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Krawczyk-Ożóg A, Hołda MK, Batko J, Jaśkiewicz K, Dziewierz A, Zdzierak B, Zasada W, Gil K, Hołda J. Description and prevalence of ventricular mitral annular disjunction: variation of normality or pathological variant? Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00129-4. [PMID: 38641167 DOI: 10.1016/j.rec.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to investigate a new variation of the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures: the ventricular mitral annular disjunction (v-MAD). This new variant is characterized by spatial displacement of the mitral leaflet hinge line by more than 2mm toward the left ventricle. METHODS We examined a cohort of autopsied human hearts (n=224, 21.9% females, 47.9±17.6 years) from patients without known cardiovascular disease to identify the presence of v-MAD. RESULTS More than half (57.1%) of the hearts showed no signs of MAD in the mural mitral leaflet or mitral commissures. However, v-MAD was found in 23.6% of cases, located within 20.1% of mural leaflets, 2.2% in superolateral commissures, and 1.3% in inferoseptal commissures. V-MAD was not uniformly distributed along the mitral annulus circumference, with the most frequent site being the P2 scallop (19.6% of hearts). The v-MAD height was significantly greater in mural leaflets than in commissures (4.4 mm±1.2 mm vs 2.1 mm±0.1 mm; P<.001). No specific variations in mitral valve morphology or anthropometrical features of donors were associated with the presence or distribution of v-MADs. Microscopic examinations revealed the overlap of the thin layer of atrial myocardium over ventricular myocardium in areas of v-MAD. CONCLUSIONS Our study is the first to present a detailed definition and morphometric description of v-MAD. Further studies should focus on the clinical significance of v-MAD to elucidate whether it represents a benign anatomical variant or a significant clinical anomaly.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland; Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland.
| | - Mateusz K Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Jakub Batko
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland
| | - Kacper Jaśkiewicz
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland; 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland. https://twitter.com/@Jakub_Batko_
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Krawczyk-Ożóg A, Batko J, Zdzierak B, Dziewierz A, Tyrak K, Bolechała F, Kopacz P, Strona M, Gil K, Hołda J, Hołda MK. Morphology of the mural and commissural atrioventricular junction of the mitral valve. Heart 2024; 110:517-522. [PMID: 37935571 DOI: 10.1136/heartjnl-2023-322965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/23/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE This study investigates mitral annular disjunctions (MAD) in the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures. METHODS We examined 224 adult human hearts (21.9% females, 47.9±17.6 years) devoid of cardiovascular diseases (especially mitral valve disease). These hearts were obtained during forensic medical autopsies conducted between January 2018 and June 2021. MAD was defined as a spatial displacement (≥2 mm) of the leaflet hinge line towards the left atrium. We provided a detailed morphometric analysis (disjunction height) and histological examination of MADs. RESULTS MADs were observed in 19.6% of all studied hearts. They appeared in 12.1% of mural leaflets. The P1 scallop was the primary site for disjunctions (8.9%), followed by the P2 scallop (5.4%) and P3 scallop (4.5%). MADs were found in 9.8% of all superolateral and 5.8% of all inferoseptal commissures. The average height for leaflet MADs was 3.0±0.6 mm, whereas that for commissural MADs was 2.1±0.5 mm (p<0.0001). The microscopical arrangement of MADs in both the mural leaflet and commissures revealed a disjunction shifted towards left atrial aspect, filled with connective tissue and covered by elongated valve annulus. The size of the MAD remained remarkably uniform and showed no correlation with other anthropometric factors (all p>0.05). CONCLUSIONS In the cohort of the patients with healthy hearts, MAD is present in about 20% of all studied hearts. The MADs identified tend to be localised, confined to a single scallop. Moreover, MADs in the commissures are notably smaller than those in the mural leaflet.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Jakub Batko
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Kamil Tyrak
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Kopacz
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Hołda
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K Hołda
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- The University of Manchester, Manchester, UK
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Batko J, Jakiel R, Krawczyk-Ożóg A, Litwinowicz R, Hołda J, Bartuś S, Bartuś K, Hołda MK, Konieczyńska M. Definition and anatomical description of the left atrial appendage neck. Clin Anat 2024; 37:201-209. [PMID: 38031393 DOI: 10.1002/ca.24125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
The left atrial appendage (LAA) is well known as a source of cardiac thrombus formation. Despite its clinical importance, the LAA neck is still anatomically poorly defined. Therefore, this study aimed to define the LAA neck and determine its morphometric characteristics. We performed three-dimensional reconstructions of the heart chambers based on contrast-enhanced electrocardiography-gated computed tomography scans of 200 patients (47% females, 66.5 ± 13.6 years old). The LAA neck was defined as a truncated cone-shaped canal bounded proximally by the LAA orifice and distally by the lobe origin and was present in 98.0% of cases. The central axis of the LAA neck was 14.7 ± 2.3 mm. The mean area of the LAA neck walls was 856.6 ± 316.7 mm2 . The LAA neck can be divided into aortic, arterial (the smallest), venous (the largest), and free surfaces. All areas have a trapezoidal shape with a broader proximal base. There were no statistically significant differences in the morphometric characteristics of the LAA neck between LAA types. Statistically significant differences between the sexes in the main morphometric parameters of the LAA neck were found in the central axis length and the LAA neck wall area. The LAA neck can be evaluated from computed tomography scans and their three-dimensional reconstructions. The current study provides a complex morphometric analysis of the LAA neck. The precise definition and morphometric details of the LAA neck presented in this study may influence the effectiveness and safety of LAA exclusion procedures.
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Affiliation(s)
- Jakub Batko
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Jakiel
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Agata Krawczyk-Ożóg
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, Krakow, Poland
| | - Radosław Litwinowicz
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland
| | - Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, Krakow, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Department of Diagnostic Medicine, John Paul II Hospital in Kraków, Krakow, Poland
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Małgorzata Konieczyńska
- Department of Diagnostic Medicine, John Paul II Hospital in Kraków, Krakow, Poland
- Department of Thromboembolic Diseases, Jagiellonian University Medical College, Cracow, Poland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Krawczyk-Ożóg A, Batko J, Koziej M, Tokarek T, Sorysz D, Siudak Z, Dudek D, Bartuś S, Surdacki A, Hołda MK. Computed tomography and transthoracic echocardiography for assessment of left ventricle geometry in patients with aortic valve stenosis. Postepy Kardiol Interwencyjnej 2023; 19:47-55. [PMID: 37090214 PMCID: PMC10114178 DOI: 10.5114/aic.2023.124406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/27/2022] [Indexed: 04/25/2023] Open
Abstract
Introduction Standard transthoracic echocardiography (TTE) often is not sufficient to properly visualize the geometry of the left ventricle. One of the clinical imaging modalities that can be used for this purpose is contrast-enhanced, electrocardiologically gated cardiac computed tomography (CT). Aim To compare cardiac CT and TTE as tools for assessing geometry and function of the left ventricle in patients with severe aortic stenosis. Material and methods We analyzed 58 consecutive patients (43.1% males, mean age 81.4 ±6.0 years) with severe aortic stenosis, who underwent both cardiac CT and TTE. Results Left ventricle major axis length is significantly longer in CT than in TTE (81.5 ±11.7 mm vs. 74.6 ±13.5 mm, p = 0.004). No difference was found in end-systolic left ventricle volume between the two imaging methods, while end-diastolic volume of the left ventricle was significantly larger when measured in CT than in both 2D biplane and 3D triplane TTE. The stroke volume was not different between the 2D biplane TTE and CT. No significant difference was found between CT and TTE in the calculation of ejection fraction and LV mass/indexed LV mass (p > 0.05). Conclusions The use of three-dimensional postprocessing provides a very accurate image of heart structures in CT, which in some aspects may significantly differ from the values estimated by TTE.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Jakub Batko
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Koziej
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Tokarek
- Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
- Center for Invasive Cardiology, Electrotherapy and Angiology, Nowy Sacz, Poland
| | - Danuta Sorysz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland
| | - Dariusz Dudek
- Digital Medicine and Robotics Center, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K. Hołda
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Lis M, Krawczyk-Ożóg A, Hołda J, Tyrak K, Dudkiewicz D, Yakovliev A, Strona M, Bolechała F, Jakiel R, Jakiel M, Hołda MK. Pulmonary valve morphometry revisited: Clinical implications for valvular and supravalvular interventions. Clin Anat 2023; 36:234-241. [PMID: 36193818 DOI: 10.1002/ca.23959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
In this cadaver-based study, we aimed to present a novel approach to pulmonary valve (PV) anatomy, morphometry, and geometry to offer comprehensive information on PV structure. The 182 autopsied human hearts were investigated morphometrically. The largest PV area was seen for the coaptation center plane, followed by basal ring and the tubular plane (626.7 ± 191.7 mm2 vs. 433.9 ± 133.6 mm2 vs. 290.0 ± 110.1 mm2 , p < 0.001). In all leaflets, fenestrations are noted and occur in 12.5% of PVs. Only in 31.3% of PVs, the coaptation center is located in close vicinity of the PV geometric center. Similar-sized sinuses were found in 35.7% of hearts, in the remaining cases, significant heterogeneity was seen in size. The mean sinus depth was: left anterior 15.59 ± 2.91 mm, posterior: 16.04 ± 2.82 mm and right anterior sinus: 16.21 ± 2.81 mm and the mean sinus height: left anterior 15.24 ± 3.10 mm, posterior: 19.12 ± 3.79 mm and right anterior sinus: 18.59 ± 4.03 mm. For males, the mean pulmonary root perimeters and areas were significantly larger than those for females. Multiple forward stepwise regression model showed that anthropometric variables might predict the coaptation center plane (sex, age, and heart weight; R2 = 33.8%), tubular plane (sex, age, and BSA; R2 = 20.5%) and basal ring level area (heart weight and sex; R2 = 17.1%). In conclusion, the largest pulmonary root area is observed at the coaptation center plane, followed by the basal ring and tubular plane. The PV geometric center usually does not overlap valve coaptation center. Significant heterogeneity is observed in the size of sinuses and leaflets within and between valves. Anthropometric variables may be used to predict pulmonary root dimensions.
