Abstract 14803: Use of Real-Time Transesophageal Echocardiography to Improve Safety of Lead Extraction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Brett Oestreich ◽  
Bryan Ahlgren ◽  
Christine Tompkins ◽  
Paul Varosy ◽  
Tamas Seres ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Right Atrium ◽  
Premature Termination ◽  
Average Length ◽  
Vena Cava ◽  
Lead Extraction ◽  
Lead Removal ◽  
Severe Hypotension

Background: Transvenous lead extraction (TLE) carries a small but measurable risk of serious adverse events. Few studies have examined the potential benefit of continuous monitoring with transesophageal echocardiography (TEE) during this procedure. Objective: Evaluate the utility of TEE during TLE involving both conventional and laser lead removal. Methods: TEE was performed in 100 consecutive patients undergoing TLE. All patients underwent TLE in the operating room with general anesthesia and continuous TEE monitoring. TLE was attempted for 193 leads in 100 patients. Eighty patients required laser lead extraction (80%). Indications for extraction were device endocarditis (28), lead fracture (28), recalled lead (21), pocket infection (17), and other (6). Results: Sixty-seven patients were male and the average age was 56.96 +- 17.01 years. The average length since lead implant was 78±55.19 (1.4-274.43) months. Complete success occurred in 181 leads (94%), partial success in 4 leads (2%), and failure in 8 leads (4%). Major complications included right ventricle laceration (1) and right atrium/superior vena cava laceration (2) which resulted in detection and localization within 1-2 minutes and prompt surgical repair. Premature termination and unnecessary surgery were prevented in 4 patients with hypotension but no intracardiac abnormalities seen on TEE (Figure 1). There was one upper gastrointestinal bleed from the TEE probe (1). In-hospital mortality was 0%. Conclusion: In total the clinical management was changed in 7 patients (7%) based on real-time TEE monitoring helping to decrease the TLE related mortality and premature termination of the procedure. Figure 1 Monitoring with real time TEE prevented premature termination of cases with severe hypotension showing RV obstruction due to invagination of the free wall. RA: right atrium; RV: right ventricle.

P2854Floating connecting tissue scars ghosts after transvenous lead extraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Polewczyk ◽  
D Nowosielecka ◽  
A Tomaszewski ◽  
W Brzozowski ◽  
D Szczesniak Stanczyk ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Transesophageal Echocardiography ◽  
Tricuspid Valve ◽  
Coronary Sinus ◽  
Right Atrium ◽  
Vena Cava ◽  
Lead Extraction ◽  
Frequency Of Occurrence ◽  
Before And After ◽  
Mean Size

Abstract Background The phenomenon of appearance of connecting tissue remnants floating in vena cava (VC), right atrium (RA) tricuspid valve (TV), right ventricle (RV) or coronary sinus (CS) was described recently. Frequency of occurrence and their significance remain unknown. Till now, our knowledge is limited due lack exact description in the literature. Purpose The goal of this study was analysis of the appearance of this phenomenon using trans-esophageal echocardiography. Methods Between 2006 and January 2018 we performed 2408 TLE procedures using conventional mechanical sheaths. 3836 leads (mean implant duration 96,13 months) were extracted, mainly due to non-infective indications in 64,2%. Results of exact TEE before and after the procedure were available in 2034 patients. All patients with incomplete ECHO/TEE evaluation were excluded from the analysis. Results Results are presented in the table Conclusions In about 25% of patients after TLE floating connecting tissue scars can be observed. Most frequently they can be noted in VC (33%) RA (28%) and RV (10%). In 23% ghosts has numerous location in different combinations. Mean size of “ghosts” is about 20x4 mm. This phenomenon should be known for doctors who perform transesophageal echocardiography to avoid faulty diagnosis.

scholarly journals The Potential for Arrhythmia during Central Venous Catheter Insertion- to where does the guidewire migrate?

