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BACKGROUND: This study compared clinical and hemodynamic in-hospital outcomes of patients undergoing sutureless vs rapid deployment aortic valve replacement (SURD-AVR) in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS: We examined 4695 patients who underwent isolated or combined SURD-AVR. The "sutureless" Perceval valve (LivaNova PLC, London, United Kingdom) was used in 3133 patients and the "rapid deployment" Intuity (Edwards Lifesciences, Irvine, CA) in 1562. Potential confounding factors were addressed by the use of propensity score matching. After matching, 2 well-balanced cohorts of 823 pairs (isolated SURD-AVR) and 467 pairs (combined SURD-AVR) were created. RESULTS: Patients who received Perceval and Intuity valves showed similar in-hospital mortality and rate of major postoperative complications. Perceval was associated shorter cross-clamp and cardiopulmonary bypass times. In the isolated SURD-AVR group, patients receiving Perceval were more likely to undergo anterior right thoracotomy incision. Postoperative transvalvular gradients were significantly lower for the Intuity valve compared with those of the Perceval valve, either in isolated and combined SURD-AVR. The Intuity valve was associated with a lower rate of postoperative mild aortic regurgitation. CONCLUSIONS: Our results confirm the safety and efficacy of SURD-AVR regardless of the valve type. The Perceval valve was associated with reduced operative times and increased anterior right thoracotomy incision. The Intuity valve showed superior hemodynamic outcomes and a lower incidence of postoperative mild aortic regurgitation. ispartof: ANNALS OF THORACIC SURGERY vol:114 issue:3 pages:758-+ ispartof: location:Netherlands status: published

A 37-year-old man with Brugada syndrome and frequent appropriate implantable cardioverter-defibrillator shocks received an epicardial substrate ablation. During the procedure to eliminate delayed potentials, transient, marked ST-segment elevation in lead V2 was observed, particularly in the anterior right ventricle with a borderline between normal and low-voltage areas. (Level of Difficulty: Intermediate.), Graphical abstract, A 37-year-old man with Brugada syndrome and frequent appropriate implantable cardioverter-defibrillator shocks received an epicardial substrate ablation…

Background Lung ultrasound examination is becoming an even more important part of pulmonologists' clinical routine. As indicated in the literature, the coordinates of any findings on lung parenchyma are based on surface landmarks or conventional quadrants. In our experience we have noticed that lung fissures are clearly detectable as interruptions of the pleural line, but this has never been investigated previously. The aim of this study was to evaluate whether lung fissures are detectable under normal conditions in routine clinical practice. Methods Ten operators were enrolled from Pleural-Hub, a scientific discussion group. After compiling a prestudy survey to investigate whether they had observed fissures previously, they were asked to note if the following fissures were detectable: posterior right (PR) and left (PL), lateral right (LR) and left (LL), anterior right (AR), and anterolateral left (AL). Enrollment was competitive, aiming to reach 100 case subjects. Results We found that general fissure detection was 61.3%, in particular: PR, 59%; LR, 75%; AR, 69%; PL, 45%; LL, 64%; AL, 56%. Single operators yielded different detection rates ranging from 90% to 25%, showing strong operator dependency. Before being made aware of general results operators indicated operator's skill and rib shadow artifacts as the principal factors affecting fissure detection. Conclusions Lung fissures may be detected with ultrasound once adequate training is provided. This may allow the clinician a more precise anatomical delineation of pathology identified by lung ultrasound.

Context According to evo-devo theory, the embryonic development of the nasal organ mimics its phylontogenic formation: the lateral masses of the human ethmoid bone develop by curved “onion” stacking of the endoturbinals (the horizontal bone septa of the mammalian olfactory chamber) under the impact of facial and skull-base remodeling, rather than by pneumatization of cavities communicating via ostia. Objectives To assess the frequency of the onion structure on coronal CT. Material and methods Three independent examiners performed a retrospective descriptive study of coronal CT scans taken ahead of septorhinoplasty between June 2010 and December 2012 in adult patients without history of sinonasal surgery. Results Fifty patients were included. In the anterior right and left and posterior right ethmoid, an onion arrangement of the endoturbinals was systematically found on at least 1 view, and on 60% of views taking all ethmoid compartments together. Two endoturbinals were generally involved, but a rolling-up of 3 endoturbinals was also observed, significantly more frequently in the posterior compartments (P = 0.004 on the right side, P = 0.012 on the left). Conclusion The onion structure of the lateral masses of the ethmoid can be observed on coronal CT scans. This structure confirms evo-devo theory. The ethmoid thus appears fundamentally different from the paranasal sinuses, suggesting that the pathogenesis of nasal polyposis and ethmoidectomy techniques need to be reconsidered.

