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Superior septal approach

Jacopo Marazzato, Giuseppe Fonte, Raffaella Marazzi, Lorenzo A Doni, Gianfranco Mitacchione, Manola Vilotta, Roberto De Ponti
PURPOSE: Radiofrequency (RF) catheter ablation of para-Hisian (P-H) and mid-septal (M-S) accessory pathways (APs) is a potentially harmful procedure due to their close location to the A-V node. Conversely, cryoablation (CA) appears safer in this setting. The aim of this study was to assess the efficacy and safety of CA of these APs using a specific protocol. METHODS: Fifty-three patients undergoing CA for P-H (45) or M-S (8) APs were included. CA was performed with a 4-mm catheter at - 75 °C for 480 s in the site where conduction block over the AP was obtained by a specific cryomapping protocol...
January 3, 2019: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Edinson Najera, Joao T Alves Belo, Huy Q Truong, Paul A Gardner, Juan C Fernandez-Miranda
BACKGROUND: Suprachiasmatic subcallosal lesions may have an intimate relationship with the anterior communicating artery (AcomA); injury to AcomA branches can result in basal forebrain infarction and cognitive dysfunction. OBJECTIVE: To evaluate anatomic variations of the AcomA basal perforating branches, especially the subcallosal artery (ScA), for clinical implications when approaching the suprachiasmatic subcallosal region from endonasal and transcranial routes...
December 18, 2018: Operative Neurosurgery (Hagerstown, Md.)
Mel J Sharafuddin, Jay K Bhama, Mohammad Bashir, Maen S Aboul-Hosn, Jeanette H Man, Alexandra J Sharp
BACKGROUND: The general goals of endovascular management in chronic distal thoracic aortic dissection are optimizing the true lumen, maintaining branch patency, and promoting false lumen (FL) thrombosis. Distal seal can be challenging in chronic distal thoracic aortic dissection due to the well-established secondary fenestrations and fibrotic septum. We describe our approach of distal landing zone optimization (DLZO) to enable full-diameter contact of the distal endoprosthesis. MATERIALS AND METHODS: Our experience includes 19 procedures in 16 patients (12 male, age 68 ± 8 years) between May 2014 and November 2017...
January 2019: Journal of Thoracic and Cardiovascular Surgery
Pedro Santos, Aniela Petrescu, Joao Pedrosa, Marta Orlowska, Vangjush Komini, Jens-Uwe Voigt, Jan D'hooge
Left ventricular myocardial stiffness could offer superior quantification of cardiac systolic and diastolic function when compared to the current diagnostic tools. Shear wave elastography in combination with acoustic radiation force has been widely proposed to non-invasively assess tissue stiffness. Interestingly, shear waves can also result from intrinsic cardiac mechanical events (e.g., closure of valves) without the need for external excitation. However, it remains unknown whether these natural shear waves always occur, how reproducible they can be detected and what the normal range of shear wave propagation speed is...
November 15, 2018: IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control
Katsunori Okajima, Tomoyuki Nakanishi, Hirotoshi Ichibori, Takeaki Shirai, Makoto Kadotani, Hiroki Shimizu, Yoshio Onishi, Kohei Yamashiro
A 51-year-old male with dextrocardia and situs inversus underwent catheter ablation for paroxysmal atrial fibrillation. Because the procedure through the trans-septal approach was impossible due to the inferior vena cava continuity with azygos vein, we performed pulmonary vein isolation using magnetic navigation system through the retrograde trans-aortic approach. Superior and inferior left-sided and superior right-sided pulmonary veins could be isolated which was confirmed by the ablation catheter. The patient was free from atrial fibrillation episode at the 12 months follow-up except only one palpitation episode lasting nearly 12 hours at 9 months after the ablation...
October 2018: Journal of Arrhythmia
Charlène Bredy, François-Pierre Mongeon, Line Leduc, Annie Dore, Paul Khairy
Atrial septal defect (ASD) is the most common form of congenital heart disease. Left-to-right shunting leads to right ventricular (RV) volume overload with excessive pulmonary blood flow. Complications include exercise intolerance, pulmonary vascular disease, RV dysfunction, paradoxical thromboemboli, and atrial arrhythmias. Women with coexisting severe pulmonary hypertension should be counselled against pregnancy due to high incidence of maternal and fetal morbidity and mortality. In the absence of pulmonary hypertension, pregnancy is generally well tolerated in the setting of an ASD...
September 2018: Journal of Thoracic Disease
Suresh Babu Kale, Senthilkumar Ramalingam
BACKGROUND: A minimally invasive approach without any peripheral cannulation was used as an alternative to median sternotomy for the correction of a wide range of cardiac defects with superior results and good cosmetic outcome. METHODS: From October 2015 to March 2017, 145 patients underwent correction of congenital cardiac malformations with cardiopulmonary bypass through right anterior minithoracotomy (RAMT) with routine cannulation. The average age was 9.69±4...
