AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 201...AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 2013. This study was approved by the Medical Ethics Committee at our hospital. Informed,written consent was obtained from each patient prior to study enrollment. Three hundred and twenty-two patients with a na?ve papilla of Vater who underwent endoscopic retrograde cholangiopancreatography(ERCP) for the purpose of selective bile duct cannulation with WGC were enrolled in this study. Fifty-three patients were excluded based on the exclusion criteria,and 269 patients were randomly allocated to two groups by a computer and analyzed:the 0.025-inch GW group(n = 109) and the 0.035-inch GW group(n = 160). The primary endpoint was the success rate of selective bile duct cannulation with WGC. Secondary endpoints were the success rates of the pancreatic GW technique and precutting,selective bile duct cannulation time,ERCP procedure time,the rate of pancreatic duct stent placement,the final success rate of selective bile duct cannulation,andthe incidence of post-ERCP pancreatitis(PEP).RESULTS:The primary success rates of selective bile duct cannulation with WGC were 80.7%(88/109) and 86.3%(138/160) for the 0.025-inch and the 0.035-inch groups,respectively(P = 0.226). There were no statistically significant differences in the success rates of selective bile duct cannulation using the pancreatic duct GW technique(46.7% vs 52.4% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.884) or in the success rates of selective bile duct cannulation using precutting(66.7% vs 63.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.893). The final success rates for selective bile duct cannulation using these procedures were 92.7%(101/109) and 97.5%(156/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.113). There were no significant differences in selective bile duct cannulation time(median ± interquartile range:3.7 ± 13.9 min vs 4.0 ± 11.2 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.851),ERCP procedure time(median ± interquartile range:32 ± 29 min vs 30 ± 25 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.184) or in the rate of pancreatic duct stent placement(14.7% vs 15.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.832). The incidence of PEP was 2.8%(3/109) and 2.5%(4/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.793).CONCLUSION:The thickness of the GW for WGC does not appear to affect either the success rate of selective bile duct cannulation or the incidence of PEP.展开更多
AIM: To perform wire-guided cannulation using a newly designed J-shaped tip guidewire, and to verify feasibility and safety for use. METHODS: The study was conducted on endoscopic retrograde cholangiopancreatography (...AIM: To perform wire-guided cannulation using a newly designed J-shaped tip guidewire, and to verify feasibility and safety for use. METHODS: The study was conducted on endoscopic retrograde cholangiopancreatography (ERCP) patients with na ve papilla undergoing diagnosis and treatment of biliary diseases between September 2011 and July 2012. We performed ERCP in a succession of 50 cases with a J-shaped tip guidewire. The first insertion attempt began with a trainee who had 5 min to complete cannulation, followed if necessary by the trainer for another 5 min. We assessed the primary success rate of selective biliary cannulation within 10 min and adverse events such as post-ERCP pancreatitis (PEP), bleeding or perforation.RESULTS: The primary success rate was 90% (45/50) within 10 min, the initial success rate within 5 min by trainee staff was 76% (38/50). The rate of PEP was 6% (3/50), but all 3 cases were mild pancreatitis. All patients were managed successfully with conservative treatment. There was no bleeding or perforation. CONCLUSION: A newly designed J-shaped tip guidewire has the possibility to facilitate selective biliary cannulation for ERCP and appears to be safe.展开更多
The virtual reality based motion simulation of the guide wire and the catheter inside specific vascular structures can benefit a lot for the endovascular intervention. A fast and well-performed collision cancellation ...The virtual reality based motion simulation of the guide wire and the catheter inside specific vascular structures can benefit a lot for the endovascular intervention. A fast and well-performed collision cancellation algorithm is proposed based on the geometric analysis and the angular propagation （AP）, and a 3-D real-time interactive system is developed for the motion simulation of the guide wire and the catheter inside the specific patient vascular. The guide wire or the catheter is modeled as the ＂multi-body＂ representation and properties are defined by its intrinsic characteristics. The motion of the guide wire or the catheter inside the vascular is guided by the collision detection and the collision cancellation algorithm. Finally, a relaxation procedure is used to achieve more realistic status. Experimental results show that the behavior of the guide wire or the catheter depends on the defined parameters. The real-time simulation can be achieved. The result shows that the simulation system is effective and promising.展开更多
