Surface Of Ventricle Research Articles

The Different Associations of White Matter Hyperintensities With Severity of Dementia and Cognitive Impairment According to the Distance From the Lateral Ventricular Surface in Patients With Alzheimer's Disease.

White matter hyperintensities (WMH) are common among the elderly. Although WMH play a key role in lowering the threshold for the clinical expression of dementia in Alzheimer's disease (AD)-related pathology, the clinical significance of their location is not fully understood. This study aimed to investigate the association between WMH and cognitive function according to the location of WMH in AD. Subjects underwent clinical evaluations including volumetric brain magnetic resonance imaging study and neuropsychological tests using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet. WMH were calculated using automated quantification method. According to the distance from the lateral ventricular surface, WMH within 3 mm, WMH within 3-13 mm, and WMH over 13 mm were classified as juxtaventricular WMH (JVWMH), periventricular WMH (PVWMH), and deep WMH (DWMH), respectively. Total WMH volume was associated with poor performance in categorical verbal fluency test (β=-0.197, p=0.035). JVWMH volume was associated with poor performances on categorical verbal fluency test (β=-0.201, p=0.032) and forward digit span test (β= -0.250, p=0.012). PVWMH volume was associated with poor performances on categorical verbal fluency test (β=-0.185, p=0.042) and word list memory test (β=-0.165, p=0.042), whereas DWMH volume showed no association with cognitive tests. PVWMH volume were also related to Clinical Dementia Rating Scale Sum of Boxes score (β=0.180, p=0.026). WMH appear to exhibit different associations with the severity of dementia and cognitive impairment according to the distance from ventricle surface in AD.

Capillary connections between sensory circumventricular organs and adjacent parenchyma enable local volume transmission.

Among contributors to diffusible signaling are portal systems which join two capillary beds through connecting veins (Dorland 2020). Portal systems allow diffusible signals to be transported in high concentrations directly from one capillary bed to the other without dilution in the systemic circulation. Two portal systems have been identified in the brain. The first was discovered almost a century ago and connects the median eminence to the anterior pituitary gland (Popa & Fielding 1930). The second was discovered a few years ago, and links the suprachiasmatic nucleus to the organum vasculosum of the lamina terminalis, a sensory circumventricular organ (CVO) (Yao et al. 2021). Sensory CVOs bear neuronal receptors for sensing signals in the fluid milieu (McKinley et al. 2003). They line the surface of brain ventricles and bear fenestrated capillaries, thereby lacking blood brain barriers. It is not known whether the other sensory CVOs, namely the subfornical organ (SFO), and area postrema (AP) form portal neurovascular connections with nearby parenchymal tissue. This has been difficult to establish as the structures lie at the midline and protrude into the ventricular space. To preserve the integrity of the vasculature of CVOs and their adjacent neuropil, we combined iDISCO clearing and light-sheet microscopy to acquire volumetric images of blood vessels. The results indicate that there is a portal pathway linking the capillary vessels of the SFO and the posterior septal nuclei, namely the septofimbrial nucleus and the triangular nucleus of the septum. Unlike the latter arrangement, the AP and the nucleus of the solitary tract share their capillary beds. Taken together, the results reveal that all three sensory circumventricular organs bear specialized capillary connections to adjacent neuropil, providing a direct route for diffusible signals to travel from their source to their targets.

Ventricular-subventricular zone stem cell niche adaptations in a mouse model of post-infectious hydrocephalus.

