Talon's cusp in a primary maxillary central incisor A report of a rare odontogenic anomaly

Talon's cusp, a type of dens evaginatus (DE) in a primary tooth, is a rare odontogenic anomaly which is reported sparingly in the literature. We report this case describing the presence of a talon's cusp on the right primary maxillary central incisor in a 2-year-old boy precipitating discomfort, owing to occlusal interference. The treatment plan involved pulpectomy and reduction of the lingula DE extension under general anesthesia.

Radiofrequency ablation of ventricular arrhythmias from the pulmonary sinus cusp in pediatric patients and the follow-up / 中华实用儿科临床杂志

Objective:To evaluate the strategy and safety of the radiofrequency ablation (RFA) on ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) in pediatric patients.Methods:Retrospective study.Fifteen patients with VAs originating from the PSC who were intervened by RFA in the Department of Pediatric Cardiology, Guangdong Provincial People′s Hospital between March 2014 to July 2020 were enrolled.All the patients met the indication criteria for RFA in pediatric patients.The electrocardiogram, ablation method of ablation were analyzed.Different curved catheters were selected for RFA according to the age and weight of the patients.The catheter was then inserted in a " U" or inverted " P" shape to the PSC.The long-term effect of ablation were reviewed.Results:The mean age and body weight of 15 patients with VAs originating from the PSC were (11.6±2.6) (6-15) years and (39.9±12.2) (19-65) kg, respectively.The electrocardiogram recorded during VAs originating from the PSC showed left bundle branch block and inferior axis with monomorphic R pattern, as well as a QS-wave in aVR and aVL.The electrocardiogram characteristics varied in patients with VAs originating from the PSC.The ideal excitation point was not found in the right ventricular outflow tract or the ablation was unsuccessful in all patients, and the earliest target was mapped and RFA was successful.Among the 15 patients, the successful ablation site was in the lower regions of the PSC, involving the right cusp in 11 patients(73.3%), the anterior cusp in 3 patients(20.0%), and the left cusp in 1 patient(6.7%). The earliest potential recorded at the PSC ablation site preceded the QRS complex onset by (27.3±6.0) ms.During the follow-up period for (2.7±2.0) years, no recurrence of VAs or complications were recorded.Conclusions:Under the premise of gentle catheterization procedure and appropriate radiofrequency energy, ablation was effective, safe and with low recurrence rate to eradicate VAs originating from the PSC in children.

Clinical application of molar uprighting for impacted mandibular second molars / 口腔疾病防治

Objective @#To investigate the effect of the clinical application of molar uprighting in the treatment of impacted mandibular second molars.@*Methods@# A total of 16 cases of impacted mandibular second molars were chosen, and the impacted molars were treated with straight wire appliances and molar uprighting. Before and after treatment, the vertical angle of the molar, the height of the distal buccal tip, the height of the distal buccal tip of the anchorage molar, the depth of the periodontal pocket and the height of the alveolar bone were measured. Moreover, the treatment cycles of the third molar extraction group, the premolar group and the nonextraction group were compared.@*Results @#All impacted molars responded well to treatment. The vertical time of impacted molars was (1.34 ± 0.45) months, (2.20 ± 0.57) months, and (2.30 ± 0.45) months in the third molar extraction group, the premolar extraction group and the nonextraction group, respectively. The treatment time of the third molar extraction group was shorter than that of the other two groups, and the difference was statistically significant (P < 0.05). After treatment, the inclination of impacted second molars increased by (25.94 ± 8.85)°, the elongated distal buccal tip was depressed by (1.00 ± 1.48) mm, the depth of the proximal and middle periodontal pocket of impacted molars decreased by (1.21 ± 1.03) mm, and the height of the alveolar bone of the proximal and middle adjacent surfaces of impacted second molars increased by (4.57 ± 1.45) mm; these differences were statistically significant (P < 0.05). There was no significant difference in the height of the distal buccal tip of the first molar before and after treatment (P > 0.05).@*Conclusion @#Molar uprighting is an efficient, reliable, and convenient method that can shorten the treatment period. Extraction of crowded third molars is beneficial for the vertical and periodontal health of impacted second molars.

