METHOD FOR ISOLATING TRUNK OF LEFT PULMONARY VEIN EXCEEDING DIAMETER OF CRYO-BALLOON

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely cardiovascular surgery. Cryo-balloon isolation is carried out, while a series of 3 applications is carried out with sequential isolation of walls of a trunk of left pulmonary veins (hereinafter – TLPV) lasting 240 seconds according to a trefoil type with a temperature at a tip of the balloon from -30°C to -45°C. A series of 3 applications is carried out with sequential isolation of rear upper, rear lower and front walls. In the antero-posterior projection, the Achieve electrode is inserted into the trunk of the left pulmonary vein, in the straightened state of a vascular introducer with the FlexCath hemostatic valve, the ArcticFront cryo-balloon is carried inside the Achieve electrode, which is blowed proximal to the mouth. The vascular introducer with the FlexCath hemostatic valve is brought close to the proximal end of the blowed cryo-balloon ArcticFront in such a way that a bend is made on the vascular introducer with the FlexCath hemostatic valve at an angle of 30°. A handle of the vascular introducer with the FlexCath hemostatic valve is rotated clockwise by 45° until the resistance of the rear upper wall of TLPV appears, then the mouth of the left pulmonary vein (hereinafter – LPV) is contrasted, and the first application is performed. Then, in the right oblique projection, at an angle of 40°, the balloon is blowed proximal to the mouth of TLPV. The vascular introducer with the FlexCath hemostatic valve is brought close to the proximal end of the blowed cryo-balloon ArcticFront, maximum bending is created on the vascular introducer with the FlexCath hemostatic valve until the resistance of the lower wall of TLPV is reached. Then the handle of the vascular introducer with the FlexCath hemostatic valve is rotated clockwise by 45° until the resistance of the rear lower part of the mouth of TLPV is reached. Then, contrasting the mouth of left pulmonary veins (LPV) is performed, and the second application is performed. At the same time, in the right oblique projection, at an angle of 40°, the ArcticFront cryo-balloon is blowed proximal to the mouth of TLPV, the bending is removed, and the vascular introducer with the FlexCath hemostatic valve is straightened, which is then brought close to the proximal end of the blowed ArcticFront cryo-balloon. A bending is created on the vascular introducer with the FlexCath hemostatic valve at an angle of 30°. Then the handle of the vascular introducer with the FlexCath hemostatic valve is rotated counterclockwise at an angle of 45° until the resistance of the front wall of TLPV is reached, then the LPV mouth is contrasted, and the third application is performed. If necessary, walls of the trunk of left pulmonary veins is re-isolated by carrying out applications of 3 series. ;EFFECT: method makes it possible to increase the achievement of effective isolation of all LP, making the cryo-balloon ablation procedure less dependent on variable anatomy, and also reduces the risk of complications, reducing the need for repeated procedures, the frequency of hospitalizations and improving the quality of life of patients.;2 cl, 2 ex, 4 dwg