scholarly journals Right Ventricular Perforation by a Defibrillator Lead Migrating to the Left Breast

2018 ◽  
Vol 21 (2) ◽  
pp. 087
Author(s):  
Jerneja Tasic ◽  
Rok Zbacnik ◽  
Igor Zupan ◽  
Jus Ksela
Keyword(s):  
Right Ventricular ◽  
Clinical Course ◽  
Rare Complication ◽  
Clinical Signs ◽  
Left Breast ◽  
Thoracic Wall ◽  
Icd Implantation ◽  
Cardiac Wall ◽  
Defibrillator Lead ◽  
Acute Perforation

Cardiac perforation after an ICD implantation is a rare complication, with a reported incidence between 0.6-5.2%. Its manifestation might be acute, subacute, or delayed, with an acute perforation occurring within the first 24 hours after implantation, frequently accompanied by severe clinical signs, while subacute and delayed perforations have a more benign progression. Here, we report a case of a 69-year old patient with an acute right ventricular perforation by a defibrillator lead migrating all the way through the pericardium and thoracic wall into the left breast, with an unusually mild and benign clinical course, delaying prompt diagnosis and postponing subsequent surgical treatment. Heart perforation with a defibrillator electrode is a rare but dangerous complication, which may lead to pacing failure, cardiac tamponade, cardiogenic shock, and even death. Even with a benign clinical course, one must think of cardiac wall perforation at any time after device implantation, and a contrast enhanced computer tomography (CTA) must be performed if perforation is suspected. At re-implantation, the lead should be located at a different anatomical position within the RV, preferably at the interventricular septal site, and manipulation of the injury site within the RV avoided.

scholarly journals Poorly Differentiated Breast Adenocarcinoma as a Rare Cause of Right Ventricular Outflow Tract Compression: Case Report and Review of the Literature

2020 ◽  
Vol 8 ◽  
pp. 232470962092323
Author(s):  
Ashleigh Long ◽  
Paul Marik
Keyword(s):  
Right Ventricular ◽  
Metastatic Cancer ◽  
Rare Complication ◽  
Right Ventricular Outflow Tract ◽  
Mass Effect ◽  
Ventricular Outflow Tract ◽  
Left Breast ◽  
Outflow Tract ◽  
Cardiac Conduction ◽  
Breast Adenocarcinoma

Metastatic cancer that involves the structures of the heart is a rare complication and most commonly diagnosed during postmortem examination. Classically, the development of secondary tumors involves invasion of the pericardium or the myocardium and may disrupt the cardiac conduction system, causing new arrhythmias and heart failure. In this article, we present the case of a 58-year-old female with new diagnosis of ventricular bigeminy, and evidence of cardiac tamponade physiology from direct compression of the right ventricular outflow tract from high-grade carcinoma of the left breast. As oncologic therapies advance and provide more life-prolonging options to patients, recognition of the mass effect of large tumors should be recognized.

scholarly journals Aorto-Right Ventricular Shunt after TAVR: Rare Complication of Common Procedure

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Abdelkader Almanfi ◽  
Ahmad Qurie ◽  
Neil Strickman
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Right Ventricular ◽  
Valve Replacement ◽  
Clinical Course ◽  
Case Reports ◽  
Rare Complication ◽  
Primary Treatment ◽  
Common Procedure ◽  
Exertional Dyspnea

Background. The primary treatment of symptomatic aortic stenosis is aortic valve replacement. Instead of open chest surgery, transcatheter aortic valve replacement (TAVR) is an alternative intervention for high-risk surgical candidates. Clinical Case. A 92-year-old male presented with progressive exertional dyspnea and recurrent syncopal attacks secondary to severe AS. The patient underwent successful transfemoral TAVR with 29 mm Edwards SAPIEN XT valve. His postoperative course was complicated by aorto-right ventricular shunt. The patient’s clinical course was followed up for one year. Conclusion. This case reports the incidence and clinical course of one of the rare complications of TAVR, aorto-right ventricular fistula. Conservative medical management is appropriate in hemodynamically stable patients with this specific complication.

scholarly journals Ibuprofen-Induced Aseptic Meningitis in a Male Adolescent with Intracranial Hypertension and Visual Impairment: A Case Report

2021 ◽  
Vol 13 (1) ◽  
pp. 233-238
Author(s):  
Seyed Mohammad Mousavi Mirzaei ◽  
Zahra Ahmadi
Keyword(s):  
Visual Impairment ◽  
Intracranial Hypertension ◽  
Aseptic Meningitis ◽  
Rare Complication ◽  
Clinical Signs ◽  
Male Adolescent ◽  
Drug Induced ◽  
Blurred Vision ◽  
Inflammatory Drugs

