Ostium Height Research Articles

Relationships Between Radiomorphometric Parameters of the Maxillary Sinus and Development of Sinusitis: A Cone Beam Computed Tomography Study.

The presence of maxillary sinusitis can complicate dental procedures. This study aimed to explore the relationship between maxillary sinus radiomorphometric factors, observed in cone-beam computed tomography (CBCT) images, and inflammatory sinus diseases. In this cross-sectional study, CBCT images from patients referred to a private radiology center between January 2018-January 2020 were analyzed. Sinuses were categorized as healthy or pathologic. Sinus pathologies were further classified into subgroups; mucosal thickening, retention cyst, partial opacification, complete opacification and air-fluid level. Radiomorphometric parameters, including ostium height, drainage length, ostium opening size, and drainage angle, were measured in the coronal plane. A p value less than 0.05 was considered statistically significant. A total of 433 maxillary sinuses from 258 patients were examined. Height of the ostium and drainage path length in the groups with various sinus pathologies was significantly higher than in healthy sinuses (p < 0.05 for each subgroup) except for air-fluid level (p = 0.334 and p = 0.520, respectively). Drainage path length was significantly longer in all patient groups. Maxillary ostium openings were significantly smaller in retention cyst and partial opacification subgroups, compared to healthy patients (p = 0.000 and p = 0.006, respectively) except for mucosal thickening or air-fluid levels conditions (p = 0.094 and p = 0.62). Drainage angle did not significantly differ. This study reveals that longer drainage length is associated with a higher risk of inflammatory sinus diseases, with increased severity. Smaller ostium openings are linked to retention cysts and partial opacification, while higher ostium locations increase the likelihood of sinus inflammation and disease severity.

Three-dimensional morphometric and volumetric analysis of maxillary sinuses.

The maxillary sinus is a pyramid-shaped cavity with varying shapes, sizes, and capacities. Its dimensions grow gradually and develop until early adulthood. Anatomical knowledge of the maxillary sinus is essential to understanding sinonasal disorders, planning surgical procedures and preventing complications. Awareness of the sinus's proximity to critical structures helps avoid injuries during surgery. The European, Korean, and Sri Lankan population study parameters show varying results and do not necessarily apply to the Indian population. The standard morphometric data of the maxillary sinus is scanty in the Indian population. The study aimed to determine the volume and morphometry of the maxillary sinus along with gender differences in the Eastern population of the Indian. A retrospective cross-sectional study was conducted using cone beam computed tomography data of maxillary sinuses of 100 normal individuals. The data were analysed after the three-dimensional reconstruction of digital imaging and communications in medicine (DICOM) images with the help of DICOM to print and Geomagic freeform software in the Anatomy department. The different linear morphometric variables and volume of the maxillary sinus were studied. SPSS version 27.0. was utilised for statistical analyses. The mean values of Antero-posterior diameter, Transverse diameter, Craniocaudal diameters, the height of ostium from the floor and volume of the maxillary sinus in males on the right side are 36.61 mm, 20.7 mm, 40.31 mm, 26.02 mm and 16055.24 mm³ and on the left side are 37.17 mm, 20.17 mm, 40.73 mm, 26.91 mm and 15712.66 mm³ whereas in females the values on the right side are 38.10 mm, 21.56 mm, 38.96 mm, 25.81 mm and 14687.78 mm³ and on left side are 38.23 mm, 21.53 mm, 38.48 mm, 25.28 mm and 14203.13 mm3 respectively. The side-to-side parameter differences were non-significant within the male and female groups, respectively. The females had significantly (p < 0.05) larger transverse diameters than males in both the right and left maxillary sinuses. The males tend to have a slightly larger mean craniocaudal diameter than females, but the difference was found statistically significant (p < 0.05) only in the left maxillary sinus. The gender differentiation based on the measured parameters of bilateral maxillary sinus accuracy rate was 89.4% in males and 61.8% in females. These parameters serve as a standard or reference point, allowing radiologists and surgeons to compare individual patient scans to population averages and aid in better clinical outcomes. The mean values of different parameters of the maxillary sinus may be utilised to differentiate various suspected sinus pathologies, which is helpful for functional endoscopic sinus surgery. Gender differentiation can be done more accurately by forensic experts using Maxillary sinus transverse diameter bilaterally, followed by craniocaudal diameter of the left side sinus for predicting the gender of an unknown maxilla.

