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Ventricular Outflow Tract (ventricular + outflow_tract)
Kinds of Ventricular Outflow Tract Terms modified by Ventricular Outflow Tract Selected AbstractsSurgery for Ruptured Sinus of Valsalva Aneurysm into Right Ventricular Outflow Tract: Role of Intraoperative 2D and Real Time 3D Transesophageal EchocardiographyECHOCARDIOGRAPHY, Issue 7 2010Shrinivas Gadhinglajkar M.D. A major limitation of the 2D echocardiography during surgery for a complex cardiac lesion is its inability to provide an accurate spatial orientation of the structure. The real time 3D transesophageal echocardiography (RT-3D-TEE) technology available in Philips IE 33 ultrasound machine is relatively new to an operation suite. We evaluated its intraoperative utility in a patient, who was operated for repair of a ruptured sinus of Valsalva aneurysm (RSOVA) and closure of a supracristal ventricular septal defect. The VSD and RSOVA were visualized through different virtual windows in a more promising way on intraoperative RT-3D-TEE than on the 2D echocardiography. The acquired images could be virtually cropped and displayed in anatomical views to the operating surgeon for a clear orientation to the anatomy of the lesion. RT-3D-TEE is a potential intraoperative monitoring tool in surgeries for complex cardiac lesions. (Echocardiography 2010;27:E65-E69) [source] The Rupture of Periaortic Infective Aneurysm into the Left Atrium and the Left Ventricular Outflow Tract: Preoperative Diagnosis by Transthoracic EchocardiographyECHOCARDIOGRAPHY, Issue 3 2002Ewa Lastowiecka M.D. We present a rare complication of infective endocarditis, perforated periaortic abscess with fistulous communication between the aortic root, the left atrium, and the left ventricular outflow tract. Preoperative transthoracic echocardiographic diagnosis was confirmed intraoperatively. The patient was treated successfully by aortic homograft implantation. [source] Current Strategy of Repair of Tetralogy of Fallot in Children and Adults: Emphasis on a New Technique to Create a Monocusp-Patch for Reconstruction of the Right Ventricular Outflow TractJOURNAL OF CARDIAC SURGERY, Issue 6 2008D.Sc., Guo-Wei He M.D., Ph.D. Methods: From 2001 through 2005, 74 patients (50 male, 24 female; mean age of 13.6 ± 0.8 years, ranging from four to 34 years) with TOF (67) or double outlet RV (DORV)-type-TOF (seven) underwent complete repair. The resection of RVOT stenosis ± pulmonary valvotomy was principally through RA. A new two-patch technique to create a folded mono-cusp valve by using autologous pericardium was applied since August 2004. Results: The repair was through RA in 52 patients and through RA + RVOT/PA in 22 patients (18/4). TAPR was performed in 17 patients (23%, eight non-valved and nine valved). The aortic cross-clamp time was 130.1 ± 6.8 min in TAPR group and 85.8 ± 4.6 min in non-TAPR group (p < 0.0001). The operative mortality was 4.0% (3/74) in all and 2.9% (2/67) in TOF patients (due to low output, uncontrollable bleeding, and repeated bleeding from the pulmonary collateral vessels late) and was similar in TAPR or non-TAPR. The valved patch-repaired patients had mild PI and good RV function postoperatively up to eight to 12 months. Conclusions: Repair of TOF in older children/adults should include low rate of TAPR of RVOT. If indicated, the new folded monocusp-patch technique is recommended. It is an effective and simple way to markedly reduce postoperative PI with no additional cost. [source] A Case Report of Surgical Septal Myectomy of Hypertrophic Cardiomyopathy With Concomitant Left Ventricular Outflow Tract and Mid-Ventricular ObstructionsJOURNAL OF CARDIAC SURGERY, Issue 6 2006Dr W. Williams No abstract is available for this article. [source] Clinical Usefulness of a Multielectrode Basket Catheter for Idiopathic Ventricular Tachycardia Originating from Right Ventricular Outflow TractJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2001TAKESHI AIBA M.D. Basket Catheter in Idiopathic VT.Introduction: It often is difficult to determine the optimal ablation site for idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT) when the VT or premature ventricular complex (PVC) does not occur frequently. The aim of our study was to evaluate the usefulness of a multielectrode basket catheter for ablation of idiopathic VT originating from the RVOT. Methods and Results: Radiofrequency (RF) catheter ablation was performed using a 4-mm tip, quadripolar catheter in 50 consecutive patients with 81 VTs originating from the RVOT with (basket group = 25 patients with 45 VTs) or without (control group = 25 patients with 36 VTs) predeployment of a multielectrode basket catheter composed of 64 electrodes. Deployment of the multielectrode basket catheter was possible and safe in all 25 patients in the basket group. Ablation