Normal Dimensions Research Articles

Posterior Pituitary Bright Spot Normal Dimensions on MRI

Aim: To assess the measurements of posterior pituitary bright spot on MRI in Khyber Pakhtunkhwa Methods: The study was done in RMI, Peshawar. Duration is January, 2016 to February, 2019. 78 patients with normal pituitary MRI studies were selected for study. MRI without contrast was done along cranio caudal and antero posterior axis on sagital T1WI. Three cases of ectopic posterior pituitary were also included. Results: Dimensions were taken in antero posterior and cranio caudal axis on sagittal T1WI. Dimension of PPBS was 1.8--8.6mm in cranio caudal axis and 0.8-6mm in antero posteriorly. Mean±SD of cranio caudal measurement was 5.09±1.28mm and of antero posteriorly 2.42±0.9mm. Pearsons analysis showed direct correlation i.e. as value of cranio caudal diameter increased, the antero posteriorly also increased. Conclusion: PPBS was identified in 100% of normal pituitary glands. Mean PPBS size normally ranged from 1.8 to 8mm i.e. mean± SD was 5.09±1.28mm craniocaudally. There is a direct correlation in cranio caudal and antero posterior dimensions of PPBS. Keywords: Pituitary, Magnetic resonance imaging. Posterior pituitary bright spot

Ektopičan karlični bubreg deteta - prikaz slučaja

Ntroduction. An ectopic pelvic kidney is an anatomical anomaly in the position of the kidney. In the stage of metanephros, its movement, rotation, and lifting from the pelvis to the lumbar area are absent. Due to vascular or other abnormalities, the kidney does not reach its usual anatomical position and therefore remains ectopic. The position in which it can be placed is retroperitoneal, abdominal, or thoracic, with numerous variations. Case report: A three-month-old male infant underwent kidney screening during an ultrasound examination of the hips. There had been a positive family history in the mother and maternal aunt of the existence of an ectopic, left pelvic kidney, without complications and accompanying symptoms. The clinical findings of the infant's systems were normal, he was developing in terms of body mass. The analyzes of urine, biochemistry, and urine culture did not show any pathological findings. Ultrasound examination showed that the left renal lobe was completely filled with spleen, without visualization of the left kidney. In the right lumbar box, there was the right kidney, with regular dimensions, clear edges and normal thickness of the parenchyma. Inferior to the right kidney, in the area of the right lumbar region, facing inwards, there was the left kidney with regular ultrasonographic characteristics. Urinary bladder was properly positioned, with normal dimensions and wall thickness. The infant was advised to see a pediatric nephrologist. Conclusion: This is another case of an ectopic kidney recorded during an echosonographic examination of the hips, thus demonstrating the importance of routine ultrasound examinations of the abdomen, in order to increase the possibility of early detection of anomalies of the abdominal organs.

A study on normal reference values of echocardiographic chamber dimensions in newborn infants from Eastern India – A pilot study

Introduction: Echocardiography has been an integral part of neonatal care since the 1990s and the application of this technology is increasing ever since. It is already known that differences in weight, age, and race significantly affect the normal heart dimensions. Therefore, establishing the normative values for cardiac dimensions among Indian healthy newborn infants is of paramount importance. In this study, we report the normal reference values of echocardiographic chamber dimensions of newborn infants from Eastern India. Methodology: One hundred healthy newborn infants were included in this cross-sectional, observational, single hospital-based pilot study. A single experienced cardiologist performed the transthoracic echocardiographic studies on the participants in supine position in their respective bassinets. No sedation was used. The parameters were distributed according to body weight and in percentiles. Results: Participants were categorized according to their body weight into three groups: 2–2.4 kg, 2.5–2.9 kg, and 3–3.5 kg. Each group comprises 7, 50, and 43 newborns, respectively. The left ventricular end-diastolic dimension and left ventricular end-systolic dimension showed incremental trends across body weight. Conclusion: This study shows the difference of cardiac dimensions in Indian newborn infants from Western data. This is the first study presenting the normative reference ranges and percentiles of echocardiographic parameters in Indian newborn infants which needs confirmation with larger multicenter studies.

Electrical injury - induced atrial fibrillation

Introduction. An electrical injury can cause various cardiac arrhythmias, such as asystole, ventricular fibrillation, sinus tachycardia, and heart blocks. However, it rarely causes atrial fibrillation (AF). Case report. The 47-year-old patient was admitted to the Emergency Department after receiving an electric shock (< 600 V). He subsequently lost consciousness, fell, and sustained back and head injuries. During the examination, the heart rate was irregular but with no heart murmurs. There was an entry wound on the front of the left thigh and an exit wound on the front of the neck. An electrocardiogram showed newly appearing AF. The laboratory tests showed no pathological deviation, and focus cardiac ultrasound showed that contractile force was preserved with no wall-motion abnormalities and normal left atrium dimensions. The patient was administered low-molecular-weight heparin subcutaneously and propafenone (600 mg) orally. At follow-up after 24 hrs, the electrocardio-gram showed normal sinus rhythm. Conclusion. We reported a rare case of an electricity shock-induced AF, which was converted to sinus rhythm with the help of drug therapy. Although most cases of electricity shock-induced AF represent benign conditions that are self-limited, cardiac monitoring as a routine measure should be considered.