Evaluation of osteomeatal complex by cone-beam computed tomography in patients with maxillary sinus pathology and nasal septum deviation

BackgroundThis study aimed to determine if there is a relationship between the presence of maxillary sinus pathology, nasal septum deviation and various lengths of the osteomeatal complex.MethodsA total of 223 CBCT images were included in the study. The lengths of the osteomeatal complex (maxillary sinus ostium width, infundibulum length, maxillary sinus ostium height) were analyzed. The presence of maxillary sinus pathology, nasal septum deviation, age, sex, right-left, septum deviation level, and the relationship between pathology level and all variables were evaluated.ResultsThe average maxillary sinus ostium width, ostium height and infundibulum length were 3.06 ± 0.70 mm, 30.10 ± 5.43 mm and 8.82 ± 1.86 mm, respectively. Ostium width was significantly higher in the healthy group than in the groups evaluated in the presence of deviation and pathology. A significant difference was found in infundibulum length only between the healthy condition and the condition evaluated in the presence of deviation. No significant difference was observed between the groups in terms of ostium height. In all groups, ostium height and infundibulum length were significantly higher in men than in women. The age group with the highest average ostium height was found in the 35–44 age group (p < 0.001).ConclusionIdentifying normal and abnormal conditions in the osteomeatal complex area is important for diagnosing the cause of a patient's complaint, guiding the surgical procedures to be performed, and preventing possible complications that may arise during surgical procedures.

Evaluation of Anatomical Variations of the Maxillary Sinus in Patients With and Without Mucous Retention Cyst.

Objectives: Mucous retention cyst (MRC) is a benign and self-limited lesion that can be caused by many risk factors, including anatomical variations of the sinonasal region. This study aims to investigate the relationship between anatomical variations and the presence of MRC. Materials and Methods: In total, 2109 sinonasal cone beam computed tomography images were evaluated for the presence of MRC, and the sinonasal anatomical regions such as the osteomeatal complex (OMC), infundibulum length, ostium height, the diameter of the ostium, the presence of accessory ostium, concha bullosa, and mucosal thickening of the maxillary sinuses. Shapiro-Wilk normality test, independent sample t-test, and chi-square test were used for statistical analysis, and P < .05 was considered significant. Results: The prevalence of MRC was 119 (5.6%) cases. The average diameter of the ostium in cases with and without MRC was 0.49 ± 0.41 mm and 0.99 ± 0.76 mm, respectively, which showed a significant inverse relationship(P < .001). A significant relationship was found between the septum deviation, the ostium height, the concha bullosa, and the accessory ostium with the presence of MRC (P < .001). Conclusions: Sinonasal anatomical variations such as ostium diameter, ostium height, septal deviation, the presence of accessory ostium, and concha bullosa can cause MRC development, and considering that surgery may be necessary in some cases; this could be of great importance to clinicians and surgeons for treatment and prevention of development or recurrence of these pseudocysts in patients.