A model suitable for describing the mechanical response of thin elastic objects is proposed to simulate the deformation of guide wires in minimally invasive interventions. The main objective of this simulation is to p...A model suitable for describing the mechanical response of thin elastic objects is proposed to simulate the deformation of guide wires in minimally invasive interventions. The main objective of this simulation is to provide doctors an opportunity to rehearse the surgery and select an optimal operation plan before the real surgery. In this model the guide wire is discretized with the multi-body representation and its elastic energy derivate from elastic theory is a polynomial function of the nodal displacements. The vascular structure is represented by a tetrahedron mesh extended from the triangular mesh of the artery, which can be extracted from the patient＇s CT image data. The model applies the energy decline process of the conjugate gradient method to the deformation simulation of the guide wire. Experimental results show that the polynomial relationship between elastic energy and nodal displacements tremendously simplifies the evaluation of the conjugate gradient method and significantly improves the model＇s efficiency. Compared with models depending on an explicit scheme for evaluation, the new model is not only non-conditionally stable but also more efficient. The model can be applied to the real-time simulation of guide wire in a vascular structure.展开更多
AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challen...AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.展开更多
Objective To compare the clinical outcomes of open surgical peritoneal dialysis catheter （PDC） insertion with guide wire and the outcomes of PDC insertion without guide wire. Methods Data of the patients receiving ...Objective To compare the clinical outcomes of open surgical peritoneal dialysis catheter （PDC） insertion with guide wire and the outcomes of PDC insertion without guide wire. Methods Data of the patients receiving open surgical Tenkchoff straight catheter insertion in our department from January 2005 to January 2011 were retrospectively analyzed. The 117 patients in whom PDC insertion was conducted with the guidance of guide wire were enrolled into group A, and the 121 cases receiving PDC insertion without guide wire were enrolled into group B. The incidences of post-operative complications （catheter obstruction, catheter displacement, bloody dialysate, and dialysate leakage）, catheter survival, and patient survival rates were compared between the 2 groups. Results The baseline characteristics （gender, age, body mass index, prothrombin time, activated partial thromboplastin time, platelet count, serum creatinine, follow-up time, primary diseases, and outcomes） of the 2 groups were comparable （all P〉0.05）. In post-operative complications, only the incidence of early bloody dialysate showed significant difference, being 16.2% in group A and 7.4% in group B （P=0.04）. Catheter and patient survival rates were not significantly different between the two groups. Overweight patients showed a higher incidence of catheter obstruction compared with normal weight patients [16.0% （4/25） vs. 3.3% （7/213）, P=0.02], but no differences in post-operative between the 2 groups. complications were found among overweight patients Conclusions Open surgical Tenkchoff straight catheter insertion without guide wire does not lead to higher risk of post-operative complications and catheter removal. It may be an alternative option when guide wire is not available.展开更多
Femoral venous catheterization is the most used technic in emergency he-modialysis. Some uncommon mechanical complications can occur during a catheterization. We report the case of an accidental migration of a guide w...Femoral venous catheterization is the most used technic in emergency he-modialysis. Some uncommon mechanical complications can occur during a catheterization. We report the case of an accidental migration of a guide wire during the placement of a hemodialysis femoral catheter. The case of a patient admitted in the nephrology department at Aristide Le Dantec University Hospital for malignant hypertension was investigated. Emergency hemodialysis was indicated. Surgical extraction of the metal guide has been performed and the outcome was favorable.展开更多
Objective: To evaluate the therapeutic effects of 0. 014' Choice PTTM wire in chronic total occlusion angioplasty. Methods: Balloon angioplasty was attempted in 25 arteries with chronic total occlusion, with the m...Objective: To evaluate the therapeutic effects of 0. 014' Choice PTTM wire in chronic total occlusion angioplasty. Methods: Balloon angioplasty was attempted in 25 arteries with chronic total occlusion, with the mean time of occlusion of 17±13 months (ranging from 2 to 84 months) and mean length of 14±6 mm (ranging from 5 to 25 mm). The morphology of the lesions included bridging collaterals (4 cases), calcification (3 cases) and major side branch at the lesion (4 cases) . Choice PT?wire was used electively in all the cases. Results: Lesion was crossed successfully in 92% (23/25) cases, without incidences of dissection of the coronary artery with subintimal entry. Balloon angioplasy and stenting (n = 21) were performed with good immediate angiograghic results. Acute myocardial infarction or death occurred in none of the patients. Conclusion Successful recanalization of chronic coronary total occlusions using Choice PTTM wire can be achieved with good safety.展开更多
