Publications by authors named "Mateusz K Hołda"

59 Publications

Morphology of the Left Atrial Appendage: Introduction of a New Simplified Shape-Based Classification System.

Heart Lung Circ 2021 Feb 10. Epub 2021 Feb 10.

HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland; Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK. Electronic address:

Background: The left atrial appendage (LAA) is a heart structure with known prothrombogenic and pro-arrhythmogenic properties.

Aim: The aim of this study was to evaluate the specific anatomy of the LAA and to create a simple classification system based on the shape of its body.

Method And Results: This study investigated 200 randomly selected autopsied human hearts (25.0% females, 46.6±19.1 years old). Three (3) types of LAAs were distinguished: the cauliflower type (no bend, limited overall length, compact structure [36.5%]); the chicken wing type (substantial bend in the dominant lobe [37.5%]), and the arrowhead type (no bend, one dominant lobe of substantial length [26.0%]). Additional accessory lobes were present in 55.5% of all LAAs. Significant variations between category types were noted in LAA length (chicken wing: 35.7±9.8 mm, arrowhead: 30.8±10.1 mm, cauliflower: 22.3±9.6 mm [p<0.001]) and in the thickness of pectinate muscles located within the LAA apex (arrowhead: 1.2±0.7 mm; cauliflower: 1.1±0.6 mm; chicken wing: 0.9±0.6 mm [p<0.001]). Left atrial appendage volume and orifice size were not affected by the type of LAA shape. The age of the donor was positively correlated with LAA volume (r=0.29, p=0.005), body length (r=0.26, p=0.012), and area of the orifice (r=0.36, p<0.001). Donors with an oval LAA orifice were significantly older than those with round orifices (50.2±16.6 vs 43.7±20.4 years [p=0.014]) and had significantly heavier hearts (458.2±104.8 vs 409.6±114.1g [p=0.002]).

Conclusions: This study delivered a new simple classification system of the LAA based on its body shape. An increase in age and heart weight was associated with LAA enlargement and a more oval-shaped orifice. Results of current study may help to estimate the different thrombogenic properties associated with each LAA type and be an assistance during planning and performing interventions on LAA.
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http://dx.doi.org/10.1016/j.hlc.2020.12.006DOI Listing
February 2021

Myocardial bridges: A meta-analysis.

Clin Anat 2020 Oct 19. Epub 2020 Oct 19.

Department of Anatomical Sciences, St. George's University, School of Medicine, Grenada, West Indies.

Myocardial bridges are anatomical entities characterized by myocardium covering segments of coronary arteries. In some patients, the presence of a myocardial bridge is benign and is only incidentally found on autopsy. In other patients, however, myocardial bridges can lead to compression of the coronary artery during systolic contraction and delayed diastolic relaxation, resulting in myocardial ischemia. This ischemia in turn can lead to myocardial infarction, ventricular arrhythmias and sudden cardiac death. Myocardial bridges have also been linked to an increased incidence of atherosclerosis, which has been attributed to increased shear stress and the presence of vasoactive factors. Other studies however, demonstrated the protective roles of myocardial bridges. In this study, using systematic review and a meta-analytical approach we investigate the prevalence and morphology of myocardial bridges in both clinical imaging and cadaveric dissections. We also discuss the pathophysiology, clinical significance, and management of these anatomical entities.
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http://dx.doi.org/10.1002/ca.23697DOI Listing
October 2020

Topographical anatomy of the right atrial appendage vestibule and its isthmuses.

J Cardiovasc Electrophysiol 2020 12 11;31(12):3199-3206. Epub 2020 Oct 11.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Introduction: The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures.

Methods And Results: We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001).

Conclusions: This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.
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http://dx.doi.org/10.1111/jce.14767DOI Listing
December 2020

Identification of CD34+/PGDFRα+ Valve Interstitial Cells (VICs) in Human Aortic Valves: Association of Their Abundance, Morphology and Spatial Organization with Early Calcific Remodeling.

Int J Mol Sci 2020 Aug 31;21(17). Epub 2020 Aug 31.

Department of Histology, Jagiellonian University Medical College, 31-034 Kraków, Poland.

Aortic valve interstitial cells (VICs) constitute a heterogeneous population involved in the maintenance of unique valvular architecture, ensuring proper hemodynamic function but also engaged in valve degeneration. Recently, cells similar to telocytes/interstitial Cajal-like cells described in various organs were found in heart valves. The aim of this study was to examine the density, distribution, and spatial organization of a VIC subset co-expressing CD34 and PDGFRα in normal aortic valves and to investigate if these cells are associated with the occurrence of early signs of valve calcific remodeling. We examined 28 human aortic valves obtained upon autopsy. General valve morphology and the early signs of degeneration were assessed histochemically. The studied VICs were identified by immunofluorescence (CD34, PDGFRα, vimentin), and their number in standardized parts and layers of the valves was evaluated. In order to show the complex three-dimensional structure of CD34+/PDGFRα+ VICs, whole-mount specimens were imaged by confocal microscopy, and subsequently rendered using the Imaris (Bitplane AG, Zürich, Switzerland) software. CD34+/PDGFRα+ VICs were found in all examined valves, showing significant differences in the number, distribution within valve tissue, spatial organization, and morphology (spherical/oval without projections; numerous short projections; long, branching, occasionally moniliform projections). Such a complex morphology was associated with the younger age of the subjects, and these VICs were more frequent in the spongiosa layer of the valve. Both the number and percentage of CD34+/PDGFRα+ VICs were inversely correlated with the age of the subjects. Valves with histochemical signs of early calcification contained a lower number of CD34+/PDGFRα+ cells. They were less numerous in proximal parts of the cusps, i.e., areas prone to calcification. The results suggest that normal aortic valves contain a subpopulation of CD34+/PDGFRα+ VICs, which might be involved in the maintenance of local microenvironment resisting to pathologic remodeling. Their reduced number in older age could limit the self-regenerative properties of the valve stroma.
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http://dx.doi.org/10.3390/ijms21176330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503258PMC
August 2020

Myocardial proteomic profile in pulmonary arterial hypertension.

