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1.
Medicine (Baltimore) ; 98(49): e18281, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804369

RESUMO

RATIONALE: Cardiac papillary fibroelastoma is a small, benign endocardial tumor, while it is clinically important because of its strategic position and propensity for causing embolic events and hemodynamic complications. PATIENT CONCERNS: A 59-year-old female presented our hospital for investigation and treatment of a sudden onset of syncope lasted about 2 minutes. DIAGNOSES: Cardiac papillary fibroelastoma arising from left inferior pulmonary vein in left atrium. INTERVENTIONS: The tumor was successfully removed by cardiac surgery. OUTCOMES: The patient's postoperative course was uneventful, and she was discharged 10 days after surgery. The patient remained free of neurologic deficits and had no evidence of residual or recurrence of tumor with echocardiography during 1 year of follow-up. LESSONS: Cardiac papillary fibroelastoma is a benign tumor, with increased risk of thromboembolic events. It is often diagnosed in patients with echocardiography by chance or after a neurologic event. Complete surgical resection should be considered when the patient is indicated and the long-term postoperative prognosis is excellent.


Assuntos
Fibroma/cirurgia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/cirurgia , Veias Pulmonares/cirurgia , Diagnóstico Diferencial , Feminino , Fibroma/patologia , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Humanos , Pessoa de Meia-Idade , Músculos Papilares , Veias Pulmonares/patologia
2.
Angiol Sosud Khir ; 25(4): 146-157, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31855212

RESUMO

Presented in the article is a detailed description of a modified technique of minimally invasive surgical treatment of patients with atrial fibrillation - thoracoscopic radiofrequency fragmentation of the left atrium. This modification differs from the prototype GALAXY procedure by a significant increase of the 'quantitative' rather than 'qualitative' parameter of surgical aggression in relation to the left atrium. This technique results in creation of multiple transmural continuous closed lines of lesion to the left atrium and, consequently, a reduced risk of inadequate surgical treatment for atrial fibrillation. Besides the radiofrequency action on the wall of the left atrium, the protocol of the operation included destruction of the ligament of Marshall and resection of the left atrial appendage. An indication for performing this operation is the presence of various forms of atrial fibrillation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Átrios do Coração/cirurgia , Ablação por Cateter/instrumentação , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Toracoscopia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(51): e18386, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861001

RESUMO

RATIONALE: Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare. PATIENT CONCERNS: A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass. DIAGNOSIS: A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made. INTERVENTION: Right atrial and pulmonary artery embolectomy. OUTCOMES: The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful. LESSONS: RAMs should be considered unlikely reasons for fatal pulmonary embolisms.


Assuntos
Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Embolia Pulmonar/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Embolia Pulmonar/cirurgia
4.
Braz J Cardiovasc Surg ; 34(5): 525-534, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719006

RESUMO

OBJECTIVE: To evaluate the factors impacting on the conversion to sinus rhythm and on the postoperative rhythm findings in the six-month follow-up period of a mitral valve surgery combined with cryoablation Cox-Maze III procedure, in patients with atrial fibrillation. METHODS: In this study, we evaluated 80 patients who underwent structural valve disease surgery in combination with cryoablation. Indications for the surgical procedures were determined in the patients according to the presence of rheumatic or non-rheumatic structural disorders in the mitral valve as evaluated by echocardiography. Cox-Maze III procedure and left atrial appendix closure were applied. RESULTS: The results of receiver operating characteristics analysis indicated that the rate of conversion to the sinus rhythm was significantly higher in patients with left atrial diameters ≥ 45.5 mm and with ejection fraction (EF) ≥ 48.5%. However, the statistical differences disappeared in the sixth month. Thromboembolic (TE) events were seen only in three patients in the early period and no more TE events occurred in the six-month follow-up period. CONCLUSION: The EF and the preoperative left atrial diameter were determined to be the factors impacting on the conversion to sinus rhythm in patients who underwent mitral valve surgery in combination with cryoablation. Mitral valve surgery in combination with ablation for atrial fibrillation does not affect mortality and morbidity in the experienced health centers; however, it remains controversial whether it will provide additional health benefits to the patients compared to those who underwent only mitral valve surgery.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Criocirurgia/métodos , Frequência Cardíaca/fisiologia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Adulto , Fibrilação Atrial/prevenção & controle , Eletrocardiografia , Feminino , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Resultado do Tratamento
5.
J Cardiothorac Surg ; 14(1): 188, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694695

