Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 762
Filtrar
1.
Arkh Patol ; 81(6): 5-15, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31851187

RESUMO

Hypertrophic cardiomyopathy (HCM) is a congenital disease caused by mutations in a number of sarcomere proteins. According to the type of mutation, clinical observations record similar clinical manifestations, myocardial pathological changes, and the timing of manifestation of the disease in HCM patients. OBJECTIVE: To study cardiomyocyte (CMC) ultrastructural changes in the interventricular septum (IVS) of patients with HCM and evaluate their specificity for this pathology. MATERIAL AND METHODS: IVS myocardial samples taken from 44 HCM patients aged 18-59 years at IVS myoectomy underwent an electron microscopic study. The diameter of CMCs and their nuclei was measured in semithin sections. RESULTS: A morphometric examination of the IVS myocardium in HCM patients revealed moderate hypertrophy of CMCs and their nuclei, the diameters of which averaged 23.7±4.4 and 5.2±0.9 µm, respectively. The IVS CMCs were characterized by the ultrastructural signs of hypertrophy: the larger size and number of structures ensuring contractile and synthetic functions; the myocytes contained higher amounts of myofibrils, intermyofibrillar mitochondria, granular endoplasmic reticulum cisterns, and free ribosomes. On the contrary, some CMCs had fewer myofibrils in the perinuclear region, which is an adaptive change under hemodynamic overload conditions. In addition, a number of myocytes displayed signs of dystrophic changes: the appearance of lipofuscin granules, myelin figures, phagosomes, lipid droplets, and vacuoles, which can fill all free sarcoplasmic zones. CONCLUSION: Ultrastructural changes characteristic of hypertrophy were found in IVS CMCs in HCM patients. In addition, there was partial myofibrillar loss and dystrophic changes in a number of myocytes, which are stereotypic compensatory-adaptive changes under hemodynamic overload conditions. All the above-mentioned changes in the CMC ultrastructure are characteristic of myocardial hypertrophy, but not specific for hypertrophic cardiomyopathy.


Assuntos
Cardiomiopatia Hipertrófica , Septo Interventricular , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Miocárdio , Miócitos Cardíacos , Miofibrilas , Adulto Jovem
2.
Rev Port Cardiol ; 38(7): 473-480, 2019 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31495717

RESUMO

INTRODUCTION: In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study. METHODS: We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years. RESULTS: A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker. The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes. CONCLUSION: ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause.


Assuntos
Técnicas de Ablação/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Etanol/farmacologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Septo Interventricular/cirurgia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/etiologia , Septo Interventricular/diagnóstico por imagem
3.
Int J Infect Dis ; 88: 120-126, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31499211

RESUMO

Human hydatidosis occurs mainly as a result of infection with the larvae of Echinococcus granulosus. Cardiac echinococcosis is an uncommon disease and the interventricular septum is rarely involved. This article is a review of all of the literature related to hydatid cyst in the interventricular septum included in the PubMed database. Forty-five cases reported between 1964 and 2019 were identified.


Assuntos
Equinococose/parasitologia , Echinococcus granulosus/isolamento & purificação , Cardiopatias/parasitologia , Septo Interventricular/parasitologia , Animais , Echinococcus granulosus/genética , Echinococcus granulosus/fisiologia , Humanos
4.
Int Heart J ; 60(5): 1226-1229, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484871

RESUMO

This paper presents two cases of human hearts (a 75-year-old woman and an 88-year-old man) with double posterior descending arteries (PDA) of various sizes originating from the right coronary artery, mainly supplying the interventricular septum as well as the posterior walls of both heart ventricles in a different scope. In the analysis of the arterial vasculature, a range of aspects were considered, such as the point of exit of the right coronary artery, the course of the vessel, the range of the blood supply of the interventricular septum and both ventricles, as well as selected morphometric parameters that were simultaneously compared with one another. These atypical changes presented based on the example of the analyzed cases will certainly constitute a valuable source of information for cardiac surgeons and interventional cardiologists in planning operations.


