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Sachverhaltsdokumentation
TBE
Apr 7, 2021 17:53
3 yrs ago
37 viewers *
German term

Schenkelsanteil

German to English Medical Medical: Cardiology Cardiovascular diseases
This is taken from a cardiovascular medical report:

Koronare 3-Gefäßerkrankung mit erhaltener RV-Funktion (EF: 64%, TTE 03.03.2021).

PTCA/stenting des einer Abgangsstenose des Schenkelsanteil zu R. Marginalis, PTCA/stenting der subtotal verschlossenen RCA 03/2010.
Proposed translations (English)
3 stenting of the proximal RCA towards the right marginal artery
3 middle segment (of the RCA)/mid-RCA
3 (RCA) segment
References
Kammerschenkel?

Discussion

Stuart and Aida Nelson Apr 12, 2021:
The Y-stents are designed to fit the anatomical structure of bronchi around the main carina, and so the left limb of the Y-stent branches off at an acute angle from the tracheal limb compared with the right limb.

https://erj.ersjournals.com/content/40/6/1483
thefastshow Apr 11, 2021:
@ Stuart&Aida, This is very confusing as I find contradicting statements.... but this one https://faculty.washington.edu/jeff8rob/trauma-radiology-ref... , this one http://cardiolatina.com/wp-content/uploads/2020/01/Coronary-... and this one: https://www.wikidoc.org/index.php/Right_coronary_artery seems to indicate that the RMD is located in the middle segment of the RCA.

Regarding Schenkelsanteil . I guess what is meant here is if you imagine RCA and RMD to be two legs (Schenkel = thighs), then the thigh part of the RMD close to the bifurcation from the RCA is occluded.

The bifurcation is located in the middle segment of the RCA , but I guess it needs to be added that the stenting happened in RMD part of the bifurcation (RMD branch).

Abgangsstenose was translated like this here https://www.proz.com/kudoz/german-to-english/medical/17688-a... ... maybe Anne is right in assuming an Y stent but I am inclined to interprete it as a Stenosis at the bifurcation to the RMD.
thefastshow Apr 11, 2021:
@Anne I would not think that this is about renewing an existent stent. The doc would have used "Restenose" otherwise. Additionally PTCA is mentioned here .https://www.netdoktor.at/therapie/ptca-8560
Stuart and Aida Nelson Apr 11, 2021:
@ Anne Nice to see you here Anne and it is a comfort: Ich verstehe auch nur Bahnhof here :). Good point yours!
Stuart and Aida Nelson Apr 11, 2021:
Uyuni and Thefastshow Thank you for the explanations and thank you, Uyuni, for explaining that the term Schenkel is somewhat erratic. The problem I see is that the text does only mention Schenkelsanteil which I would also translate as a segment in agreement with Uyuni.

However, I have also found the following:

The segment of the RCA from the ostium to the origin of the first acute marginal artery is usually referred to as the proximal RCA.

https://www.sciencedirect.com/topics/immunology-and-microbio...

Would this imply that the origin of the marginal branch is in the proximal segment according to Thefastshow?

In der Mathematik gilt Schenkel für ‘Winkelseite’ (18. Jh.), nach lat. crūs angulī.

https://www.dwds.de/wb/Schenkel.

By the way, I also see the difficulty in translating Abgangsstenose and I am perfectly aware of the wonderful coronary anatomy.
Anne Schulz Apr 11, 2021:
Ich verstehe bei diesem kraus formulierten Text ja zugegebenermaßen eher nur Bahnhof - aber der Begriff Schenkel könnte darauf hindeuten, dass hier 2010 ein "Y stenting" oder "V stenting" der RCA am Abgang des RM durchgeführt wurde und jetzt der im RM liegende Schenkel dieser Prothesenkonfiguration am Abgang des RM verstopft ist und neu kanalisiert wurde.
thefastshow Apr 11, 2021:
I could not quite figure out in which third the RMD is branching ,whether proximal.or middle part. Hence I gave proximal to middle part...The last link I posted locates it in the proximal part - at least that's how I interprete " Ramus marginalis dexter - ist ebenfalls ein Ast aus dem ersten Abschnitt der A. coronaria dextra und versorgt die vordere Wand des rechten Ventrikels." I would love to find or see more clarifying links regarding the exact location on the RCA. Sorry am on.a bus ,rather difficult....
uyuni Apr 11, 2021:
Hi thefastshow No bullshit at all!
Glad to see we are in the same scope of coronary anatomy here.