September 12, 2018: Heart, Lung & Circulation
Min-Young Kim, Markus B Sikkel, Ross J Hunter, Guy A Haywood, David R Tomlinson, Muzahir H Tayebjee, Rheeda L Ali, Chris D Cantwell, Hanney Gonna, Belinda C Sandler, Elaine Lim, Guy Furniss, Dimitrios Panagopoulos, Gordon Begg, Gurpreet Dhillon, Nicola J Hill, James O'Neill, Darrel P Francis, Phang Boon Lim, Nicholas S Peters, Nick W F Linton, Prapa Kanagaratnam
INTRODUCTION: The ganglionated plexuses (GPs) of the intrinsic cardiac autonomic system are implicated in arrhythmogenesis. GP localization by stimulation of the epicardial fat pads to produce atrioventricular dissociating (AVD) effects is well described. We determined the anatomical distribution of the left atrial GPs that influence atrioventricular (AV) dissociation. METHODS AND RESULTS: High frequency stimulation was delivered through a Smart-Touch catheter in the left atrium of patients undergoing atrial fibrillation (AF) ablation...
August 31, 2018: Journal of Cardiovascular Electrophysiology
Jackson J Liang, Sanghamitra Mohanty, Joe Fahed, Daniele Muser, David F Briceno, J David Burkhardt, Jeffrey S Arkles, Gregory E Supple, David S Frankel, Saman Nazarian, Fermin C Garcia, David J Callans, Sanjay Dixit, Luigi Di Biase, Andrea Natale, Francis E Marchlinski, Pasquale Santangeli
OBJECTIVES: This study reports outcomes of bailout atrial balloon septoplasty (ABS) to overcome challenging left atrial (LA) access in patients undergoing atrial fibrillation (AF) ablation. BACKGROUND: Transseptal puncture (TSP) and LA access for AF ablation can be challenging in patients with prior atrial septal surgery, percutaneous closure, or scarred septum due to multiple prior TSPs. METHODS: The study identified patients who underwent AF ablation at 2 ablation centers from 2011 to 2017 with challenging TSP in whom bailout percutaneous ABS was performed to allow LA access...
August 2018: JACC. Clinical Electrophysiology
Jeremy P Moore, David Cho, Jeannette P Lin, Gentian Lluri, Leigh C Reardon, Jamil A Aboulhosn, Abbie Hageman, Kevin M Shannon
BACKGROUND: Patients with congenitally corrected transposition of the great arteries (CCTGA) are at risk of congestive heart failure (CHF). There are limited data on cardiac resynchronization therapy (CRT) techniques and long-term outcomes in this population. OBJECTIVE: The purpose of this study was to determine implantation techniques and efficacy of CRT for CCTGA. METHODS: A 15-year retrospective review of patients with CCTGA undergoing CRT was performed...
December 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Gabriel Prada, Antoine Vieillard-Baron, Archer K Martin, Antonio Hernandez, Farouk Mookadam, Harish Ramakrishna, Jose L Diaz-Gomez
Proficiency in echocardiography and lung ultrasound has become essential for anesthesiologists and critical care physicians. Nonetheless, comprehensive echocardiography measurements often are time-consuming and technically challenging, and conventional 2-dimensional images do not permit evaluation of specific conditions (eg, systolic anterior motion of the mitral valve, pneumothorax), which have important clinical implications in the perioperative setting. M-mode (motion-based) ultrasonographic imaging, however, provides the most reliable temporal resolution in ultrasonography...
June 30, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Anthony Li, Zia Zuberi, Jason S Bradfield, John K Zarif, David E Ward, Robert H Anderson, Kalyanam Shivkumar, Magdi M Saba
BACKGROUND: Idiopathic ventricular ectopy (VE) shows predilection to sites within the left ventricular (LV) base such as the outflow tract/aortic sinuses, LV summit, and areas adjacent to the aortomitral continuity. We characterize VE arising from the inferior septum of the LV base that was successfully managed by LV endocardial ablation from the inferoseptal recess of the LV. OBJECTIVE: The purpose of this study was to determine the incidence, electrocardiographic (ECG) findings, electrophysiological findings, and anatomical features associated with VE arising from the basal inferoseptal process of the LV (ISP-LV) ablated using an LV endocardial approach via the inferoseptal recess of the LV...
September 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
James H P Gamble, Neil Herring, Matthew R Ginks, Kim Rajappan, Yaver Bashir, Tim R Betts
BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with heart failure, but it can be limited by the inability to place the left ventricular (LV) lead via the coronary sinus. OBJECTIVE: The purpose of this study was to develop an alternative approach, placing the LV lead endocardially via an interventricular septal puncture, and to assess the feasibility and safety of this technique. METHODS: All patients were anticoagulated with warfarin (international normalized ratio 2...
