First experience in quadripolar active fixation coronary sinus lead extraction: a case report

Abstract Background The Attain Stability Quadripolar 4798 lead is a relatively new quadripolar active fixation coronary sinus (CS) lead. No cases of extraction of a chronically implanted 4798 lead have been published to date. Case summary A 52-year-old man with a history of previous cardiac resynchronization therapy pacemaker (CRT-P) insertion and atrioventricular node ablation presented to our institution with a pocket infection 69 weeks after implantation. Directed intravenous antibiotic therapy was commenced and an extraction was performed the following day. Extraction of the right atrial and right ventricular leads was simple and achieved with gentle manual traction. Extraction of the CS lead was more difficult. Significant traction was required due to the formation of adhesions inside the CS but extraction of the lead was eventually successful without complication. Specialized extraction equipment was not required. A new contralateral CRT-P device was implanted, and the patient was discharged home. He remains well at 3 months of follow-up. Discussion We present the first case of extraction of a chronically implanted active fixation Attain Stability Quadripolar lead. Our experience demonstrates that this has been performed successfully without specialist tools and with preservation of the CS branch. Significant adhesion was noted at the site of active fixation, however. Potential difficulty with this lead’s extraction should therefore be considered when contemplating its use.

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Ratchet mechanism selectively causing idiopathic macrodislodgement of an active-fixation coronary sinus lead: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa466 ◽

2020 ◽

Author(s):

Pier Giorgio Golzio ◽

Arianna Bissolino ◽

Raffaele Ceci ◽

Simone Frea

Keyword(s):

Coronary Sinus ◽

Pulse Generator ◽

Thoracic Inlet ◽

Ratchet Mechanism ◽

Active Fixation ◽

First Case ◽

Time In Literature ◽

Pacemaker Leads ◽

Coronary Sinus Lead ◽

Arm Motion

Abstract Background ‘Idiopathic’ lead macrodislodgement may be due to Twiddler’s syndrome depending on active twisting of pulse generator within subcutaneous pocket. All leads are involved, at any time from implantation, and frequently damaged. In the past few years, a reel syndrome was also observed: retraction of pacemaker leads into pocket without patient manipulation, owing to lead circling the generator. In other cases, a ‘ratchet’ mechanism has been postulated. Reel and ratchet mechanisms require loose anchoring, occur generally briefly after implantation, with non-damaged leads. We report the first case of an active-fixation coronary sinus lead selective macrodislodgement involving such ratchet mechanism. Case summary A 65-year-old man underwent biventricular defibrillator device implantation, with active-fixation coronary sinus lead. Eight months later, he complained of muscle contractions over device pocket. At fluoroscopy, coronary sinus lead was found near to pocket, outside of thoracic inlet. Atrial and ventricular leads were in normal position. After opening pocket, a short tract of coronary sinus lead appeared anteriorly dislocated to generator, while greater length of lead body twisted a reel behind. The distal part of lead was found outside venous entry at careful dissection. Atrial and ventricular leads were firmly anchored. Discussion Our case is a selective ‘Idiopathic’ lead macrodislodgement, possibly due to a ratchet mechanism between the lead and the suture sleeve, induced by normal arm motion; such mechanism incredibly, and for first time in literature involves a coronary sinus active-fixation lead. Conclusion Careful attention should always be paid to secure anchoring even of active-fixation coronary sinus leads.

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A Rare Case of Left Ventricular Non-Compaction with Coronary Artery Anomaly Complicated by ST-Elevation Myocardial Infarction and Subcutaneous Defibrillator Implantation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020791 ◽

2022 ◽

Vol 19 (2) ◽

pp. 791

Author(s):

Francesca Romana Prandi ◽

Federica Illuminato ◽

Chiara Galluccio ◽

Marialucia Milite ◽

Massimiliano Macrini ◽

...