Prevalence of Developmental Anomalies of Teeth in a Group of Indian Children A Cross Sectional.

Introduction: Developmental anomalies of the tooth areroutinely encountered by paediatric dental professionalsand may present with esthetic and or functional problems.The reported literature has shown a wide variation in theprevalence of these conditions across the globe. Study aimedto assess the prevalence of various developmental anomaliesof tooth in a sample of Indian paediatric populationMaterial and Methods: A total of 3000 children in the agegroup of 6 to 13 years visiting the OPD of pedodontics andpreventive dentistry of BIDSH, Patna were examined clinicalyand radiologicaly when required and the data was tabulated.Descriptive statistics methods were used using SPSS.Results: Prevalence of dental anomalies was 4.86%.in thestudy population and Enamel hypoplasia, hypodontia andtalon's cusp were the most frequently encountered anomalies.The presence of developmental anomalies was a statisticalysignificant finding.Conclusion: Early detection of developmental anomaliesmay prevent future complications and eliminate the need forcomplex therapeutic intervention.

Aortic Stenosis and Regurgitation with Aortic Subannular Left Ventricular Diverticulum and Occlusion of the Right Coronary Ostium by the Bicuspid Aortic Valve / 日本心臓血管外科学会雑誌

A 63-year old man was referred to our hospital with dyspnea on exertion and palpitation. An echocardiogram disclosed aortic stenosis and regurgitation, mitral regurgitation and tricuspid regurgitation. During cardiac catheterization, the right coronary ostium could not be cannulated, by coincidence, showed ventricular outpouching. Preoperative contrast-enhanced CT showed the partition wall isolating the right coronary ostium and the left ventricular outpouching in the subaortic valve area. The patient underwent aortic valve replacement after resection of the rudimentary right coronary cusp, and we resected the outpouching and closed the orifice with mattress sutures from the inside of the LV and the outside. Histopathology demonstrated that the resected outpouching was congenital fibrous left ventricular diverticulum.

Effect of the restorative technique on load-bearing capacity, cusp deflection, and stress distribution of endodontically-treated premolars with MOD restoration

OBJECTIVES: To evaluate the influence of the restorative technique on the mechanical response of endodontically-treated upper premolars with mesio-occluso-distal (MOD) cavity. MATERIALS AND METHODS: Forty-eight premolars received MOD preparation (4 groups, n = 12) with different restorative techniques: glass ionomer cement + composite resin (the GIC group), a metallic post + composite resin (the MP group), a fiberglass post + composite resin (the FGP group), or no endodontic treatment + restoration with composite resin (the CR group). Cusp strain and load-bearing capacity were evaluated. One-way analysis of variance and the Tukey test were used with α = 5%. Finite element analysis (FEA) was used to calculate displacement and tensile stress for the teeth and restorations. RESULTS: MP showed the highest cusp (p = 0.027) deflection (24.28 ± 5.09 µm/µm), followed by FGP (20.61 ± 5.05 µm/µm), CR (17.72 ± 6.32 µm/µm), and GIC (17.62 ± 7.00 µm/µm). For load-bearing, CR (38.89 ± 3.24 N) showed the highest, followed by GIC (37.51 ± 6.69 N), FGP (29.80 ± 10.03 N), and MP (18.41 ± 4.15 N) (p = 0.001) value. FEA showed similar behavior in the restorations in all groups, while MP showed the highest stress concentration in the tooth and post. CONCLUSIONS: There is no mechanical advantage in using intraradicular posts for endodontically-treated premolars requiring MOD restoration. Filling the pulp chamber with GIC and restoring the tooth with only CR showed the most promising results for cusp deflection, failure load, and stress distribution.

