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Introduction: Despite rapid technological progress, some arrhythmias are still resistant to standard unipolar ablation. These include arrhythmias arising from the base of the heart, cardiac crux, or epicardium. Bipolar radiofrequency ablation (B‐RFA) may be useful in some cases, however, data on the efficacy of this approach in various arrhythmia localizations are scarce. The aim of this study was to assess the efficacy of B‐RFA in patients with ventricular arrhythmias originating from various locations, occurring refractory to standard unipolar ablation approaches. Methods: An observational, single center study was conducted over a 30‐month period. B‐RFA were performed using dedicated radio frequency (RF) generator and electroanatomic mapping system. Results: Twenty‐four procedures, in 23 patients with a median (range) of 1 (1–2) previously failed unipolar ablation procedures, were included in the final analysis. There were 12 ablations of ventricular arrhythmias originating from interventricular septum with an acute success rate of 75%, and 12 from left ventricular (LV) summit with an acute success rate of 58%. The midterm success rate (median interquartile range follow‐up of 205 days [188–338]) was 66% and 50%, respectively. Conclusions: B‐RFA is a promising method of catheter ablation for refractory cardiac arrhythmias. A higher success rate was observed in ablation for difficult ventricular arrhythmias originating from interventricular septal region than LV summit. [ABSTRACT FROM AUTHOR]

Background: Sinus of Valsalva aneurysm (SVA) is an extremely rare condition, and its rupture causes acute symptoms such as chest pain and dyspnea. Ruptured SVA is frequently associated with other congenital defects. Case presentation: A 37-year-old male presented with SVA originating from the left coronary sinus that ruptured into the interventricular septum. SVA was diagnosed by echocardiography, cardiac computed tomography and magnetic resonance imaging, and confirmed during the operation. Conclusions: SVA is a rare cardiac abnormality which can lead to severe clinical symptoms upon rupture. Immediate surgery is necessary to repair the ruptured SVA. [ABSTRACT FROM AUTHOR]

Absent pulmonary valve with tricuspid atresia or tricuspid stenosis (APV-TA/TS) is an extremely rare congenital heart defect associated with significant morbidity and mortality. Compared to Tetralogy of Fallot with Absent Pulmonary Valve Syndrome, branch pulmonary arteries are not typically significantly dilated. We present the case of a newborn male prenatally diagnosed APV-TA with intact ventricular septum (IVS) and nearly discontinuous branch pulmonary arteries, the surgical strategy employed, and the salient hemodynamic factors considered in the medical decision-making. [ABSTRACT FROM AUTHOR]

To demonstrate possible functional changes in the frequently affected fetal interventricular septum (IVS) with spectral tissue Doppler imaging (TDI) and M-mode imaging to compare gestational diabetes mellitus (GDM) and control groups. A total of 63 pregnant women with GDM, 30 on diet (A1 GDM) and 33 on treated with insulin (A2 GDM), and 63 healthy pregnant women randomly selected and matched to the case group in the control group were included. The GDM fetuses had significantly thickened IVS, increased early diastole (E′), atrial contraction (A′), systole (S′), higher myocardial performance index (MPI′), prolonged isovolumetric relaxation time (IVRT′), shortened ejection time (ET′), and decreased septal annular plane systolic excursion (SAPSE) than the controls. The A2 GDM group fetuses had significantly thickened IVS, increased S′ and shortened ET′ than the A1 GDM group. In the GDM group, we found a significantly positive low correlation between glycated hemoglobin levels and maternal serum fasting glucose and one-hour postprandial glucose with fetal IVS thickness. We demonstrated a significantly negative low correlation between maternal serum one-hour postprandial glucose, glycated hemoglobin levels, and gestational weight gain with fetal IVS ET′. Fetal IVS diastolic and systolic functions were altered in the GDM group compared to controls, and systolic functions were altered in A2 GDM compared to A1 GDM. This may alert clinicians to possible cardiovascular diseases in the postnatal life, and early preventive strategies and long-term lifestyle changes may provide protection in fetuses with GDM. [ABSTRACT FROM AUTHOR]

Cardiac remodeling is frequently observed in patients with heart failure (HF) and serves as an indicator of disease progression and severity. Septal hypertrophy represents an aspect of remodeling that can be easily assessed via an echocardiographic measurement of the interventricular septal end diastole (IVSd), but it has not been evaluated for its prognostic value, particularly in patients with heart failure with mildly reduced ejection fraction (HFmrEF). We retrospectively included 1881 consecutive patients hospitalized with HFmrEF (i.e., a left ventricular ejection fraction of 41–49% and signs and/or symptoms of HF) at one institution during a study period from 2016 to 2022. Septal hypertrophy, defined as an IVSd > 12 mm, was prevalent in 34% of the HFmrEF patients. Although septal hypertrophy was not associated with all-cause mortality at 30 months (median follow-up) (HR = 1.067; 95% CI: 0.898–1.267; p = 0.460), it was associated with an increased risk of hospitalization due to worsening HF at 30 months (HR = 1.303; 95% CI: 1.008–1.685; p = 0.044), which was confirmed even after multivariable adjustment (HR = 1.340; 95% CI: 1.002–1.792; p = 0.049) and propensity score matching (HR = 1.399; 95% CI: 1.002–1.951; p = 0.048). Although septal hypertrophy was not associated with the risk of all-cause mortality in patients with HFmrEF, it was identified as an independent predictor of long-term HF-related rehospitalization. [ABSTRACT FROM AUTHOR]

Coronary artery lesions related to pacemaker implantation are rare complications. With the increasing adoption of the technique of permanent transseptal pacing of the left bundle branch area pacing (LBBAP), an increase in the incidence of these complications may be expected. We report two cases of coronary lesions after permanent transeptal pacing of the LBBAP: the first with a small coronary artery fistula, and the second with an extrinsic coronary compression. Both complications occurred with stylet‐driven pacing leads with extendable helix. In the first case, since the shunt volume was small and no major complications were reported, the patient was treated conservatively with good outcome. The second case required lead repositioning due to acute decompensated heart failure. [ABSTRACT FROM AUTHOR]

