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1.
Cardiology ; 143(3-4): 107-113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476754

RESUMO

Atrial fibrillation (AF) is the most frequent atrial arrhythmia. During the last few decades, owing to numerous advancements in the field of electrophysiology, we reached satisfactory outcomes for paroxysmal AF with the help of ablation procedures. But the most challenging type is still persistent AF. The recurrence rate of AF in patients with persistent AF is very high, which shows the inadequacy of pulmonary vein isolation (PVI). Over the last few decades, we have been trying to gain insight into AF mechanisms, and have come to the conclusion that there must be some triggers and substrates other than pulmonary veins. According to many studies, PVI alone is not enough to deal with persistent AF. The purpose of our review is to summarize updates and to clarify the role of coronary sinus (CS) in AF induction and propagation. This review will provide updated knowledge on developmental, histological, and macroscopic anatomical aspects of CS with its role as arrhythmogenic substrate. This review will also inform readers about application of CS in other electrophysiological procedures.


Assuntos
Fibrilação Atrial/etiologia , Ablação por Cateter/efeitos adversos , Seio Coronário/cirurgia , Seio Coronário/embriologia , Seio Coronário/fisiologia , Humanos , Recidiva
2.
J Card Surg ; 34(10): 1106-1109, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31269291

RESUMO

Coronary artery fistula is a rare congenital or acquired anomaly. It involves an abnormal connection between the coronary artery and the cardiac chambers or the large thoracic vessels. In some cases, the feeding coronary artery can become extremely dilated. The treatment includes a transcatheter or a surgical intervention depending on the complexity of the anomaly. We present the surgical treatment of the coronary artery to coronary sinus fistula, which includes the complete exclusion of the giant right coronary artery and followed by triple bypass surgery.


Assuntos
Aneurisma Coronário/cirurgia , Seio Coronário/anormalidades , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Fístula Vascular/complicações , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/etiologia , Angiografia Coronária , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgia
4.
Curr Cardiol Rep ; 21(6): 46, 2019 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-31011835

RESUMO

PURPOSE OF REVIEW: Refractory angina (RA), which is characterized by tissue ischemia along with neurological, mitochondrial, and psychogenic dysfunction, is becoming a major cause of morbidity in patients with advanced coronary artery disease. In this review, we discuss in detail the invasive mechanical non-cell therapy-based options, the evidence behind these therapies, and future trends. RECENT FINDINGS: There is extensive ongoing research in the areas of spinal-cord stimulation, transmyocardial laser revascularization, sympathectomy, angiogenesis, and other non-cell-based therapies to explore the best therapy for refractory angina. There is conflicting data in the literature suggesting subjective improvement in angina, but very few studies boast improvement in core objective parameters such as myocardial blood flow, survival, or rehospitalizations. Patients with refractory angina are a complex group of patients that need novel approaches to help alleviate their symptoms and reduce mortality. A carefully selected sequence of therapies may provide the best results in this patient population.


Assuntos
Angina Pectoris/terapia , Doença da Artéria Coronariana/terapia , Revascularização Miocárdica/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/cirurgia , Seio Coronário/cirurgia , Contrapulsação , Previsões , Humanos , Terapia a Laser , Neovascularização Fisiológica/efeitos dos fármacos , Dor Intratável , Estimulação da Medula Espinal , Simpatectomia
5.
Heart Vessels ; 34(10): 1710-1716, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30972550

