Accessory Chamber Research Articles

Cirugía del glaucoma: TRABECULO - IRIDO - ENCLEISIS INTRAESCLERAL

The objective of this work is lo appraise a surgical proposal for [he treatmentof glaucoma which attempts to avoid [he relapses and complications. The technique consists of the fulfillment of a filtering blister (chamber of pressure derivation) using a support of corneoscleral trabeculae together with a support of iris placed mio the sclera through a scieral flapping. 70 patients (125 eyes) with more iban 7 years after surgery with ibis technique were selected at random. Their field of vision and eye pressure were evaluated and biomicroscopy and gonioscopy were practiced.The efficiency was of 95%, and patients with a field of vision between 10 and 20 degrees, and with pressures higher than 40 mmHg [he successful endothelization of the accessory chamber achieved and m [he building of a bond thai stops the closing of [he channel between [he anterior and accessory chambers.

A new pseudolepidinid foraminifer, Hanovolepidina browni gen. nov. sp. nov., from the middle Eocene (mid-Lutetian) of Jamaica and its significance

The new larger benthic foraminifer, Hanovolepidina browni gen. nov. sp. nov., is described from the Chapelton Formation (mid-Lutetian, middle Eocene, ABZ7) of Jamaica. The genus shows the characteristic transition from a single to double equatorial layer about mid-way across the radius as seen in axial sections that characterises the family Pseudolepidinidae. Equatorial sections show the embryo followed by 4 or 5 spiral rotaliid chambers with the last chamber giving rise to a primary spiral and secondary (counter-) spiral of equatorial chambers. The presence of a long rotaliid stage suggests a more primitive form that Pseudolepidina, and Hanovolepidina gen. nov. differs also from the latter in lacking the extra principal accessory chamber seen in axial section. Hanovolepidina gen. nov. is provisionally suggested as an ancestor of the late Eocene Triplalepidina. The new discovery demonstrates a greater diversity of the family Pseudolpeidinidae in the Caribbean that previously recorded, although occurrences of this family are very restricted stratigraphically suggesting that it may appear in the region due to migration events.

Double-chambered left ventricle: diagnosis by CMR and review of the literature

BackgroundA double-chambered left ventricle (DCLV) is an extremely rare congenital malformation. The exact prevalence of DCLV is not known, although studies have reported prevalence of 0.04–0.42%. This abnormality is characterized by the sub-division of left ventricle into two chambers, the main left ventricular chamber (MLVC) and the accessory chamber (AC) by a septum or muscle band.Case presentationWe are reporting two cases of DCLV, one in an adult male and an infant, who were referred for undergoing cardiac magnetic resonance (CMR) imaging. The adult patient was asymptomatic, whereas the infant had the diagnosis of left ventricular aneurysm on fetal echocardiography. On CMR, we confirmed the diagnosis of DCLV in both patients, as well as moderate aortic insufficiency in the adult patient. Both patients were lost to follow-up.ConclusionsThe double-chambered left ventricle (DCLV) is commonly detected in infancy or childhood. Although echocardiography can help detect double-chambered ventricles, MRI provides a better knowledge of this problem and can also be used to diagnose other related heart disorders.

From Double-Chambered Right Ventricle to Double-Chambered Left Ventricle: Unusual Evolution of a Ventricular Septal Defect

We present the first imaging registry of the progressive isolation of an apical chamber of the right ventricle caused by the hypertrophy of the moderator band generated from the hemodynamic effect of a ventricular septal defect, leaving the apex of the right ventricle as an accessory chamber of the left ventricle. (Level of Difficulty: Advanced.)

Double chambered left ventricle-Two chambers are not better than one.

