Interventricular Groove Research Articles

Abstract PS15-08: Definition of a high risk cardiac zone on non-contrast computed tomography (CT) scans for indirect optimization of left anterior descending coronary artery (LADCA) dosimetry for breast radiotherapy

Abstract Background : Breast radiotherapy is associated with a cardiotoxicity risk which could be decreased by optimizing radiation dose to the left anterior descending coronary artery (LADCA). However, precise delineation of the LADCA on non-contrast computed tomography (CT) scans is complex and poorly reproducible. Purpose : This study aimed to define a reproducible “high risk cardiac zone” (HRCZ) which could straightforwardly replace LADCA delineation on non-contrast CT scans for treatment planning optimization. Additionally, we compared standard dosimetric parameters (mean and maximum doses) of the proposed HRCZ and of the LADCA. Materials/methods : Forty breast cancer patients treated with intensity-modulated radiation therapy (IMRT) were randomly selected from our institutional database. The LADCA was manually delineated on the non-contrast simulation CT scans according to ESTRO guidelines (Duane et al., 2017), to ensure reproducibility, and each contour was validated by a staff of three radiation oncologists. “High risk cardiac zones” (HRCZ) were defined as segments of the anterior cardiac wall, geometrically centered around the inter-ventricular groove where the LADCA anatomically lies (from top to bottom) with a constant 1cm-thickness and a symmetrical lateral expansion on both sides of the groove (HRCZ width). For each patient, eight “high risk cardiac zones” (HRCZ) were delineated differing by their width, ranging between 1 cm and 8 cm (by steps of 1cm). Mean and maximum doses to the LADCA and to the HRCZ were retrieved, and relative variations were calculated as follows, as a function of the HRCZ width: Mean dose relative variation = [mean dose (HRCZ) - mean dose (LADCA)]/mean dose (LADCA) Max. dose relative variation = [max. dose (HRCZ) - max. dose (LADCA)]/max. dose (LADCA) Results : Mean and maximum dose relative variations between HRCZ and LADCA are reported in table 1 as a function of HRCZ width, for left-sided and right-sided irradiation. For a given HRCZ width, LADCA radiation exposure can be straightforwardly deducted from HRCZ dosimetric parameters, by applying the corresponding dose adjustments. HRCZ had higher maximum doses than LADCA, independently of the width. However, for a HRCZ width larger than 4 cm, dosimetric adjustments for the maximum doses drastically increased for right-sided irradiation with a potential risk of non-representativeness. Conclusion : When planning breast radiotherapy on non-contrast CT scans, delineating a segment of the anterior cardiac wall centered on the inter-ventricular groove from top to bottom, with a 1cm thickness and a 3-4cm width, can replace LADCA uncertain contouring and can be conveniently used for indirect coronary sparing. Table 1: maximum and mean dose relative variation between the LADCA and the proposed HRCZHRCZ width (cm)Max. dose var. (left-sided RT)Mean dose var. (left-sided RT)Max. dose var.(right-sided RT)Mean dose var. (right-sided RT)15.3%-13.0%7.8%-1.4%212.6%-19.1%16.3%-2.4%319.1%-22.6%26.4%-2.8%424.8%-26.0%38.6%-2.8%529.0%-28.5%52.2%-2.2%629.0%-32.3%71.3%-1.1%729.9%-36.0%92.4%0.5%829.9%-38.8%118.3%2.8%Table 1: maximum and mean dose relative variation between the LADCA and the proposed HRCZ, as a function of the HRCZ width. HRCZ: “high risk cardiac zone”. LADCA: Left anterior descending coronary artery. Citation Format: Pierre Loap, Nicolas Tkatchenko, Eliot Nicolas, Youlia Kirova. Definition of a high risk cardiac zone on non-contrast computed tomography (CT) scans for indirect optimization of left anterior descending coronary artery (LADCA) dosimetry for breast radiotherapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS15-08.

