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Copyright of Health Bulletin / Zdravstveni Glasnik is the property of Faculty of Health Studies, University of Mostar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Patients requiring temporal or permanent catheter or arterio‐venous fistula (AVF) for haemodialysis may be in challenging situation, if they are cardiovascular implantable electronic devices (CIED) carriers. Materials and Methods: The authors analysed preoperative venogrphies of 3100 patients referred for transvenous lead extraction for a possible chance of safe haemodialysis catheter (HC) implantation or proper AVF function. Results: A chance of safe catheter implantation parallel to existing leads reaches 68.8% ipsilaterally to CIED. Contraindications for implantation have been found in less than 2% of cases contralaterally. Ipsilaterally proper AVF function chance has been found in 50.3% of the cases and almost 98% contralaterally. A bilateral chest electrodes location require the special attention. Abandoned lead, lead burden, bilateral leads, additional lead implantation or abandonment, and implant duration may have a significant influence on HC insertion or proper function of arteriovenous fistula. Conclusion: (1) Obstruction of prominent thoracic veins is a frequent finding in CIED carriers and may impede or disable implantation haemodialysis accesses. (2) Implantation of temporary or permanent HC may be questionable ipsilaterally to the CIED in 31.2% and contralaterally in 2.0% of patients. Proper function of AVF is uncertain in 49.7% ipsilaterally and 2.1% contralaterally to CIED. (3) Pacing history and leads dwell time influence chances of success haemodialysis access even on the free‐from CIED chest side. (4) Proper venous flow evaluation seems to be valuable in CIED carriers before an attempt of haemodialysis access formation, even contralaterally. [ABSTRACT FROM AUTHOR]

Introduction: The anconeus epitrochlearis (AE) muscle is an accessory muscle located between the medial cortex of the olecranon and the inferior surface of the medial epicondyle, posterior to the ulnar nerve. This muscle may compress the ulnar nerve causing a clinical neuropathy. We aimed to determine the gender and side characteristics of the AE muscle in patients who underwent elbow magnetic resonance imaging (MRI) and report its prevalence in a Turkish population. Materials and methods: A total of 209 patients (210 elbows) who underwent elbow MRI between January and December 2020 were retrospectively evaluated. Cases with the AE muscle were included in the study. The craniocaudal (CC) dimension was examined from the coronal section, and the transverse (TR) and anteroposterior (AP) dimensions from the axial sections. Statistical analyses were performed to determine the relationship between the presence of the AE muscle and age, gender, and side (right/left). Differences between sexes and sides in terms of muscle sizes were evaluated using statistical tests. Results: The AE muscle was detected in 17 patients (18 elbows) (8.1%). The mean age of the patients was 41.52 ± 14.63 years. There was no statistically significant difference between the male and female patients in terms of age. This accessory muscle was found in nine female (9.8%) and eight male (6.3%) patients in total. There was one (0.5%) patient with the bilateral AE muscle, who was female. The accessory muscle was located in the right elbow in 13 patients (10.71%), and left elbow in five (4.10%). It was more common in the right elbow in both genders. The muscle was larger in the male patients and the right elbow, but this was not statistically significant. Conclusion: The prevalence of the AE muscle was determined to be 8.1% in a Turkish population, and this muscle was more common among the women and in the right elbow. [ABSTRACT FROM AUTHOR]

Purpose: Internal thoracic veins are increasingly used as recipient's vessels in chest wall reconstructive surgery due to their predictable anatomy and to the possibility to make a double venous anastomosis, exploiting the retrograde flow within them. Over the years, retrograde flow had been explained by the absence of valves in internal thoracic veins, which have been found recently instead. Therefore, our aim is to analyze the retrograde flow and its relationship with valves in the internal thoracic veins. Methods: We evaluated 32 internal thoracic veins of 16 fresh-frozen specimens with undamaged thoracic cages by dynamic analysis focused on retrograde flow assessment through a partial external circulation system obtained cannulating the subclavian veins. Gross anatomical and morphological evaluations about the presence of valves and their pattern were then made. Results: Efficient, partial, and absent retrograde flow was, respectively, found in 17/30, 8/30 and ITVs and 5/30 internal thoracic veins. Following Arnez's classification, 20/32 Type I and 12/32 Type II internal thoracic veins were identified. Valves were observed in 10/16 specimens (62.50%) corresponding to 36.67% of examined veins (11/30). Three valves were found between the 2nd intercostal space and 12 valves in the 3rd intercostal space. 13/15 valves were bicuspid, 2/15 tricuspid. A significant correlation (p < 0.001) between the retrograde flow and the presence of valves in internal thoracic veins was observed. Conclusion: Our study suggests a possible influence of the presence and the number of valves in the efficient retrograde flow of the internal thoracic veins, suggesting that, especially for more complex cases, a preoperative or intraoperative evaluation of the chest wall drainage should be recommended. [ABSTRACT FROM AUTHOR]