In this month's Journal,1 Ali and colleagues present a case series consisting of two adults who underwent surgical resection for a double chamber left ventricle (DCLV). The first case was an 18-year-old female with several years of progressive chest pain and dyspnea who was ultimately found to have both a double chamber right ventricle (DCRV) and DCLV after transthoracic echocardiography (TTE) and cardiac catheterization. She underwent surgical resection of the fibromuscular bands in both ventricles with an uncomplicated postoperative course. The second case was a 27-year-old male with a history of supravalvular aortic stenosis that had been previously addressed who on TTE was found to have aortic regurgitation, aortic stenosis, and DCLV with elevated left ventricular outflow tract and accessory chamber (AC) gradients. He underwent mechanical aortic valve replacement, ascending aorta replacement, and muscle bundle excision with a course notable for delayed sternal closure and retroperitoneal hematoma. Both patients had technically successful operations with band resection and appropriate biventricular function confirmed on TTE. Both survived their index operations and had resolution of their symptoms, with the second patient dying at 6 months due to complications from anticoagulation. The authors should be congratulated for the successful identification and operative treatment of these patients. DCLV is an incredibly rare diagnosis and is even less common than its counterpart DCRV—which is seen in less than 2% of all congenital cardiac anomalies.2 Ali and colleagues successfully differentiated DCLV from other similar pathologies such as left ventricular aneurysms and left ventricular diverticulum. This is critical given their difference in etiology and overall management. Those with asymptomatic DCLV do not require surgical intervention. Symptoms are rare but can present as fatal tachyarrhythmias or heart failure. Patients can also be found to have mid-ventricular obstructions, particularly those with superior–inferior arrangements according to Bao et al.3 Those who are intervened upon typically undergo resection with patch reconstruction or cardiac transplant for large communications.4 Furthermore, diagnosing DCLV can be a challenge in and of itself. Some patients, including the second case of this study, have previous imaging that does not confirm the presence of DCLV.5 This just reiterates the importance of having a high clinical suspicion. Nevertheless, TTE is typically the first test performed and serves as a fairly reliable starting point. Bao et al.3 showed that in their series of nine patients, eight were correctly diagnosed during their initial TTE. Although a tissue diagnosis would be the best confirmatory test, a second imaging modality is typically used to confirm the diagnosis. The authors used cardiac catheterization and magnetic resonance imaging (MRI) in their first and second case, respectively, as their second modality of choice. The advantages of cardiac MRI are stated throughout the literature. It offers high inherent contrast resolution, good spatial and temporal resolutions, a wide field of view, multiplanar imaging capabilities, and the absence of radiation.4, 6 Gadolinium is particularly useful as a similar enhancement of the AC wall compared to the remainder of the left ventricular myocardium supports the diagnosis of DCLV.7 We (Figure 1) commend the authors on their work with this complex patient population. Both cases presented were unique and challenging. The authors demonstrated the ability to address DCLV in addition to the patient's existing congenital abnormalities. Furthermore, they demonstrate the ability to do so through both a transaortic and transmitral approach. DCLV is an incredibly rare diagnosis, making it difficult to establish practice guidelines. One should always pause when deciding when and how to operate on these patients. Still, Ali and colleagues add to the body of literature that suggests operating on DCLV can be done safely and that patients may derive a meaningful benefit. This work was supported by a research grant from NHLBI/NIH (No. T32HL007849). The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. The authors declare no conflict of interest.

Submitral aneurysm communicating with coronary sinus in a child.

A newborn girl was referred for a suspected abnormal pulmonary venous return in coronary sinus. Echocardiogram revealed a large outpouching of the left ventricle creating an accessory cardiac chamber that was connected to the left ventricle behind the mural leaflet of the mitral valve, and with the right atrium via the coronary sinus. Ten years later, the orifice between the submitral aneurysm and the left ventricle was closed percutaneously.

Diagnosis of Double-chambered Left Ventricle of Superior-inferior Type by Echocardiography: A Retrospective Study of 9 Subjects across Two Heart Centers.