was successful in 25 (100%) of 25 patients in the basket group and in 22 (88%) of 25 patients in the control group. The total number of RF applications and the number of RF applications per PVC morphology did not differ between the two groups. However, both the fluoroscopic and ablation procedure times per PVC morphology were shorter in the basket group than in the control group (36.8 ± 14.1 min vs 52.0 ± 32.5 min, P = 0.04; 60.0 ± 14.6 vs 81.5 ± 51.2 min, P = 0.05). This difference was more pronounced in the 29 patients in whom VT or PVC was not frequently observed. Conclusion: The multielectrode basket catheter is safe and useful for determining the optimal ablation site in patients with idiopathic VT originating from the RVOT, especially in those without frequent VT or PVC. [source] Early Results of Balloon Dilatation of the Stenotic Bovine Jugular Vein Graft in the Right Ventricular Outflow Tract in ChildrenJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2008J. STEINBERG M.D. The aim of this study was to evaluate the early results of interventional balloon dilatation of stenotic bovine jugular vein (BJV) grafts implanted for reconstruction of the right ventricular outflow tract (RVOT) in children. Methods: From May 2001 to December 2005, 153 BJV grafts were implanted in children in our institution. An average of 16.9 (7.6,41.1) months after implantation, 17 balloon dilatations in a significant stenosis proximal (n = 1), distal anastomosis (n = 8), BJV valve (n = 3), or at multiple sites (n = 5) were performed in 15 children (male:female = 9:6) with a mean age of 3.9 (0.8,13.0) years. Balloon diameter was 75,133.3% (mean 100.3) of the original BJV size. Mean follow-up was 8.8 (2 days to 22.8 months) months. Results: In 10 interventions (58.8%) the instantaneous peak gradient was reduced below 50 mmHg. A balloon diameter ,100% of the original BJV size correlated significantly with a successful intervention. No major complications, two minor (nonobstructive floating membranes at the dilatation site and one septicemia) occurred afterward. Freedom from reintervention after 6 months was 58.2% for all, 77.8% for dilatations of the proximal anastomosis and mixed stenotic lesions, and 33.3% for the distal anastomosis. Conclusion: Balloon dilatation of stenotic BJV grafts is safe and can significantly reduce the pressure gradient in two-thirds of interventions. Balloon diameters above the original graft size should be aimed for. The most frequent stenosis of the distal anastomosis tends to renarrow early after dilatation. Nevertheless, balloon dilatation should be considered in nearly every stenotic graft to gain time until a surgical or interventional graft exchange. [source] Problems in the Canine Left Ventricular Outflow TractJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2001DACVIM, John D. Bonagura DVM No abstract is available for this article. [source] Compression of the Left Ventricular Outflow Tract During Cardiopulmonary ResuscitationACADEMIC EMERGENCY MEDICINE, Issue 10 2009Sung Oh Hwang MD Abstract Objectives:, This prospective observational study was performed to investigate if the hand position used for external chest compressions is in an optimal position for compressing the ventricles during standard cardiopulmonary resuscitation (CPR). Methods:, Transesophageal echocardiography (TEE) was performed during standard CPR in 34 patients with nontraumatic cardiac arrest (24 males, mean ± standard deviation [SD] age = 56 ± 12 years). On the recorded image of TEE, an area of maximal compression (AMC) was identified, and the degree of compression at the AMC and the left ventricular stroke volume was calculated. Results:, A significant narrowing of the left ventricular outflow tract (LVOT) or the aorta was noted in all patients, with the degree of compression at the AMC ranging from 19% to 83% (mean ± SD = 49 ± 19%). The AMC was found at the aorta in 20 patients (59%) and at the LVOT in 14 patients (41%). A significant narrowing of more than 50% of the diameter at the end of the relaxation phase occurred in 15 patients (44%). On linear regression, the left ventricular stroke volume was correlated with the location of the AMC (R2 = 0.165, p = 0.017). Conclusions:, The outflow of the left ventricle is affected during standard CPR, resulting in varying degrees of narrowing in the LVOT and/or the aortic root. [source] Frequent Premature Ventricular Complexes Originating from the Right Ventricular Outflow Tract Are Associated with Left Ventricular DysfunctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2008Yumiko Kanei M.D. Background: Recent case series have shown reversal of left ventricular (LV) dysfunction after catheter ablation of frequent premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT). We conducted a retrospective study to evaluate the prevalence of