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The spectrum of cardiovascular diseases is the leading cause of morbidity and mortality globally. Early assessment and treatment of these conditions, acquired as well as congenital, is therefore of paramount importance. The human heart has a great ability to adapt to various hemodynamic conditions by cardiac remodeling. Pathologic cardiac remodeling can occur as a result of cardiovascular disease in an effort to maintain satisfactory cardiac function. With time, cardiac function diminishes leading to disease progression and subsequent heart failure, the end-point of many heart diseases, associated with very poor prognosis. Within the normal cardiac ventricles blood flows in highly organized patterns, and changes in cardiac configuration or function will affect these flow patterns. Conversely, altered flows and pressures can bring about cardiac remodeling. In congenital heart disease, even after corrective surgery, cardiac anatomy and thereby intracardiac blood flow patterns are inherently altered. The clinically most available imaging technique, ultrasound with Doppler, allows only for one-directional flow assessment and is limited by the need of clear examination windows, thus failing to fully assess the complex three-dimensional blood flow within the beating heart. Cardiovascular magnetic resonance imaging (CMR) with phase-contrast has the ability to acquire three-dimensional (3D), three-directional time resolved velocity data (3D + time = 4D flow data) from which visualization and quantification of blood flow patterns over the complete cardiac cycle can be performed. Four functional blood flow components have previously been defined based on the blood route and distribution through the ventricle, where the inflowing blood that passes directly to the outflow is called Direct flow. From these components, various quantitative measures can be derived, such as component volumes and kinetic energy (KE) throughout the cardiac cycle. In addition, the 4D flow technique has the ability to quantify and visualize turbulent flow with increased velocity fluctuations in the heart and vessels, turbulent kinetic energy (TKE). The technique has been developed and evaluated for assessment of left ventricular (LV) blood flow in healthy subjects and in patients with dilated dysfunctional left ventricles, showing significant changes in blood flow patterns and energetics with disease. There is however still no study addressing the gap in the spectrum from the healthy cohorts to patients with moderate to severe left ventricular remodeling. In Paper III, 4D flow CMR was utilized to assess LV blood flow in patients with subtle LV dysfunction, and a shift in blood flow component volumes and KE was seen from the Direct flow to the non-ejecting blood flow components. In patients with both left- and right-sided acquired and congenital heart disease, right ventricular (RV) function is of great prognostic significance, however this ventricle has historically been somewhat overseen. With its complex geometry, advanced physiology and retrosternal location, assessment of the RV is still challenging and the right ventricular blood flow is still incompletely described. In Paper I, the RV blood flow in healthy subjects was assessed, and the proportionally larger Direct flow component was located in the most basal region of the ventricle and possessed higher levels of KE at end-diastole than the other flow components suggesting that this portion of blood was prepared for efficient systolic ejection. In Paper II, the blood flow was assessed in the RV of patients with subtle primary LV disease, and even if conventional echocardiographic or CMR RV parameters did not show any RV dysfunction, alterations of flow patterns suggestive of RV impairment were found in the patients with the more remodeled LVs. With improvements of the cardiovascular health care, including the surgical techniques, the number of adult patients with surgically corrected complex congenital heart diseases increases, one of which is tetralogy of Fallot (ToF). Surgical repair of ToF involves widening of the pulmonary stenosis, which postoperatively may cause pulmonary insufficiency and regurgitation (PR). Disturbed or turbulent flow patterns are rare in the healthy cardiovascular system. With pathological changes, such as valvular insufficiency, increased amounts of TKE have been demonstrated. Turbulence is known to be harmful to organic tissues and could be significant in the development of ventricular remodeling, such as dilation and other complications seen in Fallot patients. In Paper IV, the RV intraventricular TKE levels were assessed in relation to conventional measures of PR. Results showed that RV TKE was increased in ToF patients with PR compared to healthy controls, and that these 4D flow-specific measures related slightly stronger to indices of RV remodeling than the conventional measures of PR. 4D flow CMR analysis of the intracardiac blood flow has the potential of adding to pathophysiological understanding, and thereby provide useful diagnostic information and contribute to optimization of treatment of heart disease at earlier stages before irreversible and clinically noticeable changes occur. The flow specific measures used in this thesis could be utilized to detect these alterations of intracardiac blood flow and could thus act as potential markers of progressing ventricular dysfunction, pathological remodeling or used for risk stratification in adults with early repair tetralogy of Fallot. Visualizations of intracardiac flow patterns could provide useful information to cardiac/thoracic surgeons pre- and post-operatively.
Research centering on blood flow in the heart continues to hold an important position, especially since a better understanding of the subject may help reduce the incidence of coronary arterial disease and heart attacks. This book summarizes recent advances in the field; it is the product of fruitful cooperation among international scientists who met in Japan in May, 1990 to discuss the regulation of coronary blood flow.
