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Advances in Experimental Medicine and... 2024Ebstein's anomaly is a congenital malformation of the tricuspid valve characterized by abnormal attachment of the valve leaflets, resulting in varying degrees of valve... (Review)
Review
Ebstein's anomaly is a congenital malformation of the tricuspid valve characterized by abnormal attachment of the valve leaflets, resulting in varying degrees of valve dysfunction. The anatomic hallmarks of this entity are the downward displacement of the attachment of the septal and posterior leaflets of the tricuspid valve. Additional intracardiac malformations are common. From an embryological point of view, the cavity of the future right atrium does not have a direct orifice connected to the developing right ventricle. This chapter provides an overview of current insight into how this connection is formed and how malformations of the tricuspid valve arise from dysregulation of molecular and morphological events involved in this process. Furthermore, mouse models that show features of Ebstein's anomaly and the naturally occurring model of canine tricuspid valve malformation are described and compared to the human model. Although Ebstein's anomaly remains one of the least understood cardiac malformations to date, the studies summarized here provide, in aggregate, evidence for monogenic and oligogenic factors driving pathogenesis.
Topics: Ebstein Anomaly; Animals; Disease Models, Animal; Humans; Dogs; Mice; Tricuspid Valve
PubMed: 38884760
DOI: 10.1007/978-3-031-44087-8_58 -
Cardiovascular Revascularization... Jun 2024The valve-in-valve transcatheter-aortic-valve-implantation (VIV-TAVI) represents an emerging procedure for the treatment of degenerated aortic bio-prostheses, and the...
AIMS
The valve-in-valve transcatheter-aortic-valve-implantation (VIV-TAVI) represents an emerging procedure for the treatment of degenerated aortic bio-prostheses, and the occurrence of patient-prosthesis mismatch (PPM) after VIV-TAVI might affect its clinical efficacy. This study aimed to test a multimodal imaging approach to predict PPM risk during the TAVI planning phase and assess its clinical predictivity in VIV-TAVI procedures.
METHODS
Consecutive patients undergoing VIV-TAVI procedures at our Institution over 6 years were screened and those treated by self-expandable supra-annular valves were selected. The effective orifice area (EOA) was calculated with a hybrid Gorlin equation combining echocardiographic data with invasive hemodynamic assessment. Severe PPM was defined according to such original multimodality assessment as EOAi≤0.65 cm/m (if BMI < 30 kg/m) or < 0.55 cm/m (if BMI ≥ 30 kg/m). The primary endpoint was a composite of all-cause mortality and valve-related re-hospitalization during the clinical follow-up.
RESULTS
A total of 40 VIV-TAVI was included in the analysis. According to the pre-specified multimodal imaging modality assessment, 18 patients (45.0 %) had severe PPM. Among all baseline clinical and anatomical characteristics, estimated glomerular filtration rate before VIV-TAVI (OR 0.872, 95%CI[0.765-0.994],p = 0.040), the echocardiographic pre-procedural ≥moderate AR (OR 0.023, 95%CI[0.001-0.964],p = 0.048), the MSCT-derived effective internal area (OR 0.958, 95%CI[0.919-0.999],p = 0.046) and the implantation depth (OR 2.050, 95%CI[1.028-4.086],p = 0.041) resulted as independent predictors of severe PPM at multivariable logistic analysis. At a mean follow-up of 630 days, patients with severe PPM showed a higher incidence of the primary endpoint (9.1%vs.44.4 %;p = 0.023).
CONCLUSION
In VIV-TAVI using self-expandable supra-annular valves, a multimodal imaging approach might improve clinical outcome predicting severe PPM occurrence.
PubMed: 38880697
DOI: 10.1016/j.carrev.2024.06.012 -
The American Journal of Case Reports Jun 2024BACKGROUND Laparoscopic-perineal neovagina construction by sigmoid colpoplasty is a popular therapeutic approach for patients with Mayer-Rokitansky-Kuster-Hauser (MRKH)...
