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Right Atrial (right + atrial)
Terms modified by Right Atrial Selected AbstractsThree-Dimensional Mapping of Atypical Right Atrial Flutter Late after Chest StabbingPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2008DANIEL STEVEN M.D. We present the case of a female patient who previously underwent cardiac surgery for traumatic anterior right atrial perforation after a stabbing attack. Four years later the patient presented with right atrial common type flutter and isthmus ablation was performed subsequently. However, three years after isthmus ablation the patient was readmitted with atypical right atrial flutter. Electrophysiological study revealed persistent bidirectional isthmus block. Three-dimensional mapping (NavX, St. Jude Medical, St. Paul, MN, USA) demonstrated an incisional tachycardia with the critical isthmus at the border of the anterior area of scar in a close proximity to the superior tricuspid annulus. After ablation of this isthmus the patient was arrhythmia free after a follow-up of 9 months. This case illustrates that three-dimensional scar mapping may help to identify unusual isthmus sites that may be simultaneously responsible for both typical and atypical atrial flutter. [source] Giant Right Atrium in an AdultECHOCARDIOGRAPHY, Issue 10 2008Vignendra Ariyarajah M.D. Massive right atrial (RA) enlargement is certainly more common in children than in adults, owing to rare congenital anomalies. Indeed, the largest description of such chamber enlargement was noted in a child, where the RA volume was reported to be 900 ml. We now report one of the largest descriptions of the RA in an adult, in absence of tricuspid stenosis and other common adult associations of RA abnormality, such as chronic pulmonary disease, severe mitral valvular pathology with pulmonary hypertension, and pulmonary embolism or infarct. The RA volume was estimated to be well over 500 ml and was notably disproportionate to that of the left atrium and either ventricle. [source] Clenbuterol administration does not attenuate the exercise-induced pulmonary arterial, capillary or venous hypertension in strenuously exercising Thoroughbred horsesEQUINE VETERINARY JOURNAL, Issue 6 2000M. MANOHAR Summary The present study was carried out to ascertain whether ,2 -adrenergic receptor stimulation with clenbuterol would attenuate the pulmonary arterial, capillary and venous hypertension in horses performing high-intensity exercise and, in turn, modify the occurrence of exercise-induced pulmonary haemorrhage (EIPH). Experiments were carried out on 6 healthy, sound, exercise-trained Thoroughbred horses. All horses were studied in the control (no medications) and the clenbuterol (0.8 ,g/kg bwt, i.v.) treatments. The sequence of these treatments was randomised for every horse, and 7 days were allowed between them. Using catheter-tip-transducers whose in-vivo signals were referenced at the point of the left shoulder, right heart/pulmonary vascular pressures were determined at rest, sub-maximal exercise and during galloping at 14.2 m/s on a 3.5% uphill grade - a workload that elicited maximal heart rate and induced EIPH in all horses. In the control experiments, incremental exercise resulted in progressive significant increments in right atrial as well as pulmonary arterial, capillary and venous (wedge) pressures and all horses experienced EIPH. Clenbuterol administration to standing horses caused tachycardia, but significant changes in mean right atrial or pulmonary vascular pressures were not observed. During exercise performed after clenbuterol administration, heart rate as well as right atrial and pulmonary arterial, capillary and wedge pressures also increased progressively with increasing work intensity. However, these values were not found to be statistically significantly different from corresponding data in the control study and the incidence of EIPH remained unaffected. Since clenbuterol administration also does not affect the transpulmonary pressure during exercise, it is unlikely that the transmural force exerted onto the blood-gas barrier of exercising horses is altered following i.v. clenbuterol administration at the recommended dosage. [source] Interatrial Mechanical Dyssynchrony Worsened Atrial Mechanical Function in Sinus