Beat-to-beat repolarisation variability in body surface electrocardiograms.

The repolarisation variability in body surface electrocardiograms has been evaluated by beat-to-beat QT interval variability. Interpolated R-peak time and template T-wave matching algorithms were used to determine the characteristic time points of the R-wave and T-wave, respectively. The T-wave time can be determined accurately and robustly by searching for the best match between a template T-wave and measured T-waves. The authors studied 5 min multichannel ECG recordings (35 channels) measured in 20 healthy subjects. A QT variability of 2.24 +/- 0.79 ms was obtained (1.15 +/- 0.30 ms, if linear detrend was used), which is significantly lower than that reported in several other studies. To explore this discrepancy, the sensitivity of the template matching algorithm to periodic and random noise on the ECG was estimated by a simulation study. The results showed that the repolarisation variability depended on selection of the appropriate lead, the signal-to-noise ratio and the effectiveness of baseline correction. Lead II of a standard 12-lead ECG is a reasonable choice for QT variability analysis; however, precordial leads V3-V6 could be better with regard to the amplitude of the T-wave. Poor signal-to-noise ratios can lead to unrealistic values for repolarisation variability.

Beat-to-beat QT interval variability before and after cardiac surgery.

Non-uniform recovery of excitability may be essential in triggering malignant ventricular tachycardia after cardiac surgery. Thirty-five channels ECG was recorded for 6 min in 27 patients before and after heart surgery and in 20 control subjects. Off-line analysis was performed. RR interval duration, RR SD, QT SD and power spectra of RR variability were computed from 256 s stable RR and QT interval series. When compared to controls, patients had decreased RR SD and increased QT SD before surgery (p<0.002 and p<0.0005, respectively); RR SD further decreased and QT SD increased after the surgery (p<0.0001 and p<0.0002, respectively). Increase of QT variability and decrease of RR variability after cardiac surgery may reflect disrupted electrophysiological stability of the myocardium and thus electrophysiological substrate for triggering malignant arrhythmia.

Visualization of computer simulated heart temperature during topical cooling.

A local hypothermia is often used during cardiac operations to slow down the tissue metabolism. The heart is cooled down with cold cardioplegic solution. Sometimes even the topical cooling with or without ice slush is used. Different heart models have been used earlier to simulate heart temperature distribution, but the resolution of the model has always been limited by the speed of the computer. We used the computer heart model derived from Visible Human Dataset with the spatial resolution of 1 mm. In this article, the step-by-step generation of 3D computer heart model is described. The heat transfer was modeled by a diffusion equation that was discretised in space and time and solved by a parallel algorithm. Finally, the cooling of heart during an operation, with and without topical ice slush, was simulated on a cluster of 9 PC-based computers, which assured sufficient computing power. The simulated results are presented as images of cross sections in different planes with temperatures shown by different colors.

Imaging of power spectral heart rate variability regarding subject position.

Heart rate variability (HRV) and its assessment using power spectral analysis revealed a possibility to quantify the characteristics of autonomic nervous system, related cardiovascular status and sympathovagal interaction. This study was designed to assess vagal tone in supine and right recumbent position in normal healthy subjects as many maneuvers that potentially increase vagal tone have been sought both in normal subjects and in patients with heart disease. Seven subjects, four male and three female, aged 20-27 years were enrolled in the study. To evaluate the time-dependent stability of short term ECG recordings, every subject participated in six ECG recording sessions (three successive morning and three successive afternoon measurements). Heart rate power spectra were obtained by off-line Fast Fourier Transform analysis. The frequency domain measures, namely very low frequency power (VLF), low frequency power (LF), high frequency power (HF) and total power were determined, and their normalized correlates used in the comparison between supine and right recumbent position. Normalized high frequency (nHF) indicated cardiac vagal activity, normalized low frequency power indexed sympathetic modulated activity, low frequency power/high frequency power ratio (LF/HF) represented sympathovagal balance. The results showed remarkable variation among successive day measurements as well as among study subjects. However, several types of response to adopting right recumbent position could be identified. In the first, in right recumbent position the values of nHF, indicator of vagal activity did not differ appreciably from the values measured in supine position. Secondly, there was a tendency towards higher nHF values and lower LF/HF power ratio in supine position. We were not able to notice any appreciable difference among morning and afternoon short-term measurements. Finally, our results do not suggest higher vagal modulation when lying in right recumbent position.

Intraoperative localization of retained metallic fragments in missile wounds.