Analysis of risk variables for association with maxillary sinus mucosal thickenings: a cone-beam computed tomography-based retrospective study

PurposeThis study aimed to determine which patient-related, anatomical, pathologic, or iatrogenic variables may be directly associated with and which may have a modifying effect on the generation of maxillary sinus (MS) mucosal thickenings.MethodsA total of 278 cone-beam computed tomography (CBCT) scans obtained from 114 males and 164 females were evaluated. The protocol included the assessment of 21 candidate variables, of which 18 were bilateral and 3 were unique. The relationship among the study variables and the mucosal thickenings were examined individually and adjusted for confounding using univariate and multivariate binary logistic regression models.ResultsThe prevalence of mucosal thickenings was 71.20% at patient level and 53.40% at sinus level. The ostium height > 28.15 mm, the infundibulum length ≤ 9.55 mm, the infundibulum width ≤ 0.50 mm, along the occurrence of periapical lesions and slight-to-severe periodontal bone loss acted as strong/independent risk variables for MS mucosal thickenings. Confounding and interaction relationships between MS height and depth, and between the alveolar process type and the presence of foreign materials with respect to age stratum > 47.50 years might be also associated with the mucosal thickenings.ConclusionsWhile increased ostium height, decreased infundibulum length/width, the presence of periapical lesions and periodontal involvement might be the foremost indicator variables for MS mucosal thickenings, there are synergistic relationships among the increased sinus height and depth as well as aging regarding atrophic/partially atrophic alveolar process status and the presence of foreign materials that may be also associated with a greater proportion of these mucosal abnormalities.

Self-navigated versus navigator-gated 3D MRI sequence for non-enhanced aortic root measurement in transcatheter aortic valve intervention

Abstract Funding Acknowledgements Type of funding sources: None. Background Preprocedural transcatheter aortic valve intervention (TAVI) evaluation requires reliable aortic root measurements for correct valve sizing. Purpose To prospectively compare image-quality, reliability and graft sizing of a prototype self-navigated and a navigator-gated non-contrast three dimensional (3D) whole-heart magnetic-resonance-angiography (MRA) sequence with computed-tomography-angiography (CTA) for planning transcatheter-aortic-valve-intervention (TAVI). Methods Self- and navigator-gated 1.5T MRA were performed in 27 patients (aged 83 ± 5 years, 41% male) for aortic root sizing and coronary ostia height measurements; 15 (56%) patients underwent additional CTA. Subjective-image quality was graded on a 4-point Likert scale, objective MRA image-quality was assessed by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis, valve sizing by kappa statistics. Results Median image-quality as rated by two observers was 1.5 [interquartile range (IQR) 1-3] for self-navigated MRA and 1 [IQR 1-2] for navigator-gated MRA (p = 0.059). SNR and CNR were comparable between MRA sequences (p = 0.471 and 0.445, respectively). Acquisition time was shorter for self-navigated MRA compared to navigator-gated MRA (5.5 ± 1 minutes vs, 6.5 ± 2 minutes, p = 0.029). Inter-observer correlation of aortic root measurements was high to very high for both self- and navigator-gated MRA (r = 0.75 to 0.94 and r = 0.85 to 0.96, respectively, all p &amp;lt; 0.0001). Theoretical prosthetic valve sizing of self-navigated MRA and CTA was equivalent (κ=1). However, in four patients (15%) one coronary ostium each (right coronary artery 3, left main artery 1) was not clearly definable on self-navigated MRA. Conclusion Self-navigated MRA enables aortic annulus TAVI measurements without significant difference to navigator-gated MRA at shortened acquisition time. Prosthesis sizing by self-navigated MRA measurements is equivalent to navigator-gated MRA and CTA-based choice. Abstract Figure.

Aortic invovement in fibromuscular dysplasia. 3-dimensional CT, case-control study. THE ARCADIA-POL BIS study

