DOCSLIB.ORG

Late Incompetence of the Left Atrioventricular Valve After Repair of Atrioventricular Septal Defects: the Morphologic Perspective

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Late Incompetence of the Left Atrioventricular Valve After Repair of Atrioventricular Septal Defects: the Morphologic Perspective View metadata, citation and similar papers at core.ac.uk brought to you by CORE Surgery for Congenital Heart Disease Kanani et al provided by Elsevier - Publisher Connector Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: The morphologic perspective Mazyar Kanani, MRCS,a Martin Elliott, MD, FRCS,a Andrew Cook, PhD,a Amy Juraszek, MD,b William Devine, BS,c and Robert H. Anderson, MD, FRCPatha Objective: The mortality following repair of atrioventricular septal defects has fallen Supplemental material is dramatically in the last 4 decades, but reoperation for late regurgitation across the available online. left atrioventricular valve has remained disconcertingly stagnant. Seeking potential structural causes, we compared the morphology of the surgically created septal leaflet of the left valve following repair of atrioventricular septal defects to the aortic leaflet of the normal mitral valve. Methods: We compared the mitral valves of 92 normal hearts to the left ventricular components of the bridging leaflets of hearts with atrioventricular septal defect with common atrioventricular junction, determining the shape of the leaflets and the arrangement of the subvalvar apparatus. Results: The aortic leaflet of the mitral valve is triangular compared with its rectangular septal counterpart after repair of atrioventricular septal defect. The cordal arrangement in the mitral valve is well organized, compared with the deficient cordal arrangement of the abnormal valve. A greater proportion of cords in the mitral valve divide to 3 generations (55.5% compared with 8.7%; P Ͻ .001), and a higher percentage of cords remain undivided in atrioventricular septal defects (60.8% compared with 25%; P Ͻ .001). Conclusions: Not only is the annular component in the left atrioventricular valve abnormal, but the subvalvar apparatus is characterized by deficiency and disarray. Furthermore, the axis of cordal insertion may potentiate to separation over the long term of the leaflets joined surgically. Valvar repair in this setting will never restore the arrangement of the normal mitral valve. From the Cardiac Unit,a Great Ormond Street Hospital for Children, London, UK; Cardiac Registry,b Department of Pathol- ogy, Harvard Medical School, Children’s Hospital, Boston, Mass; and Department of Pathology,c University of Pittsburgh Medi- n this present era of repair of atrioventricular septal defects with common cal School, Children’s Hospital of Pitts- CHD atrioventricular junction, or atrioventricular canal, attention has veered from burgh, Pittsburgh, Pa. early mortality as the best measure of operative success and focused onto the Funded by the British Heart Foundation. I long-term quality of life subsequent to surgical repair. This is commonly measured Received for publication July 6, 2005; re- visions received Jan 13, 2006; accepted for in terms of exercise ability and freedom from reoperation for residual lesions. Of publication Jan 30, 2006. these latter problems, the most common and troublesome is progressive regurgita- Address for reprints: Mazyar Kanani, MRCS, tion across the newly created left atrioventricular valve, occurring even if the repair Cardiac Unit, Great Ormond Street Hospital was considered robust initially. for Children, Great Ormond Street, London The key to the durability of this trifoliate valve is the zone of apposition WC1N 3JH, UK (E-mail: mazzykanani@ hotmail.com). between its bridging leaflets. Despite the belief that complete closure of this J Thorac Cardiovasc Surg 2006;132:640-6 zone is the single, and best, way of ensuring competence, the rate of reoperation 0022-5223/$32.00 has remained disconcertingly stagnant over the last 30 years. Why should this be? The reasons are probably multifactorial, but to help provide some insights, Copyright © 2006 by The American Asso- ciation for Thoracic Surgery we have returned to first principles and compared the structure of the surgically doi:10.1016/j.jtcvs.2006.01.063 created septal leaflet of the left valve in atrioventricular septal defects with its normal counterpart, the aortic leaflet of the mitral valve. Our findings illustrate 640 The Journal of Thoracic and Cardiovascular Surgery ● September 2006 Kanani et al Surgery for Congenital Heart Disease Figure 1. Photographs of the ventric- ular surface of the aortic leaflet of the mitral valve. There is an orderly and radial arrangement to the tendinous cords. The close-up view of another heart (right panel) reveals that many of these cords divide as they arise from the papillary muscle, giving the ventricular surface a laminated ap- pearance. The leaflet is continuous with the aortic valve (AV). why this surgically created leaflet will, from the morpho- Statistical Analysis logic perspective, always remain the Achilles’ heel of The degree of cordal division was expressed as the median and surgical repair, even in the best hands. range. A Poisson regression analysis was performed in order to compare the