Technical Aspects of Using the AngioVac System for Thrombus Aspiration From the Ascending Aorta

2018 ◽  
Vol 25 (5) ◽  
pp. 550-553 ◽  
Author(s):  
Nikolaos Tsilimparis ◽  
Konstantinos Spanos ◽  
E. Sebastian Debus ◽  
Fiona Rohlffs ◽  
Tilo Kölbel
Keyword(s):  
Therapeutic Option ◽  
Femoral Vein ◽  
Ascending Aorta ◽  
Arterial System ◽  
Mural Thrombus ◽  
System Technique ◽  
The Right ◽  
Extracorporeal Bypass ◽  
Near Future

Purpose: To present the technique for removing mural thrombus from the ascending aorta using the AngioVac System. Technique: The technique is demonstrated in a 66-year-old woman who presented with free-floating mural thrombus in the ascending aorta and was considered unsuitable for either open (comorbidities) or endovascular approaches (high risk of stroke). Because of the free-floating thrombus, the Angiovac system was suggested, although it is approved for only the venous system. The technique was adapted for the arterial system with the 2 access points being (1) the proximal left subclavian artery with a 10-mm conduit for device access and (2) the right femoral vein. The AngioVac cannula and the reinfusion cannula were inserted into the artery and vein, respectively. The extracorporeal bypass circuit was created, and the carotid arteries were clamped during aspiration (<1 minute). The mural thrombus was aspirated successfully. The patient had an uneventful postoperative course with no signs of free thrombus on the postoperative or follow-up computed tomography angiograms. Conclusion: The use of the AngioVac System seems to be a feasible technique for aspiration of thrombus from the ascending aorta. Expanding this therapeutic option for patients unsuitable for open or endovascular repair may be proven efficient in the near future.

scholarly journals 731 Single centre experience tricuspid valve transcatheter edge to edge repair

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Luca Paolucci ◽  
Annunziata Nusca ◽  
Valeria Cammalleri ◽  
Edoardo Nobile ◽  
Aurelio De Filippis ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Therapeutic Option ◽  
Femoral Vein ◽  
Single Centre ◽  
Vein Access ◽  
Increased Risk ◽  
Single Centre Experience ◽  
Procedural Success ◽  
The Right

Abstract Aims Severe tricuspid valve regurgitation (TVR) is critically associated with an increased risk of morbidity and mortality, surgical treatment is limited by high perioperative risk. In these patients, transcatheter edge to edge valve repair (TEER) is progressively recognized as an effective treatment strategy. The aim of this work is to report the single centre experience procedural results and clinical outcomes in ‘real-world’ patients suffering TVR treated with the TriClip™ device (Abbott Vascular, Santa Clara, California). Methods From January up to July 2021, we screened 30 patients with severe TR, among which 8 were treated with TEER. All patients underwent cardiac computerized tomography and both transesophageal and transthoracic echocardiography, with the purpose to identify a dedicated grasping strategy. TEER was performed through right common femoral vein access, advancing a 24 F steerable guiding catheter (SGC) in the right atrium. Following, the TriClip delivery system was advanced and positioned over the valve centroid and, once oriented, the clip was opened. Under fluoroscopic and transesophageal monitoring, the clip was advanced in the right ventricle and pulled back to grasp the target leaflets. Following echocardiographic control, the clip was released. Results Procedural success, defined as a significative reduction of the regurgitation’s severity, was achieved in all patients. No procedural or in-hospital adverse events were reported. At 30 days follow-up, all patients were alive and no further hospitalizations occurred. Conclusions In our single centre experience, TEER appeared to be a valid and feasible therapeutic option in patients with severe TVR. Multicentre prospective studies are mostly needed to assess the long terms outcomes of TEER in these patients, with the purpose to introduce in the clinical practice a valid alternative to the highly risk surgical option.

scholarly journals Characteristics and long-term outcomes of aortico-left ventricular tunnel