Echocardiography is essential in the practice of pediatric cardiology. A clinical pediatric cardiologist is expected to be adept at the non-invasive diagnosis of congenital heart disease and those who plan to specialize in echocardiography will need to have knowledge of advanced techniques. Echocardiography in Pediatric and Congenital Heart Disease addresses the needs of trainees and practitioners in this field, filling a void caused by the lack of material in this fast-growing area. This new title comprehensively covers the echocardiographic assessment of congenital heart disease, from the fetus to the adult, plus acquired heart disease in children. Topics covered include: ultrasound physics laboratory set-up a protocol for a standard pediatric echocardiogram quantitative methods of echocardiographic evaluation, including assessment of diastolic function in depth coverage of congenital cardiovascular malformations acquired pediatric heart disease topics of special interest, such as 3D echocardiography, transesophageal echocardiography, and fetal echocardiography The approach of this book is a major advancement for educational materials in the field of pediatric cardiology, and greatly enhances the experience for the reader. An accompanying DVD with moving images of the subjects covered in the textbook will further enhance the learning experience.
This unique book provides clinicians and administrators with a comprehensive understanding of perioperative hemodynamic monitoring and goal directed therapy, emphasizing practical guidance for implementation at the bedside. Successful hemodynamic monitoring and goal directed therapy require a wide range of skills. This book will enable readers to: • Detail the rationale for using perioperative hemodynamic monitoring systems and for applying goal directed therapy protocols at the bedside • Understand the physiological concepts underlying perioperative goal directed therapy for hemodynamic management • Evaluate hemodynamic monitoring systems in clinical practice • Learn about new techniques for achieving goal directed therapy • Apply goal directed therapy protocols in the perioperative environment (including emergency departments, operating rooms and intensive care units) • Demonstrate clinical utility of GDT and hemodynamic optimization using case presentations. Illustrated with diagrams and case examples, this is an important resource for anesthesiologists, emergency physicians, intensivists and pneumonologists as well as nurses and administrative officers.
This book systematically focuses on central sleep apneas, analyzing their relationship especially with heart failure and discussing recent research results and emerging treatment strategies based on feedback modulation. The opening chapters present historical background information on Cheyne-Stokes respiration (CSR), clarify terminology, and explain the mechanics and chemistry of respiration. Following a description of the physiology of respiration, the pathophysiology underlying central apneas in different disorders and particularly in heart failure is discussed. The similarities and differences of obstructive and central apneas are then considered. The book looks beyond the concept of sleep apnea to daytime CSR and periodic breathing during effort and contrasts the opposing views of CSR as a compensatory phenomenon or as detrimental to the failing heart. The diagnostic tools currently in use for the detection of CSR are thoroughly reviewed, with guidance on interpretation of findings. The book concludes by describing the various forms of treatment that are available for CSR and by explaining how to select patients for treatment.
A panel of leading researchers and clinician-scientists distill from years of practical experience and recent scientific and clinical advances the essence of cardiology principles and techniques today. In this second edition, all of the original chapters have been extensively rewritten and two new chapters on acute coronary syndromes following the modern classification have been added: one on unstable angina pectoris and non-ST-segment elevation myocardial infarction, and the other on ST-segment elevation myocardial infarction. Compact yet comprehensive, Essential Cardiology: Principles and Practice, Second Edition offers today's busy cardiology and internal medicine practitioners, cardiology fellows, and medical residents rapid access to the latest ideas and techniques needed for today's gold standard diagnosis and management of cardiac patients.
It is quite natural that literature related to car heart disease, cardiomyopathy, pulmonary and diac structure, function, pathology, and patho pulmonary vascular disease, trauma, acquired valvular disease, congenital disease, and surgi physiology has emphasized the left heart and systemic circulation. The relative lack of im cal considerations. The pathologic and clinical relevance of myocardial infarction of the right portance of the right ventricle was supported by studies performed in the 1940s and 1950s ventricle has only been documented over the which suggested that the right ventricular free last 15 years. The chapter on right ventricular wall could be effectively destroyed in an animal infarction integrates clinical, functional, patho model without detectable untoward hemody physiologic, and pathologic observations to pro namic consequences. The relative inadequacy vide the reader with a thorough review, equally of noninvasive tools to study right ventricular relevant to the clinician and investigator. The contribution on dilated cardiomyopathy pro structure and function obviated detailed and systematic investigation. However, over the vides novel insight into the impact of right ventricular performance on the functional in past 15 years there has been a resurgence of interest in the right ventricle by a variety of capacity accompanying left heart failure. A book dealing with the right ventricle would investigators. The skeptic would argue that this renewed interest resulted from an exhaustion be incomplete without at least cursory reference we have of clinically-related observations that could be to the pulmonary circulation.
The world of echocardiography continues to be full of exciting new technological developments with an ultimate goal of better patient care. In this book, titled "Echocardiography in Heart Failure and Cardiac Electrophysiology", authors from various parts of the world contributed to the advancement of the field. We have included various chapters about the use of echocardiography and modalities of imaging in various common clinical scenarios - ranging from evaluation of commonly ignored right ventricle, imaging in congestive heart failure, to echocardiographic evaluation of critically ill patients. We have also included topics describing the use of echocardiography in cardiac electrophysiology with special interest to cardiac resynchronization therapy and atrial fibrillation ablation. These topics would be of great interest to the clinicians whether they are trainees, physicians, advanced care providers, or anyone involved in the patient care.
For many years, there has been a great deal of work done on chronic congestive heart failure while acute heart failure has been considered a difficult to handle and hopeless syndrome. However, in recent years acute heart failure has become a growing area of study and this is the first book to cover extensively the diagnosis and management of this complex condition. The book reflects the considerable amounts of new data reported and many new concepts which have been proposed in the last 3-4 years looking at the epidemiology, diagnostic and treatment of acute heart failure.