The modified Fontan operation in hearts associated with atrioventricular valvar atresia or common atrioventricular valve—neoseptation of the atriums using a right atrial flap

1994 ◽  
Vol 4 (4) ◽  
pp. 353-357 ◽  
Author(s):  
Tayyar Sarioglu ◽  
Tufan Paker ◽  
Halil Türkoglu ◽  
Atif Akçevin ◽  
Ayse Sarioglu ◽  
...  
Keyword(s):  
Left Atrium ◽  
Right Atrium ◽  
Fontan Operation ◽  
Right Atrial ◽  
Moderate Hypothermia ◽  
Atrioventricular Valve ◽  
Venous Flow ◽  
The Right ◽  
Modified Fontan Operation ◽  
Common Atrioventricular Valve

SummarySummary Between June 1988 and December 1992, six patients with dominant left and rudimentary right ventricles underwent orthoterminal correction with a modified Fontan operation in which the atriums were neoseptated using a flap constructed from the right atrial wali. Four patients had anomalous systemic venous connections. The operations were performed under direct caval cannulation, standard cardiopulmonary bypass, moderate hypothermia and cardioplegic arrest. After opening the right atrium with a longitudinal incision, the atrial septum was completely resected and the coronary sinus was cut back. The upper wall of the right atrial incision was brought down in such a way that the pulmonary venous atrium was drained into the dominant ventricle via the right-sided or common atrioventricular valve. This was followed by direct connection of the right atrium with its anterior wall reconstructed with pericardium to the pulmonary arteries. In one patient, a left superior caval vein draining to the left atrium was divided and anastomosed to left pulmonary artery. One patient died on the 12th postoperative day with pulmonary infection and sepsis, though he had no hemodynamic problem, and another died on the sixth day due to high pulmonary vascular resistance. The remaining four patients are progressing well at a mean of 23.4 months postoperatively with functional capacity of NYHA I-IT and sinus rhythm. Echocardiographic and angiocardiographic examinations during follow-up showed unobstructed pulmonary and systemic venous pathways in all. This modification of the Fontan operation seems a good alternative technique which creates a contractile left atrium with large enough dimensions and an unobstructed pathway for pulmonary venous flow.

scholarly journals The Value of Voltage Histogram Analysis Derived Right Atrial Scar Burden in the Prediction of Left Atrial Scar Burden

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Szilvia Herczeg ◽  
Joseph Galvin ◽  
John J. Keaney ◽  
Edward Keelan ◽  
Roger Byrne ◽  
...  
Keyword(s):  
Left Atrium ◽  
Right Atrium ◽  
Low Voltage ◽  
Histogram Analysis ◽  
Right Atrial ◽  
Analysis Tool ◽  
Invasive Treatment ◽  
Scar Burden ◽  
Tissue Burden ◽  
The Right

Introduction. Growing evidence suggests that fibrotic changes can be observed in atrial fibrillation (AF) in both atria. Quantification of the scar burden during electroanatomical mapping might have important therapeutic and prognostic consequences. However, as the current invasive treatment of AF is focused on the left atrium (LA), the role of the right atrium (RA) is less well understood. We aimed to characterize the clinical determinates of the RA low-voltage burden and its relation to the LA scaring. Methods. We have included 36 patients who underwent catheter ablation for AF in a prospective observational study. In addition to LA mapping and ablation, high-density RA bipolar voltage maps (HD-EAM) were also reconstructed. The extent of the diseased RA tissue (≤0.5 mV) was quantified using the voltage histogram analysis tool (CARTO®3, Biosense Webster). Results. The percentage of RA diseased tissue burden was significantly higher in patients with a CHA2DS2-VASc score ≥ 2 p=0.0305, higher indexed LA volume on the CTA scan and on the HD‐EAM (p=0.0223 and p=0.0064, respectively), or higher indexed RA volume on the HD‐EAM p=0.0026. High RA diseased tissue burden predicted the presence of high LA diseased tissue burden (OR = 7.1, CI (95%): 1.3–38.9, p=0.0145), and there was a significant correlation of the same (r = 0.6461, p<0.0001). Conclusions. Determining the extent of the right atrial low-voltage burden might give useful clinical information. According to our results, the diseased tissue burden correlates well between the two atria: the right atrium mirrors the left atrium.

scholarly journals Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 960
Author(s):  
Jakub Hołda ◽  
Katarzyna Słodowska ◽  
Karolina Malinowska ◽  
Marcin Strona ◽  
Małgorzata Mazur ◽  
...  
Keyword(s):  
Right Atrium ◽  
Variable Structure ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Variable Component ◽  
Atrioventricular Valve ◽  
Stable Point ◽  
Complex Anatomy ◽  
Right Atrial Appendage ◽  
The Right

