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Deng J, Wang E, Liu G, Qin C, Dong Q, Yang W, Wang Y, Abdul Qadir R, Jia F. Feasibility and safety of cryoballoon ablation for atrial fibrillation and closing patent foramen ovale without implantation:A pilot study. Heart Rhythm 2024:S1547-5271(24)02682-1. [PMID: 38871264 DOI: 10.1016/j.hrthm.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Patent foramen ovale (PFO) affects 20%-34% of adults and is associated with strokes and other disorders. The conventional treatment of PFO-related strokes is a closure procedure. The metal device is associated with some adverse events. OBJECTIVE Our aim was to investigate the efficacy and safety of PFO closure using cryoablation without implantation in patients with atrial fibrillation (AF) who underwent pulmonary vein isolation (PVI). METHODS We divided the 22 patients with both PFO and AF who underwent PVI via cryoablation into 2 groups: standard PVI + atrial septal (AS) cryoablation group (group 1, n = 11) and standard PVI group (group 2, n = 11). The guidewire accesses the left atrium through the PFO without AS puncture during the procedure. Standard PVI via cryoablation was performed. The cryoballoon was retracted to the right atrium and inflated against the AS post-PVI. Patients in group 1 had cryoablation for 120-150 seconds, whereas patients in group 2 received sham ablation. The co-primary end points were the PFO closure rate and a composite of AF recurrence and stroke/transient ischemic attack (TIA) events. RESULTS There were no differences in procedure-related adverse events between the 2 groups. Neither group had an ischemic stroke report at 1-year follow-up. The PFO closure rate at 6 months in group 1 was significantly higher than that in group 2 (7 [63.6%] vs 1 [9.1%]; P = .002). AF recurrence post ablation was comparable in both groups at 3 months (3 [27.3%] vs 1 [9.1%]; P = .269), 6 months (0 vs 0), and 12 months (2 [18.2%%] vs 1 [9.1%]; P = .534) of follow-up. CONCLUSION Cryoablation is a safe and effective approach to close PFO in patients with AF undergoing PVI in a single procedure.
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Affiliation(s)
- Jiang Deng
- Department of Cardiovascular Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - EnRun Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - ChunChang Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - YanFei Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rana Abdul Qadir
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fengpeng Jia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Wakamatsu Y, Nagashima K, Watanabe R, Hirata S, Hirata M, Okumura Y. Beyond the lens: Unveiling the invisible atrioventricular node in the era of high-density mapping. J Cardiol 2024:S0914-5087(24)00099-6. [PMID: 38834137 DOI: 10.1016/j.jjcc.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
Numerous studies have clarified the histological characteristics of the area surrounding the atrioventricular (AV) node, commonly referred to as the triangle of Koch (ToK). Although it is suggested that the conduction of electric impulses from the atria to the ventricles via the AV node involves myocytes possessing distinct conduction properties and gap junction proteins, a comprehensive understanding of this complex conduction has not been fully established. Moreover, although various pathways have been proposed for both anterograde and retrograde conduction during atrioventricular nodal reentrant tachycardia (AVNRT), the reentrant circuits of AVNRT are not fully elucidated. Therefore, the slow pathway ablation for AVNRT has been conventionally performed, targeting both its anatomical location and slow pathway potential obtained during sinus rhythm. Recently, advancements in high-density three-dimensional (3D) mapping systems have facilitated the acquisition of more detailed electrophysiological potentials within the ToK. Several studies have indicated that the activation pattern, the low-voltage area within the ToK obtained during sinus rhythm, and the fractionated potentials acquired during tachycardia may be optimal targets for slow pathway ablation. This review provides an overview of the tissue surrounding the AV node as reported to date and summarizes the current understanding of AV conduction and AVNRT circuits. Furthermore, we discuss recent findings on slow pathway ablation utilizing high-density 3D mapping systems, exploring strategies for optimal slow pathway ablation.
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Affiliation(s)
- Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shu Hirata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Moyuru Hirata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Fan L, Wang H, Kassab GS, Lee LC. Review of cardiac-coronary interaction and insights from mathematical modeling. WIREs Mech Dis 2024; 16:e1642. [PMID: 38316634 PMCID: PMC11081852 DOI: 10.1002/wsbm.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/10/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
Cardiac-coronary interaction is fundamental to the function of the heart. As one of the highest metabolic organs in the body, the cardiac oxygen demand is met by blood perfusion through the coronary vasculature. The coronary vasculature is largely embedded within the myocardial tissue which is continually contracting and hence squeezing the blood vessels. The myocardium-coronary vessel interaction is two-ways and complex. Here, we review the different types of cardiac-coronary interactions with a focus on insights gained from mathematical models. Specifically, we will consider the following: (1) myocardial-vessel mechanical interaction; (2) metabolic-flow interaction and regulation; (3) perfusion-contraction matching, and (4) chronic interactions between the myocardium and coronary vasculature. We also provide a discussion of the relevant experimental and clinical studies of different types of cardiac-coronary interactions. Finally, we highlight knowledge gaps, key challenges, and limitations of existing mathematical models along with future research directions to understand the unique myocardium-coronary coupling in the heart. This article is categorized under: Cardiovascular Diseases > Computational Models Cardiovascular Diseases > Biomedical Engineering Cardiovascular Diseases > Molecular and Cellular Physiology.
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Affiliation(s)
- Lei Fan
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Haifeng Wang
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, California, USA
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
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4
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Batko J, Jakiel R, Krawczyk-Ożóg A, Litwinowicz R, Hołda J, Bartuś S, Bartuś K, Hołda MK, Konieczyńska M. Definition and anatomical description of the left atrial appendage neck. Clin Anat 2024; 37:201-209. [PMID: 38031393 DOI: 10.1002/ca.24125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
The left atrial appendage (LAA) is well known as a source of cardiac thrombus formation. Despite its clinical importance, the LAA neck is still anatomically poorly defined. Therefore, this study aimed to define the LAA neck and determine its morphometric characteristics. We performed three-dimensional reconstructions of the heart chambers based on contrast-enhanced electrocardiography-gated computed tomography scans of 200 patients (47% females, 66.5 ± 13.6 years old). The LAA neck was defined as a truncated cone-shaped canal bounded proximally by the LAA orifice and distally by the lobe origin and was present in 98.0% of cases. The central axis of the LAA neck was 14.7 ± 2.3 mm. The mean area of the LAA neck walls was 856.6 ± 316.7 mm2 . The LAA neck can be divided into aortic, arterial (the smallest), venous (the largest), and free surfaces. All areas have a trapezoidal shape with a broader proximal base. There were no statistically significant differences in the morphometric characteristics of the LAA neck between LAA types. Statistically significant differences between the sexes in the main morphometric parameters of the LAA neck were found in the central axis length and the LAA neck wall area. The LAA neck can be evaluated from computed tomography scans and their three-dimensional reconstructions. The current study provides a complex morphometric analysis of the LAA neck. The precise definition and morphometric details of the LAA neck presented in this study may influence the effectiveness and safety of LAA exclusion procedures.
