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Objective Cerebral aneurysm growth often precedes rupture. Definite contributors to aneurysm growth have not been determined even by means of recently developed commercially available computational fluid dynamics (CFD) software. We developed an original CFD tool that can analyze data from time-of-flight magnetic resonance angiography (TOF-MRA) before growth in the growing aneurysms and investigate possible factors for aneurysm growth in the near future. Methods We retrospectively reviewed unruptured aneurysms that were treated at our institute because of aneurysm growth (growing group) between April 2013 and March 2017. Stable aneurysms that had demonstrated no growth for more than 5 years were selected (stable group). TOF-MRA data of these aneurysms were retrospectively converted to 3-dimensional vessel geometric data; 3 hemodynamic indices including streamline, wall shear stress (WSS), and oscillatory shear index were calculated by our original CFD tool using the lattice Boltzmann method to quantitatively compare the 2 groups. Results Six growing aneurysms and 6 stable aneurysms were analyzed. Of the 6 growing aneurysms, WSS on the focal aneurysmal sac increased temporally in the vicinity of the constant low WSS area at the peak systolic phase. By contrast, WSS did not increase during any part of the cardiac cycle in 3 of the 6 stable aneurysms. The peak values of WSS were significantly different between the 2 groups. Conclusions A focal increase in WSS in the peak systolic phase may be a risk factor for aneurysm enlargement in the near future.

Intracranial bruits (ICB) are faint, high-pitched, and mostly heard on the orbit in the systolic phase of the cardiovascular cycle. This report discusses a case of Listeria monocytogenes meningitis in a 17-month-old male patient in whom ICB were auscultated. ICB is thought to be caused by compression of blood vessels due to increased intracranial pressure and may serve as an additional sign supporting the diagnosis of meningitis. The present report contains video data on the ICB.

Background T1 mapping is emerging as a powerful tool in cardiac magnetic resonance (CMR) to evaluate diffuse fibrosis. However, right ventricular (RV) T1 mapping proves difficult due to the limited wall thickness in diastolic phase. Several studies focused on systolic T1 mapping, albeit only on the left ventricle (LV). Purpose To estimate intra- and inter-observer variability of native T1 (nT1) mapping of the RV, and its correlations with biventricular and pulmonary function in patients with congenital heart disease (CHD). Material and Methods In this retrospective, observational, cross-sectional study we evaluated 36 patients with CHD, having undergone CMR on a 1.5-T scanner. LV and RV functional evaluations were performed. A native modified look-locker inversion recovery short-axis sequence was acquired in the systolic phase. Intra- and inter-reader reproducibility were reported as complement to 100% of the ratio between coefficient of reproducibility and mean. Spearman ρ and Mann–Whitney U-test were used to compare distributions. Results Intra- and inter-reader reproducibility was 84% and 82%, respectively. Median nT1 was 1022 ms (interquartile range [IQR] 1108–972) for the RV and 947 ms (IQR 986–914) for the LV. Median RV–nT1 was 1016 ms (IQR 1090–1016) in patients with EDVI ≤100 mL/m2 and 1100 ms (IQR 1113–1100) in patients with EDVI >100 mL/m2 ( P = 0.049). A significant negative correlation was found between RV ejection fraction and RV–nT1 (ρ = −0.284, P = 0.046). Conclusion Systolic RV-nT1 showed a high reproducibility and a negative correlation with RV ejection fraction, potentially reflecting an adaptation of the RV myocardium to pulmonary valve/conduit (dys)-function.

Introduction: Systemic arterial hypertension is a disease that mainly affects women. Objective: This study aimed to verify the hypotensive effect and blood pressure reactivity in women submitted to a concurrent cross exercise (CC) session. Methods: Fifteen volunteers (54±3) performed aerobic exercise alternated with a series of weights exercises, for the analysis of blood pressure variation (by the oscillometric method) and pressure reactivity (by the Cold pressure test) before and after exercise. Results: The results demonstrated the occurrence of post-exercise hypotension in the systolic phase in the comparison between CC and C post-exercise (−11.65 mmHg). CC led to attenuation of 7mmHg and 4mmHg for SBP and DBP, respectively, in the blood pressure reactivity after one session. Conclusion: It is concluded that concurrent cross exercise ensures hypotension and positive reactivity of systolic blood pressure. Level of evidence II; Therapeutic studies-Investigating the results of treatment.

