We report the case of a 14-year-old boy with ventricular preexcitation. A standard, fluoroscopy guided, ablation procedure was successfully performed in a postero-midseptal region with a total fluoroscopy time of abou...We report the case of a 14-year-old boy with ventricular preexcitation. A standard, fluoroscopy guided, ablation procedure was successfully performed in a postero-midseptal region with a total fluoroscopy time of about 45 min (2430 cGy.cm2). A few hours after the procedure, preexcitation reappeared. A second ablation procedure was scheduled using the EnSite NavXTM mapping system. During mapping along the tricuspid groove, preexcitation suddenly disappeared due to mechanical "bumping" of the accessory pathway and it did not recover over the next 30 min. As per our routine practice, the phase of geometry reconstruction has been continuously recorded by the system; thus, an off-line analysis allowed to pinpoint the site of earliest activation and the site of mechanical bumping, where radiofrequency obtained the accessory pathway ablation. The second procedure was performed without using fluoroscopy at all. Thanks to the geometry reconstruction, the procedure was completely successful thus avoiding a further rehospitalization.展开更多
Recent developments in the novel imaging technology of cardiac computed tomography(CT)not only permit detailed assessment of cardiac anatomy but also provide insight into cardiovascular physiology.Foremost,coronary CT...Recent developments in the novel imaging technology of cardiac computed tomography(CT)not only permit detailed assessment of cardiac anatomy but also provide insight into cardiovascular physiology.Foremost,coronary CT angiography(CCTA)enables direct noninvasive examination of both coronary artery stenoses and atherosclerotic plaque characteristics.Calculation of computational fl uid dynamics by cardiac CT allows the noninvasive estimation of fractional fl ow reserve,which increases the diagnostic accuracy for detection of hemodynamically signifi cant coronary artery disease.In addition,a combination of myocardial CT perfusion and CCTA can provide simultaneous anatomical and functional assessment of coronary artery disease.Finally,detailed anatomical evaluation of atrial,ventricular,and valvular anatomy provides diagnostic information and guidance for procedural planning,such as for transcatheter aortic valve replacement.The clinical applications of cardiac CT will be extended with the development of these novel modalities.展开更多
Invasive fractional fl ow reserve(FFR)measurement is currently the gold standard for coronary intervention.FFR measurement by coronary computed tomography angiography(FFRCT)is a novel and promising imaging technology ...Invasive fractional fl ow reserve(FFR)measurement is currently the gold standard for coronary intervention.FFR measurement by coronary computed tomography angiography(FFRCT)is a novel and promising imaging technology that permits noninvasive assessment of physiologically signifi cant coronary lesions.FFRCT is capable of combining the anatomic information provided by coronary computed tomography angiography with computational fl uid dynamics to compute FFR.To date,several studies have reported the diagnostic performance of FFRCT compared with invasive FFR measurement as the reference standard.Further studies are now being implemented to determine the clinical feasibility and economic implications of FFRCT techniques.This article provides an overview and discusses the available evidence as well as potential future directions of FFRCT.展开更多
文摘We report the case of a 14-year-old boy with ventricular preexcitation. A standard, fluoroscopy guided, ablation procedure was successfully performed in a postero-midseptal region with a total fluoroscopy time of about 45 min (2430 cGy.cm2). A few hours after the procedure, preexcitation reappeared. A second ablation procedure was scheduled using the EnSite NavXTM mapping system. During mapping along the tricuspid groove, preexcitation suddenly disappeared due to mechanical "bumping" of the accessory pathway and it did not recover over the next 30 min. As per our routine practice, the phase of geometry reconstruction has been continuously recorded by the system; thus, an off-line analysis allowed to pinpoint the site of earliest activation and the site of mechanical bumping, where radiofrequency obtained the accessory pathway ablation. The second procedure was performed without using fluoroscopy at all. Thanks to the geometry reconstruction, the procedure was completely successful thus avoiding a further rehospitalization.
文摘Recent developments in the novel imaging technology of cardiac computed tomography(CT)not only permit detailed assessment of cardiac anatomy but also provide insight into cardiovascular physiology.Foremost,coronary CT angiography(CCTA)enables direct noninvasive examination of both coronary artery stenoses and atherosclerotic plaque characteristics.Calculation of computational fl uid dynamics by cardiac CT allows the noninvasive estimation of fractional fl ow reserve,which increases the diagnostic accuracy for detection of hemodynamically signifi cant coronary artery disease.In addition,a combination of myocardial CT perfusion and CCTA can provide simultaneous anatomical and functional assessment of coronary artery disease.Finally,detailed anatomical evaluation of atrial,ventricular,and valvular anatomy provides diagnostic information and guidance for procedural planning,such as for transcatheter aortic valve replacement.The clinical applications of cardiac CT will be extended with the development of these novel modalities.
文摘Invasive fractional fl ow reserve(FFR)measurement is currently the gold standard for coronary intervention.FFR measurement by coronary computed tomography angiography(FFRCT)is a novel and promising imaging technology that permits noninvasive assessment of physiologically signifi cant coronary lesions.FFRCT is capable of combining the anatomic information provided by coronary computed tomography angiography with computational fl uid dynamics to compute FFR.To date,several studies have reported the diagnostic performance of FFRCT compared with invasive FFR measurement as the reference standard.Further studies are now being implemented to determine the clinical feasibility and economic implications of FFRCT techniques.This article provides an overview and discusses the available evidence as well as potential future directions of FFRCT.
