Anatomic Sinus Research Articles

Valvular and perivalvular thrombosis following self-expandable aortic valve replacement: analysis of 100 multi-detector computed tomography scans

Abstract Aims Subclinical thrombosis may represent an early stage of prosthesis structural disease. Most of the available evidence on the incidence, location, predictors, and consequences of thrombosis comes from studies that have employed balloon-expandable valves. We aimed to describe the different localisations of valvular and perivalvular thrombosis and analyse prosthesis-host multi-detector computed tomography predictors in the context of self-expandable prosthesis. Additionally, we aimed to assess the impact of valvular and perivalvular thrombosis on prosthesis performance and subsequent clinical outcomes. Methods and results This analysis includes 100 consecutive patients with normal renal function who underwent transcatheter aortic valve replacement using Evolut R and received multi-detector computed tomography and transthoracic bi-dimensional echocardiography at the 6 month follow-up. Leaflet thrombosis was detected in 18 (18%) patients; 6 (6%) had at least one leaflet with severe thrombosis. Thrombosis of the anatomic sinus was detected in 24 patients (24%) and was more prevalent in the non-coronary sinus. Subvalvular thrombosis with partial or complete circumferential involvement of the prosthesis inner skirt was diagnosed in 23 patients (23%). Bicuspid valve was the predictor with highest association with hypoattenuated lesions [least absolute shrinkage and selection operator coefficient 0.35, 95%, confidence interval (CI) 0.21–0.68]. There was no difference in terms of haemodynamic structural valve dysfunction, neurological events, and re-hospitalisation between the groups with and without thrombosis (hazard ratio: 0.86, 95% CI: 0.24–3.06, P = 0.82). Conclusion This study showed that in a relatively low-risk population, valvular and perivalvular thrombosis were not rare phenomena following transcatheter aortic valve replacement at early follow-up. Bicuspid valve showed the strongest association with post-implant thrombosis.

LEAFLETS AND EXTRA–LEAFLETS HYPOATTENUATED LESIONS FOLLOWING TAVR

Abstract Introduction Subclinical leaflets thrombosis is a condition diagnosed with multi–detector computer tomography (MDCT) characterized by a meniscal–shaped hypoattenuated lesion of one or more leaflets. Transcatheter aortic self–expandable valves are commonly manufactured with pliable pericardium over a nitinol frame that forms the leaflets and the extra–leaflets components, such as the valve skirt. Little is known about extra–leaflets hypoattenuated lesions localization, including the anatomic sinus level. Methods This was an ambi–directional study. Fifty patients underwent MDCT at follow–up. Results At mean follow–up was of 12 months, hypoattenuated leaflet lesion with mild to severe restricted movement was detected in 8 individuals (16%); anatomic sinus lesion was identified in 9 patients (18%) with higher prevalence in the non–coronary sinus (16%); subvalvular lesion with a variable extension toward the valve inflow, was diagnosed in 8 patients (16%). In 4 patients (8%) the anatomic sinus thrombus was ‘in overlap’ with the leaflet thrombus; in 3 patients (6%) was in continuity with the subvalvular frame thrombus. Bicuspid valve was the only independent predictor associated with hypoattenuated lesions (adj OR 8.25 (95% CI: 1.38, 49.21), p=0.02). Conclusions This study demonstrated that hypoattenuated lesions could be identified not only at leaflet, but also at subvalvular and anatomic sinus level. The clinical relevance of such lesions remains uncertain.

Recurrent reflex syncope in idiopathic intracranial hypertension patient resolved after lumbar puncture: pathogenetic implications

