The study aimed to investigate the alterations of myocardial deformation responding to long-standing pressure overload and the effects of focal myocardial fibrosis using feature-tracking cardiac magnetic resonance (FT-CMR) in patients with resistant hypertension (RH). Consecutive RH patients were prospectively recruited and underwent CMR at a single institution. FT-CMR analyses based on cine images were applied to measure left ventricular (LV) peak systolic global longitudinal (GLS), radial (GRS), and circumferential strain (GCS). Functional and morphological CMR variables, and late gadolinium enhancement (LGE) imaging were also obtained. A total of 50 RH patients (63 ± 12 years, 32 men) and 18 normotensive controls (57 ± 8 years, 12 men) were studied. RH patients had a higher average systolic blood pressure than controls (166 ± 21 mmHg vs. 116 ± 8 mmHg, p < 0.001) with the intake of 5 ± 1 antihypertensive drugs. RH patients showed increased LV mass index (78 ± 15 g/m2 vs. 61 ± 9 g/m2, p < 0.001), decreased GLS (− 16 ± 3

Purpose To investigate the effects of renal denervation (RDN) on left ventricular (LV) mass, myocardial strain and diastolic function in patients with treatment-resistant arterial hypertension by cardiac magnet resonance imaging on a 12-month follow-up. Materials and methods Sixteen patients (38% female) were examined before and 12 months after RDN. LV morphology and strain were analyzed. Diastolic function was determined by early (EPFR) and atrial peak filling rates (APFR) derived from differential volume–time-curve analysis. Clinical visits included 24-h ambulant blood pressure monitoring (ABPM). Results Twelve months after RDN LV mass decreased from 80 ± 21 g/m 2 to 74 ± 20 g/m 2 ( P < 0.05). Global radial (35 ± 12% vs. 41 ± 10%, P < 0.05) and longitudinal strain improved (− 15 ± 4% vs. − 17 ± 3%, P < 0.05). Global circumferential strain (− 16 ± 5% vs. − 18 ± 4%, P = 0.12) remained unchanged. The parameter of diastolic LV function PFRR (EPFR/APFR) improved following RDN (0.9 ± 0.4 vs. 1.1 ± 0.5, P < 0.05). Individual changes of LV mass were associated with an increase of EPFR ( r = − 0.54, P < 0.05) and a reduction of APFR by trend ( r = 0.45, P = 0.08). Systolic ABPM showed a decrease by trend (152 mmHg vs. 148 mmHg, P = 0.08). Conclusions After RDN we observed a reduction of LV mass, improvement of global strain and diastolic function.

Die therapieresistente arterielle Hypertonie (AHT), definiert als Blutdruckwerte oberhalb des Zielbereichs trotz einer Medikation mit mindestens drei verschiedenen Antihypertensiva einschließlich einem Diuretikum, stellt ein großes Risiko für die hypertone Population dar. Das Ziel dieser Studie war es die Effekte der AHT auf die systolische linksventrikuläre (LV) Funktion mittels myokardialem feature-tracking Kardio-MRT (CMR) zu untersuchen.

Vergleich der Patienten-Strahlendosis bei Bronchialarterienembolisation (BAE) vor und nach Upgrade der angiografischen Bildverarbeitungstechnologie.

In der jüngeren Vergangenheit, wurde die Katheter-Ablation (renale Denervierung, RDN) als vielversprechende Therapieoption bei Patienten mit therapierefraktärem Hypertonus untersucht. Ziel dieser Studie war es die Auswirkungen auf die kardiale Masse und die diastolische Funktion mittels Kardio-MRT (CMR) zu quantifizieren.

Transjugular intrahepatic portosystemic shunt (TIPS) procedure has been used for the treatment of portal hypertension induced due to liver cirrhosis. A small metallic tube called stent graft is inserted during TIPS for rerouting blood flow in the liver. Common complications after TIPS is partial or complete blockage inside or at either ends of the stent graft. This paper presents the design and fabrication of a smart stent graft containing two pressure sensors for detecting blockages occuring after TIPS. The active implant device with pressure sensor is powered wirelessly and it transmits measured pressure data wirelessly to the external monitoring station using inductive coupling. Ferrite inductor antennas are used for wireless power reception and PCB trace antenna is used for wireless data transmission in the implant device. A smart stent graft is fabricated by coating PTFE membrane on the bare stent followed by mounting of the implant devices. The in vivo setup is emulated by placing the smart stent graft inside meat and powering the implant device with wireless inductive telemetry link. Test result shows that implant device can be operated for a wireless range of 4.5 cm using 15 W 2.05 MHz RF power sender.

The optimisation of inductive telemetry link for increasing wireless range of a medical implant device is studied in detail. An active implant device using separate wireless power and data links at 2 MHz and 420 kHz has been fabricated and tested. A test setup consisting of RF power transmitter and data reader hardware has been implemented. Measurement results show that the fabricated device achieved a wireless range of 25 cm.

