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A 60 Age - year Age - old Age white Personal_background Brazilian Personal_background man Sex , with controlled History hypertension History and stage History 2 History obesity History presented Clinical_event to our institution Nonbiological_location with a complaint of progressive Detailed_description fatigue Sign_symptom with moderate Detailed_description to Detailed_description light Detailed_description exertion Detailed_description of approximately Duration 1 Duration year Duration ’s duration.
During that period, he had undergone myocardial Detailed_description perfusion Detailed_description scintigraphy Diagnostic_procedure without evidence of obstructive Disease_disorder ischemic Disease_disorder disease Disease_disorder .
He had no clinical evidence of systolic Detailed_description heart Disease_disorder failure Disease_disorder .
He had undergone biological Detailed_description mitral Therapeutic_procedure valve Therapeutic_procedure replacement Therapeutic_procedure 3 Date years Date previously Date for mitral Disease_disorder valve Disease_disorder stenosis Disease_disorder and had undergone ablation Therapeutic_procedure of atrioventricular Biological_structure nodal Biological_structure reentry Biological_structure tachycardia Sign_symptom 18 Date months Date previously Date .
At the time of valve Coreference replacement Coreference , there was no reported evidence of pulmonary Disease_disorder arterial Disease_disorder hypertension Disease_disorder .
The patient’s medication list included aspirin Medication 100 Dosage mg/day Dosage , carvedilol Medication 50 Dosage mg/day Dosage , atorvastatin Medication 10 Dosage mg/day Dosage , and losartan Medication 25 Dosage mg/day Dosage .
His echocardiogram Diagnostic_procedure showed normal Lab_value function Lab_value of a mitral Biological_structure prosthesis Biological_structure , global Diagnostic_procedure left Diagnostic_procedure ventricular Diagnostic_procedure systolic Diagnostic_procedure function Diagnostic_procedure within Lab_value normal Lab_value limits Lab_value ( left Diagnostic_procedure ventricular Diagnostic_procedure ejection Diagnostic_procedure fraction Diagnostic_procedure 62 Lab_value % Lab_value measured using Detailed_description the Detailed_description Teichholz Detailed_description method Detailed_description ), stage Lab_value I Lab_value diastolic Disease_disorder dysfunction Disease_disorder , and mean Detailed_description pulmonary Biological_structure arterial Biological_structure systolic Detailed_description blood Diagnostic_procedure pressure Diagnostic_procedure of 50 Lab_value mmHg Lab_value .
In the 6 Detailed_description - minute Detailed_description walk Diagnostic_procedure test Diagnostic_procedure , the patient walked 104 Lab_value meters Lab_value (Table 1).
Catheterization Diagnostic_procedure of his right Biological_structure heart Biological_structure chambers Biological_structure and pulmonary Biological_structure arteries Biological_structure confirmed the diagnosis of pulmonary Disease_disorder hypertension Disease_disorder (Table 2).
During the follow Clinical_event - up Clinical_event period, therapy with nifedipine Medication and sildenafil Medication was not tolerated secondary to orthostatic Detailed_description hypotension Sign_symptom .
The patient was referred Clinical_event for radiofrequency Detailed_description ablation Therapeutic_procedure of the pulmonary Biological_structure artery Biological_structure trunk Biological_structure for the treatment of refractory Detailed_description pulmonary Disease_disorder hypertension Disease_disorder .
The procedure was performed in the catheterization Nonbiological_location laboratory Nonbiological_location with direct Detailed_description visualization Detailed_description using Detailed_description fluoroscopy Detailed_description and Detailed_description radiopaque Detailed_description contrast Detailed_description dye Detailed_description .
The patient remained under unconscious sedation Therapeutic_procedure .
Catheterization Diagnostic_procedure of the right Biological_structure femoral Biological_structure artery Biological_structure via the standard Detailed_description Seldinger Detailed_description technique Detailed_description was performed using Detailed_description an Detailed_description 8 Detailed_description - French Detailed_description valved Detailed_description short Detailed_description sheath Detailed_description after subcutaneous Administration injection Administration of a local Medication anesthetic Medication .