Correlation between cusp pattern and deflecting wrinkle in six ethnic groups from southwestern colombia / Correlación entre el patrón cuspídeo y el pliegue acodado en seis grupos étnicos del suroccidente colombiano

ABSTRACT. Introduction: the cusp pattern and the deflecting wrinkle are two morphological traits whose expression and variability contribute to the morphological configuration of the occlusal surface of deciduous and permanent lower molar teeth. The objective of the present study was to estimate the correlation between cusp pattern and deflecting wrinkle in six ethnic groups from southwestern Colombia. Methods: analysis of 480 plaster models corresponding to 100 mixed Caucasoid mestizos from Cali (50 men and 50 women), 60 Afro-descendants from Cali (34 women and 26 men), 84 Afro-descendants from Puerto Tejada (42 women and 42 men), 116 Afro-descendants from Villa Rica (57 men and 59 women), 60 misak indigenous (37 women and 23 men) and 60 nasa indigenous (35 women and 25 men). Results: there were high frequencies (over 60%) of cusp pattern (Y expression) and deflecting wrinkle (grades 2 and 3) in deciduous first lower molars, mid frequencies (between 40 and 59%) of cusp pattern (Y and + expressions) and deflecting wrinkle (grades 1 and 2) in permanent first lower molars, and mid frequencies (between 40 and 59%) of cusp pattern (+ and X expressions) and deflecting wrinkle (grades 1 and 2) in permanent lower second molars. Conclusions: these frequencies suggest a trend in cusp pattern, which may vary according to the degree of expression of the deflecting wrinkle. This tendency consists of the Y cusp pattern when the deflecting wrinkle is expressed in grades 2 and 3. Bilaterally was observed and there was no sexual dimorphism.

RESUMEN. Introducción: el patrón cuspídeo y el pliegue acodado son dos rasgos morfológicos cuya expresión y variabilidad contribuyen con la configuración morfológica de la superficie oclusal de los dientes molares inferiores temporales y permanentes. El objetivo del presente estudio consistió en estimar la correlación entre el patrón cuspídeo y el pliegue acodado en seis grupos étnicos del suroccidente colombiano. Métodos: se observaron 480 modelos de yeso correspondientes a 100 mestizos caucasoides de Cali (50 mujeres y 50 hombres), 60 afrodescendientes de Cali (34 mujeres y 26 hombres), 84 afrodescendientes de Puerto Tejada (42 mujeres y 42 hombres), 116 afrodescendientes de Villa Rica (59 mujeres y 57 hombres), 60 indígenas misak (37 mujeres y 23 hombres) y 60 indígenas nasa (35 mujeres y 25 hombres). Resultados: se presentaron frecuencias altas (mayores al 60%) de patrón cuspídeo (expresión Y) y pliegue acodado (grados 2 y 3) de los primeros molares inferiores temporales, frecuencias medias (entre 40 y 59%) de patrón cuspídeo (expresiones Y y +) y pliegue acodado (grados 1 y 2) de los primeros molares inferiores permanentes, y frecuencias medias (entre 40 y 59%) de patrón cuspídeo (expresiones + y X) y pliegue acodado (grados 1 y 2) de los segundos molares inferiores permanentes. Conclusiones: con base en dichas frecuencias, se observó una tendencia en la configuración del patrón cuspídeo, el cual puede variar de acuerdo al grado de expresión del pliegue acodado; dicha tendencia consiste en el patrón cuspídeo Y cuando el pliegue acodado se expresa en los grados 2 y 3. Se observó bilateralidad y no hubo dimorfismo sexual.

Permanent mandibular protostylid: A rare developmental anomaly and its overview

Developmental malformations of the teeth might result in alterations of their size, shape, and structure. An accessory cusp is a developmental alteration to the shape of the teeth and is more commonly found in anterior teeth, and its occurrence in permanent molars is quite rare. Accessory cusps occurring in permanent mandibular molars are termed as protostylids. Although they do not pose any significant problem with respect to the function and occlusion, it is of tremendous importance in forensic odontology. This case report presents a rare finding of protostylid on the permanent mandibular molar, and its clinical implications are illustrated.

Feasibility of Complete Aortic Valve Cusp Replacement Using CardioCel® in Early Childhood

The presented case is the report on a successful complete aortic valve cusp replacement using tissue-engineered xenogenic CardioCel® material in early childhood.

