4D display of the outflow track of embryonic-chick hearts (HH 14-19) using a high speed streak mode OCT

NASA Astrophysics Data System (ADS)

Ma, Siyu; Wang, Rui; Goodwin, Richard L.; Markwald, Roger R.; Borg, Thomas K.; Runyan, Raymond B.; Gao, Zhi

2013-02-01

Congenital Heart Disease (CHD) is the most common congenital malformation in newborns in the US. Although knowledge of CHD is limited, altered hemodynamic conditions are suspected as the factor that stimulates cardiovascular cell response, resulting in the heart morphology remodeling that ultimately causes CHDs. Therefore, one of recent efforts in CHD study is to develop high-speed imaging tools to correlate the rapidly changing hemodynamic condition and the morphological adaptations of an embryonic heart in vivo. We have developed a high-speed streak mode OCT that works at the center wavelength of 830 nm and is capable of providing images (292x220 μm2) of the outflow tract of an embryonic chick heart at the rate of 1000 Hz. The modality can provide a voxel resolution in the range of 10 μm3, and the spectral resolution allows a depth range of 1.63 mm. In the study reported here, each of the 4D images of an outflow tract was recorded for 2 seconds. The recording was conducted every 2 hours (HH17 to HH18), 3 hours (HH14 to HH17), and 4 hours (HH18 to HH19). Because of the fast scan speed, there is no need for postacquisition processing such as use of gating techniques to provide a fine 3D structure. In addition, more details of the outflow tract are preserved in the recorded images. The 4D images can be used in the future to determine the role of blood flow in CHD development.

An FGF autocrine loop initiated in second heart field mesoderm regulates morphogenesis at the arterial pole of the heart

PubMed Central

Park, Eon Joo; Watanabe, Yusuke; Smyth, Graham; Miyagawa-Tomita, Sachiko; Meyers, Erik; Klingensmith, John; Camenisch, Todd; Buckingham, Margaret; Moon, Anne M.

2009-01-01

In order to understand how secreted signals regulate complex morphogenetic events, it is crucial to identify their cellular targets. By conditional inactivation of Fgfr1 and Fgfr2 and overexpression of the FGF antagonist sprouty 2 in different cell types, we have dissected the role of FGF signaling during heart outflow tract development in mouse. Contrary to expectation, cardiac neural crest and endothelial cells are not primary paracrine targets. FGF signaling within second heart field mesoderm is required for remodeling of the outflow tract: when disrupted, outflow myocardium fails to produce extracellular matrix and TGFβ and BMP signals essential for endothelial cell transformation and invasion of cardiac neural crest. We conclude that an autocrine regulatory loop, initiated by the reception of FGF signals by the mesoderm, regulates correct morphogenesis at the arterial pole of the heart. These findings provide new insight into how FGF signaling regulates context-dependent cellular responses during development. PMID:18832392

Double-switch Ross procedure.

PubMed

Chang, Jen-Ping; Kao, Chiung-Lun; Hsieh, Ming-Jang

2002-06-01

Aortic root replacement with pulmonary autograft (Ross procedure) is a valuable technique. However, the best material for right ventricular outflow tract reconstruction remains controversial. We report on the experience with use of an aortic autograft with reimplantation of the diseased aortic valve for right ventricular outflow tract reconstruction in 3 patients with satisfactory result.

Normal and Abnormal Development of the Intrapericardial Arterial Trunks in Man and Mouse

PubMed Central

Anderson, Robert H.; Chaudhry, Bill; Mohun, Timothy J.; Bamforth, Simon D.; Hoyland, Darren; Phillips, Helen M.; Webb, Sandra; Moorman, Antoon F.J.; Brown, Nigel A.; Henderson, Deborah J.

2014-01-01

Aims The definitive cardiac outflow channels have three components: the intrapericardial arterial trunks; the arterial roots with valves; and the ventricular outflow tracts. We studied the normal and abnormal development of the most distal of these, the arterial trunks, comparing findings in mouse and man. Methods and Results Using lineage tracing and three-dimensional visualization by episcopic reconstruction and scanning electron microscopy, we studied embryonic day 9.5 to 12.5 mouse hearts, clarifying the development of the outflow tracts distal to the primordia of the arterial valves. We characterize a transient aortopulmonary foramen, located between the leading edge of a protrusion from the dorsal wall of the aortic sac and the distal margins of the two outflow cushions. The foramen is closed by fusion of the protrusion, with its cap of neural crest cells, with the neural crest cell-filled cushions; the resulting structure then functioning transiently as an aortopulmonary septum. Only subsequent to this closure is it possible to recognize, more proximally, the previously described aortopulmonary septal complex. The adjacent walls of the intrapericardial trunks are derived from the protrusion and distal parts of the outflow cushions, while the lateral walls are formed from intrapericardial extensions of pharyngeal mesenchyme derived from the second heart field. Conclusions We provide, for the first time, objective evidence of the mechanisms of closure of an aortopulmonary foramen that exists distally between the lumens of the developing intrapericardial arterial trunks. Our findings provide insights into the formation of aortopulmonary windows and the variants of common arterial trunk. PMID:22499773

Electrophysiological changes of autonomic cells in left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with chronic heart failure.

PubMed

Fan, Ling; Chen, Li-Feng; Fan, Jing

2017-12-01

To investigate the electrophysiological changes of autonomic cells in left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with chronic heart failure. Guinea pigs model of iron deficiency anemia complicated with chronic heart failure in 10 guinea pigs of the experimental group was made by feeding a low iron diet, pure water and subcutaneous injection of isoproterenol. The control group consisting of 11 guinea pigs was given normal food, normal water and injected with normal saline. The left ventricular outflow tract model specimen was also prepared. The standard microelectrode technique was used to observe electrophysiological changes of autonomic cells in the outflow tract of left ventricular heart failure complicated with iron deficiency anemia in guinea pig model. The indicators of observation were maximal diastolic potential, action potential amplitude, 0 phase maximal depolarization velocity, 4 phase automatic depolarization velocity, repolarization 50% and 90%, and spontaneous discharge frequency. Compared with the control group, 4 phase automatic depolarization velocity, spontaneous discharge frequency and 0 phase maximal depolarization velocity decreased significantly (P < 0.01) and action potential amplitude reduced (P < 0.01) in model group. Moreover, repolarization 50% and 90% increased (P < 0.01). There are electrophysiological abnormalities of the left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with heart failure. Copyright © 2017 Hainan Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Differentiating the origin of outflow tract ventricular arrhythmia using a simple, novel approach.

PubMed

Efimova, Elena; Dinov, Borislav; Acou, Willem-Jan; Schirripa, Valentina; Kornej, Jelena; Kosiuk, Jedrzej; Rolf, Sascha; Sommer, Philipp; Richter, Sergio; Bollmann, Andreas; Hindricks, Gerhard; Arya, Arash

2015-07-01

Numerous electrocardiographic (ECG) criteria have been proposed to identify localization of outflow tract ventricular arrhythmias (OT-VAs); however, in some cases, it is difficult to accurately localize the origin of OT-VA using the surface ECG. The purpose of this study was to assess a simple criterion for localization of OT-VAs during electrophysiology study. We measured the interval from the onset of the earliest QRS complex of premature ventricular contractions (PVCs) to the distal right ventricular apical signal (the QRS-RVA interval) in 66 patients (31 men aged 53.3 ± 14.0 years; right ventricular outflow tract [RVOT] origin in 37) referred for ablation of symptomatic outflow tract PVCs. We prospectively validated this criterion in 39 patients (22 men aged 52 ± 15 years; RVOT origin in 19). Compared with patients with RVOT PVCs, the QRS-RVA interval was significantly longer in patients with left ventricular outflow tract (LVOT) PVCs (70 ± 14 vs 33.4±10 ms, P < .001). Receiver operating characteristic analysis showed that a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 100%, 94.6%, 93.5%, and 100%, respectively, for prediction of an LVOT origin. The same analysis in the validation cohort showed sensitivity, specificity, and positive and negative predictive values of 94.7%, 95%, 95%, and 94.7%, respectively. When these data were combined, a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 98%, 94.6%, 94.1%, and 98.1%, respectively, for prediction of an LVOT origin. A QRS-RVA interval ≥49 ms suggests an LVOT origin. The QRS-RVA interval is a simple and accurate criterion for differentiating the origin of outflow tract arrhythmia during electrophysiology study; however, the accuracy of this criterion in identifying OT-VA from the right coronary cusp is limited. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Impact of earliest activation site location in the septal right ventricular outflow tract for identification of left vs right outflow tract origin of idiopathic ventricular arrhythmias.

PubMed

Acosta, Juan; Penela, Diego; Herczku, Csaba; Macías, Yolanda; Andreu, David; Fernández-Armenta, Juan; Cipolletta, Laura; Díaz, Andrés; Korshunov, Viatcheslav; Brugada, Josep; Mont, Lluis; Cabrera, Jose A; Sánchez-Quintana, Damián; Berruezo, Antonio

2015-04-01

The earliest activation site (EAS) location in the septal right ventricular outflow tract (RVOT) could be an additional mapping data predictor of left ventricular outflow tract (LVOT) vs RVOT origin of idiopathic ventricular arrhythmias (VAs). The purpose of this study was to assess the impact of EAS location in predicting LVOT vs RVOT origin. Macroscopic and histologic study was performed in 12 postmortem hearts. Electroanatomic maps (EAMs) from 37 patients with outflow tract (OT) VA with the EAS in the septal RVOT were analyzed. Pulmonary valve (PV) was defined by voltage scanning after validation of voltage thresholds by image integration. EAM measurements were correlated with those of macroscopic/histologic study. A cutoff value of 1.9 mV discriminated between subvalvular and supravalvular positions (90% sensitivity, 96% specificity). EAS ≥1 cm below PV excluded RVOT site of origin (SOO). According to anatomic findings (distance PV-left coronary cusp = 5 ± 3 vs PV-right coronary cusp = 11 ± 5 mm), EAS-PV distance was significantly shorter in VAs arising from left coronary cusp than from the other LVOT locations (4.2 ± 5.4 mm vs 9.2 ± 7 mm; P = .034). The 10-ms isochronal longitudinal/perpendicular diameter ratio was higher in the RVOT vs the LVOT SOO group (1.97 ± 1.2 vs 0.79 ± 0.49; P = .001). An algorithm based on EAS-PV distance and the 10-ms isochronal longitudinal/perpendicular diameter ratio predicted LVOT SOO with 91% sensitivity and 100% specificity. An algorithm based on the EAS-PV distance and the 10-ms isochronal longitudinal/perpendicular diameter ratio accurately predicts LVOT vs RVOT SOO in outflow tract VAs with EAS in the septal RVOT. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Discrete potentials guided radiofrequency ablation for idiopathic outflow tract ventricular arrhythmias.

PubMed

Liu, Enzhao; Xu, Gang; Liu, Tong; Ye, Lan; Zhang, Qitong; Zhao, Yanshu; Li, Guangping

2015-03-01

Discrete potentials (DPs) have been recorded and targeted as the site of ablation of the outflow tract arrhythmias. The aim of the present study was to investigate the significance of DPs with respect to mapping and ablation for idiopathic outflow tract premature ventricular contractions (PVCs) or ventricular tachycardias (VTs). Seventeen consecutive patients with idiopathic right or left ventricular outflow tract PVCs/VTs who underwent radiofrequency catheter ablation were included. Intracardiac electrograms during the mapping and ablation were analysed. During sinus rhythm, sharp high-frequency DPs that displayed double or multiple components were recorded following or buried in the local ventricular electrograms in all of the 17 patients, peak amplitude 0.51 ± 0.21 mV. The same potential was recorded prior to the local ventricular potential of the PVCs/VTs. Spontaneous reversal of the relationship of the DPs to the local ventricular electrogram during the arrhythmias was noted. The DPs were related to a region of low voltage showed by intracardiac high-density contact mapping. At the sites with DPs, lower unipolar and bipolar ventricular voltage of sinus beats were noted compared with the adjacent regions without DPs (unipolar: 6.1 ± 1.8 vs. 8.3 ± 2.3 mV, P < 0.05; bipolar: 0.62 ± 0.45 vs. 1.03 ± 0.60 mV, P < 0.05). The targeted DPs were still present in 12 patients after successful elimination of the ectopies. Discrete potentials were not present in seven controls. Discrete potentials and related low-voltage regions were common in idiopathic outflow tract ventricular arrhythmias. Discrete potential- and substrate-guided ablation strategy will help to reduce the recurrence of idiopathic outflow tract arrhythmias. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Extracting cardiac shapes and motion of the chick embryo heart outflow tract from four-dimensional optical coherence tomography images

NASA Astrophysics Data System (ADS)

Yin, Xin; Liu, Aiping; Thornburg, Kent L.; Wang, Ruikang K.; Rugonyi, Sandra

2012-09-01

Recent advances in optical coherence tomography (OCT), and the development of image reconstruction algorithms, enabled four-dimensional (4-D) (three-dimensional imaging over time) imaging of the embryonic heart. To further analyze and quantify the dynamics of cardiac beating, segmentation procedures that can extract the shape of the heart and its motion are needed. Most previous studies analyzed cardiac image sequences using manually extracted shapes and measurements. However, this is time consuming and subject to inter-operator variability. Automated or semi-automated analyses of 4-D cardiac OCT images, although very desirable, are also extremely challenging. This work proposes a robust algorithm to semi automatically detect and track cardiac tissue layers from 4-D OCT images of early (tubular) embryonic hearts. Our algorithm uses a two-dimensional (2-D) deformable double-line model (DLM) to detect target cardiac tissues. The detection algorithm uses a maximum-likelihood estimator and was successfully applied to 4-D in vivo OCT images of the heart outflow tract of day three chicken embryos. The extracted shapes captured the dynamics of the chick embryonic heart outflow tract wall, enabling further analysis of cardiac motion.

Survey of Current Practice Patterns in the Management of Frontal Sinus Fractures

PubMed Central

Choi, Kevin J.; Chang, Bora; Woodard, Charles R.; Powers, David B.; Marcus, Jeffrey R.; Puscas, Liana

2017-01-01

The management of frontal sinus fractures has evolved in the endoscopic era. The development of functional endoscopic sinus surgery (FESS) has been incorporated into management algorithms proposed by otolaryngologists, but the extent of its influence on plastic surgeons and oral and maxillofacial surgeons is heretofore unknown. A cross-sectional survey was performed to assess the practice pattern variations in frontal sinus fracture management across multiple surgical disciplines. A total of 298 surveys were reviewed. 33.5% were facial plastic surgeons with otolaryngology training, 25.8% general otolaryngologists, 25.5% plastic surgeons, and 15.1% oral and maxillofacial surgeons. 74.8% of respondents practiced in an academic setting. 61.7% felt endoscopic sinus surgery changed their management of frontal sinus fractures. 91.8% of respondents favored observation for uncomplicated, nondisplaced frontal sinus outflow tract fractures. 36.4% favored observation and 35.9% favored endoscopic sinus surgery for uncomplicated, displaced frontal sinus outflow tract fractures. For complicated, displaced frontal sinus outflow tract fractures, obliteration was more frequently favored by plastic surgeons and oral and maxillofacial surgeons than those with otolaryngology training. The utility of FESS in managing frontal sinus fractures appears to be recognized across multiple surgical disciplines. PMID:28523084

Septation and separation within the outflow tract of the developing heart

PubMed Central

Webb, Sandra; Qayyum, Sonia R; Anderson, Robert H; Lamers, Wouter H; Richardson, Michael K

2003-01-01

The developmental anatomy of the ventricular outlets and intrapericardial arterial trunks is a source of considerable confusion. First, major problems exist because of the multiple names and definitions used to describe this region of the heart as it develops. Second, there is no agreement on the boundaries of the described components, nor on the number of ridges or cushions to be found dividing the outflow tract, and the pattern of their fusion. Evidence is also lacking concerning the role of the fused cushions relative to that of the so-called aortopulmonary septum in separating the intrapericardial components of the great arterial trunks. In this review, we discuss the existing problems, as we see them, in the context of developmental and postnatal morphology. We concentrate, in particular, on the changes in the nature of the wall of the outflow tract, which is initially myocardial throughout its length. Key features that, thus far, do not seem to have received appropriate attention are the origin, and mode of separation, of the intrapericardial portions of the arterial trunks, and the formation of the walls of the aortic and pulmonary valvar sinuses. Also as yet undetermined is the formation of the free-standing muscular subpulmonary infundibulum, the mechanism of its separation from the aortic valvar sinuses, and its differentiation, if any, from the muscular ventricular outlet septum. PMID:12739611

Pulmonary damage following right ventricular outflow tachycardia ablation in a child: When electroanatomical mapping isn't good enough.

PubMed

Bansal, Neha; Kobayashi, Daisuke; Karpawich, Peter P

2017-11-11

A 14-year-old female was referred for severe pulmonary valve insufficiency after undergoing radiofrequency ablation for a right ventricular outflow tract tachycardia that originated in the proximal pulmonary artery at 10 years of age. Clinical records indicated that ablation was guided solely by electrograms and electroanatomical mapping. Due to myocardial tissue extensions, mapping failed to identify the level of the pulmonary valve annulus, which resulted in delivery of energy on the valve proper and into the pulmonary artery. She developed severe pulmonary valve insufficiency and moderate proximal pulmonary artery stenosis necessitating intravascular stent placement 4 years later with an associated transcatheter valve. Although the nonfluoroscopic approach during ablation has gained wide acceptance for use in children, this report highlights the benefits of adjunctive imaging to identify the precise location of the pulmonary valve when ablation therapy is contemplated in the right ventricle outflow tract. © 2017 Wiley Periodicals, Inc.

THE EFFECT OF RIGHT VENTRICULAR PACEMAKER LEAD POSITION ON FUNCTIONAL STATUS IN PATIENTS WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION.

PubMed

Mitov, Vladimir M; Perisic, Zoran; Jolic, Aleksandar; Kostic, Tomislav; Aleksic, Aleksandar; Aleksic, Zeljka

2016-07-01

The study was aimed at assessing the difference between the right ventricle apex versus the right ventricular outflow tract lead position in functional capacity in the patients with the preserved left ventricular ejection fraction after 12 months of pacemaker stimulation. This was a prospective, randomized, follow-up study, which lasted for 12 months. The study sample included 132 consecutive patients who were implanted with permanent anti-bradicardiac pacemaker. Regarding the right ventricular lead position the patients were divided into two groups: the right ventricle apex group consisting of 61 patients with right ventricular apex lead position. The right ventricular outflow tract group included 71 patients with right ventricular outflow tract lead position. Functional capacity was assessed by Minnesota Living With Heart Failure score, New York Heart Association class and Six Minute Walk Test. Left ventricular ejection fraction was assessed by echocardiography. Minnesota Living With Heart Failure score and New York Heart Association class had a statistically significant improvement in both study groups. The patients from right ventricle apex group walked 20.95% (p=O.03) more in comparison to starting values. The patients from right ventricular outflow tract group walked only 13.63% (p=0.09) longer distance than the startingoneConclusion. Analysis of tests of functional status New York Heart Association class and Minnesota Living With Heart Failure questionnaire showed an even improvement in the right ventricle apex and right ventricular outflow tract groups. Analysis of 6 minute walk test showed that only the patients with the preserved left ventricular ejection fraction from the right ventricle apex group had a significant improvement after 12 months of pacemaker stimulation..

Acromegaly-induced cardiomyopathy with dobutamine-induced outflow tract obstruction.

PubMed

Abdelsalam, Mahmoud A; Nippoldt, Todd B; Geske, Jeffrey B

2016-03-09

A 50-year-old man with a history of acromegaly was referred for preoperative cardiac evaluation preceding trans-sphenoidal resection of a pituitary macroadenoma. Dobutamine stress echocardiography was negative for myocardial ischaemia. Resting left ventricular (LV) LV ejection fraction (LVEF) was 64% and there was hypertrophy of ventricular septum (18 mm) without resting LV outflow tract obstruction. With 40 µg/kg/min of dobutamine, the LVEF became hyperdynamic at 80%, and there was a maximal instantaneous LV outflow tract gradient of 77 mm Hg. There was no delayed myocardial enhancement on cardiac MRI and the pattern of hypertrophy was concentric. Acromegaly-induced cardiomyopathy can mimic hypertrophic cardiomyopathy in the setting of dobutamine provocation. Because cardiomyopathy is an important cause of mortality in acromegaly, diagnosis and appropriate management are critical to improve survival. 2016 BMJ Publishing Group Ltd.

[Development and evaluation of a prosthetic valved conduit dilated by percutaneous approach: experimental study in the lamb].

PubMed

Boudjemline, Y; Laborde, F; Pineau, E; Mollet, A; Abadir, S; Bonhoeffer, P; Bonnet, D; Sidi, D

2006-05-01

This study was undertaken to develop a dilated valved conduit for reconstruction of the right ventricular outflow tract in the animal. The conduits were made by sewing a valved tube (Medtronic Inc) inside a vascular stent (Numed Inc). After preparation, they were inserted surgically in five lambs. The conduits were then dilated 6 weeks and 3 months after their implantation. Before sacrificing the animals at 3 months, a 22 mm valved stent was implanted percutaneously inside the surgical conduits. One animal died suddenly due to kinking of the conduit. Balloon dilatation was performed in the surviving animals. The first dilatation only had a modest impact on valvular function but it was much aggravated after the second dilatation. A valved stent was successfully inserted percutaneously. At sacrifice, all the conduits were completely engulfed in an intense fibrosis. In conclusion, a valved biological conduit for reconstruction of the right ventricular ejection tract has been developed and can be dilated sequentially to follow growth. The new product could have an important role to play in the management of congenital malformations involving the right ventricular outflow tract.

Prediction and characterisation of a highly conserved, remote and cAMP responsive enhancer that regulates Msx1 gene expression in cardiac neural crest and outflow tract.

PubMed

Miller, Kerry Ann; Davidson, Scott; Liaros, Angela; Barrow, John; Lear, Marissa; Heine, Danielle; Hoppler, Stefan; MacKenzie, Alasdair

2008-05-15

Double knockouts of the Msx1 and Msx2 genes in the mouse result in severe cardiac outflow tract malformations similar to those frequently found in newborn infants. Despite the known role of the Msx genes in cardiac formation little is known of the regulatory systems (ligand receptor, signal transduction and protein-DNA interactions) that regulate the tissue-specific expression of the Msx genes in mammals during the formation of the outflow tract. In the present study we have used a combination of multi-species comparative genomics, mouse transgenic analysis and in-situ hybridisation to predict and validate the existence of a remote ultra-conserved enhancer that supports the expression of the Msx1 gene in migrating mouse cardiac neural crest and the outflow tract primordia. Furthermore, culturing of embryonic explants derived from transgenic lines with agonists of the PKC and PKA signal transduction systems demonstrates that this remote enhancer is influenced by PKA but not PKC dependent gene regulatory systems. These studies demonstrate the efficacy of combining comparative genomics and transgenic analyses and provide a platform for the study of the possible roles of Msx gene mis-regulation in the aetiology of congenital heart malformation.

Muscular subaortic stenosis: the initial left ventricular inflow tract pressure as evidence of outflow tract obstruction.

PubMed

Wigle, E D; Auger, P; Marquis, Y

1966-10-15

Two types of intraventricular pressure differences within the left ventricle of man are described. The first is encountered in cases of muscular (or fibrous) subaortic stenosis, in which the outflow tract pressure distal to the stenosis (and proximal to the aortic valve) is low, whereas all pressures recorded in the left ventricle proximal to the stenosis, including that just inside the mitral valve (the initial inflow tract pressure) are high.The second type of intraventricular pressure difference may be recorded in patients without muscular subaortic stenosis when a heart catheter is advanced to the left ventricular wall in such a manner that it becomes imbedded or entrapped by cardiac muscle in systole. Such an entrapped catheter records a high intraventricular pressure that is believed to reflect intramyocardial tissue pressure, which normally exceeds intracavitary pressure. In such cases the initial inflow tract pressure is not high and is precisely equal to the outflow tract systolic pressure, i.e. both are recording intracavity pressure. This type of intramyocardial to intracavitary pressure difference may also be encountered in the left ventricle of dogs.The recent suggestion that intraventricular pressure differences in the left ventricle of cases of muscular subaortic stenosis are due to catheter entrapment by cardiac muscle is refuted by using the initial inflow tract pressure as the means of differentiation between the two types of intraventricular pressure differences outlined.

Suicide right ventricle after lung transplantation for pulmonary vascular disease.

PubMed

Gangahanumaiah, Shivanand; Scarr, Bronwyn C; Buckland, Mark R; Pilcher, David V; Paraskeva, Miranda A; McGiffin, David C

2018-06-19

A 27-year-old female with Eisenmenger's syndrome underwent closure of a patent ductus arteriosus, closure of a perimembranous ventricular septal defect and mid muscular defect and bilateral lung transplantation. Her immediate postoperative course was complicated by severe right ventricular outflow tract (RVOT) obstruction resulting in hemodynamic collapse, a condition described as suicide right ventricle. The patient was placed on central Veno-Arterial Extra-Corporeal Membrane Oxygenation as a bridge to the relief of RVOT obstruction which included a right ventricular outflow muscle resection and a right ventricle outflow tract patch. The patient made an uneventful recovery. © 2018 Wiley Periodicals, Inc.

[Radionuclide diagnosis of upper urinary tract patency in patients with cancer of the cervix uteri ].

PubMed

Ashrafian, L A; Fomin, D K; Trushin, V I; Trepin, A V

2011-01-01

The experience with dynamic renal scintigraphy has shown its high informative value and safety in evaluating the degree of intrarenal urine outflow disorders. However, failure to make an objective assessment of ureteral patency considerably limits its study. The set of studies, which is given in this paper, is devoted to precisely this, highly urgent, problem. The authors have developed an original procedure for diagnosing impaired urine outflow along the ureters during dynamic renal scintigraphy. The visual and digital characteristics of normal and impaired urine outflow in the supravesical segment are defined. The criteria characterizing severe impairments of renal urine derivation along the ureters are denoted. Risk factors for urine outflow disorders are identified in patients with cancer of the cervix uteri, who receive various treatment modalities.

[The reasonable use of right ventricular protection strategy in right ventricular outflow tract reconstruction].

PubMed

Zhang, Y; Yuan, H Y; Liu, X B; Wen, S S; Xu, G; Cui, H J; Zhuang, J; Chen, J M

2018-06-01

As a result of right ventricular outflow tract reconstruction, which is the important and basic step of complex cardiac surgery, the blood flow of right ventricular outflow tract is unobstructed, while pulmonary valve regurgitation and right heart dysfunction could be happened. These problems are often ignored in early days, more and more cases of right heart dysfunction need clinical intervention, which is quite difficult and less effective. How to protect effectively the right ventricular function is the focus. At present main methods to protect the right ventricular function include trying to avoid or reduce length of right ventricular incision, reserving or rebuilding the function of the pulmonary valve, using growth potential material for surgery. The protection of the right ventricular function is a systemic project, it involves many aspects, single measures is difficult to provide complete protection, only the comprehensive use of various protection strategy, can help to improve the long-term prognosis.

Overlapping and differential localization of Bmp-2, Bmp-4, Msx-2 and apoptosis in the endocardial cushion and adjacent tissues of the developing mouse heart.

PubMed

Abdelwahid, E; Rice, D; Pelliniemi, L J; Jokinen, E

2001-07-01

The bone morphogenetic proteins BMP-2 and BMP-4 and the homeobox gene MSX-2 are required for normal development of many embryonic tissues. To elucidate their possible roles during the remodeling of the tubular heart into a fully septated four-chambered heart, we have localized the mRNA of Bmp-2, Bmp-4, Msx-2 and apoptotic cells in the developing mouse heart from embryonic day (E)11 to E17. mRNA was localized by in situ hybridization, and apoptotic cells by TUNEL (TDT-mediated dUTP-biotin nick end-labeling) as well as by transmission electron microscopy. By analyzing adjacent serial sections, we demonstrated that the expression of Msx-2 and Bmp-2 strikingly overlapped in the atrioventricular canal myocardium, in the atrioventricular junctional myocardium, and in the maturing myocardium of the atrioventricular valves. Bmp-4 was expressed in the outflow tract myocardium and in the endocardial cushion of the outflow tract ridges from E12 to E14. Msx-2 appeared in the mesenchyme of the atrioventricular endocardial cushion from E11 to E14, while Bmp-2 and Bmp-4 were detected between E11 and E14. Apoptotic cells were also detected in the mesenchyme of the endocardial cushion between E12 and E14. Our results suggest that BMP-2 and MSX-2 are tightly linked to the formation of the atrioventricular junction and valves and that BMP-4 is involved in the development of the outflow tract myocardium and of the endocardial cushion. In addition, BMP-2, BMP-4 and MSX-2 and apoptosis seem to be associated with differentiation of the endocardial cushion.

STAR (Simple Targeted Arterial Rendering) Technique: a Novel and Simple Method to Visualize the Fetal Cardiac Outflow Tracts

PubMed Central

Yeo, Lami; Romero, Roberto; Jodicke, Cristiano; Kim, Sun Kwon; Gonzalez, Juan M.; Oggè, Giovanna; Lee, Wesley; Kusanovic, Juan Pedro; Vaisbuch, Edi; Hassan, Sonia S.

2010-01-01

Objective To describe a novel and simple technique (STAR: Simple Targeted Arterial Rendering) to visualize the fetal cardiac outflow tracts from dataset volumes obtained with spatiotemporal image correlation (STIC) and applying a new display technology (OmniView). Methods We developed a technique to image the outflow tracts by drawing three dissecting lines through the four-chamber view of the heart contained in a STIC volume dataset. Each line generated the following plane: 1) Line 1: ventricular septum “en face” with both great vessels (pulmonary artery anterior to the aorta); 2) Line 2: pulmonary artery with continuation into the longitudinal view of the ductal arch; and 3) Line 3: long axis view of the aorta arising from the left ventricle. The pattern formed by all 3 lines intersecting approximately through the crux of the heart resembles a “star”. The technique was then tested in 50 normal hearts (15.3 – 40.4 weeks of gestation). To determine if the technique could identify planes that departed from the normal images, we tested the technique in 4 cases with proven congenital heart defects (ventricular septal defect, transposition of great vessels, tetralogy of Fallot, and pulmonary atresia with intact ventricular septum). Results The STAR technique was able to generate the intended planes in all 50 normal cases. In the abnormal cases, the STAR technique allowed identification of the ventricular septal defect, demonstrated great vessel anomalies, and displayed views that deviated from what was expected from the examination of normal hearts. Conclusions This novel and simple technique can be used to visualize the outflow tracts and ventricular septum “en face” in normal fetal hearts. The inability to obtain expected views or the appearance of abnormal views in the generated planes should raise the index of suspicion for congenital heart disease involving the great vessels and/or the ventricular septum. The STAR technique may simplify examination of the fetal heart and could reduce operator dependency. PMID:20878672

[Evaluation of upper urinary tract function in patients undergoing autoplastic surgery for hydronphrosis of the intrarenal pelvis].

PubMed

Kurbanaliev, R M; Usupbaev, A Ch; Kolesnichenko, I V; Sadyrbekov, N Zh; Sultanov, B M

2018-05-01

To investigate the functional state of the upper urinary tract in patients undergoing autoplastic surgery for a hydronophrosis of the intrarenal pelvis. The study comprised 78 patients with the intrarenal pelvis and impaired urinary outflow due to stricture of the ureteropelvic junction and vascular conflict (interatrial and arteriovenous narrowing), who underwent pyeloplasty using autologous tunica vaginalis. All patients underwent an incision of ureteropelvic stricture and resection of the parietal layer of the tunica vaginalis which was used to repair the obstruction site and internal stenting of the upper urinary tract. The patients were examined at baseline and during follow-up ranging from 3 months to 3 years. At three months after surgery, there was a decrease in the size of the renal pelvis and calyces with an improvement of all parameters of uro- and hemodynamics. At three years after surgery, the structural and functional parameters of the upper urinary tract were completely restored. Obstructive uropathy, resulting from the intrarenal pelvis, leads to persistently impaired urinary outflow from the upper urinary tract. Surgical intervention is the only curative treatment able to restore the urinary flow. In men with the intrarenal pelvis, the autoplastic surgery of the ureteropelvic junction obstruction using a parietal layer of the tunica vaginalis is an effective surgical modality improving renal pelvis capacity and contributing to the recovery of urinary outflow from the upper urinary tract.

Short- and Medium-Term Outcomes After Transcatheter Pulmonary Valve Placement in the Expanded Multicenter US Melody Valve Trial

PubMed Central

McElhinney, Doff B.; Hellenbrand, William E.; Zahn, Evan M.; Jones, Thomas K.; Cheatham, John P.; Lock, James E.; Vincent, Julie A.

2014-01-01

Background Transcatheter pulmonary valve placement is an emerging therapy for pulmonary regurgitation and right ventricular outflow tract obstruction in selected patients. The Melody valve was recently approved in the United States for placement in dysfunctional right ventricular outflow tract conduits. Methods and Results From January 2007 to August 2009, 136 patients (median age, 19 years) underwent catheterization for intended Melody valve implantation at 5 centers. Implantation was attempted in 124 patients; in the other 12, transcatheter pulmonary valve placement was not attempted because of the risk of coronary artery compression (n=6) or other clinical or protocol contraindications. There was 1 death from intracranial hemorrhage after coronary artery dissection, and 1 valve was explanted after conduit rupture. The median peak right ventricular outflow tract gradient was 37 mm Hg before implantation and 12 mm Hg immediately after implantation. Before implantation, pulmonary regurgitation was moderate or severe in 92 patients (81% with data); no patient had more than mild pulmonary regurgitation early after implantation or during follow-up (≥1 year in 65 patients). Freedom from diagnosis of stent fracture was 77.8±4.3% at 14 months. Freedom from Melody valve dysfunction or reintervention was 93.5±2.4% at 1 year. A higher right ventricular outflow tract gradient at discharge (P=0.003) and younger age (P=0.01) were associated with shorter freedom from dysfunction. Conclusions In this updated report from the multicenter US Melody valve trial, we demonstrated an ongoing high rate of procedural success and encouraging short-term valve function. All reinterventions in this series were for right ventricular outflow tract obstruction, highlighting the importance of patient selection, adequate relief of obstruction, and measures to prevent and manage stent fracture. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00740870. PMID:20644013

Dishevelled 2 is essential for cardiac outflow tract development, somite segmentation and neural tube closure.

PubMed

Hamblet, Natasha S; Lijam, Nardos; Ruiz-Lozano, Pilar; Wang, Jianbo; Yang, Yasheng; Luo, Zhenge; Mei, Lin; Chien, Kenneth R; Sussman, Daniel J; Wynshaw-Boris, Anthony

2002-12-01

The murine dishevelled 2 (Dvl2) gene is an ortholog of the Drosophila segment polarity gene Dishevelled, a member of the highly conserved Wingless/Wnt developmental pathway. Dvl2-deficient mice were produced to determine the role of Dvl2 in mammalian development. Mice containing null mutations in Dvl2 present with 50% lethality in both inbred 129S6 and in a hybrid 129S6-NIH Black Swiss background because of severe cardiovascular outflow tract defects, including double outlet right ventricle, transposition of the great arteries and persistent truncus arteriosis. The majority of the surviving Dvl2(-/-) mice were female, suggesting that penetrance was influenced by sex. Expression of Pitx2 and plexin A2 was attenuated in Dvl2 null mutants, suggesting a defect in cardiac neural crest development during outflow tract formation. In addition, approximately 90% of Dvl2(-/-) mice have vertebral and rib malformations that affect the proximal as well as the distal parts of the ribs. These skeletal abnormalities were more pronounced in mice deficient for both Dvl1 and Dvl2. Somite differentiation markers used to analyze Dvl2(-/-) and Dvl1(-/-);Dvl2(-/-) mutant embryos revealed mildly aberrant expression of Uncx4.1, delta 1 and myogenin, suggesting defects in somite segmentation. Finally, 2-3% of Dvl2(-/-) embryos displayed thoracic spina bifida, while virtually all Dvl1/2 double mutant embryos displayed craniorachishisis, a completely open neural tube from the midbrain to the tail. Thus, Dvl2 is essential for normal cardiac morphogenesis, somite segmentation and neural tube closure, and there is functional redundancy between Dvl1 and Dvl2 in some phenotypes.

Changes in dynamic embryonic heart wall motion in response to outflow tract banding measured using video densitometry

NASA Astrophysics Data System (ADS)

Stovall, Stephanie; Midgett, Madeline; Thornburg, Kent; Rugonyi, Sandra

2016-11-01

Abnormal blood flow during early cardiovascular development has been identified as a key factor in the pathogenesis of congenital heart disease; however, the mechanisms by which altered hemodynamics induce cardiac malformations are poorly understood. This study used outflow tract (OFT) banding to model increased afterload, pressure, and blood flow velocities at tubular stages of heart development and characterized the immediate changes in cardiac wall motion due to banding in chicken embryo models with light microscopy-based video densitometry. Optical videos were used to acquire two-dimensional heart image sequences over the cardiac cycle, from which intensity data were extracted along the heart centerline at several locations in the heart ventricle and OFT. While no changes were observed in the synchronous contraction of the ventricle with banding, the peristaltic-like wall motion in the OFT was significantly affected. Our data provide valuable insight into early cardiac biomechanics and its characterization using a simple light microscopy-based imaging modality.

Surgical treatment of pulmonic stenosis in dogs under cardiopulmonary bypass: outcome in nine dogs.

PubMed

Bristow, P; Sargent, J; Luis Fuentes, V; Brockman, D

2018-01-01

To describe the outcome for nine dogs with pulmonic stenosis treated by open patch grafting using expanded polytetrafluoroethylene under cardiopulmonary bypass. Data were collected from the hospital records of all dogs that had undergone right ventricular outflow tract grafting with an expanded polytetrafluoroethylene patch under cardiopulmonary bypass between 2006 and 2012 for the treatment of pulmonic stenosis. Echocardiographic images were reviewed and the pressure gradient across the right ventricular outflow tract re-measured. Owners of dogs still alive at the time of writing were invited to return to the hospital for reassessment. Nine dogs met the inclusion criteria. Median pressure gradient preoperatively was 118 mmHg, (range 102 to 259 mmHg) reducing to a median of 20 mmHg (range 7 to 53 mmHg) at 48 hours postoperatively and 14 mmHg (range 10 to 70 mmHg), with a median percentage reduction of 89% (range 41 to 94%) at long-term follow-up. Eight of nine dogs survived surgery, with six of nine surviving to hospital discharge. Two dogs were still alive over 6 and 8 years postoperatively. No long-term deaths were believed to be attributable to pulmonic stenosis. Expanded polytetrafluoroethylene patch grafting of the right ventricular outflow tract for treatment of severe pulmonic stenosis in dogs is feasible and can be an effective method to reduce the severity of right ventricular outflow tract obstruction. © 2017 British Small Animal Veterinary Association.

Murine Dishevelled 3 Functions in Redundant Pathways with Dishevelled 1 and 2 in Normal Cardiac Outflow Tract, Cochlea, and Neural Tube Development

PubMed Central

Etheridge, S. Leah; Ray, Saugata; Li, Shuangding; Hamblet, Natasha S.; Lijam, Nardos; Tsang, Michael; Greer, Joy; Kardos, Natalie; Wang, Jianbo; Sussman, Daniel J.; Chen, Ping; Wynshaw-Boris, Anthony

2008-01-01

Dishevelled (Dvl) proteins are important signaling components of both the canonical β-catenin/Wnt pathway, which controls cell proliferation and patterning, and the planar cell polarity (PCP) pathway, which coordinates cell polarity within a sheet of cells and also directs convergent extension cell (CE) movements that produce narrowing and elongation of the tissue. Three mammalian Dvl genes have been identified and the developmental roles of Dvl1 and Dvl2 were previously determined. Here, we identify the functions of Dvl3 in development and provide evidence of functional redundancy among the three murine Dvls. Dvl3 −/− mice died perinatally with cardiac outflow tract abnormalities, including double outlet right ventricle and persistent truncus arteriosis. These mutants also displayed a misorientated stereocilia in the organ of Corti, a phenotype that was enhanced with the additional loss of a single allele of the PCP component Vangl2/Ltap (LtapLp/+). Although neurulation appeared normal in both Dvl3 −/− and LtapLp/+ mutants, Dvl3 +/−;LtapLp/+ combined mutants displayed incomplete neural tube closure. Importantly, we show that many of the roles of Dvl3 are also shared by Dvl1 and Dvl2. More severe phenotypes were observed in Dvl3 mutants with the deficiency of another Dvl, and increasing Dvl dosage genetically with Dvl transgenes demonstrated the ability of Dvls to compensate for each other to enable normal development. Interestingly, global canonical Wnt signaling appeared largely unaffected in the double Dvl mutants, suggesting that low Dvl levels are sufficient for functional canonical Wnt signals. In summary, we demonstrate that Dvl3 is required for cardiac outflow tract development and describe its importance in the PCP pathway during neurulation and cochlea development. Finally, we establish several developmental processes in which the three Dvls are functionally redundant. PMID:19008950

Murine dishevelled 3 functions in redundant pathways with dishevelled 1 and 2 in normal cardiac outflow tract, cochlea, and neural tube development.

PubMed

Etheridge, S Leah; Ray, Saugata; Li, Shuangding; Hamblet, Natasha S; Lijam, Nardos; Tsang, Michael; Greer, Joy; Kardos, Natalie; Wang, Jianbo; Sussman, Daniel J; Chen, Ping; Wynshaw-Boris, Anthony

2008-11-01

Dishevelled (Dvl) proteins are important signaling components of both the canonical beta-catenin/Wnt pathway, which controls cell proliferation and patterning, and the planar cell polarity (PCP) pathway, which coordinates cell polarity within a sheet of cells and also directs convergent extension cell (CE) movements that produce narrowing and elongation of the tissue. Three mammalian Dvl genes have been identified and the developmental roles of Dvl1 and Dvl2 were previously determined. Here, we identify the functions of Dvl3 in development and provide evidence of functional redundancy among the three murine Dvls. Dvl3(-/-) mice died perinatally with cardiac outflow tract abnormalities, including double outlet right ventricle and persistent truncus arteriosis. These mutants also displayed a misorientated stereocilia in the organ of Corti, a phenotype that was enhanced with the additional loss of a single allele of the PCP component Vangl2/Ltap (LtapLp/+). Although neurulation appeared normal in both Dvl3(-/-) and LtapLp/+ mutants, Dvl3(+/-);LtapLp/+ combined mutants displayed incomplete neural tube closure. Importantly, we show that many of the roles of Dvl3 are also shared by Dvl1 and Dvl2. More severe phenotypes were observed in Dvl3 mutants with the deficiency of another Dvl, and increasing Dvl dosage genetically with Dvl transgenes demonstrated the ability of Dvls to compensate for each other to enable normal development. Interestingly, global canonical Wnt signaling appeared largely unaffected in the double Dvl mutants, suggesting that low Dvl levels are sufficient for functional canonical Wnt signals. In summary, we demonstrate that Dvl3 is required for cardiac outflow tract development and describe its importance in the PCP pathway during neurulation and cochlea development. Finally, we establish several developmental processes in which the three Dvls are functionally redundant.

Elevated left ventricular outflow tract velocities on exercise stress echocardiography may be a normal physiologic response in healthy youth.

PubMed

Wittlieb-Weber, Carol A; Cohen, Meryl S; McBride, Michael G; Paridon, Stephen M; Morrow, Robert; Wasserman, Melissa; Wang, Yan; Stephens, Paul

2013-12-01

Children with heart disease are at risk for sudden death during exercise, yet decisions regarding sports participation are often based on resting data. Acceleration across the left ventricular outflow tract (LVOT) assessed on stress echocardiography may suggest a diagnosis of hypertrophic cardiomyopathy in patients in whom it is not otherwise obvious. However, the range of peak velocities across the LVOT in healthy youth is unknown. The aim of this study was to describe LVOT velocities with maximal exercise in this age group. Subjects up to 18 years old were prospectively enrolled if they had normal results on resting echocardiography and were undergoing exercise testing for other reasons. Subjects with significant comorbidities, suspected cardiomyopathy, or family histories of cardiomyopathy were excluded. Peak LVOT velocities were measured in the upright position using continuous-wave Doppler immediately after maximal exercise. Fifty subjects (mean age, 13.8 ± 2.8 years) were included. Twenty-eight (56%) were male, and 40 (80%) were Caucasian. The median peak LVOT velocity measured immediately after exercise was 2.5 m/sec (range, 1.3-5.9 m/sec). Sixteen subjects (32%) developed peak LVOT velocities of ≥3 m/sec. Twelve of the 16 (75%) with elevated velocities had a dynamic outflow tract Doppler pattern, of whom eight had evidence of intracavitary narrowing on two-dimensional echocardiography. The development of significant exercise-induced LVOT velocities may be a normal physiologic finding in healthy youth. The measurement of LVOT velocities alone with maximal exercise may not help distinguish patients with hypertrophic cardiomyopathy from healthy children. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

Myocardialization of the cardiac outflow tract

NASA Technical Reports Server (NTRS)

van den Hoff, M. J.; Moorman, A. F.; Ruijter, J. M.; Lamers, W. H.; Bennington, R. W.; Markwald, R. R.; Wessels, A.

1999-01-01

During development, the single-circuited cardiac tube transforms into a double-circuited four-chambered heart by a complex process of remodeling, differential growth, and septation. In this process the endocardial cushion tissues of the atrioventricular junction and outflow tract (OFT) play a crucial role as they contribute to the mesenchymal components of the developing septa and valves in the developing heart. After fusion, the endocardial ridges in the proximal portion of the OFT initially form a mesenchymal outlet septum. In the adult heart, however, this outlet septum is basically a muscular structure. Hence, the mesenchyme of the proximal outlet septum has to be replaced by cardiomyocytes. We have dubbed this process "myocardialization." Our immunohistochemical analysis of staged chicken hearts demonstrates that myocardialization takes place by ingrowth of existing myocardium into the mesenchymal outlet septum. Compared to other events in cardiac septation, it is a relatively late process, being initialized around stage H/H28 and being basically completed around stage H/H38. To unravel the molecular mechanisms that are responsible for the induction and regulation of myocardialization, an in vitro culture system in which myocardialization could be mimicked and manipulated was developed. Using this in vitro myocardialization assay it was observed that under the standard culture conditions (i) whole OFT explants from stage H/H20 and younger did not spontaneously myocardialize the collagen matrix, (ii) explants from stage H/H21 and older spontaneously formed extensive myocardial networks, (iii) the myocardium of the OFT could be induced to myocardialize and was therefore "myocardialization-competent" at all stages tested (H/H16-30), (iv) myocardialization was induced by factors produced by, most likely, the nonmyocardial component of the outflow tract, (v) at none of the embryonic stages analyzed was ventricular myocardium myocardialization-competent, and finally, (vi) ventricular myocardium did not produce factors capable of supporting myocardialization. Copyright 1999 Academic Press.

Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry.

PubMed

Veselka, Josef; Jensen, Morten Kvistholm; Liebregts, Max; Januska, Jaroslav; Krejci, Jan; Bartel, Thomas; Dabrowski, Maciej; Hansen, Peter Riis; Almaas, Vibeke Marie; Seggewiss, Hubert; Horstkotte, Dieter; Tomasov, Pavol; Adlova, Radka; Bundgaard, Henning; Steggerda, Robbert; Ten Berg, Jurriën; Faber, Lothar

2016-05-14

The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated. We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01). The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Anatomy of the ventricular septal defect in outflow tract defects: similarities and differences.

PubMed

Mostefa-Kara, Meriem; Bonnet, Damien; Belli, Emre; Fadel, Elie; Houyel, Lucile

2015-03-01

The study objective was to analyze the anatomy of the ventricular septal defect found in various phenotypes of outflow tract defects. We reviewed 277 heart specimens with isolated outlet ventricular septal defect without subpulmonary stenosis (isolated outlet ventricular septal defect, 19); tetralogy of Fallot (71); tetralogy of Fallot with pulmonary atresia (51); common arterial trunk (54); double outlet right ventricle (65) with subaortic, doubly committed, or subpulmonary ventricular septal defect; and interrupted aortic arch type B (17). Special attention was paid to the rims of the ventricular septal defect viewed from the right ventricular side and the relationships between the tricuspid and aortic valves. The ventricular septal defect was always located in the outlet of the right ventricle, between the 2 limbs of the septal band. There was a fibrous continuity between the tricuspid and aortic valves in 74% of specimens with isolated outlet ventricular septal defect, 66% of specimens with tetralogy of Fallot, 39% of specimens with tetralogy of Fallot with pulmonary atresia, 4.6% of specimens with double outlet right ventricle, 1.8% of specimens with common arterial trunk, and zero of specimens with interrupted aortic arch type B (P < .005). When present, this continuity always involved the anterior tricuspid leaflet. The ventricular septal defect in outflow tract defects is always an outlet ventricular septal defect, cradled between the 2 limbs of the septal band. However, there are some differences regarding the posteroinferior and superior rims of the ventricular septal defect. These differences suggest an anatomic continuum from the isolated outlet ventricular septal defect to the interrupted aortic arch type B rather than distinct physiologic phenotypes, related to various degrees of abnormal rotation of the outflow tract during heart development: minimal in isolated outlet ventricular septal defect; incomplete in tetralogy of Fallot, tetralogy of Fallot with pulmonary atresia, and double outlet right ventricle; absent in common arterial trunk; and excessive in interrupted aortic arch type B. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Stenting of the right ventricular outflow tract in 2 dogs for palliation of dysplastic pulmonary valve stenosis and right-to-left intracardiac shunting defects.

PubMed

Scansen, Brian A; Kent, Agnieszka M; Cheatham, Sharon L; Cheatham, John P; Cheatham, John D

2014-09-01

Two dogs with severe dysplastic pulmonary valve stenosis and right-to-left shunting defects (patent foramen ovale, perimembranous ventricular septal defect) underwent palliative stenting of the right ventricular outflow tract and pulmonary valve annulus using balloon expandable stents. One dog received 2 over-lapping bare metal stents placed 7 months apart; the other received a single covered stent. Both procedures were considered technically successful with a reduction in the transpulmonary valve pressure gradient from 202 to 90 mmHg in 1 dog and from 168 to 95 mmHg in the other. Clinical signs of exercise intolerance and syncope were temporarily resolved in both dogs. However, progressive right ventricular concentric hypertrophy, recurrent stenosis, and erythrocytosis were observed over the subsequent 6 months leading to poor long-term outcomes. Stenting of the right ventricular outflow tract is feasible in dogs with severe dysplastic pulmonary valve stenosis, though further study and optimization of the procedure is required. Copyright © 2014 Elsevier B.V. All rights reserved.

EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Congenital left-sided heart obstruction

PubMed Central

Carr, Michelle; Curtis, Stephanie; Marek, Jan

2018-01-01

Congenital obstruction of the left ventricular outflow tract remains a significant problem and multilevel obstruction can often coexist. Obstruction can take several morphological forms and may involve the subvalvar, valvar or supravalvar portion of the aortic valve complex. Congenital valvar stenosis presenting in the neonatal period represents a spectrum of disorders ranging from the hypoplastic left heart syndrome to almost normal hearts. Treatment options vary dependent on the severity of the left ventricular outflow tract obstruction (LVOTO) and the variable degree of left ventricular hypoplasia as well as the associated lesions such as arch hypoplasia and coarctation. PMID:29681546

An unusual presentation of papillary fibroelastoma originating from right ventricular outflow tract.

PubMed

Erdogan, Mehmet; Guney, Murat Can; Ayhan, Hüseyin; Kasapkara, Hacı Ahmet; Uğuz, Emrah; Durmaz, Tahir; Keleş, Telat; Bozkurt, Engin

2017-03-01

Papillary fibroelastomas (PFEs) are primary cardiac tumors with a benign and avascular nature. Majority of the PFEs are originated from the valvular endocardium, while the most common site is aortic valve. In this case, we present a patient with multiple PFEs originating from the right ventricular outflow tract who was admitted to our clinic with exertional dyspnea. As far as we know, this is the first case of this unusual presentation of multiple PFEs and also had a history of breast cancer and permanent pacemaker reported in the literature. © 2017, Wiley Periodicals, Inc.

Right Ventricular Outflow Tract Tachycardia with Structural Abnormalities of the Right Ventricle and Left Ventricular Diverticulum.

PubMed

Martini, Bortolo; Trevisi, Nicola; Martini, Nicolò; Zhang, Li

2015-01-01

A 43-year-old woman presented to the emergency room with a sustained ventricular tachycardia (VT). ECG showed a QRS in left bundle branch block morphology with inferior axis. Echocardiography, ventricular angiography, and cardiac magnetic resonance imaging (CMRI) revealed a normal right ventricle and a left ventricular diverticulum. Electrophysiology studies with epicardial voltage mapping identified a large fibrotic area in the inferolateral layer of the right ventricular wall and a small area of fibrotic tissue at the anterior right ventricular outflow tract. VT ablation was successfully performed with combined epicardial and endocardial approaches.

Right Ventricular Outflow Tract Tachycardia with Structural Abnormalities of the Right Ventricle and Left Ventricular Diverticulum

PubMed Central

Martini, Bortolo; Trevisi, Nicola; Martini, Nicolò; Zhang, Li

2015-01-01

A 43-year-old woman presented to the emergency room with a sustained ventricular tachycardia (VT). ECG showed a QRS in left bundle branch block morphology with inferior axis. Echocardiography, ventricular angiography, and cardiac magnetic resonance imaging (CMRI) revealed a normal right ventricle and a left ventricular diverticulum. Electrophysiology studies with epicardial voltage mapping identified a large fibrotic area in the inferolateral layer of the right ventricular wall and a small area of fibrotic tissue at the anterior right ventricular outflow tract. VT ablation was successfully performed with combined epicardial and endocardial approaches. PMID:26509086

Dynamic right ventricular outflow tract (infundibular) stenosis and pectus excavatum in a dog

PubMed Central

Fournier, Tanya E.

2008-01-01

This is the first published report of a dog with dynamic right ventricular outflow tract (infundibular) stenosis, right ventricular hypertrophy, and pectus excavatum. A juvenile dog presented with a grade V/VI left base systolic heart murmur, tachycardia, and pectus excavatum. Diagnosis of the aforementioned conditions was based on radiography, electrocardiography, and echocardiography. At 9 1/2 wk of age the heart murmur was no longer audible and the right ventricular stenosis and hypertrophy had dissipated and regressed, respectively. Resolution may be associated with growth of the dog. A good prognosis is foreseen. PMID:18512460

Percutaneous pulmonary valve implantation in patients with dysfunction of a "native" right ventricular outflow tract - Mid-term results.

PubMed

Georgiev, Stanimir; Tanase, Daniel; Ewert, Peter; Meierhofer, Christian; Hager, Alfred; von Ohain, Jelena Pabst; Eicken, Andreas

2018-05-01

To investigate the feasibility and mid-term results of percutaneous pulmonary valve implantation (PPVI) in patients with conduit free or "native" right ventricular outflow tracts (RVOT). We identified all 18 patients with conduit free or "native" right ventricular outflow tract, who were treated with percutaneous pulmonary valve implantation (PPVI) in our institution. They were divided into two groups - these in whom the central pulmonary artery was used as an anchoring point for the preparation of the landing zone (n=10) for PPVI and these, in whom a pulmonary artery branch was used for this purpose (n=8). PPVI was performed successfully in all patients with significant immediate RVOT gradient and pulmonary regurgitation grade reduction. Four patients had insignificant paravalvular regurgitation. In one patient the valve was explanted after 4months because of bacterial endocarditis. A follow-up of 19 (4-60) months showed sustained good function of the other implanted valves. The MRI indexed right ventricular end diastolic volume significantly decreased from 108(54-174) ml/m 2 before the procedure to 76(60-126) ml/m 2 six months after PPVI, p=0.01. PPVI is feasible with good mid-term results in selected patients with a "native" RVOT without a previously implanted conduit. Creating a stable landing zone with a diameter less than the largest available valve (currently 29mm) is crucial for the technical success of the procedure. Further studies and the development of new devices could widen the indications for this novel treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

An electrocardiographic scoring system for distinguishing right ventricular outflow tract arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy from idiopathic ventricular tachycardia.

PubMed

Hoffmayer, Kurt S; Bhave, Prashant D; Marcus, Gregory M; James, Cynthia A; Tichnell, Crystal; Chopra, Nagesh; Moxey, Laura; Krahn, Andrew D; Dixit, Sanjay; Stevenson, William; Calkins, Hugh; Badhwar, Nitish; Gerstenfeld, Edward P; Scheinman, Melvin M

2013-04-01

Ventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and idiopathic ventricular tachycardia (VT) can share a left bundle branch block/inferior axis morphology. We previously reported electrocardiogram characteristics during outflow tract ventricular arrhythmias that helped distinguish VT related to ARVD/C from idiopathic VT. To prospectively validate these criteria. We created a risk score by using a derivation cohort. Two experienced electrophysiologists blinded to the diagnosis prospectively scored patients with VT/premature ventricular contractions (PVCs) with left bundle branch block/inferior axis pattern in a validation cohort of 37 ARVD/C tracings and 49 idiopathic VT tracings. All patients with ARVD/C had their diagnosis confirmed based on the revised task force criteria. Patients with idiopathic VT were selected based on structurally normal hearts with documented right ventricular outflow tract VT successfully treated with ablation. The scoring system provides 3 points for sinus rhythm anterior T-wave inversions in leads V1-V3 and during ventricular arrhythmia: 2 points for QRS duration in lead I≥120 ms, 2 points for QRS notching, and 1 point for precordial transition at lead V5 or later. A score of 5 or greater was able to correctly distinguish ARVD/C from idiopathic VT 93% of the time, with a sensitivity of 84%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 91%. We describe a simple scoring algorithm that uses 12-lead electrocardiogram characteristics to effectively distinguish right ventricular outflow tract arrhythmias originating from patients with ARVD/C versus patients with idiopathic VT. Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

The bulbus arteriosus of the holocephalan heart: gross anatomy, histomorphology, pigmentation, and evolutionary significance.

PubMed

Rodríguez, Cristina; Lorenzale, Miguel; López-Unzu, Miguel A; Fernández, Borja; Salmerón, Francisca; Sans-Coma, Valentín; Durán, Ana C

2017-08-01

This study was designed to determine whether the outflow tract of the holocephalan heart is composed of a myocardial conus arteriosus and a non-myocardial bulbus arteriosus, as is the case in elasmobranchs. This is a key issue to verify the hypothesis that these two anatomical components existed from the onset of the jawed vertebrate radiation. The Holocephali are the sister group of the elasmobranchs, sharing with them a common, still unknown Palaeozoic ancestor. The sample examined herein consisted of hearts from individuals of four species, two of them belonging to the Chimaeridae and the other two to the Rhinochimaeridae. In all specimens, the cardiac outflow tract consisted of a conus arteriosus, with myocardium in its walls and two rows of valves at its luminal side, and an intrapericardial bulbus arteriosus shorter than the conus and devoid of valves. The bulbus, mainly composed of elastin and smooth musculature, was covered by the epicardium and crossed longitudinally by coronary artery trunks. These findings give added support to the viewpoint that the outflow tract of the primitive heart of the gnathostomes was not composed of a single component, but two, the conus and the bulbus. All rabbitfish (Chimaera monstrosa) examined had pigment cells over the surface of the heart. The degree of pigmentation, which varied widely between individuals, was particularly intense in the cardiac outflow tract. Pigment cells also occurred in the bulbus arteriosus of one of the two hearts of the straightnose rabbitfish (Rhinochimaera atlantica) included in the study. The cells containing pigment, presumably derived from the neural crest, were located in the subepicardium. Copyright © 2017 Elsevier GmbH. All rights reserved.

Inhibition of agonist-induced smooth muscle contraction by picotamide in the male human lower urinary tract outflow region.

PubMed

Hennenberg, Martin; Tamalunas, Alexander; Wang, Yiming; Keller, Patrick; Schott, Melanie; Strittmatter, Frank; Herlemann, Annika; Yu, Qingfeng; Rutz, Beata; Ciotkowska, Anna; Stief, Christian G; Gratzke, Christian

2017-05-15

Male lower urinary tract symptoms (LUTS) due to bladder outlet obstruction are characterized by abnormal smooth muscle contractions in the lower urinary tract. Alpha 1 -adrenoceptor antagonists may induce smooth muscle relaxation in the outflow region and represent the current gold standard of medical treatment. However, results may be unsatisfactory or inadequate. Apart from α 1 -adrenoceptor agonists, smooth muscle contraction in the outflow region may be induced by thromboxane A 2 (TXA 2 ), endothelins, or muscarinic receptor agonists. Here, we studied effects of the thromboxane A 2 receptor (TP receptor) antagonist picotamide on contraction in the human male bladder trigone and prostate. Carbachol, the α 1 -adrenoceptor agonist phenylephrine, the thromboxane A 2 analog U46619, and electric field stimulation (EFS) induced concentration- or frequency-dependent contractions of trigone tissues in an organ bath. Picotamide (300µM) inhibited carbachol-, phenylephrine-, U46619-, and EFS-induced contractions. Endothelins 1-3 induced concentration-dependent contractions of prostate tissues, which were inhibited by picotamide. Analyses using real time polymerase chain reaction and antibodies suggested expression of thromboxane A 2 receptors and synthase in trigone smooth muscle cells. Thromboxane B 2 (the stable metabolite of thromboxane A 2 ) was detectable by enzyme immune assay in trigone samples, with most values ranging between 50 and 150pg/mg trigone protein. Picotamide inhibits contractions induced by different stimuli in the human lower urinary tract, including cholinergic, adrenergic, thromboxane A 2 - and endothelin-induced, and neurogenic contractions in different locations of the outflow region. This distinguishes picotamide from current medical treatments for LUTS, and suggests that picotamide may induce urodynamic effects in vivo. Copyright © 2017. Published by Elsevier B.V.

Acquired discrete subaortic stenosis late after mitral valve replacement.

PubMed

Mohan, Jagdish C; Shukla, Madhu; Mohan, Vishwas; Sethi, Arvind

2016-09-01

Although acquired left ventricular outflow obstruction has been reported in a variety of conditions, there are scant reports of its occurrence following mitral valve replacement (MVR). This study describes two female patients, who developed severe discrete subaortic stenosis, five years following MVR. In both cases, the mitral valve was replaced by a porcine Carpentier-Edwards 27-mm bioprosthesis with preservation of mitral valve leaflets. The risk of very late left ventricular outflow tract obstruction after bio-prosthetic MVR with preservation of subvalvular apparatus needs to be kept in mind in symptomatic patients. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Anatomic Guidance For Ablation: Atrial Flutter, Fibrillation, and Outflow Tract Ventricular Tachycardia

PubMed Central

Sehar, Nandini; Mears, Jennifer; Bisco, Susan; Patel, Sandeep; Lachman, Nirusha; Asirvatham, Samuel J

2010-01-01

After initial documentation of excellent efficacy with radiofrequency ablation, this procedure is being performed increasingly in more complex situations and for more difficult arrhythmia. In these circumstances, an accurate knowledge of the anatomic basis for the ablation procedure will help maintain this efficacy and improve safety. In this review, we discuss the relevant anatomy for electrophysiology interventions for typical right atrial flutter, atrial fibrillation, and outflow tract ventricular tachycardia. In the pediatric population, maintaining safety is a greater challenge, and here again, knowing the neighboring and regional anatomy of the arrhythmogenic substrate for these arrhythmias may go a long way in preventing complications. PMID:20811537

Giant pseudoaneurysm of the left ventricular outflow tract: a rare disease.

PubMed

Acioli Pereira, Larissa; Fontes Gontijo, Paula; Alcântara Farran, Jorge; Palandri Chagas, Antonio Carlos; Romano, Edson Renato; Bento de Souza, Luis Carlos

2013-06-01

Pseudoaneurysm of the left ventricular outflow tract (LVOT) is a rare disease with high morbidity and mortality, resulting from left ventricular damage due to myocardial infarction, infective endocarditis or surgical trauma. A case of giant pseudoaneurysm of the LVOT, even more rarely reported in the literature, is described. The lesion was detected 12 years after aortic valve replacement for infective endocarditis in a young patient, a former intravenous drug user. As it is an uncommon disease, little is known about its clinical presentation and treatment. Copyright © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Origins location of the outflow tract ventricular arrhythmias exhibiting qrS pattern or QS pattern with a notch on the descending limb in lead V1.

PubMed

Lin, Cong; Zheng, Cheng; Zhou, De-Pu; Li, Xiao-Wei; Wu, Shu-Jie; Lin, Jia-Feng

2017-05-15

Ventricular outflow tract(VOT) ventricular arrhythmias(VAs) presenting qrS pattern or QS pattern with a notch on the descending limb in lead V1 were consistently thought of arising from the commissure between left and right coronary cusp (L-RCC) by previous studies. However, we found they could originate from other anatomic structures in VOT. This study aimed to investigate the exact origin of this kind VAs. Forty-nine patients of VOT premature ventricular contrations/ventricular tachycardia(PVCs/VT) with lead V1 presenting qrS pattern or QS pattern with a notch on the descending limb undergoing successful radiofrequency catheter ablation(RFCA) in our center were analyzed. 12-lead electrocardiogram(ECG) of these PVCs/VT were summarized. Among these PVCs/VT, 37 cases exhibited qrS morphology in lead V1, 12 cases presented QS pattern with a notch on the descending limb in the same lead. Based on the successful ablation sites, these PVCs/VT were divided into 2 groups: (1)Right ventricular outflow tract(RVOT) group (26 cases), and (2) Left ventricular outflow tract (LVOT) group(23 cases, 4 cases originating from the left coronary cusp(LCC), 2 from the right coronary cusp(RCC), 16 from the L-RCC, 1 from the area inferior to LCC(ILCC)). The ECG characteristics of each PVCs/VT were analyzed. Among these PVCs/VT, applying the precordial transitional zone index(TZ index) < 0 to predict LVOT origin was demonstrated with sensitivity of 95.65%, specificity of 96.15%, positive predicting value(PPV) of 95.65% and negative predicting value(NPV) of 96.15%. In LVOT group, further applying the r, R, m,or Rs morphology in lead I to predict L-RCC and RCC origin was demonstrated with sensitivity of 94.44%, specificity of 60.00%, PPV of 89.47% and NPV of 75.00%. Ventricular outflow tract PVCs/VT with lead V1 presenting qrS pattern or QS pattern with a notch on descending limb not only arising from L-RCC, but also RVOT, LCC, RCC and ILCC. Combining TZ index and QRS morphology in lead I to predict origin site of these kind VAs is a convenient, simple and reliable method and facilitates the RFCA procedure.

Mitral stenosis and hypertrophic obstructive cardiomyopathy: An unusual combination.

PubMed

Hong, Joonhwa; Schaff, Hartzell V; Ommen, Steve R; Abel, Martin D; Dearani, Joseph A; Nishimura, Rick A

2016-04-01

Systolic anterior motion of mitral valve (MV) leaflets is a main pathophysiologic feature of left ventricular outflow tract (LVOT) obstruction in hypertrophic obstructive cardiomyopathy. Thus, restricted leaflet motion that occurs with MV stenosis might be expected to minimize outflow tract obstruction related to systolic anterior motion. From January 1993 through February 2015, we performed MV replacement and septal myectomy in 12 patients with mitral stenosis and hypertrophic obstructive cardiomyopathy at Mayo Clinic Hospital in Rochester, Minn. Preoperative data, echocardiographic images, operative records, and postoperative outcomes were reviewed. Mean (standard deviation) age was 70 (7.6) years. Preoperative mean (standard deviation) maximal LVOT pressure gradient was 75.0 (35.0) mm Hg; MV gradient was 13.7 (2.8) mm Hg. From echocardiographic images, 4 mechanisms of outflow tract obstruction were identified: systolic anterior motion without severe limitation in MV leaflet excursion, severe limitation in MV leaflet mobility with systolic anterior motion at the tip of the MV anterior leaflet, septal encroachment toward the LVOT, and MV displacement toward the LVOT by calcification. Mitral valve replacement and extended septal myectomy relieved outflow gradients in all patients, with no death or serious morbidity. Patients with mitral stenosis and hypertrophic obstructive cardiomyopathy have multiple LVOT obstruction mechanisms, and MV replacement may not be adequate treatment. We favor septal myectomy and MV replacement in this complex subset of hypertrophic obstructive cardiomyopathy. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Apical Aortic Conduit Infection 27 Years After Repaired Left Ventricular Outflow Tract Obstruction.

PubMed

Carpenter, Dustin J; Fiore, Andrew C; Huddleston, Charles B

2014-07-01

Left ventricle to aortic conduits were used for the treatment of complex left ventricular outflow tract obstruction in the pediatric population in the mid-1970s. Although this technique has been largely replaced by the Ross-Konno procedure, many patients still have functioning apicoaortic conduits in place today. Few clinical reports or case series exist in pediatric cohorts documenting the natural history or potential long-term complications of this prosthesis. In this report, we describe our experience managing a patient with Shone's syndrome and an apical aortic porcine-valved conduit remnant that became infected 17 years postconduit valve excision for valvular insufficiency. © The Author(s) 2014.

[Experiences with the extracardial conduit in the reconstruction of the right ventricular outflow tract].

PubMed

Egloff, L; Schönbeck, M; Arbenz, U; Turina, M; Senning, A

1982-12-18

Operative correction of certain congenital cardiac malformations with discontinuity between the right ventricle and pulmonary artery is technically possible today with satisfactory late results. The atretic or hypoplastic outflow tract can be bridged by an external tubular graft containing a valvular prosthesis. Of 22 patients operated upon from 1978-1981, 16 survived the operation and perioperative period. There was one late death. Routine cardiac catheterization was performed in 6 non-selected patients between 7 and 22 months after surgery. No hemodynamically important gradients were found. The extracardiac conduit between the right ventricle and pulmonary artery has become an important tool in correcting certain forms of congenital heart disease.

Biomechanics of the Chick Embryonic Heart Outflow Tract at HH18 Using 4D Optical Coherence Tomography Imaging and Computational Modeling

PubMed Central

Liu, Aiping; Yin, Xin; Shi, Liang; Li, Peng; Thornburg, Kent L.; Wang, Ruikang; Rugonyi, Sandra

2012-01-01

During developmental stages, biomechanical stimuli on cardiac cells modulate genetic programs, and deviations from normal stimuli can lead to cardiac defects. Therefore, it is important to characterize normal cardiac biomechanical stimuli during early developmental stages. Using the chicken embryo model of cardiac development, we focused on characterizing biomechanical stimuli on the Hamburger–Hamilton (HH) 18 chick cardiac outflow tract (OFT), the distal portion of the heart from which a large portion of defects observed in humans originate. To characterize biomechanical stimuli in the OFT, we used a combination of in vivo optical coherence tomography (OCT) imaging, physiological measurements and computational fluid dynamics (CFD) modeling. We found that, at HH18, the proximal portion of the OFT wall undergoes larger circumferential strains than its distal portion, while the distal portion of the OFT wall undergoes larger wall stresses. Maximal wall shear stresses were generally found on the surface of endocardial cushions, which are protrusions of extracellular matrix onto the OFT lumen that later during development give rise to cardiac septa and valves. The non-uniform spatial and temporal distributions of stresses and strains in the OFT walls provide biomechanical cues to cardiac cells that likely aid in the extensive differential growth and remodeling patterns observed during normal development. PMID:22844414

Remote magnetic navigation for mapping and ablating right ventricular outflow tract tachycardia.

PubMed

Thornton, Andrew S; Jordaens, Luc J

2006-06-01

Navigation, mapping, and ablation in the right ventricular outflow tract (RVOT) can be difficult. Catheter navigation using external magnetic fields may allow more accurate mapping and ablation. The purpose of this study was to assess the feasibility of RVOT tachycardia ablation using remote magnetic navigation. Mapping and ablation were performed in eight patients with outflow tract ventricular arrhythmias. Tachycardia mapping was undertaken with a 64-polar basket catheter, followed by remote activation and pace-mapping using a magnetically enabled catheter. The area of interest was localized on the basket catheter in seven patients in whom an RVOT arrhythmia was identified. Remote navigation of the magnetic catheter to this area was followed by pace-mapping. Ablation was performed at the site of perfect pace-mapping, with earliest activation if possible. Acute success was achieved in all patients (median four applications). Median procedural time was 144 minutes, with 13.4 minutes of patient fluoroscopy time and 3.8 minutes of physician fluoroscopy time. No complications occurred. One recurrence occurred during follow-up (mean 366 days). RVOT tachycardias can be mapped and ablated using remote magnetic navigation, initially guided by a basket catheter. Precise activation and pace-mapping are possible. Remote magnetic navigation permitted low fluoroscopy exposure for the physician. Long-term results are promising.

Real-time three-dimensional color Doppler echocardiography for characterizing the spatial velocity distribution and quantifying the peak flow rate in the left ventricular outflow tract

NASA Technical Reports Server (NTRS)

Tsujino, H.; Jones, M.; Shiota, T.; Qin, J. X.; Greenberg, N. L.; Cardon, L. A.; Morehead, A. J.; Zetts, A. D.; Travaglini, A.; Bauer, F.;

Reliability of Peak Exercise Stroke Volume Assessment by Impedance Cardiography in Patients with Residual Right Outflow Tract Lesions After Congenital Heart Disease Repair.

PubMed

Legendre, Antoine; Bonnet, D; Bosquet, L

2018-01-01

Global ventricular response to exercise may be useful in follow-up of patients with residual right outflow tract lesions after congenital heart disease repair. In this context, impedance cardiography is considered accurate for stroke volume (SV) measurement during exercise testing, however, to date, only partial assessment of its reliability has been reported. We retrospectively evaluated relative and absolute reliability of peak SV by impedance cardiography during exercise using intraclass correlation (ICC) and standard error of measurement (SEM) in this population. Peak SV was measured in 30 young patients (mean age 14.4 years ± 2.1) with right ventricular outflow tract reconstruction who underwent two cardiopulmonary exercise tests at a mean one-year interval. SV was measured using a signal morphology impedance cardiography analysis device (PhysioFlow ® ) and was indexed to body surface area. ICC of peak indexed SV measurement was 0.80 and SEM was 10.5%. High heterogeneity was seen when comparing patients according to peak indexed SV; in patients with peak SV < 50 ml/m 2 (15 patients), ICC rose to 0.95 and SEM dropped to 2.7%, while in patients with a peak SV > 50 ml/m 2 relative and absolute reliability decreased (ICC = 0.45, SEM = 12.2%). Peak exercise SV assessment by a PhysioFlow ® device represents a highly reliable method in patients with residual right outflow tract lesions after congenital heart disease repair, especially in patients with peak SV < 50 ml/m 2 . In this latter group, a peak SV decrease > 7.3% (corresponding to the minimum "true" difference) should be considered a clinically-relevant decrease in global ventricular performance and taken into account when deciding whether to perform residual lesion removal.

Percutaneous pulmonary valve implantation for free pulmonary regurgitation following conduit-free surgery of the right ventricular outflow tract.

PubMed

Cools, Bjorn; Brown, Stephen C; Heying, Ruth; Jansen, Katrijn; Boshoff, Derize E; Budts, Werner; Gewillig, Marc

2015-01-01

Pulmonary regurgitation (PR) following surgery of the right ventricular outflow tract (RVOT) is not innocent and leads to significant right heart dysfunction over time. Recent studies have demonstrated that percutaneous valves can be implanted in conduit free outflow tracts with good outcomes. To evaluate in patients with severe PR--anticipated to require future pulmonary valve replacement--the feasibility and safety of pre-stenting dilated non-stenotic patched conduit-free right ventricular outflow tracts before excessive dilation occurs, followed by percutaneous pulmonary valve implantation (PPVI). Twenty seven patients were evaluated, but only 23 were deemed suitable based on the presence of an adequate retention zone ≤ 24 mm defined by semi-compliant balloon interrogation of the RVOT. A 2 step procedure was performed: first the landing zone was prepared by deploying a bare stent, followed 2 months later by valve implantation. RVOT pre-stenting with an open cell bare metal stent (Andrastent XXL range) was performed at a median age of 13.0 years (range: 6.0-44.9) with a median weight of 44.3 kg (range: 20.0-88.0). Ninety six percent (22/23) of patients proceeded to PPVI a median of 2.4 months (range: 1.4-3.4) after initial pre-stent placement. Twenty one Melody valves and one 26 mm Edwards SAPIEN™ valve were implanted. Complications consisted of embolization of prestent (n = 1), scrunching (n = 4) and mild stent dislocation (n = 2). During follow-up, no stent fractures were observed and right ventricular dimensions decreased significantly. Post-surgical conduit-free non-stenotic RVOT with free pulmonary regurgitation can be treated percutaneously with a valved stent if anatomical (predominantly size) criteria are met. In experienced hands, the technique is feasible with low morbidity. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Ramipril retards development of aortic valve stenosis in a rabbit model: mechanistic considerations.

PubMed

Ngo, Doan Tm; Stafford, Irene; Sverdlov, Aaron L; Qi, Weier; Wuttke, Ronald D; Zhang, Yuan; Kelly, Darren J; Weedon, Helen; Smith, Malcolm D; Kennedy, Jennifer A; Horowitz, John D

2011-02-01

Aortic valve stenosis (AVS) is associated with significant cardiovascular morbidity and mortality. To date, no therapeutic modality has been shown to be effective in retarding AVS progression. We evaluated the effect of angiotensin-converting enzyme inhibition with ramipril on disease progression in a recently developed rabbit model of AVS. The effects of 8 weeks of treatment with either vitamin D₂ at 25,000 IU for 4 days a week alone or in combination with ramipril (0.5 mg·kg⁻¹) on aortic valve structure and function were examined in New Zealand white rabbits. Echocardiographic aortic valve backscatter (AV(BS)) and aortic valve:outflow tract flow velocity ratio were utilized to quantify changes in valve structure and function. Treatment with ramipril significantly reduced AV(BS) and improved aortic valve :outflow tract flow velocity ratio. The intravalvular content of the pro-oxidant thioredoxin-interacting protein was decreased significantly with ramipril treatment. Endothelial function, as measured by asymmetric dimethylarginine concentrations and vascular responses to ACh, was improved significantly with ramipril treatment. Ramipril retards the development of AVS, reduces valvular thioredoxin-interacting protein accumulation and limits endothelial dysfunction in this animal model. These findings provide important insights into the mechanisms of AVS development and an impetus for future human studies of AVS retardation using an angiotensin-converting enzyme inhibitor. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

High left ventricular outflow tract gradient: Aortic stenosis, obstructive hypertrophic cardiomyopathy or both?

PubMed

Almeida, Inês; Caetano, Francisca; Trigo, Joana; Mota, Paula; Marques, António Leitão

2015-05-01

The authors report the case of a patient diagnosed with both hypertrophic cardiomyopathy and aortic stenosis. Due to clinical deterioration, additional investigation was performed, and a high left ventricular outflow tract gradient was identified. Correct identification of the condition causing the symptoms was challenging, and involved several imaging techniques, the contribution of transesophageal echocardiography being crucial. The final diagnosis of severe aortic stenosis led to successful valve replacement surgery. The presence of these two conditions in the same patient has been documented, although it is uncommon. This association poses particular diagnostic and therapeutic challenges, which are discussed in this paper. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Management of a large atrial septal occluder embolized to the left ventricular outflow tract without the use of cardiac surgery.

PubMed

Loh, Joshua P; Satler, Lowell F; Slack, Michael C

2014-09-01

Transcatheter closure of secundum-type atrial septal defects (ASDs) using the AMPLATZER™ Septal Occluder (ASO) has been in use for more than a decade since its US Food and Drug Administration approval in 2001. Device embolization remains an uncommon complication, which can sometimes occur after the initial deployment. Previous reports of ASO devices embolized to the left ventricle have primarily been managed by open-heart surgical retrieval. We present a case of an ASO device embolized to the left ventricular outflow tract (LVOT) 18 hr after initial implantation, which was successfully retrieved percutaneously, followed by successful closure of the ASD using a larger device. © 2014 Wiley Periodicals, Inc.

Cost-effectiveness of prenatal screening strategies for congenital heart disease.

PubMed

Pinto, N M; Nelson, R; Puchalski, M; Metz, T D; Smith, K J

2014-07-01

The economic implications of strategies to improve prenatal screening for congenital heart disease (CHD) in low-risk mothers have not been explored. The aim was to perform a cost-effectiveness analysis of different screening methods. We constructed a decision analytic model of CHD prenatal screening strategies (four-chamber screen (4C), 4C + outflow, nuchal translucency (NT) or fetal echocardiography) populated with probabilities from the literature. The model included whether initial screens were interpreted by a maternal-fetal medicine (MFM) specialist and different referral strategies if they were read by a non-MFM specialist. The primary outcome was the incremental cost per defect detected. Costs were obtained from Medicare National Fee estimates. A probabilistic sensitivity analysis was undertaken on model variables commensurate with their degree of uncertainty. In base-case analysis, 4C + outflow referred to an MFM specialist was the least costly strategy per defect detected. The 4C screen and the NT screen were dominated by other strategies (i.e. were more costly and less effective). Fetal echocardiography was the most effective, but most costly. On simulation of 10 000 low-risk pregnancies, 4C + outflow screen referred to an MFM specialist remained the least costly per defect detected. For an additional $580 per defect detected, referral to cardiology after a 4C + outflow was the most cost-effective for the majority of iterations, increasing CHD detection by 13 percentage points. The addition of examination of the outflow tracts to second-trimester ultrasound increases detection of CHD in the most cost-effective manner. Strategies to improve outflow-tract imaging and to refer with the most efficiency may be the best way to improve detection at a population level. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

Flow Behavior in the Left Heart Ventricle Following Apico-Aortic Bypass Surgery

NASA Astrophysics Data System (ADS)

Shahriari, Shahrokh; Jeyhani, Morteza; Labrosse, Michel; Kadem, Lyes

2013-11-01

Apico-aortic bypass (AAB) surgery is an alternative for transcatheter aortic valve implantation (TAVI) to reduce left ventricle (LV) overload in patients with severe aortic stenosis (AS). It consists in connecting the apex of the LV to the descending thoracic aorta with a valved conduit. Postoperative flow assessments show that two thirds of the outflow is conducted from the LV apex to the conduit, while only one third crosses the native aortic valve. In this study, we performed high speed particle image velocimetry (PIV) measurements of flow pattern within an in vitro elastic model of LV in the presence of a very severe AS, before and after AAB. Results indicate that AAB effectively relieves the LV outflow obstruction; however, it also leads to abnormal ventricular flow patterns. Normal LV flow dynamics is characterized by an emerging mitral jet flow followed by the development of a vortical flow with velocities directed towards the aortic valve, while measurements in the presence of AAB show systolic flow bifurcating to the apical conduit and to the aortic valve outflow tract. This study provides the first insight into the LV flow structure after AAB including outflow jets and disturbed stagnation regions.

Lack of genetic interaction between Tbx20 and Tbx3 in early mouse heart development.

PubMed

Gavrilov, Svetlana; Harvey, Richard P; Papaioannou, Virginia E

2013-01-01

Members of the T-box family of transcription factors are important regulators orchestrating the complex regionalization of the developing mammalian heart. Individual mutations in Tbx20 and Tbx3 cause distinct congenital heart abnormalities in the mouse: Tbx20 mutations result in failure of heart looping, developmental arrest and lack of chamber differentiation, while hearts of Tbx3 mutants progress further, loop normally but show atrioventricular convergence and outflow tract defects. The two genes have overlapping areas of expression in the atrioventricular canal and outflow tract of the heart but their potential genetic interaction has not been previously investigated. In this study we produced compound mutants to investigate potential genetic interactions at the earliest stages of heart development. We find that Tbx20; Tbx3 double heterozygous mice are viable and fertile with no apparent abnormalities, while double homozygous mutants are embryonic lethal by midgestation. Double homozygous mutant embryos display abnormal cardiac morphogenesis, lack of heart looping, expression patterns of cardiac genes and time of death that are indistinguishable from Tbx20 homozygous mutants. Prior to death, the double homozygotes show an overall developmental delay similar to Tbx3 homozygous mutants. Thus the effects of Tbx20 are epistatic to Tbx3 in the heart but Tbx3 is epistatic to Tbx20 with respect to developmental delay.

4D Subject-Specific Inverse Modeling of the Chick Embryonic Heart Outflow Tract Hemodynamics

PubMed Central

Goenezen, Sevan; Chivukula, Venkat Keshav; Midgett, Madeline; Phan, Ly; Rugonyi, Sandra

2015-01-01

Blood flow plays a critical role in regulating embryonic cardiac growth and development, with altered flow leading to congenital heart disease. Progress in the field, however, is hindered by a lack of quantification of hemodynamic conditions in the developing heart. In this study, we present a methodology to quantify blood flow dynamics in the embryonic heart using subject-specific computational fluid dynamics (CFD) models. While the methodology is general, we focused on a model of the chick embryonic heart outflow tract (OFT), which distally connects the heart to the arterial system, and is the region of origin of many congenital cardiac defects. Using structural and Doppler velocity data collected from optical coherence tomography (OCT), we generated 4D (3D + time) embryo-specific CFD models of the heart OFT. To replicate the blood flow dynamics over time during the cardiac cycle, we developed an iterative inverse-method optimization algorithm, which determines the CFD model boundary conditions such that differences between computed velocities and measured velocities at one point within the OFT lumen are minimized. Results from our developed CFD model agree with previously measured hemodynamics in the OFT. Further, computed velocities and measured velocities differ by less than 15% at locations that were not used in the optimization, validating the model. The presented methodology can be used in quantifications of embryonic cardiac hemodynamics under normal and altered blood flow conditions, enabling an in depth quantitative study of how blood flow influences cardiac development. PMID:26361767

Dynamic left ventricular outflow tract obstruction secondary to hypovolemia in a German Shepard dog with splenic hemangiosarcoma.

