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1.
Heart Rhythm ; 17(2): 238-242, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31476412

RESUMO

BACKGROUND: Complete tumor resection is a standard strategy in the surgical treatment of ventricular tachycardia (VT) associated with cardiac tumors. Recently, an intraoperative electroanatomic mapping system (CARTO) has enabled surgeons to target the localized arrhythmogenic substrate for partial resection and/or cryoablation in nonresectable cardiac tumors. OBJECTIVE: The purpose of this study was to evaluate the surgical procedures and late outcomes of the treatment of VT associated with cardiac tumors. METHODS: We examined six patients (age 1-65 years) who had undergone surgical treatment of VT associated with cardiac tumors between 2010 and 2016. The 4 pathologies of the cardiac tumors were lipoma 2, fibroma 2, hemangioma 1, and lymphoma 1. Intraoperative epicardial mapping using CARTO was performed in 5 patients(80%). Surgical procedures and long-term outcomes were evaluated. RESULTS: Arrhythmogenic substrates with abnormal electrograms, such as fractionated or late potential, were identified locally or circumferentially beside the tumor in every patient. Complete tumor resection with cryoablation was performed in 3 patients. Two patients underwent partial tumor resection with cryoablation. Cryoablation without tumor resection was performed in 1 patient. No mortality and morbidity occurred. Additional catheter ablation was required in 2 patients to treat occurrence of nonclinical VT and induction of clinical VT during hospital stay. Mean follow-up time was 90 ± 52.5 months. There was no recurrence of clinical VT. CONCLUSION: The outcomes of surgical treatment of VT associated with cardiac tumors were excellent. Intraoperative CARTO mapping was beneficial to eliminate the VT substrates associated with nonresectable cardiac tumors.

2.
Kyobu Geka ; 72(13): 1093-1096, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879387

RESUMO

The patient was a 52-year-old man who had undergone total arch replacement for type A aortic dissection 2 months before. He was admitted to our hospital with hemoptysis due to aortobronchial fistula. We planned to perform 1-stage open chest surgery, but he passed away before the surgery. We considered that earlier open surgery or emergency endovascular stent grafting might have been effective in avoiding this result.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Fístula Brônquica , Implante de Prótese Vascular/efeitos adversos , Fístula Brônquica/etiologia , Emergências , Hemoptise , Humanos , Masculino , Pessoa de Meia-Idade , Stents
3.
Surg Case Rep ; 5(1): 2, 2019 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-30610405

RESUMO

BACKGROUND: Surgery for infective endocarditis involving the aorto-mitral curtain (AMC) is challenging and requires extensive incisions and complex reconstruction procedures. However, in patients with preserved aortic annulus, reconstruction of the AMC is possible using a simple technique with limited incisions. CASE PRESENTATION: A handmade bovine three-portion pericardial patch was used to reconstruct the AMC in a patient with severe endocarditis requiring double valve replacement; the technique allowed for steady anchorage of prosthetic valves without additional incisions other than conventional aortotomy and atriotomy. Postoperative echocardiography revealed normal cardiac function and no significant perivalvular leakage. The patient displayed complete recovery and was discharged on postoperative day 33. The patient was symptom-free at his 1-year follow-up and displayed normal laboratory and echocardiographic findings. CONCLUSION: The bovine three-portion pericardial patch is useful for reconstructing the AMC in patients with infective endocarditis accompanied by preserved aortic annulus.

4.
Surg Today ; 49(2): 124-129, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30178212

RESUMO

PURPOSE: We examined the outcome of modified-maze procedures reflecting a single-center strategy in the treatment of atrial fibrillation (AF) associated with atrial septal defect (ASD) in adults. METHODS: A retrospective chart review was performed for 29 patients who underwent surgical ASD closure and 2 types of maze procedures (full and simplified maze procedures) for AF. The outcome related to the each procedure was examined. A Cox proportional hazards analysis was performed to assess the independent predictors of AF and atrial tachycardia (AT) recurrence. RESULTS: The rates of freedom from AF and AT recurrence at 1 and 4 years were 86.6% and 72.2% in the full maze group and 78.5% and 62.8% in the simplified maze group, respectively (p = 0.70). The only risk factor for recurrence was the age at the time of surgery. A receiver operating characteristic curve analysis gave an optimum cut-off value of 58 years of age for predicting recurrence within 2 years (58.4% for ≥ 58 years versus 5.9% for < 58 years, p = 0.003). CONCLUSIONS: Simplification of the maze procedure was not associated with AF or AT recurrence. The age at the time of surgery might be a clinical predictor of success or failure in adult patients.


