Modified mini-maze via left thoracic cavity under VATS for paroxysmal atrial fibrillation in a patient with complete interruption of the inferior vena cava

Objectives: We sought to determine the technical feasibility of surgical bipolar radiofrequency ablation (endoscopic maze procedure) through the left chest cavity in patients with an interrupted inferior vena cava (IVC). Methods and Results: A 57-year-old female with paroxysmal atrial fibrillation (AF) and an interrupted IVC was referred to our hospital for radiofrequency ablation. Transseptal puncture and left atrium (LA) ablation failed through a standard IVC approach via the femoral vein due to intrahepatic interruption of IVC. We performed a modified surgical bipolar radiofrequency ablation (RF) on the beating heart through 3 ports in the left chest wall. Pulmonary vein isolation and ablation of the left atrium were achieved by bipolar radiofrequency ablation. Ganglionic plexus ablation was completed using the ablation pen. The left atrial appendage was excluded. No complications occurred during or after the procedure. The patient was discharged with sinus rhythm 3 days later after the procedure. She was taking amiodarone (100mg bid) within 6 months after the procedure, and had no recurrence of AF. Conclusions: We successfully performed a modified mini-maze procedure in a patient with paroxysmal AF and IVC interruption through the left thoracic cavity under video-assisted thoracoscopic surgery (VATS). We can successfully complete pulmonary vein (PV) isolation, left atrium box isolation, cardiac ganglia ablation, Marshall ligament ablation, and coronary sinus epicardium ablation using this technique.

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Modified Mini-Maze for Atrial Fibrillation with Interruption of Inferior Vena Cava

The Heart Surgery Forum ◽

10.1532/hsf.4163 ◽

2021 ◽

Vol 24 (6) ◽

pp. E1046-E1048

Author(s):

Bijun Xu ◽

Fan He ◽

Shiqiang Wang ◽

Huaidong Chen ◽

Weimin Zhang

Keyword(s):

Atrial Fibrillation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Inferior Vena ◽

Thoracoscopic Surgery ◽

Femoral Vein ◽

Vena Cava ◽

Maze Procedure ◽

Cardiac Ganglia ◽

Video Assisted Thoracoscopic Surgery

A 57-year-old female with paroxysmal atrial fibrillation and an interrupted inferior vena cava (IVC) was referred to our hospital for radiofrequency ablation. Transseptal puncture and left atrium ablation failed through a standard IVC approach via the femoral vein due to intrahepatic interruption of IVC. We performed a modified mini-maze procedure in this patient through the left thoracic cavity under video-assisted thoracoscopic surgery (VATS). We can successfully complete pulmonary vein (PV) isolation, left atrium box isolation, cardiac ganglia ablation, Marshall ligament ablation, and coronary sinus epicardium ablation using this technique.

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A case report of pulmonary vein isolation with radiofrequency catheter using superior vena cava approach in patient with paroxysmal atrial fibrillation and inferior vena cava filter

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa562 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Masatoshi Narikawa ◽

Masayoshi Kiyokuni ◽

Junya Hosoda ◽

Toshiyuki Ishikawa

Keyword(s):

Atrial Fibrillation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Inferior Vena ◽

Superior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Transseptal Puncture ◽

Mapping Catheter ◽

Steerable Sheath

Abstract Background Transseptal puncture and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are generally performed via the inferior vena cava (IVC). However, in cases where the IVC is inaccessible, a specific strategy may be needed. Case summary An 86-year-old woman with paroxysmal AF and an IVC filter in situ was referred to our hospital for ablation therapy. An IVC filter for pulmonary embolism and deep venous thrombosis had been implanted 15 years prior, therefore we selected a transoesophageal echocardiography (TOE)-guided transseptal puncture using a superior vena cava (SVC) approach. After the single transseptal puncture, we performed fast anatomical mapping, voltage mapping by multipolar mapping catheter, and then PVI by contact force-guided radiofrequency catheter using a steerable sheath. Following the ablation, bidirectional conduction block between the four pulmonary veins and the left atrium was confirmed by both radiofrequency and mapping catheter. No complications occurred and no recurrence of AF was documented in the 12 months after the procedure. Discussion When performing a transseptal puncture during AF ablation, an SVC approach, via access through the right internal jugular vein, enables the sheath to directly approach the left atrium without angulation and improves operability of the ablation catheter. Combining the use of general anaesthesia, TOE, a steerable sheath, and contact force-guided ablation may contribute to achieving minimally invasive PVI with a single transseptal puncture via an SVC approach.

