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Sample records for pulmonary vein isolation

  1. Left Atrial Tachycardia After Pulmonary Vein Isolation for Atrial Fibrillation

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    Kenichi Hashimoto, MD

    2005-01-01

    Full Text Available Left atrial tachycardia (AT has been reported to occur after pulmonary vein isolation (PVI for the treatment of atrial fibrillation (AF. We treated 3 patients who developed AT of different mechanisms following PVI. In case 1, focal AT originating at the ostium of the left superior PV was demonstrated and focal radiofrequency ablation was performed at the breakthrough point at the ostium of the left superior PV terminated the AT. In case 2, AT was shown to be counterclockwise macroreentrant AT around the left inferior PV through the conduction gap of the left sided posterior wall for which linear ablation was performed between left superior and inferior PVs. Focal ablation at the conduction gap terminated the AT. In case 3, a macroreentrant AT propagating around the mitral annulus was demonstrated and linear ablation between left inferior pulmonary vein and mitral annulus (mitral isthmus terminated the AT.

  2. Radiofrequency ablation of an atypical left atrial flutter after pulmonary vein isolation

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    Bockeria L.A.

    2014-12-01

    Full Text Available In paroxysmal atrial fibrillation usually pulmonary veins isolation is enough, while in persistent and long-standing persistent forms ablation lines in the left atrium are needed. After that post ablational macroreentry tachycardia and focal atrial tachycardia, resistant to antiarrhythmic therapy, occur. Left atrial macroreentry tachycardia are localized perimitrally, around pulmonary veins and septally. There are also roof and posterior wall-associated macroreentry tachycardia. Considering relevance of postablation arrhythmias, we present our case report. A patient had paroxysmal atrial fibrillation. Pulmonary vein isolation was performed. After patient’s radiofrequency pulmonary vein isolation, three-dimensional map of left atrium was made using CARTO XP navigation system. Macroreentry tachycardia around left inferior pulmonary vein was revealed.There were fragmented potentials between left superior and left inferior pulmonary veins. An ablation lineconnecting inferior and superior pulmonary veins was made. After the completion of ablation line sinus rhythmwas restored.

  3. Asymptomatic Primary Isolated Pulmonary Vein Stenosis in an Adult: A Case Report

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    Kim, Ji Hyun; Lee, Ho Sung; Choi, Jae Sung; Na, Ju Ock; Kim, Yong Hoon; Jou, Sung Shick; Seo, Ki Hyun [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2010-08-15

    A 31-year-old man without respiratory symptoms was transferred to our clinic with incidentally detected small nodular densities in both the upper lung zones on chest radiography. Chest computed tomography and pulmonary angiography demonstrated that the entrance of the right inferior pulmonary vein to the left atrium was completely blocked, and the venous return of the right lower lobe was achieved through the right superior pulmonary vein with a tortuous venous collateral complex in the venous phase. With echocardiography, mild pulmonary hypertension was detected. Here, we present an asymptomatic adult with isolated stenosis of the pulmonary vein with chronic compensation by venous collateral circulation in spite of mild pulmonary hypertension

  4. Pulmonary vein isolation in the treatment of atrial fibrillation

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    Kumar S

    2016-05-01

    Full Text Available Saurabh Kumar, Gregory F Michaud Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA Abstract: Atrial fibrillation (AF is the commonest arrhythmia in humans and is associated with marked reduction in quality of life and an elevated thromboembolic risk. Paroxysmal, persistent, and permanent forms of AF have been recognized. Whilst antiarrhythmic drugs are considered as first-line therapy, the role of catheter ablation is increasing due to its superior efficacy in terms of quality of life and reduction in AF burden. The central paradigm for catheter ablation of AF is that triggers for AF are located near and within the pulmonary veins (PVs, and electrical isolation of the PVs from the left atrium forms the cornerstone of most catheter ablation strategies. Whilst paroxysmal form is generally trigger dependent, persistent and permanent forms are associated with variable interaction between triggers and "substrate" comprised of atrial and PV electrical and structural remodeling. Nevertheless, isolation of the PVs still forms a critical component of catheter ablation strategies, regardless of AF type. Procedural efficacy, however, is limited by PV conduction recovery. This is likely due to deficiencies in ablation tools or limitations of intraprocedural assessment of lesion efficacy. Careful attention to surrogates of tissue heating, such as impedance decrease and electrogram morphology changes, along with advances in catheter technology like contact force catheters may improve rates of durable PV isolation and single-procedural success. This review discusses the mechanism of paroxysmal AF with particular focus on the role of the PVs in AF initiation and PV isolation in the management of AF. Keywords: contact force, lesion transmurality, radiofrequency catheter ablation, paroxysmal atrial fibrillation, electrophysiology, AF

  5. Recurrence of paroxysmal atrial fibrillation after pulmonary vein isolation: is repeat pulmonary vein isolation enough? A prospective, randomized trial.

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    Fichtner, Stephanie; Sparn, Korbinian; Reents, Tilko; Ammar, Sonia; Semmler, Verena; Dillier, Roger; Buiatti, Alexandra; Kathan, Susanne; Hessling, Gabriele; Deisenhofer, Isabel

    2015-09-01

    In patients with paroxysmal atrial fibrillation (pAF), pulmonary vein isolation (PVI) has become an accepted treatment option with single procedure success rates of 60-80%. A repeat ablation is performed in ∼30% of patients because of arrhythmia recurrence. The strategy for this repeat procedure is not defined. Patients with pAF recurrence after PVI were prospectively randomized and underwent a second ablation procedure with either PVI of all reconnected veins or PVI with an additional left atrial anterior line. Follow-up in our arrhythmia clinic was every 3 months up to 12 months including 7 day Holter monitoring. A total of 77 patients (mean age 63 ± 9 years, 69% males) were included in the analysis. A repeat PVI was performed in 41 patients, PVI + anterior line in 36 patients. After a follow-up of 12 months, 26 of 41 (63%) patients after repeat PVI and 18 of 36 (50%) patients with PVI + anterior line were in stable sinus rhythm off antiarrhythmic medication (P = 0.26). In most patients (12 of 15 patients with PVI and 14 of 18 patients with PVI + anterior line) with an arrhythmia recurrence after the second procedure, the recurring arrhythmia was paroxysmal AF. In 2 of 15 patients of the PVI group and in 4 of 18 patients of the PVI + anterior line group atypical flutter was the reoccurring arrhythmia (P = NS). In this prospective randomized trial, patients with a recurrence of paroxysmal AF had no better outcome after repeat PVI + one left atrial line compared with patients with repeat PVI only. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  6. Regular atrial tachycardias developing after cryoballoon pulmonary vein isolation: Incidence, characteristics, and predictors

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    E. Mikhaylov (Evgeny); R. Bhagwandien (Rohit); P. Janse (Petter); D.A.M.J. Theuns (Dominic); T. Szili-Torok (Tamas)

    2013-01-01

    textabstractAimsCryoballoon ablation (CBA) is a well-used technique when performing pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). Our aim is to describe incidence, characteristics, and clinical predictors for developing atrial tachycardias (ATs) after cryoballoo

  7. Adenosine testing after cryoballoon pulmonary vein isolation improves long-term clinical outcome

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    Y. van Belle (Yves); P. Janse (Petter); N. de Groot (Natasja); W. Anné (Wim); D.A.M.J. Theuns (Dominic); L.J.L.M. Jordaens (Luc)

    2012-01-01

    textabstractBackground Adenosine infusion after pulmonary vein isolation (PVI) with radiofrequency energy reveals dormant muscular sleeves and predicts atrial fibrillation (AF) recurrence. The aim of our study was to determine whether adenosine could reveal dormant PV sleeves after cryoballoon isola

  8. Atrioesophageal fistula complicating cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation.

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    Kawasaki, Raymond; Gauri, Andre; Elmouchi, Darryl; Duggal, Manoj; Bhan, Adarsh

    2014-07-01

    Although atrioesophageal fistula (AEF) formation is a well known, albeit rare, catastrophic complication of atrial fibrillation radiofrequency ablation procedures, there are less data regarding this complication using the cryoballoon technique. We report on 3 cases of AEF as a complication of cryoballoon pulmonary vein isolation at 3 different institutions with 2 different generations of cryoballoons.

  9. Freedom from paroxysmal atrial fibrillation after successful pulmonary vein isolation with pulmonary vein ablation catheter-phased radiofrequency energy: 2-year follow-up and predictors of failure

    NARCIS (Netherlands)

    Mulder, A.A.W.; Wijffels, M.C.; Wever, E.F.; Boersma, L.V.

    2012-01-01

    AIMS: In patients with paroxysmal atrial fibrillation (PAF) the pattern of atrial fibrillation (AF) episodes and the total AF burden, may be related to the efficacy of pulmonary vein isolation (PVI). We evaluated (pre)-procedural factors explaining the long-term outcome after PVI, using a ring-shape

  10. Efficacy of adjunctive measures used to assist pulmonary vein isolation for atrial fibrillation: a systematic review.

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    Nair, Girish M; Raut, Roshan; Bami, Karan; Nery, Pablo B; Redpath, Calum J; Sadek, Mouhannad M; Green, Martin S; Birnie, David H

    2017-01-01

    Pulmonary vein reconnection leading to recurrence of atrial arrhythmias after pulmonary vein isolation (PVI) for atrial fibrillation remains a significant challenge. A number of adjunctive measures during PVI have been used to attempt to reduce pulmonary vein reconnection and recurrence of atrial arrhythmias. We performed a systematic review of the literature and meta-analysis of studies evaluating the efficacy of adjunctive measures used during PVI in reducing recurrent atrial arrhythmias. Our literature search found four interventions that met the prespecified definition of adjunctive measure: adenosine testing post-PVI, contact force-guided PVI, pacing inexcitability of the ablation line during PVI and additional ablation based on the computed tomography thickness of the pulmonary vein-left atrial appendage ridge. Sixteen studies enrolling 3507 patients met all inclusion and exclusion criteria. PVI performed with adjunctive measures was shown to reduce the 1-year recurrence rate of atrial arrhythmias. The point estimate for the combined relative risk of atrial arrhythmia recurrence was 0.56 [95% confidence interval (CI): 0.43-0.73; P value PVI with adjunctive measures group. PVI for atrial fibrillation assisted by adjunctive measures results in clinically significant reduction of recurrent atrial arrhythmias. Additional research is required to assess the relative efficacy of individual or combined adjunctive strategies used during PVI for atrial fibrillation.

  11. The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

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    Paolo D. Dallaglio

    2016-01-01

    Full Text Available The cornerstone of atrial fibrillation (AF ablation is pulmonary vein isolation (PVI, which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC. The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.

  12. Usefulness of multidetector computed tomography before and after pulmonary vein isolation.

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    Revilla Orodea, Ana; Sánchez Lite, Israel; Gallego Beuth, Julio César; Sevilla Ruiz, Teresa; Sandín Fuentes, María G; Amat Santos, Ignacio Jesús; San Román Calvar, José Alberto

    To analyze the usefulness of multidetector computed tomography (MDCT) in the preprocedural evaluation and follow-up of patients undergoing radiofrequency ablation of pulmonary veins and the impact of the MDCT findings on the approach to treatment. We retrospectively analyzed 92 consecutive MDCT studies done in 80 patients between January 2011 and June 2013; 70 (76%) studies were done before a first ablation procedure and 22 (24%) were done in patients who had undergone an ablation procedure. Findings were useful in 34% of the patients who underwent MDCT before the first ablation procedure and in 68% of the studies done after a procedure. The incidence of stroke associated with the ablation procedure was 3%, similar to the incidence recorded in our center before we started to use MDCT to evaluate the anatomy of the left atrium. All symptomatic patients had some pulmonary vein stenosis, and 80% had significant stenosis. Furthermore, the stenoses progressed very rapidly; treatment with balloon angioplasty was associated with early restenosis. Stenting was an alternative in cases of failed angioplasty. In the preprocedural evaluation and postprocedural follow-up of patients undergoing pulmonary vein isolation, MDCT is useful for guiding treatment and detecting complications. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. A three-pulmonary vein isolation approach to treat paroxysmal atrial fibrillation

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    Lexin WANG; Jing ZHOU

    2004-01-01

    Objective To investigate the safety and efficacy of a 3-pulmonary vein (PV) isolation approach in treating paroxysmal atrial fibrillation (AF). Methods Radiofrequency catheter ablation was used to eliminate PV potential in 11 patterns with frequent paroxysmal AF refractory to anti-arrhythmic agents. During sinus rhythm, PV potential was mapped in the left and right superior PVs and left inferior PV. The procedural success was defined as the elimination of PV potential in the 3 PVs. Restults PV potential was identified and abolished in a total of 24 PVs, mostly in the left and right superior PV. There was no pulmonary stenosis or other complications during or after the procedures. AF recurred in one patient after an average of 12 ± 3 month follow-up. Conclusions PV potemials were present mostly in the left or right superior PV. The 3-PVs isolation approach is safe and effective in preventing drug-resistant paroxysmal AF.

  14. Successful cryoballoon pulmonary vein isolation in a patient with situs inversus and dextrocardia

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    Yasuhiro Yoshiga, MD

    2016-12-01

    Full Text Available A 79-year-old man with situs inversus and dextrocardia underwent catheter ablation of symptomatic paroxysmal atrial fibrillation. Pulmonary vein isolation (PVI, using second-generation cryoballoon under Ensite NavX system guidance, was performed successfully in a reverse manner, which required short procedure and fluoroscopy times, as required in a PVI performed on a normal heart without any complications. Cryoballoon-based PVI under Ensite NavX guidance was feasible and safe to achieve a favorable outcome in this patient with abnormal anatomy.

  15. Termination of persistent atrial fibrillation during pulmonary vein isolation: insight from the MAGIC-AF trial.

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    Singh, Sheldon M; d'Avila, Andre; Kim, Young-Hoon; Aryana, Arash; Mangrum, J Michael; Michaud, Gregory F; Dukkipati, Srinivas R; Barrett, Conor D; Heist, E Kevin; Parides, Michael K; Thorpe, Kevin E; Reddy, Vivek Y

    2016-10-04

    Controversy on the optimal ablation strategy for persistent atrial fibrillation (AF) exists with limited work evaluating a strategy of pulmonary vein isolation (PVI) alone when AF terminates during PVI. Thirty-five patients had AF termination during PVI in the Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF; ClinicalTrials.gov number: NCT01014741) study. The objective of the current study is to report the 1-year outcome after PVI alone in this unique patient group. The 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs was reported for the 35 patients in the MAGIC-AF study with persistent AF termination during or upon completion of PVI.Freedom from recurrent atrial arrhythmia was achieved in 60% of patients where AF terminated during PVI. Cavotricuspid isthmus flutter was common when AF terminated to a macro re-entrant flutter during PVI, and responsible for 92% of all flutter circuits with AF termination. Persistent AF termination during PVI may identify a subgroup of patients who experience a similar long-term clinical outcome with PVI ablation alone when compared with other more extensive persistent AF ablation strategies. Pulmonary vein isolation alone may be an appropriate tactic in this subgroup of persistent AF patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  16. Influence of Clinical Parameters and Anticoagulation on Intraprocedural Cerebral Microembolic Signals during Pulmonary Vein Isolation.

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    Robert Larbig

    Full Text Available We had the objective to determine the impact of clinical parameters and anticoagulation status on cerebral microembolic signals (MES during pulmonary vein isolation (PVI for atrial fibrillation (AF.Thromboembolism and stroke are the most feared complications of PVI. MES can help to evaluate embolic burden. It is unknown whether clinical parameters have an impact on embolic risk during PVI.In this retrospective analysis we investigated the impact of clinical parameters, including the CHADS2- and CHA2DS2-VASc-score, pulmonary vein variants and echocardiographic parameters on MES rates in patients that underwent PVI using three different ablation approaches (radiofrequency ablation (iRF, pulmonary vein ablation catheter (PVAC with deactivated electrode pair 1 or 5 (PVAC-red or PVAC without deactivation (PVAC-all.118 AF patients (61±12 years were included between 2011 and 2013 (Median: 489 MES during PVI. Patients were more likely to have more MES (within 4th quartile with the PVAC-all approach (60.7% vs. 25.0% (iRF vs. 14.3% (PVAC-red respectively (p<0.001. Patients with oral anticoagulation (OAC pre-ablation were more likely to have lower MES-counts (1st-3rd quartile; (65.6% vs. 35.7%; p = 0.005. Additionally, patients with lower MES counts (1st-3rd quartile had significantly higher INR values than those in the 4th quartile (1.78 vs. 1.09; p = 0.029. 2 patients developed a potentially thromboembolic event during the procedure.Clinical predictors of cerebral emboli and stroke do not correlate with cerebral embolic burden during PVI. Pre-ablation OAC and increased INR values correlate with decreased MES-rates. Therefore, it might be beneficial to perform PVI with pre-ablation anticoagulation even in low risk patients.

  17. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging Post-robotic Radiosurgical Pulmonary Vein Isolation (RRPVI): First Case in the World

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    Azpiri, Jose; De La Peña, Cuauhtémoc; Cardona, Carlos; Hinojosa, Miguel; Zamarripa, Rafael; Assad, Jose

    2016-01-01

    Pulmonary vein isolation using robotic radiosurgery system CyberKnife is a new non-invasive treatment of atrial fibrillation, currently in clinical phase. Robotic radiosurgical pulmonary vein isolation (RRPVI) uses stereotactic, non-invasive (painless) pinpoint radiation energy delivery to a small, precise area to accomplish ablation. The purpose of this report is to describe the finding of an increase in the enhancement of the left atrium demonstrated with the use of cardiac magnetic resonance imaging using late gadolinium enhancement (LGE-CMR) as a result of RRPVI in the first case in the world in humans using CyberKnife as a treatment for paroxysmal atrial fibrillation (PAF). PMID:27660737

  18. Recurrence of pulmonary vein conduction and atrial fibrillation after pulmonary vein isolation for atrial fibrillation: a randomized trial of the ostial versus the extraostial ablation strategy

    DEFF Research Database (Denmark)

    Nilsson, Brian; Chen, Xu; Pehrson, Steen;

    2006-01-01

    BACKGROUND: Both segmental ostial and circumferential extraostial pulmonary vein (PV) isolation have been proven effective in the treatment of atrial fibrillation (AF). However, the recurrence of AF and PV conduction after the 2 ablation strategies has never been compared in a randomized study....... METHODS: A total of 100 consecutive patients (age 56 +/- 10; 71 men) with symptomatic AF (paroxysmal, 51; persistent, 49) were randomized to segmental ostial (n = 54) or circumferential extraostial (n = 46) PV isolation. A circular catheter positioned at the ostium of each target PV guided the ostial PV...... who underwent ostial PV isolation (P strategies was mainly seen in patients known with persistent AF (52% and 15%, respectively; P = .02) as opposed to patients with paroxysmal AF (65% and 46%, respectively; P = .26). CONCLUSIONS: Overall...

  19. Vagal Reactions during Cryoballoon-Based Pulmonary Vein Isolation: A Clue for Autonomic Nervous System Modulation?

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    Michaël Peyrol

    2016-01-01

    Full Text Available Although paroxysmal atrial fibrillation (AF is known to be initiated by rapid firing of pulmonary veins (PV and non-PV triggers, the crucial role of cardiac autonomic nervous system (ANS in the initiation and maintenance of AF has long been appreciated in both experimental and clinical studies. The cardiac intrinsic ANS is composed of ganglionated plexi (GPs, located close to the left atrium-pulmonary vein junctions and a vast network of interconnecting neurons. Ablation strategies aiming for complete PV isolation (PVI remain the cornerstone of AF ablation procedures. However, several observational studies and few randomized studies have suggested that GP ablation, as an adjunctive strategy, might achieve better clinical outcomes in patients undergoing radiofrequency-based PVI for both paroxysmal and nonparoxysmal AF. In these patients, vagal reactions (VR such as vagally mediated bradycardia or asystole are thought to reflect intrinsic cardiac ANS modulation and/or denervation. Vagal reactions occurring during cryoballoon- (CB- based PVI have been previously reported; however, little is known on resulting ANS modulation and/or prevalence and significance of vagal reactions during PVI with the CB technique. We conducted a review of prevalence, putative mechanisms, and significance of VR during CB-based PVI.

  20. Impact of right upper pulmonary vein isolation on atrial vagal innervation and vulnerability to atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    LIU Yuan; ZHANG Shu-long; DONG Ying-xue; ZHAO Hong-wei; GAO Lian-jun; YIN Xiao-meng; LI Shi-jun; LIN Zhi-hu; YANG Yan-zong

    2006-01-01

    Background Based on the hypothesis that pulmonary vein isolation could result in the damage of the epicardial fat pads, this study aimed to investigated the impact of right upper pulmonary vein (RUPV) isolation on vagal innervation to atria.Methods Bilateral cervical sympathovagal trunks were decentralized in 6 dogs. Metoprolol was given to block sympathetic effects. Multipolar catheters were placed into the right atrium (RA) and coronary sinus (CS). RUPV isolation was performed via transseptal procedure. Atrial effective refractory period (ERP), vulnerability window (VW) of atrial fibrillation (AF), and sinus rhythm cycle length (SCL) were measured at RA and distal coronary sinus (CSd) at baseline and vagal stimulation before and after RUPV isolation. Serial sections of underlying tissues before and after ablation were stained with haematoxylin and eosin.Results SCL decreased significantly during vagal stimulation before RUPV isolation (197 ± 21 vs 13 ±32 beats per minute, P<0.001), but remained unchanged after RUPV isolation (162±29 vs 140±39 beats per minute,P>0.05). ERP increased significantly before RUPV isolation compared with that during vagal stimulation [(85.00±24.29) ms vs (21.67±9.83) ms at RA, P<0.001; (90.00± 15.49) ms vs (33.33±25.03) ms at CSd P<0.005],but ERP at baseline hardly changed after RUPV isolation compared with that during vagal stimulation [(103.33 ±22.50) vs (95.00± 16.43) ms at RA, P = 0.09; (98.33±24.83) vs (75.00±29.50) ms at CSd, P=0.009]. The ERP shortening during vagal stimulation after RUPV isolation decreased significantly [(63.33 ± 22.51) ms vs (8.33 ±9.83) ms at RA, P<0.005; (56.67±20.66) ms vs (23.33± 13.66) ms at CSd, P<0.05]. AF was rarely induced at baseline before and after RUPV isolation (VW close to 0), while VW of AF to vagal stimulation significantly decreased after RUPV isolation [(40.00± 10.95) vs 0 ms at RA, P<0.001; (45.00±32.09) vs (15.00±23.45) ms at CS, P <0.05]. The

  1. Radiofrequency Catheter Ablation Targeting the Vein of Marshall in Difficult Mitral Isthmus Ablation or Pulmonary Vein Isolation.

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    Lee, Ji Hyun; Nam, Gi-Byoung; Kim, Minsu; Hwang, You Mi; Hwang, Jongmin; Kim, Jun; Choi, Kee-Joon; Kim, You-Ho

    2017-04-01

    The ligament of Marshall may hinder the creation of mitral isthmus (MI) block or pulmonary vein (PV) isolation (PVI) in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). We aimed to assess the benefit of RF ablation targeting the vein of Marshall (VOM) in failed cases of MI block or PVI. We reviewed the medical records of patients who underwent RF ablation targeting the VOM after failed MI ablation or left PVI using the conventional method, which included circumferential point-by-point ablation around the PV antrum and carina for PVI, and endocardial MI and epicardial distal coronary sinus (CS) ablation for MI block. The VOM was identified by using selective VOM venography with an external irrigation RF ablation catheter. RF ablation targeting the VOM was performed with RF application at the ostium of the VOM inside the CS or at the endocardial region facing the VOM course. During the set period, CS venography was performed in 42 patients after failure of left PVI (n = 5) or MI block (n = 37). Under CS venography, the VOM was visualized in 22 of 42 patients (MI = 19 and PVI = 3). During selective venography of the VOM, no procedure-related complication was observed. RF application targeting the VOM successfully achieved MI block in 13 patients (68.4%) and PVI in 2 patients (66.7%). Selective VOM venography using an irrigated ablation catheter is feasible and safe. RF ablation targeting the VOM may provide additional benefit in failed cases of MI block or PVI. © 2017 Wiley Periodicals, Inc.

  2. Pulmonary veins isolation in a patient with atrial fibrillation and pronounced vagal response: Is it enough?

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    Dinčić Dragan

    2017-01-01

    Full Text Available Introduction. Pulmonary vein isolation (PVI by antral circumferential ablation is the standard procedure for patients with symptomatic and drug-refractory paroxysmal atrial fibrillation (AF. In some patients addition of ganglionated plexi (GP modification in anatomic locations to PVI confers significantly better outcomes than PVI alone. Case report. We reported a patient with paroxysmal, symptomatic AF and severe bradycardia a month prior to ablation. The patient was treated with antiarrhythmic drugs without success. Because of severe bradicardia the patient was implanted with a temporary pace maker two days before PVI. During PVI the decision was made to also do a modification of the left GP. Three months after the procedure the patients was in stable sinus rhythm without any symptoms. Conclusion. In selected patients with paroxysmal AF and pronounced vagal response PVI by circumferential antral ablation combined with GP modification during single ablation procedure can produce higher success rates than PVI or GP ablation alone.

  3. Pulmonary vein isolation during cryoballoon ablation using the novel Achieve inner lumen mapping catheter: a feasibility study.

    NARCIS (Netherlands)

    Chierchia, G.B.; Asmundis, C. de; Namdar, M.; Westra, S.W.; Kuniss, M.; Sarkozy, A.; Bayrak, F.; Ricciardi, D.; Casado-Arroyo, R.; Rodriguez Manero, M.; Rao, J.Y.; Smeets, J.; Brugada, P.

    2012-01-01

    AIMS: Cryoballoon (CB) ablation has proven very effective in achieving pulmonary vein isolation (PVI). The Achieve catheter (AC) is a novel inner lumen catheter designed to be used in conjunction with the CB, which serves the double purpose of a guidewire and a mapping catheter. We aimed to evaluate

  4. Surgical vs. transcatheter pulmonary vein isolation as first invasive treatment in patients with atrial fibrillation : a matched group comparison

    NARCIS (Netherlands)

    De Maat, Gijs E.; Van Gelder, Isabelle C.; Rienstra, Michiel; Quast, Anne-Floor B. E.; Tan, Eng S.; Wiesfeld, Ans C. P.; Pozzoli, Alberto; Mariani, Massimo A.

    2014-01-01

    AIMS: Pulmonary vein isolation (PVI) can be considered for treatment of symptomatic atrial fibrillation (AF). Nowadays, in addition to transcatheter ablation, thoracoscopic surgical PVI is available. The aim of this study is to compare clinical outcome of surgical with transcatheter PVI as first inv

  5. One year follow-up after cryoballoon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation

    NARCIS (Netherlands)

    Y. van Belle (Yves); P. Janse (Petter); D.A.M.J. Theuns (Dominic); T. Szili-Torok (Tamas); L.J.L.M. Jordaens (Luc)

    2008-01-01

    textabstractAims: Pulmonary vein isolation (PVI) with cryoenergy delivered through a balloon is a new approach in the treatment of atrial fibrillation (AF), but long-term follow-up is lacking. The aim of this study was to provide insight in the success rate and the incidence of recurrences. Methods

  6. Surgical vs. transcatheter pulmonary vein isolation as first invasive treatment in patients with atrial fibrillation : a matched group comparison

    NARCIS (Netherlands)

    De Maat, Gijs E.; Van Gelder, Isabelle C.; Rienstra, Michiel; Quast, Anne-Floor B. E.; Tan, Eng S.; Wiesfeld, Ans C. P.; Pozzoli, Alberto; Mariani, Massimo A.

    2014-01-01

    AIMS: Pulmonary vein isolation (PVI) can be considered for treatment of symptomatic atrial fibrillation (AF). Nowadays, in addition to transcatheter ablation, thoracoscopic surgical PVI is available. The aim of this study is to compare clinical outcome of surgical with transcatheter PVI as first inv

  7. Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins

    NARCIS (Netherlands)

    Y. van Belle (Yves); S.P. Knops (Simon); P. Janse (Petter); M. Rivero-Ayerza (Maximo); E. Jessurun; T. Szili-Torok (Tamas); L.J.L.M. Jordaens (Luc)

    2009-01-01

    textabstractIntroduction: The 28 mm cryoballoon catheter is a device used for pulmonary vein isolation (PVI). The aim of this study was to evaluate the extent of the ablation in the antral regions of the left atrium. Methods and Results: Eighteen patients with drug refractory, symptomatic, paroxysma

  8. Pulmonary vein isolation during cryoballoon ablation using the novel Achieve inner lumen mapping catheter: a feasibility study.

    NARCIS (Netherlands)

    Chierchia, G.B.; Asmundis, C. de; Namdar, M.; Westra, S.W.; Kuniss, M.; Sarkozy, A.; Bayrak, F.; Ricciardi, D.; Casado-Arroyo, R.; Rodriguez Manero, M.; Rao, J.Y.; Smeets, J.; Brugada, P.

    2012-01-01

    AIMS: Cryoballoon (CB) ablation has proven very effective in achieving pulmonary vein isolation (PVI). The Achieve catheter (AC) is a novel inner lumen catheter designed to be used in conjunction with the CB, which serves the double purpose of a guidewire and a mapping catheter. We aimed to evaluate

  9. Cardiovascular magnetic resonance imaging of scar development following pulmonary vein isolation: a prospective study.

    Directory of Open Access Journals (Sweden)

    Jeff Hsing

    Full Text Available AIMS: Cardiovascular magnetic resonance (MR provides non-invasive assessment of early (24-hour edema and injury following pulmonary vein isolation (by ablation and subsequent scar formation. We hypothesize that 24-hours after ablation, cardiovascular MR would demonstrate a pattern of edema and injury due to ablation and the severity would correlate with subsequent scar. METHODS: Fifteen atrial fibrillation patients underwent cardiovascular MR prior to pulmonary vein isolation, 24-hours post (N = 11 and 30-days post (N = 7 ablation, with T2-weighted (T2W and late gadolinium enhancement (LGE imaging. Left atrial wall thickness, edema enhancement ratio and LGE enhancement were assessed at each time point. Volumes of LGE and edema enhancement were measured, and the circumferential presence of injury was assessed at 24-hours, including comparison with LGE enhancement at 30 days. RESULTS: Left atrial wall thickness was increased 24-hours post-ablation (10.7 ± 4.1 mm vs. 7.0 ± 1.8 mm pre-PVI, p<0.05. T2W enhancement at 24-hours showed increased edema enhancement ratio (1.5 ± 0.4 for post-ablation, vs. 0.9 ± 0.2 pre-ablation, p < 0.001. Edema and LGE volumes at 24-hours were correlated with 30-day LGE volume (R = 0.76, p = 0.04, and R = 0.74, p = 0.09, respectively. Using a 16 segment model for assessment, 24-hour T2W had sensitivity, specificity, and accuracy of 82%, 63%, and 79% respectively, for predicting 30-day LGE. 24-hour LGE had sensitivity, specificity, and accuracy of 91%, 47%, and 84%. CONCLUSIONS: Increased left atrial wall thickening and edema were characterized on cardiovascular MR early post-ablation, and found to correlate with 30-day LGE scar.

  10. Feasibility and efficacy of simultaneous pulmonary vein isolation and cavotricuspid isthmus ablation using cryotherapy.

    Science.gov (United States)

    Dhillon, Paramdeep S; Domenichini, Giulia; Gonna, Hanney; Bastiaenen, Rachel; Norman, Mark; Gallagher, Mark M

    2014-07-01

    Pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) ablation are often performed as part of the same procedure. In many cases, PVI is performed by cryotherapy and then CTI ablation by radiofrequency (RF) energy. We sought to determine whether it is more efficient to perform CTI ablation simultaneously with PVI using separate cryogenerators. We performed cryoablation of the CTI during PVI with the Arctic Front cryoballoon in 25 consecutive patients with clinical indications for both (PVI/CTI-cryo group). Procedural data were compared to those of 25 matched patients who underwent PVI only by the same operator (PVI-only group), and 25 patients who underwent PVI by cryotherapy and CTI ablation using RF energy sequentially during the same procedure (PVI/CTI-mixed group). No complication occurred. All veins were isolated; bidirectional CTI block was demonstrated in all cases where it was attempted, except for 1 patient in the PVI/CTI-mixed group. Procedure and fluoroscopy duration were significantly shorter in the PVI/CTI-cryo group (162 ± 34 and 24 ± 5 minutes) than in the PVI/CTI-mixed group (209 ± 46 minutes, P PVI-only group (155 ± 32 and 22 ± 8 minutes) were similar to those in the PVI/CTI-cryo group (P = NS) but significantly shorter than in the PVI/CTI-mixed group (P PVI by cryoballoon, it adds significantly to the procedure and fluoroscopy durations; when performed contemporaneously using cryotherapy at both sites, the procedure and fluoroscopy durations are not prolonged. © 2014 Wiley Periodicals, Inc.

  11. Loss of local capture of the pulmonary vein myocardium after antral isolation: prevalence and clinical significance.

    Science.gov (United States)

    Squara, Fabien; Liuba, Ioan; Chik, William; Santangeli, Pasquale; Zado, Erica S; Callans, David J; Marchlinski, Francis E

    2015-03-01

    Capture of the myocardial sleeves of the pulmonary veins (PV) during PV pacing is mandatory for assessing exit block after PV isolation (PVI). However, previous studies reported that a significant proportion of PVs failed to demonstrate local capture after PVI. We designed this study to evaluate the prevalence and the clinical significance of loss of PV capture after PVI. Thirty patients (14 redo) undergoing antral PVI were included. Before and after PVI, local PV capture was assessed during circumferential pacing (10 mA/2 milliseconds) with a circular multipolar catheter (CMC), using EGM analysis from each dipole of the CMC and from the ablation catheter placed in ipsilateral PV. Pacing output was varied to optimize identification of sleeve capture. All PVs demonstrated sleeve capture before PVI, but only 81% and 40% after first time and redo PVI, respectively (P PVI). In multivariate analysis, absence of spontaneous PV depolarizations after PVI and previous PVI procedures were associated with less PV sleeve capture after PVI (40% sleeve capture, P PVI resulting in entrance block, and may be used as a specific alternate endpoint for PV electrical isolation. Additionally, loss of PV local capture may identify PVs at very low risk of acute reconnection during adenosine challenge. © 2014 Wiley Periodicals, Inc.

  12. Biophysical and molecular comparison of sodium current in cells isolated from canine atria and pulmonary vein.

    Science.gov (United States)

    Barajas-Martinez, Hector; Goodrow, Robert J; Hu, Dan; Patel, Payal; Desai, Mayurika; Panama, Brian K; Treat, Jacqueline A; Aistrup, Gary L; Cordeiro, Jonathan M

    2017-02-27

    The collar of the pulmonary vein (PV) is the focal point for the initiation of atrial arrhythmias, but the mechanisms underlying how PV cells differ from neighboring left atrial tissue are unclear. We examined the biophysical and molecular properties of INa in cells isolated from the canine pulmonary sleeve and compared the properties to left atrial tissue. PV and left atrial myocytes were isolated and patch clamp techniques were used to record INa. Action potential recordings from either tissue type were made using high-resistance electrodes. mRNA was determined using quantitative RT-PCR and proteins were determined by Western blot. Analysis of the action potential characteristics showed that PV tissue had a lower Vmax compared with left atrial tissue. Fast INa showed that current density was slightly lower in PV cells compared with LA cells (-96 ± 18.7 pA/pF vs. -120 ± 6.7 pA/pF, respectively, p < 0.05). The recovery from inactivation of INa in PV cells was slightly slower but no marked difference in steady-state inactivation was noted. Analysis of late INa during a 225-ms pulse showed that late INa was significantly smaller in PV cells compared to LA cells at all measured time points into the pulse. These results suggest PV cells have lower density of both peak and late INa. Molecular analysis of Nav1.5 and the four beta subunits showed lower levels of Nav1.5 as well as Navβ1 subunits, confirming the biophysical findings. These data show that a lower density of INa may lead to depression of excitability and predispose the PV collar to re-entrant circuits under pathophysiological conditions.

  13. Predicting Successful Pulmonary Vein Isolation In Patients With Atrial Fibrillation By Brain Natriuretic Peptide Plasma Levels

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    Dong-In Shin

    2009-09-01

    Full Text Available Background: Catheter ablation for atrial fibrillation is a clinically established treatment by now while success rate varies between 60% and 85%. Interventional treatment of atrial fibrillation is still a challenging technique associated with a long procedure time and risk of major complications in up to 6 % of treated patients. The aim of this study was to investigate the predictive value of plasma brain natriuretic peptide (BNP in patients undergoing pulmonary vein isolation concerning stable sinus rhythm after ablation.Methods: In 68 consecutive patients with atrial fibrillation (AF and normal left ventricular ejection fraction, BNP was measured at baseline before pulmonary vein isolation (PVI. All patients received a 7-days-holter monitoring 3 months after radiofrequency (RF ablation in order to detect recurrent AF episodes. Results: 48 patients with paroxysmal and 20 patients with persistent AF were enrolled. Baseline BNP was significantly higher in patients with persistent AF compared to patients with paroxysmal AF (145,5 pg/ml vs. 84,4 pg/ml; p<0,05. 3 months after PVI 38 patients (79,1% with paroxysmal AF had a stable sinus rhythm documented on 7-days-holter monitoring, where as in 10 patients (20,9% AF episodes were detected. Patients with a successful PVI showed significantly lower BNP plasma levels at baseline compared to patients with AF recurrrence (68,7 pg/ml vs. 144,1 pg/ml; p<0,05. In patients with persistent AF 55% (11 cases had no recurrence of AF at 3 months 7-days holter and in 9 patients (45% AF recurred. BNP plasma levels at baseline were lower in patients with stable sinusrhythm after 3 months compared to the group of recurrent AF (105,8 pg/ml vs. 193,3 pg/ml; p=0,11. Conclusion: Patients with AF and low preprocedural BNP plasma levels showed a better outcome after PVI. Thus BNP may be helpful in patient selection for a successful treatment of AF by PVI.

  14. Epicardial isolation of pulmonary veins with ethanol in open chest dogs

    Institute of Scientific and Technical Information of China (English)

    YIN Xian-dong; DONG Jian-zeng; MA Chang-sheng; NING Man; SANG Cai-hua; MIAO Cheng-long; LIANG Cui; TANG Ri-bo; LONG De-yong; YU Rong-hui; LIU Xing-peng

    2011-01-01

    Background Radiofrequency (RF) ablation has become a widely accepted treatment for atrial fibrillation (AF). This study aimed to identify the efficacy and safety of pulmonary vein (PV) ablation with ethanol and to explore an alternative energy source for catheter ablation of AF.Methods Twelve open-chest mongrel dogs were randomized into ethanol ablation group and control group. Both the injections and electrophysiological mapping procedures were performed epicardialy. In ethanol ablation group (n=6),injections were performed to circumferentially ablate the root of each PV (0.2 ml each site, 3 mm apart) with 95% ethanol using an 1 ml injector. In control group (n=-6), saline was injected other than ethanol. PV isolation was confirmed with a circular catheter immediately after the procedure and at follow up of 30 days. PV isolation was defined as the absence of PV potentials at each electrode of the circular catheter positioned at the PV side of the lesions, as well as complete conduction block into left atrium (LA) during PV pacing.Results PV electrical isolation with complete bidirectional conduction block was achieved with ethanol immediately and at 30 days in 95% of PVs, while saline injection caused only transient conduction changes between LA and PVs. In ethanol group, histologic analysis showed transmural lesions at 30 days. And there was no evidence of PV stenosis or thrombus formation. Mean LA diameter was not significantly different between baseline and 30 days.Conclusion Ethanol is a safe energy source to effectively isolate PV in canine model and may be promising in endocardial ablation procedure of AF patients in the future.

  15. Varicosity of the pulmonary veins

    Energy Technology Data Exchange (ETDEWEB)

    Leicher-Dueber, A.; Lindner, P.; Schild, H.; Plewe, G.

    1986-04-01

    Varicosity of the pulmonary veins is a rare anomaly of the pulmonary vascular system. The varices do not usually change in size over years, do not cause symptoms and need no therapy. However, raised left atrial pressure can cause increase in the diameter of pulmonary vein varices. A case of lung vein varicosity in the right middle and upper lobe associated with coarctation of the aorta and an anomalous upper-middle lobe vein was observed over a period of 10 years. Increase in left atrial pressure (aortic and relative mitral regurgitation) led to enlargement of the pulmonary veins.

  16. Characteristics of Residual Atrial Posterior Wall and Roof-Dependent Atrial Tachycardias after Pulmonary Vein Isolation.

    Science.gov (United States)

    Matsumoto, Akinori; Fukuzawa, Koji; Kiuchi, Kunihiko; Konishi, Hiroki; Ichibori, Hirotoshi; Imada, Hiroshi; Hyogo, Kiyohiro; Kurose, Jun; Takaya, Tomofumi; Mori, Shumpei; Yoshida, Akihiro; Hirata, Ken-Ichi; Nishii, Tatsuya; Kono, Atsushi

    2016-10-01

    Roof-dependent atrial tachycardia (roof AT) sometimes occurs after pulmonary vein isolation (PVI) of atrial fibrillation (AF). This study aimed to investigate the relationship between the anatomy of the residual left atrial posterior wall and occurrence of roof AT. A total of 265 patients with AF who underwent PVI were enrolled. After the PVI, induced or recurrent roof AT was confirmed by an entrainment maneuver or activation mapping using a three-dimensional (3D) mapping system. To identify the predictors of roof AT, the minimum distance between both PVI lines (d-PVI) was measured by a 3D mapping system and the anatomical parameters, including the left atrial (LA) diameter, left atrial volume index (LAVi), and shape of the left atrial roof, were analyzed by 3D computed tomography. Roof AT was documented in 11 (4.2%) of 265 patients. A multivariable analysis demonstrated that the d-PVI, Deep V shape of the LA roof, and LAVi were associated with roof AT occurrences (d-PVI: odds ratio: 0.72, confidence interval [CI]: 0.61-0.86, P PVI and LAVi, respectively. The shorter d-PVI at the LA roof, greater LAVi, and Deep V shape were associated with the occurrence of a roof AT. © 2016 Wiley Periodicals, Inc.

  17. Effect of pulmonary vein isolation on the distribution of complex fractionated electrograms in humans.

    Science.gov (United States)

    Roux, Jean-François; Gojraty, Sattar; Bala, Rupa; Liu, Christopher F; Dixit, Sanjay; Hutchinson, Mathew D; Garcia, Fermin; Lin, David; Callans, David J; Riley, Michael; Marchlinski, Francis; Gerstenfeld, Edward P

    2009-02-01

    Targeting of complex fractionated electrograms (CFEs) has been used as an adjunctive strategy to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF). However, it is unclear whether CFEs should be targeted before or after PVI. The purpose of this study was to examine the effect of PVI on CFE distribution in humans. We compared left atrial (LA) CFE maps acquired using the NavX system before and after PVI in patients with persistent AF. CFE maps were constructed from bipolar electrograms acquired from a circular mapping catheter. At each point, the mean AF cycle length (CL) was calculated automatically by averaging the intervals between deflections over a 4-second window. Sites with mean CL CFE+. A total of 22 consecutive patients (82% male, age 58 +/- 9 years) were studied. At baseline, 47% of the LA was encompassed by electrograms with CL CFE characteristics, with an increase in mean LA AF CL (144 ms pre-PVI vs. 214 ms post-PVI; P CFE+ LA surface area (47% vs 23%; P CFE burden after PVI in both PV (50% vs. 6%; P CFE. To limit extensive LA ablation, PVI should be performed before targeting CFE when a combined approach is pursued.

  18. Impact of pulmonary vein isolation on atrial vagal activity and atrial electrical remodeling

    Institute of Scientific and Technical Information of China (English)

    Yingxue Dong; Shulong Zhang; Lianjun Gao; Hongwei Zhao; Donghui Yang; Yunlong Xia; Yanzong Yang

    2008-01-01

    Objective Mechanisms of pulmonary vein isolation (PVI) for atrial fibrillation remain controversy.This study aimed to investigate the impact of PVI on vagal modulation to atria.Methods Eighteen adult mongrel dogs under general anesthesia were randomly divided into two groups.Bilateral cervical sympathovagal trunks were decentralized and sympathetic effects was blocked by metoprolol administration.Atrial electrical remodeling (AER) was established by rapid right atrial pacing at the rate of 600 bpm for 30 minutes.PVI was performed in group A.Atrial effective refractory period (ERP),vulnerability window (VW) of atrial fibrillation,and sinus rhythm cycle length (SCL) were measured at baseline and during vagal stimulation before and after atrial rapid pacing with and without PVI at fight atrial appendage (RAA),left atrial appendage (LAA),distal coronary sinus (CSd) and proximal coronary sinus (CSp).Results (1) Effects of PVI on vagal modulation:Shortening of SCL during vagal stimulation decreased significantly after PVI compared with that before PVI in group A (P<0.001).Shortening of ERP during vagal stimulation decreaseed significantly after PVI compared with that before PVI (P<0.05).VW of atrial fibrillation during vagal stimulation decreased significantly after PVI compared with that before PVI (P<0.05).(2) Effects of PVI on AER:shortening of ERP before and after atrial rapid pacing increased significantly at baseline and vagal stimulation in group B compared with that in group A (P<0.05).VW during vagal stimulation increased significantly after atrial rapid pacing in group B (P<0.05).Conclusion PVI attenuates the vagal modulation to the atria,thereby decreases the susceptibility to atrial fibrillation mediated by vagal activity.PVI releases AER,which maybe contributes to the vagal denervation.Our study indicates that PVI not only can eradicate triggered foci but also modify substrates for AF.(J Geriatr Cardiol 2008;5:28-32)

  19. Autonomic denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation: a randomized clinical trial.

    Science.gov (United States)

    Katritsis, Demosthenes G; Pokushalov, Evgeny; Romanov, Alexander; Giazitzoglou, Eleftherios; Siontis, George C M; Po, Sunny S; Camm, A John; Ioannidis, John P A

    2013-12-17

    The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). Conventional PVI transects the major left atrial GP, and it is possible that autonomic denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered. Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Preventive pulmonary vein isolation in patients with cavotricuspid isthmus ablation: PREVENT-AF Study I

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    С. А. Байрамова

    2015-10-01

    Full Text Available Background. Although catheter ablation of isthmus-dependent atrial flutter (AFL is extremely successful at eliminating the target arrhythmia, many patients subsequently experience a new onset of atrial fibrillation (AF due to shared mechanisms. The development of AF may necessitate additional interventions and expose patients to long-term risks.Objective. The study was designed to test a hypothesis whether it is possible to keep AF down during cavotricuspid isthmus (CTI ablation.Methods. This prospective blind randomized study included 50 patients with detected AFL, without AF in the medical history. The patients were randomized to undergo either CTI ablation alone or CTI with concomitant pulmonary vein isolation (PVI. All patients received an implantable loop recorder (ILR during the ablation procedure.Results. CTI ablation was successful in all 50 patients. PVI was effective in all 25 patients randomized to CTI+PVI group, with no complications recorded in both groups. The procedure (p<0.0001 and fluoroscopy (p<0.0001 times were longer in the CTI+PVI group. More patients in the CTI alone group experienced a new onset of AF, 52% vs 12%, during follow-up for minimum of one year (p=0.005. No patient experienced recurrent AFL. The one-year AF burden on ILR also favored the CTI+PVI group compared to the CTI alone group: 8.3% vs 4.0% (p=0.034. In the CTI alone group, 32% patients subsequently required another ablation for AF. PVI and female gender proved to be independent predictors of freedom from AF.Conclusions. The PREVENT-AF Study I trial results show that the addition of PVI to CTI ablation for patients with typical AFL only leads to a marked reduction of a new onset of AF during clinical follow-up as assessed by implantable ILR.

  1. Pulmonary Vein Isolation for Atrial Fibrillation Can Be Achieved with Low Radiation Exposure.

    Science.gov (United States)

    Huang, Alex L; Mughal, Nadeem; Tabas, Ferdinand; Patterson, Natalie L; Wong, Wen Kai; Whalley, David; Kanagaratnam, Logan

    2017-08-08

    Atrial fibrillation is common and management by pharmacotherapy is limited by modest efficacy and significant toxicities. Pulmonary vein isolation (PVI) is a safe and effective alternative in select patients with atrial fibrillation. However, prolonged procedure time raises concerns of health risks from radiation exposure. This study aims to determine the significance of radiation exposure from PVI. In this study, we retrospectively reviewed patient demographics, fluoroscopy time, entrance skin dose and dose area product in 80 cases of PVI, radiofrequency ablation for atrial flutter and diagnostic coronary angiogram performed in our institution. Compared to other procedures, patients who underwent PVI were younger (age, mean±standard error of mean, 59.4±1.1 years old, pPVI (20.8 and 13.1-30.7mins) and flutter ablation (17.6 and 11.1-26.1mins) but longer than diagnostic angiography (4.2 and 2.3-6.7mins, pPVI and flutter ablation groups but significantly higher in the diagnostic angiography group, with median and IQR for PVI vs. flutter ablation vs. diagnostic angiography, 100.4 (52.8-179.9) vs. 73.2 (37.0-142.1) vs. 393.5 (276.1-555.6) mGy (pPVI (1831.2 and 887.7-3460.8cGycm(2)) was higher than flutter ablation (1077.8 and 452.9-2410.2cGycm(2), pPVI decreased over time, likely due to increased operator experience. Despite prolonged procedure time, radiation exposure from PVI was comparable to, or lower than, other fluoroscopy-guided cardiac procedures. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

  2. Pulmonary vein isolation in patients with paroxysmal atrial fibrillation is associated with regional cardiac sympathetic denervation

    Science.gov (United States)

    2013-01-01

    Background Circumferential pulmonary vein isolation (PVI) is the cornerstone of the current state-of-the-art management of atrial fibrillation (AF). However, the precise mechanisms behind AF relapses post PVI are still unknown. Since the activity of the autonomous nervous system is crucial in triggering paroxysmal AF, we hypothesized that PVI is associated with changes of cardiac sympathetic activity. Methods Sixteen patients with paroxysmal AF underwent cardiac iodine-123-meta-iodobenzylguanidine (123I-mIBG) planar cardiac imaging and single-photon emission computed tomography with low-dose computed tomography (SPECT/CT) for attenuation correction before and 4 weeks after PVI. The heart-to-mediastinum ratio (H/M ratio), washout rate (WR), regional myocardial uptake, and regional washout were analyzed. Results The late H/M ratio was unchanged by PVI (pre, 2.9 ± 0.5 vs. post, 2.7 ± 0.6, p = 0.53). Four of the 16 patients (25%) displayed regional deficits before PVI. After PVI, regional deficits were present in ten patients (62.5%) with newly emerging deficits localized in the inferolateral wall. In a 6-month follow-up, four out of the ten patients (40%) with regional 123I-mIBG defects suffered from a recurrence of AF, while only one of the six patients (16.7%) without a regional 123I-mIBG defect experienced a recurrence. Conclusion A significant number of patients with paroxysmal AF show regional cardiac sympathetic innervation deficits at baseline. In addition, PVI is associated with newly emerging defects. The presence of regional sympathetic denervation after PVI may correlate with the risk of AF relapses. PMID:24360192

  3. Optimization of imaging before pulmonary vein isolation by radiofrequency ablation: breath-held ungated versus ECG/breath-gated MRA

    Energy Technology Data Exchange (ETDEWEB)

    Allgayer, C.; Haller, S.; Bremerich, J. [University Hospital Basel, Department of Radiology, Basel (Switzerland); Zellweger, M.J.; Sticherling, C.; Buser, P.T. [University Hospital Basel, Department of Cardiology, Basel (Switzerland); Weber, O. [University Hospital Basel, Department of Medical Physics, Basel (Switzerland)

    2008-12-15

    Isolation of the pulmonary veins has emerged as a new therapy for atrial fibrillation. Pre-procedural magnetic resonance (MR) imaging enhances safety and efficacy; moreover, it reduces radiation exposure of the patients and interventional team. The purpose of this study was to optimize the MR protocol with respect to image quality and acquisition time. In 31 patients (23-73 years), the anatomy of the pulmonary veins, left atrium and oesophagus was assessed on a 1.5-Tesla scanner with four different sequences: (1) ungated two-dimensional true fast imaging with steady precession (2D-TrueFISP), (2) ECG/breath-gated 3D-TrueFISP, (3) ungated breath-held contrast-enhanced three-dimensional turbo fast low-angle shot (CE-3D-tFLASH), and (4) ECG/breath-gated CE-3D-TrueFISP. Image quality was scored from 1 (structure not visible) to 5 (excellent visibility), and the acquisition time was monitored. The pulmonary veins and left atrium were best visualized with CE-3D-tFLASH (scores 4.50 {+-} 0.52 and 4.59 {+-} 0.43) and ECG/breath-gated CE-3D-TrueFISP (4.47 {+-} 0.49 and 4.63 {+-} 0.39). Conspicuity of the oesophagus was optimal with CE-3D-TrueFISP and 2D-TrueFISP (4.59 {+-} 0.35 and 4.19 {+-} 0.46) but poor with CE-3D-tFLASH (1.03 {+-} 0.13) (p < 0.05). Acquisition times were shorter for 2D-TrueFISP (44 {+-} 1 s) and CE-3D-tFLASH (345 {+-} 113 s) compared with ECG/breath-gated 3D-TrueFISP (634 {+-} 197 s) and ECG/breath-gated CE-3D-TrueFISP (636 {+-} 230 s) (p < 0.05). In conclusion, an MR imaging protocol comprising CE-3D-tFLASH and 2D-TrueFISP allows assessment of the pulmonary veins, left atrium and oesophagus in less than 7 min and can be recommended for pre-procedural imaging before electric isolation of pulmonary veins. (orig.)

  4. Two cases of delayed cardiac tamponade due to pericarditis after pulmonary vein (PV) isolation for atrial fibrillation.

    Science.gov (United States)

    Torihashi, Sadayoshi; Shiraishi, Hirokazu; Hamaoka, Tetsuro; Imai, Mikimasa; Kuroyanagi, Akira; Nakanishi, Naohiko; Nakamura, Takeshi; Yamano, Tetsuhiro; Matsumuro, Akiyoshi; Shirayama, Takeshi

    2015-01-01

    Catheter ablation is an established treatment for atrial fibrillation (AF). The incidence of major complications related to the procedure is reported to be 4.5%, and delayed cardiac tamponade (DCT) is a rare, although recently recognized, complication. However, the mechanisms underlying the development of DCT remain unclear. We herein report the cases of two men, both 49 years of age, who developed cardiac tamponade requiring pericardiocentesis a few weeks after undergoing pulmonary vein isolation for persistent AF. Physicians should explain to the patient the potential for DCT as a complication prior to performing catheter ablation and provide careful follow-up for at least a few weeks after the session.

  5. Catheter ablation of atrial fibrillation guided by complex fractionated atrial electrogram mapping with or without pulmonary vein isolation

    Directory of Open Access Journals (Sweden)

    Naoya Oketani

    2012-12-01

    Full Text Available Pulmonary vein isolation (PVI was the main strategy for catheter ablation of atrial fibrillation (AF until a remarkable report was published by Nademanee et al. in 2004. The ablation targeting complex fractionated atrial electrograms (CFAE achieved not only a high rate of AF termination but also excellent outcomes in both paroxysmal and persistent AF without isolating pulmonary veins. AF is thought to be caused by random or spiral reentry, as the fixed circuit to maintain AF may not exist, although the CFAE-guided ablation strategy is based on the theory that AF is not entirely random. CFAEs play an important role in identifying AF substrates, and have temporal and spatial stability, thus representing desirable targets for AF ablation; however, CFAE-guided ablation has not been fully replicated by others. In reports showing that CFAE ablation did not yield a good outcome either alone or combined with PVI, the AF termination rates were extremely low. Although AF termination is not mandatory in CFAE-ablation, terminating AF in the majority of patients appears to be necessary to yield good outcomes; therefore, this review will discuss AF ablation guided by CFAE with or without PVI, with particular emphasis given to practical aspects of achieving AF termination.

  6. Role of adenosine-guided pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a meta-analysis.

    Science.gov (United States)

    Chen, Yi-He; Lin, Hui; Xie, Cheng-Long; Hou, Jian-Wen; Li, Yi-Gang

    2017-04-01

    Adenosine had been reported to unmask dormant conduction and thus identify pulmonary vein at risk of reconnection. However, the role of adjunctive adenosine infusion after pulmonary vein isolation (PVI) on long-term arrhythmia-free survival was still contentious. The purpose of the present meta-analysis was to assess the association of adenosine testing with long-term ablation success in patients with atrial fibrillation (AF) (i.e. freedom from AF recurrence). We systematically searched the electronic databases and finally included 10 studies, with 1771 patients undergoing adenosine-guided PVI and 1787 patients undergoing conventional PVI. In comparison to conventional PVI alone, adenosine-guided PVI improved the arrhythmia-free survival by 17% during a median follow-up of 12 months [relative risk (RR): 1.17; 95% confidence interval (CI): 1.07 to 1.27; P = 0.014]. Patients undergoing adenosine-guided PVI had similar fluoroscopy time to those who undergoing conventional PVI [weighted mean difference (WMD): 1.76; 95% CI: -5.66 to 9.17; P = 0.64], despite longer procedure time (WMD: 20.6; 95% CI: 0.70 to 40.50; P = 0.042). From the available data of clinical studies, adenosine-guided PVI was associated with an increased arrhythmia-free survival when compared with conventional PVI in patients undergoing catheter ablation for AF.

  7. Five-year efficacy of pulmonary vein antrum isolation as a primary ablation strategy for atrial fibrillation : a single-centre cohort study

    NARCIS (Netherlands)

    Teunissen, Cas; Kassenberg, W; van der Heijden, Jeroen F; Hassink, RJ; van Driel, Vincent J H M; Zuithoff, NPA; Doevendans, Pieter A; Loh, KP

    2016-01-01

    AIMS: Pulmonary vein antrum isolation (PVAI) is the cornerstone of atrial fibrillation (AF) ablation. There is an ongoing discussion on whether and when to add substrate modification to PVAI. This study evaluates (1) long-term efficacy of PVAI as a primary ablation strategy in all patients independe

  8. Feasibility and outcome of epicardial pulmonary vein isolation for lone atrial fibrillation using minimal invasive surgery and high intensity focused ultrasound

    NARCIS (Netherlands)

    Klinkenberg, Theo J.; Ahmed, Sheba; Ten Hagen, Anita; Wiesfeld, Ans C. P.; Tan, Eng S.; Zijlstra, Felix; Van Gelder, Isabelle C.

    2009-01-01

    Transvenous pulmonary vein isolation (PVI) is the cornerstone of non-pharmacological rhythm control therapy in symptomatic atrial fibrillation (AF). Success and complications rates are, however, still not optimal. New techniques and energy sources are therefore being developed. Fifteen patients with

  9. Verification of pulmonary vein isolation during single transseptal cryoballoon ablation: a comparison between the classical circular mapping catheter and the inner lumen mapping catheter

    NARCIS (Netherlands)

    Chierchia, G.B.; Namdar, M.; Sarkozy, A.; Sorgente, A.; Asmundis, C. de; Casado-Arroyo, R.; Capulzini, L.; Bayrak, F.; Rodriguez-Manero, M.; Ricciardi, D.; Rao, J.Y.; Overeinder, I.; Paparella, G.; Brugada, P.

    2012-01-01

    AIMS: Cryoballoon ablation has proven very effective in achieving pulmonary vein isolation (PVI). The novel Achieve inner lumen mapping catheter designed to be used in conjunction with the cryoballoon, serves as both a guidewire and a mapping catheter. To our knowledge, this is the first study compa

  10. Early recurrence of atrial fibrillation as a predictor for 1-year efficacy after successful phased RF pulmonary vein isolation: evaluation of complaints and multiple Holter recordings

    NARCIS (Netherlands)

    Mulder, A.A.W.; Wijffels, M.C.; Wever, E.F.; Boersma, L.V.

    2013-01-01

    BACKGROUND: Early arrhythmia recurrences after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are accepted as part of the blanking period. Their relevance for long-term efficacy is not well-known. We evaluated patients, who came to hospital with a documented recurrence of AF, or had a r

  11. Early recurrence of atrial fibrillation as a predictor for 1-year efficacy after successful phased RF pulmonary vein isolation: evaluation of complaints and multiple Holter recordings

    NARCIS (Netherlands)

    Mulder, A.A.W.; Wijffels, M.C.; Wever, E.F.; Boersma, L.V.

    2013-01-01

    BACKGROUND: Early arrhythmia recurrences after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are accepted as part of the blanking period. Their relevance for long-term efficacy is not well-known. We evaluated patients, who came to hospital with a documented recurrence of AF, or had a

  12. Early recurrence of atrial fibrillation as a predictor for 1-year efficacy after successful phased RF pulmonary vein isolation: evaluation of complaints and multiple Holter recordings

    NARCIS (Netherlands)

    Mulder, A.A.W.; Wijffels, M.C.; Wever, E.F.; Boersma, L.V.

    2013-01-01

    BACKGROUND: Early arrhythmia recurrences after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are accepted as part of the blanking period. Their relevance for long-term efficacy is not well-known. We evaluated patients, who came to hospital with a documented recurrence of AF, or had a r

  13. Feasibility and outcome of epicardial pulmonary vein isolation for lone atrial fibrillation using minimal invasive surgery and high intensity focused ultrasound

    NARCIS (Netherlands)

    Klinkenberg, Theo J.; Ahmed, Sheba; Ten Hagen, Anita; Wiesfeld, Ans C. P.; Tan, Eng S.; Zijlstra, Felix; Van Gelder, Isabelle C.

    2009-01-01

    Transvenous pulmonary vein isolation (PVI) is the cornerstone of non-pharmacological rhythm control therapy in symptomatic atrial fibrillation (AF). Success and complications rates are, however, still not optimal. New techniques and energy sources are therefore being developed. Fifteen patients with

  14. Pulmonary vein isolation of symptomatic refractory paroxysmal and persistent atrial fibrillation : A single centre and single operator experience in the Netherlands

    NARCIS (Netherlands)

    Tan, E. S.; Mulder, B. A.; Rienstra, M.; Wiesfeld, A. C. P.; Ahmed, S.; Zijlstra, F.; Van Gelder, I. C.

    2009-01-01

    Aim. To investigate long-term outcome and to determine predictors of successful pulmonary vein isolation (PVI) in patients with symptomatic paroxysmal or persistent atrial fibrillation (A-F) who are refractory or intolerant to antiarrhythmic drugs. Background. The treatment of AF has traditionally b

  15. Pulmonary vein isolation of symptomatic refractory paroxysmal and persistent atrial fibrillation : A single centre and single operator experience in the Netherlands

    NARCIS (Netherlands)

    Tan, E S; Mulder, B A; Rienstra, M; Wiesfeld, A C P; Ahmed, S; Zijlstra, F; Van Gelder, I C

    2009-01-01

    Aim. To investigate long-term outcome and to determine predictors of successful pulmonary vein isolation (PVI) in patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) who are refractory or intolerant to antiarrhythmic drugs.Background. The treatment of AF has traditionally bee

  16. Verification of pulmonary vein isolation during single transseptal cryoballoon ablation: a comparison between the classical circular mapping catheter and the inner lumen mapping catheter

    NARCIS (Netherlands)

    Chierchia, G.B.; Namdar, M.; Sarkozy, A.; Sorgente, A.; Asmundis, C. de; Casado-Arroyo, R.; Capulzini, L.; Bayrak, F.; Rodriguez-Manero, M.; Ricciardi, D.; Rao, J.Y.; Overeinder, I.; Paparella, G.; Brugada, P.

    2012-01-01

    AIMS: Cryoballoon ablation has proven very effective in achieving pulmonary vein isolation (PVI). The novel Achieve inner lumen mapping catheter designed to be used in conjunction with the cryoballoon, serves as both a guidewire and a mapping catheter. To our knowledge, this is the first study compa

  17. A Tight Spot After Pulmonary Vein Catheter Ablation

    NARCIS (Netherlands)

    Amir, Rabia; Yeh, Lu; Montealegre-Gallegos, Mario; Saraf, Rabya; Matyal, Robina; Mahmood, Feroze

    2016-01-01

    A 52-YEAR-OLD woman with a history of embolic stroke due to paroxysmal atrial fibrillation was referred to the authors’ institution for epicardial surgical pulmonary vein isolation with left atrial appendage resection. The patient had 2 previous failed pulmonary vein catheter ablations. Dense

  18. A Tight Spot After Pulmonary Vein Catheter Ablation

    NARCIS (Netherlands)

    Amir, Rabia; Yeh, Lu; Montealegre-Gallegos, Mario; Saraf, Rabya; Matyal, Robina; Mahmood, Feroze

    2016-01-01

    A 52-YEAR-OLD woman with a history of embolic stroke due to paroxysmal atrial fibrillation was referred to the authors’ institution for epicardial surgical pulmonary vein isolation with left atrial appendage resection. The patient had 2 previous failed pulmonary vein catheter ablations. Dense fibrou

  19. [Treatment of pulmonary vein stenosis secondary to radiofrequency ablation].

    Science.gov (United States)

    Ferrero Guadagnoli, Adolfo; Contreras, Alejandro E; Leonardi, Carlos R; Ballarino, Miguel A; Atea, Leonardo; Peirone, Alejandro R

    2014-01-01

    Isolation of the pulmonary veins by applying radiofrequency is an effective treatment for atrial fibrillation. One of the potential complications with higher clinical compromise utilizing this invasive technique is the occurrence of stenosis of one or more pulmonary veins. This complication can be treated by angioplasty with or without stent implantation, with an adequate clinical improvement, but with a high rate of restenosis.

  20. Pulmonary vein isolation using the Rhythmia mapping system: Verification of intracardiac signals using the Orion mini-basket catheter.

    Science.gov (United States)

    Anter, Elad; Tschabrunn, Cory M; Contreras-Valdes, Fernando M; Li, Jianqing; Josephson, Mark E

    2015-09-01

    During pulmonary vein isolation (PVI), a circular lasso catheter is positioned at the junction between the left atrium (LA) and the pulmonary vein (PV) to confirm PVI. The Rhythmia mapping system uses the Orion mini-basket catheter with 64 electrodes instead of the lasso catheter. However, its feasibility to determine PVI has not been studied. The purpose of this study was to compare signals between the mini-basket and lasso catheters at the LA-PV junction. In 12 patients undergoing PVI using Rhythmia, the mini-basket and lasso catheters were placed simultaneously at the LA-PV junction for baseline and post-PVI signal assessment. Pacing from both catheters was performed to examine the presence of exit block. At baseline, recordings of LA and PV potentials were concordant in all PVs. However, after PVI, concordance between the catheters was only 68%. Discordance in all cases resulted from loss of PV potentials on the lasso catheter with persistence of PV potentials on the mini-basket catheter. In 9 of 13 PVs (69%), these potentials represented true PV potentials that were exclusively recorded with the smaller and closely spaced mini-basket electrodes. In the other 4 PVs (31%), these potentials originated from neighboring structures and resulted in underestimation of PVI. The use of the mini-basket catheter alone is sufficient to determine PVI. While it improves recording of PV potentials after incomplete ablation, it is also associated with frequent recording of "PV-like" potentials originating from neighboring structures. In these cases, pacing maneuvers are helpful to determine PVI and avoid excessive ablation. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  1. The slope of the initial temperature drop predicts acute pulmonary vein isolation using the second-generation cryoballoon.

    Science.gov (United States)

    Deubner, Nikolas; Greiss, Harald; Akkaya, Ersan; Zaltsberg, Sergey; Hain, Andreas; Berkowitsch, Alexander; Güttler, Norbert; Kuniss, Malte; Neumann, Thomas

    2017-09-01

    There is no objective, early indicator of occlusion quality, and efficacy of cryoballoon pulmonary vein isolation. As previous experience suggests that the initial cooling rate correlates with these parameters, we investigated the slope of the initial temperature drop as an objective measure. A systematic evaluation of 523 cryoapplications in 105 patients using a serial ROC-AUC analysis was performed. We found the slope of a linear regression of the temperature-time function to be a good predictor (PPV 0.9, specificity 0.72, sensitivity 0.71, and ROC-AUC 0.75) of acute isolation. It also correlated with nadir temperatures (P< 0.001, adjusted R2= 0.43), predicted very low nadir temperatures, and varied according to visual occlusion grades (ANOVA P< 0.001). About 25 s after freeze initiation, the temperature-time slope predicts important key characteristics of a cryoablation, such as nadir temperature. The slope is the only reported predictor to actually precede acute isolation and thus to support decisions about pull-down manoeuvres or aborting a cryoablation early on. It is also predictive of very low nadir temperatures and phrenic nerve palsy and thus may add to patient safety.

  2. Computer-assisted diagnostic tool to quantify the pulmonary veins in sickle cell associated pulmonary hypertension

    Science.gov (United States)

    Jajamovich, Guido H.; Pamulapati, Vivek; Alam, Shoaib; Mehari, Alem; Kato, Gregory J.; Wood, Bradford J.; Linguraru, Marius George

    2012-03-01

    Pulmonary hypertension is a common cause of death among patients with sickle cell disease. This study investigates the use of pulmonary vein analysis to assist the diagnosis of pulmonary hypertension non-invasively with CT-Angiography images. The characterization of the pulmonary veins from CT presents two main challenges. Firstly, the number of pulmonary veins is unknown a priori and secondly, the contrast material is degraded when reaching the pulmonary veins, making the edges of these vessels to appear faint. Each image is first denoised and a fast marching approach is used to segment the left atrium and pulmonary veins. Afterward, a geodesic active contour is employed to isolate the left atrium. A thinning technique is then used to extract the skeleton of the atrium and the veins. The locations of the pulmonary veins ostia are determined by the intersection of the skeleton and the contour of the atrium. The diameters of the pulmonary veins are measured in each vein at fixed distances from the corresponding ostium, and for each distance, the sum of the diameters of all the veins is computed. These indicators are shown to be significantly larger in sickle-cell patients with pulmonary hypertension as compared to controls (p-values < 0.01).

  3. Impact of the origin of sinus node artery on recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhi-jun; CHEN Ke; TANG Ri-bo; gANG Cai-hua; Edmundo Patricio Lopes Lao; YAN Qian; HE Xiao-nan

    2013-01-01

    Background Major atrial coronary arteries,including the sinus node artery (SNA),were commonly found in the areas involved in atrial fibrillation (AF) ablation and could cause difficulties in achieving linear block at the left atrial (LA) roof.The SNA is a major atrial coronary artery of the atrial coronary circulation.This study aimed to determine impact of the origin of SNA on recurrence of AF after pulmonary vein isolation (PVI) in patients with paroxysmal AF.Methods Seventy-eight patients underwent coronary angiography for suspected coronary heart disease,followed by catheter ablation for paroxysmal AF.According to the origin of SNA from angiographic findings,they were divided into right SNA group (SNA originating from the right coronary artery) and left SNA group (SNA originating from the left circumflex artery).Guided by an electroanatomic mapping system,circumferential pulmonary vein ablation (CPVA) was performed in both groups and PVI was the procedural endpoint.All patients were followed up at 1,3,6,9 and 12 months post-ablation.Recurrence was defined as any episode of atrial tachyarrhythmias (ATAs),including AF,atrial flutter or atrial tachycardia,that lasted longer than 30 seconds after a blanking period of 3 months.Results The SNA originated from the right coronary artery in 34 patients (43.6%) and the left circumflex artery in 44 patients (56.4%).Freedom from AF and antiarrhythmic drugs (AADs) at 1 year was 67.9 % (53/78) for all patients.After 1 year follow-up,79.4% (27/34) in right SNA group and 59.1% (26/44) in left SNA group (P=0.042) were in sinus rhythm.On multivariate analysis,left atrium size (HR=1.451,95%CI:1.240-1.697,P <0.001) and a left SNA (HR=6.22,95%CI:2.01-19.25,P=0.002)were the independent predictors of AF recurrence.Conclusions The left SNA is more frequent in the patients with paroxysmal AF.After one year follow-up,the presence of a left SNA was identified as an independent predictor of AF recurrence after CPVA in

  4. Five-year efficacy of pulmonary vein antrum isolation as a primary ablation strategy for atrial fibrillation : a single-centre cohort study

    OpenAIRE

    Teunissen, Cas; Kassenberg, W; van der Heijden, Jeroen F.; Hassink, RJ; van Driel, Vincent J H M; Zuithoff, NPA; Pieter A Doevendans; Loh, KP

    2016-01-01

    AIMS: Pulmonary vein antrum isolation (PVAI) is the cornerstone of atrial fibrillation (AF) ablation. There is an ongoing discussion on whether and when to add substrate modification to PVAI. This study evaluates (1) long-term efficacy of PVAI as a primary ablation strategy in all patients independently from AF type and (2) predictors of arrhythmia recurrence. METHODS AND RESULTS: A total of 509 consecutive patients (mean age 57 years, 38.9% non-paroxysmal AF) with AF underwent PVAI. In redo ...

  5. Sequential Percutaneous LAA Ligation and Pulmonary Vein Isolation in Patients with Persistent AF: Initial Results of a Feasibility Study.

    Science.gov (United States)

    Badhwar, Nitish; Lakkireddy, Dhanunjaya; Kawamura, Mitsuharu; Han, Frederick T; Iyer, Sivaraman K; Moyers, Brian S; Dewland, Thomas A; Woods, Chris; Ferrell, Ryan; Nath, Jayant; Earnest, Mathew; Lee, Randall J

    2015-06-01

    Left atrial appendage (LAA) ligation results in LAA electrical isolation and a decrease in atrial fibrillation (AF) burden. This study assessed the feasibility of combined percutaneous LAA ligation and pulmonary vein isolation (PVI) in patients with persistent AF. A total of 22 patients with persistent AF underwent LAA ligation with the LARIAT device followed by PVI. PVI was confirmed with the demonstration of both entrance and exit block. Patients (n = 10) in sinus rhythm pre- and post-LAA ligation underwent P-wave analysis. Monitoring for AF was performed at 1, 3, and 6 months postablation. LAA ligation was successful in 21 of 22 (95%) patients. The procedure was aborted in one patient due to pericardial adhesions. PVI was performed in 20 of 21 patients. One patient converted to atrial flutter with a controlled ventricular response after LAA ligation and refused subsequent PVI. Demonstration of entrance and exit block was achieved in 19 of 20 patients. At 3 months, 13 of 19 (68.4%) patients were in sinus rhythm. Four patients underwent a second PVI. At 6 months, 15 of 20 (75%) patients were in sinus rhythm. There was a significant decrease in P-wave duration and P-wave dispersion after LAA ligation. Complications with LAA ligation included pericarditis, a delayed pleural effusion, and a late pericardial effusion. Staged LAA ligation and PVI is feasible and decreases P-wave dispersion. Randomized studies are needed to assess the efficacy of LAA ligation as adjunctive therapy to PVI for maintaining sinus rhythm in patients with persistent AF. © 2015 Wiley Periodicals, Inc.

  6. Mechanical function of left atrium and pulmonary vein sleeves before and after their antrum isolation

    Directory of Open Access Journals (Sweden)

    Sergey Mamchur

    2014-01-01

    Conclusions: The PVs take an active part in left atrial filling by contraction of their sleeves. Antrum isolation of the PVs leads to the deterioration of their contractility and LA reservoir function.

  7. AF Ablation Guided by Spatiotemporal Electrogram Dispersion Without Pulmonary Vein Isolation: A Wholly Patient-Tailored Approach.

