The radial procedure was developed as an outgrowth
|
|
- Noel Perkins
- 5 years ago
- Views:
Transcription
1 The Radial Procedure for Atrial Fibrillation Takashi Nitta, MD The radial procedure was developed as an outgrowth of an alternative to the maze procedure. The atrial incisions are designed to radiate from the sinus node toward the atrioventricular annular margins and parallel the atrial activation sequence and the atrial coronary arteries. And the procedure avoids isolation of any atrial segments. The procedure has been shown to preserve a physiological atrial activation sequence, recruit more myocardium for the atrial transport function, and to prevent thromboembolism more effectively. The lesion set of the radial procedure in the right atrium (RA) are the same as the maze procedure, except for the excision of the right atrial appendage. The differences are in the left atrium (LA) and interatrial septum. The LA incisions, complying with the radial concept, recruit the posterior LA as a contractile component and preserve a physiological activation sequence and the atrial coronary arteries. The septal incision is reversed horizontally to preserve the blood supply to the posterior septum. The radial procedure is technically easier than the maze procedure, because the incisions are more linear and there is no isolation incision in the LA. 1 Atrial incisions, ablation lines, and sites of cryothermia in the radial procedure are shown. The left upper and middle schemas represent the anterior and posterior views of the atria, respectively. The four circles in the posterior left atrium indicate the pulmonary vein orifices. The right lower panel represents the interatrial septum. The broken lines indicate the cut-and-sew incisions and the full lines indicate the bipolar radiofrequency (RF) linear ablation lines. The small circles indicate the cryothermia at the atrioventricular annuli. The right atrial appendage is not excised, unlike the maze procedure, to preserve the secretion of the atrial natri-uretic peptide. The left atrial appendage is excised to prevent systemic thromboembolism due to thrombosis in the left atrial appendage. MV, mitral valve; TV, tricuspid valve; RAA, right atrial appendage; LAA, left atrial appendage; SVC, superior vena cava; IVC, inferior vena cava; FO, fossa ovalis; CS, coronary sinus. Operative Techniques in Thoracic and Cardiovascular Surgery, Vol 9, No 1 (Spring), 2004: pp
2 84 NITTA SURGICAL TECHNIQUE Preparation for Cardiopulmonary Bypass The chest is opened through a mid-line sternotomy. Both the superior vena cava (SVC) and inferior vena cava (IVC) are snared. The pericardium between the IVC and the right inferior pulmonary vein (PV) is dissected extensively, so that the oblique sinus between the right and left PVs is exposed. The patient is cannulated in the ascending aorta, SVC, and lower RA. A normothermic cardiopulmonary bypass is then initiated. We usually isolate the right and left PVs by means of a bipolar radiofrequency (RF) device before making the RA incisions in patients with paroxysmal AF. Complete electrical isolation is verified by the demonstration of conduction block during pacing with the maximal output from the isolated right and left PVs while the heart is beating. 2 A small incision is made at the top of the right atrial appendage. The appendage is not excised, but all the major trabeculae inside the appendage are divided to prevent microreentry. The incision is extended inferiorly by a pair of scissors or a bipolar RF device. One jaw of the bipolar RF device is inserted into the RA and a linear ablation line is made on the lateral RA. The distal end of this incision should be 4 cm above the IVC cannula. A horizontal incision is made on the lower RA between the lateral RA incision and the IVC cannula. At least 2 cm of distance should be kept between the distal end of the lateral RA ablation line and the horizontal incision to allow the sinus impulse to propagate into the anterior RA between the lateral incision and the atrioventricular groove. The horizontal incision is extended posteriorly, crossing the crista terminalis, down to the interatrial septum. A marker in the middle of the incision assists later closure.
3 RADIAL PROCEDURE FOR ATRIAL FIBRILLATION 85 3 This incision is then extended, using angled scissors, all the way up to the SVC, where no myocardium is visible. The incision is made posteriorly to the crista terminalis, and care is needed to be taken to avoid any injury to the sinoatrial node located at the junction of the RA and the SVC.
4 86 NITTA 4 This lesion can be replaced by the bipolar RF device. The device is properly placed at the posterior RA between the crista terminalis and the interatrial septum, anterior to the right superior and inferior PVs, so that a transmural linear ablation lesion is made along the entire length. 5 A linear lesion between the horizontal incision and the IVC is then made with the bipolar RF device.
5 RADIAL PROCEDURE FOR ATRIAL FIBRILLATION 87 6 The horizontal incision made in the lower RA is extended anteriorly toward the atrioventricular groove. The atrial myocardium in the atrioventricular groove is carefully dissected by means of a #15 scalpel from inside the RA. It is extremely important to divide all the muscle fibers across this incision. Then the distal end of the atriotomy is cryoablated using a 5-mm cryoprobe for 2 minutes at 60 C.
