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Condori Leandro HI, Vakhrushev AD, Goncharova NS, Korobchenko LE, Koshevaya EG, Mitrofanova LB, Andreeva EM, Moiseeva OM, Lebedev DS, Mikhaylov EN. Stimulation Mapping of the Pulmonary Artery for Denervation Procedures: an Experimental Study. J Cardiovasc Transl Res 2020; 14:546-555. [PMID: 33111219 DOI: 10.1007/s12265-020-10079-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Transcatheter pulmonary artery denervation (PADN) has been developed for the correction of pulmonary hypertension. We investigated pulmonary artery stimulation mapping and its role in PADN procedures. Artery stimulation was performed in 17 Landrace pigs. Low-frequency stimulation defined areas of ventricular and atrial capture. High-frequency stimulation evoked the following responses: sinus rhythm slowing and/or atrial rhythm acceleration in 59% of animals, phrenic nerve capture in 100%, and laryngeal recurrent nerve capture in 23%. The sites with evoked heart rate responses were marked by discrete radiofrequency ablations (RFA). An autopsy showed nerves in the adventitia and perivascular fat under the RFA sites, and the lack of muscarinic-1, tyrosine hydroxylase, and dopamine-5 receptors' expression. During PADN, areas adjacent to the course of phrenic and recurrent laryngeal nerves should be avoided. RFA at points with heart rate responses leads to the non-reproducibility of evoked reactions and the disappearance of neural markers' expression. Graphical abstract.
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Affiliation(s)
- Heber Ivan Condori Leandro
- Neuromodulation Laboratory, Almazov National Medical Research Centre, 197341, Akkuratova st.2, Saint Petersburg, Russian Federation
| | - Aleksandr D Vakhrushev
- Neuromodulation Laboratory, Almazov National Medical Research Centre, 197341, Akkuratova st.2, Saint Petersburg, Russian Federation
| | - Natalia S Goncharova
- Non-coronary Heart Disease Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Lev E Korobchenko
- Pavlov First Saint Petersburg Medical University, Saint Petersburg, Russian Federation
| | - Elena G Koshevaya
- Pathology Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Lubov B Mitrofanova
- Pathology Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Elizaveta M Andreeva
- Pavlov First Saint Petersburg Medical University, Saint Petersburg, Russian Federation
| | - Olga M Moiseeva
- Non-coronary Heart Disease Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Dmitry S Lebedev
- Arrhythmia Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.,Department of Bioengineering Systems, Saint Petersburg Electrotechnical University "LETI", Saint Petersburg, Russian Federation
| | - Evgeny N Mikhaylov
- Neuromodulation Laboratory, Almazov National Medical Research Centre, 197341, Akkuratova st.2, Saint Petersburg, Russian Federation. .,Arrhythmia Department, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation. .,Department of Bioengineering Systems, Saint Petersburg Electrotechnical University "LETI", Saint Petersburg, Russian Federation.
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2
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Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
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Karkowski G, Kielczewski S, Lelakowski J, Kuniewicz M. Ortner's syndrome after cryoballoon ablation. J Interv Card Electrophysiol 2019; 54:309-310. [PMID: 30353375 PMCID: PMC6456463 DOI: 10.1007/s10840-018-0466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Grzegorz Karkowski
- Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | | | - Jacek Lelakowski
- Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Kuniewicz
- Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland.
