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Curry BA, Drane AL, Atencia R, Feltrer Y, Calvi T, Milnes EL, Moittié S, Weigold A, Knauf-Witzens T, Sawung Kusuma A, Howatson G, Palmer C, Stembridge MR, Gorzynski JE, Eves ND, Dawkins TG, Shave RE. Left ventricular trabeculation in Hominidae: divergence of the human cardiac phenotype. Commun Biol 2024; 7:682. [PMID: 38877299 PMCID: PMC11178792 DOI: 10.1038/s42003-024-06280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/02/2024] [Indexed: 06/16/2024] Open
Abstract
Although the gross morphology of the heart is conserved across mammals, subtle interspecific variations exist in the cardiac phenotype, which may reflect evolutionary divergence among closely-related species. Here, we compare the left ventricle (LV) across all extant members of the Hominidae taxon, using 2D echocardiography, to gain insight into the evolution of the human heart. We present compelling evidence that the human LV has diverged away from a more trabeculated phenotype present in all other great apes, towards a ventricular wall with proportionally greater compact myocardium, which was corroborated by post-mortem chimpanzee (Pan troglodytes) hearts. Speckle-tracking echocardiographic analyses identified a negative curvilinear relationship between the degree of trabeculation and LV systolic twist, revealing lower rotational mechanics in the trabeculated non-human great ape LV. This divergent evolution of the human heart may have facilitated the augmentation of cardiac output to support the metabolic and thermoregulatory demands of the human ecological niche.
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Affiliation(s)
- Bryony A Curry
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Aimee L Drane
- International Primate Heart Project, Cardiff Metropolitan University, Cyncoed Road, Cardiff, CF23 6XD, UK.
- Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, SA2 8PP, UK.
| | - Rebeca Atencia
- Jane Goodall Institute, Tchimpounga Chimpanzee Rehabilitation Centre, Pointe-Noire, Republic of Congo
| | - Yedra Feltrer
- International Primate Heart Project, Cardiff Metropolitan University, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Thalita Calvi
- Chimfunshi Wildlife Orphanage, Solwesi Road, Chingola, Zambia
| | - Ellie L Milnes
- Wildlife Health, Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK
- Zoological Society of London, Regent's Park, London, NW1 4RY, UK
- Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, Pretoria, 0110, South Africa
| | - Sophie Moittié
- Tacugama Chimpanzee Sanctuary, Congo Dam Access Road, Freetown, Sierra Leone
- School of Veterinary Medicine, St. George's University, St. George's, West Indies, Grenada
| | - Annika Weigold
- Wilhelma Zoological-Botanical Gardens, Wilhelma 13, Stuttgart, 70376, Germany
| | | | - Arga Sawung Kusuma
- Borneo Orangutan Survival Foundation, Central Kalimantan Orangutan Reintroduction Project at Nyaru Menteng, Jalan Cilik Riwut km 28, Palangkaraya, 73111, Central Kalimantan, Indonesia
| | - Glyn Howatson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK
- Water Research Group, Faculty of Natural and Environmental Sciences, North West University, Potchefstroom, 2531, South Africa
| | - Christopher Palmer
- Biological Science, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mike R Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF23 6XD, UK
| | - John E Gorzynski
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Neil D Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Tony G Dawkins
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Rob E Shave
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada.
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2
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Yilmaz H, Güler H. Can video-assisted and three-dimensional (3D) anatomy teaching be an alternative to traditional anatomy teaching? Randomized controlled trial on muscular system anatomy. Clin Anat 2024; 37:227-232. [PMID: 37382417 DOI: 10.1002/ca.24088] [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: 11/21/2022] [Revised: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
The aim of this study was to determine the optimal method for teaching human anatomy by comparing classical laboratory (traditional), video-assisted and three-dimensional (3D) application methods for students who had previously received only online academic anatomy education. GPower 3.1.9.4 was used for power analysis to establish sample size. After power analysis, it was decided to have 28 people in each group. Participants were given pre-anatomy education tests and divided into four matched groups: Group 1: no additional education, Group 2: Video-assisted education, Group 3: Applied 3D anatomy education, Group 4: Practical laboratory anatomy education. Each group received 5 weeks of education in muscular system anatomy. The pre-test results showed no statistically significant differences among the groups. The post-test results showed statistically significant improvement in scores (p < 0.001): group 4; 59%, group 3; 33%, group 2; 9%. The difference between group 1 and group 2 was statistically significant (p < 0.01). The difference between the groups in post hoc comparisons with all other groups was also statistically significant (p < 0.001). The results of this study show that while the optimal anatomy teaching method is conservative, the best alternative is 3D application.
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Affiliation(s)
- Halil Yilmaz
- Department of Anatomy, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Hatice Güler
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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3
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Anderson RH, Lamers WH, Hikspoors JPJM, Mohun TJ, Bamforth SD, Chaudhry B, Eley L, Kerwin J, Crosier M, Henderson DJ. Development of the arterial roots and ventricular outflow tracts. J Anat 2024; 244:497-513. [PMID: 37957890 PMCID: PMC10862166 DOI: 10.1111/joa.13973] [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: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
The separation of the outflow tract of the developing heart into the systemic and pulmonary arterial channels remains controversial and poorly understood. The definitive outflow tracts have three components. The developing outflow tract, in contrast, has usually been described in two parts. When the tract has exclusively myocardial walls, such bipartite description is justified, with an obvious dogleg bend separating proximal and distal components. With the addition of non-myocardial walls distally, it becomes possible to recognise three parts. The middle part, which initially still has myocardial walls, contains within its lumen a pair of intercalated valvar swellings. The swellings interdigitate with the distal ends of major outflow cushions, formed by the remodelling of cardiac jelly, to form the primordiums of the arterial roots. The proximal parts of the major cushions, occupying the proximal part of the outflow tract, which also has myocardial walls, themselves fuse and muscularise. The myocardial shelf thus formed remodels to become the free-standing subpulmonary infundibulum. Details of all these processes are currently lacking. In this account, we describe the anatomical changes seen during the overall remodelling. Our interpretations are based on the interrogation of serially sectioned histological and high-resolution episcopic microscopy datasets prepared from developing human and mouse embryos, with some of the datasets processed and reconstructed to reveal the specific nature of the tissues contributing to the separation of the outflow channels. Our findings confirm that the tripartite postnatal arrangement can be correlated with the changes occurring during development.
