Antegrade Cardioplegia Decannulation Made Simple With the Cor-Knot System: Technique and Tips After 20 Consecutive and Controlled Patients

Closing the cardioplegia cannulation site can be challenging in minimally invasive video-assisted cardiac surgery. The Cor-Knot system is used to tie down valve sutures within the heart efficiently, although erosions to neighboring structures are reported. We hypothesized that a modification of the Cor-Knot system could enable safe hemostasis of the cardioplegia aortic root site and avoid erosions of the aorta or right atrium. This is a single-arm prospective study including 20 consecutive patients operated through a video-assisted method at our clinic between January 2019 and February 2019. At the end of the procedure, the suture was passed through a Cor-Knot device and crimped on a band of Teflon-felt. The two tips of the Teflon-felt toward the right atrium were put together and tightened with a 5/0 Prolene suture in order to protect the sharp ends of the device. Hemostasis was achieved using the technique in all 20 patients, with no requirement for further suture placement to ensure hemostasis of the cardioplegia cannulation site. The device was protected from the right atrial appendage and there was no bleeding. At 6-month follow-up, no patients required a reoperation for aortic or right atrial erosion. The Cor-Knot system was used off-label to close the cardioplegia cannulation site in minimally invasive surgery. This appears safe and effective in our initial 20-patient experience.

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Transthoracic Right Atrial Cannulation for Total Parenteral Nutrition — Case Report

Anaesthesia and Intensive Care ◽

10.1177/0310057x8100900109 ◽

1981 ◽

Vol 9 (1) ◽

pp. 53-57 ◽

Cited By ~ 9

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.

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Intravenous Leiomyomatosis of the Uterus: A Retrospective Single-Center Study in 14 Cases

BioMed Research International ◽

10.1155/2020/9758302 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Qingbo Su ◽

Xiquan Zhang ◽

Hui Zhang ◽

Yan Liu ◽

Zhaoru Dong ◽

...

Keyword(s):

Right Atrium ◽

Superior Vena ◽

Vena Cava ◽

Right Atrial ◽

Pelvic Cavity ◽

Intravenous Leiomyomatosis ◽

Abdominal Incision ◽

Imaging Results ◽

The Right

Purpose. This study aimed to retrospectively review the diagnosis and surgical treatment of uterine intravenous leiomyomatosis (IVL). Methods. The clinical data of 14 patients with uterine IVL admitted to our hospital between 2013 and 2018 were retrospectively analyzed, including their demographics, imaging results, surgical procedures, perioperative complications, and follow-up results. Results. The tumors were confined to the pelvic cavity in 7 patients, 1 into the inferior vena cava, 4 into the right atrium, and 2 into the pulmonary artery (including 1 into the superior vena cava). Only one case was misdiagnosed as right atrial myxoma before the operation, which was found during the surgery and was treated by staging surgery; all the other patients underwent one-stage surgical resection. Three patients underwent complete resection of the right atrial tumor through the abdominal incision, and one patient died of heart failure in the process of resection of heart tumor without abdominal surgery. During the 6–60 months of follow-up, 4 patients developed deep venous thrombosis of the lower extremity, and 1 patient developed ovarian vein thrombosis and pulmonary embolism. After anticoagulation treatment, the symptoms disappeared. One patient refused hysterectomy and the uterine fibroids recurred 4 years after the operation. Conclusion. Specific surgical plans for uterine IVL can be formulated according to cardiac ultrasound and computed tomography (CT). For the first type of tumor involving the right atrium, the right atrium tumor can be completely removed through the abdominal incision alone to avoid thoracotomy. The disease is at high risk of thrombosis and perioperative routine anticoagulation is required.

