Faculty Opinions recommendation of Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins.

The vein of Marshall (VOM) is an attractive target during ablation of atrial fibrillation due to its autonomic innervation and its location anterior to the left pulmonary veins and drainage in the coronary sinus. We studied 14 dogs. A coronary sinus venogram showed a VOM in 10, which was successfully cannulated with an angioplasty wire and a 2 mm balloon. In 5 dogs, electroanatomical (Carto) maps of the left atrium were performed at baseline and after ethanol (100%, 4 – 8 cc) was infused in the VOM, which demonstrated the creation of a new crescent-shaped scar in the left atrium, extending from the annular left atrium towards the posterior wall and left pulmonary veins. In 4 dogs, both cervical vagal trunks were isolated in the carotid sheath and cuff stimulation electrodes were attached to them. Effective refractory periods (ERP) were measured in 3 sites of the left atrium, before and after high-frequency bilateral vagal stimulation. The baseline ERP was 113.6±35.0 ms, and decreased to 82.2±25.4 ms (p<0.05) after vagal stimulation. After alcohol infusion in VOM, vagally-mediated ERP decrease was eliminated (from 108±27.2 ms to 95.6 ±16.7ms, p=NS). This elimination of vagal effects was not uniform and was limited in sites in proximity with the VOM (baseline ERP 105±18.7ms vs post vagal 98.±37.6ms, p=NS, as opposed to 106.7±27.1ms vs post vagal 73.3±19.7ms, p<0.05, in sites remote to VOM). We also tested feasibility of VOM alcohol infusion in humans: 2 patients undergoing pulmonary vein antral isolation had successful VOM cannulation: left atrial voltage maps demonstrated new scar involving the infero-posterior left atrial wall extending towards the left pulmonary veins. Retrograde alcohol infusion in the VOM achieves significant left atrial tissue ablation, abolishes local vagal responses and is feasible in humans.

Download Full-text

Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-008-9344-9 ◽

2009 ◽

Vol 25 (1) ◽

pp. 59-65 ◽

Cited By ~ 18

Author(s):

Yves Van Belle ◽

Paul Knops ◽

Petter Janse ◽

Maximo Rivero-Ayerza ◽

Emile Jessurun ◽

...

Keyword(s):

Left Atrium ◽

Pulmonary Veins ◽

Before And After

Download Full-text

Supracardiac Total Anomalous Pulmonary Venous Connection

KYAMC Journal ◽

10.3329/kyamcj.v10i2.42792 ◽

2019 ◽

Vol 10 (2) ◽

pp. 118-121

Author(s):

ASM Shariful Islam ◽

Md Lutfar Rahman ◽

Jayanta Kumar Saha ◽

Mohammad Arifur Rahman ◽

Mezanur Rahman ◽

...

Keyword(s):

Left Atrium ◽

Ductus Arteriosus ◽

Pulmonary Veins ◽

Hypertensive Crisis ◽

Right Heart Failure ◽

Residual Shunt ◽

Low Cardiac Output Syndrome ◽

Vertical Vein ◽

Autologous Pericardial Patch ◽

Anomalous Pulmonary Venous Connection

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease in which there is developmental absence of connection of all four pulmonary veins with the left atrium. To report a rare case and share our experience in surgery and post-operative management for supracardiac TAPVC. Patient with supracardiac TAPVC with atrial septal defect (ASD) secundum variety with rudimentary patent ductus arteriosus (PDA) underwent rechanneling of pulmonary veins to left atrium (LA) with gluteryldehye treated autologous pericardial patch closure of ASD with ligation of ascending vertical vein and ligation of rudimentary PDA.Post operatively there were no events of pulmonary hypertensive crisis, low cardiac output syndrome, right heart failure or conduction defect were observed and echocardiogram showed adequate pulmonary venous drainage with no residual shunt across the interatrial septum. Marked development in surgical results of TAPVC has been observed in recent years with declining mortality rate from 65% in early sixties to 5% in current surgical scenerio. KYAMC Journal Vol. 10, No.-2, July 2019, Page 118-121

Download Full-text

Anatomy of the Left Atrium and Pulmonary Veins – Lessons Learned from Novel Imaging Techniques

European Cardiology Review ◽

10.15420/ecr.2006.1.89 ◽

2006 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Josef Kautzner ◽

Hanka Micochova ◽

Petr Peichl ◽

◽

...

Keyword(s):

Left Atrium ◽

Imaging Techniques ◽

Pulmonary Veins ◽

Lessons Learned

Download Full-text

Anatomy of the Left Atrium and Pulmonary Veins – Lessons Learned from Novel Imaging Techniques

European Cardiology Review ◽

10.15420/ecr.2006.1.1f ◽

2006 ◽

Vol 2 (1) ◽

pp. 89 ◽

Cited By ~ 1

Author(s):

Josef Kautzner ◽

Hanka Micochova ◽

Petr Peichl ◽

◽

...

Keyword(s):

Left Atrium ◽

Imaging Techniques ◽

Pulmonary Veins ◽

Lessons Learned

Download Full-text

Fluid–structure interaction in a fully coupled three-dimensional mitral–atrium–pulmonary model

Biomechanics and Modeling in Mechanobiology ◽

10.1007/s10237-021-01444-6 ◽

2021 ◽

Author(s):

Liuyang Feng ◽

Hao Gao ◽

Nan Qi ◽

Mark Danton ◽

Nicholas A. Hill ◽

...

