Morphological importance of coronary ostia in sheep and swine.

The aortic valve was investigated in 58 sheep and 60 swine without heart disease. After fixation in 4% formalin, the distance between the ostia and the elements of the right/left aortic sinuses was measured. For the left coronary ostium (LCO), it was found that in sheep 81% were below and 19% at the level of intercomissural line (IL). In pigs, 88.3% were below and 11.7% at the IL level. In sheep, the OCL was close to the right valve commissure (CVR) in 98.3% and close to the left valve commissure (CVV) in 1.7%. In pigs, it was close to RVC at 83.3% and close to LVC at 16.7%. Regarding to RCO, it was found that in sheep 69% was below, 1.7% was above and 29.3% at the IL level. In pigs, 20% were below, 15% above and 65% at the IL level. The distance of the RCO in relation to the valve commissures was 56.9% close to LVC and 43.1% close to RVC in sheep. In pigs, 81.7% were close to LVC and 18.3% close to RVC. The position of LCO was balanced between sheep and swine, while the RCO in swine was closer to CVE when compared with sheep. The accessory coronary ostium was observed in 18.6% of sheep and 10% of pigs. Thus, it is concluded that in sheep and swine the left coronary artery is perfused only in ventricular diastole. Perfusion of the right coronary artery occurs more frequently in diastole and less frequently in ventricular systole.

Reappraisal and new observations on atrial tachycardia ablated from the non-coronary aortic sinus of Valsalva.

Aims: The clinical characteristics of atrial tachycardias (AT) ablated from the non-coronary aortic sinus (NCS) are thus far described only in small series. We aimed to outline, in a large cohort of patients, the clinical, electrocardiographic, electrophysiological characteristics of this tachycardia. Methods and results: We analysed data pertaining to clinical, electrocardiographic, and electrophysiological characteristics of 43 consecutive patients from an overall cohort of 441 with AT who were successfully ablated from the NCS. The tachycardias ablated from the NCS were paroxysmal (98%) and adenosine sensitive (35/35). The patients were aged 54.6 ± 12.4 years, showing female preponderance (74%). No P wave pattern was predictive of the location of ablation. Electrophysiological findings suggested a possible micro-reentrant mechanism. During tachycardia, atrial electrograms recorded in the NCS preceded the A in the His region by 10.9 ± 7.4 ms. Fractionated atrial electrograms were noted at the site of ablation in 42 patients during the tachycardia. Radiofrequency ablation terminated the tachycardia within 5 s in 88%, with thermal automaticity seen only in 3 patients. The site of ablation at the base of the NCS was adjacent to the presumed site of the retroaortic node, a remnant of the initial atrio-ventricular canal musculature. Conclusions: AT ablated from the NCS is a paroxysmal arrhythmia in middle-aged women, with distinct electrocardiographic and electrophysiological characteristics. We suspect the retroaortic node to be involved in the tachycardia circuit.

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.

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.