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Lourdes R Prieto - One of the best experts on this subject based on the ideXlab platform.
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Abstract 17260: Percutaneous Recanalization of Totally Occluded Pulmonary Veins After Pulmonary Vein Isolation
Circulation, 2011Co-Authors: James A. Hill, Larry A Latson, Athar M. Qureshi, Lourdes R PrietoAbstract:Background: Pulmonary Vein total occlusion (PVO) is an uncommon complication of Pulmonary Vein isolation (PVI). We have previously published our early experience with diagnosis and treatment of PVO...
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congenital and acquired Pulmonary Vein stenosis
Circulation, 2006Co-Authors: Larry A Latson, Lourdes R PrietoAbstract:Pulmonary Vein stenosis is a fascinating yet frustrating and difficult to manage condition with an exceptionally high mortality rate. Until recently, the disease was seen almost exclusively in young children with or without various forms of congenital heart disease. Pulmonary Vein stenosis is a relatively rare condition. In most published series from large centers, there has been an average of ≈2 or 3 cases per year that require treatment. Pulmonary Vein stenosis in the adult population is even more rare, and the small number of reported cases has often been associated with mediastinal processes such as neoplasms or fibrosing mediastinitis. However, with the advent of aggressive treatment strategies for atrial fibrillation, we have seen a new group of Pulmonary Vein stenosis patients. The stenosis appears as a complication of radiofrequency ablation procedures around the Pulmonary Veins. Small series of new surgical and interventional catheterization procedures for treatment of both the pediatric and adult forms of Pulmonary Vein stenosis suggest an improving prognosis in centers with specialized expertise. However, the prognosis of patients affected with Pulmonary Vein stenosis remains guarded and requires diligent follow-up and often repeated procedures. The purpose of this article is to review concepts of causation and possible treatments for this rare but serious condition as they evolve. The left atrium and Pulmonary Veins initially develop separately in the 3- to 5-mm embryo (25 to 27 days gestation).1 The primordial Pulmonary venous system is part of the splanchnic plexus, which initially connects to the cardinal and umbilicovitelline Veins. At 27 to 29 days gestation, a small endothelial outgrowth from the posterior superior wall of the primordial left atrium develops just to the left of the developing septum primum. At 28 to 30 days gestation, this common Pulmonary venous out-pouching engages the Pulmonary venous portion of the splanchnic …
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Pulmonary Vein stenosis after catheter ablation of atrial fibrillation emergence of a new clinical syndrome
Annals of Internal Medicine, 2003Co-Authors: Eduardo B Saad, Lourdes R Prieto, Nassir F Marrouche, Cynthia P Saad, Edward Ha, Dianna Bash, Richard D White, John F Rhodes, David O Martin, Walid I SalibaAbstract:BACKGROUND: Pulmonary Vein isolation is a new, effective curative procedure for selected patients with atrial fibrillation. Pulmonary Vein stenosis is a potential complication and may lead to symptoms that are often underrecognized. OBJECTIVE: To describe the clinical course and symptoms associated with Pulmonary Vein stenosis developing after ablation in the Pulmonary Veins. DESIGN: Retrospective study. SETTING: Tertiary care referral center. PATIENTS: 335 patients referred for catheter ablation of drug-refractory atrial fibrillation. INTERVENTION: Pulmonary Vein electrical isolation using radiofrequency catheter ablation. MEASUREMENTS: Three months after ablation, patients underwent routine screening for Pulmonary Vein stenosis with spiral computed tomography. Screening was considered earlier if symptoms suggestive of stenosis developed and was repeated at 6 and 12 months if any Pulmonary Vein narrowing was observed. Pulmonary Vein angiography and dilatation were offered to patients with severe (>70%) stenosis. RESULTS: Severe Pulmonary Vein stenosis was detected in 18 patients (5% [95% CI, 3.2% to 8.4%]) a mean (+/-SD) of 5.2 +/- 2.6 months after ablation. Eight of these 18 patients (44%) were asymptomatic, but 8 (44%) reported shortness of breath, 7 (39%) reported cough, and 5 (28%) reported hemoptysis. Radiologic abnormalities were present in 9 patients (50%) and led to diagnoses of pneumonia (4 patients), lung cancer (1 patient), and Pulmonary embolism (2 patients). Pulmonary Vein stenosis was not considered in any patient during the initial work-up. Dilatation of the affected Vein was performed in 12 patients. Postintervention lung perfusion scans revealed significant improvement in lung flow. CONCLUSIONS: Severe Pulmonary Vein stenosis after catheter ablation of atrial fibrillation is associated with respiratory symptoms that frequently mimic more common diseases, often leading to erroneous diagnostic and therapeutic procedures. Awareness of this syndrome is important for proper and prompt management.
