Commenced in January 2007
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Edition: International
Paper Count: 23

Search results for: atrium

23 Research on Natural Lighting Design of Atriums Based on Energy-Saving Aim

Authors: Fan Yu


An atrium is a place for natural climate exchanging of indoor and outdoor space of buildings, which plays an active role in the overall energy conservation, climate control and environmental purification of buildings. Its greatest contribution is serving as a natural light collector and distributor to solve the problem of natural lighting in large and deep spaces. However, in real situations, the atrium space often results in energy consumption due to improper design in considering its big size and large amount use of glass. Based on the purpose of energy conservation of buildings, this paper emphasizes the significance of natural lighting of atriums. Through literature research, case analysis and other methods, four factors, namely: the light transmittance through the top of the atrium, the geometric proportion of the atrium space, the size and position of windows and the material of the surface of walls in the atrium, were studied, and the influence of different architectural compositions on the natural light distribution of the atrium is discussed. Relying on the analysis of relevant cases, it is proposed that when designing the natural lighting of the atrium, the height and width of the atrium should be paid attention to, the atrium walls are required being rough surfaces and the atrium top-level windows need to be minimized in order to introduce more natural light into the buildings and achieve the purpose of energy conservation.

Keywords: energy conservation, atrium, natural lighting, architectural design

Procedia PDF Downloads 39
22 Improvement of Ventilation and Thermal Comfort Using the Atrium Design for Traditional Folk Houses-Fujian Earthen Building

Authors: Ying-Ming Su


Fujian earthen building which was known as a classic for ecological buildings was listed on the world heritage in 2008 (UNESCO) in China. Its design strategy can be applied to modern architecture planning and design. This study chose two different cases (Round Atrium: Er-Yi Building, Double Round Atrium: Zhen-Chen Building) of earthen building in Fu-Jian to compare the ventilation effects of different atrium forms. We adopt field measurements and computational fluid dynamics (CFD) simulation of temperature, humidity, and wind environment to identify the relationship between external environment and atrium about comfort and to confirm the relationship about atrium H/W (height/width). Results indicate that, through the atrium convection effect, it makes the natural wind guides to each space surrounded and keeps indoor comfort. It illustrates that the smaller the ratio of the H/W which is the relationship between the height and the width of an atrium is, the greater the wind speed generated within the street valley. Moreover, the wind speed is very close to the reference wind speed. This field measurement verifies that the value of H/W has great influence of solar radiation heat and sunshine shadows. The ventilation efficiency is: Er-Yi Building (H/W =0.2778) > Zhen-Chen Building (H/W=0.3670). Comparing the cases with the same shape but with different H/W, through the different size patios, airflow revolves in the atriums and can be brought into each interior space. The atrium settings meet the need of building ventilation, and can adjust the humidity and temperature within the buildings. It also creates good ventilation effect.

Keywords: traditional folk houses, atrium, tulou, ventilation, building microclimate

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21 Pulmonary Embolism Indicative of Myxoma of the Right Atrium

Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal


Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: pulmonary embolism, myxoma, right atrium, heart tumors

Procedia PDF Downloads 21
20 Human Coronary Sinus Venous System as a Target for Clinical Procedures

Authors: Wiesława Klimek-Piotrowska, Mateusz K. Hołda, Mateusz Koziej, Katarzyna Piątek, Jakub Hołda


Introduction: The coronary sinus venous system (CSVS), which has always been overshadowed by the coronary arterial tree, has recently begun to attract more attention. Since it is a target for clinicians the knowledge of its anatomy is essential. Cardiac resynchronization therapy, catheter ablation of cardiac arrhythmias, defibrillation, perfusion therapy, mitral valve annuloplasty, targeted drug delivery, and retrograde cardioplegia administration are commonly used therapeutic methods involving the CSVS. The great variability in the course of coronary veins and tributaries makes the diagnostic and therapeutic processes difficult. Our aim was to investigate detailed anatomy of most common clinically used CSVS`s structures: the coronary sinus with its ostium, great cardiac vein, posterior vein of the left ventricle, middle cardiac vein and oblique vein of the left atrium. Methodology: This is a prospective study of 70 randomly selected autopsied hearts dissected from adult humans (Caucasian) aged 50.1±17.6 years old (24.3% females) with BMI=27.6±6.7 kg/m2. The morphology of the CSVS was assessed as well as its precise measurements were performed. Results: The coronary sinus (CS) with its ostium was present in all hearts. The mean CS ostium diameter was 9.9±2.5mm. Considered ostium was covered by its valve in 87.1% with mean valve height amounted 5.1±3.1mm. The mean percentage coverage of the CS ostium by the valve was 56%. The Vieussens valve was present in 71.4% and was unicuspid in 70%, bicuspid in 26% and tricuspid in 4% of hearts. The great cardiac vein was present in all cases. The oblique vein of the left atrium was observed in 84.3% of hearts with mean length amounted 20.2±9.3mm and mean ostium diameter 1.4±0.9mm. The average length of the CS (from the CS ostium to the Vieussens valve) was 31.1±9.5mm or (from the CS ostium to the ostium of the oblique vein of the left atrium) 28.9±10.1mm and both were correlated with the heart weight (r=0.47; p=0.00 and r=0.38; p=0.006 respectively). In 90.5% the ostium of the oblique vein of the left atrium was located proximally to the Vieussens valve, in remaining cases was distally. The middle cardiac vein was present in all hearts and its valve was noticed in more than half of all the cases (52.9%). The posterior vein of the left ventricle was observed in 91.4% of cases. Conclusions: The CSVS is vastly variable and none of basic hearts parameters is a good predictor of its morphology. The Vieussens valve could be a significant obstacle during CS cannulation. Caution should be exercised in this area to avoid coronary sinus perforation. Because of the higher incidence of the presence of the oblique vein of the left atrium than the Vieussens valve, the vein orifice is more useful in determining the CS length.

