Retrograde Flow of Fluid Through the Nasolacrimal Duct System Under General Anesthesia: A Case Report.

This case report describes a rare incident of fluid exhibiting retrograde flow from the nasopharynx through the nasolacrimal duct and accumulating within the eye guard while under general anesthesia. The patient was in a steep Trendelenburg position for several hours and received multiple liters of intravenous fluid. The patient did not have a history of sinusitis, sinus surgery, cocaine use, dacryostenosis and dacryocystitis, or nasolacrimal duct irrigation and probing. This case provides insight into the potential ophthalmic implications of surgical and anesthetic management. While the patient fortunately had no complications, this case also underscores the importance of intraoperative vigilance.

Use of a diode laser balloon ablation catheter to generate circumferential pulmonary venous lesions in an open-thoracotomy caprine model.

Electrical isolation of the pulmonary veins (PVs) can be curative in certain patients with atrial fibrillation. The ability of a diode laser balloon ablation catheter to isolate PVs was assessed in an open-thoracotomy caprine model system. After a median sternotomy, the left atrial appendage was cannulated in 19 goats. A laser balloon catheter was placed at the PV ostia and used to deliver photonic energy to the periostial tissue. The applications were delivered at 3.7, 4.5, or 5.4 W/cm for 90-150 seconds. Electrical continuity of the PV with the left atrium was assessed using a multielectrode mapping catheter. After a single application of photonic energy, electrical isolation of the PVs was achieved in (70%) 19/27 PVs. However, the success of electrical PV isolation did not correlate with the dose or duration of the applications. When reflectance spectroscopy was utilized to ensure adequate orientation and contact of the laser balloon catheter with the left atrial myocardium, complete PV isolation was achieved in 5/5 veins at 3.5 W/cm for 120 seconds. Pathological examination revealed no PV stenosis, no pericardial damage, minor lung lesions without pleural perforation, minimal endothelial disruption, and, in the presence of adequate heparinization, no endocardial charring or overlying thrombus. Effective isolation of the PVs can be achieved by delivery of a continuous circular beam of photonic energy to ablate the left atrial - pulmonary venous junction. The use of reflectance spectroscopy to provide real-time monitoring of the blanching effect of balloon-tissue contact optimizes lesion delivery.

Fiberoptic balloon catheter ablation of pulmonary vein ostia in pigs using photonic energy delivery with Diode laser.

Circumferential lesions to the pulmonary vein (PV) ostia to cause conduction block at the junction of the PV and left atrium could offer a new approach during catheter ablation of patients with paroxysmal (focal) atrial fibrillation. Diode laser can deliver energy through diffusing or ring fiber tips. In three pigs weighing between 60 and 65 kg, transseptal puncture was performed and a fiberoptic balloon catheter with a collapsed profile of 10 Fr was advanced through a sheath under fluoroscopic guidance to the ostium of the right and left PVs. The balloon was inflated with a 3-cc mixture of D2O (deuterium oxide) and contrast to deliver circumferential lesions with a 15-mm diameter x 3-mm ring width of light. Applications consisted of 3.2 to 3.8 W/cm for 120 seconds; the animals were sacrificed 3 hours after ablation for pathological examination. Photonic energy was delivered successfully to the ostium of five of the five targeted PVs, and was well tolerated hemodynamically in each animal without ectopy. Gross inspection revealed endocardial lesions at the ostium of four of five PVs, confined to the atrium in each and circumferential in three of five PVs. Microscopically, transmural coagulation necrosis of the atrium was present at the ostium of three of five PVs, and extended into the myocardial sleeves of two PVs. Photonic energy delivery using a fiberoptic balloon catheter can create circumferential lesions to the PV ostia, suggesting that this new form of energy delivery may be therapeutically advantageous for pulmonary vein ablation with need to pursue chronic studies.