Efficacy of Radiofrequency Ablation of Atrial Tachycardia Originating From the Non-coronary Aortic Cusp Guided by Three-dimensional Mapping in 11 Patients / 中国循环杂志

Objectives: To analyze the electrophysiological mapping characteristic and evaluate the effect of radiofrequency ablation in atrial tachycardia (AT) originating from the non-coronary aortic cusp (NCC). Methods: Data from 11 patients with AT originated from NCC and underwent electrophysiological mapping and radiofrequency ablation under the guidance of three-dimensional mapping system were analyzed. The electrical anatomical model of right atrium, His bundle and the root of the aorta was constructed during the procedure to measure the distance between the earliest atrial activation and His bundle. Ablation was performed at the earliest atrial activation site. Results: Cardiac electrophysiological examination evidenced the focal originating of AT in all 11 cases, right atrial activation mapping showed that all the earliest activation site was located in the left or left upper posterior of His bundle, activation time was (21.0 ± 7.9) ms prior to coronary sinus proximal reference wave A, the distance between the earliest activation site and the His bundle was (6.9 ± 3.4) mm. Aortic root mapping showed that the earliest activation sites were all located in the NCC, activation time was (35.0 ± 8.6) ms prior to coronary sinus proximal reference wave A, the distance between the earliest activation site and His bundle was (7.3 ± 4.6) mm. AT in all 11 patients were terminated after ablation, Post ablation, AT could no longer be induced by repeated stimulations. No atrioventricular conduction block occurred during and after operation. No AT recurrences were observed in all 11 patients during the 6 months follow-up. Conclusions: The success rate and safety of three-dimensional mapping guided ablation of AT originated from NCC are high. The main point of the mapping, which is crucial for the successful ablation, is that if the earliest atrial activation site of AT is located at left or left upper posterior of His bundle, it is mandatory to perform aortic root mapping and to routinely determine whether NCC is the earliest activation site of AT.

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.

Occlusion of Left Coronary Ostium by Fusion of a Rudimentary Aortic Cusp to the Aortic Wall / 日本心臓血管外科学会雑誌

A 65-year old man with a diagnosis of aortic regurgitation from childhood referred to our hospital due to palpitations and dyspnea on exertion. Transthoracic echocardiography showed severe aortic regurgitation, but the form of left coronary aortic cusp was not detected clearly. Trans esophageal echocardiography revealed small left coronary aortic sinus covered with a rudimentary left coronary cusp. Right coronary angiography showed retrograde flow to left coronary artery, and pooling of contrast material in the aortic cusp. Cannulation into the left coronary ostium could not be performed, aortography revealed no antegrade left coronary blood flow. The patient underwent aortic valve replacement with mechanical valve after resection of the rudimentary left coronary cusp, and ascending aorta replacement using selective cerebral perfusion. The post operative course was uneventful. We report on a rare case of occlusion of left coronary ostium with a rudimentary aortic cusp.

Reliability study in the measurement of the cusp inclination angle of a chairside digital model / 华西口腔医学杂志

OBJECTIVE@#This study aims to evaluate the reliability of the software Picpick in the measurement of the cusp inclination angle of a digital model.@*METHODS@#Twenty-one trimmed models were used as experimental objects. The chairside digital impression was then used for the acquisition of 3D digital models, and the software Picpick was employed for the measurement of the cusp inclination of these models. The measurements were repeated three times, and the results were compared with a gold standard, which was a manually measured experimental model cusp angle. The intraclass correlation coefficient (ICC) was calculated.@*RESULTS@#The paired t test value of the two measurement methods was 0.91. The ICCs between the two measurement methods and three repeated measurements were greater than 0.9. The digital model achieved a smaller coefficient of variation (9.9%).@*CONCLUSIONS@#The software Picpick is reliable in measuring the cusp inclination of a digital model.

Geriatria ­ atualização em pistas deslizantes / Geriatria ­ sliding plates atualization

No artigo é proposta a substituição da resina lisa na região posterior das pistas deslizantes por dentes cúspide zero, respeitando o plano de orientação obtido através do desgaste de Paterson, na reabilitação do paciente edentado e sugerido um esquema de montagem dos dentes anteriores visando o equilíbrio articular.

