scholarly journals Fiber-optic laser energy for pulmonary artery denervation: results of an experimental study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H I Condori Leandro ◽  
A Vakhrushev ◽  
N Goncharova ◽  
L Korobchenko ◽  
E Koshevaya ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
New Technologies ◽  
Laser Energy ◽  
Interventional Procedure ◽  
Femoral Vein ◽  
Nerve Damage ◽  
Laser Applications ◽  
Experimental Animals ◽  
Irrigation Flow ◽  
The Right

Abstract Background/Introduction Pulmonary artery denervation (PADN) is an interventional procedure aiming to modulate and correct pulmonary artery (PA) pressure. New technologies and energy sources are being tested currently. However, the effects of laser energy on the PA wall are unknown. Purpose To assess the acute effects and impact of laser energy for PADN procedure in normotensive sheep by applying different power settings and session times. Methods A total of 10 normotensive Katumsky sheep were included in the experiment. Percutaneous vascular access was performed under general anesthesia. A fiberoptic open-irrigated non-steerable catheter was introduced via a femoral vein through a steerable sheath. Laser applications were applied in the PA trunk and the proximal areas of the right and left PA under fluoroscopic guidance with a 5mm distance between points in the anterior, posterior and lateral walls. Applications were delivered with power 10–30W, 10–35s in duration; irrigation flow 40ml/min. After the procedure, experimental animals were euthanized and underwent an autopsy. PA samples were obtained regardless of the absence of visible laser-related lesions for histological analysis (hematoxylin staining) and immunohistochemical labelling (S100). Results A total of 108 ablation sessions were performed, 33 in the right PA, 30 in the left PA and 42 in the PA trunk. During macroscopic examination, laser-related lesions described as irregular brown hemorrhage spots and rough defects observed in the PA endothelium were not homogenous in all experimental animals. Thermal injuries either in the left or right lung lobes were identified in 5 (50%) experimental animals when using 30W during 10–20sec. In 5 (50%) sheep no collateral lung injuries were identified when using 10–20W from 20–35s. A total of 64 PA fragments underwent microscopic examination, acute thermal tissue lesions were observed in all experimental animals despite the absence of laser-related lesions in the PA endothelium; dissection, edema, disruption trough tunica layers, hemorrhage and necrosis at different depth walls. The most frequent nerve damage was obtained with 20W ablation: 5/8 PAs vs, 1/6 with 10–15W and 1/14 with 25–30W (P=0.01). At the same time, there was no difference in intima necrosis between the groups (1/6, 2/8 and 4/14 for 10–15, 20 and 25–30W groups, respectively). Conclusion(s) Percutaneous PA laser ablation is feasible, reduction of perivascular nerve expression is seen most frequently, when 20W/20–35 s ablation is performed. PA lesions may differ in depth and characteristics, and perivascular nerve damage might be seen in cases with preserved intima. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant of the Ministry of Science and Higher Education of the Russian Federation

scholarly journals Saddle pulmonary emboli: an unusual presentation

CJEM ◽  
2009 ◽  
Vol 11 (06) ◽  
pp. 558-559
Author(s):  
Truptesh H. Kothari ◽  
Shivangi Kothari ◽  
Mahima Pandey ◽  
Harshit Khara ◽  
Nishant Dhungel
Keyword(s):  
Pulmonary Artery ◽  
Troponin I ◽  
Femoral Vein ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Factor V Leiden ◽  
Superficial Femoral Vein ◽  
Presenting Symptoms ◽  
Coronary Syndrome ◽  
The Right