Keywords: cardiac resynchronization therapy, coronary sinus, Thebesian valve, Vieussens valve

Procedia PDF Downloads 191
19 The Prodomain-Bound Form of Bone Morphogenetic Protein 10 is Biologically Active on Endothelial Cells

Authors: Austin Jiang, Richard M. Salmon, Nicholas W. Morrell, Wei Li


BMP10 is highly expressed in the developing heart and plays essential roles in cardiogenesis. BMP10 deletion in mice results in embryonic lethality due to impaired cardiac development. In adults, BMP10 expression is restricted to the right atrium, though ventricular hypertrophy is accompanied by increased BMP10 expression in a rat hypertension model. However, reports of BMP10 activity in the circulation are inconclusive. In particular it is not known whether in vivo secreted BMP10 is active or whether additional factors are required to achieve its bioactivity. It has been shown that high-affinity binding of the BMP10 prodomain to the mature ligand inhibits BMP10 signaling activity in C2C12 cells, and it was proposed that prodomain-bound BMP10 (pBMP10) complex is latent. In this study, we demonstrated that the BMP10 prodomain did not inhibit BMP10 signaling activity in multiple endothelial cells, and that recombinant human pBMP10 complex, expressed in mammalian cells and purified under native conditions, was fully active. In addition, both BMP10 in human plasma and BMP10 secreted from the mouse right atrium were fully active. Finally, we confirmed that active BMP10 secreted from mouse right atrium was in the prodomain-bound form. Our data suggest that circulating BMP10 in adults is fully active and that the reported vascular quiescence function of BMP10 in vivo is due to the direct activity of pBMP10 and does not require an additional activation step. Moreover, being an active ligand, recombinant pBMP10 may have therapeutic potential as an endothelial-selective BMP ligand, in conditions characterized by loss of BMP9/10 signaling.

Keywords: bone morphogenetic protein 10 (BMP10), endothelial cell, signal transduction, transforming growth factor beta (TGF-B)

Procedia PDF Downloads 163
18 Research on Renovation of Existing Interior Space Based on Post Occupancy Evaluation: A Case Study of the Atrium Space of Zhejiang University Library in Hangzhou

Authors: Qin Dai


The renovation of existing interior space is big issue for architects in today’s China. However the traditional way of space renovation in China mostly focuses on the object itself, and the method also focuses on subjective level without the support of specific data. This research focuses the application of renovation of existing interior space based on post occupancy evaluation by a case study of a typical interior space. The research hopes to give a more scientific method of interior space renovation for architects and help promoting and guiding renovation practice. This research studies the post occupancy evaluation of the atrium space of Zhejiang University Library including subjective satisfaction and physical environmental satisfaction. The result provides necessary data support to conclude the design principles and strategies of renovation. Then the research uses simulation software to verify the availability of the strategy given based on the study. In conclusion, the research summarizes the application process of design methods of renovation of existing interior space based on the post-occupancy evaluation, and testifies to the practical significance of the renovation of existing interior space.

Keywords: existing interior space, physical environmental satisfaction, post occupancy evaluation, renovation of space, subjective satisfaction of space

Procedia PDF Downloads 133
17 Healing Architecture and Evidence Based Design: An Interior Design Example in Medicana KızıLtoprak Hospital

Authors: Yunus Emre Kara, Atilla Kuzu, Levent Cirpici


Recently, in the interior design of hospitals, the effect of the physical environment on the healing process has been frequently emphasized, and the importance of psychological and behavioral factors has increased day by day. When designing new hospital interiors, it became important to create spaces that not only meet medical requirements but also support the healing process of patients with interior design. In this study, the patient rooms, corridor, atrium area, waiting area, and entrance counter in a hospital were handled with patient-centered design, evidence-based design, and remedial architectural approaches, and it was seen that the healing and reassuring elements in hospitals were extremely important.

Keywords: evidence based design, healing architecture, hospital, organic design, parametric design

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16 Health Care Provider Perception of Training and Simulation Effectiveness in Preparation for an Expanded Labor and Delivery Service Line

Authors: JaNae Joyner, Josh Nitsche, Stacy Schmauss, Maria Crawford, Carty Beaston, Louise Nixon, Alisa Starbuck


