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Stringer S, Wendt WJ, Salavitabar A, Rogers A. Ruptured sinus of Valsalva aneurysm: An uncommon presentation of shock to the pediatric emergency department. Am J Emerg Med 2021; 49:80-82. [PMID: 34089967 DOI: 10.1016/j.ajem.2021.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/21/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
This case report describes a rare etiology of cardiogenic shock, particularly in the pediatric population. A healthy 17 year old male presents from an outside hospital in undifferentiated shock requiring vasopressor support. Ruptured sinus of Valsalva aneurysm was diagnosed by echocardiogram and the patient went emergently to the operating room for surgical repair. We discuss the anatomy, incidence, and risk factors for sinus of Valsalva aneurysms, along with the range of clinical presentations and Emergency Department management of symptomatic rupture of sinus of Valsalva aneurysms.
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Affiliation(s)
- Samantha Stringer
- University of Michigan Hospital, Emergency Department, Ann Arbor, MI 48109, United States; C.S. Mott Children's Hospital, University of Michigan, Emergency Department, Ann Arbor, MI 48109, United States.
| | - Wendi-Jo Wendt
- C.S. Mott Children's Hospital, University of Michigan, Emergency Department, Ann Arbor, MI 48109, United States; Children's Wisconsin, Medical College of Wisconsin, Emergency Department, Milwaukee, WI 53226, United States
| | - Arash Salavitabar
- C.S. Mott Children's Hospital, University of Michigan, Pediatric Cardiology, Ann Arbor, MI 48109, United States
| | - Alexander Rogers
- C.S. Mott Children's Hospital, University of Michigan, Emergency Department, Ann Arbor, MI 48109, United States
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Mia I, Le M, Arendt C, Brand D, Bremekamp S, D’Angelo T, Puntmann VO, Nagel E. Quantitative perfusion-CMR is significantly influenced by the placement of the arterial input function. Int J Cardiovasc Imaging 2021; 37:1023-1031. [PMID: 33047177 PMCID: PMC7969553 DOI: 10.1007/s10554-020-02049-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
The aim of this study is to provide a systematic assessment of the influence of the position on the arterial input function (AIF) for perfusion quantification. In 39 patients with a wide range of left ventricular function the AIF was determined using a diluted contrast bolus of a cardiac magnetic resonance imaging in three left ventricular levels (basal, mid, apex) as well as aortic sinus (AoS). Time to peak signal intensities, baseline corrected peak signal intensity and upslopes were determined and compared to those obtained in the AoS. The error induced by sampling the AIF in a position different to the AoS was determined by Fermi deconvolution. The time to peak signal intensity was strongly correlated (r2 > 0.9) for all positions with a systematic earlier arrival in the basal (- 2153 ± 818 ms), the mid (- 1429 ± 928 ms) and the apical slice (- 450 ± 739 ms) relative to the AoS (all p < 0.001). Peak signal intensity as well as upslopes were strongly correlated (r2 > 0.9 for both) for all positions with a systematic overestimation in all positions relative to the AoS (all p < 0.001 and all p < 0.05). Differences between the positions were more pronounced for patients with reduced ejection fraction. The error of averaged MBF quantification was 8%, 13% and 27% for the base, mid and apex. The location of the AIF significantly influences core parameters for perfusion quantification with a systematic and ejection fraction dependent error. Full quantification should be based on obtaining the AIF as close as possible to the myocardium to minimize these errors.
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Affiliation(s)
- Ibnul Mia
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Melanie Le
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Christophe Arendt
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Diana Brand
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Sina Bremekamp
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Tommaso D’Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Valentina O. Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital, Goethe University, Frankfurt am Main, Germany
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Flemister DC, Hatoum H, Guhan V, Zebhi B, Lincoln J, Crestanello J, Dasi LP. Effect of Left and Right Coronary Flow Waveforms on Aortic Sinus Hemodynamics and Leaflet Shear Stress: Correlation with Calcification Locations. Ann Biomed Eng 2020; 48:2796-2808. [PMID: 33145675 PMCID: PMC11022940 DOI: 10.1007/s10439-020-02677-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/31/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
Coronary flow induces hemodynamic alterations in the aortic sinus region. The objectives of this study are to: (1) investigate the differences among sinus hemodynamics and leaflet wall shear stresses engendered by the left versus right versus non-coronary flow and (2) correlate respective wall shear stresses with leaflet calcification in patients. A left heart simulator flow loop with a tunable coronary circuit provided physiological coronary flow waveforms corresponding to the left coronary cusp case (LCC), right coronary cusp case (RCC), and non-coronary cusp case (NCC). High spatio-temporal resolution particle image velocimetry was conducted to quantify leaflet wall shear stress and sinus vorticity fields and to measure aortic leaflet tip kinematics. Thirty-one patients with severe calcific aortic valve disease were segmented from CT data for the calcific volumes in their respective left, right, and non-coronary cusps. Leaflet tip position during systole shows the RCC has a wider leaflet opening compared to LCC and NCC. Velocity and vorticity fields combined with leaflet position data show that sinus vorticity is diminished (peak ~ 43 s-1) in the LCC while RCC and NCC maintain high vorticity (~ 1200 and ~ 950 s-1 respectively). WSS magnitudes greater than 0.3 Pa show 20 and 81% greater occurrences in the LCC and RCC respectively compared to NCC. Significant differences [X2 (2, n = 31) = 7.31, p = 0.0258] between the calcification levels in each cusp of the patient population. Coronary flow differences between LCC, RCC, and NCC show significant impact on leaflet kinematics and sinus flow hemodynamics. Clinical data correlations of the coronary flow cases indicate the left coronary cusp has a higher likelihood of calcification compared to the right.
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Affiliation(s)
- Dorma C Flemister
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931, USA
| | - Varshini Guhan
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
| | - Banafsheh Zebhi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Joy Lincoln
- Department of Pediatric Cardiology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | | | - Lakshmi P Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA.
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Hatoum H, Lilly S, Maureira P, Crestanello J, Prasad Dasi L. Sinus Hemodynamics After Transcatheter Aortic Valve in Transcatheter Aortic Valve. Ann Thorac Surg 2020; 110:1348-1356. [PMID: 32179042 PMCID: PMC11069388 DOI: 10.1016/j.athoracsur.2020.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/07/2019] [Accepted: 02/04/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study evaluated the effect of transcatheter aortic valve (TAV)-in-TAV on sinus hemodynamics and washout. With TAV becoming the standard procedure for aortic valve replacement and with the limited valve durability, a second intervention is necessary (TAV-in-TAV) after first TAV failure. METHODS Six arrangements of TAV-in-TAV were chosen for this study as follows: (1) Evolut 23 (Medtronic, Minneapolis, MN) in Evolut 26, (2) Evolut 23 in SAPIEN 3 23 (Edwards Lifesciences, Irvine, CA), (3) Evolut 26 in Evolut 26, (4) Evolut 26 in SAPIEN 23, (5) SAPIEN 3 23 in Evolut 26, and (6) SAPIEN 3 23 in SAPIEN 3 23. These TAV-in-TAV configurations were assessed in a pulse duplicator. Particle image velocimetry was performed. RESULTS During systole, (1) the highest velocity was found with SAPIEN-in-SAPIEN (0.7 m/s) and the lowest was with Evolut 26-in-Evolut 26 (0.2 m/s); (2) the highest shear stress magnitude near the leaflet was with Evolut 23-in-SAPIEN (1.45 Pa) and the lowest was with Evolut 26-in-Evolut 26 (0.55 Pa); and (3) washout was almost equal in all sinuses of these cases (<2.5 cycles). CONCLUSIONS This study shows that TAV-in-TAV is highly dependent on the valve that is originally implanted and the valve to be implanted. Washout is not significantly degraded after TAV-in-TAV compared with valve-in-valve and TAV replacement. Further studies are needed to optimize valve size and selection.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Pablo Maureira
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia.