Congenital post-infectious hydrocephalus (PIH) is a condition characterized by enlargement of the ventricular system, consequently imposing a burden on the associated stem cell niche, the ventricular-subventricular zone (V-SVZ). To investigate how the V-SVZ adapts in PIH, we developed a mouse model of influenza virus-induced PIH based on direct intracerebroventricular injection of mouse-adapted influenza virus at two distinct time points: embryonic day 16 (E16), when stem cells line the ventricle, and postnatal day 4 (P4), when an ependymal monolayer covers the ventricle surface and stem cells retain only a thin ventricle-contacting process. Global hydrocephalus with associated regions of astrogliosis along the lateral ventricle was found in 82% of the mice infected at P4. Increased ependymogenesis was observed at gliotic borders and throughout areas exhibiting intact ependyma based on tracking of newly divided cells. Additionally, in areas of intact ependyma, stem cell numbers were reduced; however, we found no significant reduction in new neurons reaching the olfactory bulb following onset of ventriculomegaly. At P4, injection of only the non-infectious viral component neuraminidase resulted in limited, region-specific ventriculomegaly due to absence of cell-to-cell transmission. In contrast, at E16 intracerebroventricular injection of influenza virus resulted in death at birth due to hypoxia and multiorgan hemorrhage, suggesting an age-dependent advantage in neonates, while the viral component neuraminidase resulted in minimal, or no, ventriculomegaly. In summary, we tracked acute adaptations of the V-SVZ stem cell niche following onset of ventriculomegaly and describe developmental changes that help mitigate the severity of congenital PIH.

Feasibility of epicardial implantation of medtronic 3830 lead in a pediatric patient : case report

BackgroundHigh-grade atrioventricular block is the primary reason for epicardial permanent pacemaker implantation during the perioperative period in patients with congenital heart disease. Due to the smaller diameter of venous vessels in children, epicardial permanent pacemaker implantation is usually a preferred choice, we report one pediatric patient who received epicardial permanent pacemaker implantation using a new approach.Case presentationWe present the case of a 2-year-old girl who underwent the modified Konno procedure and Pulmonary valvuloplasty surgery and presented after surgery with a High-grade atrioventricular block. At over 20 days after the patient underwent a redo-sternotomy which epicardial permanent pacemaker implantation. Medtronic Model 4965 Capsure Epi ® steroid-eluting unipolar epicardial pacing lead was immobilized on the surface of the right ear. The Medtronic 3830 pacing lead was screwed obliquely and clockwise under direct view from the surface of the right ventricle to the endocardium near the interventricular septum. The patient’s recovery was uneventful.ConclusionIn this case report, we demonstrate the feasibility and potential benefits of using the Medtronic 3830 lead for epicardial pacing in a pediatric patient with severe cardiac complications following surgery for congenital heart disease. This approach offers a viable alternative to traditional epicardial pacing methods, particularly in complex cases where conventional leads fail to provide stable pacing thresholds.

Refractory cor pulmonale under extracorporeal membrane oxygenation for acute respiratory distress syndrome: the role of conversion to veno-pulmonary arterial assist-a case series.

Pulmonary vascular dysfunction during severe acute respiratory distress syndrome (ARDS) may lead to right ventricle (RV) dysfunction and acute cor pulmonale (ACP). The occurrence/persistence of ACP despite conventional extracorporeal membrane oxygenation (ECMO) is a challenging situation. We explored the usefulness of a specific dual-lumen cannula that bypasses the RV, and on which a veno-pulmonary arterial assist (V-P ECMO) was mounted, in ARDS patients. We report a case-series of ARDS patients put on conventional veno-arterial or veno-venous ECMO and presented refractory ACP as an indication for a reconfiguration to V-P ECMO using the ProtekDuo cannula. The primary endpoint was the mitigation of RV and pulmonary vascular dysfunction as assessed by the change in end-diastolic RV/left ventricle (LV) surface ratio. Six patients had their conventional ECMO reconfigured to V-P ECMO to treat refractory ACP. There was a decrease in end-diastolic RV/LV surface ratio, as well as end-systolic LV eccentricity index, and lactatemia immediately after V-P ECMO initiation. The resolution of refractory ACP was immediately achieved in four of our six (66%) patients. The V-P ECMO was weaned after a median of 26 [8-93] days after implantation. All but one patient were discharged home. We detected one case of severe hemolysis with V-P ECMO and two suspected cases of right-sided infective endocarditis. V-P ECMO is useful to mitigate RV overload and to improve hemodynamics in case of refractory ACP despite conventional ECMO.

Prevalence and electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias originating from the septal left ventricular summit.