Azygos system of veins is the main source of venous drainage from the thoracic wall. Knowledge of azygos vein anomalies could be of importance to cardiothoracic surgeons and radiologists. We report a rare variation of azygos vein as seen in an adult male cadaver aged 65 years approximately. The azygos vein was formed by the union of left ascending lumbar and subcostal veins. It coursed upwards on the left side of descending thoracic aorta and crossed the left subclavian artery and the left vagus to terminate into the left brachiocephalic vein. It received left superior intercostal vein and left fifth to eleventh posterior intercostal veins. The hemiazygos and accessory hemiazygos veins were situated on the right side of the vertebral column. They received the right posterior intercostal veins and terminated into the azygos vein at the level of eighth thoracic vertebra. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy of a conventional fluoroscopy‐guided epidural nerve block and an ultrasound (US)‐guided intercostal nerve block in patients with thoracic herpes zoster (HZ). Methods: This work was a comparative study of 38 patients with thoracic HZ pain and a chest wall herpetic eruption, aged 18 years or older, with pain intensity of 5 or greater on a numeric rating scale (NRS) for less than a 1‐month duration. Patients were consecutively enrolled and assigned to 2 groups in which the intervention was either the US‐guided intercostal nerve block or the fluoroscopy‐guided epidural nerve block approach with the addition of a 5‐mL mix of 2.5 mg of dexamethasone plus 0.5% lidocaine. The primary outcome measure was the NRS score reduction for the pain. Secondary outcomes included the duration of treatment, number of repeated injections until the final visit, and proportion of patients with pain relief after the first and final visits. Results: All patients within both intervention groups showed significant pain relief on the NRS at the final follow‐up point (P < .05). There was no significant difference in the mean value of NRS improvement based on the intervention type. There was also no statistically significant difference in the duration of treatment and the frequency of injection for pain relief. Conclusions: These findings showed that both the US‐guided intercostal nerve block and the fluoroscopy‐guided epidural nerve block were effective in patients with thoracic HZ. Compared data showed no significant differences in the pain reduction, duration of treatment, and frequency of injection. The US‐guided intercostal nerve block, which is more accessible than the fluoroscopy‐guided epidural nerve block, might be an alternative option for thoracic HZ. [ABSTRACT FROM AUTHOR]

Rodent thoracic veins are characterized by an extended myocardial coating. In the present study, the electrical activity in the cardiac tissue of the rat azygos vein (AZV) was investigated for the first time. The atrial-like action potentials (AP) and atrial-like conduction of the excitation were observed in the rat AZV under continuous electrical pacing. Termination of electrical pacing resulted in spontaneous positive shift of resting membrane potential (RMP) in AZV. Boradrenaline induced biphasic effects on RMP in all quiescent AZV preparations but only in 25% preparations—bursts of spontaneous AP, which were suppressed by both α- and β-adrenoreceptor antagonists. Phenylephrine induced additional depolarization of RMP in quiescent AZV preparations, while isoproterenol caused hyperpolarization. In conclusion, bioelectrical properties of the rat AZV resemble those of atrial myocardium under continuous electrical pacing; however, depolarized RMP and NA-induced spontaneous AP characterize AZV as a tissue prone to rare automaticity. [ABSTRACT FROM AUTHOR]

Persistent left superior vena cava (PLSVC) is the most common congenital abnormality of the thoracic systemic venous drainage; in fact, cardiology fellows in training are often quizzed on this when a dilated coronary sinus is noted on an echocardiogram. However, its association with an absent right superior vena cava (RSVC) and how to diagnose this combined condition is less commonly known. We present two cases of PLSVC with an absent RSVC, describe how to recognize and confirm this diagnosis, and discuss its clinical relevance. [ABSTRACT FROM AUTHOR]

Abstract: Asphyxiating thoracic dystrophy, also known as Jeune syndrome, is included in a group of syndromic skeletal ciliopathies associated with mutations in genes encoding proteins involved in the formation or function of motile cilia. Herein, we report a 6‐mo‐old male admitted to hospital with recurrent lung infections, thoracic dystrophy, and respiratory distress that was diagnosed as Jeune syndrome; DYNC2H1 mutation was detected via genetic analysis and ciliary dysfunction was noted via high‐speed video microscopy. [ABSTRACT FROM AUTHOR]

Civilian injuries are increasing according to the World Health Organization, and this is attributed mainly to road traffic accidents and urban interpersonal violence. Vascular injuries are common in these scenarios and are associated with high morbidity and mortality rates. Associated peripheral venous trauma is less likely to lead to death and controversy remains whether ligation or repair should be the primary approach. Conversely, non-compressible truncal venous insult can be lethal due to exsanguination, thus a high index of suspicion is crucial. Operative management is demanding with fair results but recent endovascular adjuncts demonstrate promising results and seem to be the way forward for these serious conditions.

Background Thoracic impedance (TI) decrease and pulmonary artery pressure (PAP) elevation precede acute decompensation in congestive heart failure (HF). However, the relationship between TI and PAP has been studied only in the context of acute decompensation. Methods This prospective, observational study enrolled subjects with reduced ejection fraction HF, previously implanted with an ICD capable of measuring TI. Patients underwent implantation of a sensor for direct measurement of PAP (CardioMEMs™). Both TI and PAP were remotely monitored daily during follow up. Investigators were blinded to PAP values during the first three months, then PAP was used as a guide to therapy. Results Ten patients were followed up for 405 ± 141 days (3720 patient-days). During hemodynamic guided therapy, diastolic PAP (dPAP) decreased from 27.8 ± 10.2 mm Hg to 24.0 ± 8.0 mm Hg (p < 0.001); non-significant variations of TI were observed. A significant negative correlation was found between the variations of TI and PAP vs. baseline (p < 0.001). Episodes of sustained increase of PAP preceded subsequent periods of TI decrease by 5.6 ± 3.9 days, but the former were poor predictors of the latter (sensitivity 0.37). Conclusions Our study confirms the strict correlation that exists between left ventricular filling pressures and lung water content, estimated by dPAP and TI, respectively. However, dPAP acute variation analysis showed a limited value in predicting subsequent episodes of TI decrease. [ABSTRACT FROM AUTHOR]