Sci Rep 2020 09 1;10(1):14351. Epub 2020 Sep 1.

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland.

Pulmonary arterial hypertension (PAH) is a rare, fatal, and incurable disorder. Although advances in the understanding of the PAH pathobiology have been seen in recent years, molecular processes underlying heart remodelling over the course of PAH are still insufficiently understood. Therefore, the aim of this study was to investigate myocardial proteomic profile of rats at different stages of monocrotaline-induced PAH. Samples of left and right ventricle (LV and RV) free wall collected from 32 Wistar rats were subjected to proteomic analysis using an isobaric tag for relative quantitation method. Hemodynamic parameters indicated development of mild elevation of pulmonary artery pressure in the early PAH group (27.00 ± 4.93 mmHg) and severe elevation in the end-stage PAH group (50.50 ± 11.56 mmHg). In early PAH LV myocardium proteins that may be linked to an increase in inflammatory response, apoptosis, glycolytic process and decrease in myocardial structural proteins were differentially expressed compared to controls. During end-stage PAH an increase in proteins associated with apoptosis, fibrosis and cardiomyocyte Ca currents as well as decrease in myocardial structural proteins were observed in LV. In RV during early PAH, especially proteins associated with myocardial structural components and fatty acid beta-oxidation pathway were upregulated. During end-stage PAH significant changes in RV proteins abundance related to the increased myocardial structural components, intensified fibrosis and glycolytic processes as well as decreased proteins related to cardiomyocyte Ca currents were observed. At both PAH stages changes in RV proteins linked to apoptosis inhibition were observed. In conclusion, we identified changes of the levels of several proteins and thus of the metabolic pathways linked to the early and late remodelling of the left and right ventricle over the course of monocrotaline-induced PAH to delineate potential therapeutic targets for the treatment of this severe disease.
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http://dx.doi.org/10.1038/s41598-020-71264-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462861PMC
September 2020

Morphometric characteristics of myocardial sleeves of the pulmonary veins.

J Cardiovasc Electrophysiol 2020 09 13;31(9):2455-2461. Epub 2020 Jul 13.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Background: The pulmonary veins are covered by a myocardial layer, which is often an electrical substrate for atrial fibrillation. The aim of this study was to study the morphologic characteristics of the myocardial sleeves of pulmonary veins by examining a large group of freshly autopsied human material.

Methods And Results: The study macroscopically examined a total of 498 pulmonary veins draining the left atrium (120 unpreserved human hearts). In 75.0% of specimens, a classical pulmonary venous pattern was observed. The remainder of specimens either had an additional middle right pulmonary vein (20.0% of cases) or a common left pulmonary vein (5.0% of cases). Among all the veins seen in the classical pulmonary venous drainage type, the left superior pulmonary vein had the longest myocardial sleeves (9.4 ± 4.6 mm; coverage = 60.1 ± 19.4%), followed by the left inferior pulmonary vein (6.6 ± 3.5 mm; coverage = 47.6 ± 18.3%), the right superior pulmonary vein (6.0 ± 2.7 mm; coverage = 50.5 ± 13.9%) and then the right inferior pulmonary vein (5.0 ± 2.8 mm; coverage = 45.6 ± 16.2%; analysis of variance p < .001). In hearts with an additional right pulmonary vein, this vessel had the shortest myocardial sleeves (2.7 ± 1.1 mm; coverage = 36.0 ± 11.6%). In hearts with a common left pulmonary vein, the myocardial sleeves had the longest course for the common vein (13.7 ± 4.4 mm; coverage = 79.7 ± 4.9%).

Conclusions: Myocardial sleeves of the pulmonary veins were seen in each examined specimen, however, their length varied significantly. In hearts with a classical venous drainage pattern, the left superior pulmonary vein had the longest sleeves. When present, an additional middle right pulmonary vein had the shortest myocardial sleeves, while the left common pulmonary vein had the longest sleeves.
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http://dx.doi.org/10.1111/jce.14651DOI Listing
September 2020

Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model.

J Transl Med 2020 06 30;18(1):262. Epub 2020 Jun 30.

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland.

Background: Aim of this study was to assess changes in cardiac morphometric parameters at different stages of pulmonary arterial hypertension (PAH) using a monocrotaline-induced rat model.

Methods: Four groups were distinguished: I-control, non-PAH (n = 18); II-early PAH (n = 12); III-end-stage PAH (n = 23); and IV-end-stage PAH with myocarditis (n = 7).

Results: Performed over the course of PAH in vivo echocardiography showed significant thickening of the right ventricle free wall (end-diastolic dimension), tricuspid annular plane systolic excursion reduction and decrease in pulmonary artery acceleration time normalized to cycle length. No differences in end-diastolic left ventricle free wall thickness measured in echocardiography was observed between groups. Significant increase of right ventricle and decrease of left ventricle systolic pressure was observed over the development of PAH. Thickening and weight increase (241.2% increase) of the right ventricle free wall and significant dilatation of the right ventricle was observed over the course of PAH (p < 0.001). Reduction in the left ventricle free wall thickness was also observed in end-stage PAH (p < 0.001). Significant trend in the left ventricle free wall weight decrease was observed over the course of PAH (p < 0.001, 24.3% reduction). Calculated right/left ventricle free wall weight ratio gradually increased over PAH stages (p < 0.001). The reduction of left ventricle diameter was observed in rats with end-stage PAH both with and without myocarditis (p < 0.001).