Keyword(s):

Coronary Artery ◽

Family History ◽

Lateral Wall ◽

Coronary Intervention ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Congenital Defects ◽

Circumflex Artery ◽

First Case ◽

The Right

Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy caused by arrest of normal endomyocardial embryogenesis and characterized by the persistence of ventricular hypertrabeculation, isolated or associated to other congenital defects. A 33-year-old male, with family history of sudden cardiac death (SCD), presented to our ER with typical chest pain and was diagnosed with anterior STEMI. Coronary angiography showed an anomalous origin of the circumflex artery from the right coronary artery and a critical stenosis on the proximal left anterior descending artery, treated with primary percutaneous coronary intervention. The echocardiogram documented left ventricular severe dysfunction with lateral wall hypertrabeculation, strongly suggestive for non-compaction, confirmed by cardiac MRI. At 3 months follow up, for the persistence of the severely depressed EF (30%) and the family history for SCD, the patient underwent subcutaneous ICD (sICD) implantation for primary prevention. To the best of our knowledge, this is the first case of LVNC associated with anomalous coronary artery origin and STEMI reported in the literature. Arrhythmias are common in LVNC due to endocardial hypoperfusion and fibrosis. sICD overcomes the risks of transvenous ICD, and it is a valuable option when there is no need for pacing therapy for bradycardia, cardiac resynchronization therapy and anti-tachycardia pacing.

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Recurrent Self-Induced Nontraumatic Orbital Emphysema Causing Orbital Compartment Syndrome with Optic Nerve Dysfunction

Case Reports in Ophthalmological Medicine ◽

10.1155/2021/8884009 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

S. Cutting ◽

C. Davies-Husband ◽

C. Poitelea

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Compartment Syndrome ◽

Valsalva Manoeuvre ◽

First Case ◽

Orbital Emphysema ◽

History Of ◽

Nerve Dysfunction ◽

The Right ◽

Needle Decompression

The majority of cases of orbital emphysema are due to trauma. Complications are rare, and therefore, the need for surgical intervention is uncommon. We present the first case of which we are aware in which nontraumatic orbital emphysema led to orbital compartment syndrome and subsequent optic nerve dysfunction. The patient underwent emergency needle decompression. A 51-year-old man presented to the Emergency Department with right-sided unilateral proptosis, reduced visual acuity, and binocular diplopia. This occurred after performing a Valsalva manoeuvre with no history of head trauma. He also mentioned that over the past year he had experienced multiple episodes of transient proptosis occurring after Valsalva manoeuvres. Visual acuity in the right eye was reduced to 6/21. A relative afferent pupillary defect was present and intraocular pressure (IOP) was 12 mmHg. The CT scan showed significant orbital emphysema in the medial aspect of the right orbit. Needle decompression was performed resulting in immediate resolution of his symptoms. This case demonstrates that, in cases of orbital emphysema, a lack of a history of trauma and a normal IOP cannot always be used to rule out serious pathology.

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Cardiac tamponade secondary to hemorrhagic pericardial effiision in five dogs

Journal of the Hellenic Veterinary Medical Society ◽

10.12681/jhvms.15064 ◽

2017 ◽

Vol 56 (1) ◽

pp. 9

Author(s):

C. G. HATZIGIANNAKIS (Χ.Γ. ΧΑΤΖΗΓΙΑΝΝΑΚΗΣ) ◽

M. E. MYLONAKIS (Μ. Ε. ΜΥΛΩΝΑΚΗΣ) ◽

M. N. SARIDOMICHELAKIS (Μ.Ν. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ) ◽

M. PATSIKAS (Μ. ΠΑΤΣΙΚΑΣ) ◽

D. PSALLA (Δ. ΨΑΛΛΑ) ◽

...