Introduction: The 2019 opening of an expanded labor and delivery service line at Atrium Health Wake Forest Baptist Medical Center was a herculean mission involving stakeholder groups for many institutional departments. For many months, a number of subgroups met, working in their respective areas of influence and expertise, to prepare for the facilities, technology, staffing, workflow, and training needs to guarantee day-one readiness for this Birth Center. The Center for Experiential and Applied Learning (CEAL), a hands-on simulation center internal to Atrium Health Wake Forest Baptist through our Wake Forest School of Medicine, was part of the training initiative. Objective: The objective of this study is to evaluate the perception of training and simulation effectiveness in preparing stakeholders, including women’s health care providers, for the opening of the Birth Center. Methods: Surveys were distributed to newly hired health care providers including nurses after the Birth Center opening. A survey design was used to evaluate the effectiveness of the training given to health care providers. This survey included 5-point Likert questions and qualitative opportunities to discuss lessons learned. Results: The training effectiveness quantitative survey (n=62) found that 81% of respondents indicated that simulation training was the most useful training tool they encountered in preparing them for their role or job in the Birth Center. This was compared to other training modalities utilized during the Birth Center opening which included on-the-job training (61% useful), preceptorship (57%), mentoring/coaching (56%), classroom/didactics (55%), and online modules (47%). When evaluating whether or not the training received had prepared providers for the healthcare role they were to serve once the Birth Center opened, the majority (72%) felt fully equipped while 27% did not. Of those who did not feel well-equipped, additional mentoring/coaching (25%), on-the-job training (25%), mentoring/coaching (25%), preceptor opportunities (21%); simulation training (13%); and classroom instruction (12%) were requested. The quantitative data was supported by qualitative comments and themes including the need for more hands-on training and simulation, as well as on-the-job training/preceptorships. Conclusions: Altogether, this data indicates that most Birth Center providers felt prepared for their role in the Birth Center when it opened. Simulation training was seen as an effective tool in preparing these providers. However, additional training, especially those involving one-on-one learning, should be considered when undertaking a highly specialized service line stand-up.

Keywords: labor and delivery, OBGYN, simulation, training

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15 Evaluation of Cryoablation Procedures in Treatment of Atrial Fibrillation from 3 Years' Experiences in a Single Heart Center

Authors: J. Yan, B. Pieper, B. Bucsky, B. Nasseri, S. Klotz, H. H. Sievers, S. Mohamed


Cryoablation is evermore applied for interventional treatment of paroxysmal (PAAF) or persistent atrial fibrillation (PEAF). In the cardiac surgery, this procedure is often combined with coronary arterial bypass graft (CABG) and valve operations. Three different methods are feasible in this sense in respect to practicing extents and mechanisms such as lone left atrial cryoablation, Cox-Maze IV and III in our heart center. 415 patients (68 ± 0.8ys, male 68.2%) with predisposed atrial fibrillation who initially required either coronary or valve operations were enrolled and divided into 3 matched groups according to deployed procedures: CryoLA-group (cryoablation of lone left atrium, n=94); Cox-Maze-IV-group (n=93) and Cox-Maze-III-group (n=8). All patients additionally received closure of the left atrial appendage (LAA) and regularly underwent three-year ambulant follow-up assessments (3, 6, 9, 12, 18, 24, 30 and 36 months). Burdens of atrial fibrillation were assessed directly by means of cardiac monitor (Reveal XT, Medtronic) or of 3-day Holter electrocardiogram. Herewith, attacks frequencies of AF and their circadian patterns were systemically analyzed. Furthermore, anticoagulants and regular rate-/rhythm-controlling medications were evaluated and listed in terms of anti-rate and anti-rhythm regimens. Concerning PAAF treatment, Cox Maze IV procedure provided therapeutically acceptable effect as lone left atrium (LA) cryoablation did (5.25 ± 5.25% vs. 10.39 ± 9.96% AF-burden, p > 0.05). Interestingly, Cox Maze III method presented a better short-term effect in the PEAF therapy in comparison to lone cryoablation of LA and Cox Maze IV (0.25 ± 0.23% vs. 15.31 ± 5.99% and 9.10 ± 3.73% AF-burden within the first year, p < 0.05). But this therapeutic advantage went lost during ongoing follow-ups (26.65 ± 24.50% vs. 8.33 ± 8.06% and 15.73 ± 5.88% in 3rd follow-up year). In this way, lone LA-cryoablation established its antiarrhythmic efficacy and 69.5% patients were released from the Vit-K-antagonists, while Cox Maze IV liberated 67.2% patients from continuous anticoagulant medication. The AF-recurrences mostly performed such attacks property as less than 60min duration for all 3 procedures (p > 0.05). In the sense of the circadian distribution of the recurrence attacks, weighted by ongoing follow-ups, lone LA cryoablation achieved and stabilized the antiarrhythmic effects over time, which was especially observed in the treatment of PEAF, while Cox Maze IV and III had their antiarrhythmic effects weakened progressively. This phenomenon was likewise evaluable in the therapy of circadian rhythm of reverting AF-attacks. Furthermore, the strategy of rate control was much more often applied to support and maintain therapeutic successes obtained than the one of rhythm control. Derived from experiences in our heart center, lone LA cryoablation presented equivalent effects in the treatment of AF in comparison to Cox Maze IV and III procedures. These therapeutic successes were especially investigable in the patients suffering from persistent AF (PEAF). Additional supportive strategies such as rate control regime should be initialized and implemented to improve the therapeutic effects of the cryoablations according to appropriate criteria.