incidence of undivided tendinous cords and cords that Methods divide to the third generation. We analyzed 92 normal hearts from the Cardiac Registry of the Children’s Hospital, Boston, Massachusetts, together with 72 Results hearts with atrioventricular septal defect with common atrio- Shape of the Leaflet ventricular junction. The latter were selected from 200 speci- The aortic leaflet of the mitral valve is uniformly triangular mens studied in the Cardiac Archive, Great Ormond Street Hospital, London (28 hearts); The Frank E. Sherman, Cora C. (Figure E1, left panel). The base of this triangle is contin- Lenox Heart Museum, Children’s Hospital of Pittsburgh, Penn- uous, via the area of fibrous continuity, with the left and sylvania (30 hearts); and the Cardiac Registry, Children’s Hos- noncoronary leaflets of the aortic valve, being thickened at pital, Boston, Massachusetts (14 hearts). We examined only each end as the right and left fibrous trigones. Despite this those with an intact left atrioventricular valve. Of those chosen broad base, the aortic leaflet of the mitral valve guards only for further study, 26 had separate valvar orifices, the so-called about one third of the overall annular circumference of the “ostium primum defect,” with the remaining 44 possessing a left atrioventricular orifice. Tendinous cords merge along common valvar orifice. the entirety of the sloped sides of the triangle, diverging In the normal hearts, we studied the morphologic features of the aortic leaflet of the mitral valve. In the hearts with atrioventricular away from either side of the leaflet to insert into their septal defect with common atrioventricular junction, we analyzed respective papillary muscles (Figure 1). the left ventricular components of the superior and inferior leaflets The newly created septal leaflet of the repaired left bridging the ventricular septum. We analyzed 32 hearts that had atrioventricular valve in hearts with atrioventricular sep- been repaired surgically and 40 in which surgery had not been tal defect forms a coapting surface with its smaller coun- performed. We excluded from consideration any specimens terpart, the left mural leaflet, with the latter guarding less deemed retrospectively to be unsuitable for biventricular repair, CHD than one third of the newly created left atrioventricular such as those with a small left ventricle and those with a solitary left ventricular papillary muscle. Similarly, we excluded from annulus. When the left ventricular components of the consideration any hearts with accessory orifices in the left atrio- bridging leaflets have been surgically united, a bipartite ventricular valve. leaflet is created that is more rectangular, with a triangu- We took particular note of: lar recess in its center that apposes the mural leaflet The shape of the leaflet, comparing the aortic leaflet of the (Figure E1, right panel). This septal leaflet forms an normal mitral valve with the components forming the septal leaflet antiparietal component that is a composite of different of the left atrioventricular valve subsequent to surgical repair of structures, depending on the mode of surgical septation. atrioventricular septal defect. The arrangement of the tension apparatus at the ventricular Specifically: surface of the leaflet. Following the two-patch repair, the annulus of the left The pattern of division of the tendinous cords as they arise from atrioventricular valve is composed, in part, by leaflets sand- the papillary muscles. wiched between the septal patches. The Journal of Thoracic and Cardiovascular Surgery ● Volume 132, Number 3 641 Surgery for Congenital Heart Disease Kanani et al Figure 2. Photographs of 2 ex- amples of the subvalvar arrange- ment of the neoanterior valve in atrioventricular septal defects. In the left panel, the bridging leaflets have been closed with pledgets and in the right panel with unpledgeted sutures. There is cordal disorganization in both examples with a greater degree of cordal fusion beneath the right example. Compare this with the normal mitral valve, which con- forms to a specific design with little morphologic variation. The 5-pointed arrow marks the supe- rior papillary muscle, which has fused directly with the base of the superior bridging leaflet. After the single-patch technique, the annulus is com- This pattern of cordal division and insertion produced a posed of the solitary patch, with the septal leaflet sutured to consistent organization of the ventricular surface of the its surface. aortic leaflet itself, giving it a distinctive appearance among Following the modified single-patch technique, the leaf- all the valves examined. At the point of insertion, the cord let is sandwiched between the crest of the ventricular sep- broadened and blended with the leaflet. Because there was tum and the septal patch. a maximum of three generations of division for each cord In the case of atrioventricular septal defect with separate arising from the papillary muscle, the combination of broad- valvar orifices, the base of the leaflet has the atrial patch ening and layered cordal insertion produced a trilaminar above, the bridging leaflets themselves being adherent to the configuration for the ventricular surface, with each layer ventricular septal crest.
