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1.
BMC Cardiovasc Disord ; 22(1): 352, 2022 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-35922759

RESUMO

BACKGROUND: The KODEX-EPD system is a novel, dielectric three-dimensional mapping system. We aim to illustrate the feasibility, safety, and outcomes of ablation using the KODEX-EPD system. METHODS: A total of 272 patients with supraventricular arrhythmias were enrolled and underwent catheter ablation using the KODEX-EPD system from October 2020 to July 2021. The feasibility, safety, and ablation outcomes were analyzed. RESULTS: Of the enrolled patients, 15 (5.4%) had atrial tachycardia (AT), 88 (31.4%) had atrioventricular reentrant tachycardia (AVRT), 141 (50.4%) had atrioventricular nodal reentrant tachycardia (AVNRT), 34 (12.1%) had atrial fibrillation (AF), and 9 (3.2%) had atrial flutter (AFL). All AF patients included were first-do-pulmonary vein isolation (PVI); there were 26 paroxysmal AF and 8 persistent AF. All patients achieved immediate success of ablation. The mean follow-up duration was 11.8 ± 2.4 months. One patient (1.1%) in the AVRT subgroup and two patients (1.4%) in the AVNRT subgroup experienced recurrence. When considering a three-month blanking time, the estimated freedom of AF at one-year post-ablation with and without AADs was 75.7% and 70.4%, respectively. The Kaplan-Meier analysis showed no significant difference in the overall AF recurrence (log-rank; P = 0.931) or AAD-free AF recurrence (log-rank; P = 0.841) between RFCA and cryoablation. One patient had mild pulmonary embolism. None of the patients died or had a cerebrovascular event in the periprocedural period. CONCLUSIONS: This retrospective, two-center study demonstrated that catheter ablation of supraventricular arrhythmias using the KODEX-EPD system is feasible, safe, and effective. Trial registration Retrospectively registered.


Assuntos
Fibrilação Atrial , Flutter Atrial , Ablação por Cateter , Veias Pulmonares , Taquicardia por Reentrada no Nó Atrioventricular , Taquicardia Supraventricular , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Ablação por Cateter/efeitos adversos , China , Humanos , Veias Pulmonares/cirurgia , Recidiva , Estudos Retrospectivos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/cirurgia , Resultado do Tratamento
2.
Korean J Radiol ; 23(8): 794-802, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914744

RESUMO

OBJECTIVE: To evaluate the feasibility of single-shot whole thoracic time-resolved MR angiography (TR-MRA) to identify the feeding arteries of pulmonary arteriovenous malformations (PAVMs) and reperfusion of the lesion after embolization in patients with multiple PAVMs. MATERIALS AND METHODS: Nine patients (8 females and 1 male; age range, 23-65 years) with a total of 62 PAVMs who underwent percutaneous embolization for multiple PAVMs and were subsequently followed up using TR-MRA and CT obtained within 6 months from each other were retrospectively reviewed. All imaging analyses were performed by two independent readers blinded to clinical information. The visibility of the feeding arteries on maximum intensity projection (MIP) reconstruction and multiplanar reconstruction (MPR) TR-MRA images was evaluated by comparing them to CT as a reference. The accuracy of TR-MRA for diagnosing reperfusion of the PAVM after embolization was assessed in a subgroup with angiographic confirmation. The reliability between the readers in interpreting the TR-MRA results was analyzed using kappa (κ) statistics. RESULTS: Feeding arteries were visible on the original MIP images of TR-MRA in 82.3% (51/62) and 85.5% (53/62) of readers 1 and 2, respectively. Using the MPR, the rates increased to 93.5% (58/62) and 95.2% (59/62), respectively (κ = 0.760 and 0.792, respectively). Factors for invisibility were the course of feeding arteries in the anteroposterior plane, proximity to large enhancing vessels, adjacency to the chest wall, pulsation of the heart, and small feeding arteries. Thirty-seven PAVMs in five patients had angiographic confirmation of reperfusion status after embolization (32 occlusions and 5 reperfusions). TR-MRA showed 100% (5/5) sensitivity and 100% (32/32, including three cases in which the feeding arteries were not visible on TR-MRA) specificity for both readers. CONCLUSION: Single-shot whole thoracic TR-MRA with MPR showed good visibility of the feeding arteries of PAVMs and high accuracy in diagnosing reperfusion after embolization. Single-shot whole thoracic TR-MRA may be a feasible method for the follow-up of patients with multiple PAVMs.


