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Melillo F, Fabiani D, Santoro A, Oro P, Frecentese F, Salemme L, Tesorio T, Agricola E, De Bonis M, Lorusso R. Multimodality Imaging for Right Ventricular Function Assessment in Severe Tricuspid Regurgitation. J Clin Med 2024; 13:5076. [PMID: 39274289 PMCID: PMC11395915 DOI: 10.3390/jcm13175076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
Severe tricuspid regurgitation (TR) is a pathological condition associated with worse cardiovascular outcomes. In the vicious cycle of right ventricular compensation and maladaptation to TR, the development of right ventricle (RV) dysfunction has significant prognostic implications, especially in patients undergoing surgical or percutaneous treatments. Indeed, RV dysfunction is associated with increased operative morbidity and mortality in both surgical and percutaneously treated patients. In this context, the identification of clinical or subtle right ventricle dysfunction plays a critical role inpatient selection and timing of surgical or percutaneous tricuspid valve intervention. However, in the presence of severe TR, evaluation of RV function is challenging, given the increase in preload that may lead to an overestimation of systolic function for the Frank-Starling law, reduced reliability of pulmonary artery pressure estimation, the sensitivity of RV to afterload that may result in afterload mismatch after treatment. Consequently, conventional echocardiographic indices have some limitations, and the use of speckle tracking for right ventricular free wall longitudinal strain (RV-FWLS) analysis and the use of 3D echocardiography for RV volumes and ejection fraction estimation are showing promising data. Cardiac magnetic resonance (CMR) represents the gold standards for volumes and ejection fraction evaluation and may add further prognostic information. Finally, cardiac computer tomography (CCT) provides measurements of RV and annulus dimensions that are particularly useful in the transcatheter field. Identification of subtle RV dysfunction may need, therefore, more than one imaging technique, which will lead to tip the balance between medical therapy and early intervention towards the latter before disease progression. Therefore, the aim of this review is to describe the main imaging techniques, providing a comprehensive assessment of their role in RV function evaluation in the presence of severe TR.
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Affiliation(s)
- Francesco Melillo
- Heart and Vascular Centre, Cardiovascular Research Institute, University of Maastricht, 6221 Maastricht, The Netherlands
- Echo Lab, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | - Dario Fabiani
- Echo Lab, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | - Alessandro Santoro
- Intensive Care Unit, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | - Pietro Oro
- Echo Lab, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | | | - Luigi Salemme
- Interventional Cardiology Unit, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | - Tullio Tesorio
- Interventional Cardiology Unit, Clinica Montevergine GVM Care and Research, 83013 Mercogliano, Italy
| | | | - Michele De Bonis
- Heart Valve Centre, IRCCS Ospdeale San Raffaele, 20132 Milan, Italy
| | - Roberto Lorusso
- Heart and Vascular Centre, Cardiovascular Research Institute, University of Maastricht, 6221 Maastricht, The Netherlands
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Landra F, Marallo C, Santoro A, Taddeucci S, Tavera MC, Baiocchi C, Palazzuoli A. Moderator Band and Ventricular Tachycardia: Structural or Functional Substrate? J Cardiovasc Dev Dis 2023; 10:jcdd10040159. [PMID: 37103038 PMCID: PMC10141128 DOI: 10.3390/jcdd10040159] [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: 03/15/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated in the genesis of life-threatening arrhythmias. However, right Purkinje network arrhythmias have been much less reported in the literature compared to the left counterpart. The MB has unique anatomical and electrophysiological properties, which may account for its arrhythmogenicity and may be responsible for a significant portion of idiopathic ventricular fibrillation. MB embodies autonomic nervous system cells, with important implications in arrhythmogenesis. Some idiopathic ventricular arrhythmias, defined as the absence of any identifiable structural heart disorder, can begin from this site. Due to these complex structural and functional peculiarities strictly interplayed each other, it is arduous to determine the precise mechanism underlying MB arrhythmias. MB-related arrhythmias should be differentiated from other right Purkinje fibers arrhythmias because of the opportunity for intervention and the unusual site for the ablation poorly described in the literature. In the current paper, we report the characteristics and electrical properties of the MB, their involvement in arrhythmogenesis, clinical and electrophysiological peculiarities of MB-related arrhythmias, and current treatment options.
