Although cardiovascular malformations are common in patients with Turner syndrome, dissecting thoracic aortic aneurysm is unusual. Stent-graft repair would appear to be feasible in this situation, but long-term implantation in young patients has not been explored.
Tricuspid regurgitation (TR) is a relatively common anomaly. In patients with tricuspid valve repair/replacement (TVR)the control of atrioventricular conduction irregularity can be demanding, given the unavailability for implantation of the right ventricular (RV) endocardial lead, which is not recommended in such cases because of the risk of lead fracture at the valve site and valve damage or failure. Thus, epicardial lead may be an option; it requires a surgical procedure and it is not preferred in patients with prior thoracotomy. Lead implantation via coronary sinus (CS) can be an alternative to conventional right ventricular pacing in this patient population.
K E Y W O R D SCRT, tricuspid regurgitation, tricuspid valve repair | 533 IOVEV and CHILInGIROVa of the valve obstructions mentioned above, an implantation of endocardial lead in the RV was not possible. The option for an epicardial one was discussed with the patient but was refused. The necessity of cardiac stimulation was a fact, so we needed to find an alternative approach. LV lead implantation was discussed. The venography of the CS showed good posterior-lateral branch and the lead was implanted there (Figure 1).
| CON CLUS IONThis case shows an alternative approach in patients who need cardiac stimulation and have tricuspid valve repair or replacement.Cardiac resynchronization therapy (CRT) device with one lead implanted in a branch of the coronary sinus will take place even more frequently in the future in such cases.How to cite this article: Iovev S, Chilingirova N. LV pacing as an alternative option to conventional RV pacing in patient with tricuspid valve replacement. J Arrhythmia. 2020;36:532-533. https://doi.
The genotyping of polymorphic variants in VKORC1 and CYP2C9, together with clinical and demographic parameters, can serve for more precise definition of the individual starting and maintenance doses of coumarin derivatives in each patient.
There is a vast body of evidence in favour of individualising fluid therapy using dynamic hemodynamic indices like stroke volume variation (SVV). Patients with implanted intra-aortic balloon pump (IABP) are excluded from this approach because of pulse contour artifacts caused by the pump. The aim of this work is to test whether SVV can be used for fluid responsiveness prediction in these patients. Patients after cardiac surgery with implanted IABP were included in this study. SVV was measured after placing the IABP on standby mode for one minute. Cardiac output (CO) measurement was obtained via Swan-Ganz catheter before and after a 6 ml/kg fluid challenge. Fluid responsiveness was defined as increase of CO by at least 10%. SVV above 8.5% showed a good correlation with fluid responsiveness. Sensitivity was 95 (95% CI 85 to 100) and specificity 82 (95% CI 72 to 92). SVV had an area under the ROC curve 0.91 (95% CI 0.81 to 1.0) SVV is a good predictor of fluid responsiveness in patients with IABP. SVV should not be excluded as a fluid therapy guide for these patients. Placing the pump on standby for one minute allows obtaining an accurate measurement of this important variable.
Adult patients with transposition of great vessels are often candidates for cardiac resynchronization therapy (CRT). Cardiac vein anatomy is of crucial importance in planning optimal CRT therapy. Cardiac veins are very variable. In congenitally corrected transposition of great vessels coronary arteries have an unusual course but coronary veins although much less studied have much more varieties. In such cases cardiac computed tomography (CT) might offer important information prior to electrophysiological procedures. The objective of this study is to present a series of patients with transposition of the great arteries (TGA) both congenitally corrected TGA and D TGA in which imaging was used to help planning placement of leads for CRT. CT findings are thoroughly described as well as the consequent interventional procedure.
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