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Affiliation(s)
| | - Wouter H. Lamers
- Department of Anatomy & EmbryologyMaastricht UniversityMaastrichtThe Netherlands
| | | | | | | | - Bill Chaudhry
- Biosciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Lorraine Eley
- Biosciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Janet Kerwin
- Biosciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Moira Crosier
- Biosciences InstituteNewcastle UniversityNewcastle upon TyneUK
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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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Crucean A, Spicer DE, Tretter JT, Mohun TJ, Anderson RH. Revisiting the anatomy of the right ventricle in the light of knowledge of its development. J Anat 2024; 244:297-311. [PMID: 37814425 PMCID: PMC10780169 DOI: 10.1111/joa.13960] [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: 03/04/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023] Open
Abstract
Controversies continue regarding several aspects of the anatomy of the morphologically right ventricle. There is disagreement as to whether the ventricle should be assessed in bipartite or tripartite fashion, and the number of leaflets to be found in the tricuspid valve. In particular, there is no agreement as to whether a muscular outlet septum is present in the normally constructed heart, nor how many septal components are to be found during normal development. Resolving these issues is of potential significance to those investigating and treating children with congenitally malformed hearts. With all these issues in mind, we have revisited our own experience in investigating the development and morphology of the normal right ventricle. To assess development, we have examined a large number of datasets, prepared by both standard and episcopic microscopy, from human and murine embryos. In terms of gross anatomy, we have compared dissections of normal autopsied hearts with virtual dissections of datasets prepared using computed tomography. Our developmental and postnatal studies, taken together, confirm that the ventricle is best assessed in tripartite fashion, with the three parts representing its inlet, apical trabecular, and outlet components. The ventricular septum, however, has only muscular and membranous components. The muscular part incorporates a small component derived from the muscularised fused proximal outflow cushions, but this part cannot be distinguished from the much larger part that is incorporated within the free-standing muscular infundibular sleeve. We confirm that the tricuspid valve itself has three components, which are located inferiorly, septally, and antero-superiorly.
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Affiliation(s)
- Adrian Crucean
- Department of Paediatric Cardiac SurgeryBirmingham Women's and Children's HospitalBirminghamUK
| | - Diane E. Spicer
- Congenital Heart CenterAll Children's HospitalSt PetersbergFloridaUSA
| | - Justin T. Tretter
- Department of Pediatric Cardiology, Cleveland Clinic Children's, and the Heart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOhioUSA
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6
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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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7
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Oran E, Abo-Serie E, Jewkes J, Henry M, Oran B. Design and optimisation of an Intra-Aortic Shrouded rotor axial pump. J Biomech 2024; 162:111858. [PMID: 37989028 DOI: 10.1016/j.jbiomech.2023.111858] [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: 05/05/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
Undesirable side effects in patients with a LVAD (Left Ventricular Assist Device) pump fitted include blood damage, thrombosis, blood traumatisation, and End-Organ Disfunctions. These side effects have generally been attributed to the high wall shear stresses and the induced turbulent flow. In this study, we introduce a novel design to address these effects by lowering the rotational speed and providing an optimum flow path design to minimise blood damage. We present an initial scheme for a new Intra-Aortic Shrouded Rotary Axial Pump and develop a sequence of pump geometries, for which the Taguchi Design Optimisation Method has been applied. We apply CFD tools to simulate the pressure rise, pump performance, hydraulic efficiency, wall shear stress, exposure time and mass flow rate. A prototype pump has been tested in a mock cardiovascular circuit using a water-glycerol solution. The optimum design delivered the desired pressure/mass flow rate characteristics at a significantly low rpm (2900 rpm). As a result, the estimated blood damage index is low, matching the design requirements. The theoretical performance was matched by experimental results.
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Affiliation(s)
- Elif Oran
- Coventry University, Centre for Fluid and Complex Systems, Coventry, UK
| | - Essam Abo-Serie
- University of Leicester, School of Engineering, Leicester, UK.
| | - James Jewkes
- University of Leicester, School of Engineering, Leicester, UK
| | - Manus Henry
- Coventry University, Centre for Fluid and Complex Systems, Coventry, UK; University of Oxford, Department of Engineering Science, Oxford, UK
| | - Bulent Oran
- Medicana International Hospital, Department of Pediatric Cardiology, Izmir, Turkey
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8
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Xu X, Jia Q, Yuan H, Qiu H, Dong Y, Xie W, Yao Z, Zhang J, Nie Z, Li X, Shi Y, Zou JY, Huang M, Zhuang J. A clinically applicable AI system for diagnosis of congenital heart diseases based on computed tomography images. Med Image Anal 2023; 90:102953. [PMID: 37734140 DOI: 10.1016/j.media.2023.102953] [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: 12/19/2022] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
Congenital heart disease (CHD) is the most common type of birth defect. Without timely detection and treatment, approximately one-third of children with CHD would die in the infant period. However, due to the complicated heart structures, early diagnosis of CHD and its types is quite challenging, even for experienced radiologists. Here, we present an artificial intelligence (AI) system that achieves a comparable performance of human experts in the critical task of classifying 17 categories of CHD types. We collected the first-large CT dataset from three different CT machines, including more than 3750 CHD patients over 14 years. Experimental results demonstrate that it can achieve diagnosis accuracy (86.03%) comparable with junior cardiovascular radiologists (86.27%) in a World Health Organization appointed research and cooperation center in China on most types of CHD, and obtains a higher sensitivity (82.91%) than junior cardiovascular radiologists (76.18%). The accuracy of the combination of our AI system (97.20%) and senior radiologists achieves comparable results to that of junior radiologists and senior radiologists (97.16%) which is the current clinical routine. Our AI system can further provide 3D visualization of hearts to senior radiologists for interpretation and flexible review, surgeons for precise intuition of heart structures, and clinicians for more precise outcome prediction. We demonstrate the potential of our model to be integrated into current clinic practice to improve the diagnosis of CHD globally, especially in regions where experienced radiologists can be scarce.
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Affiliation(s)
- Xiaowei Xu
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Qianjun Jia
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Catheterization Lab, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haiyun Yuan
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Hailong Qiu
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Yuhao Dong
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Catheterization Lab, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wen Xie
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Zeyang Yao
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Jiawei Zhang
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Zhiqaing Nie
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Xiaomeng Li
- Department of Electronic and Computer Engineering, The Hong Kong University of Science and Technology, Hong Kong Special Administrative Region
| | - Yiyu Shi
- Computer Science and Engineering, University of Notre Dame, IN, 46656, USA
| | - James Y Zou
- Department of Computer Science, Stanford University, Stanford, CA, 94305, USA; Department of Electrical Engineering, Stanford University, Stanford, CA, 94305, USA.
