Fatal disseminated paradoxical embolism in inferior sinus venosus atrial septal defect

2021 ◽  
Vol 3 (4) ◽  
pp. 1-6
Author(s):  
Zul Khairul Azwadi Ismail ◽  
Khairil Amir Sayuti ◽  
Mohd Shafie Abdullah
Keyword(s):  
Septal Defect ◽  
Incidental Finding ◽  
Transoesophageal Echocardiography ◽  
Systemic Circulation ◽  
Paradoxical Embolism ◽  
Sinus Venosus ◽  
Cardiac Anomaly ◽  
Limb Ischaemia ◽  
Congenital Cardiac Anomaly ◽  
Acute Limb Ischaemia

Inferior sinus venosus arterial septal defect (ASD) is a rare congenital cardiac anomaly. As with other types of ASDs and patent foramen ovale (PFO), this defect results in arteri-venous shunting with the risk of developing paradoxical embolism (PDE) to the systemic circulation from venous emboli. We report  a case of a 67-year-old lady presented to emergency department (ED) with massive pulmonary embolism (PE) and recurrent acute limb ischaemia. On CT pulmonary angiography (CTPA), an incidental finding of inferior sinus venosus ASD was discovered that has caused the PDE. Thrombolysis was administered followed by open mechanical thrombectomy. The patient developed massive lower gastrointestinal bleed post thrombolysis then passed away despite embolization. This case report describes the catastrophic effect of  PDE to cause disseminated multisystem thromboembolism. It also emphasizes the importance of early detection of a possible right-to-left shunt in patients presented with recurrent acute limb ischaemia. Transthoracic echocardiography has reduced sensitivity for inferior sinus venosus ASD requiring further assessment with transoesophageal echocardiography in selected cases.

Limb ischaemia and below-knee amputation following life-saving patent ductus arteriosus stent in a critically ill infant

2014 ◽  
Vol 25 (6) ◽  
pp. 1206-1209
Author(s):  
Apinya Bharmanee ◽  
Srinath Gowda ◽  
Harinder R. Singh
Keyword(s):  
Ventricular Septal Defect ◽  
Patent Ductus Arteriosus ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Limb Ischaemia ◽  
Knee Amputation ◽  
Pulmonary Flow ◽  
Life Saving ◽  
Acute Limb Ischaemia ◽  
Patent Ductus

AbstractLimb ischaemia is a rare but catastrophic complication related to cardiac catheterisation. We report an infant weighing 3 kg with unrepaired tricuspid atresia type 1b, small patent ductus arteriosus, and ventricular septal defect presenting with cardiogenic shock owing to progressively reduced pulmonary blood flow from closing ventricular septal defect and patent ductus arteriosus. An emergency palliative ductal stent was successfully placed with marked clinical improvement. However, acute limb ischaemia developed necessitating above-knee amputation, despite medical management and vascular surgery. The cause of limb loss in our patient was catheterisation-related vascular injury causing arterial dissection–arterial thrombosis in the presence of shock and coagulopathy. This report emphasises the complexity in managing limb ischaemia associated with coagulopathy and highlights the importance of early recognition of reduced pulmonary flow in a single ventricle patient. Timely elective placement of a surgical systemic to pulmonary shunt would prevent catastrophic clinical presentation of compromised pulmonary flow and avoid the need for an emergent life-saving intervention and its associated complications.

scholarly journals Therapeutic Dilemma of Natural Watchman: Congenital Absence of the Left Atrial Appendage

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Phoo Pwint Nandar ◽  
Asim Kichloo ◽  
Thein Tun Aung ◽  
Kevin D. Kravitz
Keyword(s):  
Left Atrial ◽  
Rare Case ◽  
Left Atrial Appendage ◽  
Incidental Finding ◽  
Scientific Data ◽  
Atrial Appendage ◽  
Congenital Absence ◽  
Cardiac Anomaly ◽  
Congenital Cardiac Anomaly

Congenital absence of the left atrial appendage is a rare congenital cardiac anomaly which is usually an incidental finding. We present a rare case of congenital absence of the left atrial appendage in a 77-year-old female patient with atrial fibrillation, and we will discuss the role of anticoagulation in the patient with congenital absence of the left atrial appendage based on the scientific data and theoretic background.

scholarly journals Unexpected Echocardiographic Findings: Accessory Mitral Valve Tissue in Adults

2020 ◽  
Author(s):  
Ying Rao ◽  
Wei Chen ◽  
Yu Wang ◽  
wenjuan Song
Keyword(s):  
Mitral Valve ◽  
Heart Diseases ◽  
Incidental Finding ◽  
Surgical Excision ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Cardiac Anomaly ◽  
Congenital Cardiac Anomaly ◽  
Valve Tissue ◽  
Accessory Mitral Valve Tissue

Abstract Background: Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly, which is associated with other congenital heart diseases. It is diagnosed in neonates or childhood and rarely in adulthood. Nevertheless, AMVT is an incidental finding or described as isolated. Echocardiography, especially three-dimensional(3D) echocardiography is considered as an optimal imaging technique for AMVT diagnosis.Case presentation: We herein presented the two asymptomatic adult cases with AMVT, who presented with varying degrees of symptomatic left ventricular outflow tract (LVOT) obstruction. One presented with mild LVOT obstruction and no surgery was required, and another one with significant LVOT obstruction was recommended for surgical excision.Conclusions: We emphasized the usefulness of echocardiography in the morphology detection of AMVT, and the importance of operation guidance and follow-up.