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Abstract
INTRODUCTION Sinus of Valsalva aneurysm (SVA) protruding into the mitral anterior leaflet is an extremely rare clinical condition; herein, we present a case of unruptured noncoronary SVA protruding into the mitral anterior leaflet. PATIENT'S CONCERNS A 46-year-old male was referred to hospital for exertional dyspnea. DIAGNOSIS Transthoracic echocardiography (TTE) and coronary computed tomography angiography (CTA) suggested a noncoronary SVA protruding into the mitral anterior leaflet, causing mitral regurgitation and aortic insufficiency. INTERVENTIONS The aneurysm was resected and the aortic and mitral valves were replaced with mechanical valves via a transaortic approach. OUTCOMES Postoperative recovery was uneventful. CONCLUSIONS A rare noncoronary SVA protruding into the mitral anterior leaflet can be diagnosed via TTE and CTA. Transaortic mitral surgery is feasible in patients with a dilated aortic annulus ring and mitral valve diseases.
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Affiliation(s)
| | | | | | - Dianbo Cao
- Department of Radiology, the First Hospital of Jilin University, Changchun, China
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Fakoya AOJ, Otohinoyi DA, Omole AE, Oladele C, Kalejaiye A, Onuegbu A, Nwalie E, Talukdar D, Erinkitola O. Correlating possible predisposing demographics and systemic conditions with the aortic root. Ann Afr Med 2018; 17:133-139. [PMID: 30185682 PMCID: PMC6126053 DOI: 10.4103/aam.aam_51_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The aortic root is an aggregate of various components that connects the left ventricle to the aorta. The most predominant pathologies have been associated with the dilation of the aortic root leading to aneurysms. Aim This study is designed to measure the role of systemic morbidities such as hypertension, diabetes, and body mass index (BMI) on the dimension of the aortic root. Materials and Methods Participants were volunteers of African descent who were recruited during and after an organized health fair by the medical students' body from All Saints University, School of Medicine. 169 participants consisting of 62 males and 107 females with ages ranging from 9 to 84 years agreed to volunteer by signing the consent after which a questionnaire was administered and a preliminary clinical procedure was used to check for blood pressure (BP), blood glucose (BG), and BMI. The measurement of the aortic root was carried out by an experienced single investigator who was not aware of the purpose of measurements, using a DUS-5000 ultrasound machine (Miami, Florida, USA) at a low-frequency micro-convex transducer preset to "adult cardiac" with a default frequency of 4 MHz. Results Among the participants, 35.03%, 47.80%, and 29.11% had normal BP, BG, and BMI readings, respectively. The Chi-squared analysis identified a significant correlation between the diameter of the aortic annulus (AA) and BMI. Diastolic BP is also correlated with the diameter of the AA. Sinus of Valsalva (SV) showed an unusual correlation with BG as opposed to BP and BMI. Conclusion The disparity in how a systemic factor individually correlates with the AA and the SV is not clear. The study targets to provide educational concept in this regard.
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Affiliation(s)
- Adegbenro Omotuyi John Fakoya
- Department of Anatomical Sciences, University of Medicine and Health Sciences, St. Kitts and Nevis, Roseau, Dominica
- Department of Anatomical Sciences, School of Medicine, All Saints University, Roseau, Dominica
| | | | - Adekunle Ebenezer Omole
- Department of Basic Medical Sciences, American University of Antigua, College of Medicine, St. John's, Antigua
| | - Charles Oladele
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Ayoola Kalejaiye
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Angel Onuegbu
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Esther Nwalie
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Debjyoti Talukdar
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
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Chen CF, Liu XH, Gao XF, Chen B, Xu YZ. Catheter ablation of premature ventricular contractions originating from aortic sinus cusps in a patient with dextrocardia and situs solitus: A case report. Medicine (Baltimore) 2017; 96:e8947. [PMID: 29310391 PMCID: PMC5728792 DOI: 10.1097/md.0000000000008947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Premature ventricular contractions (PVCs) originating from aortic sinus cusps is not infrequent and can be eliminated effectively by radiofrequency ablation with rare complications. However, after a review of the medical literature, and to our knowledge, this is the first case of successful idiopathic aortic sinus cusps-PVC-ablation using a 3-dimensional (3D) mapping system in an adult with dextrocardia. METHODS A 62-year-old male with dextrocardia and situs inversus underwent catheter ablation of frequent PVCs. The electrocardiograms (ECG) were recorded by placement of the electrodes in reversed positions. The PVCs exhibited left bundle branch block and inferior axis QRS morphology with transition at leads V2-V3. The activation mapping indicated the earliest site of ventricular activation between the left and right aortic sinus cusps, highlighting that catheter ablation was successful at this point. RESULTS The catheter ablation was successful between the left and right aortic sinus cusps, and the PVCs were not detected for the subsequent 30 min following the procedure as well as for the rest of the hospital stay. CONCLUSION Combined with ECG electrodes in reversed positions and 3D electroanatomical mapping system, catheter ablation of PVCs originating from aortic sinus cusps in patients with dextrocardia can be safely and effectively performed.
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Dellis SL, Pennel T, Said-Hartley Q, Zilla P. Sinus of Valsalva-right atrial tunnel causing heart failure in a 38-year-old. J Thorac Cardiovasc Surg 2017; 155:e51-e53. [PMID: 28673702 DOI: 10.1016/j.jtcvs.2017.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/16/2017] [Accepted: 06/03/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Sophia L Dellis
- Division of Cardiothoracic Surgery, Albany Medical Center, Albany, NY.
| | - Timothy Pennel
- Chris Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Peter Zilla
- Chris Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital, Cape Town, South Africa
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Zhu TY, Liu SR, Chen YY, Xie LZ, He LW, Meng SR, Peng J. [Zero-fluoroscopy catheter ablation for idiopathic premature ventricular contractions from the aortic sinus cusp]. Nan Fang Yi Ke Da Xue Xue Bao 2016; 36:1105-1109. [PMID: 27578581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare the safety, feasibility, and efficacy of a completely nonfluoroscopic approach to radiofrequency catheter ablation (RFCA) using CARTO3 and ablation with conventional fluoroscopic guidance for treatment of idiopathic premature ventricular contractions from the aortic sinus cusp (ASC-PVCs). METHODS From April 2013 to October 2015, we prospectively enrolled 52 consecutive patients with ASC-PVCs scheduled for either CARTO3 mapping-guided zero-fluoroscopy ablation (group A, n=23) or conventional fluoroscopic ablation (group B, n=29). The success rates, rates of complications, rates of recurrences, number of radiofrequency applications, procedure time, mapping time and fluoroscopy time were compared between the 2 groups. RESULTS s No significant differences were found in the success rates between the 2 groups [22/23 (96%) vs 24/29 (83%), P=0.21]. No major complications occurred during the procedures in either group. There was no significant difference with regard to the procedure time between the two groups (79.6∓8.8 vs 77.4∓7.2 min, P=0.332). The procedure was completed without any fluoroscopy use in group A, while the mean fluoroscopy time in group B was 23.1∓6.0 min. Group A showed a shorter mapping time than group B (4.3∓1.7 vs 7.8∓2.6 min, P<0.01) with significantly fewer radiofrequency applications (4.8∓1.1 vs 7.9∓3.2, P<0.01). The recurrence rates were comparable between the two groups over a follow-up period of 5 to 20 months. CONCLUSION Compared with the conventional fluoroscopic technique, the zero-fluoroscopy approach can shorten the total procedure time and the ablation time with significantly reduced RF applications to eliminate ionizing radiation exposure in RFCA. RFCA guided by CARTO3 system without fluoroscopy is feasible, safe, and effective for treatment of ASC-PVCs.
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Affiliation(s)
- Ting-Yan Zhu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:
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Hernández-Enríquez M, Ascaso M, Freixa X, Sandoval E, Giacchi G, Brugaletta S, Martin-Yuste V, Quintana E, Sabaté M. Late Right Coronary Ostium Occlusion After Percutaneous Aortic Paravalvular Leak Closure: Immediate Results Do Not Always Predict Long-Term Performance. J Invasive Cardiol 2016; 28:E69-E70. [PMID: 27466277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present an 83-year-old woman with history of two aortic valve replacements; 2 years after the last replacement, she developed heart failure and severe paravalvular leak (PVL) was detected. Percutaneous PVL closure was completed with a single Amplatzer Vascular Plug III. Two months later, the patient presented with late coronary obstruction requiring emergent surgical revascularization. To the best of our knowledge, this is the first report of late coronary obstruction after percutaneous PVL closure.