BACKGROUND Laparoscopic-perineal neovagina construction by sigmoid colpoplasty is a popular therapeutic approach for patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. The conventional approach requires an auxiliary abdominal incision to exteriorize the descending colon to fix the anvil for end-to-end colorectal anastomosis. We modified the natural orifice specimen extraction surgery (NOSES) approach by exteriorizing the descending colon through the artificial neovaginal tunnel to replace the anvil extracorporeally, without requiring an auxiliary abdominal incision. It was a more minimally invasive technique. CASE REPORT We performed this modified laparoscopic-perineal sigmoid colpoplasty in a 26-year-old woman with MRKH syndrome. We cut off a segment of the sigmoid colon with a vascular pedicle to make a new vagina out of it, the same as in the traditional laparoscopic-perineal sigmoid colpoplasty. What is new about this technique is that it has no need for abdominal incision and is more minimally invasive. The operating time was 315 min. No postoperative complications occurred. The postoperative hospital stay was 4 days. The modified laparoscopic-perineal approach, free from an auxiliary abdominal incision, demonstrated advantages, including a shorter hospital stay, expedited recovery, and comparable anatomical outcomes, when compared with the traditional approach. This innovation improves the surgical experience for patients with MRKH syndrome, addressing the physical and psychological aspects of their condition. CONCLUSIONS This refined laparoscopic-perineal neovagina construction by sigmoid colpoplasty represents a feasible and minimally invasive technique. It is an attractive option for MRKH syndrome patients in need of vaginal reconstruction, offering a streamlined procedure with reduced postoperative recovery time and enhanced patient outcomes.
Topics: Humans; Female; Adult; Laparoscopy; Colon, Sigmoid; Vagina; 46, XX Disorders of Sex Development; Mullerian Ducts; Perineum; Congenital Abnormalities; Plastic Surgery Procedures
PubMed: 38867420
DOI: 10.12659/AJCR.943305 -
Surgical Endoscopy Jun 2024Implementing a robotic system for minimally invasive surgical procedures necessitates a comprehensive training regimen. This involves not only mastering the...
BACKGROUND
Implementing a robotic system for minimally invasive surgical procedures necessitates a comprehensive training regimen. This involves not only mastering the technological aspects of the robotic system but also enhancing surgical proficiency in manipulating robotic instruments. Furthermore, procedural expertise in specific surgeries is critical. Minimally invasive inguinal hernia repair is particularly suitable as an initial procedure for human application. The development of a comprehensive training model for this type of repair is a crucial element of such an educational pathway.
METHOD
Anatomical dissections were carried out on pigs to assess both the similarities and differences between pig and human anatomy. A structured minimally invasive inguinal hernia repair was performed to determine the suitability of the porcine inguinal region for training purposes.
RESULTS
A detailed anatomical description of the porcine inguinal region is outlined, to provide a framework for assessing the critical view of the porcine myopectineal orifice. By integrating the human 'ten golden rules' for safe and effective minimally invasive inguinal hernia repair, the standardized porcine integrated robotic inguinal hernia training (SPIRIT) model describes a step-by-step approach to practice surgical techniques in a realistic setting.
CONCLUSION
The SPIRIT model is designed to be a well-structured training model for minimally invasive inguinal hernia repair and incorporates the specific surgical steps as encountered in a human patient.
PubMed: 38858247
DOI: 10.1007/s00464-024-10932-6 -
Journal of Endodontics Jun 2024In dental clinical practice, cone-beam computed tomography (CBCT) is commonly used to assist practitioners to recognize the complex morphology of root canal systems;...
INTRODUCTION
In dental clinical practice, cone-beam computed tomography (CBCT) is commonly used to assist practitioners to recognize the complex morphology of root canal systems; however, because of its resolution limitations, certain small anatomical structures still cannot be accurately recognized on CBCT. The purpose of this study was to perform image super-resolution (SR) processing on CBCT images of extracted human teeth with the help of a deep learning model, and to compare the differences among CBCT, super-resolution computed tomography (SRCT), and micro-computed tomography (Micro-CT) images through three-dimensional reconstruction.
METHODS
The deep learning model (Basicvsr++) was selected and modified. The dataset consisted of 171 extracted teeth that met inclusion criteria, with 40 maxillary first molars as the training set and 40 maxillary first molars as well as 91 teeth from other tooth positions as the external test set. The corresponding CBCT, SRCT, and Micro-CT images of each tooth in test sets were reconstructed using Mimics Research 17.0, and the root canal recognition rates in the 3 groups were recorded. The following parameters were measured: volume of hard tissue (V1), volume of pulp chamber and root canal system (V2), length of visible root canals under orifice (VL-X, where X represents the specific root canal), and intersection angle between coronal axis of canal and long axis of tooth (∠X, where X represents the specific root canal). Data were statistically analyzed between CBCT and SRCT images using paired sample t-test and Wilcoxon test analysis, with the measurement from Micro-CT images as the gold standard.
