Etiology-Discriminative Multimodal Imaging of Left Ventricular Hypertrophy and Synchrotron-Based Assessment of Microstructural Tissue Remodeling

The use of ethanol as contrast enhancer in synchrotron X-ray phase-contrast imaging leads to heterogeneous myocardial tissue shrinkage: a case report

One of the main limitations of conventional absorption-based X-ray micro-computed tomography imaging of biological samples is the low inherent X-ray contrast of soft tissue. To overcome this limitation, the use of ethanol as contrast agent has been proposed to enhance image contrast of soft tissues through dehydration. Some authors have shown that ethanol shrinks and hardens the tissue too much, also causing small tissue ruptures due to fast dehydration. However, the local tissue deformation occurring as a consequence of tissue dehydration and whether tissue shrinkage can modify myocardial architecture has not been quantified yet. The aim of this paper is to quantify the local myocardial tissue deformation due to ethanol dehydration based on 3D non-rigid registration and perform a detailed characterization of its myocardial tissue organization, before and after ethanol dehydration. A rat adult heart was imaged with synchrotron-radiation-based X-ray phase contrast imaging (X-PCI) three times: before, 9 h after and 342 h after ethanol immersion. The total volume shrinkage as well as changes in the left ventricular myocardial thickness were computed. Then, to determine local deformation of the heart caused by ethanol dehydration, the related 3D tomographic datasets were registered by means of a non-rigid registration algorithm. Finally, changes on the orientation and organization of myocytes were assessed. Our results show that the use of ethanol in synchrotron X-PCI can improve image contrast, but the tissue shrinkage is not homogeneous thus changing the local myocardial organization.

A tomographic microscopy-compatible Langendorff system for the dynamic structural characterization of the cardiac cycle

Introduction

Cardiac architecture has been extensively investigated ex vivo using a broad spectrum of imaging techniques. Nevertheless, the heart is a dynamic system and the structural mechanisms governing the cardiac cycle can only be unveiled when investigating it as such.

Methods

This work presents the customization of an isolated, perfused heart system compatible with synchrotron-based X-ray phase contrast imaging (X-PCI).

Results

Thanks to the capabilities of the developed setup, it was possible to visualize a beating isolated, perfused rat heart for the very first time in 4D at an unprecedented 2.75 μm pixel size (10.6 μm spatial resolution), and 1 ms temporal resolution.

Discussion

The customized setup allows high-spatial resolution studies of heart architecture along the cardiac cycle and has thus the potential to serve as a tool for the characterization of the structural dynamics of the heart, including the effects of drugs and other substances able to modify the cardiac cycle.

The first 200 septal myectomies: Ensuring gold standard outcomes

OBJECTIVES

Septal myectomy remains the gold standard treatment for symptomatic left ventricular outflow tract obstruction refractory to medical treatment. It is recommended that this operation be performed in dedicated hypertrophic obstructive cardiomyopathy centres by experienced surgeons. The septal myectomy option remains unavailable to many patients based solely on geography, including those who would clearly benefit more substantially from surgery than other therapeutic options. Here, we share our experience in starting new hypertrophic cardiomyopathy programmes.

METHODS

We retrospectively reviewed initial septal myectomy experiences at two hypertrophic cardiomyopathy programmes starting in 2014.

RESULTS

Two-hundred septal myectomies were performed. Mean age was 58.8 years and 51% were females. Advanced heart failure symptoms were present in 95.5% of patients and 23.5% had experienced syncope. Mean maximal intraventricular gradient was 89 mmHg and 48.5% underwent concomitant procedures at the time of septal myectomy. There was no perioperative (in-hospital or 30 days) mortality. Ninety-two per cent had provoked left ventricular gradients of ≤ 15 mmHg and 97% had none/mild mitral regurgitation at post-operative assessment. In our contemporary cohort, there were 2 (1%) intraoperative ventricular septal defects and 5% required a permanent pacemaker.

CONCLUSIONS

Our early septal myectomy experience targeted a complex population, frequently in need of concomitant procedures. Abolition of left ventricular obstruction and resolution of systolic anterior motion mediated mitral regurgitation can be expected. The safety and efficacy of septal myectomy carried at hypertrophic cardiomyopathy centres by properly trained surgeons achieved the desired outcomes established by recent hypertrophic cardiomyopathy guidelines.