We present the case with cardiac metastasis and thrombus simultaneously. Two intracardiac masses were evaluated by chest computed tomography and transthoracic echocardiography. Metastatic mass and thrombus were in contact with each other and thrombus formation may be associated with denudation of endocardium by metastatic mass.
Echocardiography ; Endocardium ; Neoplasm Metastasis ; Thorax ; Thrombosis

BACKGROUND: Automated border detection (ABD) echocardiography is a convenient and objective tool in the estimation of left atrial (LA) area and function when compared to the off-line, two-dimensional echocardiographic method that requires manual tracing of the endocardial border. In addition, the applicability of the ABD system to instantaneously derive LA area and function may provide a noninvasive method to assess the diastolic interaction between the left ventricle and the left atrium. METHOD: 53 patients with a normal sinus rhythm and an apical four chamber view of LA area (in which at least 75% of the endocardium was clearly visible) were selected for this study. The on-line echocardiographic assessment of LA areas and function with automated boundary detection was performed and compared with the off-line estimation. From the instantaneous cavity area displayed by the ABD system, the extents of left atrial area decrease resulting from rapid ventricular filling (D) and atrial contraction (AC) were measured. The D/AC ratio was compared with the transmitral Doppler flow velocity E/A ratio. RESULTS: 1) The end-systolic area (ESA) and the end-diastolic area (EDA) of the left atrium, diastolic atrial emptying index (AEMI) and the systolic atrial expansion index (AEXI) with the ABD system were not different from those with the off-line, manually trace method. 2) ESA, EDA, AEMI and AEXI determined by the ABD system and the off-line method showed strong correlations (r=0.87, 0.79, 0.52 and 0.49 respectively). 3) D/AC ratio with the ABD system correlated significantly with the transmitral Doppler velocity E/A ratio (r=0.70). CONCLUSION: The ABD system may be used in the assessment of LA area and LA function and the diastolic interaction between the left atrium and the left ventricle.
Echocardiography* ; Endocardium ; Heart Atria ; Heart Ventricles ; Humans

BACKGROUND: The automated border detection(ABD) echocardiography has the ability of recognizing the endocardial-blood interface, and therefore, on-line estimation of the left ventricular(LV) volume every cardiac cycle. Compared with the off-line conventional 2-dimensional echocardiographic method that requires tracing the endocardial border manually, the ABDd system can be a convenient and objective method in the estimation of the LV volume and the ejection fraction(EF). The purpose of this study is to compare the LV volume and EF between the on-line ABD system and the convertional off-line echocardiographic method. METHODS: In two weeks, 83 adult patients older than 16 years of age were referred to our echocardiographic laboratory. Among these 83 patients, 64 patients who had a normal sinus rhythm were included to our study. Using the Hewlett-Packard SONOS 1500, a 2.5 MHz transducer was placed dat the cardiac apex. Patients with an apical 4 chamber view of the LV in which at least 75% of the endocardium was clearly seen were selected for study. On that view, the ABD system was turned on, and the reansmit power and the time-gain compensation controls were adjusted in order to approximate the automated border to the visually apparent endocardial surface. The LV end-diastolic volume(LVESV) and LV end-systolic volume(LVESV) were calculated by the method of disc. LVEDV, LVESV, and EF were displayed every cardiac cycle. Also the off-line estimation of the LV volume was performed by the method of disc, after manually tracing the endocardial border on the apical 4 chamber view. RESULTS: 44 patients(69%) of 64 patients had > or =75% of the LV endocardium visualized. LVEDV, LVESV, and Ef with the ABD system were highly correlated with those with the off-line, manually traced method(r=0.95, 0.8, respectively), but LVEDV and EF with toe ABD system were significantly less than those with the latter(p<0.01). The limits of agreement between tow methods(off-line, manually traced method-ABD system) were somewhat wide. Those of LVEDV, LVESV and EF were +22~-10ml(mean 6ml), +15~-14ml(mean 0.1ml), and +19~-12%(mean 3.8%), respectively. CONCLUSION: LVEDV,LVESV, and EF measurements by the ABD system and the off-line manually traced methods thve a strong correlation, The ABD system should habe clinical applications in setting, in which measurements of LV volume and Ef are important, But, the comparison with a more reliable method is necessary.
Adult ; Compensation and Redress ; Echocardiography* ; Endocardium ; Humans ; Toes ; Transducers

