Anatomical consideration for safe pericardiocentesis assessed by three-dimensional computed tomography: Should an anterior or posterior approach be used?

AbstractBackgroundThe efficacy of epicardial catheter ablation for ventricular tachycardia has been reported. However, the safest anatomical method for pericardial puncture has not been determined.MethodsThirty patients who underwent 3-dimensional computed tomography (3D-CT) preceding catheter ablations for atrial fibrillation were enrolled in this study. We used the skin surface 1cm below the xiphisternum as the puncture site. For the anterior approach, the attainment site was the pericardium of the mid portion of right ventricular anterior site, and for the posterior approach it was the pericardium of the inferior ventricular site. The distance and the angle between the 2 sites were measured using 3D-CT.ResultsFor the anterior approach, the distance was 54±11mm and the needle angle was 37±11° toward the left scapula and 34±12° towards the back of the body. For the posterior approach, the distance was 56±10mm and the corresponding needle angles were 60±9° and 86±13°. The distance correlated with BMI for the anterior and posterior approaches (anterior approach: r2=0.43, P<0.001; posterior approach: r2=0.49, P<0.001). Liver existed along the pathway of the posterior approach in 11 (37%) of 30 patients, and through in 2 (18%) of 11 patients. The liver and lung were not located along the pathway of the anterior approach in any patients.ConclusionsPerforming subxiphoid pericardiocentesis is anatomically safer via the anterior approach than via the posterior approach

Intra-cardiac echocardiography guided catheter ablation of a right posterior accessory pathway in a patient with Ebstein׳s anomaly

AbstractWe report a case of Ebstein׳s anomaly in which radiofrequency catheter ablation of an accessory pathway was successfully performed under intra-cardiac echocardiography. A 50-year-old woman was referred to our hospital for radiofrequency catheter ablation of a paroxysmal supraventricular tachycardia. A 12-lead surface electrocardiogram revealed ventricular pre-excitation associated with type B Wolff–Parkinson–White syndrome. In the baseline electrophysiological study, an orthodromic atrioventricular reciprocating tachycardia with a right posterior accessory pathway was induced. A phased-array intra-cardiac echo probe was positioned in the right atrium to visualize the atrioventricular junction. The key structures for catheter ablation, such as the atrialized right ventricle, atrioventricular junction, and tricuspid valve, were clearly visualized on intra-cardiac echocardiography. Radiofrequency current was successfully delivered at the atrioventricular junction, where a Kent potential was recorded. During a 6-month follow-up period, the patient was free from arrhythmias. The findings in this case suggest that phased-array intra-cardiac echocardiography is useful for ablation of right-sided accessory pathways in patients with Ebstein׳s anomaly

Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography

AbstractBackgroundThe radiofrequency (RF) lesions for atrial fibrillation (AF) ablation can be visualized by delayed enhancement magnetic resonance imaging (DE-MRI). However, the quality of anatomical information provided by DE-MRI is not adequate due to its spatial resolution. In contrast, magnetic resonance angiography (MRA) provides similar information regarding the left atrium (LA) and pulmonary veins (PVs) as computed tomography angiography. We hypothesized that DE-MRI fused with MRA will compensate for the inadequate image quality provided by DE-MRI.MethodsDE-MRI and MRA were performed in 18 patients who underwent AF ablation (age, 60±9 years; LA diameter, 42±6mm). Two observers independently assessed the DE-MRI and DE-MRI fused with MRA for visualization of the RF lesion (score 0–2; where 0: not visualized and 2: excellent in all 14 segments of the circular RF lesion).ResultsDE-MRI fused with MRA was successfully performed in all patients. The image quality score was significantly higher in DE-MRI fused with MRA compared to DE-MRI alone (observer 1: 22 (18, 25) vs 28 (28, 28), p<0.001; observer 2: 24 (23, 25) vs 28 (28, 28), p<0.001).ConclusionsDE-MRI fused with MRA was superior to DE-MRI for visualization of the RF lesion owing to the precise information on LA and PV anatomy provided by DE-MRI

ケツエキ トウセキ カンジャ ノ チョウキ セイメイ ヨゴ ヨソク インシ トシテノ トウセキゴ ノ ケッショウANP ト BNPノウド ノ ユウヨウセイ : 15ネンカン ノ ヨゴ チョウサ