RESUMO

BACKGROUND: The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF). METHODS: This was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia. RESULTS: Fifty-five patients (78% males, mean age = 61.6 years) qualified for the study. The average duration in AF was 3.64 +/- 3.4 years, mean CHA2DS2-VASc Score was 2.0 +/- 1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% (n = 49/55), 85.5% (n = 47/55) and 76.9% (n = 40/52) at 6, 12 and 24 months, respectively. In the multivariate cox-proportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24 months, respectively. CONCLUSION: In this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.


Assuntos
Técnicas de Ablação/métodos , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Toracoscopia/métodos , Adulto , Idoso , Fibrilação Atrial/diagnóstico por imagem , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352392

RESUMO

A 53-year-old female patient known to have Cowden disease (PTEN mutation positive) was found to have a mass at the left atrium on a CT coronary angiography performed as part of a preoperative workup for an unrelated surgery. Further radiological characterisation of the lesion was achieved using MRI and positron emission tomography. Interval growth prompted surgical excision; however, surgery was expedited after the patient presented with haemopericardium and cardiac tamponade. The patient was discharged home 8 days postoperatively, and no intraoperative or postoperative complications were encountered. A diagnosis of cavernous haemangioma was made on histology.


Assuntos
Tamponamento Cardíaco/complicações , Síndrome do Hamartoma Múltiplo , Átrios do Coração/patologia , Hemangioma Cavernoso/patologia , Achados Incidentais , Angiografia Coronária , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , PTEN Fosfo-Hidrolase , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Braz J Cardiovasc Surg ; 34(3): 285-289, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310466

RESUMO

INTRODUCTION: This study aimed to evaluate the feasibility and efficacy of robotically assisted, minimally invasive mitral valve surgery combined with left atrial reduction for mitral valve surgery and elimination of atrial fibrillation (AF). METHODS: Eleven patients with severe mitral regurgitation, AF, and left atrial enlargement who underwent robotic, minimally invasive surgery between May 2013 and March 2018 were evaluated retrospectively. The da Vinci robotic system was used in all procedures. The patients' demographic data, electrocardiography (ECG) findings, and pre- and postoperative transthoracic echocardiography findings were analyzed. During follow up ECG was performed at postoperative 3, 6, and 12 months additionally at the 3rd month trans thoracic echocardiography was performed and functional capacity was also evaluated for all patients. RESULTS: All patients underwent robotic-assisted mitral valve surgery with radiofrequency ablation and left atrial reduction. Mean age was 45.76±16.61 years; 7 patients were male and 4 were female. Preoperatively, mean left atrial volume index (LAVI) was 69.55±4.87 mL/m2, ejection fraction (EF) was 54.62±8.27%, and pulmonary artery pressure (PAP) was 45.75±9.42 mmHg. Postoperatively, in hospital evaluation LAVI decreased to 48.01±4.91 mL/m2 (P=0.008), EF to 50.63±10.13% (P>0.05), and PAP to 39.02±3.11 mmHg (P=0.012). AF was eliminated in 8 (72%) of the 11 patients at the 1st postoperative month. There were significant improvements in functional capacity and no mortality during follow-up. CONCLUSION: Left atrial reduction and radiofrequency ablation concomitant with robotically assisted minimally invasive mitral valve surgery can be performed safely and effectively to eliminate AF and prevent recurrence.