Evaluating the effects of heart cavity volume, presence and absence of perfusion defect, gender and type of study (stress and rest) on the difference of systolic parameters of myocardial perfusion scan in 16 and 8 framing gated SPECT imaging.Cardiac gated SPECT in both 16 and 8 framing simultaneously and both stress and rest phases at one-day protocol was performed for 50 patients. Data have been reconstructed by filter back projection (FBP) method and left ventricular (LV) systolic parameters were calculated by using QGS software. The effect of some factors such as LV cavity volume, presence and absence of perfusion defect, gender and type of study on data difference between 8 and 16 frames were evaluated.The differences in ejection fraction (EF), end-diastolic volume (EDV) and end-systolic volume (ESV) in both stress and rest were statistically significant. Difference in both framing was more in stress for EF and ESV, and was more in rest for EDV. Study type had a significant effect on differences in systolic parameters while gender had a significant effect on differences in EF and ESV in rest between both framings.In conclusion, results of this study revealed that difference of both 16 and 8 frames data in systolic phase were statistically significant and it seems that because of better efficiency of 16 frames, it cannot be replaced by 8 frames. Further well-designed studies are required to verify these findings.Amaç: Kalp boşluk hacmi, perfüzyon defekti varlığı veya yokluğu, cinsiyet ve inceleme tipinin (istirahat-stres) 16 ve 8 frame modeli ile gated SPECT görüntülemede miyokard perfüzyon sintigrafisi sistolik parametrelerindeki farklılık üzerindeki etkilerini incelemektir. Yöntem: Elli hastada eş zamanlı olarak hem 16 hem 8 frame hem stres hem dinlenme fazları ile tek-gün protokolü ile kardiyak gated SPECT uygulandı. Veriler geri filtreleme yansıması (FBP) yöntemi ile rekonstrükte edildi ve QGS yazılımı kullanılarak LV sistolik parametreleri hesaplandı. LV boşluk hacmi, perfüzyon defekti varlığı ya da yokluğu, cinsiyet ve inceleme tipi gibi bazı faktörlerin 16 ve 8 frame modeli ile gated SPECT görüntülemede miyokard perfüzyon sintigrafisi sistolik parametrelerindeki farklılık üzerindeki etkileri incelendi. Bulgular: EF, EDV ve ESV’de hem stres hem istirahattaki fark istatistik olarak anlamlı idi. Her iki frame ile EF, EDV ve ESV’de artmış fark sırasıyla stres, istirahat ve streste idi. İnceleme türünün sistolik parametreler üzerinde anlamlı etkisi vardı, benzer şekilde cinsiyetin istirahat halinde her iki bölme yöntemi arasında EF ve ESV farkı üzerinde anlamlı etkisi görüldü. Sonuç: Sonuç olarak, bu çalışma sonuçları hem 16 hem 8 frame ile elde edilen sistolik verinin istatistiksel olarak anlamlı olduğunu ortaya koymaktadır ve 16 frame modelinin daha etkin olması nedeniyle 8 frame ile değiştirilemeyeceğini öne sürmektedir. Bu bulguların ileride iyi planlanmış çalışmalar ile doğrulanması gerekmektedir.