Introduction: Left bundle branch pacing (LBBP) involves the deployment of the lead deep inside the septum. Penetration of the septum by the lead depends on the texture of the septum, rapidity of rotations, operator experience, and implantation tools. Objectives: The aim of our study was to assess the behavior of the lumenless lead during rapid rotations and the physiological property of the interventricular septum(IVS) during LBBP. Methods: Patients undergoing LBBP between January 2021 and December 2022 were retrospectively included in the study. Results: Among 255 attempted patients, 20 (7.9%) had procedural failure(no LBB capture—four, inability to penetrate septum—seven, and dislodgements after sheath removal—nine). Septal penetration achieved in 248/255 patients (97.2%). Lead movement inside the IVS was assessed by lead traverse time. Based on the behavior of the IVS (n = 255), three different responses were noted. Type‐I response(normal/firm septum) in 93.7% (n = 239) characterized by constant and progressive movement of lead. Neither perforation nor further change in premature‐ventricular‐complex morphology beyond M‐beat were observed despite additional few unintentional rotations indicating the protective mechanism of LV‐endocardium. Type‐II response(soft/cheesy septum) in 3.5% (n = 9) characterized by hyper‐movement of lead without resistance due to altered texture of septum and poor LV subendocardial barrier resulting in perforation. No patients in this group had LV dysfunction or associated coronary artery disease. In type‐III response, seen in 2.8% (n = 7), lead could not be penetrated due to scar in IVS. Conclusion: Three different patterns of responses were observed during LBBP. The most distinct type‐ll response was associated with soft/cheesy septum with hyper‐movement of the lead predisposing for future dislodgments in patients without structural heart disease. [ABSTRACT FROM AUTHOR]

Background: It is unclear if the location of implantation of the leadless pacemaker (LP) makes a difference in the incidence of pacing‐induced cardiomyopathy (PICM). Aim: The aim of this study was to compare the incidence of PICM based on the location of implantation of LP. Methods: A total of 358 consecutive patients [women: 171 (48%), mean age: 73 ± 15 years] with left ventricular ejection fraction (EF) > 50%, who received an LP (Micra) between January 2017 and June 2022, formed the study cohort. Micra‐AV and Micra‐VR were implanted in 122 (34%) and 236 (66%) patients, respectively. Fluoroscopically, the location of implantation of LP in the interventricular septum (IS) was divided into two equal halves (apex/apical septum [AS] and mid/high septum [HS]). During follow‐up, PICM was defined as an EF drop of ≥10%. Results: LP was implanted in 109 (34%) and 249 (66%) patients at AS and HS locations, respectively. During a mean 18 ± 8 months follow‐up, 28 patients (7.8%) developed PICM. Among the 249 patients with HS placement of LP, 10 (4%) developed PICM, whereas among the 109 patients with AS placement of LP, 18 (16.5%) developed PICM (p =.002). AS location was associated with a higher risk of PICM compared to HS locations (adjusted hazard ratio: 4.42, p <.001). Conclusion: AS location of LP was associated with a higher risk of PICM compared to HS placement. Larger randomized studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: Human hydatid disease occurs after infection with Echinococcus granulosus, mainly involves liver and lung, while hydatid involves heart is infrequent. A great majority of hydatid diseases could be asymptomatic, and incidentally found through examination. Here, we reported a woman who suffered an isolated cardiac hydatid cyst located at the interventricular septum. Case presentation: A 48-year-old woman presented intermittent chest pain was admitted to the hospital. Imaging examination revealed a cyst located at the interventricular septum near the right ventricular apex. Considering medical history, radiological findings and serological results, cardiac hydatid disease was suspected. The cyst was successfully removed, while pathological biopsy confirmed the diagnosis of infection of Echinococcus granulosus. Postoperative course was uneventful, the patient was discharged from hospital without complications. Conclusion: For symptomatic cardiac hydatid cyst, surgical resection is necessary to avoid progression of disease. During surgical procedure, appropriate methods to reduce the potential risk of hydatid cyst metastasis are essential. Besides surgery, combined with regular drug therapy is an effective strategy to prevent reappearance. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Cardiac hydatidosis is a relatively rare complication of echinococcosis. Understanding the atypical manifestations, potential associated risk factors, and epidemiology leads to optimal and timely management. Cardiac hydatidosis is a relatively rare complication of echinococcosis, with a potentially life‐threatening condition. Here, we reported a large interventricular septal hydatid cyst bulging in the left ventricle accompanied by a huge cervical lamp with recurrent hepatic cysts that underwent cardiac surgery to excise the cyst uneventfully. [ABSTRACT FROM AUTHOR]

Background: Conventional right ventricular pacing combined with coronary venous pacing (CVP) is a mainstay for cardiac resynchronization therapy (CRT). However, QRS duration of conventional CRT may be frequently more than 130 ms. This study aimed to evaluate the effectiveness of QRS narrowing by bilateral septal pacing (BSP) in combination with CVP for CRT (BSP‐CRT). Methods: Fourteen patients with QRS > 130 ms of conventional CRT after failure of physiological conduction system pacing were enrolled. Electrophysiologic characteristics were compared among different modes of CRT during procedure. BSP which was defined as capture of both sides of interventricular septum manifested as shortened R wave peak time without a right bundle branch block QRS pattern. Results: BSP‐CRT were successfully achieved in 85.7% (12/14) patients. QRS duration at baseline was 185 ± 13 ms and significantly narrowed to 156 ± 9 ms during conventional CRT (n = 14, P <.001), to 143 ± 7 ms during left ventricular septal pacing (LVSP) in combination with CVP for CRT (LVSP‐CRT) (n = 9, P <.001), and further to 122 ± 10 ms during BSP‐CRT (n = 12, P <.001). Notably, among 7 patients in whom both LVSP and BSP were achieved, BSP‐CRT outperformed LVSP‐CRT at QRS narrowing by 16% (P <.001). At 3‐month follow‐up, left ventricular ejection fraction improved from 29 ± 6% to 41 ± 8% (P <.001). Conclusions: BSP‐CRT resulted in superior acute electrical synchronization to conventional CRT and might be considered as an alternative to conventional CRT with QRS more than 130 ms. [ABSTRACT FROM AUTHOR]

Septal coronary artery fistula is a rare but concerning complication of left bundle branch area pacing (LBBAP). We report the case of an 82‐year‐old man who was indicated for cardiac resynchronization therapy and underwent LBBAP. The patient had no chest symptoms during or after implantation. Postoperative echocardiography demonstrated a new abnormal tunnel inside the interventricular septum (IVS) and shunt flow from the IVS toward the right ventricle. Coronary angiography confirmed a septal coronary artery fistula, which might have been formed by failed deep screw attempts. Since the shunt volume assessed by the Qp/Qs was small, the patient was treated conservatively. [ABSTRACT FROM AUTHOR]