patients with frequent RVOT PVCs (,10 per hour) and LV dysfunction. Methods: RVOT PVC was defined as PVC with left bundle branch block morphology and inferior axis on a 12-lead ECG. We included patients with frequent RVOT PVCs on 24-hours Holter monitor who had a recent evaluation of LV function. Patients with structural heart disease, including obstructive coronary artery disease, were excluded. Patients were divided into three groups based on the number of PVCs (<1000/24 hour, 1000,10,000/24 hour, ,10,000/24 hour), and the prevalence of LV dysfunction was evaluated in each group. Results: Our analysis included 108 patients: 24 patients had <1000PVCs/24 hour, 55 patients had 1000,10,000PVCs/24 hour, and 29 patients had ,10,000PVCs/24 hour. The prevalence of LV dysfunction was 4%, 12%, and 34%, respectively (P = 0.02). With logistic regression analysis, non-sustained ventricular tachycardia was an independent predictor of LV dysfunction with odds ratio of 3.6 (1.3,10.1). Conclusion: We demonstrated a significant association between frequent RVOT PVCs and LV dysfunction in patients without structural heart disease. [source] Reconstruction of Right Ventricular Outflow Tract with Stentless Xenografts in Ross ProcedureARTIFICIAL ORGANS, Issue 12 2002Takuro Tsukube Abstract: To investigate whether the use of a stentless porcine aortic xenograft can be an alternative for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure, 9 patients underwent the Ross procedure and RVOT reconstruction with a stentless xenograft since January 2000. After the aortic valve was replaced with a pulmonary autograft, a stentless xenograft with a xeno- pericardial roll was implanted in the RVOT. One patient required subsequent aortic valve replacement because of severe regurgitation of the pulmonary autograft. All patients recovered well from the operation. The right ventricle-pulmonary arterial pressure gradient was 18 ± 7 mm Hg at discharge and was not significantly increased during the 2-year follow-up period. Although 1 patient died of ventricular arrhythmia 5 months after, his cardiac function was normal, and transpulmonary valve pressure was 19 mm Hg in the follow-up. The other 7 patients are currently in New York Heart Association functional Class I. Although long-term follow-up is required to explain the durability, the stentless xenograft with a pericardial roll is considered to be an alternative for reconstruction of the RVOT within 2 years after the Ross procedure. [source] Early and Midterm Results of an Alternative Procedure to Homografts in Primary Repair of Truncus Arteriosus CommunisCONGENITAL HEART DISEASE, Issue 3 2010Pedro Curi-Curi MD ABSTRACT Background., Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become a standard practice. We report our experience on primary repair of TAC with a bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early and midterm results. Methods., From January 2001 to December 2007, 15 patients with mean age 1.5 years (range 3 months to 8 years), underwent primary repair of simple TAC. Cases with cardiogenic shock, complex-associated cardiac lesions, or adverse anatomy of the truncal valve were excluded. The Collett and Edwards anatomical type classification of TAC was as follows: type I, 13 (87%); and type II, 2 (13%). Right ventricular outflow tract was reconstructed in all the cases with a bovine pericardial-valved woven Dacron conduit. Results., Overall mortality was 6.6% (1 death due to severe pulmonary hypertension). At a mean follow-up of 31 months (range 6,51), there were no deaths (5-year actuarial survival 93.4%). Out of the 14 midterm survivors, three developed stenosis of the pericardial-valved woven Dacron conduit, but only one underwent interventional procedure including percutaneous balloon dilation with stenting for associated left pulmonary artery hypoplasia. The rate of patients with no surgical or percutaneous reinterventions performed because of obstruction of the right ventricular outflow tract reconstruction in the midterm (5 years) was 86%. Conclusions., Truncus arteriosus communis repair with a bovine pericardial-valved woven Dacron conduit can be performed with a very low perioperative mortality and satisfactory midterm morbidity, favorably compared with that reported for the use of homografts. Interventional cardiac catheterization may delay the time of reoperation for inevitable conduit replacement due to stenosis. [source] Characterization of molecular markers to assess cardiac cushions formation in XenopusDEVELOPMENTAL DYNAMICS, Issue 12 2009Young-Hoon Lee Abstract The valves and septa of the mature heart are derived from the cardiac cushions, which develop from discrete swellings in two regions of developing heart tube: the atrioventricular (AV) canal and the ventricular outflow tract (OFT). In higher vertebrates, three distinct lineages