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Intravascular Ultrasound for Molecular Imaging
Published in Robert J. Gropler, David K. Glover, Albert J. Sinusas, Heinrich Taegtmeyer, Cardiovascular Molecular Imaging, 2007
Other common interventional procedures include atherectomy, brachytherapy, and coronary bypass surgery. Atherectomy uses a small rotating blade on the tip of a catheter to disrupt plaque and collect debris with a suction tube. It is usually reserved for calcified plaques resistant to angioplasty or stent procedures (14), but it has the risk of vessel rupture or injury. Another interventional treatment is brachytherapy. It delivers focused radiation at the lesion site using a catheter, preferentially killing plaque cells. In more severe cases in which angioplasty or stent procedures are ineffective, coronary bypass surgery is required. Vessels are usually grafted from extremities to provide collateral flow around coronary occlusions. This surgical procedure requires a thorocotomy to gain access to the heart.
Intravital Microscopy
Published in Margarida M. Barroso, Xavier Intes, In Vivo, 2020
Mario Perro, Jacky G. Goetz, Antonio Peixoto
The challenges to perform IVM in the heart and lung are three: These are vital organs that require extreme care during surgical preparation, access to the thoracic cage requires mechanical ventilation, and these organs constitute the major sources of motion artifacts in IVM preparations. For IVM of the heart, several methods have been employed to stabilize this organ. These rely on the externalization of the organ and fixation either by sutures (Chilian and Layne, 1990), by compression with a coverslip (Li et al., 2012), or by attachment to a mechanical or suction-based stabilizer (Lee et al., 2012; Vinegoni et al., 2012). All of the above require mechanical ventilation, as proper intrathoracic pressure is no longer maintained during surgery. Alternatively, surgical techniques for longitudinal studies have been developed that rely on the surgical implantation of GRIN lenses (Jung et al., 2013). Similarly, several techniques have been developed for the lung IVM that rely on the establishment of a thoracic window by a thoracotomy (incision in the pleural space of the chest), that may or may not involve resection of some ribs but requires mechanical ventilation. Once the thoracic window is established, the lung is stabilized using either Vetbound glue to bond the organ to a cover glass on a microscope stage (Kreisel et al., 2010), a suction-based stabilizer equipped with a cover glass (Looney et al., 2011), clamping of the bronchus to stop movement (Hasegawa et al., 2010), or a transparent membrane to seal the thoracic window, while ensuring contact with the organ (Tabuchi et al., 2008). In addition, longitudinal IVM studies of the lung, indeed, a longitudinal lung IVM approach has recently been published, but the surgical implantation of a GRIN lens equipped with a suction-based stabilizer holds some promise. Altogether, these techniques have allowed fundamental studies of the mechanisms involved in the recruitment of neutrophils during pulmonary inflammation due to transplantation (Kreisel et al., 2010), ischemia reperfusion in the heart (Li et al., 2012), the immune-modulatory role of a subset of alveolar macrophages (Westphalen et al., 2014), the establishment of pioneer metastatic cells in the lung (Headley et al., 2016; Entenberg et al., 2018), and recruitment of monocytes during acute myocardial infarction (Jung et al., 2013).
Device profile of the AltaValve system for transcatheter mitral valve replacement: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2020
Alberto Alperi, David del Val, Alfredo Nunes Ferreira-Neto, Mathieu Bernier, Afonso B Freitas-Ferraz, François Dagenais, Josep Rodés-Cabau
The procedure is performed under general anesthesia through a left anterolateral thoracotomy. After exposure of the LV apex, it is punctured, and purse-string sutures are placed. The procedure is mainly guided by fluoroscopy using pre-procedural CT-derived working and deployment angles. A high-support guidewire is advanced through the mitral valve up to the left atrial roof. While the valve is being prepared and loaded onto the delivery catheter, a 36-F sheath with a 34-F dilator is advanced over the wire. Subsequently, the dilator is withdrawn and the 34-F delivery catheter with the loaded valve is introduced inside the sheath and advanced towards the mitral valve and left atrium. The delivery catheter is then progressively pulled back, allowing the deployment of the frame system. During this maneuver, valve repositioning is feasible by performing gently angulations and/or pushing-pulling movements. Transoesophageal echocardiography facilitates and guides orientation. When valve position is considered to be optimal, the prosthesis is released and the whole system retrieved. The access site is sealed with a surgical suture. Figure 2 schematically describes the different steps for trans-apical placement, and Figure 3 provides fluoroscopy and transoesophageal echo guidance images during procedure.