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Affiliation(s)
- Maciej Lis
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Agata Krawczyk-Ożóg
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Kamil Tyrak
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Damian Dudkiewicz
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Artem Yakovliev
- Institute of Nuclear Physics, Polish Academy of Sciences, Cracow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Rafał Jakiel
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Jakiel
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, 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
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Krawczyk-Ożóg A, Hołda MK, Batko J, Bartuś S, Rajtar-Salwa R. Three-dimensional cardiac computed tomography compared with autopsied material for the assessment of the mitral valve. Clin Anat 2023; 36:250-255. [PMID: 36271778 DOI: 10.1002/ca.23967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022]
Abstract
To compare the morphometrical features of non-diseased mitral valves imaged in three-dimensional (3D) cardiac computed tomography with those analyzed macroscopically in autopsied healthy human hearts. A total of 51 cardiac computed tomography scans and 120 adult autopsied human hearts without cardiovascular disease were examined. The 3D reconstruction and visualization software (Mimics Innovation Suite 22, Materialise) was used for heart chambers semi-automatic segmentation and myocardial manual segmentation to visualize a 3D structure of the mitral valve complex and to perform all measurements. Direct comparison of corresponding mitral valve parameters revealed significant differences between obtained results. Significantly larger intercommisural diameter, aorto-mural diameter, and perimeter of the mitral annulus were observed in tomographic scans (all p < 0.0001). However, the intercommissural/aorto-mural diameter ratio showed comparable values for both groups. Nevertheless, the size of anterior mitral leaflet was higher in autopsied material. The height of the P2 scallops was the only parameter that show no significant difference between two groups (p = 0.3). The use of 3D postprocessing algorithms provides a very accurate image of the mitral valve structure, which could be useful for the precise non-invasive assessment of mitral valve size and structure. Three-dimensional contrast enhanced cardiac computed tomography significantly overestimates the measurements of the mitral annulus compared to postmortem analysis.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland.,Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Mateusz K Hołda
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Jakub Batko
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
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Dudkiewicz D, Zhingre Sanchez JD, Hołda J, Bolechała F, Strona M, Kopacz P, Iaizzo PA, Koziej M, Hołda MK, Konieczyńska M. Aortic valve fenestrations: Macroscopic assessment and functional anatomy study. Clin Anat 2023; 36:612-617. [PMID: 36597994 DOI: 10.1002/ca.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
Aortic valve fenestrations are defined as a loss of aortic valve leaflet tissue. They are a common but overlooked finding with unclear significance. The aim of this study was to investigate the varied functional anatomies of aortic valve fenestrations. A total of 400 formalin-fixed autopsied human hearts were macroscopically assessed and the function of the aortic valve of 16 reanimated human hearts were imaged using Visible Heart® methodologies. Aortic valve leaflet fenestrations were present in 43.0% of autopsied hearts (in one leaflet in 24.0%, in two leaflets 16.0%, in all leaflets 3.0%). Fenestrations were mostly present in left (25.5%) followed by right (23.3%) and noncoronary leaflet (16.3%). In 93.8% of cases, the fenestrations form clusters and were mainly located at the free edge of the leaflet in the commissural area (95.4%). Hearts with aortic valve fenestrations had significantly larger aortic valve diameters and aortic valve areas (p < 0.001). The average surface area sizes of fenestrations were 23.8 ± 16.6 mm2 , and the areas were largest for left followed by right and noncoronary leaflet fenestrations (p < 0.001). The fenestration areas positively correlated with donor age (r = 0.31; p = 0.02). Significant hypermobility and subjective weakening of the leaflet adhesion levels of the fenestrated regions were observed. In conclusion, fenestrations of the aortic leaflets are frequent, and their sizes may be significant. They occur in all age groups, yet their size increase with aging. Fragments of leaflets with fenestrations show different behaviors during the cardiac cycle versus unchanged areas.
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Affiliation(s)
- Damian Dudkiewicz
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jorge D Zhingre Sanchez
- Visible Heart® Laboratories, Departments of Biomedical Engineering and Surgery, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Kopacz
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paul A Iaizzo
- Visible Heart® Laboratories, Departments of Biomedical Engineering and Surgery, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, 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.,Department of Diagnostic Medicine, John Paul II Hospital, Kraków, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Małgorzata Konieczyńska
- Department of Diagnostic Medicine, John Paul II Hospital, Kraków, Poland.,Department of Thromboembolic Diseases, Jagiellonian University Medical College, Cracow, Poland
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Kuniewicz M, Krupiński M, Urbańczyk-Zawadzka M, Hołda MK, Defonseka R, Wadhwa T, Cholewa N, Matuszyk A, Walocha J, Dobrzynski H. Topographical anatomy of the left ventricular summit: implications for invasive procedures. Folia Morphol (Warsz) 2022; 82:291-299. [DOI: 10.5603/fm.a2022.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
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10
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Słodowska KM, Batko J, Hołda JP, Dudkiewicz D, Koziej M, Litwinowicz R, Bartuś K, Hołda MK. Morphometrical features of left atrial appendage in the atrial fibrillation patients subjected to left atrial appendage closure. Folia Morphol (Warsz) 2022; 82:814-821. [PMID: 36165901 DOI: 10.5603/fm.a2022.0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to evaluate the morphometrical features of left atrial appendage (LAA) in patients with atrial fibrillation, subjected to LAA percutaneous closure (LARIAT) for stroke prevention. MATERIALS AND METHODS Computed tomography (CT) scans of 51 patients with atrial fibrillation subjected to LARIAT procedure were comparatively evaluated with 50 patients with sinus rhythm (control group). Three-dimensional reconstructions were created using volume-rendering for evaluation. RESULTS No differences were found in LAA types of distribution (cauliflower: 25.5 vs. 34.0%, chicken wing: 45.1 vs. 46.0%, arrowhead: 29.4 vs. 20.0%, all p > 0.05) between groups. However, the study group was characterized by LAAs with a lower number of lobes. The LAA orifice anteroposterior and transverse diameters (19.3 ± 4.12 vs. 17.2 ± 4.0 mm, p = 0.01 and 25.1 ± 5.1 vs. 20.5 ± ± 4.4 mm, p = 0.001), orifice area (387.2 ± 133.9 vs. 327.1 ± 128.3 mm2, p = 0.02) and orifice perimeter (70.2 ± 12.5 vs. 61.2 ± 11.6 mm, p = 0.04) was significantly larger in atrial fibrillation patients. More oval LAA orifices was found in atrial fibrillation group (94.0 vs. 70.4%, p = 0.001). No statistically significant differences were found in LAA body length (47.4 ± 15.4 vs. 43.7 ± 10.9 mm, p = 0.17), body width (24.7 ± 5.6 vs. 24.4 ± 5.8 mm, p = 0.81), and chamber depth (17.7 ± 3.5 vs. 16.5 ± 3.8 mm, p = 0.11). Calculated LAA ejection fraction was significantly lower in study group compared to healthy patients (16.4 ± 14.9 vs. 48.2 ± 12.9%, p = 0.001). CONCLUSIONS Important morphometrical differences in LAA orifice have been found, which was significantly larger and more oval in patients with atrial fibrillation compared to healthy controls. Although no difference in LAA body type and size was observed; the LAA ejection fraction was significantly lower in atrial fibrillation rhythm patients.
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Affiliation(s)
- K M Słodowska
- Heart Embryology and Anatomy Research Team (HEART), Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - J Batko
- Heart Embryology and Anatomy Research Team (HEART), Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - J P Hołda
- Heart Embryology and Anatomy Research Team (HEART), Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - D Dudkiewicz
- Heart Embryology and Anatomy Research Team (HEART), Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - M Koziej
- Heart Embryology and Anatomy Research Team (HEART), Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - R Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - K Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - M K Hołda
- Heart Embryology and Anatomy Research Team (HEART), Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
- Division of Cardiovascular Sciences, The University of Manchester, United Kingdom.
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11
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Dudkiewicz D, Hołda MK. Interatrial septum as a possible source of thromboembolic events. Translational Research in Anatomy 2022. [DOI: 10.1016/j.tria.2022.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Batko JM, Krawczyk‐Ożóg A, Pękala J, Hołda MK. Morphometrical Description of the Left Ventricular Summit Vascular Triangle. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jakub M. Batko
- Departament of AnatomyJagiellonian University Medical CollegeKraków
| | - Agata Krawczyk‐Ożóg
- Departament of AnatomyJagiellonian University Medical CollegeKraków
- Department of Cardiology and Cardiovascular InterventionsUniversity Hospital, KrakówKraków
| | - Jakub Pękala
- Departament of AnatomyJagiellonian University Medical CollegeKraków
| | - Mateusz K. Hołda
- Departament of AnatomyJagiellonian University Medical CollegeKraków
- Division of Cardiovascular SciencesThe University of ManchesterManchester
- Department of DiagnosticsJohn Paul II HospitalKraków
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13
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Bugała K, Rubiś P, Hołda MK, Konieczyńska M, Bijak P, Płazak W. Mitral regurgitation severity dynamic during acute decompensated heart failure treatment. Int J Cardiovasc Imaging 2021; 38:10.1007/s10554-021-02495-7. [PMID: 34939153 DOI: 10.1007/s10554-021-02495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
Acute decompensated heart failure (ADHF) treatment leads to significant hemodynamic changes. The aim of our study was to quantitatively analyze the dynamics of mitral regurgitation (MR) severity (evaluated by transthoracic echocardiography) which occur during the treatment of ADHF and to correlate these changes with the clinical condition of patients as well as heart failure biochemical markers. The study included 27 consecutive adult patients (40.7% females, mean age 71.19 ± 11.2 years) who required hospitalization due to signs of acute HF. Echocardiographic assessment was performed upon admission and discharge together with clinical and laboratory evaluation. Significant reduction in dyspnea intensity [0-100 scale] (81.48 ± 9.07 vs. 45.00 ± 11.04 pts, p < 0.001), body weight (84.98 ± 18.52 vs. 79.77 ± 17.49 kg, p < 0.001), and NT-proBNP level (7520.56 ± 5288.62 vs. 4949.88 ± 3687.86 pg/ml, p = 0.001) was found. The severity of MR parameters decreased significantly (MR volume 44.92 ± 22.83 vs. 30.88 ± 18.77 ml, p < 0.001; EROA 0.37 ± 0.17 vs. 0.25 ± 0.16 cm2, p < 0.001; VC 6.21 ± 1.48 vs. 5.26 ± 1.61 mm, p < 0.001). Left atrial area (35.86 ± 9.11 vs. 32.47 ± 9.37, p < 0.001) and mitral annular diameter (42.33 ± 6.63 vs. 39.72 ± 5.05. p < 0.001) also underwent statistically significant reductions. An increase in LVEF was observed (34.73 ± 13.88 vs. 40.24 ± 13.19%, p < 0.001). In 40.7% of patients, a change in MR severity class (transition from a higher class to a lower one) was observed: 6/8 (75%) patients transitioned from severe to moderate and 6/18 (33.3%) patients transitioned from moderate to mild class. Treatment of ADHF leads to a significant reduction in MR severity, together with significant reductions in left atrial and mitral annular dimensions. Quantitative measurement of MR dynamics offer valuable assistance for ADHF management.