Assuntos
Anormalidades Múltiplas/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Cardiopatias Congênitas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Cadáver , Dissecação , Feminino , Humanos , Masculino , Doenças Raras , Septo Interventricular/patologia
5.
Kyobu Geka ; 72(7): 560-563, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31296807

RESUMO

Unobstructed atrial communication is a prerequisite for favorable pulmonary circulation in patients with single-ventricle physiology and atrial-communication-dependent pulmonary venous drainage. It might also be a prerequisite for favorable coronary circulation in patients with single-ventricle physiology and atrial-communication-dependent coronary venous drainage. Obstruction of atrial communication, on which coronary venous drainage depends, has not yet been documented. We report a patient with pulmonary atresia and an intact ventricular septum having an extracardiac total cavopulmonary connection. Spontaneous closure of the atrial septal defect( ASD), measuring 10 mm before the total cavopulmonary connection, led to a leftward ventricular septal shift and left ventricular wall thickening, causing severe left ventricular diastolic dysfunction which resolved after surgical ASD creation. Detection of spontaneous ASD closure by ultrasound was challenging because the to-and-fro blood flow in the dilated coronary sinus mimicked a patent ASD. Prophylactic ASD enlargement accompanying the cavopulmonary connection procedure is advised in such patients.


Assuntos
Cardiopatias Congênitas , Insuficiência Cardíaca , Comunicação Interatrial , Atresia Pulmonar , Septo Interventricular , Criança , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Humanos , Atresia Pulmonar/complicações , Atresia Pulmonar/cirurgia
6.
Bull Exp Biol Med ; 167(3): 320-324, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31346866

RESUMO

Magnetic resonance imaging was employed to examine the morphofunctional status of myocardium in Wistar rats with multifactor cardiovasorenal model of arterial hypertension. In 3 months after the onset of experiment, the rats demonstrated a pronounced hypertrophy in left ventricular myocardium mostly due to thickening of the posterior and lateral walls against the background of relatively stable thickness of ventricular septum. The left ventricular endsystolic volume markedly increased in parallel with moderate increase of the end-diastolic volume. The standard calculated indices were used for precise assessment of the type of remodeling of individual myocardial structures. The study showed that multifactor arterial hypertension model was characterized by domination of hypertrophic mode of the left ventricular remodeling, whereas the concentric variant was observed more rarely by 2.5 times. The greatest alterations were observed in the posterior and lateral walls of the left ventricle, which could result from the hemodynamic effects of hypervolemic arterial hypertension.


Assuntos
Coração/fisiopatologia , Hipertensão/patologia , Miocárdio/patologia , Remodelação Ventricular/fisiologia , Animais , Imagem por Ressonância Magnética , Masculino , Ratos , Ratos Wistar , Função Ventricular Esquerda/fisiologia , Septo Interventricular/fisiologia
7.
Kyobu Geka ; 72(5): 380-383, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31268037

RESUMO

The patient was a 73-year-old woman with ventricular septal rupture following acute myocardial infarction. Morphologically, it was associated with ventricular septal dissection and septal pseudoaneurysm formation. She underwent repair of the septal rupture 12 days after the onset of myocardial infarction. The rupture site was excluded with two large bovine pericardial patches after partial resection of the necrotic tissue of the septum. The patches were doubly fixed to the ventricular septum and the free wall with interrupted mattress sutures and with continuous sutures. There was no residual shunt after the operation.


Assuntos
Ruptura Cardíaca Pós-Infarto , Infarto do Miocárdio , Ruptura do Septo Ventricular , Septo Interventricular , Idoso , Animais , Bovinos , Feminino , Ruptura Cardíaca Pós-Infarto/cirurgia , Humanos , Ruptura do Septo Ventricular/cirurgia
8.
Pediatr Cardiol ; 40(6): 1253-1257, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31263917

RESUMO

Obesity is associated with additional left ventricular hypertrophy (LVH) in adults with hypertrophic cardiomyopathy (HCM). It is not known whether obesity can lead to further LVH in children with HCM. Echocardiographic LV dimensions were determined in 504 children with HCM. Measurements of interventricular septal thickness (IVST) and posterior wall thickness (PWT), and patients' weight and height were recorded. Obesity was defined as a body mass index (BMI) ≥ 99th percentile for age and sex. IVST data was available for 498 and PWT data for 484 patients. Patient age ranged from 2 to 20 years (mean ± SD, 12.5 ± 3.9) and 340 (68%) were males. Overall, patient BMI ranged from 7 to 50 (22.7 ± 6.1). Obesity (BMI 18-50, mean 29.1) was present in 140 children aged 2-19.6 (11.3 ± 4.1). The overall mean IVST was 20.5 ± 9.6 mm and the overall mean PWT was 11.0 ± 8.4 mm. The mean IVST in the obese patients was 21.6 ± 10.0 mm and mean PWT was 13.3 ± 14.7 mm. The mean IVST in the non-obese patients was 20.1 ± 9.5 mm and mean PWT was 10.4 ± 4.3 mm. Obesity was not significantly associated with IVST (p = 0.12), but was associated with increased PWT (0.0011). Obesity is associated with increased PWT but not IVST in children with HCM. Whether obesity and its impact on LVH influences clinical outcomes in children with HCM needs to be studied.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Ventrículos do Coração/patologia , Obesidade/complicações , Septo Interventricular/patologia , Adolescente , Índice de Massa Corporal , Cardiomiopatia Hipertrófica/fisiopatologia , Criança , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Masculino , Adulto Jovem
9.
Innovations (Phila) ; 14(3): 281-285, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31050323

