Atrial Appendage: Ear-shaped appendage of either atrium of the heart. (Dorland, 28th ed)Echocardiography, Transesophageal: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues using a transducer placed in the esophagus.Heart Atria: The chambers of the heart, to which the BLOOD returns from the circulation.Atrial Function, Left: The hemodynamic and electrophysiological action of the LEFT ATRIUM.Atrial Fibrillation: Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation.Thromboembolism: Obstruction of a blood vessel (embolism) by a blood clot (THROMBUS) in the blood stream.Electric Countershock: An electrical current applied to the HEART to terminate a disturbance of its rhythm, ARRHYTHMIAS, CARDIAC. (Stedman, 25th ed)Thrombosis: Formation and development of a thrombus or blood clot in the blood vessel.Heart Aneurysm: A localized bulging or dilatation in the muscle wall of a heart (MYOCARDIUM), usually in the LEFT VENTRICLE. Blood-filled aneurysms are dangerous because they may burst. Fibrous aneurysms interfere with the heart function through the loss of contractility. True aneurysm is bound by the vessel wall or cardiac wall. False aneurysms are HEMATOMA caused by myocardial rupture.Septal Occluder Device: A CATHETER-delivered implant used for closing abnormal holes in the cardiovascular system, especially HEART SEPTAL DEFECTS; or passageways intentionally made during cardiovascular surgical procedures.Atrial Function: The hemodynamic and electrophysiological action of the HEART ATRIA.Heart Diseases: Pathological conditions involving the HEART including its structural and functional abnormalities.Catheter Ablation: Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DC-shock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias.Atrial Septum: The thin membrane-like muscular structure separating the right and the left upper chambers (HEART ATRIA) of a heart.Atrial Flutter: Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES).Mitral Valve Stenosis: Narrowing of the passage through the MITRAL VALVE due to FIBROSIS, and CALCINOSIS in the leaflets and chordal areas. This elevates the left atrial pressure which, in turn, raises pulmonary venous and capillary pressure leading to bouts of DYSPNEA and TACHYCARDIA during physical exertion. RHEUMATIC FEVER is its primary cause.Prostheses and Implants: Artificial substitutes for body parts, and materials inserted into tissue for functional, cosmetic, or therapeutic purposes. Prostheses can be functional, as in the case of artificial arms and legs, or cosmetic, as in the case of an artificial eye. Implants, all surgically inserted or grafted into the body, tend to be used therapeutically. IMPLANTS, EXPERIMENTAL is available for those used experimentally.Cardiac Pacing, Artificial: Regulation of the rate of contraction of the heart muscles by an artificial pacemaker.Anticoagulants: Agents that prevent clotting.Pulmonary Veins: The veins that return the oxygenated blood from the lungs to the left atrium of the heart.Cardiac Surgical Procedures: Surgery performed on the heart.Atrial Function, Right: The hemodynamic and electrophysiological action of the RIGHT ATRIUM.Rheumatic Heart Disease: Cardiac manifestation of systemic rheumatological conditions, such as RHEUMATIC FEVER. Rheumatic heart disease can involve any part the heart, most often the HEART VALVES and the ENDOCARDIUM.Blood Flow Velocity: A value equal to the total volume flow divided by the cross-sectional area of the vascular bed.Tachycardia, Ectopic Atrial: Abnormally rapid heartbeats originating from one or more automatic foci (nonsinus pacemakers) in the HEART ATRIUM but away from the SINOATRIAL NODE. Unlike the reentry mechanism, automatic tachycardia speeds up and slows down gradually. The episode is characterized by a HEART RATE between 135 to less than 200 beats per minute and lasting 30 seconds or longer.Electrophysiologic Techniques, Cardiac: Methods to induce and measure electrical activities at specific sites in the heart to diagnose and treat problems with the heart's electrical system.Embolism: Blocking of a blood vessel by an embolus which can be a blood clot or other undissolved material in the blood stream.Sick Sinus Syndrome: A condition caused by dysfunctions related to the SINOATRIAL NODE including impulse generation (CARDIAC SINUS ARREST) and impulse conduction (SINOATRIAL EXIT BLOCK). It is characterized by persistent BRADYCARDIA, chronic ATRIAL FIBRILLATION, and failure to resume sinus rhythm following CARDIOVERSION. This syndrome can be congenital or acquired, particularly after surgical correction for heart defects.Pericardium: A conical fibro-serous sac surrounding the HEART and the roots of the great vessels (AORTA; VENAE CAVAE; PULMONARY ARTERY). Pericardium consists of two sacs: the outer fibrous pericardium and the inner serous pericardium. The latter consists of an outer parietal layer facing the fibrous pericardium, and an inner visceral layer (epicardium) resting next to the heart, and a pericardial cavity between these two layers.Cardiac Catheterization: Procedures in which placement of CARDIAC CATHETERS is performed for therapeutic or diagnostic procedures.Feasibility Studies: Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project.Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic.Therapeutic Occlusion: Methods used to temporarily or permanently block the flow of BODY FLUIDS through various ducts and tubules throughout the body, including BLOOD VESSELS and LYMPHATIC VESSELS such as by THERAPEUTIC EMBOLIZATION or LIGATION.Echocardiography, Doppler, Pulsed: Echocardiography applying the Doppler effect, with velocity detection combined with range discrimination. Short bursts of ultrasound are transmitted at regular intervals and the echoes are demodulated as they return.Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide.Dogs: The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065)Cardiac Catheters: Catheters inserted into various locations within the heart for diagnostic or therapeutic purposes.Echocardiography, Three-Dimensional: Echocardiography amplified by the addition of depth to the conventional two-dimensional ECHOCARDIOGRAPHY visualizing only the length and width of the heart. Three-dimensional ultrasound imaging was first described in 1961 but its application to echocardiography did not take place until 1974. (Mayo Clin Proc 1993;68:221-40)Extremities: The farthest or outermost projections of the body, such as the HAND and FOOT.Vena Cava, Superior: The venous trunk which returns blood from the head, neck, upper extremities and chest.Refractory Period, Electrophysiological: The period of time following the triggering of an ACTION POTENTIAL when the CELL MEMBRANE has changed to an unexcitable state and is gradually restored to the resting (excitable) state. During the absolute refractory period no other stimulus can trigger a response. This is followed by the relative refractory period during which the cell gradually becomes more excitable and the stronger impulse that is required to illicit a response gradually lessens to that required during the resting state.Stroke: A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)Pericardial Effusion: Fluid accumulation within the PERICARDIUM. Serous effusions are associated with pericardial diseases. Hemopericardium is associated with trauma. Lipid-containing effusion (chylopericardium) results from leakage of THORACIC DUCT. Severe cases can lead to CARDIAC TAMPONADE.Heart Valve Diseases: Pathological conditions involving any of the various HEART VALVES and the associated structures (PAPILLARY MUSCLES and CHORDAE TENDINEAE).Carcinoma, Skin Appendage: A malignant tumor of the skin appendages, which include the hair, nails, sebaceous glands, sweat glands, and the mammary glands. (From Dorland, 27th ed)Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Heart Conduction System: An impulse-conducting system composed of modified cardiac muscle, having the power of spontaneous rhythmicity and conduction more highly developed than the rest of the heart.Mitral Valve: The valve between the left atrium and left ventricle of the heart.Coronary Thrombosis: Coagulation of blood in any of the CORONARY VESSELS. The presence of a blood clot (THROMBUS) often leads to MYOCARDIAL INFARCTION.Echocardiography, Doppler: Measurement of intracardiac blood flow using an M-mode and/or two-dimensional (2-D) echocardiogram while simultaneously recording the spectrum of the audible Doppler signal (e.g., velocity, direction, amplitude, intensity, timing) reflected from the moving column of red blood cells.Sinoatrial Node: The small mass of modified cardiac muscle fibers located at the junction of the superior vena cava (VENA CAVA, SUPERIOR) and right atrium. Contraction impulses probably start in this node, spread over the atrium (HEART ATRIUM) and are then transmitted by the atrioventricular bundle (BUNDLE OF HIS) to the ventricle (HEART VENTRICLE).Cefamandole: Semisynthetic wide-spectrum cephalosporin with prolonged action, probably due to beta-lactamase resistance. It is used also as the nafate.Electrocardiography: Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY.Balloon Occlusion: Use of a balloon CATHETER to block the flow of blood through an artery or vein.Heart Block: Impaired conduction of cardiac impulse that can occur anywhere along the conduction pathway, such as between the SINOATRIAL NODE and the right atrium (SA block) or between atria and ventricles (AV block). Heart blocks can be classified by the duration, frequency, or completeness of conduction block. Reversibility depends on the degree of structural or functional defects.Intracranial Embolism: Blocking of a blood vessel in the SKULL by an EMBOLUS which can be a blood clot (THROMBUS) or other undissolved material in the blood stream. Most emboli are of cardiac origin and are associated with HEART DISEASES. Other non-cardiac sources of emboli are usually associated with VASCULAR DISEASES.Pacemaker, Artificial: A device designed to stimulate, by electric impulses, contraction of the heart muscles. It may be temporary (external) or permanent (internal or internal-external).Heart Septum: This structure includes the thin muscular atrial septum between the two HEART ATRIA, and the thick muscular ventricular septum between the two HEART VENTRICLES.Heart Septal Defects: Abnormalities in any part of the HEART SEPTUM resulting in abnormal communication between the left and the right chambers of the heart. The abnormal blood flow inside the heart may be caused by defects in the ATRIAL SEPTUM, the VENTRICULAR SEPTUM, or both.Myocardium: The muscle tissue of the HEART. It is composed of striated, involuntary muscle cells (MYOCYTES, CARDIAC) connected to form the contractile pump to generate blood flow.Myocardial Stunning: Prolonged dysfunction of the myocardium after a brief episode of severe ischemia, with gradual return of contractile activity.Premedication: Preliminary administration of a drug preceding a diagnostic, therapeutic, or surgical procedure. The commonest types of premedication are antibiotics (ANTIBIOTIC PROPHYLAXIS) and anti-anxiety agents. It does not include PREANESTHETIC MEDICATION.Endocardium: The innermost layer of the heart, comprised of endothelial cells.Balloon Valvuloplasty: Widening of a stenosed HEART VALVE by the insertion of a balloon CATHETER into the valve and inflation of the balloon.Heart Defects, Congenital: Developmental abnormalities involving structures of the heart. These defects are present at birth but may be discovered later in life.