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Affiliation(s)
- Jakub Batko
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Jakiel
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Agata Krawczyk-Ożóg
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, Krakow, Poland
| | - Radosław Litwinowicz
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland
| | - Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, Krakow, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Department of Diagnostic Medicine, John Paul II Hospital in Kraków, Krakow, Poland
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Małgorzata Konieczyńska
- Department of Diagnostic Medicine, John Paul II Hospital in Kraków, Krakow, Poland
- Department of Thromboembolic Diseases, Jagiellonian University Medical College, Cracow, Poland
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5
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Haq IU, Shabtaie SA, Tan NY, Lachman N, Asirvatham SJ. Anatomy of the Ventricular Outflow Tracts: An Electrophysiology Perspective. Clin Anat 2024; 37:43-53. [PMID: 37337379 DOI: 10.1002/ca.24083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
Outflow tract ventricular arrhythmias are the most common type of idiopathic ventricular arrhythmia. A systematic understanding of the outflow tract anatomy improves procedural efficacy and enables electrophysiologists to anticipate and prevent complications. This review emphasizes the three-dimensional spatial relationships between the ventricular outflow tracts using seven anatomical principles. In turn, each principle is elaborated on from a clinical perspective relevant for the practicing electrophysiologist. The developmental anatomy of the outflow tracts is also discussed and reinforced with a clinical case.
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Affiliation(s)
- Ikram U Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel A Shabtaie
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nirusha Lachman
- Department of Anatomy, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Pandozi C, Matteucci A, Galeazzi M, Russo M, Lavalle C, Ficili S, Malacrida M, Colivicchi F. New insights into atrioventricular nodal anatomy, physiology, and immunochemistry: A comprehensive review and a proposed model of the slow-fast atrioventricular nodal reentrant tachycardia circuit in agreement with direct potential recordings in the Koch's triangle area. Heart Rhythm 2023; 20:614-626. [PMID: 36634901 DOI: 10.1016/j.hrthm.2023.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent regular tachycardia in humans. In this review, we describe the most recent discoveries regarding the anatomical, physiological, and molecular biological features of the atrioventricular junction that could underlie the typical slow-fast AVNRT mechanisms, as these insights could lead to the proposal of a new theory concerning the circuit of this arrhythmia. Despite several models have been proposed over the years, the precise anatomical site of the reentrant circuit and the pathway involved in the slow-fast AVNRT have not been conclusively defined. One possible way to evaluate all the hypotheses regarding the nodal tachycardia circuit in humans is to map this circuit. Thus, we tried to identify the slow potential of nodal and inferior extension structures by using automated mapping of atrial activation during both sinus rhythm and typical slow-fast AVNRT. This constitutes a first step toward the definition of nodal area activation in sinus rhythm and during slow-fast AVNRT. Further studies and technical improvements in recording the potentials of the atrioventricular node structures are necessary to confirm our initial results.
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Affiliation(s)
- Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy.
| | | | - Marco Galeazzi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy
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7
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Koshiyama H, Ishidou M, Ito H, Hirose K, Sakamoto K, Ikai A. Simplified primum ASD closure technique in complete VSD repair: shallow suture crossing on the AV node. Gan To Kagaku Ryoho 2022; 71:321-322. [PMID: 36572755 DOI: 10.1007/s11748-022-01901-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
The primum atrial septal defect suture line adjacent to the crux is performed carefully with various techniques to avoid atrioventricular block in repair of complete atrioventricular septal defect. We describe our technical modification to simplify the shallow suture line only into the endocardium above the atrioventricular node without conduction disturbance.
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Affiliation(s)
- Hiroshi Koshiyama
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama Aoi-Ku, Shizuoka, 420-8660, Japan
| | - Motonori Ishidou
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama Aoi-Ku, Shizuoka, 420-8660, Japan
| | - Hiroki Ito
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama Aoi-Ku, Shizuoka, 420-8660, Japan
| | - Keiichi Hirose
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama Aoi-Ku, Shizuoka, 420-8660, Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama Aoi-Ku, Shizuoka, 420-8660, Japan
| | - Akio Ikai
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama Aoi-Ku, Shizuoka, 420-8660, Japan.
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Yamane K, Takahashi Y, Fujii H, Morisaki A, Sakon Y, Kishimoto N, Kawase T, Ohsawa M, Shibata T. Histology of the tricuspid valve annulus and right atrioventricular muscle distance. Interact Cardiovasc Thorac Surg 2022; 35:6633938. [PMID: 35801928 PMCID: PMC9318885 DOI: 10.1093/icvts/ivac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/31/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kokoro Yamane
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Noriaki Kishimoto
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Takumi Kawase
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
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Jansen H, Nürnberg JH, Veltmann C, Hebe J. Anatomy for ablation of atrioventricular nodal reentry tachycardia and accessory pathways. Herzschrittmacherther Elektrophysiol 2022; 33:133-147. [PMID: 35608665 DOI: 10.1007/s00399-022-00860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
The atrioventricular (AV) valve plane and the central septum are of particular importance for electrophysiological diagnosis and interventional therapy of supraventricular tachycardias because accessory electrical connections of various types may be present in addition to the specific conduction system. Although modern 3D electroanatomic reconstruction systems including high-density mapping can be of great assistance, detailed knowledge of the anatomic structures involved, their complex three-dimensional arrangement, and their electrical properties in conjunction with electrophysiological features of supraventricular arrhythmias is essential for safe and efficient electrophysiological treatment. The aim of this article is to present current anatomical, topographical, and electrophysiological findings against the background of historical, seminal, and still indispensable literature.
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Tsuda D, Mori S, Izawa Y, Toh H, Suzuki M, Takahashi Y, Toba T, Fujiwara S, Tanaka H, Watanabe Y, Kono AK, Hirata KI. Diversity and determinants of the sigmoid septum and its impact on morphology of the outflow tract as revealed using cardiac computed tomography. Echocardiography 2022; 39:248-259. [PMID: 35038184 DOI: 10.1111/echo.15298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/27/2021] [Accepted: 01/01/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The sigmoid septum has been generally evaluated subjectively and qualitatively, without detailed examination of its diversity, impact on the morphology of the left ventricular outflow tract (LVOT), and anatomical background. METHODS We enrolled 100 patients without any background cardiac diseases (67.5 ± 12.8 years old; 43% women) who underwent cardiac computed tomography. Basal septal morphology was evaluated using antero-superior and medial bulging angles (bidirectional angulation of the basal septum relative to the LVOT). The eccentricity index of the LVOT, area narrowing ratio (LVOT/virtual basal ring area), aortic-to-left ventricular axial angle (angulation of the aortic root relative to the left ventricle), and wedged height (non-coronary aortic sinus to inferior epicardium distance) were also quantified. RESULTS The antero-superior bulging, medial bulging, aortic-to-left ventricular axial angles, LVOT eccentricity index, area narrowing ratio, and wedged height were 76° ± 17°, 166° ± 27°, 127° ± 9°, 1.8 ± 0.5, 1.0 ± 0.2, and 41.2 ± 9.1 mm, respectively. Both bulging angles were correlated with each other and contributed to the narrowing and deformation of the LVOT. Angulated aortic root was not correlated with either bidirectional septal bulge or LVOT narrowing. Clockwise rotation of the aortic root rotation was an independent predictor of prominent antero-superior septal bulge. Deeper aortic wedging was a common independent predictor of bidirectional septal bulge. CONCLUSIONS The extent of septal bulge varies in normal hearts. Along with deep aortic wedging, the bidirectional bulge of the basal septum deforms and narrows the LVOT without affecting the virtual basal ring morphology.
