Variations in rotation of the aortic root and membranous septum with implications for transcatheter valve implantation

Heart ◽  
2017 ◽  
Vol 104 (12) ◽  
pp. 999-1005 ◽  
Author(s):  
Justin T Tretter ◽  
Shumpei Mori ◽  
Farhood Saremi ◽  
Sathish Chikkabyrappa ◽  
Kristen Thomas ◽  
...  
Keyword(s):  
Aortic Root ◽  
Atrioventricular Conduction ◽  
Data Sets ◽  
Clockwise Rotation ◽  
Ct Data ◽  
Transcatheter Valve ◽  
The Right ◽  
Valve Implantation ◽  
The Relationship ◽  
Membranous Septum

ObjectiveIt is intuitive to suggest that knowledge of the variation in the anatomy of the aortic root may influence the outcomes of transcatheter implantation of the aortic valve (TAVI). We have now assessed such variation.MethodsWe used 26 specimens of normal hearts and 78 CT data sets of adults with a mean age of 64±15 years to measure the dimensions of the membranous septum and to assess any influence played by rotation of the aortic root, inferring the relationship to the atrioventricular conduction axis.ResultsThe aortic root was positioned centrally in the majority of both cohorts, although with significant variability. For the cadaveric hearts, 14 roots were central (54%), 4 clockwise-rotated (15%) and 8 counterclockwise-rotated (31%). In the adult CT cohort, 44 were central (56%), 21 clockwise-rotated (27%) and 13 counterclockwise-rotated (17%). A mean angle of 15.5° was measured relative to the right fibrous trigone in the adult CT cohort, with a range of −32° to 44.7°. The dimensions of the membranous septum were independent of rotation. Fibrous continuity between the membranous septum and the right fibrous trigone increased with counterclockwise to clockwise rotation, implying variation in the relationship to the atrioventricular conduction axis.ConclusionsThe central fibrous body is wider, providing greater fibrous support, in the setting of clockwise rotation of the aortic root. Individuals with this pattern may be more vulnerable to conduction damage following TAVI. Knowledge of such variation may prove invaluable for risk stratification.

Anatomical predictors of high grade atrioventricular conduction disorders in patients with specific pacemaker implanted after TAVI

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Frey ◽  
A Brochier ◽  
N Nezzouhairi ◽  
D Irles
Keyword(s):  
Atrioventricular Block ◽  
Pacemaker Implantation ◽  
Atrioventricular Conduction ◽  
High Grade ◽  
Av Block ◽  
Conduction Disorders ◽  
Transcatheter Aortic Valve ◽  
The Difference ◽  
Valve Implantation ◽  
Membranous Septum

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf STIM TAVI-MS study Background  The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. Recent studies have identified short membranous septum (MS) length, deep implantation depth (ID) or their relation as anatomic risk of high-grade AV block and permanent pacemaker implantation. Purpose : We sought to examine whether the atrioventricular (AV) membranous septum (MS) measured by computed tomography (CT) and the depth of valve implantation measured from the final aortic angiogram could predict high-grade atrioventricular block (HG AVB) after TAVI, based on specific pacemaker memory data. Methods STIM-TAVI-MS was a prospective, multicentre observational study that enrolled patients implanted with a specific dual chamber pacemaker after TAVI, with the SafeR algorithm activated, allowing continuous monitoring of atrioventricular conduction. The primary endpoint was the occurrence of late (after Day 7) high-grade atrioventricular block(s) during the year after TAVI. We measured on CT scans the coronal MS lenght, infra-annular MS lenght and the quantification of calcifications, on the final angiogram after TAVI we measured the implant depth (ID) to identifie ΔID-MS corresponding to the difference between implant depth and MS length. The variables were compared with the occurrence of late HG-AVB on PM memory data. Results : Among 82 patients, (mean age 84,5 years ± 4,8, self-expending valve n = 24, 29,3%), n = 47 (57.3%) had ≥1 late high-grade atrioventricular block. Mean coronal MS length was 8,1 ± 2,5 mm, mean infra annular MS was 3,4 ± 3.1 mm, mean calcification volume was 93.0 ± 88, 85,5± 104 and 141,5 ± 137,5 mm3 for the noncoronary, right coronary and left coronary cusp respectively. Mean implant depth was 7,3 ± 3,3mm, and mean ΔID-MS = -0,7 ± 4,1mm. There were no association between MS length (OR = 1,06; CI 0,91 to 1,24), ID (OR = 1,6; CI 0,85 to 2,9), nor ΔID-MS (OR = 0,67; CI 0,37 to 1,23) and late HG AVB. Calcification volume were not associated with late HG AVB. Conclusion In an high risk high grade AV block population after TAVI, anatomical analysis of MS length, degree of calcification, implant depth and ΔID-MS did not predict occurrence of late (> day 7 after TAVI ) high grade AV Blocks. Abstract Figure. CT scan A : aortic plane, B : MS lenght