Keywords: AF-burden, atrial fibrillation, cardiac monitor, COX MAZE, cryoablation, Holter, LAA

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14 Case Report of Left Atrial Myxoma Diagnosed by Bedside Echocardiography

Authors: Anthony S. Machi, Joseph Minardi


We present a case report of left atrial myxoma diagnosed by bedside transesophageal (TEE) ultrasound. Left atrial myxoma is the most common benign cardiac tumor and can obstruct blood flow and cause valvular insufficiency. Common symptoms consist of dyspnea, pulmonary edema and other features of left heart failure in addition to thrombus release in the form of tumor fragments. The availability of bedside ultrasound equipment is essential for the quick diagnosis and treatment of various emergency conditions including cardiac neoplasms. A 48-year-old Caucasian female with a four-year history of an untreated renal mass and anemia presented to the ED with two months of sharp, intermittent, bilateral flank pain radiating into the abdomen. She also reported intermittent vomiting and constipation along with generalized body aches, night sweats, and 100-pound weight loss over last year. She had a CT in 2013 showing a 3 cm left renal mass and a second CT in April 2016 showing a 3.8 cm left renal mass along with a past medical history of diverticulosis, chronic bronchitis, dyspnea on exertion, uncontrolled hypertension, and hyperlipidemia. Her maternal family history is positive for breast cancer, hypertension, and Type II Diabetes. Her paternal family history is positive for stroke. She was a current everyday smoker with an 11 pack/year history. Alcohol and drug use were denied. Physical exam was notable for a Grade II/IV systolic murmur at the right upper sternal border, dyspnea on exertion without angina, and a tender left lower quadrant. Her vitals and labs were notable for a blood pressure of 144/96, heart rate of 96 beats per minute, pulse oximetry of 96%, hemoglobin of 7.6 g/dL, hypokalemia, hypochloremia, and multiple other abnormalities. Physicians ordered a CT to evaluate her flank pain which revealed a 7.2 x 8.9 x 10.5 cm mixed cystic/solid mass in the lower pole of the left kidney and a filling defect in the left atrium. Bedside TEE was ordered to follow up on the filling defect. TEE reported an ejection fraction of 60-65% and visualized a mobile 6 x 3 cm mass in the left atrium attached to the interatrial septum extending into the mitral valve. Cardiothoracic Surgery and Urology were consulted and confirmed a diagnosis of left atrial myxoma and clear cell renal cell carcinoma. The patient returned a week later due to worsening nausea and vomiting and underwent emergent nephrectomy, lymph node dissection, and colostomy due to a necrotic colon. Her condition declined over the next four months due to lung and brain metastases, infections, and other complications until she passed away.

Keywords: bedside ultrasound, echocardiography, emergency medicine, left atrial myxoma

Procedia PDF Downloads 224
13 The Enlightenment of the Ventilation System in Chinese Traditional Residence to Architecture Design

Authors: Wu Xingchun, Chen Xi


Nowadays, China's building energy consumption constitutes 25% of the total energy consumption, half of which was caused by air conditioning in both summer and winter. The ventilation system in Chinese traditional residence, which is totally passive and environmentally friendly, works effectively to create comfortable indoor environment. The research on the ventilation system in Chinese traditional residence can provide advancements to architecture design and energy savings to the society. Through field investigation, case analysis, strategy proposing and other methods, it comes out that the location and layout, the structure system and the design of atrium are the most important elements for a good ventilation system. Taking every factor into consideration, techniques are deployed extensively such as the organization of draught, the design of the thermal pressure ventilation system and the application of modern materials. With the enlightenment of the ventilation system in Chinese traditional residence, we can take effective measures to achieve low energy consumption and sustainable architecture.

Keywords: ventilation system, chinese traditional residence, energy consumption, sustainable architecture

Procedia PDF Downloads 570
12 Roof Integrated Photo Voltaic with Air Collection on Glasgow School of Art Campus Building: A Feasibility Study

Authors: Rosalie Menon, Angela Reid


Building integrated photovoltaic systems with air collectors (hybrid PV-T) have proved successful however there are few examples of their application in the UK. The opportunity to pull heat from behind the PV system to contribute to a building’s heating system is an efficient use of waste energy and its potential to improve the performance of the PV array is well documented. As part of Glasgow School of Art’s estate expansion, the purchase and redevelopment of an existing 1950’s college building was used as a testing vehicle for the hybrid PV-T system as an integrated element of the upper floor and roof. The primary objective of the feasibility study was to determine if hybrid PV-T was technically and financially suitable for the refurbished building. The key consideration was whether the heat recovered from the PV panels (to increase the electrical efficiency) can be usefully deployed as a heat source within the building. Dynamic thermal modelling (IES) and RetScreen Software were used to carry out the feasibility study not only to simulate overshadowing and optimise the PV-T locations but also to predict the atrium temperature profile; predict the air load for the proposed new 4 No. roof mounted air handling units and to predict the dynamic electrical efficiency of the PV element. The feasibility study demonstrates that there is an energy reduction and carbon saving to be achieved with each hybrid PV-T option however the systems are subject to lengthy payback periods and highlights the need for enhanced government subsidy schemes to reward innovation with this technology in the UK.