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Affiliation(s)
- Daisuke Tsuda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masataka Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Ahn Y, Koo HJ, Kang JW, Yang DH. Tricuspid Valve Imaging and Right Ventricular Function Analysis Using Cardiac CT and MRI. Korean J Radiol 2021; 22:1946-1963. [PMID: 34668349 PMCID: PMC8628151 DOI: 10.3348/kjr.2020.1507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022] Open
Abstract
Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (CMR) can reveal the detailed anatomy and function of the tricuspid valve and right ventricle (RV). Quantification of tricuspid regurgitation (TR) and analysis of RV function have prognostic implications. With the recently available transcatheter treatment options for diseases of the tricuspid valve, evaluation of the tricuspid valve using CT and CMR has become important in terms of patient selection and procedural guidance. Moreover, CT enables post-procedural investigation of the causes of valve dysfunction, such as pannus or thrombus. This review describes the anatomy of the tricuspid valve and CT and CMR imaging protocols for right heart evaluation, including RV function and TR analyses. We also demonstrate the pre-procedural planning for transcatheter treatment of TR and imaging of postoperative complications using CT.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Schlossbauer SA, Faletra FF, Paiocchi VL, Leo LA, Franciosi G, Bonanni M, Angelini G, Pavon AG, Ferrari E, Ho SY, Hahn RT. Multimodality Imaging of the Anatomy of Tricuspid Valve. J Cardiovasc Dev Dis 2021; 8:jcdd8090107. [PMID: 34564125 PMCID: PMC8469874 DOI: 10.3390/jcdd8090107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Even though the tricuspid valve is no longer “forgotten”, it still remains poorly understood. In this review, we focus on some controversial and still unclear aspects of tricuspid anatomy as illustrated by noninvasive imaging techniques. In particular, we discuss the anatomical architecture of the so-called tricuspid annulus with its two components (i.e., the mural and the septal annulus), emphasizing the absence of any fibrous “ring” around the right atrioventricular junction. Then we discussed the extreme variability in number and size of leaflets (from two to six), highlighting the peculiarities of the septal leaflet as part of the septal atrioventricular junction (crux cordis). Finally, we describe the similarities and differences between the tricuspid and mitral valve, suggesting a novel terminology for tricuspid leaflets.
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Affiliation(s)
- Susanne Anna Schlossbauer
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Francesco Fulvio Faletra
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
- Correspondence: ; Tel.: +41-91-805-3179; Fax: +41-91-805-3167
| | - Vera Lucia Paiocchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Laura Anna Leo
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Giorgio Franciosi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Michela Bonanni
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Gianmarco Angelini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Anna Giulia Pavon
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Enrico Ferrari
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London SW36NP, UK;
| | - Rebecca T. Hahn
- Cardiovascular Research Foundation, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA;
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13
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Rigby M. Atrioventricular Septal Defect: What Is in a Name? J Cardiovasc Dev Dis 2021; 8:19. [PMID: 33671890 PMCID: PMC7918985 DOI: 10.3390/jcdd8020019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022] Open
Abstract
Robert Anderson has made a huge contribution to almost all aspects of morphology and understanding of congenital cardiac malformations, none more so than the group of anomalies that many of those in the practice of paediatric cardiology and adult congenital heart disease now call 'Atrioventricular Septal Defect' (AVSD). In 1982, with Anton Becker working in Amsterdam, their hallmark 'What's in a name?' editorial was published in the Journal of Thoracic and Cardiovascular Surgery. At that time most described the group of lesions as 'atrioventricular canal malformation' or 'endocardial cushion defect'. Perhaps more significantly, the so-called ostium primum defect was thought to represent a partial variant. It was also universally thought, at that time, that the left atrioventricular valve was no more than a mitral valve with a cleft in the aortic leaflet. In addition to this, lesions such as isolated cleft of the mitral valve, large ventricular septal defects opening to the inlet of the right and hearts with straddling or overriding tricuspid valve were variations of the atrioventricular canal malformation. Anderson and Becker emphasised the differences between the atrioventricular junction in the normal heart and those with a common junction for which they recommended the generic name, 'atrioventricular septal defect'. As I will discuss, over many years, they continued to work with clinical cardiologists and cardiac surgeons to refine diagnostic criteria and transform the classification and understanding of this complex group of anomalies. Their emphasis was always on accurate diagnosis and communication, which is conveyed in this review.
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Affiliation(s)
- Michael Rigby
- MD FRCP FRCPCH, Royal Brompton Hospital, London SW3 6NP, UK
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14
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De Almeida MC, Mori S, Anderson RH. Three-dimensional visualization of the bovine cardiac conduction system and surrounding structures compared to the arrangements in the human heart. J Anat 2021; 238:1359-1370. [PMID: 33491213 DOI: 10.1111/joa.13397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022] Open
Abstract
In the human heart, the atrioventricular node is located toward the apex of the triangle of Koch, which is also at the apex of the inferior pyramidal space. It is adjacent to the atrioventricular portion of the membranous septum, through which it penetrates to become the atrioventricular bundle. Subsequent to its penetration, the conduction axis is located on the crest of the ventricular septum, sandwiched between the muscular septum and ventricular component of the membranous septum, where it gives rise to the ramifications of the left bundle branch. In contrast, the bovine conduction axis has a long non-branching component, which penetrates into a thick muscular atrioventricular septum having skirted the main cardiac bone and the rightward half of the non-coronary sinus of the aortic root. It commonly gives rise to both right and left bundle branches within the muscular ventricular septum. Unlike the situation in man, the left bundle branch is long and thin before it branches into its fascicles. These differences from the human heart, however, have yet to be shown in three-dimensions relative to the surrounding structures. We have now achieved this goal by injecting contrast material into the insulating sheaths that surround the conduction network, evaluating the results by subsequent computed tomography. The fibrous atrioventricular membranous septum of the human heart is replaced in the ox by the main cardiac bone and the muscular atrioventricular septum. The apex of the inferior pyramidal space, which in the bovine, as in the human, is related to the atrioventricular node, is placed inferiorly relative to the left ventricular outflow tract. The bovine atrioventricular conduction axis, therefore, originates from a node itself located inferiorly compared to the human arrangement. The axis must then skirt the non-coronary sinus of the aortic root prior to penetrating the thicker muscular ventricular septum, thus accounting for its long non-branching course. We envisage that our findings will further enhance comparative anatomical research.
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Affiliation(s)
- Marcos C De Almeida
- Department of Genetics and Morphology, Brasilia's University, Brasilia, Brazil
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
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15
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Ho SY. Anatomy of the Atrioventricular Junction, Atrioventricular Grooves, and Accessory Pathways. Card Electrophysiol Clin 2020; 12:437-445. [PMID: 33161994 DOI: 10.1016/j.ccep.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Accessory pathways that bypass all or part of the normal atrioventricular conduction system traverse the atrioventricular junction. The atrioventricular junction comprises of a limited septal component and much more extensive right and left parietal components. Its composition forms a plane of insulation between atrial and ventricular myocardium, preventing direct continuity between them. Typical accessory atrioventricular pathways located anywhere along the atrioventricular junction are muscle bundles or may involve muscle around the walls of coronary sinus aneurysms or coronary veins. Increasingly, variants or unusual accessory pathways, some involving an accessory node, are reported in clinical studies.
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Affiliation(s)
- Siew Yen Ho
- Cardiac Morphology, Imperial College London, Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, UK.