Assuntos
Fibrilação Atrial/etiologia , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Curva ROC , Ablação por Radiofrequência , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Semin Thorac Cardiovasc Surg ; 30(3): 271-278, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29410135

RESUMO

The purpose of this study was to determine the 22-year experience of the relationship between preoperative left atrial diameter (LAD) and atrial fibrillation (AF) recurrence after AF surgery. Between November 1993 and April 2015, 244 patients underwent AF surgery concomitant with mitral valve surgery, and were completely followed up in our institute. The full-maze procedure was performed in 231 patients and pulmonary vein isolation in 13. Three quartiles divided the list of sorted LAD data into 4 groups: group Q1: LAD = 40.5 ± 4.3 (n = 55), group Q2: LAD = 47.9 ± 2.0 (n = 61), group Q3: LAD = 54.2 ± 1.6 (n = 66), and group Q4: LAD = 64.2 ± 5.6 (n = 62). The AF cure rates for 22 years were verified between the groups. Although the AF cure rate of the full-maze procedure was 94%, 80%, 63%, and 51% at 1, 5, 10, and 20 years after AF surgery, respectively, it was 100% at 5 and 10 years after the pulmonary vein isolation (P = 0.088). Although there were no significant differences in the AF cure rate between groups Q1-Q3, the AF cure rate was significantly lower in group Q4 than the other groups (P < 0.001). A multivariate Cox proportional hazard model revealed that the preoperative LAD and cardiothoracic ratio were significant risk factors of AF recurrence (hazard ratio 1.063 per 1-mm increase, P = 0.003, and hazard ratio 1.064 per 1% increase, P = 0.043, respectively). AF surgery was effective for 22 years after surgery for AF concomitant with mitral valve disease. A preoperative LAD of ≥58.0 mm and the cardiothoracic ratio were risk factors of AF recurrence after AF surgery.


Assuntos
Técnicas de Ablação/efeitos adversos , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Veias Pulmonares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Kyobu Geka ; 69(13): 1110-1113, 2016 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-27909282

RESUMO

A 77-year-old male with many comorbidities underwent off pump coronary artery bypass grafting. A severely atherosclerotic ascending aorta was revealed by preoperative computed tomography(CT) and epiaortic echography during operation. Therefore, V-composite saphenous vein grafting was adopted for non left anterior descending artery (LAD) coronary lesions in addition to left internal thoracic artery-left anterior descending artery bypass grafting. He was discharged with no complications and all grafts were confirmed to be patent by postoperative CT. V-composite saphenous vein grafting for avoiding cerebrovascular complications might be one of the useful options in coronary artery revascularization for non-LAD lesions in elderly patients or those with many comorbidities, especially with a severely atherosclerotic ascending aorta.


Assuntos
Aorta/cirurgia , Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/métodos , Veia Safena/cirurgia , Idoso , Aorta/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X
7.
J Nippon Med Sch ; 83(5): 203-205, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27890895

RESUMO

On the basis of computed tomography (CT) examination, a prosthetic graft infection of very late onset was suspected in a 72-year-old man who had undergone replacement of an bifurcated prosthetic graft 6 years earlier because of an abdominal aortic aneurysm and bilateral common iliac artery aneurysms. Emergency CT-guided needle aspiration was performed, and analysis of directly aspirated fluid confirmed the rapid diagnosis. Instead of conventional emergency surgery, CT-guided catheter drainage was the initial treatment and led to the gradual improvement of symptoms and laboratory data. Elective staged surgery was performed later to examine the cavity around the prosthetic graft. The cavity was then filled with in-situ omentum. Thus, CT-guided catheter drainage as the initial treatment and following omentopexy as the staged surgery avoided the need for highly invasive conventional surgery.