The authors propose replacing the smooth resin in the posterior region of the sliding tracks by zero cusp teeth, respecting the guidance plan obtained by Paterson wear in the rehabilitation of the edentulous patient and suggest an arrangement of the anterior teeth in order to articulate the balance.

Bilateral Occurrence Of Talon Cusps In Primary Dentition: A Rare Entity

Talon cusps are very common in permanent dentition, while rarely reported in primary dentition. Unilateral is more common than bilateral occurrence of talon cusps and more common in males than females. The occurrence of bilateral occurrence of talon cusps in primary dentition has not been reported very frequently. The purpose of the present case report was to describe a rare case of bilateral talons in 4-year old child.

Treatment of pulmonary sinus cusp-derived ventricular arrhythmia with reversed U-curve catheter ablation / 中国介入心脏病学杂志

Objective To summarize the ablation methods,and to provide experience reference for the treatment of pulmonary since cusp(PSC)-derived ventricular arrhythmia(VA)with ablation. Methods A retrospective analysis of the clinical data of 19 patients undergoing catheter ablation for PSC-derived VA in Cardiac Intervention Therapy Center,The Second Xiangya Hospital of Central South University between January 2013 and March 2016 was conducted. Results Among the 19 patients,PSC-derived VA originated from the lower regions of the pulmonary sinuses,generating from the right,left,and anterior sinuses of the PSC were identified in 5,7,and 7 patients,respectively. Twelve patients with PSC-derived VAs originating from the right and anterior sinuses underwent successful reversed U-curve catheter ablation,while the other 7 patients with arrhythmias originating from the left sinus underwent successful ablation with the conventional method(non-reversed U-curve catheter ablation). All the patients were followed-up for 6 to 31 months,and no recurrence of VA or complications were recorded. Conclusions Reversed U-curve catheter ablation is suitable for VA originating from the right and anterior PSCs,while conventional ablation can be used for those originating from the left PSCs.

Multidisciplinary management of a fused maxillary central incisor moved through the midpalatal suture: A case report / 대한치과교정학회지

Fusion of teeth is a developmental anomaly. It occurs at the stage of tooth formation, which determines the shape and size of the tooth crown, when one or more teeth fuse at the dentin level during the morphodifferentiation of the dental germs. Such teeth show macrodontia and may cause crowding, as well as esthetic and endodontic problems. In this article, we report a rare case of a maxillary central incisor fused to a supernumerary tooth showing labial and palatal talon cusps, which was orthodontically moved across the midpalatal suture. A 13-year-old Caucasian boy sought treatment for the unesthetic appearance of his maxillary central incisor and anterior crowding. He was rehabilitated successfully via a multidisciplinary approach involving orthodontic, nonsurgical endodontic, periodontal, and prosthodontic treatments. After a 26-month treatment period, the patient's macroesthetics and microesthetics were improved. The overall improvement of this macrodontic tooth and its surrounding tissues through multidisciplinary treatment was documented using cone-beam computed tomography.

Insuficiencia aórtica aguda por ruptura espontánea de una sigmoidea aórtica: Reporte de nueve casos / Acute aortic regurgitation due to spontaneous rupture of an aortic sigmoid: Report of nine cases / Insuficiência aórtica aguda devida à ruptura espontânea de uma cúspide aórtica: Relato de nove casos

