Falha de integridade dos elétrodos de desfibrilhação Riata e Riata ST: um problema atual

Riata and Riata ST silicone defibrillation leads are prone to externalization of conductors due to inside-out abrasion in the high-voltage system, causing structural damage which may be accompanied by electrical failure. These situations are easily detected by fluoroscopy or radiology and by inspection of intracardiac electrograms and/or measurement of impedance. However, older pulse generators do not automatically perform all the measurements needed to assess the integrity of the high-voltage electrical system, nor do they have patient notifier alerts in case of dysfunction.The authors describe the case of a patient in whom structural damage was detected on fluoroscopy during pulse generator replacement. They discuss the best strategy in these patients, considering current knowledge of this dysfunction.     

Stroke Risk Before and After Central Retinal Artery Occlusion in a US Cohort

Objective

To determine the risk of ischemic stroke, transient ischemic attack (TIA), and amaurosis fugax around the time of central retinal artery occlusion (CRAO).

Central retinal artery occlusion as a first sign of atrial fibrillation: A 3‐year retrospective single‐center analysis

BackgroundCentral retinal artery occlusion ((C)RAO) is known to be associated with stroke and/or atrial fibrillation (AF). Nevertheless, patients often present at the ophthalmologist initially and it is unknown how many of these receive an adequate cardiological/neurological work‐up (CWU/NWU), including a 24 h‐Holter‐ECG.HypothesisHypothesis of this study was that patients with (C)RAO do not undergo CWU on regular basis and that new‐onset AF is more often detected in patients with CWU.Methods and resultsWe performed a retrospective analysis of n = 292 consecutive patients who presented at an ophthalmology department with the diagnosis of (C)RAO during a 3‐year period. After excluding patients with known AF, meeting exclusion criteria, inability to comply with the protocol, missed land phoneline, or death during follow‐up a total of 174 patients were enrolled; mean follow‐up was 20 ± 12 months. The CHA₂DS₂‐VASc score of the cohort was 5.3 ± 1.4. Our analysis revealed that only 50.6% of patients received a CWU including a single Holter‐ECG after the index‐event. In 12.6% cases new‐onset AF was diagnosed, while the rate was higher in patients with CWU compared to patients without CWU (18.2 vs. 7.0%; p = 0.26). Evaluation of oral anticoagulation (OAC) therapy showed that only 66% of patients with AF were treated according to guidelines.ConclusionOnly half of patients with (C)RAO underwent CWU. Despite minimal monitoring, rate of new diagnosed AF was high. Our results confirm that (C)RAO identifies a high‐risk population for AF. These results illustrate the importance to implement standardized CWU in (C)RAO patients presenting at the ophthalmologist.     

Fluoroscopic Anatomy of Right-Sided Heart Structures for Transcatheter Interventions

Performing transcatheter tricuspid valve interventions requires a thorough knowledge of right-heart imaging. Integration of chamber views across the spectrum of imaging modalities (i.e., multislice computed tomography, fluoroscopy, and echocardiography) can facilitate transcatheter interventions on the right heart. Optimal fluoroscopic viewing angles for guiding interventional procedures can be obtained using pre-procedural multislice computed tomography scans. The present paper describes fluoroscopic viewing angles necessary to appreciate right-heart chamber anatomy and their relationship to echocardiography using multislice computed tomography.     

Original methods to move femoral head medially and caudally after rotational acetabular osteotomy: especially to use ceramic spacer

The operative procedures chosen to treat arthrosis in patients with severe acetabular dysplasia vary among orthopaedic surgeons, particularly in younger patients. We operated on 450 hips with acetabular dysplasia by using the rotational acetabular osteotomy (RAO) method of Ninomiya and Tagawa by Ninomiya (Clin Orthop 247:127–137, 1989). In this report, we describe our technique of performing RAO with hydroxyapatite tricalcium phosphate-composite (HAP-TCP) blocks to achieve good acetabular coverage and the results of this procedure in 16 hips with severe dysplasia, including nine with advanced arthrosis. Adequate coverage of the osteotomized acetabulum was maintained and symptoms, especially pain, showed marked improvement at the latest follow up.     

Estimation of left ventricular volume from apical orthogonal 2-D echocardiograma

In 42 consecutive patients undergoing biplane left ventricularcine-angiography, left ventricular volumes were first determinedultrasonically using a phased array transducer. To this end,two orthogonal apical long axis views were recorded one illustratingall four chambers, the other being the ‘RA O equivalent’view. Left ventricular volumes wer estimated by applying thearea-length method to both two-dimensional echocardiograms andcine-angiograms, consistently including in the former the leftventricular outflow tract of the ‘RAO equivalent’view. The echocardiographic approach employed was shown to yield goodpredictions of the angiographic results. For the end-diastolicvolume the correlation is characterized by r=0.98 and SEE 21ml or 9.7% of the angiographic mean and for the end-systolicvolume by r=0.97 and SEE 17 ml or 18.1% of the mean. The correlationfor the ejection fraction showed an r value of 0.87 and a SEEof 5.4%. Equally good correlations were obtained in the subgroupwith wall motion disorders for which the r values of the end-diastolicand end-systolic volumes were both 0.98 and that of the ejectionfraction was 0.89     

Fluoroscopic Anatomy of Left-Sided Heart Structures for Transcatheter Interventions: Insight From Multislice Computed Tomography

With the introduction of transcatheter structural heart therapies, cardiologists are increasingly aware of the importance of understanding anatomical details of left-sided heart structures. Understanding fluoroscopic cardiac anatomy can facilitate optimal positioning and deployment of prostheses during transcatheter valve repair/replacement, left atrial appendage occlusion, septal defect closure, and paravalvular leak closure. It is possible to use multislice computed tomography to determine optimal fluoroscopic viewing angles for such transcatheter therapies. The purpose of this paper is to describe how optimal fluoroscopic viewing angles of left-sided heart structures can be obtained using computed tomography. Two- and 3-chamber views are described and may become standard in the context of transcatheter structural heart interventions.