Normal Dimensions Research Articles

Right Ventricular Dimensions and Tricuspid Annular Plane Systolic Excursion among Medical Students of Tertiary Care Hospital: A Descriptive Cross-sectional Study.

The change in morphology and functions of the right ventricle is an important predictor of heart and lung disease. There is limited data on the normal dimension of the right ventricle. The study aimed to find the right ventricular diameter, its thickness, and tricuspid annular plane systolic excursion in healthy male medical students of a tertiary care hospital. It is a descriptive cross-sectional study conducted in healthy medical students of Kathmandu Medical College and Teaching Hospital, from February-April, 2019. Ethical approval was taken from the institutional review committee (reference number 120720193). Convenient sampling method was used. We measured various dimensions of the right ventricle in different views. The data was analyzed in the Statistical Package for the Social Sciences. In the 96 male students included in the study, the mean right ventricular basal diameter was 36.45±3.49 mm, right ventricular mid cavity diameter was 29±3.63 mm, right ventricular longitudinal dimension was 65.72±7.52 mm, right ventricular outflow tract in parasternal long-axis view was 27.07±2.12 mm, proximal and distal right ventricular outflow in parasternal short-axis view was 25.33±2.57 mm and 20.08±1.99 mm, right ventricular thickness was 4.20±0.54 mm, and tricuspid annular plane systolic excursion was 23.02±3.54 mm. The study found that the values of right ventricular dimensions and the right ventricle's tricuspid annular plane systolic excursion among male medical students of a tertiary care hospital to be in accordance with the guidelines by the American Society of Echocardiography. The upper limits of the normal values of the right ventricle could be very helpful in clinical practice in determining the right ventricle dimension.

Massive pulmonary thromboembolism combined with transient thyrotoxicosis in an 18\u2009year old girl

BackgroundPulmonary thromboembolism (PTE) is thought to usually stem from deep vein thrombosis (DVT). However, evidence of DVT could not be found in many cases. Furthermore, transient thyrotoxicosis is a rare but potentially life–threatening emergency involving a systemic hypercoagulable state. We report on an 18 year-old-girl with transient thyrotoxicosis with massive PTE without DVT.Case presentationAn 18-year-old girl was admitted to the hospital with syncope. Patient had no history of trauma, any known underlying disease or oral contraceptives use. Chest computed tomography (CT) showed massive PTE in both central pulmonary arteries and diffuse goiter. However, a low extremity Doppler sonogram did not detect DVT. To manage the PTE, we administered low molecular weight heparin. On the other hands, thyroid function test indicated a state of thyrotoxicosis. In addition, patient had a partial protein S deficiency but no other immunologic abnormality. Therefore, the patient was diagnosed with massive PTE, thyrotoxicosis, and partial protein S deficiency. Patient was discharged with oral warfarin and methimazole. A follow-up echocardiogram obtained 3 months after anticoagulation therapy demonstrated normal dimensions and systolic function. After thyrotoxicosis was treated with methimazole for a month, a euthyroid state was achieved and the goiter decreased to a normal size. The methimazole was gradually tapered off and stopped at 4 months. At a 6-month follow up visit, PTE and pulmonary hypertension had disappeared but the patient still had a partial protein S deficiency. We decided to stop all medication with careful monitoring. During a 4-year follow-up period after the episode, she was asymptomatic without any evidence of recurrent systemic thromboembolism or hyperthyroidism.ConclusionsEarly recognition and appropriate treatment of PTE combined with transient thyrotoxicosis were vital to preventing other complications.

The Shapes and Normal Dimensions of the Sella Turcica.

