Oval Orifice Research Articles

Anatomical and morphometric variation of the orifice of the left atrial appendage

Background. Knowledge of the anatomical variations of the shape and size of the left atrial appendage orifice, along with the relationship of its size with the number of left atrial appendage lobes, the size of its neck, the left atrioventricular orifice, the left atrioventricular fibrous ring and the distance to it, as well as with the overall dimensions of the heart is important in personalized surgical planning for the installation of occluder device and left atrial appendage clipping to prevent thromboembolic complications.
 Aim. To identify anatomical variations in the shape and size of the left atrial appendage orifice and analyze the dependence of these parameters on the number of left atrial appendage lobes, cardiac dimensions, mitral orifice area and the distance from the orifice to the left atrioventricular fibrous ring.
 Material and methods. We studied 37 heart specimens fixed in 10% formalin in adults who died of non-cardiac causes. Morphometry was performed by an ShTsTs-1-200 digital calliper, drawing needle calliper and 4UM goniometer. We used nonparametric analysis of variance, Spearman correlation coefficient (Rs), univariate regression analysis, cross-tabulation analysis. The results are presented as the mean and standard deviation. The significance of differences was assessed by using the MannWhitney U-test.
 Results. The left atrial appendage was single-lobed in 16.2% of cases, two-lobed in 62.2%, and three-lobed in 18.9%. The length of the orifice was 12.74.03 mm, and the width was 9.53.62 mm. The elliptical shaped orifices were 3.1 times more common than round ones (28/37 and 9/37, p=0.0027). In 17 of 28, oval orifices were located predominantly horizontally, in nine predominantly vertical, in one case obliquely. Vertically oriented orifices were significantly longer and slightly wider compared with others. The number of the left atrial appendage lobes was not a reliable predictor for the orifice shape (p=0.055). The size of the appendage orifice, variants of its shape and the distance to the left atrioventricular opening were unrelated to each other. The length and width of the orifice were correlated with each other (Rs 0.68) and correlated with the diameters of the left atrioventricular fibrous ring size. The orifice length correlated with the length of the ventricular complex (Rs 0.47) and heart width (Rs 0.53). The orifice width correlated only with the heart width (Rs 0.4) but not with other dimensions. As the length and width of the ventricular complex increased, the orifice length increased exponentially. The distance from the left atrial appendage orifice to the left atrioventricular opening did not depend on either the orifice shape or its orientation.
 Conclusion. In a normal human adult heart, the shape of the left atrial appendage orifice was oval, less often round, and the size of the orifice depends on the length and the width of the ventricles.

Clinical decision making in frequently encountered anomalous aortic origin of coronary arteries, the impact of IVUS

Abstract Introduction The aim in the diagnostic work-up of patients with an anomalous aortic origin of coronary arteries (AAOCA) is to determine whether the course of the coronary artery is benign or malignant. In patients with AAOCA with an interarterial course the guidelines on diagnostics are concise. Recommended CT-scan imaging does not evaluate stress-induced functional consequences like external compression by the pulmonary artery as the scan is performed in a resting state. Non-invasive ischemia detection techniques often lack sufficient sensitivity. To improve functional stratification, exploration of new diagnostic modalities in the diagnostic workup of AAOCA is mandatory. Purpose The purpose is to explore the potential role of intravascular ultrasound (IVUS) in the diagnostic workup of patients with AAOCA. Methods Nine patients with an anomalous right coronary artery with an interarterial course were analyzed. A cardiologist evaluated the complaints. Anatomical features of the AAOCA were assessed with CT-scan imaging. Further analyses included ischemia detection and coronary angiography. To assess stress-induced ischemia IVUS and invasive measurements – fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) – were performed at rest and during adrenaline-induced stress. A slit-like orifice was classified as a width/length (W/L) ratio of ≤0.50, an oval orifice as 0.51–0.9 and a round orifice as >0.91. Results Potential cardiac complaints were present in seven patients. In 8 (89%) patients CT-images showed an acute angle, in 8 (89%) proximal narrowing and an aortic take-off above the pulmonary valve in 4 (44%). In 7 (78%) patients a slit-like orifice and in two (22%) an oval orifice were observed (table 1). IVUS at rest showed a slit-like orifice in one patient classified as an oval orifice on the CT-images and vice versa in another patient (table 2). The patients classified as an oval orifice with IVUS showed no external compression during adrenaline-induced stress. In 4 (57%) out of 7 patients with an slit-like orifice on IVUS, the width remained unchanged or increased during adrenaline infusion. In 2 patients the width decreased slightly, however, these patients were asymptomatic and no ischemia was detected. In 1 (14%) patient the width remained 1.4mmm and the length increased from 3.2mm to 4.7mm. In this case the vessel ostium was fully engaged with the IVUS catheter, hence, the width could not decrease during adrenaline infusion. This was regarded as external compression. In addition, in this patient ischemia was detected. Conclusion(s) In two (22%) out of 9 patients IVUS gave a better insight of the shape of the orifice than CT. Additionally, the anatomic and functional-dynamic components of compression could be defined with adrenaline-induced stress. Therefore, IVUS can contribute to a better understanding of the functional consequences of the anatomical features and of potential stress-induced external compression. Funding Acknowledgement Type of funding sources: None. Table 1Table 2