RESUMO

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During "minimally invasive endoscopic" and "robotic" mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.


Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Obstrução do Fluxo Ventricular Externo/prevenção & controle , Septo Interventricular/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Septo Interventricular/diagnóstico por imagem
10.
PLoS Genet ; 15(5): e1007711, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31120883

RESUMO

Dominant mutations of Gata4, an essential cardiogenic transcription factor (TF), were known to cause outflow tract (OFT) defects in both human and mouse, but the underlying molecular mechanism was not clear. In this study, Gata4 haploinsufficiency in mice was found to result in OFT defects including double outlet right ventricle (DORV) and ventricular septum defects (VSDs). Gata4 was shown to be required for Hedgehog (Hh)-receiving progenitors within the second heart field (SHF) for normal OFT alignment. Restored cell proliferation in the SHF by knocking-down Pten failed to rescue OFT defects, suggesting that additional cell events under Gata4 regulation is important. SHF Hh-receiving cells failed to migrate properly into the proximal OFT cushion, which is associated with abnormal EMT and cell proliferation in Gata4 haploinsufficiency. The genetic interaction of Hh signaling and Gata4 is further demonstrated to be important for OFT development. Gata4 and Smo double heterozygotes displayed more severe OFT abnormalities including persistent truncus arteriosus (PTA). Restoration of Hedgehog signaling renormalized SHF cell proliferation and migration, and rescued OFT defects in Gata4 haploinsufficiency. In addition, there was enhanced Gata6 expression in the SHF of the Gata4 heterozygotes. The Gata4-responsive repressive sites were identified within 1kbp upstream of the transcription start site of Gata6 by both ChIP-qPCR and luciferase reporter assay. These results suggested a SHF regulatory network comprising of Gata4, Gata6 and Hh-signaling for OFT development.


Assuntos
Fator de Transcrição GATA4/genética , Fator de Transcrição GATA6/genética , Proteínas Hedgehog/genética , Receptor Smoothened/genética , Obstrução do Fluxo Ventricular Externo/genética , Septo Interventricular/metabolismo , Animais , Movimento Celular , Proliferação de Células , Embrião de Mamíferos , Fator de Transcrição GATA4/metabolismo , Fator de Transcrição GATA6/metabolismo , Regulação da Expressão Gênica , Haploinsuficiência , Proteínas Hedgehog/metabolismo , Heterozigoto , Humanos , Camundongos , Camundongos Transgênicos , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Transdução de Sinais , Receptor Smoothened/metabolismo , Tronco Arterial/anormalidades , Tronco Arterial/metabolismo , Obstrução do Fluxo Ventricular Externo/metabolismo , Obstrução do Fluxo Ventricular Externo/patologia , Septo Interventricular/patologia
11.
Int J Cardiovasc Imaging ; 35(10): 1853-1860, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31129743