Drug-induced aseptic meningitis (DIAM) is a rare complication of certain drugs, most commonly reported with ibuprofen use. The present study reports on a male adolescent with intracranial hypertension and visual impairment accompanied by DIAM. We present a 16-year-old male patient who after ibuprofen consumption displayed headache, fever, photophobia, and blurred vision following heavy exercises. Examination of cerebrospinal fluid showed a mononuclear pleocytosis and an increase in protein concentration. Other examinations had normal results. The development of common clinical signs following ibuprofen use reflected DIAM. The patient’s vision was found to improve with supportive care and stopping of the drug during follow-up. Given the widespread use of nonsteroidal anti-inflammatory drugs and the fact that these drugs are the most common cause of DIAM, the probability of occurrence of this event should be always kept in mind, and screening for autoimmune diseases in these patients is of great importance.

scholarly journals Sustained ventricular tachycardia of left, right or both bundle branch block morphology in patients with Arrhythmogenic Cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Milman ◽  
M Laredo ◽  
R Roudijk ◽  
G Peretto ◽  
A Andorin ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Right Bundle Branch Block ◽  
Left Bundle Branch Block ◽  
Clinical Course ◽  
Left Ventricular ◽  
Funding Source ◽  
Arrhythmogenic Cardiomyopathy ◽  
Icd Implantation ◽  
Bundle Branch Block ◽  
Group 3

Abstract Aims In arrhythmogenic cardiomyopathy (ACM) sustained monomorphic ventricular tachycardia (VT) typically displays left bundle branch block (LBBB) morphology. Sustained VT with right bundle branch block (RBBB) morphology is very rare despite the frequent left ventricular involvement. The present study sought to assess the prevalence of spontaneous sustained LBBB-VT, RBBB-VT or both as well as clinical and genetic differences associated with these VT types. Methods and results Twenty-six centers from 11 European countries provided information on 952 patients with ACM and >1 episode of sustained VT observed during the patients' clinical course. VT was classified as: LBBB-VT; RBBB-VT or LBBB+RBBB-VT. Among 952 patients, 881 (92.5%) had LBBB-VT alone, 71 (7.5%) had RBBB-VT [alone in 42 (4.4%) patients or with LBBB-VT in 29 (3.0%) patients]. Male prevalence was 90.5%, 79.2% and 55.9% in the RBBB-VT, LBBB-VT and LBBB+RBBB-VT groups, respectively (P=0.001). Patients' age at first VT did not differ amongst the 3 VT groups. ICD implantation was more frequent for the RBBB-VT and the LBBB+RBBB groups (≈90% each) vs. 67.9% for the LBBB-VT group (P=0.001). Death incidence (9.5%–17.2%) was not significantly different between the 3 groups (P=0.425). Plakophylin-2 mutations predominated in the LBBB-VT and LBBB-VT+RBBB-VT groups (47.2% and 27.3%, respectively) and Desmoplakin mutations in the RBBB-VT group (36.7%). Conclusion This large European survey demonstrates: 1) Sustained RBBB-VT is documented in 7.5% patients with ACM; 2) Males markedly predominate in the RBBB-VT and LBBB-VT groups but not in the LBBB+RBBB VT group; 3) Distribution of desmosomal mutations appears to be different in the 3 VT groups. Funding Acknowledgement Type of funding source: None

scholarly journals Right inferior phrenic artery pseudoaneurysm after a laparoscopic gastrectomy: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Kaoruko Funakoshi ◽  
Yuji Ishibashi ◽  
Shuntaro Yoshimura ◽  
Ryoto Yamazaki ◽  
Fumihiko Hatao ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Laparoscopic Gastrectomy ◽  
Rare Complication ◽  
Clinical Signs ◽  
Node Dissection ◽  
Artery Pseudoaneurysm ◽  
Inferior Phrenic Artery ◽  
Thermal Spread ◽  
Phrenic Artery

Abstract Background Ruptured pseudoaneurysms are a rare complication of gastrectomy, but when they do develop, they are often fatal. We presented herein the first report of a case of pseudoaneurysm arising from the right inferior phrenic artery (RIPA) after a laparoscopic gastrectomy. Case presentation A 61-year-old male patient underwent a laparoscopic distal gastrectomy and D1+ lymph node dissection with Roux-en-Y reconstruction for early gastric cancer. He was discharged on postoperative day (POD) 9 without any complications, such as anastomotic or pancreatic leakage. On POD 19, he was referred to the emergency room for upper abdominal pain. Enhanced abdominal computed tomography revealed a 60 × 70 mm hematoma, indicating intra-abdominal bleeding and a 10-mm pseudoaneurysm in the RIPA. Selective digital subtraction angiography confirmed the presence of a pseudoaneurysm in the RIPA, which was embolized using multiple microcoils. Thereafter, no clinical signs were observed, and the patient was discharged from the hospital 15 days after angiography without any recurrence of bleeding. We hypothesized that the cause of the pseudoaneurysm was mechanical vascular injury due to the thermal spread of the ultrasonically activated devices (USADs) during lymphatic node dissection. Conclusion Given the thermal spread of USADs, safe and appropriate lymph node dissection based on precise anatomical knowledge is crucial to preventing postoperative pseudoaneurysms.