ALCAPA: 3D MDCT presents an intuitive perspective

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is one of the rare congenital anomalies with exceptional presentation till adulthood. The complications include left ventricular dysfunction, severe mitral regurgitation and myocardial infarction. We report a case of a young female with dyspnea and murmur with left to right shunt which was finally diagnosed as ALCAPA by multi-detector cardiac computed tomography (MDCT). A 45-year-old female presented with dyspnoea on exertion New York Heart Association [(NYHA) II class] and chest heaviness for seven days. Physical examination reveals 2/6 systolic diffuse murmur over the left sided chest with predominance over the pulmonary area. Electrocardiogram (ECG) reveals sinus rhythm with infrequent premature ventricular contractions (PVCs) and echocardiography reveals left to right shunt flow with inconspicuous ends. Cardiac computed tomography (CT) study reveals very interesting and unusual findings. Only one coronary artery was found to originate from the aortic root (Figure 1A and Figure 1B). Right coronary artery (RCA) originates from the right coronary sinus as a large-sized and ecstatic artery with a highly tortuous course and abundant collaterals (Figure 1C). No coronary origin was detected from the left coronary cusp. Surprisingly, the left coronary equivalent artery was revealed, originating from the main pulmonary artery with course toward anterior interventricular groove and branching into left anterior descending and left circumflex coronary arteries with normal courses (Figure 1D and Figure 1E). Finally, cardiac CT unveiled the definitive diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA). Approximately 90% of the infants with ALCAPA die during the first year of their life and very few survive till adulthood [1]. The adult cohort of ALCAPA is increasing due to better advanced cardiac imaging techniques like multidetector computed tomography (MDCT). It is characterized by exuberance in collateral coronary circulation from RCA to left coronary artery (LCA); thus allowing survival up to adulthood, coronary “steal” phenomenon from RCA to LCA and pulmonary “steal” phenomenon as LCA to PA [2]. In the adult type of ALCAPA, re-establishment of dual coronary system by ligation of the LCA from the pulmonary artery with coronary artery bypass grafting and reimplantation of LCA coronary button to aorta with interposition graft are the preferred methods of surgical approach [3].

Dual left anterior descending coronary artery (type III) and the presence of myocardial bridges: a post-mortem examination

An observational examination of the heart was performed in the Department of Anatomy, during the routine autopsy of an 89-year-old man. The heart was fixed in 10% formalin and an analysis of arterial vasculature was performed (used morphometric abbreviations below [mm]: L - length; D - diameter of origin). Trifurcation of the left main coronary artery (L = 17.4; D = 8.1) was observed during the study, which originated in the left aortic sinus and was followed by three branches: proper left anterior descending artery (pLAD; L = 11.2; D = 7.4), intermediate branch (L = 98.6; D = 3.5) and left circumflex artery (L = 104.2; D = 4.9), respectively. In the pLAD division, there was noted LAD1 (long) which was running in the interventricular septum (L = 32.2) and further in the subepicardial segment (L = 109.3) in the anterior interventricular groove towards the apex (AC) (LAD1; L = 141.4; D = 6.3) and LAD2 (short) running subepicardial in the anterior interventricular groove in the AC direction (LAD2; L = 68.4; D = 3.2). Four diagonal branches (DB) and 9 septal perforators (SP) were observed in the course of LAD1; regarding the LAD2 there were 6 SP only. It is worth noting that the first SP supplying the interventricular septum came from LAD2. Another interesting aspect of the observation was the occurrence of 4 myocardial bridges on the LAD1, LAD2, DB1 arteries and on the second obtuse marginal branch (OM2), respectively. This case describes a rare anatomical anomaly of the LAD course and reminds clinicians of the need for careful planning of cardiac surgeries and percutaneous interventions on the coronary arteries.

Intra-Right Ventricle Course of the Coronary Arteries on Computed Tomography Angiography.