contribute to the heart valves and septa, the endocardium, the myocardium, and the cardiac neural crest that will populate the cardiac jelly of the OFT. Very little is known about cardiac cushions development in amphibians. Here, we describe the expression of eight genes during key stages of cardiac cushion development in Xenopus. Among these genes, the Wnt antagonist Frzb1 and the transcription factors Xl-Fli, Sox8, Sox9, and Sox10 are differentially expressed in the mesenchyme of the OFT and AV cushions. These genes can be used in combination with lineage-tracing experiments to determine the embryonic origin of the cardiac cushions mesenchyme in Xenopus. Developmental Dynamics 238:3257,3265, 2009. © 2009 Wiley-Liss, Inc. [source] Severe Right Ventricular Outflow Obstruction by Right Sinus of Valsalva AneurysmECHOCARDIOGRAPHY, Issue 3 2010Anil Avci M.D. Aneurysms of the sinus of Valsalva are rarely diagnosed cardiac anomalies, occurring in 0.14%,0.96% of patients who have undergone open heart surgical procedures. The most common congenital anomalies accompanying sinus of Valsalva aneurysm (SVA) are ventricular septal defect, bicuspid aortic valve, atrial septal defect, and coarctation of aorta. We report a patient with an unruptured right SVA presenting with severe right ventricular outflow tract (RVOT) obstruction, and coexisting patent foramen ovale (PFO) with a right to left shunt. It could be assumed that the increase in right atrial pressure due to RVOT obstruction had led to a right to left shunt across the patent foramen ovale. (Echocardiography 2010;27:341-343) [source] Baseline Echocardiographic Predictors of Dynamic Intraventricular Obstruction of the Left Ventricle during Dobutamine Stress EchocardiogramECHOCARDIOGRAPHY, Issue 10 2009Edmundo Jose Nassri Cāmara M.D., Ph.D. Background: Intraventricular obstruction (IVO) during dobutamine stress echocardiogram (DSE) may be associated with or reproduce symptoms. Predictors of IVO are not well established. Methods: 149 patients were studied at rest and during DSE. The normal range of the left ventricular outflow tract (LVOT) velocities was investigated in 68 healthy patients. Results: 19 patients (13%) developed IVO (peak LVOT velocity > 271 cm/sec). A significant linear correlation was observed between peak LVOT velocity during DSE and the following rest parameters: LV end-diastolic dimension (r =,0.20, P = 0.018), LV end-systolic dimension (r =, 0.27, P = 0.001), relative wall thickness (r = 0.23, P = 0.006), shortening fraction (r = 0.24, P = 0.004), LVOT diameter (r =, 0.20, P = 0.023) and LVOT velocity (r = 0.29, P < 0.0001). Only relative wall thickness (P = 0.012) and LVOT diameter (P = 0.027) were independent predictors of IVO. As a dichotomous variable, a relative wall thickness ,0.44 was the only independent predictor of IVO (OR 5.7, 95% CI 1.6,20, P = 0.006), with sensitivity, specificity, negative predictive value, and positive predictive value of 77%, 62%, 95%, and 21%, respectively, and global accuracy of 63% (area under the ROC curve = 0.7). IVO was significantly associated with general cardiovascular symptoms (P = 0.0006) and with chest pain (P = 0.008). Conclusions: Relative wall thickness and LVOT diameter were independent predictors of obstruction. As a dichotomous variable, a relative wall thickness , 0.44 was the only independent predictor of dynamic IVO. [source] Prosthetic Valve Dysfunction Presenting as Intermittent Acute Aortic RegurgitationECHOCARDIOGRAPHY, Issue 8 2008Dali Fan M.D., Ph.D. We describe the case of a 43 year old man with a history of aortic stenosis, for which he had undergone aortic valve replacement in 1991 with a 25-mm Medtronic Hall prosthesis. He presented with several acute episodes of dyspnea and flash pulmonary edema. Transthoracic and transesophageal echocardiography performed to evaluate prosthetic valve function revealed evidence of "intermittent" episodes of AI, documented on color M-mode flow mapping to have a variable duration of diastolic flow (early vs. pandiastolic) across the left ventricular outflow tract and the pulse wave Doppler in the descending thoracic aorta showed similar variability in the duration of diastolic flow reversal. [source] Transesophageal and Transpharyngeal Ultrasound Demonstration of Reversed Diastolic Flow in Aortic Arch Branches and Neck Vessels in Severe Aortic RegurgitationECHOCARDIOGRAPHY, Issue 4 2004Deepak Khanna M.D. In the current study, we describe an adult patient with torrential aortic regurgitation due to an aortic dissection flap interfering with aortic cusp motion, in whom a transesophageal echocardiogram with the probe positioned in the upper esophagus and transpharyngeal ultrasound examination demonstrated prominent reversed flow throughout diastole in the left subclavian, left vertebral, left common carotid, and left internal carotid