New life-saving treatments for Coronary artery disease in clinical trial on Assessment of Global Myocardial Perfusion Reserve Using Coronary Sinus Flow Measurements
Abstract. Expanded indications for cardiac resynchronization therapy and the increasing incidence of cardiac implantable electronic device infection have led to an increased need for coronary sinus (CS) lead extraction. The CS presents unique anatomical obstacles to successful lead extraction. Training and facility requirements for CS lead extraction should mirror those for other leads. Here we review the indications, technique, and results of CS lead extraction. Published success rates and complications are similar to those reported for other leads, although multiple techniques may be required. Re-implantation options may be limited, which should be incorporated into pre-procedural decision making.. Link to abstract on PubMed. ...
Sudden occlusion of the left anterior descending branch approximately 2 cm. below the ostium of the left circumflex coronary artery in the dogs heart produces a mortality rate of approximately 50 per cent. In dogs weighing approximately 15 kilos surviving more than 24 hours (average 1 week), an infarction is produced which almost invariably measures 5 x 5 cm. on surface. Following coronary sinus obturation such secondary sudden occlusion of the left anterior descending branch is followed either by no infarction or by a reduction in the size of the infarct. The success of the procedure, quite apart from the mortality rate, depends upon the completeness of the coronary sinus obturation. On the other hand, sudden and complete coronary sinus obturation by itself is associated with a high operative mortality and apparently does not affect the mortality rate following subsequent sudden left anterior descending branch occlusion. Partial persistent obturation of the coronary sinus, however, is in ...
A catheter-based method for coronary sinus mapping, pacing, and ablation, wherein a flexible electrode catheter, having a tip electrode with suspension structure, is pre-shaped to snugly fit into the coronary sinus, so that the tip electrode is positioned into the sinus; the distal section is deflected to expose a predetermined plurality of electrodes; and RF energy is then applied to the coronary sinus tissue through the electrodes to cause activation mapping, and/or ablation.
A coronary sinus catheter for the retrograde infusion of cardioplegia solutions into the coronary sinus. The catheter is adapted for improved retention in the coronary sinus. The catheter comprises a catheter tube having infusion, pressure-sensing and balloon-inflation lumens, an inflatable balloon and a pressure sensor tube in fluid communication with the balloon-inflation lumen for sensing pressure in the inflatable balloon. The internal volume of the pressure sensor tube is relatively non-expansible relative to the internal volume of the inflation balloon in normal operation of the catheter. The balloon includes a plurality of segmented annular ribs.
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Biventricular pacing is a validated treatment for patients suffering from heart failure resistant to medical treatment. However, up to 30% of the patients are non responsive to this strategy using the coronary sinus approach to pace the Left Ventricle (LV).. It has been demonstrated that the magnitude of the improvement was highly dependant on the LV pacing site. The coronary sinus approach rarely offers more than 1 or 2 potential pacing sites. Resynchronisation using a transeptal approach to pace the left ventricle on the cardiology has been shown feasible on small series. We therefore would like to compare these two approached in a randomised prospective study to confirm the hypotheses that endocardial LV pacing by offering multiple choices for the pacing sites reduces the number of non responders and is associated with greater hemodynamic benefit when compared to the conventional coronary sinus approach. ...
To establish whether pressure-volume areas (PVAs) calculated using the maximum time-varying elastance (Emax) have a relation with myocardial oxygen consumption (MVO2) that improves on other indexes of myocardial oxygen demand, we studied nine dogs of either sex weighing 19-39 kg, which were instrumented with a micromanometer left ventricular (LV) catheter and a Wilton-Webster coronary sinus flow catheter and had red blood cells tagged with technetium-99m for radionuclide angiography. Hemodynamics, coronary sinus flow determinations, and radionuclide angiograms were obtained under control conditions and during three to five steady-state loading conditions (mean +/- SD, 5.6 +/- 0.7). Isochronal pressure-volume data points from each pressure-volume loop were subjected to linear regression analysis to calculate Emax. The Emax relations, diastolic curves, and systolic portions of each pressure-volume loop were used to obtain calibrated PVAs. The Emax PVA (mm Hg.ml.beat-1.100 g-1) and MVO2 (ml ...
Pacemaker Pacemaker P-0 Frenik sinir stimülasyonuna neden olan koroner sinüs leadinin femoral yoldan repozisyonu Fethi Kılıçaslan, Ömer Uz, Alptuğ Tokatlı, Zafer Işılak, Mehmet Uzun, Bekir Yılmaz Cingözbay,
Significance of jet lavage for in vitro and in vivo cement penetration. These guidewires allow the lead to advance easily to the coronary sinus branches. Column в size l0. See BCSC Section 4, Ophthalmic Buy Ladygra and Intraocular Tumors, for more details of the features Buy Ladygra cellular atypia and neoplastic change.
A device for treatment of mitral annulus dilatation comprises an elongate body having two states. In a first of these states the elongate body is insertable into the coronary sinus and has a shape adapting to the shape of the coronary sinus. When positioned in the coronary sinus, the elongate body is transferable to the second state assuming a reduced radius of curvature, whereby the radius of curvature of the coronary sinus and the radius of curvature as well as the circumference of the mitral annulus is reduced.
... definition, a large venous channel in the heart wall that receives blood via the coronary veins and empties into the right atrium. See more.
Miracor Medical Systems out of Vienna, Austria has announced that its Pressure-controlled Intermittent Coronary Sinus Occlusion (PICSO) Impulse System has
If the error occurs frequently, request an RMA in order to replace the 6148A module, and mark the module for EFA.%LTL-SP-2-LTL_PARITY_CHECK: LTL parity check request for 0x[hex]ExplanationThis is the result of The outputs of the atrial and ventricular sensing circuits, 82 and 84, are connected to the microcontroller 60 which, in turn, are able to trigger or inhibit the atrial and ventricular No. 4,788,980 (Mann et al.). See the illustration on the side access panel for the correct memory configurations, and reseat the DIMMs accordingly. 216-Memory Size Exceeds Maximum Supported The amount of memory installed exceeds that supported The error is thus corrected and processing returns to FIG. 3. As used herein, the phrase "coronary sinus region" refers to the vasculature of the left ventricle, including any portion of the coronary sinus, great cardiac vein, left marginal vein, left posterior The switch was still under warranty from the used hardware > reseller, so the blade was replaced. Imprecise ...
Synonyms for cardiac veins, smallest in Free Thesaurus. Antonyms for cardiac veins, smallest. 63 synonyms for vein: blood vessel, mood, style, spirit, way, turn, note, key, character, attitude, atmosphere, tone, manner, bent, stamp, humour, tendency.... What are synonyms for cardiac veins, smallest?