Double-chambered left ventricle (DCLV) is extremely rare. Challenges remain in accurate diagnosis of DCLV by echocardiography, because it is easily confused with left ventricular diverticulum, left ventricular aneurysm, ventricular septal defect, etc. Herein, we reviewed echocardiographic characteristics of DCLV and evaluated the accuracy of echocardiographic diagnosis. Clinical and echocardiographical databases of two heart centers were reviewed. Nine children with DCLV of superior-inferior arrangement were studied retrospectively. Normal elliptical geometry of LV cavity is preserved in DCLV. Fibromuscluar bundles separate LV into the main chamber and the accessory chamber. The associated malformations included ventricular septal defects, mitral regurgitation, mitral valve stenosis, pulmonary stenosis, and left ventricular noncompaction in our study. Eight of nine subjects with DCLV of superior-inferior arrangement were diagnosed correctly by initial echocardiographic examination, and one case was mistaken as left ventricular diverticulum. Double-chambered left ventricle could be diagnosed and followed up by echocardiography. The morphological classification is a simplified way to improve diagnostic accuracy.

Accessory left ventricular chamber in a cat: multimodality imaging description by cardiac magnetic resonance imaging and echocardiography

A left ventricular accessory chamber is a complex and uncommon phenotype consisting in a subdivision of the left ventricle by a thick-walled muscle bundle or septum into two cavities. Multiple aetiologies such as congenital double-chambered left ventricle and acquired endomyocardial form of restrictive cardiomyopathy have been reported.The endomyocardial form of restrictive cardiomyopathy, owing to its structural heterogeneity, can present a similar phenotype to the congenital abnormality with intraventricular lesions bridging the ventricular septum and left ventricular free wall. Conventional echocardiography is the first-line, accepted, non-invasive imaging modality to investigate underlying cardiac disease but presents limitations for the overall assessment of myocardial tissue. This report describes the use of cardiac magnetic resonance imaging as an additional imaging modality to provide multiplanar morphological, structural, and functional information of the myocardium. In the presented images, hyperintensities on cardiac magnetic resonance imaging within the myocardium along with hyperechoic and heterogeneous myocardial tissue on echocardiography and elevated troponin I were suggestive of a presumptive acquired pathological process such as feline endomyocarditis–left ventricular endomyocardial fibrosis complex, rather than a sole congenital anomaly. Although the diagnosis was not confirmed, this case exemplifies the advantages of using complementary multimodality imaging in a cat presented with a left ventricular accessory chamber.

P1336 Sometimes the heart could appear different if seen under a magnetic resonance scanner: misdiagnosed cases of isolated left ventricle apical hypoplasia and double chambered left ventricle

Abstract Introduction Congenital heart diseases (CHD) are detected in 1% of children, often usually the first year of life; however, many defects are diagnosed later or remain undiagnosed. Both congenital and acquired disorders could affect the left ventricle (LV). First-line assessment includes echocardiography; nonetheless, because of intrinsic or technical limitations and artefacts, further investigation may be required. Cardiac Magnetic Resonance (CMR) is capable of providing anatomical and functional information without many of limitations and drawbacks of echocardiography. We describe CMR findings of misdiagnosed cases of two rare congenital LV abnormalities: isolated LV apical hypoplasia (ILVAH) and double-chambered LV (DCLV). Case report 1 (image A,B,D) An 18 yrs girl diagnosed with dilated cardiomyopathy (DCM) was submitted to our CMR Lab for a functional assessment. After birth, deep Q waves in the inferior leads were noted on the ecg, and an echocardiographic examination showed a dilated and hypokinetic LV. At 1 year of age, she underwent cardiac catheterization that excluded coronary arteries anomalies and confirmed a reduced LV systolic function. A diagnosis of idiopathic DCM was formulated and she was initiated with anticongestive therapy. During the follow-up she felt well with normal exercise tolerance, longitudinal echocardiography did not show any substantial modification over the years. In 2018, a CMR study was performed. Surprisingly, the cardiac apex was formed exclusively by the right ventricle, wrapped around the LV. The LV appeared spherical and truncated inferiorly, and the apical portion was missing; LV volumes and ejection fraction were normal; regional akinesia and subendocardial late gadolinium enhancement (LGE) were evident at the inferior wall. These findings were consistent of ILVAH. Case Report 2 (image C,E,F) A 24 yrs old boy with prenatal diagnosis of LV diverticulum came to our observation for a CMR study. He was asymptomatic, particularly, no palpitations or syncope were referred, nor arrhythmias were detected during the follow-up; exercise tolerance was normal. CMR showed a coarse muscle band in the LV cavity, extending from the apex to the posterior papillary muscle, thus delimiting a contractile accessory chamber. LV volumes and global systolic function were normal. The LV accessory chamber presented a normal structured free lateral wall with a normal systolic thikening, except at the apical infero-lateral segment where it appeared thinned and akinetic and showed LGE with a subendocardial pattern. These findings were consistent of DCLV. Conclusions the LV could be affected by many diseases with different etiological, clinical and morphological features. Compared to other imaging diagnostic modalities, CMR allows better definition of LV morphology, function and tissue characterization, becoming essential for LV abnormalities diagnosis and follow-up. Abstract P1336 Figure.

