Caracterización de cardiopatías congénitas en Manizales 2010-2016 / Characterization of Congenital Heart Defects in Manizales 2010-2016 / Caracterização de cardiopatias congênitas em Manizales, Colômbia, 2010-2016

Resumen: Las cardiopatías congénitas son la tercera causa de malformaciones congénitas y una de las principales responsables de la mortalidad en periodo neonatal en el mundo; se originan a partir de alteraciones en el desarrollo embrionario. La incidencia es variable; en Colombia, se estima que afectan del 2 al 3 % de los recién nacidos vivos. En 2015, 20,8 % de los niños menores de cinco años afectados con cardiopatías congénitas fallecieron a causa de estas alteraciones. El presente es un estudio descriptivo y retrospectivo. Se incluyeron los datos de 252 historias clínicas de pacientes con diagnóstico de cardiopatía congénita entre los años 2010 y 2016, el 56 % de la población encontrada fue de sexo femenino. Predominaron las cardiopatías congénitas no cianosantes (87 %). La mayor prevalencia fue el ductus arterioso permeable (35,3 %). La ecocardiografía Doppler se utilizó en 98,4 % de los casos; con respecto al manejo, el 47,2 % de los pacientes estuvieron en seguimiento, siendo este más común que las alternativas médicas o quirúrgicas. En conclusión, el ductus arterioso permeable, la comunicación interventricular y la comunicación interatrial son las cardiopatías no ciano-santes más frecuentes en la población estudiada y se asocian a hipertensión pulmonar que ameritan mayor seguimiento. La tetralogía de Fallot fue la cardiopatía congénita cianosante más común.

Abstract: Congenital heart defects are the third cause of congenital malformations and one of the main causes of mortality in the neonatal period in the world; they originate from alterations in embryonic development. The incidence is variable; in Colombia, it is estimated that they affect 2 to 3% of live newborns. In 2015, 20.8% of children under the age of five affected with congenital heart defects died from these disorders. This is a descriptive and retrospective study. Data of 252 clinical records of patients diagnosed with congenital heart defect between 2010 and 2016 were included, showing that 56% of this population were female. Acyanotic Congenital Heart Diseases predominated (87%). The highest prevalence was patent ductus arteriosus (35.3%). Doppler echocardiography was used in 98.4% of cases; regarding management, 47.2% of patients were in follow-up, this being more common than medical or surgical alternatives. In conclusion patent ductus arteriosus, ventricular septal defect and interatrial septal defect are the most frequent acyanotic heart diseases in the population under study and they are associated with pulmonary hypertension that require higher follow-up. Tetralogy of Fallot was the most common cyanotic congenital heart disease.

Resumo: As cardiopatias congênitas são a terceira causa de malformações congênitas e uma das principais responsáveis pela mortalidade no período neonatal no mundo. São originadas a partir de alterações no desenvolvimento embrionário. A incidência é variável; na Colômbia, é estimado que afetam de 2 a 3 % dos recém-nascidos vivos. Em 2015, 20,8 % das crianças menores de cinco anos afetadas com cardiopatias congênitas faleceram por causa dessas alterações. Este estudo é descritivo e retrospectivo. Foram incluídos dados de 252 prontuários de pacientes com diagnóstico de cardiopatia congênita entre 2010 e 2016, 56 % da população encontrada foi do sexo feminino. Predominaram as cardiopatias congênitas não cianóticas (87 %). A maior persistência foi o dueto arterioso permeável (35,3 %). A ecocardiografìa Doppler foi utilizada em 98,4 % dos casos; quanto ao manejo, 47,2 % dos pacientes estiveram em seguimento, o que foi mais comum do que as alternativas médicas ou cirúrgicas. Em conclusão, o ducto arterioso permeável, a comunicação interventricular e a comunicação interatrial são as cardiopatias não cianóticas mais frequentes na população estudada e são associadas com a hipertensão pulmonar que merecem maior seguimento. A tetralogia de Fallot foi a cardiopatia congènita cianòtica mais comum.