Node Disease With or Without Paroxysmal Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009MEI WANG M.D., Ph.D. Introduction: Atrial electromechanical dysfunction might contribute to the development of atrial fibrillation (AF) in patients with sinus node disease (SND). The aim of this study was to investigate the prevalence and impact of atrial mechanical dyssynchrony on atrial function in SND patients with or without paroxysmal AF. Methods: We performed echocardiographic examination with tissue Doppler imaging in 30 SND patients with (n = 11) or without (n = 19) paroxysmal AF who received dual-chamber pacemakers. Tissue Doppler indexes included atrial contraction velocities (Va) and timing events (Ta) were measured at midleft atrial (LA) and right atrial (RA) wall. Intraatrial synchronicity was defined by the standard deviation and maximum time delay of Ta among 6 segments of LA (septal/lateral/inferior/anterior/posterior/anterospetal). Interatrial synchronicity was defined by time delay between Ta from RA and LA free wall. Results: There were no differences in age, P-wave duration, left ventricular ejection fraction, LA volume, and ejection fraction between with or without AF. Patients with paroxysmal AF had lower mitral inflow A velocity (70 ± 19 vs 91 ± 17 cm/s, P = 0.005), LA active empting fraction (24 ± 14 vs 36 ± 13%, P = 0.027), mean Va of LA (2.6 ± 0.9 vs 3.4 ± 0.9 cm/s, P = 0.028), and greater interatrial synchronicity (33 ± 25 vs 12 ± 19 ms, P = 0.022) than those without AF. Furthermore, a lower mitral inflow A velocity (Odd ratio [OR]= 1.12, 95% Confidence interval [CI] 1.01,1.24, P = 0.025) and prolonged interatrial dyssynchrony (OR = 1.08, 95% CI 1.01,1.16, P = 0.020) were independent predictors for the presence of AF in SND patients. Conclusion: SND patients with paroxysmal AF had reduced regional and global active LA mechanical contraction and increased interatrial dyssychrony as compared with those without AF. These findings suggest that abnormal atrial electromechanical properties are associated with AF in SND patients. [source] Catheter Ablation of Peri-AV Nodal Atrial Tachycardia from the Noncoronary Cusp of the Aortic ValveJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2008Ph.D, SAUMYA DAS M.D. Introduction: Atrial tachycardias (AT) originating from the anteroseptal region of the aortic root, near the atrioventricular node can be challenging to eliminate safely by catheter ablation. In this study, we examine the characteristics of anteroseptal ATs in a cohort of patients at our centers, and demonstrate the long-term efficacy and safety of targeting the arrhythmias from within the base of the noncoronary aortic valve cusp (NCC). Methods & Results: From among a cohort of 54 patients with symptomatic focal AT undergoing invasive electrophysiological evaluation, the point of earliest right atrial (RA) activation was at the peri-AV nodal region in 10 patients, just postero-superior to the His-bundle. Before further mapping, RA lesions placed in two patients were unsuccessful in eliminating the arrhythmia. Because of its proximity to the interatrial septum, the base of the NCC was mapped using a retrograde aortic approach, and revealed a point of early activation without the presence of a His potential. The arrhythmia terminated with <10 seconds of radiofrequency or cryothermal energy delivery and was successfully eliminated in 7 of 10 patients. Transient termination or acceleration of the AT was noted in the other three patients, prompting successful ablation from a left atrial septal position or a reattempt from a para-Hisian RA position. All patients have been arrhythmia free during follow-up (41 ± 12 months). Conclusions: Catheter ablation from within the base of the NCC represents a safe and effective means to eliminate focal AT arising from the peri-AV nodal region. [source] Mapping of Epicardial Activation in a Rabbit Model of Chronic Myocardial Infarction:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2007Endocardial, Epicardial Pacing, Response to Atrial Introduction: This study examines the consequences of a large transmural apical infarct on the epicardial electrical activity in isolated rabbit hearts. Methods and Results: Hearts were isolated 8 weeks after coronary artery ligation. Membrane voltage from the