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1.
AJR Am J Roentgenol ; 202(3): W191-201, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24555614

ABSTRACT

OBJECTIVE: The purposes of this article are to review the treatment options for late-stage biventricular heart failure, discuss the clinical indications for total artificial heart (TAH) implantation, illustrate the expected imaging findings after uncomplicated TAH implantation, and highlight the radiologic findings of common and uncommon complications associated with TAH implantation through case examples. CONCLUSION: TAH implantation is an effective therapeutic option for the treatment of patients with end-stage biventricular heart failure. The duration of implantation varies depending on a particular patient's medical condition and the eventual availability of a human heart for orthotopic transplantation. TAH recipients often undergo imaging with conventional radiography, CT, or both for the assessment of device-related issues, many of which are life-threatening and require emergency management. As the clinical use of the TAH increases and becomes more commonplace, it is imperative that radiologists interpreting imaging studies recognize both the expected and the unexpected imaging findings that affect patient care.


Subject(s)
Coronary Angiography/methods , Heart Failure/diagnostic imaging , Heart Failure/surgery , Heart, Artificial/adverse effects , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Prosthesis Implantation/adverse effects , Aged , Evidence-Based Medicine , Female , Heart Failure/complications , Humans , Male , Middle Aged , Prognosis , Prosthesis Design , Prosthesis Implantation/methods , Tomography, X-Ray Computed/methods , Treatment Outcome
2.
J Neurosurg Pediatr ; 9(1): 17-23, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22208315

ABSTRACT

The authors report a rare case of multiple intracranial fetuses in fetu, fulfilling Willis' traditional criteria, which include an axial and appendicular skeleton with surrounding organized tissue. This case was ascertained from studies of a full-term female neonate who presented with ventriculomegaly. A CT scan showed intracranial calcifications that were suggestive of an axial skeleton. Her birth weight was 3.176 kg (50th-75th percentile), length was 52 cm (90th percentile), head circumference was 35 cm (50th-75th percentile), and Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Prenatal ultrasonography studies performed at 12 weeks and 5 days, and 19 weeks and 6 days revealed normal findings. A 37-week prenatal ultrasonography study showed ventriculomegaly and obstructive hydrocephalus, with a possible intracranial teratoma. Cranial imaging at birth with ultrasonography, CT and MR imaging, and MR angiography demonstrated 2 complex intraventricular masses with cystic, solid, and bony elements. A craniotomy with resection of the masses was performed at 3 months of age. The infant survived and is now 12 months old with some developmental progress. Two axial skeletons, with accompanying rib cage and extremities, including well-formed feet and toes, were noted. Both anencephalic structures had skin with hair, fat, skeletal and smooth muscle, and bony structures with bone marrow and focal areas of calcification. Multiple viscera were present and included thymus, bowel, stomach, salivary gland, kidney, adrenal gland, lung, and presumed adnexal structures. A diagnosis of fetuses in fetu was rendered. Chromosomal studies of the child and tissue from the 2 fetuses in fetu showed normal female karyotypes. A single nucleotide polymorphism array analysis from the proband infant and tissue from the 2 identified fetuses in fetu appeared to be genetically identical. These results are consistent with a monozygotic twin embryonic origin of the fetus in fetu tissue, which is a mechanism that has been suggested in previous reports in which karyotypes, blood types, and limited genetic loci have been studied. This is the first report of a rare example of intracranial intraventricular twin fetuses in fetu for which a genome-wide single nucleotide polymorphism assay has confirmed their genetic identity.


Subject(s)
Calcinosis/diagnosis , Fetus/abnormalities , Hydrocephalus/diagnosis , Twins, Monozygotic , Adult , Anencephaly/diagnosis , Anencephaly/genetics , Anencephaly/pathology , Anencephaly/surgery , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/etiology , Calcinosis/genetics , Calcinosis/pathology , Calcinosis/surgery , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/etiology , Craniotomy , Echocardiography , Female , Fetus/surgery , Follow-Up Studies , Humans , Hydrocephalus/genetics , Hydrocephalus/pathology , Hydrocephalus/surgery , Infant , Infant, Newborn , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Polymorphism, Single Nucleotide/genetics , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Pregnancy , Status Epilepticus/diagnosis , Status Epilepticus/etiology , Tomography, X-Ray Computed , Twins, Monozygotic/genetics , Ultrasonography, Prenatal
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