Soot Monitoring of Gasoline Particulate Filters Using a Radio-Frequency-Based Sensor.

Owing to increasingly stringent emission limits, particulate filters have become mandatory for gasoline-engine vehicles. Monitoring their soot loading is necessary for error-free operation. The state-of-the-art differential pressure sensors suffer from inaccuracies due to small amounts of stored soot combined with exhaust gas conditions that lead to partial regeneration. As an alternative approach, radio-frequency-based (RF) sensors can accurately measure the soot loading, even under these conditions, by detecting soot through its dielectric properties. However, they face a different challenge as their sensitivity may depend on the engine operation conditions during soot formation. In this article, this influence is evaluated in more detail. Various soot samples were generated on an engine test bench. Their dielectric properties were measured using the microwave cavity perturbation (MCP) method and compared with the corresponding sensitivity of the RF sensor determined on a lab test bench. Both showed similar behavior. The values for the soot samples themselves, however, differed significantly from each other. A way to correct for this cross-sensitivity was found in the influence of exhaust gas humidity on the RF sensor, which can be correlated with the engine load. By evaluating this influence during significant humidity changes, such as fuel cuts, it could be used to correct the influence of the engineon the RF sensor.

Mixing Rules for an Exact Determination of the Dielectric Properties of Engine Soot Using the Microwave Cavity Perturbation Method and Its Application in Gasoline Particulate Filters.

In recent years, particulate filters have become mandatory in almost all gasoline-powered vehicles to comply with emission standards regarding particulate number. In contrast to diesel applications, monitoring gasoline particulate filters (GPFs) by differential pressure sensors is challenging due to lower soot masses to be deposited in the GPFs. A different approach to determine the soot loading of GPFs is a radio frequency-based sensor (RF sensor). To facilitate sensor development, in previous work, a simulation model was created to determine the RF signal at arbitrary engine operating points. To ensure accuracy, the exact dielectric properties of the soot need to be known. This work has shown how small samples of soot-loaded filter are sufficient to determine the dielectric properties of soot itself using the microwave cavity perturbation method. For this purpose, mixing rules were determined through simulation and measurement, allowing the air and substrate fraction of the sample to be considered. Due to the different geometry of filter substrates compared to crushed soot samples, a different mixing rule had to be derived to calculate the effective filter properties required for the simulation model. The accuracy of the determined mixing rules and the underlying simulation model could be verified by comparative measurements on an engine test bench.

Modelling the Influence of Different Soot Types on the Radio-Frequency-Based Load Detection of Gasoline Particulate Filters.

Gasoline particulate filters (GPFs) are an appropriate means to meet today's emission standards. As for diesel applications, GPFs can be monitored via differential pressure sensors or using a radio-frequency approach (RF sensor). Due to largely differing soot properties and engine operating modes of gasoline compared to diesel engines (e.g., the possibility of incomplete regenerations), the behavior of both sensor systems must be investigated in detail. For this purpose, extensive measurements on engine test benches are usually required. To simplify the sensor development, a simulation model was developed using COMSOL Multiphysics® that not only allowed for calculating the loading and regeneration process of GPFs under different engine operating conditions but also determined the impact on both sensor systems. To simulate the regeneration behavior of gasoline soot accurately, an oxidation model was developed. To identify the influence of different engine operating points on the sensor behavior, various samples generated at an engine test bench were examined regarding their kinetic parameters using thermogravimetric analysis. Thus, this compared the accuracy of soot mass determination using the RF sensor with the differential pressure method. By simulating a typical driving condition with incomplete regenerations, the effects of the soot kinetics on sensor accuracy was demonstrated exemplarily. Thereby, the RF sensor showed an overall smaller mass determination error, as well as a lower dependence on the soot kinetics.

Protein kinase C regulates ErbB3 turnover.