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Abstract
Isolated sinus of Valsalva aneurysm is a rare occurrence, with an incidence of <1.5% among congenital heart disease repairs in the world. We recount the case of a 64-year-old man who presented with right-sided heart failure symptoms caused by a severely dilated right coronary sinus of Valsalva aneurysm that substantially obstructed the right ventricular outflow tract. Successful surgical repair involved right ventricular outflow tract resection and subcoronary patch repair.
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Sridhar GS, Sadiq MA, Ahmad WAW, Supuramaniam C, Watson T, Abidin IZ, Chee KH. Unruptured Sinus of Valsalva Aneurysm with Right Ventricular Outflow Tract Obstruction and Supracristal Ventricular Septal Defect: A Rare Case. Tex Heart Inst J 2015; 42:462-4. [PMID: 26504442 DOI: 10.14503/thij-14-4483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Unruptured right sinus of Valsalva aneurysm that causes severe obstruction of the right ventricular outflow tract is extremely rare. We describe the case of a 47-year-old woman who presented with exertional dyspnea. Upon investigation, we discovered an unruptured right sinus of Valsalva aneurysm with associated right ventricular outflow tract obstruction and a supracristal ventricular septal defect. To our knowledge, only 2 such cases have previously been reported in the medical literature. Although treatment of unruptured sinus of Valsalva aneurysm remains debatable, surgery should be considered for extremely large aneurysms or for progressive enlargement of the aneurysm on serial evaluation. Surgery was undertaken in our patient because there was clear evidence of right ventricular outflow tract obstruction, right-sided heart dilation, and associated exertional dyspnea.
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Jang YJ, Kim JY, Lee KB, Na GW, Lee WJ, Park WI, Lee M. Spontaneous perforation and dissection of the sinus of Valsalva and interventricular septum with intracardiac thrombus in a patient with Behcet's disease. Korean J Intern Med 2015; 30:252-5. [PMID: 25750569 PMCID: PMC4351334 DOI: 10.3904/kjim.2015.30.2.252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/22/2014] [Accepted: 08/20/2014] [Indexed: 02/07/2023] Open
Affiliation(s)
- Yoon-Jung Jang
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Young Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyung Been Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Gun Wung Na
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Won Jae Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Won Il Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Mirae Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Kumar G, Raghav V, Lerakis S, Yoganathan AP. High Transcatheter Valve Replacement May Reduce Washout in the Aortic Sinuses: an In-Vitro Study. J Heart Valve Dis 2015; 24:22-29. [PMID: 26182616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Transcatheter aortic valve replacements (TAVRs) are performed using fluoroscopic guidance, which makes precise positioning challenging. The aim of the present study was to investigate the effect of TAV positioning on flow characteristics in the ascending aorta and sinuses. METHODS A commonly used TAV design with a supra-annular support section was investigated using particle image velocimetry (PIV) under physiological flow and pressure conditions. A bioprosthetic valve served as a control and mimicked the native aortic valve. The valve assembly was mounted in a custom-designed chamber with an axisymmetric sinus, the design of which was based on anatomic dimensions. The TAV was deployed in the supra-annular (high) and sub- annular (low) implantation positions and studied at two cardiac outputs (5.0 and 2.5 l/min). RESULTS The TAV showed good systolic flow characteristics with wide forward flow jets in the ascending aorta (V = 1.5 m/s at 5.0 1/min; V = 1.0 m/s at 2.5 1/min). In the high implantation, the physical spacing between the leaflet free edge and sinotubular junction was reduced (< 10 mm), causing a weaker sinus vortex and a lower washout. A larger region of low velocity (< 0.1 m/s) in the sinus was observed at high implantation at all time points, particularly at a cardiac output of 2.5 l/min. In the low implantation, good sinus washout was observed. CONCLUSION For optimal sinus washout, sub- annular TAV deployment is recommended, particularly for patients with smaller sinuses. An impaired cardiac output may also require sub- annular deployment for adequate sinus washout. The study results confirmed the need for precise TAV deployment tailored to patient-specific annular and sinus dimensions, as sub-optimal positioning may inhibit coronary perfusion and cause potential regions of stasis near the aortic annulus.
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Pan Y, Qiao A, Dong N. Fluid-structure interaction simulation of aortic valve closure with various sinotubular junction and sinus diameters. Ann Biomed Eng 2014; 43:1363-9. [PMID: 25224079 DOI: 10.1007/s10439-014-1120-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/10/2014] [Indexed: 12/22/2022]
Abstract
This study was designed to investigate the effect of sinotubular junction and sinus diameters on aortic valve closure to prevent the regurgitation of blood from the aorta into the left ventricle during ventricular diastole. The 2-dimensional geometry of a base aortic valve was reconstructed using the geometric constraints and modeling dimensions suggested by literature as the reference model A (aortic annulus diameter (DAA) = 26, diameters of sinotubular junction (DSTJ) = 26, sinus diameter (DS) = 40), and then the DSTJ and DS were modified to create five geometric models named as B (DSTJ = 31.2, DS = 40), C (DSTJ = 20.8, DS = 40), D (DSTJ = 26, DS = 48), E (DSTJ = 26, DS = 32) and F (DSTJ = 31.2, DS = 48) with different dimensions. Fluid structure interaction method was employed to simulate the movement and mechanics of aortic root. The performance of the aortic root was quantified in terms of blood flow velocity through aortic valve, annulus diameter as well as leaflet contact pressure. For comparison among A, B and C, the differences of annulus diameter and leaflet contact pressure do not exceed 5% with DSTJ increased by 1.2 times and decreased by 0.8 times. For comparison among A, D and E, annulus diameter was increased by 6.92% and decreased by 7.87%, and leaflet contact pressure was increased by 8.99% and decreased by 12.14% with DS increased by 1.2 times and decreased by 0.8 times. For comparison between A and F, annulus diameter was increased by 5.10%, and leaflet contact pressure was increased by 13.54% both with DSTJ and DS increased by 1.1 times. The results of leaflet contact pressure presented for all models were consistent with those of aortic annulus diameters. For the Ross operation involves replacing the diseased aortic valve, aortic valve closure function can be affected by various sinotubular junction and sinus diameter. Compared with the sinus diameters, sinotubular junction diameters have less effect on the performance of aortic valve closure, when the diameter difference is within a range of 20%. So surgical planning might give sinus diameter more consideration.
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Affiliation(s)
- Youlian Pan
- College of Life Science and Bio-Engineering, Beijing University of Technology, Beijing, 100124, China
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Sirvente RA, Irigoyen MC, Souza LE, Mostarda C, La Fuente RN, Candido GO, Souza PRM, Medeiros A, Mady C, Salemi VMC. Cardiac impairment evaluated by transesophageal echocardiography and invasive measurements in rats undergoing sinoaortic denervation. PLoS One 2014; 9:e87935. [PMID: 24828834 PMCID: PMC4020758 DOI: 10.1371/journal.pone.0087935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/15/2012] [Accepted: 01/06/2014] [Indexed: 01/20/2023] Open
Abstract
Background Sympathetic hyperactivity may be related to left ventricular (LV) dysfunction and baro- and chemoreflex impairment in hypertension. However, cardiac function, regarding the association of hypertension and baroreflex dysfunction, has not been previously evaluated by transesophageal echocardiography (TEE) using intracardiac echocardiographic catheter. Methods and Results We evaluated exercise tests, baroreflex sensitivity and cardiovascular autonomic control, cardiac function, and biventricular invasive pressures in rats 10 weeks after sinoaortic denervation (SAD). The rats (n = 32) were divided into 4 groups: 16 Wistar (W) with (n = 8) or without SAD (n = 8) and 16 spontaneously hypertensive rats (SHR) with (n = 8) or without SAD (SHRSAD) (n = 8). Blood pressure (BP) and heart rate (HR) did not change between the groups with or without SAD; however, compared to W, SHR groups had higher BP levels and BP variability was increased. Exercise testing showed that SHR had better functional capacity compared to SAD and SHRSAD. Echocardiography showed left ventricular (LV) concentric hypertrophy; segmental systolic and diastolic biventricular dysfunction; indirect signals of pulmonary arterial hypertension, mostly evident in SHRSAD. The end-diastolic right ventricular (RV) pressure increased in all groups compared to W, and the end-diastolic LV pressure increased in SHR and SHRSAD groups compared to W, and in SHRSAD compared to SAD. Conclusions Our results suggest that baroreflex dysfunction impairs cardiac function, and increases pulmonary artery pressure, supporting a role for baroreflex dysfunction in the pathogenesis of hypertensive cardiac disease. Moreover, TEE is a useful and feasible noninvasive technique that allows the assessment of cardiac function, particularly RV indices in this model of cardiac disease.