BackgroundIdiopathic intracranial hypertension is a disease characterized by increased intracranial cerebrospinal fluid volume and pressure without evidence of other intracranial pathology. Dural sinuses are rigid structures representing a privileged low-pressure intracranial compartment. Rigidity of dural sinus ensures that the large physiologic fluctuations of cerebrospinal fluid pressure associated with postural changes or to Valsalva effect cannot be transmitted to the sinus. An abnormal dural sinus collapsibility, especially when associated with various anatomical sinus narrowing, has been proposed as a key factor in the pathogenesis of idiopathic intracranial hypertension. This pathogenetic model is based on an excessive collapsibility of the dural sinuses that leads to the triggering of a self-limiting venous collapse positive feedback-loop between the cerebrospinal fluid pressure, that compresses the sinus, and the increased dural sinus pressure upstream, that reduces the cerebrospinal fluid reabsorption rate, increasing cerebrospinal fluid volume and pressure at the expense of intracranial compliance and promoting further sinus compression. Intracranial compliance is the ability of the craniospinal space to accept small volumetric increases of one of its compartments without appreciable intracranial pressure rise. In idiopathic intracranial hypertension, a condition associated with a reduced rate of CSF reabsorption leading to its volumetric expansion, a pathologically reduced IC precedes and accompanies the rise of ICP. Syncope is defined as a transient loss of consciousness due to a transient cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. A transient global cerebral hypoperfusion represents the final mechanism of syncope determined by cardiac output and/or total peripheral resistance decrease. There are many causes determining low cardiac output including reflex bradycardia, arrhythmias, cardiac structural disease, inadequate venous return, and chronotropic and inotropic incompetence. Typically, syncopal transient loss of consciousness is mainly referred to an extracranial mechanism triggering a decrease in cardiac output and/or total peripheral resistance. Conversely, the association of syncope with a deranged control of intracranial compliance related to cerebral venous outflow disorders has been only anecdotally reported.Case PresentationWe report on a 57-year-old woman with daily recurrent orthostatic hypotension syncope and idiopathic intracranial hypertension-related headaches, which resolved after lumbar puncture with cerebrospinal fluid subtraction.ConclusionsA novel mechanism underlying the triggering of orthostatic syncope in the presence of intracranial hypertension-dependent reduced intracranial compliance is discussed.

About different localization of hypoattenuated lesions following transcatheter aortic valve replacement

BackgroundSubclinical leaflet thrombosis is diagnosed using multidetector computed tomography (MDCT) and is characterised by a meniscal-shaped hypoattenuated lesion of one or more leaflets. Transcatheter aortic self-expandable valves are commonly manufactured with pliable pericardium over a nitinol frame that forms leaflet and extra-leaflet components such as the valve skirt. Little is known about extra-leaflet hypoattenuated lesion localisation, including that at the anatomical sinus level. Thus, the main aim of this study was to describe leaflet and extra-leaflet (anatomic sinus and subvalvular level) hypoattenuated lesions following transcatheter aortic valve replacement with a self-expandable prosthesis. As a secondary aim, we sought to investigate predictors of hypoattenuated lesions. MethodsFifty patients underwent MDCT at the follow-up. ResultsAt a follow-up of 12 months, hypoattenuated leaflet lesions with mild to severe restricted movement were detected in eight individuals (16%), anatomic sinus lesions were identified in nine patients (18%), with higher prevalence in the non-coronary sinus (16%), and subvalvular lesions with variable extension toward the valve inflow were diagnosed in eight patients (16%). In 4 patients (8%) the anatomic sinus thrombus was ‘in overlap’ with leaflet thrombus; in 3 patients (6%) was in continuity with subvalvular frame thrombus. Bicuspid valve was the only independent predictor associated with hypoattenuated lesions (adj OR 8.25 (95% CI: 1.38, 49.21), p = 0.02)). ConclusionsThis study demonstrated that hypoattenuated lesions could be identified not only at the leaflet but also at the subvalvular and anatomic sinus levels. The clinical relevance of such lesions remains unclear.

