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Arshad A, Atkinson AJ. A 21st century view of the anaotmy of the cardiac conduction system. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sá MP, Cavalcanti LRP, Van den Eynde J, Amabile A, Escorel Neto AC, Perazzo AM, Weymann A, Ruhparwar A, Sicouri S, Bisleri G, Torregrossa G, Geirrson A, Ramlawi B. Respect versus resect approaches for mitral valve repair: a study-level meta-analysis. Trends Cardiovasc Med 2022; 33:225-239. [PMID: 35051591 DOI: 10.1016/j.tcm.2022.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
Mitral valve repair (MVr) restores leaflets coaptation while preserving the patient's own valve. The two main techniques are: (a) chordal replacement ("respect approach"), whereby artificial neochordae are used to resuspend prolapsed segments of the affected leaflet - and (b) leaflet resection ("resect approach"), whereby diseased leaflet segment is resected, and the remaining segments are sutured together. Both techniques of MVr are associated with better long-term results, fewer valve-related complications and lower mortality when compared with mitral valve replacement (MVR). They also restore quality of life and improve survival to rates equivalent to those of the general population. We performed a meta-analysis to pool data of clinical studies that compared outcomes of MVr stratified by the surgical technique. Seventeen studies accounting for 6,046 patients fulfilled our eligibility criteria. The "respect approach" outperformed the "resect approach" with lower permanent pacemaker implantation rates and lower mean gradients. Despite any possible advantages of one technique over the other, which approach is best for each patient must be decided on a case-by-case basis and more long-term follow-up data are warranted.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute / Main Line Health, Philadelphia, PA, USA; Division of Cardiac Surgery Research, Lankenau Institute for Medical Research / Main Line Health, Philadelphia, PA, USA.
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Recife, Brazil; University of Pernambuco - UPE. Recife, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Antonio C Escorel Neto
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Recife, Brazil; University of Pernambuco - UPE. Recife, Brazil
| | - Alvaro M Perazzo
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Recife, Brazil; University of Pernambuco - UPE. Recife, Brazil
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Serge Sicouri
- Division of Cardiac Surgery Research, Lankenau Institute for Medical Research / Main Line Health, Philadelphia, PA, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute / Main Line Health, Philadelphia, PA, USA; Division of Cardiac Surgery Research, Lankenau Institute for Medical Research / Main Line Health, Philadelphia, PA, USA
| | - Arnar Geirrson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Basel Ramlawi
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Recife, Brazil; University of Pernambuco - UPE. Recife, Brazil
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Gupta T, Kaur M, Sahni D. Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: an immunohistochemical proof. Surg Radiol Anat 2022; 44:129-136. [PMID: 34994828 DOI: 10.1007/s00276-021-02864-w] [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: 08/16/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The atrial muscle sleeve (AMS) of the pulmonary vein is the most common source of the arrhythmogenic triggers in atrial fibrillation (AF). Anatomical substrate generating these ectopic currents is still elusive. The present study was designed to study the AMS of pulmonary veins with an emphasis on the structural basis which might govern AF initiation and perpetuation. METHODS The study was conducted on a longitudinal tissue section of pulmonary vein, taken from 15 human cadaveric nondiseased hearts. Tissue was studied histologically using H&E and Gömöri trichrome stain. The pacemaker channels were identified by immunohistochemistry using monoclonal HCN4 and HCN1 antibodies. RESULTS The AMS was identified in each pulmonary vein, located between the tunica adventitia and tunica media. A node-like arrangement of myocytes was seen within the AMS in 30% of veins. It had a compact zone limited by a fibrous capsule and contained much smaller, paler and interconnected myocytes. Outside the capsule, there was a zone of dispersed, singly placed myocytes separating the compact zone from the working myocytes of the AMS. HCN4 and HCN1 antibodies were expressed on the cell membrane of nodal myocytes, while the working myocytes demonstrated none to minimal staining. CONCLUSION Pulmonary veins nodes are similar to the specialized cardiac conductive tissue in the histological arrangement of compact and transitional zones, cellular characteristics and the presence of pacemaker channels. They might be the anatomical basis of ectopic arrhythmogenic foci. To our knowledge, these nodes are being described for the first time in human.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Mandeep Kaur
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
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Gómez-Torres F, Ruíz-Sauri A. Morphometric analysis of the His bundle (atrioventricular fascicle) in humans and other animal species. Histological and immunohistochemical study. Vet Res Commun 2021; 45:319-327. [PMID: 34244914 DOI: 10.1007/s11259-021-09812-4] [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: 03/05/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
The His bundle is a part of the specialized electrical conduction system that provides a connection between the atrial and ventricular myocardial compartments in both normal and abnormal hearts. The aim of this study was to perform a morphometric analysis of His bundle characteristics of in humans, dogs, horses and pigs and compare them in these studied species. Histological sections of 5 μm thickness were obtained and stained with hematoxylin-eosin and Masson's trichrome; the desmin and periodic acid-Schiff methods were also used for precise identification of cells. The His bundle was found to be longer in horses (2.85 ± 1.02 mm) and pigs (1.77 ± 0.9 mm) than in dogs (1.53 ± 0.8 mm) or humans, in which it was shortest (1.06 ± 0.6 mm). The area and diameters in His bundle cells, were significantly larger in pigs and horses than in humans (p < 0.001) or dogs (p < 0.001). We found two organizational patterns of His bundle components: group I, with large cells and a high amount of collagen fibers in ungulates (pigs and horses); and group II, with smaller cells and lower abundance of collagen fibers in humans and dogs. Documenting cell size variations in the His bundle allows us not only to identify this bundle by histological or anatomical location but also to differentiate these cells from others such as nodal or Purkinje cells. Our analysis revealed that His bundle cells have discrete identities based on their morphometric and histological characteristics.