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Affiliation(s)
- Raquel A. Sirvente
- Cardiomyopathy Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hypertension Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- * E-mail:
| | - Maria C. Irigoyen
- Hypertension Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leandro E. Souza
- Hypertension Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cristiano Mostarda
- Hypertension Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Raquel N. La Fuente
- Hypertension Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Georgia O. Candido
- Hypertension Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pamella R. M. Souza
- Hypertension Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra Medeiros
- Federal University of São Paulo, Biosciences Department, Santos, São Paulo, Brazil
| | - Charles Mady
- Cardiomyopathy Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera M. C. Salemi
- Cardiomyopathy Unit of the Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Ducci A, Tzamtzis S, Mullen MJ, Burriesci G. Hemodynamics in the Valsalva sinuses after transcatheter aortic valve implantation (TAVI). J Heart Valve Dis 2013; 22:688-696. [PMID: 24383382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to assess, in vitro, the hemodynamic modifications produced by transcatheter valves in the Valsalva sinuses, by mean of phase-resolved particle image velocimetry (PIV) measurements. METHODS Flow measurements were performed on a glass mock aortic root that included three polymeric valve leaflets, before and after the implantation of a Medtronic CoreValve device and of an Edwards SAPIEN valve. All experiments were carried out in a hydro-mechanical cardiovascular pulse duplicator system (Vivitro Superpump System SP3891) that reproduced physiologically equivalent pressures and flow rates conforming to the requirements of the standard ISO 5840:2005. The flow dynamics, before and after implantation of the two prosthetic devices, was characterized on the basis of phase-resolved velocity field and viscous shear rate measurements. RESULTS Direct comparison indicated that both transcatheter valves determined a significant variation of flow during the early stages of valve opening and during valve closure. In general, the presence of the two valve implants significantly reduced the flow activity in the Valsalva sinuses, promoting regions of stagnation at their base. CONCLUSION The reduction in flow in the Valsalva sinuses could be associated with the higher incidence of ischemic events reported after transcatheter heart valve implantation.
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Affiliation(s)
- Andrea Ducci
- Department of Mechanical Engineering, University College London, London, UK
| | - Spyridon Tzamtzis
- Department of Mechanical Engineering, University College London, London, UK
| | - Michael J Mullen
- Department of Mechanical Engineering, University College London, London, UK
| | - Gaetano Burriesci
- Department of Mechanical Engineering, University College London, London, UK
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Wang YB, Chu JM, Song SK, Wang J, Liu XY, Zhao YJ, Pu JL, Zhang S. [Preferential conduction to right ventricular outflow track leads to left bundle-branch block morphology in patient with premature ventricular contraction originating from the aortic sinus cusp]. Zhonghua Xin Xue Guan Bing Za Zhi 2013; 41:13-17. [PMID: 23651961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the relationship between originate and breakout and radiofrequency catheter ablation strategy in patients undergoing radiofrequency ablation for premature ventricular contractions originating from the aortic sinus cusp (ASC) using 3-dimensional electro anatomic mapping. METHODS This study included 21 consecutive patients (10 male) underwent ablation for frequent PVCs originating from ASC in our hospital between May 2009 and February 2012. Electro anatomic mapping and ablation of right ventricular outflow track (RVOT) and left ventricular outflow track (LVOT) were performed with the 7F 4-mm-tip ablation catheter from right femoral vein and artery. Activation mapping and pacing mapping were performed in all patients. RESULTS Ablation was successful in all 21 patients successful ablation target in left coronary sinus cusp (LCC, n = 17), in right coronary sinus cusp (RCC, n = 2) and in noncoronary sinus cusp (NCC, n = 2). Seven patients showed a RBBB morphology (group A) and 14 patients showed a LBBB morphology (group B). In group A, earliest ventricular activation (EVA) was recorded 22 - 34 (27.4 ± 4.6) ms earlier before QRS at the site of catheter ablation in ASC. In group B, EVA was later in RVOT than that in ASC in 5 patients and EVA at the site of catheter ablation in RVOT and ASC was 22 - 28 (25.2 ± 2.7) ms and 26 - 40 (32.8 ± 5.2) ms, respectively (t = -3.6, P = 0.024) while EVA was earlier in the remaining 9 patients and EVA recorded in RVOT and ASC was 22 - 38 (28.7 ± 5.9) ms and 18 - 28 (22.7 ± 3.6) ms, respectively (t = 3.8, P = 0.005). CONCLUSION Patients with premature ventricular contractions originating from the ASC often show preferential conduction to the RVOT, which may explain the LBBB morphology of ECG in these patients.
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Affiliation(s)
- Yu-bin Wang
- Chinese Academy of Medical Sciences, Beijing, China
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Nascimbene A, Joggerst S, Reddy KJ, Cervera RD, Ott DA, Wilson JM, Stainback RF. Aortic valve regurgitation that resolved after a ruptured coronary sinus aneurysm was patched. Tex Heart Inst J 2013; 40:489-492. [PMID: 24082388 PMCID: PMC3783149] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sinus of Valsalva aneurysms appear to be rare. They occur most frequently in the right sinus of Valsalva (52%) and the noncoronary sinus (33%). More of these aneurysms originate from the right coronary cusp than from the noncoronary cusp. Surgical intervention is usually recommended when symptoms become evident. We report the case of a 34-year-old woman who presented with a congenital, ruptured sinus of Valsalva aneurysm that originated from the noncoronary cusp. Moderate aortic regurgitation was associated with this lesion. Simple, direct patch closure of the ruptured aneurysm resolved the patient's left-to-right shunt and was associated with decreased aortic regurgitation to a degree that valve replacement was not necessary. Only trace residual aortic regurgitation was evident after 3 months, and the patient remained free of symptoms after 6 months. Our observations support the idea that substantial runoff blood flow in the immediate supra-annular region can be responsible for aortic regurgitation in the absence of a notable structural defect in the aortic valve, and that restoring physiologic flow in this region and equalizing aortic-cusp closure pressure can largely or completely resolve aortic insufficiency. Accordingly, valve replacement may not be necessary in all cases of ruptured sinus of Valsalva aneurysms with associated aortic valve regurgitation.
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Affiliation(s)
- Angelo Nascimbene
- Departments of Cardiology (Drs. Joggerst, Nascimbene, Reddy, Stainback, and Wilson) and Cardiovascular Surgery (Drs. Cervera and Ott), Texas Heart Institute, Houston, Texas 77030
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Ghosh P, Chauhan A. Rare variant of an anomalous left coronary artery: arising from the distal continuation of a single right coronary artery. Tex Heart Inst J 2012; 39:63-64. [PMID: 22412230 PMCID: PMC3298907] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report an interesting case of single right coronary artery arising from the right sinus of Valsalva and continuing distally as a rare anomalous left coronary artery. Over the 7-year course of our clinical follow-up, the right coronary artery manifested severe, progressive atherosclerotic disease in multiple sites, which lesions were successfully stented. We hypothesize that the disease process in the right coronary artery was accelerated by shear stress in association with that vessel's need to carry the entire burden of the coronary circulation.
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Affiliation(s)
- Pradeepto Ghosh
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK.
