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Adult Congenital Heart Disease
Published in Paul Schoenhagen, Frank Dong, Cardiac CT Made Easy, 2023
Atrial septal defects (ASDs) are common congenital heart defects. The different types of defects (ostium secundum defect, ostium primum defect, sinus venosus defect, coronary sinus defect, and patent foramen ovale (PFO) are related to the embyronal development of the intraatrial septum. Unrepaired defects are occasionally identified in asymptomatic or symptomatic adults. Symptoms can include right heart failure or neurologic symptoms secondary to paradoxical embolization. Because the central intraatrial septum is a very thin structure, anatomic assessment with noninvasive imaging modalities is limited. Identification of these defects typically relies on the assessment of flow by echocardiography and MRI. Anatomic assessment with CT can define the relationship of the defect to other anatomic structures, such as the coronary sinus or the sinus venosus (Figure 13.1). Surgical or percutaneous closure of ASD is considered, depending on anatomic characteristics, shunt volume (Qp/Qs), and clinical symptoms. CT is increasingly used for pre- and post-interventional imaging in the setting of percutaneous ASD closure (Figure 13.2).175 Several papers describe ‘septal pouch’ as a blind ending tubular remnant at the interatrial septum.176,177
Anatomy of the Nose and Paranasal Sinuses
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Dustin M. Dalgorf, Richard J. Harvey
The nasal septum consists of the following structures (Figure 25.4): Bone (comprised of the perpendicular plate of the ethmoid bone, vomer, maxillary crest and palatine bone)Cartilage (composed of the quadrilateral cartilage)Membranous portions (segment of connective tissue between the caudal septal cartilage and columella)
Congenital Heart Disease in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
The incidence of ventricular septal defects (VSDs) varies widely in the literature, as many patients are asymptomatic, and many small defects close spontaneously but are among the most common forms of CHD in childhood. Approximately 10,000–11,000 isolated VSDs are diagnosed in infants in the United States annually [7,8]. Ventricular septal defects are divided into four types, based on their location within the interventricular septum: Perimembranous VSDs account for 80%Muscular VSDs account for 50%–10%Inlet VSDs account for 5%Supracristal VSDs account for 5%–7%
Update on percutaneous and perventricular device closure of congenital ventricular septal defect
Published in Expert Review of Cardiovascular Therapy, 2023
John S Lozier, Maram Sati, Ira M Cheifetz, Martin L Bocks
To cross the VSD from the LV, a pigtail catheter is advanced retrograde into the LV. The septum is profiled, and a ventriculogram is performed. Transesophageal echocardiogram (TEE) is used to assess the size and position of the VSD. After initial angiographic and echo imaging, the closure device is selected. The pigtail catheter is exchanged for a right coronary catheter or another directional catheter in the LV. To cross the VSD, a wire is advanced through the catheter, and using fluoroscopic and echocardiographic guidance, across the VSD and into the right ventricular outflow tract. A J-tipped wire is preferred to ensure that the wire and catheter cross the largest channel of the VSD. We use the Wholey wire (Medtronic, Minneapolis, MN), when a straight wire is needed. In some cases, the location of the VSD is very difficult to reach, and multiple diagnostic catheters can be used to reach the defect. In some cases, a 6- or 7-French balloon-tipped wedge catheter can be positioned in the LV, and the inflated balloon will catch the flow through the VSD and cross it unaided [13]. The wedge catheter can be directed toward the VSD by a curved stiff wire, if necessary.
Is tooth conservation possible in odontogenic sinusitis? Prospective evaluation of affected teeth condition-based protocol
Published in Acta Oto-Laryngologica, 2023
Akiko Ito, Muneo Nakaya, Kazuhiro Tada, Junko Kumada, Wataru Kida, Yasuhiro Inayoshi
ESS was performed under general anesthesia. Uncinectomy, middle meatal antrostomy, anterior and posterior ethmoidectomy, and frontal sinusotomy were performed in all the patients. In some cases, a sphenoidotomy was added depending on the extent of the disease. A septoplasty was performed in patients with septal deviation toward the affected side. Counter opening in the inferior meatus was performed to remove the maxillary sinus mucosa with granulation tissue. At the end of the surgery, the sinus was rinsed with saline. If a periapical abscess or radicular cyst was identified at the bottom of the maxillary sinus using a 70° endoscope, the granulation tissue and cyst were removed to decrease pathogens (Figure 3). All the participants gave their written informed consent for the implementation of the present treatment protocol and of any, required, additional procedures for the treatment of periapical lesions or radicular cysts during ESS. Patients whose intraoperative findings revealed an inverted papilloma or eosinophilic sinusitis were excluded.
Angioleiomyoma of the nasolacrimal duct: case report and literature review
Published in Orbit, 2022
Ariel M. Azhdam, Yao Wang, Raymond S. Douglas, Elena E. Chang, Arthur W. Wu
A 65-year-old female presented to a tertiary-care Otolaryngology – Head and Neck Surgery clinic for a nasolacrimal duct lesion found incidentally when receiving dental implants recently prior to presentation. She reported a history of chronic lower right eyelid edema, epiphora, and frequent styes. Computed tomography of the orbits without contrast revealed a well-defined mass in the right nasolacrimal duct, suggestive of a low-grade neoplasm or polyp. Magnetic resonance imaging of the head demonstrated a mass expanding the right nasolacrimal canal, suggestive of a dacryocystocele (Figure 1a,b). Endoscopy was also performed, which visualized a right deviated septum. She was subsequently referred to an oculoplastics surgeon who confirmed nasolacrimal duct obstruction with lacrimal irrigation. The patient subsequently underwent endoscopic excision of the right nasolacrimal duct lesion, medial maxillectomy, septoplasty, and dacryocystorhinostomy with both otolaryngology and oculoplastics. An intraoperative biopsy of the lesion determined that it was not cystic and that it was a solid tumor (Figure 1c). Consistent with imaging, the walls of the lesion were smooth with no evidence of bony invasion or aggressive features. In frozen section pathology, it was noted to be a benign vascular tumor and final pathology revealed an angioleiomyoma. The procedure was completed without surgical complication and the patient did well postoperatively with the resolution of her epiphora.