Bifid cardiac apex and spongiform cardiomyopathy in fetus with small microdeletion 16p12.2 of paternal origin. Critical points in family communication on 16p12.2 microdeletion.

Key Clinical Message: From a literature review, this is the first case of fetal 16p12.2 microdeletion syndrome inherited from a normal father with autopsy description and evidence of spongious cardiomyopathy. First trimester intake of doxycycline could be a cofactor. Abstract: Prenatal diagnosis of a 16p12.2 microdeletion, inherited from normal father, is reported in a dysmorphic 20 weeks fetus. Histopathological examination of the myocardium (not present in the 65 cases in literature) showed bifid apex of the heart and spongiotic structure. Correlation between the deleted genes and cardiomyopathy is discussed.

Application value of apical vertex angle and ejection velocity in diagnosis of apical hypertrophic cardiomyopathy / 中国医学影像技术

Objective: To observe the application value of apical vertical angle and ejection velocity in diagnosis of apical hypertrophic cardiomyopathy (AHCM). Methods: A total of 51 patients with AHCM, including 30 typical AHCM (T-AHCM group) and 21 pre-AHCM (P-AHCM group) were enrolled. Forty matched healthy volunteers and 44 hypertensives were recruited as normal control (NC group) and hypertension group (HT group), respectively. Echocardiographic studies were performed in all subjects to acquire and analyze apical vertical angle (θap) and its systolic rate of change (△θap) in end diastolic and end systolic stage, peak ejection velocity (Vap) in systolic stage and its ratio to the velocity in left ventricular outflow tract (VLVOT). Results: Compared with NC and HT groups, θap decreased and △θap and Vap increased significantly in both P-AHCM and T-AHCM groups (all P<0.001). Conclusion: Decreased apical vertical angle and systolic rate of angle change and local ejection velocity are found in patients with AHCM even in early stage. Combination of these indicators with specific ECG changes are expected to improve the detection rate of AHCM with ultrasound.

Bifid cardiac apex and high take off: an unusual association in a case of sudden death.

Bifid cardiac apex is a very rare finding in human and its presence is generally associated with other heart defects. We present the case of an 11-year old boy, with a positive family history for sudden cardiac death, who died while he was playing with his friends. An autopsy was performed, and on gross examination, bifid cardiac apex and high take off of right coronary artery were found. Furthermore, on histological examination, signs of myo-pericarditis were observed. This is, at our knowledge, the first case in literature in which bifid cardiac apex is associated with a high take off of right coronary artery.

Usefulness of a thermoplastic breast bra for breast cancer radiotherapy : A prospective analysis.

BACKGROUND: Despite modern techniques, in some patients receiving whole breast radiotherapy (WBI) parts of the heart and the lung might receive doses which are nowadays considered relevant for the development of late morbidity. Our aim was to analyze the usefulness of a thermoplastic breast brassiere to reduce lung and heart doses. PATIENTS AND METHODS: A total of 29 patients with left-sided and 16 patients with right-sided breast cancer treated with breast conserving surgery and WBI between 2012 and 2013 were included in a prospective study analyzing the effectiveness of a thermoplastic breast bra. WBI was performed using 3D tangential fields up to 50.4 Gy. Treatment planning was performed with and without bra. Several dosimetrical parameters were analyzed comparatively focusing on the heart and ipsilateral lung. For heart dose comparisons, subvolumes like the left anterior descending artery (LAD) and a defined apical region, so-called "apical myocardial territory" (AMT), were defined. RESULTS: By using the bra, the mean lung dose was reduced by 30.6 % (left-sided cancer) and 29.5 % (right-sided; p < 0.001). The V20Gy for the left lung was reduced by 39.5 % (4.9 vs. 8.1 % of volume; p < 0.001). The mean and maximum heart doses were significantly lower (1.6 vs. 2.1 Gy and 30.7 vs. 39.3 Gy; p = 0.01 and p < 0.001), which also applies to the mean and maximum dose for the AMT (2.5 vs. 4.4 Gy and 31.0 vs. 47.2 Gy; p < 0.01 and p < 0.001). The mean and maximum dose for LAD was lower without reaching significance. No acute skin toxicities > grade 2 were observed. CONCLUSION: By using a thermoplastic breast bra, radiation doses to the heart and especially parts of the heart apex and ipsilateral lung can be significantly lowered without additional skin toxicity.

Bifid cardiac apex in a 25-year-old male with sudden cardiac death.

Although a bifid cardiac apex is common in certain marine animals, it is an uncommon finding in humans. When present, bifid cardiac apex is usually associated with other congenital heart anomalies. We present a case of bifid cardiac apex that was an incidental finding in a 25-year-old male with sudden cardiac death from combined drug toxicity. On gross examination, there was a bifid cardiac apex with a 2-cm long cleft. There were no other significant gross or microscopic abnormalities. This case represents the very rare occurrence of a bifid cardiac apex as an isolated cardiac anomaly.

Comparative study between right ventricular septal pacing and right ventricular apical pacing / 中国医师进修杂志

Objective To explore the feasibility and safety of right ventricular septal pacing with active fixation electrodes.Methods This was a randomized and control clinical trial.Patients implanted with pacemaker were randomly divided into two groups.One group underwent the right ventrieular high septal pacing with the active fixation electrodes(RVS group),and the other group underwent the right ventricular apical pacing with the passive fixation electrodes(control group).The parameter was recorded in two groups in and after operation and compared accordingly.Results (1)There were no significant differences in the procedure time between two groups[averaged(59.6±3.2)and(60.2±3.7)minutes respectively].But the time of exposing X-ray was significant longer in RVS group.(2)There was no significant difference in acute implanting measurement,except perioperative and postoperative threshold 1 month in RVS group was higher than that in control group(P＜0.05 or＜0.01).After 3 months,there was no significant difference.(3)Impedance decreased significantly in 1 month and 3 months in RVS group[P＜0.01 or＜0.05).(4)There was no difference in R-wave sensing between two groups.(5)After 100%pacing,the mean QRS duration Was shorter in RVS group,but the difference was not significant.(6)Operations in two groups came off smoothly and there were no complications.Conclusion It is feasible and secure to pace from RVS with active fixation electrodes.