Conclusions: PAH leads to multidimensional changes in morphometric cardiac parameters. Right ventricle morphological and functional failure develop gradually from early stage of PAH, while left ventricle changes develop at the end stages of PAH.
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http://dx.doi.org/10.1186/s12967-020-02440-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325143PMC
June 2020

Topography of the oblique vein of the left atrium (vein of Marshall).

Kardiol Pol 2020 08 28;78(7-8):688-693. Epub 2020 Apr 28.

HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Division of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom.

Background: The oblique vein of the left atrium is of interest for electrophysiologists working in the field of both basic science and clinical practice.

Aims: We aimed to examine the topographic anatomy of the oblique vein and to assess the vein's location and relationships with surrounding cardiac structures.

Methods: A total of 200 autopsied adult human hearts were examined.

Results: The oblique vein was observed in 71% of the hearts. Its mean (SD) total length was 30.8 (13.6) mm. In hearts with the oblique vein, a larger distance was observed between the left inferior pulmonary vein (LIPV) and great cardiac vein (mean [SD], 18.6 [5.1] mm vs 16.3 [4.8] mm; P = 0.004), between the left atrial appendage (LAA) and LIPV (mean [SD], 17.8 [6.8] mm vs 15.1 [5.2] mm; P = 0.007), and between the LAA and left superior pulmonary vein (LSPV; mean [SD], 28.5 [7.2] mm vs 21.3 [6.4] mm; P <0.001). Hearts with a classic pattern of left‑sided pulmonary veins were categorized into 4 types based on the length of oblique vein extension. In type I, the vein extended below the level of the LIPV (21.9%); in type II, to the level of the LIPV (47.7%); in type III, to the level of the interpulmonary area (17.2%); and in type IV, to the level of the LSPV (13.3%). In each type, the distance between the oblique vein and LIPV was shorter than that between the oblique vein and LAA Conclusions: The oblique vein had a variable course and differing lengths of extension. The presence of the oblique vein was connected with a greater distance between the left‑sided pulmonary veins and LAA.
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http://dx.doi.org/10.33963/KP.15318DOI Listing
August 2020

Morphometric Features of Patent Foramen Ovale as a Risk Factor of Cerebrovascular Accidents: A Systematic Review and Meta-Analysis.

Cerebrovasc Dis 2020 25;49(1):1-9. Epub 2020 Feb 25.

Department of Anatomy, HEART, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland.

Introduction: It is still disputable whether specific morphometric features of the patent foramen ovale (PFO) may stratify patients by the related probability that a discovered PFO is incidental or stroke related.

Objective: We aimed to determine whether certain morphometrical characteristics of PFO are associated with an increased risk of cerebrovascular accidents, using a meta-analytical approach.

Methods: We performed a systematic review of electronic databases for studies that compared morphometric parameters of PFO assessed by transesophageal echocardiography (TEE) in subjects with cryptogenic cerebrovascular accidents (Group 1) and control (Group 2). Data were extracted and pooled into a meta-analysis.

Results: A total of 895 patients with PFO were reported (Group 1: 493, Group 2: 402). No difference was found in the PFO channel length (Group 1: 10.8 [8.6-12.9] mm vs. Group 2: 10.4 [9.1-11.7] mm), as well as in PFO height measured at rest (Group 1: 2.4 [1.5-3.3] mm vs. Group 2: 1.8 [1.4-2.2] mm). The PFO height measured during a Valsalva maneuver was larger in Group 1 (3.5 [2.8-4.1] mm) than in Group 2 (1.7 [1.2-2.2] mm). Also, the septal excursion distance was found to be larger in Group 1 (6.4 [5.1-7.8] mm) than in Group 2 (3.1 [1.8-4.4] mm). The risk of cerebrovascular accident was higher in patients with PFO and concomitant septal aneurysm (OR 4.00; 95% CI 2.63-6.09; p < 0.001) and with large right-to-left shunt PFO (OR 3.81; 95% CI 2.21-6.55; p < 0.001), no such relationship was found for the presence of a Eustachian valve or Chiari's network (OR 1.90; 95% CI 0.90-4.05; p = 0.094).

Conclusions: The TEE may help in identifying PFO that are of high risk of cerebrovascular accident. Greater PFO height during a Valsalva maneuver, larger septal excursion distance, concomitant atrial septal aneurysm, and large right-to-left shunt are associated with stroke-related PFOs.
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http://dx.doi.org/10.1159/000506433DOI Listing
September 2020

The left atrial septal pouch-Dispelling controversies.

Authors:
Mateusz K Holda

Echocardiography 2020 03 20;37(3):476. Epub 2020 Feb 20.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland.

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http://dx.doi.org/10.1111/echo.14619DOI Listing
March 2020

Successful closure of a symptomatic left circumflex coronary artery to coronary sinus fistula.

Kardiol Pol 2019 Dec 6;77(12):1204-1205. Epub 2019 Dec 6.

Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland.

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http://dx.doi.org/10.33963/KP.15088DOI Listing
December 2019

Anatomy of the left atrial ridge (coumadin ridge) and possible clinical implications for cardiovascular imaging and invasive procedures.

J Cardiovasc Electrophysiol 2020 01 15;31(1):220-226. Epub 2019 Dec 15.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Background: The left atrial ridge is a structure located in the left atrium between the left-sided pulmonary veins ostia and the orifice of the left atrial appendage. Since it was commonly misdiagnosed as a thrombus, the ridge is also known as the "coumadin" or "warfarin" ridge. The left atrial ridge is a potential source of arrhythmias and can be an obstacle in ablation procedures. This study aimed to provide information about the occurrence and spatial morphometric characteristics of the left atrial ridge.