A novel K(ATP) current in cultured neonatal rat atrial appendage cardiomyocytes. (1/253)

The functional and pharmacological properties of ATP-sensitive K(+) (K(ATP)) channels were studied in primary cultured neonatal rat atrial appendage cardiomyocytes. Activation of a whole-cell inward rectifying K(+) current depended on the pipette ATP concentration and correlated with a membrane hyperpolarization close to the K(+) equilibrium potential. The K(ATP) current could be activated either spontaneously or by a hypotonic stretch of the membrane induced by lowering the osmolality of the bathing solution from 290 to 260 mOsm/kg H(2)O or by the K(+) channel openers diazoxide and cromakalim with EC(50) approximately 1 and 10 nmol/L, respectively. The activated atrial K(ATP) current was highly sensitive to glyburide, with an IC(50) of 1.22+/-0.15 nmol/L. Recorded in inside-out patches, the neonatal atrial K(ATP) channel displayed a conductance of 58.0+/-2.2 pS and opened in bursts of 133.8+/-20.4 ms duration, with an open time duration of 1.40+/-0.10 ms and a close time duration of 0.66+/-0.04 ms for negative potentials. The channel had a half-maximal open probability at 0.1 mmol/L ATP, was activated by 100 micromol/L diazoxide, and was inhibited by glyburide, with an IC(50) in the nanomolar range. Thus, pending further tests at low concentrations of K(ATP) channel openers, the single-channel data confirm the results obtained with whole-cell recordings. The neonatal atrial appendage K(ATP) channel thus shows a unique functional and pharmacological profile resembling the pancreatic beta-cell channel for its high affinity for glyburide and diazoxide and for its conductance, but also resembling the ventricular channel subtype for its high affinity for cromakalim, its burst duration, and its sensitivity to ATP. Reverse transcriptase-polymerase chain reaction experiments showed the expression of Kir6.1, Kir6.2, SUR1A, SUR1B, SUR2A, and SUR2B subunits, a finding supporting the hypothesis that the neonatal atrial K(ATP) channel corresponds to a novel heteromultimeric association of K(ATP) channel subunits.  (+info)

Left atrial appendage: structure, function, and role in thromboembolism. (2/253)

The left atrial appendage (LAA) is derived from the left wall of the primary atrium, which forms during the fourth week of embryonic development. It has developmental, ultrastructural, and physiological characteristics distinct from the left atrium proper. The LAA lies within the confines of the pericardium in close relation to the free wall of the left ventricle and thus its emptying and filling may be significantly affected by left ventricular function. The physiological properties and anatomical relations of the LAA render it ideally suited to function as a decompression chamber during left ventricular systole and during other periods when left atrial pressure is high. These properties include the position of the LAA high in the body of the left atrium; the increased distensibility of the LAA compared with the left atrium proper; the high concentration of atrial natriuretic factor (ANF) granules contained within the LAA; and the neuronal configuration of the LAA. Thrombus has a predilection to form in the LAA in patients with atrial fibrillation, mitral valve disease, and other conditions. The pathogenesis has not been fully elucidated; however, relative stasis which occurs in the appendage owing to its shape and the trabeculations within it is thought to play a major role. Obliteration or amputation of the LAA may help to reduce the risk of thromboembolism, but this may result in undesirable physiological sequelae such as reduced atrial compliance and a reduced capacity for ANF secretion in response to pressure and volume overload.  (+info)

Left atrial appendage anatomy and function: short term response to sustained atrial fibrillation. (3/253)

OBJECTIVE: To determine whether there is significant atrial or atrial appendage enlargement or functional remodelling as a result of one to two months of sustained atrial fibrillation, a duration similar to that experienced by patients undergoing warfarin anticoagulation before elective cardioversion. METHODS: To test the hypothesis that left atrial and left atrial appendage enlargement develop as a result of short term atrial fibrillation, serial anatomical and functional indices were measured using transoesophageal echocardiography (TOE) in 20 patients with recent onset atrial fibrillation (14 men, six women; mean (SEM) age 67 (2) years). Serial TOE was performed 2.5 months apart in patients with sustained atrial fibrillation. RESULTS: There was no significant change in left atrial area (23.7 cm(2) to 24.1 cm(2), p = 0.98); length (5.7 cm to 5.7 cm, p = 0.48); width (5.2 cm to 5.2 cm, p = 0. 65); volume (83 cm(3) to 87 cm(3), p = 0.51) or left atrial appendage area (7.9 cm(2) to 8.1 cm(2), p = 0.89); length (4.6 cm to 4.5 cm, p = 0.8); or width (2.5 to 2.4 cm, p = 0.87). Peak left atrial appendage velocity ejection (0.2 m/s to 0.2 m/s, p = 0.57), and presence of severe spontaneous echo contrast in the left atrial appendage (n = 15 (75%) to n = 13 (72%)) were also not significantly different. There was no correlation between changes in left atrial or left atrial appendage dimensions. CONCLUSIONS: In the setting of sustained atrial fibrillation, significant left atrial and left atrial appendage functional and anatomical remodelling do not occur with atrial fibrillation of a duration similar to that used for conservative anticoagulation in preparation for cardioversion.  (+info)

Echocardiographic assessment of the left atrial appendage. (4/253)

The left atrial (LA) appendage is a common source of cardiac thrombus formation associated with systemic embolism. Transesophageal echocardiography allows a detailed evaluation of the structure and function of the appendage by two-dimensional imaging and Doppler interrogation of appendage flow. Specific flow patterns, reflecting appendage function, have been characterized for normal sinus rhythm and various abnormal cardiac rhythms. Appendage dysfunction has been associated with LA appendage spontaneous echocardiographic contrast, thrombus formation and thromboembolism. These associations have been studied extensively in patients with atrial fibrillation or atrial flutter, in patients undergoing cardioversion of atrial arrhythmias and in patients with mitral valve disease. The present review summarizes the literature on the echocardiographic assessment of LA appendage structure, function and dysfunction, which has become an integral part of the routine clinical transesophageal echocardiographic examination.  (+info)

Contractile and arrhythmic effects of endothelin receptor agonists in human heart in vitro: blockade with SB 209670. (5/253)

It is known that binding sites with endothelin(A) (ET)(A) and ET(B) receptor characteristics coexist in human heart but little is known about the receptors that mediate cardiostimulant effects of ET receptor agonists or their consequences. Functional studies were performed on isolated human cardiac tissues. The maximal positive inotropic effects of ET-1 were right atrium > left atrium = right ventricle. The rank order of potencies of agonists in right atrium was sarafotoxin S6c > ET-1 = ET-2 > or = ET-3. The ET(A) receptor-selective compounds BQ123 (10 microM) and A-127722 (1 microM) only slightly blocked (<0.5 log-unit shift) the effects of lower concentrations of ET-1, and the ET(B) receptor antagonist Ro46-8443 (10 microM) did not cause blockade. SB 209670 caused concentration-dependent rightward shifts of ET-1 and sarafotoxin S6c concentration-effect curves with Schild slopes not different from one and affinities (-logM K(B)) of 7.0 and 7.9, respectively. ET-1 caused arrhythmic contractions in right atrial trabeculae that were prevented by 10 microM SB 209670 but not 10 microM BQ123 or 1 microM A-127722, precluding ET(A) receptors. ET-1 caused a higher incidence of arrhythmic contractions in tissues taken from patients treated with beta-blockers before surgery than in tissues from non-beta blocker-treated patients. Sarafotoxin S6c produced arrhythmias that were prevented by SB 209670. The positive inotropic effects of ET-1 in human right atrial myocardium are mediated mostly by a non-ET(A), non-ET(B) receptor. Ventricular inotropic ET receptors differ from atrial inotropic ET receptors. ET-1 induced arrhythmic contractions in human atria do not appear to be mediated by an ET(A) receptor.  (+info)

Ionic mechanisms of electrical remodeling in human atrial fibrillation. (6/253)

OBJECTIVES: Atrial fibrillation (AF) is associated with a decrease in atrial ERP and ERP adaptation to rate as well as changes in atrial conduction velocity. The cellular changes in repolarization and the underlying ionic mechanisms in human AF are only poorly understood. METHODS: Action potentials (AP) and ionic currents were studied with the patch clamp technique in single atrial myocytes from patients in chronic AF and compared to those from patients in stable sinus rhythm (SR). RESULTS: The presence of AF was associated with a marked shortening of the AP duration and a decreased rate response of atrial repolarization. L-type calcium current (ICa,L) and the transient outward current (Ito) were both reduced about 70% in AF, whereas an increased steady-state outward current was detectable at test potentials between -30 and 0 mV. The inward rectifier potassium current (IKI) and the acetylcholine-activated potassium current (IKACh) were increased in AF at hyperpolarizing potentials. Voltage-dependent inactivation of the fast sodium current (INa) was shifted to more positive voltages in AF. CONCLUSIONS: AF in humans leads to important changes in atrial potassium and calcium currents that likely contribute to the decrease in APD and APD rate adaptation. These changes contribute to electrical remodeling in AF and are therefore important factors for the perpetuation of the arrhythmia.  (+info)

Prognostic value of left atrial appendage function in patients with dilated cardiomyopathy. (7/253)

The purpose of the present study was to determine whether parameters of left atrial appendage (LAA) function, assessed by transesophageal echocardiography (TEE), could predict the clinical outcome in patients with dilated cardiomyopathy (DCM). Fifty-five patients (20 had ischemic cardiomyopathy; mean age, 56+/-14 years) who underwent TEE to evaluate LAA function from 1992 to 1996 were studied. After a mean follow-up period of 34+/-13 months, 16 patients died; the cause was cardiac in 14 and noncardiac in 2. Patients who died of cardiac cause had a lower LAA emptying velocity than survivors (38+/-18 vs 54+/-18 cm/s, p=0.01). There were, however, no significant differences between survivors and nonsurvivors with regard to the maximal LAA area (4.3+/-1.3 vs 4.5+/-0.9 cm2, p=0.55), minimal LAA area (2.4+/-1.1 vs 2.9+1.1 cm2, p=0.13), and LAA ejection fraction (46+/-16 vs 36+/-18%, p=0.05). On the Cox proportional hazards model analysis, LAA emptying velocity <50 cm/s (chi-square 5.9, p=0.02), LAA ejection fraction <43% (chi-square 5.6, p=0.02), female gender (chi-square 5.2, p=0.02), pulmonary artery wedge pressure > or =14 mmHg (chi-square 4.8, p=0.03), E/A ratio > or =1.3 (chi-square 4.6, p=0.03), deceleration time <148 ms (chi-square 4.6, p=0.03), and cardiothoracic ratio > or =54% (chi-square 4.3, p=0.04) were significantly related to cardiac death. The stepwise multivariate analysis revealed that LAA emptying velocity (chi-square 6.1, p=0.01) and gender (chi-square 5.4, p=0.02) were the independent predictors for outcome. In conclusion, the parameters of LAA function may be useful predictors of the clinical outcome in patients with DCM.  (+info)

Evaluation of right atrial appendage blood flow by transesophageal echocardiography in subjects with a normal heart. (8/253)

Right atrial appendage (RAA) blood flow pattern was analyzed in 42 normal subjects-without cardiovascular disease (aged 30 to 48 years, mean 40 +/- 6) who underwent transesophageal echocardiography. RAA flow pattern was demonstrated to be bi-, tri- or quadriphasic and heart rate dependent (p < 0.01) in this study. In 15 subjects (36%), a biphasic pattern was observed. A triphasic pattern was observed in 12 subjects (28%). Fifteen subjects (36%) had a quadriphasic pattern. In these subjects, we observed a pattern consisting of two diastolic forward flow waves, each followed by a backward flow wave. Mean heart rates among subjects with bi-, tri- and quadriphasic patterns were 110 +/- 6, 91 +/- 4 and 72 +/- 13 beats/min, respectively. In the triphasic pattern, the onset of superior vena cava diastolic forward flow began 18 +/- 4 ms after the onset of tricuspid E wave, whereas the first diastolic forward flow wave in the RAA began 40 +/- 7 ms after onset of the tricuspid E wave. A similar relation was also noted in the quadriphasic pattern. This sequence was constant and independent of heart rate (p < 0.05), suggesting a temporal relation between right ventricular relaxation and the first diastolic forward flow wave in the RAA. In normal subjects, the RAA flow pattern is heart rate dependent and three distinct flow patterns can be differentiated. Right ventricular relaxation appears to induce both the superior vena cava diastolic forward flow wave and the first diastolic forward flow wave of the RAA. These results can be used for comparison with patterns found in disease states.  (+info)