ErbB3, which belongs to the epidermal growth factor receptor (EGFR) or ErbB family of receptor tyrosine kinases, is involved in progression of several human cancers and a tight regulation of its expression is crucial. An important mechanism for regulation of ErbB proteins is endocytosis and we recently showed that ErbB3, contrary to other ErbB proteins, like EGFR and ErbB2, is constitutively internalized and degraded. Several studies show that protein kinase C (PKC) can regulate the activation, localization and stability of EGFR and ErbB2. Activation of PKC causes their down-regulation from the plasma membrane, but instead of being degraded the receptors accumulate in an endosomal recycling compartment. Since little is known about possible connections between ErbB3 and PKC, we have in the present study investigated effects PKC activity has on ErbB3 stability and intracellular trafficking. While PKC inhibition tends to increase ErbB3 degradation, activation of PKC causes ErbB3 stabilization. The stabilization was not due to inhibited internalization, on the contrary we find that expression of ErbB3 at the plasma membrane is reduced upon PMA-induced PKC activation. However, while endocytosed ErbB3 under normal conditions and upon PKC inhibition is found in early endosomal antigen 1 (EEA1) positive early endosomes and lysosomal-associated membrane protein 1 (LAMP1) positive late endosomes/lysosomes, indicating that it follows the classic degradative pathway, ErbB3 localizes to EEA1 and LAMP1 negative compartments upon PMA-induced activation of PKC. Altogether this shows that PKC regulates the stability of ErbB3, and knockdown experiments show that PKCδ is essential in this process. A likely explanation is that PKC regulates endosomal sorting of ErbB3 and that activated PKC sorts ErbB3 away from the degradative pathway.

Protein kinase C mediated internalization of ErbB2 is independent of clathrin, ubiquitination and Hsp90 dissociation.

Overexpression of ErbB2 is frequent in cancer and understanding the mechanisms which regulate its expression is important. ErbB2 is considered endocytosis resistant. It has no identified ligand, but upon heterodimerization it is a potent mediator of proliferative signaling. A recent study established a role for protein kinase C (PKC) in internalization and recycling of ErbB2. We have now further investigated the molecular mechanisms involved in PKC-mediated downregulation of ErbB2. We confirm that PMA-induced PKC activation causes ErbB2 internalization, but while the Hsp90 inhibitor 17-AAG induced ErbB2 degradation, PMA had no such effect. When combined with 17-AAG, PMA had additive effect on ErbB2 internalization indicating that Hsp90 inhibition and PKC activation induce internalization by alternative mechanisms. We confirm that while 17-AAG-induced internalization was clathrin-mediated, PMA-induced internalization was clathrin independent. This difference may be explained by while both 17-AAG and PMA reduced the constitutive tyrosine phosphorylation of ErbB2, only 17-AAG induced Hsp90 dissociation, Hsp70 recruitment and ubiquitination of ErbB2. Importantly, since PMA induced internalization of ErbB2, but not dissociation of Hsp90, Hsp90 does not per se retain ErbB2 at the plasma membrane. The morphology of the compartment into which receptors are sorted upon PKC activation has not previously been identified. By immuno-electron microscopy, we show that PMA sorts ErbB2 into a complex tubulovesicular or cisternal organelle resembling a previously described endocytic recycling compartment.

Radio-Frequency-Controlled Urea Dosing for NH3-SCR Catalysts: NH3 Storage Influence to Catalyst Performance under Transient Conditions.

Current developments in exhaust gas aftertreatment led to a huge mistrust in diesel driven passenger cars due to their NOx emissions being too high. The selective catalytic reduction (SCR) with ammonia (NH3) as reducing agent is the only approach today with the capability to meet upcoming emission limits. Therefore, the radio-frequency-based (RF) catalyst state determination to monitor the NH3 loading on SCR catalysts has a huge potential in emission reduction. Recent work on this topic proved the basic capability of this technique under realistic conditions on an engine test bench. In these studies, an RF system calibration for the serial type SCR catalyst Cu-SSZ-13 was developed and different approaches for a temperature dependent NH3 storage were determined. This paper continues this work and uses a fully calibrated RF-SCR system under transient conditions to compare different directly measured and controlled NH3 storage levels, and NH3 target curves. It could be clearly demonstrated that the right NH3 target curve, together with a direct control on the desired level by the RF system, is able to operate the SCR system with the maximum possible NOx conversion efficiency and without NH3 slip.

ErbB3 interacts with Hrs and is sorted to lysosomes for degradation.

