" Watching without dealing" aortic root repair in the treatment of acute Stanford type A aortic dissection: a prospective observational study / 中华胸心血管外科杂志

Objective:To evaluate the clinical effects of " watching without dealing" aortic root repair technique in acute Stanford type A aortic dissection(ATAAD).Methods:From October 2017 to October 2018, " watching without dealing" technique was performed in ATAAD patients with mild aortic root involvement. The proximal aortic anastomosis was at the level of the sinotubular junction, without " pursuing" complete excision of the intra-sinus dissections. The perioperative clinical data and follow-up imaging results of the patients were collected and analyzed to evaluate early and mid-term efficacy of the technique.Results:A total of 20 patients received " watching without dealing" technique in our hospital, including 15 males and 5 females with a mean age of(48.0±12.1) years old(34-73 years old). The preoperative aortic sinus diameter was(41.3±3.6)mm and the aortic sinotubular junction diameter was(43.9±6.6) mm. All patients underwent ascending aortic replacement and total arch replacement plus frozen elephant trunk surgery. The cardiopulmonary bypass time was(179.5±41.5)min(132~255 min), the cross-clamp time was(120.3±23.7) min(95~180 min), and the circulatory arrest time was(8.8±7.6) min(2~22 min). During perioperative period, no adverse events such as death, secondary opening, renal failure, cerebral infarction, and paraplegia occurred. The CTA examination of the aorta before the patients were discharged showed that all residual false lumen in the sinus disappeared, the diameter of the aortic sinus was(30.8±2.6) mm, and the diameter of the aortic sinotubular junction was(27.2±2.5) mm. The patients were followed up for mean(28.5±7.8) months(3~35 months). No surgical re-intervention of the aortic root occurred. The aortic CTA during follow-up period showed no residual or new dissection in the aortic sinus, the diameters of the aortic sinus and aortic sinotubular junction were(30.9±2.4) mm and(27.5±2.7) mm respectively; the ultrasonic cardiogram showed normal aortic valve structure and function. No statistically significant differences were found when comparing the aortic sinus diameter and aortic sinotubular junction diameter between two time points of at discharge and follow-up.Conclusion:The " watching without dealing" aortic root repair technique for ATAAD is relatively simple to learn and safe in the perioperative period. Early and mid-term follow-up imaging showed normalization of the aortic sinus structure. Further follow-up and observation were necessary to figure out the long-term clinical outcome of this modified aortic root repair.

Application of aortic root repair in acute type A aortic dissection with aortic sinus involvement / 中华胸心血管外科杂志

Objective:To evaluate the outcomes of aortic root repair in acute type A aortic dissection (ATAAD) with aortic sinus involvement.Methods:The clinical data of patients with ATAAD involving the aortic sinus and an aortic root diameter of ≤45 mm who were treated from January 1, 2015, to December 31, 2016, were collected. Patients were divided into group A (involvement of one aortic sinus or part of one aortic sinus) and group B (involvement of more than one aortic sinus). The effectiveness of aortic root repair in ATAAD with sinus involvement was analyzed by comparing the preoperative imaging characteristics and postoperative results between the two groups.Results:The study cohort comprised 155 patients, including 100 patients in group A and 55 in group B. There were no differences between the two groups in baseline characteristics, aortic root diameter, 30-day mortality, and complication rates. During an average follow-up of(49.1±14.6) months, there was no difference between the two groups in the survival rate (92.0% vs. 89.5%, P=0.61). The aortic root diameter at follow-up showed no progressive expansion compared with preoperatively in either of the two groups[(38.1±3.6) mm vs. (37.9±3.5)mm, P=0.92, A; (38.4±4.1) mm vs. (38.3±3.6) mm, P=0.74, B]; furthermore, there was no difference between the two groups in aggravation of aortic regurgitation. Conclusion:Aortic root repair achieves satisfactory medium-term outcomes in ATAAD with more than one aortic sinus involved, but the long-term outcomes need to be evaluated.