Standard measurement of the normal forelimb claw dimensions in Egyptian buffalo cows (Bubalus Bubalis) before and after functional trimming: a post-mortem study.

The aim of this study was to compare forelimb claw dimensions in buffalo cows, and to establish a reference values for functional claw trimming. Medial and lateral healthy front feet claws were evaluated from 20 young (YB) and 20 mature (MB) Egyptian buffalo cows (Bubalus bubalis). The dorsal wall length (TL), dorsal wall angle (TA), heel length (HBL), height (HBH) and width (HBW), sole (SL) and claw length (CL) and sole width (SW) were measured. Differences between YB and MB were evaluated using ANOVA test, while those between the lateral and medial claws with a paired t test. Before and after trimming, the HBL, HBW, HBH, SL and CL were significantly higher for both claws in MB, while the TA was significantly lower. Before trimming the lateral HBW and HBH were significantly higher than the medial, while the SL and CL of the medial claw were significantly higher than the lateral claw. After trimming, the lateral claw HBL was significantly higher in MB. The SW of the lateral claw was significantly higher than the medial claw in both YB and MB, and it did not change after trimming. These results can be considered as a guidance during front feet trimming in buffaloes.

Anthropometric Study of the Normal External Ear in Adult Thai People; Age and Sex-Related Difference

Background: The reconstruction of an abnormal ear pinna is the most challenging problem for a plastic surgeon. Knowing the normal dimensions of the external ear pinna is an important factor for planning an ear reconstruction surgery especially in bilateral abnormality cases. There were few studies on this aspect from various populations and the ear dimensions were different among ethnicity. The present study attempted to provide anthropometry of the normal Thai ear pinna. Objective: The present study aims to study normal ear dimensions and position on the face of the Thai people. Materials and Methods: A cross-sectional study was undertaken from January 2007 to December 2008 in Ramathibodi Hospital, Bangkok, Thailand. A total of 250 subjects with normal ears and faces were measured them both ears. The 131 women and 119 men with an age of 16 to 89 years old were included and subgroup into seven age groups. Ear dimensions and related facial dimensions were measured. Results: The mean length and width of the ear pinna, concha, ear lobule, auricular inclination angle, protrusion at the most superior part of the helix level, and Tragal level in males was significantly larger than the female. The mean length and width of the ear pinna, ear lobule, and the length of concha were significantly longer in an older age group. Moreover, the mean length and width of the ear pinna and the lobule were significantly higher in the higher weight and BMI group but not for the higher height group. The left and right ear dimensions were not significantly different. Conclusion: Men’s ear pinna is a larger and wider angle of inclination than women’s. Bodyweight and BMI have a positive correlation with ear dimensions. Moreover, the ear pinna was increasing in size throughout life in both cartilaginous and non-cartilaginous parts. Keywords: Anthropometry; Ear; Auricle; Thai; Age

97 An unusual combination of rare congenital heart defects in a 70 years old lady complaining worsening dyspnea

Abstract Methods and results A 70-year-old woman presented to our outpatient clinic complaining of worsening dyspnoea in the last 3 months. She had a medical history of hypertension, diabetes, dyslipidemia, and paroxysmal atrial fibrillation. We performed a comprehensive evaluation starting with a transthoracic echocardiogram that showed a dilatation of right ventricle with normal function, severe pulmonary regurgitation, and moderate tricuspid regurgitation with estimated pulmonary artery systolic pressure of 55 mmHg; the left ventricle had normal dimension and function, with mild aortic and mitral regurgitation, and a subaortic membrane which caused a mild obstruction (maximum gradient 17 mmHg). The cardiac magnetic resonance (CMR) confirmed the enlargement of the right ventricle and of the pulmonary artery trunk (51 mm) and the severity of pulmonary regurgitation (regurgitant fraction of 41%). CMR also clearly showed the VSD just below the subaortic membrane and the left to right shunt with a jet that appeared to proceed straight from the left ventricle through the pulmonary valve (Figure 1A). The estimated Qp/Qs was 1.6 and no intramyocardial late enhancement was present. Pulmonary pressures and pulmonary vascular resistance were normal at the right heart catheterization and the Qp/Qs ratio calculated invasively was 1.45. Considering patient high-risk profile for coronary artery disease, a coronary angiography was also performed showing an abnormal origin of the right coronary artery (RCA) from the mid-portion of the left anterior descending coronary artery (LAD) with two significant stenosis: one involving the bifurcation of RCA and the other the mid-portion of the LAD (Figure 1B). The coronary computed tomography angiography (CCTA) showed a benign course of the RCA anterior to the pulmonary artery towards the auriculoventricular groove (Figure 1C, D). Taking into account all these findings, multidisciplinary heart team decided to perform a cardiac surgery intervention of pulmonary valve and trunk replacement, closure of ventricular septal defect and two coronary bypass grafts on LAD and RCA. Conclusions This case represents a combination of some rare congenital heart abnormalities where multimodality cardiovascular imaging techniques were essential to establish a proper diagnosis and to plan an adequate surgical repair. We hypothesize that the peculiar orientation of the VSD jet may have caused the pulmonary trunk dilatation considering that neither the shunt, nor the pulmonary pressure appear to have been of sufficient magnitude to cause it. Pulmonary ectasia and the damage inflicted by the jet to the cusps of the valve have led to the severe valvular insufficiency. While aortic and tricuspid regurgitation are known to be associated with VSD, to the best of our knowledge this is the first report of pulmonary regurgitation secondary to VSD.