The ErbB family of receptor tyrosine kinases mediates activation of a wide network of signaling pathways. ErbB3 has weak kinase activity, but its six docking sites for the p85 subunit of phosphoinositide 3-kinase make it an important contributor to proliferative signaling. ErbB3 has a relatively short half-life but the exact mechanisms controlling its turnover are unclear as contradictory reports exist. ErbB-mediated signaling is, however, negatively regulated by endocytosis of the receptors, followed by either recycling or degradation. Our previous studies showed that ErbB3 can be endocytosed and degraded in the absence of its ligand heregulin. However, binding of heregulin increased the degradation rate. In the current study we have investigated in more detail the trafficking and degradation of ErbB3 in the presence or absence of heregulin. We report that ErbB3 is internalized by clathrin-mediated endocytosis both in the presence and absence of heregulin. Moreover, we show that both proteasomal and lysosomal activity regulate ErbB3 degradation. Although steady-state expression of ErbB3 is regulated by proteasomal activity to a large extent, probably linked to a previously identified ER-localized quantity control, the results indicate that internalization, both constitutive and ligand-induced, causes lysosomal degradation of ErbB3. Furthermore, we show that ErbB3 interacts with the ESCRT-0 subunit Hrs both in the presence and absence of heregulin. This indicates an ESCRT-mediated sorting of ErbB3 to late endosomes and lysosomes, and in line with this we show that impaired ESCRT function leads to an endosomal accumulation of ErbB3.

Radio-Frequency-Based NH3-Selective Catalytic Reduction Catalyst Control: Studies on Temperature Dependency and Humidity Influences.

The upcoming more stringent automotive emission legislations and current developments have promoted new technologies for more precise and reliable catalyst control. For this purpose, radio-frequency-based (RF) catalyst state determination offers the only approach for directly measuring the NH3 loading on selective catalytic reduction (SCR) catalysts and the state of other catalysts and filter systems. Recently, the ability of this technique to directly control the urea dosing on a current NH3 storing zeolite catalyst has been demonstrated on an engine dynamometer for the first time and this paper continues that work. Therefore, a well-known serial-type and zeolite-based SCR catalyst (Cu-SSZ-13) was investigated under deliberately chosen high space velocities. At first, the full functionality of the RF system with Cu-SSZ-13 as sample was tested successfully. By direct RF-based NH3 storage control, the influence of the storage degree on the catalyst performance, i.e., on NOx conversion and NH3 slip, was investigated in a temperature range between 250 and 400 °C. For each operation point, an ideal and a critical NH3 storage degree was found and analyzed in the whole temperature range. Based on the data of all experimental runs, temperature dependent calibration functions were developed as a basis for upcoming tests under transient conditions. Additionally, the influence of exhaust humidity was observed with special focus on cold start water and its effects to the RF signals.

Interaction with epsin 1 regulates the constitutive clathrin-dependent internalization of ErbB3.

BACKGROUND: In contrast to other members of the EGF receptor family, ErbB3 is constitutively internalized in a clathrin-dependent manner. Previous studies have shown that ErbB3 does not interact with the coated pit localized adaptor complex 2 (AP-2), and that ErbB3 lacks two AP-2 interacting internalization signals identified in the EGF receptor. Several other clathrin-associated sorting proteins which may recruit cargo into coated pits have, however, been identified, and the study was performed to identify adaptors needed for constitutive internalization of ErbB3. METHODS: A high-throughput siRNA screen was used to identify adaptor proteins needed for internalization of ErbB3. Upon knock-down of candidate proteins internalization of ErbB3 was identified using an antibody-based internalization assay combined with automatic fluorescence microscopy. RESULTS: Among 29 candidates only knock-down of epsin 1 turned out to inhibit ErbB3. Epsin 1 has ubiquitin interacting motifs (UIMs) and we show that ErbB3 interacts with an epsin 1 deletion mutant containing these UIMs. In support of an ErbB3-epsin 1 UIM dependent interaction, we show that ErbB3 is constitutively ubiquitinated, but that both ubiquitination and the ErbB3-epsin 1 interaction increase upon ligand binding. CONCLUSION: Altogether the results are consistent with a model whereby both constitutive and ligand-induced internalization of ErbB3 are regulated through interaction with epsin 1. GENERAL SIGNIFICANCE: Internalization is an important regulator of growth factor receptor mediated signaling and the current study identify mechanisms regulating plasma membrane turnover of ErbB3.