July 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Rong Liufu, Guocheng Shi, Fang Zhu, Yongmei Guan, Zhaohui Lu, Weimin Chen, Zhongqun Zhu, Huiwen Chen
BACKGROUND: Studies on the outcomes of surgical repair for supracardiac total anomalous pulmonary venous connection through the superior approach are uncommon. METHODS: From January 2004 to January 2016, 198 patients with supracardiac total anomalous pulmonary venous connection underwent side-to-side anastomosis between the common pulmonary vein and left atrium through the superior approach. Kaplan-Meier curve was used to demonstrate the survival estimates. Cox proportional hazard model and competing risk regression model were used to identify risk factors for death and postoperative pulmonary venous obstruction...
May 2018: Annals of Thoracic Surgery
Luciano Lobato Gregorio, Nicolas Y Busaba, Marcel M Miyake, Suzanne K Freitag, Benjamin S Bleier
INTRODUCTION: Endoscopic orbital surgery is a nascent field and new tools are required to assist with surgical planning and to ascertain the limits of the tumor resectability. OBJECTIVE: We purpose to utilize three-dimensional radiographic reconstruction to define the theoretical lateral limit of endoscopic resectability of primary orbital tumors and to apply these boundary conditions to surgical cases. METHODS: A three-dimensional orbital model was rendered in 4 representative patients presenting with primary orbital tumors using OsiriX open source imaging software...
December 26, 2017: Brazilian Journal of Otorhinolaryngology
Natalia Gass, Robert Becker, Markus Sack, Adam J Schwarz, Jonathan Reinwald, Alejandro Cosa-Linan, Lei Zheng, Christian Clemm von Hohenberg, Dragos Inta, Andreas Meyer-Lindenberg, Wolfgang Weber-Fahr, Peter Gass, Alexander Sartorius
RATIONALE: Evidence indicates that ketamine's rapid antidepressant efficacy likely results from its antagonism of NR2B-subunit-containing NMDA receptors (NMDAR). Since ketamine equally blocks NR2A- and NR2B-containing NMDAR, and has affinity to other receptors, NR2B-selective drugs might have improved therapeutic efficiency and side effect profile. OBJECTIVES: We aimed to compare the effects of (S)-ketamine and two different types of NR2B-selective antagonists on functional brain networks in rats, in order to find common circuits, where their effects intersect, and that might explain their antidepressant action...
April 2018: Psychopharmacology
Quang-Huy Dang, Ngoc-Thanh Le, Cong-Huu Nguyen, Dac-Dai Tran, Do-Hung Nguyen, Trung-Hieu Nguyen, Thi-Hai-Linh Ngo
OBJECTIVE: The aim of the study was to investigate the effectivity and safety of totally endoscopic cardiac surgery without robotic assistance for atrial septal defect (ASD) closure on beating hearts. METHODS: Twenty-five patients (adults/children: 15/10) underwent ASD closure using nonrobotically assisted totally endoscopic approach on beating heart. Three 5-mm trocars and one 12-mm trocar were used, only the superior vena cava is snared, filling the pleural and pericardial cavities with CO2, and the heart was beating during the surgery...
November 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Carola Gianni, Javier E Sanchez, Sanghamitra Mohanty, Chintan Trivedi, Domenico G Della Rocca, Amin Al-Ahmad, J David Burkhardt, G Joseph Gallinghouse, Patrick M Hranitzky, Rodney P Horton, Luigi Di Biase, Andrea Natale
Aims: Superior vena cava (SVC) isolation might be difficult to achieve because of the vicinity of the phrenic nerve (PN) and sinus node. Based on its embryogenesis, we hypothesized the presence of preferential conduction from the right atrial (RA) posterior wall, making it possible to isolate the SVC antrally, sparing its anterior and lateral aspect. Methods and results: This is a descriptive cohort study of 105 consecutive patients in which SVC isolation was obtained with radiofrequency ablation, starting in the septal aspect of the SVC-RA junction and continued posteriorly and inferiorly targeting sites of early activation until electrical isolation was obtained...
September 1, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Marinos Kantzis, Christoph M Happel, Nikolaus A Haas
Introduction Although the right jugular vein approach for percutaneous pulmonary valve implantation is well described, there are no reports that describe a percutaneous pulmonary valve implantation through a left superior caval vein to coronary sinus pathway. Case A 14-year-old female with tetralogy of Fallot, mesocardia, left superior caval vein draining into the coronary sinus, and hemiazygos continuation of the inferior caval vein underwent ventricular septal defect closure, with homograft insertion from the right ventricle to the pulmonary artery, patch augmentation of the left pulmonary artery, and creation of an atrial communication...
February 2018: Cardiology in the Young
Kanishka Ratnayaka, John W Moore, Rodrigo Rios, Robert J Lederman, Sanjeet R Hegde, Howaida G El-Said
BACKGROUND: In the care of patients with congenital heart disease, percutaneous interventional treatments have supplanted many surgical approaches for simple lesions, such as atrial septal defect. By contrast, complex congenital heart defects continue to require open-heart surgery. In single-ventricle patients, a staged approach is employed, which requires multiple open-heart surgeries and significant attendant morbidity and mortality. A nonsurgical transcatheter alternative would be attractive...
August 8, 2017: Journal of the American College of Cardiology
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