BACKGROUND Hepatocellular carcinoma(HCC)is the most important primary malignant liver disease.A large proportion of patients with advanced HCC have macrovascular invasion.HCC tends to infiltrate vascular structures,pa...BACKGROUND Hepatocellular carcinoma(HCC)is the most important primary malignant liver disease.A large proportion of patients with advanced HCC have macrovascular invasion.HCC tends to infiltrate vascular structures,particularly the portal vein and its branches,and more rarely,the hepatic veins.The intravascular tumor thrombus can affect the inferior vena cava(IVC)or even the right atrium(RA),the latter having a poor prognosis.CASE SUMMARY HCC is one of the most aggressive malignant tumors.Tumor thrombus(TT)formation in advanced HCC stages is common and usually involves the hepatic or portal veins.Herein,we report a 69-year-old woman who presented with dyspnea to the emergency department.A ventilation/perfusion lung scan was performed,ruling out pulmonary embolism.Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography,but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging.Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA.HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.CONCLUSION HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.There is no consensus about anticoagulation or other interventions in these patients.展开更多
The objective of this study was to describe the myxoma of the right atrium occurring in an 11-year-old girl. It was an 11</span><span style="font-family:Verdana;">-</span><span style=&qu...The objective of this study was to describe the myxoma of the right atrium occurring in an 11-year-old girl. It was an 11</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">year</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">old girl weighing 22 kg, admitted for exertional dyspnea, dry cough, palpitations, hepatitis, abdominal bloating, fever evolving for more than 9 months without a history of known cardiovascular disease;referral from a pulmonology department for cardiomegaly and right pleurisy.</span><span style="font-family:""> </span><span style="font-family:Verdana;">At cardiac auscultation, the rhythm was irregular</span><span style="font-family:Verdana;">ly</span><span style="font-family:Verdana;"> fast at 130 beats without added noise with a blood pressure of 110/65</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">mmhg. In the lungs, there was silence and a decrease in vocal vibrations at the right base, SaO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> at 70%. Elsewhere a thoracic collateral venous circulation was visible. Electrocardiogram recorded rapid atrial fibrillation at 134 cycles. The cardiac ultrasound concluded that there was a mobile mass in the right atrium prolapsing in the right ventricle measuring 25 mm × 18.9 mm suggesting a myxoma. The myxoma of the right atrium is of a rare localization with a polymorphic clinical manifestation. It should be diagnosed as early as possible to avoid the occurrence of dreaded complications. Its management is surgical.展开更多
In this paper,eleven consecutive hepatocellular carcinoma(HCC) patients with an embolus in the hepatic vein(HV),inferior vena cava(IVC)and right atrium(RA) were studied with 18F-FDG PET/CT and contrast enhanced CT.Whe...In this paper,eleven consecutive hepatocellular carcinoma(HCC) patients with an embolus in the hepatic vein(HV),inferior vena cava(IVC)and right atrium(RA) were studied with 18F-FDG PET/CT and contrast enhanced CT.When correlated with final diagnosis,18F-FDG PET/CT and contrast enhanced CT was positive in 11 patients(100%),7 patients(63.6%),respectively.The accuracy of PET/CT and contrast-enhanced CT were 100%,63.6%.Three cases with secondary blood thrombi in the distant IVC,which were confirmed by PET/CT,cannot be identified by contrast enhanced CT.The average survival was 3 months(range,1-12mo).The 12 months survival rate was 9.1%.Our results suggest that highly metabolic tumor thrombus in the HV,IVC and RA may be depicted on 18F-FDG PET/CT in HCC patients.It may discriminate between malignant and secondary benign blood thrombi.展开更多
