Filip Bolechała

Atrial septal pouch — Morphological features and clinical considerations

BACKGROUND The atrial septal pouch (SP) is a new anatomical entity within the interatrial septum. The left-sided SP may be the source of thrombus and contribute to ischemic stroke. The aim of this study was to provide a detailed morphometric description of the SP. METHODS Two hundred autopsied hearts (23% deriving from females) with a mean age of 46.7±19.1years were investigated. We assessed the morphology of the interatrial septum. We obtained measurements and casts of the SPs, and we conducted histological staining of the left-sided SPs. RESULTS Patent foramen ovale was observed in 25% of hearts. We found a left SP in 41.5%, right in 5.5% and a double SP in 5.5% of hearts. We found the patent foramen ovale (PFO) more often in younger hearts, and the SP and smooth septum were more prevalently found in older hearts (p=.0023). The mean volume of the left-sided SP was 0.31±0.11ml, which represented 13.6±9.4% (range: 3.1-44.9%) of the left atrial appendage volume. The SP shape resembled a cone or a cylinder with some smaller diverticula originating from the main body. The SP free wall was composed of two layers of endocardium, transverse muscle fibers and connective tissue. CONCLUSIONS A left-sided SP was present in 47% of individuals. The SP arises as a result of PFO channel closure. The anatomy of left-sided SP may promote blood stasis and thrombus formation. The universal formula for SP volume was calculated.

Clinical Anatomy of the Cavotricuspid Isthmus and Terminal Crest

The aim of this study was to provide useful information about the cavotricuspid isthmus (CTI) and surrounding areas morphology, which may help to plan CTI radio-frequency ablation. We examined 140 autopsied human hearts from Caucasian individuals of both sexes (29.3% females) with a mean age of 49.1±17.2 years. We macroscopically investigated the lower part of the right atrium, the CTI, the inferior vena cava ostium and the terminal crest. The paraseptal isthmus (18.5±4.0 mm) was significantly shorter than the central isthmus (p<0.0001), and the central isthmus (24.0±4.2 mm) was significantly shorter than the inferolateral isthmus (29.3±4.9 mm) (p<0.0001). Heart weight was positively correlated with all isthmus diameters. Three different sectors of CTI were distinguished: anterior, middle and posterior. The middle sector of the CTI presented a different morphology: trabeculae (N = 87; 62.1%), intertrabecular recesses (N = 35; 25.0%) and trabecular bridges (N = 18; 12.9%). A single sub-Eustachian recess was present in 48.6% of hearts (N = 68), and a double recess was present in 2.9% of hearts (N = 4) with mean depth = 5.6±1.8mm and diameter = 7.1±3.4mm. The morphology of the distal terminal crest was varied; 10 patterns of the distal terminal crest ramifications were noted. There were no statistically significant differences in any of the investigated CTI parameters between groups with different types of terminal crest ramifications. The presence of intertrabecular recesses (25.0%), trabecular bridges (12.9%) and sub-Eustachian recesses (48.6%) within the CTI can make ablation more difficult. We have presented the macroscopic patterns of final ramifications of the terminal crest within the quadrilateral CTI area.

Anatomic characteristics of the mitral isthmus region: The left atrial appendage isthmus as a possible ablation target

The mitral isthmus is a part of the postero-inferior area of the lateral left atrial wall located between the mitral annulus and the left inferior pulmonary vein ostium. Linear ablation lesions are created within the mitral isthmus for the invasive treatment of left atrial arrhythmias. However, the anatomy of this region is not fully understood. The aim of this study has been to provide a detailed morphometric description of the mitral isthmus region and to propose another possible isthmus within the investigated heart area that may serve as a potential new ablation target. Two hundred autopsied, non-atrial fibrillation hearts (23.5% deriving from females) whose donors were a mean of 47.6±17.6years old were investigated. We macroscopically assessed the anatomy of the postero-inferior area of the lateral left atrial wall. The mean mitral isthmus length was 28.8±7.0mm and was significantly longer than the left atrial appendage (LAA) isthmus (14.2±4.8mm) (p=.00). The distance between the LAA orifice and the left inferior pulmonary vein ostium (18.4±4.8mm) was longer than the LAA isthmus (p=.00) and shorter than the mitral isthmus (p=.00). The LAA isthmus was longer in hearts with a common left pulmonary vein (p=.037). In 65.5% of all cases the area between the right and left mitral isthmus lines was completely smooth. In the remaining hearts, crevices and diverticula (18.0%), intertrabecular recesses (7.0%), trabecular bridges (3.5%), or co-existence of these structures (6%) could be observed. The LAA isthmus line was smooth in 95.5% of all cases, with only small crevices in the remaining 4.5%. In conclusion, regardless of the anatomical variants of the left-sided pulmonary veins, the mitral isthmus area is quite uniform in size. The LAA isthmus is considerably shorter than the mitral isthmus. The mitral isthmus line has many unwanted structures that may entrap the catheter, which is not the case for the LAA isthmus. We proposed the LAA isthmus line for potential clinical use.