Evaluation of the anatomic sinus after transcatheter aortic valve replacement

Abstract Background Transcatheter aortic valve replacement (TAVR) determines the creation of outer area between the cage and the aortic wall named the ‘anatomic sinus’ (Figure 1 A-B). This newly formed space of the sinuses of Valsalva (SOV) might disrupt the physiological currents of Valsalva and contribute to the formation of subclinical leaflets thrombosis (SLT). The evaluation of the root geometry after TAVR is generally performed with multi detector computer tomography (MDCT), and the role of transthoracic echocardiography (TTE) needs further validation. Purpose The aim of this study was to test reproducibility of 2D TTE assessment of the anatomic sinus dimension with MDCT as reference. We also investigated predictors for SLT. Methods We enrolled 90 patients who underwent TAVR with self-expandable prosthesis. 2D TTE was performed using Philips EPIQ-7, and echocardiograms analysed offline with Philips QLAB cardiac analysis. Both SOV and prosthesis diameters were assessed in long and short-axis parasternal view (PLAX / PSAX) and the bidimensional area of the anatomic sinus was calculated (Figure 2 A-B). Inter-observer (observer 1 – 2) reproducibility was assessed by the means of interclass correlation coefficient (ICC). MDCT was performed in 50 individuals to evaluate concordance (Bland Altman test) with the 2D TTE anatomic sinus area and also to detect SLT (Figure 2 C-D). Multivariable model was built to assess predictors of SLT. Results Mean follow-up was 13.1 months. There was excellent and good correlation with regard to the diameter of the SOV and the prosthesis measured in PLAX view by observer 1 and 2: ICC: 0.93, 95% Confidence Interval (CI) (0.76–0.97), p< 0.001; ICC: 0.87(0.63,0.96), p<0.001, SOV and prosthesis respectively. The correlation found with regard to the diameter of the SOV and the prosthesis measured in PSAX view was also excellent ICC: 0.90(0.68,0.97), p=0.001; and good ICC: 0.88(0.63,0.96), p <0.001, SOV and prosthesis respectively. The anatomic sinus areas assessed by 2D TTE were similar compared to areas derived by MDCT (4.1 ± 1.09 cm2 vs. 4.02 ± 1.55 cm2, respectively, p=0.57). Bland–Altman analysis of anatomic sinus area measured on 2D TTE and MDCT respectively, indicated high level of agreement and no fixed or proportional bias. Native bicuspid valve, but not the anatomic sinus area, was the only independent predictors for SLT. Conclusions Following TAVR, the newly formed anatomic sinus could be assessed with good reproducibility with 2D TTE. We found a significant association between native bicuspid valve and SLT diagnosed with MDCT.Figure 1A-BFigure 2A-D

Evaluation of the anatomic sinus after transcatheter aortic valve replacement

BackgroundFollowing transcatheter aortic valve replacement (TAVI), the newly formed ‘anatomic sinus’.may contribute to the formation of subclinical leaflet thrombosis (SLT).The evaluation of root geometry after TAVI is generally performed using multi-detector computed tomography (MDCT), and the role of transthoracic echocardiography (2D TTE) requires further validation. Thus, we aimed to test the reproducibility of 2D TTE assessment of the anatomic sinus with MDCT as a reference and its association with SLT. Methods2D TTE was performed in 90 patients, and the echocardiograms were analyzed offline. Both sinus of Valsalva (SOV) and prosthesis diameters were assessed in the long- and short-axis parasternal views (PLAX/PSAX), and the anatomic sinus area was calculated. Inter- and intra-observer reproducibility were assessed using the interclass correlation coefficient (ICC). MDCT was performed in 50 individuals to evaluate concordance with 2D TTE and to detect SLT. ResultsThere was excellent correlation regarding the diameter of the SOV and the prosthesis in PLAX (ICC: 0.93 (95% CI: 0.76,0.97); ICC: 0.80 (95% CI: 0.63,0.96)) and PSAX view (ICC: 0.90 (95% CI: 0.68,0.97); ICC: 0.88 (95% CI: 0.63,0.96)). Bland–Altman analysis of 2D TTE and MDCT anatomic sinus areas indicated a high level of agreement. SLT was detected in 8 individuals (16%); 3 patients had severe SLT at the level of 1 cusp. Conclusions2D TTE might play a role in the evaluation of the anatomic sinus after TAVI. The importance of this space and its effects on the SLT remain uncertain.

