Accidental finding of ALCAPA in a child with severe mitral regurgitation: A case study.

CASE REPORT: A six-year-old child who had undergone cardiac surgery five years ago presented to us with severe mitral valve regurgitation. During her current surgery, the coronary artery was injured during the attempt to release extensive epicardial adhesion, resulting in very poor contractility that prompted a delay in the intended valve repair. The injured coronary vessels were successfully repaired, yet low cardiac output syndrome persisted during perioperative care, necessitating further investigation of the coronary problem. It was later discovered that the patient had anomalous left coronary artery from pulmonary artery (ALCAPA) syndrome. DISCUSSION: The presence of severe mitral regurgitation, pulmonary hypertension, and anatomical factors may have contributed to the delayed presentation and diagnosis in this case. The severity of mitral regurgitation and the most likely underlying mechanism indicates a low possibility of recovery following coronary repair alone, warranting the need for concomitant mitral surgery. Coronary and mitral repair were performed in this patient, resulting in a favorable outcome. CONCLUSIONS: The management of ALCAPA presents unique challenges, especially in cases with delayed diagnosis. Proper diagnosis and tailored surgical approaches are crucial for achieving favorable outcomes in patients with ALCAPA.

Analysis and Visualization of Inter-/Intra-surgeon Variability Using Surgical Simulation for Partial Anomalous Pulmonary Venous Connection Repair.

There may be inter-/intra-surgeon variability in the repair of congenital heart defects. The objective was to analyze and visualize inter-/intra-surgeon variability in the level of patch suture lines and in the shape and size of patches developed through surgical simulation for partial anomalous pulmonary venous connection (PAPVC) repair using a patient-specific 3D-printed heart model. A patient with PAPVC and preoperative computed tomography data were selected, and a patient-specific heart model was obtained. Two different exposures on the model were tested. Two surgeons were enrolled. Both surgeons performed a single-patch repair on four heart models with one exposure and four models with the other. On the potential suture line, 20 points common in each model were allocated. The level of patch suture lines was represented as a deviation from the 20 points. The shape and size of the patches were analyzed and visualized using geometric morphometrics approaches, using the 20 points as landmarks to represent the patches. There was inter-surgeon variability in the level of patch suture lines, and the variability was higher in particular locations. There was inter-surgeon variability in the shape and size of patches, which was not affected by the exposures. The inter-surgeon variability in the shape of patches was higher in particular locations. There was intra-surgeon variability in the shape of patches. Inter-/intra-surgeon variability was analyzed and visualized by the surgical simulation using geometric morphometrics approaches. Further studies are needed to scrutinize whether the variability affects postoperative hemodynamics in actual surgery.

Pseudo hepatic vein thrombosis in a newborn with infracardiac total anomalous pulmonary venous connection.

We report an interesting incidental liver finding during ECG-gated cardiac computed tomography (CT) in a newborn with infracardiac total anomalous pulmonary venous connection to the portal vein. This case shows a unique abnormality in hepatic perfusion that was initially mistaken for hepatic vein thrombosis. We review the altered hepatic blood flow distribution in this pathologic anatomy to help explain the observed hepatic perfusion abnormality on CT. This understanding will enable an imager to anticipate hepatic perfusion patterns in similar patients, potentially avoiding misdiagnosis and unnecessary further testing.

Coronary arteriovenous fistula originating from the left coronary artery and draining into the superior vena cava.

Coronary arteriovenous fistulas are rare coronary anomalies. Most fistulas arise from the right coronary artery and drain into the right heart structures. We report a case of a 59-year-old man with a rare coronary arteriovenous fistula that originates from the left coronary artery and drains into the superior vena cava. He was diagnosed incidentally with cardiac computed tomography during the investigation for atrial fibrillation. Surgical fistula ligation was successfully performed under cardiac arrest with cardiopulmonary bypass. The patient was discharged without complications.

Percutaneous Coronary Intervention to a Hypoplastic Reimplanted Left Main Coronary in an Adolescent.

Critical ostial stenosis following reimplantation of an anomalous left main coronary artery is extremely rare. Currently, there is no consensus on management following diagnosis. This report demonstrates the feasibility of percutaneous coronary intervention in an adolescent with such a condition and emphasizes the importance of periprocedural multimodality imaging.

Chronic total occlusion percutaneous coronary intervention of anomalous coronary arteries: insights from the PROGRESS CTO registry.