The aim of this study was to evaluate the normal dimensions and shape of the sella turcica (ST) in the Turkish population using multidetector computed tomography. This single-center, retrospective study included 188 patients who met the study criteria and had paranasal multidetector computed tomography taken between January 2019 and December 2019. The patients included in the study comprised 77 females and 111 males. The whole patient group was separated into 3 age groups of 18 to 25 years (group 1), 25 to 40 years (group 2), and 40 years and over (group 3). They were also separated according to gender. The mean length of the ST was determined as 8.52 ± 1.42 mm (min-max 4.61-12.73 mm), mean height as 7.00 ± 1.31 mm (min-max 3.00-10.51 mm), mean aperture as 6.50 ± 2.00 mm (min-max 2.24-12.51 mm), and mean width as 11.01 ± 1.50 mm (min-max 7.78-14.94 mm). No statistically significant difference was determined between the length, height, width, and aperture size values of the ST according to gender and age groups. The results of this study demonstrated no significant difference in ST dimensions according to gender or age groups. It can be considered that the shape and dimensions of the ST can be more accurately evaluated with computed tomography and classification can be more robustly applied.

Ultrasound assessment of normal liver, spleen, and kidney dimensions in southwest Nigerian children: a bedside formula for sonologists.

Knowledge of the normal sizes of the liver, spleen, and kidneys is important to radiologists when assessing for pathology using ultrasound scan. The need for a local determination of a easy-to-use formula for estimating the expected normal sonographic dimensions of these organs in children in order to serve as baseline when assessing them for pathology cannot be over emphasized. To determine ultrasonographic sizes of the liver, spleen, and kidneys among primary school children in southwestern Nigeria and correlate these with anthropometric measures to provide local reference data and an easy-to-use formula for assessing these organs for pathology in clinical practice. This is an observational, cross-sectional study using 1000 public primary school children in Ogbomoso. Sonographic dimensions of their liver, spleen, and both kidneys with anthropometric parameters were obtained and correlated. Data were analyzed using SPSS version 20. The liver span was higher in boys than in girls (P = 0.048) while the left lobe of the liver was higher in girls than in boys (P = 0.003). The spleen length was higher in boys than in girls (P = 0.011). There was no gender difference in kidney dimensions (P > 0.05). All anthropometric measures correlated significantly (P < 0.001) with organ dimensions. Body surface area is the strongest predictor of the liver and kidney sizes (P < 0.001) and height for spleen size (P < 0.001). Nomograms for the liver, spleen, and kidneys and regression equations for estimating the dimensions of these organs were formulated based on the best multivariate correlates.

Improved Tactile Perception of 3D Geometric Bumps Using Coupled Electrovibration and Mechanical Vibration Stimuli

Abstract At present, the tactile perception of 3D geometric bumps (such as sinusoidal bumps, Gaussian bumps, triangular bumps, etc.) on touchscreens is mainly realized by mapping the local gradients of rendered virtual surfaces to lateral electrostatic friction, while maintaining the constant normal feedback force. The latest study has shown that the recognition rate of 3D visual objects with electrovibration is lower by 27$\%$ than that using force-feedback devices. Based on the custom-designed tactile display coupling with electrovibration and mechanical vibration stimuli, this paper proposes a novel tactile rendering algorithm of 3D geometric bumps, which simultaneously generates the lateral and the normal perceptual dimensions. Specifically, a mapping relationship with the electrostatic friction proportional to the gradient of 3D geometric bumps is firstly established. Then, resorting to the angle between the lateral friction force and the normal feedback force, a rendering model of the normal feedback force using mechanical vibration is further determined. Compared to the previous works with electrovibration, objective evaluations with 12 participants showed that the novel version significantly improved recognition rates of 3D bumps on touchscreens.

The role of strut chordae in mitral valve competence during annular dilation.

Strut chordae, on their own, are not typically thought to aid mitral valve competence. The aim of this study is to assess whether strut chordae aid mitral valve competence during acute annular dilation. Twelve porcine hearts were dissected and tested using an in vitro simulator, with the mitral annulus tested in either a ‘normal’ or a dilated configuration. The normal configuration included a diameter of 30 mm, a posterior leaflet ‘radius’ of 15 mm and a commissural corner ‘radius’ of 7.5 mm; the dilated annular template instead used dimensions of 50 mm, 25 mm and 12.5 mm, respectively. Each mitral valve underwent ten repeat tests with a target systolic pressure of 100 mmHg. No significant difference in the pressure was detected between the dilated and regular annuli for the mitral valves tested (95 ± 3 mmHg cf. 95 ± 2 mmHg). However, the volume of regurgitation for a dilated annulus was 28 ml greater than for a valve with a normal annulus. Following severing of strut chordae, there was a significant reduction in the systolic pressure withstood before regurgitation by mitral valves with dilated annuli (60 ± 29 mmHg cf. 95 ± 2 mmHg for normal annular dimensions; p < 0.05). In conclusion, strut chordae tendineae may play a role in aiding mitral valve competence during pathophysiology.

