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The Anatomical Record Sep 1996There 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...
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 -
CMAJ : Canadian Medical Association... Feb 2021
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 -
The Journal of Thoracic and... Mar 2021
Topics: Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Coronary Artery Bypass; Heart Septum; Humans
PubMed: 33041063
DOI: 10.1016/j.jtcvs.2020.09.035 -
The Annals of Thoracic Surgery Jan 2014
Topics: Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Female; Heart Septum; Humans; Male; Myocardial Bridging; Ventricular Outflow Obstruction
PubMed: 24384169
DOI: 10.1016/j.athoracsur.2013.08.004 -
Journal of Cardiology Sep 2022About 30% of patients with hypertrophic cardiomyopathy have a significant left ventricular pressure gradient at rest, and 60%-70% of these patients are diagnosed with... (Review)
Review
About 30% of patients with hypertrophic cardiomyopathy have a significant left ventricular pressure gradient at rest, and 60%-70% of these patients are diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) because an induced pressure gradient is also present. Percutaneous transluminal septal myocardial ablation (PTSMA) is a procedure in which ethanol is used to ablate the portion of the septal myocardium that is involved in the pathogenesis of the left ventricular outflow tract pressure gradient (LVOT PG). In 1995, Sigwart et al. reported three cases of PTSMA in The Lancet. The introduction of PTSMA into clinical practice has enabled the reduction of LVOT PG and improvement of heart failure symptoms in elderly and high-risk patients with symptomatic, drug-refractory HOCM. In 1998, Faber et al. published a report in Circulation on selective septal myocardial ablation using myocardial contrast echocardiography (MCE). MCE-guided PTSMA is now recognized as the standard method of PTSMA in many countries and regions, including Europe, North America, and Asia, and is estimated to be performed on about 300 to 400 patients per year in Japan based on reports from the Japanese Circulation Society's Clinical Practice Survey. The current problems with this technique are: 1) the outcome is greatly influenced by operators' and institutional experience, and 2) it is difficult to determine in advance whether the patient is a PTSMA responder or not. Recently, advancements in imaging modalities, including cardiac computed tomography and magnetic resonance imaging, have facilitated clarification of the mechanisms of LVOT obstruction. Therefore, more appropriate decisions regarding PTSMA and surgical myectomy (SM) are now made. Better treatment selection will undoubtedly improve the prognosis of patients with drug-refractory HOCM complicated by heart failure, and further elucidation of the pathogenesis of LVOT obstruction and technical advances in PTSMA and SM are eagerly awaited.
Topics: Aged; Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Catheter Ablation; Echocardiography; Heart Failure; Heart Septum; Humans; Treatment Outcome
PubMed: 34924238
DOI: 10.1016/j.jjcc.2021.11.023 -
Trends in Cardiovascular Medicine Feb 2020Cardiac resynchronization therapy (CRT) has been a major step in the treatment of heart failure patients and intraventricular conduction delay. As a considerable number... (Review)
Review
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 -
JACC. Cardiovascular Imaging Jul 2012
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 -
Heart (British Cardiac Society) Oct 2022Preclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device... (Clinical Trial)
Clinical Trial
OBJECTIVE
Preclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH).
METHODS
Between July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66-92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8-23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially.
RESULTS
After CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1-5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m and room-air resting SatO2 decreased by 6.2±1.9% (p<0.001). One patient experienced increased pericardiac effusion postoperatively; the others had no complications. On follow-up (median: 15.5 months), all interatrial communications were patent with stable size (intraclass correlation coefficient=0.96, 95%CI:0.89 to 0.99). The WHO functional class increased by 1 (IQR: 1-2) (p<0.001) with improvement of exercise capacity (+159.5 m, P<0.001).
CONCLUSION
The interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory.
TRIAL REGISTRATION NUMBER
NCT03554330.
Topics: Adult; Atrial Septum; Cardiac Catheterization; Catheter Ablation; Catheterization; Dilatation; Familial Primary Pulmonary Hypertension; Heart Septum; Humans; Hypertension, Pulmonary; Young Adult
PubMed: 35676068
DOI: 10.1136/heartjnl-2022-321212 -
Current Cardiology Reviews Nov 2013A significant clinical problem is patients presenting with exercise-limiting dyspnoea, sometimes with associated chest pain, in the absence of detectable left... (Review)
Review
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 -
Journal of Cardiovascular... Aug 2022Transseptal left atrial catheterization is routinely used for many common catheter-based interventions. Tools for transseptal catheterization have advanced over the... (Review)
Review
Transseptal left atrial catheterization is routinely used for many common catheter-based interventions. Tools for transseptal catheterization have advanced over the recent years. Such tools include imaging advances with intracardiac echocardiology as well as an array of needles, wires, and dilators to achieve transseptal access with greater ease and safety. This study will discuss the contemporary tools for transseptal catheterization and guidance for difficult cases.
Topics: Atrial Appendage; Cardiac Catheterization; Catheter Ablation; Heart Atria; Heart Septum; Humans; Punctures
PubMed: 35229417
DOI: 10.1111/jce.15428