The Experts below are selected from a list of 516 Experts worldwide ranked by ideXlab platform
Neelam Desai - One of the best experts on this subject based on the ideXlab platform.
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Septum primum malposition defect a rare congenital anomaly
Turkish Journal of Thoracic and Cardiovascular Surgery, 2013Co-Authors: Trushar Gajjar, Neelam DesaiAbstract:Displacement of the Septum primum-leftward in atrial situs solitus or rightward in atrial situs inversus is termed as Septum primum malposition defect. It appears to be responsible for the anomalous pulmonary venous drainage. This abnormality occurs predominantly in patients with visceral heterotaxy, usually with polysplenia, or rarely with asplenia or a normally formed spleen. Poor development and absence of Septum Secundum are considered to be responsible for the malposition of Septum primum. Transthoracic echocardiographic recognition of the displacement of Septum primum facilitates surgical management. In this article, we present an 18-year-old male case of an echocardiographic diagnosis of Septum primum malposition defect and its repair technique.
Trushar Gajjar - One of the best experts on this subject based on the ideXlab platform.
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Septum primum malposition defect a rare congenital anomaly
Turkish Journal of Thoracic and Cardiovascular Surgery, 2013Co-Authors: Trushar Gajjar, Neelam DesaiAbstract:Displacement of the Septum primum-leftward in atrial situs solitus or rightward in atrial situs inversus is termed as Septum primum malposition defect. It appears to be responsible for the anomalous pulmonary venous drainage. This abnormality occurs predominantly in patients with visceral heterotaxy, usually with polysplenia, or rarely with asplenia or a normally formed spleen. Poor development and absence of Septum Secundum are considered to be responsible for the malposition of Septum primum. Transthoracic echocardiographic recognition of the displacement of Septum primum facilitates surgical management. In this article, we present an 18-year-old male case of an echocardiographic diagnosis of Septum primum malposition defect and its repair technique.
James E. Lock - One of the best experts on this subject based on the ideXlab platform.
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contemporary management of patent foramen ovale
Circulation, 2003Co-Authors: Bernhard Meier, James E. LockAbstract:In 1877, Cohnheim performed a necropsy on a young woman who had died from a stroke. He hypothesized that a clot passing through the patent foramen ovale must have caused her demise.1 Thus, the first description in medical literature on paradoxical embolism appeared. The foramen ovale is a pivotal feature during intrauterine life. As depicted in Figure 1, the interatrial Septum primum on the left side and the interatrial Septum Secundum on the right side maintain a central hole after having grown from the periphery to the center. This hole is positioned caudally in the Septum Secundum and cranially in the Septum primum, forming a slit valve that opens with pressure from the right. The blood from the umbilical vein entering through the inferior vena cava from the bottom of the right atrium keeps this door open until after birth. From then on, the left atrial pressure, slightly higher than the right atrial pressure, keeps the valve shut. In most individuals, the caudal portion of the Septum primum on the left side and the cranial portion of the Septum Secundum on the right side fuse permanently, closing the foramen. In a minority of the population, however, the fusion does not take place and the foramen remains able to be opened (patent). Figure 1. Center, Frontal aspect of the heart of an individual with a patent foramen ovale. The caudal portion of the interatrial Septum is primarily formed by the Septum primum (white) on the left side. At the base, it is reinforced by a remnant of the Septum Secundum (black) on the right side. The caudal portion of the Septum primum (*) is thin and occasionally shows aneurysmatic hypermobility (atrial septal aneurysm). The cranial part of the interatrial Septum is primarily formed by the Septum Secundum on the …
Subramaniam C Krishnan - One of the best experts on this subject based on the ideXlab platform.