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Affiliation(s)
- Kamil Bugała
- Department of Diagnostics, John Paul II Hospital, Kraków, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital in Kraków, ul. Prądnicka 80, 31-202, Kraków, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Department of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | | | - Piotr Bijak
- Department of Diagnostics, John Paul II Hospital, Kraków, Poland
| | - Wojciech Płazak
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital in Kraków, ul. Prądnicka 80, 31-202, Kraków, Poland.
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14
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Hołda MK, Krawczyk-Ożóg A, Koziej M, Kołodziejczyk J, Sorysz D, Szczepanek E, Jędras J, Dudek D. Patent Foramen Ovale Channel Morphometric Characteristics Associated with Cryptogenic Stroke: The MorPFO Score. J Am Soc Echocardiogr 2021; 34:1285-1293.e3. [PMID: 34389468 DOI: 10.1016/j.echo.2021.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND It is still disputable whether the specific morphologic properties of patent foramen ovale (PFO) may contribute to the occurrence of stroke. The aim of this study was to evaluate the differences in the morphometric and functional features of the PFO channel in patients with cryptogenic stroke and those without stroke. METHODS PFO channel morphology in 106 consecutive patients with cryptogenic stroke and 93 control patients without stroke with diagnosed PFO (by transesophageal echocardiography) was analyzed using transesophageal echocardiography. A validation cohort was established that consisted of 31 patients with cryptogenic stroke and 30 without stroke. RESULTS Multivariable regression logistic analyses indicated PFO channel length change (odds ratio [OR], 2.50; 95% confidence interval [CI], 1.75-3.55; P < .001), PFO length/height ratio during the Valsalva maneuver (OR, 0.75; 95% CI, 0.60-0.95; P = .015), septum primum thickness (OR, 0.34; 95% CI, 0.14-0.80; P = .013), septum secundum height (OR, 0.91; 95% CI, 0.84-0.98; P = .013), the presence of an atrial septal aneurysm (OR, 3.38; 95% CI, 1.27-8.97; P = .014), and large shunt (OR, 2.49; 95% CI, 1.13-5.46; P = .022) as PFO-related stroke factors. The Morphologic Stroke Factors of PFO (MorPFO) score was developed, in which six factors were included: PFO channel length reduction (≥21%; 7 points), short septum secundum (<8.6 mm; 5 points), thin septum primum (<1.6 mm; 3 points), large right-to-left shunt (3 points), low PFO channel length/height ratio during the Valsalva maneuver (≤2.1; 2 points), and atrial septal aneurysm presence (1 point). Patients with scores of 0 to 7 points have low-risk PFO channels, those with scores of 8 to 11 points have intermediate-risk PFO channels, and those with scores of 12 to 21 points have high-risk PFO channels. External validation showed good MorPFO score performance (C index = 0.90). CONCLUSIONS Transesophageal echocardiography can be used to differentiate pathogenic from incidental PFO channels on the basis of their morphologic characteristics. The MorPFO score may help identify high-stroke-risk PFO channels.
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Affiliation(s)
- Mateusz K Hołda
- Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
| | - Agata Krawczyk-Ożóg
- Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland; Department of Interventional Cardiology, University Hospital, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Kołodziejczyk
- Department of Computer Science and Information Technology, West Pomeranian University of Technology, Szczecin, Poland
| | - Danuta Sorysz
- Department of Interventional Cardiology, University Hospital, Jagiellonian University Medical College, Cracow, Poland
| | - Elżbieta Szczepanek
- Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Justyna Jędras
- Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology, University Hospital, Jagiellonian University Medical College, Cracow, Poland
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15
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Solewski B, Lis M, Pękala JR, Brzegowy K, Lauritzen SS, Hołda MK, Walocha JA, Tomaszewski KA, Pękala PA, Koziej M. The persistent median artery and its vascular patterns: A meta-analysis of 10,394 subjects. Clin Anat 2021; 34:1173-1185. [PMID: 34371525 DOI: 10.1002/ca.23770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/17/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022]
Abstract
The presence of a persistent median artery (PMA) has been implicated in the development of compression neuropathies and surgical complications. Due to the large variability in the prevalence of the PMA and its subtypes in the literature, more awareness of its anatomy is needed. The aim of our meta-analysis was to find the pooled prevalence of the antebrachial and palmar persistent median arteries. An extensive search through the major databases was performed to identify all articles and references matching our inclusion criteria. The extracted data included methods of investigation, prevalence of the PMA, anatomical subtype (antebrachial, palmar), side, sex, laterality, and ethnicity. A total of 64 studies (n = 10,394 hands) were included in this meta-analysis. An antebrachial pattern was revealed to be more prevalent than a palmar pattern (34.0% vs. 8.6%). A palmar PMA was reported in 2.6% of patients undergoing surgery for carpal tunnel syndrome when compared to cadaveric studies of adult patients in which the prevalence was 8.6%. Both patterns of PMA are prevalent in a considerable portion of the general population. As the estimated prevalence of the PMA was found to be significantly lower in patients undergoing surgery for carpal tunnel syndrome than those reported in cadaveric studies, its etiological contribution to carpal tunnel syndrome is questionable. Surgeons operating on the forearm and carpal tunnel should understand the anatomy and surgical implications of the PMA and its anatomical patterns.
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Affiliation(s)
- Bernard Solewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Lis
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Brzegowy
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Sigurd S Lauritzen
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz K Hołda
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Orthopaedics, Scanmed St. Raphael Hospital, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Mateusz Koziej
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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16
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Słodowska K, Hołda J, Dudkiewicz D, Malinowska K, Bolechała F, Kopacz P, Koziej M, Hołda MK. Thickness of the left atrial wall surrounding the left atrial appendage orifice. J Cardiovasc Electrophysiol 2021; 32:2262-2268. [PMID: 34245483 DOI: 10.1111/jce.15157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the thickness of the left atrial wall surrounding the left atrial appendage (LAA) orifice. METHODS AND RESULTS The tissue thickness around the LAA orifice was measured at four points (superior, inferior, anterior, and posterior) in 200 randomly selected autopsied human hearts. The thickest tissue was observed at the anterior point (3.17 ± 1.41 mm), followed by the superior (2.47 ± 1.00 mm), inferior (2.22 ± 0.80 mm) and posterior (2.22 ± 0.83 mm). The chicken wing LAA type was associated with the lowest thickness at the superior point compared to the cauliflower and arrowhead shapes (p = .024). In hearts with an oval LAA orifice, the atrial wall was significantly thicker in all points than in specimens with a round LAA orifice (p > .05). Both the LAA orifice anteroposterior diameter and orifice surface area were negatively correlated with the tissue thickness in the anterior (r = -.22, p = .004 and r = -.23, p = .001) and posterior points (r = -.24, p = .001 and r = -.28, p = .005). Endocardial surface roughness was commonly in the inferior pole of the LAA orifice (75.5% of cases), while they are much less prevalent in other sectors around the orifice (anterior: 17.5%), superior: 4.0%, and posterior: 1.5%). CONCLUSIONS Although a significant heterogeneity in the atrial wall thickness around the LAA orifice was observed, the thickness in the respective points is quite conservative and depends only on LAA orifice size and shape, as well as LAA body shape. Thin atrial wall and endocardial surface roughness might challenge invasive procedures within this region.
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Affiliation(s)
- Katarzyna Słodowska
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jakub Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Damian Dudkiewicz
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Karolina Malinowska
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Filip Bolechała
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Kopacz
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Mateusz K Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Jastrzębski M, Moskal P, Hołda MK, Strona M, Bednarek A, Kiełbasa G, Czarnecka D. Deep septal deployment of a thin, lumenless pacing lead: a translational cadaver simulation study. Europace 2021; 22:156-161. [PMID: 31722391 DOI: 10.1093/europace/euz270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The recently introduced technique of direct transseptal pacing of the left bundle branch is poorly characterized with many questions with regard to the optimal implantation strategy and safety concerns largely left unanswered. We developed a cadaver model for deep septal lead deployment in order to investigate the depth of penetration in relation to lead behaviour, lead tip position, and the number of rotations. METHODS AND RESULTS Five fresh human hearts and five lumenless, 4.1-Fr pacing leads were used for deep septal deployment simulations. The leads were positioned with the use of a dedicated delivery sheath and screwed into the interventricular septum at several sites progressively more distal from the atrioventricular ring with a predetermined number of lead rotations. During each lead deployment, the depth of tip penetration was measured and the lead behaviour was noted. Four distinct lead behaviours were observed: (i) helix only penetration, no matter how many rotations were performed, due to the 'endocardial entanglement effect' (43.1% cases) or (ii) 'endocardial barrier effect' (19.6% cases), (iii) shallow/moderate penetration, with ensuing 'drill effect' when more rotations were added (9.8% cases), and (iv) deep progressive penetration with each additional rotation, occurring when the 'screwdriver effect' was present (27.4% cases, including three septal perforations). These different lead behaviours seemed to be determined by the lead position-mainly the strength of the initial endocardial layer-and the number of fully transmitted rotations. CONCLUSION New insights into deep septal lead deployment technique were gained with regard to safe and successful implantation.
