Topographical anatomy of the left ventricular summit: implications for invasive procedures.

BACKGROUND: Recent clinical reports have emphasized the clinical significance of the left ventricular summit (LVS), a specific triangular epicardial area, as the source of ventricular arrhythmias where radiofrequency ablation is of great difficulty. MATERIALS AND METHODS: The macroscopic morphology of the LVS has been assessed in 80 autopsied and 48 angio-computed tomography (CT) human hearts. According to Yamada's equation, the size was calculated based on the distance to the first, most prominent septal perforator. RESULTS: The size of the LVS varies from 33.69 to 792.2 mm2, is highly variable, and does not correlate with body mass index, sex, or age in general. The mean size of the LVS was 287.38 ± 144.95 mm2 in autopsied and angio-CT (p = 0.44). LVS is mostly disproportionately bisected by cardiac coronary veins to superior-inaccessible and inferior-accessible areas. The superior aspect dominates over the inferior in both groups (p = 0.04). The relation between superior and inferior groups determines three possible arrangements: the most common type is superior domination (50.2%), then inferior domination (26.6%), and finally, equal distribution (17.2%). In 10.9%, the inferior aspect is absent. Only 16.4% of the LVS were empty, without additional trespassing coronary arteries. CONCLUSIONS: The difference in size and content of the LVS is significant, with no correlation to any variable. The size depends on the anatomy of the most prominent septal perforator artery. The superior, inaccessible aspect dominates, and the LVS is seldom free from additional coronary vessels, thus making this region hazardous for electrophysiological procedures.

Morphometrical features of left atrial appendage in the atrial fibrillation patients subjected to left atrial appendage closure.

BACKGROUND: This study aimed to evaluate the morphometrical features of left atrial appendage (LAA) in patients with atrial fibrillation, subjected to LAA percutaneous closure (LARIAT) for stroke prevention. MATERIALS AND METHODS: Computed tomography (CT) scans of 51 patients with atrial fibrillation subjected to LARIAT procedure were comparatively evaluated with 50 patients with sinus rhythm (control group). Three-dimensional reconstructions were created using volume-rendering for evaluation. RESULTS: No differences were found in LAA types of distribution (cauliflower: 25.5 vs. 34.0%, chicken wing: 45.1 vs. 46.0%, arrowhead: 29.4 vs. 20.0%, all p > 0.05) between groups. However, the study group was characterized by LAAs with a lower number of lobes. The LAA orifice anteroposterior and transverse diameters (19.3 ± 4.12 vs. 17.2 ± 4.0 mm, p = 0.01 and 25.1 ± 5.1 vs. 20.5 ± ± 4.4 mm, p = 0.001), orifice area (387.2 ± 133.9 vs. 327.1 ± 128.3 mm2, p = 0.02) and orifice perimeter (70.2 ± 12.5 vs. 61.2 ± 11.6 mm, p = 0.04) was significantly larger in atrial fibrillation patients. More oval LAA orifices was found in atrial fibrillation group (94.0 vs. 70.4%, p = 0.001). No statistically significant differences were found in LAA body length (47.4 ± 15.4 vs. 43.7 ± 10.9 mm, p = 0.17), body width (24.7 ± 5.6 vs. 24.4 ± 5.8 mm, p = 0.81), and chamber depth (17.7 ± 3.5 vs. 16.5 ± 3.8 mm, p = 0.11). Calculated LAA ejection fraction was significantly lower in study group compared to healthy patients (16.4 ± 14.9 vs. 48.2 ± 12.9%, p = 0.001). CONCLUSIONS: Important morphometrical differences in LAA orifice have been found, which was significantly larger and more oval in patients with atrial fibrillation compared to healthy controls. Although no difference in LAA body type and size was observed; the LAA ejection fraction was significantly lower in atrial fibrillation rhythm patients.

Hand anthropometry in patients with carpal tunnel syndrome: a case-control study with a matched control group of healthy volunteers.

BACKGROUND: The aim of this study was to perform anthropometrical measure- ments of patients' hands with carpal tunnel syndrome (CTS) in order to evaluate if there is a correlation between CTS occurrence and hand features regarding sexual dimorphism, age and physical activity. MATERIALS AND METHODS: Study sample consisted of 48 patients (33 females) and control group included 80 healthy volunteers (58 females) with no history of CTS. The following measurements were performed: the wrist circumference, length of the hand, the hand's width, width of the wrist, thickness of the wrist, height of the hypothenar and thenar, length of the arm and forearm, circumference of the proximal phalanges and width of the digits; as well as several indexes were calculated i.e.: body mass index (BMI), shape index, digit index, wrist index, hand length/height ratio (HLH-ratio) and hand length/upper limb length ratio (HLULL-ratio). RESULTS: Correlation coincidences were analysed between circumferences within the hand, palm and body weight. All parameters except fingers were correlated with body weight in either gender in both groups (p < 0.05; r = 0.40-0.80); Furthermore, width of the hand was correlated with body height (p < 0.001; r = 0.56-0.71). Mean values of wrist index for CTS patients were: males: 0.8, females: 0.74 (significantly higher than in healthy individuals and indicating square shape); shape index: males 76.5, females 75.8; digit index: males 55.7, females 56.5. The calculated HLH-ratio in CTS group was: males 10.6, females 10.9; HLULL-ratio: males 23.6, females 24.9 and they did not differ significantly from healthy volunteers. Almost 90.0% of females with diagnosed CTS have BMI > 25.0 kg/m2. CONCLUSIONS: There are significant differences in morphometrical features of the upper limbs between CTS patients and healthy individuals. Hands of patients with CTS are more massive and with 'plumb' fingers and square shape of the wrist. Furthermore, higher BMI values were confirmed to be predisposing factors in CTS occurrence.

A comprehensive guide to telocytes and their great potential in cardiovascular system.

Telocytes, a recently discovered type of interstitial cells, have a very distinctive morphology - the small cell body with long extensions, named telopodes. In our review, apart from introducing general aspects of telocytes, we focus on properties, functions and future potential of those cells in cardiovascular system. However, physiological functions of telocytes in cardiovascular system are still regarded as quite enigmatic. Previous studies claim that they play a role in organogenesis and regeneration, bioelectrical signalling, mechanoelectrical coupling, anti-oxidative protection, angiogenesis and regulation of blood flow. As well, they are presumably connected with the presence of blood-myocardium barrier and proper organisation of extracellular matrix. Moreover, there exists a significant link between the quantity of telocytes in tissue and numerous cardiovascular diseases such as: myocardial infarction, cardiomyopathies, systemic sclerosis, heart failure, atrial fibrillation, isolated atrial amyloidosis, myxomatous valve degeneration and hyperplastic consequences of vascular injury. Thanks to their unique properties, telocytes might be a breakthrough in treatment of cardiovascular diseases, as they may be effective in reversing effects of myocardial infarction. Telocytes also may play a major role in tissue engineering - they might be the key factor in creating stable and efficient vascular network in larger synthetic tissues or organs (Tab. 1, Fig. 3, Ref. 53).