Aortic Dissection Type a after Right Atrial Cryoablation during Port Access Mitral Valve Surgery

2012 ◽  
Vol 7 (5) ◽  
pp. 376-378
Author(s):  
Tatjana Fleck ◽  
Martin Dworschak ◽  
Wilfried Wisser
Keyword(s):  
Multiorgan Failure ◽  
Mitral Valve Surgery ◽  
Minimal Invasive ◽  
Ascending Aorta ◽  
Maze Procedure ◽  
Right Atrial ◽  
Tricuspid Valve Repair ◽  
Port Access ◽  
Right Atrial Appendage ◽  
The Right

The case of a 63-year-old woman who underwent minimal invasive mitral and tricuspid valve repair and a concomitant CryoMaze is described. During creation of the last lesion of the right-sided maze procedure, dissection of the ascending aorta occurred that necessitated emergency sternotomy, replacement of the ascending aorta, and aortocoronary bypass grafting to the right coronary artery (RCA) because of detachment of the RCA from the aortic annulus. Repair of this complication was successful; nevertheless, the patient died 5 days after the operation because of multiorgan failure. The cause of this complication can only be speculated, but a relation to the CyroMaze is obvious. Because of the restricted incision with impaired vision especially in the area of the right atrial appendage, the cryoprobe could have come into contact with the orifice of the RCA during the last lesion, with subsequent detachment of the RCA from the aorta, which could subsequently have caused dissection.

Abstract 15570: Direct Evidence of Endo-Epicardial Dissociation of the Atrial Wall in Patients With Longstanding Persistent Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Natasja de Groot ◽  
Lisette vd Does ◽  
Ameeta Yaksh ◽  
Paul Knops ◽  
Pieter Woestijne ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Direct Evidence ◽  
Persistent Atrial Fibrillation ◽  
Right Atrial ◽  
Electrode Arrays ◽  
Atrial Wall ◽  
Ablative Therapies ◽  
Epicardial Layer ◽  
Right Atrial Appendage ◽  
The Right

Introduction: Transition of paroxysmal to longstanding persistent atrial fibrillation (LsPAF) is associated with progressive longitudinal dissociation in conduction and a higher incidence of focal fibrillation waves. The aim of this study was to provide direct evidence that the substrate of LsPAF consists of an electrical double-layer of dissociated waves, and that focal fibrillation waves are caused by endo-epicardial breakthrough. Hypothesis: LsPAF in humans is caused by electrical dissociation of the endo- and epicardial layer. Methods: Intra-operative mapping of the endo- and epicardial right atrial wall was performed in 9 patients with induced (N=4), paroxysmal (N=1), persistent (N=2) or longstanding-persistent AF (N=2). A clamp of two rectangular electrode-arrays (128 electrodes; inter-electrode distance 2mm) was introduced through an incision in the right atrial appendage. Series of 10 seconds of AF were analyzed and the incidence of endo-epicardial dissociation (≥15ms) was determined for all 128 endo-epicardial recording sites. Results: In patients with LsPAF the averaged degree of endo-epicardial dissociation was highest (24.9% vs. 5.9%). Using strict criteria for breakthrough (presence of an opposite wave within 4mm and <15ms before the origin of the focal wave), the far majority (77%) of all focal fibrillation waves could be attributed to endo-epicardial excitation. Conclusions: During LsPAF considerable differences in activation of the right endo- and epicardial wall exist. Endo-epicardial fibrillation waves that are out of phase, may conduct transmurally and create breakthrough waves in the opposite layer. This may explain the high persistence of AF and the low succes rate of ablative therapies in patients with LsPAF.

scholarly journals Transthoracic Right Atrial Cannulation for Total Parenteral Nutrition — Case Report

1981 ◽  
Vol 9 (1) ◽  
pp. 53-57 ◽  
Author(s):  
L. Hayden ◽  
G. Ramsey Stewart ◽  
D. C. Johnson ◽  
M. McD. Fisher
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Right Atrium ◽  
Venous Catheter ◽  
Right Atrial ◽  
X Ray ◽  
Right Thoracotomy ◽  
Right Atrial Appendage ◽  
The Right ◽  
Nutrition Programme

A man with severe peripheral vascular disease and requiring total parenteral nutrition because of short bowel syndrome was referred because a central venous catheter could not be inserted by conventional techniques. A right thoracotomy was performed and a Hickman catheter inserted via the right atrial appendage into the right atrium. This catheter was used for a total of seven months for total parenteral nutrition. For the last two months of this time, the patient was maintained at home on a Home Parenteral Nutrition Programme. After four months of total parenteral nutrition the patient developed recurrent fevers and the catheter was found to have migrated from the right atrium into the pulmonary artery. The catheter was resited under x-ray control and used for a further three months until the recurrence of fever and dyspnoea heralded the onset of septic pulmonary emboli resulting in his death.

