RESUMEN
AIMS: Complex fractionated electrograms (CFEs) and high-dominant-frequency (DF) sites theoretically represent abnormal substrates and targets for atrial fibrillation (AF) ablation. The relationship between the high-DF sites in the left atrium (LA) and commonly used linear ablation line to the distribution of the CFEs in patients with persistent AF is unknown. METHODS AND RESULTS: This study enrolled 62 persistent AF patients who underwent construction of LA CFE and DF maps (>350 points/map). Circumferential pulmonary vein isolation and linear ablation including that at the septum, roof, mitral-annulus, and ridge of the appendage were performed. Multipolar catheter mapping identified sites with high DFs (≥ 8 Hz) in all patients (9.8 ± 4.6/patient). In 47 patients in whom AF persisted despite ablation, there was a significant reduction in the continuous CFE (<50 ms) burden after the linear ablation (62 vs.11%; P < 0.0001), with a decrease in both the DF within the coronary sinus (6.9 ± 0.9 vs. 5.9 ± 0.8 Hz; P < 0.0001) and CFE surface area (42.8 ± 18.8 vs. 12.6 ± 10.5 cm(2); P < 0.0001). Comparing the high-DF sites with the ablated lesions, 64% of the high-DF sites (324 of 507) were on or adjacent to the ablation lines. Residual CFEs were observed in the infero-posterior regions in 83% of the patients. Almost half of the high-DF sites away from the linear ablation line were identified in the inferior (34%) and posterior (14%) LA regions. CONCLUSION: Linear ablation resulted in the localization of the continuous CFE regions and reduced the global LA DF in patients with persistent AF. This may be related to the proximity relationship between the linear ablation lines and high-DF sites except for in the infero-posterior regions.
Asunto(s)
Fibrilación Atrial/patología , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Técnicas Electrofisiológicas Cardíacas/métodos , Anciano , Algoritmos , Apéndice Atrial/patología , Apéndice Atrial/fisiopatología , Apéndice Atrial/cirugía , Fibrilación Atrial/fisiopatología , Tabique Interatrial/patología , Tabique Interatrial/fisiopatología , Tabique Interatrial/cirugía , Seno Coronario/patología , Seno Coronario/fisiopatología , Seno Coronario/cirugía , Femenino , Atrios Cardíacos/patología , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/patología , Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Venas Pulmonares/patología , Venas Pulmonares/fisiopatología , Venas Pulmonares/cirugía , Resultado del TratamientoRESUMEN
A 79-year-old man with unstable angina developed localized left atrial tamponade after conventional coronary artery bypass grafting (CABG) with endoscopic radial artery harvesting (ERAH). Hemodynamic instability developed several hours after the systemic heparinization. Transthoracic and later intraoperative transesophageal echocardiography revealed a large, isolated hematoma compressing the left atrium. The radial artery for the circumflex artery bled during an emergent re-sternotomy. Incomplete hemostasis of the radial artery by ERAH was the likely cause of this serious complication. Surgeons, especially those who are new to ERAH, should examine the harvested radial arterial conduit carefully and confirm complete hemostasis before performing the procedure.
Asunto(s)
Angina Inestable/cirugía , Taponamiento Cardíaco/etiología , Puente de Arteria Coronaria/efectos adversos , Endoscopía/efectos adversos , Arteria Radial/trasplante , Recolección de Tejidos y Órganos/efectos adversos , Anciano , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/cirugía , Ecocardiografía Transesofágica , Hematoma/etiología , Hemodinámica , Hemostasis Quirúrgica , Humanos , Masculino , Arteria Radial/lesiones , Reoperación , Esternotomía , Recolección de Tejidos y Órganos/métodos , Resultado del TratamientoRESUMEN
We report a surgical case of infected thoracic aortic aneurysm. Before arrival of the cryopreserved aortic allograft, the patient had hemoptysis resulting from aneurysm rupture. Therefore endovascular stent grafting was urgently performed three days prior to in situ allograft implantation. Palliative stent grafting prevented circulatory collapse and stabilized the patient until successful allograft implantation.
Asunto(s)
Aneurisma Infectado/cirugía , Aorta/trasplante , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Criopreservación , Stents , Anciano , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Angiografía de Substracción Digital , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/microbiología , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/microbiología , Aortografía/métodos , Remoción de Dispositivos , Hemoptisis/microbiología , Humanos , Masculino , Cuidados Paliativos , Diseño de Prótesis , Reoperación , Salmonella/aislamiento & purificación , Choque/microbiología , Choque/prevención & control , Tomografía Computarizada por Rayos X , Trasplante Homólogo , Resultado del TratamientoRESUMEN
We report a case of recurrent malignant fibrous histiocytoma (MFH) in the left atrium, treated by removal of the tumor and the right half of the left atrium, which was reconstructed with two equine pericardial patches. Postoperative echocardiography showed patent right pulmonary veins and a properly shaped left atrium. The patient survived for 3 years after the operation with no cardiac symptoms.
Asunto(s)
Atrios Cardíacos/cirugía , Neoplasias Cardíacas/cirugía , Histiocitoma Fibroso Maligno/cirugía , Pericardio/trasplante , Procedimientos de Cirugía Plástica/métodos , Adolescente , Animales , Encefalocele , Resultado Fatal , Atrios Cardíacos/patología , Neoplasias Cardíacas/diagnóstico , Histiocitoma Fibroso Maligno/diagnóstico , Caballos , Humanos , Masculino , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Trasplante HeterólogoRESUMEN
Prevention of paraplegia remains an important issue in repair of descending thoracic and thoracoabdominal aneurysms. Therefore, we investigated the protective effect of sivelestat sodium hydrate (ONO-5046) on ischemia-induced spinal cord damage in a rabbit model. Twenty New Zealand white rabbits were divided into two equal groups; ONO-5046 (1.6 mg/kg)+isotonic NaCl (30 ml) was administered selectively to the spinal cord via the lumbar arteries for the first 3 min during 30 min of infra-renal aorta clamping in the experimental group (group E), whereas NaCl was given alone in the control group (group C). Motor function of the lower limbs was assessed two days later by Tarlov criteria. The number of intact motor neurons in the anterior segment of the cord (L5 level) was counted after hematoxylin-eosin staining and the number of apoptotic motor neurons after TUNEL staining. Motor function of the lower limbs in group E was significantly better (P=0.003) than that in group C. The number of intact motor neurons was greater and of apoptotic motor neurons was less in group E than C. Selective infusion of sivelestat sodium hydrate directly into the spinal cord via the lumbar arteries significantly attenuated functional and morphological ischemia-induced spinal cord injury.