Transesophageal Echocardiography-Guided Transseptal Left Atrial Access to Improve Safety in Patients Undergoing Pulmonary Vein Isolation

BACKGROUND: Endovascular pulmonary vein isolation (PVI) has become an important strategy for rhythm control in patients with symptomatic atrial fibrillation (AF). Transseptal access is a critical step of this procedure and can result in potentially life-threatening complications. This retrospective study evaluates the safety of standardized, transesophageal echocardiography (TEE)-guided transseptal access to the left atrium in consecutive patients who underwent PVI. METHODS: After the implementation of a standardized, TEE-guided procedure for transseptal access, the data of 404 consecutive PVI procedures using radiofrequency ablation and 3D-mapping were prospectively collected over 5 years. TEE-guided transseptal punctures were performed on 375 patients undergoing one to three PVIs. The patient cohort was retrospectively analyzed for major and minor complications, fluoroscopy time, fluoroscopy dose and ablation outcomes. RESULTS: No single complication related to transseptal access occurred, affirming the safety of the TEE-guided approach. Fluoroscopy time and fluoroscopy dose decreased significantly after 152 procedures. PVI-related minor complications occurred in 11 procedures (2.6%) and included 10 vascular-access-related complications (2.4%) and 1 TEE-related esophageal hematoma (0.2%), which healed spontaneously. CONCLUSION: Our single-center study shows that TEE guidance may allow safe transseptal access to the left atrium in patients undergoing PVI

Assessing the return on investments (cost-benefits) in prevention in Switzerland : a feasibility study

This study was commissioned by the Federal Office of Public Health, contract no. 06.003951

Influence of Pulse Bursts on the Specific Removal Rate for Ultra-Fast Pulsed laser Micromachining of Copper.

Compared to single pulses the utilization of pulse bursts on steel samples was reported to be more efficient. But with regards to the specific removal rate it can be shown that a maximum value is achieved when the applied peak fluence equals exp(2) times the threshold fluence. The higher reported efficiency is caused by the reduced energy of the single pulses nearer to the optimum value. Recent investigations on the application of pulse bursts on copper samples suggest an interaction of the single pulses in a pulse burst in terms of the specific removal rate. The specific removal rate drops to less than 50% for a 2-pulse-burst consisting of two pulses of identical pulse energy, whereas the maximum specific removal rate for a 3-pulse-burst exceeds that of a single pulse by approx. 20%. The results of investigations on the variation of pulse energy for 2-pulse-bursts and 3-pulse-bursts regarding specific removal rate and surface quality are presented

Cardiomyopathy Associated With Coronary Arteriosclerosis in Free-Ranging Eurasian Lynx (Lynx lynx carpathicus).

The Eurasian lynx (subspecies Lynx lynx carpathicus) was reintroduced to Switzerland in the 1970's. Health monitoring of the reintroduced population started in the late 1980's. Since then, six lynx have been found affected by a myocardial disease. The earliest case was an animal that died after a field anesthesia. Two lynx were found dead, two were euthanized/culled because of disease signs, and one was hit by car. Two had a heart murmur at clinical examination. At necropsy, the first animal showed only lung edema but the other five had cardiomegaly associated with myocardial fibrosis. Three had multisystemic effusions. Histological examination of all six lynx showed mild to severe, multifocal, myocardial interstitial and perivascular fibrosis along with multifocal myocyte degeneration and loss, and replacement fibrosis. Moderate to severe multifocal arteriosclerosis with associated luminal stenosis of the small and medium-sized intramural coronary arteries and the presence of Anitschkow cells was also observed. The heart lesions may have led to sudden death in the first case and to a chronic right-sided heart failure in the remaining. None of the lynx showed lesions or signs suggestive of an acute or subacute infection. Given the common geographic origin of these animals and the severe loss of heterozygocity in this population, a genetic origin of the disease is hypothesized

GPI-specific phospholipase D (GPI-PLD) is expressed during mouse development and is localized to the extracellular matrix of the developing mouse skeleton

Glycosylphosphatidylinositol-specific phospholipase D (GPI-PLD) is abundant in serum and has a well-characterized biochemistry; however, its physiological role is completely unknown. Previous investigations into GPI-PLD have focused on the adult animal or on in vitro systems and a putative role in development has been neither proposed nor investigated. We describe the first evidence of GPI-PLD expression during mouse embryonic ossification. GPI-PLD expression was detected predominantly at sites of skeletal development, increasing during the course of gestation. GPI-PLD was observed during both intramembraneous and endochondral ossification and localized predominantly to the extracellular matrix of chondrocytes and to primary trabeculae of the skeleton. In addition, the mouse chondrocyte cell line ATDC5 expressed GPI-PLD after experimental induction of differentiation. These results implicate GPI-PLD in the process of bone formation during mouse embryogenesis