Introducción. La regurgitación valvular aórtica tiene diversos mecanismos, formas de presentación y etiología. La causa de ruptura espontánea es muy rara, la literatura se limita a casos aislados. Objetivo. Evaluar la correlación clínico-patológica de la ruptura o fenestración o eversión valvular aórtica espontánea y sus formas de presentación. Materiales. Estudio observacional, retrospectivo, de 9 pacientes, con aparición de nuevo soplo diastólico, 7 hombres de 28, 36, 42, 53, 56 y dos de 58 años, 2 mujeres de 66 y 75 años; quienes ingresaron por mayor deterioro de su clase funcional (CF) según New York Heart Association (NYHA). Resultados. La forma de presentación fue con mayor deterioro de la CF en los pacientes más jóvenes (CF III/ lV NYHA). El eco-Doppler cardíaco mostró: a) leve a moderada degeneración mixomatosa de la válvula aórtica (VAo), trivalva en 8 pacientes y bicúspide en uno. b) La cúspide aórtica evertida fue la valva coronariana derecha en 8 pacientes y en un paciente, masculino, la sigmoidea izquierda; en todos con ruptura y amplia protrusión o fenestración en tracto de salida del ventrículo izquierdo. c) Severa insuficiencia valvular aórtica (IAo). d) Dilatación de cavidad izquierda y moderada a severa disfunción sistólica. e) Válvula mitral con leve degeneración mixomatosa sin prolapso. f) Hipertensión pulmonar moderada. f) No se identificaron vegetaciones valvulares y no hubo signos de endocarditis aguda o curada en todos los pacientes. Se derivó a cirugía al 100% de los pacientes, 1 óbito post quirúrgico inmediato (11,1%), 2 óbitos en prequirúrgico (22,2%) y 3 pacientes con cirugías exitosas (33,3%), se desconoce evolución del resto. Conclusiones. 1) La patogénesis de la afección puede ser mixomatosis de una cúspide y del anillo aórtico. En el 88,8% de los casos la ruptura correspondió a la valva coronariana derecha. 2) La fenestración extensa de una cúspide valvular aórtica, de causa degenerativa puede causar IAo moderada-severa y disfunción sistólica del ventrículo izquierdo después de la ruptura de una cúspide valvular. 3) Dicha ruptura no infecciosa y no traumática de una VAo puede resultar además en una IAo aguda severa, particularmente, en hombres con hipertensión arterial crónica.

Antecedents. Aortic valvular regurgitation has diverse mechanisms, forms of presentation and etiology. The cause like spontaneous rupture is very rare and literature is limited isolated reports of cases. Objective. To evaluate the clinic pathological correlation of rupture or fenestration or eversion spontaneous aortic valve and its presentation. Materials. Observational, retrospective study of 9 patients with new onset diastolic murmur, 7 men of 28, 36, 42, 53, 56 and two of 58 years and 2 women of 66 and 75 years; who they were admitted for further deterioration of the New York Heart Association functional class (NYHA FC). Results. The mode of presentation was to further deterioration of the FC in younger patients (NYHA FC III/IV). Doppler echocardiography color showed: a) mild to moderate myxomatous degeneration of the aortic valve, tricuspid in 8 patients and one bicuspid; b) the everted aortic cusp was the right coronary cusp in 8 patients and in one patient, male, left sigmoid; all with break and wide fenestration protrusion or outflow tract of the left ventricle; c) severe aortic regurgitation; d) dilated left cavity and moderate to severe systolic dysfunction; e) mitral valve myxomatous degeneration with mild without prolapse; f) moderate pulmonary hypertension; f) no valvular vegetations were identified and there were no signs of acute or cured endocarditis in all patients. It was referred to surgery 100% of patients 1 immediate post operative death (11.1%), 2 deaths in pre-surgical (22.2%) and 3 patients with successful surgeries (33.3%), evolution is unknown the other patients. Conclusions. 1) The pathogenesis of this one affection would be the mixomatosis of cusp and the ring to valvular aortic. In 88.8% of cases he corresponded to rupture the right coronary cusp. 2) A fenestrated cusp in extensive form with an expanded aortic ring of degenerative cause can cause chronic insufficiency or sudden deterioration after the rupture of a one cusp valvular. 3) No infectious and no traumatic rupture of cord-like aortic valve structures may result in severe acute aortic regurgitation. Particularly in men with chronic hypertension.