epicardial surface of the left ventricle (LV) including the infarct was monitored using the voltage sensitive dye RH237. Optical action potentials were detected from the epicardial surface of the infarct; the signal amplitude was ,20% of those in the noninfarcted zone (NZ). Epicardial activation mapping of the LV free wall showed that during right atrial (RA) pacing, the activation sequence was not significantly different between infarcted and sham-operated groups. However, direct stimulation of the epicardium in the NZ revealed an area of slow conduction velocity (CV ,5 cm/s,1, ,10% of normal values) at the margin of the infarct zone (IZ). Within the IZ, CV was ,50% of normal. A prominent endocardial rim of myocardium in the infarct was not the source of epicardial optical signals because chemical ablation of the endocardium did not affect the epicardial activation pattern. Concluson: Therefore, remnant groups of myocytes in the mid-wall and epicardium of the infarct scar support normal electrical activation during RA pacing. Areas of delayed conduction emerge only on epicardial stimulation. [source] Surface Electrocardiographic Patterns and Electrophysiologic Characteristics of Atrial Flutter Following Modified Radiofrequency MAZE ProceduresJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2007JOSEPH G. AKAR M.D., Ph.D. Introduction: The radiofrequency MAZE is becoming a common adjunct to cardiac surgery in patients with atrial fibrillation. While a variety of postoperative arrhythmias have been described following the original Cox-MAZE III procedure, the electrophysiological characteristics and surgical substrate of post-radiofrequency MAZE flutter have not been correlated. We sought to determine the location, ECG patterns, and electrophysiological characteristics of post-radiofrequency MAZE atrial flutter. Methods: Nine consecutive patients with post-radiofrequency MAZE flutter presented for catheter ablation 9 ± 10 months after surgery. Results: Only one patient (11%) had an ECG appearance consistent with typical isthmus-dependent right atrial (RA) flutter. However, on electrophysiological study, 3/9 patients (33%) had typical right counter-clockwise flutter entrained from the cavo-tricuspid isthmus, despite description of surgical isthmus ablation. Six patients (67%) had left atrial (LA) circuits. These involved the mitral annulus in 5/6 cases (83%) despite description of surgical mitral isthmus ablation in the majority (60%). LA flutters had a shorter cycle length compared with RA flutters (253 ± 39 msec and 332 ± 63 msec respectively, P < 0.05). After a mean of 8 ± 4 months following ablation, 8/9 patients (89%) were in sinus rhythm. Conclusion: Up to one-third of post-radiofrequency MAZE circuits are typical isthmus-dependent RA flutters, despite a highly atypical surface ECG morphology. Therefore, diagnostic electrophysiological studies should commence with entrainment at the cavo-tricuspid isthmus in order to exclude typical flutter, regardless of the surface ECG appearance. Incomplete surgical lesions at the mitral and cavo-tricuspid isthmus likely predispose to the development of post-radiofrequency MAZE flutter. [source] Entrainment Mapping of Dual-Loop Macroreentry in Common Atrial Flutter:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2004New Insights into the Atrial Flutter Circuit Introduction: The aim of this study was to determine using entrainment mapping whether the reentrant circuit of common type atrial flutter (AFL) is single loop or dual loop. Methods and Results: In 12 consecutive patients with counterclockwise (CCW) AFL, entrainment mapping was performed with evaluation of atrial electrograms from the tricuspid annulus (TA) and the posterior right atrial (RA) area. We hypothesized that a dual-loop reentry could be surmised from "paradoxical delayed capture" of the proximal part of the circuit having a longer interval from the stimulus to the captured beat compared with the distal part of the circuit. In 6 of 12 patients with CCW AFL, during entrainment from the septal side of the posterior blocking line, the interval from the stimulus to the last captured beat was longer at the RA free wall than at the isthmus position. In these six patients with paradoxical delayed capture, flutter cycle length (FCL) was 227 ± 12 ms and