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A patient with borderline left ventricle successfully underwent biventricular repair following a staged surgical approach to promote left ventricular growth. Despite initial concerns about left ventricle size, apex formation and adequate size of atrioventricular valve indicated potential for future growth. The patient demonstrated significant left ventricular growth, resulting in stable biventricular circulation and a favourable outcome over a three-year postoperative follow-up period.Clinical Registration Number: Institutional Review Board of Osaka City General Hospital, number 1902139.

Introduction: Coronary artery anomalies are rare congenital variations of the arteries that supply the heart. Examples of these anomalies include the development of a single coronary artery (SCA) to supply the entire myocardium, two left anterior descending arteries (LAD) occupying the anterior interventricular sulcus, and three posterior descending arteries (PDA) occupying the posterior interventricular sulcus. Reports of rare, simultaneously occurring coronary artery anomalies serve as valuable references for medical education and clinical practice but are scarce in the literature. The present study describes a human cadaveric heart where a SCA gives rise to distinct dual LADs and three PDAs. The study aims to characterize the anomalies and investigate the anatomy, histology, and clinical considerations of this unique coronary anatomy. Methods: The SCA, dual LAD, and triple PDA were discovered during routine cadaveric dissection in a medical education curriculum. The heart was eviscerated, and the anomalies were cleaned of extraneous tissue and photographed. Color replacement was performed on the images to aid in structure identification. The SCA was characterized using Lipton's classifications, and the dual LAD was classified according to the thirteen variations (“Types”) of dual LAD described in the literature. Length, luminal area, and plaque buildup were recorded for each of the relevant arteries. A constriction on the great cardiac vein and an unknown tissue mass associated with the left main coronary artery (LMCA) were examined via histological staining and light microscopy. Courses of the coronary artery anomalies were superimposed on volume rendered computerized tomographic angiography images depicting typical coronary anatomy for comparison. Results: The SCA arose from a solitary coronary ostium in the right coronary sinus and traveled 0.57 cm from the aortic trunk before branching the right coronary artery (RCA), long LAD, LMCA, and descending septal artery. The RCA maintained typical anatomic course before terminating as a right-dominant triple PDA. The long LAD coursed pre-pulmonic along the anterior interventricular sulcus for 13.89 cm before terminating near the apex of the heart. The LMCA tracked retro-aortic, between the aorta and the atrial wall, for 5.67 cm before bifurcating into the left circumflex artery (LCX) and 10.8 cm short LAD. Multiple anastomoses were noted involving the long LAD, short LAD, second PDA, third PDA, diagonal branches of the short LAD, and left marginal artery. The constriction on the great cardiac vein, caused by an overlaying left diagonal artery, decreased the venous wall thickness and altered its tissue composition. The unknown tissue adhered to LMCA appeared mucinous in origin. Conclusions: The heart presented in this study was supplied by a unique (Lipton's) RIII-C SCA with Type IV dual LAD and right-dominant triple PDA. Unexpected complications can arise during cardiac procedures for patients with coexisting coronary artery anomalies such as these. This report may serve as an important reference for cardiothoracic surgeons, interventional cardiologists, coronary angiographers, and medical educators when presented with a similar case and determining therapeutic design.

When participants respond to a task-relevant stimulus attribute by pressing a left or right key with the respective index finger, reaction time is shorter if task-irrelevant left-right stimulus location corresponds to that of the response key than if it does not. For right-handers, this Simon effect is larger for right-located than left-located stimuli; for left-handers this Simon-effect asymmetry is reversed. A similar asymmetry has been found for right-footers pressing pedals with their feet. For analyses that separate stimulus- and response-location factors, these asymmetries appear as a main effect of response location, with responses being faster with the dominant effector. If the Simon-effect asymmetry is strictly a function of effector dominance, it should reverse for left-footers responding with their feet. In Experiment 1, left-dominant persons showed faster responses with the left than right hand but with the right than left foot, a finding consistent with prior research on tapping actions. Right-dominant persons also showed the right-foot asymmetry but, unexpectedly, not the typical asymmetry with hand responses. To evaluate whether hand-presses yield results distinct from finger-presses, in Experiment 2 participants performed the Simon task with finger-presses and hand-presses. The opposing asymmetries for right- and left-dominant persons were evident for both response modes. Our results are consistent with the view that the Simon effect asymmetry is primarily due to differences in effector efficiency, usually but not always favoring the dominant effector.

