Kazuyasu Yoshitani

Left atrial appendage contributes to left atrial booster function after the maze procedure: quantitative assessment with multidetector computed tomography

OBJECTIVE Although the left atrial appendage (LAA) is excised to prevent thrombosis in the maze procedure, it remains unclear whether LAA is retained in expectation of LAA booster function. Therefore, we quantitatively assessed LAA size and function after the maze procedure in patients with chronic atrial fibrillation (AF) and mitral valve disease (MVD), and compared with those in patients with sinus rhythm after coronary artery bypass grafting (CABG). METHODS We studied 23 patients (maze group: 65.0 + or - 9.2 (SD) years) undergoing the maze procedure for chronic AF and mitral valve surgery and 16 patients having sinus rhythm after CABG (CABG group: 66.5 + or - 9.3 years). The maze procedure was conducted by radiofrequency (RF) ablation and LAA was preserved in all cases. Left atrium (LA) and LAA volume and booster function were quantitatively evaluated by multidetector computed tomography (MDCT) at 11.7 + or - 10.4 months (maze group) and 16.8 + or - 19.9 months (CABG group) after the surgery. RESULTS In all 23 patients of the maze group, sinus rhythm was well restored. LAA was clearly visualised without thrombi in all 39 patients. The maximal LA volume in the maze group was 128.8 + or - 54.6 ml, being larger than 105.3 + or - 36.1 ml in the CABG group. LA ejection fraction (EF) in the maze group was 16.1 + or - 7.0%, being significantly lower than 26.8 + or - 8.7% in the CABG group. Meanwhile, the maximal LAA volume in the maze group was significantly larger (16.9 + or - 7.3 ml vs 8.4 + or - 4.7 ml), but LAA EF (34.1 + or - 12.8% vs 36.1 + or - 7.4%) was comparable in the two groups. CONCLUSION LAA largely contributes to LA booster function, particularly in the maze group, because LA booster function is deteriorated in this group of patients.

Another Gate Keeper to Protect the Mitral Isthmus?: Importance of the Vein of Marshall

A 70-year-old man was referred for treatment of symptomatic persistent atrial fibrillation (AF). The duration of the AF was almost 6 months. He had a history of familial hyperlipidemia and had undergone coronary bypass graft surgery 20 years prior. The patient was deeply sedated and the catheter ablation was performed using a 3.5 mm-tip irrigation catheter (Thermocool Surround Flow, SF R

Cardiac tamponade during transesophageal echocardiography in a patient with infective endocarditis.

An 81-year-old man with a history of diabetes mellitus and end-stage renal disease was admitted because of infective endocarditis. During transesophageal echocardiography (TEE), pericardial effusion rapidly increased and led to cardiac tamponade. Despite intensive therapy, the patient did not recover. Autopsy showed hemopericardium, ruptured sinus of Valsalva, and vegetation on the aortic valve. Our case suggests that cardiac tamponade due to the rupture of a sinus of Valsalva can occur in patients with aortic valve endocarditis complicated by perivalvular abscess. Therefore, we must be aware of this devastating complication and take preventive measures when performing TEE in such patients.

Simultaneous re-isolation of the left pulmonary veins and termination of peri-mitral flutter with only an ethanol infusion in the vein of Marshall: killing two birds with one stone

A 65-year-old male patient was admitted for ablation of a recurrent atrial tachycardia (AT) after a previous ablation of persistent atrial fibrillation that consisted of a bilateral pulmonary vein (PV) isolation, electrogram-based ablation, and linear ablation at the …

The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed-Cavotricuspid isthmus ablation using intracardiac echocardiography

The aim of this study was to explore whether the pouch depth influenced the radiofrequency (RF) duration and total delivered RF energy for cavotricuspid isthmus (CTI) ablation and define the cutoff value for a deep pouch‐specified ablation strategy.

Ventricular Tachycardia Rotating a Scar of a Total Right Ventricular Exclusion

We describe a 15-year-old postoperative girl who underwent surgical 3-dimensional mapping and ablation of hemodynamically unstable ventricular tachycardia (VT) with an on-pump beating heart surgical technique. She had previously received a tricuspid valve closure, entire right ventricular free wall resection, and finally Fontan operation with an extracardiac conduit to treat a severe Ebsteins anomaly. Activation mapping revealed a VT rotating around a large right ventricular free wall incisional scar with a narrow conduction channel between the scar and a tricuspid annulus (TA). A linear radiofrequency ablation connecting the scar and the TA terminated the VT.

The usefulness of contrast echocardiography for detecting right-to-left cardiac shunts during the diagnosis of hypoxemia: 2 case reports

We report two cases in which contrast echocardiography was useful for detecting right-to-left shunt. In case 1, a 53-year-old man was admitted to our hospital after being diagnosed with acute heart failure. Even after improvement of the heart failure, hypoxemia remained. Contrast echocardiography was performed. When contrast medium was injected into the left antecubital vein, it directly drained into the left atrium. When contrast medium was injected into the right antecubital vein, it drained into the right atrium not the left atrium. These findings proved the existence of a right-to-left shunt. In case 2, a 68-year-old man felt dyspnea on mild effort, especially when sitting in an anteflexing posture. In room air, his SpO2 was 95% when sitting in a resting posture and 79% when in an anteflexing sitting posture. Contrast echocardiography was performed. A patent foramen ovale (PFO) was proved using the Valsalva maneuver, and the contrast medium drained from right atrium into the left atrium via the PFO. He underwent patch closure of the PFO, and his symptoms disappeared. Contrast echocardiography should be performed for the diagnosis of chronic hypoxemia for which causes are not detected with routine clinical examinations, in order to confirm right-to-left shunt.