Christopher A. Caldarone - One of the best experts on this subject based on the ideXlab platform.
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Losartan ameliorates “upstream” Pulmonary Vein vasculopathy in a piglet model of Pulmonary Vein stenosis
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Yaqin Yana Fu, John G Coles, Anouk-martine Teichert, Hideyuki Kato, Richard D. Weisel, Jason T. Maynes, Christopher A. CaldaroneAbstract:Objectives Pulmonary Vein stenosis (PVS) is a relentless disease with a poor prognosis. Although surgical repair can effectively treat “downstream” (near left atrial junction) PVS, residual “upstream” (deep in lung parenchyma) PVS commonly dictates long-term survival. Our initial studies revealed an association between PVS and transforming growth factor-β signaling, which led us to investigate the effect of losartan on upstream Pulmonary Vein vasculopathy in a piglet model of PVS. Methods Neonatal Yorkshire piglets underwent sham surgical banding (sham, n = 6), staged bilateral Pulmonary Vein banding of all Pulmonary Veins except the right middle Pulmonary Vein (banded, n = 6), and staged Pulmonary Vein banding with losartan treatment (losartan, 1 mg/kg/d, n = 7). After 7 weeks, the hemodynamic data were obtained and the piglets killed. Results Pulmonary Vein banding (compared with sham) was associated with continuous turbulent flow in banded Pulmonary Veins, Pulmonary hypertension (Pulmonary artery/systemic blood pressure ratio 0.51 ± 0.06 vs 0.23 ± 0.02, P P P = .007) but it remained greater than those in the sham group ( P = .001). Losartan was also associated with diminished Pulmonary Vein intimal hyperplasia compared with that in the banded piglets ( P P = .035). Pulmonary Vein banding reduced vascular endothelial-cadherin expression, indicative of diminished endothelial integrity, which was restored with losartan. Conclusions Losartan treatment improved PVS-associated Pulmonary hypertension and intimal hyperplasia and might be a beneficial prophylactic therapy for patients at high risk of developing PVS after Pulmonary Vein surgery.
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Primary Pulmonary Vein stenosis: The impact of sutureless repair on survival
Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Nicole Viola, Donald G. Perrin, Abdullah A Alghamdi, John G Coles, Gregory J. Wilson, Christopher A. CaldaroneAbstract:Background: Primary Pulmonary Vein stenosis is often associated with relentless restenosis and early death. During the last 2 decades, we have developed a sutureless repair to improve prognosis. Methods: Hospital records for patients undergoing repair of primary Pulmonary Vein stenosis from 1989 to 2008 were reviewed. Pulmonary Vein stenosis was quantified with a Pulmonary Vein stenosis score. Survival was determined by Kaplan-Meier analysis. Results: Twenty-three patients underwent surgical repair. Mean ages at diagnosis and index repair were 23.3 ± 45.6 and 24.1 ± 40.9 months, respectively. Systemic or suprasystemic Pulmonary artery pressures were present in 13 of 18 patients (72%). Seven (31%) had single-ventricle circulation. A sutureless technique was used in 19 of 23 cases (83%). Other types of repair were used in 4 of 23 (17%). There were 11 recorded deaths (47%). Survivals were 64%, 47%, and 31% at 1, 5, and 10 years, respectively. Five patients (22%) required 1 reintervention. Surgical repair significantly reduced the total Pulmonary Vein stenosis score (5.6 ± 2.10 before repair, 2.6 ± 2.72 after repair, P = .0057). The preoperative Pulmonary Vein stenosis score was the only independent predictor of mortality (hazard ratio, 1.732; P < .01). A preoperative Pulmonary Vein stenosis score of greater than 4 was a poor prognostic indicator (area under the curve, 0.83). Conclusions: Mortality and restenosis rates remained high despite the adoption of a sutureless technique. A preoperative Pulmonary Vein stenosis score of greater than 4 was a strong predictor of poor prognosis. Copyright © 2011 by The American Association for Thoracic Surgery.
