ABSTRACT
BACKGROUND: The aim of this study was to assess effectiveness, stability, position, and expansibility of an expansible aortic annuloplasty ring with computed tomography (CT). METHODS: Ten men (median age 51 years) scheduled for aortic root remodeling with implantation of external annuloplasty ring underwent contrast-enhanced CT of the aortic root preoperatively, postoperatively, and at a median of 21 months after operation. A reconstructed transverse double oblique view of the aortic base (AB) and of the new defined annuloplasty ring base (ARB; plane of the lower edge of the ring) in systole and diastole were obtained. The diameters, perimeter, and area were measured. In addition, the distances between AB and ARB in the nadir of each sinus were measured. RESULTS: We found 12% reduction of the postoperative AB and 19% of ARB perimeter in both systole (p = 0.004, p < 0.001, respectively) and diastole (p = 0.001, p < 0.001, respectively) compared with preoperative. There was 22% reduction of the postoperative AB area in systole and 24% in diastole (p = 0.002, p = 0.001, respectively) and 33% reduction of the ARB area in systole and 32% in diastole (p < 0.001 for both) compared with the preoperative period. Nearly all measured variables in the follow-up period showed a slight increase compared with the postoperative period; however, they did not reach statistical significance. The postoperative systolic-diastolic differences in the three measured variables at the level of AB and ARB were statistically significant and were maintained throughout the follow-up period. The base of the ring was implanted 2 ± 2 mm at the right, 0 ± 1 mm at the left above the AB, and 2 (-3 to 2) mm at the noncoronary nadir below the AB. CONCLUSIONS: This study demonstrates imaging evidence of the effectiveness, stability, and pulsatility of the annuloplasty ring in aortic root remodeling in follow-up and describes the exact position of the ring at the base of the aortic root.
Subject(s)
Aorta, Thoracic/diagnostic imaging , Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Cardiac Valve Annuloplasty/methods , Imaging, Three-Dimensional , Prostheses and Implants , Tomography, X-Ray Computed/methods , Adult , Aged , Aorta, Thoracic/physiopathology , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Design , Retrospective Studies , Time Factors , Ventricular Function, Left/physiologyABSTRACT
A one-step supraclavicular approach for the surgical treatment of the aberrant right subclavian artery is described in a case of dysphagia lusoria in a 38-year-old female. The approach allows for safe division of the arteria lusoria and its re-anastomosis to the common carotid artery while the patient benefits from a mini-invasive extrathoracic procedure. doi: 10.1111/jocs.12287 (J Card Surg 2014;29:519-522).
Subject(s)
Deglutition Disorders/etiology , Deglutition Disorders/surgery , Subclavian Artery/abnormalities , Subclavian Artery/surgery , Vascular Surgical Procedures/methods , Adult , Anastomosis, Surgical/methods , Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Carotid Artery, Common/surgery , Female , Humans , Minimally Invasive Surgical Procedures/methods , Postoperative Complications/prevention & control , Thoracic Surgical Procedures/methods , Treatment OutcomeABSTRACT
PURPOSE: To investigate whether the use of magnetic resonance imaging (MRI) in prostate bed treatment planning could influence definition of the clinical target volume (CTV) and organs at risk. METHODS AND MATERIALS: A total of 21 consecutive patients referred for prostate bed radiotherapy were included in the present retrospective study. The CTV was delineated according to the European Organization for Research and Treatment of Cancer recommendations on computed tomography (CT) and T(1)-weighted (T(1)w) and T(2)-weighted (T(2)w) MRI. The CTV magnitude, agreement, and spatial differences were evaluated on the planning CT scan after registration with the MRI scans. RESULTS: The CTV was significantly reduced on the T(1)w and T(2)w MRI scans (13% and 9%, respectively) compared with the CT scans. The urinary bladder was drawn smaller on the CT scans and the rectum was smaller on the MRI scans. On T(1)w MRI, the rectum and urinary bladder were delineated larger than on T(2)w MRI. Minimal agreement was observed between the CT and T(2)w images. The main spatial differences were measured in the superior and superolateral directions in which the CTV on the MRI scans was 1.8-2.9 mm smaller. In the posterior and inferior border, no difference was seen between the CT and T(1)w MRI scans. On the T(2)w MRI scans, the CTV was larger in these directions (by 1.3 and 1.7 mm, respectively). CONCLUSIONS: The use of MRI in postprostatectomy radiotherapy planning resulted in a reduction of the CTV. The main differences were found in the superior part of the prostate bed. We believe T(2)w MRI enables more precise definition of prostate bed CTV than conventional planning CT.
Subject(s)
Magnetic Resonance Imaging/methods , Organs at Risk , Prostatectomy , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Radiotherapy Planning, Computer-Assisted/methods , Tumor Burden , Aged , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/blood , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/radiotherapy , Neoplasm, Residual , Organ Size , Organs at Risk/anatomy & histology , Organs at Risk/diagnostic imaging , Postoperative Period , Prostate/anatomy & histology , Prostate/diagnostic imaging , Prostatic Neoplasms/blood , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/surgery , Radiotherapy, Adjuvant/methods , Rectum/anatomy & histology , Rectum/diagnostic imaging , Retrospective Studies , Salvage Therapy/methods , Seminal Vesicles/anatomy & histology , Seminal Vesicles/diagnostic imaging , Tomography, X-Ray Computed/methods , Urinary Bladder/anatomy & histology , Urinary Bladder/diagnostic imagingABSTRACT
BACKGROUND: Ultrafast T2-weighted (T2-W) MRI sequences are currently considered a routine technique for fetal MR imaging. Limited experience exists with fetal T1-weighted (T1-W) imaging techniques. OBJECTIVE: To determine MRI patterns of some fetal abdominal or haemorrhagic disorders with particular respect to the diagnostic value of T1-W images. MATERIALS AND METHODS: In addition to standard T2-W single-shot sequences, T1-W single-shot and/or multislice sequences were employed in 25 MR examinations performed in 23 fetuses between 20 and 36 weeks of gestation for more detailed assessment of liver, meconium-filled digestive tract, haemorrhage, or further characterization of a fetal abdominal mass. Diagnostic value and presence of motion artefacts on T1-W images was recorded in each case. RESULTS: T1-W images enabled superior delineation of fetal liver and large intestine. They provided additional diagnostic information in 9 (39%) of 23 fetuses. One false-positive and one false-negative MRI diagnosis of malrotation anomaly were encountered. Use of single-shot T1-W sequences reduced the occurrence of motion artefacts in 64%. CONCLUSION: Our results suggest that the specific signal properties of methaemoglobin, meconium and liver are sufficiently important for T1-W sequences to become a routine part of fetal MRI protocols when dealing with digestive tract anomalies, diaphragmatic and abdominal wall defects, intraabdominal masses, and fetal haemorrhage.
Subject(s)
Abdomen/abnormalities , Hemorrhage/diagnosis , Liver/abnormalities , Magnetic Resonance Imaging , Prenatal Diagnosis/methods , Female , Humans , Meconium , Pregnancy , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Retrospective StudiesABSTRACT
The prevention of ischemic stroke by surgical means goes back half a century. Interventional treatment of significant carotid artery occlusive disease should be performed by the method that provides the least periprocedural risk and best durability while providing long-term freedom from stroke. The aim of this study was to analyzed the group of 108 patients following 130 carotid endarterectomies from the point of view of risk and clinical importance of restenosis and occlusion, and probability of recurrent ischemic stroke. Carotid endarterectomy represents an efficacious stroke-preventing strategy for acceptable risk of restenosis of a small clinical importance and low risk of subsequent ipsilateral ischemic stroke.
