Top PDF VARIATION IN THE OPENINGS (OSTIA) OF LEFT PULMONARY VEINS INTO THE LEFT ATRIUM: A CASE REPORT

VARIATION IN THE OPENINGS (OSTIA) OF LEFT PULMONARY  VEINS INTO THE LEFT ATRIUM: A CASE REPORT

VARIATION IN THE OPENINGS (OSTIA) OF LEFT PULMONARY VEINS INTO THE LEFT ATRIUM: A CASE REPORT

ABSTRACT: During early embryonic development, absorption of pulmonary venous network by the left primitive atrial chamber results in opening of four pulmonary veins which drain independently into its chamber. The extent of absorption and hence, the number of pulmonary veins which open into the left atrium, may vary. Here we report a variation in the opening of the Left upper (superior) pulmonary vein into the Left atrium. A total of six openings observed.
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Braz. J. Cardiovasc. Surg.  vol.26 número4 en v26n4a07

Braz. J. Cardiovasc. Surg. vol.26 número4 en v26n4a07

The connection of the anomalous pulmonary venous return, commonly called total anomalous connection of pulmonary veins (TAPV) is a rare congenital disease that encompasses a group of changes in which the pulmonary veins (PV) connect directly to the systemic venous circulation, and not the left atrium (LA) [1]. According to the anatomical characteristics, it can be classified into supracardiac, infracardiac or mixed, with the possible use of various surgical techniques for correction of the defect [2,3]. Regardless of the technique used, it is known that the PV can be compromised and do not present proper development, both because the tissue and the constitution of the common pulmonary vein (CPV) or suture lines used during the procedure. This situation is a late complication of most concern because it has important clinical consequences and compromises the prognosis [4,5].
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Braz. J. Cardiovasc. Surg.  vol.22 número3 en v22n3a19

Braz. J. Cardiovasc. Surg. vol.22 número3 en v22n3a19

Approach by longitudinal median sternotomy with establishment of cardiopulmonary bypass by introducing cannulas into the following: aorta, superior and inferior vena cava was performed. The sites of incision at the right atrium were marked. The right atrium was opened with a longitudinal incision toward the inferior vena cava. Resection of interatrial septum, opening of the left atrium along the right pulmonary veins (Figure 2A), and suture of the bovine pericardium below the mitral valve, by isolating the pulmonary veins (Figure 23B), which was named first plane, were performed. Together with the right atrium lateral wall, a suture was initiated along the valve of inferior vena cava (Eustachian valve), thus, forming the tunnel of inferior vena cava. This procedure was performed in the same very
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Arq. Bras. Cardiol.  vol.79 número1

Arq. Bras. Cardiol. vol.79 número1

characterized by the presence of a stenosing ring in the form of a shelf-like membrane above the mitral valve. This membrane has 1 or 2 small orifices, which obstruct the left atrial outflow. The mitral valve may be normal or deformed. This condition has to be distinguished from abnormal partition of the left atrium (cor triatriatum), in which a membrane divides this cavity into 2 chambers: a dorsal chamber, that receives the pulmonary veins and a ventral chamber that gives rise to the left atrial appendage.
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Radiol Bras  vol.46 número6

Radiol Bras vol.46 número6

Venous abnormalities of the thorax may involve either systemic or pulmonary veins, ranging from incidental findings to compo- nents of more complex abnormalities, most frequently congenital heart disease (1) . How- ever, complete absence of pulmonary venous drainage into the left atrium is a rare condition and may affect a whole lung, without associated anomalous drainage (2) . Atresia may be divided into common, in- dividual or unilateral (3) ; the latter is a rare condition corresponding to the absence of pulmonary veins in one of the lungs.
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Arq. Bras. Cardiol.  vol.91 número1 en a11v91n1

