1
|
Crucean A, Spicer DE, Tretter JT, Mohun TJ, Cook AC, Sanchez‐Quintana D, Hikspoors JPJM, Lamers WH, Anderson RH. Revisiting the anatomy of the left ventricle in the light of knowledge of its development. J Anat 2024; 245:201-216. [PMID: 38629319 PMCID: PMC11259752 DOI: 10.1111/joa.14048] [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: 01/11/2024] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 07/22/2024] Open
Abstract
Despite centuries of investigation, certain aspects of left ventricular anatomy remain either controversial or uncertain. We make no claims to have resolved these issues, but our review, based on our current knowledge of development, hopefully identifies the issues requiring further investigation. When first formed, the left ventricle had only inlet and apical components. With the expansion of the atrioventricular canal, the developing ventricle cedes part of its inlet to the right ventricle whilst retaining the larger parts of the cushions dividing the atrioventricular canal. Further remodelling of the interventricular communication provides the ventricle with its outlet, with the aortic root being transferred to the left ventricle along with the newly formed myocardium supporting its leaflets. The definitive ventricle possesses inlet, apical and outlet parts. The inlet component is guarded by the mitral valve, with its leaflets, in the normal heart, supported by papillary muscles located infero-septally and supero-laterally. There is but a solitary zone of apposition between the leaflets, which we suggest are best described as being aortic and mural. The trabeculated component extends beyond the inlet to the apex and is confluent with the outlet part, which supports the aortic root. The leaflets of the aortic valve are supported in semilunar fashion within the root, with the ventricular cavity extending to the sinutubular junction. The myocardial-arterial junction, however, stops well short of the sinutubular junction, with myocardium found only at the bases of the sinuses, giving rise to the coronary arteries. We argue that the relationships between the various components should now be described using attitudinally appropriate terms rather than describing them as if the heart is removed from the body and positioned on its apex.
Collapse
Affiliation(s)
- Adrian Crucean
- Department of Paediatric Cardiac SurgeryBirmingham Women's and Children's HospitalBirminghamUK
| | - Diane E. Spicer
- Congenital Heart Center, All Children's HospitalSt PetersbergFloridaUSA
| | - Justin T. Tretter
- Department of Pediatric CardiologyCleveland Clinic Children's, and the Heart, Vascular and Thoracic Institute, Cleveland ClinicClevelandOhioUSA
| | | | | | - Damian Sanchez‐Quintana
- Departamento de Anatomía Humana y Biología Celular, Facultad de MedicinaUniversidad de ExtremaduraBadajozSpain
| | | | | | - Robert H. Anderson
- Department of Paediatric Cardiac SurgeryBirmingham Women's and Children's HospitalBirminghamUK
- Biosciences InstituteNewcastle UniversityNewcastle‐upon‐TyneUK
| |
Collapse
|
2
|
Wang L, Cai C, Ju W, Chen M. Right ventricular false tendon-originating premature ventricular complexes triggering ventricular tachycardia: Identification and ablation. HeartRhythm Case Rep 2024; 10:418-421. [PMID: 38983892 PMCID: PMC11228068 DOI: 10.1016/j.hrcr.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Affiliation(s)
- Linlin Wang
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Cai
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
3
|
Silbiger JJ, Tunovic S, Chen H, Kamran M, Bagh I, Parikh A, Minsky D. Do False Tendons Prevent Adverse Left Ventricular Remodeling After Anterior Wall Myocardial Infarction? An Echocardiographic Strain Imaging Study. Am J Cardiol 2024; 217:136-140. [PMID: 38402927 DOI: 10.1016/j.amjcard.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/23/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
The role of muscular left ventricular (LV) false tendons (FTs) is poorly understood. To gain insight into their pathophysiologic significance, we adapted echocardiographic LV strain imaging software to measure LVFT longitudinal strain in subjects with normal left ventricles and in patients who sustained previous anterior wall myocardial infarction (AWMI). GE EchoPAC software was used to measure longitudinal strain in LVFTs ≥0.3 cm in diameter. Tendinous strain was measured in 11 patients with LVFTs confined to the left anterior descending artery territory (connecting the anteroseptum or anterior wall to the apex) ≥6 months after AWMI (myocardial infarction [MI]+FT+ group) and in 25 patients with normal hearts containing LVFTs (MI-FT+ group). We also compared the indexed LV end-diastolic volumes in the MI+FT+ group to that of 25 patients with previous AWMI without LVFTs (MI+FT- group). The mean LVFT strain in MI+FT+ group was 5.5 ± 6.2% and -28.9 ± 4.7% in the MI-FT+ group (p <0.0001). The indexed LV end-diastolic volume in the MI+FT+ group did not differ from the MI+FT- group (88.4 ± 17.8 vs 87.9 ± 17 ml/m2, p = 0.90). In conclusion, the negative strain (contraction) developed by LVFTs in the MI-FT+ group may help maintain normal LV size and shape by generating inward restraining forces. The development of positive strain (stretch) in LVFTs in patients in the MI+FT+ group suggests they become infarcted after AWMI. This implies that they are incapable of generating inward restraining forces that might otherwise mitigate adverse remodeling. Of note, LV volumes after AWMI do not differ whether or not LVFTs are present.
Collapse
Affiliation(s)
| | - Sanjin Tunovic
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Huazhen Chen
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Imad Bagh
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Aditya Parikh
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Minsky
- Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
4
|
Carrasco M, Cabrito TMS, Montalbano MJ, Hołda MK, Walocha J, Tubbs RS, Loukas M. Cardiac ventricular false tendons: A meta-analysis. Clin Anat 2024; 37:114-129. [PMID: 37819143 DOI: 10.1002/ca.24116] [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: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross dissection and echocardiography. This study aimed to comprehensively evaluate the prevalence, morphology, and clinical importance of ventricular false tendons using a systematic review. In multiple studies, these structures have had a wide reported prevalence ranging from less than 1% to 100% of cases. This meta-analysis found the overall pooled prevalence of LVFTs to be 30.2%. Subgroup analysis indicated the prevalence to be 55.1% in cadaveric studies and 24.5% in living patients predominantly studied by echocardiography. Morphologically, left and right ventricular false tendons have been classified into several types based on their location and attachments. Studies have demonstrated false tendons have important clinical implications involving innocent murmurs, premature ventricular contractions, early repolarization, and impairment of systolic and diastolic function. Despite these potential complications, there is evidence demonstrating that the presence of false tendons can lead to positive clinical outcomes.
Collapse
Affiliation(s)
- Mark Carrasco
- Department of Family Medicine, HealthQuest, Rhinebeck, New York, USA
| | | | | | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, West Indies
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, West Indies
- Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
| |
Collapse
|
5
|
Sorrell VL. What's So False about a False Chord? CASE (PHILADELPHIA, PA.) 2023; 7:427-428. [PMID: 38028388 PMCID: PMC10679517 DOI: 10.1016/j.case.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
•▪▪▪.•▪▪▪.•▪▪▪.