A 38-year-old man with a history of polyposis syndrome diagnosed 3 years previously, with poor compliance for follow-up, presented to the emergency department with symptoms of retrosternal chest pain associated with dizziness and shortness of breath. His blood pressure was 94/43 mm Hg, his pulse was 123 beats/min and he had an oxygen saturation of 84% on room air. The patient’s initial laboratory results showed a hemoglobin of 80 g/L and blood gas with a pH of 7.23. He had a normal chest radiograph and electrocardiogram, but had an elevated troponin I at 0.12 μg/L. He was given acetylsalicylic acid for suspicion of acute coronary syndrome. On physical examination, the patient was found to have right calf tenderness. With this finding and the presenting symptoms, he underwent computed tomography angiography (CTA) of the chest. The chest CTA showed a massive saddle embolus with a filling defect completely occluding the right pulmonary artery and extending through the main pulmonary artery segment to involve the left pulmonary artery. There were also diffuse filling defects involving bilateral pulmonary segmental arteries (Fig. 1 and Fig. 2). The patient received alteplase and underwent a workup for a hypercoagulable state. His workup revealed positive anticardiolipin antibodies and factor V Leiden. The Doppler ultrasound of his lower extremities showed an extensive thrombus measuring more than 6 cm extending in the right superficial femoral vein. The patient was then referred for placement of an inferior vena cava filter.

scholarly journals A Novel Two-Step Technique for Retrieving Fractured Peripherally Inserted Central Catheter Segments Migrating into the Heart or the Pulmonary Artery

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Juan Peng ◽  
Xiao-Ming Zhang ◽  
Lin Yang ◽  
Hao Xu ◽  
Nan-Dong Miao ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Interventional Procedure ◽  
Femoral Vein ◽  
Vena Cava ◽  
Percutaneous Technique ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Percutaneous Retrieval ◽  
Vein Access ◽  
Ewing’S Tumor

Objective. To report the experience of a percutaneous technique for retrieving fractured peripherally inserted central catheter (PICC) segments migrating into the heart or the pulmonary artery.Method. From April 2013 to July 2015, we performed percutaneous retrieval of fractured PICC segments migrating into the heart or the pulmonary artery in five cancer patients who had undergone chemotherapy via PICC. The fractures were diagnosed with chest plain radiography. The patients included three cases of breast cancer, one case of rectal cancer, and one case of lower limb Ewing’s tumor. The fractures were retained in the vessels of the patients for 1 to 3 days. All the fractures were retrieved by using a novel two-step technique in the digital subtraction angiography (DSA) suite. This two-step technique involves inserting a pigtail catheter to the heart or the pulmonary artery to grasp the fractured catheter fragment and bring it to the lower segment of the inferior vena cava, followed by grasping and removing the catheter fragment with a retrieval loop system of the vena cava filter retrieval set.Result. The fractured PICC segments were removed successfully in all five patients via unilateral (four patients) or bilateral (one patient) femoral vein access. No complications occurred during the interventional procedure.Conclusion. Percutaneous retrieval can be a safe, convenient, and minimally invasive method for the removal of fractured PICC segments. The technique reported in this paper will be applicable for the retrieval of fractured PICC segments and other catheter fragments migrating into the heart or the pulmonary artery.

Successful Retrieval of a Knotted Pulmonary Artery Catheter Trapped in the Right Ventricle Using a Dormier Basket

1997 ◽  
Vol 42 (6) ◽  
pp. 184-184 ◽  
Author(s):  
S. Hood ◽  
H.M. McAlpine ◽  
J. A. H. Davidson
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Artery Catheter ◽  
Tricuspid Valve ◽  
Right Atrium ◽  
Femoral Vein ◽  
Tricuspid Valve Annulus ◽  
Valve Annulus ◽  
Successful Retrieval ◽  
The Right

We report the case of a 71 year old patient in whom a pulmonary artery catheter (Swan Ganz) formed a knot which was fixed within the right ventricle in the region of the tricuspid valve annulus. The catheter was successfully dislodged to the right atrium, subsequently snared by a dormier basket advanced from the right femoral vein and retrieved by localised cut down of the femoral vein.