| | - Meiping Huang
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Catheterization Lab, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Jian Zhuang
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
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9
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Davies J, Thai MT, Low H, Phan PT, Hoang TT, Lovell NH, Do TN. Bio-SHARPE: Bioinspired Soft and High Aspect Ratio Pumping Element for Robotic and Medical Applications. Soft Robot 2023; 10:1055-1069. [PMID: 37130309 DOI: 10.1089/soro.2021.0154] [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] [Indexed: 05/04/2023] Open
Abstract
The advent of soft robots has solved many issues posed by their rigid counterparts, including safer interactions with humans and the capability to work in narrow and complex environments. While much work has been devoted to developing soft actuators and bioinspired mechatronic systems, comparatively little has been done to improve the methods of actuation. Hydraulically soft actuators (HSAs) are emerging candidates to control soft robots due to their fast responses, low noise, and low hysteresis compared to compressible pneumatic ones. Despite advances, current hydraulic sources for large HSAs are still bulky and require high power availability to drive the pumping plant. To overcome these challenges, this work presents a new bioinspired soft and high aspect ratio pumping element (Bio-SHARPE) for use in soft robotic and medical applications. This new soft pumping element can amplify its input volume to at least 8.6 times with a peak pressure of at least 40 kPa. The element can be integrated into existing hydraulic pumping systems like a hydraulic gearbox. Naturally, an amplification of fluid volume can only come at the sacrifice of pumping pressure, which was observed as a 19.1:1 reduction from input to output pressure. The new concept enables a large soft robotic body to be actuated by smaller fluid reservoirs and pumping plant, potentially reducing their power and weight, and thus facilitating drive source miniaturization. The high amplification ratio also makes soft robotic systems more applicable for human-centric applications such as rehabilitation aids, bioinspired untethered soft robots, medical devices, and soft artificial organs. Details of the fabrication and experimental characterization of the Bio-SHARPE and its associated components are given. A soft robotic squid and an artificial heart ventricle are introduced and experimentally validated.
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Affiliation(s)
- James Davies
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Mai Thanh Thai
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Harrison Low
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Phuoc Thien Phan
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Trung Thien Hoang
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Hamilton Lovell
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Thanh Nho Do
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
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10
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Ohlsson L, Moreira ADL, Bäck S, Lantz J, Carlhäll CJ, Persson A, Hedman K, Chew MS, Dahlström N, Ebbers T. Enhancing students' understanding of cardiac physiology by using 4D visualization. Clin Anat 2023; 36:542-549. [PMID: 36695446 DOI: 10.1002/ca.24009] [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: 11/29/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
Difficulties in achieving knowledge about physiology and anatomy of the beating heart highlight the challenges with more traditional pedagogical methods. Recent research regarding anatomy education has mainly focused on digital three-dimensional models. However, these pedagogical improvements may not be entirely applicable to cardiac anatomy and physiology due to the multidimensional complexity with moving anatomy and complex blood flow. The aim of this study was therefore to evaluate whether high quality time-resolved anatomical images combined with realistic blood flow simulations improve the understanding of cardiac structures and function. Three time-resolved datasets were acquired using time-resolved computed tomography and blood flow was computed using Computational Fluid Dynamics. The anatomical and blood flow information was combined and interactively visualized using volume rendering on an advanced stereo projection system. The setup was tested in interactive lectures for medical students. Ninety-seven students participated. Summative assessment of examinations showed significantly improved mean score (18.1 ± 4.5 vs 20.3 ± 4.9, p = 0.002). This improvement was driven by knowledge regarding myocardial hypertrophy and pressure-velocity differences over a stenotic valve. Additionally, a supplementary formative assessment showed significantly more agreeing answers than disagreeing answers (p < 0.001) when the participants subjectively evaluated the contribution of the visualizations to their education and knowledge. In conclusion, the use of simultaneous visualization of time-resolved anatomy data and simulated blood flow improved medical students' results, with a particular effect on understanding of cardiac physiology and these simulations may be useful educational tools for teaching complex anatomical and physiological concepts.
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Affiliation(s)
- Linus Ohlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - André Da Luz Moreira
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Sophia Bäck
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Jonas Lantz
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Michelle S Chew
- Department of Anesthesiology and Intensive Care, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nils Dahlström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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11
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Performance of Radiomics Models Based on Coronary Computed Tomography Angiography in Predicting The Risk of Major Adverse Cardiovascular Events Within 3 Years: A Comparison Between the Pericoronary Adipose Tissue Model and the Epicardial Adipose Tissue Model. Acad Radiol 2023; 30:390-401. [PMID: 35431140 DOI: 10.1016/j.acra.2022.03.015] [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: 11/24/2021] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES To compare the prediction performance of the epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) radiomics models based on coronary computed tomography angiography for major adverse cardiovascular events (MACE) within 3 years. MATERIALS AND METHODS Our study included 288 patients (144 with MACE and 144 without MACE within 3 years) by matching age, gender, body mass index, and medication intake. Patients were randomly assigned either to the training (n = 201) or validation cohort (n = 87). A total of 184 radiomics features were extracted from EAT and PCAT images. Spearman's rank correlation coefficient and the gradient boosting decision tree algorithm were performed for feature selection. Five models were established based on PCAT or EAT radiomics features and clinical factors, including PCAT, EAT, clinical, PCAT-clinical, and EAT-clinical model (MPCAT, MEAT, Mclinical, MPCAT-clinical, and MEAT-clinical). Receiver operating characteristic curves, calibration curves, and the decision curve analysis were plotted to evaluate the model performance. RESULTS The MPCAT achieved an area under the curve (AUC) of 0.703 in the validation cohort, which was better than MEAT with AUC of 0.538. The MPCAT-clinical showed better performance (AUC = 0.781) in predicting MACE than the Mclinical (AUC = 0.748) or MEAT-clinical (AUC = 0.745). CONCLUSION Our results showed that the PCAT was better than the EAT in both single modality and combined models, and the MPCAT-clinical had the most significant clinical value in predicting the occurrence of MACE within 3 years.
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12
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Mori S, Hayase J, Sridharan A, Fukuzawa K, Shivkumar K, Bradfield JS. Revisiting the Anatomy of the Left Ventricular Summit. Card Electrophysiol Clin 2023; 15:1-8. [PMID: 36774131 DOI: 10.1016/j.ccep.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The left ventricular summit corresponds to the epicardial side of the basal superior free wall, extending from the base of the left coronary aortic sinus. The summit composes the floor of the compartment surrounded by the aortic root, infundibulum, pulmonary root, and left atrial appendage. The compartment is filled with thick adipose tissue, carrying the coronary vessels. Thus, the treatment of ventricular tachycardia originating from the summit is challenging, and three-dimensional understanding of this complicated region is fundamental. We revisit the clinical anatomy of the left ventricular summit with original images from the Wallace A. McAlpine collection.
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Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA.