Cadaveric Study On Normal And Variant Anatomy Of Left Coronary Artery

Background: Human heart is supplied by coronary arteries – Right and Left coronary artery. The coronary arteriesarise from the aortic sinuses and the left coronary artery from the left posterior aortic sinus. The left coronaryartery has two branches, the anterior interventricular and circumflex arteries. The anterior interventricularbranch is the continuation of left coronary artery, gives off septal branches, right and left ventricular branches.The left ventricular branches are called diagonal arteries. The left circumflex artery gives off left atrial and leftventricular branches. One of these atrial branches supply the sinoatrial node in 35% of subjects and AV node in10-20% of the subjects.Materials and Methods: The study was carried out in the department of anatomy, Kasturba Medical College,Manipal, India. The study was performed on 50 formalin fixed human hearts of unknown sex and age. The leftcoronary artery and their branches were carefully dissected. The origin, branches & branching pattern of leftcoronary artery was observed, noted and photographed.Results: In present study, 49 samples (98%) showed the origin of left coronary artery from left posterior aorticsinus while 01 sample (02%) had no trunk of left coronary artery. Sino-atrial nodal artery was originating formcircumflex artery in 13 samples (26%) and atrio-ventricular nodal artery from the circumflex artery in 05samples (10%). The trunk of left coronary artery was bifurcating in 37 samples (74%) and trifurcating in 12samples (24%) with one sample (02%) showing absent trunk of left coronary artery. The median artery waspresent in 12 samples (24%) and posterior interventricular artery was originating from circumflex artery in 05samples (10%).Conclusion: Left coronary artery commonly originated from left posterior aortic sinus with very few variations.Sino-atrial nodal artery and atrioventricular nodal artery commonly originates from right coronary artery.Bifurcation of left coronary artery is commoner than trifurcation. The present study is useful in better understandingof the normal and variant anatomy of left coronary artery

Application of "Z"type aortic sinus angioplasty in acute Stanford A aortic dissection with severe aortic valve insuffi-ciency / 中华胸心血管外科杂志

Objective To evaluate the clinical efficacy of "Z"type aortic sinus angioplasty in acute Stanford A aortic dissection with severe aortic valve insufficiency .Methods A total of 384 cases of acute Stanford A aortic dissection were ana-lyzed retrospectively from January 2014 to March 2018 at Wuhan Asian Heart Hospital Great Vascular Center.There were 56 cases with severe aortic valve insufficiency, with 40 males and 16 females, aged 32-72 years old, averaged(53.92 ±9.26) years old.The root treatment of the 56 patients were all simulated with the "Z"type aortic sinus angioplasty technique, with 3 cases of distal semi-aortic arch replacement and 53 cases of total aortic arch replacement(placed with "trunk"stent).Results The average cardiopulmonary bypass time of all patients was(175.0 ±43.5)min, cross-clamp time was(133.3 ±31.9)min, and circulatory arrest time was(26.9 ±2.7)min.The degree of aortic valve regurgitation was 0-Ⅰin all patients after surger-y.Patients were followed-up 3 months to 4 years, the degree of aortic valve regurgitation of 45 cases was 0, 8 cases wasⅠ, and 3 cases wasⅡ.After operation, transesophageal ultrasonography immediately examined 2 cases with residual dissection of aor-tic sinus.Followed-up 1.5 years and 2.0 years respectively, no aneurysm was formed, and the diameter of the sinus of the aor-ta was 4.2 cm and 4.5 cm, respectively.No reoperation due to aortic valve regurgitation and sinus conditions was found during the follow-up.Conclusion The "Z"type aortic sinus angioplasty technique has a good clinical effect in acute Stanford A aor-tic dissection with severe aortic valve insufficiency.The operation is simple, safe and effective, easy to grasp and develop.

Study Of Coronary Ostia In Preserved Human Cadaveric Heart Specimens In Western Maharashtra By Dissection Method

