Relationships between left atrial pericardial fat and permanent atrial fibrillation: Results of a case-control study.

PURPOSE: The goal of this study was to retrospectively investigate the relationships between pericardial fat, left atrium volume (LAV) as measured on multidetector row computed tomography (MDCT) and persistent atrial fibrillation (AF) using a case-control study. MATERIALS AND METHODS: The study population consisted of 58 patients (19 men, 39 women; mean age, 67.8±10 [SD] years) with persistent AF and 74 control subjects (30 men, 44 women; mean age, 67.8±10.9 [SD] years). The associations between the presence of persistent AF and periatrial pericardial fat volume (PAFV), periatrial pericardial fat thickness (PAFT), and LAV as measured on MDCT were searched for using univariate and multiple linear regression analysis. RESULTS: On univariate analysis, significant differences were found between patients with AF and control subjects for mean PAFV (54.33cm(3)±23.43 [SD]; range: 12.2-111.1cm(3) vs 42.99cm(3)±20.76 [SD]; range: 7.4-103.9cm(3), respectively) (P=0.01), PAFT at the esophagus (1.87mm±1.65 [SD]; range: 0.1-9.5mm vs 1.12mm±0.77 [SD]; range: 0.1-3.6mm, respectively) (P<0.001) and normalized LAV (78.3cm(3)/m(2)±48.84 [SD]; range: 32.1-319.6cm(3)/m(2) vs 42.1cm(3)/m(2)±25.43 [SD]; range: 15.7-191.4cm(3)/m(2), respectively) (P<0.001). Multiple linear regression analysis revealed that only LAV was an independent predictor (P<0.001) of persistent AF. Also PAFV was significantly associated with LAV (P=0.01). CONCLUSION: LAV is greater in patients with AF than in control subjects and PAFV is strongly associated with LAV. PAFV and PAFT are not independently associated with AF.

Persistent left superior vena cava with absent right superior vena cava: a case report and review of the literature.

We report on a rare case of persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC), an anomaly that is also known as isolated PLSVC. This venous malformation was identified incidentally in a 30-year-old woman during thoracic multi-detector computed tomography (MDCT), which was performed with the suspicion of intra-thoracic malignancy. On thoracic MDCT, the RSVC was absent. A bridging vein drained the right jugular and right subclavian veins and joined the left brachiocephalic vein in order to form the PLSVC, which descended on the left side of the mediastinum and drained into the right atrium (RA) via a dilated coronary sinus (CS). The patient was referred to the cardiology department for further evaluation. Transthoracic echocardiography revealed a dilated CS, and agitated saline injected from the left or right arms revealed opacification of the CS before the RA. The patient had no additional cardiac abnormality. Isolated PLSVC is usually asymptomatic but it can pose difficulties with central venous access, pacemaker implantation and cardiothoracic surgery. This condition is also associated with an increased incidence of congenital heart disease, arrhythmias and conduction disturbances. A wide spectrum of clinicians should be aware of this anomaly, its variations and possible complications.

Comparison of unilateral hemilaminotomy and bilateral hemilaminotomy according to dural sac area in lumbar spinal stenosis.

INTRODUCTION: Unilateral hemilaminotomy (ULH) and/or bilateral hemilaminotomy (BLH) with limited facetectomy are defined approaches to decompress the thecal sac and exiting lumbar nerve roots without increasing the risk of subsequent spinal instability. METHODS: We retrospectively analyzed 18 cases with degenerative lumbar spinal stenosis (LSS) with BLH or ULH that was performed in 11 and 7 cases, respectively. Magnetic resonance imaging (MRI) was performed at the follow-up examination and dural sac area (DSA) was calculated on T(2)-weighted MRI images and then compared statistically. In addition, the economic and functional status of the patients were evaluated with the Prolo scale. RESULTS: The mean preoperative values on the visual analogue scale (VAS) were 7.1 for lumbalgia and 7.0 for leg pain, respectively. These values were calculated as 4.8 and 4.4 at the follow-up, respectively. The VAS was significantly improved after operation compared to preoperative values (p=0.001). The mean value of the DSA was 84 (+/-32) mm(2) before the operation and 126 (+/-35) mm(2) at the follow-up and the comparison was statistically significant (p=0.001). No statistical correlation was found between VAS and DSA or between VAS and ULH-BLH groups, however, DSA of the BLH cases was significantly higher than in the ULH group (p=0.035). There was a significant negative correlation between VAS scores (back and leg pain) and Prolo status. However, there was no significant difference between DSA and Prolo scores, and between ULH or BLH groups in terms of Prolo scores. CONCLUSION: A unilateral approach with bilateral decompression and bilateral approach with bilateral hemilaminotomy are both minimal invasive, adequate and safe approaches with excellent prognosis. However, BLH leads to a bigger expansion of DSA.