Abstract Background Fibromuscular dysplasia (FMD) is a non-atherosclerotic arterial disease that manifests as the presence of beaded or focal lesions in medium or small-sized arteries and may also include arterial dissection, aneurysm, and tortuosity. FMD could be revealed in various manifestations, however limited data on the involvement of the thoracic aorta is reported. Purpose To measure and evaluate involvement of thoracic aorta in patients with FMD. Methods We analysed aortas of 144 consecutive patients (mean age 50.2±14.0, 116 women) with confirmed FMD in at least one vascular bed. The control group consisted of 144 (mean age 50.5±14.0, 116 women) age and sex matched individuals. All patients underwent detailed clinical evaluation including angio-CT scan including aortic valve, thoracic aorta and coronary arteries. We measured the aortic valve annulus, sinus of valsalva, sinotubular junction, the diameters of ascending and descending aorta, aortic unfolding, the height of ostium of RCA and LCA and diameter of right and left coronary artery ostia in patients with fibromuscular dysplasia and compared them to matched controls. Results The FMD group had significantly smaller dimensions of aortic valve annulus and sinus of Valsalva than control group (2.3 [2.1–2.6] vs 2.9 [2.7–3.1] p&amp;lt;0,0001; 2.9 [2.7–3.2] vs 3.1 [2.8–3.3] p=0,0011 respectively). In addition the FMD group had a significantly greater mean diameter of the ascending and the descending aorta than the control group (3.1 [2.7–3.3] vs 3 [2.9–3] p=0,0436; 2.4 [2.2–2.7] vs 2.3 [1.8–2.5] p&amp;lt;0,0001 respectively). The height of the ostium of the left and of the right coronary artery was smaller in FMD than in the control group (1.2 [1.1–1.4] vs 1.3 [1.2–1.4] p=0,0001; 1.1 [1–1.3] vs 1.3 [1.1–1.4] p&amp;lt;0,0001 respectively). There was no difference in the diameter of sinotubular junction and the right and the left coronary artery ostias between the FMD and control groups (2.7 [2.5–2.9] vs 2.7 [2.5–2.9]; 0.3 [0.2–0.3] vs 0.3 [0.2–0.3]; 0.3 [0.3–0.3] vs 0.3 [0.3–0.4] respectively). Conclusions Patients with fibromuscular dysplasia display smaller dimensions of aortic valve and larger diameter of ascending and descending aorta as compared to control subjects. Despite the predominant clinical significance of focal pathologies in FMD patients, the disease may display a specific, pan-vascular phenotype. Funding Acknowledgement Type of funding source: None

Ostium Characteristics and Its Relevance in Successful Outcome Following Endoscopic Dacryocystorhinostomy.

Study aims to assess the postoperative ostium shrinkage pattern and also attempted to evaluate various ostium parameters and their impact on surgical outcome by using DOS scoring system. Prospective study comprising 44 patients of NLD obstruction with 52 procedures performed during October 2016 to November 2018. Various dimensions of bony neo-ostium were recorded intraoperatively and during 1st, 3rd and 6th month follow up. Degree of ostium shrinkage and its correlation with anatomical and functional success was studied. DCR ostium (DOS) scoring system, comprised of ten various ostium parameters, was used to evaluate postoperative ostium. Intraoperative mean ostium height and width were 13.67 ± 2.76mm and 7.0 ± 1.94mm and surface area was 98.33 ± 38.46 mm2. Maximum ostium shrinkage (by 66.93%) occurred at 1month and after which, average size of ostium was quite stable with little change. The anatomical and functional success rate was 94.23% and failure rate was 5.77%. DOS score was "excellent" in 40(75.92%), "good" in 9(17.31%) and "poor" in 3(5.77%) cases. Meticulous evaluation at regular intervals is important for surgeon to understand the characters of ostium during healing and also helps in early detection of pathologies and may facilitate early corrective intervention. We believe that DOS system provides an effective protocol to standardize the ostium evaluation. The ostium parameters with favourable surgical outcome are ostium location anterior to axilla of MT, circular/ oval shape with shallow base, size > 8 × 5mm, clearly visualized and dynamic ICO, absence of ostium cicatrization, granulomas, synechiae and other pathologies.