Primary cardiac epithelioid hemangioendothelioma (EHE) is extremely uncommon. To our knowledge, only fourteen cases have been reported. We report a case of a primary EHE of the right atrium which incidentally detected...Primary cardiac epithelioid hemangioendothelioma (EHE) is extremely uncommon. To our knowledge, only fourteen cases have been reported. We report a case of a primary EHE of the right atrium which incidentally detected in 77-year-old woman. Echocardiograhpy revealed a 26 × 16 mm right atrial mass attached to the base of the interatrial septum and moderate regurgitation of the tricuspid valve. The tumor and stalk were completely resected from the interatrial septum with a partial resection of the septal leaflet of the tricuspid valve. The patient had an uneventful postoperative course and no signs of recurrence nor metastasis of EHE 4 years after operation. Because of malignant potential of EHE, a longer period of close follow up is necessary.展开更多
Hepatocellular carcinoma(HCC),one of the most common liver cancers,often has a poor prognosis when it involves macrovascular invasion.Oncological emergencies including pulmonary embolism,heart failure,and even sudden ...Hepatocellular carcinoma(HCC),one of the most common liver cancers,often has a poor prognosis when it involves macrovascular invasion.Oncological emergencies including pulmonary embolism,heart failure,and even sudden death could happen when it develops a tumor thrombus(TT)in the inferior vena cava(IVC)or right atrium(RA),indicating an exceptionally grim prognosis(1).Although systemic therapy is the only standard treatment recommended by guidelines(2),other treatment modalities are explored including surgery,radiotherapy,etc.in some centers.Surgery,as the only potential curative treatment,has been explored in several selected cases.A case of long-term survival of 15 years and cancer-free survival of 9 years was reported by surgical resection with a heart-first approach under cardiopulmonary bypass(CPB)(3),suggesting that aggressive surgery together with multidisciplinary treatments might achieve long survival.However,due to the aggressiveness and challenge of surgical resection-massive resection area,potential significant blood loss,and bypass needed,surgical resection is applied in very limited centers.Nevertheless,safety,efficacy,and long-term survival benefits for these patients are poorly investigated.展开更多
A trial electrophysiological heterogeneity, which plays an important role in the genesis and maintenance of atrial arrhythmia, is a major determinant of atrial reentrant arrhythmias. Recently, many studies on atrial f...A trial electrophysiological heterogeneity, which plays an important role in the genesis and maintenance of atrial arrhythmia, is a major determinant of atrial reentrant arrhythmias. Recently, many studies on atrial flutter have demonstrated the anatomic architecture in the right atrium plays an important role in the genesis of atrial reentry. The crista terminalis （CT） in the right atrium, which is a unique anatomic structure of the right atrium, provides an area for conduction block and delay, leading to initiation, maintenance, and termination of atrial arrhythmias. Catheter ablation of CT can successfully eliminate these atrial arrhythmias. These literatures contrast with limited knowledge of the basic electrophysiological properties of CT and how these promote arrhythmia generation. Compared to pectinate muscles （PM） and right atrial appendage （RAA）, CT have distinct electrophysiological properties related to different densities of several ionic currents, the transient outward current （Ito） and L-type Ca^2＋ current （Ica-L） underlie the bulk of the different densities of several ionic currents. Cardiac Ito and Ica-L play a major role in action potential repolarization. Ito is particularly important in early （phase 1） repolarization and influences the participation of other currents. It is generally believed that Ica-L plays an important role in the plateau phase of repolarization. However, the mechanisms for these ionic current differences are unknown. One possible is a difference in ion channel subunit expression, but virtually no data are available regarding ion-channel subunit expression in CT, PM, and RAA. The Kv4.3 channel underlies the bulk of the α-subunit of Ito in canine and human heart.展开更多