Load more

Recommended publications
  • Severe Aortic Stenosis and the Valve Replacement Procedure
    Severe Aortic Stenosis and the Valve Replacement Procedure A Guide for Patients and their Families If you’ve been diagnosed with severe aortic stenosis, you probably have a lot of questions and concerns. The information in this booklet will help you learn more about your heart, severe aortic stenosis, and treatment options. Your heart team will recommend which treatment option is best for you. Please talk with them about any questions you have. Table of Contents 4 About Your Heart 5 What Is Severe Aortic Stenosis? 5 What Causes Severe Aortic Stenosis? 7 What Are the Symptoms of Severe Aortic Stenosis? 8 Treatment Options for Severe Aortic Stenosis 10 Before a TAVR Procedure 12 What Are the Risks of TAVR? 2 3 About Your Heart What Is Severe See the difference between healthy and The heart is a muscle about the size of your fist. It is a pump that works nonstop to Aortic Stenosis? diseased valves send oxygen-rich blood throughout your entire body. The heart is made up of four The aortic valve is made up of two or three chambers and four valves. The contractions (heartbeats) of the four chambers push Healthy Valve the blood through the valves and out to your body. tissue flaps, called leaflets. Healthy valves open at every heart contraction, allowing blood to flow forward to the next chamber, and then close tightly to prevent blood from backing Pulmonic controls the flow of Aortic controls the flow of blood up. Blood flows in one direction only. This is Valve blood to the lungs Valve out of your heart to the important for a healthy heart.
    [Show full text]
  • Blood Vessels
    BLOOD VESSELS Blood vessels are how blood travels through the body. Whole blood is a fluid made up of red blood cells (erythrocytes), white blood cells (leukocytes), platelets (thrombocytes), and plasma. It supplies the body with oxygen. SUPERIOR AORTA (AORTIC ARCH) VEINS & VENA CAVA ARTERIES There are two basic types of blood vessels: veins and arteries. Veins carry blood back to the heart and arteries carry blood from the heart out to the rest of the body. Factoid! The smallest blood vessel is five micrometers wide. To put into perspective how small that is, a strand of hair is 17 micrometers wide! 2 BASIC (ARTERY) BLOOD VESSEL TUNICA EXTERNA TUNICA MEDIA (ELASTIC MEMBRANE) STRUCTURE TUNICA MEDIA (SMOOTH MUSCLE) Blood vessels have walls composed of TUNICA INTIMA three layers. (SUBENDOTHELIAL LAYER) The tunica externa is the outermost layer, primarily composed of stretchy collagen fibers. It also contains nerves. The tunica media is the middle layer. It contains smooth muscle and elastic fiber. TUNICA INTIMA (ELASTIC The tunica intima is the innermost layer. MEMBRANE) It contains endothelial cells, which TUNICA INTIMA manage substances passing in and out (ENDOTHELIUM) of the bloodstream. 3 VEINS Blood carries CO2 and waste into venules (super tiny veins). The venules empty into larger veins and these eventually empty into the heart. The walls of veins are not as thick as those of arteries. Some veins have flaps of tissue called valves in order to prevent backflow. Factoid! Valves are found mainly in veins of the limbs where gravity and blood pressure VALVE combine to make venous return more 4 difficult.