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16
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Gumpangseth T, Lekawanvijit S, Mahakkanukrauh P. Histological assessment of the human heart valves and its relationship with age. Anat Cell Biol 2020; 53:261-271. [PMID: 32727956 PMCID: PMC7527117 DOI: 10.5115/acb.20.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022] Open
Abstract
The human heart valves are complex anatomical structures consisting of leaflets with many supporting structures. With advancing age, the microstructure of the components of the valves can change. Knowledge and understanding of the anatomical relationships between the different components of the heart valve structures and their relationship with age is crucial for the development and progression of treatment of valvular disease. The purpose of this study was to determine histological changes of the components of the heart valves and their relationship with age. Fifty hearts taken from cadavers were included to examine the histology of the tricuspid, mitral, pulmonary, and aortic valves. All specimens were stained with Elastic Van Gieson, and picrosirius red to enable the evaluation of elastic and collagen fibers, respectively. There was a gradual increase in elastic and collagen fibers with advancing age, particularly over 40 years, in all valve types. In the case of tricuspid and mitral valves increases in collagen and elastic fibers were observed starting in the fifth decade. Elastic fiber fragmentation was observed in specimens over 50 years. In the case of the pulmonary and the aortic valves, collagen fibers were denser and more irregular in the sixth to seventh decades when compared to younger ages while elastic fibers were significantly increased in the sixth decade. In addition, an increase in fat deposition had an association with aging. These findings provide additional basic knowledge in age-related morphological changes of the heart valves and will increase understanding concerning valvular heart diseases and treatment options.
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Affiliation(s)
- Treerat Gumpangseth
- PhD Degree Program in Anatomy, Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suree Lekawanvijit
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, Thailand
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17
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Wang Y, Liu L, Lakin R, Polidovitch N, Liu G, Yang H, Yu M, Yan M, Zhao D, Backx PH, Sun H, He Y, Yang P. Revisiting right anterior oblique projections for the triangle of Koch: implications from computed tomography. BMC Cardiovasc Disord 2020; 20:383. [PMID: 32838758 PMCID: PMC7446209 DOI: 10.1186/s12872-020-01632-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022] Open
Abstract
Background Variability in the anatomy and orientation of the triangle of Koch (TK) complicates ablation procedures involving the atrioventricular (AV) node. We used CT angiography (CTA) to assess the anatomical TK orientation, the CS ostium direction, and the relationship between the two, and we validated an individualized CS-guided projection during ablation procedures. Methods In 104 patients without structural heart disease undergoing computed tomography (CT) angiography, TK orientations were determined in relation to the coronary sinus ostium (CSo) as well as two standard right anterior oblique (RAO) projection angles (30o and 45o) commonly used in ablation procedures. Results A CS-guided RAO projection (RAOCS) was shown to best track the orientation of the TK compared to RAO30° and 45°, with TK orientation strongly correlating with the CSo direction (r = 0.86, P < 0.001). In addition, the mean relative difference between the angle of the CSo and TK orientation was 5.54 ± 0.48°, consistent with a reduction in the degree of image shortening compared to traditional RAOs. Moreover, in vivo validation following ablation revealed that using a CS-guided projection limited the degree of on-screen image shortening compared to both the RAO30° and 45° in 25 patients with catheter ablation procedures. Conclusion In hearts with a normal structure, the CSo direction offers a reliable predictor of the TK orientation which can be used to guide the projection of the TK during ablation procedures.
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Affiliation(s)
- Yanjing Wang
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai street, Changchun, Jilin Province, 130033, China
| | - Lin Liu
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai street, Changchun, Jilin Province, 130033, China
| | - Robert Lakin
- Department of Biology, York University, 4700 Keele Street, Toronto, ON, Canada
| | - Nazari Polidovitch
- Department of Biology, York University, 4700 Keele Street, Toronto, ON, Canada
| | - Guohui Liu
- Cardiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin Province, 130033, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin Province, 130033, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, 130033, China
| | - Hongliang Yang
- Cardiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin Province, 130033, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin Province, 130033, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, 130033, China
| | - Ming Yu
- Cardiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin Province, 130033, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin Province, 130033, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, 130033, China
| | - Mingzhou Yan
- Cardiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin Province, 130033, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin Province, 130033, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, 130033, China
| | - Dong Zhao
- Cardiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin Province, 130033, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin Province, 130033, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, 130033, China
| | - Peter H Backx
- Department of Biology, York University, 4700 Keele Street, Toronto, ON, Canada
| | - Huan Sun
- Cardiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin Province, 130033, China. .,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin Province, 130033, China. .,Jilin Provincial Cardiovascular Research Institute, Changchun, 130033, China.
| | - Yuquan He
- Cardiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin Province, 130033, China. .,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin Province, 130033, China. .,Jilin Provincial Cardiovascular Research Institute, Changchun, 130033, China.
| | - Ping Yang
- Cardiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin Province, 130033, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin Province, 130033, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, 130033, China
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18
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Kibler M, Marzak H, Jesel L, Ohlmann P. High-grade atrioventricular block occurring during percutaneous closure of patent foramen ovale: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32974462 PMCID: PMC7501918 DOI: 10.1093/ehjcr/ytaa141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/12/2020] [Accepted: 05/05/2020] [Indexed: 12/02/2022]
Abstract
Background Percutaneous closure of patent foramen ovale (PFO) is recommended for patients presenting with PFO-related stroke. Acute high-grade conduction disturbances occurring during PFO closure procedure have not been previously reported. Case summary We describe for the first time a case of reversible complete atrioventricular block which occurred during closure of a PFO. Discussion We hypothesized that the block was the result of atrioventricular node compression—likely caused by the right-atrial disc of the 35-mm PFO closure device. We suggest implanting smaller devices in order to prevent atrioventricular conduction disturbances.
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Affiliation(s)
- Marion Kibler
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426 - 67091 Strasbourg, France
| | - Halim Marzak
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426 - 67091 Strasbourg, France
| | - Laurence Jesel
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426 - 67091 Strasbourg, France
- UMR 1260 INSERM Nanomédecine Régénérative Université de Strasbourg, Strasbourg, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, BP 426 - 67091 Strasbourg, France
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19
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20
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Mathur M, Meador WD, Jazwiec T, Malinowski M, Timek TA, Rausch MK. The Effect of Downsizing on the Normal Tricuspid Annulus. Ann Biomed Eng 2020; 48:655-668. [PMID: 31659604 PMCID: PMC8353055 DOI: 10.1007/s10439-019-02387-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/11/2019] [Indexed: 12/17/2022]
Abstract
Tricuspid annuloplasty is a surgical procedure that cinches the valve's annulus in order to reduce regurgitant blood flow. One of its critical parameters is the degree of downsizing. To provide insight into the effect of downsizing, we studied the annulus of healthy sheep during suture annuloplasty. To this end, we implanted fiduciary markers along the annulus of sheep and subsequently performed a DeVega suture annuloplasty. We performed five downsizing steps in each animal while recording hemodynamic and sonomicrometry data in beating hearts. Subsequently, we used splines to approximate the annulus at baseline and at each downsizing step. Based on these approximations we computed clinical metrics of annular shape and dynamics, and the continuous field metrics height, strain, and curvature. With these data, we demonstrated that annular area reduction during downsizing was primarily driven by compression of the anterior annulus. Similarly, reduction in annular dynamics was driven by reduced contractility in the anterior annulus. Finally, changes in global height and eccentricity of the annulus could be explained by focal changes in the continuous height profile and changes in annular curvature. Our findings are important as they provide insight into a regularly performed surgical procedure and may inform the design of transcatheter devices that mimic suture annuloplasty.
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Affiliation(s)
- Mrudang Mathur
- Department of Mechanical Engineering, University of Texas at Austin, 204 E Dean Keeton Street, Austin, TX, 78712, USA
| | - William D Meador
- Department of Biomedical Engineering, University of Texas at Austin, 107 W Dean Keeton Street, Austin, TX, 78712, USA
| | - Tomasz Jazwiec
- Silesian Centre for Heart Diseases, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Marcin Malinowski
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, 49503, USA
| | - Manuel K Rausch
- Departments of Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, University of Texas at Austin, 2617, Wichita Street, Austin, TX, 78712, USA.
