Angiology
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Catheter ablation is the treatment of choice for certain patients with drug-refractory paroxysmal or even persistent atrial fibrillation. Several techniques are used with a similar success rate of approximately 70% over 6 to 12 months of follow-up. Pulmonary vein isolation by conventional antral or electroanatomic circumferential ablation is mainly used in patients with paroxysmal atrial fibrillation. Electrogram-guided and combined approaches are also used, particularly in patients with persistent atrial fibrillation, whereas new methods such as autonomic denervation are under investigation.
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Behçet's disease is a systemic inflammatory disorder characterized by vasculitis, which affects all types and sizes of blood vessels. A thrombotic tendency with a predilection for the venous side of the vasculature is well known for Behçet's disease. However, central vein involvement is a rare complication. The authors report an unusual case of complete thrombosis of the supraazygos superior vena cava, brachiocephalic veins, as well as right internal jugular vein in a patient who is a young woman with Behçet's disease.
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Venous catheters are important therapeutic devices for the administration of fluid and chemotherapeutic agents; however, their use may be associated with serious complications, such as catheter rupture and embolism. Most data on port catheter embolization consist of isolated case reports; only a few studies have examined a large number of patients with port catheter embolism. The purpose of this study was to identify the incidence of clinical symptoms in patients with catheter dislocation and to determine the role of catheter fragment localization in combination with the presenting symptoms. ⋯ In these patients, predominantly local symptoms occur; however, severe systemic clinical signs may develop. The risk of serious complications in asymptomatic catheter embolism is unknown. Catheter fragments should be removed to prevent further complications.
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Migration of endovascular stents is a rare problem but can be fatal. We report an unusual case of an endovascular stent in the right ventricular outflow tract, which migrated from superior vena cava in a patient with superior vena cava syndrome.
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Sympathetic skin response (SSR) and R-R interval variation (RRIV) are noninvasive electrophysiological tests used in the assessment of sympathetic and parasympathetic nervous system function, respectively. Cardiac syndrome X (CSX) is usually diagnosed in the presence of typical angina pectoris, a positive response to exercise testing, and normal-appearing coronary angiograms without spasm induced by hyperventilation or ergonovine. Alterations of autonomic nervous system control of cardiac function have been described in CSX. ⋯ A linear correlation was found between SSR amplitude and D%/R% (r = 0.336, p = 0.036). The authors conclude that, among patients with CSX, there are alterations of autonomic nervous control of skin as well as of other organs (ie, heart). SSR and RRIV testing can be done easily in the neurophysiology laboratory to assess the sympathetic and parasympathetic system, respectively.