The relationship between body fat depots and the left atrial (LA) dimensions has not been fully explored. Our objective is to determine if there is a relationship not only with total body fat depots, but specifically with regional fatty depots.It was an observational, retrospective study that included consecutive patients referred to our institution with an order to perform computed tomography angiography triggered by electrocardiogram for different clinical indications. Measurements of the LA were made in the systolic phase, using four and two cameras views.A total of 87 patients were included. The mean age was 66.4 ± 12.5 years; 67% were men. The LA volume indexed by the body surface area was 48.0 ± 16.6 cmIn this study, we did not identify significant relationships between LA dimensions and global or regional body fat depots.La relación entre los depósitos de grasa corporal y las dimensiones de la aurícula izquierda (AI) no ha sido del todo explorada. Nuestro objetivo es determinar si existe relación no solo con los depósitos de grasa corporal totales, sino específicamente con los depósitos grasos regionales.Estudio observacional, retrospectivo, que incluyó pacientes consecutivos remitidos a nuestra institución con orden de realización de angiotomografía computarizada toracoabdominal gatillada con electrocardiograma por distintas indicaciones clínicas. Las mediciones de la AI se realizaron en la fase sistólica, utilizando vistas de cuatro y dos cámaras.Se incluyeron un total de 87 pacientes. La edad media fue de 66.4 ± 12.5 años; un 67% de los sujetos fueron hombres. El volumen de la AI indexado por la superficie corporal fue de 48.0 ± 16.6 cmEn este estudio, no identificamos relaciones significativas entre las dimensiones de la AI y los depósitos de grasa corporal globales o regionales.

Objectives This study aimed to elucidate the physiological feasibility of aortic valve neocuspidization (AVNeo) by comparing the aortic annulus dimensions between patients after AVNeo and patients with normal aortic valves. Methods From December 2010 to October 2017, we performed AVNeo for various aortic valve pathologies in 147 patients. Of these patients, the aortic annulus dimensions were measured in 25 patients who underwent AVNeo for aortic valve disease as follow-up examination and compared with those measured in 15 patients who had normal aortic valves. Measurements were recorded using electrocardiography-gated transthoracic echocardiography. Results No significant differences in the aortic annulus dimensions were observed between the patients who had undergone AVNeo and those who had normal aortic valves. In a cardiac cycle, the annulus area in the systolic phase was consistently larger than that in the diastolic phase, which was a physiological condition. Conclusions The movement of the aortic annulus after AVNeo is comparable with that of the aortic annulus of a normal aortic valve. Thus, AVNeo can be regarded as a more physiological operation in that it maintains the characteristics of the aortic valve similar to those of a normal aortic valve.

Author(s): Contijoch, Francisco; Witschey, Walter RT; Rogers, Kelly; Gorman, Joseph; Gorman, Robert C; Ferrari, Victor; Han, Yuchi | Abstract: PurposeTo evaluate the impact of end-diastolic (ED) and end-systolic (ES) cardiac phase selection methods, since task force recommendations have neither provided quantitative evidence nor explored errors introduced by clinical shortcuts.Materials and methodsMultislice, short-axis cine images were collected in 60 clinical patients on a 1.5T scanner. User-initialized active contour segmentation software quantified global left ventricular (LV) volume across all cardiac phases. Different approaches for selection of ED and ES phase were evaluated by quantification of temporal and volumetric errors.ResultsFor diastole, the mid-ventricular maximum slice volume coincided with maximum global volume in 82.1% of patients with ejection fraction (EF) ≥55% (P = 0.66) and 71.9% of patients with EF l55% (P = 0.28) and is an accurate approximation of maximum global volume while the first and last phases in a retrospectively electrocardiogram (ECG)-gated acquisition introduced differences in cardiac phase selection (P l 0.001) which led to large errors in measured volume in some patients (12.7 and 10.1 mL, respectively). For systole, post-systolic shortening occurred in a significantly higher number of patients with EF l55% (18.9%) compared to 3.6% of patients with EF ≥55% (P = 0.001), which differentially impacted end-systolic volume estimation.ConclusionFor end-diastolic phase selection, our results indicated that the use of the mid-ventricular slice volume maximum provided accurate volume estimates, while selection of the first or last cardiac phase introduced differences in measured volume. For end-systolic phase, patients with EF l55% had a higher prevalence of post-systolic shortening, which suggests aortic valve closure should be used to estimate end-systolic volume.