Objective: Thyroid hormone is required for normal fetal brain development, neuronal proliferation, migration and structural organization. We aimed to investigate fetal cardiac structure in fetuses of hypothyroid pregnant women receiving thyroid hormone replacement therapy and to compare it with normal pregnancies, including fetal outcome and delivery results. Methods: Singleton pregnant women whose ages were between 18-45 years and weeks of gestation were between 26-34 were included in the study. Their routine laboratory test reports, ultrasonographic measurements (fetal echo) and postnatal follow-up data were recorded. Patients were grouped according to the presence of diagnosis of hypothyroidism. The patients with hypothyroidism during pregnancy were included in Group 1 while healthy pregnancies with similar features were considered as controls and included in Group 2. All women with hypothyroidism were taking thyroid hormone replacement. All ultrasonographic and laboratory data measurements were collected from the system files and were compared between groups. Results: A total of 89 patients (41 hypothyroidism and 48 controls) were recruited to the study. Serum TSH levels of patients with hypothyroidism (Group 1) was significantly higher than the controls. In fetal cardiac examination, left ventricular (LV) and right ventricular (RV) wall thicknesses, and interventricular septum thicknesses at the end of systole and diastole were not statistically significant in both groups. Apgar scores, fetal gender and mean fetal birth weight were all similar between the groups. Conclusion: There is no myocardial structural difference in fetuses of pregnant women who were diagnosed with hypothyroidism and received thyroid hormone replacement therapy compared to healthy controls. Thyroid replacement therapy in hypothyroid mothers might affect and treat fetal cardiac abnormalities. [ABSTRACT FROM AUTHOR]

Vertebrates developed pulmonary circulation and septated the heart into venous and arterial compartments, as the adaptation from aquatic to terrestrial life requires more oxygen and energy. The interventricular septum (IVS) accommodates the ventricular portion of the conduction system and contributes to the mechanical function of both ventricles. Conditions or diseases that affect IVS structure and function (e.g., hypertrophy, defects, other) may lead to ventricular pump failure and/or ventricular arrhythmias with grave consequences. IVS structure and function can be evaluated today using current imaging techniques. Effective therapies can be provided in most cases, although definitions of underlying etiologies may not always be easy, particularly in the elderly due to overlap between genetic and acquired causes of IVS hypertrophy, the most common being IVS abnormality. In this review, state-of-the-art information regarding IVS morphology, physiology, physiopathology, and disease is presented. [ABSTRACT FROM AUTHOR]

To evaluate whether certain parameters on fetal cardiac morphology and geometry measured at 20–22 weeks of gestation differ in subsequently diagnosed gestational diabetes mellitus (GDM) pregnancies and whether these changes are associated with disease severity as indicated by class A1 and A2 GDM. It was designed as a retrospective study. All measurements were taken between 20 and 22 weeks of gestation. We compared fetal cardiac structural measurements of 200 uncomplicated pregnancies (control group) with those of 307 GDM patients (160 of the them were regulated with diet (GDM A1) and 147 of them received insulin treatment (GDM A2) during pregnancy). GDM were diagnosed between 24-28 weeks of gestation with 75 gram (g) oral glucose tolerance test. The interventricular septum (IVS) was thicker in both in GDM A2 and GDM A1 than control (p <.001, p <.001), and there was statistically significant difference between GDM A2 and GDM A1 (p =.012). In both left and right wall thickness in GDM A1 and GDM A2 were remarkably higher than control group (p <.001, p <.001, p <.001, p <.001). The left and right spherical indices were higher in both GDM A1 and GDM A2 groups than controls (p =.021 and p =.028). Left and right area in GDM A1 and GDM A2 groups were significantly smaller than control groups (p <.001 and p =.001). Gestational diabetes is a common obstetric morbidity, which causes fetal cardiac structural changes. Our study shows that these changes can occur during the early weeks of pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Left Ventricular False Tendons (LVFT) is normal and common anatomical variants of the left ventricle. They may be associated with findings of cardiac pathology or they may be an isolated finding from 2D echocardiogram. These structures may mimic pathologic structures, such as intraventricular chorda rupture, vegetation or thrombus, but considered as false tendon. Aim: To study the morphology, age and gender specific proportions of false tendons in cadaveric heart specimens. Materials and Methods: A descriptive cross-sectional study was conducted in Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from October 2015 to March 2017. A total of 100 human cadaveric heart specimens of both male and female (n=50) and female (n=50) aged 18-76 years were collected from Department of Anatomy and postmortem specimens from Department of Forensic Medicine. The morphology of tendons was studied regarding its location, gross appearance and parameters such as its length and width. The statistical analysis was done using Chi-square test and Analysis of Variance (ANOVA) test appropriately using the software Statistical Package for Social Service (SPSS), version 20.0 for windows. Results: False tendons were seen in 49 of heart specimens. Total 40 of the specimens showed one LVFT and nine showed two LVFT. Out of total 44 (58.67%) specimens aged 50 years or less had false tendons, while in older specimens, only 5 (20%) were found to have false tendon (p-value <0.05). The common location of false tendons was Posteromedial Papillary Muscle (PMPM) to mid interventricular septum 11 (18.9%), followed by PMPM to free wall 9 (15.5%). The tendons were fibrous in 53 (91.4%), fibromuscular in 4 (6.9%)and 1 (1.7%) was muscular in nature. Out of 50 female and 50 male heart specimens, 24 and 25 had LVFT, respectively (p-value=0.891). Conclusion: Sound knowledge of heart morphology can avoid false diagnosis in patients with false tendon, as it can simulate other pathological murmurs and structural heart disease in echocardiography. [ABSTRACT FROM AUTHOR]

Background: Ventricular septal defects (VSDs) are the most common congenital cardiac defect in horses. Objectives: To identify prevalence, age, breed, and sex distribution of VSD and to describe associated clinical and ultrasonographic findings. Animals Hospital‐based population of 21 136 horses presented to the equine internal medicine department. Methods: Medical records over a 12‐year period were reviewed for VSD confirmed by ultrasonography. Age, breed, sex, sport discipline, murmur, clinical signs, outcome, VSD type, VSD size, shunt velocity, cardiac dimensions, concomitant cardiac anomalies, and valvular regurgitations were recorded. Results: From 1894 horses that underwent echocardiography, 54 had a VSD: 42 as an isolated lesion and 12 as part of complex congenital heart disease (CHD). Median age was 5 years (range, 0‐26) and 1 year (range, 0‐8), respectively. Warmbloods and males were overrepresented. In the isolated VSD group, only 15% had associated clinical signs and most horses had a perimembranous VSD (pmVSD; 36/42). Horses with a pmVSD and clinical signs showed a significantly lower maximal shunt velocity (3.77 vs 5.20 m/s; P <.001), higher VSD/Aortic root (Ao) diameter (0.52 vs 0.38; P =.05), higher left atrium/Ao diameter (1.94 vs 1.22; P <.001), and higher pulmonary artery/Ao diameter (1.15 vs 0.88; P =.005) compared to horses without clinical signs. All horses with complex CHD had clinical signs and abnormal cardiac dimensions. Conclusion and Clinical Importance: Most isolated VSD were diagnosed only at a later age and were not associated with clinical signs. Horses with complex CHD were more likely to have or develop clinical signs at younger age. [ABSTRACT FROM AUTHOR]

