20 research outputs found
The topography of the subthebesian fossa in relation to neighbouring structures within the right atrium
The majority of anatomical structures within the heart during typical atrial flutters’ ablation, right sided accessory pathway ablation or slow pathway ablation are invisible
or blurred. Therefore it is very important to know in details interior right atrial structures during such procedures. In the neighborhood of coronary sinus orifice small concavity is visible. This area, called subthebesian fossa, is placed between
the os of coronary sinus, the orifice of vena cava inferior and tricuspid annulus. The fossa is on the way of typical atrial flutters’ reentrant circuit and is placed next to the isthmus area, which has become a target site for ablative therapy.
Regarding the facts mentioned above we decided to examine the topography of
this concavity in relation to neighboring structures.
Research was conducted on material consisting of 45 human hearts of both
sexes, from 19 to 71 years of age. The hearts came from patients whose death
was not cardiologic in origin. The topography of the fossa was examined in
relation to coronary sinus orifice (diameter A), vena cava inferior orifice (diameter B) and the attachment of the posterior leaflet of the tricuspid valve (diameter C).
Besides we measured two perpendicular sizes in the inlet plane of the fossa.
There were the longest size (diameter D) and the shortest size of the fossa (diameter E). We also defined deepness of the fossa (diameter F).
Diameter A was from to 2 to 7 mm (avg. 4.9 ± 1.4 mm), diameter B from 2 to 8 mm (avg. 4.0 ± 1.6 mm) and diameter C from 5 to 9 mm (avg. 7.0 ± 1.5 mm). The
longest size in inlet plane of the concavity (diameter D) was from 12 to 18 mm (avg.14.1 ± 1.7 mm) and shortest size (diameter E) was from 7 to 14 mm
(avg. 9.0 ± 1.7 mm). The deepness of the fossa (diameter F) was from 2 to 7 mm (avg. 4.8 ± 1.2 mm).
The subthebesian concavity is inconstant anatomical structure, occurring in all forty five examined hearts (100%).
The shape and sizes of the subthebesian fossa were variable in examined group of hearts. Our data suggest that differences in diameters between subthebesian fossa and neighboring structures may have clinical importance during ablation
procedure
Left ventricle systolic volume in vasovagal syncope patients
One of the hypotheses put forward concerning the mechanism of vasovagal syncope is that the vagal afferent fibres are activated during vigorous contractions against a partly empty left ventricle. The aim of the study was to confirm this hypothesis by using 2D echocardiography during a head-up tilt test. The study was carried out on 39 patients (17 male, 22 female, age range 21–64 years), all with a history of recurrent syncope. The patients were examined using
a 2D echo to measure the end-diastolic and end-systolic volume before the head-up tilt test after the Westminster protocol (45min/60 grade) and every five minutes after tilting. T patients during head-up tilt test had a positive response and 32 proved negative. A reduction of both the end-diastolic and end-systolic
volumes of the left ventricle was noticed. There was no significant difference in the degree of ejection fraction reduction. The difference in ejection fraction reduction between the two groups was similarly non-significant. It was also noticed that the patients with a positive response had more vigorous contractions than those with a negative test. The decision was therefore taken to use a different parameter for the left ventricle contraction, namely the LV posterior wall slope. As this parameter is partly dependent on time, its use in confirming the extremely vigorous nature of the contractions was considered appropriate. Only 6 patients were tested using this parameter. A tendency towards greater left ventricle posterior wall slope values, both before and during tilting was noticed in the group of patients with vasovagal reaction. Our data shows that vigorous contraction is probably less responsible for vasovagal syncope release than left ventricle volume reduction
The arrangement of muscle fibres in the region of the subthebesian fossa in the aspect of atrial flutter
The typical atrial flutter is the most common supraventricular tachycardia with
reentrant circuit. This tachyarrythmia is based on macroreentry wave going around
established anatomic landmarks. The reentry in the inferior right atrial wall passes
through narrow isthmus, which is the goal for ablative therapy. The isthmus
area is bordered anteriorly by the tricuspid valve and posteriorly by the inferior
vena cava, coronary sinus, and eustachian ridge. Near to this area we can find
anatomical structure, which can be very important during arising, perpetuation
and curing of atrial flutter. The concavity, so-called subthebesian fossa [15], is on
the way of typical atrial flutters’ reentrant circuit.