Persistent primitive hypoglossal artery and fenestration of posterior cerebral artery: CT and MR angiography.

Persistent primitive hypoglossal artery (PPHA) which is a persistent carotid-basilar anastomosis is a rare vascular anomaly. It is usually found incidentally. Fenestrations of cerebral arteries are uncommon. Herein we present a case of PPHA with fenestration of posterior cerebral artery. A 28 year old man was admitted to our hospital with complaints of dizziness and temporary loss of vision. Neurological examination revealed no abnormal findings. The patient was further evaluated with CT and MR angiography. To our knowledge, the case we reported is the first case in the literature with PPHA and fenestration of posterior cerebral artery. The detection of PPHA and associated vascular anomalies and diseases are important before surgical and interventional procedures. CT and MR angiography are much safer diagnostic alternatives in the detection of PPHA and fenestrations. When PPHA is detected, attention should be given to the coexistent posterior circulation anomalies.

Persistent primitive hypoglossal artery and fenestration of posterior cerebralartery: CT and MR angiography

Persistent primitive hypoglossal artery (PPHA) which is a persistent carotid-basilar anastomosis is ar are vascular anomaly. It is usually found incidentally. Fenestrations of cerebral arteries are uncommon. Herein we present a case of PPHA with fenestration of posterior cerebral artery. A 28 year old man was admitted to our hospital with complaints of dizzinessand temporary loss of vision. Neurological examination revealed no abnormal findings. The patient was further evaluated with CT and MR angiography.To our knowledge, the case we reported is the firstcase in the literature with PPHA and fenestration ofposterior cerebral artery. The detection of PPHA and associated vascular anomalies and diseases are important before surgical and interventional procedures.CT and MR angiography are much safer diagnosticalternatives in the detection of PPHA and fenestrations.When PPHA is detected, attention should be given tothe coexistent posterior circulation anomalies (AU)

La arteria hipoglosa primitiva persistente (AHPP) que es una anastomosis carótido-basilar persistente es una anomalía vascular rara. Se encuentra de forma incidental más frecuentemente. Las fenestraciones de arterias cerebrales son raras. Presentamos aquí un caso de AHPP con fenestración de la arteria cerebral posterior. Un varón de 28 años fue admitido en nuestrohospital por presentar mareo y pérdida transitoria devisión. El paciente fue evaluado con TC y angiografía de RM. Para nuestro conocimiento este es el primer casodescrito de una AHPP asociada a fenestración de laarteria cerebral posterior. La detección de AHPP y una anomalía vascular asociada son importantes antes de planificar tratamientos quirúrgicos o endovasculares. El CT y la angiografía en RM son formas de diagnóstico seguras ante anomalías vasculares. Cuando se detecta una AHPP se debe prestar atención a la coexistencia de nanomalías de la circulación posterior (AU)

Case report: Multidetector CT presentation of a parachute-like asymmetric mitral valve.

A 24-year-old man with a complaint of exertional dyspnoea had a Grade III/VI apical pansystolic murmur on physical examination. He underwent a transthoracic echocardiogram, which revealed a funnel-shaped mitral valve with moderately thick leaflet tissue and an eccentric orifice, as well as a bicuspid aortic valve. The mitral valve was mildly stenotic and severely regurgitant. Although demonstration of a single papillary muscle in the parasternal short axis view suggested a parachute mitral valve, the diagnosis was uncertain owing to poor echocardiographic acoustic quality. 16-row multidetector CT (MDCT) clearly demonstrated two papillary muscles and the patient was diagnosed as having a parachute-like asymmetric mitral valve. In conclusion, MDCT can be used as a complementary imaging technique for the evaluation of subvalvular mitral apparatus and papillary muscles, especially in patients with poor echocardiographic acoustic quality.