Advanced endovascular technology and techniques allow interventional radiologists to utilize novel ways of basilar artery recanalization in the setting of acute ischemic stroke, especially when routine approaches are not eligible. Several authors described nonstandard revascularization techniques in acute ischemic strokes due to basilar and middle cerebral arteries occlusions with full technical and clinical success. In this report, we present retrograde right vertebral artery recanalization using left posterior communicating artery for subsequent anterograde balloon angioplasty and stenting of a right vertebral artery ostium followed by full vertebrobasilar blood flow restoration. The case underscores the complexity of arterial thrombotic events, the beneficial role of endovascular intervention in vertebral occlusions and the necessity of prospective studies that identify optimal methods of treating vertebrobasilar stroke due to large vessel occlusions and their effectiveness and safety. Keywords: Ischemic, Stroke, Vertebral, Basilar, Occlusion, Recanalization

Unbalance in atrioventricular septal defect can be found in more than one anatomic level and in different degrees at each level. The definition of “unbalance” has historically been focused in comparing the dimensions of main cardiac structures, such as the atrioventricular valve and the ventricles. However, the hemodynamic aspects of unbalance need to be considered as having, at least, similar relevance. New concepts and already described parameters must be combined and understood as a whole to help the surgical decision-making process.

Arrhythmogenic cardiomyopathy with right dominant form (ACR) is a rare heritable cardiac cardiomyopathy disorder associated with sudden cardiac death. Pathogenic variants (PVs) in desmosomal genes have been causally related to ACR in 40% of cases. Other genes encoding nondesmosomal proteins have been described in ACR, but their contribution in this pathology is still debated. A panel of 71 genes associated with inherited cardiopathies was screened in an ACR population of 172 probands and 856 individuals from the general population. PVs and uncertain significance variants (VUS) have been identified in 36% and 18.6% of patients, respectively. Among the cardiopathy-associated genes, burden tests show a significant enrichment in PV and VUS only for desmosomal genes PKP2 (plakophilin-2), DSP (desmoplakin), DSC2 (desmocollin-2), and DSG2 (desmoglein-2). Importantly, VUS may account for 15% of ACR cases and should then be considered for molecular diagnosis. Among the other genes, no evidence of enrichment was detected, suggesting an extreme caution in the interpretation of these genetic variations without associated functional or segregation data. Genotype-phenotype correlation points to (1) a more severe and earlier onset of the disease in PV and VUS carriers, underlying the importance to carry out presymptomatic diagnosis in relatives and (2) to a more prevalent left ventricular dysfunction in DSP variant carriers., (© 2022 The Authors. Human Mutation published by Wiley Periodicals LLC.)

Background: Right dominant heart (RDH) in fetuses can occur with a number of cardiac as well as noncardiac anomalies. Analysis of the enlargement of the right cardiac chamber in the fetus remains a major challenge for sonographers and echocardiographers. The aim of this study was to report the experience with prenatal diagnosis of RDH in the fetuses over a 7-year period. Methods: Fetuses with prenatal diagnosis of RDH from July 2009 to July 2016 were evaluated in two different categories: according to the gestational age, Group I (n = 154, second trimester) and Group II (n = 298, third trimester); and according to the fetal echocardiography diagnosis, Group A (n = 452, abnormal cardiac structure) and Group B (n = 90, normal cardiac structure). Differences in categorical variables were assessed by Chi-square exact test and continuous variables were evaluated by independent Student's t-test or Mann–Whitney U-test depending on parametric or nonparametric nature of the data. Results: Over a 7-year period, 452 fetuses were referred for the assessment of suspected RDH. Left-sided obstructive lesions were observed most frequently in the fetuses with RDH. When comparing Group I with Group II and Group A with Group B, the latter groups exhibited significant differences in the right/left ventricle (RV/LV) ratio (1.435 vs. 1.236, P = 0.002; 1.309 vs. 1.168, P = 0.047), RV width Z-score (1.626 vs. 1.104, P < 0.001; 1.553 vs. 0.814, P = 0.014), and above +2 cutoff percentages (14.3% vs. 22.5%; P = 0.038; 21.5% vs. 12.2%, P = 0.046). Multivariable logistic regression revealed no variables associated with perinatal survival. Conclusions: The study demonstrates that RDH warrants careful attention to the possible presence of a structural cardiac anomaly, especially left-sided obstructive lesions. A diagnosis of RDH is best supported by a combination of the RV Z-score and RV/LV ratio. Most of the fetuses with RDH and structurally normal hearts had favorable outcomes.

Background: Primary progressive aphasia (PPA) is a degenerative disease that presents as progressive decline of language ability with preservation of other cognitive functions in the early stages. Three subtypes of PPA are known: progressive nonfluent aphasia, semantic dementia, and logopenic aphasia (LPA). Patients and Methods: We report the case of a 77-year-old patient with PPA whose clinical findings did not correspond to the three subtypes but mainly fit LPA. Unlike other LPA patients, however, this patient showed a right hemisphere predominant glucose hypometabolism and tau accumulation and a left hemisphere predominant amyloid deposition. The right-handed patient presented with comprehension difficulty followed by problems naming familiar objects. This isolated language problem had deteriorated rapidly for 2 years, followed by memory difficulties and impairment of daily activities. Using a Korean version of the Western Aphasia Battery, aphasia was consistent with a severe form of Wernicke's aphasia. According to the brain magnetic resonance imaging and 18F-fludeoxyglucose positron emission tomography results, right hemisphere atrophy and hypometabolism, more predominant on the right hemisphere than the left, were apparent despite the fact that Edinburgh Handedness Questionnaire scores indicated strong right-handedness. On Pittsburgh compound B-PET, amyloid accumulation was asymmetrical with the left hemisphere being more predominant than the right, whereas 18F-T807-PET showed a right dominant tau accumulation. Conclusions: This is the first report of atypical PPA, in which the patient exhibited crossed aphasia and asymmetrical amyloid accumulation.