788 Reverse McConnell’s sign in biventricular Takotsubo cardiomyopathy: how echo can guide the diagnosis

Abstract An 89-years-old woman presented at Emergency Department with a 10-h history of vertigo, headache, nausea, fatigue, and general discomfort. No chest pain or shortness of breath were reported. She had a history of hypertension, chronic kidney disease, paroxysmal atrial fibrillation (AF), osteoporosis, and hypoacusia. The patient suffered of chronic anxiety and the caregiver referred for a recent and acute emotional distress. At the admission, the patient didn’t show clinical signs of peripheral hypoperfusion. Fine crackles at lungs bases were objectivable with coherent ultra-sound lung comets and mild bilateral pleural effusion. Her usual therapy included nebivolol, apixaban, torsemide, candesartan, and D-vitamin. The EKG showed AF with a heart rate of about 110 b.p.m., no ST-segment deviation and normal QTc. The echo findings showed a slight increase in left ventricle volume with a severe reduction of the ejection fraction due to the akinesia of all apical segments with the typical aspect of the ‘apical ballooning’ and concomitant hyperkinesia of the basal segments. Despite normal dimensions, also the right ventricle showed a peculiar contractile pattern, with hyperkinetic basal movement and akinesia of the apex with the hinge point located in the free wall portion in continuity with the LV septal wall. No significant valvular disease was documented except for moderate tricuspid regurgitation. High-sensitive I troponin peaked up to 1500 pg/ml. The clinical appearance was very suggestive of TTS but INTERTAK score of 61 was not diagnostic and, according to the most recent consensus document, a coronary angiography was performed, without documentation of coronary artery disease. During the hospitalization serial electrocardiographic monitoring showed significant and transient QTc prolongation and dynamic T wave changes resulting in progressive INTERTAK score increase. No ventricular arrhythmic events occurred. The patient was treated with careful fluid support and with beta-blockers for AF rate control. Multiple echocardiographic evaluations documented a progressive recovery of systolic function up to complete normalization of biventricular global and regional systolic function. Clinical data, instrumental evidences and dynamic evolution oriented the diagnosis towards TTS with unusual and uneven impairment of right and left ventricular function. The described case focuses the attention on the reverse McConnell’s sign, an echocardiographic finding not often described in the literature, consisting of akinetic right ventricle apical segment and hyperkinetic basal and mid free wall. This discordant motion is exactly opposite to the classic echocardiographic RV aspect detected in acute significative pulmonary embolism described as McConnell’s sign, hence the name. It has been suggested that this functional variation might be a self-protection system of the heart through a mechanism of hibernation that is similar to that occurring during chronic hypoxia, consisting in a decrease in the ATP utilization and O2 consumption, as suggested by the activation of intracellular β2-induced signalling patterns documented in TTS. Recognizing this finding it’s important not only because it has been associated with a higher risk of developing haemodynamic instability but also to orient working diagnosis of TTS when initial clinical assessment through the INTERTAK score is inconclusive.

