1
|
Crucean A, Spicer DE, Tretter JT, Mohun TJ, Anderson RH. Revisiting the anatomy of the right ventricle in the light of knowledge of its development. J Anat 2024; 244:297-311. [PMID: 37814425 PMCID: PMC10780169 DOI: 10.1111/joa.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023] Open
Abstract
Controversies continue regarding several aspects of the anatomy of the morphologically right ventricle. There is disagreement as to whether the ventricle should be assessed in bipartite or tripartite fashion, and the number of leaflets to be found in the tricuspid valve. In particular, there is no agreement as to whether a muscular outlet septum is present in the normally constructed heart, nor how many septal components are to be found during normal development. Resolving these issues is of potential significance to those investigating and treating children with congenitally malformed hearts. With all these issues in mind, we have revisited our own experience in investigating the development and morphology of the normal right ventricle. To assess development, we have examined a large number of datasets, prepared by both standard and episcopic microscopy, from human and murine embryos. In terms of gross anatomy, we have compared dissections of normal autopsied hearts with virtual dissections of datasets prepared using computed tomography. Our developmental and postnatal studies, taken together, confirm that the ventricle is best assessed in tripartite fashion, with the three parts representing its inlet, apical trabecular, and outlet components. The ventricular septum, however, has only muscular and membranous components. The muscular part incorporates a small component derived from the muscularised fused proximal outflow cushions, but this part cannot be distinguished from the much larger part that is incorporated within the free-standing muscular infundibular sleeve. We confirm that the tricuspid valve itself has three components, which are located inferiorly, septally, and antero-superiorly.
Collapse
Affiliation(s)
- Adrian Crucean
- Department of Paediatric Cardiac SurgeryBirmingham Women's and Children's HospitalBirminghamUK
| | - Diane E. Spicer
- Congenital Heart CenterAll Children's HospitalSt PetersbergFloridaUSA
| | - Justin T. Tretter
- Department of Pediatric Cardiology, Cleveland Clinic Children's, and the Heart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOhioUSA
| | | | | |
Collapse
|
2
|
The Medical versus Zoological Concept of Outflow Tract Valves of the Vertebrate Heart. J Cardiovasc Dev Dis 2022; 9:jcdd9100318. [PMID: 36286270 PMCID: PMC9604109 DOI: 10.3390/jcdd9100318] [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: 07/06/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
The anatomical elements that in humans prevent blood backflow from the aorta and pulmonary artery to the left and right ventriclesare the aortic and pulmonary valves, respectively. Each valve regularly consists of three leaflets (cusps), each supported by its valvular sinus. From the medical viewpoint, each set of three leaflets and sinuses is regarded as a morpho-functional unit. This notion also applies to birds and non-human mammals. However, the structures that prevent the return of blood to the heart in other vertebrates are notably different. This has led to discrepancies between physicians and zoologists in defining what a cardiac outflow tract valve is. The aim here is to compare the gross anatomy of the outflow tract valvular system among several groups of vertebrates in order to understand the conceptual and nomenclature controversies in the field.
Collapse
|
3
|
Preoperative Morphological Prediction of Early Reoperation Risk After Primary Repair in Tetralogy of Fallot: A Contemporary Analysis of 83 Cases. Pediatr Cardiol 2021; 42:1512-1525. [PMID: 34075431 DOI: 10.1007/s00246-021-02635-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
This study was conducted to investigate the pulmonary artery (PA) variations in tetralogy of Fallot (TOF) and preoperative morphological predictors for early reoperation. Eighty-three TOF patients and 20 children with normal PA were included. The TOF group was divided into two subsets according to whether or not reoperation was performed within 3 years postoperatively. Clinical information was obtained, along with computed tomography (CT)-based three-dimensional geometry of the PA. Morphological measurements of the length of the main PA branches, the angles between them, and the cross-sectional area of each segment of the PAs were acquired using computer software. Logistic regression and receiver operating characteristic curves were applied to analysis. The TOF group showed a significantly smaller PA size and irregular PA shape, with lower Nakata and McGoon indices, than the control group. The median bifurcation angle (angle-γ) was greater than 100° in the TOF group, as compared to 66.70° in the control group (P < 0.000). Residual obstruction of the infundibulum or PAs was the main reason for early reoperation in this series. The development of the main PA and left PA was poorer in the reoperation subset than in the non-reoperation subset (P ≤ 0.01). The preoperative angle-γ in the reoperation subset was larger than that in the non-reoperation subset (median, 117.8° vs. 112.0°, P = 0.026). Higher weight (OR = 0.372) and McGoon index (OR = 0.122) were protective factors, while larger angle-γ (> 114.8°, OR = 5.040) and angle-γ normalized by body surface area (BSA) (γ/BSA > 297.9, OR = 18.860) were risk factors. This study provides an intuitive perspective of PA anatomical variations in TOF. Larger preoperative PA bifurcation angle and γ/BSA were morphological risk predictors of postoperative reoperation in patients with TOF.