Keyword(s):

Mitral Valve ◽

Left Atrium ◽

Left Atrial ◽

Left Atrial Appendage ◽

Pulmonary Veins ◽

Three Dimensional ◽

Left Heart ◽

Structure Interaction ◽

Acute Mitral Regurgitation ◽

Reversal Flow

AbstractThis paper aims to investigate detailed mechanical interactions between the pulmonary haemodynamics and left heart function in pathophysiological situations (e.g. atrial fibrillation and acute mitral regurgitation). This is achieved by developing a complex computational framework for a coupled pulmonary circulation, left atrium and mitral valve model. The left atrium and mitral valve are modelled with physiologically realistic three-dimensional geometries, fibre-reinforced hyperelastic materials and fluid–structure interaction, and the pulmonary vessels are modelled as one-dimensional network ended with structured trees, with specified vessel geometries and wall material properties. This new coupled model reveals some interesting results which could be of diagnostic values. For example, the wave propagation through the pulmonary vasculature can lead to different arrival times for the second systolic flow wave (S2 wave) among the pulmonary veins, forming vortex rings inside the left atrium. In the case of acute mitral regurgitation, the left atrium experiences an increased energy dissipation and pressure elevation. The pulmonary veins can experience increased wave intensities, reversal flow during systole and increased early-diastolic flow wave (D wave), which in turn causes an additional flow wave across the mitral valve (L wave), as well as a reversal flow at the left atrial appendage orifice. In the case of atrial fibrillation, we show that the loss of active contraction is associated with a slower flow inside the left atrial appendage and disappearances of the late-diastole atrial reversal wave (AR wave) and the first systolic wave (S1 wave) in pulmonary veins. The haemodynamic changes along the pulmonary vessel trees on different scales from microscopic vessels to the main pulmonary artery can all be captured in this model. The work promises a potential in quantifying disease progression and medical treatments of various pulmonary diseases such as the pulmonary hypertension due to a left heart dysfunction.

Download Full-text

Metastatic renal cell carcinoma extending to the left atrium through the inferior pulmonary vein

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivab018 ◽

2021 ◽

Author(s):

Alan G Dawson ◽

Cathy J Richards ◽

Leonidas Hadjinikolaou ◽

Apostolos Nakas

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Left Atrium ◽

Pulmonary Vein ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Pulmonary Veins ◽

Lower Lobe ◽

Inferior Pulmonary Vein ◽

The Right

Abstract Metastatic renal cell carcinoma with involvement through the pulmonary veins to the left atrium is very rare. We report the case of a 70-year-old male with metastatic renal cell carcinoma to the right lower lobe of the lung abutting the inferior pulmonary vein with extension to the left atrium without pre-operative evidence. Surgical resection was achieved through a posterolateral thoracotomy. Lung masses that abut the pulmonary veins should prompt further investigation with a pre-operative transoesophageal echocardiogram to minimize unexpected intraoperative findings.

Download Full-text

P649 Before and after: sinus venosus atrial septal defect

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.331 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Marco Clement ◽

R Eiros ◽

R Dalmau ◽

T Lopez ◽

G Guzman ◽

...

Keyword(s):

Atrial Septal Defect ◽

Left Atrium ◽

Atrial Flutter ◽

Superior Vena Cava ◽

Right Atrium ◽

Septal Defect ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

The Right

Abstract Introduction The diagnosis of sinus venosus atrial septal defect (SVASD) is complex and requires special imaging. Surgery is the conventional treatment; however, transcatheter repair may become an attractive option. Case report A 60 year-old woman was admitted to the cardiology department with several episodes of paroxysmal atrial flutter, atrial fibrillation and atrioventricular nodal reentrant tachycardia. She reported a 10-year history of occasional palpitations which had not been studied. A transthoracic echocardiography revealed severe right ventricle dilatation and moderate dysfunction. Right volume overload appeared to be secondary to a superior SVASD with partial anomalous pulmonary venous drainage. A transesophageal echocardiography confirmed the diagnosis revealing a large SVASD of 16x12 mm (Figure A) with left-right shunt (Qp/Qs 2,2) and two right pulmonary veins draining into the right superior vena cava. Additionally, it demonstrated coronary sinus dilatation secondary to persistent left superior vena cava. CMR and cardiac CT showed right superior and middle pulmonary veins draining into the right superior vena cava 18 mm above the septal defect (Figures B and C). After discussion in clinical session, a percutaneous approach was planned to correct the septal defect and anomalous pulmonary drainage. For this purpose, anatomical data obtained from CMR and CT was needed to plan the procedure. During the intervention two stents graft were deployed in the right superior vena cava. The distal stent was flared at the septal defect level so as to occlude it while redirecting the anomalous pulmonary venous flow to the left atrium (Figure D). Control CT confirmed the complete occlusion of the SVASD without residual communication from pulmonary veins to the right superior vena cava or the right atrium (Figure E). Anomalous right superior and middle pulmonary veins drained into the left atrium below the stents. Transthoracic echocardiographies showed progressive reduction of right atrium and ventricle dilatation. The patient also underwent successful ablation of atrial flutter and intranodal tachycardia. She is currently asymptomatic, without dyspnea or arrhythmic recurrences. Conclusions In this case, multimodality imaging played a key role in every stage of the clinical process. First, it provided the diagnosis and enabled an accurate understanding of the patient’s anatomy, particularly of the anomalous pulmonary venous connections. Secondly, it allowed a transcatheter approach by supplying essential information to guide the procedure. Finally, it assessed the effectiveness of the intervention and the improvement in cardiac hemodynamics during follow-up. Abstract P649 Figure.

Download Full-text