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Journal of Cardiovascular... Sep 2014Certain anatomical characteristics of the left atrial appendage (LAA) are associated with complexity in the implantation of occluder devices. (Observational Study)
Observational Study
BACKGROUND
Certain anatomical characteristics of the left atrial appendage (LAA) are associated with complexity in the implantation of occluder devices.
OBJECTIVE
The aim was to define characteristics measurable by three-dimensional imaging that would predict complexities both in the implantation procedure and the selection of the appropriate device size.
METHODS
An anatomical study was performed of 50 postmortem hearts, of which 15 had a history of atrial fibrillation, and of 30 consecutive patients undergoing LAA occlusion with the Amplatzer cardiac plug (ACP). The specimens were classified according to variables that can be visualized using computerized tomography (CT). The CT scans of 30 consecutive patients were classified according to the level of the LAA ostium, the left lateral ridge (LLR), the LAA limbus and distance from LAA to the mitral annulus before undergoing LAA occlusion, and the results were correlated.
RESULTS
Three types of LAA orifice were defined: type I, with a usually higher, anterior LAA ostium, a short, flattened and wide LLR and almost nonexistent limbus; type II, presenting a long, pointed and narrow LLR, and a longer, more defined limbus; type III, with a lower LAA ostium, close to the left atrium floor and the mitral annulus, a marked separation from the left pulmonary vein orifices and a limbus of intermediate length.
CONCLUSION
LAA with lower ostia are more difficult to occlude. Types II and III have very prominent LLRs with longer limbi, which may increase the difficulty of inserting the guide and making measurements for selection of the right ACP size.
Topics: Aged; Atrial Appendage; Cadaver; Humans; Imaging, Three-Dimensional; Longitudinal Studies; Male; Prospective Studies; Prosthesis Implantation; Septal Occluder Device; Tomography, X-Ray Computed
PubMed: 24716814
DOI: 10.1111/jce.12429 -
Acta Otorrinolaringologica Espanola 2011The position of the sphenopalatine artery is essential for the endoscopic treatment of severe posterior epistaxis. This artery passes through its own foramen, which has...
INTRODUCTION
The position of the sphenopalatine artery is essential for the endoscopic treatment of severe posterior epistaxis. This artery passes through its own foramen, which has a wide range of locations and anatomic relations.
OBJECTIVE
To carry out a descriptive osteological study on the sphenopalatine foramen area. Its anatomy, size, position and relations with turbinates and choanae are described, as well as the existence of accessory foramina.
MATERIAL AND METHODS
Exploration and anatomical study was carried out in 32 human hemi-crania.
RESULTS
The area between middle and superior meatus was considered the most common location of the sphenopalatine foramen in 56.24% of the cases (18 specimens), followed by the superior meatus, with 37.5% (12 hemi-skulls). The foramen was located in middle meatus in just two cases. We found accessory foramina in 50% of the cases, most commonly positioned below the middle meatus. The ethmoidal crest appeared in every skull, producing an anterior osseous projection on the sphenopalatine foramen.
CONCLUSION
There are variations in position, number and anatomic relations that may cause changes in the sphenopalatine artery orifice and its branches into the nasal fossa. The ethmoidal crest, located on the anterior side of the sphenopalatine foramen, can be considered a permanent landmark to find the foramen.
Topics: Arteries; Cephalometry; Endoscopy; Epistaxis; Hemostasis, Endoscopic; Humans; Nose; Palate, Hard; Sphenoid Bone
PubMed: 21429469
DOI: 10.1016/j.otorri.2011.01.009 -
European Journal of Dentistry 2016This article reviews the basic clinical techniques of performing a maxillary molar endodontic access opening, starting from the initial access opening into the pulp... (Review)
Review
This article reviews the basic clinical techniques of performing a maxillary molar endodontic access opening, starting from the initial access opening into the pulp chamber, to the point where a size #10 file has been advanced to the apices of all three or four (or more) canals. The article explains how the use of the dental surgical operating microscope or microscope-level loupes magnification of ×6-8 or greater, combined with head-mounted or coaxial illumination, improve the ability of a dentist to identify microscopic root canal orifices, which facilitates the efficient creation of conservative access openings with adequate straight-line access in maxillary molars. Magnified photos illustrate various microscopic anatomical structures or landmarks of the initial access opening. Techniques are explored for implementing an access opening for teeth with vital versus necrotic pulpal tissues. The article also explores the use of piezoelectric or ultrasonic instruments for revealing root canal orifices and for removing pulp stones or calcified pulpal tissue inside the pulp chamber.