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
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Raut MS, Dubey S, Maheshwari A. Iatrogenic vocal cord paralysis after cardiac surgery: evocative note for surgeon and anesthesiologist. Ann Card Anaesth 2017; 20:117-118. [PMID: 28074812 PMCID: PMC5290684 DOI: 10.4103/0971-9784.197852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Monish S Raut
- From the Department of Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India
| | - Sumir Dubey
- Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Maheshwari
- From the Department of Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India
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Raut MS, Maheshwari A, Joshi R, Joshi R, Dubey S, Shivnani G, Shad S. Vocal Cord Paralysis After Cardiac Surgery and Interventions: A Review of Possible Etiologies. J Cardiothorac Vasc Anesth 2016; 30:1661-1667. [DOI: 10.1053/j.jvca.2016.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Indexed: 11/11/2022]
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Mesolella M, Ricciardiello F, Tafuri D, Varriale R, Testa D. Delayed recurrent nerve paralysis following post-traumatic aortic pseudoaneurysm. Open Med (Wars) 2016; 11:215-219. [PMID: 28352797 PMCID: PMC5329828 DOI: 10.1515/med-2016-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/07/2016] [Indexed: 11/15/2022] Open
Abstract
Blunt trauma to the neck or to the chest are increasingly observed in the emergency clinical practice. They usually follow motor vehicle accidents or may be work or sports related. A wide pattern of clinical presentation can be potentially encountered. We report the uncommon case of a patient who was referred to our observation presenting with hoarseness and disphagia. Twenty days before he had sustained a car accident with trauma to the chest, neck and the mandible. Laryngoscopy showed a left recurrent laryngeal nerve palsy. Further otolaryngo-logical examination showed no other abnormality. At CT and MR imaging a post-traumatic aortic pseudoaneurysm was revealed. The aortic pseudoaneurysm was consequently repaired by implantation of an endovascular stent graft under local anesthesia. The patient was discharged 10 days later. At 30-days follow-up laryngoscopy the left vocal cord palsy was completely resolved. Hoarseness associated with a dilated left atrium in a patient with mitral valve stenosis was initially described by Ortner more than a century ago. Since then several non malignant, cardiovascular, intrathoracic disease that results in embarrassment from recurrent laryngeal nerve palsy usually by stretching, pulling or compression; thus, the correlations of these pathologies was termed as cardiovocal syndrome or Ortner's syndrome. The reported case illustrates that life-threatening cardiovascular comorbidities can cause hoarseness and that an impaired recurrent laryngeal nerve might be correctable.
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Affiliation(s)
- Massimo Mesolella
- Department of Neuros-cience Reproductive and Dentistry Sciences, Otholaryngology Unit; University of Naples "Federico II", Naples - Italy. Via G. Filangieri 36, 80121 Napoli, Italy
| | - Filippo Ricciardiello
- Department of Neuroscience Reproductive and Dentistry Sciences, Otholaryngology Unit; University of Naples "Federico II", Naples, Italy
| | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Roberto Varriale
- Department of Anesthesiologic, Surgical and Emergency Sciences; Otolaryngology, Head and Neck Surgery Unit; Second University of Naples, Italy
| | - Domenico Testa
- Department of Anesthesiologic, Surgical and Emergency Sciences; Otolaryngology, Head and Neck Surgery Unit; Second University of Naples, Italy
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Anatomical Basis for the Cardiac Interventional Electrophysiologist. BIOMED RESEARCH INTERNATIONAL 2015; 2015:547364. [PMID: 26665006 PMCID: PMC4668306 DOI: 10.1155/2015/547364] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/28/2015] [Indexed: 12/11/2022]
Abstract
The establishment of radiofrequency catheter ablation techniques as the mainstay in the treatment of tachycardia has renewed new interest in cardiac anatomy. The interventional arrhythmologist has drawn attention not only to the gross anatomic details of the heart but also to architectural and histological characteristics of various cardiac regions that are relevant to the development or recurrence of tachyarrhythmias and procedural related complications of catheter ablation. In this review, therefore, we discuss some anatomic landmarks commonly used in catheter ablations including the terminal crest, sinus node region, Koch's triangle, cavotricuspid isthmus, Eustachian ridge and valve, pulmonary venous orifices, venoatrial junctions, and ventricular outflow tracts. We also discuss the anatomical features of important structures in the vicinity of the atria and pulmonary veins, such as the esophagus and phrenic nerves. This paper provides basic anatomic information to improve understanding of the mapping and ablative procedures for cardiac interventional electrophysiologists.