Keywords: building integrated, photovoltatic thermal, pre-heat air, ventilation

Procedia PDF Downloads 53
11 Prenatal Development of Heart and Great Vessels in Buffalo (Bubalus bubalis)

Authors: Anuradha Gupta, Neelam Bansal, Varinder Uppal


The present investigation was made on 35 Indian buffalo fetuses ranging from 0.9 cm to 104 cm curved crown rump length (CVRL). The gross anatomical study revealed that all structures were developed at 13 cm CVRL (87 days) in group I. At 0.9 cm CVRL (32 days) the heart was unseptated and tubular and was clearly divided into common atrial chamber dorsally and primitive ventricle in 1.2 cm CVRL fetus (34 days). Septum primum appeared at 1.9 cm CVRL (37 days), truncal ridges at 2.5 cm CVRL (39 days) and foramen ovale in 3.0 cm CVRL (42 days) buffalo foetuses. At 7.6 cm CVRL (62 days) endocardial cushions fused to form left and right atrioventricular openings and four chambered heart was formed in 8.7 cm CVRL (66 days). Endocardium and epicardium was thicker in atria as compared to ventricles in all the age groups. Myocardium of atria was thin as compared to ventricles in all the age groups and was loosely arranged. Immature hyaline cartilage was first appeared at base of aorta in 62 cm CVRL (213 days) fetuses. Intercalated discs were seen in group III and aorta, pulmonary artery, coronary artery were well appreciated in 3.2 cm CVRL (43 days). Neutral and acid mucopolysaccharides were comparatively more in atria than ventricles. Basic proteins showed strong reaction in atrium and ventricle, and intense in conduction system. Lipids and phospholipids were more in myocardium and conduction system than endocardium and epicardium. All the histochemical moieties were comparatively more in tunica intima than media and adventitia of all the great vessels of heart.

Keywords: buffalo, fetal development, histochemistry, heart

Procedia PDF Downloads 143
10 Shared Heart with a Common Atrial Complex and Persistent Right Dorsal Aorta in Conjoined Twins

Authors: L. C. Prasanna, Antony Sylvan D’Souza, Kumar M. R. Bhat


Although life as a conjoined twin would seem intolerable, there has recently been an increased interest in this subject because of the increasing number of cases where attempts have been made to separate them surgically. We have reviewed articles on cardiovascular anomalies in conjoined twins and presenting rarest anomaly in dicephalus parapagus fetus having two heads attached to one body from the neck or upper chest downwards, with a pair of limbs and a set of reproductive organs. Both the twins shared a common thoracic cavity with a single sternum. When the thoracic cavity was opened, a common anterior mediastinum was found. On opening the pericardium, two separate, closely apposed hearts were exposed. The two cardia are placed side by side. The left heart was slightly larger than the right and were joined at the atrial levels. Four atrial appendages were present, two for each twin. The atrial complex was a common chamber posterior to the ventricles. A single large tributary which could be taken as inferior vena cava drains into the common atrial chamber. In this case, the heart could not be assigned to either twin and therefore, it is referred to as the shared heart within a common pericardial sac. The right and left descending thoracic aorta have joined with each other just above the diaphragm to form a common descending thoracic aorta which has an opening in the diaphragm to be continued as common abdominal aorta which has a normal branching pattern. Upon an interior dissection, it is observed that the two atria have a wide communication which could be a wide patent foramen ovale and this common atrial cavity has a communication with a remnant of a possible common sinus venosus.

Keywords: atrium, congenital anomaly, conjoined twin, sinus venosus

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9 3D-printing for Ablation Planning in Patients Undergoing Atrial Fibrillation Ablation: 3D-GALA Trial

Authors: Terentes Printzios Dimitrios, Loanna Gourgouli, Vlachopoulos Charalambos


Aims: Atrial fibrillation (AF) remains one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity. Ablation techniques are becoming more appealing after the latest results of randomized trials showing the overall clinical benefit. On the other hand, imaging techniques and the frontier application of 3D printing are emerging as a valuable ally for cardiac procedures. However, no randomized trial has directly assessed the impact of preprocedural imaging and especially 3D printing guidance for AF ablation. The present study is designed to investigate for the first time the effect of 3D printing of the heart on the safety and effectiveness of the ablation procedure. Methods and design: The 3D-GALA trial is a randomized, open-label, controlled, multicentre clinical trial of 2 parallel groups designed to enroll a total of 100 patients undergoing ablation using cryo-balloon for paroxysmal and persistent AF. Patients will be randomized with a patient allocation ratio of 1: 1 to preprocedural MRI scan of the heart and 3D printing of left atrium and pulmonary veins and cryoablation versus standard cryoablation without imaging. Patients will be followed up to 6 months after the index procedure. The primary outcome measure is the reduction of radiation dose and contrast amount during pulmonary veins isolation. Secondary endpoints will include the percentage of atrial fibrillation relapse at 24h-Holter electrocardiogram monitoring at 6 months after initial treatment. Discussion: To our knowledge, the 3D-GALA trial will be the first study to provide evidence about the clinical impact of preprocedural imaging and 3D printing before cryoablation.

Keywords: atrial fibrillation, cardiac MRI, cryoablation, 3-d printing

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8 Quantitative Evaluation of Mitral Regurgitation by Using Color Doppler Ultrasound

Authors: Shang-Yu Chiang, Yu-Shan Tsai, Shih-Hsien Sung, Chung-Ming Lo


Mitral regurgitation (MR) is a heart disorder which the mitral valve does not close properly when the heart pumps out blood. MR is the most common form of valvular heart disease in the adult population. The diagnostic echocardiographic finding of MR is straightforward due to the well-known clinical evidence. In the determination of MR severity, quantification of sonographic findings would be useful for clinical decision making. Clinically, the vena contracta is a standard for MR evaluation. Vena contracta is the point in a blood stream where the diameter of the stream is the least, and the velocity is the maximum. The quantification of vena contracta, i.e. the vena contracta width (VCW) at mitral valve, can be a numeric measurement for severity assessment. However, manually delineating the VCW may not accurate enough. The result highly depends on the operator experience. Therefore, this study proposed an automatic method to quantify VCW to evaluate MR severity. Based on color Doppler ultrasound, VCW can be observed from the blood flows to the probe as the appearance of red or yellow area. The corresponding brightness represents the value of the flow rate. In the experiment, colors were firstly transformed into HSV (hue, saturation and value) to be closely align with the way human vision perceives red and yellow. Using ellipse to fit the high flow rate area in left atrium, the angle between the mitral valve and the ultrasound probe was calculated to get the vertical shortest diameter as the VCW. Taking the manual measurement as the standard, the method achieved only 0.02 (0.38 vs. 0.36) to 0.03 (0.42 vs. 0.45) cm differences. The result showed that the proposed automatic VCW extraction can be efficient and accurate for clinical use. The process also has the potential to reduce intra- or inter-observer variability at measuring subtle distances.