The clinical relevance and anatomic characteristics of intracavitary coronary arteries coursing within the right ventricle (RV) are largely unknown. The aim of our study was to assess the clinical and computed tomographic characteristics of patients diagnosed with intracavitary coronary arteries coursing within RV (intra-RV coronaries). Electronic records from a single high-volume cardiac center were retrospectively screened for the presence of intra-RV coronaries among consecutive patients who underwent coronary computed tomography angiography (coronary CTA) from 2008 to 2019. Overall, 31,748 coronary CTA reports were evaluated, and 17 subjects with intra-RV coronaries were identified. None of these patients was referred for subsequent invasive coronary angiography. One patient underwent coronary artery bypass grafting, 1 patient had a history of percutaneous coronary intervention, and 1 patient had a concomitant coronary anomaly: left circumflex coronary artery originating from the right coronary artery. All of the involved coronaries (n = 17) were the left anterior descending coronary arteries (LADs). Typical segmental coronary course within RV was along the border between free RV wall and interventricular septum (beneath interventricular groove), often within trabeculae carneae of the RV. Only the midsegment and distal segment of the LAD traversed within the RV. The mean ± SD distance from the aorta to the coronary entrance into the RV was 74.5 ± 17.1 mm, whereas the mean ± SD intra-RV coronary length was 25.1 ± 14.0 mm. Intra-RV course of the coronaries in an adult CTA population is an infrequent anatomical variant involving LAD. It may require additional attention during interventional and surgical interventions.

Coronary perivascular epicardial adipose tissue and major adverse cardiovascular events after ST segment-elevation myocardial infarction

Background and aimsPerivascular epicardial adipose tissue (pEAT) plays a key role in the progression of atherosclerosis, plaque rupture, and thrombosis. However, the relationship between pEAT and prognosis after revascularization of ST-segment elevation myocardial infarction (STEMI) is unknown. This study aimed to investigate the relationship between pEAT thickness and prognosis after STEMI. MethodsWe studied 180 STEMI patients (mean age 59.4 ± 13.3 years, 78.9% male) who underwent cardiac magnetic resonance (CMR) imaging within 1 week of prompt infarct-related artery revascularization and 52 age/sex/body mass index-matched controls (mean age 59.9 ± 13.5 years, 78.9% male). pEAT thickness indexed to body surface area at five locations, infarct size, left ventricular ejection fraction (LVEF), and coronary microvascular obstruction (MVO) were evaluated by CMR. Associations between pEAT index and 1-year composite major adverse cardiovascular events (MACE), infarct size, LVEF, and MVO were analyzed. ResultsMean pEAT indices were significantly higher in STEMI patients than controls. In STEMI patients, higher pEAT indices at the superior and inferior interventricular groove (SIVG and IIVG, respectively) were significantly associated with larger infarct size, higher prevalence of MVO, and inversely correlated with post-infarct LVEF. SIVG pEAT index was an independent predictor of composite MACE in post-STEMI patients with an odds ratio of 2.26 (95% confidence interval 1.63–3.13; p < 0.0001) after adjustment for age, sex, LVEF, and 2.71 (95% confidence interval 1.93–3.80; p < 0.0001) after adjustment for age, sex, previous myocardial infarction, diabetes mellitus, and renal function. ConclusionsSTEMI patients have significantly higher pEAT indices than controls. SIVG pEAT index independently predicts composite MACE in revascularized STEMI patients, underscoring the potentially prognostic value of this variable.

Gross and microscopic assessment of pre-paturent heart and lungs of the red Sokoto goat

The aim of this study is to determine the state of fetal preparedness to terrestrial life by studying the heart and lung of the red Sokoto goat fetus and to establish approximate fetal survival age. In this study, the cardiopulmonary status of fifty (50) red Sokoto goat fetuses recovered post slaughter were assessed. Grossly, the heart in 6 to 7 weeks old fetuses showed external divisions of the paraconal and subsinosal interventricular grooves, great vessels at the base and pointed apex. The full lobations of the lungs were identifiable. Microscopically, the cardiac fibers are arranged in a branching fashion with centrally located nuclei and large perimysial spaces. The alveolar cells were emerging with establishment of the apparatus. By 14 to 15 weeks of age, the alveoli cells were well established with well developed respiratory bronchioles. Similarly, cardiac fibers were developed with recognizable cross striation and greatly reduce perimysial spaces. Both the macroscopic and microscopic findings on the fetal heart and lungs of a day-old kid were similar to the findings observed on 14 to 15 weeks old fetuses. This therefore suggests that, in the event of a premature kidding at 14 to 15 weeks of gestation, the red Sokoto goat fetus could cope with extra uterine life, with adequate veterinary care.

