Characterization of Spontaneous Vascular Findings in the Papillary Muscles of Beagle Dogs

2020 ◽  
Vol 48 (7) ◽  
pp. 899-904
Author(s):  
Rebecca Kohnken ◽  
Angella Weber
Keyword(s):  
Papillary Muscle ◽  
Interventricular Septum ◽  
Vascular Supply ◽  
Left Ventricular ◽  
Papillary Muscles ◽  
Beagle Dogs ◽  
Internal Elastic Lamina ◽  
Posterior Papillary Muscle ◽  
Medial Hypertrophy

Standard histology trimming practices for toxicity studies in dogs include preparation of a section of the papillary muscle associated with the left ventricular free wall—the anteriolateral or anterior muscle. In contrast, the posteromedial or posterior papillary muscle, associated with the interventricular septum, is not commonly evaluated. In humans, the posterior papillary muscle is more often affected in ischemic myocardial disease, in large part due to the absence of collateral circulation, in contrast to the anterior muscle. Due to the differential vascular supply to the papillary muscles, we sought to determine whether there is a higher incidence of spontaneous coronary vascular changes in the posterior papillary muscle versus the anterior muscle in dogs. The hearts of 30 vehicle-treated or untreated beagle dogs that were euthanized for other purposes were collected and sectioned in a consistent manner to include both papillary muscles for histologic evaluation. The posterior muscle consistently had higher incidences of intramural coronary arteries affected by vascular medial hypertrophy, medial arteriosclerosis, intimal hyperplasia, and/or disruption or loss of the internal elastic lamina. This observation may have significant implications for the evaluation and characterization of spontaneous and xenobiotic-induced cardiovascular lesions in dogs.

scholarly journals The Violin Heart

2010 ◽  
Vol 4 ◽  
pp. 117954681000400 ◽  
Author(s):  
James Ker
Keyword(s):  
Case Report ◽  
Papillary Muscle ◽  
Interventricular Septum ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
Papillary Muscles ◽  
Musical Note ◽  
Bundle Of His

Left ventricular false tendons are thin, fibromuscular structures which traverse the left ventricular cavity. They are thought to be intracavitary radiations of the bundle of His. Usually these tendons span between the interventricular septum and the lateral wall or a papillary muscle. They have been known to be a source of innocent and musical murmurs. In this case report a peculiar left ventricular false tendon is shown—one extending between the two papillary muscles, giving the appearance of a musical note. During ventricular diastole the tendon is pulled taut between the two heads of the papillary muscles and during ventricular systole the tendon relaxes. The echocardiographic characteristics and possible long term implications are discussed.

Inter-Basal and Septal Connections of Papillary Muscles - An Anatomical Rationale for Rhythmic Opening of AV Valves - A Multicentric Medical College Based Cross Sectional Study

2021 ◽  
Vol 8 (31) ◽  
pp. 2865-2869
Author(s):  
Praveen Mulki Shenoy ◽  
Amith Ramos ◽  
Narasimha Pai ◽  
Bharath Shetty ◽  
Aravind Pallipady Rao
Keyword(s):  
Left Ventricle ◽  
Papillary Muscle ◽  
Interventricular Septum ◽  
Cross Sectional Study ◽  
Papillary Muscles ◽  
Cross Sectional ◽  
Medical College ◽  
Moderator Band ◽  
Almost All ◽  
And Function