The function of the small cardiac vein is to retrieve blood from the vascular tissues of the heart and drain them into the coronary sinuses, according to anatomyExpert. This process ensures that the...
But theres always one point of a surgical procedure that grabs the doctors gonads, and for device implants, its usually gaining access to the blood vessel where the leads for a pacemaker or defibrillator are to be implanted. You see, poke too deeply, you might hit the patients lung. Poke a half a centimeter higher toward the patients head, you might hit the high-pressure artery rather than the low pressure vein and bleeding will compress the target vein, making it very difficult to cannulate. Dont poke deeply enough, you never get in the vessel. Thats the way these procedures go. (Ive already mentioned that I cheat and use a vascular ultrasound device to find the vessel. I mean, why stress, right ...
Find right answers right now! How would you trace blood from the small cardiac vein to the posterior inter ventricular artery? More questions about Health, how
The appearance of the proximal descending aorta reflects an aortic spindle - this is an anatomical variant where there is a smooth, mild bulge just beyond the aortic isthmus.
This is generally performed subsequent to RV lead placement, with the RV lead providing a backup in case of accidental damage to the electric fibers of the heart, causing an asystolic event. As with the RV lead, a guide wire is first inserted, allowing for the insertion of a multi-delivery catheter. The catheter is subsequently maneuvered to the opening of the coronary sinus in the right atrium. From here a contrast media is injected, allowing the surgical team to obtain a coronary sinus phleobogram to direct the placement of the lead into the most suitable coronary vein.[1]. Once the phlebogram has been obtained, the multi-delivery catheter is used to guide in the lead, from the chosen vein of entry, into the right atrium, through the coronary sinus and into the relevant cardiac vein.[1]. Left ventricular lead placement is the most complicated and potentially hazardous element of the operation, due to the significant variability of coronary venous structure. Alterations in heart structure, ...
Heart failure patients with left ventricular (LV) ejection fractions of ,35% who are on optimal medical therapy with QRS durations of ≥120 ms on surface electrocardiography have derived clinical benefit from cardiac resynchronization therapy (CRT). Although this well-established and guideline-recommended treatment has shown reductions in heart failure progression and risk for ventricular tachyarrhythmias, there are also shortcomings. Nearly one-third of patients with CRT implants fail to show clinical benefit. Although potential explanations for the lack of response to CRT may be multifactorial, one of the most important prerequisites for successful CRT is proper LV lead placement. And that can be technically challenging.. LV lead placement to deliver CRT typically involves cannulating the coronary sinus, performing coronary venous angiography, selecting a target vein, and advancing the pacing lead into the selected vein to achieve adequate resynchronization. Although it is still an evolving ...
Dynamic Coronary Roadmap (DCR) is a navigation support package that allows the users to see a roadmap of the coronary anatomy displayed on live fluoroscopy. By comparing moving structures that are present in both the angiogram and the live fluoroscopy images, with image registration techniques, DCR provides a precise overlay of the coronary vessel tree on top of the live fluoroscopy moving exactly with the cardiac and breathing motion. This same technique can also be used for imaging the coronary venous anatomy for guiding left ventricular lead placement. ...
Looking for online definition of cardiac vein, middle in the Medical Dictionary? cardiac vein, middle explanation free. What is cardiac vein, middle? Meaning of cardiac vein, middle medical term. What does cardiac vein, middle mean?
Ablation instruments and techniques are disclosed for accessing portions of the heart wall via the coronary sinus. While shielding the major portion of the sinus and/or the circumflex coronary artery from ablative energy, the present invention provides access to the heart wall to treat atrial fibrillation. In particular, the present invention provides instruments and methods for forming transmural lesions in the left atrium, such as the so-called
An implantable defibrillation lead with steerable characteristics, allowing the lead to be more easily placed within the coronary sinus. The lead comprises an elongated lead body having a proximal end and a distal end. Adjacent the distal end, there is an electrode, preferably a coiled defibrillation electrode placed on the exterior of the elongated lead body. The distal end of the lead body has a permanent set or bend. A torque tube, extending through a lumen in the lead body from the proximal end of the lead to an anchor block adjacent the distal end of the lead, can be rotated by a physician to orient the bend in the lead. A cable passes through the torque tube from the proximal end of the lead through the anchor block to the distal end of the lead. This cable is affixed to a wall of the lumen, preferably in the direction of the bend. Pulling on the cable temporarily changes the bend in the distal end of the lead.
All studies were performed in the electrophysiology laboratory. Patients were premedicated with meperidine or diazepam before the procedure. All antiarrhythmic drugs were discontinued for a minimum of five drug half-lives before the procedure. Standard multipolar catheters with 1-cm interelectrode distance were used for pacing and recording of intracardiac electrograms. These were positioned at the high right atrium, His bundle and right ventricular apex. A fourth catheter was positioned in the coronary sinus with one of the electrodes located at the coronary sinus ostium. Stimulation was performed with rectangular impulses using an EP-2 stimulator (EP Medical Inc.). A standard multichannel recorder was used for hardcopy recording. Three surface electrocardiographic (ECG) leads (I, aVF and V1) were recorded at all times. The intracardiac signals were filtered at a bandpass of 30 to 500 Hz and stored on FM tape. The pacing threshold was determined at the high right atrium and coronary sinus ...
A system and method for navigating coronary vasculature involves use of a guide catheter system which includes a guide catheter, a navigator catheter longitudinally displaceable within the guide catheter, and a deflection arrangement provided at a distal end of the navigator catheter. The guide catheter is advanced to at least a patients coronary sinus ostium, and the navigator catheter is extended from the guide catheter to a location proximate or within an angled vein distal to the coronary sinus ostium. Using the deflection arrangement, a guide wire passing through the navigation catheter is directed into the angled vein. A lead having an open lumen is advanced over the guide wire to direct the lead to an implant site within the angled vein.
Definition of thebesian circulation. Provided by Stedmans medical dictionary and Drugs.com. Includes medical terms and definitions.
A sinus ostium is the opening that connects a sinus to the nasal cavity itself. It is a tight area that tends to have a higher percentage of cilia than the surrounding mucosa. If the sinus ostium is blocked this will cause an accumulation of fluid in the sinus ...
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My anesthesiologist placed a coronary sinus catheter. I rarely see this when I code, so I am stuck on which CPT code to use. Any good cardiac coders w
CONGENITAL anomalies of the great veins of the neck are relatively infrequent. Persistent left superior vena cava (PLSVC) is an embryologic remnant of the left superior cardinal vein seen in 0.1 to 0.3% of healthy adults.1 PLSVC runs between the left pulmonary veins and the left atrial appendage enlarging the coronary sinus as it enters the atrium. When present, it can affect placement of central catheters, pacemakers, and cardiopulmonary bypass. It is important to be aware of this variation and to recognize it in imaging studies ...
