scholarly journals Left-Sided Pulmonary Isolations After Complete Right-Sided Pneumonectomy: Technical Challenges to Clinical Success

2021 ◽  
Vol 34 (1) ◽  
pp. 48-52
Author(s):  
Gustavo Henrique Sumnienski Bertoldi ◽  
Rafael March Ronsoni ◽  
Tiago Luiz Silvestrini
Keyword(s):  
Left Atrium ◽  
Male Patient ◽  
Clinical Success ◽  
Clinical Situation ◽  
New Approach ◽  
Af Ablation ◽  
Intracardiac Ultrasound ◽  
The Right ◽  
Safety Procedures

Male patient, 76 years old, presented symptomatic paroxysmal AF for almost 2 years. Long submitted to total right pneumonectomy and having a major cardiac rotation. The use of tomography and intracardiac ultrasound were fundamental for a better anatomic comprehension and optimization of the safety procedures for AF ablation in these patients, due to the difficulty in accessing the left atrium and the consequent manipulation of catheters. In this case, electrical signals have not yet been detected in the stumps on the right side, with only the left veins being isolated. This approach constitutes a new approach in this clinical situation, with clinical success in a 3-year follow-up.

scholarly journals Sex-Related Differences in Atrial Remodeling in Patients With Atrial Fibrillation: Relationship to Ablation Outcomes

2021 ◽  
Author(s):  
Geoffrey R. Wong ◽  
Chrishan J. Nalliah ◽  
Geoffrey Lee ◽  
Aleksandr Voskoboinik ◽  
David Chieng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Conduction Velocity ◽  
Regional Analysis ◽  
High Density ◽  
Electroanatomic Mapping ◽  
Atrial Remodeling ◽  
Af Ablation ◽  
Density Maps

Background: Population studies have demonstrated a range of sex differences including a higher prevalence of atrial fibrillation (AF) in men and a higher risk of AF recurrence in women. However, the underlying reasons for this higher recurrence are unknown. This study evaluated whether sex-based electrophysiological substrate differences exist to account for worse AF ablation outcomes in women. Methods: High-density electroanatomic mapping of the left atrium was performed in 116 consecutive patients with AF. Regional analysis was performed across 6 left atrium segments. High-density maps were created using a multipolar catheter (Biosense Webster) during distal coronary sinus pacing at 600 and 300 ms. Mean voltage and conduction velocity was determined. Complex fractionated signals and double potentials were manually annotated. Results: Overall, 42 (36%) were female, mean age was 61±8 years and AF was persistent in 52%. Global mean voltage was significantly lower in females compared with males at 600 ms (1.46±0.17 versus 1.84±0.15 mV, P <0.001) and 300 ms (1.27±0.18 versus 1.57±0.18 mV, P =0.013) pacing. These differences were seen uniformly across the left atrium. Females demonstrated significant conduction velocity slowing (34.9±6.1 versus 44.1±6.9 cm/s, P =0.002) and greater proportion of complex fractionated signals (9.9±1.7% versus 6.0±1.7%, P =0.014). After a median follow-up of 22 months (Q1–Q3: 15–29), females had significantly lower single-procedure (22 [54%] versus 54 [75%], P =0.029) and multiprocedure (24 [59%] versus 60 [83%], P =0.005) arrhythmia-free survival. Female sex and persistent AF were independent predictors of single and multiprocedure arrhythmia recurrence. Conclusions: Female patients demonstrated more advanced atrial remodeling on high-density electroanatomic mapping and greater post-AF ablation arrhythmia recurrence compared with males. These changes may contribute to sex-based differences in the clinical course of females with AF and in part explain the higher risk of recurrence.

scholarly journals 12-Year Follow-Up of Regenerative Endodontic Treatment of Immature Permanent Upper Incisors with Acute Abscess

2020 ◽  
Vol 31 (6) ◽  
pp. 680-684
Author(s):  
Claudio Maniglia-Ferreira ◽  
Eduardo Diogo Gurgel Filho ◽  
Fabio de Almeida Gomes ◽  
Sthefanny Amaral Reis ◽  
Fernanda Geraldo Pappen
Keyword(s):  
Clinical Success ◽  
Glass Ionomer Cement ◽  
Mineral Trioxide Aggregate ◽  
Endodontic Treatment ◽  
Treatment Access ◽  
Root Canals ◽  
Immature Teeth ◽  
The Right ◽  
Regenerative Endodontic Treatment

Abstract This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.

scholarly journals Endoscope-Assisted Microsurgical Removal of an Optic Foramen Meningioma through a Frontolateral Minicraniotomy