arteries. Another unique finding was the demonstration of aortic valve leaflets held in the fully opened position in diastole by the dissection flap as it prolapsed into the left ventricular outflow tract, dramatically documenting the mechanism of torrential aortic regurgitation in this patient. (ECHOCARDIOGRAPHY, Volume 21, May 2004) [source] 5 DIAGNOSTIC PITFALLS IN THE ECHOCARDIOGRAPHIC EVALUATION OF HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM) REFERRED FOR CATHETER INTERVENTIONAL THERAPYECHOCARDIOGRAPHY, Issue 1 2004G. Beer Introduction: Generally, the diagnosis of typical HOCM with subaortic obstruction and a dynamic pressure gradient across the left ventricular outflow tract is made by noninvasive diagnostic procedures with great certainty by employing transthoracic (TTE) and/or transoesophageal (TEE) echocardiography. However, in patients with asymmetric septal hypertrophy pitfalls in echocardiographic examination may arise from several additional diseases as described in casuistic reports. To date systematic investigations in patients referred for catheter interventional therapy of HOCM are lacking. Patients and Methods: Therefore we investigated for the first time in a systematic study 200 symptomatic patients. (180 consecutive and 20 nonconsecutive patients; functional class 3 or 4 according to NYHA) with HOCM who were referred for this new catheter interventional therapy. In all patients TTE, bicycle exercise Doppler echocardiography and multiplane TEE were performed. Results: In 4 of 180 consecutive patients. (2.2%) discrete subvalvular membranous aortic stenosis (DSAS) (3 female patients and 1 male patient; age 20 to 58 years; mean septal diameter 19 mm; Sam-like motion in all 4 patients) was made. In all cases the diagnosis could be confirmed by surgical treatment. TEE evaluation was of crucial importance with demonstration of a typical subvalvular membrane that was situated a few millimeters below the aortic valve. In all cases a typical asymmetric septal hypertrophy mimicking HOCM was seen. Additionally, in 2 patients there was a conincidence of severe symptomatic valvular aortic stenosis and HOCM and in 1 patient a tunnel type of subvalvular aortic stenosis was present. Conclusion: These results show the potential pitfalls in echocardiographic diagnosis of HOCM. Especially, the frequency of DSAS in symptomatic patients referred for HOCM is unexpectedly high (2.2%). Especially in patients in whom TTE is of insufficient quality, investigation employing multiplane TEE with careful evaluation of the small poststenotic subvalvular area in HOCM is of crucial importance. This is of special significance prior to catheter interventional therapy, because in these patients surgical treatment is mandatory. [source] The Rupture of Periaortic Infective Aneurysm into the Left Atrium and the Left Ventricular Outflow Tract: Preoperative Diagnosis by Transthoracic EchocardiographyECHOCARDIOGRAPHY, Issue 3 2002Ewa Lastowiecka M.D. We present a rare complication of infective endocarditis, perforated periaortic abscess with fistulous communication between the aortic root, the left atrium, and the left ventricular outflow tract. Preoperative transthoracic echocardiographic diagnosis was confirmed intraoperatively. The patient was treated successfully by aortic homograft implantation. [source] Critical Left Ventricular Outflow Tract Obstruction Due to Accessory Mitral Valve TissueECHOCARDIOGRAPHY, Issue 2 2000RAFFAELE CALABRO M.D. Left ventricular outflow tract (LVOT) obstruction due to anomalous tissue tag arising from the mitral valve is a rare congenital cardiac anomaly. It generally becomes symptomatic during the first decade of life as exercise intolerance, chest pain, or syncope at effort. To date, only a few cases of critical systemic obstruction due to isolated mitral valve anomaly in neonates have been reported. We report the case of a neonate who was a few hours old and was referred in severe clinical condition due to critical left ventricular outflow obstruction resulting from an anomalous tissue tag of mitral valve origin. [source] Normal embryonic development and cardiac morphogenesis in mice with Wnt1-Cre-mediated deletion of connexin43GENESIS: THE JOURNAL OF GENETICS AND DEVELOPMENT, Issue 6 2006M. Kretz Abstract Mice harboring a null mutation in the gap junction protein connexin43 (Cx43) die shortly after birth due to an obstruction of the right ventricular outflow tract of the heart. These hearts exhibit prominent pouches at the base of the pulmonary outlet, i.e., morphological abnormalities that were ascribed to Cx43-deficiency in neural crest cells. In order to examine the Cx43 expression pattern in neural crest cells and derived tissues and to test whether neural crest-specific deletion of Cx43 leads to the conotruncal defects seen in Cx43null mice, we ablated