Coronary dominance pattern in Myocardial bridged hearts

Posterior interventricular artery (PIA) present in the posterior interventricular groove over the inferior surface of the heart. Human hearts consist of either Right coronary predominance or Left coronary predominance. Left coronary predominant people are more prone to get ischemic heart diseases. In left coronary predominance entire left ventricle except a part of the right ventricle adjoining anterior interventricular groove supplied by the left main coronary artery. Left coronary dominance has a poor prognosis in acute coronary syndrome when compared with the right coronary predominance. Myocardial bridging may be benign or malignant. So myocardial bridging with left coronary dominance may be a risk factor to the ischemic heart disease. The aim of the present study is to find out the coronary dominance pattern in myocardial bridged hearts in cadavers. Ninety cadaveric hearts were procured from the Department of Anatomy, IMS &amp; SUM Hospital Bhubaneswar. After a simple dissecting procedure, myocardial bridges and coronary dominance patterns were observed. Myocardial bridging was present over the left anterior interventricular artery in 51(56.7%) hearts. Out of 51 myocardial bridged hearts, right coronary predominance is present in 45 (88.24%) hearts and left coronary predominance present in 6(11.76%) hearts. Along with the left dominance, if myocardial bridge present over the left epicardial coronary artery, there may be an increased frequency of myocardial ischemia.

Heart anatomy and topography of the common marmoset (Callithrix jacchus Linnaeus, 1758).

The morphological study of wild animals serves as a base for more advanced studies in clinical medicine, surgery, and pathology. Due to an urgent need and demand for professionals specialized in this area, studies of this nature have become indispensable and so the objective of the present study was to describe the heart morphology of Callithrix jacchus. Ten anatomic pieces of common marmoset were used. The hearts were removed and dissected for better visualization and thus to makes a detailed description of the structures of the organ of the Cjacchus species. The Cjacchus heart is similar to that of other mammals, with small anatomical modifications such as division of the apex by the interventricular grooves, shallow fossa ovalis, and less salient intervenous tubercle. This study may serve as taxonomic base for research and also as a basis for clinical and surgical procedures with the Cjacchus.

P876 I may still steal you : huge coronary cameral fistula (non-dominant right coronary artery to right ventricle) in a neonate causing heart failure

Abstract Funding Acknowledgements Not applicable OnBehalf Not applicable A 25 days old neonate, weighing 2.8kg was brought with complaints of feeding difficulties, not gaining birth weight and rapid breathing. The parents had not noticed any cyanosis. He was further referred to us as the treating paediatrician heard a pansystolic murmur over the left sternal border. When examined, baby was afebrile, tachypnoea (70 per minute), regularly tachycardia(180bpm). We did not appreciate any dysmorphism. On cardiovascular examination we found a mild cardiomegaly, RV S3, mild hepatomegaly with no signs of active infection. Systemic saturations were 98% in all limbs. Other systemic examinations were essentially normal. 12 lead ECG showed, physiological RV dominance, with no signs of LV volume overload. Chest radiograph showed cardiomegaly of RV type with adequate PBF. 2 D echocardiogram : The intra-cardiac structures were found to be normal. A huge coronary-cameral fistula originating from RCA, traversing in right AV groove and draining into the RV with mild RV enlargement. No signs of PAH. Biventricular function was preserved. CT coronary angiogram : CT confirmed the presence and anatomy of the RCA—RV fistulous tract seen on echocardiography. The fistula measured ∼ 6mm at the origin and 3.5mm at the point of entry into RV. As we could not see any PDA arising from RCA and a twig from LCX traversing in interventricular groove, we thought it’s a left dominant coronary circulation. Hemodynamics in the index case The symptoms of heart failure in the index neonate is due to the volume overload on the RV. The non-dominance of RCA is probably a blessing in disguise for this baby in preventing coronary steal. The "steal phenomenon" will be apparent once the physiological (high) PVR comes down. Plan Baby is on diuretics and nutritional support, under weekly follow up. We will be performing catheter study (around 12 weeks of life or as per clinical indications) to look for dominance and need/feasibility of device closure. Abstract P876 Figure.