2018 ◽  
Vol 79 (S 02) ◽  
pp. S227-S228 ◽  
Author(s):  
Peter Kurucz ◽  
Holger Opitz ◽  
Michael Buchfelder ◽  
Oliver Ganslandt
Keyword(s):  
Male Patient ◽  
Visual Disturbance ◽  
Skin Incision ◽  
Optic Canal ◽  
Visual Recovery ◽  
Microsurgical Technique ◽  
The Right

AbstractA 72-year-old male patient with visual disturbance of the right eye was diagnosed with a small meningioma of the right optic foramen extending to the carotid cistern. The operation was performed through an individually tailored frontolateral minicraniotomy via a curvilinear skin incision behind the hairline. Endoscope-assisted microsurgical technique was used to resect the lesion. The roof of the optic canal was partly removed to get access to the intraforaminal tumor parts. The lesion could be completely removed and the patient showed a satisfactory visual recovery in the follow-up examinations.The link to the video can be found at: https://youtu.be/p8EZx7aryeQ.

scholarly journals Corneal crosslinking in a case with Axenfeld–Rieger syndrome and unilateral pellucid marginal degeneration

2019 ◽  
Vol 11 ◽  
pp. 251584141882228 ◽  
Author(s):  
Mustafa Koc ◽  
Pinar Kosekahya ◽  
Merve Inanc ◽  
Kemal Tekin
Keyword(s):  
Visual Acuity ◽  
Male Patient ◽  
Vision Loss ◽  
Slit Lamp ◽  
Slit Lamp Examination ◽  
Corneal Crosslinking ◽  
Rieger Syndrome ◽  
Corrected Distance Visual Acuity ◽  
The Right

A 31-year-old male patient presented with the complaint of progressive vision loss in his left eye. Slit-lamp examination showed posterior embryotoxon, iris hypoplasia, and iridocorneal adhesion in both eyes, corectopia in the right, and peripheral inferior thinning and ectasia in the left eye. Corneal topography showed slightly asymmetric bowtie pattern in the right eye and crab-claw pattern in the left eye. Topographic examination was compared with his previous topography. The comparison showed 1.6-D steepening of maximum keratometry ( Kmax) and 22-µm decrease of thinnest corneal pachymetry. Corneal crosslinking treatment was performed on the left eye. At the postoperative 28-month follow-up visit, Kmax decreased from 54.1 to 53.0 D and corrected distance visual acuity improved to 20/20 with scleral lens. This is the first reported a case with Axenfeld–Rieger syndrome and pellucid marginal degeneration association. We suggest that corneal crosslinking can be useful for management of pellucid marginal degeneration and longer follow-up might be needed in order to corroborate the effectiveness of the corneal crosslinking procedure.

scholarly journals Cor triatriatum and stroke

2017 ◽  
pp. bcr-2017-219763 ◽  
Author(s):  
Jose Danilo Bengzon Diestro ◽  
Joseph Justin Hipolito Regaldo ◽  
Eddieson Masangcay Gonzales ◽  
Maria Kristina Casanova Dorotan ◽  
Adrian Isidoro Espiritu ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Left Atrium ◽  
Cor Triatriatum ◽  
Neurological Morbidity ◽  
Cardiac Condition ◽  
Hospital Acquired Pneumonia ◽  
Membrane Spanning ◽  
The Right ◽  
Hospital Acquired

Cor triatriatum sinistrum (CTS) is a congenital anomaly where the left atrium is divided into two compartments by a fibromuscular membrane. This report aims to add to the literature on a rare cardiac condition that can cause neurological morbidity. We report a case of a 19-year-old female with an infarct in the right middle cerebral artery (MCA) territory initially maintained on aspirin. Eighteen months later, she had recurrence of weakness, for which repeat transthoracic echocardiography (TTE) and re-evaluation of the first TTE demonstrated a hyperechoic membrane spanning the width of the left atrium, clinching the diagnosis of CTS. Despite anticoagulation with apixaban, she was admitted for a third stroke where she succumbed to hospital-acquired pneumonia. Among cases of CTS associated with stroke, anticoagulation and surgery were the main modes of treatment. This case has the longest follow-up and the first to demonstrate failure of antiplatelet therapy and anticoagulation.