The right atrioventricular valve (RAV) is an important anatomical structure that prevents blood backflow from the right ventricle to the right atrium. The complex anatomy of the RAV has lowered the success rate of surgical and transcatheter procedures performed within the area. The aim of this study was to describe the morphology of the RAV and determine its spatial position in relation to selected structures of the right atrium. We examined 200 randomly selected human adult hearts. All leaflets and commissures were identified and measured. The position of the RAV was defined. Notably, 3-leaflet configurations were present in 67.0% of cases, whereas 4-leaflet configurations were present in 33.0%. Septal and mural leaflets were both significantly shorter and higher in 4-leaflet than in 3-leaflet RAVs. Significant domination of the muro-septal commissure in 3-leflet valves was noted. The supero-septal commissure was the most stable point within RAV circumference. In 3-leaflet valves, the muro-septal commissure was placed within the cavo-tricuspid isthmus area in 52.2% of cases, followed by the right atrial appendage vestibule region (20.9%). In 4-leaflet RAVs, the infero-septal commissure was located predominantly in the cavo-tricuspid isthmus area and infero-mural commissure was always located within the right atrial appendage vestibule region. The RAV is a highly variable structure. The supero-septal part of the RAV is the least variable component, whereas the infero-mural is the most variable. The number of detected RAV leaflets significantly influences the relative position of individual valve components in relation to right atrial structures.

scholarly journals Atypical size and location of a right atrial myxoma: a case report

2017 ◽  
Vol 4 (6) ◽  
pp. 2073
Author(s):  
Sushil Kumar Singhal ◽  
Palash Aiyer ◽  
Vijay Grover ◽  
Vijay Kumar Gupta
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Left Atrium ◽  
Right Atrium ◽  
Atrial Myxoma ◽  
Right Atrial ◽  
Right Atrial Myxoma ◽  
Intracardiac Tumors ◽  
The Right ◽  
Uncommon Location

Primary intracardiac tumors are rare and approximately 50-55% are myxomas. The majority of myxomas are located in the left atrium. Here We report a case of a large myxoma in the right atrium, which is an uncommon location for this type of tumor who underwent operative intervention with excision of a 9x6 cm multilobulated mass. In this case report, we emphasize the rarity of large myxomas in the right atrium and the difficulty of differential diagnosis given their dimension and location.

scholarly journals Cardiac changes in mediastinal seminoma - a case report

2003 ◽  
Vol 131 (9-10) ◽  
pp. 403-407
Author(s):  
Branislava Ivanovic ◽  
Bosiljka Vujisic-Tesic ◽  
Dragana Jovanovic ◽  
Dimitra Kalimanovska-Ostric
Keyword(s):  
Left Atrium ◽  
Right Atrium ◽  
Pulmonary Veins ◽  
Distant Metastases ◽  
Large Mass ◽  
Right Atrial ◽  
Adjacent Structures ◽  
Arm Swelling ◽  
Mediastinal Seminoma ◽  
The Right

Primary pure cell seminoma of the mediastinum is a rare and potentially fatal lesion. Encroachment or invasion of adjacent structures is common, as are distant metastases. We present an unusual case of mediastinal seminoma with directly intracavitary invasion into the right atrium and extension to the left atrium. A 22-year-old male with right side chest pain, progressive cough, dispnea, fever and right arm swelling lasting about a month is presented. Chest radiography on admission revealed a large mass in the anterior mediastinum. A cardiac ultrasonographic examination showed right atrial compression by the mass, with invasion of the right atrium wall. We also found polyp-like (about 2.5 cm in diameter) masses in left atrium near the area of the right pulmonary veins and a circumferential pericardial effusion. Percutaneous needle biopsy revealed mediastinal seminoma. To our knowledge, no similar case has been previously reported.

scholarly journals P1703 Cardiac metastasis of germ cell tumor "like beads" in the right heart chambers and also left atrium

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Akturk ◽  
T S Tan ◽  
A Mammadli ◽  
M Mammadov ◽  
I Dincer ◽  
...  
Keyword(s):  
Germ Cell ◽  
Left Atrium ◽  
Germ Cell Tumor ◽  
Right Atrium ◽  
Germ Cell Tumors ◽  
Vena Cava ◽  
Cell Tumor ◽  
Right Atrial ◽  
Mobile Mass ◽  
The Right