Three-dimensional deformation analysis of human organs is very important from both diagnostic and therapeutic point of view. For example, comparing the deformation field in healthy and pathologic cardiac walls in the systolic phase allows to gather early and accurate information on the onset of heart diseases. MRI tagging is utilized in medicine to visualize with a great deal of detail the structure and morphology of tissues. The tagging process introduces a volumetric system of planes of reference similar to the process of introducing a grating in the 3-D moire method in transparent media. The paper will analyze the kinematics of 3-D deformation fields and the fundamental concepts involved in 3-D deformation analysis within the restrictions imposed by the MRI method thus providing solutions for the inherent shortcomings encountered in the MRI tagging technique.

d v w a AORTIC INSUFFICIENCY (AI) in patients after left ventricular assist device (LVAD) implantation is one of the nintended and potentially harmful consequences.1,2 Excessive LVAD flows, resulting in diminished and infrequent aortic valve (AV) opening, may facilitate AI progression and extend its duration to the systolic phase of the cardiac cycle.2,3 The igh temporal resolution of the echocardiographic M mode akes it very effective in monitoring the effects of LVAD speeds n AV function in real time. This case report describes the pathohysiology of AV leaflets akinesis and systolic aortic insufficiency n patients supported with continuous-flow LVAD and shows the rayscale and color M-mode AV surveillance in the perioperative ptimization of the LVAD setting.

Key Clinical Message Examination of apical impulse is an important component of nonauscultatory cardiac examination. Seesaw‐like movements of the chest wall during the systolic phase suggest severe tricuspid regurgitation.

The aim of this study was to evaluate the regional (i.e. myocardial segments) variability as well as the overall image quality of cardiac T1 and T2 maps obtained in diastole and in systole. In 22 healthy subjects (group-1), diastolic T1 and T2 maps were obtained at 1.5T in short-axis view at basal, mid-ventricular and apical level, as well as in 4-chamber (4ch) and in 2-chamber (2ch) views. In another group of 25 patients (group-2), the maps were obtained in both diastole and systole. In the group-1, 15.4 % of myocardial segments in T1 maps and 0.8 % of myocardial segments in T2 maps, mainly located at apical level, showed relevant artifacts and/or partial-volume effect and had to be discarded. We found no significant difference in T1 values among basal, mid-ventricular and apical segments. T2 values at apical level were significantly higher than at basal and mid-ventricular level (short-axis, p < 0.0001; 4ch, p < 0.009; 2ch, p = 0.0002 at ANOVA tests). In the group-2, 21.1 %/5.3 % and 4.0 %/0.8 % of segments showed relevant artifacts in diastolic/systolic T1 and T2 maps, respectively. Apical T2 values were significantly lower in systole than in diastole. In systole, there were no significant differences in T1/T2 among basal, mid-ventricular and apical segments. The overall quality of T1 and T2 maps drops in apical segments. This could be problematic when evaluating focal myocardial changes. The acquisition in systole increases the number of evaluable segments.

In the present case, development of the string sign in an internal thoracic arterial graft was observed using transthoracic Doppler echocardiography. Following surgery, the diameter of the internal thoracic graft decreased; however, the diameter of the left anterior descending coronary artery did not change from 1.9 mm. Further, the flow velocity in the internal thoracic artery during the systolic phase became greater than that in the early phase and then decreased on postoperative day 19, and it was not detected on postoperative day 31. Coronary arteriography performed on postoperative day 31 revealed a severely stringed internal thoracic artery.

The physiological assessment of a lesion is a key to quality of life and prognosis of a patient with moderate coronary stenosis. Blood flow in coronary arteries occurs primarily during diastole, it is evident especially in the LAD. The systolic phase lasts roughly 300 ms and its duration is almost

Presaturation of fat signals by frequency-selective radiofrequency (RF) pulses is often applied in MR angiography to improve the visualization of the blood vessels. Unfortunately, standard fat saturation methods might cause a considerable reduction of the blood signal in the measured slices. This effect is caused by an attenuation of blood magnetization in remote tissue regions with water protons showing a similar Larmor frequency as the fat protons in the recorded slice. The affected blood water protons subsequently flow into the recorded slice and provide low signal intensity. Suitable spatial-spectral selective methods for slice-selective fat saturation were developed to avoid this unwanted effect. A spatial-spectral fat saturation technique was compared with a corresponding only spectrally selective approach. Both saturation techniques were included in a standard two-dimensional (2D) cine sequence and applied in angiographic examinations of the thighs. The results indicate that spatial-spectral saturation (acting slice selectively) leads to a clearly higher blood signal intensity in fat-suppressed MR angiography compared with standard techniques, especially in measurements performed during the systolic phase of the cardiac cycle.