透析患者52人において心胸比を透析前に,収縮期血圧,血清アルブミン,血漿心房性ナトリウム利尿ペプチド(atrial natriuretic peptide ; ANP),脳性ナトリウム利尿ペプチド(brain natriuretic peptide ; BNP),血漿レニン活性(plasma renin activity ; PRA),血漿ノルアドレナリン(plasma noradrenaline ; PNA)濃度を透析直後に測定した.患者は上記測定の中央値で高低2群に分けてKaplan-Meier (KM)生存曲線を求め,両群の比較をLogrank法で行った.生存期間に及ぼす因子解析は測定値を説明変数,生存期間を目的変数としてCox比例hazard法で行った.いずれもp<0.05を有意と判定した. 15年間で43人が死亡し,うち40人が病死であった. KM生存曲線は高年齢群(p<0.001),高ANP群(p=0.006),高BNP群(p=0.039)で有意に生存期間が短く,心胸比,収縮期血圧,血清アルブミン, PRA, PNAにおいては高低2群間に有意差を認めなかった. Cox比例hazard法による単変量解析では年齢(p<0.001),心胸比(p=0.011), ANP (p=0.003), BNP (p=0.002)が生命予後の有意なリスク因子となり,多変量解析ではp値は年齢<0.001,心胸比0.965, ANP 0.055, BNP 0.041となり,年齢とBNPが生命予後の独立したリスク因子であった.以上より透析患者において透析直後の血漿BNP濃度は長期生命予後の独立したリスク因子であり,血漿ANP濃度もリスク因子としてBNPに次いで重要であることが示された.This study was designed to clarify the clinical significance of post-dialysis plasma vasoactive substances including atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), plasma renin activity (PRA) and noradrenaline (PNA) as a survival predictor in chronic hemo-dialysis (HD) patients. Immediately after HD, blood samples were collected for the measurements of serum albumin, ANP, BNP, PRA and PNA in 52 HD patients. During 15-year follow-up period 43 patients died ; 40 of diseases, 2 accident, 1 suicide. Patients were divided into two groups using the median of their age and clinical and laboratory variables. Kaplan-Meier survival analysis revealed that the groups of older age, higher plasma ANP and BNP concentration had significantly lower survival rates as compared with each counterpart (p<0.001, p=0.006, p=0.039, respectively). Univariate and multivariate Cox proportional hazard regression analyses were used to assess the potential association of their age, and clinical and laboratory variables with a survival rate. As a result of Univariate Cox hazard analysis, age, cardiothoracic ratio (CTR), and plasma ANP, and BNP concentrations had significant relationship with overall mortality (p<0.001, p=0.011, p=0.003, and p=0.002, respectively). However, stepwise multivariate analysis revealed that the significant relationship with overall mortality was shown for their age (p<0.001) and BNP (p=0.041). These results demonstrated that the post-dialysis plasma BNP concentration was an independent risk factor for long-term survival and the post-dialysis plasma ANP concentration was also an important risk factor next to the BNP concentration

Near-Infrared Fluorescence Imaging of Renal Cell Carcinoma with ASP5354 in a Mouse Model for Intraoperative Guidance

Renal cell carcinoma is a prevalent disease associated with high morbidity and mortality rates. Partial nephrectomy is a first-line surgical option because it allows the preservation of renal function. Clear differentiation between normal and cancerous tissues is critical for increasing the negative margin rates. This study investigated the capability of the near-infrared (NIR) fluorescent imaging agent ASP5354 for in vivo fluorescence imaging of renal cell carcinoma. ASP5354 at a single dose of 12 nmol (0.037 mg)/kg body weight was intravenously administered to healthy and orthotopic renal cell carcinoma mice under anesthesia. NIR images of the abdominal cavity were obtained using a near-infrared fluorescence (NIRF) camera system. In addition, the cancerous kidneys were harvested, and the NIRF in their sections was measured using an NIRF microscope. Normal renal tissue emitted strong NIRF but the cancer tissue did not. The difference in NIRF intensity between the normal and cancer tissues clearly presented the boundary between the normal and cancer tissues in macro and micro NIRF imaging. ASP5354 can distinguish cancer tissue from normal tissue using NIRF. Thus, ASP5354 is a promising agent for renal cell carcinoma tissue imaging in partial nephrectomy for renal cell carcinoma patients

In Vivo Optical Imaging of Bladder Cancer Tissues in an MB49 Bladder Cancer Orthotopic Mouse Model Using the Intravesical or Intravenous Administration of Near-Infrared Fluorescence Probe

Bladder cancer was the twelfth most common cancer worldwide in 2020. Although bladder cancer has been diagnosed using macroscopic techniques, such as white-light cystoscopy and fluorescence blue-light cystoscopy, there is a need to explore more effective noninvasive optical imaging techniques for accurate bladder cancer diagnosis. This study demonstrates the high effectiveness of the near-infrared fluorescence (NIRF) probe ASP5354, which has been developed for ureteral identification during in vivo diagnosis of bladder cancer in an MB49 bladder cancer orthotopic mouse model. After the intravesical injection of 2.4 μM ASP5354 followed by bladder rinsing with saline at 5 min post injection or intravenous administration of ASP5354 at 240 nmol/kg mouse body weight, followed by a waiting period of 5–24 h in mice, ASP5354 was absorbed specifically by cancerous tissue and not by normal tissues in the bladder. NIRF of ASP5354 in cancer tissues was detected using the NIRF imaging camera system. The NIRF clearly showed a boundary between cancerous and normal tissues. Therefore, ASP5354 provides noninvasive and specific optical in vivo imaging of MB49 bladder cancer using intravesical or intravenous injection of ASP5354. ASP5354 may allow for new diagnostic applications for bladder cancer in humans

生体酸化ストレスの簡便・非破壊的化学発光イメージング技術の開発

application/pdf本研究は、生体組織における酸化ストレスを非破壊的にリアルタイムで解析する技術の開発を目的とした。 酸化ストレスの上流で産生されるスーパーオキサイドアニオンと化学反応し、生体での光透過性に優れた近赤外光を放出する化学発光プローブを開発し、ラットにおける皮膚炎、関節炎、急性腎臓障害における患部組織でのスーパーオキサイドアニオンをリアルタイムでin vivoイメージングし、スパーオキシドアニオンのin vivo挙動を解析・評価することに成功した。The purpose of this study was to develop a technology for non-destructive real-time analysis of oxidative stress in living tissues. I have developed a chemiluminescent probe that chemically reacts with superoxide anions produced upstream of oxidative stress and emits near-infrared light with excellent light transmission in vivo, in dermatitis, arthritis, and acute kidney damage in rats. I have succeeded in analyzing and evaluating the in vivo behavior of spuroxide anion by in vivo imaging of superoxide anion in the affected tissue in real time.2019年度～2021年度科学研究費補助金(基盤研究(C))研究成果報告書19K0554