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At least 739 records · Page 41Linked to original sources
PubMed2004

Harvest of the radial artery for coronary artery surgery preserves maximal blood flow of the forearm.

BACKGROUND: Use of the radial artery as a conduit for coronary artery surgery has increased dramatically. It has been assumed that blood flow to the forearm will not be compromised by its removal. METHODS: Sixteen patients who had the left radial artery harvested for coronary surgery at least 3 months earlier were studied. The right radial artery was not harvested. The radial, ulnar, and brachial artery diameters and flows were measured using pulsed wave Doppler with a 15-MHz linear array transducer. Measurements were performed at rest, with the right radial artery compressed, and after ischemia with forearm exercise. RESULTS: At rest, the (mean +/- SE) diameter of the left ulnar artery was consistently greater than the right (2.4 +/- 0.09 versus 2.1 +/- 0.09 mm, p = 0.001) as was flow (74 +/- 9.9 versus 48 +/- 8.5 mL/min, p = 0.005). There was no difference between diameters or flows in the brachial arteries. After compression of the radial artery, flow increased in the right ulnar artery from 39 +/- 8.0 to 72 +/- 17.6 mL/min (p = 0.019) without an increase in ulnar artery size and was not different from the left ulnar artery flow at rest (p = 0.440). After ischemic forearm exercise, flow increased in the two brachial arteries almost equally (left, 348 +/- 50; right, 371 +/- 63 mL/min). CONCLUSIONS: Blood flow to the forearm and hand is not compromised by harvest of the radial artery.

Aged↗
PubMed2004

Ulnar recurrent adipofascial flap for reconstruction of massive defects around the elbow and forearm.

An ulnar recurrent adipofascial flap was raised and turned over to reconstruct massive defects around the elbow and forearm after wide resection of malignant tumours. Compared to the fasciocutaneous flap, the ulnar recurrent adipofascial flap has the following advantages: (1) a larger flap can be harvested without the problem of primary closure of the donor site, (2) the contour and scar of the donor site is reasonably acceptable since no tension is presented, (3) the flap can be turned over to cover a wider area, and (4) debulking of the flap can be performed during the operation if needed. The rotation arc of the ulnar recurrent adipofascial flap reaches a wide region, including the distal one-half of the upper arm, the elbow, and the proximal two-thirds of the forearm. Sensory deficit in the forearm was avoided in our patients because meticulous separation and preservation of the medial cutaneous nerve of the forearm was achieved without jeopardising the blood supply to the flap. The ulnar recurrent adipofascial flap is an easy and reliable option for one-stage reconstruction of massive defects around the elbow.

Elbow↗
PubMed2006

Changes in corticomotor excitability of forearm muscles in relation to static shoulder positions.

We examined whether the recruitment properties of the corticospinal pathway to forearm muscles are influenced by variations of the shoulder joint angle. Flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles motor evoked potentials (MEPs) in response to transcranial magnetic stimulation were examined during different static positions of shoulder joint in the horizontal plane: from 30 degrees abduction to 30 degrees adduction. We found that at 30 degrees shoulder adduction, maximum slope and plateau phase of the ECR and FCR input-output relationship (i.e., relation between MEP size and stimulus intensity) were significantly higher and lower than at 30 degrees abduction of the shoulder joint, respectively. Intracortical inhibition (ICI) and intracortical facilitation (ICF) of the FCR were assessed using a paired-magnetic pulse paradigm. A significant decrease in ICF was observed after changing shoulder position from 30 degrees abduction to 30 degrees adduction. On the contrary, no variation in the amount of ICI occurred in relation to the same changes in shoulder position. FCR H-reflex to electrical stimulation of median nerve at elbow did not differ significantly between the two shoulder positions. We conclude that shoulder position influences the recruitment efficiency (gain) of the corticospinal volleys to motoneurones of forearm muscles. It is proposed that activity of peripheral receptors signaling static shoulder position influences corticomotor excitability of forearm muscles mainly at cortical level, although C3-C4 propriospinal system could be also involved. It is proposed that the above changes in corticomotoneuronal excitability to forearm muscles as function of shoulder joint position are part of a global proximal-distal synergy operating throughout reaching movements.

Adult↗
PubMed2004

Functional connectivity between forearm and digits representations in human somatosensory area 3b.