Subsequently, this sheath Detailed_description was Detailed_description replaced Detailed_description with Detailed_description a Detailed_description steerable Detailed_description long Detailed_description sheath Detailed_description ( Agilis®; Detailed_description St. Detailed_description Jude Detailed_description Medical, Detailed_description St. Detailed_description Paul, Detailed_description MN, Detailed_description USA Detailed_description ) using Detailed_description the Detailed_description standard Detailed_description over Detailed_description - the Detailed_description - wire Detailed_description technique Detailed_description .
Unfractionated Medication heparin Medication was administered intravenously Administration , targeting an activated Diagnostic_procedure coagulation Diagnostic_procedure time Diagnostic_procedure between Lab_value 250 Lab_value and Lab_value 350 Lab_value seconds Lab_value .
Electroanatomic Diagnostic_procedure reconstruction Diagnostic_procedure of both the right Biological_structure ventricular Biological_structure outflow Biological_structure tract Biological_structure and pulmonary Biological_structure artery Biological_structure was performed using the EnSite Detailed_description Velocity Detailed_description Cardiac Detailed_description Mapping Detailed_description System Detailed_description ( St.Jude Detailed_description Medical Detailed_description ) under direct Detailed_description fluoroscopic Detailed_description visualization Detailed_description , and a merger was made with the formatted image obtained by performing cardiac Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure angiography Diagnostic_procedure (Fig.1).
The Agilis® Detailed_description sheath Diagnostic_procedure was Diagnostic_procedure advanced Diagnostic_procedure into the right Biological_structure ventricular Biological_structure outflow Biological_structure tract Biological_structure just before Biological_structure reaching Biological_structure the Biological_structure pulmonary Biological_structure valve Biological_structure .
Through this long sheath, we introduced an ablation Therapeutic_procedure catheter Therapeutic_procedure with an open Detailed_description irrigated Detailed_description tip Detailed_description ( St.Jude Detailed_description Medical Detailed_description ).
The parameters used for each application according to our protocol were as follows: power Lab_value of Lab_value 5 Lab_value W Lab_value , maximum Lab_value temperature Lab_value of Lab_value 48 Lab_value °C Lab_value , 60 Lab_value - second Lab_value duration Lab_value in Lab_value each Lab_value spot Lab_value , maximum Lab_value impedance Lab_value variation Lab_value of Lab_value 10 Lab_value % Lab_value from Lab_value baseline Lab_value values Lab_value , and an irrigation Lab_value flow Lab_value rate Lab_value of Lab_value 17 Lab_value ml/minute Lab_value , which created Therapeutic_procedure a Therapeutic_procedure circle Therapeutic_procedure in the pulmonary Biological_structure artery Biological_structure trunk Biological_structure .
The patient was discharged Clinical_event the next Time morning Time .
No noteworthy changes Sign_symptom before or after the procedure or before discharge Clinical_event in the patient’s radiographic Detailed_description or Detailed_description echocardiographic Detailed_description laboratory Detailed_description parameters Detailed_description were seen.
The patient’s blood Diagnostic_procedure pressure Diagnostic_procedure in both Biological_structure the Biological_structure right Biological_structure heart Biological_structure chambers Biological_structure and the pulmonary Biological_structure artery Biological_structure were determined using Detailed_description catheterization Detailed_description before and at 3 Date and Date 6 Date months Date after Date the procedure.
The results are shown in Table 2.
At the patient’s 3 Date - month Date follow Clinical_event - up Clinical_event examination, he showed an improvement Lab_value in functional Diagnostic_procedure class Diagnostic_procedure for Diagnostic_procedure fatigue Diagnostic_procedure with Diagnostic_procedure major Diagnostic_procedure exertion Diagnostic_procedure .
He also demonstrated an increased Lab_value distance Lab_value walked in the 6 Detailed_description - minute Detailed_description walk Diagnostic_procedure test Diagnostic_procedure and reduction Lab_value of the pressures Diagnostic_procedure in both the right Biological_structure cavities Biological_structure and the pulmonary Biological_structure artery Biological_structure .
Currently, with 6 Duration months Duration of clinical follow Clinical_event - up Clinical_event , he has maintained his improvement Lab_value in functional Diagnostic_procedure classification Diagnostic_procedure and is pedaling Activity his Activity bicycle Activity .