PubMed

Aoki, Takuma; Sunahara, Hiroshi; Sugimoto, Keisuke; Ito, Tetsuro; Kanai, Eiichi; Neo, Sakurako; Fujii, Yoko; Wakao, Yoshito

2015-09-01

Dynamic left ventricular outflow tract obstruction (DLVOTO) is a common condition in cats and humans. In this case report, a dog is described with DLVOTO secondary to severe intra-abdominal hemorrhage caused by a hemangiosarcoma. The dog was a 9-year-old, 35.7-kg, spayed female German Shepard dog that presented with a history of tachypnea and collapse. A Levine II/VI systolic murmur was present at the heart base. Abdominal ultrasonography revealed a splenic mass and a large amount of ascites. Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus. The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion.

Development of the Hearts of Lizards and Snakes and Perspectives to Cardiac Evolution

PubMed Central

Jensen, Bjarke; van den Berg, Gert; van den Doel, Rick; Oostra, Roelof-Jan; Wang, Tobias; Moorman, Antoon F. M.

2013-01-01

Birds and mammals both developed high performance hearts from a heart that must have been reptile-like and the hearts of extant reptiles have an unmatched variability in design. Yet, studies on cardiac development in reptiles are largely old and further studies are much needed as reptiles are starting to become used in molecular studies. We studied the growth of cardiac compartments and changes in morphology principally in the model organism corn snake (Pantherophis guttatus), but also in the genotyped anole (Anolis carolinenis and A. sagrei) and the Philippine sailfin lizard (Hydrosaurus pustulatus). Structures and chambers of the formed heart were traced back in development and annotated in interactive 3D pdfs. In the corn snake, we found that the ventricle and atria grow exponentially, whereas the myocardial volumes of the atrioventricular canal and the muscular outflow tract are stable. Ventricular development occurs, as in other amniotes, by an early growth at the outer curvature and later, and in parallel, by incorporation of the muscular outflow tract. With the exception of the late completion of the atrial septum, the adult design of the squamate heart is essentially reached halfway through development. This design strongly resembles the developing hearts of human, mouse and chicken around the time of initial ventricular septation. Subsequent to this stage, and in contrast to the squamates, hearts of endothermic vertebrates completely septate their ventricles, develop an insulating atrioventricular plane, shift and expand their atrioventricular canal toward the right and incorporate the systemic and pulmonary venous myocardium into the atria. PMID:23755108

Impaired cardiovascular structure and function in adult survivors of severe acute malnutrition.

PubMed

Tennant, Ingrid A; Barnett, Alan T; Thompson, Debbie S; Kips, Jan; Boyne, Michael S; Chung, Edward E; Chung, Andrene P; Osmond, Clive; Hanson, Mark A; Gluckman, Peter D; Segers, Patrick; Cruickshank, J Kennedy; Forrester, Terrence E

2014-09-01

Malnutrition below 5 years remains a global health issue. Severe acute malnutrition (SAM) presents in childhood as oedematous (kwashiorkor) or nonoedematous (marasmic) forms, with unknown long-term cardiovascular consequences. We hypothesized that cardiovascular structure and function would be poorer in SAM survivors than unexposed controls. We studied 116 adult SAM survivors, 54 after marasmus, 62 kwashiorkor, and 45 age/sex/body mass index-matched community controls who had standardized anthropometry, blood pressure, echocardiography, and arterial tonometry performed. Left ventricular indices and outflow tract diameter, carotid parameters, and pulse wave velocity were measured, with systemic vascular resistance calculated. All were expressed as SD scores. Mean (SD) age was 28.8±7.8 years (55% men). Adjusting for age, sex, height, and weight, SAM survivors had mean (SE) reductions for left ventricular outflow tract diameter of 0.67 (0.16; P<0.001), stroke volume 0.44 (0.17; P=0.009), cardiac output 0.5 (0.16; P=0.001), and pulse wave velocity 0.32 (0.15; P=0.03) compared with controls but higher diastolic blood pressures (by 4.3; 1.2-7.3 mm Hg; P=0.007). Systemic vascular resistance was higher in marasmus and kwashiorkor survivors (30.2 [1.2] and 30.8 [1.1], respectively) than controls 25.3 (0.8), overall difference 5.5 (95% confidence interval, 2.8-8.4 mm Hg min/L; P<0.0001). No evidence of large vessel or cardiac remodeling was found, except closer relationships between these indices in former marasmic survivors. Other parameters did not differ between SAM survivor groups. We conclude that adult SAM survivors had smaller outflow tracts and cardiac output when compared with controls, yet markedly elevated peripheral resistance. Malnutrition survivors are thus likely to develop excess hypertension in later life, especially when exposed to obesity. © 2014 American Heart Association, Inc.

Early graft failure of small-sized porcine valved conduits in reconstruction of the right ventricular outflow tract.

PubMed

Schreiber, Christian; Sassen, Stefanie; Kostolny, Martin; Hörer, Jürgen; Cleuziou, Julie; Wottke, Michael; Holper, Klaus; Fend, Falko; Eicken, Andreas; Lange, Rüdiger

2006-07-01

The quest for an alternative to homografts for reconstruction of the right ventricular outflow tract is ongoing. The Shelhigh No-React (NR-4000PA series) treated porcine pulmonic valve conduit (SPVC) was developed as a potential alternative. During a 12-month period from May 2004 to May 2005, the SPVC was implanted in 34 patients, of whom 62% were younger than 1 year. Median age at operation was 7 months (range, 5 days to 12 years). Thirteen SPCV conduits size 10, 11 size 12, 8 size 14, and 2 size 16 were initially implanted. Since May 2005, however, we have temporarily abandoned its implantation as we were concerned about a number of early failures. Until November 2005, 1 early and 1 late death have occurred. Both were not conduit related. Fifteen conduits were replaced in 13 patients. Of these, 10 were size 10, 3 size 12, 2 size 14, and none size 16. Mean time to replacement of the SPVC was 313 +/- 116 days. A pseudointimal peel formation and chronic inflammation with foreign-body reaction was found in all explanted conduits at all levels. The maximum of the inflammatory reaction occurred at the valvular level around the porcine tissues, with shrinkage of the valve and hemodynamic compromise. At valvular level, small punctuate calcifications were observed in 2 cases. In 6 patients an acute inflammatory component was observed. At late follow-up (mean follow-up 366 +/- 102 days, 34 patient-years), echocardiography showed a mean graft gradient of 39.8 +/- 29.7 mm Hg, with mild to moderate insufficiency in 4 patients. Although the No-React treated valve largely resists calcification, pseudointimal peel formation was found in all explanted conduits and led to multilevel conduit stenoses. The small-sized SPVC can not be regarded as an ideal conduit for right ventricular outflow tract reconstruction.

Neural crest contribution to the cardiovascular system.

PubMed

Brown, Christopher B; Baldwin, H Scott

2006-01-01

Normal cardiovascular development requires complex remodeling of the outflow tract and pharyngeal arch arteries to create the separate pulmonic and systemic circulations. During remodeling, the outflow tract is septated to form the ascending aorta and the pulmonary trunk. The initially symmetrical pharyngeal arch arteries are remodeled to form the aortic arch, subclavian and carotid arteries. Remodeling is mediated by a population of neural crest cells arising between the mid-otic placode and somite four called the cardiac neural crest. Cardiac neural crest cells form smooth muscle and pericytes in the great arteries, and the neurons of cardiac innervation. In addition to the physical contribution of smooth muscle to the cardiovascular system, cardiac neural crest cells also provide signals required for the maintenance and differentiation of the other cell layers in the pharyngeal apparatus. Reciprocal signaling between the cardiac neural crest cells and cardiogenic mesoderm of the secondary heart field is required for elaboration of the conotruncus and disruption in this signaling results in primary myocardial dysfunction. Cardiovascular defects attributed to the cardiac neural crest cells may reflect either cell autonomous defects in the neural crest or defects in signaling between the neural crest and adjacent cell layers.

The Neural Crest in Cardiac Congenital Anomalies

PubMed Central

Keyte, Anna; Hutson, Mary Redmond

2012-01-01

This review discusses the function of neural crest as they relate to cardiovascular defects. The cardiac neural crest cells are a subpopulation of cranial neural crest discovered nearly 30 years ago by ablation of premigratory neural crest. The cardiac neural crest cells are necessary for normal cardiovascular development. We begin with a description of the crest cells in normal development, including their function in remodeling the pharyngeal arch arteries, outflow tract septation, valvulogenesis, and development of the cardiac conduction system. The cells are also responsible for modulating signaling in the caudal pharynx, including the second heart field. Many of the molecular pathways that are known to influence specification, migration, patterning and final targeting of the cardiac neural crest cells are reviewed. The cardiac neural crest cells play a critical role in the pathogenesis of various human cardiocraniofacial syndromes such as DiGeorge, Velocardiofacial, CHARGE, Fetal Alcohol, Alagille, LEOPARD, and Noonan syndromes, as well as Retinoic Acid Embryopathy. The loss of neural crest cells or their dysfunction may not always directly cause abnormal cardiovascular development, but are involved secondarily because crest cells represent a major component in the complex tissue interactions in the head, pharynx and outflow tract. Thus many of the human syndromes linking defects in the heart, face and brain can be better understood when considered within the context of a single cardiocraniofacial developmental module with the neural crest being a key cell type that interconnects the regions. PMID:22595346

NF-kappaB signaling blockade by Bay 11-7085 during early cardiac morphogenesis induces alterations of the outflow tract in chicken heart.

PubMed

Hernández-Gutierrez, S; García-Peláez, I; Zentella-Dehesa, A; Ramos-Kuri, M; Hernández-Franco, P; Hernández-Sánchez, F; Rojas, E

2006-07-01

Nuclear factor kappaB (NF-kappaB) is a pleiotropic transcription factor implicated in the regulation of diverse morphologic cardiac alterations, for which the p50 and p65 subunits form the most prevalent dimeric form in the heart. NF-kappaB is inactivated by proteins of the IkappaB family, which trap it in the cytoplasm. It is not known whether NF-kappaB influences cardiac development. Here we investigated the role of NF-kappaB in regulating transcription in chicken heart morphogenesis. Specifically, we tested whether NF-kappaB activation is required for normal formation of the outflow tract (OFT) during a critical stage of heart development. We designed a reporter vector with kappaB binding sites for Rel family members in the promoter, upstream from the cDNA of Green Fluorescent Protein (GFP). This construct was injected directly into the developing heart of chicken embryos. NF-kappaB activation was subsequently inhibited by administration of the specific pharmacological agent Bay 11-7085. We found that forced NF-kappaB expression was associated with multiple congenital cardiac alterations of the OFT (mainly IVC, DORV and great arteries stenosis). These findings indicate that blockade of NF-kappaB induces apoptosis and is an important factor in the development of OFT during cardiogenesis. However, it remains unknown which members of the Rel family are relevant in this process.

Successful Feasibility Human Trial of a New Self-Expandable Percutaneous Pulmonary Valve (Pulsta Valve) Implantation Using Knitted Nitinol Wire Backbone and Trileaflet α-Gal-Free Porcine Pericardial Valve in the Native Right Ventricular Outflow Tract.

PubMed

Kim, Gi Beom; Song, Mi Kyoung; Bae, Eun Jung; Park, Eun-Ah; Lee, Whal; Lim, Hong-Gook; Kim, Yong Jin

2018-06-01

Self-expandable percutaneous pulmonary valve implantation (PPVI) for native right ventricular outflow tract lesions is still in the clinical trial phase. The aim of this study is to present the result of feasibility study of a novel self-expandable knitted nitinol wire stent mounted with a treated trileaflet α-Gal-free porcine pericardial valve for PPVI. A feasibility study using Pulsta valve (TaeWoong Medical Co, Gyeonggi-do, South Korea) was designed for patients with severe pulmonary regurgitation in the native right ventricular outflow tract, and 6-month follow-up outcomes were reviewed. Ten tetralogy of Fallot patients were enrolled. Before PPVI, severe pulmonary regurgitation (mean pulmonary regurgitation fraction, 45.5%±7.2%; range, 34.9%-56%) and enlarged right ventricular volume (mean indexed right ventricular end-diastolic volume, 176.7±14.3 mL/m 2 ; range, 158.9-205.9 mL/m 2 ) were present. The median age at PPVI was 21.7±6.5 years (range, 13-36 years). Five patients were successfully implanted with 28 mm and the other 5 with 26 mm valves loaded on the 18F delivery cable. No significant periprocedural complications were noted in any patient. At the 6-month follow-up, indexed right ventricular end-diastolic volume was dramatically decreased to 126.3±20.3 mL/m 2 (range, 99-164.2 mL/m 2 ), and the mean value of peak instantaneous pressure gradient between the right ventricle and the pulmonary artery decreased from 6.8±3.5 mm Hg (range, 2-12 mm Hg) before PPVI to 5.7±6.7 mm Hg (range, 2-12 mm Hg) without significant pulmonary regurgitation. There was no adverse event associated with the valve. A feasibility study of the Pulsta valve for native right ventricular outflow tract lesions was completed successfully with planned Pulsta valve implantation and demonstrated good short-term effectiveness without serious adverse events. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02555319. © 2018 American Heart Association, Inc.

Muscular Subaortic Stenosis

PubMed Central

Wigle, E. Douglas; Auger, Pierre; Marquis, Yves

1966-01-01

Two types of intraventricular pressure differences within the left ventricle of man are described. The first is encountered in cases of muscular (or fibrous) subaortic stenosis, in which the outflow tract pressure distal to the stenosis (and proximal to the aortic valve) is low, whereas all pressures recorded in the left ventricle proximal to the stenosis, including that just inside the mitral valve (the initial inflow tract pressure) are high. The second type of intraventricular pressure difference may be recorded in patients without muscular subaortic stenosis when a heart catheter is advanced to the left ventricular wall in such a manner that it becomes imbedded or entrapped by cardiac muscle in systole. Such an entrapped catheter records a high intraventricular pressure that is believed to reflect intramyocardial tissue pressure, which normally exceeds intracavitary pressure. In such cases the initial inflow tract pressure is not high and is precisely equal to the outflow tract systolic pressure, i.e. both are recording intracavity pressure. This type of intramyocardial to intracavitary pressure difference may also be encountered in the left ventricle of dogs. The recent suggestion that intraventricular pressure differences in the left ventricle of cases of muscular subaortic stenosis are due to catheter entrapment by cardiac muscle is refuted by using the initial inflow tract pressure as the means of differentiation between the two types of intraventricular pressure differences outlined. PMID:5951625

Hypertrophic Cardiomyopathy in Liver Transplantation Patients.

PubMed

Pai, S-L; Aniskevich, S; Logvinov, I I; Matcha, G V; Palmer, W C; Blackshear, J L

2018-06-01

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder that presents with a hypertrophied nondilated left ventricle. In the absence of other known causes of cardiomyopathy, it is often associated with left ventricular outflow tract obstruction during systole, systolic anterior motion of the mitral valve, mitral regurgitation, and increased risk of sudden cardiac death. When HCM coexists with end-stage liver disease, it can be further complicated by cirrhosis-associated cardiovascular abnormalities, including hyperdynamic circulation, systolic and diastolic dysfunction, and electrophysiologic abnormalities. We retrospectively examined patient characteristics, comorbidities, preoperative echocardiogram results, sudden cardiac death risk prediction model score, and 1-year postoperative mortality of patients with HCM who underwent liver transplantation at our institution from January 1, 2000, through January 1, 2015. Of the 2,812 liver transplantations performed during the study period, we identified 15 patients with a preoperative diagnosis of HCM. When comparing the patients who did vs did not survive the first year after orthotopic liver transplantation, we identified significant differences in maximal left ventricular wall thickness (P = .004) and resting left ventricular outflow tract gradient (P = .004). Preoperative left atrium size (measured by echocardiography; P = .66) and the sudden cardiac death risk prediction model score (P = .32) were not significantly associated with 1-year survival. Preoperative left ventricular outflow tract gradient exceeding 60 mm Hg was strongly associated with death during the first year after transplant. These results suggest that the severity of HCM influences patient outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

Longitudinal analysis of head and somatic growth in fetuses with congenital heart defects.

PubMed

Turan, Sifa; Rosenbloom, Joshua I; Hussein, Mostafa; Berg, Christoph; Gembruch, Ulrich; Baschat, Ahmet A; Turan, Ozhan M

2017-02-01

Fetal head and somatic growth dynamics differs in fetuses with congenital heart defects (CHD). We longitudinally characterized fetal head and somatic growth in relation to the type of CHD. Four hundred eleven exams from isolated CHD were compared with 1,219 controls. Head and somatic growth was assessed using head circumference (HC), brain volume (BrV = 1/6 × π × (HC/π)3)/2), fetal cephalization index (FCI = BrV/[estimated fetal weight]), and growth percentile. Umbilical and middle cerebral artery Doppler indices were obtained. CHD were grouped as: (1) d-transposition of great arteries (n = 11); (2) left ventricular outflow tract obstruction with retrograde isthmic flow (n = 18); (3) left ventricular outflow tract obstruction with antegrade isthmic flow (n = 16); (4) pulmonary outflow tract obstructions (n = 22). The smallest head size was seen in group 1. Growth asymmetry was diagnosed in group 2. Brain sparing was seen in groups 2 and 4 (p < 0.0001). HC and BrV percentiles decreased with advancing gestational age (p < 0.001) in group 2, and a significant drop was observed around 28 weeks. d-Transposition of great arteries and left-sided CHD leading to isthmic blood flow reversal are associated with delayed head growth. Prenatal evaluation of central hemodynamics in CHD may be contributive for predicting neurodevelopmental risks in CHD and help directing prenatal interventions. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:96-104, 2017. © 2016 Wiley Periodicals, Inc.

Tetralogy of Fallot with absent pulmonary valve syndrome; appropriate surgical strategies.

PubMed

Shahid, Fatima; Siddiqui, Maria Tariq; Amanullah, Muhammad Muneer

2015-05-01

To evaluate patients presenting with Tetralogy of Fallot with absent pulmonary valve syndrome to a tertiary care hospital and their surgical management. The retrospective study was conducted at Congenital Cardiac Services, Aga Khan University Hospital, Karachi, Pakistan, and comprised data of Tetralogy of Fallot patients between April 2007 and June 2012. Data was analysed together with follow-up echocardiography. Variables assessed included demographics, imaging, operative technique, complications, post-operative recovery and follow-up echocardiography. SPSS 17 was used for statistical analysis. Of the 204 patients, 6 (3%) had undergone surgical correction for Tetralogy of Fallot with absent pulmonary valve syndrome. All 6(100%) patients underwent complete repair. Median age for surgery was 8.5 years (range: 0.5-29 years). Of the different surgical strategies used, Contegra and Bioprosthetic valve placement had satisfactory outcome with minimal gradient at Right Ventricular Outflow Tract, good ventricular function and mild valvular regurgitation. One (16.6%) patient with Trans Annular Patch developed post-operative Right Ventricle Outflow Tract gradient of 80mmHg with moderate pulmonary regurgitation. One (16.6%) patient with monocusp valve developed free pulmonary regurgitation at 6 months. The other 4(66.6%) patients are currently free from any complications or re-intervention. Early surgery is preferred in symptomatic patients. The repair depends upon achieving integrity of pulmonary circulation which is best achieved by using right ventricle to pulmonary artery conduit or inserting a pulmonary valve.

Flow-related Right Ventricular - Pulmonary Arterial Pressure Gradients during Exercise.

PubMed

Wright, Stephen P; Opotowsky, Alexander R; Buchan, Tayler A; Esfandiari, Sam; Granton, John T; Goodman, Jack M; Mak, Susanna

2018-06-06

The assumption of equivalence between right ventricular and pulmonary arterial systolic pressure is fundamental to several assessments of right ventricular or pulmonary vascular hemodynamic function. Our aims were to 1) determine whether systolic pressure gradients develop across the right ventricular outflow tract in healthy adults during exercise, 2) examine the potential correlates of such gradients, and 3) consider the effect of such gradients on calculated indices of right ventricular function. Healthy untrained and endurance-trained adult volunteers were studied using right-heart catheterization at rest and during submaximal cycle ergometry. Right ventricular and pulmonary artery pressures were simultaneously transduced, and cardiac output was determined by thermodilution. Systolic pressures, peak and mean gradients, and indices of chamber, vascular, and valve function were analyzed offline. Summary data are reported as mean ± standard deviation or median [interquartile range]. No significant right ventricular outflow tract gradients were observed at rest (mean gradient = 4 [3-5] mmHg), and calculated effective orifice area was 3.6±1.0 cm2. Right ventricular systolic pressure increases during exercise were greater than that of pulmonary artery systolic pressure. Accordingly, mean gradients developed during light exercise (8 [7-9] mmHg) and increased during moderate exercise (12 [9-14] mmHg, p < 0.001). The magnitude of the mean gradient was linearly related to cardiac output (r2 = 0.70, p < 0.001). In healthy adults without pulmonic stenosis, systolic pressure gradients develop during exercise, and the magnitude is related to blood flow rate.

Mitral valve replacement complicated by iatrogenic left ventricular outflow obstruction and paravalvular leak: case report and review of literature.

PubMed

Lee, Justin Z; Tey, Kai R; Mizyed, Ahmad; Hennemeyer, Charles T; Janardhanan, Rajesh; Lotun, Kapildeo

2015-10-09

Left ventricular outflow tract (LVOT) obstruction and paravalvular leak (PVL) are relatively uncommon, but are serious complications of prosthetic valve replacement. We present a case that displays the unique therapeutic challenges of treating a patient who developed both LVOT obstruction and mitral PVL after undergoing surgical aortic and mitral valve replacement (MVR). We also describe the use of alcohol septal ablation and albumin-glutaraldehyde (BioGlue) for septal ablation to percutaneously treat the patient's LVOT obstruction, followed by use of an Amplatzer vascular plug for percutaneous closure of an antero-medial mitral PVL associated with severe regurgitation. Percutaneous interventional management of these entities may be considered as an initial therapeutic option, especially in high-risk patients with significant morbidity and mortality of repeat surgical operations.

Evaluation of a new 3-dimensional color Doppler flow method to quantify flow across the mitral valve and in the left ventricular outflow tract: an in vitro study.

PubMed

Kimura, Sumito; Streiff, Cole; Zhu, Meihua; Shimada, Eriko; Datta, Saurabh; Ashraf, Muhammad; Sahn, David J

2014-02-01

The aim of this study was to assess the accuracy, feasibility, and reproducibility of determining stroke volume from a novel 3-dimensional (3D) color Doppler flow quantification method for mitral valve (MV) inflow and left ventricular outflow tract (LVOT) outflow at different stroke volumes when compared with the actual flow rate in a pumped porcine cardiac model. Thirteen freshly harvested pig hearts were studied in a water tank. We inserted a latex balloon into each left ventricle from the MV annulus to the LVOT, which were passively pumped at different stroke volumes (30-80 mL) using a calibrated piston pump at increments of 10 mL. Four-dimensional flow volumes were obtained without electrocardiographic gating. The digital imaging data were analyzed offline using prototype software. Two hemispheric flow-sampling planes for color Doppler velocity measurements were placed at the MV annulus and LVOT. The software computed the flow volumes at the MV annulus and LVOT within the user-defined volume and cardiac cycle. This novel 3D Doppler flow quantification method detected incremental increases in MV inflow and LVOT outflow in close agreement with pumped stroke volumes (MV inflow, r = 0.96; LVOT outflow, r = 0.96; P < .01). Bland-Altman analysis demonstrated overestimation of both (MV inflow, 5.42 mL; LVOT outflow, 4.46 mL) with 95% of points within 95% limits of agreement. Interobserver variability values showed good agreement for all stroke volumes at both the MV annulus and LVOT. This study has shown that the 3D color Doppler flow quantification method we used is able to compute stroke volumes accurately at the MV annulus and LVOT in the same cardiac cycle without electrocardiographic gating. This method may be valuable for assessment of cardiac output in clinical studies.

Differential right ventricular regional function and the effect of pulmonary hypertension: three-dimensional echo study.

PubMed

Calcutteea, Avin; Chung, Robin; Lindqvist, Per; Hodson, Margaret; Henein, Michael Y

2011-06-01

The right ventricle is multicompartmental in orientation. To assess the normal differential function of the right ventricular (RV) inflow, apical and outflow compartments, also their inter-relations and the response to pulmonary arterial hypertension (PAH). 45 people were studied--16 controls and 29 patients with left-sided heart failure, 15 without (group 1) and 14 with (group 2) secondary PAH, using two-dimensional (2D) and 3D echocardiography in addition to conventional Doppler techniques. There was a strong correlation between RV inlet diameter (2D) and end-diastolic volume (3D) (r=0.69, p<0.001) and between tricuspid annular plane systolic excursion and RV ejection fraction (3D) (r=0.71, p<0.001). In controls and patients, the apical ejection fraction was less than the inflow and outflow (controls: p<0.01 and p<0.01, group 1: p<0.05 and p<0.01 and group 2: p<0.05 and p<0.01, respectively). Ejection fraction was reduced in patients (inflow: p<0.001 for both, apical: p<0.01 for both and outflow tract: p<0.05 for both). In controls, the inflow compartment reached the minimum volume 20 ms before the outflow and apex but in group 2 it was simultaneous. Isovolumic contraction and relaxation times were prolonged in patients (Group 1: p=0.02 and p<0.01 and Group 2: p=0.01 for both). Peak RV ejection time correlated with the rate of outflow volume fall in controls but with the apex in group 2 (r=0.6, p<0.05). The right ventricle has distinct features for the inflow, apical and outflow tract compartments, with different extent of contribution to the overall systolic function. In PAH, the right ventricle becomes one dyssynchronous compartment, which itself may have perpetual effect on overall cardiac dysfunction.

Impact of left ventricular outflow tract area on systolic outflow velocity in hypertrophic cardiomyopathy: a real-time three-dimensional echocardiographic study

NASA Technical Reports Server (NTRS)

Qin, Jian Xin; Shiota, Takahiro; Lever, Harry M.; Rubin, David N.; Bauer, Fabrice; Kim, Yong Jin; Sitges, Marta; Greenberg, Neil L.; Drinko, Jeanne K.; Martin, Maureen;

Two-dimensional and Doppler echocardiographic findings in healthy non-sedated red-eared slider terrapins (Trachemys scripta elegans).

PubMed

Poser, H; Russello, G; Zanella, A; Bellini, L; Gelli, D

2011-12-01

Echocardiographic evaluation was performed in six healthy young adult non-sedated terrapins (Trachemys scripta elegans). The best imaging quality was obtained through the right cervical window. Base-apex inflow and outflow views were recorded, ventricular size, ventricular wall thickness and ventricular outflow tract were measured, and fractional shortening was calculated. Pulsed-wave Doppler interrogation enabled the diastolic biphasic atrio-ventricular flow and the systolic ventricular outflow patterns to be recorded. The following Doppler-derived functional parameters were calculated: early diastolic (E) and late diastolic (A) wave peak velocities, E/A ratio, ventricular outflow systolic peak and mean velocities and gradients, Velocity-Time Integral, acceleration and deceleration times, and Ejection Time. For each parameter the mean, standard deviation and 95% confidence interval were calculated. Echocardiography resulted as a useful and easy-to-perform diagnostic tool in this poorly known species that presents difficulties during evaluation.

Surgical treatment of left ventricular outflow tract obstruction with apicoaortic valved conduit.

PubMed

Cooley, D A; Norman, J C; Reul, G J; Kidd, J N; Nihill, M R

1976-12-01

From Aug. 13, 1975, through May, 1976, nine patients underwent creation of a left ventricular "vent" for relief of severe left ventricular outflow tract obstruction. A Dacron fabric graft containing a heterograft valve was used to establish a conduit from the left ventricle to the abdominal aorta. There were five male and four female patients in this group; their ages ranged from 4 to 72 years. All had valvular, subvalvular, or supravalvular aortic stenosis, and all but two had undergone previous surgical procedures for relief of the stenosis. All patients survived the operation and none are receiving anticoagulant therapy. All are asymptomatic at present and follow-up is approaching one year. Postoperative cardiac catheterization studies revealed gradients across the aortic valve to be reduced by approximately 90% and mean ventricular systolic pressures by 45%. Although this concept is not new, it has not been used widely and we believe its effectiveness warrants further application.

Facial trauma caused by electronic cigarette explosion.

PubMed

Vaught, Brian; Spellman, Joseph; Shah, Anil; Stewart, Alexander; Mullin, David

2017-03-01

Electronic cigarettes are increasingly popular as a supposed safer alternative to tobacco cigarettes or a smoking cessation tool. Research and debate have focused primarily on possible adverse effects caused by the inhaled aerosol produced by electronic cigarettes and on smoking cessation efficacy. Few reports in the medical literature describe injuries secondary to device malfunction. We present a case of electronic cigarette explosion, with a projectile fracturing the patient's right naso-orbital-ethmoid complex and anterior and posterior frontal sinus tables, with frontal sinus outflow tract involvement. The patient underwent combined open and endoscopic repair, including open reduction internal fixation, with reconstitution and preservation of the frontal sinus and frontal sinus outflow tract. Additionally, we review the available data on electronic cigarette malfunction-including fires, explosions, associated injuries, and possible reasons for device malfunction-and discuss new 2016 U.S. Food and Drug Administration regulations pertaining to electronic cigarettes.

Cardiac outflow tract anomalies

PubMed Central

Neeb, Zachary; Lajiness, Jacquelyn D.; Bolanis, Esther; Conway, Simon J

2014-01-01

The mature outflow tract (OFT) is, in basic terms, a short conduit. It is a simple, although vital, connection situated between contracting muscular heart chambers and a vast embryonic vascular network. Unfortunately, it is also a focal point underlying many multifactorial congenital heart defects (CHDs). Through the use of various animal models combined with human genetic investigations, we are beginning to comprehend the molecular and cellular framework that controls OFT morphogenesis. Clear roles of neural crest cells (NCC) and second heart field (SHF) derivatives have been established during OFT formation and remodeling. The challenge now is to determine how the SHF and cardiac NCC interact, the complex reciprocal signaling that appears to be occurring at various stages of OFT morphogenesis, and finally how endocardial progenitors and primary heart field (PHF) communicate with both these colonizing extra-cardiac lineages. Although we are beginning to understand that this dance of progenitor populations is wonderfully intricate, the underlying pathogenesis and the spatiotemporal cell lineage interactions remain to be fully elucidated. What is now clear is that OFT alignment and septation are independent processes, invested via separate SHF and cardiac neural crest (CNC) lineages. This review will focus on our current understanding of the respective contributions of the SHF and CNC lineage during OFT development and pathogenesis. PMID:24014420

Right ventricular outflow tract tachycardia due to a somatic cell mutation in G protein subunitalphai2.

PubMed Central

Lerman, B B; Dong, B; Stein, K M; Markowitz, S M; Linden, J; Catanzaro, D F

1998-01-01

Idiopathic ventricular tachycardia is a generic term that describes the various forms of ventricular arrhythmias that occur in patients without structural heart disease and in the absence of the long QT syndrome. Many of these tachycardias are focal in origin, localize to the right ventricular outflow tract (RVOT), terminate in response to beta blockers, verapamil, vagal maneuvers, and adenosine, and are thought to result from cAMP-mediated triggered activity. DNA was prepared from biopsy samples obtained from myocardial tissue from a patient with adenosine-insensitive idiopathic ventricular tachycardia arising from the RVOT. Genomic sequences of the inhibitory G protein Galphai2 were determined after amplification by PCR and subcloning. A point mutation (F200L) in the GTP binding domain of the inhibitory G protein Galphai2 was identified in a biopsy sample from the arrhythmogenic focus. This mutation was shown to increase intracellular cAMP concentration and inhibit suppression of cAMP by adenosine. No mutations were detected in Galphai2 sequences from myocardial tissue sampled from regions remote from the origin of tachycardia, or from peripheral lymphocytes. These findings suggest that somatic cell mutations in the cAMP-dependent signal transduction pathway occurring during myocardial development may be responsible for some forms of idiopathic ventricular tachycardia. PMID:9637720

Left ventricular outflow tract arrhythmias with divergent QRS morphology: mapping of different exits and ablation strategy.

PubMed

Reithmann, Christopher; Fiek, Michael

2018-01-01

Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) can have multiple exits exhibiting divergent ECG features. In a series of 131 patients with VAs with LVOT origin, 10 patients presented with divergent QRS morphologies. Multisite endo- and epicardial mapping of different exit sites was performed. The earliest ventricular activity of 23 LVOT VAs in 10 patients was detected in the endocardium of the LV in 7 patients, the aortic sinuses of Valsalva (SoV) in 3 patients, the distal coronary sinus in 6 patients, the anterior interventricular vein in 3 patients, and the posterior right ventricular outflow tract (RVOT) in 4 patients. Simultaneous elimination of two divergent QRS morphologies of LVOT VAs by ablation from a single site was achieved in 5 patients (aorto-mitral continuity in 3 patients, SoV and RVOT in each 1 patient) using a mean maximum ablation energy of 46 ± 5 W. Sequential ablation from two or three different sites, including trans-pericardial and distal coronary sinus ablation in each 2 patients, led to elimination of the divergent VA QRS morphologies in the other 5 patients. During the follow-up of 28 ± 29 months, 4 of the 10 patients had recurrence of at least one LVOT VA. A 43-year-old patient with muscular dystrophy Curschmann-Steinert had recurrence of sustained LVOT VTs and died of sudden cardiac death. Multisite mapping of different exit sites of LVOT VAs can guide ablation of intramural foci but the recurrence rate after initially successful ablation was high.

Satisfactory rate of postprocessing visualization of standard fetal cardiac views from 4-dimensional cardiac volumes acquired during routine ultrasound practice by experienced sonographers in peripheral centers.

PubMed

Rizzo, Giuseppe; Capponi, Alessandra; Pietrolucci, Maria Elena; Capece, Giuseppe; Cimmino, Ernesto; Colosi, Enrico; Ferrentino, Salvatore; Sica, Carmine; Di Meglio, Aniello; Arduini, Domenico

2011-01-01

The aim of this study was to evaluate the feasibility of visualizing standard cardiac views from 4-dimensional (4D) cardiac volumes obtained at ultrasound facilities with no specific experience in fetal echocardiography. Five sonographers prospectively recorded 4D cardiac volumes starting from the 4-chamber view on 500 consecutive pregnancies at 19 to 24 weeks' gestation undergoing routine ultrasound examinations (100 pregnancies for each sonographer). Volumes were sent to the referral center, and 2 independent reviewers with experience in 4D fetal echocardiography assessed their quality in the display of the abdominal view, 4-chamber view, left and right ventricular outflow tracts, and 3-vessel and trachea view. Cardiac volumes were acquired in 474 of 500 pregnancies (94.8%). The 2 reviewers respectively acknowledged the presence of satisfactory images in 92.4% and 93.6% of abdominal views, 91.5% and 93.0% of 4-chamber views, in 85.0% and 86.2% of left ventricular outflow tracts, 83.9% and 84.5% of right ventricular outflow tracts, and 85.2% and 84.5% of 3-vessel and trachea views. The presence of a maternal body mass index of greater than 30 altered the probability of achieving satisfactory cardiac views, whereas previous maternal lower abdominal surgery did not affect the quality of reconstructed cardiac views. In conclusion, cardiac volumes acquired by 4D sonography in peripheral centers showed high enough quality to allow satisfactory diagnostic cardiac views.

Quantification of mitral regurgitation by automated cardiac output measurement: experimental and clinical validation

NASA Technical Reports Server (NTRS)

Sun, J. P.; Yang, X. S.; Qin, J. X.; Greenberg, N. L.; Zhou, J.; Vazquez, C. J.; Griffin, B. P.; Stewart, W. J.; Thomas, J. D.

1998-01-01

OBJECTIVES: To develop and validate an automated noninvasive method to quantify mitral regurgitation. BACKGROUND: Automated cardiac output measurement (ACM), which integrates digital color Doppler velocities in space and in time, has been validated for the left ventricular (LV) outflow tract but has not been tested for the LV inflow tract or to assess mitral regurgitation (MR). METHODS: First, to validate ACM against a gold standard (ultrasonic flow meter), 8 dogs were studied at 40 different stages of cardiac output (CO). Second, to compare ACM to the LV outflow (ACMa) and inflow (ACMm) tracts, 50 normal volunteers without MR or aortic regurgitation (44+/-5 years, 31 male) were studied. Third, to compare ACM with the standard pulsed Doppler-two-dimensional echocardiographic (PD-2D) method for quantification of MR, 51 patients (61+/-14 years, 30 male) with MR were studied. RESULTS: In the canine studies, CO by ACM (1.32+/-0.3 liter/min, y) and flow meter (1.35+/-0.3 liter/min, x) showed good correlation (r=0.95, y=0.89x+0.11) and agreement (deltaCO(y-x)=0.03+/-0.08 [mean+/-SD] liter/min). In the normal subjects, CO measured by ACMm agreed with CO by ACMa (r=0.90, p < 0.0001, deltaCO=-0.09+/-0.42 liter/min), PD (r=0.87, p < 0.0001, deltaCO=0.12+/-0.49 liter/min) and 2D (r=0.84, p < 0.0001, deltaCO=-0.16+/-0.48 liter/min). In the patients, mitral regurgitant volume (MRV) by ACMm-ACMa agreed with PD-2D (r= 0.88, y=0.88x+6.6, p < 0.0001, deltaMRV=2.68+/-9.7 ml). CONCLUSIONS: We determined that ACM is a feasible new method for quantifying LV outflow and inflow volume to measure MRV and that ACM automatically performs calculations that are equivalent to more time-consuming Doppler and 2D measurements. Additionally, ACM should improve MR quantification in routine clinical practice.

AcvR1-mediated BMP signaling in second heart field is required for arterial pole development: implications for myocardial differentiation and regional identity.

PubMed

Thomas, Penny S; Rajderkar, Sudha; Lane, Jamie; Mishina, Yuji; Kaartinen, Vesa

2014-06-15

BMP signaling plays an essential role in second heart field-derived heart and arterial trunk development, including myocardial differentiation, right ventricular growth, and interventricular, outflow tract and aortico-pulmonary septation. It is mediated by a number of different BMP ligands, and receptors, many of which are present simultaneously. The mechanisms by which they regulate morphogenetic events and degree of redundancy amongst them have still to be elucidated. We therefore assessed the role of BMP Type I receptor AcvR1 in anterior second heart field-derived cell development, and compared it with that of BmpR1a. By removing Acvr1 using the driver Mef2c[AHF]-Cre, we show that AcvR1 plays an essential role in arterial pole morphogenesis, identifying defects in outflow tract wall and cushion morphology that preceded a spectrum of septation defects from double outlet right ventricle to common arterial trunk in mutants. Its absence caused dysregulation in gene expression important for myocardial differentiation (Isl1, Fgf8) and regional identity (Tbx2, Tbx3, Tbx20, Tgfb2). Although these defects resemble to some degree those in the equivalent Bmpr1a mutant, a novel gene knock-in model in which Bmpr1a was expressed in the Acvr1 locus only partially restored septation in Acvr1 mutants. These data show that both BmpR1a and AcvR1 are needed for normal heart development, in which they play some non-redundant roles, and refine our understanding of the genetic and morphogenetic processes underlying Bmp-mediated heart development important in human congenital heart disease. Copyright © 2014 Elsevier Inc. All rights reserved.

Percutaneous pulmonary valve implantation: an update.

PubMed

Lurz, Philipp; Bonhoeffer, Philipp; Taylor, Andrew M

2009-07-01

The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology. Percutaneous pulmonary valve implantation (PPVI) represents the first in-human application of these techniques and is a nonsurgical option for treating right ventricular outflow tract/pulmonary trunk dysfunction. With the growing numbers of patients with right ventricle to pulmonary artery conduit dysfunction after repair of congenital heart disease, the importance of a technique with lower morbidity and mortality, good patient acceptance and efficacy, that is comparable to surgery, cannot be underestimated. Over the last 9 years, PPVI has become a feasible, safe and effective treatment for both conduit stenosis and regurgitation. Median follow-up data show good freedom from reoperation and recatheterization and demonstrate that PPVI can postpone open-heart surgery, thereby potentially reducing the number of operations that patients have to undergo within their lifetime. Complications seen after PPVI, in particular stent fractures, can require reintervention in some cases (second stent-in-stent PPVI); however, valve competency remains good, with significant regurgitation during follow-up only seen in the context of occasional endocarditis. Attempts are now being made to prolong the lifespan of the device by reducing the incidence of stent fractures. Further, meticulous patient selection must be maintained to ensure that hemodynamic results are optimized and the safety of the procedure remains high. Finally, new devices have to be developed that will allow for PPVI in dilated, distensible outflow tracts, to offer this nonsurgical treatment option to a larger patient population with congenital heart disease.

An unusual location of a papillary fibroelastoma.

PubMed

Bajaj, Sharad; Nandigam, Harish; Gupta, Nishant; Alkhouri, Yazan; Galldin, Lars M; Parikh, Nalini S; Patel, Nilesh; Shamoon, Fayez

2014-03-01

Papillary fibroelastomas are benign, avascular tumors and 90 % of them are attached to the cardiac valves. We present an unusual case, where papillary fibroelastoma was found attached to the interventricular septum, flopping in and out of the left ventricular outflow tract.

Development and evaluation of a pliable biological valved conduit. Part II: Functional and hemodynamic evaluation.

PubMed

Sung, H W; Witzel, T H; Hata, C; Tu, R; Shen, S H; Lin, D; Noishiki, Y; Tomizawa, Y; Quijano, R C

1993-04-01

Many congenital cardiac malformations may require a valved conduit for the reconstruction of the right ventricular outflow tract. In spite of many endeavors made in the last 25 years, the clinical results of right ventricular outflow tract reconstruction with currently available valved conduits are still not satisfactory. Specific problems encountered clinically include suboptimal hemodynamic performance, conduit kinking or compression, and fibrous peeling from the luminal surface. To address these deficiencies, we undertook the development of a biological valved conduit: a bovine external jugular vein graft with a retained native valve cross-linked with a diglycidyl ether (DE). This study, using a canine model, was to evaluate the functional and hemodynamic performance of this newly developed valved conduit. Three 14 mm conduits, implanted as bypass grafts, right ventricle to pulmonary artery, were evaluated. The evaluation was conducted with a noninvasive color Doppler flow mapping system at pre-implantation, immediately post implantation, one- and three-months post implantation, and prior to retrieval (five-months post implantation). The two-dimensional tomographic inspection of the leaflet motion at various periods post implantation showed that the valvular leaflets in the DE treated conduit was quite pliable. No cardiac failure or valvular dysfunction was observed in any of the studied cases. The color Doppler flow mapping study demonstrated that the valve in the DE treated conduit was competent, with no conduit kinking or compression observed in any of the three cases. The spectral Doppler velocity study evidenced that the transvalvular pressure gradients of the DE treated conduit were minimal as compared to those of the currently available conduits. In conclusion, from the functional and hemodynamic performance points of view, this newly developed valved conduit is superior to those currently available.

Potential pitfalls and methods of improving in utero diagnosis of transposition of the great arteries, including the baby bird's beak image.

PubMed

McGahan, John P; Moon-Grady, Anita J; Pahwa, Anokh; Towner, Dena; Rhee-Morris, Laila; Gerscovich, Eugenio O; Fogata, Maria

2007-11-01

The goal of this study was to analyze our recent experience with fetuses with transposition of the great arteries (TGA) to identify potential pitfalls and possible methods to better detect conotruncal anomalies such as TGA. We analyzed all nonreferral obstetric ultrasound examinations in which we performed basic, targeted, or formal fetal echocardiography with a newborn diagnosis of TGA. Nine neonates had TGA. Five of these cases were diagnosed prenatally, and 4 of these had complex congenital heart abnormalities. In these 4 cases, there were abnormalities in the cardiac axis (n = 3), abnormal valves or ventricular size (n = 2), and ventricular septal defects (n = 3) that were detected on the 4-chamber view of the heart. In all cases that were not detected prenatally, both prospective and retrospective reviews of the 4-chamber heart appeared normal. The prospective analyses of the outflow tracts were all interpreted as normal, whereas the retrospective review showed subtle abnormalities such as the "baby bird's beak" image. In review of these cases, there was failure to show the "crisscross" relationship of the outflow tracts. In 1 case, 5 short axis views of the heart, retrospectively showed the artery originating from the left ventricle and bifurcated, representing the pulmonary artery. Transposition of the great arteries may be associated with complex cardiac disease that could be detected on the 4-chamber view of the heart. When the 4-chamber view is normal, it is important to identify the crisscross relationship of the outflow tracts. If this is not done, it is important to document that the pulmonary artery bifurcates and originates from the right ventricle. Five short axis views of the heart may be helpful to detect conotruncal abnormalities.

22q11 deletions in fetuses with malformations of the outflow tracts or interruption of the aortic arch: impact of additional ultrasound signs.

PubMed

Volpe, Paolo; Marasini, Maurizio; Caruso, Gilda; Marzullo, Andrea; Buonadonna, Antonia Lucia; Arciprete, Paolo; Di Paolo, Salvatore; Volpe, Gennaro; Gentile, Mattia

2003-09-01

One hundred and forty-one consecutive cases of malformations of the outflow tracts or interrupted aortic arch (IAA), detected by fetal echocardiography, underwent detailed anatomy scan, karyotyping and fluorescence in situ hybridization analysis (FISH) to detect the prevalence of 22q11 microdeletion and to evaluate neonatal clinical findings and outcome according to the presence of the genetic defect. Then, we sought to investigate whether some prenatal ultrasound findings could help identify fetuses at higher risk of carrying the 22q11 microdeletion. Echocardiography and FISH for the DiGeorge critical region (22q11) were performed in all cases. 22q11 microdeletion was detected in 28 of 141 fetuses (19.8%). Intrauterine growth restriction (IUGR) appeared to be associated with the worst prognosis, being present in 2/2 intrauterine fetal deaths and 5/6 post-natal deaths. IUGR, additional aortic arch anomalies and thymic hypo/aplasia were significantly more frequent in fetuses with 22q11 microdeletion (p=0.011, 0.011 and <0.0001, respectively). Prenatal ultrasound thymus examination, performed on the last 84 fetuses, showed 75% sensitivity and 94% specificity. The combination of 2 predictors, namely, thymus defects and IUGR associated with additional aortic arch anomalies reached more than 90% sensitivity and 100% specificity. Our study demonstrates that 22q11 microdeletion occurs in 20% of malformations of the outflow tracts and IAA type B, as detected in utero, and that this association is significantly predicted by the presence of associated ultrasound findings: thymic hypo/aplasia, IUGR and additional aortic arch anomalies. The feasibility of a correct prenatal diagnosis should enable clinicians to provide the couple with further informative counselling and to plan adequate post-natal medical interventions. Copyright 2003 John Wiley & Sons, Ltd.

Modified Ross procedure using a conduit with a synthetic valve.

PubMed

Takabayashi, Shin; Kado, Hideaki; Shiokawa, Yuichi; Fukae, Kouji; Nakano, Toshihide

2004-12-01

In the Ross procedure, a homograft conduit is commonly used in place of an autotransplanted pulmonary valve. Homograft availability may be a problem and has resulted in a search for alternatives. We performed a modified Ross procedure for right ventricular outflow tract reconstruction with a synthetic valved conduit as an alternative to homograft. Our early results of valvular and right ventricular function were evaluated in patients who used a conduit with a synthetic valve. Subjects consisted of 11 patients, who ranged in age from 5 to 22 years (12.0+/-4.9), and whose body weight ranged from 15.1 to 52.5 (34.3+/-14.4) kg. Indications for surgery were aortic stenosis (n=3), aortic stenosis and regurgitation (n=4), and aortic regurgitation (n=4). Right ventricular outflow tract reconstruction was performed using a hand-fashioned valved conduit prepared by sewing a 0.1 mm thick polytetrafluoroethylene sheet onto the luminal cavity of the 20-28 mm conduit. A conduit made with polytetrafluoroethylene was used in 8 patients, and a Dacron graft was used in 3 patients. There was no in-hospital or late mortality and angiocardiography at discharge revealed that all artificial valves remained active. The mean right atrial pressure and right ventricular end-diastolic pressure were not statistically different from preoperative values. The latest echocardiography (mean interval, 12.6 months) revealed that a mean pressure gradient across the synthetic valve was 11.4+/-11.1 mmHg and none of the patients had moderate or severe regurgitation. We demonstrated that a modified Ross procedure for right ventricular outflow tract reconstruction using a conduit with an appropriate synthetic valve is particularly effective in older children.

Electrocardiographic characteristics of left ventricular outflow tract tachycardia.

PubMed

Hachiya, H; Aonuma, K; Yamauchi, Y; Harada, T; Igawa, M; Nogami, A; Iesaka, Y; Hiroe, M; Marumo, F

2000-11-01

Catheter ablation of idiopathic left ventricular outflow tract tachycardia (LVOT-VT) is rare because a safe ablation technique at this site has not been described, and serious complications may occur. This study compared the QRS morphology of LVOT-VT with that of idiopathic right ventricular outflow tract tachycardia. A comparison was made between the electrocardiographic characteristics of LVOT-VT originating from the supravalvular region of a coronary cusp (Supra-Ao group) with those of LVOT-VT originating from the infravalvular endocardial region of a coronary cusp of the aortic valve within the LV (Infra-Ao group). After precise mapping of the right ventricle, left ventricle, pulmonary artery, coronary cusps, and proximal portion of the anterior interventricular vein, there were 17 patients in whom VT was thought to be located at the LVOT by both activation and pace mapping. They were divided between a Supra-Ao group (n = 8), and an Infra-Ao group (n = 9). Analysis of the 12-lead electrocardiogram (ECG) revealed an S wave in lead I in all 17 patients. A precordial R wave transition was also observed at V1 or V2 in 16 patients (94%). In 7 of 8 patients (88%) with Supra-Ao LVOT-VT, no S wave was observed in either V5 or V6. In contrast, an Rs pattern was observed in both V5 and V6, or in V6 only, in 100% of the patients with Infra-Ao LVOT-VT. A LVOT-VT should be suspected when the ECG shows an S wave in lead I and an R/S ratio greater than 1 in lead V1 or V2, versus a coronary cusp location if there is no S wave in either lead V5 or V6.

Contemporary Natural History and Management of Nonobstructive Hypertrophic Cardiomyopathy.

PubMed

Maron, Martin S; Rowin, Ethan J; Olivotto, Iacopo; Casey, Susan A; Arretini, Anna; Tomberli, Benedetta; Garberich, Ross F; Link, Mark S; Chan, Raymond H M; Lesser, John R; Maron, Barry J

2016-03-29

Left ventricular outflow tract gradients are absent in an important proportion of patients with hypertrophic cardiomyopathy (HCM). However, the natural course of this important patient subgroup remains largely unresolved. The authors systematically employed exercise (stress) echocardiography to define those patients without obstruction to left ventricular outflow at rest and/or under physiological exercise and to examine their natural history and clinical course to create a more robust understanding of this complex disease. We prospectively studied 573 consecutive HCM patients in 3 centers (44 ± 17 years; 66% male) with New York Heart Association functional class I/II symptoms at study entry, including 249 in whom left ventricular outflow tract obstruction was absent both at rest and following physiological exercise (<30 mm Hg; nonobstructive HCM) and retrospectively assembled clinical follow-up data. Over a median follow-up of 6.5 years, 225 of 249 nonobstructive patients (90%) remained in classes I/II, whereas 24 (10%) developed progressive heart failure to New York Heart Association functional classes III/IV. Nonobstructive HCM patients were less likely to experience advanced limiting class III/IV symptoms than the 324 patients with outflow obstruction (1.6%/year vs. 7.4%/year rest obstruction vs. 3.2%/year provocable obstruction; p < 0.001). However, 7 nonobstructive patients (2.8%) did require heart transplantation for progression to end stage versus none of the obstructive patients. HCM-related mortality among nonobstructive patients was low (n = 8; 0.5%/year), with 5- and 10-year survival rates of 99% and 97%, respectively, which is not different from expected all-cause mortality in an age- and sex-matched U.S. population (p = 0.15). HCM patients with nonobstructive disease appear to experience a relatively benign clinical course, associated with a low risk for advanced heart failure symptoms, other disease complications, and HCM-related mortality, and largely without the requirement for major treatment interventions. A small minority of nonobstructive HCM patients progress to heart transplant. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Management of Cardiovascular Disorders in Patients with Noonan Syndrome: A Case Report.

PubMed

Khorgami, Mohammad Rafie; Moradian, Maryam; Omidi, Negar; Aarabi Moghadam, Mohammad Yousef

2017-10-01

The Noonan syndrome is a rare disorder, one of whose major complications is cardiovascular involvement. A wide spectrum of congenital heart diseases has been observed in this syndrome. The most common cardiac disorder is pulmonary valve stenosis, which has a progressive nature. Hypertrophic cardiomyopathy is less common, but its morbidity and mortality rates are high. We herein introduce a 12-year-old boy with the typical findings of the Noonan syndrome. His symptoms began from infancy, and there was a gradual exacerbation in his respiratory and cardiac manifestations with age. The cardiac involvement included right ventricular outflow tract and pulmonary valve stenosis, hypertrophic cardiomyopathy, and subaortic valve stenosis. Due to the progressive course of the disease, surgical repair was done. Although the patient had a difficult postoperative period, his general condition improved and he was discharged. At 3 months' follow-up, his symptoms showed improvement. Additionally, there was a reduction in the echocardiographic parameters of the outflow tract stenosis gradient as well as a significant improvement in the cardiac hemodynamic indices.

Interesting Electrophysiological Findings in a Patient With Coincidental Right Ventricular Outflow Tract and Atrioventricular Nodal Reentrant Tachycardia

PubMed Central

Ozin, Bulent; Pirat, Bahar; Muderrisoglu, Haldun

2004-01-01

Tachycardia induced tachycardias are not common in clinical practice, and it is believed that most cases of double tachycardia are coincidental. The existence of two different tachycardias in the same patient almost always poses problems in the electrophysiology laboratory. However, in rare instances, the emergence of a second tachycardia can actually provide invaluable information about the first one. In this report, we describe a 30-year-old woman who presented with palpitations. Electrophysiological study revealed that atrial programmed stimulation at baseline induced right ventricular outflow tract (RVOT) tachycardia and supraventricular tachycardia. The study also showed that each of the tachycardias was able to induce the other. A short run of RVOT tachycardia during supraventricular tachycardia was able to entrain the latter. This finding provided important information about the nature of the supraventricular tachycardia, which proved to be atrioventricular nodal reentrant tachycardia. Both of these tachycardias were successfully ablated, and the patient’s palpitations disappeared. PMID:16943976

Outcome of Radiofrequency Catheter Ablation as a non-pharmacological therapy for idiopathic Ventricular Tachycardia.

PubMed

Samore, Naseer Ahmed; Imran Majeed, Syed Muhammad; Kayani, Azhar Mahmud; Bhalli, Muhammad Asif; Shabbir, Muhammad

2009-09-01

To determine the outcome of Radiofrequency Catheter Ablation (RFCA) as a non-pharmacological curative therapy for idiopathic Ventricular Tachycardia (VT) and to identify procedure-related complications. Descriptive study. The Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from February 2001 to October 2008. Ninety eight consecutive patients with idiopathic VT, resistant to drug therapy, who underwent Electrophysiology Studies (EPS) radiofrequency catheter ablation were enrolled. Clinical and electrophysiological variables were recorded and a descriptive analysis was done. Out of the 98 patients, 79 were males (80.6%). The mean age was 33.29+11.93 years. Modes of presentation were sustained VT, Repetitive Monomorphic VT (RMVT), Non-sustained VT (NSVT) and Ventricular Premature Beats (VPBs). Right Ventricular Outflow Tract (RVOT) VT was found in 37 patients, 37 had Idiopathic Left Ventricular Tachycardia (ILVT), 20 had Left Ventricular Outflow Tract (LVOT) VT, and Inflow Right Ventricular Tachycardia (IRVT) was found in 7 patients. Other sites of origin of VT were infrequent. Eight patients had dual morphologies of VT. Atrioventricular Nodal Re-entry Tachycardia (AVNRT) was found in 8 patients. RFCA was successful in abolishing inducible VT in 88 patients. One patient developed complete AV block requiring a permanent pacemaker. Results of this study confirm a high degree of success and safety of radiofrequency catheter ablation as curative therapy for idiopathic ventricular tachycardia.

Recent advances in cardiac catheterization for congenital heart disease

PubMed Central

Kang, Sok-Leng; Benson, Lee

2018-01-01

The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety. PMID:29636905

Spatial resolution of pace mapping of idiopathic ventricular tachycardia/ectopy originating in the right ventricular outflow tract.

PubMed

Bogun, Frank; Taj, Majid; Ting, Michael; Kim, Hyungjin Myra; Reich, Stephen; Good, Eric; Jongnarangsin, Krit; Chugh, Aman; Pelosi, Frank; Oral, Hakan; Morady, Fred

2008-03-01

Pace mapping has been used to identify the site of origin of focal ventricular arrhythmias. The spatial resolution of pace mapping has not been adequately quantified using currently available three-dimensional mapping systems. The purpose of this study was to determine the spatial resolution of pace mapping in patients with idiopathic ventricular tachycardia or premature ventricular contractions originating in the right ventricular outflow tract. In 16 patients with idiopathic ventricular tachycardia/ectopy from the right ventricular outflow tract, comparisons and classifications of pace maps were performed by two observers (good pace map: match >10/12 leads; inadequate pace map: match < or =10/12 leads) and a customized MATLAB 6.0 program (assessing correlation coefficient and normalized root mean square of the difference (nRMSd) between test and template signals). With an electroanatomic mapping system, the correlation coefficient of each pace map was correlated with the distance between the pacing site and the effective ablation site. The endocardial area within the 10-ms activation isochrone was measured. The ablation procedure was effective in all patients. Sites with good pace maps had a higher correlation coefficient and lower nRMSd than sites with inadequate pace maps (correlation coefficient: 0.96 +/- 0.03 vs 0.76 +/- 0.18, P <.0001; nRMSd: 0.41 +/- 0.16 vs 0.89 +/- 0.39, P <.0001). Using receiver operating characteristic curves, appropriate cutoff values were >0.94 for correlation coefficient (sensitivity 81%, specificity 89%) and < or =0.54 for nRMSd (sensitivity 76%, specificity 80%). Good pace maps were located a mean of 7.3 +/- 5.0 mm from the effective ablation site and had a mean activation time of -24 +/- 7 ms. However, in 3 (18%) of 16 patients, the best pace map was inadequate at the effective ablation site, with an endocardial activation time at these sites of -25 +/- 12 ms. Pace maps with correlation coefficient > or =0.94 were confined to an area of 1.8 +/- 0.6 cm2. The 10-ms isochrone measured 1.2 +/- 0.7 cm2. The spatial resolution of a good pace map for targeting ventricular tachycardia/ectopy is 1.8 cm2 in the right ventricular outflow tract and therefore is inferior to the spatial resolution of activation mapping as assessed by isochronal activation. In approximately 20% of patients, pace mapping is unreliable in identifying the site of origin, possibly due a deeper site of origin and preferential conduction via fibers connecting the focus to the endocardial surface.

Decreased levels of embryonic retinoic acid synthesis accelerate recovery from arterial growth delay in a mouse model of DiGeorge syndrome.

PubMed

Ryckebüsch, Lucile; Bertrand, Nicolas; Mesbah, Karim; Bajolle, Fanny; Niederreither, Karen; Kelly, Robert G; Zaffran, Stéphane

2010-03-05

Loss of Tbx1 and decrease of retinoic acid (RA) synthesis result in DiGeorge/velocardiofacial syndrome (DGS/VCFS)-like phenotypes in mouse models, including defects in septation of the outflow tract of the heart and anomalies of pharyngeal arch-derived structures including arteries of the head and neck, laryngeal-tracheal cartilage, and thymus/parathyroid. Wild-type levels of T-box transcription factor (Tbx)1 and RA signaling are required for normal pharyngeal arch artery development. Recent studies have shown that reduction of RA or loss of Tbx1 alters the contribution of second heart field (SHF) progenitor cells to the elongating heart tube. Here we tested whether Tbx1 and the RA signaling pathway interact during the deployment of the SHF and formation of the mature aortic arch. Molecular markers of the SHF, neural crest and smooth muscle cells, were analyzed in Raldh2;Tbx1 compound heterozygous mutants. Our results revealed that the SHF and outflow tract develop normally in Raldh2(+/-);Tbx1(+/-) embryos. However, we found that decreased levels of RA accelerate the recovery from arterial growth delay observed in Tbx1(+/-) mutant embryos. This compensation coincides with the differentiation of smooth muscle cells in the 4th pharyngeal arch arteries, and is associated with severity of neural crest cell migration defects observed in these mutants. Our data suggest that differences in levels of embryonic RA may contribute to the variability in great artery anomalies observed in DGS/VCFS patients.

Definition of normality of pressure-flow parameters based on observations in asymptomatic men.

PubMed

Rosario, Derek J; Woo, Henry H; Chapple, Christopher R

2008-01-01

Clinical nomograms for differentiating obstructed from unobstructed voiding and poor detrusor contractility from normal contractility have traditionally been drawn on the basis of symptomatic response to outflow tract surgery or on urodynamic changes in men with LUTS before and after surgery. The aim of this study was to examine pressure-flow parameters in asymptomatic male volunteers before age-related changes in the lower urinary tract had taken place and to assess detrusor contractility and outflow conditions during physiological bladder filling against clinically used pressure-flow nomograms. Thirty-seven healthy male subjects between the ages of 18 and 40 years volunteered to undergo AUM. A total of 66 fill-void cycles in 25 individuals were evaluable. Mean p(det.Qmax) for the group was 53 +/- 3 cmH(2)O with a mean Q(max) of 24 +/- 2 ml sec(-1). URA of 21 cmH(2)O defined the upper border of normality for the outflow condition. Schäfer's OCO showed the most consistent relationship between estimated urethral pressure at minimal flow and true measured urethral closure pressure. From a clinical perspective, the linear nomograms (ICS and Schäfer) are more easily accessible with the ICS BOOI and obstruction index being the simplest to calculate manually. Minimal differences found between these urodynamic nomograms confirm the clinical value of recommending a single method to facilitate future comparisons between studies. An upper limit of normality for the male outflow condition can be defined by an URA of 21 cmH(2)O, AGN of 40 cmH(2)O or OCO of 1. Results above these reference values should be considered abnormal in this age group and where identified in a different age-group should be explained by physiological or pathophysiological events.

Left ventricular to left atrial communication secondary to a paraaortic abscess: color flow Doppler documentation.

PubMed

Fisher, E A; Estioko, M R; Stern, E H; Goldman, M E

1987-07-01

Aortic root abscess occurs frequently in aortic prosthetic valve infective endocarditis. The present echocardiographic report documents a ruptured abscess that led to a direct communication between the left ventricular outflow tract and the left atrium confirmed by real-time (color flow) Doppler imaging.

Gastric malpositioning and chronic, intermittent vomiting following prophylactic gastropexy in a 20-month-old great Dane dog.

PubMed

Sutton, Jessie S; Steffey, Michele A; Bonadio, Cecily M; Marks, Stanley L

2015-10-01

A 20-month-old castrated male great Dane dog was presented for evaluation of chronic intermittent vomiting of 2 months' duration. A prophylactic incisional gastropexy performed at 6 mo of age resulted in gastric malpositioning and subsequent partial gastric outflow tract obstruction.

Aneurysm of the right ventricular outflow following bovine valved venous conduit insertion.

PubMed

Boudjemline, Younes; Bonnet, Damien; Agnoletti, Gabriella; Vouhé, Pascal

2003-01-01

A case of aneurysm of the right ventricular outflow tract is described after repair of tetralogy of Fallot using a Contegra supported conduit. Angiograms revealed that the aneurysm was located between the ventricular anastomosis and the proximal ring of the conduit confirming echocardiographic data. Because the conduit between the rings was not dilated, the valve was perfectly functioning. Pulmonary anastomosis was severely stenosed explaining the dilatation seen below. Conduit replacement with resection of the aneurysmal part of the failing conduit was performed. Supported conduits do not eliminate the risk of secondary dilatation below the artificial ring but preserve valvular function.

Partial rescue of defects in Cited2-deficient embryos by HIF-1alpha heterozygosity.

PubMed

Xu, Bing; Doughman, Yongqiu; Turakhia, Mona; Jiang, Weihong; Landsettle, Chad E; Agani, Faton H; Semenza, Gregg L; Watanabe, Michiko; Yang, Yu-Chung

2007-01-01

Hypoxia inducible factor-1 (HIF-1) initiates key cellular and tissue responses to physiological and pathological hypoxia. Evidence from in vitro and structural analyses supports a critical role for Cited2 in down-regulating HIF-1-mediated transcription by competing for binding with oxygen-sensitive HIF-1alpha to transcriptional co-activators CBP/p300. We previously detected elevated expression of HIF-1 target genes in Cited2(-/-) embryonic hearts, indicating that Cited2 inhibits HIF-1 transactivation in vivo. In this study, we show for the first time that highly hypoxic cardiac regions in mouse embryos corresponded to the sites of defects in Cited2(-/-) embryos and that defects of the outflow tract, interventricular septum, cardiac vasculature, and hyposplenia were largely rescued by HIF-1alpha haploinsufficiency. The hypoxia of the outflow tract and interventricular septum peaked at E13.5 and dissipated by E15.5 in wild-type hearts, but persisted in E15.5 Cited2(-/-) hearts. The persistent hypoxia and abnormal vasculature in the myocardium of interventricular septum in E15.5 Cited2(-/-) hearts were rescued with decreased HIF-1alpha gene dosage. Accordingly, mRNA levels of HIF-1-responsive genes were reduced in Cited2(-/-) embryonic hearts by HIF-1alpha heterozygosity. These findings suggest that a precise level of HIF-1 transcriptional activity critical for normal development is triggered by differential hypoxia and regulated through feedback inhibition by Cited2.

Gastric malpositioning and chronic, intermittent vomiting following prophylactic gastropexy in a 20-month-old great Dane dog

PubMed Central

Sutton, Jessie S.; Steffey, Michele A.; Bonadio, Cecily M.; Marks, Stanley L.

2015-01-01

A 20-month-old castrated male great Dane dog was presented for evaluation of chronic intermittent vomiting of 2 months’ duration. A prophylactic incisional gastropexy performed at 6 mo of age resulted in gastric malpositioning and subsequent partial gastric outflow tract obstruction. PMID:26483580

The Manifestation of Vortical and Secondary Flow in the Cerebral Venous Outflow Tract: An In Vivo MR Velocimetry Study

PubMed Central

Kefayati, Sarah; Amans, Matthew; Faraji, Farshid; Ballweber, Megan; Kao, Evan; Ahn, Sinyeob; Meisel, Karl; Halbach, Van; Saloner, David

2016-01-01

Aberrations in flow in the cerebral venous outflow tract (CVOT) have been implicated as the cause of several pathologic conditions including idiopathic intracranial hypertension (IIH), multiple sclerosis (MS), and pulsatile tinnitus (PT). The advent of 4D Flow magnetic resonance imaging (4D-Flow MRI) has recently allowed researchers to evaluate blood flow patterns in the arterial structures with great success. We utilized similar imaging techniques and found several distinct flow characteristics in the CVOT of subjects with and without lumenal irregularities. We present the flow patterns of 8 out of 38 subjects who have varying heights of the internal jugular bulb and varying lumenal irregularities including stenosis and diverticulum. In the internal jugular vein (IJV) with an elevated jugular bulb (JB), 4DFlow MRI revealed a characteristic spiral flow that was dependent on the level of JB elevation. Vortical flow was also observed in the diverticula of the venous sinuses and IJV. The diversity of flow complexity in the CVOT illustrates the potential importance of hemodynamic investigations in elucidating venous pathologies. PMID:27894675

Right Ventricular Outflow Tract Stenting in Tetralogy of Fallot Infants With Risk Factors for Early Primary Repair.

PubMed

Sandoval, Juan Pablo; Chaturvedi, Rajiv R; Benson, Lee; Morgan, Gareth; Van Arsdell, Glen; Honjo, Osami; Caldarone, Christopher; Lee, Kyong-Jin

2016-12-01

Tetralogy of Fallot with cyanosis requiring surgical repair in early infancy reflects poor anatomy and is associated with more clinical instability and longer hospitalization than those who can be electively repaired later. We bridged symptomatic infants with risk factors for early primary repair by right ventricular outflow tract stenting (stent). Four groups of tetralogy of Fallot with confluent central pulmonary arteries were studied: stent group (n=42), primary repair (aged <3 months) with pulmonary stenosis (early-PS group; n=44), primary repair (aged <3 months) with pulmonary atresia (early-PA group; n=49), and primary repair between 3 and 11 months of age (surg>3mo group; n=45). Stent patients had the smallest pulmonary arteries with a median (95% credible intervals) Nakata index (mm 2 /m 2 ) of 79 (66-85) compared with the early-PA 139 (129-154), early-PS 136 (121-153), and surg>3mo 167 (153-200) groups. Only stent infants required unifocalization of aortopulmonary collaterals (17%). Stent and early-PA infants had younger age and lower weight than early-PS infants. Stent infants had the most multiple comorbidities. Stenting allowed deferral of complete surgical repair to an age (6 months), weight (6.3 [5.8-7.0] kg), and Nakata index (147 [132-165]) similar to the low-risk surg>3mo group. The 3 early treatment groups had similar intensive care unit/hospital stays and high reintervention rates in the first 12 months after repair, compared with the surg>3mo group. Right ventricular outflow tract stenting of symptomatic tetralogy of Fallot with poor anatomy (small pulmonary arteries) and adverse factors (multiple comorbidities, low weight) relieves cyanosis and defers surgical repair. This allowed pulmonary arterial and somatic growth with clinical results comparable to early surgical repair in more favorable patients. © 2016 American Heart Association, Inc.

Reasons for failed ablation for idiopathic right ventricular outflow tract-like ventricular arrhythmias.

PubMed

Yokokawa, Miki; Good, Eric; Crawford, Thomas; Chugh, Aman; Pelosi, Frank; Latchamsetty, Rakesh; Jongnarangsin, Krit; Ghanbari, Hamid; Oral, Hakan; Morady, Fred; Bogun, Frank

2013-08-01

The right ventricular outflow tract (RVOT) is the most common site of origin of ventricular arrhythmias (VAs) in patients with idiopathic VAs. A left bundle branch block, inferior axis morphology arrhythmia is the hallmark of RVOT arrhythmias. VAs from other sites of origin can mimic RVOT VAs, and ablation in the RVOT typically fails for these VAs. To analyze reasons for failed ablations of RVOT-like VAs. Among a consecutive series of 197 patients with an RVOT-like electrocardiographic (ECG) morphology who were referred for ablation, 38 patients (13 men; age 46 ± 14 years; left ventricular ejection fraction 47% ± 14%) in whom a prior procedure failed within the RVOT underwent a second ablation procedure. ECG characteristics of the VA were compared to a consecutive series of 50 patients with RVOT VAs. The origin of the VA was identified in 95% of the patients. In 28 of 38 (74%) patients, the arrhythmia origin was not in the RVOT. The VA originated from intramural sites (n = 8, 21%), the pulmonary arteries (n = 7, 18%), the aortic cusps (n = 6, 16%), and the epicardium (n = 5, 13%). The origin was within the RVOT in 10 (26%) patients. In 2 (5%) patients, the origin could not be identified despite biventricular, aortic, and epicardial mapping. The VA was eliminated in 34 of 38 (89%) patients with repeat procedures. The ECG features of patients with failed RVOT-like arrhythmias were different from the characteristics of RVOT arrhythmias. In patients in whom ablation of a VA with an RVOT-like appearance fails, mapping of the pulmonary artery, the aortic cusps, the epicardium, the left ventricular outflow tract, and the aortic cusps will help identify the correct site of origin. The 12-lead ECG is helpful in differentiating these VAs from RVOT VAs. Copyright © 2013 Heart Rhythm Society. All rights reserved.

Nonsurgical reduction of the interventricular septum in patients with hypertrophic cardiomyopathy.

PubMed

Shamim, Waqar; Yousufuddin, Mohammed; Wang, Duolao; Henein, Michael; Seggewiss, Hubert; Flather, Marcus; Coats, Andrew J S; Sigwart, Ulrich

2002-10-24

In patients with hypertrophic cardiomyopathy and obstruction of the left ventricular outflow tract, nonsurgical reduction of the septum is a treatment option when medical therapy has failed. We investigated the long-term effects of nonsurgical reduction of the septum on functional capacity and electrocardiographic and echocardiographic characteristics. Sixty-four consecutive patients with hypertrophic cardiomyopathy and a mean (+/-SD) age of 48.5+/-17.2 years underwent nonsurgical reduction of the septum by injection of ethanol into the septal perforator branch of the left anterior descending coronary artery. These patients were assessed by exercise testing, electrocardiography, and resting and dobutamine (stress-induced) echocardiography after a mean period of 3.0+/-1.3 years. At follow-up, patients had significant improvements in New York Heart Association class, peak oxygen consumption (from 18.4+/-5.8 to 30.0+/-4.4 ml per kilogram of body weight per minute, P<0.001), and left ventricular outflow tract gradients (resting gradient, from 64+/-36 to 16+/-15 mm Hg; P<0.001; stress-induced gradient, from 132+/-34 to 45+/-19 mm Hg; P<0.001). Procedure-related complications included right bundle-branch block in all patients, complete heart block in 31 patients (48 percent), and significant increases in QRS and corrected QT intervals. Seventeen patients (27 percent) required permanent pacing. R-wave amplitude was significantly decreased (from 32+/-8 to 17+/-7 mV, P<0.001). The dimensions of the left ventricular cavity increased, and the interventricular septal thickness was reduced. Nonsurgical septal reduction leads to sustained improvements in both subjective and objective measures of exercise capacity in association with a persistent reduction in resting and stress-induced left ventricular outflow tract gradients. It is also associated with a high incidence of procedure-related complete heart block, however, often requiring permanent pacing. Copyright 2002 Massachusetts Medical Society

Computational Fluid Dynamics of Developing Avian Outflow Tract Heart Valves

PubMed Central

Bharadwaj, Koonal N.; Spitz, Cassie; Shekhar, Akshay; Yalcin, Huseyin C.; Butcher, Jonathan T.

2012-01-01

Hemodynamic forces play an important role in sculpting the embryonic heart and its valves. Alteration of blood flow patterns through the hearts of embryonic animal models lead to malformations that resemble some clinical congenital heart defects, but the precise mechanisms are poorly understood. Quantitative understanding of the local fluid forces acting in the heart has been elusive because of the extremely small and rapidly changing anatomy. In this study, we combine multiple imaging modalities with computational simulation to rigorously quantify the hemodynamic environment within the developing outflow tract (OFT) and its eventual aortic and pulmonary valves. In vivo Doppler ultrasound generated velocity profiles were applied to Micro-Computed Tomography generated 3D OFT lumen geometries from Hamburger-Hamilton (HH) stage 16 to 30 chick embryos. Computational fluid dynamics simulation initial conditions were iterated until local flow profiles converged with in vivo Doppler flow measurements. Results suggested that flow in the early tubular OFT (HH16 and HH23) was best approximated by Poiseuille flow, while later embryonic OFT septation (HH27, HH30) was mimicked by plug flow conditions. Peak wall shear stress (WSS) values increased from 18.16 dynes/cm2 at HH16 to 671.24 dynes/cm2 at HH30. Spatiotemporally averaged WSS values also showed a monotonic increase from 3.03 dynes/cm2 at HH16 to 136.50 dynes/cm2 at HH30. Simulated velocity streamlines in the early heart suggest a lack of mixing, which differed from classical ink injections. Changes in local flow patterns preceded and correlated with key morphogenetic events such as OFT septation and valve formation. This novel method to quantify local dynamic hemodynamics parameters affords insight into sculpting role of blood flow in the embryonic heart and provides a quantitative baseline dataset for future research. PMID:22535311

Comparison of peak flow velocity through the left ventricular outflow tract and effective orifice area indexed to body surface area in Golden Retriever puppies to predict development of subaortic stenosis in adult dogs.

PubMed

Javard, Romain; Bélanger, Marie-Claude; Côté, Etienne; Beauchamp, Guy; Pibarot, Philippe

2014-12-15

To evaluate the usefulness of Doppler-derived peak flow velocity through the left ventricular outflow tract (LVOT Vmax) and effective orifice area indexed to body surface area (EOAi) in puppies to predict development of subaortic stenosis (SAS) in the same dogs as adults. Prospective, longitudinal, observational study. 38 Golden Retrievers. Cardiac auscultation and echocardiography were performed on 2- to 6-month-old puppies, then repeated at 12 to 18 months. Subaortic stenosis was diagnosed when LVOT Vmax was ≥ 2.3 m/s in adult dogs with left basilar systolic murmurs. All puppies with EOAi < 1.46 cm(2)/m(2) had SAS as adults. All adults with EOAi < 1.29 cm(2)/m(2) had SAS. An LVOT Vmax > 2.3 m/s in puppyhood was 63% sensitive and 100% specific for SAS in adulthood. In puppies, LVOT Vmax was more strongly associated with a future diagnosis of SAS (area under the curve [AUC], 0.89) than was EOAi (AUC, 0.80). In puppies, the combination of LVOT Vmax and EOAi yielded slightly higher sensitivity (69%) and specificity (100%) for adult SAS than did LVOT Vmax alone. In unaffected and affected dogs, LVOT Vmax increased significantly from puppyhood to adulthood but EOAi did not. In Golden Retriever puppies, LVOT Vmax > 2.3 m/s and EOAi < 1.46 cm(2)/m(2) were both associated with a diagnosis of SAS at adulthood. The combination of these 2 criteria may result in higher sensitivity for SAS screening. Unlike LVOT Vmax, EOAi did not change during growth in either unaffected Golden Retrievers or those with SAS.

Hemodynamic and metabolic characteristics associated with development of a right ventricular outflow tract pressure gradient during upright exercise

PubMed Central

van Riel, Annelieke C. M. J.; Systrom, David M.; Oliveira, Rudolf K. F.; Landzberg, Michael J.; Mulder, Barbara J. M.; Bouma, Berto J.; Maron, Bradley A.; Shah, Amil M.; Waxman, Aaron B.

2017-01-01

Background We recently reported a novel observation that many patients with equal resting supine right ventricular(RV) and pulmonary artery(PA) systolic pressures develop an RV outflow tract(RVOT) pressure gradient during upright exercise. The current work details the characteristics of patients who develop such an RVOT gradient. Methods We studied 294 patients (59.7±15.5 years-old, 49% male) referred for clinical invasive cardiopulmonary exercise testing, who did not have a resting RVOT pressure gradient defined by the simultaneously measured peak-to-peak difference between RV and PA systolic pressures. Results The magnitude of RVOT gradient did not correspond to clinical or hemodynamic findings suggestive of right heart failure; rather, higher gradients were associated with favorable exercise findings. The presence of a high peak RVOT gradient (90th percentile, ≥33mmHg) was associated with male sex (70 vs. 46%, p = 0.01), younger age (43.6±17.7 vs. 61.8±13.9 years, p<0.001), lower peak right atrial pressure (5 [3–7] vs. 8 [4–12]mmHg, p<0.001), higher peak heart rate (159±19 vs. 124±26 beats per minute, p<0.001), and higher peak cardiac index (8.3±2.3 vs. 5.7±1.9 L/min/m2, p<0.001). These associations persisted when treating peak RVOT as a continuous variable and after age and sex adjustment. At peak exercise, patients with a high exercise RVOT gradient had both higher RV systolic pressure (78±11 vs. 66±17 mmHg, p<0.001) and lower PA systolic pressure (34±8 vs. 50±19 mmHg, p<0.001). Conclusions Development of a systolic RV-PA pressure gradient during upright exercise is not associated with an adverse hemodynamic exercise response and may represent a normal physiologic finding in aerobically fit young people. PMID:28636647

Blood flow patterns underlie developmental heart defects

PubMed Central

Midgett, Madeline; Thornburg, Kent

2017-01-01

Although cardiac malformations at birth are typically associated with genetic anomalies, blood flow dynamics also play a crucial role in heart formation. However, the relationship between blood flow patterns in the early embryo and later cardiovascular malformation has not been determined. We used the chicken embryo model to quantify the extent to which anomalous blood flow patterns predict cardiac defects that resemble those in humans and found that restricting either the inflow to the heart or the outflow led to reproducible abnormalities with a dose-response type relationship between blood flow stimuli and the expression of cardiac phenotypes. Constricting the outflow tract by 10–35% led predominantly to ventricular septal defects, whereas constricting by 35–60% most often led to double outlet right ventricle. Ligation of the vitelline vein caused mostly pharyngeal arch artery malformations. We show that both cardiac inflow reduction and graded outflow constriction strongly influence the development of specific and persistent abnormal cardiac structure and function. Moreover, the hemodynamic-associated cardiac defects recapitulate those caused by genetic disorders. Thus our data demonstrate the importance of investigating embryonic blood flow conditions to understand the root causes of congenital heart disease as a prerequisite to future prevention and treatment. NEW & NOTEWORTHY Congenital heart defects result from genetic anomalies, teratogen exposure, and altered blood flow during embryonic development. We show here a novel “dose-response” type relationship between the level of blood flow alteration and manifestation of specific cardiac phenotypes. We speculate that abnormal blood flow may frequently underlie congenital heart defects. PMID:28062416

Results of transcatheter pulmonary valvulation in native or patched right ventricular outflow tracts.

PubMed

Malekzadeh-Milani, Sophie; Ladouceur, Magalie; Cohen, Sarah; Iserin, Laurence; Boudjemline, Younes

2014-11-01

Although widely accepted worldwide, indications for percutaneous valve replacement are limited to treatment of dysfunction of prosthetic conduits inserted in the right ventricular outflow tract (RVOT). There has been little evaluation of the use of the Melody(®) valve for patched non-circular pulmonary pathways. To evaluate the outcomes of Melody valve insertion in patients with a patched non-circular RVOT. We analysed procedural and outcomes data from 34 patients who underwent Melody valve implantation for a non-circular RVOT. RVOT preparation was done in all patients, using different techniques (conventional, Russian doll and/or PA jailing). Melody valve insertion was performed concomitantly in most patients. All procedures were successful. Sixteen patients had complex additional procedures, including the jailing technique (n=5), the Russian doll technique (n=6) and multiple stent implantations (Russian jailing; n=5). The remaining patients were treated using the conventional technique with systematic prestenting. Three early complications occurred: one haemoptysis; one residual RVOT obstruction needing recatheterization 48 hours after percutaneous pulmonary valve implantation; and one stent embolization during advancement of the Ensemble(®) delivery system. The mean follow-up period was 2.6 years postprocedure. There was no stent fracture, migration or embolization. Two patients developed a significant paraprosthetic leak and one received a second Melody valve. Careful patient selection, balloon sizing and RVOT preparation with prestenting are required to create a safe landing zone for the Melody valve. Short-term follow-up shows excellent results with no stent fracture or migration and appears promising. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Anatomic, histopathologic, and echocardiographic features in a dog with an atypical pulmonary valve stenosis with a fibrous band of tissue and a patent ductus arteriosus.

PubMed

Yoon, Hakyoung; Kim, Jaehwan; Nahm, Sang-Soep; Eom, Kidong

2017-07-11

Congenital pulmonary valve stenosis and patent ductus arteriosus are common congenital heart defects in dogs. However, concurrence of atypical pulmonary valve stenosis and patent ductus arteriosus is uncommon. This report describes the anatomic, histopathologic, and echocardiographic features in a dog with concomitant pulmonary valve stenosis and patent ductus arteriosus with atypical pulmonary valve dysplasia that included a fibrous band of tissue. A 1.5-year-old intact female Chihuahua dog weighing 3.3 kg presented with a continuous grade VI cardiac murmur, poor exercise tolerance, and an intermittent cough. Echocardiography indicated pulmonary valve stenosis, a thickened dysplastic valve without annular hypoplasia, and a type IIA patent ductus arteriosus. The pulmonary valve was thick line-shaped in systole and dome-shaped towards the right ventricular outflow tract in diastole. The dog suffered a fatal cardiac arrest during an attempted balloon pulmonary valvuloplasty. Necropsy revealed pulmonary valve dysplasia, commissural fusion, and incomplete opening and closing of the pulmonary valve because of a fibrous band of tissue causing adhesion between the right ventricular outflow tract and the dysplastic intermediate cusp of the valve. A fibrous band of tissue between the right ventricular outflow track and the pulmonary valve should be considered as a cause of pulmonary valve stenosis. Pulmonary valve stenosis and patent ductus arteriosus can have conflicting effects on diastolic and systolic dysfunction, respectively. Therefore, beta-blockers should always be used carefully, particularly in patients with a heart defect where there is concern about left ventricular systolic function.

Genetic Modifiers of the Physical Malformations in Velo-Cardio-Facial Syndrome/DiGeorge Syndrome

ERIC Educational Resources Information Center

Aggarwal, Vimla S.; Morrow, Bernice E.

2008-01-01

Velo-cardio-facial syndrome/DiGeorge syndrome (VCFS/DGS), the most common micro-deletion disorder in humans, is characterized by craniofacial, parathyroid, and thymic defects as well as cardiac outflow tract malformations. Most patients have a similar hemizygous 3 million base pair deletion on 22q11.2. Studies in mouse have shown that "Tbx1", a…

Experimental assessment of valve performance in healthy and diseased right ventricular outflow tracts using magnetic resonance velocimetry

NASA Astrophysics Data System (ADS)

Schiavone, Nicole; Elkins, Christopher; McElhinney, Doff; Eaton, John K.; Marsden, Alison

2017-11-01

Tetralogy of Fallot (ToF), the most common type of cyanotic congenital heart defect, affects 1 in every 2500 newborns annually and typically requires surgical repair of the right ventricular outflow tract (RVOT) and placement of an artificial pulmonary valve. All artificial valves are subject to dysfunction, but their longevity is highly variable. Clinical observation reveals large variations in RVOT anatomy in ToF patients, which may affect longevity. This work aims to experimentally assess the performance of artificial pulmonary valves in anatomically realistic healthy and diseased RVOT geometries using magnetic resonance velocimetry (MRV). With MRV, we can capture 3D, three-component, phase-averaged velocity fields in 3D printed RVOT geometries. The experiment is designed to ensure physiological flow rate and pressure waveforms, while the RVOT geometries are based on anatomies seen clinically in ToF patients. Two models are used in the current work: an idealized RVOT based on healthy subjects aged eleven to thirteen and a diseased geometry with a dilation of 150% in vessel diameter downstream of the pulmonary valve. We will also present preliminary rigid-wall blood flow simulations in each model, towards the ultimate goal of experimental validation of valve simulations.