Introduction: Coronary artery disease is responsible for 70% cases of sudden cardiac deaths. Small coronaryostia may cause significant difficulty in canulation of it during diagnostic and therapeutic procedures. Highorigin of coronary arteries increases risk of myocardial ischaemia and sudden death. Considering thesesignificance of variations of coronary ostia in cardiac procedures, detailed study was undertaken so it would beof use to cardiologists and interventional radiologists.Material and Methods: Sample size for the study comprised of 50 human cadaveric heart specimens. Dissectionmethod was adopted.Observation and Results: In anterior aortic sinus, 41 specimens had single ostium, while 09 specimens showedtwo separate ostia. The mean of ostium diameter of right coronary artery was found to be 2.84 mm with astandard deviation (S.D.) of +0.85 mm. The mean distance of main ostium of right coronary artery fromsupravalvular ridge was found to be 1.23 mm. with a S.D. of +0.32 mm. In case of accessory ostia in anterioraortic sinus, the mean diameter was found to be 1.32 mms. with a S.D. of +0.20 mms. The mean distance of theseostia from supravalvular ridge was found to be 1.16 mms. with a S.D. of +0.17 mms. In left posterior aortic sinus,49 specimens had single ostium, while 01 specimen had two separate ostia. This ostium was 0.8 mms. indiameter at a distance of 02 mms. below from supravalvular ridge. The mean of ostium diameter of left coronaryartery was found to be 3.31 mm with a S.D.of+0.52 mm. The mean distance of main ostium of left coronary arteryfrom supravalvular ridge was found to be 1.40 mm. with a S.D. of +0.27 mm.Conclusion: the study provides data on coronary morphometry and topography. It provides basis for understandingthe normal variants for determining incidence of anomalies and for evaluating value of screening of suchanomalies.

Feasibility of transesophageal echocardiography guided transthoracic incision closure of aortic sinus aneurysm rupture / 中国医学影像技术

Objective To explore the feasibility of transesophageal echocardiography (TEE) guided transthoracic incision closure of aortic sinus aneurysm rupture (RASA).Methods Data of 30 patients with RASA underwent TEE guided transthoracic incision closure of RASA were retrospectively analyzed.The distance between the coronary artery ostium and crevasse was measured in right coronary sinus aneurysm rupture patients.During the operation,the guide wire and sheath pipe were guided accurately into rupture mouth of aortic sinus aneurysm with TEE.After the operation,the position of closure and the function of aortic valves were checked carefully,while in right coronary sinus aneurysm rupture patients,coronary ostium should not be occluded by the occluder.Results Totally 20 of 30 patients accepted interventional treatment successfully.Right coronary sinus aneurysm rupture was found in 10 patients,including 7 with rupture developing into right ventricle and 3 with rupture into right atrium.Posterior coronary sinus tumor rupture was found in 10 patients,including 8 with rupture developing into right atrium and 3 with rupture into right ventricle.Patients who received intervention treatment successfully had stable vital signs,and no obvious changes of heart cavity structure and cardiac function was found.Postoperative multiple reexaminations showed all patients had normal closure position,aortic valve opening and closing movement was normal.No stenosis,reflux signal nor residual shunt were found.Conclusion RASA can be diagnosed accurately with TEE,and the occluder can be placed guided by TEE.TEE guided transthoracic incision closure of RASA is a feasible method.

Safety and efficacy of transcatheter closure of ruptured sinus of Valsalva aneurysm / 中华心血管病杂志

Objective@#To investigate the safety and efficacy of transcatheter closure of ruptured sinus of Valsava aneurysm(RSVA).@*Methods@#A total of 33 RSVA patients underwent transcatheter closure from January 2006 to March 2017 in our hospital were included in this retrospective study. The RSVA was diagnosed by echocardiography.Different type of occluders were applied for transcatheter closure based on the aortography results. All the patients were followed up after the procedure.@*Results@#The patients were (37.6±12.1) years old,and the male patients accounted for 78.8%(26 cases).RSVA from right coronary sinus was found in 25 patients,and draining chamber was right atrium in 13 cases, right ventricle in 12 cases. RSVA from noncoronary sinus was diagnosed in 8 patients,and the draining chamber was right atrium. Aortography defined the narrowest diameter at the rupture site was (6.4±1.7)mm. The ratio of Qp/Qs was 2.2±0.5,and the mean pressure of pulmonary artery was 24.0(21.2,33.7)mmHg(1 mmHg=0.133 kPa). One patient developed serious occluder related aortic regurgitation and underwent surgery, transcatheter closure was successfully performed in 32 patients. The success rate of transcatheter closure was 97.0%. Two types of device were used in the study including small-waist double-disk ventricular septal defect(VSD) occluders in 20 cases and patent ductus arteriosus(PDA) occluders in 12 cases. During a median follow-up of 73.5(28.3,89.5) months, there were no infective endocarditis, residual shunt, thrombosis, device displacement,serious aortic regurgitation, serious arrhythmia or death.At the last follow-up, the left atrial diameter((37.4±6.5) mm vs. (41.5±5.3)mm,P<0.01),right atrial diameter((42.4±3.0) mm vs. (48.5±6.0)mm,P<0.01), right ventricular diameter((22.2±3.8) mm vs. (27.7±7.2)mm,P<0.01) and left ventricular end-diastolic diameter((51.3±4.9) mm vs.(55.0±4.3)mm,P<0.01)measured by echocardiography were all smaller than pre-procedural level.@*Conclusion@#Transcatheter closure of RVSA is a safe and effective strategy and associated with a good long-term outcome.