OBJECTIVE: We compared the effects of tactile interference to the forearm on magnetic responses evoked by electric stimulation of the little finger (D5) and the thumb (D1). METHODS: Electric stimulation was delivered to D5 or D1 individually. In each stimulus session, magnetic recordings were conducted with or without concurrent tactile interference to the radial side of the anterior forearm. RESULTS: With forearm interference, the amplitude of the primary response (N20m) following D5 stimulation was reduced to 90.7% of the control value without interference, while that following D1 stimulation was not affected (100.7%). CONCLUSIONS: In human somatosensory area 3b, the representation of the forearm is immediately adjacent to that of the D5, and distant from that of the D1. Thus, the result suggests that the tactile interference effect on N20m depends on the cortical distance between electrically and mechanically activated 3b areas. SIGNIFICANCE: Intrinsic synaptic connections between the 3b hand representation and its surroundings have been hypothesized as a neural basis for plastic changes of the human brain, such as a phantom hand phenomenon. The present finding implies that these connections may play some physiological roles even in normal adult humans.

Adult↗
PubMed2005

Does radial artery harvesting for coronary revascularization cause neurological injury in the forearm and hand?

OBJECTIVE: Radial artery (RA) is now used widely as a conduit of choice in coronary artery bypass grafting. Although RA removal is considered safe in the presence of adequate collateral arterial supply, there is still a considerable suspicion on the functional status of the forearm and hand. However, a neurological dysfunction may occur owing to either surgical trauma or ischemic neuropathy. This study was aimed to investigate the functional outcome of the donor forearm nerves of the patients who underwent coronary artery bypass grafting surgery with RA conduits. METHODS: A consecutive series of 50 patients who underwent coronary artery bypass graft surgery with one or two RA grafts were investigated in the study. Motor and sensory functions of donor forearm nerves were measured by ENMG studies, pre- and postoperatively at the third week and sixth month of the operation. The conduction velocities, distal latencies and amplitudes of action potentials for motor and sensorial conductions of radial, ulnar and median nerves were measured in each ENMG examination. Neurologic status of the donor forearm and hand was assessed by the same neurologist who performed a detailed neurologic physical examination and ENMG studies. Results were statistically compared using one-way ANOVA test. RESULTS: The incidence of any neurologic symptoms was 32% in early postoperative period. All reported neurologic complaints were associated with sensory conduction deceleration in ENMG investigations of related nerves. In postoperative assessment, median nerve sensory-motor, and ulnar nerve motor conduction records were slightly lower than the preoperative values, but no statistical difference was observed. Pre- and postoperative radial nerve motor and sensory conduction records were statistically similar (P>0.05). CONCLUSIONS: We advocate that removal of RA does not lead to any major neurologic hand complications in the presence of adequate collateral arterial blood supply. ENMG studies confirmed minimal conduction alterations with no statistical significance, even if neurologic symptoms were stated.

Action Potentials↗
PubMed2006

Function of the sensate free forearm flap after partial glossectomy.

AIMS: To compare functional recovery of sensitive free forearm flaps with non-sensitive free forearm flaps, following reconstruction for partial glossectomy. MATERIAL: Sixteen patients underwent partial glossectomy for oncological reasons, of whom: nine patients underwent repair with non-sensitive free forearm flaps (group A) and seven with sensitive free flaps (group B). METHODS: All patients underwent the following tests: (1) tactile sensitivity evaluation, localization of stimulus, sharp/blunt definition, discrimination between two points (static and dynamic), thermal sensitivity to heat/cold; (2) speech evaluation by means of the modified Fanzago test; (3) subjective evaluation concerning the degree of satisfaction of the following functions: swallowing, feeding and talking. RESULTS: The sensitivity and logopaedic evaluation tests and the subjective evaluation charts highlight an overall better functional recovery of the sensitive repair than the non-sensitive ones. CONCLUSION: In patients who have undergone partial glossectomy repair with free forearm neurofasciocutaneous flaps allow good recovery of oral functions and, therefore, a good quality of life.

Forearm↗
PubMed2004

Prediction of handgrip forces using surface EMG of forearm muscles.