The evaluation of epicardial adipose tissue radiodensity according to age

Aim: The grading of fatty degeneration by cardiac computerized tomography (CCT) is an important bioradiological marker to discriminate biological characteristics. Epicardial adipose tissue (EAT) degeneration has been accused of causing heart disease. However, the relationship between age and EAT radiodensity is not well known. In this study we examined epicardial adipose tissue radiodensity with CCT. Methods: A total of 147 subjects who underwent contrast-enhanced evaluation of coronary arteries with CCT between Jun 2018-July 2019 due to intermediate probability of coronary artery disease (CAD) were included in this retrospective cohort study. The radiodensities of three epicardial regions (right atrioventricular groove, posterior interventricular groove, and anterior epicardial area) and individual subxiphoid fat radiodensity ratios were obtained. Group comparisons were made according to 10-year-periods (between 10- 80 years of age). Results: We found that epicardial adipose tissue/ subxiphoid fat radiodensity ratio decreased with increasing age. After the 3rd decade, we detected a negative correlation between EAT/subxiphoid fat radiodensity ratio (r=-0.11). The radiodensity ratios of patients between 20-30 and 30-40 years of age in the LCX, RCA and anterior epicardial regions were 1.71 (0.14) and 1.06 (0.40) (P

A new measurement site for echocardiographic epicardial adipose tissue thickness and its value in predicting metabolic syndrome.

Echocardiographic epicardial adipose tissue (EAT) thickness is defined as the thickness of the low-isoechoic area on the free wall of the right ventricle in the parasternal long-axis and short-axis views. Recent studies have suggested that it might support current risk stratification strategies in identifying an increased risk of metabolic syndrome. The aim of this study is to explore a new measurement site which can better reflect EAT thickness and to assess its value in predicting metabolic syndrome. A total of 975 Chinese adults were measured for EAT thickness on the right ventricular anterior free wall (EAT-rv) and on the anterior interventricular groove (EAT-ivg) with echocardiography. The correlation between EAT thickness and metabolic syndrome was analyzed, as was the agreement between epicardial adipose volume (EAV) and EAT thickness. Independent risk factors of EAT thickness were identified and the predictive value of EAT thickness was assessed. Epicardial adipose tissue thickness was higher in older participants and those with obesity, diabetes, hypertension, hypertriglyceridemia, and metabolic syndrome, and it was lower in male participants. The EAT-ivg was higher in the participants with hypo-high-density-lipoprotein cholesterolemia than in those without the disorder, but the EAT-rv values were not statistically different. The kappa value was 0.524 between EAT-rv and EAV, and 0.783 between EAT-ivg and EAV. Advanced age, large waist circumference and female gender were independent risk factors of high EAT-ivg, while high-density-lipoprotein (HDL) cholesterol was a protective factor. The EAT-ivg was associated with metabolic syndrome. The area under the curve of EAT-ivg applied in predicting metabolic syndrome was greater than that of EAT-rv (0.715 vs 0.648). The EAT-ivg was more consistent with EAV than EAT-rv, was independently associated with metabolic syndrome and had a higher value in predicting metabolic syndrome than EAT-rv. Therefore, the anterior interventricular groove can serve as a new measurement site which better reflects EAT thickness.

Epicardial adipose tissue thickness as an independent predictor of ventricular tachycardia recurrence following ablation