Lead aVL in combination with lead V1:A new method for identifying premature ventricular contractions originating from aortic sinus cusp / 中国介入心脏病学杂志

Objective To explore the validity of lead aVL in combination with lead V1 for identifying idiopathic outflow tract premature ventricular contractions(PVCs)originating from aortic sinus cusp(ASC).Methods This study consecutively enrolled 102 idiopathic outflow tract PVCs patients who underwent radiofrequency catheter ablation at the Second Xiangya Hospital,Central South University between January 2015 and August 2017.We compared the QRS wave amplitudes in the surface twelve leads electrocardiography between PVCs originating from ASC and right ventricular outflow tract(RVOT).Results(1)The origin sites of PVCs were ASC(n=28,27.5％)and RVOT(n=74,72.5％).The lead V1R/S wave amplitude ratio and lead aVL S wave amplitude were significantly higher in the ASC group than in the RVOT group[(1.14±1.32)vs.(0.16±0.18),P＜0.001;(0.99±0.36)mV vs.(0.56±0.26)mV,P＜0.001].The areas under the receiver operating characteristic curve(AUCs)and 95％confidence intervals of V1R/S wave amplitude ratio and aVL S wave amplitude had relatively larger AUCs which were 0.894(0.824-0.964)and 0.831(0.749-0.912),with the cut-offs of 0.25 and 0.80 respectively.(2)The sensitivity,specificity and accuracy of the lead V1R/S wave amplitude ratio＞0.25 to identify ASC originating PVCs were 78.9％,83.7％and 82.4％,respectively.The sensitivity,specificity and accuracy of the lead aVL S wave amplitude＞0.80 mV were 78.6％,85.1％and 83.3％,respectively.The lead aVL S wave amplitude＞0.80 mV in combination with the lead V1R/S wave amplitude ratio＞0.25 was applied to developed a new diagnostic approach and the sensitivity,specificity and accuracy were 60.7％,93.2％and 84.3％,respectively.Conclusions Lead aVL in combination with lead V1 could be applied to develop a more accurate method for identifying ASC originating PVCs.

Transcatheter closure versus surgical closure for ruptured aortic sinus aneurysm: a comparative study / 介入放射学杂志

Objective To compare the safety and clinical efficacy of transcatheter closure for ruptured aortic sinus aneurysm (RASA) with those of surgical treatment.Methods A total of 31 successive patients with RASA,who were treated in a single center during the period from October 2003 to May 2017,were enrolled in this study.Among them,11 patients received transcatheter closure therapy,their mean age was (36.64±10.87) years old;20 patients received surgical closure,their mean age was (28.90± 10.06) years old.The technical success rate,complications,residual shunt,operation time,hospitalization days,amount of blood transfusion,medical expenses,etc.were compared between the two groups.Results No statistically significant differences in age,sex and preoperative cardiac functional grading established by the Heart Disease Association of New York (NYHA) existed between the two groups (P＞0.05).The technical success rates in transcatheter closure group and surgical closure group were 100％ (11/11) and 95％ (19/20)respectively (P＞0.05).The amounts of blood transfusion in transcatheter closure group and surgical closure group were 0 ml and (427.25±331.36) ml respectively (P＜0.01).The time spent for operation in transcatheter closure group and surgical closure group was (60.00±00.00) min and (205.50±129.35) min respectively (P＜0.05).Days staying in intensive care unit (ICU) in transcatheter closure group and surgical closure group were 0 day and (1.50±0.61) days respectively (P＜0.01).The residual shunt rates in transcatheter closure group and surgical closure group were 9.09％ (1/11) and 10.00％ (2/20) respectively.None perioperative death occurred in both groups.No statistically significant differences in hospitalization days and in medical expenses existed between the two groups (P＞0.05).Conclusion Both transcatheter closure and surgical closure are safe and effective for the treatment of ruptured RASA,although transcatheter closure therapy has more advantageous in aspect of minimally-invasive management,operative time and length of hospital stay.For patients with a RASA which position is suitable for percutaneous interventional management,transcatheter closure therapy should be employed as a preferred therapy.