2021 ◽  
Author(s):  
Daphna Reichmann ◽  
Re'em Sadeh ◽  
Ori Galante ◽  
Yaniv Almog ◽  
Victor Novack ◽  
...  
Keyword(s):  
Intensive Care ◽  
Right Ventricle ◽  
Real Time ◽  
Right Atrium ◽  
Medical Center ◽  
Insertion Site ◽  
Vena Cava ◽  
Venous Catheter ◽  
Seldinger Technique ◽  
The Right

Abstract BackgroundCentral Venous Catheters (CVC) are being used in both intensive care units and general wards for multiple purposes. A previous study1 observed that during CVC insertion through Subclavian Vein (SCV) or the Internal Jugular Vein (IJV) the guidewire is sometimes advanced to the Inferior Vena Cava (IVC), and at other times to the right atrium. The rate of IVC wire cannulation and the association with side and point of insertion is unknown.ObjectiveIn this study, we describe guidewire migration location during real time CVC cannulation (right atrium versus IVC) and report the association between the insertion site and side of the CVC and the location of guidewire migration, Right Atrium (RA)/Right Ventricle (RV) versus IVC guidewire migration.DesignThis is a retrospective study of the prospectively and systematically collected data on CVC insertion under real time trans thoracic ultrasound.SettingThe medical Intensive Care Unit in Soroka Medical Center, among patients that have received CVC during the study years 2014–2020.Main outcome measures:The rate of IVC versus right atrium/right ventricle wire migration during the procedure were analyzed. The association between the side and point of CVC insertion and the wire migration site was analyzed as well.ResultsOne hundred and sixty-six patients were enrolled. 33.7% of wires migrated to the IVC and 66.3% to the versus right atrium/right ventricle. The rate of wire migration to the IVC was similar in the IJV site and the SCV site. There was no association between the side of CVC insertion and wire migration to the IVC.ConclusionAbout a third of all wire migrations, during CVC Seldinger technique insertion, were identified in the IVC, with no potential for wire associated arrhythmia. There was no association between CVC insertion point (SCV versus IJV) nor the side of insertion and the site of guidewire migration.

Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography

2006 ◽  
Vol 105 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Theofilos G. Machinis ◽  
Kostas N. Fountas ◽  
John Hudson ◽  
Joe Sam Robinson ◽  
E. Christopher Troup
Keyword(s):  
Transesophageal Echocardiography ◽  
Real Time ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Distal Catheter ◽  
The Mean ◽  
The Right

Objective Ventriculoatrial (VA) shunts remain a valid option for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Correct positioning of the distal end of the catheter in the right atrium is of paramount importance for maintaining shunt patency and reducing the incidence of VA shunt-associated morbidity. The authors present their experience with real-time transesophageal echocardiography (TEE) monitoring for the accurate placement of the distal catheter of a VA shunt. Methods Four patients underwent conversion of a VP shunt to a VA shunt under the guidance of intraoperative fluoroscopy and TEE between May 2003 and December 2004. After induction of general anesthesia, the TEE transducer was advanced into the esophagus. A cervical incision was made and the external jugular vein was visualized. An introducer was passed through an opening in the jugular vein and a guidewire was placed through the introducer. Under continuous TEE guidance, the guidewire was carefully advanced into the superior vena cava. A distal shunt catheter overlying a J-wire was then passed to the superior vena cava, again under TEE guidance. The catheter was advanced to the right atrium after removing the guidewire. Final visualization with TEE and fluoroscopy revealed a good position of the catheter in the right atrium in all four cases. The mean duration of the operation was 91 minutes (range 65–120 minutes) and the mean operative blood loss was 23 ml (range 10–50 ml). No procedure-related complication was noted. Conclusions Real-time TEE is a safe and simple technique for the accurate placement of the distal catheter of a VA shunt.

Role of Transesophageal Echocardiography in Detection of Residual Tumor in Renal Cell Carcinoma Extending into Right Atrium

2015 ◽  
Vol 3 (1) ◽  
pp. 35-38
Author(s):  
Sethu Madhavan, ◽  
Ravi Mohan
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Transesophageal Echocardiography ◽  
Right Atrium ◽  
Renal Cell ◽  
Vena Cava ◽  
Residual Tumor ◽  
Cardiac Complications ◽  
Accurate Identification

ABSTRACT Renal cell carcinoma (RCC) has a tendency to invade inferior vena cava and thereby reach the right heart. This may necessitate a combined surgical procedure. These procedures impose a challenge to the anesthesiologist and may require the use of veno-venous or cardiopulmonary bypass (CPB). Among the serious and feared complication is embolization of the thrombus during mobilization of the tumor causing a massive pulmonary embolism. Transesophageal echocardiography (TEE) not only provide accurate identification and definition of the cranial extent of the tumor, but may also provide continuous monitoring of the hemodynamic status and cardiac complications during surgical manipulation of tumor. In this case report, we have described TEE helped in recognizing not only the extent of the tumor but also (the adequacy of removal of the tumor thrombus) diagnose the residual tumor after removal during right radical nephrectomy. How to cite this article Negi SL, Dutta V, Puri GD, Madhavan S, Mohan R. Role of Transesophageal Echocardiography in Detection of Residual Thrombus in Renal Cell Carcinoma extending into Right Atrium. J Perioper Echocardiogr 2015;3(1):35-38.

