Magnetocardiographic localization results need to be combined with anatomical imaging in order to be of clinical usefulness. Usually, magnetic resonance imaging is preferred in clinical MCG applications. We have compared different imaging modalities as to their applicability in combination with magnetocardiographic localization.

Thorough phantom and patient studies conducted during Stimulation at a known site using a biomagnetic multichannel system (37 SQUID system Kremkon®) have demonstrated a localization accuracy of about 15 mm for recordings in a single plane. [1]. With a growing distance from the source to the sensors, an increasing spatial error, mainly concerning the depth of the localization result was observed, which could impair especially cardiac investigations [2]. In the course of technical progress, multiplane systems (e.g., 2×37 Channels) have become available for cardiac applications. In the MagnesII® system (BTI, San Diego), the second set of sensors can be approached to the patient’s back ftom a dorsal position.

HomeCirculationVol. 96, No. 9Pseudoaneurysm in the Intervalvular Mitral-Aortic Region After Endocarditis and Prosthetic Aortic Valve Replacement Free AccessResearch ArticleDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticleDownload EPUBPseudoaneurysm in the Intervalvular Mitral-Aortic Region After Endocarditis and Prosthetic Aortic Valve Replacement Gerhard Pongratz, Magdalena Pohlmann, Gisbert Gehling and Kurt Bachmann Gerhard PongratzGerhard Pongratz From the Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Germany. , Magdalena PohlmannMagdalena Pohlmann From the Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Germany. , Gisbert GehlingGisbert Gehling From the Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Germany. and Kurt BachmannKurt Bachmann From the Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Germany. Originally published4 Nov 1997https://doi.org/10.1161/01.CIR.96.9.3241Circulation. 1997;96:3241–3242A 50-year-old man was referred for transesophageal echocardiography. The patient had undergone a prosthetic aortic valve replacement (Medtronic Hall A 23) 5 months previously because of severe aortic regurgitation due to staphylococcal endocarditis. The postoperative course was complicated by a fever that lasted 3 months. Actually, the multiplane transesophageal echocardiography examination revealed an echo-free pouch located posteriorly, in the mitral aortic intervalvular region that was bounded by the base of the anterior mitral leaflet, the posterior aortic root, and the medial wall of the left atrium. A marked pulsatility was detected, with the cavitary lesion expanding in early systole and collapsing in diastole (Figure, top). The maximal cavity area was 3.35 cm2, and the minimal area was 1.85 cm2. The cavitary pouch opened to the left ventricular outflow tract through a fistulous dehiscence in the mitral-aortic continuity as shown by color-flow Doppler imaging (Figure, bottom). No signs indicating a rupture of the lesion to the aorta or the left atrium were found. The characteristic pulsatile dynamic of the lesion during the cardiac cycle and the communication with the left ventricular outflow tract are criteria diagnostic of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC1-267, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. Transesophageal echocardiogram shows longitudinal views of the intervalvular pseudoaneurysm. LA indicates left atrium; LVOT, left ventricular outflow tract. Top, Marked pulsatility of cavitary lesion during heart cycle is demonstrated in systole and in diastole. Bottom, Fistulous flow between pseudoaneurysm and LVOT is demonstrated by color Doppler.FootnotesCorrespondence to Gerhard Pongratz, MD, Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Östliche Stadtmauerstr 29, D-91054 Erlangen, Germany. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hayley B and Leung Chan K (2016) Infectious Complications in Infective Endocarditis Infective Endocarditis, 10.1007/978-3-319-32432-6_10, (123-136), . Şahan E, Gül M, Şahan S, Sokmen E, Guray Y and Tufekçioglu O (2014) Pseudoaneurysm of the mitral–aortic intervalvular fibrosaPseudoaneurysma der mitral-aortalen intervalvulären Fibrosa, Herz, 10.1007/s00059-014-4185-z, 40:S2, (182-189), Online publication date: 1-Apr-2015. Xie M, Li Y, Cheng T, Wang X, Lu Q, He L and Fu M (2013) Pseudoaneurysm of the mitral-aortic intervalvular fibrosa, International Journal of Cardiology, 10.1016/j.ijcard.2012.03.004, 166:1, (2-7), Online publication date: 1-Jun-2013. Baydar O, Coşkun U, Balaban B, Cetin G, Firatli I, Ersanli M and Kucukoglu M (2013) Cardiac Tamponade due to Left Ventricular Pseudoaneurysm After Aortic Valve Replacement, The Heart Surgery Forum, 10.1532/HSF98.20121083, 16:1, (49) Sudhakar S, Sewani A, Agrawal M and Uretsky B (2010) Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa (MAIVF): A Comprehensive Review, Journal of the American Society of Echocardiography, 10.1016/j.echo.2010.07.015, 23:10, (1009-1018), Online publication date: 1-Oct-2010. Kassim T, Lowery R, Nasur A, Corrielus S, Weissman G, Sears-Rogan P, Greenberg M and Singh S (2009) Pseudoaneurysm of mitral–aortic intervalvular fibrosa: two case reports and review of literature, European Heart Journal - Cardiovascular Imaging, 10.1093/ejechocard/jep189, 11:3, (E7-E7), Online publication date: 1-Apr-2010., Online publication date: 1-Apr-2010. Da Col U, Ramoni E, Di Bella I and Ragni T (2008) An Unusual Left Ventricular Outflow Pseudoaneurysm: Usefulness of Echocardiography and Multidetector Computed Tomography for Surgical Repair, CardioVascular and Interventional Radiology, 10.1007/s00270-008-9406-5, 32:1, (188-191), Online publication date: 1-Jan-2009. Garneau S, Demers P and Denault A (2007) Unexpected Periaortic Cavity During Heart Surgery, Anesthesia & Analgesia, 10.1213/01.ane.0000247701.02087.c6, 104:1, (75-76), Online publication date: 1-Jan-2007. Ghersin E, Litmanovich D, Agmon Y and Milo S (2005) Pseudoaneurysm of the mitral-aortic intervalvular fibrosa following aortic valve replacement – diagnosis and dynamic evaluation with multidetector CT and transesophageal echocardiography, Interactive CardioVascular and Thoracic Surgery, 10.1510/icvts.2005.112607, 4:6, (502-504), Online publication date: 1-Dec-2005., Online publication date: 1-Dec-2005. November 4, 1997Vol 96, Issue 9 Advertisement Article InformationMetrics Copyright © 1997 by American Heart Associationhttps://doi.org/10.1161/01.CIR.96.9.3241 Originally publishedNovember 4, 1997 Advertisement