A review on sinoscopy in the horse: Traditional and minimally invasive techniques and sinoscopic treatment of paranasal disease

SummarySinoscopy consists of direct visualisation of the paranasal sinuses and was first conceived for diagnostic purposes using a rigid endoscope through a skull trephination. Since then, the use and approaches to perform it have evolved thanks to current advancements in knowledge (sinus anatomy and pathology) and technology. The aim of this article is to review the techniques reported to perform traditional and minimally invasive sinoscopy and to review the current use of sinoscopy to treat paranasal sinus disease. The history of sinoscopy, as we know it today, is relatively recent, but its use among clinicians is not necessarily widespread despite the invasiveness of the traditional technique when compared to imaging techniques. This limitation could be bypassed using the newer intranasal or extranasal minimally invasive sinoscopic approaches. These techniques allowed sinoscopic visualisation through natural orifices or minimally invasively created openings. Despite the potential of these techniques, case selection is still crucial as visualisation can be limited in selected disorders (i.e. sinus cyst), some sinuses (i.e. rostral maxillary with intranasal approaches) and if haemorrhage or severe exudate accumulation is found. Nevertheless, sinoscopy offers a diagnostic rate superior to traditional imaging and it is an alternative diagnostic tool when advanced imaging techniques, such as CT, are not available. In recent years, sinoscopic treatment has been progressively replacing the use of sinusotomies to treat most sinus disorders. Sinoscopic treatment yields a high‐resolution rate while complications are kept low. Familiarisation with sinoscopic techniques and in‐depth anatomic sinus knowledge will likely make sinoscopy the gold standard technique to treat sinus disease in the near future.

Self-Expandable Prosthesis Valve Adaptation: Non-Uniform Expansion and Stent Frame Decoupling

The incidence of non-uniform expansion in the context of the self-expandable transcatheter heart valve (THV) is little investigated, along with stent-frame decoupling, which is a form of stent adaptation, in which the lower part of the THV stent conforms to both the ellipticity of the left ventricle outflow tract and the native annulus while maintaining the higher part of the valve more circular. We analyzed post-implant multi-detector computed tomography scans in 50 patients. Prosthesis non-uniform expansion was assessed by computing the prosthesis eccentricity on 6 prespecified levels: (1) frame inflow, (2) native annulus, (3) leaflet inflow, (4) prosthesis waist, (5) leaflet outflow, and (6) frame outflow. Stent-frame decoupling was assessed by comparing the mean eccentricity on 6 different prosthesis levels. Implantation depth, leaflet expansion and alignment, and residual anatomic sinus area ratios were also calculated. Subclinical leaflet thrombosis was defined as hypoattenuated lesion of a meniscal shape. At a 12-month follow-up, non-uniform expansion was consistently detected at each valvular level. Highest eccentricity was measured at the native annulus level (eccentricity: 0.54 ± 0.12), while the lowest index at the frame outflow level (0.23 ± 0.11). Similar results were observed in the subgroup analyses of sizes 23, 26, 29, and 34. Eccentricity significantly decreased from the annulus level to the prosthesis frame outflow (p <0.001). Notably, the incidence of mild-to-severe subclinical leaflet thrombosis was relevant (16%). In conclusion, prosthesis non-uniform expansion and stent frame decoupling frequently occur after self-expandable THV replacement. The clinical and hemodynamic implications remain uncertain.

Age Differences of Human Sphenoid Sinus Dimensions: a Comparative Study by Gross Anatomical Dissection and CT Scan Imaging

Introduction: The sphenoid sinus is a central skull cavity situated inside the sphenoid bone as a twin structure, separated by a complete bony septum. The aim of the study to measure the length, width, and height of human sphenoid sinus through dissection compared to CT scan images in different age groups of both genders. Methods: A prospective study of 360 human bodies including 110 dissected cadavers and 250 individuals with CT scan images during a period from January 2019 to February 2020. Results: In male cadavers, the mean value of length was (24.8±4.2) and (23.6±3.8) mm for right and left sides, while for females was (24.5±3.7) and (25.3±4.1) mm. Whereas, for CT cases were (25.4±3.1), (27.2±4.1), (21.3±4.2), and (24.4±3.8) mm respectively. Otherwise, the width was (15.8±3.2) and (19.2±4.5) mm for right and left sides in male cadavers; but for females was (18.2±3.8) and (22.7±3.7). In comparison to CT cases, were (19.6±4.1), (20.4±4.7), (17.3±5.2), and (19.2±5.6) mm respectively. In male cadavers, the height was (21.4±3.1) and (26.8±2.8) mm for right and left sides, while for females was (13.8±3.3) and (19.6±3.1) mm. Whereas, for CT cases were (16.7±2.5), (18.2±2.7), (14.6±2.9), and (15.8±3.3) mm respectively. Conclusion: Findings of both methods yield accurate anatomic sinus views, which may determine the age, gender, and race of alive or dead individuals.