The left ventricular summit (LVS) is the highest point on the epicardial surface of the left ventricle. A part of the LVS that is located between the left coronary arteries (lateral-LVS) is one of the major sites of idiopathic ventricular arrhythmia (VA) origins. Some idiopathic epicardial VAs can be ablated at endocardial sites adjacent to the epicardial area septal to the lateral-LVS (septal-LVS). This study examined the prevalence and electrocardiographic and electrophysiological characteristics of septal-LVS VAs. We studied consecutive patients with idiopathic VAs originating from the LVS (67 patients) and aortic root (93 patients). Based on the ablation results, among 67 LVS VAs, 54 were classified as lateral and 13 as septal-LVS VAs. As compared with the lateral-LVS VAs, the septal-LVS VAs were characterized by a greater prevalence of left bundle branch block with left inferior-axis QRS pattern, later precordial transition, lower R-wave amplitude ratio in leads III to II, lower Q-wave amplitude ratio in leads aVL to aVR, and later local ventricular activation time relative to the QRS onset during VAs (V-QRS) in the great cardiac vein. The electrocardiographic and electrophysiological characteristics of the septal-LVS VAs were similar to those of the aortic root VAs. However, the V-QRS at the successful ablation site was significantly later during the septal-LVS VAs than aortic root VAs (p < .0001). The precordial transition was significantly later during the septal-LVS VAs than aortic root VAs (p < .05). Septal-LVS VAs are considered a distinct subgroup of idiopathic VAs originating from the left ventricular outflow tract.

Endoscopic Supracerebellar Infratentorial Transpineal Approach for Posterior-Medial Thalamic Lesions: Surgical Technique and Clinical Experience.

Accessing lesions in the posterior-medial thalamus can be challenging because of their deep location and intricate neurovascular anatomy. This study aims to describe the techniques and feasibility of the endoscopic supracerebellar infratentorial transpineal approach for treating posterior-medial thalamus lesions. We reviewed and analyzed the clinical outcomes and endoscopic surgical experience of 11 patients with posterior-medial thalamic lesions. The first 4 cases used the endoscopic midline supracerebellar infratentorial transpineal approach, whereas the subsequent 7 cases used the endoscopic contralateral paramedian supracerebellar infratentorial transpineal approach. All cases involved the upward transposition of the pineal gland to access the posterior-medial thalamus. The extent of resection and the endoscopic techniques were the main focus of analysis. Neurological examinations and MRI/computed tomography follow-up were conducted for 3-12 months after surgery. The pathology of the group included 6 gliomas, 1 cavernous malformation, 1 inflammation, 1 melanoma, and 2 hematomas. All 11 patients achieved gross total resection (6 patients, 54.5%) or subtotal resection (5 patients, 45.5%) with no new neurological deficits. Most patients (9 patients, 81.8%) experienced improvement in Karnofsky Performance Status after surgery. Postoperative hydrocephalus occurred in 2 patients (18.2%) and was relieved by endoscopic third ventriculostomy. The endoscopic supracerebellar infratentorial transpineal approach is an effective approach for removing posterior-medial thalamic lesions that require access through the third ventricle surfaces of the thalamus. The endoscopic contralateral paramedian supracerebellar infratentorial transpineal approach provides a more superior and lateral view of the posterior-medial thalamic lesions.

Cardiac tamponade complicating esophagectomy and retrosternal gastric tube reconstitution in a patient with an abnormal ascending aorta position: a case report