Collapse
|
6
|
Ma W, Qiu J, Lu F, Michael Shehata, Wang X, He L, Zhang F, Fan S, Zhang E, Wu D, Wang Z, Xu J. Catheter ablation of idiopathic left fascicular ventricular tachycardia: Implications of false tendons for mapping and ablation. J Cardiovasc Electrophysiol 2023; 34:673-681. [PMID: 36651353 DOI: 10.1111/jce.15822] [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: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The anatomical substrate for idiopathic left ventricular tachycardia (ILVT) remains speculative. Purkinje networks surrounding false tendons (FTs) might be involved in the reentrant circuit of ILVT. The objective was to evaluate the anatomical and electrophysiological features of false tendons FTs in relation to ILVT. METHODS Intracardiac echocardiography (ICE) was conducted on patients with ILVT. The relationship of the FTs with ILVT was determined using electro-anatomical mapping. RESULTS Electrophysiological evaluation and radiofrequency ablation were conducted in 23 consecutive patients with ILVT. FTs were identified in 19/23 cases (82.6%) with P1 potentials during VT recorded at the FT in 14 of these patients (73.7%). Three FT types were identified. In type 1, the FT attached the septum to the base of the posteromedial papillary muscle (PPM) (4/19); type 2 FTs ran between the septum and the PPM apex (3/19), while in type 3, the connection occurred between the septum and apex (11/19) or between the septum and the LV free wall (1/19). The effective ILVT ablation sites were situated at the FT-PPM (3/19) and the FT-septum (16/19) attachment sites. CONCLUSIONS This series demonstrates the association between Purkinje fibers and FTs during catheter ablation of ILVT and verifies that left ventricular FTs are an important substrate in this type of tachycardia.
Collapse
Affiliation(s)
- Wei Ma
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Jiuchun Qiu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fengmin Lu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | | | - Xunzhang Wang
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Le He
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Fan Zhang
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Shaobo Fan
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Enyuan Zhang
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Dongyan Wu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern eater Command, Shenyang, China
| | - Jing Xu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| |
Collapse
|
7
|
Idiopathic Ventricular Tachycardia. J Clin Med 2023; 12:jcm12030930. [PMID: 36769578 PMCID: PMC9918172 DOI: 10.3390/jcm12030930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
Idiopathic ventricular tachycardia (VT) is an important cause of morbidity and less commonly, mortality in patients with structurally normal hearts. Appropriate diagnosis and management are predicated on an understanding of the mechanism, relevant cardiac anatomy, and associated ECG signatures. Catheter ablation is a viable strategy to adequately treat and potentially provide a cure in patients that are intolerant to medications or when these are ineffective. In this review, we discuss special approaches and considerations for effective and safe ablation of VT arising from the right ventricular outflow tract, left ventricular outflow tract, left ventricular fascicles, papillary muscles, and moderator band.
Collapse
|
8
|
Sumerkan MC, Cetin S, Helvaci FB, Yaslikaya SS, Karabay U, Hamit T, Gurdal A, Agirbasli M, Alyan O. Three-dimensional echocardiographic assessment of Chiari’s network relationship with the left ventricular false tendon. Egypt Heart J 2022; 74:49. [PMID: 35704119 PMCID: PMC9200920 DOI: 10.1186/s43044-022-00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Left ventricular false tendon (LVFT) is a fibromuscular band crossing the left ventricular cavity. And Chiari’s network (CN) is a highly mobile, mesh-like, echogenic structure in right atrium. In this study, we aimed to evaluate the coexistence of LVFT in patients with CN. CN patients were examined with live/real-time three-dimensional transthoracic echocardiography (TTE) for visualization of LVFT. Results This is a single-center prospective study of 49 patients with CN. In literature studies, the average ratios of LVFT were 22% in the normal population. In our study, an increased ratio of LVFT (n = 31, 63.3%) was found in CN patients evaluated with a three-dimensional TTE (63.3% versus 22%) (p = 0.01). The interatrial septal aneurysm was found in 31 (63.3%) patients with CN. And, the positive contrast echocardiography examination was determined in 22 (61.1%) patients with CN. Conclusions Our study reveals that CN is associated with LVFT and is also associated with cardiac anomalies like an interatrial septal aneurysm, and atrial septal defect. And LVFT can be evaluated better with three-dimensional TTE than with traditional two-dimensional TTE. Patients with CN should be evaluated more carefully by three-dimensional echocardiography as they can be in synergy in terms of the cardiac pathologies they accompany. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-022-00287-5.
Collapse
|
9
|
Maleszewski JJ, Lai CK, Nair V, Veinot JP. Anatomic considerations and examination of cardiovascular specimens (excluding devices). Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
10
|
Riekerk HCE, Coolen BF, J Strijkers G, van der Wal AC, Petersen SE, Sheppard MN, Oostra RJ, Christoffels VM, Jensen B. Higher spatial resolution improves the interpretation of the extent of ventricular trabeculation. J Anat 2021; 240:357-375. [PMID: 34569075 PMCID: PMC8742974 DOI: 10.1111/joa.13559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 12/21/2022] Open
Abstract
The ventricular walls of the human heart comprise an outer compact layer and an inner trabecular layer. In the context of an increased pre-test probability, diagnosis left ventricular noncompaction cardiomyopathy is given when the left ventricle is excessively trabeculated in volume (trabecular vol >25% of total LV wall volume) or thickness (trabecular/compact (T/C) >2.3). Here, we investigated whether higher spatial resolution affects the detection of trabeculation and thus the assessment of normal and excessively trabeculated wall morphology. First, we screened left ventricles in 1112 post-natal autopsy hearts. We identified five excessively trabeculated hearts and this low prevalence of excessive trabeculation is in agreement with pathology reports but contrasts the prevalence of approximately 10% of the population found by in vivo non-invasive imaging. Using macroscopy, histology and low- and high-resolution MRI, the five excessively trabeculated hearts were compared with six normal hearts and seven abnormally trabeculated and excessive trabeculation-negative hearts. Some abnormally trabeculated hearts could be considered excessively trabeculated macroscopically because of a trabecular outflow or an excessive number of trabeculations, but they were excessive trabeculation-negative when assessed with MRI-based measurements (T/C <2.3 and vol <25%). The number of detected trabeculations and T/C ratio were positively correlated with higher spatial resolution. Using measurements on high resolution MRI and with histological validation, we could not replicate the correlation between trabeculations of the left and right ventricle that has been previously reported. In conclusion, higher spatial resolution may affect the sensitivity of diagnostic measurements and in addition could allow for novel measurements such as counting of trabeculations.
Collapse
Affiliation(s)
- Hanne C E Riekerk
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bram F Coolen
- Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Allard C van der Wal
- Department of Pathology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Mary N Sheppard
- Department of Cardiovascular Pathology, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Roelof-Jan Oostra
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Dubey MK, Mani A, Ojha V. Causal Relationship of the Transverse Left Ventricular Band and Bicuspid Aortic Valve. Sultan Qaboos Univ Med J 2021; 21:403-407. [PMID: 34522405 PMCID: PMC8407896 DOI: 10.18295/squmj.4.2021.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Bicuspid aortic valve (BAV) is the most common congenital lesion found in adults. It can be seen in combination with a transverse left ventricular (LV) band. This study aimed to find an essential relationship between the presence of transverse ventricular band and BAV. Methods A total of 13 patients from a tertiary care centre in India with transverse LV band were investigated during a six-month period from January 2019 to July 2019. LV band thickness and gradients at the site of the LV band were evaluated as part of its effect on LV haemodynamics. The morphology of the aortic valve and LV outflow tract gradients was assessed. Results The mean age of the participants was 41 years. A majority had a BAV (n = 11). Average thickness of the LV band was 6.2 mm and the average mean aortic gradient was 4 mmHg. Sequestration of blood was noted at the level of the transverse band in all the patients with two separate jets at the left ventricular outflow tract. The anterolateral jet was deflected from the transverse band and showed higher velocity compared to the other jet, causing turbulence at the BAV. No correlation was found between the thickness of the transverse band and aortic valve gradient. Conclusion Presence of a robust transverse LV band can serve as a surrogate marker for BAV.