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21
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Truong BL, Jouk PS, Auriau J, Michalowicz G, Usson Y. Polarized Light Imaging of the Myoarchitecture in Tetralogy of Fallot in the Perinatal Period. Front Pediatr 2020; 8:503054. [PMID: 33072668 PMCID: PMC7536283 DOI: 10.3389/fped.2020.503054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The pathognomonic feature of tetralogy of Fallot (ToF) is the antero-cephalad deviation of the outlet septum in combination with an abnormal arrangement of the septoparietal trabeculations. Aims: The aim of this article was to study perinatal hearts using Polarized Light Imaging (PLI) in order to investigate the deep alignment of cardiomyocytes that bond the different components of the ventricular outflow tracts both together and to the rest of the ventricular mass, thus furthering the classic description of ToF. Methods and Materials: 10 perinatal hearts with ToF and 10 perinatal hearts with no detectable cardiac anomalies (control) were studied using PLI. The orientation of the myocardial cells was extracted and studied at high resolution. Virtual dissections in multiple section planes were used to explore each ventricular structure. Results and Conclusions: Contrary to the specimens of the control group, for all ToF specimens studied, the deep latitudinal alignment of the cardiomyocytes bonds together the left part of the Outlet septum (OS) S to the anterior wall of the left ventricle. In addition, the right end of the muscular OS bonds directly on the right ventricular wall (RVW) superior to the attachment of the ventriculo infundibular fold (VIF). Thus, the OS is a bridge between the lateral RVW and the anterior left ventricular wall. The VIF, RVW, and OS define an "inverted U" that roofs the cone between the interventricular communication and the overriding aorta. The opening angle and the length of the branches of this "inverted U" depend however on three components: the size of the OS, the size of the VIF, and the distance between the points of insertion of the OS and VIF into the RVW. The variation of these three components accounts for a significant part of the diversity observed in the anatomical presentations of ToF in the perinatal period.
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Affiliation(s)
- Ba Luu Truong
- Centre National de la Recherche Scientifique (CNRS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques, Applications, Grenoble (TIMC-IMAG), Grenoble, France.,Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital, Paris, France.,Department of Pediatric Cardiology, Nhi Dong 2 Children Hospital, Ho Chi Minh City, Vietnam
| | - Pierre-Simon Jouk
- Centre National de la Recherche Scientifique (CNRS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques, Applications, Grenoble (TIMC-IMAG), Grenoble, France.,Department of Genetics and Procreation, Grenoble-Alpes University Hospital, Grenoble, France
| | - Johanne Auriau
- Department of Cardiology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Gabrielle Michalowicz
- Centre National de la Recherche Scientifique (CNRS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques, Applications, Grenoble (TIMC-IMAG), Grenoble, France
| | - Yves Usson
- Centre National de la Recherche Scientifique (CNRS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques, Applications, Grenoble (TIMC-IMAG), Grenoble, France
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22
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Functional Regurgitation of Atrioventricular Valves and Atrial Fibrillation: An Elusive Pathophysiological Link Deserving Further Attention. J Am Soc Echocardiogr 2020; 33:42-53. [DOI: 10.1016/j.echo.2019.08.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 12/15/2022]
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23
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A comprehensive review of the anatomical variations in the right atrium and their clinical significance. TRANSLATIONAL RESEARCH IN ANATOMY 2019. [DOI: 10.1016/j.tria.2019.100046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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24
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Rausch MK, Mathur M, Meador WD. Biomechanics of the Tricuspid Annulus: A Review of the Annulus' In Vivo Dynamics With Emphasis on Ovine Data. MITTEILUNGEN DER GESELLSCHAFT FUR ANGEWANDTE MATHEMATIK UND MECHANIK 2019; 42:e201900012. [PMID: 38690196 PMCID: PMC11058966 DOI: 10.1002/gamm.201900012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/28/2019] [Indexed: 05/02/2024]
Abstract
The tricuspid annulus forms the boundary between the tricuspid valve leaflets and their surrounding perivalvular tissue of the right atrioventricular junction. Its shape changes throughout the cardiac cycle in response to the forces from the contracting right heart myocardium and the blood-valve interaction. Alterations to annular shape and dynamics in disease lead to valvular dysfunctions such as tricuspid regurgitation from which millions of patients suffer. Successful treatment of such dysfunction requires an in-depth understanding of the normal shape and dynamics of the tricuspid annulus and of the changes following disease and subsequent repair. In this manuscript we review what we know about the shape and dynamics of the normal tricuspid annulus and about the effects of both disease and repair based on non-invasive imaging studies and invasive fiduciary marker-based studies. We further show, by means of ovine data, that detailed engineering analyses of the tricuspid annulus provide regionally-resolved insight into the kinematics of the annulus which would remain hidden if limiting analyses to simple geometric metrics.
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Affiliation(s)
- Manuel K. Rausch
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
| | - Mrudang Mathur
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
| | - William D. Meador
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
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25
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Gumpangseth T, Mahakkanukrauh P, Das S. Gross age-related changes and diseases in human heart valves. Anat Cell Biol 2019; 52:25-33. [PMID: 30984448 PMCID: PMC6449582 DOI: 10.5115/acb.2019.52.1.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Abstract
Cardiac valves are highly complex structures optimizing their function during the cardiac cycle. They open and close directed by blood flow under different pressure conditions in the dynamic environment in the heart. It is acknowledged that the aging process affects the structure and functions of the heart valves. With regard to morphometry, age-related changes of the heart valve can be found in valve circumference, thickness of the leaflet, luminal area at the sinotubular junction, valve diameter, orifice area, and leaflet size in circumferential and radial direction. In addition, there are differences between male and female hearts in some features. Moreover, there are studies the qualitative and quantitative assessment of histological compositions, echocardiography study to investigate the annular circumference and diameter in the human heart valves related with age. Studies into the detailed anatomy of the changes in heart valves with age are important and the correlation between valve morphology and age may be used as an age indicator. This study reviews the basic anatomical structure of the heart valves, age-related changes of valve morphometry, heart valve diseases, and general treatment of valvular diseases in humans. Detailed knowledge of the anatomical features of the morphology of the human heart valve is useful for any treatments of valve pathology.
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Affiliation(s)
- Treerat Gumpangseth
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, Thailand
| | - Srijit Das
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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Faletra FF, Leo LA, Paiocchi VL, Schlossbauer SA, Pedrazzini G, Moccetti T, Ho SY. Revisiting Anatomy of the Interatrial Septum and its Adjoining Atrioventricular Junction Using Noninvasive Imaging Techniques. J Am Soc Echocardiogr 2019; 32:580-592. [PMID: 30803863 DOI: 10.1016/j.echo.2019.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 10/27/2022]
Abstract
Interest in the anatomy of the interatrial septum (IAS) and its adjoining atrioventricular (AV) junction has risen enormously in the past two decades with the simultaneous evolution of left-sided percutaneous structural heart disease and complex electrophysiologic procedures. These procedures require, in fact, a direct route to the left atrium through the IAS. Thus, a thorough understanding of the complex anatomy of the IAS and AV junction is essential for performing a safe and effective transseptal puncture. There is a large amount of literature carefully describing the anatomy of the IAS and AV junction. These studies are based almost exclusively on anatomic specimens. Conversely, in this review the authors emphasize the role of noninvasive imaging techniques, in particular cardiac magnetic resonance, two- and three-dimensional transesophageal echocardiography, and computed tomography in visualizing specific aspects of the normal IAS and AV junction. Where appropriate, the authors present images side by side, with corresponding anatomic specimens.