Methods And Results: The macroscopic morphology of the left atrial ridge was assessed in 200 autopsied human hearts. The ridge was observed in 59.5% of specimens and was absent in the remaining 40.5% of cases. The mean length of the ridge was 22.4 ± 5.1 mm. It was wider at its inferior sector when compared to its superior sector (9.1 ± 5.0 vs 7.9 ± 3.2 mm; P = .028). The total wall thickness measured at the cross section of the ridge was significantly larger in the inferior than in superior sector (6.2 ± 3.5 vs 4.3 ± 1.8 mm; P < .001), although the myocardial thickness was significantly larger at the superior sector (3.1 ± 1.4 vs 1.9 ± 0.9 mm in inferior sector, P < .001).

Conclusion: The left atrial ridge is a variable structure, present in 59.5% of humans. The ridge is significantly wider and thicker at its inferior sector, although the actual myocardial layer present within the ridge is thinner at this location. Knowledge about the left atrial ridge morphology is key in avoiding unnecessary interventions or complications during invasive procedures.
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http://dx.doi.org/10.1111/jce.14307DOI Listing
January 2020

Quadricuspid pulmonary valve: macroscopic and microscopic morphometric examination.

Surg Radiol Anat 2020 Apr 29;42(4):385-389. Epub 2019 Nov 29.

Department of Histology, Jagiellonian University Medical College, Kraków, Poland.

A quadricuspid pulmonary valve obtained upon autopsy of a 26-year-old male was examined. The macroscopic evaluation revealed three normal (posterior, right anterior and left anterior) leaflets and one additional leaflet of the pulmonary valve. Except that, the heart showed neither other anatomical variabilities nor any signs of heart disease. The additional leaflet was located between the left anterior and right anterior leaflets and was significantly smaller in size. Under the microscope, all leaflets showed preservation of the typical, layered structure. The thickness and extracellular matrix composition of the particular layers differed between the leaflets. Right ventricular myocardium (myocardial sleeves) exceeded the level of the hinge line in all three normal leaflets, which was not observed in the additional leaflet. Autonomic nerves and ganglia were not seen in the perivalvular epicardial adipose tissue surrounding the additional leaflet. The sinus wall of all the leaflets revealed typical organization of collagen bundles as well as elastic fibers and showed no signs of disruption. The abnormality seen in the structure of the pulmonary valve is likely to be a result of disturbed embryonic development and may affect the clinical management of patients with such variation.
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http://dx.doi.org/10.1007/s00276-019-02387-5DOI Listing
April 2020

Deep septal deployment of a thin, lumenless pacing lead: a translational cadaver simulation study.

Europace 2020 01;22(1):156-161

First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kopernika 17, 31-501 Kraków, Poland.

Aims: The recently introduced technique of direct transseptal pacing of the left bundle branch is poorly characterized with many questions with regard to the optimal implantation strategy and safety concerns largely left unanswered. We developed a cadaver model for deep septal lead deployment in order to investigate the depth of penetration in relation to lead behaviour, lead tip position, and the number of rotations.

Methods And Results: Five fresh human hearts and five lumenless, 4.1-Fr pacing leads were used for deep septal deployment simulations. The leads were positioned with the use of a dedicated delivery sheath and screwed into the interventricular septum at several sites progressively more distal from the atrioventricular ring with a predetermined number of lead rotations. During each lead deployment, the depth of tip penetration was measured and the lead behaviour was noted. Four distinct lead behaviours were observed: (i) helix only penetration, no matter how many rotations were performed, due to the 'endocardial entanglement effect' (43.1% cases) or (ii) 'endocardial barrier effect' (19.6% cases), (iii) shallow/moderate penetration, with ensuing 'drill effect' when more rotations were added (9.8% cases), and (iv) deep progressive penetration with each additional rotation, occurring when the 'screwdriver effect' was present (27.4% cases, including three septal perforations). These different lead behaviours seemed to be determined by the lead position-mainly the strength of the initial endocardial layer-and the number of fully transmitted rotations.

Conclusion: New insights into deep septal lead deployment technique were gained with regard to safe and successful implantation.
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http://dx.doi.org/10.1093/europace/euz270DOI Listing
January 2020

Topographic characteristics of the left atrial medial isthmus.

Pacing Clin Electrophysiol 2019 12 11;42(12):1579-1585. Epub 2019 Nov 11.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Background: The purpose of this study was to provide detailed topography of the left atrial medial isthmus (situated between the right inferior pulmonary vein ostium and the medial part of the mitral annulus).

Methods: Two hundred human hearts (Caucasian, 22.5% females, 48.7 ± 4.9 years old) were investigated.

Results: The mean length of the medial isthmus was 42.4 ± 8.6 mm. Additionally, the medial isthmus line was divided by the oval fossa into three sections with equal mean lengths (upper: 14.2 ± 7.2 vs middle: 14.1 ± 6.1 vs lower: 14.9 ± 4.6 mm; P > .05). The left upper section of the atrial wall was thinner than the lower section (2.5 ± 1.1 vs 3.4 ± 1.6 mm; P < .0001). This study noted three separate spatial arrangements of the isthmus line. Type I (54.5%) had an oval fossa located outside the isthmus line; type II (32.5%) had an oval fossa crossed by the isthmus line, and type III (13.0%) had an oval fossa rim located tangentially to the isthmus line. In 68.5% of the examined specimens, the isthmus area had a smooth surface. Conversely, the remaining 31.5% had additional structures within its borders such as diverticula, recesses, and tissue bridges.

