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Abstract

Minimally invasive procedures for the kidney tumour removal require a 3D visualization of topological relations between kidney, cancer, the pelvicalyceal system and the renal vascular tree. In this paper, a novel methodology of the pelvicalyceal system segmentation is presented. It consists of four following steps: ROI designation, automatic threshold calculation for binarization (approximation of the histogram image data with three exponential functions), automatic extraction of the pelvicalyceal system parts and segmentation by the Locally Adaptive Region Growing algorithm. The proposed method was applied successfully on the Computed Tomography database consisting of 48 kidneys both healthy and cancer affected. The quantitative evaluation (comparison to manual segmentation) and visual assessment proved its effectiveness. The Dice Coefficient of Similarity is equal to 0.871 ± 0.060 and the average Hausdorff distance 0.46 ± 0.36 mm. Additionally, to provide a reliable assessment of the proposed method, it was compared with three other methods. The proposed method is robust regardless of the image acquisition mode, spatial resolution and range of image values. The same framework may be applied to further medical applications beyond preoperative planning for partial nephrectomy enabling to visually assess and to measure the pelvicalyceal system by medical doctors.
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Abstract

T h e a i m: The aim of the study is to present the initial experience with continuous flow left ventricle assist device (CF-LVAD) in pediatric patients with BSA below 1.5 m2. M a t e ri a l a n d M e t h o d s: Between 2016 and 2017, CF-LVAD (the Heartware System) have been implanted in three pediatric patients in the Department of Pediatric Cardiac Surgery, Jagiellonian University, Krakow, Poland. The indications for initiating CF-LVAD were end-stage congestive heart failure due to dilated cardiomyopathy in all children. R e s u l t s: Implanted patients have had BSA of 1.09, 1.42, 1.2 m2, and 37, 34, 34 kg of body weight and the age 12, 11, 12 years, respectively. The time of support was 550 days in two patients and 127 in another one, and is ongoing. The main complication has been driveline infection. C o n c l u s i o n: The outcomes from our single-center experience using the HeartWare CF-LVAD have been excellent with a low incidence of complication and no necessity to reoperation in our patients. Children could be successfully and safely discharged home.
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Abstract

Background: Recoarctation (reCoA) of the aorta is a common complication after the Norwood procedure. Untreated, it can lead to failure of the systemic ventricle and death. The main goal of the study is to defi ne risk factors of reCoA after the Norwood procedure in hypoplastic left heart syndrome (HLHS). Methods: We retrospectively analyzed the pre-, intra- and postoperative data of 96 successive patients who underwent the Norwood procedure between 2007 and 2011. In case of reCoA balloon angioplasty was performed. We analyzed and compared the data of the patients with reCoA and without reCoA using the StatSoft STATISTICA™ 10 soft ware. Results: ReCoA was noted in 23 patients (33.3%). Th is complication was diagnosed 95.1 days (49–156 days) on the average aft er the Norwood procedure. Balloon angioplasty successfully allowed for decreasing the mean gradient across the site of the narrowing from the average 27.5 mmHg to the average 9.7 mmHg (p = 0.008) and enlarged the neo-isthmus by the average of 2 mm (p <0.05). Th e risks factors seemed to be the diameter of the ascending aorta OR = 7.82 (p = 0.001), atresia of the mitral valve OR = 7.00 (p = 0.003) and atresia of the aortic valve — OR = 6.22 (p = 0.002). Conclusion: Balloon angioplasty seems to be an eff ective intervention in case of reCoA. A low diameter of the native ascending aorta (≤3mm) and the presence of atresia of the mitral and/or aortic valve should intensify the vigilance of a cardiologist in the search for signs of reCoA of the aorta.
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