scholarly journals Repair of double-chambered right ventricle using right ventricular outflow chamber ventriculotomy via left intercostal thoracotomy under beating heart in two dogs

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Keiichi Sato ◽  
Isamu Kanemoto ◽  
Kippei Mihara ◽  
Koudai Kawase ◽  
Takuya Mori ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Continuous Wave ◽  
Clinical Signs ◽  
Major Complication ◽  
Beating Heart ◽  
Moderate Hypothermia ◽  
Continuous Wave Doppler ◽  
Novel Approach ◽  
The Right

Double-chambered right ventricle was diagnosed in two dogs, one of them a pup and the other full grown. Both dogs underwent surgery using the novel approach of right ventricular outflow chamber ventriculotomy via left intercostal thoracotomy with moderate hypothermia and moderate pump flow cardiopulmonary bypass under beating heart. No major complication occurred during and after the operation. On continuous wave Doppler echocardiography, the pressure gradient across the stenosis in the right ventricle decreased from 130 mmHg pre-operatively to 40 mmHg post-operatively at 1 year 5 months in the adult dog, and from 209 mmHg pre-operatively to 47 mmHg post-operatively at 1 year in the pup. Both dogs are active without clinical signs.

scholarly journals Ischemic myelopathy caused by fibrocartilaginous embolism in a horse

2018 ◽  
Vol 48 (2) ◽  
Author(s):  
Welden Panziera ◽  
Ronaldo Michel Bianchi ◽  
Paula Reis Pereira ◽  
Mariana Martins Flores ◽  
Monique Togni ◽  
...  
Keyword(s):  
Cross Sections ◽  
Clinical Course ◽  
Clinical Signs ◽  
Histological Findings ◽  
Hind Limbs ◽  
Fibrocartilaginous Embolism ◽  
Mixed Breed ◽  
Liquefactive Necrosis ◽  
Gross Lesions ◽  
Multiple Blood

ABSTRACT: This report described clinical, epidemiological, and pathological aspects of ischemic myelopathy caused by fibrocartilaginous embolism (FCE) in a 10-year-old, mixed breed gelding. Clinically, the horse presented acute hind limbs paralysis, with a clinical course of approximately 24 hours. At necropsy, no gross lesions were observed. Cross-sections of the spinal cord revealed focally extensive areas of malacia from the T10 to L4 segments. Focally extensive areas of liquefactive necrosis involving the gray matter and adjacent white matter were observed on histologic sections. The lumen of multiple blood vessels in the periphery of the necrotic areas was occluded by fibrocartilaginous emboli that strongly stained with alcian blue. Clinical signs, gross necropsy, and histological findings observed in this case were identical to those described in the literature for ischemic myelopathy caused by FCE in the horse and other species.

scholarly journals Successful Modified Therapy in a Patient with Probable Infection-Associated Hemophagocytic Lymphohistiocytosis

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Carl L. Kay ◽  
Matthew J. Rendo ◽  
Paul Gonzales ◽  
Sead G. Beganovic ◽  
Magdalena Czader
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Clinical Course ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Good Patient ◽  
Good Patient Outcome ◽  
Distributive Shock ◽  
Probable Infection ◽  
Clinical Signs And Symptoms ◽  
Baseline Renal Function

Hemophagocytic lymphohistiocytosis (HLH) is a rare, hyperinflammatory syndrome characterized by clinical signs and symptoms of extreme inflammation. In adults, HLH is typically a complication of infections, autoimmune diseases, and malignancies. While the disease is often fatal, classic management of HLH revolves around early diagnosis and initiation of protocolized therapy. We present a case of a previously healthy 56-year-old female who developed distributive shock requiring intubation, vasopressors, and continuous venovenous hemofiltration. In the setting of multiple infectious syndromes, severe cytopenias, and rising direct hyperbilirubinemia, her diagnosis of HLH was confirmed. Therapy was initiated with dexamethasone and two doses of reduced-intensity etoposide based on the patient’s clinical course. Over the next few weeks, she continued to improve on dexamethasone monotherapy and has maintained remission up to the present with complete resolution of her cytopenias and return of baseline renal function. Our case highlights the variability in the management of probable infection-associated HLH (IHLH) with a good patient outcome. We demonstrate the potential to treat IHLH with partial protocols and minimal chemotherapeutics.

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