Despite half a century of use, mechanical heart valves still require further research to reduce the non-physiologic nature of the flow field, which is the source of potential medical complications, of which the most serious complication is thrombus formation [1]. In the systolic phase of the flow, excessive fluid stresses are generated by the non-physiologic flow patterns [2, 3]. In the closed valve position, a large pressure gradient is imposed across the device which leads to the generation of strong and damaging small-scale leakage flows that entrain platelets such that they are exposed to elevated stresses for excessive time durations [4–6].

End-systolic pressure-volume relation (ESPVR) in the left ventricle is used to study the problem of heart failure with normal or preserved ejection fraction (HFpEF). This problem has recently been the object of several studies; most of these studies have concentrated on the variation of the dimensions of the left ventricle during the systolic phase. In this communication, we introduce mathematical relations that show the importance of the forces acting on the myocardium and the energy involved in the systolic contraction on the calculation of the ejection fraction (EF). Both can be derived in a simple way from the study of the pressure-volume relation (PVR) and the areas under the ESPVR. Alternative ways to assess the performance of the left ventricle are suggested.

This paper deals with the automated segmentation of left ventricle in cardiac MRI using level set and enhanced filtering technique. The main focus is on the graphical analysis techniques such as Bland & Altman plot and regression analysis in order to verify the validity of the system. The area of end diastolic and end systolic phase of the base to apex levels has been found using the above algorithm and compared with the manually segmented images.

MRI appears to be particularly attractive for the study of the Sinuses of Valsalva (SV), however there is no global consensus on their suitable measurements. In this paper, we propose a new method, based on the mathematical morphology and combining a numerical geodesic reconstruction with an area estimation, to automatically evaluate the SV from a cine-MRI in a cross-sectional orientation. It consists in the extraction of the shape of the SV, the detection of relevant points (commissures, cusps and the centre of the SV), the measurement of relevant distances and in a classification of the valve as bicuspid or tricuspid by a metric evaluation of the SV. Our method was tested on 23 patient examinations and radii calculations were compared with a manual measurement. The classification of the valve as tricuspid or bicuspid was correct for all the cases. Moreover, there are an excellent correlation and an excellent concordance between manual and automatic measurements for images at diastolic phase (r= 0.97; y = x - 0.02; p=NS; mean of differences = -0.1 mm; standard deviation of differences = 2.3 mm) and at systolic phase (r= 0.96; y = 0.97 x + 0.80; p=NS ; mean of differences = -0.1 mm; standard deviation of differences = 2.4 mm). The cross-sectional orientation of the image acquisition plane conjugated with our automatic method provides a reliable morphometric evaluation of the SV, based on the automatic location of the centre of the SV, the commissure and the cusp positions. Measurements of distances between relevant points allow a precise evaluation of the SV.

An experimental apparatus to model the systolic phase of a heartbeat has been developed to investigate the controversy surrounding the cause of high intraventricular pressures for HCM patients. The model, which is two-dimensional, has approximately seven times the volume of an average human heart and operates at Reynolds numbers which are similar to those measured in the left ventricle/aortic arch. Preliminary tests of the model show pressure time relationships similar to those found in vivo.

