Subject(s)
Humans , Female , Adult , Coronary Sinus/pathology , Anomalous Left Coronary Artery/pathology , Anomalous Left Coronary Artery/diagnostic imaging , Hernia, Umbilical/surgery , Iliac Artery/pathology , Iliac Artery/diagnostic imaging , Time Factors , Echocardiography/methods , Cardiac Catheterization/methods , Clinical Evolution/methods , Arterio-Arterial Fistula/diagnostic imaging , Aftercare , Magnetic Resonance Angiography/methods , Echocardiography, Doppler, Color/methods , Electrocardiography , Computed Tomography Angiography/methodsABSTRACT
Introdução:A terapia de ressincronização cardíaca é um dos grandes avanços no tratamento de pacientescom insuficiência cardíaca refratária; entretanto, o implante do cabo-eletrodo de estimulação ventricular esquerdaatravés do seio coronário permanece um grande desafio. Diversas técnicas foram descritas para estabilizaçãodesses cabos-eletrodos em sua posição final. Este estudo tem por objetivo avaliar os cabos-eletrodos de seiocoronário estabilizados com a técnica do fio-guia retido.Método:Análise retrospectiva da evolução de 6 pacientessubmetidos a ressincronização cardíaca, em que foi utilizada a técnica do fio-guia retido.Resultados:Em 5(83,3%) dos 6 pacientes avaliados observaram-se alterações nos parâmetros do cabo-eletrodo, e apenas 1 paciente(16,7%) manteve os parâmetros do cabo-eletrodo inalterados em 10 meses de seguimento clínico.Conclusão:A técnica do fio-guia retido, apesar de proporcionar sustentação e estabilidade ao cabo-eletrodo do ventrículoesquerdo durante o implante, não demonstra ser uma boa opção, em decorrência da grande probabilidade de danoaos cabos-eletrodos a curto ou longo prazos e da necessidade de reabordagem cirúrgica.
Background:Cardiac resynchronization therapy is a great advance in the treatment of patientswith chronic heart failure, however, implantation of left ventricular leads through the coronary sinus remains amajor challenge. Several techniques have been reported for the stabilization of theses leads in their final position.This study is aimed at evaluating coronary sinus leads stabilized by the retained guidewire technique.Method:Retrospective analysis of the outcomes of 6 patients undergoing cardiac resynchronization, using the retainedguidewire technique.Results:In 5 (83.3%) of the 6 patients there were abnormalities in the lead parameters, andonly 1 patient (16.7%) maintained lead parameters without changes throughout 10 months of clinical follow-up.Conclusion:Even though the retained guidewire technique provides support and stability to left ventricular leadsduring implantation it does not seem to be a good alternative due to the significant probability of short or long-term damage to the leads and to the need of a new surgical approach.
Subject(s)
Humans , Male , Female , Middle Aged , Cardiac Resynchronization Therapy , Heart Failure/diagnosis , Coronary Sinus/pathology , Pacemaker, Artificial , Surgical Procedures, Operative/methods , Retrospective Studies , Time FactorsABSTRACT
OBJECTIVE: To report on the double superior vena cava occurring with anomalous azygous vein and abnormal termination of the cardiac veins, which has not been reported before in one individual. RESULTS: Examination of the heart revealed the presence of both the right and left superior vena cava. The right superior vena cava terminated into the right atrium and received the right root of the azygous vein, and the left superior vena cava received the left root of the azygous vein before entering the dilated coronary sinus. The azygous vein ascended in the right chest, and at the level of the third thoracic vertebra, it divided into the right and left roots, which joined the respective superior vena cava. Observation of the left lung revealed the presence of both the oblique and horizontal fissures that demarcated the upper, middle, and lower lobes. Dissection of the neck revealed abnormal connection of the superficial veins. The left external and anterior jugular veins opened at the confluence of veins that was drained by the venous arch that passed to the right side of the neck to open into the right external jugular vein. CONCLUSION: The coexistence of double superior vena cava with azygous and superficial jugular venous anomalies is considered to be incidental finding. However, continued documentation of such anomalies is clinically important, and it remains to be important in medical science.
Subject(s)
Azygos Vein/abnormalities , Cadaver , Coronary Sinus/pathology , Female , Humans , Jugular Veins/abnormalities , Middle Aged , Vena Cava, Superior/abnormalitiesABSTRACT
In this paper, we describe a case of an aneurysmal circumflex artery connected to the coronary sinus through a fistula in a 40-year-old man with a two-year history of palpitation and chest pain. We discussed surgical management for patients with coronary artery fistula [CAF], particularly for asymptomatic patients with a small left-to-right shunt