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Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland
| | - Paweł Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland
| | - Mateusz K Hołda
- Department of Anatomy, HEART-Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Bednarek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland
| | - Danuta Czarnecka
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland
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Dudkiewicz D, Słodowska K, Jasińska KA, Dobrzynski H, Hołda MK. The clinical anatomy of the left atrial structures used as landmarks in ablation of arrhythmogenic substrates and cardiac invasive procedures. Translational Research in Anatomy 2021. [DOI: 10.1016/j.tria.2020.100102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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20
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Hołda J, Słodowska K, Malinowska K, Strona M, Mazur M, Jasińska KA, Matuszyk A, Koziej M, Walocha JA, Hołda MK. Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures. Diagnostics (Basel) 2021; 11:960. [PMID: 34073631 PMCID: PMC8227200 DOI: 10.3390/diagnostics11060960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
The right atrioventricular valve (RAV) is an important anatomical structure that prevents blood backflow from the right ventricle to the right atrium. The complex anatomy of the RAV has lowered the success rate of surgical and transcatheter procedures performed within the area. The aim of this study was to describe the morphology of the RAV and determine its spatial position in relation to selected structures of the right atrium. We examined 200 randomly selected human adult hearts. All leaflets and commissures were identified and measured. The position of the RAV was defined. Notably, 3-leaflet configurations were present in 67.0% of cases, whereas 4-leaflet configurations were present in 33.0%. Septal and mural leaflets were both significantly shorter and higher in 4-leaflet than in 3-leaflet RAVs. Significant domination of the muro-septal commissure in 3-leflet valves was noted. The supero-septal commissure was the most stable point within RAV circumference. In 3-leaflet valves, the muro-septal commissure was placed within the cavo-tricuspid isthmus area in 52.2% of cases, followed by the right atrial appendage vestibule region (20.9%). In 4-leaflet RAVs, the infero-septal commissure was located predominantly in the cavo-tricuspid isthmus area and infero-mural commissure was always located within the right atrial appendage vestibule region. The RAV is a highly variable structure. The supero-septal part of the RAV is the least variable component, whereas the infero-mural is the most variable. The number of detected RAV leaflets significantly influences the relative position of individual valve components in relation to right atrial structures.
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Affiliation(s)
- Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Katarzyna Słodowska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Karolina Malinowska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, 31-007 Cracow, Poland;
| | - Małgorzata Mazur
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Aleksandra Matuszyk
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Jerzy A. Walocha
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
- Department of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL, UK
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Słodowska K, Szczepanek E, Dudkiewicz D, Hołda J, Bolechała F, Strona M, Lis M, Batko J, Koziej M, Hołda MK. Morphology of the Left Atrial Appendage: Introduction of a New Simplified Shape-Based Classification System. Heart Lung Circ 2021; 30:1014-1022. [PMID: 33582020 DOI: 10.1016/j.hlc.2020.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The left atrial appendage (LAA) is a heart structure with known prothrombogenic and pro-arrhythmogenic properties. AIM The aim of this study was to evaluate the specific anatomy of the LAA and to create a simple classification system based on the shape of its body. METHOD AND RESULTS This study investigated 200 randomly selected autopsied human hearts (25.0% females, 46.6±19.1 years old). Three (3) types of LAAs were distinguished: the cauliflower type (no bend, limited overall length, compact structure [36.5%]); the chicken wing type (substantial bend in the dominant lobe [37.5%]), and the arrowhead type (no bend, one dominant lobe of substantial length [26.0%]). Additional accessory lobes were present in 55.5% of all LAAs. Significant variations between category types were noted in LAA length (chicken wing: 35.7±9.8 mm, arrowhead: 30.8±10.1 mm, cauliflower: 22.3±9.6 mm [p<0.001]) and in the thickness of pectinate muscles located within the LAA apex (arrowhead: 1.2±0.7 mm; cauliflower: 1.1±0.6 mm; chicken wing: 0.9±0.6 mm [p<0.001]). Left atrial appendage volume and orifice size were not affected by the type of LAA shape. The age of the donor was positively correlated with LAA volume (r=0.29, p=0.005), body length (r=0.26, p=0.012), and area of the orifice (r=0.36, p<0.001). Donors with an oval LAA orifice were significantly older than those with round orifices (50.2±16.6 vs 43.7±20.4 years [p=0.014]) and had significantly heavier hearts (458.2±104.8 vs 409.6±114.1g [p=0.002]). CONCLUSIONS This study delivered a new simple classification system of the LAA based on its body shape. An increase in age and heart weight was associated with LAA enlargement and a more oval-shaped orifice. Results of current study may help to estimate the different thrombogenic properties associated with each LAA type and be an assistance during planning and performing interventions on LAA.
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Affiliation(s)
- Katarzyna Słodowska
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Elżbieta Szczepanek
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Damian Dudkiewicz
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Lis
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Batko
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, 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.
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Hołda J, Słodowska K, Tyrak K, Bolechała F, Jasińska KA, Koziej M, Hołda MK, Walocha JA. Topographical anatomy of the right atrial appendage vestibule and its isthmuses. J Cardiovasc Electrophysiol 2020; 31:3199-3206. [PMID: 33010077 DOI: 10.1111/jce.14767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures. METHODS AND RESULTS We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001). CONCLUSIONS This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.
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Affiliation(s)
- Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Słodowska
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Kamil Tyrak
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- 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
| | - Mateusz Koziej
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, 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.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland.,Department of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Jerzy A Walocha
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Hołda MK, Stachowicz A, Suski M, Wojtysiak D, Sowińska N, Arent Z, Palka N, Podolec P, Kopeć G. Myocardial proteomic profile in pulmonary arterial hypertension. Sci Rep 2020; 10:14351. [PMID: 32873862 PMCID: PMC7462861 DOI: 10.1038/s41598-020-71264-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/31/2020] [Indexed: 01/04/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, fatal, and incurable disorder. Although advances in the understanding of the PAH pathobiology have been seen in recent years, molecular processes underlying heart remodelling over the course of PAH are still insufficiently understood. Therefore, the aim of this study was to investigate myocardial proteomic profile of rats at different stages of monocrotaline-induced PAH. Samples of left and right ventricle (LV and RV) free wall collected from 32 Wistar rats were subjected to proteomic analysis using an isobaric tag for relative quantitation method. Hemodynamic parameters indicated development of mild elevation of pulmonary artery pressure in the early PAH group (27.00 ± 4.93 mmHg) and severe elevation in the end-stage PAH group (50.50 ± 11.56 mmHg). In early PAH LV myocardium proteins that may be linked to an increase in inflammatory response, apoptosis, glycolytic process and decrease in myocardial structural proteins were differentially expressed compared to controls. During end-stage PAH an increase in proteins associated with apoptosis, fibrosis and cardiomyocyte Ca2+ currents as well as decrease in myocardial structural proteins were observed in LV. In RV during early PAH, especially proteins associated with myocardial structural components and fatty acid beta-oxidation pathway were upregulated. During end-stage PAH significant changes in RV proteins abundance related to the increased myocardial structural components, intensified fibrosis and glycolytic processes as well as decreased proteins related to cardiomyocyte Ca2+ currents were observed. At both PAH stages changes in RV proteins linked to apoptosis inhibition were observed. In conclusion, we identified changes of the levels of several proteins and thus of the metabolic pathways linked to the early and late remodelling of the left and right ventricle over the course of monocrotaline-induced PAH to delineate potential therapeutic targets for the treatment of this severe disease.
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Affiliation(s)
- Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Kraków, Poland. .,Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland. .,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
| | - Aneta Stachowicz
- Department of Pharmacology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Suski
- Department of Pharmacology, Jagiellonian University Medical College, Kraków, Poland
| | - Dorota Wojtysiak
- Department of Animal Genetics, Breeding and Ethology, University of Agriculture in Cracow, Kraków, Poland
| | - Natalia Sowińska
- Center of Experimental and Innovative Medicine, University Center of Veterinary Medicine JU-AU, University of Agriculture in Cracow, Kraków, Poland
| | - Zbigniew Arent
- Center of Experimental and Innovative Medicine, University Center of Veterinary Medicine JU-AU, University of Agriculture in Cracow, Kraków, Poland
| | - Natalia Palka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
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Lis GJ, Dubrowski A, Lis M, Solewski B, Witkowska K, Aleksandrovych V, Jasek-Gajda E, Hołda MK, Gil K, Litwin JA. Identification of CD34+/PGDFRα+ Valve Interstitial Cells (VICs) in Human Aortic Valves: Association of Their Abundance, Morphology and Spatial Organization with Early Calcific Remodeling. Int J Mol Sci 2020; 21:ijms21176330. [PMID: 32878299 PMCID: PMC7503258 DOI: 10.3390/ijms21176330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022] Open
Abstract
Aortic valve interstitial cells (VICs) constitute a heterogeneous population involved in the maintenance of unique valvular architecture, ensuring proper hemodynamic function but also engaged in valve degeneration. Recently, cells similar to telocytes/interstitial Cajal-like cells described in various organs were found in heart valves. The aim of this study was to examine the density, distribution, and spatial organization of a VIC subset co-expressing CD34 and PDGFRα in normal aortic valves and to investigate if these cells are associated with the occurrence of early signs of valve calcific remodeling. We examined 28 human aortic valves obtained upon autopsy. General valve morphology and the early signs of degeneration were assessed histochemically. The studied VICs were identified by immunofluorescence (CD34, PDGFRα, vimentin), and their number in standardized parts and layers of the valves was evaluated. In order to show the complex three-dimensional structure of CD34+/PDGFRα+ VICs, whole-mount specimens were imaged by confocal microscopy, and subsequently rendered using the Imaris (Bitplane AG, Zürich, Switzerland) software. CD34+/PDGFRα+ VICs were found in all examined valves, showing significant differences in the number, distribution within valve tissue, spatial organization, and morphology (spherical/oval without projections; numerous short projections; long, branching, occasionally moniliform projections). Such a complex morphology was associated with the younger age of the subjects, and these VICs were more frequent in the spongiosa layer of the valve. Both the number and percentage of CD34+/PDGFRα+ VICs were inversely correlated with the age of the subjects. Valves with histochemical signs of early calcification contained a lower number of CD34+/PDGFRα+ cells. They were less numerous in proximal parts of the cusps, i.e., areas prone to calcification. The results suggest that normal aortic valves contain a subpopulation of CD34+/PDGFRα+ VICs, which might be involved in the maintenance of local microenvironment resisting to pathologic remodeling. Their reduced number in older age could limit the self-regenerative properties of the valve stroma.