Objective To observe the therapeutic effect of acupuncture plus Ligustrazine on vertebrobasilar insufficiency (VBI) by transcranial Doppler (TCD) sonography. Methods 86 VBI patients including 56 cases of low flow rate velocity type (LFVT) and 30 cases of high flow velocity type (HFVT) were randomly divided into Ligustrazine group (26 LFRT and 14 HFVT) and acupuncture plus Ligustrazine group (30 LFVT and 16 HFVT). The blood flow velocity (BFV) of vertebral artery (VA) and basilar artery (BA) in systole before and after treatment was measured with TCD and therapeutic effects were evaluated after 10 days' treatment in the two groups. Results In the acupuncture plus Ligustrazine group, the total effective rate was 93.3% and 88.5% in cases of LFVT and HFVT respectively, and BFV of VA and BA increased in LFVT patients while that in HFVT patients decreased significantly ( P P Conclusion Owing to its dual regulation on blood flow of VA and BA, the therapeutic effect of acupuncture plus Ligustrazine was better than that of simple Ligustrazine.

The changes of coronary blood circulation occur mainly due to changes in the rate of the resistance of coronary arteries. EECP is one of the new effective facilities in treatment of coronary arteries diseases and cardiac failure through increasing the flow in coronary arteries in diastole and lowering the load in systolic phase.

Background The effects of ischemia are first realized in the subendocardium and progress transmurally. Hence, detection of the transmural extent of myocardial perfusion (MP) defects has important diagnostic/prognostic implications. Systolic MP imaging using ECG-gated methods has been shown to provide improved visualization of subendocardial defects [1]. We developed an innovative non-ECGgated perfusion CMR technique capable of imaging all slices at the same systolic phase, and hypothesized that it improves visualization of the transmural extent of MP defects compared to the conventional method in CMR studies of CAD patients.

This study is to quantitatively evaluate abnormal movement of mitral apparatus (MA) in patient with congenital mitral valve regurgitation using self-designed three dimensional motion analyses software and enable doctors to intuitionistic and "en-face" visualize the mitral valve's movement by using pseudocolor coding of the moving velocity of mitral valve leaflet. Initial evaluation of the software was conducted in 20 children with congenital mitral valve regurgitation (MR) including 10 children with mild MR and 10 children with moderate to severe MR. Results showed that, the moving velocity of the rough zone of mitral valve during systolic phase in children with moderate to severe MR is much high than that in control group. It's indicated that three dimensional motion analysis of mitral valve could emerge to be a new potential useful parameter for evaluation the truly mechanism of MR

We propose a new approach for tracking the cardiac motion by using simultaneously short-axis and long-axis MR images in non-rigid registration. The fusion of two image orientations allows to track more precisely the basal and apical movement of the ventricles. In addition, the motion of the atria is tracked. Correlation coefficients were 0:94 at the systolic phase and 0:97 at the diastolic phase as the volumes of manually and automatically detected chambers were compared. The results were obtained using 7 subjects.

says that the annular dilatation process is predominantly seen in the posterior annulus and it also involves the anterior part of the annulus, although to a lesser extent than the posterior annulus. There is no structure that prevents the annulus from dilatation in the sutureless transapical replacement of the valved stent in the mitral position. Therefore, left ventricular pressure in the systolic phase of cardiac cycle and even dynamic movement of the left heart may result in the separation of the annulus from the valved stent, especially in the posterior part of the annulus in the long-term follow-up. In conclusion, it is an admirable study. We readers thank the authors for sharing their experience and knowledge of a new surgical approach to minimally invasive mitral valve replacement. The explanation of previously described points may necessitate further investigation to overcome possible fixation problems.

CSF flow dynamics has been known to have a key role the pathogenesis of syringomyelia. Our purpose was to evaluate the CSF flow pattern in syringomyelia with spatial modulation of magnetization (SPAMM) that can depict directional flow, and to determine the relationship between flow dynamics and clinical outcome after decompress surgery. We performed pre- and post-operative MRI in 9 patients with syringomyelia with SPAMM technique. They showed caudal shift of tagging bands in the syrinx cavity in systolic phase while stagnation of CSF flow was seen in diastolic phase. The degree of band shift in syrinx was well correlated with the degree of shrinkage in size of syrinx after operation. Evaluation of syringomyelia by SPAMM technique can predict postsurgical outcome after decompress surgery.