The central nervous system (CNS) develops motor strategies that minimize various hidden criteria, such as end-point variance or effort. A large body of literature suggests that the dominant (D) arm is specialized for such open-loop optimization-like processes, whereas the nondominant (ND) arm is specialized for closed-loop postural control. Building on recent results suggesting that the brain plans arm movements that take advantage of gravity effects to minimize muscle effort, the present study tests the hypothesized superiority of the dominant arm motor system for effort minimization. Thirty participants (22.5 ± 2.1 yr old; all right-handed) performed vertical arm movements between two targets (40° amplitude), in two directions (upward and downward) with their two arms (dominant and nondominant). We recorded the arm kinematics and electromyographic activities of the anterior and posterior deltoid to compare two motor signatures of the gravity-related optimization process; i.e., directional asymmetries and negative epochs on phasic muscular activity. We found that these motor signatures were still present during movements performed with the nondominant arm, indicating that the effort-minimization process also occurs for the nondominant motor system. However, these markers were reduced compared with movements performed with the dominant arm. This difference was especially prominent during downward movements, where the optimization of gravity effects occurs early in the movement. Assuming that the dominant arm is optimal to minimize muscle effort, as demonstrated by previous studies, the present results support the hypothesized superiority of the dominant arm motor system for effort minimization. NEW & NOTEWORTHY The hypothesis of hemispheric specialization for feedforward and feedback control has been developed and is still debated. Here, taking advantage of recent knowledge on optimal planning and control of arm movements in the gravity field, we recorded kinematics and electromyographic activities during vertical arm movements performed with the dominant and nondominant arms. Our results reveal that the nondominant arm takes advantage of gravity effects to minimize muscle effort, but less than the dominant arm.

Acute myocardial infarction is a condition that classically presents with chest pain and corresponding biomarkers and changes on electrocardiogram. Although most causes of acute coronary syndrome are due to acute plaque rupture resulting in coronary thrombosis, an increasingly prevalent condition known as spontaneous coronary artery dissection (SCAD) is becoming more commonly diagnosed. SCAD is characterized by a tear in the tunica media resulting in an intramural hematoma. Depending on the size of the hematoma, progressive extension can ultimately lead to coronary occlusion. Our team presents a 52-year-old female patient that presented with substernal chest pain and positive cardiac enzymes. Urgent coronary catheterization revealed bilateral SCAD involving the left anterior descending and posterior descending arteries in a right coronary dominant circuit. Our patient was treated with medical therapy alone and was safely discharged to home after close monitoring in the coronary care unit. Our team hopes to contribute to a growing body of evidence that bilateral SCAD can occur and can be successfully treated without percutaneous coronary intervention., Competing Interests: None to declare., (Copyright 2021, Mararenko et al.)

Introduction: Semantic dementia (SD) is characterized by fluent speech, anomia, and loss of word and object knowledge with varying degrees of right and left anterior-medial temporal lobe hypometabolism on [18F] fluorodeoxyglucose (FDG)-PET. We assessed neurobehavioral features in SD patients across 3 FDG-PET-defined metabolic patterns and investigated progression over time. Methods: Thirty-four patients with SD who completed FDG-PET were classified into a left- and right-dominant group based on the degree of hypometabolism in each temporal lobe. The left-dominant group was further subdivided depending on whether hypometabolism in the right temporal lobe was more or less than 2 standard deviations from controls (left+ group). Neurobehavioral characteristics determined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) were compared across groups. Progression of NPI-Q scores and FDG-PET hypometabolism was assessed in 14 patients with longitudinal follow-up. Results: The right-dominant group performed worse on the NPI-Q and had a greater frequency of abnormal behaviors and more severe disinhibition compared to the left-dominant group. Performance on the NPI-Q and severity of disinhibition correlated with right medial and lateral, but not left, temporal lobe hypometabolism. Severity of abnormal behaviors worsened over time in most left-dominant and left+ patients but appeared to improve in the 2 right-dominant patients with longitudinal follow-up. All groups showed progressive worsening of metabolism in both temporal lobes over time, with hypometabolism spreading from anteromedial to posterior temporal regions. However, the degree of temporal lobe asymmetry remained relatively constant over time. Conclusion: In SD, neurobehavioral features, especially disinhibition, are associated with right medial and lateral temporal lobe hypometabolism and commonly develop over time even in patients that present with left-dominant patterns of hypometabolism. [ABSTRACT FROM AUTHOR]