Simulations of heart mechanics over the cardiac cycle

NASA Astrophysics Data System (ADS)

Tavoularis, Stavros; Doyle, Matthew; Bourgault, Yves

2009-11-01

This study is concerned with the numerical simulation of blood flow and myocardium motion with fluid-structure interaction of the left ventricle (LV) of a canine heart over the entire cardiac cycle. The LV geometry is modeled as a series of nested prolate ellipsoids and is capped with cylindrical tubes representing the inflow and outflow tracts. The myocardium is modeled as a multi-layered, slightly compressible, transversely isotropic, hyperelastic material, with each layer having different principal directions to approximate the fibrous structure. Blood is modeled as a slightly compressible Newtonian fluid. Blood flow into and out of the LV is driven by left atrial and aortic pressures applied at the distal ends of the inflow and outflow tracts, respectively, along with changes in the stresses in the myocardium caused by time-dependent changes in its material properties, which simulate the cyclic contraction and relaxation of the muscle fibers. Numerical solutions are obtained with the use of a finite element code. The computed temporal and spatial variations of pressure and velocity in the blood and stresses and strains in the myocardium will be discussed and compared to physiological data. The variation of the LV cavity volume over the cardiac cycle will also be discussed.

Will Catheter Interventions Replace Surgery for Valve Abnormalities?

PubMed Central

O’Byrne, Michael L; Gillespie, Matthew J

2015-01-01

Purpose of Review Catheter-based valve technologies have evolved rapidly over the last decade. Transcatheter aortic valve replacement (TAVR) has become a routine procedure in high-risk adult patients with calcific aortic stenosis. In patients with congenital heart disease (CHD), transcatheter pulmonary valve replacement represents a transformative technology for right ventricular outflow tract dysfunction with the potential to expand to other indications. This review aims to summarize 1) the current state of the art for transcatheter valve replacement (TVR) in CHD, 2) the expanding indications for TVR, and 3) the technological obstacles to optimizing TVR. Recent findings Multiple case series have demonstrated that TVR with the Melody transcatheter pulmonary valve in properly selected patients is safe, effective, and durable in short-term follow-up. The Sapien transcatheter heart valve represents an alternative device with similar safety and efficacy in limited studies. Innovative use of current valves has demonstrated the flexibility of TVR, while highlighting the need for devices to address the broad range of post-operative anatomies either with a single device or strategies to prepare the outflow tract for subsequent device deployment. Summary The potential of TVR has not been fully realized, but holds promise in treatment of CHD. PMID:24281347

Left ventricle to aorta valved conduit for relief of diffuse left ventricular outflow tract obstruction.

PubMed

Reder, R F; Dimich, I; Steinfeld, L; Litwak, R S

1977-06-01

Operative relief of congenital tunnel subaortic stenosis by means of local incision or excision, or both, has generally been unsatisfactory. The use of a valve-bearing conduit between the left ventricular apex and thoracic aorta offers a predictable means of bypassing the left ventricular outflow obstruction. The procedure was used in a 17 year old girl with an excellent hemodynamic result. The history of operative management with diverting plantation of valved conduits in this position have not been defined, but use of these prostheses appears advisable in severe subvalvular, valvular and supravalvular obstructions that are not readily amenable to predictable and safe surgical palliation. The operation may prove useful in selected cases of idiopathic hypertrophic obstructive cardiomyopathy.

Evaluation of aortic valve stenosis using cardiovascular magnetic resonance: comparison of an original semiautomated analysis of phase-contrast cardiovascular magnetic resonance with Doppler echocardiography.

PubMed

Defrance, Carine; Bollache, Emilie; Kachenoura, Nadjia; Perdrix, Ludivine; Hrynchyshyn, Nataliya; Bruguière, Eric; Redheuil, Alban; Diebold, Benoit; Mousseaux, Elie

2012-09-01

Accurate quantification of aortic valve stenosis (AVS) is needed for relevant management decisions. However, transthoracic Doppler echocardiography (TTE) remains inconclusive in a significant number of patients. Previous studies demonstrated the usefulness of phase-contrast cardiovascular magnetic resonance (PC-CMR) in noninvasive AVS evaluation. We hypothesized that semiautomated analysis of aortic hemodynamics from PC-CMR might provide reproducible and accurate evaluation of aortic valve area (AVA), aortic velocities, and gradients in agreement with TTE. We studied 53 AVS patients (AVA(TTE)=0.87±0.44 cm(2)) and 21 controls (AVA(TTE)=2.96±0.59 cm(2)) who had TTE and PC-CMR of aortic valve and left ventricular outflow tract on the same day. PC-CMR data analysis included left ventricular outflow tract and aortic valve segmentation, and extraction of velocities, gradients, and flow rates. Three AVA measures were performed: AVA(CMR1) based on Hakki formula, AVA(CMR2) based on continuity equation, AVA(CMR3) simplified continuity equation=left ventricular outflow tract peak flow rate/aortic peak velocity. Our analysis was reproducible, as reflected by low interoperator variability (<4.56±4.40%). Comparison of PC-CMR and TTE aortic peak velocities and mean gradients resulted in good agreement (r=0.92 with mean bias=-29±62 cm/s and r=0.86 with mean bias=-12±15 mm Hg, respectively). Although good agreement was found between TTE and continuity equation-based CMR-AVA (r>0.94 and mean bias=-0.01±0.38 cm(2) for AVA(CMR2), -0.09±0.28 cm(2) for AVA(CMR3)), AVA(CMR1) values were lower than AVA(TTE) especially for higher AVA (mean bias=-0.45±0.52 cm(2)). Besides, ability of PC-CMR to detect severe AVS, defined by TTE, provided the best results for continuity equation-based methods (accuracy >94%). Our PC-CMR semiautomated AVS evaluation provided reproducible measurements that accurately detected severe AVS and were in good agreement with TTE.

Left ventricular outflow tract mean systolic acceleration as a surrogate for the slope of the left ventricular end-systolic pressure-volume relationship

NASA Technical Reports Server (NTRS)

Bauer, Fabrice; Jones, Michael; Shiota, Takahiro; Firstenberg, Michael S.; Qin, Jian Xin; Tsujino, Hiroyuki; Kim, Yong Jin; Sitges, Marta; Cardon, Lisa A.; Zetts, Arthur D.;

Outcomes of Right Ventricular Outflow Tract Reconstruction for Children with Persistent Truncus Arteriosus: A 10-Year Single-Center Experience.

PubMed

Luo, Kai; Zheng, Jinghao; Zhu, Zhongqun; Gao, Botao; He, Xiaomin; Xu, Zhiwei; Liu, Jinfen

2018-03-01

The purpose of this report is to assess the mid- and long-term outcomes of right ventricular outflow tract (RVOT) reconstruction for children with persistent truncus arteriosus. Between September 2006 and 2016, 105 patients with persistent truncus arteriosus (PTA) received surgical treatment at Shanghai Children's Medical Center. Direct right ventricle-pulmonary artery anastomosis (pulmonary artery pull-down) was performed in 51 patients; a left auricle or pericardial conduit was inserted between the RVOT and pulmonary artery as a connection in 17 patients; heterograft (bovine jugular vein or Gore-tex) conduits and homograft conduits were used in 30 and 7 cases, respectively, to connect the distal pulmonary and right ventricle outflow tract; and pulmonary valve reconstruction was performed in 38 patients using a Gore-tex monocusp. There were six in-hospital deaths and one delayed death 5 months after operation. After a mean follow-up of 55.8 ± 16.5 months (6-113 months), 19 patients underwent reoperation (3 with pulmonary patch enlargement, 14 with conduit replacement and 2 with aortic valve replacement) 10-89 months after the first operation, with 1 hospital death. The actuarial survival rates were 94.2, 93.3 and 93.3% at 1, 5 and 10 years, respectively. Freedom from reoperation was 98.0, 87.8 and 82.7% at 1, 5 and 10 years, respectively. The follow-up variables included echocardiography, chest radiography, cardiac CT and cardiac function. At the last examination, most of the patients exhibited an improvement of New York Heart Association functional class from III or IV preoperatively to I or II at follow-up. Surgical treatment for PTA has an acceptable survival rate and satisfactory outcomes. Most patients exhibited an improvement in cardiac function during follow-up. Aortic arch deformity, truncal valvular regurgitation and long cardiopulmonary bypass time were regarded as risk factors for hospital mortality. Autologous tissue has a lower reoperation rate and better growth potential than extracardiac conduits. A monocusp valve effectively reduces pulmonary regurgitation in the early postoperative stage.

Four-dimensional ultrasonography of the fetal heart with spatiotemporal image correlation.

PubMed

Gonçalves, Luís F; Lee, Wesley; Chaiworapongsa, Tinnakorn; Espinoza, Jimmy; Schoen, Mary Lou; Falkensammer, Peter; Treadwell, Marjorie; Romero, Roberto

2003-12-01

This study was undertaken to describe a new technique for the examination of the fetal heart using four-dimensional ultrasonography with spatiotemporal image correlation (STIC). Volume data sets of the fetal heart were acquired with a new cardiac gating technique (STIC), which uses automated transverse and longitudinal sweeps of the anterior chest wall. These volumes were obtained from 69 fetuses: 35 normal, 16 with congenital anomalies not affecting the cardiovascular system, and 18 with cardiac abnormalities. Dynamic multiplanar slicing and surface rendering of cardiac structures were performed. To illustrate the STIC technique, two representative volumes from a normal fetus were compared with volumes obtained from fetuses with the following congenital heart anomalies: atrioventricular septal defect, tricuspid stenosis, tricuspid atresia, and interrupted inferior vena cava with abnormal venous drainage. Volume datasets obtained with a transverse sweep were utilized to demonstrate the cardiac chambers, moderator band, interatrial and interventricular septae, atrioventricular valves, pulmonary veins, and outflow tracts. With the use of a reference dot to navigate the four-chamber view, intracardiac structures could be simultaneously studied in three orthogonal planes. The same volume dataset was used for surface rendering of the atrioventricular valves. The aortic and ductal arches were best visualized when the original plane of acquisition was sagittal. Volumes could be interactively manipulated to simultaneously visualize both outflow tracts, in addition to the aortic and ductal arches. Novel views of specific structures were generated. For example, the location and extent of a ventricular septal defect was imaged in a sagittal view of the interventricular septum. Furthermore, surface-rendered images of the atrioventricular valves were employed to distinguish between normal and pathologic conditions. Representative video clips were posted on the Journal's Web site to demonstrate the diagnostic capabilities of this new technique. Dynamic multiplanar slicing and surface rendering of the fetal heart are feasible with STIC technology. One good quality volume dataset, obtained from a transverse sweep, can be used to examine the four-chamber view and the outflow tracts. This novel method may assist in the evaluation of fetal cardiac anatomy.

Recent Development in Pulmonary Valve Replacement after Tetralogy of Fallot Repair: The Emergence of Hybrid Approaches

PubMed Central

Suleiman, Tariq; Kavinsky, Clifford J.; Skerritt, Clare; Kenny, Damien; Ilbawi, Michael N.; Caputo, Massimo

2015-01-01

An increasing number of patients with tetralogy of Fallot require repeat surgical intervention for pulmonary valve replacement secondary to pulmonary regurgitation. Catheter-based interventions have emerged as an attractive alternative to surgery in this patient population but it is limited by patient size or the anatomy of the right ventricular outflow tract. Hybrid approaches involving both cardiac interventionists and surgeons are being developed to overcome these limitations. The purpose of this review is to highlight the recent advances in the hybrid field of pulmonary valve replacement, summarizing the advantages and disadvantages of the “traditional” surgical and the new catheter-based techniques and discuss the direction future research should take to determine the optimal management for individual patients. PMID:26082929

Pyloric obstruction secondary to epicardial pacemaker implantation: a case report.

PubMed

Bedoya Nader, G; Kellihan, H B; Bjorling, D E; McAnulty, J

2017-02-01

A 10-year old Lhasa Apso dog was presented for an acute history of exercise intolerance and hind limb weakness. High grade second degree atrioventricular block with an atrial rate of 200 beats per minute, ventricular rate of 40 beats per minute and an intermittent ventricular escape rhythm, was diagnosed on electrocardiograph. A transdiaphragmatic, unipolar, epicardial pacemaker was implanted without immediate surgical complications. Severe vomiting was noted 12 h post-operatively. Abdominal ultrasound and a barium study supported a diagnosis of pyloric outflow obstruction and exploratory abdominal surgery was performed. The pyloric outflow tract appeared normal and no other causes of an outflow obstruction were identified. The epicardial generator was repositioned from the right to the left abdominal wall. Pyloric cell pacing was presumed to be the cause for the pyloric obstruction and severe vomiting, and this was thought to be due to close proximity of the pacemaker generator to the pylorus situated in the right abdominal wall. Repositioning of the pulse generator to the left abdominal wall resulted in resolution of vomiting. Copyright © 2016 Elsevier B.V. All rights reserved.

The Hancock® Valved Conduit for Right Ventricular Outflow Tract Reconstruction in Sheep for Assessing New Devices.

PubMed

Carney, John P; Zhang, Lindsey M; Larson, Jeffrey J; Lahti, Matthew T; Robinson, Nicholas A; Dalmasso, Agustin P; Bianco, Richard W

2017-07-01

Xenograft conduits have been used successfully to repair congenital heart defects, but are prone to failure over time. Hence, in order to improve patient outcomes, better xenografts are being developed. When evaluating a conduit's performance and safety it must first be compared against a clinically available control in a large animal model. The study aim was to evaluate a clinically available xenograft conduit used in right ventricular outflow tract (RVOT) reconstruction in a sheep model. RVOT reconstruction was performed in 13 adult and juvenile sheep, using the Medtronic Hancock® Bioprosthetic Valved Conduit (Hancock conduit). The method had previously been used on patients, and a newly modified variant termed 'RVOT Extraction' was employed to facilitate the surgical procedure. Animals were monitored over predetermined terms of 70 to 140 days. Serial transthoracic echocardiography, intracardiac pressure measurements and angiography were performed. On study completion the animals were euthanized and necropsies performed. Two animals died prior to their designated study term due to severe valvular stenosis and distal conduit narrowing, respectively. Thus, 11 animals survived the study term, with few or no complications. Generally, maximal and mean transvalvular pressure gradients across the implanted conduits were increased throughout the postoperative course. Among 11 full-term animals, seven conduits were patent with mild or no pseudointimal proliferation and with flexible leaflets maintaining the hemodynamic integrity of the valve. RVOT reconstruction using the Hancock conduit was shown to be successful in sheep, with durable and efficient performances. With its extensive clinical use in patients, and ability for long-term use in sheep (as described in the present study) it can be concluded that the Hancock conduit is an excellent control device for the evaluation of new xenografts in future preclinical studies.

[Percutaneous catheter-based implantation of artificial pulmonary valves in patients with congenital heart defects].

PubMed

Wyller, Vegard Bruun; Aaberge, Lars; Thaulow, Erik; Døhlen, Gaute

2011-07-01

Percutaneous catheter-based implantation of artificial heart valves is a new technique that may supplement surgery and which may be used more in the future. We here report our first experience with implantation of artificial pulmonary valves in children with congenital heart defects. Eligible patients were those with symptoms of heart failure combined with stenosis and/or insufficiency in an established artificial right ventricular outflow tract. The valve was inserted through a catheter from a vein in the groin or neck. Symptoms, echocardiography, invasive measurements and angiography were assessed for evaluation of treatment effect. Our treatment results are reported for the period April 2007-September 2009. Ten patients (seven men and three women, median age 17 years) were assessed. The procedure reduced pressure in the right ventricle (p = 0.008) and resolved the pulmonary insufficiency in all patients. The median time in hospital was two days. No patients had complications that were directly associated with the implantation procedure. One patient developed a pseudoaneurysm in the femoral artery, another had a short-lasting fever two days after the procedure and one patient experienced a stent fracture that required surgery 9 months after the implantation. After 6 months all patients had a reduced pressure gradient in the right ventricular outflow tract (p = 0.008), the pulmonary insufficiency had improved (p = 0.006) and they all reported improval of symptoms. These results persisted for at least 24 months for the four patients who were monitored until then. Percutaneous catheter-based implantation of artificial pulmonary valves improves hemodynamics in the right ventricle of selected patients with congenital heart defects. A randomized controlled study should be undertaken to provide a stronger evidence-base for usefulness of this procedure.

Contribution of mitral valve leaflet length and septal wall thickness to outflow tract obstruction in patients with hypertrophic cardiomyopathy.

PubMed

Morant, Kareem; Mikami, Yoko; Nevis, Immaculate; McCarty, David; Stirrat, John; Scholl, David; Rajchl, Martin; Giannoccaro, Peter; Kolman, Louis; Heydari, Bobby; Lydell, Carmen; Howarth, Andrew; Grant, Andrew; White, James A

2017-08-01

We sought to examine whether elongation of the mitral valve leaflets in patients with hypertrophic cardiomyopathy (HCM) is synergistic to septal wall thickness (SWT) in the development of left ventricular outflow tract obstruction (LVOTO). HCM is a common genetic cardiac disease characterized by asymmetric septal hypertrophy and predisposition towards LVOTO. It has been reported that elongation of the mitral valve leaflets may be a primary phenotypic feature and contribute to LVOTO. However, the relative contribution of this finding versus SWT has not been studied. 152 patients (76 with HCM and 76 non-diseased age, race and BSA-matched controls) and 18 young, healthy volunteers were studied. SWT and the anterior mitral valve leaflet length (AMVLL) were measured using cine MRI. The combined contribution of these variables (SWT × AMVLL) was described as the Septal Anterior Leaflet Product (SALP). Peak LVOT pressure gradient was determined by Doppler interrogation and defined as "obstructive" if ≥ 30 mmHg. Patients with HCM were confirmed to have increased AMVLL compared with controls and volunteers (p < 0.01). Among HCM patients, both SWT and SALP were significantly higher in patients with LVOTO (N = 17) versus without. SALP showed modest improvement in predictive accuracy for LVOTO (AUC = 0.81) among the HCM population versus SWT alone (AUC = 0.77). However, in isolated patients this variable identified patients with LVOTO despite modest SWT. Elongation of the AMVLL is a primary phenotypic feature of HCM. While incremental contributions to LVOTO appear modest at a population level, specific patients may have dominant contribution to LVOTO. The combined marker of SALP allows for maintained identification of such patients despite modest increases in SWT.

Cortico-Cerebellar Structural Connectivity Is Related to Residual Motor Output in Chronic Stroke.

PubMed

Schulz, Robert; Frey, Benedikt M; Koch, Philipp; Zimerman, Maximo; Bönstrup, Marlene; Feldheim, Jan; Timmermann, Jan E; Schön, Gerhard; Cheng, Bastian; Thomalla, Götz; Gerloff, Christian; Hummel, Friedhelm C

2017-01-01

Functional imaging studies have argued that interactions between cortical motor areas and the cerebellum are relevant for motor output and recovery processes after stroke. However, the impact of the underlying structural connections is poorly understood. To investigate this, diffusion-weighted brain imaging was conducted in 26 well-characterized chronic stroke patients (aged 63 ± 1.9 years, 18 males) with supratentorial ischemic lesions and 26 healthy participants. Probabilistic tractography was used to reconstruct reciprocal cortico-cerebellar tracts and to relate their microstructural integrity to residual motor functioning applying linear regression modeling. The main finding was a significant association between cortico-cerebellar structural connectivity and residual motor function, independent from the level of damage to the cortico-spinal tract. Specifically, white matter integrity of the cerebellar outflow tract, the dentato-thalamo-cortical tract, was positively related to both general motor output and fine motor skills. Additionally, the integrity of the descending cortico-ponto-cerebellar tract contributed to rather fine motor skills. A comparable structure-function relationship was not evident in the controls. The present study provides first tract-related structural data demonstrating a critical importance of distinct cortico-cerebellar connections for motor output after stroke. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

In vitro evaluation of valve hemodynamics in the pediatric pulmonary outflow tract

NASA Astrophysics Data System (ADS)

Schiavone, Nicole; Elkins, Chris; McElhinney, Doff; Eaton, John; Marsden, Alison

2016-11-01

Tetraology of Fallot (ToF) is a congenital heart disease that affects 1 in every 2500 newborns each year and requires surgical repair of the right ventricular outflow tract (RVOT) and subsequent placement of an artificial pulmonary valve. While a wide variety of artificial valves are available, essentially all of them become subject to degradation and dysfunction during the patient's lifetime, which leads to additional interventions. However, there is little understanding about the mechanical function of replacement pulmonary valves and no quantitative placement guidelines to ensure maximum failure-free lifetime. This work aims to experimentally assess the biomechanics of pulmonary valves in realistic RVOT geometries using magnetic resonance velocimetry (MRV), which can measure 3D, three-component phase-averaged velocity fields. The RVOT geometries are constructed using 3D printing, allowing for variation in crucial geometric parameters such as the radius of curvature of the main pulmonary artery (MPA) and the dilation of the artery downstream of the valve. A St. Jude Medical Epic valve is secured inside the RVOT geometry and can be interchanged, allowing for variation of the ratio between valve diameter and MPA diameter. This work will discuss the use of MRV to capture the flow structure in the RVOT and evaluate pulmonary valve performance under different conditions.

Satisfactory visualization rates of standard cardiac views at 18 to 22 weeks' gestation using spatiotemporal image correlation.

PubMed

Cohen, Leeber; Mangers, Kristie; Grobman, William A; Platt, Lawrence D

2009-12-01

The purpose of this study was to determine the frequency with which 3 standard screening views of the fetal heart (4-chamber, left ventricular outflow tract [LVOT], and right ventricular outflow tract [RVOT]) can be obtained satisfactorily with the spatiotemporal image correlation (STIC) technique. A prospective study of 111 patients undergoing anatomic surveys at 18 to 22 weeks was performed. Two ultrasound machines with fetal cardiac settings were used. The best volume set that could be obtained from each patient during a 45-minute examination was graded by 2 sonologists with regard to whether the 4-chamber, LVOT, and RVOT images were satisfactory for screening. All 3 views were judged satisfactory for screening in most patients: 1 sonologist graded the views as satisfactory in 70% of the patients, whereas the other found the views to be satisfactory in 83%. The position of the placenta did not alter the probability of achieving a satisfactory view, but a fetus in the spine anterior position was associated with a significantly lower probability that the views were regarded as satisfactory for screening (odds ratio, 0.28; 95% confidence interval, 0.09-0.70; P < .05). This study suggests that STIC may assist with screening for cardiac anomalies at 18 to 22 weeks' gestation.

Effect of valsalva in the pulmonary prosthetic conduit valve on hemodynamic function in a mock circulatory system.

PubMed

Tsuboko, Yusuke; Shiraishi, Yasuyuki; Yamada, Akihiro; Yambe, Tomoyuki; Matsuo, Satoshi; Saiki, Yoshikatsu; Yamagishi, Masaaki

2015-01-01

Pulmonary conduit valves are used as one of the surgical treatment methods of congenital heart diseases. We have been designing a sophisticated pulmonary conduit valve for the right ventricular outflow tract reconstruction in pediatric patients. In this study, two types of polyester grafts with or without bulging structures for the conduit valves were used and evaluated from the hemodynamic point of view focusing on the application of these conduit valves in the grown-up congenital heart failure patients. We examined valvular function in the originally developed pulmonary mock circulatory system, which consisted of a pneumatic driven right ventricular model, a pulmonary valve chamber, and an elastic pulmonary compliance model with peripheral vascular resistance units. Prior to the measurement, a bileaflet valve was sutured in each conduit. Each conduit valve was installed in the mock right ventricular outflow portion, and its leaflet motion was obtained by using a high-speed camera synchronously with pressure and flow waveforms. As a result, we could obtain hemodynamic changes in two different types of conduits for pulmonary valves, and it was indicated that the presence of the Valsalva shape might be effective for promoting valvular response in the low cardiac output condition.

Respiratory distress after surgery of RVOT pathologies: a word of caution on pseudoaneurysm development.

PubMed

Antal, A Donmez; Cikirikcioglu, M; Myers, P O; Didier, D; Kalangos, A

2010-09-01

Pseudoaneurysm of the right ventricle outflow tract (RVOT) is a rare complication in pediatric cardiac surgery. We report a patient who developed a right ventricular pseudoaneurysm 8 months after RVOT enlargement using a pericardial patch for infundibular pulmonary stenosis. Our patient was born with severe pulmonary valvular stenosis and treated with percutaneous balloon valvotomy in the neonatal period. Six months later, she developed infundibular pulmonary stenosis, which required surgical resection of right ventricle infundibular trabeculations and bovine pericardial patch enlargement. The postoperative period was normal. She was readmitted to hospital 5 months later complaining of wheezing, coughing and shortness of breath. Echocardiography showed a huge aneurysmal dilatation of the outflow patch in connection with the right ventricular cavity. The patient underwent resection of the pseudoaneurysm and former patch, followed by interposition of a bovine jugular vein conduit between the RVOT and pulmonary bifurcation. The early postoperative period was uncomplicated. On echocardiography, no significant residual gradient was measured through the conduit and there was no insufficiency of the valve. RVOT reconstruction with patch enlargement, homograft or conduit implantation can be the origin of pseudoaneurysms. Although their incidence is rare, they are often asymptomatic before becoming quite large and causing compression symptoms as in our patient with respiratory complaints due to airway compression. It is important to follow up these patients closely, especially in the first year after surgery since most aneurysms develop within 6 months of surgery. Georg Thieme Verlag KG Stuttgart, New York.

Cardiac distribution of the binding sites for natriuretic peptides in vertebrates.

PubMed

Cerra, M C

1994-12-01

Natriuretic peptides are hormones that play an important role in the cardiovascular control of mammalian and non-mammalian vertebrates. They have been classified into four groups. Of these, ANP (atrial natriuretic peptide), BNP (brain atriuretic peptides), CNP (C-type natriuretic peptide) are detected in cardiac and non cardiac tissues of all vertebrates; while VNP (ventricular natriuretic peptide) has been isolated only from the fish ventricle. All peptides have shown a high degree of sequence homology. The expression of the three principal types of natriuretic peptide (ANP, BNP and CNP) in cardiac tissues is developmentally and functionally regulated in a highly tissue-specific manner. Three types of natriuretic peptide receptors have been identified in numerous target tissues. Two receptors are transmembrane guanylyl cyclases (ANPR-A and ANPR-B) that mediate biological effects of natriuretic peptides; the third one (ANPR-C) has no guanylyl cyclase and is called "clearance receptor." The presence of natriuretic peptide binding sites in the heart suggests new aspects of paracrine control of cardiac function. A relevant localization of natriuretic peptide receptors was found in those cardiac regions particularly suitable for monitoring blood volume and pressure oscillations such as the inflow tract and the outflow tract. For example, in birds (quail) the highest levels of natriuretic peptide receptors were detected in the inflow tract represented by the vena cava. In both fish and birds, the outflow chamber, the bulbus cordis, had a high number of natriuretic peptide binding sites. In mammals, a remarkable concentration of natriuretic peptide receptors was also observed in the coronary vessels. This zoning of cardiac natriuretic peptide receptors indicates an intracardiac action of the hormones and adds a humoral dimension to the morphofunctional design of the vertebrate heart.

Cardiovascular Development and the Colonizing Cardiac Neural Crest Lineage

PubMed Central

Snider, Paige; Olaopa, Michael; Firulli, Anthony B.; Conway, Simon J.

2007-01-01

Although it is well established that transgenic manipulation of mammalian neural crest-related gene expression and microsurgical removal of premigratory chicken and Xenopus embryonic cardiac neural crest progenitors results in a wide spectrum of both structural and functional congenital heart defects, the actual functional mechanism of the cardiac neural crest cells within the heart is poorly understood. Neural crest cell migration and appropriate colonization of the pharyngeal arches and outflow tract septum is thought to be highly dependent on genes that regulate cell-autonomous polarized movement (i.e., gap junctions, cadherins, and noncanonical Wnt1 pathway regulators). Once the migratory cardiac neural crest subpopulation finally reaches the heart, they have traditionally been thought to participate in septation of the common outflow tract into separate aortic and pulmonary arteries. However, several studies have suggested these colonizing neural crest cells may also play additional unexpected roles during cardiovascular development and may even contribute to a crest-derived stem cell population. Studies in both mice and chick suggest they can also enter the heart from the venous inflow as well as the usual arterial outflow region, and may contribute to the adult semilunar and atrioventricular valves as well as part of the cardiac conduction system. Furthermore, although they are not usually thought to give rise to the cardiomyocyte lineage, neural crest cells in the zebrafish (Danio rerio) can contribute to the myocardium and may have different functions in a species-dependent context. Intriguingly, both ablation of chick and Xenopus premigratory neural crest cells, and a transgenic deletion of mouse neural crest cell migration or disruption of the normal mammalian neural crest gene expression profiles, disrupts ventral myocardial function and/or cardiomyocyte proliferation. Combined, this suggests that either the cardiac neural crest secrete factor/s that regulate myocardial proliferation, can signal to the epicardium to subsequently secrete a growth factor/s, or may even contribute directly to the heart. Although there are species differences between mouse, chick, and Xenopus during cardiac neural crest cell morphogenesis, recent data suggest mouse and chick are more similar to each other than to the zebrafish neural crest cell lineage. Several groups have used the genetically defined Pax3 (splotch) mutant mice model to address the role of the cardiac neural crest lineage. Here we review the current literature, the neural crest-related role of the Pax3 transcription factor, and discuss potential function/s of cardiac neural crest-derived cells during cardiovascular developmental remodeling. PMID:17619792

Phylogeny informs ontogeny: a proposed common theme in the arterial pole of the vertebrate heart

PubMed Central

Grimes, Adrian C.; Durán, Ana Carmen; Sans-Coma, Valentín; Hami, Danyal; Santoro, Massimo M.; Torres, Miguel

2014-01-01

SUMMARY In chick and mouse embryogenesis, a population of cells described as the secondary heart field (SHF) adds both myocardium and smooth muscle to the developing cardiac outflow tract (OFT). Following this addition, at approximately HH stage 22 in chick embryos, for example, the SHF can be identified architecturally by an overlapping seam at the arterial pole, where beating myocardium forms a junction with the smooth muscle of the arterial system. Previously, using either immunohistochemistry or nitric oxide indicators such as diaminofluorescein 2-diacetate, we have shown that a similar overlapping architecture also exists in the arterial pole of zebrafish and some shark species. However, although recent work suggests that development of the zebrafish OFT may also proceed by addition of a SHF-like population of cells, the presence of a true SHF in zebrafish and in many other developmental biological models remains an open question. We performed a comprehensive morphological study of the OFT of a wide range of vertebrates. Our data suggest that all vertebrates possess three fundamental OFT components: a proximal myocardial component, a distal smooth muscle component, and a middle component that contains overlapping myocardium and smooth muscle surrounding and supporting the outflow valves. Because the middle OFT component of avians and mammals is derived from the SHF, our observations suggest that a SHF may be an evolutionarily conserved theme in vertebrate embryogenesis. PMID:21040422

Small-sized conduits in the right ventricular outflow tract in young children: bicuspidalized homografts are a good alternative to standard conduits.

PubMed

François, Katrien; De Groote, Katya; Vandekerckhove, Kristof; De Wilde, Hans; De Wolf, Daniel; Bové, Thierry

2017-10-03

Downsizing a homograft (HG) through bicuspidalization has been used for more than 2 decades to overcome the shortage of small-sized conduits for reconstruction of the right ventricular outflow tract (RVOT) in young children. Our goal was to investigate the durability of bicuspidalized HGs compared with other small HGs. A retrospective analysis of 93 conduits ≤20 mm, implanted over 23 years, was performed. The end-points were survival, structural valve degeneration and conduit replacement. The conduits comprised 40 pulmonary HGs, 12 aortic HGs, 17 bicuspidalized HGs and 24 xenografts. The median age, mean conduit diameter and z-value at implantation were 1.4 (interquartile range 0.3-3) years, 16.5 ± 2.7 mm and 2.8 ± 1.3, respectively. Valve position was heterotopic in 59 patients and orthotopic in 34 patients. At a mean follow-up period of 7.6 ± 5.9 years, the hospital survival rate was 89%. Freedom from explant at 5 and 10 years was 83 ± 5% and 52 ± 6%, respectively. Freedom from structural valve degeneration was 79 ± 5% at 5 years and 47 ± 6% at 10 years [68 ± 8% for pulmonary HG, 42 ± 16% for bicuspidalized HG, 31 ± 15% for aortic HG and 20 ± 9% for xenografts (log rank P < 0.001)]. Multivariable analysis indicated an increased risk for structural valve degeneration with smaller conduit size (hazard ratio 0.79, 95% confidence interval 0.67-0.94; P < 0.008), extra-anatomic position (hazard ratio 2.71, 95% confidence interval 1.33-5.50; P = 0.006) and the use of xenografts compared with non-downsized pulmonary HGs (hazard ratio 4.90, 95% confidence interval 2.23-10.76; P < 0.001). Appropriately sized pulmonary HGs remain the most durable option for a right ventricular outflow tract conduit in young children. However, when a small pulmonary HG is unavailable, bicuspidalization offers a valid alternative, preferable to xenograft conduits, at mid-term follow-up. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Regional difference of microcirculation in patients with asymmetric hypertrophic cardiomyopathy: transthoracic Doppler coronary flow velocity reserve analysis.

PubMed

Tesic, Milorad; Djordjevic-Dikic, Ana; Beleslin, Branko; Trifunovic, Danijela; Giga, Vojislav; Marinkovic, Jelena; Petrovic, Olga; Petrovic, Milan; Stepanovic, Jelena; Dobric, Milan; Vukcevic, Vladan; Stankovic, Goran; Seferovic, Petar; Ostojic, Miodrag; Vujisic-Tesic, Bosiljka

2013-07-01

To evaluate, by noninvasive coronary flow velocity reserve (CFVR), whether patients with asymmetric hypertrophic cardiomyopathy (HC), with or without left ventricular outflow tract obstruction, demonstrate significant regional differences of CFVR. We evaluated 61 patients with HC (27 men; mean age 49 ± 16 years), including 20 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 41 patients without obstruction (HCM). The control group included 20 age- and sex-matched subjects. Transthoracic Doppler echocardiography CFVR of the left anterior descending coronary artery (LAD) and the posterior descending coronary artery (PD) were performed, including calculation of relative CFVR as the ratio between CFVR LAD and CFVR PD. Compared with the controls, all the patients with HC had lower CFVR LAD (2.12 ± 0.53 vs 3.34 ± 0.67; P < .001) and CFVR PD (2.29 ± 0.49 vs 3.21 ± 0.65; P < .001). CFVR LAD in HOCM group in comparison with the HCM group was significantly lower (1.93 ± 0.42 vs 2.22 ± 0.55; P = .047), due to higher basal diastolic coronary flow velocities (0.40 ± 0.09 vs 0.33 ± 0.07 m/sec; P = .002), with similar hyperemic diastolic flow velocities (0.71 ± 0.16 vs 0.76 ± 0.19 m/sec; P = .330), respectively. There was no significant difference in CFVR PD between patients with HOCM and those with HCM (2.33 ± 0.46 vs 2.27 ± 0.50; P = .636), respectively. Relative CFVR was lower in the HOCM group compared with the HCM group (0.84 ± 0.16 vs 0.98 ± 0.14; P = .001). By multivariable regression analysis, left ventricular outflow tract gradient was the independent predictor of CFVR LAD (B = -0.24; P = .008) and relative CFVR (B = -0.34; P = .016). CFVR LAD and relative CFVR were significantly lower in patients with HOCM compared with patients with HCM. Regional differences of CFVR are present only in patients with significant left ventricular outflow tract obstruction, which suggests that obstruction per se, by increasing wall stress in basal conditions, leads to higher basal diastolic coronary flow velocities and results in lower CFVR in LAD compared with PD. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

Comparison of left ventricular diastolic function in obstructive hypertrophic cardiomyopathy in patients undergoing percutaneous septal alcohol ablation versus surgical myotomy/myectomy

NASA Technical Reports Server (NTRS)

Sitges, Marta; Shiota, Takahiro; Lever, Harry M.; Qin, Jian Xin; Bauer, Fabrice; Drinko, Jeannie K.; Agler, Deborah A.; Martin, Maureen G.; Greenberg, Neil L.; Smedira, Nicholas G.;

Idiopathic ventricular outflow tract arrhythmias from the great cardiac vein: challenges and risks of catheter ablation.

PubMed

Steven, D; Pott, C; Bittner, A; Sultan, A; Wasmer, K; Hoffmann, B A; Köbe, J; Drewitz, I; Milberg, P; Lueker, J; Mönnig, G; Servatius, H; Willems, S; Eckardt, L

2013-11-20

Catheter ablation for idiopathic ventricular arrhythmia is well established but epicardial origin, proximity to coronary arteries, and limited accessibility may complicate ablation from the venous system in particular from the great cardiac vein (GCV). Between April 2009 and October 2010 14 patients (56 ± 15 years; 9 male) out of a total group of 117 patients with idiopathic outflow tract tachycardias were included undergoing ablation for idiopathic VT or premature ventricular contractions (PVC) originating from GCV. All patients in whom the PVC arose from the GCV were subject to the study. In these patients angiography of the left coronary system was performed with the ablation catheter at the site of earliest activation. Successful ablation was performed in 6/14 (43%) and long-term success was achieved in 5/14 (36%) patients. In 4/14 patients (28.6%) ablation was not performed. In another 4 patients (26.7%), ablation did not abolish the PVC/VT. In the majority, the anatomical proximity to the left coronary system prohibited effective RF application. In 3 patients RF application resulted in a coronary spasm with complete regression as revealed in repeat coronary angiography. A relevant proportion idiopathic VT/PVC can safely be ablated from the GCV without significant permanent coronary artery stenosis after RF application. Our data furthermore demonstrate that damage to the coronary artery system is likely to be transient. © 2013.

Right Ventricular Outflow Tract Septal Pacing Is Superior to Right Ventricular Apical Pacing

PubMed Central

Zou, Cao; Song, Jianping; Li, Hui; Huang, Xingmei; Liu, Yuping; Zhao, Caiming; Shi, Xin; Yang, Xiangjun

2015-01-01

Background The effects of right ventricular apical pacing (RVAP) and right ventricular outflow tract (RVOT) septal pacing on atrial and ventricular electrophysiology have not been thoroughly compared. Methods and Results To identify a more favorable pacing strategy with fewer adverse effects, 80 patients who had complete atrioventricular block with normal cardiac function and who were treated with either RVAP (n=42) or RVOT septal pacing (n=38) were recruited after an average of 2 years of follow‐up. The data from electrocardiography and echocardiography performed before pacemaker implantation and at the end of follow‐up were collected. The patients in the RVOT septal pacing and RVAP groups showed similar demographic and clinical characteristics before pacing treatments. After a mean follow‐up of 2 years, the final maximum P‐wave duration; P‐wave dispersion; Q‐, R‐, and S‐wave complex duration; left atrial volume index; left ventricular end‐systolic diameter; ratio of transmitral early diastolic filling velocity to mitral annular early diastolic velocity; and interventricular mechanical delay in the RVOT septal pacing group were significantly less than those in the RVAP group (P<0.05). The final left ventricular ejection fraction of the RVOT septal pacing group was significantly higher than that of the RVAP group (P<0.05). Conclusions Compared with RVAP, RVOT septal pacing has fewer adverse effects regarding atrial electrical activity and structure in patients with normal cardiac function. PMID:25896891

Urodynamic findings in women with pelvic organ prolapse and obstructive voiding symptoms.

PubMed

Dain, Lena; Auslander, Ron; Rosen, Talma; Segev, Yakir; Goldschmidt, Eyal; Abramov, Yoram

2010-11-01

To determine whether obstructive voiding symptoms in women with advanced pelvic organ prolapse (POP) were associated with objective bladder outflow tract obstruction. We reviewed preoperative data from patients with advanced POP who underwent surgical correction at the Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, between December 1, 2005, and November 30, 2007. Obstructive voiding symptoms were recorded from Pelvic Floor Distress Inventory-20 questionnaires. Of the 81 women aged 44-80 years who were included in the study, 40 (49.4%) reported incomplete bladder emptying preoperatively. There was no significant difference between these women and asymptomatic women in terms of demographic and clinical parameters such as age, parity, and stage of prolapse. Furthermore, there was no significant difference with regard to postvoid residual bladder volume (52.8 ± 65.8 vs 41.6 ± 41.2 mL), maximal (23.8 ± 11 vs 21.9 ± 9.6 mL/second) and average (10.3 ± 6.2 vs 9.3 ± 4 mL/second) urinary flow velocities, prevalence of increased postvoid residual volume (10.0% vs 4.8%), or obstructive urinary flow (17.5% vs 7.3%). Almost half of all women with advanced POP experienced incomplete bladder emptying; however, this symptom did not correlate with objective urodynamic bladder outflow tract obstruction. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

A Closer Look at Schlemm's Canal Cell Physiology: Implications for Biomimetics.

PubMed

Dautriche, Cula N; Tian, Yangzi; Xie, Yubing; Sharfstein, Susan T

2015-09-21

Among ocular pathologies, glaucoma is the second leading cause of progressive vision loss, expected to affect 80 million people worldwide by 2020. A primary cause of glaucoma appears to be damage to the conventional outflow tract. Conventional outflow tissues, a composite of the trabecular meshwork and the Schlemm's canal, regulate and maintain homeostatic responses to intraocular pressure. In glaucoma, filtration of aqueous humor into the Schlemm's canal is hindered, leading to an increase in intraocular pressure and subsequent damage to the optic nerve, with progressive vision loss. The Schlemm's canal encompasses a unique endothelium. Recent advances in culturing and manipulating Schlemm's canal cells have elucidated several aspects of their physiology, including ultrastructure, cell-specific marker expression, and biomechanical properties. This review highlights these advances and discusses implications for engineering a 3D, biomimetic, in vitro model of the Schlemm's canal endothelium to further advance glaucoma research, including drug testing and gene therapy screening.

Genetics of Congenital Heart Disease: Past and Present.

PubMed

Muntean, Iolanda; Togănel, Rodica; Benedek, Theodora

2017-04-01

Congenital heart disease is the most common congenital anomaly, representing an important cause of infant morbidity and mortality. Congenital heart disease represents a group of heart anomalies that include septal defects, valve defects, and outflow tract anomalies. The exact genetic, epigenetic, or environmental basis of congenital heart disease remains poorly understood, although the exact mechanism is likely multifactorial. However, the development of new technologies including copy number variants, single-nucleotide polymorphism, next-generation sequencing are accelerating the detection of genetic causes of heart anomalies. Recent studies suggest a role of small non-coding RNAs, micro RNA, in congenital heart disease. The recently described epigenetic factors have also been found to contribute to cardiac morphogenesis. In this review, we present past and recent genetic discoveries in congenital heart disease.

SDOCT Doppler velocimetry for investigating the morphological influences on blood flow in the developing chick embryo heart

NASA Astrophysics Data System (ADS)

Davis, Anjul M.; Rothenberg, Florence G.; Law, Tzuo H.; Taber, Larry A.; Izatt, Joseph A.

2007-02-01

The onset of congenital heart disease (CHD) is believed to occur at very early stages of development. Investigations in the initiation and development of CHD has been hampered by the inability to image early stage heart structure and function, in vivo. Imaging small animals using optical coherence tomography (OCT) has filled a niche between the limited penetration depth of confocal microscopy and insufficient resolution from ultrasound. Previous demonstrations of chick heart imaging using OCT have entailed excision of, or arresting the heart to prevent motion artifacts. In this summary, we introduce SDOCT Doppler velocimetry as an enhancement of Doppler OCT for in vivo measurement of localized temporal blood flow dynamics. With this technique, dynamic velocity waveforms were measured in the outflow tract of the heart tube. These flow dynamics correlate to a finite element model of pulsatile flow and may lead to a further understanding of morphological influences on early heart development.

Takotsubo cardiomyopathy complicated with acute pericarditis and cardiogenic shock.

PubMed Central

Guevara, Rodolfo; Aguinaga-Meza, Melina; Hazin, Moustafa Imran; Hazin, Ribhi; McCord, James

2007-01-01

Takotsubo cardiomyopathy (TC) is a relatively uncommon stress-induced cardiomyopathy that accounts for 2.2% of all acute myocardial infarctions. It occurs most commonly in postmenopausal women between the ages of 55-70. The most common complications that have been described are cardiogenic shock and left ventricular outflow tract obstruction, stroke and apical thrombus formation. There have been multiple prior case reports of TC; however, our case is the first to report acute pericarditis as one of its complications. Images Figure 1 Figure 2 PMID:17393953

A Cerebellar Tremor in a Patient with Human Immunodeficiency Virus-1 Associated with Progressive Multifocal Leukoencephalopathy

PubMed Central

Kim, Hee-Jin; Lee, Jae-Jung; Lee, Phil Hyu

2009-01-01

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system (CNS) caused by JC virus infection in oligodendrocytes, especially in patients with acquired immunodeficiency syndrome (AIDS). Movement disorders associated with PML are very rare. Here, we report a case of PML in an AIDS patient who presented with a cerebellar tremor, caused by lesions in the cerebellar outflow tract. A cerebellar tremor can be a rare clinical manifestation in patients with PML. PMID:24868366

Clinical and pathological findings of severe subvalvular aortic stenosis and mitral dysplasia in a rottweiler puppy.

PubMed

Fernández del Palacio, M J; Bayón, A; Bernal, L J; Cerón, J J; Navarro, J A

1998-10-01

Subvalvular aortic stenosis (SAS) and mitral dysplasia were diagnosed in an asymptomatic eight-week-old rottweiler. Clinical and pathological findings were compatible with a fixed and dynamic obstruction of the left ventricular outflow tract. Gross and microscopic pathological findings were consistent with the most severe form of SAS, described previously in Newfoundland dogs over six months of age. These observations demonstrate that very young asymptomatic puppies may suffer a severe complex form of SAS.

Intraoperative bronchoscopic visualization of left ventricular assist device thrombus.

PubMed

Yost, Gardner; Bhat, Geetha; Modi, Sejal; Pappas, Pat; Tatooles, Antone

2016-07-01

Despite advancements in left ventricular assist device (LVAD) design and clinical management, device thrombosis remains a pertinent complication. Limited imaging makes precise visualization of clot location and shape very challenging. We report the usage of videobronchoscopic exploration of explanted LVADs for direct visualization of clot in two patients. This technique is a rapid and inexpensive means of improving our understanding of LVAD clot formation and may be useful in surgical exploration of inflow and outflow tracts during LVAD exchange. © The Author(s) 2015.

Right ventricular outflow tract obstruction in complicated monochorionic twin pregnancy.

PubMed

Eschbach, S J; Boons, L S T M; Van Zwet, E; Middeldorp, J M; Klumper, F J C M; Lopriore, E; Teunissen, A K K; Rijlaarsdam, M E; Oepkes, D; Ten Harkel, A D J; Haak, M C

2017-06-01

Severe right ventricular outflow tract obstruction (RVOTO) is a potential complication in recipient twins of twin-to-twin transfusion syndrome (TTTS) that requires postnatal follow-up or treatment. We aimed to evaluate pregnancy characteristics of neonates with RVOTO from complicated monochorionic twin pregnancies, determine the incidence of RVOTO in TTTS cases and construct a prediction model for its development. This was an observational cohort study of all complicated monochorionic twin pregnancies with a postnatal diagnosis of RVOTO examined at our center. Cases were referred for evaluation of the need for fetal therapy or intervention because of TTTS, selective intrauterine growth restriction (sIUGR) or multiple congenital malformations in one of the twins. Ultrasound data were retrieved from our monochorionic twin database. Among liveborn TTTS recipients treated prenatally with laser therapy, those with RVOTO were compared with those without RVOTO (controls). We describe four additional cases with RVOTO that were not TTTS recipients. A total of 485 twin pregnancies received laser therapy for TTTS during the study period. RVOTO was diagnosed in 3% (11/368) of liveborn TTTS recipients, of whom two showed mild Ebstein's anomaly. Before laser therapy, pericardial effusion was seen in 45% (5/11) of RVOTO cases (P < 0.01) and abnormal A-wave in the ductus venosus (DV) in 73% (8/11) (P = 0.03), significantly higher proportions than in controls. Mean gestational age at laser therapy was 17 + 3 weeks in RVOTO cases compared with 20 + 3 weeks in controls (P = 0.03). A prediction model for RVOTO was constructed incorporating these three significant variables. One TTTS donor had RVOTO after the development of transient hydrops following laser therapy. Three larger twins in pregnancies complicated by sIUGR developed RVOTO, the onset of which was detectable early in the second trimester. RVOTO occurs in TTTS recipient twins but can also develop in TTTS donors and larger twins of pregnancies complicated by sIUGR. Abnormal flow in the DV, pericardial effusion and early gestational age at onset of TTTS are predictors of RVOTO in TTTS recipients, which suggests increased vulnerability to hemodynamic imbalances in the fetal heart in early pregnancy. These findings could guide diagnostic follow-up protocols after TTTS treatment. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Evaluation of cryopreserved homografts in the right ventricular outflow tract after the Ross procedure: intermediate-term follow up.

PubMed

Ward, K E; Elkins, R C; Overholt, E D; Knott-Craig, C J; Razook, J D; Lane, M M; Gilliland, S S

1997-03-01

The Ross procedure involves replacing a transplanted pulmonary valve with a cryopreserved homograft in order to re-establish right ventricle-pulmonary artery continuity. This study reviews mid-term results of such surgery in children and young adults. Since November 1986, 114 patients have undergone the Ross procedure at the Children's Hospital of Oklahoma using cryopreserved pulmonary homografts (n = 113) and aortic homograft (n = 1) to reconstruct the right ventricular outflow tract. Graft size ranged from 16 to 32 mm. Ninety-three patients (mean age at implant 10.4 years (range: 0.8-22 years) have had complete mean follow up of 3.2 years (range: 5 months to 8.4 years) after surgery. Homograft evaluation included clinical reports and comparison of early post-implant and latest echocardiography. Measurements of homograft valve annulus and peak instantaneous Doppler gradient were compared; quality of valve leaflets, location of obstruction, and the degree of pulmonary regurgitation were assessed. Compared with early postoperative data, mean homograft annulus size decreased by 15% (p < 0.0001); in 88% of patients, the decrease ranged from one to nine millimeter. Peak Doppler gradient increased significantly (from 10 to 17 mmHg, p < 0.0001); 25% of patients developed gradients > 25 mmHg, and four had gradients > 50 mmHg. Significant obstruction developed most often at the supravalvular level or in the homograft conduit itself. This usually occurred within one year of implant, and was associated with calcification and contracture of the homograft wall. Significant pulmonary regurgitation developed in 19 cases (20%), but was more than mild in only three. Leaflet integrity was maintained except in those who developed severe stenosis or regurgitation. Two patients have undergone re-operation for homograft stenosis 2.8 and 5.4 years respectively after the Ross procedure; one has developed recurrent severe stenosis in the homograft four months later. After the Ross procedure: (i) Pulmonary homografts undergo significant annular reduction in most patients, though this is usually not associated with the development of significant obstruction. (ii) Peak Doppler gradients across the homograft increase in most patients, though only 4% develop more than mild obstruction. (iii) Mild pulmonary regurgitation is common (20%); moderate or severe regurgitation is rare and usually develops in concert with severe stenosis. (iv) Severe homograft valve degeneration usually occurs within one year of implant, and may reflect an immune-mediated response.

Reconstruction of the right ventricular outflow tract with a bovine jugular vein graft fixed with a naturally occurring crosslinking agent (genipin) in a canine model.

PubMed

Chang, Y; Tsai, C C; Liang, H C; Sung, H W

2001-12-01

This study was designed to evaluate a newly developed biologic valved conduit fixed with genipin used to reconstruct the right ventricular outflow tract in a canine model. Fresh bovine jugular veins with a retained native valve procured from a slaughterhouse were used as raw materials to fabricate the valved conduits. A naturally occurring crosslinking agent, genipin, was used to fix the procured jugular veins. The glutaraldehyde-fixed counterpart was used as a control. A canine model was used in the study. Echocardiography revealed that the motion of the valvular leaflets in both the glutaraldehyde- and genipin-fixed conduits was satisfactory. The transvalvular pressure gradients of both studied groups were minimal. No endothelium-like cells were observed on the luminal surface of the conduit and the valvular leaflet for the glutaraldehyde-fixed group throughout the entire course of the study. In contrast, endothelium-like cells were observed on the entire surface of the genipin-fixed valved conduit retrieved at 6 months postoperatively in all the cases studied. There was no evidence of luminal fibrous peel in any the valved conduits studied. Degradation of valvular leaflet in one of the glutaraldehyde-fixed conduits was observed. In this particular case, thrombus formation was also observed on the surface of the valvular leaflet. On the other hand, no apparent degradation or thrombus formation was observed on the surfaces of the genipin-fixed valvular leaflet and conduit. A significantly more severe inflammatory reaction was observed for the glutaraldehyde-fixed conduit than for its genipin-fixed counterpart throughout the entire course of the study. The calcium contents of the samples before implantation and those retrieved at distinct implantation duration were minimal for both the glutaraldehyde- and genipin-fixed tissues. Although further studies are necessary, the genipin-fixed valved conduit appears to have great potential in helping mitigate the complications observed in the commercially available conduits.

Early fetal heart ultrasonography as additional indicator for chromosomopathies.

PubMed

Dmitrovic, A; Jeremic, K; Babic, U M; Perovic, M; Mihailovic, T; Opric, D; Zecevic, N; Gojnić-Dugalić, M

2016-01-01

First trial of estimating values of scans of fetal heart structures (FHS) in first trimester of pregnancy, as more primary facts of possible chromosomopathies. The study included 2,643 fetuses that were examined in first trimester of pregnancy on Sono CT convex (C5-2MHz), endovaginal (ev 8-4MHz), and linear transducers (L12-5MHz) during a period of eight years. Fetal heart was evaluated using appropriate software with broad-band transducers and color Doppler, Sono CT, and HD ZOOM technologies. The scan was performed by three experienced physicians. FHS were based on: left and right ventricle morphology; AV valves (atrioventricular) position and existence of primal ostium; relationship of left ventricle outflow tract (LVOT) and right ventricle outflow tract (RVOT) and great vessels on three vessel view (3VV) and estimation of ductal and aortic arch. Several developments, one being the ability to identify fetuses at risk for cardiac defects combining nuchal translucency (NT), ductus venosus (DV) Doppler, and evaluation of tricuspid regurgitation, have prompted reconsideration of the role of the first trimester prognostic factor of fetal evaluation. In low-risk pregnancies group, 36 (1.8%) fetuses were found to have congenital heart disease (CHD), and in high-risk pregnancies the number of fetuses with CHD was 75 (12%). Genetic amniocentesis or chorionic villus sampling (CVS) was performed in all fetuses with CHD. Forty-two (37.8%) fetuses with CHD were found to have chromosomal anomalies. Out of 111 fetuses with CHD 39 (35.1%) had an nuchal translucency (NT) above three mm. Out of 42 fetuses with chromosomal anomalies and CHD, 29 (69%) had an increased NT. Using first trimester fetal echosonography constitutes a further step in the earlier recognition of chromosomopathies, even in low risk groups. Still further steps are necessary as all facts of good clinical practice. In order to offer further benefits during pregnancies, improvements in diagnostics are still required.

Regression of left ventricular hypertrophy provides an additive physiological benefit following treatment of aortic stenosis: insights from serial coronary wave-intensity analysis.

PubMed

Broyd, Christopher J; Rigo, Fausto; Nijjer, Sukhjinder; Sen, Sayan; Petraco, Ricardo; Al-Lamee, Rasha; Foin, Nicolas; Chukwuemeka, Andrew; Anderson, Jon; Parker, Jessica; Malik, Iqbal S; Mikhail, Ghada W; Francis, Darrel P; Parker, Kim; Hughes, Alun D; Mayet, Jamil; Davies, Justin E

2018-06-23

Severe aortic stenosis frequently involves the development of left ventricular hypertrophy (LVH) creating a dichotomous hemodynamic state within the coronary circulation. Whilst the increased force of ventricular contraction enhances its resultant relaxation and thus increases the distal diastolic coronary 'suction' force, the presence of LVH has a potentially opposing effect on ventricular-coronary interplay. The aim of this study was to use non-invasive coronary wave-intensity analysis (WIA) to separate and measure the sequential effects of outflow-tract obstruction relief and then left ventricular hypertrophy (LVH) regression following intervention for aortic stenosis. 15 patients with unobstructed coronary arteries undergoing aortic valve intervention (11 SAVR, 4 TAVI) were successfully assessed before and after intervention, and at 6- and 12-months post-procedure. Coronary WIA was constructed from simultaneously acquired coronary flow from transthoracic echo and pressure from an oscillometric brachial-cuff system. Immediately following intervention, a decline in the BDW was noted (9.7±5.7 vs 5.1±3.6 x10 3 Wm -2 s -1 , p<0.01). Over 12 months, LV mass-index fell from 114±19 to 82±17 kg/m 2 . Accompanying this, the BDW fraction increased to 32.8±7.2% (p=0.01 vs post-procedure) and to 34.7±6.7% at 12 months (p<0.001 vs post-procedure). In aortic stenosis, both the outflow-tract gradient and the presence of LVH impact significantly on coronary haemodynamics that cannot be appreciated by examining resting coronary flow rates alone. An immediate change in coronary wave-intensity occurs following intervention with further effects appreciable with hypertrophy regression. The improvement in prognosis with treatment is likely to be attributable to both features. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Expression of homeobox genes Msx-1 (Hox-7) and Msx-2 (Hox-8) during cardiac development in the chick.

PubMed

Chan-Thomas, P S; Thompson, R P; Robert, B; Yacoub, M H; Barton, P J

1993-07-01

The vertebrate homeobox genes Msx-1 and Msx-2 are related to the Drosophila msh gene and are expressed in a variety of tissues during embryogenesis. We have examined their expression by in situ hybridisation during critical stages of cardiac development in the chick from stages 15+ to 37. Msx-1 expression is apparent in a number of non-myocardial cell populations, including cells undergoing an epithelial to mesenchymal transformation in the atrioventricular and the outflow tract regions that play an integral role in heart septation and valve formation. Msx-2 expression is restricted to a distinct subpopulation of myocardial cells that, in later stages, coincides morphologically with the cardiac conduction system. The timing of Msx-2 expression suggests that it plays a role in conduction system tissue formation and that it identifies precursor cells of this specialised myocardium. The pattern of Msx-2 expression is discussed with reference to current models of conduction tissue development.

Decellularized Allografts for Right Ventricular Outflow Tract Reconstruction in Children.

PubMed

da Costa, Francisco Diniz Affonso; Etnel, Jonathan R G; Torres, Renato; Balbi Filho, Eduardo M; Torres, Rafael; Calixto, Allyson; Mulinari, Leonardo A

2017-09-01

Determine the midterm outcomes of decellularized allografts for right ventricular outflow tract (RVOT) reconstruction in children less than 12 years of age. The study included all consecutive patients submitted to RVOT reconstruction with decellularized allografts between June 2006 and June 2016. Besides clinical and echocardiographic control, 20 patients with more than five years of follow-up were evaluated with computed tomography (CT) scans to determine allograft diameters and calcium scores. Structural valve deterioration was defined as any peak gradient above 40 mm Hg and/or insufficiency of moderate or severe degree. Conduit failure was defined as the need for allograft reintervention. There were 59 patients with a median age of six years (range = 0.01-12 years). The most common operation was the Ross procedure (34%). Mean clinical follow-up was 5.4 (2.8) years and was 94% complete. At eight years, only two patients needed a reintervention, with a 90.9% freedom from this event. Structural valve deterioration occurred in 13 patients, 5 due to stenosis and 8 due to insufficiency, with a freedom from structural valve deterioration due to any cause of 64.9% at eight years. Late CT scans demonstrated the absence or minimal calcification of the conduits. Decellularized allografts for RVOT reconstruction in children were associated with a low incidence of structural valve deterioration and conduit failure. Although these results still need to be confirmed in larger series and with longer follow-up, our data suggest favorable outcomes, at least in the first decade after the operation.

First trimester fetal echocardiography: which planes and defects can be displayed during the daily routine in a prenatal medicine unit?

PubMed

Krapp, M; Ludwig, A; Axt-Fliedner, R; Kreiselmaier, P

2011-08-01

The objective of this study was to evaluate which cardiac planes and malformations can be visualized by first trimester fetal echocardiography during the daily routine in a prenatal medicine unit. From October 2007 to June 2009, all fetuses with a crown rump length between 45 and 84 mm were included in the study. The fetal echocardiographies were carried out by one examiner. The entire examination including fetal echocardiography was completed within a time interval of 30 minutes. When possible, the abdominal plane, 4-chamber view (CV), pulmonary veins, left ventricular outflow tract, 3-vessel view (3-VV) and the aortic arch were visualized by color Doppler and/or power Doppler sonography. 690 fetuses were enrolled in the retrospective study. The abdominal plane, 4-CV, pulmonary veins, left ventricular outflow tract, 3-VV and the aortic arch were visualized in 99 %, 96 %, 23 %, 97 %, 98 % and 72 % of cases, respectively. During the study interval, 17 cardiac malformations were diagnosed. Outcome data were obtained in 92 % of the normal fetuses. 5 cardiac anomalies were diagnosed beyond the first trimester. The standard planes of fetal echocardiography can be displayed in the first trimester in the clinical routine. Pulmonary veins can be visualized in almost a quarter of the cases. First trimester congenital heart diseases are strongly associated with chromosomal abnormalities during the first trimester. © Georg Thieme Verlag KG Stuttgart · New York.

Differential phenotype profile between main right ventricular chamber and outflow tract in chronic pulmonary hypertension: echocardiographic observation.

PubMed

López-Candales, Angel

2014-07-01

Right ventricular (RV) dilatation and systolic dysfunction are known remodeling changes occurring in chronic pulmonary hypertension and are likely the result of increases in pulmonary vascular resistance (PVR). It remains unclear whether PVR affects primarily the main RV chamber (mRVc) or the RV outflow tract (RVOT). Standard echocardiography data were collected from a heterogeneous population of 85 consecutive patients (mean age of 54 ± 12 years and mean pulmonary artery systolic pressure of 56 ± 28 mm Hg) to determine how PVR affected size and function of both RV chambers. Regarding size, PVR correlated more with mRVc end systolic area (r = 0.77; P < 0.0001) than either mRVc end diastolic area (r = 0.58; P < 0.0001) or RVOT systolic length (r = 0.54; P < 0.0001), although it did not correlate with RVOT end diastolic length. In terms of fractional area change, a stronger negative correlation was seen between PVR and mRVc (r = -0.77; P < 0.0001) than with PVR and RVOT (r = -0.69; P < 0.0001). Systolic velocity of the tricuspid annulus was the best parameter in identifying elevated PVR. Based on the echocardiography results, increasing PVR values appear to result in differential RV remodeling with significant mRVc dilation and systolic dysfunction when compared with RVOT. It is important to determine whether the different RV remodeling processes occur in all patients with chronic pulmonary hypertension, regardless of etiology; alter therapeutic response; or determine clinical outcomes.

Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients.

PubMed

Blancas, R; Martínez-González, Ó; Ballesteros, D; Núñez, A; Luján, J; Rodríguez-Serrano, D; Hernández, A; Martínez-Díaz, C; Parra, C M; Matamala, B L; Alonso, M A; Chana, M

2018-02-07

To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. A prospective, descriptive, multicenter study was performed. Five intensive care units from university hospitals. Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO ® ) thermodilution methods. The relation between LVOT VTI and SVI was tested by linear regression analysis. One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m 2 . Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Discrete prepotential as an indicator of successful ablation in patients with coronary cusp ventricular arrhythmia.

PubMed

Hachiya, Hitoshi; Yamauchi, Yasuteru; Iesaka, Yoshito; Yagishita, Atsuhiko; Sasaki, Takeshi; Higuchi, Koji; Kawabata, Mihoko; Sugiyama, Koji; Tanaka, Yasuaki; Kusa, Shigeki; Nakamura, Hiroaki; Miyazaki, Shinsuke; Taniguchi, Hiroshi; Isobe, Mitsuaki; Hirao, Kenzo

2013-10-01

Although coronary cusp (CC) ventricular arrhythmia (VA) can be treated by catheter ablation, reliable indicators of successful ablation sites have not been fully identified. This study comprised 392 patients undergoing radiofrequency catheter ablation for outflow tract-VA at 3 institutions from January 2007 to August 2012. The successful ablation site was on the left CC or right CC in 35 (8.9%) of the 392 patients. In 9 (26%) of these 35 patients, a discrete prepotential was recognized, 5 of whom had left CC-VAs and 4 of whom had right CC-VAs. Radiofrequency catheter ablation was successful at the site of the prepotential in all 9 of these patients. The duration of the isoelectric line between the end of the discrete prepotential and the onset of the ventricular electrogram was 27±13 ms. The time from onset of the discrete prepotential at the successful ablation site on the CC to the QRS onset (activation time) was 69±20 ms (range, 50-98 ms). Pace mapping was graded as excellent at the successful ablation site in only 1 patient. No discrete prepotential was recorded in any successful right outflow tract-VA ablation case in this study. A discrete prepotential was seen in 9 (26%) of 35 patients with CC-VA. In left and right CC-VA, the site of a discrete prepotential with ≥50 ms activation time may indicate a successful ablation site.

Four-dimensional ultrasonography of the fetal heart using color Doppler spatiotemporal image correlation.

PubMed

Gonçalves, Luís F; Romero, Roberto; Espinoza, Jimmy; Lee, Wesley; Treadwell, Marjorie; Chintala, Kavitha; Brandl, Helmut; Chaiworapongsa, Tinnakorn

2004-04-01

To describe clinical and research applications of 4-dimensional imaging of the fetal heart using color Doppler spatiotemporal image correlation. Forty-four volume data sets were acquired by color Doppler spatiotemporal image correlation. Seven subjects were examined: 4 fetuses without abnormalities, 1 fetus with ventriculomegaly and a hypoplastic cerebellum but normal cardiac anatomy, and 2 fetuses with cardiac anomalies detected by fetal echocardiography (1 case of a ventricular septal defect associated with trisomy 21 and 1 case of a double-inlet right ventricle with a 46,XX karyotype). The median gestational age at the time of examination was 21 3/7 weeks (range, 19 5/7-34 0/7 weeks). Volume data sets were reviewed offline by multiplanar display and volume-rendering methods. Representative images and online video clips illustrating the diagnostic potential of this technology are presented. Color Doppler spatiotemporal image correlation allowed multiplanar visualization of ventricular septal defects, multiplanar display and volume rendering of tricuspid regurgitation, volume rendering of the outflow tracts by color and power Doppler ultrasonography (both in a normal case and in a case of a double-inlet right ventricle with a double-outlet right ventricle), and visualization of venous streams at the level of the foramen ovale. Color Doppler spatiotemporal image correlation has the potential to simplify visualization of the outflow tracts and improve the evaluation of the location and extent of ventricular septal defects. Other applications include 3-dimensional evaluation of regurgitation jets and venous streams at the level of the foramen ovale.

Clinical, Radiographic, and Microbiologic Features of Infective Endocarditis in Patients With Hypertrophic Cardiomyopathy.

PubMed

Sims, Jason R; Anavekar, Nandan S; Bhatia, Subir; O'Horo, John C; Geske, Jeffrey B; Chandrasekaran, Krishnaswamy; Wilson, Walter R; Baddour, Larry M; Gersh, Bernard J; DeSimone, Daniel C

2018-02-15

Infective endocarditis (IE) is an infection of the inner lining of the heart with high morbidity and mortality despite medical and surgical advancements in recent decades. Hypertrophic cardiomyopathy (HC) is one of several medical conditions that have been linked to an increased risk of IE, but there is a paucity of data on this association. We therefore sought to define the clinical phenotype of IE in patients with HC at a single tertiary care center. A retrospective cohort of 30 adult patients with HC diagnosed with IE between January 1, 2006 and December 31, 2016 at Mayo Clinic Rochester were identified. Similar rates of aortic (n = 14) and mitral (n = 16) valve involvement by IE were noted (47% vs 53%). This finding persisted even in patients with left-ventricular outflow tract obstruction and systolic anterior motion of the mitral valve. Symptomatic embolic complications occurred in 10 cases (33%). Surgical intervention was performed in 11 cases (37%). One-year mortality was remarkably low at 7%. In conclusion, in the largest single-center cohort of IE complicating HC, there were similar rates of both mitral and aortic valve involvement regardless of the presence of left ventricular outflow tract obstruction, which is contrary to a long-standing tenet regarding the association of HC and IE. Moreover, no "high risk" IE subset was identified based on HC-related parameters. Copyright © 2017 Elsevier Inc. All rights reserved.

Intermediate-term efficacy of Tm:YAG laser prostate vaporesection for bladder outlet obstruction: initial experience from a UK teaching hospital.

PubMed

Pal, Raj P; Khan, Masood A

2012-01-01

To assess the safety and clinical efficacy of Tm:YAG laser vaporesection of the prostate (ThuVaRP) at intermediate-term follow-up. We identified the first 60 consecutive patients who underwent ThuVaRP at our institute. Operative outcomes assessed were resection time, resection weight, drop in haemoglobin, transfusion rate, catheter time and complication rate. The International Prostate Symptom Score (IPSS) was documented at a mean follow-up period of 19 months postoperatively. 45/60 patients underwent treatment due to lower urinary tract symptoms secondary to benign prostatic obstruction, 11/60 patients had a long-term catheter in situ for refractory urinary retention secondary to benign prostatic obstruction, and 4/60 patients had bladder outflow obstruction secondary to adenocarcinoma of the prostate. 1/60 patients developed urosepsis, 1/60 patients developed a urinary tract infection and 1/60 patients required 3-way catheterization and irrigation due to haematuria. No patients required a blood transfusion. The mean IPSS at a mean follow-up interval of 19 months (range 15-28 months) was 5.1 (range 1-23). Postoperative maximum flow rate improved from 7.9 to 17.1 ml/s, and post-micturition residual volume decreased from 254 to 86 ml. ThuVaRP is safe and appears to have durable efficacy at intermediate follow-up. Copyright © 2011 S. Karger AG, Basel.

[Hypertrophic cardiomyopathy: an intraoperative death case analysis and substantiation of the standards of perioperative anesthetic management in a non-cardiosurgery clinic].

PubMed

Fedosiuk, Roman N; Shchupachynska, Liliia O

2018-01-01

The article is based on the case analysis of a sudden and unexpected intraoperative death of a 51-year-old female patient with hypertrophic cardiomyopathy, who was undergoing a non-cardiac operation in a non-cardiosurgery clinic, from acute precipitation of left ventricular outflow tract obstruction provoked by surgery and anesthesia. It emphasizes the importance of raising non-cardiac anesthesiologists' awareness of the issue and having clear standards of pre-operative evaluation and perioperative management of patients with hypertrophic cardiomyopathy in order to avoid fatal medical errors. A literature review on the disease with an accent on anesthesia-related issues is also given, and four standards of perioperative anesthetic management of patients with hypertrophic cardiomyopathy presenting for non-cardiac surgery in general hospital settings are developed and offered.

Regression equations for calculation of z scores for echocardiographic measurements of right heart structures in healthy Han Chinese children.

PubMed

Wang, Shan-Shan; Zhang, Yu-Qi; Chen, Shu-Bao; Huang, Guo-Ying; Zhang, Hong-Yan; Zhang, Zhi-Fang; Wu, Lan-Ping; Hong, Wen-Jing; Shen, Rong; Liu, Yi-Qing; Zhu, Jun-Xue

2017-06-01

Clinical decision making in children with congenital and acquired heart disease relies on measurements of cardiac structures using two-dimensional echocardiography. We aimed to establish z-score regression equations for right heart structures in healthy Chinese Han children. Two-dimensional and M-mode echocardiography was performed in 515 patients. We measured the dimensions of the pulmonary valve annulus (PVA), main pulmonary artery (MPA), left pulmonary artery (LPA), right pulmonary artery (RPA), right ventricular outflow tract at end-diastole (RVOTd) and at end-systole (RVOTs), tricuspid valve annulus (TVA), right ventricular inflow tract at end-diastole (RVIDd) and at end-systole (RVIDs), and right atrium (RA). Regression analyses were conducted to relate the measurements of right heart structures to 4body surface area (BSA). Right ventricular outflow-tract fractional shortening (RVOTFS) was also calculated. Several models were used, and the best model was chosen to establish a z-score calculator. PVA, MPA, LPA, RPA, RVOTd, RVOTs, TVA, RVIDd, RVIDs, and RA (R 2  = 0.786, 0.705, 0.728, 0.701, 0.706, 0.824, 0.804, 0.663, 0.626, and 0.793, respectively) had a cubic polynomial relationship with BSA; specifically, measurement (M) = β0 + β1 × BSA + β2 × BSA 2  + β3 × BSA. 3 RVOTFS (0.28 ± 0.02) fell within a narrow range (0.12-0.51). Our results provide reference values for z scores and regression equations for right heart structures in Han Chinese children. These data may help interpreting the routine clinical measurement of right heart structures in children with congenital or acquired heart disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:293-303, 2017. © 2017 Wiley Periodicals, Inc.

Post-natal myogenic and adipogenic developmental

PubMed Central

Konings, Gonda; van Weeghel, Michel; van den Hoogenhof, Maarten MG; Gijbels, Marion; van Erk, Arie; Schoonderwoerd, Kees; van den Bosch, Bianca; Dahlmans, Vivian; Calis, Chantal; Houten, Sander M; Misteli, Tom

2011-01-01

A-type lamins are a major component of the nuclear lamina. Mutations in the LMNA gene, which encodes the A-type lamins A and C, cause a set of phenotypically diverse diseases collectively called laminopathies. While adult LMNA null mice show various symptoms typically associated with laminopathies, the effect of loss of lamin A/C on early post-natal development is poorly understood. Here we developed a novel LMNA null mouse (LMNAGT−/−) based on genetrap technology and analyzed its early post-natal development. We detect LMNA transcripts in heart, the outflow tract, dorsal aorta, liver and somites during early embryonic development. Loss of A-type lamins results in severe growth retardation and developmental defects of the heart, including impaired myocyte hypertrophy, skeletal muscle hypotrophy, decreased amounts of subcutaneous adipose tissue and impaired ex vivo adipogenic differentiation. These defects cause death at 2 to 3 weeks post partum associated with muscle weakness and metabolic complications, but without the occurrence of dilated cardiomyopathy or an obvious progeroid phenotype. Our results indicate that defective early post-natal development critically contributes to the disease phenotypes in adult laminopathies. PMID:21818413

Angle stability and outflow in dual blade ab interno trabeculectomy with active versus passive chamber management

PubMed Central

Wang, Chao; Dang, Yalong; Waxman, Susannah; Xia, Xiaobo; Weinreb, Robert N.

2017-01-01

Purpose To compare intraoperative angle stability and postoperative outflow of two ab interno trabeculectomy devices that excise the trabecular meshwork with or without active aspiration and irrigation. We hypothesized that anterior segment optical coherence tomography (AS-OCT) allows for a quantitative comparison of intraoperative angle stability in a microincisional glaucoma surgery (MIGS) pig eye training model. Methods Twelve freshly enucleated porcine eyes were measured with AS-OCT at baseline, at the beginning of the procedure and at its conclusion to determine the anterior chamber depth (ACD) and the nasal angle α in degrees. The right and left eye of pairs were randomly assigned to an active dual blade goniectome (aDBG) and a passive dual blade goniectome (pDBG) group, respectively. The aDBG had irrigation and aspiration ports while the pDBG required surgery under viscoelastic. We performed the procedures using our MIGS training system with a standard, motorized ophthalmic operating microscope. We estimated outflow by obtaining canalograms with fluorescent spheres. Results In aDBG, the nasal angle remained wide open during the procedure at above 90° and did not change towards the end (100±10%, p = 0.9). In contrast, in pDBG, ACD decreased by 51±19% to 21% below baseline (p<0.01) while the angle progressively narrowed by 40±12% (p<0.001). Canalograms showed a similar extent of access to the outflow tract with the aDBG and the pDBG (p = 0.513). The average increase for the aDBG in the superonasal and inferonasal quadrants was between 27 to 31% and for the pDBG between 15 to 18%. Conclusion AS-OCT demonstrated that active irrigation and aspiration improved anterior chamber maintenance and ease of handling with the aDBG in this MIGS training model. The immediate postoperative outflow was equally good with both devices. PMID:28486513

Tetralogy of Fallot: General Principles of Management.

PubMed

Downing, Tacy E; Kim, Yuli Y

2015-11-01

Repaired tetralogy of Fallot (TOF) is one of the most common diagnoses encountered when caring for adults with congenital heart disease. Although long-term survival after childhood TOF repair is excellent, morbidity is common and most patients require reintervention in adulthood. This review provides an overview of key surveillance and management issues for adults with TOF, including residual right ventricular outflow tract disease and timing of pulmonary valve replacement, arrhythmias and risk stratification, left-sided heart disease and heart failure, and pregnancy management. Copyright © 2015 Elsevier Inc. All rights reserved.

The Effect of Perioperative Rescue Transesophageal Echocardiography on the Management of Trauma Patients

PubMed Central

Griffee, Matthew J.; Singleton, Andrew; Zimmerman, Joshua M.; Morgan, David E.; Nirula, Raminder

2018-01-01

To evaluate the effect of rescue transesophageal echocardiography (TEE) on the management of trauma patients, we reviewed imaging and charts of unstable trauma patients at a level I trauma center. Critical rescue TEE findings included acute right ventricular failure, stress cardiomyopathy, type B aortic dissection, mediastinal air, and dynamic left ventricular outflow tract obstruction. Left ventricular filling was classified as low (underfilled) in 57% of all cases. Rescue TEE revealed a variety of new diagnoses and led to a change in resuscitation strategy about half of the time. PMID:27301053

Acquired Large Calcified Unruptured Sinus of Valsalva Aneurysm.

PubMed

Park, Sang-Hyun; Seol, Sang-Hoon; Seo, Guang-Won; Song, Pil-Sang; Kim, Dong-Kie; Kim, Ki-Hun; Kim, Doo-Il

2015-11-01

Acquired aneurysms of the sinus of Valsalva are rare. They are caused by infections such as tuberculosis, syphilis and endocarditis, as well as atherosclerosis and traumatic injury. They may be asymptomatic and incidentally discovered. We present a rare case of a large acquired calcified unruptured aneurysm of the right coronary sinus of Valsalva that was compressing the right ventricular outflow tract. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Variability in cardiovascular control: the baroreflex reconsidered.

PubMed

Karemaker, John M; Wesseling, Karel H

2008-03-01

Although blood pressure control is often viewed as a paradigmatic example of a "homeostatic" biological control system, blood pressure levels can fluctuate considerably over shorter and longer time scales. In modern signal analysis, coherence between heart rate and blood pressure variability is used to estimate baroreflex gain. However, the shorter the measurement period, the more variability this gain factor reveals. We review evidence that this variability is not due to the technique used for the estimation, but may be an intrinsic property of the circulatory control mechanisms. The baroreflex is reviewed from its evolutionary origin, starting in fishes as a reflex mechanism to protect the gills from excessively high pressures by slowing the heart via the (parasympathetic) vagus nerve. Baroreflex inhibition of cardiovascular sympathetic nervous outflow is a later development; the maximally possible extent of sympathetic activity probably being set in the central nervous system by mechanisms other than blood pressure per se. In the sympathetic outflow tract not only baroreflex inhibition but also as yet unidentified, stochastic mechanisms decide to pass or not pass on the sympathetic activity to the periphery. In this short essay, the "noisiness" of the baroreflex as nervous control system is stressed. This property is observed in all elements of the reflex, even at the--supposedly--most basic relation between afferent receptor nerve input and efferent--vagus--nerve output signal.

Time-dependent and outflow boundary conditions for Dissipative Particle Dynamics

PubMed Central

Lei, Huan; Fedosov, Dmitry A.; Karniadakis, George Em

2011-01-01

We propose a simple method to impose both no-slip boundary conditions at fluid-wall interfaces and at outflow boundaries in fully developed regions for Dissipative Particle Dynamics (DPD) fluid systems. The procedure to enforce the no-slip condition is based on a velocity-dependent shear force, which is a generalized force to represent the presence of the solid-wall particles and to maintain locally thermodynamic consistency. We show that this method can be implemented in both steady and time-dependent fluid systems and compare the DPD results with the continuum limit (Navier-Stokes) results. We also develop a force-adaptive method to impose the outflow boundary conditions for fully developed flow with unspecified outflow velocity profile or pressure value. We study flows over the backward-facing step and in idealized arterial bifurcations using a combination of the two new boundary methods with different flow rates. Finally, we explore the applicability of the outflow method in time-dependent flow systems. The outflow boundary method works well for systems with Womersley number of O(1), i.e., when the pressure and flowrate at the outflow are approximately in-phase. PMID:21499548

Heart valve cardiomyocytes of mouse embryos express the serotonin transporter SERT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pavone, Luigi Michele; Department of Biochemistry and Medical Biotechnologies, University of Naples Federico II, Naples; Spina, Anna

2008-12-12

Multiple evidence demonstrate a role for serotonin and its transporter SERT in heart valve development and disease. By utilizing a Cre/loxP system driven by SERT gene expression, we recently demonstrated a regionally restricted distribution of SERT-expressing cells in developing mouse heart. In order to characterize the cell types exhibiting SERT expression within the mouse heart valves at early developmental stages, in this study we performed immunohistochemistry for Islet1 (Isl1) and connexin-43 (Cx-43) on heart sections from SERT{sup Cre/+};ROSA26R embryos previously stained with X-gal. We observed the co-localization of LacZ staining with Isl1 labelling in the outflow tract, the right ventriclemore » and the conal region of E11.5 mouse heart. Cx-43 labelled cells co-localized with LacZ stained cells in the forming atrioventricular valves. These results demonstrate the cardiomyocyte phenotype of SERT-expressing cells in heart valves of the developing mouse heart, thus suggesting an active role of SERT in early heart valve development.« less

Cell death and survival signalling in the cardiovascular system.

PubMed

Tucka, Joanna; Bennett, Martin; Littlewood, Trevor

2012-01-01

The loss of cells is an important factor in many diseases, including those of the cardiovascular system. Whereas apoptosis is an essential process in development and tissue homeostasis, its occurrence is often associated with various pathologies. Apoptosis of neurons that fail to make appropriate connections is essential for the selection of correct neural signalling in the developing embryo, but its appearance in adults is often associated with neurodegenerative disease. Similarly, in the cardiovascular system, remodeling of the mammalian outflow tract during the transition from a single to dual series circulation with four chambers is accompanied by a precise pattern of cell death, but apoptosis of cardiomyocytes contributes to ischemia-reperfusion injury in the heart. In many cases, it is unclear whether apoptosis represents a causative association or merely a consequence of the disease itself. There are many excellent reviews on cell death in the cardiovascular system (1-5); in this review we outline the critical signalling pathways that promote the survival of cardiovascular cells, and their relevance to both physiological cell death and disease.

Can We Define and Characterize the Aging Lower Urinary Tract?—ICI-RS 2015

PubMed Central

Vahabi, Bahareh; Wagg, Adrian S.; Rosier, Peter F.W.M.; Rademakers, Kevin L.J.; Denys, Marie-Astrid; Pontari, Michel; Lovick, Thelma; Valentini, Francoise A.; Nelson, Pierre P.; Andersson, Karl-Erik; Fry, Christopher H.

2017-01-01

The prevalence of lower urinary tract (LUT) symptoms increases with age but the etiology is unknown. This article aims to identify research directions that clarify the basis of this association. The initial question is whether biological age is the variable of interest or a time-dependent accumulation of factors that impact on LUT function at rates that differ between individuals. In particular, the accumulation of conditions or agents due to inflammatory states or tissue ischemia is important. Much of the above has been concerned with changes to bladder function and morphology. However, the outflow tract function is also affected, in particular changes to the function of external sphincter skeletal muscle and associated sacral motor nerve control. Nocturia is a cardinal symptom of LUT dysfunction and is more prevalent with aging. Urine production is determined by diurnal changes to the production of certain hormones as well as arterial blood pressure and such diurnal rhythms are blunted in subjects with nocturia, but the causal links remain to be elucidated. Changes to the central nervous control of LUT function with age are also increasingly recognized, whether in mid-brain/ brainstem regions that directly affect LUT function or in higher centers that determine psychosocial and emotional factors impinging on the LUT. In particular, the linkage between increasing white matter hyperintensities and LUT dysfunction during aging is recognized but not understood. Overall, a more rational approach is being developed to link LUT dysfunction with factors that accumulate with age, however, the precise causal pathways remain to be characterized. PMID:28444710

10-year follow-up after radiofrequency ablation of idiopathic ventricular arrhythmias from right ventricular outflow tract.