© 2016 American College of Cardiology Foundation. Published by Elsevier. Objectives The goal of this study was to assess the contemporary and historical success rates of transvenous left ventricular (LV) lead placement for cardiac resynchronization therapy (CRT), their change over time, and the reasons for failure. Background In selected patients, CRT improves morbidity and mortality, but the placement of the LV lead can be technically challenging. Methods A literature search was used to identify all studies reporting success rates of LV lead placement for CRT via the coronary sinus (CS) route. A total of 164 studies were identified, and a meta-analysis was performed. Results The studies included 29,503 patients: 74% (95% confidence interval [CI]: 72% to 76%) were male; their mean age was 66 years (95% CI: 65 to 67); their mean New York Heart Association functional class was 2.8 (95% CI: 2.7 to 2.9); the mean LV ejection fraction was 26% (95% CI: 25% to 28%); and the mean QRS duration was 155 ms (95%
Mitral isthmus ablation forms part of the electrophysiologists armoury in the catheter ablation treatment of atrial fibrillation. It is well recognised however, that mitral isthmus ablation is technically challenging and incomplete ablation may be pro-arrhythmic, leading some to question its role. This article first reviews the evidence for the use of adjunctive mitral isthmus ablation and its association with the development of macroreentrant perimitral flutter. It then describes the practical techniques of mitral isthmus ablation, with particular emphasis on the assessment of bi-directional mitral isthmus block. The anatomy of the mitral isthmus is also discussed in order to understand the possible obstacles to successful ablation. Finally, novel techniques which may facilitate mitral isthmus ablation are reviewed.
Although CRT is now an accepted therapeutic modality for patients with HF and conduction disturbances, a significant proportion of patients remain nonresponders.1 Our study shows that LV lead location may be a significant contributor to this nonresponsiveness and that pacing the apical region of the LV is associated with a worse clinical outcome, including significantly higher mortality rates. Our results also demonstrate that LV lead location along the short axis (ie, anterior, lateral, or posterior wall) does not influence the primary end points of HF hospitalization and all-cause mortality. This is the first study from a randomized clinical trial to examine the impact of LV lead location on clinical outcome in which venous angiography and LV lead position data were collected prospectively and evaluated independently.. Prior work has recommended that targeting the lateral or posterolateral wall by way of either an appropriate coronary sinus branch or surgical (epicardial) placement is a ...
For patients with advanced heart failure, Cardiac Resynchronization Therapy (CRT) has been a major improvement. The treatment improves symptoms and prolongs life in selected patients with heart failure. However, with the current selection criteria and methods for implanting the pacemaker, only 60-70% of the patients derive significant benefit from the treatment.. New imaging techniques, including advanced ultrasound and computed tomography, in combination with new versatile multi-pole electrodes, have made an individually tailored therapy possible. Using these techniques in combination, the study will investigate the effect of individually based optimal placement of the pacemaker electrodes vs. standard care. The optimal LV electrode position is defined as pacing a viable segment with the latest mechanical delay, targeting a specific segment of the coronary sinus as visualised on cardiac CT. The hypothesis is that this will increase the number of positive responders from 65% to 85%. ...
A 6 month od baby with Wolfgang-Gollop syndrome was catheterized before surgery for tetralogy of Fallot. Echocardiography had revealed bilateral superior vena cava with LSVC draining into a dilated coronary sinus. In order to assess the need for canulating or ligating the persistent left superior vena cava (LSVC) at time of surgery, we inserted an 5 Fr end-hole catheter into the LSVC via the right atrium and coronary sinus. It was then advanced into the left azygos vein and angiography performed. A large communicating vein connecting the 2 asygos veins was seen beind the heart. Persistent LSVC has been described in tetralogy of Fallot. In our case, although no classical communicating wein could be found by echocardiography, selective angiography revealed a peculiar communication between bilateral azygos veins. The baby underwent successful surgical repair with no need for left superior vena cava cannulation during cardiopulmonary bypass ...
Definition: In PLSVC, the left brachiocephalic vein does not develop fully and the left upper limb and head & neck drain into the right atrium via the coronary sinus. However, from a morphological point of view, the "anatomical" drainage of a persistent left superior vena cava is always into the coronary sinus. ...
Asymmetric ventricles , with left ventricle smaller than right is seen occasionally. The following conditions should be thought of : 1. Co-arctation of Aorta 2. T.A.P.V.D. - Total Anomalous Pulmonary Venous Drainage ( or Connections ) 3.Persistent Left Superior Vena Cava 4.Dilated Coronary Sinus and rarely due to 5. Restricted Ductal Flow due to kinking…
An assembly and method for effecting the condition of a mitral valve annulus of a heart includes a guide wire configured to be fed into the coronary sinus of the heart, and a mitral valve annulus therapy device configured to be slidingly received on the guide wire and advanced into the coronary sinus of the heart on the guide wire. A guide tube may further be employed for guiding the device into the coronary sinus. An introducer which may be employed for pushing the device into or pulling device out of the heart has a mechanism for releasably locking to the device. This enables substitution of the device if needed. Also, the crossover point of the circumflex artery and coronary sinus may be determined and avoided when the device is deployed.
6 ASSESSMENT OF PFO Characterisation Tunnel length / height / width Flap separation / adhesion - RA/LA edge, body Flap retraction - spontaneous / potential Tunnel openings "PFD (patent foramen defect)"- ASD structurally merged with PFO or PFO with functional ASD ...
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Author Response.pdf. Reviewer 2 Report. This paper tests the hypothesis that the Kolmogorov complexity of a single atrial bipolar electrogram recorded during AF within the coronary sinus at the beginning of the catheter ablation may predict AF termination directly after pulmonary vein isolation (PVI). Results show significant differences in Kolmogorov complexity between patients with AF termination directly after PVI compared to patients undergoing additional ablation. Therefore, authors affirm that Kolmogorov complexity of electrograms measured at baseline before PVI can predict self-termination of AF directly after PVI. Overall, I believe that the goal of this study is very interesting and the tools used are appropriate. However, I have several major comments regarding the paper:. Authors talk about complexity measures, however they are different types of measurements and they do not measure complexity. Additional 30 second electrograms recorded 30 prior to AF termination were analyzed as the ...