Evaluation of handgrip forces constitutes an essential component of ergonomic evaluation (e.g. of hand tools), but is difficult to perform at the workplace. The present study describes a series of experiments on 8 healthy male subjects to determine the validity of linear regression models using the surface electromyography (EMG) of up to 6 forearm muscles to predict handgrip forces. For isometric gripping tasks, normalized EMG to grip force calibrations using a series of dynamic force bursts up to 300 N resulted in a valid prediction of grip forces based on the EMG of 6 forearm muscles. Absolute differences between observed and predicted grip force were small (between 27 and 41 N) which shows that the proposed method might be used for the ergonomic evaluation of the use of hand tools. The EMG - handgrip force model appeared to be minimally affected by grip width, i.e. a model for 67 mm grip width was able to validly predict grip forces for 59 and 75 mm grip widths. Furthermore, it was shown that of the 6 forearm muscles studied at least 3 have to be assessed to arrive at a sufficient level of validity, while it seems to be irrelevant which 3 of those 6 forearm muscles are assessed.

Adult↗
PubMed2005

Reconstruction of the interosseous ligament restores normal forearm compressive load transfer in cadavers.

PURPOSE: Longitudinal radioulnar dissociation may result when compressive load to the hand causes excessive proximal migration of the radius with interosseous ligament (IOL) disruption and radial head fracture. Although radial head salvage or arthroplasty and temporary distal radioulnar joint pinning constitute the current treatment for this injury IOL reconstruction has been proposed to restore normal forearm mechanics. To help provide a biomechanical basis for IOL reconstruction we measured load transfer and proximal migration of the radius with the IOL intact, cut, and reconstructed while leaving the radial head intact. METHODS: We dissected the central third of 12 normal cadaveric forearms to bone-IOL-bone. We applied 136 N of compressive load to the hand and measured proximal radial migration and 3-dimensional force vectors acting in the distal radius, distal ulna, IOL, proximal radius, and proximal ulna. Experiments were performed in neutral forearm rotation and neutral elbow varus-valgus. The protocol was repeated with the IOL intact, cut, and reconstructed with single and double flexor carpi radialis allografts. RESULTS: With the IOL intact 94% +/- 3 % of hand load was in the distal radius with 75% +/- 2% was transmitted to the proximal radius. With the IOL cut 92% +/- 2% of hand load was in the distal radius and this was unchanged at the proximal radius. With single flexor carpi radialis reconstruction 94% +/- 3% of hand load was in the distal radius and 80% +/- 2% was in the proximal radius; with double flexor carpi radialis reconstruction these numbers changed to 95% +/- 3% and 74% +/- 2%, respectively. Forces in the forearm were mainly in the longitudinal and transverse directions with negligible components in the dorsal-volar direction. Transverse force in the IOL was about half that of the longitudinal force in the intact and reconstructed states. CONCLUSIONS: When the IOL is cut and load is applied to the hand the unloading of the proximal radius and the transversely directed force that compresses normally across the proximal and distalradioulnar joints is lost. Reconstruction of the IOL can restore the normal load transfer characteristics. These data help provide a biomechanical basis for IOL reconstruction. Further research on the biomechanics of IOL reconstruction in the setting of radial head replacement along with clinical evaluation is needed.

Aged↗
PubMed2005

Anatomy of the lateral antebrachial cutaneous and superficial radial nerves in the forearm: a cadaveric and clinical study.