Assuntos
Malformações Arteriovenosas , Embolização Terapêutica , Veias Pulmonares , Adulto , Idoso , Angiografia , Fístula Arteriovenosa , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
Ann Card Anaesth ; 25(3): 356-358, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35799568

RESUMO

Pulmonary vein thrombosis (PVT) is a potentially fatal complication following lung transplantation (LT). The clinical presentation of PVT is nonspecific and mimics other common postoperative complications such as reperfusion injury, infection, and rejection. Transesophageal echocardiography (TEE) plays a pivotal role in detecting abnormalities of the pulmonary venous anastomosis in the perioperative period. Echocardiographic findings that warrant concern include a visible thrombus in pulmonary vein, pulmonary vein diameter <5 mm, turbulence on color Doppler, and peak systolic velocity >100 cm/s. Transplant centers should strongly consider TEE in individual patients with unexplained graft failure.


Assuntos
Transplante de Pulmão , Veias Pulmonares , Trombose Venosa , Ecocardiografia Transesofagiana , Humanos , Hipóxia/diagnóstico por imagem , Hipóxia/etiologia , Hipóxia/terapia , Transplante de Pulmão/efeitos adversos , Circulação Pulmonar , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Trombose Venosa/etiologia
4.
Am J Case Rep ; 23: e936315, 2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35821628

RESUMO

BACKGROUND Pulmonary vein isolation is a method of cardiac ablation therapy used to treat irregular heart rhythm, including atrial fibrillation (AF). This report presents a case of esophagopericardial fistula (EPF) and pneumopericardium as a complication of pulmonary vein isolation in a 62-year-old man with AF. CASE REPORT We report the rare case of a 62-year-old man with a medical history of persistent atrial fibrillation status after ablation 3 days prior to his initial Emergency Department visit for chest pain. Acute coronary syndrome was ruled out with normal electrocardiogram, echocardiography, and troponin tests. Fluid overload and sotalol adverse effects were presumed to be the cause of his symptoms. We discontinued sotalol with diuresis and he was discharged home when his chest pain subsided. Nine days later, he returned to the Emergency Department with worsening similar symptoms and was eventually diagnosed with EPF and pneumopericardium on a computed tomography scan of the chest with contrast. He was managed with esophagogastroduodenoscopy and stent placement along with subxiphoid pericardial window and pericardial drain placement. The patient was discharged in stable condition after removing the pericardial drain. At 10-day and 1-month follow-up, he had no recurrent symptoms. CONCLUSIONS This report shows that although EPF with pneumopericardium is a rare complication of pulmonary vein isolation, it should be rapidly diagnosed and treated as a life-threatening emergency.


Assuntos
Fibrilação Atrial , Fístula , Pneumopericárdio , Veias Pulmonares , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Dor no Peito , Fístula/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumopericárdio/diagnóstico por imagem , Pneumopericárdio/etiologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Sotalol
5.
Kardiologiia ; 62(6): 23-29, 2022 Jun 30.
Artigo em Russo | MEDLINE | ID: mdl-35834338