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Aadhavi Sridharan
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
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13
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Xue X, Luo X, Liu Z, Jin Y. Use of a two-handed model to improve comprehension of ventricular outflow tract anatomy. BMC MEDICAL EDUCATION 2023; 23:101. [PMID: 36755226 PMCID: PMC9909947 DOI: 10.1186/s12909-023-04083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mastering cardiac anatomy is a formidable obstacle in the learning process for cardiac electrophysiology trainees. The complex three-dimensional characteristics and contiguous relationship of the ventricular outflow tract are particularly difficult to visualize with the limited study methods available. The hands can recreate a morphology similar to the ventricular outflow tract; this study explored whether a two-handed model of the heart helps electrophysiology trainees improve their understanding of ventricular outflow tract anatomy. METHODS After an initial assessment, trainees were randomly placed into variable and control groups. Subsequently, all trainees learned the outflow tract anatomy using routine methods, with the variable group receiving additional instruction using the two-handed model. One day and one week after the course conclusion, knowledge of the ventricular outflow tract anatomy was assessed for the participants in both groups. RESULTS Thirty-eight trainees participated (19 in each group). The median scores obtained for the first, second, and third tests were 38 (24,55), 80 (70,86), and 75 (70,81) points, respectively. In the second test, trainees in the variable group had a mean score 6.8 points higher than those in the control group (p = 0.103); in the last test, the mean score was 9.7 points higher in the variable group than in the control group (p = 0.003). CONCLUSIONS It is convenient to use hands to create a model representing the ventricular outflow tract. Trainees using this model had a better understanding and retention of the ventricular outflow tract anatomy compared to those of the control group.
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Affiliation(s)
- Xiang Xue
- Division of Cardiology, Changzhou Geriatric Hospital Affiliated With Soochow University (Changzhou No.7 People's Hospital), 288 Yanling East Road, Changzhou 213011, Jiangsu, China
| | - Xianyuan Luo
- Division of Cardiology, Changzhou Geriatric Hospital Affiliated With Soochow University (Changzhou No.7 People's Hospital), 288 Yanling East Road, Changzhou 213011, Jiangsu, China
| | - Zhaoyang Liu
- Division of Cardiology, Changzhou Geriatric Hospital Affiliated With Soochow University (Changzhou No.7 People's Hospital), 288 Yanling East Road, Changzhou 213011, Jiangsu, China
| | - Yun Jin
- Division of Cardiology, Changzhou Geriatric Hospital Affiliated With Soochow University (Changzhou No.7 People's Hospital), 288 Yanling East Road, Changzhou 213011, Jiangsu, China.
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14
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Hisley K. An Overview of Traditional and Advanced Visualization Techniques Applied to Anatomical Instruction Involving Cadaveric Dissection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1431:35-63. [PMID: 37644287 DOI: 10.1007/978-3-031-36727-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This work provides an overview of the role, basic concepts, significance, and instructional contributions of current and evolving digital visualization technologies being applied in first-year anatomy curricula. These are visualization methods that have been and are being used to support both basic science and clinical applications of gross anatomical teaching and learning to the health professions (i.e., medical, dental, physical therapy, chiropractic and nursing students). It first presents a foundation as to how this discipline has been and is being taught within the professional school environment using visualization and illustration: aspects of learning, the format of the first-year anatomy curriculum, the nature of the visual information network in support of educational excellence and newer opportunities afforded by advanced technologies placing the student at the center of the learning experience. Then, the nature of each of these new methods is presented with their individual unique characteristics, and the results that anatomy faculty running cadaveric dissection courses had with the evaluation of the new technologies.The Conclusion section lists key points found in the literature as reported. Finally, the Future Work section proposes investigations into standardizing the presentation and assessment of anatomical concepts using prominent in situ structures of viscera, their enclosures and resident compartments for more precise and reproducible measurement of then instructional effectiveness of the new techniques.
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Affiliation(s)
- Kenneth Hisley
- Pre-Clinical Studies - Anatomy, William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA.
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15
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Yohannan DG, Oommen AM, Amogh BJ, Raju NK, Suresh RO, Nair SJ. "Air Anatomy" - Teaching Complex Spatial Anatomy Using Simple Hand Gestures. ANATOMICAL SCIENCES EDUCATION 2022; 15:552-565. [PMID: 33855807 DOI: 10.1002/ase.2088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Spatial understanding of complex anatomical concepts is often a challenge for learners, as well as for educators. It is even more challenging for students with low mental spatial abilities. There are many options to teach spatial relationships, ranging from simple models to high-end three-dimensional (3D) virtual reality tools. Using a randomized controlled trial design, this study explored the use of a unique combination of deictic and iconic hand gestures to enhance spatial anatomical understanding, coining the term "Air Anatomy". The control group (n = 45) was given a lecture on the anatomy of extraocular muscles, while the intervention group (n = 49) received the same lecture including "Air Anatomy" hand gestures. When compared to the control group, the post-test scores for the intervention group were significantly higher for basic recall (P < 0.001; Mann-Whitney U test) and for the application of knowledge (P = 0.015; Mann-Whitney U test). Students with low to moderate spatial ability (as assessed by a mental rotation test) were found to benefit most by this technique. Students in the intervention group also reported a lower extrinsic cognitive load and higher germane load, when compared to the control group. An instructional skills questionnaire survey indicated the effectiveness of this technique in improving overall classroom experience. Feedback of the students in the intervention group was also favorable for instruction using "Air Anatomy". The study suggests that "Air Anatomy" is a useful, "no-cost", accessible method that aids spatial understanding of anatomical concepts.
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16
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Tretter JT, Spicer DE, Anderson RH. Letter: The time has come to use attitudinally appropriate terminology when describing cardiac anatomy. EUROINTERVENTION 2022; 17:1538. [PMID: 35446254 PMCID: PMC9896397 DOI: 10.4244/eij-d-21-01077l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Justin T. Tretter
- Pediatric and Adult Congenital Heart Center, Cleveland Clinic, 9500 Euclid Avenue, M-41, Cleveland, OH, 44195, USA
| | - Diane E. Spicer
- Heart Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA,Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA
| | - Robert H. Anderson
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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17
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Nuñez-Borque E, Fernandez-Bravo S, Yuste-Montalvo A, Esteban V. Pathophysiological, Cellular, and Molecular Events of the Vascular System in Anaphylaxis. Front Immunol 2022; 13:836222. [PMID: 35371072 PMCID: PMC8965328 DOI: 10.3389/fimmu.2022.836222] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/07/2022] [Indexed: 01/10/2023] Open
Abstract
Anaphylaxis is a systemic hypersensitivity reaction that can be life threatening. Mechanistically, it results from the immune activation and release of a variety of mediators that give rise to the signs and symptoms of this pathological event. For years, most of the research in anaphylaxis has focused on the contribution of the immune component. However, approaches that shed light on the participation of other cellular and molecular agents are necessary. Among them, the vascular niche receives the various signals (e.g., histamine) that elicit the range of anaphylactic events. Cardiovascular manifestations such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and cardiac alterations are crucial in the pathophysiology of anaphylaxis and are highly involved to the development of the most severe cases. Specifically, the endothelium, vascular smooth muscle cells, and their molecular signaling outcomes play an essential role downstream of the immune reaction. Therefore, in this review, we synthesized the vascular changes observed during anaphylaxis as well as its cellular and molecular components. As the risk of anaphylaxis exists both in clinical procedures and in routine life, increasing our knowledge of the vascular physiology and their molecular mechanism will enable us to improve the clinical management and how to treat or prevent anaphylaxis. Key Message Anaphylaxis, the most severe allergic reaction, involves a variety of immune and non-immune molecular signals that give rise to its pathophysiological manifestations. Importantly, the vascular system is engaged in processes relevant to anaphylactic events such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and decreased cardiac output. The novelty of this review focuses on the fact that new studies will greatly improve the understanding of anaphylaxis when viewed from a vascular molecular angle and specifically from the endothelium. This knowledge will improve therapeutic options to treat or prevent anaphylaxis.
