Recent years have witnessed an upsurge in the usage of ballistocardiography (BCG) and seismocardiography (SCG) to record myocardial function both in normal and pathological populations. Kinocardiography (KCG) combines these techniques by measuring 12 degrees-of-freedom of body motion produced by myocardial contraction and blood flow through the cardiac chambers and major vessels. The integral of kinetic energy (iK) obtained from the linear and rotational SCG/BCG signals, and automatically computed over the cardiac cycle, is used as a marker of cardiac mechanical function. The present work systematically evaluated the test–retest (TRT) reliability of KCG iK derived from BCG/SCG signals in the short term (<15 min) and long term (3–6 h) on 60 healthy volunteers. Additionally, we investigated the difference of repeatability with different body positions. First, we found high short-term TRT reliability for KCG metrics derived from SCG and BCG recordings. Exceptions to this finding were limited to metrics computed in left lateral decubitus position where the TRT reliability was moderate-to-high. Second, we found low-to-moderate long-term TRT reliability for KCG metrics as expected and confirmed by blood pressure measurements. In summary, KCG parameters derived from BCG/SCG signals show high repeatability and should be further investigated to confirm their use for cardiac condition longitudinal monitoring.
Objective: Superior venous system stenosis (superior vena cava (SVC) -right subclavian vein -innominate vein -left subclavian vein) is a clinical situation that frequently appears in patients with long-term implanted cardiac stimulation devices, due to venous system thrombosis and in those with congenital heart disease who need corrective surgery, due to chronic complications inherent to surgical techniques. In clinical practice, venous system stenosis may manifest as a SVC syndrome. In many cases, we are not able to correct stenosis or obstructions, since it is impossible to cross them. In this article, we describe the surgical technique that we have implemented in our hospital to solve this challenge, especially in those patients with pacing/defibrillation devices who present with this pathology. Our objective was to perform an extraction of the pacemaker and defibrillation electrodes, to allow the passage of a support wire to achieve the implantation of the endovascular stent(s) to correct the SVC syndrome. Methods: We present a retrospective series of six consecutive patients with SVC syndrome studied in a single center from 2012 to 2021.Three of them presented with thrombosis related to pacing or defibrillation electrodes and the other three presented with complications derived from Mustard or Senning techniques in patients with pacemakers and D-transposition of the great arteries. Results: In all cases, a complete re-vascularization of the SVC system was achieved using a stent, and new leads could have been implanted through it. Combined treatment of lead extraction and endovascular stent implantation corrected the syndrome in all cases. Conclusions: Angioplasty and stenting of the central venous system is a standardized technique with validated results, in acute, for the recanalization of chronic occlusions secondary to transvenous devices.
Background The percutaneous extraction of endovascular cardiostimulation and defibrillation leads is the most frequent technique nowadays. The tools used today must guarantee the success of the procedure, with the minimum of complications. Our objective was to analyze the safety and efficacy of lead extraction using the Evolution mechanical dissection tool (Cook Medical, USA). Methods A retrospective study was carried out in a total of 826 consecutive patients from October 2009 to December 2018 who underwent the procedure with the Evolution mechanical dissection tool. Preoperative study included complete blood tests, echocardiogram, and chest X‐ray. The procedures were performed in the operating room, under general anesthesia and echocardiographic control. Results A total of 1227 leads were extracted with a mean chronicity of 10.3 ± 5.1 years. Clinical success (CS) rate was 99.7%. A total of 16 (1.9%) complications occurred, 2 (0.24%) were major complications and 14 (1.7%) were minor complications. There was no operative mortality. There was no statistically significant relationship between implant chamber and complete efficacy. The complete extraction was achieved in all left ventricular leads, in 762 of 774 (98.45%) of right ventricular lead removal, and in 330 of 334 (98.8%) of right atrial leads (p = .31). Conclusion In our experience, percutaneous extraction of intravenous leads via the use of the Evolution tool (Cook Medical, USA), is a very effective and safe technique that offers low morbidity and mortality.
Mural aortic thrombus is a rare pathology that is more frequently seen in severe atherosclerotic aortic walls, in aneurysms and acute aortic syndrome(1). However this can be found in patients without aortic disease, and be responsible for systemic or cerebral emboli. A 54-year-old male was admitted to our institution for syncope and aphasia, he was found in the street with ethylic intoxication. After neurological examination mixed type aphasia was observed, cerebral and supra aortic arteries CT angiography were performed. Cerebral CT showed focal filling defect of left middle cerebral artery. Supra aortic arteries CT angiography was completed with toracoabdominal CT because massive ascending and arch thrombus was found. The thrombus measured 130 x 33 x 15 mm (Figures 1A and 1B and 1C), and covered from mid ascending aorta to 40 mm distal to the ostium of left subclavian artery. The patient was referred to our unit for urgent surgical treatment. Surgery was performed throw median sterntomy, cardiopulmonary bypass with moderate hypothermic arrest and anterograde cerebral perfusion via right axillary artery. Longitudinal aortotomy was made and 140 x 30 x 15 mm thrombus (Figure 2), attached to posterior mid ascending aorta, was found and resected, the aortic wall did not show any abnormality. The patient had an eventful recovery and was discharged 9 days later with oral anticoagulation and aspirin.
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