BackgroundCardiac tamponade is a rare postoperative complication of esophageal cancer surgery, which leads to rapid hemodynamic changes and can be fatal if not treated properly and promptly. Herein, we report a case of cardiac tamponade after thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstitution for esophageal cancer that was successfully treated with surgical drainage.Case presentationAn 86-year-old man with lower thoracic esophageal cancer underwent thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstitution. No intra-operative complications were observed. On the first postoperative day, tachycardia and hypotension were observed, and pericardial effusion was identified on computed tomography images. The patient was diagnosed with obstructive shock secondary to cardiac tamponade. As percutaneous puncture drainage was not possible due to the presence of a retrosternal gastric tube, pericardiotomy with a small left anterior thoracotomy was performed, and a large amount of hematogenous fluid was drained, which instantly improved circulation. On the second postoperative day, the patient showed decreased pulse pressure, and computed tomography revealed a residual and enlarged hematoma around the right ventricle. The patient underwent surgical drainage and another pericardiotomy with a small right anterior thoracotomy was performed to drain the hematoma. At this time, multiple injuries to the fatty tissue, epicardium, and myocardium with active bleeding were observed on the anterior surface of the right ventricle near the root of the pulmonary artery. In this patient, the ascending aorta ran further to the right and dorsal sides than usual, causing the anterior wall of the right ventricle near the root of the pulmonary artery to be closer to the back of the sternum. This abnormality may have contributed to injury during the creation of the retrosternal pathway, leading to cardiac tamponade.ConclusionsCardiac tamponade after esophagectomy can occur because of manipulation during creation of the retrosternal route, with an anomaly in the aortic position being present in this case. Gentle manipulation and selection of the reconstruction route according to the patient’s condition are necessary in cases with such anatomical abnormalities.

Should an emergency physician be a "surgeon" in a rural area? A case of blunt cardiac rupture successfully treated by an emergency physician.

Blunt cardiac rupture is a life-threatening injury that requires surgical repair by cardiovascular or trauma surgeons. We report a case of blunt cardiac rupture in a rural area in which emergency physicians performed emergency department thoracotomy and surgical repair to save the patient's life. This case involved an 18-year-old female who was injured in a traffic accident and underwent emergency thoracotomy and surgical repair. The patient's left thorax was deformed, and sonographic assessment revealed pericardial effusion. She experienced cardiopulmonary arrest 13 min after hospital arrival. An emergency physician performed an emergency department thoracotomy. The clots were removed from the surface of the left ventricle, followed by wound compression to control bleeding from the ruptured left ventricular wall. After the recovery of spontaneous circulation, the emergency physician sutured the ruptured heart. The patient survived with good neurological function. In rural areas, blunt cardiac rupture may require emergency department thoracotomy and cardiac repair by emergency physicians. The establishment of educational systems that include continuous education on trauma surgical procedures and consensus guidelines is needed to assist rural emergency physicians in performing surgical procedures.

Quantification and Visualization of CT Myocardial Perfusion Imaging to Detect Ischemia-Causing Coronary Arteries.

Coronary computed tomography angiography (cCTA) has poor specificity to identify coronary stenosis that limit blood flow to the myocardial tissue. Integration of dynamic CT myocardial perfusion imaging (CT-MPI) can potentially improve the diagnostic accuracy. We propose a method that integrates cCTA and CT-MPI to identify culprit coronary lesions that limit blood flow to the myocardium. Coronary arteries and left ventricle surfaces were segmented from cCTA and registered to CT-MPI. Myocardial blood flow (MBF) was derived from CT-MPI. A ray-casting approach was developed to project volumetric MBF onto the left ventricle surface. MBF volume were divided into coronary-specific territories based on proximity to the nearest coronary artery. MBF and normalized MBF were computed for the myocardium and each of the coronary artery. Projection of MBF onto cCTA allowed for direct visualization of perfusion defects. Normalized MBF had higher correlation with ischemic myocardial territory compared to MBF (MBF: R2=0.81 and Index MBF: R2=0.90). There were 18 vessels that showed angiographic disease (stenosis >50%); however, normalized MBF demonstrated only 5 coronary territories to be ischemic. These findings demonstrate that cCTA and CT-MPI can be integrated to visualize myocardial defects and detect culprit coronary arteries responsible for perfusion defects. These methods can allow for non-invasive detection of ischemia-causing coronary lesions and ultimately help guide clinicians to deliver more targeted coronary interventions.

High-risk Brugada syndrome: factors associated with arrhythmia recurrence and benefits of epicardial ablation in addition to implantable cardioverter defibrillator implantation.