Ventricular premature depolarizations (VPD) commonly arise from the septal anterior right ventricular outflow tract (sRVOT), the left coronary cusp (LCC) and the distal great cardiac vein (dGCV). The use of non-invasive electroanatomic mapping (NIEAM) is superior to the 12 lead ECG alone in

The autonomic nervous system (ANS) plays an important role in the initiation and maintenance of atrial fibrillation (AF), and modulation of the ANS function may contribute to AF control.Anesthetized dogs received either sham treatment (SHAM group, n = 8) or low-level carotid baroreceptor stimulation (LL-CBS) treatment (LL-CBS group, n = 8). The stimulation voltage was set at 80% below the threshold. To simulate focal AF, high-frequency stimulation (HFS) was applied to local nerves during the atrial refractory period. Multielectrode catheters were attached to the atria and all the pulmonary veins to determine the changes in the AF threshold (AF-TH), the atrial effective refractory period (AERP), and the window of vulnerability (WOV) during HFS in both groups. Microelectrodes were inserted into the anterior right ganglionated plexus (ARGP) to record neural firing.HFS induced sinus rate (SR) slowing in the superior left ganglionated plexus (SLGP). LL-CBS induced a progressive increase in AF-TH and AERP at all sites and a significant decrease in the sum of WOV at 2 hours (all P0.05). LL-CBS inhibited the ability of SLGP stimulation to slow the SR and the mean values of frequency and amplitude of ARGP neural activity compared with the SHAM group (all P0.05).LL-CBS suppressed AF inducibility by inhibiting the neural activity of ganglionated plexuses. LL-CBS may serve as a novel therapeutic modality to treat AF.

Individuals need feedback from the context to determine the success of their actions. In the present study, the explicit process of the feedback judgement (explicit response to feedback correctness) was examined by recording ERPs. A systematic mismatch between the expected feedback information and the observed feedback (incorrect feedback) linked to the subject's performance was used. Thirteen subjects participated in the study, and they were required to detect the correct vs. incorrect feedback with an explicit response. The experimental procedure included three main tasks: the subject's performance (spatial decisional task); the system's response to the performance (external feedback); and the subject's judgement of the external feedback (feedback monitoring). A FRN (feedback-related negativity) ERP effect with a higher amplitude was revealed in case of an explicit feedback monitoring for the incorrect feedback. Moreover, as shown by the cortical source analysis (LORETA), monitoring of an erroneous feedback produced a significant increased response by the right prefrontal area. This negative deflection may be viewed as a specific marker of the conscious monitoring functions. Considering the cortical distribution of this effect, whereas the anterior portion of the cingulate cortex could represent a more automatic cognitive processing of a mismatching, the anterior right dorsolateral area would intervene to reconfigure the subjective expectations when a violation is consciously detected. Generally, this system could explain the significance of the mechanism to the erroneous feedback and the necessity to restore the incoherent information.

We have previously shown that neurally-mediated syncope and inappropriate sinus bradycardia can be treated by cardio-neuromodulation (CardNM), which is a selective and tailored ablation of the anterior right ganglionated plexus (ARGP) [(1)][1]. In our first publication, the left-sided approach was

The occurrence of Alexandrium taylori and Alexandrium peruvianum is reported for the first time in Malaysia waters. The Malaysian A. taylori isolates were pyriform in shape with a transdiameter range of 36‐40 mm and a cell length range of 33‐ 37 mm. The first apical plate (1 0 ) was pentagonal with two distinctive anterior margins. No direct connection between 1 0 and the apical pore complex was observed. The posterior sulcal plate (S.p.) was large, elongated and oblique to the right with anterior projections. The ventral pore (vp) was relatively large and situated at a confluence point of 1 0 , the second apical (2 0 ) and the fourth apical (4 0 ) plates. Cells of A. peruvianum were slightly anteriorly and posteriorly compressed. S.p. had an irregular pentagonal shape, with the anterior margin divided into 2 portions. 1 0 was boomerang-shaped with a large and truncated ventral pore in the middle right margin. The anterior right margin of 1 0 was straight. The sixth precingular plate (6 00 ) was wider than long. The anterior sulcal plate (S.a.) was triangular and lacked a left portion extension. In laboratory cultures, both A. taylori and A. peruvianum produced paralytic shellfish toxins, with GTX4 and GTX6 as the predominant toxin, respectively. This is the first report of PSP toxins production for both species as well as the occurrences in Malaysia waters. # 2004 Elsevier B.V. All rights reserved.