RESULTS
Images from all tested teeth were successfully processed with the SR program. In 4-canal maxillary first molar, identification of MB2 was 72% (18/25) in CBCT group, 92% (23/25) in SRCT group, and 100% (25/25) in Micro-CT group. The difference of hard tissue volume between SRCT and Micro-CT was significantly smaller than that between CBCT and Micro-CT in all tested teeth except 4-canal mandibular first molar (P < .05). Similar results were obtained in volume of pulp chamber and root canal system in all tested teeth (P < .05). As for length of visible root canals under orifice, the difference between SRCT and Micro-CT was significantly smaller than that between CBCT and Micro-CT (P < .05) in most root canals.
CONCLUSIONS
The deep learning model developed in this study helps to optimize the root canal morphology of extracted teeth in CBCT. And it may be helpful for the identification of MB2 in the maxillary first molar.
PubMed: 38848947
DOI: 10.1016/j.joen.2024.05.015 -
Sisli Etfal Hastanesi Tip Bulteni 2024This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.
OBJECTIVES
This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.
METHODS
Between 2013 and 2019, 113 patients (77 males; mean age 57.8±16.36 years) who underwent isolated AVR were evaluated. The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR. The most commonly used valves in surgeries St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%).
RESULTS
The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR. However, there was no significant difference between the two groups in terms of postoperative adverse events. There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings.
CONCLUSION
When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions. Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features. However, this issue needs to be investigated in future prospective studies with more patients.
PubMed: 38808047
DOI: 10.14744/SEMB.2024.39112 -
Techniques in Coloproctology May 2024Visualising the course of a complex perianal fistula on imaging can be difficult. It has been postulated that three-dimensional (3D) models of perianal fistulas improve... (Comparative Study)
Comparative Study
INTRODUCTION
Visualising the course of a complex perianal fistula on imaging can be difficult. It has been postulated that three-dimensional (3D) models of perianal fistulas improve understanding of the perianal pathology, contribute to surgical decision-making and might even improve future outcomes of surgical treatment. The aim of the current study is to investigate the accuracy of 3D-printed models of perianal fistulas compared with magnetic resonance imaging (MRI).
METHODS
MRI scans of 15 patients with transsphincteric and intersphincteric fistulas were selected and then assessed by an experienced abdominal and colorectal radiologist. A standardised method of creating a 3D-printed anatomical model of cryptoglandular perianal fistula was developed by a technical medical physicist and a surgeon in training with special interest in 3D printing. Manual segmentation of the fistula and external sphincter was performed by a trained technical medical physicist. The anatomical models were 3D printed in a 1:1 ratio and assessed by two colorectal surgeons. The 3D-printed models were then scanned with a 3D scanner. Volume of the 3D-printed model was compared with manual segmentation. Inter-rater reliability statistics were calculated for consistency between the radiologist who assessed the MRI scans and the surgeons who assessed the 3D-printed models. The assessment of the MRI was considered the 'gold standard'. Agreement between the two surgeons who assessed the 3D printed models was also determined.
RESULTS
Consistency between the radiologist and the surgeons was almost perfect for classification (κ = 0.87, κ = 0.87), substantial for complexity (κ = 0.73, κ = 0.74) and location of the internal orifice (κ = 0.73, κ = 0.73) and moderate for the percentage of involved external anal sphincter in transsphincteric fistulas (ICC 0.63, ICC 0.52). Agreement between the two surgeons was substantial for classification (κ = 0.73), complexity (κ = 0.74), location of the internal orifice (κ = 0.75) and percentage of involved external anal sphincter in transsphincteric fistulas (ICC 0.77).
CONCLUSIONS
Our 3D-printed anatomical models of perianal fistulas are an accurate reflection of the MRI. Further research is needed to determine the added value of 3D-printed anatomical models in preoperative planning and education.