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Iqtidar AF, O'Rourke DJ, Silverman DI, Thompson PD, DiScipio AW, Palac RT. Predictors of rapid aortic dilatation in adults with a bicuspid aortic valve. J Heart Valve Dis 2011; 20:292-298. [PMID: 21714419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The role of atherosclerosis and atherosclerotic risk factors in predicting progressive aortic dilatation in patients with bicuspid aortic valve (BAV) is not well defined. The study aim was to assess the role of these risk factors in progressive aortic dilatation in patients with this condition. METHODS Adult patients were identified with BAV who displayed rapid aortic dilatation, and the association of the condition with hemodynamic and atherosclerotic risk factors was assessed. By using the Dartmouth-Hitchcock and Hartford Hospital echocardiographic databases between 1997 and 2009, a total of 135 patients with BAV and serial echocardiograms recorded at least one year apart were allocated to groups of rapid progressors (RP; n = 53) or slow progressors (SP; n = 82). Rapid aortic progression was defined as an annual rate of progression > or = 75th percentile at the sinus of Valsalva or ascending aorta level. Univariate atherosclerotic and hemodynamic variables that correlated with rapid aortic dilatation were analyzed, and independent predictors of rapid aortic dilatation identified. RESULTS The RP group had higher mean random blood glucose levels, greater coronary artery disease, more tobacco use, and a higher National Heart, Lung and Blood Institute 10-year risk of developing coronary heart disease (10-year risk). An elevated 10-year risk of > 7% (OR 4.5; 95% CI 1.92-10.73), tobacco use (OR 5.05; 95% CI 1.51-16.86) and higher random blood glucose level (OR 1.01; 95% CI 1.002-1.03) were independent predictors of rapid aortic dilatation. CONCLUSION In adults with BAV and non-dilated aortas at baseline, an elevated 10-year risk, tobacco use and hyperglycemia may serve as predictors of rapid aortic dilatation.
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Affiliation(s)
- Ali F Iqtidar
- Section of Cardiology, Department of Medicine, Hartford Hospital, Hartford, CT, USA.
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Jakrapanichakul D, Chirakarnjanakorn S. Comparison of aortic diameter in normal subjects and patients with systemic hypertension. J Med Assoc Thai 2011; 94 Suppl 1:S51-S56. [PMID: 21721428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Standard aortic root dimensional measurement by the two dimensional echocardiography should be routinely performed in all patients. There is limited data on the normal reference on Thai population. OBJECTIVE Aims of this study were (1) to determine the normal reference of aortic root dimension in Thai population and (2) to determine the difference in the aortic root size in patients with hypertension comparing with normal population. MATERIAL AND METHOD We retrospectively reviewed 81 patients who had the transthoracic echocardiographic examinations in our echocardiographic lab and had the aortic root measurement data. The patients with ascending aortic aneurysm, aortic dissection, aortic stenosis and/or regurgitation more than mild in degree, Marfan's syndrome and annuloaortic ectasia were excluded. The echocardiographic data of were collected; the aortic root dimensions at four levels; aortic valve annulus, sinus of Valsava, sinotubular junction and tubular parts. Hypertension was indentified if the patient had the prior diagnosis of hypertension and on antihypertensive medications, or who had blood pressure more than 140/90 mmHg for two or more occasions. RESULTS Eighty-one patients were enrolled. Sixty patients (74.1%) were diagnosed hypertension. Mean age was 66.9 +/- 11.2 years in hypertensive patients and 49.1 +/- 16.4 years in normotensive patients. Normal reference values based on 95% upper normal limit of aortic valve annulus, sinus of Valsava, sinotubular junction and tubular part were 2.30 (2.21-2.38), 3.56 (3.35-3.77), 2.79 (2.61-2.97), and 3.36 (3.13-3.59), respectively. Patients with hypertension had significant larger sinus of Valsava and tubular part of aortic root than patients with normotension. CONCLUSION We reported a normal reference value for aortic root size in Thai population. The aortic root sizes are influenced by hypertensive status, age and gender.
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Affiliation(s)
- Decho Jakrapanichakul
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Fazliogullari Z, Karabulut AK, Unver Dogan N, Uysal II. Coronary artery variations and median artery in Turkish cadaver hearts. Singapore Med J 2010; 51:775-780. [PMID: 21103812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION This study examined the routes and variations of the left coronary artery (LCA), the right coronary artery (RCA), and their branches, as well as the frequency of a median artery in cadaver hearts. METHODS The hearts of 50 adult Turkish cadavers from various centres were dissected. RESULTS The LCAs branched out of the aortic sinus and had an average diameter of 4.44 +/- 1.79 mm. They gave rise to two branches (bifurcation) in 46 percent, three branches (trifurcation) in 44 percent and four branches (quadrifurcation) in ten percent of the hearts. The median artery was identified in 27 hearts, with a mean diameter of 2.00 mm (standard deviation 0.67). The RCAs branched out from the right aortic sinus and had an average diameter of 3.32 +/- 0.79 mm. The conus branch, classically known as a branch of the RCA, branched out from the RCA in 32 percent of the hearts and from the right aortic sinus in 68 percent. Right dominance was observed in 42 percent, left dominance in 14 percent, and equal dominance in 44 percent of the hearts. Myocardial bridges were found on the LCA branches in 22 of the 27 hearts in which the median artery existed. CONCLUSION There is a close relationship between the existence of the median artery and myocardial bridges. This suggests that the median artery might be important in myocardial bridges, which exist in embryos but do not result in any clinical symptoms for many years in a large number of people.
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Affiliation(s)
- Z Fazliogullari
- Department of Anatomy, Meram Medical Faculty, Selçuk University, Konya 42080, Turkey
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Schoenhoff FS, Loupatatzis C, Immer FF, Stoupis C, Carrel TP, Eckstein FS. The role of the sinuses of Valsalva in aortic root flow dynamics and aortic root surgery: evaluation by magnetic resonance imaging. J Heart Valve Dis 2009; 18:380-385. [PMID: 19852141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Combined replacement of the aortic valve and ascending aorta using a composite graft represents the standard treatment for dilated aortic root with concomitant structural damage of the aortic valve, especially when the aortic valve cannot be preserved. Unfortunately, hemodynamic changes associated with prosthetic replacement of the aortic root have not been fully elucidated. The study aim was to compare hemodynamics within the replaced aortic root using either a prosthetic vascular graft with bulges mimicking the sinuses of Valsalva and including a stented pericardial valve, or a straight xenopericardial conduit and a stentless porcine valve. METHODS Between July 2004 and March 2006, a total of 35 patients (mean age 65.2 years: range: 32-80 years) was enrolled into the present study. Aortic root replacement was performed in nine patients with a Valsalva graft (Gelweave Valsalva; Vascutek, Renfrewshire, UK) including a stented pericardial valve, and in 19 patients with a xenopericardial conduit containing a stentless porcine valve. All patients underwent postoperative magnetic resonance imaging (MRI). A control group of seven patients allowed for comparison with native aortic root hemodynamics. RESULTS Maximum flow-velocity above the aortic valve as one marker of compliance of the aortic root was slightly higher in patients with a Valsalva graft compared to native aortic roots (1.9 m/s versus 1.3 m/s, p = 0.001), but was significantly lower than in patients with the xenopericardial graft without neo-sinuses (1.3 m/s versus 2.4 m/s, p < 0.001). CONCLUSION The pre-shaped bulges in the prosthetic Valsalva graft effectively mimic the native sinuses of Valsalva, improve compliance of the aortic root, and result in a more physiologic flow pattern, as demonstrated by postoperative MRI.
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Yamada T, Yoshida Y, Inden Y, Murohara T, Kay GN. Vagal reflex provoked by radiofrequency catheter ablation in the right aortic sinus cusp: a Bezold-Jarisch-like phenomenon. J Interv Card Electrophysiol 2008; 23:199-204. [PMID: 18758931 DOI: 10.1007/s10840-008-9292-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Accepted: 06/24/2008] [Indexed: 11/26/2022]
Abstract
A 66-year-old woman with idiopathic premature ventricular contractions with a left bundle branch block QRS morphology and left inferior axis underwent electrophysiologic testing. Successful radiofrequency ablation was achieved in the right coronary cusp (RCC). However, radiofrequency ablation at sites adjacent to the successful ablation site provoked sinus bradycardia followed by atrioventricular conduction block. That phenomenon might be explained by a vagal reflex through stimulation of vagal pathways or receptors in the anterior epicardial fat pads neighboring to the RCC. A vagal reflex should be kept in mind as a complication during catheter ablation of ventricular arrhythmias originating from the RCC.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, AL 35294-0019, USA.