Anatomy of the septal perforating arteries of the heart / 대한해부학회지

The septal perforating arteries of the heart usually branch off from the anterior and inferior interventricular arteries and supply the interventricular septum and the conduction system therein. Since the septal perforating arteries are not directly visible from the outside of the heart, their anatomy and variations might be overlooked. However, the septal perforating arteries have their unique anatomy that needs to be recognized to avoid the damage of the vessels especially during common cardiac procedures such as the coronary artery bypass graft, percutaneous coronary intervention, and aortic valve replacement. A better understanding of these important arteries will help physicians to enhance the overall cardiac care for their patients. Therefore, this article discusses the anatomy, the relationship to the conduction system of the heart and the clinical significance of the septal perforating arteries.

Rotura del septum interventricular posinfarto agudo de miocardio. Reporte de caso / Interventricular septum rupture post acute myocardial infarction. A case report

Resumen: La rotura del septum interventricular es una complicación grave del infarto agudo de miocardio (IAM), aunque poco frecuente. Se evidencia clínicamente como un deterioro hemodinámico progresivo, posterior al infarto. El ecocardiograma transtorácico es el principal estudio de imagen para el diagnóstico y la corrección quirúrgica constituye el pilar del tratamiento, ya que conlleva menor mortalidad que el tratamiento médico. Presentamos el caso de un paciente joven con IAM inferior que en la evolución presenta esta complicación, siendo intervenido de urgencia, con recuperación posterior.

Summary: The interventricular septum rupture is a serious, although infrequent complication of acute myocardial infarction. It is clinically evident as a progressive hemodynamic deterioration, after the infarction. Transthoracic echocardiography is the main imaging study for diagnosis, and surgical correction is the mainstay of treatment, since it has lower mortality than medical therapy. We present the case of a young patient with an inferior acute myocardial infarction, who presents this complication in the evolution, and was urgently operated, with subsequent recovery.

Caso Clínico: Tetralogía de Fallot Extrema / Case Report: Extreme Tetralogy of Fallot

INTRODUCCIÓN: La tetralogía de Fallot representa la cardiopatía congénita cianógena más frecuente después del primer año de vida, ocurre aproximadamente en 1 de cada 3 500 nacimientos y representa el 7 al 10% de todas las Enfermedades Cardiacas Congénitas. Su variante extrema que se acompaña de atresia pulmonar representa el 1 a 2% de las cardiopatías congénitas. Presentamos una Tetralogía de Fallot Extrema Ductus Dependiente de manejo complejo. CASO CLÍNICO: Se trata de un neonato a término de 12 días de vida, adecuado para la edad gestacional, sin factores de riesgo prenatales, ni antecedentes patológicos familiares, el cual es diagnosticado de Tetralogía de Fallot Extrema por ecocardiograma. EVOLUCIÓN: Paciente inicialmente tratado con infusión de prostaglandina E1. Posteriormente mediante fístula Blalock-Taussig izquierda. CONCLUSIONES: Para mejorar el pronóstico y sobrevida de un paciente con Tetralogía de Fallot Extrema el diagnóstico prenatal oportuno y el tratamiento apropiado es de vital importancia, sin embargo el tratamiento definitivo con derivaciones pulmonares sistémicas representan complicaciones con riesgo de mortalidad. El presente caso tuvo un desenlace desfavorable.

BACKGROUND: The Tetralogy of Fallot represents the most common cyanogenic heart disease after the first year of life. It occurs in 1 of 3 500 live births and accounts as 7 to 10% of all Congenital Heart Diseases. Its extreme variant is accompanied by pulmonary atresia and accounts 1 to 2% of the Congenital Heart Diseases. We present an Extreme Tetralogy of Fallot­ Ductus Dependent of complex management. CLINICAL CASE: A full term 12 day neonate, adequate for gestational age, without prenatal risk factors or pathologic family antecedents, is diagnosed with Extreme Tetralogy of Fallot by echocardiogram. EVOLUTION: The patient was treated initially with an infusion of prostaglandin E1. Then, a left Blalock-Taussig shunt was performed. CONCLUSIONS: To improve the prognosis and survival rates of patients with Extreme Tetralogy of Fallot , a timely diagnosis and treatment are of vital importance. Definitive treatment with systemic pulmonary shunts carries high risk complications. The present case had an unfavorable evolution.

