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Seminars in Thoracic and Cardiovascular... Mar 2018Total anomalous pulmonary venous connection (TAPVC) constitutes a spectrum of congenital lesions whereby the pulmonary veins remain connected to systemic venous vessels... (Review)
Review
Total anomalous pulmonary venous connection (TAPVC) constitutes a spectrum of congenital lesions whereby the pulmonary veins remain connected to systemic venous vessels or aberrantly connect to the right atrium. Definitive management requires surgical intervention and, in patients with obstruction to pulmonary venous flow, urgent operation is required. Use of temporizing catheter-based interventions allow for optimization in hemodynamically unstable neonates. Overall, survival has significantly improved over the past decades through better perioperative management and evolution of surgical approaches to minimize post-repair pulmonary vein stenosis, which persists as a major determinant of long-term outcomes.
Topics: Cardiac Surgical Procedures; Heart Defects, Congenital; Humans; Pulmonary Veins; Plastic Surgery Procedures
PubMed: 29425529
DOI: 10.1053/j.pcsu.2017.11.010 -
JACC. Clinical Electrophysiology May 2019
Topics: Catheter Ablation; Cryosurgery; Pulmonary Veins
PubMed: 31122377
DOI: 10.1016/j.jacep.2019.03.011 -
Sultan Qaboos University Medical Journal Dec 2023This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the... (Review)
Review
This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the superior caval vein. In the sinus venosus defects, this wall was absent. Current evidence shows that the superior rim of the oval fossa, rather than forming a second septum or representing a common wall, is an infolding between the walls of the caval veins and the right pulmonary veins. The sinus venosus defect is caused by the anomalous connection of one or more pulmonary veins to a systemic vein. However, the pulmonary vein(s) retain their left atrial connections, leading to a veno-venous bridge that allows interatrial shunting outside the oval fossa. True atrial septal defects are located within the oval fossa or in the anteo-inferior buttress, while sinus venosus defects, ostium defects and coronary sinus defects are morphologically distinct from them.
Topics: Humans; Vena Cava, Superior; Heart Septal Defects, Atrial; Pulmonary Veins; Heart Atria
PubMed: 38161764
DOI: 10.18295/squmj.12.2023.075 -
Journal of Cardiovascular... Feb 2021
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins
PubMed: 33368814
DOI: 10.1111/jce.14854 -
Europace : European Pacing,... Feb 2022
Topics: Humans; Pulmonary Veins
PubMed: 34086860
DOI: 10.1093/europace/euab089 -
The Journal of Thoracic and... Jun 2021
Topics: Humans; Pulmonary Veins; Pulmonary Veno-Occlusive Disease; Stenosis, Pulmonary Vein
PubMed: 32868046
DOI: 10.1016/j.jtcvs.2020.06.066 -
Interactive Cardiovascular and Thoracic... Jan 2020In a living-donor lobectomy, the donor undergoes a right or left lower lobectomy. The surgical procedures for living-donor lobectomy are sometimes influenced by the...
OBJECTIVES
In a living-donor lobectomy, the donor undergoes a right or left lower lobectomy. The surgical procedures for living-donor lobectomy are sometimes influenced by the anatomical variations of the pulmonary vein (PV). The goal of this study was to analyse the PV variations in living donors and to review the influence of these variations on the surgical procedures used.
METHODS
Between June 2008 and September 2018, 154 living donors underwent right or left lower lobectomy. The PV variations were analysed using 3-dimensional computed tomography (3D-CT), and the surgical management of these variations was reviewed.
RESULTS
Among 154 donors, 21 PV variations that could influence the surgical procedure for a right lower lobectomy were found in 19 (12.3%) donors, whereas no such variations for a left lower lobectomy were found. Detected PV variations were dorsal branch of the right upper PV (n = 12), middle PV draining into the right lower PV (n = 6) and the superior segment branch of the right lower PV draining into the right upper PV (n = 3). Among 96 donors undergoing right lower lobectomy, 9 (9.4%) donors had PV variations that could influence the surgical procedure. In 2 donors, sparing of PV branches with multiple vascular clamps was required. Pulmonary venoplasty was not required in any donor, whereas pulmonary venoplasty in recipient surgery was required in 4 recipients. There were no complications related to the surgical procedures performed on the PV.
CONCLUSIONS
Living-donor lobectomy was performed safely owing to the preoperative evaluation of PV on 3D-CT and the use of appropriate surgical approaches to PV.
Topics: Adult; Female; Humans; Living Donors; Lung Transplantation; Male; Middle Aged; Pneumonectomy; Pulmonary Veins; Tissue and Organ Harvesting; Tomography, X-Ray Computed; Young Adult
PubMed: 31605611
DOI: 10.1093/icvts/ivz238 -
Journal of Thoracic Imaging May 2020The purpose of this study was to define the full spectrum of pulmonary computed tomography (CT) changes characteristic of postablation pulmonary vein stenosis (PVS).
PURPOSE
The purpose of this study was to define the full spectrum of pulmonary computed tomography (CT) changes characteristic of postablation pulmonary vein stenosis (PVS).
