Liver stiffness increases rapidly after total cavopulmonary connection and perioperative variations in some liver enzymes appear to correlate with this change. Since a true anatomical damage is known to develop gradually with Fontan circulation, early liver stiffness raise is likely due to parenchymal congestion only. Fibro-Scan can easily recognize and assess the entity of such a change. For these reasons, this diagnostic tool must be considered useful only to monitor liver stiffness changes and evolution with time, but a conventional evaluation of results, like in other acquired hepatic fibrosis, can be misleading.
Introduction The Coaptation Triangle, or Tenting Area, can be identified on long‐axis 2D images. Its assessment is a routine practice during echocardiographic mitral evaluation. The Golden Proportion is a particular geometric ratio between two segments. Its value is an irrational number, commonly rounded to 0.618 and showing unique geometrical/mathematical properties. Interestingly, its presence has been documented in an extremely variable number of natural settings. Hypothesizing the presence of the Golden Proportion in normal mitral anatomy, we examined the Coaptation Triangle of healthy valves to investigate such a theory. Methods and Results A total of 41 healthy adults, with normal mitral valves, underwent 2D echocardiography. Adequate images were chosen and loaded into custom software. Firstly, the Coaptation Triangle was manually drawn by the operator. Then, a second Coaptation Triangle, with the same base, but based on Golden Proportion, was automatically built by the software. Eventually, the two triangles were analyzed and compared. All retrieved measurements were investigated for differences and correlations. Ratios close to the Golden Proportion were found in several locations of the manually drawn Coaptation Triangle. On the other hand, comparing the manually drawn Coaptation Triangle with the automatically built one, no significant differences were revealed, and very strong correlations were demonstrated. Conclusion The Golden Proportion appears present in the geometry of normal mitral valves. Studying such an aspect and identifying disruption in anatomical proportions could improve early diagnosis of mitral alterations, and allows a more standardized follow‐up and help surgeons to plan a repair strategy, particularly quantifying the needed surgical modifications.
Introduction The Golden Proportion is a particular geometric ratio between two segments. It results in an irrational number, commonly rounded to 1.618, or 0.618, and showing unique geometrical/mathematical properties. Its presence has been documented in a huge amount of natural settings, as well as the human body and the heart. In light of a previous research of ours, about its presence in the Coaptation Triangle, we investigated the dimensions of both mitral leaflets in healthy mitral valves and then compared our results to literature data, in order to search whether this proportional pattern could be extended to other valve aspects. Methods and Results Forty‐one adults, with healthy mitral valves, underwent 2D echocardiography. Adequate long‐axis three‐chamber view images were chosen, at mid‐diastole, where the central scallop of both the anterior and posterior leaflets (A2 and P2, respectively) could be well identified and measured. We then investigated these measurements, calculating their ratio and comparing our findings to literature data on normal mitral anatomy. The ratio between the two scallop heights appeared very close to the Golden Ratio. Literature data supported our results and, apparently, showed the mitral leaflets to be like a jigsaw puzzle of components highly interconnected each other with an extremely simple geometry, based on the Golden Proportion. Conclusion The Golden Proportion looks to determine the geometry of normal mitral scallops. Studying such a pattern of anatomical proportions could improve surgical techniques for conservative surgery, as well as innovate the design of mitral repair rings and valve prostheses.
B ecause congenital anomalies of the right side of the heart are often characterized by a wide spectrum of right ventricular outflow tract (RVOT) and pulmonary valve (PV) alterations, the RVOT and PV are frequently involved in pediatric cardiac surgery. Nevertheless, the PV remained neglected for a very long time; it has gained consideration only in recent years.The first surgical corrections involved ventricular septal defect (VSD) closure and RVOT enlargement with a simple transannular patch, without attention to the PV. Emphasis on short-term results led incorrectly to the idea that the PV had no significance. The belief that "no valve is better than a stenotic valve" induced surgeons to leave many RVOTs unvalved.1-3 When long-term follow-up results became available, it became clear that unvalved patients could develop pulmonary artery dilation and right ventricular (RV) failure, 4-7 which led to additional valve procedures. A new idea-that "a working valve is better than no valve"-then arose, and valve preservation gradually became a must in tetrology of Fallot (TOF) treatment. For this reason, much surgical effort in dealing with an altered RVOT is today directed toward sparing the valve whenever possible. 3,8,9 Unfortunately, valve-sparing is often difficult and sometimes impossible. When the valve is atretic or very narrow, there is no doubt that the only solution is a transannular patch.10 On the other hand, when pulmonary diameter is acceptable or good, the valve often presents alterations: it is bicuspid, has leaflet tethering, leaflet thickening, commissural fusion, etc. 11,12 Repairing the valve is not as easy as it sounds. When the anatomic defects are substantial, the results of repair can be unsatisfactory or outright
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