Cx43 using a Wnt1-Cre transgene. Deletion of Cx43 was complete and occurred in neural crest cells as well as in neural crest-derived tissues. Nevertheless, hearts of mice lacking Cx43 specifically in neural crest cells were indistinguishable from controls. Thus, the morphological heart abnormalities of Cx43 null mice are most likely not caused by lack of Cx43 in neural crest cells. genesis 44:269,276, 2006. © 2006 Wiley-Liss, Inc. [source] Temporary Epicardial Ventricular Stimulation in Patients with Atrial Fibrillation: Acute Effects of Ventricular Pacing Site on Bypass Graft FlowsJOURNAL OF CARDIAC SURGERY, Issue 4 2009Navid Madershahian M.D. This study aimed to evaluate the optimal epicardial ventricular pacing site in patients with AF following coronary artery bypass surgery (CABG). Methods: In 23 consecutive patients (mean age = 69.2 ± 1.9 years, gender = 62% male, ejection fraction [EF]= 50.4 ± 2.1%) monoventricular stimulations (VVI) were tested with a constant pacing rate of 100 bpm. The impact of ventricular pacing on bypass graft flow (transit-time flow probe) and pulsatility index (PI) were measured after lead placement on the mid paraseptal region of the right (RVPS) and the left (LVPS) ventricle, on the right inferior wall (RVIW), and on the right ventricular outflow tract (RVOT). In addition, hemodynamic parameters were measured. Patients served as their own control. Results: Comparison of all tested pacing locations revealed that RVOT stimulation provided the highest bypass grafts flows (59.9 ± 6.1 mL/min) and PI (2.2 ± 0.1) when compared with RVPS (51.3 ± 4.7 mL/min, PI = 2.6 ± 0.2), RVIW (54.0 ± 5.1 mL/m; PI = 2.4 ± 0.2), and LVPS (53.1 ± 4.5 mL/min; PI = 2.3 ± 0.1), respectively (p < 0.05). When analyzing patients according to their preoperative LV function (group I = EF > 50%; group II = EF < 50%), higher bypass graft flows were observed with RVOT pacing in patients with lower EF (p = n.s.). Conclusions: Temporary RVOT pacing facilitates optimal bypass graft flows when compared with other ventricular pacing sites and should be the preferred method of temporary pacing in cardiac surgery patients with AF. Especially in patients with low EF following CABG, RVOT pacing may improve myocardial oxygen conditions for the ischemic myocardium and enhance graft patency in the early postoperative period. [source] Total Autologous Ross Procedure in a Child With Aortic Root AbscessJOURNAL OF CARDIAC SURGERY, Issue 5 2006Yusuf Kenan Yalcinbas M.D. Methods: An 8-year-old girl was presented with dyspnea, high fever, and fatigue. She had stenotic bicuspid aortic valve with endocarditis and aortic root abscess. Ross procedure was performed with fresh autologous pericardial tube and pericardial monocusp valve. Right internal mammary artery to right coronary artery bypass was also done due to destructed right coronary artery ostium. Results: Four years after the operation she is in excellent clinical condition without medications. Echocardiography reveals mild autograft regurgitation and mildly stenotic right ventricular outflow tract. Conclusions: If homografts are not available, total reconstruction of RVOT with autologous fresh pericardium may offer reasonable early and mid-term results especially when active endocarditis and aortic root abscess is involved. [source] Repair of Complete Atrioventricular Septal Defect with Tetralogy of Fallot:JOURNAL OF CARDIAC SURGERY, Issue 2 2004Literature Review, Our Experience Materials and Methods: Between January 1990 and January 2002, 17 consecutive children with CAVSD-TOF underwent complete correction. Nine patients (53%) underwent previous palliation. Mean age at repair was 2.9 ± 1.9 years. Mean gradient across the right ventricular outflow tract was 63 ± 16 mmHg. All children underwent closure of septal defect with a one-patch technique, employing autologous pericardial patch. Maximal tissue was preserved for LAVV reconstruction by making these incisions along the RV aspect of the ventricular septal crest. LAVV annuloplasty was performed in 10 (59%) patients. Six patients (35%) required a transannular patch. Results: Three (17.6%) hospital deaths occurred in this series. Causes of death included progressive heart failure in two patients and multiple organ failure in the other patient. Two patients required mediastinal exploration due to significant bleeding. Dysrhythmias were identified in 4 of 11 patients undergoing a right ventriculotomy versus none of the patients undergoing a transatrial transpulmonary approach (p = ns). The mean intensive care unit stay was 3.2 ± 2.4 days. Two patients required late reoperation due to severe LAVV regurgitation at 8.5 and 21 months, respectively, after the intracardiac complete repair. The mean follow-up time was 36 ± 34 months. All patients survived and are in NYHA functional class I or II. The LAVV regurgitation