Objective To map and compare the right atrium in patients with AF to those with atrioventricular nodal reentrant tachycardias (AVNRT, as control group) and to investigate the anatomical and electrophysiological abnorm...Objective To map and compare the right atrium in patients with AF to those with atrioventricular nodal reentrant tachycardias (AVNRT, as control group) and to investigate the anatomical and electrophysiological abnormality of the right atrium in AF.Methods The anatomy and electrophysiology of right atrium and cavotricuspid isthmus were evaluated in 20 patients with AF (16 M/4 F, mean age 55.9±10.68 years) and 26 patients with AVNRT (9 M/17 F, mean age 47.50±19.56 years) during coronary sinus pacing at 600 ms prior to ablation with electro-anatomical mapping system. Right atrial volume (RAV), the length and width of cavotricuspid isthmus (IsL, IsW), unipolar and bipolar voltage in the right atrium (UniV-RA, BiV-RA) were measured and compared between patients with AF and those with AVNRT. Results RAV, IsL, IsW, UniV-RA, and BiV-RA were 143.22±40.72 vs 104.35±21.06 ml, 39.31±8.10 vs 32.42±9.77 mm, 30.54±7.48 vs 23.15±6.61 mm, 1.96±1.24 vs 1.53±0.91 mv and 1.47±1.47 vs 1.29±1.12 mv in AF and AVNRT respectively.Conclusion The right atrial volume is larger; both the length and width of cavotricuspid isthmus are greater. Unipolar and bipolar voltages in the right atrium are higher in AF than in AVNRT, suggesting that the enlarged right atrium, increased length and width of cavotricuspid isthmus, and concomitant atrial hypertrophy are important substrates for initiation and perpetuation of typical AF.展开更多
右心房结构和功能在维持心血管系统稳态中扮演关键角色,其形态重构及功能异常与多种心血管疾病进程紧密相连。近年来,随着心脏磁共振(cardiac magnetic resonance,CMR)技术的快速发展,其在无创评估心脏解剖、功能及心肌组织病理特征方...右心房结构和功能在维持心血管系统稳态中扮演关键角色,其形态重构及功能异常与多种心血管疾病进程紧密相连。近年来,随着心脏磁共振(cardiac magnetic resonance,CMR)技术的快速发展,其在无创评估心脏解剖、功能及心肌组织病理特征方面展现出独特优势,为右心房功能的精确评价提供了新的视角和方法。本文重点阐述CMR评估右心房功能的常用参数并深入探讨其在多种心血管疾病中的临床应用,指出当前CMR在右心房功能评估领域的研究不足和挑战,指明未来研究方向。本文旨在提高对CMR评估右心房功能的全面认识,促进其在心血管疾病诊疗中的广泛应用,为疾病的早期诊断、病情评估及预后判断提供参考。展开更多
AIM: To analyze the imaging findings of hepatic malignancy with right atrial (RA) embolus. METHODS: Forty-six patients with an embolus in the RA were diagnosed, including 44 patients with hepatocellular carcinoma (HCC...AIM: To analyze the imaging findings of hepatic malignancy with right atrial (RA) embolus. METHODS: Forty-six patients with an embolus in the RA were diagnosed, including 44 patients with hepatocellular carcinoma (HCC), 1 patient with cholangiocellular carcinoma and 1 patient with hepatic carcinoma metastasis. The diagnosis was confirmed by clinical examination, serum α-fetoprotein and imaging. Seventeen patients underwent transcatheter arterial chemoembolization (TACE). RESULTS: On enhancement computer tomography (CT) or magnetic resonance (MR) imaging, a nodular filling defect in the RA could be easily found, with a slight enhancement in the arterial phase. The coronal images of CT or MR showed the extent of lesion. Lipiodol entered the embolus after TACE, hence reducing the speed of embolus growth. There was a survival benefit for patients receiving anticancer treatment. CONCLUSION: Patients with HCC, showing a filling defect of the inferior vena cava (IVC), hepatic vein (HV) and RA on images, can be diagnosed with RA embolus. Encroachment of the RA is very rare in patients with hepatic malignancies. Furthermore, a prolongation of survival time is found in those patients who underwent TACE.展开更多
The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynami...The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane（LA 8-plane） method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group（n=30）. The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method（4D RVQ） and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume（P〈0.001）. The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated（P〈0.05）. The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group（P=0.0001）. The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group（P=0.043）. The right ventricular ejection fraction in the ASD group was lower than that in the normal control group（P=0.032）. The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant（P=0.005）. The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group（P=0.031）. The a RVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group（P=0.0005）. The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.展开更多