Collapse
|
4
|
Lis M, Solewski B, Chrzanowski J, Dudkiewicz D, Strona M, Jasińska KA, Wiater J, Wartalski K, Lis GJ, Hołda MK. Microanatomy of the myocardial extensions of the pulmonary valve in light of modern catheter ablation methodology. J Cardiovasc Electrophysiol 2021; 32:2269-2274. [PMID: 34164879 DOI: 10.1111/jce.15125] [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: 04/06/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The muscular sleeves (or myocardial extensions) derived from the right ventricle infundibulum myocardium are considered the true anatomic substrate for right ventricular outflow tract arrhythmias. METHODS Pulmonary valve specimens obtained from 65 donors (24.6% females, mean age 45.9 ± 15.8 years) were investigated micro-anatomically. Specimens were histologically processed, stained with Masson's Trichrome, and examined under a light microscope. RESULTS The myocardial extensions were present in the left anterior pulmonary valve sinus in 86.2% of cases, in the right anterior sinus in 89.2% of cases and in 90.7% of cases in the posterior sinus (p = .699). In 69.2% of examined hearts, the myocardial extensions were present in all sinuses. The mean height of the extensions was 4.12 ± 1.76 (left anterior) versus 3.69 ± 1.47 (right anterior) versus 4.28 ± 1.73 mm (posterior) (p = .137). The myocardial extensions occupied an average of 28.9 ± 10.4% of the left anterior sinus, 26.7 ± 11.2% of the right anterior sinus, and 31.9 ± 11.3% of the posterior sinus (p = .044). Sleeves extending beyond the fibro-arterial transition zone were present in at least one sinus in 33.8% of hearts (in 7.7% (5/65) of the left and right anterior sinuses and 21.5% (14/65) of posterior sinus, p = .021). CONCLUSIONS The myocardial extensions of the pulmonary valve are common anatomical entities. Although the length of the myocardial sleeves is similar in all pulmonary valve sinuses, their relative extent is greatest in the posterior sinus. Long sleeves that spread beyond the fibro-arterial transition zone were observed in one-third of hearts, predominantly in the posterior sinus. Myocardial and fibrous tissue layer thicknesses varied considerably.
Collapse
Affiliation(s)
- Maciej Lis
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Histology, Jagiellonian University Medical College, Cracow, Poland
| | - Bernard Solewski
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Histology, Jagiellonian University Medical College, Cracow, Poland
| | - Jan Chrzanowski
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Histology, Jagiellonian University Medical College, Cracow, Poland
| | - Damian Dudkiewicz
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Histology, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna A Jasińska
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jerzy Wiater
- Department of Histology, Jagiellonian University Medical College, Cracow, Poland
| | - Kamil Wartalski
- Department of Histology, Jagiellonian University Medical College, Cracow, Poland
| | - Grzegorz J Lis
- Department of Histology, Jagiellonian University Medical College, Cracow, Poland
| | - 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
| |
Collapse
|
5
|
De Sensi F, Addonisio L, Miracapillo G, Breschi M, Cresti A, Limbruno U. Stepwise approach for visualization and reconstruction of pulmonary valve with intracardiac echocardiography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1267-1276. [PMID: 33786840 DOI: 10.1111/pace.14233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/02/2021] [Accepted: 03/21/2021] [Indexed: 12/31/2022]
Abstract
Ventricular tachycardia and premature ventricular complexes (PVCs) arising from right ventricular outflow tract (RVOT) are the most common type of ventricular arrhythmias (VAs) in patients without structural heart disease. Radiofrequency ablation is now the gold standard of treatment in this setting due to high efficacy rates and optimal safety profile. During the last few years, the pulmonary valve (PV) and the pulmonary artery (PA) have attracted much attention as reliable sites of origin of RVOT-type arrhythmias. In the mean while intracardiac echocardiogram (ICE) has undoubtedly improved our understanding of the cardiac anatomy. Aim of this paper is to provide an illustrated step-by-step guide on how to use ICE with the CARTOSOUND module to visualize and reconstruct 3D shell of the RV, the PV, as well of other contiguous anatomical structures (i.e., the aortic valve and coronary arteries) to perform aware and safe ablation in this region.
Collapse
Affiliation(s)
- Francesco De Sensi
- Cardiology Department, ESTAV Toscana Sud Est, Misericordia Hospital, Grosseto, Italy
| | - Luigi Addonisio
- Cardiology Department, ESTAV Toscana Sud Est, Misericordia Hospital, Grosseto, Italy
| | - Gennaro Miracapillo
- Cardiology Department, ESTAV Toscana Sud Est, Misericordia Hospital, Grosseto, Italy
| | - Marco Breschi
- Cardiology Department, ESTAV Toscana Sud Est, Misericordia Hospital, Grosseto, Italy
| | - Alberto Cresti
- Cardiology Department, ESTAV Toscana Sud Est, Misericordia Hospital, Grosseto, Italy
| | - Ugo Limbruno
- Cardiology Department, ESTAV Toscana Sud Est, Misericordia Hospital, Grosseto, Italy
| |
Collapse
|
6
|
Tsunoda S, Kobayashi Y, Hirano H, Kitamura R, Nakamori S, Matoba S. Isolated pulmonary valvular stenosis with equilateral triangle orifice. J Cardiol Cases 2020; 21:145-148. [DOI: 10.1016/j.jccase.2019.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
|
7
|
Anderson RH, Mohun TJ, Sánchez-Quintana D, Mori S, Spicer DE, Cheung JW, Lerman BB. The anatomic substrates for outflow tract arrhythmias. Heart Rhythm 2019; 16:290-297. [DOI: 10.1016/j.hrthm.2018.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 12/13/2022]
|
8
|
Congenital Heart Disease Classification, Epidemiology, Diagnosis, Treatment, and Outcome. CONGENIT HEART DIS 2019. [DOI: 10.1007/978-3-319-78423-6_1] [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: 10/27/2022]
|
9
|
Shen X, Bai L, Cai L, Cao X. A geometric model for the human pulmonary valve in its fully open case. PLoS One 2018; 13:e0199390. [PMID: 29940008 PMCID: PMC6016897 DOI: 10.1371/journal.pone.0199390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 06/06/2018] [Indexed: 11/17/2022] Open
Abstract
The human pulmonary valve, one of the key cardiac structures, plays an important role in circulatory system. However, there are few mathematical models to accurately simulate it. In this paper, we establish a geometric model of the normal human pulmonary valve from a mathematical perspective in the fully opening case. Based on the statistical data of the human pulmonary valves, we assume that the motions of the three cusps are symmetrical in the cardiac cycle. Thus, we first propose that each cusp is a part of the cylindrical shell according to its structure and physiological feature. The parameters for the pulmonary valve cusps in three-dimensional space are obtained by the fitting functions. We verify the accuracy of our results by comparing the areas of the pulmonary valve and pulmonary valve flap.