Abstract Introduction Testis tumors constitute 1-2% of all malignant tumors in men. But it is the most common solid tumor in men between 15-35 years of age. Germ cell tumors constitute for almost 90% of all testis tumors. Intracardiac metastasis of testicular carcinomas is rare. We now report a case of a testicular germ cell tumor with right atrial metastasis. Case report A 30-year-old male patient was diagnosed with B-cell ALL.Chemotherapy and radiotherapy were completed in 2016. In January 2017, the patient applied to the hospital with pain in the right testicle.A mass detected and orchiectomy was performed.Pathologic examination revealed mixed germ cell tumor and B-cell ALL infiltration.Chemotherapy was started. The patient was admitted to our hospital with fever, in March 2018.Antibiotics were started but fever contuniued.Transthoracic echocardiography showed a large,hypoechogen,mobile mass in the right atrium.Then transesophageal echocardiography revealed a 2x3,3 cm mobile mass within the right atrium that prolapsed through the tricuspid valve into the right ventricle in diastole.We could not distinguish if it is a vegetation or a metastatic mass. The patient underwent cardiac surgery.Pathologic examination revealed mixed germ cell tumor metastasis. After the surgery, the patient was transferred to the intensive care unit because of sepsis. Antibiotics were expanded due to fever. Control transthoracic echocardiography and also transesophageal echocardiography showed a 1,8 x 0,6 cm mobile mass extending from the inferior vena cava into the right atrium and through the patent foramen ovale into the left atrium. One week after the surgery, a mass was detected in the transthoracic echocardiography. But no further examination was done. We thought that the mass may not have been completely removed in the the operation (residual tumor?). The patient was evaluated with the department of oncology and cardiovascular surgery. It was decided that reoperation would be very risky. Conclusion Metastatic tumors of the heart are seen more frequently than primary tumors. Although intracardiac metastasis of testicular germ cell tumors are rare (less than %1), it has been related to short survival. They may lead to the congestive heart failure, paradoxical systemic emboli and vena cava superior syndrome. Most cases in the literature are associated with right atrial mass. But in our case, the mass was extending from the inferior vena cava into the right atrium and through the patent foramen ovale into the left atrium. We wanted to share our experience and also wanted to discuss the treatment modality for similar patients. Abstract P1703 Figure.

scholarly journals Investigations Into the Distribution of Blood in the Heart and Aortic Arches of Xenopus Laevis (Daud.)

1957 ◽  
Vol 34 (2) ◽  
pp. 143-172 ◽  
Author(s):  
A. R. DE GRAAF
Keyword(s):  
Xenopus Laevis ◽  
Left Atrium ◽  
Right Atrium ◽  
Pulmonary Veins ◽  
The Body ◽  
Right Atrial ◽  
Considerable Proportion ◽  
Open Communication ◽  
Selective Distribution ◽  
The Right

The structure of the heart of Xenopus laevis is described, and the differences between Xenopus and Rana are stressed. 2. A fluorescein-cinematographic method of tracing blood flow and an optical manometer for the measurement of blood pressure in Xenopus are described. 3. The right atrial blood is absorbed into the trabecular meshwork only on the right side of the ventricle. 4. Whereas the output of the right atrium is not, or only in negligible quantities, transferred to the left side of the ventricle, a considerable proportion of the output of the left atrium moves to the right half of the ventricle. 5. The left atrium has a larger output than the right atrium. 6. Almost all the blood expelled from the right atrium is sent to the pulmo-cutaneous arches. 7. The blood from the left atrium is distributed to all the arterial arches and the pulmo-cutaneous arches receive a considerable proportion of this blood. 8. More blood flows through the pulmo-cutaneous arches at each beat than is sent through the carotid and systemic arches together. 9. The rate of flow in the pulmonary circuit is much higher than that in the body circuit. 10. A physiological connexion is demonstrated between the left side of the ventricle and the systemic and carotid arches, and between the right side of the ventricle and the pulmo-cutaneous arches. 11. Pressures in the pulmo-cutaneous arch are consistently lower than in either the carotid or systemic arches. 12. The pressures in the carotid and systemic arches are remarkably similar. There is, therefore, no sound reason for postulating a mechanism in the carotid labyrinths which should maintain a higher pressure in the carotids than in the systemics. 13. The pulse curves in the arches show two waves: the first, major, one produced by contraction of the ventricle, the second one by contraction of the bulbus cordis. 14. The spiral valve may not come into contact with the opposite wall of the bulbus before contraction of the latter. Before that time, i.e. as long as the major propulsive force of the ventricular contraction is not expended, the cavum pulmo-cutaneum is in open communication with the ventricle. 15. The pulmonary veins show a weak pulse, and their pressure is higher than in the hepatic veins. This indicates smaller resistance in the pulmonary circuit than in the body circuit. 16. The selective distribution is neither in agreement with the ‘classical theory’ nor with ideas of random distribution. 17. The forces underlying the selective distribution and the significance of the pattern are discussed.