RESUMO

Aim      To identify risk factors for recurrence of atrial fibrillation (AF) following cryoballoon ablation (CBA).Material and methods  This prospective study included patients with paroxysmal AF who had undergone CBA (141 patients, median age 60 years, 3% men). The evaluation prior to CBA included clinical instrumental parameters (electrocardiography (ECG), 24-h ECG monitoring, echocardiography, contrast-enhanced cardiac multispiral computed tomography). Also, possible intraoperative indexes that could affect the CBA effectivity, were evaluated. The postoperative follow-up duration was 12 months. Effectivity was assessed during in-person visits at 3, 6, and 12 months, when questioning of patients and 24-h ECG monitoring were performed. CBA was considered ineffective if the patient had recurrences of any atrial tachyarrhythmia longer than 30 sec after the end of the 3-month "blind" period.Results During the 12-month follow-up, recurrences of atrial tachyarrhythmia were observed in 46 (32.6 %) patients. Patients with ineffective CBA more frequently had AF during the first 3 months (71.7 % vs. 11.6 %; р<0.001). Such patients had a history of multiple ineffective treatments with antiarrhythmic drugs (AAD), common pulmonary venous (PV) collector (41.3 % vs. 20.0 %; р=0.008), and stroke/recurrent ischemic attacks (15.2 % vs. 5.2 %; р=0.047). Multifactorial regression analysis showed that the factors of AF recurrence included common PV collector (relative risk (RR) 2.35; 95 % confidence interval (CI) 1.29-4.25; р=0.005), multiple ineffective AADs (RR 1.42; 95 % CI 1.08-1.86; р=0.011), and early AF recurrence (RR 7.57; 95 % CI 3.84-14.90; р<0.001).Conclusion      Common PV collector and multiple ineffective AADs are risk factors of ineffective CBA. Early recurrences during the first 3 postoperative months are a significant risk factor of long-term AF recurrences.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/cirurgia , Recidiva , Fatores de Risco , Resultado do Tratamento
6.
Int Heart J ; 63(4): 708-715, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35908854

RESUMO

Ablation index (AI)-guided linear ablation is reported to be feasible.We assessed the feasibility of AI-guided left atrial (LA) posterior wall isolations (PWIs) using different target AI values.Seventy-one persistent atrial fibrillation patients who underwent AI-guided PWIs following pulmonary vein isolation were included. LA linear lesions were created with strict contiguity (inter-lesion distance < 4 mm) and different predetermined AI target values (Group-1: 430, Group-2: 450). The data was analyzed retrospectively.The total radiofrequency application time of the roof and bottom-line ablation was a median of 2.8 (2.0, 3.8) and 3.6 (2.8, 4.3) minutes. The first-pass PWI success rate (26/35 [74.3%] versus 16/36 [44.4%], P = 0.011) and a first-pass roof line block (28/35 [80.0%] versus 21/36 [58.3%], P = 0.048) were significantly higher in Group-2 than Group-1, but that for the first-pass bottom line block was similar between Group-1 and Group-2 (29/36 [80.6%] versus 29/35 [82.9%], P = 0.80). Successful PWIs were achieved by additional applications in all. The significant parameter associated with a successful first-pass LA roof line block was a greater RF power, and that for the LA bottom were a higher radiofrequency power and shorter inter-lesion distance. Conduction gaps were mostly located at the middle of both lines. Among 22 roof line gaps, 12 were closed on the line whereas 10 (45.4%) required ablation inside the posterior wall for PWIs. On the contrary, all 11 gaps on bottom lines were closed on the line.Successful first-pass PWIs were obtained in 74% of patients using a target AI value of 450 and strict criteria for the lesion contiguity.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Humanos , Veias Pulmonares/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
7.
PLoS One ; 17(7): e0265482, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35895713

RESUMO

BACKGROUND: Cryoballoon ablation was established as an effective and safe modality to achieve pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). However, its role in persistent atrial fibrillation (PersAF) remains unclear. OBJECTIVE: This study aimed to evaluate the efficacy and safety of cryoballoon PVI in PAF and PersAF comparing conventional radiofrequency catheter ablation (RFCA). METHODS: Two hundred patients undergoing cryoballoon ablation for symptomatic AF were consecutively enrolled in this retrospective study. For comparison, 210 patients undergoing RFCA in the same period were included. The primary outcome was a recurrence of any atrial tachyarrhythmias (ATas) after the index ablation. 12-lead ECG and 24-hour Holter monitoring were obtained at 1,3,6 and 9-12 months. RESULTS: PVI by cryoablation alone was achieved in 197 patients (98.5%). ATas-free survival at 12 months post-ablation was 72.7% in the cryoablation and 80.6% in the RFCA group (P = 0.123), respectively. The cryoablation showed comparable efficacy maintaining sinus rhythm compared with RFCA in PAF (P = 0.539), whereas in PersAF, ATas-free survival was significantly lower in cryoablation (P = 0.039). PV reconnection was observed in the majority of patients (14/16, 87.5%) who receive redo RFCA. Complications were encountered in 10 patients, including femoral arteriovenous fistula (n = 1), transient phrenic nerve palsy (n = 8), and minimal amount pericardial effusion (n = 1). CONCLUSION: The efficacy of cryoballoon PVI is comparable with conventional RFCA in PAF, whereas PVI alone using cryoballoon may not be insufficient to maintaining sinus rhythm in PersAF. The safety of cryoballlon PVI is tolerable.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Humanos , Veias Pulmonares/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
11.
JACC Clin Electrophysiol ; 8(7): 882-891, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35863814