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closure of foramen ovale triggered by injury to tunnel surfaces of Septum primum and Secundum
Journal of Interventional Cardiac Electrophysiology, 2019Co-Authors: Luigi Di Biase, David J Burkhardt, Prasant Mohanty, Shane Bailey, Rodney Horton, Javier Sanchez, Andrea Natale, Sanghamitra Mohanty, Joseph G Gallinghouse, Subramaniam C KrishnanAbstract:We investigated the feasibility to proactively stimulate subsequent closure of a patent foramen ovale (PFO) by injuring (mechanical trauma or radiofrequency [RF] energy) the opposing surfaces of the Septum primum (SP) and Septum Secundum (SS). 1. Mechanical Injury: The interatrial Septum of patients who underwent multiple left atrial (LA) ablations over 6 years, where a PFO was used for LA access, were examined. Patients whose PFO was absent during a later procedure were identified. Eleven patients with LA accessed via a PFO also underwent subsequent LA procedures. 2. Ablation: Ten patients undergoing ablation for drug-resistant atrial fibrillation (AF), who also had a PFO, were studied. RF delivery was extended along the upper SP. Transthoracic echocardiogram (TTE) bubble study was repeated after 3 months. 1. Mechanical Injury: Seven were male with a mean age of 58.3 ± 9.99. LA size was 42.73 ± 3.52 mm. The mean left ventricular ejection fraction (EF) was 62 ± 7.4%. During the repeat procedure, in 4 patients, the PFO could not be visualized and the fossa ovalis (FO) was punctured. The fourth patient had three procedures. During the second procedure the PFO was accessed, but with difficulty. During the third procedure, it was no longer present. All four patients had subsequent TTE showing no PFO. 2. Ablation: Seven were male with a mean age of 61.1 ± 9.8 years. The mean EF and LA diameters were 55 ± 5% and 4.4 ± 0.8 cm respectively. The mean RF time was 5.4 ± 2.2 min. At 3 months, 9 patients out of 10 showed no interatrial communication. Injury of tunnel surfaces of the SP and SS by mechanical trauma or ablation can fuse the foramen ovale.
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septal pouch in the left atrium a new anatomical entity with potential for embolic complications
Jacc-cardiovascular Interventions, 2010Co-Authors: Subramaniam C Krishnan, Miguel SalazarAbstract:Objectives The purpose of this study was to develop a better understanding of the pathophysiology of the condition, we studied the patterns by which the Septum primum (SP) and Septum Secundum (SS) fuse. Background A patent foramen ovale (PFO) is a communication across the interatrial Septum between a nonadherent SP and SS and is considered to be a risk factor for serious clinical syndromes. Methods We examined the interatrial Septum in 94 randomly selected autopsied hearts, with a focus on the SP and SS and the patterns by which the 2 structures fuse. Results Of the 94 specimens that were suitable for analysis, 26 (27.66%) had a PFO. Of the remaining 68 hearts, complete fusion of the SP and SS along the entire zone of overlap was seen in 27 (28.7%) hearts. In the remaining 41 hearts (60.29%), a PFO was absent, but incomplete fusion of the SP and SS was seen. Of 41 hearts, 37 (90%) had a septal pouch that opened into the left atrial (LA) cavity. Four hearts (10%) had a pouch accessible from the right atrium. Hearts with left-sided pouches tended to be younger (50 ± 18 years of age) than hearts where there was complete fusion (age 63 ± 23 years) (p = 0.06). Conclusions Our data suggest that when a foramen ovale closes spontaneously, the SP and SS fuse initially at the caudal limit of the zone of overlap of the 2 structures. This incomplete fusion results in a pouch that, in the majority of instances, communicates with the LA cavity.
Jonathan M Tobis - One of the best experts on this subject based on the ideXlab platform.
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the association of patent foramen ovale morphology and stroke size in patients with paradoxical embolism
Circulation-arrhythmia and Electrophysiology, 2010Co-Authors: Andre Akhondi, Rubine Gevorgyan, Chihong Tseng, Leo Slavin, Catherine Dao, David S Liebeskind, Jonathan M TobisAbstract:Background-Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke through paradoxical embolization to the cerebral circulation. This study evaluated the relationship between the morphological and functional size of the PFO by echocardiography compared with cerebral infarct volume identified on MRI. Methods and Results—Patients who were referred to interventional cardiology with the diagnosis of cryptogenic stroke were included and had either a transesophageal echocardiogram or an intracardiac echo and a brain MRI at the time of stroke. Transesophageal echocardiogram or intracardiac echo was used to obtain PFO measurements. MRI of the brain with 3 sequences (T2, diffusion-weighted imaging, and fluid-attenuated inversion recovery) was used to diagnose acute stroke and measure the infarct volume. In the 72 patients studied, the median measured stroke volume was 4.3 cm 3 on diffusion-weighted imaging, 4.1 cm 3 on T2, and 3.5 cm 3 on fluid-attenuated inversion recovery. There was no significant correlation between the PFO height, length, Septum Secundum thickness, or echo bubble grade and the infarct volume measured from the 3 MRI sequences. There was a significant correlation between septal excursion distance and infarct volume (r=0.35; P=0.005), but the 12 patients with atrial septal aneurysm did not have the largest strokes. Conclusions-This analysis revealed that septal excursion distance correlates with stroke size by MRI. However, smaller PFO size without the presence of atrial septal aneurysm may still be associated with significant strokes. There was no significant association between PFO height, length by echo, or shunt grade by transcranial Doppler study and brain infarct volume. Therefore, PFO size or morphology should not be the only criteria to decide whether a PFO should be closed.