787 Ablation of the ventricular ectopic foci: a therapeutic option for dilated cardiomyopathy due to arrhythmic MVP

Abstract Aims A subset of patients with mitral valve prolapse (MVP) are affected by a still not well understood condition characterized by frequent ventricular arrhythmias (mostly originating from papillary muscles) and sudden cardiac death (SCD). It is called MVP malignant syndrome (MVP MS). In these patients, the high arrhythmic burden may lead to left ventricular (LV) dyssynchrony and dysfunction, determining a tachycardia-induced cardiomyopathy (TIC). Reduction in arrhythmic burden determines LV recovery and ejection fraction improvement and interrupts LV progressive dilatation. Methods and reports We report the case of a 52-year-old woman with MVP and family history of both MVP and SCD who was referred to our department for symptomatic extrasystoles and dyspnoea during exercise. Palpitations begun 11 years before: in that occasion she performed a 3-lead-ECG-Holter monitoring which documented 3457 ventricular extrasystoles. Transthoracic echocardiography (TTE) showed normal LV dimension and function and a myxomatous mitral valve with prolapse of both leaflets. At that time beta-blocker therapy was introduced, but soon suspended because of patient’s clinical intolerance (bradycardia and hypotension). Since then she was lost at follow-up for years, until symptoms worsened. When she came to our attention, TTE showed dilated and hypokinetic LV (ejection fraction was 38%, S2 wave at TDI was 6.4 cm/s and global longitudinal strain value was −13%). CMR was performed and confirmed TTE findings. Mitral-annulus disjunction was described in anterior, lateral, and posterior wall and late gadolinium enhancement analyses showed subendocardial fibrosis in correspondence of the posterior papillary muscle (PM) and in the mid-inferior wall. Holter monitoring enlightened a high arrhythmic burden with 24 065 premature ventricular complexes (PVCs) of two morphologies (right bundle branch block-like and −120° axis and right bundle branch block-like and −75° axis). During stress test, PVCs increased as the heart rate increased, resulting in bigeminism at peak exercise. Considering all these features, we hypothesized a case of MVP MS in which the high ventricular arrhythmic burden resulted in TIC. Any available pharmacological attempt to reduce arrhythmias failed. Transcatheter (TC) ablation of PVCs was then proposed. Electrophysiological study identified the inner part of the posterior papillary muscle implantation region and the antero-lateral basal wall as PVCs sites of origin. Radiofrequency ablation was performed in both sites. After the procedure, despite an incomplete suppression of the posterior PM focus, 12-lead 24-h Holter monitoring and TTE performed during the hospitalization showed a consistent arrhythmic burden reduction and LV function improvement. At 6 months from the procedure, symptoms improved and Holter monitoring showed 7515 PVCs with a 54% arrhythmic burden reduction compared with the presentation. TE showed lower LV end-diastolic volume and an increase in ejection fraction up to 47%; global longitudinal strain was −17% and TDI showed a S2 wave on lateral wall of 11 cm/s, confirming left ventricle improvement after the arrhythmic burden reduction. Conclusions Complete suppression of PMs PVCs with TC ablation is difficult to obtain, especially when the focus is in the inner part of the PM and TC ablation of ventricular arrhythmias in MVP patients has not yet demonstrated his efficacy in reducing SCD. Nevertheless, it should be taken into consideration to obtain at least PVCs reduction in patients with high arrhythmic burden leading to TIC.

770 Small heart and single coronary artery in a young patient with chronic fatigue syndrome: a case report

Abstract Aims Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a clinically defined condition reported mostly in adults, characterized by fatigue and unexplained aspecifical symptoms. Patients with CFS/ME frequently have reduced stroke volume with an inverse relation between cardiac output and post-exertional malaise severity. We describe a rare case of a young man affected by CFS/ME, small heart, and anomalous anatomy of left main coronary artery (LMCA). Methods and results A 19-year-old Caucasian male referred to our clinic complaining weakness, lack of concentration, and sleepiness. He suffered by CFS/ME, D hypovitaminosis, inflammatory bowel disease, and exocrine pancreas insufficiency. Blood tests revealed no pathological findings. Faecal exams documented intestinal dysbiosis and low pancreatic elastase. He was treated with oxygen-ozone rectal insufflations and probiotics. Physical examination was unremarkable. Electrocardiogram showed normal sinus rhythm. Echocardiogram revealed reduced diameters of the left ventricle (LV), normal aortic root dimensions and, in a five-chamber apical view, a binary structure that seemed to cross the aorta perpendicularly. Cardiac magnetic resonance (CMR) found reduced LV stroke volume (34 ml/m2) and end-diastolic volume (57 ml/m2) together with reduced end-diastolic wall mass (51 g/m2). Right ventricle volumes were reduced too. In addition, the exam confirmed the anomalous origin of LMCA stemming from the proximal segment of right coronary artery and following a retro-aortic course. Mechanism of CFS/ME remains unknown, although various factors have been implicated, including immune activation, chronic viral infection, and emotional disorders. A considerable number of patients affected by CFS has an anatomically small heart. Small heart syndrome, in fact, may contribute to the onset of CFS/ME. Previous studies hypothesized that clinical manifestations of CMS/ME were caused by reduced venous return, cardiac output, and heart mass, together with decreased arterial oxygen saturation. Single coronary artery is an uncommon congenital anatomic abnormality identified by a single coronary ostium giving rise to all arteries supplying the heart. Thus, we reported a rare case of a very young man affected by chronic fatigue syndrome and small heart, investigated not only with echocardiogram but also with CMR, not often used in this clinical setting. More, we found an anomalous origin of LMCA. From literature, it’s not reported any cases of a patient including these three rare conditions (CFS/ME, small heart, and single coronary artery). Conclusions This case highlights that CFS/ME together with small heart is a condition possible also in young people. More studies and reports could be necessary to better define the association between cardiac congenital anomalies and CFS/ME. 770 Figure

154 Transient left ventricular systolic dysfunction during intravenous immunoglobulins treatment for myasthenia gravis exacerbation