postpacing interval minus FCL was significantly shorter at the posterior blocking line than at the RA free wall (20 ± 11 ms vs 48 ± 33 ms, P < 0.05). In two of these patients, early breakthrough occurred at the lateral TA. A posterior block line was confirmed in all six patients in the sinus venosa area by intracardiac echocardiography. Conclusion: Half of the patients with common type AFL had a dual-loop macroreentrant circuit consisting of an anterior loop (circuit around the TA) and a posterior loop (circuit around the inferior vena cava and the posterior blocking line). (J Cardiovasc Electrophysiol, Vol. 15, pp. 679-685, June 2004) [source] Focal Origin of Atrial Tachycardia in Dogs with Rapid Ventricular Pacing-Induced Heart FailureJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2003GUILHERME FENELON M.D. Introduction: Dogs with rapid ventricular pacing-induced congestive heart failure (CHF) have inducible atrial tachycardia (AT), with a mechanism consistent with delayed afterdepolarization-mediated triggered activity. We assessed the hypothesis that AT has a focal origin. Methods and Results: Twenty-one CHF dogs undergoing 3 to 4 weeks of ventricular pacing at 235 beats/min were studied. Biatrial epicardial mapping of 20 sustained AT episodes (cycle length [CL], 175 ± 53 msec) in 5 dogs revealed an area of earliest activation in the right atrial (RA) free wall (13 episodes), RA appendage (4 episodes), or between the pulmonary veins (3 episodes). Total epicardial activation time during AT (73 ± 19 msec) was similar to that during sinus rhythm (72 ± 13 msec) and on average was <50% of the AT CL. Higher-density mapping of the RA free wall during 30 sustained AT episodes (163 ± 55 msec) in 9 dogs identified a site of earliest activation along the sulcus terminalis most frequently as a stable, focal activation pattern from a single site. Endocardial mapping of 49 sustained AT episodes (156 ± 27 msec) in 10 dogs revealed multiple sites of AT origin arising along the crista terminalis and pulmonary veins. Right and left ATs were terminated with discrete radiofrequency ablation, but other ATs remained inducible. A rapid, left AT generating an ECG pattern of atrial fibrillation was ablated inside the pulmonary vein. Conclusion: AT induced in this CHF model after 3 to 4 weeks of rapid ventricular pacing has an activation pattern consistent with a focal origin. Sites of earliest activation are distributed predominately along the crista terminalis and within or near the pulmonary veins. (J Cardiovasc Electrophysiol, Vol. 14, pp. ***-***, October 2003) [source] Electrical Remodeling and Atrial Dilation During Atrial Tachycardia are Influenced by Ventricular Rate: Role of Developing TachycardiomyopathyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2001BAS A. SCHOONDERWOERD M.D. Atrial Remodeling in Tachycardiomyopathy. Introduction: Atrial fibrillation (AF) and congestive heart failure (CHF) are two clinical entities that often coincide. Our aim was to establish the influence of concomitant high ventricular rate and consequent development of CHF on electrical remodeling and dilation during atrial tachycardia. Methods and Results: A total of 14 goats was studied. Five goats were subjected to 3:1 AV pacing (A-paced group, atrial rate 240 beats/min, ventricular rate 80 beats/min). Nine goats were subjected to rapid 1:1 AV pacing (AV-paced group, atrial and ventricular rates 240 beats/min). During 4 weeks, right atrial (RA) and left ventricular (LV) diameters were measured during sinus rhythm. Atrial effective refractory periods (AERP) and inducibility of AF were assessed at three basic cycle lengths (BCL). After 4 weeks of rapid AV pacing, RA and LV diameters had increased to 151% and 113% of baseline, whereas after rapid atrial pacing alone, these parameters were unchanged. Right AERP (157 ± 10 msec vs 144 ± 16 msec at baseline with BCL of 400 msec in the A-paced and AV-paced group, respectively) initially decreased in both groups, reaching minimum values within 1 week. Subsequently, AERP partially recovered in AV-paced goats, whereas AERP remained short in A-paced goats (79 ± 7 msec vs 102 ± 12 msec after 4 weeks; P < 0.05). Left AERP demonstrated a similar time course. Inducibility of AF increased in both groups and reached a maximum during the first week in