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Affiliation(s)
- Francesco F Faletra
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
| | - Laura Anna Leo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Vera Lucia Paiocchi
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Giovanni Pedrazzini
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom
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27
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Mori S, Tretter JT, Spicer DE, Bolender DL, Anderson RH. What is the real cardiac anatomy? Clin Anat 2019; 32:288-309. [PMID: 30675928 PMCID: PMC6849845 DOI: 10.1002/ca.23340] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 12/24/2022]
Abstract
The heart is a remarkably complex organ. Teaching its details to medical students and clinical trainees can be very difficult. Despite the complexity, accurate recognition of these details is a pre‐requisite for the subsequent understanding of clinical cardiologists and cardiac surgeons. A recent publication promoted the benefits of virtual reconstructions in facilitating the initial understanding achieved by medical students. If such teaching is to achieve its greatest value, the datasets used to provide the virtual images should themselves be anatomically accurate. They should also take note of a basic rule of human anatomy, namely that components of all organs should be described as they are normally situated within the body. It is almost universal at present for textbooks of anatomy to illustrate the heart as if removed from the body and positioned on its apex, the so‐called Valentine situation. In the years prior to the emergence of interventional techniques to treat cardiac diseases, this approach was of limited significance. Nowadays, therapeutic interventions are commonplace worldwide. Advances in three‐dimensional imaging technology, furthermore, now mean that the separate components of the heart can readily be segmented, and then shown in attitudinally appropriate fashion. In this review, we demonstrate how such virtual dissection of computed tomographic datasets in attitudinally appropriate fashion reveals the true details of cardiac anatomy. The virtual approach to teaching the arrangement of the cardiac components has much to commend it. If it is to be used, nonetheless, the anatomical details on which the reconstructions are based must be accurate. Clin. Anat. 32:288–309, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
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Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Diane E Spicer
- Department of Pediatric Cardiology, University of Florida, Gainesville, Florida
| | - David L Bolender
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
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29
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Stephenson RS, Rowley-Nobel J, Jones CB, Guerrero R, Lowe T, Zhao J, Zhang H, Jarvis JC. Morphological Substrates for Atrial Arrhythmogenesis in a Heart With Atrioventricular Septal Defect. Front Physiol 2018; 9:1071. [PMID: 30190677 PMCID: PMC6115687 DOI: 10.3389/fphys.2018.01071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
Due to advances in corrective surgery, congenital heart disease has an ever growing patient population. Atrial arrhythmias are frequently observed pre- and post-surgical correction. Pharmaceutical antiarrhythmic therapy is not always effective, therefore many symptomatic patients undergo catheter ablation therapy. In patients with atrioventricular septal defects (AVSD), ablation therapy itself has mixed success; arrhythmogenic recurrences are common, and because of the anatomical displacement of the atrioventricular node, 3-degree heart block post-ablation is a real concern. In order to develop optimal and safe ablation strategies, the field of congenital cardiac electrophysiology must combine knowledge from clinical electrophysiology with a thorough understanding of the anatomical substrates for arrhythmias. Using image-based analysis and multi-cellular mathematical modeling of electrical activation, we show how the anatomical alterations characteristic of an AVSD serve as arrhythmogenic substrates. Using ex-vivo contrast enhanced micro-computed tomography we imaged post-mortem the heart of a 5 month old male with AVSD at an isometric spatial resolution of 38 μm. Morphological analysis revealed the 3D disposition of the cardiac conduction system for the first time in an intact heart with this human congenital malformation. We observed displacement of the compact atrioventricular node inferiorly to the ostium of the coronary sinus. Myocyte orientation analysis revealed that the normal arrangement of the major atrial muscle bundles was preserved but was modified in the septal region. Models of electrical activation suggest the disposition of the myocytes within the atrial muscle bundles associated with the "fast pathway," together with the displaced atrioventricular node, serve as potential substrates for re-entry and possibly atrial fibrillation. This study used archived human hearts, showing them to be a valuable resource for the mathematical modeling community, and opening new possibilities for the investigations of arrhythmogenesis and ablation strategies in the congenitally malformed heart.
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Affiliation(s)
- Robert S Stephenson
- Comparative Medicine Lab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jack Rowley-Nobel
- School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Caroline B Jones
- Department of Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Rafael Guerrero
- Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Tristan Lowe
- Manchester X-ray Imaging Facility, Photon Science Institute, University of Manchester, Manchester, United Kingdom
| | - Jichao Zhao
- Auckland Bioengineering Institute, Auckland University, Auckland, New Zealand
| | - Henggui Zhang
- School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Jonathan C Jarvis
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Enriquez A, Tapias C, Rodriguez D, Ramirez J, Rosso R, Viskin S, Schaller R, Marchlinski F, Saenz L, Garcia F. Role of intracardiac echocardiography for guiding ablation of tricuspid valve arrhythmias. HeartRhythm Case Rep 2018; 4:209-213. [PMID: 29922578 PMCID: PMC6006487 DOI: 10.1016/j.hrcr.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carlos Tapias
- International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia
| | - Diego Rodriguez
- International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia.,Universidad de la Sabana, Bogotá, Colombia
| | - Juan Ramirez
- International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia
| | - Raphael Rosso
- Department of Cardiac Electrophysiology, Cardiology Division, Sourasky Medical Center, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiac Electrophysiology, Cardiology Division, Sourasky Medical Center, Tel Aviv, Israel
| | - Robert Schaller
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis Marchlinski
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luis Saenz
- International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia.,Universidad de la Sabana, Bogotá, Colombia
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Versacci P, Pugnaloni F, Digilio MC, Putotto C, Unolt M, Calcagni G, Baban A, Marino B. Some Isolated Cardiac Malformations Can Be Related to Laterality Defects. J Cardiovasc Dev Dis 2018; 5:jcdd5020024. [PMID: 29724030 PMCID: PMC6023464 DOI: 10.3390/jcdd5020024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 12/22/2022] Open
Abstract
Human beings are characterized by a left–right asymmetric arrangement of their internal organs, and the heart is the first organ to break symmetry in the developing embryo. Aberrations in normal left–right axis determination during embryogenesis lead to a wide spectrum of abnormal internal laterality phenotypes, including situs inversus and heterotaxy. In more than 90% of instances, the latter condition is accompanied by complex and severe cardiovascular malformations. Atrioventricular canal defect and transposition of the great arteries—which are particularly frequent in the setting of heterotaxy—are commonly found in situs solitus with or without genetic syndromes. Here, we review current data on morphogenesis of the heart in human beings and animal models, familial recurrence, and upstream genetic pathways of left–right determination in order to highlight how some isolated congenital heart diseases, very common in heterotaxy, even in the setting of situs solitus, may actually be considered in the pathogenetic field of laterality defects.