Clinical efficacy and long-term outcome of transcatheter occlusion for rupture of valsalva aneurysm ruptured into right atrium / 中国介入心脏病学杂志

Objective To evaluate the clinical safety, efficacy and long-term outcome of transcatheter occlusion for ruptured aortic sinus of valsalva aneurysm (RASA) into the right atrium.Methods Between January 2006 and April 2013, fifteen patients [11 males and 4 females,aged from 21 to 48 years with an mean age of (35.50±8.79) years] with RASA ruptured into the right atrium were enrolled in this study.Domestic made patent ductus arteriosus (applied in six patients) or small waist double-disk ventricular septal defect (applied in nine patients) occluders were used for transcatheter closure.All the patients were followed up for any change in cardiac rhythm,and residual shunt,occluders morphology and possible valve regurgitation by echocardiography.Results All RASA were confirmed by aortography,including eleven cases with rupture of right coronary sinus of valsalva and four cases with rupture of the noncoronary sinus of valsalva shunting into the right atrium.NYHA function class was(2.56±0.63)before the occlusion.Cardiac catheterization showed mean pulmonary arterial pressure and Qp/Qs ratio were (25.38±8.21)mmHg (1 mmHg=0.133 kPa) and 1.34-2.81(1.93±0.39), respectively.Aortic angiography showed that the RSA was 4-10(6.42±1.92)mm at its narrowest end.There was no serious complication during the operation and all the patients had successful transcatheter closure without residual shunt.After transcatheter RASA occlusion, mean pulmonary artery pressure decreased to (16.1±5.3) mmHg (P<0.05).The diameter of right atrium,right ventricle, left atrium and pulmonary artery diameter and left ventricular end-diastolic dimension all showed significant decrease (P<0.01).All patients were followed up for 35-132(78.6±28.57)months.All patients presented with a NYHA function class Ⅰ to Ⅱ cardiac function in their last follow up which was significantly improved compare to pre-occlusion level (P<0.01).There were no infective endocarditis,device displacement and embolism,serious aortic regurgitation,myocardial ischemia,serious arrhythmia or death in any of the patients during follow up.Conclusions Transcatheter closure of Valsalva aneurysm ruptured into right atrium with the domestic made patient ductus arteriosus and small-waist ventricular septal defect occluder is safe and effective with a good long term prognosis.

Double non coronary aortic sinuses: an autopsy case finding showing the arterial variation / Senos aórticos dobles, no coronarios: un caso de autopsia que demuestra la variación arterial

We report a case of variant origin of the right coronary artery from the left posterior aortic sinus. This was observed routinely during a medico legal autopsy of a 58 year old male who died in a road traffic accident. Initially it was believed that the right coronary artery was absent since there was no obvious right coronary artery ostium from the anterior aortic sinus. However it was found later that the right coronary ostium was present just beside the left coronary ostium in the left posterior aortic sinus and the right coronary artery was arising from the left posterior aortic sinus. The right coronary artery had an intramural course between the aorta and pulmonary trunk, which is considered as very dangerous and life threatening. We believe that the present case report will be enlightening to the cardiologist and cardiothoracic surgeon. It is also true that the conduction of medico legal autopsies of coronary arteries is important for the medico legal resolution.

Se presenta un caso de variación de origen de la arteria coronaria derecha desde el seno aórtico posterior izquierdo. Esto se observó de forma rutinaria durante una autopsia médico-legal de un hombre de 58 años que murió en un accidente de tránsito. Inicialmente se creía que la arteria coronaria derecha estaba ausente ya que no había un ostium observable desde el seno aórtico anterior. Sin embargo, se descubrió más tarde que el ostium de la arteria coronaria derecha estaba presente justo al lado del ostium de la arteria coronaria izquierda en el seno aórtico posterior izquierdo y la arteria coronaria derecha se originaba del seno aórtico posterior izquierdo. La arteria coronaria derecha presentó un recorrido intramural entre la aorta y el tronco pulmonar, que se considera como muy peligroso y potencialmente mortal. Creemos que el presente trabajo será esclarecedor para el cardiólogo y el cirujano cardiotorácico. También consideramos que el conocimiento de la anatomía de las arterias coronarias es importante durante el desarrollo de la autopsia médico-legal para lograr alcanzar una correcta resolución del proceso medicolegal.