Correlating the Integral Sensing Properties of Zeolites with Molecular Processes by Combining Broadband Impedance and DRIFT Spectroscopy--A New Approach for Bridging the Scales.

Zeolites have been found to be promising sensor materials for a variety of gas molecules such as NH3, NOx, hydrocarbons, etc. The sensing effect results from the interaction of the adsorbed gas molecules with mobile cations, which are non-covalently bound to the zeolite lattice. The mobility of the cations can be accessed by electrical low-frequency (LF; mHz to MHz) and high-frequency (HF; GHz) impedance measurements. Recent developments allow in situ monitoring of catalytic reactions on proton-conducting zeolites used as catalysts. The combination of such in situ impedance measurements with diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS), which was applied to monitor the selective catalytic reduction of nitrogen oxides (DeNOx-SCR), not only improves our understanding of the sensing properties of zeolite catalysts from integral electric signal to molecular processes, but also bridges the length scales being studied, from centimeters to nanometers. In this work, recent developments of zeolite-based, impedimetric sensors for automotive exhaust gases, in particular NH3, are summarized. The electrical response to NH3 obtained from LF impedance measurements will be compared with that from HF impedance measurements, and correlated with the infrared spectroscopic characteristics obtained from the DRIFTS studies of molecules involved in the catalytic conversion. The future perspectives, which arise from the combination of these methods, will be discussed.

Microwave-Based Oxidation State and Soot Loading Determination on Gasoline Particulate Filters with Three-Way Catalyst Coating for Homogenously Operated Gasoline Engines.

Recently, a novel method emerged to determine the oxygen storage degree of three way catalysts (TWC) by a microwave-based method. Up to now, this method has been investigated only in lab-scale reactors or under steady state conditions. This work expands those initial studies. A TWC-coated gasoline particulate filter was investigated in a dynamic engine test bench simulating a typical European driving cycle (NEDC). It could be shown that both the oxygen storage degree and the soot loading can be monitored directly, but not simultaneously due to their competitive effects. Under normal driving conditions, no soot accumulation was observed, related to the low raw emissions and the catalytic coating of the filter. For the first time, the quality factor of the cavity resonator in addition to the resonance frequency was used, with the benefit of less cross sensitivity to inconstant temperature and water. Therefore, a temperature dependent calibration of the microwave signal was created and applied to monitor the oxidation state in transient driving cycles. The microwave measurement mirrors the oxidation state determined by lambda probes and can be highly beneficial in start-stop phases (where lambda-probes do not work) and to determine the oxygen storage capacity (OSC) without unnecessary emissions.

A laboratory test setup for in situ measurements of the dielectric properties of catalyst powder samples under reaction conditions by microwave cavity perturbation: set up and initial tests.

The catalytic behavior of zeolite catalysts for the ammonia-based selective catalytic reduction (SCR) of nitrogen oxides (NOX) depends strongly on the type of zeolite material. An essential precondition for SCR is a previous ammonia gas adsorption that occurs on acidic sites of the zeolite. In order to understand and develop SCR active materials, it is crucial to know the amount of sorbed ammonia under reaction conditions. To support classical temperature-programmed desorption (TPD) experiments, a correlation of the dielectric properties with the catalytic properties and the ammonia sorption under reaction conditions appears promising. In this work, a laboratory test setup, which enables direct measurements of the dielectric properties of catalytic powder samples under a defined gas atmosphere and temperature by microwave cavity perturbation, has been developed. Based on previous investigations and computational simulations, a resonator cavity and a heating system were designed, installed and characterized. The resonator cavity is designed to operate in its TM010 mode at 1.2 GHz. The first measurement of the ammonia loading of an H-ZSM-5 zeolite confirmed the operating performance of the test setup at constant temperatures of up to 300 °C. It showed how both real and imaginary parts of the relative complex permittivity are strongly correlated with the mass of stored ammonia.

Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.