P1337 Left ventricle outpouchings. Assesing diagnostic complexity

Abstract Congenital left ventricle outpouchings (LVO) are a very rare condition that include left ventricle accessory chamber, left ventricle aneurysm (LVA), left ventricle diverticulum (LVD), double-chambered left ventricle and accessory left ventricle, without well-stablished diagnostic criteria. A recent article by Elaheh Malakan et al tries to show this difficulties and propose an algorithm to help define this different pathologies. We present the case of a 26-day-old boy that was admitted to our Hospital with suspicion of dilated cardiomyopathy. In his physical exam a systolic murmur was detected, and his mother described tiredness during intakes and tachypnea. His ECG showed a sinus rhythm, with an 80º QRS axis. No signs of hypertrophy or dilated cavities were detected. As part of the study a TTE was performed, detecting a dilated left ventricle with a tract crossing the apical side from the LV lateral wall. The MRI confirmed the presence of an incomplete muscular septum from de LV lateral wall up to the apex encompassing the papillary muscles in the mid left ventricle, dividing the LV in two chambers with telediastolic size of 3.5x3cm and 2.6x2.4cm respectively. This secondary appendix, with a pseudoaneurysm morphology, distended in systole with a dyskinetic motion. Globally, the left ventricle was dilated and had mild systolic disfunction. The right cavities were morphological and functionally normal. In this case initially a common dilated cardiomyopathy was suspected, being able to confirm the presence of a muscular tract crossing the mid left ventricle. The MRI described the image as an LV pseudoaneurysm, however the TTE images and the diagnostic algorithm proposed by Elaheh Malakan et al would include this case as a two-chamber left ventricle, denoting the still present difficulties in the diagnostic process in these cases, and its impact in their therapeutic approach. Abstract P1337 Figure.

P1333 The importance of multimodality imaging in the characterization of a congenital myocardial diverticulum

Abstract Congenital ventricular diverticulum is a rare cardiac malformation, usually detected on echocardiographic examinations in asymptomatic patients. However, they can also cause embolisms, arrhythmias and sudden death due to ventricular rupture. Multimodality imaging can help in the characterization of its morphology and in the differential diagnosis. We report a case of an 83-year-old woman, pacemaker carrier due to complete atrioventricular block, who consulted for paroxysmal episodes of palpitations, being diagnosed of atrial fibrillation. A transthoracic echocardiogram was performed, observing an appendix at basal septal level with contractility of its wall and with doppler-colour inside, suggestive of myocardial diverticulum. Echocardiographic contrast was injected for better delimitation and characterization of the cavity. MRI was after performed for better characterization of this structure, confirming the presence of an accessory chamber with muscular wall and normal contractility at the level of the basal interventricular septum, without pathological enhancements. We reviewed an angioCT performed for other reasons some years ago, confirming the presence of the same structure, which went unnoticed in that study. The patient followed controls and remained asymptomatic, without evolutionary echocardiographic changes, so that a conservative attitude was maintained. Congenital ventricular diverticulum is formed by an appendix of the entire left ventricular (LV) wall. It can be differentiated into two types: muscular (more frequent, not prone to rupture and associated with other congenital malformations) or fibrous (frequently localized at the base of the heart or in subvalvular areas). Differential diagnosis may include true LV aneurysms (abnormal LV contour with systolic dyskinesia and involving thinned fibrous tissue) and LV pseudoaneurysms (acute contained rupture of the ventricle wall, often after myocardial infarction, also akinetic or dyskinetic). Congenital cardiac diverticulum is characterized by a rapid contrast filling and a narrow neck. MRI provide tissue characterization and is an important tool that helps in the differential diagnosis. In cardiac diverticulums, a thinned but contractile wall is present, without pathological delayed enhancements. In true aneurysms, the wall shows delayed enhancement (scar tissue). Pseudoaneurysms are only composed by pericardium, and the border of the aneurysms show enhancement indicating peri-aneurysmal infarcted area. Left ventricular catheterization can also be useful assessing the morphology and dynamics of the left ventricular chamber. In small, muscular and asymptomatic diverticulums, conservative treatment with follow-up is often recommended. When symptoms appear, medical or surgical treatment should be proposed. Abstract P1333 Figure. Congenital myocardial diverticulum