BACKGROUND: There is limited information about the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in anomalous coronary arteries (ACA). METHODS: We examined the clinical and angiographic characteristics and procedural outcomes of CTO PCI in ACA among 14,173 patients who underwent 14,470 CTO PCIs at 46 US and non-US centers between 2012 and 2023. RESULTS: Of 14,470 CTO PCIs, 36 (0.24%) were CTO PCIs in an ACA. ACA patients had similar baseline characteristics as those without an ACA. The type of ACA in which the CTO lesion was found were as follows: anomalous origin of the right coronary artery (ARCA) (17, 48.5%), anomalous origin of left circumflex coronary artery (9, 25.7%), left anterior descending artery and left circumflex artery with separate origins (4, 11.4%), anomalous origin of the left anterior descending artery (2, 5.7%), dual left anterior descending artery (2, 5.7%) and woven coronary artery 1 (2.8%). The Japan CTO score was similar between both groups (2.17 ± 1.32 vs 2.38 ± 1.26, p = 0.30). The target CTO in ACA patients was more likely to have moderate/severe tortuosity (44% vs 28%, p = 0.035), required more often use of retrograde approach (27% vs 12%, p = 0.028), and was associated with longer procedure (142.5 min vs 112.00 min [74.0, 164.0], p = 0.028) and fluoroscopy (56 min [40, 79 ml] vs 42 min [25, 67], p = 0.014) time and higher contrast volume (260 ml [190, 450] vs 200 ml [150, 300], p = 0.004) but had similar procedural (91.4% vs 85.6%, p = 0.46) and technical (91.4% vs 87.0%, p = 0.59) success. No major adverse cardiac events (MACE) were seen in ACA patients (0% [0] vs 1.9% [281] in non-ACA patients, p = 1.00). Two coronary perforations were reported in ACA CTO PCI (p = 0.7 vs. non-ACA CTO PCI). CONCLUSIONS: CTO PCI of ACA comprise 0.24% of all CTO PCIs performed in the PROGRESS CTO registry and was associated with higher procedural complexity but similar technical and procedural success rates and similar MACE compared with non-ACA CTO PCI.

A Low-Profile and Ultra-Wideband Pancharatnam-Berry Coding Metasurface for High-Efficiency and Wide-Angle Circular Polarization Anomalous Reflection.

The manipulation of electromagnetic waves using metasurfaces is important in areas such as stealth and communication. In this paper, we reported on the use of an element-based polarizer for the first step, which enables the incident electromagnetic waves to integrate into the cross-polarized waves with a relative bandwidth of 88% within 15-37.1 GHz. Then, an eight-element coding metasurface based on the Pancharatnam-Berry phase is presented for circular polarization anomalous reflection. The simulated values show that our work can achieve a high-efficiency (94%) and wide-angle (70°) anomalous reflection under normal incidence. The simulated values present good agreement with the experimental values. Our work reveals the ability to manipulate the waves and electromagnetic stealth.

Bose Metals, from Prediction to Realization.

Bose metals are metals made of Cooper pairs, which form at very low temperatures in superconducting films and Josephson junction arrays as an intermediate phase between superconductivity and superinsulation. We predicted the existence of this 2D metallic phase of bosons in the mid 1990s, showing that they arise due to topological quantum effects. The observation of Bose metals in perfectly regular Josephson junction arrays fully confirms our prediction and rules out alternative models based on disorder. Here, we review the basic mechanism leading to Bose metals. The key points are that the relevant vortices in granular superconductors are core-less, mobile XY vortices which can tunnel through the system due to quantum phase slips, that there is no charge-phase commutation relation preventing such vortices from being simultaneously out of condensate with charges, and that out-of-condensate charges and vortices are subject to topological mutual statistics interactions, a quantum effect that dominates at low temperatures. These repulsive mutual statistics interactions are sufficient to increase the energy of the Cooper pairs and lift them out of condensate. The result is a topological ground state in which charge conduction along edges and vortex movement across them organize themselves so as to generate the observed metallic saturation at low temperatures. This state is known today as a bosonic topological insulator.

Endovascular embolization of a congenital inferior phrenic artery-to-pulmonary arteriovenous malformation: a rare case report.