Eventbrite - Boston Scientific presents TCT 2016 LOTUS Edge™ Valve System and the WATCHMAN™ Left Atrial Appendage Closure Device - Saturday, 29 October 2016 at Prequel, Washington, DC. Find event and ticket information.
A left atrial appendage closure device can be used for atrial fibrillation patients to help prevent strokes and as an alternative to blood thinners such as warfarin (Coumadin).. In atrial fibrillation, the hearts upper chambers, or atria, beat irregularly. Pooling of blood flow during atrial fibrillation in an area called the left atrial appendage can increase the risk of blood clot formations that could travel to the brain and cause a stroke.. To perform the procedure, a catheter is inserted over a guide wire through a small incision in the thigh. This catheter travels up a vein and into the right atrium then across the atrial septum and into the left atrium of the heart.. The closure device is deployed securely into the left atrial appendage and the catheter and guide wire are removed.. With the device in place, the left atrial appendage is closed off from blood flow, reducing the risk of blood clot formation and strokes.. ...
A left atrial appendage closure device can be used for atrial fibrillation patients to help prevent strokes and as an alternative to blood thinners such as warfarin (Coumadin).. In atrial fibrillation, the hearts upper chambers, or atria, beat irregularly. Pooling of blood flow during atrial fibrillation in an area called the left atrial appendage can increase the risk of blood clot formations that could travel to the brain and cause a stroke.. To perform the procedure, a catheter is inserted over a guide wire through a small incision in the thigh. This catheter travels up a vein and into the right atrium then across the atrial septum and into the left atrium of the heart.. The closure device is deployed securely into the left atrial appendage and the catheter and guide wire are removed.. With the device in place, the left atrial appendage is closed off from blood flow, reducing the risk of blood clot formation and strokes.. ...
This is a multi-center, prospective, randomized study, stratified by center, comparing the WATCHMAN device to long term warfarin therapy, demonstrating that the treatment arm is non-inferior to the control arm. This study was amended to allow for a non-randomized arm and increased enrollment ...
Methods and apparatus for closing a left atrial appendage are described. The methods rely on introducing a closure tool from a location beneath the rib cage, over an epicardial surface, and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage, preferably at its base, by any one of a variety of techniques. A specific technique using graspers and a closing loop is illustrated.
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A membrane applied to the ostium of an atrial appendage for blocking blood from entering the atrial appendage which can form blood clots therein is disclosed. The membrane also prevents blood clots in the atrial appendage from escaping therefrom and entering the blood stream which can result in a blocked blood vessel, leading to strokes and heart attacks. The membranes are percutaneously installed in patients experiencing atrial fibrillations and other heart conditions where thrombosis may form in the atrial appendages. A variety of means for securing the membranes in place are disclosed. The membranes may be held in place over the ostium of the atrial appendage or fill the inside of the atrial appendage. The means for holding the membranes in place over the ostium of the atrial appendages include prongs, stents, anchors with tethers or springs, disks with tethers or springs, umbrellas, spiral springs filling the atrial appendages, and adhesives. After the membrane is in place a filler substance may be
Disclosed is an occlusion device for use in a body lumen such as the left atrial appendage. The occlusion device includes an occlusion member and may also include a stabilizing member. The stabilizing member inhibits compression of the left atrial appendage, facilitating tissue in-growth onto the occlusion member. Methods are also disclosed.
Objective To evaluate the predictive value of left atrial appendage (LAA) function in success of electrial cardioversion (ECV) in patients with nonvalvular atrial fibrillation (NVAF), and observe the course of the recovery of LAA systaltic function Methods To test blood flow wave patterns, peak emptying velocity (PEV) of LAA and left atrial spontaneous echo contrast (SEC) of left atrial appendage before ECV and after ECV 24 hours, 3 days and 1 week in 60 patients with NVAF by using transesophageal echocardiography (TEE) Results (1) Patients with LAAPEV20 cm/s had a ECV success rate of 75%, in contrast, LAAPEV20 cm/s had that of 30% (2) LAA blood flow wave patterns converted to a organized contraction patterns LAAPEV (2310 cm/s) was lower than that (3010 cm/s) before ECV (P0001); SEC could be generated in 8 patients, intensified in 11 patients Conclusion LAA mechanical activity prior to ECV is highly
The final diagnosis was AL (primary) amyloidosis and smoldering multiple myeloma with cardiac involvement. Treatment was started with CYBord (velcade, cytoxan, dexamethasone). Enoxaparin therapy was started for the left atrial appendage thrombus. Given major cardiac involvement, and a clinically estimated 5 yr overall survival of 40%, ICD implantation for primary prevention was not recommended. Perspective: Several key findings of cardiac amyloidosis were identified in this study. Atrial fibrillation is common in this population, for which real-time cine imaging was helpful. CMR has not gained widespread use for LAA thrombus detection, despite prior reports suggesting high sensitivity and specificity. This may be attributable to the overall low incidence of thrombus in study populations comparing CMR to transesopohageal echocardiography2. With the addition of three dimensional contrast MRA, which was not performed in this study, detection may approach that of transesophageal echocardiography. ...
WASHINGTON - November 2, 2016 - Results from the U.S. real-world, post-FDA approval experience of the Watchman device found high procedural success and low complication rates despite implantations by a large percentage of new operators. The Watchman device was approved by the U.S. Food and Drug Administration (FDA) in March 2015 for left atrial appendage occlusion (LAAC) to reduce the risk of stroke in patients with non-valvular atrial fibrillation (AF). Findings from the Watchman US Post-Approval Experience were reported today at the 28th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the worlds premier educational meeting specializing in interventional cardiovascular medicine. The results of the study were also published simultaneously in the Journal of the American College of Cardiology (JACC).. "While LAAC avoids the anticoagulant-related lifetime risk of bleeding, implantation of the device can ...
Anticoagulants/therapeutic use; Atrial Appendage/*physiopathology; Atrial Fibrillation/etiology/*prevention & control; Heart Catheterization; Humans; Patient Selection; *Prostheses and Implants/adverse effects; Prosthesis Design; Safety; Treatment Outcome; Warfarin/therapeutic ...
When the Watchman left atrial appendage (LAA) closure device (Boston Scientific) came on the market, the number of complications reported to the US Food and Drug Administration (FDA) shot up initially but then started to come back down, a new analysis shows.. The lesson, according to senior author Dhanunjaya Lakkireddy, MD (University of Kansas Hospital & Medical Center, Kansas City), is not that there is a problem with the Watchman device itself, but that there is an adjustment period for technology in general when moving from clinical trials to real-world use.. "I was not at all surprised and, in fact, [the findings] actually fit in very well with our hypothesis that when you really roll out something new the learning curve oftentimes impacts the safety performance of most of these devices in the real world," Lakkireddy told TCTMD.. He noted that his team has since extended follow-up from the current study, finding that the number of complications reported to FDA has continued to decline after ...
Open, randomized, controlled, multicenter clinical investigation. Transesophageal echocardiography (TEE) for all patients within 14 days of the Enrolment Visit. Patients randomized to oral anticoagulation (OAC) will receive standard of care (SOC) vitamin K antagonist treatment throughout the 24 months clinical investigation period, managed by the primary care physician, with the goal of achieving and maintaining an INR of 2-3 (INR monitoring by the primary care physician every two weeks throughout study period).. Patients randomized to the WATCHMAN device will undergo device implantation within 48 hours of the screening TEE and after confirmation of INR ≤ 1.7 in the catheterization laboratory with a subsequent hospitalization for 24-48 hours.. Concomitant treatment with Aspirin/Clopidogrel (managed by the patients primary care physician) will be initiated on the day prior to device implantation, and will be continued for 6 months after the procedure, at which time Clopidogrel will be ...
A 58-year-old female with a medical history of ≈2 years of chronic atrial fibrillation (on warfarin treatment), previous right mastectomy for invasive ductal carcinoma, and hypertension presented with a hypertensive emergency and mental status changes. Her symptoms resolved with appropriate antihypertensive treatment. The international normalized ratio on presentation was 2.9. During an additional work-up for transient neurological symptoms, transesophageal echocardiography was performed, revealing a 2×2-cm, well-circumscribed, spherical, mobile echodensity within the ostium of the left atrial appendage (LAA), which was attached by an 8-mm-long stalk to the lateral wall of the appendage (Figure 1). Continuous, mild-to-moderate spontaneous echo contrast was noted in the left atrium and LAA, and the peak emptying velocity in the appendage was 10 cm/s (Figure 2). It was unclear whether the mass represented a thrombus or an unusually located atrial myxoma. The patient underwent uncomplicated ...
Introduction: Patients with atrial fibrillation (Afib) routinely undergo transesophageal echocardiogram (TEE) for evaluation of left atrial appendage (LAA) to rule out thrombus prior to undergoing cardioversion or pulmonary vein isolation (PVI). Cardiac MRI (CMR) is now increasingly used for evaluation of these patients for defining pulmonary vein anatomy prior to PVI. We hypothesized that 2D and 3D non-contrast and contrast CMR is as effective as TEE in evaluating the LAA thrombus while providing simultaneous comprehensive non-invasive evaluation of the pulmonary vein anatomy within a single exam.. Methods: Afib Pts (n=110, male=82) underwent TEE and non-contrast and contrast CMR prior to undergoing an initial PVI procedure. CMR was performed on 1.5T GE scanner and two blinded CMR experts analyzed the images. The CMR images were analyzed under two categories: 1) the 2D non-contrast cine images showing LAA in 2 chamber and orthogonal views 2) 3D atrial contrast source-images acquired during ...
Dr. Vivek Reddy from Mount Sinai School of Medicine in New York City gave a very well referenced and persuasive presentation on the Watchman device which closes off the Left Atrial Appendage to prevent clots and strokes. The theory behind the Watchman device is that most A-Fib clots originate in the Left Atrial Appendage (LAA). The Watchman closes off the LAA where 90-95% of A-Fib strokes come from. Its a very low risk procedure that takes as little as 20 minutes to install. Afterward, you would usually not need to be on blood thinners. (For more, see my article, The Watchman Device: The Alternative to Blood Thinners).. Dr. Reddy certainly persuaded me that the FDA should approve the Watchman device. Dr. Reddy, earlier in Washington, had made the same persuasive arguments before the FDA.. Dr. Andrew Farb from the FDA took the bull by the horns and gave his perspective on the various LAA Closure (Occlusion) Devices. But as one would expect, he didnt indicate how the FDA would rule on the ...
Dr. Vivek Reddy from Mount Sinai School of Medicine in New York City gave a very well referenced and persuasive presentation on the Watchman device which closes off the Left Atrial Appendage to prevent clots and strokes. The theory behind the Watchman device is that most A-Fib clots originate in the Left Atrial Appendage (LAA). The Watchman closes off the LAA where 90-95% of A-Fib strokes come from. Its a very low risk procedure that takes as little as 20 minutes to install. Afterward, you would usually not need to be on blood thinners. (For more, see my article, The Watchman Device: The Alternative to Blood Thinners).. Dr. Reddy certainly persuaded me that the FDA should approve the Watchman device. Dr. Reddy, earlier in Washington, had made the same persuasive arguments before the FDA.. Dr. Andrew Farb from the FDA took the bull by the horns and gave his perspective on the various LAA Closure (Occlusion) Devices. But as one would expect, he didnt indicate how the FDA would rule on the ...
Transcatheter left atrial appendage (LAA) ligation may represent an alternative to oral anticoagulation for stroke prevention in atrial fibrillation. This study sought to assess the early safety and efficacy of transcatheter ligation of the LAA
WatchmanNew Technology for AF patients Watchman− Questions? Contact PHSW Cardiology 360-514-4444 The WATCHMAN™ left atrial appendage closure device offers a new stroke risk reduction option for patients with atrial fibrillation who are seeking an alternative to oral anticoagulants (blood thinners).What is Atrial Fibrillation (AF) Atrial fibrillation is a common heart condition
Patient Care and General Interest. A 7-year-old girl who received a heart transplant as an infant is now competing in the Canadian Transplant Games, which are underway at the University of British Columbia in Vancouver, Canada.. The Lung Cancer Alliance held its National Advocacy Summit in the US capitol, working to increase awareness of the disease and support for research. Thoracic surgeons in the US also join the call for increased funding for lung cancer research.. A surgical team from Dubai, UAE, performs free heart surgery for children in Mumbai, India, as part of the Nabadat initiative of the Mohamed bin Rashid Charity and Humanitarian Establishment.. Englands National Health Service has approved routine funding for percutaneous left atrial appendage occlusion for patients with atrial fibrillation who cannot take blood thinning medication.. Drugs and Devices. The US Food and Drug Administration has approved the next-generation MitraClip® from Abbott. The device received the CE Mark ...
Video articles in JoVE about venous thromboembolism include Stenosis of the Inferior Vena Cava: A Murine Model of Deep Vein Thrombosis, A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis, Deep Vein Thrombosis Induced by Stasis in Mice Monitored by High Frequency Ultrasonography, Intravital Microscopy and Thrombus Induction in the Earlobe of a Hairless Mouse, Mouse Complete Stasis Model of Inferior Vena Cava Thrombosis, Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood, The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation.
Nearly two years after being the first commercial site in New England to implant the WATCHMAN Left Atrial Appendage Closure (LAAC) device, Catholic Medical Center (CMC) has performed the procedure on previously ineligible patients.
Results Eighty-five (96%) of 89 patients underwent successful LAA ligation. Eighty-one of 85 patients had complete closure immediately. Three of 85 patients had a ≤2-mm residual LAA leak by TEE color Doppler evaluation. One of 85 patients had a ≤3-mm jet by TEE. There were no complications due to the device. There were 3 access-related complications (during pericardial access, n = 2; and transseptal catheterization, n = 1). Adverse events included severe pericarditis post-operatively (n = 2), late pericardial effusion (n = 1), unexplained sudden death (n = 2), and late strokes thought to be non-embolic (n = 2). At 1 month (81 of 85) and 3 months (77 of 81) post-ligation, 95% of the patients had complete LAA closure by TEE. Of the patients undergoing 1-year TEE (n = 65), there was 98% complete LAA closure, including the patients with previous leaks. ...
Left atrial appendage closure (LAAC) with the Watchman device prevents stroke in patients with nonvalvular atrial fibrillation (AFib) comparable to warfarin, with reduced major bleeding and mortality, according to the five-year results of the PREVAIL and PROTECT-AF trials, presented at TCT 2017 and simultaneously published in the Journal of the American College of Cardiology.. Vivek Y. Reddy, MD, et al., reported the final, five-year results of PREVAIL, both alone and as part of a patient-level meta-analysis with PROTECT-AF five-year data. In the two trials combined, 1,114 patients with nonvalvular AFib were randomized to LAAC with the Watchman device (n = 732) or warfarin (n = 382) for 4,343 patient-years. The first primary efficacy endpoint in PREVAIL was the same as the primary endpoint in PROTECT-AF - the composite of stroke, systemic embolism or cardiovascular/unexplained death. In PREVAIL, the second primary efficacy endpoint was the composite of ischemic stroke or systemic embolism after ...
53. 54. 55. 56. 57. 58. 59. 60. involvement in intracardiac thrombogenesis. Thromb Res 2003;111(3):137-42. Yamashita T, Sekiguchi A, Iwasaki YK, et al. Thrombomodulin and tissue factor pathway inhibitor in endocardium of rapidly paced rat atria. Circulation 2003;108(20):2450-2. Fukuchi M, Watanabe J, Kumagai K, et al. Increased von Willebrand factor in the endocardium as a local predisposing factor for thrombogenesis in overloaded human atrial appendage. J Am Coll Cardiol 2001;37(5):1436-42. Kumagai K, Fukuchi M, Ohta J, et al. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation. ) was seen in patients with LV dysfunction even in the absence of AF,41,42 which suggests that intact LV function may help decrease the risk of thromboembolism. 44 It is therefore possible that decreased nitric oxide in addition to increased free radicals may increase thrombotic milieu. 48 Altered ...
The right atrial appendage is an uncommon site of origin for ectopic atrial tachycardia. Right atrial appendage tachycardia (RAAT) has been noted to be prevalent in young males and responds well to radiofrequency ablation. We report a case of RAAT resistant to multiple attempts of ablation that responded to ablation using Stereotaxis Niobe™ Magnetic Navigation System (RMN, Stereotaxis, St. Louis, MO, USA).. (PACE 2013; 36:e15-e18) ...
The Food and Drug Administrations (FDA) Circulatory System Device Panel met on Oct. 8, 2014, for the third time to discuss Boston Scientifics application for approval of the WATCHMAN device, a left atrial appendage closure device. The panel voted six to five with one abstention that the benefits outweighed the risks of the device for the specified patient population, a far closer vote than those of previous panels. The close nature of the vote reflected the panels concerns regarding the proposed label indication. Discussion throughout the day conveyed panel members concerns that this be an option only as a second-line therapy for a select group of patients and the need to include this as part of the label indication. Other concerns included the need for sufficient patient education regarding the benefits and risks of the WATCHMAN device, as well as the sufficiency of the proposed post approval study should the device be approved.. The major debate of the day was whether the new data from the ...
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Kitkungvan D et al.. J Am Coll Cardiol Img. 2016;():. doi:10.1016/j.jcmg.2015.11.029 Link: https://imaging.onlinejacc.org/article.aspx?articleid=2524096. Objectives The goal of this study was to evaluate the diagnostic performance of a comprehensive, multicomponent cardiac magnetic resonance (CMR) study for assessment of left atrial (LA) and left atrial appendage (LAA) thrombus.. Background Pre-operative evaluation for pulmonary vein isolation (PVI) typically requires tomographic imaging to define pulmonary venous anatomy and transesophageal echocardiogram (TEE) to assess for the presence of LA/LAA thrombus. CMR is increasingly being used to define pulmonary venous anatomy before PVI. Limited data are available on the utility of a multicomponent CMR protocol in assessing LA/LAA thrombus.. Methods We studied patients who underwent multicomponent CMR for evaluation of pulmonary venous anatomy before PVI and underwent TEE within 7 days. LA and LAA thrombi were evaluated by using CMR as follows: 1) ...
LEFT ATRIAL APPENDAGE ANATOMY. The publication chosen for the description of the LAA anatomy was signed by DeSimone et al.[3] from Mayo Clinic, Rochester, MN, USA. The three-dimensional LAA morphology is, by itself, the substrate for thrombus generation, and should be the subtract for embolism due to its direct connection to the left-sided circulation. The LAA mesodermal justify its exclusion from the atrial circulation and thereby can lead to a significant reduction in stroke risk. This process also provides insight into the LAA as an endocrine organ, its fluid homeostasis involvement, and its autonomic nervous system connection. The surrounding LAA structural knowledge arrangement is critical to identify the endocardial and epicardial landmarks perspective to improve devices placement. Furthermore, correlation of the LAA body, neck, and ostium to the surrounding anatomy can also improve both procedural safety and efficacy. Also, a working knowledge of the regional anatomy adds a prudent degree ...
WASHINGTON, DC-In initial commercial experiences, both the Watchman and Amplatzer Amulet left atrial appendage (LAA) closure devices were be implanted with high rates of success and low risks of periprocedural complications, two new analyses show.. In one study, patients implanted with Watchman in the months following the March 2015 approval by the US Food and Drug Administration (FDA) had a pericardial tamponade rate of about 1%, with procedure-related mortality seen in less than 0.1%, David Holmes Jr, MD (Mayo Clinic, Rochester, MN), reported here at TCT 2016, noting that about half of operators were new to the procedure.. And in the other study of the Amulet device, a postmarket registry following European approval, the overall rate of device- and procedure-related major adverse events was 2.7%, with rates of death, stroke, and pericardial effusion of 0.5% or less, reported David Hildick-Smith, MD (Royal Sussex Brighton Hospital, England).. Commenting for TCTMD, Jacqueline Saw, MD (University ...
Left atrial appendage (LAA) exclusion therapy is becoming an important management tool for minimizing stroke potential. More than 30 percent of strokes in individuals over the age of 75 years are due to atrial fibrillation.
The developmental origin of the c-kit expressing progenitor cell pool in the adult heart has remained elusive. Recently, it has been discovered that the injured heart is enriched with c-kit(+) cells, which also express the hematopoietic marker CD45.In this study, we characterize the phenotype and transcriptome of the c-kit+/CD45+/CD11b+/Flk-1+/Sca-1±(B-type) cell population, originating from the left atrial appendage. These cells are defined as cardiac macrophage progenitors. We also demonstrate that the CD45+ progenitor cell population activates heart development, neural crest and pluripotency-associated pathways in vitro, in conjunction with CD45 down-regulation, and acquire a c-kit+/CD45-/CD11b-/Flk-1-/Sca-1+ (A-type) phenotype through cell fusion and asymmetric division. This putative spontaneous reprogramming evolves into a highly proliferative, partially myogenic phenotype (C-type).Our data suggests that A-type cells and cardiac macrophage precursor cells (B-type) have a common lineage ...
Left atrial appendage aneurysm (LAAA) is a rare condition caused by congenital dysplasia of the atrial muscles. Patients usually present with atrial tachyarrhythmias as a result of ectopic foci of atrial rhythm generation or systemic thromboembolism.
The majority of patients with nonvalvular atrial fibrillation (AF) have an indication for anti-coagulation to reduce the risk of stroke. As the left atrial appendage (LAA) is thought to the be the predominant source of thromboembolic events in the setting of AF, LAA closure may provide an alternative to anti-coagulation for stroke risk reduction without […]. Read More…. ...
Atrial fibrillation, or Afib, is the most common cardiac arrhythmia, resulting in a fast or irregular heart rhythm among more than 5 million Americans. Afib is traditionally treated with blood-thinners or anticoagulants such as warfarin, but a new device, recently approved by the FDA, is changing the way Afib is treated.. The WATCHMAN™ Left Arial Appendage Closure Device offers patients with non-valvular atrial fibrillation a potentially life-changing stroke risk treatment option that could free them from the challenges of long-term warfarin therapy.. The Frankel Cardiovascular Center is among the first heart centers in the nation to use the WATCHMAN Device. With stroke being one of the most feared consequences of Afib, the WATCHMAN Device has proved to be a viable alternative to blood-thinning medications, which are not well-tolerated by some patients and have a significant risk for bleeding complications. Continue reading →. ...
Cardiovascular Disease 1 Cardiovascular Disease 1. More target specific oral anticoagulants (TSOAC) 2. Vorapaxar (Zonivity) 3. Continued noise about a polypill 4. WATCHMAN Left Atrial Appendage
[107 Pages Report] Check for Discount on Global Epicardial LAA Closure Device Market Professional Survey Report 2016 report by QYResearch Group. Notes: Production, means the output of Epicardial LAA Closure Device...
A 76-year-old woman with a medical history of permanent atrial fibrillation (CHA2DS2-VASc stage 4) underwent left atrium (LA) appendage closure with a LARIAT device (SentreHEART, Redwood City, California). She was then maintained on aspirin only due to major bleeding during postoperative period. Two years later, she presented with a mechanical fall. Chest computed tomography with contrast, done as work-up for trauma, showed a large unenhanced LA mass (Figure 1A). She underwent further evaluation with transesophageal echocardiogram (TEE), which showed very severe LA dilatation (LA volume = 150 ml or 79 ml/m2), LA appendage occlusion, and a new, very large, sessile mass attached to the posterior wall of the LA (Figures 1B and 1C, Online Video 1). The mass did not enhance after contrast infusion (Figure 1D, Online Video 2). This mass was new compared to her prior TEE during the procedure and the findings were consistent with thrombus. She was treated with vitamin K antagonist and had no clinical ...
Because the LAA is generally multilobed, it can be difficult to visualize in its entirety, even with 3D imaging. In addition, TEE has limited sensitivity for identification of small thrombi or thrombi within a side lobe. Thus, the absence of visualizing an LAA thrombus does not equate with the absence of an LAA thrombus. To better assess the LAA and the risk of thromboembolism, functional assessment of the LAA using Doppler echocardiography is routinely used (47). Evaluation of LAA Doppler velocities is requisite to help exclude LAA thrombi. In SR, the LAA is usually a highly contractile muscular sac that obliterates its apex during atrial systole. This can be seen by TEE and confirmed by pulsed and color flow Doppler. The LAA velocity and color flow in SR are concordant with LAA reduction in size, reflecting true contraction, whereas in AF this normal pattern is usually replaced by a chaotic one of varying velocities (Figure 9). Flow in the appendage should be assessed after optimally aligning ...
First, epicardial LAAE significantly decreased SBP at 3 and 12 months in patients with a history of AF and hypertension. Second, the epicardial LAAE cohort had a significantly lower number of antihypertensive medications than the endocardial exclusion cohort at 1 year. Third, there was no significant difference in serum electrolytes (sodium, potassium, magnesium) and creatinine at 3 months between both groups. This substantial decrease in SBP on both short-term and long-term follow-up is due to the impact of epicardial exclusion on 2 separate pathways-the natriuretic peptide and neural pathways-both ultimately leading to inhibition of the RAAS. The impact on systemic blood pressure seems to be that of a group effect with epicardial exclusion compared with endocardial occlusion.. Prior studies have reported that although the right atrial appendage is the major source of cardiac atrial natriuretic peptides (ANP), the LAA stores about 30% of ANP, which is released into the blood circulation with ...
Watch WATCHMAN key opinion leaders discuss which patients they believe are eligible for left atrial appendage closure and how they discuss the therapy with their patients.
Denegri, Andrea; Yousif, Nooraldaem; Manka, Robert; Alkadhi, Hatem; Maier, Willibald (2017). Rare coronary anomaly with hemodynamic consequence: squeezing of the right coronary artery. European Heart Journal, 38(47):3539.. Frangieh, Antonio H; Alibegovic, Jasmina; Templin, Christian; Gaemperli, Oliver; Obeid, Slayman; Manka, Robert; Holy, Erik W; Maier, Willibald; Lüscher, Thomas F; Binder, Ronald K (2017). Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman. Catheterization and Cardiovascular Interventions, 90(2):331-338.. Jaguszewski, Milosz; Dörig, Manuela; Frangieh, Antonio H; Ghadri, Jelena-Rima; Cammann, Victoria Lucia; Diekmann, Johanna; Napp, L Christian; DAscenzo, Fabrizio; Imori, Yoichi; Obeid, Slayman; Maier, Willibald; Lüscher, Thomas F; Templin, Christian (2016). Safety and efficacy profile of bioresorbable-polylactide-polymer-biolimus-A9-eluting stents versus durable-polymer-everolimus- and zotarolimus-eluting stents in ...
Atrial fibrillation (AF) is a common type of arrhythmia that increases significantly the risk of blood clots in the heart and of stroke. Therefore, stroke prevention is a key goal of AF treatment. In the past, patients were required to take anticoagulants for the remainder of their life, to regularly the monitor international normalized ratio (INR) of prothrombin time (PT), and to avoid possible negative interactions with various drugs and foods. Left atrial appendage occlusion (LAAO), a novel device and technique, was thus developed for AF patients with contraindications to anticoagulants and a high risk of bleeding ...
Atrial fibrillation, ablation, ventricular arrhythmias, SVT - supraventricular tachycardia, cardiac electrophysiology, pacemakers, ICDs and CRT devices, resynchronisation therapy - CRT, laser balloon therapy for atrial fibrillation, left atrial appendage occlusion device implantation, reveal linq device ...
Coronary artery disease, percutaneous coronary intervention, cardiac risk factor management, vascular biology, cardiac disease and diving medicine, closure of PFO and ASD, left atrial appendage occlusion ...
Abstract. Left atrial appendage (LAA) thrombus is an accepted risk factor for ischemic stroke. Following a literature review we were unable to identify a study that determined the incidence of ischemic stroke in patients with a confirmed LAA thrombus. The purpose of this study was to establish the incidence of ischemic stroke in patients with a LAA thrombus confirmed on trans-oesophageal echocardiography (TOE). A ten year retrospective single centre study was conducted for the period March 2005 to February 2014 in St. Vincents University Hospital, Ireland. All TOE studies performed during this period were reviewed. A chart review was carried out on any patient who had a LAA thrombus, left atrial (LA) thrombus or pre-thrombus state identified. Charts were reviewed for documented neurological deficits consistent with ischemic stroke or transient ischemic attack within six months following TOE study. Overall 1903 TOE studies were reviewed. A total of 67 TOE studies detected a LAA thrombus, LA ...
This section deals with minimal invasive therapies related to structural heart disease. Various resources are included in topics such as left atrial appendage closure and Transcatheter Aortic Valve Replacement.Structural Heart Disease Learning for Physicians and Allied Health Professionals
A 63-year-old man with a history of persistent AF on chronic warfarin oral anticoagulation was referred for LAA exclusion after severe gastrointestinal bleeding and history of falling resulting in a hip fracture. His past medical history included hypertension, diabetes mellitus, previous myocardial infarctions, congestive heart failure, end-stage renal disease on hemodialysis, peripheral vascular disease, status post-femoral popliteal bypass surgery, and hip fracture. The patient had a CHADS2 score of 3, CHADS-Vasc score of 4, and a HAS-Bleed score of 4. The patient underwent an uncomplicated closed-chested LAA ligation with the LARIAT suture delivery device.2 LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy acutely (Figure 1). The patient did well post-LAA closure and was on no antiplatelet or antithrombin medications. A follow-up TEE performed at 8 months revealed a closed LAA with no leaks. Eleven months after his LAA ligation, the patient was ...
Results from the AMULET OBSERVATIONAL STUDY Reported at TCT 2016. WASHINGTON - November 2, 2016 - Initial results from the largest, prospective evaluation of a percutaneous transcatheter left atrial appendage (LAA) closure device (Amplatzer Amulet) for stroke prevention in patients with non-valvular atrial fibrillation show that the device has a high implant success rate and low major adverse events.. Findings from the AMULET OBSERVATIONAL STUDY were reported today at the 28th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the worlds premier educational meeting specializing in interventional cardiovascular medicine.. The study enrolled 1,073 patients between June 2015 and September 2016 at 64 clinical sites in Europe, the Middle East, Asia, Australia and South America. 1,060 patients had device implantation, giving a technical success rate of 98.8%. Major adverse events (MAEs) within 7 days of ...
Using the streptozotocin-induced diabetic rat model, we have recently showed that the expression and function of β1-adrenoreceptor were decreased in the diabetic rat heart. However, the effect of diabetes on expression of β-adrenoreceptors in human cardiac tissue remains undefined. Therefore, the focus of the present study was to investigate the effect of diabetes on mRNA encoding β1- and β2-ARs in human atrial tissues. Right atrial appendages from five diabetic (mean age 65 ± 4.5; 4 female, 1 male) and five nondiabetic patients (mean age 56.2 ± 2.8; 4 male, 1 female) undergoing coronary artery bypass grafting were collected and assayed using reverse transcriptase-polymerase chain reaction (RT-PCR) for their mRNA content. No patient from these two groups suffered from acute myocardial infarction and/or failure. All diabetic patients received insulin for at least two years and had been diagnosed as diabetics for at least five years. When compared with levels in nondiabetics, steady state levels of
The role of LAA in the initiation and maintenance of AF and AT has been described in several recent studies. Two studies (5,12) of AT originating from the LAA proposed that the underlying mechanism is increased automaticity. Epicardial exclusion of the appendage with a minimally invasive occlusion device (Atriclip, AtriCure, West Chester, Ohio) implanted from outside the heart through a thoracoscopic approach has been shown to be successful in achieving electrical isolation and thus elimination of focal AT (11). In a series of 10 consecutive patients undergoing coronary bypass surgery, epicardial LAA clip occlusion led to the complete electrical isolation of the LAA. Thus, LAA ligation resulted not only in the elimination of an important source of systemic thromboembolism but also in the electrical exclusion of potential triggers of AF (14).. Di Biase et al. (4) reported that 266 (27%) of 987 patients undergoing redo catheter ablation for paroxysmal and persistent AF showed firing from the LAA, ...
Doukky R, Garcia-Sayan E, Patel M, Pant R, Wassouf M, Shah S, DSilva O, Kehoe RF. Impact of Diastolic Function Parameters on the Risk for Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation: A Prospective Study. J Am Soc Echocardiogr. 2016 06; 29(6):545-53 ...
The most notable association between the LAA and disease is in the context of AF. In this setting, reduced contractility and stasis of the LAA occur, resulting in thrombus formation and thereafter the potentially catastrophic consequences of embolisation. In individuals with non-valvular AF, 90% of thrombi have been identified within the LAA; (Figure 1) [14]. Additionally it has been observed that up to 14% of patients have thrombus identifiable in the LAA within 3 days of AF onset [15]. It is these observations which have led to the LAA being termed our most lethal human attachment [16]. Remodelling of the LAA in subjects with AF has been observed with chamber enlargement and decreased pectinate muscle volume [17]. Typical histological appearances include endocardial thickening, fibrosis and myocyte hypertrophy [18]. A reduced LAA peak flow velocity studied during transoesophageal echocardiography (TOE) is established to be an independent and powerful predictor of thromboembolic risk [19]. ...
Patient had 2 CABGs done and while the heart was retracted, sutures were placed around the base of atrial appendage and tied. A heavy silk tie was use
The LARIAT® Suture Delivery Device permanently closes the Left atrial appendage (LAA), which is a benefit for individuals with Atrial Fibrillation (AFib) who cannot tolerate blood thinners.. The left atrial appendage (LAA) is a small, ear-shaped sac in the muscle wall of the left atrium (top left chamber of the heart). The LAA is a structure in the heart that normally contracts, allowing blood to flow in and out of the LAA. For patients with AFib, the most common heart rhythm disorder, the LAA no longer rhythmically contracts, creating a sluggish blood flow that can cause blood to pool and clot. These blood clots can lead to stroke. About 90% of the clots in atrial fibrillation originate in the LAA. Atrial fibrillation patients are often prescribed a blood thinners, such as warfarin or Coumadin or newer blood thinners such as Xarelto, Eliquis to prevent clotting; however these drugs cannot be tolerated by all patients.. During the LARIAT procedure, a local anesthetic is used to numb the area ...
Left Atrial Appendage Thrombus in the Modern Anticoagulant Era Heart, Lung and Circulation Volume 22, Supplement 1 , Page S185, 2013 - G Scalia, J Humphries, A Rainbird, D Cross, J Presnell, B Fitzgerald
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On patients with atrial fibrillation without anticoagu-lants treatment, the global risk of stoke is 5 times hi-gher. Thus, this arrhythmia remains one of the major causes for stroke, sudden death and cardiovascular morbidity in the world. For this reason, permanent an-ticoagulation is recommended on patients with atrial fibrillation and a score of CHA2DS2-VASc ≥1 according to the current guide for atrial fi brillation treat-ment and management developed by the European Society of Cardiology (ESC)1. Drug therapy with non-vitamin K anticoagulants is very efficient in preventing the stroke and reduces the risk of brain hemorrha-ge in comparison with vitamin K antagonist therapy (VKA)2. The bleeding risk represented by HAS-BLED score is partially congruent with CHA2DS2-VASc score. According to the European Society of Cardi-ology (ESC), the relative contraindication regarding oral anticoagulants is represented for atrial fi brillation not only by HAS-BLED score, but also by the clinical assessment ...