both groups, being 20% and 48% in the A-paced and AV-paced group, respectively. Conclusion: Nature and time course of atrial electrical remodeling and dilation during atrial tachycardia are influenced by concurrent high ventricular rate and consequent development of CHF. [source] Predicting the Arrhythmogenic Foci of Atrial Fibrillation Before Atrial Transseptal Procedure:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2000Implication for Catheter Ablation Arrhythmosenic Foci of Atrial Fibrillation. Introduction: Use of endocardial atrial activation sequences from recording catheters in the right atrium. His bundle, and coronary sinus to predict the location of initiating foci of atrial fibrillation (AF) before an atrial transseptal procedure has not been reported. The purpose of the present study was to develop an algorithm using endocardial atrial activation sequences to predict the location of initiating foci of AF before transseptal procedure. Methods and Results: Seventy-five patients (60 men and 15 women, age 68 ± 12 years) with frequent episodes of paroxysmal AF were referred for radiofrequency ablation. By retrospective analysis, characteristics of the endocardial atrial activation sequences of right atrial, His-bundle, and coronary sinus catheters from the initial 37 patients were correlated with the location of initiating foci of AF, which were confirmed by successful ablation. The endocardial atrial activation sequences of the other 38 patients were evaluated prospectively to predict the location of initiating foci of AF before transseptal procedure using the algorithm derived from the retrospective analysis. Accuracy of the value <0 msee (obtained by subtracting the time interval between high right atrium and His-bundle atrial activation during atrial premature beats from that obtained during sinus rhythm) for discriminating the superior vena cava or upper portion of the crista terminalis from the pulmonary vein (PV) foci was 100%. When the interval between atrial activation ostial and distal pairs of the coronary sinus catheter of the atrial premature beats was <0 msec, the accuracy for discriminating left PV foci from right PV foci was 92% in the 24 foci from the left PVs and 100% in the 19 foci from the right PVs. Conclusion: Endocardial atrial activation sequences from right atrial, His-bundle, and coronary sinus catheters can accurately predict the location of initiating foci of AF before transseptal procedure. This may facilitate mapping and radiofrequency ablation of paroxysmal AF. [source] Congestive heart failure caused by intracardiac tumours in two dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 8 2006S. M. Warman Congestive heart failure is a common presentation in small animal practice. Cardiac tumours are an unusual cause of congestive heart failure and, when they occur, usually cause clinical signs associated with pericardial effusion and cardiac tamponade. This case report outlines the clinical and histological findings in two dogs presented with clinical signs of congestive heart failure caused by obstruction of blood flow by intracavitary cardiac tumours. Case 1 showed signs of left-sided heart failure caused by osteosarcoma within the left atrial lumen, and case 2 presented with clinical signs of right-sided heart failure due to haemangiosarcoma occupying the right atrial and ventricular lumens. This case report provides further evidence for the inclusion of intracardiac neoplasia in the differential diagnosis for dogs with clinical signs of congestive heart failure. [source] Three-Dimensional Mapping of Atypical Right Atrial Flutter Late after Chest StabbingPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2008DANIEL STEVEN M.D. We present the case of a female patient who previously underwent cardiac surgery for traumatic anterior right atrial perforation after a stabbing attack. Four years later the patient presented with right atrial common type flutter and isthmus ablation was performed subsequently. However, three years after isthmus ablation the patient was readmitted with atypical right atrial flutter. Electrophysiological study revealed persistent bidirectional isthmus block. Three-dimensional mapping (NavX, St. Jude Medical, St. Paul, MN, USA) demonstrated an incisional tachycardia with the critical isthmus