Abstract Aims In adult patients with transposition of the great arteries (dTGA) after arterial switch operation (ASO), the coronary artery circulation after neonatal surgical transfer remains a major ...culprit for long-term sequelae, including myocardial ischaemia and sudden cardiac death. As coronary imaging in paediatric age is often incomplete and classification mainly relies on the surgeon’s description in the operation report, we intended to develop a systematic, understandable pattern of the coronary status for each young patient, combining unambiguous coding with non-invasive imaging. Methods and results The monocentric prospective study evaluated 89 young adults (mean 23 years) after ASO for dTGA including cardiac magnetic resonance (CMR) coronary angiography. Following ‘The Leiden Convention coronary coding system’, we describe the systematic transformation process and provide a graphical illustration considering surgical and imaging views for the six main coronary types, followed by a comparison with adult CMR. Discordance between surgeon’s and CMR classification is evaluated. In seven (7.9%) patients, a discordance between the surgeon’s post-operative and the CMR classification was found; therefore, the initial classification had to be corrected according to adult CMR. Three cases (3.4%) with particularly challenging coronary variants (intramural and interarterial course, functional common ostium) are presented. Conclusion Considering the risks of a possible neonatal coronary misclassification and of increasing additional acquired coronary artery disease with age, reliable cooperation between surgeons, cardiologists, and imaging specialists must be ensured. Therefore, after completion of growth, a systematic pattern of the coronary artery status, combining unambiguous coding with CMR imaging, should be established for each patient.
A 43-year-old woman with clinical signs of a febrile respiratory infection with cough and dyspnea despite several antecedent antibiotic treatments was admitted to hospital because of persistent ...bilateral pulmonary infiltrates.
In the diagnostic work-up, the most striking laboratory abnormality was an eosinophilia of 31% within the differential blood count. Specimen obtained from bronchoalveolar lavage showed an abnormally high level of eosinophils as well. In the absence of other known causes of an eosinophilic pulmonary disease the diagnosis of idiopathic chronic eosinophilic pneumonia was made. After initiation of corticosteroid medication the abnormal laboratory results, the clinical signs, and the radiologic findings almost completely normalized within 1 week.
If an apparent pneumonia fails to respond to conventional antibiotic treatment, a blood eosinophil count should be obtained. If blood eosinophils are abnormally high, diagnosis of idiopathic acute or chronic eosinophilic pneumonia should be considered and confirmed by demonstrating an excess of eosinophils in bronchoalveolar lavage fluid. Due to prognostic and therapeutic consequences idiopathic acute and chronic eosinophilic pneumonia should be distinguished from one another. A rapid response to glucocorticoid therapy supports the diagnosis. In order to avoid relapses, patients with chronic eosinophilic pneumonia have to complete a 6-month treatment.
This study sought to evaluate whether objective assessment of the myocardial functional reserve, using strain rate imaging (SRI), allows accurate detection of viable myocardium.
Strain rate imaging ...is a new echocardiographic modality that allows quantitative assessment of segmental myocardial contractility.
In 37 patients (age 58 ± 9 years) with ischemic left ventricular dysfunction, myocardial viability was assessed using low-dose (10 μg/kg body weight per min) two-dimensional dobutamine stress echocardiography (DSE), tissue Doppler imaging, SRI and 18F-fluorodeoxyglucose (18FDG) positron emission tomography (PET). The peak systolic tissue Doppler velocity and peak systolic myocardial strain rate were determined at baseline and during low-dose dobutamine stress from the apical views.
A total of 192 segments with dyssynergy at rest were classified by 18FDG PET as viable in 94 and nonviable in 98. An increase of peak systolic strain rate from rest to dobutamine stimulation by more than −0.23 1/s allowed accurate discrimination of viable from nonviable myocardium, as determined by 18FDG PET with a sensitivity of 83% and a specificity of 84%. Receiver operating characteristic (ROC) curve analysis showed an area under the curve for prediction of nonviable myocardium, as determined by 18FDG PET using SRI, of 0.89 (95% confidence interval CI 0.88 to 0.90), whereas the area under the ROC curve using tissue Doppler imaging was 0.63 (95% CI 0.61 to 0.65).
The increase in the peak systolic strain rate during low-dose dobutamine stimulation allows accurate discrimination between different myocardial viability states. Strain rate imaging is superior to two-dimensional DSE and tissue Doppler imaging for the assessment of myocardial viability.
This study sought to evaluate whether objective assessment of the myocardial functional reserve, using strain rate imaging (SRI), allows accurate detection of viable myocardium.
Strain rate imaging ...is a new echocardiographic modality that allows quantitative assessment of segmental myocardial contractility.
In 37 patients (age 58 +/- 9 years) with ischemic left ventricular dysfunction, myocardial viability was assessed using low-dose (10 microg/kg body weight per min) two-dimensional dobutamine stress echocardiography (DSE), tissue Doppler imaging, SRI and (18)F-fluorodeoxyglucose ((18)FDG) positron emission tomography (PET). The peak systolic tissue Doppler velocity and peak systolic myocardial strain rate were determined at baseline and during low-dose dobutamine stress from the apical views.
A total of 192 segments with dyssynergy at rest were classified by (18)FDG PET as viable in 94 and nonviable in 98. An increase of peak systolic strain rate from rest to dobutamine stimulation by more than -0.23 1/s allowed accurate discrimination of viable from nonviable myocardium, as determined by (18)FDG PET with a sensitivity of 83% and a specificity of 84%. Receiver operating characteristic (ROC) curve analysis showed an area under the curve for prediction of nonviable myocardium, as determined by (18)FDG PET using SRI, of 0.89 (95% confidence interval CI 0.88 to 0.90), whereas the area under the ROC curve using tissue Doppler imaging was 0.63 (95% CI 0.61 to 0.65).
The increase in the peak systolic strain rate during low-dose dobutamine stimulation allows accurate discrimination between different myocardial viability states. Strain rate imaging is superior to two-dimensional DSE and tissue Doppler imaging for the assessment of myocardial viability.
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