Characteristics of Ventricular Function in Pulmonary Hypertension Patients with Different Shape of Interventricular Septum: Preliminary Study with Cardiac Magnetic Resonance Imaging / 中国肺癌杂志

BACKGROUND@#To study the characteristics of ventricular function in Pulmonary Hypertension (PH) Patients with different shape of Interventricular Septum (IVS) by cardiac magnetic resonance (CMR).@*METHODS@#36 PH patients diagnosed by right heart catheterization accepted CMR. According to the morphology of IVS, the patients were divided into two groups: the non-deformation group (10 patients) and the deformation group (26 patients). The ventricular function parameters were as follows: RV and LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), cardiac index (CI), ejection fraction (EF), and myocardial mass index (MMI).@*RESULTS@#ANOVA analysis showed that the differences of RVEDVI, RVESVI, RVSVI, RVCI, RVEF, RVMMI, LVEDVI, LVESVI, LVSVI and LVCI were significant among the three groups. Compared with control group, RVSVI (P=0.017), RVEF (P<0.001), LVEDVI (P=0.048) and LVSVI (P=0.015) decreased in IVS non-deformation group. Compared with IVS non-deformation group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.002) and RVMMI (P=0.017) were increased in IVS deformation group; while RVEF (P=0.001), LVEDVI (P=0.003), LVSVI (P<0.001) and LVCI (P=0.029) were decreased. Compared with the control group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.004) and RVMMI (P=0.003) were increased in the IVS deformation group, while RVEF (P<0.001), LVEDVI (P<0.001), LVESVI (P<0.001), LVSVI (P<0.001), LVCI (P<0.001) were decreased.@*CONCLUSIONS@#Ventricular function is different in PH Patients with different IVS shape. The IVS shape can represent the changes of ventricular function in PH patients.

Síndrome de Eisenmenger em um gato / Eisenmenger syndrome in cat

A 6-month-old female, 1.0kg, uncastrated female Persian cat was brought to the Veterinary Hospital at State University of Ceara, with a history of dyspnea, prostration, hyporexia and progressive weight loss for a month. On physical examination, systolic cardiac murmur, cyanosis and dyspnea were detected. Unfortunately, the cat died during oxygen therapy. Necropsy examination revealed an increase in cardiac silhouette and ventricular septal defect of 2cm in diameter. Macroscopically the lungs were collapsed, with absent and diffusely reddish blackish crepitus, and the liver with blackish red coalescent multifocal areas, interspersed with lighter areas and lobular pattern with irregular brownish multifocal areas intercepted by brownish areas. Thus, the necropsy results together with the history and physical examination of the animal confirmed the diagnosis of Eisenmenger Syndrome, becoming the report of the first case, in a cat, in Brazil.(AU)

Relationship between interventricular septum thickness and renal prognosis in IgA nephropathy patients / 中华肾脏病杂志

