Background-Cardiac

fQRS on a 12-lead ECG in patients with suspected cardiac sarcoidosis are associated with cardiac involvement as detected by GDE on CMR.

Objectives The objective of this study was to determine whether premature ventricular contractions (PVCs) arising from the aortic sinuses of Valsalva (SOV) and great cardiac vein (GCV) have coupling interval (CI) characteristics that differentiate them from other ectopic foci. Background PVCs occur at relatively fixed CI from the preceding normal QRS complex in most patients. However, we observed patients with PVCs originating in unusual areas (SOV and GCV) in whom the PVC CI was highly variable. We hypothesized that PVCs from these areas occur seemingly randomly because of the lack of electrotonic effects of the surrounding myocardium. Methods Seventy-three consecutive patients referred for PVC ablation were assessed. Twelve consecutive PVC CIs were recorded. The ΔCI (maximum – minimum CI) was measured. Results We studied 73 patients (age 50 ± 16 years, 47% male). The PVC origin was right ventricular (RV) in 29 (40%), left ventricular (LV) in 17 (23%), SOV in 21 (29%), and GCV in 6 (8%). There was a significant difference between the mean ΔCI of RV/LV PVCs compared with SOV/GCV PVCs (33 ± 15 ms vs. 116 ± 52 ms, p < 0.0001). A ΔCI of >60 ms demonstrated a sensitivity of 89%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 94%. Cardiac events were more common in the SOV/GCV group versus the RV/LV group (7 of 27 [26%] vs. 2 of 46 [4%], p < 0.02). Conclusions ΔCI is more pronounced in PVCs originating from the SOV or GCV. A ΔCI of 60 ms helps discriminate the origin of PVCs before diagnostic electrophysiological study and may be associated with increased frequency of cardiac events.

Background. Spontaneous onset transethmoidal meningocele is a rare entity among the adult population. Methods. A retrospective chart review was performed and cases of adults diagnosed with spontaneous transethmoidal meningoceles from November 2000 till February 2014 were reported. Data collected included demographics, clinical presentation, diagnostic modalities, and results. Intraoperative findings, the type of surgical reconstruction performed, and the percentage of recurrence, if present, were also reported. Results. Ten cases of spontaneous transethmoidal meningoceles in adults were diagnosed. Eight were females and two males with a mean age of 47.5 years. All patients presented with CSF leakage with or without meningitis. They underwent a reconstruction of the base of skull defect using the temporalis fascia graft in addition to fibrin glue (Tissucol) and Surgicel (Ethicon). In two cases with a larger defect, a piece of septal bone and turbinate mucosa were applied achieving a watertight seal in all cases. Conclusion. Spontaneous transethmoidal meningocele in adults is a rare condition. It usually presents with clear rhinorrhea with or without meningitis and an endoscopic multilayer reconstruction is advocated for treatment of such conditions.

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