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Monwarul Islam AKM, Zaman S, Doza F. Ortner syndrome due to concomitant mitral stenosis and bronchiectasis. Korean Circ J 2012; 42:507-10. [PMID: 22870088 PMCID: PMC3409403 DOI: 10.4070/kcj.2012.42.7.507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/29/2011] [Accepted: 01/11/2012] [Indexed: 02/05/2023] Open
Abstract
Ortner syndrome or cardiovocal syndrome is a rare condition characterized by hoarseness of voice associated with cardiovascular pathology. Compression of the left recurrent laryngeal nerve by the pulmonary artery or left atrium is usually responsible. Recurrent aspiration pneumonia may cause significant morbidity and mortality. Early recognition and treatment along with removal of the underlying cause, if possible, may change an otherwise poor prognosis of the condition. The case presented here describes a 35-year old female with hoarseness of voice in association with mitral stenosis and bronchiectasis. Presence of dual pathology contributed to the overall pathophysiology of the disease, and made its management difficult.
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Affiliation(s)
- A K M Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.
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Affiliation(s)
- Siew Yen Ho
- From the Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom (S.Y.H.); Hospital Universitario Quirón-Madrid, European University of Madrid, Madrid, Spain (J.A.C.); and the Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain (D.S.-Q.)
| | - José Angel Cabrera
- From the Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom (S.Y.H.); Hospital Universitario Quirón-Madrid, European University of Madrid, Madrid, Spain (J.A.C.); and the Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain (D.S.-Q.)
| | - Damian Sanchez-Quintana
- From the Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom (S.Y.H.); Hospital Universitario Quirón-Madrid, European University of Madrid, Madrid, Spain (J.A.C.); and the Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain (D.S.-Q.)
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HO SIEWYEN, McCARTHY KARENP. Anatomy of the Left Atrium for Interventional Electrophysiologists. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 33:620-7. [DOI: 10.1111/j.1540-8159.2009.02659.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Romagnoli E, Nasso G, Angeloni G, Biondi-Zoccai GGL, Rigante M, Burzotta F, Trani C, Materazzo G, Crea F. Cardiovocal syndrome after transradial cardiac catheterization: An unusual complication. Int J Cardiol 2008; 124:e39-41. [PMID: 17337075 DOI: 10.1016/j.ijcard.2006.11.188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 11/18/2006] [Indexed: 02/08/2023]
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12
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Mulpuru SK, Vasavada BC, Punukollu GK, Patel AG. Cardiovocal Syndrome: A Systematic Review. Heart Lung Circ 2008; 17:1-4. [DOI: 10.1016/j.hlc.2007.04.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 03/02/2007] [Accepted: 04/18/2007] [Indexed: 11/24/2022]
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Chugh A, Morady F. Atrial fibrillation: Catheter ablation. J Interv Card Electrophysiol 2006; 16:15-26. [PMID: 17053976 DOI: 10.1007/s10840-006-9018-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 05/17/2006] [Indexed: 02/01/2023]
Abstract
Catheter ablation of atrial fibrillation (AF) has evolved dramatically over the last several years. The initial efforts in the catheter-based management of AF targeted the atrial substrate in an effort to mimic the maze procedure. After the pulmonary veins (PV) were shown to be critical in the initiation and perpetuation of AF, the focus then shifted to a trigger approach in which the PVs and other foci were targeted for ablation. The pendulum then appeared to swing back toward the substrate approach after it was shown that left atrial circumferential ablation afforded improved outcomes in patients with paroxysmal and persistent AF. It has become clear that there are several possible approaches in the catheter ablation of AF, each with its strengths and limitations. It is also becoming evident that not all patients will respond to a single ablation technique and that the ablation protocol is best tailored to suit the individual patient. This article strives to present an evidence-based review of the many techniques, and then offer a practical guide to the catheter ablation of AF.
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Affiliation(s)
- Aman Chugh
- Division of Cardiology, University of Michigan Hospitals, TC B1 D140, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0311, USA.
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Tada H, Naito S, Oshima S, Taniguchi K. Vasospastic angina shortly after left atrial catheter ablation for atrial fibrillation. Heart Rhythm 2005; 2:867-70. [PMID: 16051126 DOI: 10.1016/j.hrthm.2005.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2005] [Accepted: 05/10/2005] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
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