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Affiliation(s)
- Grzegorz J. Lis
- Department of Histology, Jagiellonian University Medical College, 31-034 Kraków, Poland; (E.J.-G.); (J.A.L.)
- Correspondence:
| | - Andrzej Dubrowski
- Department of Anatomy, Jagiellonian University Medical College, 31-034 Kraków, Poland; (A.D.); (M.K.H.)
| | - Maciej Lis
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland; (M.L.); (B.S.); (K.W.)
- HEART—Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, 31-034 Kraków, Poland
| | - Bernard Solewski
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland; (M.L.); (B.S.); (K.W.)
| | - Karolina Witkowska
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland; (M.L.); (B.S.); (K.W.)
| | - Veronika Aleksandrovych
- Department of Pathophysiology, Jagiellonian University Medical College, 31-121 Kraków, Poland; (V.A.); (K.G.)
| | - Ewa Jasek-Gajda
- Department of Histology, Jagiellonian University Medical College, 31-034 Kraków, Poland; (E.J.-G.); (J.A.L.)
| | - Mateusz K. Hołda
- Department of Anatomy, Jagiellonian University Medical College, 31-034 Kraków, Poland; (A.D.); (M.K.H.)
- HEART—Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, 31-034 Kraków, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, 31-121 Kraków, Poland; (V.A.); (K.G.)
| | - Jan A. Litwin
- Department of Histology, Jagiellonian University Medical College, 31-034 Kraków, Poland; (E.J.-G.); (J.A.L.)
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Szczepanek E, Bolechała F, Koziej M, Jasińska KA, Hołda MK. Morphometric characteristics of myocardial sleeves of the pulmonary veins. J Cardiovasc Electrophysiol 2020; 31:2455-2461. [PMID: 32621361 DOI: 10.1111/jce.14651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The pulmonary veins are covered by a myocardial layer, which is often an electrical substrate for atrial fibrillation. The aim of this study was to study the morphologic characteristics of the myocardial sleeves of pulmonary veins by examining a large group of freshly autopsied human material. METHODS AND RESULTS The study macroscopically examined a total of 498 pulmonary veins draining the left atrium (120 unpreserved human hearts). In 75.0% of specimens, a classical pulmonary venous pattern was observed. The remainder of specimens either had an additional middle right pulmonary vein (20.0% of cases) or a common left pulmonary vein (5.0% of cases). Among all the veins seen in the classical pulmonary venous drainage type, the left superior pulmonary vein had the longest myocardial sleeves (9.4 ± 4.6 mm; coverage = 60.1 ± 19.4%), followed by the left inferior pulmonary vein (6.6 ± 3.5 mm; coverage = 47.6 ± 18.3%), the right superior pulmonary vein (6.0 ± 2.7 mm; coverage = 50.5 ± 13.9%) and then the right inferior pulmonary vein (5.0 ± 2.8 mm; coverage = 45.6 ± 16.2%; analysis of variance p < .001). In hearts with an additional right pulmonary vein, this vessel had the shortest myocardial sleeves (2.7 ± 1.1 mm; coverage = 36.0 ± 11.6%). In hearts with a common left pulmonary vein, the myocardial sleeves had the longest course for the common vein (13.7 ± 4.4 mm; coverage = 79.7 ± 4.9%). CONCLUSIONS Myocardial sleeves of the pulmonary veins were seen in each examined specimen, however, their length varied significantly. In hearts with a classical venous drainage pattern, the left superior pulmonary vein had the longest sleeves. When present, an additional middle right pulmonary vein had the shortest myocardial sleeves, while the left common pulmonary vein had the longest sleeves.
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Affiliation(s)
- Elżbieta Szczepanek
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, 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
| | - 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
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Hołda MK, Szczepanek E, Bielawska J, Palka N, Wojtysiak D, Frączek P, Nowakowski M, Sowińska N, Arent Z, Podolec P, Kopeć G. Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model. J Transl Med 2020; 18:262. [PMID: 32605656 PMCID: PMC7325143 DOI: 10.1186/s12967-020-02440-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background Aim of this study was to assess changes in cardiac morphometric parameters at different stages of pulmonary arterial hypertension (PAH) using a monocrotaline-induced rat model. Methods Four groups were distinguished: I–control, non-PAH (n = 18); II–early PAH (n = 12); III–end-stage PAH (n = 23); and IV–end-stage PAH with myocarditis (n = 7). Results Performed over the course of PAH in vivo echocardiography showed significant thickening of the right ventricle free wall (end-diastolic dimension), tricuspid annular plane systolic excursion reduction and decrease in pulmonary artery acceleration time normalized to cycle length. No differences in end-diastolic left ventricle free wall thickness measured in echocardiography was observed between groups. Significant increase of right ventricle and decrease of left ventricle systolic pressure was observed over the development of PAH. Thickening and weight increase (241.2% increase) of the right ventricle free wall and significant dilatation of the right ventricle was observed over the course of PAH (p < 0.001). Reduction in the left ventricle free wall thickness was also observed in end-stage PAH (p < 0.001). Significant trend in the left ventricle free wall weight decrease was observed over the course of PAH (p < 0.001, 24.3% reduction). Calculated right/left ventricle free wall weight ratio gradually increased over PAH stages (p < 0.001). The reduction of left ventricle diameter was observed in rats with end-stage PAH both with and without myocarditis (p < 0.001). Conclusions PAH leads to multidimensional changes in morphometric cardiac parameters. Right ventricle morphological and functional failure develop gradually from early stage of PAH, while left ventricle changes develop at the end stages of PAH.
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Affiliation(s)
- Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Kraków, Poland. .,Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland. .,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
| | - Elżbieta Szczepanek
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Kraków, Poland
| | | | - Natalia Palka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Dorota Wojtysiak
- Department of Animal Genetics, Breeding and Ethology, University of Agriculture in Cracow, Kraków, Poland
| | - Paulina Frączek
- Department of Clinical Oncology, University Hospital, Kraków, Poland
| | - Michał Nowakowski
- Center of Experimental and Innovative Medicine, University Center of Veterinary Medicine JU-AU, University of Agriculture in Cracow, Kraków, Poland
| | - Natalia Sowińska
- Center of Experimental and Innovative Medicine, University Center of Veterinary Medicine JU-AU, University of Agriculture in Cracow, Kraków, Poland
| | - Zbigniew Arent
- Center of Experimental and Innovative Medicine, University Center of Veterinary Medicine JU-AU, University of Agriculture in Cracow, Kraków, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
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Żabówka A, Jakiel M, Bolechała F, Jakiel R, Jasińska KA, Hołda MK. Topography of the oblique vein of the left atrium (vein of Marshall). Kardiol Pol 2020; 78:688-693. [PMID: 32347083 DOI: 10.33963/kp.15318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The oblique vein of the left atrium is of interest for electrophysiologists working in the field of both basic science and clinical practice. AIMS We aimed to examine the topographic anatomy of the oblique vein and to assess the vein's location and relationships with surrounding cardiac structures. METHODS A total of 200 autopsied adult human hearts were examined. RESULTS The oblique vein was observed in 71% of the hearts. Its mean (SD) total length was 30.8 (13.6) mm. In hearts with the oblique vein, a larger distance was observed between the left inferior pulmonary vein (LIPV) and great cardiac vein (mean [SD], 18.6 [5.1] mm vs 16.3 [4.8] mm; P = 0.004), between the left atrial appendage (LAA) and LIPV (mean [SD], 17.8 [6.8] mm vs 15.1 [5.2] mm; P = 0.007), and between the LAA and left superior pulmonary vein (LSPV; mean [SD], 28.5 [7.2] mm vs 21.3 [6.4] mm; P <0.001). Hearts with a classic pattern of left‑sided pulmonary veins were categorized into 4 types based on the length of oblique vein extension. In type I, the vein extended below the level of the LIPV (21.9%); in type II, to the level of the LIPV (47.7%); in type III, to the level of the interpulmonary area (17.2%); and in type IV, to the level of the LSPV (13.3%). In each type, the distance between the oblique vein and LIPV was shorter than that between the oblique vein and LAA Conclusions: The oblique vein had a variable course and differing lengths of extension. The presence of the oblique vein was connected with a greater distance between the left‑sided pulmonary veins and LAA.
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Affiliation(s)
- Anna Żabówka
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Jakiel
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Rafał Jakiel
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna A Jasińska
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz K Hołda
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Division of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom.
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Hołda MK, Koziej M. Morphometric Features of Patent Foramen Ovale as a Risk Factor of Cerebrovascular Accidents: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2020; 49:1-9. [PMID: 32097931 DOI: 10.1159/000506433] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION It is still disputable whether specific morphometric features of the patent foramen ovale (PFO) may stratify patients by the related probability that a discovered PFO is incidental or stroke related. OBJECTIVE We aimed to determine whether certain morphometrical characteristics of PFO are associated with an increased risk of cerebrovascular accidents, using a meta-analytical approach. METHODS We performed a systematic review of electronic databases for studies that compared morphometric parameters of PFO assessed by transesophageal echocardiography (TEE) in subjects with cryptogenic cerebrovascular accidents (Group 1) and control (Group 2). Data were extracted and pooled into a meta-analysis. RESULTS A total of 895 patients with PFO were reported (Group 1: 493, Group 2: 402). No difference was found in the PFO channel length (Group 1: 10.8 [8.6-12.9] mm vs. Group 2: 10.4 [9.1-11.7] mm), as well as in PFO height measured at rest (Group 1: 2.4 [1.5-3.3] mm vs. Group 2: 1.8 [1.4-2.2] mm). The PFO height measured during a Valsalva maneuver was larger in Group 1 (3.5 [2.8-4.1] mm) than in Group 2 (1.7 [1.2-2.2] mm). Also, the septal excursion distance was found to be larger in Group 1 (6.4 [5.1-7.8] mm) than in Group 2 (3.1 [1.8-4.4] mm). The risk of cerebrovascular accident was higher in patients with PFO and concomitant septal aneurysm (OR 4.00; 95% CI 2.63-6.09; p < 0.001) and with large right-to-left shunt PFO (OR 3.81; 95% CI 2.21-6.55; p < 0.001), no such relationship was found for the presence of a Eustachian valve or Chiari's network (OR 1.90; 95% CI 0.90-4.05; p = 0.094). CONCLUSIONS The TEE may help in identifying PFO that are of high risk of cerebrovascular accident. Greater PFO height during a Valsalva maneuver, larger septal excursion distance, concomitant atrial septal aneurysm, and large right-to-left shunt are associated with stroke-related PFOs.