6 88 NITTA 7 The incision made at the top of the right atrial appendage is extended antero-medially toward the right atrioventricular fat pad. Usually, the sino-atrial nodal artery from the right coronary artery can be identified close to this incision, and care needs to be taken to avoid any injury to or traction on this artery. The lateral RA is lifted using a couple of forceps and the incision is extended down to the tricuspid valve annulus by means of a #15 scalpel. The dissection ends at the annulus 1 to 2 cm above the membranous septum. Then the distal end of the atriotomy at the annulus is cryoablated. The incision is closed with a 3-0 Prolene continuous suture. The lower RA incision is also closed in the same fashion. As the top of the atrioventricular groove is reached, the RA flap is turned back down, and the incision is closed from outside the RA to one third of its length.
7 RADIAL PROCEDURE FOR ATRIAL FIBRILLATION 89 8 The ascending aorta is cross-clamped and cardioplegic solution is infused antegradely and retrogradely. A vertical septal incision is made at the fossa ovalis and extended infero-posteriorly. Then the posterior RA is incised, and extended to the septal incision.
8 90 NITTA 9 From the junction of the septal incision and the posterior RA incision, the lower LA is incised transversely toward the posterior mitral valve annulus. Again, a marker in the middle of the incision assists later closure. The incision ends at the posterior mitral annulus between the middle (P2) and postero-medial scallops (P3) of the posterior mitral leaflet. This is because the distal ends of the left circumflex coronary artery and right coronary artery converge at the level of P2-P3 junction in most patients so that the dissection of the atrioventricular fat pad can be safely performed. However, approximately 10% of humans are said to have a large posterior interventricular artery that perfuses the right and almost half of the left ventricles. In these particular patients, the LA incision should be directed more craniad at the posterior mitral annulus. For this reason, preoperative coronary angiography is recommended in all patients who are scheduled for surgery for AF.
9 RADIAL PROCEDURE FOR ATRIAL FIBRILLATION The atrial myocardium at the atrioventricular groove is carefully dissected in the same fashion as in the RA. Then the distal end of the incision at the mitral annulus and the coronary sinus (CS) are cryoablated. A 5-mm and a 15-mm cryoprobe are used for the mitral annulus and the CS ablation, respectively. During the CS ablation, the cardioplegia catheter inserted into the CS is pulled back to make a complete circumferential cryolesion on the CS.
10 92 NITTA 11 The left atrial appendage is safely excised from outside the heart. The operating table is inclined toward the surgeon and the main trunk of the pulmonary artery is displaced toward the right side by a retractor to expose the left atrial appendage. The appendage is totally removed and any atrial myocardium having a trabecula is excised.
11 RADIAL PROCEDURE FOR ATRIAL FIBRILLATION The bipolar RF device is introduced into the left superior PV through the excised appendage orifice with the tip directed into the left superior PV and a linear ablation is made between the orifice and the PV. The left superior PV is dissected between the left pulmonary artery, and the superior and inferior PVs are taped. The LA is clamped 1 cm proximal to the orifice of the left superior and inferior PVs, and RF energy is applied to electrically isolate the PVs from the LA. Then the left atrial appendage is closed with a 3-0 Prolene continuous suture.
12 94 NITTA 13 The inclined table is restored, and the right superior PV is dissected between the right pulmonary artery and the superior and inferior PVs are taped. The LA at the junction of the right superior and inferior PVs is clamped with the bipolar RF device, and the PVs are isolated in the same fashion as on the left side. A linear ablation is made between the right inferior PV and the posterior LA incision with the bipolar RF device to block the reentrant circuit around the right PVs. Another linear ablation is made between the left inferior PVs and the posterior LA incision in the same fashion. After the completion of the radial incisions, all the atrial incisions are closed with a 3-0 Prolene continuous suture. The continuous suture is started from the distal end of the LA incision at the posterior mitral annulus. The atrial endocardium and myocardium are closed over the atrioventricular fat pad and the CS. The continuous suture makes a transition to full-thickness stitches on the infero-posterior LA free wall. It is important to avoid making a dog ear at the epicardial distal end of the LA incision to prevent bleeding from the suture line. The inferior LA, interatrial septum, and the posterior RA are closed. The LA is deaired most effectively from the interatrial septum while keeping the suture loosely tied. Then the aortic cross-clamp is removed and the heart is reperfused. The intercaval incision in the posterior RA and the horizontal incision in the lower RA are closed. Lastly, the remaining incision at the top of the right atrial appendage is closed while deairing from the RA. SUMMARY Sequence of the Procedures If the radial procedure is not the lone procedure and is concomitant to other cardiac procedures, there are considerations for the sequence of the procedures. A mitral valve repair or replacement is safely performed after all the radial incisions are made. After completion of the mitral valve surgery, the displacement of the heart can be unsafe and the exposure of the left atrial appendage and inside of the LA is limited to some extent. Coronary artery bypass grafting is also performed after completion of the radial procedure for the same reason. The distal coronary anastomosis can be performed even on the beating heart after the release of the aortic cross-clamp. Aortic valve replacement, particularly in patients with aortic valve regurgitation, is performed before the LA incisions are made, after the aorta is cross-clamped. In this way, the time for selective infusion of cardioplegic solution directly into the coronary artery ostia can be saved. The atrial septal defect is closed at the time of closure of the septal incision of the radial procedure. The tricuspid valve repair is usually performed after the LA is closed, and the aortic cross-clamp is released. Modifications of the Radial Procedure In the radial procedure, the longitudinal septal incision, which is extended down to the mitral valve annulus, provides an excellent exposure of the mitral valve,