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conventional and sutureless techniques for management of the Pulmonary Veins evolution of indications from postrepair Pulmonary Vein stenosis to primary Pulmonary Vein anomalies
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: John G Coles, Igor E Konstantinov, Osman O Alradi, Rachel M Wald, Vitor C Guerra, Nilto C De Oliveira, Glen S Van Arsdell, William G Williams, Jeffrey F Smallhorn, Christopher A. CaldaroneAbstract:Objective We have previously reported a limited but favorable experience with a novel sutureless technique for surgical management of postoperative Pulmonary Vein stenosis occurring after repair of total anomalous Pulmonary venous drainage. Because this technique requires integrity of the retrocardiac space for hemostasis, extension of the technique to the primary repair of Pulmonary Vein anomalies requires evaluation. This analysis reviews our experience with the sutureless technique in patients with postrepair Pulmonary Vein stenosis, as well as our extension of the technique into primary repair of Pulmonary Vein anomalies. Methods Retrospective univariable-multivariable analysis of all Pulmonary Vein stenosis procedures and sutureless Pulmonary Vein procedures over a 20-year period was performed. Cox proportional hazards modeling was used to identify variables associated with freedom from reoperation or death. Results Sixty patients underwent 73 procedures, with Pulmonary Vein stenosis present in 65 procedures. The sutureless technique was used in 40 procedures. Freedom from reoperation or death at 5 years after the initial procedure was 49%. Unadjusted freedom from reoperation or death was greater with the sutureless technique for patients with postrepair Pulmonary Vein stenosis ( P = .04). By using multivariable analysis, a higher Pulmonary Vein stenosis score was associated with greater risk of reoperation or death. After adjustment, the sutureless repair was associated with a nonsignificant trend toward greater freedom from reoperation or death ( P = .12). Despite the absence of retrocardiac adhesions, operative mortality was not increased with the sutureless technique ( P = .64). Techniques to control bleeding (intrapleural hilar reapproximation) and improve exposure (inferior vena cava division) were identified. Conclusion The sutureless technique for postrepair Pulmonary Vein stenosis is associated with encouraging midterm results. Extension of the indications for the technique to primary repair appears safe with the development of simple intraoperative maneuvers.
Kazuyoshi Suenari - One of the best experts on this subject based on the ideXlab platform.
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The distance between the Vein and lesions predicts the requirement of carina ablation in circumferential Pulmonary Vein isolation
Europace, 2011Co-Authors: Yenn Jiang Lin, Chien Jung Chang, Ching Tai Tai, Wen Chin Tsai, Shih-lin Chang, Li Wei Lo, Yu-feng Hu, Ta Chuan Tuan, Hsuan Ming Tsao, Kazuyoshi SuenariAbstract:Additional ablation in the Pulmonary Vein (PV) carina region is sometimes required to achieve electrical isolation following circumferential Pulmonary Vein isolation (PVI). This study investigated the procedural predictors for the requirement of additional carina ablation to achieve complete electrical isolation with PVI.
Carlo Pappone - One of the best experts on this subject based on the ideXlab platform.
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circumferential Pulmonary Vein ablation for chronic atrial fibrillation
The New England Journal of Medicine, 2006Co-Authors: Hakan Oral, Frank Pelosi, Carlo Pappone, Aman Chugh, Eric Good, Frank Bogun, Eric R Bates, Michael H Lehmann, Gabriele Vicedomini, Giuseppe AugelloAbstract:Background We conducted a randomized, controlled trial of circumferential Pulmonary-Vein ablation for the treatment of chronic atrial fibrillation. Methods A total of 146 patients with a mean (±SD) age of 57±9 years who had chronic atrial fibrillation were randomly assigned to receive amiodarone and undergo two cardioversions during the first three months alone (the control group) or in combination with circumferential Pulmonary-Vein ablation. Cardiac rhythm was assessed with daily telephonic transmissions for one year. The left atrial diameter and the severity of symptoms were assessed at 12 months. Results Among the 77 patients assigned to undergo circumferential Pulmonary-Vein ablation, ablation was repeated because of recurrent atrial fibrillation in 26 percent of patients and atypical atrial flutter in 6 percent. An intention-to-treat analysis showed that 74 percent of patients in the ablation group and 58 percent of those in the control group were free of recurrent atrial fibrillation or flutter wit...