Arq. Bras. Cardiol. vol.91 número1 en a11v91n1

We report on the rare case of partial anomalous return of four pulmonary veins in the right atrium and superior vena cava with intact interatrial septum in a five-year-old child. There were few symptoms in contrast with the left ventricular output dependent on the flow of the left upper lobe vein and from the lingula. Reduced compliance to the left led to a severe picture of pulmonary venocapillary hypertension in the immediate postoperative period, mitigated by an 8-mm interatrial septal defect. The patient progressed well after the intervention.
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Braz. J. Cardiovasc. Surg.  vol.20 número4

Braz. J. Cardiovasc. Surg. vol.20 número4

Fig. 2 - A – right atrium open where the right pulmonary veins can be seen draining into the left atrium and the flow towards the superior sinus venosus interatrial communication. B – Interatrial connection closed with a bovine pericardial patch. C and D – Enlargement of the superior vena cava with tissue from the right atrium open in a “V-Y” shape.

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Arq. Bras. Cardiol.  vol.83 número3

Arq. Bras. Cardiol. vol.83 número3

of the pulmonary veins for reducing the indices of late recurrence of atrial fibrillation. In this regard, the benefit of the treatment was evident, which makes it an effective and recommendable therapeutic option. However, when clinically relevant atrial ta- chycardias were considered (including atrial fibrillation and flutter) and their occurrence was assessed, no significant differences in the incidence were identified between the 2 groups studied. The frequent manifestation of atrial flutter in the treated group patients was the determinant factor of this finding. And considering the hypothesis that the left atrial incisions were the cause, the benefits of the treatment could not be clearly defined in a perspective of global clinical advantages. The size of the sample studied may have contributed to this type of result. On the other hand, it is worth noting that atrial flutter is a tachycardia depending on a well-defined substrate, even when depending on a scar, which may be eliminated by use of catheter ablation 40-42 , a characteristic
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Clinics  vol.64 número10

Clinics vol.64 número10

Bronchovascular fistulas are a very dangerous complication of airway anastomoses. The type or form of treatment depends on early diagnosis and is based on re-operation or stent placement. Even though it is a very rare condition, improved evaluation of the factors that contribute to istula formation must be developed and always considered during follow-up evaluations of lung transplant patients. In addition, surveillance bronchoscopy should be routinely performed in order to identify patients at risk for developing istulas.
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Anatomical variation of the origin of the left vertebral artery

Anatomical variation of the origin of the left vertebral artery

The vertebral arteries begin in the root of the neck as the first branches of the supero-posterior aspect of the subclavian arteries. The vertebral arteries ascend the neck to enter the cranial cavity to supply blood to the brain. The two vertebral arteries are usually unequal in size; the left is frequently larger than right one [1]. The vertebral arteries pass through the foramina transversaria of the first six cervical vertebrae on both sides, penetrate the posterior atlanto-occipital membrane and enter the cranial cavity through the foramen magnum. Vertebral arteries unite at the caudal border of the pons to form unpaired basilar artery. This vessel courses along the ventral aspect of the brainstem [2–4]. The different variations of the branches arising from the arch of aorta are well known and documented by several authors [5]. Case Report
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PDF EN Jornal Brasileiro de Pneumologia 2 18 english

PDF EN Jornal Brasileiro de Pneumologia 2 18 english

Despite the RHT and the findings of impending systemic embolism, the cardiovascular surgeon refused to perform surgical thrombectomy because of the simultaneous, heavy clot burden on the pulmonary arteries. In addition, the size of the thrombus at the left atrium raised concerns

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Unruptured retroperitoneal pregnancy implanted in the left broad ligament: A case report