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Affiliation(s)
- Mateusz K Hołda
- Department of Anatomy, HEART, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland, .,Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA,
| | - Mateusz Koziej
- Department of Anatomy, HEART, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland
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Samitowski Z, Mędrzycki M, Hołda MK, Kędziora A. Successful closure of a symptomatic left circumflex coronary artery to coronary sinus fistula. Kardiol Pol 2019; 77:1204-1205. [PMID: 31808422 DOI: 10.33963/kp.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Zbigniew Samitowski
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Michał Mędrzycki
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Mateusz K Hołda
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Kędziora
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland.
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Hołda MK, Zhingre Sanchez JD, Bateman MG, Iaizzo PA. Right Atrioventricular Valve Leaflet Morphology Redefined: Implications for Transcatheter Repair Procedures. JACC Cardiovasc Interv 2019; 12:169-178. [PMID: 30678795 DOI: 10.1016/j.jcin.2018.09.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The authors aimed to comprehensively detail the right atrioventricular valve functional leaflet anatomies. BACKGROUND The rapid development of both surgical and percutaneous repair techniques for tricuspid regurgitation has renewed interest in variations in the morphology of the right atrioventricular valve. METHODS The functioning right atrioventricular valves of 40 reanimated human hearts were imaged using Visible Heart methodologies. Hearts were then perfusion-fixed and dissected, uniquely allowing for the comparative assessments of functional versus fixed valve anatomies from the same set of donor hearts. RESULTS The right atrioventricular valves have "3-leaflet" configurations in 57.5% and "4-leaflet" configurations in the remaining hearts. For 4-leaflet valves, extra leaflets were commonly observed in the most inferior regions of the annuli. No difference in valve perimeters between 2 valve types were observed (112.2 vs. 117.1 mm; p = 0.14). In 3-leaflet valves, septal, mural, and superior leaflets occupied 32.2 ± 6.5%, 15.9 ± 5.5%, and 25.5 ± 6.2% of the annulus, respectively, whereas in the 4-leaflet arrangements, these values were 27.0 ± 5.8% (septal), 12.0 ± 4.5% (inferior), 13.7 ± 9.4% (mural), and 19.8 ± 6.1% (superior). The muroseptal/inferoseptal commissures were usually located in the cavotricuspid regions, whereas the inferomural and superomural commissures were in the right atrial appendage vestibule area. CONCLUSIONS The right atrioventricular valve has 4 functional leaflets in more than 40% of cases. The authors found that the inferomural region is the most variable area of the valve and believe that anatomic variation is an important consideration for planned interventions.
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Affiliation(s)
- Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University, Kraków, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University, Kraków, Poland.
| | - Jorge D Zhingre Sanchez
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michael G Bateman
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Iaizzo
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
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Piątek‐Koziej K, Hołda J, Tyrak K, Bolechała F, Strona M, Koziej M, Lis M, Jasińska KA, Hołda MK. Anatomy of the left atrial ridge (coumadin ridge) and possible clinical implications for cardiovascular imaging and invasive procedures. J Cardiovasc Electrophysiol 2019; 31:220-226. [DOI: 10.1111/jce.14307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/15/2019] [Accepted: 11/30/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Katarzyna Piątek‐Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Kamil Tyrak
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Filip Bolechała
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Marcin Strona
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Maciej Lis
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
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Majorczyk M, Staszkiewicz M, Szklarczyk J, Major P, Pisarska M, Wysocki M, Stefura T, Kacprzyk A, Droś J, Hołda MK, Pędziwiatr M, Budzyński A, Jaworek J. The influence of bariatric surgery on serum levels of irisin and nesfatin-1. Acta Chir Belg 2019; 119:363-369. [PMID: 30388390 DOI: 10.1080/00015458.2018.1534393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Bariatric surgery is associated with multiple endocrine and metabolic changes. Irisin and nesfatin-1 have recently been described as regulatory peptides involved in obesity-related insulin resistance. Our aim was to analyze the changes of those two molecules observed in patients after bariatric procedures. Materials and methods: This prospective study involved 40 patients treated for morbid obesity. Irisin and nesfatin-1 were measured before, 6 months and 1 year after surgical intervention. We also gathered demographic data, information concerning comorbidities, factors related to the surgery and outcomes of bariatric treatment. Results: Twenty-seven patients completed the study (15 females). The mean age of the group was 43.5 ± 10.4 years. Six (22.2%) patients were submitted to Laparoscopic Sleeve Gastrectomy and 21 (77.8%) patients were submitted to Laparoscopic Roux-en-Y Gastric Bypass. The participants in our study achieved significant weight loss. The irisin level remained stable in the whole study group during all three measurements included in our study protocol (p = .71). Our study group presented a reduction of the nesfatin-1 level 6 months after bariatric surgery and a slight further decrease after one-year observation, although these changes were also not significant (p = .17). Conclusions: We did not find any significant correlation between changes of irisin or nesfatin-1 level and bariatric surgery, as an aid in the regulation of glucose metabolism.
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Affiliation(s)
- Marta Majorczyk
- Department of Medical Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - Magdalena Staszkiewicz
- Department of Medical Physiology, Jagiellonian University Medical College, Cracow, Poland
- Department Clinical Nursing, Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Szklarczyk
- Department of Medical Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Tomasz Stefura
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Artur Kacprzyk
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Droś
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K. Hołda
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Jolanta Jaworek
- Department of Medical Physiology, Jagiellonian University Medical College, Cracow, Poland
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Piątek-Koziej K, Hołda J, Bolechała F, Kopacz P, Koziej M, Chłosta M, Tyrak K, Jasińska KA, Hołda MK. Topographic characteristics of the left atrial medial isthmus. Pacing Clin Electrophysiol 2019; 42:1579-1585. [PMID: 31691995 DOI: 10.1111/pace.13834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/22/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to provide detailed topography of the left atrial medial isthmus (situated between the right inferior pulmonary vein ostium and the medial part of the mitral annulus). METHODS Two hundred human hearts (Caucasian, 22.5% females, 48.7 ± 4.9 years old) were investigated. RESULTS The mean length of the medial isthmus was 42.4 ± 8.6 mm. Additionally, the medial isthmus line was divided by the oval fossa into three sections with equal mean lengths (upper: 14.2 ± 7.2 vs middle: 14.1 ± 6.1 vs lower: 14.9 ± 4.6 mm; P > .05). The left upper section of the atrial wall was thinner than the lower section (2.5 ± 1.1 vs 3.4 ± 1.6 mm; P < .0001). This study noted three separate spatial arrangements of the isthmus line. Type I (54.5%) had an oval fossa located outside the isthmus line; type II (32.5%) had an oval fossa crossed by the isthmus line, and type III (13.0%) had an oval fossa rim located tangentially to the isthmus line. In 68.5% of the examined specimens, the isthmus area had a smooth surface. Conversely, the remaining 31.5% had additional structures within its borders such as diverticula, recesses, and tissue bridges. CONCLUSION This study is the first to describe the morphometric and topographical features of the left atrial medial isthmus. Interventions within the medial isthmus line should be performed cautiously, especially when they are transected by the oval fossa (32.5%). Careful navigation of the area is also recommended due to the possibility of existent additional structures. The latter could lead to catheter entrapment during ablation procedures.