Regarding the facts mentioned above we decided to examine the morphology
and the arrangement of the muscle fibres in this fossa.
Research was conducted on material consisting of 70 human hearts of both
sexes from the age of 34 to 72 years. 50 hearts came from patients whose
death was not cardiologic in origin. 20 hearts came from humans in whose
common atrial flutter was confirmed. We observed the arrangement of muscle
fibres in the area of subthebesian fossa. Besides we measured the size and deepness
of the subthebesian fossa in both groups of hearts.
We found that regular arrangement of muscle fibres within subthebesian fossa
was present in 23 healthy human hearts (46%) and 7 cases (35%) of hearts with
atrial flutter. The irregular arrangement of muscle fibres was observed in 27
hearts (54%) of control group and 13 hearts (65%) with dysrrhythmia. The thickness
of the right atrial wall within the subthebesian fossa was very thin in 8
normal hearts (16%) and in 5 dysrrhythmic hearts (25%). The sizes of examined
structure were variable in both groups of hearts, and are presented in the table.
It seems that the subthebesian concavity can be the substrate for reentrant
circuit during atrial flutter, and there could be such special arrangement of muscle
fibres, which allows for microreentrant circuit to arise in this area
Diameters of the cavo-sinus-tricuspid area in relation to type I atrial flutter
Cardiac arrhythmias have troubled patients and fascinated physicians for centuries. The twentieth century was an era of progress, when the mechanism of cardiac disorders became more commonly recognised. Arrhythmias may be due to abnormalities of automaticity, to abnormalities of conduction, or to a combination of both. In order for re-entry to occur, an area of slowing conduction combined with unidirectional block must be present. Much investigation has
centred on the underlying re-entry mechanisms of atrial flutter. In the light of these facts, it would seem that a close acquaintance with the detailed topography of the vena cava orifice (cavo), coronary sinus orifice (sinus) and the attachment of the septal leaflet of the tricuspid valve (tricupid) area could be of great
interest, especially for invasive cardiologists.
The research was conducted carried out on material consisting of 41 hearts of humans of both sexes from the age of 12 to 80 (6 female, 35 male). Classical macroscopic methods of anatomical evaluation were used. The following measurements were made: the shortest distance between the Eustachian valve and the attachment of
the tricuspid valve on the left margin of the coronary sinus orifice (diameter 1), the distance between the attachment of the tricuspid valve and the inferior margin of the sinus orifice (diameter 2), the distance between the Eustachian valve and the attachment of the tricuspid valve on the right margin of the coronary sinus orifice (diameter 3), the distance between the inferior margin of the vena cava inferior and the attachment of the tricuspid valve (diameter 4) and, finally, the diameter between the attachment of the septal cusp of the tricuspid valve and the external border of the vena cava inferior (diameter 5).
No correlation was found between the age and sex of the three groups of the material. The dimensions of the structure examined were similar in the three groups of hearts. In young adult hearts all the diameters measured ranged from 4 to 47 mm The average diameters were, respectively: 15.02 mm (diameter 1), 8.97 mm (diameter 2), 17.27 mm (diameter 3), 26.87 mm (diameter 4), 36.42 mm (diameter
5). In the mature adult hearts all the diameters measured ranged from 8 to 45 mm: 18.19 mm (diameter 1), 10.54 mm (diameter 2), 19.95 mm (diameter 3), 28.90 mm (diameter 4), 39.63 mm (diameter 5). In the older adults hearts all the diameters measured ranged from 4 to 47 mm. The average diameters were, respectively: 15.65 mm (diameter 1), 8.70 mm (diameter 2), 7.25 mm (diameter 3), 26.80 mm (diameter 4), 35.85 mm (diameter 5).