Collapse
Affiliation(s)
- Xiaoqin Shen
- School of Sciences, Xi'an University of Technology, Xi'an, 710054, P.R.China.,NPU-UoG International Cooperative Lab for Computation & Application in Cardiology, Northwestern Polytechnical University, Xi'an, 710072, P.R.China
| | - Lin Bai
- School of Sciences, Xi'an University of Technology, Xi'an, 710054, P.R.China
| | - Li Cai
- NPU-UoG International Cooperative Lab for Computation & Application in Cardiology, Northwestern Polytechnical University, Xi'an, 710072, P.R.China
| | - Xiaoshan Cao
- School of Sciences, Xi'an University of Technology, Xi'an, 710054, P.R.China.,State Key Laboratory of Transducer Technology, Chinese Academy of Sciences, Shanghai, 200050, P.R.China
| |
Collapse
|
10
|
Kilic T, Sahin T, Karauzum K, Ural E, Pedersen WR. New Pulmonary Valvuloplasty Technique by Use of an Hourglass-Shaped Balloon in 3 Adults with Severe Pulmonary Valve Stenosis. Tex Heart Inst J 2018; 45:76-83. [PMID: 29844739 DOI: 10.14503/thij-16-6018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous balloon pulmonary valvuloplasty is the preferred therapy for pulmonary valve stenosis. However, the designs of the cylindrical balloons historically used for valvuloplasty have limitations, especially in patients who have large pulmonary annular diameters. The hourglass-shaped V8 Aortic Valvuloplasty Balloon may prove to be an effective alternative. The balloon has 2 large bulbous segments that are separated by a narrowed waist. The geometric shape is maintained throughout inflation, improving fixation and enabling broader leaflet opening. We present our first experience with the V8 balloon in 3 adults who had severe, symptomatic pulmonary valve stenosis. In addition to describing their cases, we detail our sizing technique for pulmonary valvuloplasty with the V8 balloon. Our successful results suggest that the V8 balloon is efficient and safe for balloon pulmonary valvuloplasty in adults with severe pulmonary valve stenosis.
Collapse
|
11
|
Faletra FF, Murzilli R, Leo LA, Ho SY. Cardiac Anatomy by Three-Dimensional Echocardiography. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
12
|
Hong D, Qian MY, Zhang ZW, Wang SS, Li JJ, Li YF, Liu T. Immediate Therapeutic Outcomes and Medium-term Follow-up of Percutaneous Balloon Pulmonary Valvuloplasty in Infants with Pulmonary Valve Stenosis: A Single-center Retrospective Study. Chin Med J (Engl) 2017; 130:2785-2792. [PMID: 29176137 PMCID: PMC5717856 DOI: 10.4103/0366-6999.219155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous balloon pulmonary valvuloplasty (PBPV) is the preferred therapy for pulmonary valve stenosis (PVS). This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim of this study was to evaluate factors associated with immediate therapeutic outcomes and restenosis during medium-term follow-up. METHODS The study included 158 infants with PVS who underwent PBPV from January 2009 to July 2015. Demographic characteristics and patient records were reviewed, including detailed hospitalization parameters, hemodynamic data before and immediately after balloon dilation, cineangiograms, and echocardiograms before PBPV and at each follow-up. All procedures were performed by more than two experienced operators. RESULTS Immediately after balloon dilation, the pressure gradient across the pulmonary valve decreased from 73.09 ± 21.89 mmHg (range: 43-151 mmHg) to 24.49 ± 17.00 mmHg (range: 3-92 mmHg; P < 0.001) and the right ventricular systolic pressure decreased from 95.34 ± 23.44 mmHg (range: 60-174 mmHg) to 52.07 ± 18.89 mmHg (range: 22-134 mmHg; P < 0.001). Residual transvalvular pressure gradients of 67.31 ± 15.19 mmHg (range: 50-92 mmHg) were found in 8.2% of patients, indicating poor therapeutic effects; 6.4% of patients had variable-staged restenosis at follow-up and 3.8% underwent reintervention by balloon dilation or surgical repairs. Further analysis demonstrated that the balloon/annulus ratio showed statistically significant differences (P < 0.05) among groups with different therapeutic effects and between the restenosis and no-stenosis groups. Binary logistic regression analysis further revealed that higher balloon/annulus ratio (odds ratio: 0.005, 95% confidence interval: 0-0.39) was an independent protective factor for restenosis. The rate of severe complications was 1.9%. CONCLUSIONS PBPV is a definitive therapy for infants with PVS based on its effectiveness, feasibility, and safety. Restenosis upon medium-term follow-up is relatively rare.