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Rillig A, Meyerfeldt U, Birkemeyer R, Treusch F, Kunze M, Brasch M, Jung W. Catheter ablation within the sinus of Valsalva--a safe and effective approach for treatment of atrial and ventricular tachycardias. Heart Rhythm 2008; 5:1265-72. [PMID: 18774100 DOI: 10.1016/j.hrthm.2008.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Accepted: 06/07/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ablation of the aortic sinus of Valsalva in adults for ectopic atrial tachycardia (EAT) and ventricular tachycardia (VT)/premature ventricular complexes (PVCs) has been reported in only a very few patients. Limited data exist concerning the safety of aortic ablation. OBJECTIVE The purpose of this study was to confirm aortic wall and aortic valve integrity after ablation and to evaluate for potential cerebral embolism due to thrombus formation at aortic wall lesions. METHODS From January 2006 to August 2007, 21 patients with EAT (n = 6) or VT/PVCs (n = 15) originating from the sinus of Valsalva underwent successful ablation. The aortic wall structure was evaluated using transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI) the day after ablation and at 6-month follow-up for all patients. To rule out cerebral embolism due to postablation thromboembolic events, a cerebral MRI was performed immediately after ablation in six patients and at 6-month follow-up in all patients. Ablation success was defined by 24-hour Holter monitoring before hospital discharge and after 6 months. RESULTS Aortic wall integrity was confirmed in all patients by TEE and MRI. Cerebral MRI showed evidence of silent cerebral ischemia in one patient. Aortic valve thickening was detected in one patient by TEE. CONCLUSION Ablation in the aortic sinus of Valsalva is a safe and effective approach for atrial tachycardia or VT/PVCs. The incidence of silent ischemia needs further evaluation.
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Affiliation(s)
- Andreas Rillig
- Department of Cardiology, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Academic Hospital of the University of Freiburg, Germany.
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Prashanth P, Mukhaini M. Single right coronary artery continuing as left circumflex artery and hypoplastic left anterior descending artery: a rare coronary anomaly. J Invasive Cardiol 2008; 20:E192-E194. [PMID: 18523335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The occurrence of a single coronary artery (SCA) is rare in the absence of other associated anomalies of the heart and is often detected incidentally during coronary angiography. This anomaly is usually benign and various types of SCA have been described. We report a rare type of SCA originating from the right sinus of Valsalva, with the left circumflex artery (LCX) continuing from right coronary artery (RCA) and hypoplastic left anterior descending artery (LAD), which was incidentally found in a 63-year-old female presenting as unstable angina.
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Abstract
An apparently healthy young adult was referred for echocardiography because of a cardiac 2/6 diastolic murmur, heard during physical examination in the context of our competitive sports screening program.
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Affiliation(s)
- Nicola Gaibazzi
- Cardiology Department at Ospedale Maggiore di Parma, Parma, Italy.
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Yamada T, Murakami Y, Yoshida N, Okada T, Shimizu T, Toyama J, Yoshida Y, Tsuboi N, Muto M, Inden Y, Hirai M, Murohara T, McElderry HT, Epstein AE, Plumb VJ, Kay GN. Preferential Conduction Across the Ventricular Outflow Septum in Ventricular Arrhythmias Originating From the Aortic Sinus Cusp. J Am Coll Cardiol 2007; 50:884-91. [PMID: 17719476 DOI: 10.1016/j.jacc.2007.05.021] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 04/16/2007] [Accepted: 05/05/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the relationship between the origin and breakout site of idiopathic ventricular tachycardia (VT) or premature ventricular contractions (PVCs) originating from the myocardium around the ventricular outflow tract. BACKGROUND The myocardial network around the ventricular outflow tract is not well known. METHODS We studied 70 patients with idiopathic VT (n = 23) or PVCs (n = 47) with a left bundle branch block and inferior QRS axis morphology. Electroanatomical mapping was performed in both the right ventricular outflow tract (RVOT) and aortic sinus cusp (ASC) during VT or PVCs. RESULTS The earliest ventricular activation (EVA) was recorded in the RVOT in 55 patients (group R) and in the ASC in 15 (group A). In all group R patients, the closest pace map and successful ablation were achieved at the EVA site. Although a successful ablation was achieved at the EVA site in all group A patients, the closest pace map was obtained at the EVA site in 8 and RVOT in 7 (with an excellent pace map in 4). The stimulus to QRS interval was 0 ms during pacing from the RVOT and 36 +/- 8 ms from the ASC. The distance between the EVA and perfect pace map sites in those 4 patients was 11.9 +/- 3.0 mm. CONCLUSIONS Ventricular arrhythmias originating from the ASC often show preferential conduction to the RVOT, which may render pace mapping or some algorithms using the electrocardiographic characteristics less reliable. In some of those cases, an insulated myocardial fiber across the ventricular outflow septum may exist.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Diseases, Cardiac Rhythm Management Laboratory, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd Avenue South, Birmingham, Alabama 35294-0019, USA.
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32
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Bortone A, Combes N, Boveda S, Albenque JP. Dual tachycardias associating double-exit left aortic sinus cusp tachycardia with paroxysmal atrial fibrillation: evidence of a link between both arrhythmias by means of the autonomic nervous system. J Cardiovasc Electrophysiol 2007; 18:1334-7. [PMID: 17655674 DOI: 10.1111/j.1540-8167.2007.00888.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dual tachycardias associating paroxysmal atrial fibrillation (AF) with double-exit left aortic sinus cusp tachycardia (LASCT) are described for the first time in a patient referred for AF ablation. CASE Both tachycardias were successfully ablated under Carto-Merge guidance. Noteworthy, vagal denervation during AF ablation was responsible for an immediate decrease in LASCT occurrence and inducibility. CONCLUSION This case highlights the critical role that the autonomic nervous system plays within the cardiac arrhythmia framework.
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Affiliation(s)
- Agustín Bortone
- Electrophysiology and Pacing/Defibrillation Department, Clinique Pasteur, Toulouse, France
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33
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Chun KRJ, Satomi K, Kuck KH, Ouyang F, Antz M. Left Ventricular Outflow Tract Tachycardia Including Ventricular Tachycardia from the Aortic Cusps and Epicardial Ventricular Tachycardia. Herz 2007; 32:226-32. [PMID: 17497256 DOI: 10.1007/s00059-007-2977-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Idiopathic outflow tract ventricular tachycardia (VT) can arise from the right (RVOT) or left ventricular outflow tract (LVOT). The electrocardiographic (ECG) pattern of RVOT VT is typical in most patients, showing a monomorphic left bundle branch block (LBBB) QRS morphology with an inferior axis. Radiofrequency catheter ablation can be performed with a high success rate and provides a curative therapeutic approach. However, not all VTs with LBBB and inferior axis can be ablated from the RVOT. It has become apparent that LVOT VTs including VT originating from the aortic sinus of Valsalva or epicardium represent underrecognized VT entities which are also amenable to successful catheter ablation. Twelve-lead ECG criteria can contribute to distinguish between sites of VT origin.LVOT arrhythmias represent an increasingly recognized VT entity which can be safely and successfully treated by catheter ablation. Identification of VT origin using ECG criteria and differentiation of LVOT versus RVOT origin is essential in the careful planning of the ablation strategy.
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Affiliation(s)
- K R Julian Chun
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
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34
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Abstract
In 1999, Haissaguerre et al published a landmark article showing that atrial fibrillation can be initiated by electrical activity in the pulmonary veins. Not only does it appear that electrical activity in the veins initiates fibrillation, but it also may be responsible for perpetuating fibrillation. Subsequently, similar evidence has suggested that other thoracic veins (vena cavae, coronary sinus, ligament of Marshall) initiate and perpetuate atrial fibrillation. How does electrical impulse initiation occur in the veins? The results of numerous in vivo and in vitro studies on this subject have not conclusively defined a mechanism. Impulse initiation by automaticity and triggered activity as well as impulse initiation resulting from reentry have been suggested. In this article, we focus only on those data suggesting the possibility that triggered activity initiates and/or perpetuates atrial fibrillation.
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Affiliation(s)
- Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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35
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Abstract
We report a patient with atrioventricular reentrant tachycardia (AVRT) with bidirectional conduction over an anteroseptal accessory pathway (AP) who underwent successful ablation in the non-coronary aortic sinus (AS). In three previous attempts, the intracardiac recordings showed an anteroseptal AP with antegrade and retrograde conduction that failed to be ablated in spite of radiofrequency (RF) applications from the right and left anteroseptal regions. During the study, the earliest atrial activation during tachycardia was recorded in the non-coronary AS preceding the atrial activation at the His bundle (HB) region by 24 ms, and the anteroseptal AP was successfully blocked by one single ablation in the non-coronary AS. These data strongly suggest that careful mapping of an anteroseptal AP in the non-coronary AS may provide an alternative ablation approach in patients with previously failed ablation.