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

2017 Design of Medical Devices Conference ◽

10.1115/dmd2017-3491 ◽

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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A simple method for eliminating strain on aortocoronary saphenous vein bypass grafts: The suspension of the right atrial appendage and plication of the right atrium

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2012.134 ◽

2012 ◽

Vol 20 (3) ◽

pp. 669-671

Author(s):

Denyan Mansuroğlu

Keyword(s):

Saphenous Vein ◽

Right Atrium ◽

Atrial Appendage ◽

Right Atrial ◽

Bypass Grafts ◽

Simple Method ◽

Saphenous Vein Bypass ◽

Vein Bypass ◽

Right Atrial Appendage ◽

The Right

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Right Atrial Thrombosis in the Fetus with Dilatation of the Right Atrium with in Utero Spontaneous Resolution - A Case Report with Neonatal Follow-Up

Prenatal Cardiology ◽

10.1515/pcard-2015-0004 ◽

2015 ◽

Vol 5 (4) ◽

pp. 26-33

Author(s):

Joanna Płużańska ◽

Kinga Jaguszewska ◽

Jolanta Binikowska ◽

Adam Oleś ◽

Maciej Łukaszewski ◽

...

Keyword(s):

Case Report ◽

Treatment Strategy ◽

Right Atrium ◽

In Utero ◽

Spontaneous Resolution ◽

Right Atrial ◽

Cardiac Malformation ◽

The Right ◽

Optimal Treatment Strategy

Abstract We present an extraordinary case of congenital enlargement of the right atrium diagnosed at 31 weeks of gestation. This case emphasizes the fact that timing of the detection of this particular cardiac malformation is of capital importance to tract the optimal treatment strategy in order to monitor further progression (in this case accompanying thrombosis) and prevent complications.

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Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures

Diagnostics ◽

10.3390/diagnostics11060960 ◽

2021 ◽

Vol 11 (6) ◽

pp. 960

Author(s):

Jakub Hołda ◽

Katarzyna Słodowska ◽

Karolina Malinowska ◽

Marcin Strona ◽

Małgorzata Mazur ◽

...

Keyword(s):

Right Atrium ◽

Variable Structure ◽

Atrial Appendage ◽

Right Atrial ◽

Variable Component ◽

Atrioventricular Valve ◽

Stable Point ◽

Complex Anatomy ◽

Right Atrial Appendage ◽

The Right

The right atrioventricular valve (RAV) is an important anatomical structure that prevents blood backflow from the right ventricle to the right atrium. The complex anatomy of the RAV has lowered the success rate of surgical and transcatheter procedures performed within the area. The aim of this study was to describe the morphology of the RAV and determine its spatial position in relation to selected structures of the right atrium. We examined 200 randomly selected human adult hearts. All leaflets and commissures were identified and measured. The position of the RAV was defined. Notably, 3-leaflet configurations were present in 67.0% of cases, whereas 4-leaflet configurations were present in 33.0%. Septal and mural leaflets were both significantly shorter and higher in 4-leaflet than in 3-leaflet RAVs. Significant domination of the muro-septal commissure in 3-leflet valves was noted. The supero-septal commissure was the most stable point within RAV circumference. In 3-leaflet valves, the muro-septal commissure was placed within the cavo-tricuspid isthmus area in 52.2% of cases, followed by the right atrial appendage vestibule region (20.9%). In 4-leaflet RAVs, the infero-septal commissure was located predominantly in the cavo-tricuspid isthmus area and infero-mural commissure was always located within the right atrial appendage vestibule region. The RAV is a highly variable structure. The supero-septal part of the RAV is the least variable component, whereas the infero-mural is the most variable. The number of detected RAV leaflets significantly influences the relative position of individual valve components in relation to right atrial structures.

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Early Results of the Modified Right Atrial Lesion Set for the Cox-Cryomaze Procedure

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000311 ◽

2016 ◽

Vol 11 (5) ◽

pp. 342-348 ◽

Cited By ~ 1

Author(s):

Faisal Habib Cheema ◽

Muhammad Amir Younus ◽

Osama T. Siddiqui ◽

Muhammad Jabran Younus ◽

Muhammad Arif Mahmood ◽

...

