Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate....Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate. With the development of imaging technology, especially echocardiography, this complication has been gradually recognized. Case Presentation: The patient had intermittent chest and back pain without obvious inducement and did not seek medical treatment in time. One month later, the patient came to the hospital for treatment due to the aggravation of the condition. Transthoracic echocardiography (TTE) in the other hospital showed segmental wall motion abnormality and hypoechoic mass in the left ventricular apex, which was considered thrombosis. In our hospital, the diagnosis by Transthoracic echocardiography combined with left ventricular opacification (LVO) was: segmental wall motion abnormality, left ventricular apex hypoecho mass, intramyocardial dissecting with hematoma formation were considered. Later, the diagnosis of Intramyocardial dissecting with hematoma formation was confirmed by cardiac magnetic resonance (CMR) examination in a superior hospital. Conclusion: In this case report, by analyzing the ultrasound imaging manifestations of left ventricular intramyocardial dissecting hematoma after myocardial infarction and its differential diagnosis with left ventricular mural thrombosis, we deepened the understanding of this rare complication and provided a reliable basis for clinical treatment decisions.展开更多
Objective:To explore the approach of minimally invasive transthoracic intramyocardial cellular transplantation under echocardiographic guidance to promote ischemic myocardial repair in a preclinical big-animal study.M...Objective:To explore the approach of minimally invasive transthoracic intramyocardial cellular transplantation under echocardiographic guidance to promote ischemic myocardial repair in a preclinical big-animal study.Methods:Female Guangxi Bama miniature pigs(weight:25–30 kg)were randomly allocated into the sham group,untreated myocardial infarction(MI)group(MI group),the MI and surgical intramyocardial injection(SIM)group(MI-SIM group),and the MI and transthoracic echocardiography-guided percutaneous intramyocardial injection(TTEPIM)group(MI-TTEPIM group)(n=4 each)using a lottery method.A swine MI model was established in the 3 groups excluding the sham group,and human induced pluripotent stem cell-derived cardiomyocytes(hiPS-CM)labeled with the herpes simplex virus type-1 thymidine kinase reporter gene(hiPS-CM^(TK+))were transplanted by SIM in MI-SIM group and TTEPIM in MI-TTEPIM group.The operation time,postoperative recovery time of animals and volume of blood loss were collected for comparison between MI-SIM group and MI-TTEPIM group.9-(4-[^(18)F]fluoro-3-(hydroxymethyl)butyl)guanine positron emission tomography/computed tomography imaging was performed to track the hiPS-CM^(TK+)in vivo.Cardiac function and morphology were evaluated by echocardiography.Results:The operation time and postoperative recovery time of MI-TTEPIM group were significantly shorter than those of MI-SIM group((28.3±3.6)min vs.(97.0±6.7)min,P<0.001;(1.3±0.3)d vs.(7.5±0.9)d,P<0.001).MI-TTEPIM also showed significantly lesser volume of blood loss during cell transplantation than MI-SIM group((4.3±0.8)mL vs.(47.0±4.1)mL,P<0.001).The transplanted cells could be traced more accurately in vivo in MI-TTEPIM than in MI-SIM.The circumferential strain of intervention region in the MI-TTEPIM group(–25.07%±0.27%)was significantly higher than that of the MI-SIM(–20.39%±0.67%)and MI groups(–19.68%±0.67%),respectively(P<0.01).Conclusion:A minimally invasive TTEPIM protocol with stem cells for treating the ischemic myocardium was established in this study.Transplantation of hiPS-CM^(TK+)with this method could promote the recovery of the circumferential strain of the ischemic myocardium.The findings of this study lay a foundation for the clinical transformation of this auxiliary means of treatment in the future.展开更多
Background Acute allograft rejection in heart transplantation remains as one of the major complications. Obligatory graft surveillance is still achieved with the invasive and expensive endomyocardial biopsy （EMB）. O...Background Acute allograft rejection in heart transplantation remains as one of the major complications. Obligatory graft surveillance is still achieved with the invasive and expensive endomyocardial biopsy （EMB）. Our study aimed to study the use of intramyocardial electrograms combined with other noninvasive methods for the monitoring of acute rejection after human heart transplantation. Methods Permanent pacemakers were implanted in 58 patients undergoing heart transplantations. Intramyocardial electrograms （IMEG） were recorded periodically and the results were compared with those from EMBs. The R wave amplitude of the IMEG was used as the index value, the average R wave amplitude at the third