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Biomedical subjects

S Victor

Publications and source records attributed to S Victor.

At least 37 records · Page 2Linked to original sources
PubMed1995

Variations in the papillary muscles of the normal mitral valve and their surgical relevance.

A mid-mitral plane passing through the middle of the aortic and mural leaflets divides the chordopapillary support of the mitral valve into anterolateral and posteromedial halves. The papillary muscles of the mitral valve were studied in 100 human autopsy hearts collected at random. The anterolateral papillary support had 1 belly in 67 hearts, 2 in 27, 3 in 4, 4 in 1, and 5 in 1 heart. Likewise, the posteromedial papillary support had 1 muscle belly in 50 hearts, 2 in 36, 3 in 11, and 4 in 3. The single papillary muscles were conical, mammillated, flat topped, grooved, stepped, wavy, arched, sloped or saucerized. When there were two bellies they presented a two tiered, interlinked, parallel, arched, V, Y, or H configuration. Three papillary muscles formed a parallel, interlinked or arched arrangement; or two bellies were interlinked or formed a two tiered arrangement with the third belly separate. When four or five bellies existed, they were parallel or interlinked. In the anterolateral and posteromedial group, the papillary muscle bellies were mostly intraluminal in 14% and 11%, mostly intraluminal with the tip anchored in 19% and 28%, equally sessile and intraluminal in 54.5% and 41.5%, mostly sessile in 12.5% and 19.5%, respectively. In the anterolateral group 19% of papillary muscle bellies arose from the upper third of the ventricle, 79.5% from middle third, and 1.5% from lower third. The corresponding figures for posteromedial group are 6%, 92.5%, and 1.5%, respectively. Four to 22 chordae originated from the anterolateral papillary group, ending in 14 to 72 chordal insertions into the corresponding half of the valve. Likewise, 2 to 18 chordae arose from the posteromedial papillary group ended in 12 to 80 leaflet insertions. The chordae in each group are best considered in toto as a fan. The configuration of the fan is unique in each heart. Imaging techniques need to be refined to outline these variations more precisely. The relevance of chordopapillary variations in rheumatic heart disease, reparative procedures, papillary muscle dysfunction, mitral valve prolapse, mitral valve replacement, and use of mitral valve homograft for mitral/tricuspid replacement is discussed.

Cardiac Surgical Procedures↗
PubMed1995

Deringing procedure for congenital pulmonary vein stenosis.

We operated on a 14-year-old boy who had an echocardiographic diagnosis of ventricular septal defect. At surgery we found, in addition, an anomalous and obstructive intraventricular muscle bundle. Detection of a continuous thrill over the right pulmonary veins, prior to cardiopulmonary bypass, led to exploration of the left atrium. The ostia of the right superior and inferior pulmonary veins were impeded by circumferential membranous rings of endocardium with central stenotic openings. Excision of these annular rings relieved the obstruction. The left lung was drained by a long intrapericardial common venous channel that entered the left atrium through a stenotic ostium; excision of an annular ridge of endocardium restored normal flow. The patient remains asymptomatic after 23 months. The case is reported for the new deringing technique and the rarity of successful correction of congenital pulmonary vein stenosis.

Adolescent↗
PubMed1995

Sinoatrial malfusion presenting with caudal position of right atrial appendage.

A 5-year-old boy underwent surgery at our institution for closure of an ostium secundum atrial septal defect. Median sternotomy revealed that the right atrial appendage lay at the acute margin of the heart. Atriotomy revealed that the crista terminalis was also displaced clockwise, extending from the left of the superior vena caval orifice anteriorly along the interatrial septum, to the left border of the inferior vena cava; the musculi pectinati radiated forward and to the right. This highly unusual anomaly is likely due to clockwise rotation of the atrial portion in relation to the normally positioned sinus venarum portion of the atrium, which resulted in sinoatrial malfusion.

Child, Preschool↗
PubMed1995

Bicuspid evolution of the arterial and venous atrioventricular valves.