RESUMO

Phrenic nerve (PN) stimulation is essential for the elimination of PN palsy during balloon-based pulmonary vein isolation (PVI). Although ultrasound-guided vascular access is safe, insertion of a PN stimulation catheter via central venous access carries a potential risk of the development of mechanical complications. We evaluated the safety of a left cubital vein approach for positioning a 20-electrode atrial cardioversion (BeeAT) catheter in the coronary sinus (CS), and the feasibility of right PN pacing from the superior vena cava (SVC) using proximal electrodes of the BeeAT catheter. In total, 106 consecutive patients who underwent balloon-based PVI with a left cubital vein approach for BeeAT catheter positioning were retrospectively assessed. The left cubital approach was successful in 105 patients (99.1%), and catheter insertion into the CS was possible for 104 patients (99.0%). Among these patients, constant right PN pacing from the SVC was obtained for 89 patients (89/104, 85.6%). In five patients, transient loss of right PN capture occurred during right pulmonary vein ablation. No persistent right PN palsy was observed. Small subcutaneous hemorrhage was observed in eight patients (7.5%). Neuropathy, pseudoaneurysm, arteriovenous fistula, and perforations associated with the left cubital approach were not detected. Body mass index was significantly higher in the right PN pacing failure group than in the right PN pacing success group (26.2 ± 3.2 vs. 23.8 ± 3.8; P = 0.025). CS catheter placement with a left cubital vein approach for right PN stimulation was found to be safe and feasible. Right PN pacing from the SVC using a BeeAT catheter was successfully achieved in the majority of the patients. This approach may prove to be preferable for non-obese patients.


Assuntos
Fibrilação Atrial/cirurgia , Estimulação Cardíaca Artificial/métodos , Ablação por Cateter/efeitos adversos , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Frênico/lesões , Idoso , Idoso de 80 Anos ou mais , Seio Coronário/cirurgia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Veias Pulmonares/cirurgia , Estudos Retrospectivos , Veia Cava Superior/cirurgia
6.
BMC Cardiovasc Disord ; 19(1): 90, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987582

RESUMO

BACKGROUND: The ECG characteristics of the distal coronary venous system ventricular arrhythmias (VAs) share common features with VAs arising from the aortic cusps or the endocardial left ventricular outflow tract (LVOT) beneath the cusps. The purpose of this study was to identify specific electrocardiographic and electrophysiological characteristics of VAs originating from the distal great cardiac vein (GCV). METHODS: Based on the successful ablation site, patients with idiopathic VAs from the distal GCV, left coronary cusp (LCC) or the subvalvular left ventricular outflow tract (LVOT) area were included in the present study. RESULTS: The final population consisted of 39 patients (35 males, mean age 51 ± 23 years). All VAs displayed a right bundle branch block (RBBB) morphology with inferior axis. Among these patients, 15 were successfully ablated at the GCV, 15 at the LCC and 9 at the subvalvular region. A "w" pattern in lead I was present in 12 out of 15 (80%) VAs originating from the distal GCV compared to none of VAs arising from the other two sites (p < 0.01). VAs with a GCV origin exhibited more commonly increased intrinsicoid deflection time, higher maximum deflection index and wider QRS duration compared to LCC and subvalvular sites (p < 0.05). Acceptable pace mapping at the successful ablation site was achieved in 10 patients. After an average of 36 ± 24 months follow up, 14 (93.3%) patients were free from VAs recurrence. CONCLUSION: A "w" pattern in lead I may distinguish distal GCV VAs from VAs arising from the LCC or the subvalvular region.


Assuntos
Potenciais de Ação , Arritmias Cardíacas/diagnóstico , Bloqueio de Ramo/diagnóstico , Seio Coronário/fisiopatologia , Eletrocardiografia , Ventrículos do Coração/fisiopatologia , Adulto , Idoso , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/cirurgia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/cirurgia , Ablação por Cateter , Seio Coronário/cirurgia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Frequência Cardíaca , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Fatores de Tempo
7.
J Card Surg ; 34(5): 348-349, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30868639

RESUMO

In the spectrum of congenital heart diseases, anomalies involving the venous coronary sinus have received relatively little attention, although they are often associated with major congenital defects, such as atrioventricular septal defects. In cases of mitral surgery in patients with these conditions, it is mandatory to keep the problem in mind and to respect the coronary sinus when approaching the left atrium and the mitral valve.


