Connection Of Vessels Research Articles

Mechanical vascular anastomoses

Mechanical anastomoses of blood vessels represent amajor advance in modern surgery. Highly specialized instruments ensure the precise connection of blood vessels, enabling the immediate restoration of blood flow. Ring coupler systems for venous anastomoses, in particular, have proven themselves in clinical practice due to their convenience and reliability and are now an indispensable part of surgical routines. Precise and functionally proper anastomosis of blood vessels; shortening of the anastomosis time; minimization of perfusion disorders in the affected tissue; reduction of intraoperative and postoperative complications. Replantation of extremities after amputations and injuries; defect reconstruction using free flaps; microsurgical vascular bypass procedures. Severe vascular pathologies such as vascular aneurysms, arteriosclerosis or severe inflammation in the area of the anastomosis; large differences between the vessel lumina; too small or too large vessels. Clamping of both vessel ends; selection of the appropriate ring coupler size based on the vessel diameter; mobilization of at least 1 cm at each vessel end; functional testing of the coupler device; threading the vessels, securely joining the rings and removing the holding device; removing clamps, inspection of the anastomosis. Regular blood circulation checks; avoiding pressure on the anastomosis; adequate anticoagulation. Precise anastomoses; reduction in operating time.

Therapy of Tooth Decay and Gingivitis Using a Multi-Wavelength Halogen Lamp

The effect of a halogen lamp with multiple wavelengths was studied on the shrinkage of the number and size of infected organ cells in the gum areas and carious holes in the teeth. Various tests were conducted using a halogen lamp (500 watts) for time periods ranging from (0.5 - 1) hour, intermittent and with variable wavelength, with control In the frequency and intensity of the light used. Tests were conducted on a group of 170 cases, and the results were 90% successful regarding the treatment of caries and molars. From the practical results, we find it possible to use the technique of reducing the number and size of affected organ cells to treat many different diseases. Toothache is still treated when necessary by extracting the tooth, but the side effects are serious and may lead to a stroke, especially if the person with the tooth suffers from atherosclerosis due to the connection of blood vessels between the nervous system, the face and the heart. Nerve removal as an alternative treatment for tooth extraction leads to almost the same complications as removing some of the vessels. As for molar fillings, as a third alternative, it is also dangerous, for reasons including that the filling contains a toxic substance in one form or another. As for our treatment, it is a fourth and successful alternative.

The angiography of uterine arteries in non-pregnant, pregnant, and twin-pregnant sheep

The shape, size, and connection of uterine vessels change during pregnancy. The mechanism of luteolysis and vascular anastomosis between fetuses in twin pregnancies differs among species. Angiography is used to evaluate the anatomical structure of vessels. In this study, angiography was performed on the uterine vessels, in open, single and twin bearing ewes. Sheep uteri were collected from the slaughterhouse and the gestational age of fetus was determined using ultrasound. Five gestational periods (30–39, 40–49, 50–59, 60–69 and 70–79 days of pregnancy) were considered. Barium sulfate with a concentration of 30% in warm water was used as the contrast agent. The injection volume and angiocath gauge were proportional to the size of the pregnant uterus. The uterine arteries and their branches were accurately observed on radiographs. Additionally, small branches of arteries and even small vessels of caruncles were clearly defined. Unilateral anastomosis was observed between the uterine artery and ovary. Anastomosis occurred between the middle uterine arteries from day 30 of pregnancy. There was no anastomosis between the twins' fetal sacs at days 40–60 of pregnancy. These results demonstrate that angiography is a useful method for imaging the development of uterine arteries during pregnancy in sheep.

Twin to Twin Transfusion Syndrome in Discordance Twins: Diagnostic and Management Approach

Twin to twin tranfusion syndrome (TTTS) is a rare condition that affects the identical twin pregnancy or other multiples. TTTS occurs when there is an imbalance in blood flow between fetuses who share one placenta. This condition can cause one fetus to be dominant among other fetuses or is called discordant twins. The cause of discordant twins is still unclear. But one of the causes is Twin-to-Twin Tranfusion Syndrome. The incidence of discordant twin pregnancies is around 15-29% of total pregnancies. The chance of developing TTTS is estimated to be around 10-15% of monochorionic diamniotic. TTTS is diagnosed by ultrasonography with measuring the single deepest pocket (SDP). TTTS can be treated by fetoscopy laser ablation. The aim of this treatment is to close the connection of blood vessels. There are alternative treatments such as amnioreduction, selective fetal reduction, or termination of pregnancy.