13 RADIAL PROCEDURE FOR ATRIAL FIBRILLATION 95 which is satisfactory to undergo complex valve repair. The septal incision can be replaced by a right-sided LA incision in patients who do not require complex mitral valve repair. In that case, the postero-inferior interatrial septum should be ablated by crythermia or RF energy to interrupt the potential reentrant circuit around the fossa ovalis. Recently developed ablation devices may enable minimally invasive procedures for AF without undergoing cardiopulmonary bypass. It is extremely important to preserve the concept of the radial procedure in the lesion set for the off-pump AF procedure to resume a physiological atrial activation and sufficient atrial transport function, and to most surely prevent thromboembolism. Clinical Results Between October 1997 and December 2003, we performed the radial procedure in 100 patients. There were 53 male and 47 female patients, and the average age was years. Of those patients, 82 patients had valvular heart disease and 9 patients were associated with congenital heart disease, while the remaining 9 patients had no structural heart disease. There were 67 patients with continuous AF and 33 with intermittent AF. Thirteen patients had experienced thromboembolic events before the surgery. Seven patients had left atrial thrombi present at the time of surgery. There were two surgical mortalities, not related to the radial procedure. The success rate for AF was 91%. A pacemaker implantation was required in six patients. In all the patients who were cured of AF, a significant contraction of the LA was detected by transthoracic Doppler echocardiography postoperatively. During the follow-up period of up to 74 months (median 35 months), no patient has experienced thromboembolic events. These results suggest that the radial procedure provides a greater atrial transport function and prevents thromboembolism, and thus may represent a physiological alternative to the maze procedure as a surgical procedure for AF. From the Department of Cardiothoracic Surgery, Nippon Medical School 1-1-5, Sendagi, Bunkyo-ku, Tokyo, , Japan. Address correspondence to Takashi Nitta, MD, Department of Cardiothoracic Surgery, Nippon Medical School 1-1-5, Sendagi, Bunkyo-ku, Tokyo , Japan Elsevier Inc. All rights reserved /04/ $30.00/0 doi: /j.optechstcvs
Atrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationMODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION
MODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION II. Surgical technique of the maze III procedure The operative technique of the maze III procedure for the treatment of patients
More informationPartial anomalous pulmonary venous connection to superior
Cavo-Atrial Anastomosis Technique for Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava The Warden Procedure Robert A. Gustafson, MD Partial anomalous pulmonary venous connection
More informationEbstein s anomaly is defined by a downward displacement
Repair of Ebstein s Anomaly Sylvain Chauvaud, MD Ebstein s anomaly is a tricuspid valve anomaly associated with poor right ventricular contractility in severe cases. Surgery is indicated in all symptomatic
More informationConcomitant procedures using minimally access
Surgical Technique on Cardiac Surgery Concomitant procedures using minimally access Nelson Santos Paulo Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia, Oporto, Portugal Correspondence to:
More informationAtrial Fibrillation Procedures Data Summary. Participant STS Period Ending 12/31/2016
Period Ending 12/31/2016 Number of Cases Preoperative Predominant Atrial Arrhythmia Type Paroxysmal Atrial Fibrillation... - - Persistent Atrial Fibrillation... - - Longstanding Persistent Atrial Fibrillation...
More informationAn anterior aortoventriculoplasty, known as the Konno-
The Konno-Rastan Procedure for Anterior Aortic Annular Enlargement Mark E. Roeser, MD An anterior aortoventriculoplasty, known as the Konno-Rastan procedure, is a useful tool for the cardiac surgeon. Originally,
More information2. right heart = pulmonary pump takes blood to lungs to pick up oxygen and get rid of carbon dioxide
A. location in thorax, in inferior mediastinum posterior to sternum medial to lungs superior to diaphragm anterior to vertebrae orientation - oblique apex points down and to the left 2/3 of mass on left
More informationthe Cardiovascular System I
the Cardiovascular System I By: Dr. Nabil A Khouri MD, MsC, Ph.D MEDIASTINUM 1. Superior Mediastinum 2. inferior Mediastinum Anterior mediastinum. Middle mediastinum. Posterior mediastinum Anatomy of
More informationCV Anatomy Quiz. Dr Ella Kim Dr Pip Green
CV Anatomy Quiz Dr Ella Kim Dr Pip Green Q1 The location of the heart is correctly described as A) lateral to the lungs. B) medial to the sternum. C) superior to the diaphragm. D) posterior to the spinal
More informationLab Activity 23. Cardiac Anatomy. Portland Community College BI 232
Lab Activity 23 Cardiac Anatomy Portland Community College BI 232 Cardiac Muscle Histology Branching cells Intercalated disc: contains many gap junctions connecting the adjacent cell cytoplasm, creates
More informationAnatomical Problems with Identification and Interruption of Posterior Septa1 Kent Bundles
Anatomical Problems with Identification and Interruption of Posterior Septa1 Kent Bundles Will C. Sealy, M.D., and Eileen M. Mikat, Ph.D. ABSTRACT To gain insight into the cause of the complex anatomical
More informationLAB 12-1 HEART DISSECTION GROSS ANATOMY OF THE HEART
LAB 12-1 HEART DISSECTION GROSS ANATOMY OF THE HEART Because mammals are warm-blooded and generally very active animals, they require high metabolic rates. One major requirement of a high metabolism is
More informationKent Bundles in the Anterior Septal Space Will C. Sealy, M.D.