Collapse
Affiliation(s)
- Manoj K Dubey
- Department of Internal Medicine, Patliputra Medical College and Hospital, Dhanbad, India
| | - Avinash Mani
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
12
|
Velthuis S, Senden PJ. Left ventricular false tendons. Neth Heart J 2021; 29:419-422. [PMID: 34232482 PMCID: PMC8397804 DOI: 10.1007/s12471-021-01592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/04/2022] Open
Abstract
Left ventricular false tendons (LVFTs) are fibromuscular structures, connecting the left ventricular free wall or papillary muscle and the ventricular septum. There is some discussion about safety issues during intense exercise in athletes with LVFTs, as these bands have been associated with ventricular arrhythmias and abnormal cardiac remodelling. However, presence of LVFTs appears to be much more common than previously noted as imaging techniques have improved and the association between LVFTs and abnormal remodelling could very well be explained by better visibility in a dilated left ventricular lumen. Although LVFTs may result in electrocardiographic abnormalities and could form a substrate for ventricular arrhythmias, it should be considered as a normal anatomic variant. Persons with LVFTs do not appear to have increased risk for ventricular arrhythmias or sudden cardiac death.
Collapse
Affiliation(s)
- S Velthuis
- Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
| | - P J Senden
- Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
| |
Collapse
|
13
|
Zhang J, Liang M, Wang Z, Zhang X, Fan J, Jia Y, Xiao F, Fu B, Zhang H, Huang J. Catheter ablation of premature ventricular complexes associated with left ventricular false tendons. Heart Rhythm 2021; 18:1968-1975. [PMID: 34214648 DOI: 10.1016/j.hrthm.2021.06.1197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical studies have suggested that there is a significant correlation between left ventricular (LV) false tendon and premature ventricular complexes (PVCs). OBJECTIVE This study aimed to investigate the electrophysiological characteristics and the outcome of radiofrequency catheter ablation (RFCA) for this category of PVCs. METHODS From a total of 2284 patients with idiopathic PVCs who underwent catheter ablation at 6 institutions in China, intracardiac echocardiography (ICE) was used during the procedure in 346 cases; 10 patients (2.9%) with PVCs associated with false tendon were retrospectively reviewed and enrolled in the present study. Activation mapping and pace mapping were performed to localize the origin of PVCs. ICE was used in all patients. If the false tendon was directly visualized and identified, we attempted to identify the distinct relationship with the PVC origin. RESULTS The PVCs were successfully eliminated by ablation in all patients. The target sites were confirmed to be related to false tendon. The origin of PVCs was located at the attachment of the false tendon to the papillary muscle, LV septum, or LV apex. At the target site, high-frequency Purkinje potentials were observed preceding local ventricular activation in 7 patients. CONCLUSION LV false tendon can be associated with PVCs, which can be cured by RFCA. An ICE-guided electroanatomical approach should be considered to improve the safety and feasibility of this procedure.
Collapse
Affiliation(s)
- Jinlin Zhang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China.
| | - Ming Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xi Zhang
- Department of Cardiology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Jie Fan
- Department of Cardiology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Yuhe Jia
- Center for Cardiac Arrhythmia, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fangyi Xiao
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Biao Fu
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Hao Zhang
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Jin Huang
- Johnson & Johnson (Shanghai) Medical Equipment Co, Ltd, Shanghai, China
| |
Collapse
|
14
|
Laakkonen J. Distribution and morphology of ventricular bands in the hearts of ringed seals. Anat Histol Embryol 2021; 50:756-759. [PMID: 34117789 DOI: 10.1111/ahe.12717] [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: 03/30/2021] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
In contrast to studies on domestic animals, few reports describe ventricular bands in wildlife, and none in aquatic mammals. Ventricular bands in the endangered Saimaa ringed seal (Pusa hispida saimensis) and the Baltic ringed seal (Pusa hispida botnica) were examined as part of an ongoing research on the comparative anatomy of ringed seal subspecies. The dissections illustrated that a varying number of thin or thick ventricular bands from the papillary muscles to the ventricular walls were visible in the ventricles of all ringed seal specimens examined. The histological appearance of the ventricular bands was characterized by a fibromuscular pattern.
Collapse
Affiliation(s)
- Juha Laakkonen
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
15
|
Lo Presti S, Baruqui DL, Perez J, Vadasseril BJ, Escolar E, Horvath SA, Mihos CG. The Role of False Tendons in Left Ventricular Remodeling and Secondary Mitral Regurgitation After Acute Myocardial Infarction. J Cardiovasc Imaging 2021; 29:46-56. [PMID: 33511800 PMCID: PMC7847792 DOI: 10.4250/jcvi.2020.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/20/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Left ventricular false tendons (LVFT) are common structures visualized on transthoracic echocardiography (TTE). The present study tested the hypothesis that LVFT, via a possible 'constraint' mechanism, attenuate left ventricular (LV) remodeling and secondary mitral regurgitation after acute myocardial infarction. METHODS Seventy-one patients admitted to the Coronary Care Unit following an ST-elevation (n = 63) or non-ST-elevation (n = 8) myocardial infarction were analyzed; 29 (41%) had LVFT, and 42 (59%) did not (no-LVFT). All had a TTE and at least 1 follow-up study after revascularization. The χ² analysis, Student's t-test, and Mann Whitney U test were used for the statistical analyses. RESULTS The mean age (64 vs. 66 years), left ventricular ejection fraction (LVEF) (41% vs. 39%), left ventricular end-diastolic diameter (LVEDd) index (23 mm/m² for both), and prevalence of ≥ moderate secondary/functional mitral regurgitation (MR) (17% vs. 14%) were similar between the LVFT and no-LVFT groups. At 1-year follow-up, there was no significant difference in chamber remodeling amongst the LVFT versus no-LVFT group when assessed by: 1) ≥ 10% decrease in the relative LVEF (24% vs. 26%; p = 0.83); 2) ≥ 10% increase in the LVEDd index (41% vs. 38%, p = 0.98); and, 3) ≥ 10% increase in the LV mass index (48% vs. 41%, p = 0.68). There was no difference in the prevalence of ≥ moderate secondary/functional MR (17% vs. 12%, p = 0.77). Outcomes remained similar when stratifying by LVFT morphology or ischemic territory. CONCLUSIONS In patients with mild to moderate LV dysfunction and normal chamber size, LVFT do not affect the development of LV remodeling or secondary/functional MR post-myocardial infarction.
Collapse
Affiliation(s)
- Saberio Lo Presti
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Diego Lugo Baruqui
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Jorge Perez
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ben Johns Vadasseril
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Esteban Escolar
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
- Coronary Care Unit, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Sofia A Horvath
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
- Echocardiography Laboratory, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christos G Mihos
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
- Echocardiography Laboratory, Mount Sinai Medical Center, Miami Beach, FL, USA. ,
| |
Collapse
|
16
|
Rajiah P, MacNamara J, Chaturvedi A, Ashwath R, Fulton NL, Goerne H. Bands in the Heart: Multimodality Imaging Review. Radiographics 2019; 39:1238-1263. [DOI: 10.1148/rg.2019180176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
17
|
Nan J, Sugrue A, Ladas TP, Mehra N, Asirvatham SJ. Anatomic Considerations Relevant to Atrial and Ventricular Arrhythmias. Card Electrophysiol Clin 2019; 11:421-432. [PMID: 31400867 DOI: 10.1016/j.ccep.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Knowledge of relevant cardiac anatomy is crucial in understanding the pathophysiology and treatment of arrhythmias, and helps avoid potential complications in mapping and ablation. This article explores the anatomy, relevant to electrophysiologists, relating to atrial flutter and atrial fibrillation, ventricular tachycardia relating to the outflow tracts as well as endocardial structure, and also epicardial considerations for mapping and ablation.