Panax notoginseng saponins normalises tumour blood vessels by inhibiting EphA2 gene expression to modulate the tumour microenvironment of breast cancer

BackgroundPanax notoginseng saponins (PNS), the main active component of Panax notoginseng, can promote vascular microcirculation. PNS exhibits antitumor effects in various cancers. However, the molecular basis of the relationship between PNS and tumor blood vessels remains unclear. PurposeTo study the relationship between PNS inhibiting the growth and metastasis of breast cancer and promoting the normalization of blood vessels. MethodsWe performed laser speckle imaging of tumor microvessels and observed the effects of PNS on tumor growth and metastasis of MMTV-PyMT (FVB) spontaneous breast cancer in a transgenic mouse model. Immunohistochemical staining of Ki67 and CD31 was performed for tumors, scanning electron microscopy was used to observe tumor vascular morphology, and flow cytometry was used to detect tumor tissue immune microenvironment (TME). RNA-seq analysis was performed using the main vessels of the tumor tissues of the mice. HUVECs were cultured in tumor supernatant in vitro to simulate tumor microenvironment and verify the sequencing differential key genes. ResultsAfter treatment with PNS, we observed that tumor growth was suppressed, the blood perfusion of the systemic tumor microvessels in the mice increased, and the number of lung metastases decreased. Moreover, the vascular density of the primary tumor increased, and the vascular epidermis was smoother and flatter. Moreover, the number of tumor-associated macrophages in the tumor microenvironment was reduced, and the expression levels of IL-6, IL-10, and TNF-α were reduced in the tumor tissues. PNS downregulated the expression of multiple genes associated with tumor angiogenesis, migration, and adhesion. In vitro tubule formation experiments revealed that PNS promoted the formation and connection of tumor blood vessels and normalized the vessel morphology primarily by inhibiting EphA2 expression. In addition, PNS inhibited the expression of tumor vascular marker proteins and vascular migration adhesion-related proteins in vivo. ConclusionIn this study, we found that PNS promoted the generation and connection of tumor vascular endothelial cells, revealing the key role of EphA2 in endothelial cell adhesion and tumor blood vessel morphology. PNS can inhibit the proliferation and metastasis of breast cancer by inhibiting EphA2, improving the immune microenvironment of breast cancer and promoting the normalization of tumor blood vessels.

Alternative Options of Blood Vessels Anastomosis

For a number of centuries, the problem of bleeding arrest from damaged vessels remains the major issue of surgery (alongside with infectious complications and fight against the pain syndrome). The development of vascular surgery began exactly when bleeding from a damaged vessel was arrested by tying it, and the introduction of reconstructive vascular surgery, being one of the most outstanding achievements of the 20th century, was the peak of creation. With the advent and development of this relatively young branch of clinical surgery, it became possible to effectively help patients with various vascular pathologies, previously considered incurable and doomed to death. However, the development of each industry is necessarily associated with the development of technical support. The lack of high-quality suture material and instruments has restrained the development of reconstructive vascular surgery for a long time; this fact forced researchers and surgeons to develop techniques for the seamless connection of blood vessels. Despite the widespread use of manual surgical suture, it is not always possible to use this option due to altered vascular walls. Development of technology for manufacturing synthetic materials allowed for techniques providing fast and high-quality connection of blood vessels, significantly reducing the time required for reconstruction and, as a result, reducing the incidence of complications.

An efficient new method for electrospinning chitosan and heparin for the preparation of pro‐angiogenic nanofibrous membranes for wound healing applications

