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Autopsy Cardiac Examination
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
The heart lies in the middle of the inferior mediastinum, mainly to the left of the midline behind the second to the sixth costal cartilage, with the left edge extending to the midclavicular line (Fig. 1.1). On each side, the heart abuts the lungs and the pleural cavity overlies the right side of the heart as far as the midline. On the left side, the lung and pleura are pushed to the left and in the area of the cardiac notch; the surface of the heart comes to lie directly against the rib cage, separated from it only by the pericardium. Anatomically, because of its rotated position within the chest, the right border of the heart is occupied by the right atrium (RA) while the inferior and anterior surface is formed by the right ventricle (RV), lying on the diaphragm. The left ventricle (LV) only comes to the anterior surface as a thin strip between the anterior interventricular groove and the obtuse margin of the heart. The left atrium (LA) is a completely posterior structure lying close to the oesophagus. That is why transoesophageal echocardiography gives such excellent views of the left side of the heart. The tips of the right and left atrial appendages can be seen at the upper right and left margins of the heart (Fig. 1.1). Pathologists must relate the features of the excised heart and natural cardiac anatomy. Thus, the under surface, mainly with the RV resting on the diaphragm, is now universally referred to as the inferior/basal surface. In the past, pathologists called this the posterior surface.
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The epiploic appendages are small fatty appendages sited along the large bowel. When these twist they cause acute abdominal pain which can be difficult to clinically differentiate from other causes of pain. This most commonly occurs anterior to the rectosigmoid colon. On ultrasound the appearance of a hyperechoic mass indicates fat. Sometimes a slightly hypoechoic line can be seen peripherally, and there is no internal vascularity. CT is usually diagnostic and demonstrates a lesion of fat density adjacent to the colon with peripheral enhancement and surrounding fat stranding. Sometimes a hyperechoic dot centrally can be seen representing thrombosed vessels.
The Musculoskeletal System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Of the 206 bones in the body, three are located in each ear and transmit the vibrations of sound rather than function as a support mechanism; the remainder are divided between the axial skeleton—the skeleton of the central axis—and the appendicular skeleton of the appendages such as the arms (Figure 7.2). In addition, small sesamoid bones develop within the tendons. These are named for their general size and shape (literally, "in the form of a sesame seed") and act to reduce friction and sometimes function as pulleys to influence the direction of muscle pull.
Epicardial transplantation of autologous atrial appendage micrografts: evaluation of safety and feasibility in pigs after coronary artery occlusion
Published in Scandinavian Cardiovascular Journal, 2022
Annu Nummi, Tommi Pätilä, Severi Mulari, Milla Lampinen, Tuomo Nieminen, Mikko I. Mäyränpää, Antti Vento, Ari Harjula, Esko Kankuri
Atrial appendage offers a good tissue-matched reservoir for various cardiac cell types which contribute to paracrine signaling [11–13]. Interestingly, especially the noncardiomyocyte pool has been identified as the dynamically proliferating one and active in the secretion of soluble mediators [14], being thus able to contribute to the mechanically disaggregated atrial appendage’s effect on the failing myocardium. The use of autologous cells can minimize rejection and thus ensure better cell engraftment. The extracellular matrix (ECM) and the microtissue architecture of the micrografts can support cellular adherence and survival of transplanted cells [15]. Moreover, the mixture of different myocardial cell types can enable better tissue-mimicking interplay in the micrografts and improve their therapeutic effect via enhanced survival and improved paracrine signaling [16,17].
Safety and feasibility of same-day discharge after elective percutaneous balloon mitral valvotomy: a prospective, single-center registry in India
Published in Acta Cardiologica, 2021
Sharad Chandra, Abhishek Gupta, Gaurav Chaudhary, VS Narain, SK Dwivedi, Rishi Sethi, Akshyaya Pradhan, Pravesh Vishwakarma, Akhil Sharma, Monika Bhandari, Salvatore Cassese
This is a single-centre registry performed at the Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India. Between January 2018 and November 2018 all patients admitted at our institution with severe MV stenosis were screened for possible enrolment in the registry. Patients above the age of 12 years were included in the registry if they had: (a) severe symptomatic (New York Heart Association – NYHA class II–IV) MV stenosis; (b) MV stenosis suitable for elective PBMV; or (c) history of restenosis after previous PBMV (pending anatomical suitability for repeat elective PBMV). Patients were excluded if they had: (a) mild MV stenosis; (b) pre-procedural more than mild MV regurgitation; (c) other significant concomitant valvular disease (except secondary tricuspid regurgitation); (d) decompensated congestive heart failure; (e) atrial flutter/fibrillation; (f) indication to oral anticoagulants due to other comorbid conditions; (g) clot in left atrium or left atrial appendage; (h) need for cardiac surgery due to other cardiac disease; or (i) pregnancy (supposed or planned).
Left Atrial Appendage Closure Review: Addressing Unmet Needs of AF Mediated Stroke Prevention with Evolving Science
Published in Structural Heart, 2021
Anwar Tandar, Jack Nielsen, Brian K. Whisenant
Imaging is essential to exclude LAA thrombus, inform device selection, and guide LAA closure. While some operators evaluate the LAA with TEE or CT prior to undergoing LAA device closure, others first image the LAA with TEE during the index procedure. Rarely, patients with extraordinarily large appendages may be excluded based on the limitations of current devices. On occasion, pre-procedure imaging can identify patients in whom the likelihood of a successful implant is below average, such as those with shallow appendages and/or proximal bifurcations between lobes. However, as size exclusions are rare and the ability to predict unsuccessful procedures remains unproven, many operators choose to image the LAA initially at the time of device implantation. As required in the landmark clinical trials, TEE remains the gold standard for anatomic characterization and procedural guidance.11 Cardiac computer tomographic angiography (CTA) yields superior spatial resolution, detailed three-dimensional (3D) LAA characterization, accurate sizing, and noninvasive acquisition.45–48 However, concerns regarding radiation, contrast exposure, and the lack of institutional expertise have limited routine pre-procedure CT analysis at many institutions.