Unruptured retroperitoneal pregnancy implanted in the left broad ligament: A case report

dings. The corpus luteum was located on the left ovary. The- re was no bleeding from the fimbria bilaterally. The perito- neum was opened above the described mass using the ultra- cision, and evacuation of ovulary tissue was started, but suddenly significant bleeding appeared and urgent laparotomy was immediately performed. There was about 500 mL of fresh blood in the abdomen. The bleeding was controlled by two finger digital compression of the left broad ligament and the remaining ovulary tissue was removed. There were no macroscopic signs of communication or fistu- la between the described mass and the uterine cavity or the left Fallopian tube. Hemostasis was completed with hemosta- tic sutures and the abdomen was closed with drainage placed in the pouch of Douglas. Postoperative course was unevent- ful. Serum β-HCG levels decreased to 750 mU/mL two days after the surgery and became negative after seven days. The histopathology report confirmed ectopic gravidity (Figure 5).
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Int. braz j urol.  vol.30 número6 vol30n6a08

Int. braz j urol. vol.30 número6 vol30n6a08

Urethral leiomyomas are also rare, with only 40 cases reported in the literature. Ovarian hormones are believed to influence the growth of leiomyomas. We report the genitourinary presentation of 2 separate disease entities with known hormonal influence in a postmenopausal woman receiving estrogen replacement therapy. We believe the patient’s hormonal milieu affected the development of her concurrent pathology.

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Arq. Bras. Cardiol.  vol.81 número5

Arq. Bras. Cardiol. vol.81 número5

the system by the operator (tab. III). The device was with- drawn within the delivery catheter and discarted. A new de- vice with the same diameter was successfully placed une- ventfully. In the 3rd patient, the retrieval cord was inadver- tently tractioned together with the withdrawal of the man- drel after proper locking of the disks. There was traction of the device that was already well positioned in the interatrial septum leading to erasure of its configuration (tab. III). With traction movements in the retrieval cord and rotation of the delivery catheter, the device was withdrawn toward the catheter inside the inferior vena cava and withdrawn outside the body without problems (fig. 4). A new device with the same diameter was successfully implanted. In the 4th patient, the operator did not maintain enough traction in the mandrel during the locking of the disks, leading them far from the interatrial septum, with an unsatisfactory final appearance. Using the retrieval cord, the device was with- drawn from the septum with erasure of is configuration and was withdrawn within the delivery catheter as already des- cribed. In a second attempt, accentuated tension in the man- drel was applied during locking of the disks, causing incom- plete locking with the “eyelet” of the proximal disk excluded from the locking hook. Still connected in the retrieval cord, the device was dismantled, and retrieved from the body as previously described. A third device, with the same diame- ter (25 mm), was successfully implanted (tab. III). In the other patients, the devices were implanted at the first attempt, without technical problems. In the patient with 2 ASDs, both devices were successfully implanted at the first attempt without problems. The inferior atrial septal defect was initially approached followed by the superior. The device used in the anterior-superior hole was greater than desirable because a smaller device was not available for implantation at that time. Thus, the superior part of the distal disk was in contact with the roof of the left atrium leading to mild prolapse towards its interior, but with satisfactory final results (fig. 6). In the 3 patients with patent foramen ovale, immediate echocardiography with microbubbles and Valsalva’s maneuver (hyperinflation with ambu ± abdominal compression) was negative without passage of contrast from the right to the left side (tab. II). Immediate residual shunt was present in 4 patients with atrial septal defects in the catheterization laboratory (tab. IV). In these patients, the
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Rev. bras. ortop.  vol.46 número2 en a16v46n2

Rev. bras. ortop. vol.46 número2 en a16v46n2

Follow-up after treatment should initially be done every three to four months and should include phy- sical and x-ray tests on the affected bone. This will enable any recurrence to be detected at an early stage. CT or MRI are useful for clarifying a suspected recur- rence. After two to three years, the follow-up should be every six months, and then annually after five years of treatment. Chest x-ray should be requested in each follow-up visit due to the risk of pulmonary metastasis. Chest CT can be performed on diagnosis to check for early signs of pulmonary metastasis since CT is more sensitive than x-ray. Subsequently, in the absence of lesions, the patient is followed-up with x-ray at the above-mentioned intervals (7) .
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LEFT ATRIAL APPENDAGE ANEURYSM: A CASE REPORT