2020 ◽  
Author(s):  
Jing Sun ◽  
Hongxia Qi ◽  
Hongyuan Lin ◽  
Wenying Kang ◽  
Shoujun Li ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Surgical Repair ◽  
Mechanical Valve ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Orifice ◽  
The Right

Abstract OBJECTIVES Aortico-left ventricular tunnel (ALVT) is an extremely rare, abnormal paravalvular communication between the aorta and the left ventricle. Few studies have identified the characteristics and long-term prognosis associated with ALVT. METHODS The data of 31 patients with ALVT from July 2002 to December 2019 were reviewed. Echocardiography was performed in all patients during the follow-up period. RESULTS The median age of the patients was 11.5 years. Bicuspid aortic valve and dilatation of the ascending aorta were found in 13 patients, respectively. The aortic orifice in 20 patients showed a close relation to the right sinus and the right–left commissure. Of the 31 patients, 26 were operated on. Mechanical valve replacement was performed in 4 patients and aortic valve repair, in 6 patients. Ascending aortoplasty was performed in 5 patients and aortic replacement was done in 2 patients. One patient died of ventricular fibrillation before the operation. Follow-up of the remaining 30 patients ranged from 1 to 210 months (median 64 months). There were 4 deaths during the follow-up period: 1 had mechanical valve replacement and 3 did not undergo surgical repair. In the 26 patients without aortic valve replacement, 6 had severe regurgitation and 2 had moderate regurgitation. In the 28 patients without replacement of the ascending aorta, 11 had continued dilatation of the ascending aorta, including those who had aortoplasty. CONCLUSIONS The aortic orifice of ALVT showed an association with the right sinus and the right–left commissure. For patients who did not have surgery, the long-term survival rate remained terrible. Surgical closure should be done as soon as possible after ALVT is diagnosed. The main long-term complications after surgical repair included aortic regurgitation and ascending aortic dilatation.

Rupture of pulmonary aneurysms in association with long-standing Waterston shunts

2001 ◽  
Vol 11 (1) ◽  
pp. 123-127 ◽  
Author(s):  
Dearbhla A. Hull ◽  
Elliot Shinebourne ◽  
Leon Gerlis ◽  
Andrew G. Nicholson ◽  
Mary N. Sheppard
Keyword(s):  
Late Complication ◽  
Adult Life ◽  
Ascending Aorta ◽  
Cyanotic Congenital Heart Disease ◽  
Palliative Procedure ◽  
Right Pulmonary Artery ◽  
Long Term Follow Up ◽  
The Right

AbstractAnastomosis of the ascending aorta to the right pulmonary artery, the so-called Waterston shunt, was undertaken as a palliative procedure for children with cyanotic congenital heart disease due to obstruction of the pulmonary outflow tract with reduced pulmonary blood flow. We present the clinico-pathological correlations in two patients who underwent construction of Waterston shunts as neonates, and subsequently died of ruptured pulmonary aneurysms in adult life. Rupture should, therefore, be recognized as a late complication of this procedure, and be considered in the long-term follow-up of such patients, especially when the shunted lung is hypertensive.

Primary repair of tetralogy of Fallot in infancy – the effect on growth of the pulmonary arteries and the risk for late reinterventions

2001 ◽  
Vol 11 (4) ◽  
pp. 391-398 ◽  
Author(s):  
Renate Kaulitz ◽  
Christian Jux ◽  
Harald Bertram ◽  
Thomas Paul ◽  
Gerhard Ziemer ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Primary Repair ◽  
Pulmonary Arteries ◽  
Arterial System ◽  
Asymptomatic Patients ◽  
The Right ◽  
Normal Controls