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Affiliation(s)
- Emilio Nuñez-Borque
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Sergio Fernandez-Bravo
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Alma Yuste-Montalvo
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Vanesa Esteban
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Faculty of Medicine and Biomedicine, Alfonso X El Sabio University, Madrid, Spain
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18
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Santos VA, Barreira MP, Saad KR. Technological resources for teaching and learning about human anatomy in the medical course: Systematic review of literature. ANATOMICAL SCIENCES EDUCATION 2022; 15:403-419. [PMID: 34664384 DOI: 10.1002/ase.2142] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
The consolidation of technology as an alternative strategy to cadaveric dissection for teaching anatomy in medical courses was accelerated by the recent Covid-19 pandemic, which caused the need for social distance policies and the closure of laboratories and classrooms. Consequently, new technologies were created, and those already been developed started to be better explored. However, information about many of these instruments and resources is not available to anatomy teachers. This systematic review presents the technological means for teaching and learning about human anatomy developed and applied in medical courses in the last ten years, besides the infrastructure necessary to use them. Studies in English, Portuguese, and Spanish were searched in MEDLINE, Scopus, ERIC, LILACS, and SciELO databases, initially resulting in a total of 875 identified articles, from which 102 were included in the analysis. They were classified according to the type of technology used: three-dimensional (3D) printing (n = 22), extended reality (n = 49), digital tools (n = 23), and other technological resources (n = 8). It was made a detailed description of technologies, including the stage of the medical curriculum in which it was applied, the infrastructure utilized, and which contents were covered. The analysis shows that between all technologies, those related to the internet and 3D printing are the most applicable, both in student learning and the financial cost necessary for its structural implementation.
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Affiliation(s)
- Vinícius A Santos
- School of Medicine, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Matheus P Barreira
- School of Medicine, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Karen R Saad
- Department of Morphology, School of Medicine, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
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19
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Anderson RH, Sanchez-Quintana D, Mori S, Spicer DE, Wellens HJJ, Lokhwandala Y, Cabrera JA, Farre J, Sternick EB. Miniseries 2-septal and paraseptal accessory pathways-Part I: The anatomic basis for the understanding of para-Hisian accessory atrioventricular pathways. Europace 2022; 24:639-649. [PMID: 34999776 DOI: 10.1093/europace/euab292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Although the anatomy of the atrioventricular conduction axis was well described over a century ago, the precise arrangement in the regions surrounding its transition from the atrioventricular node to the so-called bundle of His remain uncertain. We aimed to clarify these relationships. METHODS AND RESULTS We have used our various datasets to examine the development and anatomical arrangement of the atrioventricular conduction axis, paying particular attention to the regions surrounding the point of penetration of the bundle of His. It is the areas directly adjacent to the transition of the atrioventricular conduction axis from the atrioventricular node to the non-branching atrioventricular bundle that constitute the para-Hisian areas. The atrioventricular conduction axis itself traverses the membranous part of the ventricular septum as it extends from the node to become the bundle, but the para-Hisian areas themselves are paraseptal. This is because they incorporate the fibrofatty tissues of the inferior pyramidal space and the superior atrioventricular groove. In this initial overarching review, we summarize the developmental and anatomical features of these areas along with the location and landmarks of the atrioventricular conduction axis. We emphasize the relationships between the inferior pyramidal space and the infero-septal recess of the subaortic outflow tract. The details are then explored in greater detail in the additional reviews provided within our miniseries. CONCLUSION Our anatomical findings, described here, provide the basis for our concomitant clinical review of the so-called para-Hisian arrhythmias. The findings also provide the basis for understanding the other variants of ventricular pre-excitation.
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Affiliation(s)
- Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Diane E Spicer
- Department of Pediatric Cardiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hein J J Wellens
- CARIM- Cardiovascular Research Centre, Maastricht, Maastricht, The Netherlands
| | | | - Jose-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud, Madrid and Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, Spain
| | - Jeronimo Farre
- Cardiology Department, Arrhythmia Unit, Institute of Health Sciences Investigations of Jiménez Díaz Foundation, and Madrid Autonomous University, Madrid, Spain
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
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20
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Varma PK, Jose RL, Krishna N, Srimurugan B, Valooran GJ, Jayant A. Perioperative right ventricular function and dysfunction in adult cardiac surgery-focused review (part 1-anatomy, pathophysiology, and diagnosis). Indian J Thorac Cardiovasc Surg 2022; 38:45-57. [PMID: 34898875 PMCID: PMC8630124 DOI: 10.1007/s12055-021-01240-y] [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: 03/12/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023] Open
Abstract
Right ventricle (RV) dysfunction and failure are now increasingly recognized as an important cause of perioperative morbidity and mortality after cardiac surgery. Although RV dysfunction is common, RV failure is very rare (0.1%) after routine cardiac surgery. However, it occurs in 3% of patients after heart transplantation and in up to 30% of patients after left ventricular assist device implantation. Significant RV failure after cardiac surgery has high mortality. Knowledge of RV anatomy and physiology are important for understanding RV dysfunction and failure. Echocardiography and haemodynamic monitoring are the mainstays in the diagnosis of RV dysfunction and failure. While detailed echocardiography assessment of right heart function has been extensively studied and validated in the elective setting, gross estimation of RV chamber size, function, and some easily obtained quantitative parameters on transesophageal echocardiography are useful in the perioperative setting. However, detailed knowledge of echocardiography parameters is still useful in understanding the differences in contractile pattern, ventriculo-arterial coupling, and interventricular dependence that ensue after open cardiac surgery. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12055-021-01240-y.