Application of intraoperative transesophageal echocardiography for occluding the rupture of aortic sinus aneurysm by cardiac interventional therapy via mini-thoracotomy / 中华超声影像学杂志

Objective To assess the application of intraoperative transesophageal echocardiography for occluding the rupture of aortic sinus aneurysm ( RASA ) by cardiac interventional therapy via mini thoracotomy . Methods After anesthesia transesophageal echocardiography ( TEE ) was performed in patients with RASA to confirm or correct primary diagnosis from transthoracic echocardiography( TTE) and to predict the operative effect . During the operation the guide wire and Sheath pipe were accurately guided into rupture mouth of aortic sinus aneurysm by TEE . After the operation ,the position of closure and the function of aortic valve need to check carefully . Results Collection of 38 patients with aortic sinus aneurysm rupture ,20 patients who can be received interventional therapy were select by TEE . Sixteen patients accepted interventional treatment successfully ,including 8 cases with non‐coronary sinus tumor to break into the right atrium ,5 cases with non‐coronary sinus tumor to break into the right ventricle ,and 3 cases with right coronary sinus tumor to break into the right ventricular outflow tract ( 3 cases) . The patients who received intervention treatment successfully had stable vital signs ,and no obvious changes of heart cavity structure and cardiac function in normal . Postoperative multiple reexamination ,all patients showed the normal closure position ,aortic valve opening and closing movement . And no stenosis and reflux signal ,no residual shunt was detected . Conclusions TEE can confirm or correct primary diagnosis of TTE before the operation and guide the surgery operator to place the closure correctly during the operation and evaluate the effect of the treatment after the operation .

Radiofrequency catheter ablation of ventricular arrhythmia arising from the left aortic sinus of Valsalva / 中国综合临床

Objective To investigate the electrocardiographic characteristics and assess the efficiency of ra-diofrequency catheter ablation(RFCA) in ventricular arrhythmia arising from the aortic sinus of Valsalva. Methods Eighteen patients(6 males and 12 females)were selected to undergo RFCA for ventficular arrhythmia originating from the left aortic sinus of Valsava. All of them were symptomatic,but without evidence of structural heart disease. Activation mapping was performed in the endocardium of the aortic sinus of Valsalva,then ablation was performed at the site with the earliest ventricular wave in endocardium electrograms. At the same time, coronary and aortic angiog-raphy were performed to assess the anatomic relationship between the ventricular tachycardia (VT)/ventricular pre-mature contraction (VPC) origin and coronary arteries and aortic valve before the RF energy delivery. Results Eighteen patients were successfully managed, with no major complications related to the procedure. VT eliminated and VPC counts on 24-hour ECG monitoring decreased significantly after the ablation[18 474(12 399,26 812)/24h vs 4 (1,7)/24 h, Wilcoxon signed-rank test, P<0.05]. During a follow-up period of 6 monthes, there was no recur-rence. Conclusions Ventricular arrhythmia arising from the aortic sinus of Valsalva has specific electrocardiograph-ic characteristics, and it can be successfully and safely treated under the guidance of activation mapping.

Clinical analysis of 54 patients with rupture of aortic sinus aneurysm / 中国基层医药

Objective To summarize the ruptured types, operational ways and therapy effect for rupture of aortic sinus aneurysm. Methods The operational cured 54 eases with aneurysm of aortic sinus were retrospectively analyzed. Results There were 48 cases of right aortic sinus aneurysm and 6 cases with null aneurysm of aortic sinus. 50 cases among them rupture was permeated into right ventricle ,4 eases among them reptured into right atrium. There were 11 cases with ventricular septal defect, 15 cases with aortic valvular imcompetence,6 cases complicated with in-fective endocarditis. 54 cases received operation, 1 case was died from MSOF. 53 patients were followed up,the mean follow up period was 4. 5 years. The cardiac function of 16 cases were found to be of NYHA class Ⅰ , 17 cases of class l] and 3 cases of class m. Conclusions The right aneurysm of aortic sinus were the most types, and it always rup-tured into right ventricle. It suggests that it is important for aneurysm of aortic sinus operated as early as possible in or-der to avoid losing the chance of operation.