Topics: Humans; Printing, Three-Dimensional; Rectal Fistula; Magnetic Resonance Imaging; Models, Anatomic; Reproducibility of Results; Anal Canal; Female; Male; Adult; Imaging, Three-Dimensional; Middle Aged
PubMed: 38801550
DOI: 10.1007/s10151-024-02925-3 -
Medicina (Kaunas, Lithuania) Apr 2024A rare case of an anomalous location of the orifice of the coronary artery was found in a 99-year-old male cadaver undergoing routine dissection. The presence of the... (Review)
Review
A rare case of an anomalous location of the orifice of the coronary artery was found in a 99-year-old male cadaver undergoing routine dissection. The presence of the right coronary artery (RCA), left coronary artery (LCA), and conus artery (conus branch) originating from the right Valsalva sinus are the characteristic findings of this case. Then, the LCA passed through the aorta and the pulmonary artery. The LCA and RCA branches were normal. These findings are useful for future surgical procedures, including cardiac catheterization.
Topics: Humans; Male; Sinus of Valsalva; Cadaver; Aged, 80 and over; Coronary Vessel Anomalies; Coronary Vessels; Japan; East Asian People
PubMed: 38792913
DOI: 10.3390/medicina60050730 -
Otology & Neurotology : Official... Jul 2024This cadaveric anatomical study aimed to explore precise morphometric measurements of the eustachian tube (ET) and adjacent structures in the middle cranial fossa,...
PURPOSE
This cadaveric anatomical study aimed to explore precise morphometric measurements of the eustachian tube (ET) and adjacent structures in the middle cranial fossa, focusing on identifying reliable surgical landmarks when traditional markers are compromised due to tumors or trauma.
METHODS
Twenty-two temporal bones from 11 adult cadavers (mean age: 75.70 ± 13.75 yr, range: 40-90 yr; sex: 5 females and 6 males) were dissected bilaterally. Surgical tools, including an operation microscope, endoscope, and digital caliper, were used for meticulous measurements. Parameters such as ET dimensions, distances between key points, and relevant angles were quantified, ensuring precise anatomical data.
RESULTS
ET width at the foramen spinosum (FS) level, the midline level, and the eustachian orifice level were measured as 2.18 ± 0.68, 2.42 ± 0.70, and 2.30 ± 0.74 mm, respectively. The distances from the zygomatic root (ZR) to FS, ET, superior semicircular canal (SSC), and internal carotid artery (ICA) were 29.61 ± 2.56, 23.28 ± 2.61, 26.53 ± 2.56, and 32.61 ± 3.69 mm, respectively. The angles between SSC-ZR-ICA and FS-ZR-ICA were measured as 36.57 ± 10.32 and 13.63 ± 3.72 degrees, respectively. No statistical difference was found between right-left or male-female measurements ( p > 0.05).
CONCLUSION
The present study offers invaluable insights for neurotological surgeons performing middle fossa approaches. ET and ZR may serve as crucial reference points, enhancing surgical orientation and minimizing risks during complex procedures. These precise anatomical data may empower surgeons, ensuring safer and more confident middle cranial fossa operations, even in challenging clinical scenarios.
Topics: Humans; Eustachian Tube; Male; Temporal Bone; Female; Aged; Cranial Fossa, Middle; Aged, 80 and over; Adult; Middle Aged; Cadaver; Semicircular Canals
PubMed: 38769098
DOI: 10.1097/MAO.0000000000004203 -
Pediatric and Developmental Pathology :... May 2024Ebstein anomaly (EA) is a rare congenital heart defect characterized by abnormal development of the tricuspid valve (TV) and right ventricular myocardium. This study...
Ebstein anomaly (EA) is a rare congenital heart defect characterized by abnormal development of the tricuspid valve (TV) and right ventricular myocardium. This study documents 2 dramatic cases of fetal EA characterized by hydrops and cardiomegaly, leading to intrauterine or early neonatal death. These clinical outcomes were associated with morphological abnormalities including severe tricuspid regurgitation, unguarded TV orifice, pulmonary atresia, and flattened right ventricular myocardium. This study highlights that these adverse anatomical features may result in unfavorable clinical outcomes in fetal EA. While timely identification of such features by prenatal ultrasound is crucial for providing accurate prognostic stratification and guiding treatment decisions, fetopsy may be necessary to discern EA among the spectrum of right-heart anomalies.
PubMed: 38762771
DOI: 10.1177/10935266241250235