ABSTRACT
BACKGROUND: Pulmonary vein (PV) antrum isolation with ganglionated plexi (GP) ablation is a novel atrial fibrillation (AF) ablation technique. The aim of this study was to evaluate acute changes in left atrial and PV flow velocities following PV antrum isolation with GP ablation using transesophageal echocardiography (TEE). METHODS: TEE was performed before and after PV antrum isolation with GP ablation in 88 consecutive patients. All four PVs, when possible, were analyzed with regard to peak systolic and diastolic pulsed-wave Doppler flow velocities. Left atrial appendage emptying velocities were also obtained. PV stenosis was defined as a peak PV Doppler flow velocity of ≥110 cm/sec with spectral broadening (turbulence). RESULTS: All but four right inferior and four left inferior PVs were visualized. Compared to preablation values, both PV systolic and diastolic velocities increased after ablation (P < 0.05 for each of the four PVs). However, the systolic to diastolic ratio decreased significantly after ablation in all PVs (1.3 ± 0.6 to 0.9 ± 0.4, P < 0.0001, 1.2 ± 0.7 to 0.9 ± 0.4, P < 0.0001, 1.2 ± 0.6 to 1.0 ± 0.6, P = 0.035 and 1.1 ± 0.5 to 0.9 ± 0.5, P = 0.0001, for left superior, left inferior, right superior and right inferior PV, respectively). Left atrial appendage emptying velocities showed a trend towards higher values following ablation (62.7 ± 26.1 cm/sec vs. 67.5 ± 23.2 cm/sec, P = 0.07). Asymptomatic PV stenosis occurred in seven patients (seven PVs). CONCLUSIONS: PV antrum isolation with GP ablation acutely increased PV flow velocities and altered the pattern of PV Doppler flow signal, likely correlating with increased left atrial pressures, but did not appear to adversely impact on left atrial appendage physiology.
Subject(s)
Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/surgery , Catheter Ablation/methods , Echocardiography, Transesophageal/methods , Heart Atria/diagnostic imaging , Heart Atria/surgery , Pulmonary Veins/diagnostic imaging , Pulmonary Veins/surgery , Adult , Aged , Atrial Fibrillation/physiopathology , Blood Flow Velocity , Comorbidity , Female , Heart Atria/physiopathology , Humans , Male , Middle Aged , Pulmonary Veins/physiopathology , ReoperationABSTRACT
PURPOSE: To report a case of group B streptococcus (GBS) endogenous endophthalmitis in a patient presenting with septic arthritis and a homonymous hemianopsia due to embolic stroke. DESIGN: Observational case report. METHODS: A 75-year-old woman with septic arthritis and a homonymous hemianopsia due to embolic stroke was examined and found to have endogenous GBS endophthalmitis due to bacterial endocarditis. RESULTS: Magnetic resonance imaging showed many septic emboli to the brain, including the left occipital lobe. Fundus examination showed evidence for endogenous endophthalmitis. Blood and urine cultures were positive for GBS. A mitral valve vegetation was presumed to be the cause of the intracranial septic emboli and was demonstrated on transesophageal echocardiography. CONCLUSIONS: Septic arthritis and embolic stroke are suggestive of endocarditis and sepsis. Endogenous endophthalmitis in this case led to transesophageal echocardiography, which was diagnostic for endocarditis.
Subject(s)
Arthritis, Infectious/diagnosis , Endophthalmitis/diagnosis , Eye Infections, Bacterial/diagnosis , Hemianopsia/diagnosis , Intracranial Embolism/diagnosis , Streptococcal Infections/diagnosis , Streptococcus agalactiae , Stroke/diagnosis , Aged , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Echocardiography, Transesophageal , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Endophthalmitis/drug therapy , Endophthalmitis/microbiology , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Female , Hemianopsia/drug therapy , Hemianopsia/microbiology , Humans , Intracranial Embolism/drug therapy , Intracranial Embolism/microbiology , Magnetic Resonance Imaging , Streptococcal Infections/drug therapy , Streptococcal Infections/microbiology , Stroke/drug therapy , Stroke/microbiology , Visual Acuity , Visual Field TestsABSTRACT
The Chiari malformations are characterized by herniation of posterior fossa contents through the foramen magnum. Chiari I malformation is currently defined as ectopia of the cerebellar tonsils more than 5 mm below the foramen magnum. Extension of the cerebellar tonsils up to 3 mm may be found in the normal population. Although Chiari malformations are congenital, symptoms often do not manifest until the third and fourth decades of life, or even later. Patients usually present with headache, lower cranial nerve palsies, downbeat nystagmus, ataxia, or dissociated anesthesia of the trunk and extremities. Definitive diagnosis is made by magnetic resonance imaging (MRI), which shows the compressed tonsils extending through the foramen magnum into the cervical subarachnoid space. One of the rare presenting signs of Chiari I malformations is acquired esotropia with a divergence insufficiency pattern. We report such a case in which the initial neuroimaging showed tonsillar herniation, but of insufficient magnitude to meet diagnostic criteria for Chiari I malformation. When the strabismus recurred after initially successful eye muscle surgery, follow-up scan showed progressive tonsillar herniation.
