scholarly journals P842 The sword in the heart

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Scheggi ◽  
T Mariani ◽  
B Alterini
Keyword(s):  
Pericardial Effusion ◽  
Right Ventricle ◽  
Cardiac Biomarkers ◽  
Empiric Antibiotic Therapy ◽  
Surgical Removal ◽  
Recurrent Pericarditis ◽  
Peripheral Vessel ◽  
Pericardial Cavity ◽  
Surgical Extraction ◽  
The Right

Abstract Introduction Needle embolism is a rare complication of intravenous drug abuse which has only been reported on a handful of occasions. Potential sequelae include cardiac perforation, tamponade, infective endocarditis and recurrent pericarditis. We report the case of a young intravenous opiate abuser. Case Report A 23-year-old heroin addicted man presented to the emergency department because of chest pain ensued six months before; the pain was sharp, was relieved by sitting up and leaning forward and increased with coughing, swallowing, deep breathing or lying flat. He complained also fatigue and fever since one month before presentation. Echocardiography revealed non haemodinamic pericardial effusion and pleural effusion, treated with pleural drainage. Three haemocoltures were negative. Cardiac biomarkers were negative. HIV, HBV and HCV sierology was negative. He was treated with cochicine and ibuprofen and empiric antibiotic therapy with initial improvement of symptoms and rapid recurrence of them. After a few weeks an ECG showed widespread concave ST segment elevation and an echocardiogram revealed pericardial effusion relapse. A chest radiograph showed a needle near the right ventricle. The patient underwent computed tomography angiography that was able to localize a needle inside the pericardium. A second echocardiogram confirmed the presence of the fragment in the pericardial cavity, beside the right ventricle. The patient underwent minithoracototomy surgical removal of the needle fragment and of 500 cc of haematic pericardial fluid. Discussion and conclusions The presence of a foreign body in the heart may result from either a direct injury to the heart such as a gunshot injury or from some other embolization to the heart from distal penetration sites (eg, the migration of a catheter or a needle fragment from a peripheral vessel). It may cause fever, recurrent pericarditis and arrhythmia. Surgical extraction in the therapy of choice. Abstract P842 Figure.

scholarly journals Perforation of the Right Ventricle as a Complication of Pericardiocentesis: A Case report

2016 ◽  
Vol 33 (2) ◽  
pp. 141-147
Author(s):  
Milovan Stojanović ◽  
Bojan Ilić ◽  
Sanja Stojanović ◽  
Stevan Ilić ◽  
Marina Deljanin Ilić
Keyword(s):  
Cardiac Surgery ◽  
Case Report ◽  
Pericardial Effusion ◽  
Right Ventricle ◽  
Ultrasound Examination ◽  
Permanent Pacemaker ◽  
Invasive Procedures ◽  
Pericardial Cavity ◽  
Medical Reports ◽  
The Right

Summary Pericardial effusion represents the accumulation of larger amounts of fluid in the pericardial cavity. If not timely diagnosed and adequately treated, it can lead to cardiac tamponade. The treatment of pericardial effusion includes primarily the use of drugs like aspirin, NSAIDs, corticosteroids, and/or colchicine followed by invasive procedures such as pericardiocentesis or pericardiectomy. Pericardiocentesis complications are extremely rare but very serious especially in the case of the rupture of the right ventricle or the coronary arteries. Patient S.V, born in 1938, from Svrljig, was examined because of suffocating and swollen shin. The medical reports showed that the patient previously had had a permanent pacemaker implanted and that he had undergone a triple coronary artery bridging. Medical reports also showed that two months before the examination he was hospitalized due to pericardial effusion at the reference institution. The ultrasonographic examination registered large circular effusion with the motion of the right ventricle and the patient underwent urgent pericardiocentesis. During pericardiocentesis, the rupture of the right ventricle occurred and the patient was sent to the cardiac surgery clinic where he had catheter extraction performed. The control ultrasound examination of the heart showed no pericardial effusion, and no signs of damage to the right ventricle.

Right Ventricle Mass Removal from Tricuspid Valve Apparatus: An Unusual Thromboembolic Complication of Severe Ketoacidosis

2016 ◽  
Vol 19 (2) ◽  
pp. 077
Author(s):  
Ireneusz Haponiuk ◽  
Maciej Chojnicki ◽  
Konrad Paczkowski ◽  
Wojciech Kosiak ◽  
Radosław Jaworski ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Tricuspid Valve ◽  
Mild Hypothermia ◽  
Heart Function ◽  
Thromboembolic Complication ◽  
Surgical Removal ◽  
Unusual Complication ◽  
Type I ◽  
Definitive Therapy ◽  
The Right