PubMed: 27403069
DOI: 10.4103/1305-7456.184153 -
Urology Case Reports Nov 2022Catheter-related injuries to the distal urinary tract are well described however injury to the ureters are very rare. A 76-year-old Caucasian female presented with...
Catheter-related injuries to the distal urinary tract are well described however injury to the ureters are very rare. A 76-year-old Caucasian female presented with proximal ureteric rupture and sepsis caused by cannulation of the ureter with a catheter and inflation of the balloon within the lumen. The patient was managed with intravenous antibiotics, nephrostomy and ureteric stenting. Patients with neurogenic bladder may have vesico-ureteric reflux with patulous ureteric orifice. Long-term catheters may result in a contacted bladder, thereby altering the anatomical relationship of the bladder neck and ureteric orifice. Both of which may increase the risk of this complication.
PubMed: 35991214
DOI: 10.1016/j.eucr.2022.102185 -
Journal of Conservative Dentistry : JCD 2019Comprehensive understanding of the anatomic position of pulp canal orifices and the measurements of the molar pulp space may maintain the pulp health during conservative...
Morphological measurements of anatomical landmarks in human maxillary first molar pulp chambers and evaluation of number of pulp canal orifices using spiral computed tomography: An study.
CONTEXT
Comprehensive understanding of the anatomic position of pulp canal orifices and the measurements of the molar pulp space may maintain the pulp health during conservative tooth preparation and minimize the possibility of mishaps during endodontic therapy.
AIMS
The idea of the present study was to analyze the morphological measurements of anatomical landmarks in human maxillary first molar pulp chambers and evaluation of number of pulp canal orifices using three-dimensional spiral computed tomography (SCT).
SUBJECTS AND METHODS
One hundred and thirty extracted intact human adult maxillary first molars were chosen from the North Indian population and were analyzed using SCT in axial and coronal sections.
STATISTICAL ANALYSIS USED
Standard deviation, mean, and coefficient of variance were calculated. Interobserver reliability was evaluated using kappa value to avoid any bias.
RESULTS
The results from our study showed that 69.23% of the sample teeth had four canal orifices, the mesial and distal pulp horns were present at an average distance of 0.80 ± 0.36 mm and 0.41 ± 0.34 mm, respectively, above the cementoenamel junction (CEJ), and the mean distance from the central groove of central fossa to furcation and the central groove of central fossa to the pulp chamber's roof was 8.37 ± 0.33 mm and 3.87 ± 0.29 mm, respectively. The average distance of the pulp chamber's floor from the furcation was found to be 2.47 ± 0.11 mm. The highest degree of variance was observed in case of relation of CEJ to pulp horns, i.e., 44.85% and 82.60%.
CONCLUSIONS
The dimensions observed in this study and its resemblance to the various studies reported in literature shift the fundamental anatomic approach to a more systemic quantifiable approach to the endodontic maxillary first molar access preparation.
PubMed: 31367104
DOI: 10.4103/JCD.JCD_568_18 -
The Annals of Thoracic Surgery Apr 2006Atrioventricular valve regurgitation represents the principal indication for reoperation after repair of atrioventricular septal defect. Deciding how to correct...
BACKGROUND
Atrioventricular valve regurgitation represents the principal indication for reoperation after repair of atrioventricular septal defect. Deciding how to correct atrioventricular valve regurgitation is challenging in some cases because of the complexity of the anatomic features. This report deals with our surgical experience in using a double-orifice valve plasty technique in cases with atrioventricular septal defect.
METHODS
From August 2002 to August 2004, 8 patients underwent double-orifice valve plasty in surgical correction of atrioventricular septal defect. Anatomic types were partial (6 patients), intermediate (1 patient), and complete (1 patient). After the mitral cleft was closed, moderate to severe atrioventricular valve regurgitation was still present in these patients. Double-orifice valve plasty was used in the mitral valve in 7 patients and in the tricuspid valve in 1.
