| Anatomic aspects of the atrioventricular junction influencing radiofrequency Cox maze IV procedures. | |
| | |
MedLine Citation:
|
PMID: 18692651 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: This study analyzes the anatomic structure of the mitral and tricuspid annuli, their relationship with the coronary arteries and veins, and how this anatomic distribution may affect atrial ablation with bipolar radiofrequency clamps, the only technology that ensures transmurality. METHODS: Nine explanted fresh human hearts were studied, two of them with left coronary dominance. Two types of bipolar radiofrequency clamps were positioned to reach the mitral and tricuspid annuli, and relationships within the atrioventricular junction were analyzed, including coronary sinus and coronary arteries. RESULTS: In all hearts studied, the coronary arteries and veins within the adipose tissue of the right or left atrioventricular groove lay in the atrial side, 3 to 18 mm away from the mitral or tricuspid annuli. When the bipolar radiofrequency clamp was closed toward the mitral annulus, the coronary sinus was always included between the jaws, and in left coronary-dominant hearts, the circumflex artery was also included. Nevertheless, the clamp never reached the annulus owing to the increase in thickness of the adipose tissue around the groove and the ventricular mass, leaving 5 to 10 mm of atrial myocardium free from the radiofrequency electrodes. In the right atrium, clamp placement toward the tricuspid annulus excluding the right coronary left 8 to 18 mm of atrial muscle free from the bipolar electrodes. CONCLUSIONS: Bipolar radiofrequency clamps are not sufficient to complete a Cox maze IV procedure. Moreover, they may compromise coronary arteries in patients with left coronary dominance. Lines to the atrioventricular annuli need to be completed with the cut-and-sew technique or with alternative monopolar energy devices. |
| | |
Authors:
|
Manuel Castellá; Antonio García-Valentín; Daniel Pereda; Andrea Colli; Antonio Martinez; Daniel Martinez; José Ramirez; Jaime Mulet |
Publication Detail:
|
Type: In Vitro; Journal Article Date: 2008-06-12 |
Journal Detail:
|
Title: The Journal of thoracic and cardiovascular surgery Volume: 136 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2008 Aug |
Date Detail:
|
Created Date: 2008-08-11 Completed Date: 2008-08-29 Revised Date: 2009-05-26 |
Medline Journal Info:
|
Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 419-23 Citation Subset: AIM; IM |
Affiliation:
|
Department of Cardiovascular Surgery, Institut del Tòrax, Hospital Clínic, University of Barcelona, Barcelona, Spain. mcaste@clinic.ub.es |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Atrioventricular Node / anatomy & histology* Catheter Ablation / instrumentation* Female Humans Male Middle Aged Mitral Valve / anatomy & histology* Tricuspid Valve / anatomy & histology* |
| Comments/Corrections | |
Comment In:
|
J Thorac Cardiovasc Surg. 2009 Jun;137(6):1573-4; author reply 1574-5
[PMID:
19464492
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Routine ganglionic plexi ablation during Maze procedure improves hospital and early follow-up result...
Next Document: Complicated acute type B aortic dissection: midterm results of emergency endovascular stent-grafting...