RESUMO

BACKGROUND: Benefits of adjunctive ablation strategies beyond circumferential pulmonary vein isolation (CPVI) are uncertain in patients with persistent atrial fibrillation (PeAF). OBJECTIVES: This study sought to compare clinical outcomes of CPVI plus low-voltage area (LVA) modification during STABLE-SR (SubsTrate ABlation in the LEft Atrium during Sinus Rhythm) vs circumferential pulmonary vein isolation (CPVI) alone in patients with PeAF. METHODS: From March 2018 to August 2019, 300 patients with PeAF who underwent de novo ablation were recruited and prospectively randomized to either STABLE-SR group (n = 150) or CPVI alone (n = 150) group. In the STABLE-SR group, after CPVI, high-density voltage mapping of left atrium (LA) was performed during sinus rhythm, and additive ablation targeted LVA and complex electrograms, if any were present. All the ablations were titrated by ablation index. The primary endpoint was freedom from documented atrial arrhythmias lasting for ≥30 s without the use of antiarrhythmic drugs, after a single ablation procedure and blanking period of 3 months. RESULTS: After 18 months, atrial-arrhythmia-free survival did not differ significantly between STABLE-SR group and CPVI alone group (67.2% vs 67.4%; HR: 0.89; 95% CI: 0.55-1.36; P = 0.52). Only around one-half of the patients (50.2%) had abnormal LA substrate with a medium LVA burden of 4.6% (2.1%-9.5%). However, the success rate differs dramatically between patients with normal vs abnormal LA substrate (84.8% vs 60.9%; P < 0.001). CONCLUSIONS: Additional LVA ablation did not improve successful rates of CPVI in this PeAF cohort, of whom one-half had normal LA substrate. Voltage map could identify patients with PeAF with normal LA substrate who can achieve excellent rhythm control with CPVI alone. (CPVI Alone Versus CPVI Plus Electrophysiological Substrate Ablation in the LA During SR for the Treatment of Non-PAF [STABLE-SR_II]; NCT03448562).


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Humanos , Veias Pulmonares/cirurgia , Fatores de Tempo , Resultado do Tratamento
12.
JACC Clin Electrophysiol ; 8(7): 895-904, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35863816

RESUMO

BACKGROUND: Pulmonary vein isolation (PVI) by radiofrequency (RF) energy is associated with a collateral ganglionated plexi ablation. Pulsed electric field (PEF) is a nonthermal energy source that preferentially affects the myocardial cells and spares neural tissue. OBJECTIVES: This study investigated whether PVI by a PEF compared with RF energy will result in less prominent alteration of the cardiac autonomic nervous system. METHODS: A total of 31 patients with atrial fibrillation underwent PVI using a novel lattice-tip catheter and PEF energy (n = 18) or a conventional irrigated-tip catheter and RF energy (n = 13). The response of the sinoatrial node and atrioventricular node to extracardiac high-frequency, high-output, right vagal nerve stimulation was evaluated at baseline and during and at the end of the ablation procedure. Substantial reduction in responsiveness was arbitrarily defined as stimulation-inducible pause <1.5 seconds. RESULTS: Reduced response of the sinoatrial node was documented in 13 of 13 (100%) and 6 of 18 (33%) patients (P = 0.0001) in RF and PEF groups, respectively. Reduced response of the atrioventricular node was found in 10 of 11 (93%) and 6 of 18 (33%) patients (P = 0.002) in RF and PEF groups, respectively. The major effects were observed predominantly during ablation around the right pulmonary veins. Early recovery of ganglionated plexi function was noticed only in the PEF ablation group. RF ablation resulted in higher acceleration of the sinus rhythm compared with PEF ablation (20 ± 13 beats/min vs 12 ± 10 beats/min; P = 0.04). CONCLUSIONS: PEF compared with RF energy used for PVI induces significantly weaker and less durable suppression of cardiac autonomic regulations.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Sistema Nervoso Autônomo , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Humanos , Veias Pulmonares/cirurgia , Nó Sinoatrial
13.
Expert Rev Med Devices ; 19(5): 431-439, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35786107

