Accessory Mitral Valve Tissue and Internal Mammary Artery Stenosis: Unique Considerations After Cardiac Arrest.

A man with recurrent syncope and remote aortic coarctation repair experienced cardiac arrest with exercise stress testing. Critical coronary stenosis was discovered. Further evaluation revealed accessory mitral valve tissue and internal mammary artery occlusion. These rare abnormalities, not previously reported together, presented challenges to treatment. (Level of Difficulty: Intermediate.).

Fluoroless catheter ablation in adults: a single center experience.

BACKGROUND: Ablation procedures for arrhythmias have increased in frequency and complexity over the last decade. Improvements in technology have allowed for less reliance on fluoroscopy to guide these procedures. Ablation without fluoroscopy has been reported in small cohorts. We report a single center experience of fluoroless ablation after adoption of this technique for all endovascular ablations. METHODS: This retrospective study evaluated 107 consecutive patients who underwent a catheter ablation procedure for an atrial or ventricular arrhythmias after adoption of a completely fluoroless technique. No fluoroscopy was used in any case. A mapping system was utilized in all cases. Intracardiac echocardiography (ICE) catheters were utilized in 75 of the ablation cases (70.4%). Of the 107 patients who underwent EP study, three patients did not undergo ablation as they were non-inducible for SVT. Of the remaining 104 patients, 56 patients (53.8%) underwent ablation for atrial fibrillation, 23 patients (22.1%) for SVT, 10 patients (9.6%) for lone atrial flutter, and 16 patients (15.4%) for a ventricular arrhythmia including PVC, idiopathic VT or ventricular tachycardia. RESULTS: Catheters were able to be placed in 100% of patients without complication. Time to placement in the coronary sinus was 2.1 min ± 1.4 min. Mean transseptal time was 3.54 min ± 3 min. Mean procedure time for all ablations was 2 h 6 min ± 50 min. There were no complications in the series of patients. CONCLUSIONS: Fluoroless ablation is feasible and safe with acceptable procedure times. Adoption of this technique is encouraged in order to eliminate unnecessary risk of fluoroscopy.

Rotors in patients with persistent atrial fibrillation: case report of a left atrial appendage rotor identified by a novel computational mapping algorithm integrated into 3-dimensional mapping and termination of atrial fibrillation with ablation.

Recent clinical trials using panoramic mapping techniques have shown success in targeting rotors and focal impulses in atrial fibrillation (AF). Ablations directed toward these organized sources improve outcomes in AF. The left atrial appendage (LAA) has been suspected as a possible extrapulmonary source of AF, and ablation within the LAA or electrical isolation of the LAA improves outcomes in certain cases. This case highlights a unique example of panoramic imaging created with a computational mapping algorithm integrated in 3-dimensional mapping, which identified rotors within the LAA. Furthermore, ablations performed near an identified rotor core within the LAA terminated AF.

Risk factors for laryngospasm in children during general anesthesia.

BACKGROUND: Laryngospasm is a common and often serious adverse respiratory event encountered during anesthetic care of children. We examined, in a case control design, the risk factors for laryngospasm in children. MATERIAL AND METHODS: The records of 130 children identified as having experienced laryngospasm under general anesthesia were examined. Cases were identified from those prospectively entered into the Mayo Clinic performance improvement database between January 1, 1996 and December 31, 2005. Potential demographic, patient, surgical and anesthetic related risk factors were determined in a 1 : 2 case-control study. RESULTS: No individual demographic factors were found to be significantly associated with risk for laryngospasm. However, multivariate analysis demonstrated significant associations between laryngospasm and intercurrent upper respiratory infection (OR 2.03 P = 0.022) and the presence of an airway anomaly (OR = 3.35, P = 0.030). Among those experiencing laryngospasm during maintenance or emergence, the use of a laryngeal mask airway was strongly associated even when adjusted for the presence of upper respiratory infection and airway anomaly (P = 0.019). Ten patients experienced postoperatively one or more complications whereas only three complications were observed among controls (P = 0.008). No child required cardiopulmonary resuscitation and there were no deaths in either study cohort. CONCLUSIONS: In our pediatric population, the risk of laryngospasm was increased in children with upper respiratory tract infection or an airway anomaly. The use of laryngeal mask airway was found to be associated with laryngospasm even when adjusted for the presence of upper respiratory tract infection and airway anomaly.