Objective To investigate the relationship between interventricular septum thickness (IVST) and renal prognosis in IgA nephropathy patients.Methods A total of 213 patients with IgA nephropathy proven by biopsy from Department of Nephrology of Shenzhen Second People's Hospital were enrolled in this study,and these participants were divided into normal IVST group (＜ 11 mm) and higher IVST (≥ 11 mm) group according to IVST.The demographic characteristics,clinical biochemical indexs,CKD stage and pathologic characteristics in these two groups were compared.Binary logistic regression analysis was used to analyze the influencing factors of eGFR ＜ 60 ml · min-1 ·(1.73 m2)-1,and Kaplan-Meier survival curve was used to analyze the effect of IVST on renal prognosis.Results Compared with IVST normal group,the patients in IVST higher group were more male sex,older,and had higher level of systolic pressure,Hb,Scr,BUN,UA,24 h urine protein excretion,urinary protein creatinine ratio,triacylglycerol,total cholesterol,LDL,Serum C3,C4,and had more serious mesangial proliferation,tubular atrophy (all P ＜ 0.05).However,the levels of eGFR and HDL were decreased in IVST higher group (both P ＜ 0.05).There were a significant difference in CKD staging distributions and IgA Lee grade between two groups (both P ＜ 0.01).Spearman and Pearson correlation analysis indicated that IVST was negatively correlated with eGFR and positively correlated with proteinuria level in IgA nephropathy patients.Baseline IVST was an independent risk factor of eGFR ＜ 60 ml · min-1 · (1.73 m2)-1 in IgA nephropathy patients.Serum C3,UA and hemoglobin were independent influential factors of eGFR decline (all P ＜ 0.05).Kaplan-Meier survival curve indicated that the renal function was worse in patients with thickened interventricular septum.Conclusion The IgA nephropathy patients with thicker interventricular septum has a poor renal prognosis.

Relationship between interventricular septum thickness and renal function in patients with type 2 diabetes mellitus / 中华肾脏病杂志

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus.Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study.According to their IVS,the patients were divided into normal group (IVS≤ 11 mm) and higher IVS group (IVS ＞ 11 mm).All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml· min-1 · (1.73 m2) 1 group and eGFR ＜ 60 ml· min-1 · (1.73 m2)-1 group.The demographic characteristic,biochemical examination,eGFR,and proteinuria of different groups were compared.Pearson or spearman correlation was used to analyze the relationship between eGFR,IVS and other parameters.eGFR ＜ 60 ml · min-1 · (1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression.Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis.Results Compared with normal group,patients in the higher IVS group had higher systolic pressure (P=0.002),their level of Scr,BUN,24 h urinary protein were increased (all P ＜ 0.05),while the level of eGFR,albumin (ALB),hemoglobin (Hb) and fasting blood glucose were decreased (all P ＜ 0.05).The prevalence of hypertension was increased (81.16％ vs 58.67％,x2=11.273,P=0.001),and there was also a difference in the proportion of patients in each stage of CKD (x2=34.593,P ＜ 0.001).Correlation analysis showed that IVS was positively correlated with BMI,systolic BP,Scr,BUN,24 h urinary albumin,24 h urinary protein (all P ＜ 0.05),while negative correlation was observed between the thickened degree of IVS and Hb,albumin,eGFR and total calcium (all P ＜ 0.05).It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P ＜ 0.01).Logistic regression analysis showed that longer duration of diabetes,higher systolic pressure and BUN were independent risk factors for eGFR ＜ 60 ml·min-1·(1.73 m2)-1 (all P ＜ 0.05),while higher Hb and Alb were independent protective factors for eGFR ＜ 60 ml· min-1· (1.73 m2)-1 (all P ＜ 0.05).Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P ＜ 0.05),while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P ＜ 0.05).Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396,95％ CI=1.098-1.774,P=0.006).Conclusion Interventricular septum thickness is closely related to the state of renal function,as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.

Basal Interventricular Septal Aneurysm in Rheumatic Mitral Stenosis

No abstract available.

The echocardiographic features of dissection into interventricular septum and etiology analysis / 中华超声影像学杂志

Objective To summary the echocardiographie features of the patients with dissection into interventricular septum (IVS) and to analyze the etiology.Methods The data of 13 cases with the dissection into the interventricular septum diagnosed by echocardiography were reviewed to summarize the echocardiographic features and the analysis of etiology.Results Among the 13 patients with dissection into IVS,11 patients were dissected into IVS from the right sinus of Valsalva (SOV),in which 5 patients were from single aneurysm of the right SOV,one patient was from a combination of a bicuspid aortic valve and right SOV,4 patients were from aortic valve infection of infective endocarditis,and one patient was induced by severe paravalvular leak after mechanical aortic valve prosthetic replacement was complicated by annular detachment.In all 11 patients,eehocardiography showed a dissecting cystic-like mass in the IVS from the base to mid septum or confined to the septal base.The path of the dissection in all these patients was traced to the right SOV.In the other 2 patients,IVS dissection followed septum rupture due to a myocardial infarction.Conclusions Echocardiography could accurately diagnose dissections of the IVS and to analyze the etiology,which is very helpful to make the clinical medical strategy.