    Science.gov (United States)

    Seitz, Julien; Bars, Clément; Théodore, Guillaume; Beurtheret, Sylvain; Lellouche, Nicolas; Bremondy, Michel; Ferracci, Ange; Faure, Jacques; Penaranda, Guillaume; Yamazaki, Masatoshi; Avula, Uma Mahesh R; Curel, Laurence; Siame, Sabrina; Berenfeld, Omer; Pisapia, André; Kalifa, Jérôme

    2017-01-24

    The use of intracardiac electrograms to guide atrial fibrillation (AF) ablation has yielded conflicting results. The authors evaluated the usefulness of spatiotemporal dispersion, a visually recognizable electric footprint of AF drivers, for the ablation of all forms of AF. The authors prospectively enrolled 105 patients admitted for AF ablation. AF was sequentially mapped in both atria with a 20-pole PentaRay catheter. The authors tagged and ablated only regions displaying electrogram dispersion during AF. Results were compared to a validation set in which a conventional ablation approach was used (pulmonary vein isolation/stepwise approach). To establish the mechanism underlying spatiotemporal dispersion of AF electrograms, the authors conducted realistic numerical simulations of AF drivers in a 2-dimensional model and optical mapping of ovine atrial scar-related AF. Ablation at dispersion areas terminated AF in 95% of the 105 patients. After ablation of 17 ± 10% of the left atrial surface and 18 months of follow-up, the atrial arrhythmia recurrence rate was 15% after 1.4 ± 0.5 procedures per patient versus 41% in the validation set after 1.5 ± 0.5 procedures per patient (arrhythmia free-survival: 85% vs. 59%; log-rank p dispersion is mostly recorded in the vicinity of a driver. The clustering of intracardiac electrograms exhibiting spatiotemporal dispersion is indicative of AF drivers. Their ablation allows for a nonextensive and patient-tailored approach to AF ablation. (Substrate Ablation Guided by High Density Mapping in Atrial Fibrillation [SUBSTRATE HD]; NCT02093949). Copyright © 2017 American College of Cardiology Foundation. All rights reserved.

  8. Pulmonary vein isolation alone and combined with renal sympathetic denervation in chronic kidney disease patients with refractory atrial fibrillation.

    Science.gov (United States)

    Kiuchi, Márcio G; Chen, Shaojie; E Silva, Gustavo R; Paz, Luis M R; Kiuchi, Tetsuaki; de Paula Filho, Ary G; Souto, Gladyston L L

    2016-12-01

    Atrial fibrillation (AF) commonly occurs in association with chronic kidney disease (CKD), resulting in adverse outcomes. Combining pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may reduce the recurrence of AF in patients with CKD and hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. Our goal was to compare the impact of PVI + RSD with that of PVI alone in patients with concurrent AF and CKD. This was a single-center, prospective, longitudinal, randomized, double-blind study. Forty-five patients with controlled hypertension, symptomatic paroxysmal AF and/or persistent AF, stage 2 or 3 CKD, and a dual-chamber pacemaker were enrolled from January 2014 to January 2015. We assessed the 30-second recurrence of AF recorded by the pacemaker, 24-hour ambulatory blood pressure measurements, estimated glomerular filtration rate, albuminuria, echocardiographic parameters, and safety of RSD. No patient developed procedural or other complications. The ambulatory blood pressure measurements did not differ within the PVI + RSD group or between the PVI + RSD and PVI groups throughout the study. Significantly more patients in the PVI + RSD group than in the PVI group were free of AF at the 12-month follow-up evaluation. The PVI group had an unacceptable response to ablation with respect to changes in echocardiographic parameters, whereas these parameters improved in the PVI + RSD group. PVI + RSD were associated with a lower AF recurrence rate than PVI alone; it also improved renal function and some echocardiographic parameters. These encouraging data will serve as baseline information for further long-term studies on larger patient populations.

  9. Alteration of Endothelin 1, MCP-1 and Chromogranin A in patients with atrial fibrillation undergoing pulmonary vein isolation.

    Science.gov (United States)

    Lackermair, K; Clauss, S; Voigt, T; Klier, I; Summo, C; Hildebrand, B; Nickel, T; Estner, H L; Kääb, S; Wakili, R; Wilbert-Lampen, U

    2017-01-01

    The relation between arrhythmias and stress is known. The aim of our current study was to elucidate whether plasma levels of previously described stress parameters are altered in highly symptomatic patients with atrial fibrillation (AF) per se and in patients undergoing ablation therapy by pulmonary vein isolation (PVI). 96 patients with AF undergoing PVI were recruited. Plasma levels of Endothelin-1 (ET-1), MCP-1 and Chromogranin-A (CGA) were measured before and three months after ablation completed with clinical follow-up with respect to AF recurrence. Additionally, we examined 40 healthy age- and sex-matched volunteers as a reference. Symptomatic AF patients showed increased levels of ET-1 compared to healthy controls (2.62pg/ml vs. 1.57pg/ml; pPVI (2.96pg/ml vs. 2.57pg/ml;p = 0.02). The temporal comparison revealed decreased ET-1 levels in patients without (2.57pg/ml vs. 2.33pg/ml; pPVI. Baseline MCP-1 was increased in AF patients vs. controls (268pg/ml vs. 227 pg/ml; p = 0.03). Both groups, with and without AF after PVI, showed an increase of MCP-1 compared to baseline (268pg/ml vs. 349pg/ml;pPVI showed an increase of CGA (14.2ng/ml vs. 20.7ng/ml;pPVI. Our study demonstrated dysregulated levels of ET-1, MCP-1 and CGA in symptomatic AF patients. We could demonstrate an association between ET-1 to presence or absence of AF. Furthermore, we could show that a decrease of ET-1 as well as an increase of CGA after PVI, representing a trend towards control cohort levels, were both associated with restoration of sinus rhythm. These results provide new insights into the role of stress-related biomarkers in AF and AF treatment by ablation therapy.

  10. Left atrial appendage closure device implantation and pulmonary vein isolation as a comprehensive treatment for atrial fibrillation

    Directory of Open Access Journals (Sweden)

    А. А. Якубов

    2016-01-01

    Full Text Available Objective. This randomized clinical trial was designed to assess the impact of pulmonary vein isolation (PVI combined with LAA occlusion on patients with high-risk AF. Methods. Patients with a history of symptomatic paroxysmal (P AF and/or persistent (Pers AF and CHA2DS2-VASc score ≥2 and HAS-BLED score ≥3 were randomized in groups with PVI only (n = 44 and PVI combined with LAA occlusion (n = 45. All patients were followed during 24 months in order to evaluate the safety of thromboembolic complications and to monitor the heart rhythm conducted by means of an implantable cardiac monitor. Results. 6 patients from the PVI with LAA occlusion group were transferred to the PVI only group because of a failure to implant a LAA closure device. Based on ILR data, by the end of the follow-up 33 (66% out of 50 patients in the PVI only group and 23 (59% out of 39 patients in the PVI with LAA closure device implantation group were free from atrial fibrillation and flutter without antiarrhythmic drugs (p = 0.34. In the blanking period, AF% was significantly higher in the PVI with LAA closure group than that in the PVI-only group, 9.7±10.8 and 4.2±4.1% respectively (p = 0.004. After the blanking period, the AF% was similar in both groups. During the entire follow-up, no AF/intervention-related complications were observed. Conclusion. The combination of LAA closure device implantation with PVI seems to be a safe procedure. However, it does not improve the efficacy of PVI in patients with symptomatic refractory AF. But in the blanking period LAA occlusion increases AF %.

  11. Efficacy and safety of novel epicardial circumferential left atrial ablation with pulmonary vein isolation in sustained atrial fibrillation.

    Science.gov (United States)

    Jiang, Zhaolei; Yin, Hang; He, Yi; Ma, Nan; Tang, Min; Liu, Hao; Ding, Fangbao; Mei, Ju

    2015-09-01

    The aim of this study was to examine the efficacy and safety of this novel epicardial circumferential left atrial ablation (CLAA) with pulmonary vein isolation (PVI) in sustained atrial fibrillation (AF). Thirty domestic pigs were divided equally into 3 groups: AF without ablation (AF group), AF with PVI (PVI group), and AF with CLAA and PVI (CLAA + PVI group). AF was induced by rapid atrial pacing. After AF was induced, CLAA and PVI were performed for pigs in CLAA + PVI group, and PVI was performed for pigs in PVI group. AF vulnerability, AF duration, and histology were performed in all groups. All pigs developed sustained AF after 6.27 ± 0.69 weeks of rapid atrial pacing. All pigs successfully underwent isolated PVI or CLAA with PVI on the beating heart in PVI group or CLAA + PVI group. Isolated PVI terminated AF in 3 of 20 pigs (15 %), and CLAA with PVI terminated AF in 5 of 8 pigs (62.5 %, P = 0.022). Compared with AF group (10/10), the incidence of sustained AF by burst pacing was significantly decreased in PVI group (3/10, P = 0.003) or CLAA + PVI group (0/10, P PVI group and CLAA + PVI group (P = 0.211). AF duration was significantly decreased in CLAA + PVI group (734.70 ± 177.81 s, 95 % CI 607.51-861.89) compared with PVI group (1217.90 ± 444.10 s, 95 % CI 900.21-1535.59, P = 0.008). Also, AF duration was significantly decreased in PVI group (P = 0.003) or CLAA + PVI group (P PVI alone, CLAA with PVI may be able to improve the rate of acute termination of persistent AF. It may be useful in selecting the best ablation approaches for patients with persistent AF.

  12. Unilateral pulmonary vein atresia: A rare case of hemoptysis

    Directory of Open Access Journals (Sweden)

    Cindy S. DeMastes-Crabtree

    2015-01-01

    Full Text Available We present a rare case of hemoptysis secondary to isolated unilateral pulmonary vein atresia. Isolated pulmonary vein atresia is a rare condition in which patients typically acquire a diagnosis in infancy and early childhood [Mataciunas et al.; Pourmoghadam et al.]. Our patient presented during puberty with several previous episodes of hemoptysis prior to her admission and diagnosis. The initial diagnosis was suspected in our patient from chest computerized tomography (CT, and confirmed with cardiac catheterization and pulmonary angiography. Treatment aim is to preserve lung function and minimize irreversible pulmonary remodeling [Pourmoghadam et al.; Harrison et al.]. Conservative monitoring can be considered with milder or asymptomatic cases, while others may require preoperative collateral artery banding, surgical anastomosis between the pulmonary vein (PV & left atrium (LA and even pneumonectomy [Pourmoghadam et al.].

  13. Long-term results of a minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Shuai Zheng

    Full Text Available BACKGROUND: Ganglionated plexi (GP ablation has been become an adjunct to pulmonary vein isolation (PVI. This study describes the long-term results of minimally invasive surgical PVI, ablation of GPs, and exclusion of the left atrial appendage for atrial fibrillation (AF. METHODS: Long-term follow-up of 55 months was performed in 139 consecutive patients (age 58.3±20.8 years with symptomatic, drug-refractory lone AF who underwent minimally invasive surgical PVI, GPs ablation, and exclusion of the left atrial appendage. Success was defined as freedom from AF, atrial flutter, or atrial tachycardia off antiarrhythmic drugs. RESULTS: AF was paroxysmal in 77.7%, persistent in 12.2% and long-standing persistent in 10.1%. Single-procedure success rate was 71.7%, 59.4% and 46.6% at 12, 24 and 60 months respectively. Single-procedure success rate was 72.9%, 62.6% and 51.8% for paroxysmal AF, 64.7%, 35.3%, and 28.2% for persistent AF, 71.4%, 64.3% and 28.6% for long-standing persistent AF at 12, 24 and 60 months respectively. Duration of AF>24 months (hazard ratio [HR]: 3.09, 95% confidence interval [CI]: 1.51 to 6.32; p = 0.002, left atrial diameter≥40 mm (HR: 4.03, 95% CI: 1.88 to 8.65; p<0.001, early recurrence of AF (HR: 4.66, 95% CI: 2.25 to 9.63; p<0.001 independently predicted long-term recurrence of AF. There was no procedure-related death. One patient converted to median sternotomy because of uncontrolled bleeding. Two patients underwent perioperative cerebrovascular events. CONCLUSIONS: At nearly 5-year of clinical follow-up, single-procedure success rate of minimally invasive surgical PVI with GP ablation was 51.8% for paroxysmal AF, 28.2% for persistent AF, 28.6% for long-standing persistent AF after initial procedure. Patients with AF duration≤24 months, left atrial diameter<40 mm and no early recurrence of AF, had favorable outcomes.

  14. Hemodynamic instability after pulmonary veins isolation in a patient with dual chamber pacemaker: The phantom injury of the ventricular lead.

    Science.gov (United States)

    Kiuchi, Márcio Galindo; Lobato, Guilherme Miglioli; Chen, Shaojie

    2017-06-01

    The standard treatment of sinus node dysfunction (SND) is the pacemaker implantation, and the ideal methodology for the management of atrial fibrillation (AF) is rhythm control, but this is sometimes very hard to accomplish. For such actions, complete isolation of all pulmonary veins (PVI) is currently widely accepted as the best endpoint. In this case, we report a female patient, 81 years old, with controlled hypertension, without coronary artery disease, bearer of bilateral knee replacement, and dual chamber pacemaker implanted 1.5 years ago owing to sinus node disease, presenting the following symptoms: presyncope episodes associated with sustained irregular palpitation tachycardia. The evaluation of the pacemaker-recorded episodes of atrial fibrillation, the echocardiogram-presented normal systolic function and measurements, as well as the resting myocardial scintigraphy and with drug use did not demonstrate ischemia and/or fibrosis. The patient was in use of valsartan 320 mg daily, amlodipine 10 mg daily, sotalol hydrochloride 120 mg 2 times daily, and dabigatran 110 mg 2 times daily. At the end of the PVI, the patient presented hemodynamic instability, with a decrease in heart rate to 30 bpm and invasive arterial blood pressure to 60/30 mmHg. The pericardial puncture was quickly carried out with the possibility of cardiac tamponade as the first hypothesis, but no pericardial effusion was found. Next, we detected acute capture loss from the ventricular pacemaker lead, unvarying with high voltage and pulse width, even with stable impedance, sense and keeping the same position visualized by fluoroscopy. And there was soon afterwards induction of sustained ventricular tachycardia degenerating to spontaneous ventricular fibrillation. Electrical cardioversion-defibrillation was performed with 200J, and the sinus rhythm was reestablished, but there was a dead short, and the pacemaker generator was burned and disabled. So, we can speculate that

  15. Initial experience with circumferential pulmonary vein isolation guided by Overlay Ref and CartoMerge in the treatment of paroxysmal atrial fibrillation.

    Science.gov (United States)

    Tang, Kai; Zhao, Dong-dong; Zhang, Jing-ying; Chen, Yan-qing; Xu, Ya-wei

    2010-05-20

    CartoMerge has been widely used in guiding circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal atrial fibrillation (PAF). However, the procedure of landmarks selection varies among operators according to their experience. Techniques have to be established to standardize this procedure. We propose that Overlay Ref could facilitate this procedure. This paper aimed to report our initial experience with CPVI guided by Overlay Ref and CartoMerge for the treatment of PAF. Fifty-nine patients with PAF were enrolled in this study. Using Overlay Ref technique, a reference image (inverted) was faded into the live fluoroscopic image. Landmarks of CartoMerge were selected from anatomic points of the top of superior pulmonary veins (PVs) and the bottom of inferior PVs guided by Overlay Ref image. Overlay Ref images were also used to guide the ablation procedure combining with CartoMerge. All patients were successfully mapped by CartoMerge guided by Overlay Ref. The distance between the mapping points and the CT surfaces was (1.42 +/- 0.67) mm for the patients as a whole. This led to a successful rate of 96% for isolation of pulmonary veins. Duration of ablation procedure was (92 +/- 17) minutes. And the total duration of procedure was (139 +/- 32) minutes. CartoMerge could also be performed just with 3 paries to 4 paries selected landmarks guided by Overlay Ref without a full anatomic model constructed by Carto. Then, the total duration of procedure could be shortened to (115 +/- 38) minutes. Overlay Ref technique can facilitate the catheter ablation of PAF and can help to standardize the procedure of landmarks selection.

  16. Initial experience with circumferential pulmonary vein isolation guided by Overlay Ref and CartoMerge in the treatment of paroxysmal atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    TANG Kai; ZHAO Dong-dong; ZHANG Jing-ying; CHEN Yan-qing; XU Ya-wei

    2010-01-01

    Background CartoMerge has been widely used in guiding circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal atrial fibrillation (PAF).However, the procedure of landmarks selection varies among operators according to their experience.Techniques have to be established to standardize this procedure.We propose that Overlay Ref could facilitate this procedure.This paper aimed to report our initial experience with CPVI guided by Overlay Ref and CartoMerge for the treatment of PAF.Methods Fifty-nine patients with PAF were enrolled in this study.Using Overlay Ref technique, a reference image (inverted) was faded into the live fluoroscopic image.Landmarks of CartoMerge were selected from anatomic points of the top of superior pulmonary veins (PVs) and the bottom of inferior PVs guided by Overlay Ref image.Overlay Ref images were also used to guide the ablation procedure combining with CartoMerge.Results All patients were successfully mapped by CartoMerge guided by Overlay Ref.The distance between the mapping points and the CT surfaces was (1.42±0.67) mm for the patients as a whole.This led to a successful rate of 96%for isolation of pulmonary veins.Duration of ablation procedure was (92±17) minutes.And the total duration of procedure was (139±32) minutes.CartoMerge could also be performed just with 3 paries to 4 paries selected landmarks guided by Overlay Ref without a full anatomic model constructed by Carto.Then, the total duration of procedure could be shortened to (115±38) minutes.Conclusions Overlay Ref technique can facilitate the catheter ablation of PAF and can help to standardize the procedure of landmarks selection.

  17. Remote-controlled magnetic pulmonary vein isolation combined with superior vena cava isolation for paroxysmal atrial fibrillation: a prospective randomized study.

    Science.gov (United States)

    Da Costa, Antoine; Levallois, Marie; Romeyer-Bouchard, Cécile; Bisch, Laurence; Gate-Martinet, Alexis; Isaaz, Karl

    2015-03-01

    Radiofrequency ablation (RFA) of paroxysmal atrial fibrillation (PAF) has focused on pulmonary vein isolation (PVI). However, despite initial positive results, significant recurrences have occurred, partly because of pulmonary vein (PV) reconnection or non-PV ectopic foci, including the superior vena cava (SVC). This prospective, randomized study sought to investigate the efficacy of additional SVCI combined with PVI in symptomatic PAF patients referred for ablation. From November 2011 to May 2013, RFA was performed remotely using a CARTO(®) 3 System in patients randomized to undergo PVI for symptomatic drug-refractory PAF, with (PVI+SVCI group) or without (PVI alone group) SVCI. PVI and SVCI were confirmed by spiral catheter recording during ablation. Procedural data, complications and freedom from atrial tachycardia (AT) and atrial fibrillation (AF) were assessed. Over an 18-month period, 100 consecutive patients (56±9years; 17 women) with symptomatic PAF were included in the study (PVI+SVCI, n=51; PVI, n=49); the CHA2DS2-VASc score was 0.9±1. Median duration of procedure (±interquartile), 2.5±1hours; total X-ray exposure, 13.3±8minutes; transseptal puncture and catheter positioning, 8±5minutes; left atrium electroanatomical reconstruction, 3±2minutes; and catheter ablation, 3.7±3minutes. After a median follow-up of 15±8months, and having undergone a single procedure, 84% of patients were symptom free, while 86% remained asymptomatic after undergoing two procedures. The cumulative risks of atrial arrhythmias (AT or AF) were interpreted using Kaplan-Meier curves and compared using the log-rank test. Long-term follow-up revealed no significant difference between groups, with atrial arrhythmias occurring in six (12%) patients in the PVI+SVCI group and nine (18%) patients in the PVI alone group (P=0.6). One transient phrenic nerve palsy and one phrenic nerve injury with partial recovery occurred in the PVI+SVCI group. SVCI combined with PVI did not reduce

  18. The effectiveness of a high output/short duration radiofrequency current application technique in segmental pulmonary vein isolation for atrial fibrillation

    DEFF Research Database (Denmark)

    Nilsson, Brian; Chen, Xu; Pehrson, Steen;

    2006-01-01

    AIMS: Segmental pulmonary vein (PV) isolation by radiofrequency (RF) catheter ablation has become a curative therapy for atrial fibrillation (AF). However, the long procedure time limits the wide application of this procedure. The aim of the current study was to compare a novel ablation technique...... with a high power output and short application time vs. a conventional technique using a low power output and long application time. METHODS AND RESULTS: The study included 90 consecutive patients (age 53+/-10 years; 66 men). Segmental PV isolation was performed by irrigated RF catheter ablation in both...... groups. In the conventional group (Group 1, 45 patients), the power output was limited to 30 W with a target temperature of 50 degrees C and an RF preset duration of 120 s. In the novel group (Group 2, 45 patients), the maximum power output was preset to 45 W, with a target temperature of 55 degrees C...

  19. A randomized prospective comparison of CartoMerge and CartoXP to guide circumferential pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    TANG Kai; MA Jian; ZHANG Shu; ZHANG Jing-ying; WEI Yi-dong; CHEN Yan-qing; YU Xue-jing; XU Ya-wei

    2008-01-01

    Background CartoXP and CartoMerge have been used to treat atrial fibrillation(AF)for several years.Our randomized prospective study compared clinical outcomes of these two versions of three dimensional electroanatomic mapping system in guiding catheter ablation for paroxysmal atrial fibrillation (PAF).Methods Eighty-one patients with symptomatic,drug refractory PAF were randomly assigned to CartoMerge group (n=42,mean age(54.5±13.1)years,history of AF=3.2 years)or CartoXP group(n=39,mean age(59.8±15.6)years,history of AF=2.9 years).All patients underwent 64-slice computed tomography(MSCT)1 to 3 days prior to ablation procedure.Using CartoMergeTM Image Integration Module,3D anatomical images of the left atrium(LA)and pulmonary veins(PVs)derived from MSCT of CartoMerge group were established and merged with the electroanatomical map.The integrated images were used to guide the procedure of circumferential pulmonary vein isolation (CPVI).In the other group,CPVI was guided just by CartoXP.The endpoint of CPVI in both groups was abolition or dissociation of pulmonary vein potentials(PVPs).Results Mapping points to establish the electroanatomical model of the LA/PVs were 48.7±13.4 in CartoMerge group and 62.5±15.7 in CartoXP group(P<0.001).Mean distance between mapping points and the MSCT surfaces in CartoMerge group was(1.59±0.33)mm.Accomplishment of abolition or dissociation of PVPs was achieved 95.2% in CartoMerge group and 92.3% in CartoXP group.Durations of procedure and exposure to X-ray were(156±25)minutes,(179±21)minutes(P<0.001) and(19.6±7.5)minutes,(28.5±12.8)minutes(P<0.001),respectively.After a follow-up with duration of(11.9±3.1)months vs (12.4±3.6)months post the first ablation procedure,patients free of AF were 33(78.6%)in CartoMerge group and 29(74.4%) in CartoXP group(P>0.50).No patient suffered pulmonary vein stenosis,alrioesophageal fistula,stroke or death.Conclusion Compared to CartoXP,CartoMerge shortened the catheter ablation

  20. Thoracoscopic Video-Assisted Pulmonary Vein Antrum Isolation, Ganglionated Plexus Ablation and Periprocedural Confirmation of Ablation Lesions. First Results of a Hybrid Surgical-Electrophysiological Approach for Atrial Fibrillation

    NARCIS (Netherlands)

    S.P.J. Krul; A.H.G. Driessen; W.J. van Boven; A.C. Linnenbank; G.S.C. Geuzebroek; W.M. Jackman; A.A.M. Wilde; J.M.T. de Bakker; J.R. de Groot

    2011-01-01

    BACKGROUND: -Thoracoscopic pulmonary vein isolation (PVI) and ganglionated plexus (GP) ablation is a novel approach in the treatment of atrial fibrillation (AF). We hypothesize that meticulous electrophysiological confirmation of PVI results in fewer recurrences of AF during follow-up. METHODS AND R

  1. Comparison of resource utilization of pulmonary vein isolation: cryoablation versus RF ablation with three-dimensional mapping in the Value PVI Study.

    Science.gov (United States)

    DeVille, J Brian; Svinarich, J Thomas; Dan, Dan; Wickliffe, Andrew; Kantipudi, Charan; Lim, Hae W; Plummer, Lisa; Baker, James; Kowalski, Marcin; Baydoun, Hassan; Jenkins, Mark; Chang-Sing, Peter

    2014-06-01

    Point-to-point focal radiofrequency (RF) catheter ablation for aberrant pulmonary vein triggers that manifest into atrial fibrillation (AF) is the traditional method for treating symptomatic drug-resistant paroxysmal AF (PAF) when an ablation procedure is warranted. More recently, pulmonary vein isolation (PVI) using the cryoballoon has been demonstrated to be safe and effective (STOP AF clinical trial). Currently, two small studies have reviewed the procedural efficiency when comparing cryoballoon to focal RF catheter ablation procedures; however, no multicenter study has yet reported on this comparison of the two types of ablation catheters. A multicenter retrospective chart extraction and evaluation was conducted at seven geographically mixed cardiac care centers. The study examined procedural variables during ablation for PVI in PAF patients. In several procedural measurements, the two modalities were comparable in efficiencies, including: acute PVI >96%; length of hospital stay at approximately 27 hours; and about 30% usage of adenosine after procedural testing. However, when compared to RF catheters, the cryoballoon procedure demonstrated a 13% reduction in laboratory occupancy time (247 min vs 283 min), a 13% reduction in procedure time (174 min vs 200 min), and a 21% reduction in fluoroscopy time (33 min vs 42 min). Additionally, when comparing the material usage of both cryoballoon and RF catheters, the cryoballoon used more radiopaque contrast agent (78 cc vs 29 cc) while using less intraprocedural saline (1234 cc vs 2386 cc), intracardiac echocardiography (88% vs 99%), three-dimensional electroanatomic mapping (30% vs 87%), and fewer transseptal punctures (1.5 vs 1.9). This study is the first United States multicenter examination to report the procedural comparisons between the cryoballoon and focal RF catheters when used for the treatment of PAF patients. In this hospital chart review study, potential advantages were found when operating the cryoballoon

  2. Pulmonary vein isolation supported by MRI-derived 3D-augmented biplane fluoroscopy: a feasibility study and a quantitative analysis of the accuracy of the technique.

    Science.gov (United States)

    Bourier, Felix; Vukajlovic, Dejan; Brost, Alexander; Hornegger, Joachim; Strobel, Norbert; Kurzidim, Klaus

    2013-02-01

    Despite the advancement of technology in electroanatomic mapping systems (EAMS), fluoroscopy remains a necessary, basic imaging modality for electrophysiology procedures. We present a feasibility study of new software that enables 3D-augmented fluoroscopy in biplane catheterization laboratories for planning and guidance of pulmonary vein isolation (PVI). The computer-assisted overlay registration accuracy was assessed in a clinical setting using an automatic calculation of overlay projection geometry that was derived from hardware sensors in C-arms, detectors, and patient table. Consecutive patients (n = 89) underwent left atrium (LA) magnetic resonance imaging MRI scan prior to PVI. Ideal ablation lines encircling the ipsilateral pulmonary veins (PVs) at antral level were drawn onto the segmented LA surface. The 3D-model was superimposed onto biplane fluoroscopy and matched with angiographies of LA and PVs. Three-dimensional-overlay projection geometry was automatically calculated from C-arm, detectors, and table sensors. Accuracy of technique was assessed as alignment of MRI-derived 3D overlay and angiographic LA/PV anatomy. Integrity of registered overlay was quantified using landmark measurements. Alignment offsets were 1.3 ± 1.5 mm in left PV, 1.2 ± 1.5 mm in right PV, and 1.1 ± 1.4 mm in LA roof region. Bravais-Pearson correlation of the landmark measurements was r = 0.978 (s overlay registration was 9.5 ± 3.5 seconds. MRI-derived 3D-augmented fluoroscopy demonstrated a high level of accuracy when compared with LA/PV angiography. The new system could be especially useful to guide procedures not supported by EAMS, such as cryotechnique PVI. © 2012 Wiley Periodicals, Inc.

  3. Meandering right pulmonary vein associated with severe and progressive "idiopathic-like" pulmonary hypertensive vascular disease.

    Science.gov (United States)

    Cuenca, Sofia; Bret, Montserrat; del Cerro, Maria Jesus

    2016-03-01

    Congenital anomalies of the pulmonary veins are rare. Meandering right pulmonary vein, considered a part of the Scimitar syndrome spectrum, is often an incidental finding during chest imaging. We present the case of a 4-year-old girl diagnosed with meandering pulmonary vein, who developed pulmonary hypertensive disease with an aggressive course, in spite of absence of hypoxia or elevated pulmonary wedge pressure.

  4. Successful correction of unroofed coronary sinus with pulmonary vein stenosis.

    Science.gov (United States)

    Li, Yang; An, Qi; Zhang, Eryong

    2012-07-01

    We present a case of an infant with an unroofed coronary sinus associated with a persistent left superior vena cava draining into the left atrium, right superior pulmonary vein stenosis, an atretic left superior pulmonary vein and a double-outlet right ventricle. For pulmonary vein stenosis and atresia, we used a sutureless technique with an autologous pericardial patch to create a neoatrium.

  5. Nitroprusside modulates pulmonary vein arrhythmogenic activity

    Directory of Open Access Journals (Sweden)

    Chen Yao-Chang

    2010-03-01

    Full Text Available Abstract Background Pulmonary veins (PVs are the most important sources of ectopic beats with the initiation of paroxysmal atrial fibrillation, or the foci of ectopic atrial tachycardia and focal atrial fibrillation. Elimination of nitric oxide (NO enhances cardiac triggered activity, and NO can decrease PV arrhythmogensis through mechano-electrical feedback. However, it is not clear whether NO may have direct electrophysiological effects on PV cardiomyocytes. This study is aimed to study the effects of nitroprusside (NO donor, on the ionic currents and arrhythmogenic activity of single cardiomyocytes from the PVs. Methods Single PV cardiomyocytes were isolated from the canine PVs. The action potential and ionic currents were investigated in isolated single canine PV cardiomyocytes before and after sodium nitroprusside (80 μM, using the whole-cell patch clamp technique. Results Nitroprusside decreased PV cardiomyocytes spontaneous beating rates from 1.7 ± 0.3 Hz to 0.5 ± 0.4 Hz in 9 cells (P Conclusion Nitroprusside regulates the electrical activity of PV cardiomyocytes, which suggests that NO may play a role in PV arrhythmogenesis.

  6. Pulmonary vein stenosis: Etiology, diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Pablo Pazos-López; Cristina García-Rodríguez; Alba Guitián-González; Emilio Paredes-Galán; María ángel; De La Guarda álvarez-Moure; Marta Rodríguez-álvarez; José Antonio Baz-Alonso; Elvis Teijeira-Fernández; Francisco Eugenio Calvo-Iglesias; Andrés í?iguez-Romo

    2016-01-01

    Pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become the main cause of the disease. PVS is characterized by a progressive lumen size reduction of one or more pulmonary veins that, when hemodynamically significant, may raise lobar capillary pressure leading to signs and symptoms such as shortness of breath, cough, and hemoptysis. Image techniques(transesophageal echocardiography, computed tomography, magnetic resonance and perfusion imaging) are essential to reach a final diagnosis and decide an appropriate therapy. In this regard, series from referral centers have shown that surgical and transcatheter interventions may improve prognosis. The purpose of this article is to review the etiology, assessment and management of PVS.

  7. Validation of electrical ostial pulmonary vein isolation verified with a spiral inner lumen mapping catheter during second-generation cryoballoon ablation.

    Science.gov (United States)

    Miyazaki, Shinsuke; Kajiyama, Takatsugu; Watanabe, Tomonori; Taniguchi, Hiroshi; Nakamura, Hiroaki; Hamaya, Rikuta; Kusa, Shigeki; Igarashi, Miyako; Hachiya, Hitoshi; Hirao, Kenzo; Iesaka, Yoshito

    2017-08-01

    Achieve catheters are cryoballoon guidewires that enable pulmonary vein (PV) potential mapping. The single catheter approach in conjunction with the Achieve catheter is currently standard practice in second-generation cryoballoon ablation, yet circumferential mapping catheters are the gold standard for evaluating PV isolation (PVI). The study sought to validate the ostial PVI verified by an Achieve catheter alone. One hundred fifty-one paroxysmal atrial fibrillation patients undergoing PVI using exclusively 28-mm second-generation cryoballoons were enrolled. PV recordings were analyzed during (real-time recordings) and after cryoballoon applications with 20-mm Achieve mapping catheters, and subsequently validated by 20-mm conventional circumferential mapping catheters. Out of 596 PVs, 576 (96.6%) were isolated using cryoballoons, and 20 required touch-up ablation. PVI was verified during cryoballoon applications with real-time monitoring in 299, and after applications in 280 PVs by Achieve catheters alone. The time-to-isolation was 27.2 ± 22.0 seconds. Validation with standard circumferential mapping catheters confirmed ostial PVIs in 296 of 299 (99.0%) PVs that real-time PVI was obtained during applications, and in 242 of 280 (86.5%) PVs that PV activities were not visible during applications and PVI was verified after the applications. The accuracy of ostial PVIs with Achieve catheters in PVs without obtaining real-time PV recordings was 40/47 (85.1%), 58/65 (89.2%), 77/79 (97.5%), 61/81 (75.3%), and 6/8 (75.0%) in left superior, left inferior, right superior, right inferior, and left common PVs, respectively. In second-generation 28-mm cryoballoon ablation, verification of ostial PVIs using Achieve mapping catheters alone might not be sufficient to accurately confirm an ostial PVI when real-time PVI was not obtained. © 2017 Wiley Periodicals, Inc.

  8. Apnea-hypopnea index as a predictor of atrial fibrillation recurrence following initial pulmonary vein isolation: usefulness of type-3 portable monitor for sleep-disordered breathing.

    Science.gov (United States)

    Kawakami, Hiroshi; Nagai, Takayuki; Fujii, Akira; Uetani, Teruyoshi; Nishimura, Kazuhisa; Inoue, Katsuji; Suzuki, Jun; Oka, Yasunori; Okura, Takafumi; Higaki, Jitsuo; Ogimoto, Akiyoshi; Ikeda, Shuntaro

    2016-11-01

    The relationship between atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) and sleep-disordered breathing (SDB) evaluated using type-3 portable monitoring (PM) is still unknown. We investigated high-risk patients with AF recurrence after initial PVI using the apnea-hypopnea index (AHI) measured by type-3 PM. One hundred twenty-four (85 males; age 62 ± 10 years) AF patients undergoing initial PVI were enrolled: 83, paroxysmal AF; 41, persistent AF. At baseline, all patients were subjected to in-hospital unattended overnight polygraphy using type-3 PM for SDB. During 13 ± 7 months following initial PVI, 47 patients (38 %) experienced AF recurrence. AHI and left atrial volume index (LAVI) were significantly greater in patients with than in those without AF recurrence (AHI P = 0.011; LAVI P PVI in patients with both paroxysmal AF and persistent AF (paroxysmal AF P = 0.008; persistent AF P = 0.002). However, AHI was an independent predictor of AF recurrence following initial PVI in patients with paroxysmal AF (P = 0.034) but not in those with persistent AF. The optimal cutoff value was defined as AHI = 14.1. AF recurrence following PVI is three times higher in patients with AHI ≥14.1 than in patients with AHI PVI in patients with paroxysmal AF.

  9. Atrial Electrogram Fractionation Distribution before and after Pulmonary Vein Isolation in Human Persistent Atrial Fibrillation—A Retrospective Multivariate Statistical Analysis

    Science.gov (United States)

    Almeida, Tiago P.; Chu, Gavin S.; Li, Xin; Dastagir, Nawshin; Tuan, Jiun H.; Stafford, Peter J.; Schlindwein, Fernando S.; Ng, G. André

    2017-01-01

    Purpose: Complex fractionated atrial electrograms (CFAE)-guided ablation after pulmonary vein isolation (PVI) has been used for persistent atrial fibrillation (persAF) therapy. This strategy has shown suboptimal outcomes due to, among other factors, undetected changes in the atrial tissue following PVI. In the present work, we investigate CFAE distribution before and after PVI in patients with persAF using a multivariate statistical model. Methods: 207 pairs of atrial electrograms (AEGs) were collected before and after PVI respectively, from corresponding LA regions in 18 persAF patients. Twelve attributes were measured from the AEGs, before and after PVI. Statistical models based on multivariate analysis of variance (MANOVA) and linear discriminant analysis (LDA) have been used to characterize the atrial regions and AEGs. Results: PVI significantly reduced CFAEs in the LA (70 vs. 40%; P PVI that remained fractionated after PVI (31% of the collected points); (ii) fractionated that converted to normal (39%); (iii) normal prior to PVI that became fractionated (9%) and; (iv) normal that remained normal (21%). Individually, the attributes failed to distinguish these LA regions, but multivariate statistical models were effective in their discrimination (P PVI, while others are affected by it. Although, traditional methods were unable to identify these different regions, the proposed multivariate statistical model discriminated LA regions resistant to PVI from those affected by it without prior ablation information. PMID:28883795

  10. Atrial Electrogram Fractionation Distribution before and after Pulmonary Vein Isolation in Human Persistent Atrial Fibrillation-A Retrospective Multivariate Statistical Analysis.

    Science.gov (United States)

    Almeida, Tiago P; Chu, Gavin S; Li, Xin; Dastagir, Nawshin; Tuan, Jiun H; Stafford, Peter J; Schlindwein, Fernando S; Ng, G André

    2017-01-01

    Purpose: Complex fractionated atrial electrograms (CFAE)-guided ablation after pulmonary vein isolation (PVI) has been used for persistent atrial fibrillation (persAF) therapy. This strategy has shown suboptimal outcomes due to, among other factors, undetected changes in the atrial tissue following PVI. In the present work, we investigate CFAE distribution before and after PVI in patients with persAF using a multivariate statistical model. Methods: 207 pairs of atrial electrograms (AEGs) were collected before and after PVI respectively, from corresponding LA regions in 18 persAF patients. Twelve attributes were measured from the AEGs, before and after PVI. Statistical models based on multivariate analysis of variance (MANOVA) and linear discriminant analysis (LDA) have been used to characterize the atrial regions and AEGs. Results: PVI significantly reduced CFAEs in the LA (70 vs. 40%; P multivariate statistical models were effective in their discrimination (P multivariate statistical model discriminated LA regions resistant to PVI from those affected by it without prior ablation information.

  11. Voltage mapping for delineating inexcitable dense scar in patients undergoing atrial fibrillation ablation: a new end point for enhancing pulmonary vein isolation.

    Science.gov (United States)

    Squara, Fabien; Frankel, David S; Schaller, Robert; Kapa, Suraj; Chik, William W; Callans, David J; Marchlinski, Francis E; Dixit, Sanjay

    2014-11-01

    Characterization of left atrial scar using bipolar voltage (BiV) mapping is not well defined. We have previously shown that the BiV range of 0.2-0.45 mV can identify chronic scar from prior pulmonary vein isolation (PVI). This study sought to determine a BiV range that can identify atrial inexcitable dense scar (IDS) in patients acutely and chronically after PVI. Thirty consecutive patients undergoing first time (n = 15) or redo (n = 15) PVI were included. A left atrial shell was created using electroanatomic mapping, and IDS was defined by inability to capture at an output of 10 mA and a pulse width of 2 ms in sinus rhythm, circumferentially at the edge of PVI-related scar (≤5 mm). At each pacing site, BiV amplitude and atrial capture were recorded. Overall, 837 pacing sites were assessed. BiV predicted IDS (receiver operating characteristic curve area 0.93 for first time PVI and 0.90 for redo PVI). In first time PVI, the best BiV value to predict IDS was 0.45 mV for the left pulmonary vein-left atrial appendage (LAA-LPV) ridge (sensitivity 0.98; specificity 1.0) and 0.2 mV for other localizations (sensitivity 0.91; specificity 0.86). In redo PVI, the best BiV value to predict IDS was 0.2 mV for the LAA-LPV ridge (sensitivity 0.77; specificity 1.0) and 0.15 mV for other localizations (sensitivity 0.81; specificity 0.82). BiV reproducibly identifies acute and chronic IDS using a cutoff value of 0.2 mV (0.45 mV for the LAA-LPV ridge) in patients undergoing first time PVI and 0.15 mV (0.2 mV for the LAA-LPV ridge) in patients undergoing redo PVI. IDS thus identified may be a rigorous tool for validating PVI. Published by Elsevier Inc.

  12. Left atrial appendage morphology and risk of stroke following pulmonary vein isolation for drug-refractory atrial fibrillation in low CHA2DS2Vasc risk patients.

    Science.gov (United States)

    Kelly, Faith R; Hull, Robert A; Arrey-Mbi, Takor B; Williams, Michael U; Lee, Joshua S; Slim, Ahmad M; Thomas, Dustin M

    2017-02-28

    Cardiac CT angiography (CCTA) has become an important adjunct in the structural assessment of the pulmonary veins (PV) prior to pulmonary vein isolation (PVI). Published data is conflicting regarding a relationship between left atrial appendage (LAA) and the risk of ischemic stroke (CVA) following PVI. We investigated the associations of volumetric and morphologic left atrial (LA) and LAA measurements for CVA following PVI. We retrospectively reviewed 332 consecutive patients with drug refractory atrial fibrillation who obtained cardiac CT angiogram (CCTA) prior to PVI. Baseline demographic data, procedural and lab details, and outcomes were obtained from abstraction of an electronic medical records system. LA, LAA, and PV volumes were measured using CCTA datasets utilizing a semi-automated 3D workstation application. LAA morphology was assigned utilizing volume rendered images as previously described. The study cohort was 55 ± 13 years-old, 83.7% male, low CVA risk (median CHA2DS2Vasc 1; IQR 1, 3), and 30.4% were treated with novel oral anticoagulants. Chicken wing (CW) was the most common morphology (52%), followed by windsock (WS), cauliflower (CF), and cactus (CS) at 18, 9, and 2%, respectively. CVAs occurred in 4 patients following PVI with median time to CVA of 170.5 days. All CVAs were observed in CW morphology patients. When comparing CW morphology with non-CW morphology, CVAs occurred more frequently with the CW morphology (2.1% vs 0%, p = 0.03). This difference was not significant, though, after adjusting for CHA2DS2Vasc risk factors (p = 0.14). The CW morphology was observed more commonly in patients who experienced post-PVI CVA. After adjusting for CHA2DS2Vasc risk factors, CW morphology was not an independent predictor of post-PVI CVA. These findings should be interpreted in the setting of a low CVA event rate amongst a low risk population that was highly compliant with indicated anticoagulation therapy.

  13. [NHG guideline 'Deep-vein thrombosis and pulmonary embolus'].

    Science.gov (United States)

    de Jong, Jip; Lucassen, Wim A M; Geersing, Geert-Jan; Burgers, Jako S; Wiersma, Tjerk

    2015-01-01

    The revised Dutch College of General Practitioners (Nederlands Huisartsen Genootschap [NHG]) guideline 'Deep-vein thrombosis and pulmonary embolus' includes recommendations for the treatment of patients with deep-vein thrombosis (DVT) and thrombophlebitis, and for the exclusion of pulmonary embolism (PE). The general practitioner (GP) can exclude the presence of DVT or PE in some patients by using a decision rule and a D-dimer test. When using D-dimer test as a point-of-care test, meticulous care is essential during the test procedure and storage of blood. The GP can treat many patients with DVT; the NHG guideline does not advise use of direct oral anticoagulants. In the case of an isolated DVT in the calf, treatment with anticoagulants or ultrasound follow-up can be chosen in consultation with the patient or on the basis of regional agreements. In the case of patients with superficial thrombophlebitis, a wait-and-see approach is usually sufficient.

  14. Morphofunctional study of the junction between the left atrium and the pulmonary veins in patient with pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Cavalcanti Jennecy Sales

    2001-01-01

    Full Text Available OBJECTIVE: To study the arrangement of the myocardial fiber bundles at the pulmonary venous left atrial junction in patients with pulmonary hypertension, and to discuss the pathophysiological importance of this element in the etiology of acute pulmonary edema. METHODS: We obtained 12 hearts and their pulmonary vein extremities from postmortem examinations of patients with the anatomicopathological diagnosis of acute pulmonary edema. The specimens, which had no grossly visible morphological cardiac alterations, were fixed in 10% formalin, and the muscular arrangement of the pulmonary venous left atrial junctions was analyzed. This material was then isolated, embedded in paraffin, underwent serial cutting (50 µm of thickness, and was stained with Azam's trichrome. RESULTS: We observed in our specimens that: a the myocardial fiber bundles that originate in the atrial wall and involve the openings of the pulmonary veins were fewer than those observed in healthy material; b the myocardial fiber bundles that extend into the pulmonary veins were shorter than those found in material originating from individuals with no pulmonary hypertension. CONCLUSION: Anatomical changes that result in a reduction in the amount of myocardial fiber bundles in the pulmonary venous left atrial junction, isolated or associated with other factors, may be the cause of disorders in pulmonary circulation, leading to an increase in pulmonary venous pressure, and, consequently, to acute pulmonary edema.

  15. Simultaneous kissing stent in a patient with severe bifurcation pulmonary vein stenosis.

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    Cubeddu, Roberto J; Gulati, Vishal K

    2015-02-01

    Pulmonary vein stenosis (PVS) is a late and rare complication of pulmonary vein isolation for the treatment of atrial fibrillation. The ideal approach to the management of PVS has not yet been established, however, corrective procedures may include both surgical and percutaneous techniques. We describe the case of a complex bifurcation lesion involving the left superior pulmonary vein. The condition required percutaneous intervention using a modified kissing stent technique with bare metal stents that resulted in an excellent post-operative course, sustained symptomatic relief, and uncomplicated 1-year follow-up. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  16. Current role of cardiac and extra-cardiac pathologies in clinically indicated cardiac computed tomography with emphasis on status before pulmonary vein isolation

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    Sohns, J.M.; Lotz, J. [Goettingen University Medical Center (Germany). Inst. for Diagnostic and Interventional Radiology; German Center for Cardiovascular Research (DZHK), Goettingen (Germany); Menke, J.; Staab, W.; Fasshauer, M.; Kowallick, J.T.; Zwaka, P.A.; Schwarz, A. [Goettingen University Medical Center (Germany). Inst. for Diagnostic and Interventional Radiology; Spiro, J. [Koeln University Hospital (Germany). Radiology; Bergau, L.; Unterberg-Buchwald, C. [Goettingen University Medical Center (Germany). Cardiology and Pneumology

    2014-09-15

    Purpose: The aim of this study was to assess the incidence of cardiac and significant extra-cardiac findings in clinical computed tomography of the heart in patients with atrial fibrillation before pulmonary vein isolation (PVI). Materials and Methods: 224 patients (64 ± 10 years; male 63%) with atrial fibrillation were examined by cardiac 64-slice multidetector CT before PVI. Extra-cardiac findings were classified as 'significant' if they were recommended to additional diagnostics or therapy, and otherwise as 'non-significant'. Additionally, cardiac findings were documented in detail. Results: A total of 724 cardiac findings were identified in 203 patients (91% of patients). Additionally, a total of 619 extra-cardiac findings were identified in 179 patients (80% of patients). Among these extra-cardiac findings 196 (32%) were 'significant', and 423 (68%) were 'non-significant'. In 2 patients (1%) a previously unknown malignancy was detected (esophageal cancer and lung cancer, local stage, no metastasis). 203 additional imaging diagnostics followed to clarify the 'significant' findings (124 additional CT, costs 38,314.69 US dollars). Overall, there were 3.2 cardiac and 2.8 extra-cardiac findings per patient. Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p < 0.05). Conclusion: Cardiac CT scans before PVI should be screened for extracardiac incidental findings that could have important clinical implications for each patient. (orig.)

  17. Early recurrence of atrial fibrillation as a predictor for 1-year efficacy after successful phased RF pulmonary vein isolation: evaluation of complaints and multiple Holter recordings.

    Science.gov (United States)

    Mulder, Anton A W; Wijffels, Maurits C E F; Wever, Eric F D; Boersma, Lucas V A

    2013-04-30

    Early arrhythmia recurrences after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are accepted as part of the blanking period. Their relevance for long-term efficacy is not well-known. We evaluated patients, who came to hospital with a documented recurrence of AF, or had a registered episode of AF on the 24-hour Holter 6 weeks after PVI and compared it with long-term outcome. One hundred consecutive patients with paroxysmal AF were treated with the PVAC. In the 3-month blanking period patients who came to hospital with a documented recurrence of AF on ECG were recorded. 6 weeks after procedure a 24-hour Holter was performed. After 3 months patients were asked if they felt a relapse. Follow-up was performed at 3, 6, and 12 months with ECG, 7-day Holter at 6 and/or 12 months, and event recording if needed. Within the blanking period, 25/100 (25%) patients had a documented recurrence of AF while 46/100 (46%) patients felt a relapse. After the blanking period up to 12 months, 53/100 (53%) patients were free of AF without anti-arrhythmic drugs. Multivariate regression analyses revealed that absence of AF in the blanking period (OR 0.22 95%CI [0.05-0.98]) and absence of a relapse of symptoms suspect for AF during the blanking period (OR 0.21 95%CI [0.06-0.52]) were independent predictors of successful long-term outcome. Poor long-term outcome is strongly related to patients who experienced palpitations with ECG documented AF, AF on the 24-hour Holter at 6 weeks after PVI and a relapse in the blanking period. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. Fluoroscopy-Free Pulmonary Vein Isolation in Patients with Atrial Fibrillation and a Patent Foramen Ovale Using Solely an Electroanatomic Mapping System.

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    Michael Kühne

    Full Text Available The advent of electroanatomical mapping (EAM systems for pulmonary vein isolation (PVI has dramatically decreased radiation exposure. However, the need for some fluoroscopy remains for obtaining left atrial (LA access. The aim was to test the feasibility of fluoroscopy-free PVI in patients with atrial fibrillation (AF and a patent foramen ovale (PFO guided solely by an EAM system.Consecutive patients with AF undergoing PVI and documented PFO were studied. An EAM-guided approach without fluoroscopy and ultrasound was used. After completing the map of the right atrium, the superior vena cava and the coronary sinus, a catheter pull-down to the PFO was performed allowing LA access. The map of the LA and subsequent PVI was also performed without fluoroscopy.30 patients [age 61±12 years, 73% male, ejection fraction 0.64 (0.53-0.65, LA size in parasternal long axis 38±7 mm] undergoing PVI were included. The time required for right atrial mapping including transseptal crossing was 9±4 minutes. Total procedure time was 127±37 minutes. Fluoroscopy-free PVI was feasible in 26/30 (87% patients. In four patients, fluoroscopy was needed to access (n = 3 or to re-access (n = 1 the LA. In these four patients, total fluoroscopy time was 5±3 min and the DAP was 14.9±13.4 Gy*cm2. Single-procedure success rate was 80% (24/30 after a median follow-up of 12 months.In patients with a documented PFO, completely fluoroscopy-free PVI is feasible in the vast majority of cases.

  19. Atrial Electrogram Fractionation Distribution before and after Pulmonary Vein Isolation in Human Persistent Atrial Fibrillation—A Retrospective Multivariate Statistical Analysis

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    Tiago P. Almeida

    2017-08-01

    Full Text Available Purpose: Complex fractionated atrial electrograms (CFAE-guided ablation after pulmonary vein isolation (PVI has been used for persistent atrial fibrillation (persAF therapy. This strategy has shown suboptimal outcomes due to, among other factors, undetected changes in the atrial tissue following PVI. In the present work, we investigate CFAE distribution before and after PVI in patients with persAF using a multivariate statistical model.Methods: 207 pairs of atrial electrograms (AEGs were collected before and after PVI respectively, from corresponding LA regions in 18 persAF patients. Twelve attributes were measured from the AEGs, before and after PVI. Statistical models based on multivariate analysis of variance (MANOVA and linear discriminant analysis (LDA have been used to characterize the atrial regions and AEGs.Results: PVI significantly reduced CFAEs in the LA (70 vs. 40%; P < 0.0001. Four types of LA regions were identified, based on the AEGs characteristics: (i fractionated before PVI that remained fractionated after PVI (31% of the collected points; (ii fractionated that converted to normal (39%; (iii normal prior to PVI that became fractionated (9% and; (iv normal that remained normal (21%. Individually, the attributes failed to distinguish these LA regions, but multivariate statistical models were effective in their discrimination (P < 0.0001.Conclusion: Our results have unveiled that there are LA regions resistant to PVI, while others are affected by it. Although, traditional methods were unable to identify these different regions, the proposed multivariate statistical model discriminated LA regions resistant to PVI from those affected by it without prior ablation information.

  20. The addition of renal sympathetic denervation to pulmonary vein isolation reduces recurrence of paroxysmal atrial fibrillation in chronic kidney disease patients.

    Science.gov (United States)

    Kiuchi, Márcio Galindo; Chen, Shaojie; E Silva, Gustavo Ramalho; Rodrigues Paz, Luis Marcelo; Kiuchi, Tetsuaki; de Paula Filho, Ary Getulio; Lima Souto, Gladyston Luiz

    2017-03-01

    Atrial fibrillation (AF) frequently complicates chronic kidney disease (CKD). AF treatment is challenging and requires complete pulmonary vein isolation (PVI). Recently, renal sympathetic denervation (RSD) has been reported to reduce AF recurrence when performed alongside PVI. A prospective therapeutic study of patients with controlled hypertension and paroxysmal AF was undertaken. Renal function was evaluated using estimated glomerular filtration rate. Outcomes for patients with normal renal function who underwent PVI (n = 101) were compared with those for CKD patients who underwent either PVI alone (n = 96) or PVI + RSD (n = 39). The primary endpoint was recurrence of AF recorded by 24-h Holter monitoring. During the 22.4 ± 12.1 months following intervention, the incidence of AF recurrence was higher in CKD patients treated with PVI alone (61.5 %) than in CKD patients treated with PVI + RSD (38.5 %; HR 1.86, 95 % CI 1.14-3.03, P = 0.0251) or patients without CKD subjected to PVI (35.6 %; hazard ratio (HR) 2.27, 95 % confidence interval (CI) 1.51-3.42, P PVI significantly reduced AF recurrence in CKD stage 4, but not stage 2 or 3, patients. Ambulatory blood pressure and mean heart rate were not different between groups or time points. No complications of either procedure were observed. PVI + RSD is a safe treatment that is superior to PVI alone for treatment of paroxysmal AF in CKD patients.

  1. Recurrence of atrial fibrillation within three months after pulmonary vein isolation for patients with paroxysmal atrial fibrillation: Analysis using external loop recorder with auto-trigger function.

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    Kawasaki, Shiro; Tanno, Kaoru; Ochi, Akinori; Inokuchi, Koichiro; Chiba, Yuta; Onishi, Yoshimi; Onuma, Yoshimasa; Munetsugu, Yumi; Kikuchi, Miwa; Ito, Hiroyuki; Onuki, Tatsuya; Miyoshi, Fumito; Minoura, Yoshino; Watanabe, Norikazu; Adachi, Taro; Asano, Taku; Kobayashi, Youichi

    2015-04-01

    Pulmonary vein isolation (PVI) via catheter ablation has been shown to be a highly effective treatment option for patients with symptomatic paroxysmal atrial fibrillation (AF). The recurrence of AF within 3 months after PVI is not considered to be the result of ablation procedure failure, because early recurrence of AF is not always associated with late recurrence. We examined the usefulness of an external loop recorder with an auto-trigger function (ELR-AUTO) for the detection of atrial fibrillation following PVI to characterize early recurrence and to determine the implications of AF occurrence within 3 months after PVI. Fifty-three consecutive symptomatic patients with paroxysmal AF (age 61.6±12.6 years, 77% male) who underwent PVI and were fitted with ELR-AUTO for 7±2.0 days within 3 months after PVI were enrolled in this study. Of the 33 (62.2%) patients who did not have AF recurrence within 3 months after PVI, only 1 patient experienced AF recurrence at 12 months. Seven (35%) of the 20 patients who experienced AF within 3 months of PVI experienced symptomatic AF recurrence at 12 months. The sensitivity, specificity, positive predictive value, and negative predictive value of early AF recurrence for late recurrence were 87.5%, 71.1%, 35.0%, and 96.9%, respectively. AF recurrence measured by ELR-AUTO within 3 months after PVI can predict the late recurrence of AF. Freedom from AF in the first 3 months following ablation significantly predicts long-term AF freedom. ELR-AUTO is useful for the detection of symptomatic and asymptomatic AF.

  2. Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison.

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    Pokushalov, Evgeny; Romanov, Alexandr; Katritsis, Demosthenes G; Artyomenko, Sergey; Shirokova, Natalya; Karaskov, Alexandr; Mittal, Suneet; Steinberg, Jonathan S

    2013-09-01

    The optimal ablation technique for persistent and long-standing persistent atrial fibrillation (AF) is unclear. Both linear lesion (LL) and ganglionated plexus (GP) ablation have been used in addition to pulmonary vein isolation (PVI), but no direct comparison of the 2 methods exists. The aim of this study is to assess the comparative safety and efficacy of 2 different ablation strategies-PVI+LL vs PVI+GP ablation -in patients with persistent or long-standing persistent AF. Two hundred sixty-four consecutive patients with persistent/long-standing persistent AF were randomly assigned to 2 different ablation schemes: PVI+LL (n = 132) and PVI+GP (n = 132) ablation. Consistent sinus rhythm (SR) off antiarrhythmic drug was assessed after follow-up of at least 3 years with the use of an implanted monitoring device. All procedural end points were acutely achieved. At 12 months after a single procedure, 47% of the patients treated with PVI+LL were in SR compared to 54% of the patients treated with PVI+GP (P = .29). At 3 years, 34% of the patients with PVI+LL and 49% of the patients with PVI+GP maintained SR (P = .035). Atrial flutter was more frequent in the PVI+LL group than in PVI+GP group (18% vs 6%; P = .002). After a second procedure in 78 patients of the PVI+LL group and 55 patients of the PVI+GP group, the long-term overall success rate was 52% and 68%, respectively (P = .006). PVI+GP ablation confers superior clinical results with less ablation-related left atrial flutter and reduced AF recurrence compared to PVI+LL ablation at 3 years of follow-up. © 2013 Heart Rhythm Society. All rights reserved.

  3. Recurrence of atrial fibrillation within three months after pulmonary vein isolation for patients with paroxysmal atrial fibrillation: Analysis using external loop recorder with auto-trigger function

    Science.gov (United States)

    Kawasaki, Shiro; Tanno, Kaoru; Ochi, Akinori; Inokuchi, Koichiro; Chiba, Yuta; Onishi, Yoshimi; Onuma, Yoshimasa; Munetsugu, Yumi; Kikuchi, Miwa; Ito, Hiroyuki; Onuki, Tatsuya; Miyoshi, Fumito; Minoura, Yoshino; Watanabe, Norikazu; Adachi, Taro; Asano, Taku; Kobayashi, Youichi

    2014-01-01

    Background Pulmonary vein isolation (PVI) via catheter ablation has been shown to be a highly effective treatment option for patients with symptomatic paroxysmal atrial fibrillation (AF). The recurrence of AF within 3 months after PVI is not considered to be the result of ablation procedure failure, because early recurrence of AF is not always associated with late recurrence. We examined the usefulness of an external loop recorder with an auto-trigger function (ELR-AUTO) for the detection of atrial fibrillation following PVI to characterize early recurrence and to determine the implications of AF occurrence within 3 months after PVI. Methods Fifty-three consecutive symptomatic patients with paroxysmal AF (age 61.6±12.6 years, 77% male) who underwent PVI and were fitted with ELR-AUTO for 7±2.0 days within 3 months after PVI were enrolled in this study. Results Of the 33 (62.2%) patients who did not have AF recurrence within 3 months after PVI, only 1 patient experienced AF recurrence at 12 months. Seven (35%) of the 20 patients who experienced AF within 3 months of PVI experienced symptomatic AF recurrence at 12 months. The sensitivity, specificity, positive predictive value, and negative predictive value of early AF recurrence for late recurrence were 87.5%, 71.1%, 35.0%, and 96.9%, respectively. Conclusions AF recurrence measured by ELR-AUTO within 3 months after PVI can predict the late recurrence of AF. Freedom from AF in the first 3 months following ablation significantly predicts long-term AF freedom. ELR-AUTO is useful for the detection of symptomatic and asymptomatic AF. PMID:26336538

  4. Modified Maze lines plus pulmonary vein isolation created by radiofrequency catheter ablation on the atrial wall to treat atrial fibrillation in elderly

    Institute of Scientific and Technical Information of China (English)

    Caiyi LU; Shiwen WANG; Xinping DU; Yinglong HOU; Qiao XUE; Xinli WU; Rui CHEN; Peng LIU

    2005-01-01

    Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF

  5. A study of images of Projective Angles of pulmonary veins

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    Wang Jue [Beijing Anzhen Hospital, Beijing (China); Zhaoqi, Zhang [Beijing Anzhen Hospital, Beijing (China)], E-mail: zhaoqi5000@vip.sohu.com; Yu Wei; Miao Cuilian; Yan Zixu; Zhao Yike [Beijing Anzhen Hospital, Beijing (China)

    2009-09-15

    Aims: In images of magnetic resonance and computed tomography (CT) there are visible angles between pulmonary veins and the coronary, transversal or sagittal section of body. In this study these angles are measured and defined as Projective Angles of pulmonary veins. Several possible influential factors and characters of distribution are studied and analyzed for a better understanding of this imaging anatomic character of pulmonary veins. And it could be the anatomic base of adjusting correctly the angle of the central X-ray of the angiography of pulmonary veins undergoing the catheter ablation of atrial fibrillation (AF). Method: Images of contrast enhanced magnetic resonance angiography (CEMRA) and contrast enhanced computer tomography (CECT) of the left atrium and pulmonary veins of 137 health objects and patients with atrial fibrillation (AF) are processed with the technique of post-processing, and Projective Angles to the coronary and transversal sections are measured and analyzed statistically. Result: Project Angles of pulmonary veins are one of real and steady imaging anatomic characteristics of pulmonary veins. The statistical distribution of variables is relatively concentrated, with a fairly good representation of average value. It is possible to improve the angle of the central X-ray according to the average value in the selective angiography of pulmonary veins undergoing the catheter ablation of AF.

  6. Contact force and impedance decrease during ablation depends on catheter location and orientation: insights from pulmonary vein isolation using a contact force-sensing catheter.

    Science.gov (United States)

    Knecht, Sven; Reichlin, Tobias; Pavlovic, Nikola; Schaer, Beat; Osswald, Stefan; Sticherling, Christian; Kühne, Michael

    2015-09-01

    Contact force (CF) sensing during radiofrequency (RF) ablation allows controlling lesion size. The aim of this study was to analyze the impact of catheter tip location and orientation on the association of CF and impedance decrease. We retrospectively analyzed RF applications from 32 patients undergoing catheter ablation for paroxysmal atrial fibrillation using a force-sensing catheter and 3D mapping system. CF, catheter location and orientation relative to the tissue during ablation as well as the absolute impedance decrease during the first 20 s of ablation as a surrogate for lesion effectiveness were analyzed for 791 RF applications. While a higher CF was achieved around the right pulmonary veins (12.5 vs. 11.4 g, p = 0.045), a lower median absolute impedance decrease within the first 20 s was seen around the right veins compared to the left veins (9.3 vs. 10.2 Ω, p = 0.02). With different catheter orientations relative to the tissue, higher CF and impedance decrease was seen when the catheter was orientated parallel or oblique to the tissue (30°-145°) as compared perpendicularly (0-30°) with a median CF of 13.2 vs. 8.0 g (p decrease during the first 20 s of 11 vs. 7 Ω (p decrease in a multivariable linear regression model (p decrease, is not only dependent on the achieved catheter CF but also on catheter orientation and location.

  7. Denervation as a Common Mechanism Underlying Different Pulmonary Vein Isolation Strategies for Paroxysmal Atrial Fibrillation: Evidenced by Heart Rate Variability after Ablation

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    Kejing Wang

    2013-01-01

    Full Text Available Backgrounds. Segmental and circumferential pulmonary vein isolations (SPVI and CPVI have been demonstrated to be effective therapies for paroxysmal atrial fibrillation (PAF. PVI is well established as the endpoint of different ablation techniques, whereas it may not completely account for the long-term success. Methods. 181 drug-refractory symptomatic PAF patients were referred for segmental or circumferential PVI (SPVI = 67; CPVI = 114. Heart rate variability (HRV was assessed before and after the final ablation. Results. After following up for 62.23±12.75 months, patients underwent 1.41±0.68 procedures in average, and the success rates in SPVI and CPVI groups were comparable. 119 patients were free from AF recurrence (SPVI-S, n=43; CPVI-S, n=76. 56 patients had recurrent episodes (SPVI-R, n=21; CPVI-R, n=35. Either ablation technique decreased HRV significantly. Postablation SDNN and rMSSD were significantly lower in SPVI-S and CPVI-S subgroups than in SPVI-R and CPVI-R subgroups (SPVI-S versus SPVI-R: SDNN 91.8±32.6 versus 111.5±36.2 ms, rMSSD 47.4±32.3 versus 55.2±35.2 ms; CPVI-S versus CPVI-R: SDNN 83.0±35.6 versus 101.0±40.7 ms, rMSSD 41.1±22.9 versus 59.2±44.8 ms; all P<0.05. Attenuation of SDNN and rMSSD remained for 12 months in SPVI-S and CPVI-S subgroups, whereas it recovered earlier in SPVI-R and CPVI-R subgroups. Multivariate logistic regression analysis identified SDNN as the only predictor of long-term success. Conclusions. Beyond PVI, denervation may be a common mechanism underlying different ablation strategies for PAF.

  8. Maintenance of atrial fibrillation by pulmonary vein tachycardia with ostial conduction block: evidence of an interpulmonary vein electrical connection.

    Science.gov (United States)

    Matsuo, Seiichiro; Jaïs, Pierre; Wright, Matthew; Lim, Kang-Teng; Knecht, Sébastien; Haïssaguerre, Michel

    2008-10-01

    We report a case of a 56-year-old man with paroxysmal atrial fibrillation who underwent segmental, ostial pulmonary vein (PV) isolation while in arrhythmia. During isolation of the left superior PV (LSPV), organized electrical activity was seen within the vein, suggestive of a PV tachycardia with a cycle length of 90 ms. Simultaneously, organized electrical activity with a cycle length of 180 ms was seen in the left inferior PV (LIPV), suggestive of 2:1 conduction between the LSPV and the LIPV. Isolation of the LIPV resulted in conversion to sinus rhythm, while confirming isolation of the LSPV by the presence of ongoing PV tachycardia in this vein. This case demonstrates a direct electrical connection between the ipsilateral left PVs, leading to maintenance of atrial fibrillation.

  9. Pulmonary vein region ablation in experimental vagal atrial fibrillation: role of pulmonary veins versus autonomic ganglia.

    Science.gov (United States)

    Lemola, Kristina; Chartier, Denis; Yeh, Yung-Hsin; Dubuc, Marc; Cartier, Raymond; Armour, Andrew; Ting, Michael; Sakabe, Masao; Shiroshita-Takeshita, Akiko; Comtois, Philippe; Nattel, Stanley

    2008-01-29

    Pulmonary vein (PV) -encircling radiofrequency ablation frequently is effective in vagal atrial fibrillation (AF), and there is evidence that PVs may be particularly prone to cholinergically induced arrhythmia mechanisms. However, PV ablation procedures also can affect intracardiac autonomic ganglia. The present study examined the relative role of PVs versus peri-PV autonomic ganglia in an experimental vagal AF model. Cholinergic AF was studied under carbachol infusion in coronary perfused canine left atrial PV preparations in vitro and with cervical vagal stimulation in vivo. Carbachol caused dose-dependent AF promotion in vitro, which was not affected by excision of all PVs. Sustained AF could be induced easily in all dogs during vagal nerve stimulation in vivo both before and after isolation of all PVs with encircling lesions created by a bipolar radiofrequency ablation clamp device. PV elimination had no effect on atrial effective refractory period or its responses to cholinergic stimulation. Autonomic ganglia were identified by bradycardic and/or tachycardic responses to high-frequency subthreshold local stimulation. Ablation of the autonomic ganglia overlying all PV ostia suppressed the effective refractory period-abbreviating and AF-promoting effects of cervical vagal stimulation, whereas ablation of only left- or right-sided PV ostial ganglia failed to suppress AF. Dominant-frequency analysis suggested that the success of ablation in suppressing vagal AF depended on the elimination of high-frequency driver regions. Intact PVs are not needed for maintenance of experimental cholinergic AF. Ablation of the autonomic ganglia at the base of the PVs suppresses vagal responses and may contribute to the effectiveness of PV-directed ablation procedures in vagal AF.

  10. Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation: The Randomized Alster-Lost-AF Trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation).

    Science.gov (United States)

    Fink, Thomas; Schlüter, Michael; Heeger, Christian-Hendrik; Lemes, Christine; Maurer, Tilman; Reissmann, Bruno; Riedl, Johannes; Rottner, Laura; Santoro, Francesco; Schmidt, Boris; Wohlmuth, Peter; Mathew, Shibu; Sohns, Christian; Ouyang, Feifan; Metzner, Andreas; Kuck, Karl-Heinz

    2017-07-01

    Pulmonary vein isolation (PVI) for persistent atrial fibrillation is associated with limited success rates and often requires multiple procedures to maintain stable sinus rhythm. In the prospective and randomized Alster-Lost-AF trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation), we sought to assess, in patients with symptomatic persistent or long-standing persistent atrial fibrillation, the outcomes of initial ablative strategies comprising either stand-alone PVI (PVI-only approach) or a stepwise approach of PVI followed by complex fractionated atrial electrogram ablation and linear ablation (Substrate-modification approach). Patients were randomized 1:1 to stand-alone PVI or PVI plus substrate modification. The primary study end point was freedom from recurrence of any atrial tachyarrhythmia, outside a 90-day blanking period, at 12 months. A total of 124 patients were enrolled, with 118 patients included in the analysis (61 in the PVI-only group, 57 in the Substrate-modification group). Atrial tachyarrhythmias recurred in 28 PVI-only group patients and 24 Substrate-modification group patients, for 1-year freedom from tachyarrhythmia recurrence after a single ablation procedure of 54% (95% confidence interval, 43%-68%) in the PVI-only and 57% (95% confidence interval, 46%-72%) in the Substrate-modification group (P=0.86). Twenty-four patients in the PVI-only group (39%) and 18 in the Substrate-modification group (32%) were without arrhythmia recurrence and off antiarrhythmic drug therapy at the end of the 12-month follow-up. In patients with persistent and long-standing persistent atrial fibrillation, no significant difference was observed in 12-month freedom from atrial tachyarrhythmias between an index ablative approach of stand-alone PVI and a stepwise approach of PVI plus complex fractionated atrial electrogram and linear ablation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00820625. © 2017 American Heart

  11. Isolamento das veias pulmonares em pacientes com fibrilação atrial permanente secundária a valvopatia mitral Isolation of the pulmonary veins in patients with permanent atrial fibrillation secondary to mitral valve disease

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    Gustavo G. Lima

    2004-04-01

    Full Text Available OBJETIVO: Analisar a eficácia do isolamento cirúrgico das veias pulmonares para restabelecer ritmo sinusal em pacientes com fibrilação atrial secundária à doença mitral. MÉTODOS: 33 pacientes com indicação de correção cirúrgica da valva mitral e com fibrilação atrial permanente, foram submetidos ao isolamento cirúrgico das veias pulmonares, sendo 67% mulheres. Média de idade de 56,3±10 anos, classe funcional NYHA pré-operatória de 3,2±0,6, tamanho de átrio esquerdo de 5,5± 0,9 cm, fração de ejeção de 61,3±13%. A técnica cirúrgica consistiu de incisão circunferencial ao redor das 4 veias pulmonares, excisão do apêndice atrial esquerdo e de incisão perpendicular desde a borda inferior da incisão, isolando as veias pulmonares, até o ânulo da valva mitral. Arritmias precoces foram tratadas, agressivamente, com cardioversão. RESULTADOS: O seguimento médio foi de 23,9±17 meses e ocorreram 3 óbitos no pós-operatório. Dez pacientes necessitaram de cardioversão elétrica no pós-operatório; 87% apresentavam ritmo sinusal na última consulta e 33% estavam em uso de amiodarona. CONCLUSÃO: Isolamento das veias pulmonares associado à cirurgia da valva mitral é uma técnica efetiva e segura na manutenção de ritmo sinusal em pacientes com fribilação atrial permanente.OBJECTIVE: To assess the efficacy of surgical isolation of the pulmonary veins for re-establishing sinus rhythm in patients with atrial fibrillation secondary to mitral valve disease. METHODS: Thirty-three (67% were women patients with permanent atrial fibrillation and indication for surgical correction of the mitral valve underwent surgical isolation of the pulmonary veins. Their mean age was 56.3±10 years, preoperative NYHA functional class was 3.2±0.6, left atrial size was 5.5±0.9 cm, and ejection fraction was 61.3±13%. The surgical technique consisted of a circumferential incision surrounding the 4 pulmonary veins, excision of the left

  12. Isolated Pulmonary Valve Endocarditis

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    Mohammad Ali Hatamizadeh

    2009-06-01

    Full Text Available Infective endocarditis is one of the most severe complications of parenteral drug abuse. The outstanding clinical feature of infective endocarditis in intravenous drug abusers is the high incidence of right-sided valve infection, and the tricuspid valve is involved in 60% to 70% of the cases. We herein report a case of isolated pulmonic valve infective endocarditis with a native pulmonary valve.

  13. Pulmonary vein and atrial wall pathology in human total anomalous pulmonary venous connection

    NARCIS (Netherlands)

    Douglas, Yvonne L.; Jongbloed, Monique R. M.; den Hartog, Wietske C. E.; Bartelings, Margot M.; Bogers, Ad J. J. C.; Ebels, Tjark; DeRuiter, Marco C.; Gittenberger-de Groot, Adriana C.

    2009-01-01

    Background: Normally, the inside of the left atrial (LA) body and pulmonary veins (PVs) is lined by vessel wall tissue covered by myocardium. In total anomalous pulmonary venous connection (TAPVC), no connection of the PVs with the LA body exists. These veins have an increased incidence of PV

  14. Achieving Bidirectional Long Delays In Pulmonary Vein Antral Lines Prior To Bidirectional Block In Patients With Paroxysmal Atrial Fibrillation (The Bi-Bi Technique For Atrial Fibrillation Ablation)

    OpenAIRE

    Mina MD FACC, FHRS, Adel F; L Warnecke, PA-C, Nicholas

    2016-01-01

    Background: Pulmonary Vein Antral isolation (PVAI) is currently the standard of care for both paroxysmal and persistent atrial fibrillation ablation. Reconnection to the pulmonary vein is the most common cause of recurrence of atrial fibrillation. Achieving the endpoint of bidirectional block (BDB) for cavotricuspid isthmus dependant flutter has improved our outcomes for atrial flutter ablation. With this we tried to achieve long delays in the pulmonary veins antral lines prior to complete is...