AbstractChronic skin wounds and surgical sutures need critical care and fast recovery, robust connection of blood vessels and effective restoration of circulation is necessary in progressive wound healing. Heparin is well known for its' anticoagulant properties, VEGF activation and antithrombosis action. Chitosan aid in the development of the vascular grafts due to its ECM like properties of blood vessels. For electrospinning of Heparin negatively charged and low molecular weight positively charges chitosan, the homogenous solution is required, they precipitate out during mixing due to opposite charges. In the current study, a an efficient strategy is developed for the electrospinning of chitosan and heparin in the presence of lysozyme. The insolubility/non‐homogenous solution formation for electrospinning from charged chitosan and heparin fast acting was solved by using a small amount of N‐cetyl‐N,N,N‐trimethyl ammonium bromide (CTAB) and the resulting solution produced very smooth nanofibers. Polycaprolactone (PCL) was found to be a suitable polymer for the electrospinning of chitosan and heparin using organic and inorganic solvents. Surface morphology of the synthesized fibers was investigated by scanning electron microscopy (SEM) and the presence of functional groups was investigated by FTIR. Degradation studies were performed which revealed that lysozyme loaded materials were degraded much faster as compared to other materials. The angiogenic and biocompatible potential of heparin with 1 mg/ml and 4 mg/ml lysozyme concentration was demonstrated by chorionic allantoic membrane (CAM) assay and it was estimated that 1 mg/ml (lysozyme) loaded CS/HA material was found to be an efficient biomaterial to stimulate angiogenesis.

The Patent Ductus Arteriosus in Extremely Preterm Neonates Is More than a Hemodynamic Challenge: New Molecular Insights.

Complications to preterm birth are numerous, including the presence of a patent ductus arteriosus (PDA). The biological understanding of the PDA is sparse and treatment remains controversial. Herein, we speculate whether the PDA is more than a cardiovascular imbalance, and may be a marker in response to immature core molecular and physiological processes driven by biological systems, such as inflammation. To achieve a new biological understanding of the PDA, we performed echocardiography and collected plasma samples on day 3 of life in 53 consecutively born neonates with a gestational age at birth below 28 completed weeks. The proteome of these samples was analyzed by mass spectrometry (nanoLC-MS/MS) and immunoassay of 17 cytokines and chemokines. We found differences in 21 proteins and 8 cytokines between neonates with a large PDA (>1.5 mm) compared to neonates without a PDA. Amongst others, we found increased levels of angiotensinogen, periostin, pro-inflammatory associations, including interleukin (IL)-1β and IL-8, and anti-inflammatory associations, including IL-1RA and IL-10. Levels of complement factors C8 and carboxypeptidases were decreased. Our findings associate the PDA with the renin-angiotensin-aldosterone system and immune- and complement systems, indicating that PDA goes beyond the persistence of a fetal circulatory connection of the great vessels.

Particle-Based Imaging Tools Revealing Water Flows in Maize Nodal Vascular Plexus

In plants, water flows are the major driving force behind growth and play a crucial role in the life cycle. To study hydrodynamics, methods based on tracking small particles inside water flows attend a special place. Thanks to these tools, it is possible to obtain information about the dynamics of the spatial distribution of the flux characteristics. In this paper, using contrast-enhanced magnetic resonance imaging (MRI), we show that gadolinium chelate, used as an MRI contrast agent, marks the structural characteristics of the xylem bundles of maize stem nodes and internodes. Supplementing MRI data, the high-precision visualization of xylem vessels by laser scanning microscopy was used to reveal the structural and dimensional characteristics of the stem vascular system. In addition, we propose the concept of using prototype “Y-type xylem vascular connection” as a model of the elementary connection of vessels within the vascular system. A Reynolds number could match the microchannel model with the real xylem vessels.

Left Ventricular Wall Reconstruction with Autologous Vascularized Tunica Muscularis of Stomach in a Porcine Pilot Model

Introduction: Surgical replacement of dysfunctional cardiac muscle with regenerative tissue is an important option to combat heart failure. But, current available myocardial prostheses like a Dacron or a pericardium patch neither have a regenerative capacity nor do they actively contribute to the heart’s pump function. This study aimed to show the feasibility of utilizing a vascularized stomach patch for transmural left ventricular wall reconstruction. Methods: A left ventricular transmural myocardial defect was reconstructed by performing transdiaphragmatic autologous transplantation of a vascularized stomach segment in six Lewe minipigs. Three further animals received a conventional Dacron patch as a control treatment. The first 3 animals were followed up for 3 months until planned euthanasia, whereas the observation period for the remaining 3 animals was scheduled 6 months following surgery. Functional assessment of the grafts was carried out via cardiac magnetic resonance tomography and angiography. Physiological remodeling was evaluated histologically and immunohistochemically after heart explantation. Results: Five out of six test animals and all control animals survived the complex surgery and completed the follow-up without clinical complications. One animal died intraoperatively due to excessive bleeding. No animal experienced rupture of the stomach graft. Functional integration of the heterotopically transplanted stomach into the surrounding myocardium was observed. Angiography showed development of connections between the gastric graft vasculature and the coronary system of the host cardiac tissue. Conclusions: The clinical results and the observed physiological integration of gastric grafts into the cardiac structure demonstrate the feasibility of vascularized stomach tissue as myocardial prosthesis. The physiological remodeling indicates a regenerative potential of the graft. Above all, the connection of the gastric vessels with the coronary system constitutes a rationale for the use of vascularized and, therefore, viable stomach tissue for versatile tissue engineering applications.