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Affiliation(s)
- Katarzyna Piątek-Koziej
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Kopacz
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Chłosta
- Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Czech Republic
| | - Kamil Tyrak
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, 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
| | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Kacprzyk A, DroŚ J, Stefura T, Krzysztofik M, JasiŃska K, PĘdziwiatr M, Major P, K Hołda M. Variations and morphometric features of the vermiform appendix: A systematic review and meta-analysis of 114,080 subjects with clinical implications. Clin Anat 2019; 33:85-98. [PMID: 31576604 DOI: 10.1002/ca.23474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/14/2019] [Accepted: 09/14/2019] [Indexed: 12/16/2022]
Abstract
Determining the true and indisputable data regarding the vermiform appendix (VA) morphology is of a great clinical interest. The aim of this study was to provide the best evidence-based anatomical overview of the variations in location and size of VA using a systematic and meta-analytical approach. A systematic review with meta-analysis was performed of studies reporting variants of the location and morphometric data regarding the VA. The MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science databases were thoroughly searched throughout June 2018. The reported locations of the body of the VA were re-classified into a new, standardized classification system divided into nine categories. The AQUA tool was used to assess the quality of included studies. The research was conducted following PRISMA guidelines and registered at PROPSERO database. Our meta-analysis included 242 studies (n = 114,080). Overall, the VA was most commonly found in the retrocecal location (32.1%, 95%CI: 29.2-35.1), followed by the pelvic (28.5%, 95%CI: 26.7-30.4) and ileal (14.5%, 95%CI: 11.8-17.7) locations. Subjects without known appendiceal pathologies had significantly smaller VA outer diameters (5.84 mm, 95%CI: 5.68-5.99) than patients diagnosed with acute appendicitis (10.64 mm, 95%CI: 10.14-11.15). The overall pooled mean length of the VA was 80.29 mm (95%CI: 76.68-83.89). Significant differences were found in size of the VA between imaging modalities. The results obtained from this evidence-based anatomy study will improve the clinical understanding of the VA anatomy, which in turn will have major implications for clinical practice. Clin. Anat. 32:85-98, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Jakub DroŚ
- Jagiellonian University Medical College, Cracow, Poland
| | | | | | - Katarzyna JasiŃska
- School of Medicine in English, Jagiellonian University Medical College, Cracow, Poland
| | - Michał PĘdziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Mateusz K Hołda
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Brzeziński M, Sejda A, Pęksa R, Pawlak M, Bury K, Adamiak Z, Kowalik M, Jagielak D, Bartus K, Hołda MK, Litwinowicz R, Rogowski J. Evaluation of Local Tissue Reaction After the Application of a 3D Printed Novel Holdfast Device for Left Atrial Appendage Exclusion. Ann Biomed Eng 2019; 48:133-143. [PMID: 31309369 PMCID: PMC6928093 DOI: 10.1007/s10439-019-02320-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/04/2019] [Indexed: 12/16/2022]
Abstract
The left atrial appendage (LAA) is a small, finger-like extension of the left atrium and its exclusion is used as a treatment strategy to prevent ischemic stroke. Existing holdfast devices may damage the tissue, are unisized and not adjustable. A novel holdfast device for LAA exclusion devoid of these shortcomings was designed and 3D-printed using the Selective Laser Sintering (SLS) technology with polyamide powder and tested it on animal model. We selected the SLS 3D printing technology due to its wid14e availability and low production costs which could provide on-site 3D printing for specific patient. The purpose of this study was to evaluate the biocompatibility of the reported holdfast device and compare the histological results obtained for local tissue reactions to those obtained for an established grafting material. Thirty swine subdivided into two groups were examined. The LAA exclusion device was implanted and was either coated with a polyester vascular implant or not coated at all and the histological response to the device’s presence was evaluated which is a standard approach to test the device biocompatibility. In all cases, complete occlusion was seen without any pathological findings during the incubation time. In both groups, the surface of the atrium under a holdfast device was smooth and shiny and had no clots. The foreign body reaction of the LAA holdfast device made of polyamide powder was insignificantly lower compared to the polyester graft. Thus, it fulfils the parameters of biocompatibility at the highest degree, and makes it suitable material for the manufacturing of LAA holdfast devices.
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Affiliation(s)
- Maciej Brzeziński
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Aleksandra Sejda
- Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland
| | - Rafał Pęksa
- Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Pawlak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Kamil Bury
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Zbigniew Adamiak
- Department of Surgery and Roentgenology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Maciej Kowalik
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Gdańsk, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Kraków, Poland.
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
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Żabówka A, Hołda J, Strona M, Koziej M, Krawczyk‐Ożóg A, Jasińska KA, Kuniewicz M, Lelakowski J, Hołda MK. Morphology of the Vieussens valve and its imaging in cardiac multislice computed tomography. J Cardiovasc Electrophysiol 2019; 30:1325-1329. [DOI: 10.1111/jce.14018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/17/2019] [Accepted: 05/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Żabówka
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Marcin Strona
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Agata Krawczyk‐Ożóg
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Marcin Kuniewicz
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital in CracowJagiellonian University Medical College Cracow Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital in CracowJagiellonian University Medical College Cracow Poland
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
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Mazur M, Żabówka A, Bolechała F, Kopacz P, Klimek‐Piotrowska W, Hołda MK. Variations and angulation of the coronary sinus tributaries: Implications for left ventricular pacing. Pacing Clin Electrophysiol 2019; 42:423-430. [DOI: 10.1111/pace.13618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Małgorzata Mazur
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Anna Żabówka
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Filip Bolechała
- Department of Forensic MedicineJagiellonian University Medical College Krakow Poland
| | - Paweł Kopacz
- Department of Forensic MedicineJagiellonian University Medical College Krakow Poland
| | - Wiesława Klimek‐Piotrowska
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Mateusz K. Hołda
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
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Piątek-Koziej K, Hołda J, Koziej M, Tyrak K, Jasińska KA, Bonczar A, Walocha JA, Hołda MK. Fixative properties of honey solutions as a formaldehyde substitute in cardiac tissue preservation. Folia Med Cracov 2019; 59:101-114. [PMID: 31180079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the properties of natural sweetener solutions in whole organ preservation and assess their influence on the dimension, weight and shape of cardiac tissue samples in stated time intervals, up to a one-year period of observation. BACKGROUND Tissue fixation is essential for biological sample examination. Many negative toxic effects of formaldehyde-based fixatives have forced us to seek alternatives for formaldehyde based solutions. It has been demonstrated that natural sweeteners can preserve small tissue samples well and that these solutions can be used in histopathological processes. However, their ability to preserve whole human organs are unknown. METHODS A total of 30 swine hearts were investigated. Three study groups (n = 10 in each case) were formed and classified on the type of fixative: (1) 10% formaldehyde phosphate-buffered solution (FPBS), (2) 10% alcohol-based honey solution (ABHS), (3) 10% water-based honey solution (WBHS). Samples were measured before fixation and in the following time points: 24 hours, 72 hours, 168 hours, 3 months, 6 months and 12 months. RESULTS The WBHS failed to preserve heart samples and decomposition of tissues was observed one week after fixation. In half of the studied parameters, the ABHS had similar modifying tendencies as compared to FPBS. e overall condition of preserved tissue, weight, left ventricular wall thickness, right ventricular wall thickness and the diameter of the papillary muscle differed considerably. CONCLUSIONS The ABHS may be used as an alternative fixative for macroscopic studies of cardiac tissue, whereas the WBHS is not suited for tissue preservation.
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Affiliation(s)
- Katarzyna Piątek-Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland.
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland
| | - Kamil Tyrak
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna A Jasińska
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland
| | - Anna Bonczar
- Department of Ophthalmology, University Clinical Center SUM in Katowice, Poland
| | - Jerzy A Walocha
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland
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Hołda MK, Pietsch-Fulbiszewska A, Trybus M, Koziej M. Morphological variations of the interatrial septum in ovine heart. PLoS One 2018; 13:e0209604. [PMID: 30566482 PMCID: PMC6300291 DOI: 10.1371/journal.pone.0209604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022] Open
Abstract
Smooth septum interatrial septum, patent foramen ovale (PFO) channel and atrial septal pouches (SPs) are commonly described variants in humans. Recent discoveries on the clinical significance of left-sided SP may encourage the creation of new strategies and devices for the management of SPs. However, these strategies may first be tested in the ovine model before implementation in humans. Unfortunately, little is known about the presence of SPs in ovine. In this study a total of 60 ovine (Ovis aries) hearts were examined. The interatrial septum morphology was assessed and the PFO channel and SPs were measured. The most commonly occurring variant were PFO channels (25.0%) with channel lengths of 5.4±2.3 mm. Smooth septums were observed in 18.3% of hearts. In the remaining cases, septums had a left septal ridge (15.0%), left SP (11.7%), left septal bridge (10.0%), right SP (10.0%), or had both a right SP and left septal ridge (10.0%). No double SPs were observed. The mean right SP depth was 3.4 ± 1.2 mm, and its mean ostium width and height were 7.9±1.8 mm and 2.8±1.0, respectively. For the left SP, the mean depth was 6.0±1.7mm, the ostium width was 7.9±2.4mm, and the ostium height was 4.1±1.6mm (range: 2.3-6.4mm). In conclusion the interatrial septum of ovine hearts exhibit morphologies that are more similar to humans than they are to swine, which should be taken into account during experimental studies. The presence of a left SP in sheep hearts make ovine models a promising alternative to the human heart for developing left-sided SP management devices and techniques.
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Affiliation(s)
- Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- * E-mail:
| | | | - Marek Trybus
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Hołda MK. Letter by Hołda Regarding Article, “Patent Foramen Ovale Closure Versus Medical Therapy for Cryptogenic Ischemic Stroke: A Topical Review”. Stroke 2018; 49:e335. [DOI: 10.1161/strokeaha.118.022550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hołda MK, Hołda J, Strona M, Koziej M, Klimek-Piotrowska W. Blood Vessels and Myocardial Thickness within the Left Atrial Appendage Isthmus Line. Clin Anat 2018; 31:1024-1030. [DOI: 10.1002/ca.23242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/13/2018] [Accepted: 06/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Mateusz K. Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Marcin Strona
- Department of Forensic Medicine; Jagiellonian University Medical College; Cracow Poland
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Wiesława Klimek-Piotrowska
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
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Chmiel J, Książek MK, Stryszak W, Iwaszczuk P, Hołda MK, Świtacz G, Kozanecki A, Wilkołek P, Rubiś P, Kopeć G, Odrowąż-Pieniążek P, Przewłocki T, Tracz W, Podolec P, Musiałek P. Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resources utilization. Postepy Kardiol Interwencyjnej 2018; 14:247-257. [PMID: 30302100 PMCID: PMC6173087 DOI: 10.5114/aic.2018.78327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Invasive coronary angiography (CAG), the 'gold standard' in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources. AIM To assess recent (throught out 10 years) evolution of 'significant' (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center. MATERIAL AND METHODS Anonymized medical records were compared for the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively (p < 0.001). RESULTS The median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly (p < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, p = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 (p < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories. CONCLUSIONS Despite more advanced age and a higher proportion of subjects with 'any' coronary atherosclerosis on CAG, the likelihood of a 'negative' angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD.
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Affiliation(s)
- Jakub Chmiel
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Miłosz K. Książek
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Weronika Stryszak
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Paweł Iwaszczuk
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Mateusz K. Hołda
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Grażyna Świtacz
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Artur Kozanecki
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Piotr Wilkołek
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Piotr Odrowąż-Pieniążek
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Wiesława Tracz
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
| | - Piotr Musiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland
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Hołda MK, Iwaszczuk P, Wszołek K, Chmiel J, Brzychczy A, Trystuła M, Misztal M. Coexistence and management of abdominal aortic aneurysm and coronary artery disease. Cardiol J 2018; 27:384-393. [PMID: 30234902 DOI: 10.5603/cj.a2018.0101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/07/2018] [Accepted: 07/23/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented. METHODS 271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD. RESULTS Significant coronary stenosis (> 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6-18.2, p < 0.001) and patients' age (OR = 1.1, 95% CI 1.0-1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p < 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2-70] vs. 7 [3-181] days, p = 0.007) and intensive care unit stay (1 [0-9] vs. 1 [0-70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms. CONCLUSIONS Patients with AAA might benefit from an early coronary artery evaluation strategy.