Revisiting the relationship between left ventricular ejection fraction and ventricular-arterial coupling.

The aim of this article was to analyse in‐depth the relationship between left ventricular (LV) ejection fraction (EF) (LVEF) and the most commonly used formulas for the calculation of LV elastance (Ees), volume intercept at 0 mmHg pressure (V0), effective arterial elastance (Ea), and ventricular–arterial coupling (VAC) as are validated today. We analyse the mathematical resulting consequences, raising the question on the physiological validity. To our knowledge, some of the following mathematical consequences have never been published. On the basis of studies demonstrating that normal LV dimensions and LVEF have a Gaussian unimodal distribution, we considered that the normal modal LVEF is 62% or very close to it. Expressed as a fraction, it is 0.62, that is, the reciprocal of the Phi number (namely, 1/Φ ~ 0.618). Applying Euclid's mathematical law on the extreme and mean ratio (the golden ratio), we studied the LVEF–VAC relationship in normal hearts. The simplification of the VAC formula (with V0 = 0) leads to false physiological results; V0 extraction from single‐beat Chen's formula leads to high negative results in normal subjects; based on the Euclid law, LVEF and Ea/Ees will be equal for a ratio value of 0.618 (62%) where V0 cannot be different from 0 mL; LVEF and VAC inverse relationship formula (Ea/Ees = 1/LVEF − 1) is reducible to a fundamental property of Phi: 1/Φ = (Φ − 1), being valid only if LVEF = VAC at a 0.618 value; according to this restriction, Vo can only be 0 mL, thus describing a very limited range. The Ea/Ees ratio, owing to its mathematical more dynamic behaviour, can be more sensitive than LVEF, being a valuable clinical tool in patients with heart failure (HF) with reduced EF, acute unstable haemodynamic situations, where Ees and Ea variations are disproportionate. However, the application is doubtful in HF with preserved EF where Ees and Ea may have same‐direction augmentation. The modified VAC formula suffers from oversimplification, reducing it to a dimensionless ratio, which is supposed to approximate non‐linear time‐varying functions. Thus, we advocate for caution and in‐depth understanding when using simplified formulas in clinical practice.

Association of left atrial deformation indices with left atrial appendage thrombus in patients with non valvular atrial fibrillation

AimAssessment of the value of left atrial deformation indices for prediction of left atrial appendage functioning patients with non-valvular atrial fibrillation. MethodThe study included 250 patients with non-valvular atrial fibrillation and normal left atrial dimension. Trans-thoracic and trans-esophageal echocardiography were performed. Patients were divided into two groups; patients with LAA thrombus (group I) and patients without LAA thrombus (group II), a correlation between trans-esophageal and trans-thoracic data was analyzed. ResultsGroup I included110 patients (44%) and Group II 140 patients (56%). By TDI mean LA strain and strain rate were lower in group I (21.89 ± 7.75% vs 35.14 ± 9.28%; p < 0.001) and (1.15/sec, IQR 0.12–3/sec versus 2.1/sec, IQR 0.21–3/sec, p < 0.001) respectively. By speckle tracking PALS and strain rate were lower in group I (24.79 ± 7.78% vs 37.63 ± 8.64%; p value < 0.001) and (0.95 ± 0.32/sec. Vs 1.27 ± 0.32/sec p, value < 0.001) respectively. By TEE; group I had lower LAA EF (39.2 ± 13.55% vs 53.86 ± 12.7%); p < 0.001, and lower LAA emptying velocity (17.53 cm/s, IQR 9.54–77.4 vs 63.5 cm/s, IQR 7.89–86.4; p < 0.001). There was a good correlation between LA TDI and speckle tracking PALS and PALSR and LAA EF% and velocity p < 0.001. TDI and PALS and PALSR were found to be significant predictors for LAA thrombus (P < 0.05) with good sensitivity and specificity. ConclusionLeft atrium deformation indices are predictors of LAA thrombus or SEC in patients with non-valvular AF with accepted sensitivity and specificity.