PURPOSE: To define the anatomy of the lateral antebrachial cutaneous nerve (LACN) and the superficial radial nerve (SRN) in relation to easily identifiable landmarks in the dorsoradial forearm to minimize the risk to both nerves during surgical approaches to the dorsal radius. METHODS: In this study 37 cadaveric forearms and 20 patients having distal radius external fixation were dissected to identify these nerves in relation to various anatomic landmarks. RESULTS: Based on these dissections the anatomy was divided into 2 zones that can be identified by easily visible and palpable landmarks. Zone 1 extends from the elbow to the cross-over of the abductor pollicis longus with the extensor carpi radialis brevis and longus. Zone 2 is distal to the cross-over. In zone 1 the 2 nerves can be differentiated through limited incisions based on their depth and anatomic location. Within this zone the SRN is deep to the brachioradialis until 1.8 cm proximal to zone 2 (9 cm proximal to the radial styloid), where it becomes superficial and pierces the fascia of the mobile wad and then remains deep to the subcutaneous fat. In contrast the LACN pierces the fascia between the brachialis and biceps muscles at the level of the elbow. In all specimens the LACN ran parallel to the cephalic vein within the subcutaneous fat. In 31 specimens it ran volar to the vein and in 5 specimens the nerve crossed under the cephalic vein at the elbow and ran dorsal to the vein in the forearm. One specimen had 2 branches with 1 on either side of the vein. Differentiation of these nerves was found to be possible through limited incisions in zone 1 during placement of external fixation pins for distal radius fractures. The LACN always was located in the superficial fat running with the cephalic vein, whereas the SRN was deeper to this nerve either covered by the brachioradialis or closely adherent to it within the investing fascia of the mobile wad. In zone 2 the nerves arborized and ran in the same tissue plane, making differentiation through limited incisions difficult. CONCLUSIONS: Dividing forearm anatomy into zones aids in understanding the complex 3-dimensional anatomy. Recognition of the consistent location of both the LACN and SRN facilitates surgical exposure. This allows localization through limited incisions during nerve repair and hardware placement, thereby enhancing uncomplicated and favorable outcomes.

Cadaver↗
PubMedDate not supplied

Ulnar nonunion after osteoclasis for rotational deformities of the forearm.

PURPOSE: Osteoclasis, a minimally invasive technique to rotate the radius and ulna, is used commonly to correct forearm rotational deformities in children. The purpose of this investigation was to evaluate objectively osteotomy healing in patients treated with osteoclasis, with specific attention given to the risk for nonunion. METHODS: We identified 69 extremities in 65 children treated with osteoclasis and performed retrospective chart and radiographic reviews to evaluate the time to union of the radius and ulna and factors influencing healing. RESULTS: The average rotational correction was 90 degrees. Twenty-one ulnas had either delayed union or nonunion. Forty-eight of the forearms healed in less than 3 months. Factors correlated with a significantly decreased union rate included increased patient age, percutaneous technique, osteoclasis site in the proximal ulna, and primary diagnoses other than congenital radioulnar synostosis. Preoperative forearm position, magnitude of position correction, and treatment of the periosteum were not associated with changes in union rates. CONCLUSIONS: Forearm osteoclasis has a delayed union rate of 16%. Timely union of the ulna appears to be influenced by both patient-centered factors and surgical technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗
PubMed2006

Comparison of forearm and conventional Bier's blocks for manipulation and reduction of distal radius fractures.

Forearm-based Bier's block has been advocated as a useful anaesthesic technique in hand surgery. However, there is limited data comparing forearm blocks with the conventional Bier's block. We conducted a randomised controlled trial (n=30) comparing the two techniques of anaesthesia for manipulation and reduction of closed distal radius fractures in an emergency room setting. Pain scores measured using the Visual Analogue Scale during the procedure were used as the primary outcome assessment. There was no significant difference in pain scores between the forearm and conventional Bier's block (mean VAS 18.4 SD 22.10 versus 33.7 SD 29.6). No major complications were observed in either group. The forearm-based Bier block is an effective alternative to the conventional block.

Adult↗
PubMed2007

Grip strength and forearm circumference in a healthy population.

Two hundred and fifty subjects were recruited. Age, sex, hand preference and anthropometric measurements were recorded for each subject. Grip strength was measured using a Jamar hydraulic dynamometer. Multiple regression analyses were performed. One hundred and seventy two subjects were men and 78 were women. Twenty-six subjects were left hand dominant. Hand grip strength was greatest for the 35 to 44 year old group for both sexes. Grip strength was consistently greater for men than women. Contralateral grip strength predicted maximum grip strength for both sexes. Forearm circumference predicted maximum hand grip strength for men. Although there was a large range of forearm circumferences in the population, there was little difference between sides for each subject (100% less than 2 cm). The demonstrated relationships between: (i) contralateral grip strengths and (ii) grip strength and forearm circumference lead us to suggest that for certain pathologies, a difference in forearm circumference greater than 2 cm may lend credence to a measurement of diminished grip strength.

Adolescent↗
PubMed2006

Comparisons of the bone mineral density in dominant and nondominant forearm following clean-cut tendon injuries, repair, and passive mobilization.

