Mapeamento do Potencial da Superfície Corporal durante a Despolarização Ventricular em Atletas com Intervalo PQ Prolongado após Exercício / Body Surface Potential Mapping during Ventricular Depolarization in Athletes with Prolonged PQ Interval after Exercise

Resumo Fundamento: O prolongamento do intervalo PQ, geralmente associado a um atraso na condução atrioventricular, pode estar relacionado a alterações na propagação do impulso intraventricular. Objetivo: Avaliar, por meio do mapeamento do potencial de superfície corporal (BSPM), o processo de despolarização ventricular em atletas com intervalos PQ prolongados em repouso e após o exercício. Métodos: O estudo incluiu 7 esquiadores cross-country com intervalo PQ superior a 200 ms (grupo PQ Prolongado) e 7 com intervalo PQ inferior a 200 ms (grupo PQ Normal). O BSPM de 64 derivações unipolares do tronco foi realizado antes (Pré-Ex) e após o teste ergométrico de bicicleta (Pós-Ex). Mapas equipotenciais da superfície corporal foram analisados durante a despolarização ventricular. O nível de significância foi de 5%. Resultados: Comparado com atletas com PQ Normal, o primeiro e o segundo períodos de posição estável dos potenciais cardíacos na superfície do tronco foram mais longos, e a formação da distribuição de potencial "sela" ocorreu mais tarde, no Pré-Ex, nos atletas com PQ Prolongado. No Pós-Ex, o grupo PQ Prolongado apresentou um encurtamento do primeiro e segundo períodos de distribuições de potencial estáveis e uma diminuição no tempo de aparecimento do fenômeno "sela" em relação ao Pré-Ex (para valores próximos aos do Normal -Grupo PQ). Além disso, no Pós-Ex, a primeira inversão das distribuições de potencial e a duração total da despolarização ventricular em atletas com PQ Prolongado diminuíram em comparação com o Pré-Ex e com valores semelhantes em atletas com PQ Normal. Em comparação com atletas com PQ Normal, a segunda inversão foi mais longa no Pré-Ex e Pós-Ex em atletas com PQ Prolongado. Conclusão: Atletas com PQ prolongado apresentaram diferenças significativas nas características temporais do BSPM durante a despolarização ventricular, tanto em repouso quanto após o exercício, em comparação com atletas com PQ normal.

Abstract Background: Prolongation of the PQ interval, generally associated with an atrioventricular conduction delay, may be related to changes in intraventricular impulse spreading. Objective: To assess, using body surface potential mapping (BSPM), the process of ventricular depolarization in athletes with prolonged PQ intervals at rest and after exercise. Methods: The study included 7 cross-country skiers with a PQ interval of more than 200 ms (Prolonged-PQ group) and 7 with a PQ interval of less than 200 ms (Normal-PQ group). The BSPM from 64 unipolar torso leads was performed before (Pre-Ex) and after the bicycle exercise test (Post-Ex). Body surface equipotential maps were analyzed during ventricular depolarization. The significance level was 5%. Results: Compared to Normal-PQ athletes, the first and second periods of the stable position of cardiac potentials on the torso surface were longer, and the formation of the "saddle" potential distribution occurred later, at Pre-Ex, in Prolonged-PQ athletes. At Post-Ex, the Prolonged-PQ group showed a shortening of the first and second periods of stable potential distributions and a decrease in appearance time of the "saddle" phenomenon relative to Pre-Ex (to the values near to those of the Normal-PQ group). Additionally, at Post-Ex, the first inversion of potential distributions and the total duration of ventricular depolarization in Prolonged-PQ athletes decreased compared to Pre-Ex and with similar values in Normal-PQ athletes. Compared to Normal-PQ athletes, the second inversion was longer at Pre-Ex and Post-Ex in Prolonged-PQ athletes. Conclusion: Prolonged-PQ athletes had significant differences in the temporal characteristics of BSPM during ventricular depolarization both at rest and after exercise as compared to Normal-PQ athletes.

Coração em Criss-Cross: um relato de caso / Criss-Cross Heart: a case report

Coração em criss-cross (ou coração entrecruzado) foi descrito pela primeira vez em 1974. Trata-se de uma malformação cardíaca congênita, rara, ocorrendo 8 casos a cada 1.000.000 de crianças, e representando somente 0,1% das malformações congênitas. Os métodos diagnósticos de escolha são o ecocardiograma transtorácico, a ressonância magnética cardíaca (RMC), a angiotomografia (TC) e, eventualmente, o cateterismo cardíaco. Neste relato, descreve-se o caso de um recém-nascido com coração em criss-cross somado à dupla via de saída do ventrículo direito (VD), com vasos mal posicionados, além de comunicação interatrial (CIA), comunicação interventricular (CIV), displasia de valva tricúspide e veia cava superior esquerda persistente. Não se sabe a etiologia exata dessa malformação, mas parece ocorrer pela rotação dos ventrículos em seu eixo longitudinal, não acompanhada das rotações atrial e das valvas atrioventriculares (AV). Esse movimento produz uma alteração das vias de entrada dos ventrículos, determinando que o VD se posicione em plano superior e o esquerdo em plano inferior. Apesar de ainda não se saber a exata causa dessa anomalia, acredita-se que uma alteração genética possa estar levando a esses casos: a mutação do gene Cx43. O diagnóstico do caso em questão foi dado pela ecocardiografia transtorácica e da TC de aorta e artérias pulmonares, que mostraram, além do criss-cross, outras alterações, como dupla via de saída do VD, CIA e CIV amplas.(AU)

Criss-cross heart was first described in 1974. It is a rare congenital heart malformation that occurs in 8 cases per 1,000,000 children, and represents only 0.1% of congenital malformations. The diagnostic methods of choice are transthoracic echocardiography, cardiac magnetic resonance (CMR), computed tomography angiography (CT) and, sometimes, cardiac catheterization. This report describes the case of a newborn with a criss-cross heart in addition to double-outlet right ventricle (RV), with poorly positioned vessels, in addition to atrial septal defect (ASD), interventricular septal defect, tricuspid valve dysplasia and persistent left superior vena cava. The exact etiology of this malformation is not known, but it seems to occur due to rotation of the ventricles in their longitudinal axis, not accompanied by rotation of the atrial and atrioventricular (AV) valves. This movement produces abnormal ventricular inlets, determining that the RV be positioned on a superior plane and the left ventricle on an inferior plane. Although the exact cause of this anomaly is still unknown, it is believed that a genetic abnormality may be leading to these cases: mutation of the Cx43 gene. Diagnosis of the case concerned was given by transthoracic echocardiography and computed CT of the aorta and pulmonary arteries, which showed, in addition to the criss-cross heart, other abnormalities, such as double-outlet RV, large ASD and ventricular septal defect (VSD).(AU)