Kent Bundles in the Anterior Septal Space Will C. Sealy, M.D. ABSTRACT Kent bundles in the anterior septal area of the heart occupy a region of complex morphology. In this study, the anatomical characteristics
More informationThe off pump technique demonstrated here for the
Off Pump Microwave Ablation of Atrial Fibrillation during Mitral Valve Surgery David C. Kress, MD, Alfred J. Tector, MD, Francis X. Downey, MD, and Monica M. McDonald, MD The off pump technique demonstrated
More informationMiddle mediastinum---- heart & pericardium. Dep. of Human Anatomy Zhou Hongying
Middle mediastinum---- heart & pericardium Dep. of Human Anatomy Zhou Hongying eaglezhyxzy@163.com Subdivisions of the mediastinum Contents of Middle mediastinum Heart Pericardium: a serous sac enclosing
More informationThe Heart. The Heart A muscular double pump. The Pulmonary and Systemic Circuits
C H A P T E R 19 The Heart The Heart A muscular double pump circuit takes blood to and from the lungs Systemic circuit vessels transport blood to and from body tissues Atria receive blood from the pulmonary
More informationhuman anatomy 2016 lecture thirteen Dr meethak ali ahmed neurosurgeon
Heart The heart is a hollow muscular organ that is somewhat pyramid shaped and lies within the pericardium in the mediastinum. It is connected at its base to the great blood vessels but otherwise lies
More informationDuring the past several years, surgical intervention
Radial Approach: A New Concept in Surgical Treatment for Atrial Fibrillation I. Concept, Anatomic and Physiologic Bases and Development of a Procedure Takashi Nitta, MD, Richard Lee, MD, Richard B. Schuessler,
More informationAnatomy lab -1- Imp note: papillary muscle Trabeculae Carneae chordae tendineae
Anatomy lab -1- Imp note: the arrangement of this sheet is different than the lab recording, it has been arranged in a certain way to make it easier to study. When you open the left ventricle you can see
More informationRead Chapters 21 & 22, McKinley et al
ACTIVITY 9: BLOOD AND HEART OBJECTIVES: 1) How to get ready: Read Chapters 21 & 22, McKinley et al., Human Anatomy, 5e. All text references are for this textbook. Read dissection instructions BEFORE YOU
More informationChapter 20 (1) The Heart
Chapter 20 (1) The Heart Learning Objectives Describe the location and structure of the heart Describe the path of a drop of blood from the superior vena cava or inferior vena cava through the heart out
More informationThe purposes of surgical treatment for atrial fibrillation
Radial Approach: A New Concept in Surgical Treatment for Atrial Fibrillation. II. Electrophysiologic Effects and Atrial Contribution to Ventricular Filling Takashi Nitta, MD, Richard Lee, MD, Hiroshi Watanabe,
More informationThe multi purse string maze procedure: A new surgical technique to perform the full maze procedure without atriotomies
Ad Evolving Technology The multi purse string maze procedure: A new surgical technique to perform the full maze procedure without atriotomies Niv Ad, MD Objective: The maze procedure is the most effective
More informationA atrial rate of 250 to 350 beats per minute that usually
Use of Intraoperative Mapping to Optimize Surgical Ablation of Atrial Flutter Shigeo Yamauchi, MD, Richard B. Schuessler, PhD, Tomohide Kawamoto, MD, Todd A. Shuman, MD, John P. Boineau, MD, and James
More informationMinimal access aortic valve surgery has become one of
Minimal Access Aortic Valve Surgery Through an Upper Hemisternotomy Approach Prem S. Shekar, MD Minimal access aortic valve surgery has become one of the accepted forms of surgical therapy for patients
More informationObstructed total anomalous pulmonary venous connection
Total Anomalous Pulmonary Venous Connection Richard A. Jonas, MD Children s National Medical Center, Department of Cardiovascular Surgery, Washington, DC. Address reprint requests to Richard A. Jonas,
More informationChapter 18 - Heart. I. Heart Anatomy: size of your fist; located in mediastinum (medial cavity)
Chapter 18 - Heart I. Heart Anatomy: size of your fist; located in mediastinum (medial cavity) A. Coverings: heart enclosed in double walled sac called the pericardium 1. Fibrous pericardium: dense connective
More informationCardiac tumors are unusual and cardiac malignancy, usually
Cardiac Autotransplantation Shanda H. Blackmon, MD,* and Michael J. Reardon, MD Cardiac tumors are unusual and cardiac malignancy, usually sarcoma, is a very small subset of these. The literature on cardiac
More informationEbstein s anomaly is a congenital malformation of the right
Cone Reconstruction of the Tricuspid Valve for Ebstein s Anomaly: Anatomic Repair Joseph A. Dearani, MD, Emile Bacha, MD, and José Pedro da Silva, MD Division of Cardiovascular Surgery, Mayo Clinic, Rochester,
More informationTHE CARDIOVASCULAR SYSTEM. Part 1
THE CARDIOVASCULAR SYSTEM Part 1 CARDIOVASCULAR SYSTEM Blood Heart Blood vessels What is the function of this system? What other systems does it affect? CARDIOVASCULAR SYSTEM Functions Transport gases,
