[Perforation of interventricular cardiac septum diagnosed during life].
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Cardiac lipomas are uncommon, usually asymptomatic benign primary tumors of the heart that may incidentally be discovered during computed tomography (CT) or magnetic resonance imaging (MRI). Although the finding of a low-attenuation mass with density similar to fat on CT is pathognomonic, the MRI appearances of fatty cardiac masses are variable depending on the sequences employed. The MRI findings of 4 patients with cardiac lipomas or lipomatous hypertrophy of the interatrial septum are presented. All patients had lesions with characteristic low-signal-intensity margins and high central signal intensity on "bright-blood" balanced gradient-echo cardiac MRI sequences with very low repetition and echo times. It is proposed that this appearance results from intravoxel phase cancellation effects occurring at the fat/tissue interface and is sufficiently characteristic to obviate the need for confirmatory CT.
An immunohistochemical study was undertaken to determine the distribution of calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers in the cardiac septum of the mudpuppy, Necturus maculosus. Numerous long, CGRP-immunoreactive nerve fibers course across the septum, run in the nerve trunks connecting clusters of postganglionic parasympathetic cells, form complexes over groups of ganglion cells and make pericellular networks around individual ganglion cells. The postganglionic parasympathetic neurons and small intensely fluorescent (SIF)-like cells did not exhibit CGRP immunoreactivity. Most of the CGRP-immunoreactive nerve fibers also are labeled for substance P. In freshly dissected preparations, the staining pattern for CGRP was not similar to that obtained using an antiserum against synaptic vesicle membrane, which appears to preferentially label cholinergic preganglionic terminals on all postganglionic parasympathetic cells in the mudpuppy preparation. Further, in explanted ganglia (maintained 10 days in culture) almost no reactivity was obtained with the antivesicle antiserum whereas numerous nerve fibers still exhibited CGRP-immunoreactivity. These observations demonstrate that the CGRP-immunoreactive nerve fibers are not parasympathetic preganglionic axons. Rather we suggest that the CGRP-immunoreactive nerve fibers are processes of primary sensory fibers.
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The arrangement of collagen and elastic fibers of the membranous part of the interventricular septum (PMS) was studied in hearts from adult humans. Connective bundles formed a network of fairly independent tendons arranged in two layers. The tendinous bundles consisted essentially of type I collagen fibers while type III fibers were visible as a thin network with transversely and longitudinally oriented meshes around the muscle bundles. Cranial and caudal to the PMS were narrow and irregular bands of collagen fibers that apparently represented zones of low resistance to the high blood pressures acting from the left to the right heart chambers. The predominance of fiber bundles arranged in an approximately transverse direction with regard to the arterial cone axis suggests a resistance to enlargement resulting from high aortic blood pressure. Elastic fibers were observed in the transitional zone between the cardiac muscle and the PMS. They were continuous with elaunin fibers and these with oxytalan fibers closely intermingled with the narrow network of type I collagen fibers of the PMS. The successive transformation of elastic fibers, which were very numerous in the muscle-tendon transition, into elaunin and these into oxytalan fibers toward the central portions of the PMS suggests a functional sequence characterized by a high elasticity and consequent mobility of the transition region itself and by a progressive increase of resistance in this portion.
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A new morphological-clinical classification was suggested for this type of heart malformations based on confrontation of authors' results with literature. The classification took into consideration appearance of the top of ventricular septum, form of atrioventricular valves, topography of the defect and its relation to the location of conducting system.