This study aims to evaluate the prognostic impact of the arrhythmogenic substrate size in symptomatic Brugada syndrome (BrS) as well as to validate the long-term safety and effectiveness of epicardial radiofrequency ablation (RFA) compared with no-RFA group. In this prospective investigational long-term registry study, 257 selected symptomatic BrS patients with implantable cardioverter defibrillator (ICD) implantation were included. Among them, 206 patients underwent epicardial RFA and were monitored for over 5 years post-ablation (RFA group), while 51 patients received only ICD implantation declining RFA. Primary endpoints included risk factors for ventricular fibrillation (VF) events pre-ablation and freedom from VF events post-ablation. In the RFA group, BrS substrates were identified in the epicardial surface of the right ventricle. During the pre-RFA follow-up period (median 27 months), VF episodes and VF storms were experienced by 53 patients. Independent risk factors included substrate size [hazard ratio (HR), 1.13; 95% confidence interval (CI), 1.08-1.18; P < 0.001], aborted cardiac arrest (HR, 2.98; 95% CI, 1.68-5.28; P < 0.001), and SCN5A variants (HR, 2.22; 95% CI, 1.15-4.27; P = 0.017). In the post-RFA follow-up (median 40 months), the RFA group demonstrated superior outcomes compared with no-RFA (P < 0.001) without major procedure-related complications. Our study underscores the role of BrS substrate extent as a crucial prognostic factor for recurrent VF and validates the safety and efficacy of RFA when compared with a no-RFA group. Our findings highlight the importance of ajmaline in guiding epicardial mapping/ablation in symptomatic BrS patients, laying the groundwork for further exploration of non-invasive methods to guide informed clinical decision-making.

Association between retinal layer thickness and cerebral white matter hyperintensities in older adults

AbstractBackgroundThe brain and retina may share pathophysiological mechanisms in various central nervous system disorders, suggesting the potential associations between retinal layer thickness and cerebral white matter hyperintensities (WMH).MethodA total of 149 participants without dementia aged over 65 years (mean age: 75.4, SD: 5.4, range: 65‐91; male: 90 [60.4%]) from the randomly sampled community‐dwelling prospective cohort were included in the analysis. Using spectral‐domain optical coherence tomography, we assessed the thickness of 6 retinal layers in the macular region, the peripapillary retinal nerve fiber layers, and the subfoveal choroid. We classified WMH into 3 groups using the distance from the ventricle surface: juxtaventricular (JVWMH, &lt; 4mm), periventricular (PVWMH, &gt;4mm, &lt;14mm), and deep WMH (DWMH &gt; = 14mm). The associations between retinal layer thickness and WMH volume were examined using linear regression models adjusting age, sex, comorbid hypertension, and diabetes.ResultThe thicknesses of superior outer, inferior outer ganglion cell layers (GCL) and superior outer, inferior outer, total outer inner plexiform layers (IPL) were negatively associated with the total WMH, PVWMH, and DWMH volumes. Reduced thicknesses of total outer GCL and temporal outer inner nuclear layer (INL) were associated with higher total WMH and PVWMH volumes. Center GCL thickness was positively associated with JVWMH volume, and nasal outer GCL thickness was negatively associated with DWMH volume.ConclusionOuter GCL and IPL thicknesses may be associated with WMH volume in older adults. This study may also suggest differential associations based on etiology between retinal layer subfields and WMH subgroups.