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More than half of the patients who have suffered a stroke with no well-defined aetiology have an enlarged left atrial appendage of the heart, according to a Finnish study. The results indicate that the enlargement of the left atrial appendage may be an independent risk factor of strokes with cardiac origin.
... ) - Did you know that more than 3 million Americans are affected by atrial fibrillation? Atrial fibrillation, which is also referred to as AF or AFib, is the most common irregular or abnormal heart rhythm disorder. It decreases the hearts pumping ability and can make the heart work less efficiently. In addition, patients must be aware that AFib can lead to potentially life-threatening problems such as blood clots and a higher risk of stroke.. The first step in effectively minimizing the risk of blood clots and strokes caused by AFib is to identify those patients at high risk for a stroke. These high-risk patients are often treated successfully with anticoagulant medications. However, some patients cannot take these medications long term due to side effects-most commonly bleeding-or because they interfere with their lifestyle. Thats where the WATCHMAN™ Device comes in.. The WATCHMAN™ Device is the first proven non-pharmacologic alternative to reduce stroke risk for ...
Anticoagulation. Cardioversion in the setting of sludge is controversial and associated with a higher risk of thrombus being present ...
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Percutaneous interventions such as MitraClip (Abbott Vascular, Santa Clara, California, USA) implantation and left atrial appendage (LAA) closure …
Methods, apparatus, and systems for occluding a left atrial appendage are provided. One embodiment includes an elongate body having a tissue apposition member extendably positioned within a lumen of the elongate body to appose tissue of the LAA. An energy emitting device coupled to the elongate body can be used for emitting high intensity focused ultrasound to the tissues to fuse the tissues.
RESULTS: There were significant difference between two groups with regard hypertension (HT), left atrial (LA) diameter, left atrial appendage emptying peak flow velocity (LAAV), and vitD. On univariate analysis, hypertension (HT), LA diameter, LAAV, and vitD were associated with AF recurrence. On multivariate analysis LA diameter, LAAV, and vitD were independent predictors for AF recurrence (OR=2.168; 95% CI: 1.487-3.651; ...
Disclosed is a closure catheter, for closing a tissue opening such as an atrial septal defect, patent foreman ovale, or the left atrial appendage of the heart. The closure catheter carries a plurality of tissue anchors, which may be deployed into tissue surrounding the opening, and used to draw the opening closed. Methods are also disclosed.
Disclosed is a closure catheter, for closing a body cavity such as a vessel, or the left atrial appendage of the heart. The closure catheter includes a plurality of deployable tissue anchors, which may be laterally deployed into surrounding tissue. The anchors may thereafter be used to draw the tissue radially inwardly, to close the body cavity. Methods are also disclosed.
According to the FDA, use of Lariat Suture Delivery Device linked to patient deaths & other complications when used to close the left atrial appendage.
Koretz RL. In nonvalvular AF, DOAC-related risk for GI bleeding was lower with apixaban than dabigatran or rivaroxaban. Ann Intern Med. 2017;167:JC21. doi: 10.7326/ACPJC-2017-167-4-021. Download citation file:. ...
Results In AF group, the rhythm of LAA and RAA tissue field potential were irregular, LAA increased in the percent of 15.67%, RAA decreased in the percent of 34.62% than the control group. The voltage of LAA and RAA decreased than the control group, the duration of field potential of LAA and RAA shorted than control group. Electricity impulse represents anisotropic alteration.. ...
Matters developed normally until 02:00 hrs., when then watchman saw a shadow through the window. Arming himself with a pistol for protection, he went out to investigate. He headed toward a light panel located between the vessels. At that location, he saw a shadow facing him, and according to the remark he later shared with his co-workers, he heard a voice that said: "Mátate" (kill yourself) over and over again, imperatively. At that moment, his wife reached the site (she had been keeping him company during the late shift) and she managed to pull away the gun that the watchman was pointing at his head. At no time did the wife see or hear any of the things reported by the watchman. Returning to the office, the watchman headed for the restroom, babbling "kill yourself" over and over. When the officer-in-charge arrived, he asked the watchman to taka few days off, in view of the state he was in ...
Hobbs, R. F., Song, H., Watchman, C. J., Bolch, W. E., Aksnes, A. K., Ramdahl, T., Flux, G. D. & Sgouros, G., May 21 2012, In : Physics in Medicine and Biology. 57, 10, p. 3207-3222 16 p.. Research output: Contribution to journal › Article ...
Buy Watchmen [Blu-ray] [2 Discs] (Enhanced Widescreen for 16x9 TV) (English/French) 2009 online and read movie reviews at Best Buy. Free shipping on thousands of items.
My copy of the Watchmen graphic novel has a back-cover blurb from Damon Lindelof, who I think I heard was one of the few people to have already seen the full film. So theyre definitely aware of Lost. But to go so far as to say these shows were "borrowing" from Watchmen seems a bit of a reach. Donkey wheels and gears existed long before Watchmen, flashes of blinding light arent a new idea, and the only real connection between the symbolic falling in the Mad Men titles and the actual falling of the Comedian is the fact that both are falling froma skyscraper. On the other hand, I can definitely see the possibility of Watchmen being a partial inspiration for Dharma. Definite similarities. ...
DOWNLOAD MP3 Join the Watchmen, Bob, Bill and Chris as we talk about what God is showing us, sharing our struggles, and hope. Isa 28:25 When he hath made plain the face thereof, doth he not cast abroad the fitches, and scatter the cummin, and cast in the principal wheat and the appointed barley and…
(PhysOrg.com) -- New atomic-level snapshots published in the June 2, 2011, issue of Nature reveal details of how bacteria such as E. coli produce and secrete sticky appendages called pili, which help the microbes attach ...
This came out at the weekend, but I think it could be fun to talk about a wee bit (If only to remind the Indie Devs who read us, youve still a few days to put
Kalia, the watchman was feeling a vague sense of unease. He looked around at the snaking road and the bleak landscape. He looked at the ruins going around the tomb of the beautiful Mughal queen. There was no change. Everything looked the same as it was yesterday, or the day before that or as far back as he could remember. Then why did he feel that there was something different? Why did he feel so sure about it?
With all the gear for the night unloaded, I bid the Lady farewell and set about the task of carrying everything to my chosen swim. Not for me, one of those barrows, oh no, Im far too stubborn to acquire one of them. Id much rather put my back under immense pressure and yomp through the slippery mud with all manner of things hanging from every available appendage (well, almost !!), arriving at the swim knackered, although, at least I didnt fall on my arse this time ...
Atrial fibrillation, or Afib, is the most common cardiac arrhythmia, resulting in a fast or irregular heart rhythm among more than 5 million Americans. Afib is traditionally treated with blood-thinners or anticoagulants such as warfarin, but a new device, recently approved by the FDA, is changing the way Afib is treated.. The WATCHMAN™ Left Arial Appendage Closure Device offers patients with non-valvular atrial fibrillation a potentially life-changing stroke risk treatment option that could free them from the challenges of long-term warfarin therapy.. The Frankel Cardiovascular Center is among the first heart centers in the nation to use the WATCHMAN Device. With stroke being one of the most feared consequences of Afib, the WATCHMAN Device has proved to be a viable alternative to blood-thinning medications, which are not well-tolerated by some patients and have a significant risk for bleeding complications. Continue reading →. ...
The ELAT study assessed interobserver variabilities for atrial thrombi, spontaneous echocardiographic contrast, and left atrial appendage size; the SPAF-III study did not [4, 5]. Although criteria for thrombi differed between these studies, both studies showed that patients with atrial thrombi who received anticoagulation have a high stroke rate. Thus, with no treatment better than anticoagulation, identification of thrombi by TEE has no relevance ...
Heterotaxy, also referred to as isomerism of the atrial appendages, is defined as an abnormal assembly of the thoracic and abdominal organs from the normal arrangement known as situs solitus. It is caused by disruption of left-right axis orientation
This study investigates whether closing the small pouch at the top of the heart, called the left atrial appendage, can reduce the risk of stroke in patients with a history of atrial fibrillation. The left atrial appendage is present in everyone, but the irregular heart rhythm in atrial fibrillation may cause blood clots to form in it. The clots can travel through the bloodstream leading to stroke or injury to other organs. This study compares rates of ischemic stroke or transient ischemic attack in patients who have the LAA closed during surgery to rates among patients who undergo similar surgeries without having the LAA closed.. Who might be eligible: Adults with atrial fibrillation for whom heart surgery with the use of the cardiopulmonary bypass machine is recommended. How long the study will last: About 4 years. Study Lead: Anson Lee, MD. More information on ClinicalTrials.gov. ...
Not all echo laboratories have the capability of measuring direct online 3D images, but do have the capability of turning 3D images into 2D ones
BACKGROUND: The left atrial appendage (LAA) flow velocity is an important factor for thrombus formation in patients with non-valvular atrial fibrillation (NV-AF). Recently, the relation of plasma brain natriuretic peptide (BNP) levels and thromboembolism has been reported in patients with NV-AF. The aim of this study was to determine whether the plasma BNP is predictive of lower LAA flow velocity in patients with NV-AF and normal left ventricular (LV) systolic function. METHODS AND RESULTS: A total of 184 patients with NV-AF (132 men; 65 ± 12 years, LV ejection fraction; 65 ± 10%) underwent transthoracic echocardiography, transesophageal echocardiography (TEE), and measurement of plasma BNP ...
AGA Medical commences enrollment in AMPLATZER Cardiac Plug clinical trial AGA Medical Holdings, Inc. Dr http://sildenafil-100mg.org/ . William Nicholson, an interventional cardiologist and structural heart... ...
Lobar Collapse. Lung Anatomy. (1) aortic arch (2) pulmonary trunk (3) left atrial appendage (4) left ventricle (5) right atrium (6) superior vena cava (7 & 8) diaphragm (9) transverse fissure. Lung Anatomy. (1) oblique fissure (2) transverse fissure (3) retrocardiac...
Roly has undertaken two interventional fellowships, firstly locally at Princess Alexandra Hospital in Brisbane. He was then awarded the Chamberlain Scholarship in Advanced Coronary and Structural Intervention at the world renowned Royal Sussex County Hospital, England. During his time there Roly was involved in many international trials and several first-in-man developments. Rolys main interest is in clinical cardiology with a focus on coronary and structural intervention. Unusually for an interventional cardiologist, Roly is also trained, accredited and performs cardiac CT giving a unique perspective in the diagnosis, investigation and management of cardiovascular diseases. Roly performs a wide range of percutaneous interventional procedures including coronary stents, rotablation and chronic total occlusion revascularisation. He performs the full range of structural interventions including TAVI, PFO / ASD closure, percutaneous treatments of aortic and mitral valves, left atrial appendage ...
Rationale: Studies have demonstrated that exosomes can repair cardiac tissue post-myocardial infarction and recapitulate the benefits of cellular therapy. Objective: We evaluated the role of donor age and hypoxia of human pediatric cardiac progenitor cell (CPC)-derived exosomes in a rat model of ischemia-reperfusion injury. Methods and Results: Human CPCs from the right atrial appendages from children of different ages undergoing cardiac surgery for congenital heart defects were isolated and cultured under hypoxic or normoxic conditions. Exosomes were isolated from the culture-conditioned media and delivered to athymic rats after ischemia-reperfusion injury. Echocardiography at day 3 post-myocardial infarction suggested statistically improved function in neonatal hypoxic and neonatal normoxic groups compared with saline-treated controls. At 28 days post-myocardial infarction, exosomes derived from neonatal normoxia, neonatal hypoxia, infant hypoxia, and child hypoxia significantly improved ...