Purpose: Comparison of radiation doses in patients undergoing angiographic bronchial artery embolization (BAE) before and after a noise reduction imaging technology upgrade. Methods: We performed a retrospective study of 70 patients undergoing BAE. Procedures were performed before (n = 32) and after (n = 38) the technology upgrade containing additional filters and improved image-processing. Cumulative air kerma (AK), cumulative dose area product (DAP), number of exposure frames, total fluoroscopy time and amount of contrast agent were recorded. Mean values were calculated and compared using two-tailed t-tests. DSA image quality was assessed independently by two blinded readers and compared using the Wilcoxon signed-rank test. Results: Using the new technology resulted in a significant reduction of 59% in DAP (149.2 (103.1-279.1) vs. 54.8 (38.2-100.7) Gy* cm(2), p < 0.001) and a significant reduction of 60% for AK (1.3 (0.6-1.9) vs. 0.5 (0.3-0.9) Gy, p < 0.001) in comparison to procedures before the upgrade. There was no significant difference between the number of exposure frames in both groups (251 +/- 181 vs. 254 +/- 133 frames, p= 0.07), time of fluoroscopy (28.8 (18.5-50.4) vs. 28.1 (23.3-38.7) min, p = 0.73), or the amount of contrast agent used (139.5 +/- 70.8 vs. 163.1 +/- 63.1 ml, p= 0.11). No significant difference regarding image quality could be detected (3 (2,3) vs. 3 (2-4), p= 0.64). Conclusions: The new angiographic noise reduction technology significantly decreases the radiation dose during bronchial artery embolization without compromising image quality or increasing time of fluoroscopy or contrast volume.

Objective To compare patient radiation dose in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation before and after an imaging-processing technology upgrade. Methods In our retrospective single-center-study, cumulative air kerma (AK), cumulative dose area product (DAP), total fluoroscopy time and contrast agent were collected from an age- and BMI-matched collective of 108 patients undergoing TIPS implantation. 54 procedures were performed before and 54 after the technology upgrade. Mean values were calculated and compared using two-tailed t-tests. Two blinded, independent readers assessed DSA image quality using a four-rank likert scale and the Wilcoxcon test. Results The new technology demonstrated a significant reduction of 57% of mean DAP (402.8 vs. 173.3 Gycm2, p < 0.001) and a significant reduction of 58% of mean AK (1.7 vs. 0.7 Gy, p < 0.001) compared to the precursor technology. Time of fluoroscopy (26.4 vs. 27.8 min, p = 0.45) and amount of contrast agent (109.4 vs. 114.9 ml, p = 0.62) did not differ significantly between the two groups. The DSA image quality of the new technology was not inferior (2.66 vs. 2.77, p = 0.56). Conclusions In our study the new imaging technology halved radiation dose in patients undergoing TIPS maintaining sufficient image quality without a significant increase in radiation time or contrast consumption.

Background: The aim of this study was to compare arterial embolization (AE) with portal vein embolization (PVE) for the induction of segmental hypertrophy regarding procedural efficacy, safety and outcome. Methods: A total of 29 mini pigs were subjected to PVE, AE or assigned to the sham (SO) group. Correspondingly, 75% of the hepatic artery or portal vein branches were embolized. Growth and atrophy of the liver lobes, calculating the liver-to-body weight index (LBWI), laboratory data, arteriography, portography, Doppler ultrasound (US) and histopathology were analyzed. Results: After PVE, 2 animals had to be excluded due to technical problems. After AE, 4 animals had to be excluded because of technical problems and early sacrifice. Postprocedural US demonstrated effective AE and PVE of the respective lobes. Four weeks after PVE, portography showed a slow refilling of the embolized lobe by collateral portal venous vessels. Four weeks after AE, arteriography revealed a slight revascularization of the embolized lobes by arterial neovascularization. Segmental AE led to extensive necrotic and inflammatory alterations in the liver and bile duct parenchyma. Significant hypertrophy of the non-embolized lobe was only noted in the PVE group (LBWI: 0.91 ± 0.28%; p = 0.001). There was no increase in the non-embolized lobe in the AE (LBWI: 0.45 ± 0.087%) and SO group (LBWI: 0.45 ± 0.13%). Conclusion: PVE is safe and effective to induce segmental hypertrophy. Portal reperfusion by collateral vessels may limit hypertrophy. AE did not increase the segmental hepatic volume but carries the risk of extensive necrotic inflammatory damage.

