patients.

“Swiss-Cheese” Left Ventricle in Acute Myocardial Infarction—A Case Report

Introduction: To present a rare occurrence of “Swiss-cheese” defects of left ventricle in acute myocardial infarction. Case Report: A 64-year-old male with persistent ST segment elevation in anterior and inferior leads developed sudden deterioration within 2 days after thrombolysis. Echocardiography revealed ventricular septal and LV (left ventricular) free wall ruptures at multiple sites with contractile dysfunction and the patient died suddenly, followed by an episode of ventricular tachycardia. Discussion: Myocardial rupture may complicate in 10% of acute myocardial infarctions and it is the second most common cause of in-hospital mortality next to pump failure. It is responsible for 15% of in-hospital deaths and 50% died within 5 days and 82% died within two weeks of index infarction. Conclusion: Aggressive early diagnosis and surgery may confer a survival rate as high as 75%. The prognosis is grave in patients presented with cardiogenic shock and multiorgan dysfunction;surgery is best avoided and supportive medical therapy may be adequate in such cases.

The Adult Ventricular Septum;A Unique Portion of the Left and Right Ventricle

The ventricular septum separates the right and left ventricles and thus is part of both ventricles.It is directed obliquely backward to the right,and curved with the convexity toward the right ventricle;it must be emphasized that the total cardiac septum has a complex,longitudinal twist and does not lie in any single plane.Its upper and posterior part,is thin and fibrous,and is termed the membranous ventricular septum.The greater portion of the septum is thick and muscular and constitutes the muscular ventricular septum.The ventricular septum consists of two layers,a thin layer on the RV side and a thicker layer on the LV side[1].The major septal arteries tend to run between these two layers.