Single-Blinded Prospective Implementation of a Preoperative Imaging Checklist for Endoscopic Sinus Surgery.

Objective To determine if the introduction of a systematic preoperative sinus computed tomography (CT) checklist improves identification of critical anatomic variations in sinus anatomy among patients undergoing endoscopic sinus surgery. Study Design Single-blinded prospective cohort study. Setting Tertiary care hospital. Subjects and Methods Otolaryngology residents were asked to identify critical surgical sinus anatomy on preoperative CT scans before and after introduction of a systematic approach to reviewing sinus CT scans. The percentage of correctly identified structures was documented and compared with a 2-sample t test. Results A total of 57 scans were reviewed: 28 preimplementation and 29 postimplementation. Implementation of the sinus CT checklist improved identification of critical sinus anatomy from 24% to 84% correct ( P < .001). All residents, junior and senior, demonstrated significant improvement in identification of sinus anatomic variants, including those not directly included in the systematic review implemented. Conclusion The implementation of a preoperative endoscopic sinus surgery radiographic checklist improves identification of critical anatomic sinus variations in a training population.

Are Chronic Rhinosinusitis and Paranasal Sinus Pneumatization Related?

The relationship between paranasal sinus pneumatization and chronic rhinosinusitis (CRS) without cystic fibrosis is not well understood. Previous investigations have confirmed sinus hypoplasia in cystic fibrosis (CF) patients. This study compares paranasal sinus pneumatization of CRS patients to unaffected controls to determine if there is an analogous effect to that seen in CF. 591 sinus computed tomography (CT) scans, comprised of 303 adolescents (age 13–18) and 288 adults (age &gt; 18), were analyzed for Lund-MacKay and Assessment of Pneumatization of the Paranasal Sinuses (APPS) scores. The APPS score is validated for measuring the extent of sinus pneumatization. A diagnosis of CRS and CRS phenotype was determined from the medical record. The mean APPS score for patients with a diagnosis of CRS was 10.61 (n = 111) compared to 9.62 (n = 448) for unaffected controls (p = 0.001). This was significant in adult (p = 0.021) and adolescent subgroups (p = 0.035). Sinus pneumatization did not differ according to CRS phenotype (p = 0.699). This suggests that there is not analogous anatomical sinus variation between CRS and CF, and that the mechanisms underlying sinus hypoplasia in CF may not be universal in patients with other types of sinus inflammation.

E-004 Vascular Causes of Pediatric Intracranial Hypertension

PurposeAfter space-occupying lesions and mechanical disruptions of CSF drainage have been excluded, intracranial venous hypertension (ICVH) often is the central mechanism leading to intracranial hypertension and its causes can be...

Sinus node revisited

Sinus node disease (SND) is a common clinical condition and is the most common indication for permanent pacemaker implantation. This review aims to revisit the complex sinus node anatomy, the evolving understanding of its pacemaking mechanisms, the atrial myopathy in SND and sinus node remodeling. Recent high-density noncontact mapping of the human sinus node showed multiple origins of sinus activation and exit sites with preferential pathways of conduction. Perhaps, a newly described discrete paranodal area containing a molecular mixture of nodal and atrial cells may account for this long recognized discrepancy between the anatomical and functional sinus node. The funny current (I(f)) driven 'membrane clock' is not solely responsible for sinus node automaticity, following recent recognition of the importance of the 'calcium clock'. Several molecular links to sinus node remodeling have recently been identified: loss of connexin-43 expression and down-regulation of I(ca,L) in aging; reduced I(f) and down-regulation of I(f) encoding HCN4 and HCN2 subunits in heart failure; and calcium clock malfunction with down-regulated HCN4, HCN2 and minK in atrial fibrillation. Ongoing research with improved technology and techniques continues to unravel new understandings and challenges to the century old discovery of the anatomical sinus node.