Collapse
Affiliation(s)
- Dian Hong
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
- Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Ming-Yang Qian
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
- Address for correspondence: Dr. Ming-Yang Qian, Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China E-Mail:
| | - Zhi-Wei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| | - Shu-Shui Wang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| | - Jun-Jie Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| | - Yi-Fan Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| | - Tian Liu
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong 510100, China
| |
Collapse
|
13
|
Hsia HH, Scheinman M. Pulmonary sinus of Valsalva arrhythmias: A new twist to an old story. Heart Rhythm 2017; 15:46-47. [PMID: 28917567 DOI: 10.1016/j.hrthm.2017.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Henry H Hsia
- Cardiac Electrophysiology Service, University of California, San Francisco, San Francisco, California.
| | - Melvin Scheinman
- Cardiac Electrophysiology Service, University of California, San Francisco, San Francisco, California
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW Our review is intended to provide readers with an overview of disease processes involving the pulmonic valve, highlighting recent outcome studies and guideline-based recommendations; with focus on the two most common interventions for treating pulmonic valve disease, balloon pulmonary valvuloplasty and pulmonic valve replacement. RECENT FINDINGS The main long-term sequelae of balloon pulmonary valvuloplasty, the gold standard treatment for pulmonic stenosis, remain pulmonic regurgitation and valvular restenosis. The balloon:annulus ratio is a major contributor to both, with high ratios resulting in greater degrees of regurgitation, and small ratios increasing risk for restenosis. Recent studies suggest that a ratio of approximately 1.2 may provide the most optimal results. Pulmonic valve replacement is currently the procedure of choice for patients with severe pulmonic regurgitation and hemodynamic sequelae or symptoms, yet it remains uncertain how it impacts long-term survival. Transcatheter pulmonic valve replacement is a rapidly evolving field and recent outcome studies suggest short and mid-term results at least equivalent to surgery. The Melody valve® was FDA approved for failing pulmonary surgical conduits in 2010 and for failing bioprosthetic surgical pulmonic valves in 2017 and has been extensively studied, whereas the Sapien XT valve®, offering larger diameters, was approved for failing pulmonary conduits in 2016 and has been less extensively studied. Patients with pulmonic valve disease deserve lifelong surveillance for complications. Transcatheter pulmonic valve replacement is a novel and attractive therapeutic option, but is currently only FDA approved for patients with failing pulmonary conduits or dysfunctional surgical bioprosthetic valves. New advances will undoubtedly increase the utilization of this rapidly expanding technology.
Collapse
|
15
|
|
16
|
Saremi F, Sánchez-Quintana D, Mori S, Muresian H, Spicer DE, Hassani C, Anderson RH. Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging. Radiographics 2017; 37:1330-1351. [DOI: 10.1148/rg.2017170004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farhood Saremi
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Damián Sánchez-Quintana
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Shumpei Mori
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Horia Muresian
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Diane E. Spicer
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Cameron Hassani
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Robert H. Anderson
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| |
Collapse
|
17
|
Tretter JT, Spicer DE, Mori S, Chikkabyrappa S, Redington AN, Anderson RH. The Significance of the Interleaflet Triangles in Determining the Morphology of Congenitally Abnormal Aortic Valves: Implications for Noninvasive Imaging and Surgical Management. J Am Soc Echocardiogr 2016; 29:1131-1143. [DOI: 10.1016/j.echo.2016.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 10/20/2022]
|
18
|
Kuetting M, Pott D, Sedaghat A, Ng YA, Egron S, Rosefort C, Werner N, Sachweh J, Steinseifer U. Right heart transcatheter valve therapies – a review of prostheses for the pulmonary and tricuspid positions. Expert Rev Med Devices 2014; 12:163-74. [DOI: 10.1586/17434440.2015.985654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
19
|
|
20
|
Ouyang F, Mathew S, Wu S, Kamioka M, Metzner A, Xue Y, Ju W, Yang B, Zhan X, Rillig A, Lin T, Rausch P, Deiß S, Lemes C, Tönnis T, Wissner E, Tilz RR, Kuck KH, Chen M. Ventricular Arrhythmias Arising From the Left Ventricular Outflow Tract Below the Aortic Sinus Cusps. Circ Arrhythm Electrophysiol 2014; 7:445-55. [PMID: 24795340 DOI: 10.1161/circep.114.001690] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach.
Methods and Results—
This study included 27 patients with symptomatic VA, of which 13 patients had previous failed ablations. LVOT endocardial 3-dimensional mapping via retrograde transaortic and antegrade transseptal approaches was performed. Previous ECG markers for procedure failure were analyzed. In all patients, earliest activation with low-amplitude potentials was identified at the anterosuperior LVOT 5.1±2.8 mm below the aortic cusp and preceded the QRS onset by 39.5±7.7 ms only via an antegrade transseptal approach using a reversed S curve. In all patients, pace mapping failed to demonstrate perfect QRS morphology match. The anatomic location was below the left coronary cusp in 16, below the left coronary cusp/right coronary cusp junction in 8, and below the right coronary cusp in 3 patients. Radiofrequency energy resulted in rapid disappearance of VAs in all patients. ECG analysis showed aVL/aVR Q-wave amplitude ratio >1.4 in 7, lead III/II R-wave amplitude ratio >1.1 in 10, and peak deflection index >0.6 in 11 patients. There were no complications or clinical VA recurrence during a mean follow-up of 8.4±2.5 months.
Conclusions—
The anterosuperior LVOT can be reached via a transseptal approach with a reversed S curve of the ablation catheter. The rapid effect from radiofrequency energy indicates that the VA is most likely located under the endocardium. Also, previous ECG markers for procedure failure need further investigation.