BACKGROUND: Pulmonary arteriovenous malformation (PAVM) is abnormal arteriovenous shunts between pulmonary artery (PA) and pulmonary vein, and rarely has congenital direct communications with systemic arteries. CASE PRESENTATION: A 33-year-old male presented to our hospital with intermittent bloody sputum with no evidence of pulmonary infection, trauma or surgery. Chest computed tomography angiography (CTA) indicated the congenital inferior phrenic artery (IPA)-to-PAVM surrounded by diffuse alveolar hemorrhage located in the lower lobe of right lung. Both the afferent PA and IPA were successfully embolized with coils. Recurrent hemoptysis did not occur during one-year follow up. CONCLUSIONS: The congenital communication between IPA and PAVM is rare, and the abnormal direct shunt would induce hemodynamically unstable condition within PAVM. Endovascular embolization of the afferent PA and IPA is a safe and effective method for this abnormal congenital shunt in lung.

Progress of surgical treatment of anomalous left coronary artery from the pulmonary artery.

Anomalous left coronary artery from the pulmonary artery is a rare CHD. It is the most common type of anomalous coronary origin. It may cause myocardial ischaemia or infarction, mitral regurgitation, congestive heart failure, and early death in infancy if left untreated. Surgery is the only treatment for anomalous left coronary artery from the pulmonary artery. In recent years, with advancements in surgical techniques and the widespread utilisation of extracorporeal cardiac assist devices such as extracorporeal membrane oxygenation, the treatment outcomes for anomalous left coronary artery from the pulmonary artery have demonstrated significant improvements. However, the surgical indications and methods of anomalous left coronary artery from the pulmonary artery, especially the surgical methods of anomalous left coronary artery from the pulmonary artery with intramural coronary artery, and whether to treat mitral regurgitation at the same time are still controversial. The long-term complications and prognosis remain discouraging simultaneously, with significant variations in outcomes across different centres. The present review specifically addresses these aforementioned concerns. Based on the literature published at home and abroad, we found that no matter what type of anomalous left coronary artery from the pulmonary artery patients, even asymptomatic patients, regardless of the collateral circulation between the left and right coronary arteries, should immediately undergo surgical treatment to promote the recovery of left ventricular function. Based on different coronary artery anatomical morphology and preoperative cardiac function, the long-term follow-up results of individualised surgical treatment of anomalous left coronary artery from the pulmonary artery children show good prognosis, and most children have significant improvement in cardiac function. Patients with moderate to severe mitral regurgitation should undergo mitral valve operation at the same time as anomalous left coronary artery from the pulmonary artery repair. Mitral valvuloplasty can quickly improve mitral regurgitation and promote the early recovery of cardiac function after operation, and does not increase the risk of operation. Mechanical circulatory support is a safe and effective means of early postoperative transition for children with severe anomalous left coronary artery from the pulmonary artery. Anomalous left coronary artery from the pulmonary artery with intramural coronary artery is a rare anomaly. According to different anatomical types, different surgical methods can be used for anatomical correction, and satisfactory early and mid-term results can be obtained.

Temporal and spatial analysis of event-related potentials in response to color saliency differences among various color vision types.

Introduction: Human color vision exhibits significant diversity that cannot be fully explained by categorical classifications. Understanding how individuals with different color vision phenotypes perceive, recognize, and react to the same physical stimuli provides valuable insights into sensory characteristics. This study aimed to identify behavioral and neural differences between different color visions, primarily classified as typical trichromats and anomalous trichromats, in response to two chromatic stimuli, blue-green and red, during an attention-demanding oddball task. Methods: We analyzed the P3 component of event-related potentials (ERPs), associated with attention, and conducted a broad spatiotemporal exploration of neural differences. Behavioral responses were also analyzed to complement neural data. Participants included typical trichromats (n = 13) and anomalous trichromats (n = 5), and the chromatic stimuli were presented in an oddball paradigm. Results: Typical trichromats exhibited faster potentiation from the occipital to parietal regions in response to the more salient red stimulus, particularly in the area overlapping with the P3 component. In contrast, anomalous trichromats revealed faster potentiation to the expected more salient blue-green stimulus in the occipital to parietal regions, with no other significant neural differences between stimuli. Comparisons between the color vision types showed no significant overall neural differences. Discussion: The large variability in red-green sensitivity among anomalous trichromats, along with neural variability not fully explained by this sensitivity, likely contributed to the absence of clear neural distinctions based on color saliency. While reaction times were influenced by red-green sensitivity, neural signals showed ambiguity regarding saliency differences. These findings suggest that factors beyond red-green sensitivity influenced neural activity related to color perception and cognition in minority color vision phenotypes. Further research with larger sample sizes is needed to more comprehensively explore these neural dynamics and their broader implications.

Selective Control of Electric Charge of Weyl Fermions in Pyrochlore Iridates.