Background: To date, no study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients. The purpose of this study is to evaluate the cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder treated by either full fusion or partial/non fusion of the proximal thoracic curve.Methods: A total of 30 Lenke type 2 AIS patients with preoperative right-elevated shoulder underwent posterior spinal instrumentation from 2009 to 2011 were included in this study. All the subjects were divided into 2 groups according to the selection of upper instrumented vertebra. There were 14 cases proximally fused to T1 or T2 (Group A) and 16 cases proximally fused to T3 or below (Group B). Both standing anteroposterior and sagittal X-ray films of the spine obtained preoperatively, one week after the operation, and at a minimum of two-year follow-up were analyzed with respect to the following parameters: cervical tilt, T1 tilt, proximal thoracic Cobb angle, main thoracic Cobb angle, apical vertebral translation of proximal thoracic curve, apical vertebral translation of main thoracic curve, radiographic shoulder height, cervical lordosis, proximal thoracic kyphosis and main thoracic kyphosis.Results: Most (83.3%) of the patients in these two groups gained satisfactory shoulder balance after surgery. However, the cervical tilt significantly improved in group A (p < 0.001) but deteriorated in group B (p < 0.001). In group A, the decrease of cervical tilt significantly positively correlated with that of T1 tilt (p < 0.001). In group B, the increase of cervical tilt significantly positively correlated with both the increase of T1 tilt (p < 0.001) and the increase of apical vertebral translation of proximal thoracic curve (p < 0.05).Conclusions: Lenke type 2 AIS patients with right-elevated shoulder gain improved shoulder but deteriorated cervical tilt after partial/non fusion of proximal thoracic curve. Full fusion of proximal thoracic curve helps to prevent the residual cervical tilt in these patients. [ABSTRACT FROM AUTHOR]

The development of new devices to improve treatment and to explore new indications that have not yet been adequately addressed is a natural consequence of the clinical demand for solutions to as yet unmet needs. The frozen elephant trunk technique was one of the major steps within the last 15 years to improve on existing treatments as well as to explore new indications. The goal of this article is to provide technical details about advances in implantation techniques for the treatment of acute and chronic thoracic aortic pathological conditions. [ABSTRACT FROM AUTHOR]

Thoracic venous injuries are predominantly attributed to traumatic and iatrogenic causes. Gunshot wounds and knife stabbings make up the vast majority of penetrating trauma whereas motor vehicle collisions are the leading cause of blunt trauma to the chest. Iatrogenic injuries, mostly from central venous catheter complications are being described in growing detail. Although these injuries are rare, they pose a diagnostic challenge as their clinical presentation does not substantially differ from that of arterial injury. Furthermore, the highly lethal nature of some of these injuries provides limited literature for review and probably underestimates their true incidence. The widespread use of multi-detector computed tomography (MDCT) has increased the detection rate of these lesions in hemodynamically stable patients that survive the initial traumatic event. In this article, we will discuss and illustrate various causes of injury to each vein and their supporting CT findings while briefly discussing management. The available literature will be reviewed for penetrating, blunt, and iatrogenic injuries to the vena cava, innominate, subclavian, axillary, azygos, and pulmonary veins. [ABSTRACT FROM AUTHOR]

Background: About 50 cases of azygos venous system injuries following civilian trauma have been published in current literature. The purpose of our study was to investigate the incidence of these injuries, the causative mechanism and type of trauma, the co-existing injuries, and the mortality rate in our institution. Methods: We performed a retrospective review of all trauma patients who were admitted to the surgical department of the General Hospital of Rethymno during an 11-year period. Our study included patients arriving at our institution dead or alive with an azygos venous system injury following blunt or penetrating civilian trauma. Results: Seven patients-five men and two women-were identified with azygos venous system injuries. Five had an azygos vein laceration, one suffered from both azygos and hemiazygos vein lacerations, and the last one had sustained hemiazygos and accessory hemiazygos vein injuries. All of them suffered from a blunt trauma. Three arrived at our hospital in extremis, and all died within 24 h despite our resuscitation attempts. All of our patients were polytrauma patients. All of them had co-existing torso injuries which were severe in all but one case, three of them suffered also from serious head injuries, and all but one had at least serious extremity's injuries. Conclusion: Azygos venous system injuries are rare, although it seems that they are more frequent than current literature would indicate. Blunt trauma mechanism seems to be predominant in civilian trauma setting, and the patients have usually sustained a lot of serious and severe co-existing injuries with high resultant lethality. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of injuries sustained in cyclists and compare the injury patterns in road vs trail biking accidents.Methods: A retrospective chart review was performed of injured road and trail cyclists presenting to a rural mountain resort-based medical center during a 3-year study period.Results: Of 304 patients, 70% were male, with 67% sustaining trail injuries and 33% sustaining road cycling injuries. There was a bimodal age distribution. Prehospital care was activated in 16% of patients. The most common injuries were lacerations and abrasions (64%), upper extremity fractures (26%), head injuries (9%), and thoracic trauma (6%). Head injury was more common in road- vs trail-related trauma (16% vs 6%; P = .005), whereas thoracic injury was more common in trail riders (7% vs 2%; P = .053). Head injury and lower extremit y fracture were the most common reasons for patient transfer. Patients with head injuries who did not use a helmet were more likely to require transfer to a neurosurgical unit (38% vs 17%; P = .296); however, this difference did not meet statistical significance.Conclusions: Lacerations and abrasions are the most common injuries sustained in cycling. Quantifying the role of protective extremity gear in reducing these injury patterns may be of interest for future studies. Protective helmet use may be important in reducing morbidity from cycling-related head trauma; however, more data are needed. Prehospital care providers responding to the injured trail cyclist should be equipped to manage laceration, fracture, head injury, and thoracic trauma in the field. [ABSTRACT FROM AUTHOR]

