Station 3A. On the right side, the mediastinal pleura medially to the superior vena cava is divided, with exploration of the anterior tracheal area above the level of the right main pulmonary artery

ASVIDE ◽  
2017 ◽  
Vol 4 ◽  
pp. 388-388
Author(s):  
Antonio E. Martin-Ucar ◽  
Laura Socci
Keyword(s):  
Pulmonary Artery ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
The Right ◽  
Mediastinal Pleura

A Computational Pulsatile Model of the Bidirectional Cavopulmonary Anastomosis: The Influence of Pulmonary Forward Flow

1996 ◽  
Vol 118 (4) ◽  
pp. 520-528 ◽  
Author(s):  
Francesco Migliavacca ◽  
Marc R. de Leval ◽  
Gabriele Dubini ◽  
Riccardo Pietrabissa
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Similar Distribution ◽  
Pulsatile Blood Flow ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis

The bidirectional cavopulmonary anastomosis (BCPA or bidirectional Glenn) is an operation to treat congenital heart diseases of the right heart by diverting the systemic venous return from the superior vena cava to both lungs. The main goal is to provide the correct perfusion to both lungs avoiding an excessive increase in systemic venous pressure. One of the factors which can affect the clinical outcome of the surgically reconstructed circulation is the amount of pulsatile blood flow coming from the main pulmonary artery. The purpose of this work is to analyse the influence of this factor on the BCPA hemodynamics. A 3-D finite element model of the BCPA has been developed to reproduce the flow of the surgically reconstructed district. Geometry and hemodynamic data have been taken from angiocardiogram and catheterization reports, respectively. On the basis of the developed 3-D model, four simulations have been performed with increasing pulsatile blood flow rate from the main pulmonary artery. The results show that hemodynamics in the pulmonary arteries are greatly influenced by the amount of flow through the native main pulmonary artery and that the flow from the superior vena cava allows to have a similar distribution of the blood to both lungs, with a little predilection for the left side, in agreement with clinical postoperative data.

scholarly journals Right atrium and superior vena cava pressure measurements in a novel animal model to study one and a half ventricle repair as compared to Fontan type procedure

2017 ◽  
Vol 12 (4) ◽  
pp. 143-149 ◽  
Author(s):  
Anil Bhattarai ◽  
Arben Dedja ◽  
Vladimiro L. Vida ◽  
Francesco Cavallin ◽  
Massimo A. Padalino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Inferior Vena Cava ◽  
Superior Vena Cava ◽  
Inferior Vena ◽  
Superior Vena ◽  
Stress Test ◽  
Vena Cava ◽  
Right Pulmonary Artery ◽  
The Right ◽  
Group 1

Background & Objectives: To evaluate the advantages of the one and a half ventricle repair on maintaining a low pressure in the inferior vena cava district. Also evaluate the competition of flows at the superior vena cava – right pulmonary artery anastomosis site, in order to understand the hemodynamic interaction of a pulsatile flow in combination to a laminar one. Materials & Methods: Adult rabbits (n=30) in terminal anaesthesia with a follow up of 8 h were used, randomly distributed in three experimental groups: Group 1: animals with an anastomosis between superior vena cava and right pulmonary artery, as a model of one and one half ventricle repair; Group 2: animals with the cavopulmonary anastomosis followed by clamping of the right pulmonary artery proximal to the anastomosis; and Group 3: sham animals. Pressures of superior vena cava and pulmonary arteries were afterwards measured, in a resting condition as well as after induced pharmacological stress test.Results: In Group 1, superior vena cava pressure was significantly higher, while venous pressure in the inferior vena cava – right atrium district was constant or lower in comparison with the other groups. After stress test, the pressure in the superior vena cava and the heart rate both increased further, but the right ventricular, right atrial and pulmonary artery pressures remained similar to the values in a resting condition. This proved that the inferior vena cava return was well-preserved, and no venous hypertension was present in the inferior vena cava district even after stress test (good exercise tolerance).Conclusion: One and one half ventricle repair can be considered a good surgical strategy for maintaining a low pressure in the inferior vena cava district with potential for right ventricle growth, restoring the more physiological circulation in borderline or failing right ventricle conditions. The experiment presented a positive finding in favour of one and one half ventricle repair, as compared to Fontan type procedure.