Abstract A 61-year-old man suffering from myasthenia gravis with predominant bulbar involvement since 10 months before admission, was diagnosed with thymoma in April 2021. He had no relevant comorbidities except for history of polymorphic ventricular ectopic beats. In this regard, in 2019 he had undergone transthoracic echocardiogram and coronary computed tomography angiography, which resulted both normal. After 1 month, due to poor response to standard medical therapy with prednisone and pyridostigmine and in preparation for thymectomy, an intravenous immunoglobulins (IVIG) treatment was prescribed leading to mild clinical improvement (Myasthenia Gravis Foundation of America Clinical Classification IIIA—MGFA). Two weeks later, the patient underwent robotic-assisted thoracoscopic thymectomy without complications. Pathological findings were consistent with type B1 Thymoma classified as Masaoka Stage IIB (TNM Stage pT1a). After discharge the patient complained a rapid worsening of neurological symptoms (MGFA IIIB) leading to an urgent hospitalization for Myasthenia Gravis exacerbation in the middle of June. On admission Intravenous Immunoglobulins (IVIG) treatment was immediately started. After administration of the second IVIG dose, he had a myasthenic crisis complicated by refractory heart failure with significant increase of cardiac troponin up to 5.768 ng/L, requiring invasive ventilation, inotropic support and urgent transfer to the Cardiac Intensive Care Unit (CICU). The 2D echo showed severe left ventricular systolic dysfunction (LVEF 20%) with diffuse hypokinesis. The patient underwent cardiac catheterization and coronary angiography that confirmed severe reduction of the LVEF (LVEF 23%) with embolic occlusion of the distal posterior descending coronary artery (PDA) without other significant coronary artery stenosis. An endomyocardial biopsy was performed, which revealed cardiomyocytes of normal dimensions with sporadic cytoplasmic vacuolization and excluded signs of inflammation, fibrosis, necrosis and viral myocarditis. The day after the patient completed IVIG treatment. During the following days, despite persistence of severe left ventricular systolic dysfunction, he was successfully weaned form inotropic and ventilatory support. At neurological evaluation he reported persistence of severe bulbar involvement with upper and lower limbs weakness. Five days later, the patient had a sudden cardiac arrest for pulseless electrical activity. Advanced cardiac life support requiring inotropes and invasive ventilation was performed for 28 min before returning to spontaneous circulation. The echocardiogram excluded pulmonary embolism and mechanical complications but showed severe left ventricular systolic dysfunction. A new coronary angiography showed clear coronary arteries including PDA. Because of severe haemodynamic compromise, an Impella CP device was implanted and set at maximum support level (P8 flow, >3 L/min). A neurological exam revealed no severe neurological sequelae. As a result of the long CPR the patient had a massive left haemothorax, initially treated with multiple blood transfusions and pleural drainage. Two days later, due to persistence of haemodynamic instability and active pleural bleeding with incessant severe anaemia the case underwent a Heart Team discussion where it was decided to escalate Impella CP device to Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) and then perform a video-assisted thoracoscopic evacuation of the haemothorax. Both procedures were carried out without complications. The patient had an immediate haemodynamic improvement which led to rapid weaning from inotropic support. Haemoglobin was stable. The 2D echo showed significant improvement of the LVEF (40%). After 3 days, given the persistence of haemodynamic stability, ECMO device was removed and invasive ventilation stopped shortly afterwards. Eleven days later, another 2D echo demonstrated complete recovery of left ventricular systolic function (LVEF 59%). Notwithstanding, the patient reported a progressive worsening of neurological symptoms with generalized myasthenia and severe bulbar involvement (MGFA IVB) along with episodes of respiratory muscle fatigue requiring non-invasive ventilation. For this reason, the patient was transferred to Subintensive Respiratory Unit and the case underwent a new multidisciplinary discussion involving neurologists, cardiologists and haematologists. Specialists agreed upon potential causal role of IVIG treatment in transient left ventricular dysfunction and considered re-administration absolutely contraindicated. Thus, they prescribed five plasmapheresis treatments and up-titration of corticosteroid therapy (methylprednisolone up to 60 mg od). An immediate and outstanding improvement of neurological symptoms was obtained (MGFA IIIA) and the patient was discharged from hospital 1 week later.