OBJECTIVE: Oral P2Y12 platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y12 platelet receptor inhibitors before surgery. Cangrelor, a short-acting, reversible, intravenously administered P2Y12 platelet inhibitor is effective in achieving appropriate platelet inhibition in patients who are awaiting coronary artery bypass grafting (CABG) and require P2Y12 inhibition. The objective of this study was to assess the effects of preoperative cangrelor on the incidence of perioperative complications, which are currently unknown. METHODS: Patients (n = 210) requiring preoperative clinical administration of thienopyridine therapy were randomized in a multicenter, double-blinded study to receive cangrelor or placebo while awaiting CABG after discontinuation of the thienopyridine. Optimal platelet reactivity, which was defined as <240 P2Y12 platelet reaction units, was measured with serial point-of-care testing (VerifyNow). Pre- and postoperative outcomes, bleeding values, and transfusion rates were compared. To quantify potential risk factors for bleeding, we developed a multivariate logistic model. RESULTS: The differences between the groups in bleeding and perioperative transfusion rates were not significantly different. The rate of CABG-related bleeding was 11.8% (12/102) in cangrelor-treated patients and 10.4% (10/96) in the placebo group (P = .763). Transfusion rates for the groups were similar. Serious postoperative adverse events for the cangrelor and placebo groups were 7.8% (8/102) and 5.2% (5/96), respectively (P = .454). CONCLUSIONS: Compared with placebo, bridging patients with cangrelor prior to CABG effectively maintains platelet inhibition without increasing post-CABG complications, including bleeding and the need for transfusions. These data suggest cangrelor treatment is a potential strategy for bridging patients requiring P2Y12 receptor inhibition while they await surgery.

Rationale and design of the Cangrelor versus standard therapy to acHieve optimal Management of Platelet InhibitiON PHOENIX trial.

BACKGROUND: Despite robust efficacy in the reduction of ischemic events in patients who require percutaneous coronary intervention (PCI), current P2Y(12) inhibitors have limitations. In particular, they require hours to be effective, and they can only be administered orally. Cangrelor is an intravenous, potent, and reversible P2Y(12) inhibitor with fast onset and offset of action. We designed CHAMPION PHOENIX to evaluate the efficacy and safety of cangrelor in patients with atherosclerosis undergoing PCI. TRIAL DESIGN: The CHAMPION PHOENIX is a randomized, double-blind, double-dummy, superiority trial comparing cangrelor with clopidogrel standard of care in approximately 10,900 patients who have not previously received a P2Y(12) inhibitor and who require PCI, including patients with stable angina and with acute coronary syndromes (with or without ST-segment elevation). The primary objective of the study is to demonstrate that cangrelor will reduce the incidence of the composite of death, myocardial infarction (MI), ischemia-driven revascularization, or stent thrombosis in the 48 hours after randomization compared with clopidogrel without excessive periprocedural bleeding. The key secondary objective is to demonstrate that cangrelor will reduce the incidence of stent thrombosis. Myocardial infarction will be defined according to the universal MI definition, adapting the definition of PCI-related (type 4a) MI. Bleeding will be assessed according to the thrombolysis in myocardial infarction, GUSTO, and Bleeding Academic Research Consortium (BARC) scales. CONCLUSION: The CHAMPION PHOENIX may establish the role of cangrelor in the care of patients who require PCI across the spectrum of stable and unstable coronary diseases in the setting of current treatment strategies.

Decreased intermediate term patency of automated proximal anastomoses evaluated by sequential ultrafast CT.