Introduction: In patients with nonischemic cardiomyopathy (NICM) little is known about the clinical impact of catheter ablation (CA) of septal ventricular tachycardia (VT) resulting in the collateral injury of the conduction system (CICS). Methods and Results: Ninety‐five consecutive patients with NICM underwent CA of septal VT. Outcomes in patients with no baseline conduction abnormalities who developed CICS (group 1, n = 28 [29%]) were compared to patients with no CICS (group 2, n = 17 [18%]) and to patients with preexisting conduction abnormalities or biventricular pacing (group 3, n = 50 [53%]). Group‐1 patients were younger, had a higher left ventricular ejection fraction and a lower prevalence of New York Heart Association III/IV class compared to group 3 while no significant differences were observed with group 2. After a median follow‐up of 15 months, VT recurred in 14% of patients in group 1, 12% in group 2 (P =.94) and 32% in group 3 (P =.08) while death/transplant occurred in 14% of patients in group 1, 18% in group 2 (P =.69) and 28% in group 3 (P =.15). A worsening of left ventricular ejection fraction (LVEF) (median LVEF variation, −5%) was observed in group 1 compared to group 2 (median LVEF variation, 0%; P <.01) but not group‐3 patients (median LVEF variation, −4%; P =.08) with a consequent higher need for new biventricular pacing in group 1 (43%) compared to group 2 (12%; P =.03) and group 3 (16%; P <.01). Conclusions: In patients with NICM and septal substrate, sparing the abnormal substrate harboring the conduction system provides acceptable VT control while preventing a worsening of the systolic function. [ABSTRACT FROM AUTHOR]

Left bundle branch pacing was associated with narrower QRS in patients with pacemaker indications. LBBP guided by ICE improves the accuracy of LBBP, facilitates the lead localization, minimizes complications, and above all reduces radiation exposure time. [ABSTRACT FROM AUTHOR]

• Cardiac echinococcosis is an uncommon disease and the interventricular septum is rarely involved. • Echocardiography is the initial modality for the diagnosis. • Computed tomography scans and magnetic resonance imaging provide a detailed characterization of the cysts. • Albendazole is used for preoperative sterilization and during the postoperative period to prevent recurrence. • Surgical excision is performed in the vast majority of cases and is associated with a high rate of complete recovery. Human hydatidosis occurs mainly as a result of infection with the larvae of Echinococcus granulosus. Cardiac echinococcosis is an uncommon disease and the interventricular septum is rarely involved. This article is a review of all of the literature related to hydatid cyst in the interventricular septum included in the PubMed database. Forty-five cases reported between 1964 and 2019 were identified. [ABSTRACT FROM AUTHOR]

The septal perforating arteries of the heart usually branch off from the anterior and inferior interventricular arteries and supply the interventricular septum and the conduction system therein. Since the septal perforating arteries are not directly visible from the outside of the heart, their anatomy and variations might be overlooked. However, the septal perforating arteries have their unique anatomy that needs to be recognized to avoid the damage of the vessels especially during common cardiac procedures such as the coronary artery bypass graft, percutaneous coronary intervention, and aortic valve replacement. A better understanding of these important arteries will help physicians to enhance the overall cardiac care for their patients. Therefore, this article discusses the anatomy, the relationship to the conduction system of the heart and the clinical significance of the septal perforating arteries. [ABSTRACT FROM AUTHOR]

The septal perforating arteries of the heart usually branch off from the anterior and inferior interventricular arteries and supply the interventricular septum and the conduction system therein. Since the septal perforating arteries are not directly visible from the outside of the heart, their anatomy and variations might be overlooked. However, the septal perforating arteries have their unique anatomy that needs to be recognized to avoid the damage of the vessels especially during common cardiac procedures such as the coronary artery bypass graft, percutaneous coronary intervention, and aortic valve replacement. A better understanding of these important arteries will help physicians to enhance the overall cardiac care for their patients. Therefore, this article discusses the anatomy, the relationship to the conduction system of the heart and the clinical significance of the septal perforating arteries. [ABSTRACT FROM AUTHOR]

Objective: To investigate and evaluate the value as accuracy of diagnosis different degrees of anemia through the unenhanced thoracic computed tomography (CT) scan.Materials and Methods: The CT attenuation of right ventricle (RV) cavity, left ventricular (LV) cavity, interventricular septum and difference between the interventricular septum and left ventricle cavity (IVS-LV) were retrospectively analyzed and measured in 317 patients with different degrees of anemia and the normal patients. The hemoglobin (Hb) level was estimated within 24 h. Statistical analysis was made to obtain the best diagnostic threshold of anemia levels by CT scan, measurement repeatability was assessed using the intra-class correlation coefficient (ICC) values.Results: An obvious parallel correlation of hemoglobin concentration and CT attenuation of IVS-LV existed (the determination coefficient was 0.818; P < .001). Based on receiver operating characteristic (ROC) curves, the conclusion was that when the threshold of CT attenuation of IVS-LV at (5.5-9.5) HU in male and (4.5-8.5) HU in female, the specificity for diagnosing mild anemia was low, while the sensitivity was very high (87.1%, 100%, respectively), if the CT value was among (9.5-13.5) HU in male or (8.5-13.5) HU in female, the sensitivity and specificity for diagnosing moderate anemia were fine (92.9% and 74.8% in male; 93.9% and 60.0% in female), and once the CT value was more than 13.5 HU the sensitivity and specificity for diagnosing severe anemia in all gender were greatly good (94.7% and 83.6% in male; 82.4% and 84.6% in female). The intra-and inter-observer reliability and reproducibility were good (ICC were all more than 0.99).Conclusion: The CT attenuation of IVS-LV could predict the severity of anemia with good sensitivity and specificity, which could add value to clinical practice and more importantly facilitating patient care as hematologic laboratory investigations are lacking. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Unipolar voltage mapping through its wider “field of view” can identify substrate deeper to the endocardium on the right ventricular (RV) free wall and left ventricle. The reference value(s) for normal endocardial (ENDO) unipolar voltage (UNI) for the septal aspect of the right ventricle (RV) and the effect of the aortic root that is directly opposed to the posterior septal plane of the RV outflow tract (RVOT) have not been established. Methods and results: We performed detailed (185 ± 70, range 127–342 points) RV ENDO UNI maps in 9 patients without structural heart disease; 6 had magnetic resonance (MR) imaging; 5 were males; the mean age was 49 ± 11 years. For MR analysis, the location of the aortic root was defined and its effect on unipolar voltage determined. The UNI voltage on posterior RVOT was lower (mean 6.56 ± 2.33 mV, 95% CI 6.08–7.05), compared to the rest of the septal aspect of RV (mean 8.33 ± 2.34 mV, P < 0.001, 95% CI 7.84–8.84). MR analysis confirmed that the lowest voltage region was opposite to MR‐defined aortic root. Using a cutoff for UNI abnormality of 6.0 mV for the posterior aspect of the RVOT opposite to the aortic root and 7.5 mV for the rest of the septal aspect of the RV, there was no confluent area of unipolar abnormality in any patient. Conclusion: We defined normal ENDO UNI cutoffs as 7.5 mV for the septal aspect of the RV with adjustment to 6.0 mV over the posterior RVOT opposite to the aortic root. [ABSTRACT FROM AUTHOR]

