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The purpose of this study was to analyze the intrahepatic perfusion redistribution after embolization of hepatic arterial variants during percutaneous arterial port catheter placement as well as to investigate the treatment efficacy of intraarterial chemotherapy in perfusion redistribution-dependent compared to redistribution-independent liver areas.This retrospective study included 62 patients (67.7% males, mean age of 56 ± 12 years). A replaced left hepatic artery was encountered in 36/62 (58.1%), a replaced right hepatic artery in 19/62 (30.6%) and a replaced left and right hepatic artery in 7/62 of patients (11.3%), respectively. Subjective perfusion analysis was performed on digital subtracted angiography and computed tomography (CT)/cone-beam computed tomography (CBCT) images evaluating the visibility of the main, segmental and subsegmental branches of the embolized variant hepatic artery, re-perfused from intrahepatic arterial anastomoses. For objective perfusion analysis ROI measurements on CT/CBCT images were taken in the redistribution-dependent and redistribution-independent liver lobe. Response analysis according to RECIST 1.1 was separately calculated for the redistribution-dependent and redistribution-independent liver lobe.Intrahepatic reperfusion of the embolized variant hepatic artery was observed immediately after embolization with visualization of the subsegmental branches in 95.2% of patients. ROI measurements on CT/CBCT images (right lobe mean 76 ± 30.2 HU, left lobe mean 74.4 ± 30.5, p-value 0.88) did not show any differences. Treatment response after intraarterial chemotherapy did not differ between the redistribution-dependent and redistribution-independent liver lobes.Embolization of hepatic arterial variants during percutaneous arterial port catheter placement results in effective intrahepatic perfusion redistribution and does not compromise treatment efficacy of intraarterial chemotherapy in the redistribution-dependent liver lobe.

Mitral annulus (MA) enlargement can be observed in various cardiac conditions but respective influence of left atrial (LA) and left ventricle (LV) size remained unclear.In 120 patients who underwent a clinically indicated 3D-transesophageal-echocardiography, 30 atrial fibrillation (AF), 30 secondary mitral regurgitation (SMR), 30 primary myxomatous mitral regurgitation (PMR) and 30 mitral stenosis (MS), we evaluated the association between MA area (MA-area) and LA volume (LAvol) measured using the biplane area-length method, end-diastolic (LVEDV) and end-systolic (LVESV) volumes measured using the biplane Simpson method. MA-area was measured based on 3D datasets using QLab10.MA-area was correlated to LVEDV (r = 0.42, p 0.0001), LVESV (r = 0.29, p = 0.001) but more markedly to LAvol (r = 0.62, p 0.0001). Correlation between MA-area and LAvol was sustained in all subsets whereas MA-area was not correlated to LVEDV and LVESV in patients with SMR and with PMR (all p 0.10). In multivariate analysis main predictors of MA-area were LAvol (p 0.0001) and myxomatous etiology of MR (p = 0.0003) followed by LVEDV (p = 0.006) and LVESV (p = 0.02).In a population of patients with a wide range of LA/LV size related to various conditions, LA volume and myxomatous MR etiology appeared as main predictors of MA size whereas LV size had a more modest influence.

Background Type 2 diabetes mellitus (DM2) is associated with a high prevalence of cardio vascular (CV) disorders including heart failure. The prevalence of asymptomatic cardiac dysfunction in DM2 remains poorly documented in patients without a history of cardio vascular disease. The purpose of DIACAR is to characterize cardiac function by doppler-echocardiography in a population of DM2 without documented CV disease. Methods One hundred and sixteen consecutive outpatients (63 males, 53 females) with DM2 were evaluated prospectively in a single center: 2D (Simpson biplane) & 3D (Heart Model Philips) left ventricular (LV) ejection fraction (EF), LV and left atrial (LA) volumes, 2D global longitudinal strain, diastolic function and LV mass index were measured. All patients with a documented history of CV disease or presenting with symptoms suggestive of any cardiac disorder were excluded. Results Patients were 57.8 ± 10.9 years old and had a history of DM2 of 12.7 ± 8.7 years. Fifty-two patients (45%) were treated with insulin. Body mass index was 29 ± 4.9 kg/m2. Mean values of the echo Doppler parameters were in the normal range ( Table 1 ). 2D Simpson EF and E/e’ were normal in all except one and two patients respectively. However, LV mass index was increased in 8/63 men and 10/53 women and LA volume index was increased in 14/116 patients whereas 2D Simpson LV volumes were all in the normal range. Finally, 2D global longitudinal strain was reduced in 44/105 patients. Conclusion In a selected population of DM2 without documented CV disease, cardiac function assessed by EF and E/e’ was in the normal range in nearly all patients. By contrast, subtle abnormalities of LV and LA morphology as well as 2D global longitudinal strain were found in a significant proportion of these asymptomatic patients. These results suggest that a systematic screening of DM2 patients by doppler- echocardiography with 2D global longitudinal strain is useful for the early detection of cardiac abnormalities.