High-resolution polarization-sensitive optical coherence tomography and optical coherence tomography angiography for zebrafish skin imaging

Zebrafish is an important animal model, which is used to study development, pathology, and genetic research. The zebrafish skin model is widely used in cutaneous research, and angiogenesis is critical for cutaneous wound healing. However, limited by the penetration depth, the available optical methods are difficult to describe the internal skin structure and the connection of blood vessels between the skin and subcutaneous tissue. By a homemade high-resolution polarization-sensitive optical coherence tomography (PS-OCT) system, we imaged the polarization contrast of zebrafish skin and the zebrafish skin vasculature with optical coherence tomography angiography (OCTA). Based on these OCT images, the spatial distribution of the zebrafish skin vasculature was described. Furthermore, we monitored the healing process of zebrafish cutaneous wounds. We think the high-resolution PS-OCT system will be a promising tool in studying cutaneous models of zebrafish.

Anomalous Connection of Umbilical Vessels to the Left Ventricle

The anomalous connection of umbilical vessels to the heart is rare and has not yet been reported in the international scientific literature. Herein, we report the case of a newborn who was diagnosed with an anomalous connection of the umbilical vessels to the left ventricle. These anomalous vessels were functionally open for 2 weeks, and cellulitis was present in the area of the blood vessels connected to the skin. We performed division of these abnormal vessels and removal of the skin lesion.

Generation of a large-scale vascular bed for the invitro creation of three-dimensional cardiac tissue.

IntroductionThe definitive treatment for severe heart failure is transplantation. However, only a small number of heart transplants are performed each year due to donor shortages. Therefore, novel treatment approaches based on artificial organs or regenerative therapy are being developed as alternatives. We have developed a technology known as cell sheet-based tissue engineering that enables the fabrication of functional three-dimensional (3D) tissue. Here, we report a new technique for engineering human cardiac tissue with perfusable blood vessels. Our method involved the layering of cardiac cell sheets derived from human induced pluripotent stem cells (hiPSCs) on a vascular bed derived from porcine small intestinal tissue.MethodsFor the vascular bed, a segment of porcine small intestine was harvested together with a branch of the superior mesenteric artery and a branch of the superior mesenteric vein. The small intestinal tissue was incised longitudinally, and the mucosa was resected. Human cardiomyocytes derived from hiPSCs were co-cultured with endothelial cells and fibroblasts on a temperature-responsive dish and harvested as a cardiac cell sheet. A triple-layer of cardiac cell sheets was placed onto the vascular bed, and the resulting construct was subjected to perfusion culture in a bioreactor system.ResultsThe cardiac tissue on the vascular bed pulsated spontaneously and synchronously after one day of perfusion culture. Electrophysiological recordings revealed regular action potentials and a beating rate of 105 ± 13/min (n = 8). Furthermore, immunostaining experiments detected partial connection of the blood vessels between the vascular bed and cardiac cell sheets.ConclusionsWe succeeded in engineering spontaneously beating 3D cardiac tissue in vitro using human cardiac cell sheets and a vascular bed derived from porcine small intestine. Further development of this method might allow the fabrication of functional cardiac tissue that could be used in the treatment of severe heart failure.

DESIGN FEATURES OF RIVER-SEA CRUISE PASSENGER VESSELS FOR RUSSIAN INLAND WATERWAYS AND ADJACENT SEAS

New concepts of river-sea cruise passenger vessels are not only new vessels, but also new tourist product. In market of sea and river cruises there are practically no offers on earlier popular cruises between ports of Black, Mediterranean and Baltic, and Caspian seas. Thus, absence of offers is connected, first, with lack of river-sea cruise vessels. For the solution of problem of connection of sea and river routes modern cruise vessels of PV09, PV300 and PV300VD projects developed by Marine Engineering Bureau are offered. Researches have shown that generally for native conditions traditional single hull type passenger vessel can be recommended. CFD-modelling tests were executed to optimize hull form. Module principles of creating inner living space were used widely. Standard module cabins usage let alternate passenger capacity by using passenger cabin modules with different area in accordance with required comfort level.