To determine reference values for fetal heart biometric parameters using the spatiotemporal image correlation (STIC) M mode and their applicability in congenital heart diseases (CHDs). A cross-sectional prospective study was conducted with 300 singleton pregnancies between 20 and 33 + 6 weeks of gestation. Right ventricular wall thickness (RVWT), interventricular septum thickness (IVST), and left ventricular wall thickness (LVWT) were measured off-line using the STIC-M mode with the cursor perpendicular to the interventricular septum. Polynomial regressions adjusted with the coefficient of determination ( R ) were performed. The curves were applied to 14 fetuses with structural CHD. For the reproducibility calculations, the concordance correlation coefficient (CCC) was used. The mean RVWT, IVST, and LVWT were 0.34 ± 0.09 cm, 0.28 ± 0.09 cm, and 0.30 ± 0.07 cm, respectively. There was correlation between RVWT, IVST, and LVWT and gestational age (GA): RVWT = −0.002 + 0.013 × GA ( R = 0.33), IVST = −0.011 + 0.011 × GA ( R = 0.25), and LVWT = 0.056 + 0.009 × GA ( R = 0.26). RVWT, IVST, and LVWT were altered (<5th or >95th percentile) in 5/14, 5/14, and 7/14 of the fetuses with CHD, respectively. For RVWT, IVST, and LVWT, intra-observer (CCC = 0.86, 0.85, and 0.87, respectively) and inter-observer (CCC = 0.86, 0.86, and 0.86, respectively) reproducibility were good/moderate. The reference ranges determined for fetal heart biometric parameters using STIC-M had good intra- and inter-observer reproducibility and were applicable to fetuses with CHD. [ABSTRACT FROM AUTHOR]

Abstract Isolated cardiac location is an uncommon presentation of echinococcosis (0.5-2%), and involvement of the interventricular septum is even rarer. It may lead to various complications because of rupture and embolization. We report the case of a 26 - year- old man who was diagnosed to have a large inter-ventricular hydatid cyst complicated by both cerebral and coronary embolism. Presentation, management and follow-up of the patient is discussed. This case is of particular interest because of the rarity of septal localization of a hydatid cyst, and the conflict between the severity of the complications that occurred and the absence of correlated symptoms. [ABSTRACT FROM AUTHOR]

There is a very low prevalence of cardiac fibroma in the adult population. Cardiac fibromas arise from heart fibroblasts, and these tumors are primarily located in the ventricles or in the interventricular septum. Symptomatic tumors are treated by resection. By contrast, asymptomatic tumors require a long‑term follow‑up or surgical resection as a preventive measure to avoid complications. The present study reports the case of a 43‑year‑old man, who presented with a cough and shortness of breath for 2 months. Echocardiogram and cardiac magnetic resonance imaging indicated a large mass located in the left ventricular lateral wall. The patient underwent surgical excision of the tumor, and histopathological examination confirmed the mass to be a fibroma. The patient had a good postoperative recovery and was discharged on day 9 post‑surgery. [ABSTRACT FROM AUTHOR]

We report an exceedingly rare case of spontaneous dissecting aneurysm involving the interatrial and interventricular septum, concomitant ventricular septal defect in an 8-year-old girl, echocardiographic and multislice computed tomographic imaging, and successful surgical repair. [ABSTRACT FROM AUTHOR]

The rupture of the inter-ventricular septum is a rare, but extremely severe mechanical complication of the acute myocardial infarction, which in most cases of no immediate surgery is fatal (30 days death rate - 80%). The incidence of the septum ventricular defect post-acute myocardial infarction was 1-3% in the period before crash injury therapy, dropping to 0.2% after introducing the thrombolytic treatment. The acute mitral failure and the septum ventricular defect are two mechanical complications of the acute myocardial infarction associated with high death rate, regardless of the progress made in medical and surgery therapeutic approach. This paper highlights the peculiarities of a clinical case like the acute myocardial infarction as the first manifestation of heart disease in a patient with no history of cardiovascular disease but with risk factors (obesity, dyslipidemia, hypertension), the ECG evident changes in the anterior territory and more discrete in the inferior territory, which established the initial diagnosis to be myocardial infarction and the presence of two mechanical threatening complications: ventricular septal flaw and acute mitral failure through posterior papillary muscle incomplete rupture. [ABSTRACT FROM AUTHOR]

Introduction: Third coronary artery (TCA) is a direct branch arising from the anterior aortic sinus (right aortic sinus) which supplies right ventricular outflow tract. It is found frequently and may be an important source for collateral coronary blood flow through a vascular anastomotic bridge (circle of Vieussens) between the right and left coronary systems. Aim: To evaluate the gross anatomy of third coronary artery in terms of their number, origin, extent and distribution. Materials and Methods: After an ethical approval, 150 formalin fixed adult human cadaveric hearts were collected from Department of Anatomy, BVDU Medical College and Hospital, Sangli and Pune over the period of six years. The careful dissection was carried out to note details about third coronary artery and data was analysed using SPSS computer software. Results: The TCA was present in 32% of the heart specimens. In 42 hearts (28%) single TCA and in 6 hearts (4%) double TCA were noted. It was found to be variably distributed to conus arteriosus, anterior wall of the right ventricle, interventricular septum and the apex of the heart. TCA was larger than right coronary artery in 8 hearts and later ended at inferior border of heart. Myocardial bridge was noted over large third coronary artery in one specimen. Conclusion: TCA is present frequently. It anastomoses with branches of left anterior descending artery (LADA) and contributes to apical and septal perfusion. Hence role of TCA should always be considered during diagnostic and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objective: To determine reference values for fetal interventricular septum (IVS) volume by 3D/4D ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL). Methods: A prospective cross-sectional study was conducted on 200 consecutive normal low-risk pregnant women at a gestational age ranging from 18w0d to 33w6d. The volume data sets of the fetal heart were acquired by applying STIC to a four-chamber plane. IVS volume was calculated offline using VOCAL with rotation of 30° (six planes). To assess the correlation of fetal IVS volume as a function of gestational age (GA), Pearson’s correlation coefficient (r) and polynomial regression models with adjustments through the coefficient of determination (R2) were calculated. The intra-class coefficient (ICC) was used to evaluate intra- and inter-observer reproducibility. Results: A good correlation between GA and fetal IVS volume (r = 0.827) was observed. The mean fetal IVS volume ranged from 0.13 ± 0.03 cm3(0.08–0.18 cm3) at 18wd0 of gestation to 1.33 ± 0.37 cm3(0.41–1.98 cm3) at 33w6d. The best correlation between fetal IVS volume and GA was exponential: fetal IVS volume = 0.11e0.139×GA(R2 = 0.785). A good intra- and inter-observer reliability were observed, with ICC = 0.999 and 0.991, respectively. Conclusions: Reference values for fetal IVS volume using STIC and VOCAL by 3D/4D ultrasound between 18w0d and 33w6d of gestation were determined and showed to be reliable and concordant. [ABSTRACT FROM AUTHOR]