Assuntos
Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Valva Mitral/cirurgia , Ablação por Radiofrequência/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
9.
J Cardiothorac Surg ; 14(1): 127, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262322

RESUMO

BACKGROUND: Total Anomalous Pulmonary Venous Connection (TAPVC) is a rare heterogeneous condition That accounting for 1.5-3% of congenital heart diseases. It is characterized by failure of the Pulmonary Venous Confluence (PVC) to be directly connected to the left atrium in combination with a persistent splanchnic connection to the systemic venous circulation. The most critical status occurs when it is accompanied by pulmonary venous obstruction. Managing of this situation is very difficult and in fact, pulmonary venous obstruction is usually lethal. The real aim of this study is offering a new palliative surgical technique (Sarmast - Takriti Shunt) in order to alleviate the patient's signs and symptoms until becomes ready for the main surgical correction. CASE PRESENTATION: The study included a 4-day old, low birth weight boy who suffered from Critical Obstructive Total Anomalous Pulmonary Venous Connection. The decision was made to perform the new palliative technique using Gore - Tex (ePTFE). Anastomosis was established without Cardiopulmonary Bypass (CPB) between Pulmonary Venous Confluence (PVC) and the left atrial appendage. Therefore the Sarmast - Takriti Shunt (STS) was taken place. CONCLUSION: After completion of the procedure, the pressure gradient across the venous confluence and the Left innominate vein became zero. Cyanosis, agitation and feeding Problem subsided. Three days later, when he was discharged, arterial oxygen saturation had reached as high as 91%. After 7 months we perfomed the main correction.


Assuntos
Derivação Arteriovenosa Cirúrgica , Cuidados Paliativos/métodos , Pneumopatia Veno-Oclusiva/cirurgia , Síndrome de Cimitarra/cirurgia , Prótese Vascular , Átrios do Coração/cirurgia , Humanos , Recém-Nascido , Masculino , Veias Pulmonares/cirurgia , Pneumopatia Veno-Oclusiva/complicações , Síndrome de Cimitarra/complicações
10.
Rev Bras Ter Intensiva ; 31(2): 262-265, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166560

RESUMO

Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.


Assuntos
Forame Oval Patente/etiologia , Átrios do Coração/cirurgia , Músculos Papilares/lesões , Valva Tricúspide/lesões , Acidentes de Trânsito , Anuloplastia da Valva Cardíaca/métodos , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Músculos Papilares/cirurgia , Valva Tricúspide/cirurgia
11.
Pediatr Cardiol ; 40(6): 1266-1274, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31250046

RESUMO

Left heart distension during venoarterial extracorporeal membrane oxygenation (VA ECMO) often necessitates decompression to facilitate myocardial recovery and prevent life-threatening complications. The objectives of this study were to compare clinical outcomes between patients who did and did not undergo left atrial (LA) decompression, quantify decompression efficacy, and identify risk factors for development of left heart distension. This was a single-center retrospective case-control study. Pediatric VA ECMO patients who underwent LA decompression from June 2004 to March 2016 were identified, and a control cohort of VA ECMO patients who did not undergo LA decompression were matched based on diagnosis, extracorporeal cardiopulmonary resuscitation, and age. Among 194 VA ECMO cases, 21 (11%) underwent LA decompression. Compared to the control cohort, patients with decompression had longer hospital length of stay (60 ± 55 vs. 27 ± 23 days, p = 0.012), but similar in-hospital mortality (29% vs. 38%, p = 0.513). Decompression successfully decreased mean LA pressure (24 ± 11 to 14 ± 4 mmHg, p = 0.022) and LA:RA pressure gradient (10 ± 7 to 0 ± 1 mmHg, p = 0.011). No significant differences in early quantitative measures of cardiac function were observed between cases and controls to identify risk factors for left heart distension. Despite higher qualitative risk for impaired cardiac recovery, patients who underwent LA decompression had comparable outcomes to those who did not. Given that traditional quantitative measures of cardiac function are insufficient to predict development of eventual left heart distension, a combination of clinical history, radiographic findings, hemodynamic monitoring, and laboratory markers should be used during the evaluation and management of these patients.