Myocardial contractility is a cyclic phenomenon regulated by individual autonomous mechanisms. In each cycle, two defined phases, may be distinguished. 1. The systolic phase corresponding to the setting in tension of the myocardial fibers and their secondary stretch. This phase has as consequence the expulsion of a part of the blood volume contained in the ventricular cavities, denominated stroke volume (SV). 2. The diastolic phase, during which a progressive relaxation of the myocardial fibers takes place, allowing the filling, also progressive, of the ventricular cavities.

In considering whether to extend β-blocker therapy to dilated cardiomyopathy, we encountered a valuable case. A 40-year-old man with dilated cardiomyopathy developed heart failure with quite poor systolic function. After administration of β-blocker, his pump function improved. In echocardiographic monitoring before β-blocker therapy, only his early diastolic filling velocity was very responsive to dobutamine loading among functional parameters, including the systolic phase. This finding supports the hypothesis that the enhancement of left ventricular filling by dobutamine loading is a useful predictor in dilated cardiomyopathy patients of whether β-blocker will be effective or not.

We report a case of flail mitral valve in an elderly man. Contrast enhanced images of the left ventricle were compared with transthoracic echocardiography. MSCT during systolic phase accurately identified the flail P2 cusp of posterior mitral valve leaflet. It can be performed non-invasively without requiring sophisticated software. Our case suggests that MSCT may have a role in preoperative assessment of coronary arteries and mitral valve apparatus before mitral valve surgery.

Digital image analysis supports diagnostic activities by highlighting geometric and temporal features of physiological phenomena that are not perceivable to the human observation. These features can be exploited to build up symbolic representations of visual data in medical reports and to index them within large databases. The comparison of such representations against descriptive queries capturing the properties of significant physiological phenomena supports new diagnostic approaches through the systematic analysis of database reports. A prototype system is presented which supports the construction of symbolic representations and their comparison against descriptive queries capturing geometric and temporal properties of time-varying 2D shapes deriving from dynamic cardiac analyses. The system is embedded within a visual shell allowing physicians to compose content-oriented queries through iconic interaction.

Purpose: To evaluate the physiologic background of aneurysms poorly visualized during 3D-TOF MRA, contrast-enhanced MRA (CEMRA) and DSA due to hemodynamic isolation. Materials and Methods: Using handmade elastic silicon phantoms to represent terminal basilar tip aneurysms, 3D-TOF MRA, CEMRA and DSA were used to determine blood turnover. Aneurysmal neck size was 2 mm and 10 mm, and the use of a pulsatile pump also helped recreate human physiologic parameters. We compared the results with those of computational fluid dynamics. Results: DSA images of the narrow-necked aneurysm showed that a small volume of contrast medium washed into it during the systolic phase. As the width of its neck increased, the turnover volume of fragments of contrast bolus also increased. At CEMRA, the broad-necked aneurysm was visualized as the main bolus of Gd-DT PA passed through it, and at delayed CEMRA, the narrow-necked aneurysm was visualized faintly after the passage of bolus Gd-DT PA. The results correlated closely with those of 3DTOF MRA and computational fluid dynamics. Conclusion: The visualization of intracranial aneurysms at 3D-TOF MRA, CEMRA and DSA was greatly dependent upon blood turnover, which varied according to aneurismal neck size. A narrow-necked aneurysm might be missed at 3D-TOF MRA, CEMRA and DSA due to hemodynamic isolation

Laser speckle is an interference phenomenon which is the result of the interference of the scattered radiations due to the roughness of the surface. By the superposition of the speckle patterns during systolic phase of the cardiac cycle, by time average speckle interfocometry and point-wise filtering methods, the absolute displacements at various locations on the chest above cardiac region are determined. The displacement cardiograph is constructed by IBM 370/155 computer in the form of a three dimensional plot. The results provide the displacement pattern of the complete heart and show that in normal subjects the displacements above the left and right ventricles, aortic and pulmonary outflow tracts are significantly higher than that of the septum region. Depending on the clinical status of the heart in cardiac patients, these patterns show the respective variations.