grade at follow-up was significantly lower than soon after operation, 1.1 ± 0.4 versus 1.7 ± 0.5 (p = 0.002). At follow-up, the mean gradient across the right ventricular outflow tract was 17 ± 6 mmHg, significantly lower than preoperatively (p < 0.001). Conclusions: Complete repair in patients with CAVSD-TOF seems to offer acceptable early and mid-term outcome in terms of mortality, morbidity, and reoperation rate. Palliation prior to complete repair may be reserved in specific cases presenting small pulmonary arteries or severely cyanotic neonates. The RVOT should be managed in the same fashion as for isolated TOF; however, a transatrial transpulmonary approach is our approach of choice. (J Card Surg 2004;19:175-183) [source] Delayed Presentation of Injury to the Sinus of Valsalva with Aortic Regurgitation Resulting from Penetrating Cardiac WoundsJOURNAL OF CARDIAC SURGERY, Issue 3 2003Narutoshi Hibino M.D. An emergency operation was performed successfully to repair the penetrating cardiac injury of the right ventricular outflow tract without using cardiopulmonary bypass. Two years after the operation, he was complained of dyspnea and a continuous murmur was detected. Echocardiography and cardiac catheterization revealed aorto-right ventricular fistula in the sinus of valsalva with aortic regurgitation. In operation, the healed laceration of the right coronary cusp and the fistula between aorta and right ventricle were identified. The fistula was closed using a Dacron patch and the aortic valve was replaced with a mechanical valve. Long-term follow-up of penetrating thoracic injuries is important for detecting underlying intracardiac lesions. (J Card Surg 2003;18:236-239) [source] Long-Term Mechanical Consequences of Permanent Right Ventricular Pacing: Effect of Pacing SiteJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2010DARRYL P. LEONG M.B.B.S. Optimal Right Ventricular Pacing,Introduction: Long-term right ventricular apical (RVA) pacing has been associated with adverse effects on left ventricular systolic function; however, the comparative effects of right ventricular outflow tract (RVOT) pacing are unknown. Our aim was therefore to examine the long-term effects of septal RVOT versus RVA pacing on left ventricular and atrial structure and function. Methods: Fifty-eight patients who were prospectively randomized to long-term pacing either from the right ventricular apex or RVOT septum were studied echocardiographically. Left ventricular (LV) and atrial (LA) volumes were measured. LV 2D strain and tissue velocity images were analyzed to measure 18-segment time-to-peak longitudinal systolic strain and 12-segment time-to-peak systolic tissue velocity. Intra-LV synchrony was assessed by their respective standard deviations. Interventricular mechanical delay was measured as the difference in time-to-onset of systolic flow in the RVOT and LV outflow tract. Septal A' was measured using tissue velocity images. Results: Following 29 ± 10 months pacing, there was a significant difference in LV ejection fraction (P < 0.001), LV end-systolic volume (P = 0.007), and LA volume (P = 0.02) favoring the RVOT-paced group over the RVA-paced patients. RVA-pacing was associated with greater interventricular mechanical dyssynchrony and intra-LV dyssynchrony than RVOT-pacing. Septal A' was adversely affected by intra-LV dyssynchrony (P < 0.05). Conclusions: Long-term RVOT-pacing was associated with superior indices of LV structure and function compared with RVA-pacing, and was associated with less adverse LA remodeling. If pacing cannot be avoided, the RVOT septum may be the preferred site for right ventricular pacing. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1120-1126) [source] Successful Catheter Ablation of Two Types of Ventricular Tachycardias Triggered by Cardiac Resynchronization Therapy: A Case ReportJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2007PETR PEICHL M.D., Ph.D. We report a case of a patient with nonischemic dilated cardiomyopathy and implantable cardioverter-defibrillator, in whom an upgrade to biventricular pacing triggered multiple episodes of ventricular tachycardias (VTs) of two morphologies. First VT presented as repetitive nonsustained arrhythmia of the same morphology as isolated ectopic beats, suggesting its focal origin. Second VT was reentrant and was triggered by the former ectopy, leading to a therapy from the device. Electroanatomical mapping of the left ventricle revealed relatively small low voltage area in the left ventricular outflow tract and identified both an arrhythmogenic focus as well as critical isthmus for reentrant VT. Radiofrequency catheter ablation successfully abolished both VTs. After the procedure, biventricular pacing was continued without any recurrences during a period of 24 months. The report emphasizes the role of catheter