Assuntos
Cateteres , Procedimentos Cirúrgicos do Sistema Digestório , Drenagem , Omento/cirurgia , Infecções Relacionadas à Prótese/dietoterapia , Infecções Relacionadas à Prótese/cirurgia , Tomografia Computadorizada por Raios X , Idoso , Humanos , Cuidados Intraoperatórios , Masculino , Resultado do Tratamento
8.
J Thorac Cardiovasc Surg ; 151(4): 1062-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26651965

RESUMO

OBJECTIVE: In a U lesion set, the left atrium (LA) roof between the right and left superior pulmonary veins is not ablated, to allow activation to propagate across the posterior LA and to recruit this segment as a contractile atrial component. In contrast, the box lesion set isolates the entire posterior LA. METHODS: To compare the two lesion sets, postoperative freedom from atrial fibrillation (AF) and LA transport function were examined in 402 patients who underwent surgery for AF with a U lesion (n = 329) or box lesion (n = 73) set. Patients who underwent pulmonary vein isolation alone or other simplified procedures were excluded from the study. LA transport function was quantified at 20 ± 33 months postoperatively by the ratio of peak velocity of the A wave to the E wave (peak A/E) of the transmitral Doppler flow. RESULTS: In patients with long-standing persistent AF, freedom from AF was 85% with the U lesion set and 77% with the box lesion set at 5 years after the maze procedure, and 82% and 77%, respectively, at 10 years after the procedure. There was no significant difference between the U lesion set and box lesion set in patients with long-standing persistent AF (P = .30) and those with paroxysmal or persistent AF (P = .90). Proportional hazards analysis identified increased LA diameter (P = .003) and long-standing persistent AF (P = .03), but not the type of lesion set (P = .51), as predictive of postoperative AF recurrence. The postoperative peak A/E was significantly greater after the U lesion set than after the box lesion set (0.42 ± 0.22 vs 0.23 ± 0.17), and multiple regression analysis demonstrated that the type of lesion set and preoperative LA diameter significantly affected postoperative A/E. CONCLUSIONS: The U lesion set restores sinus rhythm frequently as the box lesion set and provides better LA transport function. A dilated LA is a risk factor for postoperative recurrence of AF and poor postoperative LA transport function.


Assuntos
Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo , Ablação por Cateter/métodos , Átrios do Coração/cirurgia , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Ecocardiografia Doppler , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Ann Thorac Surg ; 100(1): e11-3, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26140800

RESUMO

Thoracoscopic surgery for the treatment of Wolff-Parkinson-White syndrome is rare. We report a case of thoracoscopic surgical ablation of the epicardial pathway in a 13-year-old female patient. Intraoperative electroanatomic mapping was performed to identify the exact location of accessory electrical conduction in the right atrioventricular groove. Stamping ablation using a bipolar radiofrequency pen device achieved irreversible disappearance of the delta wave. Eight months after the surgical procedure, there has been no recurrence of arrhythmia in this patient.


Assuntos
Toracoscopia , Síndrome de Wolff-Parkinson-White/cirurgia , Adolescente , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Humanos
10.
Ann Thorac Surg ; 99(3): 1064-6, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25742832

RESUMO

Surgical treatment for ventricular tachycardia associated with congenital cardiac tumors is rare. Intraoperative electroanatomic mapping was performed in a 23-month-old female infant to identify the arrhythmogenic substrate of the epicardium before tumor resection. Verification of the localized abnormal electrocardiogram on the tumor in the treatment of ventricular tachycardia was useful for successful partial resection and cryoablation of the giant fibroma.


Assuntos
Mapeamento Epicárdico/métodos , Fibroma/congênito , Fibroma/cirurgia , Neoplasias Cardíacas/congênito , Neoplasias Cardíacas/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Taquicardia Ventricular/complicações , Taquicardia Ventricular/cirurgia , Eletrocardiografia , Feminino , Fibroma/complicações , Neoplasias Cardíacas/complicações , Humanos , Lactente , Taquicardia Ventricular/diagnóstico
11.
Ann Thorac Surg ; 98(5): 1598-604, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25200727

RESUMO

BACKGROUND: Ganglionated plexi ablation during atrial fibrillation surgery is not technically standardized for precise ganglionated plexi locations or ablation sequence. We aimed to identify precise active ganglionated plexi locations in patients with structural heart disease and explore the feasibility of anatomic ganglionated plexi ablation without prior mapping in patients with atrial fibrillation. METHODS: Thirty patients with valvular disease-associated atrial fibrillation underwent ganglionated plexi ablation and a modified maze procedure. In 20 patients, ganglionated plexi mapping was performed to identify active plexi. According to mapping results, anatomically determined plexi were ablated without mapping in the final 10 patients. Ganglionated plexi ablation outcomes with and without prior mapping were compared between perioperative and early postoperative periods. RESULTS: Active ganglionated plexi common to more than 20% of patients were identified in the superior and inferior right pulmonary veins, superior left pulmonary vein, interatrial groove, and inferior left atrium. Inferior left atrial plexi ablation resulted in maximum vagal modulation. Compared with ablation using mapping, anatomic ablation yielded more vagal modulation in heart rate variability and decreased the requisite cardiopulmonary bypass time. CONCLUSIONS: The sequential pacing and ablation technique identified an optimal ablation sequence that best ensured vagal reflex elimination from all ganglionated plexi. Anatomic ablation using a predetermined ganglionated plexi map may be a viable alternative to individual plexus mapping before ablation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Gânglios Autônomos/cirurgia , Ganglionectomia/métodos , Sistema de Condução Cardíaco/cirurgia , Frequência Cardíaca/fisiologia , Modelos Teóricos , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Eletrocardiografia Ambulatorial , Feminino , Seguimentos , Gânglios Autônomos/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Ann Thorac Surg ; 96(4): 1266-1272, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23972934