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Affiliation(s)
- He Huang
- Medizinische Abteilung, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany
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36
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, 35294-0001, USA.
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37
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Ouyang F, Ma J, Ho SY, Bänsch D, Schmidt B, Ernst S, Kuck KH, Liu S, Huang H, Chen M, Chun J, Xia Y, Satomi K, Chu H, Zhang S, Antz M. Focal Atrial Tachycardia Originating From the Non-Coronary Aortic Sinus. J Am Coll Cardiol 2006; 48:122-31. [PMID: 16814658 DOI: 10.1016/j.jacc.2006.02.053] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 02/07/2006] [Accepted: 02/14/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We sought to investigate electrophysiological characteristics and catheter ablation in patients with focal atrial tachycardia (AT) originating from the non-coronary aortic sinus (AS). BACKGROUND In patients with failed ablation of focal AT near the His bundle (HB) region, an origin from the non-coronary AS should be considered because of the close anatomical relationship. METHODS This study included 9 patients with focal AT, in 6 of whom attempted radiofrequency (RF) ablation had previously failed. Activation mapping was performed during tachycardia to identify an earliest activation in the atria and the AS. The aortic root angiography was performed to identify the origin in the AS before RF ablation. RESULTS Focal AT was reproducibly induced by atrial pacing. Mapping in atria demonstrated that the earliest atrial activation was located at the HB region, whereas mapping in the non-coronary AS demonstrated that an earliest atrial activation preceded the atrial activation at the HB by 12.2 +/- 6.9 ms and was anatomically located superoposterior to the HB in all 9 patients. Also, His potentials were not found at the successful site in the non-coronary AS in all 9 patients. The focal AT was terminated in <8 s in all 9 patients. Junctional beats and PR prolongation did not occur during RF application in all 9 patients. No complications occurred in any of the nine patients. All 9 patients were free of arrhythmias without antiarrhythmic drugs during a follow-up of 9 +/- 3 months. CONCLUSIONS In patients with focal AT near the HB region, mapping in the non-coronary AS can improve clinical outcome.
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Affiliation(s)
- Feifan Ouyang
- II. Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
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38
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Abstract
Background—
Despite the success of catheter ablation for treatment of idiopathic ventricular tachycardia (VT), occasional patients have been reported in whom VT could not be ablated from the right or left ventricular endocardium or from the aortic sinus of Valsalva (ASOV).
Methods and Results—
In 12 of 138 patients (9%) with idiopathic VT referred for ablation, an epicardial left ventricular site of origin was identified >10 mm from the ASOV. Coronary venous mapping demonstrated epicardial preceding endocardial activation by >10 ms (41±7 versus 15±11 ms before QRS onset;
P
<0.001). VT induction was facilitated by catecholamines and terminated by adenosine. Ablation through the coronary veins or via percutaneous transpericardial catheterization was successful in 9 patients; 2 required direct surgical ablation as a result of anatomic constraints. No ECG pattern was specific for epicardial VT. However, slowed initial precordial QRS activation, as quantified by a novel metric, the maximum deflection index, was more useful. A delayed precordial maximum deflection index ≥0.55 identified epicardial VT remote from the ASOV with a sensitivity of 100% and a specificity of 98.7% relative to all other sites of origin (
P
<0.001).
Conclusions—
Although clinically underrecognized, idiopathic VT may originate from the perivascular sites on the left ventricular epicardium. The mechanism is consistent with triggered activity. It is amenable to ablation by transvenous or transpericardial approaches, although technical challenges remain. Recognition of a prolonged precordial maximum deflection index and early use of transvenous epicardial mapping are critical to avoid protracted and unsuccessful ablation elsewhere in the ventricles.
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Affiliation(s)
- David V Daniels
- Cardiovascular Institute, Loyola University Medical Center, Maywood, IL 60153, USA
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39
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Gupta PR, Tewari R, Singh AK, Kumar A. Ruptured sinus of valsalva into right ventricle: a unique case with prolonged survival. J Assoc Physicians India 2006; 54:126. [PMID: 16715617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- P R Gupta
- Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi
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40
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Gavri S, Nashashibi M, Perles Z, Milgarter E, Marzouka B, Rein AJJT. Tetralogy of Fallot with pulmonic atresia with cyclic occlusion of an associated aortic sinus of Valsalva-pulmonary artery window. Pediatr Cardiol 2006; 27:131-133. [PMID: 16132292 DOI: 10.1007/s00246-005-1058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A first case of an unusual aortopulmonary window with tetralogy of Fallot associated with pulmonary atresia is presented. The aortopulmonary window was at the aortic sinus of Valsalva. The left aortic leaflet prevented pulmonary hypertension by occluding the window in systole.
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Affiliation(s)
- S Gavri
- Division of Pediatric Cardiology, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - M Nashashibi
- Makassed Hospital, Mount of Olives, Jerusalem, Israel
| | - Z Perles
- Division of Pediatric Cardiology, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - E Milgarter
- Department of Cardiac Surgery, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - B Marzouka
- Department of Cardiac Surgery, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - A J J T Rein
- Division of Pediatric Cardiology, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel.
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41
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Maury P, Couderc P, Celse D, Coulier H, Duparc A, Delay M. [Ablation of ventricular extra-systole in the left Valsalva sinus. A case report]. Arch Mal Coeur Vaiss 2005; 98:1257-61. [PMID: 16435608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We report the case of a patient presenting with unrelenting isolated or repetitive monomorphic ventricular extra-systoles, with left block and right axis deviation, which appeared to arise from the right ventricular chamber, but for which ablation was finally performed in the left Valsalva sinus. The ECG and endocavity electro-physiological features which led us to suspect this atypical, although not exceptional, situation are reported, as well as the techniques for ablation available in this case.
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Affiliation(s)
- P Maury
- Fédération de cardiologie, CHU Toulouse, hôpital de Rangueil, 31059 Toulouse 09.
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42
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Memisoglu E, Ropers D, Hobikoglu G, Tepe MS, Labovitz AJ. Usefulness of electron beam computed tomography for diagnosis of an anomalous origin of a coronary artery from the opposite sinus. Am J Cardiol 2005; 96:1452-5. [PMID: 16275198 DOI: 10.1016/j.amjcard.2005.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 07/01/2005] [Accepted: 07/01/2005] [Indexed: 11/27/2022]
Abstract
The ectopic origination of a coronary artery from the opposite sinus is a rare condition, often discovered as an incidental finding during invasive catheter angiography performed for the evaluation of atherosclerotic coronary artery disease. Although most patients lack hemodynamic significance, a small fraction of these anomalies have been associated with sudden cardiac death and ischemic complications. The exact anatomic definition of the anomalous coronary artery and its course, especially in relation to the ascending aorta and the pulmonary trunk, is therefore crucial for every imaging modality that attempts coronary artery visualization. To underline the potential of 3-dimensional electron-beam computed tomography as an important complement to invasive angiography in the delineation of anomalous coronary arteries, this study focused on the potentially malignant ectopic contralateral origination of a coronary artery.
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Affiliation(s)
- Esat Memisoglu
- Department of Radiology, St. Louis University Hospital, St. Louis, Missouri, USA.
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43
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Bradley TJ, Potts JE, Potts MT, DeSouza AM, Sandor GGS. Echocardiographic Doppler assessment of the biophysical properties of the aorta in pediatric patients with the Marfan syndrome. Am J Cardiol 2005; 96:1317-21. [PMID: 16253606 DOI: 10.1016/j.amjcard.2005.06.080] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Revised: 06/21/2005] [Accepted: 06/21/2005] [Indexed: 11/25/2022]
Abstract
In the Marfan syndrome (MS), aortic root involvement is usually clinically monitored according to the aortic sinus of Valsalva dilation. Using an echocardiographic Doppler method in this cross-sectional study, abnormal biophysical properties of the ascending aorta were found in pediatric patients with MS compared with healthy controls but not consistently in association with the aortic sinus of Valsalva dilation.
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Affiliation(s)
- Timothy J Bradley
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital and The University of British Columbia, Vancouver, British Columbia, Canada.