Mapeamento Potencial de Superfície Corporal durante a Despolarização Ventricular em Ratos Após Exercício Exaustivo Agudo / Body Surface Potential Mapping during Ventricular Depolarization in Rats after Acute Exhaustive Exercise

Resumo Fundamento O exercício físico exaustivo pode causar alterações significantes nas propriedades elétricas do miocárdio. Objetivo Avaliar, através do mapeamento potencial de superfície corporal, a atividade elétrica do coração de ratos durante a despolarização ventricular após exercício exaustivo agudo. Métodos Ratos machos com doze semanas de idade foram submetidos a exercício agudo em esteira a 36 m/min até a exaustão. Eletrocardiogramas unipolares (ECGs) da superfície do tronco foram registrados em ratos anestesiados com zoletil três a cinco dias antes (Pré-Ex), 5 e 10 minutos após exercício exaustivo (Pós-Ex 5 e Pós-Ex 10, respectivamente) simultaneamente com ECGs nas derivações dos membros. Os mapas potenciais de superfície corporal instantâneos (BSPMs, body surface potential maps ) foram analisados durante a despolarização ventricular. Os valores de p <0,05 foram considerados estatisticamente significantes. Resultados Comparado com o Pré-Ex, uma conclusão precoce da segunda inversão de distribuições de potencial, uma conclusão precoce da despolarização ventricular, bem como uma diminuição na duração da fase média e a duração total da despolarização ventricular nos BSPMs foram reveladas no Pós-Ex5. Além disso, em comparação com o Pré-Ex, um aumento na amplitude do extremo negativo do BSPM no pico da onda R no ECG na derivação II (pico RII) e uma diminuição na amplitude do extremo negativo do BSPM a 3 e 4 ms após o pico RII foram demonstrados no Pós-Ex 5. No Pós-Ex 10, os parâmetros dos BSPMs não diferiram daqueles do Pré-Ex. Conclusão Em ratos, o exercício exaustivo agudo causa alterações reversíveis nas características temporais e de amplitude dos BSPMs durante a despolarização ventricular, provavelmente relacionadas a alterações na excitação da massa principal do miocárdio ventricular.

Abstract Background Exhaustive physical exercise can cause substantial changes in the electrical properties of the myocardium. Objective To evaluate, using body surface potential mapping, the electrical activity of the heart in rats during ventricular depolarization after acute exhaustive exercise. Methods Twelve-week-old male rats were submitted to acute treadmill exercise at 36 m/min until exhaustion. Unipolar electrocardiograms (ECGs) from the torso surface were recorded in zoletil-anesthetized rats three to five days before (Pre-Ex), 5 and 10 minutes after exhaustive exercise (Post-Ex 5 and Post-Ex 10, respectively) simultaneously with ECGs in limb leads. The instantaneous body surface potential maps (BSPMs) were analyzed during ventricular depolarization. P values <0.05 were considered statistically significant. Results Compared with Pre-Ex, an early completion of the second inversion of potential distributions, an early completion of ventricular depolarization, as well as a decrease in the duration of the middle phase and the total duration of ventricular depolarization on BSPMs were revealed at Post-Ex 5. Also, compared with Pre-Ex, an increase in the amplitude of negative BSPM extremum at the R-wave peak on the ECG in lead II (RII-peak) and a decrease in the amplitude of negative BSPM extremum at 3 and 4 ms after RII-peak were showed at Post-Ex 5. At Post-Ex 10, parameters of BSPMs did not differ from those at Pre-Ex. Conclusion In rats, acute exhaustive exercise causes reversible changes in the temporal and amplitude characteristics of BSPMs during ventricular depolarization, most likely related to alterations in the excitation of the main mass of the ventricular myocardium.

Investigación anatómica del ápex cardíaco / Anatomical investigation of the cardiac ápex

RESUMEN Objetivo: Comprender la anatomía cardíaca es la clave para resolver incógnitas sobre su función. La estructura miocárdica continua y helicoidal desempeña un papel fundamental en los movimientos de torsión-detorsión. El ápex, parte constitutiva del ventrículo, ¿tiene relevancia en la dinámica cardíaca o es simplemente un fondo de saco? El objetivo del presente trabajo fue responder este interrogante. Material y métodos: Se utilizaron para los estudios anátomo-histológicos cuatro corazones de bovinos jóvenes y cuatro corazones humanos (dos embriones y dos adultos). Para esta investigación se realizaron dos procedimientos: a) desplegamiento del miocardio continuo para observar la disposición de las fibras en la punta del ventrículo izquierdo, denominada zona apexiana; b) cortes horizontales y longitudinales para estudiar la estructura del ápex. Los primeros se realizaron entre los 2/3 medio y apexiano, y los longitudinales seccionando la punta ventricular izquierda con una orientación ápex-base. Resultados: Hemos encontrado en todos los corazones humanos y bovinos estudiados que el ápex corresponde únicamente al ventrículo izquierdo, en donde se ubica el giro del segmento descendente en la continuidad ascendente del miocardio continuo. El fondo de saco apexiano no posee prácticamente plano muscular en su extremo final. Está tapizado por dentro por el endocardio y por fuera por el epicardio. El plano muscular es apenas un 10% en espesor del miocardio contiguo. La transiluminación reafirma este concepto estructural. Conclusiones: El ápex es un fondo de saco prácticamente sin músculo, en el que el endocardio y el epicardio se hallan adosados, pero que cumple funciones del soporte de las presiones intraventriculares y es parte constitutiva de los movimientos de torsión y detorsión.

ABSTRACT Objective: Understanding cardiac anatomy is the key to solve unknown issues about its function. The continuous and helical myocardial structure plays a fundamental role in its torsion-detorsion motions. Does the apex, a constitutive part of the ventricle, have relevance in cardiac dynamics or is it simply a cul-de-sac? The aim of this study was to answer this question. Methods: Four young bovine and four human hearts (two embryos and two adults) were used for the anatomo-histological studies. Two procedures were carried out for this investigation: a) the continuous myocardium unfolding to observe the fiber arrangement at the tip of the left ventricle, called the apical zone; and b) horizontal and longitudinal sections to study the structure of the apex. The horizontal sections were performed between the middle 2/3 and the apex, and the longitudinal ones, sectioning left ventricular apex, with an apex-base orientation. Results: In all the human and bovine hearts studied we found that the apex corresponds only to the left ventricle, where the twist of the descending segment is located, in the ascending continuity of the myocardium. The apical cul-de-sac has practically no muscular plane at its end. It is internally lined by the endocardium and externally by the epicardium. The muscular plane has only 10% thickness of the adjacent myocardium, a structural concept confirmed by transillumination. Conclusions: The apex is a cul-de-sac practically devoid of muscle, in which the endocardium and epicardium are attached, but which performs the functions of supporting intraventricular pressures and being a constitutive part of the torsion and detorsion motions.