Dimensões e esqueletopia dos rins em duas populações de Cerdocyon thous (Linnaeus, 1766)

Cerdocyon thous is the South American canid with great geographic distribution. To the south of Ecuador, two isolated populations have been identified, living in different average temperatures and food availability. The objective was to measure the length, width, thickness and volume of the kidneys, length of renal vessels, and verify the renal skeletopy in two populations of C. thous. Kidneys and renal vessels were measured from 34 cadavers collected on highways in the Brazilian territory. From the Atlantic Forest biome (latitude 22º), 14 specimens (seven males and seven female) were analyzed, and from the Pampa biome (latitude 29º), 20 specimens (eight males and twelve female). On average, in the right antimere the kidneys measured 49.9 ´ 25.2 ´ 24.4 mm, had a volume of 16.5 cm3, the renal artery measured 21.3 mm and the renal vein 19.4 mm. In the left antimere, the kidneys measured 49.3 ´ 24.4 ´ 22.8 mm, with a&nbsp; volume of 14.6 cm3 and the artery and vein measured 21.0 mm and 28.4 mm, respectively. The right kidney was always cranial and predominantly positioned ventrally to vertebrae L1–L3, while the left one was positioned ventrally to vertebrae L2–L4. There was no difference in the comparison between sexes or antimeres. Most renal dimensions were significantly higher in the specimens from the Pampa biome, possibly due to the body size and type of diet. This result warns of interpreting diagnoses that depend on the evaluation of the normal renal dimensions in this species.

Fulminant myocarditis triggered by OC43 subtype coronavirus: a disease deserving evidence-based care bundles

Fulminant myocarditis triggered by OC43 subtype coronavirus: a disease deserving evidence-based care bundles

Ultrasonographic and anatomical examination of normal thyroid and internal parathyroid glands in goats.

Ultrasonographic examination of the normal thyroid and parathyroid glands has been described for humans and many animal species. However, similar reports for goats are still missing. The aim of the study was to present ultrasound features of the normal thyroid and internal parathyroid glands in goats with the determination of their dimensions and volume, followed by a comparison of the results to the gross examination. Seventy-two goats were used in the study. The echostructure and echogenicity of the thyroid and parathyroid glands were assessed. The length, width and height of the thyroid and the length and width of the parathyroid glands were measured. The thyroid volume was calculated using the ellipsoid formula, basing on the ultrasonographic dimensions. Size and volume of the dissected thyroid glands were established grossly, followed by a histological examination. In order to accurately describe the anatomy of the thyroid, new anatomical terminology characterizing this gland was proposed. The mean dimensions of the thyroid lobes were 30.2 x 10.5 x 6.3 mm. There were no statistically significant differences between the right and left lobe. Parathyroid glands measured an average of 3.6 x 2.4 mm. The percentage Root Mean Square Error between the results of ultrasonographic and gross examination was 16.73%, 20.65% and 17.01% for thyroid length, width and height, respectively, and 46.30% for volume. In order to obtain more precise calculation of the thyroid volume, a modified correction factor for the ellipsoid formula was introduced. For the first time, the normal ultrasonographic characteristics and dimensions of the caprine thyroid and internal parathyroid glands were presented. The results may serve as a radiological reference and be the basis for further research.

Novel Approach to Imaging Active Takayasu Arteritis Using Somatostatin Receptor Positron Emission Tomography/Magnetic Resonance Imaging

Novel Approach to Imaging Active Takayasu Arteritis Using Somatostatin Receptor Positron Emission Tomography/Magnetic Resonance Imaging

Left ventricular (LV) pacing in newborns and infants: Echo assessment of LV systolic function and synchrony at 5-year follow-up.