Assuntos
Seio Coronário/anormalidades , Seio Coronário/cirurgia , Comunicação Interatrial/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Reoperação , Adulto , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Índice de Gravidade de Doença , Resultado do Tratamento
9.
Card Electrophysiol Clin ; 11(1): 131-140, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30717845

RESUMO

Cardiac resynchronization therapy (CRT) has become the gold standard for patients with systolic left ventricular function, left ventricular ejection fraction less than or equal to 35%, wide complex QRS, and symptomatic heart failure. Annual implantation volume has steadily increased because of expanding indications for CRT. Improved survival resulted in many of these patients having their CRT devices for many years and eventually requiring an increased number of device-related procedures, including coronary sinus lead revisions and replacements following a coronary sinus lead extraction.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Seio Coronário/cirurgia , Remoção de Dispositivo , Insuficiência Cardíaca/cirurgia , Humanos , Reoperação
10.
Card Electrophysiol Clin ; 11(1): 75-87, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30717855

RESUMO

The EP Clinics article "How to implant CRT devices in a busy clinical practice" describes the basics of the "interventional telescoping technique". This article focuses on specific circumstances where the tools and techniques are invaluable: (1) inability to locate the coronary sinus (CS), (2) inability to advance a catheter into the CS, (3) patients with CS atresia, (4) unstable CS access, (4) angulated target veins, (5) small and/or tortuous target veins, (6) target veins into which a wire cannot be advanced, (7) target veins with a drain pipe takeoff, (8) target veins close to the CS ostium.


Assuntos
Estimulação Cardíaca Artificial , Seio Coronário/cirurgia , Eletrodos Implantados , Implantação de Prótese , Humanos , Marca-Passo Artificial , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos
11.
Echocardiography ; 36(3): 613-614, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30735270

RESUMO

Coronary sinus atrial septal defect (ASD) is a rare congenital cardiac anomaly, which might be difficult to diagnose. In this report, we describe a patient with small secundum ASDs and an associated large coronary sinus ASD, which had been missed at initial evaluation. The diagnosis of coronary sinus ASD was established by using transesophageal echocardiography after percutaneous closure of a small secundum ASD at another center. Patient underwent corrective surgery.


Assuntos
Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Ecocardiografia Transesofagiana/métodos , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade
12.
J Cardiothorac Vasc Anesth ; 33(5): 1197-1204, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30655202

RESUMO

OBJECTIVE: To compare myocardial protection with retrograde cardioplegia alone with antegrade and retrograde cardioplegia in minimally invasive mitral valve surgery (MIMS). DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: The authors studied 97 MIMS patients using retrograde cardioplegia alone and 118 MIMS patients using antegrade and retrograde cardioplegia. INTERVENTIONS: The data from patients admitted for MIMS using retrograde cardioplegia (MIMS retro) between 2009 to 2012 were compared with the data from patients undergoing MIMS with antegrade and retrograde cardioplegia (MIMS ante-retro) between 2006 and 2010 (control group). Cardioplegia in the MIMS retro group was delivered solely through an endovascular coronary sinus (CS) catheter positioned under echographic and fluoroscopic guidance. Antegrade and retrograde cardioplegia was used in the MIMS ante-retro group. Data regarding myocardial infarction (MI; creatine kinase Mb, troponin T, electrocardiogram), myocardial function, and hemodynamic stability were collected for comparison. MEASUREMENTS AND MAIN RESULTS: Adequate cardioplegia administration (CS pressure >30 mmHg and asystole) was attained in 74.2% of the patients with retrograde cardioplegia alone. In 23.7% of the patients, the addition of an antegrade cardioplegia was necessary. No difference was observed in the incidence of MI (0 MIMS retro v 1 for MIMS ante-retro, p = 0.3623), difficult separation from cardiopulmonary bypass, and postoperative malignant arrhythmia. No difference was found for maximal creatine kinase Mb (39.1 [28.0-49.1] v 37.9 [28.6-50.9]; p = 0.8299) and for maximal troponin T levels (0.39 [0.27-0.70] v 0.47 [0.32-0.79]; p = 0.1231) for MIMS retro and MIMS ante-retro, respectively. However, lactate levels in the MIMS retro group were significantly lower than in the MIMS ante-retro group (2.1 [1.4-3.05] v 2.4 [1.8-3.3], respectively; p = 0.0453). No difference was observed in duration of intensive care unit stay and death. MIMS retro patients had a shorter hospital stay (7.0 [6.0-8.0] v 8.0 [7.0-9.0] days; p = 0.0003). CONCLUSION: Retrograde cardioplegia administration alone provided comparable myocardial protection to antegrade and retrograde cardioplegia during MIMS, but was not sufficient to achieve asystole in one-fifth of patients.