The lumbar artery perforator (LAP) flap, which contains excess skin and fat tissue, love handles, that extends from the lower back to upper buttock, may provide an alternate tissue source for autologous breast reconstruction. However, LAP flap use during this procedure frequently requires vessel interposition grafts to correct the short flap pedicle length and mismatched recipient vessel calibre. A 46-year-old patient underwent a right nipple-sparing mastectomy using a lateral approach for ductal carcinoma in situ and immediate LAP flap breast reconstruction. The lateral thoracic vessel served as the recipient vessel, and a lateral thoracic vein interposition graft from the distal remnant was performed to adjust the arterial length and size discrepancy between the recipient lateral thoracic artery and pedicle artery. This procedure facilitates microsurgical anastomosis and medialisation of LAP flap to make a natural decollete line and create a cleavage for the reconstructed breast. [ABSTRACT FROM AUTHOR]

Ultrasound guided vascular access has been well-characterized as a safe and effective technique for internal jugular and femoral vein catheterization. However, there is limited experience with the use of ultrasound to access the infraclavicular subclavian vein. Multiple ultrasound techniques do exist to identify the subclavian vein, but real time access is limited by vessel identification in a single planar view. To overcome this limitation, a novel technique of ultrasound guided infraclavicular subclavian vein catheterization using a real time multiplanar approach has been developed. The initial experience with this approach is described. A single surgeon used combined oblique, transverse, and longitudinal views along with Doppler color flow images to both define the infraclavicular anatomy and to obtain subclavian vein access in 42 adult patients (20 M/22 F and 22 L/20 R) with a mean body mass index of 29.2 (range = 18.9-55.4). Chest x-ray was obtained to confirm position and to rule out pneumothorax. Subclavian vein cannulation was achieved in 100 per cent of patients; subsequent catheterization was successful in 92.9 per cent. The number of attempts required for cannulation averaged 1.3 (range = 1-5), and decreased after a five patient learning curve. No patient developed a pneumothorax, hematoma, or cannula malposition. Ultrasound guided multiplanar infraclavicular subclavian vein access appears to be a safe and effective adjunct for central line placement. [ABSTRACT FROM AUTHOR]

Background Thoracic bioreactance is a noninvasive and continuous method of cardiac output ( CO) measurement that is being developed in adult patients. Very little information is available on thoracic bioreactance use in children. Objective The aim of the study was to evaluate the ability of a bioreactance device ( NICOM®; Cheetah Medical, Tel Aviv, Israel) to estimate CO and to track changes in CO induced by volume expansion (VE) in children. Methods Cardiac output values obtained using the NICOM® device ( CONICOM) and measured by trans-thoracic echocardiography ( COTTE) were compared in pediatric neurosurgical patients during the postoperative period. Results Seventy-three pairs of measurements of CO obtained in 30 children were available for analysis. The bias (lower and upper limits of agreement) between CONICOM and COTTE was −0.11 (−1.4 to 1.2) l·min−1. The percentage error (PE) was 55%. The precision of the NICOM® device was 45%. A significant correlation was observed between the CO values obtained using the two methods ( r = 0.89, <0.001). The concordance percentage between changes in COTTE and CONicom induced by VE was 84% following exclusion of patients with changes in CO <15% ( n = 5). Conclusions The PE observed is too large, and the limits of agreement too wide, to enable us to comment on the equivalence of the two techniques of CO measurements. However, the NICOM® device performs well in tracking changes in CO following VE. [ABSTRACT FROM AUTHOR]

Introduction: Totally implantable venous access ports are widely used for the administration of chemotherapy in patients with cancer. Although there are several approaches to implantation, here we describe Port-A-Cath (PAC) placement by percutaneous puncture of the subclavian vein with ultrasonographic guidance. Patients and methods: Data on our vascular access service were collected prospectively from June 2004. This service included port-a-caths and Hickman lines. Once 1000 consecutive port-a-caths had been reached the study was closed and data analysed for the port-a-caths alone. The left subclavian vein was the preferred site for venous access, with the right subclavian and jugular veins being the alternative choices if the initial approach failed. Patients were followed up in the short-term, and all the procedures were carried out by a single surgeon at each one of two institutions. Results: Venous access by PAC was established in 100 % of the 1,000 cases. Of the 952 patients where the left subclavian vein was chosen for the first attempt of puncture, the success rate of PAC placement was 95 % ( n = 904). Pneumothorax occurred in 12 patients (1.2 %), and a wound haematoma occurred in 4 (0.4 %) out of the total 1,000 patients. No infections were recorded during the immediate post-operative period but only in the long-term post-operative use with 8 patients requiring removal of the PAC due to infection following administration of chemotherapy. Conclusion: This is a very large series of PAC placement with an ultrasound-guided approach for left subclavian vein and X-ray confirmation, performed by a single surgeon, demonstrating both the safety and effectiveness of the procedure. [ABSTRACT FROM AUTHOR]

Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and is a persistent congenital remnant of the vena caval system from early cardiac development. Patients with congenital anomalous venous return are at increased risk of developing various cardiac arrhythmias, due to derangement of embryologic conductive tissue during the early development of the heart. Previously this discovery was commonly made during the placement of pacemakers or defibrillators for the treatment of the arrhythmias, when the operator encountered difficulty with proper lead deployment. However, in today’s world of various easily obtainable imaging modalities, PLSVC is being discovered more and more by primary care providers during routine testing or screening for other ailments. Given the known association between anomalous venous return and the propensity for cardiac arrhythmias, we review the embryology of PLSVC and the mechanisms by which it leads to conduction abnormalities. We also provide the practitioner with recommendations for certain baseline cardiac observations and suggestions for proper surveillance in hopes that better understanding will reduce unnecessary and potentially harmful testing, premature subspecialty referral, and unneeded patient anxiety. [ABSTRACT FROM AUTHOR]

Although the cephalic vein follows a fairly consistent course, numerous variants have been reported. We found a rare anatomical presentation of the cephalic vein in a 75-year-old Korean male cadaver. The left cephalic vein was identified in the deltopectoral groove, ascended over the clavicle, and terminated into the left subclavian vein just before its union with the left internal jugular vein. The detailed knowledge on the variations of the cephalic vein is important for clinicians as well as anatomists since the approach through the axillary base is favored in many invasive clinical procedures. [ABSTRACT FROM AUTHOR]

We recently demonstrated the abundant presence of cardiomyocytes in the wall of thoracic veins of adult mouse and rat. The highly differentiated morphology and myofilament protein contents of the venous cardiomyocytes suggested contractile functions. Here we further investigated the contractility of mouse and rat azygos venous rings compared with that of atrial strips and ventricular papillary muscle. 5-Bromo-4-chloro-indolylgalactopyranoside (X-gal) staining of transgenic mouse vessels expressing lacZ under a cloned cardiac troponin T promoter demonstrated that the venous cardiomyocytes are discontinuous from atrial myocardium and aligned in the wall of thoracic veins perpendicular to the vessel axis. Histological sections displayed sarcomeric striations in the venous cardiomyocytes, which indicate an encirclement orientation of myofibrils in the vessel wall. Mechanical studies found that the rings of mouse and rat azygos vein produce strong cardiac type twitch contractions when stimulated with electrical pacing in contrast to the weak and slow smooth muscle contractions induced using 90 mM KCl. The twitch contraction and relaxation of mouse azygos veins further exhibited a cardiac type of adrenergic responses. Quantitative comparison showed that the contractions of venous cardiomyocytes are slightly slower than those of atrium muscle but significantly faster than those of ventricular papillary muscle. These novel findings indicate that the cardiomyocytes abundant in the wall of rodent thoracic veins possess fully differentiated cardiac muscle phenotype despite their anatomical and functional segregations from the heart. [ABSTRACT FROM AUTHOR]

Introduction: Venous anomalies of the thorax can involve systemic or pulmonary veins and range from isolated incidental findings to components of more complex anomalies, most often congenital heart disease (CHD). Although echocardiography and catheter directed cardiac angiography are generally accepted as the primary imaging techniques for evaluation of CHD, CT and MRI are important complementary diagnostic tools. Multi-detector computed tomography (MDCT) with its increasing availability and utility is now becoming a further method of imaging CHD. In light of its widespread availability, MDCT and 3D imaging are increasingly considered as a viable "one-stop shop" for preoperative imaging evaluation of cardiovascular structures in selected pediatric patients. Aim of the work: The aim of this work is to evaluate the role of MDCT in visualization of the thoracic venous system in pediatrics with congenital heart disease, show prevalence and types of venous anomalies and to compare this data with echocardiographic findings. Methods: The studied group included 30 cases referred to us by pediatric cardiologists to be examined by MSCT angiography of the heart and thoracic vessels. All the patients were known cases of congenital heart disease and underwent echocardiography. They were referred to answer specific anatomic question raised by inconclusive echocardiography, to assess suspected systemic and suspected pulmonary venous anomalies. All patients were subjected to full history taking, clinical examination and MDCT examination with CT lightspeed VCT XT 64-detectors row scanner (General Electric, Medical Systems, Milwaukee, Wisconsin, USA). Results: CTA findings had 77.8 % concordance with echocardiographic findings regarding SVC anomalies, 66.7 % concordance with echocardiography regarding IVC anomalies and 90 % concordance regarding pulmonary venous anomalies. Conclusion: Low dose protocol CTA is a promising method that complementary to Echocardioraphy for imaging of extracardiac vascular structures in pediatrics with congenital heart diseases. [ABSTRACT FROM AUTHOR]

Objective: Moderate to severe aortic regurgitation is occurring in 20% to 30% of cases after transcatheter aortic valve implantation. Methods: The purpose of the study was to investigate the impact of a prospective policy of “oversizing” the Edwards SAPIEN bioprosthesis (Edwards Lifesciences LLC, Irvine, Calif) relative to the diameter of the aortic annulus on the rate and severity of aortic regurgitation in 28 consecutive patients initially considered eligible for transcatheter aortic valve implantation on the basis of angiography, multislice computed tomography, and transthoracic echocardiography. This policy included the systematic use of transesophageal echocardiography to exclude borderline patients and the modification of the procedure to use the larger device possible. The results were studied on an individual patient basis. Results: Because 6 of 28 patients (21%) had an annulus diameter greater than 24 mm by transesophageal echocardiography, 22 patients underwent implantation of the Edwards SAPIEN prosthesis. In 6 of 22 patients, the procedure was adapted to follow our “oversizing” policy. As a result, the “prosthesis/annulus cover index” was 12.4% ± 4.3%. The procedure was successful in 21 of 22 patients (95%), and 18 patients were available for echocardiography at 1 month. Although a moderate to severe aortic regurgitation was observed pretreatment in 4 of 18 patients (22%), it was no longer the case at 1 month (0/18, 0%; P = .03). The improvement was secondary to a disappearance of the aortic regurgitation in all 7 patients with a significant aortic regurgitation at pretreatment, whereas the new aortic regurgitations appearing in 5 of the 11 patients with no aortic regurgitation at pretreatment were only mild aortic regurgitations. Conclusions: In patients with a successful implantation of an Edwards SAPIEN valve, a simple “oversizing” policy based on a systematic use of transesophageal echocardiography and modification of the procedure may prevent the occurrence of moderate and severe aortic regurgitations. [Copyright &y& Elsevier]

