Authors: R H Anderson, N A Brown

BACKGROUND

There is a marked conservative tendency to be found in anatomic descriptions, with a seeming reluctance on the part of acknowledged experts to test new theories by returning to direct studies of gross anatomy. This tendency has become manifest to us during recent attempts to review the structure and function of the heart.

METHODS

We have reviewed our recent experience in trying to describe the structure and development of the atrial septum and arterial roots, attempting at the same time to establish the place of semantic as opposed to morphologic factors in disagreements on these topics.

RESULTS

Dissection of the structures separating the right atrium from the left atrium shows a fundamental difference between the infolded superior rim of the oval foramen, made up of the atrial walls, versus the make up of the sinus and atrioventricular septums, which are true septal structures. Analysis of the arterial roots shows that the major feature is the semilunar attachment of the valvar leaflets, an arrangement not ideally described in terms of an annulus.

CONCLUSIONS

Understanding of details of cardiac anatomy, as set out in standard textbooks, is hindered by a reluctance on the part of some to accept material presented on the basis of straightforward gross dissection. Instead, there is a seeming desire to depend on conventional wisdom, often unsupported by anatomic fact. Such controversies can be ameliorated by appropriate recognition to contributions of gross morphology and by using simple words to describe the observed anatomic features.

Topics: Anatomy; Arteries; Coronary Vessels; Heart; Heart Septum; Heart Valves; Humans; Terminology as Topic

PubMed: 8876818
DOI: 10.1002/(SICI)1097-0185(199609)246:1<1::AID-AR1>3.0.CO;2-Y

Clinical Trial

Authors: Jing Fang, Yani Liu, Ying Zhu...

BACKGROUND

To simplify surgical septal reduction therapy for hypertrophic obstructive cardiomyopathy (HOCM), we developed a novel transapical beating-heart septal myectomy (TA-BSM) procedure.

OBJECTIVES

In this study, we sought to evaluate the clinical utility of TA-BSM in a first-in-human trial.

METHODS

Patients with HOCM were enrolled if they presented with drug-refractory disabling symptoms. TA-BSM was performed via minithoracotomy with the use of our beating-heart myectomy device under echocardiographic guidance, without the use of cardiopulmonary bypass. Repeated resections were performed to tailor the extent of the septal myectomy for sufficient abolishment of left ventricular outflow tract (LVOT) obstruction and mitral regurgitation (MR). The primary outcome measure was procedural success, defined by resting/provoked LVOT gradient <30/50 mm Hg and residual MR grade ≤1+ (of 4+) at 3-month follow-up.

RESULTS

A total of 47 patients aged 12 to 77 years were enrolled. Of the 46 patients who were followed for 3 months, 42 achieved procedural success. The maximal LVOT gradient decreased from 86 mm Hg (IQR: 67-114 mm Hg) at baseline to 19 mm Hg (IQR: 14-28 mm Hg) at 3 months. MR grade was ≤1+ in 3 patients at baseline and in 45 patients at 3 months. One patient died on postoperative day 10 owing to device-unrelated reasons. Other major adverse events included 1 delayed ventricular septal perforation and 1 intraoperative left ventricular apical tear.

CONCLUSIONS

TA-BSM is a safe and efficient minimally invasive procedure for septal reduction of heterogeneous HOCM. Compared with conventional septal myectomy, TA-BSM provides real-time evaluation to guide resection while reducing surgical trauma. (Transapical Beating-Heart Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy; NCT05332691).

Topics: Humans; Cardiomyopathy, Hypertrophic; Coronary Artery Bypass; Echocardiography; Heart Septum; Mitral Valve Insufficiency; Treatment Outcome; Male; Female; Child; Adolescent; Adult; Middle Aged; Aged

PubMed: 37558369
DOI: 10.1016/j.jacc.2023.05.052

Authors: Shubham Agarwal, Haitham Al Hashimi, Sanjeev Kumar Agarwal...

Topics: Adult; COVID-19; Echocardiography; Electrocardiography; Heart Septum; Humans; Magnetic Resonance Imaging; Male; Myocardial Infarction; SARS-CoV-2; Thrombosis

PubMed: 33526551
DOI: 10.1503/cmaj.202106-f

Authors: Ertan Ural

Topics: Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Catheter Ablation; Heart Septum; Humans

PubMed: 29853690
DOI: 10.5543/tkda.2018.09076

Review

Authors: Mihir A Kelshiker, Jamil Mayet, Beth Unsworth...

A significant clinical problem is patients presenting with exercise-limiting dyspnoea, sometimes with associated chest pain, in the absence of detectable left ventricular (LV) systolic dysfunction, coronary artery disease, or lung disease. Often the patients are older, female, and have isolated basal septal hypertrophy (BSH), frequently on a background of mild hypertension. The topic of breathlessness in patients with clinical heart failure, but who have a normal ejection fraction (HFNEF) has attracted significant controversy over the past few years. This review aims to analyse the literature on BSH, identify the possible associations between BSH and HFNEF, and consequently explore possible pathophysiological mechanisms whereby clinical symptoms are experienced.

Topics: Cardiomyopathy, Hypertrophic; Diastole; Dyspnea; Heart Septum; Humans; Hypertrophy; Stroke Volume; Systole; Ultrasonography

PubMed: 24313643
DOI: 10.2174/1573403x09666131202125424

Authors: Harold G Roberts, Lawrence M Wei, Vinay Badhwar...

Topics: Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Coronary Artery Bypass; Heart Septum; Humans

PubMed: 33041063
DOI: 10.1016/j.jtcvs.2020.09.035

Authors: Burak Açar, Sefa Ünal, Pelin Aladağ...

Topics: Adult; Female; Heart Neoplasms; Heart Septum; Humans; Lipoma; Ventricular Septum

PubMed: 29226904
DOI: 10.5543/tkda.2017.80195

Authors: Nathaniel Reichek

Topics: Cardiomyopathy, Hypertrophic; Female; Heart Septum; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging, Cine; Male

PubMed: 22789939
DOI: 10.1016/j.jcmg.2012.05.005

Review

Authors: Simon Calle, Christophe Delens, Victor Kamoen...

Cardiac resynchronization therapy (CRT) has been a major step in the treatment of heart failure patients and intraventricular conduction delay. As a considerable number of patients do not respond adequately to CRT, echocardiographic dyssynchrony selection criteria have been proposed to improve CRT response, but these parameters eventually failed to provide superior selection of CRT candidates. In the last decade, an echo-dyssynchrony parameter called "septal flash" was been reported by several investigators and opinion leaders in the field of CRT. This parameter has a strong pathophysiological rationale and was shown to be a robust and predominant predictor of CRT response in recent observational and retrospective studies. We here provide a comprehensive and balanced overview of septal flash and address several important aspects, questions and potential future implications of septal flash in cardiomyopathy and CRT.

Topics: Action Potentials; Animals; Bundle-Branch Block; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Clinical Decision-Making; Heart Failure; Heart Rate; Heart Septum; Humans; Recovery of Function; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Remodeling

PubMed: 31000325
DOI: 10.1016/j.tcm.2019.03.008

Authors: Paul Sorajja, William T Katsiyiannis, Kevin M Harris...

Topics: Cardiomyopathy, Hypertrophic; Catheter Ablation; Heart Septum; Humans; Radiofrequency Ablation

PubMed: 30309467
DOI: 10.1016/j.jacc.2018.06.077