Correction of left ventricular outflow tract obstruction caused by anomalous papillary muscle and subaortic membrane

Abstract This paper presents a case study of a 30-year-old male patient with dyspnea on exertion had echocardiographic diagnosis of aortic subvalvar stenosis. Discrete mitral regurgitation and aortic valve dysplasia with mild to moderate insufficiency and hypertrophic cardiomyopathy were also noted. During surgery, a rare condition was identified: presence of papillary muscle anomaly associated with the subaortic membrane as a cause of obstruction of the left ventricular outflow tract. With the resection of these structures and a mitral valve annuloplasty, the patient evolved with a significant improvement of clinical condition and heart failure, with no residual mitral insufficiency.

Congenital Double-Orifice Mitral Valve with Mitral Regurgitation due to Flail Leaflet in an Elderly Patient

We report here on a case of double-orifice mitral valve with mitral regurgitation in a 75-year-old female who had complaints of mild dyspnea. Transthoracic and transesophageal echocardiography showed two orifices that were supplied by their own chordae from a different papillary muscle. Color Doppler echocardiography revealed moderate to severe mitral regurgitation due to the flail posterior leaflet of the anterolateral orifice. Except for the persistent left superior vena cava, no other congenital anomaly was demonstrated. The patient became asymptomatic with the administration of angiotensin-converting enzyme inhibitor and diuretics, and she has been scheduled for long term follow-up.

Variations in the papillary muscles of normal tricuspid valve and their clinical relevance in medicolegal autopsies

In our study, tricuspid valves in cases of sudden death secondary to congenital differences of the tricuspid valve with significant papillary muscle anatomy were investigated. No studies of papillary muscle anatomy of the tricuspid valve have been found in medicolegal autopsies in literature. The purpose of our study is to investigate the relationship of papillary muscle in tricuspid valve in cases of sudden deaths, especially those resulting from cardiac disease, with the muscle structure, as well as the number of the muscle leading congenital changes. The study was carried out in the Department of Anatomy, Faculty of Medicine, Ege, University, Izmir, Turkey and comprised of 400 human hearts obtained between 2000 and 2002 from 400 autopsy cases during a medicolegal autopsy with permission from the Council of Forensic Medicine, Izmir. Quantitative and morphological aspects of the papillary muscles of the right ventricle were evaluated. The criteria such as number, incidence, length and shape of the anterior, [APM] septal [SPM] and posterior papillary muscles [PPM] have been observed. Although the papillary muscle presented great variability in numbers, with a minimum of 2 and a maximum of 9 papillary muscles in the right ventricle, there were usually 3 papillary muscles in the right ventricle; APM, PPM and SPM. The one headed APM was found to be more often in cardiac deaths. However, observing more frequent conical and flat topped configurations in all PPM was striking. The absence or lower ratio, or both of attachment bridges of SPM and APM/PPM in deaths of cardiac origin is also significant. We have found that the presence of this attachment is higher in deaths of noncardiac origin. This anatomical study may explain the increased in incidence wide variations of papillary muscle tricuspid valve in deaths of cardiac origin. The verdict in legal affairs may change with this. The knowledge regarding wide variations and minor anatomical abnormalities of papillary muscle helps forensic examiners not to get confused at unexpected deaths

Insuficiência tricúspide pós trauma associada a agnesia de músculo papilar anterior / Post-traumatic tricuspid insufficiency associated with agenesis of the anterior papillary muscle

Relatamos o caso de paciente do sexo masculino com 36 anos de idade com sinais e sintomas de insuficiência cardíaca direita. A história revelou trauma torácico há aproximadamente cinco anos. Submetido a operaçäo para tratamento de insuficiência tricúspide, notou-se ausência do músculo papilar anterior da valva tricúspide, fenda na cúspide anterior e dilataçäo do anel tricuspídeo. Foi realizada sutura da fenda localizada na cúspide anterior e feita sua sustentaçäo utilizando-se tira de pericárdio bovino fixada na face atrial e base do músculo papilar posterior. A operaçäo foi completada com anuloplastia de Revuelta. O paciente obteve nítida melhora dos sintomas no pós-operatório imediato, mantendo-se em classe funcional I (NYHA), após 22 meses de evoluçäo

Marcadores sutiles de anomalías cromosómicas en el feto: detección ultrasonográfica, significado clínico y manejo / Soft markers of cromosomal anomalies in the fetus: ultrasonographic detection, clinical meaning and management

Se analiza el manejo clínico, en la detección de anomalías cromosómicas mínimas, diagnosticadas por ecografía y su relación con diferentes aneuploidias

Disfunción del músculo papilar en el infarto agudo del miocardio : un estudio clínico y ecocardiografía con Doppler / Papillary muscle dysfunction in acute myocardial infarction : clinical study and Doppler echocardiography

La expresión disfunción del músculo papilar incluye anormalidades en el funcionamiento de uno o varios de los componentes del aparato valvular mitral, es decir, no se limita a disfunción de un músculo papilar. Con el objeto de conocer la frecuencia y las características de la regurgitación mitral durante la fase aguda del infarto del miocardio, se estudiaron 17 pacientes (14 hombres y 3 mujeres) con edad media de 51 y 39 años, respectivamente. En todos se realizó ecocardiograma modo M y bidimensional con Doppler, a los 5 y 15 días después de su ingreso a la unidad coronaria. El estudio con ultrasonido incluyó la medición de los diámetros de las cavidades cardiácas, el análisis segmentario de la movilidad parietal del ventrículo izquierdo y la detección con Doppler de regurgitación de las válvulas mitral y/o tricúspide. Se encontró regurgitación mitral en el 29 por ciento de los casos; su sospecha clínica sólo existió en el 17 por ciento La regurgitación mitral fue similar en los pacientes con infarto anterior y en los con infarto inferior. Los pacientes con insuficiencia mitral tuvieron elevación mayor en el nivel sérico de CPK, en relación con el grupo sin regurgitación mitral. La presencia de regurgitación tricuspídea, detectada con Doppler, se asoció a regurgitación mitral en el 80 por ciento de los casos, principalmente en los pacientes con extensión del infarto hacia el ventrículo derecho (pacientes con mayor deterioro hemodinámico). La información ecocardiográfica obtenida sugiere que la regurgitación mitral en el infarto agudo del miocardio se debe tanto a la dilatación del anillo valvular por aumento de los diámetros del ventrículo izquierdo, como a deterioro de su función global como bomba