Excursão sistólica do anel tricúspide e do anel mitral: correlação com função diastólica ventricular esquerda / Tricuspid annular plane systolic excursion and mitral annular systolic excursion: correlation with left ventricular diastolic function

Introdução: A excursão sistólica do anel tricúspide e a do anel mitral são parâmetros utilizados para se avaliar a função contrátil do ventrículo direito e do ventrículo esquerdo, respectivamente. Pouco se conhece sobre sua relação com a função diastólica ventricular esquerda. Objetivo: Avaliar se os valores de excursão sistólica do anel tricúspide e do anel mitral se correlacionam com parâmetros utilizados na avaliação da função diastólica ventricular esquerda. Métodos: Estudo observacional transversal. Foram selecionados 219 indivíduos, sendo 116 mulheres, com função sistólica preservada de ambos os ventrículos. As análises foram feitas separadamente para os sexos masculino e feminino, por meio dos coeficientes de correlação de Pearson e de Sperman. Foram obtidos: excursão sistólica do anel tricúspide, excursão sistólica do anel mitral, volumes atriais e medidas relacionadas à avaliação da função diastólica do ventrículo esquerdo ao ecocardiograma transtorácico. Resultados: No sexo feminino, a excursão sistólica do anel mitral se correlacionou positivamente com o e' lateral (coeficiente de correlação de Sperman de 0,22; p=0,016) e a excursão sistólica do anel tricúspide se correlacionou positivamente com a relação E/A (coeficiente de correlação de Sperman de 0,23, p=0,037), com o e' lateral (coeficiente de correlação de Sperman de 0,28; p=0,012), com o e' septal (coeficiente de correlação de Sperman de 0,28; p=0,012) e negativamente com a relação E/e' (coeficiente de correlação de Pearson de -0,27; p=0,018) e onda A (coeficiente de correlação de Pearson de -0,29; p= 0,009). No sexo masculino, apenas a excursão sistólica do anel mitral se correlacionou positivamente com a onda E (coeficiente de correlação de Pearson de 0,21; p=0,037), e' lateral (coeficiente de correlação de Sperman de 0,34; p <0,001) e e' septal (coeficiente de correlação de Sperman de 0,26; p=0,008). Não houve correlação entre excursão sistólica do anel mitral e do anel tricúspide e volumes atriais. A presença de hipertensão arterial sistêmica e diabetes melito influenciou nos valores de excursão sistólica do anel tricúspide e do anel mitral correlacionados a ondas E e A, relação E/A, ondas e' septal e lateral e relação E/e'. Conclusão: No presente estudo, os valores da excursão sistólica do anel mitral e do anel tricúspide apresentaram correlação significativa com algumas variáveis da função diastólica ventricular esquerda com maior evidência no sexo feminino.(AU)

Introduction: Tricuspid annular plane systolic excursion and mitral annular systolic excursion are parameters used to assess the systolic function of the right ventricle and left ventricle, respectively. Little is known about its relationship with left ventricular diastolic function. Objective: To assess whether the values of mitral annular systolic excursion and tricuspid annular plane systolic excursion correlate with parameters used in the evaluation of left ventricular diastolic function. Method: Observational cross-sectional study. Two hundred nine individuals were selected, 116 women, with both ventricles normal systolic function. The analyzes were performed for men and women, through Pearson correlation coefficient and Sperman correlation coefficient. Tricuspid annular plane systolic excursion, mitral annular systolic excursion, atrial volumes and left ventricular diastolic function parameters on transthoracic echocardiogram were obtained. Results: In women, mitral annular systolic excursion was positively correlated with lateral e '(Sperman correlation coefficient of 0.22; p=0.016) and tricuspid annular plane systolic excursion was positively correlated with E / A ratio (Sperman correlation coefficient of 0.23; p=0.037), lateral e' (Sperman correlation coefficient of 0.28; p=0.012), and septal e' (Sperman correlation coefficient of 0.28; p=0.012), and negatively with the E/e' ratio (Pearson correlation coefficient of -0.27; p=0.018), and A wave (Pearson correlation coefficient of -0.29; p=0.009). In men, only mitral annular systolic excursion correlated positively with E wave (Pearson correlation coefficient of 0.21; p=0.037), lateral e' (Sperman correlation coefficient of 0.34; p <0.001) and the septal e' (Sperman correlation coefficient of 0.26; p=0.008). There was no correlation between mitral annular systolic excursion E and tricuspid annular plane systolic excursion and atrial volumes. Hypertension and diabetes mellitus influenced tricuspid annular plane systolic excursion and mitral annular systolic excursion values correlated to E and A waves, E/A ratio, septal and lateral e' waves, and E/e' ratio. Conclusion: In the present study, mitral annular systolic excursion and tricuspid annular plane systolic excursion values showed a significant correlation with some parameters of left ventricular diastolic function, with stronger evidence on female sex.(AU)

Efectos de la actividad locomotriz voluntaria gestacional sobre la morfología cardiaca en crías murinas / Effects of gestational voluntary locomotor activity on cardiac morphology in murine offspring

RESUMEN: El objetivo del presente estudio es analizar los efectos de la actividad locomotriz voluntaria gestacional, como un tipo de entrenamiento físico, sobre la morfología de la bomba cardíaca de la cría, en modelo murino de la cepa CF-1. 12 hembras gestantes fueron divididas aleatoriamente en un grupo control y un grupo que realizó actividad locomotriz voluntaria, accediendo a una rueda de actividad durante los primero 12 días de gestación. Se evaluó la morfología cardiaca mediante cortes transversales, midiendo espesor y área de las paredes del ventrículo derecho, ventrículo izquierdo y septum, tanto en valores absolutos como en valores relativos a la masa corporal del individuo. Se observó que la masa corporal de las crías control (GC) fue significativamente mayor que las del grupo cuyas hembras accedieron a la rueda de actividad (GE) (p<0.01). Solo hubo diferencias en los valores absolutos de espesores y áreas miocárdicas de ventrículo derecho, entre el grupo GE y GC (p<0.05), pero al evaluar los espesores y áreas relativos a la masa corporal se observó que las crías del grupo GE presentaron espesores y áreas significativamente mayores que las que grupo GC (p<0.01). En conclusión, la actividad física gestacional altera el desarrollo morfológico de la bomba cardíaca en ratones CF-1, aumentando significativamente el espesor y área de las paredes miocárdicas en relación a la masa corporal total de la cría.

