Ebook Computed tomography of the cardiovascular system: Part 2
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Ebook Computed tomography of the cardiovascular system: Part 2
21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2Diagnosis and management of complex heart rhythm disorders, in particular atrial fibrillation (AF), continues to evolve. Understanding of the mechanisms of arrhythmias, along with advances in catheter ablative technology and advanced mapping technique*, facilitates execution of electrophysio-logic p Ebook Computed tomography of the cardiovascular system: Part 2rocedures which, in experienced centers, can be carried out with high efficacy and low complication rates.Evolution in electrophysiologic and ablativeEbook Computed tomography of the cardiovascular system: Part 2
procedures has been possible in large pan because of advances in cardiac imaging technology, which have a role both in the diagnosis of cardiac disor21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2rocedures.Imaging modalities most useful in the management of heart ihythm disorders include echocardiography(transthoracic, transesophageal ami intra-cardiac). MRI and multi-gated CT. Each of these imaging techniques has inherent benefits and limitations.The purpose of this chapter is to describe t Ebook Computed tomography of the cardiovascular system: Part 2he utility of multi-detector cardiac Computed tomography (MDCT) in diagnosis ami treatment of heart rhythm disorders (Table 21.1). Since MDCT is mostEbook Computed tomography of the cardiovascular system: Part 2
commonly used in the management of patients with atrial fibrillation, this rhythm will be used as the basis for understanding the applications and ben21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2tion is a disorganized atrial rhythm believed to initiate from rapidly-firing foci within the thoracic veins.Table 21.1 Cardiac CT imaging in electrophysiologyDiagnosisPeri-operative evaluationArrhythmogenic right venkicular dysplasia-'cardiomyopathy (ARVD.'C) Pulmonary vein anatomy Intracardiac mas Ebook Computed tomography of the cardiovascular system: Part 2s'lhrombusLeft atrial and pulmonary vein topography (electro-anatomic mapping) Anatomy and post-operative substrate including conduit function in congEbook Computed tomography of the cardiovascular system: Part 2
enital heart disease Coronary sinus anatomy lor planned cardiac resynchronization therapy273Computed Tomography of the Cardiovascular SystemImpulses f21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2ocardial catheter based techniques that use radiofrequency energy delivered via steerable catheters placed within the left atrium aim, in most cases, to electrically isolate the thoracic veins from the left atrium. .Although differences exist in the precise techniques used to isolate electrical acti Ebook Computed tomography of the cardiovascular system: Part 2vity arising from the pulmonary and other thoracic veins, whether circumferential lesions at the veno-atrial junction or encircling lesions remote froEbook Computed tomography of the cardiovascular system: Part 2
m the vein orifice, the success rate of AP ablation in eradicating symptomatic episodes of AF in experienced centers IS high.1' -Figure 21.1 3D CT (po21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2CONSIDERATIONS2.1Pre-operative MDCTPre-operative M1X7I" allows precise anatomic imaging ot the heart and thoracic Veins and IS importer, since successful planning of catheter ablation of AF is facilitated by detailed information regarding the number and topology of pulmonary veins, left atrial size Ebook Computed tomography of the cardiovascular system: Part 2and the relationship of the left atrium to other thoracic structures such as the esophagus. In addition, MIX IT may reveal the presence of inflammatorEbook Computed tomography of the cardiovascular system: Part 2
y or malignant extra-cardiac tumors that may rarely be the cause of AF or atrial septal anomalies, including fibromas or lipomatous atrial septa that 21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2to AF ablation.2.2Normal pulmonary vein anatomy and the relationship of thoracic structures to the left atriumIn most cases 4 pulmonary veins empty into the left atrium (two left sided veins - superior and inferior, and two right sided veins - superior and inferior).1'' The most common anatomic rela Ebook Computed tomography of the cardiovascular system: Part 2tionship between these veins is illustrated in Figures 21.1-21.3.2.3Normal anatomic relationship between left atrium and esophagusIn the majority of iEbook Computed tomography of the cardiovascular system: Part 2
ndividuals the esophagus course immediately posterior to the kit atrium separated by approximately 2-5 mm of soft tissue. The importance of this close21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2may risk damage to the esophagus which can have important and possibly fatal consequences. The relationship between the left atrium and the esophagus IS shown in Figure 21.4.2.4Anatomic variants of pulmonary veinsAlthough the most common anatomic Configuration of the pulmonary veins is two left and Ebook Computed tomography of the cardiovascular system: Part 2two right skied pulmonary veins that each connect to the left atrium via separate ostia, variation is not uncommon. Prior knowledge of the correct numEbook Computed tomography of the cardiovascular system: Part 2
ber and topology is important since undetected anatomic variation may increase the complexity of ablation ami impact procedural success.The most commo21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2ostia for the right middle pulmonary vein into the left atrium, multiple accessory pulmonary veins or a single pulmonary vein. Anomalous pulmonary venous connectionsComputed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyFigure 21.2 Normal anatomic relationship (cor Ebook Computed tomography of the cardiovascular system: Part 2onal view) between inferior (lower) pulmonary veins (right and left). RIPV. right interior pulmonary vein: LIPV. left inferior pulmonary vein.(c.g. puEbook Computed tomography of the cardiovascular system: Part 2
lmonary veins that drain into the right atrium) and persistent left superior vena cava (with or without occlusion of the coronary sinus) arc important21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND Ebook Computed tomography of the cardiovascular system: Part 2other rare hut important anatomic variation in pulmonary vein and left atiial anatomy that impacts AF ablation and is also easily identified by M1XÍT.Examples of anatomic variants of pulmonary veins arc illustrated in Figures 21.5 - 21.9.Figure 21.3 Normal anatomic relationship (coronal view) betwee Ebook Computed tomography of the cardiovascular system: Part 2n superior (upper) pulmonary veins (right and left). Note: right ventricle and pulmonary trunk (anterior) and proximity of the esophagus and descendinEbook Computed tomography of the cardiovascular system: Part 2
g aorta to ostia of the left SKled veins. LSPV. left superior pulmonary vein: RSPV. right superior pulmonary vein: PA. pulmonary artery: RV. right ven21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIOND21Computed Tomographic Imaging of the Cardiac and Pulmonary Veins: Role in ElectrophysiologyKalpathi L. Venkatachalam and Peter A. BradyIINTRODUCTIONDGọi ngay
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