nach oben

General Thoracic and Cardiovascular Surgery

Erschienen in:

19.09.2017 | Current Topics Review Article

New imaging tools in cardiovascular medicine: computational fluid dynamics and 4D flow MRI

verfasst von: Keiichi Itatani, Shohei Miyazaki, Tokoki Furusawa, Satoshi Numata, Sachiko Yamazaki, Kazuki Morimoto, Rina Makino, Hiroko Morichi, Teruyasu Nishino, Hitoshi Yaku

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 11/2017

Einloggen, um Zugang zu erhalten

Abstract

Blood flow imaging is a novel technology in cardiovascular medicine and surgery. Today, two types of blood flow imaging tools are available: measurement-based flow visualization including 4D flow MRI (or 3D cine phase-contrast magnetic resonance imaging), or echocardiography flow visualization software, and computer flow simulation modeling based on computational fluid dynamics (CFD). MRI and echocardiography flow visualization provide measured blood flow but have limitations in temporal and spatial resolution, whereas CFD flow calculates the flow according to assumptions instead of flow measurement, and it has sufficiently fine resolution up to the computer memory limit, and it enables even virtual surgery when combined with computer graphics. Blood flow imaging provides profound insight into the pathophysiology of cardiovascular diseases, because it quantifies and visualizes mechanical stress on the vessel walls or heart ventricle. Wall shear stress (WSS) is a stress on the endothelial wall caused by the near wall blood flow, and it is thought to be a predictor of atherosclerosis progression in coronary or aortic diseases. Flow energy loss (EL) is the loss of blood flow energy caused by viscous friction of turbulent diseased flow, and it is expected to be a predictor of ventricular workload on various heart diseases including heart valve disease, cardiomyopathy, and congenital heart diseases. Blood flow imaging can provide useful information for developing predictive medicine in cardiovascular diseases, and may lead to breakthroughs in cardiovascular surgery, especially in the decision-making process.

Itatani K. Advances in hemodynamics research. Nova Science Publisher. 2015.

Richter Y, Edelman ER. Cardiology is flow. Circulation. 2006;113(23):2679–82.CrossRefPubMed

Landau LD, Lifshitz EM. Course of theoretical physics. Fluid mechanics. 2nd edn. Butterworth Heinemann: 1987.

Pedrizzetti G, La Canna G, Alfieri O, Tonti G. The vortex—an early predictor of cardiovascular outcome? Nat Rev Cardiol. 2014;11(9):545–53.CrossRefPubMed

Whitehead KK, Pekkan K, Kitajima HD, Paridon SM, Yoganathan AP, Fogel MA. Nonlinear power loss during exercise in single-ventricle patients after the Fontan: insights from computational fluid dynamics. Circulation. 2007;116(11 Suppl):I165-I171.

Dasi LP, Rema RK, Kitajima HD, Pekkan K, Sundareswaran KS, Fogel M, Sharma S, Whitehead K, Kanter K, Yoganathan AP. Fontan hemodynamics: importance of artery diameter. J Thorac Cardiovasc Surg. 2009;137:560–4.CrossRefPubMedPubMedCentral

Honda T, Itatani K, Takanashi M, Mineo E, Kitagawa A, Ando H, Kimura S, Nakahata Y, Oka N, Miyaji K, Ishii M. Quantitative evaluation of hemodynamics in the Fontan circulation: a cross-sectional study measuring energy loss in vivo. Pediatr Cardiol. 2014;35(2):361–7.CrossRefPubMed

Itatani K, Ono M. Blood flow visualiziong diagnostic device. Patent WO2013077013 A1 PCT/JP2012/063484 2013-05-30.

Itatani K, Okada T, Uejima T, Tanaka T, Ono M, Miyaji K, Takenaka K. Intraventricular flow velocity vector visualization based on the continuity equation and measurements of vorticity and wall shear stress. Jpn J Appl Phys. 2013;52:07HF16.CrossRef

10.