When participants respond to a task-relevant stimulus attribute by pressing a left or right key with the respective index finger, reaction time is shorter if task-irrelevant left-right stimulus location corresponds to that of the response key than if it does not. For right-handers, this Simon effect is larger for right-located than left-located stimuli; for left-handers this Simon-effect asymmetry is reversed. A similar asymmetry has been found for right-footers pressing pedals with their feet. For analyses that separate stimulus- and response-location factors, these asymmetries appear as a main effect of response location, with responses being faster with the dominant effector. If the Simon-effect asymmetry is strictly a function of effector dominance, it should reverse for left-footers responding with their feet. In Experiment 1, left-dominant persons showed faster responses with the left than right hand but with the right than left foot, a finding consistent with prior research on tapping actions. Right-dominant persons also showed the right-foot asymmetry but, unexpectedly, not the typical asymmetry with hand responses. To evaluate whether hand-presses yield results distinct from finger-presses, in Experiment 2 participants performed the Simon task with fingerpresses and hand-presses. The opposing asymmetries for right- and left-dominant persons were evident for both response modes. Our results are consistent with the view that the Simon effect asymmetry is primarily due to differences in effector efficiency, usually but not always favoring the dominant effector. [ABSTRACT FROM AUTHOR]

Definition and management of right dominant unbalanced atrioventricular septal defect (AVSD) remains challenging because unbalance entails a spectrum of left heart hypoplasia. Previous work has highlighted atrioventricular valve (AVV) index as a reasonable defining echocardiographic measure. We sought to assess which additional echocardiographic features might provide further characterization.From a multi-institutional cohort of complete AVSD, 52 preoperative echocardiograms of patients with presumed right dominant unbalanced AVSD (based on AVV index) and 60 randomly selected preoperative echocardiograms from patients with presumed balanced AVSD were reviewed. Cluster analysis of echocardiographic variables was used to group patients with similar features. Discriminant function analysis was used to explore which variables differentiated these groups. Three groups were identified from the cluster analysis. Echocardiographic variables that differentiated these groups were right ventricle:left ventricle inflow angle, LV width/LV length, left AVV color diameter at smallest inflow, left AVV color diameter at annulus, right AVV overriding left atrium, and LV width. Based on procedures and outcomes, 1 group likely represented balanced patients, whereas 2 groups with similar outcomes likely represented unbalanced patients. The dominant differentiating echocardiographic variable between the 3 cluster groups was the right ventricle:LV inflow angle (partial R2=0.86), defined as the angle between the base of the right ventricle and LV free wall, using the crest of the ventricular septum as apex of the angle.The angle of right ventricle/LV inflow and other surrogates of inflow may be important defining echocardiographic measures of right dominant unbalanced AVSD, although confirmation is needed. [ABSTRACT FROM AUTHOR]

Background: Ablation of drivers maintaining atrial fibrillation (AF) has been demonstrated as an effective therapy. Drivers in the form of rapidly activated atrial regions can be noninvasively localized to either left or right atria (LA, RA) with body surface potential mapping (BSPM) systems. This study quantifies the accuracy of dominant frequency (DF) measurements from reduced-leads BSPM systems and assesses the minimal configuration required for ablation guidance., Methods: Nine uniformly distributed lead sets of eight to 66 electrodes were evaluated. BSPM signals were registered simultaneously with intracardiac electrocardiograms (EGMs) in 16 AF patients. DF activity was analyzed on the surface potentials for the nine leads configurations, and the noninvasive measures were compared with the EGM recordings., Results: Surface DF measurements presented similar values than panoramic invasive EGM recordings, showing the highest DF regions in corresponding locations. The noninvasive DFs measures had a high correlation with the invasive discrete recordings; they presented a deviation of <0.5 Hz for the highest DF and a correlation coefficient of >0.8 for leads configurations with 12 or more electrodes., Conclusions: Reduced-leads BSPM systems enable noninvasive discrimination between LA versus RA DFs with similar results as higher-resolution 66-leads system. Our findings demonstrate the possible incorporation of simplified BSPM systems into clinical planning procedures for AF ablation., (© 2017 Wiley Periodicals, Inc.)

Background: Unbalanced forms of atrioventricular septal defect continue to be challenging and present poor surgical outcomes. Echocardiographic indicators such as atrioventricular valve index, right ventricle/left ventricle inflow angle, and size of the ventricular septal defect have been identified as relevant discriminators that may guide surgical strategy. Our purpose is to describe another metric to refine surgical decision-making., Methods: We outline a geometrical description of the anatomic features of atrioventricular septal defect and describe equations that help explain the interplay between the main echocardiographic variables., Results: A new metric called "indexed ventricular septal defect" is defined as the size of the defect in relation to the valve diameter. We derive a final equation relating this index with the atrioventricular valve index and the right ventricle/left ventricle inflow angle. In the light of that equation, we discuss the interdependence of variables and employ data from a Congenital Heart Surgeons' Society study to set the limits of the new index., Conclusion: Combined use of indexed ventricular septal defect and atrioventricular valve index might help clarify surgical decision-making in patients with mild and moderate unbalance (modified atrioventricular valve index between 0.2 and 0.39). For indexed ventricular septal defect smaller than 0.2, biventricular repair may be recommended. Between 0.2 and 0.35, this strategy could probably be achieved depending on other factors. However, other strategies should be considered for those patients showing an indexed ventricular septal defect between 0.35 and 0.5. For values above 0.5 to 0.55, univentricular palliation might be a reasonable strategy.