Collapse
Affiliation(s)
- John Nan
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Alan Sugrue
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Thomas P Ladas
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Nandini Mehra
- Department of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
18
|
Possible association of papillary muscle hypertrophy with the genesis of J-waves. J Cardiol 2019; 75:90-96. [PMID: 31327704 DOI: 10.1016/j.jjcc.2019.07.001] [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: 09/13/2018] [Accepted: 11/30/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although J-waves have been known to be associated with vulnerability to ventricular fibrillation, their electrophysiologic mechanism remains to be elucidated. The papillary muscles (PMs) of the left ventricle (LV) have been recognized as the target site of radiofrequency ablation for ventricular arrhythmias. However, the relationship between PM hypertrophy and J-waves has not been investigated. OBJECTIVE To investigate the electrocardiographic characteristics, including the J-waves, in patients with solitary PM hypertrophy. METHODS We studied 101 patients with PM hypertrophy without LV hypertrophy (PMH group) and 159 age- and sex-matched control subjects (control group). The parameters of the 12-lead electrocardiogram and the echocardiogram were compared between the two groups. RESULTS Compared with the control group, the PMH group had significantly higher incidence (15% vs. 33%, p=0.001) and amplitude (0.17±0.06mV vs. 0.28±0.17mV, p<0.01) of J-waves; significantly longer QRS, QTc, and JTc intervals (p=0.0001, p<0.0001, and p<0.05, respectively); significantly greater Sokolow-Lyon index (p<0.001); and significantly greater LV wall thickness and LV mass index (p<0.0001 for each). Multivariate logistic regression analysis showed that only the PM hypertrophy was an independent predictor of the presence of J-waves. CONCLUSION PM hypertrophy was related to the genesis of J-waves.
Collapse
|
19
|
Cope LA. Multiple ventricular bands and the associated trabecula septomarginalis dextra in the right ventricle of the domestic dog (
Canis familiaris
). Anat Histol Embryol 2019; 48:397-403. [DOI: 10.1111/ahe.12451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 02/18/2019] [Accepted: 04/26/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Lee Anne Cope
- Division of Biomedical Sciences Mercer University School of Medicine Macon Georgia
| |
Collapse
|
20
|
Merlocco A, Brown DW, Gauvreau K, Mah DY, Triedman JK, Alexander ME, Walsh EP. Evaluation of left ventricular false tendons in children with idiopathic left ventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1143-1149. [PMID: 29989175 DOI: 10.1111/pace.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/29/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left ventricular false tendons (FT) traverse the ventricular cavity and are thought to have some association with idiopathic left ventricular tachycardia (ILVT). However, reported prevalence of FT varies widely, making correlation difficult. Superior echocardiographic windows of pediatric patients may permit better analysis of FT in ILVT. Our study describes the relationship between FT and ILVT in young patients. METHODS Retrospective case-control study of 30 ILVT patients with 98 controls compared for FT. Diagnosis of ILVT was made by electrocardiogram and clinical history, and for 25 patients was further confirmed by electrophysiology study (EPS). Presence of FT was identified by one blinded observer and verified by a second blinded observer. Presence of FT was then compared between ILVT patients and controls using Fisher's exact test. RESULTS Presence of FT did not differ significantly between patients and controls (53% vs 43%, P = 0.40). Twelve FT patients (19%) had multiple FTs detected, though the incidence of ILVT was no higher in the setting of multiple FTs. A total of 25 patients with ILVT underwent EPS for intended ablation therapy, with ultimate success in 22/25 (88%) after one or more ablation sessions. Of the 25 EPS patients, FTs were present in 11, but precise correlation between successful ablation location and FT location was not possible since intraprocedural echocardiography was not performed in this patient group. CONCLUSIONS Presence of FTs did not differ between ILVT patients and controls. While FTs are not absolutely required for ILVT, they may still play a role in some cases.
Collapse
Affiliation(s)
- Anthony Merlocco
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Abstract
Echocardiography is a powerful and convenient tool used routinely in the cardiac evaluation of many patients. Improved resolution and visualization of cardiac anatomy has led to the discovery of many normal variant structures that have no known pathologic consequence. Importantly, these findings may masquerade as pathology prompting unnecessary further evaluation at the expense of anxiety, cost, or potential harm. This review provides an updated and comprehensive collection of normal anatomic variants on both transthoracic and transesophageal imaging.
Collapse
|
22
|
Cope LA. Morphology and Classification of Right Ventricular Bands in the Domestic Dog (Canis familiaris
). Anat Histol Embryol 2017; 46:464-473. [DOI: 10.1111/ahe.12291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- L. A. Cope
- Division of Basic Medical Sciences; Mercer University School of Medicine; 1550 College Street Macon GA 31207-0001 USA
| |
Collapse
|
23
|
Duan D, Yu S, Cui Y, Li C. Morphological study of the atrioventricular conduction system and Purkinje fibers in yak. J Morphol 2017; 278:975-986. [DOI: 10.1002/jmor.20691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/16/2017] [Accepted: 04/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Deyong Duan
- Laboratory of Animal Anatomy & Tissue Embryology; Department of Basic Veterinary Medicine, College of Veterinary Medicine, Gansu Agricultural University; Lanzhou Gansu China
- Laboratory of Molecular Physiology; Department of Basic Veterinary Medicine, College of Veterinary Medicine, Hunan Agricultural University; Changsha Hunan China
| | - Sijiu Yu
- Laboratory of Animal Anatomy & Tissue Embryology; Department of Basic Veterinary Medicine, College of Veterinary Medicine, Gansu Agricultural University; Lanzhou Gansu China
| | - Yan Cui
- Laboratory of Animal Anatomy & Tissue Embryology; Department of Basic Veterinary Medicine, College of Veterinary Medicine, Gansu Agricultural University; Lanzhou Gansu China
| | - Chaoxu Li
- Laboratory of Animal Anatomy & Tissue Embryology; Department of Basic Veterinary Medicine, College of Veterinary Medicine, Gansu Agricultural University; Lanzhou Gansu China
| |
Collapse
|
24
|
Lazarevic Z, Ciminelli E, Quaranta F, Sperandii F, Guerra E, Pigozzi F, Borrione P. Left ventricular false tendons and electrocardiogram repolarization abnormalities in healthy young subjects. World J Cardiol 2016; 8:590-595. [PMID: 27847560 PMCID: PMC5088365 DOI: 10.4330/wjc.v8.i10.590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/26/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe echocardiographically left ventricular false tendon characteristics and the correlation with ventricular repolarization abnormalities in young athletes.
METHODS Three hundred and sixteen healthy young athletes from different sport disciplines were evaluated from 2009 to 2011 during routine screening for agonistic sports eligibility. All subjects, as part of standard pre-participation screening medical evaluation, underwent a basal and post step test 12-lead electrocardiogram (ECG). The athletes with abnormal T-wave flattening and/or inversion were considered for an echocardiogram evaluation and an incremental maximal exercise test on a cycle ergometer. Arterial blood pressure and heart rate, during and after exercise, were also measured.
