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Pulmonary Vascular Disease
Published in Paul Schoenhagen, Frank Dong, Cardiac CT Made Easy, 2023
In congenital heart disease, pulmonary vein anatomy is relevant in the assessment of abnormal venous return (see Chapter 11). In the context of electrophysiology, pulmonary vein anatomy is relevant for treatment planning and assessment of complications of percutaneous ablation procedures at the pulmonary vein ostia for chronic atrial fibrillation. Imaging of the pulmonary veins before the procedure for 3-D guidance and more frequently after the procedure for diagnosis and surveillance of pulmonary vein stenosis is now commonly performed.124 Post-interventional complications include wall thickening and luminal stenosis (Figures 9.3–9.7). CT is sensitive in identifying and grading stenosis, but limited in differentiating subtotal and total venous occlusion. An important advantage of CT is the ability to visualize inflammatory changes associated with the development of vein stenosis, including wall thickening at the vein ostia and mediastinal lymph node enlargement. Other imaging modalities including echocardiography and MRI can reliably image the pulmonary veins.125 If severe pulmonary vein stenosis requires angioplasty and stenting, pre-procedural planning and post-procedural assessment of stent position and patency can reliably be performed with CT (Figures 9.8 and 9.9).
Lung Matters
Published in Namrita Lall, Medicinal Plants for Cosmetics, Health and Diseases, 2022
The lungs are the major organs of the respiratory system, with this pulmonary circulation aiding in gaseous exchange. Each of the lungs is paired and separated into lobes, with the left lung consisting of two lobes and the right lung consisting of three lobes. Blood circulation to the lungs plays a vital role, as blood is required to transport oxygen from the lungs to other tissues throughout the body. Deoxygenated blood from the body is delivered to the lungs via the pulmonary artery to the capillaries that form respiratory membranes with the alveoli, where oxygen is replenished. The pulmonary veins then return newly oxygenated blood to the heart for further transport throughout the body. Parasympathetic and sympathetic nervous systems throughout the lungs coordinate both bronchodilation and bronchoconstriction of the airways. The pleural membrane that is composed of visceral and parietal pleural layers encloses the lungs. These two layers have a space between them known as the pleural cavity. The pleural membrane has mesothelial cells which create pleural fluid, serving as a lubricant to reduce friction during breathing and as an adhesive to adhere the lungs to the thoracic wall, thereby facilitating the movement of the lungs during ventilation (Baile, 1996).
Cardiorespiratory system
Published in Helen Butler, Neel Sharma, Tiago Villanueva, Student Success in Anatomy - SBAs and EMQs, 2022
4 Which structure receives the four pulmonary veins? Right atriumRight ventricleLeft atriumLeft ventricleAortic arch
Optimizing a MitraClip procedure with high frequency jet ventilation
Published in Baylor University Medical Center Proceedings, 2023
Manesh Kumar Gangwani, Fawad Haroon, Fnu Priyanka, Anthony Sonn
Transthoracic echocardiogram during hospitalization demonstrated moderate to severe mitral regurgitation and mild mitral annular calcification (Figure 1a). Transesophageal echocardiography (TEE) confirmed the presence of mildly thickened leaflets with some tethering/restriction of the posterior mitral valve leaflet (Figure 1b-1f). The effective regurgitant orifice was 0.37 cm2 and the regurgitant volume, 50 mL (Figure 1g). Pulmonary vein flow showed systolic blunting. The posterior leaflet length was 1 cm. She had severe three-vessel native coronary artery disease, with patent in situ left internal mammary artery to left anterior descending artery and patent vein grafts from the aorta to the diagonal system and posterior descending artery. The case was reviewed by a multidisciplinary team (that included a cardiothoracic surgery team), and given the patient’s age, multiple comorbidities, and failure of medical management, it was decided that she was not a surgical candidate. As a result, elective MitraClip deployment (Generation 3 XTR clip) was pursued.
Real-world data meta-analysis: procedural success and clinical outcomes after radiofrequency ablation of atrial fibrillation in South America
Published in Hospital Practice, 2022
Carlos Pablo Boissonnet, Mariano Aníbal Giorgi, Gastón Claudio Köhler, Luciano García Roura, Juan María Ginestar
Pooled estimation of arrhythmia recurrence at 12 months was 19.9% (95% CI 17.0–23.1). Unfortunately, criteria for arrhythmia recurrence were dissimilar between studies: a) any episode of AF ≥30 seconds (one study), b) any episode of supraventricular tachyarrhythmia ≥30 seconds (3 studies), c) any episode of atrial flutter o AF without mention to duration (2 studies), d) any episode of supraventricular tachyarrhythmia without mention to duration (2 studies), and e) no mention about the applied criteria (3 studies). We did not make any estimation about 3 months nor 6 months recurrence (reported by only one and two studies, respectively) nor the rate of re-do procedures (reported in 4 studies without a clear specification of time elapsed from the index procedure). The only clinical complication reported after hospital phase was pulmonary vein stenosis, whose incidence was estimated by the random-effects model at 1.0%, 95% CI 0.5–1.9.
Interventions in Congenital Heart Disease:A Review of Recent Developments: Part I
Published in Structural Heart, 2021
Congenital pulmonary vein stenosis (PVS) is rare and can occur in isolation or in association with other CHD. Acquired PVS is most commonly observed after surgical repair of anomalous pulmonary venous connections. The disease is often progressive, leading to pulmonary hypertension, right ventricular failure, and death. Bilateral and multivessel PVS and younger age at presentation portend a poor prognosis.64,65 Reported 1-year mortality among those with 3 to 4 vein stenoses compared to those with 1 or 2 vein stenoses is 83% versus 36% (p < 0.01), and in those with bilateral compared to unilateral disease, 78.7% versus 26% (p <0.01). The substantial mortality rate even in those with 1 to 2 vessel disease highlights the importance of disease severity and location as predictors of outcomes.64 Histologic studies have shown myofibroblastic proliferation as the mechanism responsible for primary PVS and recurrence in progressive lesions,66 with activated tyrosine kinase receptors noted in human specimens.67 In a surgical porcine model, neointimal proliferation was associated with transforming growth factor beta signaling and activation of other signaling pathways.68,69