SUMMARY: The objective of the present study is to analyze the effects of gestational voluntary locomotor activity, as a type of physical training, on the morphology of the offspring´s heart pump, in a murine model of the CF-1 strain. Twelve (12) pregnant females were randomly divided in a control group and a group performing voluntary locomotor activity, by accessing an activity wheel during the first 12 days of gestation. Cardiac morphology was evaluated using cross sections, measuring thickness and area of the walls of the right ventricle, left ventricle, and septum, both in absolute values and values relative to the individual's body mass. It was observed that the body mass of the control pups (CG) was significantly higher than those of the group whose females accessed the activity wheel (GE) (p <0.01). Differences were observed only in absolute values of thickness and myocardial areas of the right ventricle, between the GE and GC group (p <0.05). However, when evaluating the thickness and areas relative to body mass, it was observed that the offspring of the GE group presented thicknesses and areas significantly larger than those in the GC group (p <0.01). In conclusion, gestational physical activity alters the morphological development of the heart pump in CF-1 mice, significantly increasing the thickness and area of the myocardial walls in relation to offspring total body mass.

Leonardo da Vinci y la Neurociencia / Leonardo da Vinci and Neuroscience

Leonardo da Vinci (1452-1529) fue un reconocido personaje que hizo grandes aportes a la ciencia y el arte. Demostró un gran interés por la anatomía y fisiología en su paso por el taller de Andrea del Verrocchio, el cual se iría incrementando con el tiempo hasta realizar sus propias autopsias y descripciones. Gracias a sus prodigiosas manos realizó múltiples procedimientos en cadáveres humanos y animales muertos, junto con algunos experimentos que alimentaban su interés por la fisiología. Sus primeros dibujos fueron del cráneo y del encéfalo. Propuso estudiarlo de afuera hacia adentro, por capas. Esquematizó e incluso replicó algunas estructuras que en aquella época tenían un papel fundamental sobre el entendimiento del cuerpo humano. Con relación al encéfalo, describió el bulbo olfatorio y el recorrido de algunas ramas de los pares craneales. Demostró especial interés en detallar los ventrículos cerebrales debido a la influencia de las teorías propuestas por sus antecesores, que integró con sus descubrimientos para explicar las funciones que se les atribuían en la época. Además, fue pionero en neurofisiología con sus experimentos de la médula espinal en ranas. Realizó un trabajo extenso en anatomía y fisiología, dejando grandes aportes en estos campos que desafortunadamente no fueron publicados. Debieron pasar cerca de tres siglos para que fueran interpretados.

Introduction: Leonardo da Vinci (1452-1529) was a renowned figure who made far-reaching contributions to science and art. He was very interested in anatomy and physiology during his time at the workshop of Andrea d ́ Verrocchio, which would increase over time with his own dissections and descriptions. Thanks to his prodigious hands he conducted multiple procedures on human cadavers and dead animals, along with some experiments which fed his interest into physiology. He first drew the skull and the encephalon. He undertook his study of the brain from the outside to the inside, by layers. He schematized and even replicated some structures that at that time played a fundamental role in providing explanations on the human body. Regarding the encephalon, he described the olfactory bulb and the course of some branches of the cranial nerves. He was especially interested in making a detailed study of the cerebral ventricles influenced by the theories proposed by his predecessors, which he integrated with his discoveries to explain the functions attributed to them at that time. In addition, he made pioneering experiments on neurophysiology through his study of the spinal cord of frogs. He extensively worked in anatomy and physiology, which led to great contributions in these fields. Unfortunately these discoveries went unpublished. Nearly three centuries had to pass before they were interpreted.

Quiste aracnoideo intraventricular asintomático: reporte de un caso / Asymptomatic intraventricular arachnoid cyst: a case report

Introducción: Los Quistes Aracnoideos son colecciones benignas de líquido cefalorraquídeo que representan el 1% de lesiones ocupantes de espacios intracraneales. Se detecta frecuentemente antes de los 20 años, entre 60 a 90% de los casos. La prevalencia estimada es de 1,4% en adultos, siendo la menos frecuente la ubicación intraventricular. Caso Clínico: Mujer de 60 años de edad, consultó por cefalea holocraneana de larga data y ocasionales mareos. Sin alteraciones al examen físico neurológico. Se le realizó tomografía axial computarizada donde llamó la atención una leve alteración de la densidad intraventricular por lo que se procedió a realizar resonancia magnética nuclear que demostró imágenes quísticas en atrio de ventrículos laterales, bilateral. No se requirió de una intervención quirúrgica debido a que la paciente no presentaba sintomatología significativa. Discusión: El tratamiento quirúrgico es recomendado en pacientes sintomáticos, en quistes de gran extensión y en los que cursan con complicaciones. Para los pacientes que cursen sólo con dolor de cabeza, sin hidrocefalia secundaria o un aumento evidente de la presión intracraneal se recomienda la observación con o sin repetición de las imágenes.

Introduction: Arachnoid cysts are benign collections of cerebrospinal fluid that represents 1% of lesions occupying intracranial spaces. It is frequently detected before the age of 20, between 60 to 90% of cases. The estimated prevalence is 1.4% in adults, the least frequent being intraventricular location. Clinical Case: A 60-year-old woman attended for a long-standing holocranial headache and occasional dizziness. No alteration in the neurological physical examination. A computerized axial tomography was performed, where a slight alteration in the intraventricular density drew attention, for which a nuclear magnetic resonance was carried out, which showed cystic images in the atrium of bilateral lateral ventricles. No surgical intervention was required because the patient did not present a significant symptomatology. Discussion: Surgical treatment is recommended in symptomatic patients, in cysts of great extension and in those with complications. For patients with only headache, without secondary hydrocephalus or an obvious increase in intracranial pressure, observation with or without repetition of the images is recommended.

Caracterización clínico epidemiológica del infarto agudo del miocardio inferior extendido a ventrículo derecho en Ciego de Ávila / Clinical epidemiological characterization of the lower face acute myocardial infarction extended to the right ventricle in Ciego de Ávila

RESUMEN Fundamento: La cardiopatía isquémica es uno de los principales problemas de salud tanto en países desarrollados como en países en vías de desarrollo, una de las enfermedades que prevalece en el mundo y con mayor mortalidad. Cada año, millones de personas son ingresadas en los servicios de urgencias por motivos de consulta relacionados con el sistema cardiovascular; de estos ingresos, una gran proporción corresponde al infarto agudo de miocardio. Objetivo: Describir las características clínicas epidemiológicas de los pacientes con infarto agudo de miocardio inferior con extensión al ventrículo derecho. Metodología: Se realizó un estudio observacional, descriptivo transversal, en 46 pacientes ingresados en la Sala de Cardiología en el Hospital Provincial General Docente "Dr. Antonio Luaces Iraola", provincia Ciego de Ávila, período julio de 2016 a junio de 2019 y que cumplieron con los criterios establecidos en el estudio. Resultados: En la mayoría de los pacientes los factores de riesgo que predominaron fueron la hipertensión arterial y la diabetes mellitus, en el grupo de edades entre 60 y 69 años del sexo masculino. La forma de presentación más frecuente fue el dolor precordial y la complicación el bloqueo auriculoventricular. Un porcentaje alto de los pacientes recibió terapia trombolítica. Conclusiones: Predominaron los pacientes en edades comprendidas entre 60 y 69 años del sexo masculino y con antecedentes de hipertensión arterial y diabetes mellitus. La complicación más frecuente fue el bloqueo auriculoventricular y su forma de presentación el dolor precordial. Un alto número de pacientes recibieron tratamiento trombolítico.