  15. The developing pulmonary veins and left atrium: implications for ablation strategy for atrial fibrillation.

    Science.gov (United States)

    Sherif, Hisham M F

    2013-11-01

    The majority of cases of atrial fibrillation (AF) are the result of triggers originating in the area of the pulmonary veins. The reason for the predilection for that area remains unclear. We sought to examine the different mechanisms responsible for this observation through an extensive search of the medical literature, examining the development of the pulmonary veins, genetics of AF and left to -right cardiac chamber differentiation. Results confirm that the LAA is anatomically and embryologically different from other areas of the atrial walls and develops under distinct genetic and transcriptional pathways. Findings support an ablation strategy whose primary focus should be the creation of a 'box' lesion set, plus additional lines to prevent propagation to the left atrial appendage, the isthmus of the left atrium and the right atrium are likely to be more effective than simple pulmonary vein isolation.

  16. Pulmonary vein dilatation in a case of total pulmonary vein occlusion: Contemporary approach using a combination of 3D-mapping system and image integration.

    Science.gov (United States)

    Hilbert, Sebastian; Sommer, Philipp; Bollmann, Andreas

    2016-12-01

    Pulmonary vein stenosis (PVS) is a known complication of PV isolation procedures for atrial fibrillation. In this report a case of recurring PV occlusion after repeated percutaneous procedures has been described. Focus is on a novel interventional technique employing a three-dimensional mapping system which enables targeting total occlusion of PVs and on the use of a drug eluting balloon. A focused review of the current literature regarding ongoing limitations of PV stenosis treatment has been provided. © 2015 Wiley Periodicals, Inc.

  17. Levoatriocardinal vein with normal intracardiac anatomy and pulmonary venous return

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    Ender Odemis

    2011-01-01

    Full Text Available Levoatriocardinal vein (LACV is characterized by an abnormal connection between pulmonary and systemic venous return. This extremely rare cardiac malformation is usually associated with left-sided obstructive lesions including mitral atresia, hypoplastic left-heart syndrome, and abnormal pulmonary venous connection. Patients may have low systemic cardiac output and pulmonary venous obstruction symptoms. In this manuscript, we report a case with LACV and normal pulmonary venous return with absence of any intracardiac pathology. LACV was demonstrated with echocardiography, angiography, and computed tomography. Surgical correction was made successfully.

  18. Effect of K201, a novel antiarrhythmic drug on calcium handling and arrhythmogenic activity of pulmonary vein cardiomyocytes

    Science.gov (United States)

    Chen, Y-J; Chen, Y-C; Wongcharoen, W; Lin, C-I; Chen, S-A

    2007-01-01

    Background and purpose: Pulmonary veins are the most important focus for the generation of atrial fibrillation. Abnormal calcium homeostasis with ryanodine receptor dysfunction may underlie the arrhythmogenic activity in pulmonary veins. The preferential ryanodine receptor stabilizer (K201) possesses antiarrhythmic effects through calcium regulation. The purpose of this study was to investigate the effects of K201 on the arrhythmogenic activity and calcium regulation of pulmonary vein cardiomyocytes. Experimental approach: The ionic currents and intracellular calcium were studied in isolated single cardiomyocytes from rabbit pulmonary vein before and after the administration of K201, by the whole-cell patch clamp and indo-1 fluorimetric ratio techniques. Key results: K201 (0.1, 0.3, 1 μM) reduced the firing rates in pulmonary vein cardiomyocytes, decreased the amplitudes of the delayed afterdepolarizations and prolonged the action potential duration. K201 decreased the L-type calcium currents, Na+/Ca2+ exchanger currents, transient inward currents and calcium transients. K201 (1 μM, but not 0.1 μM or 0.3 μM) also reduced the sarcoplasmic reticulum calcium content. Moreover, both the pretreatment and administration of K201 (0.3 μM) decreased the isoprenaline (10 nM)-induced arrhythmogenesis in pulmonary veins. Conclusions and implications: K201 reduced the arrhythmogenic activity of pulmonary vein cardiomyocytes and attenuated the arrhythmogenicity induced by isoprenaline. These findings may reveal the anti-arrhythmic potential of K201. PMID:17994112

  19. Integration of cardiac computed tomography into pulmonary vein isolation in patients with paroxysmal atrial fibrillation; Integration einer praeinterventionellen Computertomografie des Herzens in die therapeutische Pulmonalvenenisolation bei Patienten mit paroxysmalem Vorhofflimmern

    Energy Technology Data Exchange (ETDEWEB)

    Weber, T.F. [Abt. Radiologie, Deutsches Krebsforschungszentrum, Heidelberg (Germany); Klemm, H.; Willems, S. [Klinik und Poliklinik fuer Kardiologie und Angiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Koops, A.; Adam, G.; Begemann, P.G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Nagel, H.D. [Philips Medizin Systeme GmbH, Hamburg (Germany)

    2007-12-15

    Purpose: Detailed anatomic information of the left atrium is necessary for securely performing radiofrequency ablation of atrial fibrillation-triggering ectopies in the pulmonary vein ostia. In this study the impact of a preinterventionally acquired cardiac computed tomography (CT) on pulmonary vein isolation (PVI) was assessed. Materials and methods: Examinations of 54 patients with paroxysmal atrial fibrillation undergoing PVI were analyzed. In 27 patients a supplementary cardiac CT was obtained prior to PVI (CT group, 12 women, 15 men, 59.7 {+-} 9.9 years of age): 16 x 1.5 mm collimation, 0.2 pitch, 120 kV tube voltage, 400 effective mAs. The fluoroscopy time, effective dose and quantity of radiofrequency (RF) pulses of the following catheter ablation were compared to 27 patients undergoing stand-alone PVI (11 women, 16 men, 62.0 {+-} 9.9 years of age). Mann-Whitney tests served for statistical comparison. Results: CT datasets were successfully integrated into the ablation procedure of each patient in the CT group. The mean quantity of RF pulses was significantly lower in the CT group (22.1 {+-} 8.0 vs. 29.1 {+-} 11.9, p = 0.030), and a significant reduction of fluoroscopy time was found (41.8 {+-} 12.0 min vs. 51.2 {+-} 16.0 min, p = 0.005). Effective doses of the catheter ablation differed in an equivalent dimension but altogether not significantly (14.9 {+-} 10.0 mSv vs. 20.0 {+-} 16.0 mSv, p = 0.203). The mean additive effective dose of the cardiac CT was 85 {+-} 0.3 mSv. (orig.)

  20. Pathogenetics of alveolar capillary dysplasia with misalignment of pulmonary veins

    NARCIS (Netherlands)

    Szafranski, P.; Gambin, T.; Dharmadhikari, A.V.; Akdemir, K.C.; Jhangiani, S.N.; Schuette, J.; Godiwala, N.; Yatsenko, S.A.; Sebastian, J.; Madan-Khetarpal, S.; Surti, U.; Abellar, R.G.; Bateman, D.A.; Wilson, A.L.; Markham, M.H.; Slamon, J.; Santos-Simarro, F.; Palomares, M.; Nevado, J.; Lapunzina, P.; Chung, B.H.; Wong, W.L.; Chu, Y.W.; Mok, G.T.; Kerem, E.; Reiter, J.; Ambalavanan, N.; Anderson, S.A.; Kelly, D.R.; Shieh, J.; Rosenthal, T.C.; Scheible, K.; Steiner, L.; Iqbal, M.A.; McKinnon, M.L.; Hamilton, S.J.; Schlade-Bartusiak, K.; English, D.; Hendson, G.; Roeder, E.R.; DeNapoli, T.S.; Littlejohn, R.O.; Wolff, D.J.; Wagner, C.L.; Yeung, A.; Francis, D.; Fiorino, E.K.; Edelman, M.; Fox, J.; Hayes, D.A.; Janssens, S.; Baere, E. De; Menten, B.; Loccufier, A.; Vanwalleghem, L.; Moerman, P.; Sznajer, Y.; Lay, A.S.; Kussmann, J.L.; Chawla, J.; Payton, D.J.; Phillips, G.E.; Brosens, E.; Tibboel, D.; Klein, A.; Maystadt, I.; Fisher, R.; Sebire, N.; Male, A.; Chopra, M.; Pinner, J.; Malcolm, G.; Peters, G.; Arbuckle, S.; Lees, M.; Mead, Z.; Quarrell, O.; Sayers, R.; Owens, M.; Shaw-Smith, C.; Lioy, J.; McKay, E.; Leeuw, N. de; Feenstra, I.; Spruijt, L.; Elmslie, F.; Thiruchelvam, T.; Bacino, C.A.; Langston, C.; Lupski, J.R.; Sen, P.; Popek, E.; Stankiewicz, P.

    2016-01-01

    Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV) is a lethal lung developmental disorder caused by heterozygous point mutations or genomic deletion copy-number variants (CNVs) of FOXF1 or its upstream enhancer involving fetal lung-expressed long noncoding RNA genes LINC0108

  1. Isolated Pulmonary Embolism following Shoulder Arthroscopy

    Directory of Open Access Journals (Sweden)

    Nicole H. Goldhaber

    2014-01-01

    Full Text Available Pulmonary embolism (PE following shoulder arthroscopy is a rare complication. We present a unique case report of a 43-year-old right-hand dominant female who developed a PE 41 days postoperatively with no associated upper or lower extremity DVT. The patient had minimal preoperative and intraoperative risk factors. Additionally, she had no thromboembolic symptoms postoperatively until 41 days following surgery when she developed sudden right-hand swelling, labored breathing, and abdominal pain. A stat pulmonary computed tomography (CT angiogram of the chest revealed an acute PE in the right lower lobe, and subsequent extremity ultrasounds showed no upper or lower extremity deep vein thrombosis. After a thorough review of the literature, we present the first documented isolated PE following shoulder arthroscopy. Although rare, sudden development of an isolated PE is possible, and symptoms such as sudden hand swelling, trouble breathing, and systemic symptoms should be evaluated aggressively with a pulmonary CT angiogram given the fact that an extremity ultrasound may be negative for deep vein thrombosis.

  2. Isolated pulmonary Goodpasture syndrome.

    Science.gov (United States)

    Harrity, P; Gilbert-Barness, E; Cabalka, A; Hong, R; Zimmerman, J

    1991-01-01

    The case of a 13-year-old girl with Goodpasture syndrome is reported. The presentation at this age with only pulmonary hemorrhage is unusual among Goodpasture syndrome patients. The case illustrates well the diagnostic difficulties in Goodpasture syndrome. The choices of treatment modalities available for this disease and the results and risks of such treatment options are reviewed. A discussion and classification of diffuse pulmonary hemorrhage is presented. The case emphasizes that Goodpasture syndrome should be considered in the differential diagnosis of diffuse pulmonary hemorrhage in spite of a lack of renal abnormalities and that serum anti-glomerular basement membrane antibody testing can be of great help in confirming the diagnosis.

  3. The Role of Pulmonary Veins in Cancer Progression from a Computed Tomography Viewpoint

    Science.gov (United States)

    Chang, Hung; Liao, Tzu-Yao; Wen, Ming-Sheng; Yu, Chih-Teng

    2016-01-01

    Background. We studied the role of pulmonary veins in cancer progression using computed tomography (CT) scans. Methods. We obtained data from 260 patients with pulmonary vein obstruction syndrome (PVOS). We used CT scans to investigate pulmonary lesions in relation to pulmonary veins. We divided the lesions into central and peripheral lesions by their anatomical location: in the lung parenchymal tissue or pulmonary vein; in the superior or inferior pulmonary vein; and by unilateral or bilateral presence in the lungs. Results. Of the 260 PVOS patients, 226 (87%) had central lesions, 231 (89%) had peripheral lesions, and 190 (75%) had mixed central and peripheral lesions. Among the 226 central lesions, 93% had lesions within the superior pulmonary vein, either bilaterally or unilaterally. Among the 231 peripheral lesions, 65% involved bilateral lungs, 70% involved lesions within the inferior pulmonary veins, and 23% had obvious metastatic extensions into the left atrium. All patients exhibited nodules within their pulmonary veins. The predeath status included respiratory failure (40%) and loss of consciousness (60%). Conclusion. CT scans play an important role in following tumor progression within pulmonary veins. Besides respiratory distress, PVOS cancer cells entering centrally can result in cardiac and cerebral events and loss of consciousness or can metastasize peripherally from the pulmonary veins to the lungs.

  4. Refractory Pulmonary Edema Caused by Late Pulmonary Vein Thrombosis After Lung Transplantation: A Rare Adverse Event.

    Science.gov (United States)

    Denton, Eve J; Rischin, Adam; McGiffin, David; Williams, Trevor J; Paraskeva, Miranda A; Westall, Glen P; Snell, Greg

    2016-09-01

    After lung transplantation, pulmonary vein thrombosis is a rare, potentially life-threatening adverse event arising at the pulmonary venous anastomosis that typically occurs early and presents as graft failure and hemodynamic compromise with an associated mortality of up to 40%. The incidence, presentation, outcomes, and treatment of late pulmonary vein thrombosis remain poorly defined. Management options include anticoagulant agents for asymptomatic clots, and thrombolytic agents or surgical thrombectomy for hemodynamically significant clots. We present a rare case highlighting a delayed presentation of pulmonary vein thrombosis occurring longer than 2 weeks after lung transplantation and manifesting clinically as graft failure secondary to refractory pulmonary edema. The patient was treated successfully with surgical thrombectomy and remains well. We recommend a high index of suspicion of pulmonary vein thrombosis when graft failure after lung transplantation occurs and is not responsive to conventional therapy, and consideration of investigation with transesophageal echocardiography or computed tomography with venous phase contrast in such patients even more than 2 weeks after lung transplantation.

  5. Thoracic exploration for the diagnosis of multiple pulmonary vein varices: case report

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xun; HAN Hong-li; SHI Zhen-liang

    2007-01-01

    @@ Pulmonary vein varix, congenital or acquired dilation of the pulmonary vein, is a rare vascular abnormality.This disease often presents as a pulmonary mass on chest roentgenography, and pulmonary angiography, computed tomography (CT), or magnetic resonance imaging (MRI)is considered necessary for diagnosis.1 The diagnosis of the disease by thoracic exploration is rare because the present case was diagnosed as a pulmonary arteriovenous fistula before operation.

  6. Atresia of the bilateral pulmonary veins: a rare and dismal anomaly identified on cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo; Park, Sang-Hyub; Koo, Hyun Jung; Cho, Young Hoon; Lee, Eunsol [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of)

    2014-08-15

    Imaging findings of bilateral pulmonary vein atresia have not been described. To describe cardiac CT findings and clinical outcomes of bilateral pulmonary vein atresia. Three newborns with bilateral pulmonary vein atresia were encountered at our institution during a period of 8 years. We evaluated prenatal echocardiographic findings, clinical presentations, postnatal echocardiographic findings, chest radiographic findings, cardiac CT findings and clinical outcomes. All newborns presented immediately after birth with severe cyanosis, respiratory distress and acidosis that were unresponsive to medical management. Prenatal and postnatal echocardiographic studies and chest radiography were misleading, inconclusive or nonspecific in making the diagnosis in these children; however cardiac CT clearly demonstrated atresia of the bilateral pulmonary veins with multiple small mediastinal collateral veins and pulmonary edema. Surgical treatments were not feasible for this anomaly. Their clinical outcomes were universally dismal and all infants died within 3 days. Cardiac CT provides an accurate diagnosis of bilateral pulmonary vein atresia and leads to prompt treatment decision in these children. (orig.)

  7. VARIATION IN THE OPENINGS (OSTIA OF LEFT PULMONARY VEINS INTO THE LEFT ATRIUM: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sesi

    2015-03-01

    Full Text Available During early embryonic development, absorption of pulmonary venous network by the left primitive atrial chamber results in opening of four pulmonary veins which drain independently into its chamber. The extent of absorption and hence, the number of pulmon ary veins which open into the left atrium, may vary. Here we report a variation in the opening of the Left upper (superior pulmonary vein into the Left atrium. A total of six openings observed

  8. Varicose vein trauma: a risk for pulmonary embolism.

    Science.gov (United States)

    Joy, Parijat S; Marak, Creticus P; Ponea, Anna M; Guddati, Achuta K

    2014-10-01

    Pulmonary embolism (PE) is a deceptive condition which is often incorrectly diagnosed leading to high morbidity and mortality. We present a case where symptoms were localised to different areas of the body starting with post-traumatic pain over lower extremity varicosities that migrated sequentially over a month to the knee, hip, back, abdomen and chest finally presenting as syncope. Despite a low pre-test clinical probability, a very high index of suspicion led to a timely diagnosis of a massive bilateral PE that eventually caused a troponin leak. The aetiology is highly suspicious of a thrombus which originated in the veins of the leg due to trauma over varicose veins.The case described here exemplifies the importance of considering trauma to varicosities as a risk factor for embolism when the clinical picture is concerning but other signs and symptoms of PE are not apparent.

  9. Diagnosis-to-ablation time as a predictor of success: early choice for pulmonary vein isolation and long-term outcome in atrial fibrillation: results from the Middelheim-PVI Registry.

    Science.gov (United States)

    De Greef, Y; Schwagten, B; Chierchia, G B; de Asmundis, C; Stockman, D; Buysschaert, I

    2017-03-02

    The aim of the study is to define long-term outcome of pulmonary vein isolation (PVI) in atrial fibrillation (AF) and to determine whether time window between AF diagnosis and PVI affects outcome. Consecutive AF patients undergoing PVI (2006-14) were followed for 5 years. Primary outcome was clinical success, defined as freedom of documented AF without anti-arrhythmic drugs respecting a 1-month blanking period. A 1000 patients were included (age 60 ± 10 years, CHA2DS2-VASc score 1 ± 1). The cohort was divided in four quartiles (Q) according to the diagnosis-to-ablation time (DAT): Q1 DAT 0-11 months (N = 244), Q2 DAT 12-≤33 months (N = 254), Q3 DAT 34-≤70 months (N = 252) and Q4 DAT 71-360 months (N = 250). Mean follow-up was 44.3±21.0 months. At 5 years, clinical success was achieved in 45.2 ± 2.0% of patients. Independent predictors of clinical success were AF type (HR = 0.61; 95%CI 0.50-0.74; P PVI was performed within the first year, and gradually declined with increasing DAT: 55.9 ± 4.6% for Q1, 46.9 ± 4.0% for Q2, 45.5 ± 3.6% for Q3, and 35.5 ± 3.6% for Q4 (P PVI is 45.2 ± 2.0%. Shorter diagnosis-to-ablation times are associated with better clinical success. Our data advocate for early PVI following diagnosis of AF.

  10. The Hunter pulmonary angiography catheter for a brachiocephalic vein approach.

    Science.gov (United States)

    Rosen, Galia; Kowalik, Karen J; Ganguli, Suverano; Hunter, David W

    2006-01-01

    The purpose of this work was to describe our experience in performing pulmonary angiography using the Hunter pulmonary catheter, manufactured by Cook, Inc., which is a modified 6F pigtail catheter with a "C-shaped" curve, designed for a brachiocephalic vein approach. One hundred twenty-three patients underwent pulmonary angiograms using the Hunter catheter between August 1997 and January 2002. Operator comments were gathered in 86 (70%) of the cases. The operator was, if possible, the most junior resident on the service. Thirty-nine operators participated in the survey. Efficacy, safety, and ease of use of the catheter were determined by operators' comments and ECG observations during the procedure. Corroborating clinical data were gathered from medical records. In 68 (79%) of the procedures that were commented upon, the operator described insertion into the pulmonary artery (PA) as easy; only 2 (2%) indicated difficulty in accessing the PA. In 41 (63%) of the bilateral angiograms that were commented upon, the operator described accessing the left PA from the right PA as easy; only 6 (9%) rated it as difficult and all were with an older technique in which the catheter was withdrawn to the pulmonary bifurcation without a wire or with only the soft tip of the wire in the pigtail and then rotated to the left main pulmonary artery. Thirty-one of the 41 patients who demonstrated premature ventricular contractions (PVCs) had a previous history of heart disease. Nineteen of the 39 patients who did not have PVCs had a history of heart disease (p = 0.018). The maneuverability and shape of the Hunter catheter make pulmonary angiography an easy procedure, even for operators with minimal experience and limited technical proficiency. PVCs demonstrated a statistically significant correlation with a positive patient history for cardiac disease, rather than being a universal risk.

  11. Total anomalous connection of pulmonary veins to the portal vein. Value of multislice angiotomography. Report on three cases

    Directory of Open Access Journals (Sweden)

    Sara Alejandra Solórzano-Morales

    2014-07-01

    15 and 26% if all its varieties. Multislice angiotomography allows us to view the blood vessels and adjacent organs under consideration and obtain high-definition anatomic information. In the patients in this study, total anomalous connection of pulmonary veins to the portal vein was viewed with three-dimensional volumetric tomographic reconstructions and their correlation with ultrasonography studies.

  12. OCT imaging of myocardium extending to pulmonary vein

    Science.gov (United States)

    Li, Zhifang; Dickfeld, Timm; Tang, Qinggong; Wang, Bohan; Chen, Yu

    2016-02-01

    In this study, we propose to use optical coherence tomography to enable a direct visualization of myocardium extending into the pulmonary vein (PV). The results showed that there are obvious differences in the morphology of myocardium and fibrous tissue in the transition region of myocardial sleeve, which is in agreement with the histological analysis. In addition, the myocardial area in transition point has three layers in the depth of 1 mm, and the depth-resolved myocardial fiber show different orientation in the different layers. This characteristic was applied for segmentation of the structures of myocardium extending into PV.

  13. Donor lung assessment using selective pulmonary vein gases.

    Science.gov (United States)

    Costa, Joseph; Sreekanth, Sowmyashree; Kossar, Alex; Raza, Kashif; Lederer, David J; Robbins, Hilary; Shah, Lori; Sonett, Joshua R; Arcasoy, Selim; D'Ovidio, Frank

    2016-11-01

    Standard donor lung assessment relies on imaging, challenge gases and subjective interpretation of bronchoscopic findings, palpation and visual assessment. Central gases may not accurately represent true quality of the lungs. We report our experience using selective pulmonary vein gases to corroborate the subjective judgement. Starting, January 2012, donor lungs have been assessed by intraoperative bronchoscopy, palpation and visual judgement of lung collapse upon temporary disconnection from ventilator, central gases from the aorta and selective pulmonary vein gases. Partial pressure of oxygen (pO2) <300 mmHg on FiO2 of 1.0 was considered low. The results of the chest X-ray and last pO2 in the intensive care unit were also collected. Post-transplant primary graft dysfunction and survival were monitored. To date, 259 consecutive brain-dead donors have been assessed and 157 transplants performed. Last pO2 in the intensive care unit was poorly correlated with intraoperative central pO2 (Spearman's rank correlation rs = 0.29). Right inferior pulmonary vein pO2 was associated (Mann-Whitney, P < 0.001) with findings at bronchoscopy [clean: median pO2 443 mmHg (25th-75th percentile range 349-512) and purulent: 264 mmHg (178-408)]; palpation [good: 463 mmHg (401-517) and poor: 264 mmHg (158-434)] and visual assessment of lung collapse [good lung collapse: 429 mmHg (320-501) and poor lung collapse: 205 mmHg (118-348)]. Left inferior pulmonary pO2 was associated (P < 0.001) with findings at bronchoscopy [clean: 419 mmHg (371-504) and purulent: 254 mmHg (206-367)]; palpation [good: 444 mmHg (400-517) and poor 282 mmHg (211-419)] and visual assessment of lung collapse [good: 420 mmHg (349-496) and poor: 246 mmHg (129-330)]. At 72 h, pulmonary graft dysfunction 2 was in 21/157 (13%) and pulmonary graft dysfunction 3 in 17/157 (11%). Ninety-day and 1-year mortalities were 6/157 (4%) and 13/157 (8%), respectively. Selective pulmonary vein gases provide corroborative objective

  14. Paucicellular Fibrointimal Proliferation Characterizes Pediatric Pulmonary Vein Stenosis: Clinicopathologic Analysis of 213 Samples From 97 Patients.

    Science.gov (United States)

    Kovach, Alexandra E; Magcalas, Philip M; Ireland, Christina; McEnany, Kerry; Oliveira, Andre M; Kieran, Mark W; Baird, Christopher W; Jenkins, Kathy; Vargas, Sara O

    2017-09-01

    Pulmonary vein stenosis (PVS) is a luminal narrowing of extrapulmonary pulmonary veins. In pediatric patients, it arises following repair of congenital heart disease, particularly anomalous pulmonary venous return; in lung disease, especially prematurity; and rarely in isolation. The etiology is unknown and the course often fatal without lung transplantation. We hypothesized that systematic clinicopathologic review of pediatric PVS could provide further pathogenic insight. We included patients who underwent first resection of pulmonary venous tissue for symptomatic PVS at our pediatric referral center from 1995 to 2014. Clinical records and hematoxylin and eosin slides were reviewed. Subsets were immunostained for smooth muscle actin, Ki-67, β-catenin, estrogen receptor, and other markers and analyzed for USP6 gene rearrangement. A total of 97 patients (57% male; median age: 6 mo) were identified. Overall, 59 (61%) had prior congenital heart disease repair, 35 involving pulmonary vein manipulation. Samples included 213 separate anatomic sites (median: 2/patient). Histologically, all showed sparsely cellular intimal expansion composed of haphazardly arranged fibroblasts with slender nuclei in myxoid matrix. This tissue merged with underlying collagen. Most samples had a variably continuous sheath of cardiomyocytes. Ancillary tests supported a reactive fibroblastic proliferation; in particular, fibroblasts showed cytoplasmic β-catenin localization, no estrogen receptor expression, and no USP6 rearrangement. At last follow-up (mean: 2.3 y), 46% of patients had died of disease. Pediatric PVS uniformly consists of a paucicellular fibrointimal proliferation, irrespective of clinical scenario. It may be best conceived of as a form of reactive hyperplasia. As with other forms of vascular remodeling, trauma (iatrogenic or occult) is likely an inciting factor. A comprehensive understanding of the surgical pathology of PVS may further inform therapeutic strategies in this

  15. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    Directory of Open Access Journals (Sweden)

    G Raghavendra Prasad

    2013-01-01

    Full Text Available Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric - inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.

  16. Normal and abnormal development of pulmonary veins : State of the art and correlation with clinical entities

    NARCIS (Netherlands)

    Douglas, Yvonne L.; Jongbloed, Monique R. M.; DeRuiter, Marco C.; Gittenberger-de Groot, Adriana C.

    2011-01-01

    Interest for the pulmonary veins has increased in the past decade after the potential arrhythmogenicity of the myocardial sleeve surrounding these structures has been recognized. Furthermore, there are several clinical entities, such as anomalous connection pattern and pulmonary vein stenosis, that

  17. Portal Vein Thrombosis of a Newborn with Corrected Total Anomalous Pulmonary Venous Return

    Directory of Open Access Journals (Sweden)

    Ufuk Çakır

    2015-09-01

    Full Text Available Total anomalous pulmonary venous return (TAPVR is a rare and frequently isolated defect identified in 1% to 3% of all congenital heart diseases. To the best of our knowledge, portal vein thrombosis (PVT associated with TAPVR has not been reported in the literature. We report a successfully managed PVT in a newborn with infracardiac-type TAPVR and review the literature. Anticoagulation therapies were used during the neonatal period to prevent thrombus progression. PVT should be kept in mind in TAPVR patients who have open heart repair with total correction. The treatment in each neonate should be individualized with consideration of the risk/benefit ratio.

  18. Prevalence, Patterns, and Clinical Predictors of Left Ventricular Late Gadolinium Enhancement in Patients Undergoing Cardiac Magnetic Resonance Prior to Pulmonary Vein Antral Isolation for Atrial Fibrillation: A Cross-Sectional Observational Study.

    Science.gov (United States)

    Nance, John W; Khurram, Irfan M; Nazarian, Saman; DeWire, Jane; Calkins, Hugh; Zimmerman, Stefan L

    2015-09-01

    Cardiac magnetic resonance (CMR) imaging is increasingly used to evaluate patients with atrial fibrillation (AF) before pulmonary vein antral isolation (PVAI). The purpose of this study was to assess the incidence and pattern of left ventricular (LV) late gadolinium enhancement (LGE) in patients undergoing CMR before PVAI and compare the clinical and demographic differences of patients with and without LV LGE. Clinical and demographic data on 62 patients (mean age 61 ± 7.9, 69% male) undergoing CMR before PVAI for AF were collected. Two observers, masked to clinical histories, independently recorded the prevalence, extent (number of myocardial segments), and pattern (subendocardial, midmyocardial, or subepicardial) of LV LGE in each patient. Clinical and demographic predictors of LV LGE were determined using logistic regression. Twenty-three patients (37%) demonstrated LV LGE affecting a mean of 3.0 ± 2.1 myocardial segments. There was no difference in LV ejection fraction between patients with and without LGE, and most (65%) patients with LGE had normal wall motion. Only age (P = 0.04) and a history of congestive heart failure (P = .03) were statistically significant independent predictors of LGE. The most common LGE pattern was midmyocardial, seen in 17 of 23 (74%) patients. Only 4 of 23 (17%) patients had LGE in an "expected" pattern based on clinical history. Of the remaining 19 patients, 4 had known congestive heart failure, 5 nonischemic cardiomyopathy, 4 known coronary artery disease, and 2 prior aortic valve replacement. Six of 23 (26%) patients had no known coronary artery, valvular, or myocardial disease. There is a high prevalence of unexpected LV scar in patients undergoing CMR before PVAI for AF, with most patients demonstrating a nonischemic pattern of LV LGE and no wall motion abnormalities (ie, subclinical disease). The high prevalence of unexpected LGE in these patients may argue for CMR as the modality of choice for imaging

  19. Relationship between complex fractionated electrograms (CFE) and dominant frequency (DF) sites and prospective assessment of adding DF-guided ablation to pulmonary vein isolation in persistent atrial fibrillation (AF).

    Science.gov (United States)

    Verma, Atul; Lakkireddy, Dhanunjaya; Wulffhart, Zaev; Pillarisetti, Jayasree; Farina, Domenic; Beardsall, Marianne; Whaley, Bonnie; Giewercer, David; Tsang, Bernice; Khaykin, Yaariv

    2011-12-01

    Sites of high DF are potential targets for AF ablation, but it is unknown if addition of DF ablation can improve procedural outcome. We sought to (1) examine the relationship between DF sites and complex fractionated electrograms (CFE) and (2) prospectively assess the long-term outcome of adding DF ablation to pulmonary vein antral isolation (PVAI) for persistent AF. First, 20 patients with persistent AF who underwent previous CFE-guided ablation and who had AF terminate during ablation were studied retrospectively (group I). Bipolar, 8-second electrograms were collected by a circular catheter (288 ± 86 points/map). The EnSite NavX system allows for automated display of both CFE and DF maps. Electrograms with cycle length CFE and were compared to DF sites > 8 Hz (direct inverse relationship). Sites of AF termination were related to CFE and DF sites. Based on these observations, 30 different patients (group II) with persistent AF prospectively underwent DF-guided ablation plus PVAI. They were followed every 3 months for 1 year (visit, Holter, ECG). These patients were compared to case-matched controls undergoing PVAI alone (group III). In group I, there was a significant, inverse correlation between DF and CFE values at each point (r =-0.24, P CFE area (27 ± 5 cm(2) vs 34 ± 4 cm(2) , P = 0.03). CFE sites overlapped 48 ± 27% with the DF surface area. Nonoverlapping CFE sites were contiguous to DF sites. AF termination occurred where DF and CFE overlapped, and at these sites, DF was always greater than the mean DF for the map. In group II, all DF sites above the mean value were prospectively ablated during AF. AF termination was noted in only 2/30 (7%) patients. After DF ablation, PVAI was performed and termination increased to 4/30 patients (14%). At 1 year, freedom from atrial arrhythmia > 30 seconds occurred in 57% of DF+PVAI compared to 60% in patients receiving PVAI alone (P = 0.18). DF and CFE regions overlap only about 50%. AF termination retrospectively

  20. Idiopathic Pulmonary Vein Thrombus Extending into Left Atrium: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Muhammad Asim Rana

    2016-01-01

    Full Text Available Pulmonary vein thrombosis (PVT is rather an uncommon condition which presents nonspecifically and is usually associated with lung malignancy and major pulmonary surgery. Rarely could no cause be found. It causes increased pulmonary venous pressure leading to pulmonary arterial vasoconstriction and subsequent pulmonary arterial hypertension and subsequently can cause cor pulmonale if not addressed in timely fashion. Other associated complications like peripheral embolization and stroke have also been reported. This case emphasizes the importance of maintaining high index of clinical suspicion especially when CT pulmonary angiogram is negative for pulmonary embolism.

  1. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency

    Directory of Open Access Journals (Sweden)

    Sarac A

    2014-04-01

    Full Text Available Atilla Sarac,1 Artan Jahollari,1 Sureyya Talay,1 Sevket Ozkaya,2 Ertugrul Ozal1 1Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey Objective: The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV insufficiency. Methods: External valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes. Results: A complete clinical and radiological healing was observed in 50 patients (60%. In 13 cases (15.6%, a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6% developed superficial vein thrombosis, and only one patient (1.2% developed deep vein thrombosis. Contact was lost from 32 patients (38.5% for different reasons. Conclusion: External valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping. Keyword: vein, saphenous, insufficiency, external valv, valvuloplasty, varicosis

  2. [Clinically non-symptomatic pulmonary embolism in patients with deep vein thrombosis of the lower limb].

    Science.gov (United States)

    Janica, Jacek Robert; Kordecki, Kazimierz; Jurgilewicz, Dorota; Polaków, Jerzy; Budlewski, Tadeusz; Walecki, Jerzy; Pepiński, Witold

    2002-06-01

    The pulmonary embolism (PE) is the common and severe complication of the deep vein thrombosis of the lower limbs. The lack of accurate diagnosis of PE is a cause of 5-10% of the hospital deaths. The aim of the study was to assess the incidence of the pulmonary embolism in patients with the deep vein thrombosis of the lower limbs with no clinical symptoms of pulmonary embolism. Pulmonary perfusion scintigraphy was performed in 25 patients with angiographic findings confirmative to the deep vein thrombosis of the lower limbs. The results of the study were analysed according to the PIOPED criteria. In the group of patients with common thrombosis of the deep vein a high probability of lung embolism was assessed in 70%, medium and low by 12% in each group, and very low in 6%. In the group of patients with femoral thrombosis of the deep vein a high probability of lung embolism was assessed in 60%, medium in 20% and very low in 20%. In the group of patients with calf thrombosis of the deep vein high, medium and very low probability of lung embolism was assessed by 25% in each group. Results of this study indicate the need of searching the pulmonary embolism in patients with thrombosis of the deep vein of the lower limbs despite the lack of clinical symptoms of the pulmonary embolism.

  3. Treatment of atrial fibrillation with radiofrequency ablation and simultaneous multipolar mapping of the pulmonary veins

    Directory of Open Access Journals (Sweden)

    Rocha Neto Almino C.

    2001-01-01

    Full Text Available OBJECTIVE: To demonstrate the feasibility and safety of simultaneous catheterization and mapping of the 4 pulmonary veins for ablation of atrial fibrillation. METHODS: Ten patients, 8 with paroxysmal atrial fibrillation and 2 with persistent atrial fibrillation, refractory to at least 2 antiarrhythmic drugs and without structural cardiopathy, were consecutively studied. Through the transseptal insertion of 2 long sheaths, 4 pulmonary veins were simultaneously catheterized with octapolar microcatheters. After identification of arrhythmogenic foci radiofrequency was applied under angiographic or ultrasonographic control. RESULTS: During 17 procedures, 40 pulmonary veins were mapped, 16 of which had local ectopic activity, related or not with the triggering of atrial fibrillation paroxysms. At the end of each procedure, suppression of arrhythmias was obtained in 8 patients, and elimination of pulmonary vein potentials was accomplished in 4. During the clinical follow-up of 9.6±3 months, 7 patients remained in sinus rhythm, 5 of whom were using antiarrhythmic drugs that had previously been ineffective. None of the patients had pulmonary hypertension or evidence of stenosis in the pulmonary veins. CONCLUSION: Selective and simultaneous catheterization of the 4 pulmonary veins with microcatheters for simultaneous recording of their electrical activity is a feasible and safe procedure that may help ablation of atrial fibrillation.

  4. Renal infarction in a patient with pulmonary vein thrombosis after left upper lobectomy.

    Science.gov (United States)

    Manabe, Shun; Oshima, Yasuko; Nakano, Marie; Fujii, Teruhiro; Maehara, Takamitsu; Nitta, Kosaku; Hatano, Michiyasu

    2014-05-01

    A 43-year-old male experienced renal infarction (RI) following left upper lobectomy for lung cancer. The patient complained of acute-onset severe left flank pain on the 14th postoperative day. A contrast-enhanced computed tomography (CT) of the abdomen revealed RI by a large wedge-shaped defect in the left kidney. A chest CT scan located the thrombus in the stump (a blind-ended vessel) of the left superior pulmonary vein. Therefore, thromboembolic RI caused by pulmonary vein thrombosis was suspected. Anticoagulation therapy was initiated with heparin and warfarin to treat RI and to prevent further embolic episodes. Two months later, pulmonary vein thrombosis had resolved without the appearance of additional peripheral infarction. This case emphasizes the need to consider thrombus in the stump of the pulmonary vein as a cause of RI.

  5. Are pulmonary embolism and deep-vein thrombosis always one disease?

    NARCIS (Netherlands)

    Langevelde, Kirsten van

    2012-01-01

    Pulmonary embolism is traditionally, since autopsy studies by Virchow in the mid 1800s, thought to originate from embolization of a deep-vein thrombosis, resulting in two clinical manifestations of one disease: venous thrombosis. The incidence of deep-vein thrombosis in the population is twice as hi

  6. Idiopathic pulmonary vein thrombosis extending to left atrium:a case report with a literature review

    Institute of Scientific and Technical Information of China (English)

    WU Jun-ping; WU Qi; YANG Yang; DU Zhong-zhen; SUN Hong-fen

    2012-01-01

    Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of atrial fibrillation,pulmonary tumors,and Iobectomy.Although it is a potentially life threatening condition,the venous disease is easy to misdiagnose because of the non-specific symptoms.In this article,we present a 30-year-old patient who suffered from pulmonary vein thrombosis without any causes.He was diagnosed with other pulmonary disorders till the thrombus within the pulmonary vein extended into the left atrium.Left atrium mass resection and a left lower Iobectomy were undertaken with relative urgency.The postoperative course was uneventful.The patient received a long course of oral anticoagulant therapy.

  7. Unusual presentation of renal vein thrombosis with pulmonary artery embolism.

    Science.gov (United States)

    Mzayen, Khaled; Al-Said, Jafar; Nayak-Rao, Shobhana; Catacutan, Maria Teresa; Kamel, Olfat

    2013-05-01

    A young 23-year-old male patient presented with a two-day history of right flank pain. He had no history of any significant illnesses in the past. His investigations showed nephrotic range proteinuria with hypoalbuminemia. The patient developed cough and shortness of breath after having a left kidney biopsy. He did not respond to regular respiratory tract infection treatment. The kidney biopsy revealed membranoproliferative glomerulonephritis. Further investigations for the cough showed thromboembolism of the posterior and lateral basal segments of the right lower lobe. Moreover he was found to have thrombosis of the right upper pole renal vein. The patient was started on full anticoagulation along with three days pulse steroid, followed by 1 mg/kg oral steroid. Clinical improvement was noticed within 48 h. After eight weeks the proteinuria decreased from 8.5 gm/day to 1.1 gm/day. The kidney function was normal with eGFR 145 mL/min through the course of the disease. This case represent one of the unusual presentation of nephrotic syndrome with pulmonary and renal vascular thromboembolic events. The response to the combination of anticoagulation and steroid was remarkable.

  8. Unusual presentation of renal vein thrombosis with pulmonary artery embolism

    Directory of Open Access Journals (Sweden)

    Khaled Mzayen

    2013-01-01

    Full Text Available A young 23-year-old male patient presented with a two-day history of right flank pain. He had no history of any significant illnesses in the past. His investgations showed nephrotic range proteinuria with hypoalbuminemia. The patient developed cough and shortness of breath after having a left kidney biopsy. He did not respond to regular respiratory tract infection treat-ment. The kidney biopsy revealed membranoproliferative glomerulonephritis. Further investigations for the cough showed thromboembolism of the posterior and lateral basal segments of the right lower lobe. Moreover he was found to have thrombosis of the right upper pole renal vein. The patient was started on full anticoagulation along with three days pulse steroid, followed by 1 mg/kg oral steroid. Clinical improvement was noticed within 48 h. After eight weeks the proteinuria decreased from 8.5 gm/day to 1.1 gm/day. The kidney function was normal with eGFR 145 mL/min through the course of the disease. This case represent one of the unusual presentation of nephrotic syndrome with pulmonary and renal vascular thromboembolic events. The response to the combination of anticoagulation and steroid was remarkable.

  9. Hemodynamic Change in Pulmonary Vein Stenosis after Radiofrequency Ablation: Assessment with Magnetic Resonance Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Doyoung; Jung, Jung Im; Oh, Yong Seog; Youn, Ho Joong [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2012-11-15

    We present a case of pulmonary vein (PV) stenosis after radio-frequency (RF) ablation, in which a hemodynamic change in the pulmonary artery was similar to that of congenital PV atresia on time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA). A 48-year-old man underwent RF ablation due to atrial fibrillation. The patient subsequently complained of hemoptysis, dyspnea on exertion, and right chest pain. Right PV stenosis after catheter ablation was diagnosed through chest computed tomography and lung perfusion scan. Pulmonary TR-MRA revealed the pulmonary artery via systemic arterial collaterals and draining systemic collateral veins. On a velocity-encoded cine image, the flow direction of the right pulmonary artery was reversed in the diastolic phase and the left pulmonary artery demonstrated continuous forward flow throughout the cardiac cycle. These hemodynamic changes were similar to those seen in congenital unilateral PV atresia.

  10. Transesophageal Echocardiographically-Confirmed Pulmonary Vein Thrombosis in Association with Posterior Circulation Infarction.

    LENUS (Irish Health Repository)

    Kinsella, Justin A

    2010-01-01

    Pulmonary venous thromboembolism has only been identified as a cause of stroke with pulmonary arteriovenous malformations\\/fistulae, pulmonary neoplasia, transplantation or lobectomy, and following percutaneous radiofrequency ablation of pulmonary vein ostia in patients with atrial fibrillation. A 59-year-old man presented with a posterior circulation ischemic stroke. \\'Unheralded\\' pulmonary vein thrombosis was identified on transesophageal echocardiography as the likely etiology. He had no further cerebrovascular events after intensifying antithrombotic therapy. Twenty-eight months after initial presentation, he was diagnosed with metastatic pancreatic adenocarcinoma and died 3 months later. This report illustrates the importance of doing transesophageal echocardiography in presumed \\'cardioembolic\\' stroke, and that potential \\'pulmonary venous thromboembolic\\' stroke may occur in patients without traditional risk factors for venous thromboembolism. Consideration should be given to screening such patients for occult malignancy.

  11. Usefulness of helical computed tomography in diagnosing pulmonary vein stenosis in infants.

    Directory of Open Access Journals (Sweden)

    Ohtsuki,Shinnichi

    2005-06-01

    Full Text Available

    We investigated the usefulness of helical computed tomography(CTin the morphological diagnosis of pulmonary vein stenosis, particularly that in infants and small children. In total, 20 helical CT examinations were performed in 10 post-operative cases of Total Anomalous Pulmonary Venous Drainage(TAPVD, 3 cases of single right ventricle, and 1 case of single left ventricle. In all cases, distinct morphological imaging was possible. Pulmonary vein stenosis could be categorized into three types: (1stenosis from the anastomosis of the common pulmonary vein (CPV-the left atrium (LA to the peripheral pulmonary vein; (2 stenosis only at the anastomosis of CPV-LA; and (3 stenosis due to compression by nearby organs. Coronal views by multiplanar reconstruction (MPR provided morphological information along the up-down direction of the body axis. Morphological diagnosis of pulmonary vein stenosis is important in deciding prognosis and therapeutic regimens, and helical CT was considered useful for such diagnosis in our 14 young patients.

  12. Specific echocardiographic findings useful for the diagnosis of common pulmonary vein atresia

    Directory of Open Access Journals (Sweden)

    Hiroyuki Nagasawa

    2015-12-01

    Full Text Available In this paper, we report a case of common pulmonary vein atresia, which is a very rare disease characterized by cyanosis, heart failure and pulmonary hypertension. Reverse flow in the pulmonary artery at end-diastole as well as in the isthmus of the aorta from early systole to end-diastole detected by echocardiography were found to be specific features useful in diagnosing the disease.

  13. Pathogenetics of alveolar capillary dysplasia with misalignment of pulmonary veins.

    Science.gov (United States)

    Szafranski, Przemyslaw; Gambin, Tomasz; Dharmadhikari, Avinash V; Akdemir, Kadir Caner; Jhangiani, Shalini N; Schuette, Jennifer; Godiwala, Nihal; Yatsenko, Svetlana A; Sebastian, Jessica; Madan-Khetarpal, Suneeta; Surti, Urvashi; Abellar, Rosanna G; Bateman, David A; Wilson, Ashley L; Markham, Melinda H; Slamon, Jill; Santos-Simarro, Fernando; Palomares, María; Nevado, Julián; Lapunzina, Pablo; Chung, Brian Hon-Yin; Wong, Wai-Lap; Chu, Yoyo Wing Yiu; Mok, Gary Tsz Kin; Kerem, Eitan; Reiter, Joel; Ambalavanan, Namasivayam; Anderson, Scott A; Kelly, David R; Shieh, Joseph; Rosenthal, Taryn C; Scheible, Kristin; Steiner, Laurie; Iqbal, M Anwar; McKinnon, Margaret L; Hamilton, Sara Jane; Schlade-Bartusiak, Kamilla; English, Dawn; Hendson, Glenda; Roeder, Elizabeth R; DeNapoli, Thomas S; Littlejohn, Rebecca Okashah; Wolff, Daynna J; Wagner, Carol L; Yeung, Alison; Francis, David; Fiorino, Elizabeth K; Edelman, Morris; Fox, Joyce; Hayes, Denise A; Janssens, Sandra; De Baere, Elfride; Menten, Björn; Loccufier, Anne; Vanwalleghem, Lieve; Moerman, Philippe; Sznajer, Yves; Lay, Amy S; Kussmann, Jennifer L; Chawla, Jasneek; Payton, Diane J; Phillips, Gael E; Brosens, Erwin; Tibboel, Dick; de Klein, Annelies; Maystadt, Isabelle; Fisher, Richard; Sebire, Neil; Male, Alison; Chopra, Maya; Pinner, Jason; Malcolm, Girvan; Peters, Gregory; Arbuckle, Susan; Lees, Melissa; Mead, Zoe; Quarrell, Oliver; Sayers, Richard; Owens, Martina; Shaw-Smith, Charles; Lioy, Janet; McKay, Eileen; de Leeuw, Nicole; Feenstra, Ilse; Spruijt, Liesbeth; Elmslie, Frances; Thiruchelvam, Timothy; Bacino, Carlos A; Langston, Claire; Lupski, James R; Sen, Partha; Popek, Edwina; Stankiewicz, Paweł

    2016-05-01

    Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV) is a lethal lung developmental disorder caused by heterozygous point mutations or genomic deletion copy-number variants (CNVs) of FOXF1 or its upstream enhancer involving fetal lung-expressed long noncoding RNA genes LINC01081 and LINC01082. Using custom-designed array comparative genomic hybridization, Sanger sequencing, whole exome sequencing (WES), and bioinformatic analyses, we studied 22 new unrelated families (20 postnatal and two prenatal) with clinically diagnosed ACDMPV. We describe novel deletion CNVs at the FOXF1 locus in 13 unrelated ACDMPV patients. Together with the previously reported cases, all 31 genomic deletions in 16q24.1, pathogenic for ACDMPV, for which parental origin was determined, arose de novo with 30 of them occurring on the maternally inherited chromosome 16, strongly implicating genomic imprinting of the FOXF1 locus in human lungs. Surprisingly, we have also identified four ACDMPV families with the pathogenic variants in the FOXF1 locus that arose on paternal chromosome 16. Interestingly, a combination of the severe cardiac defects, including hypoplastic left heart, and single umbilical artery were observed only in children with deletion CNVs involving FOXF1 and its upstream enhancer. Our data demonstrate that genomic imprinting at 16q24.1 plays an important role in variable ACDMPV manifestation likely through long-range regulation of FOXF1 expression, and may be also responsible for key phenotypic features of maternal uniparental disomy 16. Moreover, in one family, WES revealed a de novo missense variant in ESRP1, potentially implicating FGF signaling in the etiology of ACDMPV.

  14. Measurements of pulmonary vein ostial diameter and distance to first bifurcation: A comparison of different measurement methods

    Energy Technology Data Exchange (ETDEWEB)

    Cronin, Paul [Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, Ann Arbor, MI (United States)], E-mail: pcronin@med.umich.edu; Saab, Ali [Des Moines University, College of Osteopathic Medicine 3200 Grand Avenue, Des Moines, IA (United States); Kelly, Aine Marie; Gross, Barry H.; Patel, Smita; Kazerooni, Ella A. [Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, Ann Arbor, MI (United States); Carlos, Ruth C. [Division of Magnetic Resonance Imaging, University of Michigan Medical Center, Ann Arbor, MI (United States)

    2009-07-15

    The purpose of this study was to evaluate the agreement between axial, multiplanar reformatted (MPR) and semi-automated software measurements of pulmonary vein ostial diameters and distance to the first bifurcation. CT examinations of the thorax were retrospectively reviewed in 150 consecutive patients. The pulmonary vein ostial diameter and distance to the first bifurcation of the four main pulmonary veins were independently measured. The three measurement methods were compared using a Bland-Altman test. There was no significant variation between pulmonary vein ostial diameter measurements for the superior pulmonary veins across the three measurement methods. There was significant variation between the semi-automated program and both the axial (p = 0.001) and MPR (p < 0.001) measured diameters for the right inferior pulmonary vein ostial diameter and between the MPR and semi-automated program measurements (p = 0.02) for the left inferior pulmonary vein ostial diameter. There was no significant variation between the pulmonary vein distance to first bifurcation measurements for any pulmonary vein across the three measurement methods. However, from a clinical perspective, differences were negligible; therefore, the clinician may confidently use any of the three measurement methods presented.

  15. Isolated Facial Vein Thrombophlebitis: A Variant of Lemierre Syndrome

    DEFF Research Database (Denmark)

    Karnov, Kirstine KS; Lilja-Fischer, Jacob Kinggaard; Randrup, Thomas Skov

    2014-01-01

    Lemierre syndrome is a rare complication of acute tonsillitis. It is caused by the anaerobic bacterium Fu- sobacterium necrophorum and is characterized by bacteremia and septic thrombosis of the internal jug- ular vein. Dissemination of septic emboli may occur. The diagnosis can be difficult since...... different organs can be involved. We discuss a case of Lemierre syn- drome in a 35-year-old woman with isolated throm- bophlebitis of the facial vein and fusobacteria growth in blood culture. This case emphasizes the need for awareness of the condition....

  16. [Thrombectomy and plication of veins as a method of preventing pulmonary artery thromboembolism at a multidisciplinary surgical hospital].

    Science.gov (United States)

    Galkin, S V; Pashin, N V; Dedyukhin, I G; Aleksandrov, A G; Lebedeva, M V

    2016-01-01

    The authors assessed efficacy and safety of the operation of plication of deep veins of lower extremities, pelvic veins, and the inferior vena cava as a method of preventing fatal pulmonary artery thromboembolism. A total of 48 patients were operated on. Of these, 23 patients belonged to traumatological-and-orthopaedical cohort, 3 to general surgical cohort, 4 to gynaecological, and 18 to vascular cohort (isolated deep vein thrombosis). The length of the floating head of the thrombus varied from 2 to 10 cm. The presence of a floating thrombus in traumatological, surgical and gynaecological patients, regardless of the length of the floating part was an absolute indication for thrombectomy and venous plication. Vascular patients were operated on in accordance with the National Guidelines (with the length of the thrombus floating portion of not less than 4 cm). In all cases, surgical management envisaged direct and indirect thrombectomy. Plication was always performed above the level of venotomy. It was shown that thrombectomy combined with plication of major veins is a reliable and safe method of prophylaxis, being in some cases the only possible method of preventing fatal pulmonary artery thromboembolism. The operation of plication makes it possible not to cancel a scheduled surgical intervention in patients with a detected floating thrombus of major veins. The operation of thrombectomy and plication above the level of the floating head of the thrombus may be considered an operation of choice in the conditions where there is no possibility to use endovascular methods of treatment (implantation of a cava filter, endovascular catheter thrombectomy), as well as in pregnant women. Restoration of the venous lumen occurs at safe terms spontaneously, not requiring repeat surgical intervention. Simultaneous plication of the vein does not complicate the course of the postoperative period of the main surgical intervention. Thrombectomy and plication do not lead to the

  17. Nerves projecting from the intrinsic cardiac ganglia of the pulmonary veins modulate sinoatrial node pacemaker function

    Science.gov (United States)

    Zarzoso, Manuel; Rysevaite, Kristina; Milstein, Michelle L.; Calvo, Conrado J.; Kean, Adam C.; Atienza, Felipe; Pauza, Dainius H.; Jalife, José; Noujaim, Sami F.

    2013-01-01

    Aims Pulmonary vein ganglia (PVG) are targets for atrial fibrillation ablation. However, the functional relevance of PVG to the normal heart rhythm remains unclear. Our aim was to investigate whether PVG can modulate sinoatrial node (SAN) function. Methods and results Forty-nine C57BL and seven Connexin40+/EGFP mice were studied. We used tyrosine-hydroxylase (TH) and choline-acetyltransferase immunofluorescence labelling to characterize adrenergic and cholinergic neural elements. PVG projected postganglionic nerves to the SAN, which entered the SAN as an extensive, mesh-like neural network. PVG neurones were adrenergic, cholinergic, and biphenotypic. Histochemical characterization of two human embryonic hearts showed similarities between mouse and human neuroanatomy: direct neural communications between PVG and SAN. In Langendorff perfused mouse hearts, PVG were stimulated using 200–2000 ms trains of pulses (300 μs, 400 µA, 200 Hz). PVG stimulation caused an initial heart rate (HR) slowing (36 ± 9%) followed by acceleration. PVG stimulation in the presence of propranolol caused HR slowing (43 ± 13%) that was sustained over 20 beats. PVG stimulation with atropine progressively increased HR. Time-course effects were enhanced with 1000 and 2000 ms trains (P < 0.05 vs. 200 ms). In optical mapping, PVG stimulation shifted the origin of SAN discharges. In five paroxysmal AF patients undergoing pulmonary vein ablation, application of radiofrequency energy to the PVG area during sinus rhythm produced a decrease in HR similar to that observed in isolated mouse hearts. Conclusion PVG have functional and anatomical biphenotypic characteristics. They can have significant effects on the electrophysiological control of the SAN. PMID:23559611

  18. Effects of pulmonary veins ligation style for the patients' stress and cardiac on lung cancer

    Directory of Open Access Journals (Sweden)

    Yang SHENTU

    2008-10-01

    Full Text Available Background and objective It is needed to explore the effects of operation on stress statue, myocardial damage and arrhythmia to lung cancer. This study would compare the effects of two ligation styles of pulmonary vein on lung cancer patients' stress and cardiac postoperative. Methods 54 cases were divided into two groups randomly:the pulmonary vein trunk-ligation group (trunk group, 27 cases and the pulmonary vein branch-ligation group (branch group, 27 cases. The blood concentrations of hydrocortisone (HC, blood glucose (BG and cardial troponin-I (cTnI were determined at different time point. The surgical data, the quantum of pain and ECG also recorded. Results ① There were no significance difference of the operation time, blood loss during operation and drainage volume in first day after operation between two groups. ② There're no differences of the quantum of pain between two groups. ③ The HC of the two groups' ascend obviously on the end of operation and descend during postoperative. ④ The BG of the two groups' rise on the 1st day obviously, maintain high level on the 2nd day, descend on the 3rd day but still higher than that of preoperation.⑤ The BG and HC show a direct positive correlation postoperative. ⑥ The cTnIs of the trunk group ascend immediatelyafter operation, but there's no statistically significance between two groups. ⑦ The arrhythmia incidence is higher in the trunk group, but the arrhythmia incidences classified by the date after operation of the two groups' show no distinction. Conclusion ① The effects of two pulmonary vein ligation styles on postoperative stress show no significance differences.② The style of pulmonary vein trunk-ligation has a more obvious tendency to do harm to heart than that of branch-ligation. ③ The style of pulmonary vein branch-ligation may reduce the arrhythmia incidence after operation.

  19. Extralobar pulmonary sequestration with venous drainage to the portal vein: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kamata, S.; Sawai, T.; Nose, K.; Hasagawa, T.; Nakajima, K.; Soh, H.; Okada, A. [Department of Paediatric Surgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan)

    2000-07-01

    Venous drainage to the portal vein in pulmonary sequestration is rare. A 7-month-old girl was referred to our hospital following surgery for ventricular septal defect because of a left upper abdominal mass with a large feeding artery from the abdominal aorta and venous drainage to the portal vein. She had had frequent pulmonary infections and was growth retarded. MRI demonstrated that the mass was above the left diaphragm, suggesting extralobar sequestration. An extralobar sequestered lung was resected at thoracotomy. Diagnostic problems and clinical features are presented. (orig.)

  20. Pulmonary Embolism following Endovenous Laser Ablation (EVLA of the Great Saphenous Vein

    Directory of Open Access Journals (Sweden)

    Nnamdi Nwaejike

    2008-08-01

    Full Text Available

    A 70yr old lady presented to accident and emergency with sudden onset pleuritic chest pain. A pulmonary embolus (PE was diagnosed by CTPA. Ten days earlier she had bilateral EVLA for recurrent long saphenous vein disease. Confounding risk factors for pulmonary embolism included bilateral ligation and stripping of the long saphenous vein a year earlier, malignancy, EVLA and phlebitic tributary varices. EVLA has been shown to be an effective treatment for superficial venous insufficiency with low morbidity and high patient satisfaction. The investigation of confounding risk factors and possible causes should not compromise the initial treatment of PE.

  1. A novel multiscale topo-morphometric approach for separating arteries and veins via pulmonary CT imaging

    Science.gov (United States)

    Saha, Punam K.; Gao, Zhiyun; Alford, Sara; Sonka, Milan; Hoffman, Eric

    2009-02-01

    Distinguishing arterial and venous trees in pulmonary multiple-detector X-ray computed tomography (MDCT) images (contrast-enhanced or unenhanced) is a critical first step in the quantification of vascular geometry for purposes of determining, for instance, pulmonary hypertension, using vascular dimensions as a comparator for assessment of airway size, detection of pulmonary emboli and more. Here, a novel method is reported for separating arteries and veins in MDCT pulmonary images. Arteries and veins are modeled as two iso-intensity objects closely entwined with each other at different locations at various scales. The method starts with two sets of seeds -- one for arteries and another for veins. Initialized with seeds, arteries and veins grow iteratively while maintaining their spatial separation and eventually forming two disjoint objects at convergence. The method combines fuzzy distance transform, a morphologic feature, with a topologic connectivity property to iteratively separate finer and finer details starting at a large scale and progressing towards smaller scales. The method has been validated in mathematically generated tubular objects with different levels of fuzziness, scale and noise. Also, it has been successfully applied to clinical CT pulmonary data. The accuracy of the method has been quantitatively evaluated by comparing its results with manual outlining. For arteries, the method has yielded correctness of 81.7% at the cost of 6.7% false positives and 11.6% false negatives. Our method is very promising for automated separation of arteries and veins in MDCT pulmonary images even when there is no mark of intensity variation at conjoining locations.

  2. [Total anomalous connection of the pulmonary veins in the adult. Presentation of 4 cases].

    Science.gov (United States)

    Rangel-Abundis, A; Rendón Aguilar, P; Badui, E

    1989-01-01

    The authors described the clinical, echocardiographic, and hemodynamic studies, as well as the surgical findings in four adult patients with total anomalous connexion of the pulmonary veins (TACPV); two of them with pulmonary arterial hypertension and T A C P V draining in the coronary sinus, and the other two cases with normal pulmonary artery pressure and T A C P V draining in the superior vena cava. None of the patients had symptoms nor signs of congestive heart failure. All cases had successful surgical interventions. Patients survival into adulthood is discussed.

  3. Radiofrequency Ablation Mapping with Circumferential Catheter for Paroxys-mal Atrial Fibrillation Originating From the Pulmonary Veins

    Institute of Scientific and Technical Information of China (English)

    刘震; 吴书林; 杨平珍; 方咸宏; 李海杰; 陈泗林; 詹贤章; 薛玉梅

    2002-01-01

    Objectives To assessed thefeasibility and effectiveness of electrophysiologicalmapping of pulmonary veins with a circumferential 10-electrode catheter and radiofrequency catheter abla-tion therapy for patients with paroxysmal atrial fibril-lation. Background Standard mapping and ablationof focal sources of atrial fibrillation are associated withvery long procedure times and low efficacy. Mappingand ablation pulmonary veins guide with a circularcatheter could overcome these limitations. Methods16 patients [male 11, female 5, mean age (51 +14.5) years] with paroxysmal atrial fibrillation refrac-tory to antiarrhythmic drugs were included in thisgroup. A circumferential 10-electrode catheter wasused to pulmonary vein mapping during sinus rhythm orCSd pacing to determine the origin of atrial prematurecontractions. When the ablative target pulmonary veinwas found, the pulmonary vein potentials' distributionand activation were assessment pulmonary veins' ostialablation was performed at the segments showing earliestactivation of pulnonary vein potentials. The end pointwas designed: 1 ) elimination of pulmonary vein po-tential; 2) pulmonary vein potential dissociation fromatrial waves; 3) atrial ectopic beats disappear. ResultsA total of 36 pulmonary veins were ablated, in-cluding 16 left superior, 12 right superior, 7 left in-ferior and 1 right inferior. 1 pulmonary vein in 2 pa-tients was ablated, 2 pulmonary veins in 8 patientswere ablated, 3 pulmonary veins were ablated in 5patients and 4 pulmonary veins were ablated in 1 pa-tient. Procedure duration and fluoroscopy time respec-tively were 186.7 _+ 63.8 min and 51.5 + 15.0 min.During the follow-up 1- 12 months, 11 patients(68.7 % ) were free of AF without any antiarrhythmicdrugs, 2 of them were reablation, effective in 3/16(18.7%) and unsuccessful in 2/16 (12.6%) . 2cases recurred with atrial premature, 1 was treated withamiodarone and the other was repeat electrophysiologi-cal mapping and ablation, 5 cases with

  4. Unilateral pulmonary veins atresia: evaluation by computed tomography; Atresia unilateral das veias pulmonares: avaliacao por tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Eifer, Diego Andre; Arsego, Felipe Veras, E-mail: felipesoarestorres@gmail.com [Hospital de Clinicas de Porto Alegre (HCPA), RS (Brazil). Serv. de Radiologia; Torres, Felipe Soares [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil). Escola de Medicina

    2013-11-15

    Unilateral pulmonary vein atresia is a rare congenital condition. In addition to cardiac malformations or pulmonary hypertension, patients may present with recurrent pulmonary infections or hemoptysis in childhood or adolescence. The authors report a case where the typical findings of such condition were observed at computed tomography in an adult patient. (author)

  5. Ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    王建安; 孙勇; 何红

    2003-01-01

    Objective: to evaluate the efficacy and safety of ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation. Methods: The study population consisted of 9 patients with 5 males and 4 females enrolled consecutively who had idiopathic paroxysmal atrial fibrillation(AF). The ultrasound balloon was positioned through a special sheath to the orifice of the target vein by a transseptal procedure. The balloon was inflated with contrast-mixed saline (contrast: saline = 1:4) whose volume was decided by the diameter of the target pulmonary vein. The ablation energy was usually set up at 35 to 40 watts with temperature controlled at 60℃. The duration of each ablation was about 120 seconds which was repeated not over 10 times. Results: The average duration of the total procedure was 132±68 min for our patients. The average fluoroscopy time was 33±17 min. With a mean follow-up of 16±8 months after the procedure, AF was completely eliminated in 4 patients without antiarrhythmic drugs. The episodes of atrial fibrillation were eliminated in 2 patients with low dosage of oral amiodarone (0.1, once daily) which was ineffective before the procedure. The frequency of episodes was similar to that before the procedure in 3 patients. There were no complications such as hemopericardium, air embolism and stenosis of the pulmonary veins by angiography, related to the procedure. Conclusion: Ultrasound ablation of the pulmonary veins is a new approach to treat paroxysmal atrial fibrillation. Before we determined its value, we need to do more researches with bigger sample, randomization and comparison design.

  6. Ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    王建安; 孙勇; 何红

    2003-01-01

    Objective : to evaluate the efficacy and safety of ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation. Methods : The study population consisted of 9 patients with 5 males and 4 females enrolled consecutively who had idiopathic paroxysmal atrial fibrillation(AF) . The ultrasound balloon was positioned through a special sheath to the orifice of the target vein by a transseptal procedure. The balloon was inflated with contrast-mixed saline (contrast: saline = 1:4) whose volume was decided by the diameter of the target pulmonary vein. The ablation energy was usually set up at 35 to 40 watts with temperature controlled at 60℃ . The duration of each ablation was about 120 seconds which was repeated not over 10 times. Results: The average duration of the total procedure was 132± 68 min for our patients. The average fluoroscopy time was 33 ±17 min. With a mean follow-up of 16 ±8 months after the procedure, AF was completely eliminated in 4 patients without antiarrhythmic drugs. The episodes of atrial fibrillation were eliminated in 2 patients with low dosage of oral amiodarone (0.1, once daily) which was ineffective before the procedure. The frequency of episodes was similar to that before the procedure in 3 patients. There were no complications such as hemopericardium, air embolism and stenosis of the pulmonary veins by angiography, related to the procedure. Conclusion : Ultrasound ablation of the pulmonary veins is a new approach to treat paroxysmal atrial fibrillation. Before we determined its value, we need to do more researches with bigger sample, randomization and comparison design.

  7. Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy

    Directory of Open Access Journals (Sweden)

    Sanjay Khaladkar

    2016-01-01

    Full Text Available Tuberculosis is a common infectious disease with a high prevalence in developing countries and presents a major public health issue. Internal jugular vein (IJV thrombosis is a rare complication in tuberculous cervical lymphadenopathy. We report a case of 26-year male patient with a history of low-grade evening rise in fever, dry cough, loss of appetite, and loss of weight with swelling in lower neck on right side. Ultrasonography (USG neck showed well-defined hypoechoic lymph nodes posterior to right IJV and common carotid artery in the lower neck at level IV and in the right supraclavicular region showing central necrotic areas with adjoining IJV thrombosis. The association between tuberculosis and deep vein thrombosis is rare. Awareness of IJV thrombosis in isolated cervical lymphadenopathy needs high diagnostic suspicion and prompt treatment to avoid fatal complication. Our case is rare as there was isolated tuberculous cervical lymphadenopathy with adjoining IJV thrombosis. Both USG and computed tomography (CT are accurate and reliable radiological investigations for detecting IJV thrombosis along with cervical lymph nodes. They are useful in assessing surrounding soft tissue and fat planes and knowing the size and extent of cervical lymphadenopathy. USG is inexpensive and readily available for monitoring response to treatment.

  8. Fusion of Delayed-enhancement MR Imaging and Contrast-enhanced MR Angiography to Visualize Radiofrequency Ablation Scar on the Pulmonary Vein.

    Science.gov (United States)

    Shigenaga, Yutaka; Kiuchi, Kunihiko; Ikeuchi, Kazushi; Ikeda, Takayuki; Okajima, Katsunori; Yasaka, Yoshinori; Kawai, Hiroya

    2015-01-01

    Delayed-enhancement magnetic resonance imaging (DE-MRI) is reported to detect the radiofrequency (RF) ablation scar of pulmonary vein isolation. However, the precise localization of RF scar is difficult to recognize due to the poor anatomical information of the 3-dimensionally reconstructed DE-MRI. We report 2 cases in which fusion of DE-MRI and contrast-enhanced MR angiography facilitated the identification of RF scar, and we detail our fusion method.

  9. Pulmonary vein flow pattern in children with bidirectional cavopulmonary connection or Fontan circuit

    Energy Technology Data Exchange (ETDEWEB)

    Shariat, Masoud; Yoo, Shi-Joon [Hospital for Sick Children, Department of Radiology, Toronto (Canada); Grosse-Wortmann, Lars; Windram, Jonathan [Hospital for Sick Children, Department of Cardiology, Toronto (Canada)

    2012-02-15

    Typical flow velocity profiles in the extraparenchymal pulmonary veins (PVs) demonstrate two major antegrade flow waves: a biphasic systolic wave (S), with S1 and S2 peaks and a monophasic early diastolic wave (D). Flow reversal during atrial systole (A) is common. There is agreement that the forward diastolic PV flow wave is caused by left ventricular relaxation with opening of the mitral valve. The origin of the PV systolic wave, however, remains a topic of debate. Some studies have suggested that the S wave is created by the relaxation of the left atrium and descent of the mitral valve plane. These studies have concluded that forces generated by the right ventricle (RV) have no effect on the S wave. Others suggest that the forward propagation of the right ventricular systolic pressure pulse is the major contributor to the S wave. To determine whether any part of the systolic wave of PV flow is dependent on forces created by the right ventricle. We assessed PV flow pattern, as obtained by cardiac MRI in 12 cases (39 pulmonary veins) with RV-independent pulmonary circulation (bidirectional cavopulmonary connection or Fontan circulation). Phase-contrast imaging of the PVs was performed on a 1.5-T MR scanner with velocity encoding set at 120 cm/s. We compared these flow patterns with those of a control group of ten children (15 pulmonary veins) who had RV-dependent pulmonary circulation and underwent CMR for other indications. In all PVs of children with RV-independent pulmonary circulation the flow curves showed a single systolic peak in early systole (S1) with the S2 peak consistently absent. PV flow pattern in the control group consistently showed distinct early and late systolic peaks. This study supports the concept that S2 is caused by forward propagation of the right ventricular systolic pressure pulse. It also demonstrates that the S1 is independent of the right ventricle. (orig.)

  10. Pulmonary vein flow pattern in children with bidirectional cavopulmonary connection or Fontan circuit.

    Science.gov (United States)

    Shariat, Masoud; Grosse-Wortmann, Lars; Windram, Jonathan; Yoo, Shi-Joon

    2012-02-01

    Typical flow velocity profiles in the extraparenchymal pulmonary veins (PVs) demonstrate two major antegrade flow waves: a biphasic systolic wave (S), with S1 and S2 peaks and a monophasic early diastolic wave (D). Flow reversal during atrial systole (A) is common. There is agreement that the forward diastolic PV flow wave is caused by left ventricular relaxation with opening of the mitral valve. The origin of the PV systolic wave, however, remains a topic of debate. Some studies have suggested that the S wave is created by the relaxation of the left atrium and descent of the mitral valve plane. These studies have concluded that forces generated by the right ventricle (RV) have no effect on the S wave. Others suggest that the forward propagation of the right ventricular systolic pressure pulse is the major contributor to the S wave. To determine whether any part of the systolic wave of PV flow is dependent on forces created by the right ventricle. We assessed PV flow pattern, as obtained by cardiac MRI in 12 cases (39 pulmonary veins) with RV-independent pulmonary circulation (bidirectional cavopulmonary connection or Fontan circulation). Phase-contrast imaging of the PVs was performed on a 1.5-T MR scanner with velocity encoding set at 120 cm/s. We compared these flow patterns with those of a control group of ten children (15 pulmonary veins) who had RV-dependent pulmonary circulation and underwent CMR for other indications. In all PVs of children with RV-independent pulmonary circulation the flow curves showed a single systolic peak in early systole (S1) with the S2 peak consistently absent. PV flow pattern in the control group consistently showed distinct early and late systolic peaks. This study supports the concept that S2 is caused by forward propagation of the right ventricular systolic pressure pulse. It also demonstrates that the S1 is independent of the right ventricle.

  11. Isolated Left Pulmonary Artery Agenesis: A Case Report

    Directory of Open Access Journals (Sweden)

    Tansel Ansal Balcı

    2012-08-01

    Full Text Available Unilateral pulmonary artery agenesis without any cardiovascular malformation is a rare anomaly. We present the imaging findings of a patient who was diagnosed as isolated left pulmonary artery agenesis. A 27-year-old female patient was admitted to our hospital due to dyspnea during exercise for five years. Chest X-ray revealed minimally small left pulmonary hilum and left lung. She was admitted to our clinic with the suspicion of pulmonary artery pathology. Absent perfusion of the left lung with normal ventilation was visualized on scintigraphy. MDCT angiography of pulmonary arteries showed absent left main pulmonary artery with systemic collaterals around left hemithorax. Pulmonary artery agenesis can be asymptomatic and isolated until adulthood. Both scintigraphy and CT angiography images of pulmonary artery agenesis of a patient are rare in the literature. Pulmonary ventilation- perfusion scintigraphy can be used not only for pulmonary embolism but also pathologies involving pulmonary artery and its branches. (MIRT 2012;21:80-83

  12. Velocity time integral for right upper pulmonary vein in VLBW infants with patent ductus arteriosus.

    Science.gov (United States)

    Lista, Gianluca; Bianchi, Silvia; Mannarino, Savina; Schena, Federico; Castoldi, Francesca; Stronati, Mauro; Mosca, Fabio

    2016-10-01

    Early diagnosis of significant patent ductus arteriosus reduces the risk of clinical worsening in very low birth weight infants. Echocardiographic patent ductus arteriosus shunt flow pattern can be used to predict significant patent ductus arteriosus. Pulmonary venous flow, expressed as vein velocity time integral, is correlated to ductus arteriosus closure. The aim of this study is to investigate the relationship between significant reductions in vein velocity time integral and non-significant patent ductus arteriosus in the first week of life. A multicenter, prospective, observational study was conducted to evaluate very low birth weight infants (patent ductus compared to those with closed patent ductus arteriosus and the difference was significant. A significant reduction in vein velocity time integral in the first days of life is associated with ductus closure. This parameter correlates well with other echocardiographic parameters and may aid in the diagnosis and management of patent ductus arteriosus.

  13. Case Series: Fetal Pulmonary Vein A-Wave Reversal: An Early Marker of Left-Sided Cardiac Anomalies?

    Directory of Open Access Journals (Sweden)

    Aldo L. Schenone

    2015-04-01

    Full Text Available Background - Improvements in congenital heart disease (CHD screening are needed based on the lack of sensitivity of current screening methods and the understanding that the early detection of certain CHDs may improve outcomes. Fetal venous circulation has caught medical attention, and two studies demonstrated that it is feasible to register pulmonary vein flow velocity waveforms (FVWs during early gestation. Meanwhile, the latter study proposed pulmonary vein A-wave reversal as a marker of cardiac anomaly. Methods - We report a series of six consecutive fetuses with confirmed cardiac anomalies that underwent first-trimester screening, including pulmonary vein FVWs, at our center during 2013. CHD was confirmed by late pregnancy echocardiography, and in three cases fetal autopsies were performed. Result/Discussion - The ductus venosus (DV and nuchal translucency (NT predicted 50% of CHD cases, whereas the combination of markers identified 66.6% of CHD cases. When adding pulmonary vein assessment, the rate of detection rose to 83.3%. Total five of six cases of CHD had reversal of pulmonary vein A-wave during early pregnancy. The sixth case with CHD and nonreversal of A-wave was described as right ventricle hypoplasia with type 1 tricuspid atresia and persistent ductus arteriosus. Conclusion This is the first series reporting pulmonary vein end-diastolic reversal as a CHD screening add-on during early pregnancy. The addition of pulmonary vein FVW assessment to the current CHD screening bundle could increase the rate detection of cardiac anomalies. This pilot study suggests that pulmonary vein end-diastolic flow reversal favors detection of left-sided CHD over the right-sided ones.

