Cryoballoon ablation with left lateral decubitus position in atrial fibrillation patient where the left atrium was compressed by the vertebra.
ABSTRACT: Catheter ablation of atrial fibrillation is difficult when the left atrium is compressed by the vertebra. The heart may shift forward, and compression of the left atrium may be relieved in the left lateral decubitus position. Therefore, catheter ablation could be performed in the left lateral decubitus position even in such cases.
Project description:<h4>Background</h4>Air embolus penetrating into heart chamber as a complication during percutaneous radiofrequency catheter ablation has been infrequently reported.<h4>Case presentation</h4>A 55-year-old man with dextrocardia who suffered from abdominal pain was suspected to have multiple arterial thromboembolisms, which might have originated from left atrium thrombosis since he had atrial fibrillation. He received oral anticoagulant therapy and catheter ablation of the arrhythmia. During the ablation procedure, an iatrogenic aeroembolism penetrated into the left atrium due to improper operation. Ultimately, the entire air embolus was extracted from the patient, who was free of any aeroembolism events thereafter.<h4>Conclusions</h4>It is essential for an operator to pay full attention to all details of the procedure to avoid an aeroembolism during catheter ablation. In case of aeroembolism, removal by aspiration is an optimal and effective treatment.
Project description:To test the ability of four circulating biomarkers of fibrosis, and of low left atrial voltage, to predict recurrence of atrial fibrillation after catheter ablation.Circulating biomarkers potentially may be used to improve patient selection for atrial fibrillation ablation. Low voltage areas in the left atrium predict arrhythmia recurrence when mapped in sinus rhythm. This study tested type III procollagen N terminal peptide (PIIINP), galectin-3 (gal-3), fibroblast growth factor 23 (FGF-23), and type I collagen C terminal telopeptide (ICTP), and whether low voltage areas in the left atrium predicted atrial fibrillation recurrence, irrespective of the rhythm during mapping.92 atrial fibrillation ablation patients were studied. Biomarker levels in peripheral and intra-cardiac blood were measured with enzyme-linked immunosorbent assay. Low voltage (<0.5mV) was expressed as a proportion of the mapped left atrial surface area. Follow-up was one year. The primary endpoint was recurrence of arrhythmia. The secondary endpoint was a composite of recurrence despite two procedures, or after one procedure if no second procedure was undertaken.The biomarkers were not predictive of either endpoint. After multivariate Cox regression analysis, high proportion of low voltage area in the left atrium was found to predict the primary endpoint in sinus rhythm mapping (hazard ratio 4.323, 95% confidence interval 1.337-13.982, p = 0.014) and atrial fibrillation mapping (hazard ratio 5.195, 95% confidence interval 1.032-26.141, p = 0.046). This effect was also apparent for the secondary endpoint.The studied biomarkers do not predict arrhythmia recurrence after catheter ablation. Left atrial voltage is an independent predictor of recurrence, whether the left atrium is mapped in atrial fibrillation or sinus rhythm.
Project description:Arthroscopic shoulder surgery can be performed in both the beach chair and lateral decubitus positions. The lateral decubitus position allows for excellent exposure to all aspects of the glenohumeral joint and is therefore frequently employed in procedures such as stabilization, in which extensive visualization of the inferior and posterior aspects of the joint is required. Improved visualization is imparted due to applied lateral and axial traction on the operative arm, which increases the glenohumeral joint space. To perform arthroscopy surgery in the lateral decubitus position successfully, meticulous care during patient positioning and setup must be taken. In this Technical Note, we describe the steps required to safely, efficiently, and reproducibly perform arthroscopic shoulder surgery in the lateral decubitus position.
Project description:<h4>Objectives</h4>The aim of this study is to compare thoracoscopic mobilization of the oesophagus in the lateral decubitus position and the semiprone position and to identify potential differences between the two techniques.<h4>Methods</h4>A retrospective review of a prospectively maintained oesophagectomy database identified 150 patients undergoing combined thoracoscopic and laparoscopic oesophagectomy (TLO). Of these, 90 cases underwent thoracoscopic oesophageal mobilization in the left lateral decubitus position. The remaining 60 cases underwent thoracoscopic oesophageal mobilization in the semiprone position.<h4>Results</h4>There were no differences in the clinicopathological factors and tumour characteristics between the two groups. There was no significant difference in the blood loss, operation time, the incidence of conversion, length of hospital stay or in the number of retrieved mediastinal and abdominal nodes between the two groups. There was no significant difference with regard to the incidence of respiratory complications, anastomotic leaks, vocal cord palsy, chylothorax, delayed gastric emptying, arrhythmia and intestinal obstruction between the two groups.<h4>Conclusions</h4>The semiprone and lateral decubitus positions each have their inherent advantages and disadvantages. Our initial experience confirmed that while the semiprone position is associated with superior surgical ergonomics and better exposure of the posterior mediastinum, there is no convincing evidence that semiprone thoracoscopic oesophagectomy is superior to the left lateral decubitus positioning with respect to the major surgical outcomes and oncological clearance.