scholarly journals A case of restrictive cardiomyopathy complicated by recurrent pulmonary thromboembolism originating at the right atrial appendage

2020 ◽  
Vol 21 (6) ◽  
pp. 220-223
Author(s):  
Hiroaki Yamamoto ◽  
Chieko Itamoto ◽  
Minato Hayashi ◽  
Tsunesuke Kohno ◽  
Yu Matsumura ◽  
...  
Keyword(s):  
Pulmonary Thromboembolism ◽  
Restrictive Cardiomyopathy ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Right Atrial Appendage ◽  
The Right

Expression of Follistatin-Like 3 is not Altered in the Right Atrial Appendage in Patients with Myocardial Infarction

2018 ◽  
Vol 27 ◽  
pp. S317
Author(s):  
M. Morten ◽  
T. Senanayake ◽  
L. Butel-Simões ◽  
N. Mabotuwana ◽  
A. Boyle ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Right Atrial Appendage ◽  
The Right

Right atrial appendectomy reduces the renal response to acute hypervolemia in the rat

1984 ◽  
Vol 247 (3) ◽  
pp. R610-R613 ◽  
Author(s):  
A. T. Veress ◽  
H. Sonnenberg
Keyword(s):  
Atrial Natriuretic Factor ◽  
Control Period ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Blood Flows ◽  
Natriuretic Factor ◽  
Right Atrial Appendage ◽  
The Right ◽  
Experimental Group ◽  
Atrial Natriuretic

We have shown previously that an extract of atrial tissue from rat heart contains a potent natriuretic factor. In this study anesthetized rats were connected to a respirator and the right atrial appendage was either excised, using a loop ligature (experimental group), or the loop was placed around the appendage and then removed (sham-operated group). After equilibration and control urine collection periods an isooncotic Ringers-albumin solution was infused intravenously (25% of estimated blood volume), and renal function was monitored over the next hour. There were no differences between groups in control period arterial or central venous pressures, heart rates, cardiac outputs, renal blood flows, or filtration rates. However, the diuretic and natriuretic responses to infusion in the experimental group were only one half of those in the sham-operated series (vol = 23.4 +/- 6.2 vs. 68.2 +/- 11.0 microliter X min-1 X g kidney wt-1, UNa V = 2,731 +/- 856 vs. 6,504 +/- 962 nmol X min-1 X g kidney wt-1). These differences were not affected by prior bilateral vagotomy. Administration of homologous atrial natriuretic factor or furosemide resulted in identical renal responses in both groups. We conclude therefore that acute hypervolemia is associated with release of atrial natriuretic factor into the bloodstream and that removal of the atrial appendage reduces the amount available for such release.

Assessing the Relationship Between Right Atrial Stiffness and Chamber Pressure to Quantitatively Define Myocardial Tensile Properties

2017 ◽  
Author(s):  
Alexander R. Mattson ◽  
Michael D. Eggen ◽  
Vladimir Grubac ◽  
Paul A. Iaizzo
Keyword(s):  
Right Atrium ◽  
Right Atrial ◽  
Chamber Pressure ◽  
Detailed Knowledge ◽  
Cardiac Device ◽  
Clinical Procedures ◽  
Tensile Forces ◽  
Pacemaker Leads ◽  
Right Atrial Appendage ◽  
The Right

Developing a successful cardiac device requires detailed knowledge of cardiac mechanical properties. For example, tissue failure characteristics and compliance feed into design criteria for many pacemaker leads (Zhao et al., 2011). In the right atrium, tensile forces are exerted on the right atrial appendage in multiple clinical procedures. In a traditional lead implant, mechanical manipulations with a stylet aid a clinician in assessing lead fixation, with a seldom used “tug” test providing additional input. Atrial lead dislodgement remains one of the top complications for bradycardia pacing leads (Chahuan et al., 1994), in part because there is no standard mechanical assessment at implant to verify fixation. Thus, a deeper understanding of forces exerted on the atrium during implant, is fundamental to understanding the problem. Further characterization of the biomechanics relevant to atrial device implants will provide valuable design input for fixation tests and help drive research toward new atrial fixation mechanisms. This study aims to better define the relationships between right atrial stiffness and the chamber pressures within the right atrium, so to characterize the link between tensile displacement within the right atrium, and the force exerted on an implanted device in a functional heart. These experiments quantitatively define the fixation force of a fixed cardiac device with a given pulled displacement; i.e. displacing the device a given distance will effectively ensure the experimentally derived fixation force.

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