BACKGROUND The papillary muscle basal connections have significant clinical implications. Variety of studies done on its morphology and function by various specialists in different departments. A close look on these revealed the interconnections of papillary muscles to one another and to the interventricular septum of both ventricles is related to uncoordinated contractions of papillary muscles, leading to hyper or hypokinesia or prolapse or even its rupture. METHODS Our study done in 25 formalin soaked hearts revealed after the deep and meticulous dissection, reflecting the walls of ventricles laterally the numerous interconnections of papillary muscles at its bases and IVS. Ventricles are opened by inverted ‘L’ shaped incision and its reflected more laterally till all the papillary muscles is visible in one frame after incising the moderator band. The connections were noted, measured, photographed, tabulated, compared with similar studies and analysed with experts with respective fields. RESULTS Almost all the specimens did have the interconnections. Further the post mortem findings of the cardiac related deaths with involvement of papillary muscles suggest damage to such ‘bridges’. The moderator band extensions to the base of right APM, and its extension to the posterior groups is noted in all the specimens. The bridge from the IVS to bases of both the groups of papillary muscles is noted in left ventricle. In90% of specimens the one PPM is found to be loosely connected, more so in left ventricle. CONCLUSIONS We are of a conclusion that such basal interconnections and to the interventricular septum are responsible for rhythmic contractions of papillary muscles of both ventricles. Since the AV valves have to open simultaneously, interconnections becomes mandatory as the impulse has to reach it before it reaches the trabeculae carniae. One of the Posterior papillary muscles is loosely connected to other papillary muscles, may be the reason for its rupture, more so in left ventricle. KEYWORDS Papillary Muscle, Interbasal Connection, Moderator Band, Valvular Prolapse, AV Valves

Characterization of Cardiac Diseases in Dogs Prevalent in Indian Conditions

2021 ◽  
Author(s):  
A. Yadav ◽  
T. Kumar ◽  
N. Sindhu ◽  
D. Agnihotri ◽  
C. Jajoria ◽  
...  
Keyword(s):  
Troponin I ◽  
Interventricular Septum ◽  
Clinical Signs ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Cardiac Diseases ◽  
Left Ventricular Dilation ◽  
Atrial Enlargement

Background: Cardiac diseases defined as structural, functional, mechanical and electrical abnormality of heart. Characterization of different cardiac diseases in dogs prevalent in North Indian conditions is least studied. Methods: Out of total 2582 registered dogs, 41 were suspected for cardiac diseases based on clinical signs. Further confirmation and characterization was done by electrocardiography, radiography, echocardiography and cardiac biomarkers. Statistical analysis was done through SPSS 23. Result: Present study inferred, Dilated cardiomyopathy (DCM) as the most prevalent cardiac affection. Left ventricular dilation, interventricular septum thinning, increased E point septal separation and left atrial enlargement were characteristic echocardiographic indices in DCM. Echocardiographic indices in hypertrophic cardiomyopathy were increased interventricular septum, left ventricular posterior wall and reduced left ventricular lumen. Labrador retriever found to be most predisposed breed for DCM while Rottweiler reported to be most affected with pericardial effusion. Cardiac Troponin-I (cTnI) was statistically (p less than 0.05) increased in all cardiac categories with cut off value above 92 ng/l indicating cardiac affection, while Lactate dehydrogenase serve as screening biochemical marker with significant increase in all the cardiac cases ranging from 291 IU/l to 586.4 IU/l.

scholarly journals P1333 The importance of multimodality imaging in the characterization of a congenital myocardial diverticulum

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Ramirez-Escudero Ugalde ◽  
A M R Arantza Manzanal Rey ◽  
N G I Nora Garcia Ibarrondo ◽  
M C P Mireia Codina Prat ◽  
L R G Lara Ruiz Gomez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Tissue Characterization ◽  
Multimodality Imaging ◽  
Interventricular Septum ◽  
Fibrous Tissue ◽  
Scar Tissue ◽  
Left Ventricular ◽  
Ventricular Diverticulum ◽  
Asymptomatic Patients