We sought to analyse the long-term follow-up after primary repair of tetralogy of Fallot in infancy in the first year of life, paying particular attention to growth of the pulmonary arteries and the need for reintervention. We performed a combined retro- and prospective echocardiographic study, including measurements of the pulmonary valve and right and left pulmonary arteries, indexed to the square root of body surface area, in 62 patients prior to primary repair, 18 to 24 months after this event, and at the most recent follow-up, with a mean of 80.4 ± 24 months. Of these, 38 patients, with an age at operation of 5.0 ± 3.4 months, had presented preoperatively with hypoxic spells or increasing cyanosis. The remaining 24 patients had been asymptomatic, with adequate flow of blood to the lungs. Their age at elective operation was 7.4 ± 3.0 months. A transannular patch was needed in 37 patients (63%). There were 3 early postoperative deaths (4.8%).Cross-sectional echocardiography revealed a significantly smaller diameter for the pulmonary valve in patients who had been symptomatic preoperatively compared to the asymptomatic patients (1.09 versus 1.3 cm/BSA0.5; p = 0.019). The diameters of the right and left pulmonary arteries did not differ significantly between the groups. Examination of echocardiographic data obtained 18 to 24 months postoperatively in 43 patients revealed a significant increase in the diameter of the pulmonary arteries; 0.83 ± 0.17 cm/BSA0.5 versus 1.1 ± 0.26 cm/BSA0.5 for the diameter of the right pulmonary artery, 0.85 ± 0.2 cm/BSA0.5 versus 1.0 ± 0.25 cm/BSA0.5 for the left pulmonary artery. On comparison between individuals, 18.6% and 25.6% of the patients, respectively, did not show any change in the diameters of their right and left pulmonary arteries, whereas the increase in diameter reached or exceeded the measurements in normal controls in 55.8% and 46.5% of the patients, respectively. On recent follow-up, with a range from 56 to 147 months, no further increase in the indexed diameters of the pulmonaries could be documented in 21 of 33 patients. Of these, 9.1% and 18.2%, respectively, presented with small right and left pulmonary arteries compared with measurements obtained in normal controls. Moderate pulmonary incompetence was found on colour flow mapping in one-third. Of 56 longterm survivors, 8 (14%) had required reinterventions, which were surgical in 6 and achieved by transcatheter techniques in the other 2 patients. Thus, primary correction of tetralogy of Fallot in infancy, with restoration of normal pressures and flows, resulted in sustained increase in the diameters of the right and left pulmonary arteries. It allowed for early normal development of the proximal pulmonary arterial system in most patients regardless of their age and symptomatic status at operation. Patients with persistent subnormal diameter of the pulmonary arteries did not present with significantly elevated right ventricular pressure. Early one-stage repair of tetralogy of Fallot in infancy was associated with a low rate of reinterventions.

scholarly journals Repair of Aorto-Right Ventricular Tunnel: A Case Report

1970 ◽  
Vol 3 (1) ◽  
pp. 98-100 ◽  
Author(s):  
Naveen Sheikh
Keyword(s):  
Right Ventricular ◽  
Myocardial Protection ◽  
Congenital Heart ◽  
Septal Defect ◽  
Ascending Aorta ◽  
Mattress Suture ◽  
Cold Blood ◽  
The Right ◽  
Cold Blood Cardioplegia

Aorto-ventricular tunnel is a congenital, extracardiac channel which connects the ascending aorta above the sinutubular junction to the cavity of the left, or less commonly, to the right ventricle. Here, I report a successful surgical correction of aorto-right ventricular tunnel with anomalous right coronary artery (RCA) arising from the tunnel in a 42 years old woman diagnosed preoperatively with echocardiography and cardiac catheterization. The operation was performed with cardiopulmonary bypass and hypothermia. Myocardial protection was achieved by antegrade cold blood cardioplegia. The tunnel below the origin of RCA was closed with pericardial patch. Tunnel was closed with mattress suture and running stitches to reduce the diameter and making channel for RCA blood flow. Atrial septal defect was closed by patch. The postoperative course was uneventful except pericardial effusion which was managed conservatively. A follow-up transthoracic echocardiogram demonstrated a securely closed communication without any aortic valve incompetence. Keywords: Congenital heart disease; Aorto- RV Tunnel (ARVT). DOI: 10.3329/cardio.v3i1.6435Cardiovasc. j. 2010; 3(1): 98-100