How should we diagnose and differentiate hearts with double-outlet right ventricle?

2016 ◽  
Vol 27 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Tara Bharucha ◽  
Anthony M. Hlavacek ◽  
Diane E. Spicer ◽  
Paraskevi Theocharis ◽  
Robert H. Anderson
Keyword(s):  
Right Ventricle ◽  
Double Outlet Right Ventricle ◽  
Data Sets ◽  
Normal Heart ◽  
Anatomical Features ◽  
Important Principle ◽  
Ventricular Structure ◽  
Number Of Patients ◽  
Ct Data ◽  
The Right

AbstractMany, if not most, of the controversies regarding the description of the congenitally malformed heart have been resolved over the turn of the 20th century. A group of lesions that remains contentious is the situation in which both arterial trunks, in their greater part, are supported by the morphologically right ventricle. It was considered, for many years, that presence of bilateral infundibulums, or conuses, was a necessity for such a diagnosis. It has now been appreciated that this suggestion founders on many counts. In the first instance, such bilateral infundibulums are to be found in patients with other ventriculo-arterial connections, including the otherwise normal heart. In the second instance, it is clear that such an approach abrogates the important principle now known as the morphological method. This states that entities should be defined in terms of their intrinsic morphology and not on the basis of other variable features. It is now also clear that, when assessed simply on the basis of the ventricular origin of the arterial trunks, a significant number of patients fulfil the criteria for so-called “200%” origin of the trunks from the right ventricle when there is fibrous continuity between the leaflets of the atrioventricular and arterial valves. In this review, we show how attention to the morphology of the channel between the ventricles now provides the key to accurately diagnose the ventriculo-arterial connection in patients with suspected double-outlet right ventricle.This is because, when both arterial trunks arise exclusively or predominantly from the morphologically right ventricle, the outlet septum, of necessity, is itself a right ventricular structure. The channel between the ventricles, therefore, is roofed by the inner heart curvature, whether that structure is fibrous or muscular. Our observations then confirm that it is the attachment of the outlet septum, which itself can be muscular or fibrous, which determines the commitment of the interventricular communication to the subarterial outlets. The interventricular communication itself, when directly committed to the ventricular outlets, opens between the limbs of the septomarginal trabeculation or septal band. The defect is subaortic when the outlet septum is attached to the cranial limb of the trabeculation, subpulmonary when attached to the caudal limb, and doubly committed when attached to the inner heart curvature in the roof of the defect. Non-committed defects are no longer positioned within the limbs of the septomarginal trabeculation. Although readily demonstrable by a skilled echocardiographer, we show how these anatomical features are more easily demonstrated with added accuracy when using CT data sets.

P6015Histological pattern of penetrating His bundle division: implications for atrioventricular conduction damage during and following transcatheter aortic valve implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J A Cabrera ◽  
A Porta-Sanchez ◽  
D Nunez Pernas ◽  
J M Rubio ◽  
F Navarro ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
His Bundle ◽  
Transcatheter Aortic Valve ◽  
Av Conduction ◽  
Left Ventricular Outflow ◽  
The Right ◽  
Valve Implantation ◽  
Membranous Septum