Here we report a rare case of immunoglobulin G4 (IgG4)–related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66‐year‐old man was admitted to our hospital with right‐dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right‐dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video‐assisted thoracoscopic surgery showed fibrosis‐associated lymphoplasmacytic infiltration, 45–60 IgG4‐positive plasma cells per high‐power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4‐related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy. [ABSTRACT FROM AUTHOR]

We did a retrospective analysis of 102 coronary angiograms for coronary dominance. Right-dominant circulation was seen in 62 (60.8%) patients, whereas left-dominant and codominant circulation was seen in 25 (24.5%) and 15 (14.7%) patients, respectively. Regarding gender variations, among males 71.42% had right-dominant circulation, where it was left dominant in 20.63% and codominant in 7.93%. For females, right-dominant circulation was present in 43.59% of patients, and left-dominant and codominant circulation was present in 30.77% and 25.64% of patients, respectively.

Background: Factors affecting the outcomes after Fontan palliation are still controversial. Thus, this study aimed to compare hospital and long-term outcomes after Fontan palliation in patients with left-dominant, right-dominant, and co-dominant ventricles. Moreover, the study sought to identify factors associated with long-term surgical reintervention, catheter-based interventions, and morality. This retrospective cohort study was conducted in a single tertiary referral center between 2010 and 2024 and included all patients who had Fontan palliation (n = 247). The patients were grouped according to the dominant ventricle into three groups: left-dominant (n = 105), right-dominant (n = 108), and codominant (n = 36). Results: No significant differences were found in demographic variables among groups. Heterotaxy was more common in codominant patients who exhibited higher preoperative saturation levels. Early postoperative complications were more frequent in right-dominant patients, with low cardiac output significantly lower in left-dominant patients. Codominant patients experienced more arrhythmias and complete heart block, while operative mortality rates were similar across groups. During a median follow-up of 80 months, the freedom from surgical reintervention at 5, 10, and 15 years was highest in the left-dominant group (97%) compared to right dominance (93%, 78%) and codominance (97%, 87%). Mortality was significantly higher in the right-dominant and codominant groups, with survival rates at 5, 10, and 15 years being 97% for left dominance, 92% for right dominance, and 91% for codominance. Factors influencing long-term mortality were older age, right dominance, and elevated pulmonary artery pressure. Conclusions: Patients with left dominance exhibited superior survival rates and fewer complications compared to those with right dominance and codominance. The findings emphasize the importance of anatomical considerations in risk stratification and clinical decision-making. Young age at the time of palliation could improve the outcomes of the Fontan procedure. [ABSTRACT FROM AUTHOR]

R380 --> 480.5 --> INTRODUCTION: Coronary artery anomalies (CAAs) are rare congenital variations of normal coronary artery anatomy. Examples of CAAs include a single coronary artery (SCA) (instead of separate, left and right vessels) arising from the aortic trunk to supply the entire myocardium (prevalence = 0.024% to 0.066%), two left anterior descending arteries (LAD) (instead of one) occupying the anterior interventricular sulcus (prevalence = 0.02% to 1%), and three posterior descending arteries (PDA) (instead of one) occupying the posterior interventricular sulcus (prevalence uncertain). Reports of rare CAAs, especially those previously undocumented to occur simultaneously, serve as valuable references for medical education and clinical practice. The present study describes an especially unique CAA discovered in a human cadaveric heart where a SCA gives rise to distinct dual LAD and triple PDA. The study aims to characterize the involved CAAs and investigate the anatomy, histology, and clinical considerations of this unique coronary anatomy. METHODS: The SCA, dual LAD, and triple PDA CAAs were discovered during routine cadaveric dissection in a medical education curriculum. The heart was eviscerated, and the CAAs were carefully cleaned of extraneous tissue, photographed, and measured. The SCA was characterized using Lipton's classifications, and the dual LAD was classified according to the thirteen variations ("Types") of dual LAD described in the literature. Masson's Trichrome histological staining was performed to examine CAA tissue integrity via light microscopy. Courses of the CAAs were superimposed on volume rendered computerized tomographic angiography (CTA) images depicting normal coronary anatomy for comparison. RESULTS: The SCA arose from a solitary coronary ostium in the right coronary sinus and traveled 0.57 cm from the aortic trunk before quadfurcating into the right coronary artery (RCA), long LAD, left main coronary artery (LMCA), and descending septal artery (DSA). The RCA maintained normal anatomic course before terminating in a right‐dominant triple PDA. The long LAD coursed pre‐pulmonic along the anterior interventricular sulcus for 13.89 cm before terminating near the apex of the heart. The LMCA tracked retro‐aortic, between the aorta and the atrial wall, for 5.67 cm before bifurcating into the left circumflex artery (LCX) and short LAD. The short LAD paralleled long LAD within the anterior interventricular sulcus for 10.8 cm before anastomosing with the second PDA near the apex. Additional anastomoses were noted near the apex of the heart between the long LAD, short LAD, second PDA, third PDA, diagonal branches of the short LAD, and left marginal artery. The DSA coursed between the aorta and pulmonary trunk before entering the interventricular septum. CONCLUSIONS: The heart presented in this study was supplied by a unique (Lipton's) RIII‐C SCA with Type IV dual LAD and right‐dominant triple PDA. Unexpected complications can arise from cardiac procedures involving patients with unknown CAAs such as these. This report may serve as a key reference for cardiothoracic surgeons, interventional cardiologists, coronary angiographers, and medical educators when considering simultaneous occurrence of these rare CAAs. [ABSTRACT FROM AUTHOR]