Antegrade Cardioplegia Decannulation Made Simple With the Cor-Knot System: Technique and Tips After 20 Consecutive and Controlled Patients

2020 ◽  
Vol 15 (5) ◽  
pp. 494-496
Author(s):  
Aristotelis Panos ◽  
Kyriakos Mpellos ◽  
Sylvio Vlad ◽  
Patrick O. Myers
Keyword(s):  
Minimally Invasive ◽  
Right Atrium ◽  
Right Atrial ◽  
Video Assisted ◽  
Cannulation Site ◽  
System Technique ◽  
Prolene Suture ◽  
Right Atrial Appendage ◽  
The Right

Closing the cardioplegia cannulation site can be challenging in minimally invasive video-assisted cardiac surgery. The Cor-Knot system is used to tie down valve sutures within the heart efficiently, although erosions to neighboring structures are reported. We hypothesized that a modification of the Cor-Knot system could enable safe hemostasis of the cardioplegia aortic root site and avoid erosions of the aorta or right atrium. This is a single-arm prospective study including 20 consecutive patients operated through a video-assisted method at our clinic between January 2019 and February 2019. At the end of the procedure, the suture was passed through a Cor-Knot device and crimped on a band of Teflon-felt. The two tips of the Teflon-felt toward the right atrium were put together and tightened with a 5/0 Prolene suture in order to protect the sharp ends of the device. Hemostasis was achieved using the technique in all 20 patients, with no requirement for further suture placement to ensure hemostasis of the cardioplegia cannulation site. The device was protected from the right atrial appendage and there was no bleeding. At 6-month follow-up, no patients required a reoperation for aortic or right atrial erosion. The Cor-Knot system was used off-label to close the cardioplegia cannulation site in minimally invasive surgery. This appears safe and effective in our initial 20-patient experience.

scholarly journals Intraoperative ultrasound-guided enucleation of testicular nodule

2016 ◽  
Vol 88 (4) ◽  
pp. 335
Author(s):  
Riccardo Boschian ◽  
Giovanni Liguori ◽  
Stefano Bucci ◽  
Michele Bertolotto ◽  
Carlo Trombetta
Keyword(s):  
Therapeutic Option ◽  
Young Patients ◽  
Intraoperative Ultrasound ◽  
Ultrasound Guided ◽  
Testicular Lesions ◽  
The Right ◽  
Clinical Conditions ◽  
Ultrasonography Guidance ◽  
Diagnostic Investigations

Objective: We report a case of enucleation of a non-palpable right testicular lesion found incidentally at testicular ultrasonography during investigations in a patient with azoospermia. Materials and methods: In 2011 bilateral hypoechoic nonpalpable testicular lesions (5 mm and 3 mm to the right, 3 mm to the left) were found in a 28 years old patient, during diagnostic investigations for azoospermia. In March 2016, ultrasonography showed that the diameter of the right major nodule had grown to 12 mm, characterized by increased vascularization and increased texture. Blood exams showed serum FSH above normal levels with negative oncologic markers. The patients underwent surgical enucleation of the right nodule under ultrasonography guidance. Results: In post operative day 1 a control ultrasonography documented the disappearance of the lesion. Hystopathologic examination diagnosed a Leydig cell tumor, with negative surgical margins. The patient is in good clinical conditions and is under periodic ultrasonographic follow up. Conclusion: Organ sparing surgery represent a good therapeutic option for little intraparenchymal lesions, mostly in young patients in which is preferable to preserve fertility. Intraoperatory ultrasonography represent an important tool for the localization of the lesion.