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Paracardioscopy Provides Endoscopic Visualization of the Heart

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181b03b78 ◽

2009 ◽

Vol 4 (4) ◽

pp. 233-235 ◽

Cited By ~ 3

Author(s):

Andy C. Kiser

Keyword(s):

Atrial Fibrillation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Inferior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Right Atrial ◽

Cardiac Procedures ◽

Left And Right ◽

Right Atrial Appendage

Paracardioscopy provides totally endoscopic access to the heart via a transabdominal, transdiaphragmatic approach. Structures such as the pulmonary veins, inferior vena cava, left and right atrial appendage, and posterior left atrium can be visualized. Epicardial cardiac procedures, such as ablation procedures for atrial fibrillation, can be successfully performed using this development. This report describes paracardioscopy.

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Focal ablation for atrial fibrillation originating from the inferior vena cava and the posterior left atrium

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-006-9037-1 ◽

2006 ◽

Vol 16 (2) ◽

pp. 131-134 ◽

Cited By ~ 4

Author(s):

Masahiro Mizobuchi ◽

Yoshihisa Enjoji ◽

Kensaku Shibata ◽

Atsushi Funatsu ◽

Itaru Yokouchi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Inferior Vena ◽

Vena Cava ◽

Focal Ablation

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Response to flecainide infusion predicts long-term success of inferior vena cava-tricuspid annulus ablation in patients with atrial fibrillation

EP Europace ◽

10.1016/s1099-5129(01)80075-1 ◽

2001 ◽

Vol 2 ◽

pp. A7-A7

Keyword(s):

Atrial Fibrillation ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Tricuspid Annulus

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Combination of Superselective Arterial Embolization and Radiofrequency Ablation for the Treatment of a Giant Renal Angiomyolipoma Complicated with Caval Thrombus

Case Reports in Oncological Medicine ◽

10.1155/2016/8087232 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Konstantinos N. Stamatiou ◽

Hippocrates Moschouris ◽

Kiriaki Marmaridou ◽

Michail Kiltenis ◽

Konstantinos Kladis-Kalentzis ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Transarterial Embolization ◽

Vena Cava ◽

Arterial Embolization ◽

Maximum Diameter ◽

Renal Angiomyolipoma ◽

Efficient Treatment ◽

Extrinsic Compression

This is a case of a 78-year-old male patient with multiple angiomyolipomas of a solitary right kidney. The largest of these tumors (maximum diameter: 13.4 cm) caused significant extrinsic compression of the inferior vena cava complicated by thrombosis of this vessel. Treatment of thrombosis with anticoagulants had been ineffective and the patient had experienced a bleeding episode from the largest right renal angiomyolipoma, which had been treated by transarterial embolization in another institution, 4 months prior to our intervention. Our approach included superselective transarterial embolization of the dominant, right kidney angiomyolipoma with hydrogel microspheres, which was combined, 20 days later, with ultrasonographically guided radiofrequency ablation. Both interventions were uneventful. Computed tomography 2 months after ablation showed a 53% reduction in tumor volume, reduced space-occupying effect on inferior vena cava, and resolution of caval thrombus. Nine months after intervention the patient has had no recurrence of thrombosis or hemorrhage and no tumor regrowth has been observed. The combination of superselective transarterial embolization and radiofrequency ablation seems to be a feasible, safe, and efficient treatment of large renal angiomyolipomas.

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