RESUMO

BACKGROUND: Adult patients with atrial septal defect frequently experience atrial fibrillation. However, the electrophysiologic mechanism has not been directly examined, and the optimal surgical procedure has not been determined. METHODS: Ten patients undergoing operations for atrial septal defect and atrial fibrillation underwent intraoperative mapping by use of 253 epicardial electrodes. There were 7 men and 3 women, whose average age was 54 ± 11 years. Eight patients had a secundum defect and 2 a primum defect. There were 4 patients with paroxysmal atrial fibrillation and 6 with long-standing persistent atrial fibrillation. A modified biatrial Maze procedure was performed in 6 patients and pulmonary vein isolation with no other left atrial lesions in 4. RESULTS: The reentrant or focal activations driving atrial fibrillation were confined within the right atrium in all patients with paroxysmal atrial fibrillation, whereas multiple focal activations arising from the pulmonary veins or posterior left atrium and reentrant activations in the left atrium were observed in 5 of 6 patients with long-standing persistent atrial fibrillation. In 9 patients, sinus rhythm was restored postoperatively and 8 of those patients have been free of any atrial fibrillation during a follow-up period of 94 ± 45 months. CONCLUSIONS: The pattern of the atrial activation during atrial fibrillation correlated with the type of atrial fibrillation and varied from a simple right atrial reentry to complex reentrant and focal activations in the left atrium.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Comunicação Interatrial/fisiopatologia , Comunicação Interatrial/cirurgia , Fibrilação Atrial/etiologia , Feminino , Seguimentos , Comunicação Interatrial/complicações , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade
14.
Ann Thorac Surg ; 93(4): 1285-8, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22450076

RESUMO

PURPOSE: An electroanatomic mapping system using an electromagnetic navigation technology constructs a 3-dimensional structure of the heart with high geometric accuracy of the data that provides a precise localization of the substrates of arrhythmias. The system was tested for the feasibility and efficacy in intraoperative mapping. DESCRIPTION: The strength of the magnetic field is measured by a location sensor with three different frequencies generated by a location pad placed beneath the operating table, and the spatial location of the sensor is determined. By roving the catheter on the heart while the local electrogram is recorded simultaneously, the 3-dimensional figure of the heart is reconstructed and an activation or voltage map is generated. EVALUATION: The system was used in 19 patients with ventricular tachycardia or other arrhythmias. The focus or reentrant circuit of the tachycardia was precisely located and a map-guided procedure was successfully performed in all patients. Cardiopulmonary bypass allowed for the tachycardias to be mapped without any hemodynamic compromise. CONCLUSIONS: Intraoperative mapping using the electroanatomic mapping system enables a precise localization of the tachycardia substrate.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/cirurgia , Técnicas Eletrofisiológicas Cardíacas , Coração/fisiopatologia , Adulto , Idoso , Ponte Cardiopulmonar , Cateteres , Eletrocardiografia , Fenômenos Eletromagnéticos , Estudos de Viabilidade , Feminino , Coração/anatomia & histologia , Humanos , Imagem Tridimensional , Período Intraoperatório , Campos Magnéticos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/cirurgia , Procedimentos Cirúrgicos Torácicos , Adulto Jovem
15.
Gen Thorac Cardiovasc Surg ; 60(1): 13-20, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22237734