Assuntos
Descompressão Cirúrgica/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Átrios do Coração/cirurgia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/cirurgia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Descompressão Cirúrgica/mortalidade , Feminino , Átrios do Coração/patologia , Mortalidade Hospitalar , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Risco
12.
Echocardiography ; 36(6): 1191-1193, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31206792

RESUMO

A 59-year-old woman with episodes of chest pain was diagnosed with cardiac myxoma. Transesophageal echocardiography (TEE) showed a massive vascularized tumor and there was a blood stream spurting from the internal cavity of tumor into left atrium through an interconnected sinus tract. Coronary artery angiography (CAG) indicated that the mass was enhanced upon the administration of contrast media, which spouted into the cardiac chamber. This is the first case to report the development of the coronary artery steal syndrome due to hemorrhage and associated fistula formation in a left atrial myxoma, which was detected by TEE and confirmed by CAG.


Assuntos
Doença da Artéria Coronariana/etiologia , Neoplasias Cardíacas/complicações , Hemorragia/etiologia , Mixoma/complicações , Fístula Vascular/etiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Ecocardiografia Transesofagiana/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Síndrome , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
13.
Pediatr Cardiol ; 40(6): 1199-1207, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31218373

RESUMO

Right to left (R-L) shunts resulting in cyanosis or systemic embolization occur after the Fontan procedure. The primary modality of diagnosing these is angiography. Successful delineation of these shunts in Fontan patients using selective saline contrast transesophageal echocardiography (SCTEE) may allow for reduced radiation and contrast exposure. We hypothesized that SCTEE could accurately determine the presence, type, and semiquantitative shunt size of R-L shunts in Fontan patients. SCTEE was performed in Fontan patients undergoing angiography for clinical indications. Injections were performed in six sites: mid-Fontan, right and left pulmonary arteries, superior and inferior vena cavae, and innominate vein. R-L shunt size was subjectively graded as 0 = absent, 1 = small, and 2 = medium or large based on echo contrast density in the left atrium. SCTEE was compared to angiography. 33 patients with Fontan were studied with median age 15 years, median weight 50.1 kg, and median O2 saturation of 90% in the R-L shunt group and 95% in the no R-L shunt group. R-L shunt types included intracardiac shunts (ICS), veno-venous collaterals (VVCs), arteriovenous malformations (AVMs), and their combinations. SCTEE versus angiography results were the same for the presence, type, and size of R-L shunts in 79% (26/33). SCTEE identified shunts in 88% (29/33). Angiography identified shunts in 85% (28/33). Neither method missed any medium or large R-L shunts. SCTEE and angiography had similar accuracy. SCTEE accurately detected the presence, type, and size of R-L shunts in most Fontan patients in this study. This can be used to guide targeted angiography, reducing radiation exposure and contrast load.


Assuntos
Angiografia/métodos , Ecocardiografia Transesofagiana/métodos , Técnica de Fontan/efeitos adversos , Átrios do Coração/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Cianose/etiologia , Embolização Terapêutica , Feminino , Átrios do Coração/cirurgia , Humanos , Masculino , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Adulto Jovem
14.
J Clin Ultrasound ; 47(9): 564-567, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31074511

RESUMO

Of the primary cardiac tumors, well-differentiated papillary mesothelioma (WDPM) is very rare, with only one case report documenting WDPM of the pericardium. We report herein a 17-year-old boy who had an abnormal chest X-ray on a routine college-entrance examination. A giant cardiac tumor was detected by echocardiography. The neoplasm was partially resected, and histopathological examination revealed a WDPM. The patient recovered without any complication.