Small retrospective studies reported that left ventricular (LV) pacing is likely to preserve LV function in children with isolated congenital complete atrioventricular block (CCAVB). The aim of this study was to prospectively evaluate LV contractility and synchrony in a cohort of neonates/infants at pacemaker implantation and follow-up. Patients with CCAVB who underwent LV pacing were evaluated with electrocardiogram and echocardiogram in a single-center, prospective study. Data were collected at implantation, at 1-month and every year of follow-up, up to 5 years. LV ventricular dimensions (diameters and volumes), systolic function (ejection fraction [EF] and global longitudinal strain [GLS]), and synchrony were evaluated. Data are reported as median (25th-75th centiles). Twenty consecutive patients with CCAVB underwent pacemaker implantation (12 single-chamber pacemaker [VVIR] and eight dual-chamber pacemaker [DDD]) with epicardial leads: 17 on the LV apex and three on the free wall. Age at implantation was 0.3 months (1 day-4.5 months). Patients showed good clinical status, normal LV dimensions, preserved systolic function, and synchrony at 60 (30-60) months follow-up. EF increased to normal values in patients with preimplantation EF<50%. Presence of antibodies and pacing mode (DDD vs VVIR) had no impact on the outcome. LV pacing preserved LV systolic function and synchrony in neonates and infants with CCAVB at 5-year follow-up. LV EF improved in patients with low preimplantation EF. Pacing mode or the presence of autoantibodies did not demonstrated an impact on LV contractility and synchrony.

Correlation of the vertical dimension of occlusion with five distances between facial landmarks among those of Batak Toba ethnicity

Background: The normal vertical dimension of occlusion (VDO) results in orofacial and temporomandibular joint (TMJ) biomechanical balance. If the VDO changes due to attrition, full edentulism, accidents involving the lower third of the face and even improper denture manufacturing will result in the disruption of mastication, speech and aesthetic functions. Therefore, the right technique is needed to predict the correct VDO. Purpose: To identify the correlation values and regression equation of the VDO for five distances between facial landmarks among people of Batak Toba ethnicity. Methods: This research is an analytical study with a cross-sectional design. A purposive-sampling technique obtained 30 Batak Toba subjects, consisting of 15 males and 15 females aged 19–24 years. The data were analysed by an independent t-test, one-way ANOVA, the Pearson correlation, and linear regression (p&lt;0.05). Results: A significant difference distance in the VDO (p=0.0001, p&lt;0.05) was observed between male subjects (72.96±3.75mm) and female subjects (65.24±5.12mm). A positive and significant correlation was observed between the VDO distance and the facial landmark distances, where the criteria for significant correlation were the RO–Pu distance being {r male=0.723(p=0.02) and female=0.650(p=0.09)} and the OC–RO distance being {r male=0.689(p=0.004) and female=0.615(p=0.015)}; the moderate correlation criteria were the OC–IC distance being {r male=0.476(p=0.045) and female=0.428(p=0.043)}, the E–E being {r male=0.435(p=0.043) and female=0.458(p=0.047)}, and the EH being {r male=0.398(p=0.051) and female=0.414(p=0.051)}. The regression equation for the VDO distance in males is {[22.694 + 0.673 (RO–Pu)], [24.371 + 0.642 (OC–RO} and in females is {[23.017 + 0.616 (RO–Pu)], [21.795 + 0.632 (OC–RO)]}. Conclusion: The distances of RO–Pu and OC–RO have the strongest correlation with the VDO in people of Batak Toba ethnicity.

Computed Tomography Evaluation of Normal Lacrimal Gland Dimensions in the Adult Pakistani Population

ObjectivesTo estimate the normal dimensions of lacrimal glands (LGs) in the Pakistani population using computed tomography (CT) scan and to determine the associations of LG dimensions with age, sex, and laterality.MethodsThe study population included subjects aged ≥16 years without orbital pathology who underwent CT evaluation of both the right and left LGs at Dr. Ziauddin University Hospital from June 2018 to November 2019. The mean axial length (AL), axial width (AW), coronal length (CL), and coronal width (CW) of each LG were measured separately.ResultsThe 108 subjects enrolled in this study included 75 (69.4%) men and 33 (30.6%) women, with a mean age of 49±20 years. Right and left LG dimensions were similar, including mean AL (13.53±1.80 mm vs. 13.35±1.72 mm), mean AW (4.20±0.81 mm vs. 4.05±0.93 mm), mean CL (15.46±1.97 mm vs. 15.26±1.87 mm), and mean CW (3.99±0.80 mm vs. 3.86±0.81 mm). The AL of both LGs and the CL and CW of right but not left LGs were significantly lower in women than in men. Age showed significant correlations with the AL and CL of both LGs.ConclusionThese findings establish the normal range of LG dimensions in adult Pakistani populations. Some LG dimensions are smaller in women than in men, as well as correlating with age.