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Affiliation(s)
- Fabián Gómez-Torres
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, 1st floor, Av. de Blasco Ibáñez, 15, 46010, Valencia, Spain.,Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Cra, 32 # 29-31, 68002, Bucaramanga, Colombia
| | - Amparo Ruíz-Sauri
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, 1st floor, Av. de Blasco Ibáñez, 15, 46010, Valencia, Spain. .,INCLIVA Biomedical Research Institute, Av. de Blasco Ibáñez, 17, 46010, Valencia, Spain.
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Kawashima T, Sato F. First in situ 3D visualization of the human cardiac conduction system and its transformation associated with heart contour and inclination. Sci Rep 2021; 11:8636. [PMID: 33883659 PMCID: PMC8060315 DOI: 10.1038/s41598-021-88109-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 02/07/2023] Open
Abstract
Current advanced imaging modalities with applied tracing and processing techniques provide excellent visualization of almost all human internal structures in situ; however, the actual 3D internal arrangement of the human cardiac conduction system (CCS) is still unknown. This study is the first to document the successful 3D visualization of the CCS from the sinus node to the bundle branches within the human body, based on our specialized physical micro-dissection and its CT imaging. The 3D CCS transformation by cardiac inclination changes from the standing to the lying position is also provided. Both actual dissection and its CT image-based simulation identified that when the cardiac inclination changed from standing to lying, the sinus node shifted from the dorso-superior to the right outer position and the atrioventricular conduction axis changed from a vertical to a leftward horizontal position. In situ localization of the human CCS provides accurate anatomical localization with morphometric data, and it indicates the useful correlation between heart inclination and CCS rotation axes for predicting the variable and invisible human CCS in the living body. Advances in future imaging modalities and methodology are essential for further accurate in situ 3D CCS visualization.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Fumi Sato
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
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Left sided ablation for Atrioventricular Nodal Re-entrant Tachycardia: Frequency, Characteristics and Outcomes. Indian Pacing Electrophysiol J 2020; 21:5-10. [PMID: 33129971 PMCID: PMC7854377 DOI: 10.1016/j.ipej.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/04/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background Left-sided ablation, targeting left inferior AV nodal extensions, is thought to be necessary for success in a small proportion of atrioventricular nodal re-entrant tachycardia (AVNRT) ablations; however Indian data are scarce in this regard. Methods Consecutive cases of AVNRT undergoing slow pathway ablation in a single centre over an 18-month period were retrospectively analyzed. Left-sided ablation at the posteroseptal mitral annulus was performed if right-sided ablation failed to abolish AVNRT. Results From January 2017 to June 2018, out of 215 consecutive supraventricular tachycardia (SVT) cases, 154 (71.6%) were AVNRT (47.1 ± 13.1 years, 46.1% male). Trans-septal ablation was required in 5 (3.2%) cases (mean age 48.8 ± 9.4 years; 4 female, 1 male); all with typical (slow-fast) form of AVNRT. Compared with cases needing only right-sided ablation, radiofrequency time (50.8 ± 16.9 vs. 9.9 ± 8.5 min; p = 0.005) and procedure time (166.0 ± 35.0 vs 79.6 ± 35.9 min; p = 0.004) were significantly longer for trans-septal cases, while baseline intervals and tachycardia cycle length were not significantly different. Junctional ectopy was seen in only 2 of the 5 cases during left-sided ablation, but acute success (non-inducibility) was obtained in 3 cases. There were no instances of AV block. Over mean follow-up of 12.2 ± 4.0 months, clinical recurrence of AVNRT occurred in one case, while others remained arrhythmia-free without medication. Conclusion Left-sided ablation was required in a small proportion of AVNRT ablations. Trans-septal approach targeting the posteroseptal mitral annulus was safe and yielded good mid-term clinical success.