Pulsed Doppler echocardiographic assessment of patterns of venous flow after the modified Fontan operation: potential clinical implications

1998 ◽  
Vol 8 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Renate Kaulitz ◽  
Ingrid Luhmer ◽  
Hans Carlo Kallfelz
Keyword(s):  
Cardiac Catheterization ◽  
Fontan Operation ◽  
Right Atrial ◽  
Venous Blood Flow ◽  
Portal Venous Flow ◽  
Venous Flow ◽  
Cavopulmonary Anastomosis ◽  
Hepatic Venous Flow ◽  
Modified Fontan Operation ◽  
Total Cavopulmonary Anastomosis

AbstractTo assess the effect of a modified Fontan operation on systemic venous blood flow and the hepatic circulation, we compared 11 patients having an atriopulmonary connection and 35 with total cavopulmonary anastomosis. The Doppler echocardiographic study of the caval venous, hepatic venous and portal venous flow was performed so as to calculate the pulsatility ratio and the variation of flow with respiration. All patients had undergone cardiac catheterization. In addition, we included specific laboratory investigations to assess function of various organs.Significantly lower maximum velocities of flow at inspiration (0.31±0.12 rn/sec vs 0.45±0.14 m/sec) and expiration (0.23±0.09 rn/sec vs 0.32±0.11 m/sec), less pulsatility (0.43 vs 0.16) and a lower ratio of systolic to diastolic velocity (1.22 vs 1.85) were found in the patients having a cavopulmonary as compared to an atriopulmonary anastomosis. Peak velocities of hepatic venous flow during inspiration and expiration were significantly lower in those with a cavopulmonary anastornosis (p=O.OOl and p<O.OOl, respectively). In these patients, forward flow was extremely dependent on respiration, with decrease or cessation of antegrade flow during expiration in 22 patients. The velocity of portal venous flow was also significantly lower in these patients, although the pulsatility ratio did not differ significantly between the groups (0.5 ± 0.21 and 0.57 ± 0.23, respectively). The ratio of inspiratory and expiratory velocities showed no significant difference between the groups, nor was there any correlation between the pulsatility ratio of the venous vessels or the ratio of peak flow velocities during expiration and the mean systemic venous/right atrial pressure on postoperative cardiac catheterization. Hypoproteinemia was found in 8 patients after total cavopulmonary anastomosis; 9 of 10 patients with protein C deficiency belonged to this group.The dependence of hepatic venous flow on respiration in the presence of a chronically elevated systemic venous pressure in patients after the total cavopulmonary anastornosis may influence hepatic function in the postoperative period.

Atrial distension of isolated rabbit hearts and release of atrial natriuretic factor

1988 ◽  
Vol 255 (2) ◽  
pp. R232-R236
Author(s):  
D. P. Synhorst ◽  
J. Gutkowska
Keyword(s):  
Left Atrium ◽  
Right Atrium ◽  
Atrial Natriuretic Factor ◽  
Tissue Concentration ◽  
Regression Line ◽  
Right Atrial ◽  
Laboratory Animals ◽  
Natriuretic Factor ◽  
The Right ◽  
Atrial Natriuretic

Interventions that increase atrial pressures in humans or laboratory animals release atrial natriuretic factor (ANF) into the circulation. We studied the relation between distension of the right or left atrium and release of ANF in retrograde-perfused isolated rabbit hearts. A fluid-filled balloon within the right or left atrium was inflated to a mean pressure of 5, 10, 15, or 20 mmHg, and ANF in the cardiac effluent was measured by radioimmunoassay. The slope of the regression line relating ANF release to atrial distending pressure was steeper for the left than right atrium (P less than 0.001), indicating that, at comparable increases in mean pressures, the left atrium releases more ANF than does the right atrium. Left atrial tissue concentration of ANF was greater than right atrial (1.58 +/- 0.15 vs. 1.05 +/- 0.09 micrograms ANF/mg protein, P less than 0.01). In contrast to previous studies showing right atrial dominance in rats, the left atria of isolated, perfused rabbit hearts contain more ANF and release more in response to atrial distension.

Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

2005 ◽  
Vol 8 (2) ◽  
pp. 96 ◽  
Author(s):  
Osman Tansel Dar�in ◽  
Alper Sami Kunt ◽  
Mehmet Halit Andac
Keyword(s):  
Atrial Septal Defect ◽  
Right Atrium ◽  
Septal Defect ◽  
Complete Recovery ◽  
Interatrial Septum ◽  
Right Atrial ◽  
Atrial Wall ◽  
Residual Shunt ◽  
Asd Closure ◽  
The Right

Background: Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. Case: In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. Results: During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. Conclusion: Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

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