Persistent left superior vena cava is the most common congenital venous anomaly of the thoracic venous system, occurring in 0.3% to 0.5% of individuals in the general population. It may remain asymptomatic throughout life and be incidentally found in healthy individuals undergoing vascular procedures such as venous access device placements and endovascular cardiac interventions. Here we present a case of persistent left superior vena cava incidentally realized during chemoport insertion in a patient with breast cancer. [ABSTRACT FROM AUTHOR]

Interposition with a vascular prosthesis or patch closure using autologous pericardiumhas been applied for superior vena cava (SVC) reconstruction during surgery for thoracic malignancies such as thymic epithelial tumors or lymphadenopathy that invade the SVC. We herein report a novel and simple method for repair of the SVC using a left brachiocephalic vein flap. This procedure is useful to repair the anterior wall of the distal portion of the SVC, which is a common site of invasion of thoracic malignancies. [ABSTRACT FROM AUTHOR]

Ectopic activity in cardiac muscle within pulmonary veins (PVs) is associated with the onset and the maintenance of atrial fibrillation in humans. The mechanism underlying this ectopic activity is unknown. Here we investigate automatic activity generated by catecholaminergic stimulation in the rat PV. Intracellular microelectrodes were used to record electrical activity in isolated strips of rat PV and left atrium (LA). The resting cardiac muscle membrane potential was lower in PV [-70 ± 1 (SE) mY, n = 8] than in LA (-85 ± 1 mY, n = 8). No spontaneous activity was recorded in PV or LA under basal conditions. Norepinephrine (10-5 M) induced first a hyperpolarization (-8 ± I mV in PV, -3 ± 1 mV in LA, n = 8 for both) then a slowly developing depolarization (+21 ± 2 mV after 15 mm in PV, +1 ± 2 mV in LA) of the resting membrane potential. Automatic activity occurred only in PY; it was triggered at approximately -50 mV, and it occurred as repetitive bursts of slow action potentials. The diastolic membrane potential increased during a burst and slowly depolarized between bursts. Automatic activity in the PV was blocked by either atenolol or prazosine, and it could be generated with a mixture of cirazoline and isoprenaline. In both tissues, cirazoline (10-6 M) induced a depolarization (+37 ± 2 mV in PV, n = 5; +5 ± 1 mV in LA, n = 5), and isoprenaline (10-6 M) evoked a hyperpolarization (- 11 ± 3 mV in PV, n = 7; -3 ± 1 mV in LA, n = 6). The differences in membrane potential and reaction to adrenergic stimulation lead to automatic electrical activity occurring specifically in cardiac muscle in the PV. [ABSTRACT FROM AUTHOR]

Persistent left superior vena cava (PLSVC) is a very rare and yet the most commonly described thoracic venous anomaly in medical literature. It has a 10-fold higher incidence with congenital heart disease. PLSVC often becomes apparent when an unknown PLSVC is incidentally discovered during central venous line placement, intracardiac electrode/pacemaker placement or cardiopulmonary bypass, where it may cause technical difficulties and life-threatening complications. PLSVC is also associated with disturbances of cardiac impulse formation and conduction including varying degrees of heart blocks, supraventricular arrhythmias and Wolff Parkinson White syndrome. We describe the case of an 86-year-old male with a history of coronary artery disease and chronic atrial fibrillation who presented with worsening dyspnea and syncopal episodes. An ECG was consistent with complete heart block. During lead placement for the pacemaker, a left subclavian approach was unsuccessful. A left venogram was performed through the brachial vein that demonstrated a left superior vena cava. The diagnosis was confirmed with echocardiography using a bubble study and also a chest CT. The anatomy was unique as there was anomalous left hepatic vein drainage into the right atrium. The case provides insight into the diagnostic modalities and clinical considerations of this unusual thoracic venous anomaly. [ABSTRACT FROM AUTHOR]

In 1999, Haissaguerre et al published a landmark article showing that atrial fibrillation can be initiated by electrical activity in the pulmonary veins. Not only does it appear that electrical activity in the veins initiates fibrillation, but it also may be responsible for perpetuating fibrillation. Subsequently, similar evidence has suggested that other thoracic veins (vena cavae, coronary sinus, ligament of Marshall) initiate and perpetuate atrial fibrillation. How does electrical impulse initiation occur in the veins? The results of numerous in vivo and in vitro studies on this subject have not conclusively defined a mechanism. Impulse initiation by automaticity and triggered activity as well as impulse initiation resulting from reentry have been suggested. In this article, we focus only on those data suggesting the possibility that triggered activity initiates and/or perpetuates atrial fibrillation. [ABSTRACT FROM AUTHOR]