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Gómez-Torres F, Ballesteros-Acuña L, Ruíz-Sauri A. Morphological variations of the conduction system in the atrioventricular zone and its clinical relationship in different species. Anat Sci Int 2020; 96:212-220. [PMID: 32997266 DOI: 10.1007/s12565-020-00575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Abstract
Atrioventricular node is responsible for delaying the passage of the electrical impulse to ventricles in order to protect them from fast depolarizations coming from the atria. The importance of this study is to identify the morphological variations of the components of atrioventricular zone that affect the conduction system and its clinical relationship in different species of mammals. We analyzed ten human hearts, nine from horses, eight from pigs, and five from dogs without a clinical history of cardiac pathologies. Histological section thickness of 5 μm were obtained with a microtome and stained with hematoxylin-eosin and Masson's trichrome. We observed both an increase in collagen fibers and a decrease in the size of P cells (nodal pacemaker cells) within the atrioventricular node in dogs, horses and pigs in cases that presented cartilage in fibrous body. The percentage of fundamental substance in atrioventricular node was significantly higher in dogs and the percentage of collagen fibers was higher in pigs, both than in humans. The presence of cartilaginous metaplasia in cardiac fibrous skeleton from different species decreases the size of atrioventricular node and its cells and increases the percentage of collagen fibers within the node, which can reduce the transmission of the electrical impulse to ventricles and therefore predispose to the presentation of ventricular arrhythmias. Morphometric analysis has allowed us to objectively quantify each of the components of AV node and compare them in the different species.
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Affiliation(s)
- Fabián Gómez-Torres
- Department of Pathology, Faculty of Medicine, 1st floor, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010, Valencia, Spain.,Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Cra 32 # 29-31, 68002, Bucaramanga, Colombia
| | - Luis Ballesteros-Acuña
- Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Cra 32 # 29-31, 68002, Bucaramanga, Colombia
| | - Amparo Ruíz-Sauri
- Department of Pathology, Faculty of Medicine, 1st floor, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010, Valencia, Spain. .,INCLIVA Biomedical Research Institute, Av. de Blasco Ibáñez, 17, 46010, Valencia, Spain.
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Gómez-Torres FA, Sebastian R, Ruíz-Sauri A. Morphometry and comparative histology of sinus and atrioventricular nodes in humans and pigs and their relevance in the prevention of nodal arrhythmias. Res Vet Sci 2019; 128:275-285. [PMID: 31869593 DOI: 10.1016/j.rvsc.2019.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
Abstract
The cardiac conduction system is a network structure that allows the initiation and fast propagation of electrical impulses that trigger the electrical depolarization of the myocardial tissue. The purpose of this work is to study the histological and morphometric characteristics of the different components of the sinus and atrioventricular nodes in humans and pigs and their relationship with supraventricular arrhythmias. In this study, we describe the morphometry of the sinus and atrioventricular nodes of 10 adult humans and 10 pig hearts. A computerized morphometric study has been carried out, where we determined the number of cells that compose the nodes as well as different parameters related to their shape and size. The sinus node in human and pig is a compact structure, whose shape is oblong. Their cells (nodal and transitional cells) are pale and located in the center and the periphery, respectively. The atrioventricular node has also a shape oblong. P cells are pale in both species, but in humans, they are smaller than cardiomyocytes. The T cells are small and pale in both species, identified by hematoxylin-eosin and desmin stains. We have observed through a morphometric profile that the structure of sinus and atrioventricular nodes of pigs and humans show few differences. Pigs can be used as models for hemodynamic applications and experimental studies that include atrial electrical conduction and, in this way, prevent the presentation of arrhythmias that can generate sudden deaths in humans and pigs.
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Affiliation(s)
- F A Gómez-Torres
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain; Department of Basic Sciences, Medicine School, Universidad Industrial de Santander, Cra 32 # 29-31, 68002 Bucaramanga, Colombia.
| | - R Sebastian
- Computational Multiscale Simulation Lab, Universitat de Valencia, Valencia 46100, Spain.
| | - A Ruíz-Sauri
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain; INCLIVA Biomedical Research Institute, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain.