Pottery from Tell el-Murra Graves

Excavations conducted at the Tell el-Murra cemetery in seasons 2011 and 2012 revealed five graves with pottery assemblages. Grave no. 3 contained pottery vessels which could be dated to the end of the Naqada IIIB period. The pottery vessels found here included two cylindrical jars (one with a cord impression and the second with an incised continuous line beneath the rim), as well as a quite elongated, ovoid jar with impressed halfbows on its shoulders. Two chronologically later graves (nos 1 and 2) should probably be dated to the Naqada IIIC2 period. The pottery assemblage of these graves included large, tall-shouldered jars with impressed halfbows and pot marks (grave no. 1), jars with rope band decorations, wine jars (grave no. 2), ovoid jars, barrel-shaped jars, small broad-shouldered jars, beer jars and undecorated cylindrical jars. Other pottery types included bowls with convex sides, a tray with an oval orifice, a red-polished plate and pot stands. Grave no. 7 seems to date to a different time period, as it contained rough ware beer jars and bowls with convex sides and simple rims. It therefore probably dates to the Naqada IIIC2/IIID period. The most recent of the graves containing pottery vessels (grave no. 5) was discovered in the 2012 season. It contained two pottery vessels: one was a miniature and the other was a bowl with convex sides, a simple rim, a slightly narrowing area of concave contour below the rim and a flat base. Based on pottery analysis, it should be dated to the second half of the 2nd Dynasty.

Root canal morphology of mandibular first premolars in an Indian population: a laboratory study

To determine the root canal morphology of mandibular first premolar teeth in an Indian population using a decalcification and clearing technique. One hundred extracted adult mandibular first premolar teeth were studied following decalcification and clearing. The shape of the canal orifice, root canal pattern and length of the teeth were determined. The mandibular first premolars were identified to have a round orifice (38%), oval orifice (44%), flattened orifice (17%) and C-shaped orifice (1%). The canal patterns were classified as Type I (72%), Type II (6%), Type III (3%), Type IV (10%) and Type V (8%) according to Vertucci's classification. C-shaped canals were identified in one tooth (1%). The average length of the teeth was 21.6 mm. Fourteen per cent of the teeth had mesial invaginations of the root. Type I canal patterns were the most frequently occurring in mandibular first premolars amongst the Indian population. 85.7% of the teeth with mesial invagination of the root had either two canals or division of canals.

Ongoing pregnancy after a corrective surgery of an endomyometrial fistula diagnosed by the use of virtual histerosalpingography in an infertile patient

OBJECTIVE: To report an ongoing pregnancy after a uterine corrective surgery of an endomyometrial fistula, after uterine embolization failure in an infertile patient, and to assess the value of virtual histerosalpingography in the diagnosis of myometrial pathology. DESIGN: Case report. MATERIALS AND METHODS: A 36 year-old-nulliparous woman presented in 2006 with diagnosis of primary infertility and previous history of symptomatic multiple uterine myomas. She was treated in 2003 with gonadotropin-releasing hormone agonist for a six-month-period.A year later she underwent a uterine embolization (UE) in another institution. One year after the procedure, she was submitted to our center with a diagnosis of a uterine cavity-myoma communication.A virtual histerosalpingography (VHSG) was performed and revealed a distortion of the uterine cavity, shown as a uterine cavity-myoma communication. The VHSG allowed us to diagnose and plan the surgical approach.After 14 months of the UE, she underwent a diagnostic histeroscopy and an abdominal laparotomy. RESULTS: A non-well-delineated oval orifice, covered by endometrium (endomyometrial fistula) was seen during the procedure. This orifice was connected to a hollow, a remnant of the myoma, seen as a cavity. An abdominal multiple myomectomy and correction of the wall defect was performed with microsurgical technique.A post-operative ultrasound and histerosalpingography revealed a normal uterine cavity.The patient underwent an intracitoplasmatic sperm injection (ICSI) treatment for male infertility. A two-good quality-embryo transfer was performed in January 2008 with a clinical pregnancy result. A 20 weeks-pregnancy is currently ongoing. CONCLUSIONS: Using microsurgical techniques allowed the surgeons to performed a fertility preservative surgery.Careful study of the uterine cavity should be performed after a UE failure to detect myometrial abnormalities. The VHSG may be used as a non-invasive diagnostic imaging method for uterine myometrial pathology, giving an excellent endoscopic and 3D panoramic view of the uterine cavity. In this case the VHSG not only did allow us to diagnose and observe the endomyometrial fistula, but also to plan the surgical approach.As UE failure may lead to complications with distorsion of the uterine cavity,we suggest to avoid this method in patients who are considering pregnancy.Despite the existing reports in the literature, this may be the first report of an ongoing pregnancy following a corrective surgery in a patient with a long- term UE failure.

子ウシに認められた異常冠状静脈洞の1例

An anomalous coronary sinus emptying into the left and right atria was observed in an 8-monthold female Japanese black calf. The V. cordis magna, V. ventricularis sinistra posterior (V. cordis caudalis) and V. cordis media drained normally into the coronary sinus. The left end of the coronary sinus opened into the left atrium through an oval orifice 1 cm in longer diameter, while the right atrial ostium of the coronary sinus was completely obstructed. The four Vv. cordis dextrae from the lateral wall of the right ventricle drained into an anomalous common stem above the coronary groove. The posterior part of this stem was continuous with the coronary sinus and the anterior part opened into the right atrium through an oval orifice 3 mm in longer diameter.