Tendon lacerations at the distal forearm are a common clinical problem. The aim of this study is to investigate whether there is any significant bone loss of the dominant and nondominant forearm due to early passive mobilization in surgically treated patients for acute tendon-artery-nerve clean-cut injuries at the wrist level. Fifty-eight dominant right-handed patients who underwent such an operation were enrolled in this study. Patients were divided into two groups. Patients in group 1 (n=26) were operated on for dominant forearm clean-cut injuries; patients in group 2 (n=29) were operated on for nondominant forearm clean-cut injuries. Bone mineral density (BMD) measurements of ulna and radius were obtained at weeks 1 and 6, and at months 3 and 12 after the operation. Bone mineral density (BMD) of the radius and ulna did not change significantly with time in group 1 (p>0.05). In group 2, BMD measurements were reduced significantly more with time in the mid-diaphysis and distal regions of the ulna and in the ultra-distal region of the radius. Most BMD decreases were observed at month 3 of the study. Eventually, these bone losses were found to be recovered at month 12.

Adolescent↗
PubMed2006

Long-term results of free radial forearm flap used for oral reconstruction: functional and histological evaluation.

PURPOSE: The aim of this study was to evaluate the radial forearm flap with regard to recovery of sensory function, general performance status, cutaneous blood flow and histological observations. PATIENTS AND METHODS: Thirty patients (23 male and 7 female) with oral carcinoma underwent immediate reconstruction with radial forearm flap after ablative surgery and returned for evaluation. Interviews were conducted to assess the degree of articulation and mastication. RESULTS: Sensory function tests suggested the restoration of cutaneous sensibility of the forearm flap. Histological findings indicated mucosa-like changes of flaps about 10 months after reconstruction. The clarity of conversation recovered favorably in most patients. However, the degree of recovery was generally related to the time after surgery. CONCLUSION: The radial forearm flap is a unique flap with specific characters that allowed for best available functional reconstruction of the oral cavity in terms of restoration of sensation, performance, and histological changes to adapt to the new oral environment.

Adult↗
PubMed2005

Sonomyography: monitoring morphological changes of forearm muscles in actions with the feasibility for the control of powered prosthesis.

Electromyography (EMG) has been widely used for the assessment of musculoskeletal functions and the control of electrical prostheses, which make use of the EMG signal generated by the contraction of the residual muscles. In spite of the successful applications of EMG in different fields, it has some inherent limitations, such as the difficulty to differentiate the actions of neighboring muscles and to collect signals from deep muscles using the surface EMG. The majority of current EMG controlled prostheses can only provide sequential on-off controls using signals from two groups of muscles, so the users are required to put many conscious efforts in monitoring the speed and range of motion of the terminal devices being controlled. Recently, many alternative signals based on the detection of dimensional changes of muscles or tendons during actions have been reported. The objective of this study was to investigate the potential of the dimensional change of muscles detected using sonography for musculoskeletal assessment and control. A portable B-mode ultrasound scanner was used to collect the dynamic ultrasound images of the forearm muscles of six normally limbed young adults and three amputee subjects. A motion analysis system was used to collect the movement of the wrist angle during the experiments for the normal subjects. It was demonstrated that the morphological changes of forearm muscles during actions can be successfully detected by ultrasound and linearly correlated (R(2)=0.876+/-0.042, mean+/-S.D.) with the wrist angle. We named these sonographically detected signals about the architectural change of the muscle as sonomyography (SMG). The mean ratio between the wrist angle and the percentage deformation of the forearm muscle was 7.2+/-3.7 degrees /% for the normal subjects. The intraclass correlation coefficient (ICC) of this ratio among the three repeated tests was 0.868. The SMG signals from the residual forearms were also successfully detected when the three amputee subjects contracted their residual muscles. The results demonstrated that SMG had potentials for the musculoskeletal control and assessment.

Amputees↗
PubMed2005

Effects of intradermal foot and forearm capsaicin injections in normal and vulvodynia-afflicted women.