Image-based finite element modeling of the three-point bending test of cortical bone

The numerical simulation of the response of bone tissue to loading is a very common method in the biomedical engineering. The high diversity of bone quality, fractures and metabolic diseases, requires different approaches to numerical simulation. The main aim of this study was image-based finite element modeling (FEM) of the three-point bending tests of cortical bone. The results from the simulation performed based on own materials can be then used to non-destructive prediction of the bone mechanical strength. The samples were scanned by X-ray microcomputed tomography (XMT). Grey values of the imaged phantom were calibrated to known values of the phantom densities. It enabled estimation of the calibration curve for mineral level in bone, that was further applied to the calculation of bone density and the estimation of the material parameters in the FE model. In one example, the finite element analysis gives the deflection y=0.7 mm that match results from experiments where deflection was equal to y =0,69mm. The reported studies delivered useful data for future prediction of the mechanical parameters based on only imaging data.

Anatomy of the mitral subvalvular apparatus

Objectives: To characterize morphologic variations in the papillary muscles and tendinous cords of the left ventricle and ventricular zones of the mitral valve leaflets. Methods: A total of 100 autopsied human hearts from healthy donors with classical mitral valve type were investigated. Results: In 1 heart, only 1 group of papillary muscles was found, and in the remaining 99%, we could distinguish 2 groups of muscles: Superolateral (SLPM) and inferoseptal papillary muscle (ISPM) groups. The SLPM group had 1 papillary muscle (75.8%), 2 in 20.2%, and >3 in 4.0%. In the ISPM group, the muscle percentages were 38.4%, 36.4%, and 25.2%, respectively. The apex of at least 1 papillary muscle was situated higher than the plane of the opened anterior leaflet (AML) in 47.5% and 50.5% for the SLPM and ISPM groups, respectively. The number of strut cords arising from the SLPM group was 0 (2.0%), 1 (50.5%), 2 (33.3%), 3 (12.1%), and 4 (2.0%), and from the ISPM group was 0 (6.1%), 1 (52.5%), 2 (35.4%), or 3 (6.1%). Cords to left ventricular outflow tract were present in 14 specimens. Muscular cords were found in eight hearts. In all hearts specimens AML had rough and clear zones. The classical zones (rough, clear, and basal) in the posterior mitral leaflet were observed in 38.4%. Conclusions: There is a high variability in the papillary muscles and tendinous cords in the mitral valve complex. Proper nomenclature, simple classification, and the most common variants for papillary muscle groups and tendinous cords were presented.

Medicolegal aspects of PMA-related deaths.

Unlike amphetamine, amphetamine-like substances accessible on the drug market are less expensive and more easily available; they also produce hallucinogenic effects expected by the users. Such properties render them more attractive as compared to amphetamine. On the other hand, the knowledge of the toxicity of these compounds is very limited, what in consequence generates problems that create ever-expanding research areas, including analytical, clinical and medicolegal issues, thus leading to development of systemic databases. An example here is paramethoxyamphetamine (PMA), which appeared on the drug market in recent years as a result of creative inventiveness of producers of psychoactive substances, who aimed at PMA replacing the popular ecstasy (MDMA) as a less expensive and more available product. It is more potent than MDMA, but has a slower onset of action, which encourages users to take more. The problem is illustrated in the present paper by three fatal cases involving PMA, which were comprehensively investigated taking into consideration case histories, pathological and toxicological findings obtained with the use of LC-MS-MS method. In blood samples taken from all the three victims, very high concentrations of PMA were found (in the range of 10-27mg/L) and thus the cause of deaths was determined as overdoses of PMA with the underlying mechanism of acute cardiorespiratory failure.

Homicides with corpse dismemberment in the material collected by the Department of Forensic Medicine, Krakow, Poland

Aim of the study: To determine the circumstances which can be useful for offenders profiling in homicide cases with victims body dismemberment. Material and methods: Study of all homicide cases with victims corpse dismemberment examined in Krakow Department of Forensic Medicine over the last 50 years. Results: Within the past 50 years, a total number of 30 cases of homicides with dismembered bodies were examined in Krakow. 22 cases represent defensive mutilations performed by offender, 3 cases can be classified as offensive muti-lations and 3 cases represent aggressive mutilations - decapitation as a method of committing homicide. In this period the only 1 case of necrophilic mutilations was examined, when the body was dismembered without murder. In most cases the background of homicide was the family conflict, 6 was cause of mental illness of perpetrator and in 3 was sexual motive. Only in 3 cases (from 25 when the offender was known) perpetrator kill a stranger. In the other the offender belonged to the family or friends of the victim. In all cases where the perpetrator was determined, homicide and dismemberment was performed in his place of residence. The findings of the Police investigations indicate that in most cases homicides were not planned, occurred under the influence of emotion, only two have been previously scheduled. Conclusions: Homicides with corpses dismemberment usually are committed by offenders who is in close relationship with victim (family or friend). Dismemberment is almost always performed in the same place as murder - home of perpetrator. This type of homicide usually is not planned.