Assuntos
Cateterismo Cardíaco/métodos , Seio Coronário/cirurgia , Procedimentos Endovasculares/métodos , Parada Cardíaca Induzida/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Adulto , Idoso , Cateterismo Cardíaco/normas , Soluções Cardioplégicas/administração & dosagem , Terapia Combinada/métodos , Terapia Combinada/normas , Procedimentos Endovasculares/normas , Feminino , Parada Cardíaca Induzida/normas , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Estudos Retrospectivos
15.
Circ Arrhythm Electrophysiol ; 12(1): e006933, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30606034

RESUMO

BACKGROUND: The mitral isthmus is the critical element of perimitral reentrant tachycardias. Prolongation in transisthmus conduction time and differential pacing techniques are commonly used to determine block. However, these may not distinguish block from slow conduction or conduction via epicardial bridging connections. The aim of this study was to examine these standard criteria for mitral line block with endocardial and epicardial activation mapping. METHODS: In 56 patients, posterior mitral line was performed using radiofrequency ablation. Conduction block was defined as transisthmus time (≥100 ms) and reversal of coronary sinus activation during pacing from the left atrial appendage. These results were compared with high-resolution activation mapping (Rhythmia) of the endocardium and epicardium via the coronary sinus. RESULTS: Mitral block determined by pacing was achieved in 51 out of 56 (91%) patients. In 11 out of 51 (21.6%), activation mapping demonstrated residual endocardial (3/11; 27.2%) or epicardial (8/11; 72.7%) connections. Epicardial bridging connections were distant from the line (2.4±1.6 cm), inserting laterally at the proximal-middle coronary sinus and septally at the left atrial ridge. Patients with residual conduction were prone to complex circuits involving the epicardium (7/11; 63.6%). Mitral line block was achieved in 75% by targeting these insertion site(s). The transisthmus conduction time had limited predictive value for distinguishing block from pseudoblock. CONCLUSIONS: Standard criteria for posterior mitral line block may not distinguish block from pseudoblock. In particular, epicardial bridging connections can result in prolonged transisthmus conduction time and reversal in coronary sinus activation to falsely suggest block. These connections are a frequent cause for complex circuits, and their insertion site(s) can be targeted for ablation.


Assuntos
Fibrilação Atrial/cirurgia , Flutter Atrial/cirurgia , Seio Coronário/cirurgia , Frequência Cardíaca , Valva Mitral/cirurgia , Veias Pulmonares/cirurgia , Ablação por Radiofrequência/métodos , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Estimulação Cardíaca Artificial , Seio Coronário/fisiopatologia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estudos Prospectivos , Veias Pulmonares/fisiopatologia , Ablação por Radiofrequência/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
16.
J Robot Surg ; 13(2): 319-323, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29796843