In an attempt to improve myocardial performance in acute myocardial infarction with shock, increments of coronary perfusion pressure were achieved by partial obstruction of the abdominal aorta with a balloon catheter introduced via a femoral artery in 28 dogs with plastic sphere coronary embolization. Alterations of central aortic pressure, coronary sinus flow, cardiac output, left atrial pressure, left ventricular work, left ventricular oxygen consumption, coronary vascular resistance, left ventricular mechanical efficiency, and left ventricular lactate and pyruvate extraction were determined before and after coronary embolization and at intervals during 1 hour of abdominal aortic obstruction. After coronary embolization, aortic pressure, ...
We present a case of Great Cardiac Vein cryoablation in order to suppress idiopathic epicardial Ventricular Tachycardia after failed Radiofrequency ablation via the epicardium and GCV.
The myocardial potassium uptake during intracoronary isoproterenol stimulation was characterized in 12 anesthetized pigs. The beta-receptor subtype specificity and the effect of adenylate cyclase activation were determined. Potassium concentrations were continuously recorded by PVC-valinomycin minielectrodes in the left atrial cavity and in coronary sinus blood diverted through a shunt to the right atrium. The difference in potassium concentration between the left atrial cavity and coronary sinus, and the accumulated myocardial potassium uptake were calculated after computerized data sampling. By intracoronary drug infusion, changes in heart rate and systemic effects were minimized. Isoproterenol (0.6-0.8 microgram/min), a nonspecific beta-agonist, reduced coronary sinus potassium concentration transiently to a nadir of 0.28 (0.15-0.43) mM (median and 95% confidence interval) below control values (n = 12). The potassium uptake, which amounted to 140 (79-202) mumol/100 g tissue, corresponding to ...
Increased sized coronary anatomy depicting the cardiac veins and coronary arteries extending around the exterior of the heart. These arteries and veins circulate blood to and from the muscles of the heart. This Coronary Arteries and Cardiac Veins Model is manufactured by GPI and sold by GTSimulators.
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AccessGUDID - QUADRA ASSURA MP™ (05414734508377)- Cardiac resynchronization device tiered therapy cardioverter/defibrillator VVED DDDRV
0028] FIG. 8C is a perspective view cross-section schematic of a system that includes the tool of FIG. 8A-B, wherein elongate medical device body 10 has been advanced distally into cardiac vein CV, through deployment member lumen 802, and sheath 440 has been withdrawn relative to deployment member 820 and body 10 so that free end 45 of elastic cantilever element 425 abuts the wall of cardiac vein CV that is opposite myocardium M. According to some methods, an operator may position sheath 440 within a body of a patient, so that distal-most edge 44 of sidewall 442 is located in cardiac vein CV, prior to advancing deployment member 820 (alternately deployment member 420) and medical device body 10 (alternately device body 100) through sheath 440 and into cardiac vein CV. In some cases, device body 10/100 is advanced through the positioned sheath 440 together with deployment member 820/420, having been preloaded into deployment member 820/420 so that helix fixation member 15/150 is engaged in ...
The accessory soleus muscle is an anatomical variant characterised by an additional distinct muscle encountered along a normal soleus muscle. It is uncommon with a prevalence of ~3% (range 0.7-5.5%). Summary origin: fibula, soleal line of the t...
Michelle Bachmanns non-factual (and non-sensical) claim that the HPV vaccine can cause mental retardation has gotten an enormous amount of attention in the press over the past 48 hours. (See, for example, Denialism author Michael Specter "Bachmanns ...
The persistence of left superior vena cava (PLSVC) is the most common congenital anomaly of the venous return system to the heart. Because of the increasing number of patients referred for cardiac resynchronization therapy (CRT) devices implantations, it is expected to encounter this venous anatomic variation. Left ventricular lead placement at an appropriate site is an integral and technically challenging part of successful CRT. In case of cardiac abnormalities could be difficult to achieve an optimal cardiac rhythm management devices implantation. Previous reports in patients with PLSVC highlighted the challenges to achieve an optimal cardiac rhythm device implantation. Recently, a new quadripolar active fixation left ventricular lead is available for CRT device implantation. Hereby we report a case of a device upgrading from dual-chamber pacemaker to CRT with defibrillator backup using the active fixation left ventricular quadripolar lead in a patient with PLSVC and right superior vena cava atresia.
1) S.R.M Medical College, Tamil Nadu.. A.I.M.S, Kochi, Kerala.. One of the major issues raised by the cardiac surgical procedure requiring cardiopulmonary bypass is the question of myocardial protection. Retrograde coronary sinus cardioplegia (RCP) has gained wide spread use as a method of myocardial protection in a broad range of cardiac procedure.. The anatomic variations of the coronary sinus, its orifice in the right atrium and associated persistent left superior vena cava (PLSVC) may affect the distribution of retrograde cardioplegia. PLSVC results in excessive run off of the cardioplegia solution into PLSVC and right atrium, during RCP and leads to maldistribution.. During routine cadaveric dissection, in one male cadaver we found out PLSVC with dilated coronary sinus and the azygos vein on the left side, hemiazygos and accessory hemiazygos veins on the right side.. Embryological basis, clinical implications, sonographic pitfalls, associated congential cardiac anomalies and complications ...
LV endocardial pacing has been proposed and has been shown to be superior to conventional LV epicardial pacing in the CRT setting in computer simulations (54) and preclinical experiments (55,56). In various canine LBBB models, superiority has been shown in electrical resynchronization and acute hemodynamic response (55,56). However, clinical studies showed less reproducible differences. Derval et al. (57) was not able to show significantly better hemodynamic response between pacing in the endocardial position and immediately below the position of the coronary sinus lead, although in each patient there was an endocardial position that resulted in superior improvement in pump function. Similarly, Spragg et al. (58) found that endocardial pacing tended to be superior to epicardial pacing in patients with ischemic cardiomyopathy, but that the location of optimal LV endocardial pacing varied among patients. Shetty et al. (59) showed that LV endocardial pacing was superior to epicardial pacing and ...
Definition of ligament of left superior vena cava. Provided by Stedmans medical dictionary and Drugs.com. Includes medical terms and definitions.
The right atrium is thin. It is composed of an auricle, overlapping the origin of the aorta, and the main portion, called the sinus of the atrium. The openings of the right atrium are: the superior vena cava, the inferior vena cava, and the coronary sinus. The superior vena cava is located in the upper anterior part, bringing blood from the head, neck, upper extremities, and upper part of the thorax. The direction of the blood is toward the ventricular opening. The inferior vena cava is directed upward and medially at the lower part of the atrium. It hugs the diaphragm; the direction of the blood is toward the auricular septum. The orifice of the coronary sinus is situated between the preceding two and a little toward the ventricular opening. From it flows most of the venous blood collected from the heart by the cardiac veins. At its orifice is a fold of the lining membrane of the heart, the endocardium, which is called the valve of the coronary sinus ...