PubMed

Rørvik, Synne Dragesund; Chen, Jian; Hoff, Per Ivar; Solheim, Eivind; Schuster, Peter

The aim of this study was to examine the effect of radiofrequency ablation (RFA) of ventricular arrhythmias from right ventricular outflow tract (RVOT) during long-term follow-up. A follow-up analysis was conducted using an in-house questionnaire, as well as a qualitative assessment of the patients' medical records. The study population of 34 patients had a previous diagnosis of idiopathic VT or frequent PVCs from the RVOT, and received RFA treatment between 2002 and 2005. The main symptoms prior to RFA were palpitations (82.4%) and dizziness (76.5%). A reduction in symptoms following RFA was reported by 91.2% of patients (p < 0.001). Furthermore, there was a reduced use of antiarrhythmic medication after RFA (p < 0.001). General health perception classified on a scale of 1 (poor) to 4 (excellent), improved from median class 1 to 3 (p < 0.001) during long-term follow-up. The fitness to work increased from median class 3 to class 5 (1 = incapacitated, 5 = full time employment, p = 0.038), while the rate of patients in full time employment increased from 26.5% to 55.9% after RFA (p = 0.02). A reduction of symptoms and use of antiarrhythmic medication, as well as an improvement in the general health perception and fitness to work after RFA of idiopathic ventricular arrhythmias can be demonstrated at ten-year follow-up. Copyright © 2016 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

PLUTO trial protocol: percutaneous shunting for lower urinary tract obstruction randomised controlled trial.

PubMed

Kilby, Mark; Khan, Khalid; Morris, Katie; Daniels, Jane; Gray, Richard; Magill, Laura; Martin, Bill; Thompson, Peter; Alfirevic, Zarko; Kenny, Simon; Bower, Sarah; Sturgiss, Stephen; Anumba, Dilly; Mason, Gerald; Tydeman, Graham; Soothill, Peter; Brackley, Karen; Loughna, Pamela; Cameron, Alan; Kumar, Sailesh; Bullen, Phil

2007-07-01

The primary objective is to determine whether intrauterine vesicoamniotic shunting for fetal bladder outflow obstruction, compared with conservative, noninterventional care, improves prenatal and perinatal mortality and renal function. The secondary objectives are to determine if shunting for fetal bladder outflow obstruction improves perinatal morbidity, to determine if improvement in outcomes is related to prognostic assessment at diagnosis and, if possible, derive a prognostic risk index and to determine the safety and long-term efficacy of shunting. A multicentre randomised controlled trial (RCT). Fetal medicine units. Pregnant women with singleton, male fetus with isolated lower urinary tract obstruction (LUTO). Following ultrasound diagnosis of LUTO in a male fetus and exclusion of other structural and chromosomal anomalies, participation in the trial will be discussed with the mother and written information given. Consent for participation in the trial will be taken and the mother randomised via the internet to either insertion of a vesicoamniotic shunt or expectant management. During pregnancy, both groups will be followed with regular ultrasound scans looking at viability, renal measurements and amniotic fluid volume. Following delivery, babies will be followed up by paediatric nephrologists/urologists at 4-6 weeks, 12 months and 3 and 5 years to assess renal function via serum creatinine, renal ultrasound and need for dialysis/transplant. The main outcome measures will be perinatal mortality rates and renal function at 4-6 weeks and 12 months measured via serum creatinine, renal ultrasound and need for dialysis/transplant. Wellbeing of Women. ESTIMATED COMPLETION DATE: September 2010. TRIAL ALGORITHM: [flowchart: see text].

Improving left ventricular outflow tract obstruction repair in common atrioventricular canal defects.

PubMed

Myers, Patrick O; del Nido, Pedro J; Marx, Gerald R; Emani, Sitaram; Mayer, John E; Pigula, Frank A; Baird, Christopher W

2012-08-01

Left ventricular outflow tract obstruction (LVOTO) is the second most frequent reason for reoperation after atrioventricular canal (AVC) defect repair. Limited data are available on the mechanisms of LVOTO, their treatment, and outcomes. Between 1998 and 2010, 56 consecutive children with AVC underwent 68 LVOTO procedures. The AVC was partial in 4, transitional in 9, and complete in 43. The LVOTO procedure was required in 21 patients at the primary AVC repair, and the initial LVOTO procedure in 35 patients was a late reoperation after AVC repair. During a mean follow-up of 50±41 months, 5 patients (24%) with LVOTO repair at AVC repair required a reoperation for LVOTO, and 7 patients (20%) whose initial LVOTO repair was a reoperation required a second reoperation for LVOTO repair. Overall freedom from LVOTO reoperation was 98.5% at 1 year, 92.5% at 3 years, 81% at 5 years, 72.2% at 7 years, and 52.5% at 10 and 12 years. The freedom from reoperation was neither significantly different between partial, transitional, and complete AVC (p=0.78) nor between timing of the LVOT procedure (p=0.49). Modified single-patch AVC repair was associated with a higher LVOTO reoperation rate (p=0.04). Neither the mechanisms leading to LVOTO nor the surgical techniques used were independent predictors of reoperation. LVOTO in AVC is a complex and multifactorial disease. Aggressive surgical repair has improved late outcomes; however, risk factors for reoperation and the ideal approach for repair remain to be defined. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Change of heart dimensions and function during pregnancy in goats.

PubMed

Szaluś-Jordanow, Olga; Czopowicz, Michał; Witkowski, Lucjan; Moroz, Agata; Mickiewicz, Marcin; Frymus, Tadeusz; Markowska-Daniel, Iwona; Bagnicka, Emilia; Kaba, Jarosław

2018-03-08

The study aimed to evaluate the effect of pregnancy on heart diameters and function in goats. Transthoracic echocardiography of 12 female dairy goats of two Polish regional breeds was performed. A Mindray M7 diagnostic ultrasound system with Phased Array transducer was used. Simultaneously, electrocardiography was recorded. All animals were examined four times - at mating season, at the end of the first trimester, at the end of the second trimester and just before kidding. Eleven measurements were taken each time: aortic and left atrial diameter (AoD and LAD), right and left ventricular internal diameter in diastole (RVIDd and LVIDd), left ventricular internal diameter in systole (LVIDs), inter-ventricular septum thickness in diastole and systole (IVSd and IVSd) and left ventricular posterior wall in diastole and systole (LVPWd and LVPWs), maximum left and right ventricular outflow tract velocity (RVOT Vmax and LVOT Vmax). Nine consecutive measurements were derived: the ratio of the left atrial diameter to the aortic diameter (AoD/LAD), left ventricular fractional shortening (FS%), left ventricular ejection fraction (EF%), maximum outflow tract pressure gradients (RVOT PGmax and LVOT PGmax), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV), stroke volume (SV) and cardiac output (CO). HR, LAD, LVPWs, IVSs increased significantly in the first trimester. AoD and RVIDd were significantly higher around parturition. LVIDd, FS%, EF%, SV and CO rose both in the first and third trimester. No measurement decreased during pregnancy. The study confirms that pregnancy causes changes in the heart size and functioning. Copyright © 2018. Published by Elsevier Ltd.

Echocardiography of the normal camel (Camelus dromedaries) heart: technique and cardiac dimensions

PubMed Central

2012-01-01

Background Echocardiography and intra-cardiac dimensions have not previously been reported in adult camels despite its potential application for medical purpose. The aim of this study was to describe the results of a prospective study, aiming to report normal cardiac appearance and normal chamber dimensions in adult camels (Camelus dromedarius). Results On the right side, when the probe was placed in the 5th or 4th intercostal space (ICS), the caudal long-axis four-chamber view of the ventricles, atria, and the interventricular septum was obtained. Placing the probe slightly more cranially in the 4th ICS, the caudal long-axis four-chamber view and the caudal long-axis view of the left ventricular outflow tract (LVOT) were imaged. In 7 camels, a hybrid view between a “four-chamber” and “LVOT view” was imaged from the same position. The short-axis view of the ventricles was obtained in the 4th ICS where the transducer was rotated between 0° and 25°. Placement of the transducer in the 3rd ICS allowed visualisation of the right ventricular outflow tract (RVOT). On the left side, when the probe was placed in the 5th or 4th ICS, a four-chamber view was obtained. The LVOT is imaged in the 4th ICS and the RVOT was seen from the 3rd ICS. Conclusions This study showed that it is possible to obtain good-quality echocardiograms in adult camels and provide normal cardiac dimensions. This study could be used as a reference for further studies concerning camels with cardiac diseases. PMID:22862855

Virtual Surgery for Conduit Reconstruction of the Right Ventricular Outflow Tract.

PubMed

Ong, Chin Siang; Loke, Yue-Hin; Opfermann, Justin; Olivieri, Laura; Vricella, Luca; Krieger, Axel; Hibino, Narutoshi

2017-05-01

Virtual surgery involves the planning and simulation of surgical reconstruction using three-dimensional (3D) modeling based upon individual patient data, augmented by simulation of planned surgical alterations including implantation of devices or grafts. Here we describe a case in which virtual cardiac surgery aided us in determining the optimal conduit size to use for the reconstruction of the right ventricular outflow tract. The patient is a young adolescent male with a history of tetralogy of Fallot with pulmonary atresia, requiring right ventricle-to-pulmonary artery (RV-PA) conduit replacement. Utilizing preoperative magnetic resonance imaging data, virtual surgery was undertaken to construct his heart in 3D and to simulate the implantation of three different sizes of RV-PA conduit (18, 20, and 22 mm). Virtual cardiac surgery allowed us to predict the ability to implant a conduit of a size that would likely remain adequate in the face of continued somatic growth and also allow for the possibility of transcatheter pulmonary valve implantation at some time in the future. Subsequently, the patient underwent uneventful conduit change surgery with implantation of a 22-mm Hancock valved conduit. As predicted, the intrathoracic space was sufficient to accommodate the relatively large conduit size without geometric distortion or sternal compression. Virtual cardiac surgery gives surgeons the ability to simulate the implantation of prostheses of different sizes in relation to the dimensions of a specific patient's own heart and thoracic cavity in 3D prior to surgery. This can be very helpful in predicting optimal conduit size, determining appropriate timing of surgery, and patient education.

Radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from intramural foci in the left ventricular outflow tract: efficacy of sequential versus simultaneous unipolar catheter ablation.

PubMed

Yamada, Takumi; Maddox, William R; McElderry, H Thomas; Doppalapudi, Harish; Plumb, Vance J; Kay, G Neal

2015-04-01

Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the efficacy of sequential and simultaneous unipolar radiofrequency catheter ablation from the endocardial and epicardial sides in treating intramural LVOT VAs. Fourteen consecutive LVOT VAs, which required sequential or simultaneous irrigated unipolar radiofrequency ablation from the endocardial and epicardial sides for their elimination, were studied. The first ablation was performed at the site with the earliest local ventricular activation and best pace map on the endocardial or epicardial side. When the first ablation was unsuccessful, the second ablation was delivered on the other surface. If this sequential unipolar ablation failed, simultaneous unipolar ablation from both sides was performed. The first ablation was performed on the epicardial side in 9 VAs and endocardial side in 5 VAs. The intramural LVOT VAs were successfully eliminated by the sequential (n=9) or simultaneous (n=5) unipolar catheter ablation. Simultaneous ablation was most likely to be required for the elimination of the VAs when the distance between the endocardial and epicardial ablation sites was >8 mm and the earliest local ventricular activation time relative to the QRS onset during the VAs of <-30 ms was recorded at those ablation sites. LVOT VAs originating from intramural foci could usually be eliminated by sequential unipolar radiofrequency ablation and sometimes required simultaneous ablation from both the endocardial and epicardial sides. © 2015 American Heart Association, Inc.

Utility of a super-flexible three-dimensional printed heart model in congenital heart surgery.

PubMed

Hoashi, Takaya; Ichikawa, Hajime; Nakata, Tomohiro; Shimada, Masatoshi; Ozawa, Hideto; Higashida, Akihiko; Kurosaki, Kenichi; Kanzaki, Suzu; Shiraishi, Isao

2018-05-28

The objective of this study was to assess the utility of 3D printed heart models of congenital heart disease for preoperative surgical simulation. Twenty patient-specific 3D models were created between March 2015 and August 2017. All operations were performed by a young consultant surgeon who had no prior experience with complex biventricular repair. All 15 patients with balanced ventricles had outflow tract malformations (double-outlet right ventricle in 7 patients, congenitally corrected transposition of great arteries in 5, transposition of great arteries in 1, interrupted aortic arch Type B in 1, tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries in 1). One patient had hypoplastic left heart complex, and the remaining 4 patients had a functional single ventricle. The median age at operation was 1.4 (range 0.1-5.9) years. Based on a multislice computed tomography data set, the 3D models were made of polyurethane resins using stereolithography as the printing technology and vacuum casting as the manufacturing method. All but 4 patients with a functional single ventricle underwent complete biventricular repair. The median cardiopulmonary bypass time and aortic cross-clamp time were 345 (110-570) min and 114 (35-293) min, respectively. During the median follow-up period of 1.3 (0.1-2.5) years, no mortality was observed. None of the patients experienced surgical heart block or systemic ventricular outflow tract obstruction. Three-dimensional printed heart models showed potential utility, especially in understanding the relationship between intraventricular communications and great vessels, as well as in simulation for creating intracardiac pathways.

Anatomical Basis for the Cardiac Interventional Electrophysiologist

PubMed Central

Sánchez-Quintana, Damián; Doblado-Calatrava, Manuel; Cabrera, José Angel; Macías, Yolanda; Saremi, Farhood

2015-01-01

The establishment of radiofrequency catheter ablation techniques as the mainstay in the treatment of tachycardia has renewed new interest in cardiac anatomy. The interventional arrhythmologist has drawn attention not only to the gross anatomic details of the heart but also to architectural and histological characteristics of various cardiac regions that are relevant to the development or recurrence of tachyarrhythmias and procedural related complications of catheter ablation. In this review, therefore, we discuss some anatomic landmarks commonly used in catheter ablations including the terminal crest, sinus node region, Koch's triangle, cavotricuspid isthmus, Eustachian ridge and valve, pulmonary venous orifices, venoatrial junctions, and ventricular outflow tracts. We also discuss the anatomical features of important structures in the vicinity of the atria and pulmonary veins, such as the esophagus and phrenic nerves. This paper provides basic anatomic information to improve understanding of the mapping and ablative procedures for cardiac interventional electrophysiologists. PMID:26665006

Contractile markers distinguish structures of the mouse aqueous drainage tract

PubMed Central

Ko, MinHee K.

2013-01-01

Purpose Structures of the aqueous humor drainage tract are contractile, although the tract is not entirely composed of muscle. We characterized the mouse aqueous drainage tract by immunolabeling contractile markers and determined whether profiling these markers within the tract distinguished its key structures of the trabecular meshwork (TM) and ciliary muscle (CM). Methods Enucleated eyes from pigmented C57BL/6 (n=8 mice) and albino BALB/c (n=6 mice) mice were processed for cryo- and formalin-fixed paraffin-embedded sectioning. Immunofluorescence labeling was performed for the following: (a) filamentous actin (using fluorescence-conjugated phalloidin), representing a global contractile marker; (b) α-smooth muscle actin (α-SMA), caldesmon, and calponin, representing classic smooth muscle epitopes; and (c) nonmuscle myosin heavy chain, representing a nonmuscle contractile protein. Tissue labeling was identified by confocal microscopy and analyzed quantitatively. Hematoxylin and eosin staining provided structural orientation. Results A small portion of the TM faced the anterior chamber; the rest extended posteriorly alongside Schlemm’s canal (SC) within the inner sclera. Within the drainage tract, filamentous actin labeling was positive in TM and CM. α-SMA and caldesmon labeling was seen primarily along the CM, which extended from the anterior chamber angle to its posterior termination beyond the SC near the retina. Low intensity, patchy α-SMA and caldesmon labeling was seen in the TM. Myosin heavy chain immunoreactivity was primarily found in the TM and calponin was primarily observed in the CM. C57BL/6 and BALB/c comparison showed that pigment obscured fluorescence in the ciliary body. Conclusions Our strategy of profiling contractile markers distinguished mouse aqueous drainage tract structures that were otherwise indistinguishable by hematoxylin and eosin staining. The mouse TM was seen as an intervening structure between SC, a part of the conventional drainage tract, and CM, a part of the unconventional drainage tract. Our findings provide important insights into the structural and functional organization of the mouse aqueous drainage tract and a basis for exploring the role of contractility in modulating aqueous outflow. PMID:24357924

Validity of Single Tract Microelectrode Recording in Subthalamic Nucleus Stimulation

PubMed Central

Umemura, Atsushi; Oka, Yuichi; Yamada, Kazuo; Oyama, Genko; Shimo, Yasushi; Hattori, Nobutaka

2013-01-01

In surgery for subthalamic nucleus (STN) deep brain stimulation (DBS), precise implantation of the lead into the STN is essential. Physiological refinement with microelectrode recording (MER) is the gold standard for identifying STN. We studied single tract MER findings and surgical outcomes and verified our surgical method using single tract MER. The number of trajectories in MER and the final position of lead placement were retrospectively analyzed in 440 sides of STN DBS in 221 patients. Bilateral STN DBS yielded marked improvement in the motor score, dyskinesia/fluctuation score, and reduced requirement of dopaminergic medication in this series. The number of trajectories required to obtain sufficient activity of the STN was one in 79.0%, two in 18.2%, and three or more in 2.5% of 440 sides. In 92 sides requiring altered trajectory, the final direction of trajectory movement was posterior in 73.9%, anterior in 13.0%, lateral in 5.4%, and medial in 4.3%. In 18 patients, posterior moves were required due to significant brain shift with intracranial air caused by outflow of CSF during the second side procedure. Sufficient STN activity is obtained with minimum trajectories by proper targeting and precise interpretation of MER findings even in the single tract method. Anterior–posterior moves rather than medial–lateral moves should be attempted first in cases with insufficient recording of STN activity. PMID:24140767

Aggressive Surgical Resection of Pulmonary Artery Intimal Sarcoma.

PubMed

Yamamoto, Yoko; Shintani, Yasushi; Funaki, Soichiro; Taira, Masaki; Ueno, Takayoshi; Kawamura, Tomohiro; Kanzaki, Ryu; Minami, Masato; Sawa, Yoshiki; Okumura, Meinoshin

2018-05-03

Intimal sarcoma of the pulmonary artery is a rare and highly malignant neoplasm. We herein report a case of a 30-year-old woman with an extensive right pulmonary artery tumor who underwent an emergent operation. The tumor was aggressively resected with right pneumonectomy and reconstruction of the right ventricle outflow tract and left pulmonary artery. Although the resected margin at the left pulmonary artery was positive, as confirmed by Mouse double minute type 2 homolog staining, she is doing well and remains free of relapse at 16 months after the operation. Copyright © 2018. Published by Elsevier Inc.

Anesthetic Considerations for Transcatheter Pulmonary Valve Replacement.

PubMed

Gregory, Stephen H; Zoller, Jonathan K; Shahanavaz, Shabana; Chilson, Kelly L; Ridley, Clare H

2018-02-01

The introduction of transcatheter therapy for valvular heart disease has revolutionized the care of patients with valvular disorders. Pathologic regurgitation or stenosis of the pulmonary valve, right ventricular outflow tract, or a right ventricle-to-pulmonary artery conduit represent emerging indications for transcatheter therapy. To date, minimal literature exists detailing the anesthetic management of patients undergoing transcatheter pulmonary valve replacement. In this review, the pathophysiology and indications for transcatheter pulmonary valve replacement and possible complications unique to this procedure are reviewed. Anesthetic management, including preoperative assessment, intraoperative considerations, and early postoperative monitoring, are discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

Prosthetic valve implantation with preservation of the entire valvular and subvalvular apparatus of the tricuspid valve in congenitally corrected transposition of the great arteries.

PubMed

Ergenoglu, Mehmet U; Yerebakan, Halit; Ozveren, Olcay; Koner, Ozge; Kalangos, Afksendiyos; Demirsoy, Ergun

2011-10-01

Congenitally corrected transposition of the great arteries, which is characterized by atrioventricular and ventriculoarterial discordance, is a rare congenital heart disease. Most of the cases are diagnosed in childhood, owing to associated cardiac anomalies, such as ventricular septal defect, pulmonary stenosis or pulmonary atresia, and Ebstein-like malformation of the tricuspid valve. We present a patient with congenitally corrected transposition of the great arteries who underwent surgical replacement of the tricuspid valve with a bioprosthesis and reconstruction of the left ventricular outflow tract with bovine conduit.

Atrioventricular and intraventricular block after transcatheter aortic valve implantation.

PubMed

Lee, Jane J; Goldschlager, Nora; Mahadevan, Vaikom S

2018-06-24

Aortic stenosis is the most common valvular heart disease in industrialized countries and the most common cause of left ventricular outflow tract (LVOT) obstruction. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement for intermediate to high-risk surgical candidates with symptomatic severe aortic stenosis. Conduction system abnormalities, including atrioventricular (AV) and intraventricular (IV) block, are the most common complication of TAVR. In this review, we aim to explore the anatomical issues relevant to atrioventricular block, the relevant clinical and procedural aspects, and the management and long-term implications of AV and IV block.

A Benign Cardiac Growth but Not So Indolent

PubMed Central

Reddy, Sahadev T.; Biederman, Robert W. W.

2016-01-01

Cardiac lipomatous hypertrophy is a rare benign condition that usually involves the interatrial septum. Due to its benign nature it rarely requires intervention. Its presence outside the interatrial septum is reported infrequently. We present a case of lipomatous hypertrophy in the intraventricular septum that was complicated by a severe, symptomatic, and disabling dynamic left ventricular outflow tract obstruction. The symptoms significantly improved following the excision of the mass. In our case transthoracic echocardiogram was used to visualize the mass and measure the severity of the obstruction; Cardiac Magnetic Resonance Imaging was used to characterize the mass and histopathology confirmed the diagnosis. PMID:27293911

Fetal Intelligent Navigation Echocardiography (FINE): a novel method for rapid, simple, and automatic examination of the fetal heart.

PubMed

Yeo, Lami; Romero, Roberto

2013-09-01

To describe a novel method (Fetal Intelligent Navigation Echocardiography (FINE)) for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC) and application of 'intelligent navigation' technology. We developed a method to: 1) demonstrate nine cardiac diagnostic planes; and 2) spontaneously navigate the anatomy surrounding each of the nine cardiac diagnostic planes (Virtual Intelligent Sonographer Assistance (VIS-Assistance®)). The method consists of marking seven anatomical structures of the fetal heart. The following echocardiography views are then automatically generated: 1) four chamber; 2) five chamber; 3) left ventricular outflow tract; 4) short-axis view of great vessels/right ventricular outflow tract; 5) three vessels and trachea; 6) abdomen/stomach; 7) ductal arch; 8) aortic arch; and 9) superior and inferior vena cava. The FINE method was tested in a separate set of 50 STIC volumes of normal hearts (18.6-37.2 weeks of gestation), and visualization rates for fetal echocardiography views using diagnostic planes and/or VIS-Assistance® were calculated. To examine the feasibility of identifying abnormal cardiac anatomy, we tested the method in four cases with proven congenital heart defects (coarctation of aorta, tetralogy of Fallot, transposition of great vessels and pulmonary atresia with intact ventricular septum). In normal cases, the FINE method was able to generate nine fetal echocardiography views using: 1) diagnostic planes in 78-100% of cases; 2) VIS-Assistance® in 98-100% of cases; and 3) a combination of diagnostic planes and/or VIS-Assistance® in 98-100% of cases. In all four abnormal cases, the FINE method demonstrated evidence of abnormal fetal cardiac anatomy. The FINE method can be used to visualize nine standard fetal echocardiography views in normal hearts by applying 'intelligent navigation' technology to STIC volume datasets. This method can simplify examination of the fetal heart and reduce operator dependency. The observation of abnormal echocardiography views in the diagnostic planes and/or VIS-Assistance® should raise the index of suspicion for congenital heart disease. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

[Embryology of the heart walls].

PubMed

Tardy, M-M; Galvaing, G; Sakka, L; Garcier, J-M; Chazal, J; Filaire, M

2013-03-01

Although anatomically simple structures, the atrial septum and the ventricular septum have complex embryological origins. Recent findings in molecular biology allowed better comprehension of their formation. As soon as the heart tube is formed, cells migrate from several cardiogenic fields to take part in the septation. Elongation, ballooning, and later inflexion of the heart tube create chamber separating grooves, facing the future septa. The systemic venous tributaries conflate at the venous pole of the heart; it will partially involute while contributing to the atrial septum. The primary atrial septum grows from the atrial roof towards the atrioventricular canal. It fuses there with the atrioventricular cushions, while its upper margin breaks down to form the ostium secundum. Then a deep fold develops from the atrial roof and partly covers the ostium secundum, leaving a flap-like interatrial communication through the oval foramen. It will close at birth. The interventricular septum has three embryological origins. The ventricular septum primum, created during the ballooning process, origins from the primary heart tube. It will form the trabecular septum and the inlet septum. The interventricular ring, surrounding the interventricular foramen, will participate in the inlet septum and also form the atrioventricular conduction axis. The outflow cushions will separate the outflow tract in the aorta and pulmonary artery, and grow to create the outlet septum. After merging with the atrioventricular cushions, they will also be part of the membranous septum. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Key Issues in the Production of Ionospheric Outflows

NASA Astrophysics Data System (ADS)

Lotko, W.

2017-12-01

Global models demonstrate that outflows of ionospheric ions can have profound effects on the dynamics of the solar wind-magnetosphere-ionosphere-thermosphere system, particularly during geomagnetic storms. Yet the processes that determine where and when outflows occur are poorly understood, in large part because a full complement of critical multivariable measurements of outflows and their causal drivers has yet to be assembled. Development of accurate regional and global predictive models of outflows has been hampered by this lack of empirical knowledge, but models are also challenged by the additional requirement of having to reduce the complex microphysics of ion energization into lumped relations that specify outflow characteristics through causal regulators. Opportunities to improve understanding of this problem are vast. This overview will focus on a limited set of priority questions that address how ions overcome gravity to leave the ionosphere; the timing, rate, spatial distribution and energetics of their exodus; how their flight impacts the ionosphere-thermosphere environment that spawns outflows; and the influence of magnetospheric feedback on outflow production.

Can we define and characterize the aging lower urinary tract?-ICI-RS 2015.

PubMed

Vahabi, Bahareh; Wagg, Adrian S; Rosier, Peter F W M; Rademakers, Kevin L J; Denys, Marie-Astrid; Pontari, Michel; Lovick, Thelma; Valentini, Francoise A; Nelson, Pierre P; Andersson, Karl-Erik; Fry, Christopher H

2017-04-01

The prevalence of lower urinary tract (LUT) symptoms increases with age but the etiology is unknown. This article aims to identify research directions that clarify the basis of this association. The initial question is whether biological age is the variable of interest or a time-dependent accumulation of factors that impact on LUT function at rates that differ between individuals. In particular, the accumulation of conditions or agents due to inflammatory states or tissue ischemia is important. Much of the above has been concerned with changes to bladder function and morphology. However, the outflow tract function is also affected, in particular changes to the function of external sphincter skeletal muscle and associated sacral motor nerve control. Nocturia is a cardinal symptom of LUT dysfunction and is more prevalent with aging. Urine production is determined by diurnal changes to the production of certain hormones as well as arterial blood pressure and such diurnal rhythms are blunted in subjects with nocturia, but the causal links remain to be elucidated. Changes to the central nervous control of LUT function with age are also increasingly recognized, whether in mid-brain/brainstem regions that directly affect LUT function or in higher centers that determine psycho-social and emotional factors impinging on the LUT. In particular, the linkage between increasing white matter hyperintensities and LUT dysfunction during aging is recognized but not understood. Overall, a more rational approach is being developed to link LUT dysfunction with factors that accumulate with age, however, the precise causal pathways remain to be characterized. Neurourol. Urodynam. 36:854-858, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Provocation of left ventricular outflow tract obstruction using nitrate inhalation in hypertrophic cardiomyopathy: Relation to electromechanical delay.

PubMed

Badran, Hala Mahfouz; Ibrahim, Waleed Abdou; Faheem, Naglaa; Yassin, Rehab; Alashkar, Tamer; Yacoub, Magdi

2015-01-01

Left ventricular outflow tract obstruction (LVOT) is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). It is of major importance that the provocation modalities used are validated against each other. To define the magnitude of LVOT gradients provocation during both isosorbide dinitrate (ISDN) inhalation and treadmill exercise in non-obstructive HCM and analyze the correlation to the electromechanical delay using speckle tracking. We studied 39 HCM pts (64% males, mean age 38 ± 13 years) regional LV longitudinal strain and electromechanical delay (TTP) was analyzed at rest using speckle tracking. LVOT gradient was measured at rest and after ISDN then patients underwent a treadmill exercise echocardiography (EE) and LVOT gradient was measured at peak exercise. The maximum effect of ISDN on LVOT gradient was obtained at 5 minutes, it increased to a significant level in 12 (31%) patients, and in 14 (36%) patients using EE, with 85.6% sensitivity & 100% specificity. Patients with latent obstruction had larger left atrial volume and lower E/A ratio compared to the non-obstructive group (p < 0.01). LVOTG using ISDN was significantly correlated with that using EE (p < 0.0001), resting LVOTG (p < 0.0001), SAM (p < 0.0001), EF% (p < 0.02) and regional electromechanical delay but not related to global LV longitudinal strain. Using multivariate regression, resting LVOTG (p = 0.006) & TTP mid septum (p = 0.01) were found to be independent predictors of latent LVOT obstruction using ISDN. There is a comparable diagnostic value of nitrate inhalation to exercise testing in provocation of LVOT obstruction in HCM. Latent obstruction is predominantly dependent on regional electromechanical delay.

Provocation of left ventricular outflow tract obstruction using nitrate inhalation in hypertrophic cardiomyopathy: Relation to electromechanical delay

PubMed Central

Badran, Hala Mahfouz; Ibrahim, Waleed Abdou; Faheem, Naglaa; Yassin, Rehab; Alashkar, Tamer; Yacoub, Magdi

2015-01-01

Background: Left ventricular outflow tract obstruction (LVOT) is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). It is of major importance that the provocation modalities used are validated against each other. Aim: To define the magnitude of LVOT gradients provocation during both isosorbide dinitrate (ISDN) inhalation and treadmill exercise in non-obstructive HCM and analyze the correlation to the electromechanical delay using speckle tracking. Methods: We studied 39 HCM pts (64% males, mean age 38 ± 13 years) regional LV longitudinal strain and electromechanical delay (TTP) was analyzed at rest using speckle tracking. LVOT gradient was measured at rest and after ISDN then patients underwent a treadmill exercise echocardiography (EE) and LVOT gradient was measured at peak exercise. Results: The maximum effect of ISDN on LVOT gradient was obtained at 5 minutes, it increased to a significant level in 12 (31%) patients, and in 14 (36%) patients using EE, with 85.6% sensitivity & 100% specificity. Patients with latent obstruction had larger left atrial volume and lower E/A ratio compared to the non-obstructive group (p < 0.01). LVOTG using ISDN was significantly correlated with that using EE (p < 0.0001), resting LVOTG (p < 0.0001), SAM (p < 0.0001), EF% (p < 0.02) and regional electromechanical delay but not related to global LV longitudinal strain. Using multivariate regression, resting LVOTG (p = 0.006) & TTP mid septum (p = 0.01) were found to be independent predictors of latent LVOT obstruction using ISDN. Conclusion: There is a comparable diagnostic value of nitrate inhalation to exercise testing in provocation of LVOT obstruction in HCM. Latent obstruction is predominantly dependent on regional electromechanical delay. PMID:26779503

Erythrocyte creatine as a marker of intravascular hemolysis due to left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

PubMed

Kubo, Toru; Okumiya, Toshika; Baba, Yuichi; Hirota, Takayoshi; Tanioka, Katsutoshi; Yamasaki, Naohito; Sugiura, Tetsuro; Doi, Yoshinori L; Kitaoka, Hiroaki

2016-03-01

Erythrocyte creatine, a marker of erythrocyte age that increases with shortening of erythrocyte survival, has been reported to be a quantitative and reliable marker for intravascular hemolysis. We hypothesized that hemolysis could also occur due to intraventricular obstruction in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to examine the presence of subclinical hemolysis and the relation between intravascular hemolysis and intraventricular pressure gradient (IVPG). We measured erythrocyte creatine in 92 HCM patients. Twelve patients had left ventricular outflow tract obstruction (LVOTO), 4 had midventricular obstruction (MVO), and the remaining 76 were non-obstructive. Erythrocyte creatine levels ranged from 0.92 to 4.36μmol/g hemoglobin. Higher levels of erythrocyte creatine were associated with higher IVPG (r=0.437, p<0.001). If erythrocyte creatine levels are high (≥1.8μmol/g hemoglobin), subclinical hemolysis is considered to be present. Half of LVOTO patients and no MVO patients showed high erythrocyte creatine levels. Although non-obstructive patients did not show significant intraventricular obstruction at rest, some showed high erythrocyte creatine levels. When LVOT-PG was measured during the strain phase of the Valsalva maneuver in 20 non-obstructive patients, 7 of those 20 patients showed LVOTO. In the 20 patients, there was no relation between erythrocyte creatine levels and LVOT-PG before the Valsalva maneuver (r=0.125, p=0.600), whereas there was a significant correlation between erythrocyte creatine and LVOT-PG provoked by the Valsalva maneuver (r=0.695, p=0.001). There is biochemical evidence of subclinical hemolysis in patients with HCM, and this hemolysis seems to be associated with LVOTO provoked by daily physical activities. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Sustained Improvement in Right Ventricular Chamber Dimensions 10 Years Following Xenograft Pulmonary Valve Replacement.

PubMed

Schubmehl, Heidi B; Swartz, Michael F; Atallah-Yunes, Nader; Wittlieb-Weber, Carol; Pratt, Rebecca E; Alfieris, George M

2017-01-01

The goals following pulmonary valve replacement (PVR) are to optimize right ventricular hemodynamics and minimize the need for subsequent reoperations on the right ventricular outflow tract. We hypothesized PVR using a xenograft valved conduit would result in superior freedom from reoperation with sustained improvement in right ventricular chamber dimensions. Xenograft valved conduits placed in patients aged >16 years were reviewed from 2000 to 2010 to allow for a 5-year minimum follow-up. Preoperative, one-year, and the most recent echocardiograms quantified right ventricular chamber dimensions, corresponding Z scores, and prosthetic valve function. Magnetic resonance imaging (MRI) studies compared preoperative and follow-up right ventricular volumes. A total of 100 patients underwent PVR at 24 (19-34) years. Freedom from reintervention was 100% at 10 years. At most recent follow-up, only one patient had greater than mild pulmonary insufficiency. The one-year (17.3 ± 7.2 mm Hg; P < .01) and most recent follow-up (18.6 ± 9.8 mm Hg; P < .01) Doppler-derived right ventricular outflow tract gradients remained significantly lower than preoperative measurements (36.7 ± 27.0 mm Hg). Similarly, right ventricular basal diameter, basal longitudinal diameter, and the corresponding Z scores remained lower at one year and follow-up from preoperative measurements. From 34 MRI studies, the right ventricular end-diastolic indexed volume (161.7 ± 58.5 vs 102.9 ± 38.3; P < .01) and pulmonary regurgitant fraction (38.0% ± 15.9% vs 0.8% ± 3.3%; P < .01) were significantly lower at 7.1 ± 3.4 years compared to the preoperative levels. Use of a xenograft valved conduit for PVR results in excellent freedom from reoperation with sustained improvement in right ventricular dimensions at an intermediate-term follow-up.

Clinical significance of a presystolic wave on Doppler examination of the left ventricular outflow tract.

PubMed

Joshi, Kamal R; Kabirdas, Deepa; Romero-Corral, Abel; Shah, Mahek; Figueredo, Vincent M; Pressman, Gregg S

2014-11-15

A presystolic wave (PSW) is commonly seen on Doppler examination of the left ventricular outflow tract (LVOT), but is little studied. We conducted a retrospective study to assess the prevalence of the PSW, correlations with various Doppler parameters, and its clinical significance. Two hundred echocardiograms, 100 with ejection fraction (EF) >55% and 100 with EF <45%, were reviewed. Mitral inflow velocities, septal annular velocities, LVOT, and PSW velocities were measured. Major adverse cardiovascular events (MACE [death, heart failure hospitalization, atrial fibrillation, and stroke]) were compared between those with and without a PSW, in both EF groups. Mean age was 58 ± 15 years; 56% were men and 69% were African-American. PSW prevalence was similar between normal (68%) and reduced EF groups (62%). However, its velocity was less in the low EF group (37 ± 10 vs 48 ± 16 cm/s, p <0.0001). In subjects with normal EF PSW velocity correlated with mitral A velocity (rho = 0.43, p = 0.0003). In subjects with reduced EF the association with A velocity was not significant (rho = 0.22, p = 0.09), but there was a significant association with annular a' velocity (rho = 0.38, p = 0.002). Over a mean follow-up of 1.7 ± 0.3 years, 57 subjects (28%) experienced MACE. Those without a PSW had more MACE (39% vs 23%, p = 0.02); PSW absence remained predictive of MACE after adjustment for multiple variables, especially in patients with reduced EF. In conclusion, PSW is common in the LVOT. Its presence and magnitude are associated with measures of atrial contraction. Its absence is associated with increased rates of adverse events, especially in patients with low EF. Copyright © 2014 Elsevier Inc. All rights reserved.

Prevalence and Clinical Significance of an E-Reversal Wave in the Left Ventricular Outflow Tract.

PubMed

Pressman, Gregg S; Matejkova, Magdalena; Horrow, Jay C; Pai, Ramdas G

2016-11-15

Diastolic waves are commonly seen in the left ventricular outflow tract on echocardiography. This work focuses on the E-reversal wave (Er) that occurs early in diastole, shortly after the mitral E wave. Factors associated with Er presence and velocity were investigated in a broad patient sample: 100 subjects with normal ejection fraction (EF >55%) and 100 subjects with reduced EF (<45%). Er presence was noted in 58% of the total cohort and correlated inversely with age. It was more common with normal EF (70% vs 45%, p = 0.0005) and was associated with higher mitral E velocity (78.3 ± 23.3 vs 68.4 ± 19.0 cm/s; p = 0.002) and septal e' velocity (6.7 ± 2.5 vs 5.3 ± 2.3 cm/s; p <0.0001). Er velocity was higher in the normal EF group (50 ± 18 vs 34 ± 13 cm/s, p <0.0001) and showed moderate correlation with septal e' velocity (r = 0.43; p <0.0001); 56 subjects experienced major adverse cardiovascular events (MACE) over 1.7 ± 0.3 years of follow-up. Those with an Er had less MACE (particularly heart failure), even after adjustment for multiple clinical and echocardiographic variables (OR 0.28, 95% CI 0.11 to 0.65; p = 0.003). When stratified by EF, the association between Er presence and MACE was significant only in the low EF group. Thus, Er occurs more commonly in younger subjects and those with preserved EF. It is associated with less MACE although this effect appears to be limited to patients with reduced EF. Copyright © 2016 Elsevier Inc. All rights reserved.

Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps.

PubMed

Roca-Luque, Ivo; Rivas, Nuria; Francisco, Jaume; Perez, Jordi; Acosta, Gabriel; Oristrell, Gerard; Terricabres, Maria; Garcia-Dorado, David; Moya, Angel

2017-01-01

Ablation in aortic cusps could be necessary in up to 15% of the patients, especially in para-Hisian atrial tachycardia and ventricular arrhythmias arising from outflow tracts. Risk of coronary damage has led to recommendation of systematic coronary angiography (CA) during the procedure. Other image tests as intravascular (ICE) or transesophageal echocardiography (TEE) have been proposed. Both methods have limitations: additional vascular access for ICE and need for additional CA in some patients in case of TEE. We describe an alternative method to assess relation of catheter tip and coronary ostia during ablation in aortic cusps without additional vascular accesses by performing selective angiography with the ablation catheter. We prospectively evaluated 12 consecutive patients (69.3 ± 8.5, 6 female) who underwent ablation in right (1), left (5), and noncoronary cusps (6). We performed angiography through the ablation cooled tip radiofrequency catheter at the ablation site. Ablation was effective in 91.6% of the patients (3 patients needed additional ablation out of coronary cusps: pulmonary cusp, right ventricular outflow tract (RVOT), and coronary sinus and 1 patient underwent a second procedure because recurrence). No complications occurred neither during procedure nor follow-up (6.2 ± 3.8 months). No technical problems occurred with the ablation catheter after contrast injection. Selective angiography through a cooled-tip radiofrequency ablation catheter is feasible to assess relation of coronary ostia and ablation site when ablation in aortic cusps. It allows continuous real-time assessment of this relation, avoids the need for additional vascular accesses and no complications occurred in our series. © 2016 Wiley Periodicals, Inc.

Long-term results after the Rastelli repair for transposition of the great arteries.

PubMed

Hörer, Jürgen; Schreiber, Christian; Dworak, Eva; Cleuziou, Julie; Prodan, Zsolt; Vogt, Manfred; Holper, Klaus; Lange, Rüdiger

2007-06-01

This study sought to assess risk factors for late mortality after the Rastelli operation for patients with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction. Records of 39 patients who underwent the Rastelli operation between 1977 and 2004 were reviewed. Median age at the time of operation was 5.1 years (2.2 years within the last 5 years). There were no early deaths. During a median follow-up of 8.9 years (range, 0 to 25 years), 2 patients died of sudden death, 1 of pneumonia, 1 during reoperation, and 2 received heart transplantation. Freedom from death or transplantation was 93.8% +/- 4.3% and 57.5% +/- 15.1% at 10 and 20 years, respectively. Freedom from conduit replacement was 48.8% +/- 10.3% and 32.5% +/- 10.3% at 10 and 20 years, respectively. Subvalvular and valvular left ventricular outflow tract obstruction (p = 0.012), stenosis of the peripheral pulmonary arteries (p < 0.001), enlargement of the ventricular septal defect (p = 0.030), and longer ischemic time (p = 0.015) were predictive for death or transplantation. Patients younger than 4 years at the time of the Rastelli operation showed a trend toward a better freedom from death or transplantation (p = 0.068), but needed significantly more conduit replacements (p = 0.038) compared with patients 4 years or older. The Rastelli operation is a low-risk procedure with regard to early mortality. The status of the pulmonary arteries and ventricular septal defect enlargement are predictive for long-term survival. Patients 4 years of age or older at the time of the Rastelli operation require fewer reoperations for conduit exchange. Nevertheless, early Rastelli repair is recommended because patients 4 years or older are at risk for a higher long-term mortality.

Magnetic versus manual catheter navigation for mapping and ablation of right ventricular outflow tract ventricular arrhythmias: a randomized controlled study.

PubMed

Zhang, Fengxiang; Yang, Bing; Chen, Hongwu; Ju, Weizhu; Kojodjojo, Pipin; Cao, Kejiang; Chen, Minglong

2013-08-01

No randomized controlled study has prospectively compared the performance and clinical outcomes of remote magnetic control (RMC) vs manual catheter control (MCC) during ablation of right ventricular outflow tract (RVOT) ventricular premature complexes (VPC) or ventricular tachycardia (VT). The purpose of this study was to prospectively evaluate the efficacy and safety of using either RMC vs MCC for mapping and ablation of RVOT VPC/VT. Thirty consecutive patients with idiopathic RVOT VPC/VT were referred for catheter ablation and randomized into either the RMC or MCC group. A noncontact mapping system was deployed in the RVOT to identify origins of VPC/VT. Conventional activation and pace-mapping was performed to guide ablation. If ablation performed using 1 mode of catheter control was acutely unsuccessful, the patient crossed over to the other group. The primary endpoints were patients' and physicians' fluoroscopic exposure and times. Mean procedural times were similar between RMC and MCC groups. The fluoroscopic exposure and times for both patients and physicians were much lower in the RMC group than in the MCC group. Ablation was acutely successful in 14 of 15 patients in the MCC group and 10 of 15 in the RMC group. Following crossover, acute success was achieved in all patients. No major complications occurred in either group. During 22 months of follow-up, RVOT VPC recurred in 2 RMC patients. RMC navigation significantly reduces patients' and physicians' fluoroscopic times by 50.5% and 68.6%, respectively, when used in conjunction with a noncontact mapping system to guide ablation of RVOT VPC/VT. Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Actual management and prognosis of severe isolated tricuspid regurgitation associated with atrial fibrillation without structural heart disease.

PubMed

Takahashi, Yusuke; Izumi, Chisato; Miyake, Makoto; Imanaka, Miyako; Kuroda, Maiko; Nishimura, Shunsuke; Yoshikawa, Yusuke; Amano, Masashi; Imamura, Sari; Onishi, Naoaki; Tamaki, Yodo; Enomoto, Soichiro; Tamura, Toshihiro; Kondo, Hirokazu; Kaitani, Kazuaki; Nakagawa, Yoshihisa

2017-09-15

Patients with atrial fibrillation (AF) without structural heart diseases can show severe tricuspid regurgitation (TR), especially among aged people. The aim of this study was to clarify the actual management, prognosis, and prognostic factors for severe isolated TR associated with AF without structural heart diseases. We retrospectively investigated actual management in 178 consecutive patients with severe isolated TR associated with AF between 1999 and 2011 in our institution. Prognosis and its predictors were also investigated in 115 patients (68 persistent TR and 47 transient TR) who were followed-up for >1year. During the follow-up period (mean: 5.9years), event free rate from death due to right-sided heart failure (RHF) was 97% at 5years. Persistent TR was associated with higher risk of hospitalization due to RHF than transient TR (log-rank P=0.048) and death due to RHF were all seen in patients with persistent TR who experienced hospitalization due to RHF. Among patients with persistent TR, right ventricular outflow tract dimension >35.3mm, right atrial area >40.3cm 2 , and tenting height >2.1mm were associated with higher risk of hospitalization due to RHF (adjusted hazard ratio: 3.32, 3.83, and 2.89, respectively; P=0.003, 0.002, and 0.009, respectively). The prognosis of severe isolated TR associated with AF was good with a focus on cardiac death. However, the incidence of cardiac death increased among patients who experienced hospitalization due to RHF. Larger right ventricular outflow tract dimension, right atrial area and tenting height were predictors of hospitalization due to RHF. Copyright © 2017 Elsevier B.V. All rights reserved.

Inheritance Analysis of Congenital Left Ventricular Outflow Tract Obstruction Malformations: Segregation, Multiplex Relative Risk, and Heritability

PubMed Central

McBride, Kim L.; Pignatelli, Ricardo; Lewin, Mark; Ho, Trang; Fernbach, Susan; Menesses, Andres; Lam, Wilbur; Leal, Suzanne M.; Kaplan, Norman; Schliekelman, Paul; Towbin, Jeffrey A.; Belmont, John W.

2006-01-01

The left ventricular outflow tract (LVOTO) malformations, aortic valve stenosis (AVS), coarctation of the aorta (COA), and hypoplastic left heart (HLH) constitute a mechanistically defined subgroup of congenital heart defects that have substantial evidence for a genetic component. Evidence from echocardiography studies has shown that bicuspid aortic valve (BAV) is found frequently in relatives of children with LVOTO defects. However, formal inheritance analysis has not been performed. We ascertained 124 families by an index case with AVS, COA, or HLH. A total of 413 relatives were enrolled in the study, of which 351 had detailed echocardiography exams for structural heart defects and measurements of a variety of aortic arch, left ventricle, and valve structures. LVOTO malformations were noted in 30 relatives (18 BAV, 5 HLH, 3 COA, and 3 AVS), along with significant congenital heart defects (CHD) in 2 others (32/413; 7.7%). Relative risk for first-degree relatives in this group was 36.9, with a heritability of 0.71–0.90. Formal segregation analysis suggests that one or more minor loci with rare dominant alleles may be operative in a subset of families. Multiplex relative risk analysis, which estimates number of loci, had the highest maximum likelihood score in a model with 2 loci (range of 1–6 in the lod-1 support interval). Heritability of several aortic arch measurements and aortic valve was significant. These data support a complex but most likely oligogenic pattern of inheritance. A combination of linkage and association study designs is likely to enable LVOTO risk gene identification. This data can also provide families with important information for screening asymptomatic relatives for potentially harmful cardiac defects. PMID:15690347

Stent fracture, valve dysfunction, and right ventricular outflow tract reintervention after transcatheter pulmonary valve implantation: patient-related and procedural risk factors in the US Melody Valve Trial.

PubMed

McElhinney, Doff B; Cheatham, John P; Jones, Thomas K; Lock, James E; Vincent, Julie A; Zahn, Evan M; Hellenbrand, William E

2011-12-01

Among patients undergoing transcatheter pulmonary valve (TPV) replacement with the Melody valve, risk factors for Melody stent fracture (MSF) and right ventricular outflow tract (RVOT) reintervention have not been well defined. From January 2007 to January 2010, 150 patients (median age, 19 years) underwent TPV implantation in the Melody valve Investigational Device Exemption trial. Existing conduit stents from a prior catheterization were present in 37 patients (25%, fractured in 12); 1 or more new prestents were placed at the TPV implant catheterization in 51 patients. During follow-up (median, 30 months), MSF was diagnosed in 39 patients. Freedom from a diagnosis of MSF was 77±4% at 14 months (after the 1-year evaluation window) and 60±9% at 39 months (3-year window). On multivariable analysis, implant within an existing stent, new prestent, or bioprosthetic valve (combined variable) was associated with longer freedom from MSF (P<0.001), whereas TPV compression (P=0.01) and apposition to the anterior chest wall (P=0.02) were associated with shorter freedom from MSF. Freedom from RVOT reintervention was 86±4% at 27 months. Among patients with a MSF, freedom from RVOT reintervention after MSF diagnosis was 49±10% at 2 years. Factors associated with reintervention were similar to those for MSF. MSF was common after TPV implant in this multicenter experience and was more likely in patients with severely obstructed RVOT conduits and when the TPV was directly behind the anterior chest wall and/or clearly compressed. A TPV implant site protected by a prestent or bioprosthetic valve was associated with lower risk of MSF and reintervention.

Integration of intracardiac echocardiography and computed tomography during atrial fibrillation ablation: Combining ultrasound contours obtained from the right atrium and ventricular outflow tract.

PubMed

Nakamura, Kohki; Naito, Shigeto; Kaseno, Kenichi; Nakatani, Yosuke; Sasaki, Takehito; Anjo, Naofumi; Yamashita, Eiji; Kumagai, Koji; Funabashi, Nobusada; Kobayashi, Yoshio; Oshima, Shigeru

2017-02-01

We aimed to optimize the acquisition of the left atrial (LA) and pulmonary vein (PV) ultrasound contours for more accurate integration of intracardiac echocardiography (ICE) and computed tomography (CT) using the CARTO ® 3 system during atrial fibrillation (AF) ablation. Eighty-five AF patients underwent integration of ICE and CT using (1) the LA roof and posterior wall contours acquired from the right atrium (RA), (2) all LA/PV contours from the RA (Whole-RA-integration), (3) the LA roof/posterior wall contours from the RA and right ventricular outflow tract (RVOT) (Posterior-RA/RV-integration), and (4) all LA/PV contours from the RA and RVOT (Whole-RA/RV-integration). The integration accuracy was compared using the (1) surface registration error, (2) distances between the three-dimensional CT and eight specific sites on the anterior, posterior, superior, and inferior aspects of the right and left circumferential PV isolation lines, and (3) registration score: a score of 0 or 1 was assigned for whether or not each specific site was visually aligned with the CT, and summed for each method (0 best, 8 worst). Posterior-RA/RV-integration revealed a significantly lower surface registration error (1.30±0.15mm) than Whole-RA- and Whole-RA/RV-integration (p<0.001). The mean distances of the eight specific sites and the registration score for Posterior-RA/RV-integration (median 1.26mm and 2, respectively) were significantly smaller than those for the other integration approaches (p<0.001). Image integration with the LA roof and posterior wall contours acquired from the RA and RVOT may provide greater accuracy for catheter navigation with three-dimensional CT during AF ablation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Periconceptional Folic Acid Supplementation and Infant Risk of Congenital Heart Defects in Norway 1999-2009.

PubMed

Leirgul, Elisabeth; Gildestad, Trude; Nilsen, Roy Miodini; Fomina, Tatiana; Brodwall, Kristoffer; Greve, Gottfried; Vollset, Stein Emil; Holmstrøm, Henrik; Tell, Grethe S; Øyen, Nina

2015-09-01

The birth prevalence of congenital heart defects (CHDs) has decreased in Canada and Europe. Recommended intake of folic acid in pregnancy is a suggestive risk-reducing factor for CHDs. We investigated the association between periconceptional intake of folic acid supplements and infant risk of CHDs. Information on maternal intake of folic acid supplements before and during pregnancy in the Medical Birth Registry of Norway 1999-2009 was updated with information on CHD diagnoses from national health registers and the Cardiovascular Diseases in Norway Project. The association between folic acid intake and infant risk of CHD was estimated as relative risk (RR) with binomial log linear regression. Among 517 784 non-chromosomal singleton births, 6200 children were identified with CHD and 1153 with severe CHD. For all births, 18.4% of the mothers initiated folic acid supplements before pregnancy and 31.6% during pregnancy. The adjusted RR for severe CHD was 0.99 [95% confidence interval [CI] 0.86, 1.13] comparing periconceptional intake of folic acid with no intake. Specifically, RR for conotruncal defects was 0.99 [95% CI 0.80, 1.22], atrioventricular septal defects 1.19 [95% CI 0.78, 1.81], left ventricular outflow tract obstructions 1.02 [95% CI 0.78, 1.32], and right ventricular outflow tract obstructions 0.97 [95% CI 0.72, 1.29]. Birth prevalence of septal defects was higher in the group exposed to folic acid supplements with RR 1.19 [95% CI 1.10, 1.30]. Periconceptional folic acid supplement use showed no association with severe CHDs in the newborn. An unexpected association with an increased risk of septal defects warrants further investigation. © 2015 The Authors. Paediatric and Perinatal Epidemiology Published by John Wiley & Sons Ltd.

Disruption of Smad4 in neural crest cells leads to mid-gestation death with pharyngeal arch, craniofacial and cardiac defects

PubMed Central

Nie, Xuguang; Deng, Chu-xia; Wang, Qin; Jiao, Kai

2008-01-01

TGFβ/BMP signaling pathways are essential for normal development of neural crest cells (NCCs). Smad4 encodes the only common Smad protein in mammals, which is a critical nuclear mediator of TGFβ/BMP signaling. In this work, we sought to investigate the roles of Smad4 for development of NCCs. To overcome the early embryonic lethality of Smad4 null mice, we specifically disrupted Smad4 in NCCs using a Cre/loxP system. The mutant mice died at mid-gestation with defects in facial primordia, pharyngeal arches, outflow tract and cardiac ventricles. Further examination revealed that mutant embryos displayed severe molecular defects starting from E9.5. Expression of multiple genes, including Msx1, 2, Ap-2α, Pax3, and Sox9, which play critical roles for NCC development, was downregulated by NCC disruption of Smad4. Moreover, increased cell death was observed in pharyngeal arches from E10.5. However, the cell proliferation rate in these areas was not substantially altered. Taken together, these findings provide compelling genetic evidence that Smad4-mediated activities of TGFβ/BMP signals are essential for appropriate NCC development. PMID:18334251

Quantification of Focal Outflow Enhancement Using Differential Canalograms

PubMed Central

Loewen, Ralitsa T.; Brown, Eric N.; Scott, Gordon; Parikh, Hardik; Schuman, Joel S.; Loewen, Nils A.

2016-01-01

Purpose To quantify regional changes of conventional outflow caused by ab interno trabeculectomy (AIT). Methods Gonioscopic, plasma-mediated AIT was established in enucleated pig eyes. We developed a program to automatically quantify outflow changes (R, package eye-canalogram, github.com) using a fluorescent tracer reperfusion technique. Trabecular meshwork (TM) ablation was demonstrated with fluorescent spheres in six eyes before formal outflow quantification with two-dye reperfusion canalograms in six additional eyes. Eyes were perfused with a central, intracameral needle at 15 mm Hg. Canalograms and histology were correlated for each eye. Results The pig eye provided a model with high similarity to AIT in human patients. Histology indicated ablation of TM and unroofing of most Schlemm's canal segments. Spheres highlighted additional circumferential and radial outflow beyond the immediate area of ablation. Differential canalograms showed that AIT caused an increase of outflow of 17 ± 5-fold inferonasally, 14 ± 3-fold superonasally, and also an increase in the opposite quadrants with a 2 ± 1-fold increase superotemporally, and 3 ± 3 inferotemporally. Perilimbal specific flow image analysis showed an accelerated nasal filling with an additional perilimbal flow direction into adjacent quadrants. Conclusions A quantitative, differential canalography technique was developed that allows us to quantify supraphysiological outflow enhancement by AIT. PMID:27227352

Mutations in HPSE2 cause urofacial syndrome.

PubMed

Daly, Sarah B; Urquhart, Jill E; Hilton, Emma; McKenzie, Edward A; Kammerer, Richard A; Lewis, Malcolm; Kerr, Bronwyn; Stuart, Helen; Donnai, Dian; Long, David A; Burgu, Berk; Aydogdu, Ozgu; Derbent, Murat; Garcia-Minaur, Sixto; Reardon, Willie; Gener, Blanca; Shalev, Stavit; Smith, Rupert; Woolf, Adrian S; Black, Graeme C; Newman, William G

2010-06-11

Urinary voiding dysfunction in childhood, manifesting as incontinence, dysuria, and urinary frequency, is a common condition. Urofacial syndrome (UFS) is a rare autosomal recessive disease characterized by facial grimacing when attempting to smile and failure of the urinary bladder to void completely despite a lack of anatomical bladder outflow obstruction or overt neurological damage. UFS individuals often have reflux of infected urine from the bladder to the upper renal tract, with a risk of kidney damage and renal failure. Whole-genome SNP mapping in one affected individual defined an autozygous region of 16 Mb on chromosome 10q23-q24, within which a 10 kb deletion encompassing exons 8 and 9 of HPSE2 was identified. Homozygous exonic deletions, nonsense mutations, and frameshift mutations in five further unrelated families confirmed HPSE2 as the causative gene for UFS. Mutations were not identified in four additional UFS patients, indicating genetic heterogeneity. We show that HPSE2 is expressed in the fetal and adult central nervous system, where it might be implicated in controlling facial expression and urinary voiding, and also in bladder smooth muscle, consistent with a role in renal tract morphology and function. Our findings have broader implications for understanding the genetic basis of lower renal tract malformations and voiding dysfunction.

Mutations in HPSE2 Cause Urofacial Syndrome

PubMed Central

Daly, Sarah B.; Urquhart, Jill E.; Hilton, Emma; McKenzie, Edward A.; Kammerer, Richard A.; Lewis, Malcolm; Kerr, Bronwyn; Stuart, Helen; Donnai, Dian; Long, David A.; Burgu, Berk; Aydogdu, Ozgu; Derbent, Murat; Garcia-Minaur, Sixto; Reardon, Willie; Gener, Blanca; Shalev, Stavit; Smith, Rupert; Woolf, Adrian S.; Black, Graeme C.; Newman, William G.

2010-01-01

Urinary voiding dysfunction in childhood, manifesting as incontinence, dysuria, and urinary frequency, is a common condition. Urofacial syndrome (UFS) is a rare autosomal recessive disease characterized by facial grimacing when attempting to smile and failure of the urinary bladder to void completely despite a lack of anatomical bladder outflow obstruction or overt neurological damage. UFS individuals often have reflux of infected urine from the bladder to the upper renal tract, with a risk of kidney damage and renal failure. Whole-genome SNP mapping in one affected individual defined an autozygous region of 16 Mb on chromosome 10q23-q24, within which a 10 kb deletion encompassing exons 8 and 9 of HPSE2 was identified. Homozygous exonic deletions, nonsense mutations, and frameshift mutations in five further unrelated families confirmed HPSE2 as the causative gene for UFS. Mutations were not identified in four additional UFS patients, indicating genetic heterogeneity. We show that HPSE2 is expressed in the fetal and adult central nervous system, where it might be implicated in controlling facial expression and urinary voiding, and also in bladder smooth muscle, consistent with a role in renal tract morphology and function. Our findings have broader implications for understanding the genetic basis of lower renal tract malformations and voiding dysfunction. PMID:20560210

Increasing dwell time of mitomycin C in the upper tract with a reverse thermosensitive polymer.

PubMed

Wang, Agnes J; Goldsmith, Zachariah G; Neisius, Andreas; Astroza, Gaston M; Oredein-McCoy, Olugbemisola; Iqbal, Muhammad W; Simmons, W Neal; Madden, John F; Preminger, Glenn M; Inman, Brant A; Lipkin, Michael E; Ferrandino, Michael N

2013-03-01

Abstract Background and Purpose: Topical chemotherapy for urothelial cancer is dependent on adequate contact time of the chemotherapeutic agent with the urothelium. To date, there has not been a reliable method of maintaining this contact for renal or ureteral urothelial carcinoma. We evaluated the safety and feasibility of using a reverse thermosensitive polymer to improve dwell times of mitomycin C (MMC) in the upper tract. Using a porcine model, four animals were treated ureteroscopically with both upper urinary tracts receiving MMC mixed with iodinated contrast. One additional animal received MMC percutaneously. The treatment side had ureteral outflow blocked with a reverse thermosensitive polymer plug. MMC dwell time was monitored fluoroscopically and intrarenal pressures measured. Two animals were euthanized immediately, and three animals were euthanized 5 days afterward. In control kidneys, drainage occurred at a mean of 5.3±0.58 minutes. Intrarenal pressures stayed fairly stable: 9.7±14.0 cm H20. In treatment kidneys, dwell time was extended to 60 minutes, when the polymer was washed out. Intrarenal pressures in the treatment kidneys peaked at 75.0±14.7 cm H20 and reached steady state at 60 cm H20. Pressures normalized after washout of the polymer with cool saline. Average washout time was 11.8±9.6 minutes. No histopathologic differences were seen between the control and treatment kidneys, or with immediate compared with delayed euthanasia. A reverse thermosensitive polymer can retain MMC in the upper urinary tract and appears to be safe from our examination of intrarenal pressures and histopathology. This technique may improve the efficacy of topical chemotherapy in the management of upper tract urothelial carcinoma.

Characterization of intraventricular flow patterns in healthy neonates from conventional color-Doppler ultrasound

NASA Astrophysics Data System (ADS)

Tejman-Yarden, Shai; Rzasa, Callie; Benito, Yolanda; Alhama, Marta; Leone, Tina; Yotti, Raquel; Bermejo, Javier; Printz, Beth; Del Alamo, Juan C.

2012-11-01

Left ventricular vortices have been difficult to visualize in the clinical setting due to the lack of quantitative non-invasive modalities, and this limitation is especially important in pediatrics. We have developed and validated a new technique to reconstruct two-dimensional time-resolved velocity fields in the LV from conventional transthoracic color-Doppler images. This non-invasive modality was used to image LV flow in 10 healthy full-term neonates, ages 24-48 hours. Our results show that, in neonates, a diastolic vortex developed during LV filling, was maintained during isovolumic contraction, and decayed during the ejection period. The vortex was created near the base of the ventricle, moved toward the apex, and then back toward the base and LVOT during ejection. In conclusion, we have characterized for the first time the properties of the LV filling vortex in normal neonates, demonstrating that this vortex channels blood from the inflow to the outflow tract of the LV. Together with existing data from adults, our results confirm that the LV vortex is conserved through adulthood. Funded by NIH Grant R21HL108268.

A Zebrafish Loss-of-Function Model for Human CFAP53 Mutations Reveals Its Specific Role in Laterality Organ Function.

PubMed

Noël, Emily S; Momenah, Tarek S; Al-Dagriri, Khalid; Al-Suwaid, Abdulrahman; Al-Shahrani, Safar; Jiang, Hui; Willekers, Sven; Oostveen, Yara Y; Chocron, Sonja; Postma, Alex V; Bhuiyan, Zahurul A; Bakkers, Jeroen

2016-02-01

Establishing correct left-right asymmetry during embryonic development is crucial for proper asymmetric positioning of the organs. Congenital heart defects, such as dextrocardia, transposition of the arteries, and inflow or outflow tract malformations, comprise some of the most common birth defects and may be attributed to incorrect establishment of body laterality. Here, we identify new patients with dextrocardia who have mutations in CFAP53, a coiled-coil domain containing protein. To elucidate the mechanism by which CFAP53 regulates embryonic asymmetry, we used genome editing to generate cfap53 zebrafish mutants. Zebrafish cfap53 mutants have specific defects in organ laterality and randomization of asymmetric gene expression. We show that cfap53 is required for cilia rotation specifically in Kupffer's vesicle, the zebrafish laterality organ, providing a mechanism by which patients with CFAP53 mutations develop dextrocardia and heterotaxy, and confirming previous evidence that left-right asymmetry in humans is regulated through cilia-driven fluid flow in a laterality organ. © 2015 WILEY PERIODICALS, INC.

Intracardiac echocardiography to diagnose pannus formation after aortic valve replacement.

PubMed

Yamamoto, Yoshiya; Ohara, Takahiro; Funada, Akira; Takahama, Hiroyuki; Amaki, Makoto; Hasegawa, Takuya; Sugano, Yasuo; Kanzaki, Hideaki; Anzai, Toshihisa

2016-03-01

A 66-year-old female, under regular follow-up for 20 years after aortic valve replacement (19-mm Carbomedics), presented dyspnea on effort and hypotension during hemodialysis. A transthoracic echocardiogram showed elevation of transvalvular velocity up to 4 m/s, but the structure around the aortic prosthesis was difficult to observe due to artifacts. Fluoroscopy revealed normal motion of the leaflets of the mechanical valve. Intracardiac echocardiography (ICE) revealed a pannus-like structure in the left ventricular outflow tract. Transesophageal echocardiogram also revealed this structure. ICE can visualize structural abnormalities around a prosthetic valve after cardiac surgery even in patients in whom conventional imaging modalities failed.

A New Look at America's Refugee Policy.

ERIC Educational Resources Information Center

Suhrke, Astri

1980-01-01

Implications of recent developments in refugee outflow from Indochina demand a reexamination of American policy on Indochinese refugees. These developments include patterns of increased Vietnamese and Laotian refugee outflow despite Vietnam's disapproval of departure and Laos' liberalizing economic policies; the greater influx of "low…

Unconventional Aqueous Humor Outflow: A Review

PubMed Central

Johnson, Mark; McLaren, Jay W.; Overby, Darryl R.

2016-01-01

Aqueous humor flows out of the eye primarily through the conventional outflow pathway that includes the trabecular meshwork and Schlemm's canal. However, a fraction of aqueous humor passes through an alternative or ‘unconventional’ route that includes the ciliary muscle, supraciliary and suprachoroidal spaces. From there, unconventional outflow may drain through two pathways: a uveoscleral pathway where aqueous drains across the sclera to be resorbed by orbital vessels, and a uveovortex pathway where aqueous humor enters the choroid to drain through the vortex veins. We review the anatomy, physiology and pharmacology of these pathways. We also discuss methods to determine unconventional outflow rate, including direct techniques that use radioactive or fluorescent tracers recovered from tissues in the unconventional pathway and indirect methods that estimate unconventional outflow based on total outflow over a range of pressures. Indirect methods are subject to a number of assumptions and generally give poor agreement with tracer measurements. We review the variety of animal models that have been used to study conventional and unconventional outflow. The mouse appears to be a promising model because it captures several aspects of conventional and unconventional outflow dynamics common to humans, although questions remain regarding the magnitude of unconventional outflow in mice. Finally, we review future directions. There is a clear need to develop improved methods for measuring unconventional outflow in both animals and humans. PMID:26850315

Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sun, Fei, E-mail: feisun@ccmijesususon.com; Crisóstomo, Verónica, E-mail: crisosto@ccmijesususon.com; Báez-Díaz, Claudia, E-mail: cbaez@ccmijesususon.com

Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance.more » BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.« less

In vivo quantification of intraventricular flow during left ventricular assist device support

NASA Astrophysics Data System (ADS)

Vu, Vi; Wong, Kin; Del Alamo, Juan; Aguilo, Pablo M. L.; May-Newman, Karen; Department of Bioengineering, San Diego State University Collaboration; Department of Mechanical; Aerospace Engineering, University of California San Diego Collaboration; Mechanical Assist Device Program, Sharp Memorial Hospital Collaboration

2014-11-01

Left ventricular assist devices (LVADs) are mechanical pumps that are surgically connected to the left ventricle (LV) and aorta to increase aortic flow and end-organ perfusion. Clinical studies have demonstrated that LVADs improve patient health and quality of life and significantly reduce the mortality of cardiac failure. However, In the presence of left ventricular assisted devices (LVAD), abnormal flow patterns and stagnation regions are often linked to thrombosis. The aim of our study is to evaluate the flow patterns in the left ventricle of the LVAD-assisted heart, with a focus on alterations in vortex development and blood stasis. To this aim, we applied color Doppler echocardiography to measure 2D, time resolved velocity fields in patients before and after implantation of LVADs. In agreement with our previous in vitro studies (Wong et al., Journal of Biomechanics 47, 2014), LVAD implantation resulted in decreased flow velocities and increased blood residence time near the outflow tract. The variation of residence time changes with LVAD operational speed was characterized for each patient.

Origins and consequences of congenital heart defects affecting the right ventricle.

PubMed

Woudstra, Odilia I; Ahuja, Suchit; Bokma, Jouke P; Bouma, Berto J; Mulder, Barbara J M; Christoffels, Vincent M

2017-10-01

Congenital heart disease is a major health issue, accounting for a third of all congenital defects. Improved early surgical management has led to a growing population of adults with congenital heart disease, including patients with defects affecting the right ventricle, which are often classified as severe. Defects affecting the right ventricle often cause right ventricular volume or pressure overload and affected patients are at high risk for complications such as heart failure and sudden death. Recent insights into the developmental mechanisms and distinct developmental origins of the left ventricle, right ventricle, and the outflow tract have shed light on the common features and distinct problems arising in specific defects. Here, we provide a comprehensive overview of the current knowledge on the development into the normal and congenitally malformed right heart and the clinical consequences of several congenital heart defects affecting the right ventricle. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Neonatal aortic stenosis.

PubMed

Drury, Nigel E; Veldtman, Gruschen R; Benson, Lee N

2005-09-01

Neonatal aortic stenosis is a complex and heterogeneous condition, defined as left ventricular outflow tract obstruction at valvular level, presenting and often requiring treatment in the first month of life. Initial presentation may be catastrophic, necessitating hemodynamic, respiratory and metabolic resuscitation. Subsequent management is focused on maintaining systemic blood flow, either via a univentricular Norwood palliation or a biventricular route, in which the effective aortic valve area is increased by balloon dilation or surgical valvotomy. In infants with aortic annular hypoplasia but adequately sized left ventricle, the Ross-Konno procedure is also an attractive option. Outcomes after biventricular management have improved in recent years as a consequence of better patient selection, perioperative management and advances in catheter technology. Exciting new developments are likely to significantly modify the natural history of this disorder, including fetal intervention for the salvage of the hypoplastic left ventricle; 3D echocardiography providing better definition of valve morphology and aiding patient selection for a surgical or catheter-based intervention; and new transcutaneous approaches, such as duel beam echo, to perforate the valve.

Embryological origin of the endocardium and derived valve progenitor cells: from developmental biology to stem cell-based valve repair.

PubMed

Pucéat, Michel

2013-04-01

The cardiac valves are targets of both congenital and acquired diseases. The formation of valves during embryogenesis (i.e., valvulogenesis) originates from endocardial cells lining the myocardium. These cells undergo an endothelial-mesenchymal transition, proliferate and migrate within an extracellular matrix. This leads to the formation of bilateral cardiac cushions in both the atrioventricular canal and the outflow tract. The embryonic origin of both the endocardium and prospective valve cells is still elusive. Endocardial and myocardial lineages are segregated early during embryogenesis and such a cell fate decision can be recapitulated in vitro by embryonic stem cells (ESC). Besides genetically modified mice and ex vivo heart explants, ESCs provide a cellular model to study the early steps of valve development and might constitute a human therapeutic cell source for decellularized tissue-engineered valves. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Cardiac Pathways of Differentiation, Metabolism and Contraction. Copyright © 2012 Elsevier B.V. All rights reserved.

Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications.

PubMed

Sun, Fei; Crisóstomo, Verónica; Báez-Díaz, Claudia; Sánchez, Francisco M

2016-01-01

Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.

Meis2 is essential for cranial and cardiac neural crest development.

PubMed

Machon, Ondrej; Masek, Jan; Machonova, Olga; Krauss, Stefan; Kozmik, Zbynek

2015-11-06

TALE-class homeodomain transcription factors Meis and Pbx play important roles in formation of the embryonic brain, eye, heart, cartilage or hematopoiesis. Loss-of-function studies of Pbx1, 2 and 3 and Meis1 documented specific functions in embryogenesis, however, functional studies of Meis2 in mouse are still missing. We have generated a conditional allele of Meis2 in mice and shown that systemic inactivation of the Meis2 gene results in lethality by the embryonic day 14 that is accompanied with hemorrhaging. We show that neural crest cells express Meis2 and Meis2-defficient embryos display defects in tissues that are derived from the neural crest, such as an abnormal heart outflow tract with the persistent truncus arteriosus and abnormal cranial nerves. The importance of Meis2 for neural crest cells is further confirmed by means of conditional inactivation of Meis2 using crest-specific AP2α-IRES-Cre mouse. Conditional mutants display perturbed development of the craniofacial skeleton with severe anomalies in cranial bones and cartilages, heart and cranial nerve abnormalities. Meis2-null mice are embryonic lethal. Our results reveal a critical role of Meis2 during cranial and cardiac neural crest cells development in mouse.

Hes1 expression is reduced in Tbx1 null cells and is required for the development of structures affected in 22q11 deletion syndrome

PubMed Central

van Bueren, Kelly Lammerts; Papangeli, Irinna; Rochais, Francesca; Pearce, Kerra; Roberts, Catherine; Calmont, Amelie; Szumska, Dorota; Kelly, Robert G.; Bhattacharya, Shoumo; Scambler, Peter J.

2010-01-01

22q11 deletion syndrome (22q11DS) is characterised by aberrant development of the pharyngeal apparatus and the heart with haploinsufficiency of the transcription factor TBX1 being considered the major underlying cause of the disease. Tbx1 mutations in mouse phenocopy the disorder. In order to identify the transcriptional dysregulation in Tbx1-expressing lineages we optimised fluorescent-activated cell sorting of β-galactosidase expressing cells (FACS-Gal) to compare the expression profile of Df1/Tbx1lacZ (effectively Tbx1 null) and Tbx1 heterozygous cells isolated from mouse embryos. Hes1, a major effector of Notch signalling, was identified as downregulated in Tbx1−/− mutants. Hes1 mutant mice exhibited a partially penetrant range of 22q11DS-like defects including pharyngeal arch artery (PAA), outflow tract, craniofacial and thymic abnormalities. Similar to Tbx1 mice, conditional mutagenesis revealed that Hes1 expression in embryonic pharyngeal ectoderm contributes to thymus and pharyngeal arch artery development. These results suggest that Hes1 acts downstream of Tbx1 in the morphogenesis of pharyngeal-derived structures. PMID:20122914

Anatomy of the Vestibulo-automatic Outflow to the Gut

NASA Technical Reports Server (NTRS)

Torigoe, Y.

1985-01-01

Motion sickness can be induced by vestibular effects on the sympathetic portion of the autonomic nervous system. However, the pathways linking the vestibular and autonomic pathways are unknown. As a first step in this analysis, the locations of preganglionic sympathetic neurons (PSN) and dorsal root afferent ganglionic neurons (DRG) which supply sympathetic innervation to major portions of the gastrointestinal tract in rabbits were identified. The objective of a second series of experiments is to determine which of the brainstem nuclei project to the autonomic regions of the spinal cord that control gastrointestinal motility. To achieve this goal, a trans-synaptic retrograde tracer (3H-tetanus toxoid) is applied to the greater splanchnic nerve. This method allows the labeling of neurons within the brainstem that project only to the preganglionic synpathetic neurons. One structure that has been strongly implicated in mediating vestibulo-autonomic control is the cerebellum (i.e., nodulus and uvula). The outflow of these lobules to the autonomic regions of the brainstem is mediated by the fastigial nucleus. To determine the precise projections of the fastigial nucleus to the brainstem nuclei involved in emesis, anterograde tracer (3H-leucine) was injected into the fastigial nucleus in a third series of experiments.

Diagnostic imaging of the nasolacrimal drainage system. Part I. Radiological anatomy of lacrimal pathways. Physiology of tear secretion and tear outflow.

PubMed

Maliborski, Artur; Różycki, Radosław

2014-04-17

Excessive watering of the eye is a common condition in ophthalmological practice. It may be the result of excessive production of tear fluid or obstruction and insufficiency of efferent tear pathways. The differentiation between obstruction and insufficiency of the lacrimal pathways is still clinically questionable. In the diagnostic process it is necessary to perform clinical tests and additional diagnostic imaging is often needed. Dacryocystography, with or without the extension of the dynamic phase or subtraction option, still remains the criterion standard for diagnostic imaging of the lacrimal obstruction. It may help to clarify the cause and exact place of the obstruction and provide information for further management, especially surgical treatment. Increasingly, new techniques are used in diagnostic imaging of the lacrimal tract, such as computed tomography, magnetic resonance, and isotopic methods. Adequate knowledge of the anatomy and physiology of the lacrimal system and the secretion and outflow of tears is the basis for proper diagnostic imaging. The purpose of this paper is to present the exact anatomy of the lacrimal system, with particular emphasis on the radiological anatomy and the current state of knowledge about the physiology of tear secretion and drainage.

Budd-Chiari syndrome and liver transplantation

PubMed Central

Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Kokudo, Norihiro

2015-01-01

Summary Budd-Chiari syndrome involves obstruction of hepatic venous outflow tracts at various levels from small hepatic veins to the inferior vena cava and is the result of thrombosis or its fibrous sequelae. There is a conspicuous difference in its etiology in the West and the East. Myeloproliferative disease predominates in the West and obstruction of the vena cava predominates in the East. The clinical presentation and clinical manifestations are so varied that it should be suspected in any patient with acute or chronic liver dysfunction. It should be treated with step-wise management. First-line therapy should be anticoagulation with medical treatment of the underlying illness, and interventional revascularization and TIPS are indicated in the event of a lack of response to medical therapy. Liver transplantation may be indicated as a rescue treatment or for fulminant cases with promising results. This step-by-step strategy has achieved a 5-year transplant-free survival rate of 70% and a 5-year overall survival rate of 90%. Living donor liver transplantation can also be used for patients with Budd-Chiari syndrome if deceased donor livers are scarce, but it requires a difficult procedure particularly with regard to venous outflow reconstruction. PMID:25674385

Mef2c Regulates Transcription of the Extracellular Matrix Protein Cartilage Link Protein 1 in the Developing Murine Heart

PubMed Central

Phelps, Aimee L.; Ghatnekar, Angela V.; Barth, Jeremy L.; Norris, Russell A.; Wessels, Andy

2013-01-01

Cartilage Link Protein 1 (Crtl1) is an extracellular matrix (ECM) protein that stabilizes the interaction between hyaluronan and versican and is expressed in endocardial and endocardially-derived cells in the developing heart, including cells in the atrioventricular (AV) and outflow tract (OFT) cushions. Previous investigations into the transcriptional regulation of the Crtl1 gene have shown that Sox9 regulates Crtl1 expression in both cartilage and the AV valves. The cardiac transcription factor Mef2c is involved in the regulation of gene expression in cardiac and skeletal muscle cell lineages. In this study we have investigated the potential role of Mef2c in the regulation of ECM production in the endocardial and mesenchymal cell lineages of the developing heart. We demonstrate that the Crtl1 5′ flanking region contains two highly conserved Mef2 binding sites and that Mef2c is able to bind to these sites in vivo during cardiovascular development. Additionally, we show that Crtl1 transcription is dependent on Mef2c expression in fetal mitral valve interstitial cells (VICs). Combined, these findings highlight a new role for Mef2c in cardiac development and the regulation of cardiac extracellular matrix protein expression. PMID:23468913

Effect of amiodarone-induced hyperthyroidism on left ventricular outflow obstruction after septal myectomy for hypertrophic cardiomyopathy.

PubMed

Pokorney, Sean D; Stone, Neil J; Passman, Rod; Oyer, David; Rigolin, Vera H; Bonow, Robert O

2010-12-01

Patients with obstructive hypertrophic cardiomyopathy who undergo septal myectomy are at risk for developing postoperative atrial fibrillation. Amiodarone is effective in treating this arrhythmia but is associated with multiple adverse effects, often with delayed onset. A novel case is described of a patient who developed type 2 amiodarone-induced hyperthyroidism that presented as recurrence of outflow obstruction after septal myectomy. The patient's symptoms and echocardiographic findings of outflow obstruction resolved substantially with the treatment of the amiodarone-induced hyperthyroidism. Amiodarone-induced hyperthyroidism of delayed onset can be a subtle diagnosis, requiring a high index of suspicion. In conclusion, recognition of this diagnosis in patients with recurrence of outflow obstruction by symptoms and cardiac imaging after septal myectomy may avoid unnecessary repeat surgical intervention. Copyright © 2010 Elsevier Inc. All rights reserved.

Semi-automation of Doppler Spectrum Image Analysis for Grading Aortic Valve Stenosis Severity.

PubMed

Niakšu, O; Balčiunaitė, G; Kizlaitis, R J; Treigys, P

2016-01-01

Doppler echocardiography analysis has become a golden standard in the modern diagnosis of heart diseases. In this paper, we propose a set of techniques for semi-automated parameter extraction for aortic valve stenosis severity grading. The main objectives of the study is to create echocardiography image processing techniques, which minimize manual image processing work of clinicians and leads to reduced human error rates. Aortic valve and left ventricle output tract spectrogram images have been processed and analyzed. A novel method was developed to trace systoles and to extract diagnostic relevant features. The results of the introduced method have been compared to the findings of the participating cardiologists. The experimental results showed the accuracy of the proposed method is comparable to the manual measurement performed by medical professionals. Linear regression analysis of the calculated parameters and the measurements manually obtained by the cardiologists resulted in the strongly correlated values: peak systolic velocity's and mean pressure gradient's R2 both equal to 0.99, their means' differences equal to 0.02 m/s and 4.09 mmHg, respectively, and aortic valve area's R2 of 0.89 with the two methods means' difference of 0.19 mm. The introduced Doppler echocardiography images processing method can be used as a computer-aided assistance in the aortic valve stenosis diagnostics. In our future work, we intend to improve precision of left ventricular outflow tract spectrogram measurements and apply data mining methods to propose a clinical decision support system for diagnosing aortic valve stenosis.

Diabetes and apoptosis: neural crest cells and neural tube.

PubMed

Chappell, James H; Wang, Xiao Dan; Loeken, Mary R

2009-12-01

Birth defects resulting from diabetic pregnancy are associated with apoptosis of a critical mass of progenitor cells early during the formation of the affected organ(s). Insufficient expression of genes that regulate viability of the progenitor cells is responsible for the apoptosis. In particular, maternal diabetes inhibits expression of a gene, Pax3, that encodes a transcription factor which is expressed in neural crest and neuroepithelial cells. As a result of insufficient Pax3, cardiac neural crest and neuroepithelial cells undergo apoptosis by a process dependent on the p53 tumor suppressor protein. This, then provides a cellular explanation for the cardiac outflow tract and neural tube and defects induced by diabetic pregnancy.

Diabetes and apoptosis: neural crest cells and neural tube

PubMed Central

Chappell, James H.; Dan Wang, Xiao

2016-01-01

Birth defects resulting from diabetic pregnancy are associated with apoptosis of a critical mass of progenitor cells early during the formation of the affected organ(s). Insufficient expression of genes that regulate viability of the progenitor cells is responsible for the apoptosis. In particular, maternal diabetes inhibits expression of a gene, Pax3, that encodes a transcription factor which is expressed in neural crest and neuroepithelial cells. As a result of insufficient Pax3, cardiac neural crest and neuroepithelial cells undergo apoptosis by a process dependent on the p53 tumor suppressor protein. This, then provides a cellular explanation for the cardiac outflow tract and neural tube and defects induced by diabetic pregnancy. PMID:19333760

Apico-brachiocephalic artery bypass for aortic stenosis with porcelain aorta.

PubMed

Shimizu, Shuji; Nakai, Mikizo; Itoh, Atsushi; Yoshizumi, Ko; Ochi, Yoshiki; Okada, Masahiro; Sano, Shunji

2010-02-01

Apicoaortic bypass for left ventricular outflow tract obstruction has been performed with acceptable mid-term mortality. However, sometimes it is difficult to anastomose the distal end of the conduit to the calcified descending aorta in patients with a porcelain aorta. We report an aortic non-touch modification of the apicoaortic bypass in an 80-year-old woman with valvular aortic stenosis and a porcelain aorta extending from the ascending to abdominal aorta. We performed apico-brachiocephalic artery bypass under circulatory arrest with deep hypothermia. This procedure may become a useful surgical option for patients with a severe porcelain aorta. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Wolfram Syndrome presenting with optic atrophy and diabetes mellitus: two case reports

PubMed Central

2009-01-01

Wolfram syndrome is the constellation of juvenile onset diabetes mellitus and optic atrophy, known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness). Patients demonstrate diabetes mellitus followed by optic atrophy in the first decade, diabetes insipidus and sensorineural deafness in the second decade, dilated renal outflow tracts early in the third decade, and multiple neurological abnormalities early in the fourth decade. This study reports two siblings with late diagnosed wolfram syndrome with diabetes insipidus, diabetes mellitus, optic atrophy, deafness and severe urological abnormalities. In conclusion, cases having early onset insulin-dependent diabetes mellitus and optic atrophy together need to be evaluated with respect to Wolfram. PMID:20062605

Isolated supravalvular pulmonary stenosis in a 25-day-old newborn infant: an occasional and early diagnosis.