The visibility of moving images during cardiac catheterization and treatment may be reduced by a number of factors. First, it involves multiple movements that occur simultaneously, such as the movements due to the hea...The visibility of moving images during cardiac catheterization and treatment may be reduced by a number of factors. First, it involves multiple movements that occur simultaneously, such as the movements due to the heart beat and movement of the guide wire used during the treatment. There is also the influence of the X-ray dose on the image quality in the X-ray output. If X-rays are irradiated onto moving objects such as a guide wire moving during treatment of the heart, cardiac catheterization may be displaced to the next image recorded even when an insufficient X-ray dose has been irradiated because the imaged object is moving during the time the X-rays are emitted (pulse width). If the X-ray dose planned to be irradiated to the target is low, there is also the possibility that noise will appear in the image, and the imaged object may be lost in noise and visibility be reduced. For this reason, we conducted basic research into how changes in the speed of rotation of guide wires affect visibility when wires are positioned horizontally and vertically, using a dynamic phantom and recorded X-ray moving images. The purpose of this study is to elucidate whether the deterioration in the visibility is affected by the X-ray dose, the orientation or movement of a guide wire, or caused by other conditions, in order to contribute to improving the visibility in the X-ray moving images. The results showed a lower visual evaluation only in the vertical direction at the more rapid movement here, but this did not result in significant changes in the physical evaluation. This suggests that the structure and characteristics of the human eyes would be involved, as human vision is stronger with lateral movements and weaker with vertical movements due to the arrangement of the human eyes, side by side. Findings from this basic study can be utilized to improve the visibility in the X-ray moving images by paying attention to the observation environment of the observer of the X-ray moving images. In addition, the findings of this study can also be used to determine protocols for improving visibility in X-ray moving images, such as adjusting the X-ray dose in an X-ray device when further improvement is required. Therefore, this study was able to provide suggestions to contribute to the development of improved visibility of X-ray moving images.展开更多
A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the inte...A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped "Safe Sept" trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the "Safe Sept" guidewire, when advanced into the left atrium, becomes atraumatic.展开更多
目的探讨一种新型Visionwire标测导丝在心脏再同步化治疗(CRT)左室电极植入过程中的应用价值。方法 5例因心力衰竭接受CRT的患者,分别采用Visionwire导丝及左室电极到达可植入左室电极的冠状静脉(CS)分支内进行起搏参数测试及电生理标测...目的探讨一种新型Visionwire标测导丝在心脏再同步化治疗(CRT)左室电极植入过程中的应用价值。方法 5例因心力衰竭接受CRT的患者,分别采用Visionwire导丝及左室电极到达可植入左室电极的冠状静脉(CS)分支内进行起搏参数测试及电生理标测,比较两种方法的起搏参数测试、电生理标测结果及手术时间。结果在5例患者的16个CS分支中,两种方法所测的起搏参数值无显著性差异,二者的起搏阈值有强相关性(r=0.90,P<0.01),感知亦有相关性(r=0.67,P<0.01),二者最大起搏电压引起膈肌刺激的部位相似。应用Visionwire导丝可以进行局部电位电激动顺序标测。Visionwire导丝对单个CS分支进行起搏参数测定比应用左室电极进行起搏参数测定所需时间明显缩短(12.4±7.5 min vs 18.3±12.2 min,P<0.01)。结论应用Visionwire标测导丝可以预测CS分支的左室电极起搏参数,根据局部电位延迟可准确定位左室电极植入部位。展开更多
文摘AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 2013. This study was approved by the Medical Ethics Committee at our hospital. Informed,written consent was obtained from each patient prior to study enrollment. Three hundred and twenty-two patients with a na?ve papilla of Vater who underwent endoscopic retrograde cholangiopancreatography(ERCP) for the purpose of selective bile duct cannulation with WGC were enrolled in this study. Fifty-three patients were excluded based on the exclusion criteria,and 269 patients were randomly allocated to two groups by a computer and analyzed:the 0.025-inch GW group(n = 109) and the 0.035-inch GW group(n = 160). The primary endpoint was the success rate of selective bile duct cannulation with WGC. Secondary endpoints were the success rates of the pancreatic GW technique and precutting,selective bile duct cannulation time,ERCP procedure time,the rate of pancreatic duct stent placement,the final success rate of selective bile duct cannulation,andthe incidence of post-ERCP pancreatitis(PEP).RESULTS:The primary success rates of selective bile duct cannulation with WGC were 80.7%(88/109) and 86.3%(138/160) for the 0.025-inch and the 0.035-inch groups,respectively(P = 0.226). There were no statistically significant differences in the success rates of selective bile duct cannulation using the pancreatic duct GW technique(46.7% vs 52.4% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.884) or in the success rates of selective bile duct cannulation using precutting(66.7% vs 63.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.893). The final success rates for selective bile duct cannulation using these procedures were 92.7%(101/109) and 97.5%(156/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.113). There were no significant differences in selective bile duct cannulation time(median ± interquartile range:3.7 ± 13.9 min vs 4.0 ± 11.2 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.851),ERCP procedure time(median ± interquartile range:32 ± 29 min vs 30 ± 25 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.184) or in the rate of pancreatic duct stent placement(14.7% vs 15.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.832). The incidence of PEP was 2.8%(3/109) and 2.5%(4/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.793).CONCLUSION:The thickness of the GW for WGC does not appear to affect either the success rate of selective bile duct cannulation or the incidence of PEP.