Assessment of Subtle Myocardial Dysfunction in Asymptomatic Infants of Diabetic Mothers

Abstract Background Cardiovascular abnormalities in infants of diabetic mothers (IDMS) occur in the form of congenital heart diseases (CHD), and hypertrophic cardiomyopathy (HCM). Aim of the Work We hypothesized that two dimensional speckle tracking imaging and pulsed wave tissue Doppler imaging (TM) may uncover subtle myocardial dysfunction in asymptomatic IDMs. Patients and Methods This study was a cross sectional descriptive study conducted at Ain shams University Children’s Hospital Pediatric cardiology unit during the period from June 2017 till January 2018. Thirty IDMs were recruited. IDMs with CHD and HCM were excluded. We further subdivided them into 2 groups; Infants of gestational diabetic mothers (IGDM) and infants of pregestational diabetic mothers (IPGDM). They were all examined using TDI and STI echocardiography in the first week of life. This group was compared to a group of age and sex matched healthy controls. Results All IDMs had normal cardiac dimensions and global cardiac functions as controls, IVS (P = 0.434), LVED (P = 0.318), EF (P = 0.291), LVFS(P = 0.644) and GLS(P = 0.240). However, evidence of LV dysfunction proved by increased Tei index (p = 0.018). This subtle affection of myocardial function was more prominent in infants of IPGDM when compared to IGDMs (P = 0.004). Conclusion Subtle affection of myocardial functions may occur in IDMs even in the absence of morphological cardiac changes. This was detected by TDI. Neither conventional assessment of myocardial functions, nor STI are sensitive tools in detecting these changes. IPGDMs are at risk of more profound affection of myocardial function than infants of IGDMs.

Hepatorenal Syndrome in Dogs with Experimental Extrahepatic Cholestasis

Hepatorenal syndrome (HRS) is a unique form of functional and potentially reversible renal failure secondary to liver diseases. It occurs typically in kidneys that are histologically normal. In this study, the hepatorenal syndrome was observed in a model of extrahepatic biliary stasis. Seven mature male mongrel dogs were subjected to complete surgical ligation of common bile duct at the duodenal region Clinical, ultrasonographic, , histopathological examinations along with biochemical analysis for liver enzymes and urinalysis were performed before and throughout the experimental periods. Clinical observations post-surgery revealed icteric mucosa, abdominal pain, weight loss, dehydration, orange-colored urine, bilirubinurea, and clay feces. Biochemical analysis showed an abrupt increase in the mean values of serum blood urea nitrogen and creatinine from the 3rd day till reaching the peak at the 2nd week post-surgery. A strong positive correlation was detected between BUN and creatinine, and serum total and direct bilirubin. Ultrasonographic findings of liver revealed a progressive dilatation of gallbladder and the common bile duct from the 3rd day post-ligation, with an increase in the echogenicty of the liver, whereas, the kidneys demonstrate normal renal parenchyma and dimensions. Histopathological examination of the kidney revealed hemorrhage, vacuolation, hyaline droplet were observed in renal tubules and edema and yellowish-brown granules were seen in the interstitial tissue, but the significant renal changes that refer to renal failure weren’t detected,. In conclusion, the dogs are considered a suitable model for studying hepatorenal syndrome and also there is an association between obstructive jaundice and renal failure.