    [Show full text]
  • Heart and Circulatory System Heart Chambers
    160 Allen Street Rutland, Vermont 05701 www.rrmc.org 802.775.7111 Anatomy of the Heart Overview The heart is a muscular organ that pumps blood HEART AND throughout your body. It is positioned behind the CIRCULATORY SYSTEM lungs, slightly to the left side of the chest. Your heart is a bit larger than the size of your fist. Let's examine the structures of the heart and learn how blood travels through this complex organ. Right Side The heart is divided into two sides and four chambers. On the right side, blood that has already circulated through the body enters the heart through the superior vena cava and the inferior vena cava. The blood flows into the right atrium. When this chamber is full, the heart pushes the blood through the tricuspid valve and into the the next chamber - the right ventricle. From there, the blood is pushed out of the heart through the pulmonary valve. The blood travels through the pulmonary artery to the lungs, where it will pick up oxygen and give up carbon dioxide. HEART CHAMBERS Left Side On the left side of the heart, blood that has received oxygen from the lungs enters the heart through the pulmonary veins. The blood flows into the left atrium. It is pushed through the mitral valve into the left ventricle. Finally, it is pushed through the aortic valve and into the aorta. The aorta is the body's largest artery. It helps distribute the oxygen-rich Right Left blood throughout the body. Valves Now let's take a closer look at the valves.
    [Show full text]
  • Avalus™ Pericardial Aortic Surgical Valve System
    FACT SHEET Avalus™ Pericardial Aortic Surgical Valve System Aortic stenosis is a common heart problem caused by a narrowing of the heart’s aortic valve due to excessive calcium deposited on the valve leaflets. When the valve narrows, it does not open or close properly, making the heart work harder to pump blood throughout the body. Eventually, this causes the heart to weaken and function poorly, which may lead to heart failure and increased risk for sudden cardiac death. Disease The standard treatment for patients with aortic valve disease is surgical aortic valve Overview: replacement (SAVR). During this procedure, a surgeon will make an incision in the sternum to open the chest and expose the heart. The diseased native valve is then Aortic removed and a new artificial valve is inserted. Once in place, the device is sewn into Stenosis the aorta and takes over the original valve’s function to enable oxygen-rich blood to flow efficiently out of the heart. For patients that are unable to undergo surgical aortic valve replacement, or prefer a minimally-invasive therapy option, an alternative procedure to treat severe aortic stenosis is called transcatheter aortic valve replacement (TAVR). The Avalus Pericardial Aortic Surgical Valve System is a next- generation aortic surgical valve from Medtronic, offering advanced design concepts and unique features for the millions of patients with severe aortic stenosis who are candidates for open- heart surgery. The Avalus Surgical Valve The Avalus valve, made of bovine tissue, is also the only stented surgical aortic valve on the market that is MRI-safe (without restrictions) enabling patients with severe aortic stenosis who have the Avalus valve to undergo screening procedures for potential co-morbidities.