Honda T, Itatani K, Miyaji K, Ishii M. Assessment of the vortex flow in the post-stenotic dilatation above the pulmonary valve stenosis in an infant using echocardiography vector flow mapping. Eur Heart J. 2014;35(5):306.CrossRefPubMed

11.

Stugaard M, Koriyama H, Katsuki K, Masuda K, Asanuma T, Takeda Y, Sakata Y, Itatani K, Nakatani S. Energy loss in the left ventricle obtained by vector flow mapping as a new quantitative measure of severity of aortic regurgitation: a combined experimental and clinical study. Eur Heart J Cardiovasc Imaging. 2015;16(7):723–30.CrossRefPubMed

12.

Fukuda N, Itatani K, Kimura K, Ebihara A, Negishi K, Uno K, Miyaji K, Kurabayashi M, Takenaka K. An inefficient vortex remains during the ejection period in the left ventricle with a low ejection fraction—a study by vector flow mapping-. J Med Ultrasonic. 2014;41(3):301–10.CrossRef

13.

Nabeta T, Itatani K, Miyaji K, Ako J. Vortex flow energy loss reflects therapeutic effect in dilated cardiomyopathy. Eur Heart J. 2015;36(11):637.CrossRefPubMed

14.

Hwang J, Saha A, Boo YC, Sorescu GP, McNally JS, Holland SM, Dikalov S, Giddens DP, Griendling KK, Harrison DG, Jo H. Oscillatory shear stress stimulates endothelial production of O₂—from p47phox-dependent NAD(P)H oxidases, leading to monocyte adhesion. J Biol Chem. 2003;278(47):47291–8.CrossRefPubMed

15.

Fukumoto Y, Hiro T, Fujii T, Hashimoto G, Fujimura T, Yamada J, Okamura T, Matsuzaki M. Localized elevation of shear stress is related to coronary plaque rupture: a 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution. J Am Coll Cardiol. 2008;51(6):645–50.CrossRefPubMed

16.

Chatzizisis YS, Jonas M, Coskun AU, Beigel R, Stone BV, Maynard C, Gerrity RG, Daley W, Rogers C, Edelman ER, Feldman CL, Stone PH. Prediction of the localization of high-risk coronary atherosclerotic plaques on the basis of low endothelial shear stress: an intravascular ultrasound and histopathology natural history study. Circulation. 2008;117(8):993–1002.CrossRefPubMed

17.

Numata S, Itatani K, Kanda K, Doi K, Yamazaki S, Morimoto K, Manabe K, Ikemoto K, Yaku H. Blood flow analysis of the aortic arch using computational fluid dynamics. Eur J Cardiothorac Surg. 2016;49(6):1578–85.CrossRefPubMed

18.

Yiannis S, Ahmet UC, Michael J, Elazer RE, Charles LF, Peter HS. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling. J Am Coll cardiol. 2007;49:2379–93.CrossRef

19.

Chatzizisis YS, Coskun AU, Jonas M, Edelman ER, Feldman CL, Stone PH. Role of endotherial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular and vascular behavior. J Am Coll Cardiol. 2007;49:2379–93.CrossRefPubMed

20.

Jones L, Pressdee DJ, Lamont PM, Baird RN, Murphy KP. A phase contrast (PC) rephase/dephase sequence of magnetic resonance angiography (MRA): a new technique for imaging distal run-off in the pre-operative evaluation of peripheral vascular disease. Clin Radiol. 1998;53(5):333–7.CrossRefPubMed

21.

Bogren HG, Mohiaddin RH, Kilner PJ, Jimenez-Borreguero LJ, Yang GZ, Firmin DN. Blood flow patterns in the thoracic aorta studied with three-directional MR velocity mapping: the effects of age and coronary artery disease. J Magn Reson Imaging. 1997;7(5):784–93.CrossRefPubMed

22.