Objective: this study was conducted to determine the results of the left subclavian artery (LSA) coverage during Thoracic Endovascular Aortic Repair (TEVAR). Materials and methods: we retrospectively reviewed the results of 22 patients who underwent TEVAR from January 2013 to May 2014. The LSA was completely covered in 18 patients (13 male, 5 female), with a mean age of 62 years (range 36-81 years of age). There was no revascularization. The mean follow-up was 8 months (range 1-12 months). Results: indications for TEVAR treatment included aneurysm in 7, dissection in 3, combination of aneurism and dissection in 4, pseudoaneurysm in 1, aortic injury in 1, and penetrating ulcer in 2 cases. Out of this number of cases, 16 were elective and 2 emergency operations. Aortic coverage extended from the left common carotid artery (LCCA) to the distal arch (1 patient), middle thoracic aorta (3 patients). Operative success was 99%. In our study we did not record 30-days mortality, paraplegia appearance or stroke related to LSA coverage. Left upper extremity symptoms developed in 2 patients (10%) by subclavian steal syndrome. Permanent left upper extremity dysfunction or ischemia was not found. Conclusion: landing Zone 2 TEVAR with LSA coverage can be accomplished safely in both elective and emergency settings without revascularization and long-term damage to the left arm. [ABSTRACT FROM AUTHOR]

Compression or irritation of the sciatic nerve and its branches, the common fibular and tibial nerves, causes sciatica which is a common syndrome characterized most often by radiating pain from the lower back down the legs and also manifesting as sensory and motor deficits. Sciatica is a common presentation of lumbosacral disc prolapse and degenerative disease of the lumbar spine in ambulatory settings. Schwannomas rarely cause sciatica; hence, it is seldom considered in evaluation of a patient with radiculopathy. Our patient presented with lumbar radiculopathy, mild degenerative changes on lumbar magnetic resonance imaging (MRI) scan, and failed conservative treatment. Myelopathy was confirmed with electromyogram (EMG). Thoracolumbar spine MRI revealed the schwannoma in the thoracic region. He recovered neurologic function after tumor excision. This case highlights the diagnostic challenge that may arise in evaluating a patient with lumbar radiculopathy, negative lumbosacral spine imaging, and failure of conservative therapy. [ABSTRACT FROM AUTHOR]

Anomalous left brachiocephalic vein (ALBCV) is a rare condition of the major thoracic veins. It is usually associated with a congenital cardiac anomaly. Most reports on ALBCV are on aberrant left BCV, and there are few reports on double left BCV. Persistent left superior vena cava (PLSVC) is also a rare vascular anomaly that is caused by the failure of the left anterior cardinal vein to regress. To our knowledge, double left BCV with PLSVC has not been reported. Here, we report a case of double left BCV with PLSVC in a 72-year-old male patient with no previous cardiac abnormality. [ABSTRACT FROM AUTHOR]

Introduction. Persistent left superior vena cava is the most common thoracic venous abnormality which is usually asymptomatic, found incidentally during pacemaker implantation. The main problem is related to reaching the appropriate pacing site and ensuring stable lead placement. Case report. We reported a successful implantation of a biventricular pacing and defibrillator device (CRT-D) via a persistent left superior vena cava in a 55-year-old man with dilated cardiomyopathy and severe heart failure. A persistent left superior vena cava was detected during CRT-D implantation. We managed to position electrodes in the right ventricular outflow tract, a posterior branch of the coronary sinus and in the right atrium. Conclusion. Congenital anomalies of thoracic veins may complicate lead placement on the appropriate and stable position. The presented case demonstrates a successful biventricular pacing and defibrillator therapy device implantation in a patient with dilated cardiomyopathy and severe heart failure. [ABSTRACT FROM AUTHOR]

Abstract: Placement of a central venous catheter (CVC) is a common procedure in Neonatology. Complications associated with CVCs include infections and thrombosis. We describe a case of fatal cardiac tamponade due to chylous effusion in a newborn infant with catheter-associated intrathoracic venous thrombosis. [Copyright &y& Elsevier]

A 61-year-old man was found dead in the yard of his house with penetrating injury of the trunk. Initial examination of the body revealed a single penetrating injury on his chest with a collar abrasion-the injury pattern that is similar to a gunshot entry wound or shored exit wound. According to witnesses, the man had cut wooden frames from old windows with a circular saw. X-rays of the torso revealed a contrast object resembling a projectile in the left scapular region. The internal examination disclosed an isolated trunk trauma involving the left lung. In the soft tissue, between the inner edge of the left scapula and thoracic spine, the fragment of a metal nail was found. The autopsy confirmed that the wound on the chest was a non-firearm-related injury. The death of deceased was attributed to massive internal hemorrhage. Further investigation revealed that the pseudo-gunshot wound injury of the trunk of the victim was caused by a fast-flying metal object thrown against the man's trunk from a circular saw while cutting the wooden beams of old windows. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Surgical procedures for pacemaker implantation vary among facilities. The extrathoracic venous puncture method has been utilized for lead insertion, although patients'' body movements can displace the targeted vein from the area into which a contrast agent has been injected for imaging. Failed punctures cause edema around the puncture site, spasm, or venous collapse due to bleeding, which may render another puncture impractical. To overcome these problems, we report a new technique for the extrathoracic puncture method. Methods and results: From April 2007 through March 2011, we performed 35 new dual chamber pacemaker implantation procedures. This study compared a conventional puncture group (from April 2007 through March 2009; Group A) with a catheter-guided puncture group (from April 2009 through March 2011; Group B). We analyzed procedure time and procedure-related complications in each group. The procedure time was 138.6±41.8min in the conventional puncture group (Group A) and 109.8±23.2 in the catheter-guided puncture group (Group B). There was a significant reduction in the procedure time in the catheter-guided puncture group (Group B) compared with the conventional puncture group (Group A; p=0.016). No patients in either group had pneumothorax, hematoma, or any other complications. Conclusion: Our puncture method involving catheter insertion appears to be safe and effective. [Copyright &y& Elsevier]