    [Show full text]
  • Transcatheter Aortic Valve Replacement
    What is TAVR? Cardiac Catheterization: Important things to know that will help you get ready Transcatheter Aortic Valve Replacement (TAVR) is a procedure Your doctor will tell if you need to stop eating or drinking to fix the aortic valve without taking out the old valve. A TAVR before your procedure. Your doctor also will tell you if you does not need open heart surgery and the heart does not need must stop taking any medications before the procedure. to be stopped. Catheterization Lab In the Pre-Operative (Pre-Op) Room before your The surgeon puts a catheter (thin tube) into an artery in your Cardiac Catheterization upper leg or through a small cut in your chest. The catheter will • You will wear a hospital gown. We will ask you to take off all Transcatheter Aortic Valve carry a new valve to your heart. your clothing (even underwear), jewelry, dentures, glasses, Replacement (TAVR) hearing aids, etc. • An intravenous line (IV) may be put into a vein in your arm • We will prepare and clean the catheter site (where the catheter goes into your body). We will clean your skin with a special wash that kills germs. We may need to trim body hair. • We will ask you to empty your bladder (pee) before your procedure After Your Cardiac Catheterization • You may be on bed rest (lying flat) for 2 to 6 hours. To lower the risk of bleeding, we do not want you to bend your body at the catheter site (where the catheter went into your body) • Your nurse will often check your vital signs (blood pressure, heart rate, temperature) and catheter site • You must use a urinal or bed pan until you can safely stand and walk to the bathroom • While you are healing, do not do strenuous exercise (such as running or lifting weights).
    [Show full text]
  • How Your Heart Works
    FACT SHEET FOR PATIENTS AND FAMILIES How Your Heart Works Your heart is the main muscle in your circulatory [SUR-kue-luh-tor-ee] system, which pumps blood throughout your body. Blood carries oxygen to your organs, muscles, tissues, and bones. If an injury or disease keeps your heart from working right, your body parts may not get enough oxygen. This can cause additional health problems or even death. The heart is about the size of your fist and is An electrical system tells the heart when to divided into 4 chambers: 2 on the top — the atria contract (beat). Each beat pumps blood through [AY-tree-uh] — and 2 on the bottom — the ventricles the heart’s chambers and a network of blood [VEN-treh-kuhlz]. The septum is a wall of tissue that vessels (see page 2) that include: separates the right and left sides of the heart. • Arteries that carry blood with fresh oxygen The chambers are connected by 4 valves that keep away from the heart and lungs blood flowing in one direction through the heart. • Veins that carry blood with low oxygen back They are the tricuspid [try-KUSS-pid], mitral [MY-truhl], to the heart to then be sent to the lungs for pulmonary [PULL-mon-air-ee], and aortic valves. more oxygen. Parts of the heart and circulatory system Valves that open and close to control blood flow within the heart: 1 The tricuspid valve controls blood flow from the right atrium to the Aorta right ventricle. Vena cava Left pulmonary 2 The pulmonary valve arteries Right controls blood flow from pulmonary the right ventricle into arteries Left pulmonary veins the pulmonary artery that delivers blood to the lungs.
    [Show full text]
  • Symptomatic Presentations of Severe Aortic Stenosis
    Precision and Future Medicine 2017;1(3):122-128 REVIEW https://doi.org/10.23838/pfm.2017.00156 ARTICLE pISSN: 2508-7940 · eISSN: 2508-7959 Symptomatic presentations of severe aortic stenosis Sung-Ji Park Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Received: August 2, 2017 Revised: September 12, 2017 Accepted: September 19, 2017 ABSTRACT Aortic stenosis (AS) is the most common type of valvular heart disease. A manifestation Corresponding author: Sung-Ji Park of ageing, the disorder is becoming more frequent as the average age of the population Division of Cardiology, increases. Onset of cardinal manifestation of AS—angina, syncope, and heart failure— Department of Internal remains the major demarcation point in the disease’s course. It has been well described Medicine, Cardiovascular that patients’ survival is limited once they develop symptoms from AS and survival after Imaging Center, Heart Vascular the onset of a symptom depends on what type of symptom a patient develops. Know- Stroke Institute, Samsung ing how the pathophysiology of AS causes typical symptoms and death is paramount to Medical Center, Sungkyunkwan understanding the disease. We discuss these issues in this review. University School of Medicine, 81 Irwon-ro, Gangnam-gu, Keywords: Aortic valve stenosis, Chest pain, Dyspnea, Echocardiography, syncope Seoul 06351, Korea Tel: +82-2-3410-3419 E-mail: [email protected] INTRODUCTION Aortic stenosis (AS) is the most common valvular heart disease in the elderly characterized by fixed aortic valve narrowing, left ventricular (LV) remodeling with hypertrophy, and progressive diastolic dysfunction [1].