  14. Isolated absence of right pulmonary artery

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    Singhi Anil

    2010-01-01

    Full Text Available Background : Absence of right pulmonary artery (RPA is a rare congenital abnormality with variable presentation. The diagnosis is often missed in infants Objective : The aim of this study was to describe infantile presentation of isolated absence of RPA along with a brief review of the literature. Methods : The details of five patients diagnosed with isolated absence of RPA from April 2007 to October 2009 were reviewed retrospectively Results : Five patients were identified with this anomaly. The median age of presentation was 86 days (range, 40-120 days and the median weight was 3.65 kg (range, 3.1-5.5 kg. All patients presented with breathing difficulty and had severe pulmonary hypertension (PHT along with absent RPA on echocardiography. A multidetector computed tomographic scan was performed to confirm the diagnosis in four cases. Three patients had major aortopulmonary collateral and the hilar RPA was not well developed in all. A correct diagnosis was made before referral in one patient only. Differential vascularity in chest X-ray, a useful clue, was seen in four of five cases. Surgical correction was not considered in view of the small hilar pulmonary artery. The patients were all managed medically with diuretics and Sildenafil. Conclusion : Isolated absence of RPA is a rare congenital abnormality with varied presentation. Infantile presentation is marked with congestive cardiac failure and PHT. Specific diagnostic clue includes differential vascularity on the chest X-ray.

  15. Bilateral chylothorax in a patient with chronic central vein thrombosis and chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Avdhesh Bansal

    2015-01-01

    Full Text Available The chylothorax is not a common presentation, and bilateral chylothorax in patients with chronically high central venous pressure secondary to venous thrombosis is a rare in incidence. We reported a case of bilateral chylothorax in a patient of chronic deep vein thrombosis (DVT in central veins with chronic thromboembolic pulmonary hypertension who presented with 2 weeks history of increased breathlessness, bilateral chest discomfort and weakness. Work-up with chest X-ray and ultrasonography-chest showed gross left sided and mild right sided pleural effusion, thoracocentesis was consistent with chylothorax. Contrast enhanced computed tomography-chest showed multiple collateral formation of left side subclavian vein, venous Doppler showed old DVT in right and left subclavian veins and two-dimensional echocardiogram showed finding of severe pulmonary hypertension. After 24 h of fasting and conservative management, pleural drain became clear and decreased in the amount. Patient′s video assisted thoracoscopic surgery was done, and thoracic duct was ligated and cut down at diaphragmatic level and bilateral talc pleurodesis done. Patient improved clinically and radiologically.

  16. Cystic lung changes in a thin section CT in an asymptomatic young adult with unilateral pulmonary vein atresia: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Choul; Yi, Jeong Geun; Park, Jeong Hee [Konkuk Univ. Medical Center, Seoul (Korea, Republic of)

    2012-07-15

    Unilateral pulmonary vein atresia is a rare anomaly, usually associated with symptoms of recurrent hemoptysis and pneumonia in early childhood. Only one report of an asymptomatic adult patient can be found in the literature. We present the case of an asymptomatic patient with unilateral right pulmonary vein atresia in a 20 year old man. Chest radiograph and multidetector computed tomography showed not only pulmonary vein atresia, pulmonary artery hypoplasia, but also cystic lung changes on thin section CT, along with septal and bronchovascular bundle thickening, and ground-glass opacity. Unilateral pulmonary vein atresia could be another disease which can show cystic lung changes on thin section chest CT.

  17. The role of the second heart field in pulmonary vein development : new insights in the origin of clinical abnormalities

    NARCIS (Netherlands)

    Douglas, Yvonne Louise

    2010-01-01

    In this thesis we describe normal and abnormal pulmonary vein development in human and mouse hearts, and focus on the histo(patho)logy of the pulmonary venous and left atrial dorsal wall, in order to elucidate the role of the posterior heart field in the formation and differentiation of the pulmonar

  18. Achieving Bidirectional Long Delays In Pulmonary Vein Antral Lines Prior To Bidirectional Block In Patients With Paroxysmal Atrial Fibrillation (The Bi-Bi Technique For Atrial Fibrillation Ablation).

    Science.gov (United States)

    Mina Md Facc Fhrs, Adel F; L Warnecke Pa-C, Nicholas

    2016-01-01

    Background: Pulmonary Vein Antral isolation (PVAI) is currently the standard of care for both paroxysmal and persistent atrial fibrillation ablation. Reconnection to the pulmonary vein is the most common cause of recurrence of atrial fibrillation. Achieving the endpoint of bidirectional block (BDB) for cavotricuspid isthmus dependant flutter has improved our outcomes for atrial flutter ablation. With this we tried to achieve long delays in the pulmonary veins antral lines prior to complete isolation comparable to those delays found in patient with bidirectional block of atrial flutter lines. Study Objective:The objective of this paper was to evaluate feasibility and efficacy of achieving Bidirectional long delays in pulmonary vein antral lines prior to Bidirectional Block in patient with paroxysmal atrial fibrillation. Method: A retrospective analysis was performed on patients who had paroxysmal atrial fibrillation procedures at Unity Point Methodist from January 2015 to January 2016. 20 consecutive patients with paroxysmal atrial fibrillation who had AF ablation using the Bi-Bi technique were evaluated. Result: Mean age was 63, number of antiarrhythmic used prior to ablation was 1.4, mean left atrial size was 38 mm. Mean chads score was 1.3. Mean EF was 53%. Long delays in the left antral circumferential lines were achieved with mean delay of 142 milliseconds +/-100. Also long delays in the right antral circumferential lines were achieved with mean delay of 150 milliseconds +/-80. 95 % (19/20) of patients were free of any atrial arrhythmias and were off antiarrhythmic medications for AF post procedure. There was only one transient complication in one patient who developed a moderate pericardial effusion that was successfully drained with no hemodynamic changes. The only patient who had recurrence was found to have asymptomatic AF with burden on his device paroxysmal atrial fibrillation is feasible and highly effective technique in this small cohort of patients

  19. Periodic conduction and 2:1 block from the left atrium to the pulmonary vein during radiofrequency ablation.

    Science.gov (United States)

    Landolina, Maurizio; Petracci, Barbara; De Ferrari, Gaetano M; Frattini, Folco; Cantù, Francesco; Rordorf, Roberto; De Filippo, Paolo

    2004-11-01

    Paroxysmal atrial fibrillation is often initiated by foci in the pulmonary veins (PVs); the junction between the PVs and the left atrium (LA) has become the target of radiofrequency (RF) ablation performed to isolate the PVs. Ectopic atrial beats originating from the PVs propagate to the LA with a characteristically long conduction time, often with a conduction delay or block within the PV or at the PV-LA junction. However, details about the conduction properties within the PVs and across the PV-LA junction are still scanty. We report a unique case of LA-PV decremental conduction caused by RF applications. New insights into the electroanatomical characteristics of the PV-LA junction are provided. The present report demonstrates, for the first time in humans, that decremental conduction may be related to the progressive damage of the conducting myocardial bundle due to RF energy applications.

  20. Rare case of coronary to pulmonary vein fistula with coronary steal phenomenon

    Institute of Scientific and Technical Information of China (English)

    Emad; A; Barsoum; Faisal; B; Saiful; Deepak; Asti; Rewais; Morcus; Georges; Khoueiry; James; Lafferty; Donald; A; McCord

    2014-01-01

    Coronary artery fistulas are abnormal connections between coronary artery territories and cardiac chambers or major vessels,most of them are congenital.Patients with coronary artery fistula can be asymptomatic or present with different symptoms like angina.Cardiac computed tomography(CT)is one of the best modalities for diagnosis.We present an elderly patient that presented with angina symptoms,non invasive stress test was positive for ischemic heart disease,coronary angiogram could not reveal any obstructive lesions,but an abnormal branch of the left descending coronary artery(LAD),cardiac CT showed fistula that connect left anterior descending coronary artery to left superior pulmonary vein.Our case is extremely rare as most of the reported cases were fistulas between LAD and pulmonary artery,but in our case the fistula between LAD and left superior pulmonary vein.In addition,our patients’symptoms resolved with anti-ischemic medical treatment without any surgical intervention.

  1. Down Syndrome with Complete Atrioventricular Septal Defect, Hypertrophic Cardiomyopathy, and Pulmonary Vein Stenosis.

    Science.gov (United States)

    Mahadevaiah, Guruprasad; Gupta, Manoj; Ashwath, Ravi

    2015-10-01

    The prevalence of congenital heart disease in infants with Down syndrome is 40%, compared with 0.3% in children who have normal chromosomes. Atrioventricular and ventricular septal defects are often associated with chromosomal aberrations, such as in trisomy 21, whereas hypertrophic cardiomyopathy is chiefly thought to be secondary to specific gene mutations. We found only one reported case of congenital hypertrophic cardiomyopathy and atrioventricular septal defect in an infant with Down syndrome. Here, we report atrioventricular septal defect, hypertrophic cardiomyopathy, and pulmonary vein stenosis in a neonate with Down syndrome-an apparently unique combination. In addition, we discuss the relevant medical literature.

  2. The incidence of deep vein thrombosis and pulmonary embolism with the elective use of external fixators

    OpenAIRE

    Roberts, David J. S.; Panagiotidou, Anna; Sewell, Matthew; Calder, Peter; Goodier, David

    2015-01-01

    Little evidence exists about the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) with the use of external fixators. We investigated this in a cohort of 207 consecutive patients undergoing 258 elective frame applications by case note review. Case notes were obtained for 84 % of the sample population. The type of surgery, demographic data, thromboembolic risk factors and the incidence of DVT/PE were recorded. One patient experienced DVT (0.39 %) and one a PE (0.39 %). Both w...

  3. Isolated Left Pulmonary Artery Agenesis: A Case Report

    OpenAIRE

    Tansel Ansal Balcı; Zehra Pınar Koç; Gamze Kırkıl; Ahmet Kürşad Poyraz

    2012-01-01

    Unilateral pulmonary artery agenesis without any cardiovascular malformation is a rare anomaly. We present the imaging findings of a patient who was diagnosed as isolated left pulmonary artery agenesis. A 27-year-old female patient was admitted to our hospital due to dyspnea during exercise for five years. Chest X-ray revealed minimally small left pulmonary hilum and left lung. She was admitted to our clinic with the suspicion of pulmonary artery pathology. Absent perfusion of the left lung w...

  4. Isolated pulmonary vasculitis: case report and literature review.

    Science.gov (United States)

    Riancho-Zarrabeitia, Leyre; Zurbano, Felipe; Gómez-Román, Javier; Martínez-Meñaca, Amaya; López, Marta; Hernández, Miguel A; Pina, Trinitario; González-Gay, Miguel A

    2015-04-01

    Single-organ vasculitis has been reported to affect the skin, kidneys, central nervous system, peripheral nerves, genitourinary tract, calf muscles, aorta, coronary arteries, retina, or gastrointestinal tract. However, isolated pulmonary vasculitis is a very rare entity. Our aims were to describe a case of localized pulmonary vasculitis affecting medium-sized vessels and review the literature. A patient with localized pulmonary vasculitis affecting medium-sized vessels that presented as pulmonary arterial hypertension is described. A MEDLINE database search of cases with localized pulmonary vasculitis was also conducted. A 30-year-old man presented with pulmonary hypertension due to isolated pulmonary medium-sized vessel vasculitis that was confirmed histologically. Initially he responded to corticosteroids and vasodilator treatment, but therapy eventually lost efficacy. Treatment with rituximab was not effective, and as the clinical situation worsened, lung transplant was performed. Isolated large pulmonary vessel disease, often related to Takayasu disease or giant cell arteritis, may present as pulmonary artery hypertension, thus mimicking chronic thromboembolic disease. Medium- and small-vessel pulmonary vasculitis usually develops in the context of a systemic disease. Some cases of isolated small-vessel vasculitis have been reported presenting as diffuse alveolar hemorrhage. In contrast, our case developed pulmonary artery hypertension secondary to medium-sized vessels vasculitis. To our knowledge, this is the first case of lung transplantation in isolated pulmonary vasculitis. Pulmonary isolated vasculitis is a rare cause of pulmonary hypertension but it must be taken into consideration after more common disorders are excluded. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Deep vein thrombosis and pulmonary embolus associated with a ruptured popliteal aneurysm – a cautionary note

    Directory of Open Access Journals (Sweden)

    Lewis Mike H

    2007-12-01

    Full Text Available Abstract Popliteal artery aneurysms representing 80% of peripheral artery aneurysms rarely rupture (a reported incidence of 0.1–2.8 % and second commonest in frequency after aorto-iliac aneurysms. They usually present with pain, swelling, occlusion or distal embolisation and can cause diagnostic difficulties. We report a 78 year old man who was previously admitted to hospital with a pulmonary embolus secondary to deep venous thrombosis. He was heparinized then warfarinised and was readmitted with a ruptured popliteal aneurysm leading to a large pseudo aneurysm formation. The pulmonary embolus had been due to popliteal vein thrombosis and propagation of the clot. A thorough review of literature identified only one previously reported case of ruptured popliteal artery aneurysm and subsequent large pseudo aneurysm formation. We feel it is important to exclude a popliteal aneurysm in a patient with DVT. This may be more common than the published literature suggests.

  6. Isolated unilateral pulmonary artery hypoplasia with accompanying pulmonary parenchymal findings on CT: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Surin; Cha, Yoon Ki; Kim, Jeung Sook; Kwon, Jae Hyun; Jeong, Yun Jeong [Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang (Korea, Republic of); Kim, Seon Jeong [Dept. of Radiology, Myongji Hospital, Goyang (Korea, Republic of)

    2017-05-15

    Unilateral pulmonary artery hypoplasia or agenesis without congenital cardiovascular anomalies is rare in adults. We report a case of a 36-year-old man with isolated left unilateral pulmonary artery hypoplasia with recurrent hemoptysis. On computed tomography (CT), the left pulmonary artery showed hypoplasia with multiple collateral vessels seen in the mediastinum and the left hemithorax. Also, parenchymal bands and peripheral linear opacities were seen in the affected lung, which were probably due to chronic infarction induced by unilateral pulmonary artery hypoplasia. There are only a few reports focusing on the radiologic findings in the pulmonary parenchyma induced by unilateral pulmonary artery hypoplasia, such as parenchymal bands and peripheral linear opacities. Therefore we report this case, which focused on the CT findings in the pulmonary parenchyma due to isolated unilateral pulmonary artery hypoplasia.

  7. Development of the pulmonary vein and the systemic venous sinus: an interactive 3D overview.

    Directory of Open Access Journals (Sweden)

    Gert van den Berg

    Full Text Available Knowledge of the normal formation of the heart is crucial for the understanding of cardiac pathologies and congenital malformations. The understanding of early cardiac development, however, is complicated because it is inseparably associated with other developmental processes such as embryonic folding, formation of the coelomic cavity, and vascular development. Because of this, it is necessary to integrate morphological and experimental analyses. Morphological insights, however, are limited by the difficulty in communication of complex 3D-processes. Most controversies, in consequence, result from differences in interpretation, rather than observation. An example of such a continuing debate is the development of the pulmonary vein and the systemic venous sinus, or "sinus venosus". To facilitate understanding, we present a 3D study of the developing venous pole in the chicken embryo, showing our results in a novel interactive fashion, which permits the reader to form an independent opinion. We clarify how the pulmonary vein separates from a greater vascular plexus within the splanchnic mesoderm. The systemic venous sinus, in contrast, develops at the junction between the splanchnic and somatic mesoderm. We discuss our model with respect to normal formation of the heart, congenital cardiac malformations, and the phylogeny of the venous tributaries.

  8. Left ventricular hypertrophy are associated with increased ostial pulmonary vein diameter

    Directory of Open Access Journals (Sweden)

    Yoga Yuniadi

    2006-09-01

    Full Text Available Atrial fibrillation (AF, which is called as a global epidemic disease, frequently found in hypertensive patients with left ventricular hypertrophy (LVH. Pulmonary vein (PV, which is known to have an important role in AF initiation and maintenance, increases in its diameter during AF. We sought to investigate PVs diameter changes in LVH with sinus rhythm. Of 70 hypertensive patients with sinus rhythm, 42 subjects demonstrated LVH. The mean ostial diameter of patient with and without LVH, assessed by doing spiral multisliced CT scan in the axial plane, were as follow: right superior (RSPV of 19.6±2.78 vs 17.8±1.93 (p = 0.003, right inferior (RIPV of 18.4±3.12 vs 16.0±2.19 (p < 0.001, left superior (LSPV of 18.1±2.62 vs 16.0±2.16 (p < 0.001, and left inferior (LIPV of 15.9±1.93 vs 15.4±1.85 mm (p = 0.284, respectively. Even during sinus rhythm, LVH causes PV dilation. This result might give an explanation of frequent AF prevalence in hypertensive patients. (Med J Indones 2006; 15:173-6 Keywords: Pulmonary veins, Left ventricular hypertrophy

  9. Ganglionated plexi stimulation induces pulmonary vein triggers and promotes atrial arrhythmogenecity: In silico modeling study

    Science.gov (United States)

    Hwang, Minki; Lim, Byounghyun; Song, Jun-Seop; Yu, Hee Tae; Ryu, Ah-Jin; Lee, Young-Seon; Joung, Boyoung; Shim, Eun Bo; Pak, Hui-Nam

    2017-01-01

    Background The role of the autonomic nervous system (ANS) on atrial fibrillation (AF) is difficult to demonstrate in the intact human left atrium (LA) due to technical limitations of the current electrophysiological mapping technique. We examined the effects of the ANS on the initiation and maintenance of AF by employing a realistic in silico human left atrium (LA) model integrated with a model of ganglionated plexi (GPs). Methods We incorporated the morphology of the GP and parasympathetic nerves in a three-dimensional (3D) realistic LA model. For the model of ionic currents, we used a human atrial model. GPs were stimulated by increasing the IK[ACh], and sympathetic nerve stimulation was conducted through a homogeneous increase in the ICa-L. ANS-induced wave-dynamics changes were evaluated in a model that integrated a patient’s LA geometry, and we repeated simulation studies using LA geometries from 10 different patients. Results The two-dimensional model of pulmonary vein (PV) cells exhibited late phase 3 early afterdepolarization-like activity under 0.05μM acetylcholine (ACh) stimulation. In the 3D simulation model, PV tachycardia was induced, which degenerated to AF via GP (0.05μM ACh) and sympathetic (7.0×ICa-L) stimulations. Under sustained AF, local reentries were observed at the LA-PV junction. We also observed that GP stimulation reduced the complex fractionated atrial electrogram (CFAE)-cycle length (CL, p<0.01) and the life span of phase singularities (p<0.01). GP stimulation also increased the overlap area of the GP and CFAE areas (CFAE-CL≤120ms, p<0.01). When 3 patterns of virtual ablations were applied to the 3D AF models, circumferential PV isolation including the GP was the most effective in terminating AF. Conclusion Cardiac ANS stimulations demonstrated triggered activity, automaticity, and local reentries at the LA-PV junction, as well as co-localized GP and CFAE areas in the 3D in silico GP model of the LA. PMID:28245283

  10. Recurrence of alveolar capillary dysplasia with misalignment of pulmonary veins in two consecutive siblings

    Directory of Open Access Journals (Sweden)

    Gabriel Nuncio Benevides

    2015-03-01

    Full Text Available Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV is a rare, developmental lung disorder, which has been increasingly reported. This entity usually presents as neonatal persistent pulmonary hypertension that is unresponsive to treatment, and is known to be uniformly fatal. Recent discoveries in the genetic field, and intensive treatments, may change the natural course of this disease, permitting easier diagnosis and giving new hope for the dismal prognosis. The authors present two cases of siblings, with two years of difference, from different fathers - one of them was a first-degree and the other a second-degree cousin of the mother. Both patients were full-term babies born apparently without malformations and were sent to the nursery. Both siblings near 35 hours of age presented severe respiratory failure due to pulmonary hypertension. The outcome was fatal in both cases and at autopsy ACD/MPV was diagnosed. The authors call attention to this entity in the differential diagnosis of acute respiratory distress in early life.

  11. Isolated Splenic Vein Thrombosis: An Unusual Cause and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Seyfettin Köklü

    2004-01-01

    Full Text Available Isolated obstruction (mainly due to thrombosis of the splenic vein usually results in left-sided portal hypertension and isolated fundal varice formation. This syndrome is a rare cause of gastrointestinal bleeding. Pancreatic diseases are among the most common etiologies of splenic vein obstruction. Renal disorders are rarely reported as a cause of splenic vein thrombosis. In the present article, a case of a 26-year-old woman with a perirenal abscess presenting with gastrointestinal bleeding as a complication of an isolated splenic vein thrombosis is described. The thrombosis could not be visualized with ultrasonography and angiography because of its extremely proximal localization. Fundal varices disappeared following splenectomy and nephrectomy. Follow-up at one year revealed the patient to be well both clinically and endoscopically.

  12. Atypical clinical and pathological findings in a patient with isolated cortical vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    Yan Ding; Vance Fredrickson; Yicong Lin; Yueshan Piao; Xiangbo Wang; Dehong Lu; Cunjiang Li

    2012-01-01

    Isolated cortical vein thrombosis often produces a focal lesion. Because of the rapid development of collateral circulation, increased intracranial pressure has never been reported in a patient with isolated cortical vein thrombosis. The diagnosis of isolated cortical vein thrombosis is based mainly on MRI, catheter digital subtraction angiography, and histological findings, but may be challenging. We report a patient who presented with intermittent seizures and left-sided limb weakness. Her symptoms gradually progressed, and she eventually developed signs of increased intracranial pressure. Imaging studies showed a space-occupying lesion in the right frontal lobe of the brain. As we could not diagnose isolated cortical vein thrombosis based on the preoperative findings, surgical excision of the lesion was performed under general anesthesia. Histological examination showed destruction of the brain parenchyma with infiltration of macrophages, proliferation of reactive astrocytes and small vessels, and foci of hemorrhage. Further examination found that a number of small vessels in both the subarachnoid space and brain parenchyma were filled with thrombus, some of which was organized. Elastic fiber staining showed that the obstructed vessels were veins. We diagnosed isolated cortical vein thrombosis with atypical clinical features.

  13. Isolation and culture of human umbilical vein endothelial cells (HUVEC).

    Science.gov (United States)

    Cheung, Ambrose L

    2007-02-01

    Human-derived endothelial cells can now be routinely harvested from human umbilical veins. Studies with human umbilical vein endothelial cells (HUVEC) have been conducted with cells from passage 2 to 5. It is now also possible to cryopreserve primary and early-passaged HUVEC for future propagation and for forwarding to an end user by express courier. Stored HUVEC have been stably retrieved even after several years. These retrieval techniques have facilitated the deployment of HUVEC for many studies, including those for homeostasis, inflammatory disorders, atherosclerosis, cancer, and microbial adhesion and invasion. In this unit, we will delineate the procedure for harvesting, propagation, and storage of HUVEC.

  14. 应用重叠参考图像透视技术易化环肺静脉电隔离术操作治疗阵发性心房颤动%Circumferential pulmonary vein isolation guided by overlay ref for the treatment of paroxysmal atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    唐恺; 肖彬; 赵冬冬; 张敬莹; 陈艳清; 徐亚伟

    2012-01-01

    目的 探讨重叠参考图像透视技术(Overlay Ref)对环肺静脉电隔离术治疗阵发性心房颤动(房颤)的影响.方法 入选194例阵发性房颤患者,随机分为Overlay Ref组(97例)及对照组(97例).Overlay Ref组使用Overlay Ref技术(将参考图像以反白的形式叠加于透视屏上)辅助环肺静脉电隔离术的操作.对照组常规方法完成环肺静脉电隔离术.比较两组的总消融手术时间、消融时间、X线曝光量、肺静脉隔离率及随访1年的成功率.结果 两组患者的基线临床特征差异无统计学意义.所有患者均接受了环肺静脉电隔离术.Overlay Ref组的消融时间〔(89±13) min对(102±22) min,P<0.01〕和总消融术时间[ (139±22) min对(162±31) min,P<0.01]均明显比对照组短.Oveday Ref组的X线曝光量[( 13531±283) mGy对(13123±369)mGy]稍大,但差异无统计学意义(P>0.05).两组的环肺静脉电隔离率(97.9%对96.9%,P=NS)及随访1年的成功率(84.5%对81.4%,P>0.05)差异也无统计学意义.结论 Overlay Ref技术可以易化环肺静脉电隔离术的操作,缩短房颤导管消融术的学习曲线.%Objective Circumferential pulmonary vein isolation (CPVI) is still not a easy task to an inexperienced operator for the treatment of paroxysmal atrial fibrillation(PAF).We hypothesized that Overlay Ref technique could facilitate the procedure of CPVI.This study was to report the results of CPVI guided by Overlay Ref for the treatment of PAF.Methods One hundred and ninety-four patents suffered PAF were enrolled into this study,and randomly assigned to Overlay Ref group ( n =97 ) and control group ( n =97 ).CPVI procedure was guided by inverted and faded overlay reference imaging in the Overlay Ref group and conventional approach in the control group.The total procedure time,duration of ablation,successful rate of isolation of pulmonary veins(PVs),radiation dose as well as results of follow up in 12 months were recorded.Results All

  15. A familial case of alveolar capillary dysplasia with misalignment of pulmonary veins supports paternal imprinting of FOXF1 in human

    Science.gov (United States)

    Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare developmental lung disorder that is uniformly lethal. Affected infants die within the first few weeks of their life despite aggressive treatment, although a few cases of late manifestation and longer survival have ...

  16. Initial experience with circumferential pulmonary vein ablation guided by fusion of magnetic resonance imaging with three-dimensional electroanatomic mapping

    Institute of Scientific and Technical Information of China (English)

    TANG Kai; MA Jian; MA Fu-sheng; JlA Yu-he; ZHANG Shu

    2006-01-01

    @@ Catheter ablation for the treatment of atrial fibrillation (AF) has been a focal target of electrophysiological study in recent years. Up to date,circumferential pulmonary vein ablation (CPVA)guided by three-dimensional (3-D) electroanatomic mapping (Carto, USA) has been one of the most favourable procedures for the treatment of AF.

  17. Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report

    Directory of Open Access Journals (Sweden)

    Guo Shan

    2007-09-01

    Full Text Available Abstract Introduction Coexistence of pulmonary embolism and systemic arterial embolism suggest the diagnosis of paradoxical embolism which suggests the presence of intracardiac defects such as patent foramen ovale (PFO. Case presentation A 42 year old man was found to have a paradoxical embolism in the systemic arterial circulation, in the setting of pulmonary embolism and deep vein thrombosis (DVT in the lower extremities. Conclusion Paradoxical embolism and intracardiac shunt should be immediately considered in a patient with pulmonary embolism and systemic arterial embolism. Diagnostic modalities included arteriogram and saline contrast echocardiography. Closure of intracardiac shunt is needed for patients who are at risk for recurrent embolic events.

  18. Isolated Facial Vein Thrombophlebitis: A Variant of Lemierre Syndrome

    DEFF Research Database (Denmark)

    Karnov, Kirstine KS; Lilja-Fischer, Jacob Kinggaard; Randrup, Thomas Skov

    2014-01-01

    Lemierre syndrome is a rare complication of acute tonsillitis. It is caused by the anaerobic bacterium Fu- sobacterium necrophorum and is characterized by bacteremia and septic thrombosis of the internal jug- ular vein. Dissemination of septic emboli may occur. The diagnosis can be difficult since...

  19. Proximal pulmonary vein stenosis detection in pediatric patients: value of multiplanar and 3-D VR imaging evaluation.

    Science.gov (United States)

    Lee, Edward Y; Jenkins, Kathy J; Muneeb, Muhammad; Marshall, Audrey C; Tracy, Donald A; Zurakowski, David; Boiselle, Phillip M

    2013-08-01

    One of the important benefits of using multidetector computed tomography (MDCT) is its capability to generate high-quality two-dimensional (2-D) multiplanar (MPR) and three-dimensional (3-D) images from volumetric and isotropic axial CT data. However, to the best of our knowledge, no results have been published on the potential diagnostic role of multiplanar and 3-D volume-rendered (VR) images in detecting pulmonary vein stenosis, a condition in which MDCT has recently assumed a role as the initial noninvasive imaging modality of choice. The purpose of this study was to compare diagnostic accuracy and interpretation time of axial, multiplanar and 3-D VR images for detection of proximal pulmonary vein stenosis in children, and to assess the potential added diagnostic value of multiplanar and 3-D VR images. We used our hospital information system to identify all consecutive children (VR images. Final diagnosis was confirmed by angiographic findings. Diagnostic accuracy was compared using the z-test. Confidence level of diagnosis (scale 1-5, 5 = highest), perceived added diagnostic value (scale 1-5, 5 = highest), and interpretation time of multiplanar or 3-D VR images were compared using paired t-tests. Interobserver agreement was measured using the chance-corrected kappa coefficient. The final study population consisted of 28 children (15 boys and 13 girls; mean age: 5.2 months). Diagnostic accuracy based on 116 individual pulmonary veins for detection of proximal pulmonary vein stenosis was 72.4% (84 of 116) for axial MDCT images, 77.5% (90 of 116 cases) for multiplanar MDCT images, and 93% (108 of 116 cases) for 3-D VR images with significantly higher accuracy with 3-D VR compared to axial (z = 4.17, P VR images (mean level: 4.6) compared to axial MDCT images (mean level: 1.7) and multiplanar MDCT images (mean level: 2.0) (paired t-tests, P VR images (mean added diagnostic value: 4.7) were found to provide added diagnostic value for detecting

  20. A Behcet’s Disease Patient with Right Ventricular Thrombus, Pulmonary Artery Aneurysms, and Deep Vein Thrombosis Complicating Recurrent Pulmonary Thromboembolism

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    Selvi Aşker

    2013-01-01

    Full Text Available Intracardiac thrombus, pulmonary artery aneurysms, deep vein thrombosis, and pulmonary thromboembolism are rarely seen symptoms of Behcet’s disease. A 20-year-old female patient was admitted for complaints of cough, fever, palpitations, and chest pain. On the dynamic thorax computed tomograms (CT obtained because of significantly enlarged hilar structures seen on chest radiograms, aneurysmal dilatation of the pulmonary artery segments bilaterally, chronic thrombus with collapse, and consolidation substances compatible with pulmonary embolism involving both lower lobes have been observed. It is learned that, four years ago, the patient had been diagnosed with Behcet’s disease and received colchicine treatment but not regularly. The patient was hospitalized. On the transthoracic echocardiogram, a thrombosis with a dimension of 4.2 × 1.6 cm was recognized in the right ventricle. On abdomen CT, aneurysmal iliac veins and deep vein thrombus on Doppler ultrasonograms were diagnosed. At the controls after three months of immunosuppressive and anticoagulant therapies, some clinical and radiological improvements were recognized. The patient suspended the treatment for a month and the thrombus recurred. We present our case in order to show the effectiveness of immunosuppressive and anticoagulant therapies and rarely seen pulmonary thromboembolism in recurrent Behcet’s disease.

  1. Bilateral Morgagni hernia: operative discovery of appendix lying on superior pulmonary vein.

    Science.gov (United States)

    Lammy, S; Stewart, M; Carnochan, F M; Walker, W S

    2013-08-01

    A patient presented having an acute abdomen on a background of a twelve-month history of worsening asthma. Computed tomography showed giant bilateral intrathoracic hernias extending to both thoracic apices. Our case was unusual as the defect was bilateral and left-sided. Surgical repair revealed each hernia sac measuring >20 cm and to contain the entirety of the small bowel and colon (including retroperitoneal bowel). The appendix was discovered adjacent to right superior pulmonary vein. Both sacs were excised and the defects dissected and transfixed in a single stage operation. In the post-operative stage, he developed a 6.3 cm fluid collection anterior to the right atrium and a left-sided pleural effusion. Morgagni hernias can escape detection and be attributed to other diagnoses courtesy of false localising signs on clinical examination and symptoms in the history.

  2. Geometric analysis on the unidirectionality of the pulmonary veins for atrial reentry

    CERN Document Server

    Chun, Sehun

    2013-01-01

    It is widely believed that the pulmonary veins (PVs) of the atrium play the central role in the generation of atrial reentry leading to atrial fibrillation, but its mechanism has not been analytically explained. In order to improve the current clinical procedures for atrial reentry by understanding its mechanism, geometrical analysis is proposed on the conditions of conduction failure at the PVs and is validated by various computational modeling. To achieve this, a new analytic approach is proposed by adapting the geometric relative acceleration analysis from spacetime physics on the hypothesis that a large relative acceleration can translate to a dramatic increase in the curvature of the wavefront and subsequently to conduction failure. This analytic method is applied to a simplified model of the PV to reveal the strong dependency of the propagational direction and the magnitude of anisotropy for conduction failure. The unidirectionality of the PVs follows directly and is validated by computational tests in ...

  3. Deep venous thrombosis and pulmonary embolism caused by an intravascular synovial sarcoma of the common femoral vein.

    Science.gov (United States)

    Schoneveld, J M; Debing, E; Verfaillie, G; Geers, C; Van den Brande, P

    2012-11-01

    Malignant tumors arising in deep veins of the lower extremities are very uncommon. To our best knowledge, this is the seventh case of a primary venous intravascular synovial sarcoma (SS) reported in literature. A 32-year-old woman was admitted with a second episode of deep venous thrombosis of the right lower limb and pulmonary embolism. Physical and radiological examinations showed besides the thrombosis a tumor arising from the right common femoral vein involving the bifurcation of the common femoral artery. At surgery, en block resection of the tumor including the deep femoral vein and arterial bifurcation was done with an arterial reconstruction using a synthetic graft. Histopathological examination revealed an intravascular SS of the common femoral vein. The mainstay of curative therapy is complete surgical resection of all tumor manifestations with negative histological margins.

  4. Pulmonary vein triggers play an important role in the initiation of atrial flutter: Initial results from the prospective randomized Atrial Fibrillation Ablation in Atrial Flutter (Triple A) trial.

    Science.gov (United States)

    Schneider, Ralph; Lauschke, Joerg; Tischer, Tina; Schneider, Cindy; Voss, Wolfgang; Moehlenkamp, Felix; Glass, Aenne; Diedrich, Doreen; Bänsch, Dietmar

    2015-05-01

    The incidence of atrial fibrillation (AF) after ablation of a cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is high. The purpose of this study was to test the hypothesis that AFL and AF may be initiated by pulmonary vein triggers. This prospective randomized trial tested the efficacy of a standalone pulmonary vein isolation (PVI) in patients with AFL but without AF. Patients with AFL but without documented AF were randomly assigned to 1 of 3 treatment groups: (1) antiarrhythmic drugs (AAD), (2) CTI ablation, or (3) circumferential PVI. The primary end-point was defined as any recurrent atrial tachyarrhythmia and the secondary end-point as recurrence of AFL. In case of tachyarrhythmia recurrence in the PVI group, a second PVI was performed to close gaps in the ablation lines. Of the 60 patients, 17 were randomized to AAD, 23 to CTI ablation, and 20 to PVI. During follow-up of 1.42 ± 0.83 years, 14 of 17 patients (82.4%) in the AAD group, 14 of 23 patients (60.9%) in the CTI group, and 2 of 20 patients (10%) in the PVI group reached the primary end-point (P PVI procedures per patient. AFL reoccurred in 9 patients (52.9.%) in the AAD group, in 2 patients (8.7%) in the CTI group, and after a single PVI in 3 patients (15%) in the PVI group (P = .003). After closure of gaps, 1 patient (5%) in the PVI group presented with recurrent AFL. Pulmonary vein triggers play an important role in AFL. PVI can prevent the recurrence of AFL, even without CTI ablation. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  5. Introduction of an expert system for the discrimination of local pulmonary vein and atrial far field signals.

    Science.gov (United States)

    Klemm, Hanno Ulrich; Heitzer, Thomas; Ruprecht, Ute; Johnsen, Christin; Meinertz, Thomas; Ventura, Rodolfo

    2010-11-01

    Discrimination of local and far field potentials during sinus rhythm and atrial fibrillation (AF) is essential for successful pulmonary vein (PV) isolation. We sought to introduce an expert system for the classification of electrophysiologic PV signals. For the expert system database, we analyzed ablation procedures of 50 patients with paroxysmal and persistent AF. Standard circumferential catheters and bipolar recordings were required. In a prospective trial, the expert system was compared with the performing electrophysiologists' classifications of potentials during 15 procedures. A total of 1,343 recordings of local PV and far field signals were validated by the sudden disappearance of local potentials during ablation, the presence of dissociated PV activity, and pacing maneuvers. A fast Fourier transform was applied to the individual potentials. Analysis continued in the amplitude and phase representation. Four parameters significant (p expert system correctly predicted their local origin in 86%. An expert system for the evaluation of electrophysiologic signals based on morphology analysis using the Fourier transform is feasible. The ease of use and online availability facilitate a widespread use for AF ablation procedures.

  6. Sites With Small Impedance Decrease During Catheter Ablation for Atrial Fibrillation Are Associated With Recovery of Pulmonary Vein Conduction.

    Science.gov (United States)

    Chinitz, Jason S; Kapur, Sunil; Barbhaiya, Chirag; Kumar, Saurabh; John, Roy; Epstein, Laurence M; Tedrow, Usha; Stevenson, William G; Michaud, Gregory F

    2016-12-01

    To correlate impedance decrease during atrial fibrillation (AF) ablation with lesion durability and PV conduction recovery demonstrated during redo procedures. Markers of successful ablation beyond acute conduction block are needed to improve durability of pulmonary vein (PV) isolation (PVI). Local impedance decrease resulting from ablation is a real-time marker of tissue heating and is correlated with lesion creation. Impedance changes associated with point-by-point radiofrequency ablation in the PV antra were recorded during 167 consecutive first-time AF ablations. During clinically indicated redo procedures, sites of recovered PV conduction were identified, and were correlated with the impedance change achieved during ablation at these locations during the initial procedure. Redo procedures were performed in 28 patients, in whom 19 sites of recovered PV conduction were documented. Most sites of PV reconnection (58%) occurred along the posterior PV antra. Ablation resulting in impedance decrease decrease decrease than patients without PV conduction recovery (Group 2) (21.9 ± 15.5 mm vs. 11.5 ± 2.1 mm, P decreases <10 ohms. Impedance-guided ablation strategies may improve durability of PVI. © 2016 Wiley Periodicals, Inc.

  7. Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair

    Directory of Open Access Journals (Sweden)

    David Walmsley

    2014-01-01

    Full Text Available Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunded or insensate patients. We present the case of a 34-year-old woman who sustained a Gustilo-Anderson grade III open midshaft femur fracture with an isolated femoral vein injury treated with direct repair. She developed lower leg compartment syndrome at 48 hours postoperatively, necessitating fasciotomies. She was subsequently found to have a DVT in her femoral vein at the level of the repair and was started on therapeutic anticoagulation. This case highlights the importance of recognition of isolated venous injuries in a trauma setting as a risk factor for developing compartment syndrome.

  8. Isolated renal vein thrombosis associated with MTHFR-1298 and PAI-1 4G gene mutations.

    Science.gov (United States)

    Cinemre, Hakan; Bilir, Cemil; Akdemir, Nermin

    2010-12-01

    Isolated renal vein thrombosis is very rare without the presence of nephrotic syndrome. It is more common in the newborns and infants. Whereas major risk factors in adults are the procoagulant states such as protein C or S deficiency, factor V Leiden mutation, primary or secondary antiphospholipid syndrome, severe hypothyroidism, and trauma. Here, we report a case of isolated renal vein thrombosis associated with MTHFR-1298 and PAI-1 4G gene mutations. It should be noted that the presence of MTHFR-1298 and PAI-1 4G gene mutations together might be one of the examples of genetic mutation combinations that increase the likelihood of a thrombotic event.

  9. Systematic review and Meta-analysis of the efficacy of pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation%肺静脉隔离在房颤患者中维持窦性节律的系统评价

    Institute of Scientific and Technical Information of China (English)

    张琰; 黄从新; 王克军; 刘小熊; 闫力永

    2013-01-01

    目的 系统评价使用肺静脉隔离(PVI)的导管消融治疗方法对房颤患者维持窦性节律的效果.方法 检索PubMed、CENTRAL、EMbase、NTIS、CNKI、VIP、万方数据库和CBM中所有对比PVI和抗心律失常药物(ADD)治疗维持房颤患者窦性心律的临床随机对照试验(RCT),同时追索纳入文献的参考文献.检索时限均为从建库至2013年2月.对符合质量标准的RCT进行系统评价和Meta分析.结果 共纳入9个随机对照试验.Meta分析主要和次要终点的结果显示:在1年的随访期时,PVI的有效性显著[77% (466/631)比38%(227/590),OR=5.93,95% CI 4.52~7.80,P<0.01],GRADE系统推荐分级为中级.PVI可显著降低因心血管事件导致的住院率(5%比24%,RR=0.15,95%CI 0.06~0.36,P< 0.01),GRADE系统推荐分级为高级.在PVI组,严重并发症的发生率是2.7%(17/631).结论 与ADD治疗策略相比,PVI显著增加1年期的窦律维持率,显著减少因心血管疾病原因导致的再住院率,而并发症的发生率甚至低于其他介入治疗.%Objective To evaluate pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation.Methods PubMed,CENTRAL,Embase,NTIS,CNKI,VIP,Wanfang Data and CBM were search for all randomized,controlled trials comparing PVI and medical therapy for the maintenance of sinus rhythm in patients with atrial fibrillation from the date of establishment of the databases to December 2012.The bibliographies of the include studies were searched too.Systematic review and Meta-analysis were conducted for the eligible RCTs.Results 9 trials were discovered.Meta-analyses show that PVI was associated with markedly increased odds of freedom from AF at 1 year of follow-up [77% (466/631) vs 38% (227/590),OR=5.93,95% CI 4.52-7.80,P < 0.01],it was moderate grade in the GRADE system.PVI was associated with a decreased hospitalization for cardiovascular causes (5% vs 24%,RR =0.15,95%CI 0.06-0.36,P

  10. A Case of Antiphospholipid Syndrome Refractory to Secondary Anticoagulating Prophylaxis after Deep Vein Thrombosis-Pulmonary Embolism

    OpenAIRE

    Gu, Kang Mo; Shin,Jong Wook; Park, In Won

    2014-01-01

    Antiphospholipid syndrome (APS) is an acquired systemic autoimmune disorder characterized by a combination of clinical criteria, including vascular thrombosis or pregnancy morbidity and elevated antiphospholipid antibody titers. It is one of the causes of deep vein thrombosis and pulmonary embolism that can be critical due to the mortality risk. Overall recurrence of thromboembolism is very low with adequate anticoagulation prophylaxis. The most effective treatment to prevent recurrent thromb...

  11. Disseminated tuberculosis causing isolated splenic vein thrombosis and multiple splenic abscesses.

    Science.gov (United States)

    Jain, Deepak; Verma, Kamal; Jain, Promil

    2014-09-01

    Tuberculosis is a common infectious cause of splenic enlargement in developing countries, but tubercular splenic abscesses are a rare presentation, found predominantly in immunocompromised populations. We report a case of tubercular splenic abscesses with isolated splenic vein thrombosis in an immunocompetent person.

  12. Isolated large vulvar varicose veins in a non-pregnant woman

    Directory of Open Access Journals (Sweden)

    Abdullah M Al Wahbi

    2016-09-01

    Full Text Available Vulvar varicosities are often asymptomatic, and they may be associated with varicose veins of the lower extremity. Also, they may be a part of pelvic congestion syndrome and usually occur during pregnancy. We present a case of a huge isolated and disfiguring vulvar varicosities in a non-pregnant women managed successfully by combination of surgery and sclerotherapy.

  13. Isolated large vulvar varicose veins in a non-pregnant woman

    Science.gov (United States)

    Al Wahbi, Abdullah M

    2016-01-01

    Vulvar varicosities are often asymptomatic, and they may be associated with varicose veins of the lower extremity. Also, they may be a part of pelvic congestion syndrome and usually occur during pregnancy. We present a case of a huge isolated and disfiguring vulvar varicosities in a non-pregnant women managed successfully by combination of surgery and sclerotherapy.

  14. Anticoagulant Treatment of Deep Vein Thrombosis and Pulmonary Embolism: The Present State of the Art

    Science.gov (United States)

    Thaler, Johannes; Pabinger, Ingrid; Ay, Cihan

    2015-01-01

    Venous thromboembolism (VTE), a disease entity comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years, the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH) or fondaparinux, followed by a vitamin K antagonist (VKA). The so-called direct oral anticoagulants (DOAC) were introduced rather recently in clinical practice for the treatment of VTE. DOAC seem to have a favorable risk-benefit profile compared to VKA. Moreover, DOAC significantly simplify VTE treatment because they are administered in fixed doses and no routine monitoring is needed. Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months. Whether a patient ought to receive extended treatment needs to be evaluated on an individual basis, depending mainly on risk factors determined by characteristics of the thrombotic event and patient-related factors. In specific patient groups (e.g., pregnant women, cancer patients, and elderly patients), treatment of VTE is more challenging than that in the general population and additional issues need to be considered in those patients. The aim of this review is to give an overview of the currently available treatment modalities of acute VTE and secondary prophylaxis. In particular, specific aspects regarding the initiation of VTE treatment, duration of anticoagulation, and specific patient groups will be discussed. PMID:26664901

  15. Ectopic activity induced by elevated atrial pressure in rabbit pulmonary vein in vitro

    Institute of Scientific and Technical Information of China (English)

    LIU Jie; HUANG Cong-xin; BAO Ming-wei; WANG Teng

    2005-01-01

    @@ Atrial fibrillation (AF) is a common tachyarrhythmia and may cause serious complications, such as stroke. When atrial pressure was elevated, the effect refraction period (ERP) was shortened and the conductivity in atria was slowed and the heterogeneity of different parts of atria was increased. These changes facilitate the occurrence and maintenance of AF. Recent researches demonstrated that pulmonary veins (PVs) are important sources of ectopic beats in the initiation of paroxysmal AF. In patients with drug-resistant chronic AF and structural heart disease, after electrical cardioversion, the PVs are also the dominant trigger in reinitiating AF.1 Yamane et al2 reported that, AF patients were often with dilated PVs if the AF was initiated by focal activity in PVs. Atrial myocardial fibers wrap around the PVs entering the left atrium to form PV myocardial sleeves (PVMSs), and this structure is the origin of focal activity. Little is known about the effects of elevated atrial pressure on PV electrophysiology. In the present study, we found that, spontaneous activity in PVMSs could be induced by elevated atrial pressure and it could affect the atrial rhythm.

  16. MR evaluation of pulmonary vein diameter reduction after radiofrequency catheter ablation of atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Anselme, Frederic; Savoure, Arnaud; Mabru, Mikael; Cribier, Alain [Rouen University Hospital, Department of Cardiology, Rouen (France); Gahide, Gerald [Rouen University Hospital, Department of Radiology and Laboratoire QuantIF, Rouen (France); Gerbaud, Edouard [Rouen University Hospital, Department of Cardiology, Rouen (France); Rouen University Hospital, Department of Radiology and Laboratoire QuantIF, Rouen (France); Dacher, Jean-Nicolas [Rouen University Hospital, Department of Radiology and Laboratoire QuantIF, Rouen (France); University Hospital, Department of Radiology, Rouen, Cedex (France)

    2006-11-15

    Fifty consecutive patients aged 52{+-}12 years suffering from drug refractory atrial fibrillation (AF) underwent baseline and post-ablation MR angiography (MRA) at a mean follow-up of 4{+-}3.5 months. Pulmonary vein (PV) disconnection was performed with a maximum energy delivery of 30 W. MRA allowed a two-plane measurement of each PV ostium. After ablation, no significant stenosis was observed, and only 1/194 (0.5%) and 3/194 (2%) PVs had a diameter reduction of 31-40% in the coronal and axial planes, respectively. There was a significant overall post-procedural PV narrowing of 4.9% in the coronal plane and 6.5% in the axial plane (P=ns between both planes). MRA is an efficient technique that can be used in pre- and postoperative evaluation of AF patients. Using a maximal power delivery limited to 30 W, no significant PV stenosis was observed at mid-term follow-up. Late PV anatomical assessment is needed to confirm these results on long-term follow-up. (orig.)

  17. Treatment of deep vein thrombosis and pulmonary embolism: The present state of the art

    Directory of Open Access Journals (Sweden)

    Johannes eThaler

    2015-07-01

    Full Text Available AbstractVenous thromboembolism (VTE, a disease entity comprising deep vein thrombosis (DVT and pulmonary embolism (PE, is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH or fondaparinux, followed by a vitamin K antagonist (VKA. The so-called direct oral anticoagulants (DOACs were introduced rather recently in clinical practice for the treatment of VTE. DOACs seem to have a favourable risk-benefit profile compared to VKAs. Moreover, DOACs significantly simplify VTE treatment, because they are administered in fixed doses and no routine monitoring is needed.Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months. Whether a patient ought to receive extended treatment needs to be evaluated on an individual basis, depending mainly on risk factors determined by characteristics of the thrombotic event and patient-related factors. In specific patients groups (e.g. pregnant women, cancer patients and elderly patients treatment of VTE is more challenging than in the general population and additional issues need to be considered in those patients.The aim of this review is to give an overview of the currently available treatment modalities of acute VTE and secondary prophylaxis. In particular, specific aspects regarding the initiation of VTE treatment, duration of anticoagulation and specific patient groups will be discussed.

  18. Anticoagulant Treatment of Deep Vein Thrombosis and Pulmonary Embolism: The Present State of the Art.

    Science.gov (United States)

    Thaler, Johannes; Pabinger, Ingrid; Ay, Cihan

    2015-01-01

    Venous thromboembolism (VTE), a disease entity comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years, the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH) or fondaparinux, followed by a vitamin K antagonist (VKA). The so-called direct oral anticoagulants (DOAC) were introduced rather recently in clinical practice for the treatment of VTE. DOAC seem to have a favorable risk-benefit profile compared to VKA. Moreover, DOAC significantly simplify VTE treatment because they are administered in fixed doses and no routine monitoring is needed. Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months. Whether a patient ought to receive extended treatment needs to be evaluated on an individual basis, depending mainly on risk factors determined by characteristics of the thrombotic event and patient-related factors. In specific patient groups (e.g., pregnant women, cancer patients, and elderly patients), treatment of VTE is more challenging than that in the general population and additional issues need to be considered in those patients. The aim of this review is to give an overview of the currently available treatment modalities of acute VTE and secondary prophylaxis. In particular, specific aspects regarding the initiation of VTE treatment, duration of anticoagulation, and specific patient groups will be discussed.

  19. 远程磁导航指导下加强肺静脉前庭消融策略治疗心房纤颤有效性研究%Efficacy of enhanced ablation on pulmonary vein antrum isolation under remote magnetic navigation in patients with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    郭文杰; 徐伟豪; 兰凯; 彭利; 张玉霄; 卢才义

    2016-01-01

    目的:探讨在远程磁导航系统( RMN)辅助下应用加强消融策略行心房纤颤( AF)射频消融治疗对AF远期成功率的影响。方法连续选取2013年1月至2015年6月在解放军总医院住院行导管射频消融治疗且自愿参加该临床研究的患者49例非瓣膜性AF患者随机分成两组,传统消融组(CAG, n=24)和加强消融组(EAG, n=25)。 CAG组对左右肺静脉行单环线性消融,EAG组在CAG消融基础上,靠近原有消融径线,在心房侧再次行线性消融,形成双环线性消融。术中应用磁导航消融导管,RMN系统、CARTO 3系统和Lasso环状标测电极,术后常规使用24 h动态心电图随访。结果所有患者均消融成功,EAG组较CAG组消融时间明显延长[(45.66±6.59)vs (40.10±3.48)min,P<0.01],而在曝光时间、手术时间和静脉血测定脑利钠肽前体上差异无统计学意义( P>0.05)。术后随访(19.3±5.6)个月,应用动态心电图随访发现EAG组复发率较CAG组明显降低(33.33%vs 8.00%,P<0.05)。二次手术时发现复发患者均存在电传导恢复情况,8例再次手术均成功。结论加强消融策略能有效改善AF患者的远期成功率,降低复发率。%Objective To assess the long-term efficacy of enhanced ablation in pulmonary vein antrum ( PVA) guided by remote magnetic navigation ( RMN) in the patients with atrial fibrillation ( AF) .Methods From January 2013 to June 2015, 49 consecutive patients with refractory non-valvular AF who undergoing radiofrequency catheter ablation and voluntarily taking part in this study in our hospital were recruited in this study .They were randomized into a conventional ablation group ( CAG, n =24 ) and an enhanced ablation group ( EAG, n=25) .PVA isolation was achieved by creating a single ablation circle in the patients of CAG group , and was double ablation circles at PVA in those of EAG group .An irrigated

  20. Successful thoracoscopic lobectomy for lung cancer in a patient with anatomic variation of the left inferior pulmonary vein

    Directory of Open Access Journals (Sweden)

    Nakano,Hideharu

    2007-04-01

    Full Text Available We present a case of primary lung cancer with a rare distribution pattern of left inferior pulmonary vein (PV, encountered in the thoracoscopic left lower lobectomy. Thoracoscopic observation revealed 2 trunks of inferior PV (ventral and dorsal branch at the stem level. The ventral trunk consisted of a branch of vein (V(5 from the lingular segment and venous ramifications (V(8a, V(9 and V(10a from the basal segment. On the other hand, a branch of vein (V(6 from the superior segment in the lower lobe and other veins (V(8b and V(10b + c from the basal segment emptied together into the dorsal trunk. We successfully carried out a thoracoscopic left lower lobectomy without excision of the aberrant vein (V(5. Retrospective review of the preoperative chest CT demonstrates the double trunk inferior PV and the aberrant lingular branch emptying with V(8a into the ventral trunk. Knowledge of the branching variations of PV from preoperative evaluations leads to appropriate thoracoscopic procedures for lung cancer.

  1. CLINICAL APPLICATION OF 99mTc MAA PULMONARY SCINTISCAN IN DEEP VEIN THROMBOSIS AND RHEUMATIC HEART DISEASE

    Institute of Scientific and Technical Information of China (English)

    陈万春; 曾昭瑞; 金立仁; 包玉倩

    1992-01-01

    We studied 21 cases of pulmonary thromboembolism (PTE) in 67 consecutive cases of deep vein thrombosis (DVT) of the lower limbs and 4 cases in 9 selective cases of rheumatic heart disease (RHD). The incidence of PTE in DVT could be inferred as being 31.3%. PTE were diagnosed by 99mTc MAA lung scintiscans. In the DVT cases, lung scintiscan were done right after venography of the legs. Six cases underwent pulmonary angiography, ⅠDSA. As PTE in the DVT cases were all subclinical, only oligemia andvascular "pruning" were noted. Injection of urokinase into the pulmonary artery concerned through a catheter after which intravenous infusion was continued for 10-14 days, only 3 PTE resolved, probably representing early cases.

  2. Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy.

    Science.gov (United States)

    Kim, Ki-Hun; Mohanty, Sanghamitra; Mohanty, Prasant; Trivedi, Chintan; Morris, Eli Hamilton; Santangeli, Pasquale; Bai, Rong; Al-Ahmad, Amin; Burkhardt, John David; Gallinghouse, Joseph G; Horton, Rodney; Sanchez, Javier E; Bailey, Shane; Hranitzky, Patrick M; Zagrodzky, Jason; Kim, Soo G; Di Biase, Luigi; Natale, Andrea

    2017-08-01

    Thyroid hormone (TH) is known to enhance arrhythmogenicity, and high-normal thyroid function is related with an increased recurrence of atrial fibrillation (AF) after catheter ablation. However, the impact of thyroid hormone replacement (THR) on AF ablation is not well known. This study evaluated 1163 consecutive paroxysmal AF patients [160 (14%) on THR and 1003 (86%) without THR] undergoing their first catheter ablation. A total of 146 patients on THR and 146 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model (age, sex, body mass index, and left atrium size). The presence of non-pulmonary vein (PV) triggers was disclosed by a high-dose isoproterenol challenge (up to 30 μg/min) after PV isolation. Clinical characteristics were not different between the groups. When compared to the control, non-PV triggers were significantly greater in the THR patients [112 (77%) vs. 47 (32%), P right atrium (95 vs. 56%, P sources of non-PV triggers were the interatrial septum (25 vs. 11%, P = 0.002), coronary sinus (70 vs. 52%, P = 0.01), left atrial appendage (47 vs. 34%, P = 0.03), crista terminalis/superior vena cava (11 vs. 8%, P = 0.43), and mitral valve annulus (7 vs. 5%, P = 0.45) (THR vs. control), respectively. After mean follow-up of 14.7 ± 5.2 months, success rate was lower in patients on THR therapy [94 (64.4%)] compared to patients not receiving THR therapy [110 (75.3%), log-rank test value = 0.04]. Right atrial non-PV triggers were more prevalent in AF patients treated with THR. Elimination of non-PV triggers provided better arrhythmia-free survival in the non-THR group.

  3. Migration to the pulmonary artery of nine metallic coils placed in the internal iliac vein for treatment of giant rectal varices.

    Science.gov (United States)

    Yamasaki, Wataru; Kakizawa, Hideaki; Ishikawa, Masaki; Date, Shuji; Tatsugami, Fuminari; Terada, Hiroaki; Masaki, Keiichi; Kawaoka, Tomokazu; Tsuge, Masataka; Aikata, Hiroshi; Chayama, Kazuaki; Awai, Kazuo

    2012-01-01

    Transcatheter venous embolization with metallic coils is a safe and reliable method for the treatment of pelvic congestion syndrome and pelvic varicocele. While rare, coil migration to the pulmonary arteries is potentially fatal. We report the migration to the pulmonary artery of a cluster of nine metallic microcoils placed in the internal iliac vein to obliterate giant rectal varices. Our patient suffered no severe sequelae. To avoid coil migration to the pulmonary arteries, the coils chosen for placement must take into consideration the characteristics of the target vessels, particularly of larger veins.

  4. Isolated metastasis of testicular seminoma to extralobar pulmonary sequestration.

    Science.gov (United States)

    Fudulu, Daniel; Casali, Gianluca; Sohail, Muhammed; Krishnadas, Rakesh

    2016-05-01

    This case report describes a 46-year-old patient with a very unusual pattern of isolated metastasis to an extralobar pulmonary sequestration following orchidectomy for seminoma. The patient underwent uncomplicated video-assisted thoracoscopic resection of the metastasis, involving the whole of the sequestration mass. © The Author(s) 2016.

  5. Accelerated free breathing ECG triggered contrast enhanced pulmonary vein magnetic resonance angiography using compressed sensing.

    Science.gov (United States)

    Roujol, Sébastien; Foppa, Murilo; Basha, Tamer A; Akçakaya, Mehmet; Kissinger, Kraig V; Goddu, Beth; Berg, Sophie; Nezafat, Reza

    2014-11-22

    To investigate the feasibility of accelerated electrocardiogram (ECG)-triggered contrast enhanced pulmonary vein magnetic resonance angiography (CE-PV MRA) with isotropic spatial resolution using compressed sensing (CS). Nineteen patients (59±13 y, 11 M) referred for MR were scanned using the proposed accelerated free breathing ECG-triggered 3D CE-PV MRA sequence (FOV=340×340×110 mm3, spatial resolution=1.5×1.5×1.5 mm3, acquisition window=140 ms at mid diastole and CS acceleration factor=5) and a conventional first-pass breath-hold non ECG-triggered 3D CE-PV MRA sequence. CS data were reconstructed offline using low-dimensional-structure self-learning and thresholding reconstruction (LOST) CS reconstruction. Quantitative analysis of PV sharpness and subjective qualitative analysis of overall image quality were performed using a 4-point scale (1: poor; 4: excellent). Quantitative PV sharpness was increased using the proposed approach (0.73±0.09 vs. 0.51±0.07 for the conventional CE-PV MRA protocol, p<0.001). There were no significant differences in the subjective image quality scores between the techniques (3.32±0.94 vs. 3.53±0.77 using the proposed technique). CS-accelerated free-breathing ECG-triggered CE-PV MRA allows evaluation of PV anatomy with improved sharpness compared to conventional non-ECG gated first-pass CE-PV MRA. This technique may be a valuable alternative for patients in which the first pass CE-PV MRA fails due to inaccurate first pass timing or inability of the patient to perform a 20-25 seconds breath-hold.

  6. An Independent Risk of Gout on the Development of Deep Vein Thrombosis and Pulmonary Embolism

    Science.gov (United States)

    Huang, Chien-Chung; Huang, Po-Hao; Chen, Jiunn-Horng; Lan, Joung-Liang; Tsay, Gregory J.; Lin, Hsiao-Yi; Tseng, Chun-Hung; Lin, Cheng-Li; Hsu, Chung-Yi

    2015-01-01

    Abstract Previous studies indicated that gout is a risk factor of cardiovascular diseases. This study aimed to determine if patients with gout have an increased risk of deep vein thrombosis (DVT) or pulmonary embolism (PE). We used the Longitudinal Health Insurance Database, a subset of the national insurance claim dataset, which enrolled 1 million Taiwanese to identify 57,981 patients with gout and 115,961 reference subjects matched by sex, age, and entry date of diagnosis. The risk of DVT and PE was analyzed using the Cox proportional hazards model. In this Taiwanese dataset observed from 2000 to 2010, we found the incidence of DVT was 5.26 per 104 person-years in the gout cohort, which was twofold higher than the incidence of 2.63 per 104 person-years in the reference cohort. After adjusting for age, sex, and 9 comorbidities, the hazard ratio (HR) of developing DVT was 1.66 (95% confidence interval [CI] = 1.37–2.01). Among patients with gout, the youngest age group had the highest increase in the risk of developing DVT (HR [95% CI] = 2.04 [1.24–3.37] for ages 20 to 49 years, 1.80 [1.28–2.51] for ages 50 to 64 years, and 1.45 [1.11–1.91] for ages ≥65 years). The incidence of PE was about one-fifth that of DVT in gout patients, but the effect of gout on the risk was similar (HR [95% CI] = 1.53 [1.01–2.29]). Our analysis confirmed that gout increased the risk of DVT and PE. Further exploration is needed in the future. PMID:26705202

  7. Estenosis de venas pulmonares post ablación por radiofrecuencia Pulmonary vein stenosis after radio frequency ablation

    Directory of Open Access Journals (Sweden)

    Marcelo Guzzi

    2011-06-01

    Full Text Available Es importante estar atento ante la aparición de síntomas respiratorios luego de la realización de un procedimiento de ablación por radiofrecuencia en el tratamiento de la fibrilación auricular, pues la estenosis de venas pulmonares (EVP tiene una incidencia de entre 1 y 3% y puede aparecer hasta en los dos años posteriores al procedimiento1. Presentamos el caso de un paciente de 41 años de sexo masculino, que ingresó por un cuadro de hemoptisis y toracodinia de tres semanas de evolución, con antecedente de ablación por radiofrecuencia 6 meses antes de la admisión. La angiotomografía no evidenció tromboembolismo pulmonar (TEP y la angiorresonancia detectó hipoperfusión deI lóbulo superior del pulmón izquierdo (LSI. Debido a los antecedentes de ablación se solicitó angiotomografía de venas pulmonares, que evidenció estenosis de la vena del LSI. Se realizó estudio hemodinámico con dilatación y colocación de stent.Physicians should be alert to the occurrence of respiratory symptoms after radio frequency ablation for the treatment of atrial fibrillation. Pulmonary veins stenosis could appear with an incidence of between 1and 3% during the two years following the procedure. We present the case of a 41year-old-male patient admitted with a three weeks old hemoptysis and thoracodinia and a prior history of a radiofrecuency ablation procedure performed six months earlier. The angiotomography was not compatible with the diagnosis of pulmonary embolism and the angio-MRI detected hypoperfusion of the left upper pulmonary lobe. Consequently pulmonary veins angiotomography was requested, showing upper pulmonary lobe vein stenosis. An hemodynamic study with vein expansion and stent placement was successfully performed.

  8. Correlation of left atrial low voltage zone with recurrence after pulmonary antrum vein isolation in patients with paroxysmal atrial fibrillation%阵发性心房颤动患者左心房低电压区与肺静脉电隔离术后复发的关系

    Institute of Scientific and Technical Information of China (English)

    田颖; 刘兴鹏; 尹先东; 周旭; 石亮; 王彦江; 刘小青; 杨新春

    2014-01-01

    目的:分析阵发性心房颤动(房颤)患者左心房低电压与肺静脉电隔离术后复发的关系。方法连续168例阵发性房颤患者[女性76例,年龄(62±11岁)],窦性心律下行左心房高密度(≥100点)标测,之后行肺静脉电隔离术治疗,在肺静脉隔离20min后给予异丙肾上腺素+腺苷三磷酸(0.2mg/kg),观察肺静脉传导恢复与否以及是否存在肺静脉外局灶触发的房颤,并对传导恢复的肺静脉以及肺静脉外局灶再次消融,直至激发试验阴性。本组患者均不进行基质改良。低电压的定义为CARTO消融导管记录的心肌局部双极电图振幅<0.5mV。结果42例(25.0%)患者的左心房存在低电压区,主要位于左心房前壁(22例,52.4%),与女性和左房直径增大相关。所有患者均完成肺静脉电隔离。随访(23±12)个月,35例患者复发房性快速心律失常,其中左房低电压者14例(14/42,33.3%),非低电压者21例(21/126,16.7%,P=0.028)。结论阵发性房颤患者左心房存在低电压区增加肺静脉电隔离术后的复发率,其形成可能与性别和左房直径有关。%Objective To investigate the correlation of left atrial low-voltage zones (LVZs) with atrial fibrillation (AF) recurrence after pulmonary vein (PV) antrum isolation (PVAI) in paroxysmal AF patients. Methods A total of 168 consecutive patients [92 males and 76 females, with age of (62±11) years] who underwent PVAI for treating AF in our department were enrolled in this study. High density (≥100 points) left atrial voltage maps were reconstructed during sinus rhythm using CARTO 3 system. LVZs were defined as areas with bipolar peak-to-peak voltage amplitudes <0.5mV. In 20min after PVAI, all patients were given intravenous injection of isoproterenol and adenosine triphosphate (ATP, 0.2 mg/kg) in an attempt to unmask PV reconnection and AF triggered by non-PV foci. If PV reconnection

  9. Sudden Death by Pulmonary Thromboembolism due to a Large Uterine Leiomyoma with a Parasitic Vein to the Mesentery

    Directory of Open Access Journals (Sweden)

    Varsha Podduturi

    2014-01-01

    Full Text Available The pathophysiology of venous thrombosis is classically attributed to alterations in one or more components of Virchow’s triad: hypercoagulability, stasis, and damage to the vascular endothelium. Deep vein thrombosis (DVT may lead to pulmonary thromboembolism (PE, and the latter is culpable for many deaths annually in the United States; however, DVT as a complication of uterine leiomyoma has rarely been reported. We report a case of a 57-year-old woman whose death was due to a large pedunculated subserosal leiomyoma externally compressing the pelvic veins resulting in stasis and venous thrombosis leading to fatal PE. The association of large pelvic masses with venous thrombosis has clinical implications, since prophylactic surgery could be life-saving.

  10. Whole heart cine MR imaging of pulmonary veins in patients with congenital heart disease. Comparison with Spin Echo MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mitsui, Hideaki [Yamagata City Hospital Saiseikan (Japan); Saito, Haruo; Ishibashi, Tadashi; Takahashi, Shoki; Zuguchi, Masayuki; Yamada, Shogo

    2002-01-01

    We evaluated the accuracy of Whole Heart Cine (WHC) magnetic resonance (MR) imaging in the depiction of pulmonary veins (PVs) in patients with congenital heart disease (CHD) compared to that of spin echo (SE) MR imaging. Among our 35 patients, 4 patients had anomalous PV return. Detectability of four PVs on each MR examination images were evaluated. MR imaging is an effective modality for the clarification of PVs, and WHC MR imaging is more useful in delineating PV anomalies than SE MR imaging. (author)

  11. Isolated pauci-immune pulmonary capillaritis

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    Ashok Kumar Mehrotra

    2015-01-01

    Full Text Available A young house wife presented with low grade fever, cough, haemoptysis and SOB of unknown aetiology for 40 days duration. Respiratory system examination revealed diffuse crepts and rhonchi. Other organ system examination did not reveal any abnormality. X-ray chest PA view and CT thorax showed diffuse bilateral necrotising nodular lesions of various sizes with small pleural effusion. She also had low resting oxygen saturation with falling haematocrit. Her Serum was week positive for p-ANCA and negative for MPO-ANCA. Bronchoscopy revealed continuous bloody aspirates. We could not isolate any organisms in any of the specimens from her and she was unresponsive to any of the antibiotics either. Based on the clinical, laboratory data, radiological features and positive outcome to pulse therapy of methylprednisolone and cyclophosphamide, she was diagnosed as a case of IPIPC.

  12. Isolated left innominate vein aneurysm: A rare cause of mediastinal widening

    Directory of Open Access Journals (Sweden)

    S G Dua

    2011-01-01

    Full Text Available Mediastinal widening in an adult is mostly nodal in origin. Occasionally vascular aneurysms may be the underlying cause, in which case the aorta or its branches are most frequently involved. Thoracic venous aneurysms, on the other hand, have been reported only in anecdotes, with fusiform aneurysm of the superior vena cava being the commonest. Isolated aneurysms involving the brachiocephalic/innominate vein are extremely rare. We describe detection of a saccular aneurysm of the innominate vein, as the underlying cause of mediastinal widening seen on a chest radiograph in a 42-year-old asymptomatic woman. The characteristic radiological findings of thoracic venous aneurysms are described with particular reference to the importance of multiplanar computed tomography in such settings. Also discussed is the role of imaging in the diagnosis and guiding the management of this rare entity.

  13. Sudden hearing loss followed by deep vein thrombosis and pulmonary embolism in a patient with factor V Leiden mutation.

    Science.gov (United States)

    Lovato, A; Tormene, D; Staffieri, C; Breda, S; Staffieri, A; Marioni, G

    2014-09-01

    Factor V Leiden (FVL) is by far the most prevalent inherited thrombophilic abnormality in Western countries, and this genetic condition has been associated with sudden sensorineural hearing loss (SSHL). Audiologists should be aware that SSHL may be the precursor of life-threatening thromboembolic events, especially in Caucasians who are more likely to be FVL carriers. Case report. A 41-year-old male patient. Although this is not the first report of SSHL in a FVL carrier, it is the first to describe SSHL occurring in a heterozygous FVL carrier who--within a month--was also diagnosed with deep vein thrombosis of the left common femoral, saphenous, and popliteal veins, and pulmonary embolism of the left pulmonary artery branch serving the posterior basal segment of the inferior lobe. SSHL is an emergency condition that warrants prompt medical examination and treatment. Hematological investigations should be considered in SSHL patients at least for those with a family history of thrombotic events, and for women on estrogen-progestin therapy or during pregnancy, with a view to providing adequate antithrombotic prophylaxis and reducing the risk of other thromboembolic events.

  14. Topographic anatomy of the fetal inferior vena cava, coronary sinus, and pulmonary veins: Variations in Chiari's network.

    Science.gov (United States)

    Naito, Michiko; Yu, Hee Chul; Kim, Ji Hyun; Rodríguez-Vázquez, José Francisco; Murakami, Gen; Cho, Baik Hwan

    2015-07-01

    To understand anomalies in Chiari's network better, we assessed the topographical anatomy of the fetal inferior vena cava (IVC), coronary sinus, and atria. We examined sagittal serial paraffin sections of 15 human fetuses of crown-rump length 24-36 mm, corresponding to a gestational age of 8 weeks. Although their outflow tract morphologies were similar, these 15 specimens could be classified into two groups. In eight specimens, the left common cardinal vein reached the body wall, whereas in the other seven the vein was obliterated near the left pulmonary vein. Irrespective of the group in which the specimen was included, the anteroposterior arrangement of the coronary sinus, the sinus septum (septum), and the right sinus valve (right valve) could be classified into three types: the right valve-septum-coronary sinus arrangement in seven specimens; the right valve-coronary sinus-septum arrangement in five; and the coronary sinus-right valve-septum arrangement in three. Depending on differences in topographical anatomy, the sinus septum separated the coronary sinus opening from either the right or the left atrium. Likewise, the coronary sinus opening was either adjacent to or distant from the IVC terminal. Rather than the counter-side position of the right valve being at the IVC terminal, the left sinus valve protruded leftward, forming an incomplete interatrial septum. Fetal variations seemed to be closely connected with individual variations and a high frequency of Chiari's network anomalies in adults.

  15. Imaging in congenital pulmonary vein anomalies: the role of computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Dyer, Kevin Todd; McQuiston, Andrew Douglas [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Hlavacek, Anthony Marcus; Pietris, Nicholas Peter [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology Department of Pediatrics, Charleston, SC (United States); Meinel, Felix Gabriel [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Ludwig-Maximilians-University Hospital, Institute for Clinical Radiology, Munich (Germany); De Cecco, Carlo Nicola [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' - Polo Pontino, Department of Radiological Sciences Oncology and Pathology, Latina (Italy); Schoepf, Uwe Joseph [Medical University of South Carolina, Division of Cardiology Department of Medicine, Charleston, SC (United States); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology Department of Pediatrics, Charleston, SC (United States)

    2014-09-15

    Pulmonary venous anomalies comprise a wide spectrum of anatomical variations and their clinical presentations may vary from the relatively benign single partial anomalous pulmonary venous connection (PAPVC) to the critical obstructed total anomalous pulmonary venous connection (TAPVC). We briefly review the common anomalies encountered, while highlighting the utility that computed tomographic angiography (CTA) provides for this spectrum of extracardiac vascular malformations and connections. CTA has established itself as an invaluable imaging modality in these patients. A detailed knowledge of the CTA imaging findings in pulmonary venous anomalies is crucial to guide clinical decision-making in these patients. (orig.)

  16. Different risk of deep vein thrombosis and pulmonary embolism in carriers with factor V Leiden compared with non-carriers, but not in other thrombophilic defects. Results from a large retrospective family cohort study

    NARCIS (Netherlands)

    Makelburg, Anja B. U.; Veeger, Nic J. G. M.; Middeldorp, Saskia; Hamulyak, Karly; Prins, Martin H.; Buller, Harry R.; Lijfering, Willem M.

    2010-01-01

    The term factor V Leiden (FVL) paradox is used to describe the different risk of deep vein thrombosis and pulmonary embolism that has been found in carriers of FVL. In a thrombophilic family-cohort, we estimated differences in absolute risks of deep vein thrombosis and pulmonary embolism for various

  17. Venous velocity of the right femoral vein decreases in the right lateral decubitus position compared to the supine position: a cause of postoperative pulmonary embolism?

    Directory of Open Access Journals (Sweden)

    Sato,Shizou

    2007-04-01

    Full Text Available The right lateral decubitus position is a risk factor for postoperative pulmonary embolism. We examined postural changes of femoral vein velocity in order to elucidate the mechanism. Thirty patients scheduled for general thoracic surgery were enrolled in this study. The common femoral veins on both sides were examined by color-duplex ultrasound for venous caliber and velocity when the patients were in the right lateral, left lateral, and supine positions. The maximum diameters of the right femoral vein in the right lateral decubitus position and the left femoral vein in the left decubitus position were significantly larger than those in the other positions. The venous velocity of the right femoral vein in the right lateral decubitus position was significantly smaller than that in the supine position, while the velocity of the left femoral vein in the left lateral decubitus position was not significantly decreased. We speculate that the decreased venous velocity of the right femoral vein in the right lateral decubitus position could result in a deep venous thromboembolism in the right leg, making this position a possible risk factor for postoperative pulmonary embolism.