RESUMO

INTRODUCTION: Catheter ablation has been demonstrated to be a safe and an effective treatment for drug resistant atrial fibrillation (AF); electrical isolation of pulmonary veins (PVI) is the main strategy in paroxysmal AF, since pulmonary vein triggers have a pivotal role in its pathogenesis; non-paroxysmal AF is a complex arrhythmia that results from the interplay of a substrate, namely AF-induced electrical and structural atrial remodeling, and a trigger that can be often found outside pulmonary veins, namely non-pulmonary veins triggers. AREAS COVERED: The aim of this review is to provide a state-of-the-art overview of non-pulmonary veins triggers with special focus on cryoballoon (CB) catheter ablation. EXPERT OPINION: Besides PVI, CB catheter ablation of non-pulmonary veins triggers is a novel and promising strategy for non-paroxysmal AF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Humanos , Veias Pulmonares/cirurgia , Resultado do Tratamento
14.
Circ J ; 86(8): 1229-1236, 2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35786690

RESUMO

BACKGROUND: Pulmonary vein (PV) stenosis after atrial fibrillation (AF) ablation is rare; however, it remains a serious complication. PV angioplasty is reportedly an effective therapy; however, a dedicated device for PV angioplasty has not been developed, and the detailed procedural methods remain undetermined. This study describes the symptoms, indications, treatment strategies, and long-term outcomes for PV stenosis after AF ablation.Methods and Results: This study retrospectively analyzed 7 patients with PV stenosis after catheter ablation for AF and who had undergone PV angioplasty at our hospital during 2015-2021. PV stenosis occurred in the left superior (5 patients) and left inferior (2 patients) PV. Six patients had hemoptysis, chest pain, and dyspnea. Seven de novo lesions were treated using balloon angioplasty (BA) (3 patients), a bare metal stent (BMS) (3 patients), and a drug-coated balloon (DCB) (1 patient). The restenosis rate was 42.9% (n=3; 2 patients in the BA group and 1 patient in the DCB group). The repeat treatment rate was 28.6% (2 patients in the BA group). Stenting was performed as repeat treatment. One patient with subsequent repeat restenosis development underwent BA. Ten PV angioplasties were performed; there were no major complications. CONCLUSIONS: Regarding PV angioplasty after ablation therapy for AF, stenting showed superior long-term PV patency than BA alone; therefore, it should be considered as a standard first-line approach.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Estenose de Veia Pulmonar , Angioplastia/efeitos adversos , Angioplastia/métodos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Constrição Patológica/complicações , Humanos , Veias Pulmonares/cirurgia , Estudos Retrospectivos , Estenose de Veia Pulmonar/diagnóstico por imagem , Estenose de Veia Pulmonar/etiologia , Estenose de Veia Pulmonar/terapia , Resultado do Tratamento
15.
Circ J ; 86(8): 1219-1228, 2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35786692