Primary cardiac tumors are quite rare and most of these tumors are benign.In this report,a patient presented with chest distress and shortness of breath after activity.Echocardiography of other hospital showed a hyper...Primary cardiac tumors are quite rare and most of these tumors are benign.In this report,a patient presented with chest distress and shortness of breath after activity.Echocardiography of other hospital showed a hyperechoic right atrial mass.Electrocardiogram-gated cardiac computed tomography(ECG-Gated CT) of our hospital provided accurate information about the site and extent of the tumor,and the involvement of neighboring structures,even about the malignant nature of the lesion.The pathological study indicated angiosarcoma.The role of ECG-Gated CT in the assessment of cardiac masses and tumors was discussed.Cardiac tumors are extremely rare and can be divided into benign and malignant lesions.Myxomas are the most common type of cardiac benign tumor,while angiosarcomas are the most common type of cardiac malignant tumor.Imaging studies play an important role in the diagnosis of cardiac angiosarcomas.Echocardiogram,computed tomography(CT) and magnetic resonance imaging(MRI) are the most common imaging studies for tumors evaluation.However,the precise tumor location is often difficult to evaluate precisely on the basis of two-dimensional source images.We conducted ECG-gated cardiac CT examination with 3D reconstruction for preoperative assessment in a patient with a angiosarcoma arising in the right atrium.展开更多
BACKGROUND Renal cell carcinoma(RCC)is an aggressive tumor,with an incidental discovery in most patients.Classic presentation is rare,and it has a high frequency of local and distant metastasis at the time of detectio...BACKGROUND Renal cell carcinoma(RCC)is an aggressive tumor,with an incidental discovery in most patients.Classic presentation is rare,and it has a high frequency of local and distant metastasis at the time of detection.CASE SUMMARY We present a rare case of a 58-year-old man with a ball-shaped thrombus in the right atrium at the time of first incidental identification of RCC in the emergency department.Cardiac metastasis,especially thrombus in the right atrium,is rare.It could either be a bland thrombus or a tumor thrombus,and physicians should consider this potentially fatal complication of RCC early at the time of initial presentation.CONCLUSION Ball-shaped lesions in the right atrium are rare,and bland thrombus should be differentiated from tumor thrombus secondary to intracardiac metastasis.展开更多
Myxomas comprise 6% to 10% of primary cardiac tumors in childhood. Less than 10% of patients with cardiac myxomas are under 15 years of age. A large myxoma occupying in the right atrium and prolapsing into the right v...Myxomas comprise 6% to 10% of primary cardiac tumors in childhood. Less than 10% of patients with cardiac myxomas are under 15 years of age. A large myxoma occupying in the right atrium and prolapsing into the right ventricle, pulmonary artery and producing tricuspid and pulmonary valve obstructions was diagnosed by Transthoracic 2D echocardiographic imaging in a 12-year-old male child.展开更多
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the most important primary malignant liver disease.A large proportion of patients with advanced HCC have macrovascular invasion.HCC tends to infiltrate vascular structures,particularly the portal vein and its branches,and more rarely,the hepatic veins.The intravascular tumor thrombus can affect the inferior vena cava(IVC)or even the right atrium(RA),the latter having a poor prognosis.CASE SUMMARY HCC is one of the most aggressive malignant tumors.Tumor thrombus(TT)formation in advanced HCC stages is common and usually involves the hepatic or portal veins.Herein,we report a 69-year-old woman who presented with dyspnea to the emergency department.A ventilation/perfusion lung scan was performed,ruling out pulmonary embolism.Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography,but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging.Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA.HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.CONCLUSION HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.There is no consensus about anticoagulation or other interventions in these patients.