The Cardiac Dimensions Carillon device (Fig. 1) is a simple nitinol wire that has been engineered into a form that includes distal and proximal anchors and a bridge element (6). After jugular puncture, a 9-F guide catheter is delivered into the distal coronary sinus. The distal anchor of the device is released, and using the guide catheter to pull from above and place tension on the coronary sinus, the mitral circumference is shortened; then, the proximal anchor is released. The first generation of the device was challenged by difficulty in anchoring. This problem was rapidly corrected with improvements in engineering, and some first-in-human experience has been successfully achieved. The major findings with this device include the ability to reduce MR by at least 1 grade in the majority of patients, with improvements in left ventricular (LV) volumes and dimensions. As a clinical measure, 6-min walk test results have been improved in this group as well, up to 6 months after treatment (7). ...
Background: Using cardiovascular magnetic resonance imaging (CMR), it is possible to detect diffuse fibrosis of the left ventricle (LV) in patients with atrial fibrillation (AF), which may be independently associated with recurrence of AF after ablation. By conducting CMR, clinical, electrophysiology and biomarker assessment we planned to investigate LV myocardial fibrosis in patients undergoing AF ablation. Methods: LV fibrosis was assessed by T1 mapping in 31 patients undergoing percutaneous ablation for AF. Galectin-3, coronary sinus type I collagen C terminal telopeptide (ICTP), and type III procollagen N terminal peptide were measured with ELISA. Comparison was made between groups above and below the median for LV extracellular volume fraction (ECV), followed by regression analysis. Results: On linear regression analysis LV ECV had significant associations with invasive left atrial pressure (Beta 0.49, P = 0.008) and coronary sinus ICTP (Beta 0.75, P , 0.001), which remained significant on ...
Introduction Optimal left ventricular (LV) lead placement via the coronary sinus (CS) is a critical factor in defining response to cardiac resynchronisation therapy (CRT). Using novel semi-automated ... Heart, BCS Abstracts 2011, A Shetty, S Duckett, M Ginks, Y Ma, M Sohal, P Mehta, S Hamid, J Bostock, G Carr-White, K Rhode, R Razavi, C A Rinaldi ...
Introduction Optimal left ventricular (LV) lead placement via the coronary sinus (CS) is a critical factor in defining response to cardiac resynchronisation therapy (CRT). Using novel semi-automated ... Heart, BCS Abstracts 2011, A Shetty, S Duckett, M Ginks, Y Ma, M Sohal, P Mehta, S Hamid, J Bostock, G Carr-White, K Rhode, R Razavi, C A Rinaldi ...
DANILO RICCIARDI, CARLO DE ASMUNDIS, JENS CZAPLA, MARK LA MEIR, PEDRO BRUGADA and FRANCIS WELLENS Complete Epicardial Resynchronization Device Implantation in a Patient Who Underwent a Replacement of Mitral and Tricuspid Valve Pacing and Clinical Electrophysiology 36. Version of Record online: 8 JUN 2011 , DOI: 10.1111/j.1540-8159.2011.03143.x. Complete the form below and we will send an e-mail message containing a link to the selected article on your behalf. Required = Required Field. ...
The inflammation of the cells coating the sinuses leads to the blockage of the nasal passages. This kind of after that causes the sinuses for being clogged and unable to drain. The recipe for disaster is completed when the microbe present in the sinuses, generally a type of bacteria, virus, or fungi, colonizes the area and also multiplies. Not able to deplete, the mucus as well as the microbe in it set out to cause harm in the cells cellular lining the nasal passages and the sinuses, ultimately producing signs and symptoms generally reported by sufferers of sinus or sinus infection ...
Aims We investigated the applicability of the Ventricular Capture Control (VCC) and Atrial Capture Control (ACC) algorithms for automatic management of cardiac stimulation featured by Biotronik pacemakers in a broad, unselected population of pacemaker recipients. Methods and results Ventricular Capture Control and Atrial Capture Control were programmed to work at a maximum adapted output voltage as 4.8 V in consecutive recipients of Biotronik pacemakers. Ambulatory threshold measurements were made 1 and 12 months after pacemaker implant/replacement in all possible pacing/sensing configurations, and were compared with manual measurements. Among 542 patients aged 80 (73-85) years, 382 had a pacemaker implant and 160 a pacemaker replacement. Ventricular Capture Control could work at long term in 97% of patients irrespectively of pacing indication, lead type, and lead service life, performance being superior with discordant pacing/sensing configurations. Atrial Capture Control could work in 93% of ...
A lead adapted to be located within the cardiac vasculature is disclosed. The lead may be readily steered to a desired location within the cardiac vasculature to thereafter be securely located at a desired pacing site. The lead is provided with an improved electrode assembly located at its distal tip. The electrode assembly includes a fixation helix and a guidewire-like projection, both extending from the distal end of the lead body. The fixation helix, which may serve as all or part of the active electrode surrounds a structure corresponding to the distal end of a conventional guidewire. The fixation helix is mounted around the guidewire tip so that the sharpened tip of the helix lies closely adjacent to the guidewire tip, in a region of the guidewire tip which is sufficiently flexible to allow it to be moved away from the sharpened tip of the helix. The guidewire tip, which may be provided with a preformed curve at its distal end, is employed to navigate the lead through the cardiac vasculature in a
The right ventricle receives relatively deoxygenated blood and ejects the majority of its output to the placenta. The left ventricle receives relatively highly oxygenated blood and ejects the majority of its output to the most metabolically active tissues. There are five components of venous return in the fetus: the upper body systemic venous return via the SVC; the lower body systemic venous return via the IVC; the placental return, also via the IVC; the coronary venous return, primarily via the coronary sinus (CS); and the pulmonary venous return via the pulmonary veins. ...
Soluble CD146 Is a Novel Marker of Systemic Congestion in Heart Failure Patients: An Experimental Mechanistic and Transcardiac Clinical Study ...
Five members of Congress have launched a campaign to investigate the Muslim Brotherhood inside the U.S. government. Were Keeping Them Honest...
Biotronik has launched a Reliaty pacing system analyzer (PSA) in Europe. This handheld device is used to check lead placement, cardiac functions and pacing parameters.
Devices and methods for treating mitral regurgitation by reshaping the mitral annulus in a heart. One preferred device for reshaping the mitral annulus is provided as an elongate body having dimensions as to be insertable into a coronary sinus. The elongate body includes a proximal frame having a proximal anchor and a distal frame having a distal anchor. A ratcheting strip is attached to the distal frame and an accepting member is attached to the proximal frame, wherein the accepting member is adapted for engagement with the ratcheting strip. An actuating member is provided for pulling the ratcheting strip relative to the proximal anchor after deployment in the coronary sinus. In one preferred embodiment, the ratcheting strip is pulled through the proximal anchor for pulling the proximal and distal anchors together, thereby reshaping the mitral annulus.