RESUMO

BACKGROUND: The existence of epicardial connection(s) (ECs) between the pulmonary veins (PVs) and atrium may hinder establishing a complete PV antrum isolation (AI) (PVAI) in patients with atrial fibrillation (AF). Thus, the purpose of this study was to determine the prevalence and location of ECs inside the conventional PVAI lines.Methods and Results: Three-hundred consecutive patients with non-valvular AF were evaluated. This study revealed that: (1) the prevalence of patients with ECs and the number of ECs per patient between the PVs and atrium became significantly greater, respectively, in accordance with the progression of paroxysmal to long-lasting AF and left atrial enlargement; (2) some ECs were located at sites far distal to the PVAI lines; (3) 25% of ECs could be detected only by high-density mapping catheters, but not by conventional circular mapping catheters; (4) a B-type natriuretic peptide (BNP) level of 176.6pg/mL and left atrial volume (LAV) of 129.0 mL may be important predictors of the presence of ECs; and (5) the rate of conduction of ECs from the right PVs was dominantly to the atrium and His-bundle, and that from the left PVs to the coronary sinus was most dominant. CONCLUSIONS: The PVAI may not be completed by using only a conventional PVAI method, and additional EC ablation inside the PVAI lines detected using high-density mapping may be able to achieve a more complete PVAI.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Átrios do Coração/cirurgia , Frequência Cardíaca , Humanos , Veias Pulmonares/cirurgia , Resultado do Tratamento
16.
PLoS One ; 17(7): e0271958, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35881612

RESUMO

BACKGROUND: Neutrophil activation drives lung complications after cardiopulmonary bypass (CPB). Evidence suggests the healthy, ventilated lung may beneficially re-condition pro-inflammatory neutrophils. However, evidence in humans is lacking, due to a paucity of good models. CPB with simultaneous central venous and bilateral pulmonary vein sampling provides an opportunity to model effects of one-lung ventilation. The study's primary objectives were to establish a model of intra-operative, bilateral pulmonary vein sampling and to determine whether neutrophil function differed after passing through inflated or deflated lungs. METHODS: Seventeen patients having "on pump" coronary artery bypass grafting (CABG) with one-lung ventilation (in two cohorts with tidal volume 2ml kg-1 and FiO2 0.21, or tidal volume 4 ml kg-1 and FiO2 0.5 respectively) were recruited. Cohort 1 consisted of 9 patients (7 male, median age 62.0 years) and Cohort 2 consisted of 8 male patients (median age 65.5 years). Recruitment was via prospective screening of scheduled elective and non-elective CABG procedures with cardiopulmonary bypass. Each patient had five blood samples taken-central venous blood pre-operatively; central venous blood pre-CPB; central venous blood post-CPB; pulmonary venous blood draining the ventilated lung post-CPB; and pulmonary venous blood draining the deflated lung post-CPB. Neutrophil phagocytosis and priming status were quantified. Plasma cytokines were measured. RESULTS: Phagocytosis and priming were not significantly different in neutrophils returning from the ventilated lung as compared to the non-ventilated lung. Plasma IL-6, IL-8 and IL-10 were significantly elevated by CPB. CONCLUSIONS: The intra-operative, bilateral pulmonary vein sampling model provides unique opportunities to assess biological effects of interventions to one lung, with the other lung acting as an internal control. Single-lung ventilation during CPB had no significant effects on neutrophil function.


Assuntos
Ventilação Monopulmonar , Veias Pulmonares , Idoso , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Oxigênio , Estudos Prospectivos , Veias Pulmonares/cirurgia
17.
Am J Vet Res ; 83(10)2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35895754

RESUMO

OBJECTIVE: To evaluate pulmonary vein (PV)-to-pulmonary artery (PA) ratios obtained in healthy dogs by means of various CT protocols, accounting for the effects of the respiratory phase and contrast agent used. ANIMALS: 10 healthy Beagles. PROCEDURES: Before and after contrast medium (600 mg iodine/kg) was injected IV, thoracic CT was performed with a positive-pressure breath-hold (inspiratory phase) and at the end of expiration (expiratory phase). After CT scanning, echocardiography was performed, and an optimized right parasternal long-axis view was obtained for measurement of PV and PA diameters. The PV and PA diameters were measured subsequently for each CT protocol. RESULTS: Mean ± SD PV:PA values obtained from pre- and postcontrast inspiratory CT were 1.058 ± 0.072 and 1.020 ± 0.053, respectively, which were comparable to the echocardiographic value (P > .05). Mean PV:PA values obtained with pre- and postcontrast expiratory CT were 1.259 ± 0.094 and 1.239 ± 0.066, respectively, which were significantly (P = .005) greater than inspiratory CT measurements. There was a significant (r > 0.5, P < .05) linear relationship between PV:PA values obtained with pre- and postcontrast inspiratory CT and echocardiography. CLINICAL RELEVANCE: PV:PA could be measured with thoracic CT in a manner similar to that for echocardiography. However, PV:PA values measured with expiratory CT were different from previously reported values. Therefore, the respiratory phase should be considered when evaluating pulmonary vascular size through CT, and measurements with the inspiratory CT protocol would be more accurate.