Cutaneous response to capsaicin has been used to assess central sensitization in pain research. This study compared the response to intradermal capsaicin in the forearm and foot of vulvar vestibulitis (vestibulodynia)-afflicted cases and controls. We hypothesized that cases will experience greater spontaneous pain, larger cutaneous areas of punctate hyperalgesia and dynamic allodynia, and greater vascular flow than controls. We also hypothesized enhanced post-injection pain in the foot compared to the forearm based on dermatome proximity of the foot and vulva. Methods. Ten vulvar vestibulitis syndrome (VVS) cases and 10 age and ethnically matched controls underwent two randomized, cross-over trials with intra-dermal injections of capsaicin or a saline placebo in the forearm and foot. Outcome measures included spontaneous pain level, surface area of punctate hyperalgesia, surface area of dynamic allodynia, cutaneous blood flow, regional skin temperature and vital signs. Results. VVS cases experienced greater spontaneous pain, punctate hyperalgesia and dynamic allodynia than pain-free controls. Within the VVS group, post-capsaicin spontaneous pain, punctate hyperalgesia and dynamic allodynia were similar in the forearm and foot. Post-capsaicin blood flow did not differ between cases and controls by anatomic site. Measures of depression and anxiety correlated with spontaneous pain intensity but did not correlate with measures of hyperalgesia, allodynia, or blood flow. VVS cases had higher resting pulse rates and lower resting systolic blood pressures than in controls. Conclusion. VVS patients show enhancement of post-capsaicin pain response extending far beyond the anatomic location of the primary complaint.

Adult↗
PubMedDate not supplied

Dependence of human forearm skin postocclusive reactive hyperemia on occlusion time.

INTRODUCTION: Human postocclusive forearm skin reactive hyperemia is not only a potential means of identifying early signs of cardiovascular diseases, it can also be used in the assessment of local microvascular response to topically applied compounds on skin. The method is not fully characterized. In this study, we investigated the influence of occlusion time on postocclusive forearm skin reactive hyperemia using laser Doppler fluximetry (LDF). METHODS: Twenty healthy male volunteers were studied on three separate days (at least 24 h apart) via a randomized design. Volunteers were studied in a supine position while fasted. Laser Doppler probes were placed on the volar surface of the antebrachium. In preliminary studies, 3 min of upper arm blood flow occlusion at suprasystolic pressure was found to be the upper limit of tolerability. Subsequently, volunteers were randomized to receive 1, 2, or 3 min occlusion on 3 different days. Skin blood flux was measured before, during, and after occlusion using LDF. The primary outcome calculated was maximal change in skin blood flux before and after occlusion, expressed in arbitrary units (AU). RESULTS: Skin blood flux changes (mean+/-S.E.M.) after 1, 2, and 3 min occlusion period were 15.39+/-1.27 AU, 24.84+/-1.62 AU, and 32.14+/-1.73 AU, respectively. Using repeated-measures analysis of variance (ANOVA), significant difference (P<.05) in skin blood flux changes were revealed between these three occlusion durations, where 3 min occlusion produced significantly greater in skin blood flux occlusion change compared to 1 and 2 min occlusion. DISCUSSION: Three minutes of occlusion produces the greater postocclusive reactive hyperemia. It is recommended that studies using postocclusive forearm skin reactive hyperemia should occlude the forearm for at least 3 min.

Adult↗
PubMed1996

Ethnic differences in forearm vasodilator capacity.

Previous studies have demonstrated significant ethnic differences in left ventricular structure in both normotensive and hypertensive subjects. To determine if these differences in ventricular geometry are associated with differences in vascular structure, we measured the minimum forearm vascular resistance in 30 healthy young African-American adults and in 30 whites matched for age, gender, and blood pressure. Average daytime blood pressure was determined by ambulatory monitoring during a typical work day. Minimum forearm vascular resistance was measured by plethysmography after 10 minutes of forearm ischemia. Indexed left ventricular mass and relative wall thickness were measured by 2-dimensional-directed M-mode echocardiography. The mean (+/-SD) ambulatory pressure was 126 +/- 11/79 +/- 8 mm Hg in African-Americans and 126 +/- 11/79 +/- 7 mm Hg in whites. The 2 groups were similar in body mass index and in family history of hypertension. African-Americans had a higher minimum forearm vascular resistance than did whites (2.39 +/- 0.75 vs 2.03 +/- 0.55 mm Hg, p <0.05). There was a trend toward a greater left ventricular relative wall thickness in African-Americans (0.38 +/- 0.07 vs 0.35 +/- 0.06, p=0.09). These results suggest that early vascular remodeling is present in African-Americans who do not have established hypertension, and that this ethnic difference in vascular structure is associated with a difference in ventricular geometry.

Adult↗