Stadlbauer A, van der Riet W, Crelier G, Salomonowitz E. Accelerated time-resolved three-dimensional MR velocity mapping of blood flow patterns in the aorta using SENSE and k-t BLAST. Eur J Radiol. 2010;75(1):e15-21.CrossRefPubMed

23.

Vasanawala SS, Hanneman K, Alley MT, Hsiao A. Congenital heart disease assessment with 4D flow MRI. J Magn Reson Imaging. 2015;42:870–86.CrossRefPubMed

24.

Semaan E, Markl M, Malaisrie SC, Barker A, Allen B, McCarthy P, Carr JC, Collins JD. Haemodynamic outcome at four-dimensional flow magnetic resonance imaging following valve-sparing aortic root replacement with tricuspid and bicuspid valve morphology. Eur J Cardiothorac Surg. 2014;45(5):818–25.CrossRefPubMed

25.

Collins JD, Semaan E, Barker A, McCarthy PM, Carr JC, Markl M, Malaisrie SC. Comparison of hemodynamics after aortic root replacement using valve-sparing or bioprosthetic valved conduit. Ann Thorac Surg. 2015;100(5):1556–62.CrossRefPubMedPubMedCentral

26.

Keller EJ, Malaisrie SC, Kruse J, McCarthy PM, Carr JC, Markl M, Barker AJ, Collins JD. Reduction of aberrant aortic haemodynamics following aortic root replacement with a mechanical valved conduit. Interact Cardiovasc Thorac Surg. 2016;23(3):416–23.CrossRefPubMed

27.

Kilner PJ, Yang GZ, Mohiaddin RH, Firmin DN, Longmore DB. Helical and retrograde secondary flow patterns in the aortic arch studied by three-directional magnetic resonance velocity mapping. Circulation. 1993;88:2235–47.CrossRefPubMed

28.

Oechtering TH, Hons CF, Sieren M, Hunold P, Hennemuth A, Huellebrand M, Drexl J, Scharfschwerdt M, Richardt D, Sievers HH, Barkhausen J, Frydrychowicz A. Time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI) analysis of hemodynamics in valve-sparing aortic root repair with an anatomically shaped sinus prosthesis. J Thorac Cardiovasc Surg. 2016;152(2):418–27.CrossRefPubMed

29.

Clough RE, Waltham M, Giese D, Taylor PR, Schaeffter T. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging. J Vasc Surg. 2012;55(4):914–23.CrossRefPubMed

30.

Eriksson J, Carlhäll CJ, Dyverfeldt P, Engvall J, Bolger AF, Ebbers T. Semi-automatic quantification of 4D left ventricular blood flow. J Cardiovasc Magn Reson. 2010;12:9.CrossRefPubMedPubMedCentral

31.

Silber HA, Bluemke DA, Ouyang P, Du Y. P. P., Post WS, Lima JAC. The relationship between vascular wall shear stress and flow-mediated dilation: endothelial function assessed by phase-contrast magnetic resonance angiography. J Am Coll Cardiol. 2001;38:1859–65.CrossRefPubMed

32.

Barker AJ, Lanning C, Shandas R. Quantification of hemodynamic wall shear stress in patients with bicuspid aortic valve using phase-contrast MRI. Ann Biomed Eng. 2010;38(3):788–800.CrossRefPubMed

33.

Harloff A, Nussbaumer A, Bauer S, Stalder AF, Frydrychowicz A, Weiller C, Hennig J, Markl M. In vivo assessment of wall shear stress in the atherosclerotic aorta using flow-sensitive 4D MRI. Magn Reson Med. 2010;63(6):1529–36.CrossRefPubMed

34.

Prakash S, Ethier CR. Requirements for mesh resolution in 3D computational hemodynamics. J Biomech Eng. 2001;123(2):134–44.CrossRefPubMed

35.