More informationACTIVITY 9: BLOOD AND HEART BLOOD
ACTIVITY 9: BLOOD AND HEART OBJECTIVES: 1) How to get ready: Read Chapters 21 & 22, McKinley et al., Human Anatomy, 4e. All text references are for this textbook. Read dissection instructions BEFORE YOU
More informationThe Heart. Happy Friday! #takeoutyournotes #testnotgradedyet
The Heart Happy Friday! #takeoutyournotes #testnotgradedyet Introduction Cardiovascular system distributes blood Pump (heart) Distribution areas (capillaries) Heart has 4 compartments 2 receive blood (atria)
More information14 Valvular Stenosis
14 Valvular Stenosis 14-1. Valvular Stenosis unicuspid valve FIGUE 14-1. This photograph shows severe valvular stenosis as it occurs in a newborn. There is a unicuspid, horseshoe-shaped leaflet with a
More informationThe Heart & Pericardium Dr. Rakesh Kumar Verma Assistant Professor Department of Anatomy KGMU UP Lucknow
The Heart & Pericardium Dr. Rakesh Kumar Verma Assistant Professor Department of Anatomy KGMU UP Lucknow Fibrous skeleton Dense fibrous connective tissue forms a structural foundation around AV & arterial
More informationHUMAN HEART. Learn the following structures on the heart models.
HUMAN HEART Learn the following structures on the heart models. The human heart has four chambers that consist of the right atrium, left atrium, right ventricle, and left ventricle. The atria are smaller
More informationTHE HEART. A. The Pericardium - a double sac of serous membrane surrounding the heart
THE HEART I. Size and Location: A. Fist-size weighing less than a pound (250 to 350 grams). B. Located in the mediastinum between the 2 nd rib and the 5 th intercostal space. 1. Tipped to the left, resting
More informationThe Cardiovascular System
The Cardiovascular System The Manila Times College of Subic Prepared by: Stevens B. Badar, RN, MANc THE HEART Anatomy of the Heart Location and Size approx. the size of a person s fist, hollow and cone-shaped,
More informationHybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure. Spectrum of Atrial Fibrillation
Hybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure Paul J. Wang, MD Amin Al-Ahmad, MD Gan Dunnington, MD Stanford University Cox J, et al. Ann Thorac Surg. 1993;55:578-580.
More informationHeart transplantation is the gold standard treatment for
Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, and Yoshifumi Naka, MD, PhD Primary graft failure is a rare, but
More informationThe problem with concomitant atrial fibrillation in non-mitral valve surgery
Safeguards and Pitfalls The problem with concomitant atrial fibrillation in non-mitral valve surgery Mark La Meir 1,2, Sandro Gelsomino 2, Bart Nonneman 3 1 Department of Cardiothoracic Surgery, University
More informationAcute type A aortic dissection (Type I, proximal, ascending)
Acute Type A Aortic Dissection R. Morton Bolman, III, MD Acute type A aortic dissection (Type I, proximal, ascending) is a true surgical emergency. It is estimated that patients suffering this calamity
More informationAnatomy of the Heart
Biology 212: Anatomy and Physiology II Anatomy of the Heart References: Saladin, KS: Anatomy and Physiology, The Unity of Form and Function 8 th (2018). Required reading before beginning this lab: Chapter
More informationAnatomy of the Heart. Figure 20 2c
Anatomy of the Heart Figure 20 2c Pericardium & Myocardium Remember, the heart sits in it s own cavity, known as the mediastinum. The heart is surrounded by the Pericardium, a double lining of the pericardial
More informationThe arterial switch operation has been the accepted procedure
The Arterial Switch Procedure: Closed Coronary Artery Transfer Edward L. Bove, MD The arterial switch operation has been the accepted procedure for the repair of transposition of the great arteries (TGA)
More informationMitral Repair/AF Ablation Sternotomy Approach
Mitral Repair/AF Ablation Sternotomy Approach Patrick M. McCarthy MD, FACC Executive Director of the Bluhm Cardiovascular Institute Chief of Cardiac Surgery Division Heller-Sacks Professor of Surgery in
More informationDISSECTION OF A SHEEP HEART
DISSECTION OF A SHEEP HEART I. INTRODUCTION A. You will soon appreciate the point made previously the heart models just don t teach us what a real heart is like! Dissecting a sheep heart will give you
More informationHeart Anatomy. 7/5/02 Stephen G Davenport 1
Heart Anatomy Copyright 1999, Stephen G. Davenport, No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form without prior written permission. 7/5/02 Stephen
More informationRepair of Congenital Mitral Valve Insufficiency
Repair of Congenital Mitral Valve Insufficiency Roland Hetzer, MD, PhD, and Eva Maria Delmo Walter, MS, MD, PhD Principles of Mitral Valve Repair We believe that mitral valve repair for congenital mitral
More information4. The two inferior chambers of the heart are known as the atria. the superior and inferior vena cava, which empty into the left atrium.