Keywords: mitral regurgitation, vena contracta, color doppler, image processing

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7 The Efficacy of Box Lesion+ Procedure in Patients with Atrial Fibrillation: Two-Year Follow-up Results

Authors: Oleg Sapelnikov, Ruslan Latypov, Darina Ardus, Samvel Aivazian, Andrey Shiryaev, Renat Akchurin


OBJECTIVE: MAZE procedure is one of the most effective surgical methods in atrial fibrillation (AF) treatment. Nowadays we are all aware of its modifications. In our study we conducted clinical analysis of “Box lesion+” approach during MAZE procedure in two-year follow-up. METHODS: We studied the results of the open-heart on-pump procedures performed in our hospital from 2017 to 2018 years. Thirty-two (32) patients with atrial fibrillation (AF) were included in this study. Fifteen (15) patients had concomitant coronary bypass grafting and seventeen (17) patients had mitral valve repair. Mean age was 62.3±8.7 years; prevalence of men was admitted (56.1%). Mean duration of AF was 4.75±5.44 and 7.07±8.14 years. In all cases, we performed endocardial Cryo-MAZE procedure with one-time myocardium revascularization or mitral-valve surgery. All patients of this study underwent pulmonary vein (PV) isolation and ablation of mitral isthmus with additional isolation of LA posterior wall (Box-lesion+ procedure). Mean follow-up was 2 years. RESULTS: All cases were performed without any complications. Additional isolation of posterior wall did not prolong the operative time and artificial circulation significantly. Cryo-MAZE procedure directly lasted 20±2.1 min, the whole operation time was 192±24 min and artificial circulation time was 103±12 min. According to design of the study, we performed clinical investigation of the patients in 12 months and in 2 years from the initial procedure. In 12 months, the number of AF free patients 81.8% and 75.8% in two years of follow-up. CONCLUSIONS: Isolation of the left atrial posterior wall and perimitral area may considerably improve the efficacy of surgical treatment, which was demonstrated in significant decrease of AF recurrences during the whole period of follow-up.

Keywords: atrial fibrillation, cryoablation, left atrium isolation, open heart procedure

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6 Gross Morphological Study on Heart of Yellow Bellied Sea Snake

Authors: Jonnalagadda Naveen, M. P. S. Tomar, Putluru Satish, Palanisamy Dharani


Present investigation was carried out on a single specimen of the heart of yellow-bellied sea snake, which accidentally came to the seashore with the fisherman’s net. After the death, these specimens was preserved in 10% neutral buffered formalin and observe for its morphology. The literature cited revealed that meager information was available on the anatomy of the heart of this species of snake thus present study was planned on the gross anatomy of the heart of yellow-bellied sea snake. The heart of yellow-bellied sea snake was located between 28-35th rib in an oblique direction in the pericardial sac. It was three chambered with the complete division of atria but the ventricular cavity was incompletely divided. The apex did not show any gubernaculum cordis. The sinus venosus was the common cavity for confluence of anterior and posterior vana cava and the jugular vein was opened with anterior vena cava. The opening of posterior vena cava was slit-like and it was guarded by membranous valves whereas no valve could be observed at the opening of anterior vana cava and the jugular vein. Both the caval veins ran along the right border of the heart. Pulmonary vein was single which later divided into two branches. The length-width index for the atria was 1.33 whereas it was 1.67 for the ventricle. The atrioventricular canal was situated slightly towards the left of the midline of the heart and was divided into a right cavum pulmonale and left cavum arteriosum of which the right one was slightly larger and longer than the left. The cavum venosum was present in between the cavum pulmonale and the cavum arteriosum. The Ventricle was elongated triangle muscular compartment with ventrally located apex. Internally the cavity of ventricle was divided into two partial chambers dorsally by a muscular ridge and ventrally by an incomplete inter ventricular septum.

Keywords: aorta, atrium, heart, sea snake, sinus venosus, ventricle

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5 Construction Strategy of Urban Public Space in Driverless Era

Authors: Yang Ye, Hongfei Qiu, Yaqi Li


The planning and construction of traditional cities are oriented by cars, which leads to the problems of insufficient urban public space, fragmentation, and low utilization efficiency. With the development of driverless technology, the urban structure will change from the traditional single-core grid structure to the multi-core model. In terms of traffic organization, with the release of land for traffic facilities, public space will become more continuous and integrated with traffic space. In the context of driverless technology, urban public reconstruction is characterized by modularization and high efficiency, and its planning and layout features accord with points (service facilities), lines (smart lines), surfaces (activity centers). The public space of driverless urban roads will provide diversified urban public facilities and services. The intensive urban layout makes the commercial public space realize the functions of central activities and style display, respectively, in the interior (building atrium) and the exterior (building periphery). In addition to recreation function, urban green space can also utilize underground parking space to realize efficient dispatching of shared cars. The roads inside the residential community will be integrated into the urban landscape, providing conditions for the community public activity space with changing time sequence and improving the efficiency of space utilization. The intervention of driverless technology will change the thinking of traditional urban construction and turn it into a human-oriented one. As a result, urban public space will be richer, more connected, more efficient, and the urban space justice will be optimized. By summarizing the frontier research, this paper discusses the impact of unmanned driving on cities, especially urban public space, which is beneficial for landscape architects to cope with the future development and changes of the industry and provides a reference for the related research and practice.