In clinical situation, left ventricular (LV) function especially systolic function is generally assessed by measuring the extent and velocity of fiber shortening i.e., ejection fraction (EF) and fractional shortening (FS). Ejection fraction is commonly measured by echocardiography, in which the volumes of chambers are measured during the cardiac cycle. Sometimes the evaluation of LV function in the patients with left ventricular hypertrophy (LVH) is problematic. Although their LV function is almost always normal or supernormal, the prognosis of patients with LVH is poorer than normal subjects. The possible reason is that conventional EF or FS measured at endocardial surface may not accurately reflect the contractile behavior of myocardial fiber across the wall. Therefore, many researchers have recommended to use the midwall instead of the endocardium when the ventricular function of LVH was assessed. In the present article, all that midwall will be reviewed.
Echocardiography* ; Endocardium ; Humans ; Hypertrophy, Left Ventricular ; Myocardium ; Prognosis ; Ventricular Function

Primary pericardial tumors are rare than those originating within the myocardium or endocardium and, moreover, primary benign pericardial tumors are much rare in occurrence. Fine(1986) was able to collect only 43 cases of lipoma. Most cases are diagnosed only at autopsy. One fourth of the cardiac lipoma arise subepicardially, where they suggest the presence of pericardial effusion with compression or displacement of the heart. A case of primary intrapericardial lipoma simulating pericardial effusion is presented. This tumor originated in left anterior aspect of pericardium. The tumor was measured 30x30x5cm in size and 2,200mg in weight. Total excision of the mass was accomplished by posterior lateral thoracotomy incision, resulting in complete cure. This is the first case of primary benign lipoma of the pericardium in literatures in our knowledge.
Autopsy ; Endocardium ; Heart ; Lipoma* ; Myocardium ; Pericardial Effusion* ; Pericardium ; Thoracotomy

OBJECTIVEThe purpose of this study was to observe histopathological changes post cryoablation in canine myocardium, to characterize the specific ablation lesion post cryoablation.

METHODSCryothermal ablation was applied on myocardium (both epicardium and endocardium) of 14 mongrel dogs with different ablation parameters (-25 degrees C x 4 min, -50 degrees C x 4 min, -75 degrees C x 4 min, -75 degrees C x 2 min, -75 degrees C x 6 min, -75 degrees C x 8 min). Lesion dimensions and histopathologic changes were observed.

RESULTSThe discrete, sharply delimited lesions were detected in cryoablated myocardium. Histologically, cryoablation in all temperatures studied induced heterogeneous necrosis of the myocardium. Lesion dimensions are related to freezing time and temperature.

CONCLUSIONCryoablation is a feasible and preferably choice for clinical application due to its controllable myocardium lesions.

BACKGROUND: Monophasic Action Potential(MAP) recording using contact electrode is very sensitive method to detect the ischemic changes of myocardium. The purpose of this study were to investigate changes of MAP during percutaneous transluminal coronary angioplasty(PTCA) and to evaluate through MAP whether or not a brief episode of ischemia influenced on subsequent ischemic episode during PTCA. Method: MAPs using endocardial contact electrode were recorded dbefore, during the fitst and second inflation and 3 min after PTCA in 7 patients undergoing PTCA. RESULTS: 1) MAP amplitude significantly decreased to 79.1+/-11.0% during the first inflation(p<0.05) and to 86.3+/-9.0% during the second inflation(p<0.05) and recovered to 92.7+/-3.7% at 3 min after PTCA. 2) MAP duration to 90% repolarization(MAPD 90) significantly decreased to 91.4+/-5.1% during the first inflation(p<0.05) and to 95.3+/-3.5% dudring second inflation(p<0.05) and recovered to 97.3+/-2.8% at 3 min after PTCA. 3) Double prodducts showed no significant difference between the first and second inflation. 4) The changes of MAP amplitude and MAP duration during the second inflation was significantly lower than that recorded during the first inflation. CONCLUSION: MAP recording using endocardial contact electode may be safe and very sensitive method to detect the ischemic changes of human endocardium and the lessened MAP changes during the second inflation supports the concept of preconditioning ischemia.
Action Potentials* ; Electrodes ; Endocardium ; Humans ; Inflation, Economic ; Ischemia ; Myocardium