To the Editor: We read with great interest the comments by Aloia and Vauthey on the original article on ‘‘Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS)’’ published in Annals of Surgery in March 2012 by Schnitzbauer et al. One essential comment was that the ALPPS was supposed to be an ‘‘all-touch’’ technique that would reduce the oncological efficacy to treat liver malignancy. Recently, avoiding manipulation of the right liver by using ‘‘anterior approach’’ has been reported. In patients with tumor close to or even infiltrating the right liver hilum, successful ALPPS with ‘‘non-touch’’ technique has not been described despite its oncological superiority. After overcoming the learning curve with the refinement of surgical technique as well as the strategy, 11 ALPPS have been performed in University Medical Center Hamburg-Eppendorf from May 2012 to March 2014. Two cases of advanced gallbladder carcinoma (GBCA) are presented here to demonstrate how to complete the concept of ALPPS without comprising the oncological efficacy by ‘‘non-touch’’ technique. The first patient was a 48-year-old woman (178 cm inheight and 102 kg inweight) referred with the diagnosis of gallbladder empyema as well as local advanced GBCA of 8 cm diameter. The systemic bilirubin and International Normalized Ratiowerewithin the normal range. After controlling the infection by intravenous antibiotic therapy and decompression of the gallbladder through a computer tomography (CT)-guided cholecystostomy, she was consented for staged right trisectionectomy by means of ALPPS because of insufficient future liver remnant (segment 1, 2, and 3 with a volume of 491 mL) with a future liver remnant to total liver volume ratio (FLR/ TLV) of 23.4% and FLR to body weight ratio (FLR/BW) of 0.48%. The surgical exploration confirmed local advanced GBCA with infiltration of the duodenum. No peritoneal carcinosis was found. A right trisectionectomy with portal vein resection in combination with pancreaticoduodenectomy was indicated. First, the left portal vein (LPV) and the left hepatic artery (LHA) were dissected and identified with rubber bands. The umbilical portion of the

An abdominal aortic aneurysm (AAA) is the dilation of the abdominal aorta due to weakening of the arterial wall. Endovascular aneurysm repair (EVAR) using an implantable stent graft is the commonly used method for treatment of AAA. An endoleak, which is the leakage of blood around the stent graft, is the complication after EVAR creating trauma to the weakened arterial walls of the aneurysm leading to further enlargement and risk of rupture. This paper details the design, implementation and testing of a wirelessly powered implant device containing multiple pressure sensors to be mounted on a stent graft for detecting endoleak. The tested implant device can be powered for distance of 20 cm using an external RF power source of 2.65 W. A stent prototype with sixteen pressure sensors is fabricated and tested using an in-vitro chamber. The resolution and directionality of the pressure sensors in the stent prototype are measured. Different wire bonding glob top encapsulations are evaluated for mechanical stress induced during stent delivery.

Guest Editors Christiane Bruns, Cologne Walter Halangk, Magdeburg

Segmental hepatic arterial embolization has been proposed as an alternative to portal vein embolization to induce segmental hypertrophy of a future liver remnant after major resection. The purpose was to compare efficacy and safety of both techniques in a mini-pig model. A total of 29 mini-pigs were either subject to hepatic arterial embolization (AE-group, n=12), portal vein embolization (PVE-group, n=11), or a sham operation (SO-group, n=6). In the AE-group 75% of the hepatic arterial flow was excluded by NBCA-embolization. In the PVE-group 75% of the portal vein were embolized in similar technique. Sham operation included laparotomy with mobilization of the liver and preparation of the duodenal ligament. The animals were sacrificed after 4 weeks. Analyzed data were growth and atrophy of the liver lobes, laboratory data, arteriography and portography controls after 4 weeks, and histopathology. In the PVE-group 2 animals were excluded due to technical problems. In the AE-group 4 animals were excluded after technical problems and an earlier sacrificed related to post-interventional complications. The PVE-group demonstrated a significant increase of the liver-to-body weight index in the non-embolized lobe compared to the AE- and SO-group (p<0.05). Portography 28 days after PVE days showed slow refilling of the portal branches by collateral vessels; arteriography follow-up in the AE-group showed a only slight recanalization by neocollaterals. However, after extended arterial embolization necrotic and inflammatory alterations as well as abscess formations of the liver and bile duct parenchyma were observed. Portal vein embolization is a safe and effective technique to induce segmental hypertrophy. In comparison, arterial embolization showed no significant hypertrophy of the non-embolized liver lobe, resulted in extended necrotic inflammatory damage of the liver in several cases and should not be the favored technique for embolization to induce segmental hypertrophy.

Welche Informationen sind mittels Post-Mortem-CT (PMCT) bzw. multiphasischer Post-mortem-CT-Angiografie (MPMCTA) bei der Abklärung der Todesursache nach endovaskulärer oder operativer Behandlung von Aortenaneurysmen, -dissektionen und –rupturen zu erlangen?

Um frühzeitig die Entwicklung von Endoleakagen nach EVAR zu erkennen, wurde ein Stentgraft-Design mit integrierten Sensoren zur kabellosen Abfrage von Drücken an der Stent-Außenwand entworfen. Die Stentgrafts sollten anschließend in vitro und im Tiermodell getestet werden, um eine Produktentwicklung zu evaluieren.