Answer each statement true or false. If the statement is false, change the underlined word to make it true. 1. The heart is located approximately between the second and fifth ribs and posterior to the
More informationMinimally invasive mitral valve surgery: tips, tricks and technique
Surgical Technique on Cardiac Surgery Page 1 of 6 Minimally invasive mitral valve surgery: tips, tricks and technique Allen Cheng, Amy M. Ramsey Division of Cardiovascular and Thoracic Surgery, Oklahoma
More informationHuman Anatomy, First Edition
Human Anatomy, First Edition McKinley & O'Loughlin Chapter 22 : Heart 1 Functions of the Heart Center of the cardiovascular system, the heart. Connects to blood vessels that transport blood between the
More informationMitral valve infective endocarditis (IE) is the most
Mitral Valve Replacement for Infective Endocarditis With Annular Abscess: Annular Reconstruction Gregory J. Bittle, MD, Murtaza Y. Dawood, MD, and James S. Gammie, MD Mitral valve infective endocarditis
More informationThis lab activity is aligned with Visible Body s A&P app. Learn more at visiblebody.com/professors
1 This lab activity is aligned with Visible Body s A&P app. Learn more at visiblebody.com/professors 2 PRE-LAB EXERCISES: A. Watch the video 29.1 Heart Overview and make the following observations: 1.
More informationSaphenous Vein Autograft Replacement
Saphenous Vein Autograft Replacement of Severe Segmental Coronary Artery Occlusion Operative Technique Rene G. Favaloro, M.D. D irect operation on the coronary artery has been performed in 180 patients
More informationAortic root enlargement is an invaluable surgical technique
Aortic Root Enlargement in the Adult Christopher M. Feindel, MD, CM, FRCS(C) Aortic root enlargement is an invaluable surgical technique with which every cardiac surgeon performing aortic valve replacement
More informationRepair of Complete Atrioventricular Septal Defects Single Patch Technique
Repair of Complete Atrioventricular Septal Defects Single Patch Technique Fred A. Crawford, Jr., MD The first repair of a complete atrioventricular septal defect was performed in 1954 by Lillehei using
More informationCh.15 Cardiovascular System Pgs {15-12} {15-13}
Ch.15 Cardiovascular System Pgs {15-12} {15-13} E. Skeleton of the Heart 1. The skeleton of the heart is composed of rings of dense connective tissue and other masses of connective tissue in the interventricular
More informationAF ABLATION Concepts and Techniques
AF ABLATION Concepts and Techniques Antony F Chu, M.D. Director of Complex Ablation Arrhythmia Services Section Division of Cardiology at the Rhode Island and Miriam Hospital HIGHLIGHTS The main indications
More informationCJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1. Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book)
CJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1 Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book) Introduction When you have finished examining the model, you are ready to begin your
More informationThe Cardiovascular System. Chapter 15. Cardiovascular System FYI. Cardiology Closed systemof the heart & blood vessels. Functions
Chapter 15 Cardiovascular System FYI The heart pumps 7,000 liters (4000 gallons) of blood through the body each day The heart contracts 2.5 billion times in an avg. lifetime The heart & all blood vessels
More informationJOINT MEETING 2 Tricuspid club Chairpersons: G. Athanassopoulos, A. Avgeropoulou, M. Khoury, G. Stavridis
JOINT MEETING 2 Tricuspid club Chairpersons: G. Athanassopoulos, A. Avgeropoulou, M. Khoury, G. Stavridis Similarities and differences in Tricuspid vs. Mitral Valve Anatomy and Imaging. Echo evaluation
More informationCARDIOVASCULAR SYSTEM
CARDIOVASCULAR SYSTEM Overview Heart and Vessels 2 Major Divisions Pulmonary Circuit Systemic Circuit Closed and Continuous Loop Location Aorta Superior vena cava Right lung Pulmonary trunk Base of heart
More informationThe pericardial sac is composed of the outer fibrous pericardium
Pericardiectomy for Constrictive or Recurrent Inflammatory Pericarditis Mauricio A. Villavicencio, MD, Joseph A. Dearani, MD, and Thoralf M. Sundt, III, MD Anatomy and Preoperative Considerations The pericardial
More informationChapter 14. The Cardiovascular System
Chapter 14 The Cardiovascular System Introduction Cardiovascular system - heart, blood and blood vessels Cardiac muscle makes up bulk of heart provides force to pump blood Function - transports blood 2
More informationPart 1. Copyright 2011 Pearson Education, Inc. Figure Copyright 2011 Pearson Education, Inc.