RESULTS Twenty-one of the 316 subjects (6.9%) showed false tendons in the left ventricle. The majority of false tendons (52.38%) were localized between the middle segments of the inferior septum and the lateral wall, 19.06% between the distal segments of the septum and the lateral wall, in 5 subjects between the middle segments of the anterior and inferior walls, and in one subject between the middle segments of the anterior septum and the posterior wall. ECG abnormalities, represented by alterations of ventricular repolarization, were found in 11 subjects (52.38%), 90% of these anomalies were T wave abnormalities from V1 to V3. These anomalies disappeared with an increasing heart rate following the three minute step test as well as during the execution of the maximal exercise.
CONCLUSION Left ventricular false tendons are frequently localized between the middle segments of the inferior septum and the lateral wall and are statistically associated with ventricular repolarization abnormalities.
Collapse
|
25
|
Häggström J, Luis Fuentes V, Wess G. Screening for hypertrophic cardiomyopathy in cats. J Vet Cardiol 2016; 17 Suppl 1:S134-49. [PMID: 26776573 DOI: 10.1016/j.jvc.2015.07.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/27/2015] [Accepted: 07/01/2015] [Indexed: 11/17/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common heart disease in cats, and it can lead to increased morbidity and mortality. Cats are often screened for HCM because of the presence of a heart murmur, but screening for breeding purposes has also become common. These cats are usually purebred cats of breeding age, and generally do not present with severe disease or with any clinical signs. This type of screening is particularly challenging because mild disease may be difficult to differentiate from a normal phenotype, and the margin for error is small, with potentially major consequences for the breeder. This article reviews HCM screening methods, with particular emphasis on echocardiography.
Collapse
Affiliation(s)
- Jens Häggström
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Box 7054, Uppsala, Sweden.
| | - Virginia Luis Fuentes
- The Royal Veterinary College, Department of Clinical Science and Services, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - Gerhard Wess
- Clinic of Small Animal Medicine, LMU University, Veterinaerstr. 13, 80539 Munich, Germany
| |
Collapse
|
26
|
Preprocedural Computed Tomography Evaluation for Minimally Invasive Mitral Valve Surgery: What the Surgeon Needs to Know. J Thorac Imaging 2016; 30:386-96. [PMID: 26258601 DOI: 10.1097/rti.0000000000000170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The proven success of endoscopic and videoscopic surgery combined with recent advancements in telemanipulation has made the performance of minimally invasive cardiac surgery a clinical reality during the past decade. A complete understanding of the basic concepts of minimally invasive surgery and the recent advancements in peripheral cardiopulmonary bypass techniques help the cardiac imager to provide a clinically meaningful interpretation for the surgical team. In this article we present an overview of minimally invasive mitral valve surgery and the fundamentals of preprocedural computed tomography angiography imaging and highlight the usefulness of cardiac computed tomography as a supplementary tool to echocardiography.
Collapse
|
27
|
Silbiger JJ. Abnormalities of the Mitral Apparatus in Hypertrophic Cardiomyopathy: Echocardiographic, Pathophysiologic, and Surgical Insights. J Am Soc Echocardiogr 2016; 29:622-39. [DOI: 10.1016/j.echo.2016.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 12/30/2022]
|
28
|
Mercer BN, Begg GA, Page SP, Bennett CP, Tayebjee MH, Mahida S. Early Repolarization Syndrome; Mechanistic Theories and Clinical Correlates. Front Physiol 2016; 7:266. [PMID: 27445855 PMCID: PMC4927622 DOI: 10.3389/fphys.2016.00266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/15/2016] [Indexed: 12/20/2022] Open
Abstract
The early repolarization (ER) pattern on the 12-lead electrocardiogram is characterized by J point elevation in the inferior and/or lateral leads. The ER pattern is associated with an increased risk of ventricular arrhythmias and sudden cardiac death (SCD). Based on studies in animal models and genetic studies, it has been proposed that J point elevation in ER is a manifestation of augmented dispersion of repolarization which creates a substrate for ventricular arrhythmia. A competing theory regarding early repolarization syndrome (ERS) proposes that the syndrome arises as a consequence of abnormal depolarization. In recent years, multiple clinical studies have described the characteristics of ER patients with VF in more detail. The majority of these studies have provided evidence to support basic science observations. However, not all clinical observations correlate with basic science findings. This review will provide an overview of basic science and genetic research in ER and correlate basic science evidence with the clinical phenotype.
Collapse
Affiliation(s)
- Ben N. Mercer
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK
| | - Gordon A. Begg
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK
| | - Stephen P. Page
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK
- Regional Inherited Cardiovascular Conditions Service, Leeds General InfirmaryLeeds, UK
| | | | | | - Saagar Mahida
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK
- Regional Inherited Cardiovascular Conditions Service, Leeds General InfirmaryLeeds, UK
| |
Collapse
|
29
|
Lange M, Di Marco LY, Lekadir K, Lassila T, Frangi AF. Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study. PLoS One 2016; 11:e0146477. [PMID: 26766041 PMCID: PMC4713054 DOI: 10.1371/journal.pone.0146477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/17/2015] [Indexed: 12/24/2022] Open
Abstract
False tendons (FTs) are fibrous or fibromuscular bands that can be found in both the normal and abnormal human heart in various anatomical forms depending on their attachment points, tissue types, and geometrical properties. While FTs are widely considered to affect the function of the heart, their specific roles remain largely unclear and unexplored. In this paper, we present an in silico study of the ventricular activation time of the human heart in the presence of FTs. This study presents the first computational model of the human heart that includes a FT, Purkinje network, and papillary muscles. Based on this model, we perform simulations to investigate the effect of different types of FTs on hearts with the electrical conduction abnormality of a left bundle branch block (LBBB). We employ a virtual population of 70 human hearts derived from a statistical atlas, and run a total of 560 simulations to assess ventricular activation time with different FT configurations. The obtained results indicate that, in the presence of a LBBB, the FT reduces the total activation time that is abnormally augmented due to a branch block, to such an extent that surgical implant of cardiac resynchronisation devices might not be recommended by international guidelines. Specifically, the simulation results show that FTs reduce the QRS duration at least 10 ms in 80% of hearts, and up to 45 ms for FTs connecting to the ventricular free wall, suggesting a significant reduction of cardiovascular mortality risk. In further simulation studies we show the reduction in the QRS duration is more sensitive to the shape of the heart then the size of the heart or the exact location of the FT. Finally, the model suggests that FTs may contribute to reducing the activation time difference between the left and right ventricles from 12 ms to 4 ms. We conclude that FTs may provide an alternative conduction pathway that compensates for the propagation delay caused by the LBBB. Further investigation is needed to quantify the clinical impact of FTs on cardiovascular mortality risk.