scholarly journals P1464 A case of cortriatriatum dexter accidentally discovered in an adult

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H S A Abdelgawad ◽  
M Abdelnabi ◽  
A Almaghrabi ◽  
M Shehata ◽  
M A Abdelhay
Keyword(s):  
Transesophageal Echocardiography ◽  
Right Atrium ◽  
Vena Cava ◽  
Interatrial Septum ◽  
Right Atrial ◽  
Cor Triatriatum ◽  
Free Wall ◽  
3D Transesophageal Echocardiography ◽  
Cor Triatriatum Dexter ◽  
The Right

Abstract Introduction Cor triatriatum dexter, or partitioning of the right atrium (RA) to form a triatrial heart, is an extremely rare congenital anomaly that is caused by the persistence of the right valve of the sinus venosus. The incidence of cor triatriatum is approximately 0.1% of congenital heart malformation. Typically, the right atrial partition is due to exaggerated fetal eustachian and the besian valves, which together form an incomplete septum across the lower part of the atrium. This septum may range from a reticulum to a substantial sheet of tissue Case report: 45-years old female patient with history of surgical closure of an atrial septal defect at the age of 14 years .She presented to our medical facility complaining of exertional dyspnea and bilateral lower limb edema for 4 years. On clinical examination, she had bilateral congested neck veins, a pansystolic murmur over the tricuspid area and a tender hepatomegaly. 2D Transthoracic Echocardiography revealed an unusual membranous structure that stretched across the right atrium with attachments superiorly at the free wall and inferiorly at the inter-atrial septum with a severe tricuspid regurgitation (Panel A)Intravenous agitated saline injection revealed an incomplete membrane. (Panel B).2D Transesophageal echocardiography showed an unusually prominent eustachian valve arose normally from the ostium of the inferior vena cava (IVC) and was pointing towards the interatrial septum just below the level of the fossa ovalis and no residual ASD could be seen. (Panel C) . 3D transesophageal echocardiography with zoomed mode from right atrial perspective confirmed the presence of an incomplete membrane extending transversely from the ostium of IVC and interatrial septum immediately below the fossa ovalis but not reaching RA free wall (arrow), no obstruction to the flow of the IVC, superior vena cava (SVC) , coronary sinus (CS) and the tricuspid valve (TV) was seen .(Panels D,E,F). Conclusion Since many patients are asymptomatic, the diagnosis of cor triatriatum dexter often is determined at postmortem examination. Antemortem diagnosis can be determined by echocardiography. 3D transesophageal echocardiography was able to detect cor triatriatum dexter that can be easily missed by 2D echocardiography. Abstract P1464 Figure.

scholarly journals A case of Wilms tumor with right ventricular extension of tumor thrombus

2017 ◽  
Vol 4 (1) ◽  
pp. 60
Author(s):  
Mustafa Çakan ◽  
Ayşe Gülnur Tokuç ◽  
Kıvılcım Karadeniz Cerit ◽  
Koray Ak ◽  
Rabia Ergelen
Keyword(s):  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Right Atrium ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Renal Tumor ◽  
Wilms Tumor ◽  
Vena Cava ◽  
Renal Tumors ◽  
Tumor Extension

Primary renal tumors comprise 6% of all childhood cancers. Wilms tumor is the most common primary renal tumor in pediatric age group and the peak age of diagnosis is 3-4 years. In 10% of cases tumor extension into hepatic vein and inferior vena cava can be seen. But tumor extension into whole inferior vena cava, right atrium and right ventricle is only seen in less than 1% of patients. A 2-year-old girl was admitted to the hospital because of abdominal distension that was noticed by the parents two weeks ago. Imaging studies revealed that she had a mass at the right renal lodge which was favoring to Wilms tumor and on thorax tomography tumor thrombus was seen in the whole inferior vena cava, right atrium and right ventricle. Neoadjuvant chemotherapy was given for 7 weeks. On the 8th week of diagnosis, under cardiopulmonary bypass, surgical operation by pediatric and cardiovascular surgery teams for primary renal tumor and for cavo-atrial tumor thrombus was performed. Pathological examination of the mass was reported as stage 3 diffuse anaplastic Wilms tumor. The patient completed 24 weeks of chemotherapy protocol and she is being followed for 15 months without any morbidity. We present our case to emphasize the importance of multidisciplinary approach in Wilms tumor with cardiac extension.