Effect of the Sampurna Hriday Shuddhikaran (SHS) Model in Heart Failure Patients in India: A Prospective Study.

Background and Objectives: Chronic heart failure (CHF) is an increasingly widespread, costly and deadly disease, frequently named as an epidemic of the 21st century. Herbal treatments may provide promising & beneficial treatment for heart failure. But unfortunately there is no promising report that shows herbal treatment is effective treatment for chronic heart failure. In that context we planned present study. The objective of the study was to evaluate the effect of the herbal procedure Sampurna Hriday Shuddhikaran (SHS) model in improving the left ventricular (LV) structure & function and exercise tolerance capacity in patients with heart failure. Methods: 133 patients (107 male & 26 Female) were selected for study. A prospective interventional study with novel noninvasive intervention SHS consist of the 4 pronged interventions of Snehan, Swedan, Hrid Dhara and Basti was used in each patient who received twice daily sessions of 90 mins each for 6 consecutive days. Preintervention 2 D echo & 6 minute walk test in meters were done on first day of admission. Postintervention 2 D echo & 6 MWT were done after 30 days and 6 days respectively. Results: Preintervention mean Ejection fractions was 39 ±, 14.6 & after intervention ejection fraction was 45 ±13.6. This difference was found to be highly significant (p<0.001). Preintervention Interventricular septum (IVS) was 9.2 ±2.8 & Post intervention IVS was 9.7 ±3 (p<0.05). Preintervention mean of 6 MWT in meters was 395 ±93.3 & after intervention 510 ±123.3 found to be highly significant (p<0.001). Conclusion: Herbal treatment procedure SHS is associated with improvements in ejection fraction, myocardial thickness and exercise tolerance.

A Giant Hydatid Cyst in the Interventricular Septum with Papillary Muscle Involvement

We present here a 44-year-old male patient with hydatid disease who was referred to our hospital due to dyspnea and chest pain for the last 2 month before admission. Using echocardiography and contrast-enhanced computed tomography the heart hydatid was diagnosed. However, hydatid disease of the interventricular septum is rare; particularly, the involvement of mitral apparatus with mitral regurgitation (MR) is an exceptionally rare presentation. Early diagnosis and an integrated treatment strategy are crucial. Surgical excision was performed and the patient had an uneventful recovery and follow-up at 3 months.

Synchronous assessment of mechanical charaterization of left and right myocardial band of interventricular septum by dual Doppler tissue imaging / 中华超声影像学杂志

Objective To reveal the potential different longitudinal motion characteristics and differences of left and right muscular band (L-MB,R-MB)of interventricular septum (IVS) during systole and diastole in normal subjects.Methods Dual Doppler tissue imaging was applied for the longitudinal velocity curves of L-MB and R-MB of anterior and posterior interventricular septum(P-IVS,A-IVS) at basal,mid,and apical levels in eighty-two healthy subjects.Peak isovolumetric contraction (VIVC),systolic (Vs),early(Ve) and late (Va) diastolic velocities were measured,and myocardial velocity gradient(MVG)and Ve/Va ratio of each segment of L-MB and R-MB were calculated.Results ①Peak velocity of MB:the VrvC,Vs,Ve and Va of R-MB of both A-IVS and P-IVS were higher than those of L-MB; the VrvC,Vs,Ve and Va were gradually decreased from the base to apex of both A-IVS and P-IVS;the VIVC and Vs of A-IVS were higher than those of P-IVS; the Ve and Va of A-IVS were lower than those of P-IVS.②Correlation and MVG analyses of peak velocity of MB:the systolic and diastolic velocities between L-MB and R-MB of both A-IVS and P-IVS have shown a very strong positive correlation;the isovolumetric systolic MVG1 of L-MBof A-IVS,systolic MVG1 of R-MB of P-IVS and the diastolic MVG1 of both A-IVS and P-IVS were higher than those of MVG2.Conclusions The heterogeneity of longitudinal peak systolic and diastolic velocity and regional myocardial compliance,the consistency of moving direction and positive correlation of longitudinal peak systolic and diastolic velocity between L-MB and R-MB of both A-IVS and P-IVS have been demonstrated in normal subjects.