week following transplantation was considered as the baseline, and a reduction of 〉20% compared with the baseline was regarded as a positive result. EMB was performed in cases of positive IMEG results and also at other times. Other noninvasive methods were used to help the diagnosis. Acute rejection （AR） was defined as International Society of Heart-Lung Transplantation grade IliA or higher. Results We obtained 1231 IMEG records and 127 EMBs. Of the total 127 EMBs, 53 were positive, in which there were 42 IMEG positive results and 11 negative, while in the rest 74 negative EMBs, there were 9 IMEG positive results and 65 negative. The sensitivity of IMEG for the diagnosis of AR was 79.2%, and the specificity was 87.8%. The positive predictive value was 82.4% and the negative predictive value was 85.5%. Of the total of 1231 IMEG records, 51 were positive and 1180 were negative. Excluding 11 proved by EMB to be false negative, if the other 1169 were considered as no evidence of rejection, through the other noninvasive methods, AR diagnosed by this noninvasive monitoring strategy, the sensitivity was 79.2%, and the specificity was 99.2%. The positive predictive value was 82.4% and the negative predictive value was 99.1%. Conclusions IMEG can be used as a noninvasive method for monitoring AR following heart transplantation. It is a continuous, safe and inexpensive method, and could reduce the need for EMB combined with other noninvasive methods without reducing the detection of rejection. Chin Med J 2009; 122（2）： 136-139展开更多
Changes in intramyocardial tissue pressure modulate the relationship between coronary pressure and flow during the cardiac cycle. The present study compared the relation between measured and calculated diastolic suben...Changes in intramyocardial tissue pressure modulate the relationship between coronary pressure and flow during the cardiac cycle. The present study compared the relation between measured and calculated diastolic subendocardial tissue pressure and coronary pressure at zero flow in anesthetized dogs after modulation of either coronary sinus (i.e. Fogarty catheter) or left ventricular intracavity (i.e. volume loading) pressure. Experiments were conducted in anesthetized, instrumented dogs;coronary pressure flow relations were constructed during pharmacologic vasodilatation and intramyocardial tissue pressure was measured using micromanometer pressure sensors. Elevated coronary sinus pressures did not affect subendocardial pressure-flow relations signifying that diastolic tissue pressure within this layer is the effective coronary back pressure. Higher left ventricular intracavity pressure did not affect either diastolic subendocardial tissue pressure or pressure flow relations within this layer. Results show a direct linear relation (y = 1.106x - 0.652;r2 = 0.59. P = 0.001) between measured and calculated diastolic subendocardial tissue pressure and coronary pressure at zero-flow over a wide range of pressures after either LV systemic or coronary sinus pressure modulation. Knowledge of back pressure in the subendocardium is useful for the evaluation of efficacy of cardiac interventions on myocardial perfusion particularly at the level of the microcirculation.展开更多
文摘Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate. With the development of imaging technology, especially echocardiography, this complication has been gradually recognized. Case Presentation: The patient had intermittent chest and back pain without obvious inducement and did not seek medical treatment in time. One month later, the patient came to the hospital for treatment due to the aggravation of the condition. Transthoracic echocardiography (TTE) in the other hospital showed segmental wall motion abnormality and hypoechoic mass in the left ventricular apex, which was considered thrombosis. In our hospital, the diagnosis by Transthoracic echocardiography combined with left ventricular opacification (LVO) was: segmental wall motion abnormality, left ventricular apex hypoecho mass, intramyocardial dissecting with hematoma formation were considered. Later, the diagnosis of Intramyocardial dissecting with hematoma formation was confirmed by cardiac magnetic resonance (CMR) examination in a superior hospital. Conclusion: In this case report, by analyzing the ultrasound imaging manifestations of left ventricular intramyocardial dissecting hematoma after myocardial infarction and its differential diagnosis with left ventricular mural thrombosis, we deepened the understanding of this rare complication and provided a reliable basis for clinical treatment decisions.
基金funded by the National Key Research and Development Projects of China(2022YFA1104500,2022YFC3602400)National Nature Science Foundation of China(91939303,92249301,U22A6008)Youth Independent Innovation Project of Chinese People's Liberation Army General Hospital(22QNFC043).