Analytical evaluation of elastic interaction in bolted flange joints

Bolted flange joints are the most popular type of connection of pressure vessels and piping equipment because of their ease of assembly and disassembly. However, the initial tightening of their bolts is a delicate operation because it is extremely difficult to achieve the target load and uniformity due to elastic interaction. This study consists of developing an analytical model to evaluate the elastic interaction of bolted flange joints subjected to multi-pass tightening patterns. The proposed analytical model is based on the theory of circular beams on elastic foundation. The parameters such as elastic compliance due to bending, twisting and bearing are involved to describe the effects of elastic interaction during the tightening sequence. The developed model based on the theory of circular beams on elastic foundation is compared to the straight beam on elastic foundation theory. The validity of the approach is supported by experimental tests conducted on a NPS 4 class 900 weld neck bolted flange joint and by finite element analysis on this bolted joint and a 52 heat exchanger flange joint using the criss-cross tightening and sequential patterns. This study provides an attractive alternative to evaluate the bolt tension scatter due to elastic interaction avoiding costly experimental tests and cumbersome FEA simulations.

Management of Arteriovenous Fistula in a 39-year Old Male Patient

Dural arteriovenous fistula (DAVF), is an abnormal connection of vessels in the tissues around the brain or spinal cord in which one or more arteries are directly connected to one or more veins or venous spaces called sinuses, which may or may not be asymptomatic for years. The case presented is about an osteodural arteriovenous fistula which is not a common location for DAVFs and reported through its clinical and pharmacotherapeutic management during and after the patient’s diagnosis. The patient interviewed is a 39-year old Asian male his symptoms were non-aggressive as manifested by severe headaches and tinnitus. He is already hyperlipidemic and hypertensive prior to the admission with history of asthma attacks.

Heparin-Eluting Electrospun Nanofiber Yarns for Antithrombotic Vascular Sutures.

The surgical connection of blood vessels, anastomosis, is a critical procedure in many reparative, transplantation, and reconstructive surgical procedures. However, effective restoration of circulation is complicated by pathological clotting (thrombosis) or progressive occlusion due to excess cell proliferation that often leads to additional surgeries and increases morbidity and mortality risk for patients. Pharmaceutical agents have been tested to prevent these complications, but many have unacceptable systemic side effects. Therefore, an alternative approach to deliver these drugs at the site of injury in a controlled manner is necessary. The objective of this study was to develop electrospun nanofibers composed of polyester poly(lactide- co-glycolide) (PLGA), poly(ethylene oxide) (PEO), and positively charged copolymer, poly(lactide- co-glycolide)- graft-polyethylenimine (PgP) for electrostatic binding and release of heparin for application as an antithrombotic microvascular suture. PgP was synthesized with different coupling ratios between PLGA and branched polyethylenimine (bPEI) to obtain PgP1 (∼1 PLGA grafted to 1 bPEI) and PgP3.7 (∼3.7 PLGA grafted to 1 bPEI). Nanofiber yarns (PLGA/PEO/PgP1 and PLGA/PEO/PgP3.7) were fabricated by electrospinning. Heparin immobilization on the positively charged nanofiber yarns was visualized using fluorescein-conjugated heparin (F-Hep), and the amount of immobilized F-Hep was higher on both PLGA/PEO/PgP3.7 and PLGA/PEO/PgP1 than yarns without PgP (PLGA/PEO). We also found that F-Hep was released from both PgP-containing yarns in a sustained manner over 20 days, while over 60% of F-Hep was released within 4 h from PLGA/PEO. Finally, we observed that heparin-eluting nanofiber yarns with both PgP1 and PgP3.7 showed significantly longer clotting times than nanofiber yarns without PgP. The clotting time of PLGA/PEO/PgP3.7 was not significantly different than that of free heparin (0.5 μg/mL). These results show that heparin-eluting electrospun nanofiber yarns may offer a basis for the development of microvascular sutures with anticoagulant activity.