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Affiliation(s)
- Praveen Kerala Varma
- Divisions of Cardiovascular & Thoracic Surgery, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India
| | - Reshmi Liza Jose
- Divisions of Cardiac Anesthesiology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Divisions of Cardiovascular & Thoracic Surgery, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India
| | - Balaji Srimurugan
- Divisions of Cardiovascular & Thoracic Surgery, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India
| | | | - Aveek Jayant
- Divisions of Cardiac Anesthesiology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India
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21
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Mori S, Bradfield JS, Peacock WJ, Anderson RH, Shivkumar K. Living Anatomy of the Pericardial Space: A Guide for Imaging and Interventions. JACC Clin Electrophysiol 2021; 7:1628-1644. [PMID: 34949433 DOI: 10.1016/j.jacep.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022]
Abstract
The pericardium of the human heart has received increased attention in recent times due to interest in the epicardial approach for cardiac interventions to treat cardiac arrhythmias refractory to conventional endocardial approaches. To support further clinical application of this technique, it is fundamental to appreciate the living anatomy of the pericardial space, as well as its relationships to the surrounding structures. The anatomy of the pericardial space, however, is extremely difficult regions to visualize. This is due to its complex 3-dimensionality, and the "potential" nature of the space, which becomes obvious only when there is collection of pericardial fluid. This potential space, which is bounded by the epicardium and pericardium, can now be visualized by special techniques as we now report, permitting appreciation of its living morphology. Current sources of knowledge are limited to the dissection images, surgical images, and/or illustrations, which are not necessarily precise or sufficient to provide relevant comprehensive anatomical knowledge to those undertaking the epicardial approach. The authors demonstrate, for the first time to their knowledge, the 3-dimensional living anatomy of the pericardial space relative to its surrounding structures. They also provide correlative anatomy of the left sternocostal triangle as a common site for subxiphoid access. The authors anticipate their report serving as a tool for education of imaging and interventional specialists.
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Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, California, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, California, USA
| | | | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, California, USA.
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22
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Tretter JT, Izawa Y, Spicer DE, Okada K, Anderson RH, Quintessenza JA, Mori S. Understanding the Aortic Root Using Computed Tomographic Assessment: A Potential Pathway to Improved Customized Surgical Repair. Circ Cardiovasc Imaging 2021; 14:e013134. [PMID: 34743527 DOI: 10.1161/circimaging.121.013134] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is continued interest in surgical repair of both the congenitally malformed aortic valve, and the valve with acquired dysfunction. Aortic valvar repair based on a geometric approach has demonstrated improved durability and outcomes. Such an approach requires a thorough comprehension of the complex 3-dimensional anatomy of both the normal and congenitally malformed aortic root. In this review, we provide an understanding of this anatomy based on the features that can accurately be revealed by contrast-enhanced computed tomographic imaging. We highlight the complimentary role that such imaging, with multiplanar reformatting and 3-dimensional reconstructions, can play in selection of patients, and subsequent presurgical planning for valvar repair. The technique compliments other established techniques for perioperative imaging, with echocardiography maintaining its central role in assessment, and enhances direct surgical evaluation. This additive morphological and functional information holds the potential for improving selection of patients, surgical planning, subsequent surgical repair, and hopefully the subsequent outcomes.
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Affiliation(s)
- Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH (J.T.T.)
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine (Y.I.), Kobe University Graduate School of Medicine, Japan
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL (D.E.S., J.A.Q.)
| | - Kenji Okada
- Department of Cardiovascular Surgery (K.O.), Kobe University Graduate School of Medicine, Japan
| | - Robert H Anderson
- Cardiovascular Research Centre, Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (R.H.A.)
| | - James A Quintessenza
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL (D.E.S., J.A.Q.)
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA (S.M.)
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Mori S, Izawa Y, Nishii T. Simple Stereoscopic Display of 3-Dimensional Living Heart Anatomy Relevant to Electrophysiological Practice. JACC Clin Electrophysiol 2021; 6:1473-1477. [PMID: 33213806 DOI: 10.1016/j.jacep.2020.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
Comprehensive appreciation of the 3-dimensional anatomy of the living heart is essential for accurate diagnosis and establishment of safe interventional treatment by clinical electrophysiologists. Three-dimensional images displayed on a 2-dimensional surface usually undergo distortion and are not considered a real 3-dimensional representation because they cannot provide accurate depth perception. Currently, the availability of 3-dimensional visualization techniques, including 3-dimensional printing, 3-dimensional projectors, 3-dimensional monitors, and virtual reality, is limited owing to their limited user-friendliness and high costs. The authors discuss an alternative conventional approach of a cross-eyed method for viewing stereoscopically displayed images for better appreciation of real 3-dimensional images based on a simple technique.
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Affiliation(s)
- 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, Hyogo, Japan
| | - Tatsuya Nishii
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Multimodality Imaging of the Anatomy of the Aortic Root. J Cardiovasc Dev Dis 2021; 8:jcdd8050051. [PMID: 34064421 PMCID: PMC8147821 DOI: 10.3390/jcdd8050051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 12/14/2022] Open
Abstract
The aortic root has long been considered an inert unidirectional conduit between the left ventricle and the ascending aorta. In the classical definition, the aortic valve leaflets (similar to what is perceived for the atrioventricular valves) have also been considered inactive structures, and their motion was thought to be entirely passive—just driven by the fluctuations of ventricular–aortic gradients. It was not until the advent of aortic valve–sparing surgery and of transcatheter aortic valve implantation that the interest on the anatomy of the aortic root again took momentum. These new procedures require a systematic and thorough analysis of the fine anatomical details of the components of the so-called aortic valve apparatus. Although holding and dissecting cadaveric heart specimens remains an excellent method to appreciate the complex “three-dimensional” nature of the aortic root, nowadays, echocardiography, computed tomography, and cardiac magnetic resonance provide excellent images of cardiac anatomy both in two- and three-dimensional format. Indeed, modern imaging techniques depict the aortic root as it is properly situated within the thorax in an attitudinally correct cardiac orientation, showing a sort of “dynamic anatomy”, which admirably joins structure and function. Finally, they are extensively used before, during, and after percutaneous structural heart disease interventions. This review focuses on the anatomy of the aortic root as revealed by non-invasive imaging techniques.
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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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26
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Song Y, Wang H, Yue F, Lv Q, Cai B, Dong N, Wang Z, Wang L. Silk-Based Biomaterials for Cardiac Tissue Engineering. Adv Healthc Mater 2020; 9:e2000735. [PMID: 32939999 DOI: 10.1002/adhm.202000735] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/29/2020] [Indexed: 12/18/2022]
Abstract
Cardiovascular diseases are one of the leading causes of death globally. Among various cardiovascular diseases, myocardial infarction is an important one. Compared with conventional treatments, cardiac tissue engineering provides an alternative to repair and regenerate the injured tissue. Among various types of materials used for tissue engineering applications, silk biomaterials have been increasingly utilized due to their biocompatibility, biological functions, and many favorable physical/chemical properties. Silk biomaterials are often used alone or in combination with other materials in the forms of patches or hydrogels, and serve as promising delivery systems for bioactive compounds in tissue engineering repair scenarios. This review focuses primarily on the promising characteristics of silk biomaterials and their recent advances in cardiac tissue engineering.