Collapse
Affiliation(s)
- Matthias Lange
- Center for Computational Imaging and Simulation Technologies in Biomedicine, The University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Luigi Yuri Di Marco
- Center for Computational Imaging and Simulation Technologies in Biomedicine, The University of Sheffield, Sheffield, United Kingdom
| | - Karim Lekadir
- Center for Computational Imaging and Simulation Technologies in Biomedicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Toni Lassila
- Center for Computational Imaging and Simulation Technologies in Biomedicine, The University of Sheffield, Sheffield, United Kingdom
| | - Alejandro F. Frangi
- Center for Computational Imaging and Simulation Technologies in Biomedicine, The University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
30
|
Maleszewski J, Lai C, Veinot J. Anatomic Considerations and Examination of Cardiovascular Specimens (Excluding Devices). Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00001-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
31
|
Taniguchi H, Kobayashi Y, Maruyama M, Morita N, Hayashi M, Miyauchi Y, Shimizu W. Electrophysiological and anatomical background of the fusion configuration of diastolic and presystolic Purkinje potentials in patients with verapamil-sensitive idiopathic left ventricular tachycardia. J Arrhythm 2015; 31:261-7. [PMID: 26550080 DOI: 10.1016/j.joa.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 12/27/2014] [Accepted: 01/16/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is unclear whether false tendons (FTs) are a substantial part of the reentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia (ILVT). This study aimed to prove the association between FTs and the slow conduction zone by evaluating the electro-anatomical relationship between the so-called diastolic Purkinje (Pd) potentials and FTs using an electro-anatomical mapping (EAM) system (CARTO). METHODS The 1st protocol evaluated the spatial distribution of Pd and presystolic Purkinje (Pp) potentials in 6 IVLT patients using a conventional CARTO system. In the remaining 2 patients (2nd protocol), the electro-anatomical relationship between the Pd-Pp fusion potential and the septal connection of the FT was evaluated using an EAM system incorporating an intra-cardiac echo (CARTO-Sound). RESULTS Pd potentials were observed in the posterior-posteroseptal region of the LV and had a slow conduction property, whereas Pp potentials were widely distributed in the interventricular (IV) septum. At the intersection of the 2 regions, which was located in the mid-posteroseptal area, both Pd and Pp potentials were closely spaced and often had a fused configuration. In the latter 2 patients (2nd protocol), it was confirmed that the intra-cardiac points at which the Pd-Pp fusion potential was recorded were located in the vicinity of the attachment site of the FT to the IV septum. In all patients, ILVTs were successfully eliminated by the application of radiofrequency at those points. CONCLUSION FTs may at least partly contribute to the formation of the Pd potential, and thus form a critical part of the reentry circuit of ILVT.
Collapse
Affiliation(s)
- Hiroshi Taniguchi
- Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-machi Hachioji-shi, Tokyo 192-0032, Japan
| | - Mitsunori Maruyama
- Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Chiba-Hokuso Hospital, Chiba, Japan
| | - Norishige Morita
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-machi Hachioji-shi, Tokyo 192-0032, Japan
| | - Meiso Hayashi
- Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasushi Miyauchi
- Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
32
|
Sánchez Ferrer F, Sánchez Ferrer ML, Grima Murcia MD, Sánchez Ferrer M, Sánchez del Campo F. Estudio básico e implicaciones clínicas del falso tendón del ventrículo izquierdo. ¿Está asociado al soplo inocente infantil o a enfermedad cardiaca? Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
33
|
Liu Y, Mi N, Zhou Y, An P, Bai Y, Guo Y, Hong C, Ji Z, Ye P, Wu C. Transverse false tendons in the left ventricular cavity are associated with early repolarization. PLoS One 2015; 10:e0125173. [PMID: 25933440 PMCID: PMC4416704 DOI: 10.1371/journal.pone.0125173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/22/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Left ventricular false tendons (LVFTs) are related to precordial murmurs, ventricular arrhythmias and some repolarization abnormalities. Early repolarization (ER) is a specific type of repolarization abnormality. OBJECTIVE The aim of the present study was to investigate the relationship between LVFTs and ER. METHODS This study retrospectively included 99 consecutive healthy subjects and 33 patients with ER. Early repolarization was defined as an elevation of the QRS-ST junction of >0.1 mV from baseline in at least 2 inferior or lateral leads, manifested as QRS slurring or notching. Each participant was examined using echocardiography with second harmonic imaging, and the attachments of the LVFTs were recorded. RESULTS A total of 93 LVFTs were present in 82 (83%) of the 99 healthy subjects. Of these 93 LVFTs, the majority (79/93, or 84.9%) were longitudinal-type LVFTs, which originated from the basal interventricular septum (IVS) and progressed toward the apical segment of the left ventricular free wall. There were significant differences in the positioning of the LVFTs between the ER patients and control (P < 0.0001). LVFTs between mid-IVS to the middle of the LV free wall were found more common in patients with ER compared with control subjects (47.5% vs. 6.5%, P < 0.0001). In the ER group, LVFTs between the basal IVS to the apical segment of LV free wall were only identified in 21% of the LVFTs, compared to a value of 84.9% for the control group (P < 0.0001). The distribution of LVFT trends in the ER group was also significantly different from that in the control group (P < 0.05). CONCLUSIONS LVFTs are commonly visualized using echocardiography. An LVFT from the basal IVS to the apical segment of the left ventricular free wall may be a normal anatomical structure in the left ventricular cavity. On the contrary, transverse false tendons in the left ventricular cavity may be associated with ER.
Collapse
Affiliation(s)
- Yuan Liu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Ning Mi
- Clinical medicine department of Bethune medical profession sergeant school, Shijiazhuang, China
| | - Yiming Zhou
- Department of liver disease, Beijing General Hospital of Beijing Military Command, Beijing, China
| | - Peng An
- Department of internal medicine, the First People’s Hospital of Qujing, Qujing, China
| | - Yongyi Bai
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yifang Guo
- Department of Geriatric Cardiology, Hebei Provincial People’s Hospital, Shijiazhuang, Hebei Province, China
| | - Changming Hong
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Zhixin Ji
- Medical Administration, Chinese PLA General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Caie Wu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail:
| |
Collapse
|
34
|
Sánchez Ferrer F, Sánchez Ferrer ML, Grima Murcia MD, Sánchez Ferrer M, Sánchez del Campo F. Basic Study and Clinical Implications of Left Ventricular False Tendon. Is it Associated With Innocent Murmur in Children or Heart Disease? ACTA ACUST UNITED AC 2015; 68:700-5. [PMID: 25649973 DOI: 10.1016/j.rec.2014.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/15/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Left ventricular false tendon is a structure of unknown function in cardiac physiology that was first described anatomically by Turner. This condition may be related to various electrical or functional abnormalities, but no consensus has ever been reached. The purpose of this study was to determine the time of appearance, prevalence and histologic composition of false tendon, as well as its association with innocent murmur in children and with heart disease. METHODS The basic research was performed by anatomic dissection of hearts from adult human cadavers to describe false tendon and its histology. The clinical research consisted of echocardiographic study in a pediatric population to identify any relationship with heart disease, innocent murmur in children, or other abnormalities. Fetal echocardiography was performed prenatally at different gestational ages. RESULTS False tendon was a normal finding in cardiac dissection and was composed of muscle and connective tissue fibers. In the pediatric population, false tendon was present in 83% on echocardiography and showed a statistically significant association only with innocent murmur in children and slower aortic acceleration. The presence of false tendon was first observed on fetal echocardiography from week 20 of pregnancy. CONCLUSIONS Left ventricular false tendon is a normal finding visualized by fetal echocardiography from week 20 and is present until adulthood with no pathologic effects except for innocent murmur during childhood. It remains to be determined if false tendon is the cause of the murmurs or if its absence or structural anomalies are related to disease.
