Background: Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly which has potential for spontaneous rupture into other cardiac chambers or the pericardial space (depending on its location). A ruptured SVA has a very poor prognosis with high morbidity and mortality. The development of a shunt between the sinus of Valsalva and right-sided cardiac chambers results in a continuous murmur on examination. Our case report is a case of SVA rupture into the right atrium. Case presentation: In this case report, we describe a 23-year-old patient with an acute onset of chest pain, shortness of breath, palpitations and dizziness starting 2 days prior to presentation to the emergency department. The patient was initially treated for presumed pulmonary embolism overnight while awaiting CTPA the next morning. However, further examination by the inpatient medical team demonstrated a continuous machinery cardiac murmur. Subsequent echocardiography demonstrated an acutely ruptured SVA with shunting to the right atrium. Emergency surgical repair resulted in an excellent outcome for the patient. Conclusion: A thorough clinical history and physical examination is the cornerstone of all medical encounters. An SVA could be asymptomatic until acute rupture. Echocardiography is the preferred initial diagnostic tool. Additional imaging techniques can be used to confirm the diagnosis. In cases of rupture, prognosis is poor and surgical repair is always required.
Micro-ct scan images enhanced by iodine staining provide high-resolution visualisation of soft tissues in laboratory mice. We have compared Micro-ct scan-derived left ventricular (LV) mass with dissection and weighing. ex-vivo micro-ct scan images of the mouse hearts were obtained following staining by iodine. the LV was segmented and its volume was assessed using a semi-automated method by Drishti software. the left ventricle was then dissected in the laboratory and its actual weight was measured and compared against the estimated results. LV mass was calculated multiplying its estimated volume and myocardial specific gravity. Thirty-five iodine-stained post-natal mouse hearts were studied. Mice were of either sex and 68 to 352 days old (median age 202 days with interquartile range 103 to 245 days) at the time of sacrifice. Samples were from 20 genetically diverse strains. Median mouse body weight was 29 g with interquartile range 24 to 34 g. Left Ventricular weights ranged from 40.0 to 116.7 mg. The segmented LV mass estimated from micro-CT scan and directly measured dissected LV mass were strongly correlated (R 2 = 0. 97). Segmented LV mass derived from Micro-CT images was very similar to the physically dissected LV mass (mean difference = 0.09 mg; 95% confidence interval − 3.29 mg to 3.1 mg). Micro-CT scanning provides a non-destructive, efficient and accurate visualisation tool for anatomical analysis of animal heart models of human cardiovascular conditions. Iodine-stained soft tissue imaging empowers researchers to perform qualitative and quantitative assessment of the cardiac structures with preservation of the samples for future histological analysis. Left ventricular (LV) mass has been shown to be prognostic of cardiovascular morbidity and mortality irrespective of traditional risk factors 1-3. Estimation of LV mass can be performed by several imaging modalities including echocardiography, cardiac computerised tomography scan (CT scan) and cardiac magnetic resonance (CMR) 4. Echocardiography has been traditionally established as the most widely used diagnostic tool despite inherent limitations 4. CMR is accurate and without risks of radiation but its availability, cost and patient tolerance make it an unattractive tool for clinical use 5. Despite radiation and use of contrast agents, cardiac CT scan is another viable option for assessment of LV mass with high spatial resolution 6. Cardiac imaging in mice as opposed to humans poses problems that arise chiefly from their small size and fast heart rates 7. Variable results have been reported with CMR in mice 8-10 where fast heart rates pose a challenge and cost limits availability. Radiation exposure is not a significant impediment to studying mouse hearts but fast heart rates remain a challenge 11. Ex-vivo measurements of mouse tissue are more easily implemented and have been evaluated here.
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