MATERIALS AND METHODS
We retrospectively reviewed our pulmonary vein isolation database. PVS was graded as follows: grade 1:<50%, grade 2: 50% to 75%, grade 3: 76% to 99%, and grade 4: total occlusion. CT parenchymal and vascular changes were detected and correlated with clinical course and nuclear scans.
RESULTS
Of 486 patients who underwent pulmonary vein isolation, 56 patients (11%) were symptomatic, prompting referral to CT evaluation. Grades 1, 2, 3, and 4 PVS were documented in 42, 1, 2, and 11 patients, respectively. Apart from PVS, abnormal CT findings were present only in patients with PVS grades 2 to 4. Pulmonary parenchymal changes (consolidation, "ground glass" opacities, interlobular septal thickening, and volume loss) were found in PVS grades 2 to 4. Pulmonary vascular changes (oligemia, "sluggish flow," and collateral mediastinal vessels) were shown in patients with grades 3 to 4 PVS. Concomitant nuclear scans documented reduced lung perfusion. All findings were located to the lobe drained by the affected vein. Complete resolution of pulmonary findings on follow-up CT scans was demonstrated in 20% of patients. Eleven stents were inserted in 7 patients with PVS grades 2 to 4, none of which demonstrated radiologic or clinical resolution.
CONCLUSIONS
A typical CT complex of both parenchymal and vascular findings in the affected lobe is diagnostic of postablation PVS. Lack of clinical and radiologic resolution in most patients, even after stent insertion, further highlights the importance of early recognition of this underdiagnosed condition.
Topics: Catheter Ablation; Humans; Pulmonary Veins; Retrospective Studies; Stenosis, Pulmonary Vein; Tomography, X-Ray Computed
PubMed: 31385876
DOI: 10.1097/RTI.0000000000000435 -
Europace : European Pacing,... Dec 2023Pulsed field ablation (PFA) is emerging as a non-thermal, tissue-specific technique for pulmonary vein isolation (PVI) in atrial fibrillation therapy. This pre-clinical...
AIMS
Pulsed field ablation (PFA) is emerging as a non-thermal, tissue-specific technique for pulmonary vein isolation (PVI) in atrial fibrillation therapy. This pre-clinical study aims to investigate the feasibility and safety of PVI using a novel PFA system including a nanosecond-scale PFA generator, a novel lotos PFA catheter, and a customized 12 Fr steerable sheath.
METHODS AND RESULTS
A total of 11 Yorkshire swine were included in this study, with 4 in the acute cohort and 7 in the chronic cohort. Under general anaesthesia, transseptal puncture and pulmonary vein (PV) angiography was initially performed. The PFA catheter was navigated to position at the right and left PV antrum after the electroanatomic reconstruction of the left atrium. Biphasic PFA applications were performed on PVs in both the spindle-shaped and the lotos-shaped poses. Pulmonary vein isolation and PFA-associated safety were assessed 30 min after ablation in both cohorts and 30 days later in the chronic cohort. Detailed necropsy and histopathology were performed. Additional intracardiac echocardiography and coronary angiogram were evaluated for safety. All target PVs (n = 20) were successfully isolated on the first attempt. No spasm of coronary artery or microbubble was seen during the procedure. Eleven of 12 PVs (91.6%) remained in isolation at the 30-day invasive study. No evidence of PV stenosis was observed in any targets. However, transient diaphragm capture occurred in 17.6%. Histopathological examinations showed no evidence of collateral injury.
CONCLUSION
This study provides scientific evidence demonstrating the safety and efficacy of the novel PFA catheter and system for single-shot PVI, which shows great potential.
Topics: Humans; Swine; Animals; Pulmonary Veins; Feasibility Studies; Atrial Fibrillation; Catheter Ablation; Catheters; Treatment Outcome
PubMed: 38109928
DOI: 10.1093/europace/euad362 -
Expert Review of Medical Devices May 2022Catheter ablation has been demonstrated to be a safe and an effective treatment for drug resistant atrial fibrillation (AF); electrical isolation of pulmonary veins... (Review)
Review
INTRODUCTION
Catheter ablation has been demonstrated to be a safe and an effective treatment for drug resistant atrial fibrillation (AF); electrical isolation of pulmonary veins (PVI) is the main strategy in paroxysmal AF, since pulmonary vein triggers have a pivotal role in its pathogenesis; non-paroxysmal AF is a complex arrhythmia that results from the interplay of a substrate, namely AF-induced electrical and structural atrial remodeling, and a trigger that can be often found outside pulmonary veins, namely non-pulmonary veins triggers.
AREAS COVERED
The aim of this review is to provide a state-of-the-art overview of non-pulmonary veins triggers with special focus on cryoballoon (CB) catheter ablation.
EXPERT OPINION
Besides PVI, CB catheter ablation of non-pulmonary veins triggers is a novel and promising strategy for non-paroxysmal AF.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Treatment Outcome
PubMed: 35786107
DOI: 10.1080/17434440.2022.2096437