Keywords: driverless, urban public space, construction strategy, urban design

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4 Tracking the Effect of Ibutilide on Amplitude and Frequency of Fibrillatory Intracardiac Electrograms Using the Regression Analysis

Authors: H. Hajimolahoseini, J. Hashemi, D. Redfearn


Background: Catheter ablation is an effective therapy for symptomatic atrial fibrillation (AF). The intracardiac electrocardiogram (IEGM) collected during this procedure contains precious information that has not been explored to its full capacity. Novel processing techniques allow looking at these recordings from different perspectives which can lead to improved therapeutic approaches. In our previous study, we showed that variation in amplitude measured through Shannon Entropy could be used as an AF recurrence risk stratification factor in patients who received Ibutilide before the electrograms were recorded. The aim of this study is to further investigate the effect of Ibutilide on characteristics of the recorded signals from the left atrium (LA) of a patient with persistent AF before and after administration of the drug. Methods: The IEGMs collected from different intra-atrial sites of 12 patients were studied and compared before and after Ibutilide administration. First, the before and after Ibutilide IEGMs that were recorded within a Euclidian distance of 3 mm in LA were selected as pairs for comparison. For every selected pair of IEGMs, the Probability Distribution Function (PDF) of the amplitude in time domain and magnitude in frequency domain was estimated using the regression analysis. The PDF represents the relative likelihood of a variable falling within a specific range of values. Results: Our observations showed that in time domain, the PDF of amplitudes was fitted to a Gaussian distribution while in frequency domain, it was fitted to a Rayleigh distribution. Our observations also revealed that after Ibutilide administration, the IEGMs would have significantly narrower short-tailed PDFs both in time and frequency domains. Conclusion: This study shows that the PDFs of the IEGMs before and after administration of Ibutilide represents significantly different properties, both in time and frequency domains. Hence, by fitting the PDF of IEGMs in time domain to a Gaussian distribution or in frequency domain to a Rayleigh distribution, the effect of Ibutilide can easily be tracked using the statistics of their PDF (e.g., standard deviation) while this is difficult through the waveform of IEGMs itself.

Keywords: atrial fibrillation, catheter ablation, probability distribution function, time-frequency characteristics

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3 Heritage Preservation and Cultural Tourism; The 'Pueblos Mágicos' Program and Its Role in Preserving Traditional Architecture in Mexico

Authors: Claudia Rodríguez Espinosa, Erika Elizabeth Pérez Múzquiz


The Pueblos Mágicos federal program tries to preserve the traditional environment of small towns (under 20,000 inhabitants), through economic investments, legislation, and legal aid. To access the program, it’s important to cover 8 requirements; one of them is the fourth, which considers ‘Promotion of symbolic and differentiated touristic attractions, such as architecture, emblematic buildings, festivities and traditions, artisan production, traditional cuisine, and touristic services that guarantee their commercialization along with assistantship and security services’. With this objective in mind, the Federal government of Mexico had developed local programs to protect emblematic public buildings in each of the 83 towns included in the Pueblos Mágicos program that involved federal and local administrations as well as local civil associations, like Adopte una Obra de Arte. In this paper, we present 3 different intervention cases: first the restoration project (now concluded) of the 16th century monastery of Santa María Magdalena in Cuitzeo, an enormous building which took 6 years to be completely restored. Second case, the public spaces intervention in Pátzcuaro, included the Plaza Grande or Vasco de Quiroga square, and the access to the arts and crafts house known as Casa de los once patios or eleven backyards house. The third case is the recovery project of the 16th century atrium of the Tzintzuntzan monastery that included the original olive trees brought by Franciscans monks to this town in the middle 1500’s. This paper tries to present successful preservation projects in 3 different scales: building, urban spaces and landscape; and in 3 different towns with the objective to preserve public architecture, public spaces and cultural traditions. Learn from foreign experiences, different ways to manage preservation projects focused on public architecture and public spaces.