Assuntos
Ecocardiografia/métodos , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Mesotelioma/diagnóstico por imagem , Mesotelioma/cirurgia , Adolescente , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Masculino
15.
J Card Surg ; 34(7): 563-569, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31111535

RESUMO

BACKGROUND AND AIM OF THE STUDY: To determine whether the type of atrial access to the mitral valve (left atriotomy, superior trans-septal, or limited trans-septal) influenced postoperative permanent pacemaker implantation and to investigate the effect of the sinoatrial (SA) node artery origin (right coronary or circumflex arteries) on the rate of pacemaker insertion. METHODS: We retrospectively reviewed consecutive cases of patients who had mitral valve surgery at the Trent Cardiac Centre (2008-2016). The primary outcome was the incidence of permanent pacemaker insertion. The data were analyzed using univariate then binary multivariate regression analysis. RESULT: Four hundred sixty nine patients had mitral valve surgery. The mean age was 66.5 ± 12.3 years and 47.5% were female. One hundred fifty patients (32%) had mitral valve surgery via the standard left atriotomy approach, while 226 (48.2%) and 93 (19.8%) cases were performed using the limited trans-septal and superior trans-septal approaches, respectively. Concomitant tricuspid valve surgery was carried out in 33 cases (7%). The overall rate of pacemaker implantation was 5.3%. On univariate analysis, only age (≥70 years old) and concomitant tricuspid valve surgery were significant predictors of postoperative pacemaker insertion, while on multivariate analysis only age (≥70 years old) remained as a predictor. The type of atrial incision and the origin of the SA node artery did not affect the rate of pacemaker implantation. CONCLUSION: The type of atrial approach to the mitral valve and the origin of the SA node artery did not influence the incidence of postoperative permanent pacemaker insertion.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Valva Mitral/cirurgia , Marca-Passo Artificial , Nó Sinoatrial/cirurgia , Idoso , Feminino , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Valva Tricúspide/cirurgia
16.
Medicine (Baltimore) ; 98(15): e15170, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985700

RESUMO

Atrial remodeling plays a significant role during the progression of atrial fibrillation (AF). Left atrial wall thickness (LAT) is a subjective and easily acquirable indicator referring to structural remodeling. Therefore, we aimed to investigate the association between LAT and atrial remodeling substrate, and to explore the predictive role of LAT about strong maintenance substrate and poor response to catheter ablation.LAT was measured by cardiac computed tomography in 2 selected locations (roof and floor) in 100 persistent AF patients. Then the low-dose-ibutilide-facilitated catheter ablation was performed and atrial maintenance substrate was categorized as weak, mild, and strong, based on the response to circumferential pulmonary vein isolation or complex fractionated atrial electrograms ablation. During follow-up, the success rate was evaluated. LAT showed a progressive thickening tendency from weak, mild, to strong maintenance substrate (roof: 2.2 mm vs. 2.6 mm vs. 3.9 mm, P < .0001; floor: 1.7 mm vs. 2.0 mm vs. 2.5 mm, P < .0001). During follow-up, the success rate of ablation was decreased with the maintenance substrate strengthening (weak 80%, mild 64.53%, strong 31.43%, P = .009). LA roof thickness >3.10 mm might be the predictor to strong atrial maintenance substrate and poor response to ablation.LAT was associated with the remodeling extent of atrial maintenance substrate and might predict the response to catheter ablation. These findings could help the clinicians to select the appropriate ablative strategy and predict the complexity and prognosis before catheter ablation.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Remodelamento Atrial , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Idoso , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/terapia , Ablação por Cateter , Meios de Contraste , Feminino , Seguimentos , Átrios do Coração/efeitos dos fármacos , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Sulfonamidas/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Heart Surg Forum ; 22(2): E162-E164, 2019 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-31013229

RESUMO

Primary cardiac neoplasms are extremely rare and often overlooked as differential diagnosis. Angiosarcomas are the most common primary malignant neoplasms of the heart often with nonspecific symptoms. We present a 43-year-old woman admitted to our hospital with chest pain and inferoposterolateral myocardial infarction. Coronary angiography indicated the distal occlusion of the left circumflex artery. Transthoracic and transoesophagic echocardiography revealed a mass in the left atrium with probable myocardial infiltration and vascularisation. The mass in the left atrium was removed by surgical resection, and histopathology confirmed angiosarcoma. We emphasize the pivotal role of transthoracic and transoesophageal echocardiography in evaluating even rare differential diagnosis of acute coronary syndrome as cardiac neoplasms.