ABSTRACT Background: Ischemic heart disease is one of the main health problems in both developed and developing countries, one of the most prevalent diseases in the world and with higher mortality. Every year, millions of people are admitted to the emergency services for consulting reasons related to the cardiovascular system; of these admissions, a large proportion corresponds to acute myocardial infarction. Objective: To describe the epidemiological clinical characteristics of patients with lower acute myocardial infarction with extension to the right ventricle. Methodology: An observational, descriptive cross-sectional study was carried out in 46 hospitalized patients in the Cardiology Room at the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola", Ciego de Ávila province, from July 2016 to June 2019 and who had the criteria established in the study. Results: In the majority of patients, the predominant risk factors were hypertension and diabetes mellitus, in the age group between 60 and 69 years of male sex. The most frequent form of presentation was precordial pain and the complication was atrioventricular block. A high percentage of the patients received thrombolytic therapy. Conclusions: Prevailed patients between 60 and 69 years of age, male and with a history of high blood pressure and diabetes mellitus. The most frequent complication was ventricular atrium block and its presentation was precordial pain. A high number of patients received thrombolytic treatment.

Avaliação da Dinâmica do Acoplamento da Condução Atrioventricular à Variação dos Intervalos RR em Atletas e Indivíduos Sedentários / Assessing Dynamic Atrioventricular Conduction Time to RR-interval Coupling in Athletes and Sedentary Subjects

Resumo Fundamento O tempo de condução atrioventricular (TCAV) é influenciado pelo estímulo autonômico e sujeito a remodelação fisiológica. Objetivo Avaliar a variabilidade da TCAV batimento-a-batimento e o intervalo RR em atletas e indivíduos sedentários saudáveis. Métodos Vinte adultos, incluindo 10 indivíduos sedentários saudáveis (controles) e 10 corredores de elite de longa distância (atletas), com idade, peso e altura ajustados foram submetidos à avaliação do equivalente metabólico máximo (MET) e registro de ECG em repouso supino de 15 minutos sete dias depois. O intervalo entre os picos da onda P e da onda R definiu o TCAV. Foram calculadas a média (M) e o desvio padrão (DP) de intervalos RR consecutivos (RR) e TCAV acoplados, bem como as linhas de regressão de RR vs. TCAV (RR-TCAV). A condução AV concordante foi definida como o slope RR-AVCT positivo e, caso contrário, discordante. Um modelo de regressão linear multivariada foi desenvolvido para explicar o MET com base nos parâmetros de variabilidade do TCAV e intervalo RR. Nível de significância: 5%. Resultados Nos atletas, os valores de M-RR e DP-RR foram maiores que nos controles, enquanto M-TCAV e DP-TCAV não foram. Os slopes RR-TCAV foram, respectivamente, 0,038 ± 0,022 e 0,0034 ± 0,017 (p < 0,05). Utilizando um valor de corte de 0,0044 (AUC 0,92 ± 0,07; p < 0,001), o slope RR-TCAV mostrou 100% de especificidade e 80% de sensibilidade. Em um modelo multivariado, o slope DP-RR e RR-TCAV foram variáveis explicativas independentes do MET (razão F: 17,2; p < 0,001), apresentando especificidade de 100% e sensibilidade de 90% (AUC: 0,99 ± 0,02; p < 0,001). Conclusão Em corredores de elite, o acoplamento dinâmico de TCAV para intervalo RR apresenta condução AV discordante espontânea, caracterizada por slope na linha de regressão TCAV negativa vs. intervalo RR. O desvio padrão dos intervalos RR e o slope da linha de regressão do TCAV vs. intervalo RR são variáveis explicativas independentes do MET. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Atrioventricular conduction time ( AVCT ) is influenced by autonomic input and subject to physiological remodeling. Objective To evaluate beat-by-beat AVCT and RR-interval variability in athletes and healthy sedentary subjects. Methods Twenty adults, including 10 healthy sedentary (Controls) and 10 elite long-distance runners (Athletes), age, weight and height-adjusted, underwent maximal metabolic equivalent (MET) assessment, and 15-min supine resting ECG recording seven days later. The interval between P-wave and R-wave peaks defined the AVCT . Mean (M) and standard deviation (SD) of consecutive RR-intervals (RR) and coupled AVCT were calculated, as well as regression lines of RR vs. AVCT (RR-AVCT) . Concordant AV conduction was defined as positive RR-AVCT slope and discordant otherwise. A multivariate linear regression model was developed to explain MET based on AVCT and RR-interval variability parameters. Significance-level: 5 %. Results In Athletes, M-RR and SD-RR values were higher than in Controls, whereas M-AVCT and SD-AVCT were not. RR-AVCT slopes were, respectively, 0.038 ± 0.022 and 0.0034 ± 0.017 (p < 0.05). Using a cut-off value of 0.0044 (AUC 0.92 ± 0.07; p < 0.001), RR-AVCT slope showed 100% specificity and 80% sensitivity. In a multivariate model, SD-RR and RR-AVCT slope were independent explanatory variables of MET (F-ratio: 17.2; p < 0.001), showing 100% specificity and 90% sensitivity (AUC 0.99 ± 0.02; p < 0.001). Conclusion In elite runners, AVCT to RR -interval dynamic coupling shows spontaneous discordant AV conduction, characterized by negative AVCT vs. RR -interval regression line slope. RR -intervals standard deviation and AVCT vs. RR -interval regression line slope are independent explanatory variables of MET (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Morphometric MRI study of the brain ventricles in healthy Turkish subjects / Estudio morfométrico de resonancia magnética de los ventrículos cerebrales en sujetos turcos sanos