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Affiliation(s)
- Federico Landra
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Carmine Marallo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Amato Santoro
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Simone Taddeucci
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Maria Cristina Tavera
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
| | - Claudia Baiocchi
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
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Aminu AJ, Chen W, Yin Z, Kuniewicz M, Walocha J, Perde F, Molenaar P, Iaizzo PA, Dobrzynski H, Atkinson AJ. Novel micro-computed tomography contrast agents to visualise the human cardiac conduction system and surrounding structures in hearts from normal, aged, and obese individuals. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Das D, Das T, Pramanik S, Bannerjee A, Kumar A. Moderator band calcification masquerading infrahisian conduction system disease. JOURNAL OF CLINICAL AND PREVENTIVE CARDIOLOGY 2022. [DOI: 10.4103/jcpc.jcpc_48_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Erdem B, Tutar T, Takci L, Akaydin Bozkurt Y, Ateş S. Morphology of septomarginal trabeculae in Hatay mountain gazelle (Gazella gazella). Anat Histol Embryol 2021; 51:189-196. [PMID: 34927745 DOI: 10.1111/ahe.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
This study was conducted to reveal the anatomical and histological features of left and right septomarginal trabeculae in the heart of the Hatay mountain gazelle. In the study, two female and two male adult Hatay mountain gazelle hearts were used. For this purpose, the materials detected in 10% formaldehyde solution were stained with Crossman's modified triple staining technique and examined under a light microscope after anatomical examinations and measurements were made. The presence of trabeculae in both ventricles was demonstrated. While the number of septomarginal trabeculae was 1 in each of the samples in the right ventricle, it was determined that it was 2 in each of three hearts and 3 in one heart in the left ventricle. It was observed that the right trabeculae were unbranched and fleshy, while the left trabeculae were filamentous and mostly branched. The lengths and thicknesses of the right trabeculae were measured 12-17 mm and 3-4 mm and the lengths and thicknesses of the left trabeculae were measured 6-15 mm and 0.5-1 mm. In the histological examination of both trabeculae, connective tissue, Purkinje fibres and blood vessels were observed, in addition, it was detected that the right trabeculae had myocardial fibres. Few capillaries were found in the left trabecula, while both more capillaries and blood vessels were found in the right trabeculae.
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Affiliation(s)
- Baran Erdem
- Department of Anatomy, Faculty of Veterinary Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Tolga Tutar
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Lutfi Takci
- Faculty of Veterinary Medicine, Department of Anatomy, Sivas Cumhuriyet University, Sivas, Turkey
| | - Yeşim Akaydin Bozkurt
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Sevinç Ateş
- Department of Anatomy, Faculty of Veterinary Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
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Meetham K, Taerujjirakul T, Garitjirapath N, Navic P, Shinlapawittayatorn K, Mahakkanukrauh P. The morphometric study of the moderator band in Thais. Anat Sci Int 2021; 97:188-196. [PMID: 34825348 DOI: 10.1007/s12565-021-00641-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
A moderator band, also known as the septomarginal trabecula, is a group of muscle bundles located in the ventricle of almost all human hearts. The morphology of the moderator band has various forms and several studies have focused mostly on its structure. Thus, in the present study, we sought to study the morphology and morphometry of the moderator band and tried to rearrange the criteria based on the previous studies to classify the moderator band in Thais. The study investigated 67 formalin-fixed human hearts of both sexes obtained from Thai donors aged 24-101 years with mean age at death 69.92 years. The moderator band was evident in 66 of the 67 specimens (98.51%). The moderator band had the mean or median of overall length, thickness, distance to the base of the tricuspid valve, distance to the base of the pulmonary valve, distance to the apex of the right ventricle, the angle at the septal connection, and angle of the papillary, which were 18.9 ± 6.4 mm, 3.17 (2.04-4.55) mm, 33.0 ± 7.97 mm, 38.8 ± 9.62 mm, 56.4 ± 8.09 mm, 50 (30-105)°, 73.9 ± 30.1°, respectively. The mean distance originating point from the supraventricular crest to the anterior papillary muscle was 0.396 ± 0.07 of the distance from the base of the tricuspid valve to the apex of the right ventricle. Our present classification found that crest-like and thick moderator band with complex secondary branching at high origin (type IVc), and low origin (type IVd) were the most common subtypes. This study provided both anatomical and clinical information that should be useful in cardiac surgery, radiology, and cardiac electrophysiological interventions.
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Affiliation(s)
- Kantapit Meetham
- Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | | | | | - Pagorn Navic
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Krekwit Shinlapawittayatorn
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.,Cardiac Electrophysiology Research and Training (CERT) Center, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. .,Excellence in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, 50200, Thailand.
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