Balloon sinuplasty

Balloon sinuplasty is a technique in endoscopic sinus surgery that involves minimally invasive procedures to dilate the obstructed or stenosed anatomical sinus pathways. Procedure is derived from the well-recognized techinique of angioplasty. This article highlights the procedural methods with review of literature and my personal experience in balloon sinupalsty.

High‐Density Mapping of the Sinus Node in Humans: Role of Preferential Pathways and the Effect of Remodeling

The area of the functional sinus node complex exceeds that of the anatomical sinus node; however, reasons for this discrepancy are unknown. We aimed to characterize the functional sinus node complex in health and disease with high-density simultaneous mapping. Sinus node activity was characterized in 15 reference patients after ablation for supraventricular tachycardia. A further 16 patients were studied following ablation of chronic atrial flutter to determine effects of atrial remodeling. High-density simultaneous mapping of the sinus node complex was performed using a multi-electrode array. In reference patients, distance from superior vena cava-right atrial (SVC-RA) junction to earliest activation (EA) was 4 +/- 4 mm and sinus break-out (SBO) 9 +/- 6 mm. Preferential pathways of conduction were observed between EA and SBO. For patients with flutter, these distances were greater (EA: 15 +/- 12 mm, P = 0.003; SBO: 23 +/- 11 mm, P < 0.001). Conduction time along preferential pathways was 15 +/- 5 ms for reference patients and 23 +/- 8 ms for patients with flutter (P = 0.005). Following pacing, distance from SVC-RA junction to EA and SBO lengthened to 13 +/- 8 mm (P = 0.006) and 16 +/- 10 mm (P = 0.02), respectively, in reference patients, and 19 +/- 12 mm (P = 0.045), 28 +/- 9 mm (P = 0.02) in patients with flutter. This resulted in caudal shifts in EA and SBO of 10 +/- 9 mm and 7 +/- 8 mm in reference patients but diminished shifts in patients with flutter; 4 +/- 7 mm and 4 +/- 6 mm. The functional sinus node complex demonstrates dynamic changes in activation. There are preferential pathways of conduction from sinus node to atrial myocardium. The remodeled atria demonstrate longer conduction times along preferential pathways and a restricted functional sinus node complex.

Alternative Applications of Guided Surgery: Precise Outlining of the Lateral Window in Antral Sinus Bone Grafting

Computed tomography (CT) and the application of CT-based guided implant surgery allow clinicians to provide enhanced precision and accuracy in implant surgery. Because of the difficulty in transferring a patient's often complex anatomic sinus configurations, as viewed on a preoperative CT scan, into precise osteotomy cuts at antral bone graft surgery, a prototype cutting guide was developed. The surgical guide was developed through the use of CT imaging, SimPlant module Oral and Maxillofacial Surgery computer software (Materialise Dental, Glen Burnie, MD), and the stereolithographic process to precisely position the lateral window, facilitating Schneiderian membrane elevation. This report demonstrates the step-by-step method to perform precise guided sinus window preparation using computer software and a stereolithographically generated surgical guide.

High-resolution fluid-structure interaction simulations of flow through a bi-leaflet mechanical heart valve in an anatomic aorta.