The aim of this study was to determine the normal values of brain ventricles and indices in healthy subjects in our population using magnetic resonance imaging (MRI) and to reveal sex and age related differences. The MRI of two hundred-sixty-five healthy individuals aged between eighteen and eighty-seven years were examined and the midsagittal and axial images were used for measurements. The measurements were performed from MRI on a Workstation. The following mean values of brain ventricles and indices were observed; frontal horn width (FHW) (33.14 mm); third (3rd) ventricle width (TVW) (3.37 mm); fourth ventricle anteroposterior width (FVWAP) (9.93 mm); fourth ventricle transverse width (FVWT) (12.40 mm); and the maximum transverse inner diameter of the skull (TIDS) (128.75 mm) in females. The same dimensions were 34.85 mm, 3.91 mm, 10.26 mm, 12.81 mm, and 134.68 mm in males, respectively. There were statistically significantly differences in the frontal horn width, third (3rd) ventricle width, and the maximum transverse inner diameter of the skull values in between sexes. The mean values of Evans' index which obtanied with maximum width between the frontal horns of the lateral ventricles divided by the maximum transverse inner diameter of the skull were found as 0.280 ±0.172 in females; whereas the same dimensions were calculated 0.276±0.161 in males. These values were lower in healthy male subjects than females, however; there were no found significantly difference between groups. Present findings obtained from MRI are necessary anatomical baseline data for interpreting pathological changes, planning surgery, and determining presence and progress of some neurological diseases.

El objetivo de este estudio fue determinar los valores normales de los ventrículos e índices cerebrales en sujetos sanos en nuestra población mediante el uso de imágenes de resonancia magnética (RM) y revelar las diferencias relacionadas con el sexo y la edad. Se examinó la resonancia magnética de 265 individuos sanos de entre 18 y 87 años, y se utilizaron las imágenes en sentido medio y sagital para las mediciones. Las mediciones se realizaron a partir de IRM en una estación de trabajo. Se observaron los siguientes valores medios de ventrículos e índices cerebrales: longitud del asta frontal (FHW) (33,14 mm); longitud del tercer ventrículo (TVW) (3,37 mm); longitud anteroposterior del cuarto ventrículo (FVWAP) (9,93 mm); longitud transversal del cuarto ventrículo (FVWT) (12,40 mm); y el diámetro transversal máximo del cráneo (SID) (128,75 mm) en las hembras. Las mismas dimensiones fueron 34,85 mm, 3,91 mm, 10,26 mm, 12,81 mm y 134,68 mm en machos, respectivamente. Hubo diferencias estadísticamente significativas en el ancho del asta frontal, el ancho del tercer ventrículo y el diámetro interno transversal máximo de los valores del cráneo entre los sexos. Los valores medios del índice de Evans que obtuvieron el ancho máximo entre los cuernos frontales de los ventrículos laterales dividido por el diámetro interno transversal máximo del cráneo se encontraron en 0,280 ± 0,172 en las mujeres; mientras que las mismas dimensiones se calcularon en hombres (0,276 ± 0,161). Sin embargo, estos valores fueron más bajos en hombres sanos que en mujeres; no se encontraron diferencias significativas entre los grupos. Los hallazgos actuales obtenidos de IRM son datos anatómicos de referencia necesarios para interpretar los cambios patológicos, planificar la cirugía y determinar la presencia y el progreso de algunas enfermedades neurológicas.

Migración intracraneal de aceite de silicona a través del nervio óptico post-vitrectomía / Intracranial migration of silicone oil through the optic nerve post-vitrectomy

La migración intracraneal del aceite de silicona intraocular es una complicación rara en el tratamiento de las complicaciones de la retinopatía diabética. Se han postulado varios posibles mecanismos etiopatogénicos para explicar este fenómeno de migración. El aceite de silicona se presenta hiperdenso en la tomografía, siendo un desafío distinguirlo de la hemorragia subaracnoidea, resaltando la utilidad de la resonancia magnética. En pacientes con evidencia de retinopexia de silicona previa, la visualización de una lesión intraventricular con un artefacto de desplazamiento químico asociado aumenta la posibilidad de que se trate de una migración del aceite de silicona. Presentamos el caso de un paciente con antecedente de retinopexia con aceite de silicona y cefalea intensa, identificándose migración del aceite de silicona al sistema ventricular con estudios de tomografía y resonancia.

The intracranial migration of intraocular silicone oil is a rare complication in the treatment of complications of diabetic retinopathy. Several possible etiopathogenic mechanisms have been published to explain this phenomenon of migration. Silicone oil appears hyperdense on tomography, being a challenge to distinguish it from subarachnoid hemorrhage, highlighting the usefulness of magnetic resonance imaging. In patients with evidence of previous silicone retinopexy, the visualization of an intraventricular lesion with a chemical displacement device presents the possibility that it is a migration of the silicone oil. To present the case of a patient with a history of retinopexy with silicone oil and intense headache, identifying the migration of silicone oil in the ventricular system with tomography and resonance studies.

Leiomiosarcoma de la vena cava superior con extensión a las cavidades cardíacas derechas / Leiomyosarcoma of the superior vena cava with extension to the right heart cavities

RESUMEN Fundamento: el leiomiosarcoma de la vena cava superior es una enfermedad rara y más cuando se extiende a las cavidades cardíacas. Objetivo: presentar una paciente con leiomiosarcoma de la vena cava superior que se extendió de forma intraluminal a las cavidades derechas del corazón lo que provocó obstrucción de las mismas y choque cardiogénico. Caso clínico: paciente de 45 años de edad, blanca, femenina sin antecedentes mórbidos de salud, la cual presentó enrojecimiento del rostro y agotamiento de las extremidades al peinarse. Se le realiza tomografía axial computarizada donde se identificó una lesión sugestiva de trombosis, se decide su traslado hacia un centro especializado, se llega a la conclusión de que la paciente era portadora de una lesión tumoral no trombótica, la cual resultó ser benigna en una biopsia realizada por lo cual se decide seguimiento. La paciente reingresa en estado de shock cardiogénico por progresión de la enfermedad y se decide su tratamiento quirúrgico de emergencia, durante la cirugía fallece. Conclusiones: el leiomiosarcoma de la vena cava superior es una enfermedad rara, existen pocos reportes en la literatura sobre este padecimiento. Se presentó un caso en el cual el tumor se extendía de forma intraluminal a las cavidades cardíacas derechas (aurícula y ventrículo).

ABTRACT Background: the leiomyosarcoma of the superior cava vein is a rare illness and more when it extends to the cardiac cavities. Objective: to present to the medical community a female patient with leiomyosarcoma of the superior cava vein that extended intraluminal form to the right cavities of the heart causing obstruction and cardiogenic shock. Clinical case: a 45-year-old white female patient with no morbid health history, who presented redness of the face and exhaustion of the extremities when combing. A computerized axial tomography was performed where a lesion suggestive of thrombosis was identified. It was decided to transfer her to a specialized center, in which it is concluded that the patient was a carrier of a non-thrombotic tumor lesion, which turned out to be benign in a biopsy done for which follow-up is decided. The patient reenters in a state of cardiogenic shock due to progression of the disease, which is why her emergency surgical treatment is decided and die during surgery. Conclusions: the leiomyosarcoma of the superior vena cava is a rare illness, with few reports in the literature. A case in which the tumor extended intraluminally to the right cardiac cavities (atrium and ventricle) is presented.