Stabilizing Ryanodine Receptors Improves Left Ventricular Function in Juvenile Dogs With Duchenne Muscular Dystrophy

BackgroundDuchenne muscular dystrophy is associated with progressive deterioration in left ventricular (LV) function. The golden retriever muscular dystrophy (GRMD) dog model recapitulates the pathology and clinical manifestations of Duchenne muscular dystrophy. Importantly, they develop progressive LV dysfunction starting at early age. ObjectivesThe authors tested the cardioprotective effect of chronic administration of the ARM036, a small molecule that stabilizes the closed conformation of the cardiac sarcoplasmic reticulum ryanodine receptor/calcium release channel (RyR2) in young GRMD-dogs. MethodsTwo-month-old GRMD-dogs were treated with ARM036 or placebo for 4 months. Healthy-dogs of the same genetic background served as controls. Cardiac function was evaluated by conventional and 2-dimensional speckle-tracking echocardiography. Cardiac cellular and molecular analyses were performed at 6 months old. ResultsConventional echocardiography showed normal LV dimensions and ejection fraction in 6-month-old GRMD dogs. Interestingly, 2-dimensional speckle-tracking echocardiography revealed decreased global longitudinal strain and the presence of hypokinetic segments in placebo-treated GRMD dogs. Single-channel measurements revealed higher RyR2 open probability at low resting Ca2+ in GRMD cardiomyocytes than in controls. ARM036 prevented those in vivo and in vitro dysfunctions in GRMD dogs. Myofilament Ca2+-sensitivity was increased in permeabilized GRMD cardiomyocytes at short sarcomere length. ARM036 had no effect on this parameter. Cross-bridge cycling kinetics were altered in GRMD myocytes and recovered with ARM036 treatment, which coincided with the level of myosin binding protein-C-S glutathionylation. ConclusionsGRMD-dogs exhibit early LV dysfunction associated with altered myofilament contractile properties. These abnormalities were prevented pharmacologically by stabilizing RyR2 with ARM036.

Relationship Between Leaflets and Root in Normal Aortic Valve Based on Computed Tomography Imaging: Implication for Aortic Valve Repair.

Objective: By assessing the normal dimensions and the relationship between the aortic root and leaflets in Chinese population, the objective of this three-dimensional computed tomography (3DCT)-based study was to establish a matching reference for leaflets and aortic root for aortic valve (AV) repair.Method: Electrocardiogram-gated multi-detector CT was performed on 168 Chinese participants with a normal aortic valve. Measurements of the aortic annuli and leaflets were obtained. The correlations between and the ratios of the specific root and leaflet measurements were analyzed. The references for the leaflet and root dimensions were suggested based on geometric height (gH) using a linear regression equation. The utility of the ratios was tested with CT images of 15 patients who underwent aortic valve repair.Result: The mean annulus diameter (AD), sino-tubular junction (STJ) diameter, geometric height (gH), effective height (eH), free margin length (FML), commissural height (ComH), inter-commissural distance (ICD), and coaptation height (CH) were 22.4 ± 1.7 mm, 27.3 ± 2, 0.4 mm, 15.5 ± 1.7 mm, 8.9 ± 1.2 mm, 32.0 ± 3.4 mm, 17.9 ± 1.9 mm, 23.1 ± 2.3 mm, and 3.1 ± 0.6 mm, respectively. The gH/AD, FML/ICD, and eH/ComH ratios were 0.69 ± 0.07, 1.38 ± 0.08, and 0.50 ± 0.07, respectively. The gH correlated with all other leaflet and root measurements (P < 0.01), whereas the FML demonstrated a better correlation with ICD compared with gH (R2 = 0.75, and R2 = 0.37, respectively). The FML/ICD and eH/ComH ratios might be used to assess leaflet-root mismatch and post-repair leaflet billowing.Conclusion: The normal aortic valve measurements based on 3DCT revealed a specific relationship between the root and leaflets; and this will guide the development of an objective method of aortic valve repair.

C56. Isolated Right Ventricular Non-Compaction Cardiomyopathy (IRVNC) in Adolescence: A Case Report

Abstract Background Non-compaction ventricular myocardium (NCVM) is a rare genetic cause of cardiomyopathy which mostly affects the left ventricle. A limited case of IRVNC was reported which render a limited knowledge for clinician. Case Summary A 16-y.o male presented to our emergency unit with recurrent syncope, chest discomfort, palpitation which exaggerated by strenuous exercise. There was no familial history of sudden death. On admission, BP of 102/64 mmHg and bradycardia of 49 bpm were remarkable. Electrocardiography revealed sinus arrhythmia, 49 bpm with early repolarization on precordial leads and LVH. Laboratory tests were in normal limits. Echocardiography revealed hyper-trabeculated RV with no LV-dysfunction. CMR was performed and showed normal LV dimension and function. Right atrium and RV were dilated with RV-dysfunction. RV trabeculae were indicative for IRVNC (NC/C ratio of 4.3). Holter ECG monitoring was done and remarkable for sinus arrhythmia without sinus pause nor ventricular arrhythmia. Anticoagulant was given for embolic prevention in the non-compacted area. ACEi, β-blockers, and diuretic were not given due to hypotension, bradycardia and no signs of congestion. The patient showed clinical improvement and discharged after 5 days of hospitalization. Discussions Recently, there has been no specific criteria and cut off for IRNVC. Earlier studies mentioned that ILVNC criteria could be used for diagnosing IRNVC, as we used in our case. In the future, it’s necessary to determine new cut off points dedicated for IRVNC. Furthermore, close follow-up is needed as complications such as arrhythmia, embolic events and heart failure might occurred.