I introduced the term "segment" merely following the (somehow erratic) term "Schenkel" in Pamela's OT. As the RM leaves the main RCA considerably downwards/inferior to its origin I'd prefer "middle" or (perhaps) "intermediate" segment.

Moreover, "proximal" is misleading somehow in the sense of vascular anatomy because the term relates to the centre of the body (this fact often confused even by interventional cardiologists in their cath lab reports). In a stricter sense the word "proximal" (in case of the heart) would point to some region inferior to it and "distal" to some structures cranial to it, as the heart is not the anatomical centre of the human body.

So, our mutual perceptions are only centimeters apart...;-)
Have a nice Sunday!
thefastshow Apr 11, 2021:
Check page 8 of this PDF https://semmelweis.hu/anatomia/files/2019/01/Herz2_RT.pdf it will show you the exact location of the ramus marginalis dexter (if this really is the RMD in question).
As uyuni pointed out correctly Abgangsstenose is a stenosis of the bifurcation area https://befunddolmetscher.de/abgangsstenose
Since it branches off the RCA we could talk about a Schenkel since RCA and RMD form an angle. I belief the author meant the stenosis is located where the RMD branches off from the RCA possibly with a tiny fraction of the RMD affected too.
thefastshow Apr 11, 2021:
Hm Uyuni I chose proximal because of this "Ramus marginalis dexter - ist ebenfalls ein Ast aus dem ersten Abschnitt der A. coronaria dextra und versorgt die vordere Wand des rechten Ventrikels." https://www.kenhub.com/de/library/anatomie/arteria-coronaria... unless that's bullshit.
uyuni Apr 11, 2021:
@ Stuart & Aida "Abgangsstenose" denotes a stenosis which is located right at or within the bifurcation of an arterial branch (here: bifurcation RCA giving off the RM). The latter is anatomically located in the middle - not proximal - segment/section/portion (choice at your discretion...) of the right coronary artery (RCA). "Schenkel" in the OT is not really the correct denotation here as it is merely a part of the RCA without any branches before the first bifurcation...Hope this helps at least a bit.
Stuart and Aida Nelson Apr 11, 2021:
Schenkelsanteil Can anyone precisely explain what is Schenkel here? How can a Abgangsstenose be found in either the proximal ... or the middle segment of the RCA?

It would help non-native German speakers to understand this a bit more.
uyuni Apr 11, 2021:
RV-Funktion...? BTW, Pamela, let alone various typos there seems to be another flaw in your OT. Left ventricular function is usually measured by EF (ejection fraction). Of course there is a right ventricular EF too but it is very rarely referred to as such. RV function is mostly quantified in terms of the so-called TAPSE (reference values in mm not %).

https://echobasics.de/rv-en.html

So my guess is that it must read "LV-Funktion" instead of "RV-Funktion".

Proposed translations

20 hrs

stenting of the proximal RCA towards the right marginal artery

The Ramus Marginalis is a part of the coronary arteries.
Hence the reference is moving in the wrong area. The Tawara Schenkel is part of the electrical conduction system of the heart: The bundle of His splits into two branches in the interventricular septum: the left bundle branch and the right bundle branch. - These are nodes not arteries.

To my knowledge one can only put stents in arteries :) .