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Affiliation(s)
- Yu Song
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huifang Wang
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Feifei Yue
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qiying Lv
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bo Cai
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zheng Wang
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lin Wang
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Tretter JT, Gupta SK, Izawa Y, Nishii T, Mori S. Virtual Dissection: Emerging as the Gold Standard of Analyzing Living Heart Anatomy. J Cardiovasc Dev Dis 2020; 7:E30. [PMID: 32806725 PMCID: PMC7570024 DOI: 10.3390/jcdd7030030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Traditionally, gross cardiac anatomy has been described mainly based on the findings in the dissection suite. Analyses of heart specimens have contributed immensely towards building a fundamental knowledge of cardiac anatomy. However, there are limitations in analyzing the autopsied heart removed from the thorax. Three-dimensional imaging allows visualization of the blood-filled heart in vivo in attitudinally appropriate fashion. This is of paramount importance for not only demonstration of cardiac anatomy for educational purposes, but also for the detailed anatomical evaluation in patients with acquired and congenital heart disease. In this review, we discuss the advantages of three-dimensional imaging, specifically focusing on virtual dissection, a volume rendering-based reconstruction technique using computed tomographic data. We highlight examples of three-dimensional imaging in both education and guiding patient management.
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Affiliation(s)
- Justin T. Tretter
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan;
| | - Tatsuya Nishii
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan;
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Liashenko I, Hrynevich A, Dalton PD. Designing Outside the Box: Unlocking the Geometric Freedom of Melt Electrowriting using Microscale Layer Shifting. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e2001874. [PMID: 32459023 DOI: 10.1002/adma.202001874] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
Melt electrowriting, a high-resolution additive manufacturing technology, has so far been developed with vertical stacking of fiber layers, with a printing trajectory that is constant for each layer. In this work, microscale layer shifting is introduced through deliberately offsetting the printing trajectory for each printed layer. Inaccuracies during the printing of sinusoidal walls are corrected via layer shifting, resulting in accurate control of their geometry and mechanical properties. Furthermore, more substantial layer shifting allows stacking of fiber layers in a horizontal manner, overcoming the electrostatic autofocusing effect that favors vertical layer stacking. Novel nonlinear geometries, such as overhangs, wall texturing and branching, and smooth and abrupt changes in printing trajectory are presented, demonstrating the flexibility of the layer shifting approach beyond the state-of-the-art. The practice of microscale layer shifting for melt electrowriting enables more complex geometries that promise to have a profound impact on the development of products in a broad range of applications.
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Affiliation(s)
- Ievgenii Liashenko
- Department of Chemical Engineering, Universitat Rovira i Virgili, Av. dels Països Catalans 26, Tarragona, 43007, Spain
- Catalonia Institute for Energy Research - IREC, Sant Adrià de Besòs 1, Pl 2, Barcelona, 08930, Spain
- Department of Functional Materials in Medicine and Dentistry and Bavarian Polymer Institute, University Hospital of Würzburg, Pleicherwall 2, Würzburg, 97070, Germany
| | - Andrei Hrynevich
- Department of Functional Materials in Medicine and Dentistry and Bavarian Polymer Institute, University Hospital of Würzburg, Pleicherwall 2, Würzburg, 97070, Germany
| | - Paul D Dalton
- Department of Functional Materials in Medicine and Dentistry and Bavarian Polymer Institute, University Hospital of Würzburg, Pleicherwall 2, Würzburg, 97070, Germany
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29
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Muresian H. The aortic root hexagon and the need for clearer descriptions of the aortic root. Clin Anat 2020; 34:1124-1125. [PMID: 32253773 DOI: 10.1002/ca.23602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Horia Muresian
- Cardiovascular Sugery, The University Hospital of Bucharest, Bucharest, Romania
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30
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Suzuki M, Mori S, Izawa Y, Shimoyama S, Takahashi Y, Toh H, Tsuda D, Toba T, Fujiwara S, Tanaka H, Hirata KI, Anderson RH, Tretter JT. Three-dimensional volumetric measurement of the aortic root compared to standard two-dimensional measurements using cardiac computed tomography. Clin Anat 2020; 34:333-341. [PMID: 32249462 DOI: 10.1002/ca.23597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Two-dimensional measurements are self-evidently limited when seeking accurately to represent the three-dimensional complexity of the aortic root. Volumetric measurement, therefore, seems an ideal alternative for a more accurate assessment. MATERIALS AND METHODS We retrospectively analyzed 123 individuals undergoing cardiac computed tomography. We measured the dimensions of the sinuses of Valsalva using routine multiplanar short axis imaging. Three conventional two-dimensional methods were applied to measure the dimensions of the sinuses. These involved bisecting center of sinus-to-center of interleaflet triangle measures, along with center of sinus-to-center of sinus, and largest sinus-to-sinus measurements. We then quantified the volumes of the root using the volume-rendering method. RESULTS The mean dimensions of the sinuses were significantly greater when measured using the largest sinus-to-sinus method as opposed to center of sinus-to-center of interleaflet triangle and center of sinus-to-center of sinus methods (33.6 ± 3.6 mm vs. 31.1 ± 3.1 mm and 30.9 ± 3.3 mm, p < .0001). The mean root volume of 13.6 ± 4.2 ml showed the strongest correlation with the mean dimensions of the sinuses of Valsalva measured using the bisecting method (R2 = .8401, p < .0001). CONCLUSIONS By using two- and three-dimensional measurements, we have provided average data for the structurally normal aortic root. The differences and correlations encountered should be noted when evaluating and following changes in the diseased root.
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Affiliation(s)
- Masataka Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumpei Mori
- 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
| | - Shinsuke Shimoyama
- Department of Radiology, 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
| | - Hiroyuki Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Tsuda
- 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
| | - Ken-Ichi Hirata
- 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
| | - Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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McGovern EM, Tretter JT, Moore RA, Goldstein BH. Simulation to Success. JACC Case Rep 2020; 2:486-487. [PMID: 34317270 PMCID: PMC8311611 DOI: 10.1016/j.jaccas.2019.11.078] [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: 10/15/2019] [Accepted: 11/21/2019] [Indexed: 12/26/2022]
Abstract
Three-dimensional imaging and printed heart models have become increasingly valuable in the management of patients with complex congenital heart disease. We successfully simulated a stenting procedure on a 3-dimensional printed model of a patient with d-transposition of the great arteries status post-Mustard operation with caval baffle atresia and stenosis. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Eimear M. McGovern
- Heart Institute, Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Justin T. Tretter
- Heart Institute, Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan A. Moore
- Heart Institute, Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bryan H. Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Address for correspondence: Dr. Bryan H. Goldstein, Heart Institute, UPMC Children's Hospital of Pittsburgh, 5th Floor Faculty Pavilion, 4401 Penn Avenue, Pittsburgh, Pennsylvania 15224.