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Affiliation(s)
- Paolo Versacci
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Flaminia Pugnaloni
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital and Research Institute, 00165 Rome, Italy.
| | - Carolina Putotto
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Marta Unolt
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, 00165 Rome, Italy.
| | - Anwar Baban
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, 00165 Rome, Italy.
| | - Bruno Marino
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
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32
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Mori S, Tretter JT, Toba T, Izawa Y, Tahara N, Nishii T, Shimoyama S, Tanaka H, Shinke T, Hirata KI, Spicer DE, Saremi F, Anderson RH. Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve. Clin Anat 2018. [DOI: 10.1002/ca.23071] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Justin T. Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Natsuko Tahara
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tatsuya Nishii
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Shinsuke Shimoyama
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Diane E. Spicer
- Division of Pediatric Cardiology; University of Florida; Gainesville Florida
| | - Farhood Saremi
- University of Southern California; Los Angeles California
| | - Robert H. Anderson
- Institute of Genetic Medicine, Newcastle University; Newcastle-upon-Tyne United Kingdom
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Muslem R, Ouhlous M, Akin S, Fares AA, Soliman OI. Tricuspid Valve Disease: A Computed Tomographic Assessment. PRACTICAL MANUAL OF TRICUSPID VALVE DISEASES 2018:179-203. [DOI: 10.1007/978-3-319-58229-0_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abstract
Atrial arrhythmias are common in patients with atrial septal defects. A myriad of factors are responsible for these that include remodeling related to the defect and scar created by the repair or closure. An understanding of potential arrhythmias, along with entrainment and high-density activation mapping can result in accurate diagnosis and successful ablation. Atrial fibrillation is being seen increasingly after patent foramen ovale closure and may be the primary etiology of recurrent stroke in these patients.
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Affiliation(s)
- Tahmeed Contractor
- Arrhythmia Center, Loma Linda University International Heart Institute, Department of Cardiology, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Ravi Mandapati
- Arrhythmia Center, Loma Linda University International Heart Institute, Department of Cardiology, 11234 Anderson Street, Loma Linda, CA 92354, USA
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35
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Saremi F, Sánchez-Quintana D, Mori S, Muresian H, Spicer DE, Hassani C, Anderson RH. Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging. Radiographics 2017; 37:1330-1351. [DOI: 10.1148/rg.2017170004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farhood Saremi
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Damián Sánchez-Quintana
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Shumpei Mori
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Horia Muresian
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Diane E. Spicer
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Cameron Hassani
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Robert H. Anderson
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
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36
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Tchou P. Inflammation, scarring, and atrioventricular nodal reentrant tachycardia. Heart Rhythm 2017; 14:1647-1648. [PMID: 28843421 DOI: 10.1016/j.hrthm.2017.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Patrick Tchou
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Role of low kilovoltage electrocardiographic-gated multidetector CT in electrophysiological procedures in the paediatric age group. Cardiol Young 2017; 27:617-624. [PMID: 27938453 DOI: 10.1017/s1047951116002596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Treatment of arrhythmias by catheter ablation targeting the anatomical foci of arrhythmias by radiofrequency has evolved dramatically in recent years. A road map for the relevant heart structures is an important asset for the success of the procedure and should be obtained before the intervention. This can be achieved by intra-cardiac echocardiography, conventional angiographic methods, multidetector CT, or MRI. The electrophysiological technique comprises a diagnostic procedure and an interventional - therapeutic - procedure. Electrocardiographic-gated multidetector CT is important in the diagnostic session to evaluate the anatomical details in combination with electric activity mapping. This combined protocol provides a unique view of the propagation of electrical activity, either normal or abnormal, over cardiac structures and allows a precise functional and anatomical evaluation to be obtained. In this review, we evaluate the role of electrocardiographic-gated multidetector CT in roadmapping arrhythmias in the paediatric age group, focussing on its strengths; we also evaluated some additional aspects that need further improvement in the future.
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38
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Mori S, Anderson RH, Takaya T, Toba T, Ito T, Fujiwara S, Watanabe Y, Nishii T, Kono AK, Hirata KI. The association between wedging of the aorta and cardiac structural anatomy as revealed using multidetector-row computed tomography. J Anat 2017; 231:110-120. [PMID: 28397961 DOI: 10.1111/joa.12611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 11/29/2022] Open
Abstract
The aortic root is wedged within the cardiac base. The precise extent of aortic wedging, however, and its influence on the surrounding cardiac structures, has not been systematically investigated. We analysed 100 consecutive patients, who underwent coronary arterial computed tomographic angiography. We assessed the extent of aortic wedging by measuring the vertical distance between the non-adjacent aortic sinus and the inferior epicardium. A shorter distance indicates deeper aortic wedging. We assessed the tilt angle and diameter of the ascending aorta, the relative heights of the left atrial roof and the oval fossa, the shape of the proximal right coronary artery, the angle of the aorta relative to the left ventricular axis, and the lung volume. The mean extent of wedging was 42.7 ± 9.8 mm. Multivariate analysis revealed that ageing, male gender, increased body mass index, patients without cardiomyopathy, the extent of tilting and dilation of the ascending aorta, and lung volume were all independent predictors for deeper aortic wedging (R2 = 0.7400, P < 0.0001). The extent of wedging was additionally correlated with a relatively high left atrial roof (R2 = 0.1394, P < 0.0001) and oval fossa (R2 = 0.1713, P < 0.0001), the shepherd's crook shape of the proximal right coronary artery (R2 = 0.2376, P < 0.0001), and the narrowness of the angulation of the root relative to the left ventricular axis (R2 = 0.2544, P < 0.0001). In conclusion, ageing, male gender, obesity, background cardiac disease, aortic tilting and dilation, and lung volume are all correlated with the extent of wedging of the aortic root within the cardiac base.
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Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuro Ito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Nishii
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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39
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Xu Y, Peng Y, Qu R, Zheng G, Feng F, Feng Y, He L, He S, Li Z, Liu C, Xiao Z, Ouyang J, Dai J. Locating the Human Cardiac Conduction System Using a 3D Model of Its Nutritious Arteries. Sci Rep 2017; 7:344. [PMID: 28336939 PMCID: PMC5428715 DOI: 10.1038/s41598-017-00504-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/28/2017] [Indexed: 11/24/2022] Open
Abstract
It is difficult for anatomists to dissect the human cardiac conduction system (CCS) on specimens as well as for cardiovascular clinicians to locate the CCS during cardiac operations. Here, we demonstrate a new method for locating the CCS using a 3D model of its nutritious arteries. First, we perfused the coronary arteries with contrast material and then acquired a set of data of thin computer tomography (CT) scans. Then, we generated a 3D model of the coronary artery and distinguished the arteries that supply the CCS. We then located the CCS on the 3D model via its nutritious arteries and dissected the CCS. Finally, the structures that were dissected were removed for histological and immunofluorescent staining. The results of histological and immunofluorescence examination proved the structure to be the CCS. Thus, we successfully located the CCS using a 3D model of its nutritious arteries. We suggest that with this new method, cardiac surgeons can locate a patient’s CCS during cardiac surgeries such as transcatheter aortic valve implantation (TAVI) or radiofrequency catheter ablation (RFCA).
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Affiliation(s)
- Yu Xu
- First Clinical School, Southern Medical University, Guangzhou, China
| | - Yukun Peng
- First Clinical School, Southern Medical University, Guangzhou, China
| | - Rongmei Qu
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Guorong Zheng
- Department of Radiology, Guangdong No. 2 Provincial People's Hospital, Guangzhou, China
| | - Feiyan Feng
- First Clinical School, Southern Medical University, Guangzhou, China
| | - Yan Feng
- Department of Electrocardiogram, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, China
| | - Linying He
- Second Clinical School, Southern Medical University, Guangzhou, China
| | - Shanli He
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Zeyu Li
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Chang Liu
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Zhaoming Xiao
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China.
| | - Jingxing Dai
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China.