Pseudoaneurysm Fistulated into the Right Atrium after Double Valve Replacement

2015 ◽  
Vol 18 (4) ◽  
pp. 143
Author(s):  
Hiromu Kehara ◽  
Tamaki Takano ◽  
Kazunori Komatsu ◽  
Takamitsu Terasaki ◽  
Kenji Okada
Keyword(s):  
Computed Tomography ◽  
Cardiopulmonary Bypass ◽  
Valve Replacement ◽  
Right Atrium ◽  
Rare Case ◽  
Femoral Vein ◽  
Ascending Aorta ◽  
Double Valve Replacement ◽  
Left Femoral Artery ◽  
The Right

We discuss a rare case of an ascending aorta pseudoaneurysm fistulating into the right atrium following prior aortic and mitral valve replacement. Transthoracic echocardiography and computed tomography revealed a pseudoaneurysm of the ascending aorta attached to the right atrium with fistulous communication. The pseudoaneurysm arose from the center of the former aortotomy. Emergency remedian sternotomy was performed without aneurysmal injury and with exposure of the left femoral artery and femoral vein. Aneurysmal resection and ascending aorta repair were performed without complication. Exposing peripheral vessels, and initiating cardiopulmonary bypass only after reentry, might be effective in resternotomy to approach ascending aorta pseudoaneurysms.<br /><br />

scholarly journals Anomalous Right Coronary Artery Arising from the Pulmonary Artery with Associated Enlargement of the Left Coronary Artery: A Case Report

2021 ◽  
Vol 24 (2) ◽  
pp. E293-E295
Author(s):  
Yueqiu Su ◽  
Zhongze Cao ◽  
Yunfei Ling ◽  
Yong jun Qian
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Coronary Artery ◽  
Left Coronary Artery ◽  
Female Child ◽  
Ascending Aorta ◽  
Coronary Anomalies ◽  
The Right ◽  
Congenital Coronary Anomalies

An anomalous right coronary artery arising from the pulmonary artery (ARCAPA) is among the least common form of congenital coronary anomalies, accounted for the incidence of only 0.002% in the general population. Most ARCAPA patients have no symptoms but may develop myocardial ischemia. Surgical correction of the anomaly is recommended to prevent subsequent fatal outcomes. Here, we reported a case of a 2-year-old female child initially hospitalized for diarrhea, but later diagnosed with an ARCAPA through echocardiogram and computed tomography. Surgical reimplantation of the right coronary artery from the pulmonary artery to the ascending aorta was performed. The patient recovered well from the surgery with no postoperative complications. In the follow-up assessments, normal coronary function and myocardial effusion were demonstrated.

Optimal sizing of iliac vein stents

2017 ◽  
Vol 33 (7) ◽  
pp. 451-457 ◽  
Author(s):  
Seshadri Raju ◽  
William J Buck ◽  
William Crim ◽  
Arjun Jayaraj
Keyword(s):  
Therapeutic Option ◽  
Femoral Vein ◽  
Iliac Vein ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Initial Procedure ◽  
The Common ◽  
The Right ◽  
Vein Stenosis ◽  
Scaling Rule

Background Iliac vein stenting has emerged as a therapeutic option in chronic venous disease. The optimal stent size is unknown but should match normal caliber at a minimum. Methods Teleology: The iliac-femoral outflow caliber was measured by Duplex in healthy volunteers to determine normal caliber. Patient IVUS data: The distribution curve of IVUS planimetry data in 345 chronic venous disease limbs was analyzed: values at the right tail end of the curve should approach normal values according to distribution theory. The optimal stent size was also projected using Poiseuille equation and Young’s scaling rule. Results The optimal stent sizes in the common iliac, external iliac, and common femoral vein segments are: 16, 14, and 12 mm diameters, respectively. Conclusion Stent correction of iliac vein stenosis should aim to restore the lumen to the minimum recommended caliber during the initial procedure and later re-interventions.

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