Background: Accurate anatomical landmarks to locate the thoracodorsal nerve are important in axillary clearance surgery. Methods: Twenty axillary dissections were carried out on ten preserved Sri Lankan cadavers. Cadavers were positioned dorsal decubitus with upper limbs abducted to 900. An incision was made in the upper part of the anterior axillary line. The lateral thoracic vein was identified and traced bi-directionally. The anatomical location of the thoracodorsal nerve was studied in relation to the lateral border of pectoralis minor and from a point along the lateral thoracic vein, 2 cm inferior to its confluence with the axillary vein. Results: The lateral thoracic vein was invariably present in all the specimens. All the lateral thoracic veins passed lateral to the lateral border of pectoralis minor except in one specimen, where the lateral thoracic vein passed along its lateral border. The thoracodorsal nerve was consistently present posterolateral to the lateral thoracic vein. The mean distance to the lateral thoracic vein from the lateral border of pectoralis minor was 28.7 ± 12.6 mm. The mean horizontal distance, depth, and displacement, from a point along the lateral thoracic vein, 2 cm inferior to its confluence with the axillary vein to the thoracodorsal nerve were 14.5 ± 8.9 mm, 19.7 ± 7.3 mm and 25 ± 5 mm respectively. The thoracodorsal nerve was found in a posterolateral direction, at a 540 ± 120 angle to the horizontal plane, 95% of the time. Conclusions: The lateral thoracic vein is an accurate guide to the thoracodorsal nerve. We recommend exploring for the thoracodorsal nerve from a point 2 cm from the confluence of the lateral thoracic vein and the axillary vein for a distance of 25 ± 5 mm in a posterolateral direction, at a 540 ± 120 angle to the horizontal plane. [ABSTRACT FROM AUTHOR]

A drop in the air-fluid level in the postpneumonectomy space on a chest radiogram is an early sign of bronchopleural fistula (BPF). Any suspicion of BPF points to the need for urgent evaluation and appropriate management. Very rarely may this drop occur without the existence of a fistula, but such a condition is defined as benign emptying of the postpneumonectomy space. We share our successful conservative management in a case of postpneumonectomy space emptying with a suspicion of BPF. [ABSTRACT FROM AUTHOR]

Introduction: Although aberrant right subclavian artery (ARSA) is a rare abnormality but it is the most common anomaly of aortic arch. Compressive effects of the artery are responsible for the patients' symptoms. Association of this disorder with other anomalies and necessity of treatment in symptomatic patients are the important aspects of this condition. Case Presentation: Here we describe a 12 years old girl with dysphagia and ultimate diagnosis of ARSA. The ligation procedure of the artery was successful without any complications. Conclusion: Dysphagia could be the main symptom of the ARSA in children as same as old adults. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Diagnostic Accuracy of Ultrasonography in the Acute Assessment of Common Thoracic Lesions After Trauma," by Anne-Claire Hyacinthe et al. published in the May 2012 issue and a reply by the authors to this letter are presented.

Civilian injuries are increasing according to the World Health Organization, and this is attributed mainly to road traffic accidents and urban interpersonal violence. Vascular injuries are common in these scenarios and are associated with high morbidity and mortality rates. Associated peripheral venous trauma is less likely to lead to death and controversy remains whether ligation or repair should be the primary approach. Conversely, non-compressible truncal venous insult can be lethal due to exsanguination, thus a high index of suspicion is crucial. Operative management is demanding with fair results but recent endovascular adjuncts demonstrate promising results and seem to be the way forward for these serious conditions.

We recently demonstrated the abundant presence of cardiomyocytes in the wall of thoracic veins of adult mouse and rat. The highly differentiated morphology and myofilament protein contents of the venous cardiomyocytes suggested contractile functions. Here we further investigated the contractility of mouse and rat azygos venous rings compared with that of atrial strips and ventricular papillary muscle. 5-Bromo-4-chloro-indolyl-galactopyranoside (X-gal) staining of transgenic mouse vessels expressing lacZ under a cloned cardiac troponin T promoter demonstrated that the venous cardiomyocytes are discontinuous from atrial myocardium and aligned in the wall of thoracic veins perpendicular to the vessel axis. Histological sections displayed sarcomeric striations in the venous cardiomyocytes, which indicate an encirclement orientation of myofibrils in the vessel wall. Mechanical studies found that the rings of mouse and rat azygos vein produce strong cardiac type twitch contractions when stimulated with electrical pacing in contrast to the weak and slow smooth muscle contractions induced using 90 mM KCl. The twitch contraction and relaxation of mouse azygos veins further exhibited a cardiac type of β-adrenergic responses. Quantitative comparison showed that the contractions of venous cardiomyocytes are slightly slower than those of atrium muscle but significantly faster than those of ventricular papillary muscle. These novel findings indicate that the cardiomyocytes abundant in the wall of rodent thoracic veins possess fully differentiated cardiac muscle phenotype despite their anatomical and functional segregations from the heart.