BACKGROUND: Automated border detection(ABD) is a new echocardiographic modality providing continuous on-line measurements of left ventricular(LV) cavitary ares, volume, and ejection fraction(EF) throughout the cardiac cycle. Previous study showed that LV volume and EF measurements with ABD system approximate manually traced LV volume and EF obtained with conventional 2-dimensional echocardiography. But further clinical validation needs a comparison of LV function between the ABD system and established methods. The purpose of this study is to compare EF, peak ejection rate(PER) and peak filling rate(PFR) between on-line ABD system and the gated cardiac blood pool scinitigraphy. METHOD: 27 patients with an apical 4 chamber view of LV in which at least 75% of the endocardium was clearly seen were selected for this study. They had a normal sinus rhythm and underwent echocardiographic study on the same day of or one day before gated cardiac blood pool scintigraphic study. The off-line estimation of LV volume was performed by the method of disc, after manually tracing the endocardial border on the apical 4 chamber view and EFoff was calculated. Also on that view the ABD system was turned on, and EFABD, PEABD, PEABD were calculated automatically from LV volume curve. They were compared with EFRI, PERRI, and PERRI obtained by the gated cardiac blood pool scintigraphy. RESULTS: 1) EFoff and EFABD were highly correlated with EFRI(r=0.78, 0.90 respectively : p<0.001). The mean difference between EFRI and EFoff was 4+/-9%, and the limits of agreement between EFRI and EFoff were -16~22%, EFoff were less than EFRI(p<0.05). The mean difference between EFRI and EFABD was 5+/-7%, and the limits of agreement between EFRI and EFoff were -9~+19%. EFABD was also less than EFRI(p<0.05). 2) PERABD and PERABD were highly correlated with PERRI and PERRI(r=0.74, 0.60, respectively ; p<0.001). The mean difference between PERRI and PERABD was -0.1+/-0.7EDV(enddiastolic volume)/sec, and the limits of agreement were -1.5~+1.3EDV/sec. PEABD was slightly greater than PERRI(p>0.05). The mean difference between PERRI and PEABD was -0.8+/-0.8EDV/sec, and the limits of agreement were -2.4~+0.8EDV/sec. PEABD were greater than PERRI(p<0.01). CONCLUSION: EF, PER, PER measurements by the ABD system and the gated cardiac blood pool scintigraphy have significant correlations. Thus ABD echocardiography is a useful method for assessement of LV function.
Echocardiography* ; Endocardium ; Gated Blood-Pool Imaging* ; Humans ; Ventricular Function, Left*

Infant ; Humans ; Atrioventricular Block/therapy* ; Subclavian Vein ; Pacemaker, Artificial ; Endocardium

BACKGROUND: The sinus conversion rate after the maze procedure in chronic atrial fibrillation using radiofrequency energy is lower than with either conventional 'cut and saw' technique or cryothermia. The creation of incomplete transmural lesions due to poor tissue-catheter contact is thought to be the main cause. To address this problem, the current study was aimed to evaluate the effectiveness of a specially constructed compression device designed to enhance tissue catheter contact during unipolar radiofrequency catheter ablation. MATERIAL AND METHOD: Circumferential right auricular epicardial lesions were created with a linear radiofrequency catheter in 10 anesthetized pigs. A device specially designed to increase contact by compression of the catheter to the atrial wall was used in 5 pigs (study group). This device was not used in the control group (5 pigs). Conduction block across the right auricular lesion was assessed by pacing, and the transmurality of the lesions were confirmed by microscopic examination. RESULT: Conduction block was observed in a total of 8 pigs; 5 in study group and 3 in control group. Transmural injury was confirmed microscopically by the accumulation of acute inflammatory cells and loss of elastic fibers in the endocardium. In two pigs with failed conduction block, microscopic examination of the endocardium appeared normal. CONCLUSION: Failed radiofrequency ablation is strongly related to non-transmural energy delivery. The specially constructed compression device in the current study was successful in creating firm tissue-catheter contact and thereby generating transmural lesions during unipolar radiofrequency ablation.
Atrial Fibrillation ; Catheter Ablation ; Catheters ; Elastic Tissue ; Endocardium ; Equipment Design ; Swine