PubMed

Patanè, Salvatore; Marte, Filippo; Di Bella, Gianluca; Di Tommaso, Eleonora; Pagano, Giuseppina Tindara; Coglitore, Sebastiano

2009-04-03

Pulmonary stenosis comprises variable pathologic features from the right ventricular outflow tract to the peripheral pulmonary arteries. Most frequently, the obstruction occurs at the level of the pulmonary valve; however, it occurs less frequently at the infindibular level. It can occur as part of more congenital cardiac malformations such as tetralogy of Fallot, complete transposition of great arteries, or atrial septal defect. Proximal pulmonary artery stenosis has also been reported as an acquired lesion in infants treated for congenital heart disease. Primary isolated supravalvular pulmonary stenosis is less common. We present a case of primary isolated pulmonary artery stenosis in an asymptomatic 25-day-old newborn infant.

Durability of hand-sewn valves in the right ventricular outlet.

PubMed

Nunn, Graham R; Bennetts, Jayme; Onikul, Ella

2008-08-01

The objective was to compare the medium- and long-term outcomes for pericardial monocusp valves, polytetrafluoroethylene (Gore-Tex, WL Gore and Associates Inc, Flagstaff, Ariz) 0.1-mm monocusp valves, and bileaflet 0.l-mm polytetrafluoroethylene valves and their efficiency in the right ventricular outlet. We reviewed all hand-sewn right ventricular outlet valves created by the author (Graham R. Nunn) in the setting of repaired tetralogy of Fallot or equivalent right ventricular outlet pathology when the native pulmonary valve could not be preserved. The valves were assessed by serial transthoracic echocardiography and more recently by magnetic resonance imaging angiography for late valve function. The bileaflet polytetrafluoroethylene valves were constructed in a standardized fashion from a semicircle of 0.1-mm polytetrafluoroethylene (the radius of which equaled the length of the outflow tract incision) that gave a lengthened free edge to the leaflets, central fixation of the free edge posteriorly just proximal to the branch pulmonary arteries, and generous augmentation of the outflow tract with polytetrafluoroethylene patch-plasty. The bileaflet configuration shortens the closing time against the posterior wall, and the leaflets are forced to maintain their configuration without prolapse into the right ventricular outlet. The valve can be generously oversized in young children to try to avoid the need for replacement. A total of 54 patients met the selection criteria--22 patients received fresh autologous pericardial monocusps, 7 patients received polytetrafluoroethylene (0.1-mm) monocusps, and 25 patients received bileaflet polytetrafluoroethylene (0.1-mm) outlet valves. The pericardial valves have the longest follow-up, and all valves developed free pulmonary incompetence. Polytetrafluoroethylene monocusps had reliable competence early after surgery but progressed to pulmonary incompetence. The bileaflet polytetrafluoroethylene (0.1-mm) valves have remained competent with regurgitant fractions of only 5% to 30% (magnetic resonance imaging angiography), and this has remained stable with time. The maximum follow-up for these valves is 5 years. No stenosis or peripheral emboli have been recognized, and no valves have been replaced to date. Hand-sewn bileaflet polytetrafluoroethylene valves in the right ventricular outlet can reliably provide competence and maintain function in the medium term. Their shape and size allow placement in young children with a reasonable expectation that they will remain competent with growth of the native annulus and not require replacement. Their durability is superior to the pericardial and polytetrafluoroethylene monocusp valves in this series.

Ultrasonography and renography to visualize upper urinary tract in children with meningomyelocele - a prospective study.

PubMed

Abrahamsson, Kate; Stokland, Eira; Sixt, Rune; Jodal, Ulf

2012-04-01

Ultrasonography (US) is commonly used to visualize the upper urinary tract in children and adolescents with meningomyelocele (MMC). The aim of this investigation was to prospectively evaluate US in those with spinal angulation or obesity and compare it to the corresponding results obtained by mercaptoacetyltriglycine renography. Twenty-five children and adolescents with MMC and pronounced angulation of the spine or obesity, were prospectively investigated with both US and renography during the period 2006 to 2008. In 13 (52%) patients the kidneys could not be fully evaluated; in 4 (16%) neither renal size nor pelvic dilation, in 12 (48%) renal length and in 5 (20%) dilation was not accessible. In 23 individuals where dilatation could be evaluated uni- or bilaterally, US was compared to OEE% (%outflow excretion efficiency) at renography. In 1 of these individuals there was normal OEE% while slight dilatation on US was noticed. In 2/15 individuals, split function at renography did not correlate with renal length on US. Severe spinal angulation and obesity in individuals with MMC reduced the possibility to evaluate the urinary tract by US. However, it seems that renography could be a reliable alternative to evaluate renal condition in those patients where US is insufficient. Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

An In Vitro Perfusion System to Enhance Outflow Studies in Mouse Eyes

PubMed Central

Kizhatil, Krishnakumar; Chlebowski, Arthur; Tolman, Nicholas G.; Freeburg, Nelson F.; Ryan, Margaret M.; Shaw, Nicholas N.; Kokini, Alexander D. M.; Marchant, Jeffrey K.; John, Simon W. M.

2016-01-01

Purpose The molecular mechanisms controlling aqueous humor (AQH) outflow and IOP need much further definition. The mouse is a powerful system for characterizing the mechanistic basis of AQH outflow. To enhance outflow studies in mice, we developed a perfusion system that is based on human anterior chamber perfusion culture systems. Our mouse system permits previously impractical experiments. Methods We engineered a computer-controlled, pump-based perfusion system with a platform for mounting whole dissected mouse eyes (minus lens and iris, ∼45% of drainage tissue is perfused). We tested the system's ability to monitor outflow and tested the effects of the outflow-elevating drug, Y27632, a rho-associated protein kinase (ROCK) inhibitor. Finally, we tested the system's ability to detect genetically determined decreases in outflow by determining if deficiency of the candidate genes Nos3 and Cav1 alter outflow. Results Using our system, the outflow facility (C) of C57BL/6J mouse eyes was found to range between 7.7 and 10.4 nl/minutes/mm Hg (corrected for whole eye). Our system readily detected a 74.4% Y27632-induced increase in C. The NOS3 inhibitor L-NG-nitroarginine methyl ester (L-NAME) and a Nos3 null mutation reduced C by 28.3% and 35.8%, respectively. Similarly, in Cav1 null eyes C was reduced by 47.8%. Conclusions We engineered a unique perfusion system that can accurately measure changes in C. We then used the system to show that NOS3 and CAV1 are key components of mechanism(s) controlling outflow. PMID:27701632

Interactions between gravity waves and cold air outflows in a stably stratified uniform flow

NASA Technical Reports Server (NTRS)

Lin, Yuh-Lang; Wang, Ting-An; Weglarz, Ronald P.

1993-01-01

Interactions between gravity waves and cold air outflows in a stably stratified uniform flow forced by various combinations of prescribed heat sinks and sources are studied using a hydrostatic two-dimensional nonlinear numerical model. The formation time for the development of a stagnation point or reversed flow at the surface is not always directly proportional to the Froude number when wave reflections exist from upper levels. A density current is able to form by the wave-otuflow interaction, even though the Froude number is greater than a critical value. This is the result of the wave-outflow interaction shifting the flow response to a different location in the characteristic parameter space. A density current is able to form or be destroyed due to the wave-outflow interaction between a traveling gravity wave and cold air outflow. This is proved by performing experiments with a steady-state heat sink and an additional transient heat source. In a quiescent fluid, a region of cold air, convergence, and upward motion is formed after the collision between two outflows produced by two prescribed heat sinks. After the collision, the individual cold air outflows lose their own identity and merge into a single, stationary, cold air outflow region. Gravity waves tend to suppress this new stationary cold air outflow after the collision. The region of upward motion associated with the collision is confined to a very shallow layer. In a moving airstream, a density current produced by a heat sink may be suppressed or enhanced nonlinearly by an adjacent heat sink due to the wave-outflow interaction.

Structure and Evolution of an Undular Bore on the High Plains and Its Effects on Migrating Birds.

NASA Astrophysics Data System (ADS)

Locatelli, John D.; Stoelinga, Mark T.; Hobbs, Peter V.; Johnson, Jim

1998-06-01

On 18 September 1992 a series of thunderstorms in Nebraska and eastern Colorado, which formed south of a synoptic-scale cold front and north of a Rocky Mountain lee trough, produced a cold outflow gust front that moved southeastward into Kansas, southeastern Colorado, and Oklahoma around sunset. When this cold outflow reached the vicinity of the lee trough, an undular bore developed on a nocturnally produced stable layer and moved through the range of the Dodge City WSR-88D Doppler radar. The radar data revealed that the undular bore, in the leading portion of a region of northwesterly winds about 45 km wide by 4 km high directly abutting the cold outflow, developed five undulations over the course of 3 h. Contrary to laboratory tank experiments, observations indicated that the solitary waves that composed the bore probably did not form from the enveloping of the head of the cold air outflow by the stable layer and the breaking off of the head of the cold air outflow. The synoptic-scale cold front subsequently intruded on the surface layer of air produced by the cold outflow, but there was no evidence for the formation of another bore.Profiler winds, in the region affected by the cold air outflow and the undular bore, contained signals from nocturnally, southward-migrating birds (most likely waterfowl) that took off in nonfavorable southerly winds and remained aloft for several hours longer than usual, thereby staying ahead of the turbulence associated with the undular bore.

Ultra-fast outflows (aka UFOs) from AGNs and QSOs

NASA Astrophysics Data System (ADS)

Cappi, M.; Tombesi, F.; Giustini, M.

During the last decade, strong observational evidence has been accumulated for the existence of massive, high velocity winds/outflows (aka Ultra Fast Outflows, UFOs) in nearby AGNs and in more distant quasars. Here we briefly review some of the most recent developments in this field and discuss the relevance of UFOs for both understanding the physics of accretion disk winds in AGNs, and for quantifying the global amount of AGN feedback on the surrounding medium.

[Premature outflow tract ventricular contraction combined with complete bundle branch block: the characteristic electrocardiographic and ablation target potential features].

PubMed

Di, C Y; Wan, Z; Li, K; Ding, Y S; Lin, W H

2017-12-01

Objective: To explore the characteristics of electrocardiogram(ECG) and target potential features of premature ventricular contraction (PVC) in patients with complete left/right bundle branch block (CL/RBBB) and compare with those without CL/RBBB. Methods: A retrospective analysis was done in 8 outflow tract PVC patients with CL/RBBB, who successfully underwent radiofrequency ablation from August 2009 to June 2017. According to the bundle branch block chamber, patients were divided into the complete right bundle branch block (CRBBB) group ( n= 4) and the complete left bundle branch block (CLBBB) group ( n= 4). The control group were those who successfully underwent ablation at the same position as the above two groups but without CL/RBBB. The characteristics of ECG and target potential features were compared among groups. Results: One case in the CRBBB group was successfully ablated in the great cardiac vein with precordial R/S>1 transition at V(1) and one case in the CLBBB group was successfully ablated in the right coronary cusp with precordial R/S>1 transition at V(2), while other 6 cases were all with precordial R/S>1 transition at lead V(4). Precordial R/S>1 transition was not later than sinus rhythm (SR) in the CLBBB group. No statistical difference was found in the QRS complex duration between SR and PVC in the CL/RBBB patients [(134.38±23.80)ms vs (156.75±25.93)ms, P> 0.05], while statistical difference was shown in the control group [(92.63±5.76)ms vs (140.25±15.97)ms, P< 0.05]. Conclusion: Bundle branch block can lead to misjudgment of PVC origin with CL/RBBB during sinus rhythm, thus the origin chamber of the PVC should be determined according to the mapping and ablation result.

Report of the Dutch experience with the Ross procedure in 343 patients.

PubMed

Takkenberg, J J M; Dossche, K M E; Hazekamp, M G; Nijveld, A; Jansen, E W L; Waterbolk, T W; Bogers, A J J C

2002-07-01

Limited information is available on outcome after autograft aortic valve replacement, in particular with respect to the durability of the autograft and of the allograft used to reconstruct the right ventricular outflow tract. A retrospective follow-up study of all patients who underwent a Ross procedure in the Netherlands since 1988 was done to obtain an overview of the Dutch experience with this procedure. From 1988 to January 2000, 348 Ross procedures were performed in nine centers in the Netherlands. Pre-operative, peri-operative and follow-up data from 343 patients in seven centers (99% of all Dutch autograft patients) were collected and analyzed. Mean patient age was 26 years (SD 14, range 0-58) and male/female ratio was 2.1. Bicuspid valve or other congenital heart valve disease was the most common indication for operation. The root replacement technique was used in 95% of patients and concomitant procedures were done in 12%. Hospital mortality was 2.6% (N=9). Mean follow-up was 4 years (median 3.8, SD 2.8, range 0-12.5). Overall cumulative survival was 96% at 1 year (95% confidence interval (CI) 94-98%) and 94% at 5 and 7 post-operative years, respectively (95% CI 91-97%). At last follow-up, 87% of the surviving patients was in New York Heart Association (NYHA) class I. Independent predictors of overall mortality were pre-operative NYHA class IV/V and longer perfusion time. Autograft reoperation had to be performed in 14 patients and reintervention on the pulmonary allograft in 10 patients. Freedom from any valve-related reintervention was 88% at 7 years (95% CI 81-94%). The Dutch experience with the Ross procedure is favorable, with low operative mortality and good mid-term results. Although both the autograft in aortic position and the allograft in the right ventricular outflow tract have a limited durability, this has not yet resulted in considerable reoperation rates and associated morbidity and mortality.

Functional characteristics of left ventricular synchronization via right ventricular outflow-tract pacing detected by two-dimensional strain echocardiography.

PubMed

Hirayama, Yasutaka; Kawamura, Yuichiro; Sato, Nobuyuki; Saito, Tatsuya; Tanaka, Hideichi; Saijo, Yasuaki; Kikuchi, Kenjiro; Ohori, Katsumi; Hasebe, Naoyuki

2017-02-01

Recently, due to the detrimental effects on the ventricular function associated with right ventricular apical (RVA) pacing, right ventricular septal (RVS) pacing has become the preferred pacing method. However, the term RVS pacing refers to both right ventricular outflow-tract (RVOT) and mid-septal (RVMS) pacing, leading to a misinterpretation of the results of clinical studies. The purpose of this study, therefore, was to elucidate the functional differences of RVA, RVOT, and RVMS pacing in patients with atrioventricular block. We compared the QRS duration, global longitudinal strain (GLS), and left ventricular (LV) synchronization parameters at the three pacing sites in 47 patients. The peak systolic strain (PSS) time delay between the earliest and latest segments among the 18 LV segments and standard deviation (SD) of the time to the PSS were also calculated for the 18 LV segments at each pacing site using two-dimensional (2D) strain echocardiography. RVMS pacing was associated with a significantly shorter QRS duration compared with RVA and RVOT pacing (154.4±21.4 vs 186.5±19.9 and 171.1±21.5 ms, P <0.001). In contrast, RVOT pacing revealed a greater GLS (-14.69±4.92 vs -13.12±4.76 and -13.51±4.81%, P <0.001), shorter PSS time delay between the earliest and latest segments (236.0±87.9 vs 271.3±102.9 and 281.9±126.6%, P =0.007), and shorter SD of the time to the PSS (70.8±23.8 vs 82.7±30.8 and 81.5±33.7 ms, P =0.002) compared with RVA and RVMS pacing. These results suggest that the functional characteristics of RVOT pacing may be a more optimal pacing site than RVMS, regardless of the pacing QRS duration, in patients with atrioventricular conduction disorders.

Adverse cardiac events in children with Williams syndrome undergoing cardiovascular surgery: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

PubMed

Hornik, Christoph P; Collins, Ronnie Thomas; Jaquiss, Robert D B; Jacobs, Jeffrey P; Jacobs, Marshall L; Pasquali, Sara K; Wallace, Amelia S; Hill, Kevin D

2015-06-01

Patients with Williams syndrome (WS) undergoing cardiac surgery are at risk for major adverse cardiac events (MACE). Prevalence and risk factors for such events have not been well described. We sought to define frequency and risk of MACE in patients with WS using a multicenter clinical registry. We identified cardiac operations performed in patients with WS using the Society of Thoracic Surgeons Congenital Heart Surgery Database (2000-2012). Operations were divided into 4 groups: isolated supravalvular aortic stenosis, complex left ventricular outflow tract (LVOT), isolated right ventricular outflow tract (RVOT), and combined LVOT/RVOT procedures. The proportion of patients with MACE (in-hospital mortality, cardiac arrest, or postoperative mechanical circulatory support) was described and the association with preoperative factors was examined. Of 447 index operations (87 centers), median (interquartile range) age and weight at surgery were 2.4 years (0.6-7.4 years) and 10.6 kg (6.5-21.5 kg), respectively. Mortality occurred in 20 patients (5%). MACE occurred in 41 patients (9%), most commonly after combined LVOT/RVOT (18 out of 87; 21%) and complex LVOT (12 out of 131; 9%) procedures, but not after isolated RVOT procedures. Odds of MACE decreased with age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99), weight (OR, 0.97; 95% CI, 0.93-0.99), but increased in the presence of any preoperative risk factor (OR, 2.08; 95% CI, 1.06-4.00), and in procedures involving coronary artery repair (OR, 5.37; 95% CI, 2.05-14.06). In this multicenter analysis, MACE occurred in 9% of patients with WS undergoing cardiac surgery. Demographic and operative characteristics were associated with risk. Further study is needed to elucidate mechanisms of MACE in this high-risk population. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Right Ventricular Strain and Dyssynchrony Assessment in Arrhythmogenic Right Ventricular Cardiomyopathy: Cardiac Magnetic Resonance Feature-Tracking Study.

PubMed

Prati, Giulio; Vitrella, Giancarlo; Allocca, Giuseppe; Muser, Daniele; Buttignoni, Sonja Cukon; Piccoli, Gianluca; Morocutti, Giorgio; Delise, Pietro; Pinamonti, Bruno; Proclemer, Alessandro; Sinagra, Gianfranco; Nucifora, Gaetano

2015-11-01

Analysis of right ventricular (RV) regional dysfunction by cardiac magnetic resonance (CMR) imaging in arrhythmogenic RV cardiomyopathy (ARVC) may be inadequate because of the complex contraction pattern of the RV. Aim of this study was to determine the use of RV strain and dyssynchrony assessment in ARVC using feature-tracking CMR analysis. Thirty-two consecutive patients with ARVC referred to CMR imaging were included. Thirty-two patients with idiopathic RV outflow tract arrhythmias and 32 control subjects, matched for age and sex to the ARVC group, were included for comparison purpose. CMR imaging was performed to assess biventricular function; feature-tracking analysis was applied to the cine CMR images to assess regional and global longitudinal, circumferential, and radial RV strains and RV dyssynchrony (defined as the SD of the time-to-peak strain of the RV segments). RV global longitudinal strain (-17±5% versus -26±6% versus -29±6%; P<0.001), global circumferential strain (-9±4% versus -12±4% versus -13±5%; P=0.001), and global radial strain (18 [12-26]% versus 22 [15-32]% versus 27 [20-39]%; P=0.015) were significantly lower and SD of the time-to-peak RV strain in all 3 directions were significantly higher among patients with ARVC compared with patients with RV outflow tract arrhythmias and controls. RV global longitudinal strain >-23.2%, SD of the time-to-peak RV longitudinal strain >113.1 ms, and SD of the time-to-peak RV circumferential strain >177.1 ms allowed correct identification of 88%, 75%, and 63% of ARVC patients with no or only minor CMR criteria for ARVC diagnosis. Strain analysis by feature-tracking CMR helps to objectively quantify global and regional RV dysfunction and RV dyssynchrony in patients with ARVC and provides incremental value over conventional cine CMR imaging. © 2015 American Heart Association, Inc.

The performance of Hancock porcine-valved Dacron conduit for right ventricular outflow tract reconstruction.

PubMed

Belli, Emre; Salihoğlu, Ece; Leobon, Bertrand; Roubertie, François; Ly, Mohammed; Roussin, Régine; Serraf, Alain

2010-01-01

The surgical reconstruction of right ventricle outflow tract (RVOT) often requires the implantation of a valved conduit. Homografts are lacking availability and are associated with limited durability in children. Our experience with the Hancock porcine-valved Dacron (DuPont, Wilmington, DE) conduit (Medtronic, Minneapolis, MN) was retrospectively assessed. Follow-up was studied in 214 survivors who underwent 247 conduit implants between January 1990 and January 2007. Pulmonary atresia/ventricular septal defect was present in 86 (40.2%) and truncus arteriosus in 62 (29%). Conduit implantation was associated with anatomic repair in 136, conduit replacement in 96, and secondary pulmonary valve insertion in 15. Median age at operation was 62.5 months (range, 1 week to 50 years), including 14 neonates (6%). Median conduit size was 17.4 mm because of routine over-sizing. Pulmonary bifurcation patch augmentation was necessary in 26 patients. Periodic echocardiography studies were performed for a median follow-up of 98 months (range, 13 to 142 months). Three (1.4%) late deaths occurred. No conduit-related deaths or complications occurred. Conduit degeneration was associated with increase in valvular gradient. Valve regurgitation was absent or mild. Higher RVOT systolic pressure gradient at discharge did not influence conduit longevity. Conduit reoperation was delayed due to percutaneous balloon dilatation in 14 patients, associated with stenting in 7. Survival with freedom from conduit reoperation was 98% (95% confidence interval [CI], 97% to 100%) at 1 year, 81% (95% CI, 75% to 87%) at 5 years, and 32% (95% CI, 22% to 42%) at 10 years. The Hancock valved conduit is a safe and reliable alternative to homografts. It appears to be appropriate in patients with limited pulmonary vascular bed and high pulmonary artery pressures. Caution is required in neonates because of the rigidity of the Dacron housing. Initial results with secondary percutaneous procedures are encouraging. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Coronary anatomy in children with bicuspid aortic valves and associated congenital heart disease.

PubMed

Koenraadt, Wilke M C; Bartelings, Margot M; Bökenkamp, Regina; Gittenberger-de Groot, Adriana C; DeRuiter, Marco C; Schalij, Martin J; Jongbloed, Monique Rm

2018-03-01

In patients with bicuspid aortic valve (BAV), coronary anatomy is variable. High take-off coronary arteries have been described, but data are scarce, especially when associated with complex congenital heart disease (CHD). The purpose of this study was to describe coronary patterns in these patients. In 84 postmortem heart specimens with BAV and associated CHD, position and height of the coronary ostia were studied and related to BAV morphology. High take-off right (RCA) and left coronary arteries (LCA) were observed in 23% and 37% of hearts, respectively, most frequently in hearts with hypoplastic left ventricle (HLV) and outflow tract anomalies. In HLV, high take-off was observed in 18/40 (45%) more frequently of LCA (n=14) than RCA (n=6). In hearts with aortic hypoplasia, 8/13 (62%) had high take-off LCA and 6/13 (46%) high take-off RCA. High take-off was seen 19 times in 22 specimens with perimembranous ventricular septal defect (RCA 8, LCA 11). High take-off was associated with type 1A BAV (raphe between right and left coronary leaflets), more outspoken for the RCA. Separate ostia of left anterior descending coronary artery and left circumflex coronary artery were seen in four hearts (5%), not related to specific BAV morphology. High take-off coronary arteries, especially the LCA, occur more frequently in BAV with associated CHD than reported in normal hearts and isolated BAV. Outflow tract defects and HLV are associated with type 1A BAV and high take-off coronary arteries. Although it is unclear whether these findings in infants with detrimental outcome can be related to surviving adults, clinical awareness of variations in coronary anatomy is warranted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Dysphagia in Infants with Single Ventricle Anatomy Following Stage 1 Palliation: Physiologic Correlates and Response to Treatment

PubMed Central

McGrattan, Katlyn Elizabeth; McGhee, Heather; DeToma, Allan; Hill, Elizabeth G.; Zyblewski, Sinai C.; Lefton-Greif, Maureen; Halstead, Lucinda; Bradley, Scott M.; Martin-Harris, Bonnie

2017-01-01

Background Deficits in swallowing physiology are a leading morbidity for infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliation. Despite the high prevalence of this condition, the underlying deficits that cause this post-operative impairment remain poorly understood. Objective Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery. Methods Postoperative fiberoptic laryngoscopies and videofluoroscopic swallow studies (VFSS) were conducted sequentially on infants with functional single ventricles following stage 1 palliative surgery. Infants were dichotomized as having normal or impaired laryngeal function based on laryngoscopy findings. VFSS were evaluated frame-by-frame using a scale that quantifies performance within 11 components of swallowing physiology. Physiologic attributes within each component were categorized as high functioning or low functioning based on their ability to support milk ingestion without bolus airway entry. Results Thirty-six infants (25 male) were included in the investigation. Twenty-four underwent the Norwood procedure and twelve underwent the Hybrid procedure. Low function physiologic patterns were observed within multiple swallowing components during the ingestion of thin barium as characterized by ≥ 4 sucks per swallow (36%), initiation of pharyngeal swallow below the level of the valleculae (83%), and incomplete late laryngeal vestibular closure (56%) at the height of the swallow. Swallowing deficits contributed to aspiration in 50% of infants. Although nectar thick liquids reduced the rate of aspiration (p=0.006), aspiration rates remained high (27%). No differences in rates of penetration or aspiration were observed between infants with normal and impaired laryngeal function. Conclusions Deficits in swallowing physiology contribute to penetration and aspiration following stage 1 palliation among infants with normal and impaired laryngeal function. Although thickened liquids may improve airway protection for select infants, they may inhibit their ability to extract the bolus and meet nutritional needs. PMID:28244680

Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment.

PubMed

McGrattan, Katlyn Elizabeth; McGhee, Heather; DeToma, Allan; Hill, Elizabeth G; Zyblewski, Sinai C; Lefton-Greif, Maureen; Halstead, Lucinda; Bradley, Scott M; Martin-Harris, Bonnie

2017-05-01

Deficits in swallowing physiology are a leading morbidity for infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliation. Despite the high prevalence of this condition, the underlying deficits that cause this post-operative impairment remain poorly understood. Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery. Postoperative fiberoptic laryngoscopies and videofluoroscopic swallow studies (VFSS) were conducted sequentially on infants with functional single ventricles following stage 1 palliative surgery. Infants were dichotomized as having normal or impaired laryngeal function based on laryngoscopy findings. VFSS were evaluated frame-by-frame using a scale that quantifies performance within 11 components of swallowing physiology. Physiologic attributes within each component were categorized as high functioning or low functioning based on their ability to support milk ingestion without bolus airway entry. Thirty-six infants (25 male) were included in the investigation. Twenty-four underwent the Norwood procedure and twelve underwent the Hybrid procedure. Low function physiologic patterns were observed within multiple swallowing components during the ingestion of thin barium as characterized by ≥4 sucks per swallow (36%), initiation of pharyngeal swallow below the level of the valleculae (83%), and incomplete late laryngeal vestibular closure (56%) at the height of the swallow. Swallowing deficits contributed to aspiration in 50% of infants. Although nectar thick liquids reduced the rate of aspiration (P = .006), aspiration rates remained high (27%). No differences in rates of penetration or aspiration were observed between infants with normal and impaired laryngeal function. Deficits in swallowing physiology contribute to penetration and aspiration following stage 1 palliation among infants with normal and impaired laryngeal function. Although thickened liquids may improve airway protection for select infants, they may inhibit their ability to extract the bolus and meet nutritional needs. © 2017 Wiley Periodicals, Inc.

Impact of audit of routine second-trimester cardiac images using a novel image-scoring method.

PubMed

Sairam, S; Awadh, A M A; Cook, K; Papageorghiou, A T; Carvalho, J S

2009-05-01

To assess the impact of using an objective scoring method to audit cardiac images obtained as part of the routine 21-23-week anomaly scan. A prospective audit and re-audit (6 months later) were conducted on cardiac images obtained by sonographers during the routine anomaly scan. A new image-scoring method was devised based on expected features in the four-chamber and outflow tract views. For each patient, scores were awarded for documentation and quality of individual views. These were called 'Documentation Scores' and 'View Scores' and were added to give a 'Patient Score' which represented the quality of screening provided by the sonographer for that particular patient (maximum score, 15). In order to assess the overall performance of sonographers, an 'Audit Score' was calculated for each by averaging his or her Patient Scores. In addition, to assess each sonographer's performance in relation to particular aspects of the various views, each was given their own 'Sonographer View Scores', derived from image documentation and details of four-chamber view (magnification, valve offset and septum) and left and right outflow tract views. All images were scored by two reviewers, jointly in the primary audit and independently in the re-audit. The scores from primary and re-audit were compared to assess the impact of feedback from the primary audit. Eight sonographers participated in the study. The median Audit Score increased significantly (P < 0.01), from 10.8 (range, 9.8-12.4) in the primary audit to 12.4 (range, 10.4-13.6) in the re-audit. Scores allocated by the two reviewers in the re-audit were not significantly different (P = 0.08). Objective scoring of fetal heart images is feasible and has a positive impact on the quality of cardiac images acquired at the time of the routine anomaly scan. This audit tool has the potential to be applied in every obstetric scanning unit and may improve the effectiveness of screening for congenital heart defects.

Deceleration time of left ventricular outflow tract flow as a simple surrogate marker for central haemodynamics at rest and as well as during exercise.

PubMed

Cho, In-Jeong; Shim, Chi Young; Moon, Sun-Ha; Lee, Hyun-Jin; Hong, Geu-Ru; Chung, Namsik; Ha, Jong-Won

2017-05-01

The shape and duration of left ventricular outflow tract (LVOT) flow has not been applied to assess the central haemodynamics, although LVOT flow is confronted with afterload of arterial system during systole. The aim of this study was to evaluate whether the LVOT flow parameters are related with central systolic blood pressure (BP) and arterial compliance at rest and as well as during exercise. We studied 258 subjects (175 females, age 61 ± 11 years) with normal left ventricular (LV) systolic function who underwent supine bicycle stress echocardiography and arterial tonometry simultaneously at rest and at peak exercise. Deceleration time (DT) of LVOT flow and RR interval were measured and deceleration time corrected for heart rate (DTc) was calculated. Peripheral and central haemodynamic parameters including systolic and diastolic BP, and augmentation index at a heart rate of 75 (AIx@75) were assessed using radial artery tonometry. Carotid femoral pulse wave velocity (PWV) was measured. Deceleration time corrected for heart rate was independently associated with central systolic BP and AIx@75 at rest (P < 0.001 and 0.006). Similarly, it also showed significant independent correlations with central systolic BP and AIx@75 during peak exercise (P = 0.006 and P = 0.021). In addition, DTc which measured both at rest and at peak exercise demonstrated significant positive correlations with PWV, suggesting association of prolonged DTc with arterial stiffening (P = 0.023 and P = 0.005). Prolongation of LVOT flow DTc represents raised central systolic BP and increased arterial stiffness not only at rest but also during exercise. Therefore, central aortic pressures and arterial stiffness influence the DT of LVOT flow at rest as well as during exercise in individuals with normal LV systolic function. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Banking cryopreserved heart valves in Europe: assessment of a 5-year operation in an international tissue bank in Brussels.

PubMed

Goffin, Y; Grandmougin, D; Van Hoeck, B

1996-01-01

The heart valve bank of the European Homograft Bank has been set up in 1988 to meet the growing demand of cardiac surgeons for various sized and quality controlled cryopreserved homografts. Heart valve donors less than 60 years of age were classified in 3 categories: multiorgan donors with non transplantable hearts, recipients of cardiac transplantation and non beating heart cadavers with a warm ischemic time of less than 6 hours. Past history and biology were checked for transmissible diseases. Preparation, progressive freezing and storage in liquid nitrogen vapors, and quality control were according to the standards of the Belgian Ministry of Health. From end January 1989 to end May 1994, 989 homograft valves were cryopreserved (514 pulmonary, 475 aortic and 3 mitral) whereas 962 valves were discarded. The first cause of rejection being a major macroscopic lesion (41.48%). 138 hearts accepted at inspection were contaminated and 43 cases remained so after antibiotics. 38 cases were positive for hepatitis B or C. Complication at distribution and thawing included 10 instances of bag rupture and 15 of transversal fracture through the wall of the conduit. 477 aortic, 474 pulmonary valves as well as one mitral were implanted between May 1989 and May 1994, either for left or right ventricular outflow tract reconstruction. In the left ventricular outflow tract series 111 aortic and 23 pulmonary homograft valves were used in cases of native endocarditis, prosthetic endocarditis or recurrent endocarditis after homograft implantation. 9.6% of the requests could no be satisfied. Regular follow up information was available from 382 implants-40.1% only. The assessment of 5 years operation of the heart valve bank indicates: 1) the efficiency of selecting, cryopreserving and allocating quality controlled homograft valves from a large pool of donor hearts provided by a network of hospitals; 2) the difficulty of obtaining regular follow up information on the implants.

Geometry of the left ventricular outflow tract assessed by 3D TEE in patients with aortic stenosis: impact of upper septal hypertrophy on measurements of Doppler-derived left ventricular stroke volume.

PubMed

Koto, Dan; Izumo, Masaki; Machida, Takafumi; Suzuki, Kengo; Yoneyama, Kihei; Suzuki, Tomomi; Kamijima, Ryo; Kobayashi, Yasuyuki; Harada, Tomoo; Akashi, Yoshihiro J

2018-05-24

It is unclear how upper septal hypertrophy (USH) affects Doppler-derived left ventricular stroke volume (SV) in patients with AS. The aims of this study were to: (1) validate the accuracy of 3D transesophageal echocardiography (TEE) measurements of the left ventricular outflow tract (LVOT), (2) evaluate the differences in LVOT geometry between AS patients with and without USH, and (3) assess the impact of USH on measurement of SV. In protocol 1, both 3D TEE and multi-detector computed tomography were performed in 20 patients with AS [aortic valve area (AVA) ≤ 1.5 cm 2 ]. Multiplanar reconstruction was used to measure the LVOT short and long diameters in four parts from the tip of the septum to the annulus. In protocol 2, the same 3D TEE measurements were performed in AS patients (AVA ≤ 1.5 cm 2 , n = 129) and controls (n = 30). We also performed 2D and 3D transthoracic echocardiography in all patients. In protocol 1, excellent correlations of LVOT parameters were found between the two modalities. In protocol 2, the USH group had smaller LVOT short and long diameters than the non-USH group. Although no differences in mean pressure gradient, or SV calculated with the 3D method existed between the two groups, the USH group had greater SV calculated with the Doppler method (73 ± 15 vs. 66 ± 15 ml) and aortic valve area (0.89 ± 0.26 vs. 0.73 ± 0.24 cm 2 ) than the non-USH group. 3D TEE can provide a precise assessment of the LVOT in AS. USH affects the LVOT geometry in patients with AS, which might lead to inaccurate assessments of disease severity.

Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy?

PubMed

Nguyen, Anita; Schaff, Hartzell V; Nishimura, Rick A; Dearani, Joseph A; Geske, Jeffrey B; Lahr, Brian D; Ommen, Steve R

2018-03-01

Patients with hypertrophic obstructive cardiomyopathy and basal septal thickness <18 mm are often considered unsuitable candidates for myectomy. Mitral valve (MV) replacement is frequently performed instead. We aimed to determine whether septal thickness affects outcomes and adequacy of myectomy. Clinical and echocardiographic data were reviewed for 1486 consecutive adult patients with hypertrophic obstructive cardiomyopathy who underwent transaortic septal myectomy from January 2005 through December 2014. Comparisons between patients, grouped by septal thickness (<18 mm, n = 369; 18-21 mm, n = 612 and >21 mm, n = 505), were performed with the Kruskal-Wallis and the Pearson χ2 tests and semiparametric analysis of covariance. Median group ages were 57, 57 and 54 years (P = 0.007); men comprised 50.4%, 56.7% and 62.0%, respectively (P = 0.003). Intrinsic MV disease was present in 5.9%, 5.2% and 4.6%, respectively (P = 0.80). All patients underwent transaortic septal myectomy. Additional mitral procedures were performed in 7.6%, 7.8% and 8.1%, respectively (P = 0.90). Reasons for MV surgery included intrinsic MV disease (66.7%), residual mitral regurgitation (30.8%) and residual gradient (2.6%). All groups had postoperative gradient relief (median reduction: 51, 54 and 50 mmHg; P = 0.11). Ventricular septal defect occurred in 4 patients (0.3%), and risk did not differ by group (P = 0.24). Adequate relief of left ventricular outflow tract obstruction can be achieved via transaortic septal myectomy without concomitant MV procedures when septal thickness is < 18 mm, and the risk of ventricular septal defect is minimal. Concomitant MV repair/replacement should be reserved for patients with intrinsic MV disease or inadequate relief of mitral regurgitation/left ventricular outflow tract obstruction following adequate extended septal myectomy. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Cardiovascular System Sonographic Evaluation Algorithm: A New Sonographic Algorithm for Evaluation of the Fetal Cardiovascular System in the Second Trimester.

PubMed

De León-Luis, Juan; Bravo, Coral; Gámez, Francisco; Ortiz-Quintana, Luis

2015-07-01

To evaluate the reproducibility and feasibility of the new cardiovascular system sonographic evaluation algorithm for studying the extended fetal cardiovascular system, including the portal, thymic, and supra-aortic areas, in the second trimester of pregnancy (19-22 weeks). We performed a cross-sectional study of pregnant women with healthy fetuses (singleton and twin pregnancies) attending our center from March to August 2011. The extended fetal cardiovascular system was evaluated by following the new algorithm, a sequential acquisition of axial views comprising the following (caudal to cranial): I, portal sinus; II, ductus venosus; III, hepatic veins; IV, 4-chamber view; V, left ventricular outflow tract; VI, right ventricular outflow tract; VII, 3-vessel and trachea view; VIII, thy-box; and IX, subclavian arteries. Interobserver agreement on the feasibility and exploration time was estimated in a subgroup of patients. The feasibility and exploration time were determined for the main cohort. Maternal, fetal, and sonographic factors affecting both features were evaluated. Interobserver agreement was excellent for all views except view VIII; the difference in the mean exploration time between observers was 1.5 minutes (95% confidence interval, 0.7-2.1 minutes; P < .05). In 184 fetuses (mean gestational age ± SD, 20 ± 0.6 weeks), the feasibility of all views was close to 99% except view VIII (88.7%). The complete feasibility of the algorithm was 81.5%. The mean exploration time was 5.6 ± 4.2 minutes. Only the occiput anterior fetal position was associated with a lower frequency of visualization and a longer exploration time (P < .05). The cardiovascular system sonographic evaluation algorithm is a reproducible and feasible approach for exploration of the extended fetal cardiovascular system in a second-trimester scan. It can be used to explore these areas in normal and abnormal conditions and provides an integrated image of extended fetal cardiovascular anatomy. © 2015 by the American Institute of Ultrasound in Medicine.

Device landing zone calcification and its impact on residual regurgitation after transcatheter aortic valve implantation with different devices.

PubMed

Seiffert, Moritz; Fujita, Buntaro; Avanesov, Maxim; Lunau, Clemens; Schön, Gerhard; Conradi, Lenard; Prashovikj, Emir; Scholtz, Smita; Börgermann, Jochen; Scholtz, Werner; Schäfer, Ulrich; Lund, Gunnar; Ensminger, Stephan; Treede, Hendrik

2016-05-01

Calcification of the device landing zone is linked to paravalvular regurgitation after transcatheter aortic valve implantation (TAVI). The mechanisms remain incompletely understood and the performance of next-generation transcatheter heart valves (THV) has not been investigated. We evaluated the impact of calcification patterns on residual aortic regurgitation (AR) after TAVI with different THV in patients with severe aortic stenosis. TAVI was performed in 537 patients at two centres. Devices implanted were the Edwards Sapien XT (n = 254), Medtronic CoreValve (n = 123), JenaValve (n = 62), Medtronic Engager (n = 56), and Symetis Acurate (n = 42) prostheses. Calcification of the device landing zone was retrospectively assessed from contrast-enhanced multidetector computed tomography data and correlated with echocardiographic and clinical data. Calcium volumes of the aortic valve and left-ventricular outflow tract were associated with residual AR: No AR, 604 mm(3) (inter-quartile range, IQR 349-916); trace AR, 639 mm(3) (IQR 368-948); mild AR, 710 mm(3) (IQR 412-2078); ≥moderate AR, 1041 mm(3) (IQR 791-1417, P = 0.001). Device landing zone calcium, particularly if located in the left-ventricular outflow tract, and a low cover index were predictive of AR. Differences in the incidence of AR were observed with regard to THV type. Higher calcium volume was associated with the need for post-dilation (n = 134, median 852 [IQR 342-945] vs. 604 [IQR 542-1207] mm(3), P < 0.001). Calcification of the device landing zone, particularly if located inferior to the annulus, was independently associated with residual AR after TAVI with all evaluated THV; however, the incidence of paravalvular leakage differed significantly between the devices implanted. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Fibulin-1 is required for morphogenesis of neural crest-derived structures

PubMed Central

Cooley, Marion A.; Kern, Christine B.; Fresco, Victor M.; Wessels, Andy; Thompson, Robert P.; McQuinn, Tim C.; Twal, Waleed O.; Mjaatvedt, Corey H.; Drake, Christopher J.; Argraves, W. Scott

2008-01-01

Here we report that mouse embryos homozygous for a gene trap insertion in the fibulin-1 (Fbln1) gene are deficient in Fbln1 and exhibit cardiac ventricular wall thinning and ventricular septal defects with double outlet right ventricle or overriding aorta. Fbln1 nulls also display anomalies of aortic arch arteries, hypoplasia of the thymus and thyroid, underdeveloped skull bones, malformations of cranial nerves and hemorrhagic blood vessels in the head and neck. The spectrum of malformations is consistent with Fbln1 influencing neural crest cell (NCC)-dependent development of these tissues. This is supported by evidence that Fbln1 expression is associated with streams of cranial NCCs migrating adjacent to rhombomeres 2–7 and that Fbln1-deficient embryos display patterning anomalies of NCCs forming cranial nerves IX and X, which derive from rhombomeres 6 and 7. Additionally, Fbln1-deficient embryos show increased apoptosis in areas populated by NCCs derived from rhombomeres 4, 6 and 7. Based on these findings, it is concluded that Fbln1 is required for the directed migration and survival of cranial NCCs contributing to the development of pharyngeal glands, craniofacial skeleton, cranial nerves, aortic arch arteries, cardiac outflow tract and cephalic blood vessels. PMID:18538758

Simulation of California's Major Reservoirs Outflow Using Data Mining Technique

NASA Astrophysics Data System (ADS)

Yang, T.; Gao, X.; Sorooshian, S.

2014-12-01

The reservoir's outflow is controlled by reservoir operators, which is different from the upstream inflow. The outflow is more important than the reservoir's inflow for the downstream water users. In order to simulate the complicated reservoir operation and extract the outflow decision making patterns for California's 12 major reservoirs, we build a data-driven, computer-based ("artificial intelligent") reservoir decision making tool, using decision regression and classification tree approach. This is a well-developed statistical and graphical modeling methodology in the field of data mining. A shuffled cross validation approach is also employed to extract the outflow decision making patterns and rules based on the selected decision variables (inflow amount, precipitation, timing, water type year etc.). To show the accuracy of the model, a verification study is carried out comparing the model-generated outflow decisions ("artificial intelligent" decisions) with that made by reservoir operators (human decisions). The simulation results show that the machine-generated outflow decisions are very similar to the real reservoir operators' decisions. This conclusion is based on statistical evaluations using the Nash-Sutcliffe test. The proposed model is able to detect the most influential variables and their weights when the reservoir operators make an outflow decision. While the proposed approach was firstly applied and tested on California's 12 major reservoirs, the method is universally adaptable to other reservoir systems.

Triggering a Wet Climate on Mars: The Role of Outflow Channels in Martian Water Cycles

NASA Astrophysics Data System (ADS)

Santiago, D.; Asphaug, E. I.; Colaprete, A.

2011-12-01

The triggering of a robust water cycle on Mars has been hypothesized to be caused by gigantic flooding events evidenced by outflow channels. Here we use the Ames Mars General Circulation Model (MGCM) to study how these presumably abrupt eruptions of water (Carr,1996) affected the climate of Mars. We model where the water ultimately went as part of a transient hydrologic cycle. Chryse Planitia, east of Tharsis, has evidence for multiple water outflow channels. One of the largest channels is Ares Valles, which was carved by floods with estimated water volumes of order 10^5 km^2 (Andrews-Hanna, 2007 & Carr, 1996). Outflow discharge rate estimates range from 10^6 to 10^7 m^3/seconds or greater (Andrews-Hanna & Phillips, 2007, Harrison & Grimm, 2008). Studies suggest that outflow channels formed with smaller, successive floods instead of a single large flood (Wilson, et al.,2004). Warner et al. (2009) suggest up to six outflow events for the formation of Ares Valles, while estimates for another large outflow, Kasei Valles, might have been flooded by over two thousand floods with a total water volume of 5.5 x 10^5 km^3 (Harrison & Grimm, 2008). By adding water to the surface of Mars at the given outflow rate, as an expanding one-layer lake, we are able to study quantitatively how these outflow events influenced Mars climate, particularly the hydrologic cycle. In particular: Could sudden introductions of large amounts of water on the Martian surface lead to a new equilibrated water cycle? Can we tie certain fluvial surface features to transient or sustained water cycles? What are the roles of water vapor and water ice clouds to sudden changes in the water cycle on Mars? How are radiative feedbacks involved with this? What is the ultimate fate of the outflow water? This work uses the NASA Ames MGCM version 2.1 and other schemes that are part of the NASA Ames MGCM suite of tools. Various versions of the MGCM developed at Ames have been used extensively to examine dust and volatile distributions on Mars (e.g., Kahre et al., 2006, 2008). The MGCM 2.1 currently has a well-developed water ice cloud formation scheme (Montmessin et al., 2002, 2004a), which includes calculation of cloud particle concentrations, nucleation, growth, and gravitational sedimentation. For examining the effect of a large water outflow on the climate of Mars, we include water tracers, with an advanced cloud particle scheme Preliminary results suggest that water may have been transported globally for years post-outflow. Post-outflow water cloud formation increases dramatically, with water ice clouds and water vapor potentially transporting water globally. The global mass of water vapor and of water ice clouds increases substantially, with the post-outflow patterns settling into annual cycles, with increasing water entering the atmosphere from the surface over time. Future work will examine the radiative effects of the water vapor and water ice clouds, and the longer-term persistence of a new hydrological or climate regime Detailed comparisons of post-outflow precipitation locations with fluvial features on Mars will be done.

Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience.

PubMed

Kotkar, Kunal D; Said, Sameh M; Dearani, Joseph A; Schaff, Hartzell V

2017-07-01

Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease characterized by left ventricular hypertrophy in the absence of other etiologies. Clinical presentation may vary from asymptomatic to sudden cardiac death. Medical treatment is the first-line therapy for symptomatic patients. Extended left ventricular septal myectomy is the procedure of choice if medical treatment is unsuccessful or intolerable. More than 3,000 patients have had septal myectomy for HCM at the Mayo Clinic (MN, USA) from 1993 to 2016. Risk of hospital death after isolated septal myectomy for obstructive HCM is <1% and is similar to the risk of operation for elective mitral valve repair. Complications, such as complete heart block requiring permanent pacemaker, are uncommon (2%), although partial or complete left bundle branch block is a frequent finding on the postoperative ECG. Relief of left ventricular outflow tract (LVOT) obstruction with septal myectomy dramatically improves symptoms and exercise capacity in symptomatic patients with obstructive HCM. More than 90% of severely symptomatic patients have improvement by at least two functional classes, and reduction of outflow gradients by myectomy decreases or eliminates symptoms of dyspnea, angina and/or syncope. Basal obstruction with systolic anterior motion (SAM) is treated by transaortic myectomy. The transapical approach was applied in 115 patients with obstructive midventricular and apical variants of HCM between 1993 and 2012. All patients with midventricular obstruction had gradient relief and none developed an apical aneurysm or ventricular septal defect. Recurrent obstruction after satisfactory myectomy was rare. Septal myectomy effectively and definitively relieves LVOT obstruction and cardiac symptoms in patients with obstructive HCM. In experienced centers, early mortality for isolated septal myectomy is less than 1%, and overall results are excellent and continue to improve in the current era.

Trend-outflow method for understanding interactions of surface water with groundwater and atmospheric water for eight reaches of the Upper Rio Grande

NASA Astrophysics Data System (ADS)

Liu, Yi; Sheng, Zhuping

2011-11-01

SummaryAtmospheric water, surface water, and groundwater interact very actively through hydrologic processes such as precipitation, infiltration, seepage, irrigation, drainage, evaporation, and evapotranspiration in the Upper Rio Grande Basin. A trend-outflow method has been developed in this paper to gain a better understanding of the interactions based on cumulated inflow and outflow data for any river reaches of interest. A general trend-outflow equation was derived by associating the net interaction of surface water with atmospheric water as a polynomial of inflow and the net interaction of surface water with groundwater as a constant based on surface water budget. Linear and quadratic relations are probably two common trend-outflow types in the real world. It was found that trend-outflows of the Upper Rio Grande reaches, Española, Albuquerque, Socorro-Engle, Palomas, and Rincon are linear with inflow, while those of reaches, Belen, Mesilla and Hueco are quadratic. Reaches Belen, Mesilla and Hueco are found as water deficit reaches mainly for irrigated agriculture in extreme drought years.

Long-Term Results of Stent Placement in Patients with Outflow Block After Living-Donor-Liver Transplantation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fujimori, Masashi, E-mail: fujimorim@clin.medic.mie-u.ac.jp; Yamakado, Koichiro, E-mail: yamakado47@gmail.com; Takaki, Haruyuki, E-mail: takaki-h@clin.medic.mie-u.ac.jp

PurposeTo evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT).Materials and MethodsFor this institutional review board approved retrospective study conducted during 2002–2012, stents were placed in outflow veins in 15 patients (11.3 %, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4–69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complicationsmore » were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT.ResultsStents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100 %, 15/15). Clinical manifestations improved in 11 patients (73.3 %, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7 %, 4/15) who died in the hospital 1.0–3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2 %, p = .405).ConclusionStenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.« less

Early chordate origins of the vertebrate second heart field.

PubMed

Stolfi, Alberto; Gainous, T Blair; Young, John J; Mori, Alessandro; Levine, Michael; Christiaen, Lionel

2010-07-30

The vertebrate heart is formed from diverse embryonic territories, including the first and second heart fields. The second heart field (SHF) gives rise to the right ventricle and outflow tract, yet its evolutionary origins are unclear. We found that heart progenitor cells of the simple chordate Ciona intestinalis also generate precursors of the atrial siphon muscles (ASMs). These precursors express Islet and Tbx1/10, evocative of the splanchnic mesoderm that produces the lower jaw muscles and SHF of vertebrates. Evidence is presented that the transcription factor COE is a critical determinant of ASM fate. We propose that the last common ancestor of tunicates and vertebrates possessed multipotent cardiopharyngeal muscle precursors, and that their reallocation might have contributed to the emergence of the SHF.

New Insights into the Surgical Management of Tetralogy of Fallot: Physiological Fundamentals and Clinical Relevance.

PubMed

Bove, Thierry; François, Katrien; De Wolf, Daniel

2015-01-01

The surgical treatment of tetralogy of Fallot can be considered as a success story in the history of congenital heart diseases. Since the early outcome is no longer the main issue, the focus moved to the late sequelae of TOF repair, i.e. the pulmonary insufficiency and the secondary adaptation of the right ventricle. This review provides recent insights into the pathophysiological alterations of the right ventricle in relation to the reconstruction of the right ventricular outflow tract after repair of tetralogy of Fallot. Its clinical relevance is documented by addressing the policy changes regarding the optimal management at the time of surgical repair as well as properly defining criteria and timing for late pulmonary valve implantation.

[Tricuspid insufficiency and right traumatic ventricular aneurysm. Apropos of a case].

PubMed

Boisselier, P; Lombaert, M; Rey, J L; Quiret, J C; Bernasconi, P

1981-12-01

Tricuspid incompetence associated with a right ventricular aneurysm wa discovered after a non-penetrating thoracic injury. The severity of the tricuspid lesion was confirmed by phonomechanography, catheterisation and angiography. The mechanism was demonstrated by two-dimensional echocardiography: the right ventricular aneurysm was located in the right ventricular outflow tract. As the hemodynamic tolerance was good, surgery was not performed. A review of the literature found 41 other reports of traumatic tricuspid incompetence, and 4 cases of right ventricular aneurysm, only one of which was associated with tricuspid regurgitation. The points of interest of ths case: the rarity of the association, the good hemodynamic tolerance and the value of two-dimensional echocardiography for the diagnosis of ruptured chordae in the absence of surgical observations.

Intraoperative Two- and Three-Dimensional Transesophageal Echocardiography in Combined Myectomy-Mitral Operations for Hypertrophic Cardiomyopathy.

PubMed

Nampiaparampil, Robert G; Swistel, Daniel G; Schlame, Michael; Saric, Muhamed; Sherrid, Mark V

2018-03-01

Transesophageal echocardiography is essential in guiding the surgical approach for patients with obstructive hypertrophic cardiomyopathy. Septal hypertrophy, elongated mitral valve leaflets, and abnormalities of the subvalvular apparatus are prominent features, all of which may contribute to left ventricular outflow tract obstruction. Surgery aims to alleviate the obstruction via an extended myectomy, often with an intervention on the mitral valve and subvalvular apparatus. The goal of intraoperative echocardiography is to assess the anatomic pathology and pathophysiology in order to achieve a safe intraoperative course and a successful repair. This guide summarizes the systematic evaluation of these patients to determine the best surgical plan. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Congestive heart failure caused by transvenous pacemaker lead prolapse and associated right ventricular outflow tract obstruction in a dog.

PubMed

Djani, D M; Coleman, A E; Rapoport, G S; Schmiedt, C W; Layher, J; Thomason, J D

2016-12-01

A 16-year-old dog was presented for cough as well as increased respiratory rate and effort three years after implantation of a single-lead transvenous artificial pacemaker system. Thoracic radiographs and echocardiography disclosed prolapse of the pacemaker lead into the main pulmonary artery, causing severe pulmonary insufficiency and right-sided volume overload. Repositioning of the pacemaker lead led to improvement of pulmonary insufficiency and resolution of the dog's clinical signs and cavitary effusions. This case describes a late complication of pacemaker implantation that may be avoided by appropriate use of the manufacturer-provided anchoring sleeve and avoidance of excessive lead redundancy. Copyright © 2016 Elsevier B.V. All rights reserved.

Rate-dependent Loss of Capture during Ventricular Pacing.

PubMed

Wang, Jingfeng; Chen, Haiyan; Su, Yangang; Ge, Junbo

2015-01-01

A 63-year-old patient who had undergone atrial septal defect surgical repair received implantation of a single chamber VVI pacemaker for long RR intervals during atrial fibrillation. One week later, an intermittent loss of capture and sensing failure was detected at a pacing rate of 70 beats/min. However, a successful capture was observed during rapid pacing. Consequently, the pacing rate was temporarily adjusted to 90 beats/min. At the 3-month follow-up, the pacemaker was shown to be functioning properly independent of the pacing rate. An echocardiogram showed that the increased pacing rates were accompanied by a reduction in the right ventricular outflow tract dimension. The pacemaker was then permanently programmed at a lower rate of 60 beats/min.

Therapy of stress (takotsubo) cardiomyopathy: present shortcomings and future perspectives.

PubMed

Brunetti, Natale Daniele; Santoro, Francesco; De Gennaro, Luisa; Correale, Michele; Kentaro, Hayashi; Gaglione, Antonio; Di Biase, Matteo

2016-09-01

Several therapeutic options are available for the treatment of the acute phase of stress cardiomyopathy, pharmacological (β-blockers, diuretics, anticoagulants, antiarrhythmics, noncatecholamine inotropics [levosimendan]), and nonpharmacological (intra-aortic balloon pumping, extracorporeal membrane oxygenation), according to the wide possible clinical presentation and course of the disease. However, there is a gap in evidence, and very few data come from randomized and adequately powered studies. Some evidence supports the use of β-blockers, in particular with a short half-life, in the case of left ventricular outflow tract obstruction, and angiotensin-converting enzyme inhibitors in secondary prevention. Future perspectives include the study of genetic basis of stress cardiomyopathy, role of miRNA and neurovegetative modulation. Randomized studies, however, are surely warranted.

Frizzled 1 and frizzled 2 genes function in palate, ventricular septum and neural tube closure: general implications for tissue fusion processes

PubMed Central

Yu, Huimin; Smallwood, Philip M.; Wang, Yanshu; Vidaltamayo, Roman; Reed, Randall; Nathans, Jeremy

2010-01-01

The closure of an open anatomical structure by the directed growth and fusion of two tissue masses is a recurrent theme in mammalian embryology, and this process plays an integral role in the development of the palate, ventricular septum, neural tube, urethra, diaphragm and eye. In mice, targeted mutations of the genes encoding frizzled 1 (Fz1) and frizzled 2 (Fz2) show that these highly homologous integral membrane receptors play an essential and partially redundant role in closure of the palate and ventricular septum, and in the correct positioning of the cardiac outflow tract. When combined with a mutant allele of the planar cell polarity gene Vangl2 (Vangl2Lp), Fz1 and/or Fz2 mutations also cause defects in neural tube closure and misorientation of inner ear sensory hair cells. These observations indicate that frizzled signaling is involved in diverse tissue closure processes, defects in which account for some of the most common congenital anomalies in humans. PMID:20940229

Altered cerebellar feedback projections in Asperger syndrome.

PubMed

Catani, Marco; Jones, Derek K; Daly, Eileen; Embiricos, Nitzia; Deeley, Quinton; Pugliese, Luca; Curran, Sarah; Robertson, Dene; Murphy, Declan G M

2008-07-15

It has been proposed that the biological basis of autism spectrum disorder includes cerebellar 'disconnection'. However, direct in vivo evidence in support of this is lacking. Here, the microstructural integrity of cerebellar white matter in adults with Asperger syndrome was studied using diffusion tensor magnetic resonance tractography. Fifteen adults with Asperger syndrome and 16 age-IQ-gender-matched healthy controls underwent diffusion tensor magnetic resonance imaging. For each subject, tract-specific measurements of mean diffusivity and fractional anisotropy were made within the inferior, middle, superior cerebellar peduncles and short intracerebellar fibres. No group differences were observed in mean diffusivity. However, people with Asperger syndrome had significantly lower fractional anisotropy in the short intracerebellar fibres (p<0.001) and right superior cerebellar (output) peduncle (p<0.001) compared to controls; but no difference in the input tracts. Severity of social impairment, as measured by the Autistic Diagnostic Interview, was negatively correlated with diffusion anisotropy in the fibres of the left superior cerebellar peduncle. These findings suggest a vulnerability of specific cerebellar neural pathways in people with Asperger syndrome. The localised abnormalities in the main cerebellar outflow pathway may prevent the cerebral cortex from receiving those cerebellar feedback inputs necessary for a successful adaptive social behaviour.

Multi-fluid simulations of the coupled solar wind-magnetosphere-ionsphere system

NASA Astrophysics Data System (ADS)

Lyon, J.

2011-12-01

This paper will review recent work done with the multi-fluid version of the Lyon-Fedder-Mobarry (MF-LFM) global MHD simulation code. We will concentrate on O+ outflow from the ionosphere and its importance for magnetosphere-ionosphere (MI) coupling and also the importance of ionospheric conditions in determining the outflow. While the predominant method of coupling between the magnetosphere and ionosphere is electrodynamic, it has become apparent the mass flows from the ionosphere into the magnetosphere can have profound effects on both systems. The earliest models to attempt to incorporate this effect used very crude clouds of plasma near the Earth. The earliest MF-LFM results showed that depending on the details of the outflow - where, how much, how fast - very different magnetospheric responses could be found. Two approaches to causally driven models for the outflow have been developed for use in global simulations, the Polar Wind Outflow Model (PWOM), started at the Univ. of Michigan, and the model used by Bill Lotko and co-workers at Dartmouth. We will give a quick review of this model which is based on the empirical relation between outflow fluence and Poynting flux discovered by Strangeway. An additional factor used in this model is the precipitating flux of electrons, which is presumed to correlate with the scale height of the upwelling ions. parameters such as outflow speed and density are constrained by the total fluence. The effects of the outflow depend on the speed. Slower outflow tends to land in the inner magnetosphere increasing the strength of the ring current. Higher speed flow out in the tail. Using this model, simulations have shown that solar wind dynamic pressure has a profound effect on the amount of fluence. The most striking result has been the simulation of magnetospheric sawtooth events. We will discuss future directions for this research, emphasizing the need for better physical models for the outflow process and its coupling to the ionosphere.

Theory of Bipolar Outflows from Accreting Hot Stars

NASA Astrophysics Data System (ADS)

Konigl, A.

1996-05-01

There is a growing number of observational indicators for the presence of bipolar outflows in massive, young stellar objects that are still accreting mass as part of their formation process. In particular, there is evidence that the outflows from these objects can attain higher velocities and kinetic luminosities than their lower-mass counterparts. Furthermore, the higher-mass objects appear to smoothly continue the correlation found in T Tauri stars between outflow and accretion signatures, and in several cases there are direct clues to the existence of a disk from optical and infrared spectroscopy. These results suggest that the disk--outflow connection found in low-mass pre--main-sequence stars extends to more massive objects, and that a similar physical mechanism may drive the outflows in both cases. In this presentation, I first critically examine the observational basis for this hypothesis, considering, among other things, the possibility that several low-luminosity outflows might occasionally masquerade as a single flow from a luminous object, and the effects that the radiation field of a hot star could have on the spectroscopic diagnostics of an accretion-driven outflow. I then go on to consider how the commonly invoked centrifugally driven wind models of bipolar outflows in low-mass stars would be affected by the various physical processes (such as photoionization, photoevaporation, radiation pressure, and stellar wind ram pressure) that operate in higher-mass stars. I conclude by mentioning some of the tantalizing questions that one could hope to address as this young field of research continues to develop (for example: is there a high-mass analog of the FU Orionis outburst phenomenon? Could one use observations of progressively more massive, and hence less convective, stars to elucidate the role of stellar magnetic fields in the accretion and outflow processes? Would it be possible to observationally identify massive stars that have reached the main sequence while they were still accreting? Does the evolution of protostellar disks differ in low-mass and high-mass objects?).

Level of Neutral Buoyancy, Deep Convective Outflow, and Hot Tower: New Perspectives Based on the A-Train Observations

NASA Astrophysics Data System (ADS)

Takahashi, H.; Luo, J.; Stephens, G. L.

2016-12-01

Deep convective cores, or "hot towers (HTs)", play a significant role in controlling the energy budgets and hydrological cycles. The vertical convective transport by HTs is like an express elevator transporting the near-surface air directly into the upper troposphere or lower stratosphere (e.g., Riehl and Malkus, 1958; Sun and Lindzen, 1993; Soden and Fu, 1995). The vertical convective transport will eventually make a transition to horizontal outflows where widespread cirrus anvils develop, which also play an important role in radiative-convective feedbacks (e.g., Stephens et al. 2008). In this study, we introduce two proxies to evaluate the strength of vertical and horizontal convective mass transport by hot towers. Result shows that HTs tend to have wider horizontal mass transport over land than ocean. In addition, an important aspect of the deep convection-to-outflow transition is the altitude where the outflow occurs, which can be conveniently summarized into a single parameter called level of neutral buoyancy (LNB). LNB is a critical parameter for understanding convection because it sets the potential vertical extent for convective development. This study develops a deeper and more comprehensive understanding of the relationship between LNB and deep convective outflow, including regional variations. To this end, a useful proxy to estimate convective dilution is introduced. Results show that active convective dilution can be seen over the Warm Pool throughout the year, while deep convection over tropical Africa and Amazonia tends to be less diluted.

The collapse of a molecular cloud core to stellar densities using radiation non-ideal magnetohydrodynamics

NASA Astrophysics Data System (ADS)

Wurster, James; Bate, Matthew R.; Price, Daniel J.

2018-04-01

We present results from radiation non-ideal magnetohydrodynamics (MHD) calculations that follow the collapse of rotating, magnetized, molecular cloud cores to stellar densities. These are the first such calculations to include all three non-ideal effects: ambipolar diffusion, Ohmic resistivity, and the Hall effect. We employ an ionization model in which cosmic ray ionization dominates at low temperatures and thermal ionization takes over at high temperatures. We explore the effects of varying the cosmic ray ionization rate from ζcr = 10-10 to 10-16 s-1. Models with ionization rates ≳10-12 s-1 produce results that are indistinguishable from ideal MHD. Decreasing the cosmic ray ionization rate extends the lifetime of the first hydrostatic core up to a factor of 2, but the lifetimes are still substantially shorter than those obtained without magnetic fields. Outflows from the first hydrostatic core phase are launched in all models, but the outflows become broader and slower as the ionization rate is reduced. The outflow morphology following stellar core formation is complex and strongly dependent on the cosmic ray ionization rate. Calculations with high ionization rates quickly produce a fast (≈14 km s-1) bipolar outflow that is distinct from the first core outflow, but with the lowest ionization rate, a slower (≈3-4 km s-1) conical outflow develops gradually and seamlessly merges into the first core outflow.

Estimating outflow facility through pressure dependent pathways of the human eye

PubMed Central

Gardiner, Bruce S.

2017-01-01

We develop and test a new theory for pressure dependent outflow from the eye. The theory comprises three main parameters: (i) a constant hydraulic conductivity, (ii) an exponential decay constant and (iii) a no-flow intraocular pressure, from which the total pressure dependent outflow, average outflow facilities and local outflow facilities for the whole eye may be evaluated. We use a new notation to specify precisely the meaning of model parameters and so model outputs. Drawing on a range of published data, we apply the theory to animal eyes, enucleated eyes and in vivo human eyes, and demonstrate how to evaluate model parameters. It is shown that the theory can fit high quality experimental data remarkably well. The new theory predicts that outflow facilities and total pressure dependent outflow for the whole eye are more than twice as large as estimates based on the Goldman equation and fluorometric analysis of anterior aqueous outflow. It appears likely that this discrepancy can be largely explained by pseudofacility and aqueous flow through the retinal pigmented epithelium, while any residual discrepancy may be due to pathological processes in aged eyes. The model predicts that if the hydraulic conductivity is too small, or the exponential decay constant is too large, then intraocular eye pressure may become unstable when subjected to normal circadian changes in aqueous production. The model also predicts relationships between variables that may be helpful when planning future experiments, and the model generates many novel testable hypotheses. With additional research, the analysis described here may find application in the differential diagnosis, prognosis and monitoring of glaucoma. PMID:29261696

Anatomical factors determining surgical decision-making in patients with transposition of the great arteries with left ventricular outflow tract obstruction.

PubMed

Honjo, Osami; Kotani, Yasuhiro; Bharucha, Tara; Mertens, Luc; Caldarone, Christopher A; Redington, Andrew N; Van Arsdell, Glen

2013-12-01

Transposition of the great arteries (TGA) and left ventricular outflow tract obstruction (LVOTO) with or without ventricular septal defect have multiple surgical treatment options. We sought to identify pre- and intraoperative factors that determine the timing of repair, procedure type and subsequent LVOT outcome. Twenty-eight (8.2% of all TGA) patients with TGA with LVOTO (double outlet ventricle, n = 5, TGA/intact septum, n = 1) between 2000 and 2012 were reviewed. Anatomical factors were identified by prerepair echocardiography. LVOTO complexity was characterized by the degree of obstruction (0 = none, 0.33 = mild, 0.66 moderate and 1 = severe) at various levels: pulmonary valve (PV) dysplasia/hypoplasia, posterior deviation of the infundibular septum, fibromuscular ridge, tissue tag and abnormal chordal attachment. Summation of the obstruction score, at each level, yielded the LVOT complexity score. The descriptive analysis of intraoperative decision-making at late repair was performed. early arterial switch operation (ASO) + LVOT resection (n = 9, 32%), late ASO + LVOT resection (n = 3, 10%), Nikaidoh (n = 8, 29%), Rastelli (n = 6, 21%), single-ventricle palliation (n = 2, 7%). The primary LVOT obstruction mechanism was posterior deviation of the infundibular septum (n = 16, 57%) and PV dysplasia (n = 6, 21%). The early ASO group had a lower PV complexity score (0.42 ± 0.22 vs 0.96 ± 0.55, P = 0.007), tissue tag score (0.03 ± 0.15 vs 0.26 ± 0.34, P = 0.018) and LVOT complexity score (2.11 ± 0.86 vs 3.2 ± 0.96, P = 0.006). The LVOT complexity score in the Nikaidoh group was higher than in the late ASO group (P = 0.019). Of 16 candidates for the Nikaidoh procedure, 6 patients underwent a Rastelli operation due to coronary artery patterns (single coronary, n = 3, 1RL-2Cx, n = 2 or an abnormal left anterior descending coronary artery course, n = 1). Two patients underwent single-ventricle palliation due to the interference of essential chordae. All patients survived the operation. The 3-year survival was 96%. One patient who underwent late ASO required re-LVOT resection. A newly developed scoring system, the LVOT complexity score, helped to quantify the LVOT complexity and was correlated with our choice of the surgical procedure of TGA with LVOTO. The current strategy achieved reasonable survival and LVOT outcome with three quarters of the patients having an anatomically aligned LVOT. The coronary anatomy pattern was the primary determinant in the decision-making between the Nikaidoh procedure and the Rastelli operation.

Left ventricular outflow obstruction and necrotizing enterocolitis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Allen, H.A.; Haney, P.J.

1984-02-01

Two neonates had unusually rapid development of necrotizing enterocolitis within 24 hours of birth. Both patients had decreased systemic perfusion secondary to aortic atresia. Onset of either clinical or radiographic manifestations of necrotizing enterocolitis in the first day of life should alert one to the possible presence of severe left ventricular outflow obstruction.

Remote magnetic navigation to map and ablate left coronary cusp ventricular tachycardia.

PubMed

Burkhardt, J David; Saliba, Walid I; Schweikert, Robert A; Cummings, Jennifer; Natale, Andrea

2006-10-01

Premature ventricular contractions (PVCs) and ventricular tachycardia may arise from the coronary cusps. Navigation, mapping, and ablation in the coronary cusps can be challenging. Remote magnetic navigation may offer an alternative to conventional manually operated catheters. We report a case of left coronary cusp ventricular tachycardia ablation using remote magnetic navigation. Right ventricular outflow tract and coronary cusp mapping, and ablation of the left coronary cusp using a remote magnetic navigation and three-dimensional (3-D) mapping system was performed in a 28-year-old male with frequent, symptomatic PVCs and ventricular tachycardia. Successful ablation of left coronary cusp ventricular tachycardia was performed using remote magnetic navigation. Remote magnetic navigation may be used to map and ablate PVCs and ventricular tachycardia originating from the coronary cusps.

Hypertrophic cardiomyopathy.

PubMed

Santos Mateo, Juan José; Sabater Molina, María; Gimeno Blanes, Juan Ramón

2018-06-08

Hypertrophic cardiomyopathy is the most common inherited cardiovascular disease. It is characterized by increased ventricular wall thickness and is highly complex due to its heterogeneous clinical presentation, several phenotypes, large number of associated causal mutations and broad spectrum of complications. It is caused by mutations in sarcomeric proteins, which are identified in up to 60% of cases of the disease. Clinical manifestations of Hypertrophic Cardiomyopathy include shortness of breath, chest pain, palpitations and syncope, which are related to the onset of diastolic dysfunction, left ventricular outflow tract obstruction, ischemia, atrial fibrillation and abnormal vascular responses. It is associated with an increased risk of sudden cardiac death, heart failure and thromboembolic events. In this article, we discuss the diagnostic and therapeutic aspects of this disease. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Amplatzer angled duct occluder for closure of patent ductus arteriosus larger than the aorta in an infant.

PubMed

Vijayalakshmi, I B; Chitra, N; Rajasri, R; Prabhudeva, A N

2005-01-01

Transcatheter closure of patent ductus arteriosus (PDA) by Amplatzer duct occluder is the treatment of choice. However, closure of very large ducts in infants with low weight is a challenge for the interventionalist because a large device may obstruct the aorta or left pulmonary artery. Difficulty is also encountered in advancing the device around the curve of the right ventricular outflow tract toward the pulmonary artery; this curve is tight, more or less at a right angle in infants, leading to kinking of the sheath, which increases fluoroscopic time. This is the first reported case of a very large PDA (8.7 mm), larger than the aorta (8.2 mm), successfully closed by an Amplatzer angled duct occluder in an infant weighing 5 kg.

Cutting balloon and high-pressure balloon dilation for palliative treatment of congenital double-chambered right ventricle and primary infundibular stenosis in a Golden retriever dog.

PubMed

Schober, Karsten E; Rhinehart, Jaylyn; Kohnken, Rebecca; Bonagura, John D

2017-12-01

Combined cutting balloon and high-pressure balloon dilation was performed in a dog with a double-chambered right ventricle and severe infundibular stenosis of the right ventricular outflow tract. The peak systolic pressure gradient across the stenosis decreased by 65% after dilation (from 187 mmHg before to 66 mmHg after) affirming the intervention as successful. However, early re-stenosis occurred within 3 months leading to exercise intolerance, exercise-induced syncope, and right-sided congestive heart failure. Cutting balloon followed by high-pressure balloon dilation provided temporary but not long-term relief of right ventricular obstruction in this dog. Copyright © 2017 Elsevier B.V. All rights reserved.

Condensation onto grains in the outflows from mass-losing red giants

NASA Technical Reports Server (NTRS)

Jura, M.; Morris, M.

1985-01-01

In the outflows from red giants, grains are formed which are driven by radiation pressure. For the development of a model of the outflows, a detailed understanding of the interaction between the gas and dust is critical. The present investigation is concerned with condensation processes which occur after the grains nucleate near the stars. A physical process considered results from the cooling of the grains as they flow away from the star. Molecules which initially do not condense onto the grains can do so far from the star. It is shown that for some species this effect can be quite important in determining their gas-phase abundances in the outer circumstellar envelope. One of the major motivations of this investigation was provided by the desire to understand the physical conditions and molecular abundances in the outflows from the considered stars.

Propellant Feed Subsystem for a 26 kW flight arcjet propulsion system

NASA Astrophysics Data System (ADS)

Vaughan, C. E.; Morris, J. P.

1993-06-01

The USAF arcjet ATTD program demanded the development of a low-cost ammonia Propellant Feed Subsystem (PFS). A flow rate of 240 +/- 5 mg/sec during a total of ten 15-min ammonia outflows was required for the flight mission. The precision of the flow tolerance required a departure from the design of previous ammonia propellant feed systems. Since a propellant management device was not used, thermocapillary forces were explored as a means to limit outflow of liquid phase ammonia. A high energy density feedline heater with an internal wick was developed to guarantee that only gas phase propellant would reach the arcjet. A digital control algorithm was developed to implement bang-bang control of mass flow rate metered by a sonic venturi. Development tests of this system have been completed. The system is capable of continuous gas phase outflows regardless of orientation. Integrated tests with the arcjet and power conditioning unit have also been successfully completed.

Wnt/β-catenin signaling enables developmental transitions during valvulogenesis

PubMed Central

Bosada, Fernanda M.; Devasthali, Vidusha; Jones, Kimberly A.; Stankunas, Kryn

2016-01-01

Heart valve development proceeds through coordinated steps by which endocardial cushions (ECs) form thin, elongated and stratified valves. Wnt signaling and its canonical effector β-catenin are proposed to contribute to endocardial-to-mesenchymal transformation (EMT) through postnatal steps of valvulogenesis. However, genetic redundancy and lethality have made it challenging to define specific roles of the canonical Wnt pathway at different stages of valve formation. We developed a transgenic mouse system that provides spatiotemporal inhibition of Wnt/β-catenin signaling by chemically inducible overexpression of Dkk1. Unexpectedly, this approach indicates canonical Wnt signaling is required for EMT in the proximal outflow tract (pOFT) but not atrioventricular canal (AVC) cushions. Furthermore, Wnt indirectly promotes pOFT EMT through its earlier activity in neighboring myocardial cells or their progenitors. Subsequently, Wnt/β-catenin signaling is activated in cushion mesenchymal cells where it supports FGF-driven expansion of ECs and then AVC valve extracellular matrix patterning. Mice lacking Axin2, a negative Wnt regulator, have larger valves, suggesting that accumulating Axin2 in maturing valves represents negative feedback that restrains tissue overgrowth rather than simply reporting Wnt activity. Disruption of these Wnt/β-catenin signaling roles that enable developmental transitions during valvulogenesis could account for common congenital valve defects. PMID:26893350

Investigating alcohol-induced congenital heart defects using optical coherence tomography (Conference Presentation)

NASA Astrophysics Data System (ADS)

Gu, Shi; Peterson, Lindsy M.; Ma, Pei; Karunamuni, Ganga; Watanabe, Michiko; Jenkins, Michael W.; Rollins, Andrew M.

2016-03-01

Fetal alcohol syndrome commonly results in neurological and craniofacial defects, additionally, as high as 54% of live-born children with this syndrome also possess cardiac abnormalities. We have previously shown that CNCC-ablated embryos exhibit similar structural and functional phenotypes as ethanol-exposed embryos. Here, we present progress on two fronts toward understanding the association between CNCC dysfunction and FAS-related CHDs. We have developed a technique for measuring the thickness of the cardiac cushions throughout the heart. These values were then mapped onto a surface mesh of the myocardial wall for 3-D visualization. The cushions were observed to be significantly reduced in the outflow tract of CNCC-ablated embryos. We also observed a correlation between abnormal pulsed Doppler waveforms and increased separation of the atrioventricular inferior and superior cushions. This correlation between function and structure will enable rapid phenotyping of perturbed embryos. Finally, we present our preliminary results using methyl donors to rescue ethanol-exposed embryonic CHDs. Betaine was administered along with the ethanol injection to embryos at 21 hours of development. The embryos were then analyzed at day 8 for survival and heart morphology. The administration of betaine resulted in a significant increase in survival and normalization of atrioventricular valve leaflet volume and interventricular septum thickness.

Understanding Satellite-based Monthly-to-Seasonal Reservoir Outflow Estimation as a function of Hydrologic Controls

NASA Astrophysics Data System (ADS)

Bonnema, M.; Sikder, M. S.; Hossain, F.; Chen, X.; Miao, Y.; Lee, H.

2015-12-01

Growing population and increased demand for water in developing nations is causing an increase in dam construction in these regions. Entities and stakeholders downstream of dams experience drastically altered river flows. When rivers cross international boundaries, these downstream stakeholders often have little knowledge of upstream reservoir operation practices. Satellite remote sensing in the form of radar altimetry and multi-sensor precipitation products can be used as a way to provide downstream stakeholders with the upstream information needed to make important water management decisions. This study uses a mass balance between three hydraulic controls, precipitation induced inflow, evaporation, and reservoir storage change, to estimate reservoir outflow at a monthly time scale. Two reservoirs were examined in differing regions of the world, the Hungry Horse Reservoir in a mountainous region in northwest U.S. and the Kaptai Reservoir in a low-lying, forested region of Bangladesh. It was found that this mass balance method estimated the outflow of Kaptai Reservoir with reasonable skill when compared with observed flows. The estimation of outflow from Hungry Horse Reservoir was similarly skillful for outflows in winter and fall months, but summer and spring outflow estimates had high errors due to snowmelt effects. Furthermore, it was found that the important hydrologic controls for reservoir outflow estimation at the monthly time scale differs between the two reservoirs, with precipitation induced inflow being the most important control for the Kaptai Reservoir and storage change being the most important for Hungry Horse Reservoir. In both cases, a standard energy balance approach of evaporation estimation appeared to have little effect on the accuracy of outflow estimation.

Infrahepatic vena cavocavostomy, a modification of the piggyback technique for liver transplantation.

PubMed

Khanmoradi, Kamran; Defaria, Werviston; Nishida, Seigo; Levi, David; Kato, Tomoaki; Moon, Jang; Selvaggi, Gennaro; Tzakis, Andreas

2009-05-01

We describe our experience with a modification of the piggyback (PB) technique for orthotopic liver transplantation in which the donor infrahepatic vena cava is used as the venous outflow tract. From May 1997 to January 2006, a total of 109 cases using this technique were performed in 101 patients. Collected data included recipient demographics and diagnosis, warm ischemia time, use of venovenous bypass or temporary portacaval shunt and complications related to the venous outflow and graft, and patient survival. Data were compared with the patients undergoing standard PB technique during the same period. The reasons for using the technique were grouped according to whether there was a problem with the recipient hepatic veins or a concern about the length or diameter of the donor suprahepatic vena cava. These included the presence of a transjugular intrahepatic portosystemic shunt (eight cases), retransplantation (22 cases), thin-walled, friable hepatic veins (32 cases), Budd-Chiari syndrome (two cases), domino liver procurement (six cases), reduced or split liver grafts (five cases), and graft inferior vena cava to recipient hepatic veins size discrepancy (34 cases). There was no graft loss. The warm ischemia time was 39.65 minutes compared with 37 minutes in the standard PB group. The long-term graft and patient survival rates were similar in the two groups. Infrahepatic vena cavocavostomy is a useful variation of the standard PB technique.

Hemodynamic changes in systolic and diastolic function during isoproterenol challenge predicts symptomatic response to myectomy in hypertrophic cardiomyopathy with labile obstruction.

PubMed

Prasad, Megha; Geske, Jeffrey B; Sorajja, Paul; Ommen, Steve R; Schaff, Hartzell V; Gersh, Bernard J; Nishimura, Rick A

2016-11-15

We aimed to assess the utility of changes in systolic and diastolic function by isoproterenol challenge in predicting symptom resolution post-myectomy in selected patients with hypertrophic cardiomyopathy (HCM) and labile obstruction. In a subset of symptomatic HCM patients without resting/provocable obstruction on noninvasive assessment, isoproterenol challenge during hemodynamic catheterization may elicit labile left ventricular outflow tract (LVOT) obstruction, and demonstrate the effect of obstruction on diastolic function. These changes may determine whether patients achieve complete symptom resolution post-myectomy. Between February 2003 and April 2009, 18 symptomatic HCM patients without LVOT obstruction on noninvasive testing underwent isoproterenol provocation and septal myectomy due to presence of provocable gradient and were followed for 4 (IQR 3-7) years. Thirteen (72.2%) had complete symptom resolution, while 5 (27.8%) had improved, but persistent symptoms. Those with provoked gradient >100 mm Hg or increase in left atrial pressure (LAP) with isoproterenol had symptom resolution. Symptomatic HCM patients without LVOT gradient on noninvasive testing may demonstrate labile obstruction with isoproterenol. With isoproterenol, patients with high LVOT gradient or increase in LAP concomitant with an increase in gradient achieved complete symptom resolution post-myectomy. Thus, improved diastolic filling as well as outflow gradient production in patients with HCM may predict symptom response to myectomy. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Genetic modification of human trabecular meshwork with lentiviral vectors.

PubMed

Loewen, N; Fautsch, M P; Peretz, M; Bahler, C K; Cameron, J D; Johnson, D H; Poeschla, E M

2001-11-20

Glaucoma, a group of optic neuropathies, is the leading cause of irreversible blindness. Neuronal apoptosis in glaucoma is primarily associated with high intraocular pressure caused by chronically impaired outflow of aqueous humor through the trabecular meshwork, a reticulum of mitotically inactive endothelial-like cells located in the angle of the anterior chamber. Anatomic, genetic, and expression profiling data suggest the possibility of using gene transfer to treat glaucomatous intraocular pressure dysregulation, but this approach will require stable genetic modification of the differentiated aqueous outflow tract. We injected transducing unit-normalized preparations of either of two lentiviral vectors or an oncoretroviral vector as a single bolus into the aqueous circulation of cultured human donor eyes, under perfusion conditions that mimicked natural anterior chamber flow and maintained viability ex vivo. Reporter gene expression was assessed in trabecular meshwork from 3 to 16 days after infusion of 1.0 x 10(8) transducing units of each vector. The oncoretroviral vector failed to transduce the trabecular meshwork. In contrast, feline immunodeficiency virus and human immunodeficiency virus vectors produced efficient, localized transduction of the trabecular meshwork in situ. The results demonstrate that lentiviral vectors permit efficient genetic modification of the human trabecular meshwork when delivered via the afferent aqueous circulation, a clinically accessible route. In addition, controlled comparisons in this study establish that feline and human immunodeficiency virus vectors are equivalently efficacious in delivering genes to this terminally differentiated human tissue.

Secondary chaotic terrain formation in the higher outflow channels of southern circum-Chryse, Mars

USGS Publications Warehouse

Rodriguez, J.A.P.; Kargel, J.S.; Tanaka, K.L.; Crown, D.A.; Berman, D.C.; Fairen, A.G.; Baker, V.R.; Furfaro, R.; Candelaria, P.; Sasaki, S.