PowerPoint Lecture Slides prepared by Leslie Hendon University of Alabama, Birmingham C H A P T E R The Heart 19 Part 1 The Heart A muscular double pump circuit vessels transport blood to and from the
More informationThe HEART. What is it???? Pericardium. Heart Facts. This muscle never stops working It works when you are asleep
This muscle never stops working It works when you are asleep The HEART It works when you eat It really works when you exercise. What is it???? Located between the lungs in the mid thoracic region Apex
More informationSurgical Management of Left Ventricular Aneurysms by the Jatene Technique
Surgical Management of Left Ventricular Aneurysms by the Jatene Technique James L. Cox Few significant improvements in left ventricular aneurysm (LVA) surgery occurred from the time of Cooley s report
More informationCardiovascular System. Heart Anatomy
Cardiovascular System Heart Anatomy 1 The Heart Location & general description: Atria vs. ventricles Pulmonary vs. systemic circulation Coverings Walls The heart is found in the mediastinum, the medial
More informationTricuspid Valve Repair for Ebstein's Anomaly
Tricuspid Valve Repair for Ebstein's Anomaly Joseph A. Dearani, MD, and Gordon K. Danielson, MD E bstein's anomaly is a malformation of the tricuspid valve and right ventricle that is characterized by
More informationMODULE 2: CARDIOVASCULAR SYSTEM ANTOMY An Introduction to the Anatomy of the Heart and Blood vessels
MODULE 2: CARDIOVASCULAR SYSTEM ANTOMY An Introduction to the Anatomy of the Heart and Blood vessels The cardiovascular system includes a pump (the heart) and the vessels that carry blood from the heart
More informationMap-Guided Ablation of Non-ischemic VT. Takashi Nitta Cardiovascular Surgery, Nippon Medical School Tokyo, JAPAN
Map-Guided Ablation of Non-ischemic VT Takashi Nitta Cardiovascular Surgery, Nippon Medical School Tokyo, JAPAN nothing Declaration of Interest Catheter Ablation of Non-ischemic VT Sarcoidosis, 13, 6%
More informationEHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology
EHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important
More informationDisease of the aortic valve is frequently associated with
Stentless Aortic Bioprosthesis for Disease of the Aortic Valve, Root and Ascending Aorta John R. Doty, MD, and Donald B. Doty, MD Disease of the aortic valve is frequently associated with morphologic abnormalities
More informationBlood supply of the Heart & Conduction System. Dr. Nabil Khouri
Blood supply of the Heart & Conduction System Dr. Nabil Khouri Arterial supply of Heart Right coronary artery Left coronary artery 3 Introduction: Coronary arteries - VASAVASORUM arising from aortic sinuses
More information2. Obtain the following: eye guards gloves dissection tools: several blunt probes, scissors, a scalpel and forceps dissection pan sheep heart
Week 04 Lab Heart Anatomy LEARNING OUTCOMES: Describe the gross external and internal anatomy of the heart. Identify and discuss the function of the valves of the heart. Identify the major blood vessels
More informationThe Rastelli procedure has been traditionally used for repair
En-bloc Rotation of the Truncus Arteriosus A Technique for Complete Anatomic Repair of Transposition of the Great Arteries/Ventricular Septal Defect/Left Ventricular Outflow Tract Obstruction or Double
More informationTracheal stenosis in infants and children is typically characterized
Slide Tracheoplasty for Congenital Tracheal Stenosis Peter B. Manning, MD Tracheal stenosis in infants and children is typically characterized by the presence of complete cartilaginous tracheal rings and
More informationAtrial tachyarrhythmias, especially atrial fibrillation
Right-Sided Maze Procedure for Right Atrial Arrhythmias in Congenital Heart Disease David A. Theodoro, MD, Gordon K. Danielson, MD, Co-burn J. Porter, MD, and Carole A. Warnes, MD Division of Cardiovascular
More informationAnatomy of the coronary arteries in transposition
Thorax, 1978, 33, 418-424 Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction MAGDI H YACOUB AND ROSEMARY RADLEY-SMITH From Harefield
More informationCirculation. Circulation = is a process used for the transport of oxygen, carbon! dioxide, nutrients and wastes through-out the body
Circulation Circulation = is a process used for the transport of oxygen, carbon! dioxide, nutrients and wastes through-out the body Heart = muscular organ about the size of your fist which pumps blood.