RESUMO

Right ventricular longitudinal strain (RVLS) by 2D speckle-tracking echocardiography (2D-STE) is a useful parameter for assessing systolic function. However, the exact method to perform it is not well defined as some authors evaluate only free wall (FW) segments while others include all six RV segments. To compare the assessment of RVLS at rest and during exercise by these two approaches. Echocardiography was performed on 80 healthy subjects at rest and during exercise. The analysis consisted of standard and 2D-STE assessment of RV global and segmental strain tracing only RVFW and also tracing all six RV segments. At rest, RVLS could be assessed in 78 (feasibility 97.5%) subjects by both methods. However, during exercise, RVLS by RVFW method was feasible in 67 (83.8%) as compared to 74 (92.5%) by RV6S approach. Both at rest and during exercise, RVLS values by the two methods showed excellent correlation (r = > 0.90). However, RVLS values assessed by RV6S were lower (absolute values) than those by RVFW approach (RV6S vs. RVFW; rest: - 27.0 ± 3.9 vs. - 9.5 ± 3.9, p < 0.001 and exercise: - 30.7 ± 5.2 vs. - 33.3 ± 5.1, p < 0.001). Furthermore, basal strain was higher and apical strain lower (absolute values) by RV6S approach. At rest, reproducibility for RVLS was excellent and similar for the two methods. However, during exercise, reproducibility for RVFW method was poorer, especially at the apex. The two currently described methods for RVLS assessment by 2D-STE demonstrated excellent agreement. However, the RV6S approach seemed to be more feasible and reproducible, particularly during exercise. Moreover, global and segmental strain values are different with both methods and should not be interchanged.


Assuntos
Ecocardiografia Doppler , Ecocardiografia sob Estresse/métodos , Teste de Esforço , Função Ventricular Direita , Septo Interventricular/diagnóstico por imagem , Adulto , Fenômenos Biomecânicos , Estudos de Viabilidade , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sístole , Septo Interventricular/fisiopatologia , Adulto Jovem
13.
Echocardiography ; 36(5): 992-995, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30873637

RESUMO

A 20-year-old Congolese woman presented with presyncope, dyspnea, and anasarca. Past medical history was unremarkable. Echocardiography revealed a rare combination of giant right atrium (RA), a dilated and hypertrophied right ventricle, subvalvular pulmonary stenosis (subPS), severe tricuspid regurgitation (TR), pericardial effusion and what appeared to be a spontaneously closed ventricular septal defect (VSD). Cardiac Magnetic Resonance and Cardiac Computed Tomography confirmed the findings excluding the presence of intra-cardiac and extra-cardiac shunt and other associated congenital anomalies. The patient underwent subPS resection, right atrioplasty, and tricuspid annuloplasty. Multimodality approach facilitated the detection of the abnormalities and provided clarity when determining the optimal surgical strategy.


Assuntos
Ecocardiografia/métodos , Estenose Subvalvar Pulmonar/diagnóstico por imagem , Adulto , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Tamanho do Órgão , Estenose Subvalvar Pulmonar/patologia , Estenose Subvalvar Pulmonar/cirurgia , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/patologia , Septo Interventricular/cirurgia , Adulto Jovem
14.
Environ Sci Pollut Res Int ; 26(10): 10037-10043, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30746621

RESUMO

This study sought to determine correlations between the presence of isolated ventricular septum defects (VSDs) and blood levels of trace elements. A total of 144 patients with VSDs and 144 controls were recruited for cross-sectional assessment of trace elements and examination of cardiac structures in the Jiangsu and Anhui provinces between 2016 and 2018. Logistic regression was performed to explore the relationships between VSDs and trace elements. Additionally, general linear regression models were used to investigate relationships between trace elements and echocardiography indicators. Relative to the lowest zinc (Zn) concentrations, the highest Zn concentrations may be associated with lower odds of VSD development (OR = 0.03, 95% confidence interval [CI] = 0.01-0.29, P < 0.001). However, no significant relationships between the concentrations of other trace elements and the risk of VSD were identified. Aorta (AO) diameters were markedly smaller in the VSD group, whereas no significant between-group differences were observed for other echocardiography indicators. After adjusting for age and gender, linear regression indicated a significant association between Zn level and mean AO diameter (beta coefficient = 0.247, 95% CI = 0.126-0.367). Zn deficiency was observed in patients with isolated VSDs. Further work to explore the mechanisms by which Zn deficiency leads to VSDs is warranted.


Assuntos
Comunicação Interventricular/sangue , Metais Pesados/sangue , Oligoelementos/sangue , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Ecocardiografia , Feminino , Comunicação Interventricular/induzido quimicamente , Humanos , Lactente , Masculino , Metais Pesados/toxicidade , Medição de Risco , Oligoelementos/toxicidade , Septo Interventricular
15.
Am J Cardiol ; 123(9): 1517-1526, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30791998

