Impact of asymmetric tethering on outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation

Background The impact of postero-anterior and medio-lateral mitral valve (MV) tethering patterns on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR) is unknown. Methods The ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in MV segment 2 was defined as postero-anterior tethering asymmetry. Medio-lateral tethering asymmetry was assessed as the ratio of the medial (segment 3) to lateral (segment 1) MV tenting area. We used receiver-operating characteristics and a Cox regression model to identify cut-off values of asymmetric anteroposterior and medio-lateral tethering for prediction of 2 year all-cause mortality after TMVR. Results Among 178 SMR patients, postero-anterior tethering was asymmetric in 67 patients (37.9%, PLA/ALA ratio > 1.54). Asymmetric medio-lateral tethering (tenting area ratio > 1.49) was observed in 49 patients (27.5%). M-TEER reduced MR to ≤ 2 + in 92.1% of patients; MR reduction was less effective in the presence of asymmetric postero-anterior tethering (p = 0.02). A multivariable Cox regression model identified both types of asymmetric MV tethering to be associated with increased all-cause 2-year mortality (postero-anterior tethering asymmetry: HR = 2.77, CI 1.43–5.38; medio-lateral tethering asymmetry: HR = 2.90, CI 1.54–5.45; p < 0.01). Conclusions Asymmetric postero-anterior and medio-lateral MV tethering patterns are associated with increased 2-year mortality in patients undergoing M-TEER for SMR. A detailed echocardiographic analysis of MV anatomy may help to identify patients who profit most from M-TEER. Graphical abstract

Successful surgical rescue of delayed onset diaphragmatic hernia following radiofrequency ablation using a thoracoscopic approach for hepatocellular carcinoma: a case report

Background Radiofrequency ablation (RFA) is widely used as a minimally invasive treatment for hepatocellular carcinoma (HCC). RFA has a low risk of complications, especially compared with liver resection. Nevertheless, various complications have been reported after RFA for HCC; however, diaphragmatic hernia (DH) is extremely rare. Case presentation A 78-year-old man underwent thoracoscopic RFA for HCC located at the medial segment adjacent to the diaphragm approximately 7 years before being transported to the emergency department due complaints of nausea and abdominal pain. Computed tomography revealed a prolapsed small intestine through a defect in the right diaphragm, and emergency surgery was performed. The cause of diaphragmatic hernia was the scar of RFA. We confirmed that the small intestine had prolapsed into the right diaphragm, and we resected the necrotic small intestine and repaired the right diaphragm. Herein, we report a case of ileal strangulation due to diaphragmatic hernia after thoracoscopic RFA. Conclusions Care should be taken when performing thoracoscopic RFA, especially for tumors located on the liver surface adjacent to the diaphragm. Patients should be carefully followed up for possible DH, even after a long postoperative interval.

The Efficacy of Thrombolytic Therapy in Inferior Myocardial Infarction with Damage to the Right Ventricular

Aim. To study the results of thrombolytic therapy and accuracy of electrocardiographic assessment of thrombolysis efficiency in inferior myocardial infarction with and without right ventricular lesion.Material and methods. The118 patients with inferior myocardial infarction were included in this study. They received TLT in the first 12 hours of the disease. The dynamics of ST-segment in 90 minutes from the TLT start and coronary angiography data were analyzed.Results. Right ventricular myocardial infarction (RVMI) was diagnosed in 49 (41.5%) of 118 patients by echocardiography. Patients with and without RVMI did not differ in age, gender and comorbidities, but patients with RVMI were more likely to have arterial hypotension, atrioventricular block, and atrial fibrillation. All patients with RVMI had occlusion of the right coronary artery (RCA) in the proximal (34.7%) or medial segment (65.3%). Occlusion of the circumflex coronary artery was found in 20 (29.0%) patients without RVMI, and RCA occlusion - in other patients. The infarction-associated artery blood flow equal TIMI 2-3 was found in 17 (34.7%) patients with RVMI and in 46 (66.7%) patients without RVMI (p<0.005). ST-segment decrease by 50% or more in 90 minutes from the TLT was found in 35 (71.4%) patients with RVMI and in 49 (71.0%) patients without RVMI (p>0.05). The false-positive assessment of thrombolysis efficiency was noted in patients with and without RVMI in 21 (42.9%) and 11 (15.9%) cases (p <0.005), respectively. There were no false-positive assessments in patients with RVMI when using ST-segment decrease to the isoline.Conclusion. TLT should be considered effective in patients with inferior myocardial infarction with the right ventricle lesion, if ST-segment decreases to isoline in 90 minutes from the TLT start.

Brain functional network alterations in patients with asymptomatic carotid disease

Background: The best therapeutic approach to asymptomatic carotid stenosis (ACS) is still subject to discussion. Previous studies have agreed on the findings that ACS patients present with cerebral atrophy and cognitive decline compared to healthy controls. The present study aims to identify possible alterations in the brain functional network of such patients. Objectives: Study alternations in the connectivity of the Default Mode Network (DNM) in patients with ACS of at least 70%, compared to controls. Design and Setting: A cross-sectional case-control study was carried out at the Neuroimaging Laboratory at Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP) - Campinas, São Paulo (Brazil). Methods: Two groups of 15 individuals matched by sex and age, the first composed ACS patients with stenosis and the second of healthy volunteers, were submitted to 3 Tesla magnetic resonance imaging. The images were analyzed using Statistical Parametric Mapping 12 and UF2C User Friendly Functional Connectivity Toolbox software. All patients signed the Informed Consent Form. Results: ACS patients were 13 men and 2 women with an average age of 72 years. Regarding DMN connectivity, the control presented higher activity, particularly in the medial segment of the superior frontal gyrus. Conclusion: ACS patients with stenosis higher than 70% displayed prejudiced cerebral connectivity compared to healthy controls.