The presence of a pathologic mass in the right ventricle (RV) may lead to hemodynamic consequences and to a life-threatening incident of pulmonary embolism. The diagnosis of an unstable thrombus in the right heart chamber usually necessitates intensive treatment to dissolve or remove the pathology. We present a report of an unusual complication of severe ketoacidosis: thrombus in the right ventricle, removed from the tricuspid valve (TV) apparatus. A four-year-old boy was diagnosed with diabetes mellitus (DM) type I de novo. During hospitalization, a 13.9 × 8.4 mm tumor in the RV was found in a routine cardiac ultrasound. The patient was referred for surgical removal of the floating lesion from the RV. The procedure was performed via midline sternotomy with extracorporeal circulation (ECC) and mild hypothermia. Control echocardiography showed complete tumor excision with normal atrioventricular valves and heart function. Surgical removal of the thrombus from the tricuspid valve apparatus was effective, safe, and a definitive therapy for thromboembolic complication of pediatric severe ketoacidosis.<br /><br />

scholarly journals A Case of Diffuse Endomyocardial Fibrosis of the Right Ventricle with Persistent Pericardial Effusion

1976 ◽  
Vol 17 (6) ◽  
pp. 774-783
Author(s):  
Sukenobu ITO ◽  
Morio ITO ◽  
Takehiko FUJINO ◽  
Teruo FUKUMOTO ◽  
Syozo KANAYA ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Right Ventricle ◽  
Endomyocardial Fibrosis ◽  
The Right

scholarly journals Removal of Unusual Foreign Metal Object (Nail) from the Right Ventricle of Human Heart: A Case Report

2021 ◽  
Vol 24 (3) ◽  
pp. E560-E563
Author(s):  
Mingliang Zuo ◽  
Qiuyi Chen ◽  
Bo Xiang ◽  
Tao Yu ◽  
Lixue Yin
Keyword(s):  
Right Ventricle ◽  
Rare Case ◽  
Human Heart ◽  
Foreign Bodies ◽  
Jugular Vein ◽  
Comet Tail ◽  
Metal Object ◽  
Surgical Extraction ◽  
Life Threatening ◽  
The Right

Migration of foreign bodies (FB) with the blood flow to the heart is a rare, but very alarming condition as it may lead to life-threatening complications and death. Objects that are larger than 5 mm in diameter and/or irregular in shape are recommended for removal from extra- and intracardiac areas to prevent incurable embolization. Surgical extraction of intracardiac objects is a serious surgical challenge associated with difficulties to operate, during the continuous movement of the heart, and identify the exact FB location. Early diagnosis and timely removal of FBs are crucial treatment factors for this rare case resolution. We report a case of accidental migration of a metal FB object (nail) about 1.0*0.3 cm from the right neck area jugular vein to the right ventricle apex in the heart. The FB localization was accurately detected using Bi-plane transesophageal echocardiography (TEE) with a special comet-tail artifact. TEE provided valuable information before surgery, and the nail was successfully removed through open-heart surgical procedures and cardiopulmonary bypass (CPB). Postoperative tests indicated no complications.

Quantification of effect of pericardium on LV diastolic PV relation in dogs

1987 ◽  
Vol 252 (5) ◽  
pp. H963-H968 ◽  
Author(s):  
M. Junemann ◽  
O. A. Smiseth ◽  
H. Refsum ◽  
R. Sievers ◽  
M. J. Lipton ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Right Ventricle ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Volume Loading ◽  
Upward Shift ◽  
Volume Curve ◽  
Pericardial Pressure ◽  
Volume Relation ◽  
The Right

The aim of the present study was to quantify the effect of the pericardium on the left ventricular (LV) diastolic pressure-volume relation. The experiments were done in 10 anesthetized closed-chest dogs. Pericardial and cardiac volumes were determined by computed tomography. Pericardial effusion (n = 5) and volume loading (6% dextran iv; n = 5) were used to increase pericardial volume. Volumes were normalized as multiples of the LV volume measured when LV transmural pressure was 6 mmHg (VLV6). Using the data from the pericardial effusion experiments, we calculated the best-fit exponential equations for the pericardial pressure-volume relations. From these equations we calculated that the changes in pericardial volume necessary to shift the LV diastolic pressure-volume curve upward by 2, 5, 10, and 20 mmHg were 0.6 +/- 0.1, 1.1 +/- 0.2, 1.6 +/- 0.2, and 2.2 +/- 0.3 times VLV6, respectively. Using the data from the volume loading experiments, we also calculated the degree of upward shift of the LV pressure-volume relation caused by volume loading, which increased LV mean diastolic pressure by 12 mmHg. (The upward shift is that increment in pericardial pressure caused by the total increase in volume of the extra-LV contents of the pericardium, i.e., the atria, the right ventricle, and any pericardial effusion.) This volume loading increased the total volume of the right ventricle and the atria by 1.0 +/- 0.1 VLV6, which, in itself, increased pericardial pressure by 3.6 +/- 0.8 mmHg. We conclude that in situations in which heart or pericardial volume increases acutely, the pericardium shifts the diastolic pressure-volume relation of the LV upward by a significant amount.