  18. A patient who experienced thyroid storm complicated by rhabdomyolysis, deep vein thrombosis, and a silent pulmonary embolism: a case report

    Science.gov (United States)

    2013-01-01

    Background Thyroid storm is a serious condition of thyrotoxicosis. Hyperthyroidism often presents with thrombotic events, especially at cerebral sites; however, the possible association between a lower extremity deep vein thrombosis (LEDVT) and thyroid storm has not been previously reported. We encountered a patient who developed thyroid storm, associated with rhabdomyolysis, followed by LEDVT and a small silent pulmonary embolism (PE). The case is discussed with references to the pertinent literature. Case presentation A 50-year-old woman with no past medical history was referred to our hospital because of severe diarrhea, muscle weakness in her lower limbs (manual muscle testing: MMT 3), and disturbances of consciousness. She was diagnosed as having Graves’ disease based on the presence of struma, exophthalmos, and hyperthyroidism with TSH receptor antibody positivity; we further determined that the patient was experiencing thyroid storm based on the results of the Burch-Wartofsky scoring system and a Japanese diagnostic criteria. Treatment with steroids, iodine potassium, methimazole, and propranolol was initiated. Severe watery diarrhea continued, and the laboratory data revealed hypokalemia (2.0 meq/L). On day 14, a blood analysis showed a sudden elevation in her creatinine kinase (CK) level, leading to a diagnosis of rhabdomyolysis. Thereafter, the muscle weakness in her lower limbs advanced to a degree of MMT 1. Seven days after the diagnosis of rhabdomyolysis, pitting edema began to appear in bilateral lower extremities. Contrast-enhanced CT scans revealed a LEDVT involving the left common iliac vein, bilateral femoral veins, and left popliteal vein. Furthermore, a small PE was identified. Hyperthyroidism often presents with thrombotic events, especially at cerebral sites, but few reports of PE or LEDVT have been made. Conclusion This case suggests that the occurrence of thyroid storm may be associated with a risk of LEDVT and/or PE. We suggest that DVT

  19. Thromboembolic complications following a first isolated episode of superficial vein thrombosis: a cross-sectional retrospective study.

    Science.gov (United States)

    Bell, Lauren N; Berg, Richard L; Schmelzer, John R; Liang, Hong; Mazza, Joseph J; Kanth, Rajan; Bray, Christopher L; Zaldivar, Calixto B; Yale, Steven H

    2017-01-01

    Superficial vein thrombosis (SVT) may be associated with complications such as venous thromboembolism (VTE) and recurrent SVT. The purpose of this study was to explore risk factors among patients with a first isolated episode of SVT (index SVT) involving upper and lower extremities and to estimate the prevalence of VTE complications within 1 year of index SVT. Retrospective chart review of electronic records at Marshfield Clinic in Wisconsin identified 381 subjects with a first isolated SVT diagnosis (male/female: 170/211; median age 59.4 years). Patients were stratified based on whether they did (n = 44; 11.5 %) or did not (n = 337; 88.5 %) experience VTE complications and whether they did (n = 25; 6.6 %) or did not (n = 356; 93.4 %) experience pulmonary embolism (PE) and/or deep vein thrombosis (DVT) within 1 year of index SVT. There were 49 complications among 44 patients; these included DVT (n = 18, 36.7 %), propagation of SVT (n = 18, 36.7 %), PE (n = 9, 18.4 %), new SVT at different location (n = 3, 6.1 %), and recurrent SVT (n = 1, 2.0 %). Univariate analysis of all VTE complications identified seven potential risk factors and similar analysis of PE/DVT complications identified eight potential risk factors, with six common risk factors identified in both analyses. Multivariate analysis identified indwelling venous catheter 30 days prior to SVT (p = 0.044), cancer history with treatment in the previous year (p = 0.001), and non-surgical trauma 7 days prior to SVT (p PE/DVT complications. Independent risk factors identified in the current study may convey greater risk for VTE complications, especially PE/DVT, following an initial isolated SVT episode.

  20. Differential actions of the prostacyclin analogues treprostinil and iloprost and the selexipag metabolite, MRE-269 (ACT-333679) in rat small pulmonary arteries and veins.

    Science.gov (United States)

    Orie, N N; Ledwozyw, A; Williams, D J; Whittle, B J; Clapp, L H

    2013-10-01

    The prostacyclin (IP) receptor agonists, treprostinil, iloprost and the selexipag metabolite, MRE-269 (ACT-333679) were evaluated in rat distal pulmonary blood vessels. Small pulmonary arteries and veins were pre-contracted with the thromboxane mimetic, U46619 (25 and 100nM, respectively), and relaxation determined with and without IP receptor antagonists, RO1138452 and RO3244794. In arteries, treprostinil was a more potent vasorelaxant than iloprost, while the efficacy of iloprost was greater. In pulmonary arteries, treprostinil-induced relaxation was essentially abolished by both IP antagonists (1μM), while responses to iloprost were partially inhibited. Both treprostinil and iloprost were equipotent, prominently relaxing pulmonary veins with responses being similarly and partially sensitive to IP antagonists. In contrast, RO1138452 failed to inhibit relaxations to MRE-269 in either pulmonary arteries or veins, suggesting no involvement of typical IP receptors. Thus, rat pulmonary tissues cannot be considered appropriate to assess classical IP receptors using the proposed highly selective non-prostanoid agonist MRE-269, contrasting with the IP receptor agonism profile of prostacyclin analogues, iloprost and treprostinil. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound

    Institute of Scientific and Technical Information of China (English)

    SU Li-ya; GUO Fa-jin; XU Guang; HAN Xiu-jie; SUN Chang-kun; ZHANG Zheng; JING Qing-hong

    2013-01-01

    Background Differential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT).This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.Methods A retrospective case series of 35 ICMVT (M∶F,21∶14; mean age (64.5±10.6) years) and 23 gastrocnemius hematoma (M∶F,16∶7; mean age (75.4±11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012.Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein,great saphenous vein,calf muscles,skin,and soft tissue were examined.Results ICMVT hypoechoic signals were characterized by long,tube-like masses on longitudinal sections and oval masses on transverse sections,with apparent muscle thrombosis boundaries,distal and proximal venous connections,and,often,lower limb DVT.Gastrocnemius hematoma hypoechoic signals were characterized by large volumes,enhanced posterior hematoma echo,hyperechoic muscle boundaries,no hematoma blood flow,and no DVT,and clear differences in trauma/exercise-and oral anticoagulant-induced hematomas were readily apparent.According to the measurement,the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0,whereas in gastrocnemius hematoma patients the ratio was more than 2.0.Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas.Partial muscle fibers in the hematoma due to muscle fractures were apparent.Conclusion High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.

  2. Sixteen multidetector row computed tomography of pulmonary veins: 3-months' follow-up after treatment of paroxysmal atrial fibrillation with cryothermal ablation

    Energy Technology Data Exchange (ETDEWEB)

    Maksimovic, Ruzica; Cademartiri, Filippo; Pattynama, Peter M.T. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Scholten, Marcoen F.; Jordaens, Luc J. [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands)

    2005-06-01

    The aim of the study was to assess pulmonary veins (PVs) for the presence of stenosis 3 months after cryothermal ablation (CA) with a new method of electrical isolation of PVs using contrast-enhanced 16 multidetector row computed tomography (MDCT). Twenty four patients with symptomatic atrial fibrillation underwent CA in 46 PVs. MDCT of PVs was performed before the treatment and after 3-months' follow-up. Following cryoablation, 13/24 (54%) patients showed clinical improvement and had reduced attacks of atrial fibrillation. The dimensions of the treated PVs remained unchanged: the coronal ostial diameter was 19.1{+-}2.4 preprocedural versus 18.6{+-}2.4 mm at follow-up, p>0.05; the ratio of the coronal and axial diameters at the ostium was 1.2{+-}0.2 versus 1.2{+-}0.1, p>0.05, respectively, and the coronal diameter of the proximal 10 mm was 17.1{+-}2.5 mm versus 16.5{+-}2.2 mm, p>0.05, respectively. CA is a promising technique for electrical isolation of PVs that has not been associated with stenosis at the orifice and the proximal 10 mm of the PVs after 3-months' follow-up. MDCT is a noninvasive, fast and comfortable method for assessment of PVs in a three-dimensional manner prior to ablative treatment and during the follow-up. (orig.)

  3. Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism: A randomized, placebo-controlled, double-blind trial.

    NARCIS (Netherlands)

    Heijer, M. den; Willems, H.P.J.; Blom, H.J.; Gerrits, W.B.J.; Cattaneo, M.; Eichinger, S.; Rosendaal, F.R.; Bos, G.M.

    2007-01-01

    The Vitamins and Thrombosis (VITRO) study investigated the effect of homocysteine lowering by daily supplementation of B vitamins on the risk reduction of deep vein thrombosis (DVT) and pulmonary embolism (PE). Patients between 20 to 80 years old with a first objectively confirmed proximal DVT or PE

  4. Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism: A randomized, placebo-controlled, double-blind trial.

    NARCIS (Netherlands)

    Heijer, M. den; Willems, H.P.J.; Blom, H.J.; Gerrits, W.B.J.; Cattaneo, M.; Eichinger, S.; Rosendaal, F.R.; Bos, G.M.

    2007-01-01

    The Vitamins and Thrombosis (VITRO) study investigated the effect of homocysteine lowering by daily supplementation of B vitamins on the risk reduction of deep vein thrombosis (DVT) and pulmonary embolism (PE). Patients between 20 to 80 years old with a first objectively confirmed proximal DVT or PE

  5. A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

    Directory of Open Access Journals (Sweden)

    Erika Leung

    2015-09-01

    Full Text Available Background: Obesity is a growing problem all over the world, including the United States. Single-incision laparoscopic sleeve gastrectomy is a surgery performed for patients who want to lose weight. The number of deaths resulting from thromboembolic complications from bariatric surgeries continues to be of major concern. Case Description: A 38-year-old female was admitted for single incision sleeve gastrectomy and was discharged home three days later. Subsequently she began to have abdominal pain, nausea and vomiting. A CT scan revealed superior mesenteric vein thrombosis with small bowel ischemia, splenic infarction and main and right portal vein branch thrombosis. An exploratory laparotomy demonstrated necrotic bowel due to abdominal compartment syndrome, and an area of small bowel was resected due to internal hernia. Surgical management of the patient during her second hospital stay included a decompressive laparotomy, internal hernia reduction, a small bowel resection. Discussion: Superior mesenteric vein thrombosis can be a life-threatening complication and present with non-specific presentations; thus, it is imperative that it is identified and managed promptly as these cases carry significant morbidity and mortality. Obese patients who undergo bariatric surgery frequently have other co-morbidities; many of which can complicate a case further. Mesenteric vein thromboses are normally treated with unfractionated or low-molecular-weight heparin.

  6. Pulmonary embolus

    Science.gov (United States)

    ... Blood clot - lung; Embolus; Tumor embolus; Embolism - pulmonary; DVT-pulmonary embolism; Thrombosis - pulmonary embolism ... area). This type of clot is called a deep vein thrombosis (DVT) . The blood clot breaks off and travels ...

  7. Multi-level tree analysis of pulmonary artery/vein trees in non-contrast CT images

    Science.gov (United States)

    Gao, Zhiyun; Grout, Randall W.; Hoffman, Eric A.; Saha, Punam K.

    2012-02-01

    Diseases like pulmonary embolism and pulmonary hypertension are associated with vascular dystrophy. Identifying such pulmonary artery/vein (A/V) tree dystrophy in terms of quantitative measures via CT imaging significantly facilitates early detection of disease or a treatment monitoring process. A tree structure, consisting of nodes and connected arcs, linked to the volumetric representation allows multi-level geometric and volumetric analysis of A/V trees. Here, a new theory and method is presented to generate multi-level A/V tree representation of volumetric data and to compute quantitative measures of A/V tree geometry and topology at various tree hierarchies. The new method is primarily designed on arc skeleton computation followed by a tree construction based topologic and geometric analysis of the skeleton. The method starts with a volumetric A/V representation as input and generates its topologic and multi-level volumetric tree representations long with different multi-level morphometric measures. A new recursive merging and pruning algorithms are introduced to detect bad junctions and noisy branches often associated with digital geometric and topologic analysis. Also, a new notion of shortest axial path is introduced to improve the skeletal arc joining two junctions. The accuracy of the multi-level tree analysis algorithm has been evaluated using computer generated phantoms and pulmonary CT images of a pig vessel cast phantom while the reproducibility of method is evaluated using multi-user A/V separation of in vivo contrast-enhanced CT images of a pig lung at different respiratory volumes.

  8. A modified rat model of isolated bilateral pulmonary contusion

    OpenAIRE

    Wang, Shaohua; Ruan, Zheng; Jie ZHANG; ZHENG, JIN

    2012-01-01

    The aim of the present study was to create a feasible specific rat model of isolated bilateral pulmonary contusion (PC) and to evaluate the relationship between severity of hypoxemia and quantity of contusion lesions. Anesthetized rats were placed in a prone position. Injury energy ranging from 2.1 to 3.0 J was produced by a falling weight passed through a specially designed arched shield to the bilateral chest wall of rats. After injury (4 h), the contusion volume was measured using computer...

  9. Imaging of pulmonary vein anatomy using low-dose prospective ECG-triggered dual-source computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Blanke, Philipp; Baumann, Tobias; Langer, Mathias; Pache, Gregor [University Hospital Freiburg, Department of Diagnostic Radiology, Freiburg (Germany)

    2010-08-15

    To prospectively investigate the feasibility, image quality and radiation dose estimates for computed tomography angiography (CTA) of the pulmonary veins and left atrium using prospective electrocardiography (ECG)-triggered sequential dual-source (DS) data acquisition at end-systole in patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation. Thirty-five patients (mean age 66.2 {+-} 12.6 years) with paroxysmal atrial fibrillation underwent prospective ECG-triggered sequential DS-CTA with tube current (250 mAs/rotation) centred 250 ms past the R-peak. Tube voltage was adjusted to the BMI (<25 kg/m{sup 2}: 100 kV, >25 kg/m{sup 2}: 120 kV). Presence of motion or stair-step artefacts was assessed. Effective radiation dose was calculated from the dose-length product. All data sets could be integrated into the electroanatomical mapping system. Twenty-two patients (63%) were in sinus rhythm (mean heart rate 69.2 {+-} 11.1 bpm, variability 1.0 {+-} 1.7 bpm) and 13 (37%) showed an ECG pattern of atrial fibrillation (mean heart rate 84.8 {+-} 16.6 bpm, variability 17.9 {+-} 7.5 bpm). Minor step artefacts were observed in three patients (23%) with atrial fibrillation. Mean estimated effective dose was 1.1 {+-} 0.3 and 3.0 {+-} 0.5 mSv for 100 and 120 kV respectively. Imaging of pulmonary vein anatomy is feasible using prospective ECG-triggered sequential data acquisition at end-systole regardless of heart rate or rhythm at the benefit of low radiation dose. (orig.)

  10. Why can pulmonary vein stenoses created by radiofrequency catheter ablation worsen during and after follow-up ? A potential explanation

    Directory of Open Access Journals (Sweden)

    Dorsaz Pierre-André

    2008-05-01

    Full Text Available Abstract Background Radiofrequency catheter ablation of excitation foci inside pulmonary veins (PV generates stenoses that can become quite severe during or after the follow-up period. Since severe PV stenoses have most often disastrous consequences, it would be important to know the underlying mechanism of this temporal evolution. The present study proposes a potential explanation based on mechanical considerations. Methods we have used a mathematical-physical model to examine the cyclic increase in axial wall stress induced in the proximal (= upstream, non-stenosed segment of a stenosed pulmonary vein during the forward flow phases. In a representative example, the value of this increase at peak flow was calculated for diameter stenoses (DS ranging from 1 to 99%. Results The increase becomes appreciable at a DS of roughly 30% and rise then strongly with further increasing DS value. At high DS values (e.g. > 90% the increase is approximately twice the value of the axial stress present in the PV during the zero-flow phase. Conclusion Since abnormal wall stresses are known to induce damages and abnormal biological processes (e.g., endothelium tears, elastic membrane fragmentations, matrix secretion, myofibroblast generation, etc in the vessel wall, it seems plausible that the supplementary axial stress experienced cyclically by the stenotic and the proximal segments of the PV is responsible for the often observed progressive reduction of the vessel lumen after healing of the ablation injury. In the light of this model, the only potentially effective therapy in these cases would be to reduce the DS as strongly as possible. This implies most probably stenting or surgery.

  11. Effect of ivaradine on hyperpolarization activated cation current in canine pulmonary vein sleeve cardiomyocytes with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Yang Li; Yan Huang; Zongbin Li; Hao Wang; Jianguo Song; Yuqi Liu; Lei Gao; Shiwen Wang

    2008-01-01

    Objective To study the effect of ivabradine on hyperpolarization activated cation current in canine pulmonary vein(PY) sleeve cardiomyocytes with atrial fibrillation.Methods Dissociation of PVs yielded single cardiomyocytes from a Landengorff column without or with pacemaker activity from long-term rapidly atrial pacing (RAP) canines.If current was measured with the whole-cell patch-clamp technique.Results Compared with the control group,the rapidly atrial pacing canine PV cardiomyocytes had spontaneous diastolic depolarization and had larger If densities.Ivabradine (Iva,1 μM),a selective inhibitor of the If current,markedly reduced If currents in the RAP from -2.66±0.4 pA/pF to -1.58±0.1 pA/pF at the test potential of-120 mV (P<0.01,n=12).Inhibition effect of Iva of If current showed concentration-dependent range from 0.1 to 10.0μM,with IC50 of 2.2 μ M ( 1.8-2.9 μM,95% CL).Furthermore,V1/ of steady-state activated curve was shifted from -84.3±4.9 mV to -106.9±3.4 mV and k value of steady-state activated curve was changed from 12.1+2.6 mV to 9.9±3.4 mV by the application of.1.0 μM Iva ( P<0.01,n=12).Conclusions Our study revealed that Ivarbadine may significantly decrease If of rapidly atrial pacing pulmonary vein sleeve ceUs with atrial fibdllation.(J Geriatr Cardiol 2008;5:39-42)

  12. Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Jing; Yang, Zhi-Gang; Xu, Hua-Yan; Shi, Ke; Long, Qi-Hua [Sichuan University, Department of Radiology, West China Hospital, Chengdu, Sichuan (China); Guo, Ying-Kun [Sichuan University, Department of Radiology, West China Second University Hospital, Chengdu (China)

    2017-02-15

    To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT. Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed. In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293). PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy. (orig.)

  13. Sixteen-row multislice computed tomography in the assessment of pulmonary veins prior to ablative treatment: validation vs conventional pulmonary venography and study of reproducibility

    Energy Technology Data Exchange (ETDEWEB)

    Maksimovic, R.; Cademartiri, F.; Pattynama, P.M.T. [Erasmus Medical Center, Rotterdam (Netherlands). Dept. of Radiology; Scholten, M; Jordaens, L.J. [Erasmus Medical Center, Rotterdam (Netherlands). Dept. of Cardiology

    2004-03-01

    The aim of this study was to validate multislice computed tomography (MSCT) venography measurements of pulmonary vein (PV) diameters vs conventional pulmonary venography (CPV), and to assess the reproducibility of MSCT data. The study included 21 consecutive patients with atrial fibrillation who were planned for cryothermal ablation of PVs. One day before ablation, all patients underwent CPV and contrast-enhanced non-gated MSCT venography. The MSCT was repeated 3 months after ablation. The CPV images of the treated PVs (n=40) were analyzed and compared with the results of MSCT measurements. Reproducibility of MSCT venography-based data was assessed by interobserver (n=84 PVs) and interexamination (n=44 PVs) variability. Pre-treatment PV diameters on MSCT and CPV showed good correlation (r=0.87, p<0.01; 18.9{+-}2.3 mm, 188.5{+-}2.4 mm, respectively). Interobserver agreement and interexamination reproducibility were good (r=0.91, r=0.82, respectively, p<0.01), with narrow limits of agreement (Bland and Altman method). The MSCT venography allows accurate and reproducible assessment of PVs. It can be used both in non-invasive planning of treatment for ablative therapy and in the follow-up of patients.

  14. Rare Anomalous Origin of Superior Left Pulmonary Artery from Left Subclavian Vein

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Tian-shi, E-mail: TerrenceLv@126.com; Wang, Chao, E-mail: wangchaoxs@163.com; Song, Li, E-mail: song9981@163.com; Lv, Yong-xing, E-mail: lyongxing@msn.com; Zou, Ying-hua, E-mail: yinghzou@139.com [Peking University First Hospital, Department of Interventional Radiology and Vascular Surgery (China)

    2013-10-15

    We report for the first time an extremely rare anomalous origin of the superior left pulmonary artery in a 60 year-old man. Although it was occult in clinical indications, such a malformation still ought to be considered, especially during endovascular procedures.

  15. Drug-Coated Balloon Venoplasty for In-Stent Restenosis in a Patient With Recurrent Pulmonary Vein Stenosis Post Ablation for Atrial Fibrillation: Initial Experience With a New Treatment Technique.

    Science.gov (United States)

    Rosenberg, Jonathan; Fisher, Westby G; Guerrero, Mayra; Smart, Steve; Levisay, Justin; Feldman, Ted; Salinger, Michael

    2016-05-01

    Pulmonary vein stenosis (PVS) is an uncommon but serious complication following radiofrequency ablation for atrial fibrillation. Occurrence of this complication has risen with increased rates of ablation procedures, with >50,000 AF ablation procedures performed per year, and can occur within weeks to months post procedure. Currently, the main therapies for PVS include percutaneous interventions with balloon angioplasty and stenting, but these treatments are complicated by a high rate of restenosis. The optimal treatment for recurrent pulmonary vein in-stent restenosis has not been determined. We describe the novel use of a paclitaxel drug-coated balloon for the treatment of in-stent restenosis of the pulmonary veins.

  16. A retrospective review of a tertiary Hospital’s isolation and de-isolation policy for suspected pulmonary tuberculosis

    OpenAIRE

    2014-01-01

    Background Effective protocols for the isolation and de-isolation of patients with suspected pulmonary tuberculosis (PTB) are essential determinants of health-care costs. Early de-isolation needs to be balanced with the need to prevent nosocomial transmission of PTB. The aim of our study was to evaluate the efficiency of our hospital’s current protocol for isolating and de-isolating patients with suspected PTB, in particular assessing the timeliness to de-isolation of patients with AFB smear ...

  17. A modified rat model of isolated bilateral pulmonary contusion.

    Science.gov (United States)

    Wang, Shaohua; Ruan, Zheng; Zhang, Jie; Zheng, Jin

    2012-09-01

    The aim of the present study was to create a feasible specific rat model of isolated bilateral pulmonary contusion (PC) and to evaluate the relationship between severity of hypoxemia and quantity of contusion lesions. Anesthetized rats were placed in a prone position. Injury energy ranging from 2.1 to 3.0 J was produced by a falling weight passed through a specially designed arched shield to the bilateral chest wall of rats. After injury (4 h), the contusion volume was measured using computer-generated three-dimensional reconstruction from a chest computed tomographic scan and expressed as a percentage of total lung volume. Arterial partial pressure of oxygen (PaO(2)) in blood gas analysis and contusion volume percentage were used to assess the severity of contusion. Heart and lung biopsy was used to confirm the diagnosis and rule out the existence of myocardial contusion. There were 3 cases of death and 1 case of death in the 3.0 J and the 2.4 J group, respectively. PaO(2) in the 2.7 J group was significantly lower than that in the lower energy groups (Ppulmonary contusion in the 2.7 J group was significantly higher compared to that of the lower energy groups (Pcontusion percentage (R(2)=0.76). Hemorrhage, edema and neutrophil infiltration were determined by lung biopsy. No evidence of myocardial contusion was documented in multiple heart biopsies. The method illustrated in this research effectively duplicates isolated bilateral pulmonary contusion in rats, the severity of which is highly correlated with the contusion size. Thus, 2.7 J can be regarded as the maximal energy for sublethal injury.

  18. Isolated Pulmonary Infective Endocarditis with Septic Pulmonary Embolism Complicating a Right Ventricular Outflow Tract Obstruction: Scarce and Devious Presentation

    Directory of Open Access Journals (Sweden)

    Abdelrahmen Abdelbar

    2013-01-01

    Full Text Available We present a case of a fifty-three-year-old male who presented with severe sepsis. He had been treated as a pneumonia patient for five months before the admission. Investigations revealed isolated pulmonary valve endocarditis and septic pulmonary embolism in addition to undiagnosed right ventricular outflow tract (RVOT obstruction. The patient underwent surgery for the relief of RVOT obstruction by substantial muscle resection of the RVOT, pulmonary artery embolectomy, pulmonary valve replacement, and reconstruction of RVOT and main pulmonary artery with two separate bovine pericardial patches. He was discharged from our hospital after 6 weeks of intravenous antibiotics. He recovered well on follow-up 16 weeks after discharge. A high-suspicion index is needed to diagnose right-side heart endocarditis. Blood cultures and transesophageal echocardiogram are the key diagnostic tools.

  19. Cerebral air embolism as a complication of computed tomography-guided marking of the lung: depiction of air inflow route from a pulmonary vein to the left atrium.

    Science.gov (United States)

    Higashino, Takanori; Noma, Satoshi; Nishimoto, Yuko; Endo, Junki; Taguchi, Yoshio; Shindo, Toru

    2011-02-01

    Air embolism in the arterial system is a very rare but potentially fatal complication of percutaneous transthoracic needle biopsy or marking. We report a case of a patient with interstitial pneumonia associated with Sjögren syndrome, who presented with systemic arterial air embolism as a complication of computed tomography-guided marking of the lung. The air inflow route was depicted clearly on computed tomography from the peripheral pulmonary vein that crossed the needle pathway to the left atrium.

  20. Lung Infarction due to Pulmonary Vein Stenosis after Ablation Therapy for Atrial Fibrillation Misdiagnosed as Organizing Pneumonia: Sequential Changes on CT in Two Cases

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Mi Ri; Lee, Ho Yun; Cho, Jong Ho; Um, Sang Won [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2015-08-15

    Pulmonary vein (PV) stenosis is a complication of ablation therapy for arrhythmias. We report two cases with chronic lung parenchymal abnormalities showing no improvement and waxing and waning features, which were initially diagnosed as nonspecific pneumonias, and finally confirmed as PV stenosis. When a patient presents for nonspecific respiratory symptoms without evidence of infection after ablation therapy and image findings show chronic and repetitive parenchymal abnormalities confined in localized portion, the possibility of PV stenosis should be considered.

  1. Effects of new antiarrhythmic agent SS-68 on excitation conduction, electrical activity in Purkinje fibers and pulmonary veins: Assessment of safety and side effects risk.

    Science.gov (United States)

    Bogus, Saida K; Kuzmin, Vladislav S; Abramochkin, Denis V; Suzdalev, Konstantin F; Galenko-Yaroshevsky, Pavel A

    2017-03-02

    The compound SS-68 has been selected among numerous new derivatives of indole and demonstrated antiarrhythmic effects in animal models. The present study concerns several aspects of SS-68 safety and efficacy as a potential antiarrhythmic drug. The first estimation of atrioventricular conduction in mammalian heart under SS-68 has been carried out; effects of SS-68 in Purkinje fibers and myocardium of pulmonary veins have been investigated. The drug weakly affects cardiac atrioventricular conduction: only high concentrations of SS-68 (≥10 μmol/L) significantly decrease this parameter. Also, the drug weakly affects Purkinje fibers automaticity, but effectively alters action potential waveform in Purkinje fibers in a concentration-dependent manner. SS-68 (0.1-100 μmol/L) failed to induce any early or delayed afterdepolarizations in Purkinje fibers both in basal conditions and under provocation of proarrhythmic activity by norepinephrine (NE). Moreover, 10 μmol/L SS-68 suppressed NE-induced extra-beats and rapid firing in Purkinje fibers. In pulmonary veins only high concentrations of SS-68 significantly increased action potential duration, while lower concentrations (0.1-1 μmol/L) were ineffective. Also, 0.1-100 μmol/L SS-68 was unable to elicit arrhythmogenic alternations of action potential waveform in pulmonary veins. In conclusion, SS-68 has no proarrhythmic effects, such as afterdepolarizations or abnormal automaticity in used experimental models.

  2. Magnetic resonance angiography virtual endoscopy in the assessment of pulmonary veins before radiofrequency ablation procedures for atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Cirillo, S.; Tosetti, Irene; Giuseppe, M.De; Longo, M.; Regge, D. [Institute for Cancer Research and Treatment (IRCC), Unit of Radiology, Candiolo (Torino) (Italy); Bonamini, R. [University of Torino, Department of Cardiology, Torino (Italy); Gaita, F.; Bianchi, F.; Vivalda, L. [Ospedale Mauriziano Umberto I, Department of Cardiology, Torino (Italy)

    2004-11-01

    Magnetic resonance angiography (MRA) is a safe and non-invasive imaging method that can readily depict the pulmonary veins (PV), whose imaging has acquired momentum with the advent of new techniques for radiofrequency ablation of atrial fibrillation (AF). We evaluated whether virtual endoscopy from 3D MRA images (MRA-VE) is feasible in studying the morphology of PV. Fifty patients with AF underwent pre-ablative MRA (1.5 T). Images were acquired with axial T-2 weighted and 3D-SPGR sequences after intravenous administration of Gd-DTPA and automatic triggering. Postprocessing was performed by an experienced radiologist with maximum intensity projection (MIP) and virtual endoscopy software (Navigator, GEMS). The venoatrial junction was visualized with MRA-VE in 49 of 50 patients (98.0%). Twenty-seven patients (55.1%) had two ostia on both sides, 13 patients (26.5%) had two ostia on the right and a single common ostium on the left, 5 patients (10.2%) had accessory PV and 4 patients (8.2%) had both an accessory right PV and a single common ostium on the left. Flythrough navigation showed the number and spatial disposition of second-order PV branches in 48 out of 49 patients (98.0%). MRA-VE is an excellent tool for at-a-glance visualization of ostia morphology, navigation of second-generation PV branches and easy endoluminal assessment of left atrial structures in pre-ablative imaging. (orig.)

  3. Effect of anxiety and depression on the recurrence of persistent atrial fibrillation after circumferential pulmonary vein ablation

    Institute of Scientific and Technical Information of China (English)

    YU Sheng-bo; HU Wei; ZHAO Qing-yan; QIN Mu; HUANG He; CUI Hong-ying; HUANG Cong-xin

    2012-01-01

    Background The effects of anxiety and depression on the recurrence of persistent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA) are not clear.Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown.Methods One hundred and sixty-four patients with persistent AF,of which 43 treated with CPVA (CPVA group) and 103 treated with anti-arrhythmics drugs (medicine group),were enrolled.The Zung Self-Rating Anxiety Scale (SAS),and Zung Self-Rating Depression Scale (SDS) were assessed before and 12 months after treatment in all patients.Results The scores of SAS (40.33±7.90 vs.49.76±9.52,P <0.01) and SDS (42.33±8.73 vs.48.17±8.77,P <0.01)decreased 12 months after CPVA.Over 12 months follow-up,AF relapsed in 17 patients in CPVA group.Compared with the data in the recurrent group (17 patients),the scores of SAS and SDS were significantly lower in the non-recurrent group (26 patients) at baseline.The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA.Conclusions Anxiety and depression increase the recurrence risk of persistent AF after CPVA.CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF.

  4. The study in pulmonary vein anatomy and the variation by DSCT%DSCT在肺静脉解剖及变异中的应用研究

    Institute of Scientific and Technical Information of China (English)

    赵昕; 时季成; 吕京光

    2013-01-01

    目的 利用DSCT对肺静脉正常解剖及变异类型、变异率进行研究,指导房颤导管消融手术的准确定位.方法 选择300例通过DSCT冠状动脉成像序列进行肺静脉成像,其中男性210例,女性90例,年龄14~81岁,平均年龄54.8岁,对肺静脉的数量、位置、分型和变异进行分析.结果 300例样本中,双侧均为标准型肺静脉者共144例,肺静脉总变异率为52%,左侧、右侧肺静脉变异分别为123例、102例,其变异率分别为41%、34%,其中右侧肺静脉变异以独立肺静脉较为常见,占60%,左侧肺静脉变异以肺静脉共同口较为常见,占96%;此外,本样本中肺静脉开口数目为2个、3个、4个、5个和6个的分别有19例、72例、196例、36例和4例.结论 肺静脉解剖存在较大变异,DSCT增强扫描可准确显示肺静脉解剖及其变异和类型,对指导房颤射频消融及心胸外科手术均具有重要意义.%Objective To study pulmonary vein anatomy and variation types and variation rate by the dual-source CT (DSCT) for guiding catheter ablation of atrial fibrillation( Af). Methods A total of 300 Patients (210 males, 90 females, aged 14 to 81 years old, with an average age of 54. 8 years) was undergone the pulmonary vein imaging by the DSCT coronary angiography imaging sequence. The number and position and classification and variation of the pulmonary vein (PV) were analyzed by multi-angle analysis of observation. Results Of 300 cases, 144 cases were found in both sides of normal pulmonary veins, with the variation rate of 52%. Among these cases, 123 cases had anatomic variation in the left PV, with the variation of 41 % , and the additional PV was common relatively, accounting for 60% , and 102 cases had anatomic variation in the right PV, with the variation rate of 34%, and the common vein opening PV was common relatively, accounting for 96%. In addition, according to the number of pulmonary vein opening, there were five types

  5. Isolated splenic vein thrombosis secondary to splenic metastasis: A case report

    Institute of Scientific and Technical Information of China (English)

    Kunihiko Hiraiwa; Kyoei Morozumi; Hiroshi Miyazaki; Keiichi Sotome; Akio Furukawa; Makoto Nakamaru; Yoichi Tanaka; Hisami Iri

    2006-01-01

    A 49-year-old, previously healthy woman sought treatment for abdominal pain. Colonoscopy revealed ascending colon cancer. Computed tomography and angiography showed splenic metastasis and thrombosis extending from the splenic vein to the portal vein. She underwent right hemicolectomy, splenectomy, and distal pancreatomy. Histological findings showed no malignant cell in the splenic vein which was filled with organizing thrombus. We postulate the mechanism of splenic vein thrombosis in our case to be secondary to the extrinsic compression of the splenic vein by the splenic metastasis or by the inflammatory process produced by the splenic metastasis. In conclusion, we suggest that splenic metastasis should be added to the list of differential diagnosis which causes splenic vein thrombosis. In the absence of other sites of neoplastic disease, splenectomy seems to be the preferred therapy because it can be performed with low morbidity and harbors the potential for long-term survival.

  6. Imaging Features of Isolated Unilateral Pulmonary Artery Agenesis: a review of four cases

    OpenAIRE

    Batur, Abdussamet; Ödev, Kemal; Pekcan, Sevgi

    2015-01-01

    To highlight the variation in imaging and clinical manifestations of four cases of isolated unilateral absence of pulmonary artery presented in varied ages. Four patients with unilateral pulmonary artery agenesis were referred to our institution They underwent a series of investigations, including chest radiography, computed tomography and magnetic resonance imaging. Two of the four patients had absence of the right main pulmonary artery, while the remaining two patients had absence of the le...

  7. Electroanatomical systems to guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the Ensite/NavX and CARTO system

    Institute of Scientific and Technical Information of China (English)

    LIU Xu; WANG Xin-hua; GU Jia-ning; ZHOU Li; QIU Jian-hua

    2005-01-01

    Background The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) treatment and is becoming more widely accepted and practiced. This study aims to evaluate the characteristics of the CARTO and the Ensite/NavX system and draw a comparison between them on the aspects of procedural parameters and clinical effectiveness.Methods Seventy-five cases with paroxysmal or chronic symptomatic AF were randomly assigned to CPVA procedure guided by the Ensite/NavX system (group Ⅰ, n=40) and by the CARTO system (group Ⅱ, n=35). After successful transseptal procedure, the geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferentially ablate tissues out of pulmonary veins' (PVs') ostia. In cases with chronic AF, linear ablation was applied to modify the substrate of left atrium (LA). The endpoint of the procedure was complete PVs isolation. Results Seventy-five cases underwent the procedure successfully. The total procedure and fluoroscopic durations in group Ⅱ were significantly shorter than in group Ⅰ [(150±23) min and (18±17) min versus (170±34) min and (25±16) min, P=0.03 and 0.04, respectively]. There was no significant difference in the fluoroscopic and procedure durations for geometry creation between group Ⅰ and group Ⅱ [(8±4) min and (16±11) min versus (5±4) min and (14±8) min, respectively]. The fluoroscopic durations for CPVA were (15±5) min in group Ⅰ versus (10±6) min in group Ⅱ (P=0.05), and the CPVA procedural durations were significantly shorter in group Ⅱ than in group Ⅰ [(18±11) min versus (25±10) min, P=0.04]. AF was terminated by radio frequency delivery in 14 cases (35%) in group Ⅰ versus 5 cases (14%) in group Ⅱ (P=0.035). After CPVA complete PV isolation was attained in 26 cases (65%) in group Ⅰ versus 11 cases (31%) in group Ⅱ (P=0.004). During a mean follow-up of 7 months, 32 (80%) cases in group

  8. A RARE CASE OF EXTENSIVE THROMBOSIS OF INFERIOR VENA CAVA, PORTAL VEIN, SPLENIC VEIN AND SUPERIOR MESENTRIC VEIN

    Directory of Open Access Journals (Sweden)

    Giridhar

    2015-03-01

    Full Text Available While the most common presentation of venous thromboembolic disease is deep vein thrombosis (DVT or pulmonary thromboembolism, rarer manifestations are thrombosis of jugular vein, cerebral sinus and inferior vena cava. Here we are presenting a rare case of inferior vena caval thrombosis with multiple thrombus in portal vein, splenic vein and superior mesenteric vein

  9. Impact of ECG gating in contrast-enhanced MR angiography for the assessment of the pulmonary veins and the left atrium anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Katoh, M.; Buecker, A.; Muehlenbruch, G.; Guenther, R.W.; Spuentrup, E. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum RWTH Aachen (Germany); Schauerte, P. [Medizinische Klinik 1, Universitaetsklinikum RWTH Aachen (Germany)

    2006-02-15

    Purpose: Implementation of ECG gating in contrast-enhanced MR angiography (ceMRA) for improved visualization of the pulmonary veins, the left atrium, and the thoracic vessels. Materials and Methods: CeMRA was performed on twelve patients with a history of recurrent atrial fibrillation for the purpose of an intra-individual comparison with and without ECG gating on a 1.5 Tesla MR system (Gyroscan Intera, Philips Medical Systems, Best, NL). Objective image quality parameters such as the signal-to-noise ratio (SNR) of the blood and the contrast-to-noise ratio (CNR) between the blood and myocardium or lung parenchyma were analyzed. The contour sharpness of the pulmonary veins, left atrium, ascending aorta, and pulmonary trunk was also measured. In addition, the artifact level was subjectively assessed by two observers blinded with respect to the sequence parameters. Statistically significant differences (p<0.05) between the procedures were analyzed using the Wilcoxon test and Pearson Chi-square test. Results: The use of ECG gating in ceMRA significantly reduced artifacts caused by cardiac motion and vessel pulsation. This in turn lead to a significant increase in the contour sharpness of the left atrium and the thoracic vessels. In addition, higher SNR and CNR were found using ECG-gated ceMRA compared to standard ceMRA. Conclusion: The use of ECG gating in ceMRA results in artifact-free and sharper delineation of the structures of the heart and thoracic vessels. (orig.)

  10. Imaging of pulmonary vein anatomy and progress of multislice Computed tomography%多层螺旋CT肺静脉解剖成像及进展

    Institute of Scientific and Technical Information of China (English)

    赵昕

    2012-01-01

    肺静脉的解剖结构存在着一定的共性,但是也常发生变异.随着医疗技术的不断发展和对肺静脉相关疾病的逐渐认识,充分了解肺静脉的正常解剖关系及变异显得越发重要.因此,对MSCT技术在肺静脉成像中的应用现状、优缺点和进展作一综述患者.%The anatomical structure of pumonary vein exists certain common characters, but it also exists variations. As the development of the medical technology and the recognize of the related disease of pumonary vein, fully understanding of the normal anatomy and variation of pulmonary vein is becoming more and more important. So. the present situation of application, advantage, disadvantage and the progress for the usage of MSCT in the image of pumonary vein are reviewed.

  11. Pre-ablative high-resolution MRA facilitates electrophysiologic pulmonary vein ablation and reduces fluoroscopy time in patients with paroxysmal atrial fibrillation

    Science.gov (United States)

    Collins, Jeremy D.; Pereles, F. S.; Bello, David; Betts, Timothy; Zachariah, Anish; Kaliney, Ryan; Song, Gina K.; Shors, Stephanie M.; Carr, James C.; Finn, John P.

    2003-05-01

    Pulmonary MRA generates high-resolution images of the pulmonary veins (PV) and left atrium (LA), permitting characterization of complex PV anatomy, which is useful in electrophysiologic PV catheter ablation, a proven technique for the treatment of paroxysmal atrial fibrillation (PAF). The purpose of this study was to determine if pre-ablative pulmonary MRA with intra-ablative viewing facilitates ablation by reducing fluoroscopy time. We studied the morphology of the LA and PV at 1.5T (Magnetom Sonata, Siemens Medical Solutions, Erlangen Germany) with breath-held gadolinium-enhanced 3D MRA in 7 patients with PAF undergoing PV ablation. Data was volume rendered (VR) on a stereoscopic workstation. PV ostial diameter and cross-sectional area measurements were obtained on multi-planar reformatted (MPR) images. VR datasets were converted into digital movies and were viewed on a laptop computer adjacent to real-time fluoroscopic images. Fluoroscopy times for patients undergoing pre-ablative MPA mapping were compared with a cohort of 22 consecutive patients diagnosed with PAF who underwent catheter ablation without pre-ablative MRA planning. Mean PV ablation fluoroscopic time with MRA planning versus fluoroscopic imaging alone were 84+/-20 minutes and 114+/-20 minutes respectively. Pre-ablative MRA planning resulted in a significant mean fluoroscopy time savings of 26% (p<0.05). In patients with PAF undergoing PV ablation, analysis of MRA datasets depicting PV anatomy confirms that there is great variability in anatomy between veins. Pre-ablative 3D PV mapping by MRA greatly facilitates fluoroscopic identification of individual veins and significantly reduces fluoroscopic radiation time.

  12. Different risk of deep vein thrombosis and pulmonary embolism in carriers with factor V Leiden compared with non-carriers, but not in other thrombophilic defects. Results from a large retrospective family cohort study

    Science.gov (United States)

    Mäkelburg, Anja B.U.; Veeger, Nic J.G.M.; Middeldorp, Saskia; Hamulyák, Karly; Prins, Martin H.; Büller, Harry R.; Lijfering, Willem M.

    2010-01-01

    The term factor V Leiden (FVL) paradox is used to describe the different risk of deep vein thrombosis and pulmonary embolism that has been found in carriers of FVL. In a thrombophilic family-cohort, we estimated differences in absolute risks of deep vein thrombosis and pulmonary embolism for various thrombophilic defects. Of 2,054 relatives, 1,131 were female, 41 had pulmonary embolism and 126 deep vein thrombosis. Annual incidence for deep vein thrombosis in non-carriers of FVL was 0.19% (95%CI, 0.16–0.23), and 0.41% (95%CI, 0.28–0.58) in carriers; relative risk (RR) 2.1 (95%CI, 1.4–3.2). For pulmonary embolism these incidences were similar in carriers and non-carriers 0.07%, respectively; RR 1.0 (95% CI, 0.4–2.5). When co-inheritance of other thrombophilic defects was excluded the RR for deep vein thrombosis in FVL carriers was 7.0 (95%CI, 2.3–21.7) compared to non-carriers and 2.8 (95%CI, 0.5–14.4) for pulmonary embolism. For other thrombophilic defects no such effect was observed. Thus the FVL paradox was confirmed in our study. However, a similar paradox in carriers of other thrombophilic defects was not observed. PMID:20007142

  13. Isolated agenesis of the right pulmonary artery with late manifestation of pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Huebsch, P.; Pichler, W.; Lang, I.; Mlczoch, J.

    1987-01-01

    The case of a woman patient of 25 years of age with acute cardiac decompensation is presented. The chest X-ray as well as the lung scan showed the typical features of absence of the right pulmonary artery. The diagnosis was confirmed angiographically. The sudden and late onset of symptoms of pulmonary hypertension is a remarkable feature.

  14. Surgical treatment for congeaital pulmonary vein stenosis combined with other cardiac malformations%先天性心脏畸形合并肺静脉狭窄的外科治疗

    Institute of Scientific and Technical Information of China (English)

    吴向阳; 陶凉; 朱洁; 周丹; 庾华东; 刘燕; 祁明

    2009-01-01

    Objective Pulmonnary vein stenosis (PVS) is a rare congenital disease. It leads to progressive pulmonary hyperten-sion and heart failure with a high mortality. PVS may be isolated or asaseiated with other cardiac malformtions. There were few litera- tores regarding surgical treatmenta and the timing for intervention. The aim of this article is to summarize the surgical treatment for PVS combined with other cardiac malformations. Methods Five patients were diagnosed as PVS. The accompanied cardiac malformations were: xtrocordia(n = 1), patent duetus arteriosuss(n = 2), ventricular septal defect(n = 4), atrial septal defect(n = 2), double- chambered right ventricle(n = 1), pulmonary arterial stenosis (n = 1), tricuspid valve insufficiency(n= 2), partial anomalous pulmo- nary venous connection(n = 1), persistent left superior vena cava(n = 1). The mean age was(8.5 4± 6.4) years. The mean body weight was(15.2 ± 6.3) kg. The mean gradient pressure through the stenotie pulmonary veins was(22.0 ± 6.2) mmHg. Nine stenotic pulmonary veins wore found, including 6 cristal stenosises located at venoatrial junetiom and 3 tubular stauosises outside of the lung. The surgical procedures included eristal stenosis ring resection (n=6) and two of them repaired additionally by "longitudinally open and transeversoly suture of the endomembrane" plasty method. Pulmonary veins repair used auto-pericardium (n= 1) and unitization of neighbonring pulmonary veins(n = 1), etc. Remits Cardiopulmonary bypass and aortic cross-clamp time were(129.2 ± 74.6) and (74.24±39.1) rain, respectively. All the petients had a satisfying honmdynmnic aud no death happened. The mean length of hos- pital stay after operation was (10±3) days. Follow-up waa completed in a duration of 6 month - 3 years. There was a trace residual shunt of VSD and PDA and Ⅱ degree auriculo-ventricular block happened in one patient. Residual stenosis was found by color ulltra- sonograph in a cristal stenosis case, whose

  15. Isolation and structural characterization of glycosphingolipids of in vitro propagated human umbilical vein endothelial cells.

    Science.gov (United States)

    Müthing, J; Duvar, S; Heitmann, D; Hanisch, F G; Neumann, U; Lochnit, G; Geyer, R; Peter-Katalinic, J

    1999-05-01

    To investigate in detail the expression of glycosphingolipids (GSLs) on endothelial cells, 4.85 x 10(9) human umbilical vein endothelial cells (HUVECs) were cultivated in a 2 l bioreactor using microcarriers as a support for anchorage dependent growing cells. Neutral GSLs and gangliosides were isolated and their structures were determined by TLC immunostaining, fast atom bombardment-mass spectrometry (FAB-MS) of the native GSLs, and gas chromatography-electron impact mass spectrometry (GC-EIMS) of partially methylated alditol acetates. GbOse4Cer, GbOse3Cer, and LacCer, all carrying mainly C24- and C16-fatty acid beside C18-sphingosine, were detected as the major neutral GSLs (36%, 23%, and 15% of the total orcinol stain, respectively); GlcCer, nLcOse4Cer, and nLcOse6Cer were expressed to substantial minor amounts (9%, 12%, and 5% of the total orcinol stain, respectively). TLC immunostaining revealed the presence of lipid bound Lewisx antigen, whereas the isomeric Lewisa structure was detectable only in very low quantities. GM3(Neu5Ac) with C18-sphingosine was the major ganglioside constituting about 90% of the whole ganglioside fraction. The fatty acid composition was determined by GC-MS of fatty acid methyl esters, indicating the predominance of C24- and C16-substituted GM3(Neu5Ac), followed by C18- and C22-substituted species. Terminally alpha2-3 sialylated neolacto-series ganglioside IV3Neu5Ac-nLcOse4Cer was the second most abundant ganglioside in HUVECs (8% of the total resorcinol stain), and IV6Neu5Ac-nLcOse4Cer and VI3Neu5Ac-nLcOse6Cer (together less than 2% of total resorcinol stain) were found in minor quantities. Lipid bound sialyl Lewisx antigen with poly-N-acetyllactosaminyl chains, and traces of gangliotetraose-type gangliosides GM1 and GD1a were identified by TLC immunostaining. The expression of dominant neutral GSLs LacCer, GbOse3Cer, and GbOse4Cer, and of ganglioside GM3(Neu5Ac) was assayed by indirect immunofluorescence microscopy of cell layers

  16. Comparative analyses of lung transcriptomes in patients with alveolar capillary dysplasia with misalignment of pulmonary veins and in foxf1 heterozygous knockout mice.

    Directory of Open Access Journals (Sweden)

    Partha Sen

    Full Text Available Alveolar Capillary Dysplasia with Misalignment of Pulmonary Veins (ACDMPV is a developmental disorder of the lungs, primarily affecting their vasculature. FOXF1 haploinsufficiency due to heterozygous genomic deletions and point mutations have been reported in most patients with ACDMPV. The majority of mice with heterozygous loss-of-function of Foxf1 exhibit neonatal lethality with evidence of pulmonary hemorrhage in some of them. By comparing transcriptomes of human ACDMPV lungs with control lungs using expression arrays, we found that several genes and pathways involved in lung development, angiogenesis, and in pulmonary hypertension development, were deregulated. Similar transcriptional changes were found in lungs of the postnatal day 0.5 Foxf1+/- mice when compared to their wildtype littermate controls; 14 genes, COL15A1, COL18A1, COL6A2, ESM1, FSCN1, GRINA, IGFBP3, IL1B, MALL, NOS3, RASL11B, MATN2, PRKCDBP, and SIRPA, were found common to both ACDMPV and Foxf1 heterozygous lungs. Our results advance knowledge toward understanding of the molecular mechanism of ACDMPV, lung development, and its vasculature pathology. These data may also be useful for understanding etiologies of other lung disorders, e.g. pulmonary hypertension, bronchopulmonary dysplasia, or cancer.

  17. Isolated Anomalous Origin of Left Pulmonary Artery From the Descending Aorta: An Embryologic Ambiguity.

    Science.gov (United States)

    Gnanappa, Ganesh Kumar; Laohachai, Karina; Orr, Yishay; Ayer, Julian

    2016-11-01

    Anomalous origin of a branch pulmonary artery from the aorta is a rare malformation, accounting for 0.12% of all congenital heart defects. Anomalous origin of the left pulmonary artery from the aorta (ALPA) constitutes a small proportion of these cases. ALPA has been reported to arise from the ascending aorta with various embryologic postulates. We report a case of isolated ALPA arising from the descending aorta in association with a patent ductus arteriosus, to emphasize its embryologic ambiguity.

  18. In Vitro Vasoactive Effects of Levobupivacaine and Ropivacaine on the Isolated Human Umbilical Artery and Vein

    Directory of Open Access Journals (Sweden)

    Alper Kılıçaslan

    2011-06-01

    Full Text Available Objective: In this in vitro study, we investigated the vasoactive effects of levobupivacaine and ropivacaine on vascular smooth muscle derived from human umbilical arteries and veins.Material and Methods: The strips were mounted in tissue baths at 37°C continuously gassed with 5% CO2 in oxygen for isometric recording of contractile activity on a polygraph. The endothelium of some tissues was mechanically removed to assess the influence of the endothelium on contractility. The strips were precontracted with serotonin (10-6 M 5-HT; n=7. After obtaining the maximal contraction, responses obtained by adding levobupivacaine and ropivacaine (10-9-10-4 M; n=7 cumulatively were recorded. Contractions were expressed as the (% of 5HT maximal response percentage of 5 HT’s maximal response.Results: Both levobupivacaine and ropivacaine induce a concentration-dependent contraction in the smooth muscle cells of umbilical arteries and veins. Maximum contractile response (Emax of levobupivacaine (79.2±2.5, 71.1±2.6 was higher than ropivacaine (68.4±2, 36.2±2.8 on both umbilical arteries and veins. There were no statistically significant differences between contraction responses of endothelium-intact and endothelium-denuded tissues. Conclusion: The results suggest that, in high concentrations, levobupivacaine and ropivacaine may affect umbilical blood flow by contracting the umbilical artery and vein, thus reducing fetal blood flow.

  19. Peripartum Isolated Cortical Vein Thrombosis in a Mother with Postdural Puncture Headache Treated with an Epidural Blood Patch

    Directory of Open Access Journals (Sweden)

    Etienne Laverse

    2013-01-01

    Full Text Available A 32-year-old woman presented with low pressure headache 3 days after delivery of her baby. An assessment of postdural puncture headache was made. This was initially treated with analgesia, caffeine, and fluids for the presumed cerebrospinal fluid (CSF leak. The woman was readmitted two days after her hospital discharge with generalised seizures. A brain scan showed features of intracranial hypotension, and she was treated for CSF leak using an epidural blood patch. Her symptoms worsened and three days later, she developed a left homonymous quadrantanopia. An MRI scan confirmed a right parietal haematoma with evidence of isolated cortical vein thrombosis (ICVT.

  20. Circumferential lesion formation around the pulmonary veins in the left atrium with focused ultrasound using a 2D-array endoesophageal device: a numerical study

    Energy Technology Data Exchange (ETDEWEB)

    Pichardo, Samuel; Hynynen, Kullervo [Imaging Research-Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room C713, Toronto, ON M4N 3M5 (Canada)

    2007-08-21

    Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia affecting humans. The electrical isolation by ablation of the pulmonary veins (PVs) in the left atrium (LA) of the heart has been proven as an effective cure of AF. The ablation consists mainly in the formation of a localized circumferential thermal coagulation of the cardiac tissue surrounding the PVs. In the present numerical study, the feasibility of producing the required circumferential lesion with an endoesophageal ultrasound probe is investigated. The probe operates at 1 MHz and consists of a 2D array with enough elements (114 x 20) to steer the acoustic field electronically in a volume comparable to the LA. Realistic anatomical conditions of the thorax were considered from the segmentation of histological images of the thorax. The cardiac muscle and the blood-filled cavities in the heart were identified and considered in the sound propagation and thermal models. The influence of different conditions of the thermal sinking in the LA chamber was also studied. The circumferential ablation of the PVs was achieved by the sum of individual lesions induced with the proposed device. Different scenarios of lesion formation were considered where ultrasound exposures (1, 2, 5 and 10 s) were combined with maximal peak temperatures (60, 70 and 80 {sup 0}C). The results of this numerical study allowed identifying the limits and best conditions for controlled lesion formation in the LA using the proposed device. A controlled situation for the lesion formation surrounding the PVs was obtained when the targets were located within a distance from the device in the range of 26 {+-} 7 mm. When combined with a maximal temperature of 70 {sup 0}C and an exposure time between 5 and 10 s, this distance ensured preservation of the esophageal structures, controlled lesion formation and delivery of an acoustic intensity at the transducer surface that is compatible with existing materials. With a peak

  1. Atrial ectopy predicts late recurrence of atrial fibrillation after pulmonary vein isolation

    DEFF Research Database (Denmark)

    Gang, Uffe J O; Nalliah, Chrishan J; Lim, Toon Wei

    2015-01-01

    BACKGROUND: Late recurrence of atrial fibrillation (AF) after radiofrequency ablation remains significant. Asymptomatic recurrence poses a difficult clinical problem as it is associated with an equally increased risk of stroke and death compared with symptomatic AF events. Meta-analyses reveal th...... with a significantly increased risk of late AF recurrence. These results could have important clinical implications for the design of post-PVI follow-up. CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. Unique identifier: ACRTN12606000467538....

  2. Is radiofrequency energy a necessary and safe complement to cryotherapy for successful pulmonary vein isolation?

    Directory of Open Access Journals (Sweden)

    Ahmed Abdelaal

    2011-06-01

    Conclusions: Our study suggests that hybrid ablation therapy is necessary in most patients to achieve PV disconnection after a maximum of four blinded applications of balloon-cryotherapy (especially in inferior PVs, with a significant short-term success rate.

  3. Isolated Hypoplasia of Left Pulmonary Artery with Agenesis of Left Lobe of Thyroid: A Case Report.

    Science.gov (United States)

    Khadir, Mohammed Abdul; Narayana, Ganesh; Ramagopal, Ganavi; Nayar, Pradeep G

    2016-12-01

    Isolated Unilateral hypoplasia or agenesis of a branch of pulmonary artery is very rare. It is usually seen associated with congenital heart diseases such as tetralogy of Fallot, atrial septal defect, coarctation of the aorta, right aortic arch, truncus arteriosus, patent ductus arteriosus and pulmonary atresia. It occurs as a result of lack of embryological development of either the left or right sixth aortic arch and has been found to present itself with various clinical manifestations as during childhood it presents as contralateral pulmonary hypertension and in adults as haemoptysis. Early diagnosis and early surgical indication avoids the evolution of pulmonary hypertension to unfavourble state of more severe and progressive degrees and also prevents the development of pulmonary systemic collateral circulation, which is mainly responsible for subsequent haemoptysis in the adulthood. We hereby, report the case of an infant who presented with features of lower respiratory tract infection and later diagnosed as isolated congenital hypoplasia of left pulmonary artery and hence planned for proper follow-up for early surgery thereby preventing complications in the future.

  4. The influence of male pheromones on the contractile reactivity of the isolated superficial veins of the nose and face during the estrous cycle in gilts.

    Science.gov (United States)

    Grzegorzewski, W J

    2005-01-01

    This study was designed to determine whether steroid sex pheromones of the boar may affect the contractile activity of the superficial venous vessels of the nose and face in gilts, and in this way contribute to recently discovered humoral transfer of pheromones to the brain and hypophysis. The dependence between the reactivity of nasal and facial veins to male pheromones and the phase of the estrous cycle in gilts was also studied. The gilts were used in the luteal phase of the cycle and in the follicular phase of the cycle. The dorsal nasal, frontal and facial veins were isolated on an appropriate day of the estrous cycle. The isolated rings of veins were treated with androstenone (5alpha-androst-16-en-3-one), androstenol (5alpha-androst-16-en-3-ol) and testosterone (17beta-hydroxy-4-androsten-3-one) in concentrations of 1 or 10 microM. Changes in the contractile activity of the isolated vein segments were measured using isometric transducer and recorded on HSE-ACAD software for Windows. Androstenone--main signaling boar pheromone--induced much stronger reactions of the vessels than androstenol. Androstenone caused significant relaxation of the dorsal nasal and frontal veins, and significant increased tension of the facial vein in the follicular phase of the estrous cycle. The results obtained suggest a direct effect of male pheromones on the contractile reactivity of the superficial veins of the nose and face in the female, and in this way contribute to a humoral pathway for transfer of pheromones to the brain and hypophysis. Moreover, the present study revealed changes in the reactivity during the estrous cycle of the veins, transporting blood from the region of the nasal cavity, to male pheromones participating in the regulation of female reproductive processes.

  5. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism.

    Science.gov (United States)

    Kiani, Mohammad Ali; Forouzan, Arash; Masoumi, Kambiz; Mazdaee, Behnaz; Bahadoram, Mohammad; Kianifar, Hamid Reza; Ravari, Hassan

    2015-01-01

    We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT) scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy.

  6. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Kiani

    2015-01-01

    Full Text Available We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy.

  7. Isolated left ventricular apical hypoplasia with infundibular pulmonary and aortic stenosis: A rare combination

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Jin Il; Jeong, Yeon Joo; Lee, Gee Won; Choi, Jung Hyun; Lee, Ji Won [Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of)

    2013-12-15

    Isolated left ventricular (LV) apical hypoplasia is a rare congenital cardiac anomaly which is not accompanied by other cardiac abnormalities, with the exception of two cases. We report a case of a 33-year-old male patient with isolated LV apical hypoplasia combined with infundibular pulmonary stenosis and aortic stenosis. We review a literature focusing on the characteristic magnetic resonance features and combined cardiac abnormalities.

  8. Post-menopause is the main risk factor for developing isolated pulmonary hypertension in systemic sclerosis.

    Science.gov (United States)

    Scorza, Raffaella; Caronni, Monica; Bazzi, Sonia; Nador, Filippo; Beretta, Lorenzo; Antonioli, Rita; Origgi, Laura; Ponti, Alessandra; Marchini, Maurizio; Vanoli, Massimo

    2002-06-01

    In scleroderma patients, isolated pulmonary hypertension (PHT) has been associated with selected HLA haplotypes, severe impairment of the diffusing capacity for carbon monoxide and the diagnosis of CREST. Most patients with CREST have a late-age onset of the disease, corresponding to the perimenopausal or postmenopausal period. We conducted a retrospective cohort study to determine the role of post-menopause and of the other known clinical and biological markers in the development of isolated pulmonary hypertension in Italian patients with systemic sclerosis. 189 female patients with scleroderma who had no ecographic signs of pulmonary hypertension (PHT) and radiographic signs of lung fibrosis at the first visit and did not develop significant pulmonary fibrosis during the observation time were included. Sixty-three out of 189 patients (33.3%) presented isolated pulmonary hypertension. A severe impairment of diffusing capacity for carbon monoxide at admission was found to be an early predictive element for its development. An increased risk was associated with postmenopausal condition (RR = 5.2, p = 0.000), CREST syndrome (RR = 2.8, p = 0.001) and haplotype HLA-B35 (RR = 2.8; p = 0.002). A significant positive interaction between postmenopausal condition and either HLA-B35 (RR = 15.2; p = 0.000) or the diagnosis of CREST (RR = 14.1; p = 0.000) was found. Postmenopausal condition alone or in combination with HLA-B35 and CREST syndrome is the main risk-factor for developing primary pulmonary hypertension in scleroderma patients. This suggests that hormonal replacement therapy could play a role in preventing isolated PHT in patients with systemic sclerosis.

  9. Non-cardiac complications during pregnancy in women with isolated congenital pulmonary valvar stenosis

    NARCIS (Netherlands)

    Drenthen, W.; Pieper, P. G.; Roos-Hesselink, J. W.; Schmidt, A. C. M.; Mulder, B. J. M.; van Dijk, A. P. J.; Vliegen, H. W.; Sollie, K. M.; Voors, A. A.; Ebels, T.; van Veldhuisen, D. J.

    2006-01-01

    Background: Information on the outcome of pregnancy in patients with pulmonary valvar stenosis is scarce, mostly limited to cardiac complications observed during pregnancy. Objectives: To investigate the magnitude and determinants of non-cardiac and fetal risks during pregnancy of women with isolate

  10. Non-cardiac complications during pregnancy in women with isolated congenital pulmonary valvar stenosis.

    NARCIS (Netherlands)

    Drenthen, W.; Pieper, P.G.; Roos-Hesselink, J.W.; Schmidt, A.C.; Mulder, B.J.M.; Dijk, A.P.J. van; Vliegen, H.W.; Sollie, K.M.; Voors, A.A.; Ebels, T.; Veldhuisen, D.J. van

    2006-01-01

    BACKGROUND: Information on the outcome of pregnancy in patients with pulmonary valvar stenosis is scarce, mostly limited to cardiac complications observed during pregnancy. OBJECTIVES: To investigate the magnitude and determinants of non-cardiac and fetal risks during pregnancy of women with isolate

  11. Varicose Veins

    Science.gov (United States)

    Varicose veins are swollen, twisted veins that you can see just under the skin. They usually occur in ... of the body. Hemorrhoids are a type of varicose vein. Your veins have one-way valves that help ...

  12. The vasorelaxing effect of hydrogen sulfide on isolated rat aortic rings versus pulmonary artery rings

    Institute of Scientific and Technical Information of China (English)

    Yan SUN; Chao-shu TANG; Hong-fang JIN; Jun-bao DU

    2011-01-01

    Aim:To compare the vasorelaxing effects of hydrogen sulfide(H2S)on isolated aortic and pulmonary artery rings and to determine their action mechanisms.Methods:H2S-induced vasorelaxation of isolated rat aortic versus pulmonary artery tings under 95%02 and 5%CO2 was analyzed.The expression of cystathinonine gamma-lyase(CSE),cystathionine beta synthase(CBS),3-memaptopyruvate sulfurtransferase(3MST),SUR2B and Kir6.1 was examined.Results:NaHS caused vasorelaxation of rat aortic and pulmonary artery rings in a dose-dependent mannener NaHS dilated aortic rings to a greater extent(16.4%,38.4%,64.1%,84.3%,and 95.9%at concentrations of 50,100.200, 500,and 1000 μmol/L,respectively)than pulmonary artery rings(10.1%,22.2%.50.6%,73.6%,and 84.6%at concentrations of 50,100,200, 500 and 1000 μmol/L,respectively).The EC50 of the vasorelaxant effect for aortic rings was 152.17 pmol/L,whereas the EC50 for pulmonary artery tings was233.65 μmol/L.The vasorelaxing effect of H2was markedly blocked b y cellular and mitochondrial membrane Km channel blockers in aortic rings(P<0.01).In contrast.only the cellular membrane KATP channel blocker inhibited H2S-induced vasorelaxation in pulmonary artery rings.SUR2B mRNA and protein expression was higher in aortic rings than in pulmonary artery rings.Cystathinonine gamma-lyase(CSE)but not cystathionine beta synthase(CBS)expression in aortic rings was higher than in pulmonary artery rings.3.Mercapto PYruvate sulfurtransferase(3MST)mRNA was lower in aortic rings than in pulmonary artery rings.Conclusion:The vasorelaxing effect of H2S on isolated aortic rings was more pronounced than the effect on pulmonary artery rings at specific concentrations,which might be associated with increased expression of the KATP channel subunit SUR2B.

  13. L-propionylcarnitine and synchronization of spontaneous activity in rat isolated portal vein.

    Science.gov (United States)

    Mancinelli, R

    1993-04-01

    The effects of L-propionylcarnitine (LPC) on spontaneous mechanical and electrical activity of rat portal vein have been studied "in vitro" by means of an isometric technique. Mechanical activity in normal Krebs solution consisted, in the majority of cases, in phasic contractions with variable amplitude, duration and frequency, while electrical activity showed both slow and fast spike potential components. By adding LPC to the medium at doses ranging from 10(-5) M to 10(-3) M, no effect has been observed while at concentrations from 2 x 10(-3) M to 8 x 10(-3) M, after an initial period of total inhibition, a dose-dependent increase in amplitude associated with a parallel decrease in frequency of contraction waves have been observed. The pattern of electrical activity was characterized by a regular slow wave component with the same frequency of the mechanical waves, and by an increase in number, amplitude and frequency of spike potentials. Experiments on synchronization of contractile activity showed that, in presence of LPC, hepatic and mesenteric regions of the vessel contract in close synchronism. These results suggest that LPC synchronizes spontaneous activity of rat portal vein by means of a mechanism which is at the present unknown.

  14. Study of images of projective angles of pulmonary veins by modern imaging modalities%现代影像学技术对肺静脉投射角的测量与研究

    Institute of Scientific and Technical Information of China (English)

    王珏; 张兆琪; 马晓海; 刘佳祎

    2012-01-01

    Objective:In cross-sectional images of contrast enhanced magnetic resonance angiography ( CEMRA) and contrast enhanced computed tomography angiography (CECTA) of pulmonary veins-left atri-um there is a visible angle between every pulmonary vein and the coronary, transversal or sagittal section of hotly. These angles are constant, because the myocardial sleeve in the initiation of every pulmonary vein fasten the shape of the initiation of every pulmonary vein. These are so-called projective angles of pulmonary veins. In this study these angles are measured in many ways. Several possible influence factors and characters of distribu-tion are studied and analysed in order to understand better the characters sectional analomy of pulmonary veins. It is possible to provide anatomic basis for a reasonable choice of appropriate projection angle of X-rays in the angiography of pulmonary veins undergoing atrial fibrillation ablation. Methods:Cross-sectional images of CEM-RA and CECTA of pulmonary veins-left atrium of 137 health objects and patients with atrial fibrillation (AF) were dealed with the technic of post-processing, Projective Angles of Pulmonary to the coronary and transversal sections were measured and analysed statistically. Results;For every projective angles of pulmonary vein threr are no significant differences ( P > 0. 05) between the male group and the female group, between the group of patienls with atrial fibrillation ( AF) and the group of health objects as well as between the group of CEMRA and the group of CECTA. All projective angles of pulmonary veins are leptocurtic ( kurtosis coefficient >0) ex-cept projective angles of the right superior pulmonary vein to the transversal and cross planes are platyeurtic dis- tribution ( kurtosis coefficient f distribution of a!I projeclive angles nf pulmonary veins are positive wkewness distribution ( skewness coefficient >0). Conclusion; Project angles of pulmonary veins are one of real and steady characters of

  15. Imaging features of isolated unilateral pulmonary artery agenesis presenting in adulthood: a review of four cases

    Energy Technology Data Exchange (ETDEWEB)

    Griffin, N. [Royal Brompton and Harefield NHS Trust, London (United Kingdom)]. E-mail: nyreegriffin@hotmail.com; Mansfield, L. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Redmond, K.C. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Dusmet, M. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Goldstraw, P. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Mittal, T.K. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Padley, S. [Royal Brompton and Harefield NHS Trust, London (United Kingdom)

    2007-03-15

    Aim: To highlight the variation in clinical manifestations, imaging and management of four cases of unilateral pulmonary artery agenesis presenting in adulthood. Method: Four patients with unilateral pulmonary artery agenesis were referred to our institution between 1995 and 2005. They underwent a series of investigations, including chest radiography, echocardiography, ventilation perfusion scintigraphy, angiography, computed tomography (CT) and magnetic resonance imaging (MRI). Results: Two of the four patients had absence of the right main pulmonary artery, whilst the remaining two patients had absence of the left main pulmonary artery. One patient showed a restrictive defect on pulmonary function tests. Two patients who had ventilation perfusion scintigraphy showed absent perfusion and reduced ventilation on the affected side. Angiography (where performed), CT and MRI confirmed the anatomy and the presence of multiple collaterals. Bronchiectasis was demonstrated on CT in two patients, with one also demonstrating a mosaic attenuation pattern. One patient had an incidental lung tumour on the side of the agenesis, which was diagnosed as a chondroid hamartoma on histology. Three of the four patients eventually underwent resection of the affected lung. Conclusion: Isolated unilateral pulmonary artery agenesis has a non-specific presentation. Awareness of this condition can lead to earlier diagnosis, with cross-sectional imaging making an important contribution.

  16. Progress about examination of doppler ultasound for fetal pulmonary veins blood flow%多普勒超声检查胎儿肺静脉血流的研究进展

    Institute of Scientific and Technical Information of China (English)

    罗兵

    2013-01-01

    胎儿肺静脉连接左心房与肺内毛细血管,其血流受心脏血流动力学的影响.胎儿肺无呼吸功能,且肺循环阻力高,流速低,血流量小.近年来,胎儿肺静脉一直受到广泛关注,本文就其近年来的相关研究进展做一综述.%Fetal pulmonary veins connect left atrial with lung capillary vessel, affected by heart blood dy-namics.Fetal lung has no ventilate function. In addition, fetal pulmonary circulation has high resistance, low blood flow velocity and small blood flow volume. In recent years, researchers have been paying attention to fetal pulmonary veins. This article is to review the recent studies.

  17. Characterization of the polymorphonuclear leukocyte-induced vasoconstriction in isolated human umbilical veins.

    Science.gov (United States)

    Kerr, S W; Yu, R; Stearns, C D; Haynes, N A; Winquist, R J

    1998-11-01

    We investigated the contractile effects of both activated and unactivated polymorphonuclear leukocytes (PMNs) on human vascular tissue to characterize the influence of human PMNs on vascular tone. PMNs were added either unactivated or after f-met-leu-phe (fMLP) activation (10(-8) M), into tissue chambers containing human umbilical vein segments under either control or cytokine-treated conditions. The activation state of different PMN preparations was measured by immunofluorescence staining of the adhesion glycoproteins Mac-1 and L-selectin. Both unactivated and activated PMNs induced a cell number-dependent (1.5 x 10(5) to 2 x 10(6) cells/ml) vasoconstriction in human umbilical vein segments. This PMN-induced response was not inhibited by treatment with indomethacin (10(-5) M), superoxide dismutase (2 x 10(-7) M) or L-nitro-monomethyl arginine (10(-4) M). However, treatment of PMNs with the leukotriene biosynthesis inhibitor BIRM-270 partially inhibited (-61 +/- 19%, P <.05) the contraction induced only by unactivated PMNs. Moreover, the supernatant from unactivated, but not that from activated, PMNs elicited a contractile response comparable to that from the addition of cells. We observed a significant correlation between the Mac-1/L-selectin ratio of activated PMNs and the contractile response they generated (r = 0.77, P <.05). The activated PMN response had an endothelium-dependent component, whereas the unactivated PMN response was endothelium-independent. These results suggest that human PMNs of varying activation states have the capacity to modulate vascular smooth muscle tone via distinct mechanisms. Unactivated PMNs appear to modulate tone via a secreted product, whereas the more activated phenotype modulates vascular tone via a cognate interaction with the endothelium.

  18. Mesenteric vein thrombosis: CT identification

    Energy Technology Data Exchange (ETDEWEB)

    Rosen, A.; Korobkin, M.; Silverman, P.M.; Dunnick, N.R.; Kelvin, F.M.

    1984-07-01

    Superior mesenteric vein thrombosis was identified on computed tomographic scans in six patients. In each case, contrast-enhanced scans showed a high-density superior mesenteric vein wall surrounding a central filling defect. Four fo the six patients had isolated superior mesenteric vein thrombosis. A fifth patient had associated portal vein and splenic vein thrombosis, and the sixth patient had associated portal vein and inferior vena cava thrombosis. One of the six patients had acute ischemic bowel disease. The other five patients did not have acute ischemic bowel symptoms associated with their venous occlusion. This study defines the computed tomographic appearance of mesenteric vein thrombosis.

  19. [Isolated agenesis of the pulmonary valve in the adult. When is the proper time for surgery?].

    Science.gov (United States)

    Rangel-Abundis, A; Chávez-Pérez, E; Badui, E; García, P; Enciso, R; Sánchez Moreira, L M; Zamora, C; Marín, G

    1993-01-01

    The congenital absence of the pulmonary valves is a rare malformation that mainly affects children, frequently is associated with other cardiac malformations and very rarely is present in adults. Elective or urgent surgery is indicated in the symptomatic child; on the other hand, surgical treatment in the asymptomatic adult with this anomaly is controversial. Based on the reported experience in the literature, in the present article, the authors discuss the therapeutic approach of an asymptomatic 22-year-old male with pulmonary valvular absence with practically no hemodynamic repercussion. Although there had been few reported cases of isolated pulmonary valvular absence, the authors concluded that surgery is not a satisfactory solution and that it might be postponed to the time that patients develop congestive heart failure and or respiratory insufficiency. In order to detect that on time, we recommend a follow up based on periodic echocardiographic studies.

  20. [A Case of Surgical Resection of Isolated Pulmonary Metastasis from Gastric Cancer].