Keyword(s):

Superior Vena ◽

Vena Cava ◽

Right Atrial ◽

Tricuspid Annulus ◽

Lesion Pattern ◽

Early Results ◽

Right Atrial Appendage ◽

The Right ◽

Alternative Set

Objective The standard right atrial lesion (RAL) set, as originally outlined in the Cox-Maze III procedure, can be technically challenging when using a cryoprobe to create the lesions. We report our initial experience with an alternative set of RALs for the surgical treatment of atrial fibrillation (AF). Methods Between September 2011 and January 2015, a total of 112 patients underwent a CryoMaze procedure with biatrial lesions using argon-based cryoablation (cryoprobe temperature, −160°C). Although the standard left atrial lesion set was used, the RAL pattern was modified in this cohort of patients. The intracaval superior vena cava-inferior vena cava lesion was performed as in the pattern described for the standard Cox-Maze III procedure. In addition, a horizontal atriotomy incision (the “T” lesion) in the mid free wall of the right atrium was based roughly in the midintercaval line and extended medially as a linear cryolesion to the lateral tricuspid annulus at the so-called 2-o'clock position as in the Cox-Maze III lesion pattern. Ordinarily, a linear cryolesion would be placed from the tip of the right atrial appendage (RAA) to the anterior tricuspid annulus at the so-called 10-o'clock position to prevent macro re-entry around the base of the RA appendage. Our modification consisted of, instead, a linear cryolesion directed perpendicularly from the mid portion of the atriotomy (T lesion) to the tip of the RA appendage, which simply interrupted RAA re-entry at another point. Results The mean ± standard deviation age was 72.7 ± 10.6 years, 56.3% were males, and 63.1% had long-standing persistent AF. There were three operative deaths (2.6% with an observed over expected of 0.58), all in the concomitant procedures with associated cardiac disease. Overall follow-up was 91.3%. Freedom from AF at discharge, 1-, 3-, 6-, 12-, 24-month, and last follow-up [16.1 ±11.3 months (range, 0.4–43 months)], was 100%, 76.3%, 84.2%, 98.3%, 89.5%, 89.2%, and 90.5%, respectively. Similarly, freedom from antiarrhythmic drugs was 74% and 81%, whereas freedom from anticoagulants was 72% and 78% at 12 and 24 months, respectively. Conclusions These results suggest the modified RAL set to be an effective alternative to the traditional RALs of Cox-Maze III. By substituting this lateral RAA lesion for the more technically difficult medial lesion, the procedure becomes easier to perform and favorably impacts operative time while achieving comparable results in reducing AF burden.

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Sensing and pacing with floating electrodes in the right atrium and right atrial appendage

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(87)80380-7 ◽

1987 ◽

Vol 9 (2) ◽

pp. 308-315 ◽

Cited By ~ 7

Author(s):

André E. Aubert ◽

Bruce N. Goldreyer ◽

Milford G. Wyman ◽

Hugo Ector ◽

Bart G. Denys ◽

...

Keyword(s):

Right Atrium ◽

Atrial Appendage ◽

Right Atrial ◽

Right Atrial Appendage ◽

The Right

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Prominent Eustachian Valve Mimicking Thrombus in Right Atrium Diagnosed with Computed Tomography in a Patient with Atrial Fibrillation

Radiology and Medical Diagnostic Imaging ◽

10.31487/j.rdi.2020.02.02 ◽

2020 ◽

pp. 1-2

Author(s):

Ibrahim SARI ◽

Gülsüm Bingöl ◽

Ibrahim SARI ◽

Muharrem Nasıfov ◽

Özge Özden Tok ◽

...

Keyword(s):

Atrial Fibrillation ◽

Right Atrium ◽

Left Atrial Appendage ◽

Thrombus Formation ◽

Correct Diagnosis ◽

Atrial Appendage ◽

Right Atrial ◽

Eustachian Valve ◽

Right Atrial Appendage ◽

The Right

A 51-year-old man presented with paroxsysmal atrial fibrillation (AF). Transthoracic echocardiography revealed mass of 2.3x0.6 cm adjacent to the superior part of the right atrium (RA) compatible with thrombus. Although thrombus formation in the setting of AF is more common in left atrial appendage and left atrium it can also be seen in right atrial appendage and RA. We performed cardiac computerized tomography (CCT) in order to clarify the nature of mass in RA and exclude coronary stenosis. CCT showed prominent eustachian valve measuring 3.2 cm which was not clear on echocardiography. This case underscores the importance of complementary cardiovascular imaging to facilitate the correct diagnosis.

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