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

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) 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*

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

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

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

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

BACKGROUND AND OBJECTIVES: Cardiovascuar MR using contrast enhancement has recently been reported to be useful for diagnosing myocarditis. It is also well known that irreversible myocardial injury by epicardial coronary artery flow obstruction spreads from the endocardium to the epicardium in a wave-front pattern with a time-dependent manner. We investigated characteristics of the patterns of contrast-enhanced MR imaging according to the underlying myocardial injury mechanism. SUBJECTS AND METHODS: Of all 275 patients who underwent coronary angiogram at our hospital due to cheat pain and elevated cardiac enzymes between October, 2002 and August, 2003, 48 patients who underwent cardiac MR were enrolled in this study. We retrospectively analyzed the pattern of delayed hyperenhancement according to presence or absence of a documented infarct related artery. Endomyocardial biopsies were done in selected patients. RESULTS: Contrast MR images of all patients showed delayed hyperenhancement. The study group was divided into 2 groups according to whether the areas of hyper-enhancement were involved in the sub-endocardial portion (endocardial sparing pattern, ESP) or not. In 8 patients (Group A, 17%) who showed the endocardial sparing pattern on contrast MR, the findings of coronary angiogram were all normal. In 40 patients (Group B, 83%), who did not show the endocardial sparing pattern on contrast MR, 39 patients (97.5 %) had an infarct related artery on coronary angiogram (p=0.001). Endomyocardial biopsies were performed in 3 patients of group A. The findings of the 3 biopsies were 2 cases of definite myocarditis and 1 case of myocardial degeneration. CONCLUSION: The endocardial sparing pattern of myocardial injury demonstrated by delayed enhancement MR imaging was very useful to predict the presence of an infarct related artery in patients with myocardial necrosis that has been determined by elevated cardiac enzymes. This result can be a useful clue to determine the nature of the underlying injury mechanism such as ischemic or non-ischemic.
Arteries ; Biopsy ; Coronary Vessels ; Endocardium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction ; Myocarditis ; Necrosis ; Pericardium ; Retrospective Studies