On the basis of our study we were able to conclude that the diameters of the cavo-sinus-tricuspid area were constant and did not differ significantly within the three (young, mature, old) adult groups examined
Anterior region of the atrioventricular perinodal area in relation to radiofrequency ablation procedures
Atrioventricular nodal reentry tachycardia base on reentry circulation in nodal-perinodal area. The radical treatment of choice is radiofrequency ablation. Procedure approached from the anterior-superior (fast) region sufficient a few seconds of energy delivery for success, however this can result in A-V block. The possibility that arrhythmias substrate may lie very superficially (success of ablation) and damage the normal structures (complication) in the perinodal region must be considered. In order to confirm this hypothesis we examined the autopsy material of 100 normal hearts, both sexes from 18 to 105 years of age (control) and 50 hearts with A-V total block 45-95 years of age (block). We paid attention to the morphology of the nodal artery (NA), atrial inputs (AI) and transitional inputs (TI).
It was observed that NA at the level of the central fibrous body was positioned in 94% in the central and in 6% in the inferior part of Koch’s triangle. It was removed from the endocardium 3-6 mm in control and 2-5 mm in block group respectively (NS). In the perinodal area we distinguished AI that directly joined the A-V compact node: superficial (right part of the interatrial septum) or deep (left part). The former occurred in 100% of controls and in 80% of block groups (NS), and the latter in 80% of control group and in 34% in block respectively (p < 0.05).
The real substrate of arrhythmia in anterior-superior region lies very superficially and far from the conduction tissue; NA in examined hearts was lying deep beneath the endocardium; ablation close to the node could result in A-V block
Preliminary study of external interatrial muscle fascicles
The atria are highly complex multidimensional structures composed of a heterogeneous
branching network of subendocardial muscular bundles. The relief of
the inner part of the right atrium includes the crista terminalis as well as multiple
pectinate muscles that bridge the thinner atrial free walls and appendages. However,
a handful of studies have focused attention on the role of the naturally
occurring complexities of the atrial subendocardial muscle structures in the mechanisms
of cardiac arrhythmias. In accordance with the facts mentioned above, it
was decided to examine the morphology and topography of the external interatrial
junctions and related structures in order to define the possible anatomical
basis of impulse propagation in focal atrial fibrillation.
Research was conducted on material consisting of 15 human hearts of both
sexes (female - 6, male - 9) from 18 to 82 years of age. In addition we were
concerned, on the basis of the history and electrocardiograph tracings, that
none of the patients had shown focal and non-focal type of atrial fibrillation.
The classic macroscopic methods of anatomical evaluation were used. The walls
of the atria were prepared via a stereoscopic microscope, the pericardium and
fatty tissue were eliminated from the surface of the atria, visualising muscle
fibres linking both of the atria, and the beginnings and the endpoints of fascicles
in the right and left atrium were estimated. The structure, large muscle
bundle, was present in all examined hearts. The muscle fascicle was descending
from the anterior wall of the right atrium just below the orifice of the superior
vena cava. The fascicle, running towards the left atrium, divided into two branches,
one of which joined with the superior fascicle from the posterior wall and created
one running above the interatrial septum and infiltrating into the wall of the
left atrium on its superior surface between the superior pulmonary veins. The
other branch of the anterior fascicle was running across the anterior wall of the
atria and it penetrated into the left atrium muscle in the region of the inferior
pole of the left auricle outlet. On the posterior wall of the atria three types of
interatrial fascicles were distinguished: unifascicular, bifascicular and trifascicular.
The bifascicular type was the most frequent configuration (9 cases - 60.0%),
in 5 cases it was trifascicular (33.3%) and finally the unifascicular configuration
was observed in just 1 heart (6.7%). On the basis of our study we can conclude
that the external interatrial fascicles are the constant structure of the heart,although they may have a variable morphology. Those structures could be responsible
for physiological conduction between the atria and may play an important
role in patients with atrial fibrillation
Morfologiczne aspekty jednojamowej prawokomorowej sta艂ej stymulacji serca. Cz臋艣膰 II: Zmiany odczynowo-w艂贸knikowe w aspekcie rozwoju niedomykalno艣ci tr贸jdzielnej
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Materia艂 i metody: Badanie zosta艂o przeprowadzone na materiale autopsyjnym 60 ludzkich serc (24 K, 36 M) w wieku 45-95 lat, utrwalonych w roztworze formaliny z etanolem. Zastosowano klasyczne metody bada艅 makroskopowych, zwracaj膮c szczeg贸ln膮 uwag臋 na odczyny pomi臋dzy elektrod膮 a strukturami zastawki tr贸jdzielnej.