Antonio Maria Valsalva: perfil biográfico de um pioneiro da otologia / Antonio Maria Valsalva: biographical profile of a pioneer of otology

Introdução: Os autores apresentam o perfil biográfico de Antonio Maria Valsalva e suas realizações, relatando a vida do ilustre médico e suas descobertas na medicina, destacando sua contribuição para a otorrinolaringologia e, em especial, a otologia, da qual é considerado um pioneiro. Revisão/Discussão: Valsalva nasceu em 1666, em Imola, Itália. Dedicou-se ao estudo da anatomia, patologia e cirurgia. Prestou enorme colaboração ao estudo da anatomia patológica, deixando inúmeras peças dissecadas, em autópsias das mais variadas doenças. Propôs inovações como a nefrectomia em cães para extirpação de tumores, assim como na fisiopatologia do acidente vascular cerebral, na oftalmologia, na cirurgia dos tumores e psiquiatria. Identificou estruturas anatômicas como os seios relacionados à artéria aorta, os ligamentos e o músculo de Valsalva. Na otorrinolaringologia foi pioneiro no estudo da anatomia do ouvido, dividindo-o em externo, médio e interno, com particular interesse nos músculos da tuba auditiva e da faringe. Verificou pela primeira vez a anquilose do estapédio na identificação da otosclerose. Criou a conhecida manobra de Valsalva, ainda hoje utilizada no diagnóstico e terapêutica em diversas situações clínicas. Faleceu em 1723, vítima de acidente vascular cerebral. Comentários Finais: Valsalva foi um notável anatomista, fisiologista, cirurgião e patologista. Forneceu valiosas contribuições para a otorrinolaringologia e para outras áreas. Seus feitos estão presentes na atualidade. É interessante que os médicos de hoje conheçam um pouco de sua história e valorizem suas descobertas, lembrando-se deste grande homem na próxima vez que usarem a manobra de Valsalva

Introduction: The authors present a biographical profile of Antonio Maria Valsalva and his main achievements, emphasizing his contribution to Otorhinolaryngology and, in particularly, to Otology. Review/Discussion: Valsalva was born in 1666, in Imola, Italy. He devoted all his life to the study of anatomy, pathology and surgery. His contribution was valuable to the study of pathological anatomy, leaving numerous specimens dissected in autopsies of many different diseases. He proposed innovations as nephrectomy in dogs for tumor resection, as well as new conceptions in the pathophysiology of brain stroke, in ophthalmology, in tumors' surgery and psychiatry. He identified anatomic structures such as the sinuses related to aortic artery, the ligaments and muscle of Valsalva. In otolaryngology, he pioneered the study of the anatomy of the ear, dividing it into external, middle and inner ears, with particular interest in the muscles of the Eustachian tube and pharynx. He viewed for the first time the stapes fixation in identifying the otosclerosis. He created the famous Valsalva maneuver, still used in the diagnosis and therapy in various clinical situations. He died in 1723, in consequence of a brain stroke. Final Comments: Valsalva was a remarkable anatomist, physiologist, surgeon and pathologist. He provided valuable contributions to otolaryngology and other areas. His achievements are still present in our medical practice. We consider to be worthy for the newly doctors to know a little about Valsalva's history and his work. We hope they remember this great man when applying Valsalva maneuver.

Successful Catheter Ablation of Atrial Tachycardia Originating from the Non-coronary Aortic Sinus

We report a rare case of atrial tachycardia originating from the non-coronary aortic sinus. After failed radiofrequency (RF) energy applications at right His-bundle region, the complete elimination of atrial tachycardia was achieved with an RF energy application in the non-coronary aortic sinus. With the review of other papers, this report emphasizes the importance of mapping in the non-coronary aortic sinus in focal atrial tachycardia near the atrioventricular node or near the His-bundle.

Epicardial Conduction Properties and Electrocardiographic Characteristics of Premature Ventricular Complexes or Ventricular Tachycardias That Originate at the Aortic Cusp