A 48 year-old obese male with hypertension was admitted to our department because of severe right-dominant heart failure. His heart rhythm was 2:1 atrial flutter and the left ventricle was diffusely hypertrophic and hypokinetic. Primary aldosteronism was diagnosed based on severe hypokalemia (2.6 mEq/L) and a low renin-high aldosterone state with hypertension despite the use of an angiotensin-II receptor blocker, but its etiology could not be clarified with computed tomography, adrenal scintigraphy, and adrenal vein sampling. Ascites and edema rapidly worsened. Ascites aspiration was performed daily, until serum potassium was normalized by a full dose of an aldosterone receptor blocker (spironolactone 100 mg/day). A diuretic (furosemide) was then added. Rate control of atrial flutter was obtained with a beta-adrenergic blocker, and anticoagulation therapy was started. His heart failure was successfully controlled. Coronary arteries were normal on coronary arteriograms, and an endomyocardial biopsy sample obtained from the left ventricle did not show any specific pathological findings. Blood pressure was well controlled with the full dose of the aldosterone receptor blocker, but he died one year later due to intracerebral hemorrhage. As his heart failure was right dominant, we believe that its etiology may have been hyperaldosteronism-induced cardiomyopathy, and not advanced hypertensive heart disease.

We present a multiagent model illustrating the emergence of two different quantum statistics, Bose-Einstein and Fermi-Dirac, in a friendly population of individuals with the right-brain dominance and in a competitive population of individuals with the left-brain hemisphere dominance, correspondingly. Doing so, we adduce the arguments that Lefebvre's "algebra of conscience" can be used in a natural way to describe decision-making strategies of agents simulating people with different brain dominance. One can suggest that the emergence of the two principal statistical distributions is able to illustrate different types of society organization and also to be used in order to simulate market phenomena and psychic disorders, when a switching of hemisphere dominance is involved.

Background: There are variations in the anatomy of the coronary arteries in patients with left dominant circulation. The influence of anatomical variations in patients with left dominant circulation on coronary arteriosclerosis is not clear., Aim: We investigated whether atherosclerotic involvement in patients with left dominant circulation differs from that in patients with right dominant circulation., Methods: We retrospectively compared 38 consecutive angiograms with left coronary dominance with 459 consecutive angiograms with right coronary dominance. By using the 29-segment coding system of the American College of Cardiology/American Heart Association, numerical values were given to each segment, according to the percentage of the decrease in luminary diameter. Using, the sum of numerical values in each coronary artery, LAD score, LCx score, RCA score, and left main coronary artery (LMCA) score were obtained. Using the sum of these 4 vessel scores, the coronary artery disease (CAD) score was calculated., Results: Total LAD score (49+/-48 vs 47+/-57), total LCx score (29+/-45 vs 41+/-58), total RCA score (32+/-68 vs 30+/-51), total LMCA score (1.8+/-11.3 vs 2.9+/-13.6) and total CAD score (108+/-108 vs 108+/-123) were similar in patients with left and right dominant circulation (all differences NS)., Conclusions: The extent of coronary atherosclerosis does not depend on the type of dominant coronary circulation.

Objective: Primary progressive apraxia of speech (PPAOS) is associated with imaging abnormalities in the lateral premotor cortex (LPC) and supplementary motor area (SMA). It is not known whether greater involvement of these regions in either hemisphere is associated with demographics, presenting, and/or longitudinal features. Methods: In 51 prospectively recruited PPAOS patients who completed [18F]‐fluorodeoxyglucose (FDG) positron emission tomography (PET), we classified patients as left‐dominant, right‐dominant, or symmetric, based on visual assessment of the LPC and SMA on FDG‐PET. SPM and statistical analyses of regional metabolic values were performed. Diagnosis of PPAOS was made if apraxia of speech was present and aphasia absent. Thirteen patients completed ioflupane‐123I (dopamine transporter [DAT]) scans. We compared cross‐sectional and longitudinal clinicopathological, genetic, and neuroimaging characteristics across the three groups, with area under the receiver‐operating curve (AUROC) determined as a measure of effect size. Results: In all, 49% of the PPAOS patients were classified as left‐dominant, 31% as right‐dominant, and 20% as symmetric, which was supported by results from the SPM and regional analyses. There were no differences in baseline characteristics. Longitudinally, right‐dominant PPAOS showed faster rates of progression of ideomotor apraxia (AUROC 0.79), behavioral disturbances (AUROC 0.84), including disinhibition symptoms (AUROC 0.82) and negative behaviors (AUROC 0.82), and parkinsonism (AUROC 0.75) compared to left‐dominant PPAOS. Symmetric PPAOS showed faster rates of dysarthria progression compared to left‐dominant (AUROC 0.89) and right‐dominant PPAOS (AUROC 0.79). Five patients showed abnormal DAT uptake. Braak neurofibrillary tangle stage differed across groups (p = 0.01). Conclusions: Patients with PPAOS and a right‐dominant pattern of hypometabolism on FDG‐PET have the fastest rates of decline of behavioral and motor features. [ABSTRACT FROM AUTHOR]