Cirugía de Fontan: experiencia a cinco años en un centro de IV nivel / Fontan surgery: five years experience in an IV level center

RESUMEN Objetivo: Describir la experiencia del servicio de unidad de cardiopatía congénita de la FVL en uso de la cirugía de Fontan, 2011-2016. Materiales y métodos: Estudio descriptivo observacional de corte histórico (serie de casos). Se analizaron 22 historias clínicas de pacientes con antecedentes de cardiopatías congénitas complejas intervendios por cirugia de Fontan en la Fundación Valle del Lili, entre enero del 2011 y diciembre del 2016. Resultados: El ventrículo único fisiológico fue la principal causa de la intervención, presentándose en 17 pacientes (77.3%). Dentro de las cirugías paliativas realizadas previas a la cirugía de Fontan se encontró la fístula sistémico-pulmonar (FSP) (73%) y el cerclaje pulmonar (32%), siendo estos en su mayoría procedimientos que se pudieron combinar entre ellos para optimizar la condición clínica, ya que se operaron, en promedio, 3.7 años después del estadio paliativo previo. De las técnicas quirúrgicas, el Fontan extracardíaco fenestrado se realizó en mayor proporción (68%), y seguido del intracardíaco fenestrado (13.6%). El 86% de los pacientes presentaron comorbilidades. Conclusión: Con una mejor selección de pacientes con fisiología univentricular se logran minimizar complicaciones y la mortalidad asociada al procedimiento quirúrgiico. Se requieren de estudios de seguimiento de los pacientes de la Fundación Valle de Lili para determinar características afines a 10, 20 y 30 años, y equipararlos con los obtenidos en la literatura mundial.

ABSTRACT Objective: To describe the experience of the congenital heart disease unit service of the FVL in the use of Fontan surgery, 2011-2016. Materials and methods: Observational descriptive study of historical cut (series of cases). We analyzed 22 clinical histories of patients with a history of complex congenital heart disease intervened by Fontan surgery at the Valle del Lili Foundation between January 2011 and December 2016. Results: The single physiological ventricle was the main cause of the intervention, occurring in 17 patients (77.3%). Among the palliative surgeries performed prior to Fontan surgery, pulmonary systemic fistula (PSF) (73%) and pulmonary cerclage (32%) were found, these mostly being procedures that could be combined to optimize the condition clinic, operating on average 3.7 years after the previous palliative stage. Of the surgical techniques, the fenestrated extracardiac fundus was performed in a greater proportion (68%), and the fenestrated intracardiac fundus (13.6%). 86% of patients presented comorbidities Conclusion: With a better selection of patients with univentricular physiology, complications and mortality associated with the surgical procedure are minimized. Follow-up studies of the patients of the Valle de Lili Foundation are required to determine characteristics related to 10, 20 and 30 years and to compare them with those obtained in the world literature.

Valores ecocardiográficos de referencia de las cavidades derechas en una población sana / Reference Values for Right-Sided Heart Chambers by Echocardiography in a Healthy Population

RESUMEN Introducción: La evaluación de las cavidades cardíacas derechas es de gran importancia diagnóstica y pronóstica en diversas patologías. Sin embargo, existen pocos datos bibliográficos acerca de los valores de referencia de sus dimensiones así como de la función del ventrículo derecho. Objetivo: Nuestro objetivo fue establecer dichos valores, identificar diferencias asociadas al sexo y a variables antropométricas y evaluar la variabilidad inter- e intraobservador en su determinación. Material y métodos: Se incluyeron prospectivamente personas sanas ≥ 16 años, de ambos sexos. Se aplicaron estrictos criterios de exclusión. Se realizó la evaluación ecocardiográfica con múltiples mediciones de cavidades derechas y la estimación de la variabilidad inter- e intraobservador en un subgrupo de 40 personas. Resultados: Se incluyeron 438 personas, el 55,2% (n = 242) fueron hombres. La media de edad fue 34 ± 9 años. Las variables analizadas mostraron diferencias significativas entre hombres y mujeres, que persistieron al indexarlas a superficie corporal. La fuerza de concordancia para la variabilidad interobservador fue excelente (CCI > 0,75) en el 50% de las variables estudiadas, regular a buena (CCI 0,4 a 0,75) en el 47,4% y pobre (CCI < 0,4) en el 2,6%. La concordancia intraobservador fue excelente en el 54,8% de las variables, regular a buena en el 42,8% de ellas y pobre en el 2,4%. Conclusión: Presentamos valores de referencia para la evaluación de las cavidades derechas. Las diferencias observadas entre sexos y según la superficie corporal hacen necesaria su discriminación acorde con dichos parámetros en la práctica diaria. La concordancia interobservador e intraobservador fue excelente a buena en la mayoría de las variables estudiadas.

ABSTRACT Background: The evaluation of right-sided heart chambers is extremely important for the diagnosis and prognosis of differ-ent conditions. However, there is little information in the bibliography about the reference values of the right-sided heart chambers dimensions and right ventricular function. Objective: The aim of this study was to establish the reference values of the right-sided heart chambers, to identify the dif-ferences associated with sex and anthropometric variables and to evaluate the interobserver and intraobserver variability in determining these values. Methods: The study included healthy men and women ≥16 years. Strict exclusion criteria were applied. A subgroup of 40 people underwent multiple measurementis of the right-sided heart chambers and interobserver and intraobserver variability was estimated. Resultis: A total of 438 persons were included; 55.2% (n=242) were men. Mean age was 34±9 years. There were significant differences in the variables analyzed between men and women that persisted after they were indexed to body surface area. Interobserver concordance (ICC>0.75) was excellent in 50% of the variables evaluated, fair to good (ICC 0.4 to 0.75) in 47.4% and poor (ICC<0.4) in 2.6%. Intraobserver concordance was excellent in 54.8% of the variables, fair to good in 42.8% and poor in 2.4%. Conclusion: The reference values for the evaluation of right-sided heart chambers are presented. The differences observed between sexes and related to body surface area emphasize the need for discriminating according to these parameters in daily practice. Interobserver and intraobserver concordance was excellent to good in most of the variables analyzed.

