Image analysis of morphometric evaluation from the heart valves for age estimation in Thai population / Análisis de la evaluación morfométrica de las valvas cardíacas para la estimación de la edad en la población tailandesa

Determination of age represents one of the most important aspects in forensic identification. Through aging, changes can occur in morphological structures of the heart valves. The objective is to examine the relationship between the dimensions of the rigth atrioventricular (tricuspid), pulmonary, left atrioventricular (mitral), and aortic valves and age at death. Sixty fresh human hearts were obtained from Department of Anatomy and Department of Forensic Medicine, Faculty of medicine, Chiang Mai University, Thailand. The age of individuals was between 20-90 years. We investigated the morphometric parameters of the valves were taken including: valve circumference, length, the height and area of each leaflet. All parameters were measured by using specific image analysis software. The correlation test and predictive equation were established. The positive correlation between the circumference, area of posterior leaflet, height of anterior leaflet, and area of anterior leaflet of the rigth atrioventricular valve were found. The left atrioventricular valve showed correlation with age in circumference, length and area of posterior leaflet. For the pulmonary and aortic valves, there were correlated between circumference at sinotubular junction and leaflet sizes in almost leaflets. The circumference at sinotubular junction of the pulmonary valve was highest significantly correlation with age (r=0.693). The predictive equation was age = -3.659+0.652(Circumference at sinotubular junction of the pulmonary valve) with standard error of ± 14.7 years. Additional knowledge of morphometric features in human heart valves and its relationship with age could be used as age indicator in forensic field.

La determinación de la edad representa uno de los aspectos más importantes en la identificación forense. Pueden ocurrir cambios a través del envejecimiento, en las estructuras morfológicas de las válvulas cardíacas. El objetivo de este estudio fue examinar la relación entre las dimensiones de las valvas atrioventricular derecha (tricúspide), pulmonar, atrioventricular izquierda (mitral) y aórtica, y la edad en relación a la muerte. Se obtuvieron sesenta corazones humanos frescos del Departamento de Anatomía y el Departamento de Medicina Forense de la Facultad de Medicina de la Universidad de Chiang Mai, Tailandia. La edad de las personas fluctuaba entre los 20 y 90 años. Investigamos los parámetros morfométricos de las valvas analizadas, incluyendo: circunferencia de la valva, longitud, altura y área de cada valva. Todos los parámetros se midieron utilizando un software de análisis de imagen específico. Se estableció la prueba de correlación y la ecuación predictiva. Se encontró la correlación positiva entre la circunferencia, el área de la valvula posterior, la altura de la valvula anterior y el área de la valvula anterior de la valva atrioventricular derecha. La valva atrioventricular izquierda mostró correlación con la edad en la circunferencia, longitud y área de la valvula posterior. Para las valvas pulmonar y aórtica, se correlacionó entre la circunferencia en la unión sinotubular y el tamaño de las válvulas. La circunferencia en la unión sinotubular de la valva pulmonar fue la mayor correlación significativa con la edad (r = 0,693). La ecuación predictiva fue edad = -3,659 + 0,652 (circunferencia en la unión sinotubular de la valva pulmonar) con error estándar de ± 14,7 años. El conocimiento adicional de las características morfométricas en las valvas cardíacas humanas y su relación con la edad podría usarse como indicador de edad en el campo forense.

Quadruple valve replacement for carcinoid heart disease

Abstract Introduction: Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature. Methods: All three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours. Results: Mean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases. Conclusion: Surgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement.

Large Eustachian valve: An incidental finding yet perplexing.

Eustachian valve (EV), a remnant of the right valve of sinus venosus in the right atrium can be puzzling. Often it is confused with Chiari network or atrial adhesions and is reported with unusual complications. We report a case of large EV impeding cannulation of inferior vena cava (IVC) during aortic valve replacement. Transesophageal echocardiography diagnosed the presence of large EV and warned of the difficulty with IVC cannulation and helped preparedness for an alternative plan during surgery.