at the border of the anterior area of scar in a close proximity to the superior tricuspid annulus. After ablation of this isthmus the patient was arrhythmia free after a follow-up of 9 months. This case illustrates that three-dimensional scar mapping may help to identify unusual isthmus sites that may be simultaneously responsible for both typical and atypical atrial flutter. [source] Comparison of Microvolt T-Wave Alternans Measurements Using Atrial Pacing Compared to Atropine AdministrationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2007STEFAN WEBER M.D Background:Microvolt T-wave alternans (MTWA) has been associated with malignant ventricular arrhythmias in patients (pts) with structural heart disease. MTWA has been shown to be a strong heart rate-dependent arrhythmia marker. However, in clinical practice some pts in which MTWA should be assessed are unable to perform physical exercise to increase heart rate due to various reasons. Methods:In this study, we investigated the feasibility of noninvasive MTWA measurement by using intravenous atropine to increase heart rate and compared the results to MTWA measurement by right atrial (RA) pacing during electrophysiologic (EP) study in 27 consecutive pts (53 ± 14 years; nine women). Determining the arrhythmia event-rate, a follow-up of 18 months was performed in all pts. Results:Using atropine, five pts (18%) did not reach the target heart rate (105 bpm). In the remaining group of pts, concordant results for MTWA assessment could be found in 21 pts (96%). Comparing MTWA positive tests there were slightly higher amplitudes using right atrial (RA) pacing than atropine (7.0 ± 2.3,V vs 6.3 ± 2.2,V, P = 0.03; r = 0.97). During follow-up all pts with a positive MTWA test had documented ventricular arrhythmias. There were no arrhythmic events in the MTWA negative group. Conclusion:Whenever target heart rate for MTWA evaluation is obtained by intravenous atropine, the results are comparable to RA pacing. In using atropine there has been observed no pharmacologically influenced increase of MTWA voltage leading to false positive MTWA results. Therefore the use of atropine can be recommended as a safe, non-invasive, and reliable method for MTWA assessment. [source] Mechanism of Atrial Flutter Occurring Late After Orthotopic Heart Transplantation with Atrio-atrial AnastomosisPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2005JOSEPH E. MARINE Objective: We sought to better define the electrophysiologic mechanism of atrial flutter in patients after heart transplantation. Background: Atrial flutter is a recognized problem in the postcardiac transplant population. The electrophysiologic basis of atrial flutter in this patient population is not completely understood. Methods: Six patients with cardiac allografts and symptoms related to recurrent atrial flutter underwent diagnostic electrophysiologic study with electroanatomic mapping and radiofrequency catheter ablation. Comparison was made with a control nontransplant population of 11 patients with typical counterclockwise right atrial flutter. Results: In each case, mapping showed typical counterclockwise activation of the donor-derived portion of the right atrium, with concealed entrainment shown upon pacing in the cavotricuspid isthmus (CTI). The anastomotic suture line of the atrio-atrial anastomosis formed the posterior barrier of the reentrant circuit. Ablation of the electrically active, donor-derived portion of the CTI was sufficient to terminate atrial flutter and render it noninducible. Comparison with the control population showed that the electrically active portion of the CTI was significantly shorter in patients with transplant-associated flutter and that ablation was accomplished with the same or fewer radiofrequency lesions. Conclusions: Atrial flutter in cardiac transplant recipients is a form of typical counterclockwise, isthmus-dependent flutter in which the atrio-atrial anastomotic suture line forms the posterior barrier of the reentrant circuit. Ablation in the donor-derived portion of the CTI is sufficient to create bidirectional conduction block and eliminate this arrhythmia. Ablation or surgical division of the donor CTI at the time of transplantation could prevent this arrhythmia. [source] Radiofrequency Catheter Ablation of an Incessant