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left atrial tachycardia after circumferential Pulmonary Vein ablation for atrial fibrillation electroanatomic characterization and treatment
Journal of the American College of Cardiology, 2004Co-Authors: Cezar Mesas, Carlo Pappone, Gabriele Vicedomini, Christopher Lang, Filippo Gugliotta, Takeshi Tomita, Simone Sala, Gabriele Paglino, Simone Gulletta, Amedeo FerroAbstract:Objectives The purpose of this study was to evaluate the electroanatomic characteristics of left atrial tachycardia (AT) in a series of patients who underwent circumferential Pulmonary Vein ablation (CPVA) and to describe the ablation strategy and clinical outcome. Background Circumferential Pulmonary Vein ablation is an effective treatment for atrial fibrillation. A potential midterm complication is the development of left AT. There are only isolated reports describing mapping and ablation of such arrhythmias. Methods Thirteen patients (age 57.4 ± 8.9 years, five female) underwent mapping and ablation of 14 left ATs via an electroanatomic mapping system a mean of 2.6 ± 1.6 months after CPVA. Results Three patients were characterized as having focal AT (cycle length: 266 ± 35.9 ms). Of 11 macro–re-entrant tachycardias studied in the remaining 10 patients (cycle length: 275 ± 75 ms), 5 showed single-loop and 6 dual-loop circuits. Re-entrant circuits used the mitral isthmus, the posterior wall, or gaps on previous encircling lines. Such gaps and all three foci occurred anterior to the left superior Pulmonary Vein or at the septal aspect of the right Pulmonary Veins. Thirteen of 14 tachycardias (93%) were successfully ablated. Conclusions Left AT after CPVA can be due to a macro–re-entrant or focal mechanism. Re-entry occurs most commonly across the mitral isthmus, the posterior wall, or gaps on previous ablation lines. Such gaps and foci occur most commonly at the anterior aspect of the left superior Pulmonary Vein and at the septal aspect of the right Pulmonary Veins. These arrhythmias can be successfully mapped and ablated with an electroanatomic mapping system.
Gabriele Vicedomini - One of the best experts on this subject based on the ideXlab platform.
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circumferential Pulmonary Vein ablation for chronic atrial fibrillation
The New England Journal of Medicine, 2006Co-Authors: Hakan Oral, Frank Pelosi, Carlo Pappone, Aman Chugh, Eric Good, Frank Bogun, Eric R Bates, Michael H Lehmann, Gabriele Vicedomini, Giuseppe AugelloAbstract:Background We conducted a randomized, controlled trial of circumferential Pulmonary-Vein ablation for the treatment of chronic atrial fibrillation. Methods A total of 146 patients with a mean (±SD) age of 57±9 years who had chronic atrial fibrillation were randomly assigned to receive amiodarone and undergo two cardioversions during the first three months alone (the control group) or in combination with circumferential Pulmonary-Vein ablation. Cardiac rhythm was assessed with daily telephonic transmissions for one year. The left atrial diameter and the severity of symptoms were assessed at 12 months. Results Among the 77 patients assigned to undergo circumferential Pulmonary-Vein ablation, ablation was repeated because of recurrent atrial fibrillation in 26 percent of patients and atypical atrial flutter in 6 percent. An intention-to-treat analysis showed that 74 percent of patients in the ablation group and 58 percent of those in the control group were free of recurrent atrial fibrillation or flutter wit...
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left atrial tachycardia after circumferential Pulmonary Vein ablation for atrial fibrillation electroanatomic characterization and treatment
Journal of the American College of Cardiology, 2004Co-Authors: Cezar Mesas, Carlo Pappone, Gabriele Vicedomini, Christopher Lang, Filippo Gugliotta, Takeshi Tomita, Simone Sala, Gabriele Paglino, Simone Gulletta, Amedeo FerroAbstract:Objectives The purpose of this study was to evaluate the electroanatomic characteristics of left atrial tachycardia (AT) in a series of patients who underwent circumferential Pulmonary Vein ablation (CPVA) and to describe the ablation strategy and clinical outcome. Background Circumferential Pulmonary Vein ablation is an effective treatment for atrial fibrillation. A potential midterm complication is the development of left AT. There are only isolated reports describing mapping and ablation of such arrhythmias. Methods Thirteen patients (age 57.4 ± 8.9 years, five female) underwent mapping and ablation of 14 left ATs via an electroanatomic mapping system a mean of 2.6 ± 1.6 months after CPVA. Results Three patients were characterized as having focal AT (cycle length: 266 ± 35.9 ms). Of 11 macro–re-entrant tachycardias studied in the remaining 10 patients (cycle length: 275 ± 75 ms), 5 showed single-loop and 6 dual-loop circuits. Re-entrant circuits used the mitral isthmus, the posterior wall, or gaps on previous encircling lines. Such gaps and all three foci occurred anterior to the left superior Pulmonary Vein or at the septal aspect of the right Pulmonary Veins. Thirteen of 14 tachycardias (93%) were successfully ablated. Conclusions Left AT after CPVA can be due to a macro–re-entrant or focal mechanism. Re-entry occurs most commonly across the mitral isthmus, the posterior wall, or gaps on previous ablation lines. Such gaps and foci occur most commonly at the anterior aspect of the left superior Pulmonary Vein and at the septal aspect of the right Pulmonary Veins. These arrhythmias can be successfully mapped and ablated with an electroanatomic mapping system.