Nail-gun injury to the heart is rare. Nail-gun injury to the interventricular septum is rarer: we could find only 5 reported cases, and none involving a child. We report 2 additional cases, in which nails penetrated the interventricular septum without causing acute pericardial tamponade, heart block, or shunt across the septum. Transesophageal echocardiography provides a dynamic way to evaluate the patient preoperatively, intraoperatively, and postoperatively. In the cases reported here, both the adult with multiple interventricular nails and the child with a single nail underwent foreign-object removal via median sternotomy. The child needed cardiopulmonary bypass for removal of the nail. There were no short-term or long-term sequelae from these interventricular septal injuries. [ABSTRACT FROM AUTHOR]

Primary cardiac tumors are rare and lipoma at interventricular septum is rarer. Most of the cardiac tumors are diagnosed incidentally on noninvasive imaging. The clinical manifestations of them depend on its anatomic location. Here we are discussing about a 35-year-old female, who presented with complaints of palpitation, dyspnoea and occasional dizziness for 6 months. On transthoracic echocardiography and Magnetic Resonance imaging (MRI) evaluation, a large mass of 5.4x5.9x6.5 cm in size at interventricular septum was detected. The mass was partially obstructing right ventricular outflow tract (RVOT). As the mass was large, the surgical resection had to be performed via both transtricuspid valve and transpulmonary artery (PA) approach to avoid residual outflow tract obstruction. Aorta was opened to rule out extension of the mass to left of septum. Histology confirmed the diagnosis of lipoma. [ABSTRACT FROM AUTHOR]

Metastatic tumors to the heart unlike primary cardiac tumors are not rare. Despite its frequency, cardiac metastasis is commonly detected only during autopsy as the symptoms of disseminated metastasis prevail over symptoms caused by cardiac metastasis and hence is overlooked most of the time. Tumors more commonly found metastasizing to the heart are malignancies of lung, breast, esophagus, lymphoma, leukemia, and malignant melanoma. Head and neck malignancies have a lower incidence of distant metastasis when compared to other malignancies and it rarely causes cardiac metastasis. Here we report the case of a 32 year old Indian male with squamous cell carcinoma of buccal mucosa who underwent surgery followed by chemoradiation. Follow up, FDG PET-CT showed extensive lymphnodal, pulmonary & skeletal metastasis apart from local recurrence in the tongue and floor of mouth. Another discrete foci of increased FDG uptake was noted in the region of heart which corresponded to a hypodense foci in the interventricular septum in contrast enhanced CT raising the possibility of cardiac metastasis. Subsequently, 2D echocardiogram with parasternal long axis view showed hyperdense anterior septum with speckled appearance with a hyperechoic structure attached to the septum towards the right ventricular side confirming metastatic deposit to the heart. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the efficacy of bipolar (BM) vs. unipolar (UM) mode of radiofrequency ablation (RFA) in terms of creating transmural lesions across the interventricular septum (IVS) and ventricular free wall (VFW). Materials and methods: We built computational models to study the temperature distributions and lesion dimensions created by BM and UM on IVS and VFW during RFA. Two different UM types were considered: sequential (SeUM) and simultaneous (SiUM). The effect of ventricular wall thickness, catheter misalignment, epicardial fat, and presence of air in the epicardial space were also studied. Results: Regarding IVS ablation, BM created transmural and symmetrical lesions for wall thicknesses up to 15 mm. SeUM and SiUM were not able to create transmural lesions with IVS thicknesses ≥12.5 and 15 mm, respectively. Lesions were asymmetrical only with SeUM. For VFW ablation, BM also created transmural lesions for wall thicknesses up to 15 mm. However, with SeUM and SiUM transmurality was obtained for VFW thicknesses ≤7.5 and 12.5 mm, respectively. With the three modes, VFW lesions were always asymmetrical. In the scenario with air or a fat tissue layer on the epicardial side, only SiUM was capable of creating transmural lesions. Overall, BM was superior to UM in IVS and VFW ablation when the catheters were not aligned. Conclusions: Our findings suggest that BM is more effective than UM in achieving transmurality across both ventricular sites, except in the situation of the epicardial catheter tip surrounded by air or placed over a fat tissue layer. [ABSTRACT FROM AUTHOR]

Objective: To compare the role of real-time 3DE and STIC technology in assessment of the fetal IVS. Methods: Fifty pregnant women with singleton pregnancies were invited to attend this study. All the fetuses were examined by both spatiotemporal image correlation and real-time three-dimensional echocardiography. There were totally six images of IVS obtained for each fetus: live xPlane image, live 3D image, multiplanar image and rendered image with the four-chamber view as the starting plane, multiplanar image and rendered image with the sagittal view of the fetal thorax as the starting plane. These images were grouped into six groups and randomized within each group for the further analysis. The images were scored and compared according to the image quality, the outline of the fetal IVS and motion artefact. The operator was also asked to judge whether VSD existed or not and the results were compared with the final diagnosis. The sensitivity, specificity, false positive percentage, positive likelihood ratio, false negative percentage and negative likelihood ratio of each group were also calculated. Results: There were 15 cases with VSD and four cases without VSD in CHD fetus and 31 cases of normal fetus enrolled in this study. A total 300 images of the lateral view of fetal IVS were obtained and grouped into six groups. The image quality in the group of STIC with the four-chamber view as the starting plane is much worse than the group of STIC with the sagittal view as the starting plane and real-time three-dimensional echocardiography ( P < 0.05). There were no significant differences in image quality between the group of STIC with the sagittal view as the starting plane and real-time three-dimensional echocardiography ( P > 0.05). Conclusion: The image quality of real-time 3DE is similar to the images acquired by STIC from the sagittal view and superior to that obtained by STIC from the four-chamber view. However, real-time 3DE has no motion artefact, which has the potentials to improve the detection rate of fetal VSD. [ABSTRACT FROM AUTHOR]

Cardiac fibromas are benign conditions; however, their location and size may cause ventricular arrhythmias and sudden cardiac death. We report a case of a 68-year-old female who died suddenly. Postmortem investigation detected a huge cardiac fibroma in the pars muscularis of the interventricular septum, occupying almost the entire muscular septum, and restricting the volume of left ventricular chamber. Histological examination revealed numerous foci of calcification in the alternating complex interlacing or strictly parallel collagenous fiber mass. Tumor mass was mainly demarcated, but in some places, fibrous infiltration of surrounding working cardiac muscle was found. We present a case when direct tumor involvement in the descending left bundle branches was evidenced. Mainly, the branches of septal fascicle were disrupted, entrapped, and degenerated by the tumor mass. This case report emphasizes that postmortem histological examination of conduction system in all sudden cardiac death cases may substantially improve the accuracy of postmortem diagnosis. [ABSTRACT FROM AUTHOR]