Longitudinal Elastic Shape Analysis of Brain Subcortical Structures

AbstractBackgroundOver the past 30 years, MRI has become a ubiquitous tool for accurately visualizing the development of the brain’s subcortical structures. However, the quantification of subcortical structures is still in its infancy due to challenges in shape extraction, representation, and modeling.MethodA simple and efficient framework of longitudinal elastic shape analysis (LESA) is developed for subcortical structures. By employing the elastic shape analysis of static surfaces using the square root normal field (SRNF) representations, we computed shape summaries of surfaces and represented the complex subcortical structures using a small number of basis functions. Further, we statistically modeled the sparse longitudinal data to predict the spatial‐temporal shape changes of subcortical structures. We also conducted the temporal registration using the square‐root velocity function (SRVF) framework to quantify the accelerated aging of Alzheimer’s disease (AD).ResultWe applied LESA to analyze longitudinal neuroimaging data sets and showcased its wide applications in estimating continuous shape trajectories, building life‐span growth patterns, and comparing shape differences among different groups. Using the Alzheimer’s Disease Neuroimaging Initiative (ADNI) data, we found that from 60 to 90 years old, the AD group always had the largest left ventricle (LV) surface area and the smallest left hippocampus (LHC) surface area, followed by the MCI and NC groups. The enlargement of LV and the atrophy of LHC had different speeds among different groups. Most of the shape‐changing differences between the AD and NC groups were visible in the anterior and posterior ends of LV. The atrophy of LHC happened mainly at the posterior end with aging. The AD group had the sharpest posterior end, and the NC group deformed the least with aging. Compared with the NC group, the AD group showed an average accelerated enlargement of 2.91 years and accelerated shape change of 2.76 years in LV; an average accelerated atrophy of 2.56 years and accelerated shape change of 2.59 years in LHC. By constructing the life‐span growth trajectories, we observed increases in shape changes’ speed in both LV and LHC after 60 years old.ConclusionAD can significantly speed up the shape change of ventricle and hippocampus compared with normal aging.

Schizencephaly: A Case Report

Schizencephaly is a rare anomaly of embryonic development characterized by the presence of linear fissures containing cerebrospinal fluid and lined with dysplastic gray matter, extending from the pial surface of the cerebral hemisphere to the ependymal surface of the lateral ventricle. Schizencephaly can affect one or both cerebral hemispheres, leading to a variety of neurological symptoms such as epilepsy, motor deficits and psychomotor retardation. An antenatal diagnosis can be made; treatment is based on rehabilitation, antiepileptic drugs and supportive psychotherapy.&#x0D; We report the case of a 3-year-old child admitted to our department for a generalized tonicoclonic convulsive seizure resistant to antiepileptic treatment. The child's antecedents included a well-monitored pregnancy carried to term, and a vaginal delivery with no evidence of neonatal distress. The parents are not consanguineous, but there have been two deaths in the siblings (at 15 days and 40 days) of unknown origin. The child also showed delayed psychomotor development.&#x0D; An MRI scan revealed a type 1 right schizencephaly with a closed cleft, but biology revealed no abnormalities, and genetic studies are still in progress.&#x0D; Management to date is based on antiepileptic drugs, psychomotor rehabilitation and sometimes surgery.

Sternotomy or Thoracotomy: Which One?

Abstract: Penetrating injuries to the chest present a frequent and challenging problems. Median sternotomy and thoracotomy are two choices to explore any trauma to the chest. We report a 37-year-old man with wound and pain in his left chest due to being stabbed with a knife one hour ago. On physical examination, an open wound measured 5x1.5 cm as high as the third rib parallel to the left parasternal line, the edges of the wound bed were flattened by the periosteum. Laboratory examination showed leukocytosis. FAST showed an important left pleural effusion and pericardial fluid. CTA study showed the presence of air in the anterior mediastinum and the left pleural cavity. In the fifth intercostal space, a left anterolateral thoracotomy was performed and 800 ml of blood was evacuated from the left chest. The left lung was lowered to open the pericardium, which caused a further drop in blood pressure; then, the pericardium was opened and a blood clot (1500 ml) was removed. An epicardial wounds were found on the anterior surface of the right ventricle. The left anterior coronary artery was actively bleeding. The hemorrhagic lesion was stitched with 4.0 polypropylene reinforced with a Teflon strip. The patient recovered uneventfully on the sixth postoperative day. During the 14-month follow-up, the patient was fine and back to work. In conclusion, surgeon must be able to decide the technique of approach in the operating room considering the site of injury and the presence of involving organ. Thoracotomy patient can also receive median sternotomy if the cardiac injuries could not be repaired through thoracotomy. In addition, some patients with median sternotomy also received additional thoracotomy due to their pulmonary injuries. Keywords: penetrating injuries; thoracotomy; sternotomy; cardiac injury

