Cardiac Radiographic Measurements in Ferrets Using the OsiriX MD Programme

Objectives: To adapt the vertebral heart scale (VHS) for use in ferrets and identify new scales and tools that allow to establish the normal heart size by means of radiography more quickly and effectively.Methods: Forty healthy pet ferrets (Mustela putorius furo) were used in this prospective study. The measurements were made on right lateral, left lateral, ventrodorsal, and dorsoventral projections, using OsiriX MD medical imaging software, to evaluate sex effect and variance within the different heart scales. Cardiac measurements were also correlated to VHS and the cardiac dimension in the same projection.Results: Most of the cardiac measurements were significantly different between males and females. The results for the VHS were: right lateral VHS (RL-VHS): 5.52 ± 0.28 v (vertebrae units); left lateral (LL-VHS): 5.55 ± 0.28 v; and dorsoventral VHS (DV-VHS): 6.22 ± 0.34 v for males and RL-VHS: 5.24 ± 0.2 v; LL-VHS: 5.25 ± 0.20 v; and DV-VHS: 5.97 ± 0.35 v for females. Regarding the sternebral heart scale (SHS), the values were: RL-SHS: 5.10 ± 0.20 s (sternebrae units) and LL-SHS: 5.11 ± 0.20 s for males and RL-SHS: 4.67 ± 0.24 s and LL-SHS: 4.67 ± 0.28 s for females. The new measurements based on determining the cardiac area were also marked by clear sexual dimorphism, as shown for the cardiac area-axis (AREA-AXIS): RL-AREA-AXIS: 3.82 ± 0.45 cm2; LL-AREA-AXIS: 3.87 ± 0.41 cm2; ventrodorsal (VD)-AREA-AXIS: 4.59 ± 0.64 cm2; and DV-AREA-AXIS: 4.80 ± 0.50 cm2 for males and RL-AREA-AXIS: 2.39 ± 0.23 cm2; LL-AREA-AXIS: 2.41 ± 0.26 cm2; VD-AREA-AXIS: 3.08 ± 0.45 cm2; and DV-AREA-AXIS: 3.06 ± 0.47 cm2 for females. The cardiac area open polygon (AREA-POL) values were: RL-AREA-POL: 6.78 ± 0.65 cm2; LL-AREA-POL: 6.88 ± 0.68 cm2; VD-AREA-POL: 7.20 ± 0.91 cm2; and DV-AREA-POL: 7.57 ± 0.88 cm2 for males and RL-AREA-POL: 4.28 ± 0.30 cm2; LL-AREA-POL: 4.35 ± 0.35 cm2; VD-AREA-POL: 4.72 ± 0.65 cm2; and DV-AREA-POL: 4.79 ± 0.66 cm2 for females, with similar differences noted from various radiographic projections. A good correlation was noted between VHS and SHS, and a very strongly positive correlation existed between cardiac area measurements and cardiac dimensions.Conclusion: The VHS adapted to ferrets, the SHS, as well as the cardiac area measurements presented in our study are ideal tools for the assessment of cardiac size in ferrets.

Aortic root prosthesis with pericardial cusps "Russian conduit": A hydrodynamic experiment