The persistence of enteroviral ribonucleic acid (RNA) in the myocardium has been implicated as a pathogenetic factor in idiopathic dilated cardiomyopathy. Enteroviral persistence may lead to myocardial cell membrane damage, resulting in increased uptake of antimyosin antibodies. To further evaluate this hypothesis, a direct comparison of myocardial antimyosin uptake with the presence of enteroviral RNA was performed in ten patients (one female, nine male; 53+/-8 years) with chronic dilated cardiomyopathy. Planar antimyosin images were obtained 48 h after the injection of indium-111-labelled antimyosin Fab. Using a region of interest technique, the heart to lung uptake ratio (HLR) was calculated as a semiquantitative parameter of myocardial tracer uptake. Cardiac catheterization was performed to assess left ventricular function and to obtain myocardial biopsy samples. In the biopsy samples, gene amplification by polymerase chain reaction (PCR) was used to specifically detect enteroviral RNA. In the ten patients, the left ventricular ejection fraction was 39%+/-11% and the end-diastolic volume 131+/-46 ml/m2. The HLR was 1.72+/-0.21 and showed no correlation with functional parameters. In two patients with a positive PCR consistent with persisting enteroviral RNA, the HLR was not higher than that in eight patients with a negative PCR (1.46+/-0. 18 vs 1.78+/-0.18, respectively). These results suggest that increased uptake of 111In-antimyosin in chronic idiopathic dilated cardiomyopathy cannot be explained by pure persistence of enteroviral RNA. Other pathogenetic factors such as myocardial autoantibodies or microvascular spasm may be responsible for myocyte membrane damage detected by antimyosin.

In industrial nations today, there are, per million inhabitants, about 2000–3000 deaths caused by cardiac problems every year [12]. Since half of these cases result from different types of arrhythmias, it is clear that a simple, fast, and noninvasive method is needed to thoroughly investigate these diseases in the early stages of development.

An acute anteroseptal infarction was diagnosed in a 51-year-old man whose ECG showed ST elevations in leads V1-V4 after acute retrosternal pain for about 20 min. Angiography revealed proximal occlusion of the right coronary artery, while the dominant left coronary artery was fully patent. After successful recanalization of the right coronary artery with intracoronary infusion of urokinase, the ST elevations quickly disappeared and impending right-heart infarction was avoided. Isolated right-heart infarction can imitate the ECG pattern of anteroseptal infarct and should be considered if the height of ST elevations diminishes from V1 to V4.

This study compared glycerol trinitrate (NTG) oral spray in a new hydrophilic formulation with a reference aerosol in a lipophilic base with respect to the time to onset of action on hemodynamics and on the coronary vasomotor tone. Differences in the profile of action between the two spray formulations were assessed in two groups of ten patients each. In each of the two groups the patients were randomly assigned to receive 0.8 mg of aerosolized NTG in either the hydrophilic or lipophilic base in double-blind fashion. The patients of group A had stable, exercise-induced angina pectoris, in whom responses to the sprays were evaluated under resting conditions. The patients of group B were suspicious of vasospastic or mixed form of angina pectoris, in whom the effects of the sprays were studied under diagnostic ergonovine provocation. The onset and extent of action of the sprays were assessed by serial measurements of hemodynamic parameters and repeat quantitative coronary angiography.

Untersuchungen über Belastbarkeit und Hämodynamik bei Koronarpatienten waren bislang aus methodischen Gründen auf Laborbedingungen beschränkt. Untersuchungen unter Alltagsbedingungen, insbesondere während Terrainbelastung, beschränken sich auf die Ekg-Telemetrie.