基金Supported by Toho University Ohashi Medical Center
文摘AIM: To perform wire-guided cannulation using a newly designed J-shaped tip guidewire, and to verify feasibility and safety for use. METHODS: The study was conducted on endoscopic retrograde cholangiopancreatography (ERCP) patients with na ve papilla undergoing diagnosis and treatment of biliary diseases between September 2011 and July 2012. We performed ERCP in a succession of 50 cases with a J-shaped tip guidewire. The first insertion attempt began with a trainee who had 5 min to complete cannulation, followed if necessary by the trainer for another 5 min. We assessed the primary success rate of selective biliary cannulation within 10 min and adverse events such as post-ERCP pancreatitis (PEP), bleeding or perforation.RESULTS: The primary success rate was 90% (45/50) within 10 min, the initial success rate within 5 min by trainee staff was 76% (38/50). The rate of PEP was 6% (3/50), but all 3 cases were mild pancreatitis. All patients were managed successfully with conservative treatment. There was no bleeding or perforation. CONCLUSION: A newly designed J-shaped tip guidewire has the possibility to facilitate selective biliary cannulation for ERCP and appears to be safe.
文摘The virtual reality based motion simulation of the guide wire and the catheter inside specific vascular structures can benefit a lot for the endovascular intervention. A fast and well-performed collision cancellation algorithm is proposed based on the geometric analysis and the angular propagation （AP）, and a 3-D real-time interactive system is developed for the motion simulation of the guide wire and the catheter inside the specific patient vascular. The guide wire or the catheter is modeled as the ＂multi-body＂ representation and properties are defined by its intrinsic characteristics. The motion of the guide wire or the catheter inside the vascular is guided by the collision detection and the collision cancellation algorithm. Finally, a relaxation procedure is used to achieve more realistic status. Experimental results show that the behavior of the guide wire or the catheter depends on the defined parameters. The real-time simulation can be achieved. The result shows that the simulation system is effective and promising.
文摘A model suitable for describing the mechanical response of thin elastic objects is proposed to simulate the deformation of guide wires in minimally invasive interventions. The main objective of this simulation is to provide doctors an opportunity to rehearse the surgery and select an optimal operation plan before the real surgery. In this model the guide wire is discretized with the multi-body representation and its elastic energy derivate from elastic theory is a polynomial function of the nodal displacements. The vascular structure is represented by a tetrahedron mesh extended from the triangular mesh of the artery, which can be extracted from the patient＇s CT image data. The model applies the energy decline process of the conjugate gradient method to the deformation simulation of the guide wire. Experimental results show that the polynomial relationship between elastic energy and nodal displacements tremendously simplifies the evaluation of the conjugate gradient method and significantly improves the model＇s efficiency. Compared with models depending on an explicit scheme for evaluation, the new model is not only non-conditionally stable but also more efficient. The model can be applied to the real-time simulation of guide wire in a vascular structure.
文摘AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.
文摘Objective To compare the clinical outcomes of open surgical peritoneal dialysis catheter （PDC） insertion with guide wire and the outcomes of PDC insertion without guide wire. Methods Data of the patients receiving open surgical Tenkchoff straight catheter insertion in our department from January 2005 to January 2011 were retrospectively analyzed. The 117 patients in whom PDC insertion was conducted with the guidance of guide wire were enrolled into group A, and the 121 cases receiving PDC insertion without guide wire were enrolled into group B. The incidences of post-operative complications （catheter obstruction, catheter displacement, bloody dialysate, and dialysate leakage）, catheter survival, and patient survival rates were compared between the 2 groups. Results The baseline characteristics （gender, age, body mass index, prothrombin time, activated partial thromboplastin time, platelet count, serum creatinine, follow-up time, primary diseases, and outcomes） of the 2 groups were comparable （all P〉0.05）. In post-operative complications, only the incidence of early bloody dialysate showed significant difference, being 16.2% in group A and 7.4% in group B （P=0.04）. Catheter and patient survival rates were not significantly different between the two groups. Overweight patients showed a higher incidence of catheter obstruction compared with normal weight patients [16.0% （4/25） vs. 3.3% （7/213）, P=0.02], but no differences in post-operative between the 2 groups. complications were found among overweight patients Conclusions Open surgical Tenkchoff straight catheter insertion without guide wire does not lead to higher risk of post-operative complications and catheter removal. It may be an alternative option when guide wire is not available.