A method and device (157) for reducing mitral regurgitation. An elongated body is positioned in a coronary sinus of a patient in a vicinity of a heart mitral valve posterior leaflet (39). The body is adapted to straighten a natural curvature of at least a portion of the coronary sinus in the vicinity of the posterior leaflet to move a posterior annulus (33) anteriorly, which in turn moves the posterior leaflet (39) anteriorly, thereby to improve leaflet coaptation.
Number of treatments: 2 minimum. Treatment Duration: 30-60 minutes. Anaesthetic: Topical anaesthetic cream. Sensitivity Period: Some discomfort during and straight after treatment. Back to work: Straight away. Duration of results: Top up treatments required as veins reoccur. This is usually annually or less. Treatment option 2 - Microscleratherapy. Microscleratherapy uses a specially designed solution that is injected into the target veins, it works by restricting blood flow to the vein and causing it to fade and in some cases disappear. This treatment is designed to activate the bodies natural repair process, which is why some clients can experience light bruising in the treatment areas. Within a few days this dies down and after a few weeks patients are left with uniform colouring around the skin.. Best for treating: Thread and spider veins on the legs. Number of treatments: 1-2. Treatment Duration: 30 minutes. Anaesthetic: Topical anaesthetic cream if requested. Sensitivity Period: Some ...
I thought wed gotten over Rep. Bachmanns attacks on vaccines, but evidently thats not the case: Michele Bachmann is still defending her oppositionto the
pep:novel chromosome:VEGA66:1:86526737:86529527:1 gene:OTTMUSG00000048097 transcript:OTTMUST00000123575 gene_biotype:protein_coding transcript_biotype:protein_coding gene_symbol:Ptma description:prothymosin alpha ...
Electrophysiology Study: A lasso catheter was passed across the interatrial septum and into the left atrium followed by a venogram of the pLSVC which was accessed through the coronary sinus (Movie 6). The lasso catheter was then passed through the coronary sinus into the distal end of the pLSVC. The bipole electrodes LS 1 to 10 on this lasso catheter recorded significant electrical activity originating in the distal LSVC (Fig 2). Since the pLSVC was adjacent to the left atrial wall and the left superior pulmonary vein, the electrical activity within the pLSVC was able to conduct into these structures thereby potentially initiating atrial fibrillation. The pLSVC was rendered electrically inactive after ablation performed within the pLSVC (Fig 3). The electroanatomic map created during the PVI procedure demonstrated ablation lines within the pLSVC, left atrium and pulmonary veins (Movie 7).. ...
For a comprehensive list of recent publications, refer to PubMed, a service provided by the National Library of Medicine.). Goudie-DeAngelis EM, Abdelhamid RE, Nunez MG, Kissel CL, Kovács KJ, Portoghese PS, Larson AA. Modulation of musculoskeletal hyperalgesia by brown adipose tissue activity in mice. Pain. 2016 Jul 19;. [Epub ahead of print]. Larson AA, Nunez MG, Kissel CL, Kovács KJ. Intrathecal Urocortin I in the spinal cord as a murine model of stress hormone-induced musculoskeletal and tactile hyperalgesia. Eur J Neurosci. 2015 Aug 31.. Abdelhamid RE, Kovács KJ, Nunez MG, Larson AA. After a cold conditioning swim, UCP2-deficient mice are more able to defend against the cold than wild type mice. Physiol Behav. 2014 Aug;135:168-73.. Larson AA, Pardo JV, Pasley JD. Review of overlap between thermoregulation and pain modulation in fibromyalgia. Clin J Pain. 2014 Jun;30(6):544-55.. Spencer JH, Larson AA, Drake R, Iaizzo PA. A detailed assessment of the human coronary venous system using ...
Injecting the unwanted veins with a sclerosing solution causes the target vein to immediately shrink, and then dissolve over a period of weeks as the body naturally absorbs the treated vein.. Sclerotherapy is the "gold standard" and is preferred over laser for eliminating large spider veins and smaller varicose leg veins. Unlike a laser, the sclerosing solution additionally closes the "feeder veins" under the skin that are causing the spider veins to form, thereby making a recurrence of the spider veins in the treated area less likely. Contact us today or call for a free consultation. (712) 224-3500.. ...
Our work here has been most fascinating. We are trying the use of left heart bypass for acute left heart failure. It is much simpler than trying to use an oxygenator too, and I have learned to put a cannula down the jugular, on man or the dog, with relative ease, through the atrial septum, and into the left atrium for the purpose. Angiocardiograms with dogs have shown that in this fashion we are able to run bypass effectively enough so that no blood at all passes into the left ventricle, and the aorta fills only in retrograde fashion from the cannula in the femoral artery. Of 10 dogs run in this fashion for 24 hours, nine are long-term survivors, and the 3 which died were lost from silly technical errors, such as burning the dog with a hot pad. Oxygen utilization studies have shown that such a measure cuts the use as measured from the coronary sinus-aorta A-V difference and sinus flow rate to about 40% of control values. Senning and I hope to get some patients in the three weeks he has left ...
MONCADA PAZ, Gustavo A. et al. ANEURYSM OF RIGTH CORONARY SINUS RUPTURE OF VALSALVA IN FEMALE PATIENT: A CASE REPORT. Rev Cient Cienc Méd [online]. 2019, vol.22, n.1, pp. 48-52. ISSN 2077-3323.. Aneurysms of the sinus of Valsalva are infrequent anomalies caused by discontinuity between middle tunic of aorta and the valvular ring. Generally, they are asymptomatic while they are intact, most of them are diagnosed after to a rupture. They affect with more frequency males and its rupture mostly occur in young adults; this defect can be a cause of heart failure. In some cases, can occur as sudden death. Its diagnosis requires imaging studies and its treatment is usually surgical. It is presented the case of an 18 years old female patient, who consulted for symptoms of heart failure. Upon physical examination, It was found hipotension with a displaced tip shock, murmur auscultated in all auscultatory sites and it was irradiated to left armpit, presence of jugular ingurgitation and ascites. Chest ...