Mechanical principle of the respiration-driven variation of cardiac function:echocardiographic study of factors affecting the swing of interventricular septum / 中华超声影像学杂志

Objective To investigate the affecting factors of interventricular septum (IVS) swing by study of the mechanical model of the respiration-driven variation of cardiac function using echocardiography.Methods In present study,the equivalent mechanical model of septal swing in previous study was used.By changing the end-diastolic pressure difference between the simulated right and left ventricles and simulated intrapericardial pressure,the subsequent influences on IVS swing using echocardiography were observed.Results Under the rhythmic respiratory intrathoracic pressure change(RIPC)(0--4 mm Hg,1 mm Hg =0.133 kPa),the swing amplitude of simulated IVS increased with decrease of the simulated end-diastolic pressure difference between the simulated right and left ventricles (2.2-17.6 mm).With increasing of the simulated intrapericardial pressure,the simulated right ventricle and left ventricle collapsed in succession,the swing amplitude of simulated IVS also increased to a maximal amplitude of 22.4 mm.Conclusions The affecting factors of IVS swing including the magnitude of RIPC,the end-diastolic pressure difference between the two ventricles and the intrapericardial pressure.

A Case of Right Sinus of Valsalva Aneurysm Dissecting into the Interventricular Septum / 日本心臓血管外科学会雑誌

A 60-year-old man was referred to our hospital for surgical treatment of sinus of Valsalva aneurysm and aortic regurgitation. He had suffered from palpitation and leg edema since a month before. Echocardiography revealed right sinus of Valsalva aneurysm dissecting into interventricular septum complicated with aortic and mitral regurgitation. He successfully underwent patch closure of aneurysm, aortic valve replacement and ring annuloplasty of mitral and tricuspid valve. His postoperative course was uneventful.

Aneurisma del seno de valsalva derecho no roto con disección hacia el tabique interventricular. Presentación de un caso / Aneurysm of an unruptured right valsalva sinus with dissection into the interventricular septum. Case presentation

Los aneurismas de los senos de valsalva (ASV) son una rara enfermedad. Algunos de estos aneurismas, aún más raros, disecan, rompiéndose o no, hacia el tabique interventricular. Presentamosen este trabajo un paciente masculino de 32 años de edad, de raza negra que se le diagnosticó un aneurisma de seno de valsalva que disecó hacia el tabique interventricular y que fue remitido a nuestro hospital en clase funcional IV (NYHA), con insuficiencia aórtica moderada, bloqueo auriculo ventricular y con disfunción ventricular. Se realizó el diagnóstico de la enfermedad porecocardiografía. Se le colocó un marcapaso permanente y se operó realizándosele plicación dela cavidad aneurismática, cierre del orificio de comunicación y plastia valvular aórtica. Evolución post-operatoria satisfactoria.

Os aneurismas dos seios de valsalva (ASV) são considerados uma doença rara. Alguns destes aneurismas, ainda mais raros, dissecam, rompendo-se ou não, atingindo o tabique interventricular. Apresentamos neste trabalho um paciente masculino de 32 anos de idade, de raça negra, que foi diagnosticado com um aneurisma de seio de valsalva que dissecou atingindo o tabique interventricular e que foi remetido ao nosso hospital em classe funcional IV (NYHA), com insuficiência aórtica moderada, bloqueio auriculo ventricular e disfunção ventricular. Realizou-se o diagnóstico da doença por ecocardiografia. Colocou-se um marcapasso permanente e foi operado, realizandose aplicação da cavidade aneurismática, fechamento do orificio de comunicação e plastia valvularaórtica. Evolução pós operatória satisfatória.