Project description:In interventional electrophysiology, catheter-based radiofrequency (RF) ablation procedures restore cardiac heart rhythm by interrupting aberrant conduction paths. Real-time feedback on lesion formation and post-treatment lesion assessment could overcome procedural challenges related to ablation of underlying structures and lesion gaps. This study aims to evaluate real-time visualization of lesion progression and continuity during intra-atrial ablation with photoacoustic (PA) imaging, using clinically deployable technology. A PA-enabled RF ablation catheter was used to ablate and illuminate porcine left atrium, both excised and intact in a passive beating heart ex-vivo, for photoacoustic signal generation. PA signals were received with an intracardiac echography catheter. Using the ratio of PA images acquired with excitation wavelengths of 790?nm and 930?nm, ablation lesions were successfully imaged through circulating saline and/or blood, and lesion gaps were identified in real-time. PA-based assessment of RF-ablation lesions was successful in a realistic preclinical model of atrial intervention.
Project description:Shoulder arthroscopy offers a minimally invasive surgical approach to treat a variety of shoulder pathologies. The patient can be positioned in either the lateral decubitus or the beach chair position. This note and accompanying video describe the operating room setup for shoulder arthroscopy in the lateral decubitus position, including positioning of the arms, head, and sterile preparation and draping. Appropriate lateral decubitus positioning for shoulder arthroscopy with careful attention to detail will promote ease of surgical intervention and minimize complications.
Project description:BACKGROUND:Radiofrequency catheter ablation is approved effective therapy for premature ventricular contraction. However, the rare but serious complication such as pseudoaneurysm should be given more attention. It is life-threatening due to the high risk of rupture. Only few cases have been reported in the literature. We herein report a huge acute left ventricular pseudoaneurysm after catheter ablation therapy. CASE PRESENTATION:A 69-year-old man underwent radiofrequency catheter ablation for premature ventricular contraction at a local hospital. The patient developed shock the second day after ablation. A chest computed tomography (CT) scan showed pericardial effusion. Pericardiocentesis was performed, and the puncture fluid was a bloody pericardial effusion. The transthoracic echocardiogram revealed an 9-?×?4-cm giant pseudoaneurysm with a cystic structure in the left ventricular inferior wall near the mitral annulus along the left atrium. The pseudoaneurysm was connected to the left ventricular cavity through a 8-mm neck, and the lumen was filled with systolic and diastolic blood flow. The patient underwent three-dimensional transesophageal echocardiography. The pseudoaneurysm and the tract was clearly visible. Emergency surgery was performed to resect the pseudoaneurysm. A bovine pericardial patch was placed on the neck of the pseudoaneurysm. Echocardiographic examination confirmed the absence of cardiac lesions after the operation. CONCLUSIONS:It is rare to see such a large pseudoaneurysm after radiofrequency catheter ablation. Clinicians should be allert to the potential risks to patients in the process of an effective treatment. Echocardiography plays an important role in the prompt diagnosis and prognosis of this disease. Emergency surgery is a better method for treatment of huge pseudoaneurysm.
Project description:The purpose of this report is to describe arthroscopic suprapectoral biceps tenodesis in the lateral decubitus position. Many technique descriptions for this procedure emphasize the beach-chair position to obtain optimal anterior subdeltoid visualization of the relevant anatomy. This is not required and may be less desirable or comfortable for a shoulder arthroscopist who prefers the lateral decubitus position. Therefore, the aim of this report is to show that the relevant anatomy may be readily and safely accessed, and the procedure effectively performed, in the lateral decubitus position.
Project description:A 67-year-old man underwent left atrial appendage (LAA) exclusion concomitant with mitral valve surgery and radiofrequency ablation maze procedure. On transoesophageal echocardiography anticipating ablation for left atrial tachycardia, an echodense thrombus was visualised in the LAA location with apparent intracavitary extension into the left atrium. Based on CT imaging findings, the echo represented thrombosis of a large left atrial appendage with probable extension into the left atrium.
Project description:Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device's utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position.69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance.Our results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position.We report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.