Although several investigations have shown a relationship between increased epicardial adipose tissue (EAT) and atrial fibrillation (AF), the association between EAT and ventricular tachycardia (VT) has not been evaluated. We investigated the association between EAT and postablation VT recurrence. Sixty-one consecutive patients (mean age = 62.0 ± 13.9 years) undergoing VT ablation with preprocedural cardiovascular magnetic resonance imaging (CMR) were recruited. EAT thickness was measured using CMR in the right and left atrioventricular grooves (AVGs), right ventricular free wall, and anterior, inferior, and superior interventricular grooves. During a mean follow-up period of 392.9 ± 180.2 days, postablation VT recurrence occurred in 15 (24.6%) patients. EAT thickness was significantly higher in the VT recurrence group than in the nonrecurrent VT group at the right (18.7 ± 5.7 mm vs 14.1 ± 4.4 mm; P = .012) and left (13.3 ± 3.9 mm vs 10.4 ± 4.1 mm; P = .020) AVGs. The best cut-off points for predicting VT recurrence were calculated as 15.5 mm for the right AVG (area under receiver operating characteristic [ROC] curve = 0.74) and 11.5 mm for the left AVG (area under ROC curve = 0.72). Multivariate Cox regression analysis showed that preprocedural right AVG-EAT (hazard ratio: 1.2; 95% confidence interval: [1.06-1.39], P = .004) was the only independent predictor of VT recurrence after adjustment for covariates. Kaplan-Meier analysis showed a difference for postablation VT recurrence between the 2 groups, with right AVG-EAT thickness cut-off value of <15.5 mm vs ≥15.5 mm (log-rank, P = .003). We suggested a new possible imaging marker for risk stratification of postablation VT recurrence. A higher EAT may be associated with VT recurrence after catheter ablation of VTs.

Characterization of coronary arteries in Giant Anteater (Myrmecophaga tridactyla: Myrmecophagidae)

ABSTRACT Were used twelve (12) adult anteaters (Myrmecophaga tridactyla), adults, 6 (six) males and 6 (six) females, weighing from 20 to 27.32kg from free life. The thoracic cavity was opened until visualization of the whole heart and lungs and later injection of the coronary vessels. The right coronary artery emerged through a single coronary ostium of the aorta, 50%, emitting the intermediate branch and the subsinuous interventricular branch, had a path directed to the subsurface interventricular groove. In the other 50%, the right coronary artery was not present, showing only its branches, intermediate branch and subsurface interventricular branch with emergence of the aorta. Left coronary artery presented, in 83.33%, origin from the aorta in single ostium, issuing the circumflex and interventricular paraconal branches. In 16.66%, the left coronary artery was not evidenced originating from the aorta, but its branches, circumflex and interventricular paraconal.

Topography of coronary arteries and their ramifications in the goat

The aim of this study was to investigate the morphology of the coronary arteries of the goat’s heart. The study was carried out on 36 hearts of adult females dairy goats, belonging to two breeds, aged 7–12 years, with an average body weight of 37 kg. A distinct view of coronary arteries and their branches was obtained by filling them with dyed synthetic latex (LBS 3060) or Batson’s No. 17. In all studied goats the common trunk of the left coronary artery was divided into the interventricular paraconal branch and the circumflex branch. The branch of the interventricular septum originated in the interventricular paraconal branch. In 25 individuals (69%) the circumflex branch ended with small ramifications on the atrial surface of the heart. In 11 individuals (31%), the vessel extended in the subsinuosal interventricular groove into the subsinuosal interventricular branch. The right coronary artery was less developed than the left coronary artery. In 35 individuals (97%) the right coronary artery ended with small ramifications on the atrial surface of the heart. In one goat (3%) the vessel reached the subsinuosal interventricular groove and extended into the subsinuosal interventricular branch.

A rare injury pattern on heart in a lightning death-A case report

Lightning strikes are one of the leading causes of death due to natural disaster in Odisha, India. This is a case report describing an elderly female who died on the spot along with a co-worker while working in the field due to lightning strike. No specific keraunopathologic features were found externally. However, on heart, a linear contusion along the interventricular groove with rupture at its apex was observed. Since the event was witnessed, the cause and manner of death could not be disputed.

PDA (Posterior Descending Artery) &amp; Coronary Dominance-A MDCT Coronary Angiographic Analysis of Anatomic Variations and Clinical Importance