Collapse
Affiliation(s)
- Francisco Sánchez Ferrer
- Servicio de Pediatría, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
| | | | | | - Marina Sánchez Ferrer
- Servicio de Pediatría, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | | |
Collapse
|
35
|
Characteristics of trabeculated myocardium burden in young and apparently healthy adults. Am J Cardiol 2014; 114:1094-9. [PMID: 25132331 DOI: 10.1016/j.amjcard.2014.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/05/2014] [Accepted: 07/05/2014] [Indexed: 11/21/2022]
Abstract
Increased myocardial trabeculations define noncompaction cardiomyopathy (NCC). Imaging advancements have led to increasingly common identification of prominent trabeculations with unknown implications. We quantified and determined the impact of trabeculations' burden on cardiac function and stretch in a population of healthy young adults. One hundred adults aged 18 to 35 years (28±4 years, 55% women) without known cardiovascular disease were prospectively studied by cardiovascular magnetic resonance. Left ventricular (LV) volumes, segmental function, and ejection fraction (EF) and left atrial volumes were determined. Thickness and area of trabeculated (T) and dense (D) myocardium were measured for each standardized LV segment. N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) was measured. Eighteen percent of the subjects had ≥1 positive traditional criteria for NCC, and 11% meet new proposed NCC cardiovascular magnetic resonance criteria. Trabeculated over dense myocardium ratio (T/D) ratios were uniformly greater at end-diastole versus end-systole (0.90±0.25 vs 0.42±0.13, p<0.0001), in women versus men (0.85±0.24 vs 0.72±0.19, p=0.006), at anterior versus nonanterior segments (1.41±0.59 vs 0.88±0.35, p<0.0001), and at apical versus nonapical segments (1.31±0.56 vs 0.87±0.38, p<0.0001). The largest T/D ratios were associated with lower LVEF (57.0±5.3 vs 62±5.5, p=0.0001) and greater Nt-pro-BNP (203±98 vs 155±103, p=0.04). Multivariable regression identified greater end-systolic T/D ratios as the strongest independent predictor of lower LVEF, beyond age and gender, left atrial or LV volumes, and Nt-pro-BNP (β=-9.9, 95% CI -15 to 4.9, p<0.001). In conclusion, healthy adults possess variable amounts of trabeculations that regularly meet criteria for NCC. Greater trabeculations are associated with decreased LV function. Apparently healthy young adults with increased trabecular burden possess evidence of mildly impaired cardiac function.
Collapse
|
36
|
Gerstman E, Murtaza G, Rashid ZA, Pagel PS. Left Ventricular “Masses” in a Patient With Protein S Deficiency and a Recent Myocardial Infarction: Evidence of Intraventricular Thrombi or a Benign Observation? J Cardiothorac Vasc Anesth 2014; 28:430-2. [DOI: 10.1053/j.jvca.2013.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Indexed: 12/26/2022]
|
37
|
Nakagawa M, Ezaki K, Miyazaki H, Ebata Y, Shinohara T, Teshima Y, Yufu K, Takahashi N, Saikawa T. False tendons may be associated with the genesis of J-waves: prospective study in young healthy male. Int J Cardiol 2014; 172:428-33. [PMID: 24507740 DOI: 10.1016/j.ijcard.2014.01.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/20/2013] [Accepted: 01/19/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recent studies showed that J-waves are associated with vulnerability to ventricular fibrillation. Recently we reported the association between false tendons (FTs) and J-waves in a retrospective study. METHODS AND RESULTS We prospectively studied 50 young healthy men (mean age 24.6±2.7 years). FTs were detected echocardiographically and classified based on their points of attachment as type 1 (longitudinal type), type 2 (diagonal type), and type 3 (transverse type). J-waves were defined as terminal QRS notching or slurring with ≥0.1 mV. The filtered QRS duration (fQRSd), RMS40, and LAS40 were measured on signal-averaged ECGs. FTs were detected in 37 of the 50 subjects (74%). The incidence of J-waves was significantly higher in subjects with type 1 or type 2 FTs than those with no- or type 3 FTs (61% vs. 26%, p<0.05). The leads with J-waves were closely associated with the location of the FT. While no late potential was recorded in any study subjects, fQRSd and LAS40 were significantly longer in subjects with type 1 or type 2 FTs (p<0.05). Univariate and multivariate logistic regression analysis revealed that only the existence of FTs (type 1 or 2) was an independent predictor of the presence of J-waves. CONCLUSIONS Our results suggest that FTs were related to the genesis of J-waves with conduction delay.
Collapse
Affiliation(s)
- Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan.
| | - Kaori Ezaki
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan
| | - Hiroko Miyazaki
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan
| | - Yuki Ebata
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan
| | - Tetsunori Saikawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City, Oita 879-5593, Japan
| |
Collapse
|
38
|
Syed FF, Hai JJ, Lachman N, DeSimone CV, Asirvatham SJ. The infrahisian conduction system and endocavitary cardiac structures: relevance for the invasive electrophysiologist. J Interv Card Electrophysiol 2013; 39:45-56. [PMID: 24322419 DOI: 10.1007/s10840-013-9858-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/24/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Faisal F Syed
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | | | | |
Collapse
|
39
|
Silbiger JJ. Novel Pathogenetic Mechanisms and Structural Adaptations in Ischemic Mitral Regurgitation. J Am Soc Echocardiogr 2013; 26:1107-1117. [DOI: 10.1016/j.echo.2013.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Indexed: 10/26/2022]
|
40
|
Kim MJ, Jung HO. Anatomic variants mimicking pathology on echocardiography: differential diagnosis. J Cardiovasc Ultrasound 2013; 21:103-12. [PMID: 24198915 PMCID: PMC3816159 DOI: 10.4250/jcu.2013.21.3.103] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 12/20/2022] Open
Abstract
Differentiation of normal from abnormal findings is critical in echocardiography. Anatomic variants occurring in normal cardiac developments often simulate pathologic entities. This review focuses on the differential diagnosis of normal anatomic structures from pathologic ones in echocardiography.
Collapse
Affiliation(s)
- Mi-Jeong Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | |
Collapse
|
41
|
Altug N, Danisman AN. Echogenic focus in the fetal left ventricular cavity: is it a false tendon? Early Hum Dev 2013; 89:479-82. [PMID: 23639508 DOI: 10.1016/j.earlhumdev.2013.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 02/27/2013] [Accepted: 03/22/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To draw attention to the left ventricular false tendon which can be misinterpreted as echogenic focus in the fetus. METHODS The study group consisted of 9 fetuses out of the 161 who had been misdiagnosed for left ventricular false tendon as echogenic focus by obstetricians. Fetal echocardiography and 2-D color Doppler echocardiography were performed in the pre-postnatal period. The standard fetal echocardiographic views (4,5 chamber views, long axis view of the left ventricle, short axis view of the ventricles and great arteries, three vessels and trachea view, long axis views of the duct and aortic arch) were obtained for each case. RESULTS Of the 161 fetuses with echogenic focus in the left ventricle which underwent fetal echocardiography, 9 (5.6%) were diagnosed with false tendons present in the left ventricular cavity with no other cardiovascular anomaly. Six out of 9 patients underwent amniocentesis as follows: for age of over 35 years (two patients), abnormal double-triple screening tests plus echogenic focus (two patients) and soft ultrasonographic markers including echogenic focus (two patients). These fetuses revealed no cardiovascular and other systemic pathology or dysmorphism except for false tendons in the left ventricular cavity. CONCLUSION False tendon should be taken into account as differential diagnosis of left ventricular echogenic focus in the fetus. Misinterpretation of false tendon as echogenic focus may cause unnecessary fetal invasive approach and maternal anxiety, especially when it arises with a background of borderline fetal findings and knowledge.
