Combined anomalous origin of a left inferior thyroid artery and a left vertebral artery: a case report

An abnormal origin of a left inferior thyroid artery from the left vertebral artery that in turn originated from the aortic arch was observed on a 72-year-old Caucasian male cadaver during a dissection anatomy practice. We describe in detail the morphology of this extremely rare anatomical variation and refer to its clinical importance

Intermediate supraclavicular nerve perforating the clavicle: a rare anatomical finding and its clinical significance

The dissection of a male 70-year-old cadaver revealed that the left intermediate supraclavicular nerve perforated the clavicle. Knowledge of this variation is important because it may cause neuropathy, with pain in the neck and shoulder region. Furthermore, it should be differentiated from a fracture of the clavicle

Blood-brain barrier dysfunction: the undervalued frontier of hypertension

The blood-brain barrier (BBB) constitutes the complex anatomic and physiologic interface between the intravascular compartment and the central nervous system, and its integrity is paramount for the maintenance of the very sensitive homeostasis of the central nervous system. Arterial hypertension is a leading cause of morbidity and mortality. The BBB has been shown to be disrupted in essential hypertension. BBB integrity is important for central autonomic control and this may be implicated in the pathophysiology of hypertension. On the other hand, evidence from experimental studies indicates that BBB disruption can be present in both hypertensive disease and dementia syndromes, suggesting a possibly key position of loss of BBB integrity in the pathophysiological pathways linking arterial hypertension with cognitive decline. Although much still remains to be elucidated with respect to the exact underlying mechanisms, the discovery of novel pathological pathways has changed our understanding of adult dementia and central nervous system disease overall, pointing out-in parallel-new potential therapeutic targets. The aim of this review is to summarize current scientific knowledge relevant to the pathophysiologic pathways that are involved in the disruption of the BBB function and potentially mediate hypertension-induced cognitive impairment. In parallel, we underline the differential cognition-preserving effect of several antihypertensive agents of similar blood pressure-lowering capacity, highlighting the presence of previously under-recognized BBB-protective actions of these drugs

Mitral valve geometrical echocardiographic analysis and 3D computational modeling of a normal mitral valve - supplementary material

Aim: This research aims to develop a consistent computational model of a normal mitral valve (MV) and describe mitral regurgitation (MR) geometry based on Carpentier’s classification. Materials &methods:MV geometry was assessed by 2D transthoracic echocardiogram in 100 individuals. A 3D parametric geometric model of the MV was developed. A computational model of a normal MV was performed. Results: The simulation of the valve function was successfully accomplished and its kinematics was analyzed. Differences in geometry were revealed between normal and type III MR. Conclusion: 3D computational models of the normal MV can be constructed relying on standard measurements performed by 2D echocardiography. Certain geometrical differences exist among the normal and the most severe type of MR.Plain language summary: Mitral insufficiency, represents the most common form of valvular heart disease and occurs when the mitral valve does not close tight causing blood to flow the wrong way in the heart. The simplest and most usual method to evaluate this dysfunction is the 2D transthoracic echocardiography, which uses ultrasound to create images of the heart. Mitral insufficiency can be classified into three types. This study tried to evaluate any differences in the clinical and/or echocardiographic geometrical characteristics between the normal MV and the three types of insufficient MV. Moreover, it tried to develop a 3D model to simulate the normal MV function. To achieve this, it enrolled 100 individuals (both normal and insufficientMV), evaluated theirMV with 2D echocardiography and compared all geometrical characteristics between them. Finally, computational simulation, using specific and appropriate methods, was used to create the 3D model. Regarding the results, the most differences were found between subjects with normal and subjects with type III mitral insufficiency. Moreover, a 3D model of the normal MV was successfully developed. To conclude, there are specific geometrical differences among the normal and the most severe type of the insufficient MV, while 3D models of the normal MV can be developed by 2D echocardiography measurements.</p

Unmet Needs in the Assessment of Right Ventricular Function for Severe Tricuspid Regurgitation

Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease that has been long overlooked, but lately its independent association with adverse cardiovascular outcomes was recognized. The time point to intervene and repair the tricuspid valve is defined by the right ventricular (RV) dilation and dysfunction that comes up at a later stage. While guidelines favor tricuspid valve repair before severe RV dysfunction ensues, the definition of RV dysfunction in a universal manner remains vague. As a result, the candidates for transcatheter or surgical TR procedures are often referred late, when advanced RV dysfunction is established, and any derived procedural survival benefit is attenuated. Thus, it is of paramount importance to establish a universal means of RV function assessment in patients with TR. Conventional echocardiographic indices of RV function routinely applied have fundamental flaws that limit the precise characterization of RV performance. More recently, novel echocardiographic indices such as strain via speckle-tracking have emerged, demonstrating promising results in the identification of early RV damage. Additionally, evidence of the role of alternative imaging modalities such as cardiac computed tomography and cardiac magnetic resonance, for RV functional assessment in TR, has recently arisen. This review provides a systematic appraisal of traditional and novel multimodality indices of RV function in severe TR and aims to refine RV function assessment, designate future directions, and ultimately, to improve the outcome of patients suffering from severe TR