Biatrial drainage of right superior caval vein with preferential streaming into the left atrium

2019 ◽  
Vol 29 (7) ◽  
pp. 996-998
Author(s):  
Omar Abu-Anza ◽  
Ravi Ashwath
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrium ◽  
Septal Defect ◽  
Venous Return ◽  
Sinus Venosus ◽  
Cardiac Anomaly ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Anomalous Pulmonary Venous Return ◽  
The Right

AbstractBiatrial drainage of the right superior caval vein is an extremely rare cardiac anomaly that generally presents in childhood. We present a case of anomalous connection of the right superior caval vein with superior sinus venosus atrial septal defect and partial anomalous pulmonary venous return in a 5-month-old male presenting with unexplained cyanosis and hypoxia.

Totally Endoscopic Robotic Correction of Cor Triatriatum Sinister Coexisting with Atrial Septal Defect

2016 ◽  
Vol 11 (6) ◽  
pp. 451-452 ◽  
Author(s):  
Changqing Gao ◽  
Ming Yang ◽  
Cangsong Xiao ◽  
Huajun Zhang ◽  
Gang Wang
Keyword(s):  
Surgical Technique ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Cor Triatriatum ◽  
Cardiac Anomaly ◽  
Safe Alternative ◽  
Congenital Cardiac Anomaly ◽  
Cor Triatriatum Sinister ◽  
Da Vinci Si ◽  
Surgical System

Cor triatriatum sinister (CTS) is a rare congenital cardiac anomaly and is mainly corrected through conventional surgery through sternotomy. We described our successful novel surgical technique of totally robotic correction of CTS in one case of CTS with concomitant repair of atrial septal defect using da Vinci SI Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA USA) with excellent surgical outcome. We conclude that robotic correction of CTS is a feasible and safe alternative to conventional surgical technique.

scholarly journals A case report of an elderly male with isolated coronary sinus atrial septal defect

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Junko Okamoto ◽  
Shinji Fukuhara ◽  
Hideki Ozawa ◽  
Takahiro Katsumata
Keyword(s):  
Elderly Patients ◽  
Atrial Septal Defect ◽  
Coronary Sinus ◽  
Septal Defect ◽  
Superior Vena ◽  
Vena Cava ◽  
Cardiac Anomaly ◽  
Elderly Male ◽  
Direct Closure ◽  
Congenital Cardiac Anomaly

Abstract Background Isolated coronary sinus atrial septal defect (CSASD) is a rare congenital cardiac anomaly, comprising <1% of atrial septal defects. Elderly patients with this anomaly are even more uncommon and sometimes overlooked. Case summary A 73-year-old man with a history of electrical defibrillation therapy for atrial flutter presented with worsening exertional dyspnoea. Cardiac examination revealed CSASD without persistent left superior vena cava, showing only moderate tricuspid regurgitation. Surgical repair of the defect and regurgitant valve improved symptoms dramatically. Discussion Elderly patients with atrial arrhythmias might show uncommon presentations of congenital heart disease. Cardiologists should pay attention to enlarged right ventricle, pulmonary artery, and, in particular, enlarged coronary sinus. Direct closure with interrupted sutures secured with pledgets is effective in some case of terminal type of CSASD.

scholarly journals The value of three-dimensional echocardiography in the diagnosis and management of ruptured sinus of Valsalva aneurysm: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Elias Daud ◽  
Tsafrir Or ◽  
Zvi Adler ◽  
Alexander Shturman
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Epigastric Pain ◽  
Good Condition ◽  
Three Dimensional ◽  
Transoesophageal Echocardiography ◽  
Cardiac Anomaly ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm

Abstract Background  A sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly. Most SVA’s rupture into right heart chambers and can be classified using the modified Sakakibara classification according to the site of rupture. Transoesophageal echocardiography (TOE) is a useful diagnostic tool and aides in treatment planning in patients with congenital anomalies in emergency situations. Three-dimensional TOE (3D-TOE) provides additional value over standard TOE. Case summary A 38-year-old man with a reported history of ventricular septal defect (VSD) presented to the emergency department complaining of chest pain and epigastric pain lasting several days. Physical examination revealed a continuous heart murmur and signs of acute heart failure. A 3D-TOE revealed an SVA rupture into the right ventricle (Type IIIv) but no evidence of a VSD. Urgent aortic valve replacement with correction of the ruptured SVA was performed. Neither a VSD nor signs of endocarditis were found during surgical exploration. The patient was discharged on post-operative Day 5 in good condition. Discussion A sinus of Valsalva aneurysm is a rare cardiac condition. Ventricular septal defect, bicuspid aortic valve, or aortic valve regurgitation may coexist with SVA. Xin-Jin et al. classified a ruptured SVA into five types according to the site of rupture. Transoesophageal echocardiography is an important tool for diagnosis, anatomical description, and typing of the ruptured SVA. Sinus of Valsalva aneurysm may be misdiagnosed as a VSD, as was the case in our patient, and 3D-TOE can be instrumental for providing both correct diagnosis and critical surgical planning.

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