Three-dimensional geometry of coronary arteries after arterial switch operation for transposition of the great arteries and late coronary events

ObjectiveUsing 3-dimensional (3D) modeling to predict late coronary events after the arterial switch operation (ASO) for transposition of the great arteries (TGA). MethodWe reviewed 100 coronary computed tomography scans performed after ASO randomly selected from free-from-coronary-event patients and 21 coronary computed tomography scans from patients who had a coronary event later than 3 years after ASO. Using 3D modeling software, we defined and measured 6 geometric criteria for each coronary artery: Clockwise position of coronary ostium, First centimeter angle defined as the angle between of the coronary artery ostium and the first centimeter of the vessel, Minimal 3D angle between the coronary first centimeter and the aortic wall, ostium height defined as the distance between the ostium and the aortic valve, distance between the coronary ostium and the pulmonary artery, and distance between the coronary first centimeter and the pulmonary artery. ResultsNone of the right ostium geometric parameters were associated with coronary events. Four out of 6 criteria of left coronary artery geometry were associated to coronary events: Clockwise position of the left ostium >67° (P < .001), First centimeter angle >62° (P < .01), minimal 3D angle <39° (P = .003), distance between the coronary ostium and the pulmonary artery <1 mm/mm (P = .03). The association of first centimeter angle >62° and minimal angle in 3D <39° had a 88% sensitivity and a 81% specificity to predict coronary events (receiver operator characteristics curve, 0.847; 95% confidence interval, 0.745-0.949; P < .001). ConclusionsThe acquired geometric characteristics of the transferred left coronary artery are associated with coronary events. Imaging coronary arteries after ASO might be useful to select patients at higher risk of coronary events and to tailor surveillance.

Computed Tomography-based evaluation of porcine cardiac dimensions to assist in pre-study planning and optimized model selection for pre-clinical research

The pig (Sus Scrofa Domestica) is an accepted model for preclinical evaluation of prosthetic heart valves and trans-catheter implantation techniques. Understanding porcine cardiac dimensions through three-dimensional computed tomography (CT), increases preclinical study success, leading to higher cost efficiency and to the observance of the obligation to the 3 R principles. Cardiac CT images of twenty-four Swiss large white pigs were segmented; aortic root, mitral valve, pulmonary trunk, tricuspid valve, as well as the aorto-mitral angle and left atrial height were analyzed. Correlation coefficient (r) was calculated in relation to body weight. In Swiss large white pigs, valvular dimensions, length of the pulmonary artery and ascending aorta as well as left atrial height correlate with body weight. Coronary ostia heights and aorto-mitral angle size can be neglected in animal size selection; no changes were found for either of the two parameters with increasing body weight.

P218 Accuracy and reproducibility of aortic root assessment by eSie Valves in patients candidate to transcatheter aortic valve implantation: a comparative study with computed tomography

Abstract Background Accurate imaging assessment of the aortic root (AR) is critical for prosthesis sizing in transcatheter aortic valve implantation. Multislice computed tomography (MSCT) is the gold standard for this purpose. 3D transesophageal (3D-TOE) reconstruction tools have recently been introduced, which automatically configures a geometric model of AR from 3D-TOE dataset and perform quantitative analyses of the AR. Purpose The aim of the study was to compare semi-automated measurements of AR obtained by eSie Valves (EV) (Siemens Medical Solution, California, USA) tool with MSCT. Methods We prospectively enrolled 26 consecutive patients (mean age 79.5 ± 7.5 years; 38% men) with severe symptomatic aortic stenosis (mean gradient 48.8± 13.6 mmHg) who underwent both 3D-TOE and MSCT as part of TAVI evaluation protocol. Volumetric datasets of the AR, acquired with 3D-TOE in mid-esophageal view, were analyzed with EV tool. EV tool automatically detected AR landmarks and, after user validation, created 3D model of AR providing values of area, perimeter, diameters of aortic annulus (AA) and coronary ostia heights (Fig 1). Results EV tool analysis on 3D-TOE volumetric data sets was feasible in all patients. Strong correlation between EV tool and MSCT assessment for AA major diameter (r = 0.79), AA minor diameter (r = 0.81), AA perimeter (r = 0.89) and AA area (r = 0.89) (all p&amp;lt; 0.0001) was found. On average EV tool underestimated MSCT measurements of AA major diameter (1.2 mm, 4.5%), AA minor diameter (2.6 mm, 11.3%), AA perimeter (4 mm, 5.2%) and AA area (65.3 mmq, 13.6%). Moderate correlation between the two methods, already in this initial sample, for right coronary artery ostium height (r = 0.53, p = 0.007) was discovered. Finally, weak correlation for left coronary artery ostium height (r = 0.33, p = 0.1) was revealed. EV tool measurements from two different volumetric datasets of the same patient showed an excellent reproducibility intraclass correlation coefficient (ICC) for AA area 0.94 and ICC for right coronary height 0.98. Conclusion With these initial results EV tool could be used in clinical practice for quick and reliable assessment of AA area, perimeter and diameters. A larger group of patients will be needed to assess the consistency of coronary ostia height evaluation by EV tool. Abstract P218 Figure. eSie Valve landmarks and 3D model of AR