Malignant Lung Carcinoid Tumour with Liver and Bone Metastasis: A Case Report

Atypical lung carcinoid tumour, which is highly malignant has not been described widely in the literature. We report a middle-age woman who initially referred for possible lung malignancy. She presented with chronic diarrhoea to surgical team initially, who incidentally found to have a minimally enhancing irregular hypodense lesion at medial segment right lower lobe based on CT thorax finding. This patient later was diagnosed to have malignant lung carcinoid tumour based on histopathological examination with liver and bone metastasis. This case highlights the rare presentation of carcinoid tumour. A thorough history, supplemented by imaging and bronchoscopic examinations may lead to the diagnosis.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 108-111

Endovascular therapy of subclavian artery occlusive disease involving the vertebral artery origin

Summary. Background: While the majority of subclavian artery (SA) lesions are localized in the proximal segment, the evidence in patients with medial SA disease involving the vertebral artery (VA) origin are scarce. Patients and methods: We retrospectively analyzed all patients who underwent percutaneous revascularization of the SA at our institution. Results: A total of 196 patients were retrospectively analyzed. The majority of SA lesions (n = 163, 83 %) were located in the proximal segment, whereas 28 lesions (14 %) were located in the medial segment, and only 5 lesions (3 %) involved the distal segment. Procedural success was high for both stenosis (96 %) and occlusion (89 %) and did not differ depending on lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 patients), and bifurcation stenting of the SA and VA using T-stenting technique (9 patients). Outcome after a median of 12 months showed no significant differences in freedom from restenosis between proximal and medial lesions (90 % vs. 95 %; p = 0.67). Conclusions: Endovascular revascularization of SA disease with medial segments involving the VA origin required more complex techniques and showed long-term patency rates comparable to those in lesions located within the proximal SA.

P4707Incidence and outcome of endovascular therapy in subclavian occlusive disease involving the vertebral artery origin

Background Endovascular revascularization represents the treatment option of choice in symptomatic steno-occlusive disease of the subclavian artery (SA). While the majority of lesions are localized in the proximal segment of the subclavian artery, studies in regards to the medial segment involving the vertebral artery (VA) origin are scarce. Purpose The aim of this study was to analyze the technical approaches and outcome of endovascular therapy of subclavian artery disease with a special focus on medial lesions involving the VA origin. Methods We retrospectively analyzed all patients who underwent percutaneous revascularization of the subclavian or innominate artery with a special focus on medial lesions involving the VA origin. Results In total 196 patients with subclavian or innominate artery intervention were analyzed. The majority of lesions (83%) were located in the proximal, whereas 28 patients (14%) presented with lesions in the medial segment of the SA, and only 3% involved the distal segment. Overall procedural success was high for both stenosis (96%) and occlusion (89%) and did not differ according to the lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 Patients), and bifurcational stenting of the SA and VA using T-stenting technique (9 patients). Overall periprocedural complication rate was low (6%) and comparable between different SA segments (6% in proximal segment vs. 7% in medial segment vs. 0% in distal segment; p=0.81). Outcome assessed after a median of 12 months (interquartile range 4–30) showed no significant differences in terms of Kaplan-Meier estimated freedom from restenosis between proximal and medial lesions despite the technically demanding approach in the medial segment (90% vs. 95%; p=0.67). Long-term patency Conclusion Endovascular revascularization of medial subclavian artery lesions involving the vertebral artery origin shows comparable safety and efficacy in terms of long-term patency rates compared to lesions located within the proximal subclavian artery. However, more complex endovascular techniques with bifurcational ballooning or stenting is required in a considerable number of patients with medial subclavian artery disease.

Differences in sodium channel densities in the apical dendrites of pyramidal cells of the electrosensory lateral line lobe

Heterogeneity of neural properties within a given neural class is ubiquitous in the nervous system and permits different sub-classes of neurons to specialize for specific purposes. This principle has been thoroughly investigated in the hindbrain of the weakly electric fish A. leptorhynchus in the primary electrosensory area, the Electrosensory Lateral Line lobe (ELL). The pyramidal cells that receive inputs from tuberous electroreceptors are organized in three maps in distinct segments of the ELL. The properties of these cells vary greatly across maps due to differences in connectivity, receptor expression, and ion channel composition. These cells are a seminal example of bursting neurons and their bursting dynamic relies on the presence of voltage-gated Na+ channels in the extensive apical dendrites of the superficial pyramidal cells. Other ion channels can affect burst generation and their expression varies across ELL neurons and segments. For example, SK channels cause hyperpolarizing after-potentials decreasing the likelihood of bursting, yet bursting propensity is similar across segments. We question whether the depolarizing mechanism that generates the bursts presents quantitative differences across segments that could counterbalance other differences having the opposite effect. Although their presence and role are established, the distribution and density of the apical dendrites’ Na+ channels have not been quantified and compared across ELL maps. Therefore, we test the hypothesis that Na+ channel density varies across segment by quantifying their distribution in the apical dendrites of immunolabeled ELL sections. We found the Na+ channels to be two-fold denser in the lateral segment than in the centro-medial segment, the centro-lateral segment being intermediate. Our results imply that this differential expression of voltage-gated Na+ channels could counterbalance or interact with other aspects of neuronal physiology that vary across segments (e.g. SK channels). We argue that burst coding of sensory signals, and the way the network regulates bursting, should be influenced by these variations in Na+ channel density.