Co-localization of lymphoid aggregates and lymphatic networks in nose- (NALT) and lacrimal duct-associated lymphoid tissue (LDALT) of mice

BackgroundThe lymphatic vascular pattern in the head of mice has rarely been studied, due to problems of sectioning and immunostaining of complex bony structures. Therefore, the association of head lymphoid tissues with the lymphatics has remained unknown although the mouse is the most often used species in immunology.ResultsHere, we studied the association of nasal and nasolacrimal duct lymphatics with lymphoid aggregates in 14-day-old and 2-month-old mice. We performed paraffin sectioning of whole, decalcified heads, and immunostaining with the lymphatic endothelial cell-specific antibodies Lyve-1 and Podoplanin. Most parts of the nasal mucous membrane do not contain any lymphatics. Only the region of the inferior turbinates contains lymphatic networks, which are connected to those of the palatine. Nose-associated lymphoid tissue (NALT) is restricted to the basal parts of the nose, which contain lymphatics. NALT is continued occipitally and can be found at both sides along the sphenoidal sinus, again in close association with lymphatic networks. Nasal lymphatics are connected to those of the ocular region via a lymphatic network along the nasolacrimal duct (NLD). By this means, lacrimal duct-associated lymphoid tissue (LDALT) has a dense supply with lymphatics.ConclusionsNALT and LDALT play a key role in the immune system of the mouse head, where they function as primary recognition sites for antigens. Using the dense lymphatic networks along the NLD described in this study, these antigens reach lymphatics near the palatine and are further drained to lymph nodes of the head and neck region.NALT and LDALT develop in immediate vicinity of lymphatic vessels. Therefore, we suggest a causative connection of lymphatic vessels and the development of lymphoid tissues.

Angiogenesis in tissue-engineered nerves evaluated objectively using MICROFIL perfusion and micro-CT scanning.

Angiogenesis is a key process in regenerative medicine generally, as well as in the specific field of nerve regeneration. However, no convenient and objective method for evaluating the angiogenesis of tissue-engineered nerves has been reported. In this study, tissue-engineered nerves were constructed in vitro using Schwann cells differentiated from rat skin-derived precursors as supporting cells and chitosan nerve conduits combined with silk fibroin fibers as scaffolds to bridge 10-mm sciatic nerve defects in rats. Four weeks after surgery, three-dimensional blood vessel reconstructions were made through MICROFIL perfusion and micro-CT scanning, and parameter analysis of the tissue-engineered nerves was performed. New blood vessels grew into the tissue-engineered nerves from three main directions: the proximal end, the distal end, and the middle. The parameter analysis of the three-dimensional blood vessel images yielded several parameters, including the number, diameter, connection, and spatial distribution of blood vessels. The new blood vessels were mainly capillaries and microvessels, with diameters ranging from 9 to 301 μm. The blood vessels with diameters from 27 to 155 μm accounted for 82.84% of the new vessels. The microvessels in the tissue-engineered nerves implanted in vivo were relatively well-identified using the MICROFIL perfusion and micro-CT scanning method, which allows the evaluation and comparison of differences and changes of angiogenesis in tissue-engineered nerves implanted in vivo.

A case of noncompaction at all segments of both right and left ventricles.

Background. Noncompaction/hypertrabeculation left ventricle (NCM/HVM) is most commonly reported in one or more segments of left ventricle and sometimes both ventricles. In this case, we present noncompaction of all segments of right and left ventricle, in a young man with mental retardation. Case Presentation. A 19-year-old male was referred to us with sudden dyspnea at rest and chest discomfort. He was a known case of mental retardation. He was born full term with birth weight = 1250 grams. On physical examination. A systolic murmur (II/VI) at left sternal border was heard. ECG showed increased voltage in precordial lead and deep ST segment depression. Chest X-ray (CXR) was within normal limits. Transthoracic echocardiography showed situs solitus, D loop, normal connection of great vessels, noncompaction LV at all segments (noncompaction/compaction = 2.5/0.5) with moderate systolic dysfunction (LVEF = 40%), diastolic dysfunction grade II, normal RV size with mild systolic dysfunction and hypertrabeculation, mild tricuspid regurgitation (TR), and normal pulmonary artery systolic pressure. After injection of agitated saline some bubbles were passed from right to left through patent foramen oval (PFO). Conclusions. Extensive sinusoid formation and trabeculation of RV and nearby all LV segments and its association with mental retardation suggest presence of strong genetic background.