Introduction: There is considerable variation in the arterial supply of diaphragmatic surface of the heart. Diaphragmatic myocardial infarction is one of the more common consequences of coronary artery disease. The aim of this study was to assess the incidence of anatomic variants of origin and termination of Posterior Descending Artery (PDA) and to determine the type of coronary dominance in North Indian population. Subjects and Methods: This prospective study was carried out on 50 routine subjects of different age groups who came to the Department of Radiodiagnosis, King George’s Medical University UP, Lucknow in the year 2010- 2011 with known or suspected coronary artery disease. All the cases were investigated on a 64 slice Multidetector Computed Tomographic (MDCT) scanner, using retrospective Electrocardiographic gating. Endeavour was made to determine the incidence of sites of origin and termination of PDA as well as to determine the type of coronary dominance. Results: PDA arose from Right Coronary Artery (RCA) in 39 (78%) cases and from Left Circumflex (LCx) artery in 11(22%) cases. The PDA was found to terminate in the upper 1/4 of Posterior Inter-Ventricular Groove (PIVG) in 18 (36%) cases, in upper 1/2 of PIVG in 19 (38%) cases, in upper 3/4 of PIVG in 10 (20%) cases and at the apex of the heart in 1 (2%) case. None of the female had termination of PDA at the apex. Termination of PDA could not be determined in 2 (4%) cases. Right dominance was seen in 36 (72%) cases, Left dominance in 11 (22%) cases. and Co-dominance in 3 (6%) cases. Conclusion: Posterior descending artery most commonly terminated after traversing the upper half of posterior inter-ventricular groove. The incidence of left coronary dominance was more in females, it was approximately twice the incidence found in males. Co-dominance was observed only in male subjects.

Dual Left Anterior Descending Artery with abberrent left circumflex artery: dual abberrency- a multi-modality imaging based identification.

Dual left anterior descending (LAD) artery with separate origin of the long LAD with left main coronary artery (LMCA) continuing as short LAD is very rare. A 67-year-old diabetic, and hypertensive male was admitted with history of exertional dyspnoea. He underwent coronary angiography, which showed LMCA continuing as short LAD with early termination while single trunk from right coronary sinus was giving rise to long LAD, right coronary artery, and left circumflex artery (LCx). The long LAD, running on the right side of the anterior interventricular groove, entered the groove distally while anomalous LCx which was dominant, was following a retro-aortic course. These were subsequently confirmed on Multidetector computed tomography angiography (MDCT). Therefore, dual LAD with long LAD, dominant anomalous circumflex artery, and right coronary artery sharing a single, and common origin is very rare and to the best of our knowledge, is being reported for the first time.

Predictors of post-operative atrial fibrillation in patients undergoing cardiac surgery: the potential role of epicardial adipose tissue

Background: Post-operative atrial fibrillation (POAF) is a common complication following cardiac surgeries, however current risk factors lack predictive accuracy. Our aim was to investigate whether computed tomography (CT) measurement of epicardial adipose tissue (EAT) improves risk prediction over clinical predictors of POAF. Methods: Fifty-six patients who underwent aortic valve replacement (AVR) and/or coronary artery bypass graft (CABG) during 2013 to 2015 were identified retrospectively. Peri-operative clinical characteristics were collected, and epicardial fat dimensions were measured using CT. Results: POAF occurred in 27 patients (48.2%). The incidence of POAF was greater in patients undergoing CABG with or without AVR compared to AVR alone (64% vs. 32%, P=0.018). Univariate logistic regression model showed CHA2DS2-VASc score [odds ratio (OR): 1.629; 95% CI: 1.086–2.443; P=0.018] and EuroSCORE II (OR: 1.528; 95% CI: 1.006–2.320; P=0.047) to be significantly associated with POAF. Between-group analysis showed left atrial (LA) diameter was significantly associated with POAF compared to no-POAF (4.18±0.74 vs. 3.74±0.36 cm; P=0.047). The sum of right coronary artery fat pocket and inferior interventricular (IV) groove was higher in POAF patients (7.75±1.70 vs. 6.87±2.27; P=0.05). A novel scoring system comprising EuroSCORE II, CHA2DS2-Vasc and LA diameter was created which was significantly associated with POAF risk compared to CHA2DS2-Vasc alone (receiver operator curve AUC 0.804; 95% CI: 1.162–15.180; P=0.029). However, adding EAT to the POAF scoring system did not improve the risk prediction model for POAF (AUC 0.79; 95% CI: 1.083–12.998; P=0.037). Conclusions: A novel POAF prediction scoring system including LA diameter, EuroSCORE II and CHA2DS2-Vasc was strongly associated with POAF and may be a useful clinical tool when planning cardiac surgery. Addition of EAT did not improve risk prediction beyond clinical predictors. Further large-scale studies are required to assess the validity and usefulness of the scoring system.