OBJECTIVE: Patients with missile wounds often retain fragments of different materials within their bodies. They are usually of no clinical consequence, but sometimes they can cause complications. Furthermore, the presence of metallic objects is a contraindication for magnetic resonance imaging. Therefore, the fragments should be removed whenever possible. A new metal detector designed for intraoperative use and a method that allows exact localization and removal of conductive fragments is presented. METHODS: Practical experience shows that the volume of missile fragments varies by a factor of 1,000. Different materials can be detected and located at distances usually not greater than 50 mm. An adaptive electronic amplifier was used in this instrument to locate missile fragments of different sizes and magnetic properties at different distances. Environmental disturbances such as electrical wires and external magnetic fields, and the limited dynamics of human perception, were compensated for by the spatial selectivity and adaptive sensitivity of the instrument. The source of the alternating magnetic field was placed in a hand-held probe connected to the instrument, with which small changes in the magnetic field were detected and exploited for the location of metallic fragments. RESULTS: The boundaries of detectability and localizability by the device have been determined for different missile fragments to demonstrate the diagnostic feasibility and limitations of the method. CONCLUSION: The successful use of the method, in cases where other imaging procedures are either not available or ineffective, is demonstrated by two cases of patients with gunshot wounds.

Spatial resolution of epicardial pace mapping using body surface potentials.

Body surface potential maps (BSPMs) recorded during pace mapping provide an important non-invasive means for identifying local cardiac events; recent clinical studies demonstrated that endocardial pacing sites can be resolved within less than 10 mm. We sought to determine whether similar spatial resolution could be achieved during epicardial pacing. Four patients who were undergoing either heart valve replacement (one), aortocoronary bypass graft (one), or both (two) were studied. In each patient, a pair of epicardial electrodes was placed intraoperatively at the middle aspect of the right ventricular free wall. The distance between the neighbouring electrodes was 10 mm. Five days after the surgery, ECGs were acquired from 35 leads during pacing from each epicardial electrode. We determined the distributions of QRS integrals (the net area under the ECG signal) and compared integrals corresponding to pacing from each of the adjacent electrodes using statistical indices. Student's t-test was applied to these indices and in all the patients revealed that differences in distributions of QRS integral maps were statistically significant (p < 0.01). Results of our study indicate that the non-invasive acquisition of body surface ECGs could resolve epicardial breakthrough sites within 10 mm, which may be useful in facilitating therapeutic ablations in patients with ventricular tachycardias.

Measurement of porcine heart temperatures.

During cardiac surgery local hypothermia of the heart is used to slow down cellular metabolism. It has been shown by computer simulation that heart muscle is not uniformly cooled to the desired temperatures. The aim of our work was to find out a way for measuring the temperatures of the ventricular wall and the septum with +/-0.1 degrees C accuracy. The measurement protocol should be applicable during operations on the human heart, during which disturbing factors should be minimized. We have tested the protocol and the equipment on porcine hearts. Two types of probes were tested, the contact-probe, which can be attached to the heart-wall surface, and the needle-probe, which can be inserted into the heart tissue. Before experiments the probes were calibrated and their heat transfer characteristics determined. We conclude that the probes and the protocol are suitable for studying the effects of cardioplegia, and for checking the results previously obtained by computer simulation.

Computer simulation and spatial modelling in heart surgery.

In this work, three dimensional modelling and computer simulation of heat transfer on generally-shaped nonhomogeneous bodies is proposed and described. The complexity of the calculation is estimated and the potential use of high performance parallel computers is discussed. The method is focused on applications in medicine. As an example, a numerical algorithm for the parallel computer simulation of heart cooling procedures during surgery is presented. On the basis of simulated results, two different methods of cooling are compared.

Loss of endothelium mediated vascular relaxation as a response to various clamping pressure. Part I. A pharmacological study.

BACKGROUND: The contraction/relaxation response of thoracic aortal rings clamped with two clamping pressures to KCl, noradrenaline and carbachol was studied. METHODS: Clamp A had the tip pressure PA = 0.60 N/mm2 and clamp B PB = 5.16 N/mm2. In fifteen Wistar albino rats, weighing 328 +/- 19 g (mean +/- SD) the thoracic aorta was occluded for 15 minutes and then three vascular rings (2 mm wide) were excised. The proximal unclamped ring served as a control. From distal rings the diameter of the aorta was calculated from their circumference 1.61 +/- 0.01 mm (n = 15, dmin = 1.51 mm, dmax = 1.70 mm). The rings were challenged with cumulative additions of KCl (10-80 mmol/l) to measure the contraction. Then cumulative relaxation to carbachol (0.01-100 mumol/l) as a response to noradrenaline precontraction (0.1 mumol/l) was determined. RESULTS: A significant loss (p < 0.05) of vascular relaxation in all clamped rings (clamped with PA and PB clamping pressures) was seen. No significant differences (p > 0.05) were observed for contraction between clamped and control rings clamped with clamp A, however the rings clamped with clamp B showed a significant reduction in contraction (p < 0.05). No significant differences were seen from control rings between groups A and B (p > 0.05), or from clamped rings between groups A and B (p > 0.05) for both the contraction and relaxation part of experiments. CONCLUSIONS: Endothelial vascular layers are much more susceptible to pressure injuries than was previously believed.