scholarly journals 60 Primary mediastinal large B-cell lymphoma: how to manage it during pregnancy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Rita Cristina Myriam Intravaia ◽  
Benedetta De Chiara ◽  
Francesco Musca ◽  
Francesca Casadei ◽  
Giuseppina Quattrocchi ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
B Cell ◽  
Cell Lymphoma ◽  
Vena Cava ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
The Right ◽  
Large B Cell

Abstract A 33 years old patient came to our attention, pregnant in her 26th week. She had dyspnoea, cough and weight loss (up to 45 kg of weight) in the previous two weeks. During urgent gynecological check-up she was found in poor general conditions, tachypnoic (respiratory rate &gt;30 acts/minutes) with pale skin and bilateral jugular turgor. There was nothing relevant in her past medical history except for a thrombocytopenia appeared 2 months before. She consulted a haematologist who recommended to look for JAK2 mutation that was excluded. Echocardiography revealed a voluminous hypoechoic mass extrinsically imprinting the roof and the anterior wall of the right atrium that also involved inferior vena cava as a sleeve; a flow acceleration with an average gradient of 6 mmHg was documented at the level of right lower pulmonary vein and a possible infiltration of atrial wall was seen. Left ventricle was normal in size and kinesis; right ventricle also showed preserved contractility of the free wall with reduction in the distal outflow portion due to diffuse soft thickening that surrounded this portion and that extended cranially towards the trunk of pulmonary artery and ascending aorta. There also was a layer of circumferential pericardial effusion, apparently organized, with irregular profile of visceral pericardial sheet adjacent to diaphragmatic wall of right ventricle. On chest contrast computed tomography (CT) a voluminous mediastinal solid mass (13 × 16 × 18 cm) was confirmed with inhomogeneous enhancement for central necrotic components determining complete atelectasis of middle and upper right lung lobes and compression of superior vena cava, of some branches of pulmonary artery and ipsilateral pulmonary veins too; supra-aortic trunks and aorta were surrounded by the mass but open; the mass enveloped the right posterolateral area of the heart, displacing it to the left and compressing right atrium with apparent pericardial infiltration. Moreover there were approximately 16 mm of pericardial effusion and multiple mediastinal adenopathies. A chest and abdomen magnetic resonance confirmed the presence of the known voluminous heteroplastic formation occupying almost all right hemithorax, indissociable from the pericardium, with compression of right heart chambers and cavae veins. A thoracic biopsy of mediastinal mass was urgently performed under ultrasound guidance and followed by systemic steroid therapy. Histological examination showed off the diagnosis of primary large B cell lymphoma of the mediastinum (PMBCL, according to WHO classification 2016). A steroid therapy and chemotherapy cycles were started (Cyclophosphamide-Hydroxydaunorubicin-Oncovin-Prednisone—CHOP scheme). On the second day after chemotherapy, we saw a sudden worsening of clinical conditions: the patient had severe respiratory distress and signs of low cardiac output such as hypotension, elevated heart rate, increased blood lactates, low venous oxygen saturation (SVO2 45%), and elevation N-terminal prohormone of brain natriuretic peptide (NT-proBNP); she was therefore admitted to intensive care unit (ICU) where a gradual optimization of haemodynamic parameters. Then she underwent a second cycle of chemotherapy: dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) and was then successfully discharged. In such cases a careful evaluation and balancing of both haematological and gynecological–obstetric aspects is needed and it requires a multidisciplinary team approach in order to identify the best diagnostic and therapeutic pathway and, most of all, the best timing for delivery depending on gestational age.

Subacute right ventricle perforation: a pacemaker lead complication

2021 ◽  
Vol 14 (5) ◽  
pp. e242489
Author(s):  
Emna Allouche ◽  
Soumaya Chargui ◽  
Marwa Fathi ◽  
Leila Bezdah
Keyword(s):  
Pericardial Effusion ◽  
Right Ventricle ◽  
Pacemaker Lead ◽  
Cardioverter Defibrillator ◽  
Active Fixation ◽  
Ventricular Lead ◽  
Life Threatening ◽  
Right Ventricular Apex ◽  
Life Threatening Complication ◽  
The Right

Myocardial perforation is an uncommon but potentially life-threatening complication of pacemaker and implantable cardioverter-defibrillator. Myocardial perforation may be acute, subacute or chronic when it occurs within 24 hours of the device insertion; between 1 day and 30 days; and more than 30 days after implantation. This complication may occur in 1.7%–7% of patients. However, subacute myocardial perforation is rare and affects 0.5%–1.2% of patients. We report the case of an 85-year-old patient with a pacemaker failure 10 days after implantation due to a subacute myocardial perforation caused by an active fixation ventricular lead. Transthoracic echocardiography showed penetration of the ventricular lead through the right ventricular apex into the pericardium without any pericardial effusion. We confirmed myocardial perforation by a CT scan. We referred her to the surgery ward where she was successfully managed.

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