Weyl fermions can exhibit exotic phenomena due to their magnetic charge in momentum space, while Weyl nodes are usually located away from Fermi energy, which forms electron or hole pockets as the electric charges. Previous studies have mostly focused on the magnetic charge, however, the electric charges are rarely explored. Here, the intriguing Hall responses arising from the interplay between magnetic and electric charges of Weyl fermions in pyrochlore iridates are reported. Explicitly, unexpected linear scaling is observed between the anomalous Hall conductivity and Hall carrier density in strained Nd2Ir2O7 thin films, and its slope shows a sign change approaching the Néel temperature of Nd. Theoretical calculations unveil that the cluster magnetic multipoles induce local energy inversion of Weyl nodes, which alters the electric charge of Weyl fermions and accounts for the observed nontrivial Hall responses. Moreover, the correlation between the magnetic and electric charges is further probed by voltage-controlled hydrogenation, which leads to the suppression of the anomalous Hall effect through electron filling. This work not only reveals the essential role of the both magnetic and electric charges of Weyl fermions, but also demonstrates the hydrogenation as an effective tuning knob in exploring correlated topological properties.

The hidden dangers of the coronary anomalies: an ARCAPA case report.

An anomalous origin of the right coronary artery from the pulmonary artery case report. The diagnosis was made by angiotomography. Reimplantation of the right coronary artery into the ascending aorta and reconstruction of the pulmonary artery were conducted.

Frightening maternal behavior over the first 2 years of life: effects on children's behavior problems in middle childhood.

Frightening maternal behavior is linked to infant disorganization, which predicts child behavioral problems. We examined continuity in frightening maternal behavior across the first 2 years by developing a new measure of anomalous/frightening (AN/FR) behavior that incorporates changes in parent-child interactions as children acquire symbolic representation. Maternal AN/FR behavior in toddlerhood also was examined in relation to later internalizing and externalizing symptoms. First-time mothers (N = 125) completed the Adult Attachment Interview (AAI) prenatally, and mother-child dyads were observed interacting at 8 months, in Strange Situations at 12-15 months, and playing at 24 months. Teachers rated children's behavior problems at 7 years. Mothers classified as Unresolved on the AAI displayed more Frightening (FR) behavior at 8 months. Mothers' FR behavior predicted both attachment disorganization at 12-15 months and maternal AN/FR behavior at 24 months, which then predicted children's internalizing symptoms at age 7. Infant disorganization was indirectly related to internalizing symptoms, mediated by maternal AN/FR behavior.

Anomalous Aortic Origin of a Coronary Artery: Results from a Single Surgical Team in Spain.

OBJECTIVES: Anomalous aortic origin of a coronary artery is a rare congenital lesion in which a coronary artery arises from an anomalous location within the aorta. Anomalous aortic origin of a coronary artery has been associated with myocardial ischemia and it is considered the second most common cause of sudden cardiac arrest in young athletes. When surgical repair is indicated, surgical unroofing is the most commonly employed technique. Our objective is to describe the outcomes of our surgically treated patients. METHODS: We present a series of 16 adult patients who underwent surgical repair of anomalous aortic origin of a coronary artery. Patients were treated in three different institutions by the same surgeon. Surgical unroofing of the anomalous coronary artery was the surgical technique chosen in the majority of the patients. Follow-up was performed. RESULTS: Unroofing of an intramural anomalous coronary artery was the procedure performed in 11 patients. Three patients underwent neo-ostium creation; one patient underwent a David procedure with coronary reimplantation; and one patient was treated with coronary bypass grafting due to severe coronary atheromatous lesions. There were no perioperative deaths, and no major postoperative complications. Follow-up period was 73.8 months, the survival rate was 100%, and there were neither ischemia or heart failure reports. CONCLUSIONS: The surgical repair of anomalous aortic origin of a coronary artery by coronary unroofing or neo-ostium creation has demonstrated excellent early and late outcomes. Late survival was excellent. The follow-up period revealed no significant morbidity or complications.

Unveiling the Rarity: An Anomaly of the Left Circumflex Artery Supplying Left Ventricular Apex and Presenting With Myocardial Infarction.

Coronary arteries are typically identified based on the myocardial territory they supply. In rare cases of coronary artery anomalies, the apex of the heart may be supplied by arteries other than the left anterior descending artery. While it is more common for the posterior descending artery from the right coronary artery to supply the apex, there are rare instances where the left circumflex (LCX) artery performs this function. This case report describes an unusual occurrence where the left ventricular apex is supplied by an obtuse marginal branch of the LCX artery. We present this case due to its rarity, unique presentation, and the challenges it poses for both medical and surgical management.