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44
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George J, Afek A, Abashidze A, Shmilovich H, Deutsch V, Kopolovich J, Miller H, Keren G. Transfer of endothelial progenitor and bone marrow cells influences atherosclerotic plaque size and composition in apolipoprotein E knockout mice. Arterioscler Thromb Vasc Biol 2005; 25:2636-41. [PMID: 16195475 DOI: 10.1161/01.atv.0000188554.49745.9e] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Recent clinical trials use cell therapy with bone marrow (BM) cells or endothelial progenitor cells (EPCs) for ischemic syndromes. We explored the effect of BM cell- or spleen cell-derived EPC transfer on plaque size and stability markers in the apolipoprotein E knockout (apoE KO) mouse model. METHODS AND RESULTS ApoE KO mice aged 10 weeks served as recipients. Labeled BM cells and spleen cell-derived EPCs from age-matched apoE KO mice were injected intravenously to 2 groups of recipient mice each. Additional mice served as controls receiving saline. Both protocols were repeated 3 times at 2 weekly intervals. On killing, plaque size and character were studied, lipid profile analyzed, and serum and aortic cytokines assayed. Spleen cell-derived cells contained a significantly larger number of endothelial cell precursors. Labeled EPCs and BM cells were found abundantly in the spleens, yet also in the lesions of the recipient mice. Aortic sinus lesion size was significantly increased in mice receiving BM cells (n=10) in the EPC-treated group (n=10) compared with controls (n=10; a 54% and a 34% increase in aortic sinus plaque area, respectively). Mice receiving EPCs exhibited plaques with larger lipid cores and thinner fibrous caps and a higher number of infiltrating CD3 cells. RT-PCR analysis of aortas revealed reduced expression of mRNA for interleukin-10 (IL-10) in both cell transfer groups. Higher serum concentrations of IL-6 and monocyte chemoattractant protein-1 were found in sera from BM recipients, whereas lower IL-10 levels were found in mice transfused with spleen-derived EPCs. CONCLUSIONS Transfer of BM cells and EPCs may result in an increase in atherosclerotic lesion size, whereas EPC transfer could also potentially influence plaque stability.
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Affiliation(s)
- Jacob George
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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45
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Kim JY, Yoon J, Jung HS, Yoo BS, Lee SH. Percutaneous coronary stenting in guide-induced aortocoronary dissection: angiographic and CT findings. Int J Cardiovasc Imaging 2005; 21:375-8. [PMID: 16047116 DOI: 10.1007/s10554-004-6137-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 11/04/2004] [Indexed: 11/30/2022]
Abstract
We report here on a case of accidental aortocoronary dissection that occurred during the engagement of a guiding catheter. This resulted in an antegrade dissection into the right coronary artery, and a retrograde extension of the dissection into the Sinus of Valsalva and the ascending aorta up to the aortic arch. It was successfully treated with a stent deployment at the RCA ostium; this restored optimal coronary blood flow and there was a complete resolution of the aortic dissection as was documented by coronary angiography and the follow-up CT scan.
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Affiliation(s)
- Jang-Young Kim
- Department of Cardiology, Wonju College of Medicine, Yonsei University, 162 Ilsan-Dong, 220 701, Wonju, Republic of Korea
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Abstract
OBJECTIVE To analyse the structural and functional abnormalities in the large arteries in women with the Turner syndrome. METHODS Aortic stiffness (assessed by means of the carotid femoral pulse wave velocity), level of amplification of the carotid pressure wave (by applanation tonometry), and carotid remodelling (by high resolution ultrasound) were studied in women with the Turner syndrome. Clinical and ambulatory blood pressures were taken into account in the analysis. Thus, 24 patients with the Turner syndrome and 25 healthy female subjects matched for age were studied. RESULTS Women with the Turner syndrome had a higher augmentation index than the controls (Turner, mean (SD) 0.04 (0.14) v controls, -0.14 (0.13), p < 0.001) but a lower peripheral pulse pressure (39 (8) mm Hg v 47 (11) mm Hg, p = 0.010 in the clinic; 44 (5) mm Hg v 47 (6) mm Hg, p = 0.036 during the 24 hour ambulatory recording). The luminal diameter of the common carotid artery and the carotid-femoral pulse wave velocity were similar in the two groups, whereas carotid intima-media thickness tended to be higher in women with the Turner syndrome (0.53 (0.06) mm v 0.50 (0.05) mm, p = 0.06). After correction for body surface area, carotid intima-media thickness and pulse wave velocity were higher in women with the Turner syndrome. CONCLUSIONS Vascular abnormalities observed in the Turner syndrome are implicated in the origin of the cardiovascular complications that occur in this syndrome. These abnormalities are morphological but also functional. An increase in the augmentation index can be explained in part by the short height of these patients.
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Affiliation(s)
- J-P Baguet
- Department of Cardiology and Hypertension, University Hospital, Grenoble, France.
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47
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Taher T, Singal R, Sonnenberg B, Ross D, Graham M. Images in cardiovascular medicine. Sinus of valsalva rupture with dissection into the interventricular septum: diagnosis by echocardiography and magnetic resonance imaging. Circulation 2005; 111:e101-2. [PMID: 15723987 DOI: 10.1161/01.cir.0000157044.63554.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Taha Taher
- University of Alberta, Edmonton, Alberta, Canada.
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48
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Tanner H, Hindricks G, Schirdewahn P, Kobza R, Dorszewski A, Piorkowski C, Gerds-Li JH, Kottkamp H. Outflow tract tachycardia with R/S transition in lead V3. J Am Coll Cardiol 2005; 45:418-23. [PMID: 15680722 DOI: 10.1016/j.jacc.2004.10.037] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Revised: 10/02/2004] [Accepted: 10/04/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to analyze different anatomic mapping approaches for successful ablation of outflow tract tachycardia with R/S transition in lead V(3). BACKGROUND Idiopathic ventricular tachycardia can originate from different areas in the outflow tract, including the right and left ventricular endocardium, the epicardium, the pulmonary artery, and the aortic sinus of Valsalva. Although electrocardiographic criteria may be helpful in predicting the area of origin, sometimes the focus is complex to determine, especially when QRS transition in precordial leads is in V(3). METHODS We analyzed surface electrocardiograms of 33 successfully ablated patients with outflow tract tachycardia: 20 from the right ventricular outflow tract (RVOT) and 13 from different sites. The R/S transition was determined, and the different anatomic approaches needed for successful catheter ablation were studied. RESULTS Overall, R/S transition in lead V(3) was present in 19 (58%) of all patients. In these patients, mapping was started and successfully completed in the RVOT in 11 of 19 (58%) patients. The remaining eight patients with R/S transition in lead V(3) needed five additional anatomic accesses for successful ablation: from the left ventricular outflow tract (n = 3), aortic sinus of Valsalva (n = 2), coronary sinus (n = 1), the epicardium via pericardial puncture (n = 1), and the trunk of the pulmonary artery (n = 1), respectively. CONCLUSIONS A R/S transition in lead V(3) is common. In patients with outflow tract tachycardia with R/S transition in lead V(3), a stepwise endocardial and epicardial mapping through up to six anatomic approaches can lead to successful radiofrequency catheter ablation.
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Affiliation(s)
- Hildegard Tanner
- University of Leipzig-Heart Center, Cardiology, Department of Electrophysiology, Struempellstrasse 39, D-04289 Leipzig, Germany.
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49
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Korneeva ON, Drapkina OM, Ivashkin VT, Ulanova IN, Kuznetsov NE. [A case of rupture of aneurysm of noncoronary sinus of Valsalva]. Klin Med (Mosk) 2005; 83:59-60. [PMID: 16279044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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50
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Abstract
Submitral aneurysm (SMA) is congenital outpouching of the left ventricular (LV) wall invariably occurring adjacent to the posterior leaflet of mitral valve. SMA is typically diagnosed in young adults who present with severe mitral regurgitation, heart failure, systemic embolism, and sudden cardiac death. African blacks account for the majority of the reported SMA cases. Our report of the very rare combination of SMA with aortic sinus aneurysm lends support to the congenital origin of this pathology occurring due to developmental deficiency in the fusion of myocardium and cardiac fibro skeleton. Complete diagnosis was made by transthoracic echocardiography.
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Affiliation(s)
- Anand Chockalingam
- Department of Cardiology, Madras Medical College & Research Institute, Chennai, India.
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