Collapse
Affiliation(s)
- Feifan Ouyang
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Shibu Mathew
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Shulin Wu
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Masashi Kamioka
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Andreas Metzner
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Yumei Xue
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Weizhu Ju
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Bing Yang
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Xianzhang Zhan
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Andreas Rillig
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Tina Lin
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Peter Rausch
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Sebastian Deiß
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Christine Lemes
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Tobias Tönnis
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Erik Wissner
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Roland Richard Tilz
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Karl-Heinz Kuck
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| | - Minglong Chen
- From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O., S.M., M.K., A.M., A.R., T.L., P.R., S.D., C.L., T.T., E.W., R.R.T., K.-H.K.); Department of Cardiology, Guangdong Cardiovascular Institute and Guangdong Provincial People’s Hospital, Guangzhou, China (S.W., Y.X., X.Z.); and Department of Cardiology, the 1st Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.J., B.Y., M.C.)
| |
Collapse
|
21
|
Saremi F, Gera A, Yen Ho S, Hijazi ZM, Sánchez-Quintana D. CT and MR Imaging of the Pulmonary Valve. Radiographics 2014; 34:51-71. [DOI: 10.1148/rg.341135026] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
22
|
Anderson RH, Brown NA, Mohun TJ, Moorman AFM. Insights from cardiac development relevant to congenital defects and adult clinical anatomy. J Cardiovasc Transl Res 2012; 6:107-17. [PMID: 23225336 DOI: 10.1007/s12265-012-9430-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/22/2012] [Indexed: 12/11/2022]
Abstract
Advances made in understanding temporal changes in structure of the developing heart, along with advances in knowledge of the lineage of cardiomyocytes forming the components of cardiac chambers, permit us to draw inferences concerning substrates for arrhythmias such as atrial fibrillation and outflow tract tachycardias. We frame these insights in our description of the formation of cardiac chambers. Adult-like electrocardiograms can be generated by developing hearts before it is possible to recognize an anatomically discrete conduction system. Working components of the atrial and ventricular chambers, which are rapidly conducting, balloon from walls of the primary heart tube, themselves slowly conducting. Recognition of the locations of these populations of primary and secondary myocardial pools suggests that some potential myocardial substrates (those producing outflow tract tachycardias) initially had a primary phenotype. In contrast, cardiomyocytes forming pulmonary venous sleeves, substrates for many cases of atrial fibrillation, have never possessed a primary phenotype. This article is part of a JCTR special issue on Cardiac Anatomy.
Collapse
|
23
|
Estenosis pulmonar supravalvular como causa probable de muerte súbita en el lactante. An Pediatr (Barc) 2012; 76:363-5. [DOI: 10.1016/j.anpedi.2012.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/03/2012] [Accepted: 01/12/2012] [Indexed: 11/23/2022] Open
|
24
|
Natale A, Raviele A, Al-Ahmad A, Alfieri O, Aliot E, Almendral J, Breithardt G, Brugada J, Calkins H, Callans D, Cappato R, Camm JA, Della Bella P, Guiraudon GM, Haïssaguerre M, Hindricks G, Ho SY, Kuck KH, Marchlinski F, Packer DL, Prystowsky EN, Reddy VY, Ruskin JN, Scanavacca M, Shivkumar K, Soejima K, Stevenson WJ, Themistoclakis S, Verma A, Wilber D. Venice Chart International Consensus document on ventricular tachycardia/ventricular fibrillation ablation. J Cardiovasc Electrophysiol 2010; 21:339-79. [PMID: 20082650 DOI: 10.1111/j.1540-8167.2009.01686.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Abstract
Each heart valve is composed of different structures of which each one has its own histological profile. Although the aortic and the pulmonary valves as well as the mitral and the tricuspid valves show similarities in their architecture, they are individually designed to ensure optimal function with regard to their role in the cardiac cycle. In this article, we systematically describe the structural elements of the four heart valves by different anatomical, light- and electron-microscopic techniques that have been presented. Without the demand of completeness, we describe main structural features that are in our opinion of importance in understanding heart valve performance. These features will also have important implications in the treatment of heart valve disease. They will increase the knowledge in the design of valve substitutes or partial substitutes and may participate to improve reconstructive techniques. In addition, understanding heart valve macro- and microstructure may also be of benefit in heart valve engineering techniques.
Collapse
Affiliation(s)
- Martin Misfeld
- University of Luebeck, Clinic of Cardiac and Thoracic Surgery, Ratzeburger Allee 160, 23538 Luebeck, Germany.
| | | |
Collapse
|
27
|
Hasdemir C, Aktas S, Govsa F, Aktas EO, Kocak A, Bozkaya YT, Demirbas MI, Ulucan C, Ozdogan O, Kayikcioglu M, Can LH, Payzin S. Demonstration of Ventricular Myocardial Extensions into the Pulmonary Artery and Aorta Beyond the Ventriculo-Arterial Junction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:534-9. [PMID: 17437578 DOI: 10.1111/j.1540-8159.2007.00704.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A subgroup of outflow tract (OT) ventricular tachycardias (VT) originate from the aortic sinuses or the main stem of the pulmonary artery. The anatomic substrate for these tachycardias is unknown. The aim of this study was to investigate the presence of ventricular myocardial extensions (VME) into the pulmonary artery (PA) and aorta (Ao) beyond the ventriculo-arterial junction (VAJ) and determine the anatomical and histological characteristics of these muscle extensions. METHODS Ninety-five consecutive human hearts obtained at autopsy were studied. Longitudinal strips of tissue containing each cusp, aortic, and pulmonary artery walls and left and right ventricular outflow tracts were excised and histologically analyzed. Anatomical measurements, including length and thickness of VMEs, obtained at autopsy, were made. RESULTS VMEs beyond the VAJ were found in 21 of 95 (22%) patients studied. VMEs were found in 16 of 95 PAs (17%) and 7 of 95 Aos (7%) were examined. VMEs were located within the adventitia in 23 (88%) and on the epicardial surface in three (12%). The majority of VMEs were in continuity with the underlying ventricular OT muscle tissue. Myocellular hypertrophy and fibrosis were present in 19 (73%) and fatty tissue between the layers of VME in 18 (69%). Clinical data were available in 14 of 21 patients with positive VME. None of the patients (clinical data available group) had history of cardiac disease or signs or symptoms (palpitations or syncope) of cardiac disease. CONCLUSIONS VMEs into the PA and Ao beyond the VAJ are relatively common. It seems that their mere presence does not predispose to OT VTs. There are probably intrinsic arrhythmogenic properties in tissues specific to these regions in those patients who develop OT VTs.