OBJECTIVE: The Symmetrytrade mark aortic connector creates proximal anastomoses of saphenous vein grafts using a nitinol implant. The device avoids partial clamping and thus possibly reduces neurologic complications. To evaluate graft patency, a single surgeon randomised study was performed in our institution. METHODS: Seventy-seven patients were randomised either to automated proximal anastomoses (group I, n=39, 61 vein grafts connected using the aortic connector, 47 as single, 15 as sequential bypasses) or controls (group II, n=38, 62 proximal anastomoses handsewn, 46 as single, 16 as sequential bypasses). Ultrafast CT-scans were performed on postoperative day 5 in 34 patients of group I and 16 patients of group II to evaluate early graft patency. Intermediate term patency was evaluated with ultrafast CT-scan in 30 patients of group I (46 grafts) and 25 patients of group II (39 grafts) 1 year after the operation. RESULTS: Two early graft occlusions were detected in group I (3.8%). In group II all evaluated grafts were patent 5 days after surgery. 11.4 months after surgery, seven out of 46 grafts were found occluded (15.2%) in group I. In the control group, only one occlusion was detected (2.6%). CONCLUSIONS: We observed a trend towards an increased occlusion rate 1 year after surgery with automated connector devices. For evaluation of long-term patency larger patient groups have to be evaluated. Other benefits of these devices have to be proven to promote their clinical application.

MDCT of the proximal anastomoses created by nitinol implants in coronary artery bypass grafting: a retrospective two-observer evaluation.

The purpose of this study was to investigate the proximal anastomosis of CABG grafts created by a nitinol aortic connector. After receiving CABG, 33 patients underwent CT examination of the heart. On the same patients, CT was performed on postoperative day 5 (4-row CT, group A) and again 1 year thereafter (16-row CT, group B). Twenty-three ACVB to RCX and 27 ACVB to RCA grafts were included. Every anastomosis was reviewed under different reformations (MIP, MPR and VRT). Interobserver correlation was determined. Five days postoperatively, 48/50 anastomoses were classified as patent. One year postoperatively, 42/50 anastomoses were classified as patent. In both groups, the aortic connector could be visualized with good quality: 1.82+/-1.10 (group A) and 1.93+/-1.22 (group B) for ACVB to RCA, similar results for ACVB to RCX grafts (MPR). Image quality at the aortic connector site did not display a significant difference for any reformation between groups (P>0.05). Within groups, MPR displayed better visualization than MIP and VRT (P<0.05). In the presence of metal implants, CT provides reliable data in evaluation of the proximal anastomosis. Sixteen-row CT does not bring a significant benefit to image quality. MPR displayed the best visualization within both groups.

Automatic connector devices for proximal anastomoses do not decrease embolic debris compared with conventional anastomoses in CABG.

OBJECTIVE: Emboli generated during cardiac surgery have been associated with aortic clamping and manipulation. Proximal anastomotic devices are thought to be less traumatic by eliminating partial clamping, potentially resulting in fewer adverse outcomes. Intra-aortic filtration has been shown to effectively capture particulate debris. We compared the amount of debris released using intra-aortic filtration and the clinical outcomes between conventionally handsewn and automated proximal anastomoses. METHODS: Seventy-seven patients undergoing primary coronary artery bypass grafting with cardiopulmonary bypass were enrolled in a prospective randomized study. Patients were assigned to the anastomotic device Group I (Symmetry Aortic Connector, n = 39) or the conventional handsewn anastomosis control Group II (n = 38). Proximal anastomoses were performed before cardiopulmonary bypass in both groups. Intra-aortic Filter 1 (EMBOL-X)was deployed prior to partial clamping or puncturing the aorta for device application and removed after the proximal anastomosis was completed. Prior to cross-clamp removal, a second filter was inserted (Filter 2). A core laboratory performed quantitative and histologic analyses of the debris captured. Clinical outcomes included adverse events, neurocognitive test scores, graft patency, and mortality. RESULTS: Preoperative variables and risk factors were not significantly different between Groups I and II (EuroSCORE 3.9+/-2.6 vs. 4.2+/-2.5). Filter analyses showed no significant difference between Groups I and II in Filter 1 or 2 for either surface area of particles or total number of particles (P> 0.005). There was a significant decrease between Filters 1 and 2 in both Groups for surface area of particles (Group I: 18.5+/-23.8 mm2 vs. 10.7+/-16.3 mm2, P = 0.017; Group II: 15.0+/-15.4 mm2 vs. 6.9+/-.6.5 mm2, P = 0.004), and for total number of particles in Group II (8.6+/-3.7 vs. 7.1+/-2.4, P = 0.023). No significant differences were observed between Group I (device) and Group II (control) outcomes for myocardial infarction, neurocognitive deficit, stroke, length of stay, graft occlusion, or mortality. CONCLUSIONS: The application of proximal aortic connectors without partial clamping does not reduce particulate emboli or affect clinical outcomes compared with conventional anastomoses. Cross-clamping during cardiopulmonary bypass produces less particulate debris than conventional or automated proximal anastomoses performed off-pump, suggesting a major source of emboli is the anastomotic process.