Abstract Congenital ventricular diverticulum is a rare cardiac malformation, usually detected on echocardiographic examinations in asymptomatic patients. However, they can also cause embolisms, arrhythmias and sudden death due to ventricular rupture. Multimodality imaging can help in the characterization of its morphology and in the differential diagnosis. We report a case of an 83-year-old woman, pacemaker carrier due to complete atrioventricular block, who consulted for paroxysmal episodes of palpitations, being diagnosed of atrial fibrillation. A transthoracic echocardiogram was performed, observing an appendix at basal septal level with contractility of its wall and with doppler-colour inside, suggestive of myocardial diverticulum. Echocardiographic contrast was injected for better delimitation and characterization of the cavity. MRI was after performed for better characterization of this structure, confirming the presence of an accessory chamber with muscular wall and normal contractility at the level of the basal interventricular septum, without pathological enhancements. We reviewed an angioCT performed for other reasons some years ago, confirming the presence of the same structure, which went unnoticed in that study. The patient followed controls and remained asymptomatic, without evolutionary echocardiographic changes, so that a conservative attitude was maintained. Congenital ventricular diverticulum is formed by an appendix of the entire left ventricular (LV) wall. It can be differentiated into two types: muscular (more frequent, not prone to rupture and associated with other congenital malformations) or fibrous (frequently localized at the base of the heart or in subvalvular areas). Differential diagnosis may include true LV aneurysms (abnormal LV contour with systolic dyskinesia and involving thinned fibrous tissue) and LV pseudoaneurysms (acute contained rupture of the ventricle wall, often after myocardial infarction, also akinetic or dyskinetic). Congenital cardiac diverticulum is characterized by a rapid contrast filling and a narrow neck. MRI provide tissue characterization and is an important tool that helps in the differential diagnosis. In cardiac diverticulums, a thinned but contractile wall is present, without pathological delayed enhancements. In true aneurysms, the wall shows delayed enhancement (scar tissue). Pseudoaneurysms are only composed by pericardium, and the border of the aneurysms show enhancement indicating peri-aneurysmal infarcted area. Left ventricular catheterization can also be useful assessing the morphology and dynamics of the left ventricular chamber. In small, muscular and asymptomatic diverticulums, conservative treatment with follow-up is often recommended. When symptoms appear, medical or surgical treatment should be proposed. Abstract P1333 Figure. Congenital myocardial diverticulum

scholarly journals Diagnostic opportunities of magnetic resonant imagingmri of heart in differential diagnosis of phenotypical forms of hypertrophic cardiomyopathy

2021 ◽  
Vol 11 (4) ◽  
pp. 44-51
Author(s):  
A. A. Malov ◽  
R. K. Dzhordzhikiya ◽  
A. I. Abushayev
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Short Pulse ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Papillary Muscles ◽  
Post Contrast ◽  
Lv Remodeling ◽  
Myocardial Crypts ◽  
Tissue Characteristics

Introduction. Phenotype variants of left ventricular (LV) remodeling in patients with hypertrophic cardiomyopathy (HCM) are often associated with abnormalities of the mitral valve (MV), myocardiumstructure, contributing to the development of medium and/or subaortic obstruction. Itcauses the detail visualization of morphological obstruction substrates, tissue characteristics.Aim. To evaluate the possibilities of magnetic resonance imaging (MRI) in the diagnosis of various forms of HCM and combined abnormalities.Materials and methods. 75 patients with suspected HCM were examined. For verification, all patients underwentMRI using protocol: short-pulse T1w-TSE/ T2w-TSE (STIR), gradient echo in cine (CINE), T1-weighted post-contrast images (Inversion Recovery IR-MDE). Results. Patients classified into 4 types according to the anatomical principle (Wiggle E.D. et al., 1985). In addition to the most frequent forms affecting the interventricular septum (IVS) — 64 patients, unusual forms covering the apical zones and papillary muscles — 11 patients. The majority of patients were diagnosed with abnormalities of MV, divided into abnormalities of the number and position of papillary muscles, as well as the ratio of chords and muscles. Myocardial crypts were diagnosed in 12 patients, some combined with areas of non-compact myocardium. Post-contrast visualization using the delayed contrast technique allowed differentiating HCM with accumulation diseases, excluding cavity thrombosis, and evaluating the severity of myocardial fibrosis.Conclusions. MRI allows to estimate in details anatomic picture of LV remodeling, to diagnose features of the mitral valve, tissue characteristics that allows to stratify risk of sudden death, classify the HCM phenotype form and to determine the volume of surgical intervention.