2011-01-01

Higher outflow channel dissection in the martian region of southern circum-Chryse appears to have extended from the Late Hesperian to the Middle Amazonian Epoch. These outflow channels were excavated within the upper 1. km of the cryolithosphere, where no liquid water is expected to have existed during these geologic epochs. In accordance with previous work, our examination of outflow channel floor morphologies suggests the upper crust excavated by the studied outflow channels consisted of a thin (a few tens of meters) layer of dry geologic materials overlying an indurated zone that extends to the bases of the investigated outflow channels (1. km in depth). We find that the floors of these outflow channels contain widespread secondary chaotic terrains (i.e., chaotic terrains produced by the destruction of channel-floor materials). These chaotic terrains occur within the full range of outflow channel dissection and tend to form clusters. Our examination of the geology of these chaotic terrains suggests that their formation did not result in the generation of floods. Nevertheless, despite their much smaller dimensions, these chaotic terrains are comprised of the same basic morphologic elements (e.g., mesas, knobs, and smooth deposits within scarp-bound depressions) as those located in the initiation zones of the outflow channels, which suggests that their formation must have involved the release of ground volatiles. We propose that these chaotic terrains developed not catastrophically but gradually and during multiple episodes of nested surface collapse. In order to explain the formation of secondary chaotic terrains within zones of outflow channel dissection, we propose that the regional Martian cryolithosphere contained widespread lenses of volatiles in liquid form. In this model, channel floor collapse and secondary chaotic terrain formation would have taken place as a consequence of instabilities arising during their exhumation by outflow channel dissection. Within relatively warm upper crustal materials in volcanic settings, or within highly saline crustal materials where cryopegs developed, lenses of volatiles in liquid form within the cryolithosphere could have formed, and/or remained stable.In addition, our numerical simulations suggest that low thermal conductivity, dry fine-grained porous geologic materials just a few tens of meters in thickness (e.g., dunes, sand sheets, some types of regolith materials), could have produced high thermal anomalies resulting in subsurface melting. The existence of a global layer of dry geologic materials overlying the cryolithosphere would suggest that widespread lenses of fluids existed (and may still exist) at shallow depths wherever these materials are fine-grained and porous. The surface ages of the investigated outflow channels and chaotic terrains span a full 500 to 700. Myr. Chaotic terrains similar in dimensions and morphology to secondary chaotic terrains are not observed conspicuously throughout the surface of Mars, suggesting that intra-cryolithospheric fluid lenses may form relatively stable systems. The existence of widespread groundwater lenses at shallow depths of burial has tremendous implications for exobiological studies and future human exploration. We find that the clear geomorphologic anomaly that the chaotic terrains and outflow channels of southern Chryse form within the Martian landscape could have been a consequence of large-scale resurfacing resulting from anomalously extensive subsurface melt in this region of the planet produced by high concentrations of salts within the regional upper crust. Crater count statistics reveal that secondary chaotic terrains and the outflow channels within which they occur have overlapping ages, suggesting that the instabilities leading to their formation rapidly dissipated, perhaps as the thickness of the cryolithosphere was reset following the disruption of the upper crustal thermal structure produced during outflow channel ex

Comparing cosmological hydrodynamic simulations with observations of high- redshift galaxy formation

NASA Astrophysics Data System (ADS)

Finlator, Kristian Markwart

We use cosmological hydrodynamic simulations to study the impact of outflows and radiative feedback on high-redshift galaxies. For outflows, we consider simulations that assume (i) no winds, (ii) a "constant-wind" model in which the mass-loading factor and outflow speed are constant, and (iii) "momentum-driven" winds in which both parameters vary smoothly with mass. In order to treat radiative feedback, we develop a moment-based radiative transfer technique that operates in both post-processing and coupled radiative hydrodynamic modes. We first ask how outflows impact the broadband spectral energy distributions (SEDs) of six observed reionization-epoch galaxies. Simulations reproduce five regardless of the outflow prescription, while the sixth suggests an unusually bursty star formation history. We conclude that (i) simulations broadly account for available constraints on reionization-epoch galaxies, (ii) individual SEDs do not constrain outflows, and (iii) SED comparisons efficiently isolate objects that challenge simulations. We next study how outflows impact the galaxy mass metallicity relation (MZR). Momentum-driven outflows uniquely reproduce observations at z = 2. In this scenario, galaxies obey two equilibria: (i) The rate at which a galaxy processes gas into stars and outflows tracks its inflow rate; and (ii) The gas enrichment rate owing to star formation balances the dilution rate owing to inflows. Combining these conditions indicates that the MZR is dominated by the (instantaneous) variation of outflows with mass, with more-massive galaxies driving less gas into outflows per unit stellar mass formed. Turning to radiative feedback, we use post-processing simulations to study the topology of reionization. Reionization begins in overdensities and then "leaks" directly into voids, with filaments reionizing last owing to their high density and low emissivity. This result conflicts with previous findings that voids ionize last. We argue that it owes to the uniqely-biased emissivity field produced by our star formation prescriptions, which have previously been shown to reproduce numerous post-reionization constraints. Finally, preliminary results from coupled radiative hydrodynamic simulations indicate that reionization suppresses the star formation rate density by at most 10-20% by z = 5. This is much less than previous estimates, which we attribute to our unique reionization topology although confirmation will have to await more detailed modeling.

The Properties and Prevalence of Galactic Outflows at z ~ 1 in the Extended Groth Strip

NASA Astrophysics Data System (ADS)

Kornei, Katherine A.; Shapley, Alice E.; Martin, Crystal L.; Coil, Alison L.; Lotz, Jennifer M.; Schiminovich, David; Bundy, Kevin; Noeske, Kai G.

2012-10-01

We investigate galactic-scale outflowing winds in 72 star-forming galaxies at z ~ 1 in the Extended Groth Strip. Galaxies were selected from the DEEP2 survey and follow-up LRIS spectroscopy was obtained covering Si II, C IV, Fe II, Mg II, and Mg I lines in the rest-frame ultraviolet. Using Galaxy Evolution Explorer (GALEX), Hubble Space Telescope (HST), and Spitzer imaging available for the Extended Groth Strip, we examine galaxies on a per-object basis in order to better understand both the prevalence of galactic outflows at z ~ 1 and the star-forming and structural properties of objects experiencing outflows. Gas velocities, measured from the centroids of Fe II interstellar absorption lines, are found to span the interval [-217, +155] km s-1. We find that ~40% (10%) of the sample exhibits blueshifted Fe II lines at the 1σ (3σ) level. We also measure maximal outflow velocities using the profiles of the Fe II and Mg II lines; we find that Mg II frequently traces higher velocity gas than Fe II. Using quantitative morphological parameters derived from the HST imaging, we find that mergers are not a prerequisite for driving outflows. More face-on galaxies also show stronger winds than highly inclined systems, consistent with the canonical picture of winds emanating perpendicular to galactic disks. In light of clumpy galaxy morphologies, we develop a new physically motivated technique for estimating areas corresponding to star formation. We use these area measurements in tandem with GALEX-derived star formation rates (SFRs) to calculate SFR surface densities. At least 70% of the sample exceeds an SFR surface density of 0.1 M ⊙ yr-1 kpc-2, the threshold necessary for driving an outflow in local starbursts. At the same time, the outflow detection fraction of only 40% in Fe II absorption provides further evidence for an outflow geometry that is not spherically symmetric. We see a ~3σ trend between outflow velocity and SFR surface density, but no significant trend between outflow velocity and SFR. Higher resolution data are needed in order to test the scaling relations between outflow velocity and both SFR and SFR surface density predicted by theory. Based, in part, on data obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California, and NASA, and was made possible by the generous financial support of the W. M. Keck Foundation.

Volcanic Structures Within Niger and Dao Valles, Mars, and Implications for Outflow Channel Evolution and Hellas Basin Rim Development

NASA Astrophysics Data System (ADS)

Korteniemi, J.; Kukkonen, S.

2018-04-01

Outflow channel formation on the eastern Hellas rim region is traditionally thought to have been triggered by activity phases of the nearby volcanoes Hadriacus and Tyrrhenus Montes: As a result of volcanic heating subsurface volatiles were mobilized. It is, however, under debate, whether eastern Hellas volcanism was in fact more extensive, and if there were volcanic centers separate from the identified central volcanoes. This work describes previously unrecognized structures in the Niger-Dao Valles outflow channel complex. We interpret them as volcanic edifices: cones, a shield, and a caldera. The structures provide evidence of an additional volcanic center within the valles and indicate volcanic activity both prior to and following the formation of the outflow events. They expand the extent, type, and duration of volcanic activity in the Circum-Hellas Volcanic Province and provide new information on interaction between volcanism and fluvial activity.

Pericardial tissue valves and Gore-Tex conduits as an alternative for right ventricular outflow tract replacement in children.

PubMed

Allen, Bradley S; El-Zein, Chawki; Cuneo, Betina; Cava, Joseph P; Barth, Mary Jane; Ilbawi, Michel N

2002-09-01

There is still no perfect conduit for reconstruction of the right ventricular outflow tract (RVOT) in children. Homografts are not always available in the appropriate size, and degenerate in a few years. This study evaluates the pericardial valve with Gore-Tex conduit as an alternative for RVOT construction. From January 1, 1993, to September 30, 1999, a pericardial tissue valve was inserted in all patients undergoing RVOT reconstruction or pulmonary valve replacement (PVR) who were large enough to accommodate a tissue valve. In patients without a native main pulmonary artery, a new technique was used to construct an RV-PA conduit out of a flat sheet of Gore-Tex, as Dacron frequently leads to stenosis. Data were collected by retrospective review, follow-up echocardiograms, and assessment by a single cardiologist. There were 48 patients, 22 undergoing a PVR alone and 26 a RV-PA valved Gore-Tex conduit. Diagnosis included tetralogy of Fallot (n = 25); truncus arteriosis (n = 9); ventricular septal defect with PA (n = 5); DORV (n = 4); D-TGA with PS (n = 2); and 1 each IAA with sub AS, VSD with PI, and PS s/p Ross procedure. Patient age ranged from 3 to 33 years and 98% were reoperations. The valve sizes ranged from 19 to 33 mm and the median hospital length of stay was 4 days. There were 2 (4.2%) perioperative and 1 (2.1%) late deaths, none related to the valve or Gore-Tex conduit. At a follow-up of 15 to 86 months (mean 43 +/- 16 months), all remaining 45 patients are New York Heart Association class I, all valves are functional, and no patient has required valve or conduit replacement or revision; more importantly, echocardiogram revealed no significant valve or conduit stenosis (mean gradient 16 +/- 8 mm Hg) and no evidence of regurgitation or structural degeneration. A pericardial tissue valve and Gore-Tex conduit provides a reliable alternative for RVOT reconstruction in pediatric patients. It is readily available, molds in the limited retrosternal space, and has outstanding intermediate results with no evidence of failure or deterioration up to 7 years after insertion.

[Non-pharmacologic therapy of hypertrophic obstructive cardiomyopathy--results of therapy based on percutaneous transluminal septal myocardial ablation compared with results of dual-chamber cardiac pacing].

PubMed

Krejcí, J; Groch, L; Meluzín, J; Vykypel, T; Halámek, J; Vitovec, J

2006-04-01

Percutaneous transluminal septal myocardial ablation (PTSMA) and pacemaker (PM) therapy with apical preexcitation are therapeutic options for hypertrophic obstructive cardiomyopathy (HOCM) patients with symptoms despite pharmacological therapy. evaluation and comparison of treatment results of PTSMA and PM implantation. 22 HOCM patients (NYHA class III and IV) with left ventricle outflow tract gradient (LVOTG) at rest more than 30 mm Hg. In group A were evaluated 11 patients treated by PTSMA. Left ventricle outflow tract gradient (LVOTG) was 90.5 +/- 16.0 mm Hg, NYHA class 3.1 +/- 0.2. Group B included 11 patients treated by dual chamber PM implantation, LVOTG in this group was 105 +/- 48 mm Hg, NYHA class 3.0 +/- 0.4. NYHA class in the group A decreased after treatment to 1.8 +/- 0.6 (p < 0.01), LVOTG to 24 +/- 12 mm Hg (p < 0.001). There was observed significant decrease in grade of systolic anterior motion (SAM), interventricular septum (IVS) thickness and left atrium (LA) size. Left ventricle end systolic diameter (LV SD) and left ventricle end diastolic diameter (LV DD) increased during follow-up. Decrease of NYHA class in the group B was to 2.1 +/- 0.6 (p < 0.001), LVOTG to 25.5 +/- 21.0 mm Hg (p < 0.001). Changes of other parameters in the group B were not significant, except decrease of SAM. Comparison of both groups: NYHA class change PTSMA/PM: 1.3 +/- 0.6/0.9 +/- 0.4 (p < 0.05), LVOTG change PTSMA/PM: -66 +/- 20/-79 +/- 46 mm Hg (p = n.s.). LV SD assessment comparison of LV SD change PTSMA/PM: 5 +/- 5/1 +/- 5 mm (p < 0.05). LA assessment - comparison of LA change PTSMA/PM: 5 +/- 5/-1 +/- 4 mm (p < 0.05). Other changes were not significant. Both therapeutic approaches - PTSMA and PM implantation - resulted in significant improvement of functional capacity assessed by NYHA classification. Decrease of LVOTG was also significant and was similar in both groups, NYHA class improvement as well as LA size decrease and LV DS increase were more expressed in PTSMA group.

Double-Outlet Right Ventricle With Noncommitted Ventricular Septal Defect and 2 Adequate Ventricles: Is Anatomical Repair Advantageous?

PubMed

Villemain, Olivier; Bonnet, Damien; Houyel, Lucile; Vergnat, Mathieu; Ladouceur, Magalie; Lambert, Virginie; Jalal, Zakaria; Vouhé, Pascal; Belli, Emre

The management of double-outlet right ventricle associated with anatomically noncommitted ventricular septal defect constitutes a surgical challenge. The limits for, and the specific outcomes after anatomical vs univentricular repair still remain to be established. Between 1993 and 2011, 36 consecutive patients presenting with double-outlet right ventricle or noncommitted ventricular septal defect (21 inlet, 10 muscular, and 5 central perimembranous) and 2 adequately sized ventricles underwent surgical repair at 2 centers. Right ventricular outflow tract obstruction was present in 18 of 36 patients (50%). A total of 21 patients had undergone previous palliative procedures. Anatomical repair (group I) by means of intraventricular baffle construction was performed in 24 (associated right ventricular outflow tract reconstruction in 12 and arterial switch in 5) at a median age of 10.5 months. Ventricular septal defect was surgically enlarged in 12 (50%) patients. The remaining 12 patients underwent univentricular repair (group II). There were 4 hospital deaths (11%), all in group I (P = 0.30 vs group II). A total of 8 of 20 patients in group I survivors underwent 13 reoperations after a median delay of 24 months: subaortic stenosis was the main cause for reoperation in 6 of 8 patients. There was 1 late death in group I and 2 late deaths in group II. The median follow-up was 5.6 years (95% CI: 0.2-9.8). The 10- year actuarial survival rate and freedom from reoperation were 74.7 ± 5% and 58 ± 5% in group I and 71 ± 7% and 70 ± 7% in group II, respectively. At the last visit, all survivors were in New York Heart Association class I-II. Univariate analysis showed that atrioventricular septal defect and isolated mitral cleft were associated with death (P = 0.04) and need for reoperation (P = 0.038). In conclusion, anatomical repair, associated with substantial rates of mortality and need for reoperation, should be considered with caution. Associated atrioventricular septal defect and isolated mitral cleft were the only risk factors for mortality and reoperation. Copyright © 2016 Elsevier Inc. All rights reserved.

Homograft conduit failure in infants is not due to somatic outgrowth.

PubMed

Wells, Winfield J; Arroyo, Hector; Bremner, Ross M; Wood, John; Starnes, Vaughn A

2002-07-01

It has been assumed that the need for homograft replacement is due to somatic outgrowth, but this has not been adequately studied. Our objective was to identify reasons for homograft conduit failure. The records and imaging studies of 40 patients undergoing homograft conduit replacement of the right ventricular outflow tract from 1996 to 2000 were retrospectively reviewed. The majority of patients had a diagnosis of tetralogy of Fallot (n = 20) and truncus arteriosus (n = 13). The median age at the initial operation was 8 months (0.25-108 months). The initial homograft sizes ranged from 9 to 22 mm, and 28 conduits were of pulmonary origin. When comparing size of the initial homograft with patients' expected pulmonary valve diameter (z = 0), oversizing was noted to be +3 (range, 0.83-5.4). Median interval to conduit failure was 5.3 years (0.83-11.3 years). At homograft replacement, only 12 patients had an existing conduit that was 1 SD below the homograft conduit size needed (z < or = -1). Most conduits had important regurgitation, but this was rarely a primary reason for reintervention (n = 1). Reoperation was usually required for stenosis, with a median gradient of 53 mm Hg (20-140 mm Hg). Stenosis was further categorized angiographically as follows: homograft valvular stenosis (shrinkage; 21/40 [53%]), distal anastomotic stenosis (4/40 [10%]), conduit kinking (3/40 [8%]), sternal compression (3/40 [8%]), posterior shelf impingement (2/40 [5%]), and somatic outgrowth (3/40 [8%]). Replacement in 2 patients was for proximal hood aneurysm. Several patients (7/40 [18%]) had stenosis at multiple levels. The average decrease in conduit diameter was 47% (28%-73%). Somatic outgrowth is seldom a primary reason for homograft conduit replacement of the right ventricular outflow tract. The most common cause for failure is conduit obstruction with thickening and shrinkage at the annular area. Conduit stenosis was responsible for failure in 53% of patients, technical issues were responsible for 30%, and only 8% failed as a result of somatic outgrowth. Placement of a smaller homograft (z = 0) at the initial operation may decrease the incidence of conduit kinking, sternal compression, and posterior shelf impingement.

Effects of systolic anterior motion of the mitral valve on haemodynamics. Evaluation by a direct method.

PubMed

Kaku, T; Sakurai, S; Furuno, Y; Yashiro, A; Nakashima, Y; Kuroiwa, A

1995-08-01

We evaluated the effects of systolic anterior motion systolic anterior motion of the mitral valve on cardiac haemodynamics. Seven adult mongrel dogs in which systolic anterior motion-septal contact was observed after dobutamine administration were used. To exclude the effects of left ventricular function and morphology, a stone removal basket catheter was placed in the left ventricular outflow tract, and haemodynamics were compared with the basket closed and opened. The basket was opened five times in three dogs not showing systolic anterior motion-septal contact, but the basket itself did not effect the haemodynamics. In the seven dogs that showed systolic anterior motion-septal contact without left ventricular hypertrophy, the basket was opened a total of 33 times in the presence of various degrees of systolic anterior motion-septal contact. After opening the basket, systolic anterior motion was reduced echocardiographically, and significant (P<0.01) changes were observed in the left ventricle-aorta pressure gradient (from 68 +/- 22 to 25 +/- 15 mm Hg), the systolic ejection period (from 146 +/- 19 to 135 +/- 16 ms), and the stroke volume (SV; from 9.4 +/- 2.9 to 10.1 +/- 3.3 ml). After basket inflation, aortic pressure and aortic flow waveforms changed but the peak pressure and flow velocity did not. The temporal distribution of left ventricular ejection also definitely changed after the basket was opened. No changes were observed in the peak dp/dt, peak negative dp/dt, time constant, left ventricular end-diastolic pressure, or left atrial pressure. These observations in this animal model of systolic anterior motion without left ventricular hypertrophy suggest that: (1) there is no potential for generation of an intra-cavity gradient in the absence of systolic anterior motion of the mitral valve, so that (2) systolic anterior motion narrowed the left ventricular outflow tract and, consequently, produced the systolic ejection period, and affected the left ventricular ejection dynamics, and that (3) the basket catheter is useful because it allows these assessments in the same heart with a nearly fixed left ventricular contractility, at least in our animal model.

Auscultation and echocardiographic findings in Bull Terriers with and without polycystic kidney disease.

PubMed

O'Leary, C A; Mackay, B M; Taplin, R H; Atwell, R B

2005-05-01

To investigate a possible association between Bull Terrier polycystic kidney disease (BTPKD) and cardiac disease, to determine the prevalence of mitral valve disease (MVD) and left ventricular outflow tract obstruction (LVOTO) in the Australian Bull Terrier population, and to compare auscultation and echocardiography in detection of cardiac disease in Bull Terriers. Ninety-nine Bull Terriers, ranging in age from 8 weeks to 13 years and 11 months were auscultated and examined using renal ultrasonography; 86 were also examined using echocardiography. The prevalence and severity of heart defects in dogs with BTPKD was compared with that in dogs without BTPKD. Nineteen of these 99 dogs were diagnosed with BTPKD. Forty-two percent of Bull Terriers with BTPKD and 28% of those without BTPKD had murmurs characteristic of mitral regurgitation or LVOTO. How recently an animal was descended from an ancestor with BTPKD was associated with presence (P = 0.008) and loudness of a murmur (P = 0.009). Overall, echocardiography detected MVD in 39% of Bull Terriers, with increased prevalence in older animals (P = 0.003). Mitral stenosis was found in eight cases. Fifty-three percent of dogs in this study had evidence of LVOTO, with obstruction consisting of a complex of lesions including dynamic or fixed subvalvular LVOTO, significantly narrowed left ventricular outflow tract or valvular aortic stenosis. Dogs with BTPKD, or those descended from dogs with BTPKD, were more likely to have MVD (P = 0.006), and while LVOTO was not more common in these dogs, if they did have LVOTO, they were more likely to have severe obstruction than dogs with no ancestors with BTPKD (analysed in three ways P = 0.028 to 0.001). In this study, 46% of Bull Terriers without a murmur or arrhythmia had cardiac disease detected on echocardiographic examination. Cardiac disease, especially MVD and LVOTO, was common in Bull Terriers in this study, and those with BTPKD had an increased risk of cardiac abnormalities. Auscultation did not detect a significant number of Bull Terriers with cardiac disease.

Right ventricular outflow tract high-density endocardial unipolar voltage mapping in patients with Brugada syndrome: evidence for electroanatomical abnormalities.

PubMed

Letsas, Konstantinos P; Efremidis, Michael; Vlachos, Konstantinos; Georgopoulos, Stamatis; Karamichalakis, Nikolaos; Asvestas, Dimitrios; Valkanas, Kosmas; Korantzopoulos, Panagiotis; Liu, Tong; Sideris, Antonios

2017-05-02

Epicardial structural abnormalities at the right ventricular outflow tract (RVOT) may provide the arrhythmia substrate in Brugada syndrome (BrS). Electroanatomical endocardial unipolar voltage mapping is an emerging tool that accurately identifies epicardial abnormalities in different clinical settings. This study investigated whether endocardial unipolar voltage mapping of the RVOT detects electroanatomical abnormalities in patients with BrS. Ten asymptomatic patients (8 males, 34.5 ± 11.2 years) with spontaneous type 1 ECG pattern of BrS and negative late gadolinium enhancement-cardiac magnetic resonance imaging (LGE-c-MRI) underwent high-density endocardial electroanatomical mapping (>800 points). Using a cut-off of 1 mV and 4 mV for normal bipolar and unipolar voltage, respectively, derived from 20 control patients without structural heart disease established by LGE-c-MRI, the extend of low-voltage areas within the RVOT was estimated using a specific calculation software. The mean RVOT area presenting low-voltage bipolar signals in BrS patients was 3.4 ± 1.7 cm2 (range 1.5-7 cm2). A significantly greater area of abnormal unipolar signals was identified (12.6 ± 4.6 cm2 [range 7-22 cm2], P: 0.001). Both bipolar and unipolar electroanatomical abnormalities were mainly located at the free wall of the RVOT. The mean RVOT activation time was significantly prolonged in BrS patients compared to control population (86.4 ± 16.5 vs. 63.4 ± 9.7 ms, P < 0.001). Isochronal mapping demonstrated lines of conduction slowing within the RVOT in 8/10 BrS patients. Wide areas of endocardial unipolar voltage abnormalities that possibly reflect epicardial structural abnormalities are identified at the RVOT of BrS patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Geologic map of MTM -40252 and -40257 quadrangles, Reull Vallis region of Mars

USGS Publications Warehouse

Mest, Scott C.; Crown, David A.

2002-01-01

Mars Transverse Mercator (MTM) quadrangles -40252 and -40257 cover a portion of the highlands of Promethei Terra northeast of the Hellas basin. The map area consists of heavily cratered ancient highland materials of moderate to high relief, isolated knobs and massifs of rugged mountainous materials, extensive tracts of smooth and channeled plains, and other surficial deposits. Reull Vallis, an approximately 1,500 km-long outflow channel system, cuts through the southeast corner of the map area. Regional slopes are to the southwest, toward the Hellas basin, as indicated by Martian topographic maps and the orientations of channels along the northeast rim of the Hellas basin. The Martian highlands cover more than 60 percent of the planet's surface and are primarily in the southern hemisphere. Most of the highlands consist of rugged, densely cratered terrains believed to represent the final phase of heavy bombardment in the inner solar system about 4.0 billion years ago. Parts of the Martian highlands show evidence of extensive degradation and modification. The map area shows landforms created by numerous geologic processes, including tectonism, fluvial activity, and mass wasting. The occurrence of fluvial features, such as outflow channels and valley networks, has significant implications for past Martian conditions. Determining the geology of the highlands northeast of the Hellas basin provides a better understanding of the role and timing of volatile-driven activity in the evolution of the highlands. Photogeologic mapping at 1:500,000 scale from analysis of Viking Orbiter images complements geomorphic studies of Reull Vallis and other highland outflow systems, of drainage networks, and of highland debris aprons and regional geologic mapping studies of the highlands at the 1:2,000,000 scale and 1:1,000,000 scale. Crater size-frequency distributions have been compiled to constrain the relative ages of geologic units and determine the timing and extents of the observed geologic processes.

Ionospheric Outflow in the Magnetosphere: Circulation and Consequences

NASA Astrophysics Data System (ADS)

Welling, D. T.; Liemohn, M. W.

2017-12-01

Including ionospheric outflow in global magnetohydrodynamic models of near-Earth outer space has become an important step towards understanding the role of this plasma source in the magnetosphere. Such simulations have revealed the importance of outflow in populating the plasma sheet and inner magnetosphere as a function of outflow source characteristics. More importantly, these experiments have shown how outflow can control global dynamics, including tail dynamics and dayside reconnection rate. The broad impact of light and heavy ion outflow can create non-linear feedback loops between outflow and the magnetosphere. This paper reviews some of the most important revelations from global magnetospheric modeling that includes ionospheric outflow of light and heavy ions. It also introduces new advances in outflow modeling and coupling outflow to the magnetosphere.

Does altered myogenic activity contribute to OAB symptoms from detrusor overactivity? ICI-RS 2013.

PubMed

Chacko, Sam; Cortes, Eduard; Drake, Marcus J; Fry, Christopher H

2014-06-01

To highlight novel experimental approaches that test if the Myogenic Hypothesis remains viable as a contributor to the aetiology of detrusor overactivity. To summarise the conclusions of a workshop held under the auspices of ICI-RS in 2013. Several theories may explain the pathology of detrusor overactivity and include a myogenic theory with fundamental changes to detrusor muscle excitation-contraction coupling. The isolated bladder displays micromotions that do not normally translate into significant changes of intravesical pressure. However, their amplitude and frequency are altered in animal models of bladder dysfunction. The origin of micromotions, if they generate significant changes of intravesical pressure and contribute to urinary tract sensations remain unanswered. Within the myocyte, changes to contractile protein phosphorylation through accessory proteins and cytoplasmic regulatory pathways occur in lower urinary tract pathologies associated with detrusor overactivity. Furthermore, myocytes isolated from overactive human bladders generate greater spontaneous activity, but a complete description of changes to ionic currents remains to be characterised. Finally, several growth factors, including mechano-growth factor, are released when bladder wall stress is increased, as with outflow obstruction. However the phenotype of the transformed detrusor myocytes remains to be measured. A number of lines of evidence suggest that the Myogenic Hypothesis remains viable as a contributor to detrusor overactivity. © 2014 Wiley Periodicals, Inc.

Crista Supraventricularis Purkinje Network and Its Relation to Intraseptal Purkinje Network.

PubMed

De Almeida, Marcos C; Araujo, Mayssa; Duque, Mathias; Vilhena, Virginia

2017-10-01

Using transparent specimens with a dual color injection, microscopy, and computer tomography, this report shows that the right and left ventricular subendocardial Purkinje networks are connected by an extensive septal network in the bovine heart. The septal network is present along the entire septum except at a free zone below ventricular valves. Being the only communication of the basal right septum with the right free wall, the supraventricular crest is an enigmatic but not, by any means, hidden muscular structure. It is one of the last structures to be activated in human heart. It is shown here that the supraventricular crest Purkinje network connects the anterosuperior right ventricular basal free wall Purkinje network to anterior right ventricular basal septal Purkinje network. It is suggested that the stimulus initiated at middle left ventricular endocardium will activate the supraventricular crest. The intraseptal connection found between the basal left ventricular subendocardial septal Purkinje network and the right ventricular basal septal Purkinje network is, probably, the pathway for the stimulus. An anatomic basis is provided to explain why the inflow tract contracts earlier than the outflow tract in the right ventricle systole. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:1793-1801, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Northwestern Tharsis Latent Outflow Activity Mars

NASA Technical Reports Server (NTRS)

Dohm, J. M.; Anderson, R. C.; Baker, V. R.; Ferris, J. C.; Hare, T. M.; Strom, R. G.; Rudd, L.; Rice, J. W., Jr.; Scott, D. H.

2000-01-01

Previously defined outflow channels, which are indicated by relict landforms similar to those observed on Earth, signify ancient catastrophic flood events on Mars. These conspicuous geomorphic features are some of the most remarkable yet profound discoveries made by geologists to date. These outflow channels, which debouched tremendous volumes of water into topographic lows such as Chryse, Utopia, Elysium, and Hellas Planitiae, may represent the beginning of warmer and wetter climatic periods unlike the present-day cold and dry Mars. In addition to the previously identified outflow channels, observations permitted by the newly acquired Mars Orbiter Laser Altimeter (MOLA) data have revealed a system of gigantic valleys, referred to as the northwestern slope valleys (NSV), that are located to the northwest of a huge shield volcano, Arsia Mons, western hemisphere of Mars. These features generally correspond spatially to gravity lows similar to the easternmost, circum-Chryse outflow channel systems. Geologic investigations of the Tharsis region suggest that the large valley system pre-dates the construction of Arsia Mons and its extensive associated lava flows of mainly Late Hesperian and Amazonian age and coincides stratigraphically with the early development of the circum-Chryse outflow channel systems that debouch into Chryse Planitia. This newly identified system, the NSV, potentially signifies the largest flood event(s) ever recorded for the solar system. Additional information is contained in original extended abstract.

[Experience of Mitral Valve Replacement Using a Pulmonary Autograft (Ross II Operation) in an Infant;Report of a Case].

PubMed

Kawahito, Tomohisa; Egawa, Yoshiyasu; Yoshida, Homare; Shimoe, Yasushi; Onishi, Tatsuya; Miyagi, Yuhichi; Terada, Kazuya; Ohta, Akira

2015-07-01

A 24-day-old boy suddenly developed progressive heart failure and was transported to our hospital. Echocardiography showed massive mitral regurgitation due to chordal rupture. Mitral valve repair was performed at 28 days of life, but postoperative valvular function was not satisfactory. A mechanical valve was implanted in the supra-annular position at 37 days of life. Two months after valve replacement, the mechanical valve was suddenly stuck. Emergent redo valve replacement was performed, but the prosthetic valve became stuck again 2 months after the 3rd operation, despite sufficient anti-coagulation therapy. At the 4th operation (6 months after birth), we implanted a pulmonary autograft in the mitral position instead of another mechanical valve in an emergent operation. The right ventricular outflow tract was reconstructed with a valved conduit. A postoperative catheter examination, which was performed 1 year after the Ross II operation, showed mild mitral stenosis with no regurgitation. Previous reports of Ross II operations in infants are rare and long-term results are unknown. However, we advocate that this procedure should be a rescue operation for mitral valve dysfunction in the early period of infants.

Transcatheter closure of moderate-to-large patent ductus arteriosus in infants using Amplatzer duct occluder.

PubMed

Wang, Jou-Kou; Wu, Mei-Hwan; Lin, Ming-Tai; Chiu, Shuenn-Nan; Chen, Chun-An; Chiu, Hsin-Hui

2010-02-01

There are difficulties in transcatheter closure of patent ductus arteriosus (PDA) in infants. The 46 infants (mean age 6.2+/-2.7 months; mean body weight 6.3+/-1.6 kg) who underwent PDA closure using the Amplatzer duct occluder (ADO). The indication for using an ADO was a ductus diameter > or =2.5 or 3 mm. Device diameter selected was 1-3 mm larger than ductal diameter. The mean systolic pulmonary artery pressure was 40.9+/-18.2 mmHg. The mean Qp/Qs ratio was 3.1+/-1.2. The mean ductus diameter was 3.3+/-0.8 mm. ADO was successfully deployed in 45 patients. Failure occurred in 1 case. The mean diameter of device used was 5.4+/-1.1 mm. No severe complications occurred. At the 1-month echocardiographic follow-up, a small residual shunt was present in 4 of 45 patients and had disappeared in all 4 patients at the 3-month follow-up. One patient developed a moderate degree of left ventricular outflow tract obstruction 2.3 years after the procedure. Transcatheter closure of PDA in infants using the ADO is a safe and effective method.

Invited Review: The Myosins: Exploration of the Development of Our Current Understanding of These Mutations in the Motor

PubMed Central

Moore, Jeffrey R.; Leinwand, Leslie; Warshaw, David M.

2013-01-01

Hypertrophic (HCM) and dilated (DCM) cardiomyopathies are inherited diseases with a high incidence of death due to electrical abnormalities or outflow tract obstruction. In many of the families afflicted with either disease, causative mutations have been identified in various sarcomeric proteins. In this review, we focus on mutations in the cardiac muscle molecular motor, myosin and its associated light chains. Despite the >300 identified mutations there is still no clear understanding of how these mutations within the same myosin molecule can lead to the dramatically different clinical phenotypes associated with HCM and DCM. Localizing mutations within myosin’s molecular structure provides insight into the potential consequence of these perturbations to key functional domains of the motor. Review of biochemical and biophysical data that characterize the functional capacities of these mutant myosins suggests that mutant myosins with enhanced contractility lead to HCM while those displaying reduced contractility lead to DCM. With gain and loss of function potentially being the primary consequence of a specific mutation, how these functional changes trigger the hypertrophic response and lead to the distinct HCM and DCM phenotypes will be the future investigative challenge. PMID:22821910

The Feedback of Star Formation Based on Large-scale Spectroscopic Mapping Technology

NASA Astrophysics Data System (ADS)

Li, H. X.

2017-05-01

Star Formation is a fundamental topic in astrophysics. Although there is a popular model of low-mass star formation, every step of the process is full of physical and chemical complexity. One of the key questions is the dynamical feedback during the process of star formation. The answer of this question will help us to understand the star formation and the evolution of molecular clouds. We have identified outflows and bubbles in the Taurus molecular cloud based on the ˜ 100 deg2 Five College Radio Astronomy Observatory 12CO(1-0) and 13CO(1-0) maps and the Spitzer young stellar object (YSO) catalog. In the main 44 deg2 area of Taurus, we found 55 outflows, of which 31 were previously unknown. We also found 37 bubbles in the entire 100 deg2 area of Taurus, all of which had not been identified before. After visual inspection, we developed an interactive IDL pipeline to confirm the outflows and bubbles. This sample covers a contiguous region with a linear spatial dynamic range of ˜ 1000. Among the 55 outflows, we found that bipolar, monopolar redshifted, and monopolar blueshifted outflows account for 45%, 44%, and 11%, respectively. There are more red lobes than blue ones. The occurrence of more red lobes may result from the fact that Taurus is thin. Red lobes tend to be smaller and younger. The total mass and energy of red lobes are similar to blue lobes on average. There are 3 expanding bubbles and 34 broken bubbles among all the bubbles in Taurus. There are more outflow-driving YSOs in Class I, Flat, and Class II while few outflow-driving YSOs in Class III, which indicates that outflows more likely appear in the earlier stage (Class I) than in the later phase (Class III) of star formation. There are more bubble-driving YSOs of Class II and Class III while there are few bubble-driving YSOs of Class I and Flat, implying that the bubble structures are more likely to occur in the later stage of star formation. The total kinetic energy of the identified outflows is estimated to be ˜ 3.9 × 1045 erg, which is 1% of the cloud turbulent energy. The total kinetic energy of the detected bubbles is estimated to be ˜ 9.2 × 1046 erg, which is 29% of the turbulent energy of Taurus. The energy injection rate from the outflows is ˜ 1.3 × 1033 erg s-1, 0.4-2 times the turbulent dissipation rate of the cloud. The energy injection rate from bubbles is ˜ 6.4 × 1033 erg s-1, 2-10 times the turbulent dissipation rate of the cloud. The gravitational binding energy of the cloud is ˜ 1.5 × 1048 erg, 385 and 16 times the energy of outflows and bubbles, respectively. We conclude that neither outflows nor bubbles can provide sufficient energy to balance the overall gravitational binding energy and the turbulent energy of Taurus. However, in the current epoch, stellar feedback is sufficient to maintain the observed turbulence in Taurus. We studied the methods of spectral data processing for large-scale surveys, which is helpful in developing the data-processing software of FAST (Five-hundred-meter Aperture Spherical radio Telescope).

Genetic modifiers of Velo- cardio- facial syndrome/DiGeorge syndrome

PubMed Central

Aggarwal, Vimla S.; Morrow, Bernice E.

2009-01-01

Velo-cardio-facial syndrome/DiGeorge syndrome (VCFS/DGS), the most common micro-deletion disorder in humans, is characterized by craniofacial, parathyroid and thymic defects as well as cardiac outflow tract malformations. Most patients have a similar hemizygous 3 million base pair deletion on 22q11.2. Studies in mouse have shown that Tbx1, a T- box containing transcription factor present on the deleted region, is likely responsible for the etiology of the syndrome. Furthermore, mutations in TBX1 have been found in rare non-deleted patients. Despite having the same sized deletion, most VCFS/DGS patients exhibit significant clinical variability. Stochastic, environmental and genetic factors likely modify the phenotype of patients with the disorder. Here, we review mouse genetics studies which may help identify genetic modifiers for VCFS/DGS. PMID:18636633

Validity of /sup 99m/Tc dimercaptosuccinic acid renal uptake for an assessment for individual kidney function

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kawamura, J.; Hosakawa, S.; Yoshida, O.

/sup 99m/Tc dimercaptosuccinic acid is a new renal scanning agent that provides a good quality of renal image as a result of preferential cortical accumulation and also makes feasible a quantitative assessment of separate kidney function, correlating well with renal plasma flow obtained from a /sup 131/I hippuran renogram of each kidney. By measuring the dimercaptosuccinic acid uptake, the cortical functioning nephrons can be determined independent of the activity from the urinary outflow tract. Such evaluations may replace the conventional split renal function study in which traumatic procedures, such as cystoscopy and ureteral catheterizations, are required. /sup 99m/Tc dimercaptosuccinic acidmore » scintigraphy causes less discomfort to the patient and can be performed repeatedly and routinely even in children and debilitated geriatric patients.« less

Observations of Water Vapor Outflow from NML Cygnus

NASA Astrophysics Data System (ADS)

Zubko, Viktor; Li, Di; Lim, Tanya; Feuchtgruber, Helmut; Harwit, Martin

2004-07-01

We report new observations of the far-infrared and submillimeter water vapor emission of NML Cygnus based on data gathered with the Infrared Space Observatory and the Submillimeter Wave Astronomy Satellite. We compare the emission from NML Cyg to that previously published for VY CMa and W Hya in an attempt to establish the validity of recently proposed models for the outflow from evolved stars. The data obtained support the contention by Ivezić & Elitzur that the atmospheres of evolved stars obey a set of scaling laws in which the optical depth of the outflow is the single most significant scaling parameter, affecting both the radiative transfer and the dynamics of the outflow. Specifically, we provide observations comparing the water vapor emission from NML Cyg, VY CMa, and W Hya and find, to the extent permitted by the quality of our data, that the results are in reasonable agreement with a model developed by Zubko & Elitzur. Using this model we derive a mass loss based on the dust opacities, spectral line fluxes, and outflow velocities of water vapor observed in the atmospheres of these oxygen-rich giants. For VY CMa and NML Cyg, we also obtain an estimate of the stellar mass.

Budgets and chemical characterization of groundwater for the Diamond Valley flow system, central Nevada, 2011–12

USGS Publications Warehouse

Berger, David L.; Mayers, C. Justin; Garcia, C. Amanda; Buto, Susan G.; Huntington, Jena M.

2016-07-29

The pre-development, steady state, groundwater budget for the Diamond Valley flow system was estimated at about 70,000 acre-ft/yr of inflow and outflow. During years 2011–12, inflow components of groundwater recharge from precipitation and subsurface inflow from adjacent basins totaled 70,000 acre-ft/yr for the DVFS, whereas outflow components included 64,000 acre-ft/yr of groundwater evapotranspiration and 69,000 acre-ft/yr of net groundwater withdrawals, or net pumpage. Spring discharge in northern Diamond Valley declined about 6,000 acre-ft/yr between pre-development time and years 2011–12. Assuming net groundwater withdrawals minus spring flow decline is equivalent to the storage change, the 2011–12 summation of inflow and storage change was balanced with outflow at about 133,000 acre-ft/yr.

Intermittent Reconnection Downflow Enhancements In A Simulated Flux Rope Eruption

NASA Astrophysics Data System (ADS)

Kliem, Bernhard; Linton, M. G.

2009-05-01

Supra-arcade downflows in X-ray and EUV flare emissions and post-eruption inflows in coronagraph data have been interpreted to be signatures of the downward reconnection outflow from a vertical (flare) current sheet. These downflows show an intermittent occurrence pattern, indicating that the reconnection is bursty in time or patchy in space, or both. We present MHD simulations of such reconnection in the realistic configuration of a vertical current sheet formed beneath and driven by an erupting flux rope. The reconnection is found to develop bursty outflows, both upward and downward, with the upward outflows generally showing the stronger variablity. While the reconnection starts early in the rise of the flux rope and its peak upward outflow velocity is closely correlated with the rope's rise velocity, the burstiness develops in a clear fashion only as the rope's height has increased from the initial position by about an order of magnitude, so that the current sheet has reached a sufficient vertical extent. The reconnection downflow shows a series of enhancements, each of them starting at a successively greater height from a newly developed magnetic X line. The plasma temporarily accelerated downward in such an enhancement soon turns into a gradual deceleration and then eventually comes to rest on top of previously accelerated plasma. These findings are consistent with the observations of intermittent downflows.

Fast breeder reactor protection system

DOEpatents

van Erp, J.B.

1973-10-01

Reactor protection is provided for a liquid-metal-fast breeder reactor core by measuring the coolant outflow temperature from each of the subassemblies of the core. The outputs of the temperature sensors from a subassembly region of the core containing a plurality of subassemblies are combined in a logic circuit which develops a scram alarm if a predetermined number of the sensors indicate an over temperature condition. The coolant outflow from a single subassembly can be mixed with the coolant outflow from adjacent subassemblies prior to the temperature sensing to increase the sensitivity of the protection system to a single subassembly failure. Coherence between the sensors can be required to discriminate against noise signals. (Official Gazette)

Understanding satellite-based monthly-to-seasonal reservoir outflow estimation as a function of hydrologic controls

NASA Astrophysics Data System (ADS)

Bonnema, Matthew; Sikder, Safat; Miao, Yabin; Chen, Xiaodong; Hossain, Faisal; Ara Pervin, Ismat; Mahbubur Rahman, S. M.; Lee, Hyongki

2016-05-01

Growing population and increased demand for water is causing an increase in dam and reservoir construction in developing nations. When rivers cross international boundaries, the downstream stakeholders often have little knowledge of upstream reservoir operation practices. Satellite remote sensing in the form of radar altimetry and multisensor precipitation products can be used as a practical way to provide downstream stakeholders with the fundamentally elusive upstream information on reservoir outflow needed to make important and proactive water management decisions. This study uses a mass balance approach of three hydrologic controls to estimate reservoir outflow from satellite data at monthly and annual time scales: precipitation-induced inflow, evaporation, and reservoir storage change. Furthermore, this study explores the importance of each of these hydrologic controls to the accuracy of outflow estimation. The hydrologic controls found to be unimportant could potentially be neglected from similar future studies. Two reservoirs were examined in contrasting regions of the world, the Hungry Horse Reservoir in a mountainous region in northwest U.S. and the Kaptai Reservoir in a low-lying, forested region of Bangladesh. It was found that this mass balance method estimated the annual outflow of both reservoirs with reasonable skill. The estimation of monthly outflow from both reservoirs was however less accurate. The Kaptai basin exhibited a shift in basin behavior resulting in variable accuracy across the 9 year study period. Monthly outflow estimation from Hungry Horse Reservoir was compounded by snow accumulation and melt processes, reflected by relatively low accuracy in summer and fall, when snow processes control runoff. Furthermore, it was found that the important hydrologic controls for reservoir outflow estimation at the monthly time scale differs between the two reservoirs, with precipitation-induced inflow being the most important control for the Kaptai Reservoir and storage change being the most important for Hungry Horse Reservoir.

Netarsudil Increases Outflow Facility in Human Eyes Through Multiple Mechanisms

PubMed Central

Ren, Ruiyi; Li, Guorong; Le, Thuy Duong; Kopczynski, Casey; Stamer, W. Daniel; Gong, Haiyan

2016-01-01

Purpose Netarsudil is a Rho kinase/norepinephrine transporter inhibitor currently in phase 3 clinical development for glaucoma treatment. We investigated the effects of its active metabolite, netarsudil-M1, on outflow facility (C), outflow hydrodynamics, and morphology of the conventional outflow pathway in enucleated human eyes. Methods Paired human eyes (n = 5) were perfused with either 0.3 μM netarsudil-M1 or vehicle solution at constant pressure (15 mm Hg). After 3 hours, fluorescent microspheres were added to perfusion media to trace the outflow patterns before perfusion-fixation. The percentage effective filtration length (PEFL) was calculated from the measured lengths of tracer distribution in the trabecular meshwork (TM), episcleral veins (ESVs), and along the inner wall (IW) of Schlemm's canal after global and confocal imaging. Morphologic changes along the trabecular outflow pathway were investigated by confocal, light, and electron microscopy. Results Perfusion with netarsudil-M1 significantly increased C when compared to baseline (51%, P < 0.01) and to paired controls (102%, P < 0.01), as well as significantly increased PEFL in both IW (P < 0.05) and ESVs (P < 0.01). In treated eyes, PEFL was significantly higher in ESVs than in the IW (P < 0.01) and was associated with increased cross-sectional area of ESVs (P < 0.01). Percentage effective filtration length in ESVs positively correlated with the percentage change in C (R2 = 0.58, P = 0.01). A significant increase in juxtacanalicular connective tissue (JCT) thickness (P < 0.05) was found in treated eyes compared to controls. Conclusions Netarsudil acutely increased C by expansion of the JCT and dilating the ESVs, which led to redistribution of aqueous outflow through a larger area of the IW and ESVs. PMID:27842161

Wind influence on a coastal buoyant outflow

NASA Astrophysics Data System (ADS)

Whitney, Michael M.; Garvine, Richard W.

2005-03-01

This paper investigates the interplay between river discharge and winds in forcing coastal buoyant outflows. During light winds a plume influenced by the Earth's rotation will flow down shelf (in the direction of Kelvin wave propagation) as a slender buoyancy-driven coastal current. Downwelling favorable winds augment this down-shelf flow, narrow the plume, and mix the water column. Upwelling favorable winds drive currents that counter the buoyancy-driven flow, spread plume waters offshore, and rapidly mix buoyant waters. Two criteria are developed to assess the wind influence on a buoyant outflow. The wind strength index (Ws) determines whether a plume's along-shelf flow is in a wind-driven or buoyancy-driven state. Ws is the ratio of the wind-driven and buoyancy-driven along-shelf velocities. Wind influence on across-shelf plume structure is rated with a timescale (ttilt) for the isopycnal tilting caused by wind-driven Ekman circulation. These criteria are used to characterize wind influence on the Delaware Coastal Current and can be applied to other coastal buoyant outflows. The Delaware buoyant outflow is simulated for springtime high-river discharge conditions. Simulation results and Ws values reveal that the coastal current is buoyancy-driven most of the time (∣Ws∣ < 1 on average). Wind events, however, overwhelm the buoyancy-driven flow (∣Ws∣ > 1) several times during the high-discharge period. Strong upwelling events reverse the buoyant outflow; they constitute an important mechanism for transporting fresh water up shelf. Across-shelf plume structure is more sensitive to wind influence than the along-shelf flow. Values of ttilt indicate that moderate or strong winds persisting throughout a day can modify plume width significantly. Plume widening during upwelling events is accompanied by mixing that can erase the buoyant outflow.

Formation of Hydrocarbons in the Outflows from Red Giants

NASA Technical Reports Server (NTRS)

Roberge, Wayne; Kress, Monika; Tielens, Alexander G.

1995-01-01

The formation of hydrocarbons in the oxygen-rich outflows from red giants was studied. The existence of organic molecules in such outflows has been known for several years; however, their surprisingly high abundances has been a mystery since all of the carbon had been thought to be irretrievably locked up in CO, the most strongly bound molecule. CO is the first molecule to form from the atoms present in the star's extended atmosphere, and as strong stellar winds drive a cooling outflow, dust grains condense out. In oxygen-rich outflows, the dust is thought to be composed mainly of silicates and other metal oxides. Perhaps the noble metals can condense out in metallic form, in particular the relatively abundant transition metals iron and nickel. We proposed that perhaps the carbon reservoir held as CO can be accessed through a catalytic process involving the chemisorption of CO and H2 onto grains rich in metallic iron. CO and H2 are the two most abundant molecules in circumstellar outflows, and they both are known to dissociate on transition metal surfaces at elevated temperatures, freeing carbon to form organic molecules such as methane. We believe methane is a precursor molecule to the organics observed in oxygen-rich red giants. We have developed a nonequilibrium numerical model of a surface chemical (catalytic) process. Based on this model, we believe that methane can be formed under the conditions present in circumstellar outflows. Although the methane formation rates are exceptionally low under these conditions, over dynamical timescales, a significant amount of CO can be converted to methane and driven further out in the envelope, explaining the presence of organics there.

Rac1 modulates cardiomyocyte adhesion during mouse embryonic development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abu-Issa, Radwan, E-mail: rabuissa@umich.edu

2015-01-24

Highlights: • Conditional knockout of Rac1 using Nkx2.5 Cre line is lethal at E13.5. • The myocardium of the mutant is thin and disorganized. • The phenotype is not due to cardiomyocyte low proliferation or apoptosis. • The phenotype is due to specific defect in cardiomyocyte adhesion. - Abstract: Rac1, a member of the Rho subfamily of small GTPases, is involved in morphogenesis and differentiation of many cell types. Here we define a role of Rac1 in cardiac development by specifically deleting Rac1 in the pre-cardiac mesoderm using the Nkx2.5-Cre transgenic driver line. Rac1-conditional knockout embryos initiate heart development normallymore » until embryonic day 11.5 (E11.5); their cardiac mesoderm is specified, and the heart tube is formed and looped. However, by E12.5-E13.5 the mutant hearts start failing and embryos develop edema and hemorrhage which is probably the cause for the lethality observed soon after. The hearts of Rac1-cKO embryos exhibit disorganized and thin myocardial walls and defects in outflow tract alignment. No significant differences of cardiomyocyte death or proliferation were found between developing control and mutant embryos. To uncover the role of Rac1 in the heart, E11.5 primary heart cells were cultured and analyzed in vitro. Rac1-deficient cardiomyocytes were less spread, round and loosely attached to the substrate and to each other implying that Rac1-mediated signaling is required for appropriate cell–cell and/or cellmatrix adhesion during cardiac development.« less

Time dependent inflow-outflow boundary conditions for 2D acoustic systems

NASA Technical Reports Server (NTRS)

Watson, Willie R.; Myers, Michael K.

1989-01-01

An analysis of the number and form of the required inflow-outflow boundary conditions for the full two-dimensional time-dependent nonlinear acoustic system in subsonic mean flow is performed. The explicit predictor-corrector method of MacCormack (1969) is used. The methodology is tested on both uniform and sheared mean flows with plane and nonplanar sources. Results show that the acoustic system requires three physical boundary conditions on the inflow and one on the outflow boundary. The most natural choice for the inflow boundary conditions is judged to be a specification of the vorticity, the normal acoustic impedance, and a pressure gradient-density gradient relationship normal to the boundary. Specification of the acoustic pressure at the outflow boundary along with these inflow boundary conditions is found to give consistent reliable results. A set of boundary conditions developed earlier, which were intended to be nonreflecting is tested using the current method and is shown to yield unstable results for nonplanar acoustic waves.

Simulating the Fate of an Ionospheric Mass Ejection

NASA Astrophysics Data System (ADS)

Moore, T. E.; Fok, M. H.; Delcourt, D. C.; Slinker, S. P.; Fedder, J. A.

2008-12-01

We report global ion kinetic (GIK) simulations of the 24-25 Sep 1998 storm, with all relevant ionospheric outflows including polar, auroral, and plasmaspheric winds. This storm included substantial periods of northward interplanetary magnetic field, but did develop a Dst of -200 nT at its peak. The solar disturbance resulted form a coronal mass ejection that reached a peak dynamic pressure at the magnetosphere of 6.2 nPa, and produced a substantial enhancement of auroral wind oxygen outflow from the dayside, which has been termed an "ionospheric mass ejection" in an earlier observational paper. We use the LFM global simulation model to produce electric and magnetic fields in the outer magnetosphere, the Strangeway-Zheng outflow scalings with Delcourt ion trajectories to include ionospheric outflows, and the Fok-Ober inner magnetospheric model for the plasmaspheric and ring current response to all particle populations. We assess the combined contributions of heliospheric and geospheric plasmas to the ring current for this event.

Differential Canalograms Detect Outflow Changes from Trabecular Micro-Bypass Stents and Ab Interno Trabeculectomy.

PubMed

Parikh, Hardik A; Loewen, Ralitsa T; Roy, Pritha; Schuman, Joel S; Lathrop, Kira L; Loewen, Nils A

2016-11-04

Recently introduced microincisional glaucoma surgeries that enhance conventional outflow offer a favorable risk profile over traditional surgeries, but can be unpredictable. Two paramount challenges are the lack of an adequate training model for angle surgeries and the absence of an intraoperative quantification of surgical success. To address both, we developed an ex vivo training system and a differential, quantitative canalography method that uses slope-adjusted fluorescence intensities of two different chromophores to avoid quenching. We assessed outflow enhancement by trabecular micro-bypass (TMB) implantation or by ab interno trabeculectomy (AIT). In this porcine model, TMB resulted in an insignificant (p > 0.05) outflow increase of 13 ± 5%, 14 ± 8%, 9 ± 3%, and 24 ± 9% in the inferonasal, superonasal, superotemporal, and inferotemporal quadrant, respectively. AIT caused a 100 ± 50% (p = 0.002), 75 ± 28% (p = 0.002), 19 ± 8%, and 40 ± 21% increase in those quadrants. The direct gonioscopy and tactile feedback provided a surgical experience that was very similar to that in human patients. Despite the more narrow and discontinuous circumferential drainage elements in the pig with potential for underperformance or partial stent obstruction, unequivocal patterns of focal outflow enhancement by TMB were seen in this training model. AIT achieved extensive access to outflow pathways beyond the surgical site itself.

Differential Canalograms Detect Outflow Changes from Trabecular Micro-Bypass Stents and Ab Interno Trabeculectomy

PubMed Central

Parikh, Hardik A.; Loewen, Ralitsa T.; Roy, Pritha; Schuman, Joel S.; Lathrop, Kira L.; Loewen, Nils A.

2016-01-01

Recently introduced microincisional glaucoma surgeries that enhance conventional outflow offer a favorable risk profile over traditional surgeries, but can be unpredictable. Two paramount challenges are the lack of an adequate training model for angle surgeries and the absence of an intraoperative quantification of surgical success. To address both, we developed an ex vivo training system and a differential, quantitative canalography method that uses slope-adjusted fluorescence intensities of two different chromophores to avoid quenching. We assessed outflow enhancement by trabecular micro-bypass (TMB) implantation or by ab interno trabeculectomy (AIT). In this porcine model, TMB resulted in an insignificant (p > 0.05) outflow increase of 13 ± 5%, 14 ± 8%, 9 ± 3%, and 24 ± 9% in the inferonasal, superonasal, superotemporal, and inferotemporal quadrant, respectively. AIT caused a 100 ± 50% (p = 0.002), 75 ± 28% (p = 0.002), 19 ± 8%, and 40 ± 21% increase in those quadrants. The direct gonioscopy and tactile feedback provided a surgical experience that was very similar to that in human patients. Despite the more narrow and discontinuous circumferential drainage elements in the pig with potential for underperformance or partial stent obstruction, unequivocal patterns of focal outflow enhancement by TMB were seen in this training model. AIT achieved extensive access to outflow pathways beyond the surgical site itself. PMID:27811973

Development of upper tract stones in patients with congenital neurogenic bladder.

PubMed

Stephany, Heidi A; Clayton, Douglass B; Tanaka, Stacy T; Thomas, John C; Pope, John C; Brock, John W; Adams, Mark C

2014-02-01

Patients with neurogenic bladder are at increased risk of developing upper tract stones. We hypothesized that patients with lower urinary tract stone disease are at greater risk of developing upper tract stones. We performed a 10-year retrospective case-control study of patients with neurogenic bladder to determine the association between bladder and upper tract stones. Independent risk factors for upper tract stones were assessed. Cases and controls were matched 1:1. Univariable analysis was performed by Fisher's exact test and the Mann-Whitney U test. Multivariable logistic regression was performed. 52 cases and controls were identified. Cases were significantly more likely to be non-ambulatory, have bowel-urinary tract interposition, thoracic level dysraphism, and history of bladder stones. On multivariable analysis, independent predictors of stone formation were male sex (OR 2.82; p = 0.02), dysraphism involving the thoracic spine (OR 3.37; p = 0.014) bowel-urinary tract interposition (OR 2.611; p = 0.038), and a history of bladder stones (OR 3.57; p = 0.015). Patients with neurogenic bladder are at increased risk for upper tract stones. The presence of bladder stones may herald the development of upper tract stones. The predictors of stone disease identified should guide prospective studies to better understand the natural history of upper tract stone development in this population. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Regionally-Specific Diffusion Tensor Imaging in Mild Cognitive Impairment and Alzheimer’s Disease

PubMed Central

Mielke, M.M.; Kozauer, N.A.; Chan, K.C.G.; George, M.; Toroney, J.; Zerrate, M.; Bandeen-Roche, K.; Wang, M-C; vanZijl, P.; Pekar, J.J.; Mori, S.; Lyketsos, C.G.; Albert, M.

2009-01-01

Background Diffusion tensor imaging (DTI) studies have shown significant cross-sectional differences among normal controls (Bozzali et al., 2002), mild cognitive impairment (Robbins et al.) and Alzheimer’s disease (AD) patients in several fiber tracts in the brain, but longitudinal assessment is needed. Methods We studied 75 participants (25 NC, 25 amnestic MCI, and 25 mild AD) at baseline and 3 months later, with both imaging and clinical evaluations. Fractional anisotropy (Bozzali et al., 2002) was analyzed in regions of interest (ROIs) in: (1) fornix, (2) cingulum bundle, (3) splenium, and (4) cerebral peduncles. Clinical data included assessments of clinical severity and cognitive function. Cross-sectional and longitudinal differences in FA, within each ROI, were analyzed with generalized estimating equations (GEE). Results Cross-sectionally, AD patients had lower FA than NC (p<0.05) at baseline and 3 months in the fornix and anterior portion of the cingulum bundle. Compared to MCI, AD cases had lower FA (p<0.05) in these regions and the splenium at 0 and 3 months. Both the fornix and anterior cingulum correlated across all clinical cognitive scores; lower FA in these ROIs corresponded to worse performance. Over the course of 3 months, when the subjects were clinically stable, the ROIs were also largely stable. Conclusions Using DTI, findings indicate FA is decreased in specific fiber tracts among groups of subjects that vary along the spectrum from normal to AD, and that this measure is stable over short periods of time. The fornix is a predominant outflow tract of the hippocampus and may be an important indicator of AD progression. PMID:19457371

Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat. Echocardiography Committee of the Specialty of Cardiology, American College of Veterinary Internal Medicine.

PubMed

Thomas, W P; Gaber, C E; Jacobs, G J; Kaplan, P M; Lombard, C W; Moise, N S; Moses, B L

1993-01-01

Recommendations are presented for standardized imaging planes and display conventions for two-dimensional echocardiography in the dog and cat. Three transducer locations ("windows") provide access to consistent imaging planes: the right parasternal location, the left caudal (apical) parasternal location, and the left cranial parasternal location. Recommendations for image display orientations are very similar to those for comparable human cardiac images, with the heart base or cranial aspect of the heart displayed to the examiner's right on the video display. From the right parasternal location, standard views include a long-axis four-chamber view and a long-axis left ventricular outflow view, and short-axis views at the levels of the left ventricular apex, papillary muscles, chordae tendineae, mitral valve, aortic valve, and pulmonary arteries. From the left caudal (apical) location, standard views include long-axis two-chamber and four-chamber views. From the left cranial parasternal location, standard views include a long-axis view of the left ventricular outflow tract and ascending aorta (with variations to image the right atrium and tricuspid valve, and the pulmonary valve and pulmonary artery), and a short-axis view of the aortic root encircled by the right heart. These images are presented by means of idealized line drawings. Adoption of these standards should facilitate consistent performance, recording, teaching, and communicating results of studies obtained by two-dimensional echocardiography.

Low frequency of V617F mutation in JAK2 gene in Indian patients with hepatic venous outflow obstruction and extrahepatic portal venous obstruction.

PubMed

Rai, Praveer; Kumar, Pankaj; Mishra, Swapnil; Aggarwal, Rakesh

2016-09-01

Hepatic venous outflow tract obstruction (HVOTO) and extrahepatic portal venous obstruction (EHPVO) are important causes of portal hypertension and related complications in India. Both these conditions result from splanchnic venous thrombosis. In recent years, a V617F somatic mutation in Janus kinase 2 (JAK2) gene which is highly specific for myeloproliferative disorders has been detected in 40 % to 50 % and 30 % to 35 % of Western patients with HVOTO and EHPVO, respectively. However, data on this mutation in these conditions from Asian countries are limited. We looked for JAK2 V617F mutation in Indian patients with HVOTO (n = 40, median age 31 [range 17-51] years, 21 female) and EHPVO (n = 50, median age 23 [15-70] years, 25 female) by using two separate methods. Both the methods involved polymerase chain reaction using allele-specific primers. Positive results on one or both of these techniques were confirmed using DNA sequencing. None of the 40 patients with HVOTO and only 1 of 50 patients with EHPVO was found to have JAK2 V617F mutation. In the one patient who was found to have this mutation, both the PCR methods and DNA sequencing showed positive results. Hypercoagulability associated with JAK2 V617F mutation and associated chronic myeloproliferative disorders was not a major cause of HVOTO and EHPVO in this population.

Studying the outflow-core interaction with ALMA Cycle 1 observations of the HH 46/47 molecular outflow

NASA Astrophysics Data System (ADS)

Zhang, Yichen; Arce, Hector G.; Mardones, Diego; Dunham, Michael; Garay, Guido; Noriega-Crespo, Alberto; Corder, Stuartt; Offner, Stella; Cabrit, Sylvie

2016-01-01

We present ALMA Cycle 1 observations of the HH 46/47 molecular outflow which is driven by a low-mass Class 0/I protostar. Previous ALMA Cycle 0 12CO observation showed outflow cavities produced by the entrainment of ambient gas by the protostellar jet and wide-angle wind. Here we present analysis of observation of 12CO, 13CO, C18O and other species using combined 12m array and ACA observations. The improved angular resolution and sensitivity allow us to detect details of the outflow structure. Specially, we see that the outflow cavity wall is composed of two or more layers of outflowing gas, which separately connect to different shocked regions along the outflow axis inside the cavity, suggesting the outflow cavity wall is composed of multiple shells entrained by a series of jet bow-shock events. The new 13CO and C18O data also allow us to trace relatively denser and slower outflow material than that traced by the 12CO. These species are only detected within about 1 to 2 km/s from the cloud velocity, tracing the outflow to lower velocities than what is possible using only the 12CO emission. Interestingly, the cavity wall of the red lobe appears at very low outflow velocities (as low as ~0.2 km/s). In addition, 13CO and C18O allow us to correct for the CO optical depth, allowing us to obtain more accurate estimates of the outflow mass, momentum and kinetic energy. Applying the optical depth correction significantly increases the previous mass estimate by a factor of 14. The outflow kinetic energy distribution shows that even though the red lobe is mainly entrained by jet bow-shocks, most of the outflow energy is being deposited into the cloud at the base of the outflow cavity rather than around the heads of the bow shocks. The estimated total mass, momentum, and energy of the outflow indicate that the outflow has the ability to disperse the parent core. We found possible evidence for a slowly moving rotating outflow in CS. Our 13CO and C18O observations also trace a circumstellar envelope with both rotation and infall motions.

Fast Outflow of Molecular Gas in the Seyfert Galaxy IC 5063

NASA Astrophysics Data System (ADS)

Morganti, Raffaella; Oosterloo, T.; Oonk, R.; Tadhunter, C.

2017-11-01

AGN-driven gas outflows may play an important role in the evolution of galaxies, as they impact on the growth on the central supermassive black hole as well on the star formation of the host galaxy. Much of the detailed physics of these gas outflows, and their actual impact on the host galaxy, is still not well understood. We present a detailed analysis, using ALMA observations, of the radio-jet driven outflow of molecular gas in the nearby radio-loud Seyfert galaxy IC 5063 which allows to derive important physical parameters of the gas and the outflow which, in turn, provide crucial input to numerical models. In recent years, a surprising result in the field of AGN-driven outflows has been that the cold phases of the gas (atomic and molecular) in some galaxies are the massive components of these outflows, despite the huge amounts of energy involved in driving these outflows. However, why most of the outflowing gas should be molecular/atomic, and in general, what are the physical conditions of the gas in the outflows and what really drives them, are still open questions. We present the results obtained from ALMA observations of multiple CO transitions and other molecules of what appears to be a textbook case of a jet-driven multi- phase outflow in the central regions of the Seyfert galaxy IC 5063. The data on multiple transitions allow us to derive the physical conditions in the different regions of the outflowing molecular gas. The signature of the impact of the radio jet is clearly seen in the spatial distribution of the excitation temperature and pressure of the outflowing gas, with the highest excitation and pressure found for the gas with the highest outflow velocities. We obtain a detailed three- dimensional picture of the outflow, and its kinematics, and find that outflowing molecular gas is present across the entire region co-spatial with the radio plasma, providing unambiguous evidence that the radio jets/cocoon are responsible for the outflow. The detailed information about the physical condition of the gas in a fast outflow will serve as template for the signatures of the impact of a radio plasma jet on a gas-rich ISM and its associated star formation, and guide the studies of outflows in other galaxies, including higher redshift objects.

VHF discharges in storm cells producing microbursts

NASA Technical Reports Server (NTRS)

Laroche, P.; Malherbe, C.; Bondiou, A.; Weber, M.; Engholm, C.; Coel, V.

1991-01-01

An experiment was carried out in which 3-D mapping of VHF sources was compared to a 3-D description of the reflectivity and dynamics of associated cloud cells observed by a radar network. Data from 61 microbursts were analyzed and it was found that, in 93 pct. of the cases, electrical activity precedes outflow development. The results confirm that the peak in intracloud activity precedes the maximum value of the outflow.

Massive Outflows Associated with ATLASGAL Clumps

NASA Astrophysics Data System (ADS)

Yang, A. Y.; Thompson, M. A.; Urquhart, J. S.; Tian, W. W.

2018-03-01

We have undertaken the largest survey for outflows within the Galactic plane using simultaneously observed {}13{CO} and {{{C}}}18{{O}} data. Out of a total of 919 ATLASGAL clumps, 325 have data suitable to identify outflows, and 225 (69% ± 3%) show high-velocity outflows. The clumps with detected outflows show significantly higher clump masses ({M}clump}), bolometric luminosities ({L}bol}), luminosity-to-mass ratios ({L}bol}/{M}clump}), and peak H2 column densities ({N}{{{H}}2}) compared to those without outflows. Outflow activity has been detected within the youngest quiescent clump (i.e., 70 μ {{m}} weak) in this sample, and we find that the outflow detection rate increases with {M}clump}, {L}bol}, {L}bol}/{M}clump}, and {N}{{{H}}2}, approaching 90% in some cases (UC H II regions = 93% ± 3%; masers = 86% ± 4%; HC H II regions = 100%). This high detection rate suggests that outflows are ubiquitous phenomena of massive star formation (MSF). The mean outflow mass entrainment rate implies a mean accretion rate of ∼ {10}-4 {M}ȯ {yr}}-1, in full agreement with the accretion rate predicted by theoretical models of MSF. Outflow properties are tightly correlated with {M}clump}, {L}bol}, and {L}bol}/{M}clump} and show the strongest relation with the bolometric clump luminosity. This suggests that outflows might be driven by the most massive and luminous source within the clump. The correlations are similar for both low-mass and high-mass outflows over 7 orders of magnitude, indicating that they may share a similar outflow mechanism. Outflow energy is comparable to the turbulent energy within the clump; however, we find no evidence that outflows increase the level of clump turbulence as the clumps evolve. This implies that the origin of turbulence within clumps is fixed before the onset of star formation.

Parameter estimation of variable-parameter nonlinear Muskingum model using excel solver

NASA Astrophysics Data System (ADS)

Kang, Ling; Zhou, Liwei

2018-02-01

Abstract . The Muskingum model is an effective flood routing technology in hydrology and water resources Engineering. With the development of optimization technology, more and more variable-parameter Muskingum models were presented to improve effectiveness of the Muskingum model in recent decades. A variable-parameter nonlinear Muskingum model (NVPNLMM) was proposed in this paper. According to the results of two real and frequently-used case studies by various models, the NVPNLMM could obtain better values of evaluation criteria, which are used to describe the superiority of the estimated outflows and compare the accuracies of flood routing using various models, and the optimal estimated outflows by the NVPNLMM were closer to the observed outflows than the ones by other models.

Investigation on Large Molecule Permeation through Liposome Lipid Bilayer Induced by Microplasma Irradiation

NASA Astrophysics Data System (ADS)

Nagaiwa, Hidenori; Aibara, Daijiro; Ikeda, Yoshihisa; Motomura, Hideki; Kido, Yugo; Satoh, Susumu; Tachibana, Kunihide; Jinno, Masahumi

2015-09-01

The authors have been developing a novel gene transfection method using microplasma irradiation. In order to clarify the mechanism of large molecule permeation process through the lipid bilayer, plasma induced outflow of hydrophilic fluorescent dye molecules, which were encapsulated in the liposome, was observed. By microplasma irradiation on the liposome suspension, the dyes flowed out from the inside of the liposomes. The outflow of the dyes was enhanced by longer plasma irradiation time. Investigation of the outflow mechanism, i.e. permeation enhancement of the lipid bilayer or burst of the liposome, is under progress. This work was partly supported by JSPS KAKENHI Grant-in-Aid for Scientific Research on Innovative Areas (Number 25108509,15H00896) and a grant from Ehime University.

A null mutation of Hhex results in abnormal cardiac development, defective vasculogenesis and elevated Vegfa levels.

PubMed

Hallaq, Haifa; Pinter, Emese; Enciso, Josephine; McGrath, James; Zeiss, Caroline; Brueckner, Martina; Madri, Joseph; Jacobs, Harris C; Wilson, Christine M; Vasavada, Hemaxi; Jiang, Xiaobing; Bogue, Clifford W

2004-10-01

The homeobox gene Hhex has recently been shown to be essential for normal liver, thyroid and forebrain development. Hhex(-/-) mice die by mid-gestation (E14.5) and the cause of their early demise remains unclear. Because Hhex is expressed in the developing blood islands at E7.0 in the endothelium of the developing vasculature and heart at E9.0-9.5, and in the ventral foregut endoderm at E8.5-9.0, it has been postulated to play a critical role in heart and vascular development. We show here, for the first time, that a null mutation of Hhex results in striking abnormalities of cardiac and vascular development which include: (1) defective vasculogenesis, (2) hypoplasia of the right ventricle, (3) overabundant endocardial cushions accompanied by ventricular septal defects, outflow tract abnormalities and atrio-ventricular (AV) valve dysplasia and (4) aberrant development of the compact myocardium. The dramatic enlargement of the endocardial cushions in the absence of Hhex is due to decreased apoptosis and dysregulated epithelial-mesenchymal transformation (EMT). Interestingly, vascular endothelial growth factor A (Vegfa) levels in the hearts of Hhex(-/-) mice were elevated as much as three-fold between E9.5 and E11.5, and treatment of cultured Hhex(-/-) AV explants with truncated soluble Vegfa receptor 1, sFlt-1, an inhibitor of Vegf signaling, completely abolished the excessive epithelial-mesenchymal transformation seen in the absence of Hhex. Therefore, Hhex expression in the ventral foregut endoderm and/or the endothelium is necessary for normal cardiovascular development in vivo, and one function of Hhex is to repress Vegfa levels during development.

Confocal imaging of whole vertebrate embryos reveals novel insights into molecular and cellular mechanisms of organ development

NASA Astrophysics Data System (ADS)

Hadel, Diana M.; Keller, Bradley B.; Sandell, Lisa L.

2014-03-01

Confocal microscopy has been an invaluable tool for studying cellular or sub-cellular biological processes. The study of vertebrate embryology is based largely on examination of whole embryos and organs. The application of confocal microscopy to immunostained whole mount embryos, combined with three dimensional (3D) image reconstruction technologies, opens new avenues for synthesizing molecular, cellular and anatomical analysis of vertebrate development. Optical cropping of the region of interest enables visualization of structures that are morphologically complex or obscured, and solid surface rendering of fluorescent signal facilitates understanding of 3D structures. We have applied these technologies to whole mount immunostained mouse embryos to visualize developmental morphogenesis of the mammalian inner ear and heart. Using molecular markers of neuron development and transgenic reporters of neural crest cell lineage we have examined development of inner ear neurons that originate from the otic vesicle, along with the supporting glial cells that derive from the neural crest. The image analysis reveals a previously unrecognized coordinated spatial organization between migratory neural crest cells and neurons of the cochleovestibular nerve. The images also enable visualization of early cochlear spiral nerve morphogenesis relative to the developing cochlea, demonstrating a heretofore unknown association of neural crest cells with extending peripheral neurite projections. We performed similar analysis of embryonic hearts in mouse and chick, documenting the distribution of adhesion molecules during septation of the outflow tract and remodeling of aortic arches. Surface rendering of lumen space defines the morphology in a manner similar to resin injection casting and micro-CT.

The Dependence of Galactic Outflows on the Properties and Orientation of zCOSMOS Galaxies at z ~ 1

NASA Astrophysics Data System (ADS)

Bordoloi, R.; Lilly, S. J.; Hardmeier, E.; Contini, T.; Kneib, J.-P.; Le Fevre, O.; Mainieri, V.; Renzini, A.; Scodeggio, M.; Zamorani, G.; Bardelli, S.; Bolzonella, M.; Bongiorno, A.; Caputi, K.; Carollo, C. M.; Cucciati, O.; de la Torre, S.; de Ravel, L.; Garilli, B.; Iovino, A.; Kampczyk, P.; Kovač, K.; Knobel, C.; Lamareille, F.; Le Borgne, J.-F.; Le Brun, V.; Maier, C.; Mignoli, M.; Oesch, P.; Pello, R.; Peng, Y.; Perez Montero, E.; Presotto, V.; Silverman, J.; Tanaka, M.; Tasca, L.; Tresse, L.; Vergani, D.; Zucca, E.; Cappi, A.; Cimatti, A.; Coppa, G.; Franzetti, P.; Koekemoer, A.; Moresco, M.; Nair, P.; Pozzetti, L.

2014-10-01

We present an analysis of cool outflowing gas around galaxies, traced by Mg II absorption lines in the coadded spectra of a sample of 486 zCOSMOS galaxies at 1 <= z <= 1.5. These galaxies span a range of stellar masses (9.45 <= log10[M */M ⊙] <= 10.7) and star formation rates (0.14 <= log10[SFR/M ⊙ yr-1] <= 2.35). We identify the cool outflowing component in the Mg II absorption and find that the equivalent width of the outflowing component increases with stellar mass. The outflow equivalent width also increases steadily with the increasing star formation rate of the galaxies. At similar stellar masses, the blue galaxies exhibit a significantly higher outflow equivalent width as compared to red galaxies. The outflow equivalent width shows strong correlation with the star formation surface density (ΣSFR) of the sample. For the disk galaxies, the outflow equivalent width is higher for the face-on systems as compared to the edge-on ones, indicating that for the disk galaxies, the outflowing gas is primarily bipolar in geometry. Galaxies typically exhibit outflow velocities ranging from -150 km s-1 ~-200 km s-1 and, on average, the face-on galaxies exhibit higher outflow velocity as compared to the edge-on ones. Galaxies with irregular morphologies exhibit outflow equivalent width as well as outflow velocities comparable to face on disk galaxies. These galaxies exhibit mass outflow rates >5-7 M ⊙ yr-1 and a mass loading factor ({ η = \\dot{M}out /SFR}) comparable to the star formation rates of the galaxies. Based on observations undertaken at the European Southern Observatory (ESO) Very Large Telescope (VLT) under Large Program 175.A-0839.

DNA methylation abnormalities in congenital heart disease.

PubMed

Serra-Juhé, Clara; Cuscó, Ivon; Homs, Aïda; Flores, Raquel; Torán, Núria; Pérez-Jurado, Luis A

2015-01-01

Congenital heart defects represent the most common malformation at birth, occurring also in ∼50% of individuals with Down syndrome. Congenital heart defects are thought to have multifactorial etiology, but the main causes are largely unknown. We have explored the global methylation profile of fetal heart DNA in comparison to blood DNA from control subjects: an absolute correlation with the type of tissue was detected. Pathway analysis revealed a significant enrichment of differential methylation at genes related to muscle contraction and cardiomyopathies in the developing heart DNA. We have also searched for abnormal methylation profiles on developing heart-tissue DNA of syndromic and non-syndromic congenital heart defects. On average, 3 regions with aberrant methylation were detected per sample and 18 regions were found differentially methylated between groups. Several epimutations were detected in candidate genes involved in growth regulation, apoptosis and folate pathway. A likely pathogenic hypermethylation of several intragenic sites at the MSX1 gene, involved in outflow tract morphogenesis, was found in a fetus with isolated heart malformation. In addition, hypermethylation of the GATA4 gene was present in fetuses with Down syndrome with or without congenital heart defects, as well as in fetuses with isolated heart malformations. Expression deregulation of the abnormally methylated genes was detected. Our data indicate that epigenetic alterations of relevant genes are present in developing heart DNA in fetuses with both isolated and syndromic heart malformations. These epimutations likely contribute to the pathogenesis of the malformation by cis-acting effects on gene expression.

Composition and digestive tract retention time of ruminal particles with functional specific gravity greater or less than 1.02.

PubMed

Hristov, A N; Ahvenjarvi, S; McAllister, T A; Huhtanen, P

2003-10-01

The objective of this study was to determine composition, particle size distribution, and in vivo kinetics of ruminal particles having functional specific gravity (FSG) greater or less than FSG of particles found in the omasum and reticulum of lactating dairy cows. Particles from the reticulum and the omasal had FSG of 1.03 and 1.02, respectively. Particles from ruminal contents with FSG higher (HP) or lower (LP) than 1.02 were isolated and labeled with Er or Dy, respectively. Four ruminally cannulated, lactating Ayrshire dairy cows were fed all-grass silage (AS) or 54% grass silage:46% concentrate (SC) diets in a cross-over design trial and used to study chemical composition and ruminal and total tract kinetics of HP and LP. Labeled particles were pulse dosed into the rumen of the cows and disappearance of the markers from ruminal HP and LP pools and excretion in feces was monitored for 72 and 120 h, respectively. Fecal marker excretion data were fitted using two-compartment mathematical age-dependent/age-independent (Gn-->G1) models. Inclusion of concentrate in the diet (SC) increased (P < 0.05) apparent total tract digestibility of dietary DM, OM and N. Digestibility of fiber fractions, NDF and ADF, was lower (P < 0.01 and P < 0.05, respectively) for SC compared with AS. The heavy particles had higher (P < 0.01) indigestible NDF and lower (P < 0.01) N concentration than LP. Particles from the HP pool passed from the rumen more rapidly (P < 0.01) than particles from LP (0.044 and 0.019 h(-1), respectively). Diet had no effect on particle rate of disappearance or pool size in the rumen. Across diets, pool size of LP was consistently larger (P < 0.05) than that of HP. Diet had no effect on total tract mean retention time (MRT) of LP or HP. Total tract MRT of LP was greater (P < 0.05) than MRT of HP (59.6 vs. 49.0 h, respectively). Results from this study support the hypothesis that functional specific gravity is an important factor determining the rate of outflow and residence time of feed particles within the reticulo-rumen and total digestive tract. Our data indicate that digesta particles with functional specific gravity greater or less than 1.02 have different composition and flow characteristics. Heavier particles contain more indigestible fiber and less N and are likely depleted of substrate available for microbial fermentation, are smaller in size, and have a higher passage rate/shorter retention time in the digestive tract than lighter particles.

Novel function of LHFPL2 in female and male distal reproductive tract development.

PubMed

Zhao, Fei; Zhou, Jun; Li, Rong; Dudley, Elizabeth A; Ye, Xiaoqin

2016-03-11

Congenital reproductive tract anomalies could impair fertility. Female and male reproductive tracts are developed from Müllerian ducts and Wolffian ducts, respectively, involving initiation, elongation and differentiation. Genetic basis solely for distal reproductive tract development is largely unknown. Lhfpl2 (lipoma HMGIC fusion partner-like 2) encodes a tetra-transmembrane protein with unknown functions. It is expressed in follicle cells of ovary and epithelial cells of reproductive tracts. A spontaneous point mutation of Lhfpl2 (LHFPL2(G102E)) leads to infertility in 100% female mice, which have normal ovarian development, ovulation, uterine development, and uterine response to exogenous estrogen stimulation, but abnormal upper longitudinal vaginal septum and lower vaginal agenesis. Infertility is also observed in ~70% mutant males, which have normal mating behavior and sperm counts, but abnormal distal vas deferens convolution resulting in complete and incomplete blockage of reproductive tract in infertile and fertile males, respectively. On embryonic day 15.5, mutant Müllerian ducts and Wolffian ducts have elongated but their duct tips are enlarged and fail to merge with the urogenital sinus. These findings provide a novel function of LHFPL2 and a novel genetic basis for distal reproductive tract development; they also emphasize the importance of an additional merging phase for proper reproductive tract development.

[The complex origin of ventricular tachycardia after the total correction of tetralogy of Fallot].

PubMed

Ressia, L; Graffigna, A; Salerno-Uriarte, J A; Viganò, M

1993-09-01

Two patients underwent surgical treatment of ventricular tachycardia after repair of tetralogy of Fallot. Both patients had right bundle branch block, moderate pulmonary valve incompetence and right ventricular dilatation, and were refractory to electrophysiologically guided drug therapy. Both patients underwent intraoperative epicardial mapping, which located the arrhythmogenic focus on the right ventricular outflow tract, on the border of the previous ventriculotomy. In one patient removal of the previous scar and endocardial cryoablation was successful in ablating the arrhythmia. In the other, the same procedure was only temporarily effective. VT recurred and was subsequently identified at the superior border of the closed ventricular septal defect. It was ablated by means of transcatheter radiofrequency. While VT from foci located on the right ventricular free wall can be easily detected and ablated, septal origin of VT requires extensive preoperative and intraoperative electrophysiological evaluation and may necessitate combined surgical and transcatheter procedures.

Intratracheal Milrinone Bolus Administration During Acute Right Ventricular Dysfunction After Cardiopulmonary Bypass.

PubMed

Gebhard, Caroline Eva; Desjardins, Georges; Gebhard, Cathérine; Gavra, Paul; Denault, André Y

2017-04-01

To evaluate intratracheal milrinone (tMil) administration for rapid treatment of right ventricular (RV) dysfunction as a novel route after cardiopulmonary bypass. Retrospective analysis. Single-center study. The study comprised 7 patients undergoing cardiac surgery who exhibited acute RV dysfunction after cardiopulmonary bypass. After difficult weaning caused by cardiopulmonary bypass-induced acute RV dysfunction, milrinone was administered as a 5-mg bolus inside the endotracheal tube. RV function improvement, as indicated by decreasing pulmonary artery pressure and changes of RV waveforms, was observed in all 7 patients. Adverse effects of tMil included dynamic RV outflow tract obstruction (2 patients) and a decrease in systemic mean arterial pressure (1 patient). tMil may be an effective, rapid, and easily applicable therapeutic alternative to inhaled milrinone for the treatment of acute RV failure during cardiac surgery. However, sufficiently powered clinical trials are needed to confirm these findings. Copyright © 2017 Elsevier Inc. All rights reserved.

Systemic aspergilloma post aortic root surgery following coronary artery stenting: diagnostic and management dilemma

PubMed Central

Hussein, Nabil; Qamar, Sombul; Abid, Qamar

2015-01-01

Aspergillus infections such as Aspergillus endocarditis were once relatively rare occurrences, however, due to the increased use of intracardiac devices, the incidence has grown. With mortality rates close to 100%, in medically treated cases, it is paramount that early diagnosis and treatment are performed. An immunocompetent aviculturist presented 8 months post aortic root replacement for severe aortic regurgitation with a composite graft, with central crushing chest pain. Investigations confirmed ST elevation inferior myocardial infarction due to stenosis of the origin of the right coronary artery, which was stented. Echocardiogram demonstrated a mobile mass posterior to the left ventricular outflow tract. Following referral to our cardiothoracic surgeons, a polypoidal mass covering the right ostial button was noted along with systemic complications of the disease. Emergency redo aortic valve replacement with a homograft and coronary artery bypass was performed. Histological analysis confirmed A. fumigatus and the patient was started on intravenous voriconazole. PMID:26025972

Surgery of a cyanotic heart defect in an 11-year-old boy with thrombocytopenic thrombocytopathy and severe anemia due to a GATA-1 defect: hemostatic therapy.