Background: In right-dominant unbalanced atrioventricular (AV) canal, there are no criteria to judge adequacy of the left ventricle for biventricular repair. The purpose of this study was to test the hypothesis that right ventricular volume overload in this condition results in right-to-left septal bowing and contributes to the appearance of a small left ventricle., Methods: Five consecutive neonates and young infants (age range, 23 days to 5 months; median age, 3 months) with right-dominant unbalanced complete AV canal underwent biventricular repair. Preoperative and postoperative echocardiographic measurements of left (LV) and right ventricular size and AV valve component size were made. Potential LV volume was assessed preoperatively using a theoretic model that assumed a normalization of septal bowing., Results: There was no perioperative mortality; 1 patient died 71 days postoperatively of problems related to the left AV valve. Preoperatively, all patients had severe LV hypoplasia, with a mean end-diastolic indexed true LV volume of 14.8 +/- 9.1 mL/m2, indexed potential LV volume of 32.0 +/- 18.8 mL/m2, left AV valve to total AV valve ratio of 0.30 +/- 0.06, and LV to right ventricular long-dimension ratio of 0.65 +/- 0.1. Postoperatively, all patients had indexed true LV volumes greater than 30 mL/m2 (mean volume, 35.6 +/- 3.9 mL/m2), and the left AV valve to total AV valve ratio and the LV to right ventricular long-dimension ratio increased to 0.42 +/- 0.03 and 0.88 +/- 0.11, respectively. Both preoperative potential and true LV volumes correlated well with postoperative true LV volumes: r = 0.90 (p = 0.040) and r = 0.93 (p = 0.023), respectively. Increases in LV length and left AV annulus size indicated contributions of volume loading and surgical patching to the right of the ventricular crest to the increase in LV size., Conclusions: In our small series, preoperative indexed potential LV volume of 15 mL/m2 or greater (present in all patients) allowed biventricular repair of right-dominant unbalanced AV canal. Any previous criteria for LV hypoplasia in this condition need to be reconsidered. This study also has implications for other right-sided volume-loaded lesions in which the left ventricle initially is judged to be hypoplastic but in which biventricular repair may be feasible.

The hierarchic branching tree structure of the right coronary artery in a right-dominant human heart is examined in terms of detailed measurements of lengths and diameters of the individual vessel segments comprising the structure. The results show that, while the right coronary artery in this heart does not supply a large portion of the posterior left ventricular wall, it nevertheless serves the left side of the heart to a greater extent than it does the right side in terms of the number and volume of vessel segments involved. The results show further that on the right side of this heart the right coronary artery exhibits clear features of a "distributing' vessel, but these features change abruptly as the vessel reaches the small region of the posterior left ventricular wall which it serves.

We have studied clinical and ECG stress features of 119 patients with left main disease and 113 matched patients with three vessels coronary disease. Clinical features and ECG stress test do not differentiate the two groups as a whole. Exercise time duration was shorter, ST criteria were more positive, and peak heart rate was lower in the subgroups of patients with left main and involvement of a right dominant coronary artery. However due to a large overlap these criteria do not seem to be clinically useful. In conclusion, in an individual patient angina and stress ECG criteria do not differentiate the patients with left main from those with three vessels coronary artery disease.

Value is expressed in average and range in brackets HT

Background. Goals of this study include observing the origin, course, termination, dominance and branching outline of the coronary arteries with emphasis on Brocq and Mouchet's triangle. The objectives were to determine the prevalence of Kugel's artery, third coronary artery and myocardial bridges in formalin fixed cadavers of Indian population. Methods This cross-sectional anatomical study utilized 30 formalin fixed cadaveric hearts. The length of the trunk is measured for both the right and left coronary arteries with the help of measuring tape and width was determined by using the digital vernier calliper (Mitutoyo Corporation, Kawasaki, Japan). Results. The 25 hearts (83%) were right dominant, 4 heart specimens (14%) were left dominant and 1 heart specimen (3%) was co-dominant. Kugel's artery was observed in 12 hearts (30%), in this study. The third coronary artery was observed in 4 hearts (14%) of this study. The myocardial bridges were observed in only 4 hearts (7%) of this study. The presence of median artery (one artery) as Brocq and Mouchet's triangle content was observed in 16 specimens (53%), while the 11 specimens (37%) had presence of two arteries (median and diagonal) as its contents, 2 specimens (7%) showed 3 arteries (median, diagonal and one extra artery) as its contents and 1 specimen (3%) didn't have any artery as its content. In the present study, LCA exhibited more variations as in 12 specimens (40%), there was bifurcation, 9 specimens (30%), there was trifurcation and in 7 specimens (23%), there was tetrafurcation (Fig. 7) and in only 2 specimens (7%), there was pentafurcation of the LCA. Conclusions. We believe that the present research has provided detailed morphology of the coronary arteries with emphasis on myocardial bridges and Brocq and Mouchet's triangle. However, the data can be still better interpreted with a larger sample size. [ABSTRACT FROM AUTHOR]