C56. Isolated Right Ventricular Non-Compaction Cardiomyopathy (IRVNC) in Adolescence: A Case Report

Abstract Background Non-compaction ventricular myocardium (NCVM) is a rare genetic cause of cardiomyopathy which mostly affects the left ventricle. A limited case of IRVNC was reported which render a limited knowledge for clinician. Case Summary A 16-y.o male presented to our emergency unit with recurrent syncope, chest discomfort, palpitation which exaggerated by strenuous exercise. There was no familial history of sudden death. On admission, BP of 102/64 mmHg and bradycardia of 49 bpm were remarkable. Electrocardiography revealed sinus arrhythmia, 49 bpm with early repolarization on precordial leads and LVH. Laboratory tests were in normal limits. Echocardiography revealed hyper-trabeculated RV with no LV-dysfunction. CMR was performed and showed normal LV dimension and function. Right atrium and RV were dilated with RV-dysfunction. RV trabeculae were indicative for IRVNC (NC/C ratio of 4.3). Holter ECG monitoring was done and remarkable for sinus arrhythmia without sinus pause nor ventricular arrhythmia. Anticoagulant was given for embolic prevention in the non-compacted area. ACEi, β-blockers, and diuretic were not given due to hypotension, bradycardia and no signs of congestion. The patient showed clinical improvement and discharged after 5 days of hospitalization. Discussions Recently, there has been no specific criteria and cut off for IRNVC. Earlier studies mentioned that ILVNC criteria could be used for diagnosing IRNVC, as we used in our case. In the future, it’s necessary to determine new cut off points dedicated for IRVNC. Furthermore, close follow-up is needed as complications such as arrhythmia, embolic events and heart failure might occurred.

Overview of Subaxial Cervical Spine Fractures and Dislocations

Injuries of the subaxial cervical spine are among the most common and potentially most devastating injuries involving the axial skeleton. The lower cervical spine can suffer minor bony or ligamentous injury that nevertheless results in severe neurologic injury. Plain radiography, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are all part of the standard imaging regimen. The delayed timing of dislocation reduction and cost-effectiveness are two issues with routine use of MRI in the diagnosis of cervical facet dislocations. Serval treatment options and approaches can be used. However Orthopedic treatment can be used to reduce the fracture or dislocation returns the vertebral canal to its normal shape and dimensions and decompresses the spinal cord. Immediate treatment should be started if there are signs of spinal cord injury or any factor that could lead to such injuries. In this review we will be looking at epidemiology, causes, evaluation and treatment of such cases.

Is Cardiomegaly an Indication of “Heart-Sparing Effect” in Small Fetuses?

Introduction: This study aimed to test the hypothesis that cardiac size is maintained in small fetuses presenting with cardiomegaly. Materials and Methods: We identified singleton fetuses with estimated fetal weight <10th centile and with cardiomegaly without another more likely cardiac or extra-cardiac cause. We used Z-scores for cardiac and thoracic circumferences normalized for gestational age (GA), biparietal diameter (BPD), head circumference (HC), and femur length (FL), obtained from 188 normally grown fetuses. Results: When comparing chest size, small fetuses had significantly lower thoracic circumferences median Z-scores (IQR) for GA = −4.82 (−6.15 to −3.51), BPD = −2.42 (−4.04 to −1.48), HC = −2.72 (−4.53 to −1.90), and FL = −1.60 (−2.87 to −0.71); p < 0.001 for all. When comparing heart size, small fetuses showed lower cardiac circumferences median Z-scores (IQR) for GA = −1.59 (−2.79 to −0.16); p < 0.001, similar cardiac circumferences Z-scores for BPD = 0.29 (−0.65 to 1.28); p = 0.284 and HC = 0.11 (−1.13 to 0.96); p = 0.953, and higher cardiac circumferences Z-scores for FL = 0.94 (−0.05 to 2.13); p < 0.001. Conclusions: Our results show that in small fetuses with cardiomegaly, the heart maintains normal dimensions when normalized to cranial diameters and higher dimensions when normalized to long bones. This provides insight into cardiac adaptation to adverse intrauterine environment.

Right ventricular assessment of the adolescent footballers heart: impact of ethnicity