文摘The objective of this study was to describe the myxoma of the right atrium occurring in an 11-year-old girl. It was an 11</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">year</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">old girl weighing 22 kg, admitted for exertional dyspnea, dry cough, palpitations, hepatitis, abdominal bloating, fever evolving for more than 9 months without a history of known cardiovascular disease;referral from a pulmonology department for cardiomegaly and right pleurisy.</span><span style="font-family:""> </span><span style="font-family:Verdana;">At cardiac auscultation, the rhythm was irregular</span><span style="font-family:Verdana;">ly</span><span style="font-family:Verdana;"> fast at 130 beats without added noise with a blood pressure of 110/65</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">mmhg. In the lungs, there was silence and a decrease in vocal vibrations at the right base, SaO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> at 70%. Elsewhere a thoracic collateral venous circulation was visible. Electrocardiogram recorded rapid atrial fibrillation at 134 cycles. The cardiac ultrasound concluded that there was a mobile mass in the right atrium prolapsing in the right ventricle measuring 25 mm × 18.9 mm suggesting a myxoma. The myxoma of the right atrium is of a rare localization with a polymorphic clinical manifestation. It should be diagnosed as early as possible to avoid the occurrence of dreaded complications. Its management is surgical.
基金Supported by National Science Foundation for Young Scholars of China (Grant No. 81101067)
文摘In this paper,eleven consecutive hepatocellular carcinoma(HCC) patients with an embolus in the hepatic vein(HV),inferior vena cava(IVC)and right atrium(RA) were studied with 18F-FDG PET/CT and contrast enhanced CT.When correlated with final diagnosis,18F-FDG PET/CT and contrast enhanced CT was positive in 11 patients(100%),7 patients(63.6%),respectively.The accuracy of PET/CT and contrast-enhanced CT were 100%,63.6%.Three cases with secondary blood thrombi in the distant IVC,which were confirmed by PET/CT,cannot be identified by contrast enhanced CT.The average survival was 3 months(range,1-12mo).The 12 months survival rate was 9.1%.Our results suggest that highly metabolic tumor thrombus in the HV,IVC and RA may be depicted on 18F-FDG PET/CT in HCC patients.It may discriminate between malignant and secondary benign blood thrombi.
文摘Primary cardiac epithelioid hemangioendothelioma (EHE) is extremely uncommon. To our knowledge, only fourteen cases have been reported. We report a case of a primary EHE of the right atrium which incidentally detected in 77-year-old woman. Echocardiograhpy revealed a 26 × 16 mm right atrial mass attached to the base of the interatrial septum and moderate regurgitation of the tricuspid valve. The tumor and stalk were completely resected from the interatrial septum with a partial resection of the septal leaflet of the tricuspid valve. The patient had an uneventful postoperative course and no signs of recurrence nor metastasis of EHE 4 years after operation. Because of malignant potential of EHE, a longer period of close follow up is necessary.
基金supported by grants from the National Natural Science Foundation of China(No.82203078,J.Y.,No.82073332,Q.W.)Natural Science Foundation of Zhejiang Province(No.LQ22H160030,J.Y.).
文摘Hepatocellular carcinoma(HCC),one of the most common liver cancers,often has a poor prognosis when it involves macrovascular invasion.Oncological emergencies including pulmonary embolism,heart failure,and even sudden death could happen when it develops a tumor thrombus(TT)in the inferior vena cava(IVC)or right atrium(RA),indicating an exceptionally grim prognosis(1).Although systemic therapy is the only standard treatment recommended by guidelines(2),other treatment modalities are explored including surgery,radiotherapy,etc.in some centers.Surgery,as the only potential curative treatment,has been explored in several selected cases.A case of long-term survival of 15 years and cancer-free survival of 9 years was reported by surgical resection with a heart-first approach under cardiopulmonary bypass(CPB)(3),suggesting that aggressive surgery together with multidisciplinary treatments might achieve long survival.However,due to the aggressiveness and challenge of surgical resection-massive resection area,potential significant blood loss,and bypass needed,surgical resection is applied in very limited centers.Nevertheless,safety,efficacy,and long-term survival benefits for these patients are poorly investigated.