The value of three-dimensional echocardiography in the evaluation of cor triatrium sinister

Introduction Cor triatrium sinister is a very rare congenital heart disease in which the pulmonary veins enter a proximal accessory left atrial chamber that is separated from a distal true left atrial chamber by a fibromuscular membrane presenting one or more ostia. Its incidence in the adulthood is extremely rare. Adult patients are symptomatic in case the orifice across the membrane becomes obstructive mimicking a mitral stenosis. It has been reported that severe obstruction is present if maximum doppler velocity across the orifice is more than 2 m/s.1 However, in a review of case series no correlation could be found between the pressure gradient across the fenestration and the clinical symptoms.2 We report the case of a symptomatic adult female with obstructive cor triatrium in whom the intraoperative three-dimensional transesophageal echocardiography (3D TEE) revealed the severity of obstruction in contrast to the mild intraoperative pressure gradients. Methods A 34-year-old female was scheduled for surgical repair of a cor triatrium sinister. The symptoms of dyspnea had increased during the last months (NYHA III) which resulted in the echocardiographic diagnosis. The mean pressure gradient across the orifice was estimated 6 mmHg at rest and 18 mmHg at effort using modified Bernoulli equation. There were no associated cardiac abnormalities and no signs of pulmonary hypertension. The patient gave written consent to present her case. Results The induction of anesthesia was performed with the aim to keep hemodynamic stability. The intraoperative TEE confirmed the diagnosis. Color flow across the orifice showed an aspect of rather laminar flow. The mean pressure gradient across the sole orifice was 2 mmHg.Three-dimensional en face view of the membrane permitted offline analysis of the lesion in several orthogonal planes and measurement of the effective opening area of the orifice which was 1.45 cm2 (Fig 1). Discussion This case illustrates that pressure gradient across an obstructive cor triatrium may underestimate the true severity of the lesion as the blood flow may be low through the channel. Therefore, 3D echocardiography should be routinely performed in patients with cor triatrium in order to measure the exact maximal fenestration orifice area.

The ant nest “bomber”: Explosive defensive system of the flanged bombardier beetle Paussus favieri (Coleoptera, Carabidae)

Bombardier beetles are famous for their unique ability to explosively discharge hot quinones from their pygidial glands when threatened. Here we provide the first detailed description of the ultrastructure of the defensive gland system of the genus Paussus, the most speciose genus in the ground beetle subfamily Paussinae. Paussine beetles are commonly known as “flanged bombardier beetles” due to the presence of a flange on their elytra that assists in directing their defensive chemicals toward the front of their bodies. In this paper, we use optical, fluorescence and focused ion beam (FIB/SEM) microscopy to analyse and illustrate anatomy and ultrastructure of the explosive defensive system of Paussus favieri, a charismatic myrmecophilous species. The defensive system of this species consists of two independent, symmetrical glands each composed of secretory lobes, a long collecting duct, a bilobed reservoir chamber, a cuticular valve, a sclerotized reaction chamber, and an accessory chamber, associated with the reaction chamber, that is surrounded by several isolated glandular cells. Differences between the pygidial defensive systems of Paussus favieri and those of Brachininae are discussed.