Background: Augmentation of coronary perfusion may improve right ventricular (RV) failure following acute increases of RV afterload. We investigated whether intra-aortic balloon counterpulsation (IABP) can improve cardiac function by enhancing myocardial perfusion and reversing compromised biventricular interactions using a model of acute pressure overload. Materials and Methods: In 10 anesthetized pigs, RV failure was induced by pulmonary artery constriction and systemic hypertension strategies with IABP, phenylephrine (PE), or the combination of both were tested. Systemic and ventricular hemodynamics [cardiac index(CI), ventricular pressures, coronary driving pressures (CDP)] were measured and echocardiography was used to assess tricuspid valve regurgitation, septal positioning (eccentricity index (ECI)), and changes in ventricular and septal dimensions and function [myocardial performance index (MPI), peak longitudinal strain]. Results: Pulmonary artery constriction resulted in doubling of RV systolic pressure (54±4mm Hg), RV distension, severe TR (4+) with decreased RV function (strain: –33%; MPI: +56%), septal flattening (Wt%: –35%) and leftward septal shift (ECI:1.36), resulting in global hemodynamic deterioration (CI: –51%; SvO2: –26%), and impaired CDP (–30%; P <0.05). IABP support alone failed to improve RV function despite higher CDP (+33%; P <0.05). Systemic hypertension by PE improved CDP (+70%), RV function (strain: +22%; MPI: –21%), septal positioning (ECI:1.12) and minimized TR, but LV dysfunction (strain: –25%; MPI: +31%) occurred after LV afterloading (P <0.05). With IABP, less PE (–41%) was needed to maintain hypertension and CDP was further augmented (+25%). IABP resulted in LV unloading and restored LV function, and increased CI (+46%) and SvO2 (+29%; P <0.05). Conclusions: IABP with minimal vasopressors augments myocardial perfusion pressure and optimizes RV function after pressure-induced failure. [Copyright &y& Elsevier]

Transseptal Dispersion and TdP. Objective: This study was designed to quantitate transseptal dispersion of repolarization (DR) and delineate its role in arrhythmogenesis using the calcium agonist BayK 8644 to mimic the gain of function of calcium channel current responsible for Timothy syndrome. Background: Amplification of transmural dispersion of repolarization (TDR) has been shown to contribute to development of Torsade de Pointes (TdP) arrhythmias under long-QT conditions. Methods: An arterially perfused septal wedge preparation was developed via cannulation of the septal artery. Action potentials (APs) were recorded using floating microelectrodes together with a transseptal electrocardiogram (ECG). These data were compared to those recorded from arterially perfused canine left ventricular (LV) wedge preparations. Results: Under control conditions, the shortest AP duration measured at 90% repolarization (APD90) was observed in right ventricular (RV) endocardium (181.8 ± 15 ms), APD90 peaked close to midseptum (278.0 ± 32 ms), and abbreviated again as LV endocardium was approached (207.3 ± 9 ms). Transseptal DR averaged 106 ± 24 ms and Tpeak–Tend 84 ± 7 ms (n = 6). TDR and Tpeak–Tend recorded from LV wedge were 36 ± 9 ms and 34 ± 19 ms, respectively (n = 30). BayK 8644 increased transseptal DR to 123.2 ± 35 ms (n = 5) and induced early and delayed afterdepolarizations (3/5), rate-dependent ST-T-wave alternans (5/5), and TdP arrhythmias (3/5). Conclusions: Our data indicate that dispersion of repolarization across the interventricular septum is twice that of the LV free wall, predisposing to development of TdP under long-QT conditions. Our findings suggest that the coronary-perfused ventricular septal preparation may be a sensitive model in which to assess the potential arrhythmogenic effects of drugs and pathophysiological conditions. (J Cardiovasc Electrophysiol, Vol. 21, pp. 441–447, April 2010) [ABSTRACT FROM AUTHOR]

Left ventricular false tendon in a structure with unknown physiology. It was first described by Turner. It has been implicated in origin of innocent murmur and some form of ventricular tachycardia but the significance has not been proven beyond doubt. During echocardiography the false tendon may be misleading many times. Here we present such a case where the false tendon really created a false impression to begin with. [ABSTRACT FROM AUTHOR]

The aim of this study was to design a new approach for the acquisition of regional radial strain from the middle portion of the interventricular septum. We designed and wrote a program in Matlab (computer-assisted method) for use on a personal computer so that the septum thickness throughout the cardiac cycle could be measured instantaneously. Computer-assisted and conventional manual methods were used on the same 2D echocardiography image frames. Then, real-time 2D color Doppler myocardial imaging and conventional 2D imaging of the septum walls of 12 healthy participants at rest using apical four-chamber view were acquired. Wall thickness was measured using both the computerized program and velocity data used for tracking the segment and intensity line profile modification automatically. Then, the radial strain was estimated. Bland-Altman statistical analysis shows good agreement between the computer-assisted method and conventional manual method. The average of the peak and mean radial strains from the mid-septum of 12 healthy participants were 63.5 +/- 10.7 and 31.7 +/- 7.5%, respectively. We introduced a simple approach that is capable of radial strain estimation of the septum wall, which cannot be measured by current Doppler based methods in echocardiography systems. [ABSTRACT FROM AUTHOR]

Echocardiography and magnetic resonance imaging showed a large tumor (4 cm diameter) on the interventricular septum (Figure 1C,D). Three years ago, the patient underwent resection of a myxoid liposarcoma from the gluteal region, and a reoperation 3 months later due to tumor relapse. A large hematoma was formed in the cavity after the tumor removal with a significant thickening of the interventricular septum (IVS) (31 mm; Figure 2C). [Extracted from the article]