基金This study was supported by a grant from the National Natural Science Foundation (No. 30470704).
文摘A trial electrophysiological heterogeneity, which plays an important role in the genesis and maintenance of atrial arrhythmia, is a major determinant of atrial reentrant arrhythmias. Recently, many studies on atrial flutter have demonstrated the anatomic architecture in the right atrium plays an important role in the genesis of atrial reentry. The crista terminalis （CT） in the right atrium, which is a unique anatomic structure of the right atrium, provides an area for conduction block and delay, leading to initiation, maintenance, and termination of atrial arrhythmias. Catheter ablation of CT can successfully eliminate these atrial arrhythmias. These literatures contrast with limited knowledge of the basic electrophysiological properties of CT and how these promote arrhythmia generation. Compared to pectinate muscles （PM） and right atrial appendage （RAA）, CT have distinct electrophysiological properties related to different densities of several ionic currents, the transient outward current （Ito） and L-type Ca^2＋ current （Ica-L） underlie the bulk of the different densities of several ionic currents. Cardiac Ito and Ica-L play a major role in action potential repolarization. Ito is particularly important in early （phase 1） repolarization and influences the participation of other currents. It is generally believed that Ica-L plays an important role in the plateau phase of repolarization. However, the mechanisms for these ionic current differences are unknown. One possible is a difference in ion channel subunit expression, but virtually no data are available regarding ion-channel subunit expression in CT, PM, and RAA. The Kv4.3 channel underlies the bulk of the α-subunit of Ito in canine and human heart.
文摘Objective To map and compare the right atrium in patients with AF to those with atrioventricular nodal reentrant tachycardias (AVNRT, as control group) and to investigate the anatomical and electrophysiological abnormality of the right atrium in AF.Methods The anatomy and electrophysiology of right atrium and cavotricuspid isthmus were evaluated in 20 patients with AF (16 M/4 F, mean age 55.9±10.68 years) and 26 patients with AVNRT (9 M/17 F, mean age 47.50±19.56 years) during coronary sinus pacing at 600 ms prior to ablation with electro-anatomical mapping system. Right atrial volume (RAV), the length and width of cavotricuspid isthmus (IsL, IsW), unipolar and bipolar voltage in the right atrium (UniV-RA, BiV-RA) were measured and compared between patients with AF and those with AVNRT. Results RAV, IsL, IsW, UniV-RA, and BiV-RA were 143.22±40.72 vs 104.35±21.06 ml, 39.31±8.10 vs 32.42±9.77 mm, 30.54±7.48 vs 23.15±6.61 mm, 1.96±1.24 vs 1.53±0.91 mv and 1.47±1.47 vs 1.29±1.12 mv in AF and AVNRT respectively.Conclusion The right atrial volume is larger; both the length and width of cavotricuspid isthmus are greater. Unipolar and bipolar voltages in the right atrium are higher in AF than in AVNRT, suggesting that the enlarged right atrium, increased length and width of cavotricuspid isthmus, and concomitant atrial hypertrophy are important substrates for initiation and perpetuation of typical AF.