Assuntos
Artéria Pulmonar , Veias Pulmonares , Animais , Meios de Contraste/farmacologia , Cães , Ecocardiografia/veterinária , Pulmão , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/veterinária
18.
Scand Cardiovasc J ; 56(1): 224-230, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35792722

RESUMO

Background. Far-field electrograms from superior vena cava (SVC) can be present in right superior pulmonary vein (RSPV) after pulmonary vein (PV) isolation. Objectives. To analyze the characteristics of far-field SVC potentials in RSPV after PV isolation and the local anatomy difference between patients with and without the potentials. Methods. Patients undergoing PV isolation were retrospectively reviewed, contrast-enhanced computed tomography (CT) was performed before procedure for observing the anatomical relationship between RSPV and SVC. The prevalence and characteristics of far-field SVC electrograms were described and compared to far-field left atrial potentials at the nearest point along the linear ablation lesion. The anatomical proximity of RSPV and SVC on a 2-dimensional horizontal CT view was compared between patients with and without far-field SVC potentials. Results. Far-field SVC electrograms were observed in 35/92(38%) patients with an amplitude of 0.24 ± 0.11 mV and a major deflection slope of 0.051 ± 0.036 mV, both significantly higher than far-field left atrial electrograms (p < .001). In patients with far-field SVC electrograms, 83% had connected RSPV-SVC, defined as distance between RSPV and SVC endocardium less than 3 mm at the layer of RSPV ostium roof, while in patients without far-field SVC electrograms, 70% had disconnected RSPV-SVC. Conclusions. Far-field SVC electrograms appeared in RSPV had a prevalence higher than previously reported and a sharper major deflection compared to far-field left atrial electrograms. Connected RSPV-SVC on CT was associated with the presence of far-field SVC electrograms.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Estudos Retrospectivos , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgia
19.
Heart Surg Forum ; 25(3): E381-E384, 2022 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-35787765

RESUMO

Williams-Beuren syndrome (WBS) is a genetic disease involving the gene deletion of a chromosome. It is sporadically caused by the disruption of the elastin gene at the locus 7q11.23, and it occurs in as many as 1:7,500 individuals [Zucker 2018]. WBS includes cardiac lesions and a wide spectrum of congenital malformations with cardiovascular disorders, representing the most worrisome ones. The most typically frequent cardiovascular anomalies primarily comprise supravalvular aortic stenosis, peripheral pulmonary stenosis, mitral regurgitation, and aortic coarctation [Matisoff 2015]. Other main features include central nervous system and connective tissue involvement, mainly with a characteristic elfin face, mental and growth retardation, and hypercalcemia. We report a rare case of WBS with right pulmonary arteriovenous fistula (PAVF), associated with supravalvular aortic membrane stenosis, mitral regurgitation, and aortic coarctation. The patient underwent two-stage surgical treatment with satisfactory results at 5 years of follow-up.  This case study was approved by the local research ethics board. Written informed consent was obtained from this patient.


Assuntos
Coartação Aórtica , Insuficiência da Valva Mitral , Síndrome de Williams , Adulto , Fístula Arteriovenosa , Humanos , Insuficiência da Valva Mitral/complicações , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Veias Pulmonares/anormalidades , Síndrome de Williams/complicações , Síndrome de Williams/diagnóstico , Síndrome de Williams/genética
20.
J Am Heart Assoc ; 11(15): e026290, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35862178

RESUMO

Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter-defibrillator (ICD) might experience inappropriate shocks for fast AF. Long-term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long-term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow-up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non-BrS group (log-rank P=0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second (P=0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% (P=0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD-inappropriate shock for fast AF. In the BrS cohort, ICD-inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P=0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies.


Assuntos
Fibrilação Atrial , Flutter Atrial , Síndrome de Brugada , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Síndrome de Brugada/complicações , Síndrome de Brugada/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Humanos , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento
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