    [Show full text]
  • Bicuspid Aortic Valve
    © 2012 The Children’s Heart Clinic NOTES: Children’s Heart Clinic, P.A., 2530 Chicago Avenue S, Ste 500, Minneapolis, MN 55404 West Metro: 612-813-8800 * East Metro: 651-220-8800 * Toll Free: 1-800-938-0301 * Fax: 612-813-8825 Children’s Minnesota, 2525 Chicago Avenue S, Minneapolis, MN 55404 West Metro: 612-813-6000 * East Metro: 651-220-6000 © 2012 The Children’s Heart Clinic Reviewed March 2019 Bicuspid Aortic Valve A bicuspid aortic valve is form of congenital heart disease where the aortic valve only has two leaflets, instead of three. This typically results from fusion (joining) of two cusps of the valve along their coaptation point. A bicuspid aortic valve occurs in 1-2% of the population. It can occur alone or be associated with other left-sided heart lesions, such as mitral valve abnormalities (see mitral stenosis), or coarctation of the aorta. Symptoms and presentation can vary for patients with bicuspid aortic valve depending upon the degree of stenosis (narrowing) or regurgitation (leaking) of the valve. Physical Exam/Symptoms: Most patients with bicuspid aortic valve have no symptoms (asymptomatic), unless there is associated aortic stenosis (AS) (narrowing) or regurgitation (leaking) (AR) Most children are asymptomatic with mild to moderate AS. Fatigue, chest pain with exertion, or syncope (fainting) may occur in severe AS. In critical AS, neonates develop poor perfusion, pulmonary edema (fluid retention in the lungs) within days or weeks after birth as the ductus arteriosus (see Patent Ductus Arteriosus) closes. Clinical picture may resemble that of sepsis (severe infection). Murmur of AS: Harsh, grade II/VI systolic murmur heard best at the second left intercostal space, with transmission to the head and neck.
    [Show full text]
  • Endocardial Thickening Associated with Diseased Valves by W
    Br Heart J: first published as 10.1136/hrt.23.2.155 on 1 March 1961. Downloaded from ENDOCARDIAL THICKENING ASSOCIATED WITH DISEASED VALVES BY W. J. S. STILL From the Royal Free Hospital Received September 16, 1960 Focal endocardial thickening is often found in relation to diseased valves and is particularly frequent on the upper part of the interventricular septum in association with aortic regurgitation. Some of the endocardial thickenings may be in the form of endocardial pockets or false valves (Fig. 1), and at times a similar type oflocalized thickening is found in the aortic intimajust above the http://heart.bmj.com/ on September 25, 2021 by guest. Protected copyright. FIG. Endocardial pocket formation associated with aortic regurgi tation and stenosis. A traumatic intimal thickening is present on the aorta just above the valve valve. It is now generally accepted that these lesions are the result of the abnormal jets and eddies of blood set up by the distorted valve impinging on these particular areas of the endocardium or intima (Krasso, 1929; Saphir, 1930; Ingham and Henthorne, 1938; Hellerstein, 1947). 155 Br Heart J: first published as 10.1136/hrt.23.2.155 on 1 March 1961. Downloaded from 156 W. J. S. STILL What appears to be a related type of endocardial thickening constitutes one form of sub-aortic stenosis. This consists of a semi-circular or annular bar of endocardium situated just below an aortic valve, which is usually stenosed or otherwise diseased. Gruenwald (1947) considered this type of endocardial thickening to be the result of inflammation, but it seems likely that many of the examples of subaortic stenosis combined with aortic valve disease are due, like the focal thickenings, to abnormal blood flow (Saphir, 1953).