Evaluation of the Relationship of Dimensions of Maxillary Sinus Drainage System with Anatomical Variations and Sinusopathy: Cone-Beam Computed Tomography Findings

Objective: The aim of this study was to evaluate the correlation between the length of the infundibulum and ostium height with the anatomic variations of osteomeatal complex (OMC) and sinus pathology using cone-beam computed tomography (CBCT). Methods: CBCT images of 204 patients (408 maxillary sinuses) were evaluated retrospectively. The height of the ostium and the length of the infundibulum were measured. The presence of maxillary sinus pathology, nasal septal deviation, Haller cells, concha bullosa, and sinus septa were analyzed. The correlation between the size of the maxillary sinus drainage system and anatomic variations was compared using the t test, Fisher’s exact test, and χ² test. The effect of tooth loss on the length of the infundibulum and ostium height was also analyzed using ANOVA. Results: The height of the ostium and the maximal septal deviation angle were found to be significantly greater in males (p < 0.05). As ostium height increased, the presence of maxillary sinus septa increased (p < 0.05). No statistically significant association was detected between other variations and the length of infundibulum or ostium height. The relationship between tooth loss and both the length of the infundibulum and ostium height were found to be insignificant (p > 0.05). Conclusions: Radiographic examination, especially on CBCT images, is important for an evaluation of maxillary sinuses. here, we demonstrated a significant relationship between ostium height and the presence of maxillary sinus septa. However, it was found that nasal septal deviation, concha bullosa, Haller cells, and other sinusopathies did not have a major effect on the size of the maxillary sinus drainage system.

Modeling risk of coronary obstruction during transcatheter aortic valve replacement

ObjectiveIn this study we aimed to evaluate risk of coronary obstruction during transcatheter aortic valve replacement and develop improved criteria based on computational modeling. MethodsPatient specific 3-dimensional models were constructed and validated for 28 patients out of 600 patients who were flagged as high risk for coronary obstruction (defined as meeting coronary ostium height < 14 mm and/or sinus of Valsalva diameter [SOVd] < 30 mm). The models consisted finite element analysis to predict the post- transcatheter aortic valve replacement native cusp apposition relative to the coronary ostium and were validated in vitro. The distance from cusp to coronary ostium (DLC) was derived from the 3-dimensional models and indexed with the coronary artery diameter to yield a fractional obstruction measure (DLC/d). ResultsTwenty-two out of 28 high-risk patients successfully underwent transcatheter aortic valve replacement without coronary obstruction and 6 did not. DLC/d between the 2 groups was significantly different (P < .00078), whereas neither coronary ostium height nor SOVd were significantly different (P > .32). A cutoff of DLC/d < 0.7 was predictive with 100% sensitivity and 95.7% specificity. The optimal sensitivity and specificity of coronary ostium height and SOVd in this high-risk group was only 60% and 40%, respectively, for cutoff coronary ostium height of 10 mm and SOVd of 30.5 mm. ConclusionsThree-dimensional modeling has the potential to enable more patients to be safely treated with transcatheter aortic valve replacement who have a low-lying coronary ostium or small SOVd. DLC/d is more predictive of obstruction than coronary ostium height and SOVd.