Keyword(s):

Ultrasound Examination ◽

Histopathological Examination ◽

Clinical Findings ◽

Pericardial Fluid ◽

Exercise Intolerance ◽

Right Atrial ◽

Atrial Wall ◽

History Of ◽

Cardiac Silhouette ◽

The Right

A 7-year old female collie (case 1), a 3-year old male Caucasian-cross (case 2) and three male German shepherds with an age of 11 (case 3), 8.5 (case 4) and 10 (case 5) years, respectively, were admitted with a history of decreased appetite, depression, exercise intolerance, dyspnea and progressive abdominal enlargement, for the last 10 to 60 days. Poor body condition (5/5), muffled heart sounds (5/5), weak femoral pulse (5/5), ascites (5/5), inspiratory or inspiratory-expiratory dyspnea (5/5), pulsus paradoxus (2/5) and jugular vein distension (2/5) were the prominent clinical findings, while mature neutrophilic leukocytosis (3/5), lymphopenia (3/5), eosinopenia (3/5), hypoproteinemia (5/5) and increased urea nitrogen (3/5) were the most prevalent clinicopathologic abnormalities. Apart from a space-occupying lesion onto the right atrial wall of one dog (case 4), radiographic and ultrasound examination showed a globe-shaped cardiac silhouette (5/5), pericardial effusion (5/5), ascites (5/5) and pleural effusion (4/5). A large amount of non-clotting hemorrhagic effusion was drained during pericardiocentesis, resulting in rapid clinical recovery. Physical, chemical and cytological evaluation of the pericardial fluid was non-contributory in the differentiation between neoplastic and non-neoplastic causes of these effusions. Case 3 died 25 days post-pericardiocentesis; right atrium hemangiosarcoma and pulmonary metastases were documented on post mortem histopathological examination. Another dog (case 5) died of unknown causes one month after pericardiocentensis. On the contrary, dogs 1, 2 and 4 were still clinically healthy for a followup period of 16, 2 and 8 months, respectively.

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Laparoscopic surgical approach for the treatment of piriformis syndrome: Intrapelvic decompression technique

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.1177/22840265211045610 ◽

2021 ◽

pp. 228402652110456

Author(s):

Ahmet Kale ◽

Gülfem Başol ◽

Elif Cansu Gündoğdu ◽

Emre Mat ◽

Gazi Yıldız ◽

...

Keyword(s):

Sciatic Nerve ◽

Decompression Surgery ◽

Piriformis Syndrome ◽

First Case ◽

Cutaneous Allodynia ◽

Pelvic Nerves ◽

Uncommon Disease ◽

History Of ◽

Vas Scores ◽

The Right

Introduction: Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome. Methods: We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots. Results: The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.

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Aorta–bal kamra tunnel sikeres sebészi kezelése modern noninvazív képalkotó diagnosztika alapján

Orvosi Hetilap ◽

10.1556/650.2015.30206 ◽

2015 ◽

Vol 156 (28) ◽

pp. 1140-1143

Author(s):

István Hartyánszky ◽

Márta Katona ◽

Krisztina Kádár ◽

Asztrid Apor ◽

Sándor Varga ◽

...

Keyword(s):

Three Dimensional ◽

Postoperative Management ◽

Left Ventricular ◽

Aortic Sinus ◽

First Case ◽

History Of ◽

Dimensional Echocardiography ◽

Aortic Orifice ◽

Three Dimensional Echocardiography ◽

The Right

Aortico-left ventricular tunnel is a rare congenital cardiac defect, which bypasses the aortic valve via the paravalvar connection from the aorta to the left ventricle. The authors report the history of a 14-year-old boy with aortico-left ventricular tunnel in whom the aortic orifice arose from the right aortic sinus and was closed by a pericardial patch. The diagnosis was confirmed by combined two-dimensional and real time three-dimensional echocardiogram and magnetic resonance imaging. This is the first case, in which these complex diagnostic imaging methods have been used in the pre- and postoperative management of this defect. Optimally the new transthoratic three-dimensional echocardiography would be needed to define the anatomy and functional consequences of the aortico-left ventricular tunnel and in the postoperative follow-up. Orv. Hetil., 2015, 156(28), 1140–1143.