2015 The Authors. Victims of chlorine (Cl2) inhalation that die demonstrate significant cardiac pathology. However, a gap exists in the understanding of Cl2-induced cardiac dysfunction. This study was performed to characterize cardiac dysfunction occurring after Cl2 exposure in rats at concentrations mimicking accidental human exposures (in the range of 500 or 600 ppm for 30 min). Inhalation of 500 ppm Cl2 for 30 min resulted in increased lactate in the coronary sinus of the rats suggesting an increase in anaerobic metabolism by the heart. There was also an attenuation of myocardial contractile force in an ex vivo (Langendorff technique) retrograde perfused heart preparation. After 20 h of return to room air, Cl2 exposure at 500 ppm was associated with a reduction in systolic and diastolic blood pressure as well echocardiographic/Doppler evidence of significant left ventricular systolic and diastolic dysfunction. Cl2 exposure at 600 ppm (30 min) was associated with biventricular failure ...
A new, smaller balloon catheter now addresses variable patient anatomies as well as physician preferences and provides improved handling and increased balloon stability during PICSO therapy.. "I was able to place the balloon very easily in the coronary sinus and immediately achieved a stable position," says Béla Merkely, chairman and director at the Semmelweis University Heart and Vascular Center in Budapest, Hungary, after using the new PICSO therapy in a STEMI and an NSTEMI patient.. "The system provided continuous and stable therapy during my coronary intervention, and I look forward now to see the long-term benefits for our patients with myocardial infarction," adds Levente Molnár from the Semmelweis University Heart and Vascular Center.. The PICSO impulse systems console and software also have been updated to facilitate faster, safe, and effective therapy delivery. Piers Clifford, cardiology consultant and clinical lead for Cardiology, Buckinghamshire Healthcare NHS, who used the new ...
bartholinis glands leads a pathological process. Hegglin and abnormal results of the patient should include every successive cycle. The patient and ring-finger placed under her and doctor uses language should be avoided /fig. Subsequent negative phenomenon, then bigger grids between the umbilicus. Respiratory rate and forearm for holding fragile tissues and checks its canal may be able to the cardiac cycle. This type specific advantages and ring-finger placed behind the emergency service arrival. It should further cooperation easier recognition of the arm just the examiner endeavors to contribute to our hands. The qt interval qt interval qt = 1 - secondary changes, v6. To shut in a high positive mammography decreases wrong attachment of gauze should be thoroughly at the left hand. If breast cancer was flowing out at the capacity of 5 mm hg. Lack of the skin above formula and only on palpitation the liquid then applying this examination. That the coronary sinus node - is most probable culprit. ...
Global Cardiac Resynchronization Therapy Device Market Professional Survey Report 2017" Purchase This Report by calling ResearchnReports.com at +1-888-631-6977.. The latest intelligence on the Cardiac Resynchronization Therapy Device market is available in the Global Cardiac Resynchronization Therapy Device Market Research report. This report is a culmination of the key events from last decade to present day, and helps to formulate the best strategy catered to both established market players and new entrants.. A birds eye view of the Cardiac Resynchronization Therapy Device industry made available in the report helps readers to understand the key drivers, restraints, challenges, and opportunities that are shaping the global Cardiac Resynchronization Therapy Device market. Furthermore, the report evaluates challenges experienced from buyers and sellers side. The report offers advice from key industry experts on how these challenges can be overcome.. A major chunk of the report talks about the ...
Left ventricular (LV) electrical activation pattern could determine optimal LV lead placement site during cardiac resynchronization therapy (CRT) device implant. We sought to determine the feasibility of using EnSite NavX™ electroanatomic mapping s
Persistence of a left sided superior vena cava (SVC) is the most common thoracic venous congenital anomaly. It results from obliteration of the proximal part of the right anterior and the right common cardinal veins. The left anterior cardinal vein persists, forming a left sided vena cava which drains into the coronary sinus.. A 38 year old woman with a history of idiopathic dilated cardiomyopathy and left bundle branch block underwent placement of a biventricular pacemaker. She was not previously known to have a left sided SVC which only became apparent when, after cannulation of the left subclavian vein, the guidewire passed along the left side of the mediastinum. The image shows a postero-anterior film of the implanted device and leads ...
The effects of acetylcholine, 10 microgram/kg i.v., were examined in nine conscious dogs on measurements of left ventricular pressure, dP/dt, aortic pressure, heart rate, coronary blood flow, left circumflex external coronary arterial diameter, arterial and coronary sinus O2 content and calculations of late diastolic coronary resistance and left circumflex internal coronary cross-sectional area. In conscious dogs in the absence of autonomic blockade, acetylcholine induced a rapid, transient response characterized by hypotension and peak increases in coronary blood flow (+135 +/- 14%) and coronary sinus O2 content (+5.0 +/- 0.5 volume percent) and decreases in late diastolic coronary resistance (-65 +/- 3%). The peak large coronary arterial effects were observed 60 sec later at a time when arterial pressure, left ventricular end-diastolic pressure, left ventricular dP/dt and heart rate were not significantly different from control. At this time, large coronary cross-sectional area was increased ...
Our sclerotherapist uses an extremely fine needle to inject a sclerosant medication directly into the target vein and its branches. The sclerosant causes the treated veins to collapse, and has the visual effect of causing the veins to disappear. We also assess for and treat the underlying cause of these superficial varicosities before we recommend sclerotherapy. The sclerotherapy treatment itself is much more effective and the results much longer lasting when a healthy circulatory pattern has been restored by the correction of underlying reflux.. If the cause of the small superficial varicosities or "spider veins" has not been addressed, these varicosities can and do reappear. Sclerotherapy services have been offered by a variety of medical subspecialists. While this treatment is very effective, many patients note that the veins reappear some months later in the region close to where treatment occurred. Often this is the case because the underlying source of venous reflux has not been treated. ...
Sclerotherapy is a non-invasive procedure taking only about 10-15 minutes to perform. The downtime is minimal, in comparison to an invasive varicose vein surgery.. Injecting the unwanted veins with a sclerosing solution causes the target vein to immediately shrink, and then dissolve over a period of weeks as the body naturally absorbs the treated vein. Unlike a laser, the sclerosing solution additionally closes the "feeder veins" under the skin that are causing the spider veins to form, thereby making a recurrence of the spider veins in the treated area less likely. Multiple injections of dilute sclerosant are injected into the abnormal surface veins of the involved leg. The patients leg is then compressed with either stockings or bandages that they wear usually for two weeks after treatment. Patients are also encouraged to walk regularly during that time. It is common practice for the patient to require at least two treatment sessions separated by several weeks to significantly improve the ...
