urgical ablation is currently the most effective means of curing atrial fibrillation (AF), but application of the Maze III operation for non-valvular paroxysmal AF has been limited by the perceived increased risk of morbidity after sternotomy/thoracotomy and cardiopulmonary bypass. 1 Since the description of catheter ablation for AF by Haïssaguerre et al in 1994, 2 the popularity of pulmonary vein (PV) and posterior left atrial isolation has grown, with increasing number of reports attesting to its efficacy and safety, notwithstanding that issues regarding the potential for various complications and relatively lower efficacy remain. Circular mapping catheter entrapment in the mitral valve (MV) is one such rare complication, which, to the knowledge of the authors, has not been shown to be treatable by robot-assisted minimally invasive surgery. The present report describes 2 cases of this complication successfully resolved with the aid of the AESOP 3000 robotic visualization system. Case Reports Case 1A 45-year-old man presented with recurrent symptomatic episodes of paroxysmal AF over the past year. Therapeutic trials with several anti-arrhythmia agents had to be aborted because of intolerable side-effects. The patient underwent PV isolation and left atrial circumferential ablation with a circular mapping catheter and an ablation catheter. A 7Fr 10-pole circular mapping catheter of 20 mm circular configuration diameter (Lasso ® , Biosense Webster, Diamond Bar, CA, USA) was used to locate and confirm the results of ablation. Successful ablation was confirmed by the mapping catheter, but catheter movement was met by resistance that prohibited further attempts at removal.Transesophageal echocardiography (TEE) revealed entrapment of the catheter tip in the MV apparatus (Fig 1). Traction and clockwise and counterclockwise rotation maneuvers to release the tip resulted in its fracture at the very proximal portion (Fig 2). Emergency operation was indicated to remove the catheter and repair any MV injuries that may have occurred. As we had experience of more than 300 cases of minimally-invasive MV surgery, the operation was performed via right anterolateral mini-thoracotomy (4 cm in size) using an AESOP 3000. The patient was supine with 30-degree right-side up. The right internal jugular vein was cannulated percutaneously and the right femoral artery and vein were cannulated via a 2-cm skin incision. Following transthoracic aortic cross-clamping with a Chitwood clamp and antegrade cardioplegic arrest, MV exposure was conducted via left atrial incision along the interatrial groove. The posterior leaflet between the middle (P2) and lateral (P1) scallops was torn and a chorda rupture at the lateral scallop of the posterior MV leaflet was found. The mapping catheter tip was severely entangled within the MV chordae and the anterolateral papillary muscle. After careful removal of the catheter under direct vision, a new chorda to the P1 scallop was formed and multiple interrupted sutures with 5-0 polypropylene were used to re-a...
Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.