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Mesothelioma in two sheep with pericardial effusion and ascites

Veterinary Record Case Reports ◽

10.1136/vetreccr-2019-001031 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001031

Author(s):

Nicola Fletcher ◽

Camilla Brena ◽

Amanda Carson ◽

Mark Wessels ◽

Tobias Floyd

Keyword(s):

Differential Diagnosis ◽

Pericardial Effusion ◽

Domestic Animals ◽

Diagnostic Pathology ◽

First Case ◽

Clinical Presentations ◽

Rare Tumours ◽

Microscopic Features ◽

History Of ◽

The Right

Mesotheliomas are rare tumours in domestic animals. These tumours have a range of clinical presentations, and a range of gross and microscopic features can be present. We report mesotheliomas in two sheep submitted to Animal and Plant Health Agency’s diagnostic pathology service with diverse clinical presentations. The first case was a 2-year-old ewe with a history of sudden death that had a nodular mass in the wall of the right auricle and marked pericardial effusion and ascites. The second case was a 3-year-old ewe with a history of recumbency which had a papillary mass in the peritoneal cavity and marked ascites. A diagnosis of mesothelioma in both cases was confirmed by immunohistochemistry for cytokeratin and vimentin. These cases highlight the diverse presenting signs that can be present with mesothelioma, and this tumour should be considered as a differential diagnosis in sheep with peritoneal, pericardial or pleural effusion at gross postmortem.

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Symptomatic solitary xanthogranuloma occupying the cavernous sinus

Journal of Neurosurgery ◽

10.3171/jns.2001.94.2.0322 ◽

2001 ◽

Vol 94 (2) ◽

pp. 322-326 ◽

Cited By ~ 6

Author(s):

Kazumichi Yamada ◽

Masaki Miura ◽

Haruhiko Miyayama ◽

Naohiko Furuyoshi ◽

Jun Matsumoto ◽

...

Keyword(s):

Cavernous Sinus ◽

Middle Meningeal Artery ◽

Magnetic Resonance Images ◽

Superior Orbital Fissure ◽

Content Type ◽

First Case ◽

History Of ◽

Mixed Pattern ◽

The Right ◽

Field Defect

✓ The authors report the first case of a solitary xanthogranuloma of the cavernous sinus without systemic manifestation. A 43-year-old woman experienced decreased visual acuity on the right side in association with papilledema and a visual field defect. She was alert and no other neurological sign was observed. She had no family history of hyperlipoproteinemia and no cutaneous and/or systemic xanthomatous lesions. Skull x-ray films showed an enlarged right superior orbital fissure. Computerized tomography revealed a low-density oval mass 2 × 3 cm in diameter in the right cavernous region that was compressing the right optic nerve in the lateral to medial direction. This mass exhibited isointensity on T1-weighted and mixed-pattern hyperintensity on T2-weighted magnetic resonance images with diffuse contrast enhancement. Cerebral angiography demonstrated fine staining in the margin, originating from the right middle meningeal artery. These neuroimaging findings closely mimicked those associated with trigeminal neuroma. The lesion was partially removed via a right-sided zygomatic approach, and her symptoms improved. Clinical characteristics and histopathological features of this rare case are discussed.

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Right Atrial Perforation Secondary to Implantable Cardioverter Defibrillator Insertion

Canadian Respiratory Journal ◽

10.1155/2001/257641 ◽

2001 ◽

Vol 8 (4) ◽

pp. 283-285 ◽

Cited By ~ 5

Author(s):

Nam T Tran ◽

Adam Zivin ◽

Darius Mozaffarian ◽

Riyad Karmy-Jones

Keyword(s):

Implantable Cardioverter Defibrillator ◽

Fibrin Glue ◽

Lung Parenchyma ◽

Right Atrial ◽

Atrial Wall ◽

Cardioverter Defibrillator ◽

Active Fixation ◽

The Right

Implantable cardioverter defibrillator (ICD) placements can be associated with serious complications. This paper reports a patient in whom percutaneous placement of an ICD resulted in a hemopneumothorax. This was due to an active fixation lead that perforated the right atrial wall and injured the adjacent lung parenchyma. The hemothorax was drained thoracoscopically, and the atrial injury was covered with fibrin glue.

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