We have performed high-resolution fluid-structure interaction simulations of physiologic pulsatile flow through a bi-leaflet mechanical heart valve (BMHV) in an anatomically realistic aorta. The results are compared with numerical simulations of the flow through an identical BMHV implanted in a straight aorta. The comparisons show that although some of the salient features of the flow remain the same, the aorta geometry can have a major effect on both the flow patterns and the motion of the valve leaflets. For the studied configuration, for instance, the BMHV leaflets in the anatomic aorta open much faster and undergo a greater rebound during closing than the same valve in the straight axisymmetric aorta. Even though the characteristic triple-jet structure does emerge downstream of the leaflets for both cases, for the anatomic case the leaflet jets spread laterally and diffuse much faster than in the straight aorta due to the aortic curvature and complex shape of the anatomic sinus. Consequently the leaflet shear layers in the anatomic case remain laminar and organized for a larger portion of the accelerating phase as compared to the shear layers in the straight aorta, which begin to undergo laminar instabilities well before peak systole is reached. For both cases, however, the flow undergoes a very similar explosive transition to the small-scale, turbulent-like state just prior to reaching peak systole. The local maximum shear stress is used as a metric to characterize the mechanical environment experienced by blood cells. Pockets of high local maximum shear are found to be significantly more widespread in the anatomic aorta than in the straight aorta throughout the cardiac cycle. Pockets of high local maximum shear were located near the leaflets and in the aortic arc region. This work clearly demonstrates the importance of the aortic geometry on the flow phenomena in a BMHV and demonstrates the potential of our computational method to carry out image-based patient-specific simulations for clinically relevant studies of heart valve hemodynamics.

Do maxillary sinus retention cysts reflect obstructive sinus phenomena?

To determine the relation of maxillary sinus retention cysts (RCs) to ostiomeatal complex (OMC) obstruction and anatomic variation of the paranasal sinuses. The results of 410 computed tomographic scans of the sinuses ordered by otolaryngologists in an academic center during a 1-year period were reviewed. Computed tomographic scans with maxillary sinus RCs were studied to determine cyst characteristics, the Lund score, OMC size and patency, and the presence of anatomic variations. Statistical analysis was conducted to determine the relation of RCs to these factors. The incidence of RCs was 12.4% (51 cases). The mean patient age was 41.3 years, with a female-male ratio of 2.4:1. Nine cases demonstrated bilateral cysts, allowing 42 unilateral cases to be analyzed with the nondiseased side as a control. The mean cyst size was 1.56 cm, and cysts were most commonly located inferiorly (30 [50%]) and were solitary (45 [88%]). The RC side had a higher mean Lund score than the control side (2.62 vs 1.93; P =. 008, Wilcoxon signed rank test). Of the cyst sides, 18 (43%) demonstrated OMC occlusion, vs 15 (36%) for the control side (P =.55, McNemar test). The mean OMC size was smaller for the cyst side vs the control side (0.77 vs 1.35 mm; P =.13). No association was found between RCs and concha bullosa or Haller cells (P =.45 and P =.39, respectively). Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC, and are not associated with potentially obstructive anatomic sinus variations. Consideration should be given to not scoring RCs as positive disease during Lund staging.

Anatomic Sinus Dissection with the 3-D Video Endoscope

Anatomic Sinus Dissection with the 3-D Video Endoscope

The human sinus nodal electrogram: Techniques and clinical results of intra-atrial recordings in patients with and without sick sinus syndrome

An intra-atrial recording technique previously employed in animal experiments was successfully used to record SNP from the anatomic sinus nodal region of the high right atrium in 29 out of 41 patients (71%) thus examined. Due to the low amplitudes (microvolt range, 40 to 120 μV, mean 79 ± 20 μV), these potentials were discernible only on high amplification (A = 10 4 to 10 6), but with a conventional electrode catheter. Against the background of a gradual diastolic depolarization (0.6 to 3.5 μV/msec, mean 1.9 ± 0.71 msec), SNP stood out distinctly from the subsequent abrupt atrial depolarization. In four patients with SSS, first- and second-degree sinoatrial blocks, respectively, were recorded. SACT were measured both directly and indirectly, and the results were compared in all 18 patients without SSS and in 11 patients with SSS. Although the recordings were not made simultaneously, the paired values for the patients without SSS correlated well ( r = 0.890, p < 0.001), whereas no correlation was found in the patients with SSS ( r = 0.163, p = 0.316). In spite of unresolved questions, direct recording of SNP appears to be of potential value in evaluating patients with SSS.