RESUMO

In obstructive hypertrophic cardiomyopathy (HC), extreme heterogeneity of septal morphology makes septal myectomy particularly challenging. Although cardiovascular magnetic resonance (CMR) reconstructs ventricular anatomy with high spatial resolution, CMR is not used systematically to plan preoperatively septal myectomy. In this study, we report our results with using CMR to plan the extent of septal excision in 112 consecutive HC patients who subsequently underwent myectomy. Depth and length of the myectomy planned at CMR were compared with those of the septal muscle excised in a single piece in all patients. Anterior septum maximal thickness at CMR was 22 ± 5 mm and excised muscle thickness 9 ± 3 mm. Planned myectomy length was 35 ± 11 mm (range 17 to 65) and excised muscle length 38 ± 10 mm (range 10 to 70), indicating extension of septal resection to mid-cavity. Thickness and length of the planned myectomy showed a significant correlation with the excised muscle (R2 = 0.345; p <0.001; and R2 = 0.358; p <0.001, respectively). Deep septal crypts were identified at CMR in 12(11%) patients, preventing muscle excision from areas at increased risk of iatrogenic septal defect. Large aberrant muscle bundles that could decrease mid-cavity dimension were identified at CMR and excised in 26(23%) patients. In the 55 patients with postoperative CMR, qualitative comparison of pre and postoperative ventricular morphology showed a smooth and apically extended myectomy. In conclusion, CMR planning of septal myectomy provided high resolution images of septal morphology and allowed us to perform a standardized and apically extended septal excision that was associated with favorable outcome. Our novel approach could make myectomy more accessible to cardiovascular surgeons.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Imagem Cinética por Ressonância Magnética/métodos , Septo Interventricular/diagnóstico por imagem , Cardiomiopatia Hipertrófica/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Septo Interventricular/cirurgia
16.
Int J Cardiol ; 280: 135-141, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30665806

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a common genetic cardiovascular disease, causing breathlessness, chest pain, syncope and sudden death. One-year outcome of echo-guided transthoracic percutaneous laser ablation (TPLA) of the sheep interventricular septum was studied as a novel treatment to reduce the septal thickness. It may partially address the limitations of surgical myectomy and alcohol septal ablation in terms of trauma, safety, and efficacy. METHODS: Twelve healthy adult sheep were randomly categorized into two groups: with and without the laser application of TPLA of the interventricular septum (IVS) at the energy level of 5 W for 3 min. Echocardiography, electrocardiography (ECG), cardiac magnetic resonance (CMR), serological and pathological examinations were performed over a 12-month follow-up. RESULTS: After the laser ablation all animals survived with normal cardiac function; No severe complications or bundle branch block were noted. The septal thickness (3.11 ±â€¯1.14 vs. 8.40 ±â€¯0.45 mm, p < 0.05), regional movement of ablated IVS and longitudinal strain significantly decreased when comparing the experimental and control groups. The Troponin I level was significantly elevated after the operation, which validated immediate cardiac coagulation necrosis. On cardiac magnetic resonance (CMR) imaging, the ablated myocardium showed significant fibrosis evidenced by late gadolinium enhancement. Pathological results revealed damaged ultra-structure of the ablated myocardium and development of fibrosis. CONCLUSIONS: TPLA is a safe and effective minimally invasive method to reduce IVS thickness in the long term, making it a potential alternative for HOCM treatment.


Assuntos
Modelos Animais de Doenças , Ecocardiografia/métodos , Terapia a Laser/métodos , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/cirurgia , Animais , Eletrocardiografia/métodos , Seguimentos , Distribuição Aleatória , Ovinos , Fatores de Tempo
17.
Anat Histol Embryol ; 48(3): 228-233, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30666708

RESUMO

The use of hearts from different animals as models in the experimental pharmacology and surgical clinic has led, in recent years, to an increase on interest of research with this organ. The heart's conducting system, from the septomarginal trabecula, presents several variations, which generates numerous controversies in the literature. So, the objective of the present study is to analyse the morphology of the septomarginal trabecula of bovine hearts, identifying possible macro- and microscopic variations. Thirty-four bovine hearts were analysed. Each trabecula was analysed macroscopically to obtain an anatomical description and measurements of its length and thickness. For histological and morphometric analysis, the samples were fixed in Bouin's solution and then subjected to histological processing. In all the analysed bovine hearts, the septomarginal trabecula presented itself as a smooth, tubular meaty structure of muscular consistency, with variable length and diameter. The anatomical variations observed included a trabecula with forked marginal fixation, and single septal fixation, in addition to a trabecula with extremely reduced or excessively thick caliber. The septomarginal trabecula consists of cardiac muscle fibres, connective tissue, vascular tissue and conduction myofibrils or Purkinje fibres. In the samples of smaller thicknesses, there was a predominance of connective tissue and scarce cardiac muscle tissue, whereas in the thicker samples the predominance was of cardiac striated muscle tissue. Therefore, there are significant macro- and microscopic differences between the bovine septomarginal trabecula concerning their diameter and constituent tissue, and that can lead to possible changes in cardiac physiology.