Introdução. A regurgitação valvular aórtica tem diversos mecanismos, formas de apresentação e etiologia. A causa da ruptura espontânea é muito rara, a literatura é limitada á casos isolados. Objetivo. Avaliar a correlação clínico-patológica da ruptura ou fenestração ou eversão da valva aórtica espontânea e sua apresentação. Materiais. Estudo observacional, retrospectivo de 9 pacientes com aparição de novo sopro diastólico, 7 homens de 28, 36, 42, 53, 56 e dois de 58 anos e 2 mulheres de 66 e 75 anos, com insuficiência aórtica grave foram admitidos à maior deterioração da classe funcional da New York Heart Association (CF-NYHA). Resultados. O modo de apresentação foi com maior deterioração da CF-NYHA em os pacientes mais jovens (NYHA CF III/IV). O ecocardiograma com Doppler colorido mostrou: a) leve a moderada degeneração mixomatosa da valva aórtica, tricúspide em 8 pacientes e bicúspide em um; b) a cúspide aórtica fenestrada foi a cúspide coronária direita em 8 pacientes e em um paciente, do sexo masculino, a cúspide esquerda; em todos com ruptura e ampla protrusão ou via de saída do ventrículo esquerdo; c) regurgitação aórtica grave; d) dilatada cavidade esquerda e moderada a grave disfunção sistólica; e) válvula mitral com leve degeneração mixomatosa sem prolapso; f) hipertensão pulmonar moderada; f) não foram identificadas vegetações valvares e não houve sinais de endocardite aguda ou curada em todos os pacientes. A intervenção cirúrgica foi recomendada em todos os casos, dois pacientes morreram no pós-operatório e um paciente morreu no pré-operatório. Conclusões. 1) A patogênese desta doença pode ser mixomatose de uma cúspide e do anel valvar aórtico. Em 88,8% dos casos, a ruptura correspondeu à cúspide coronariana direita. 2) A fenestração extensa de uma cúspide valvar aórtica de causa degenerativa pode causar insuficiência aórtica moderada a grave e disfunção sistólica do ventrículo esquerdo após da ruptura de uma cúspide. 3) Nesta ruptura não infecciosa e não traumática de uma valva aórtica pode resultar na insuficiência aórtica aguda grave. Particularmente em homens com hipertensão arterial crônica.

Severe Aortic Regurgitation Caused by Double-Folded Right Coronary Cusp / 日本心臓血管外科学会雑誌

<p>We report a case of severe aortic regurgitation due to deformation of the right coronary cusp which remained in a double-folded shape. A 76-year-old woman was admitted in August 2015 for the evaluation and treatment of dyspnea. She had no history of rheumatic fever, syphilis, endocarditis, or chest trauma. During physical examination, a grade IV/VI diastolic murmur was noted along the left sternal border. Her chest x-ray film showed marked cardiomegaly with interlobular pleural effusion (Vanishing tumor). An aortography revealed abnormally dilated proximal part of right coronary artery as well as severe aortic regurgitation. At operation, the ascending aorta was exposed through median sternotomy with the patient on total cardiopulmonary bypass. The left and non-coronary cusps were easily identified and noted to be normal. The right coronary cusp was recognized to be turned inside out and stayed in a double-folded shape, which made mal-coaptation of cusps and caused aortic regurgitation. The size of the right coronary cusp was larger than other two cusps. A very large right coronary ostium which occupied almost all of the sinus of Valsalva was confirmed. The aortic valve was excised and reconstructed with glutaraldehyde-treated autologous pericardium. She had an uneventful recovery and was discharged on POD 32. The mechanism of how right coronary cusp became disfigured was discussed. We think that the lesions of the sinus of Valsalva and proximal part of the RCA may have caused the double-folded right coronary cusp abnormality.</p>

A Case of Giant Unruptured Left Coronary Sinus of Valsalva Aneurysm / 日本心臓血管外科学会雑誌

A 40-year old man with chest pain was admitted to our hospital. A three-dimensional CT revealed an unruptured left coronary sinus of Valsalva aneurysm and mild stenosis of the left main trunk. An echocardiogram revealed severe aortic regurgitation. He was operated on with an aortic root replacement procedure. Though the procedure was itself uneventful, he could not be weaned from cardiopulmonary bypass because of unexpected coronary events ; relative stenosis of the RCA and stretched LMT due to a huge aneurysm of the sinus of Valsalva. Additional CABG with LITA to LAD and SVG to RCA led to weaning from cardiopulmonary bypass. Left coronary sinus of Valsalva aneurysm is rare, and it requires early surgical intervention for an increase in the diameter of the aneurysm together with myocardial ischemia due to compression of the coronary artery.