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Gómez-Torres F, Ballesteros-Acuña L, Ruíz-Sauri A. Histological and morphometric study of the components of the sinus and atrioventricular nodes in horses and dogs. Res Vet Sci 2019; 126:22-28. [DOI: 10.1016/j.rvsc.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/20/2019] [Accepted: 08/02/2019] [Indexed: 12/26/2022]
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Gupta T, Cheema N, Randhawa A, Sahni D. Translational anatomy of the left atrium and esophagus as relevant to the pulmonary vein antral isolation for atrial fibrillation. Surg Radiol Anat 2019; 42:367-376. [PMID: 31542799 DOI: 10.1007/s00276-019-02327-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/31/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Pulmonary vein antrum isolation by radiofrequency ablation has become a preferred treatment for atrial fibrillation. The aim of our research is to study the anatomy of the PVantrum and its related structures with special emphasis on the esophageal relation to the various components of the antrum, as thermal injury is a common complication. METHODS Mediastinal contents were extracted "en bloc" from 30 human formalin fixed adult cadavers to study the posterior wall of the left atrium along with the esophagus. RESULTS The pulmonary antrum was measured. Each pulmonary ostium was assessed for circumference and muscle thickness. The esophagus was related to the left superior ostium in 90% of cases. The esophagus was traced on the atrial wall in each case; the distance from endocardium was measured at five equidistant lines. AV node distance from the right inferior pulmonary vein was 5 cm. The atrioventricular part of the membranous septum measured 4.2 mm. CONCLUSIONS For antral isolation the ablation lines are about 3 cm superior, 3.5 cm inferior and about 1 cm apart. The esophagus is ~ 12 mm away at the superior and ~ 7 mm away at the inferior ablation line. On the left ablation line this distance would diminish from 15 to 7 mm. The pulmonary ostial circumference is ~ 5 cm with muscle thickness varying from 0.7 to 4 mm. The left ostia need more ablative power as they have a 60% (1 mm) thicker muscle coat. Care should be taken while ablating round the left superior ostium as the esophagus lies 1-3 cm behind it in 90% of the cases.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Neelkamal Cheema
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arpan Randhawa
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Daisy Sahni
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Gu M, Hu Y, Hua W, Niu H, Chen X, Cai M, Zhang N, Li H, Zhou X, Zhang S. Visualization of tricuspid valve annulus for implantation of His bundle pacing in patients with symptomatic bradycardia. J Cardiovasc Electrophysiol 2019; 30:2164-2169. [PMID: 31456266 DOI: 10.1111/jce.14140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/06/2019] [Accepted: 08/18/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Min Gu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yiran Hu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Wei Hua
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hongxia Niu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xuhua Chen
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Minsi Cai
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Nixiao Zhang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hui Li
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaohong Zhou
- Cardiac Rhythm and Heart FailureMedtronic plc Mounds View Minnesota
| | - Shu Zhang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Randhawa A, Gupta T, Singh P, Aggarwal A, Sahni D. Description of the aortic root anatomy in relation to transcatheter aortic valve implantation. Cardiovasc Pathol 2019; 40:19-23. [PMID: 30772639 DOI: 10.1016/j.carpath.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/05/2018] [Accepted: 01/12/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) has emerged as a less invasive treatment than surgical aortic valve replacement in patients with aortic stenosis. Understanding the anatomy of aortic valve complex may help in optimal positioning of prosthetic valve and circumvent complications that can arise during its implantation. MATERIAL AND METHODS The anatomy of aortic root was studied in 30 formalin-fixed cadavers. Aortic root and left ventricular cavity was opened to measure the diameter at the base of aortic root and sinotubular junction (STJ); distance of coronary ostia from base of aortic root and STJ; height and width of aortic valve leaflets; length and thickness of membranous septum (MS). RESULTS The diameter of aorta at the base of aortic root and STJ was 22.4±2.1 mm and 21.8±2.4 mm, respectively. The height of aortic leaflets was smaller than the width. The right and left coronary ostia were 10.7±1.9 mm and 10.5±1.9 mm above the base of aortic root. Membranous septum was 4.7±1.23 mm (range 2.9-6.1 mm) long and formed part of the wall of aortic root in 40% (12/30) cases. CONCLUSIONS Low lying coronary ostia speculate the use of a small prosthesis size to avoid or reduce the degree of coronary compression. Length of MS may help in deciding the extent of devise penetration into left ventricular outflow tract to avoid conduction block. Membranous septum forming wall of aortic root increases the risk of aortic root rupture and iatrogenic membranous defect during TAVI.
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Affiliation(s)
- Arpandeep Randhawa
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Parmod Singh
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anjali Aggarwal
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Daisy Sahni
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Kawashima T, Sato F. Clarifying the anatomy of the atrioventricular node artery. Int J Cardiol 2018; 269:158-164. [DOI: 10.1016/j.ijcard.2018.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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