    Science.gov (United States)

    Murata, Tomohiro; Koshiishi, Haruya; Imaizumi, Ken; Okuno, Keisuke; Nakata, Takuya; Hirano, Takayuki; Tokura, Michiyo; Matsuyama, Takatoshi; Hoshino, Mayumi; Kakimoto, Masaki; Goto, Hiroshi; Yoshimura, Tetsunori

    2015-11-01

    We report a rare case of surgical resection for pulmonary metastasis from gastric cancer. A 71-year-old man underwent total gastrectomy for gastric cancer in October 2012. After the operation, he received S-1 chemotherapy for 1 year. In January 2014, computed tomography of the chest showed a nodule shadow with a cavity at S3 in the right lung. Because it showed a tendency to gradually enlarge, we performed an operation in September 2014. The nodule was diagnosed as metastatic adenocarcinoma from gastric cancer on pathology. The patient is being treated with S-1 chemotherapy during follow-up. The pulmonary metastases of gastric cancer often develop along with carcinomatous lymphangiosis or carcinomatous pleurisy, and isolated pulmonary metastasis is rare. A consensus has not been reached about the usefulness of surgical resection, and the accumulation of further cases is required.

  1. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study.

    Science.gov (United States)

    Hoefsloot, Wouter; van Ingen, Jakko; Andrejak, Claire; Angeby, Kristian; Bauriaud, Rosine; Bemer, Pascale; Beylis, Natalie; Boeree, Martin J; Cacho, Juana; Chihota, Violet; Chimara, Erica; Churchyard, Gavin; Cias, Raquel; Daza, Rosa; Daley, Charles L; Dekhuijzen, P N Richard; Domingo, Diego; Drobniewski, Francis; Esteban, Jaime; Fauville-Dufaux, Maryse; Folkvardsen, Dorte Bek; Gibbons, Noel; Gómez-Mampaso, Enrique; Gonzalez, Rosa; Hoffmann, Harald; Hsueh, Po-Ren; Indra, Alexander; Jagielski, Tomasz; Jamieson, Frances; Jankovic, Mateja; Jong, Eefje; Keane, Joseph; Koh, Wo-Jung; Lange, Berit; Leao, Sylvia; Macedo, Rita; Mannsåker, Turid; Marras, Theodore K; Maugein, Jeannette; Milburn, Heather J; Mlinkó, Tamas; Morcillo, Nora; Morimoto, Kozo; Papaventsis, Dimitrios; Palenque, Elia; Paez-Peña, Mar; Piersimoni, Claudio; Polanová, Monika; Rastogi, Nalin; Richter, Elvira; Ruiz-Serrano, Maria Jesus; Silva, Anabela; da Silva, M Pedro; Simsek, Hulya; van Soolingen, Dick; Szabó, Nora; Thomson, Rachel; Tórtola Fernandez, Teresa; Tortoli, Enrico; Totten, Sarah E; Tyrrell, Greg; Vasankari, Tuula; Villar, Miguel; Walkiewicz, Renata; Winthrop, Kevin L; Wagner, Dirk

    2013-12-01

    A significant knowledge gap exists concerning the geographical distribution of nontuberculous mycobacteria (NTM) isolation worldwide. To provide a snapshot of NTM species distribution, global partners in the NTM-Network European Trials Group (NET) framework (www.ntm-net.org), a branch of the Tuberculosis Network European Trials Group (TB-NET), provided identification results of the total number of patients in 2008 in whom NTM were isolated from pulmonary samples. From these data, we visualised the relative distribution of the different NTM found per continent and per country. We received species identification data for 20 182 patients, from 62 laboratories in 30 countries across six continents. 91 different NTM species were isolated. Mycobacterium avium complex (MAC) bacteria predominated in most countries, followed by M. gordonae and M. xenopi. Important differences in geographical distribution of MAC species as well as M. xenopi, M. kansasii and rapid-growing mycobacteria were observed. This snapshot demonstrates that the species distribution among NTM isolates from pulmonary specimens in the year 2008 differed by continent and differed by country within these continents. These differences in species distribution may partly determine the frequency and manifestations of pulmonary NTM disease in each geographical location.

  2. The influence of steroids on the vascular tension of isolated superficial nasal and facial veins in gilts during sexual maturation.

    Science.gov (United States)

    Grzegorzewski, W J; Muszak, J; Tabecka-Łonczyńska, A; Stefańczyk-Krzymowska, S

    2010-01-01

    The arrangement of the superficial facial veins enables blood flow from the nasal cavity into the peripheral circulation by two pathways: through the facial vein into the external jugular vein and through the frontal vein into the cavernous sinus. The venous cavernous sinus is the site where hormones and pheromones permeate from venous blood into the arterial blood supplying the brain and hypophysis. The present study was designed to: (1) determine whether estradiol (E2) and progesterone (P4) affect the vascular tone of the superficial veins of the nose and face in maturating prepubertal gilts (PP) and in prepubertal gilts deprived of ovarian hormones (PPov), and (2) to analyze the immunolocalization of progesterone receptors (PR), and estradiol receptors alpha (ER alpha) and beta (ER beta) in these veins. The influence of hormones on the vascular tension differed depending on the type of vessel, the hormonal status and dose of hormone used. Estradiol decreased the vascular tension in the nasal and facial veins of PP gilts (P tension in the proximal and distal parts of the facial vein (P tension in the proximal segment of the nasal vein and in the distal segment of the frontal and facial veins, and decreased the tension in the distal segment of the nasal and facial veins (P tension of distal and proximal segments of the nasal vein (P tension of the distal part of the nasal vein (P superficial nasal and facial veins. In conclusion, the ovarian steroid hormones that modulate the vascular tension of the nasal and facial veins in prepubertal gilts may influence the transfer of boar pheromones from the nasal mucosa to the brain via local humoral pathway during sexual maturation.

  3. Spoligotype patterns of Mycobacterium tuberculosis isolated from extra pulmonary tuberculosis patients in Puducherry, India

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    G Kandhakumari

    2015-01-01

    Full Text Available Purpose: Genotyping studies like spoligotyping are valuable tools in understanding the genetic diversity and epidemiology of Mycobacterium tuberculosis. Though there are reports of spoligotyping of M. tuberculosis isolates from pulmonary specimens from different parts of India, spoligotyping of extra pulmonary tuberculosis isolates are very few. Puducherry has not yet recorded spoligopatterns of M. tuberculosis from either pulmonary or extra pulmonary (EPTB specimens. The aim of this study is to analyze the spoligotype patterns of EPTB strains circulating in Puducherry and neighboring districts of Tamil Nadu. Materials and Methods: During June 2011 to December 2013, 570 EPTB specimens were processed by culturing on to Lowenstein Jensen (LJ medium and automated Mycobacterium Growth Indicator Tube system (MGIT960. Identification of M. tuberculosis was carried out as per standard procedures, and MPT 64 antigen positivity in a commercial immunochromatography kit. Spoligotyping was carried out at National Institute of Research in Tuberculosis (ICMR, Chennai. Results: M. tuberculosis was isolated from 67 single EPTB specimens (11.8% like pus/cold abscess (34, TB spine (10, pleural fluid (10, urine (5, tissue bit (2, lymph nodes (2, ascitic fluid (2, synovial fluid (1 and endometrial curetting (1. Among 67 isolates with 41 spoligopatterns, EAI lineage with 28 isolates (41.8% predominated followed by 18 orphans (26.9%, 10 Beijing (14.9% and 8 U (11.9%. BOVIS1_BCG (ST482, T1-T2 (ST78 and H3 (ST50 were represented by one strain each (1.5%. C onclusions: Spoligotyping plays a significant role in the epidemiology of tuberculosis. Three spoligotypes, T1-T2 (ST78, EAI6 (ST292 and U (ST1429 are reported for the first time in India.

  4. PI3K and PKC contribute to membrane depolarization mediated by α2-adrenoceptors in the canine isolated mesenteric vein

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    Mutafova-Yambolieva Violeta N

    2005-06-01

    Full Text Available Abstract Background Norepinephrine (NE, a classic neurotransmitter in the sympathetic nervous system, induces vasoconstriction of canine isolated mesenteric vein that is accompanied by a sustained membrane depolarization. The mechanisms underlying the NE-elicited membrane depolarization remain undefined. In the present study we hypothesized that phosphatidylinositol 3-kinase (PI3K and protein kinase C (PKC are involved in the electrical field stimulation (EFS-induced slow membrane depolarization (SMD in canine isolated mesenteric vein. EFS (0.1–2 Hz, 0.1 ms, 15V, 10 s-induced changes in the membrane potential were recorded with a conventional intracellular microelectrode technique and evaluated in the absence and presence of inhibitors of neuronal activity, α-adrenoceptors, membrane ion channels, PI3K, inositol 1,4,5-triphosphate (InsP3 receptors, and PKC. Activation of PI3Kγ and PKCζ in response to exogenous NE and clonidine in the absence and presence of receptor and kinase inhibitors were also determined. Results Contractile responses to NE and clonidine (0.05 – 10 μM were significantly diminished in the presence of yohimbine (0.1 μM. Exogenous NE (0.1 μM and clonidine (1 μM elicited SMD. The resting membrane potential of canine mesenteric vein smooth muscle cells was -68.8 ± 0.8 mV. EFS elicited a biphasic depolarization comprised of excitatory junction potentials and SMD that are purinergic and adrenergic in nature, respectively. The magnitude of the SMD in response to EFS at 0.5 Hz was 9.4 ± 0.7 mV. This response was reduced by 65–98% by the fast Na+ channel inhibitor tetrodotoxin (1 μM, by the inhibitor of N-type Ca2+ channels ω-conotoxin GVIA (5 nM, the non-selective α-adrenoceptor blocker phentolamine (1 μM, the selective α2-adrenoceptor blocker yohimbine (0.1 μM, the ion channel inhibitors niflumic acid (NFA, 100 μM, 5-nitro-2-(3-phenylpropylamino benzoic acid (NPPB, 30 μM, 4,4'-diisothiocyanatostilbene-2

  5. SPECIFIC GYRB SEQUENCE OF MYCOBACTERIUM TUBERCULOSIS CLINICAL ISOLATED FROM SPUTUM OF PULMONARY TUBERCULOSIS PATIENTS IN INDONESIA

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    N. M. Mertaniasih

    2014-12-01

    Full Text Available Background: Indonesia have many different geographic areas which could be various on the variant strains of Mycobacterium tuberculosis. The gyrB gene codes GyrB protein as sub unit compound of Gyrase enzyme that functioning in multiplication of bacteria. Detection of gyrB gene could be a marker of active multiplication of viable bacteria in the specimen from patients; and some of the DNA sequence regions were conserved and specific in the strain of Mycobacterium tuberculosis that would be a marker for identification. This research aims to analyze the sequence of gyrB gene of Mycobacterium tuberculosis clinical isolates from sputum of pulmonary TB patients in Indonesia, and determine the specific region. Method: Mycobacterium tuberculosis clinical isolates have been collected from sputum of the patients with pulmonary TB that live in some area in Indonesia. Isolation and identification of Mycobacterium tuberculosis clinical isolates using standard culture method; sequence analysis using PCR-direct sequencing of the part bases region of gyrB. Results: this study revealed that nucleotide sequence on a fragment 764 bases of gyrB gene Mycobacterium tuberculosis strains among clinical isolates almost identically to a wild type strain Mycobacterium tuberculosis H37Rv and subspecies member of Mycobacterium tuberculosis complex (MTBC, with a little difference of SNPs; there are many difference nucleotide sequence with MOTT and Gram positive or negative bacteria, except Corynebacterium diphtheriae identically with MTBC. Conclusion: the gyrB sequence in Mycobacterium tuberculosis strains among these clinical isolates from sputum of pulmonary TB patients in Indonesia have the conserved specific DNA region that almost identically with wild type strain H37Rv and MTBC.

  6. Spider Veins

    Science.gov (United States)

    ... How to Choose the Best Skin Care Products Spider Veins Treatment Options Learn more about treatment options ... severe venous disease. What you should know about spider veins The exact cause of spider veins is ...

  7. Isolated pulmonary candidiasis in a patient with diabetes mellitus: A rare case report

    Science.gov (United States)

    Hakamifard, Atousa; Khorvash, Farzin; Raisi, Arash

    2016-01-01

    Fungal infections are as a cause of morbidity and mortality in immunocompromise patients. Because the respiratory tract is colonized with Candida, the presence of this agent in respiratory specimens makes the diagnosis of Candida pneumonia problematic. Candida pneumonia is a rare infection, and the majority of cases are secondary to hematogenous dissemination. Furthermore isolated Candida pneumonia originating from endotracheal inoculation is an extremely rare entity. We describe a case of isolated pulmonary candidiasis in the form multiple nodular lesions in a patient with long-term history of diabetes mellitus without evidence of fungemia or systemic involvement who responded to antifungal therapy. PMID:27656615

  8. BM-12CEREBRAL INFARCTION SECONDARY TO PULMONARY VEIN COMPRESSION AND LEFT ATRIAL APPENDAGE TUMOR INFILTRATION AS THE PRESENTING SIGN OF METASTATIC SQUAMOUS CELL CARCINOMA OF THE BASE OF THE TONGUE

    Science.gov (United States)

    Dredla, Brynn; Siegel, Jason; Jaeckle, Kurt

    2014-01-01

    BACKGROUND: Squamous cell carcinoma of the tongue has been documented to metastasize to the lungs and rarely involve the heart. The majority of documented cases of cardiac metastases are from postmortem analysis. Cases of sudden death, syncope, and dyspnea have been reported. However, stroke and tumor embolization to the brain as the initial clinical presentation has not been documented in the English literature. METHODS: Case Report. RESULTS: This case addresses a 61-year-old male with Stage IVA squamous cell carcinoma of the left tongue base, believed to be in remission after systemic chemotherapy and local radiation, who presented with acute cerebral infarctions involving multiple vascular territories. Cardiac CT obtained during stroke etiology evaluation displayed metastatic disease compressing the pulmonary vein resulting in virtual pulmonary vein thrombus. Transthoracic echocardiogram was negative for cardiac valvular pathology. Anticoagulation was initiated. Twelve days later he returned with recurrent strokes and suspected tumor embolization to the brain. Imaging displayed left atrial appendage structural abnormality highly suggestive of tumor infiltration. CONCLUSION: Cardiac metastases are rare and non-myxomatous tumor embolization to the brain even rarer especially in the setting of cerebral infarction due to pulmonary vein thrombus. Here we describe a case of multiple acute cerebral infarctions appearing from a proximal source refractory to anticoagulation. Thromboembolism from the pulmonary vein and tumor embolization from cardiac metastases are the likely mechanisms for his clinical presentation and radiographic findings. This case demonstrates the complexity of multiple stroke etiologies in one patient and the importance of cardiac imaging in stroke evaluation, particularly in the setting of a patient with a history of cancer.

  9. Strain Diversity of Mycobacterium tuberculosis Isolates from Pulmonary Tuberculosis Patients in Afar Pastoral Region of Ethiopia

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    Mulugeta Belay

    2014-01-01

    Full Text Available Data on genotypic diversity of Mycobacterium tuberculosis complex (MTBC is important to understand its epidemiology, human adaptation, clinical phenotypes, and drug resistance. This study aimed to characterize MTBC clinical isolates circulating in a predominantly pastoralist area in Ethiopia, a country where tuberculosis is the second leading cause of mortality. Culture of sputum samples collected from a total of 325 pulmonary TB suspects was done to isolate MTBC. Spoligotyping was used to characterize 105 isolates from culture positive slopes and the result was compared with an international database. Forty-four spoligotype patterns were observed to correspond to 35 shared-types (SITs containing 96 isolates and 9 orphan patterns; 27 SITs containing 83 isolates matched a preexisting shared-type in the database, whereas 8 SITs (n=13 isolates were newly created. A total of 19 SITs containing 80 isolates were clustered within this study (overall clustering of 76.19%. Three dominant lineages (T, CAS, and Manu accounted for 76.19% of the isolates. SIT149/T3-ETH was one of the two most dominant sublineages. Unlike previous reports, we show that Manu lineage strains not only constitute a dominant lineage, but are also associated with HIV infection in Afar region of Ethiopia. The high level of clustering suggests the presence of recent transmission that should be further studied using additional genotyping markers.

  10. Taspine isolated from Radix et Rhizoma Leonticis inhibits growth of human umbilical vein endothelial cell (HUVEC) by inducing its apoptosis.

    Science.gov (United States)

    Zhang, Yanmin; He, Langchong; Zhou, Yali

    2008-01-01

    The present study was to evaluate the effects of taspine isolated from Radix et Rhizoma Leonticsi on the growth and apoptosis of human umbilical vein endothelial cell (HUVEC) line by MTT and flow cytometer, respectively. At the same time, a series of changes were observed in HUVEC treated by taspine, including microstructure, protein expression of bax, bcl-2 and VEGF. The change of microstructure was observed by transmission electron microscope (TEM). The protein expression of bax and bcl-2 was detected by immunohistochemistry (IHC), and VEGF protein secreted was determined by enzyme-linked immunosorbent assay (ELISA). The results showed taspine could inhibit growth and induce apoptosis of HUVEC in a dose-dependent manner. Cell cycle was significantly stopped at the S phase. Under electronic microscope, the morphology of HUVEC treated with taspine showed nuclear karyopycnosis, chromatin agglutination and typical apoptotic body. Bcl-2 and VEGF expressions were decreased and bax expression was increased. All these results demonstrate that taspine has an inhibitory effect on growth of HUVEC and can induce its apoptosis.

  11. Isolated right pulmonary artery agenesis with aplasia of right upper lobe and with anomalous arterial supply from celiac axis, anomalous venous drainage

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    Tushar Madhav Kalekar

    2015-01-01

    Full Text Available Pulmonary artery agenesis is the complete absence of the right or left pulmonary artery. This lesion is commonly associated with other cardiac anomalies and is usually diagnosed incidentally. Unilateral absence of pulmonary artery with lung hypoplasia is very rare. Ipsilateral hypoplastic or absent central pulmonary artery in these patients will have a systemic arterial supply to peripheral pulmonary arteries of the affected lung from the descending thoracic or upper abdominal aorta. These findings are usually characterized as pulmonary veno lobar syndrome or scimitar syndrome when associated with ipsilateral total or partial anomalous pulmonary venous return from the lower lobe which drains into the inferior vena cava or less commonly to the hepatic, azygous, or portal vein, or into the right atrium and lung agenesis/hypoplasia.

  12. Effectiveness and Safety of the Tempofilter II to Prevent the Occurrence of Pulmonary Thromboembolism in Patients with Lower Extremity Deep Vein Thrombosis

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    Baek, Byung Hyun; Jung, Min Young; Oh, Hyun Jun; Kim, Jae Kyu; Lee, Ho Kyun [Chonnam National University College of Medicine, Gwangju (Korea, Republic of); Jang, Nam Kyu [Chonnam National University Hospital, Hwasun (Korea, Republic of)

    2010-04-15

    To evaluate the efficacy and safety of the Tempofilter II for the prevention of a pulmonary thromboembolism (PTE) in patients with lower extremity deep vein thrombosis (DVT). Between January 2007 and December 2008, thirteen patients with lower extremity DVT whom were implanted with the Tempofilter II to prevent PTE were analyzed. A chest CT was compared before and after filter placement, to evaluate effectiveness of preventing PTE. Clinical symptoms of PTE were checked. Fluoroscopy and a plain radiograph were examined to evaluate filter status. The tempofilter II was successfully inserted in 13 patients. Nine patients underwent endovascular treatment after filter insertion. Trapping of thrombus was evaluated by following CT, venography, and filter retrieval. Trapped thrombus was detected in four patients by CT or retrieved filter. Two patients showed a decrease in thrombus in a follow-up chest CT. Not all patients showed symptoms of PTE. One filter was surgically removed due to the detachment of the anchoring device. The placement and retrieval of the Tempofilter II is feasible and effective for the prophylaxis of PTE in patients with lower extremity DVT; especially for patients that underwent subsequent endovascular treatment

  13. [Predictors of Efficacy of Radiofrequency Ablation of Pulmonary Veins Performed During Coronary Bypass Surgery in Patients With Ischemic Heart Disease and Paroxysmal Atrial Fibrillation].

    Science.gov (United States)

    Iskenderov, B G; Rakhmatullov, A F

    2015-01-01

    We performed simultaneous coronary artery bypass grafting (CABG) and radiofrequency ablation (RFA) ostia of pulmonary veins in 254 patients (147 men and 107 women) with ischemic heart disease and paroxysmal atrial fibrillation (AF). In-hospital mortality in patients with early recurrence of AF was 8.4%, in patients without recurrence of AF 1.9% (χ2 = 4.65; p = 0.03). The patients were followed-up during 12 months after operation. During follow-up 166 patients (69.5%) had no recurrence of AF without receiving antiarrhythmic drugs (AAP), 33 patients (13.8%) had recurrences of AF, and 40 patients (16.7%) receiving AAD had repeated rare paroxysms of AF. Main predictors of late AF recurrence were age > 65 years, AF duration > 5 years, preoperative atrial effective refractory period 50 mm, glomerular filtration rate heart due to CABG and RFA, use of β-blockers, angiotensin converting enzyme inhibitors and aldosterone antagonists were associated with the preservation of a stable sinus rhythm. The cardiovascular mortality during 12 months follow-up accounted for 2.1% and 1.2% in groups of patients with and without late recurrences of AF respectively (p > 0.05) to coronary artery bypass grafting surgery and RFA, taking drugs--β-blockers, angiotensin converting enzyme inhibitors and aldosterone antagonists--were associated with the preservation of a stable sinus rhythm.

  14. Pulmonary Embolism and Subclavian Vein Thrombosis in a Patient with Parathyroid Carcinoma: Case Report and Review of Literature.

    Science.gov (United States)

    Manosroi, Worapaka; Wannasai, Komson; Phimphilai, Mattabhorn

    2015-09-01

    Parathyroid carcinoma is a rare etiology of primary hyperparathyroidism responsible for 0.4 to 5.2% of all primary hyperparathyroidism cases. The overt hyperparathyroid bone or renal disease with palpable neck mass, as well as severe hypercalcemia with extremely high parathyroid hormone, are clinical parameters raising the suspicionforparathyroid carcinoma. However a definite diagnosis can be confirmed only by examining the histopathology of the tumor. The curative treatment solely depends on an en bloc surgical approach. Therefore, preoperative clinical diagnosis of carcinoma is essentialfor optimal surgical planning. Thepresent study reported asymptomatic subclavian vein thrombosis andpulmonary embolism in parathyroid carcinoma, suggesting paraneoplastic syndrome of hypercoagulability in this cancer type. The presence of this paraneoplastic syndrome in a case of overt clinical hyperparathyroidism in addition to a palpable neck mass indicated the diagnosis of carcinoma preoperatively in the present patient, which led to an en bloc surgical plan. Since this paraneoplastic syndrome can be asymptomatic, the exploration ofthis syndrome by a commonly used imaging technique for parathyroid tumor localization, computerized tomography, would enable a preoperative diagnosis of cancer especially in an equivocal situation.

  15. High isoniazid resistance rates in rifampicin susceptible Mycobacterium tuberculosis pulmonary isolates from Pakistan.

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    Naima Fasih

    Full Text Available BACKGROUND: Rapid new diagnostic methods (including Xpert MTB/RIF assay use rifampicin resistance as a surrogate marker for multidrug resistant tuberculosis. Patients infected with rifampicin susceptible strains are prescribed first line anti-tuberculosis therapy. The roll out of such methods raises a concern that strains with resistance to other first line anti-tuberculosis drugs including isoniazid will be missed and inappropriate treatment given. To evaluate implications of using such methods review of resistance data from high burden settings such as ours is essential. OBJECTIVE: To determine resistance to first line anti-tuberculosis drugs amongst rifampicin susceptible pulmonary Mycobacterium tuberculosis (MTB isolates from Pakistan. MATERIALS AND METHODS: Data of pulmonary Mycobacterium tuberculosis strains isolated in Aga Khan University Hospital (AKUH laboratory (2009-2011 was retrospectively analyzed. Antimicrobial susceptibility profile of rifampicin susceptible isolates was evaluated for resistance to isoniazid, pyrazinamide, ethambutol, and streptomycin. RESULTS: Pulmonary specimens submitted to AKUH from 2009 to 2011 yielded 7738 strains of Mycobacterium tuberculosis. These included 54% (n 4183 rifampicin susceptible and 46% (n: 3555 rifampicin resistant strains. Analysis of rifampicin susceptible strains showed resistance to at least one of the first line drugs in 27% (n:1133 of isolates. Overall isoniazid resistance was 15.5% (n: 649, with an isoniazid mono-resistance rate of 4% (n: 174. Combined resistance to isoniazid, pyrazinamide, and ethambutol was noted in 1% (n: 40, while resistance to isoniazid, pyrazinamide, ethambutol, and streptomycin was observed in 1.7% (n: 70 of strains. CONCLUSIONS: Our data suggests that techniques (including Xpert MTB/RIF assay relying on rifampicin susceptibility as an indicator for initiating first line therapy will not detect patients infected with MTB strains resistant to other first line

  16. Fibroblast growth factor 23 dysregulates late sodium current and calcium homeostasis with enhanced arrhythmogenesis in pulmonary vein cardiomyocytes.

    Science.gov (United States)

    Huang, Shih-Yu; Chen, Yao-Chang; Kao, Yu-Hsun; Hsieh, Ming-Hsiung; Lin, Yung-Kuo; Chung, Cheng-Chih; Lee, Ting-I; Tsai, Wen-Chin; Chen, Shih-Ann; Chen, Yi-Jen

    2016-10-25

    Fibroblast growth factor 23 (FGF23), elevated in chronic renal failure, increases atrial arrhythmogenesis and dysregulates calcium homeostasis. Late sodium currents (INa-Late) critically induces ectopic activity of pulmoanry vein (the most important atrial fibrillation trigger). This study was to investigate whether FGF23 activates the INa-Late leading to calcium dysregulation and increases PV arrhythmogenesis. Patch clamp, western blot, and confocal microscopy were used to evaluate the electrical activities, calcium homeostasis, and mitochondrial reactive oxygen species (ROS) in PV cardiomyocytes with or without FGF23 (0.1 or 1 ng/mL) incubation for 4~6 h. Compared to the control, FGF23 (1 ng/mL, but not 0.1 ng/mL)-treated PV cardiomyocytes had a faster beating rate. FGF23 (1 ng/mL)-treated PV cardiomyocytes had larger INa-Late, calcium transients, and mitochondrial ROS than controls. However, ranolazine (an inhibitor of INa-Late) attenuated FGF23 (1 ng/mL)-increased beating rates, calcium transients and mitochondrial ROS. FGF23 (1 ng/mL)-treated PV cardiomyocytes exhibited larger phosphorylation of calcium/calmodulin-dependent protein kinase II (CaMKII). Chelerythrine chloride (an inhibitor of protein kinase C) decreased INa-Late in FGF23 (1 ng/mL)-treated PV cardiomyocytes. However, KN93 (a selective CaMKII blocker) decreased INa-Late in control and FGF23 (1 ng/mL)-treated PV cardiomyocytes to a similar extent. In conclusion, FGF23 increased PV arrhythmogenesis through sodium and calcium dysregulation by acting protein kinase C signaling.

  17. Effects of inorganic cations on K+-, 5-hydroxytryptamine- and noradrenaline-induced contractions of the isolated rat jugular vein and aorta

    NARCIS (Netherlands)

    Gouw, M.A.M.; Wilffert, B.; Van Zwieten, P.A.

    1990-01-01

    We investigated the inhibitory effects of 1 mM of the inorganic cations, La3+, Cd2+, Mn2+, Ni2+and Co2+on contractions induced by K+(100 mM) and 5-hydroxytryptamine (5-HT, 10-5M) in the isolated rat jugular vein and on contractions induced by K+(100 mM), 5-HT (10-5) and noradrenaline (NA, 10-5M) in

  18. Common femoral vein reconstruction using internal jugular vein after blast injury.

    Science.gov (United States)

    Holt, Andrew M; West, Charles A; Davis, James A; Gilani, Ramyar; Askenasy, Eric

    2014-10-01

    Common femoral vein traumatic injuries are rare. Surgical management is controversial and by nature case specific. In this report, we present an unusual case of an isolated common femoral vein injury from a gunshot blast repaired with an interposition internal jugular vein bypass. To our knowledge, this is the first reported case of an isolated common femoral vein reconstructed in this manner.

  19. Visualization of pulmonary vein stenosis after radio frequency ablation for treatment of atrial fibrillation using multidetector computed tomography with retrospective gating; Darstellung von Pulmonalvenenstenosen nach Radiofrequenzablation zur Behandlung von Vorhofflimmern unter Verwendung der Multidetektor Computertomographie mit retrospektivem Gating

    Energy Technology Data Exchange (ETDEWEB)

    Trabold, T.; Kuettner, A.; Heuschmid, M.; Kopp, A.F.; Claussen, C.D. [Radiologische Klinik, Abt. fuer Radiologische Diagnostik, Univ. Tuebingen (Germany); Burgstahler, C.; Mewis, C.; Schroeder, S.; Kuehlkamp, V. [Medizinische Klinik III, Abt. fuer Kardiologie, Univ. Tuebingen (Germany)

    2003-01-01

    Purpose: With the number of radio frequency ablations (RFA) for treatment of chronic atrial fibrillation increasing, the diagnostic evaluation for RFA associated pulmonary vein stenosis is getting more important. This study investigates the feasibility of the visualization of pulmonary vein stenosis using non-invasive multidetector computed tomography. Materials and Methods: Twenty-eight patients were examined following RFA-treatment. A 4-slice (20 patients) and a 16-slice (8 patients) multidetector CT scanner (SOMATOM Volume Zoom and Sensation 16, Siemens, Forchheim, Germany) with retrospective gating was used to assess the pulmonary veins. Lesion severity was determined on a semi-quantitative scale (< 30%, 30 - 50%, > 50%). Results: CT was performed without any complications in all patients. Diagnostic image quality could be obtained in all examinations. The pulmonary veins showed lesions < 30% in four patients, lesions of 30 - 50% in five patients and a stenosis > 50% in one patient. Eighteen patients showed no lesions. Conclusion: Multidetector CT of the pulmonary veins seems to be able to visualize high-grade and low-grade lesions, but larger catheter-controlled studies are needed for further assessment of the diagnostic accuracy and clinical reliability of this noninvasive method. (orig.) [German] Ziel: Mit steigender Anzahl von Radiofrequenzablationen (RFA) zur Behandlung des chronischen Vorhofflimmerns wird die Diagnostik von RFA assoziierten Pulmonalvenenstenosen zunehmend wichtiger. Ziel dieser Studie war es, die Moeglichkeit der Darstellung von Pulmonalvenenstenosen mittels der nichtinvasiven Multidetektor-Computertomographie zu untersuchen. Material und Methoden: 28 Patienten wurden im Anschluss an eine RFA-Behandlung untersucht. Die Untersuchung wurde an einem 4-Zeilen- (20 Patienten) bzw. 16-Zeilen- (8 Patienten) Multidetektor-CT (SOMATOM Volume Zoom bzw. Sensation 16, Siemens, Forchheim, Germany) mit retrospektivem Gating durchgefuehrt. Der

  20. The Prediction of the Risk Level of Pulmonary Embolism and Deep Vein Thrombosis through Artificial Neural Network.

    Science.gov (United States)

    Agharezaei, Laleh; Agharezaei, Zhila; Nemati, Ali; Bahaadinbeigy, Kambiz; Keynia, Farshid; Baneshi, Mohammad Reza; Iranpour, Abedin; Agharezaei, Moslem

    2016-10-01

    Venous thromboembolism is a common cause of mortality among hospitalized patients and yet it is preventable through detecting the precipitating factors and a prompt diagnosis by specialists. The present study has been carried out in order to assist specialists in the diagnosis and prediction of the risk level of pulmonary embolism in patients, by means of artificial neural network. A number of 31 risk factors have been used in this study in order to evaluate the conditions of 294 patients hospitalized in 3 educational hospitals affiliated with Kerman University of Medical Sciences. Two types of artificial neural networks, namely Feed-Forward Back Propagation and Elman Back Propagation, were compared in this study. Through an optimized artificial neural network model, an accuracy and risk level index of 93.23 percent was achieved and, subsequently, the results have been compared with those obtained from the perfusion scan of the patients. 86.61 percent of high risk patients diagnosed through perfusion scan diagnostic method were also diagnosed correctly through the method proposed in the present study. The results of this study can be a good resource for physicians, medical assistants, and healthcare staff to diagnose high risk patients more precisely and prevent the mortalities. Additionally, expenses and other unnecessary diagnostic methods such as perfusion scans can be efficiently reduced.

  1. Isolation of human umbilical vein endothelial cells and their use in the study of neutrophil transmigration under flow conditions.

    Science.gov (United States)

    Ganguly, Anutosh; Zhang, Hong; Sharma, Ritu; Parsons, Sean; Patel, Kamala D

    2012-08-08

    Neutrophils are the most abundant type of white blood cell. They form an essential part of the innate immune system. During acute inflammation, neutrophils are the first inflammatory cells to migrate to the site of injury. Recruitment of neutrophils to an injury site is a stepwise process that includes first, dilation of blood vessels to increase blood flow; second, microvascular structural changes and escape of plasma proteins from the bloodstream; third, rolling, adhesion and transmigration of the neutrophil across the endothelium; and fourth accumulation of neutrophils at the site of injury. A wide array of in vivo and in vitro methods has evolved to enable the study of these processes. This method focuses on neutrophil transmigration across human endothelial cells. One popular method for examining the molecular processes involved in neutrophil transmigration utilizes human neutrophils interacting with primary human umbilical vein endothelial cells (HUVEC). Neutrophil isolation has been described visually elsewhere; thus this article will show the method for isolation of HUVEC. Once isolated and grown to confluence, endothelial cells are activated resulting in the upregulation of adhesion and activation molecules. For example, activation of endothelial cells with cytokines like TNF-α results in increased E-selectin and IL-8 expression. E-selectin mediates capture and rolling of neutrophils and IL-8 mediates activation and firm adhesion of neutrophils. After adhesion neutrophils transmigrate. Transmigration can occur paracellularly (through endothelial cell junctions) or transcellularly (through the endothelial cell itself). In most cases, these interactions occur under flow conditions found in the vasculature. The parallel plate flow chamber is a widely used system that mimics the hydrodynamic shear stresses found in vivo and enables the study of neutrophil recruitment under flow condition in vitro. Several companies produce parallel plate flow chambers and

  2. Prenatal diagnosis of isolated right pulmonary agenesis using sonography alone: case study and systematic literature review.

    Science.gov (United States)

    Meller, Cesar H; Morris, R Katie; Desai, Tarak; Kilby, Mark D

    2012-12-01

    Pulmonary agenesis is a rare congenital anomaly, estimated to complicate around 1 per 15,000 pregnancies, in which there is complete absence or severe hypoplasia of one or both lungs, frequently associated with other abnormalities. A prospective prenatal diagnosis is a challenge, and a substantial proportion of cases are diagnosed by fetal magnetic resonance imaging, postnatal computed tomography, or postmortem. Thus, there are only a few reported cases of prenatal diagnosis in the literature. We report the prenatal diagnosis of isolated right lung agenesis diagnosed with sonography alone at a relatively early gestational age. We also present a systematic review of the literature for this condition to accompany this case study.

  3. Simultaneous Acute Pulmonary Embolism and Isolated Septal Myocardial Infarction in a Young Patient

    Directory of Open Access Journals (Sweden)

    Claudia Burkhardt

    2016-09-01

    Full Text Available We report here the case of a young patient with a simultaneous isolated septal myocardial infarction (MI and pulmonary embolism (PE. The aim was to describe a rare clinical entity and to explain why these two pathologies were present at the same time in a young patient.
 A review of literature was established. An interventional cardiologist, an interventional radiologist and a lung specialist were consulted. The diagnostic workup revealed only heterozygous Factor Leiden V mutation. This presentation was probably fortuitous, but worth reporting to our opinion.

  4. Calcium transient evoked by nicotine in isolated rat vagal pulmonary sensory neurons.

    Science.gov (United States)

    Xu, Jennings; Yang, Wenbin; Zhang, Guangfan; Gu, Qihai; Lee, Lu-Yuan

    2007-01-01

    It has been shown that inhaled cigarette smoke activates vagal pulmonary C fibers and rapidly adapting receptors (RARs) in the airways and that nicotine contained in the smoke is primarily responsible. This study was carried out to determine whether nicotine alone can activate pulmonary sensory neurons isolated from rat vagal ganglia; the response of these neurons was determined by fura-2-based ratiometric Ca(2+) imaging. The results showed: 1) Nicotine (10(-4) M, 20 s) evoked a transient increase in intracellular Ca(2+) concentration ([Ca(2+)](i)) in 175 of the 522 neurons tested (Delta[Ca(2+)](i) = 142.2 +/- 12.3 nM); the response was reproducible, with a small reduction in peak amplitude in the same neurons when the challenge was repeated 20 min later. 2) A majority (59.7%) of these nicotine-sensitive neurons were also activated by capsaicin (10(-7) M). 3) 1,1-Dimethyl-4-phenylpiperazinium iodide (DMPP; 10(-4) M, 20 s), a selective agonist of the neuronal nicotinic acetylcholine receptors (NnAChRs), evoked a pattern of response similar to that of nicotine. 4) The responses to nicotine and DMPP were either totally abrogated or markedly attenuated by hexamethonium (10(-4) M). 5) In anesthetized rats, right atrial bolus injection of nicotine (75-200 mug/kg) evoked an immediate (latency <1-2 s) and intense burst of discharge in 47.8% of the pulmonary C-fiber endings and 28.6% of the RARs tested. In conclusion, nicotine exerts a direct stimulatory effect on vagal pulmonary sensory nerves, and the effect is probably mediated through an activation of the NnAChRs expressed on the membrane of these neurons.

  5. Usefulness of maximal oxygen pulse in timing of pulmonary valve replacement in patients with isolated pulmonary regurgitation.

    Science.gov (United States)

    Legendre, Antoine; Richard, Ruddy; Pontnau, Florence; Jais, Jean-Philippe; Dufour, Marc; Grenier, Olivier; Mousseaux, Elie; Ladouceur, Magalie; Iserin, Laurence; Bonnet, Damien

    2016-10-01

    Patients with pulmonary regurgitation after tetralogy of Fallot repair have impaired aerobic capacity; one of the reasons is the decreasing global ventricular performance at exercise, reflected by decreasing peak oxygen pulse. The aims of our study were to evaluate the impact of pulmonary valve replacement on peak oxygen pulse in a population with pure pulmonary regurgitation and with different degrees of right ventricular dilatation and to determine the predictors of peak oxygen pulse after pulmonary valve replacement. The mean and median age at pulmonary valve replacement was 27 years. Mean pre-procedural right ventricular end-diastolic volume was 182 ml/m2. Out of 24 patients, 15 had abnormal peak oxygen pulse before pulmonary valve replacement. We did not observe a significant increase in peak oxygen pulse after pulmonary valve replacement (p=0.76). Among cardiopulmonary test/MRI/historical pre-procedural parameters, peak oxygen pulse appeared to be the best predictor of peak oxygen pulse after pulmonary valve replacement (positive and negative predictive values, respectively, 0.94 and 1). After pulmonary valve replacement, peak oxygen pulse was well correlated with left ventricular stroke and end-diastolic volumes (r=0.67 and 0.68, respectively). Our study confirms the absence of an effect of pulmonary valve replacement on peak oxygen pulse whatever the initial right ventricular volume, reflecting possible irreversible right and/or left ventricle lesions. Pre-procedural peak oxygen pulse seemed to well predict post-procedural peak oxygen pulse. These results encourage discussions on pulmonary valve replacement in patients showing any decrease in peak oxygen pulse during their follow-up.

  6. Nocardia kroppenstedtii sp. nov., an actinomycete isolated from a lung transplant patient with a pulmonary infection.

    LENUS (Irish Health Repository)

    Jones, Amanda L

    2014-03-01

    A novel actinomycete, strain N1286(T), isolated from a lung transplant patient with a pulmonary infection, was provisionally assigned to the genus Nocardia. The strain had chemotaxonomic and morphological properties typical of members of the genus Nocardia and formed a distinct phyletic line in the Nocardia 16S rRNA gene tree. Isolate N1286(T) was most closely related to Nocardia farcinica DSM 43665(T) (99.8% gene sequence similarity) but could be distinguished from the latter by the low level of DNA-DNA relatedness. These strains were also distinguishable on the basis of a broad range of phenotypic properties. It is concluded that strain N1286(T) represents a novel species of the genus Nocardia for which the name Nocardia kroppenstedtii sp. nov. is proposed. The type strain is N1286(T) ( = DSM 45810(T) = NCTC 13617(T)).

  7. Differential haemostatic risk factors for pregnancy-related deep-vein thrombosis and pulmonary embolism: a population-based case-control study.

    Science.gov (United States)

    Bergrem, Astrid; Dahm, Anders E A; Jacobsen, Anne Flem; Sandvik, Leiv; Sandset, Per Morten

    2012-12-01

    Limited data exist on thrombophilia and the risk of venous thrombosis (VT) during pregnancy and postpartum. The objectives of the present study were to investigate the role of haemostatic risk factors for pregnancy-related VT and their phenotypic expression in deep-vein thrombosis (DVT) and pulmonary embolism (PE). Total 313 cases with objectively verified first time VT and 353 controls were selected from a source population of 377,155 women with 613,232 pregnancies. The adjusted odds ratio (aOR) for pregnancy-related VT was 1.7 (95% confidence interval [CI] 1.1-2.8) for women with factor VIII >90th percentile. The aOR for VT for endogenous thrombin potential and D-dimer values >90th percentiles were 1.8 (95% CI 1.1-3.0) and 2.1 (95% CI 1.3-3.3), respectively. Factor IX >90th percentile or free protein S ≤the 5th percentile increased the risk for PE, and the aORs were 2.4 (95% CI 1.1-5.0) and 3.1 (95% CI 1.3-7.2), respectively. Women carrying the factor V Leiden (F5 rs6025) polymorphism, or who had reduced sensitivity to activated protein C (aPC) in the absence of F5 rs6025, had increased risk for DVT, with unadjusted ORs 7.7 (95% CI 4.7-12.7) and 3.5 (95% CI 2.2-5.4), respectively. Women with a history of pregnancy-related VT showed activation of coagulation and had elevated factor VIII. Furthermore, high levels of factor IX and low levels of free protein S were associated with increased risk for PE, whereas aPC resistance and F5 rs6025 were risk factors for DVT and not PE.

  8. A common Shox2-Nkx2-5 antagonistic mechanism primes the pacemaker cell fate in the pulmonary vein myocardium and sinoatrial node.

    Science.gov (United States)

    Ye, Wenduo; Wang, Jun; Song, Yingnan; Yu, Diankun; Sun, Cheng; Liu, Chao; Chen, Fading; Zhang, Yanding; Wang, Fen; Harvey, Richard P; Schrader, Laura; Martin, James F; Chen, YiPing

    2015-07-15

    In humans, atrial fibrillation is often triggered by ectopic pacemaking activity in the myocardium sleeves of the pulmonary vein (PV) and systemic venous return. The genetic programs that abnormally reinforce pacemaker properties at these sites and how this relates to normal sinoatrial node (SAN) development remain uncharacterized. It was noted previously that Nkx2-5, which is expressed in the PV myocardium and reinforces a chamber-like myocardial identity in the PV, is lacking in the SAN. Here we present evidence that in mice Shox2 antagonizes the transcriptional output of Nkx2-5 in the PV myocardium and in a functional Nkx2-5(+) domain within the SAN to determine cell fate. Shox2 deletion in the Nkx2-5(+) domain of the SAN caused sick sinus syndrome, associated with the loss of the pacemaker program. Explanted Shox2(+) cells from the embryonic PV myocardium exhibited pacemaker characteristics including node-like electrophysiological properties and the capability to pace surrounding Shox2(-) cells. Shox2 deletion led to Hcn4 ablation in the developing PV myocardium. Nkx2-5 hypomorphism rescued the requirement for Shox2 for the expression of genes essential for SAN development in Shox2 mutants. Similarly, the pacemaker-like phenotype induced in the PV myocardium in Nkx2-5 hypomorphs reverted back to a working myocardial phenotype when Shox2 was simultaneously deleted. A similar mechanism is also adopted in differentiated embryoid bodies. We found that Shox2 interacts with Nkx2-5 directly, and discovered a substantial genome-wide co-occupancy of Shox2, Nkx2-5 and Tbx5, further supporting a pivotal role for Shox2 in the core myogenic program orchestrating venous pole and pacemaker development.

  9. Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism: A randomized, placebo-controlled, double-blind trial.

    Science.gov (United States)

    den Heijer, Martin; Willems, Huub P J; Blom, Henk J; Gerrits, Wim B J; Cattaneo, Marco; Eichinger, Sabine; Rosendaal, Frits R; Bos, Gerard M J

    2007-01-01

    The Vitamins and Thrombosis (VITRO) study investigated the effect of homocysteine lowering by daily supplementation of B vitamins on the risk reduction of deep vein thrombosis (DVT) and pulmonary embolism (PE). Patients between 20 to 80 years old with a first objectively confirmed proximal DVT or PE in the absence of major risk factors and a homocysteine concentration above the 75th percentile of a reference group were asked to participate (hyperhomocysteinemic group). A similar study was conducted in a random sample of patients with a homocysteine below the 75th percentile of the reference group (normohomocysteinemic group). After informed consent was obtained, patients were randomized to daily multivitamin supplementation (5 mg folic acid, 50 mg pyridoxine, and 0.4 mg cyanocobalamin) or placebo and were followed for 2.5 years. End points were objectively diagnosed recurrent DVT or PE. A total of 701 patients were enrolled (360 in the hyperhomocysteinemic and 341 in the normohomocysteinemic group). The number of recurrent events of venous thrombosis was 43 of 353 in the vitamin group (54/1000 py) and 50 of 348 in the placebo group (64/1000 py). The hazard ratio associated with vitamin treatment was 0.84 (95% CI, 0.56-1.26): 1.14 (95% CI, 0.65-1.98) in the hyperhomocysteinemic group and 0.58 (95% CI, 0.31-1.07) in the normohomocysteinemic group. The results of our study do not show that homocysteine lowering by B vitamin supplementation prevents recurrent venous thrombosis.

  10. Rotational X-ray angiography: a method for intra-operative volume imaging of the left-atrium and pulmonary veins for atrial fibrillation ablation guidance

    Science.gov (United States)

    Manzke, R.; Zagorchev, L.; d'Avila, A.; Thiagalingam, A.; Reddy, V. Y.; Chan, R. C.

    2007-03-01

    Catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation in cardiac electrophysiology (EP) are complex and require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present an application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. Depending on the heart size a single or two selective contrastenhanced rotational acquisitions are performed and CT-like volumes are reconstructed with 3D filtered back projection. In case of dual injection, the two volumes depicting the left and right portions of the LAPV are registered and fused. The data sets are visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with preacquired imaging data and can be of sufficient quality for intra-operative guidance.

  11. An Independent Risk of Gout on the Development of Deep Vein Thrombosis and Pulmonary Embolism: A Nationwide, Population-Based Cohort Study.

    Science.gov (United States)

    Huang, Chien-Chung; Huang, Po-Hao; Chen, Jiunn-Horng; Lan, Joung-Liang; Tsay, Gregory J; Lin, Hsiao-Yi; Tseng, Chun-Hung; Lin, Cheng-Li; Hsu, Chung-Yi

    2015-12-01

    Previous studies indicated that gout is a risk factor of cardiovascular diseases. This study aimed to determine if patients with gout have an increased risk of deep vein thrombosis (DVT) or pulmonary embolism (PE).We used the Longitudinal Health Insurance Database, a subset of the national insurance claim dataset, which enrolled 1 million Taiwanese to identify 57,981 patients with gout and 115,961 reference subjects matched by sex, age, and entry date of diagnosis. The risk of DVT and PE was analyzed using the Cox proportional hazards model.In this Taiwanese dataset observed from 2000 to 2010, we found the incidence of DVT was 5.26 per 10 person-years in the gout cohort, which was twofold higher than the incidence of 2.63 per 10 person-years in the reference cohort. After adjusting for age, sex, and 9 comorbidities, the hazard ratio (HR) of developing DVT was 1.66 (95% confidence interval [CI] = 1.37-2.01). Among patients with gout, the youngest age group had the highest increase in the risk of developing DVT (HR [95% CI] = 2.04 [1.24-3.37] for ages 20 to 49 years, 1.80 [1.28-2.51] for ages 50 to 64 years, and 1.45 [1.11-1.91] for ages ≥65 years). The incidence of PE was about one-fifth that of DVT in gout patients, but the effect of gout on the risk was similar (HR [95% CI] = 1.53 [1.01-2.29]).Our analysis confirmed that gout increased the risk of DVT and PE. Further exploration is needed in the future.

  12. MDCT Evaluation of Left Atrium and Pulmonary Vein in the Patients with Atrial Fibrillation: Comparison with the Non-Atrial Fibrillation Group

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Jung; Choi, Eun Jeong; Ham, Soo Yeon; Oh, Yu Whan; Kim, Young Hoon [Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Yong, Hwan Seok [Korea University Guro Hospital, Seoul (Korea, Republic of); Yang, Kyung Sook [Korea University, Seoul (Korea, Republic of)

    2011-02-15

    The anatomy of the left atrium (LA) and the pulmonary veins (PVs) is important in planning and performing successful electrophysiologic ablation (EPA) for atrial fibrillation (Afib) patients. The authors estimated the findings of LA and PVs of Afib patients by MDCT, and compared these with the findings of LA and PVs of the non- Afib group using coronary CT angiography (CCTA). From September, 2009 to February, 2010, 91 Afib patients underwent PVCT (male: female = 72:19, mean age = 55.0-years-old) before EPA. At same time, 90 patients underwent CCTA (male: female = 73:17, mean age = 59.1- years-old). Two radiologists reviewed and analyzed all axial and 3D images of LA and PVs retrospectively with consensus. The average LA volumes of the Afib group(100.49 mm3) was larger than that of the non-Afib group (78.38 mm3) (p<0.05). The average lengths of the LA right wall in the Afib group (40.25 mm) was longer than that of the non-Afib group (37.3 mm) (p<0.05). The average distances between the PV ostium and first segmental bifurcation of the Lt superior PV (LSPV) and the RSPV were shorter in the Afib group (LSPV, 19.38 mm: RSPV, 11.49 mm) than in the non-Afib group (LSPV, 23.23 mm: RSPV, 14.25 mm) (p<0.05). There were higher incidences of anomalous branches such as ostial, accessory branches, or common ostia in the Afib group versus the non-Afib group (p<0.05). In Afib group, variable parameters of LA and PVs were obtained and estimated by MDCT, and there was statistically significant difference in the parameters of LA and PVs between Afib and non-Afib groups

  13. Hypoxic pulmonary vasoconstriction in isolated rat pulmonary arteries is not inhibited by antagonists of H2 S-synthesizing pathways.

    Science.gov (United States)

    Prieto-Lloret, Jesus; Shaifta, Yasin; Ward, Jeremy P T; Aaronson, Philip I

    2015-01-15

    An increase in the H2 S (hydrogen sulphide, hereafter sulphide) concentration in pulmonary artery smooth muscle cells (PASMCs) has been proposed to mediate hypoxic pulmonary vasoconstriction (HPV). We evaluated this hypothesis in isolated rat intrapulmonary arteries (IPAs) by examining the effects of the sulphide precursor cysteine and sulphide-synthesis blockers on HPV and also on normoxic pulmonary vasoconstriction (NPV) stimulated by prostaglandin F2α (PGF2α ) and by the drug LY83583, which causes contraction in IPAs by increasing cellular reactive oxygen species levels. Experiments with several blockers of cystathionine γ-lyase (CSE), the enzyme responsible for sulphide synthesis in the vasculature, demonstrated that propargylglycine (PAG, 1 mm) had little or no effect on the NPV caused by PGF2α or LY83583. Conversely, other CSE antagonists tested, aminooxyacetic acid (AOAA, 100 μm), β-cyanoalanine (BCA, 500 μm) and hydroxylamine (HA, 100 μm), altered the NPV to PGF2α (BCA increased, HA inhibited) and/or LY83583 (BCA increased, AOAA and HA inhibited). Preincubating IPAs in physiological saline solution (PSS) containing 1 mm cysteine increased the amplitude of the NPV to PGF2(α) by ∼50%, and had a similar effect on HPV elicited by hypoxic challenge with 0% O2 . The enhancement of both responses by cysteine was abolished by pretreatment with 1 mm PAG. Measurements carried out with an amperometric electrode demonstrated that incubation with 1 mm cysteine under anoxic conditions (to minimize sulphide oxidation) greatly potentiated the release of sulphide from pieces of rat liver and that this release was strongly antagonized by PAG, indicating that at this concentration PAG could enter cells intact and antagonize CSE. PAG at 1 mm had no effect on HPV recorded in control PSS, or in PSS supplemented with physiological concentrations of cysteine (10 μm), cystine (50 μm) and glutamate (100 μm) in order to prevent the possible depletion of intracellular

  14. Isolated Pulmonary Valve Endocarditis Complicated With Septic Emboli to the Lung Causing Pneumothorax, Pneumonia, and Sepsis in an Intravenous Drug Abuser

    Directory of Open Access Journals (Sweden)

    Deephak Swaminath MD

    2013-11-01

    Full Text Available Intravenous drug users are at increased risk for developing right-sided infective endocarditis involving the tricuspid and pulmonary valves. Isolated pulmonary valve endocarditis in intravenous drug users is very rare, and these patients often have more complications, such as pulmonary embolism, sepsis, and pneumonia. We report a case with pulmonary valve endocarditis and extensive pulmonary complications, including sepsis, septic emboli, pneumonia, and pneumothorax. Early identification of pulmonic valve endocarditis and treatment with appropriate antibiotics with or without surgical management should provide better outcomes, and clinicians need to think about pulmonary valve endocarditis in patients with complex respiratory presentations.

  15. [Isolated Pulmonary Valve Endocarditis in a Patient with Aortic Regurgitation and Patent Foramen Ovale;Report of a Case].

    Science.gov (United States)

    Doi, Toshio; Gyoten, Takayuki; Sakata, Kimimasa; Nagura, Saori; Yamashita, Akio; Fukahara, Kazuaki; Kotoh, Keiju; Yoshimura, Naoki

    2016-07-01

    Isolated pulmonary valve endocarditis is an extremely rare clinical condition. Here, we report a case of pulmonary valve endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA). An 84-year-old man with a history of aortic regurgitation and patent foramen ovale was admitted to our hospital due to fever of unknown origin for 4 weeks' duration. MRSA was detected in his blood cultures. Transthoracic echocardiography demonstrated a mobile vegetation attached to the pulmonary valve, moderate to severe aortic regurgitation, and patent foramen ovale with left-to-right shunt. After 30-days' treatment with vancomycin, gentamicin and rifampicin, he defervesced and blood cultures became negative. At surgery, a large vegetation was still attached to the pulmonary valve, but the leaflets remained with minimum damage. Aortic valve replacement, direct closure of the patent foramen ovale, and simple resection of the vegetation were performed. The postoperative course was uneventful.

  16. Successful liver transplantation in a patient with splanchnic vein thrombosis and pulmonary embolism due to polycythemia vera with Jak2v617f mutation and heparin-induced thrombocytopenia.

    Science.gov (United States)

    Biagioni, Emanuela; Pedrazzi, Paola; Marietta, Marco; Di Benedetto, Fabrizio; Villa, Erica; Luppi, Mario; Girardis, Massimo

    2013-10-01

    Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatment resulting in a severe acquired thrombophilic condition with an associated mortality of about 10 %. We report the first case of successful urgent liver transplantation (LT) in a patient with end-stage liver disease due to a Budd-Chiari syndrome, portal vein thrombosis and pulmonary embolism due to acquired thrombophilia associated to polycythemia vera carrying JAK2V617F gene mutation and HIT in the acute phase. Lepirudin was used to provide anticoagulation in the LT perioperative period that was performed without haemorrhagic and thrombotic complications despite the donor received heparin during liver explantation.

  17. Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies

    Science.gov (United States)

    2013-01-01

    Background The worldwide EINSTEIN DVT and EINSTEIN PE studies randomized 8282 patients with acute symptomatic deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) and, for the first time in trials in this setting, included patients in China. This analysis evaluates the results of these studies in this subgroup of patients. Methods A total of 439 Chinese patients who had acute symptomatic DVT (n=211), or PE with or without DVT (n=228), were randomized to receive rivaroxaban (15 mg twice daily for 21 days, followed by 20 mg once daily) or standard therapy of enoxaparin overlapping with and followed by an adjusted-dose vitamin K antagonist, for 3, 6, or 12 months. The primary efficacy outcome was symptomatic recurrent venous thromboembolism. The principal safety outcome was major or non-major clinically relevant bleeding. Results The primary efficacy outcome occurred in seven (3.2%) of the 220 patients in the rivaroxaban group and in seven (3.2%) of the 219 patients in the standard-therapy group (hazard ratio, 1.04; 95% confidence interval 0.36–3.0; p=0.94). The principal safety outcome occurred in 13 (5.9%) patients in the rivaroxaban group and in 20 (9.2%) patients in the standard-therapy group (hazard ratio, 0.63; 95% confidence interval 0.31–1.26; p=0.19). Major bleeding was observed in no patients in the rivaroxaban group and in five (2.3%) patients in the standard-therapy group. In fragile patients (defined as age >75 years, creatinine clearance <50 mL/min, and/or body weight ≤50 kg), the principal safety outcome occurred in four (8.9%) of the 45 patients who received rivaroxaban compared with seven (15.2%) of the 46 patients who received standard therapy. Conclusions In Chinese patients with acute symptomatic DVT and/or PE, rivaroxaban was as efficacious as enoxaparin followed by vitamin K antagonist therapy, with a similar safety profile. The relative efficacy and safety of rivaroxaban compared with enoxaparin/vitamin K antagonist were

  18. Isolated lung perfusion with gemcitabine for the treatment of pulmonary metastases : Experimental study in a rat model

    NARCIS (Netherlands)

    Putte, B.P. van

    2003-01-01

    Isolated lung perfusion is an experimental surgical technique for the treatment of pulmonary metastases in order to improve the current 5-year survival of approximately 40 % after surgical resection of manually palpable metastases. Several drugs have been tested in animals models and five phase I st

  19. Rapid isolation and identification of Mycobacterium tuberculosis from pulmonary tuberculosis patients

    Institute of Scientific and Technical Information of China (English)

    Al-Sulami AA; Ali ZM; Al-Maleky DA

    2009-01-01

    Objective:The Study aimed to develop a rapid inexpensive and simple method for preliminary isolation and detection of M.tuberculosis from clinical specimens.Also to probe the impact of deteriorating health measures on the pulmonary tuberculosis control program in Basra city.Methods:A simple monophasic-diphasic setup (MDCS)was used for the isolation and preliminary identification of M.tuberculosis.This setup consists of a slanted Lowenstein-Jensen medium,the bottom of it is covered with 1 mL of tuberculosis broth thus establishing a diphasic solid liquid environment at the bottom of the screw capped test tube and above them a monophasic one.Results:During 7 months period from the beginning of December 2003 to the end of June 2004,1 295 cases were managed in Tuberculosis and Chest Diseases Clinic in Basra city.Only 348 cases were diagnosed as active pulmonary tuberculosis.They consist of 232 new cases and 116 previously registered ones.The MDCS method showed higher recovery of isolation rate of M.tuberculosis (92.3%)than Lowenstein-Jensen,and pyruvate methods with 78.1% and 51.9% respectively.Also this method revealed more rapid appearance of results of 12 days than Lowenstein-Jensen,and pyruvate media with 22 days and 23 days respectively by the traditional culturing methods.Concurrently the study revealed that drug resistance against one or more anti tu-berculosis drugs was 23.1% for new cases and 70.8% for the old ones.Multi drug resistance accounts for 20% of total isolates from old cases.This was based on using the critical concentration and 1% proportional procedures.Tuberculosis was more common among males than females with 69.4% and 30.6% respectively. A significant correlation (P <0.05)was found between the productive age group (25-54)and incidence of tu-berculosis.Tuberculosis was higher among married (83.8%)than unmarried peoples (22%).Children,hus-bands and wives showed higher infection rates than others indicating kinship influence.Failure of treatment

  20. Population Structure among Mycobacterium tuberculosis Isolates from Pulmonary Tuberculosis Patients in Colombia

    Science.gov (United States)

    Realpe, Teresa; Correa, Nidia; Rozo, Juan Carlos; Ferro, Beatriz Elena; Gomez, Verónica; Zapata, Elsa; Ribon, Wellman; Puerto, Gloria; Castro, Claudia; Nieto, Luisa María; Diaz, Maria Lilia; Rivera, Oriana; Couvin, David; Rastogi, Nalin; Arbelaez, Maria Patricia; Robledo, Jaime

    2014-01-01

    Background Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. Principal Findings A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs). SIT42 (LAM9) and SIT62 (H1) represented 53.3% of isolates, followed by 8.21% SIT50 (H3), 5.07% SIT53 (T1), and 3.14% SIT727 (H1). Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1). The proportion of Haarlem sublineage (44.3%) was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1), as well as HIV-positive serology with SIT727 (H1) and SIT53 (T1). Conclusions This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali). Dominant spoligotypes were LAM9 (SIT 42) and Haarlem (SIT62). The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of this

  1. Population structure among mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Colombia.

    Directory of Open Access Journals (Sweden)

    Teresa Realpe

    Full Text Available BACKGROUND: Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. PRINCIPAL FINDINGS: A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP, spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs. SIT42 (LAM9 and SIT62 (H1 represented 53.3% of isolates, followed by 8.21% SIT50 (H3, 5.07% SIT53 (T1, and 3.14% SIT727 (H1. Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1. The proportion of Haarlem sublineage (44.3% was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1, as well as HIV-positive serology with SIT727 (H1 and SIT53 (T1. CONCLUSIONS: This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali. Dominant spoligotypes were LAM9 (SIT 42 and Haarlem (SIT62. The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of

  2. Drenagem anômala parcial de quatro veias pulmonares com septo interatrial íntegro: relato de um caso raro Partial anomalous return of four pulmonary veins with intact interatrial septum defect: a rare case report

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    Edmar Atik

    2008-07-01

    Full Text Available É relatado caso raro de drenagem anômala parcial de quatro veias pulmonares no átrio direito e veia cava superior, com septo interatrial íntegro em criança de cinco anos de idade. Havia poucos sintomas, em contraste com débito ventricular esquerdo dependente do fluxo da veia lobar superior esquerda e da língula. Complacência diminuída à esquerda motivou quadro acentuado de hipertensão venocapilar pulmonar no pós-operatório imediato, aliviado por feitura de comunicação interatrial de 8 mm. A evolução posterior foi boa.We report on the rare case of partial anomalous return of four pulmonary veins in the right atrium and superior vena cava with intact interatrial septum in a five-year-old child. There were few symptoms in contrast with the left ventricular output dependent on the flow of the left upper lobe vein and from the lingula. Reduced compliance to the left led to a severe picture of pulmonary venocapillary hypertension in the immediate postoperative period, mitigated by an 8-mm interatrial septal defect. The patient progressed well after the intervention.

  3. P. falciparum isolate-specific distinct patterns of induced apoptosis in pulmonary and brain endothelial cells.

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    Nadine N'Dilimabaka

    Full Text Available The factors implicated in the transition from uncomplicated to severe clinical malaria such as pulmonary oedema and cerebral malaria remain unclear. It is known that alterations in vascular integrity due to endothelial cell (EC activation and death occur during severe malaria. In this study, we assessed the ability of different P. falciparum clinical isolates to induce apoptosis in ECs derived from human lung and brain. We observed that induction of EC apoptosis was sensitive to the environmental pH and required direct contact between the parasite and the cell, though it was not correlated to the ability of the parasite to cytoadhere. Moreover, the extent of induced apoptosis in the two EC types varied with the isolate. Analysis of parasite genes transcript led us to propose that the activation of different pathways, such as Plasmodium apoptosis-linked pathogenicity factors (PALPF, PALPF-2, PALPF-5 and PF11_0521, could be implied in EC death. These observations provide an experimental framework to decipher the molecular mechanism implicated in the genesis of severe malaria.

  4. Significance of Aspergillus spp.isolation from lower respiratory tract samples for the diagnosis and prognosis of invasive pulmonary aspergillosis in chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    HE Hang-yong; CHANG Shuo; DING Lin; SUN Bing; LI Fang; ZHAN Qing-yuan

    2012-01-01

    Background Chronic obstructive pulmonary diseases (COPD) is an emerging population at risk for invasive infection of Aspergillus.Isolation of Aspergillus from lower respiratory tract (LRT) samples is important for the diagnosis of invasive pulmonary aspergillosis (IPA).The purpose of this study was to investigate the value of Aspergillus isolation from LRT samples for the diagnosis and prognosis of IPA in COPD population.Methods Clinical record with Aspergillus spp.isolation in COPD and immunocompromised patients was reviewed in a retrospective study.Patients were categorized and compared according to their severity of illness (admitted to general ward or ICU) and immunological function (COPD or immunocompromised).Results Multivariate statistical analysis showed that,combined with Aspergillus spp.isolation,APACHE Ⅱ scores >18,high cumulative doses of corticosteroids (>350 mg prednisone or equivalent dose) and more than four kinds of broad-spectrum antibiotics received in hospital may be predictors of IPA in COPD (OR=9.076,P=0.001; OR=4.073,P=-0.026; OR=4.448,P=0.021,respectively).The incidence of IPA,overall mortality,mortality of patients with IPA and mortality of patients with Aspergillus spp.colonization were higher in COPD patients in ICU than in general ward,but were similar between COPD and immunocompromised patients.Conclusions Aspergilltus spp.isolation from LRT in COPD may be of similar importance as in immunocompromised patients,and may indicate an increased diagnosis possibility of IPA and worse prognosis when these patients received corticosteroids,antibiotics,and need to admit to ICU.Aspergillus spp.isolation from LRT samples combined with certain risk factors may be useful in differentiating colonization from IPA and evaluating the prognosis of IPA in COPD patients.

  5. Bi-directional block is superior to non-inducibility in predicting freedom from atrial fibrillation after pulmonary vein isolation

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    Sherif H. Zaky

    2011-03-01

    Conclusion: Achieving BD block improves results and may predict maintenance of sinus rhythm more than NI of AF after PVI. It can be used as an electrophysiological endpoint alternative to or in conjunction with non inducibility in AF ablation procedures.

  6. Pulmonary vein isolation alone and combined with renal sympathetic denervation in chronic kidney disease patients with refractory atrial fibrillation

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    Márcio G. Kiuchi

    2016-12-01

    Conclusion: PVI + RSD were associated with a lower AF recurrence rate than PVI alone; it also improved renal function and some echocardiographic parameters. These encouraging data will serve as baseline information for further long-term studies on larger patient populations.

  7. Human Cytomegalovirus and Human Umbilical Vein Endothelial Cells: Restriction of Primary Isolation to Blood Samples and Susceptibilities of Clinical Isolates from Other Sources to Adaptation

    OpenAIRE

    2002-01-01

    In immunocompromised patients with disseminated infection, human cytomegalovirus (HCMV) is widespread in the microvascular endothelium of multiple organs. Human umbilical vein endothelial cells (HUVEC) were used in parallel to human embryonic lung fibroblasts (HELF) to recover HCMV from blood samples of immunocompromised patients. Using the shell vial technique, comparable median numbers of p72-positive HUVEC and HELF cells were found with the 26 HCMV-positive buffy coat samples out of 150 ex...

  8. Control of pulmonary surfactant secretion from type II pneumocytes isolated from the lizard Pogona vitticeps.

    Science.gov (United States)

    Wood, P G; Lopatko, O V; Orgeig, S; Codd, J R; Daniels, C B

    1999-12-01

    Pulmonary surfactant, a mixture consisting of lipids and proteins and secreted by type II cells, functions to reduce the surface tension of the fluid lining of the lung, and thereby decreases the work of breathing. In mammals, surfactant secretion appears to be influenced primarily by the sympathetic nervous system and changes in ventilatory pattern. The parasympathetic nervous system is not believed to affect surfactant secretion in mammals. Very little is known about the factors that control surfactant secretion in nonmammalian vertebrates. Here, a new methodology for the isolation and culture of type II pneumocytes from the lizard Pogona vitticeps is presented. We examined the effects of the major autonomic neurotransmitters, epinephrine (Epi) and ACh, on total phospholipid (PL), disaturated PL (DSP), and cholesterol (Chol) secretion. At 37 degrees C, only Epi stimulated secretion of total PL and DSP from primary cultures of lizard type II cells, and secretion was blocked by the beta-adrenoreceptor antagonist propranolol. Neither of the agonists affected Chol secretion. At 18 degrees C, Epi and ACh both stimulated DSP and PL secretion but not Chol secretion. The secretion of surfactant Chol does not appear to be under autonomic control. It appears that the secretion of surfactant PL is predominantly controlled by the autonomic nervous system in lizards. The sympathetic nervous system may control surfactant secretion at high temperatures, whereas the parasympathetic nervous system may predominate at lower body temperatures, stimulating surfactant secretion without elevating metabolic rate.

  9. [Treatment of renal vein thrombosis associated with nephrotic syndrome].

    Science.gov (United States)

    Funami, M; Takaba, T; Tanaka, H; Murakami, A; Kadokura, M; Hori, G; Ishii, J

    1988-06-01

    Renal vein thrombosis is a rare entity in which true incidence is unknown. The disease occurs most frequently in patients with nephrotic syndrome, but it also can occur in the presence of other hypercoagulable state. Two cases of renal vein thrombosis with nephrotic syndrome which were treated by thrombectomy are reported here. One patient was successfully treated by renal vein and inferior vena cava thrombectomy before developing severe pulmonary embolism. The other was treated by renal vein thrombectomy by which fatal shock was able to be prevented. In those cases, immediate operation was indicated, primarily to prevent additional, possibly fatal, pulmonary embolism and also to improve perfusion of the kidney. In the hope of salvaging the kidney, thrombectomy may be the treatment of choice for acute renal vein thrombosis, complication of pulmonary embolism and inferior vena cava thrombosis, right renal vein thrombosis without collateral flow and acute renal vein thrombosis with shock.

  10. Anesthesia for cesarean section in a patient with isolated unilateral absence of a pulmonary artery.

    Science.gov (United States)

    Furuya, Tomonori; Iida, Ryoji; Konishi, Jyumpei; Kato, Jitsu; Suzuki, Takahiro

    Congenital unilateral absence of a pulmonary artery (UAPA) is a rare anomaly. Although there are several reports regarding pregnancy in patients with unilateral absence of a pulmonary artery, there are no case reports describing anesthesia for Cesarean section in a patient with unilateral absence of a pulmonary artery. We present a patient with unilateral absence of a pulmonary artery who underwent Cesarean sections twice at the ages of 24 and 26 years under spinal anesthesia for surgery and epidural analgesia for postoperative pain relief. Both times, spinal anesthesia and epidural analgesia enabled successful anesthesia management without the development of either pulmonary hypertension or right heart failure. Spinal anesthesia combined with epidural analgesia is a useful anesthetic method for a Cesarean section in patients with unilateral absence of a pulmonary artery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  11. Isolation of Nontuberculous Mycobacteria (NTM) from Household Water and Shower Aerosols in Patients with Pulmonary Disease Caused by NTM

    OpenAIRE

    Thomson, Rachel; Tolson, Carla; Carter, Robyn; Coulter, Chris; Huygens, Flavia; Hargreaves, Megan

    2013-01-01

    It has been postulated that susceptible individuals may acquire infection with nontuberculous mycobacteria (NTM) from water and aerosol exposure. This study examined household water and shower aerosols of patients with NTM pulmonary disease. The mycobacteria isolated from clinical samples from 20 patients included M. avium (5 patients), M. intracellulare (12 patients), M. abscessus (7 patients), M. gordonae (1 patient), M. lentiflavum (1 patient), M. fortuitum (1 patient), M. peregrinum (1 pa...

  12. Left Aberrant Gastric Vein Causing Isolated Left Hepatic Portal Venous Gas Secondary to an Incarcerated Diaphragmatic Hernia

    Science.gov (United States)

    Mittal, Kartik; Anandpara, Karan; Dey, Amit K.; Kedar, Pradnya; Hira, Priya; Kale, Sunita

    2015-01-01

    Summary Background Hepatic portal venous gas (HPVG) is an ominous radiological sign suggestive of underlying intestinal sepsis, infection or trauma. Portal pneumatosis secondary to gastric pathologies is rare. Case Report We report a rare case of a 34-year-old man who presented with acute epigastric pain and vomiting, diagnosed to have an incarcerated diaphragmatic hernia causing gastric pneumatosis and resultant portal venous gas. Conclusions Our case highlights an unusual presentation of gastric pneumatosis secondary to an incarcerated hiatal hernia with resultant portal venous gas involving only the left lobe of the liver. An aberrant left gastric vein was responsible for this phenomenon in our case. A sound understanding of anatomical variants is thus crucial to radiological diagnosis. PMID:26251676

  13. Isolated unilateral absence of the right pulmonary artery in two cats visualized by computed tomography angiography

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    Tyler JM Jordan

    2016-10-01

    Full Text Available Case series summary Two cats were evaluated for progressive exercise intolerance, dyspnea and unilateral infiltrate of the left lung. Computed tomography angiography (CTA revealed absence of the right pulmonary artery in both cats with systemic arterial collateral vessels perfusing the right segmental pulmonary arteries. In one case, the collateral vessels arose from the esophageal artery, while in the other case they derived off the right costocervical trunk. One cat was diagnosed with pulmonary hypertension and was euthanized owing to progressive respiratory distress despite medical management with sildenafil, pimobendan, clopidogrel and furosemide. The other cat, without echocardiographic evidence of pulmonary hypertension, was successfully managed with furosemide and enalapril for more than 4 years. Relevance and novel information CTA allowed visualization of a rare congenital heart malformation, unilateral absence of the right pulmonary artery, in two cats and accurately characterized the source of collateral blood supply to the affected lung. Severe pulmonary hypertension may be a negative prognostic factor in cats with this condition as medical therapy in the cat without evidence of pulmonary hypertension resolved clinical signs, while the cat with severe pulmonary hypertension died from the disease.

  14. Regional Chemotherapy of the Lung: Investigations of Isolated Lung Perfusion and Selective Pulmonary Artery Perfusion

    NARCIS (Netherlands)

    Grootenboers, M.J.J.H.

    2008-01-01

    The aim of this thesis was two-fold. First, - part I of the dissertation -, to explore ILuP with melphalan and hyperthermia followed by pulmonary metastasectomy in patients with resectable pulmonary metastases. Second, - part II -, to investigate the feasibility and pharmacokinetics of SPAP with gem

  15. Cardiopulmonary manifestations of isolated pulmonary valve infective endocarditis demonstrated with cardiac CT.

    Science.gov (United States)

    Passen, Edward; Feng, Zekun

    2015-01-01

    Right-sided infective endocarditis involving the pulmonary valve is rare. This pictorial essay discusses the use and findings of cardiac CT combined with delayed chest CT and noncontrast chest CT of pulmonary valve endocarditis. Cardiac CT is able to show the full spectrum of right-sided endocarditis cardiopulmonary features including manifestations that cannot be demonstrated by echocardiography.