LEFT ATRIAL APPENDAGE ANEURYSM: A CASE REPORT

ABSTRACT: Aneurysm of left atrium may involve the left atrial wall or left atrial appendage. Aneurysm of left atrial appendage is usually acquired in etiology secondary to mitral valve disease, whereas its congenital variant is a rare developmental anomaly. Congenital left atrial appendage aneurysm is very rarely reported entity. They lead to complications like systemic emboli, arrhythmias and worst as death. They are usually misdiagnosed most of the times as a mediastinal mass or cardiac tumour on Chest X-ray. USG provides an easily accessible modality in providing a provisional diagnosis, in confirming the location and its communication with the mediastinal vascular structures. Cardiac and coronary CT and MR help in providing a conclusive diagnosis and earlier surgical intervention thereby preventing further mortality or morbidity. We report a case of 20 year old female incidentally diagnosed with left atrial appendage aneurysm.
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J. bras. pneumol.  vol.39 número2

J. bras. pneumol. vol.39 número2

Acute pulmonary embolism (PE) is considered a cardiovascular emergency because it can lead to acute life-threatening right ventricular failure. It has been reported that approximately 5% of patients with acute PE present with right heart thrombus (RHT), (1-3) which occasionally straddles

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A Method To Find The Area Of Sector Without The Usage Of Angle Made By The Chord

A Method To Find The Area Of Sector Without The Usage Of Angle Made By The Chord

As we know that to find the area of sector the angle made by the chord (that is chord which divides the circle) is required. But in the below method we find the ratio of the segments of the circle. Thus by relating the area of segment to the area of sector the area of sector could be found. The ratio of area of segments is related to tangents that are drawn through diameter on either side.

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CONTINUOUS CREATION IN THE PROBABILISTIC WORLD OF THE THEOLOGY OF CHANCE

CONTINUOUS CREATION IN THE PROBABILISTIC WORLD OF THE THEOLOGY OF CHANCE

The principle of divine control is very important in discussions con- cerning the relation between the Creator and His creatures. These seem to be based on two assumptions. The irst assumption is that God can achieve all His purposes in the created world (divine providence) if and only if He controls every existing being. Therefore, divine control must be perfect and unrestricted (divine volitions must be determined in every respect). Maximal possible control consists in the fact that God creates ex nihilo every being and subsequently conserves them. The second assumption is Anselmian: God is the greatest possible being one can conceive. A perfect being has everything under its control and a perfect being controls everything in the most perfect way possible. Furthermore, the best way to control everything is to create every being out of nothing and to create it as absolutely depen- dent in existence and nature upon God’s will. Omnipotence thus means to conserve continuously all created beings. Continuous creation is the best way to express divine perfection: perfect power and perfect will. Therefore, all contingent beings exist this or that way as long as divine power is acting and divine will wills itself to act upon a given being.
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Braz. J. Cardiovasc. Surg.  vol.24 número3 en v24n3a26

Braz. J. Cardiovasc. Surg. vol.24 número3 en v24n3a26

Therapy with vancomycin, gentamycin and rifampin was started, and the patient was taken to the operation room. The prostheses as well as the intervalvular fibrosa area were carefully examined. During the transvalvar aortic and transvalvar septal explorations, a cavity that communicates with the outflow tract of the left ventricle was found. It was located at the same site of the TEE abscess imaging suggesting spontaneous drainage of the abscess with an aneurysm formation. Moreover, neither valve dehiscence nor instability of the prostheses was noticed. Considering these findings along with the high morbidity and mortality associated with a fourth valve replacement, this procedure was not performed. The patient presented a progressive improvement and became afebrile. Six weeks after the beginning of the antibiotics, a new TEE strongly suggested that the mitral- aortic intervalvular fibrosa abscess had evolved into an aneurysm (Figure 2).
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