Echocardiographic measurements of epicardial adipose tissue and comparative ability to predict adverse cardiovascular outcomes in patients with coronary artery disease

The present study aimed to compare echocardiography measurements of epicardial adipose tissue (EAT) thickness and other risk factors regarding their ability to predict adverse cardiovascular outcomes in patients with coronary artery disease (CAD). Outcomes of 107 patients (86 males, 21 females, mean age 63.6 years old) submitted to diagnostic echocardiography and coronary angiography were prospectively analyzed. EAT (measures over the right ventricle, interventricular groove and complete bulk of EAT) and left ventricle ejection fraction (LVEF) were performed by echocardiography. Coronary complexity was evaluated by Syntax score. Primary endpoints were major adverse cardiovascular events (MACE’s), composite of cardiovascular death, myocardial infarction, unstable angina, intra-stent re-stenosis and episodes of decompensate heart failure requiring hospital attention during a mean follow up of 15.94 ± 3.6 months. Mean EAT thickness was 4.6 ± 1.9 mm; and correlated with Syntax score and body mass index; negatively correlated with LVEF. Twenty-three cases of MACE's were recorded during follow up, who showed higher EAT. Diagnostic ability of EAT to discriminate MACE's was comparable to LVEF (AUROC > 0.5); but higher than Syntax score. Quartile comparison of EAT revealed that measurement of the complete bulk of EAT provided a better discrimination range for MACE's, and higher, more significant adjusted risk (cutoff 4.6 mm, RR = 3.91; 95% CI 1.01–15.08; p = 0.04) than the other risk factors. We concluded that echocardiographic measurement of EAT showed higher predicting ability for MACE’s than the other markers tested, in patients with CAD. Whether location for echocardiographic measurement of EAT impacts the diagnostic performance of this method deserves further study.

Variations in the Left Coronary Artery

Background : There is a large spectrum of variations in the disposition of coronary arteries. Many of these variations are 'normal' and not considered as 'anomalous'1. These variations mainly occur in the Left Coronary Artery (LCA)2. While some of these are benign and have no clinical consequences, other variants can cause important clinical manifestations including sudden death of the individual3. Lack of knowledge of such variations can pose difficulties in percuteneous coronary arteriography, coronary artery bypass surgery or prosthetic valve replacement. A cadaveric study in unsuspected population can help to understand the variations that will be useful to determine the prevalence of certain variations. Thus the objective of this study was to analyze the characteristics of LCA that may be used in the diagnosis and treatment of its pathologies.Methods: The study was carried out in the Department of Anatomy, Chittagong Medical College (CMC) Chittagong over a period between Jan 2012 to Dec 2013 with ethical clearance. A detailed dissection of LCA and its branches in 50 cadaveric human hearts, fixed in 10% formalin was carried out to study normal and variant anatomy of LCA. The length of the main stem of LCA was measured by slide calipers.Results: The LCA was found to arise from the Left Posterior Aortic Sinus (LPAS) of the ascending aorta in 100% cases. The level of the ostia (Opening of coronary artery) was above the free margin of the aortic cusps in 98% cases. In all samples ostia were present below sinutubular ridge (A slight circumferential thickening separating bulbar aortic sinus and proximal ascending aorta). The length of the main stem of LCA (From origin to the point of termination into main branches) was found to range from 0.5-2 cm. The LCA showed bifurcation in 74%, trifurcation in 26% of cases. Left Anterior Descending artery (LAD) was found to terminate at the apex of the heart in 68% and at the posterior interventricular groove in 32% cases. The Left Circumflex artery (LCx) was terminated at the crux of the heart in 52%, near the crux in 44% and by crossing the crux in 4% cases. The Left Marginal Artery (LMA) which was present only in 34% cases, found to terminate nearer to the apex of the heart. 0% Left dominance of heart was observed.Conclusion: Simple attention to potential variations in the origin, number, level of ostia, length of the main stem, branching pattern, termination and distribution of LCA can greatly enhance clinical outcomes.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 42-47