  16. CT Pulmonary Angiography and Suspected Acute Pulmonary Embolism

    Energy Technology Data Exchange (ETDEWEB)

    Enden, T.; Kloew, N.E. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Cardiovascular Radiology

    2003-05-01

    Purpose: To evaluate the use and quality of CT pulmonary angiography in our department, and to relate the findings to clinical parameters and diagnoses. Material and Methods: A retrospective study of 324 consecutive patients referred to CT pulmonary angiography with clinically suspected pulmonary embolism (PE). From the medical records we registered clinical parameters, blood gases, D-dimer, risk factors and the results of other relevant imaging studies. Results: 55 patients (17%) had PE detected on CT. 39 had bilateral PE, and 8 patients had isolated peripheral PE. 87% of the examinations showing PE had satisfactory filling of contrast material including the segmental pulmonary arteries, and 60% of the subsegmental arteries. D-dimer test was performed in 209 patients, 85% were positive. A negative D-dimer ruled out PE detected at CT. Dyspnea and concurrent symptoms or detection of deep vein thrombosis (DVT), contraceptive pills and former venous thromboembolism (VTE) were associated with PE. The presence of only one clinical parameter indicated a negative PE diagnosis (p < 0.017), whereas two or more suggested a positive PE diagnosis (p < 0.002). CT also detected various ancillary findings such as consolidation, pleural effusion, nodule or tumor in nearly half of the patients; however, there was no association with the PE diagnosis. Conclusion: The quality of CT pulmonary angiography was satisfactory as a first-line imaging of PE. CT also showed additional pathology of importance in the chest. Our study confirmed that a negative D-dimer ruled out clinically suspected VTE.

  17. The feasibility of a Box isolation strategy for non-paroxysmal atrial fibrillation in elderly patients

    OpenAIRE

    Higuchi, Satoshi; Sohara, Hiroshi; Nakamura, Yoshinori; Ihara, Minoru; Yamaguchi, Yoshio; Shoda, Morio; Hagiwara, Nobuhisa; Satake, Shutaro

    2016-01-01

    Background Catheter ablation of non-paroxysmal atrial fibrillation (non-PAF) is a therapeutic challenge especially in elderly patients. This study describes the feasibility of a posterior left atrium isolation as a substrate modification in addition to pulmonary vein isolation, the so-called Box isolation, for elderly patients with non-PAF. Methods Two hundred twenty-nine consecutive patients who underwent Box isolations for drug-refractory non-PAF were divided into two groups according to th...

  18. Varicose vein - noninvasive treatment

    Science.gov (United States)

    Sclerotherapy; Laser therapy - varicose veins; Radiofrequency vein ablation; Endovenous thermal ablation; Ambulatory phlebectomy; Transilluminated power phlebotomy; Endovenous laser ablation; Varicose vein ...

  19. Three cases of pulmonary varix

    Energy Technology Data Exchange (ETDEWEB)

    Takishima, Teruo; Sakuma, Hajime; Tajima, Tsunemi; Okimoto, Takao; Yamamoto, Keiichiro; Dohi, Yutaka (Saitama Medical School (Japan))

    1982-06-01

    Three cases of pulmonary varix associated with valvular heart disease were reported. Round shadows were clearer on first oblique or lateral films of chest x-ray in all 3 cases. On chest tomograms, the shadows were substantial and round-elliptical. RI angiography with sup(99m)Tc-RBC demonstrated these shadows in agreement with the site of influx of the pulmonary vein into the left atrium in Cases 1 and 3 and with the pulmonary vein slightly apart from the left atrium in Case 2. On CT scans in Cases 1 and 3, enhancement with a contrast medium visualized dilatation of the pulmonary vein close to, and in continuation with, the shadow of the left atrium. The diagnosis of pulmonary varix in agreement with the venous phase of pulmonary angiography was made for all 3 cases. Non-surgical examinations (especially CT scan) proved highly useful for the diagnosis of pulmonary varix.

  20. The influence of steroids on vascular tension of isolated superficial veins of the nose and face during the estrous cycle of gilts.

    Science.gov (United States)

    Grzegorzewski, W J; Chłopek, J; Tabecka-Łonczyńska, A; Stefańczyk-Krzymowska, S

    2010-01-15

    The arrangement of the superficial facial veins enables blood flow from the nasal cavity into the peripheral circulation by two pathways: through the frontal vein into the cavernous sinus and through the facial vein into the external jugular vein. The current study was designed to determine whether estradiol and progesterone affect the vascular tone of the superficial veins of the nose and face in cycling gilts (Sus scrofa f. domestica) and to analyze the immunolocalization of progesterone receptors and estradiol receptors in these veins. The influence of hormones on vascular tension differed depending on the type of vessel and the phase of the estrous cycle. Estradiol decreased vascular tension in the nasal vein during the follicular phase (Pnose and face. In conclusion, the effect of ovarian steroid hormones on the vascular tension of the superficial veins of the nose and face in female pigs as well as the reactivity of these veins to steroid boar pheromones can affect the blood supply from the nasal cavity to the venous cavernous sinus. We propose that the ovarian steroid hormones that modulate the vascular tension of the nasal and facial veins may also influence the action of boar pheromones absorbed into the nasal mucosa in gilts and may reach the brain via local destination transfer.

  1. Molecular analysis of Rv0679c and Rv0180c genes of Mycobacterium tuberculosis from clinical isolates of pulmonary tuberculosis

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    L Rupa

    2016-01-01

    Full Text Available Context: Two novel proteins/genes Rv0679c and Rv0180c of Mycobacterium tuberculosis (MTB H37Rv were classified as a hypothetical membrane and transmembrane proteins which might have a role in the invasion. Molecular analysis of these genes in human clinical isolates of pulmonary tuberculosis (PTB patients was not well characterised. Aims: To assess the molecular diversity of Rv0679c and Rv0180c genes of MTB from clinical isolates of PTB patients. Settings and Design: DNA from 97 clinical isolates was extracted and subjected to amplification using selective primers by polymerase chain reaction (PCR. The PCR product obtained was sequenced commercially. Patients and Methods: Clinical isolates obtained from tuberculosis patients were investigated for polymorphisms in the Rv0679c and Rv0180c genes by PCR and DNA sequencing. Genomic DNA isolated by cetyltrimethylammonium bromide method was used for amplification of genes. Results: Rv0679c gene was highly conserved in 61 out of 65 clinical isolates assessed for sequence homology with wild-type H37Rv gene and was identical using ClustalW. Fifty-five out of 78 (70.5% clinical isolates assessed for Rv0180c were positive for single nucleotide polymorphism (SNP at 258th position where the nucleotide G was replaced with T (G to T. In clinical isolates of untreated cases, the frequency was 54.5% for SNP at 258th position which is low compared to cases undergoing treatment where the frequency was 73.1%. Conclusions: Molecular analysis of Rv0180c in clinical isolates of PTB assessed in this study was the first report, where an SNP at 258th position G to T was identified within the gene. Rv0679c gene was highly conserved (94%, within Indian clinical isolates as compared to reports from other nations.

  2. Varicose vein stripping

    Science.gov (United States)

    ... vein stripping; Venous reflux - vein stripping; Venous ulcer - veins Images Circulatory system References American Family Physician. Management of varicose veins. www.aafp.org/afp/2008/1201/p1289.html . ...

  3. Deep Vein Thrombosis

    Science.gov (United States)

    Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Most deep vein ... the condition is called thrombophlebitis. A deep vein thrombosis can break loose and cause a serious problem ...

  4. Bronchial compression in an infant with isolated secundum atrial septal defect associated with severe pulmonary arterial hypertension

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    Sung-Hee Park

    2012-08-01

    Full Text Available Symptomatic pulmonary arterial hypertension (PAH in patients with isolated atrial septal defect (ASD is rare during infancy. We report a case of isolated ASD with severe PAH in an infant who developed airway obstruction as cardiomegaly progressed. The patient presented with recurrent severe respiratory insufficiency and failure to thrive before the repair of the ASD. Echocardiography confirmed volume overload on the right side of heart and severe PAH (tricuspid regurgitation [TR] with a peak pressure gradient of 55 to 60 mmHg. The chest radiographs demonstrated severe collapse of both lung fields, and a computed tomography scan showed narrowing of the main bronchus because of an intrinsic cause, as well as a dilated pulmonary artery compressing the main bronchus on the left and the intermediate bronchus on the right. ASD patch closure was performed when the infant was 8 months old. After the repair of the ASD, echocardiography showed improvement of PAH (TR with a peak pressure gradient of 22 to 26 mmHg, and the patient has not developed recurrent respiratory infections while showing successful catch-up growth. In infants with symptomatic isolated ASD, especially in those with respiratory insufficiency associated with severe PAH, extrinsic airway compression should be considered. Correcting any congenital heart diseases in these patients may improve their symptoms.

  5. An Isolated Pulmonary Hematoma Mimicking a Lung Tumor as the Initial Finding of Vascular Ehlers-Danlos Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Eun Ju; Lee, Ki Nam; Choi, Pil Jo [Dept. of Radiology, Dong-A University Medicine Center, Dong-A University College of Medicine, Busan (Korea, Republic of); Ki, Chang Seok [Dept. of Radiology, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2012-09-15

    The vascular type of Ehlers-Danlos syndrome (vEDS) is an uncommon inherited disorder characterized by abnormalities in type III collagen, presenting itself as arterial dissection or rupture. We report a case of an isolated pulmonary hematoma mimicking a lung tumor in an 18-year-old man which turned out to be the initial finding of vEDS. Pneumothorax and hemothorax occurred repeatedly for 15 months following the surgical removal of the mass, and were treated by repeated left upper and lower lobectomy and thoracotomy. The diagnosis of vEDS was confirmed by pathologic and genetic studies.

  6. Genetic diversity of Mycobacterium tuberculosis complex strains isolated from patients with pulmonary tuberculosis in Anambra State, Nigeria.

    Science.gov (United States)

    Uzoewulu, Gertrude N; Lawson, Lovett; Nnanna, Ibeh S; Rastogi, Nalin; Goyal, Madhu

    2016-03-01

    In this study, we analyzed Mycobacterium tuberculosis complex (MTC) genetic diversity in Anambra State, Nigeria based on spoligotyping followed by 5-loci exact tandem repeats (ETRs). Spoligotyping of 180 MTC strains isolated in 2009-2011 from pulmonary tuberculosis (TB) patients led to a total of 31 distinct patterns. A comparison with the SITVIT2 international database showed that all the 31 patterns could be classified as Shared-types (SITs) in this database; briefly, 26/31 SITs (n=174 isolates) matched a preexisting shared-type in the database, whereas 5/31 SITs (n=6 isolates) were newly created due to 2 or more strains belonging to an identical new pattern within this study (SIT3396) or after a match with an orphan in the database (SIT3397, SIT3398, SIT3399 and SIT3400). A total of 18/31 SITs containing 167 or 92.8% isolates were clustered within this study (2-89 isolates per cluster) while 13/31 SITs contained unique strains. Using VNTR typing, a total of 36 distinct patterns were identified; 27 patterns (n=157 isolates) matched a pattern already reported in the SITVIT2 database. Combination of both the methods generated 47 combined patterns for the 180 strains: 17 belonged to clustered isolates (n=127 isolates or 70.5%) while 30 corresponded to as many unique strains (note 23 strains could not be typed using 5-loci ETRs). No correlation was found between the spoligotyping pattern and the HIV status of the patient or drug sensitivity of the strain. This study showed that the LAM10-CAM prototype SIT61 accounted for highest number of isolates (n=89) in Anambra State, showing its relative contribution to the TB burden in the study.

  7. Nutcracker Syndrome Complicated by Left Renal Vein Thrombosis

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    Faouzi Mallat

    2013-01-01

    Full Text Available Isolated renal vein thrombosis is a rare entity. We present a patient whose complaint of flank pain led to the diagnosis of a renal vein thrombosis. In this case, abdominal computed tomography angiography was helpful in diagnosing the nutcracker syndrome complicated by the renal vein thrombosis. Anticoagulation was started and three weeks later, CTA showed complete disappearance of the renal vein thrombosis. To treat the Nutcracker syndrome, we proposed left renal vein transposition that the patient consented to.

  8. Nutcracker syndrome complicated by left renal vein thrombosis.

    Science.gov (United States)

    Mallat, Faouzi; Hmida, Wissem; Jaidane, Mehdi; Mama, Nadia; Mosbah, Faouzi

    2013-01-01

    Isolated renal vein thrombosis is a rare entity. We present a patient whose complaint of flank pain led to the diagnosis of a renal vein thrombosis. In this case, abdominal computed tomography angiography was helpful in diagnosing the nutcracker syndrome complicated by the renal vein thrombosis. Anticoagulation was started and three weeks later, CTA showed complete disappearance of the renal vein thrombosis. To treat the Nutcracker syndrome, we proposed left renal vein transposition that the patient consented to.

  9. Anomalous pulmonary venous return: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Gyeong Min; Kang, MinJin; Lee, Han Bee; Bae, Kyung Eun; Lee, Jaehe; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2013-10-15

    Partial anomalous pulmonary venous return is a type of congenital pulmonary venous anomaly. We present a rare type of partial pulmonary venous return, subaortic vertical vein drains left lung to superior vena cava, accompanying hypoplasia of the ipsilateral lung and pulmonary artery. We also review the previous report and relationship of these structures.

  10. Isolating and using sections of bovine mesenteric artery and vein as a bioassay to test for vasoactivity in the small intestine.

    Science.gov (United States)

    Klotz, James L; Barnes, Adam J

    2014-10-07

    Mammalian gastrointestinal systems are constantly exposed to compounds (desirable and undesirable) that can have an effect on blood flow to and from that system. Changes in blood flow to the small intestine can result in effects on the absorptive functions of the organ. Particular interest in toxins liberated from feedstuffs through fermentative and digestive processes has developed in ruminants as an area where productive efficiencies could be improved. The video associated with this article describes an in vitro bioassay developed to screen compounds for vasoactivity in isolated cross-sections of bovine mesenteric artery and vein using a multimyograph. Once the blood vessels are mounted and equilibrated in the myograph, the bioassay itself can be used: as a screening tool to evaluate the contractile response or vasoactivity of compounds of interest; determine the presence of receptor types by pharmacologically targeting receptors with specific agonists; determine the role of a receptor with the presence of one or more antagonists; or determine potential interactions of compounds of interest with antagonists. Through all of this, data are collected real-time, tissue collected from a single animal can be exposed to a large number of different experimental treatments (an in vitro advantage), and represents vasculature on either side of the capillary bed to provide an accurate picture of what could be happening in the afferent and efferent blood supply supporting the small intestine.

  11. Antibiotic resistance profiles of Pseudomonas aeruginosa strains isolated from patients with acute exacerbation of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Nagihan Demir

    2014-12-01

    For typing and antibiotic susceptibility of isolates the Phoenix bacterial identification system (Becton Dickinson, USA was used.[¤]RESULTS[|]The antibiotic resistance rates of P. aeruginosa were 42.3% for cefepime, 41% for levofloxacin, 38.7% for ciprofloxacin, 29.4% for ceftazidime, 21.7% for cefoperazone / sulbactam, 17.9% for gentamicin, 17.9% for piperacillin / tazobactam, 8.9% for imipenem, 5.1% for amikacin and 2.5% for meropenem. Twenty eight (35.9% of the isolates were found to be sensitive to all of these antibiotics. Forty six (58.9% of the patients had steroid and 56 (71.8% of the patients had broad-spectrum antibiotic use.[¤]CONCLUSION[|]In acute exacerbations of chronic obstructive pulmonary disease, the inspection of antibiotic susceptibility of Pseudomonas infection would be beneficial for patient's health and the country's economy.[¤

  12. Use of the Trauma Embolic Scoring System (TESS) to predict symptomatic deep vein thrombosis and fatal and non-fatal pulmonary embolism in severely injured patients.

    Science.gov (United States)

    Ho, K M; Rao, S; Rittenhouse, K J; Rogers, F B

    2014-11-01

    Fatal pulmonary embolism is the third most common cause of death after major trauma. We hypothesised that the Trauma Embolic Scoring System (TESS) would have adequate calibration and discrimination in a group of severely injured trauma patients in predicting venous thromboembolism (VTE), and could be used to predict fatal and non-fatal symptomatic pulmonary embolism. Calibration and discrimination of the TESS were assessed by the slope and intercept of the calibration curve and the area under the receiver operating characteristic curve, respectively. Of the 357 patients included in the study, 74 patients (21%) developed symptomatic VTE after a median period of 14 days following injury. The TESS predicted risks of VTE were higher among patients who developed VTE than those who did not (14 versus 9%, P=0.001) and had a moderate ability to discriminate between patients who developed VTE and those who did not (area under the receiver operating characteristic curve 0.71, 95% confidence interval 0.65 to 0.77). The slope and intercept of the calibration curve were 2.76 and 0.34, respectively, suggesting that the predicted risks of VTE were not sufficiently extreme and overall, underestimated the observed risks of VTE. Using 5% predicted risk of VTE as an arbitrary cut-point, TESS had a high sensitivity and negative predictive value (both ≥0.97) in excluding fatal and non-fatal pulmonary embolism. The TESS had a reasonable ability to discriminate between patients who developed VTE and those who did not and may be useful to select different strategies to prevent VTE in severely injured patients.

  13. Heparin-induced thrombocytopenia (HIT) causing portosplenic, superior mesenteric, and splenic vein thrombosis resulting in splenic rupture and pulmonary emboli formation.

    Science.gov (United States)

    Lammering, Jeanne C; Wang, David S; Shin, Lewis K

    2012-01-01

    Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin administration. Of the few reported cases of HIT-associated intra-abdominal thrombosis, none to our knowledge provide multidetector-row computed tomography (MDCT) imaging findings or emphasize its utility in diagnosis. We describe a case of HIT with MDCT images demonstrating extensive intra-abdominal thrombosis and end-organ complications including splenic rupture and pulmonary emboli. This case emphasizes the potential role of MDCT in the rapid detection of HIT-related thromboembolic complications in patients with nonspecific abdominal pain.

  14. Isolated supra-cardiac partial anomalous pulmonary venous connection causing right heart failure

    Directory of Open Access Journals (Sweden)

    Robert Sogomonian

    2016-04-01

    Full Text Available Right heart failure (RHF has been overlooked as left heart failure has predominated. One of the many causes of RHF is partial anomalous pulmonary venous connection (PAPVC, an extremely rare entity in nature. Physicians should consider the unusual causes of RHF after ruling out the common causes.

  15. Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis

    Directory of Open Access Journals (Sweden)

    Eflatun Yücedağ

    2014-03-01

    Full Text Available Objective: Pulmonary thromboembolism (PTE named due to migration of clots formed in systemic venous system to pulmonary vascular bed is a serious clinical table. After acute DVT, asymptomatic PTE is seen about 40-60% and this situation can not be discovered because of silent clinical course. In this study, we aimed to compare sensivity and spesifity of multi detector computerized tomography (MDCT, which is used extensively in recent years, with ventilation-perfusion (V/P scintigraphy which is used formerly for diagnosis of asymptomatic PTE developed after acute lower extremity DVT. Methods: The study was carried out 25 patients who were admitted to our clinic and treated for lower extremity acute DVT. Pregnants, and cases with recurrent DVT, presence of symptomatic PTE during admission, thrombosis extending to vena cava, and history of passed PTE were excluded from the study. DVTs in patients were diagnosed by color doppler, and confirmed by D-dimer test. After patients’s admission, V/P scintigraphy and MDCT were used to detects asymptomatic PTE at 1st and 8 th day of the admission. Results: D-dimer was measured as higher in 24 of 25 patients with asemptomatic PTE. Ten patients were diagnosed by MDCT. Development of asymptomatic PTE related to acute DVT was determined as 40%. Conclusion: In terms of diagnostic value, MDCT was found more useful than V/P scintigraphy.

  16. Radiological features of azygous vein aneurysm.

    Science.gov (United States)

    Choudhary, Arabinda Kumar; Moore, Michael

    2014-04-01

    Mediastinal masses are most commonly associated with malignancy. Azygous vein aneurysm is a very rare differential diagnosis of mediastinal mass. We report here three cases of azygous vein aneurysm including children and adult patients. In the pediatric patient it was further complicated by thrombosis and secondary pulmonary embolism. We describe the radiological features on CXR, MRI, CT, PET-CT, US and angiogram and their differential diagnosis. Imaging findings of continuity with azygous vein, layering of contrast medium on enhanced CT and dynamic MRA showing filling of the mass at the same time as the azygous vein without prior enhancement will be strongly suggestive of azygous vein aneurysm with transtracheal ultrasound being the definitive test in these patients. It is important to keep a vascular origin mass in the differential diagnosis of mediastinal masses. Also, in young healthy patients with pulmonary embolism, a vascular etiology such as azygous vein aneurysm should be carefully evaluated. This article will help the clinicians to learn about the imaging features of azygous vein aneurysm on different imaging modalities.

  17. [Pelvic vein thrombosis with elevated D-dimer level and normal ultrasound scan of the femoral vein].

    Science.gov (United States)

    Stenberg, Morten Roos; Tveskov, Claus

    2014-01-13

    A 17-year-old female presented with an isolated pelvic vein thrombosis (PVT) which was not visualised at the first compression ultrasound scan of the femoral vein. Isolated PVT should be suspected when the patient demonstrates the possible symptoms of a deep vein thrombosis with unilateral leg swelling extending to the groin and a negative compression ultrasound scan of the femoral vein. Supplemental ultrasound scan with Doppler flow, computed tomography or magnetic resonance venography are alternative diagnostic modalities if PVT is suspected.

  18. Portal Vein Thrombosis

    OpenAIRE

    Hakan Demirci

    2016-01-01

    Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low...

  19. Focus on Varicose Veins

    Science.gov (United States)

    ... veins, which are the visible purple or greenish-blue veins that appear in our legs. Spider veins or teleangiectesias are tiny veins that you ... reduce leg swelling and decrease the risk of blood clots. Prescription ... sclerosing solution into spider, reticular or varicose veins. This is a minimally ...

  20. Apelin and pulmonary hypertension

    DEFF Research Database (Denmark)

    Andersen, Charlotte Uggerhøj; Hilberg, Ole; Mellemkjær, Søren;

    2011-01-01

    Pulmonary arterial hypertension (PAH) is a devastating disease characterized by pulmonary vasoconstriction, pulmonary arterial remodeling, abnormal angiogenesis and impaired right ventricular function. Despite progress in pharmacological therapy, there is still no cure for PAH. The peptide apelin...... vasoconstriction, and has positive inotropic and cardioprotective effects. Apelin attenuates vasoconstriction in isolated rat pulmonary arteries, and chronic treatment with apelin attenuates the development of pulmonary hypertension in animal models. The existing literature thus renders APLNR an interesting...

  1. Exercise capacity and ventricular function in patients treated for isolated pulmonary valve stenosis or tetralogy of Fallot.

    Science.gov (United States)

    Luijnenburg, Saskia E; de Koning, Wilfred B; Romeih, Soha; van den Berg, Jochem; Vliegen, Hubert W; Mulder, Barbara J M; Helbing, Willem A

    2012-07-26

    We hypothesized 1) that long-term ventricular outcome and exercise capacity would be better in patients with isolated pulmonary valve stenosis (PS) treated with balloon pulmonary valvuloplasty (BPV) than in patients operated for tetralogy of Fallot (TOF), and 2) that ventricular outcome and exercise capacity would not be different in PS patients and healthy controls. We included 21 PS patients after BPV (16.2 ± 5.2 years) and 21 patients operated for TOF (16.6 ± 5.6 years), matching them for gender, age at treatment, and age at study. Patients underwent cardiovascular magnetic resonance (CMR) imaging, exercise testing, 12-lead ECG and 24-hour Holter monitoring for assessment of right ventricular (RV) size and function, pulmonary regurgitation (PR), exercise capacity and electrocardiographic status. Healthy controls for CMR imaging and exercise testing were matched for gender and age at study. RV volumes and PR percentage were significantly larger in TOF patients than in PS patients; biventricular ejection fraction (EF) was not different. PR was mild in most PS patients. RV end-systolic volume was significantly larger in PS patients than in healthy controls; RVEF was significantly lower. Both patient groups had similar exercise test results. Peak workload and VO(2) max. were significantly lower in PS patients than in healthy controls. Longstanding mild PR in PS patients can lead to an enlarged RV, reduced RV function and reduced exercise capacity. Despite more PR and larger RV volumes in TOF patients, exercise capacity and biventricular function are similar in both patient groups. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  2. Isolated pulmonary regurgitation causes decreased right ventricular longitudinal function and compensatory increased septal pumping in a porcine model.

    Science.gov (United States)

    Kopic, S; Stephensen, S S; Heiberg, E; Arheden, H; Bonhoeffer, P; Ersbøll, M; Vejlstrup, N; Søndergaard, L; Carlsson, M

    2017-06-05

    Longitudinal ventricular contraction is a parameter of cardiac performance with predictive power. Right ventricular (RV) longitudinal function is impaired in patients with free pulmonary regurgitation (PR) following corrective surgery for Tetralogy of Fallot (TOF). It remains unclear whether this is a consequence of the surgical repair, or whether it is inherent to PR. The aim of this study was to assess the relationship between longitudinal, lateral and septal pumping in a porcine model of isolated PR. Piglets were divided into a control (n = 8) group and a treatment (n = 12) group, which received a stent in the pulmonary valve orifice, inducing PR. After 2-3 months, animals were subjected to cardiac magnetic resonance imaging. A subset of animals (n = 6) then underwent percutaneous pulmonary valve replacement (PPVR) with follow-up 1 month later. Longitudinal, lateral and septal contributions to stroke volume (SV) were quantified by measuring volumetric displacements from end-diastole to end-systole in the cardiac short axis and long axis. PR resulted in a lower longitudinal contribution to RV stroke volume, compared to controls (60.0 ± 2.6% vs. 73.6 ± 3.8%; P = 0.012). Furthermore, a compensatory increase in septal contribution to RVSV was observed (11.0 ± 1.6% vs. -3.1 ± 1.5%; P function were reversed by PPVR. These findings suggest that PR contributes to decreased RV longitudinal function in the absence of scarring from cardiac surgery. Measurement of longitudinal RVSV may aid risk stratification and timing for interventional correction of PR in TOF patients. © 2017 The Authors. Acta Physiologica published by John Wiley & Sons Ltd on behalf of Scandinavian Physiological Society.

  3. Spider Vein Removal

    Science.gov (United States)

    Spider veins: How are they removed? I have spider veins on my legs. What options are available ... M.D. Several options are available to remove spider veins — thin red lines or weblike networks of ...

  4. Isolated right pulmonary artery agenesis with agenesis of right upper lobe and bronchiectasis of right lower lobe with anomalous arterial supply from celiac axis with normal venous drainage.

    Science.gov (United States)

    Chaudhry, A; Rathore, M; Banavaliker, J N

    2014-01-01

    Isolated unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly. When detected in infancy, the condition is commonly associated with cardiovascular defects which are more frequently associated with left pulmonary artery agenesis. Patients with isolated right pulmonary artery agenesis survive into adulthood with minimal or no symptoms and are diagnosed incidentally on the chest radiographs. We report a case of a 19-year-old female patient who presented to us with recurrent haemoptysis. She was symptomatic since the age of four years. We report the rare occurrence of UAPA on right side, agenesis of right upper lobe and bronchiectasis of right lower lobe with anomalous arterial supply of right lung from coeliac axis in this patient.

  5. Sclerotherapy of Varicose Veins and Spider Veins

    Science.gov (United States)

    ... you as to whether the procedure was a technical success when it is completed. Your interventional radiologist ... Varicose Veins) Phlebectomy of Varicose Veins Contrast Materials Anesthesia Safety Sponsored by Please note RadiologyInfo.org is ...

  6. Vein Problems Related to Varicose Veins

    Science.gov (United States)

    ... telangiectasias. Spider veins involve the capillaries, the smallest blood vessels in the body. Spider veins often appear on the legs and face. They're red or blue and usually look like a spider web or ...

  7. Evaluation of Biphasic Culture System for Mycobacterial Isolation from the Sputum of Patients with Pulmonary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Ghatole M

    2005-01-01

    Full Text Available Mycobacterial diseases continue to cause high morbidity and mortality. Isolation, identification and sensitivity testing form the backbone of laboratory investigations. M. tuberculosis isolation needs 6-8 weeks on conventional egg containing media. For rapid isolation various methods have been evaluated. We evaluated biphasic system (Middlebrook 7H11 agar slant + Middlebrook 9H broth in comparison with Lowenstein - Jensen (LJ medium. In smear positive cases biphasic system showed the recovery rate of 97.05% as against 79.41% on LJ on incubation for 21± 4.44 and 28±3.76 days respectively. In smear negative and culture positive cases biphasic system and LJ showed isolation rates of 91.66% and 66.6% after 36±3.44 and 41± 4.09 days respectively. Biphasic system showed lower contamination rate (1.33%. Biphasic medium is superior to LJ medium in isolation of M. tuberculosis .

  8. Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hwa Yeon; Song, In Sup (Dept. of Diagnostic Radiology Chung-Ang Univ. College of Medicine, Seoul (Korea, Republic of)); Yoo, Seung Min; Rho, Ji Young (Dept. of Diagnostic Radiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)), email: smyoo68@hanmail.net; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Cha, Dong Hun (Dept. of Cardiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)); White, Charles S. (Dept. of Diagnostic Radiology Univ. of Maryland, Baltimore (United States))

    2011-05-15

    Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

  9. 旋转式左心房造影在心房颤动消融中的应用%Contrast-enhanced X-ray rotational angiographic imaging of the left atrium and pulmonary veins for atrial fibrillation ablation

    Institute of Scientific and Technical Information of China (English)

    唐闽; 张澍; 李劲宏; Charalampos Christselis; 黄从新

    2008-01-01

    Objective Atrial fibrillation(AF)ablation is a complex procedure that requires detailed anatomic information about left atrium(LA)and pulmonary veins(PVs).The goal of this study was to test rotational angiography of the LA during adenosine-induced asystole as imaging tool in patients undergoing AF ablation.Methods Seventy patients with AF undergoing PVs isolation were included.After transseptal punction adenosine(30 mg)was given intravenously and during atrioventricular block contrast medium was directly injected in the LA and a rotational angiography performed(RAO 55°to LAO 55°).Rotational angiography images were assessed qualitatively and quantitively in all patients.Results Rotational angiography was performed successfully in 65 cases(65/70,94%)in one single rotation,and it was repeated in 5 cases(5/70,6%)with adenosine(40 mg)in second rotation.All the 4 PVs,left common PVs,accessory PVs and left atrial appendage ridges were delineated in rotational angiography.A blinded quantitative comparison of PV ostial diameters showed an excellent correlation between rotational angiography and CT measurements(r>0.90 for all PVs).No serious adverse effects occurred in association with adenosine.Conclusion Intraprocedural contrast-enhanced rotational angiography of the LA-PVs during adenosine-induced asystole is feasible and provides anatomical information of hish diagnostic value for AF ablation.%目的 实时了解左心房和肺静脉的解剖结构在导管消融治疗心房颤动(房颤)中起着重要作用.通过腺苷造成完全性房室阻滞,应用旋转式造影的方法进行左心房和肺静脉的实时显像,指导房颤的消融.方法 对70例房颤患者行经导管消融术,全部患者消融术前进行64排CT扫描,且进行左心房的三维重建.房间隔穿刺后,静脉注射腺苷(30 mg)造成完全性房室阻滞,同时向左心房内注射造影剂,进行旋转式左心房造影(右前斜55°~左前斜55.).对造影结果进行定性和定

  10. Isolation of nontuberculous mycobacteria (NTM) from household water and shower aerosols in patients with pulmonary disease caused by NTM.

    Science.gov (United States)

    Thomson, Rachel; Tolson, Carla; Carter, Robyn; Coulter, Chris; Huygens, Flavia; Hargreaves, Megan

    2013-09-01

    It has been postulated that susceptible individuals may acquire infection with nontuberculous mycobacteria (NTM) from water and aerosol exposure. This study examined household water and shower aerosols of patients with NTM pulmonary disease. The mycobacteria isolated from clinical samples from 20 patients included M. avium (5 patients), M. intracellulare (12 patients), M. abscessus (7 patients), M. gordonae (1 patient), M. lentiflavum (1 patient), M. fortuitum (1 patient), M. peregrinum (1 patient), M. chelonae (1 patient), M. triplex (1 patient), and M. kansasii (1 patient). One-liter water samples and swabs were collected from all taps, and swimming pools or rainwater tanks. Shower aerosols were sampled using Andersen six-stage cascade impactors. For a subgroup of patients, real-time PCR was performed and high-resolution melt profiles were compared to those of ATCC control strains. Pathogenic mycobacteria were isolated from 19 homes. Species identified in the home matched that found in the patient in seven (35%) cases: M. abscessus (3 cases), M. avium (1 case), M. gordonae (1 case), M. lentiflavum (1 case), and M. kansasii (1 case). In an additional patient with M. abscessus infection, this species was isolated from potable water supplying her home. NTM grown from aerosols included M. abscessus (3 homes), M. gordonae (2 homes), M. kansasii (1 home), M. fortuitum complex (4 homes), M. mucogenicum (1 home), and M. wolinskyi (1 home). NTM causing human disease can be isolated from household water and aerosols. The evidence appears strongest for M. avium, M. kansasii, M. lentiflavum, and M. abscessus. Despite a predominance of disease due to M. intracellulare, we found no evidence for acquisition of infection from household water for this species.

  11. Assessment of risk and prophylaxis for deep vein thrombosis and pulmonary embolism in medically ill patients during their early days of hospital stay at a tertiary care center in a developing country

    Directory of Open Access Journals (Sweden)

    Ambarish Pandey

    2009-08-01

    Full Text Available Ambarish Pandey, Nivedita Patni, Mansher Singh, Randeep GuleriaDepartment of Medicine, All India Institute of Medical Sciences, New Delhi, IndiaAim: Deep vein thrombosis (DVT and pulmonary thromboembolism (PE are important causes of morbidity and mortality in medically ill patients. This study was done to assess risk factors and prophylaxis given for DVT and PE in newly admitted medically ill patients during the first two weeks of their hospital stay at a tertiary care center hospital in India.Methods: All patients within one week of their admission in intensive care unit (ICU and wards were enrolled in the study after an informed written consent. Patients who had DVT prophylaxis within the past month or any contraindications for DVT prophylaxis were excluded. A structured proforma was designed and effective risk stratification for DVT was done. Patients were followed for up to two weeks to record any changes in the risk categories and document any signs of PE or DVT if present. Any prophylaxis given for DVT or PE was noted.Results: Seventy-five percent of patients had the highest risk for DVT and PE. Only 12.5% had DVT prophylaxis within the first two days of admission. Within two weeks of admission, 30.8% of patients were discharged, and 16.2% died. 72.6% of the patients still in the wards belonged to the highest risk category. Clinical signs and symptoms of DVT and PE were present in 25.8% and 9.8% of patients, respectively after the second week of admission. 86% of symptomatic patients belonged to the highest risk category initially and none of them received any prophylaxis. 21.6% of the highest risk category patients died within two weeks of their admission. A statistically significant correlation was found between mortality and risk score of the patients for DVT and between lack of prophylaxis and mortality (p < 0.05.Conclusion: A significant risk for DVT and PE exists in medically ill patients, but only a small proportion of the patients

  12. Pulmonary embolism after greater saphenous vein ligation and stripping%大隐静脉曲张术后并发肺栓塞11例的治疗

    Institute of Scientific and Technical Information of China (English)

    王晓天; 胡何节; 方征东; 孙小杰; 葛新宝; 刘振明

    2015-01-01

    目的 探讨大隐静脉曲张高位结扎剥脱术后患者并发肺栓塞(pulmonary embolism,PE)的临床特点及预防措施.方法 回顾分析安徽省立医院血管外科2008年1月至2013年6月收治及会诊的大隐静脉曲张术后合并PE的11例患者临床特点、诊疗及预后等资料.结果 该组11例PE患者有6例患者经过心肺复苏、抗凝溶栓等治疗无效死亡,死亡率54.5%.5例患者经过早期的抗凝、溶栓等治疗后康复,在溶栓过程中,2例患者因彩超发现股静脉内漂浮血栓选择下腔静脉滤器植入术.对5例患者经过8 ~ 25个月随访,均无呼吸困难、胸闷、胸痛等症状.患者发病时临床表现以呼吸困难最为常见(90.9%),有胸痛症状3例(27.3%),出现晕厥2例(18.2%),猝死2例(18.2%),均无典型的呼吸困难、胸痛、咯血三联征.结论 PE的早期诊断及早期治疗可能降低大隐静脉曲张高位结扎剥脱术后PE患者的死亡率.%Objective To analyze characteristics and prophylaxis of pulmonary embolism (PE) after greater saphenous vein ligation and stripping.Methods We retrospectively analyzed the clinical characteristics and treatment of 11 inpatients with postoperative PE in Anhui Provincial Hospital and other hospitals from January 2008 to June 2013.Results In this group 6 patients died after failed cardiopulmonary resuscitation (CPR) and other treatments,the mortality was 54.5%.5 patients recovered after anticoagulation,thrombolysis and other treatments.During the process of thrombolysis,floating thrombus was found within the femoral vein in 2 patients and inferior vena cava filter was implanted.After 8-25 months follow-up,all 5 patients were free of difficulty of breathing,chest tightness,chest pain and other symptoms.Among many clinical manifestations,dyspnea (90.9%) was the most common,other clinical manifestations included chest pain (27.3%),syncope (18.2%),sudden death (18.2%).There was no typical triad of dyspnea

  13. Nursing Experience for Pulmonary Vein Radiofrequency Ablation and Left Atria Resection using Thoracoscope%全电视胸腔镜下双侧肺静脉射频消融+左心耳切除术的护理

    Institute of Scientific and Technical Information of China (English)

    陈迎霞; 周建玲; 陈丽娟; 果建军

    2011-01-01

    目的:总结8例在全麻下双腔气管内插管行全电视胸腔镜双侧肺静脉射频消融+左心耳切除术的巡回护理工作.方法:双腔气管内插管,静脉复合麻醉,左右肺交替单肺通气.患者左侧卧位,经右侧第七肋间腋前线出切开皮肤1cm.入腔镜,准确定位第七肋间腋中线和第四肋间乳中线并分别做1cm切口.通过视频显示,剪开并悬吊心包,分离显露右肺静脉轮廓.在Aticure分离诱导器辅助下,将Aticure射频钳于完全钳住右肺上下静脉(左房入口处),反复夹闭和松开射频钳3次,进行消融.患者右侧卧位,经左侧第七肋间腋前线处切开皮肤1cm.按上述同样方法行左肺上下静脉射频消融.然后,在腔镜辅助下,用GC-60切除吻合器将左心耳切掉.严密止血,逐层关胸.结果:手术均顺利完成,术中巡回护士配合达预期的目的,患者术后安返监护室.结论:术前一日访视患者,了解患者病情,做好心理护理,用物准备齐全,熟练掌握手术配合是手术成功的关键.%Objective: To summarize the nursing experience for pulmonary vein radiofrequency ablation and left atria resection using thoracoscope under general anesthesia.Methods: Nursing care for pulmonary vein radiofrequency ablation and left atria resection in 8 cases under general anesthesia was analyzed to summarize the nursing experience.Results: All operations were performed successfully and 8 patients were safely sent to ICU post-operation.Conclusion: Nurses cooperated with doctors properly during the operation time.Keys to the success of operations are as following: visiting the ptient one day before operation,knowing well of the patient's state of illness,proper paychological nursing,preparing materials useful for operations carefully and cooperating with doctors properly.

  14. Altered reactivity and nitric oxide signaling in the isolated thoracic duct from an ovine model of congenital heart disease with increased pulmonary blood flow.

    Science.gov (United States)

    Datar, Sanjeev A; Oishi, Peter E; Gong, Wenhui; Bennett, Stephen H; Sun, Christine E; Johengen, Michael; Maki, Jun; Johnson, Rebecca C; Raff, Gary W; Fineman, Jeffrey R

    2014-04-01

    We have previously shown decreased pulmonary lymph flow in our lamb model of chronically increased pulmonary blood flow, created by the in utero placement of an 8-mm aortopulmonary shunt. The purpose of this study was to test the hypothesis that abnormal lymphatic function in shunt lambs is due to impaired lymphatic endothelial nitric oxide (NO)-cGMP signaling resulting in increased lymphatic vascular constriction and/or impaired relaxation. Thoracic duct rings were isolated from 4-wk-old shunt (n = 7) and normal (n = 7) lambs to determine length-tension properties, vascular reactivity, and endothelial NO synthase protein. At baseline, shunt thoracic duct rings had 2.6-fold higher peak to peak tension and a 2-fold increase in the strength of contractions compared with normal rings (P < 0.05). In response to norepinephrine, shunt thoracic duct rings had a 2.4-fold increase in vascular tone compared with normal rings (P < 0.05) and impaired relaxation in response to the endothelium-dependent dilator acetylcholine (63% vs. 13%, P < 0.05). In vivo, inhaled NO (40 ppm) increased pulmonary lymph flow (normalized for resistance) ∼1.5-fold in both normal and shunt lambs (P < 0.05). Inhaled NO exposure increased bioavailable NO [nitrite/nitrate (NOx); ∼2.5-fold in normal lambs and ∼3.4-fold in shunt lambs] and cGMP (∼2.5-fold in both) in the pulmonary lymph effluent (P < 0.05). Chronic exposure to increased pulmonary blood flow is associated with pulmonary lymphatic endothelial injury that disrupts NO-cGMP signaling, leading to increased resting vasoconstriction, increased maximal strength of contraction, and impaired endothelium-dependent relaxation. Inhaled NO increases pulmonary lymph NOx and cGMP levels and pulmonary lymph flow in normal and shunt lambs. Therapies that augment NO-cGMP signaling within the lymphatic system may provide benefits, warranting further study.

  15. Electrophysiological characteristics of cardiocyte from excised pulmonary vein cardiac muscle of rabbit%离体兔肺静脉肌袖心肌细胞电生理特性

    Institute of Scientific and Technical Information of China (English)

    刘俊辉; 李源; 刘泰槰; 黄卫斌

    2011-01-01

    目的 应用常规玻璃微电极细胞内记录技术,研究家兔肺静脉肌袖(PVC)电生理特性,观察PVC与左心房心肌细胞(LAC)之间的电传导现象,探讨肺静脉起源的阵发性房颤的发生机制.方法 50只健康成年家兔,获取肺静脉及相连左房心肌组织,应用常规微电极细胞内技术:记录PVC与LAC动作电位(AP),并进行各项参数比较(APD20,APD50,APD90);分别于PVC端和LAC端予不同频率脉冲刺激,观察另一端AP的产生情况;改用加有钾离子通道阻滞剂2mmol/L氯化铯(CsCl)的台式液,观察二者早后除极(EAD)发生的可能性.结果 PVC的APD20,APD50,APD90均较LAC长(APD20 (23.09±5.44)ms vs (19.50±1.66)ms,APD50 (52.40±7.93)ms vs (28.90±4.36)ms,APD90 (123.35±8.26)ms vs (69.65±9.44)ms),均有显著性差异(P均<0.05);在一定的刺激频率范围内,肺静脉的刺激均能传导至左心房,而后者较少能逆传至肺静脉(100% vs 10%,P<0.05);加用药物灌流后,PVC更易发生EAD(90% vs 15%,P<0.05).结论 PVC和LAC之间的电兴奋传导是不均一的,这可能是形成折返的基础.CsCl作为一种K+通道阻滞剂能延长复极过程,为后除极的发生创造条件,PVC的长AP时程特性,具备发生EAD的倾向性,并且兴奋易于传入左心房,这可能是促进房性心律失常的发生基础.%Objective It is to study the electrophysiological characteristics of cardiocyte from pulmonary vein cardiac muscle ( PVC ) of rabbit applying intracellular recording technique of routine glass microelectrode, to observe the electrical conduction between PVC and left atrium cardiocyte ( LAC ) and to approach the mechanism of paroxysmal atrial fibrillation originated from pulmonary vein. Methods Multiple cardiocytes preparations from pulmonary vein and left atrium of 50 healthy adult rabbits were obtained. The routine intracellular microelectrode technique was applied to record action potential ( AP ) of PVC and LAC , and a comparison of action potential duration

  16. Thrombolytic therapy in pulmonary embolism.

    LENUS (Irish Health Repository)

    Nagi, D

    2010-01-01

    Massive pulmonary embolism carries a high mortality. Potential treatment includes anticoagulation, thrombolytic therapy and embolectomy. We report a case of deep vein thrombosis leading to progressive massive pulmonary embolism despite appropriate anticoagulation, where thrombolysis with IVC filter placement resulted in a successful outcome.

  17. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study

    NARCIS (Netherlands)

    Hoefsloot, W.; Ingen, J. van; Andrejak, C.; Angeby, K.; Bauriaud, R.; Bemer, P.; Beylis, N.; Boeree, M.J.; Cacho, J.; Chihota, V.; Chimara, E.; Churchyard, G.; Cias, R.; Daza, R.; Daley, C.L.; Dekhuijzen, P.N.R.; Domingo, D.; Drobniewski, F.; Esteban, J. De; Fauville-Dufaux, M.; Folkvardsen, D.B.; Gibbons, N.; Gomez-Mampaso, E.; Gonzalez, R.; Hoffmann, H.; Hsueh, P.R.; Indra, A.; Jagielski, T.; Jamieson, F.; Jankovic, M.; Jong, Eefje de; Keane, J.; Koh, W.J.; Lange, B. de; Leao, S.; Macedo, R.; Mannsaker, T.; Marras, T.K.; Maugein, J.; Milburn, H.J.; Mlinko, T.; Morcillo, N.; Morimoto, K.; Papaventsis, D.; Palenque, E.; Paez-Pena, M.; Piersimoni, C.; Polanova, M.; Rastogi, N.; Richter, E.; Ruiz-Serrano, M.J.; Silva, A.; Silva, M.P. da; Simsek, H.; Soolingen, D. van; Szabo, N.; Thomson, R.; Fernandez, T. Tortola; Tortoli, E.; Totten, S.E.; Tyrrell, G.; Vasankari, T.; Villar, M.; Walkiewicz, R.; Winthrop, K.L.; Wagner, D.; Trials, G. Nontuberculous

    2013-01-01

    A significant knowledge gap exists concerning the geographical distribution of nontuberculous mycobacteria (NTM) isolation worldwide. To provide a snapshot of NTM species distribution, global partners in the NTM-Network European Trials Group (NET) framework (www.ntm-net.org), a branch of the Tubercu

  18. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study

    NARCIS (Netherlands)

    Hoefsloot, W.; Ingen, J. van; Andrejak, C.; Angeby, K.; Bauriaud, R.; Bemer, P.; Beylis, N.; Boeree, M.J.; Cacho, J.; Chihota, V.; Chimara, E.; Churchyard, G.; Cias, R.; Daza, R.; Daley, C.L.; Dekhuijzen, P.N.R.; Domingo, D.; Drobniewski, F.; Esteban, J. De; Fauville-Dufaux, M.; Folkvardsen, D.B.; Gibbons, N.; Gomez-Mampaso, E.; Gonzalez, R.; Hoffmann, H.; Hsueh, P.R.; Indra, A.; Jagielski, T.; Jamieson, F.; Jankovic, M.; Jong, Eefje de; Keane, J.; Koh, W.J.; Lange, B. de; Leao, S.; Macedo, R.; Mannsaker, T.; Marras, T.K.; Maugein, J.; Milburn, H.J.; Mlinko, T.; Morcillo, N.; Morimoto, K.; Papaventsis, D.; Palenque, E.; Paez-Pena, M.; Piersimoni, C.; Polanova, M.; Rastogi, N.; Richter, E.; Ruiz-Serrano, M.J.; Silva, A.; Silva, M.P. da; Simsek, H.; Soolingen, D. van; Szabo, N.; Thomson, R.; Fernandez, T. Tortola; Tortoli, E.; Totten, S.E.; Tyrrell, G.; Vasankari, T.; Villar, M.; Walkiewicz, R.; Winthrop, K.L.; Wagner, D.; Trials, G. Nontuberculous

    2013-01-01

    A significant knowledge gap exists concerning the geographical distribution of nontuberculous mycobacteria (NTM) isolation worldwide. To provide a snapshot of NTM species distribution, global partners in the NTM-Network European Trials Group (NET) framework (www.ntm-net.org), a branch of the

  19. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hakan Demirci

    2016-01-01

    Full Text Available Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low molecular weight heparin achieves recanalization in more than half of acute cases.

  20. Pulmonary Venous Obstruction in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Chuang-Chi Liaw

    2015-01-01

    Full Text Available Background. We study the clinical significance and management of pulmonary venous obstruction in cancer patients. Methods. We conducted a prospective cohort study to characterize the syndrome that we term “pulmonary vein obstruction syndrome” (PVOS between January 2005 and March 2014. The criteria for inclusion were (1 episodes of shortness of breath; (2 chest X-ray showing abnormal pulmonary hilum shadow with or without presence of pulmonary edema and/or pleural effusion; (3 CT scan demonstrating pulmonary vein thrombosis/tumor with or without tumor around the vein. Results. Two hundred and twenty-two patients developed PVOS. Shortness of breath was the main symptom, which was aggravated by chemotherapy in 28 (13%, and medical/surgical procedures in 21 (9% and showed diurnal change in intensity in 32 (14%. Chest X-rays all revealed abnormal pulmonary hilum shadows and presence of pulmonary edema in 194 (87% and pleural effusion in 192 (86%. CT scans all showed pulmonary vein thrombosis/tumor (100% and surrounding the pulmonary veins by tumor lesions in 140 patients (63%. PVOS was treated with low molecular weight heparin in combination with dexamethasone, and 66% of patients got clinical/image improvement. Conclusion. Physicians should be alert to PVOS when shortness of breath occurs and chest X-ray reveals abnormal pulmonary hilum shadows.

  1. [Calcified deep vein thrombosis in a patient with recurrent deep vein thrombosis and sarcoidosis].

    Science.gov (United States)

    Krmek, Dubravka Zupanić; Brajković, Ivana; Bekić, Dinko; Krnić, Antun; Jurković, Petar; Pavlović, Tomislav

    2013-12-01

    In this article, we present a rare case of calcified deep vein thrombosis in a 42-year-old female patient with frequent relapses of pulmonary sarcoidosis since 1995, for which she was on maintenance therapy with corticosteroids and with consequential secondary diabetes. Recent femoral vein thrombosis was diagnosed with color Doppler in 2012. At the same time, calcified occlusive thrombus in vena cava inferior from the level of renal vein to the confluence of hepatic veins was diagnosed on abdominal multi-slice computed tomography (MSCT). Digital subtraction venography (DSV) revealed a well-developed collateral circulation through the paravertebral veins, azygos and hemiazygos vein. There were no risk factors for thrombosis other than sarcoidosis and diabetes. Deep vein thrombosis is rarely described with sarcoidosis, but according to literature reports, it usually appears as a recurrence and simultaneously at multiple locations. According to the current knowledge, we cannot say for sure whether it is a disease with an increased risk of deep vein thrombosis or there is a combination of multiple risk factors present simultaneously.

  2. Recurrence of superficial vein thrombosis in patients with varicose veins.

    Science.gov (United States)

    Karathanos, Christos; Spanos, Konstantinos; Saleptsis, Vassileios; Tsezou, Aspasia; Kyriakou, Despina; Giannoukas, Athanasios D

    2016-08-01

    To investigate which factors other than history of superficial vein thrombosis (SVT) are associated with recurrent spontaneous SVT episodes in patients with varicose veins (VVs). Patients with a history of spontaneous SVT and VVs were followed up for a mean period of 55 months. Demographics, comorbidities, and thrombophilia screening test were analyzed. Patients were grouped according to the clinical-etiology-anatomy-pathophysiology classification. A multiple logistic regression analysis with the forward likelihood ratio method was undertaken. Thirteen patients out of 97 had a recurrence SVT episode during the follow-up period. All those patients were identified to have a thrombophilia defect. Protein C and S, antithrombin, and plasminogen deficiencies were more frequently present in patients without recurrence. Gene mutations were present in 38% in the nonrecurrence group and 77% in the recurrence group. After logistic regression analysis, patients with dislipidemia and mutation in prothrombin G20210A (FII) had an increased risk for recurrence by 5.4-fold and 4.6-fold, respectively. No deep vein thrombosis or pulmonary embolism occurred. Dislipidemia and gene mutations of F II are associated with SVT recurrence in patients with VVs. A selection of patients may benefit from anticoagulation in the short term and from VVs intervention in the long term. © The Author(s) 2015.

  3. Molecular and conventional methods for detection of Candida species isolated from a sample of immunocompromised Iraqi patients with pulmonary symptoms

    OpenAIRE

    Azhar AF AL-Attraqchi; Jabbar Salman Hassan; Haider N Dawood; Marwa A Hadab

    2017-01-01

    Objectives Candida species has emerged as a potentially pathogenic fungus rather than benefit mucosal commensal in patients with pulmonary diseases. Therefore, our study was carried out to detect Candida species in sputum samples from patients with pulmonary diseases using conventional and molecular methods. Methods A total of 100 sputum samples obtained from patients with pulmonary symptoms such as chronic productive cough, shortness of breath, wheezing and fever were included in this stu...

  4. Reconstruction of Isolated Inferior Right Hepatic Vein(s) in Right Lobe Living Donor Liver Transplantation Using Polytetrafluoroethylene Grafts: A New Feasible Concept, Technique of 'Bridging Conduit Venoplasty' and Outcomes.

    Science.gov (United States)

    Thorat, Ashok; Hsu, Shih-Chao; Yang, Horng-Ren; Li, Ping-Chun; Li, Ming-Li; Yeh, Chun-Chieh; Chen, Te-Hung; Poon, Kin-Shing; Jeng, Long-Bin

    2016-12-02

    BACKGROUND Right lobe living donor liver transplantation (LDLT) remains the most common form of liver transplantation in Asia. However, reconstruction of the venous outflow in a right liver allograft may pose technical difficulties if hepatic venous variations are present. Recently, much emphasis has been given to the reconstruction of large and multiple inferior right hepatic veins (IRHVs). The method of reconstructive technique, type of vascular grafts, and the outcome after the procedure have been a point of debate. In this report we discuss the IRHV reconstruction techniques using expanded polytetrafluoroethylene (ePTFE) vascular grafts and the outcomes after such reconstruction. MATERIAL AND METHODS Out of 262 right liver allografts that underwent venous reconstruction using ePTFE vascular grafts, IRHVs required either venoplasty or second inferior vena cava (IVC) anastomosis in 99 recipients. Depending upon type of IRHV reconstruction, the recipients were divided in 2 groups: Group A (n=52): IRHV venoplasty using ePTFE graft, and group B (n=47): Direct IRHV-to-IVC anastomosis. The outcome after LDLT was compared for these 2 groups. RESULTS The ePTFE venoplasty group had significantly shorter warm ischemia time as compared to the direct to IVC anastomosis group (pgraft migration in the second portion of the duodenum that required surgical exploration. CONCLUSIONS The IRHVs drain a considerable portion of the posterior sector of right liver allografts and thus must be reconstructed. Use of ePTFE vascular grafts for IRHV venoplasty is a safe and feasible concept that facilitates the outflow reconstruction of liver allografts.

  5. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Ronny Cohen

    2015-01-01

    Full Text Available Portal vein thrombosis (PVT is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community.

  6. Molecular diversity of Mycobacterium tuberculosis isolates from patients with pulmonary tuberculosis in Mozambique

    Directory of Open Access Journals (Sweden)

    Hill Véronique

    2010-07-01

    Full Text Available Abstract Background Mozambique is one of the countries with the highest burden of tuberculosis (TB in Sub-Saharan Africa, and information on the predominant genotypes of Mycobacterium tuberculosis circulating in the country are important to better understand the epidemic. This study determined the predominant strain lineages that cause TB in Mozambique. Results A total of 445 M. tuberculosis isolates from seven different provinces of Mozambique were characterized by spoligotyping and resulting profiles were compared with the international spoligotyping database SITVIT2. The four most predominant lineages observed were: the Latin-American Mediterranean (LAM, n = 165 or 37%; the East African-Indian (EAI, n = 132 or 29.7%; an evolutionary recent but yet ill-defined T clade, (n = 52 or 11.6%; and the globally-emerging Beijing clone, (n = 31 or 7%. A high spoligotype diversity was found for the EAI, LAM and T lineages. Conclusions The TB epidemic in Mozambique is caused by a wide diversity of spoligotypes with predominance of LAM, EAI, T and Beijing lineages.

  7. Esclerose sistêmica difusa com hipertensão pulmonar isolada: relato de caso Diffuse systemic sclerosis with isolated pulmonary hypertension: a case report

    Directory of Open Access Journals (Sweden)

    SILMÉIA GARCIA ZANATI

    2000-12-01

    Full Text Available A esclerose sistêmica (ES é uma doença incomum, caracterizada por alterações vasculares e fibrose em pele e vários órgãos. O envolvimento pulmonar é freqüente na ES; entretanto, hipertensão pulmonar (HP na ausência de fibrose intersticial é raramente observada. Os autores descrevem um caso de ES difusa com HP isolada em paciente do sexo feminino, de 49 anos. O diagnóstico de HP pôde ser sugerido pelo exame físico e confirmado por ecodopplercardiograma, que permitiu estimar a pressão sistólica em artéria pulmonar em 80mmHg. Tratamento foi iniciado com nifedipina; entretanto, devido a efeitos colaterais da droga, não foi possível o aumento da dose além de 30mg ao dia; nesta dosagem, a nifedipina não acarretou redução da pressão arterial pulmonar.Systemic sclerosis (SS is an uncommon disease characterized by small blood vessel vasculopathy and increased connective tissue in the skin and in other organs. The pulmonary involvement is common in SS; however, pulmonary hypertension without interstitial fibrosis is rare. The authors present a case of the diffuse form of SS with isolated pulmonary hypertension. The diagnosis of pulmonary hypertension was suggested by physical examination and confirmed by doppler-echocardiography which allowed for the estimation of the pulmonary artery systolic pressure in 80 mmHg. The authors started treatment with nifedipine; however, as the patient presented side effects, it was not possible to increase the dose beyond 30 mg/day. In this dosage, nifedipine did not decrease the pulmonary arterial pressure.

  8. CECT EVALUATION OF AN ISOLATED LONG SEGMENT IVC THROMBUS IN A PATIENT WITH ACUTE ON CHRONIC PANCREATITIS: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Pronami

    2015-10-01

    Full Text Available Isolated Inferior vena cava (IVC thrombosis is a rare vascular complication of Pancreatitis. Vascular complications associated with Pancreatitis are more commonly seen in peripancreatic vessels like Splenic, portal or mesenteric veins. We report a case of isolated IVC thrombosis in a patient with chronic pancreatitis on acute exacerbation. Awareness of this rare complication will help in early diagnosis & treatment as well as prevent further dreaded complication like pulmonary embolism.

  9. Neonatal repair of total anomalous pulmonary venous connection and lung agenesis.

    Science.gov (United States)

    Kaku, Yuji; Nagashima, Mitsugi; Matsumura, Goki; Yamazaki, Kenji

    2015-07-01

    Here we report a neonatal case of total anomalous pulmonary venous connection with left lung agenesis. Diagnostic imaging demonstrated that the left pulmonary veins were totally absent and the right pulmonary veins connected with the common pulmonary chamber. Drainage from the common pulmonary venous chamber entered the persistent left suerior vena cava. In addition, it revealed complete absence of the left main bronchus and left lung vessels. The neonate successfully underwent surgical repair 18 days after birth.

  10. Antimicrobial susceptibilities and serotypes of Streptococcus pneumoniae isolates from elderly patients with pneumonia and acute exacerbation of chronic obstructive pulmonary disease.

    Science.gov (United States)

    Pérez-Trallero, Emilio; Marimón, José M; Larruskain, Julián; Alonso, Marta; Ercibengoa, María

    2011-06-01

    In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n = 401) and AECOPD (n = 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P = 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.

  11. 肺灌注单光子发射计算机断层成像术/CT对下肢深静脉血栓形成患者肺栓塞的诊断价值研究%Diagnostic Value of Pulmonary Perfusion SPECT/CT on Pulmonary Embolism in Patients with Lower Extremity Deep ;Vein Thrombosis

    Institute of Scientific and Technical Information of China (English)

    吴大勇; 张文艳; 陈江红; 边艳珠; 胡玉敬

    2014-01-01

    目的:探讨肺灌注单光子发射计算机断层成像术( SPECT)/CT对下肢深静脉血栓形成( DVT)患者肺栓塞( PE)的诊断价值。方法选取2011年7月-2013年11月河北省人民医院收治的下肢DVT患者63例,在彩色超声检查后1 d内所有患者进行肺灌注SPECT/CT显像。综合患者临床症状、病史、实验室检查、CT肺动脉造影( CTPA)、治疗效果及随访做出有无PE的最终诊断。计算经肺灌注SPECT/CT诊断下肢DVT患者PE的灵敏度、特异度、阳性预测值、阴性预测值、准确度。结果经肺灌注SPECT/CT诊断下肢DVT患者PE的灵敏度为94.4%,特异度为85.2%,阳性预测值为89.5%,阴性预测值为92.0%,准确度为90.5%。结论肺灌注SPECT/CT能够较准确地诊断下肢DVT患者的PE,为临床提供了一种可靠的诊断PE的方法。%Objective To explore the diagnostic value of pulmonary perfusion SPECT/CT on pulmonary embolism (PE)in patients with lower extremity deep vein thrombosis(DVT). Methods 63 patients with lower extremity DVT admitted to Hebei General Hospital from July 2011 to November 2013 were selected. All the patients were given pulmonary perfusion SPECT/CT within one day after color ultrasound examination. The final diagnosis of PE was confirmed by comprehensive analysis of the patients' clinical symptoms,medical history,laboratory examination,CTPA,treatment effect and follow up. The sensitivi-ty,specificity,positive predictive value,negative predictive value and accuracy of lung perfusion SPECT/CT in the diagnosis of PE in patients with lower extremity DVT were calculated. Results The sensitivity,specificity,positive predictive value,nega-tive predictive value and accuracy of lung perfusion SPECT/CT in the diagnosis of PE in patients with lower extremity DVT was 94. 4%,85. 2%,89. 5%,92. 0% and 90. 5%. Conclusion The PE of patients with lower extremity DVT can be accurately diagnosed by pulmonary perfusion SPECT

  12. Evaluation of the relation of the different leg deep vein thrombosis to the pulmonary embolism by computed tomography pulmonary angiography%CT肺血管造影评价不同下肢深静脉血栓与肺栓塞关系

    Institute of Scientific and Technical Information of China (English)

    曾秋; 赵渝; 冯江毅; 李凤贺

    2014-01-01

    目的 利用CT肺血管造影(CTPA)比较不同下肢深静脉血栓(DVT)患者肺栓塞(PE)检出率及评价不同下肢DVT合并PE患者的肺动脉阻塞严重程度.方法 本科诊断DVT并行CTPA检查患者145例,分为左下肢DVT组,右下肢DVT组,双下肢DVT组,比较三组患者PE检出率.同时以肺动脉栓塞指数(CTI)量化评价肺动脉阻塞程度,比较不同组别确诊PE患者CTI.结果 双下肢DVT组患者PE检出率(71.4%)明显高于左下肢DVT组(39.2%)(P<0.05),而与右下肢DVT组PE检出率(52.9%)比较差异无统计学意义(P>0.05).双下肢DVT合并PE患者CTI[(30.20±14.20)%]明显高于左下肢DVT合并PE[(19.26±14.02)%]及右下肢DVT合并PE[(18.56±11.79)%](P<0.05).结论 双下肢DVT患者较左下肢DVT更容易并发PE,且双下肢DVT合并PE患者肺动脉阻塞程度较单侧更高.%Objective To evaluate the incidence and severity of pulmonary embolism (PE) in patients with different leg deep vein thrombosis (DVT) by computed tomography pulmonary angiography (CTPA).Methods A total of 145 cases who had been confirmed DVT and undergone CTPA were retrospectively analyzed.The DVTs were divided into left side DVT,right side DVT,and bilateral lower DVT groups.The incidence of PE was compared among different groups.CT obstruction index (CTI) was used to estimate the severity of pulmonary artery obstruction.DVT/PEs with CTI were compared among different groups.Results The incidence of PE of the bilateral lower DVT group was 71.4%,which was higher than that in left side DVT group (39.2%).However,no significant difference was found between bilateral lower DVT group and right side DVT group (52.9%) (P > 0.05).The CTI of the bilateral lower DVT (30.20±14.20)% was higher than that of the left side DVT (19.26 ± 14.02)% and the right side DVT (18.56 ±11.79) % (P < 0.05).Conclusions The bilateral lower DVT was more likely complicated with PE than the left side DVT,the severity of pulmonary

  13. Deep vein thrombosis: a clinical review

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    Kesieme EB

    2011-04-01

    Full Text Available Emeka Kesieme1, Chinenye Kesieme2, Nze Jebbin3, Eshiobo Irekpita1, Andrew Dongo11Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria; 2Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria; 3Department of Surgery, University of Port Harcourt Teaching Hospital, Port-Harcourt, NigeriaBackground: Deep vein thrombosis (DVT is the formation of blood clots (thrombi in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein or the deep veins of the pelvis. It is a potentially dangerous condition that can lead to preventable morbidity and mortality.Aim: To present an update on the causes and management of DVT.Methods: A review of publications obtained from Medline search, medical libraries, and Google.Results: DVT affects 0.1% of persons per year. It is predominantly a disease of the elderly and has a slight male preponderance. The approach to making a diagnosis currently involves an algorithm combining pretest probability, D-dimer testing, and compression ultrasonography. This will guide further investigations if necessary. Prophylaxis is both mechanical and pharmacological. The goals of treatment are to prevent extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome.Conclusion: DVT is a potentially dangerous condition with a myriad of risk factors. Prophylaxis is very important and can be mechanical and pharmacological. The mainstay of treatment is anticoagulant therapy. Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the treatment of choice. Currently anticoagulants specifically targeting components of the common pathway have been recommended for prophylaxis. These include fondaparinux, a selective indirect factor Xa inhibitor and the new oral selective direct thrombin inhibitors (dabigatran and selective

  14. Isolation and characterization of two novel bacteria Afipia cberi and Mesorhizobium hominis from blood of a patient afflicted with fatal pulmonary illness.

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    Shyh-Ching Lo

    Full Text Available We recently isolated and discovered new Bradyrhizobiaceae microbes from the cryopreserved culture broth of blood samples from 3 patients with poorly defined illnesses using modified SP4 media and culture conditions coupled with genomic sequencing. Using a similar protocol, we studied a previously cryopreserved culture broth of blood sample from a patient who had succumbed to an acute onset of fulminant pulmonary illness. We report that two phases of microbial growth were observed in the re-initiated culture. Biochemical and genomic characterization revealed microbes isolated from the first phase of growth were new Afipia species of Bradyrhizobiaceae, tentatively named A. cberi with a ~ 5 MB chromosome that was different from those of all previously known Afipia microbes including the newly discovered A. septicemium. The microbes isolated from the second phase of growth were prominent sugar assimilators, novel Phyllobacteriaceae, phylogenetically most closely related to Mesorhizobium and tentatively named M. hominis with a ~ 5.5 MB chromosome. All A. cberi isolates carry a circular ~ 140 KB plasmid. Some M. hominis isolates possess a circular ~ 412 KB plasmid that can be lost in prolonged culture or passage. No antibiotics resistant genes could be identified in both of the A. cberi and M. hominis plasmids. Antibiotic susceptibility studies using broth culture systems revealed isolates of A. cberi could be sensitive to some antibiotics, but all isolates of M. hominis were resistant to essentially all tested antibiotics. However, the cell-free antibiotics susceptibility test results may not be applicable to clinical treatment against the microbes that are known to be capable of intracellular growth. It remains to be determined if the 2 previously unknown Rhizobiales were indeed pathogenic and played a role in the pulmonary disease process in this patient. Specific probes and methods will be developed to re-examine the diseased lungs from patient

  15. Left Ventricular Native T1 time and the Risk of Arial fibrillation Recurrence after Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation

    Science.gov (United States)

    Kato, Shingo; Foppa, Murilo; Roujol, Sébastien; Basha, Tamer; Berg, Sophie; Kissinger, Kraig V.; Goddu, Beth; Manning, Warren J; Nezafat, Reza

    2016-01-01

    Background Native T1 mapping has emerged as a noninvasive non-contrast magnetic resonance imaging (MRI) method to assess for diffuse myocardial fibrosis. However, LV native T1 time in AF patients and its clinical relevance are unclear. Methods Fifty paroxysmal AF patients referred for PVI (60±8 years, 37 male) and 11 healthy control subjects (57±8 years, 10 male) were studied. All patients were in sinus rhythm during the MRI scan. Native T1 mapping images were acquired using a Modified Look-Locker imaging (MOLLI) sequence in 3 short-axis planes (basal, mid and apical slices) using an electrocardiogram triggered single-shot acquisition with a balanced steady-state free precession readout. Late gadolinium enhanced (LGE) MRI was acquired to evaluate for LV myocardial scar. Results LV ejection fraction was similar between groups (AF: 61±6%; controls: 60±6%, p=0.75). No LV myocardial scar was observed in any patient on LGE. Myocardial native T1 time was greater in AF patients (1099±52 vs 1042±20 msec, p<0.001). During a median follow-up period of 326 days, 18 of 50 (36%) patients experienced recurrence of AF. Multivariate Cox proportional hazard analysis identified elevated native T1 time as an independent predictor of recurrence of AF (HR: 6.53, 95% CI: 1.25–34.3, p=0.026). Conclusions There are differences in the native LV myocardial T1 time between AF patients with preserved LV function referred for PVI and normal controls. Native T1 time is an independent predictor of recurrence of AF after PVI in patients with paroxysmal AF. PMID:26599750

  16. Left ventricular native T1 time and the risk of atrial fibrillation recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation.

    Science.gov (United States)

    Kato, Shingo; Foppa, Murilo; Roujol, Sébastien; Basha, Tamer; Berg, Sophie; Kissinger, Kraig V; Goddu, Beth; Manning, Warren J; Nezafat, Reza

    2016-01-15

    Native T1 mapping has emerged as a noninvasive non-contrast magnetic resonance imaging (MRI) method to assess for diffuse myocardial fibrosis. However, LV native T1 time in AF patients and its clinical relevance are unclear. Fifty paroxysmal AF patients referred for PVI (60 ± 8 years, 37 male) and 11 healthy control subjects (57 ± 8 years, 10 male) were studied. All patients were in sinus rhythm during the MRI scan. Native T1 mapping images were acquired using a Modified Look-Locker imaging (MOLLI) sequence in 3 short-axis planes (basal, mid and apical slices) using an electrocardiogram triggered single-shot acquisition with a balanced steady-state free precession readout. Late gadolinium enhanced (LGE) MRI was acquired to evaluate for LV myocardial scar. LV ejection fraction was similar between groups (AF: 61 ± 6%; controls: 60 ± 6%, p=0.75). No LV myocardial scar was observed in any patient on LGE. Myocardial native T1 time was greater in AF patients (1099 ± 52 vs 1042 ± 20 msec, p<0.001). During a median follow-up period of 326 days, 18 of 50 (36%) patients experienced recurrence of AF. Multivariate Cox proportional hazard analysis identified elevated native T1 time as an independent predictor of recurrence of AF (HR: 6.53, 95% CI: 1.25-34.3, p=0.026). There are differences in the native LV myocardial T1 time between AF patients with preserved LV function referred for PVI and normal controls. Native T1 time is an independent predictor of recurrence of AF after PVI in patients with paroxysmal AF. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Recurrence of atrial fibrillation within three months after pulmonary vein isolation for patients with paroxysmal atrial fibrillation: Analysis using external loop recorder with auto-trigger function

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    Shiro Kawasaki

    2015-04-01

    Conclusions: AF recurrence measured by ELR-AUTO within 3 months after PVI can predict the late recurrence of AF. Freedom from AF in the first 3 months following ablation significantly predicts long-term AF freedom. ELR-AUTO is useful for the detection of symptomatic and asymptomatic AF.

  18. Absent right superior caval vein in situs solitus

    DEFF Research Database (Denmark)

    Lytzen, Rebekka; Sundberg, Karin; Vejlstrup, Niels

    2015-01-01

    no postnatal complications. All children were found to have healthy hearts at follow-up. CONCLUSIONS: In all cases, the findings proved to be a benign condition with no clinical manifestations or complications. Although isolated absent right superior caval vein does not seem to affect the outcome, associated......Introduction In up to 0.07% of the general population, the right anterior cardinal vein obliterates and the left remains open, creating an absent right superior caval vein and a persistent left superior caval vein. Absent right superior caval vein is associated with additional congenital heart...... disease in about half the patients. We wished to study the consequences of absent right superior caval vein as an incidental finding on prenatal ultrasonic malformation screening. Material and methods This is a retrospective case series study of all foetuses diagnosed with absent right superior caval vein...

  19. The characteristics of the transient receptor potential canonical 3 current in the cardiomyocytes of rabbit pulmonary vein sleeves%兔肺静脉肌袖心肌细胞TRPC3离子流的特性

    Institute of Scientific and Technical Information of China (English)

    林勇; 黄卫斌; 张蓉芳; 曾松; 刘泰槰

    2013-01-01

    目的 采用TRPC3通道特异性阻断剂证实兔肺静脉肌袖细胞(PVC)与左房心肌细胞(LAC)上存在TRPC3通道,并进行比较,探讨TRPC3通道在由PVC起源的心律失常中可能的作用.方法 酶解法分离PVC和LAC,采用全细胞膜片钳制技术,分别记录总背景电流(IBG).用TRPC3通道特异性阻断剂吡唑类复合2-氨基-3甲基-5-氰基吡啶(Pyr3)确定该离子流中存在ITRPC3.结果 研究发现,加入Pyr3灌流后LAC和PVC IBG电流密度均减少,被抑制的离子流部分即为ITRPC3,且PVC ITRPC3电流密度比LAC明显减小(-0.1225±0.0848 pA/pF vs-0.3301 ±0.0863 pA/pF,-60 mY,n=10,P<0.05;0.2548±0.0898 pA/pF vs 0.6704±0.1247 pA/pF,+ 60 mY,n=10,P<0.05).结论 PVC和LAC存在TRPC3通道,且两者ITRPC3电流密度的差异与PVC动作电位时程较长有关.%Objective To identify the existence of TRPC3 current (ITRPC3) in the cardiomyocytes from rabbit pulmonary vein muscle sleeves (PVC) and left atrial cardiomyocytes (LAC) and the regional differences of the current density between the two kinds of myocytes in order to discuss the role of TRPC3 channels in the ionic mechanism of PVC.Methods The PVC and LAC were obtained by enzymatic dissociation.The whole-cell patch-clamp technique was used to record the back-ground (IBG) current in the LAC and PVC.Pyr3,the selective and direct inhibition of TRPC3 channels,was taken to identify the ITRPC3 current.Results In the present work,after Pyr3 perfusion,the IBG current density was reduced in both PVC and LAC,which was identified as the ITRP3 current.The ITRPC3 current density of PVC was significantly less than LAC (-0.1225±0.0848 pA/pF vs-0.3301±0.0863 pA/pF;-60 mV,n=10,P<0.05; 0.2548±0.0898 pA/pF vs 0.6704±0.1247 pA/pF; + 60 mV,n=10,P<0.05).Conclusion The existence of TRPC3 channels in PVC and LAC has been identified,and the ITRPC3 current density of PVC is significantly lower than LAC.