Keywords: cultural tourism, heritage preservation, traditional architecture, public policies

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2 Closed Mitral Commissurotomy: A Safe and Promising Procedure

Authors: Sushil Kumar Singh, Rahul Kumar


Objective: Rheumatic mitral stenosis continues to be a major public health problem in developing countries. When the left atrium (LA) is unable to fill the left ventricle (LV) at normal LA pressures due to impaired relaxation and impaired compliance, diastolic dysfunction occurs. The assessment of left ventricular (LV) diastolic function and filling pressures is of clinical importance to identify underlying cardiac disease, its treatment and to assess prognosis. Two D echocardiography can detect diastolic dysfunction with excellent sensitivity and minimal risk when compared to the gold standard of invasive pressure-volume measurements. The aim of this study is echocardiographic evaluation of left ventricular diastolic function after closed mitral commissurotomy in cases of rheumatic mitral stenosis. Material and Method: This was a one-year study consisting of twenty nine patients of isolated rheumatic severe mitral stenosis. Data was analyzed preoperative and post operative (at one month follow up). Transthoracic 2D echocardiographic parameters of diastolic function are transmitral flow, pulmonary venous flow, mitral annular tissue doppler, and color M-mode doppler. In our study mitral valve orifice area, ejection fraction, deceleration time, E/A-wave, E/E’-wave, myocardial performance index of left ventricle (Tei index) and Mitral inflow propagation velocity were included for echocardiographic evaluation. The statistical analysis was performed on SPSS Version 15.0 statistical analysis software. Result: Twenty nine patients underwent successful closed mitral commissurotomy for isolated mitral stenosis. The outcome measures were observed pre operatively and at 1 month follow up. Majority of patients were in NYHA (New York Heart Association) grade III (69.0%) in pre operative period which improved to New York Heart Association grade I (48.3%) after closed mitral commissurotomy. Post surgery mitral valve area increased from 0.77 ± 0.13 to 2.32 ± 0.26 cm, ejection fraction increased from 61.38 ± 4.61 to 64.79 ± 3.22. There was decrease in deceleration time from 231.55 ± 49.31 to 168.28 ± 14.30 ms, E/A ratio from 1.70 ± 0.54 from 0.89 ± 0.39, E/E’ ratio from 14.59 ± 3.34 to 8.86 ± 3.03. In addition there was improvement in TIE index from 0.50 ± 0.03 to 0.39 ± 0.06 and mitral inflow propagation velocity from 47.28 ± 3.71 to 57.86 ± 3.19 cm/sec. In peri-operative and follow up, there was no incidence of severe mitral regurgitation (MR). There was no thromboembolic incident and no mortality. Conclusion: Closed mitral commissurotomy is a forgotten procedure for mitral stenosis, but it produces excellent and comparable improvement in early hemodynamic, clinical stage of disease and diastolic function. Closed mitral commissurotomy remains a simple, safe, and effective means for treating mitral stenosis in regions where incidence of rheumatic heart disease is still high and resources for its treatment are limited. There is still a place for this procedure.

Keywords: closed mitral valvotomy, diastolic dysfunction, mitral stenosis, rheumatic heart disease

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1 The Return on Investment (ROI) of Experiential Learning/Simulation Training at Atrium Health Wake Forest Baptist

Authors: Janae Joyner, Maria Crawford, Carty Beaston, Cheryl Conner, Louise Nixon


Introduction: Today, there is a demand in areas of business, including healthcare and education, to connect investments in programs to organizational outcomes by demonstrating value and impact. In many cases, the programmatic value must outweigh the cost of the solution in order for the program to be sustained. The Center for Experiential and Applied Learning (CEAL) desired to implement return-on-investment (ROI) methodology via the ROI Institute Method in a project entitled Return on Learning (ROL) across its clinical enterprise portfolio of hands-on experiential learning/simulation training events. Objective: The objective of this study was to ensure stakeholder inclination regarding ROL implementation via a readiness assessment. Subsequently, this study’s goal was to pilot several versions of the ROL evaluation tool across the CEAL clinical enterprise portfolio of training events to determine the preferred tool to use for ROL assessment. Methods: CEAL administered a modified electronic readiness assessment survey from the ROI Institute. Stakeholders included CEAL steering committee members and faculty/staff event champions currently holding experiential learning events within CEAL. Next, CEAL conducted a modified Delphi technique with the same stakeholders to narrow down questions on a general evaluation tool to five (5) questions. After a two (2) month pilot, the evaluation tool was redesigned and expanded to ten (10) questions and re-piloted for six (6) months. Results: The readiness assessment survey results (n=41) yielded an overall institutional score of 52.3, demonstrating per the ROI Institute scale that we were ready to build skills to implement the ROI process (15-30 = not a candidate; 31-45 = not a strong candidate; 46-60 = a strong candidate). An initial pilot of the five (5) question general evaluation tool (n=339) utilizing a 1-4 Likert Scale (1=strongly disagree; 4=strongly agree) revealed high confidence to apply what was learned in the clinical environment (3.58+0.58), meeting the identified need (3.92+0.28), immediate application of use (3.86 +0.37), and recommendation of the program/course to colleagues (3.94+0.26). The longer ten (10) question evaluation tool (n=771) using a 5-point Likert scale (1=strongly disagree; 5=strongly agree) demonstrated that the training was relevant to one work of improving patient outcomes (4.84+0.02), high confidence to apply what was learned in the clinical environment (4.76 +0.02), comfortability during the debrief (4.75+0.02), engaged learning environment (4.79+0.02) and identification of opportunities to improve or sustain superior healthcare performance (4.82+0.01). Conclusions: Based upon the ROI readiness assessment, our organization was prepared to implement an ROI initiative. Data from the initial pilot indicated successful events but presented the opportunity to broaden the question base and redefine the scale to a traditional 5-point Likert scale. The ten (10) question pilot also indicated successful training events. The next steps in the ROL project are to evaluate qualitative assessment questions and finalize the evaluation tool through discussion with the original stakeholder group using these data/results. CEAL also plans to extend the ROI possibilities by using data from the electronic health record (EHR) to evaluate the impact of training on patient care.

Keywords: return on investment, simulation, training, value-based

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