P979Persistent atrial fibrillation terminated within the left atrium without recurrence at follow-up demonstrates a gradual intracardiac organization during stepwise ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pithon ◽  
A Luca ◽  
A Buttu ◽  
J M Vesin ◽  
L Roten ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Right Atrial ◽  
Linear Ablation ◽  
The Right ◽  
Dominant Frequencies ◽  
Complex Fractionated Atrial Electrograms

Abstract Introduction We previously reported that patients (pts) with recurrence (Rec) after stepwise catheter ablation (step-CA) of persistent atrial fibrillation (pAF) exhibit high bi-atrial intracardiac dominant frequencies (DF) values before ablation, indicative of a severe bi-atrial electro-anatomical remodeling. Purpose Herein, we hypothesized that a gradual decrease in DF values during step-CA is associated with pAF termination and maintenance of sinus rhythm (SR) on the long term. Method In 40 consecutive pts (61±8 yo, sustained AF duration 19±11 months), pulmonary vein isolation (PVI) and left atrium (LA) ablation were performed until pAF termination or cardioversion. 10-sec intracardiac electrograms (EGMs) epochs were recorded before ablation (BL), during PVI and during complex fractionated atrial electrograms (CFAEs) and linear ablation (post_PVI) in the right atrial (RAA) and left atrial (LAA) appendages and in the coronary sinus (CS). DF was defined as the highest peak within the [3–15] Hz EGM spectrum. Rec was defined as any atrial arrhythmia lasting >30 sec during follow-up (FU). Results pAF was terminated within the LA in 70% (28/40, LT) of the pts, while 30% (12/40, NLT) were not. After a mean FU of 34±14 months, all NLT pts had a Rec, while LT pts presented a Rec in 71% (20/28, LT_rec) and remained in SR in 29% (8/28, LT_norec). Figure 1 shows: 1) a gradient in DF values measured in the LAA (panel A), RAA (panel B) and CS (panel C) with the highest values in NLT pts (red), intermediate values in LT_rec pts (yellow) and lowest DF values in LT_norec pts (green); 2) all three groups displayed a gradual intracardiac organization during LA ablation as shown by decreasing DF values (p<0.05, BL vs post_PVI), but the LT_norec pts (green) exhibited the highest relative changes in DF from BL (p<0.05, LT_norec vs NLT, Δ range: −5.31 to −9.69%). Figure 1. Effect of ablation on DF Conclusion Low DF values before ablation and gradual intracardiac organization until pAF termination are associated with maintenance of SR on the long term.

New approach in partial cavopulmonary connection

1998 ◽  
Vol 8 (3) ◽  
pp. 364-367 ◽  
Author(s):  
Paulo. P. Paulista ◽  
Maria Virginia. T. Santana ◽  
Antonio. T. M. Henriques Neto ◽  
Valmir F. Fontes
Keyword(s):  
Limiting Factor ◽  
Late Outcome ◽  
Caval Vein ◽  
New Approach ◽  
Inferior Caval Vein ◽  
Bidirectional Glenn Shunt ◽  
Show Evidence ◽  
The Right ◽  
Cavopulmonary Connection

AbstractThe development of pulmonary atteriovenous fistulas after bidirectional cavopuomonary operat-tions, such as the bidirectional Glenn shunt and Kawashima's procedure, has raised concern. Development of these fistulas, which are more frequent than initially thought, can represnt a limiting factor in the late outcome of these patients and may even limit the indication for these of surgery. Whether the fistulas can be reversed by transforming the surgical procedures has yet to be established. In the hope of avoiding this kind of complication, thought to be caused by the lack of passage of a hypothetical hepatic factor through the pulmonary circulation. wedevelped an inverred type of gidirectional cavopulmonary connection in which the blood coming from the liver perfuses immediately both lungs. This is made possi-ble by shuntiong via an intra-atrial tunnel the blood from the superior caval vein directly to the left atrium, and the blood from the inferior caval vein to the right branch of the pulmonary trunk (keeping its bifurcation intact). We describe findings in two patients undergoing successful surgery with this technique. Serial follow -up with cohtrast echocardiography did not show evidence of arteriovenous pulmonary fistulas.Despite our numbers being small, and the time of follow-up being limited, we believe that it is importantto document these and similar cases

scholarly journals Endoscope-Assisted Minimally Invasive Microsurgical Removal of a Medium-Sized Acoustic Neuroma (T3a) through a Retrosigmoid Mini-Craniotomy with Preservation of Hearing

2019 ◽  
Vol 80 (S 03) ◽  
pp. S276-S278 ◽  
Author(s):  
Peter Kurucz ◽  
Laszlo Barany ◽  
Michael Buchfelder ◽  
Oliver Ganslandt
Keyword(s):  
Minimally Invasive ◽  
Male Patient ◽  
Acoustic Neuroma ◽  
Internal Auditory Meatus ◽  
Microsurgical Technique ◽  
Hearing Recovery ◽  
The Right

