PubMed · 5234538
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T Pamukcoglu. 1967-11-01. Endocardial tuberculosis.. https://pubmed.ncbi.nlm.nih.gov/5234538/
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Knowledge of development is of crucial importance and can help clarify mechanisms of maldevelopment, but it must be properly validated. Concepts of development must be consistent with the anatomy seen in postnatal life. Such consistency is not always achieved. We have reviewed new and old accounts of cardiac embryology with regard to the definitive structure of the atrial septum. The key to understanding is to distinguish between folds of the atrial wall and true interatrial partitions. The flap valve of the oval foramen, and its inferior rim, are true septal structures, whereas the other rims, particularly the antero-superior rim, are infoldings enclosing extracardiac fat. During embryonic life, the systemic venous tributaries must achieve entrance only to the right side of the primary atrium. Development of the pulmonary venous component is a late event, with the canalizing vein using the dorsal mesocardium to gain access to the left side of the atrium. Once the systemic venous tributaries have achieved their rightward shift, the primary septum, together with the mesenchymal cap, grows between the systemic and pulmonary venous orifices. Closure of the primary foramen is achieved by fusion of the mesenchymal cap of the primary septum with the atrioventricular endocardial cushions and the vestibular spine (an additional mesenchymal structure carried on the right side of the pulmonary venous orifice). The superior margin of the newly formed secondary foramen is produced by an infolding of the atrial walls. Historically these mechanisms received appropriate recognition, but not all receive their proper due in current writings.
Although magnetic resonance tissue tagging is a useful tool for the non-invasive measurement of three-dimensional (3-D) heart wall motion, the clinical utility of current analysis techniques is limited by the prohibitively long time required for image analysis. A method was therefore developed for the reconstruction of 3-D heart wall motion directly from tagged magnetic resonance images, without prior identification of ventricular boundaries or tag stripe locations. The method utilized a finite-element model to describe the shape and motion of the heart. Initially, the model geometry was determined at the time of tag creation by fitting a small number of guide points which were placed interactively on the images. Model tags were then created within the model as material surfaces which defined the location of the magnetic tags. An objective function was derived to measure the degree of match between the model tags and the image stripes. The objective was minimized by allowing the model to deform directly under the influence of the images, utilizing an efficient method for calculating image-derived motion constraints. The model deformation could also be manipulated interactively by guide points. Experiments were performed using clinical images of a normal volunteer, as well as simulated images in which the true motion was specified. The root-mean-squared errors between the known and calculated displacement and strain for the simulated images were similar to those obtained using previous stripe-tracking and model-fitting methods. A significant improvement in analysis time was obtained for the normal volunteer and further improvements may allow the method to be applied in a 'real-time' clinical environment.
OBJECTIVES: We sought to determine the clinical and echocardiographic characteristics of papillary fibroelastoma (PFE). BACKGROUND: PFE is a rarely encountered cardiac tumor about which relatively little is known. METHODS: Institutional records were reviewed for the years 1980 to 1995 for patients with pathologic or echocardiographic diagnosis of PFE. Group 1 included 17 patients with the pathologic diagnosis of PFE who also underwent echocardiography. Echocardiographic features of PFE were established in group 1. Group 2 included 37 patients with only echocardiographic evidence of PFE. RESULTS: In group 1, 7 (41.2%) of 17 patients had symptoms related to PFE. Neurologic events occurred in 5 (29.4%) of 17 patients. All patients had the tumor surgically removed. During follow-up, no new embolic events occurred. Echocardiographic characteristics of PFE included a small tumor (12.1 +/- 6.5 x 9.0 +/- 4.3 mm), usually pedunculated (14 [94%] of 17 patients) and mobile, with a homogeneous speckled pattern and a characteristic stippling along the edges. PFEs were most common on valvular surfaces (12 [60%] of 20 PFEs) but were not uncommon on other endocardial surfaces (8 [40%] of 20 PFEs). The tumor did not cause valvular dysfunction. In group 2, 16 (43%) of 37 patients were asymptomatic. Five patients (13.5%) had a previous neurologic event. During follow-up (mean 31 months, range 1 to 77), nine neurologic events occurred. CONCLUSIONS: PFEs are associated with embolism, can be diagnosed with echocardiography, are often an incidental clinical finding and do not cause valvular dysfunction.