Transseptal approach for catheter ablation of left-sided accessory pathways in children with Marfan syndrome:A case report

BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disease,making TS the best choice for these patients.CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness.She was diagnosed with MFS,supraventricular tachycardia,Wolff-Parkinson-White syndrome,and left-sided AP was detected by cardiac electrophysiological.Catheter ablation was successfully performed via TS under the guidance of the Ensite system.During the follow-up,no recurrence or complications occurred.CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS.Adequate evaluation and selection of the appropriate puncture site are particularly important.

Arthroscopic approach to the posterior compartment of the knee using a posterior transseptal portal

Arthroscopic surgery of the posterior compartment ofthe knee is difficult when only two anterior portals are used for access because of the inaccessibility of the back of the knee. Since its introduction, the posterior transseptal portal has been widely employed to access lesions in the posterior compartment. However, special care should be taken to avoid neurovascular injuries around the posteromedial, posterolateral, and transseptal portals. Most importantly, popliteal vessel injury should be avoided when creating and using the transseptal portal during surgery. Purpose of the present study is to describe how to avoid the neurovascular injuries during establishing the posterior three portals and to introduce our safer technique to create the transseptal portal. To date, we have performed arthroscopic surgeries via the transseptal portal in the posterior compartments of 161 knees and have not encountered nerve or vascular injury. In our procedure, the posterior septum is perforated with a 1.5-3.0-mm Kirschner wire that is protected by a sheath inserted from the posterolateral portal and monitored from the posteromedial portal to avoid popliteal vessel injury.

Transient ST-segment elevation after transseptal puncture for atrial fibrillation ablation in two cases

The present report demonstrates two cases of transient inferior ST-segment elevation accompanied by profound hypotension and bradycardia immediately after transseptal puncture for catheter ablation of atrial fibrillation. This rare complication of transseptal puncture was resolved quickly within several minutes. The most likely mechanism of this phenomenon is coronary vasospasm, although coronary embolism can not be ruled out completely. This complication is characterized as follows： （1） The right coronary artery might be the most likely involved vessel and therefore myocardial ischemia usually occurs in the inferior wall of left ventricular; （2） Reflex hypotension and bradycardia by the Bezold-Jarisch reflex secondary to inferior ischemia often occur at the same time. Though it appears to be a transient and completely reversible phenomenon, there are still potential life-threatening risks because of myocardial ischemia and profound haemodynamic instability. Clinical cardioloaists should be aware of this rare comolication and orooerlv deal with it.

Left ventricular endocardial pacing predicts the reduction of left ventricular outflow tract pressure gradient immediately after percutaneous transseptal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medicatio

Background Hypertrophic obstructive cardiomyopathy （HOCM） carries an increased risk for sudden cardiac death. No data regarding the percutaneous transseptal myocardial ablation （PTSMA） and epicardial left ventricular pacing （LVP） were reported. Methods Seven patients with recurrent symptoms and increased resting left ventricular outflow tract pressure gradient （LVOTG） after PTSMA and another 14 patients with HOCM without history of PTSMA were studied. Both resting and dobutamine stress echocardiography, PTSMA and LVP were routinely performed. Results In patients without previous PTSMA procedure, mild reduction of resting LVOTG was detected at 5 minutes after left ventricular pacing, and this reduction became significant at 10 minutes. All patients were divided into successful and unsuccessful groups according to their response to LVP. In contrary to patients in unsuccessful group, resting and R-S2 stimuli-induced LVOTG during PTSMA procedure were decreased dramatically （（9±5） mmHg vs （58±12） mmHg, （12±2） mmHg vs （113±27） mmHg, P〈0.001）. Analysis of Logistic regression demonstrated that only LVOTG level dudng left ventdcular pacing was an independent factor predicting the reduction of LVOTG immediately after PTSMA （odds ratio （OR）, 0.59; 95% CI 2.67 to 5.82; P=0.0002）. Conclusion Left ventricular endocardial temporary pacing plays a critical role in predicting acute effect on the reduction of LVOTG immediately after PTSMA procedure.

Correlation of electrophysiological characteristics Tp-ec and Tp-e/QT with myocardial injury and oxygen free radical generation in patients with acute myocardial infarction

Objective: To study the correlation of electrophysiological characteristics Tp-ec and Tp-e/QT with myocardial injury and oxygen free radical generation in patients with acute myocardial infarction. Methods: Patients who were diagnosed with acute myocardial infarction in our hospital between March 2014 and March 2017 were selected as the AMI group, and healthy subjects who received physical examination were selected as the control group, electrocardiography was done to determine Tp-ec and Tp-e/QT, serum was collected to determine the levels of myocardial injury markers, oxygen free radical generation indexes and apoptosis indexes, and peripheral blood was collected to determine the expression of oxygen free radical generation indexes. Results: Tp-ec and Tp-e/QT of AMI group were significantly higher than those of control group, and serum CK-MB, cTnI, H-FABP, MDA, sTWEAK, sFas and sTRAIL contents as well as peripheral blood Nrf-2, NRE and HO-1 mRNA expression were significantly higher than those of control group and positively correlated with Tp-ec and Tp-e/QT. Conclusion: Electrophysiological characteristics Tp-ec and Tp-e/QT increase, and the transseptal dispersion of repolarization increases in patients with acute myocardial infarction, and they are closely related to myocardial injury and oxygen free radical generation.

The Use of Esophageal Radiography in the Location of Atrial-Septal Puncture: Clinical Analysis of 486 Cases

Objectives To determine the safety and value of esophageal radiography as a means of locating transseptal puncture. Methods 486 patients who underwent transseptal puncture were randomized into two groups. An esophagus radiographic method of locating tansseptal puncture site was applied in the study group （n = 243 ） and modified-Ross locating method was used in the control group （n = 243 ）. After successful location, transseptal puncture was made. We observed the success rate and incidence complications in the 2 groups. Results Left atrium impression in the study group was clearly seen. Nonetheless in 120 cases of control group, the left atria silhouette was not clearly visualised. The success rate of locating transseptal puncture site in the study group and control group were 100% and 50. 6% respectively （ P 〈 0. 001 ）. The success rate of transseptal puncture in the study group and control group was 99. 6% and 45.7% respectively （ P 〈 0. 001 ）. There were no complications associated with puncture in the study group and pericardial tamponade occurred in 1 control patient. Conclusions The esophagus radiographic method of locating transseptal puncture site is accurate, safe and simple to perform. Transseptal puncture has a high success rate with few complications.