An alternative solution for patient with high risk of coronary obstruction underwent TAVI procedure using a novel second-generation device \u2013 a case series

BackgroundObstruction of the left or right coronary artery is a rare but lethal complication during transcatheter aortic valve implantation (TAVI). The new J-Valve™ prosthesis is a new second generation TAVI device which has several features to avoid the coronary obstruction such as low profile design and clip fixation of the native leaflets. The aim of this study is to report our initial experience of using this valve in treating patient with high risk factors for coronary obstruction during TAVI procedure.Case presentationThree high surgical risk patients (All females with 77, 76, and 75 years old) with symptomatic aortic stenosis were enrolled. All patients have the common feature of low coronary ostium height (< 10 mm) with narrowed aortic sinus (< 30 mm) on CT angiogram and marked leaflet calcification. Three 25 mm J-Valve prostheses were successfully implanted through trans-apical approach. No coronary obstruction was noted for these patients. Effective aortic open area was significantly increased after valve implantation (Preoperative 0.7, 0.7 and 0.65 cm2 – Postoperative 1.8, 1.9 and 2.0 cm2). Only one patient was noted to have trivial degree paravalvular leakage.ConclusionThe new J-Valve prosthesis is a new second generation TAVI device. This system may provide another safety treatment option for patient with high risk factor for coronary obstruction underwent TAVI procedure.

600.05 3D Computational Model to Predict Risk of Coronary Obstruction During TAVR

Current prediction of coronary obstruction during transcatheter aortic valve replacement (TAVR) based on coronary ostium height (h) and sinus of Valsalva diameter (SOVd) is unspecific and overly conservative, leading patients to be excluded even if they could potentially benefit from TAVR. In this

Morphological variations of the interatrial septum in ovine heart.

Smooth septum interatrial septum, patent foramen ovale (PFO) channel and atrial septal pouches (SPs) are commonly described variants in humans. Recent discoveries on the clinical significance of left-sided SP may encourage the creation of new strategies and devices for the management of SPs. However, these strategies may first be tested in the ovine model before implementation in humans. Unfortunately, little is known about the presence of SPs in ovine. In this study a total of 60 ovine (Ovis aries) hearts were examined. The interatrial septum morphology was assessed and the PFO channel and SPs were measured. The most commonly occurring variant were PFO channels (25.0%) with channel lengths of 5.4±2.3 mm. Smooth septums were observed in 18.3% of hearts. In the remaining cases, septums had a left septal ridge (15.0%), left SP (11.7%), left septal bridge (10.0%), right SP (10.0%), or had both a right SP and left septal ridge (10.0%). No double SPs were observed. The mean right SP depth was 3.4 ± 1.2 mm, and its mean ostium width and height were 7.9±1.8 mm and 2.8±1.0, respectively. For the left SP, the mean depth was 6.0±1.7mm, the ostium width was 7.9±2.4mm, and the ostium height was 4.1±1.6mm (range: 2.3–6.4mm). In conclusion the interatrial septum of ovine hearts exhibit morphologies that are more similar to humans than they are to swine, which should be taken into account during experimental studies. The presence of a left SP in sheep hearts make ovine models a promising alternative to the human heart for developing left-sided SP management devices and techniques.

Investigation on the relationship of dimensions of the maxillary sinus drainage system with the presence of sinusopathies: a cone beam computed tomography study

ObjectiveThis study sought to assess the relationship between the dimensions of the maxillary sinus drainage system with the content of sinuses. DesignThree-hundred cone beam computed tomography images were selected from a database (105 males and 195 females). The images were assessed by a single investigator, trained and calibrated, performing image analysis. The length of the infundibulum and the ostium height in both maxillary sinuses were measured. The data were analyzed using Minitab 16, using 5% as a critical p-value. ResultsA significant gender difference was also found for presence in the normal content of sinus for females and presence of antral pseudocyst for males (p < 0.05). Subjects with normal content in the maxillary sinus present lower ostium height values. There were statistically significant with presence of and higher ostium height values and antral pseudocyst (p < 0.01). ConclusionThe current study results demonstrated that some sinusopathies were significantly related to dimensions of maxillary sinus drainage.