Wyniki: W 44 badanych sercach (73,3%) tylny p艂atek zastawki tr贸jdzielnej by艂 pogrubiony
i wykazywa艂 cechy upo艣ledzonej ruchomo艣ci. W艣r贸d tej grupy 24 serca wykazywa艂y dodatkowo pogrubienie p艂atka przegrodowego oraz spoid艂a pomi臋dzy p艂atkiem tylnym i przegrodowym.
W wy偶ej wymienionych przypadkach odczyn zapalny obejmowa艂 p艂atki zastawki tr贸jdzielnej
i rozprzestrzenia艂 si臋 tak偶e na s膮siaduj膮ce cz臋艣ci elektrody. Powodowa艂o to rozw贸j niedomykalno艣ci tr贸jdzielnej du偶ego stopnia. W pozosta艂ych sercach ruchomo艣膰 p艂atk贸w pozostawa艂a niezmieniona. W 52 sercach (86,6%) reakcja w艂贸knikowa rozprzestrzenia艂a si臋 na s膮siaduj膮ce z zastawk膮 cz臋艣ci elektrody rozrusznika. D艂ugo艣膰 otoczki w艂贸knikowej wok贸艂 elektrody waha艂a si臋 od 4 do 8 mm (艣r. 5 ± 2 mm). Ko艅c贸wka elektrody znajduj膮ca si臋 w jamie prawej komory w 56 preparatach (93,3%) by艂a otoczona przez grub膮 otoczk臋 w艂贸knist膮 cz臋艣ciowo pokryt膮 przez wsierdzie.
Wnioski: Stwierdzili艣my, 偶e w 74% badanych serc w艂贸knienie obejmowa艂o miejsca kontaktu elektrody z wsierdziem pokrywaj膮cym struktury zastawki tr贸jdzielnej lub z miokardium prawej komory. Stopie艅 nasilenia odczynu zale偶a艂 od czasu, kt贸ry up艂yn膮艂 od implantacji elektrody, typu ko艅c贸wki, nie wykazywa艂 natomiast zwi膮zku z rodzajem materia艂u izolacyjnego elektrody
Morfologiczne aspekty jednojamowej prawokomorowej sta艂ej stymulacji serca. Cz臋艣膰 II: Zmiany odczynowo-w艂贸knikowe w aspekcie rozwoju niedomykalno艣ci tr贸jdzielnej
Cel pracy: Implantacja elektrody do sta艂ej stymulacji w prawej komorze serca niesie ze sob膮 ryzyko wytworzenia odczynu w艂贸knikowego pomi臋dzy tkank膮 a r贸偶nymi cz臋艣ciami elektrody, prowadz膮c do 艣cis艂ego jej przymocowania do mi臋艣ni贸wki serca lub innych jego struktur.
W zwi膮zku z powy偶szym postanowili艣my oceni膰 morfologiczne zmiany dotycz膮ce zastawki tr贸jdzielnej w aspekcie rozwoju jej niedomykalno艣ci.
Materia艂 i metody: Badanie zosta艂o przeprowadzone na materiale autopsyjnym 60 ludzkich serc (24 K, 36 M) w wieku 45-95 lat, utrwalonych w roztworze formaliny z etanolem. Zastosowano klasyczne metody bada艅 makroskopowych, zwracaj膮c szczeg贸ln膮 uwag臋 na odczyny pomi臋dzy elektrod膮 a strukturami zastawki tr贸jdzielnej.
Wyniki: W 44 badanych sercach (73,3%) tylny p艂atek zastawki tr贸jdzielnej by艂 pogrubiony
i wykazywa艂 cechy upo艣ledzonej ruchomo艣ci. W艣r贸d tej grupy 24 serca wykazywa艂y dodatkowo pogrubienie p艂atka przegrodowego oraz spoid艂a pomi臋dzy p艂atkiem tylnym i przegrodowym.
