The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 1999
ReviewCatheter ablation of pulmonary vein foci for atrial fibrillation: PV foci ablation for atrial fibrillation.
While experimental and human mapping studies have documented multiple wavelet reentry as the electrophysiological mechanism maintaining atrial fibrillation, recent evidence shows that nearly all paroxysms of atrial fibrillation are initiated by trains of rapid discharges from the pulmonary veins. Radiofrequency catheter ablation targeting these initiating triggers has resulted in an overall 69% freedom from atrial fibrillation at a follow-up of 8 +/- 4 months in a population of 110 patients with paroxysmal atrial fibrillation. Six of the targeted pulmonary veins (4%) developed pulmonary vein stenosis; none requiring specific treatment. Catheter ablation of pulmonary vein foci initiating atrial fibrillation is therefore an effective curative modality for paroxysmal atrial fibrillation.
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Thorac Cardiovasc Surg · Aug 1999
Case ReportsValue of video-assisted thoracic surgery in traumatic extrapleural hematoma.
The current article reports on a rare case recently experienced, in which a medially displaced extrapleural fat layer with parietal pleura, revealed by CT scan of the chest, was a sign of traumatic extrapleural hematoma. Video-assisted thoracic surgery was not suited to approaching and managing the extrapleural hematoma, so that a limited thoracotomy was mandatory. Extrapleural hematoma should be considered a relative major contraindication to video-assisted thoracic surgery.
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Thorac Cardiovasc Surg · Aug 1999
Time-dependent efficacy of initial reperfusion with 2,3 butanedione monoxime (BDM) on release of cytosolic enzymes and ultrastructural damage in isolated hearts.
Reperfusion injury after cardioplegia may not be sufficiently addressed by conventional cardioplegic techniques in open heart surgery. 2,3-butanedione monoxime (BDM) has the potential to reduce myocardial reperfusion injury by uncoupling myocyte contraction from the intracellular calcium concentration, thus reducing reperfusion contracture. The aim of this study was to investigate the effects of different application periods of BDM during initial reperfusion on myocardial tissue injury after cardioplegia. ⋯ Both 20 and 40 min of initial reperfusion effectively protected the hearts from reperfusion damage as indicated by cytosolic enzyme release, while 5 min of treatment were clearly insufficient. Toxic effects of BDM during the longer treatment period of 40 min or induction of edema by the long-term perfusion of non-beating hearts in this group may account for the worse preservation of myocardial ultrastructure in BDM-40 hearts. Thus, contraction uncoupling during initial reperfusion by BDM or similarly acting drugs may prove a viable principle for reduction of myocardial reperfusion injury. However, the ideal duration of treatment for the best therapeutic effect must be carefully evaluated.