ablation in management of VTs triggered by cardiac resynchronization therapy. [source] Successful Radiofrequency Catheter Ablation of Epicardial Left Ventricular Outflow Tract Tachycardia from the Anterior Interventricular Coronary VeinJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005YASUHIRO HIRASAWA M.D. We report a case of idiopathic left ventricular outflow tract (LVOT) tachycardia that was eliminated by a radiofrequency application from the anterior interventricular coronary vein (AIV). The ECG exhibited QRS complexes with an inferior axis and atypical left bundle branch block pattern with an early transition of the precordial R waves at V3. Several radiofrequency applications from the coronary cusps and endocardial LVOT were not effective. Radiofrequency applications in the AIV, where the activation preceded the onset of the QRS by 30 msec, successfully eliminated the tachycardia. The AIV may be an optional site for radiofrequency ablation of idiopathic epicardial LVOT tachycardia. [source] An Autopsy Case of Brugada Syndrome with Significant Lesions in the Sinus NodeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2005SHIN-ICHIRO MORIMOTO M.D. A 30-year-old man with Brugada syndrome died suddenly. The heart weighed 380 g. The left ventricular wall showed mild thickening, and marked fatty tissue deposition was noted in the right ventricular outflow tract. Neither ventricle was enlarged. Contraction band necrosis was diffuse in both ventricles. In the ventricles no cardiac muscle cell hypertrophy or atrophy, or significant interstitial fibrosis was observed. In the sinus node the number of nodal cells was reduced by half, with fatty tissue and fibrosis prominent. But no lesions were evident in the right bundle branch. [source] Reentrant Ventricular Tachycardia Originating from the Aortic Sinus Cusp:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2004A Case Report We report a case of idiopathic reentrant ventricular tachycardia (VT) originating from the left aortic sinus cusp. A prepotential preceding the QRS complex by 58 ms was recorded from the posterior right ventricular (RV) outflow tract. During VT entrainment observed by pacing from the midseptal RV, it initially was orthodromically captured with a long conduction time but then antidromically captured as the pacing cycle rate was increased. Pacing at that site failed to show concealed entrainment despite a postpacing interval similar to the VT cycle length. Radiofrequency catheter ablation abolished the VT in the left aortic sinus cusp where a prepotential preceding the QRS complex by 78 ms with a postpacing interval similar to the VT cycle length was recorded in addition to concealed entrainment. The findings suggest that, in this VT, a critical slow conduction zone is partially present extending from the left aortic sinus cusp to the posterior right ventricular outflow tract. The patient has remained free from VT recurrence after 5-month follow-up. [source] Endocardial Mapping of Right Ventricular Outflow Tract Tachycardia Using Noncontact Activation MappingJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2003Michael Ribbing M.D. Introduction: Activation mapping and pace mapping identify successful ablation sites for catheter ablation of right ventricular outflow tract (RVOT) tachycardia. These methods are limited in patients with nonsustained tachycardia or isolated ventricular ectopic beats. We investigated the feasibility of using noncontact mapping to guide the ablation of RVOT arrhythmias. Methods and Results: Nine patients with RVOT tachycardia and three patients with ectopic beats were studied using noncontact mapping. A multielectrode array catheter was introduced into the RVOT and tachycardia was analyzed using a virtual geometry. The earliest endocardial activation estimated by virtual electrograms was displayed on an isopotential color map and measured33 ± 13 msecbefore onset of QRS. Virtual unipolar electrograms at this site demonstrated QS morphology. Guided by a locator signal, ablation was performed with a mean of6.9 ± 2.2radiofrequency deliveries. Acute success was achieved in all patients. During follow-up, one patient had a recurrence of RVOT tachycardia. Compared with patients(n = 21)who underwent catheter ablation using a conventional approach, a higher success rate was achieved by noncontact mapping. Procedure time was significantly longer in the noncontact mapping group. Fluoroscopy time was not significantly different in the two groups. Conclusion: Noncontact mapping can be used as a reliable tool to identify the site of earliest endocardial activation and to guide the ablation procedure in patients with RVOT tachycardia and in patients with ectopic beats originating from the RVOT. (J Cardiovasc Electrophysiol, Vol. 14, pp. 602-608, June 2003) [source] | ||||||||||||||||||||||||||||