Barker AJ, van Ooij P, Bandi K, Garcia J, Albaghdadi M, McCarthy P, Bonow RO, Carr J, Collins J, Malaisrie SC, Markl M. Viscous energy loss in the presence of abnormal aortic flow. Magn Reson Med. 2014;72(3):620–8.CrossRefPubMed

36.

Frauenfelder T, Lotfey M, Boehm T, Wildermuth S. Computational fluid dynamics: hemodynamic changes in abdominal aortic aneurysm after stent-graft implantation. Cardiovasc Interv Radiol. 2006;29:613–23.CrossRef

37.

Kim HB, Hertzberg JR, Shandas R. Development and validation of echo PIV. Exp Fluid. 2004;36:455–62.CrossRef

38.

Hong GR, Pedrizzetti G, Tonti G, Li P, Wei Z, Kim JK, Baweja A, Liu S, Chung N, Houle H, Narula J, Vannan MA. Characterization and quantification of vortex flow in the human left ventricle by contrast echocardiography using vector particle image velocimetry. JACC Cardiovasc Imaging. 2008;1(6):705 – 17.CrossRefPubMedPubMedCentral

39.

Faludi R, Szulik M, D’hooge J, Herijgers P, Rademakers F, Pedrizzetti G, Voigt JU. Left ventricular flow patterns in healthy subjects and patients with prosthetic mitral valves: an in vivo study using echocardiographic particle image velocimetry. J Thorac Cardiovasc Surg. 2010;139(6):1501–10.CrossRefPubMed

40.

Sengupta PP, Pedrizetti G, Narula J. Multiplanar visualization of blood flow using echocardiographic particle imaging velocimetry. JACC Cardiovasc Imaging. 2012;5(5):566–9.CrossRefPubMed

41.

Prinz C, Faludi R, Walker A, Amzulescu M, Gao H, Uejima T, Fraser AG, Voigt JU. Can echocardiographic particle image velocimetry correctly detect motion patterns as they occur in blood inside heart chambers? A validation study using moving phantoms. Cardiovasc Ultrasound. 2012;10:24.CrossRefPubMedPubMedCentral

42.

Agati L, Cimino S, Tonti G, Cicogna F, Petronilli V, De Luca L, Iacoboni C, Pedrizzetti G. Quantitative analysis of intraventricular blood flow dynamics by echocardiographic particle image velocimetry in patients with acute myocardial infarction at different stages of left ventricular dysfunction. Eur Heart J Cardiovasc Imaging. 2014;15(11):1203–12.CrossRefPubMed

43.

Adrian RJ. Particle-image technique for experimental fluid mechanics. Annu Rev Fluid Mech. 1991;23:261–304.CrossRef

44.

Ohtsuki S, Tanaka M. The flow velocity distribution from the Doppler information on a plane in three-dimensional flow. J Visual. 2006;9:69–82.CrossRef

45.

Uejima T, Koike A, Sawada H, Aizawa T, Ohtsuki S, Tanaka M, Furukawa T, Fraser AG. A new echocardiography method for identifying vortex flow in the left ventricle: numerical study. Ultrasound Med Biol. 2010;36(5):772 – 88.CrossRefPubMed

46.

Garcia D, Del Almano JC, Tanne D, Yotti R, Cortina C, Bertrand E, Antoranz JC, Perez-David E, Rieu R, Fernandez-Aviles F, Bermejo J. Two-dimensional intraventricular flow mapping by digital processing conventional color-Doppler echocardiography images. IEEE Trans Med Imaging. 2010;29(10):1701–13.CrossRefPubMed

47.

48.

Nogami Y, Ishizu T, Atsumi A, Yamamoto M, Kawamura R, Seo Y, Aonuma K. Abnormal early diastolic intraventricular flow ‘kinetic energy index’ assessed by vector flow mapping in patients with elevated filling pressure. Eur Heart J Cardiovasc Imaging. 2013;14(3):253 – 60.CrossRefPubMed

49.