Acute effects of laser myocardial ablation in ex vivo and in vivo

2021 ◽  
Vol 28 (1) ◽  
pp. 47-54
Author(s):  
Н. I. Condori Leandro ◽  
A. D. Vakhrushev ◽  
L. E. Korobchenko ◽  
E. G. Koshevaya ◽  
L. B. Mitrofanova ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Right Ventricle ◽  
Right Atrium ◽  
Ex Vivo ◽  
Laser Applications ◽  
Lesion Depth ◽  
Experimental Animals ◽  
Lesion Diameter ◽  
The Right

Aim. To study and compare the lesions characteristics of laser energy in heart ex vivo and in experimental large animals.Materials and methods. For the ex vivo experiment a pig heart was obtained from a local slaughterhouse. Laser applications were applied using power 15-30 W in the left and right ventricles 5-50 seconds in duration. Immediately after ablation, examination was performed to determine myocardial damage characteristics at each point. In the experimental study, 7 sheep were included, laser applications were performed under fluoroscopic control in the right atrium with power 10, 15 and 20 W, 10-25 s; in the right ventricle 20, 25 and 30 W for 10-40 s; and in the left ventricle 20, 25 and 30 W for 20-40 s. The animals were euthanized and macroscopic examination of laser lesions was performed.Results. A total of 27 laser applications were performed on the heart ex vivo, all lesions were visualized as white spots on the endocardial surface. The maximum lesion depth was 9 mm achieved when using 20 W /50 s, the maximum lesion diameter was 6 mm, when using 25 W /40 s. The minimum lesion diameter and depth were observed when using 30 W /5 s, 2x1 mm. A total of 48 laser applications were performed in experimental animals, in one experimental animal was observed a transmural lesion in the right atrium when using 15 W /20 s. In 3 out of 7 experimental animals, transmural lesions were observed in the right ventricle when using 20 W /30 s; 20 W /40 s and 30 W /10 s. In the left ventricle, transmural lesions were observed in 2 animals, using 15 W /20 s and 20 W /40 s. In the ex vivo study, there was a strong positive correlation between ablation energy and lesion depth (R=0.91, P<0.05) and lesion volume (R=0.73, P<0.05); while there was no such statistical correlation in vivo.Conclusions. Laser ablation 15-20 W for 15-40 s seems to be optimal for achieving the deepest lesions in the atrium and ventricular myocardium. In our small pilot study with fiberoptic catheter ablation on a beating heart there was no correlation between energy delivered and the depth and volume of necrotic myocardium.

Effect of isotope infusion and sampling sites on glucose kinetics during a euglycemic clamp

1988 ◽  
Vol 255 (6) ◽  
pp. E871-E874
Author(s):  
F. Jahoor ◽  
S. Klein ◽  
H. Miyoshi ◽  
R. R. Wolfe
Keyword(s):  
Cardiac Output ◽  
Pulmonary Artery ◽  
Turnover Rate ◽  
Specific Activity ◽  
Femoral Vein ◽  
Sampling Site ◽  
Glucose Turnover ◽  
Glucose Kinetics ◽  
Euglycemic Clamp ◽  
The Right

The importance of the location of isotope infusion and blood sampling on calculating glucose kinetics was studied in five mongrel dogs in the basal state and when glucose turnover was increased during a hyperinsulinemic euglycemic clamp. [U-14C]glucose was infused into the pulmonary artery, unlabeled glucose was infused into a femoral vein to maintain euglycemia, and blood was sampled from the right atrium (AV mode) and the femoral artery (VA mode). In the basal state there was no difference between the AV or VA mode in plateau specific activity; hence, the calculated rate of appearance of glucose was the same with either mode. During the euglycemic clamp procedure, plateau specific activity of the AV mode was significantly lower than that of the VA mode (P less than 0.05). The rate of appearance of glucose calculated from the VA mode was almost identical to the rate of infusion of unlabeled glucose (13.0 +/- 1.4 vs. 12.6 +/- 1.4 mg.kg-1.min-1, respectively), but the rate of appearance of glucose calculated from the AV mode was 12% greater. This study demonstrates that the calculation of glucose kinetics is sensitive to differences in sampling site when the turnover rate is high relative to the mass flow rate (cardiac output times substrate concentration).