RESUMO

Left-sided partial anomalous pulmonary venous connection to the coronary sinus is a rare congenital cardiac defect. Surgical repair is indicated to prevent cardiopulmonary morbidities that may occur in later age. Although the conventional median sternotomy or thoracotomy incisions are used during surgical repair, robotic surgery can be a feasible alternative approach to this pathology. In this case, we report a 14-year-old child, who was diagnosed with left partial anomalous pulmonary venous connection to the coronary sinus. A total endoscopic robotic repair was successfully done via right atriotomy approach. After routing of the pulmonary venous return from the left lung to the left atrium, the interatrial septum was reconstructed with a pericardial patch. We report a successful use of totally endoscopic robotic approach in a patient diagnosed with left-sided partial anomalous pulmonary venous connection.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/métodos , Seio Coronário/anormalidades , Seio Coronário/cirurgia , Cardiopatias Congênitas/cirurgia , Comunicação Interatrial/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adolescente , Procedimentos Cirúrgicos Cardiovasculares/instrumentação , Seio Coronário/diagnóstico por imagem , Ecocardiografia Transesofagiana , Cardiopatias Congênitas/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Veias Pulmonares/diagnóstico por imagem , Procedimentos Cirúrgicos Robóticos/instrumentação , Resultado do Tratamento
18.
J Cardiovasc Electrophysiol ; 30(1): 7-15, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30461121

RESUMO

INTRODUCTION: Beyond pulmonary veins (PV) isolation, the ablation strategy for persistent atrial fibrillation (AF) remains controversial. Substrate ablation may provide a high termination rate but at the cost of impaired atrial physiology and recurrent complex re-entries. To overcome these pitfalls, we investigated a new lesion set based on important anatomical considerations. METHODS AND RESULTS: The case series included 10 consecutive patients with persistent AF. Three atrial structures were successively targeted: (1) coronary sinus and vein of Marshall (CS-VOM) musculature elimination; (2) PVs isolation; and (3) anatomical isthmuses block. The lesion set completion was the procedural endpoint. Step 1: VOM ethanol infusion was feasible in all cases (mean time of 33.4 ± 9.4 minutes), mean radiofrequency (RF) time for CS-VOM bundles was 14.4 ± 6.9 minutes. Step 2: mean RF time for PV isolation was 27.7 ± 9.3 minutes. Step 3: mean RF time for mitral, roof, and cavotricuspid lines was 5.7 ± 2.3, 8.1 ± 4.3, and 5.9 ± 1.9 minutes, respectively. The lesion set was achieved in all patients. Mean procedure time was 270 ± 29.9 minutes. AF termination and noninducibility were, respectively, obtained in 50% and 90% of the patients. After a 6-month follow-up, all patients were free from arrhythmia recurrence. CONCLUSION: The present case series reports a new ablation strategy systematically targeting anatomical structures previously identified as possibly involved in the fibrillatory process and the recurrent tachycardias. The resulting lesion set provides good short-term outcomes. Although promising, these preliminary results need to be confirmed in the larger prospective study.


Assuntos
Fibrilação Atrial/cirurgia , Seio Coronário/cirurgia , Etanol/administração & dosagem , Sistema de Condução Cardíaco/cirurgia , Veias Pulmonares/cirurgia , Ablação por Radiofrequência , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Seio Coronário/fisiopatologia , Etanol/efeitos adversos , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dados Preliminares , Intervalo Livre de Progressão , Veias Pulmonares/fisiopatologia , Ablação por Radiofrequência/efeitos adversos , Fatores de Risco , Fatores de Tempo
19.
Pacing Clin Electrophysiol ; 42(4): 470-473, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30430590

RESUMO

Escape mapping is a novel technique that can be used to locate sites of persistent conduction and achieve exit block during an atrial fibrillation ablation. This method allows for mapping solely with the ablation catheter in the left atrium by annotating to a catheter in the coronary sinus. We illustrate the utility escape mapping during an atrial fibrillation ablation where entrance block is achieved without exit block. We further expand upon this technique by describing the first reported case of escape mapping being used to achieve bidirectional block during an atrial flutter ablation.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Flutter Atrial/fisiopatologia , Flutter Atrial/cirurgia , Ablação por Cateter/métodos , Mapeamento Epicárdico , Sistema de Condução Cardíaco/fisiopatologia , Idoso , Seio Coronário/fisiopatologia , Seio Coronário/cirurgia , Ecocardiografia , Eletrocardiografia , Humanos , Masculino
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