Conclusion: This study is the first to describe the morphometric and topographical features of the left atrial medial isthmus. Interventions within the medial isthmus line should be performed cautiously, especially when they are transected by the oval fossa (32.5%). Careful navigation of the area is also recommended due to the possibility of existent additional structures. The latter could lead to catheter entrapment during ablation procedures.
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http://dx.doi.org/10.1111/pace.13834DOI Listing
December 2019

Variations and morphometric features of the vermiform appendix: A systematic review and meta-analysis of 114,080 subjects with clinical implications.

Clin Anat 2020 Jan 12;33(1):85-98. Epub 2019 Oct 12.

Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Determining the true and indisputable data regarding the vermiform appendix (VA) morphology is of a great clinical interest. The aim of this study was to provide the best evidence-based anatomical overview of the variations in location and size of VA using a systematic and meta-analytical approach. A systematic review with meta-analysis was performed of studies reporting variants of the location and morphometric data regarding the VA. The MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science databases were thoroughly searched throughout June 2018. The reported locations of the body of the VA were re-classified into a new, standardized classification system divided into nine categories. The AQUA tool was used to assess the quality of included studies. The research was conducted following PRISMA guidelines and registered at PROPSERO database. Our meta-analysis included 242 studies (n = 114,080). Overall, the VA was most commonly found in the retrocecal location (32.1%, 95%CI: 29.2-35.1), followed by the pelvic (28.5%, 95%CI: 26.7-30.4) and ileal (14.5%, 95%CI: 11.8-17.7) locations. Subjects without known appendiceal pathologies had significantly smaller VA outer diameters (5.84 mm, 95%CI: 5.68-5.99) than patients diagnosed with acute appendicitis (10.64 mm, 95%CI: 10.14-11.15). The overall pooled mean length of the VA was 80.29 mm (95%CI: 76.68-83.89). Significant differences were found in size of the VA between imaging modalities. The results obtained from this evidence-based anatomy study will improve the clinical understanding of the VA anatomy, which in turn will have major implications for clinical practice. Clin. Anat. 32:85-98, 2019. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23474DOI Listing
January 2020

Evaluation of Local Tissue Reaction After the Application of a 3D Printed Novel Holdfast Device for Left Atrial Appendage Exclusion.

Ann Biomed Eng 2020 Jan 15;48(1):133-143. Epub 2019 Jul 15.

Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland.

The left atrial appendage (LAA) is a small, finger-like extension of the left atrium and its exclusion is used as a treatment strategy to prevent ischemic stroke. Existing holdfast devices may damage the tissue, are unisized and not adjustable. A novel holdfast device for LAA exclusion devoid of these shortcomings was designed and 3D-printed using the Selective Laser Sintering (SLS) technology with polyamide powder and tested it on animal model. We selected the SLS 3D printing technology due to its wid14e availability and low production costs which could provide on-site 3D printing for specific patient. The purpose of this study was to evaluate the biocompatibility of the reported holdfast device and compare the histological results obtained for local tissue reactions to those obtained for an established grafting material. Thirty swine subdivided into two groups were examined. The LAA exclusion device was implanted and was either coated with a polyester vascular implant or not coated at all and the histological response to the device's presence was evaluated which is a standard approach to test the device biocompatibility. In all cases, complete occlusion was seen without any pathological findings during the incubation time. In both groups, the surface of the atrium under a holdfast device was smooth and shiny and had no clots. The foreign body reaction of the LAA holdfast device made of polyamide powder was insignificantly lower compared to the polyester graft. Thus, it fulfils the parameters of biocompatibility at the highest degree, and makes it suitable material for the manufacturing of LAA holdfast devices.
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http://dx.doi.org/10.1007/s10439-019-02320-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928093PMC
January 2020

Morphology of the Vieussens valve and its imaging in cardiac multislice computed tomography.

J Cardiovasc Electrophysiol 2019 08 18;30(8):1325-1329. Epub 2019 Jun 18.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Introduction: To deliver accurate morphological descriptions of the Vieussens valve (VV) and to investigate whether this structure could be visualized using standard contrast-enhanced electrocardiogram-gated multislice computed tomography (MSCT).

Methods: A total of 145 human autopsied hearts and 114 cardiac MSCT scans were examined.

Results: The VV was observed in both study groups, however, the detection rate was significantly worse in the MSCT examination (18.4% in MSCT vs 62.1% in cadavers, P < .0001). The VV height was larger in MSCT patients (2.8 ± 1.2 vs 5.4 ± 1.7 mm; P < .0001). No significant difference was found in the measured distance between the VV and the coronary sinus ostium between the two separate subgroups (27.3 ± 9.5 vs 24.4 ± 5.8 mm; P = .18). In autopsied material the most frequent valve location was the anterior wall of the coronary sinus (43.3%); the same was observed in MSCT scans (71.4%).

Conclusion: The VV is a common heart structure, present in over 60% of humans, located mainly on the anterior and superior circuit of the coronary sinus, with relatively high morphological variability. Large VVs, which pose a significant obstacle in catheterization procedures, may be visualized using standard-protocol contrast-enhanced cardiac MSCT.
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http://dx.doi.org/10.1111/jce.14018DOI Listing
August 2019

Fixative properties of honey solutions as a formaldehyde substitute in cardiac tissue preservation.

Folia Med Cracov 2019 ;59(1):101-114

HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy Jagiellonian University Medical College, Kraków, Poland.

Objectives: To evaluate the properties of natural sweetener solutions in whole organ preservation and assess their influence on the dimension, weight and shape of cardiac tissue samples in stated time intervals, up to a one-year period of observation.