Pneumopericardium and hydropneumopericardium are rare conditions in which hemodynamic compromise is common. Loss of the M-mode and two-dimensional image coincident with the systolic phase of each cardiac cycle and swirling echogenic bubbles within the pericardial space produce a distinctive M-mode and two-dimensional echocardiographic appearance. This provides an additional method for prompt diagnosis.

SUMMARY In this report we describe the follow–up of two patients who underwent total correction (ventricular septation) of a Van Praagh type C single ventricle. At the time of this report the patients are 93 and 37 months after operation, have led a normal life and have nearly normal hemodynamics. Ventricular cavity volumes were estimated from biplane cineangiocardiogravns. In the first patient, left and right ventricular end–diastolic volume indexes (LVEDVI and RVEDVI) were 133 and 98 ml/m2, respectively. Left plus right ventricular end–diastolic volume (LVEDV + RVEDV) was approximately 136% of the sum of the normal values of the left and right ventricular volumes. The right–to–left ventricular end–diastolic volume ratio (RVEDV/LVEDV) was 0.74 and the right–to–left ventricular end–systolic volume ratio (RVESV/ LVESV) was 0.56. Ejection fractions of the left and right ventricles (LVEF and RVEF) were 0.50 and 0.61, respectively. In the second patient, LVEDVI and RVEDVI were 139 and 93 mI/M2, respectively. LVEDV + RVEDV was approximately 166% of the sum of the normal values of the left and right ventricular volumes. RVEDV/LVEDV and RVESV/LVESV were 0.67 and 0.50, respectively. LVEF and RVEF were 0.31 and 0.49, respectively. Cineangiocardiograms showed that the prosthetic ventricular septums shifted toward the right ventricle 7–9 mm in the systolic phase. This movement of the prosthetic septum made LVEF lower than RVEF. The shift of the prosthetic septum was dependent upon the right ventricular pressure being lower than the left. Cardiac output in response to exercisewas excellent in the first patient and poor in the second.

In the assessment of the main determinants of cardiac function the study of the systolic phase and diastolic filling appear to be of paramount importance[1–3].

1. Cine-cholangiomanometry serves to supplement conventional T-tube cholangiography by the demonstration of the common duct in its functioning phases under varying choledochal pressures.2. This modality will demonstrate the mechanism of action of the sphincter choledochus which consists of a contractile or systolic phase and a relaxation or diastolic phase.3. The morphologic changes and duration of each of these phases are recorded in normotensive and induced hypertensive states. With increasing pressures, the interval of each phase of the cycle is prolonged.4. Serial cine-cholangiom anometry offers a method of distinguishing between edematous functional obstruction and organic fibrous obstruction in the vaterian segment.5. Observations relative to pain production and the mechanism of pancreatic duct filling are discussed.

Shape changes of cardiac chambers characterize a normal cardiac cycle. The importance of shape analysis is underlined in literature by studies of several forms of cardiac disease, revealing abnormalities in shape deformations. The aim of the paper is to describe an approach to an automated extraction of endocardial contours from a single end-systolic frame obtained by color kinesis technique, applied to 4-chamber apical view echocardiographic images. Then, global and regional indexes are applied to provide a quantification of left ventricular shape both at the beginning and at the end of systolic phase. The results prove that this approach can be useful in the assessment of the cardiac functionality.

It is customary to speak of hypertension as an entity, in the same way that we might speak of fever. This is due to the fact that the clinical estimations of blood pressure in the beginning were applicable only to the systolic phase and not until more recently, after the auscultatory method had been discovered, were we able to make estimation of the diastolic pressure as well. At present it is not correct to speak of an elevation of blood pressure without designating both systolic and diastolic phases. When we study blood pressure curves by determinations that have been carried out under control conditions, we find peculiarities in the systolic and diastolic phases which make it impossible to explain the departures from normal in so simple a way as is usually done. For example, we notice elevations in both systolic and diastolic phases, and this is the most common type