Atrioventricular valves were studied in pisces (shark), amphibians (frog), reptiles (turtle, snake and crocodile) and aves (duck, chicken and quail). Dog shark, Tiger shark and Hammerhead shark have a contractile common atrioventricular orifice with anterior and posterior bridging leaflets. Angel shark resembles the frog in having a contractile oval common atrioventricular orifice guarded by two lateral (right and left) and two central bridging (anterior and posterior) leaflets. In turtles and snakes the interatrial septation is complete. The common oval atrioventricular orifice is divided into two D-shaped orifices by the lower edge of the interatrial septum. Each orifice is guarded by a flap valve hanging down from the interatrial septum with rudimentary chordae tendinae, functionally corresponding to the septal leaflet of the human venous atrioventricular valve (VAVV) and the aortic leaflet of the human arterial atrioventricular valve (AAVV). There is no curved mural leaflet on either side related to curved contractile segments of the annuli. In crocodiles, the interventricular septation is complete. The VAVV is bicuspid with a prominent septal and diminutive mural component with no chordopapillary support. The AAVV is bicuspid with direct attachment of the fused commissural lines between the two leaflets to the ventricular musculature. In the aves, with four chambered hearts the VAVV has a curved mussular mural leaflet with a primitive muscular chorda and no septal leaflet. The AAVV resembles closely the human mitral valve. This study lends support to the view that VAVV and AAVV in man are similar in design and function with a D-shaped annulus and a skirt of leaflet tissue divisible into two functional units. The relatively straight part of the annuli suspend the straight leaflets; septal leafleft of the VAVV and aortic leaflet of the AAV. The curved annular components suspend the curved mural leaflets in both valves. Since this segment is contractile, the related mural leaflets of both valves need to have slits which split them into varying number of scallops to enable them to adapt themselves to the reduced systolic orifice and open widely during diastole. These scallops are best numbered as subsegments of the curved mural leaflet and not considered as separate leaflets. The curved leaflet of the VAVV needs to negotiate the acute border of the heart. Hence a major slit is usually present at this region which artificially divides it into an 'anterior' and 'posterior' portion resulting in assumption of a 'tricuspid' configuration.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1995

Transcaval repair of sinus venosus defect. Using a butterfly-shaped patch.

We describe an operative technique used in 30 patients from 1982 to 1995, in which sinus venosus atrial septal defect with anomalous pulmonary venous connection is repaired through longitudinal incision confined to the vena cava. A single oval patch is folded like the wings of a butterfly: the posterior wing is used to separate superior vena caval and pulmonary venous blood, and the anterior wing is used to enlarge the terminal cava. This approach avoids both sinus node dysfunction and superior vena caval or pulmonary venous obstruction. Operative findings suggest that the sinus venosus defect is a malformation involving abnormal confluence of sinus venosus, anomalous right superior pulmonary, and right common cardinal veins. Further, the sinus venosus contributes more to the formation of the right atrium, displacing the crista terminalis downward and forward and separating the atrial component of the right atrium from the terminal cava.

Adolescent↗
PubMed1994

The tricuspid valve is bicuspid.

A study of 100 normal human autopsy hearts confirms numerous variations in the configuration of the cusp tissue and chordal/papillary support of the tricuspid valve, making the interior of the right ventricle as unique to each individual as one's finger print. The tricuspid veil of tissue is split by clefts into varying number of scallops with confusing names. However, the tricuspid veil of cusp tissue lends itself into a neat subdivision functionally into two halves: a septal cusp usually with no clefts hanging down from the relatively immobile septal part of the tricuspid annulus, and a mural cusp hanging down from the annulus related to the atrioventricular groove. Since the mural part of the annulus changes its shape and size during the cardiac cycle, the related mural cusp needs to have clefts which vary in number and split it artificially into two to six segments. It appears logical to label this part of the cusp as 'mural cusp' which will include the classical 'anterior' and 'posterior' cusps and associated commissural scallops. The apparent endless variety in the papillary and chordal support also resolves into an orderly pattern if the tricuspid valve is divided on an embryologic basis by a line drawn through the maximum height of the 'anterior' and septal cusps. The superior half of the valve thus divided is derived from the anterior and posterior endocardial cushions with chordal support from the bulbar septum, sinus (inlet) and membranous part of interventricular septum (IVS). The inferior half is derived from the lateral endocardial cushions with chordal support from the trabecular part of IVS. Thus the 'tricuspid' valve can be bisected conveniently into two halves in two different ways either on a functional or an embryologic basis, bringing order out of apparent chaos inside the right ventricle.

Chordae Tendineae↗
PubMed1993

The Turcot syndrome (glioma polyposis) and its neurosurgical significance. Case report.

We report on a 12-year-old patient with Turcot Syndrome (Glioma polyposis). This patient's case deals with the association between a glioblastoma, anaplastic glioma (WHO Grade III) and colonic adenocarcinoma based on familial polyposis coli. Possible etiology and neurosurgical, clinically important characteristics of this rare syndrome, such as the young age of the patient and the relatively long survival time, will be discussed.

Adenocarcinoma↗
PubMed1993

[Unusual course of glioblastoma multiforme as calcinosis in CCT].

We report about a rare case of multifocal bihemispheric glioblastoma (WHO grade IV) with unusual course: At time of histological diagnosis via open biopsy and subtotal tumor resection right parieto-occipital the tumorous lesion presents itself for nine months unchanged as a little calcification right parietal, before developing in CCT multiocular bihemispheric hyperdens-hypodens areals with margin contrast enhancement and perifocal edema within one month. Tumor histogenesis of this special case is discussed contrasting the embryogenetic concept with the concept of tumor-grading. From clinical relevance is the fact that even a long time unchanged unifocal calcification in CCT could be the first sign of developing glioblastoma, and so short-term clinical and computer tomographic controls are necessary.

Biopsy↗