Collapse
Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Yen Ho S. Re: Catheter ablation of right ventricular outflow tract. J Cardiovasc Electrophysiol 2006; 17:E7; author reply E8. [PMID: 16987386 DOI: 10.1111/j.1540-8167.2006.00607.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
Estrada A, Moïse NS, Erb HN, McDonough SP, Renaud-Farrell S. Prospective Evaluation of the Balloon-to-Annulus Ratio for Valvuloplasty in the Treatment of Pulmonic Stenosis in the Dog. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb01799.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
30
|
Rammos S, Apostolopoulou SC, Kramer HH, Kozlik-Feldmann R, Heusch A, Laskari CV, Anagnostopoulos C. Normative angiographic data relating to the dimensions of the aorta and pulmonary trunk in children and adolescents. Cardiol Young 2005; 15:119-24. [PMID: 15845152 DOI: 10.1017/s1047951105000272] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Definition of normative data of the great arteries from neonatal to adult ages may aid in assessment of the growth of cardiovascular structures, thus guiding the timing and type of intervention in patients with congenital cardiac disease. METHODS We calculated the cross-sectional areas of the arterial roots at the basal attachment of the valvar leaflets, the sinuses, and standardized distal sites using cineangiograms of 59 normal children and adolescents with mean age of 5.4 plus or minus 4.7 years and a range from 0.1 to 16 years, the children having a mean weight of 21.2 plus or minus 15.7 kilograms, with a range from 2.2 to 68 kilograms, and mean height of 108 plus or minus 35 centimetres, with a range from 43 to 184 centimetres. Values at each site were calculated averaging end-diastolic and end-systolic measurements, and indexed to body surface area. Results are expressed as the mean plus or minus the standard deviation. RESULTS The diameter of the aortic root at the basal attachment of the leaflets was 249 plus or minus 26, the midpoint of the sinuses 379 plus or minus 59, the sinutubular junction 290 plus or minus 58, the isthmus 158 plus or minus 36, the postisthmic region 152 plus or minus 33, and the descending aorta at the level of diaphragm 130 plus or minus 18 millimetres squared per metre squared. The pulmonary root measured at the basal attachment of the leaflets was 253 plus or minus 28, the midpoint of the sinuses 352 plus or minus 58, the sinutubular junction 293 plus or minus 58, the right pulmonary artery 176 plus or minus 25, the left pulmonary artery 153 plus or minus 20, and sum of right and left pulmonary arteries 330 plus or minus 37 millimetres squared per metre squared. All indexes were consistent over a wide range for body surface areas. CONCLUSIONS Definition of normative data of the great vessels may aid in the evaluation of congenital or acquired abnormalities, serving as guidelines for intervention during medical or surgical management and follow-up.
Collapse
Affiliation(s)
- Spyridon Rammos
- Department of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens 17674, Greece
| | | | | | | | | | | | | |
Collapse
|
31
|
Icardo JM, Schib JL, Ojeda JL, Durán AC, Guerrero A, Colvee E, Amelio D, Sans-Coma V. The conus valves of the adult gilthead seabream (Sparus auratus). J Anat 2003; 202:537-50. [PMID: 12846475 PMCID: PMC1571104 DOI: 10.1046/j.1469-7580.2003.00186.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The conus (bulbo-ventricular) valves of teleosts perform a key function in the control of blood backflow during ventricular diastole. However, the structural characteristics of these valves are almost unknown. This paper presents a systematic anatomical, histological and structural study of the conus valves of the adult gilthead seabream (Sparus auratus). S. auratus shows two major left and right valves consisting of the leaflet and the supporting sinus. Each valvar leaflet can be divided into a stout proximal body and a flap-like distal region. The proximal body is structured into three layers: a luminal fibrosa, a dense cellular core and a parietal fibrosa. The luminal fibrosa is a collagenous structure extending the entire length of the leaflet, while the parietal fibrosa is restricted to the most proximal area. The dense cellular core consists of fibroblastic cells and a matrix rich in glycoconjugates, collagen and elastin. The histochemical and structural data suggest that the luminal fibrosa bears most of the force associated with valvar closure, while the cellular core acts as a cushion dampening vibrations and absorbing the elastic recoil. The sinus wall is a fibrous layer which shows proximal-distal differences in thickness. It also shows compositional differences that can be related to mechanical function. We describe the presence of a fibrous cylinder formed by the sinus wall, the fibrous interleaflet triangles and the fibrous layer that covers the inner surface of the conus myocardium. This fibrous cylinder constitutes the structural nexus between the ventricle, the conus and the bulbus arteriosus, provides support for the conus valves and separates the valvar complex from the surrounding tissues. The structure of the conus valves in S. auratus is different from that found in other vertebrates. Anatomical similarities between the conus valves and the mammalian arterial valves are emphasized. Each phyletic group appears to have developed specific structures in order to perform similar functions.