CT aortic annulus parameters for pre-operative TAVI assessment: A comparative study between manual post processing and automated software tool

ObjectiveA comparative study of manual and automated post processing software tools to measure CT parameters before Transcatheter Aortic Valve Implantation (TAVI). Patients and methods51 patients were included; all admitted to the Cardiology Department with clinically established severe aortic stenosis, in whom TAVI was the treatment of choice. All patients underwent CT angiography (CTA) pre-TAVI. The CT images were post processed and the needed CT parameters were calculated using both manual and automated methods. The results were compared for statistical analysis. ResultsOnly 43 patients completed the study, with mean age 65 years old. The automated software provided accurate almost similar results as the manual method, especially for aortic annulus area and aortic circumference measurements (p-value = 1 and 0.548) and was accepted for left and right coronary artery ostium height (p-value = 0.191 and 0.635).However, there was a statistically significant difference for the minor diameter axis and mean annular diameter (p-value = 0.001 and 0.021). ConclusionThe automated software introduced rapid, accurate and reliable measurements for the aortic annulus in cases prepared for TAVI and can be used as a standard method. Also, it can be performed by junior staff with avoidable human errors.

Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement: A systematic review.

Coronary occlusion (CO) is a rare but serious complication following transcatheter aortic valve replacement (TAVR) with limited published data. We sought to evaluate the immediate and short-term outcomes of CO complicating TAVR. Studies, including case reports, case series and original articles published from 2002 to 2016 describing CO following TAVR were identified with a systematic electronic search using the PRISMA Statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. A total of 40 publications describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean age was 83±7years and most (81%) were females. The mean logistic EuroSCORE and STS score was 23.5±14.6% and 9.1±3.2% respectively. TAVR access site was transfemoral in 73% and a balloon expandable valve was used in 78%. Among those with LCA occlusion, the mean LCA ostium height was 10.1±1.8mm while the mean RCA ostium height was 10.4±2.0mm among those with RCA occlusion. CO frequently involved the left main coronary artery (80%) and the most common mechanism was displacement of native valve leaflet (60%), and most cases occurred within 1-hour post-implantation (88%). Percutaneous coronary intervention was attempted in 82 patients and successful in 89%. Procedural death was 10.4%. CO following TAVR in native aortic valve stenosis was associated with a 30-day mortality rate of 35.3%. CO following TAVR is associated with a high procedural and 30-day mortality rate despite aggressive resuscitative measures including percutaneous coronary intervention.

Comparison study of three-dimensional transesophageal echocardiography and CT in measuring the size of aortic ring and the height of coronary ostium

Objective To investigate the difference between three-dimensional transesophageal echocardiography (3DTEE) and CT in measuring the size of aortic ring and the height of coronary ostium. Methods Fifteen patients were recruited and were treated with the transcatheter aortic valve implantation (TAVI). Routine transthoracic echocardiography,two-dimensional echocardiography (2DTEE),3DTEE and CT examinations were taken preoperatively. Results The minimal diameter,maximum diameter,perimeter,area of the aortic ring measured by 3DTTE showed a close correlation and a strong consistency with those measured by CT .The ostium height of the left and right coronary arteries measured by 3DTEE also showed a close correlation and a strong consistency with those measured by MDCT . Besides,inter-observer and intra-observer reproducibility for 3DTEE measurement data were very good. Conclusions 3DTEE has a high repeatability in evaluating minimal diameter,maximum diameter,perimeter,area of the aortic ring and the height of coronary ostium,which also shows good correlation with those measured by CT. Key words: Echocardiography,transesophageal,real-time three-dimensional; Aortic valve; Heart valve prosthesis implantation