Assuntos
Variação Anatômica , Bovinos/anatomia & histologia , Coração/anatomia & histologia , Animais , Coração/diagnóstico por imagem , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Fotomicrografia/veterinária , Septo Interventricular/anatomia & histologia , Septo Interventricular/diagnóstico por imagem
18.
Neurology ; 92(9): e924-e932, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30674593

RESUMO

OBJECTIVE: To determine the associations between transthoracic echocardiogram (TTE) cardiac structure/function measures and cardioembolic stroke (CES) and new-onset atrial fibrillation (AF) in patients without known AF. METHODS: Inpatients at a single institution (2013-2015) with imaging-confirmed ischemic stroke, no AF, and TTE within the 1st week were included. TTE structure/function variables were abstracted. Stroke subtype (CES vs other) was defined according to Trial of Org 10172 in Acute Stroke Treatment, blinded to TTE results. New AF was defined as any duration of AF on ECG, telemetry, or event monitor. Separate multivariable logistic regression models defined associations between CES or new-onset AF and TTE measures, adjusting for demographic and vascular risk factors. RESULTS: Of 322 participants (mean age 60 years), 55% were male and 56% African American. In adjusted models (odds ratio, 95% confidence interval), odds of CES increased per 0.1 cm increase in left atrial (LA) systolic diameter (1.06, 1.02-1.11), 1 cm/s in mitral E point velocity (1.03, 1.02-1.05), with presence of mitral valve dysfunction (3.78, 1.42-10.02), and with wall motion abnormality (2.00, 1.13-3.55). As ejection fraction increased (per 10%), odds of CES decreased (0.65, 0.53-0.79). New-onset AF was also associated with increasing LA systolic diameter (1.13, 1.04-1.22). CONCLUSIONS: Cardiac structural changes independent of AF and detectable on TTE may be on the CES causal pathway. Confirming these results could have implications for future use of TTE and decisions about antithrombotic vs anticoagulant treatment.


Assuntos
Fibrilação Atrial/epidemiologia , Coração/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Ecocardiografia , Feminino , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Defeitos dos Septos Cardíacos/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Tamanho do Órgão , Fatores de Risco , Volume Sistólico , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/patologia
19.
Int J Cardiovasc Imaging ; 35(7): 1211-1219, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30684080

RESUMO

Sigmoid-shaped ventricular septum (SS), a frequently encountered minor abnormality in echocardiographic examinations of the elderly, may have some influence on RV shape. We aimed to determine the influence of SS on the accuracy of the 6 RV linear diameter measurements in the light of three-dimensional echocardiographic (3DE) RV volume. The aorto-septal angle (ASA) was measured in the parasternal long-axis view using two-dimensional echocardiography (2DE) as an index of SS in 70 patients without major cardiac abnormalities who were subdivided into 35 with SS (ASA ≤ 120°) and 35 without SS (NSS). We measured RV end-diastolic volume (RVEDV) using 3DE; in addition, using 2DE, we measured basal RV diameter, mid-cavity diameter, longitudinal diameter and end-diastolic area in the apical four-chamber view; proximal RV outflow tract (RVOT) diameter in the parasternal long-axis view; and proximal and distal RVOT diameters in the parasternal short-axis view. RVEDV did not differ between the SS and NSS groups. The SS group had greater basal RV diameter and proximal and distal RVOT diameters than the NSS group. RV mid-cavity diameter, longitudinal diameter, and end-diastolic area did not differ between the groups. Among the 2DE parameters of RV size, RV end-diastolic area was most strongly correlated with RVEDV (r = 0.67), followed by RV mid-cavity diameter (r = 0.58). When SS is present, the echocardiographic basal RV diameter and RVOT diameters overestimate RV size, and the measurement of RV end-diastolic area and mid-cavity diameter more correctly reflect 3D RV volume.


Assuntos
Ecocardiografia Tridimensional , Ventrículos do Coração/diagnóstico por imagem , Septo Interventricular/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Função Ventricular Esquerda , Função Ventricular Direita , Septo Interventricular/fisiopatologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA