简介：Theballoon-basedcathetersareattractivefortheminimallyinvasiveproceduresbecausethesecatheterscanbeconfiguredtomatchrequirementsonsizeandshapefortheinteractionwiththesofttissue.Ananalyticalmechanicmodelisdevelopedforthedeformedballoontodeterminetheshapeoftheinflatedcatheter.Thebridgesalonglatitudinaldirectionshouldbehighstretchableduetothehighelongationalongthelatitudeoftheinflatablecatheter.Theseresultsagreewellwiththefiniteelementmethodwithoutanyparameterfitting.

简介：Atrialfibrillation(AF)isthecommonestcardiacarrhythmia,withsignificantmorbidityandmortality.MorethanhalfofpatientswithAFarestillsymptomaticdespiteadequateanticoagulationandratecontrol.Ifantiarrhythmicdrugsareineffectiveorpoorlytolerated,AFpatientsarethentypicallytreatedwithcatheterablationtorestoresinusrhythm.Inthepast20years,AFablationhasdevelopedfromaspecialized,experimentalprocedureintoacommontreatmentinthecardiovascularfield.Variousablationtechniquesandmappingtechnologieshavebeendescribedandarecontinuingtoevolveforincreasedsafetyandefficacy.Anincompletelistofsuchtechniquesandtechnologieswouldincludefocalandsegmental,circumferentialandlinear,complexfractionatedatrialelectrogram,ganglionatedplexus,focalimpulseandrotormodulation,bodysurfacepotentialmapping–guided,real-timeMRI–guided,cryoballoon,visuallyguidedlaserballoon,radiofrequencyhotballoon,contactforcesensingcatheter,multielectrodecatheter,andhybridablations.ThisreviewexaminesthehistoryofinvasiveAFtreatmentanditsevolutionintocatheterablationbutmainlyfocusesonthediscussionofvariousablationtechniquesandtechnologiesleadingtoourcurrentunderstandingoftheablationtherapyofthismostcommonarrhythmia.

简介：Severalcomplicationsofinsertionanduseofpulmonaryarterycatheter(PAC),includingcatheterentrapment,arerecognizedduringoraftercardiacsurgery.Earlydetectionisveryimportant.WereportacaseofPACentrapmentbecausethethecatheterwasaccidentallysuturedtothesuperiorvenacava.Bleedingfromthethermistorconnectorwasinitiallydetectedaftersurgerybecausetheneedlepuncturedthelumenofthermistorconnector.ThePACwasremovedthroughre-exploration.Therefore,bleedingfromthethermistorconnectorcouldearlyindicatethePACentrapment.Wesuggestthatabnormalbleedingfromthenon-injectatelumenportsofPACshouldbecheckedbeforesternalclosure.

简介：BackgroundPleuraleffusionaftertheFontanoperationcontributessignificantlytomorbidityandprolongedhospitalization.Thepurposeofthepresentstudywastoinvestigatewhetherchesttubesplacedindifferentcavitiesduringthesurgerywouldcontributetothedrainageandalsotoevaluateriskfactorsofthoracicdrainagewithcentralvenouscatheteraftertotalcavopulmonaryconnectionintheeraofthecentralvenouscatheter.MethodsFromJanuary2009toJune2012,109consecutivepatientsunderwenttotalcavopulmonaryconnectionatGuangdongGeneralHospital.With102patientsforinvestigation,preoperative,intraoperativeandpostoperativefactorswereobtained.Thoracicdrainagewithcentralvenouscatheterwaswhenevernecessary.Durationofchesttubedrainageandtimeofthoracicdrainagewithcentralvenouscatheteraddeduptototaldurationofpleuraldrainage.BinarylogisticregressionusingforwardLRmethodwasappliedfortheanalysisoftheriskfactorsforthoracicdrainagewithcentralvenouscatheter.ResultsAftertotalcavopulmonaryconnection,comparedwithchesttubesplacedinsinglepleuralcavitywithorwithoutpericardialorretrosternalcavity,thoseinbothpleuralcavitiesseemedtohavethechanceoflongerhospitalstay(P=0.028).Noothersignificantdifferenceswereobtainedinfactorsofventilationtime,extubatedcentralvenouspressureinsuperiorvenacava,ICUstay,totaldurationofpleuraldrainage.Sildenafilwasthepreventivefactorforreducingcentralvenouspressureandpreventingfrompostoperativepleuraleffusion.ConclusionsAftertotalcavopulmonaryconnection,patientswithtubesplacedinbothpleuralcavitieswouldnothavethechanceofshortertotaldurationofpleuraldrainageandsurprisinglyturnsouttohavelongerhospitalstay.Sildenafilisapreventivefactorforthoracicdrainagewithcentralvenouscatheter.

简介：Recurrentepisodesofperitonitiswiththesameorganismculturedatthecatheterexitsitesuggestthatearlytunnelcolonizationisassociatedwithatransferoftheseorganismsthroughthecathetertunneldirectlyfromtheskinintotheperi-tonealcavity.Inthiscircumstancethecatheterhasfailedinitsfundamentaldesigntoestablishandmaintainabacteriologicalbarrier.AthreepartstudywasconductedusingtheMoncrief-PopovichCatheterandImplantationTechnique.Thefirstpartof

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简介：ObjectivesToassessedthefeasibilityandeffectivenessofelectrophysiologicalmappingofpulmonaryveinswithacircumferential10-electrodecatheterandradiofrequencycatheterablationtherapyforpatientswithparoxysmalatrialfibrillation.BackgroundStandardmappingandablationoffocalsourcesofatrialfibrillationareassociatedwithverylongproceduretimesandlowefficacy.Mappingandablationpulmonaryveinsguidewithacircularcathetercouldovercometheselimitations.Methods16patients[male11,female5,meanage(51±14.5)years]withparoxysmalatrialfibrillationrefractorytoantiarrhythmicdrugswereincludedinthisgroup.Acircumferential10-electrodecatheterwasusedtopulmonaryveinmappingduringsinusrhythmorCSdpacingtodeterminetheoriginofatrialprematurecontractions.Whentheablativetargetpulmonaryveinwasfound,thepulmonaryveinpotentials’distributionandactivationwereassessmentpulmonaryveins’ostialablationwasperformedattheseg

简介：AbstractBackgrounds:At present, there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios. This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter (SBC) in term nulliparous women with borderline oligohydramnios.Methods:We conducted a retrospective cohort study from January 2016 to November 2018. During the study period, a total of 244 cases were enrolled. Of these, 103 cases were selected for induction using dinoprostone and 141 cases were selected for induction with SBC. The pregnancy outcomes between the two groups were compared. Primary outcomes were successful vaginal delivery rates. Secondary outcomes were maternal and neonatal adverse events. Multivariate logistic regression was used to assess the risk factors for vaginal delivery failure in the two groups.Results:The successful vaginal delivery rates were similar between the dinoprostone group and the SBC group (64.1% [66/103] vs. 59.6%, [84/141] P = 0.475), even after adjustment for potential confounding factors (adjusted odds ratio [aOR]: 1.07, 95% confidence interval [CI]: 0.57-2.00, P = 0.835). The incidence of intra-amniotic infection was lower in the dinoprostone group than in the SBC group (1.9% [2/103] vs. 7.8% [11/141], P < 0.001), but the presence of non-reassuring fetal heart rate was higher in the dinoprostone group than in the SBC group (12.6% [13/103] vs. 0.7%, [1/141] P < 0.001). Multivariate logistic regression showed that nuchal cord was a risk factor for vaginal delivery failure after induction with dinoprostone (aOR: 6.71, 95% CI: 1.96-22.95). There were three factors related to vaginal delivery failure after induction with SBC, namely gestational age (aOR: 1.51, 95% CI: 1.07-2.14), body mass index (BMI) >30 kg/m2 (aOR: 2.98, 95% CI: 1.10-8.02), and fetal weight >3500 g (aOR: 2.49, 95% CI: 1.12-5.50).Conclusions:Term nulliparous women with borderline oligohydramnios have similar successful vaginal delivery rates after induction with dinoprostone or SBC, with their advantages and disadvantages. In women with nuchal cord, the risk of vaginal delivery failure is increased if dinoprostone is used in the induction of labor. BMI >30 kg/m2, large gestational age, and estimated fetal weight >3500 g are risk factors for vaginal delivery failure after induction with SBC.

简介：AbstractBackground:The catheter-tissue contact force (CF) is one of the significant determinants of lesion size and thus has a considerable impact on the effectiveness of ablation procedures. This study aimed to evaluate the impact of CF on the lesion size during right ventricular outflow tract (RVOT) ablation in a swine model.Methods:Twelve Guangxi Bama miniature male pigs weighing 40 to 50 kg were studied. After general anesthesia, a ThermoCool SmartTouch contact-sensing ablation catheter was introduced to the RVOT via the femoral vein under the guidance of the CARTO 3 system. The local ventricular voltage amplitude and impedance were measured using different CF levels. We randomly divided the animals into the following four groups according to the different CF levels: group A (3-9 g); group B (10-19 g); group C (20-29 g); and group D (30-39 g). Radiofrequency ablations were performed at three points in the free wall and septum of the RVOT in power control mode at 30 W for 30 s while maintaining the saline irrigation rate at 17 mL/min. At the end of the procedures, the maximum depth, surface diameter, and lesion volume were measured and recorded. A linear regression analysis was performed to determine the relationship between continuous variables.Results:A total of 72 ablation lesions were created in the RVOT of the 12 Bama pigs. The maximum depth, surface diameter, and volume of the lesions measured were well correlated with the CF (free wall: β = 0.105, β = 0.162, β = 3.355, respectively, P < 0.001; septum: β = 0.093, β = 0.150, β = 3.712, respectively, P < 0.001). The regional ventricular bipolar voltage amplitude, unipolar voltage amplitude, and impedance were weakly positively associated with the CF (β = 0.065, β = 0.125, and β = 1.054, respectively, P < 0.001). There was a significant difference in the incidence of steam pops among groups A, B, C, and D (free wall: F = 7.3, P = 0.032; septum: F = 10.5, P = 0.009); and steam pops occurred only when the CF exceeded 20 g. Trans-mural lesions were observed when the CF exceeded 10 g in the free wall, while the lesions in the septum were non-trans-mural even though the CF reached 30 g.Conclusions:CF seems to be a leading predictive factor for the size of formed lesions in RVOT ablation. Maintaining the CF value between 3 and 10 g may be reasonable and effective for creating the necessary lesion size and reducing the risk of complications, such as steam pops and perforations.

简介：AbstractIn the United States, pulmonary embolism (PE) accounts for approximately 10% of all pregnancy related deaths. The standard treatment for a patient with high-risk PE is systemic thrombolysis. Systemic thrombolysis in pregnancy is associated with the risk of maternal hemorrhage and fetal complications, including spontaneous abortion, preterm delivery, and fetal bleeding. Currently, there is limited evidence for a standardized approach for the treatment and management of intermediate-and high-risk PEs in pregnancy. A 36-year-old gravida 3 para 2002 woman at 31+1 weeks of gestation with a history of deep vein thrombosis in her prior pregnancy presented with shortness of breath. A computed tomography angiogram revealed a large pulmonary embolus with a saddle component that extended into the bilateral upper and lower lobes and into the secondary and tertiary pulmonary branches. A subsequent bedside echocardiogram demonstrated a dilated right ventricle with severely reduced right ventricular systolic function. The patient was successfully treated with bilateral ultrasound-assisted catheter-directed thrombolysis. She subsequently delivered a healthy male infant at term. Reported cases of ultrasound-assisted catheter-directed thrombolysis in pregnant patients is limited. Our case demonstrates that localized thrombolysis is a viable treatment option for life-threatening PE in pregnancy. Catheter-directed thrombolysis can be efficacious in treating intermediate-and high-risk PEs in pregnancy while simultaneously reducing the risk of bleeding complications.

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简介：AbstractBackground:Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.Methods:Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.Results:A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.Conclusion:Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.

简介：瞄准：在二个不同耐心的位置调查在食道的测压法和pH加速方法之间的协议。方法：十八个题目在学习被包括。首先，到更低的食道的括约肌(LES)的近似边阶的从鼻子的距离被测量压力计的联盟者。然后一个不同调查者，被使看不见第一研究的结果，用pH加速方法测量了一样的距离，与病人在一起正直并且背卧位。对在二种技术之间的同意的一个评价被执行。结果：在背卧位，仅仅一个题目的测量在为正确的放接受的范围(对LES3厘米远侧或近似的<=)外面。在正直的位置，在测量的错误在五个题目被认出。Bland-Altman阴谋表明在大小之间的好同意获得了压力计的联盟者并且由在与在背卧位的病人一起的方法上面的pH步。结论：在情况中非压力计的察觉设备的可获得性，pH加速方法能便于放在背卧位与病人一起监视导管的24hpH。如果我们的结果被进一步的研究支持，这应该与怀疑的胃的食道的倒流疾病为题目在临床的实践增加pH-metry的使用。

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