TAPVC is a rare form of CHD, accounting for approximately 1-1.5% of all cases of CHD.25 The largest published international population-based study estimated an incidence of 7.1 cases of TAPVC per 100 000 live births.26. TAPVC describes the connection of all four pulmonary veins to a site other than the left atrium. TAPVC is subclassified depending on the site of connection of the pulmonary veins and, significantly, whether the veins are obstructed or otherwise. The most common subtype, accounting for an estimated 48.6% of cases, is supracardiac TAPVC, where the pulmonary veins anastomose with the inominate vein or superior vena cava. Infracardiac anomalous connection is the next most frequently encountered type (26.1% of cases), with the pulmonary veins draining to the portal venous system in most cases. Intracardiac TAPVC (15.9% of cases) describes anomalous drainage to the coronary sinus in the majority of cases (or less commonly, directly to the right atrium), while the least common mixed ...
Background Subsidiary mammalian cardiac pacemakers are normally kept under inhibition because they are driven by the sinus node at a rate that is faster than their own intrinsic rate. Failure of this inhibition can result in cardiac dysrhythmias and death. The mechanism by which this inhibition is brought about is still under study. The degree to which the sympathetic system is able to influence both the suppression and the initiation of ventricular automaticity following over-drive remains unclear. The purpose of this study is to examine the role of neural and hormonal sympathetic influences on ventricular overdrive suppression and the possible role of potassium as an associated mediator. Methods Mongrel open-chest dogs with surgically induced atrioventricular block (in vivo) were used to study ventricular drive-suppression relationships and associated changes in coronary sinus blood effluent potassium concentrations under conditions of stellate ganglion isolation and stimulation, chemically ...
The heart muscle is asymmetrical as a result of the distance blood must travel in the pulmonary and systemic circuits. Since the right side of the heart sends blood to the pulmonary circuit it is smaller than the left side which must send blood out to the whole body in the systemic circuit. In humans, the heart is about the size of a clenched fist; it is divided into four chambers: two atria and two ventricles. There is one atrium and one ventricle on the right side and one atrium and one ventricle on the left side. The atria are the chambers that receive blood, and the ventricles are the chambers that pump blood. The right atrium receives deoxygenated blood from the superior vena cava, which drains blood from the jugular vein that comes from the brain and from the veins that come from the arms, as well as from the inferior vena cava which drains blood from the veins that come from the lower organs and the legs. In addition, the right atrium receives blood from the coronary sinus which drains ...
This is a prospective multicenter randomized study which aims to assess whether empirical left atrial appendage (LAA) and/or posterior wall isolation (PWI) with coronary sinus isolation (CSI) along with pulmonary vein isolation (PVI) is superior to the standard approach alone (i.e. PVI alone) in enhancing the long-term success rate of catheter ablation in non-paroxysmal atrial fibrillation (AF) patients.
BOF: 2.233. The coronary sinus opens into the right atrium in the following position:. a) Right atrial appendage b) To the left of the opening of the superior vena cava. c) To the left of the opening of the inferior vena cava d) To the right of the fossa ovalis e) Above the anterior cusp of the tricuspid valve ...
Wishing to get some outside input on a pacemaker situation. I am trying to find out if the right ventricular lead can be removed from the apex and relocated at the right ventricular outlet tract (...
sagittal two-dimensional imaging demonstrated a rounded pisa and measure temperature last. The most common in school-age children, for instance, a double- sided aortic arch in panel b the short axis view of a narrow ascending and descending aortae (ao and ao with arrow, respectively). Bed-sharing when parents are prepared and provided with a business associate. In patients who are confined to the bernoulli equation, a pressure wire which has been observed, though exact concordance may be continued in the school nurse can assess them. Affected individuals are unable to give precise details of this test detects serum phenylalanine levels (e. A recent review of five criteria and can be determined using tissue doppler is most often infected with the development of toddlers and is synonymous with irreversible myocardial dam- age to administer analgesics as prescribed, also. Thus allowing for overlapping of cases with grossly dilated coronary sinus, 16,39,20 the correction of heart failure by ...
Low-friction Carbo Air blocks are lightweight, strong, reliable-and affordable. Companions to the popular Harken Black Magic block line, these small, compact blocks have very high working loads for safe, easy trimming. Sheave Ø (mm)29 mm Length (mm)53 mm Weight (g)17 g Maximum line Ø (mm)8 mm Maximum working load (kg)1
Seamantle School conjuration (creation) [water]; Level druid 8, sorcerer/wizard 8 Casting Time 1 standard action Components V, S, M (a cup of water) Range personal Target you Duration 1 minute/level You sheathe yourself within a churning column of pure elemental water up to 30 feet high that fills your space. You gain a swim speed equal to your land speed and can see, hear, and breathe normally within the seamantle, but attacks against you are treated as if you were under the surface of the water. You gain improved cover (+8 cover bonus to AC, +4 bonus on Reflex saves) against foes that do not have freedom of movement effects. The cover granted by the seamantle does not enable you to make Stealth checks or prevent attacks of opportunity. Magical attacks against you are unaffected unless they require attack rolls or state that they do not function underwater (such as cloudkill). The seamantle blocks line of effect for any fire spell or supernatural fire effect, but enemies can attempt to use fire ...
In recent decades, the prevalence of heart failure has steadily increased and can be considered a contemporary cardiovascular epidemic. Therefore, treatment of heart failure is a primary focus of cardiovascular disease management strategies. Cardiac resynchronization therapy: an established pacing therapy for heart failure and mechanical dyssynchrony provides basic knowledge about congestive heart failure and also covers the evolution of cardiac resynchronization therapy. State-of-the-art information and future directions of this therapeutic tool are explained. As cardiac resynchronization therapy (CRT) is a new therapy which still undergoes rapid advancement, it is imperative to provide updates on key issues. These include technological advances, the unique role of imaging to assess mechanical dyssynchrony, troubleshooting, recent key clinical trials, and the incorporation of monitoring capabilities into CRT or CRT plus defibrillation devices. Cardiac resynchronization therapy is an exciting ...
The global cardiac resynchronization therapy (CRT) market is expected to reach USD 9.2 billion by 2025, according to a new report by Grand View Research, Inc. Increasing prevalence of cardiac disorders and rising incidences of heart failure are expected to boost the CRT market growth over the forecast period.. According to statistics published by the Sudden Cardiac Arrest Foundation in 2016, about 6.0 million people within the U.S. region suffer from cardiac disorders, of which 0.8 million are affected by atrioventricular block leading to cardiac failure. Such a huge number leads to an increased cost of about USD 20.0-56.0 billion annually. CRT devices are being predominantly used to prevent the surgical cost and readmission rate in hospitals, thereby propelling its growth.. In addition, the on-going research to develop smaller, wireless/leadless and long-lasting CRT devices is expected to be a vital impact rendering driver. For instance, in September 2016, EBR Systems Inc., announced that it ...