  20. Venous thromboembolism: Additional diagnostic value and radiation dose of pelvic CT venography in patients with suspected pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Reichert, Miriam, E-mail: Miriam.Reichert@umm.de [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Henzler, Thomas; Krissak, Radko; Apfaltrer, Paul [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Huck, Kurt [1st Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim (Germany); Buesing, Karen [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Sueselbeck, Tim [1st Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim (Germany); Schoenberg, Stefan O.; Fink, Christian [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany)

    2011-10-15

    Purpose: To assess the additional diagnostic value of indirect CT venography (CTV) of the pelvis and upper thighs performed after pulmonary CT angiography (CTA) for the diagnosis of venous thromboembolism (VTE). Materials and methods: In a retrospective analysis, the radiology information system entries between January 2003 and December 2007 were searched for patients who received pulmonary CTA and additional CTV of the pelvis and upper thighs. Of those patients, the radiology reports were reviewed for the diagnosis of pulmonary embolism (PE) and deep venous thrombosis (DVT) in the pelvic veins and veins of the upper thighs. In cases with an isolated pelvic thrombosis at CTV (i.e. which only had a thrombosis in the pelvic veins but not in the veins of the upper thigh) ultrasound reports were reviewed for the presence of DVT of the legs. The estimated radiation dose was calculated for pulmonary CTA and for CTV of the pelvis. Results: In the defined period 3670 patients were referred to our institution for exclusion of PE. Of those, 642 patients (353 men, 289 women; mean age, 65 {+-} 15 years, age range 18-98 years) underwent combined pulmonary CTA and CTV. Among them, PE was found in 227 patients (35.4%). In patients without PE CTV was negative in all cases. In patients with PE, CTV demonstrated pelvic thrombosis in 24 patients (3.7%) and thrombosis of the upper thighs in 43 patients (6.6%). Of those patients 14 (2.1%) had DVT in the pelvis and upper thighs. In 10 patients (1.5%) CTV showed an isolated pelvic thrombosis. Of those patients ultrasound reports were available in 7 patients, which revealed DVT of the leg veins in 5 cases (1%). Thus, the estimated prevalence of isolated pelvic thrombosis detected only by pelvic CTV ranges between 1-5/642 patients (0.1-0.7%). Radiation dose ranges between 4.8 and 9.7 mSv for additional CTV of the pelvis. Conclusion: CTV of the pelvis performed after pulmonary CTA is of neglectable additional diagnostic value for the

  1. [Right ovarian vein syndrome].

    Science.gov (United States)

    Arvis, G

    1985-01-01

    Right ovarian vein syndrome is revealed in pregnancy by right lumbar pains, and even by nephritic colics. It results from a congenital malposition of the right ovarian vein, which presses the right ureter on the external iliac artery. Diagnosis is by intravenous urography and retrograde ureteral pyelography. If pain persists despite treatment by analgesics, it may be necessary to place a double-J catheter, and to operate after delivery to ligate the ovarian vein.

  2. The Role of Anion Exchanger on Pulmonary Vascular Response to Sustained Alveolar Hypoxia in the Isolated Perfused Rabbit Lung

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    Farzaneh Ketabchi

    2015-05-01

    Full Text Available Background: Some respiratory diseases may induce alveolar hypoxia thereby hypoxic pulmonary vasoconstriction (HPV. However, the mechanisms of this physiologic phenomenon are not fully understood. This study was the first to investigate the role of anion exchanger in sustained HPV. Methods: Experiments were performed in the isolated perfused rabbit lung. After preparation, the lungs were divided into six groups: two DIDS (4,4-diisothiocyanostilbene 2,2-disulfonic acid, anion exchanger inhibitor-treated [200 µM (n=5 or 400 µM (n=3] hypoxic groups, two HCO3- free hypoxic groups, one control hypoxic group (n=7 and one control normoxic group (n=4. DIDS were added to the perfusate at 10 minutes before starting the experiments. In the HCO3- free groups, HEPES (4-(2-Hydroxyethylpiperazine-1-ethanesulfonic acid were added to the perfusate instead of bicarbonate. Furthermore, in the HEPES1 (n=4 and HEPES2 (n=4 groups, the lungs were ventilated with hypoxic gas with or without CO2, respectively. Results: Ventilation of the lungs with hypoxic gas resulted in biphasic HPV, the acute (0-20 minutes and sustained (20-60 minutes phases. No alteration in both phases of HPV was detected by DIDS (200 µM. However, DIDS (400 µM, extended the ascending part of acute HPV until min 24. Both phases of HPV were decreased in the HEPES1 group. However, in the HEPES 2 group, HPV tended to increase during the rising part of the acute phase of HPV. Conclusions: Since DIDS (400 µM extended acute phase of HPV, and HCO3- free perfusate buffer enhanced rising phase of it, therefore it can be suggested that anion exchanger may modulate HPV especially during the acute phase. The abstract of this article was presented as a poster in the congress of European Respiratory Society (ERS on Monday, 08 September 2014, Munich, Germany and was published in the ERJ September 1, 2014 vol. 44 no. Suppl 58 P2343.

  3. Postpartum renal vein thrombosis.

    Science.gov (United States)

    Rubens, D; Sterns, R H; Segal, A J

    1985-01-01

    Renal vein thrombosis in adults is usually a complication of the nephrotic syndrome. Rarely, it has been reported in nonnephrotic women postpartum. The thrombosis may be a complication of the hypercoagulable state associated with both the nephrotic syndrome and pregnancy. Two postpartum patients with renal vein thrombosis and no prior history of renal disease are reported here. Neither patient had heavy proteinuria. In both cases, pyelonephritis was suspected clinically and the diagnosis of renal vein thrombosis was first suggested and confirmed by radiologic examination. Renal vein thrombosis should be considered in women presenting postpartum with flank pain.

  4. The correlation of pulmonary vein ostium area and left atrial volume index with the risk of thromboembolic events in patients with atrial fibrillation%肺静脉开口面积及左心房容积指数与房颤患者血栓栓塞风险的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王文娟; 常栋; 董颖雪; 尹晓盟; 夏云龙; 高连君; 张树龙

    2016-01-01

    Objective To investigate the correlation of pulmonary vein ostium area and left atrial volume index(LAVI)with the risk of thromboembolic events in patients with atrial fibrillation(AF). Methods A total of 206 non-valvular AF patients were continuously included in our study.Accord-ing to CHADS2 and CHA2 DS2-VASc scores,those scoring zero,1 point and no less than 2 points were divided into low-risk,average-risk and high-risk groups,respectively.All the patients were classified into thrombosis group and non-thrombosis group based on the results by transesophageal echocardiography(TEE)and brain computed tomography(CT).By the technology of multi-slice spiral computed tomography(MSCT),the ostium areas of left superior pulmonary vein (LSPV),left inferior pulmonary vein (LIPV),right superior pulmonary vein(RSPV)and right inferior pulmonary vein(RIPV)were measured.By transthoracic Doppler echocardiography,the upper and lower diam-eter,anteroposterior diameter,and left and right diameters of left atrium were measured while LAVI was calculated.By Spearman rank correlation analysis,the correlation of pulmonary vein ostium are-a and LAVI with the scores of thromboembolism risk was investigated.The clinical value of each in-dex in predicting thromboembolism of non-valvular AF patients was compared via ROC curve.Re-sults (i)According to CHADS2 scores,there were 73 cases(35.4%)in low-risk group,82 (39.8%)in average-risk group and 51 (24.8%)in high-risk group while according to CHA2 DS2-VASc scores,there were 41 cases(1 9.9%),67 cases(32.5%)and 98 cases(47.6%)separately in the three groups.LAVI,area of LSPV ostium,area of LIPV ostium,area of RSPV ostium and the total area of pulmonary vein ostium were significantly correlated with both CHADS2 and CHA2 DS2-VASc scores.(ii)LAVI,area of LSPV ostium,area of LIPV ostium and the total area of pulmonary vein ostium had diagnostic value in predicting the risk of thromboembolic events among non-valvular AF patients.Conclusion LAVI measured

  5. Manassantin A and B isolated from Saururus chinensis inhibit TNF-alpha-induced cell adhesion molecule expression of human umbilical vein endothelial cells.

    Science.gov (United States)

    Kwon, Oh Eok; Lee, Hyun Sun; Lee, Seung Woong; Chung, Mi Yeon; Bae, Ki Hwan; Rho, Mun-Chual; Kim, Young-Kook

    2005-01-01

    Leukocyte adhesion to the vascular endothelium is a critical initiating step in inflammation and atherosclerosis. We have herein studied the effect of manassantin A (1) and B (2), dineolignans, on interaction of THP-1 monocytic cells and human umbilical vein endothelial cells (HUVEC) and expression of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin in HUVEC. When HUVEC were pretreated with 1 and 2 followed by stimulation with TNF-alpha, adhesion of THP-1 cells to HUVEC decreased in dose-dependent manner with IC50 values of 5 ng/mL and 7 ng/mL, respectively, without cytotoxicity. Also, 1 and 2 inhibited TNF-alpha-induced up-regulation of ICAM-1, VCAM-1 and E-selectin. The present findings suggest that 1 and 2 prevent monocyte adhesion to HUVEC through the inhibition of ICAM-1, VCAM-1 and E-selectin expression stimulated by TNF-alpha, and may imply their usefulness for the prevention of atherosclerosis relevant to endothelial activation.

  6. Drug susceptibility patterns of the Mycobacterium tuberculosis isolated from previously treated and new cases of pulmonary tuberculosis at German-Nepal tuberculosis project laboratory, Kathmandu, Nepal

    Directory of Open Access Journals (Sweden)

    Gobinda Thapa

    2016-08-01

    Full Text Available Abstract Background Multidrug resistant tuberculosis (MDR-TB is a serious public health problem in Nepal. It is a major obstacle for the control of the tuberculosis. The main objectives of this study were to determine the prevalence of the multidrug resistant pulmonary tuberculosis and to evaluate the drug susceptibility patterns of Mycobacterium tuberculosis isolated from previously treated and newly diagnosed cases of pulmonary tuberculosis. Methods A cross-sectional study was conducted from March 2013 to August 2013 at German-Nepal tuberculosis project (GENETUP laboratory, Kathmandu, Nepal. For this the sputum samples from total of 153 (49 new and 104 previously treated suspected pulmonary tuberculosis patients were used. The diagnosis of the tuberculosis was performed by using fluorescent microscopy and culture, while the drug susceptibility testing of Mycobacterium tuberculosis was performed by proportion method. Lowenstein-Jensen (L-J medium was used for the culture of Mycobacterium tuberculosis and the colonies grown were identified on the basis of the colony morphology, pigment production and biochemical characteristics. Results The prevalence of MDR-TB among all the cases of culture positive pulmonary tuberculosis was 15.6 %. The rate of MDR-TB among previously treated culture positive tuberculosis patients was 19.4 % and that among newly diagnosed culture positive pulmonary tuberculosis cases was 7.1 %. The highest rate of resistance of Mycobacterium tuberculosis, was toward streptomycin (24.4 % followed by isoniazid (23 %, rifampicin (17.8 % and ethambutol (15.6 %. Among the total of MDR-TB cases among previously treated patients, highest percentage of the cases were relapse (61.1 % followed by chronic (16.7 %. Conclusions The high prevalence of DR/MDR-TB in our study reflects poor implementation of tuberculosis control program. On the basis of the drug susceptibility patterns of M. tuberculosis we found in our study, we

  7. Pulmonary edema

    Science.gov (United States)

    ... congestion; Lung water; Pulmonary congestion; Heart failure - pulmonary edema ... Pulmonary edema is often caused by congestive heart failure . When the heart is not able to pump efficiently, blood ...

  8. What Causes Varicose Veins?

    Science.gov (United States)

    ... blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg. Figure A shows ... blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg. Older age or ...

  9. Mechanisms of adreno- and cholinoreceptors in isolated pulmonary and systemic vasculature of the cane toad (Rhinella marina)

    DEFF Research Database (Denmark)

    Pedersen, Pil Birkefeldt Møller; Wang, Tobias; Brøndum, Emil Toft

    site of regulation of resistance and therefore holds the capacity to control blood flow and pressure. This vascular control allows amphibians to regulate their shunt, i.e. partially bypassing either the pulmonary or systemic circuit. Shunting in amphibians has been studied due to their multiple...

  10. Drenagem anômala de veia pulmonar inferior direita em veia cava inferior associada a apêndice hepático intracardíaco Anomalous drainage of the right inferior pulmonary vein into the inferior vena cava associated to intrathoracic hepatic appendix

    Directory of Open Access Journals (Sweden)

    Carlos R Moraes

    1988-08-01

    Full Text Available Descreve-se o caso de uma paciente de 61 anos de idade, com drenagem anômala de veia pulmonar inferior direita em veia cava inferior, associada a apêndice hepático intratorácico, herniado através de fenda no diafragma. A correção cirúrgica foi realizada por anastomose direta da veia anômala com o átrio esquerdo, pela redução do apêndice hepático para a cavidade abdominal e, finalmente, pelo fechamento do defeito diafragmático. O pós-operatório decorreu sem qualquer complicação. Os autores chamam a atenção para a raridade do caso.The authors present a case of a 61-year-old woman with anomalous drainage of the right inferior pulmonary vein into the inferior vena cava associated to an intrathoracic hepatic appendix herniated through a diaphragmatic defect. Surgical correction was obtained by direct anastomosis of the anomalous vein to the left atrium, reduction of the hepatic appendix to the abdominal cavity and closure of the diphragmatic defect. The postoperative course was unevenftul. The rarity of this condition is stressed.

  11. Congenital preduodenal portal vein

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Jin; Hwang, Mi Soo; Huh, Young Soo; Park, Bok Hwan [College of Medicine, Youngnam University, Gyeongsan (Korea, Republic of)

    1991-03-15

    Congenital preduodenal portal vein, first reported by Knight in 1921, is an extremely rare congenital anomaly in which the portal vein passes anteriorly to the duodenum rather than posteriorly in its normal location. It is of surgical significance because it may cause difficulties in operations involving the gall bladder, biliary duct, or duodenum. Recently, we experienced 2 cases of preduodenal portal vein. One was found during surgical exploration for the diagnosis and correction of malrotation of the bowels and the other in a 3 day-old male newborn associated with dextrocardia, situs inversus, and duodenal obstruction by diaphragm. We report these 2 cases with a review of the literature.

  12. Umbilical and portal vein calcification following umbilical vein catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, K.; Fendel, H.; Hartl, M.

    1989-07-01

    Calcifications of the umbilical vein and intrahepatic branches of the portal vein developed in a newborn who had inserted an umbilical vein catheter for 11 days postnatally. The calcified intrahepatic portal veins can still be demonstrated sonographically at the age of three years, whereby these calcifications were no longer detectable radiologically. (orig.).

  13. Surveillance, anticoagulation, or filter in calf vein thrombosis.

    Science.gov (United States)

    Yoon, Dustin Y; Riaz, Ahsun; Teter, Katherine; Vavra, Ashley K; Kibbe, Melina R; Pearce, William H; Eskandari, Mark K; Lewandowski, Robert; Rodriguez, Heron E

    2017-01-01

    This study compared the efficacy and complication rates of inferior vena cava (IVC) filters for calf vein thrombosis (CVT) vs conservative treatment with or without anticoagulation. Vascular laboratory studies of patients who had an isolated CVT (anterior and posterior tibialis, peroneal, soleal, and gastrocnemius veins) from April 2009 to January 2014 were retrospectively analyzed from a single institution. Of 647 patients with isolated CVT, 285 (44%) received an IVC filter, and 362 (56%) received medical treatment alone (38.9% surveillance, 11.6% prophylactic anticoagulation, and 49.4% therapeutic anticoagulation). Univariate, multivariate, propensity matching, and Kaplan-Meier analyses were performed on abstracted data, which included, but was not limited to, risk factors, treatment modalities, venous thromboembolism (VTE) complications (defined as propagation of deep vein thrombosis [DVT] or pulmonary embolism [PE]), bleeding complications, and IVC filter-related complications (ie, filter tilting >15°, perforation >3 mm, fracture, migration >10 mm). The overall incidence of PE in was 2.5% in the IVC filter group and 3.3% in the medical group (P = .27). The overall incidence of VTE complications (propagation of DVT, PE) was 35% for the surveillance group without anticoagulation, 30% in patients treated with prophylactic anticoagulation, and 10% in patients treated with therapeutic anticoagulation (P = .0003). Only a minority of patients underwent duplex ultrasound imaging after filter insertion. In the IVC filter group, the most common reasons that contraindicated anticoagulation were bleeding (35%) or recent surgery (27%). The number of IVC filter-related complications in the IVC filter group was 29 (10%). Because the IVC filter group was older (mean age, 65 vs 61 years, P = .004) and more likely to have a history of thromboembolic events (56% vs 16%, P filters in this study was associated with a 10% complication rate and did not significantly reduce the

  14. Postpartum Ovarian Vein Thrombophlebitis with Staphylococcal Bacteremia

    Science.gov (United States)

    Parino, Eduardo; Mulinaris, Eric; Saccomano, Edgardo; Gallo, Juan Cruz; Kohan, Gabriel

    2015-01-01

    A 34-year-old female patient presented with fever and right flank pain ten days after uncomplicated vaginal delivery. CT examination revealed right ovarian vein thrombosis and methicillin-resistant Staphylococcus aureus (MRSA) was isolated from blood cultures. No other source of bacteremia was found. Antibiotic therapy and anticoagulation with enoxaparin were instituted. Fourteen days after admission, she was discharged in good condition. Although a very uncommon complication after spontaneous vaginal delivery, septic ovarian vein thrombophlebitis should be suspected in cases of persistent puerperal fever when other diagnostic possibilities have been excluded. PMID:26221549

  15. [Oclusion of upper ophthalmic vein--a case report].

    Science.gov (United States)

    Kácerik, M; Alexík, M; Lipková, B

    2009-07-01

    Thrombosis of upper ophthalmic vein is both rare and serious pathologic event. Authors present a case of isolated unilateral upper ophthalmic vein thrombosis in 76-year-old woman, who despite treatment ended with amaurosis and secondary neovascular glaucoma. In differential diagnosis authors focused on searching for inflammatory process of orbit with adjacent structures as well as local and general causes leading to venous thrombosis. None of these were proven; it was a rare case of a patient with isolated upper ophthalmic vein thrombosis.

  16. Deep vein thrombosis.

    Science.gov (United States)

    Bandyopadhyay, Gargi; Roy, Subesha Basu; Haldar, Swaraj; Bhattacharya, Rabindra

    2010-12-01

    Occlusive clot formation in the veins causes venous thrombosis, the site most common in the deep veins of leg, called deep vein thrombosis. The clot can block blood flow and when it breaks off, called an embolism which in turn can damage the vital organs. Venous thrombosis occurs via three mechanisms ie, Virchow's triad. The mechanisms are decreased flow rate of blood, damage to the blood vessel wall and an increased tendency of the blood to clot. There are several factors which can increase a person's risk for deep vein thrombosis. The symptoms of deep vein thrombosis in the legs are pain, swelling and redness of the part. One variety of venous thrombosis is phlegmasia alba dolens where the leg becomes pale and cool. Investigations include Doppler ultrasound examination of the limb, D-dimer blood test, plethysmography of the legs, x-rays to show vein in the affected area (venography). Hospitalisation is necessary in some cases with some risk factors. The mainstream of treatment is with anticoagulants, mostly low molecular weight heparin for 6 months. Deep venous thrombosis is a rising problem. Early diagnosis and treatment is associated with a good prognosis.

  17. Ovarian vein thrombosis in Behçet disease.

    Science.gov (United States)

    Tan, Justina Wei Lynn; Howe, Hwee Siew; Chng, Hiok Hee

    2012-03-01

    We describe a 35-year-old Chinese woman with Behçet disease complicated by recurrent gastrointestinal flares. During admission for acute lower abdominal pain, a computed tomographic scan of the abdomen showed thrombosis of the left ovarian vein. She was treated with increased immunosuppressant and oral anticoagulant. Although she was not compliant to oral anticoagulant with her international normalized ratio frequently subtherapeutic, her symptoms abated and the thrombosis resolved. There has been only 1 reported case of a patient with Behçet disease presenting with postpartum ovarian vein thrombosis and pulmonary embolism and no reported case of Behçet disease with ovarian vein thrombosis occurring outside pregnancy and the puerperium. Ovarian vein thrombosis is a rare cause of abdominal pain that should be considered in patients with Behçet disease.

  18. Utilidade do Ultrassom intracardíaco no isolamento de veias pulmonares usando cateter-balão a laser Utilidad del ultrasonido intracardíaco en el aislamiento de venas pulmonares usando catéter-balón láser Utility of intracardiac ultrasound imaging to guide pulmonary vein ablation using laser balloon catheter

    Directory of Open Access Journals (Sweden)

    Luiz Leite

    2009-12-01

    . Se obtuvo el aislamiento completo en 38/59 (64%, y fue significantemente más común sin derrame: [30/38 (79% versus 8/23 (35%, pBACKGROUND: Pulmonary vein isolation (PVI with balloon catheter has been used as the endpoint for AF ablation. OBJECTIVE: To determine the usefulness of intracardiac ultrasound (ICUS to guide PVI using laser balloon catheter. METHODS: 59 PVs were ablated in 27 dogs. Doppler imaging was used to identify blood flow leaks between PV and balloon. After each energy delivery, the circular mapping catheter was repositioned to check if isolation had been achieved. The leak position was then correlated with the gap position at the pathological study. Multivariate logistic regression analysis was undertaken. RESULTS: 59 PV were ablated. Mean burn time was 279±177 sec, mean balloon diameter was 23±3 mm, and mean balloon length was 25±4 mm. Complete isolation was achieved in 38/59 (64% cases, and it was significantly more common when there was no leak: [30/38 (79% versus 8/23 (35%, p<0.001]. This occurred regardless of time of laser application (302±223 sec. vs. 266±148 sec., p=ns, laser power (3.5 W/cm, 4.5 W/cm, and 5.5 W/cm, balloon diameter (24± 3 mm vs. 22± 3 mm, p=ns and length (27±4 mm vs. 24±4mm, p=ns. The positive predictive value for predicting incomplete isolation was 65% and the negative predictive value was 83%. CONCLUSION: An identifiable leak between PV and the LBA device seen at the ICUS is predictive of lower PV isolation rates. ICUS may be useful for leak detection to avoid ineffective energy application during circumferential PV ablation. This could also be helpful when other types of energy are used.

  19. IS6110 restriction fragment length polymorphism of Mycobacterium tuberculosis isolated from patients with pulmonary tuberculosis in Campinas, Brazil: evidence of intercontinental distribution of strains

    Directory of Open Access Journals (Sweden)

    Ana Lucia Roscani Calusni

    2003-07-01

    Full Text Available Tuberculosis (TB is a major concern in developing countries. In Brazil, few genotyping studies have been conducted to verify the number of IS6110 copies present in local prevalent strains of Mycobacterium tuberculosis, the distribution and clustering of strains. IS6110 DNA fingerprinting was performed on a sample of M. tuberculosis isolates from patients with AFB smear-positive pulmonary TB, at a hospital in Brazil. The IS6110 profiles were analyzed and compared to a M. tuberculosis database of the Houston Tuberculosis Initiative, Houston, US. Seventy-six fingerprints were obtained from 98 patients. All M. tuberculosis strains had an IS6110 copy number between 5-21 allowing for differentiation of the isolates. Human immunodeficiency virus infection was confirmed in nearly half the patients of whom data was available. Fifty-eight strains had unique patterns, while 17 strains were grouped in 7 clusters (2 to 6 strains. When compared to the HTI database, 6 strains matched isolates from El Paso, Ciudad de Juarez, Houston, and New York. Recently acquired infections were documented in 19% of cases. The community transmission of infection is intense, since some clustered strains were recovered during the four-year study period. The intercontinental dissemination of M. tuberculosis strains is suspected by demonstration of identical fingerprints in a distant country.

  20. Characterization of New Isolates of Apricot vein clearing-associated virus and of a New Prunus-Infecting Virus: Evidence for Recombination as a Driving Force in Betaflexiviridae Evolution.

    Directory of Open Access Journals (Sweden)

    Armelle Marais

    Full Text Available Double stranded RNAs from Prunus samples gathered from various surveys were analyzed by a deep-sequencing approach. Contig annotations revealed the presence of a potential new viral species in an Azerbaijani almond tree (Prunus amygdalus and its genome sequence was completed. Its genomic organization is similar to that of the recently described Apricot vein clearing associated virus (AVCaV for which two new isolates were also characterized, in a similar fashion, from two Japanese plums (Prunus salicina from a French germplasm collection. The amino acid identity values between the four proteins encoded by the genome of the new virus have identity levels with those of AVCaV which fall clearly outside the species demarcation criteria. The new virus should therefore be considered as a new species for which the name of Caucasus prunus virus (CPrV has been proposed. Phylogenetic relationships and nucleotide comparisons suggested that together with AVCaV, CPrV could define a new genus (proposed name: Prunevirus in the family Betaflexiviridae. A molecular test targeting both members of the new genus was developed, allowing the detection of additional AVCaV isolates, and therefore extending the known geographical distribution and the host range of AVCaV. Moreover, the phylogenetic trees reconstructed with the amino acid sequences of replicase, movement and coat proteins of representative Betaflexiviridae members suggest that Citrus leaf blotch virus (CLBV, type member of the genus Citrivirus may have evolved from a recombination event involving a Prunevirus, further highlighting the importance of recombination as a driving force in Betaflexiviridae evolution. The sequences reported in the present manuscript have been deposited in the GenBank database under accession numbers KM507061-KM504070.

  1. Hepatic veins as a site of clot formation following liver resection

    Institute of Scientific and Technical Information of China (English)

    Emmanuel Buc; Safi Dokmak; Magaly Zappa; Marie Helene Denninger; Dominique Charles Valla; Jacques Belghiti; Olivier Farges

    2011-01-01

    Pulmonary embolism occurs more frequently after hepatectomy than previously thought but is infrequently associated with peripheral deep vein thrombosis. In thispaper, we report 2 cases of postoperative hepatic vein thrombosis after liver resection. Both patients had undergone major hepatectomy of a non-cirrhotic liver largely exposing the middle hepatic vein. Clots were incidentally found in the middle hepatic vein 4 and 17 d after surgery despite routine systemic thrombo-prophylaxis with low molecular weight heparin. Coagulation of the transitionplan in a context of mutation of the prothrombin gene and inflammation induced biloma were the likely predisposing conditions. Clots disappeared following curative anticoagulation. We conclude that thrombosis of hepatic veins may occur after liver resection and is a potential source of pulmonary embolism.

  2. First detection of insertion sequence element ISPa1328 in the oprD porin gene of an imipenem-resistant Pseudomonas aeruginosa isolate from an idiopathic pulmonary fibrosis patient in Marseille, France

    Science.gov (United States)

    Al-Bayssari, C.; Valentini, C.; Gomez, C.; Reynaud-Gaubert, M.; Rolain, J.-M.

    2015-01-01

    We report here the first case of a carbapenem-resistant Pseudomonas aeruginosa clinical isolate harboring the insertion sequence (IS) element ISPa1328 in the oprD gene in an idiopathic pulmonary fibrosis patient in France previously treated with imipenem. PMID:26137309

  3. First detection of insertion sequence element ISPa1328 in the oprD porin gene of an imipenem-resistant Pseudomonas aeruginosa isolate from an idiopathic pulmonary fibrosis patient in Marseille, France

    Directory of Open Access Journals (Sweden)

    C. Al-Bayssari

    2015-09-01

    Full Text Available We report here the first case of a carbapenem-resistant Pseudomonas aeruginosa clinical isolate harboring the insertion sequence (IS element ISPa1328 in the oprD gene in an idiopathic pulmonary fibrosis patient in France previously treated with imipenem.

  4. Effect of continuous positive airway pressure treatment on pulmonary artery pressure in patients with isolated obstructive sleep apnea: a meta-analysis.

    Science.gov (United States)

    Imran, Tasnim F; Ghazipura, Marya; Liu, Spencer; Hossain, Tanzib; Ashtyani, Hormoz; Kim, Bernard; Michael Gaziano, J; Djoussé, Luc

    2016-09-01

    Pulmonary hypertension (PH) can occur in patients with obstructive sleep apnea (OSA) in the absence of cardiac or lung disease. Data on the development and severity of PH, and the effect of continuous positive airway pressure (CPAP) therapy on pulmonary artery (PA) pressures in these patients have been inconsistent in the literature. We sought to determine whether CPAP therapy affects PA pressures in patients with isolated OSA in this meta-analysis. We searched PubMed, Medline, EMBASE and other databases from January 1980 to August 2015. Studies of patients with OSA, defined as an apnea-hypopnea index >10 events/h, and PH, defined as PA pressure >25 mmHg were included. Two reviewers independently extracted data and assessed risk of bias. A total of 222 patients from seven studies (341.53 person-years) had reported PA pressures before and after treatment with CPAP therapy. 77 % of participants were men, with a mean age of 52.5 years, a mean apnea-hypopnea index of 58 events/h, and mean PA pressure of 39.3 ± 6.3 mmHg. CPAP treatment duration ranged from 3 to 70 months. Using fixed effects meta-analysis, CPAP therapy was associated with a decrease in PA pressure of 13.3 mmHg (95 % CI 12.7-14.0) in our study population. This meta-analysis found that CPAP therapy is associated with a significantly lower PA pressure in patients with isolated OSA and PH.

  5. Depleted energy charge and increased pulmonary endothelial permeability induced by mitochondrial complex I inhibition are mitigated by coenzyme Q1 in the isolated perfused rat lung.

    Science.gov (United States)

    Bongard, Robert D; Yan, Ke; Hoffmann, Raymond G; Audi, Said H; Zhang, Xiao; Lindemer, Brian J; Townsley, Mary I; Merker, Marilyn P

    2013-12-01

    Mitochondrial dysfunction is associated with various forms of lung injury and disease that also involve alterations in pulmonary endothelial permeability, but the relationship, if any, between the two is not well understood. This question was addressed by perfusing isolated intact rat lung with a buffered physiological saline solution in the absence or presence of the mitochondrial complex I inhibitor rotenone (20 μM). Compared to control, rotenone depressed whole lung tissue ATP from 5.66 ± 0.46 (SEM) to 2.34 ± 0.15 µmol · g(-1) dry lung, with concomitant increases in the ADP:ATP and AMP:ATP ratios. Rotenone also increased lung perfusate lactate (from 12.36 ± 1.64 to 38.62 ± 3.14 µmol · 15 min(-1) perfusion · g(-1) dry lung) and the lactate:pyruvate ratio, but had no detectable impact on lung tissue GSH:GSSG redox status. The amphipathic quinone coenzyme Q1 (CoQ1; 50 μM) mitigated the impact of rotenone on the adenine nucleotide balance, wherein mitigation was blocked by NAD(P)H-quinone oxidoreductase 1 or mitochondrial complex III inhibitors. In separate studies, rotenone increased the pulmonary vascular endothelial filtration coefficient (Kf) from 0.043 ± 0.010 to 0.156 ± 0.037 ml · min(-1) · cm H2O(-1) · g(-1) dry lung, and CoQ1 protected against the effect of rotenone on Kf. A second complex I inhibitor, piericidin A, qualitatively reproduced the impact of rotenone on Kf and the lactate:pyruvate ratio. Taken together, the observations imply that pulmonary endothelial barrier integrity depends on mitochondrial bioenergetics as reflected in lung tissue ATP levels and that compensatory activation of whole lung glycolysis cannot protect against pulmonary endothelial hyperpermeability in response to mitochondrial blockade. The study further suggests that low-molecular-weight amphipathic quinones may have therapeutic utility in protecting lung barrier function in mitochondrial insufficiency.

  6. [Epidemiology and management of isolated distal deep venous thrombosis].

    Science.gov (United States)

    Galanaud, J-P; Kahn, S R; Khau Van Kien, A; Laroche, J-P; Quéré, I

    2012-12-01

    Isolated distal deep-vein thromboses (DVT) are infra-popliteal DVT without involvement of proximal veins or pulmonary embolism (PE). They can affect deep calf (tibial anterior, tibial posterior, or peroneal) or muscular (gastrocnemius or soleal) veins. They represent half of all lower limbs DVT. Proximal and distal DVTs differ in terms of risk factor profile, proximal DVT being more frequently associated with chronic risk factors and distal DVT with transient ones. Their natural history (rate of spontaneous proximal extension) is debated leading to uncertainties on the need to diagnose and treat them with anticoagulant drugs. In the long term, the risk of venous thromboembolic recurrence is lower than that of proximal DVT and their absolute risk of post-thrombotic syndrome is unknown. French national guidelines suggest treating with anticoagulants for 6 weeks a first episode of isolated distal DVT provoked by a transient risk factor and treating for at least 3 months unprovoked or recurrent or active cancer-related distal DVT. The use of compression stockings use is suggested in case of deep calf vein thrombosis. Ongoing therapeutic trials should provide important data necessary to establish an evidence-based mode of care, especially about the need to treat distal DVT at low risk of extension with anticoagulants.

  7. Cloning and expression of pab gene of M. tuberculosis isolated from pulmonary TB patient in E.coli DH5α

    Directory of Open Access Journals (Sweden)

    Tri Y. M. Raras

    2011-11-01

    Full Text Available Background: Mycobacterium tuberculosis antigen38 is a potent serodiagnostic agent containing two M. tuberculosisspecific B-cell epitopes. The high price of imported diagnostic agents hinders realization of fast clinical TB diagnosis in developing countries. Therefore, we produced recombinant antigen38 (recAg38M from M. tuberculosis local strain, which might be used to produce economical tuberculosis serodiagnostic kit.Methods: Pab gene that was isolated from pulmonary TB patient in Malang was cloned into a plasmid vector (pGEMTeasy to construct pMB38. The E.coli DH5α clone carrying pMb38 was selected on X-gal medium. The expression of pab was mediated using pPRoExHTc under the control of Trc promoter and E.coli DH5α as host.Results: Alignment of the pab sequence from the white E.coli DH5α clones with that of M. tuberculosis H37Rv showed 98% homology. The recombinant protein in which the signal peptide has been deleted to prevent the protein being secreted into medium was found in the cytoplasm.Conclusion: pab gene of M. tuberculosis isolated from a TB patient could be expressed in heterologous system in E.coliDH5α. (Med J Indones 2011; 20:247-54Keywords: Mycobacterium tuberculosis, Pab gene expression, recombinant antigen38

  8. Management of Deep Vein Thrombosis (DVT) Prophylaxis in Trauma Patients.

    Science.gov (United States)

    Paydar, Shahram; Sabetian, Golnar; Khalili, Hosseinali; Fallahi, Javad; Tahami, Mohammad; Ziaian, Bizhan; Abbasi, Hamid Reza; Bolandparvaz, Shahram; Ghaffarpasand, Fariborz; Ghahramani, Zahra

    2016-01-01

    Deep vein thrombosis (DVT) and pulmonary embolism (PTE) are known as venous thromboembolism (VTE). DVT occurs when a thrombus (a blood clot) forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury.

  9. Assessment of the efficacy and safety of steam vein sclerosis as compared to classic surgery in lower extremity varicose vein management.

    Science.gov (United States)

    Woźniak, Witold; Mlosek, Robert K; Ciostek, Piotr

    2015-04-01

    For the last 10 years, endovenous thermal ablation methods have gradually predominated over the classic Babcock procedure in varicose vein treatment. Steam vein sclerosis is the newest thermal ablation technique. To assess the efficacy and safety of steam vein sclerosis as compared to the Babcock procedure in lower extremity varicose vein treatment. One hundred and two adult subjects with varicose veins of clinical grade C2 to C6 according to the CEAP classification, treated with varicose vein surgery between 2010 and 2012, were enrolled in the study. These were subdivided into two groups: the study group of 52 patients treated with endovenous steam vein sclerosis and the control group of 50 patients treated with the Babcock procedure. A single lower extremity with isolated great or small saphenous vein insufficiency was operated on in each subject. The groups were compared for demography, disease severity, involved veins, potential perioperative and postoperative complications, as well as treatment efficacy based on the VCSS score reduction. There were no statistically significant differences between the groups in terms of demography, disease severity, involved veins, or perioperative and postoperative complications. The treatment efficacy of both methods, assessed based on the recurrence rate and the quantitative VCSS score reduction, was similar. Clinically significant recanalisation was observed in 1 (1.9%) patient in the study group. The efficacy and safety analysis shows that steam vein sclerosis is a safe, simple method which can be recommended as effective varicose vein treatment.

  10. The role of Multidetector CT in the evaluation of the left atrium and pulmonary veins anatomy before and after radio-frequency catheter ablation for atrial fibrillation. Preliminary results and work in progress.Technical note; Il ruolo della TC Multidetettore nella valutazione anatomica dell'atrio sinistro e delle vene polmonari prima e dopo ablazione percutanea con radiofrequenza della fibrillazione atriale. Risultati preliminari e work in progress

    Energy Technology Data Exchange (ETDEWEB)

    Centoze, Maurizio; Della Sala, Sabino Walter; Dalla Palma, Francesco [Azienda Provinciale per i servizi sanitari, Trento (Italy). Dipartimento di radiodiagnostica; Del Greco, Maurizio; Marini, Massimiliano [Ospedale S. Chiara, Trento (Italy). U.O. di cardiologia; Nollo, Giandomenico; Ravelli, Flavia [Trento Univ., Trento (Italy). Dipartimento di fisica

    2005-07-15

    Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial al fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this parer is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward. [Italian] La ablazione percutanea con radiofrequenza (RFCA) del tratto distale delle vene polmonari nella fibrillazione atriale, che non risponde al trattamento farmacologico e alla cardioversione elettrica, e una procedura in grande sviluppo. Il successo del trattamento dipende dalla comprensione della complessa anatomia delle vene polmonari e dell'atrio sinistro. Lo scopo di questo articolo e illustrare gli aspetti tecnici fondamentali che caratterizzano lo studio di questa regione anatomica con TC spirale multidetettore prima e dopo RFCA. Particolare risalto e stato rivolto alle tecniche di post-processing 3D estremamente utili nella pianificazione della procedura di ablazione.

  11. Renal vein thrombosis

    Science.gov (United States)

    ... Saunders; 2012:chap 34. Read More Acute kidney failure Arteriogram Blood clots Dehydration Nephrotic syndrome Pulmonary embolus Renal Tumor Review Date 5/19/2015 Updated by: Charles Silberberg, ...

  12. The effect of CO sub 2 on pulmonary artery pressure (P sub pa ) over time in the isolated perfused rabbit lung

    Energy Technology Data Exchange (ETDEWEB)

    Reynolds, P.; Shayevitz, J. (Univ. of Michigan, Ann Arbor (United States))

    1991-03-11

    The isolated perfused rabbit lung model is used in studies of pulmonary hemodynamics, structure, and function under conditions closely resembling those which occur in living animals. The purpose of this study is to observe changes in P{sub pa} in response to differing concentrations of CO{sub 2} over time. After rapid exsanguination a tracheostomy was performed. Cannulas were secured in the main pulmonary artery and the left atrium. The lungs were perfused with Krebs-Henseleit buffer mixed with blood at a rate of 120 ml/min with recirculation. The temperature of the perfusate was maintained between 35 and 38C. The lungs were then ventilated with 5% CO{sub 2} in air with a tidal volume of 10 ml/kg at 20 breaths/min. CO{sub 2} was altered randomly by ventilating the lungs 2, 5 or 10% CO{sub 2} in air. Metabolic acidosis was corrected with NaHCO{sub 3}. In the first two hour period after lung perfusion was begun, the model was allowed to stabilize at each CO{sub 2} concentration, and pH, pCO{sub 2}, pO{sub 2}, and base excess were determined at each P{sub pa}. All measurements were repeated in the second period beginning two hours after lung perfusion was started. P{sub pa} was plotted against pH for each animal in both early and late phases, and simple regression analysis was performed. The slopes and the y intercepts for the data sets in both groups were compared using one factor ANOVA, and were found to be significantly different, implying a statistical difference between regression lines. In the early phase this model behaves like the in vivo lung, i.e. hypercarbia appears to increase, while hypocarbia decreases, P{sub pa}. During the late phase of lung perfusion the opposite occurs.

  13. Deep Vein Thrombosis

    Centers for Disease Control (CDC) Podcasts

    2012-04-05

    This podcast discusses the risk for deep vein thrombosis in long-distance travelers and ways to minimize that risk.  Created: 4/5/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/5/2012.

  14. Retinal vein occlusion

    Science.gov (United States)

    ... decrease the risk of retinal vein occlusion. These measures include: Eating a low-fat diet Getting regular exercise Maintaining an ideal weight Not smoking Aspirin or other blood thinners may help prevent blockages in the other eye. Controlling diabetes may ...

  15. The vein collar

    DEFF Research Database (Denmark)

    Lundgren, F; Schroeder, Torben Veith

    2012-01-01

    Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect...

  16. Deep Vein Thrombosis

    African Journals Online (AJOL)

    OWNER

    Il s'agissait de la main et les recherches en ligne. Des termes ..... Cerrato D, Ariano G, and Fiacchino F : Deep vein ... Surg 1988; 75: 1053–7. 19. Salzman ... Alikhan R, Cohen AT, Combe S, Samama .... Kakkar AK, Williamson RCN. Thrombo.

  17. [Ovarian vein syndrome].

    Science.gov (United States)

    Ferrero Doria, R; Guzmán Valls, P; López Alba, J; Tomás Ros, M; Rico Galiano, J L; Fontana Compiano, L O

    1996-04-01

    The Ovarian Vein Syndrome has been the subject of controversy ever since first described as such by Clark in 1964. This is an uncommon entity within urologic sings and symptoms which appears as a recurrent nephritic colic coinciding with menstruation or during the immediately preceding days. The authors review a clinical case from our Urology Service, including some considerations on the case.

  18. Cucumber vein yellowing virus

    Science.gov (United States)

    Cucurbits are an important crop of temperate, subtropical and tropical regions of the world. Cucumber vein yellowing virus (CVYV) is a major viral pathogen of cucurbits. This chapter provides an overview of the biology of CVYV and the disease it causes....

  19. Squash vein yellowing virus

    Science.gov (United States)

    Cucurbits are an important crop of temperate, subtropical and tropical regions of the world. Squash vein yellowing virus (SqVYV) is a major viral pathogen of cucurbits. This chapter provides an overview of the biology of SqVYV and the disease it causes....

  20. Spectrum and antimicrobial resistance of common pathogenic bacteria isolated from patients with acute exacerbation of chronic obstructive pulmonary disease in mainland of China

    Institute of Scientific and Technical Information of China (English)

    YE Feng; HE Li-xian; CAI Bo-qiang; WEN Fu-qiang; CHEN Bai-yi; Mangunnegoro Hadiarto; CHEN Rong-chang

    2013-01-01

    Background Bacteria-induced respiratory infection has been long considered to be the major cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Therefore,a clear picture about the distribution and drug-resistance of pathogenic bacteria in the lower airways should be helpful for treatment of the disease.So far,data on this topic among Chinese are lacking.Methods A surveillance study was performed in consecutive patients with AECOPD at five areas in China between October 2006 and April 2008.The sputum from these patients was cultured and isolated for bacteria.Agar dilution method was used to determine the minimal inhibitory concentrations (MICs) of levofloxacin and other 15 antibiotics against these strains.Results Three hundred and fifty-nine pathogenic bacterial strains were isolated among 884 patients with AECOPD.The predominant bacteria were Pseudomonas aeruginosa (21.7%),Klebsiella pneumoniae (12.3%),Haemophilus influenzae (14.2%) and Streptococcus pneumoniae (11.7%),followed by Haemophilus parainfluenzae (9.5%),Acinetobacter baumannii (7.8%),Moraxella catarrhalis (6.4%) and Escherichia coli (3.6%).The majority of bacterial pathogens isolated in this study were susceptible to fluoroquinolones,ceftazidime,cefepime and imipenem.Conclusions Gram-negative bacilli are the leading pathogens in patients with AECOPD in China.Haemophilus parainfluenzae may be one of the most important pathogens in AECOPD.This study provides evidence for local surveillance of AECOPD pathogens and appropriate choice of antimicrobials in China.

  1. Endovenous treatments for varicose veins

    NARCIS (Netherlands)

    R.R. van den Bos (Renate)

    2011-01-01

    textabstractEndovenous treatment is currently one of the most frequently used methods for treating varicose veins in the Netherlands. Varicose veins are tortuous and enlarged veins due to weakening in the vein’s wall or valves. They are manifestations of chronic venous disease (CVD), which may lead

  2. In vitro characteristics of pulmonary neuroendocrine cells isolated from rabbit fetal lung. I. Effects of culture media and nerve growth factor.

    Science.gov (United States)

    Cutz, E; Yeger, H; Wong, V; Bienkowski, E; Chan, W

    1985-12-01

    Pulmonary neuroendocrine (NE) cells, dispersed throughout the airway mucosa as single cells and as innervated clusters (neuroepithelial bodies), were isolated from rabbit fetal lung and studied in short-term culture. The effects of culture media and nerve growth factor (NGF) on in vitro maintenance, differentation, and cell kinetics of isolated NE cells were examined. For demonstration of NE cells in intact lung, during cell separation and after culture, immunostaining for serotonin, formaldehyde-induced fluorescence method, histochemical reaction for acetylcholinesterase, and electron microscopy were used. The isolation procedure consisted of mechanical and enzymatic dissociation of lung tissue followed by separation of isolated cells on a discontinuous gradient of Percoll, resulting in 5- to 10-fold enrichment in NE cells. Cell fractions enriched in NE cells were cultured up to 7 days either in supplemented alpha-minimal essential medium with fetal bovine serum or in defined, hormone-supplemented, serum-free medium. NGF (2.5 S 5 to 50 ng/ml) was added to both serum-supplemented and serum-free media; cultures without NGF served as control. The number of serotonin-immunoreactive NE cells maintained in serum-supplemented medium (0.5% fetal bovine serum) increased significantly (p less than 0.05) on days 4 and 7 compared with cultures grown in serum-free medium. NE cells maintained in serum-supplemented medium incorporated [3H]thymidine and their labeling index was significantly increased (p less than 0.01) on day 7, whereas few or no NE cells were labeled in cultures grown in serum-free medium. NGF had no effect on the maintenance or kinetics of NE cells. Cultured NE cells formed elongated (unipolar or bipolar) neurite-like cytoplasmic processes with a button-like ending, regardless of the presence of NGF. Amine accumulated in perinuclear cytoplasm and in button-like endings. Staining for acetylcholinesterase (strongly positive in intact neuroepithelial bodies) was

  3. Low-frequency high-definition power Doppler in visualizing and defining fetal pulmonary venous connections.

    Science.gov (United States)

    Liu, Lin; He, Yihua; Li, Zhian; Gu, Xiaoyan; Zhang, Ye; Zhang, Lianzhong

    2014-07-01

    The use of low-frequency high-definition power Doppler in assessing and defining pulmonary venous connections was investigated. Study A included 260 fetuses at gestational ages ranging from 18 to 36 weeks. Pulmonary veins were assessed by performing two-dimensional B-mode imaging, color Doppler flow imaging (CDFI), and low-frequency high-definition power Doppler. A score of 1 was assigned if one pulmonary vein was visualized, 2 if two pulmonary veins were visualized, 3 if three pulmonary veins were visualized, and 4 if four pulmonary veins were visualized. The detection rate between Exam-1 and Exam-2 (intra-observer variability) and between Exam-1 and Exam-3 (inter-observer variability) was compared. In study B, five cases with abnormal pulmonary venous connection were diagnosed and compared to their anatomical examination. In study A, there was a significant difference between CDFI and low-frequency high-definition power Doppler for the four pulmonary veins observed (P frequency high-definition power Doppler was higher than that when employing two-dimensional B-mode imaging or CDFI. There was no significant difference between the intra- and inter-observer variabilities using low-frequency high-definition power Doppler display of pulmonary veins (P > 0.05). The coefficient correlation between Exam-1 and Exam-2 was 0.844, and the coefficient correlation between Exam-1 and Exam-3 was 0.821. In study B, one case of total anomalous pulmonary venous return and four cases of partial anomalous pulmonary venous return were diagnosed by low-frequency high-definition power Doppler and confirmed by autopsy. The assessment of pulmonary venous connections by low-frequency high-definition power Doppler is advantageous. Pulmonary venous anatomy can and should be monitored during fetal heart examination.

  4. Blood pooling in extrathoracic veins after glossopharyngeal insufflation

    DEFF Research Database (Denmark)

    Mijacika, Tanja; Frestad, Daria; Kyhl, Kasper

    2017-01-01

    Purpose: Trained breath-hold divers hyperinflate their lungs by glossopharyngeal insufflation (GPI) to prolong submersion time and withstand lung collapse at depths. Pulmonary hyperinflation leads to profound hemodynamic changes. Methods: Thirteen divers performed preparatory breath-holds followed...... divers in a sub-study. Results: After GPI, pulmonary volume increased by 0.8 ± 0.6 L above total lung capacity. The diameter of the superior caval (by 36 ± 17%) and intrathoracic part of the inferior caval vein decreased (by 21 ± 16%), while the diameters of the internal jugular (by 53 ± 34%), hepatic...

  5. Endovascular vein harvest: systemic carbon dioxide absorption.

    Science.gov (United States)

    Maslow, Andrew M; Schwartz, Carl S; Bert, Arthur; Hurlburt, Peter; Gough, Jeffrey; Stearns, Gary; Singh, Arun K

    2006-06-01

    Endovascular vein harvest (EDVH) requires CO(2) insufflation to expand the subcutaneous space, allowing visualization and dissection of the saphenous vein. The purpose of this study was to assess the extent of CO(2) absorption during EDVH. Prospective observational study. Single tertiary care hospital. Sixty patients (30 EDVH and 30 open-vein harvest) undergoing isolated coronary artery bypass graft surgery. Hemodynamic, procedural, and laboratory data were collected prior to (baseline), during, and at it the conclusion (final) of vein harvesting. Data were also collected during cardiopulmonary bypass (CPB). Data were compared by using t tests, analysis of variance, and correlation statistics when needed. There were significant increases in arterial CO(2) (PaCO(2), 35%) and decreases in pH (1.35%) during EDVH. These were associated with increases in heart rate, mean blood pressure, and cardiac output. Within the EDVH group, greater elevations (>10 mmHg) in PaCO2 were more likely during difficult harvest procedures, and these patients exhibited greater increase in heart rate. Elevated CO(2) persisted during CPB, requiring higher systemic gas flows and greater use of phenylephrine to maintain desired hemodynamics. EDVH was associated with systemic absorption of CO(2). Greater absorption was more likely in difficult procedures and was associated with greater hemodynamic changes requiring medical therapy.

  6. Automatic Synthesis of Anthropomorphic Pulmonary CT Phantoms

    OpenAIRE

    Daniel Jimenez-Carretero; Raul San Jose Estepar; Mario Diaz Cacio; Maria J Ledesma-Carbayo

    2016-01-01

    The great density and structural complexity of pulmonary vessels and airways impose limitations on the generation of accurate reference standards, which are critical in training and in the validation of image processing methods for features such as pulmonary vessel segmentation or artery-vein (AV) separations. The design of synthetic computed tomography (CT) images of the lung could overcome these difficulties by providing a database of pseudorealistic cases in a constrained and controlled sc...

  7. Teaching the effects of gravity and intravascular and alveolar pressures on the distribution of pulmonary blood flow using a classic paper by West et al.

    Science.gov (United States)

    Levitzky, Michael G

    2006-03-01

    "Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures" by J. B. West, C. T. Dollery, and A. Naimark (J Appl Physiol 19: 713-724, 1964) is a classic paper, although it has not yet been included in the Essays on the American Physiological Society Classic Papers Project (http://www.the-aps.org/publications/classics/). This is the paper that originally described the "zones of the lung." The final figure in the paper, which synthesizes the results and discussion, is now seen in most textbooks of physiology or respiratory physiology. The paper is also a model of clear, concise writing. The paper and its final figure can be used to teach or review a number of physiological concepts. These include the effects of gravity on pulmonary blood flow and pulmonary vascular resistance; recruitment and distention of pulmonary vessels; the importance of the transmural pressure on the diameter of collapsible distensible vessels; the Starling resistor; the interplay of the pulmonary artery, pulmonary vein, and alveolar pressures; and the vascular waterfall. In addition, the figure can be used to generate discovery learning and discussion of several physiological or pathophysiological effects on pulmonary vascular resistance and the distribution of pulmonary blood flow.

  8. Assess drug resistance pattern and genetic profile of Mycobacterium tuberculosis clinical isolates by molecular typing methods using direct repeats and IS6110 in pulmonary tuberculosis cases

    Science.gov (United States)

    Kalo, Deepika; Kant, Surya; Srivastava, Kanchan; Sharma, Ajay K

    2017-01-01

    Background: Tuberculosis (TB), a highly contagious disease that sees no gender, age, or race is mainly a disease of lungs. According to World Health Organization, a TB patient can be completely cured with 6–9 months of anti-TB treatment under directly observed treatment short course. Objectives: The aim of this study was to check the mono, multi- and triple-drug resistance to first line drugs (FLDs) among TB patients and to access their genetic profile using DR 3074, DR 0270, DR 0642, DR 2068, and DR 4110 using molecular techniques. Material and Methods: To gain a better understanding of drug resistant TB, we characterized 121 clinical isolates recovered from 159 drug resistant pulmonary tuberculosis patients by IS6110 genotyping. MTB isolates recovered from HIV- negative, and smear positive cases of both genders, age varied from 18 to 70 years with drug resistant-TB that was refractory to chemotherapy given for > 12 months. Of a total of 159 sputum smear positive patients sum number of male and female patients was 121 (76.10%) and 38 (23.89%), respectively. Among these patients, number of literate and illiterate patients were 123 (77.3%) and 36 (22.6%). 25 (15.7%) patients had farming as their occupation, 80 (50.3%) had nonagricultural occupation and 54 (33.9%) women were housewives. Results: Mono drug resistant, multi-drug resistant, and totally drug resistant (TDR) cases of TB were calculated as 113.83%, 125.1%, and 67.9%. Isoniazid showed the highest percentage of resistance among the patients. Conclusion: Any noncompliance to TB medications, lack of knowledge, and poor management in health centers, etc., results in the emergence of deadly direct repeat forms of TB, which are further complicated and complex to treat. PMID:28360464

  9. Deep vein thrombosis of the lower limbs: A retrospective analysis of doppler ultrasound findings

    Directory of Open Access Journals (Sweden)

    Sanjay M Khaladkar

    2014-01-01

    Full Text Available Background: Deep venous thrombosis (DVT of lower limbs is one of the most common cause for the majority of deaths caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. Most venous thrombi are clinically silent. B-mode and color Doppler imaging is needed for early diagnosis of DVT to prevent complications and sequalae of DVT. Aim and Objectives: The objectives of the following study were to evaluate the role of Doppler as an imaging modality in diagnosing DVT of lower limbs, to study the spectrum of findings on Doppler ultrasound in patients with DVT. Materials and Methods: Retrospective descriptive analysis of 78 patients of DVT diagnosed on Doppler. Results: Nearly 74% of the patients were males and 26% were females with majority belonging to fifth decade (26%. 75 (96.1% cases showed unilateral while 3 (3.9% cases showed bilateral lower limb involvement. In our study, predominant distribution of thrombus was found to be in above knee region with 69/78 (88.5% patients having thrombus in the superficial femoral vein. Popliteal vein was involved in 54/78 (69.2% patients. Complete thrombosis was observed in 54/78 (69% cases, while partial thrombosis was observed in 24/78 (31% cases. Subacute stage was seen in 42 cases (53.8%, acute stage in 23 cases (29.5% while chronic stage in 13 cases (16.7%. 71 cases (91% had multiple contiguous segmental involvement, whereas 7 cases (9% had isolated vein involvement. Conclusion: Color Doppler is useful in diagnosing DVT in symptomatic and at risk patients and provides a non-invasive method of investigation. It is also helpful in evaluating the site, extent and stage of thrombus.

  10. Isolation

    DEFF Research Database (Denmark)

    Agerholm, Frank Juul

    2011-01-01

    Næringsstoffet har i dette nummer sat fokus på ”velvære i vinterkulden”, ”indendørsaktiviteter” og ”fedtafgift”. I klummen vises det, at disse tre fokusområder, der for en umiddelbar betragtning måske nok synes noget uensartede, falder sammen i ét tema: Isolation!......Næringsstoffet har i dette nummer sat fokus på ”velvære i vinterkulden”, ”indendørsaktiviteter” og ”fedtafgift”. I klummen vises det, at disse tre fokusområder, der for en umiddelbar betragtning måske nok synes noget uensartede, falder sammen i ét tema: Isolation!...

  11. Primary pulmonary hypertension.

    Science.gov (United States)

    Rashid, A; Lehrman, S; Romano, P; Frishman, W; Dobkin, J; Reichel, J

    2000-01-01

    Primary pulmonary hypertension (PPH) is a condition characterized by sustained elevation of pulmonary artery pressure (PAP) without demonstrable cause. The most common symptom at presentation is dyspnea. Other complaints include fatigue, chest pain, syncope, leg edema, and palpitations. Right heart catheterization is diagnostic, showing a mean PAP >25 mmHg at rest and >30 mmHg during exercise, with a normal pulmonary capillary wedge pressure. In the National Institutes of Health-PPH registry, the median survival period was 2.8 years. Treatment is aimed at lowering PAP, increasing cardiac output, and decreasing in situ thrombosis. Vasodilators have been used with some success in the treatment of PPH. They include prostacyclin, calcium-channel blockers, nitric oxide and adenosine. Anticoagulation has also been advised for the prevention of deep vein thrombosis, pulmonary embolism, and in situ thromboses of the lungs. New drug treatments under investigation include L-arginine, plasma endothelin-I, and bosentan. Use of oxygen, digoxin, and diuretics for symptomatic relief have also been recommended. Patients with severe PPH refractory to medical management should be considered for surgery.

  12. Characterization of the genetic diversity of extensively-drug resistant Mycobacterium tuberculosis clinical isolates from pulmonary tuberculosis patients in Peru.

    Directory of Open Access Journals (Sweden)

    Omar Cáceres

    Full Text Available BACKGROUND: Peru holds the fourth highest burden of tuberculosis in the Americas. Despite an apparently well-functioning DOTS control program, the prevalence of multidrug resistant tuberculosis (MDR-TB continues to increase. To worsen this situation, cases of extensively drug resistance tuberculosis (XDR-TB have been detected. Little information exists about the genetic diversity of drug-susceptible vs. MDR-TB and XDR-TB. METHODS: Cryopreserved samples of XDR strains from 2007 to 2009 (second semester, were identified and collected. Starting from 227 frozen samples, a total of 142 XDR-TB strains of Mycobacterium tuberculosis complex (MTBC; 1 isolate per patient were retained for this study. Each strain DNA was analyzed by spoligotyping and the 15-loci Mycobacterial Interspersed Repetitive Unit (MIRU-15. RESULTS: Among the 142 isolates analyzed, only 2 samples (1.41% could not be matched to any lineage. The most prevalent sublineage was Haarlem (43.66%, followed by T (27.46%, LAM (16.2%, Beijing (9.15%, and X clade (1.41%. Spoligotype analysis identified clustering for 128/142 (90.1% isolates vs. 49/142 (34.5% with MIRUs. Of the samples, 90.85% belonged to retreated patients. The drug resistant profile demonstrated that 62.67% showed resistance to injectable drugs capreomycin (CAP and kanamycin (KAN vs. 15.5% to CAP alone and 21.8% to KAN alone. The SIT219/T1 and SIT50/H3 were the most prevalent patterns in our study. The spoligoforest analysis showed that SIT53/T1 was at the origin of many of the T lineage strains as well as a big proportion of Haarlem lineage strains (SIT50/H3, followed by SIT47/H1, SIT49/H3, and SIT2375/H1, as opposed to the SIT1/Beijing strains that did not appear to evolve into minor Beijing sublineages among the XDR-TB strains. CONCLUSION: In contrast with other Latin-American countries where LAM sublineage is the most predominant, we found the Haarlem to be the most common followed by T sublineage among the XDR-TB strains.

  13. Partial anomalous pulmonary venous connection to the superior vena cava.

    Science.gov (United States)

    Aramendi, José I; Rey, Estibaliz; Hamzeh, Gadah; Crespo, Alejandro; Luis, Maite; Voces, Roberto

    2011-04-01

    We describe the surgical technique of reimplantation of the right superior pulmonary vein into the left atrium in 2 patients with partial anomalous pulmonary venous connection to the superior vena cava without atrial septal defect. A right axillary minithoracotomy is done through the fourth intercostal space. The pulmonary vein is detached from its origin in the superior vena cava. This is sutured with 6-0 reabsorbable polydioxanone suture (Ethicon, Somerville, NJ). A lateral clamp is applied to the left atrium, and the pulmonary vein is reimplanted. The patient is extubated in the operating room. Neither cardiopulmonary bypass nor blood transfusion was required. It is simple, safe, and reproducible. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Ovarian vein thrombosis in a polytrauma patient.

    Science.gov (United States)

    Toman, Emma; Beaven, Alastair; Balogun, Moji; Porter, Keith

    2015-12-18

    A young mother presented to a major trauma centre following a road traffic collision. Her admission CT traumagram demonstrated liver and renal lacerations, spinal and pelvic fractures with no abnormalities of the ovarian veins. Her inpatient course was uncomplicated other than a sustained, isolated raised C reactive protein. CT of the abdomen 1 week after injury demonstrated stable solid organ injuries and the additional, unexpected finding of a right ovarian vein thrombosis (OVT). A pragmatic approach was taken towards the management of the OVT given the haemorrhagic risk from her traumatic injuries. A multidisciplinary, consultant-led plan was made to slowly increase enoxaparin to a therapeutic dose under close surveillance and to then switch to warfarin following an outpatient consultation with a consultant haematologist. A MR venogram was performed after 3 months of anticoagulation, and this demonstrated complete resolution of the OVT and normal appearances of the ovary.

  15. Retroaortic left renal vein joining the left common iliac vein

    Energy Technology Data Exchange (ETDEWEB)

    Brancatelli, G.; Galia, M.; Finazzo, M.; Sparacia, G.; Pardo, S.; Lagalla, R. [Dept. of Radiology ' ' P. Cignolini' ' , Univ. of Palermo (Italy)

    2000-11-01

    Retroaortic left renal vein joining the left common iliac vein is a rare congenital anomaly in the development of the inferior vena cava. To our knowledge, only one case has been reported in the literature; however, its imaging features have never been described. A 27-year-old male presented with a 1-year history of recurrent right flank pain, dysuria, hematuria, and fever (39 C). Computed tomography and MR venography showed a retroaortic left renal vein joining the left common iliac vein. We present the CT and MR venography findings and discuss their feasibility in showing this congenital anomaly. (orig.)

  16. Thrombosis of right ovarian vein; Trombosis de la vena ovarica derecha

    Energy Technology Data Exchange (ETDEWEB)

    Forner, J.; Talens, A.; Flores, M.; Mendez, M. [Hospital General Universitario de Valencia. Valencia (Spain)

    2001-07-01

    Ovarian vein thrombosis is a rare postpartum complication (0.1%). It can be fatal, since it can lead to sepsis, pulmonary thromboembolisms and inferior vena cava or renal vein thrombosis. Computed tomography and magnetic resonance imaging are the techniques of choice for its diagnosis, while the value of ultrasound is limited due to its low sensitivity and specificity. We report the case of a woman who, during puerperium, developed thrombosis of right ovarian vein that presented clinical, ultrasonographic and computed tomographic features of appendicitis. We describe the radiological sings and stress the fact that this diagnosis should be suspected in puerperal women. (Author) 9 refs.

  17. Unilateral absence of a pulmonary artery: Report of 3 cases

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Oh Keun; Choi, Chul Seung; Choi, Yo Won; Jeon, Seok Cheol; Seo, Heung Suk; Hahm, Chang Kok [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1994-07-15

    Unilateral absence of a pulmonary artery is an uncommon anomaly, which presents as an isolated lesion or in combination with other congenital heart disease such as TOF or PDA. We encountered three cases of isolated unilateral absence of a pulmonary artery; one was left pulmonary artery agenesis with right sided aortic arch and the others were right pulmonary artery agenesis with left sided aortic arch. Plain chest radiograph showed considerable loss of unilateral lung volume and lack of ipsilateral hilar shadow. Pulmonary angiogram which was done in two cases, revealed proximal interruption of a pulmonary artery. Chest CT was done in only one case, on which right pulmonary artery was absent and was replaced by adipose tissue. CT with its clean demonstration pulmonary artery without any evidence of acquired obstruction of a pulmonary artery by pulmonary embolism or tumor invasion, maybe a valuable method for evaluation of the unilateral absence of a pulmonary artery.

  18. Pulmonary hypertension

    Science.gov (United States)

    ... clots in the lung ( pulmonary embolism ) Heart failure Heart valve disease HIV infection Low oxygen levels in the blood for a long time (chronic) Lung disease, such as COPD or pulmonary fibrosis Medicines (for example, certain diet drugs) Obstructive sleep ...

  19. Pulmonary Edema

    Science.gov (United States)

    ... Accessed March 13, 2014. Pinto DS, et al. Pathophysiology of cardiogenic pulmonary edema. http://www.uptodate.com/ ... hvd/. Accessed March 10, 2014. What is pulmonary hypertension? National Heart, Lung, and Blood Institute. http://www. ...

  20. Pulmonary Fibrosis

    Science.gov (United States)

    Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This ... blood may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue ...

  1. Pulmonary Rehabilitation

    Science.gov (United States)

    ... shortness of breath and increase your ability to exercise. You may have heard that pulmonary rehabilitation is only for people with COPD (chronic obstructive pulmonary disease). We now know that ...

  2. Cephalic vein aneurysm.

    Science.gov (United States)

    Faraj, Walid; Selmo, Francesca; Hindi, Mia; Haddad, Fadi; Khalil, Ismail

    2007-11-01

    Cephalic vein aneurysms are rare malformations that may develop in any part of the vascular system, and their history, presentation, and management vary depending on their site. The etiology of venous aneurysms remains unclear, although several theories have been elaborated. Venous aneurysms are unusual vascular malformations that occur equally between the sexes and are seen at any age; they can present as either a painful or a painless subcutaneous mass. No serious complications have been reported from upper extremity venous aneurysms. Surgical excision is the definitive management for most of these. The case reported here presented with a painless and mobile, soft, subcutaneous mass that caused only cosmetic concern.

  3. Canine pulmonary angiostrongylosis

    DEFF Research Database (Denmark)

    Koch, Jørgen; Willesen, Jakob Lundgren

    2009-01-01

    Canine pulmonary angiostrongylosis is an emerging snail-borne disease causing verminous pnemonia and coagulopathy in dogs. The parasite is fund in Europe, North and South America and Africa, covering tropical, subtropical and temperate regions. Its distribution has been characterised by isolated ...

  4. Internal Jugular Vein Thrombosis following Oropharyngeal Infection

    Directory of Open Access Journals (Sweden)

    Asli Bostanci

    2015-01-01

    Full Text Available Internal jugular vein thrombosis (IJVT is a rare condition which may lead to life-threatening complications such as sepsis and pulmonary embolism. Prolonged central venous catheterization, intravenous (IV drug use, trauma, and radiotherapy are the most frequent causes of the IJVT. IJVT that develops after the oropharyngeal infection is a quite rare situation today. In this paper, a 37-year-old woman was presented; swelling occurred on her neck after acute tonsillitis and she was diagnosed with IJVT through Doppler ultrasonography and magnetic resonance imaging and managed without complications. Early diagnosis and conservative treatment with broad-spectrum IV antibiotics and anticoagulant agents have a critical importance for the prevention of fatal complications.

  5. Mitral Valve Regurgitation Causing Right Upper Lobe Pulmonary Edema

    OpenAIRE

    Young, Andrew L.; Langston, Charles S.; Schiffman, Robert L.; Shortsleeve, Michael J.

    2001-01-01

    When radiography is performed in patients with mitral regurgitation, cardiogenic pulmonary edema is a typical finding; however, asymmetric pulmonary edema has also been reported. We describe the case of a patient in whom mitral valve regurgitation caused isolated pulmonary edema in the right upper lung. We include a discussion of pulmonary edema in conjunction with mitral regurgitation.

  6. Computed tomography features of supracardiac total anomalous pulmonary venous connection in an infant

    Directory of Open Access Journals (Sweden)

    Tariq Alam, MMBS, FCPS

    2016-09-01

    Full Text Available Total anomalous pulmonary venous connection (TAPVC is a rare congenital anomaly of the pulmonary veins drainage. In this entity, the pulmonary veins, instead of draining to left atrium, connect abnormally to the systemic venous circulation. A right-to-left shunt is obligatory for survival. Based on its type and degree of pulmonary venous obstruction, TAPVC may result in pulmonary hypertension and congestive heart failure. In severe cases, urgent diagnosis and surgical correction is essential to reduce morbidity and mortality. Echocardiography as the first and safest imaging modality for cardiovascular abnormalities may fail in complete depiction of some complex feature of TAPVC. Computed tomography angiography is then a noninvasive and sensitive choice for mapping the pulmonary veins without the need for invasive cardiac catheterization. Contrast-enhanced MR angiography can be a radiation-free alternative. Authors present a computed tomography–detected supracardiac TAPVC with small patent ductus arteriosus in a 2 months cyanotic infant.

  7. Historical Overview of Varicose Vein Surgery

    NARCIS (Netherlands)

    van den Bremer, Jephta; Moll, Frans L.

    2010-01-01

    Varicose veins are as old as Hippocrates. Varicose vein treatments come and go. Surgery for varicose vein disease is one of the commonest elective general surgical procedures. The history of varicose vein surgery has been traced. We note the first descriptions of varicose veins, and we particularly

  8. 脂多糖增强芬太尼诱导离体兔肺动脉舒张反应%Lipopolysaccharide-pretreatment enhances fentanyl-induced relaxation in isolated rabbit pulmonary arteries

    Institute of Scientific and Technical Information of China (English)

    于泓波; 张锦; 丁学琴; 佟冬怡; 李娜

    2009-01-01

    Objective We investigated regulatory roles of fentanyl in isolated rabbit pulmonary arteries by lipopolysaccharide - preincubation. The goal was to assess the protective effect of ketamine on clinic septic shock patients. Methods Application of vascular ring tension detection technique to ob-serve the effect of fentanyl on the normal and LPS (lipopolysaccharide, LPS) incubated pulmonary vas-cular. Results The pulmonary artery in the normal group, the final concentration of fentanyl (0. 1 μmol/L, 1 μmol/L, 10 μmol/L, 100 μmol/L) to make pretreatment - PE pulmonary artery relaxation ( EC50 = 1. 699) ; the pulmonary artery in the LPS group, the final concentration of fentanyl (1 pmol/ L, 10 μmol/L, 100 μmol/L) to make pretreatment - PE pulmonary artery relaxation ( EC50 = 2.496) , final concentration of fentanyl (0. 1 μmol/L) did not affect on pulmonary artery; comparing LPS group with the normal control group, LPS group increased pulmonary artery Emax relaxation re-sponse, in the final concentration of low -dose fentanyl (0. 1 μmol/L, 1 μmol/L) decreased the sensi-tivity of pulmonary artery, and in the high - dose concentration of 10 μmol/L, 100 μmol/L which in-crease the sensitivity. Conclusion LPS can enhance the effect of fentanyl on the maximal pulmonary artery relaxation reaction; and small doses of LPS could decrease the sensitivity of the pulmonary artery to fentanyl , large doses of fentanyl increased the sensitivity; LPS can also increase fentanyl on pulmonary artery EC50 response.%目的 探讨阿片受体激动剂芬太尼对正常及内毒素休克时肺动脉血管反应性的影响,从而指导临床用药.方法 应用血管环张力检测技术,观察芬太尼对正常及脂多糖(lipopolysaccharide,LPS)孵育的肺动脉血管环反应性的影响.结果 在正常肺动脉组,芬太尼终浓度(0.1、1、10、100 μmol/L)使去氧肾上腺素(Phenylephedrine,PE)预收缩的肺动脉舒张(EC50=1.699);在LPS孵育的

  9. phenoVein - A software tool for leaf vein segmentation and analysis

    OpenAIRE

    Bühler, Jonas; Rishmawi, Louai; Pflugfelder, Daniel; Huber, Gregor; Scharr, Hanno; Hülskamp, Martin; Koornneef, Maarten; SCHURR, ULRICH; Jahnke, Siegfried

    2015-01-01

    phenoVein is a software tool dedicated to automated segmenting and analyzing images of leaf veins. It includes comfortable manual correction features. Advanced image filtering automatically emphasizes veins from background and compensates for local brightness inhomogeneities. Phenotypical leaf vein traits being calculated are total vein density, vein lengths and widths and skeleton graph statistics. For determination of vein widths, a model based vein edge estimation approach has been impleme...

  10. Pulmonary vasculitis.

    Science.gov (United States)

    Lally, Lindsay; Spiera, Robert F

    2015-05-01

    Pulmonary vasculitis encompasses inflammation in the pulmonary vasculature with involved vessels varying in caliber from large elastic arteries to capillaries. Small pulmonary capillaries are the vessels most commonly involved in vasculitis affecting the lung. The antineutrophil cytoplasmic antibody-associated vasculitides, which include granulomatosis with polyangiitis (formerly Wegener granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), are the small vessel vasculitides in which pulmonary vasculitis is most frequently observed and are the major focus of this review. Vasculitic involvement of the large pulmonary vessels as may occur in Behçet syndrome and Takayasu arteritis is also discussed.

  11. Chronic hypoxia increases TRPC6 expression and basal intracellular Ca2+ concentration in rat distal pulmonary venous smooth muscle.

    Directory of Open Access Journals (Sweden)

    Lei Xu

    Full Text Available Hypoxia causes remodeling and contractile responses in both pulmonary artery (PA and pulmonary vein (PV. Here we explore the effect of hypoxia on PV and pulmonary venous smooth muscle cells (PVSMCs.Chronic hypoxic pulmonary hypertension (CHPH model was established by exposing rats to 10% O2 for 21 days. Rat distal PVSMCs were isolated and cultured for in vitro experiments. The fura-2 based fluorescence calcium imaging was used to measure the basal intracellular Ca2+ concentration ([Ca2+]i and store-operated Ca2+ entry (SOCE. Quantitative RT-PCR and western blotting were performed to measure the expression of mRNA and levels of canonical transient receptor potential (TRPC protein respectively.Hypoxia increased the basal [Ca2+]i and SOCE in both freshly dissociated and serum cultured distal PVSMCs. Moreover, hypoxia increased TRPC6 expression at mRNA and protein levels in both cultured PVSMCs exposed to prolonged hypoxia (4% O2, 60 h and distal PV isolated from CHPH rats. Hypoxia also enhanced proliferation and migration of rat distal PVSMCs.Hypoxia induces elevation of SOCE in distal PVSMCs, leading to enhancement of basal [Ca2+]i in PVSMCs. This enhancement is potentially correlated with the increased expression of TRPC6. Hypoxia triggered intracellular calcium contributes to promoted proliferation and migration of PVSMCs.

  12. Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study.

    Science.gov (United States)

    Hogg, K; Dawson, D; Mackway-Jones, K

    2006-02-01

    Pleuritic chest pain, a symptom of pulmonary embolism, is a common presenting symptom in the emergency department. The aim of this study was to validate an algorithm for the diagnosis of pulmonary embolism in emergency department patients with pleuritic chest pain. This was a prospective, diagnostic cohort study conducted in a large UK city centre emergency department. A total of 425 patients with pleuritic chest pain presenting to the emergency department between February 2002 and June 2003 were recruited. Patients scoring a low modified Wells clinical probabi