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Affiliation(s)
- Mateusz K Hołda
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College.
| | - Paweł Iwaszczuk
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Wszołek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Chmiel
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Brzychczy
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
| | - Mariusz Trystuła
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
| | - Marcin Misztal
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
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Hołda MK, Hołda J, Koziej M, Tyrak K, Klimek-Piotrowska W. The influence of fixation on the cardiac tissue in a 1-year observation of swine hearts. Anat Histol Embryol 2018; 47:501-509. [DOI: 10.1111/ahe.12388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/29/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mateusz K. Hołda
- HEART-Heart Embryology and Anatomy Research Team; Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team; Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Mateusz Koziej
- HEART-Heart Embryology and Anatomy Research Team; Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Kamil Tyrak
- HEART-Heart Embryology and Anatomy Research Team; Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Wiesława Klimek-Piotrowska
- HEART-Heart Embryology and Anatomy Research Team; Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
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Hołda MK, Krawczyk-Ożóg A, Koziej M, Sorysz D, Hołda J, Dudek D, Klimek-Piotrowska W. Left-Sided Atrial Septal Pouch is a Risk Factor for Cryptogenic Stroke. J Am Soc Echocardiogr 2018; 31:771-776. [DOI: 10.1016/j.echo.2018.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 11/15/2022]
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Trybus M, Stepańczak B, Koziej M, Gniadek M, Kołodziej M, Hołda MK. Hand anthropometry in patients with carpal tunnel syndrome: a case-control study with a matched control group of healthy volunteers. Folia Morphol (Warsz) 2018; 78:182-190. [PMID: 29802717 DOI: 10.5603/fm.a2018.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/30/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to perform anthropometrical measure- ments of patients' hands with carpal tunnel syndrome (CTS) in order to evaluate if there is a correlation between CTS occurrence and hand features regarding sexual dimorphism, age and physical activity. MATERIALS AND METHODS Study sample consisted of 48 patients (33 females) and control group included 80 healthy volunteers (58 females) with no history of CTS. The following measurements were performed: the wrist circumference, length of the hand, the hand's width, width of the wrist, thickness of the wrist, height of the hypothenar and thenar, length of the arm and forearm, circumference of the proximal phalanges and width of the digits; as well as several indexes were calculated i.e.: body mass index (BMI), shape index, digit index, wrist index, hand length/height ratio (HLH-ratio) and hand length/upper limb length ratio (HLULL-ratio). RESULTS Correlation coincidences were analysed between circumferences within the hand, palm and body weight. All parameters except fingers were correlated with body weight in either gender in both groups (p < 0.05; r = 0.40-0.80); Furthermore, width of the hand was correlated with body height (p < 0.001; r = 0.56-0.71). Mean values of wrist index for CTS patients were: males: 0.8, females: 0.74 (significantly higher than in healthy individuals and indicating square shape); shape index: males 76.5, females 75.8; digit index: males 55.7, females 56.5. The calculated HLH-ratio in CTS group was: males 10.6, females 10.9; HLULL-ratio: males 23.6, females 24.9 and they did not differ significantly from healthy volunteers. Almost 90.0% of females with diagnosed CTS have BMI > 25.0 kg/m2. CONCLUSIONS There are significant differences in morphometrical features of the upper limbs between CTS patients and healthy individuals. Hands of patients with CTS are more massive and with 'plumb' fingers and square shape of the wrist. Furthermore, higher BMI values were confirmed to be predisposing factors in CTS occurrence.
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Affiliation(s)
- M Trybus
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - B Stepańczak
- Department of Anthropology, Jagiellonian University, Krakow, Poland
| | - M Koziej
- Department of Anatomy, Jagiellonian University, Krakow, Poland.
| | - M Gniadek
- University Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - M Kołodziej
- Department of Anthropology, Jagiellonian University, Krakow, Poland
| | - M K Hołda
- Department of Anatomy, Jagiellonian University, Krakow, Poland
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Hołda MK, Krawczyk-Ożóg A, Koziej M, Sorysz D, Hołda J, Dudek D, Klimek-Piotrowska W. Mid-esophageal bicaval versus short-axis view of interatrial septum in two-dimensional transesophageal echocardiography for diagnosis and measurement of atrial septal pouches. Echocardiography 2018; 35:827-833. [DOI: 10.1111/echo.13847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mateusz K. Hołda
- Department of Anatomy; HEART-Heart Embryology and Anatomy Research Team; Jagiellonian University Medical College; Cracow Poland
| | - Agata Krawczyk-Ożóg
- Department of Anatomy; HEART-Heart Embryology and Anatomy Research Team; Jagiellonian University Medical College; Cracow Poland
- Department of Interventional Cardiology; University Hospital; Jagiellonian University Medical College; Cracow Poland
| | - Mateusz Koziej
- Department of Anatomy; HEART-Heart Embryology and Anatomy Research Team; Jagiellonian University Medical College; Cracow Poland
| | - Danuta Sorysz
- Department of Interventional Cardiology; University Hospital; Jagiellonian University Medical College; Cracow Poland
| | - Jakub Hołda
- Department of Anatomy; HEART-Heart Embryology and Anatomy Research Team; Jagiellonian University Medical College; Cracow Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology; University Hospital; Jagiellonian University Medical College; Cracow Poland
| | - Wiesława Klimek-Piotrowska
- Department of Anatomy; HEART-Heart Embryology and Anatomy Research Team; Jagiellonian University Medical College; Cracow Poland
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Klimek-Piotrowska W, Krawczyk-Ożóg A, Suski M, Kapusta P, Wołkow PP, Hołda MK. Comparative iTRAQ analysis of protein abundance in the human sinoatrial node and working cardiomyocytes. J Anat 2018; 232:956-964. [PMID: 29484645 DOI: 10.1111/joa.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 02/06/2023] Open
Abstract
Our objective was to assess the changes in protein abundance in the human sinoatrial node (SAN) compared with working cardiomyocytes to identify SAN-specific protein signatures. Four pairs of samples (the SAN and working cardiomyocytes) were obtained postmortem from four human donors with no evidence of cardiovascular disease. We performed protein identification and quantitation using two-dimensional chromatography-tandem mass spectrometry with isobaric peptide labeling (iTRAQ). We identified 451 different proteins expressed in both the SAN and working cardiomyocytes, 166 of which were differentially regulated (110 were upregulated in the SAN and 56 in the working cardiomyocytes). We identified sarcomere structural proteins in both tissues, although they were differently distributed among the tested samples. For example, myosin light chain 4, myosin regulatory light chain 2-atrial isoform, and tropomyosin alpha-3 chain levels were twofold higher in the SAN than in working cardiomyocytes, and myosin light chain 3 and myosin regulatory light chain 2-ventricular/cardiac muscle isoform levels were twofold higher in the ventricle tissue than in SAN. We identified many mitochondrial oxidative phosphorylation, β-oxidation, and tricarboxylic acid cycle proteins that were predominantly associated with working cardiomyocytes tissue. We detected upregulation of the fatty acid omega activation pathway proteins in the SAN samples. Some proteins specific for smooth muscle tissue were highly upregulated in the SAN (e.g. transgelin), which indicates that the SAN tissue might act as the bridge between the working myocardium and the smooth muscle. Our results show possible implementation of proteomic strategies to identify in-depth functional differences between various heart sub-structures.
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Affiliation(s)
- Wiesława Klimek-Piotrowska
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Agata Krawczyk-Ożóg
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Suski
- Department of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Przemysław Kapusta
- Center for Medical Genomics OMICRON, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł P Wołkow
- Center for Medical Genomics OMICRON, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.,Department of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
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Hołda MK, Hołda J, Koziej M, Piątek K, Klimek-Piotrowska W. Porcine heart interatrial septum anatomy. Ann Anat 2018; 217:24-28. [PMID: 29458135 DOI: 10.1016/j.aanat.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The left-sided atrial septal pouch (SP), a recently re-discovered anatomical structure within the human interatrial septum, has emerged as a possible source of thrombi formation and a trigger for atrial fibrillation, thereby potentially increasing the risk for ischemic stroke. In many studies, the swine interatrial septum has been used as model of the human heart. Also, possible new strategies and devices for management of the SPs may first be tested in this pig model. Therefore, in this study, we aimed to evaluate swine interatrial septum morphology and to compare it with the human analog, especially in the light of SP occurrence. METHODS A total of 75 swine (Sus scrofa f. domestica) hearts were examined. The interatrial septum morphology was assessed, and SPs were measured. RESULTS The most common variant of the interatrial septum was smooth septum (26.6%) followed by the patent foramen ovale channel and right SP (both 22.7%). No left or double SPs were observed. In 28.0% of all cases the fold of tissue (left septal ridge) was observed on the left side of the interatrial septum in the location where the left-sided SP should be expected. The mean length of the patent foramen ovale channel was 7.1±1.5mm. The mean right SP depth was 6.3±2.2mm, and its ostium width and height were 5.8±1.2 and 5.3±1.6mm, respectively. CONCLUSIONS There are significant differences between human and porcine interatrial septum morphology that should be taken into account during experimental studies. The absence of the left SP in swine results in the inability to use porcine heart as an experimental model for left-sided SP management.
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Affiliation(s)
- Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Piątek
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland
| | - Wiesława Klimek-Piotrowska
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland
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50
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Krawczyk-Ożóg A, Hołda MK, Sorysz D, Koziej M, Siudak Z, Dudek D, Klimek-Piotrowska W. Morphologic variability of the mitral valve leaflets. J Thorac Cardiovasc Surg 2017; 154:1927-1935. [DOI: 10.1016/j.jtcvs.2017.07.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/26/2017] [Accepted: 07/13/2017] [Indexed: 11/24/2022]
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