Collapse
Affiliation(s)
- J M Icardo
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Cantabria, Santander, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Webb S, Qayyum SR, Anderson RH, Lamers WH, Richardson MK. Septation and separation within the outflow tract of the developing heart. J Anat 2003; 202:327-42. [PMID: 12739611 PMCID: PMC1571094 DOI: 10.1046/j.1469-7580.2003.00168.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The developmental anatomy of the ventricular outlets and intrapericardial arterial trunks is a source of considerable confusion. First, major problems exist because of the multiple names and definitions used to describe this region of the heart as it develops. Second, there is no agreement on the boundaries of the described components, nor on the number of ridges or cushions to be found dividing the outflow tract, and the pattern of their fusion. Evidence is also lacking concerning the role of the fused cushions relative to that of the so-called aortopulmonary septum in separating the intrapericardial components of the great arterial trunks. In this review, we discuss the existing problems, as we see them, in the context of developmental and postnatal morphology. We concentrate, in particular, on the changes in the nature of the wall of the outflow tract, which is initially myocardial throughout its length. Key features that, thus far, do not seem to have received appropriate attention are the origin, and mode of separation, of the intrapericardial portions of the arterial trunks, and the formation of the walls of the aortic and pulmonary valvar sinuses. Also as yet undetermined is the formation of the free-standing muscular subpulmonary infundibulum, the mechanism of its separation from the aortic valvar sinuses, and its differentiation, if any, from the muscular ventricular outlet septum.
Collapse
Affiliation(s)
- Sandra Webb
- Department of Anatomy and Developmental Biology, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK.
| | | | | | | | | |
Collapse
|
33
|
Kivelitz DE, Dohmen PM, Lembcke A, Kroencke TJ, Klingebiel R, Hamm B, Konertz W, Taupitz M. Visualization of the pulmonary valve using cine MR imaging. Acta Radiol 2003. [PMID: 12694104 DOI: 10.1034/j.1600-0455.2003.00045.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the capability of bright-blood cine MR to directly visualize the leaflets of the valve replacement in pulmonary position following Ross operation. MATERIAL AND METHODS Long and short axis views of the pulmonary valve were obtained in 10 normal subjects and 14 patients after Ross operation. Valve morphology and function were analyzed and signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were calculated. Flow measurements were performed in the pulmonary trunk to assess pulmonary regurgitation. RESULTS In all subjects, tricuspid morphology of the pulmonary valve was visualized. SNR of the leaflets in normal subjects (9.8 +/- 3.0) and in patients after Ross operation (7.5 +/- 2.2) differed significantly from blood (12.6 +/- 3.2 and 11.3 +/- 2.5, respectively, p < 0.05). Valvular regurgitation was seen in 5 patients as an insufficient closure of the valve which was confirmed by flow measurements. CONCLUSION Cine MR enables in-plane visualization of the pulmonary valve and allows for functional and morphological evaluation in patients after pulmonary valve surgery.
Collapse
Affiliation(s)
- D E Kivelitz
- Institut für Radiologie, and Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Charité, Humboldt-Universität zu Berlin, Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Ouyang F, Fotuhi P, Ho SY, Hebe J, Volkmer M, Goya M, Burns M, Antz M, Ernst S, Cappato R, Kuck KH. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol 2002; 39:500-8. [PMID: 11823089 DOI: 10.1016/s0735-1097(01)01767-3] [Citation(s) in RCA: 450] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to investigate the electrocardiographic (ECG) characteristics for guiding catheter ablation in patients with repetitive monomorphic ventricular tachycardia (RMVT) originating from the aortic sinus cusp (ASC). BACKGROUND Repetitive monomorphic ventricular tachycardia can originate from the right ventricular outflow tract (RVOT) and ASC in patients with a left bundle branch block (LBBB) morphology and an inferior axis. METHODS Activation mapping and ECG analysis was performed in 15 patients with RMVT or ventricular premature contractions. The left main coronary artery (LMCA) was cannulated as a marker and for protection during radiofrequency delivery if RMVT originated from the left coronary ASC. RESULTS During arrhythmia, the earliest ventricular activation was recorded from the superior septal RVOT in eight patients (group 1) and from the ASC in the remaining seven patients (group 2). The indexes of R-wave duration and R/S-wave amplitude were significantly lower in group 1 than in group 2 (31.8+/-13.5% vs. 58.3+/-12.1% and 14.9+/-9.9% vs. 56.7+/-29.5%, respectively; p < 0.01), despite similar QRS morphology. In five patients from group 2, RMVT originated from the left ASC, with a mean distance of 12.2+/-3.2 mm (range 7.3 to 16.1) below the ostium of the LMCA. In the remaining two patients, the RMVT origin was in the right ASC. All arrhythmias were successfully abolished. None of the patients had recurrence or complications during 9+/-3 months of follow-up. CONCLUSIONS On the surface ECG, RMVT from the ASC has a QRS morphology similar to that of RVOT arrhythmias. The indexes of R-wave duration and R/S-wave amplitude can be used to differentiate between the two origins. Radiofrequency ablation can be safely performed within the left ASC with a catheter cannulating the LMCA.
Collapse
Affiliation(s)
- Feifan Ouyang
- II. Med. Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Stamm C, Friehs I, Ho SY, Moran AM, Jonas RA, del Nido PJ. Congenital supravalvar aortic stenosis: a simple lesion? Eur J Cardiothorac Surg 2001; 19:195-202. [PMID: 11167112 DOI: 10.1016/s1010-7940(00)00647-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The underlying cause of congenital supravalvular aortic stenosis (SVAS) has recently been identified as a loss-of function mutation of the elastin gene on chromosome 7q11.23, resulting in an obstructive arteriopathy of varying severity, which is most prominent at the aortic sinutubular junction. The generalized nature of the disease explains the frequent association with stenoses of systemic and pulmonary arteries. Furthermore, localization of the supravalvular stenosis at the level of the commissures of the aortic valve has important implications for both aortic valve function and coronary circulation. This review summarizes the recent advances with regard to the pathogenesis of SVAS and describes the multitude of clinically relevant pathologic features other that the mere 'supra-aortic' narrowing that have important implications for surgical therapy.