Selective denervation of the heart

1983 ◽  
Vol 244 (4) ◽  
pp. H607-H613 ◽  
Author(s):  
W. C. Randall ◽  
J. X. Thomas ◽  
M. J. Barber ◽  
L. E. Rinkema
Keyword(s):  
Pulmonary Artery ◽  
Left Atrium ◽  
Superior Vena ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Canine Heart ◽  
The Right

Total denervation of the canine heart consisted of intrapericardial neural dissection of the left atrium, left superior pulmonary vein, and main pulmonary artery and cutting of the ventrolateral cardiac nerve (stage I). The fat pad and all nerves were removed from between the pulmonary artery and aorta (stage II). Dissection proceeded from the pericardial reflection along the superior vena cava to the azygos vein, which was cleared, double tied, and cut. The right pulmonary artery was cleaned, and the superior right atrium was dissected to its intersection with the left atrium (stage III). Denervation was tested by electrical stimulation of both vagi and stellate ganglia, while recording inotropic, chronotropic, and dromotropic events, before and after each stage. Stage I deleted most left autonomic input to the heart without interrupting right sympathetics. Stage II completed left autonomic denervation but preserved much of the right sympathetic input. Large nerves along the dorsal surface of the pulmonary artery carried inputs from both left and right sympathetics. Stage III completed the denervation of atrioventricular and sinoatrial nodal structures and removed all remaining ventricular inotropic influences. Selective denervation of atrioventricular and sinoatrial nodal regions appears feasible for preparation of chronic canine models.

Abstract 742: Inducibility of Atrial Fibrillation in the Myocardial Sleeve of the Superior Vena Cava is Mediated by the Ganglionated Plexi on the Right Pulmonary Artery

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Guo-Dong Niu ◽  
Benjamin J Scherlag ◽  
Zhibing Lu ◽  
Muhammad Ghias ◽  
Ralph Lazzara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Artery ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Av Block ◽  
Ganglionated Plexi ◽  
Av Conduction ◽  
Right Pulmonary Artery ◽  
The Right

Introduction: Previous studies have shown that electrical stimulation of the ganglionated plexi (GP) on the right pulmonary artery (RPA), the so-called “3rd fat pad (FP)” causes slowing of the sinus rate and AV conduction. Ablation of this GP prevents induction of atrial fibrillation (AF) caused by vagosympathetic nerve (VNS) stimulation and atrial premature beats (APBs). Methods: Eleven dogs anesthetized with Na-pentobarbital were subjected to a right thoracotomy at the 4 th intercostal space. The RPA at the upper lobe of the right lung was dissected and the distal end tied in order to insert and stabilize an 8 Fr. Sheath into the RPA. A small basket electrode catheter, consisting of 5 splines, each spline containing 3 pairs of bipolar electrodes, was inserted into the RPA underneath the superior vena cava (SVC). A Lasso catheter, inserted through a sheath in the right jugular vein was positioned in the SVC contacting the sleeve of myocardium at the SVC-right atrial (RA) junction. Octapolar electrode catheters were sutured against the right superior, inferior pulmonary veins (PVs), RA and RA appendage. Through a left sided thoracotomy, similar placements of recording electrode catheters were made at the left superior, inferior PVs and left atrium (LA) body and appendage. Right and left vagosympathetic nerve stimulation (VNS, frequency, 20 Hz; stimulus duration, 0.01 ms; voltage 1.5– 4.5 Volts) slowed the heart rate (HR) by 50% or induced 2:1 AV block. The RPA GP was also stimulated to achieve similar effects on HR and AV block. Results: RPA GP stimulation consistently and significantly reduced the threshold for AF inducibility (control 8±3; RPA GP stimulation 3.2±1.5 volts, p<0.01) whereas after RPA GP ablation, the averaged voltage to induce AF was increased to 11.5±1.5 although 7 of 11 showed non-inducibility at the maximum voltage used (12 volts). The inducibility threshold at the other atrial and PV sites were unchanged by RPA GP stimulation before or after RPA GP ablation (p=NS). Moreover, there was a loss of HR slowing and AV block with VNS stimulation. Conclusion: RPA GP stimulation which markedly decreased HR or AV conduction selectively suppressed AF inducibility at the myocardial sleeve of the SVC but did not affect AF inducibility at other atrial sites.

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