Assuntos
Átrios do Coração/cirurgia , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/cirurgia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Adulto , Biomarcadores/sangue , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/patologia , Humanos , Esternotomia , Tomografia Computadorizada por Raios X
18.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936352

RESUMO

The success of the Fontan procedure for congenital single ventricle anatomy has resulted in adult patients with Fontan physiology requiring anaesthesia for cardiac and non-cardiac procedures. We present the perioperative management of a patient with Fontan physiology who underwent electrophysiological study with radiofrequency ablation for atrial tachycardia under general anaesthesia. Good communication between the multidisciplinary teams, a detailed understanding of the patient's complex cardiac anatomy and physiology, as well as the ability to recognise and manage perioperative complications all play a vital role for a successful outcome.


Assuntos
Anestesia Geral , Anestésicos/administração & dosagem , Técnica de Fontan/métodos , Átrios do Coração/cirurgia , Cardiopatias Congênitas/cirurgia , Assistência Perioperatória/métodos , Taquicardia/cirurgia , Adulto , Anestesia Geral/métodos , Eletrofisiologia , Átrios do Coração/fisiopatologia , Humanos , Comunicação Interdisciplinar , Masculino , Ablação por Radiofrequência , Resultado do Tratamento
19.
Circ Arrhythm Electrophysiol ; 12(4): e007090, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30943762

RESUMO

BACKGROUND: High-current short-duration radiofrequency energy delivery has potential advantages for cardiac ablation. However, this strategy is limited by high current density and narrow safety-to-efficacy window. The objective of this study was to examine a novel strategy for radiofrequency energy delivery using a new electrode design capable of delivering high power at a low current density to increase the therapeutic range of radiofrequency ablation. METHODS: The Sphere9 is an expandable spheroid-shaped lattice electrode design with an effective surface area 10-fold larger than standard irrigated electrodes (lattice catheter). It incorporates 9 surface temperature sensors with ablation performed in a temperature-controlled mode. Phase I: in 6 thigh muscle preparations, 2 energy settings for atrial ablation were compared between the lattice and irrigated-tip catheters (low-energy: Tmax75°C/5 s versus 25 W/20 s; high-energy: Tmax75°C/7 s versus 30 W/20 s). Phase II: in 8 swine, right atrial lines were created in the posterior and lateral walls using low- and high-energy settings, respectively. Phase III: the safety, efficacy, and durability at 30 days were evaluated by electroanatomical mapping and histopathologic analysis. RESULTS: In the thigh model, the lattice catheter resulted in wider lesions at both low- and high-energy settings (18.7±3.3 versus 12.2±1.7 mm, P<0.0001; 19.4±2.4 versus 12.3±1.7 mm, P<0.0001). Atrial lines created with the lattice were wider (posterior: 14.7±3.4 versus 9.2±4.0 mm, P<0.0001; lateral: 15.8±4.2 versus 5.7±4.2 mm, P<0.0001) and required 85% shorter ablation time (12.4 versus 79.8 s/cm-line). While current squared (I2) was higher with Sphere9 (7.0±0.04 versus 0.2±0.002 A2; P<0.0001), the current density was lower (9.6±0.9 versus 16.9±0.09 mA/mm2; P<0.0001). At 30 days, 100% of ablation lines created with the lattice catheter remained contiguous compared with only 14.3% lines created with a standard irrigated catheter. This was achieved without steam pops or collateral tissue damage. CONCLUSIONS: In this preclinical model, a novel, high-current low-density radiofrequency ablation strategy created contiguous and durable ablation lines in significantly less ablation time and a comparable safety profile.


Assuntos
Eletrodos , Átrios do Coração/cirurgia , Ablação por Radiofrequência/instrumentação , Animais , Desenho de Equipamento , Segurança de Equipamentos , Modelos Animais , Estudos Prospectivos , Suínos , Coxa da Perna/cirurgia
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