Collapse
Affiliation(s)
- C Stamm
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Affiliation(s)
- R H Anderson
- Cardiac Unit, Institute of Child Health, University College London, UK.
| |
Collapse
|
37
|
Stamm C, Friehs I, Moran AM, Zurakowski D, Bacha E, Mayer JE, Jonas RA, Del Nido PJ. Surgery for bilateral outflow tract obstruction in elastin arteriopathy. J Thorac Cardiovasc Surg 2000; 120:755-63. [PMID: 11003759 DOI: 10.1067/mtc.2000.107477] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A number of patients with Williams syndrome or other forms of elastin arteriopathy have stenoses of pulmonary arteries in addition to supravalvular aortic stenosis. We sought to investigate the effect of the degree of pulmonary arterial stenosis on the prognosis after an operation for supravalvular aortic stenosis to help define the optimal treatment strategy for patients with severe forms of elastin arteriopathy. METHODS Between 1960 and 1999, 33 patients underwent operations for supravalvular aortic stenosis while having significant stenoses of the pulmonary arteries. We retrospectively reviewed patient charts, obtained current follow-up information, and determined risk factors for survival and reoperation. RESULTS Fifteen patients with moderate right-sided obstructions (confirmed by pulmonary artery Z-scores and right ventricular/descending aortic pressure ratio) underwent operations for supravalvular aortic stenosis only. Eighteen patients had more severe right-sided obstructions and underwent surgical relief of pulmonary arterial stenoses or right ventricular outflow tract obstruction in addition to operations for supravalvular aortic stenosis. Eight patients had undergone preoperative balloon dilations of stenotic pulmonary arteries. There were 6 early deaths and 1 late death in our series. Survival at 10 and 20 years was 76% (70% confidence interval, 68%-84%) and freedom from reintervention was 59% (70% confidence interval, 46%-71%) at 10 years and 49% (70% confidence interval, 35%-62%) at 20 years. Multivariate analysis revealed that patients with a right ventricular/descending aortic pressure ratio of 1.0 or more were at higher risk for reintervention but not for death. CONCLUSIONS Surgical treatment of pulmonary artery obstructions in elastin arteriopathy is palliative but, in conjunction with balloon dilation of peripheral pulmonary arteries, offers good long-term survival to patients with the severest form of elastin arteriopathy.
Collapse
Affiliation(s)
- C Stamm
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Mass., USA
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Cazzaniga M, Quero Jiménez C, Fernández Pineda L, Daghero F, Herraiz I, Bermúdez Cañete R, Díez Balda JI, Rico Gómez F, Maître MJ. [Balloon pulmonary valvuloplasty in the neonatal period. The clinical and echocardiographic effects]. Rev Esp Cardiol 2000; 53:327-36. [PMID: 10712965 DOI: 10.1016/s0300-8932(00)75100-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To analyze the efficacy of balloon pulmonary valvuloplasty (BPV) as the elective treatment for neonatal critical pulmonary valvar stenosis (PVS). MATERIALS AND METHODS The results of clinical and echocardiographic features before and after the BPV were reviewed in 29 neonates (18+/-12 days of life). Different hemodynamic and 2-D color Doppler echocardiographic were evaluated. The BPV result was classified as favourable if no other balloon or surgical therapy was required to normalise pulmonary flow and achieve a sustained right ventricle-pulmonary artery (RV-PA) Doppler gradient below 40 mmHg. It was considered unfavourable if the neonate died, needed surgery or redilation and/or the RV-PA Doppler gradient was > or =40 mm Hg. The study developed in three phases: pre BPV immediate post BPV until the hospital discharge (14+/-11 days), and in the mid-term follow-up of between 8 and 96 months (51+/-31 months). RESULTS Mortality was not registered with BPV. The RV/left ventricular systolic pressure decreased from 1.4+/-0.3 to 0.8+/-0.3 (p<0.01) as a consequence of the dilation, and the the systemic oxygen saturation increased from 85 +/-12 to 92+/-6% (p<0.01). The RV-PA Doppler gradient diminished from 86+/-18 to 28+/-16 mm Hg immediately after BPV (p<0.01) and was registered at 13+/-6 mm Hg in the follow-up (n = 24). The RV-PA junction Z value grew from -1.25+/-0.9 before valvuloplasty to -0.51 +/-0.7 at the final echocardiogram (p<0.01). No changes in the tricuspid diameter were detected between both periods of time. Five neonates obtained unsatisfactory results: 4 in the immediate post BPV (systemic-pulmonary artery shunt 2, transannular patch 2), and 1 in the mid-term follow-up (valvectomy + transannular patch). The actuarial curve reflects that 82,7% of the patients were free form reinterventions at 8 years. CONCLUSIONS BPV is safe and effective to relief PVS in the neonate. The balloon promotes advantageous changes in both, pulmonary annulus and the right ventricle. In addition, the RV-PA Doppler gradient observations in the follow-up, support the expectation that the BPV is a "curative" therapy.
Collapse
Affiliation(s)
- M Cazzaniga
- Cardiología Pediátrica, Laboratorio de Ecocardiografía Infantil. Hospital Ramón y Cajal, Madrid.
| | | | | | | | | | | | | | | | | |
Collapse
|