Endovascular treatment of post-laparoscopic pancreatectomy splenic arteriovenous fistula with splenic vein aneurysm.

Splenic arteriovenous fistulas (SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography (CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication.

Relationship between left ventricular function and wall motion synchrony in heart failure assessed by ECG-gated myocardial perfusion SPECT.

OBJECTIVE: To confirm the relationship between left ventricular (LV) function and wall motion synchrony, and to identify the difference of synchrony between an ischemic heart disease (IHD) patient group and other heart disease (OHD) patient group among classified groups in heart failure, systolic, and diastolic parameters were compared using electrocardiograph-gated single-photon emission computed tomography. METHODS AND RESULTS: Twenty IHD and 30 OHD patient groups, comprised New York Heart Association functional class I-III (IHD1-3 and OHD1-3), and 15 controls were examined. The LV functions (ejection fraction, EF; peak-filling rate, PFR) and synchrony, which was estimated from the time lag between the earliest and latest regional systolic or diastolic temporal parameters (maximum difference of regional time to end-systole, MD-TES, or maximum difference of regional time to peak filling, MD-TPF), were compared. The LV function correlated with its synchrony in IHD and OHD (EF vs. MD-TES: r = -0.86, P = 1.3 x 10(-6) in IHD and r = -0.69, P = 2.8 x 10(-5) in OHD. PFR versus MD-TPF: r = -0.67, P < 0.002 in IHD and r = -0.63, P < 0.0002 in OHD). Dyssynchronous normal EF was observed in three IHD (15%) and six OHD (20%). Dyssynchronous normal PFR was observed in six IHD (30%) and six OHD (20%). MD-TES was significantly smaller in control group (CG) than in IHD3 and OHD3 (P < 0.005), and in IHD1 than in IHD3 and OHD3 (P < 0.05). MD-TPF was significantly smaller in CG than in IHD2, IHD3, and OHD3 (P < 0.05). However, there was no significant difference between LV synchrony in IHD and OHD, or among LV synchrony of the same functional classes between these two groups. CONCLUSIONS: This study confirms that LV function is correlated with wall motion synchrony. No statistically significant difference was confirmed in wall motion synchrony between IHD and OHD. However, dyssynchrony appears in the patients without apparent global LV dysfunction. This feature may facilitate identification of synchronous disorder in HF patients with preserved global LV function. It is expected that detection of such a disorder may lead to the initiation of appropriate treatments for early stage HF and prevent its progression.

Regional left-ventricular diastolic wall motion assessed by a new program for ECG-gated myocardial perfusion SPECT in early-stage heart failure.

BACKGROUND: We developed a new program for gated single-photon emission computed tomography to estimate regional left-ventricular (LV) wall motion. We classified and graded diastolic wall motion, and compared its grading with global LV functions. METHODS AND RESULTS: Forty New York Heart Association functional class I (NYHA class I) patients and 15 control subjects were examined. The global time to peak filling and the regional diastolic wall motion synchrony, as estimated by the time lag between the earliest and latest regional peak filling, were evaluated. Using the control group's mean + 2 SD, diastolic wall motions were classified into four subsets: globally normal and regionally synchronous, globally normal but regionally dyssynchronous, globally prolonged and regionally dyssynchronous, and globally prolonged but regionally synchronous. These subsets were graded 0 to 3, respectively. Grade 0 was defined as normal. Grading was compared with global LV functions. Although 67.5% of patients demonstrated abnormal motion, the global diastolic parameter less frequently detected an abnormality (22.5% to 32.5%). Grading correlated with the first-third filling fraction (Spearman's rank correlation coefficient [rs] = -0.74, P = 3.8 x 10(-6)) and the first-third filling rate (rs = -0.49, P < .005). CONCLUSIONS: Regional diastolic wall motion abnormality was frequently detected even in early-stage heart failure. Grading reflected early diastolic dysfunction.

Relationships among regional diastolic impairment, elongation of global time to peak filling rate, and global diastolic function using ECG-gated myocardial perfusion SPECT in heart failure.

OBJECTIVE: The relationships among regional diastolic impairment, the elongation of global time to peak filling rate (g-TPF), and global diastolic function were examined by a novel program using electrocardiography-gated myocardial perfusion single-photon emission computed tomography (SPECT) (GMPS) in heart failure (HF). METHODS: Fifteen control subjects and 70 HF patients, New York Heart Association functional classification I (N-1) 41 cases, classification II (N-II) 15 cases, and classification III (N-III) 14 cases, were examined by GMPS. Using the reference mean +2 SD (standard deviation) of g-TPF derived from control group (CG), HF patients were divided into a normal g-TPF group (NG) and elongated g-TPF group (EG). The distributions of g-TPF and regional (r-) TPF were estimated by histograms. The extension of regional diastolic impairment was estimated by the number of r-TPF elongated segments (NES). RESULTS: g-TPF and r-TPF mainly distributed from 100 ms to 220 ms and demonstrated a peak around 150 ms in CG and NG. g-TPF distributed from 240 ms to 560 ms, but r-TPF distributed from 90 ms to 690 ms and demonstrated two peaks around 150 ms and 350 ms in EG. NES significantly correlated with g-TPF (r=0.79, P=6x10(-10) in N-I; r=0.69 and P<0.005 in N-II; r=0.89, P=2x10(-5) in N-III). NES negatively correlated with first third filling fraction (1/3FF) (r=-0.83, P=3x10(-11) in N-I; r=-0.72, P<0.0005 in N-II) and first third filling rate (1/3FR) (r=-0.49, P=0.002 in N-I; r=-0.52, P=0.002 in N-II; r=-0.81, P<0.0005 in N-III). g-TPF significantly correlated with 1/3FF (r=-0.67, P=1.5x10(-6) in N-I; r=-0.69, P<0.005 in N-II) and 1/3FR (r=-0.41, P<0.01 in N-I; r=-0.69, P<0.01 in N-III). CONCLUSIONS: The development of regional early diastolic impairment makes g-TPF elongation and induces global dysfunction in early diastole.