More informationPrepared Pulmonary venous Orifice
HOW TO DO IT The Surgical Technique of Heterotopic Heart Transplantation D. Novitzky, M.D., F.C.S.(S.A.), D. K. C. Cooper, M.A., M.B., B.S., Ph.D., F.R.C.S., and C. N. Barnard, M.D., M.Med., M.S., Ph.D.,
More informationFigure ) The specific chamber of the heart that is indicated by letter A is called the. Diff: 1 Page Ref: 364
Essentials of Anatomy and Physiology, 9e (Marieb) Chapter 11 The Cardiovascular System Short Answer Figure 11.1 Using Figure 11.1, identify the following: 1) The Purkinje fibers are indicated by label.
More informationCardiovascular System Notes: Physiology of the Heart
Cardiovascular System Notes: Physiology of the Heart Interesting Heart Fact Capillaries are so small it takes ten of them to equal the thickness of a human hair. Review What are the 3 parts of the cardiovascular
More informationHeart. Heart 2-Tunica media: middle layer (media ='middle') muscle fibers (smooth or cardiac).
t. innermost lumenal General Circulatory system heart and blood vessels walls have 3 layers (inside to outside) 1-Tunica interna: aka tunica intima layer--lumenal layer epithelium--endothelium simple squamous
More informationCardiovascular System Notes: Heart Disease & Disorders
Cardiovascular System Notes: Heart Disease & Disorders Interesting Heart Facts The Electrocardiograph (ECG) was invented in 1902 by Willem Einthoven Dutch Physiologist. This test is still used to evaluate
More informationEbstein s anomaly is characterized by malformation of
Fenestrated Right Ventricular Exclusion (Starnes Procedure) for Severe Neonatal Ebstein s Anomaly Brian L. Reemtsen, MD,* and Vaughn A. Starnes, MD*, Ebstein s anomaly is characterized by malformation
More informationAnatomy determines the close vicinity of the sinuses of
Aortic Valve Reimplantation According to the David Type I Technique Matthias Karck, MD, and Axel Haverich, MD Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
271 NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of cryoablation for atrial fibrillation as an associated procedure with other cardiac
More informationThe modified Konno procedure, or subaortic ventriculoplasty,
Modified Konno Procedure for Left Ventricular Outflow Tract Obstruction David P. Bichell, MD The modified Konno procedure, or subaortic ventriculoplasty, first described by Cooley and Garrett in1986, 1
More informationCh 19: Cardiovascular System - The Heart -
Ch 19: Cardiovascular System - The Heart - Give a detailed description of the superficial and internal anatomy of the heart, including the pericardium, the myocardium, and the cardiac muscle. Trace the
More informationDanil Hammoudi.MD 1/12/2009
Danil Hammoudi.MD Aorta the biggest and longest artery (a blood vessel carrying blood away from the heart) in the body. It carries oxygen rich blood from the left ventricle of the heart to the body.inferior
More informationThe Edge-to-Edge Technique f For Barlow's Disease
The Edge-to-Edge Technique f For Barlow's Disease Ottavio Alfieri, Michele De Bonis, Elisabetta Lapenna, Francesco Maisano, Lucia Torracca, Giovanni La Canna. Department of Cardiac Surgery, San Raffaele
More informationThe Cardiovascular System (Heart)
The Cardiovascular System The Cardiovascular System (Heart) A closed system of the heart and blood vessels The heart pumps blood Blood vessels allow blood to circulate to all parts of the body The function
More informationThe Cardiovascular System
Essentials of Human Anatomy & Physiology Elaine N. Marieb Slides 11.1 11.19 Seventh Edition Chapter 11 The Cardiovascular System Functions of the Cardiovascular system Function of the heart: to pump blood
More informationHeart Dissection. 5. Locate the tip of the heart or the apex. Only the left ventricle extends all the way to the apex.
Heart Dissection Page 1 of 6 Background: The heart is a four-chambered, hollow organ composed primarily of cardiac muscle tissue. It is located in the center of the chest in between the lungs. It is the
More informationThe Cardiovascular System
11 PART A The Cardiovascular System PowerPoint Lecture Slide Presentation by Jerry L. Cook, Sam Houston University ESSENTIALS OF HUMAN ANATOMY & PHYSIOLOGY EIGHTH EDITION ELAINE N. MARIEB The Cardiovascular
More informationSurgical thermoablation of atrial fibrillation: Epicardial
Surgical thermoablation of atrial fibrillation: Epicardial Nicolas Bonnet Centre Cardiologique du Nord CCN Saint Denis FRANCE Place of Surgery in AF treatment Historical Models and concepts Treatments
More informationMid-Term Results of Intraoperative Radiofrequency Ablation
Kitakanto Med J 37 2003 ; 53 : 37 `41 Mid-Term Results of Intraoperative Radiofrequency Ablation A new approach to atrial fibrillation Susumu Ishikawa,1 Jai S. Raman,1 Brian F. Buxton1 and Yasuo Morishita
More informationLECTURE 5. Anatomy of the heart
LECTURE 5. Anatomy of the heart Main components of the CVS: Heart Blood circulatory system arterial compartment haemomicrocirculatory (=microvascular) compartment venous compartment Lymphatic circulatory
More information