The purpose of this study was to examine the usefulness of pulsed tissue Doppler imaging for diagnosing constrictive pericarditis. Motion velocities of the ventricular septum (VS) and left ventricular (LV) posterior wall along the short axis, and those of the anterior right ventricular (RV) wall, VS, and LV posterior wall along the long axis were recorded using pulsed tissue Doppler imaging in 12 patients with constrictive pericarditis, who were diagnosed by cardiac catheterization, and also in 20 normal subjects. Peak early diastolic and atrial systolic velocities (Ew and Aw, respectively) were calculated, and the time between the aortic component of the second heart sound and the peak of the early diastolic velocity (II a -Ew) was determined. The peak Ew and II a -Ew along the short and long axes were significantly higher and shorter, respectively, in the patient group than in the normal group. In the patient group, the motion velocity of the VS along the short axis showed a “backward” motion with a sharp and marked peak velocity immediately before Ew, or a biphasic early diastolic wave; a clear “downward” motion immediately after Ew was observed in the motion velocities of the anterior RV wall, VS, and LV posterior wall along the long axis. These distinctive backward and downward motions were not observed in any of the ventricular walls of the normal subjects. In conclusion, the early diastolic RV and LV wall motion velocity patterns along the short and long axes as measured by pulsed tissue Doppler imaging provide important information for the diagnosis of constrictive pericarditis.

The effects of delayed presentation of a central theme on the comprehension and interpretation of narratives were investigated in adults with right and left hemisphere brain-damage and normal individuals. The performance of subgroups of the subjects with right and left hemisphere brain-damage also was examined. Right hemisphere brain-damaged groups with anterior and posterior lesions were significantly less accurate and identified significantly fewer central themes when central theme presentation was delayed until the end of a narrative than when the theme was presented at the beginning. Subjects with anterior right hemisphere brain-damage produced significantly more embellishments and confabulations than subjects with posterior damage and non-brain-damaged controls, regardless of theme condition. The performance of non-brain-damaged subjects and subjects with fluent and nonfluent aphasia was unaffected by the organization of the central theme in the narratives.

A case of left parasternal systolic lift due to isolated infarction of the right ventricular anterior wall is reported. This cause of a left parasternal lift should also be considered while examining a case of myocardial infarction.

Interventricular septal motion was studied by echocardiogram in 20 consecutive patients with documented Wolff-Parkinson-White (WPW) syndrome before and during electrophysiologic evaluation using His bundle recordings and pacing techniques. Characteristic abnormal interventricular septal motion was seen in 8 of 11 patients with type B WPW syndrome (groups I and II). All eight patients had electrocardiographic patterns consistent with an anomalous pathway located in the anterior right ventricular wall (group I). In five of these eight patients normalization of the QRS complex for one or more beats was accomplished and produced normalization of the septal motion in four; whereas in the fifth patient, who had an underlying atrial septal defect, the abnormal septal motion remained abnormal. All nine patients with type A WPW syndrome (groups III to V) had normal septal motion both during total preexcitation and during normalization of the QRS complex. The normalization of the abnormal interventricular septal motion with normalization of the QRS complex in type B WPW syndrome strongly suggests that the abnormal motion is related to an abnormal sequence of ventricular depolarization during preexcitation. Furthermore, persistent abnormal septal motion after normalization of the QRS complex suggests that other factors such as right ventricular volume overload may be responsible. Likewise, when abnormal septal motion occurs in the presence of type A WPW syndrome, an explanation other than preexcitation must be sought.

1)Certain factors pertaining to double aortic arch have been mentioned. 2)A case presenting a rare type of double aortic arch, previously unrecorded, has been reported. 3)The presence of a congenital vascular ring should be suspected in infants who suffer with stridor, dysphagia and associated symptoms. 4)Those patients with severe symptoms due to a constricting vascular ring will probably not survive if untreated. Surgery offers the only prospect of a cure. It has been demonstrated that young infants possess the ability to withstand major intrathoracic operative procedures surprisingly well. Operation should therefore be performed in these cases promptly after the diagnosis is established.

A 64-year-old man was admitted to the surgical department because of abnormal findings on his #{176}Associate Professor of Surgery, University of Buenos Aires Medical School; Chief, Thoracic Surgery Unit, Department of Surgery ( Prof. Dr. J. Sanchez Zinny, Surgeon-in-Chief), Hospital Ramos Mejia, Buenos Aires, Argentina. #{176}#{176}Chief of Radiology, Hospital Ramos Mejia. chest roentgenogram ( Fig 1 and 2 ) . His past history was noncontributory. For several months, he had felt a very mild discomfort in his right pectoral region. Physical examination and routine laboratory studies gave normal findings.