Background: Tissue fixation is essential for biological sample examination. Many negative toxic effects of formaldehyde-based fixatives have forced us to seek alternatives for formaldehyde based solutions. It has been demonstrated that natural sweeteners can preserve small tissue samples well and that these solutions can be used in histopathological processes. However, their ability to preserve whole human organs are unknown.

Methods: A total of 30 swine hearts were investigated. Three study groups (n = 10 in each case) were formed and classified on the type of fixative: (1) 10% formaldehyde phosphate-buffered solution (FPBS), (2) 10% alcohol-based honey solution (ABHS), (3) 10% water-based honey solution (WBHS). Samples were measured before fixation and in the following time points: 24 hours, 72 hours, 168 hours, 3 months, 6 months and 12 months.

Results: The WBHS failed to preserve heart samples and decomposition of tissues was observed one week after fixation. In half of the studied parameters, the ABHS had similar modifying tendencies as compared to FPBS. e overall condition of preserved tissue, weight, left ventricular wall thickness, right ventricular wall thickness and the diameter of the papillary muscle differed considerably.

Conclusions: The ABHS may be used as an alternative fixative for macroscopic studies of cardiac tissue, whereas the WBHS is not suited for tissue preservation.
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December 2019

Variations and angulation of the coronary sinus tributaries: Implications for left ventricular pacing.

Pacing Clin Electrophysiol 2019 Apr 21;42(4):423-430. Epub 2019 Feb 21.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.

Background: Variations of the coronary sinus tributaries might result in difficulties in left ventricle electrode insertion during cardiac resynchronizing therapy. Morphometric features of tributaries, especially angulation of the coronary sinus tributaries, are crucial for coronary sinus procedures.

Methods: This study was carried out on 200 formaldehyde-fixed human hearts (22.0% females, mean age of 48.7 ± 15.6 years).

Results: The inferolateral aspect of the left ventricle was accessible from the coronary venous tree in 77.0% (in 35% from one, 29% from two, and 13.0% from three tributaries). The middle cardiac vein was present in all cases, with a diameter of 1.8 ± 0.5 mm, cannulation distance of 5.3 ± 3.2 mm, and angle of 82.0 ± 12.8°. The inferolateral vein of the left ventricle varied greatly in number: single in 63.5%, multiple in 30.5%. The ostium diameter for a single vein was 1.3 ± 0.5 mm, cannulation distance was 21.1 ± 9.8 mm, and the angle was 98.1 ± 13.5°. The left marginal vein was present in 39.5% with an ostium diameter of 0.9 ± 0.5 mm, cannulation distance of 46.0 ± 12.0 mm, and angle of 92.0 ± 13.4°. Finally, the oblique vein of the left atrium was present in 71.0% with a diameter of 1.3 ± 0.8 mm, cannulation distance of 27.2 ± 9.4 mm, and angle of 136.8 ± 16.6°.

Conclusions: This study shows the clinically relevant morphometric characteristic of coronary sinus tributaries. The middle cardiac vein is the most constant among coronary veins. However, it is usually not suitable for left ventricular pacing. The inferolateral vein of the left ventricle is highly variable in number, but its morphology makes it a suitable target for left ventricular lead placement.
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http://dx.doi.org/10.1111/pace.13618DOI Listing
April 2019

Right Atrioventricular Valve Leaflet Morphology Redefined: Implications for Transcatheter Repair Procedures.

JACC Cardiovasc Interv 2019 01;12(2):169-178

Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota.

Objectives: The authors aimed to comprehensively detail the right atrioventricular valve functional leaflet anatomies.

Background: The rapid development of both surgical and percutaneous repair techniques for tricuspid regurgitation has renewed interest in variations in the morphology of the right atrioventricular valve.

Methods: The functioning right atrioventricular valves of 40 reanimated human hearts were imaged using Visible Heart methodologies. Hearts were then perfusion-fixed and dissected, uniquely allowing for the comparative assessments of functional versus fixed valve anatomies from the same set of donor hearts.

Results: The right atrioventricular valves have "3-leaflet" configurations in 57.5% and "4-leaflet" configurations in the remaining hearts. For 4-leaflet valves, extra leaflets were commonly observed in the most inferior regions of the annuli. No difference in valve perimeters between 2 valve types were observed (112.2 vs. 117.1 mm; p = 0.14). In 3-leaflet valves, septal, mural, and superior leaflets occupied 32.2 ± 6.5%, 15.9 ± 5.5%, and 25.5 ± 6.2% of the annulus, respectively, whereas in the 4-leaflet arrangements, these values were 27.0 ± 5.8% (septal), 12.0 ± 4.5% (inferior), 13.7 ± 9.4% (mural), and 19.8 ± 6.1% (superior). The muroseptal/inferoseptal commissures were usually located in the cavotricuspid regions, whereas the inferomural and superomural commissures were in the right atrial appendage vestibule area.

Conclusions: The right atrioventricular valve has 4 functional leaflets in more than 40% of cases. The authors found that the inferomural region is the most variable area of the valve and believe that anatomic variation is an important consideration for planned interventions.
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http://dx.doi.org/10.1016/j.jcin.2018.09.029DOI Listing
January 2019

Morphological variations of the interatrial septum in ovine heart.