Hypertrophic cardiomyopathy

2018 ◽  
pp. 243-252
Author(s):  
Carmen Chan ◽  
Martin S Maron
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Wall Thickness ◽  
Systolic Dysfunction ◽  
Management Strategies ◽  
Left Ventricular ◽  
Papillary Muscles ◽  
Common Cause ◽  
Contrast Enhanced ◽  
Increased Risk

Hypertrophic cardiomyopathy (HCM) is a genetic cardiomyopathy and the most common cause of sudden death in young people, as well as a cause of limiting heart failure symptoms at any age. Mutations in the cardiac sarcomere, the structural apparatus of the heart muscle, cause HCM and a diagnosis is made when maximal left ventricular (LV) wall thickness is ≥15 mm in the absence of another cause. Cardiovascular magnetic resonance (CMR) can reliably identify areas of increased LV wall thickness, as well as detailed characterization of myocardial structures such as the papillary muscles and mitral valve, with implications on management strategies. In addition, contrast-enhanced CMR with late gadolinium enhancement sequences (LGE) can identify areas of myocardial fibrosis/scarring in patients with HCM. Extensive LGE is an important marker for development of future systolic dysfunction and may identify patients at increased risk for ventricular tachyarrhythmias and cardiac mortality. As a result, CMR currently serves an important and evolving role in the evaluation of HCM patients by providing information with regard to diagnosis, morphology, and clinical course in HCM patients.

scholarly journals Characterization of the Electrophysiological Substrate in Patients with Barlow's Disease

2021 ◽  
Author(s):  
Pasquale Vergara ◽  
Iside Scarfò ◽  
Antonio Esposito ◽  
Caterina Colantoni ◽  
Anna Palmisano ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Low Voltage ◽  
Left Ventricular ◽  
Premature Ventricular Complex ◽  
Papillary Muscles ◽  
Gadolinium Enhancement ◽  
T Wave ◽  
Barlow’S Disease ◽  
History Of

BACKGROUND. Myxomatous mitral valve prolapse (MVP) and mitral-annular disjunction (Barlow disease) are at-risk for ventricular arrhythmias (VA). Fibrosis involving the papillary muscles and/or the infero-basal left ventricular (LV) wall was reported at autopsy in sudden cardiac death (SCD) patients with MVP. METHODS AND RESULTS: Twenty-three patients with VA were enrolled, including five with syncope and four with a history of SCD. Electrophysiological parameters were correlated with VA patterns, ECG inferior negative T wave (nTW), and late gadolinium enhancement (LGE) assessed by cardiac magnetic resonance. Premature ventricular complex (PVC) burden was 12061.9±12994.6 /24 hours with a papillary-muscle type (PM-PVC) in 18 patients (68%). Twelve-lead ECG showed nTW in 12 patients (43.5%). A large Uni<8.3mV area (62.4+/- 45.5 cm2) was detected in the basal infero-lateral LV region in 12 (73%) patients, and in the papillary muscles (2.2+/-2.9 cm2) in 5 (30%) of 15 patients undergoing EAM. A concomitant Bi<1.5 mV area (5.0±1.0 cm2) was identified in 2 patients. A history of SCD, and the presence of nTW, and LGE were associated with a greater Uni<8.3mV extension: (32.8+/-3.1 cm2 vs. 9.2+/-8.7 cm2), nTW (20.1+/-11.0vs.4.1+/-3.8cm2), and LGE (19.2 ± 11.7 cm2 vs. 1.0 ± 2.0 cm2, p=0.013), respectively. All patients with PM-PVC had a Uni<8.3mV area. CONCLUSIONS: Low unipolar low voltage areas can be identified with EAM in the basal infero-lateral LV region and in the papillary muscles as a potential electrophysiological substrate for VA and SCD in patients with MVP and Barlow disease phenotype

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