Objective: In this study we aimed to apply spatio-temporal image correlation (STIC) rendering to visualize the virtual planes of the interventricular and interatrial septa (IVS, IAS) as well as the atrioventricular (AV) annuli plane just distal to the semilunar valves (coronal atrioventricular (CAV) plane) in normal and pathological fetal hearts, to ascertain whether these planes add to fetal cardiac examination. Methods: Unselected gravidae presenting for anatomy scan or patients referred for fetal echocardiography in the second and third trimesters of pregnancy with suspected or diagnosed cardiac malformation were scanned using the five planes technique with the STIC modality to obtain cardiac volume sets for each patient. Rendering capabilities were employed to obtain the 'virtual planes' to evaluate the IVS, IAS, AV annuli, and size and alignment of the great vessels. Results: A total of 136 normal scans were performed to establish a learning curve for STIC acquisition and post-processing rendering and analysis. An additional 35 cases with cardiac anomalies were accrued. In 131/136 (96.3%) normal scans the IAS and IVS were visualized successfully, while in 127/136 (93.4%) normal fetuses the CAV plane was successfully visualized. In 13 anomalous cases the IVS plane improved ventricular septal defect (VSD) evaluation, and in four the IAS plane contributed to foramen ovale evaluation. The modality improved visualization of the septa and the assessment of the defects, as well as the foramen ovale flap and pattern of movement of the foramen ovale. In five cases the CAV plane improved evaluation of the alignment of the major vessels in relation to the AV annuli, and in three the evaluation of the semilunar valves, with or without malalignment of the great vessels. Conclusions: Rendering STIC technology allows the visualization of virtual planes (IAS, IVS, AV annuli-CAV plane), which can clarify our understanding of anatomical defects and may improve communication with the management team and family. [ABSTRACT FROM AUTHOR]

Abstract: Mammalian heart development involves complex morphogenetic events which lead to the formation of fully separated left and right atrial and ventricular chambers from a tubular heart. Separation of left and right ventricular chambers is dependent on a single structure, the interventricular septum (IVS), which has both muscular and mesenchymal components. Little is known about the morphogenetic events that lead to the formation of the muscular component of the IVS. We have analyzed two transgenic mouse lines that display complementary nlacZ reporter gene expression patterns in the embryonic ventricles: the Mlc1v-nlacZ-24 transgene is expressed in right ventricular myocardium and the Mlc3f-nlacZ-2 transgene in left ventricular myocardium. Detailed analysis of these transgene expression patterns during IVS formation reveals a symmetric left and right myocardial identity within the developing IVS between embryonic days 9.5 and 11.5. From embryonic day 12.5 onwards, myocytes with a left ventricular identity dominate the IVS, particularly in its dorsal aspect. The T-box transcription factor encoding gene, Tbx18, is expressed in the left ventricle and left side of the developing IVS, providing additional support for the presence of left and right ventricular identities within the IVS. Analysis of clonally related cardiomyocyte clusters confirms that both left and right ventricular myocardial cell populations contribute to the forming IVS, in similar domains to those defined by the Mlc-nlacZ transgenes. Examination of the orientation as well as the distribution of labeled cells in clusters provides new insights into the morphogenesis of the septum. [Copyright &y& Elsevier]

Abstract: Interventricular septum (IVS) formation is one of the key events in the development of a four-chambered heart. We previously showed that the basic helix–loop–helix transcription factor Hand1 plays an important role in the formation of the IVS. Here, we found that the other Hand gene, Hand2, regulated expansion, trabeculation, and IVS formation in the embryonic heart. In transgenic embryos expressing Hand2 in the whole ventricles, the boundary region between the left and right ventricles expanded outwards, resulting in complete absence of the IVS. Moreover, trabecular formation was observed even in a region where the IVS was expected to form. In some transgenic embryos with heterogeneous expression of the transgene, a muscular septum did not form in a region where Hand2 was expressed, but an incomplete septum was identifiable in a region where Hand2 was not expressed, suggesting that septum formation was strictly regulated by the expression domain of Hand2. Furthermore, expression of trabecular markers including ANF, BNP, and connexin40 was significantly up-regulated in the ventricles of Hand2 transgenic embryos as well as in H9c2 cells over-expressing Hand2. These results suggested that the absence of Hand2 expression in the interventricular boundary region inhibits expansion and trabeculation in this area, contributing to the proper formation of the IVS. [Copyright &y& Elsevier]

Aim: To compare echocardiographic findings of infants of diabetic mothers (IDMs), macrosomic infants of nondiabetic mothers and healthy full term appropriate-for-gestational-age (AGA) infants. Methods: Included in this study were 83 infants, admitted to our Neonatology Unit. Thirty-three IDMs, including both macrosomic and nonmacrosomic, comprised Group A, 25 macrosomic infants of nondiabetic mothers comprised group B, and 25 healthy full term AGA infants comprised group C. Echocardiographic measurements were performed in the first three days after birth and compared by using one-way ANOVA, Post Hoc Tukey HSD and Student's t tests. Results: The left ventricular end-systolic/left ventricular end-diastolic diameter ratio of group A was significantly smaller than that of group C (P<0.05). The interventricular septum/posterior wall thickness ratios of groups A and B were greater than those of group C (P<0.05). The left ventricular mass index of group A was greater than those of groups B and C (P<0.05). The shortening fraction and ejection fraction of group A were increased in comparison to group C (P<0.05). When comparing the values of echocardiographic measurements of macrosomic IDMs (n=9) with nonmacrosomic ones (n=24), and infants of pregestational diabetic mothers (n=11) with those of gestational diabetes mothers (n=22), no statistical difference was found. Conclusion: The present study suggests that underlying mechanisms common to both macrosomic infants of nondiabetic mothers and IDMs lead to less cardiac alterations in the macrosomic infants of nondiabetic mothers than in IDMs. [ABSTRACT FROM AUTHOR]

A 43-year-old man who had a Carbomedics prosthetic aortic valve replacement in 1997 was admitted to our hospital with complaints of shortness of breath and dyspnea on exertion in 2000. The patient was hospitalized due to atrioventricular(AV) complete block and a permanent pacemaker was implanted. At that time echocardiography indicated an aneurysm at the left sinus of Valsalva. In 2003, the patient was re-admitted to our clinic with complaints of shortness of breath and fatigue. Echocardiography showed a sinus of Valsalva aneurysm dissecting into interventricular septum. Operation confirmed dissection of the interventricular septum and communication between this cavity and the aneurysm of the left sinus of Valsalva. The postoperative course was uneventful and the patient was discharged in a satisfactory condition. This is the first reported case of aneurysm of the sinus of Valsalva dissecting into interventricular septum late and complicating aortic valve replacement.(ECHOCARDIOGRAPHY, Volume 21, October 2004) [ABSTRACT FROM AUTHOR]

Objectives To evaluate the measurement of the fetal abdominal fat layer (FFL), cardiac interventricular septum (IVS) and abdominal circumference (AC) percentile in the early third trimester as predictors of macrosomia at birth in the fetuses of women with gestational diabetes. Methods Ninety patients attending the hospital's special diabetic clinic were recruited prospectively. FFL and IVS were measured in addition to the routine biometry in the early third trimester. AC was measured routinely and AC percentile was determined from established antenatal charts. These measurements were then assessed as predictors of macrosomia. Results A fetal fat layer of ≥5 mm was the most useful predictor of macrosomia at term as assessed using the likelihood ratio. An AC ≥90th percentile, however, had a better sensitivity. Conclusion The usefulness of routine FFL measurement in the early third trimester in the management of diabetic pregnancies is worthy of further evaluation. [ABSTRACT FROM AUTHOR]