<p><strong>Aim.</strong> The study aimed to compare the hydrodynamic characteristics and durability of the aortic root prosthesis with pericardial cusps with various options for the formation of commissures.</p><p><strong>Methods.</strong> Nine conduits with pericardial valves were formed according to the technique described by Ozaki. The prostheses were divided into 3 groups of 3 specimens each: group 1 — without additional reinforcing seams on the top of the commissure; group 2 — with an additional U-shaped seam without gasket; and group 3 — with an additional suture with an opposite pericardial gasket. The prostheses were fixed on a stand for hydrodynamic testing of artificial heart valves. The hydrodynamic characteristics of the prostheses were evaluated. The hydrodynamics of the frame biological prosthesis was used for comparison. After assessing the hydrodynamic parameters of the aortic root prostheses, their work durability was tested. Defects of the pericardial cusps were studied macroscopically.</p><p><strong>Results. </strong>Two samples from group 2 were withdrawn from testing ahead of schedule at around 11 × 10⁶ cycles, which is approximately 3.5 months of normal heart function. The other prostheses remained competent and were removed for an examination at 32 × 10⁶ cycles, which is approximately 9.6 months of normal heart function.</p><p><strong>Conclusion. </strong>The hydrodynamics of the aortic root prosthesis with pericardial valves was comparable to the hydrodynamics of the frame biological prosthesis. Additional U-shaped sutures in the commissure area of the pericardial cusps did not increase the functional durability of the aortic root prosthesis with pericardial leaflets and served as additional risk factors for leaflet perforation. Implantation of pericardial leaflets into a vascular graft resulted in a different distribution of dynamic stress compared to the original aortic valve neocuspidisation, which preserved the aortic root.</p><p>Received 8 July 2021. Revised 30 August 2021. Accepted 7 September 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: V.V. Bazylev, P.A. Batrakov<br /> Data collection and analysis: P.A. Batrakov, D.M. Khadiev, A.A. Egorov, N.A. Eremin<br /> Drafting the article: P.A. Batrakov<br /> Critical revision of the article: V.V. Bazylev, P.A. Batrakov<br /> Final approval of the version to be published: V.V. Bazylev, P.A. Batrakov, D.M. Khadiev, A.A. Egorov, N.A. Eremin<strong> </strong></p>

Comparative Effectiveness of Virtual Reality (VR) vs 3D Printed Models of Congenital Heart Disease in Resident and Nurse Practitioner Educational Experience

Background: Medical trainees frequently note that cardiac anatomy is difficult to conceive within a two dimensional framework. The dynamics of flow and nuances of defects become more apparent when framed in three-dimensional models. Given the evidence of improved comprehension using such modeling, this study aimed to contribute further to that understanding by comparing Virtual Reality (VR) and 3D printed models (3DP) in medical education. Objectives: We sought to systematically compare the perceived subjective effectiveness of Virtual Reality (VR) and 3D printed models (3DP) in the educational experience of residents and nurse practitioners. Methods: Trainees and practitioners underwent individual 15-minute teaching sessions in which features of an anatomically normal heart as well as a congenitally diseased heart were demonstrated using both Virtual Reality (VR) and 3-D printed models (3DP). Participants then briefly explored each modality before filling out a short survey in which they identified which model (3DP or VR) they felt was more effective in enhancing their understanding of cardiac anatomy and associated defects. The survey included a binary summative assessment and a series of Likert scale questions addressing usefulness of each model type and degree of comfort with each modality. Results: 27 pediatric residents and 3 nurse practitioners explored models of normal heart and tetralogy of Fallot pathology. Participants endorsed a greater degree of understanding with VR models (8.5±1) compared with 3D Printed models (6.3±1.8) or traditional models of instruction (5.5±1.5) p<0.001. Most participants had minimal prior exposure to VR (1.1 ± 0.4) or 3-D printed models (2.1 ± 1.5). Most participants felt comfortable with modern technology (7.6 ± 2.1). 87% of participants preferred VR over 3DP. Conclusions: Our study shows that, overall, VR was preferred over 3DP models by pediatric residents and nurse practitioners for understanding cardiac anatomy and pathophysiology.

Extreme hyperthermia-induced arrhythmogenesis

Hyperthermia is defined as an elevated body temperature above the normal range due to a failure of heat regulatory mechanisms. In addition to its effects on other organ systems, hyperthermia is associated with profound cardiovascular effects. We report the sentinel case of a 6-year-old girl with structurally and electrically normal heart, who presented with life-threatening hyperpyrexia-induced ventricular tachycardia, which was refractory to cardioversion and anti-arrhythmics but responded promptly to cooling. We emphasise the lifesaving role of immediate and aggressive cooling in such patients.

Levoatrial Cardinal Vein: In two siblings with normal heart morphology

Levoatrial cardinal vein (LACV) is anomalous connection between the left atrium or pulmonary veins and any systemic vein which is derived from cardinal venous system. Presence of the levoatrial cardinal vein without a cardiac anomaly is a very rare congenital anomaly of the systemic venous return. In the literature, no LACV anomaly was found in two siblings who were asymptomatic and did not have an additional cardiac anomaly. Therefore, we present two cases ( two siblings ) the symptoms, diagnosis (the echocardiographic finding, computed tomography (CT) and aniographic images ) and treatment modalities of isolated levoatrial cardinal vein.