W wy偶ej wymienionych przypadkach odczyn zapalny obejmowa艂 p艂atki zastawki tr贸jdzielnej
i rozprzestrzenia艂 si臋 tak偶e na s膮siaduj膮ce cz臋艣ci elektrody. Powodowa艂o to rozw贸j niedomykalno艣ci tr贸jdzielnej du偶ego stopnia. W pozosta艂ych sercach ruchomo艣膰 p艂atk贸w pozostawa艂a niezmieniona. W 52 sercach (86,6%) reakcja w艂贸knikowa rozprzestrzenia艂a si臋 na s膮siaduj膮ce z zastawk膮 cz臋艣ci elektrody rozrusznika. D艂ugo艣膰 otoczki w艂贸knikowej wok贸艂 elektrody waha艂a si臋 od 4 do 8 mm (艣r. 5 ± 2 mm). Ko艅c贸wka elektrody znajduj膮ca si臋 w jamie prawej komory w 56 preparatach (93,3%) by艂a otoczona przez grub膮 otoczk臋 w艂贸knist膮 cz臋艣ciowo pokryt膮 przez wsierdzie.
Wnioski: Stwierdzili艣my, 偶e w 74% badanych serc w艂贸knienie obejmowa艂o miejsca kontaktu elektrody z wsierdziem pokrywaj膮cym struktury zastawki tr贸jdzielnej lub z miokardium prawej komory. Stopie艅 nasilenia odczynu zale偶a艂 od czasu, kt贸ry up艂yn膮艂 od implantacji elektrody, typu ko艅c贸wki, nie wykazywa艂 natomiast zwi膮zku z rodzajem materia艂u izolacyjnego elektrody
Mutual relations between the amygdala and pro-inflammatory cytokines: IL-1尾 and IL-6
Interleukin 1 (IL-1) and interleukin 6 (IL-6) are typical examples of multfunctonal pro-infammatory cytokines involved in the regulaton of the immune response, hematopoiesis, and infammaton. Both peripheral and intraventricular administraton of these cytokines causes acute phase symptoms, e.g. fever, actvaton of the hypothalamic-pituitary-adrenal axis and psychological depression. The amygdala belongs to the structures of the limbic system involved in the regulaton of the immune response. Increased actvity of immune system may lead to changes in the role of amygdala, medial prefrontal cortex, anterior cingulate cortex or insula. The aim of the study was to present the mutual interactons between the amygdala and pro-infammatory cytokines such as interleukin-1尾 (IL-1 beta) and interleukin 6 (IL-6). Most of the data included in this review comes from animal studies
Variability of the Left Atrial Appendage in Human Hearts.
Atrial fibrillation increases the risk of thrombus formation. It is commonly responsible for cerebral stroke whereas less frequently for pulmonary embolism. The aim of the study was to describe the morphology of the left atrial appendage in the human heart with respect to sex, age and weight. Macroscopic examination was carried out on 100 left appendages taken from the hearts of the patients aged 18-77, both sexes. All hearts preserved in 4% water solution of formaldehyde carried neither marks of coronary artery disease nor congenital abnormalities. Three axes of appendage orientation were performed. After the appendage had been cut off, morphological examination was performed in long and perpendicular axes. Measurements of the appendages were taken from anatomical specimens and their silicone casts. We classified the left atrial appendage into 4 morphological groups according to the number of lobes. Most left atrial appendages in female population were composed of 2 lobes. In the male group typically 2 or 3-lobed appendages were observed. The mean left atrial appendage orifice ranged from 12.0 to 16.0 mm and the most significant difference in the orifices between males and females was observed in LAA type 2 (about 3.3 mm). A smaller orifice and narrower, tubular shape of the LAA lobes could explain a higher risk of thrombus formation during nonvalvular atrial fibrillation in women. Knowledge of anatomical variability of the LAA helps diagnose some undefined echoes in the appendage during transesophageal echocardiographic examination