BACKGROUND AND OBJECTIVES: Premature ventricular contraction (PVC) or ventricular tachycardia (VT) that originates from the aortic cusp (AC) has a similar left bundle branch block (LBBB) pattern with a inferior axis as those LBBB patterns originating from the right ventricular outflow tract, but the electrocardiogram (ECG) characteristics are distinct. We sought to characterize the ECG morphology of PVCs or VTs from the AC and to assess whether these foci exit out to the surrounding epicardium by preferential conduction, resulting in an ECG with epicardial foci. SUBJECTS AND METHODS: The study subjects were ten patients (M:F=6:4, 40.9+/-11.6 years old) with VTs or PVCs that originated from the AC and they underwent radiofrequency catheter ablation (RFCA). We performed simultaneous activation mapping at the AC, the anterior interventricular vein (AIV) and the anterior mitral annulus (AMA). The conduction velocities (CV) between the successful ablation site to the epicardium in the AIV, and the endocardial earliest activation (EA) site at the AMA were calculated by triangular algebra at right anterior oblique (RAO) 35degrees and left anterior oblique (LAO) 35degrees, respectively. RESULTS: Successful ablation sites were above the left coronary cusp (LCC) in 7 patients, above and beneath the right coronary cusp (RCC) in 1 patient each, respectively, and beneath the LCC in 1 patient. The QRS width was 149.2+/-19.9 ms, the maximal depolarization time (MDT) was 88.9+/-14.9 ms and the ratio of the MDT to the QRS was 59.5+/-5.7%. The PVC from the LCC had rS or S waves in lead I and R or RS waves in V1, whereas those from the RCC had R waves in lead I and an rS wave in V1. The CV between the successful ablation site at the AC to the epicardial EA site (1.7+/-0.8 m/s) was faster than that to the endocardial EA site (0.8+/-0.4 m/s, p<0.05). CONCLUSION: Most of the PVC/VTs from the AC originated from the above LCC and they displayed a faster CV to the epicardial side of the AIV than that to the endocardial side of the AMA. This suggests the existence of preferential conduction from the AC to the left ventricle (LV) epicardium.

Late aortic root dilatation and aortic regurgitation in repaired tetralogy of fallot / 소아과

PURPOSE: Aortic valve or aortic root (AoRo) replacement is occasionally required because of AoRo dilatation and aortic regurgitation (AR) in repaired tetralogy of Fallot (TOF). We evaluated AoRo size and possible factors associated with its hemodynamic nature in patients with repaired TOF. METHODS: We investigated 130 repaired TOF patients more than 15 years of age who followed-up by echocardiography from January 2002 to December 2003. Of 130 patients, we identified 17 patients with AoRo dilatation, which was defined as ratio of expected AoRo size by standard nomogram (AoRo ratio) >1.5 (dilator group), and 113 TOF controls, with AoRo ratio <1.5 (non-dilator group). RESULTS: Mean indexed AoRo size (mm/m2) in the first echo was 24+/-3.2 in the dilator group and 18+/-3.4 in the non-dilator group (P<0.0001). AoRo rate of change (mm/year) from the first to latest echo study was 1.6+/-3.8 in dilator group and 0.05+/-1.6 in the non dilator group (P=0.0021). Patients from the dilator group showed a higher prevalence of pulmonary atresia (P=0.031) and a history of aortopulmonary shunt before repair (P=0.048), moderate to severe AR (P=0.0065), and increased left ventricular end-diastolic dimensions (P=0.003). Conclusions:A subset of patients late after TOF repair may show progressive dilatation of AoRo. To identify and prevent long-term sequelae in this patient group, regular follow-up and speculation about AoRo after TOF repair is recommended.

Clinical Study on Operation for Rupture of Aortic Sinus Aneurysm / 中国医师杂志

Objective To summarize the ruptured types, operational ways and therapy effect for rupture of aortic sinus aneurysm.Methods The operational cured 55 cases with aneurysm of aortic sinus were retrospectively analysed.Results There were 46 cases of right aortic sinus aneurysm, 45 cases among them rupture was peretrated into right ventricle, one rupture was peretrated into right atrium;there were null aneurysm of aortic sinus, 5 cases among them ruptured into right atrium, 2 cases ruptured into right ventricle; 2 cases of left aneurysm of aortic sinus, ruptured into left ventricular. There were 24 cases with ventricular septal defect, 32 cases with aortic valvular imcompetence, 6 cases with other diseases, 8 cases complicated with infective endocarditis. All cases underwent operational treatment, one patient who had severe left heart failure and huge left ventricle before operation died from refractory arrhythemia after operation, another who had severe infective endocarditis,and patients with cardic function degree Ⅳ were died from low cardic output syndrome, others were better.Conclusions The right aneurysm of aortic sinus were the most types, and it always ruptured into right ventricle; It suggests that it is important for aneurysm of aortic sinus should be operated as early as possible in order to avoid losing the chance of operation, particular in the patients complicated with infective endocarditis .