Cece wrote:
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Marked valvular and other intraluminal abnormalities with potential hemodynamic consequences were identified in 5 of 7 MS patients (7 abnormalities) and in 1 of 6 controls (1 abnormality). These abnormalities included circumferential membranous structures (1 MS and 1 control), longitudinally-oriented membranous structures (3 MS), single valve flap replacing IJV valve (2 MS), and enlarged and malpositioned valve leaflets (1 MS). In addition, minor anatomic variations without expected hemodynamic consequences were observed similarly in both MS and controls. These included valves with >2 leaflets, the presence of valves in the AZY, additional (duplicate) normal-appearing IJV valves, and small membranous septa.
This is excellent. Since we are looking at visible structural abnormalities, it is hard to argue with autopsy results.
They found more of the longitudinally-oriented membranous structures (aka septums) than what we usually hear about here. Perhaps these are underdiagnosed in patients? Could they be missed on IVUS?
Perhaps it is what we call elongated valves.
Perhaps some of the images interpreted as valves are septums. I think so.
perhaps with flow the septum is collapsed against the wall during venography and not visible.
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A single valve flap replacing IJV valve might be how you'd describe my left jugular issue, unless it were better described as an enlarged valve leaflet. Finding only three valve abnormalities total in seven MS patients (14 jugulars) is fewer than what the IRs are seeing in living patients.
It is likely that autopsy is going to miss many of the malfunctioning valves because they fixed the tissue. Thus they are seeing only anatomical derangements, but not seeing mobility challenges. Many of the valvular problems seen with IVUS represent immobile valves. During a real time physiological analysis, one seems that the valve opens incompletely and the stenosis is present. I do not think that autopsy will detect these problems.
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But this is clear support of the association between CCSVI intraluminal abnormalities and MS. It also helps clarify why there might be so much difficulty finding CCSVI, if the imaging studies are failing to differentiate between venous wall stenoses, which were found equally in both the MS patients and controls, and the intraluminal abnormalities, which were overwhelmingly found in the MS patients.
therefore emphasizing the importance of a real time intraluminal interrogation of the veins with IVUS.
There are always things I did not think of, which you have.
I agree with all of this.
If some images are being interpreted as valves but are really septums, that is going to affect outcome of those procedures, if valves are more responsive to treatment than septums are. (Although IVUS is, as usual, the solution.)