A/N: Well, here it is (sniffle), the last chapter. Lucky 13. I have to say its been a genuine pleasure writing this story and getting all your feedback. Thank you all, both those whove stuck with this from the beginning and all you newcomers reading this for the first time. Your wonderful reviews have spurred me on to write a better story than I ever imagined I could create.. Of all the characters in Watchmen, I think the saddest character, other than Rorschach, is Dr. Manhattan. Not because of what hed become, but because he remembered being human first. If he hadnt remembered being human, I dont think he would have suffered as he did, knowing all of time simultaneously and being powerless to change it. I decided to write a chapter prologue told by him in the first person, as I feel his perspective has something to offer here.. So read on, boys and girls! And take your time, cause this is all she wrote.. PS: The two song excerpts are "Faces" by Greenwheel and "Come Undone" by Duran ...
E a proposito di connessioni con Watchmen... Qualche anno fa Gary Spencer Milidge (lautore di Strangehaven, in Italia per la Black Velvet, ndr) mi chiese di contribuire al suo libro-tributo Alan Moore: Ritratto di uno straordinario gentleman (co-curato da smoky man, pubblicato in Italia sempre da Black Velvet, ndr). Io ne fui lusingato e naturalmente accettai. E così feci questo fumetto di tre pagine che aveva come protagonista uno dei personaggi di The 3 Geeks, Allen George, che, come mi aveva fatto notare un fan qualche anno prima, era del tutto identico a Seymour, il personaggio di Watchmen. Così ho scritto una storia ala Quattro Dita, come se fosse un documentario. Pensai che potevo divertirmi col fatto che i due personaggi si assomigliavano, e così creai questo "attore" chiamato Gil Lenderthol, che aveva interpretato sia Seymour in Watchmen che Allen George nel mio fumetto (oltre ad aver ricoperto altri piccoli ruoli in telefilm come Star Trek). Feci raccontare a Gil una storiella su un ...
Hi Folks ! Well, the long awaited LED information is here ! This will be as detailed as I can possibly be, and I will attempt to be as accurate as possible. If you know electronics, and you find mistakes or blatantly incorrect information PLEASE correct me ! LEDs are the wave of the future…
AVRev.com releases a Blu-ray review of Watchmen Directors Cut, starring Malin Akerman, Carla Gugino, Billy Crudup, Patrick Wilson, Jeffrey Dean Morgan
What the heck is that??? Guess what, we all have them and we dont need them at all. Now, why one would have a body part that is not needed is an interesting question. So if you dont believe in evolution, well we gotta problem even before you finish the first paragraph. Weve all heard…
night watchman {n} (a person appointed by a town or city to walk the streets at night and guard the burghers from felons and robbers ...
The revenge flick is so deeply embedded within our culture that to remove it would be akin to slicing off ones own appendage. It encompasses nearly everything
bab yang saya paling ta sukaa bilaa membelogging ialah nak kasi tajukk . saya tataw nak tulis tajuk ape sebab bagi saya crite saya adalah tajuk saya . ye tak ? ye tak ? huhu . act saya memam nak buat somethim tadi ng belogg neh tapi jadi tader mood sebab ntah laa . dua bulan sudaa saya kat sini . masehh panjang lagii perjalanan ini . menjadi perantauan bukan laa satu perkare yg seronok tapi perkare yg pling mencabar dalam hidup saya . ...
He worked on a device for left atrial appendage occlusion sold by AtriCure. He wrote a book with Steven Nissen that published ... Hughes, Sue (June 18, 2010). "AtriClip for left atrial appendage occlusion approved in US". www.medscape.com. Gillinov, Marc; ...
"The placement of a LeVeen shunt into the right atrial appendage". Journal of the Indiana State Medical Association. 74 (4): 224 ... He is the creator of the Wolf Mini Maze, a procedure used to correct atrial fibrillation (AF). Wolf hosts a weekly radio show ... IN where he serves as Co-director of the Atrial Fibrillation Center with electrophysiologist Dr. Chad Bonhomme. Prior to that ... "Take Charge of Your Health." In 2012, Wolf inaugurated the Atrial Fibrillation Center at The Indiana Heart Hospital in ...
There is an ear-shaped structure in the upper right atrium called the right atrial appendage, or auricle, and another in the ... The left atrium has an outpouching called the left atrial appendage. Like the right atrium, the left atrium is lined by ... the left atrial appendage. The right atrium and the right ventricle together are sometimes referred to as the right heart. ... which are also present in the right atrial appendage. The right atrium is connected to the right ventricle by the tricuspid ...
Left atrial appendage isomerism, also called left atrial isomerism, is a cardiac development defect in which the heart has 2 ... Right atrial appendage isomerism, also called right atrial isomerism, is a cardiac development defect in which the heart has ... Right-atrial and left-atrial isomerism and associated pulmonary issues are treated in a series of steps based on the severity ... September 26, 2015). "Anatomy, clinical manifestations and diagnosis of heterotaxy (isomerism of the atrial appendages)". Up To ...
"Left Atrial Appendage Closure for Stroke Prevention in Non-Valvular Atrial Fibrillation: Rationale, Devices in Clinical ... "Left Atrial Appendage Closure: A Percutaneous Transcatheter Approach for Stroke Prevention in Atrial Fibrillation." European ... Foundation for Cardiovascular Research, Ulf Landmesser Left Atrial Appendage Occlusion - where are we compared to new drugs, AF ... "Cardiac CT and Echocardiographic Evaluation of Peri-Device Flow after Percutaneous Left Atrial Appendage Closure Using the ...
Atrial lead at the right appendage - Right ventricular lead at the apex. - Left ventricular lead through the coronary sinus.[5] ...
... make up the part of the wall in front of this, the right atrial appendage.[citation needed] In the left ... are confined to the inner surface of its atrial appendage. This is due to the embryological origin of the auricles, which are ...
The left atrial appendage can serve as an approach for mitral valve surgery. The left atrial appendage can be seen on a ... Left atrial appendage occlusion is an experimental treatment to prevent stroke in atrial fibrillation. ... The case of a disappearing left atrial appendage thrombus: direct visualization of left atrial thrombus migration, captured by ... 1) There are no atrial inlet valves to interrupt blood flow during atrial systole. (2) The atrial systole contractions are ...
Wudel JH, Chaudhuri P, Hiller JJ (2008). "Video-assisted epicardial ablation and left atrial appendage exclusion for atrial ... "Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation". J Thorac ... The left atrial appendage is usually removed. A very thorough description of the procedure is available. Video-assisted ... and the right atrial isthmus lesion. We call this pattern of atrial lesions the "mini-maze Procedure" ... None of the present ...
The embryonic left atrium remains as the trabecular left atrial appendage, and the embryonic right atrium remains as the right ... The atrial portion starts moving in a cephalic ally and then moves to the left from its original position. This curved shape ... When forming intra-atrial septa, atrio-ventricular valves will begin to grow. An intra-muscular ventricular septum begins to ... atrial appendage. At the end of the fourth week, two atrioventricular endocardial cushions appear. Initially the ...
Also, atrial fibrillation, causes stagnant blood in the left atrium (LA), or left atrial appendage (LAA), and can lead to a ... The most common cause is atrial fibrillation, which causes a blood stasis within the atria with easy thrombus formation, but ...
TTE in adults is also of limited use for the structures at the back of the heart, such as the left atrial appendage. ... If bubbles appear in the left heart, this may indicate a shunt, such as a patent foramen ovale, atrial septal defect, ...
The line of union between the right atrium and the right atrial appendage is present on the interior of the atrium in the form ... thick portion of heart muscle in a crescent shape at the opening into the right atrial appendage. On the external aspect of the ...
... a trial to determine the effectiveness of left atrial appendage occlusion during cardiac surgery in patients with atrial ... Left Atrial Appendage Occlusion Study) trial. On April 9, 2015, Whitlock and his team performed the first transcatheter aortic ...
... venous blood from both vena cavae and the lower chamber is in contact with the tricuspid valve and the right atrial appendage. ... The natural history of this defect depends on the size of the communicating orifice between the upper and lower atrial chambers ... Understanding the nature of congenital division of the atrial chambers. Br Heart J. Jul 1992;68(1):1-3. [Medline]. Richardson ... Transoesophageal echocardiographic evaluation of atrial morphology in children with congenital heart disease. Eur Heart J. Feb ...
Surplus human tissue can sometimes be obtained at the time of planned surgery, for example specimens of right atrial appendage ... Isolation of Atrial Cardiomyocytes: Voigt N, Pearman CM, Dobrev D, Dibb KM (September 2015). "Methods for isolating atrial ... Cell sorting Voigt N, Pearman CM, Dobrev D, Dibb KM (September 2015). "Methods for isolating atrial cells from large mammals ...
... the atrium itself Right atrial appendage Left atrial appendage Auricle (botany), an earlike projection on the base of a leaf or ...
... a memory addressing mode in x86-64 processors Left atrial appendage, part of the human heart Lah (disambiguation). ...
Freudenthal has taken out a number of patents including a left atrial appendage occlusion device, embolization device, tissue ...
... atrial septum, left atrial appendage, and coronary arteries. TEE has a very high sensitivity for locating a blood clot inside ...
... commonly forms an atrial appendage clot Coronary artery disease Deep vein thrombosis - can lead to pulmonary embolism Ischemic ... 2] In November 2010, dabigatran was approved by the FDA to treat atrial fibrillation. With regards to NOAC medication and ... Some indications for anticoagulant therapy that are known to have benefit from therapy include: Atrial fibrillation - ... Werdan, Karl; Braun-Dullaeus, Rüdiger; Presek, Peter (Aug 2013). "Anticoagulation in Atrial Fibrillation: NOAC's the Word". ...
In this variant, the artery courses in the sulcus between the left superior pulmonary vein and the left atrial appendage where ... it could be susceptible to injury during catheter or surgical ablation procedures on the left atrium, especially for atrial ...
... atrial appendage MeSH A07.541.409.147 --- atrioventricular node MeSH A07.541.409.273 --- bundle of his MeSH A07.541.409.683 ...
Isomerism of atrial appendages (Q21) Congenital malformations of cardiac septa (Q21.0) Ventricular septal defect (Q21.1) Atrial ... Accessory auricle Accessory tragus Polyotia Preauricular appendage or tag (Q17.1) Macrotia (Q17.2) Microtia (Q17.3) Other ... Atrioventricular septal defect Common atrioventricular canal Endocardial cushion defect Ostium primum atrial septal defect ( ...
A thrombus is most likely to form in the atrial appendages. A blood clot in the left atrial appendage is particularly important ... Type I atrial flutter, also known as common atrial flutter or typical atrial flutter, has an atrial rate of 240 to 340 beats/ ... Left atrial flutter is considered atypical and is common after incomplete left atrial ablation procedures. Atypical atrial ... Similar to the abnormal heart rhythm atrial fibrillation, atrial flutter also leads to poor contraction of the atrial chambers ...
pulmonary veins) → left atrium (atrial appendage) → mitral valve → left ventricle → aortic valve (aortic sinus) → (aorta and ... venae cavae, coronary sinus) → right atrium (atrial appendage, fossa ovalis, limbus of fossa ovalis, crista terminalis, valve ...
The membranes may be held in place over the ostium of the atrial appendage or fill the inside of the atrial appendage. The ... After the membrane is in place a filler substance may be added inside the atrial appendage to reduce the volume, help seal the ... The membrane also prevents blood clots in the atrial appendage from escaping therefrom and entering the blood stream which can ... in patients experiencing atrial fibrillations and other heart conditions where thrombosis may form in the atrial appendages. A ...
... and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage, ... Methods and apparatus for closing a left atrial appendage are described. The methods rely on introducing a closure tool from a ... and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage,... ... and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage, ...
LAACA left atrial appendage closure device can be used for atrial fibrillation patients to help prevent strokes and as an… ... A left atrial appendage closure device can be used for atrial fibrillation patients to help prevent strokes and as an ... Pooling of blood flow during atrial fibrillation in an area called the left atrial appendage can increase the risk of blood ... With the device in place, the left atrial appendage is closed off from blood flow, reducing the risk of blood clot formation ...
Device: WATCHMAN Left Atrial Appendage Closure Technology Implant of WATCHMAN Left Atrial Appendage Closure Technology ... Implant of WATCHMAN Left Atrial Appendage Closure Technology. Intervention: Device: WATCHMAN Left Atrial Appendage Closure ... WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients With Atrial Fibrillation. The safety and scientific ... Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic ...