文摘Femoral venous catheterization is the most used technic in emergency he-modialysis. Some uncommon mechanical complications can occur during a catheterization. We report the case of an accidental migration of a guide wire during the placement of a hemodialysis femoral catheter. The case of a patient admitted in the nephrology department at Aristide Le Dantec University Hospital for malignant hypertension was investigated. Emergency hemodialysis was indicated. Surgical extraction of the metal guide has been performed and the outcome was favorable.
文摘Objective: To evaluate the therapeutic effects of 0. 014' Choice PTTM wire in chronic total occlusion angioplasty. Methods: Balloon angioplasty was attempted in 25 arteries with chronic total occlusion, with the mean time of occlusion of 17±13 months (ranging from 2 to 84 months) and mean length of 14±6 mm (ranging from 5 to 25 mm). The morphology of the lesions included bridging collaterals (4 cases), calcification (3 cases) and major side branch at the lesion (4 cases) . Choice PT?wire was used electively in all the cases. Results: Lesion was crossed successfully in 92% (23/25) cases, without incidences of dissection of the coronary artery with subintimal entry. Balloon angioplasy and stenting (n = 21) were performed with good immediate angiograghic results. Acute myocardial infarction or death occurred in none of the patients. Conclusion Successful recanalization of chronic coronary total occlusions using Choice PTTM wire can be achieved with good safety.
文摘The visibility of moving images during cardiac catheterization and treatment may be reduced by a number of factors. First, it involves multiple movements that occur simultaneously, such as the movements due to the heart beat and movement of the guide wire used during the treatment. There is also the influence of the X-ray dose on the image quality in the X-ray output. If X-rays are irradiated onto moving objects such as a guide wire moving during treatment of the heart, cardiac catheterization may be displaced to the next image recorded even when an insufficient X-ray dose has been irradiated because the imaged object is moving during the time the X-rays are emitted (pulse width). If the X-ray dose planned to be irradiated to the target is low, there is also the possibility that noise will appear in the image, and the imaged object may be lost in noise and visibility be reduced. For this reason, we conducted basic research into how changes in the speed of rotation of guide wires affect visibility when wires are positioned horizontally and vertically, using a dynamic phantom and recorded X-ray moving images. The purpose of this study is to elucidate whether the deterioration in the visibility is affected by the X-ray dose, the orientation or movement of a guide wire, or caused by other conditions, in order to contribute to improving the visibility in the X-ray moving images. The results showed a lower visual evaluation only in the vertical direction at the more rapid movement here, but this did not result in significant changes in the physical evaluation. This suggests that the structure and characteristics of the human eyes would be involved, as human vision is stronger with lateral movements and weaker with vertical movements due to the arrangement of the human eyes, side by side. Findings from this basic study can be utilized to improve the visibility in the X-ray moving images by paying attention to the observation environment of the observer of the X-ray moving images. In addition, the findings of this study can also be used to determine protocols for improving visibility in X-ray moving images, such as adjusting the X-ray dose in an X-ray device when further improvement is required. Therefore, this study was able to provide suggestions to contribute to the development of improved visibility of X-ray moving images.
文摘A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped "Safe Sept" trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the "Safe Sept" guidewire, when advanced into the left atrium, becomes atraumatic.
文摘目的探讨一种新型Visionwire标测导丝在心脏再同步化治疗(CRT)左室电极植入过程中的应用价值。方法 5例因心力衰竭接受CRT的患者,分别采用Visionwire导丝及左室电极到达可植入左室电极的冠状静脉(CS)分支内进行起搏参数测试及电生理标测,比较两种方法的起搏参数测试、电生理标测结果及手术时间。结果在5例患者的16个CS分支中,两种方法所测的起搏参数值无显著性差异,二者的起搏阈值有强相关性(r=0.90,P<0.01),感知亦有相关性(r=0.67,P<0.01),二者最大起搏电压引起膈肌刺激的部位相似。应用Visionwire导丝可以进行局部电位电激动顺序标测。Visionwire导丝对单个CS分支进行起搏参数测定比应用左室电极进行起搏参数测定所需时间明显缩短(12.4±7.5 min vs 18.3±12.2 min,P<0.01)。结论应用Visionwire标测导丝可以预测CS分支的左室电极起搏参数,根据局部电位延迟可准确定位左室电极植入部位。
