inferior pulmonary vein
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2021 ◽  

This video tutorial describes a left lower lobectomy performed by the uniportal approach. A single 2-cm incision in the lateral chest wall is used as the utility port. The procedure begins with division of the inferior pulmonary ligament and isolation of the inferior pulmonary vein. This patient has densely adherent interlobar nodes, which are then dissected to demonstrate the interlobar pulmonary artery. Then we proceed to divide the anterior part of the fissure after identifying and safeguarding the lingular branches of the pulmonary artery. This step is followed by the division of the posterior part of the fissure after identification of the posterior branches of the pulmonary artery to the upper lobe. Then we identify the basilar trunk and divide it using endostaplers. Other branches of the interlobar artery are clearly identified, and the apicobasal artery is taken separately. This is followed by division of the inferior pulmonary vein and a systematic mediastinal nodal dissection.


Author(s):  
Enida Rexha ◽  
Christian Heeger ◽  
Sabrina Maack ◽  
Laura Rottner ◽  
Peter Wohlmuth ◽  
...  

Background: Cryoballoon (CB) based pulmonary vein isolation (PVI) has proven to be as effective as radiofrequency (RF) based ablation. Different ablation protocols took the individual time-to-isolation (TTI) into account aiming at shorter but equally or even more effective freeze-cycles. The current study sought to assess the impact of the TTI on PVI durability in patients undergoing a repeat procedure for recurrence of atrial tachyarrhythmia (ATA). Methods and Results: In 205 patients with ATA recurrence after previous CB-based PVI a total of 806 PVs were identified. One hundred-twenty-six out of 806 PVs (16%) were previously treated with a TTI guided ablation (protocol #1; TTI+120 sec.), in 92/806 (11%) PVs TTI was only monitored (m) but fixed freeze-cycles were applied (protocol #2; mTTI) and in 588/806 (73%) a fixed freeze-cycle was applied without TTI-monitoring. There was no difference in the PV-reconduction rate between the groups (P=0.23). The right inferior pulmonary vein (RIPV) showed overall significantly higher reconduction rates compared to the other PVs (RIPV – left inferior PV (LIPV) p<0.003, -left superior PV (LSPV) p<0.001, - right superior PV RSPV p<0.013). In 21 patients (10%) only for the RIPV reconduction was assessed. Conclusions: TTI based CB ablation did not show significant differences regarding PV-reconduction rates compared to the other protocols.


2021 ◽  
Vol 8 ◽  
Author(s):  
Hai-yang Xie ◽  
Xiao-gang Guo ◽  
Jian-du Yang ◽  
Jia-hui Li ◽  
Yan-qiao Chen ◽  
...  

Background: Common ostium of inferior pulmonary veins (COIPV) is a kind of pulmonary vein variation. The safety and efficacy of COIPV isolation using the second-generation cryoballoon (CB) ablation remain unknown.Methods: A total of 10 patients with COIPV from a consecutive series of 1,751 patients with atrial fibrillation (AF) were included. Pulmonary vein isolation (PVI) was performed using the second-generation CB.Results: The prevalence of a COIPV was 0.57% in this study. PVI was achieved in all pulmonary veins (PVs) without the need for a touch-up. A segmental freeze strategy was applied for each inferior PV, respectively. The mean number of freeze cycles of inferior PVs was 1.4 ± 0.5 for the left inferior pulmonary vein (LIPV), and 2.0 ± 0.9 for the right inferior pulmonary vein (RIPV). Pulmonary vein potential (PVP) of RIPV could not be monitored in real-time in three cases. Eight of 10 patients (80%) were free from atrial arrhythmias without the use of antiarrhythmic drugs during a follow-up period of 23.6 ± 12.9 months. No procedure-related complications occurred in any of the 10 patients.Conclusions: Common ostium of inferior pulmonary veins is a rare but challenging PV variant. PVI with this unusual anatomic variation using the second-generation 28-mm CB is effective and safe.


Heart ◽  
2021 ◽  
pp. heartjnl-2021-319334
Author(s):  
Jay Relan ◽  
Saurabh Kumar Gupta ◽  
Rengarajan Rajagopal ◽  
Sivasubramanian Ramakrishnan ◽  
Gurpreet Singh Gulati ◽  
...  

ObjectivesWe sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography.MethodsCT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed.ResultsThe median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients.ConclusionAnomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.


2021 ◽  
pp. 20200184
Author(s):  
Kyoko Nagai ◽  
Akio Kotake ◽  
Yoshiro Hori ◽  
Nobuyuki Takeyama ◽  
Eliko Tanaka ◽  
...  

A patient with previous catheter ablation therapy for atrial fibrillation was examined for an abnormal shadow on a chest radiograph. ECG-gated multidetector CT clearly showed the left upper pulmonary vein connected with the left inferior pulmonary vein. We hypothesize an intrapulmonary venous connection as a collateral.


Author(s):  
Hideyuki Aoki ◽  
Yuichi Hori ◽  
Reiko Fukuda ◽  
Shiro Nakahara

2021 ◽  
Author(s):  
Jing Dong ◽  
Hui Li ◽  
Yu-Jiao Deng ◽  
Jin-Rong zhou ◽  
Jian Shu ◽  
...  

Abstract Purpose The purpose of this study was to explore the influence of cardiac cycle and the traditional risk factors on the four pulmonary veins (PVs) of adults and to determine the phase for measuring the maximum value of PVs. Methods Cardiac CT was performed in 101 subjects. The diameter, area, cross-sectional angle, and coronal-section angle of four PVs in 10 phase were reconstructed and measured at 10% step from 5%-95% R-R interval. The differences in PVs size and spatial angles in cardiac cycles and the correlation between the indicators of four PVs and traditional risk factors were analized using two-level model. Results All the maximum size values of the four PVs were found in 45%, while the minimum values were found in 5% or 95% of cardiac phases. Gender influenced the size of three PVs—right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV), and left inferior pulmonary vein (LSPV). The diameter of the RSPV was small in hypertensive patients and smokers. In addition, the cross-sectional angles of the left superior pulmonary vein (LIPV) changed during cardiac cycles, and age affected these changes. We found no changes in the spatial angles of the RSPV, RIPV, and LSPV, as well as the coronal-section angle of the LIPV. Conclusions PVs ostia size of normal person varies during cardiac phases. Compared with nomal person, AF could affect the cardiac phase in which the maximum and minimum of PVs is, and it may lead to a reduction of the PVs’ size slightly. For life science journals only.


Author(s):  
kohei sawasaki ◽  
natsuko hosoya ◽  
masahiro muto

The patient was an 18-year-old man who suffered frequent supraventricular premature complexes (SVPCs) and atrial fibrillation. Catheter ablation was performed and left pulmonary vein had been isolated, although firing from within the left inferior pulmonary vein remained. After that, the patient did not exhibit SVPCs and atrial fibrillation.


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