Outcomes of the Modified Warden Procedure for Partial Anomalous Pulmonary Venous Connection Drainage to a High Location in the Superior Vena Cava.

AIM: To report the safety and effectiveness of a modified Warden procedure. METHOD: Twenty-six (26) patients underwent modified Warden surgery at our centre from September 2017 to September 2021. In all patients, the superior vena cava (SVC) was reconstructed by turning the atrial wall in the main body of the right atrium upwards and applying fresh autologous pericardial patches. There were 13 male patients and 13 female patients, and the median age of the patients was 7.0 (range, 0.3-47.0) years. The median follow-up time after surgery was 47.0 (range, 32.0-80.0) months. RESULTS: The aortic cross-clamp time was 108.50±34.72 minutes, the cardiopulmonary bypass time was 154.81±41.65 minutes, the median postoperative mechanical ventilation time was 8.5 (range, 0.0-91.0) hours, the median intensive care unit stay was 43.5 (range, 15.0-352.0) hours, and the median length of postoperative hospital stay was 7.0 (range, 6.0-19.0) days. All patients were safely and successfully discharged from the hospital. No deaths or sinus node dysfunction occurred during the follow-up period. The mean gradient of the reconstructed SVC and/or the right pulmonary vein (PV) increased in eight patients and decreased to less than 1 mmHg in six patients. One (1) adult patient had already undergone two vascular interventions, and one child had persistent stenosis but did not undergo reoperation at the time of the study. In addition, two patients were subjected to pericardial windowing. CONCLUSIONS: A modified Warden technique using a right atrial flap and autologous pericardium effectively corrected the high-plane connection between the PVs and SVC. This technique effectively avoids sinus node dysfunction; however, a short-term increase in the differential pressure of the re-established SVC or PV after the procedure is acceptable, and reintervention is required only in rare cases.

Aggregation of adult parasitic nematodes in sex-mixed groups analysed by transient anomalous diffusion formalism.

Intestinal parasitic worms are widespread throughout the world, causing chronic infections in humans and animals. However, very little is known about the locomotion of the worms in the host gut. We studied the movement of Heligmosomoides bakeri, naturally infecting mice, and used as an animal model for roundworm infections. We investigated the locomotion of H. bakeri in simplified environments mimicking key physical features of the intestinal lumen, i.e. medium viscosity and intestinal villi topology. We found that the motion sequence of these nematodes is non-periodic, but the migration could be described by transient anomalous diffusion. Aggregation as a result of biased, enhanced-diffusive locomotion of nematodes in sex-mixed groups was detected. This locomotion is probably stimulated by mating and reproduction, while single nematodes move randomly (diffusive). Natural physical obstacles such as high mucus-like viscosity or villi topology slowed down but did not entirely prevent nematode aggregation. Additionally, the mean displacement rate of nematodes in sex-mixed groups of 3.0 × 10-3 mm s-1 in a mucus-like medium is in good agreement with estimates of migration velocities of 10-4 to 10-3 mm s-1 in the gut. Our data indicate H. bakeri motion to be non-periodic and their migration random (diffusive-like), but triggerable by the presence of kin.

Integrated Artificial Neural Network with Trainable Activation Function Enabled by Topological Insulator-Based Spin-Orbit Torque Devices.

Nonvolatile memristors offer a salient platform for artificial neural network (ANN), yet the integration of different function and algorithm blocks into one hardware system remains challenging. Here we demonstrate the brain-like synaptic (SOT-S) and neuronal (SOT-N) functions in the Bi2Te3/CrTe2 heterostructure-based spin-orbit torque (SOT) device. The SOT-S unit exhibits highly linear and symmetrical long-term potentiation/depression process, resulting in a fast-training of the MNIST data set with the classification accuracy above 90%. Meanwhile, the Sigmoid-shape transition curve inherited in the SOT-N cell replaces the software-based activation function block, hence reducing the system complexity. On this basis, we employ a serial-connected, voltage-mode sensing ANN architecture to enhance the vector-matrix multiplication signal strength with low reading error of 0.61% while simplifying the peripheral circuitry. Furthermore, the trainable activation function of SOT-N enables the implementation of the Batch Normalization algorithm and activation operation within one clock cycle, which bring about improved on/off-chip training performance close to the ideal baseline.