Ventricular Tachycardia Following Valve SurgeryPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2002THORSTEN LEWALTER LEWALTER, T., et al.: Radiofrequency Catheter Ablation of an Incessant Ventricular Tachycardia Following Valve Surgery. Sustained monomorphic ventricular tachycardia (VT) after valve surgery represents a clinical entity with different tachycardia mechanisms. This case report describes an incessant VT after tricuspid and aortic valve replacement that did not respond to antiarrhythmic drug treatment. The tachycardia exhibited VA block and a right bundle branch block pattern with left-axis deviation, suggesting ventricular excitation via the left posterior fascicle. The electrophysiological study was limited by the prosthetic tricuspid and aortic valve replacement, therefore a transseptal approach was necessary to obtain access to the ventricular myocardium. Radiofrequency catheter ablation was performed in the proximal left bundle or distal His region with termination of the incessant VT followed by complete AV block. After pacemaker implantation using a transvenous right atrial and an epicardial ventricular lead, no VT reoccurrence could be documented. [source] Transcatheter closure of coronary artery fistulae using the Amplatzer duct occluderCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2006Sarina K. Behera MD Abstract Objective: The aim of this study is to report our experience using the Amplatzer Duct Occluder (ADO) for occlusion of significant coronary artery fistulae (CAF). Background: Transcatheter closure of CAF with coils is well described. Use of newer devices may offer advantages such as improved control of device placement, use of a single instead of multiple devices, and high rates of occlusion. Methods: A retrospective review of all patients catheterized for CAF from July 2002 through August 2005 was performed. Results: Thirteen patients with CAF underwent cardiac catheterization, of which a total of 6 patients had ADO placement in CAF (age, 21 days to 56 years; median age, 4.3 years and weight, 3.8 kg to 74.6 kg; median weight, 13.3 kg). An arteriovenous wire loop was used to advance a long sheath antegrade to deploy the ADO in the CAF. Immediate and short-term outcomes (follow-up, 3 months to 14 months; median follow-up, 8.5 months) demonstrated complete CAF occlusion in 5 patients and minimal residual shunt in 1 patient (who had resolution of right atrial and right ventricular enlargement). On follow-up clinical evaluation, all 6 patients had absence of fistula-related murmurs, and 2 previously symptomatic patients had resolution of congestive heart failure symptoms. Early complications included transient palpitations and atrial arrhythmia in the 2 oldest patients (52 and 56 years old). Conclusions: Use of the ADO is applicable for transcatheter closure of significant CAF. Advantages of using the ADO include the antegrade approach, use of a single device, and effective CAF occlusion. © 2006 Wiley-Liss, Inc. [source] Magnetic Resonance Imaging of Carcinoid Heart DiseaseCLINICAL CARDIOLOGY, Issue 6 2009Damian Franzen In a 56-year-old lady, a carcinoid tumor of the terminal ileum metastasized to regional lymph nodes, and the liver was removed by hemicolectomy in 2002. Following a history of cutaneous flushing, diarrhea, and bronchoconstriction 3 years later, a somatostatin therapy was instituted. As flushing and diarrhea resolved and levels of urinary excretion of 5-hydoxyindoleacetic acid decreased, shortness of breath was progressive and prompted a cardiac exam. Despite poor resolution, echocardiography revealed a thickening of the tricuspid valves (TK) with reduced mobility along with right atrial (RA) and right ventricular (RV) dilatation. The pulmonary valve was unobtrusive. Magnetic resonance (MR) imaging revealed extensive fibrous tissue extending from the valvular base to the tip of the tricuspid leaflets. Retraction and immobilization of the TK caused a mild stenosis and a large regurgitant flow. Because medical treatment of tricuspid regurgitation was ineffective, the TK was excised and a Hancock 25-mm bioprosthetic valve was implanted. The postoperative course was uncomplicated, and the patient recuperated and resumed normal daily activities. Copyright © 2009 Wiley Periodicals, Inc. [source] | ||||||||||