Aneurysms of the sinus of valsalva (ASV) are a rare defect. Some of these aneurysms, though rare, dissect, rupturing or not, into the interventricular septum. This paper describes a 32 year-old man, black race, with the diagnosis of a sinus of valsalva aneurysm which dissected into the interventricular septum and who was referred to our hospital in functional class IV (NYHA), with moderate aortic failure, AV block and ventricular insufficiency. The disease was diagnosed with ultrasound. An indwelling pacemaker was inserted and the operation consisted of the plication of the aneurysmal cavity, closure of the septal defect and aortic valvuloplasty. Post-op was satisfactory.

Ruptura miocárdica y formación de aneurisma después de un infarto agudo de miocardio silente: reporte de un caso / Myocardial rupture and aneurysm after an acute, silent myocardial infarction: a case report

Los aneurismas ventriculares y la ruptura del septum interventricular son complicaciones del infarto agudo del miocardio que pueden acompañarse de alta morbimortalidad. Se reporta el caso de un paciente con formación y ruptura de un aneurisma verdadero de la pared inferior y del septum interventricular inferior después de un infarto agudo de miocardio silente. Se discuten las características clínicas, diagnóstico y manejo de estas complicaciones potencialmente letales.

Ventricular aneurysms and interventricular septal rupture are complications of acute myocardial infarction and thesecomplications may have a high morbidity and mortality. We report the case of a patient with an aneurysm involving theinferior myocardium and the inferior interventricular septum following an acute silent myocardial infarction. The clinicalcharacteristics, diagnosis and management of these potentially lethal complications are discussed.

Research in deformation and motion of interventricular septum by velocity vector imaging combining with radius of curvature and length of arc / 中华超声影像学杂志

Objective Radius of curvature (RC) and velocity vector imaging (VVI) were joined to evaluate the deformation and motion of interventricular septum(IVS). Methods VVI was performed in fifteen healthy volunteers and obtained dynamic images at chordae tendineae of mitral valve in short axis view. The images were stored and analyzed to obtain circumferential peak stain of IVS. In the same short axis view, the static images were captured at end-systole and end-diastole respectively before they were analyzed by self-made software. The length of arc and RC were measured automatically by the software, so the shortening rates of them could were calculated. Results The length of arc and RC were longer at end-diastole than those at end-systole(P<0.0001). The shortening rate of length of arc was compared with circumferential peak stain of IVS (P=0.123) and they were correlation (r = 0. 840, P = 0. 0001 ). Blant-Altman analysis indicated that the concordance was well. Conclusions The length of arc and RC can evaluate the deformation and motion of IVS.

N-cadherin Immunoreaction in the Interventricular Septum in Developing Rat Heart

BACKGROUND AND OBJECTIVES: N-cadherin is known to be expressed in neuroectodermal tissue such as central nervous system and various mesodermal origin tissues such as kidney and heart. We investigated N-cadherin expression in the endocardial cushion in developing rat heart by immunohistochemical method. MATERIALS AND METHOD: Fetal rat hearts at the 11th, 13th, 15th, 17th, and 19th day of gestation and the 1st day neonatal rat heart were used. Hematoxylin and eosin stain was performed for normal cardiogenesis, and immunohistochemistry was performed for the expression of N-cadherin in interventricular septum(IVS) during cardiogenesis in rat. RESULTS: Ventricular wall and membranous part of the IVS showed positive reaction with anti-N-cadherin at the 11th day of gestation. Membranous part of IVS was begun to show tracely positive reaction at the 15th day of gestation, and thereafter the immunoreactivity was increased with maturation. At the 17th day of gestation mesenchymal cells in membranous muscular part of the IVS showed positive reaction. The similar immunoreactivity of membranous and muscular parts of IVS were shown at the 19th day of gestation. CONCLUSION: As the immunoreaction of mesenchymal cells in the membraneous part of IVS to anti-N-cadherin was increased with time, it is suggested that mesenchymal cells in membranous part of IVS were differentiated into the cardiomyocytes.

Interventricular Septum Rupture due to Blunt Chest Trauma: A Case Report / 대한법의학회지

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.