PubMed

Hoefer, J; Streif, W; Kilo, J; Grimm, M; Berger, G; Velik-Salchner, C

2012-10-01

A child was admitted to our hospital for repair of a ventricular septal defect (VSD) characterized by a predominantly right-to-left shunt and a severe stenosis of the right ventricular outflow tract (Tetralogy of Fallot). Severe congenital anemia (hemoglobin 72 g/L), thrombocytopenia (42×G/L) and profound platelet dysfunction led a stem cell defect to be suspected. X-linked thrombocytopenia (GATA-1 mutation) was diagnosed. GATA-1 defect may complicate medical interventions due to excessive bleeding and partial or complete bone marrow failure. Maintaining a platelet count of 100 G/L and a maximal clot firmness (EXTEM-MCF) >50 mm allowed repair of the congenital heart defect without bleeding or hematological complications. Anemia and thrombocytopenia persisted after cardiac surgery, while the spontaneous bleeding tendency improved. © Georg Thieme Verlag KG Stuttgart · New York.

Subaortic membrane mimicking hypertrophic cardiomyopathy.

PubMed

Anderson, Mark Joseph; Arruda-Olson, Adelaide; Gersh, Bernard; Geske, Jeffrey

2015-11-04

A 34-year-old man was referred for progressive angina and exertional dyspnoea refractory to medical therapy, with a presumptive diagnosis of hypertrophic cardiomyopathy (HCM). Transthoracic echocardiography (TTE) revealed asymmetric septal hypertrophy without systolic anterior motion of the mitral valve leaflet and with no dynamic left ventricular outflow tract (LVOT) obstruction. However, the LVOT velocity was elevated at rest as well as with provocation, without the characteristic late peaking obstruction seen in HCM. Focused TTE to evaluate for suspected fixed obstruction demonstrated a subaortic membrane 2.2 cm below the aortic valve. Coronary CT angiography confirmed the presence of the subaortic membrane and was negative for concomitant coronary artery disease. Surgical resection of the subaortic membrane and septal myectomy resulted in significant symptomatic relief and lower LVOT velocities on postoperative TTE. This case reminds the clinician to carefully evaluate for alternative causes of LVOT obstruction, especially subaortic membrane, as a cause of symptoms mimicking HCM. 2015 BMJ Publishing Group Ltd.

Subaortic membrane mimicking hypertrophic cardiomyopathy

PubMed Central

Anderson, Mark Joseph; Arruda-Olson, Adelaide; Gersh, Bernard; Geske, Jeffrey

2015-01-01

A 34-year-old man was referred for progressive angina and exertional dyspnoea refractory to medical therapy, with a presumptive diagnosis of hypertrophic cardiomyopathy (HCM). Transthoracic echocardiography (TTE) revealed asymmetric septal hypertrophy without systolic anterior motion of the mitral valve leaflet and with no dynamic left ventricular outflow tract (LVOT) obstruction. However, the LVOT velocity was elevated at rest as well as with provocation, without the characteristic late peaking obstruction seen in HCM. Focused TTE to evaluate for suspected fixed obstruction demonstrated a subaortic membrane 2.2 cm below the aortic valve. Coronary CT angiography confirmed the presence of the subaortic membrane and was negative for concomitant coronary artery disease. Surgical resection of the subaortic membrane and septal myectomy resulted in significant symptomatic relief and lower LVOT velocities on postoperative TTE. This case reminds the clinician to carefully evaluate for alternative causes of LVOT obstruction, especially subaortic membrane, as a cause of symptoms mimicking HCM. PMID:26538250

Recurrent pannus formation causing prosthetic aortic valve dysfunction: Is excision without valve re-replacement applicable?

PubMed Central

2012-01-01

Prosthetic valve dysfunction at aortic position is commonly caused by pannus formation. The exact etiology is not known. It arises from ventricular aspect of the prosthesis encroaching its leaflets causing stenosis or it may remain localized causing left ventricular outflow tract obstruction without affecting valve function. The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement. A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve. Management of our case presents several questions, whether recurrence of pannus is caused by sparing the prosthetic valve, is it simply an exaggeration of an inflammatory healing process in certain individuals or is it ideal to re-replace the valve despite a well preserved function. PMID:22747790

Recurrent pannus formation causing prosthetic aortic valve dysfunction: is excision without valve re-replacement applicable?

PubMed

Darwazah, Ahmad K

2012-06-29

Prosthetic valve dysfunction at aortic position is commonly caused by pannus formation. The exact etiology is not known. It arises from ventricular aspect of the prosthesis encroaching its leaflets causing stenosis or it may remain localized causing left ventricular outflow tract obstruction without affecting valve function.The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement.A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve.Management of our case presents several questions, whether recurrence of pannus is caused by sparing the prosthetic valve, is it simply an exaggeration of an inflammatory healing process in certain individuals or is it ideal to re-replace the valve despite a well preserved function.

The paediatric cardiac centre for Africa--proceedings of the March 2012 symposium.

PubMed

Kinsley, Robin H; Edwin, Frank; Entsua-Mensah, Kow

2013-04-01

The Pediatric Cardiac Centre for Africa (PCCA) was opened by national patron Mr Nelson Mandela on November 7, 2003. In 2008, the Centre's international pediatric cardiac symposium was introduced as a learning forum for pediatric cardiac surgeons and cardiologists in the continent. The symposium has consistently grown in attendance and attracted distinguished leaders in the field. The 2012 symposium featured Dr. Thomas Spray of Children's Hospital of Philadelphia, Dr. David Barron of Birmingham Children's Hospital, and Dr. John Brown of Indiana University School of Medicine as guest speakers. Experience of the Fontan procedure, the small aortic root, hypoplastic left heart syndrome, right ventricular outflow tract reconstruction, transposition of the great arteries, and interrupted aortic arch were the highlights of the symposium. In the "African Corner," centers in South Africa, Ghana, and Angola presented work done from across the African continent.

Effects of a vegetated stormwater-detention basin on chemical quality and temperature of runoff from a small residential development in Monroe County, New York

USGS Publications Warehouse

Sherwood, Donald A.

2001-01-01

The vegetated stormwater-detention basin at a small residential development in Monroe County, N.Y. has been shown to be effective in reducing loads of certain chemical constituents to receiving waters. Loads of suspended solids, nitrogen, and phosphorus have been reduced by an average of 14 to 62 percent. The basin has little effect on the temperature of runoff between the inflow and the outflow; water temperatures at the outflow during summer storms averaged 0.5 degrees Celsius higher than those at the inflow.

Outflow channel sources, reactivation, and chaos formation, Xanthe Terra, Mars

USGS Publications Warehouse

Rodriguez, J.A.P.; Sasaki, S.; Kuzmin, R.O.; Dohm, J.M.; Tanaka, K.L.; Miyamoto, H.; Kurita, K.; Komatsu, G.; Fairen, A.G.; Ferris, J.C.

2005-01-01

The undulating, warped, and densely fractured surfaces of highland regions east of Valles Marineris (located north of the eastern Aureum Chaos, east of the Hydraotes Chaos, and south of the Hydaspis Chaos) resulted from extensional surface warping related to ground subsidence, caused when pressurized water confined in subterranean caverns was released to the surface. Water emanations formed crater lakes and resulted in channeling episodes involved in the excavation of Ares, Tiu, and Simud Valles of the eastern part of the circum-Chryse outflow channel system. Progressive surface subsidence and associated reduction of the subsurface cavernous volume, and/or episodes of magmatic-driven activity, led to increases of the hydrostatic pressure, resulting in reactivation of both catastrophic and non-catastrophic outflow activity. Ancient cratered highland and basin materials that underwent large-scale subsidence grade into densely fractured terrains. Collapse of rock materials in these regions resulted in the formation of chaotic terrains, which occur in and near the headwaters of the eastern circum-Chryse outflow channels. The deepest chaotic terrain in the Hydaspis Chaos region resulted from the collapse of pre-existing outflow channel floors. The release of volatiles and related collapse may have included water emanations not necessarily linked to catastrophic outflow. Basal warming related to dike intrusions, thermokarst activity involving wet sediments and/or dissected ice-enriched country rock, permafrost exposed to the atmosphere by extensional tectonism and channel incision, and/or the injection of water into porous floor material, may have enhanced outflow channel floor instability and subsequent collapse. In addition to the possible genetic linkage to outflow channel development dating back to at least the Late Noachian, clear disruption of impact craters with pristine ejecta blankets and rims, as well as preservation of fine tectonic fabrics, suggest that plateau subsidence and chaos formation may have continued well into the Amazonian Period. The geologic and paleohydrologic histories presented here have important implications, as new mechanisms for outflow channel formation and other fluvial activity are described, and new reactivation mechanisms are proposed for the origin of chaotic terrain as contributors to flooding. Detailed geomorphic analysis indicates that subterranean caverns may have been exposed during chaos formation, and thus chaotic terrains mark prime locations for future geologic, hydrologic, and possible astrobiologic exploration. ?? 2004 Elsevier Inc. All rights reserved.

[Genes in the development of female genital tract].

PubMed

Chen, Na; Zhu, Lan; Lang, Jing-he

2013-12-01

Female genital tract, which includes oviduct, uterus, and vagina, is critical for female reproduction. In recent years, animal experiments using knockout mice and genetic studies on patients with female genital malformations have contributed substantially to our understanding of the molecular mechanisms in the female genital tract development. Here we review genes that are involved in various stages of female genital tract formation and development.

Ionised outflows in z ~ 2.4 quasar host galaxies

NASA Astrophysics Data System (ADS)

Carniani, S.; Marconi, A.; Maiolino, R.; Balmaverde, B.; Brusa, M.; Cano-Díaz, M.; Cicone, C.; Comastri, A.; Cresci, G.; Fiore, F.; Feruglio, C.; La Franca, F.; Mainieri, V.; Mannucci, F.; Nagao, T.; Netzer, H.; Piconcelli, E.; Risaliti, G.; Schneider, R.; Shemmer, O.

2015-08-01

Aims: Outflows driven by active galactic nuclei (AGN) are invoked by galaxy evolutionary models to quench star formation and to explain the origin of the relations observed locally between super-massive black holes and their host galaxies. We here aim to detect extended ionised outflows in luminous quasars, where we expect the highest activity both in star formation and in black-hole accretion. Currently, there are only a few studies based on spatially resolved observations of outflows at high redshift, z > 2. Methods: We analysed a sample of six luminous (L > 1047 erg/s) quasars at z ~ 2.4, observed in H-band using the near-IR integral field spectrometer SINFONI at the VLT. We performed a kinematic analysis of the [Oiii] emission line at λ = 5007 Å. Results: We detect fast, spatially extended outflows in five out of six targets. [Oiii]λ5007 has a complex gas kinematic, with blue-shifted velocities of a few hundreds of km s-1 and line widths up to 1500 km s-1. Using the spectroastrometric method, we infer a size of the ionised outflows of up to ~2 kpc. The properties of the ionised outflows, mass outflow rate, momentum rate, and kinetic power, are correlated with the AGN luminosity. The increase in outflow rate with increasing AGN luminosity is consistent with the idea that a luminous AGN pushes away the surrounding gas through fast outflows that are driven by radiation pressure, which depends on the emitted luminosity. Conclusions: We derive mass outflow rates of about 6-700 M⊙ yr-1 for our sample, which are lower than those observed in molecular outflows. The physical properties of ionised outflows show dependences on AGN luminosity that are similar to those of molecular outflows, but indicate that the mass of ionised gas is lower than that of molecular outflows. Alternatively, this discrepancy between ionised and molecular outflows could be explained with different acceleration mechanisms. Based on Observations collected at the European Organisation for Astronomical Research in the Southern Hemisphere, Chile, P.ID: 086.B-0579(A).

Massive outflow properties suggest AGN fade slowly

NASA Astrophysics Data System (ADS)

Zubovas, Kastytis

2018-01-01

Massive large-scale active galactic nucleus (AGN) outflows are an important element of galaxy evolution, being a way through which the AGN can affect most of the host galaxy. However, outflows evolve on time-scales much longer than typical AGN episode durations, therefore most AGN outflows are not observed simultaneously with the AGN episode that inflated them. It is therefore remarkable that rather tight correlations between outflow properties and AGN luminosity exist. In this paper, I show that such correlations can be preserved during the fading phase of the AGN episode, provided that the AGN luminosity evolves as a power law with exponent αd ∼ 1 at late times. I also show that subsequent AGN episodes that illuminate an ongoing outflow are unlikely to produce outflow momentum or energy rates rising above the observed correlations. However, there may be many difficult-to-detect outflows with momentum and energy rates lower than expected from the current AGN luminosity. Detailed observations of AGN outflow properties might help constrain the activity histories of typical and/or individual AGN.

The use of simple inflow- and storage-based heuristics equations to represent reservoir behavior in California for investigating human impacts on the water cycle

NASA Astrophysics Data System (ADS)

Solander, K.; David, C. H.; Reager, J. T.; Famiglietti, J. S.

2013-12-01

The ability to reasonably replicate reservoir behavior in terms of storage and outflow is important for studying the potential human impacts on the terrestrial water cycle. Developing a simple method for this purpose could facilitate subsequent integration in a land surface or global climate model. This study attempts to simulate monthly reservoir outflow and storage using a simple, temporally-varying set of heuristics equations with input consisting of in situ records of reservoir inflow and storage. Equations of increasing complexity relative to the number of parameters involved were tested. Only two parameters were employed in the final equations used to predict outflow and storage in an attempt to best mimic seasonal reservoir behavior while still preserving model parsimony. California reservoirs were selected for model development due to the high level of data availability and intensity of water resource management in this region relative to other areas. Calibration was achieved using observations from eight major reservoirs representing approximately 41% of the 107 largest reservoirs in the state. Parameter optimization was accomplished using the minimum RMSE between observed and modeled storage and outflow as the main objective function. Initial results obtained for a multi-reservoir average of the correlation coefficient between observed and modeled storage (resp. outflow) is of 0.78 (resp. 0.75). These results combined with the simplicity of the equations being used show promise for integration into a land surface or a global climate model. This would be invaluable for evaluations of reservoir management impacts on the flow regime and associated ecosystems as well as on the climate at both regional and global scales.

Simulating Supernovae Driven Outflows in Dwarf Galaxies

NASA Astrophysics Data System (ADS)

Rodriguez, Jaimee-Ian

2018-01-01

Galactic outflows, or winds, prove to be a necessary input for galactic simulations to produce results comparable to observation, for it solves issues caused by what previous literature dubbed the “angular momentum catastrophe.” While it is known that the nature of outflows depends on the nature of the Interstellar Medium (ISM), the mechanisms behind outflows are still not completely understood. We investigate the driving force behind galactic outflows and the factors that influence their behavior, hypothesizing that supernovae within the galaxy drive these winds. We study isolated, high-resolution, smooth particle hydrodynamic simulations, focusing specifically on dwarf galaxies due to their shallow potential wells, which allow for more significant outflows. We find that outflows follow star formation (and associated supernovae) suggesting the causal relationship between the two. Furthermore, simulations with higher diffusivity differ little in star formation rate, but show significantly lower outflow rates, suggesting that environmental factors that have little effect on regulating star formation can greatly influence outflows, and so efficient outflows can be driven by a constant rate of supernovae, depending on ISM behavior. We are currently analyzing disk morphology and ambient density in order to comprehend the effect of supernovae on the immediate interstellar gas. By attaining greater understanding of the origin of galactic outflows, we will be able to not only improve the accuracy of simulations, we will also be able to gain greater insight into galactic formation and evolution, as outflows and resultant inflows may be vital to the regulation of galaxies throughout their lifetimes.

Far-Ultraviolet Observations of Outflows from Infrared-Luminous Galaxies

NASA Astrophysics Data System (ADS)

Leitherer, Claus; Chandar, Rupali; Tremonti, Christy A.; Wofford, Aida

2013-03-01

We have obtained ultraviolet spectra between 1150 and 1450 Å of four ultraviolet-bright, infrared-luminous starburst galaxies. Our selected sight-lines towards the starburst nuclei probe the conditions in the starburst-driven outflows. We detect outflowing gas with velocities of up to ˜900 km s-1. It is likely that the outflows are a major source of metal enrichment of the galaxies' halos. The mass outflow rates of several tens of M⊙ yr-1 are similar to the star-formation rates. The outflows may quench star formation and ultimately regulate the starburst.

Robust boundary treatment for open-channel flows in divergence-free incompressible SPH

NASA Astrophysics Data System (ADS)

Pahar, Gourabananda; Dhar, Anirban

2017-03-01

A robust Incompressible Smoothed Particle Hydrodynamics (ISPH) framework is developed to simulate specified inflow and outflow boundary conditions for open-channel flow. Being purely divergence-free, the framework offers smoothed and structured pressure distribution. An implicit treatment of Pressure Poison Equation and Dirichlet boundary condition is applied on free-surface to minimize error in velocity-divergence. Beyond inflow and outflow threshold, multiple layers of dummy particles are created according to specified boundary condition. Inflow boundary acts as a soluble wave-maker. Fluid particles beyond outflow threshold are removed and replaced with dummy particles with specified boundary velocity. The framework is validated against different cases of open channel flow with different boundary conditions. The model can efficiently capture flow evolution and vortex generation for random geometry and variable boundary conditions.

Observations of Superwinds in Dwarf Galaxies

NASA Astrophysics Data System (ADS)

Marlowe, A. T.; Heckman, T. M.; Wyse, R.; Schommer, R.

1993-12-01

Dwarf galaxies are important in developing our understanding of the formation and evolution of galaxies, and of the structure in the universe. The concept of supernova-driven mass outflows is a vital ingredient in theories of the structure and evolution of dwarfs galaxies. We have begun a detailed multi-waveband search for outflows in starbursting dwarf galaxies, and have obtained Fabry-Perot images and Echelle spectra of 20 nearby actively-star-forming dwarf galaxies. In about half the sample, the Fabry-Perot Hα images show loops and filaments with sizes of one to a few kpc. The Echelle spectra taken through the loops and filaments show kinematics consistent with expanding bubble-like structures. We describe these data, and present seven dwarfs in our sample that have the strongest evidence of outflows.

Forecasting of monthly inflow and outflow currency using time series regression and ARIMAX: The Idul Fitri effect

NASA Astrophysics Data System (ADS)

Ahmad, Imam Safawi; Setiawan, Suhartono, Masun, Nunun Hilyatul

2015-12-01

Currency plays an important role in economic transactions of Indonesian society. In order to guarantee the availability of currency, Bank Indonesia needs to develop demand and supply planning of currency. The purpose of this study is to get model and predict inflow and outflow of currency in KPW BI Region IV (East Java) with ARIMA method, time series regression and ARIMAX. The data of monthly inflow and outflow is used of currency in KPW BI Surabaya, Malang, Kediri and Jember.The observation period starting from January 2003 to December 2014. Based on the smallest values of out-sample RMSE and SMAPE, ARIMA is the best model to predict the outflow of currency in KPW BI Surabaya and ARIMAX for KPW BI Malang, Kediri and Jember. The best forecasting model for inflow of currency in KPW BI Surabaya, Malang, Kediri and Jember chronologically as follows are calendar variation model, transfer function, ARIMA, and time series regression. These results indicates that the more complex models may not necessarily produce a more accurate forecast as the result of M3-Competition.

Outflow monitoring of a pneumatic ventricular assist device using external pressure sensors.

PubMed

Kang, Seong Min; Her, Keun; Choi, Seong Wook

2016-08-25

In this study, a new algorithm was developed for estimating the pump outflow of a pneumatic ventricular assist device (p-VAD). The pump outflow estimation algorithm was derived from the ideal gas equation and determined the change in blood-sac volume of a p-VAD using two external pressure sensors. Based on in vitro experiments, the algorithm was revised to consider the effects of structural compliance caused by volume changes in an implanted unit, an air driveline, and the pressure difference between the sensors and the implanted unit. In animal experiments, p-VADs were connected to the left ventricles and the descending aorta of three calves (70-100 kg). Their outflows were estimated using the new algorithm and compared to the results obtained using an ultrasonic blood flow meter (UBF) (TS-410, Transonic Systems Inc., Ithaca, NY, USA). The estimated and measured values had a Pearson's correlation coefficient of 0.864. The pressure sensors were installed at the external controller and connected to the air driveline on the same side as the external actuator, which made the sensors easy to manage.

Quantifying the AGN-driven outflows in ULIRGs (QUADROS) II: evidence for compact outflow regions from HST [OIII] imaging observations

NASA Astrophysics Data System (ADS)

Tadhunter, C.; Zaurín, J. Rodríguez; Rose, M.; Spence, R. A. W.; Batcheldor, D.; Berg, M. A.; Ramos Almeida, C.; Spoon, H. W. W.; Sparks, W.; Chiaberge, M.

2018-05-01

The true importance of the warm, AGN-driven outflows for the evolution of galaxies remains uncertain. Measurements of the radial extents of the outflows are key for quantifying their masses and kinetic powers, and also establishing whether the AGN outflows are galaxy-wide. Therefore, as part of a larger project to investigate the significance of warm, AGN-driven outflows in the most rapidly evolving galaxies in the local universe, here we present deep Hubble Space Telescope (HST) narrow-band [OIII]λ5007 observations of a complete sample of 8 nearby ULIRGs with optical AGN nuclei. Combined with the complementary information provided by our ground-based spectroscopy, the HST images show that the warm gas outflows are relatively compact for most of the objects in the sample: in three objects the outflow regions are barely resolved at the resolution of HST (0.065 < R[OIII] < 0.12 kpc); in a further four cases the outflows are spatially resolved but with flux weighted mean radii in the range 0.65 < R[OIII] < 1.2 kpc; and in only one object (Mrk273) is there clear evidence for a more extended outflow, with a maximum extent of R[OIII] ˜ 5 kpc. Overall, our observations show little evidence for the galaxy-wide outflows predicted by some models of AGN feedback.

Bladder inflammatory transcriptome in response to tachykinins: Neurokinin 1 receptor-dependent genes and transcription regulatory elements

PubMed Central

Saban, Ricardo; Simpson, Cindy; Vadigepalli, Rajanikanth; Memet, Sylvie; Dozmorov, Igor; Saban, Marcia R

2007-01-01

Background Tachykinins (TK), such as substance P, and their neurokinin receptors which are ubiquitously expressed in the human urinary tract, represent an endogenous system regulating bladder inflammatory, immune responses, and visceral hypersensitivity. Increasing evidence correlates alterations in the TK system with urinary tract diseases such as neurogenic bladders, outflow obstruction, idiopathic detrusor instability, and interstitial cystitis. However, despite promising effects in animal models, there seems to be no published clinical study showing that NK-receptor antagonists are an effective treatment of pain in general or urinary tract disorders, such as detrusor overactivity. In order to search for therapeutic targets that could block the tachykinin system, we set forth to determine the regulatory network downstream of NK1 receptor activation. First, NK1R-dependent transcripts were determined and used to query known databases for their respective transcription regulatory elements (TREs). Methods An expression analysis was performed using urinary bladders isolated from sensitized wild type (WT) and NK1R-/- mice that were stimulated with saline, LPS, or antigen to provoke inflammation. Based on cDNA array results, NK1R-dependent genes were selected. PAINT software was used to query TRANSFAC database and to retrieve upstream TREs that were confirmed by electrophoretic mobility shift assays. Results The regulatory network of TREs driving NK1R-dependent genes presented cRel in a central position driving 22% of all genes, followed by AP-1, NF-kappaB, v-Myb, CRE-BP1/c-Jun, USF, Pax-6, Efr-1, Egr-3, and AREB6. A comparison between NK1R-dependent and NK1R-independent genes revealed Nkx-2.5 as a unique discriminator. In the presence of NK1R, Nkx2-5 _01 was significantly correlated with 36 transcripts which included several candidates for mediating bladder development (FGF) and inflammation (PAR-3, IL-1R, IL-6, α-NGF, TSP2). In the absence of NK1R, the matrix Nkx2-5_02 had a predominant participation driving 8 transcripts, which includes those involved in cancer (EYA1, Trail, HSF1, and ELK-1), smooth-to-skeletal muscle trans-differentiation, and Z01, a tight-junction protein, expression. Electrophoretic mobility shift assays confirmed that, in the mouse urinary bladder, activation of NK1R by substance P (SP) induces both NKx-2.5 and NF-kappaB translocations. Conclusion This is the first report describing a role for Nkx2.5 in the urinary tract. As Nkx2.5 is the unique discriminator of NK1R-modulated inflammation, it can be imagined that in the near future, new based therapies selective for controlling Nkx2.5 activity in the urinary tract may be used in the treatment in a number of bladder disorders. PMID:17519035

A single codon insertion in PICALM is associated with development of familial subvalvular aortic stenosis in Newfoundland dogs.

PubMed

Stern, Joshua A; White, Stephen N; Lehmkuhl, Linda B; Reina-Doreste, Yamir; Ferguson, Jordan L; Nascone-Yoder, Nanette M; Meurs, Kathryn M

2014-09-01

Familial subvalvular aortic stenosis (SAS) is one of the most common congenital heart defects in dogs and is an inherited defect of Newfoundlands, golden retrievers and human children. Although SAS is known to be inherited, specific genes involved in Newfoundlands with SAS have not been defined. We hypothesized that SAS in Newfoundlands is inherited in an autosomal dominant pattern and caused by a single genetic variant. We studied 93 prospectively recruited Newfoundland dogs, and 180 control dogs of 30 breeds. By providing cardiac screening evaluations for Newfoundlands we conducted a pedigree evaluation, genome-wide association study and RNA sequence analysis to identify a proposed pattern of inheritance and genetic loci associated with the development of SAS. We identified a three-nucleotide exonic insertion in phosphatidylinositol-binding clathrin assembly protein (PICALM) that is associated with the development of SAS in Newfoundlands. Pedigree evaluation best supported an autosomal dominant pattern of inheritance and provided evidence that equivocally affected individuals may pass on SAS in their progeny. Immunohistochemistry demonstrated the presence of PICALM in the canine myocardium and area of the subvalvular ridge. Additionally, small molecule inhibition of clathrin-mediated endocytosis resulted in developmental abnormalities within the outflow tract (OFT) of Xenopus laevis embryos. The ability to test for presence of this PICALM insertion may impact dog-breeding decisions and facilitate reduction of SAS disease prevalence in Newfoundland dogs. Understanding the role of PICALM in OFT development may aid in future molecular and genetic investigations into other congenital heart defects of various species.

Evidence that 50% of BALQSO Outflows Are Situated at Least 100 pc from the Central Source

NASA Astrophysics Data System (ADS)

Arav, Nahum; Liu, Guilin; Xu, Xinfeng; Stidham, James; Benn, Chris; Chamberlain, Carter

2018-04-01

The most robust way for determining the distance of quasar absorption outflows is the use of troughs from ionic excited states. The column density ratio between the excited and resonance states yields the outflow number density. Combined with a knowledge of the outflow’s ionization parameter, a distance from the central source (R) can be determined. Here we report results from two surveys targeting outflows that show troughs from S IV. One survey includes 1091 SDSS and BOSS quasar spectra, and the other includes higher-quality spectra of 13 quasars observed with the Very Large Telescope. Our S IV samples include 38 broad absorption line (BAL) outflows and four mini-BAL outflows. The S IV is formed in the same physical region of the outflow as the canonical outflow-identifying species C IV. Our results show that S IV absorption is only detected in 25% of C IV BAL outflows. The smaller detection fraction is due to the higher total column density (N H) needed to detect S IV absorption. Since R empirically anticorrelates with N H, the results of these surveys can be extrapolated to C IV quasar outflows with lower N H as well. We find that at least 50% of quasar outflows are at distances larger than 100 pc from the central source, and at least 12% are at distances larger than 1000 pc. These results have profound implications for the study of the origin and acceleration mechanism of quasar outflows and their effects on the host galaxy.

The effect of right ventricle pacemaker lead position on diastolic function in patients with preserved left ventricle ejection fraction.

PubMed

Mitov, Vladimir; Perisić, Zoran; Jolić, Aleksandar; Adamović, Dragana; Zastranović, Lale; Aleksić, Aleksandar; Kostić, Tomislav; Božinović, Nenad; Aleksić, Zeljka; Soldatović, Ivan

2013-01-01

Our aim was to analyze any changes during diastole in patients with normal left ventricular ejection fraction (LVEF), after pacemaker stimulation from the right ventricular outflow tract (RVOT) and right ventricular apex (RVA) lead position. This was a prospective, randomized, follow up study, which lasted for 12 months. Our research included 132 consecutive patients who were implanted with a permanent antibradycardiac pacemaker. Regarding the right ventricle lead position the patients were divided into two groups: The RVOT group--71 patients, with right ventricle outflow tract lead position and the RVA group--61 patients, with right ventricle apex lead position. We measured LVEF and diastolic parameters: peak filling ratio and time to peak filling ratio obtained by radionuclide ventriculography (RNV). The LVEF and various diastolic parameters and left atrial diameter were obtained by echocardiography. Based on the values of deceleration time of early diastolic filling (DTE), and other diastolic parameters like left atrial diameter, all the patients were classified into three degrees of diastolic dysfunction. Our results showed that there was no group difference in distribution of gender, age, body mass index (BMI), VVI to DDD pacemakers implantation ratio, RNV parameters (LVEF, peak filling rate (PFR), time to PFR (TPFR)) and echocardiography parameters: LVEF and parameters of diastolic dysfunction. After 12 months of pacemaker stimulation, LVEF by RNV remained the same in the RVOT group 51.31±15.80% (P=0.75), and also in the RVA group 53.83±6.57%, (P=0.19). In the RVOT group the PFR was highly lower and this finding was significant (P=0.01), while TPFR was also significantly lower (P=0.03). By dividing the patients according to the degree of diastolic dysfunction we found that most patients in both groups at enrollment had a second degree diastolic dysfunction. In both groups diastolic dysfunction increased, the number of patients with third degree diastolic dysfunction increased, and the number of patients with second degree diastolic dysfunction decreased, however, the worsening of diastolic function was significant only in the RVOT group. In conclusion, pacemaker stimulation from RVOT, but not in RVA, leads to progression of diastolic dysfunction in patients with preserved LVEF. This negative effect of pacemaker stimulation from RVOT on diastolic parameters was confirmed by two independent methods, RNV and echocardiography.

Outcomes of Subaortic Obstruction Resection in Children.

PubMed

Donald, Julia S; Naimo, Phillip S; d'Udekem, Yves; Richardson, Malcolm; Bullock, Andrew; Weintraub, Robert G; Brizard, Christian P; Konstantinov, Igor E

2017-02-01

Studies of long-term outcomes of discrete subaortic stenosis are rare. Therefore, we reviewed the long-term outcomes of fibromuscular resection in children with subaortic stenosis over 26 years from a single institution. We conducted a retrospective review of all children (n=72) who underwent resection of subaortic obstruction for discrete subaortic stenosis between 1989 and 2015. Median age at surgery was 5.0 years (2.7-7.6 years). There were no operative deaths but three late deaths (4.2%, 3/72). Overall Kaplan-Meier survival at 10 years was 93.0 ± 3.9% (95% CI: 79.6, 97.7). Peak instantaneous left ventricular outflow tract Doppler gradient decreased from 74.2±36.7mmHg (16.0-242.0mmHg) preoperatively to 12.8±7.4mmHg (2.6-36.0mmHg) postoperatively (p<0.001). Mean left ventricular outflow tract Doppler gradient decreased from 42.4±17.2mmHg (12.0-98.0) preoperatively to 7.5±2.7mmHg (1.4-19.3mmHg) postoperatively (p<0.001). However, over the mean follow-up period of 7.8±6.1 years (0.1-25.2 years), 29.0% (20/69) of patients had recurrence and 18.8% (13/69) required reoperation at median time of 4.8 years (3.1-9.1 years) after the initial repair. Freedom from reoperation at 10 years was 71.1±7.1% (95% CI: 54.6, 82.3). Risk factors for reoperation were age less than five years at initial repair (p=0.036) and extension of the membrane to the aortic valve (p=0.001). Aortic insufficiency was present in 54.2% (39/72) of patients preoperatively. Progression of aortic insufficiency occurred in 38.9% (28/72). Involvement of the aortic valve at initial repair was associated with need for subsequent aortic valve repair or replacement (p=0.01). Resection of subaortic obstruction is associated with low mortality and morbidity. Recurrence and reoperation rates are high and progression of aortic insufficiency following subaortic resection is common. Therefore, these patients warrant close follow-up into adult life. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Character and dynamics of the Red Sea and Persian Gulf outflows

NASA Astrophysics Data System (ADS)

Bower, Amy S.; Hunt, Heather D.; Price, James F.

2000-03-01

Historical hydrographic data and a numerical plume model are used to investigate the initial transformation, dynamics, and spreading pathways of Red Sea and Persian Gulf outflow waters where they enter the Indian Ocean. The annual mean transport of these outflows is relatively small (<0.4 Sv), but they have a major impact on the hydrographic properties of the Indian Ocean at the thermocline level because of their high salinity. They are different from other outflows in that they flow over very shallow sills (depth < 200 m) into a highly stratified upper ocean environment and they are located at relatively low latitudes (12°N and 26°N). Furthermore, the Red Sea outflow exhibits strong seasonal variability in transport. The four main results of this study are as follows. First, on the basis of observed temperature-salinity (T-S) characteristics of the outflow source and product waters we estimate that the Red Sea and Persian Gulf outflows are diluted by factors of ˜2.5 and 4, respectively, as they descend from sill depth to their depth of neutral buoyancy. The high-dilution factor for the Persian Gulf outflow results from the combined effects of large initial density difference between the outflow source water and oceanic water and low outflow transport. Second, the combination of low latitude and low outflow transport (and associated low outflow thickness) results in Ekman numbers for both outflows that are O(1). This indicates that they should be thought of as frictional density currents modified by rotation rather than geostrophic density currents modified by friction. Third, different mixing histories along the two channels that direct Red Sea outflow water into the open ocean result in product waters with significantly different densities, which probably contributes to the multilayered structure of the Red Sea product waters. In both outflows, seasonal variations in source water and oceanic properties have some effect on the T-S of the product waters, but they have only a minor impact on equilibrium depth. Fourth, product waters from both outflows are advected away from the sill region in narrow boundary currents, at least during part of the year. At other times, the product water appears more in isolated patches.

On the Fraction of Quasars with Outflows

NASA Astrophysics Data System (ADS)

Ganguly, Rajib; Brotherton, Michael S.

2008-01-01

Outflows from active galactic nuclei (AGNs) seem to be common and are thought to be important from a variety of perspectives: as an agent of chemical enhancement of the interstellar and intergalactic media, as an agent of angular momentum removal from the accreting central engine, and as an agent limiting star formation in starbursting systems by blowing out gas and dust from the host galaxy. To understand these processes, we must determine what fraction of AGNs feature outflows and understand what forms they take. We examine recent surveys of quasar absorption lines, reviewing the best means to determine if systems are intrinsic and result from outflowing material, and the limitations of approaches taken to date. The surveys reveal that, while the fraction of specific forms of outflows depends on AGN properties, the overall fraction displaying outflows is fairly constant, approximately 60%, over many orders of magnitude in luminosity. We emphasize some issues concerning classification of outflows driven by data type rather than necessarily the physical nature of outflows and illustrate how understanding outflows probably requires a more comprehensive approach than has usually been taken in the past.

Comparison of Echo and MRI in the Imaging Evaluation of Intracardiac Masses

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gulati, G., E-mail: gulatigurpreet@rediffmail.com; Sharma, S.; Kothari, S.S.

We compared the efficacy of echocardiography (ECHO) and magnetic resonance imaging (MRI) for evaluating intracardiac masses. Over an 8-yr period, 28 patients, 21 males, 7 females, 16 days-60 years of age (mean 25 years) with a suspected intracardiac mass on ECHO (transthoracic in all; transesophageal in 9) underwent an MRI examination. Five patients had a contrast-enhanced MRI. ECHO and MRI were compared with respect to their technical adequacy, ability to detect and suggest the likely etiology of the mass, and provide additional information (masses not seen with the other technique, inflow or outflow obstruction, and intramural component of an intracavitarymore » mass). With MRI, the image morphology (including signal intensity changes on the various sequences) and extracardiac manifestations were also evaluated. The diagnosis was confirmed by histopathology in 18, surgical inspection in 4, by follow- up imaging on conservative management in 5, and by typical extracardiac manifestations of the disease in 1 patient.Fifteen (54%) patients had tumors (benign 12, malignant 3), 5 had a thrombus or hematoma, and 4 each had infective or vascular lesions. Thirty-four masses (13 in ventricle, 11 septal, 7 atrial, 2 on valve and 1 in pulmonary artery) were seen on MRI, 28 of which were detected by ECHO. Transthoracic ECHO (TTE) and MRI were technically optimal in 82% and 100% of cases, respectively. Nine patients needed an additional transesophageal ECHO (TEE). Overall, MRI showed a mass in all patients, whereas ECHO missed it in 2 cases. In cases with a mass on both modalities, MRI detected 4 additional masses not seen on ECHO. MRI suggested the etiology in 21 (75%) cases, while the same was possible with ECHO (TTE and TEE) in 8 (29%) cases. Intramural component, extension into the inflow or outflow, outflow tract obstruction, and associated pericardial or extracardiac masses were better depicted on MRI. We conclude that MRI is advantageous over a combination of TTE and TEE for the detection and complete morphological and functional evaluation (hemodynamic effects) of cardiac masses.« less

Peripheral chemoreceptors and cardiorespiratory coupling: a link to sympatho-excitation.

PubMed

Zoccal, Daniel B

2015-02-01

What is the topic of this review? Chronic intermittent hypoxia (CIH), as observed in patients with obstructive sleep apnoea, is associated with the development of sympathetically mediated arterial hypertension. Nevertheless, the mechanisms underpinning the augmented sympathetic outflow in CIH still remain under investigation. What advances does it highlight? In this report, I present experimental evidence supporting the hypothesis that changes in the function of the respiratory network and coupling with the sympathetic nervous system may be considered as a novel and relevant mechanism for the increase in baseline sympathetic outflow in animals submitted to CIH. Chronic intermittent hypoxia (CIH) has been identified as a relevant risk factor for the development of enhanced sympathetic outflow and arterial hypertension. Several studies have highlighted the importance of peripheral chemoreceptors for the cardiovascular changes elicited by CIH. However, the effects of CIH on the central mechanisms regulating sympathetic outflow are not fully elucidated. Our research group has explored the hypothesis that the enhanced sympathetic drive following CIH exposure is, at least in part, dependent on alterations in the respiratory network and its interaction with the sympathetic nervous system. In this report, I discuss the changes in the discharge profile of baseline sympathetic activity in rats exposed to CIH, their association with the generation of active expiration and the interactions between expiratory and sympathetic neurones after CIH conditioning. Together, these findings are consistent with the theory that mechanisms of central respiratory-sympathetic coupling are a novel factor in the development of neurogenic hypertension. © 2014 The Authors. Experimental Physiology © 2014 The Physiological Society.

Two separate outflows in the dual supermassive black hole system NGC 6240

NASA Astrophysics Data System (ADS)

Müller-Sánchez, F.; Nevin, R.; Comerford, J. M.; Davies, R. I.; Privon, G. C.; Treister, E.

2018-04-01

Theoretical models and numerical simulations have established a framework of galaxy evolution in which galaxies merge and create dual supermassive black holes (with separations of one to ten kiloparsecs), which eventually sink into the centre of the merger remnant, emit gravitational waves and coalesce. The merger also triggers star formation and supermassive black hole growth, and gas outflows regulate the stellar content1-3. Although this theoretical picture is supported by recent observations of starburst-driven and supermassive black hole-driven outflows4-6, it remains unclear how these outflows interact with the interstellar medium. Furthermore, the relative contributions of star formation and black hole activity to galactic feedback remain unknown7-9. Here we report observations of dual outflows in the central region of the prototypical merger NGC 6240. We find a black-hole-driven outflow of [O iii] to the northeast and a starburst-driven outflow of Hα to the northwest. The orientations and positions of the outflows allow us to isolate them spatially and study their properties independently. We estimate mass outflow rates of 10 and 75 solar masses per year for the Hα bubble and the [O iii] cone, respectively. Their combined mass outflow is comparable to the star formation rate10, suggesting that negative feedback on star formation is occurring.

Two separate outflows in the dual supermassive black hole system NGC 6240.

PubMed

Müller-Sánchez, F; Nevin, R; Comerford, J M; Davies, R I; Privon, G C; Treister, E

2018-04-01

Theoretical models and numerical simulations have established a framework of galaxy evolution in which galaxies merge and create dual supermassive black holes (with separations of one to ten kiloparsecs), which eventually sink into the centre of the merger remnant, emit gravitational waves and coalesce. The merger also triggers star formation and supermassive black hole growth, and gas outflows regulate the stellar content 1-3 . Although this theoretical picture is supported by recent observations of starburst-driven and supermassive black hole-driven outflows 4-6 , it remains unclear how these outflows interact with the interstellar medium. Furthermore, the relative contributions of star formation and black hole activity to galactic feedback remain unknown 7-9 . Here we report observations of dual outflows in the central region of the prototypical merger NGC 6240. We find a black-hole-driven outflow of [O III] to the northeast and a starburst-driven outflow of Hα to the northwest. The orientations and positions of the outflows allow us to isolate them spatially and study their properties independently. We estimate mass outflow rates of 10 and 75 solar masses per year for the Hα bubble and the [O III] cone, respectively. Their combined mass outflow is comparable to the star formation rate 10 , suggesting that negative feedback on star formation is occurring.

Groundwater seepage controls salinity in a hydrologically terminal basin of semi-arid northwest Australia

NASA Astrophysics Data System (ADS)

Skrzypek, Grzegorz; Dogramaci, Shawan; Rouillard, Alexandra; Grierson, Pauline F.

2016-11-01

Very small groundwater outflows have the potential to significantly impact the hydrochemistry and salt accumulation processes of notionally terminal basins in arid environments. However, this limited groundwater outflow can be very difficult to quantify using classical water budget calculations due to large uncertainties in estimates of evaporation and evapotranspiration rates from the surface of dry lake beds. In this study, we used a dimensionless time evaporation model to estimate the range of groundwater outflow required to maintain salinity levels observed at the Fortescue Marsh (FM), one of the largest wetlands of semi-arid northwest Australia (∼1100 km2). The groundwater outflow from aquifers underlying the FM to the Lower Fortescue catchment is constrained by an extremely low hydraulic gradient of <0.0001 and a small 'alluvial outlet' of 0.35 km2 because of relatively high bedrock elevation. However, FM groundwater salinity is far below saturation with respect to halite (TDS < 160 g/L), episodic flood water is fresh to brackish, and salt efflorescences are very sparse and evident only when the FM is dry. We show that if the FM was 100% "leakage free" i.e., a true terminal basin, groundwater would have achieved halite saturation (>300 g/L) after ∼45 ka. We calculated that only a very small seepage of ∼2G L/yr (∼0.03% of the FM water volume) is sufficient to maintain current salinity conditions. The minimum time required to develop the current hydrochemical groundwater composition under the FM ranges from ∼60 to ∼165 ka. We conclude that a dimensionless time evaporation model versus inflow over outflow ratio model is likely more suitable than classical water budget calculations for determining outflow from large saline lakes and to estimate groundwater seepage from hydrologically terminal basins.

Radiative cooling of swept up gas in AGN-driven galactic winds and its implications for molecular outflows

NASA Astrophysics Data System (ADS)

Richings, Alexander J.; Faucher-Giguére, Claude-André

2018-05-01

We recently used hydro-chemical simulations to demonstrate that molecular outflows observed in luminous quasars can be explained by molecule formation within the AGN wind. However, these simulations cover a limited parameter space, due to their computational cost. We have therefore developed an analytic model to follow cooling in the shocked ISM layer of an AGN wind. We explore different ambient densities (1-104 {cm}^{-3}), density profile slopes (0-1.5), AGN luminosities (1044-10^{47} {erg} {s}^{-1}), and metallicities (0.1-3 Z⊙). The swept up gas mostly cools within ˜1 Myr. Based on our previous simulations, we predict that this gas would produce observable molecular outflows. The instantaneous momentum boost initially increases as the outflow decelerates. However, it reaches a maximum of ≈20, due to work done against the gravitational potential. The predicted time-averaged observational estimate of the molecular outflow momentum boost reaches a maximum of ≈1 -2, partly due to our assumed molecular fraction, 0.2, but also because the instantaneous and observational, time-averaged definitions are not equivalent. Thus recent observational estimates of order unity momentum boosts do not necessarily rule out energy-driven outflows. Finally, we find that dust grains are likely to re-form by accretion of metals after the shocked ISM layer has cooled, assuming that a small fraction of dust grains swept up after this layer has cooled are able to mix into the cool phase, and assuming that grain growth remains efficient in the presence of the strong AGN radiation field. This would enable rapid molecule formation, as assumed in our models.

Inversion Build-Up and Cold-Air Outflow in a Small Alpine Sinkhole

NASA Astrophysics Data System (ADS)

Lehner, Manuela; Whiteman, C. David; Dorninger, Manfred

2017-06-01

Semi-idealized model simulations are made of the nocturnal cold-air pool development in the approximately 1-km wide and 100-200-m deep Grünloch basin, Austria. The simulations show qualitatively good agreement with vertical temperature and wind profiles and surface measurements collected during a meteorological field expedition. A two-layer stable atmosphere forms in the basin, with a very strong inversion in the lowest part, below the approximate height of the lowest gap in the surrounding orography. The upper part of the stable layer is less strongly stratified and extends to the approximate height of the second-lowest gap. The basin atmosphere cools most strongly during the first few hours of the night, after which temperatures decrease only slowly. An outflow of air forms through the lowest gap in the surrounding orography. The outflow connects with a weak inflow of air through a gap on the opposite sidewall, forming a vertically and horizontally confined jet over the basin. Basin cooling shows strong sensitivity to surface-layer characteristics, highlighting the large impact of variations in vegetation and soil cover on cold-air pool development, as well as the importance of surface-layer parametrization in numerical simulations of cold-air-pool development.

Neonatal Staphylococcus lugdunensis urinary tract infection.

PubMed

Hayakawa, Itaru; Hataya, Hiroshi; Yamanouchi, Hanako; Sakakibara, Hiroshi; Terakawa, Toshiro

2015-08-01

Staphylococcus lugdunensis is a known pathogen of infective endocarditis, but not of urinary tract infection. We report a previously healthy neonate without congenital anomalies of the kidney and urinary tract who developed urinary tract infection due to Staphylococcus lugdunensis, illustrating that Staphylococcus lugdunensis can cause urinary tract infection even in those with no urinary tract complications. © 2015 Japan Pediatric Society.

Sleep Problems are Associated with Development and Progression of Lower Urinary Tract Symptoms: Results from REDUCE.

PubMed

Branche, Brandee L; Howard, Lauren E; Moreira, Daniel M; Roehrborn, Claus; Castro-Santamaria, Ramiro; Andriole, Gerald L; Hopp, Martin L; Freedland, Stephen J

2018-02-01

Although lower urinary tract symptoms and sleep problems often develop together, to our knowledge it is unknown whether sleep disturbances are linked to lower urinary tract symptoms development and progression. As measured by the 6-item MOS-Sleep (Medical Outcomes Study Sleep Scale) survey we examined the relationship between sleep problems, and the development and progression of lower urinary tract symptoms in the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study. REDUCE was a randomized trial testing prostate cancer chemoprevention with dutasteride in men with prostate specific antigen 2.5 to 10 ng/ml and a negative biopsy. At baseline men completed MOS-Sleep and a scaled average was used to calculate the sleep score. Men were followed for 4 years and I-PSS (International Prostate Symptom Score) was completed at baseline and every 6 months. Asymptomatic men had I-PSS less than 8 while symptomatic men had I-PSS 8 or greater. In the placebo arm of 2,588 men not receiving α-blockers or 5α-reductase inhibitors at baseline we tested the association between sleep problems and lower urinary tract symptom development and progression using Cox models. During followup lower urinary tract symptoms developed in 209 of 1,452 asymptomatic men (14%) and 580 of 1,136 (51%) with lower urinary tract symptoms demonstrated progression. On multivariable analysis higher sleep scores were suggestively associated with increased lower urinary tract symptoms in asymptomatic men (quartile 4 vs 1 HR 1.41, 95% CI 0.92-2.17, p = 0.12) and with lower urinary tract symptom progression in symptomatic men (per 10 points of sleep score HR 1.06, 95% CI 1.01-1.12, p = 0.029). Among men with lower urinary tract symptoms worse sleep scores were associated with the progression of lower urinary tract symptoms and among asymptomatic men worse sleep scores were suggestively associated with the development of lower urinary tract symptoms. If confirmed, these data suggest that sleep problems may precede such symptoms. Whether treating sleep problems would improve lower urinary tract symptoms requires further testing. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Blocking of the Hepatic Vein Outflow by Neointima Covering a Wallstent Across a Membranous Stenosis of the Inferior Vena Cava

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dutta, Usha; Garg, Pramod K.; Agarwal, Rajeev

1999-11-15

A 31-year-old man presented with idiopathic membranous obstruction of the suprahepatic inferior vena cava (IVC) and was treated by balloon dilation and placement of a Wallstent. The patient improved markedly. However, he developed obstruction of the hepatic vein outflow secondary to neointima formation over the stent that covered the hepatic vein ostia. The patient died of liver failure and septicemia. We believe that this is the first report of such a serious complication.

Current applications of lasers in heart disease

NASA Astrophysics Data System (ADS)

Lee, Garrett; Chan, Ming C.; Mason, Dean T.

1993-03-01

Although the laser has been in existence for abut 30 years, its application in heart disease has only been examined in the past decade. Much attention has been given its exciting potential in treating coronary artery disease. Transmitted through a catheter comprised of one or more thin optical fibers which can be threaded nonsurgically into the coronary artery, the laser can ablate atherosclerotic plaque that obstructs the artery and diminishes blood flow to the myocardium. In clinical studies, the laser can treat some obstructive lesions that are not suitable for balloon angioplasty (i.e., long and diffuse lesions, very tight stenoses, ostial lesions, calcified lesions). In patients who failed balloon angioplasty due to severe dissection or abrupt closure, the laser may seal up the dissections and restore antegrade blood flow. In addition, the laser may have other applications and treatment modalities that are still under investigation. It may ablate ectopic ventricular foci, or terminate supraventricular tachyrhythmia by destroying the heart's abnormal conduction pathways. It can cut the hypertrophied septum that is associated with left ventricular outflow tract obstruction, or create a channel in the atrial septum as a palliative procedure in newborns with transposition of the great vessels. It may provide a wider orifice for blood flow within the heart in infants with pulmonary outflow obstruction and in adults with aortic valvular stenosis. It is also capable of fusing small thin-walled blood vessels together. Further, a more intriguing possibility is its use to bore several tiny channels in the myocardium to allow oxygenated blood from within the ventricular chamber to perfuse the ischemic heart tissue.

Evaluation of right heart function in a rat model using modified echocardiographic views.

PubMed

Bernardo, Ivan; Wong, James; Wlodek, Mary E; Vlahos, Ross; Soeding, Paul

2017-01-01

Echocardiography plays a major role in assessing cardiac function in animal models. We investigated use of a modified parasternal mid right-ventricular (MRV) and right ventricle (RV) outflow (RVOT) view, in assessing RV size and function, and the suitability of advanced 2D-strain analysis. 15 WKY rats were examined using transthoracic echocardiography. The left heart was assessed using standard short and long axis views. For the right ventricle a MRV and RVOT view were used to measure RV chamber and free wall area. 2D-strain analysis was applied to both ventricles using off-line analysis. RV chamber volume was determined by injection of 2% agarose gel, and RV free wall dissected and weighed. Echocardiography measurement was correlated with necropsy findings. The RV mid-ventricular dimension (R1) was 0.42±0.07cm and the right ventricular outflow tract dimension (R2) was 0.34±0.06cm, chamber end-diastolic area measurements were 0.38±0.09cm2 and 0.29±0.08cm2 for MRV and RVOT views respectively. RVOT and MRV chamber area correlated with gel mass. Doppler RV stroke volume was 0.32±0.08ml, cardiac output (CO) 110±27 ml.min-1 and RV free wall contractility assessed using 2D-strain analysis was demonstrated. We have shown that modified MRV and RVOT views can provide detailed assessment of the RV in rodents, with 2D-strain analysis of the RV free wall potentially feasible.

Long-term follow-up of autologous pericardial valved conduits.

PubMed

Schlichter, A J; Kreutzer, C; Mayorquim, R C; Simon, J L; Vazquez, H; Roman, M I; Kreutzer, G O

1996-07-01

The aim of this study was to evaluate the long-term results of the use of an autologous pericardial valved conduit in the outflow tract of the venous ventricle in congenital heart malformations. Fifty-one patients were followed up for a period of 12 to 120 months; 30 for more than 36 months and 13 for more than 72 months. All were evaluated clinically and by two-dimensional and Doppler echocardiography. Eight patients were recatheterized. Postoperative evaluation included serial measurement of pressure gradients and the conduit's diameter at the proximal, valvular, and distal levels. Reoperation because of stenosis was indicated when the gradient across the right ventricular outflow was greater than 50 mm Hg. The reoperation rate in relation with postoperative time, diameter of the autologous pericardial valved conduit at the time of implantation, and malformation was statistically analyzed. In 27 patients the conduit increased its diameter 1 to 7 mm. In 20 patients the diameter remained unchanged, whereas a reduction was noted in 4. Conduit survival free of reoperation for the whole group was 89.9% at 5 years. Conduit survival free of reoperation was 100% at 5 and 7 years for conduits larger than 16 mm at the time of implantation. It was 95% (standard deviation = 4.8%) at 5 years and 72.3% at 7 years for those 16 mm or less. For patients operated after January 1, 1986 (technical modification), conduit survival free of reoperation was 95.4% at 7 years postoperatively. These results compare favorably with those of other available conduits.

Acute brown adipose tissue temperature response to cold in monosodium glutamate-treated Siberian hamsters

PubMed Central

Leitner, Claudia; Bartness, Timothy J.

2014-01-01

Neonatal monosodium glutamate (MSG) administration increases adiposity, decreases energy expenditure and is associated with arcuate nucleus (Arc) destruction. Disrupted brown adipose tissue (BAT) thermogenesis underlies some of these effects, although, interscapular BAT temperature (TIBAT) has not been measured. Therefore, we tested the effects of neonatal MSG or vehicle administration in Siberian hamsters and, when they were adults, measured TIBAT during acute cold exposure. The Arc and its projection to the hypothalamic paraventricular nucleus (PVH) are both components of the CNS outflow circuits to IBAT, with the latter implicated in BAT thermogenesis that could be compromised by MSG treatment. Using a viral transneuronal tract tracer, pseudorabies virus (PRV), we also tested whether the components of these circuits were intact. As adults, MSG-treated hamsters had significantly increased body mass and some white fat pad masses, markedly reduced Arc Nissl and neuropeptide staining, and PVH neuropeptide fiber staining. Cold-exposed (18 h at 5 °C) MSG- and vehicle-treated hamsters initially maintained TIBAT, but the ability of the former waned after 2 h being significantly decreased by 18 h. PRV immunoreactive fibers/cells were not altered by neonatal MSG treatment despite substantial Arc and PVH destruction. MSG- and vehicle-treated hamsters given an exogenous norepinephrine challenge showed identical increases in the duration and peak of TIBAT. Thus, the inability of MSG-treated animals to sustain TIBAT in the cold is not due to any obvious MSG-induced deletions of central sympathetic outflow circuits to IBAT, but appears to be extrinsic to the tissue nevertheless. PMID:19643091

Separate and shared sympathetic outflow to white and brown fat coordinately regulates thermoregulation and beige adipocyte recruitment

PubMed Central

Nguyen, Ngoc Ly T.; Barr, Candace L.; Ryu, Vitaly; Cao, Qiang; Bartness, Timothy J.

2017-01-01

White adipose tissue (WAT) and brown adipose tissue (BAT) are innervated and regulated by the sympathetic nervous system (SNS). It is not clear, however, whether there are shared or separate central SNS outflows to WAT and BAT that regulate their function. We injected two isogenic strains of pseudorabies virus, a retrograde transneuronal viral tract tracer, with unique fluorescent reporters into interscapular BAT (IBAT) and inguinal WAT (IWAT) of the same Siberian hamsters to define SNS pathways to both. To test the functional importance of SNS coordinated control of BAT and WAT, we exposed hamsters with denervated SNS nerves to IBAT to 4°C for 16–24 h and measured core and fat temperatures and norepinephrine turnover (NETO) and uncoupling protein 1 (UCP1) expression in fat tissues. Overall, there were more SNS neurons innervating IBAT than IWAT across the neuroaxis. However, there was a greater percentage of singly labeled IWAT neurons in midbrain reticular nuclei than singly labeled IBAT neurons. The hindbrain had ~30–40% of doubly labeled neurons while the forebrain had ~25% suggesting shared SNS circuitry to BAT and WAT across the brain. The raphe nucleus, a key region in thermoregulation, had ~40% doubly labeled neurons. Hamsters with IBAT SNS denervation maintained core body temperature during acute cold challenge and had increased beige adipocyte formation in IWAT. They also had increased IWAT NETO, temperature, and UCP1 expression compared with intact hamsters. These data provide strong neuroanatomical and functional evidence of WAT and BAT SNS cross talk for thermoregulation and beige adipocyte formation. PMID:27881398

An original valveless artificial heart providing pulsatile flow tested in mock circulatory loops.

PubMed

Tozzi, Piergiorgio; Maertens, Audrey; Emery, Jonathan; Joseph, Samuel; Kirsch, Matthias; Avellan, François

2017-11-24

We present the test bench results of a valveless total artificial heart that is potentially compatible with the pediatric population. The RollingHeart is a valveless volumetric pump generating pulsatile flow. It consists of a single spherical cavity divided into 4 chambers by 2 rotating disks. The combined rotations of both disks produce changes in the volumes of the 4 cavities (suction and ejection). The blood enters/exits the spherical cavity through 4 openings that are symmetrical to the fixed rotation axis of the first disk.Mock circulatory system: The device pumps a 37% glycerin solution through 2 parallel circuits, simulating the pulmonary and systemic circulations. Flow rates are acquired with a magnetic inductive flowmeter, while pressure sensors collect pressure in the left and right outflow and inflow tracts.In vitro test protocol: The pump is run at speeds ranging from 20 to 180 ejections per minute. The waveform of the pressure generated at the inflow and outflow of the 4 chambers and the flow rate in the systemic circulation are measured. At an ejection rate of 178 min-1, the RollingHeart pumps 5.3 L/min for a systemic maximal pressure gradient of 174 mmHg and a pulmonary maximal pressure gradient of 75 mmHg. The power input was 14 W, corresponding to an efficiency of 21%. The RollingHeart represents a new approach in the domain of total artificial heart. This preliminary study endorses the feasibility of a single valveless device acting as a total artificial heart.

Numerical Study on Outflows in Seyfert Galaxies I: Narrow Line Region Outflows in NGC 4151

NASA Astrophysics Data System (ADS)

Mou, Guobin; Wang, Tinggui; Yang, Chenwei

2017-07-01

The origin of narrow line region (NLR) outflows remains unknown. In this paper, we explore the scenario in which these outflows are circumnuclear clouds driven by energetic accretion disk winds. We choose the well-studied nearby Seyfert galaxy NGC 4151 as an example. By performing 3D hydrodynamical simulations, we are able to reproduce the radial distributions of velocity, mass outflow rate, and kinetic luminosity of NLR outflows in the inner 100 pc deduced from spatial resolved spectroscopic observations. The demanded kinetic luminosity of disk winds is about two orders of magnitude higher than that inferred from the NLR outflows, but is close to the ultrafast outflows (UFO) detected in the X-ray spectrum and a few times lower than the bolometric luminosity of the Seyfert. Our simulations imply that the scenario is viable for NGC 4151. The existence of the underlying disk winds can be confirmed by their impacts on higher density ISM, e.g., shock excitation signs, and the pressure in NLR.

The JCMT Gould Belt Survey: Understanding the influence of outflows on Gould Belt clouds

NASA Astrophysics Data System (ADS)

Drabek-Maunder, E.; Hatchell, J.; Buckle, J. V.; Di Francesco, J.; Richer, J.

2016-03-01

Using James Clerk Maxwell Telescope (JCMT) Gould Belt Survey data from CO J = 3 → 2 isotopologues, we present a meta-analysis of the outflows and energetics of star-forming regions in several Gould Belt clouds. The majority of the regions are strongly gravitationally bound. There is evidence that molecular outflows transport large quantities of momentum and energy. Outflow energies are at least 20 per cent of the total turbulent kinetic energies in all of the regions studied and greater than the turbulent energy in half of the regions. However, we find no evidence that outflows increase levels of turbulence, and there is no correlation between the outflow and turbulent energies. Even though outflows in some regions contribute significantly to maintaining turbulence levels against dissipation, this relies on outflows efficiently coupling to bulk motions. Other mechanisms (e.g. supernovae) must be the main drivers of turbulence in most if not all of these regions.

The Role of Cosmic-Ray Pressure in Accelerating Galactic Outflows

NASA Astrophysics Data System (ADS)

Simpson, Christine M.; Pakmor, Rüdiger; Marinacci, Federico; Pfrommer, Christoph; Springel, Volker; Glover, Simon C. O.; Clark, Paul C.; Smith, Rowan J.

2016-08-01

We study the formation of galactic outflows from supernova (SN) explosions with the moving-mesh code AREPO in a stratified column of gas with a surface density similar to the Milky Way disk at the solar circle. We compare different simulation models for SN placement and energy feedback, including cosmic rays (CRs), and find that models that place SNe in dense gas and account for CR diffusion are able to drive outflows with similar mass loading as obtained from a random placement of SNe with no CRs. Despite this similarity, CR-driven outflows differ in several other key properties including their overall clumpiness and velocity. Moreover, the forces driving these outflows originate in different sources of pressure, with the CR diffusion model relying on non-thermal pressure gradients to create an outflow driven by internal pressure and the random-placement model depending on kinetic pressure gradients to propel a ballistic outflow. CRs therefore appear to be non-negligible physics in the formation of outflows from the interstellar medium.

THE ROLE OF COSMIC-RAY PRESSURE IN ACCELERATING GALACTIC OUTFLOWS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simpson, Christine M.; Pakmor, Rüdiger; Pfrommer, Christoph

We study the formation of galactic outflows from supernova (SN) explosions with the moving-mesh code AREPO in a stratified column of gas with a surface density similar to the Milky Way disk at the solar circle. We compare different simulation models for SN placement and energy feedback, including cosmic rays (CRs), and find that models that place SNe in dense gas and account for CR diffusion are able to drive outflows with similar mass loading as obtained from a random placement of SNe with no CRs. Despite this similarity, CR-driven outflows differ in several other key properties including their overallmore » clumpiness and velocity. Moreover, the forces driving these outflows originate in different sources of pressure, with the CR diffusion model relying on non-thermal pressure gradients to create an outflow driven by internal pressure and the random-placement model depending on kinetic pressure gradients to propel a ballistic outflow. CRs therefore appear to be non-negligible physics in the formation of outflows from the interstellar medium.« less

A Comparison of Techniques for Determining Mass Outflow Rates in the Type 2 Quasar Markarian 34

NASA Astrophysics Data System (ADS)

Revalski, Mitchell; Crenshaw, D. Michael; Fischer, Travis C.; Kraemer, Steven B.; Schmitt, Henrique R.; Dashtamirova, Dzhuliya; Pope, Crystal L.

2018-06-01

We present spatially resolved measurements of the mass outflow rates and energetics for the Narrow Line Region (NLR) outflows in the type 2 quasar Markarian 34. Using data from the Hubble Space Telescope and Apache point observatory, together with Cloudy photoionization models, we calculate the radial mass distribution of ionized gas and map its kinematics. We compare the results of this technique to global outflow rates that characterize NLR outflows with a single outflow rate and energetic measurement. We find that NLR mass estimates based on emission line luminosities produce more consistent results than techniques employing filling factors.

Mock X-ray Observations of Localized LMC Outflows

NASA Astrophysics Data System (ADS)

Tomesh, Teague; Bustard, Chad; Zweibel, Ellen

2018-01-01

The Milky Way’s nearest neighbor, the Large Magellanic Cloud (LMC), is a perfect testing ground for modeling a variety of astrophysical phenomena. Specifically, the LMC provides a unique opportunity for the study of possible localized outflows driven by star formation and their x-ray signatures. We have developed FLASH simulations of theoretical outflows originating in the LMC that we have used to generate predicted observations of X-ray luminosity. This X-ray emission can be a useful probe of the hot gas in these winds which may couple to the cool gas and drive it from the disk. Future observations of the LMC may provide us with valuable checks on our model. This work is partially supported by the National Science Foundation (NSF) Graduate Research Fellowship Program under grant No. DGE-125625 and NSF grant No. AST-1616037.

Stellar physics. Observing the onset of outflow collimation in a massive protostar.

PubMed

Carrasco-González, C; Torrelles, J M; Cantó, J; Curiel, S; Surcis, G; Vlemmings, W H T; van Langevelde, H J; Goddi, C; Anglada, G; Kim, S-W; Kim, J-S; Gómez, J F

2015-04-03

The current paradigm of star formation through accretion disks, and magnetohydrodynamically driven gas ejections, predicts the development of collimated outflows, rather than expansion without any preferential direction. We present radio continuum observations of the massive protostar W75N(B)-VLA 2, showing that it is a thermal, collimated ionized wind and that it has evolved in 18 years from a compact source into an elongated one. This is consistent with the evolution of the associated expanding water-vapor maser shell, which changed from a nearly circular morphology, tracing an almost isotropic outflow, to an elliptical one outlining collimated motions. We model this behavior in terms of an episodic, short-lived, originally isotropic ionized wind whose morphology evolves as it moves within a toroidal density stratification. Copyright © 2015, American Association for the Advancement of Science.

Patients with Urinary Incontinence Appear More Likely to Develop Upper Urinary Tract Stones: A Nationwide, Population-Based Study with 8-Year Follow-Up

PubMed Central

Chung, Hsiao-Jen; Lin, Alex Tong-Long; Lin, Chih-Chieh; Chen, Tzeng-Ji; Chen, Kuang-Kuo

2016-01-01

This study aimed to investigate associations between primary urinary incontinence and development of upper urinary tract stones in a nationwide population in Taiwan. Data of 1,777 adults with primary urinary incontinence and 26,655 controls (groups A, B, and C) without urinary incontinence at study inception were retrieved from the National Health Insurance System database in Taiwan and were analyzed retrospectively. No enrolled subjects had previous diagnosis of upper urinary tract stones or spinal cord injury. All subjects were followed through end of 2009, with a minimum follow-up of 8 years. A greater percentage of study subjects (334/1777, 18.8%) developed upper urinary tract stones than that of control groups A (865/8885, 9.7%) and B (888/8885, 10%), and C (930/8885, 10.5%) (all p-values < 0.0001). Urinary incontinence was associated with significantly increased risk of developing urinary tract stones (HR 1.99, 95% CI, 1.70–2.34, p < 0.001). Age and metabolic syndrome status were both associated with developing upper urinary tract stones (both p-values < 0.0001). After adjusting for metabolic syndrome, regression analysis showed that urinary incontinence was still associated with a significantly increased risk of developing upper urinary tract stones (HR 1.99, 95% CI = 1.76–2.26, p < 0.0001). Long-term follow-up of Taiwanese patients with primary urinary incontinence suggests that urinary incontinence is associated with a significantly increased risk of developing upper urinary tract stones. Study findings suggest that physicians treating patients with urinary incontinence should give attention to early detection of upper urinary tract stones. PMID:27536881

Patients with Urinary Incontinence Appear More Likely to Develop Upper Urinary Tract Stones: A Nationwide, Population-Based Study with 8-Year Follow-Up.

PubMed

Chung, Hsiao-Jen; Lin, Alex Tong-Long; Lin, Chih-Chieh; Chen, Tzeng-Ji; Chen, Kuang-Kuo

2016-01-01

This study aimed to investigate associations between primary urinary incontinence and development of upper urinary tract stones in a nationwide population in Taiwan. Data of 1,777 adults with primary urinary incontinence and 26,655 controls (groups A, B, and C) without urinary incontinence at study inception were retrieved from the National Health Insurance System database in Taiwan and were analyzed retrospectively. No enrolled subjects had previous diagnosis of upper urinary tract stones or spinal cord injury. All subjects were followed through end of 2009, with a minimum follow-up of 8 years. A greater percentage of study subjects (334/1777, 18.8%) developed upper urinary tract stones than that of control groups A (865/8885, 9.7%) and B (888/8885, 10%), and C (930/8885, 10.5%) (all p-values < 0.0001). Urinary incontinence was associated with significantly increased risk of developing urinary tract stones (HR 1.99, 95% CI, 1.70-2.34, p < 0.001). Age and metabolic syndrome status were both associated with developing upper urinary tract stones (both p-values < 0.0001). After adjusting for metabolic syndrome, regression analysis showed that urinary incontinence was still associated with a significantly increased risk of developing upper urinary tract stones (HR 1.99, 95% CI = 1.76-2.26, p < 0.0001). Long-term follow-up of Taiwanese patients with primary urinary incontinence suggests that urinary incontinence is associated with a significantly increased risk of developing upper urinary tract stones. Study findings suggest that physicians treating patients with urinary incontinence should give attention to early detection of upper urinary tract stones.

DISCOVERY OF RELATIVISTIC OUTFLOW IN THE SEYFERT GALAXY Ark 564

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gupta, A.; Mathur, S.; Krongold, Y.

2013-07-20

We present Chandra High Energy Transmission Grating Spectra of the narrow-line Seyfert-1 galaxy Ark 564. The spectrum shows numerous absorption lines which are well modeled with low-velocity outflow components usually observed in Seyfert galaxies. There are, however, some residual absorption lines which are not accounted for by low-velocity outflows. Here, we present identifications of the strongest lines as K{alpha} transitions of O VII (two lines) and O VI at outflow velocities of {approx}0.1c. These lines are detected at 6.9{sigma}, 6.2{sigma}, and 4.7{sigma}, respectively, and cannot be due to chance statistical fluctuations. Photoionization models with ultra-high velocity components improve the spectralmore » fit significantly, providing further support for the presence of relativistic outflow in this source. Without knowing the location of the absorber, its mass and energy outflow rates cannot be well constrained; we find E-dot (outflow)/L{sub bol} lower limit of {>=}0.006% assuming a bi-conical wind geometry. This is the first time that absorption lines with ultra-high velocities are unambiguously detected in the soft X-ray band. The presence of outflows with relativistic velocities in active galactic nuclei (AGNs) with Seyfert-type luminosities is hard to understand and provides valuable constraints to models of AGN outflows. Radiation pressure is unlikely to be the driving mechanism for such outflows and magnetohydrodynamic may be involved.« less

The energetics of AGN radiation pressure-driven outflows

NASA Astrophysics Data System (ADS)

Ishibashi, W.; Fabian, A. C.; Maiolino, R.

2018-05-01

The increasing observational evidence of galactic outflows is considered as a sign of active galactic nucleus (AGN) feedback in action. However, the physical mechanism responsible for driving the observed outflows remains unclear, and whether it is due to momentum, energy, or radiation is still a matter of debate. The observed outflow energetics, in particular the large measured values of the momentum ratio (\\dot{p}/(L/c) ˜ 10) and energy ratio (\\dot{E}_k/L ˜ 0.05), seems to favour the energy-driving mechanism; and most observational works have focused their comparison with wind energy-driven models. Here, we show that AGN radiation pressure on dust can adequately reproduce the observed outflow energetics (mass outflow rate, momentum flux, and kinetic power), as well as the scalings with luminosity, provided that the effects of radiation trapping are properly taken into account. In particular, we predict a sublinear scaling for the mass outflow rate (\\dot{M} ∝ L^{1/2}) and a superlinear scaling for the kinetic power (\\dot{E}_k ∝ L^{3/2}), in agreement with the observational scaling relations reported in the most recent compilation of AGN outflow data. We conclude that AGN radiative feedback can account for the global outflow energetics, at least equally well as the wind energy-driving mechanism, and therefore both physical models should be considered in the interpretation of future AGN outflow observations.

Broad Absorption Line Quasars with Polar Outflows

NASA Astrophysics Data System (ADS)

Wang, Junxian

2005-10-01

It is widely accepted that the broad absorption line (BAL) outflow exists in most (if not all) quasars with a small covering factor. Various evidences show that equatorial outflows are responsible for the BALs in most BAL QSOs. By searching for radio variable quasars in SDSS, we built the first sample of 6 BAL QSOs with polar BAL outflows. It is very likely that polar outflows are associated with relativistic jets, and their origins should be different from the equatorial outflows in the majority of BAL QSOs. We propose an XMM snapshot survey to a) check whether strong X-ray absorption, one of the most prominent characteristics of most BAL QSOs, also exist in the polar outflows b) check whether face-on BAL QSOs are otherwise X-ray normal c) provide a baseline for future extensive X-ray studies.

A resolved outflow of matter from a brown dwarf.

PubMed

Whelan, Emma T; Ray, Thomas P; Bacciotti, Francesca; Natta, Antonella; Testi, Leonardo; Randich, Sofia

2005-06-02

The birth of stars involves not only accretion but also, counter-intuitively, the expulsion of matter in the form of highly supersonic outflows. Although this phenomenon has been seen in young stars, a fundamental question is whether it also occurs among newborn brown dwarfs: these are the so-called 'failed stars', with masses between stars and planets, that never manage to reach temperatures high enough for normal hydrogen fusion to occur. Recently, evidence for accretion in young brown dwarfs has mounted, and their spectra show lines that are suggestive of outflows. Here we report spectro-astrometric data that spatially resolve an outflow from a brown dwarf. The outflow's characteristics appear similar to, but on a smaller scale than, outflows from normal young stars. This result suggests that the outflow mechanism is universal, and perhaps relevant even to the formation of planets.

A distance-limited sample of massive molecular outflows

NASA Astrophysics Data System (ADS)

Maud, L. T.; Moore, T. J. T.; Lumsden, S. L.; Mottram, J. C.; Urquhart, J. S.; Hoare, M. G.

2015-10-01

We have observed 99 mid-infrared-bright, massive young stellar objects and compact H II regions drawn from the Red MSX source survey in the J = 3-2 transition of 12CO and 13CO, using the James Clerk Maxwell Telescope. 89 targets are within 6 kpc of the Sun, covering a representative range of luminosities and core masses. These constitute a relatively unbiased sample of bipolar molecular outflows associated with massive star formation. Of these, 59, 17 and 13 sources (66, 19 and 15 per cent) are found to have outflows, show some evidence of outflow, and have no evidence of outflow, respectively. The time-dependent parameters of the high-velocity molecular flows are calculated using a spatially variable dynamic time-scale. The canonical correlations between the outflow parameters and source luminosity are recovered and shown to scale with those of low-mass sources. For coeval star formation, we find the scaling is consistent with all the protostars in an embedded cluster providing the outflow force, with massive stars up to ˜30 M⊙ generating outflows. Taken at face value, the results support the model of a scaled-up version of the accretion-related outflow-generation mechanism associated with discs and jets in low-mass objects with time-averaged accretion rates of ˜10-3 M⊙ yr-1 on to the cores. However, we also suggest an alternative model, in which the molecular outflow dynamics are dominated by the entrained mass and are unrelated to the details of the acceleration mechanism. We find no evidence that outflows contribute significantly to the turbulent kinetic energy of the surrounding dense cores.

The Dual Role of Starbursts and Active Galactic Nuclei in Driving Extreme Molecular Outflows

NASA Astrophysics Data System (ADS)

Gowardhan, Avani; Spoon, Henrik; Riechers, Dominik A.; González-Alfonso, Eduardo; Farrah, Duncan; Fischer, Jacqueline; Darling, Jeremy; Fergulio, Chiara; Afonso, Jose; Bizzocchi, Luca

2018-05-01

We report molecular gas observations of IRAS 20100‑4156 and IRAS 03158+4227, two local ultraluminous infrared galaxies (ULIRGs) hosting some of the fastest and most massive molecular outflows known. Using Atacama Large Millimeter Array and Plateau de Bure Interferometer observations, we spatially resolve the CO (1‑0) emission from the outflowing molecular gas in both and find maximum outflow velocities of v max ∼ 1600 and ∼1700 km s‑1 for IRAS 20100‑4156 and IRAS 03158+4227, respectively. We find total gas mass outflow rates of {\\dot{M}}OF}∼ 670 and ∼350 M ⊙ yr‑1, respectively, corresponding to molecular gas depletion timescales {τ }OF}dep}∼ 11 and ∼16 Myr. This is nearly 3 times shorter than the depletion timescales implied by star formation, {τ }SFR}dep}∼ 33 and ∼46 Myr, respectively. To determine the outflow driving mechanism, we compare the starburst luminosity (L *) and active galactic nucleus (AGN) luminosity (L AGN) to the outflowing energy and momentum fluxes, using mid-infrared spectral decomposition to discern L AGN. Comparison to other molecular outflows in ULIRGs reveals that outflow properties correlate similarly with L * and L IR as with L AGN, indicating that AGN luminosity alone may not be a good tracer of feedback strength and that a combination of AGN and starburst activity may be driving the most powerful molecular outflows. We also detect the OH 1.667 GHz maser line from both sources and demonstrate its utility in detecting molecular outflows.

The effect of spaceflight on retino-hypothalamic tract development

NASA Technical Reports Server (NTRS)

Murakami, D. M.; Hoban-Higgins, T. M.; Tang, I. H.; Fuller, C. A.

1997-01-01

Researchers examined the effect of late prenatal exposure to microgravity on the development of the retina, retinohypothalamic tract, geniculo-hypothalamic tract, and suprachiasmatic nucleus. Results indicate an effect on c-fos activity in the intergeniculate leaflet between gestational day 20 and postnatal day 8, suggesting a delay in development of the circadian timing system.

A simple, analytic 3-dimensional downburst model based on boundary layer stagnation flow

NASA Technical Reports Server (NTRS)

Oseguera, Rosa M.; Bowles, Roland L.

1988-01-01

A simple downburst model is developed for use in batch and real-time piloted simulation studies of guidance strategies for terminal area transport aircraft operations in wind shear conditions. The model represents an axisymmetric stagnation point flow, based on velocity profiles from the Terminal Area Simulation System (TASS) model developed by Proctor and satisfies the mass continuity equation in cylindrical coordinates. Altitude dependence, including boundary layer effects near the ground, closely matches real-world measurements, as do the increase, peak, and decay of outflow and downflow with increasing distance from the downburst center. Equations for horizontal and vertical winds were derived, and found to be infinitely differentiable, with no singular points existent in the flow field. In addition, a simple relationship exists among the ratio of maximum horizontal to vertical velocities, the downdraft radius, depth of outflow, and altitude of maximum outflow. In use, a microburst can be modeled by specifying four characteristic parameters, velocity components in the x, y and z directions, and the corresponding nine partial derivatives are obtained easily from the velocity equations.

Secondary pseudohypoaldosteronism caused by urinary tract infection associated with urinary tract anomalies: case reports.

PubMed

Torun-Bayram, Meral; Soylu, Alper; Kasap-Demir, Belde; Alaygut, Demet; Türkmen, Mehmet; Kavukçu, Salih

2012-01-01

Secondary pseudohypoaldosteronism type 1 develops due to transient aldosterone resistance in renal tubules and is characterized by renal sodium loss, hyponatremia, hyperkalemia and high plasma aldosterone levels. Although many reasons are described, urinary tract infections and/or urinary tract anomalies are the most common causes. Although the cause of the tubular resistance is not known exactly, renal scar development due to obstruction and reduced sensitivity of mineralocorticoid receptors due to cytokines such as transforming growth factor (TGF)-beta are the possible mechanisms. It is seen especially within the first three months of life and the frequency decreases with age. The treatment is usually elimination of the underlying cause. In this article, we present four patients with several urinary tract anomalies and concomitant urinary tract infection who developed transient secondary pseudohypoaldosteronism.

Compact binary merger and kilonova: outflows from remnant disc

NASA Astrophysics Data System (ADS)

Yi, Tuan; Gu, Wei-Min; Liu, Tong; Kumar, Rajiv; Mu, Hui-Jun; Song, Cui-Ying

2018-05-01

Outflows launched from a remnant disc of compact binary merger may have essential contribution to the kilonova emission. Numerical calculations are conducted in this work to study the structure of accretion flows and outflows. By the incorporation of limited-energy advection in the hyper-accretion discs, outflows occur naturally from accretion flows due to imbalance between the viscous heating and the sum of the advective and radiative cooling. Following this spirit, we revisit the properties of the merger outflow ejecta. Our results show that around 10-3 ˜ 10-1 M⊙ of the disc mass can be launched as powerful outflows. The amount of unbound mass varies with the disc mass and the viscosity. The outflow-contributed peak luminosity is around 1040 ˜ 1041 erg s-1. Such a scenario can account for the observed kilonovae associated with short gamma-ray bursts, including the recent event AT2017gfo (GW170817).

Monitored Natural Attenuation and Enhanced Attenuation for Chlorinated Solvent Plumes - It’s All About Balance

DOE Office of Scientific and Technical Information (OSTI.GOV)

VANGELAS, KAREN

2005-05-19

Nature's inherent ability to cleanse itself is at the heart of Monitored Natural Attenuation (MNA). The complexity comes when one attempts to measure and calculate this inherent ability, called the Natural Attenuation Capacity (NAC), and determine if it is sufficient to cleanse the system to agreed upon criteria. An approach that is simple in concept for determining whether the NAC is sufficient for MNA to work is the concept of a mass balance. Mass balance is a robust framework upon which all decisions can be made. The inflows to and outflows from the system are balanced against the NAC ofmore » the subsurface system. For MNA to be acceptable, the NAC is balanced against the contaminant loading to the subsurface system with the resulting outflow from the system being in a range that is acceptable to the regulating and decision-making parties. When the system is such that the resulting outflow is not within an acceptable range, the idea of taking actions that are sustainable and that will bring the system within the acceptable range of outflows is evaluated. These sustainable enhancements are being developed under the Enhanced Attenuation (EA) concept.« less

Determining inclinations of active galactic nuclei via their narrow-line region kinematics

NASA Astrophysics Data System (ADS)

Fischer, Travis Cody

Active Galactic Nuclei (AGN) are axisymmetric systems to first order; their observed properties are likely strong functions of inclination with respect to our line of sight. However, except for a few special cases, the specific inclinations of individual AGN are unknown. We have developed a promising technique for determining the inclinations of nearby AGN by mapping the kinematics of their narrow-line regions (NLRs), which are easily resolved with Hubble Space Telescope (HST) [O III] imaging and long-slit spectra from the Space Telescope Imaging Spectrograph (STIS). Our studies indicate that NLR kinematics dominated by radial outflow can be fit with simple biconical outflow models that can be used to determine the inclination of the bicone axis, and hence the obscuring torus, with respect to our line of sight. We present NLR analysis of 53 Seyfert galaxies and resultant inclinations from models of 17 individual AGN with clear signatures of biconical outflow. From these AGN, which we can for the first time assess the effect of inclination on other observable properties in radio-quiet AGN, including the discovery of a distinct correlation between AGN inclination and X-ray column density. INDEX WORDS: AGN, Seyfert galaxies, NLR, Outflows, Kinematics, Bicones, Unified Model Graduation.

Monitored natural attenuation and enhanced attenuation for chlorinated solvent plumes - It's all about balance

USGS Publications Warehouse

Adams, K.A.; Vangelas, K.M.; Looney, B.B.; Chapelle, F.; Early, T.; Gilmore, T.; Sink, C.H.

2005-01-01

Nature's inherent ability to cleanse itself is at the heart of Monitored Natural Attenuation (MNA). The complexity comes when one attempts to measure and calculate this inherent ability, called the Natural Attenuation Capacity (NAC), and determine if it is sufficient to cleanse the system to agreed upon criteria. An approach that is simple in concept for determining whether the NAC is sufficient for MNA to work is the concept of a mass balance. Mass balance is a robust framework upon which all decisions can be made. The inflows to and outflows from the system are balanced against the NAC of the subsurface system. For MNA to be acceptable, the NAC is balanced against the contaminant loading to the subsurface system with the resulting outflow from the system being in a range that is acceptable to the regulating and decision-making parties. When the system is such that the resulting outflow is not within an acceptable range, the idea of taking actions that are sustainable and that will bring the system within the acceptable range of outflows is evaluated. These sustainable enhancements are being developed under the Enhanced Attenuation (EA) concept. Copyright ASCE 2005.

Generation of shockwave and vortex structures at the outflow of a boiling water jet

NASA Astrophysics Data System (ADS)

Alekseev, M. V.; Lezhnin, S. I.; Pribaturin, N. A.; Sorokin, A. L.

2014-12-01

Results of numerical simulation for shock waves and generation of vortex structures during unsteady outflow of boiling liquid jet are presented. The features of evolution of shock waves and vortex structures formation during unsteady outflow of boiling water are compared with corresponding structures during unsteady gas outflow.

Numerical Study on Outflows in Seyfert Galaxies I: Narrow Line Region Outflows in NGC 4151

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mou, Guobin; Wang, Tinggui; Yang, Chenwei, E-mail: gbmou@ustc.edu.cn

The origin of narrow line region (NLR) outflows remains unknown. In this paper, we explore the scenario in which these outflows are circumnuclear clouds driven by energetic accretion disk winds. We choose the well-studied nearby Seyfert galaxy NGC 4151 as an example. By performing 3D hydrodynamical simulations, we are able to reproduce the radial distributions of velocity, mass outflow rate, and kinetic luminosity of NLR outflows in the inner 100 pc deduced from spatial resolved spectroscopic observations. The demanded kinetic luminosity of disk winds is about two orders of magnitude higher than that inferred from the NLR outflows, but ismore » close to the ultrafast outflows (UFO) detected in the X-ray spectrum and a few times lower than the bolometric luminosity of the Seyfert. Our simulations imply that the scenario is viable for NGC 4151. The existence of the underlying disk winds can be confirmed by their impacts on higher density ISM, e.g., shock excitation signs, and the pressure in NLR.« less

Formation and spatial distribution of hypervelocity stars in AGN outflows

NASA Astrophysics Data System (ADS)

Wang, Xiawei; Loeb, Abraham

2018-05-01

We study star formation within outflows driven by active galactic nuclei (AGN) as a new source of hypervelocity stars (HVSs). Recent observations revealed active star formation inside a galactic outflow at a rate of ∼ 15M⊙yr-1 . We verify that the shells swept up by an AGN outflow are capable of cooling and fragmentation into cold clumps embedded in a hot tenuous gas via thermal instabilities. We show that cold clumps of ∼ 103 M⊙ are formed within ∼ 105 yrs. As a result, stars are produced along outflow's path, endowed with the outflow speed at their formation site. These HVSs travel through the galactic halo and eventually escape into the intergalactic medium. The expected instantaneous rate of star formation inside the outflow is ∼ 4 - 5 orders of magnitude greater than the average rate associated with previously proposed mechanisms for producing HVSs, such as the Hills mechanism and three-body interaction between a star and a black hole binary. We predict the spatial distribution of HVSs formed in AGN outflows for future observational probe.