RESULTS
No hospital deaths or postoperative morbidity occurred. The follow-up ranged from 6 months to 30 months (median, 14.4 months). No or trivial atrioventricular valve regurgitation was found in 6 patients and mild atrioventricular valve regurgitation was present in 2.
CONCLUSIONS
Double-orifice valve plasty is an easy and effective additional procedure for children and for adult patients who have moderate or severe atrioventricular valve regurgitation after repair of atrioventricular septal defect.
Topics: Abnormalities, Multiple; Adolescent; Adult; Cardiac Surgical Procedures; Female; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Middle Aged
PubMed: 16564291
DOI: 10.1016/j.athoracsur.2005.10.034 -
The International Journal of... Oct 2019Preoperative optimal selection of the occluder size is crucial in percutaneous left atrial appendage (LAA) occlusion, and the maximal width of the LAA orifice is the...
Preoperative optimal selection of the occluder size is crucial in percutaneous left atrial appendage (LAA) occlusion, and the maximal width of the LAA orifice is the main reference index, however it can not fully meet the practical operation requirements. We retrospectively analyzed three-dimensional (3D) transesophageal echocardiography (TEE) and computed tomography (CT) imaging dataset of the 41 patients who underwent LAA occlusion with LAmbre™ system. The LAA orifice parameters were overall evaluated to determine their role in device size selection. Eight LAA 3D models of the four cases who had been replaced their device during the procedure based on TEE and CT were printed out to verify the optimal parameter decision strategy. There was a significant concordance of the results between 3D TEE and CT in the LAA orifice evaluation. The correlations between the perimeter and maximal width measurements by 3D TEE and the closure disk of the device were stronger than that between the area measurements and the closure disk (r = 0.93, 0.95, 0.86, respectively and p < 0.001 all), and the result was similar to that by CT (r = 0.92, 0.93, 0.84, respectively and p < 0.001 all). The ratios of the maximal width to the minimal width of the four cases were all > 1.4, however the rest 37 cases were all ≤ 1.4. Based on the comprehensive assessment of the LAA orifice perimeter and maximal width of the 3D printed models, the experiments were all succeed just for one try. The LAA orifice perimeter of 3D printed model based on 3D TEE may help in choosing the optimal device size of LAmbre™, especially for the LAA with flater ostial shape.
Topics: Atrial Appendage; Atrial Fibrillation; Atrial Function, Left; Cardiac Catheterization; Clinical Decision-Making; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Humans; Models, Anatomic; Models, Cardiovascular; Observer Variation; Patient Selection; Predictive Value of Tests; Printing, Three-Dimensional; Prosthesis Design; Reproducibility of Results; Retrospective Studies; Septal Occluder Device; Treatment Outcome
PubMed: 31134413
DOI: 10.1007/s10554-019-01627-4 -
Micron (Oxford, England : 1993) 2004This study outlines a simple 'Profilometric' method for measuring the size and function of the wrinkles. Wrinkle size was measured in relaxed conditions and the... (Review)
Review
This study outlines a simple 'Profilometric' method for measuring the size and function of the wrinkles. Wrinkle size was measured in relaxed conditions and the representative parameters were considered to be the mean 'Wrinkle Depth', the mean 'Wrinkle Area', the mean 'Wrinkle Volume', and the mean 'Wrinkle Tissue Reservoir Volume' (WTRV). These parameters were measured in the wrinkle profiles under relaxed conditions. The mean 'Wrinkle to Wrinkle Distance', which measures the distance between two adjacent wrinkles, is an accurate indicator of the muscle relaxation level during replication. This parameter, identified as the 'Muscle Relaxation Level Marker', and its reduction are related to increased muscle tone or contraction and vice versa. The mean Wrinkle to Wrinkle Distance is very important in experiments where the effectiveness of an anti-wrinkle preparation is tested. Thus, the correlative wrinkles' replicas, taken during follow up in different periods, are only those that show the same mean Wrinkle to Wrinkle Distance. The wrinkles' functions were revealed by studying the morphological changes of the wrinkles and their behavior during relaxed conditions, under slight increase of muscle tone and under maximum wrinkling. Facial wrinkles are not a single groove, but comprise an anatomical and functional unit (the 