Collapse
Affiliation(s)
- Nahide Altug
- Zekai Tahir Burak Maternity Teaching Hospital, Ped. Cardiology Unit, Ankara, Turkey.
| | | |
Collapse
|
42
|
Silbiger JJ. Left ventricular false tendons: anatomic, echocardiographic, and pathophysiologic insights. J Am Soc Echocardiogr 2013; 26:582-8. [PMID: 23602169 DOI: 10.1016/j.echo.2013.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Indexed: 01/12/2023]
Abstract
Left ventricular (LV) false tendons are chordlike structures that traverse the LV cavity. They attach to the septum, to the papillary muscles, or to the free wall of the ventricle but not to the mitral valve. They are found in approximately half of human hearts examined at autopsy. Although it has been more than 100 years since their initial description, the functional significance of these structures remains largely unexplored. It has been suggested that they retard LV remodeling by tethering the walls to which they are attached, but there are few data to substantiate this. Some studies have suggested that false tendons reduce the severity of functional mitral regurgitation by stabilizing the position of the papillary muscles as the left ventricle enlarges. LV false tendons may also have deleterious effects and have been implicated in promoting membrane formation in discrete subaortic stenosis. This article reviews current understanding of the anatomy, echocardiographic characteristics, and pathophysiology of these structures.
Collapse
|
43
|
Nakagawa M, Ezaki K, Miyazaki H, Wakisaka O, Shinohara T, Teshima Y, Yufu K, Takahashi N, Saikawa T. Electrocardiographic characteristics of patients with false tendon: Possible association of false tendon with J waves. Heart Rhythm 2012; 9:782-8. [DOI: 10.1016/j.hrthm.2011.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Indexed: 10/14/2022]
|
44
|
Misra S, Koshy T, Pal S. False Tendons and Accessory Papillary Muscle in the Left Ventricle. Anesth Analg 2011; 113:1016-8. [DOI: 10.1213/ane.0b013e31822bbfb9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
45
|
Philip S, Cherian KM, Wu MH, Lue HC. Left ventricular false tendons: echocardiographic, morphologic, and histopathologic studies and review of the literature. Pediatr Neonatol 2011; 52:279-86. [PMID: 22036224 DOI: 10.1016/j.pedneo.2011.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 11/17/2010] [Accepted: 11/29/2010] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Left ventricular false tendons (LVFTs) are fibrous or fibromuscular bands stretching across the left ventricle (LV) from the ventricular septum to the papillary muscle or LV free wall but not connecting, like the chordae tendinae, to the mitral leaflet. LVFTs have become the focus of studies and discussions since the advent of echocardiography. MATERIALS AND METHODS We prospectively studied the prevalence of LVFTs by two-dimensional echocardiography in 476 infants and children referred to our institute for cardiac evaluation and cardiology workup. We also studied the morphology and histopathology of LVFTs in 68 congenital heart disease specimens and in 20 piglet hearts. The literature was reviewed and the clinical significance of LVFTs was discussed. RESULTS LVFTs of varying size and different location were detected in 371 (77.9%) of 476 infants and children studied, in 42 (61.8%) of 68 congenital heart disease specimens, and in 19 (95.0%) of 20 piglet hearts. Of the 75 LVFTs from the congenital heart disease specimens, 33 (44.4%) were fibrous type, measuring less than 1.4mm; 38 (50.7%) were fibromuscular type, 1.5-2.4mm; and 4 (5.3%) were muscular type, 2.5mm or more in diameter. Of the 33 LVFTs from the piglet hearts, 23 (69.7%) and 10 (30.3%) were fibrous and fibromuscular, respectively, and none (0.0%) was muscular. CONCLUSIONS LVFTs were detected partially or completely by modified two-dimensional echocardiography in both normal and abnormal hearts. LVFTs is a useful anatomical landmark of LV for the differentiation of morphological LV and right ventricle in segmental analysis of congenital heart disease. LVFTs are a cause of functional murmur. No pressure gradient was noted in the mid-LV or outflow tract. LVFTs could be a contributory factor in the generation of dysrhythmias during LV catheterization studies. LVFTs were more easily identifiable in neonates and young age patients because of a better delineation of images in echocardiography.
Collapse
Affiliation(s)
- Saji Philip
- Division of Pediatric Cardiology, St Gregorios Cardiovascular Center, Parumala, Mannar, Kerala, India
| | | | | | | |
Collapse
|
46
|
Saito A, Kaneko Y, Nakajima T, Irie T, Ota M, Kato T, Iijima T, Tamura M, Kobayashi H, Ito T, Manita M, Kurabayashi M. Detection of diastolic potentials around the mitral annulus of structurally normal human hearts. Int Heart J 2010; 51:394-8. [PMID: 21173514 DOI: 10.1536/ihj.51.394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To examine the electrophysiologic characteristics of the subvalvular mitral region, we retrospectively searched for the presence of subvalvular diastolic potentials (DP) in 91 patients (mean age, 46.9 ± 16.6 years) who underwent catheter ablation of left-sided accessory pathways (AP). We detected low-amplitude (0.19 ± 0.09 mV) DP in 14 patients (15.4%), including 8 with overt preexcitation and 6 patients with concealed AP. The mean interval between ventricular electrogram and DP was 383 ± 46 ms (range, 306-475). DP were detected in 4 of 20 patients with antero-lateral, 3 of 38 with lateral, 4 of 12 with postero-lateral, 2 of 14 with posterior, and 3 of 10 patients with postero-septal AP. In 6 of 14 patients, DP were detected before ablation. In 4 of 8 patients with overt preexcitation, DP were consistently recorded after elimination of the delta wave, suggesting that they were not associated with AP conduction. In 6 of 11 patients, DP were observed during both sinus rhythm and ventricular pacing, suggesting that they were not artifacts. The electrophysiologic characteristics of clinically relevant DP around the mitral annulus suggest that, in normal human hearts, an anatomical substrate may be present around the mitral annulus.
Collapse
Affiliation(s)
- Akihiro Saito
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Normal variations and anatomic pitfalls that may mimic diseases on coronary CT angiography. Int J Cardiovasc Imaging 2010; 26:281-94. [DOI: 10.1007/s10554-010-9707-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 09/14/2010] [Indexed: 10/19/2022]
|
48
|
Affiliation(s)
- Malini Madhavan
- From the Department of Internal Medicine (M.M.), Division of Cardiovascular Diseases (S.J.A.) and Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, Minn
| | - Samuel J. Asirvatham
- From the Department of Internal Medicine (M.M.), Division of Cardiovascular Diseases (S.J.A.) and Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, Minn
| |
Collapse
|
49
|
Ho SY. Anatomy and myoarchitecture of the left ventricular wall in normal and in disease. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 10:iii3-7. [PMID: 19889656 DOI: 10.1093/ejechocard/jep159] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The normal left ventricle comprises an inlet, apical trabecular, and an outlet portion although these portions do not have discrete anatomical borders. The ventricular wall is thickest near the cardiac base and thins to 1-2 mm at the apex. Characteristically, the muscle bundles at the apical portion are thin, but there are also thicker bundles and very fine strands that may be mistaken on imaging as pathologies. Transmurally through the ventricular wall, the myoarchitecture has a typical arrangement of myocardial strands that change orientation from being oblique in the subepicardium to circumferential in the middle and to longitudinal in the subendocardium. The circumferential portion is the thickest with the longitudinal portion the thinnest. In the hypertrophied ventricle the circumferential portion is reduced. In combination with alterations in the quality and quantity of the connective tissue matrix, myoarchitecture impacts on myocardial function.
Collapse
Affiliation(s)
- Siew Yen Ho
- Cardiac Morphology Unit, Imperial College London, Royal Brompton Hospital, London, UK.
| |
Collapse
|
50
|
|