Abstract Introduction Athletic training often results in electrical and structural changes that may mimic phenotypical features of pathological cardiomyopathies. These physiological changes are influenced by age, ethnicity and sporting discipline. The presence of such changes that overlap with diseases implicated in exercise related sudden cardiac death may require comprehensive assessment to confirm or refute the presence of disease. One such potential physiological overlap with pathological change in athletes can occur in arrhythmogenic right ventricular dysplasia (ARVD), with features including chamber dilatation and T-wave inversion (TWI). An erroneous interpretation may have profound consequences ranging from false reassurance in a vulnerable athlete to unfair disqualification in a healthy individual. Therefore, it is important for the clinician to distinguish physiology from pathology. Purpose Studies detailing the physiological adaptation to exercise on the right ventricle (RV) of adolescent athletes are fewer compared to the left ventricle, with even fewer reports describing the impact of ethnicity on the RV. We set out to describe the normal dimensions of the RV of academy football players. Results ECG and echocardiographic data of 3000 academy male footballers were analysed, aged between 13 and 18 years old (mean age 16.4±0.5 years), who underwent mandatory cardiac screening. Ethnicity was categorised as white (n=1000), black (African/Caribbean; n=1000) and mixed-race (one parent white and one parent black; n=1000). ARVD major criteria for TWI was seen in 6.3% of the cohort. This was more prevalent in black footballers (3.7%) when compared to mixed race footballers (2%) or white footballers (0.6%), p&amp;lt;0.05. In up to 67% of the overall cohort, RV values exceeded those for normal adult reference ranges. There were no differences in RV dimensions between ethnicities (Tables 1 &amp; 2). If ARVD criteria was applied, 13.2% would fulfil major ARVD criteria for right ventricular outflow tract. This was also demonstrated for RVOT dimensions (6.1% - 23.6%; Figure 1). Overall, 0.2% of the cohort would fulfil diagnosis for “definite” ARVD and 2.2% would fulfil diagnosis for “borderline” ARVD. This was seen more frequently in black footballers (9.9%) than mixed race footballers (3.9%) or white footballer (0.6%), P=0.0005. Among athletes meeting definite or borderline ARVD criteria, no cardiomyopathy was identified after comprehensive clinical assessment. Conclusion This is the largest study to our knowledge that reports RV dimension data among adolescent footballers of different ethnicities. Right heart sizes in excess of standard adult ranges occurred in as many as one in 22 athletes. It is not unusual to observe values that would overlap with criteria for ARVD. As with LV parameters, variations in terms of ethnicity should be accounted for when considering RV dimensions and ECG changes when performing routine cardiac assessments of adolescent athletes. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): National Institute for Health Research

ANTHROPOMETRIC MEASUREMENTS OF AURICLE IN POPULATION OF UTTAR PRADESH

External ear consists of auricle or pinna and external acoustic meatus. The auricle projects to a variable and individual degree from the side of the head. According to many studies conducted on morphometry of external ear; the size, shape and the orientation of each external ear is unique as ngerprint but it can be generalized. Males have larger ears as compared to females. The present study is attempted provide anthropometric data on normal adult male and female auricles from population of Uttar Pradesh. To st AIM: udy the anthropometric measurements of auricle in population of Uttar Pradesh. MATERIALS AND METHODS: This study was conducted on 420 adults (210 males and 210 females) who were randomly selected from the population of Uttar Pradesh. The parameters measured were, ear length, ear breadth lobule length and lobule width of both ears. RESULTS: In our study, we found that both the ears are equal dimension except for lobule breadth, irrespective of the sex. CONCLUSION: Knowledge of normal ear dimensions is important in the diagnosis of congenital malformations and acquired deformities, and in planning of treatment. The data presented in this study would help the clinician to produce an anatomically correct ear during its reconstruction.

CLINICAL PROFILE OF 2D ECHO CARDIOGRAPHY AT THE CARDIOLOGY DEPARTMENT OF CHL MULTISPECIALTY HOSPITAL AND RESEARCH CENTRE.

Introduction:Echocardiography is the basic and important imaging technique used for the diagnosing the various numbers of Cardiac Conditions. This helps clinicians for diagnosing a various number of clinical variations. This functional data is needed to care for patients with many pathologies and used to diagnose a number of diseases. Trans-Thoracic Echocardiography is the most common Echocardiography done in every Cardiology Department of Centre. The use of 2D Echo provides the proper and fast diagnosis and allows the clinicians to make further diagnosis. In this study, we focus on Current Clinical Prole of the distributed Age Groups along with risk factors and advised recommendations with comparison of Diagnosis. Methods: In this case study, total of 1447 patients were divided in 6 Age Groups, proled for the outcomes of the 2D Echocardiography. We aimed to determine the Current Clinical Prole with the Diagnosis, Risk Factors and Advised Recommendations in each age group in a Cardiac Intensive Care Unit (CICU) in CHL Multispeciality Hospital and Research Center, Chandrapur using a prospective observational study. Patients: All consecutive patients followed up for 2D Echocardiography at the Cardiology Department between April 2021 and August 2021 were included if they were aged more than 18 years. Patients eligible for the study were evaluated for the current prole of the patient, risk factors and Advised Recommendations in each Age group. Results: In the study conducted, the clinical prole had a good result in suggesting that most of the patients in all age groups had the diagnosis of Good biventricular systolic function, No RWMA, Normal chamber dimension &amp; Valve function. Uncontrolled Sugars and Accelarated Hypertension made worse for patient's cardiac management. Some Results of 2D Echo were also affected because of the emergency in the CICU, for which 2D Echo was postponed later or after stability of the patient. Past Medical History had the signicant role. The clinical prole helped us understand the proper diagnosis and recommendations done