Morpho-functional analysis of the explosive defensive system of basal bombardier beetles (Carabidae: Paussinae: Metriini)

Bombardier beetles, belonging to the carabid subfamilies Paussinae and Brachininae, are famous for their unique ability to explosively discharge a hot spray of quinones from their pygidial glands when threatened. The paussine tribe Metriini is broadly acknowledged as the most basal group of bombardiers. In order to complement the available information on the chemical substances and the primitive discharging mechanism of Metriini, we provide a detailed morpho-functional analysis of the explosive defensive system of Metrius contractus Eschscholtz, 1829 and Sinometrius turnai Wrase and J. Schmidt, 2006, representatives of the two genera in this tribe. We use dissections, histology, scanning electron microscopy (SEM), and focused ion beam microscopy (FIB/SEM) to describe and illustrate various levels of anatomical complexity. FIB/SEM microscopy is used to analyse ultrastructural features of the cellular regions, replacing the classical transmission electron microscopy (TEM). Compared to other Paussinae tribes, Metriini lacks the typical flange of Coanda, the elytral fold used to direct the defensive secretions forward, but has a similar arrangement of internal components. We find that the internal components of the explosive defensive system, including the secretory lobes, collecting duct, reservoir chamber, valve, reaction chamber, accessory chamber and accessory glands, are only slightly different between Metrius Eschscholtz, 1829 and Sinometrius Wrase and J. Schmidt, 2006. The accessory chamber to the reaction chamber is a unique, derived character state common to all Paussinae examined and therefore represents a clear apomorphy of the Paussinae. We use the same microscopy techniques as used in a recent publication on the Brachininae, to compare the defensive systems of Metriini and Brachininae. We find a lack of morphological similarity at the ultrastructural level, suggesting that the bombarding mechanism may have evolved independently in the Paussinae and the Brachininae, perhaps in response to different ecological pressures.

경산 임당지역 고분 주‧부곽 유구 형태에 대하여

경산 임당지역 고분은 대형묘와 중 소형묘가 있으며, 동혈묘광과 이혈묘광에는 주곽과 부곽으로 구분되는 것이 있다. 이 글은 이혈묘광의 묘 배치형태에 따라 직렬형과 병렬형으로 나누고, 이 두 가지 형의 변화를 시기별로 알아보아 이를 통해 사회상을 살펴보았다.BR 대형묘는 4세기 3/4분기부터 6세기 1/4분기까지 직렬형이 관찰되며, 6세기 1/4분기에 병렬형이 축조되었다. 6세기 2/4분기부터는 대형묘가 조성되지 않았다. 중소형묘는 5세기 2/4분기부터 6세기 1/4분기까지 직렬형이 조성되며, 5세기 4/4분기부터 6세기 3/4분기까지 병렬형이 만들어진다. 6세기 1/4분기부터 병렬형이 대부분을 차지하게 된다.BR 경주의 영향에 따라 도입된 병렬형은 중 소형묘에서 먼저 차용하였고, 대형묘에서 병렬형이 들어오는 시기에 중 소형묘에는 병령형이 급증한다. 이는 중 소형묘의 병렬형을 사용한 집단이 유입된 것으로 추정되며, 대형묘가 소멸하는 것으로 짐작된다. 중 소형묘의 병렬형 도입은 임당지역에 사회적 위상 변화로 대형묘 집단을 사라지게 하는 계기가 되었으며, 이는 신라의 영향 아래 있는 것으로 보인다.