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Madaffari A, Große A, Raffa S, Frommhold M, Fink A, Geller JC. Catheter ablation of ventricular ectopy with para-hisian origin: importance of mapping both sides of the interventricular septum and understanding when to stop ablating. Clin Case Rep 2016; 4:1195-1200. [PMID: 27980762 PMCID: PMC5134218 DOI: 10.1002/ccr3.739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/28/2016] [Accepted: 10/09/2016] [Indexed: 11/08/2022] Open
Abstract
Catheter ablation of para-Hisian premature ventricular contractions (PVCs) still represents a challenge and is a compromise between success and inadvertent AV block. We describe a possible strategy to address PVCs from this location with high-amplitude His-bundle potentials at the site of earliest activation.
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Affiliation(s)
- Antonio Madaffari
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - Anett Große
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - Santi Raffa
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - Markus Frommhold
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - Agnes Fink
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - J Christoph Geller
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany; Otto-von-Guericke University School of Medicine Magdeburg Germany
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Saremi F, Hassani C, Sánchez-Quintana D. Septal Atrioventricular Junction Region: Comprehensive Imaging in Adults. Radiographics 2016; 36:1966-1986. [DOI: 10.1148/rg.2016160010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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PATHAK RAJEEVK, BETENSKY BRIANP, SANTANGELI PASQUALE, DIXIT SANJAY. Distinct Electrocardiographic Form of Idiopathic Ventricular Arrhythmia Originating From the Left Bundle Branch. J Cardiovasc Electrophysiol 2016; 28:115-119. [DOI: 10.1111/jce.13085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
Affiliation(s)
- RAJEEV K. PATHAK
- Cardiovascular Medicine Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - BRIAN P. BETENSKY
- Cardiovascular Medicine Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - PASQUALE SANTANGELI
- Cardiovascular Medicine Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - SANJAY DIXIT
- Cardiovascular Medicine Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
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Ayoub S, Ferrari G, Gorman RC, Gorman JH, Schoen FJ, Sacks MS. Heart Valve Biomechanics and Underlying Mechanobiology. Compr Physiol 2016; 6:1743-1780. [PMID: 27783858 PMCID: PMC5537387 DOI: 10.1002/cphy.c150048] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Heart valves control unidirectional blood flow within the heart during the cardiac cycle. They have a remarkable ability to withstand the demanding mechanical environment of the heart, achieving lifetime durability by processes involving the ongoing remodeling of the extracellular matrix. The focus of this review is on heart valve functional physiology, with insights into the link between disease-induced alterations in valve geometry, tissue stress, and the subsequent cell mechanobiological responses and tissue remodeling. We begin with an overview of the fundamentals of heart valve physiology and the characteristics and functions of valve interstitial cells (VICs). We then provide an overview of current experimental and computational approaches that connect VIC mechanobiological response to organ- and tissue-level deformations and improve our understanding of the underlying functional physiology of heart valves. We conclude with a summary of future trends and offer an outlook for the future of heart valve mechanobiology, specifically, multiscale modeling approaches, and the potential directions and possible challenges of research development. © 2016 American Physiological Society. Compr Physiol 6:1743-1780, 2016.
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Affiliation(s)
- Salma Ayoub
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, USA
| | - Giovanni Ferrari
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, USA
| | - Robert C. Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, USA
| | - Joseph H. Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, USA
| | - Frederick J. Schoen
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael S. Sacks
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, USA
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Transcatheter device closure of perimembranous ventricular septal defect in children treated with prophylactic oral steroids: acute and mid-term results of a single-centre, prospective, observational study. Cardiol Young 2016; 26:669-76. [PMID: 26105182 DOI: 10.1017/s1047951115001018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED Background and Objective Although transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids. Materials and methods A prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3-18 years and weight >10 kg, defect diameter ⩽12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval. RESULTS Between May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose steroid and temporary pacemaker. Minor complications included post-procedure heart block (n=22) and blood loss (n=2). At 18.23±13.15 months follow-up, 8/27 (five major, 22 minor) with arrhythmia had persistent post-procedure heart block of no clinical consequences. CONCLUSION In our patient population, transcatheter device closure of the perimembranous ventricular septal defect with prophylactic oral steroid resulted in excellent closure rate and acceptably low incidence of conduction disturbances at mid-term follow-up.
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Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Diane E. Spicer
- Department of Pediatric Cardiology, University of Florida
- Johns Hopkins All Children’s Heart Institute
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MORI SHUMPEI, FUKUZAWA KOJI, TAKAYA TOMOFUMI, TAKAMINE SACHIKO, ITO TATSURO, FUJIWARA SEI, NISHII TATSUYA, KONO ATSUSHIK, YOSHIDA AKIHIRO, HIRATA KENICHI. Clinical Structural Anatomy of the Inferior Pyramidal Space Reconstructed Within the Cardiac Contour Using Multidetector-Row Computed Tomography. J Cardiovasc Electrophysiol 2015; 26:705-12. [DOI: 10.1111/jce.12687] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- SHUMPEI MORI
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - KOJI FUKUZAWA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - TOMOFUMI TAKAYA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - SACHIKO TAKAMINE
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - TATSURO ITO
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - SEI FUJIWARA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - TATSUYA NISHII
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - ATSUSHI K. KONO
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - AKIHIRO YOSHIDA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - KEN-ICHI HIRATA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
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Mori S, Fukuzawa K, Takaya T, Takamine S, Ito T, Fujiwara S, Nishii T, Kono AK, Yoshida A, Hirata KI. Clinical cardiac structural anatomy reconstructed within the cardiac contour using multidetector-row computed tomography: Left ventricular outflow tract. Clin Anat 2015; 29:353-63. [PMID: 25974872 DOI: 10.1002/ca.22547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/09/2015] [Accepted: 03/17/2015] [Indexed: 11/11/2022]
Abstract
The left ventricular outflow tract (LVOT) is a common site of idiopathic ventricular arrhythmia. Many electrocardiographic characteristics for predicting the origin of arrhythmia have been reported, and their prediction rates are clinically acceptable. Because these approaches are inductive, based on QRS-wave morphology during the arrhythmia and endocardial or epicardial pacing, three-dimensional anatomical accuracy in identifying the exact site of the catheter position is essential. However, fluoroscopic recognition and definition of the anatomy around the LVOT can vary among operators, and three-dimensional anatomical recognition within the cardiac contour is difficult because of the morphological complexity of the LVOT. Detailed knowledge about the three-dimensional fluoroscopic cardiac structural anatomy could help to reduce the need for contrast medium injection and radiation exposure, and to perform safe interventions. In this article, we present a series of structural images of the LVOT reconstructed in combination with the cardiac contour using multidetector-row computed tomography. We also discuss the clinical implications of these findings based on the accumulated insights of research pioneers.
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Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sachiko Takamine
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuro Ito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Nishii
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akihiro Yoshida
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Imaging Evaluation of Tricuspid Valve: Analysis of Morphology and Function With CT and MRI. AJR Am J Roentgenol 2015; 204:W531-42. [DOI: 10.2214/ajr.14.13551] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Affiliation(s)
- Seigo Yamashita
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France
| | - Darren A Hooks
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France
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50
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Mori S, Nishii T, Takaya T, Kashio K, Kasamatsu A, Takamine S, Ito T, Fujiwara S, Kono AK, Hirata KI. Clinical structural anatomy of the inferior pyramidal space reconstructed from the living heart: Three-dimensional visualization using multidetector-row computed tomography. Clin Anat 2014; 28:878-87. [DOI: 10.1002/ca.22483] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 10/01/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tatsuya Nishii
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Kazuhiro Kashio
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Akira Kasamatsu
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Sachiko Takamine
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tatsuro Ito
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Atsushi K. Kono
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
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