Anyway, I believe the patient received a stent in that part of the right coronary artery (RCA) leading from the aorta to the ramus marginalis dexter or right marginal artery. - This should be the proximal - middle third of the RCA

Check page 8 of :
https://semmelweis.hu/anatomia/files/2019/01/Herz2_RT.pdf
Something went wrong...
3 days 16 hrs

middle segment (of the RCA)/mid-RCA

"Middle segment" rather than "proximal" as the bifurcation (RM) is way inferior of the RCA's origin from the aortic root. Or just "mid-RCA" alternatively (more idiomatic perhaps...).

https://radiopaedia.org/articles/right-coronary-artery

https://www.sciencedirect.com/science/article/pii/S073510979...



Something went wrong...
3 days 22 hrs

(RCA) segment


I agree with the discussion that the term Schenkelsanteil is confusing here, especially because it is misleading giving the idea that the right marginal branch/artery could be stented.

Right now, according to my understanding, I would translate Schenkelsanteil just as segment and the literal translation would be:

Stenting of a stenosis of the RCA segment at the origin/ leading to the origin of the marginal branch

The source text does not specify whether it is the mid segment or proximal segment, therefore, I would go for a literal translation.

The RCA gives rise to the sinoatrial nodal branch of the right coronary artery, posterior descending artery branch of the RCA, and the marginal branch.

The marginal branch of the right coronary artery provides blood supply to the lateral portion of the right ventricle.

https://www.ncbi.nlm.nih.gov/books/NBK534790/

The RCA gives off multiple branches for the perfusion of the right atrium and ventricle. The greatest branch is the right acute marginal branch that supplies the right ventricle.

Multiple ventricular branches arise from the RCA, the largest of which is called the acute marginal branch.

The greatest branch is the right acute marginal branch that supplies the right ventricle. At the course of its downward route to the posterior surface of the heart, the RCA gives off two or three branches. The artery of the atrioventricular node (in 50%–60% of hearts), which emerges from the RCA at the crux of the heart and proceeds anteriorly along the base of the atrial septum, also supplies proximal parts of the bundles of His, and the parts of the posterior interventricular septum.

https://www.sciencedirect.com/topics/immunology-and-microbio...

Segments Right coronary artery

• Proximal: starting at RCA origin, spanning half the distance to the acute margin
• Middle: from proximal segment to the acute margin
• Distal: from middle segment to origination point of the posterior interventricular artery, where the posterior interventricular sulcus meets the atrioventricular groove on the base of the heart

https://en.wikipedia.org/wiki/Right_coronary_artery

Previous question on Abgangsstenose:

https://www.proz.com/kudoz/german-to-english/medical-general...


--------------------------------------------------
Note added at 4 days (2021-04-12 08:08:25 GMT)
--------------------------------------------------

Correction:

The literal translation for Schenkelsanteil would be part of the limb. However, it is not helpful in this context and therefore, it would best to make a description along these lines:

Stenting of a stenosis of the segment branching off to the marginal branch/artery

Or as suggested above.
Something went wrong...

Reference comments

16 hrs
Reference:

Kammerschenkel?

Das His-Bündel ist ca. 4 mm dick und etwa 20 mm lang. Es besitzt drei Anteile: einen Vorhofanteil, einen perforierenden Anteil und einen Teil, der sich dann aufzweigt. Zunächst verläuft das His-Bündel als Fortsetzung des AV-Knotens subendokardial im Vorhof (Vorhofanteil). Danach perforiert es das Trigonum und teilt sich im Septum membranaceum in die Kammerschenkel (Tawara-Schenkel) auf.

https://www.kenhub.com/de/library/anatomie/his-bundel

Von dort breitet sich die Erregung über die Vorhöfe aus. Der AV-Knoten stellt die Verbindung zwischen Vorhöfen und Ventrikeln dar. Unterhalb des AV-Knotens erfolgt die Erregungsleitung über das His-Bündel, welches sich in rechten und linken Kammerschenkel (Tawara-Schenkel) aufteilt.

https://m.thieme.de/viamedici/klinik-faecher-innere-1535/a/s...
Peer comments on this reference comment:
disagree uyuni : Definitely does not fit the context given (cf. the reply of thefastshow).
3 days 3 mins
Thank you, it does explain the question mark
Something went wrong...
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