Intracardiac Versus Transesophageal Echocardiography for Assisting Percutaneous Left Atrial Appendage Occlusion?. "Veni, vidi, ...
Left Atrial Appendage Closure Device - Saturday, 29 October 2016 at Prequel, Washington, DC. Find event and ticket information. ... TCT 2016 LOTUS Edge™ Valve System and the WATCHMAN™ Left Atrial Appendage Closure Device at Prequel 918 F Street Northwest, ... TCT 2016 LOTUS Edge™ Valve System and the WATCHMAN™ Left Atrial Appendage C.... by Boston Scientific ... TCT 2016 LOTUS Edge™ Valve System and the WATCHMAN™ Left Atrial Appendage Closure Device. ...
The stabilizing member inhibits compression of the left atrial appendage, facilitating tissue in-growth onto the occlusion ... Disclosed is an occlusion device for use in a body lumen such as the left atrial appendage. The occlusion device includes an ... the ostium of the atrial appendage by extending stent legs into the atrial appendage through the ostium of the atrial appendage ... the ostium of the atrial appendage by extending stent legs into the atrial appendage through the ostium of the atrial appendage ...
There are two atrial appendages of the heart: Right atrial appendage of the right atrium Left atrial appendage of the left ...
... covering epidemiology of atrial fibrillation and stroke, LAA anatomy, surgical approaches, imaging ... This book provides a comprehensive overview of state-of-the-art left atrial appendage (LAA) closure, ... Amplatzer Cardiac Plug LARIAT device WATCHMAN device atrial fibrillation left atrial appendage closure thromboembolic ... Left Atrial Appendage Closure. Mechanical Approaches to Stroke Prevention in Atrial Fibrillation. ...
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Left atrial appendage closure (LAAC) is a treatment strategy to reduce the risk of left atrial appendage blood clots from ... January 2003). "Left Atrial Appendage Occlusion Study (LAAOS): a randomized clinical trial of left atrial appendage occlusion ... "Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage ... Jude Medical, used to close atrial septal defects, has also been used to occlude the left atrial appendage. This can be ...
An intrapericardial left atrial appendage aneurysm is described in a 36 year old female. She was asymptomatic except for ... 9495908 - Simple right atrial procedure for chronic atrial fibrillation with atrial septal defect.... 20403678 - ... An intrapericardial left atrial appendage aneurysm is described in a 36 year old female. She was asymptomatic except for ... in association with the left atrial appendage aneurysm, and which improved after surgical resection. The patient is symptom- ...
... which is applied to the outside surface of the left atrial appendage, permanently closes the left atrial appendage at its base ... Johns Hopkins Left Atrial Appendage Occlusion Program. Learn more about the latest treatments for atrial fibrillation. ... A CT scan will need to be performed to make certain that the left atrial appendage is not too large or has an unusual location ... In the majority of cases, the clots form in the left atrial appendage, a small, pouchlike sac in the top left chamber of the ...
Find out about treatment options to reduce risk of stroke in patients with atrial fibrillation, such as blood thinners, ... Home / Medical Services / Cardiovascular Institute / Treatment Programs / Arrhythmia Treatment / Left Atrial Appendage ... With this device, the left atrial appendage is tied off by access to both inside and outside the heart. This procedure is being ... Approved by the FDA, this umbrella-shaped device fits in the left atrial appendage to form a barrier against blood clots. This ...
... sutures were placed around the base of atrial appendage and tied. A heavy silk tie was use ... Patient had 2 CABGs done and while the heart was retracted, sutures were placed around the base of atrial appendage and tied. A ...
... physiology and pathological aspects of the left atrial appendage along with old and new therapeutic strategies of stroke ... symposium is a multi-specialty cardiovascular educational symposium in North America on the frontier science of left atrial ... appendage. This topic is of tremendous interest in the practice of cardiovascular care. Over a period of two days, the ... physiology and pathological aspects of the left atrial appendage along with old and new therapeutic strategies of stroke ...
... clinicaltrials.gov The purpose of the study is to demonstrate the safety and the rate of closure of the Ultrasept Left Atrial ... A curious case of an absent left atrial appendage.. The left atrial appendage (LAA) in the setting of non-valvular atrial ... Totally Thorascopic Closure of the Left Atrial Appendage.. The left atrial appendage (LAA) is a major site of clot formation in ... Percutaneous left atrial appendage (LAA) closure (placement of an occluder to close the appendage) is a novel procedure for ...
Use this page to view details for the Proposed Decision Memo for Percutaneous Left Atrial Appendage (LAA) Closure Therapy (CAG- ... It is important to note that the terms left atrial appendage closure (LAAC) and left atrial appendage occlusion (LAAO) are used ... Safety of percutaneous left atrial appendage closure. Results from the WATCHMAN left atrial appendage system for embolic ... Safety of percutaneous left atrial appendage closure. Results from the WATCHMAN left atrial appendage system for embolic ...
Other: Left Atrial Appendage Occlusion Surgeon will occlude the left atrial appendage using a suture and/or a surgical stapler ... Experimental: Left Atrial Appendage Occlusion Group Surgeon will close the left atrial appendage using a suture and/or a ... No Intervention: No Left Atrial Appendage Occlusion Group Surgeon will not close the left atrial appendage during the patients ... Cardiac Surgery With Cardiopulmonary Bypass Atrial Fibrillation Other: Left Atrial Appendage Occlusion Not Applicable ...
Atrial Fibrillation Stroke Procedure: Surgical occlusion of the left atrial appendage Procedure: Best medical practice Phase 3 ... In patients with atrial fibrillation with 2 or more risk factors for stroke, will removal of the left atrial appendage (LAA) ... Surgical intervention: Occlusion of the left atrial appendage (LAA) using cut-and-sew technique appendage occlusion. ... Left Atrial Appendage Occlusion Study II (LAAOSII). The safety and scientific validity of this study is the responsibility of ...
Ectopic Focus in an Accessory Left Atrial Appendage. Radiofrequency Ablation of Refractory Atrial Fibrillation. Ronan P. ... A further separate source of atrial premature contractions was found originating from within the accessory LA appendage (Figure ... The appendage was clearly separated from the LA appendage (curved arrow). B, Sagittal-oblique magnetic resonance image ... Holter 24-hour ECG recordings revealed occasional atrial premature beats and paroxysmal atrial tachycardia. ...
A Left Atrial Appendage Thrombus Mimicking Atrial Myxoma. Barbara Hesse, Ross T. Murphy, Jonathan Myles, Julie Huang, Ellen ... A Left Atrial Appendage Thrombus Mimicking Atrial Myxoma. Barbara Hesse, Ross T. Murphy, Jonathan Myles, Julie Huang and Ellen ... A Left Atrial Appendage Thrombus Mimicking Atrial Myxoma. Barbara Hesse, Ross T. Murphy, Jonathan Myles, Julie Huang and Ellen ... mobile echodensity within the ostium of the left atrial appendage (LAA), which was attached by an 8-mm-long stalk to the ...
Right atrial appendage aneurysm (RAAA) is rare with fewer than 20 cases reported in the literature. We sought to systematically ... Atrial tachyarrhythmias and heart failure were the most common complications.. CONCLUSION: Right atrial appendage aneurysm ... BACKGROUND: Right atrial appendage aneurysm (RAAA) is rare with fewer than 20 cases reported in the literature. We sought to ...
More than 30 percent of strokes in individuals over the age of 75 years are due to atrial fibrillation. ... Left atrial appendage (LAA) exclusion therapy is becoming an important management tool for minimizing stroke potential. ... Left atrial appendage exclusion. LAA exclusion is not a new concept and has been performed since 1949 as an adjunct to cardiac ... Stroke reduction utilizing left atrial appendage exclusion. Stroke remains a disabling and sometimes lethal disorder. It is ...
"Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2. 3-Year Follow-up of ... Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) Trial," Circulation, vol. ... "Left atrial appendage closure: a percutaneous transcatheter approach for stroke prevention in atrial fibrillation," European ... "Percutaneous left atrial appendage closure for stroke prevention in patients with atrial fibrillation: an assessment of net ...
  • Despite the various efforts in the prior art, there remains a need for a minimally invasive method and associated devices for reducing the risk of thrombus formation in the left atrial appendage. (justia.com)
  • The term 'isomerism,' derived from Greek ( iso, meaning 'equal,' and meros , meaning 'part'), refers to this abnormal developmental symmetry in which morphologic structures that normally develop on one side or the other of the body are found on both sides of the body, and is the currently accepted term used to describe hearts with isomeric atria and atrial appendages [ 1 ]. (uptodate.com)
  • So, in affected patients, instead of a distinct left and right side, individuals with isomerism will have either two right sides or two left sides resulting in either two right atria or two left atria (atrial isomerism) [ 2 ]. (uptodate.com)
  • Right atrial appendage isomerism - Right atrial appendage isomerism, also referred to as right atrial isomerism (RAI), results in two right sides with bilateral right atria and atrial appendages, and an absence of left-sided structures (eg, coronary sinus). (uptodate.com)
  • Atria (blue) are still small and poorly developed compared to the appendages. (nih.gov)
  • Van Praagh S, O'Sullivan J, Brill S, Van Praagh R (1996) Juxtaposition of the morphologically left atrial appendage in solitus and inversus atria: a study of 18 postmartem cases. (springer.com)
  • Atrial fibrillation (AF) is the irregular and rapid beating of the upper two chambers of the heart (the atria) which increases the risk of stroke. (nice.org.uk)
  • Due to abnormal cardiac development, patients with situs ambiguous usually develop right atrial isomerism consisting of 2 bilaterally paired right atria, or left atrial isomerism consisting of 2 bilaterally paired left atria. (wikipedia.org)
  • Right atrial appendage isomerism, also called right atrial isomerism, is a cardiac development defect in which the heart has bilateral right atria and atrial attachments in the muscle wall, as opposed to the normal right atrium and left atrium. (wikipedia.org)
  • In addition, the atrial septum which distinguishes the 2 atria is absent. (wikipedia.org)
  • Left atrial appendage isomerism, also called left atrial isomerism, is a cardiac development defect in which the heart has 2 bilateral left atria and atrial appendages in the muscle wall. (wikipedia.org)
  • the primitive atrium will become the front parts of the left and right atria and their appendages, and the sinus venous will develop into the posterior part of the right atrium, the sinoatrial node and the coronary sinus. (wikipedia.org)
  • Absence of the orifice between the RIGHT ATRIUM and RIGHT VENTRICLE, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. (bioportfolio.com)
  • This catheter travels up a vein and into the right atrium then across the atrial septum and into the left atrium of the heart. (medmovie.com)
  • The right atrial appendage (RAA) is shown in yellow and the venous component of the right atrium in blue. (bmj.com)
  • The left atrial appendage could be directly entered from the right atrium at catheterization, but it was positioned behind the great arteries. (springer.com)
  • Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. (bioportfolio.com)
  • There is an ear-shaped structure in the upper right atrium called the right atrial appendage, or auricle, and another in the upper left atrium, the left atrial appendage. (wikipedia.org)
  • citation needed] In the left atrium, the pectinate muscles, fewer and smaller than in the right atrium, are confined to the inner surface of its atrial appendage. (wikipedia.org)
  • Attached to the right atrium is the right atrial appendage - a pouch-like extension of the pectinate muscles. (wikipedia.org)
  • The line of union between the right atrium and the right atrial appendage is present on the interior of the atrium in the form of a vertical crest, known as the crista terminalis (in older texts the crista terminalis of His). (wikipedia.org)
  • Cor triatriatum (or triatrial heart) is a congenital heart defect where the left atrium (cor triatriatum sinistrum) or right atrium (cor triatriatum dextrum) is subdivided by a thin membrane, resulting in three atrial chambers (hence the name). (wikipedia.org)
  • Patient #2 was a 65-year-old female with persistent atrial fibrillation, hypertension, diabetes mellitus, and gastric ulcers, with a history of partial gastrectomy for bleeding from a perforated ulcer (CHA 2 DS 2 -VASc score of 4). (eplabdigest.com)