    [Show full text]
  • AORTIC VALVE REPLACEMENT with PERCEVAL SUTURELESS VALVE Patient’S Guide
    AORTIC VALVE REPLACEMENT WITH PERCEVAL SUTURELESS VALVE Patient’s guide Perceval - Patient’s guide 1 TABLE OF CONTENTS Scope ................................................................................................................................................................. 3 The Human Heart .............................................................................................................................................. 4 How Does The Heart Work? .............................................................................................................................. 5 Heart Valve Diseases ......................................................................................................................................... 5 Valve Stenosis ................................................................................................................................................ 6 Aortic Regurgitation ...................................................................................................................................... 6 What Are the Symptoms Of Aortic Valve Disease? ........................................................................................... 7 What Are the Options in Heart Valve Replacement? ........................................................................................ 7 Mechanical Valves ......................................................................................................................................... 8 Tissue Valves .................................................................................................................................................
    [Show full text]
  • Anatomy of the True Interatrial Septum for Transseptal Access to the Left Atrium
    Annals of Anatomy 205 (2016) 60–64 Contents lists available at ScienceDirect Annals of Anatomy jou rnal homepage: www.elsevier.com/locate/aanat Research article Anatomy of the true interatrial septum for transseptal access to the left atrium 1 ∗,1 Wiesława Klimek-Piotrowska , Mateusz K. Hołda , Mateusz Koziej, Katarzyna Piatek,˛ Jakub Hołda Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland a r t i c l e i n f o a b s t r a c t Article history: Clinical anatomy of the interatrial septum is treacherous, difficult and its unfamiliarity can cause many Received 6 January 2016 serious complications. This work aims to create an anatomical map of the true interatrial septum. An Received in revised form 23 January 2016 appreciation of the anatomical situation is essential for safe and efficacious transseptal access from the Accepted 25 January 2016 right atrium to the left heart chambers. Examination of 135 autopsied human hearts (Caucasian) of 2 both sexes (28% females) aged from 19 to 94 years old (47.0 ± 18.2) with BMI = 27.1 ± 6.0 kg/m was Keywords: conducted. Focus was specifically targeted on the assessment of the fossa ovalis, patent foramen ovale Transseptal puncture (PFO), and right-sided septal pouch (RSP) morphology. Mean values of cranio-caudal and antero-posterior Septal pouch fossa ovalis diameters were 12.1 ± 3.6 and 14.1 ± 3.6 mm, respectively. The fossa ovalis was situated an Patent foramen ovale average of 10.1 ± 4.4 mm above the inferior vena cava ostium, 20.7 ± 5.2 mm from the right atrioventric- Fossa ovalis ular ring, and 12.6 ± 5.2 mm under the right atrium roof.
    [Show full text]
  • Heart Valve Disease
    Treatment Guide Heart Valve Disease Heart valve disease refers to any of several condi- TABLE OF CONTENTS tions that prevent one or more of the valves in the What causes valve disease? .................................. 2 heart from functioning adequately to assure prop- er circulation. Left untreated, heart valve disease What are the symptoms of heart valve disease? ....... 5 can reduce quality of life and become life-threat- How is valve disease diagnosed? ............................ 6 ening. In many cases, heart valves can be surgi- What treatments are available? .............................. 8 cally repaired or replaced, restoring normal func- What are the types of valve surgery? ...................... 9 tion and allowing a return to normal activities. What can I expect before and after surgery? .......... 13 Cleveland Clinic’s Sydell and Arnold Miller How can I protect my heart valves? ...................... 17 Family Heart & Vascular Institute is one of the largest centers in the country for the diagnosis and treatment of heart valve disease. The decision to prescribe medical treatment or proceed with USING THIS GUIDE surgical repair or replacement is based on the Please use this guide as a resource as you examine your type of heart valve disease you have, the severity treatment options. Remember, it is every patient’s right of damage, your age and your medical history. to ask questions, and to seek a second opinion. To make an appointment with a heart valve specialist at Cleveland Clinic, call 216.444.6697. CLEVELAND CLINIC | HEART VALVE DISEASE TREATMENT GUIDE About Valve Disease The heart valves How the Valves Work Heart valve disease means one of the heart valves isn’t working properly because The heart has four valves — one for of valvular stenosis (narrowing of the valves) or valvular insufficiency (“leaky” valve).
    [Show full text]