scholarly journals Prognostic Value of Preoperative Echocardiographic Findings in Patients Undergoing Transvenous Lead Extraction

2021 ◽  
Vol 18 (4) ◽  
pp. 1862
Author(s):  
Dorota Nowosielecka ◽  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Łukasz Tułecki ◽  
Andrzej Kleinrok ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Right Atrium ◽  
Binding Sites ◽  
Superior Vena ◽  
Fibrous Tissue ◽  
Vena Cava ◽  
Lead Extraction ◽  
Tissue Binding ◽  
Term Survival

(1) Background: In patients referred for transvenous lead extraction (TLE) transesophageal echocardiography (TEE) often reveals abnormalities related to chronically indwelling endocardial leads. The purpose of this study was to determine whether the results of pre-operative TEE might influence the long-term prognosis. (2) Methods: We analyzed data from 936 TEE examinations performed at a high volume center in patients referred for TLE from 2015 to 2019. The follow-up was 566.2 ± 224.5 days. (3) Results: Multivariate analysis of TEE parameters showed that vegetations (HR = 2.631 [1.738–3.983]; p < 0.001) and tricuspid valve (TV) dysfunction unrelated to the endocardial lead (HR = 1.481 [1.261–1.740]; p < 0.001) were associated with increased risk for long-term mortality. Presence of fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.285; p = 0.035), presence of penetration or perforation of the lead through the cardiac wall up to the epicardium (HR = 0.496; p = 0.035) and presence of excessive lead loops (HR = 0.528; p = 0.026) showed a better prognosis. After adjustment the statistical model with recognized poor prognosis factors only vegetations were confirmed as a risk factor (HR = 2.613; p = 0.039). A better prognosis was observed in patients with fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.270; p = 0.040). (4) Conclusions: Non-modifiable factors may have a negative influence on long-term survival after TLE. Various forms of connective tissue overgrowth and abnormal course of the leads modifiable by TLE can be a factor of better prognosis after TLE.

CARDIAC ARREST DURING STRENUOUS EXERCISE IN A PATIENT WITH CONGENITAL HEART DISEASE

PEDIATRICS ◽  
1963 ◽  
Vol 32 (4) ◽  
pp. 776-777
Author(s):  
Albert A. Kattus
Keyword(s):  
Heart Disease ◽  
Medical Student ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Atrium ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Strenuous Exercise ◽  
Heart Catheterization ◽  
The Right

THE FOLLOWING CASE is presented in order to introduce a note of caution into consideration of the advisability of recommending unmonitored exercise for patients with heart disease. The patient is a 24 year old third year medical student who had been known to have a heart murmur since birth. He had lived a vigorously active life and had participated in high school football as well as snow skiing in more recent years. At the age of 19 he underwent a detailed cardiac work-up including right heart catheterization at another hospital. The findings at that time included a normal examination except for a grade III/VI blowing pansystolic murmur at the 4th left intercostal space. The chest x-ray disclosed a normal cardiac silhouette with normal pulmonary vascularity. The electrocardiogram disclosed right bundle branch block and left axis deviation. Cardiac catheterization disclosed systolic pressure of 30 mm. Hg. in the right ventricle and 23 in the pulmonary artery. There was O2 saturation of 78 per cent in the superior vena cava and 75 per cent in the inferior vena cava. In the high and mid right atrium O2 saturations ranged from 76 per cent to 80 per cent. Low in the atrium, just above the tricuspid valve, there was a small step-up of O2 saturation to 83 per cent and similar saturations were found in the right ventricle and pulmonary artery. The findings suggested a small shunt from left ventricle to right atrium of the type seen in the transitional form of atrio-ventricular communis. During the two weeks prior to the present event the patient and his roommate who was also a third year medical student, had undertaken to improve their physical conditioning by performing the Canadian Air Force series of calisthenic exercises.

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