Optimal number of image slices for reliable measurement of left ventricular volumes and ejection fraction by three-dimensional transesophageal echocardiography.

PURPOSE: Quantification of the left ventricular (LV) volume by three-dimensional echocardiography is accurate but time-consuming. To shorten the time required, we sought to determine the minimum number of image planes necessary to measure LV volume reliably. METHODS: We analyzed transesophageal three-dimensional echocardiographic LV data obtained by the rotational scanning method in 16 patients: 11 had ischemic heart disease, and 5 had dilated cardiomyopathy. LV volumes were calculated from 6, 10, and 30 short-axis images using the disk-summation method and from 2, 4, 6, 10, 20, and 30 longitudinal images using the new average rotation method. RESULTS: LV volume varied less with the average rotation method than with the disk-summation method. The 95% limit of agreement between the 30-image and 6-image methods was 0.3% ± 3.7% for the average rotation method, whereas it was -2.0% ± 6.9% for the disk-summation method. The time required for analysis decreased from 12.5 ± 2.8 min with the 30-image method to only 3.3 ± 0.5 min for the 6-image method. CONCLUSIONS: Measurement of six longitudinal images provided reliable LV volume data, even in patients with enlarged or deformed left ventricles. The short measurement time supports the use of three-dimensional echocardiographic LV volume measurement in the clinical setting.

Ultrafast computed tomography for quality control of automated proximal anastomoses.

BACKGROUND: The Symmetry aortic connector uses a nitinol implant to create proximal anastomoses with saphenous vein grafts. Multiple detector-row cardiac computed tomography (MDCT) is used as a noninvasive method of quality control at our institution. METHODS: In 50 elective coronary artery bypass grafting patients who participated in a randomized trial comparing automated with conventionally hand-sewn proximal anastomoses, MDC T was performed on postoperative day 5. Fifty-three automated Symmetry anastomoses were created in 34 patients (group 1). Twenty-five conventionally hand-sewn anastomoses created in 16 patients served as controls (group 2). Graft patency and the presence or absence of high-grade stenosis at the proximal anastomotic site were evaluated. RESULTS: In group 1, 2 (3.8%) of the grafts were found occluded at MDCT or coronary angiography, and no further relevant stenosis was observed. In group 2, at postoperative MDCT all grafts were found patent without significant narrowing of the proximal anastomotic site. CONCLUSIONS: The feasibility of proximal anastomoses using the Symmetry device has been reported. Patency control with invasive angiography has been performed by other groups. With MDCT, noninvasive evaluation of proximal anastomotic quality and graft patency is possible, even if nitinol is implanted.

The Heartflo device for distal coronary anastomoses: clinical experiences in 60 patients.

BACKGROUND: The Heartflo anastomotic device automates the suturing process with simultaneous delivery of 10 standard polypropylene sutures through the graft and the coronary vessel wall to construct the anastomosis. We performed clinical testing in 60 patients undergoing coronary artery bypass grafting. METHODS: One automated distal coronary anastomosis was initially placed in each patient, the other anastomoses were created with standard running sutures. After a "flat foot"-shaped prototype was deployed in 30 patients (group I), the design of the foot was modified and deployment of the new device performed in the next 30 patients (group II). RESULTS: In group I, automated anastomoses were completed in 16 patients (53%) using 1.7 +/- 1 additional stitches. In 26 group II patients (86%), a hemostatic anastomosis using 1.2 +/- 1 additional stitches was achieved. Anastomoses were completed in 19.0 +/- 3 minutes in group I and in 15.6 +/- 2 minutes in group II. CONCLUSIONS: We have shown the feasability of coronary anastomoses using the Heartflo device. The modified version improved tissue capture, resulting in a higher rate of completed anastomoses. Because anastomotic time is still prolonged, an easier suture management is mandatory in the next developmental step.