PLoS One 2018 19;13(12):e0209604. Epub 2018 Dec 19.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Smooth septum interatrial septum, patent foramen ovale (PFO) channel and atrial septal pouches (SPs) are commonly described variants in humans. Recent discoveries on the clinical significance of left-sided SP may encourage the creation of new strategies and devices for the management of SPs. However, these strategies may first be tested in the ovine model before implementation in humans. Unfortunately, little is known about the presence of SPs in ovine. In this study a total of 60 ovine (Ovis aries) hearts were examined. The interatrial septum morphology was assessed and the PFO channel and SPs were measured. The most commonly occurring variant were PFO channels (25.0%) with channel lengths of 5.4±2.3 mm. Smooth septums were observed in 18.3% of hearts. In the remaining cases, septums had a left septal ridge (15.0%), left SP (11.7%), left septal bridge (10.0%), right SP (10.0%), or had both a right SP and left septal ridge (10.0%). No double SPs were observed. The mean right SP depth was 3.4 ± 1.2 mm, and its mean ostium width and height were 7.9±1.8 mm and 2.8±1.0, respectively. For the left SP, the mean depth was 6.0±1.7mm, the ostium width was 7.9±2.4mm, and the ostium height was 4.1±1.6mm (range: 2.3-6.4mm). In conclusion the interatrial septum of ovine hearts exhibit morphologies that are more similar to humans than they are to swine, which should be taken into account during experimental studies. The presence of a left SP in sheep hearts make ovine models a promising alternative to the human heart for developing left-sided SP management devices and techniques.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209604PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300291PMC
May 2019

Left-Sided Atrial Septal Pouch as a Risk Factor of Cryptogenic Stroke: A Systematic Review and Meta-Analysis.

Cerebrovasc Dis 2018 5;46(5-6):223-229. Epub 2018 Dec 5.

HEART, Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Background: Despite some evidence of left-sided septal pouch (LSSP) involvement in the pathogenesis of cardioembolic stroke, the question of LSSP clinical significance still remains unsolved. In this study, we aimed to determine the association between the LSSP presence and cryptogenic stroke using meta-analytical approach.

Methods: We performed a systematic review of electronic databases for studies that compared the presence of LSSP in subjects with cryptogenic stroke and non-stroke control. Data were extracted and pooled into a meta-analysis.

Results: Seven studies (400 cryptogenic stroke patients and 1,456 non-stroke controls) were included in the meta-analysis. A total of 138 LSSPs were identified among the cryptogenic stroke patients, with a pooled prevalence of 29.8% (95% CI 17.5-43.7%), and 268 LSSPs were identified in the non-stroke controls, with a pooled prevalence of 21.0% (95% CI 13.7-29.5%). After meta-analysis, the risk of cryptogenic stroke was higher in patients with an LSSP than in patients without LSSP (OR 1.52; 95% CI 1.15-2.00; p < 0.001). No significant heterogeneity was detected across the included studies (p > 0.05).

Conclusion: Our meta-analysis demonstrated association between LSSP and cryptogenic stroke. In our univariate analysis, the risk of cryptogenic stroke is higher among patients with LSSP than in cases without the LSSP.
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http://dx.doi.org/10.1159/000495573DOI Listing
July 2019

The influence of bariatric surgery on serum levels of irisin and nesfatin-1.

Acta Chir Belg 2019 Dec 2;119(6):363-369. Epub 2018 Nov 2.

Department of Medical Physiology, Jagiellonian University Medical College , Cracow , Poland.

Bariatric surgery is associated with multiple endocrine and metabolic changes. Irisin and nesfatin-1 have recently been described as regulatory peptides involved in obesity-related insulin resistance. Our aim was to analyze the changes of those two molecules observed in patients after bariatric procedures. This prospective study involved 40 patients treated for morbid obesity. Irisin and nesfatin-1 were measured before, 6 months and 1 year after surgical intervention. We also gathered demographic data, information concerning comorbidities, factors related to the surgery and outcomes of bariatric treatment. Twenty-seven patients completed the study (15 females). The mean age of the group was 43.5 ± 10.4 years. Six (22.2%) patients were submitted to Laparoscopic Sleeve Gastrectomy and 21 (77.8%) patients were submitted to Laparoscopic Roux-en-Y Gastric Bypass. The participants in our study achieved significant weight loss. The irisin level remained stable in the whole study group during all three measurements included in our study protocol ( = .71). Our study group presented a reduction of the nesfatin-1 level 6 months after bariatric surgery and a slight further decrease after one-year observation, although these changes were also not significant ( = .17). We did not find any significant correlation between changes of irisin or nesfatin-1 level and bariatric surgery, as an aid in the regulation of glucose metabolism.
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http://dx.doi.org/10.1080/00015458.2018.1534393DOI Listing
December 2019

Comparison of clinical and echocardiographic outcomes and quality of life in patients with severe mitral regurgitation treated by MitraClip implantation or treated conservatively.

Postepy Kardiol Interwencyjnej 2018 21;14(3):291-298. Epub 2018 Sep 21.

2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.

Introduction: The most common alternative method of treatment for patients with severe mitral regurgitation (MR) is the implantation of a MitraClip device.

Aim: To evaluate clinical and echocardiographic outcomes and quality of life (QoL) in patients with severe secondary MR, disqualified from surgical intervention, treated by implantation of a MitraClip in comparison to conservative therapy.

Material And Methods: A total of 33 patients were included. Patients were stratified by treatment method: group A, MitraClip implantation ( = 10); group B, conservative treatment ( = 23). Clinical, echocardiographic, and QoL (EQ-5D-3L, SF-12v2 Health Survey) characteristics were compared at baseline and at follow-up of 8.0 ±2.3 months.