Background Pulsed field ablation (PFA) is a novel ablation technology. A rare side-effect is the occurrence of mostly subclinical coronary spasms when PF energy is applied in proximity to coronary arteries. However, it has been described that prior application of nitroglycerin attenuates these effects. Case summary A 75-year-old female underwent catheter ablation with a penta-spline PFA catheter. After pulmonary vein isolation, the PFA catheter was positioned on the cavotricuspid isthmus (CTI). Before ablation, 2 mg of nitroglycerin was administered intravenously. After 10 PFA applications, the CTI was successfully blocked. After a timely delay of 95 s, a clinically apparent vasospasm with ST elevations in leads II, III, and aVF on the electrocardiogram was noticed. Shortly thereafter, the clinical course was aggravated by haemodynamically relevant non-sustained ventricular tachycardias (nsVTs) followed by asystole, requiring pacing and additional 4 mg of nitroglycerin. Twelve minutes later, a stable sinus rhythm with normalized ST segments was restored. The spasm resolved without any sequelae. Post-procedural coronary angiogram showed right dominant coronary circulation. Discussion This is the first report of a timely delayed, clinically apparent coronary spasm with a presentation of haemodynamically relevant nsVT and asystole despite the prophylactic application of high-dose intravenous nitroglycerin prior to PFA along the CTI. Subclinical vasospasm during PFA at the CTI has been described before. Severe spasms could be prevented by nitroglycerin. A word of caution needs to be raised as prophylactic nitroglycerin did not prevent the haemodynamically relevant coronary spasm in the here reported patient. Until now, it remains unclear how much later such effects may occur; therefore, patients should be monitored closely. [ABSTRACT FROM AUTHOR]

This study investigates the hypothesis that tone alternation directionality becomes a basis of structural bias for tone alternation learning, where "structural bias" refers to a tendency to prefer uni-directional tone deletions to bi-directional ones. Two experiments were conducted. In the first, Mandarin speakers learned three artificial languages, with bi-directional tone deletions, uni-directional, left-dominant deletions, and uni-directional, right-dominant deletions, respectively. The results showed a learning bias toward uni-directional, right-dominant patterns. As Mandarin tone sandhi is right-dominant while Cantonese tone change is lexically restricted and does not have directionality asymmetry, a follow-up experiment trained Cantonese speakers either on left- or right-dominant deletions to see whether the right-dominant preference was due to L1 transfer from Mandarin. The results of the experiment also showed a learning bias toward right-dominant patterns. We argue that structural simplicity affects tone deletion learning but the simplicity should be grounded on phonetics factors, such as syllables' contour-tone bearing ability. The experimental results are consistent with the findings of a survey on other types of tone alternation's directionality, i.e., tone sandhi across 17 Chinese varieties. This suggests that the directionality asymmetry found across different tone alternations reflects a phonetically grounded structural learning bias. [ABSTRACT FROM AUTHOR]

Unbalance in atrioventricular septal defect can be found in more than one anatomic level and in different degrees at each level. The definition of "unbalance" has historically been focused in comparing the dimensions of main cardiac structures, such as the atrioventricular valve and the ventricles. However, the hemodynamic aspects of unbalance need to be considered as having, at least, similar relevance. New concepts and already described parameters must be combined and understood as a whole to help the surgical decision-making process. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to investigate prevalance of coronary artery anomalies and variants in a cardiac risk group by using coronary computed tomography (CT) angiography. Materials and Methods: Coronary CT angiography scans were retrieved for 527 consecutive adult patients (265 male, 262 female) with a preliminary diagnosis or suspicion of coronary artery disease between 2021 and 2023. Coronary artery anomalies and vascular variants were retrospectively reviewed. Results: The study revealed that 85.97% had right dominant coronary circulation, 22.39% had myocardial bridging, and 9.3% having a ramus intermedius artery. Among the identified coronary anomalies, anomalies of origination and course were the leading causes (3.6 %), except for hypoplasia, which had a prevalence of 6.07 %. Overall, no significant relationships were found between gender or coronary artery disease and the frequency of coronary artery anomalies. Conclusion: Coronary artery anomalies and variants, which are mostly asymptomatic, represent a broad spectrum of entities that can be accurately diagnosed by coronary CT angiography. [ABSTRACT FROM AUTHOR]