Loss of endothelium mediated vascular relaxation as a response to various clamping pressures. Part II. Direct measurements of clamping pressures and scanning electron microscope study.

BACKGROUND: We used novel equipment for measuring the direct tip pressure (P) of a clamp arm on the vessel wall and studied the relationship between endothelial injuries and various clamping pressures. METHODS: A strain gauge was applied to the surgical clamp arm and connected via amplifier to a 12-bit analogue-digital converter on a PC--MSDOS computer. In the on-line in vivo measurements on rat thoracic aorta a momentary peak clamping pressure (MPCP) as well as the lower stationary clamping pressure (SCP) was defined. Clamping forces of two clamps commonly used in cardiovascular microsurgery were tested in the experiment on rat thoracic aortas: clamp A had the tip pressure p = 0.60 N/mm2 and clamp B p = 5.16 N/mm2. After 15 minutes of occlusion, the thoracic aorta was excised and scanning electron microscopy studies for aortas clamped with clamp A and clamp B were performed. RESULTS: Great endothelial lacerations with complete disruption of the endothelial layer in the rings clamped with the clamp B were seen, but no disruption in rings clamped with clamp A. CONCLUSIONS: The clamping vessel wall injuries, particularly in endothelial layers, depend on the momentary peak clamping pressure as well on the lower stationary clamping pressure.

Direct measurement of clamping forces in cardiovascular surgery.

Equipment for measuring the direct tip force of a clamp arm on the vessel wall is designed as an adjustable surgical clamp with strain gauges applied and connected via an amplifier to a computer-based data acquisition system. A mechanical model that incorporates the resistance of tissue against momentary deformations is developed to analyse and justify measured results. In in vivo experiments on rat thoracic aorta, the minimum occlusion force, stationary clamping force and the momentary peak clamping force are measured and observed as an important cause of damages in the endothelial layer of vascular walls.

Metal implant localizers: frontiers and diagnostic feasibility.

The paper describes and analyses a method for locating metal implants based on the interaction of a conductive object with a weak alternating magnetic field. Theoretical values for the boundary of detectability and the boundary of localability are introduced to show some technical characteristics, the diagnostic feasibility and limitations of the method. Clinical experiences are described in order to compare the theoretical expectations with practical results. Several advantages of the proposed diagnostic method in terms of inexpensive instrumentation, ease of operation and sensitivity are discussed.

Loss of endothelium-mediated vascular relaxation as a response to various clamping pressures.

The contraction/relaxation responses of thoracic aortal rings clamped with two clamping pressures to potassium chloride (KC1), noradrenaline and carbachol were studied using a scanning electron microscope (SEM) to ascertain endothelial lacerations. Clamp A had the tip pressure PA = 0.60 N/mm2 and clamp B PB = 5.16 N/mm2. In 15 Wistar albino rats, weighing 328 +/- 19 g (mean +/- SD), the thoracic aorta was occluded for 15 min and then three vascular rings (2 mm wide) were excised. The proximal unclamped ring served as a control. The aorta diameter was calculated from the circumference of distal rings 1.61 +/- 0.01 mm (n = 15, dmin = 1.51 mm, dmax = 1.70 mm). The rings were challenged with cumulative additions of KC1 (10-80 mmol/l) to measure the contraction. Then cumulative relaxation on the administration of carbachol (0.01-100 mumol/l) as a response to noradrenaline precontraction (0.1 mumol/l) was determined. A significant loss (P < 0.05) of vascular relaxation in all clamped rings (clamped with PA and PB clamping pressures) was seen. No significant differences (P > 0.05) were observed for contraction between clamped and control rings clamped with clamp A, however the rings clamped with clamp B showed significantly reduction of contraction (P < 0.05). No significant differences were seen from control rings between groups A and B (P > 0.05), as well as from clamped rings between groups A and B (P > 0.05) for both the contraction and relaxation parts of the experiments. With SEM, great endothelial lacerations with complete disruption of the endothelial layer in the rings clamped with the clamp B were seen, but no disruption in rings clamped with clamp A. Therefore endothelial vascular layers are much more susceptible to pressure injuries than was previously believed. The clamped vessel wall injuries, particularly in endothelial layers, depend on the momentary peak clamping pressure (MPCP) as well as on the lower stationary clamping pressure (SCP).