Results: In group A, 2 deaths were observed: one patient died 7 days after MitraClip implantation, and the second patient died 4 months after the procedure. No cases of rehospitalization were reported. In group B, 4 (17.4%) deaths and 6 (26.1%) hospitalizations were reported. After MitraClip implantation a significant reduction of the NYHA class ( = 0.02), decrease in grade of MR ( = 0.01), vena contracta width ( = 0.006), effective regurgitant orifice area (EROA) ( = 0.003), regurgitant volume ( = 0.03) and end-diastolic left ventricle diameter ( = 0.02) as well as an improvement in QoL were reported. There were no significant changes in the NYHA class and QoL in the group treated conservatively. In those patients, we observed increased intercommissural mitral annulus diameter ( = 0.03), left atrium diameter ( = 0.002), and right ventricle dimension ( = 0.008), more severe tricuspid regurgitation ( = 0.02) and lower mitral annular plane systolic excursion ( = 0.01).

Conclusions: Patients with severe secondary MR treated with the MitraClip achieved a significant reduction in symptoms and MR grade, as well as an improvement in QoL, as compared to patients treated conservatively.
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http://dx.doi.org/10.5114/aic.2018.78334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173086PMC
September 2018

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resources utilization.

Postepy Kardiol Interwencyjnej 2018 21;14(3):247-257. Epub 2018 Sep 21.

Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Kraków, Poland.

Introduction: Invasive coronary angiography (CAG), the 'gold standard' in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources.

Aim: To assess recent (throught out 10 years) evolution of 'significant' (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center.

Material And Methods: Anonymized medical records were compared for the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively ( < 0.001).

Results: The median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly ( < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 ( < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories.

Conclusions: Despite more advanced age and a higher proportion of subjects with 'any' coronary atherosclerosis on CAG, the likelihood of a 'negative' angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD.
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http://dx.doi.org/10.5114/aic.2018.78327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173087PMC
September 2018

Alarming decline in recognition of anatomical structures amongst medical students and physicians.

Ann Anat 2019 Jan 20;221:48-56. Epub 2018 Sep 20.

Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.

Background: Insufficient anatomical training can put patients' safety at risk. The aim of this study was to assess the proficiency of medical students and physicians in identifying labeled anatomical structures. The second aim of the study was to evaluate factors that can affect this recognition.

Methods: An internet-based survey where participants had to correctly identify labeled anatomical structures on cadaveric specimens was designed.

Results: The study group included 1186 participants (58.7% females): 931 medical students and 255 medical graduates from all twelve Polish medical schools. The mean total survey score for the entire study group was 65.6%. Students gained significantly higher results than graduates (total: 67.3% vs. 59.5%, P<0.001); 331 (27.9%) participants did not pass the test (<60). There was a correlation observed between points gained in this survey and grade obtained in the gross anatomy course (P<0.001). Multivariable logistic regression found that participation in cadaver laboratory classes most strongly increases anatomical competencies (OR=5.30, 95%CI=1.20-23.40, P=0.03). Other significant factors boosting anatomical proficiency were membership in students' scientific clubs, being male, and having a high grade (≥80%) in initial gross anatomy course. The time since anatomy course completion was negatively correlated with the total survey score (OR=0.86, 95%CI=0.81-0.92, P<0.001).

Conclusions: Anatomical knowledge of Polish medical students is moderate (<70%) and it significantly decreases with time. Anatomical structure recognition can be up to 25% lower in highly trained physicians when compared to pre-clinical medical students. This trend may be reversed by replacing subject-based anatomy courses with system-based (integrated) curricula at the undergraduate level or introducing short refresher anatomical courses during postgraduate training.
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http://dx.doi.org/10.1016/j.aanat.2018.09.004DOI Listing
January 2019

Coexistence and management of abdominal aortic aneurysm and coronary artery disease.

Cardiol J 2020 20;27(4):384-393. Epub 2018 Sep 20.

Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland.

Background: Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented.

Methods: 271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD.

Results: Significant coronary stenosis (> 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6-18.2, p < 0.001) and patients' age (OR = 1.1, 95% CI 1.0-1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p < 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2-70] vs. 7 [3-181] days, p = 0.007) and intensive care unit stay (1 [0-9] vs. 1 [0-70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms.

Conclusions: Patients with AAA might benefit from an early coronary artery evaluation strategy.
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http://dx.doi.org/10.5603/CJ.a2018.0101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016013PMC
September 2018

Blood Vessels and Myocardial Thickness within the Left Atrial Appendage Isthmus Line.

Clin Anat 2018 Oct 26;31(7):1024-1030. Epub 2018 Oct 26.

HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Electric isolation of the left atrial appendage (LAA) and linear ablations in the area of the LAA base are gaining popularity. However, very little is known about the myocardial architecture and the presence of epicardial blood vessels within this region, which could significantly influence the course of such procedures. We examined 200 autopsied hearts (22.5% females, 46.7 ± 16.8 years old). The LAA isthmus (i.e., the line between the LAA ostium and the mitral annulus) was cut longitudinally. The myocardium was thickest at the LAA end of the isthmus (2.4 ± 0.7 mm) followed by its middle sector (2.1 ± 0.7 mm) inside the LAA, 5 mm from its ostium (1.9 ± 0.7 mm), and the mitral annulus end of the isthmus (1.8 ± 0.6 mm) (P < 0.0001). At least one artery was found in 96.5% of all samples (89.5% were single branched, 7% had two branches). The great cardiac vein was found in 77.0% and the left marginal vein in 2.5%. The artery was interposed between the endocardium and the great cardiac vein in 31.5% of cases. The smallest distance between the endocardium and the artery was 0.5 mm and between the endocardium and the vein was 0.7 mm. In total, we were able to distinguish fifteen different types of vascular arrangements within the LAA isthmus line in this study. The myocardium within the LAA isthmus is thickest at its LAA end. The left circumflex coronary artery branches are the most frequently-occurring vessels within the isthmus and are present in almost all cases, while the great cardiac vein is present in three quarters of hearts. Clin. Anat. 31:1024-1030, 2018. © 2018 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23242DOI Listing
October 2018