Abstract Background Severe damage to the atrioventricular conduction system is one of the most common complications of transcatheter aortic valve implantation (TAVI) and can be linked to important comorbidity, increased healthcare expense, need for long-term monitoring and pacemaker implantation. Purpose To provide a detailed description of the His bundle (HB) arrangement within the left ventricular outflow tract. Methods We examined by dissection techniques and histological sections the course of the AV conduction axis (penetrating, non-branching and branching HB) in relation with the membranous and muscular interventricular septum in 57 structurally normal human heart specimens (48 males, 77±7 years) Results The AV conduction axis is located along the inferior edge of the membranous septum (MS). The MS is divided into AV and interventricular components and is located at the base of the interleaflet triangle between the right and non-coronary leaflets of the aortic valve. The conduction axis enters the AV component of the MS and is encircled by the fibrous tissue of the central fibrous body to reach the left ventricular outflow tract. The MS showed in cadaveric hearts variable dimensions in length (4.6±1.5 mm) with a range bewteen 1 to 9mm. In 17.5% of specimens the MS length was ≤2 mm. After penetrating the AV membranous septum it has a non-branching component that in 85.5% of cases runs only for a short distance (1–3 mm) along the septal crest before giving rise to the fascicles of the left bundle (LB) on the septal surface (Type A). The most anterior fibers of the LB originate at the end of the branching portion located underneath the inferior edge of the MS. In 5 hearts (9%) the HB division was found before it reached the interventricular MS (Type B) and in 3 cases (5.5%)2–3.5 mm distal to the crest (Type C). 22 hearts (49%) were shown to have a relatively left-sided deviation of the AV bundle with the anterior part of the bundle closely related to the nadir of attachment of the right coronary leaflet of the aortic valve. In the remaining 51% of hearts, the bundle coursed centrally or with a right-sided deviation. The HB measures were (mm, mean±SD (range)): length: 3±0.6 (2–4.5), width: 3.7±1.4 (2.5–5.6), thickness: 1.4±0.5 (0.5–2.2), HB to endocardium: 0.7±0.3 (0.2–1.5). His bundle position types Conclusions A shorter membranous septum length, the variable HB dimensions and the left-sided deviation of the AV conduction axis are extremely relevant anatomic features that are linked to the frequent injury to the HB branch or complete AV block following TAVI.

The echocardiographic anatomy of ventricular septal defects

1997 ◽  
Vol 7 (4) ◽  
pp. 471-484 ◽  
Author(s):  
Michael A. Gatzoulis ◽  
Jia Li ◽  
Siew Yen Ho
Keyword(s):  
Right Ventricle ◽  
Atrioventricular Conduction ◽  
Ventricular Septal Defects ◽  
Cross Sectional ◽  
Septal Defects ◽  
Echocardiographic Images ◽  
The Right ◽  
Descriptive Method ◽  
Membranous Septum

AbstractMany of the controversies surrounding the description of ventricular septal defects arise from differences in the perspectives from which they are viewed. In this review, we analyse these defects as seen in cross-sectional echocardiographic images, correlating them with morphologic specimens. The classification we advocate, which now has a suitable pedigree, is a simple descriptive method distinguishing between perimembranous, muscular, and doubly committed types of defects. The approach is to categorise the defects as seen from the right ventricle, the usual port of access for surgeons. The term ‘perimembranous’ highlights the proximity of the atrioventricular conduction axis to the margin of the defects in which the remnant of the membranous septum forms a direct border. This system is applicable to all interventricular communications, no matter how malformed the heart may be in which they are enclosed.

Occlusal Angles of Equine Incisors

2017 ◽  
Vol 34 (4) ◽  
pp. 259-267 ◽  
Author(s):  
Laura Listmann ◽  
Patricia Schrock ◽  
Klaus Failing ◽  
Carsten Staszyk
Keyword(s):  
Transverse Plane ◽  
Data Sets ◽  
Anatomical Landmarks ◽  
3D Reconstructions ◽  
Mean Values ◽  
3 Dimensional ◽  
Lower Jaw ◽  
Ct Data ◽  
The Right ◽  
Lower Incisors