An ultrasound-based referential of body height-adjusted normal liver organometry in school children from Bokito in rural Cameroon

The grading system for ultrasonographic assessment of Schistosoma mansoni morbidity is crucial for evaluation of control programs. This requires prior definition of normal liver organometric ranges in the population from the endemic area. A cross-sectional study was conducted in a S. mansoni endemic area in rural Cameroon. 1002 Participants were screened and 234 of them, free from all common liver-affecting diseases in the area (schistosomiasis, malaria, hepatitis B and C) and with no ultrasonographic signs of liver disease were selected and their liver parameters measured by ultrasonography. All statistics were considered significant for p-values < 0.05. Normal dimensions of livers lobe sizes, portal vein wall thickness and portal vein diameters are reported. The liver organometric data are presented for the entire study population as a whole and separately for males and females as prediction plots, with observed values and fitted regression line with 95% confidence. Reference ranges for liver parameters (size, portal vein thickness and diameter) adjusted for body height established in the current study are novel for Cameroon. The prediction plots generated should improve the accuracy of the assessment of liver morbidity by ultrasonography in the region.

Normal appearances and dimensions of the foetal cavum septi pellucidi and vergae on in utero MR imaging

PurposeThe aim of this study is to provide normative data about the appearances and dimensions of the cavum septi pellucidi and vergae (CSPV) on in utero MR (iuMR) imaging in second and third trimester foetuses.MethodsTwo hundred normal foetuses (from a low-risk pregnancy, with normal ante-natal USS findings and no intracranial abnormality of iuMR) had iuMR imaging between 18 and 37 gestational weeks (gw). The anatomical features on those studies were compared with published atlases of post-mortem foetal brains. The length, width and volume of the CSPV were measured in all foetuses.ResultsThe anatomy of the CSPV and its relationship with the corpus callosum and the fornices on iuMR imaging was comparable with post-mortem data at all gestational ages studied. The length of the CSPV increased throughout pregnancy, whereas the width and volume of CSPV reached a maximum between 29 and 31 gw and then showed a reduction later in pregnancy.ConclusionThe iuMR imaging features of the CSPV and its close anatomical relations closely correspond to post-mortem data. The CSPV was patent in all cases but we have shown that closure commences in the midpart of the third trimester and advances in a posterior to anterior direction.

Expression Patterns of Circulating MicroRNAs in the Risk Stratification of Bicuspid Aortopathy.

Objective: Aortic size-based criteria are of limited value in the prediction of aortic events, while most aortic events occur in patients with proximal aortic diameters < 50 mm. Serological biomarkers and especially circulating microRNAs (miRNAs) have been proposed as an elegant tool to improve risk stratification in patients with different aortopathies. Therefore, we aimed to evaluate the levels of circulating miRNAs in a surgical cohort of patients presenting with bicuspid aortic valve disease and distinct valvulo-aortic phenotypes. Methods: We prospectively examined a consecutive cohort of 145 patients referred for aortic valve surgery: (1) Sixty three patients (mean age 47 ± 11 years, 92% male) with bicuspid aortic valve regurgitation and root dilatation (BAV-AR), (2) thirty two patients (mean age 59 ± 11 years, 73% male) with bicuspid aortic valve stenosis (BAV-AS), and (3) fifty patients (mean age 56 ± 14 years, 55% male) with tricuspid aortic valve stenosis and normal aortic root diameters (TAV-AS) who underwent aortic valve+/-proximal aortic surgery at a single institution. MicroRNAs analysis included 11 miRNAs, all published previously in association with aortopathies. Endpoints of our study were (1) correlation between circulating miRNAs and aortic diameter and (2) comparison of circulating miRNAs in distinct valvulo-aortic phenotypes. Results: We found a significant inverse linear correlation between circulating miRNAs levels and proximal aortic diameter in the whole study cohort. The strongest correlation was found for miR-17 (r = −0.42, p < 0.001), miR-20a (r = −0.37, p < 0.001), and miR-106a (r = −0.32, p < 0.001). All miRNAs were significantly downregulated in BAV vs. TAV with normal aortic root dimensions Conclusions: Our data demonstrate a significant inverse correlation between circulating miRNAs levels and the maximal aortic diameter in BAV aortopathy. When comparing miRNAs expression patterns in BAV vs. TAV patients with normal aortic root dimensions, BAV patients showed significant downregulation of analyzed miRNAs as compared to their TAV counterparts. Further multicenter studies in larger cohorts are needed to further validate these results.