Project description:BackgroundIt is difficult to detect a common trunk of the left pulmonary vein (PV) preoperatively, which may cause intraoperative accidental complications. The purpose of this study is to establish a simple and reliable method of detecting a common trunk in preoperative computed tomography (CT) images.MethodsA total of 428 patients who underwent thin-section CT preoperatively for left lung cancer at 4 institutions were reviewed. The characteristic findings of a common trunk in the axial view were considered by confirming the preoperative CT findings of cases that had been verified to have a common trunk based on intraoperative findings. The CT images were reviewed independently by two evaluators.ResultsWe found that the distance between the mediastinal side of the left lower bronchus and the junction of two left PVs was extremely short in the cases with a common trunk in the axial view. In a typical case, the axial section of the bronchus is close to the junction. Of the 416 patients that were evaluable among the 428 total patients, 26 (6.3%) were diagnosed as having a common trunk by both evaluators, and the diagnosis was coincident in 413 patients (99.2%). We were able to evaluate the surgical videos of 16 of the 26 patients, and a common trunk was confirmed in 15 patients (94%).ConclusionsWe established a simple and reliable method of detecting a common trunk of the left PV in the axial view on chest CT that was routinely performed prior to lung cancer surgery.

| S-EPMC7475540 | biostudies-literature

A sneaky vertebra during a right inferior pulmonary vein laser ablation.

Project description: Not available

| S-EPMC8441200 | biostudies-literature

Laryngospasm During Pulsed Field Ablation of the Left Superior Pulmonary Vein.

Project description:BackgroundPulsed field ablation (PFA) is an innovative, nonthermal, and effective method for pulmonary vein isolation, with a favorable safety profile in the treatment of atrial fibrillation (AF).Case summaryA 74-year-old woman underwent elective pulmonary vein isolation with PFA for paroxysmal AF under general anesthesia with a laryngeal mask airway. During PFA delivery to the left superior pulmonary vein, a vocal cord spasm occurred, requiring immediate airway intervention. Ventilation was restored with a muscle relaxant followed by endotracheal intubation.DiscussionAlthough muscle contractions and vasospasms have been documented previously during PFA, this case is the first to be reported of laryngospasm. We hypothesize that it may result from direct stimulation of the recurrent laryngeal or vagus nerve owing to the superior vein course and deep catheter positioning.Take-home messageBecause laryngospasm may occur, preparation for acute airway obstruction management is essential during PFA for AF.

| S-EPMC11830256 | biostudies-literature

Mediastinal synovial sarcoma invading the right inferior pulmonary vein and left atrium

Project description: Not available

| S-EPMC10267862 | biostudies-literature

Lung carcinoma extended to the left atrium through the right inferior pulmonary vein.

Project description: Not available

| S-EPMC7414819 | biostudies-literature

A swinging left atrial thrombus connecting to a right lower pulmonary vein thrombus.

Project description: Not available

| S-EPMC5497279 | biostudies-literature

Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation.

Project description:BackgroundThis study thought to elucidate the anatomical features that can predict an epicardial connection (EC) between the right pulmonary vein (RPV) and right atrium.MethodsWe retrospectively analyzed 251 consecutive patients undergoing initial radiofrequency pulmonary vein isolation. We defined EC as present when RPV could not be isolated with circumferential ablation and additional ablation for the conduction gap if needed, and RPV isolation could be achieved by ablation for the earliest activation site >10 mm inside the initial ablation line. Using computed tomography data, we evaluated the RPV bifurcation angle, and the area occupation ratio of the carina region to the RPV antrum (ARC) for predicting EC. In subjects with EC undergoing RPV activation mapping after circumferential ablation, the correlation between conduction delay and bipolar/unipolar potential voltage in the carina region was investigated.ResultsThere were ECs in 45 out of 251 patients (17.9%). The RPV bifurcation angle (47.7° vs. 38.8°, p < .001) and ARC (37.2% vs. 29.7%, p < .001) were significantly greater in the EC (+) group. Multivariate logistic regression analysis revealed that RPV bifurcation angle (odds ratio [OR]: 1.994, p = .002) and ARC (OR: 3.490, p = .013) were independent predictors of EC. In nine patients with EC undergoing carina region mapping, the unipolar potential voltage was correlated with conduction delay in RPV with EC (R = -0.401, p < .001).ConclusionAnatomical features suggesting a wider RPV carina region could predict the presence of EC, and potential with high voltage could be helpful for detecting EC connection sites.

| S-EPMC10692864 | biostudies-literature

Right haemothorax secondary to pulmonary vein laceration following left-sided pacemaker implantation: a case report.

Project description:BackgroundLead perforation is a rare but potentially fatal complication of cardiac device implantation. Atrial lead perforations, though less common than ventricular ones, can have severe consequences, especially in elderly patients with underlying structural heart disease.Case summaryAn 83-year-old male with amyloid and valvular cardiomyopathy underwent dual-chamber pacemaker implantation for third-degree atrioventricular block following transcatheter aortic valve implantation. The active-fixation atrial lead was positioned on the right atrial free wall. Six hours post-implantation, the patient developed haemodynamic instability. Echocardiography revealed a small pericardial effusion, while pacemaker interrogation showed an increased atrial pacing threshold. Chest imaging demonstrated a moderate right haemothorax. Initially, conservative management was recommended. However, the patient's condition deteriorated, progressing to cardiac arrest requiring brief cardiopulmonary resuscitation. Emergency sternotomy revealed a large right haemothorax and laceration of the right upper pulmonary vein in contact with the atrial lead screw. The laceration was repaired, and the atrial lead was repositioned. The patient recovered well and was discharged 5 days after surgery.DiscussionLead perforation is an uncommon but potentially severe complication of pacemaker implantation, with an incidence of 0.5-1% of cases. Several risk factors have been identified, including advanced age, low body mass index, atrial remodelling, and lateral lead placement. In this case, the atrial lead perforation extended from the atrial wall to the right superior pulmonary vein. This case underscores the potential risks associated with lateral lead positioning in geriatric patients and emphasizes the necessity for meticulous lead placement and vigilant post-implantation monitoring to mitigate complications.

| S-EPMC11911154 | biostudies-literature

Thoracoscopic right upper lobectomy in a patient with bronchial and pulmonary vein anomalies.

Project description: Not available

| S-EPMC8304485 | biostudies-literature