Correlation relationships of the reentrant ventricular tachycardia circuit

IntroductionA quantitative analysis of the components of reentrant ventricular tachycardia (VT) circuitry could improve understanding of its onset and perpetuation. MethodIn 19 canine experiments, the left anterior descending coronary artery was ligated to generate a subepicardial infarct. The border zone resided at the epicardial surface of the anterior left ventricle and was mapped 3–5 days postinfarction with a 196–312 bipolar multielectrode array. Monomorphic VT was inducible by extrastimulation. Activation maps revealed an epicardial double-loop reentrant circuit and isthmus, causing VT. Several circuit parameters were analyzed: the coupling interval for VT induction, VT cycle length, the lateral isthmus boundary (LIB) lengths, and isthmus width and angle. ResultsThe extrastimulus interval for VT induction and the VT cycle length were strongly correlated (p < 0.001). Both the extrastimulus interval and VT cycle length were correlated to the shortest LIB (p < 0.005). A derivation was developed to suggest that when conduction block at the shorter LIB is functional, the VT cycle length may depend on the local refractory period and the delay from wavefront pivot around the LIB. Isthmus width and angle were uncorrelated to other parameters. ConclusionsThe shorter LIB is correlated to VT cycle length, hence its circuit loop may drive reentrant VT. The extrastimulation interval, VT cycle length, and shorter LIB are intertwined, and may depend upon the local refractory period. Isthmus width and angle are less correlated, perhaps being more related to electrical discontinuity caused by alterations in infarct shape at depth.

Disrupted neurogenesis, gliogenesis, and ependymogenesis in the Ccdc85c knockout rat for hydrocephalus model

Coil-coiled domain containing 85c (Ccdc85c) is a causative gene for congenital hydrocephalus and subcortical heterotopia with frequent brain hemorrhage. We established Ccdc85c knockout (KO) rats and investigated the roles of CCDC85C and intermediate filament protein expression, including nestin, vimentin, GFAP, and cytokeratin AE1/AE3 during the lateral ventricle development in KO rats to evaluate the role of this gene. We found altered and ectopic expression of nestin and vimentin positive cells in the wall of the dorso-lateral ventricle in the KO rats during development from the age of postnatal day (P) 6, whereas both protein expression became faint in the wild-type rats. In the KO rats, there was a loss of cytokeratin expression on the surface of the dorso-lateral ventricle with ectopic expression and maldevelopment of ependymal cells. Our data also revealed disturbed GFAP expression at postnatal ages. These findings indicate that lack of CCDC85C disrupts the proper expression of intermediate filament proteins (nestin, vimentin, GFAP, and cytokeratin), and CCDC85C is necessary for normal neurogenesis, gliogenesis, and ependymogenesis.

New ECG Algorithm for the Prediction of Culprit Vessel in Acute Myocardial Infarction Involving Lateral Part of the Ventricle: Ilkay Classification.

Isolated lateral myocardial infarction sometimes does not meet ST-segment elevation myocardial infarction (STEMI) criteria according to contiguous leads. This condition could cause late diagnosis and the need for revascularization therapy. To accurately predict the occlusion of lateral surface of the left ventricle, we defined a new electrocardiogram (ECG) algorithm by using angiographic and electrocardiographic correlations. This was a retrospective, multicenter observational study. The study population consisted of 200 patients with STEMI affecting lateral surface of myocardium, between 2021 and 2022. According to the coronary angiography results, we identified 74 eligible patients for study protocol. The study patients were divided into two groups: isolated DB (14 patients) or circumflex obtuse marginal group (60 patients). ST depression in lead V2 had high positive predictive values for the prediction of obtuse marginal occlusion (positive predictive values (PPV), 100%; negative predictive value (NPV), 90%). ST elevation in V2 in ECG, in conjunction with ST depression in lead III had high positive predictive values for prediction of diagonal branch of LAD. Moreover, the presence of hyperacute T wave (≥10 mm) in lead V2 and ≥2 mm ST depression in lead III had large diagonal branch of LAD (PPV, 98%; NPV, 100%). However, <10 mm T wave in lead V2 and <2 mm ST depression in lead III had small diagonal branch of LAD. We comprehensively classified the lateral STEMI definition through new electrocardiographic scheme as Ilkay classification, whereby we could accurately predict infarct-related artery and its occlusion level in lateral myocardial infarction.