AGN outflows as neutrino sources: an observational test

NASA Astrophysics Data System (ADS)

Padovani, P.; Turcati, A.; Resconi, E.

2018-04-01

We test the recently proposed idea that outflows associated with Active Galactic Nuclei (AGN) could be neutrino emitters in two complementary ways. First, we cross-correlate a list of 94 "bona fide" AGN outflows with the most complete and updated repository of IceCube neutrinos currently publicly available, assembled by us for this purpose. It turns out that AGN with outflows matched to an IceCube neutrino have outflow and kinetic energy rates, and bolometric powers larger than those of AGN with outflows not matched to neutrinos. Second, we carry out a statistical analysis on a catalogue of [O III] λ5007 line profiles using a sample of 23,264 AGN at z < 0.4, a sub-sample of which includes mostly possible outflows sources. We find no significant evidence of an association between the AGN and the IceCube events, although we get the smallest p-values (˜6 and 18 per cent respectively, pre-trial) for relatively high velocities and luminosities. Our results are consistent with a scenario where AGN outflows are neutrino emitters but at present do not provide a significant signal. This can be tested with better statistics and source stacking. A predominant role of AGN outflows in explaining the IceCube data appears in any case to be ruled out.

Bright crater outflows: Possible emplacement mechanisms

NASA Technical Reports Server (NTRS)

Chadwick, D. John; Schaber, Gerald G.; Strom, Robert G.; Duval, Darla M.

1992-01-01

Lobate features with a strong backscatter are associated with 43 percent of the impact craters cataloged in Magellan's cycle 1. Their apparent thinness and great lengths are consistent with a low-viscosity material. The longest outflow yet identified is about 600 km in length and flows from the 90-km-diameter crater Addams. There is strong evidence that the outflows are largely composed of impact melt, although the mechanisms of their emplacement are not clearly understood. High temperatures and pressures of target rocks on Venus allow for more melt to be produced than on other terrestrial planets because lower shock pressures are required for melting. The percentage of impact craters with outflows increases with increasing crater diameter. The mean diameter of craters without outflows is 14.4 km, compared with 27.8 km for craters with outflows. No craters smaller than 3 km, 43 percent of craters in the 10- to 30-km-diameter range, and 90 percent in the 80- to 100-km-diameter range have associated bright outflows. More melt is produced in the more energetic impact events that produce larger craters. However, three of the four largest craters have no outflows. We present four possible mechanisms for the emplacement of bright outflows. We believe this 'shotgun' approach is justified because all four mechanisms may indeed have operated to some degree.

AGN outflows as neutrino sources: an observational test

NASA Astrophysics Data System (ADS)

Padovani, P.; Turcati, A.; Resconi, E.

2018-07-01

We test the recently proposed idea that outflows associated with Active Galactic Nuclei (AGN) could be neutrino emitters in two complementary ways. First, we cross-correlate a list of 94 'bona fide' AGN outflows with the most complete and updated repository of IceCube neutrinos currently publicly available, assembled by us for this purpose. It turns out that AGN with outflows matched to an IceCube neutrino have outflow and kinetic energy rates, and bolometric powers larger than those of AGN with outflows not matched to neutrinos. Secondly, we carry out a statistical analysis on a catalogue of [O III] λ5007 line profiles using a sample of 23 264 AGN at z < 0.4, a subsample of which includes mostly possible outflow sources. We find no significant evidence of an association between the AGN and the IceCube events, although we get the smallest p-values (˜6 and 18 per cent, respectively, pre-trial) for relatively high velocities and luminosities. Our results are consistent with a scenario where AGN outflows are neutrino emitters but at present do not provide a significant signal. This can be tested with better statistics and source stacking. A predominant role of AGN outflows in explaining the IceCube data appears in any case to be ruled out.

Pitx2c attenuation results in cardiac defects and abnormalities of intestinal orientation in developing Xenopus laevis.

PubMed

Dagle, John M; Sabel, Jaime L; Littig, Jennifer L; Sutherland, Lillian B; Kolker, Sandra J; Weeks, Daniel L

2003-10-15

The experimental manipulation of early embryologic events, resulting in the misexpression of the homeobox transcription factor pitx2, is associated with subsequent defects of laterality in a number of vertebrate systems. To clarify the role of one pitx2 isoform, pitx2c, in determining the left-right axis of amphibian embryos, we examined the heart and gut morphology of Xenopus laevis embryos after attenuating pitx2c mRNA levels using chemically modified antisense oligonucleotides. We demonstrate that the partial depletion of pitx2c mRNA in these embryos results in alteration of both cardiac morphology and intestinal coiling. The most common cardiac abnormality seen was a failure of rightward migration of the outflow tract, while the most common intestinal laterality phenotype seen was a full reversal in the direction of coiling, each present in 23% of embryos injected with the pitx2c antisense oligonucleotide. An abnormality in either the heart or gut further predisposed to a malformation in the other. In addition, a number of other cardiac anomalies were observed after pitx2c mRNA attenuation, including abnormalities of atrial septation, extracellular matrix restriction, relative atrial-ventricular chamber positioning, and restriction of ventricular development. Many of these findings correlate with cardiac defects previously reported in pitx2 null and hypomorphic mice, but can now be assigned specifically to attenuation of the pitx2c isoform in Xenopus.

Focal adhesion kinase regulates smooth muscle cell recruitment to the developing vasculature

PubMed Central

Cheng, Zhaokang; Sundberg-Smith, Liisa J.; Mangiante, Lee E.; Sayers, Rebecca L.; Hakim, Zeenat S.; Musunuri, Srilaxmi; Maguire, Colin T.; Majesky, Mark W.; Zhou, Zhigang; Mack, Christopher P.; Taylor, Joan M.

2011-01-01

Objective The investment of newly formed endothelial cell tubes with differentiated smooth muscle cells (SMC) is critical for appropriate vessel formation, but the underlying mechanisms remain unknown. We previously showed that depletion of focal adhesion kinase (FAK) in the nkx2.5 expression domain led to aberrant outflow tract (OFT) morphogenesis and strove herein to determine the cell types and mechanisms involved. Methods and Results We crossed fakloxp targeted mice with available Cre drivers to deplete FAK in OFT SMC (FAKwnt and FAKnk) or coronary SMC (FAKcSMC). In each case, depletion of FAK led to defective vasculogenesis that was incompatible with post-natal life. Immunohistochemical analysis of the mutant vascular structures revealed that FAK was not required for progenitor cell proliferation, survival, or differentiation into SMC, but was necessary for subsequent SMC recruitment to developing vasculature. Using a novel FAK-null SMC culture model, we found that depletion of FAK did not influence SMC growth or survival, but blocked directional SMC motility and invasion toward the potent endothelial-derived chemokine, PDGFBB. FAK depletion resulted in un-stable lamellipodial protrusions due to defective spatial-temporal activation of the small GTPase, Rac-1 and lack of Rac1-dependent recruitment of cortactin (an actin stabilizing protein) to the leading edge. Moreover, FAK null SMC exhibited a significant reduction in PDGF-stimulated extracellular matrix degradation. Conclusions FAK drives PDGFBB-stimulated SMC chemotaxis/invasion and is essential for SMC to appropriately populate the aorticopulmonary septum and the coronary vascular plexus. PMID:21757658

THE MOLECULAR WIND IN THE NEAREST SEYFERT GALAXY CIRCINUS REVEALED BY ALMA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zschaechner, Laura K.; Walter, Fabian; Farina, Emanuele P.

2016-12-01

We present ALMA observations of the inner 1′ (1.2 kpc) of the Circinus galaxy, the nearest Seyfert. We target CO (1–0) in the region associated with a well-known multiphase outflow driven by the central active galactic nucleus (AGN). While the geometry of Circinus and its outflow make disentangling the latter difficult, we see indications of outflowing molecular gas at velocities consistent with the ionized outflow. We constrain the mass of the outflowing molecular gas to be 1.5 × 10{sup 5}−5.1 × 10{sup 6} M {sub ⊙}, yielding a molecular outflow rate of 0.35–12.3 M {sub ⊙} yr{sup −1}. The values within this range aremore » comparable to the star formation (SF) rate in Circinus, indicating that the outflow indeed regulates SF to some degree. The molecular outflow in Circinus is considerably lower in mass and energetics than previously studied AGN-driven outflows, especially given its high ratio of AGN luminosity to bolometric luminosity. The molecular outflow in Circinus is, however, consistent with some trends put forth by Cicone et al., including a linear relation between kinetic power and AGN luminosity, as well as its momentum rate versus bolometric luminosity (although the latter places Circinus among the starburst galaxies in that sample). We detect additional molecular species including CN and C{sup 17}O.« less

Global-scale Ionospheric Outflow: Major Processes and Unresolved Problems

NASA Astrophysics Data System (ADS)

Liemohn, M. W.; Welling, D. T.; Ilie, R.; Khazanov, G. V.; Jahn, J. M.; Zou, S.; Ganushkina, N. Y.; Valek, P. W.; Elliott, H. A.; Gilchrist, B. E.; Hoegy, W. R.; Glocer, A.

2016-12-01

Outflow from the ionosphere is a major source of plasma to the magnetosphere. Its presence, especially that of ions heavier than He+, mass loads the magnetosphere and changes reconnection rates, current system configurations, plasma wave excitation and wave-particle interactions. It even impacts the propagation of information. We present a brief overview of the major processes and scientific history of this field. There are still major gaps, however, in our understanding of the global-scale nature of ionospheric outflow. We discuss these unresolved problems highlighting the leading questions still outstanding on this topic. First and foremost, since the measurements of ionospheric outflow have largely come from individual satellites and sounding rockets, the processes are best known on the local level, while the spatial distribution of outflow has never been simultaneously measured on more global scales. The spatial coherence and correlation of outflow across time and space have not been quantified. Furthermore, the composition of the outflow is often only measured at a coarse level of H+, He+, and O+, neglecting other species such as N+ or moleculars. However, resolving O+ from N+, as is customary in planetary research, aids in revealing the physics and altitude dependence of the energization processes in the ionosphere. Similarly, fine-resolution velocity space measurements of ionospheric outflow have been limited, yet such observations can also reveal energization processes driving the outflow. A final unresolved issue to mention is magnetically conjugate outflow and the full extent of hemispherically asymmetric outflow fluxes or fluence. Each of these open questions have substantial ramifications for magnetospheric physics; their resolution could yield sweeping changes in our understanding of nonlinear feedback and cross-scale physical interactions, magnetosphere-ionosphere coupling, and geospace system-level science.

The Role of Ionospheric Outflow Preconditioning in Determining Storm Geoeffectiveness

NASA Astrophysics Data System (ADS)

Welling, D. T.; Liemohn, M. W.; Ridley, A. J.

2012-12-01

It is now well accepted that ionospheric outflow plays an important role in the development of the plasma sheet and ring current during geomagnetic storms. Furthermore, even during quiet times, ionospheric plasma populates the magnetospheric lobes, producing a reservoir of hydrogen and oxygen ions. When the Interplanetary Magnetic Field (IMF) turns southward, this reservoir is connected to the plasma sheet and ring current through magnetospheric convection. Hence, the conditions of the ionosphere and magnetospheric lobes leading up to magnetospheric storm onset have important implications for storm development. Despite this, there has been little research on this preconditioning; most global simulations begin just before storm onset, neglecting preconditioning altogether. This work explores the role of preconditioning in determining the geoeffectiveness of storms using a coupled global model system. A model of ionospheric outflow (the Polar Wind Outflow Model, PWOM) is two-way coupled to a global magnetohydrodynamic model (the Block-Adaptive Tree Solar wind Roe-type Upwind Scheme, BATS-R-US), which in turn drives a ring current model (the Ring current Atmosphere interactions Model, RAM). This unique setup is used to simulate an idealized storm. The model is started at many different times, from 1 hour before storm onset to 12 hours before. The effects of storm preconditioning are examined by investigating the total ionospheric plasma content in the lobes just before onset, the total ionospheric contribution in the ring current just after onset, and the effects on Dst, magnetic elevation angle at geosynchronous, and total ring current energy density. This experiment is repeated for different solar activity levels as set by F10.7 flux. Finally, a synthetic double-dip storm is constructed to see how two closely spaced storms affect each other by changing the preconditioning environment. It is found that preconditioning of the magnetospheric lobes via ionospheric outflow greatly influences the geoeffectiveness of magnetospheric storms.

Latent outflow activity for western Tharsis, Mars: Significant flood record exposed

USGS Publications Warehouse

Dohm, J.M.; Anderson, R.C.; Baker, V.R.; Ferris, J.C.; Rudd, L.P.; Hare, T.M.; Rice, J. W.; Casavant, R.R.; Strom, R.G.; Zimbelman, J.R.; Scott, D.H.

2001-01-01

Observations permitted by the newly acquired Mars Observer Laser Altimeter data have revealed a system of gigantic valleys northwest of the huge Martian shield volcano, Arsia Mons, in the western hemisphere of Mars (northwestern slope valleys (NSVs)). These features, which generally correspond spatially to gravity lows, are obscured by veneers of materials including volcanic lava flows, air fall deposits, and eolian materials. Geologic investigations of the Tharsis region suggest that the system of gigantic valleys predates the construction of Arsia Mons and its extensive associated lava flows of mainly late Hesperian and Amazonian age and coincides stratigraphically with the early development of the outflow channels that debouch into Chryse Planitia. Similar to the previously identified outflow channels, which issued tremendous volumes of water into topographic lows such as Chryse Planitia, the NSVs potentially represent flooding of immense magnitude and, as such, a source of water for a northern plains ocean.

Inter-annual variability and long term predictability of exchanges through the Strait of Gibraltar

NASA Astrophysics Data System (ADS)

Boutov, Dmitri; Peliz, Álvaro; Miranda, Pedro M. A.; Soares, Pedro M. M.; Cardoso, Rita M.; Prieto, Laura; Ruiz, Javier; García-Lafuente, Jesus

2014-03-01

Inter-annual variability of calculated barotropic (netflow) and simulated baroclinic (inflow and outflow) exchanges through the Strait of Gibraltar is analyzed and their response to the main modes of atmospheric variability is investigated. Time series of the outflow obtained by high resolution simulations and estimated from in-situ Acoustic Doppler Current Profiler (ADCP) current measurements are compared. The time coefficients (TC) of the leading empirical orthogonal function (EOF) modes that describe zonal atmospheric circulation in the vicinity of the Strait (1st and 3rd of Sea-Level Pressure (SLP) and 1st of the wind) show significant covariance with the inflow and outflow. Based on these analyses, a regression model between these SLP TCs and outflow of the Mediterranean Water was developed. This regression outflow time series was compared with estimates based on current meter observations and the predictability and reconstruction of past exchange variability based on atmospheric pressure fields are discussed. The simple regression model seems to reproduce the outflow evolution fairly reasonably, with the exception of the year 2008, which is apparently anomalous without available physical explanation yet. The exchange time series show a reduced inter-annual variability (less than 1%, 2.6% and 3.1% of total 2-day variability, for netflow, inflow and outflow, respectively). From a statistical point of view no clear long-term tendencies were revealed. Anomalously high baroclinic fluxes are reported for the years of 2000-2001 that are coincident with strong impact on the Alboran Sea ecosystem. The origin of the anomalous flow is associated with a strong negative anomaly (~ - 9 hPa) in atmospheric pressure fields settled north of Iberian Peninsula and extending over the central Atlantic, favoring an increased zonal circulation in winter 2000/2001. These low pressure fields forced intense and durable westerly winds in the Gulf of Cadiz-Alboran system. The signal of this anomaly is also seen in time coefficients of the most significant EOF modes. The predictability of the exchanges for future climate is discussed.

Development of vocal tract length during early childhood: A magnetic resonance imaging study

NASA Astrophysics Data System (ADS)

Vorperian, Houri K.; Kent, Ray D.; Lindstrom, Mary J.; Kalina, Cliff M.; Gentry, Lindell R.; Yandell, Brian S.

2005-01-01

Speech development in children is predicated partly on the growth and anatomic restructuring of the vocal tract. This study examines the growth pattern of the various hard and soft tissue vocal tract structures as visualized by magnetic resonance imaging (MRI), and assesses their relational growth with vocal tract length (VTL). Measurements on lip thickness, hard- and soft-palate length, tongue length, naso-oro-pharyngeal length, mandibular length and depth, and distance of the hyoid bone and larynx from the posterior nasal spine were used from 63 pediatric cases (ages birth to 6 years and 9 months) and 12 adults. Results indicate (a) ongoing growth of all oral and pharyngeal vocal tract structures with no sexual dimorphism, and a period of accelerated growth between birth and 18 months; (b) vocal tract structure's region (oral/anterior versus pharyngeal/posterior) and orientation (horizontal versus vertical) determine its growth pattern; and (c) the relational growth of the different structures with VTL changes with development-while the increase in VTL throughout development is predominantly due to growth of pharyngeal/posterior structures, VTL is also substantially affected by the growth of oral/anterior structures during the first 18 months of life. Findings provide normative data that can be used for modeling the development of the vocal tract. .

Three-dimensional high-resolution diffusion tensor imaging and tractography of the developing rabbit brain.

PubMed

D'Arceuil, Helen; Liu, Christina; Levitt, Pat; Thompson, Barbara; Kosofsky, Barry; de Crespigny, Alex

2008-01-01

Diffusion tensor imaging (DTI) is sensitive to structural ordering in brain tissue particularly in the white matter tracts. Diffusion anisotropy changes with disease and also with neural development. We used high-resolution DTI of fixed rabbit brains to study developmental changes in regional diffusion anisotropy and white matter fiber tract development. Imaging was performed on a 4.7-tesla Bruker Biospec Avance scanner using custom-built solenoid coils and DTI was performed at various postnatal ages. Trace apparent diffusion coefficient, fractional diffusion anisotropy maps and fiber tracts were generated and compared across the ages. The brain was highly anisotropic at birth and white matter anisotropy increased with age. Regional DTI tractography of the internal capsule showed refinement in regional tract architecture with maturation. Interestingly, brains with congenital deficiencies of the callosal commissure showed selectively strikingly different fiber architecture compared to age-matched brains. There was also some evidence of subcortical to cortical fiber connectivity. DTI tractography of the anterior and posterior limbs of the internal capsule showed reproducibly coherent fiber tracts corresponding to known corticospinal and corticobulbar tract anatomy. There was some minor interanimal tract variability, but there was remarkable similarity between the tracts in all animals. Therefore, ex vivo DTI tractography is a potentially powerful tool for neuroscience investigations and may also reveal effects (such as fiber tract pruning during development) which may be important targets for in vivo human studies. Copyright 2007 S. Karger AG, Basel.

Fetal Urinary Tract Anomalies: Review of Pathophysiology, Imaging, and Management.

PubMed

Mileto, Achille; Itani, Malak; Katz, Douglas S; Siebert, Joseph R; Dighe, Manjiri K; Dubinsky, Theodore J; Moshiri, Mariam

2018-05-01

Common fetal anomalies of the kidneys and urinary tract encompass a complex spectrum of abnormalities that can be detected prenatally by ultrasound. Common fetal anomalies of the kidneys and urinary tract can affect amniotic fluid volume production with the development of oligohydramnios or anhydramnios, resulting in fetal pulmonary hypoplasia and, potentially, abnormal development of other fetal structures. We provide an overview of common fetal anomalies of the kidneys and urinary tract with an emphasis on sonographic patterns as well as pathologic and postnatal correlation, along with brief recommendations for postnatal management. Of note, we render an updated classification of fetal abnormalities of the kidneys and urinary tract based on the presence or absence of associated urinary tract dilation. In addition, we review the 2014 classification of urinary tract dilation based on the Linthicum multidisciplinary consensus panel.

Role of groundwater in formation of Martian channels

NASA Technical Reports Server (NTRS)

Howard, Alan D.

1991-01-01

A global 3-D model of groundwater flow has been used to study possible behavior of groundwater on Mars and its role in creating fluvial features. Conclusions drawn from an earlier 2-D groundwater model are supplemented and expanded. Topical headings are discussed as follows: timescales of groundwater flow; wet areas on Mars and location of outflow channels; implications for valley networks; the enigma of Hellas; absence of fluvial or periglacial features on Syrtis Major; development of chaotic terrain and associated outflow channels; and structurally controlled valley networks.

Waterspout, Gust Fronts and Associated Cloud Systems

NASA Technical Reports Server (NTRS)

Simpson, J.

1983-01-01

Nine waterspouts observed on five experimental days during the GATE period of observations are discussed. Primary data used are from 2 aircraft flying in different patterns, one above the other between 30 and 300 m. There is strong evidence associating whirl initiation with cumulus outflow. Computations prepared from estimates of convergence with the region suggest the possibility of vortex generation within 4 minutes. This analysis supports (1) the importance cumulus outflows may have in waterspout initiation and (2) the possibility that sea surface temperature gradients may be important in enabling waterspout development from modest size cumuli.

PROTOSTELLAR OUTFLOWS AND RADIATIVE FEEDBACK FROM MASSIVE STARS. II. FEEDBACK, STAR-FORMATION EFFICIENCY, AND OUTFLOW BROADENING

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuiper, Rolf; Turner, Neal J.; Yorke, Harold W., E-mail: rolf.kuiper@uni-tuebingen.de, E-mail: Neal.J.Turner@jpl.nasa.gov, E-mail: Harold.W.Yorke@jpl.nasa.gov

2016-11-20

We perform two-dimensional axially symmetric radiation hydrodynamic simulations to assess the impact of outflows and radiative force feedback from massive protostars by varying when the protostellar outflow starts, and to determine the ratio of ejection to accretion rates and the strength of the wide-angle disk wind component. The star-formation efficiency, i.e., the ratio of final stellar mass to initial core mass, is dominated by radiative forces and the ratio of outflow to accretion rates. Increasing this ratio has three effects. First, the protostar grows slower with a lower luminosity at any given time, lowering radiative feedback. Second, bipolar cavities clearedmore » by the outflow become larger, further diminishing radiative feedback on disk and core scales. Third, the higher momentum outflow sweeps up more material from the collapsing envelope, decreasing the protostar's potential mass reservoir via entrainment. The star-formation efficiency varies with the ratio of ejection to accretion rates from 50% in the case of very weak outflows to as low as 20% for very strong outflows. At latitudes between the low-density bipolar cavity and the high-density accretion disk, wide-angle disk winds remove some of the gas, which otherwise would be part of the accretion flow onto the disk; varying the strength of these wide-angle disk winds, however, alters the final star-formation efficiency by only ±6%. For all cases, the opening angle of the bipolar outflow cavity remains below 20° during early protostellar accretion phases, increasing rapidly up to 65° at the onset of radiation pressure feedback.« less

Broad [C II] Line Wings as Tracer of Molecular and Multi-phase Outflows in Infrared Bright Galaxies

NASA Astrophysics Data System (ADS)

Janssen, A. W.; Christopher, N.; Sturm, E.; Veilleux, S.; Contursi, A.; González-Alfonso, E.; Fischer, J.; Davies, R.; Verma, A.; Graciá-Carpio, J.; Genzel, R.; Lutz, D.; Sternberg, A.; Tacconi, L.; Burtscher, L.; Poglitsch, A.

2016-05-01

We report a tentative correlation between the outflow characteristics derived from OH absorption at 119 μm and [C II] emission at 158 μm in a sample of 22 local and bright ultraluminous infrared galaxies (ULIRGs). For this sample, we investigate whether [C II] broad wings are a good tracer of molecular outflows, and how the two tracers are connected. Fourteen objects in our sample have a broad wing component as traced by [C II], and all of these also show OH119 absorption indicative of an outflow (in one case an inflow). The other eight cases, where no broad [C II] component was found, are predominantly objects with no OH outflow or a low-velocity (≤100 km s-1) OH outflow. The FWHM of the broad [C II] component shows a trend with the OH119 blueshifted velocity, although with significant scatter. Moreover, and despite large uncertainties, the outflow masses derived from OH and broad [C II] show a 1:1 relation. The main conclusion is therefore that broad [C II] wings can be used to trace molecular outflows. This may be particularly relevant at high redshift, where the usual tracers of molecular gas (like low-J CO lines) become hard to observe. Additionally, observations of blueshifted Na I D λλ 5890, 5896 absorption are available for 10 of our sources. Outflow velocities of Na I D show a trend with OH velocity and broad [C II] FWHM. These observations suggest that the atomic and molecular gas phases of the outflow are connected.

Geometric and Kinematic Structure of the Outflow/Envelope System of L1527 Revealed by Subarcsecond-resolution Observation of CS

NASA Astrophysics Data System (ADS)

Oya, Yoko; Sakai, Nami; Lefloch, Bertrand; López-Sepulcre, Ana; Watanabe, Yoshimasa; Ceccarelli, Cecilia; Yamamoto, Satoshi

2015-10-01

Subarcsecond-resolution images of the rotational line emissions of CS and c-C3H2 obtained toward the low-mass protostar IRAS 04368+2557 in L1527 with the Atacama Large Millimeter/submillimeter Array are investigated to constrain the orientation of the outflow/envelope system. The distribution of CS consists of an envelope component extending from north to south and a faint butterfly shaped outflow component. The kinematic structure of the envelope is well reproduced by a simple ballistic model of an infalling rotating envelope. Although the envelope has a nearly edge-on configuration, we find that the western side of the envelope faces the observer. This configuration is opposite to the direction of the large-scale (˜104 AU) outflow suggested previously from the 12CO (J = 3-2) observation, and to the morphology of infrared reflection near the protostar (˜200 AU). The latter discrepancy could originate from high extinction by the outflow cavity of the western side, or may indicate that the outflow axis is not parallel to the rotation axis of the envelope. Position-velocity diagrams show the accelerated outflow cavity wall, and its kinematic structure in the 2000 AU scale is explained by a standard parabolic model with the inclination angle derived from the analysis of the envelope. The different orientation of the outflow between the small and large scale implies a possibility of precession of the outflow axis. The shape and the velocity of the outflow in the vicinity of the protostar are compared with those of other protostars.

Quasar outflows and AGN feedback in the extreme UV: HST/COS observations of HE 0238-1904

NASA Astrophysics Data System (ADS)

Arav, Nahum; Borguet, Benoit; Chamberlain, Carter; Edmonds, Doug; Danforth, Charles

2013-12-01

Spectroscopic observations of quasar outflows at rest-frame 500-1000 Å have immense diagnostic power. We present analyses of such data, where absorption troughs from O IV and O IV* allow us to obtain the distance of the outflows from the AGN and troughs from Ne VIII and Mg X reveal the warm absorber phase of the outflow. Their inferred column densities, combined with those of O VI, N IV and H I, yield two important results. (1) The outflow shows two ionization phases, where the high-ionization phase carries the bulk of the material. This is similar to the situation seen in X-ray warm absorber studies. Furthermore, the low-ionization phase is inferred to have a volume filling factor of 10-5-10-6. (2) We determine a distance of 3000 pc from the outflow to the central source using the O IV*/O IV column density ratio and the knowledge of the ionization parameter. Since this is a typical high-ionization outflow, we can determine robust values for the outflow's mass flux and kinetic luminosity of 40 M⊙ yr-1 and 1045 erg s-1, respectively, where the latter is roughly equal to 1 per cent of the bolometric luminosity. Such a large kinetic luminosity and mass flow rate measured in a typical high-ionization wind suggest that quasar outflows are a major contributor to AGN feedback mechanisms.

Star formation inside a galactic outflow.

PubMed

Maiolino, R; Russell, H R; Fabian, A C; Carniani, S; Gallagher, R; Cazzoli, S; Arribas, S; Belfiore, F; Bellocchi, E; Colina, L; Cresci, G; Ishibashi, W; Marconi, A; Mannucci, F; Oliva, E; Sturm, E

2017-04-13

Recent observations have revealed massive galactic molecular outflows that may have the physical conditions (high gas densities) required to form stars. Indeed, several recent models predict that such massive outflows may ignite star formation within the outflow itself. This star-formation mode, in which stars form with high radial velocities, could contribute to the morphological evolution of galaxies, to the evolution in size and velocity dispersion of the spheroidal component of galaxies, and would contribute to the population of high-velocity stars, which could even escape the galaxy. Such star formation could provide in situ chemical enrichment of the circumgalactic and intergalactic medium (through supernova explosions of young stars on large orbits), and some models also predict it to contribute substantially to the star-formation rate observed in distant galaxies. Although there exists observational evidence for star formation triggered by outflows or jets into their host galaxy, as a consequence of gas compression, evidence for star formation occurring within galactic outflows is still missing. Here we report spectroscopic observations that unambiguously reveal star formation occurring in a galactic outflow at a redshift of 0.0448. The inferred star-formation rate in the outflow is larger than 15 solar masses per year. Star formation may also be occurring in other galactic outflows, but may have been missed by previous observations owing to the lack of adequate diagnostics.

Quantifying Feedback from Narrow Line Region Outflows in Nearby Active Galaxies. I. Spatially Resolved Mass Outflow Rates for the Seyfert 2 Galaxy Markarian 573

NASA Astrophysics Data System (ADS)

Revalski, M.; Crenshaw, D. M.; Kraemer, S. B.; Fischer, T. C.; Schmitt, H. R.; Machuca, C.

2018-03-01

We present the first spatially resolved mass outflow rate measurements ({\\dot{M}}out}) of the optical emission line gas in the narrow line region (NLR) of a Seyfert 2 galaxy, Markarian 573. Using long slit spectra and [O III] imaging from the Hubble Space Telescope and Apache Point Observatory in conjunction with emission line diagnostics and Cloudy photoionization models, we find a peak outflow rate of {\\dot{M}}out}≈ 3.4 +/- 0.5 {M}ȯ {yr}}-1 at a distance of 210 pc from the central supermassive black hole (SMBH). The outflow extends to distances of 600 pc from the nucleus with a total mass and kinetic energy of M ≈ 2.2 × 106 M ⊙ and E ≈ 5.1 × 1054 erg, revealing the outflows to be more energetic than those in the lower luminosity Seyfert 1 galaxy NGC 4151. The peak outflow rate is an order of magnitude larger than the mass accretion and nuclear outflow rates, indicating local in situ acceleration of the circumnuclear NLR gas. We compare these results to global techniques that quantify an average outflow rate across the NLR, and find the latter are subject to larger uncertainties. These results indicate that spatially resolved observations are critical for probing AGN feedback on scales where circumnuclear star formation occurs.

AGN feedback in action? - outflows and star formation in type 2 AGNs

NASA Astrophysics Data System (ADS)

Woo, Jong-Hak

2017-01-01

We present the statistical constraints on the ionized gas outflows and their connection to star formation, using a large sample of ~110,000 AGNs and star-forming galaxies at z < 0.3. First, we find a dramatic difference of the outflow signatures between AGNs and star-forming galaxies based on the [OIII] emission line kinematics. While the [OIII] velocity and velocity dispersion of star forming galaxies can be entirely accounted by the gravitational potential of host galaxies, AGNs clearly show non-gravitational kinematics, which is comparable to or stronger than the virial motion caused by the gravitational potential. Second, the distribution in the [OIII] velocity - velocity dispersion diagram dramatically expands toward large values with increasing AGN luminosity, implying that the outflows are AGN-driven. Third, the fraction of AGNs with a signature of outflow kinematics, steeply increases with AGN luminosity and Eddington ratio. In particular, the majority of luminous AGNs presents strong non-gravitational kinematics in the [OIII] profile. Interestingly, we find that the specific star formation of non-outflow AGNs is much lower than that of strong outflow AGNs, while the star formation rate of strong outflow AGNs is comparable to that of star forming galaxies. We interpret this trend as a delayed AGN feedback as it takes dynamical time for the outflows to suppress star formation in galactic scales.

Morphological and Hydrodynamic Correlations with Increasing Outflow Facility by Rho-Kinase Inhibitor Y-27632

PubMed Central

Yang, Chen-Yuan Charlie

2014-01-01

Abstract Rho-kinase inhibitors affect actomyosin cytoskeletal networks and have been shown to significantly increase outflow facility and lower intraocular pressure in various animal models and human eyes. This article summarizes common morphological changes in the trabecular meshwork induced by Rho-kinase inhibitors and specifically compares the morphological and hydrodynamic correlations with increased outflow facility by Rho-kinase inhibitor, Y-27632, in bovine, monkey, and human eyes under similar experimental conditions. Interspecies comparison has shown that morphological changes in the juxtacanalicular connective tissue (JCT) of these 3 species were different. However, these different morphological changes in the JCT, no matter if it's separation between the JCT and inner wall in bovine eyes, or separation between the JCT cells or between the JCT cells and their matrix in monkey eyes, or even no separation between the inner wall and the JCT but a more subtle expansion of the JCT in human eyes, appear to correlate with the increased percent change of outflow facility. More importantly, these different morphological changes all resulted in an increase in effective filtration area, which was positively correlated with increased outflow facility in all 3 species. These results suggest a link among changes in outflow facility, tissue architecture, and aqueous outflow pattern. Y-27632 increases outflow facility by redistributing aqueous outflow through a looser and larger area in the JCT. PMID:24460021

THE ORION FINGERS: NEAR-IR SPECTRAL IMAGING OF AN EXPLOSIVE OUTFLOW

DOE Office of Scientific and Technical Information (OSTI.GOV)

Youngblood, Allison; Bally, John; Ginsburg, Adam, E-mail: allison.youngblood@colorado.edu

2016-06-01

We present near-IR (1.1–2.4 μ m) position–position–velocity cubes of the 500 year old Orion BN/KL explosive outflow with spatial resolution 1″ and spectral resolution 86 km s{sup −1}. We construct integrated intensity maps free of continuum sources of 15 H{sub 2} and [Fe ii] lines while preserving kinematic information of individual outflow features. Included in the detected H{sub 2} lines are the 1-0 S(1) and 1-0 Q(3) transitions, allowing extinction measurements across the outflow. Additionally, we present dereddened flux ratios for over two dozen outflow features to allow for the characterization of the true excitation conditions of the BN/KL outflow. All of themore » ratios show the dominance of the shock excitation of the H{sub 2} emission, although some features exhibit signs of fluorescent excitation from stellar radiation or J-type shocks. We also detect tracers of the PDR/ionization front north of the Trapezium stars in [O i] and [Fe ii] and analyze other observed outflows not associated with the BN/KL outflow.« less

Density diagnostics of ionized outflows in active galacitc nuclei

NASA Astrophysics Data System (ADS)

Mao, J.; Kaastra, J.; Mehdipour, M.; Raassen, T.; Gu, L.

2017-10-01

Ionized outflows in Active Galactic Nuclei are thought to influence their nuclear and local galactic environment. However, the distance of outflows with respect to the central engine is poorly constrained, which limits our understanding of the kinetic power by the outflows. Therefore, the impact of AGN outflows on their host galaxies is uncertain. Given the density of the outflows, their distance can be immediately obtained by the definition of the ionization parameter. Here we carry out a theoretical study of density diagnostics of AGN outflows using absorption lines from metastable levels in Be-like to F-like ions. With the new self-consistent photoionization model (PION) in the SPEX code, we are able to calculate ground and metastable level populations. This enable us to determine under what physical conditions these levels are significantly populated. We then identify characteristic transitions from these metastable levels in the X-ray band. Firm detections of absorption lines from such metastable levels are challenging for current grating instruments. The next generation of spectrometers like X-IFU onboard Athena will certainly identify the presence/absence of these density- sensitive absorption lines, thus tightly constraining the location and the kinetic power of AGN outflows.

Scaling Relations Between Warm Galactic Outflows and Their Host Galaxies

NASA Astrophysics Data System (ADS)

Chisholm, John; Tremonti, Christy A.; Leitherer, Claus; Chen, Yanmei; Wofford, Aida; Lundgren, Britt

2015-10-01

We report on a sample of 48 nearby, star-forming galaxies observed with the Cosmic Origin Spectrograph on the Hubble Space Telescope. We measure the kinematics of warm gas in galactic outflows using a combination of four Si ii absorption lines. We use multi-wavelength ancillary data to estimate stellar masses (M*), star formation rates (SFR), circular velocities (vcirc), and morphologies. The galaxies cover four orders of magnitude in M* and SFR, and sample a wide range of morphologies from starbursting mergers to normal star-forming galaxies. We derive 3.0-3.5σ relations between outflow velocity and SFR, M*, and vcirc. The outflow velocities scale as SFR0.08-0.22, {M}*0.12-0.20 and {v}{circ}0.44-0.87, with the range depending on whether we use a maximum or a central velocity to quantify the outflow velocity. After accounting for their increased SFR, mergers drive 32% faster outflows than non-merging galaxies, with all of the highest velocity outflows arising from mergers. Low-mass galaxies (log(M*/ M⊙) < 10.5) lose some low-ionization gas through galactic outflows, while more massive galaxies retain all of their low-ionization gas, unless they undergo a merger.

What Fraction of Active Galaxies Actually Show Outflows?

NASA Astrophysics Data System (ADS)

Ganguly, Rajib; Brotherton, M. S.

2007-12-01

Outflows from active galactic nuclei (AGNs) seem to be common and are thought to be important from a variety of perspectives: as an agent of chemical enhancement of the interstellar and intergalactic media, as an agent of angular momentum removal from the accreting central engine, and as an agent limiting star formation in starbursting systems by blowing out gas and dust from the host galaxy. To understand these processes, we must determine what fraction of AGNs feature outflows and understand what forms they take. We examine recent surveys of outflows detected in ultraviolet absorption over the entire range of velocities and velocity widths (i.e., broad absorption lines, associated absorption lines, and high-velocity narrow absorption lines). While the fraction of specific forms of outflows depends on AGN properties, the overall fraction displaying outflows is fairly constant, approximately 60%, over many orders of magnitude in luminosity. We discuss implications of this result and ways to refine our understanding of outflows. We acknowledge support from the US National Science Foundation through grant AST 05-07781.

Unveiling the molecular bipolar outflow of the peculiar red supergiant VY Canis Majoris

NASA Astrophysics Data System (ADS)

Shinnaga, Hiroko; Claussen, Mark J.; Lim, Jeremy; Dinh-van-Trung; Tsuboi, Masato

2003-04-01

We carried out polarimetric spectral-line imaging of the molecular outflow of the peculiar red supergiant VY Canis Majoris in SiO J=1-0 line in the ground vibrational state, which contains highly linearly-polarized velocity components, using the Very Large Array. We succeeded in unveiling the highly linearly polarized bipolar outflow for the first time at subarcsecond spatial resolution. The results clearly show that the direction of linear polarization of the brightest maser components is parallel to the outflow axis. The results strongly suggest that the linear polarization of the SiO maser is closely related to the outflow phenomena of the star. Furthermore, the results indicate that the linear polarization observed in the optical and infrared also occur due to the outflow phenomena.

[Lower urinary tract dysfunction and neuropathological findings of the neural circuits controlling micturition in familial amyotrophic lateral sclerosis with L106V mutation in the SOD1 gene].

PubMed

Hineno, Akiyo; Oyanagi, Kiyomitsu; Nakamura, Akinori; Shimojima, Yoshio; Yoshida, Kunihiro; Ikeda, Shu-Ichi

2016-01-01

We report lower urinary tract dysfunction and neuropathological findings of the neural circuits controlling micturition in the patients with familial amyotrophic lateral sclerosis having L106V mutation in the SOD1 gene. Ten of 20 patients showed lower urinary tract dysfunction and 5 patients developed within 1 year after the onset of weakness. In 8 patients with an artificial respirator, 6 patients showed lower urinary tract dysfunction. Lower urinary tract dysfunction and respiratory failure requiring an artificial respirator occurred simultaneously in 3 patients. Neuronal loss and gliosis were observed in the neural circuits controlling micturition, such as frontal lobe, thalamus, hypothalamus, striatum, periaqueductal gray, ascending spinal tract, lateral corticospinal tract, intermediolateral nucleus and Onufrowicz' nucleus. Lower urinary tract dysfunction, especially storage symptoms, developed about 1 year after the onset of weakness, and the dysfunction occurred simultaneously with artificial respirator use in the patients.

Properties of the molecular gas in the fast outflow in the Seyfert galaxy IC 5063

NASA Astrophysics Data System (ADS)

Oosterloo, Tom; Raymond Oonk, J. B.; Morganti, Raffaella; Combes, Françoise; Dasyra, Kalliopi; Salomé, Philippe; Vlahakis, Nektarios; Tadhunter, Clive

2017-12-01

We present a detailed study of the properties of the molecular gas in the fast outflow driven by the active galactic nucleus (AGN) in the nearby radio-loud Seyfert galaxy IC 5063. By using ALMA observations of a number of tracers of the molecular gas (12CO(1-0), 12CO(2-1), 12CO(3-2), 13CO(2-1) and HCO+(4-3)), we map the differences in excitation, density and temperature of the gas as function of position and kinematics. The results show that in the immediate vicinity of the radio jet, a fast outflow, with velocities up to 800 km s-1, is occurring of which the gas has high excitation with excitation temperatures in the range 30-55 K, demonstrating the direct impact of the jet on the ISM. The relative brightness of the 12CO lines, as well as that of 13CO(2-1) vs. 12CO(2-1), show that the outflow is optically thin. We estimate the mass of the molecular outflow to be at least 1.2 × 106 M⊙ and likely to be a factor between two and three larger than this value. This is similar to that of the outflow of atomic gas, but much larger than that of the ionised outflow, showing that the outflow in IC 5063 is dominated by cold gas. The total mass outflow rate we estimated to be 12 M⊙ yr-1. The mass of the outflow is much smaller than the total gas mass of the ISM of IC 5063. Therefore, although the influence of the AGN and its radio jet is very significant in the inner regions of IC 5063, globally speaking the impact will be very modest. We used RADEX non-LTE modelling to explore the physical conditions of the molecular gas in the outflow. Models with the outflowing gas being quite clumpy give the most consistent results and our preferred solutions have kinetic temperatures in the range 20-100 K and densities between 105 and 106 cm-3. The resulting pressures are 106-107.5 K cm-3, about two orders of magnitude higher than in the outer quiescent disk. The highest densities and temperatures are found in the regions with the fastest outflow. The results strongly suggest that the outflow in IC 5063 is driven by the radio plasma jet expanding into a clumpy gaseous medium and creating a cocoon of (shocked) gas which is pushed away from the jet axis resulting in a lateral outflow, very similar to what is predicted by numerical simulations.

[The role of the uretral catheter in the development of catheter- related urinary tract infection].

PubMed

Vasilyev, A O; Govorov, A V; Shiryaev, A A; Pushkar, D Yu

2017-12-01

The most common source of nosocomial infection is the urinary tract, especially if they it is drained with a urethral catheter. Catheter-associated urinary tract infections account for at least 80% of all complicated urinary tract infections and are the most common type of hospital-acquired infection. Intestinal microflora plays the leading role in the pathogenesis of catheter-associated urinary tract infections, whereas the most important risk factor for their development is the long duration of urinary catheter drainage. In the case of short-term and intermittent catheterization, routine antibiotic prophylaxis is not required, but if a patient develops clinically significant infection, antibiotic therapy is required followed by definitive therapy based on culture. Urethral catheters coated with antimicrobial substances and anti-inflammatory agents can significantly reduce the adhesion and migration of bacteria, thereby reducing the incidence of urinary tract infections. Despite this, the incidence of catheter-associated infection remains high. We have reviewed recent literature related to catheter-associated urinary tract infections and the best means of preventing this condition.

Solar forcing, and ionospheric ion outflow from Venus, Earth and Mars - A comparison

NASA Astrophysics Data System (ADS)

Lundin, R. N.

2012-12-01

Solar forcing by e.g. EUV radiation and the solar wind leads to outflow and escape of ionospheric ions from Earth, Venus and Mars. In-situ measurements in the Earth's space environment have demonstrated that the ion escape rate correlates with the magnitude of solar forcing, i.e. high solar EUV and solar wind forcing leads to enhanced escape rates. The Terrestrial outflow is dominated by H+ and O+ suggesting that the ultimate origin of outflowing ions is water. Recent measurements from the two arid planets Mars and Venus, their atmospheres dominated by CO2, display characteristics similar to that of the Earth - an outflow dominated by hydrogen (H+) and oxygen (O+, O2+) ions. Despite major differences in atmospheric composition, the composition of the ion outflow from Earth and Venus is very similar, i.e. H+ and O+ dominates and the outflow has a stoichiometric H/O ratio of close to 2. The latter implies escape of water. The ion outflow from Mars is dominated by O+, O2+, and H+. Here the stoichiometric ratio between hydrogen and oxygen ion is ≈1, implying that if the ion outflow originates from water, about half of the hydrogen mass disappears by other means. The primary origin of the ion outflow from Earth, Venus and Mars is a complex issue. Nevertheless, a predominant hydrogen and oxygen loss implies that water can easily escape planets orbiting close to the Sun, while Carbon-based molecules (e.g. CO2) resides more easily. Observations shows that the outflow of e.g. CO+ and CO2+ from Mars and Venus is minute compared to the outflow of hydrogen and oxygen ions. Magnetic shielding is an issue affecting the net ion outflow and escape from a planet, because acceleration processes are also the characteristics of magnetized plasmas. Recent findings suggests that, despite magnetic field pile-up at Mars and Venus, the stand-off distance is insufficient to prohibit a direct interaction between the solar wind and the magnetized ionospheric plasma in the induced magnetospheres of Mars and Venus. On the other hand, a planetary magnetic field, such as the Earth's dipole field and the Martian multipole crustal field, may foster shielding as well as plasma acceleration. However, in this case the ion acceleration may be confined in closed planetary magnetic flux tubes, leading to a low escape rates.

Invasive and noninvasive assessment of pulmonic regurgitation: clinical, angiographic, phonocardiographic, echocardiographic, and Doppler ultrasound correlations.

PubMed

Chandraratna, P A; Wilson, D; Imaizumi, T; Ritter, W S; Aronow, W S

1982-06-01

Three patients with pulmonic regurgitation and no evidence of pulmonary hypertension were investigated. These patients had low pitched diastolic murmurs which increased on inspiration, evidence of connective tissue disease as manifested by lax joints and hyperextensible skin, and marked hilar dance which extended up to the peripheral vessels. Suprasternal echocardiography revealed dilatation and increased systolic expansion of the right pulmonary artery (RPA) (25% and 28%, respectively) in two patients; the third patient had a normal RPA dimension in diastole and a marked increase in diameter (88%) in systole. Thus, these three patients demonstrated hyperdistensibility of the RPA. The spectral signal from the pulsed doppler echocardiograph showed evidence of turbulent blood flow in diastole (wide dispersion of the dots) in the right ventricular outflow tract in all three patients. This pattern was indicative of pulmonic regurgitation. In summary, the combined use of echocardiography and Doppler ultrasound is useful in the evaluation of patients with pulmonic regurgitation.

Fatal thrombocytopenia: A rare case with possible explanation

PubMed Central

Barik, Ramachandra; Patnaik, A. N.; Gulati, A. S.

2012-01-01

A 22 year old male presented with breathlessness on exertion, ecchymosis, jaundice and features of worsening right heart failure for the last fifteen days. On physical examination, he had a mid diastolic murmur in the tricuspid area and an ejection systolic murmur in the pulmonary area. Bone marrow histopathology report showed an increased in megakaryocytes count. Routine investigations reports were normal. Echocardiography and computerized tomography (CT) revealed a single mobile large intra cardiac mass originating from the right atrium and causing dynamic obstruction of the right ventricular inflow and outflow tract. Associated fatal thrombocytopenia did not respond to intravenous steroids or platelet transfusion. Patient could not be operated because of very low platelet count, and died during hospital stay before excision biopsy could be done. Pathological autopsy was not done. This is a rare case, as the fatal thrombocytopenia observed here was the result of mechanical effects like frictional and shear force, which can be attributed to the physical presence of a large intra cardiac mass resulting in obstruction to flow. PMID:22629036

Fatal thrombocytopenia: A rare case with possible explanation.

PubMed

Barik, Ramachandra; Patnaik, A N; Gulati, A S

2012-04-01

A 22 year old male presented with breathlessness on exertion, ecchymosis, jaundice and features of worsening right heart failure for the last fifteen days. On physical examination, he had a mid diastolic murmur in the tricuspid area and an ejection systolic murmur in the pulmonary area. Bone marrow histopathology report showed an increased in megakaryocytes count. Routine investigations reports were normal. Echocardiography and computerized tomography (CT) revealed a single mobile large intra cardiac mass originating from the right atrium and causing dynamic obstruction of the right ventricular inflow and outflow tract. Associated fatal thrombocytopenia did not respond to intravenous steroids or platelet transfusion. Patient could not be operated because of very low platelet count, and died during hospital stay before excision biopsy could be done. Pathological autopsy was not done. This is a rare case, as the fatal thrombocytopenia observed here was the result of mechanical effects like frictional and shear force, which can be attributed to the physical presence of a large intra cardiac mass resulting in obstruction to flow.

An analysis of possible mechanisms of unexpected death occurring in hydatid disease (echinococcosis).

PubMed

Byard, Roger W

2009-07-01

Most cases of hydatid disease in human populations are due to Echinococcus granulosus. The hydatid life cycle involves passage between definitive hosts such as dogs and intermediate hosts such as sheep. Humans become accidental intermediate hosts following ingestion of food or water contaminated with eggs or by contact with infected dogs. Although hydatid disease may remain asymptomatic, occasional cases of sudden and unexpected death present to autopsy. Causes of rapid clinical decline involve a wide range of mechanisms including anaphylaxis (with or without cyst rupture), cardiac outflow obstruction or conduction tract disturbance, pulmonary and cerebral embolism, pericarditis, cardiac tamponade, myocardial ischemia, pulmonary hypertension, peritonitis, hollow organ perforation, intracerebral mass effect, obstructive hydrocephalus, seizures, cerebral ischemia/infarction, and pregnancy complications. The autopsy assessment of cases therefore requires careful examination of all organ systems for characteristic cystic lesions, as multiorgan involvement is common, with integration of findings so that possible mechanisms of death can be determined. Measurement of serum tryptase and specific IgE levels should be undertaken for possible anaphylaxis.

Non-invasive cardiac output trending during exercise recovery on a bathroom-scale-based ballistocardiograph.

PubMed

Inan, O T; Etemadi, M; Paloma, A; Giovangrandi, L; Kovacs, G T A

2009-03-01

Cardiac ejection of blood into the aorta generates a reaction force on the body that can be measured externally via the ballistocardiogram (BCG). In this study, a commercial bathroom scale was modified to measure the BCGs of nine healthy subjects recovering from treadmill exercise. During the recovery, Doppler echocardiogram signals were obtained simultaneously from the left ventricular outflow tract of the heart. The percentage changes in root-mean-square (RMS) power of the BCG were strongly correlated with the percentage changes in cardiac output measured by Doppler echocardiography (R(2) = 0.85, n = 275 data points). The correlation coefficients for individually analyzed data ranged from 0.79 to 0.96. Using Bland-Altman methods for assessing agreement, the mean bias was found to be -0.5% (+/-24%) in estimating the percentage changes in cardiac output. In contrast to other non-invasive methods for trending cardiac output, the unobtrusive procedure presented here uses inexpensive equipment and could be performed without the aid of a medical professional.

Complete transposition of the great arteries with double outlet right ventricle in a dog.

PubMed

Koo, S T; LeBlanc, N L; Scollan, K F; Sisson, D D

2016-06-01

A 2-year old intact male Collie dog presented to the cardiology service at Oregon State University for evaluation of cyanosis and suspected congenital cardiac disease. Echocardiography revealed a constellation of cardiac abnormalities including a single large vessel exiting the right ventricle with a diminutive left ventricular outflow tract, a ventricular septal defect, and marked concentric right ventricular hypertrophy with moderate right atrial dilation. Cardiac-gated computed tomography confirmed the previous anomalies in addition to supporting a diagnosis of complete transposition of the great arteries, double outlet right ventricle, and pulmonic hypoplasia with a single coronary ostium. Prominent bronchoesophageal collateral vessels were concurrently identified. Clinically, the dog was stable despite mild cyanosis that worsened with exercise; no intervention was elected at the time. This case report describes a rare combination of congenital cardiac defects and the usefulness of cardiac-gated cross-sectional imaging in the anatomic diagnosis. Copyright © 2016 Elsevier B.V. All rights reserved.

The evolution of basal septal hypertrophy: From benign and age-related normal variant to potentially obstructive and symptomatic cardiomyopathy.

PubMed

Pearson, Anthony C

2017-07-01

Localized thickening of the basal portion of the ventricular septum or basal septal hypertrophy (BSH) has been identified both at autopsy and by imaging studies for decades; despite numerous investigations, there is no consensus on the significance of this finding and a remarkable lack of consistency in terminology. This paper summarizes the scientific literature on the topic, focusing on recent echocardiographic findings. A case description illustrating some of the complex issues involved in measurement and diagnosis and differentiation from sigmoidal hypertrophic cardiomyopathy (HCM) is presented. Criteria are proposed for diagnosing pathologic BSH which include the following: (1) Exertional symptoms compatible with left ventricular outflow tract obstruction (LVOTO) such as dyspnea, near-syncope, and chest discomfort; (2) Documented LVOTO gradient demonstrated at peak bicycle or post-treadmill exercise >30 mm Hg; and (3) Symptomatic improvement with β-blocker (or other negative inotropic) therapy (preferably accompanied by documentation of reduction of exercise-induced LVOT). © 2017, Wiley Periodicals, Inc.

The sea anchor technique: a novel method to aid in stent-assisted embolization of giant cerebral aneurysms.

PubMed

Edwards, Landon; Kota, Gopi; Morris, Padraig P

2013-11-01

Endovascular navigation past some large or giant intracranial aneurysms for the purpose of stent deployment can be difficult. Some of these lesions have a morphology which compels the operator to navigate through the aneurysm dome in order to gain distal access, a step which requires straightening of the delivery microcatheter before a stent can be deployed. In most patients this can be achieved by simply retracting the microcatheter and reducing the loop within the aneurysm. However, in certain patients the acute angle formed between aneurysm inflow and outflow tracts as well as the dynamics of tension within the microcatheter act together to prevent this from happening. Instead of retracting and straightening across the aneurysm neck, the microcatheter withdraws leaving the intra-aneurysm loop intact. This challenge can thwart attempts at stent placement and subsequent embolization. The authors describe a simple and safe technique to circumvent this problem, a way of stabilizing the distal tip of the microcatheter which they term the 'sea anchor'.

Quantifying the AGN-driven outflows in ULIRGs (QUADROS) III: Measurements of the radii and kinetic powers of 8 near-nuclear outflows

NASA Astrophysics Data System (ADS)

Spence, R. A. W.; Tadhunter, C. N.; Rose, M.; Rodríguez Zaurín, J.

2018-05-01

As part of the QUADROS project to quantify the impact of AGN-driven outflows in rapidly evolving galaxies in the local universe, we present observations of 8 nearby ULIRGs (0.04 < z < 0.2) taken with the ISIS spectrograph on the William Herschel Telescope (WHT), and also summarize the results of the project as a whole. Consistent with Rose et al. (2018), we find that the outflow regions are compact (0.08 < R_{[O III]} < 1.5 kpc), and the electron densities measured using the [S II], [O II] trans-auroral emission-line ratios are relatively high (2.5 < log ne (cm-3) < 4.5, median log ne (cm-3) ˜ 3.1). Many of the outflow regions are also significantly reddened (median E(B - V) ˜ 0.5). Assuming that the de-projected outflow velocities are represented by the 5^{th} percentile velocities (v05) of the broad, blueshifted components of [O III] λ5007, we calculate relatively modest mass outflow rates (0.1 < \\dot{M} < 20 M⊙ yr-1, median \\dot{M} ˜ 2 M⊙ yr-1), and find kinetic powers as a fraction of the AGN bolometric luminosity (\\dot{F} = \\dot{E}/L_bol) in the range 0.02 < \\dot{F} < 3 per cent, median \\dot{F} ˜ 0.3 per cent). The latter estimates are in line with the predictions of multi-stage outflow models, or single-stage models in which only a modest fraction of the initial kinetic power of the inner disk winds is transferred to the larger-scale outflows. Considering the QUADROS sample as a whole, we find no clear evidence for correlations between the properties of the outflows and the bolometric luminosities of the AGN, albeit based on a sample that covers a relatively small range in Lbol. Overall, our results suggest that there is a significant intrinsic scatter in outflow properties of ULIRGs for a given AGN luminosity.

Quasars Outflows As A Function of SED - An Empirical Approach

NASA Astrophysics Data System (ADS)

Richmond, Joseph M.; Ganguly, Rajib

2015-08-01

Feedback from quasars (jets, outflows, and luminosity) is now recognized as a vital phase in describing galaxy evolution, growth, and star formation efficiency. Regarding outflows, roughly 60% are observed to have outflowing gas appearing at large velocities and with a variety of velocity dispersions. The most extreme observed form of these outflows appears in the ultraviolet spectrum of 15-20% of objects. Understanding the physics of these outflows is important for both astrophysical and cosmological reasons. Establishing empirical relationships to test the theoretical models of how these outflows are driven (and hence, how they impact their surroundings) is currently plagued by having too few objects, where other parameters like the black hole mass or accretion rate, may add to the scatter. We aim to fix this by using a systematic study of a large sample of objects. As a follow up to a previous study, we have identified a sample of nearly 11000 z=1.7-2 quasars using archived data from the Sloan Digital Sky Survey (Data Release 7), of which roughly 4400 appear to show outflows according to the visual inspection. The specific redshift range is chosen to feature both the Mg II 2800 emission line as well as wavelengths extending to nearly 20,000 km/s blueward of the C IV 1549 emission line. Our goals for this study are: (1) To temper our visual inspection schemes with a more automated, computer-driven scheme; (2) To measure the properties of the outflows (velocity, velocity dispersion, equivalent width, ionization); (3) To supplement the SDSS spectra with photometric measurements from GALEX, 2MASS, and WISE to further characterize the spectral energy distributions (SEDs) and dust content; (4) To form spectral composites to investigate possible SED changes with outflow properties; and (5) To use published estimates of the quasar physical properties (black hole mass, accretion rate, etc.) to fully establish in an empirical way the complex dependencies between the properties of the outflow, and the physical properties of the system.

The physics of galactic winds driven by active galactic nuclei

NASA Astrophysics Data System (ADS)

Faucher-Giguère, Claude-André; Quataert, Eliot

2012-09-01

Active galactic nuclei (AGN) drive fast winds in the interstellar medium of their host galaxies. It is commonly assumed that the high ambient densities and intense radiation fields in galactic nuclei imply short cooling times, thus making the outflows momentum conserving. We show that cooling of high-velocity shocked winds in AGN is in fact inefficient in a wide range of circumstances, including conditions relevant to ultraluminous infrared galaxies (ULIRGs), resulting in energy-conserving outflows. We further show that fast energy-conserving outflows can tolerate a large amount of mixing with cooler gas before radiative losses become important. For winds with initial velocity vin ≳ 10 000 km s-1, as observed in ultraviolet and X-ray absorption, the shocked wind develops a two-temperature structure. While most of the thermal pressure support is provided by the protons, the cooling processes operate directly only on the electrons. This significantly slows down inverse Compton cooling, while free-free cooling is negligible. Slower winds with vin ˜ 1000 km s-1, such as may be driven by radiation pressure on dust, can also experience energy-conserving phases but under more restrictive conditions. During the energy-conserving phase, the momentum flux of an outflow is boosted by a factor ˜vin/2vs by work done by the hot post-shock gas, where vs is the velocity of the swept-up material. Energy-conserving outflows driven by fast AGN winds (vin ˜ 0.1c) may therefore explain the momentum fluxes Ṗ≫LAGN/c of galaxy-scale outflows recently measured in luminous quasars and ULIRGs. Shocked wind bubbles expanding normal to galactic discs may also explain the large-scale bipolar structures observed in some systems, including around the Galactic Centre, and can produce significant radio, X-ray and γ-ray emission. The analytic solutions presented here will inform implementations of AGN feedback in numerical simulations, which typically do not include all the important physics.

WPVS 007: Dramatic Broad Absorption Line Variability in a Narrow-line Seyfert 1

NASA Astrophysics Data System (ADS)

Cooper, Erin M.; Leighly, K.; Hamann, F. W.; Grupe, D.; Dietrich, M.

2014-01-01

Blue-shifted broad absorption lines are the manifestation of gaseous outflows in astrophysical phenomena. In active galaxies, these outflowing winds may play a key role in the central engine physics by removing angular momentum and in influencing host galaxy evolution by imparting energy and chemically enriched gas to the surrounding medium. AGN wind variability affords us a valuable tool to study this still poorly understood phenomenon. The existence of a high velocity broad line outflow in WPVS007 is especially extraordinary, as Seyfert-luminosity active galaxies are unexpected to produce them. With its lower luminosity and compact size, the NLS1 galaxy WPVS007 (M_V=-19.7, z=0.02882) provides us the ability to study even colossal variability on merely human timescales. Since its 1996 FOS observation, displaying miniBALs but no true broad absorption lines, WPVS007 has experienced a short but rich history of UV BAL variability. By the 2003 FUSE observation, WPVS007 had developed a BAL with v_max ~ 6000km/s, indicating an optically thick, high velocity outflow. We present the 2010 and 2013 June and December HST COS spectra. Between 2003 and 2010, both the maximum and minimum outflow velocity had increased substantially. As of 2013 June, the continuum emission has since dimmed by a factor of ~2 and the BALs have appeared to weaken, with both decreased maximum and minimum velocities. Such dramatic shifts in BAL velocity are unprecedented, as BAL variability is typically confined to changes in optical depth. What is the nature of the variability in this BAL wind? The upcoming (as of the writing of this abstract) December observation should give us more insight into tackling that question, whether it be the transient response of a continuous flow to a fluctuating continuum or perhaps the continued decline of a discrete outflow event.

PLASMOID EJECTIONS AND LOOP CONTRACTIONS IN AN ERUPTIVE M7.7 SOLAR FLARE: EVIDENCE OF PARTICLE ACCELERATION AND HEATING IN MAGNETIC RECONNECTION OUTFLOWS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu Wei; Chen Qingrong; Petrosian, Vahe

2013-04-20

Where particle acceleration and plasma heating take place in relation to magnetic reconnection is a fundamental question for solar flares. We report analysis of an M7.7 flare on 2012 July 19 observed by SDO/AIA and RHESSI. Bi-directional outflows in forms of plasmoid ejections and contracting cusp-shaped loops originate between an erupting flux rope and underlying flare loops at speeds of typically 200-300 km s{sup -1} up to 1050 km s{sup -1}. These outflows are associated with spatially separated double coronal X-ray sources with centroid separation decreasing with energy. The highest temperature is located near the nonthermal X-ray loop-top source wellmore » below the original heights of contracting cusps near the inferred reconnection site. These observations suggest that the primary loci of particle acceleration and plasma heating are in the reconnection outflow regions, rather than the reconnection site itself. In addition, there is an initial ascent of the X-ray and EUV loop-top source prior to its recently recognized descent, which we ascribe to the interplay among multiple processes including the upward development of reconnection and the downward contractions of reconnected loops. The impulsive phase onset is delayed by 10 minutes from the start of the descent, but coincides with the rapid speed increases of the upward plasmoids, the individual loop shrinkages, and the overall loop-top descent, suggestive of an intimate relation of the energy release rate and reconnection outflow speed.« less

Assessment of the ductus arteriosus in fetuses with tetralogy of Fallot and the implication for postnatal management.

PubMed

Tuo, Giulia; Volpe, Paolo; Buffi, Davide; De Robertis, Valentina; Marasini, Maurizio

2014-01-01

To describe the antenatal and neonatal echocardiographic morphology and flow pattern of the ductus arteriosus in patients with tetralogy of Fallot. We included patients with a prenatal diagnosis of tetralogy of Fallot between January 2006 and December 2012. Among the 52 fetuses with tetralogy of Fallot the severity of right ventricular outflow obstruction was considered mild in 32, moderate in 14, and severe in 6. In the mild right ventricular outflow obstruction group (n = 32) all had normal ductal morphology and flow pattern, eight (25%) elected for termination of pregnancy and two died in the neonatal period from extracardiac causes. In the moderate right ventricular outflow obstruction group (n = 14) the fetuses had a small ductus arteriosus with antegrade but abnormal flow velocity, one (7%) elected for termination of pregnancy. Immediately after birth the ductus arteriosus was very small or already closed at echocardiographic examination. Two out of 13 patients (15%) developed severe hypoxic spells and underwent modified Blalock-Taussig shunt during the neonatal period. Six fetuses were considered to have severe right ventricular outflow obstruction with flow reversal in the ductus arteriosus, three (50%) of whom elected for termination of pregnancy. The other three newborns underwent modified Blalock-Taussig shunt. In fetuses with tetralogy of Fallot, ductal diameter can be reduced even up to prenatal closure. Prenatal ductal morphology assessment may be useful for improving management of patients with moderate right ventricular outflow obstruction and small ductus arteriosus who may become cyanotic at birth. © 2013 Wiley Periodicals, Inc.

YSO jets in the Galactic plane from UWISH2 - V. Jets and outflows in M17

NASA Astrophysics Data System (ADS)

Samal, M. R.; Chen, W. P.; Takami, M.; Jose, J.; Froebrich, D.

2018-07-01

Jets and outflows are the first signposts of stellar birth. Emission in the H2 1-0 S(1) line at 2.122- μm is a powerful tracer of shock excitation in these objects. Here we present the analysis of 2.0 × 0.8 deg2 data from the UK Wide-field Infrared Survey for H2 (UWISH2) in the 1-0 S(1) line to identify and characterize the outflows of the M17 complex. We uncover 48 probable outflows, of which 93 per cent are new discoveries. We identified driving source candidates for 60 per cent of outflows. Among the driving source candidate young stellar objects (YSOs), 90 per cent are protostars and the remaining 10 per cent are Class II YSOs. In comparison with results from other surveys, we suggest that H2 emission fades very quickly as the objects evolve from protostars to pre-main-sequence stars. We fit spectral energy distribution (SED) models to 14 candidate outflow-driving sources and conclude that the outflows of our sample are mostly driven by moderate-mass YSOs that are still actively accreting from their protoplanetary disc. We examined the spatial distribution of the outflows with the gas and dust distribution of the complex and observed that the filamentary dark cloud M17SWex, located on the south-western side of the complex, is associated with a greater number of outflows. We find that our results corroborate previous suggestions that, in the M17 complex, M17SWex is the most active site of star formation. Several of our newly identified outflow candidates are excellent targets for follow-up studies to understand better the very early phase of protostellar evolution.

A Study of PG Quasar-Driven Outflows with COS

NASA Astrophysics Data System (ADS)

Hamann, Frederick

2013-10-01

Quasar outflows are an important part of the quasar phenomenon, but many questions remain about their energetics, physical properties and the role they might play in providing feedback to host galaxy evolution. We searched our own COS far-UV observations from the QUEST survey and other large COS programs to find a sample of 6 bright PG quasars with broad {FWHM > 400 km/s} high velocity {v > 1000 km/s} absorption lines that clearly form in quasar-driven winds. These quasars can fill an important gap in our understanding between local Seyferts with low-speed winds and high-redshift quasars with extreme BAL outflows. They are also well-studied at other wavelengths, with some evidence for the quasars driving galaxy-scale blowouts and shutting down star formation. But almost nothing is known about the quasar outflows themselves. We propose a detailed study of these 6 outflow quasars using new COS FUV observations to 1} expand the existing wavelength coverage across critical lines that are diagnostic of the outflow physical conditions, kinetic energies, and metallicities, and 2} check for line variability as an indicator of the outflow structure and locations. This quasar sample includes unusual cases with many low-abundance {PV 1118,1128 and SIV 1063} and excited-state lines {SIV 1073*, CIII* 1175, CII* 1335} that will provide unprecedented constraints on the outflow properties, plus the first known OVI-only mini-BAL outflow {no lower ions detected} for which we will cover NeVIII 770,780 to probe the highest ionization gas. The high FUV sensitivity of COS is uniquely able to measure this wide range of outflow lines in low-redshift quasars with no Lya forest contamination.

Transport pathways for Asian pollution outflow over the Pacific: Interannual and seasonal variations

NASA Astrophysics Data System (ADS)

Liu, Hongyu; Jacob, Daniel J.; Bey, Isabelle; Yantosca, Robert M.; Duncan, Bryan N.; Sachse, Glen W.

2003-10-01

The meteorological pathways contributing to Asian pollution outflow over the Pacific are examined with a global three-dimensional model analysis of CO observations from the Transport and Chemical Evolution over the Pacific (TRACE-P) aircraft mission (February-April 2001). The model is used also to place the TRACE-P observations in an interannual (1994-2001) and seasonal context. The major process driving Asian pollution outflow in spring is frontal lifting ahead of southeastward-moving cold fronts (the leading edge of cold surges) and transport in the boundary layer behind the cold fronts. Orographic lifting over central and eastern China combines with the cold fronts to promote the transport of Chinese pollution to the free troposphere. Outflow of seasonal biomass burning in Southeast Asia during spring takes place mostly by deep convection but also by northeastward transport and frontal lifting, mixing with the anthropogenic outflow. Boundary layer outflow over the western Pacific is largely devoid of biomass burning influence. European and African (biomass burning) plumes in Asian outflow during TRACE-P were weak (<60 ppbv and 20 ppbv CO, respectively) and were not detectable in the observations because of superposition of the much larger Asian pollution signal. Spring 2001 (La Niña) was characterized by unusually frequent cold surge events in the Asian Pacific rim and strong convection in Southeast Asia, leading to unusually strong boundary layer outflow of anthropogenic emissions and convective outflow of biomass burning emissions in the upper troposphere. The Asian outflow flux of CO to the Pacific is found to vary seasonally by a factor of 3-4 (maximum in March and minimum in summer). The March maximum results from frequent cold surge events and seasonal biomass burning emissions.

Quenching star formation with quasar outflows launched by trapped IR radiation

NASA Astrophysics Data System (ADS)

Costa, Tiago; Rosdahl, Joakim; Sijacki, Debora; Haehnelt, Martin G.

2018-06-01

We present cosmological radiation-hydrodynamic simulations, performed with the code RAMSES-RT, of radiatively-driven outflows in a massive quasar host halo at z = 6. Our simulations include both single- and multi-scattered radiation pressure on dust from a quasar and are compared against simulations performed with thermal feedback. For radiation pressure-driving, we show that there is a critical quasar luminosity above which a galactic outflow is launched, set by the equilibrium of gravitational and radiation forces. While this critical luminosity is unrealistically high in the single-scattering limit for plausible black hole masses, it is in line with a ≈ 3 × 10^9 M_⊙ black hole accreting at its Eddington limit, if infrared (IR) multi-scattering radiation pressure is included. The outflows are fast (v ≳ 1000 km s^{-1}) and strongly mass-loaded with peak mass outflow rates ≈ 10^3 - 10^4 M_⊙ yr^{-1}, but short-lived (< 10 Myr). Outflowing material is multi-phase, though predominantly composed of cool gas, forming via a thermal instability in the shocked swept-up component. Radiation pressure- and thermally-driven outflows both affect their host galaxies significantly, but in different, complementary ways. Thermally-driven outflows couple more efficiently to diffuse halo gas, generating more powerful, hotter and more volume-filling outflows. IR radiation, through its ability to penetrate dense gas via diffusion, is more efficient at ejecting gas from the bulge. The combination of gas ejection through outflows with internal pressurisation by trapped IR radiation leads to a complete shut down of star formation in the bulge. We hence argue that radiation pressure-driven feedback may be an important ingredient in regulating star formation in compact starbursts, especially during the quasar's `obscured' phase.

Transport Pathways for Asian Pollution Outflow Over the Pacific: Interannual and Seasonal Variations

NASA Technical Reports Server (NTRS)

Liu, Hong-Yu; Jacob, Daniel J.; Bey, Isabelle; Yantosca, Robert M.; Duncan, Bryan N.; Sachse, Glen W.

2003-01-01

The meteorological pathways contributing to Asian pollution outflow over the Pacific are examined with a global three-dimensional model analysis of CO observations from the Transport and Chemical Evolution over the Pacific (TRACE-P) aircraft mission (February-April 2001). The model is used also to place the TRACE-P observations in an interannual (1994-2001) and seasonal context. The major process driving Asian pollution outflow in spring is frontal lifting ahead of southeastward-moving cold fronts (the leading edge of cold surges) and transport in the boundary layer behind the cold fronts. Orographic lifting over central and eastern China combines with the cold fronts to promote the transport of Chinese pollution to the free troposphere. Outflow of seasonal biomass burning in Southeast Asia during spring takes place mostly by deep convection but also by northeastward transport and frontal lifting, mixing with the anthropogenic outflow. Boundary layer outflow over the western Pacific is largely devoid of biomass burning influence. European and African (biomass burning) plumes in Asian outflow during TRACE-P were weak (less than 60 ppbv and 20 ppbv CO, respectively) and were not detectable in the observations because of superposition of the much larger Asian pollution signal. Spring 2001 (La Nina) was characterized by unusually frequent cold surge events in the Asian Pacific rim and strong convection in Southeast Asia, leading to unusually strong boundary layer outflow of anthropogenic emissions and convective outflow of biomass burning emissions in the upper troposphere. The Asian outflow flux of CO to the Pacific is found to vary seasonally by a factor of 3-4 (maximum in March and minimum in summer). The March maximum results from frequent cold surge events and seasonal biomass burning emissions.

Underground storage of imported water in the San Gorgonio Pass area, southern California

USGS Publications Warehouse

Bloyd, Richard M.

1971-01-01

The San Gorgonio Pass ground-water basin is divided into the Beaumont, Banning, Cabazon, San Timoteo, South Beaumont, Banning Bench, and Singleton storage units. The Beaumont storage unit, centrally located in the agency area, is the largest in volume of the storage units. Estimated long-term average annual precipitation in the San Gorgonio Pass Water Agency drainage area is 332,000 acre-feet, and estimated average annual recoverable water is 24,000 acre-feet, less than 10 percent of the total precipitation. Estimated average annual surface outflow is 1,700 acre-feet, and estimated average annual ground-water recharge is 22,000 acre-feet. Projecting tack to probable steady-state conditions, of the 22.000 acre-feet of recharge, 16,003 acre-feet per year became subsurface outflow into Coachella Valley, 6,000 acre-feet into the Redlands area, and 220 acre-feet into Potrero Canyon. After extensive development, estimated subsurface outflow from the area in 1967 was 6,000 acre-feet into the Redlands area, 220 acre-feet into Potrero Canyon, and 800 acre-feet into the fault systems south of the Banning storage unit, unwatered during construction of a tunnel. Subsurface outflow into Coachella Valley in 1967 is probably less than 50 percent of the steady-state flow. An anticipated 17,000 .acre-feet of water per year will be imported by 1980. Information developed in this study indicates it is technically feasible to store imported water in the eastern part of the Beaumont storage unit without causing waterlogging in the storage area and without losing any significant quantity of stored water.

Spatial Mapping of Structural and Connectional Imaging Data for the Developing Human Brain with Diffusion Tensor Imaging

PubMed Central

Ouyang, Austin; Jeon, Tina; Sunkin, Susan M.; Pletikos, Mihovil; Sedmak, Goran; Sestan, Nenad; Lein, Ed S.; Huang, Hao

2014-01-01

During human brain development from fetal stage to adulthood, the white matter (WM) tracts undergo dramatic changes. Diffusion tensor imaging (DTI), a widely used magnetic resonance imaging (MRI) modality, offers insight into the dynamic changes of WM fibers as these fibers can be noninvasively traced and three-dimensionally (3D) reconstructed with DTI tractography. The DTI and conventional T1 weighted MRI images also provide sufficient cortical anatomical details for mapping the cortical regions of interests (ROIs). In this paper, we described basic concepts and methods of DTI techniques that can be used to trace major WM tracts noninvasively from fetal brain of 14 postconceptional weeks (pcw) to adult brain. We applied these techniques to acquire DTI data and trace, reconstruct and visualize major WM tracts during development. After categorizing major WM fiber bundles into five unique functional tract groups, namely limbic, brain stem, projection, commissural and association tracts, we revealed formation and maturation of these 3D reconstructed WM tracts of the developing human brain. The structural and connectional imaging data offered by DTI provides the anatomical backbone of transcriptional atlas of the developing human brain. PMID:25448302

AGN outflows and feedback twenty years on

NASA Astrophysics Data System (ADS)

Harrison, C. M.; Costa, T.; Tadhunter, C. N.; Flütsch, A.; Kakkad, D.; Perna, M.; Vietri, G.

2018-03-01

It is twenty years since the seminal works by Magorrian and co-authors and by Silk and Rees, which, along with other related work, ignited an explosion of publications connecting active galactic nucleus (AGN)-driven outflows to galaxy evolution. With a surge in observations of AGN outflows, studies are attempting to test AGN feedback models directly using the outflow properties. With a focus on outflows traced by optical and CO emission lines, we discuss significant challenges that greatly complicate this task, from both an observational and theoretical perspective. We highlight the observational uncertainties involved and the assumptions required when deriving kinetic coupling efficiencies (that is, outflow kinetic power as a fraction of AGN luminosity) from typical observations. Based on recent models we demonstrate that extreme caution should be taken when comparing observationally derived kinetic coupling efficiencies to coupling efficiencies from fiducial feedback models.

Broad Redshifted Line as a Signature of Outflow

NASA Astrophysics Data System (ADS)

Titarchuk, Lev; Kazanas, Demos; Becker, Peter A.

2003-11-01

We formulate and solve the diffusion problem of line photon propagation in a bulk outflow from a compact object (black hole or neutron star) using a generic assumption regarding the distribution of line photons within the outflow. Thomson scattering of the line photons within the expanding flow leads to a decrease of their energy which is of first order in v/c, where v is the outflow velocity and c is the speed of light. We demonstrate that the emergent line profile is closely related to the time distribution of photons diffusing through the flow (the light curve) and consists of a broad redshifted feature. We analyzed the line profiles for the general case of outflow density distribution. We emphasize that the redshifted lines are intrinsic properties of the powerful outflow that are supposed to be in many compact objects.

Broad Red-Shifted Lines as a Signature of Outflow

NASA Astrophysics Data System (ADS)

Kazanas, Demosthenes; Titarchuk, Lev; Becker, Peter A.

2004-07-01

We formulate and solve the diffusion problem of line photon propagation in a bulk outflow from a compact object (black hole or neutron star) using a generic assumption regarding the distribution of line photons within the outflow. Thomson scattering of the line photons within the expanding flow leads to a decrease of their energy which is of first order in v/c, where v is the outflow velocity and c the speed of light. We demonstrate that the emergent line profile is closely related to the time distribution of photons diffusing through the flow (the light curve) and consists of a broad redshifted feature. We analyzed the line profiles for the general case of outflow density distribution. We emphasize that the redshifted lines are intrinsic properties of the powerful outflow that are supposed to be in many compact objects.

Broad Red-Shifted Lines as a Signature of Outflows

NASA Astrophysics Data System (ADS)

Titarchuck, Lev; Kazanas, Demos; Becker, Peter A.

2006-02-01

We formulate and solve the diffusion problem of line photon propagation in a bulk outflow from a compact object (black hole or neutron star) using a generic assumption regarding the distribution of line photons within the outflow. Thomson scattering of the line photons within the expanding flow leads to a decrease of their energy which is of first order in υ/c, where υ the outflow velocity and c is the speed of light. We demonstrate that the emergent line profile is closely related to the time distribution of photons diffusing through the flow (the light curve) and consists of a broad redshifted feature. We analyzed the line profiles for the general case of outflow density distribution. We emphasize that the redshifted lines are intrinsic properties of the powerful outflow that are supposed to be in many compact objects.

The Simbol-X Perspective on the Physics of Quasar Outflows

NASA Astrophysics Data System (ADS)

Giustini, M.; Cappi, M.; Vignali, C.; Palumbo, G. G. C.; Fiore, F.; Malaguti, G.

2009-05-01

There is increasing evidence that quasar outflows may play a key role in providing the feedback between AGN/QSOs and their surrounding (and feeding) media, in regulating the central supermassive black hole growth and the galaxy formation and, on larger scales, in shaping the growth of cosmic structures (see e.g. [1]). X-ray observations of quasar outflows are crucial to probe their innermost parts and assess the global energetics entrained in the outflow by studying its most extreme (in terms of velocity, ionization state, mass outflow rate) phases. Simbol-X-with its high effective area in the Fe K energy band and above-will allow the detection and the characterization of powerful outflows in bright, nearby AGN and notably also in moderately faint AGN, thus shedding light on feedback processes in these objects.

Superposed epoch analysis of O+ auroral outflow during sawtooth events and substorms

NASA Astrophysics Data System (ADS)

Nowrouzi, N.; Kistler, L. M.; Lund, E. J.; Cai, X.

2017-12-01

Sawtooth events are repeated injection of energetic particles at geosynchronous orbit. Studies have shown that 94% of sawtooth events occurred during magnetic storm times. The main factor that causes a sawtooth event is still an open question. Simulations have suggested that heavy ions like O+ may play a role in triggering the injections. One of the sources of the O+ in the Earth's magnetosphere is the nightside aurora. O+ ions coming from the nightside auroral region have direct access to the near-earth magnetotail. A model (Brambles et al. 2013) for interplanetary coronal mass ejection driven sawtooth events found that nightside O+ outflow caused the subsequent teeth of the sawtooth event through a feedback mechanism. This work is a superposed epoch analysis to test whether the observed auroral outflow supports this model. Using FAST spacecraft data from 1997-2007, we examine the auroral O+ outflow as a function of time relative to an injection onset. Then we determine whether the profile of outflow flux of O+ during sawtooth events is different from the outflow observed during isolated substorms. The auroral region boundaries are estimated using the method of (Andersson et al. 2004). Subsequently the O+ outflow flux inside these boundaries are calculated and binned as a function of superposed epoch time for substorms and sawtooth "teeth". In this way, we will determine if sawtooth events do in fact have greater O+ outflow, and if that outflow is predominantly from the nightside, as suggested by the model results.

Quasar Outflows and AGN Feedback in the Extreme UV: HST/COS Observations of QSO HE0238-1904

NASA Astrophysics Data System (ADS)

Arav, Nahum; Borguet, B.; Chamberlain, C.; Edmonds, D.; Danforth, C.

2014-01-01

Spectroscopic observations of quasar outflows at rest-frame 500-1000 Angstrom have immense diagnostic power. We present analyses of such data, where absorption troughs from three important ions are measured: first, O IV and O IV* that allow us to obtain the distance of high ionization outflows from the AGN; second, Ne VIII and Mg X that are sensitive to the very high ionization phase of the outflow. Their inferred column densities, combined with those of troughs from O VI, N IV, and H I, yield two important results: 1) The outflow shows two ionization phases, where the high ionization phase carries the bulk of the material. This is similar to the situation seen in x-ray warm absorber studies. Furthermore, the low ionization phase is inferred to have a volume filling factor of 10^(-5)-10^(-6). 2) From the O IV to O IV* column density ratio, and the knowledge of the ionization parameter, we determine a distance of 3000 pc. from the outflow to the central source. Since this is a typical high ionization outflow, we can determine robust values for the mass flux and kinetic luminosity of the outflow: 40 solar masses per year and 10^45 ergs/s, respectively, where the latter is roughly equal to 1% of the bolometric luminosity. Such a large kinetic luminosity and mass flow rate measured in a typical high ionization wind suggests that quasar outflows are a major contributor to AGN feedback mechanisms.

Investigations of protostellar outflow launching and gas entrainment: Hydrodynamic simulations and molecular emission

DOE Office of Scientific and Technical Information (OSTI.GOV)

Offner, Stella S. R.; Arce, Héctor G., E-mail: stella.offner@yale.edu

2014-03-20

We investigate protostellar outflow evolution, gas entrainment, and star formation efficiency using radiation-hydrodynamic simulations of isolated, turbulent low-mass cores. We adopt an X-wind launching model, in which the outflow rate is coupled to the instantaneous protostellar accretion rate and evolution. We vary the outflow collimation angle from θ = 0.01-0.1 and find that even well-collimated outflows effectively sweep up and entrain significant core mass. The Stage 0 lifetime ranges from 0.14-0.19 Myr, which is similar to the observed Class 0 lifetime. The star formation efficiency of the cores spans 0.41-0.51. In all cases, the outflows drive strong turbulence in themore » surrounding material. Although the initial core turbulence is purely solenoidal by construction, the simulations converge to approximate equipartition between solenoidal and compressive motions due to a combination of outflow driving and collapse. When compared to simulation of a cluster of protostars, which is not gravitationally centrally condensed, we find that the outflows drive motions that are mainly solenoidal. The final turbulent velocity dispersion is about twice the initial value of the cores, indicating that an individual outflow is easily able to replenish turbulent motions on sub-parsec scales. We post-process the simulations to produce synthetic molecular line emission maps of {sup 12}CO, {sup 13}CO, and C{sup 18}O and evaluate how well these tracers reproduce the underlying mass and velocity structure.« less