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Toh H, Mori S, Tretter JT, Izawa Y, Shimoyama S, Suzuki M, Takahashi Y, Tsuda D, Toba T, Fujiwara S, Hirata KI, Anderson RH. Living Anatomy of the Ventricular Myocardial Crescents Supporting the Coronary Aortic Sinuses. Semin Thorac Cardiovasc Surg 2020; 32:230-241. [DOI: 10.1053/j.semtcvs.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/09/2020] [Indexed: 02/01/2023]
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Virtual dissection and endocast three-dimensional reconstructions: maximizing computed tomographic data for procedural planning of an obstructed pulmonary venous baffle. Cardiol Young 2019; 29:1104-1106. [PMID: 31347481 DOI: 10.1017/s1047951119001501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We present a case of pulmonary venous baffle obstruction in a child with a history of congenitally corrected transposition status post double switch repair. We highlight two forms of volume rendering three-dimensional reconstructions from computed tomographic data which allowed for detailed pre-surgical planning. These reconstructions emphasise the concept of maximizing previously obtained two-dimensional data in a time-efficient and cost-effective manner. The benefits of these reconstructions are reviewed, highlighting the relatively novel virtual dissection reconstruction technique that appeared identical to what the surgeon encountered in the operating theatre. This technique allowed the surgeon to quickly advance a preconceived detailed surgical repair.
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34
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Anderson RH. The cavotricuspid isthmus in the setting of real cardiac anatomy. Heart Rhythm 2019; 16:1619-1620. [PMID: 31158495 DOI: 10.1016/j.hrthm.2019.05.034] [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: 05/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
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35
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De Almeida MC, Spicer DE, Anderson RH. Why do we break one of the first rules of anatomy when describing the components of the heart? Clin Anat 2019; 32:585-596. [DOI: 10.1002/ca.23356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Marcos C. De Almeida
- Instituto de Biologia‐Genetica e MorfologiaCampus Universitario Darcy Ribeiro, Universidade de Brasılia Brasılia Distrito Federal Brazil
| | - Diane E. Spicer
- Department of Pediatric CardiologyUniversity of Florida College of Medicine Gainesville Florida
| | - Robert H. Anderson
- Institute of Genetic MedicineNewcastle University Newcastle‐upon‐Tyne United Kingdom
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Anderson RH, Tretter JT, Spicer DE, Mori S. The Fate of the Outflow Tract Septal Complex in Relation to the Classification of Ventricular Septal Defects. J Cardiovasc Dev Dis 2019; 6:jcdd6010009. [PMID: 30795606 PMCID: PMC6463070 DOI: 10.3390/jcdd6010009] [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: 01/07/2019] [Accepted: 02/20/2019] [Indexed: 01/01/2023] Open
Abstract
It is now established that the entity often described as an “aortopulmonary septal complex” is better considered as an “outflow tract septal complex”. This change is crucial for appropriate understanding of not only malformations of the outflow tract, but also ventricular septal defects. Thus, the embryonic outflow tract, as it develops, is separated into its two components by fusion of a protrusion from the dorsal wall of the aortic sac with the distal end of the outflow cushions. The key point with regard to morphogenesis is that, with ongoing development, these structures lose their septal integrity, although they can still be identified as septal structures when the ventricular septum itself is deficient. In the normal postnatal heart, however, the aortic and pulmonary components have their own walls throughout the length of the outflow tracts. All of this is of clinical significance, since some current concepts of categorisation of the ventricular septal defects are based on the existence in the normal heart of a “conal septum”, along with a “septum of the atrioventricular canal”. In this review, we show how analysis of postnatal hearts reveals the definitive ventricular septum to possess only muscular and fibrous components in the absence of either discrete outflow or inlet components. We also show that this information regarding development, in turn, is of major significance in determining whether categorisation of ventricular septal defects is best approached, in the first instance, on the basis of the borders of the defects or the fashion in which they open to the right ventricle.
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Affiliation(s)
- Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne NE1 3BZ, UK.
| | - Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Diane E Spicer
- Division of Pediatric Cardiology, University of Florida, Gainesville, FL 32611, USA.
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
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O’Leary JM, McNeely DE, Damp JA, Wells QS, Nanney L, Mendes L. Hands-on Gross Anatomy Instruction Improves Clinical Imaging Skills Among Cardiovascular Fellows. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519842542. [PMID: 31065587 PMCID: PMC6488777 DOI: 10.1177/2382120519842542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Multi-modality imaging is a crucial component of cardiovascular (CV) fellowship training and requires knowledge of CV anatomy for interpretation. We hypothesized that hands-on anatomy education would improve the imaging interpretation skills of CV fellows. METHODS The first-year CV fellowship class completed a hands-on cadaveric anatomy session correlated with clinical imaging. Fellows' ability to identify CV structures on cardiac imaging was assessed using a 30-question assessment tool administered at baseline and 1 week and 6 months post intervention. Advanced CV fellows (second or third year) who had not attended the session were also tested. Scores were expressed as median [interquartile range]. RESULTS Among 9 first-year fellows, the majority reported no formal anatomy training since medical school (N = 7) and rated their knowledge of CV anatomy as fair or poor (N = 7) prior to the intervention. The median assessment score was higher 1 week after intervention vs baseline (24 [23-25] vs 19 [17-21]; P = .013) and remained higher than baseline at 6 months (26 [26-28] vs 19 [17-21]; P = .009). The 6-month post-intervention score for first-year fellows was not significantly different than that of senior fellows (n = 10) not exposed to the intervention (26 [26-28] vs 26 [23-27]; P = .434). CONCLUSIONS Gross anatomy instruction improved first-year CV fellows' interpretation of CV imaging. Anatomic instruction may be a useful adjunct to multi-modality imaging education.
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Affiliation(s)
- JM O’Leary
- Division of Cardiovascular Medicine,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - DE McNeely
- Cardiology Department, Greenville Health
System, Greenville, SC, USA
| | - JA Damp
- Division of Cardiovascular Medicine,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - QS Wells
- Division of Cardiovascular Medicine,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Nanney
- Department of Cell and Developmental
Biology, School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - L Mendes
- Division of Cardiovascular Medicine,
Vanderbilt University Medical Center, Nashville, TN, USA
| |
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