文摘右心房结构和功能在维持心血管系统稳态中扮演关键角色,其形态重构及功能异常与多种心血管疾病进程紧密相连。近年来,随着心脏磁共振(cardiac magnetic resonance,CMR)技术的快速发展,其在无创评估心脏解剖、功能及心肌组织病理特征方面展现出独特优势,为右心房功能的精确评价提供了新的视角和方法。本文重点阐述CMR评估右心房功能的常用参数并深入探讨其在多种心血管疾病中的临床应用,指出当前CMR在右心房功能评估领域的研究不足和挑战,指明未来研究方向。本文旨在提高对CMR评估右心房功能的全面认识,促进其在心血管疾病诊疗中的广泛应用,为疾病的早期诊断、病情评估及预后判断提供参考。
文摘AIM: To analyze the imaging findings of hepatic malignancy with right atrial (RA) embolus. METHODS: Forty-six patients with an embolus in the RA were diagnosed, including 44 patients with hepatocellular carcinoma (HCC), 1 patient with cholangiocellular carcinoma and 1 patient with hepatic carcinoma metastasis. The diagnosis was confirmed by clinical examination, serum α-fetoprotein and imaging. Seventeen patients underwent transcatheter arterial chemoembolization (TACE). RESULTS: On enhancement computer tomography (CT) or magnetic resonance (MR) imaging, a nodular filling defect in the RA could be easily found, with a slight enhancement in the arterial phase. The coronal images of CT or MR showed the extent of lesion. Lipiodol entered the embolus after TACE, hence reducing the speed of embolus growth. There was a survival benefit for patients receiving anticancer treatment. CONCLUSION: Patients with HCC, showing a filling defect of the inferior vena cava (IVC), hepatic vein (HV) and RA on images, can be diagnosed with RA embolus. Encroachment of the RA is very rare in patients with hepatic malignancies. Furthermore, a prolongation of survival time is found in those patients who underwent TACE.
文摘The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane（LA 8-plane） method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group（n=30）. The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method（4D RVQ） and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume（P〈0.001）. The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated（P〈0.05）. The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group（P=0.0001）. The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group（P=0.043）. The right ventricular ejection fraction in the ASD group was lower than that in the normal control group（P=0.032）. The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant（P=0.005）. The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group（P=0.031）. The a RVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group（P=0.0005）. The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.
文摘Primary cardiac tumors are quite rare and most of these tumors are benign.In this report,a patient presented with chest distress and shortness of breath after activity.Echocardiography of other hospital showed a hyperechoic right atrial mass.Electrocardiogram-gated cardiac computed tomography(ECG-Gated CT) of our hospital provided accurate information about the site and extent of the tumor,and the involvement of neighboring structures,even about the malignant nature of the lesion.The pathological study indicated angiosarcoma.The role of ECG-Gated CT in the assessment of cardiac masses and tumors was discussed.Cardiac tumors are extremely rare and can be divided into benign and malignant lesions.Myxomas are the most common type of cardiac benign tumor,while angiosarcomas are the most common type of cardiac malignant tumor.Imaging studies play an important role in the diagnosis of cardiac angiosarcomas.Echocardiogram,computed tomography(CT) and magnetic resonance imaging(MRI) are the most common imaging studies for tumors evaluation.However,the precise tumor location is often difficult to evaluate precisely on the basis of two-dimensional source images.We conducted ECG-gated cardiac CT examination with 3D reconstruction for preoperative assessment in a patient with a angiosarcoma arising in the right atrium.
文摘BACKGROUND Renal cell carcinoma(RCC)is an aggressive tumor,with an incidental discovery in most patients.Classic presentation is rare,and it has a high frequency of local and distant metastasis at the time of detection.CASE SUMMARY We present a rare case of a 58-year-old man with a ball-shaped thrombus in the right atrium at the time of first incidental identification of RCC in the emergency department.Cardiac metastasis,especially thrombus in the right atrium,is rare.It could either be a bland thrombus or a tumor thrombus,and physicians should consider this potentially fatal complication of RCC early at the time of initial presentation.CONCLUSION Ball-shaped lesions in the right atrium are rare,and bland thrombus should be differentiated from tumor thrombus secondary to intracardiac metastasis.
文摘Myxomas comprise 6% to 10% of primary cardiac tumors in childhood. Less than 10% of patients with cardiac myxomas are under 15 years of age. A large myxoma occupying in the right atrium and prolapsing into the right ventricle, pulmonary artery and producing tricuspid and pulmonary valve obstructions was diagnosed by Transthoracic 2D echocardiographic imaging in a 12-year-old male child.
