Novel approaches for the surgical treatment of atrial fibrillation: Time for a guideline revision?

Atrial fibrillation is a major health problem in Western countries, and is associated with considerable morbidity and resource consumption. Safe and reliable surgical techniques for the termination of this arrhythmia have been developed since the time of the original Cox “maze I” procedure. Novel equipment based on radiofrequency and microwave technologies can be employed to create transmural atrial lesions, even in the context of minimally invasive surgery to the atrioventricular valves via right minithoracotomy. The aim of this paper is to review the recent literature on this approach, and the clinical results in terms of arrhythmia termination and postoperative morbidity. With the aim to substantiate the practice of a simple, yet reliable, surgical ablation during minimally invasive heart valve surgery, we discuss the results of different patterns of atrial lesions having different degrees of surgical complexity. Finally, minimally invasive epicardial ablation for lone atrial fibrillation represents an emerging surgical indication. The results of state-of-the-art transcatheter ablation represent now its benchmark of comparison

Transcatheter Cardiac Surgery

The introduction of transcatheter aortic valve implantation (TAVI) have changed the management of patients affected by severe aortic stenosis. Nowadays, TAVI procedure represents the treatment of choice in patients with severe AS inoperable or at high risk. MDCT is the technique of choice in preoperative planning: it provides information regarding aortic valve and vascular access. Particular attention should be paid on bicuspid valve morphology. The choice of valve is, basically, based on confidence and experience of the operator and center

Urografia-TC multidetettore: ruolo diagnostico nella valutazione del paziente con ematuria non traumatica

L’ematuria può originare da qualsiasi tratto dell’apparato urinario e può essere anche unico segno di patologia neoplastica (cancro del rene o della vescica). La letteratura raccomanda pertanto di sottoporre ad attenta valutazione clinico-strumentale tutti i casi di ematuria, macroscopica e microscopica. Lo scopo del presente contributo è quello di definire il ruolo diagnostico dell’urografia-TC multidetettore (uTC-MD) nella valutazione di questo sintomo e analizzarne l’impatto nel management del paziente attraverso lo studio di 181 pazienti consecutivi valutati per macro- e microematuria nel periodo compreso tra gennaio 2003 e marzo 2006

Erroneous aortic arch placement of a transvenous pacemaker

[No abstract available

Transesophageal Echocardiography and Radiation-induced Damages

The long-term sequelae of mantle therapy include, especially lung and cardiac disease but also involve the vessels and the organs in the neck and thorax (such as thyroid, aorta, and esophagus). We presented the case of 66-year-old female admitted for congestive heart failure in radiation-induced heart disease. The patient had undergone to massive radiotherapy 42 years ago for Hodgkin's disease (type 1A). Transesophageal echocardiography was performed unsuccessfully with difficulty because of the rigidity and impedance of esophageal walls. Our case is an extraordinary report of radiotherapy's latency effect as a result of dramatic changes in the structure of mediastinum, in particular in the esophagus, causing unavailability of a transesophageal echocardiogram

Diagnosis of Primary Cardiac T-cell Lymphoma: Feasibility and Safety of Endomyocardial Biopsy Guided by Pre-acquired Cardiovascular Magnetic Resonance

Background: Multimodality imaging of a cardiac mass lesion may raise suspicion of a primitive cardiac lymphoma (PCL). However, a definitive diagnosis requires histopathological confirmation.Methods: This report describes the methodology we used to perform biopsy sampling of a cardiac mass lesion affecting a 45-year-old man. In order to increase endomyocardial biopsy diagnostic accuracy, we used pre-acquired cardiac magnetic resonance (CMR) images to guide the bioptome on a cardiac site overtly infiltrated by the suspected tumour. The right ventricular outflow tract was identified as the target site for biopsy sampling. To reduce the risk of the procedure, the biopsy was performed at a safe distance from the tip of a diagnostic quadripolar catheter positioned at the level of the pulmonary valve, previously identified by pacing manoeuvres. The reported approach demonstrated safety and diagnostic accuracy, allowing the identification of an extremely rare PCL subtype of T-cell origin.Conclusion: Biopsy sampling of a suspected tumour may be safely and accurately performed using pre-acquired CMR images to guide the bioptome on the target site

Submitral Ventricular Pseudoaneurysm: Unusual and Late Complication of Cardiac Surgery

Despite the background of advances in cardiac surgery procedures for higher risk population, the postoperative complication has already been a challenge for cardiac surgeon and Heart-Team. Future perspectives to exceed this challenge could be periodically patient’s follow up and advance diagnostic workup. We describe the diagnosis of a large sub mitral left Ventricle Pseudoaneurysm that was identified in a 59-year-old woman 17 years after she underwent aortic and mitral valve replacement for rheumatic valvular diseas

Dual energy CT (DECT) of the liver: Conventional versus virtual unenhanced images

OBJECTIVE: To compare image quality and noise of conventional unenhanced (CU) and virtual unenhanced (VU) images in patients who underwent hepatic dual energy computed tomography (DECT) and to assess potential radiation dose reduction. MATERIALS AND METHODS: Forty consecutive patients were studied. Mean CU and VU image quality and noise were analyzed by two blinded radiologists using a five-point grade scale. The effective radiation dose of a triple-phase protocol (CU, arterial and DE portal phases) were compared with that of a dual-phase protocol (arterial and DE portal phases). RESULTS: No significant difference in mean image quality was observed between VU (3.92 ± 0.85) and CU images (4.20 ± 0.72). A significant difference in mean image noise was observed between VU and CU (P < 0.01). The dose reduction achieved by omitting the unenhanced acquisition was 30.47 ± 7.07% (P < 0.01). In 6 patients, a complete VU liver image was not obtained. CONCLUSIONS: VU images can be obtained with similar image quality as CU. This approach favors a reduction in patient's radiation exposure. Nevertheless, a complete abdominal DECT is possible only in patients with a low body mass index, due technical limitations of the present DECT systems