RESUMO

Development and introduction of radiofrequency ablation devices allowed the maze procedures to be performed safely and easily, further enabling off-pump pulmonary vein isolation through a mini-thoracotomy or thoracoscope. The effects of the maze procedure include prevention of stroke and other complications related to atrial fibrillation, improved cardiac performance, and relief of symptoms. Indications for the maze procedure have been discussed on the basis of the evidence. Pulmonary vein isolation has been shown to be effective in most patients with paroxysmal atrial fibrillation and can be performed with endocardial catheter ablation and minimally invasive epicardial ablation. These two modalities should be compared in terms of the success rate, occurrence of cerebral microembolic signals, capability of additional lesions indicated for persistent or long-standing persistent atrial fibrillation, and closure of the left atrial appendage. Noncontinuous or nontransmural lines of conduction block as a result of incomplete ablation can result in recurrence of atrial fibrillation and induction of atrial tachycardia. Intraoperative verification of conduction block across the ablation lines is recommended to prevent these complications. Volume reduction of the enlarged left atrium or a boxlesion to isolate the entire posterior left atrium may be effective in patients with a dilated left atrium, but the potentially impaired atrial transport function should be considered. Mapping of active ganglionated plexi and their ablation may improve the outcome of the procedure, but the long-term effect on atrial fibrillation and autonomic nerve activities should be examined.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Apêndice Atrial/fisiopatologia , Apêndice Atrial/cirurgia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas , Humanos , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Veias Pulmonares/fisiopatologia , Veias Pulmonares/cirurgia , Resultado do Tratamento
16.
Innovations (Phila) ; 7(6): 429-34, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23422806

RESUMO

OBJECTIVE: Double potential mapping using bipolar electrodes that straddle the ablation line should identify the site of incomplete ablation as a conduction gap without constructing the activation maps. METHODS: Bipolar electrograms were recorded during pacing using 11 custom-made bipolar electrodes straddling the ablation line created by a bipolar radiofrequency ablation device on the lateral right atrium in seven canines. A linear ablation was made with an ablation device, of which one jaw was inserted into the atrium through a purse-string suture. A 3-mm-wide tape was placed on both jaws 10 mm from the tip of the ablation electrode to intentionally create an incomplete ablation lesion. The activation times at each dipole across the ablation line were defined as the times of the maximum positive and negative derivatives of the double potentials, and the site of conduction gap was determined as the site of the earliest activation across the linear ablation. The lateral right atrium was mapped simultaneously with 45 different bipolar electrodes to construct the activation maps and the earliest activation site across the ablation line was determined. RESULTS: The double potential mapping located the conduction gap on a real-time basis without displaying any maps. There was no significant change in the accuracy between the different times after ablation and different pacing cycle lengths. CONCLUSIONS: Double potential mapping locates the conduction gap on a real-time basis and would be useful in beating-heart epicardial ablation in off-pump setting.


Assuntos
Ablação por Cateter/métodos , Animais , Fibrilação Atrial/cirurgia , Cães , Técnicas Eletrofisiológicas Cardíacas , Cuidados Intraoperatórios
18.
J Thorac Cardiovasc Surg ; 140(1): 203-8, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20122702

RESUMO

OBJECTIVE: Over recent years, a variety of energy sources have been used to replace the traditional incisions of the Cox maze procedure for the surgical treatment of atrial fibrillation. This study evaluated the safety and efficacy of a new bipolar radiofrequency ablation device for atrial ablation in a long-term porcine model. METHODS: Six pigs underwent a Cox maze IV procedure on a beating heart off cardiopulmonary bypass using the AtriCure Isolator II bipolar ablation device (AtriCure, Inc, Cincinnati, Ohio). In addition, 6 pigs underwent median sternotomy and pericardiotomy alone to serve as a control group. All animals were allowed to survive for 30 days. Each pig underwent induction of atrial fibrillation and was then humanely killed to remove the heart en bloc for histologic assessment. Magnetic resonance imaging scans were also obtained preoperatively and postoperatively to assess atrial and ventricular function, pulmonary vein anatomy, valve function, and coronary artery patency. RESULTS: All animals survived the operation. Electrical isolation of the left atrial appendage and the pulmonary veins was documented by pacing acutely and at 30 days in all animals. No animal that underwent the Cox maze IV procedure was able to be induced into atrial fibrillation at 30 days postoperatively, compared with all the sham animals. All 257 ablations examined were discrete, linear, and transmural, with a mean lesion width of 2.2 +/- 1.1 mm and a mean lesion depth of 5.3 +/- 3.0 mm. CONCLUSIONS: The AtriCure Isolator II device was able to create reliable long-term transmural lesions of the modified Cox maze procedure on a beating heart without cardiopulmonary bypass 100% of the time. There were no discernible effects on ventricular or valvular function.