Bone cement migrated to the right heart resulting in perforation of the ventricular wall with cardiac tamponade.

An 85-year-old man came to our emergency department because of acute shock due to cardiac tamponade. Four days ago, he underwent percutaneous vertebroplasty of the T12-L4 spine because of a compression fracture of the vertebral body, and post-operative X-ray suggested a leakage of bone cement from the L1 vertebra (Panel A). Computed tomography revealed a linear-shaped hyperattenuated lesion extending from the right heart into the pericardial cavity accompanied by massive pericardial effusion (Panel B). The patient underwent emergency surgery after pericardial puncture. Intra-operative transoesophageal echocardiography revealed a strong echo in the right ventricle (Panel C; Supplementary data online, Movie S1). The pericardial cavity was opened and plenty of clots were found, the foreign body was found on the surface of the right ventricle with sharp exposed end and was pulled out, and the right ventricular wall was repaired (Panel D; Supplementary data online, Movie S2). The foreign body was hard, formed a needle-shaped, measured ∼6×0.3 cm, and was diagnosed as bone cement (Panel E). Post-operative transoesophageal echocardiography revealed no obvious residuum in the heart or vena cava. The patient was in good condition initially after the surgery, but later died of respiratory failure caused by a severe pulmonary infection.

AB-452674-4 SHORT AND SWEET: EXPLORING HIGH POWER, SHORT DURATION RADIOFREQUENCY ABLATION STRATEGIES FOR OPTIMAL LESION FORMATION

High power, short duration (HPSD) radiofrequency (RF) ablation allows for wider, more uniform ablation lesion formation as compared to moderate power, moderate duration ablation. Ablation with HPSD capitalizes on the resistive heating phase providing immediate heating to the target tissue while preventing the consequences of conductive heating. Understanding the threshold where resistive heating transitions to conductive heating may allow for optimization of parameters to favor resistive heating. Additionally, HPSD lesion application has been associated with a lower risk of complications, including cardiac perforation and atrioesophageal fistulas. To assess lesion formation with variations in RF duration and contact force utilizing a HPSD strategy in an ex vivo model. This study utilized recently harvested swine heart tissue ablated using a contact force sensing irrigation ablation catheter submerged in a saline bath with a target temperature of 36 °C and an impedance of 140 Ω. Step 1 compared various RF durations (1-5, 8, and 10 seconds(s)) with 50 Watts (W) and an average of 10g of force applied to the epicardial surface of the left ventricle. Six lesions were applied for each time duration. For step two of the procedure, we assessed the impact of contact force (1g, 5g, 10g, 20g) on lesion size and depth using 50 W and 5s RF duration. Five lesions were applied for each amount of contact force. The tissue was stained in a 2,3,5-Triphenyltetrazolium chloride bath prior to measurements. Of the 42 lesions created utilizing HPSD with variable durations of RF duration, application of >3s resulted in the creation of visual lesions within the tissue. There was an increase in lesion volume with longer duration ablation application (50W/10g), with 5, 8 and 10s durations generating lesion volumes of 16.8mm3, 26.8mm3 and 40.6mm3, respectively. All 20 lesion applications with varying degrees of contact force (50W/5s) resulted in visual lesions. There was an increase in lesion volume with higher contact force plateauing at 10 g, compared to 20g (28.9mm3 vs 31.9mm3, respectively). In an animal model, a HPSD ablation strategy focused on short duration lesion application with lower contact forces (50W/5s/10g) created lesions of similar volume to 20g of force application. In the initial 10s of lesion formation, a force >10g may have a lesser role and may potentially represent a transition point between resistive and conductive heating.