Age-related changes of the cerebral ventricles of healthy domestic cats / Alterações senis dos ventrículos cerebrais de gatos domésticos hígidos

This study aimed to determine age-related changes of the cerebral ventricles of healthy non-brachycephalic domestic cats by the acquisition of brain MRI images of 12 adult (1 to 6 years), 11 mature (7 to11 years) and 10 geriatric (12 years or more) cats. Our hypothesis is that the cerebral ventricular system of cats expands with increasing age. The possibility of the evidence of the olfactory bulb cavities and temporal horns of the lateral ventricles were evaluated in this study. Volumes of the olfactory bulb cavities, lateral ventricles (including the temporal horns), third ventricle, mesencephalic aqueduct and fourth ventricle were measured and corrected for the intracranial volume. Significant differences were found between the adult and mature groups in relation to the geriatric one for the variable related to the evidence of the temporal ventricular horns, which were most frequently visualized in geriatric cats. Percentage of the right lateral and third ventricles volume by intracranial volume were significantly higher in geriatric cats compared to the adults. The results of this study demonstrate that ventricular dilation tends to occur with advancing age in cats, as well as the increase in the frequency of the temporal ventricular horn evidence, as had been indicated in the hypothesis of the study.(AU)

O estudo objetivou a determinação das alterações senis dos ventrículos cerebrais de gatos domésticos hígidos não braquicefálicos pela aquisição de imagens encefálicas de 12 indivíduos adultos (1 a 6 anos), 11 maduros (7 a 11 anos) e 10 geriátricos (12 anos de idade ou mais) por ressonância magnética. Nossa hipótese é de que o sistema ventricular dos gatos se expande com o avanço da idade. A possibilidade de evidenciação das cavidades do bulbo olfatório e dos cornos temporais dos ventrículos laterais foi avaliada nesse estudo. Os volumes das cavidades do bulbo olfatório, ventrículos laterais (incluindo os cornos temporais), terceiro ventrículo, aqueduto mesencefálico e quarto ventrículo foram mensurados e corrigidos de acordo com o volume intracraniano. Diferenças significativas foram encontradas entre os grupos dos adultos e maduros em relação aos geriátricos para a variável referente à evidenciação dos cornos temporais, que foram visualizados de forma mais frequente nos gatos geriátricos. A porcentagem do volume do ventrículo lateral direito e do terceiro ventrículo em relação ao volume intracraniano foi significativamente maior nos animais geriátricos em comparação aos adultos. Os resultados desse estudo demonstram que a dilatação ventricular tende a ocorrer com o avanço da idade nos gatos, assim como o aumento na frequência da evidenciação dos cornos temporais, como havia sido indicado na hipótese do estudo.(AU)

The artery of Mouchet: blood supply of the septomarginal trabecula in 50 human hearts

SUMMARY The septomarginal trabecula is a muscular structure which transmits the right branch of the atrioventricular bundle. It is usually supplied by a branch from the second anterior septal artery. Anastomoses between the right and left coronary arteries may happen on the septomarginal trabecula. They are of great significance in order to prevent ischemia during a myocardial infarction. Surgeries such as Konno's and Ross' procedures implies in knowledge of these vessels anatomy. The coronary arteries of 50 human hearts were injected with latex and subsequentely dissected with the purpose of identifying the arterial branch that supplied the septomarginal trabecula. The trabecular branch arose from the second anterior septal artery in 38% of cases, and the branch arose from the first anterior septal artery in 26%. One of the hearts had its septomarginal trabecula supplied by the conus arteriosus arteryliterature. Anastomoses between the right and left coronary arteries were found inside the septomarginal trabecula. The right branch of the atrioventricular bundle is subject to a great number of clinical conditions and is often manipulated during surgery, thus, the study of the septal branches of the coronary arteries and the trabecular branch is essential.

RESUMO A trabécula septomarginal é uma estrutura muscular que transmite o ramo direito do feixe atrioventricular. É usualmente suprida por um ramo da segunda artéria septal anterior. Anastomoses entre as artérias coronárias direita e esquerda podem ocorrer na trabécula. São de grande significância especialmente na prevenção de isquemia durante um infarto do miocárdio. Procedimentos cirúrgicos como o de Konno's e Ross implicam conhecimento anatômico desses vasos. As artérias coronárias de 50 corações humanos foram injetadas com látex e dissecadas com o propósito de identificar o ramo arterial que supria a trabécula septomarginal. Em somente 38% dos casos o ramo foi proveniente da segunda artéria septal anterior, enquanto que em 26% dos casos a artéria se originou da primeira septal anterior. Um dos corações teve a trabécula septomarginal suprida por um ramo originário da artéria do cone arterioso. Além disso, foram encontradas anastomoses entre as artérias coronárias no interior da trabécula septomarginal. Em suma, o ramo direito do feixe atrioventricular está sujeito a inúmeras condições clínicas e é alvo de manuseio em cirurgias, logo, o estudo dos ramos septais das artérias coronárias, em especial o ramo trabecular é essencial.

Cerebral localization of the mind and higher functions: the beginnings / Localização cerebral da mente e das funções superiores: os primórdios

Abstract The debates about the mind and its higher functions, and attempts to locate them in the body, have represented a subject of interest of innumerable sages since ancient times. The doubt concerning the part of the body that housed these functions, the heart (cardiocentric doctrine) or the brain (cephalocentric doctrine), drove the search. The Egyptians, millennia ago, held a cardiocentric view. A very long time later, ancient Greek scholars took up the theme anew, but remained undecided between the heart and the brain, a controversy that lasted for centuries. The cephalocentric view prevailed, and a new inquiry ensued about the location of these functions within the brain, the ventricles or the nervous tissue, which also continued for centuries. The latter localization, although initially inaccurate, gained traction. However, it represented only a beginning, as further studies in the centuries that followed revealed more precise definitions and localizations of the higher mental functions.

Resumo Os debates sobre a mente e suas funções superiores, e as tentativas de estabelecer suas localizações no corpo, foram objeto de interesse de inúmeros sábios desde os tempos mais remotos. A dúvida quanto à parte do corpo que abrigava tais funções, o coração (doutrina cardiocêntrica) ou o cérebro (doutrina cefalocêntrica), abriu as buscas. Os egípcios, há milênios, mantinham um ponto de vista cardiocêntrico. Muito tempo depois, antigos acadêmicos gregos retomaram o tema, mas permaneceram indecisos entre o coração e o cérebro, uma controvérsia que durou séculos. O ponto de vista cefalocêntrico predominou, e seguiu-se uma nova questão, quanto ao lugar dessas funções no cérebro, os ventrículos ou o tecido nervoso, que também durou séculos. Esta última localização, apesar de inicialmente equivocada, prosperou. Entretanto, esta representou apenas um começo, já que mais estudos, nos séculos seguintes, revelaram definições e localizações mais precisas para as funções mentais superiores.