Nakashima K, Itatani K, Kitamura T, Oka N, Horai T, Miyazaki S, Nie M, Miyaji K. Energy dynamics of the intraventricular vortex after mitral valve surgery. Heart Vessels. 2017. doi:10.1007/s00380-017-0967-6 (in press).PubMed

50.

Akiyama K, Nakamura N, Itatani K, Naito Y, Kinoshita M, Shimizu M, Hamaoka S, Kato H, Yasumoto H, Nakajima Y, Mizobe T, Numata S, Yaku H, Sawa T. Flow-dynamics assessment of mitral-valve surgery by intraoperative vector flow mapping. Interact Cardiovasc Thorac Surg. 2017;24(6):869–75.CrossRefPubMed

51.

Akiyama K, Itatani K, Naito Y, Kinoshita M, Shimizu M, Hamaoka S, Yasumoto H, Kato H, Nakajima Y, Numata S, Yaku H, Sawa T. Vector flow mapping and impaired left ventricular flow after the alfieri stitch. J Cardiothorac Vasc Anesth. 2017;31(1):211–4.CrossRefPubMed

52.

Chung TJ. Computational fluid dynamics. 2nd edn. Cambridge: Cambridge University. 2010.CrossRef

53.

Itatani K, Miyaji K, Tomoyasu T, Nakahata Y, Ohara K, Takamoto S, Ishii M. Optimal conduit size of the extracardiac Fontan operation based on energy loss and flow stagnation. Ann Thorac Surg 2009;88(2):565–72.CrossRef

54.

Vignon-Clementel IE, Figueroa CA, Jansen KE, Taylor CA. Outflow boundary conditions for 3D simulations of non-periodic blood flow and pressure fields in deformable arteries. Comput Methods Biomech Biomed Eng. 2010;13(5):625–40.CrossRef

55.

Hsia TY, Cosentino D, Corsini C, Pennati G, Dubini G, Migliavacca F, Modeling of Congenital Hearts Alliance (MOCHA) Investigators. Use of mathematical modeling to compare and predict hemodynamic effects between hybrid and surgical Norwood palliations for hypoplastic left heart syndrome. Circulation. 2011;124(11 Suppl):S204–210.CrossRefPubMed

56.

Goto S, Nakamura M, Itatani K, Miyazaki S, Oka N, Honda T, Kitamura T, Horai T, Ishii M, Miyaji K. Synchronization of the flow and pressure waves obtained with non-simultaneous multipoint measurements. Int Heart J. 2016;57(4):449–55.CrossRefPubMed

57.

Honda T, Itatani K, Takanashi M, Kitagawa A, Ando H, Kimura S, Nakahata Y, Oka N, Miyaji K, Ishii M. Contributions of respiration and heartbeat to the pulmonary blood flow in the Fontan circulation. Ann Thorac Surg. 2016;102(5):1596–606.CrossRefPubMed

58.

Taylor C a, Fonte T a, Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol. 2013;61:2233–41.CrossRefPubMed

59.

Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, Dunning A, DeFrance T, Lansky A, Leipsic J, Min JK. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol. 2011;58(19):1989–97.CrossRefPubMed

60.

Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, Erglis A, Lin FY, Dunning AM, Apruzzese P, Budoff MJ, Cole JH, Jaffer FA, Leon MB, Malpeso J, Mancini GB, Park SJ, Schwartz RS, Shaw LJ, Mauri L. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012;308(12):1237–45.CrossRefPubMedPubMedCentral

61.

Nørgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, Jensen JM, Mauri L, De Bruyne B, Bezerra H, Osawa K, Marwan M, Naber C, Erglis A, Park SJ1, Christiansen EH, Kaltoft A, Lassen JF, Bøtker HE, Achenbach S. NXT Trial Study Group. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63(12):1145–55.CrossRefPubMed

62.