文摘Objective:To explore the approach of minimally invasive transthoracic intramyocardial cellular transplantation under echocardiographic guidance to promote ischemic myocardial repair in a preclinical big-animal study.Methods:Female Guangxi Bama miniature pigs(weight:25–30 kg)were randomly allocated into the sham group,untreated myocardial infarction(MI)group(MI group),the MI and surgical intramyocardial injection(SIM)group(MI-SIM group),and the MI and transthoracic echocardiography-guided percutaneous intramyocardial injection(TTEPIM)group(MI-TTEPIM group)(n=4 each)using a lottery method.A swine MI model was established in the 3 groups excluding the sham group,and human induced pluripotent stem cell-derived cardiomyocytes(hiPS-CM)labeled with the herpes simplex virus type-1 thymidine kinase reporter gene(hiPS-CM^(TK+))were transplanted by SIM in MI-SIM group and TTEPIM in MI-TTEPIM group.The operation time,postoperative recovery time of animals and volume of blood loss were collected for comparison between MI-SIM group and MI-TTEPIM group.9-(4-[^(18)F]fluoro-3-(hydroxymethyl)butyl)guanine positron emission tomography/computed tomography imaging was performed to track the hiPS-CM^(TK+)in vivo.Cardiac function and morphology were evaluated by echocardiography.Results:The operation time and postoperative recovery time of MI-TTEPIM group were significantly shorter than those of MI-SIM group((28.3±3.6)min vs.(97.0±6.7)min,P<0.001;(1.3±0.3)d vs.(7.5±0.9)d,P<0.001).MI-TTEPIM also showed significantly lesser volume of blood loss during cell transplantation than MI-SIM group((4.3±0.8)mL vs.(47.0±4.1)mL,P<0.001).The transplanted cells could be traced more accurately in vivo in MI-TTEPIM than in MI-SIM.The circumferential strain of intervention region in the MI-TTEPIM group(–25.07%±0.27%)was significantly higher than that of the MI-SIM(–20.39%±0.67%)and MI groups(–19.68%±0.67%),respectively(P<0.01).Conclusion:A minimally invasive TTEPIM protocol with stem cells for treating the ischemic myocardium was established in this study.Transplantation of hiPS-CM^(TK+)with this method could promote the recovery of the circumferential strain of the ischemic myocardium.The findings of this study lay a foundation for the clinical transformation of this auxiliary means of treatment in the future.
文摘Background Acute allograft rejection in heart transplantation remains as one of the major complications. Obligatory graft surveillance is still achieved with the invasive and expensive endomyocardial biopsy （EMB）. Our study aimed to study the use of intramyocardial electrograms combined with other noninvasive methods for the monitoring of acute rejection after human heart transplantation. Methods Permanent pacemakers were implanted in 58 patients undergoing heart transplantations. Intramyocardial electrograms （IMEG） were recorded periodically and the results were compared with those from EMBs. The R wave amplitude of the IMEG was used as the index value, the average R wave amplitude at the third week following transplantation was considered as the baseline, and a reduction of 〉20% compared with the baseline was regarded as a positive result. EMB was performed in cases of positive IMEG results and also at other times. Other noninvasive methods were used to help the diagnosis. Acute rejection （AR） was defined as International Society of Heart-Lung Transplantation grade IliA or higher. Results We obtained 1231 IMEG records and 127 EMBs. Of the total 127 EMBs, 53 were positive, in which there were 42 IMEG positive results and 11 negative, while in the rest 74 negative EMBs, there were 9 IMEG positive results and 65 negative. The sensitivity of IMEG for the diagnosis of AR was 79.2%, and the specificity was 87.8%. The positive predictive value was 82.4% and the negative predictive value was 85.5%. Of the total of 1231 IMEG records, 51 were positive and 1180 were negative. Excluding 11 proved by EMB to be false negative, if the other 1169 were considered as no evidence of rejection, through the other noninvasive methods, AR diagnosed by this noninvasive monitoring strategy, the sensitivity was 79.2%, and the specificity was 99.2%. The positive predictive value was 82.4% and the negative predictive value was 99.1%. Conclusions IMEG can be used as a noninvasive method for monitoring AR following heart transplantation. It is a continuous, safe and inexpensive method, and could reduce the need for EMB combined with other noninvasive methods without reducing the detection of rejection. Chin Med J 2009; 122（2）： 136-139
文摘Changes in intramyocardial tissue pressure modulate the relationship between coronary pressure and flow during the cardiac cycle. The present study compared the relation between measured and calculated diastolic subendocardial tissue pressure and coronary pressure at zero flow in anesthetized dogs after modulation of either coronary sinus (i.e. Fogarty catheter) or left ventricular intracavity (i.e. volume loading) pressure. Experiments were conducted in anesthetized, instrumented dogs;coronary pressure flow relations were constructed during pharmacologic vasodilatation and intramyocardial tissue pressure was measured using micromanometer pressure sensors. Elevated coronary sinus pressures did not affect subendocardial pressure-flow relations signifying that diastolic tissue pressure within this layer is the effective coronary back pressure. Higher left ventricular intracavity pressure did not affect either diastolic subendocardial tissue pressure or pressure flow relations within this layer. Results show a direct linear relation (y = 1.106x - 0.652;r2 = 0.59. P = 0.001) between measured and calculated diastolic subendocardial tissue pressure and coronary pressure at zero-flow over a wide range of pressures after either LV systemic or coronary sinus pressure modulation. Knowledge of back pressure in the subendocardium is useful for the evaluation of efficacy of cardiac interventions on myocardial perfusion particularly at the level of the microcirculation.