Classic cor triatriatum with opposing shunts at the atrial level: a rare association

A 6-year-old girl presented with progressive dyspnoea and cyanosis. Examination revealed grade 1 clubbing, cyanosis (saturation of 85%), right ventricular (RV) heave, and loud S2. ECG and chest radiograph showed evidence of RV pressure overload (Supplementary material online, Figures S1 and S2 ). Transthoracic echocardiography demonstrated a membrane dividing the left atrium (LA) into a proximal accessory chamber (AC) and a distal main chamber, consistent with classic cor triatriatum ( Panel A — parasternal long …

Congenital Left Ventricular Outpouchings: A Systematic Review of 839 Cases and Introduction of a Novel Classification after Two Centuries

Congenital left ventricular outpouchings (LVOs) are reported under five overlapping and poorly defined terms including left ventricular accessory chamber, left ventricular aneurysm (LVA), left ventricular diverticulum (LVD), double-chambered LV, and accessory left ventricle. Diagnostic criteria are frequently mixed and not mutually exclusive. They convey no information regarding treatment strategy and prognosis. The aim of this systematic review is to provide a clear and inclusive classification, with therapeutic and prognostic implications, for congenital LVOs. We performed three separate sets of search on three subjects including "congenital left ventricular outpouchings," "important and simply measurable markers of left ventricular function," and "relationship of mechanics of intraventricular blood flow and optimal vortex formation in left ventricle and elliptical geometry of LV." We enrolled case series, review articles, and case reports with literature review. All types of acquired LVO's were excluded. We studied the abstracts of all searched articles. We focused on diagnostic criteria and patients' outcome. To examine the validity and reliability of the novel classification, fifteen previous studies were revisited using the novel classification. A total of 20 papers from 11 countries fulfilled our inclusion criteria. The age of patients ranged from prenatal age to geriatric age range. Diagnostic criteria were clearly stated only for two of the above five terms (i.e., congenital LVA and congenital LVD). Cases with mixed diagnostic criteria were frequent.Elliptical geometry of left ventricle was found to have significant impact on effective blood flow mechanics in LV. A simple inclusive classification for congenital LVOs, with therapeutic and prognostic implications, was introduced. The cornerstone of this classification is elliptical LV geometry. Large-type IIc LVO have dismal prognosis, if left untreated. LVO type I and small LVO type IIa have the best prognosis.

Anatomy and ontogeny of a novel hemodynamic organ in zebrafish.

The zebrafish maxillary barbel can protract and retract in response to stimuli, and appears connected to a prominent blood sinus on the lateral aspect of the maxillary bone. However, the mechanism of barbel movement is not described. Using whole-mount phalloidin staining of the sinus region, we observed long filamentous actin cables, suggesting highly organized vascular smooth muscle cells, surrounding an endothelial chamber. Although the chamber is variably filled by erythrocytes in vivo, cardiac injection of fluorescent dextrans shows that it consistently contains plasma. Full-thickness confocal imaging of dextran-injected adults containing EGFP(+) endothelial cells revealed a vascular complex with three compartments, here named the distal bulb, central chamber, and accessory chamber. The early ontogeny of all three compartments was confirmed in a whole-mount series of Tg(fli1a:EGFP) juveniles. In wild type adults, the fine structure of each chamber was studied using paraffin- and plastic-section histochemistry and transmission electron microscopy. The distal bulb and central chamber have smooth muscle coats with luminally-elongated septa, forming semi-detached blood-filled lacunae. The central chamber walls and septa are extensively innervated by small, unmyelinated axons, as confirmed by immunohistochemical detection of acetylated tubulin, a component of axonal cytoplasm. The accessory chamber appears neither innervated nor muscularized, but is an endothelial cul-de-sac with a thickened elastic adventitia, suggesting an extensible fluid reservoir. We propose that we have identified a new organ in zebrafish, the maxillary barbel blood sinus, whose neurovascular specializations may contribute to zebrafish sensory biology and appendage control.

Accessory Left Ventricular Chamber

Accessory Left Ventricular Chamber

A cardiovascular cause of hematemesis

Cor triatriatum is a rare congenital heart defect in which a fibromuscular membrane forms an anomalous septum within the left atrium, dividing it into a posterosuperior higher pressure chamber and an anteroinferior anatomically true left atrium. Typically, in cor triatriatum, all four pulmonary veins enter into this accessory chamber, we present an unusual variant of cor triatriatum, in which only the right sided pulmonary veins were involved.