Construction and use of self-guiding, right heart and pulmonary artery catheter

1965 ◽  
Vol 20 (1) ◽  
pp. 148-149 ◽  
Author(s):  
William P. Fife ◽  
Bae Suk Lee
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pressure Transducer ◽  
Femoral Vein ◽  
Blood Sampling ◽  
Use Of Self ◽  
Pressure Monitoring ◽  
Right Heart ◽  
The Right ◽  
Wedge Pressure

A catheter has been developed which can be easily and rapidly implanted in the right heart or pulmonary artery. Fabricated from Tygon tubing, the catheter contains a thin section located 2 cm from the distal end. This results in a tip which follows the bloodstream without special manipulation. During implantation, its position is monitored by the use of a pressure transducer, thus eliminating the need for fluoroscopy. Since the catheter is self guiding, it may be implanted with ease from such distal locations as the femoral vein. It can be used to inject substances directly into the heart or pulmonary artery or to withdraw blood samples. It also can be used to make pressure recordings from these areas. cardiac catheter; pulmonary pressure monitoring; right atrium pressure monitoring; right ventricle pressure monitoring; pulmonary artery wedge pressure; blood sampling from pulmonary artery; blood sampling from right ventricle; infusion into right ventricle; infusion into pulmonary artery Submitted on February 10, 1964

scholarly journals An Ovine Model for Percutaneous Pulmonary Artery Laser Denervation: Perivascular Innervation and Ablation Lesion Characteristics

2021 ◽  
Vol 22 (16) ◽  
pp. 8788
Author(s):  
Heber Ivan Condori Leandro ◽  
Elena G. Koshevaya ◽  
Lubov B. Mitrofanova ◽  
Aleksandr D. Vakhrushev ◽  
Natalia S. Goncharova ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Laser Energy ◽  
Interventional Procedure ◽  
Organ Damage ◽  
Nerve Fibers ◽  
Ovine Model ◽  
Perivascular Adipose Tissue ◽  
The Media ◽  
Two Phases ◽  
Acute Changes

Background: Pulmonary artery denervation (PADN) is an evolving interventional procedure capable to reduce pulmonary artery (PA) pressure. We aimed to compare PA nerve distribution in different specimens and assess the feasibility of an ovine model for a denervation procedure and evaluate the acute changes induced by laser energy. Methods: The experiment was divided into two phases: (1) the analysis of PA nerve distribution in sheep, pigs, and humans using histological and immunochemical methods; (2) fiberoptic PADN in sheep and postmortem laser lesion characteristics. Results: PA nerve density and distribution in sheep differ from humans, although pigs and sheep share similar characteristics, nerve fibers are observed in the media layer, adventitia, and perivascular tissue in sheep. Necrosis of the intima and focal hemorrhages within the media, adventitia, and perivascular adipose tissue were evidenced post laser PADN. Among the identified lesions, 40% reached adventitia and could be classified as effective for PADN. The use of 20 W ablation energy was safer and 30 W-ablation led to collateral organ damage. Conclusions: An ovine model is suitable for PADN procedures; however, nerve distribution in the PA bifurcation and main branches differ from human PA innervation. Laser ablation can be safely used for PADN procedures.

Ligation of a Fistula between the Left Main Coronary Artery and Both the Pulmonary Artery and the Right Ventricle

2012 ◽  
Vol 15 (2) ◽  
pp. 119 ◽  
Author(s):  
I. Halil Algin ◽  
Aytekin Yesilay ◽  
N. Murat Akcar
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Left Main Coronary Artery ◽  
Coronary Artery Fistula ◽  
Left Main ◽  
Symptomatic Disease ◽  
Coronary Artery Fistulas ◽  
The Right

The frequency of coronary artery fistula among all coronary angiography patients is 0.1% to 0.2%; however, involvement of both the pulmonary artery and the right ventricle is a rare clinical entity. A 53-year-old man patient was admitted to our clinic with rarely occurring chest pain, palpitations, and dyspnea. A coronary angiogram showed a fistula between the left main coronary artery and both the pulmonary artery and the right ventricle. We performed a ligation of this fistula without cardiopulmonary bypass. Aorta and right ventricle sutures were made, and the proximal and distal portions of the fistula were obliterated with 5-0 Prolene sutures and previously prepared Teflon felt. The patient recovered and was discharged without any complications. The surgical indications for coronary artery fistulas are symptomatic disease, an aneurysmic coronary artery, signs of heart failure, and ischemia. The surgical options in such cases�depending on whether the fistula is complicated or not�are simple ligation or transarterial ligation under cardiopulmonary bypass.

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