Assuntos
Fibrilação Atrial/prevenção & controle , Ablação por Cateter/instrumentação , Animais , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Estimulação Cardíaca Artificial , Ablação por Cateter/efeitos adversos , Vasos Coronários/fisiopatologia , Modelos Animais de Doenças , Desenho de Equipamento , Valvas Cardíacas/fisiopatologia , Imagem por Ressonância Magnética , Teste de Materiais , Pericardiectomia , Veias Pulmonares/patologia , Esternotomia , Sus scrofa , Fatores de Tempo , Grau de Desobstrução Vascular , Função Ventricular Esquerda
19.
J Thorac Cardiovasc Surg ; 139(2): 444-52, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19740492

RESUMO

OBJECTIVE: Surgical ablation of ganglionated plexi has been proposed to increase efficacy of surgery for atrial fibrillation. This experimental canine study examined electrophysiologic attenuation and recovery of atrial vagal effects after ganglionated plexi ablation alone or with standard surgical lesion sets for atrial fibrillation. METHODS: Dogs were divided into 3 groups: group 1 (n = 6) had focal ablation of the 4 major epicardial ganglionated plexi fat pads, group 2 (n = 6) had pulmonary vein isolation with ablation, and group 3 (n = 6) had posterior left atrial isolation with ablation. All fat pads were ablated. Sinus and atrioventricular interval changes during bilateral vagosympathetic trunk stimulation were examined before and both immediately and 4 weeks after ablation. Vagally induced effective refractory period changes and mean QRST area changes (index of local innervation) were examined in 5 atrial regions. RESULTS: Sinus and atrioventricular interval changes and heart rate variability decreased immediately after ablation, but only sinus interval changes were restored significantly after 4 weeks in all groups. Ablation-modified vagal effects on effective refractory period or QRST area changed heterogeneously in groups 1 and 2. In group 3, regional vagal effects were attenuated extensively postablation in both atria. Posterior left atrial isolation with ablation incrementally denervated the atria. In the long term, vagal stimulation increased QRST area changes relative to control values in all groups. Heart rate variability was also assessed. CONCLUSIONS: Ganglionated plexi ablation significantly reduced atrial vagal innervation. Restoration of vagal effects at 4 weeks suggests early atrial reinnervation.


Assuntos
Técnicas Eletrofisiológicas Cardíacas , Gânglios Autônomos/fisiopatologia , Átrios do Coração/inervação , Sistema de Condução Cardíaco/fisiopatologia , Tecido Adiposo/cirurgia , Animais , Fibrilação Atrial/cirurgia , Ablação por Cateter , Cães , Eletrocardiografia , Gânglios Autônomos/cirurgia , Átrios do Coração/fisiopatologia , Sistema de Condução Cardíaco/cirurgia , Frequência Cardíaca/fisiologia , Sistema Nervoso Parassimpático/fisiopatologia , Veias Pulmonares/cirurgia , Nó Sinoatrial/fisiologia
20.
Heart Rhythm ; 6(12 Suppl): S41-5, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19959142

RESUMO

The Cox maze procedure is an effective treatment of atrial fibrillation, with a long-term freedom from recurrence greater than 90%. The original procedure was highly invasive and required cardiopulmonary bypass. Modifications of the procedure that eliminate the need for cardiopulmonary bypass have been proposed, including use of alternative energy sources to replace cut-and-sew lesions with lines of ablation made from the epicardium on the beating heart. This has been challenging because atrial wall muscle thickness is extremely variable, and the muscle can be covered with an epicardial layer of fat. Moreover, the circulating intracavitary blood acts as a potential heat sink, making transmural lesions difficult to obtain. In this report, we summarize the use of nine different unidirectional devices (four radiofrequency, two microwave, two lasers, one cryothermic) for creating continuous transmural lines of ablation from the atrial epicardium in a porcine model. We define a unidirectional device as one in which all the energy is applied by a single transducer on a single heart surface. The maximum penetration of any device was 8.3 mm. All devices except one, the AtriCure Isolator pen, failed to penetrate 2 mm in some nontransmural sections. Future development of unidirectional energy sources should be directed at increasing the maximum depth and the consistency of penetration.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Terapia a Laser , Terapia por Ultrassom , Animais , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Criocirurgia/instrumentação , Criocirurgia/métodos , Desenho de Equipamento , Segurança de Equipamentos , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Micro-Ondas/uso terapêutico , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Modelos Animais , Pericárdio/fisiopatologia , Pericárdio/efeitos da radiação , Suínos , Resultado do Tratamento , Terapia por Ultrassom/instrumentação , Terapia por Ultrassom/métodos
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