A 45-year-old male patient with reduced hearing in the right ear was diagnosed with a medium-sized (T3a) acoustic neuroma. The operation was performed through an individually tailored retrosigmoid mini-craniotomy. Endoscope-assisted microsurgical technique was applied to early detect the location of the facial and cochlear nerves as well as to look around the hidden corners during the surgery. The entire operation was performed without using brain retractors. The moderate intrameatal extension of the tumor and the use of angled endoscopes allowed to avoid the drilling of the internal auditory meatus. The lesion could be completely removed and the patient showed a satisfactory hearing recovery in the follow-up examinations 3 months after the surgery.The link to the video can be found at: https://youtu.be/dAYLakih924.

scholarly journals An 18-Month-Old Child with Infantile Pompe Disease: Oral Signs

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Derya Ceyhan ◽  
Burcu Gucyetmez Topal
Keyword(s):  
Male Patient ◽  
Pompe Disease ◽  
Tooth Eruption ◽  
Anterior Region ◽  
Information Platform ◽  
Dental Examination ◽  
Dental Abnormalities ◽  
Infantile Pompe Disease ◽  
The Right

We aim to create an information platform by contributing orodental findings of Pompe disease to literature. An 18-month-old male patient with Pompe disease was referred to our clinic due to swelling of the gums. In first dental examination, a nonfluctuant, normal gingiva colored swelling at the right anterior region of maxilla was detected. His parents were recommended to perform finger massage to the region. Six months later, 51, 52, 62, and 74 numbered teeth had erupted, there was a fusion between 51 and 52 numbered teeth, 84 numbered tooth was seen to be erupted, and a swelling at the site of this tooth, similar to previous one, was present. Finger massage was recommended for this area as well, and the swelling was found to have decreased at the follow-up, one week later. Tooth eruption problems and developmental dental abnormalities should be included in the signs for Pompe disease.

DOZ047.66: Thoracoscopic posterior tracheopexy during primary esophageal atresia repair

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S H A J Tytgat ◽  
D C van der Zee ◽  
J W Verweij ◽  
E S van Tuyll van Serooskerken ◽  
M Y A Lindeboom
Keyword(s):  
Esophageal Atresia ◽  
Respiratory Symptoms ◽  
Wide Spectrum ◽  
New Approach ◽  
Esophageal Anastomosis ◽  
Life Threatening ◽  
Syncytial Virus ◽  
The Right ◽  
Tracheal Collapse

Abstract Background Esophageal atresia (EA) is usually accompanied by some form of tracheomalacia. During the early phases in life, excessive dynamic collapse of the trachea can cause a wide spectrum of symptoms ranging from mild complaints to apparent life-threatening events (ALTE’s). Therapeutic strategies for severe tracheomalacia include aortopexy to lift the anterior weakened cartilaginous rings or posterior tracheopexy of the floppy membranous tracheal intrusion. Earlier we have introduced a new approach in which the posterior tracheopexy is performed directly during primary thoracoscopic correction of EA. Methods In the period 2017–2018, all consecutive EA patients (27) underwent a rigid tracheobronchoscopic evaluation during induction of anesthesia prior to the thoracoscopic EA repair. Tracheomalacia was diagnosed in 11 patients. During the subsequent thoracoscopic procedure, the posterior tracheal membrane was fixed to the anterior longitudinal spinal ligament with nonabsorbable sutures. The esophageal ends were then mobilized toward the right hemithorax and anastomosed. Results On preoperative RTB, six patients had a severe (66–99%) mid tracheal collapse and five patients had a moderate (33–66%) collapse. Thoracoscopic posterior tracheopexy with on to three sutures was possible in all 11 patients, prior to the formation of the esophageal anastomosis. Median time per suture was 6 minutes (range: 4–12 minutes). All operative procedures were uneventful. A median follow-up of 10 months (range: 2–22 months) revealed that eight patients recovered without any respiratory symptoms, one patient had respiratory symptoms caused by a suture granuloma that was removed by bronchoscopy, one patient had a respiratory syncytial virus bronchiolitis and one patient had a rhinovirus infection. None of the patients experienced any ALTE’s. Conclusion Eleven patients have been treated by thoracoscopic posterior tracheopexy during primary EA repair. This technique could prevent potentially deleterious sequelae of moderate to severe tracheomalacia that may complicate the lives of EA patients. Also, a second, sometimes complex surgical procedure can be prevented as the posterior tracheopexy is performed during the primary thoracoscopic EA correction.

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