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Unilateral Left-sided Thoracoscopic Ablation of Atrial Fibrillation.
单侧左侧胸腔镜消融心房颤动。
- 影响因子:1.80
- DOI:10.1016/j.athoracsur.2020.01.057
- 作者列表:"Maesen B","La Meir M
- 发表时间:2020-07-01
Abstract
:Thoracoscopic surgical ablation has evolved into a valid and effective treatment option, especially in patients with more persistent forms of atrial fibrillation. A significant part of this development is due to the capability of biparietal bipolar radiofrequency clamps to create long-lasting transmural lesions. To date, all commercially available bipolar clamps require a bilateral thoracoscopic approach. Here, we describe the surgical technique of a unilateral left-sided thoracoscopic approach for surgical atrial fibrillation ablation on the beating heart.
摘要
: 胸腔镜手术消融已经发展成为一种有效的治疗选择,尤其是对于持续性房颤患者。这种发展的重要部分是由于双顶双极射频钳能够产生持久的透壁病变。迄今为止,所有市售的双极夹具都需要双侧胸腔镜方法。在这里,我们描述了单侧左侧胸腔镜入路在跳动的心脏上进行外科心房颤动消融的手术技术。
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METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.
心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。