'Wrinkle Unit') along with the surrounding skin. This Wrinkle Unit participates in the functions of a central neuro-muscular system of the face responsible for protection, expression, and communication. Thus, the Wrinkle Unit, the superficial musculoaponeurotic system (superficial fascia of the face), the underlying muscles controlled by the CNS and Psyche, are considered to be a 'Functional Psycho-Neuro-Muscular System of the Face for Protection, Expression and Communication'. The three major functions of this system exerted in the central part of the face and around the eyes are: (1) to open and close the orifices (eyes, nose, and mouth), contributing to their functions; (2) to protect the eyes from sun, foreign bodies, etc.; (3) to contribute to facial expression, reflecting emotions (real, pretended, or theatrical) during social communication. These functions are exercised immediately and easily, without any opposition ('Wrinkling Ability') because of the presence of the Wrinkle Unit that gives (a) the site of refolding (the wrinkle is a waiting fold, ready to respond quickly at any moment for any skin mobility need) and (b) the appropriate skin tissue for extension or compression (this reservoir of tissue is measured by the parameter of WTRV). The Wrinkling Ability of a skin area is linked to the wrinkle's functions and can be measured by the parameter of 'Skin Tissue Volume Compressed around the Wrinkle' in mm(3) per 30 mm wrinkle during maximum wrinkling. The presence of wrinkles is a sign that the skin's 'Recovery Ability' has declined progressively with age. The skin's Recovery Ability is linked to undesirable cosmetic effects of ageing and wrinkling. This new Profilometric method can be applied in studies where the effectiveness of anti-wrinkle preparations or the cosmetic results of surgery modalities are tested, as well as in studies focused on the functional physiology of the Wrinkle Unit.
Topics: Aged; Anthropometry; Cosmetics; Face; Facial Expression; Female; Humans; Male; Middle Aged; Models, Anatomic; Neck; Replica Techniques; Silicon; Skin; Skin Aging; Sunlight; Terminology as Topic
PubMed: 15036275
DOI: 10.1016/j.micron.2003.11.007 -
Cor Et Vasa 1962
Topics: Cardiac Catheterization; Humans; Mitral Valve Stenosis
PubMed: 14488868
DOI: No ID Found -
Journal of Cardiovascular... Jun 2005Anatomically guided left atrial ablation is used increasingly for treatment of atrial fibrillation (AF). Three-dimensional mapping systems used for pulmonary veins (PV)...
INTRODUCTION
Anatomically guided left atrial ablation is used increasingly for treatment of atrial fibrillation (AF). Three-dimensional mapping systems used for pulmonary veins (PV) encircling ablation procedures anticipate a stable size and position of the PV orifice. The aim of the current study was therefore to analyze changes of PV orifice size and location throughout the cardiac cycle using cine magnetic resonance imaging (MRI).
METHODS AND RESULTS
Twenty-five healthy volunteers were studied using a 1.5 Tesla MRI system. MR angiograms were acquired with a breath-hold three-dimensional fast-spoiled gradient-echo imaging (3D FSPGR) sequence in the coronal plane before and after gadolinium injection. Maximum intensity projections and multiplanar reformations were performed to reconstruct images of the PV. Bright blood cine imaging in the axial view was acquired by a steady-state free precession pulse sequence. Twenty bright blood images were obtained per cardiac cycle. The axial (anterior-posterior) PV orifice diameter was measured in all 20 images. For analysis of PV movement the location of the orifice posterior edge was plotted on scale paper. PV orifice size depends on the stage of the cardiac cycle with the largest diameter in late atrial diastole and a mean decrease of 32.5% during atrial systole. Location changes of the PV orifice are in the range of up to 7.2 mm and larger in the coronal (lateral-medial) than in the sagittal (anterior-posterior) direction.
CONCLUSION
PV orifice size and location is not as stable as anticipated by three-dimensional mapping systems used for PV encircling left atrial ablation procedures. RF application close to the presumed orifice location should therefore be avoided to minimize the risk of PV stenosis.
Topics: Adult; Atrial Fibrillation; Atrial Function; Catheter Ablation; Contrast Media; Coronary Angiography; Female; Gadolinium; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Models, Anatomic; Models, Theoretical; Prospective Studies; Pulmonary Veins; Time Factors
PubMed: 15946353
DOI: 10.1046/j.1540-8167.2005.40724.x