The safety of transesophageal echocardiography to guide transcatheter tricuspid valve edge-to-edge repair.

BACKGROUND: Transesophageal echocardiography (TEE) is primarily used to guide transcatheter structural heart interventions, such as tricuspid transcatheter edge-to-edge repair (TEER). Although TEE has a good safety profile, it is still an invasive imaging technique that may be associated with complications, especially when performed during long transcatheter procedures or on frail patients. The aim of this study was to assess TEE-related complications during tricuspid TEER. METHODS: This is a prospective study enrolling 53 patients who underwent tricuspid TEER for severe tricuspid regurgitation (TR). TEE-related complications were assessed clinically and divided into major (life-threatening, major bleeding requiring transfusions or surgery, organ perforation, and persistent dysphagia) and minor (perioral hypesthesia, < 24 h dysphagia/odynophagia, minor intraoral bleeding and hematemesis not requiring transfusion) RESULTS: The median age of the patient population was 79 years; 43.4% had severe, 39.6% massive, and 17.6% torrential TR. 62.3% of patients suffered from upper gastrointestinal disorders. Acute procedural success (APS) was achieved in 88.7% in a median device time of 36 min. A negative association was shown between APS and lead-induced etiology (r = -.284, p = .040), baseline TR grade (r = -.410, p = .002), suboptimal TEE view (r = -.349, p = .012), device time (r = -.234, p = .043), and leaflet detachment (r = -.496, p < .0001). We did not observe any clinical manifest major or minor TEE-related complications during the hospitalization. CONCLUSIONS: Our study reinforces the good safety profile and efficacy of TEE guidance during tricuspid TEER. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious complications. Furthermore, suboptimal intraprocedural TEE views are associated with lower TR reduction rates. HIGHLIGHTS: Transesophageal echocardiography is a crucial and safe technique for guiding transcatheter structural heart interventions. A mix of mid/deep esophageal and trans gastric views, as well as real-time 3D imaging is generally used to guide the procedure. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious problems. A shorter device time is associated with more rarely probe-related complications. Suboptimal intraprocedural TEE views are associated with lower TR reduction rates.

Carcinogenesis from chronic exposure to radio-frequency radiation.

The past two decades have seen exponential growth in demand for wireless access that has been projected to continue for years to come. Meeting the demand would necessarily bring about greater human exposure to microwave and radiofrequency (RF) radiation. Our knowledge regarding its health effects has increased. Nevertheless, they have become a focal point of current interest and concern. The cellphone and allied wireless communication technologies have demonstrated their direct benefit to people in modern society. However, as for their impact on the radiation health and safety of humans who are unnecessarily subjected to various levels of RF exposure over prolonged durations or even over their lifetime, the jury is still out. Furthermore, there are consistent indications from epidemiological studies and animal investigations that RF exposure is probably carcinogenic to humans. The principle of ALARA-as low as reasonably achievable-ought to be adopted as a strategy for RF health and safety protection.

Artificial intelligence enabled non-invasive T-ray imaging technique for early detection of coronavirus infected patients.

A new artificial intelligence (AI) supported T-Ray imaging system designed and implemented for non-invasive and non-ionizing screening for coronavirus-affected patients. The new system has the potential to replace the standard conventional X-Ray based imaging modality of virus detection. This research article reports the development of solid state room temperature terahertz source for thermograph study. Exposure time and radiation energy are optimized through several real-time experiments. During its incubation period, Coronavirus stays within the cell of the upper respiratory tract and its presence often causes an increased level of blood supply to the virus-affected cells/inter-cellular region that results in a localized increase of water content in those cells & tissues in comparison to its neighbouring normal cells. Under THz-radiation exposure, the incident energy gets absorbed more in virus-affected cells/inter-cellular region and gets heated; thus, the sharp temperature gradient is observed in the corresponding thermograph study. Additionally, structural changes in virus-affected zones make a significant contribution in getting better contrast in thermographs. Considering the effectiveness of the Artificial Intelligence (AI) analysis tool in various medical diagnoses, the authors have employed an explainable AI-assisted methodology to correctly identify and mark the affected pulmonary region for the developed imaging technique and thus validate the model. This AI-enabled non-ionizing THz-thermography method is expected to address the voids in early COVID diagnosis, at the onset of infection.

Fluoroscopy-free AF ablation using transesophageal echocardiography and electroanatomical mapping technology.

PURPOSE: Guidelines recommend that radiation exposure during AF catheter ablation procedures should be 'as low as reasonably achievable' (ALARA), particularly since many patients may have multiple procedures. Consequently, avoiding radiation exposure altogether must, if safe to do so, be the ultimate goal. The primary objective was to determine the feasibility and efficacy of fluoroscopy-free AF ablation compared to the fluoroscopy-assisted procedure. METHODS: Patients underwent AF ablation using commercially available technology with no routine pre-procedural imaging. The use of non-fluoroscopic imaging/mapping technologies permitted us to initially reduce x-ray exposure before eliminating its use altogether. This evolution of our practice proceeded in two stages: a 9-month period of optimising our fluoroscopy-free ablation protocol followed by a 9-month period during which we set out to complete the whole procedure routinely without fluoroscopy. We describe the protocol developed and report salient endpoints, such as complications, procedure times, patient experience, and procedural success rates. RESULTS: During the study period, fluoroscopy-free AF ablation was attempted in 69 patients: 24 in the 9-month 'development phase' and 45 in the 'implementation phase'. During the development phase, 13 of 24 patients (54%) were treated without the use of fluoroscopy. In the implementation phase, 45 patients underwent AF ablation of which 42 (93.3%) were fluoroscopy-free. A detailed description is given of the three cases in which fluoroscopy had to be used despite an intention not to. CONCLUSIONS: Fluoroscopy-free complex ablation procedures for the treatment of atrial fibrillation are safe and feasible in most patients.