Douglas PS, De Bruyne B, Pontone G, Patel MR, Norgaard BL, Byrne RA, Curzen N, Purcell I, Gutberlet M, Rioufol G, Hink U, Schuchlenz HW, Feuchtner G, Gilard M, Andreini D, Jensen JM, Hadamitzky M, Chiswell K, Cyr D, Wilk A, Wang F, Rogers C, Hlatky MA. 1-Year outcomes of FFRCT-guided care in patients with suspected coronary disease: the PLATFORM study. J Am Coll Cardiol. 2016;68(5):435–45.CrossRefPubMed

63.

Haggerty CM, Restrepo M, Tang E, de Zélicourt D a, Sundareswaran KS, Mirabella L, Bethel J, Whitehead KK, Fogel M a, Yoganathan AP. Fontan hemodynamics from 100 patient-specific cardiac magnetic resonance studies: a computational fluid dynamics analysis. J Thorac Cardiovasc Surg. 2013:1–10.

64.

Van Haesdonck JM, Mertens L, Sizaire R, Montas G, Purnode B, Daenen W, Crochet M, Gewillig M. Comparison by computerized numeric modeling of energy losses in different Fontan connections. Circulation. 1995;92:322–6.CrossRef

65.

Bove EL, Migliavacca F, de Leval MR, Balossino R, Pennati G, Lloyd TR, Khambadkone S, Hsia T-Y, Dubini G. Use of mathematic modeling to compare and predict hemodynamic effects of the modified Blalock–Taussig and right ventricle-pulmonary artery shunts for hypoplastic left heart syndrome. J Thorac Cardiovasc surg. 2008;136:312–320 (e2).CrossRefPubMed

66.

Pekkan K, Kitajima HD, de Zelicourt D, Forbess JM, Parks WJ, Fogel M a, Sharma S, Kanter KR, Frakes D, Yoganathan AP. Total cavopulmonary connection flow with functional left pulmonary artery stenosis: angioplasty and fenestration in vitro. Circulation. 2005;112:3264–71.CrossRefPubMed

67.

de Zélicourt D a, Pekkan K, Parks J, Kanter K, Fogel M, Yoganathan AP. Flow study of an extracardiac connection with persistent left superior vena cava. J Thorac Cardiovasc Surg. 2006;131:785–91.CrossRefPubMed

68.

Corsini Baretta a, Yang C, Vignon-Clementel W, Marsden a IE, Feinstein L, Hsia J a, Dubini T-Y, Migliavacca G, Pennati FG. Virtual surgeries in patients with congenital heart disease: a multi-scale modelling test case. Philos Transact A Math Phys Eng Sci. 2011;369:4316–30.CrossRef

69.

Qian Y, Liu JL, Itatani K, Miyaji K, Umezu M. Computational hemodynamic analysis in congenital heart disease: simulation of the Norwood procedure. Ann Biomed Eng. 2010;38(7):2302–13.CrossRefPubMed

Titel: New imaging tools in cardiovascular medicine: computational fluid dynamics and 4D flow MRI
verfasst von: Keiichi Itatani
Shohei Miyazaki
Tokoki Furusawa
Satoshi Numata
Sachiko Yamazaki
Kazuki Morimoto
Rina Makino
Hiroko Morichi
Teruyasu Nishino
Hitoshi Yaku
Publikationsdatum: 19.09.2017
Verlag: Springer Japan
Erschienen in: General Thoracic and Cardiovascular Surgery / Ausgabe 11/2017
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-017-0834-5

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2017

Rupture of the right upper pulmonary vein and left atrium caused by blunt chest trauma

Prognostic significance of neutrophil–lymphocyte ratios in large cell neuroendocrine carcinoma

Intrathoracic tumor of the chest wall: A case of Castleman’s disease mimicking myositis of the lower extremities

Challenging mitral valve repair for double-orifice mitral valve with noncompaction of left ventricular myocardium

Physiological mitral annular dynamics preserved after ring annuloplasty in mid-term period

Predictors for hilar/intrapulmonary lymph node metastasis in discrete type of clinical N1 non-small cell lung cancer

Update Chirurgie