The angulation of equine incisors is frequently used as a parameter for dental corrections. However, the term incisor angle is only vaguely defined, and no studies exist presenting a series of reliable measurements in individual incisors of multiple horses. The aim of this study was to establish an exact method to determine incisor angles and to test whether clinically accessible landmarks (facial crest and bars) are suitable to estimate incisor angles. Eighteen horses were used to create 3-dimensional (3D) reconstructions of the skulls from computed tomography (CT) data sets. Reference planes (median and transverse plane) were calculated using defined anatomical landmarks. Subsequently, occlusal planes for incisors and for incisor quadrants were calculated. Occlusal table angles were measured in relation to the reference planes. For each incisor, sagittal and transverse angles were measured. Mean values of individual incisor angles ranged from 3.5° to 6.8° (transverse angle) and from 32.6° to 44.9° (sagittal angle). No significant differences were detected in mean between the left and the right side when teeth in same Triadan positions were compared. However, in individual horses, marked differences between the left and the right side of the jaws occurred. Mandibular incisors showed significantly steeper sagittal angles than maxillary incisors. Furthermore, angles of opposing incisors were correlated with each other. The facial crest and the upper jaw bars featured a curved shape and were therefore of limited use to estimate the angulation of the upper incisors. In contrast, the lower jaw bars were suitable to determine the angulations of lower incisors.

An evaluation of the Hennessy Grading Probe for measuring fat depth in beef carcasses

1989 ◽  
Vol 29 (6) ◽  
pp. 781 ◽  
Author(s):  
DL Hopkins
Keyword(s):  
Linear Equations ◽  
Data Sets ◽  
Regression Equations ◽  
Data Set ◽  
General Validity ◽  
Measurement Analysis ◽  
Beef Carcasses ◽  
The Right ◽  
The Relationship ◽  
Methods Of Measurement

Fat depth at the P8 site on the rump was measured by the cut-and-measure (CM) technique and with the Hennessy Grading Probe (HGP) on 2501 beef carcasses at 1 abattoir over a 12-month period. CM measurements that differed by more than 1 mm between the right and left sides of the carcass were discarded. A subsequent data set of 1850 carcasses was randomly divided so that 2 models could be developed to assess the general validity of the relationship between the 2 methods of measurement. Analysis of measurements of the left side of the carcasses of these 2 subsamples showed the data were not normally distributed. Removal of outliers at the 95% confidence level and also measurements at both extremes of the data range improved the symmetry of the sets of data. From each adjusted data set, regression equations were developed to predict CM measurements from HGP measurements. Linear equations were adequate for predicting CM measurements from HGP measurements, and curvilinear analysis did not improve the predictions. Compared with the curvilinear equations, the linear equations resulted in smaller differences between the 2 data sets for the predicted CM measurements over a range of HGP measurements.

Effect of CT-based attenuation correction on uptake ratios in skeletal SPECT

2007 ◽  
Vol 46 (01) ◽  
pp. 38-42 ◽  
Author(s):  
V. Schulz ◽  
I. Nickel ◽  
A. Nömayr ◽  
A. H. Vija ◽  
C. Hocke ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Facet Joint ◽  
One Dimension ◽  
Patient Specific ◽  
Data Sets ◽  
Facet Joints ◽  
Lumbar Vertebral Body ◽  
Ct System ◽  
Ct Data ◽  
Attenuation Corrected

SummaryThe aim of this study was to determine the clinical relevance of compensating SPECT data for patient specific attenuation by the use of CT data simultaneously acquired with SPECT/CT when analyzing the skeletal uptake of polyphosphonates (DPD). Furthermore, the influence of misregistration between SPECT and CT data on uptake ratios was investigated. Methods: Thirty-six data sets from bone SPECTs performed on a hybrid SPECT/CT system were retrospectively analyzed. Using regions of interest (ROIs), raw counts were determined in the fifth lumbar vertebral body, its facet joints, both anterior iliacal spinae, and of the whole transversal slice. ROI measurements were performed in uncorrected (NAC) and attenuation-corrected (AC) images. Furthermore, the ROI measurements were also performed in AC scans in which SPECT and CT images had been misaligned by 1 cm in one dimension beforehand (ACX, ACY, ACZ). Results: After AC, DPD uptake ratios differed significantly from the NAC values in all regions studied ranging from 32% for the left facet joint to 39% for the vertebral body. AC using misaligned pairs of patient data sets led to a significant change of whole-slice uptake ratios whose differences ranged from 3,5 to 25%. For ACX, the average left-to-right ratio of the facet joints was by 8% and for the superior iliacal spines by 31% lower than the values determined for the matched images (p <0.05). Conclusions: AC significantly affects DPD uptake ratios. Furthermore, misalignment between SPECT and CT may introduce significant errors in quantification, potentially also affecting leftto- right ratios. Therefore, at clinical evaluation of attenuation- corrected scans special attention should be given to possible misalignments between SPECT and CT.

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