scholarly journals Intra-cardiac cement embolism during hip arthroplasty

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Alexander Amir ◽  
◽  
David Bracco ◽  
Gabriele Baldini ◽  
André Denault ◽  
...  
Keyword(s):  
Treatment Options ◽  
Coronary Bypass ◽  
Aortic Valve Area ◽  
Hemodynamic Compromise ◽  
Neck Fracture ◽  
Cement Embolism ◽  
History Of ◽  
Artery Disease ◽  
The Right ◽  
Hemi Arthroplasty

A 92-year-old woman presented to the operating room with a right femoral neck fracture. She had a past medical history significant for atrial fibrillation, coronary artery disease with a history of coronary bypass, severely stenotic aortic valve (area 0.9 cm2), diabetes, dyslipidemia, hypertension and dementia. She underwent general anesthesia with continuous Transesophageal Echocardiographic (TEE) monitoring for a right hemi-arthroplasty. While cementing the prosthesis, small cement emboli were initially seen (ME ascending aorta SAX view) migrating in the pulmonary artery (Figure A*). Subsequently, a large (4 cm) cement embolus was visualized in the right atrium, adhered to the Eustachian valve, an embryonic remnant (Figure B*, supplementary video A). The patient experienced no significant hemodynamic compromise or issue with gas exchange. Given embolization risk and severe potential for harm, intervention may be indicated. Treatment options were discussed but given hemodynamic stability, patient age and comorbidities, the patient was monitored without further intervention.

Off-Pump Supraarterial Decompression Myotomy for Myocardial Bridging

2005 ◽  
Vol 8 (1) ◽  
pp. 49 ◽  
Author(s):  
Mersa M. Baryalei ◽  
Theodorus Tirilomis ◽  
Wolfgang Buhre ◽  
Stephan Kazmaier ◽  
Friedrich A. Schoendube ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Exercise Testing ◽  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Median Sternotomy ◽  
Myocardial Bridging ◽  
Off Pump ◽  
Hemodynamic Compromise ◽  
Artery Disease ◽  
The Right

Background: Myocardial bridging of the left anterior descending (LAD) artery may result in clinical symptoms. Surgery with cardiopulmonary bypass (CPB) is a therapeutic option with considerable risk. We hypothesized that off-pump supraarterial myotomy could be an effective treatment modality. Methods: Between October 1998 and May 2000, 13 patients were referred for surgery. All were symptomatic despite medical therapy. Anteroseptal ischemia had been proven by thallium scintigraphy in all 13 patients, exercise testing was positive in 11. All patients were operated on with an off-pump approach after median sternotomy. Results: Mean patient age was 61 8 years (range, 43-71 years). Coronary artery disease mandating additional bypasses was present in 3 patients. The bypasses were done off pump in 2 patients. Conversion to on-pump surgery was necessary in 3 of 13 patients (23%) because of hemodynamic compromise (1 patient), opening of the right ventricle (1 patient), and injury to the LAD (1 patient). Supraarterial myotomy was performed in all patients. One patient who underwent surgery with CPB developed postoperative anteroseptal myocardial infarction. Postoperative exercise testing was performed in all patients and did not reveal any persistent ischemia. Mortality was 0%. All patients were free from symptoms and had not undergone repeat interventions after an average of 51 7 months of follow-up. Conclusions: Off-pump supraarterial myotomy effectively relieves coronary obstruction but has a certain periprocedural risk as evidenced by 1 myocardial infarction, 1 right ventricular injury, and 1 LAD injury. Long-term freedom from symptoms and from reintervention favor further investigation of this surgical therapy.

Giant right coronary artery aneurysm

2020 ◽  
Vol 28 ◽  
pp. 1-3
Author(s):  
Alexandre Bonfim ◽  
Ronald Souza ◽  
Sérgio Beraldo ◽  
Frederico Nunes ◽  
Daniel Beraldo
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Clinical Course ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Coronary Artery Aneurysms ◽  
History Of ◽  
Artery Disease ◽  
The Right

Right coronary artery aneurysms are rare and may result from severe coronary disease, with few cases described in the literature. Mortality is high, and therapy is still controversial. We report the case of a 72-year-old woman with arterial hypertension, and a family history of coronary artery disease, who evolved for 2 months with episodes of palpitations and dyspnea on moderate exertion. During the evaluation, a giant aneurysm was found in the proximal third of the right coronary artery. The patient underwent surgical treatment with grafting of the radial artery to the right coronary artery and ligation of the aneurysmal sac, with good clinical course.

scholarly journals Rumpel-Leede Phenomenon: A Case Report

1970 ◽  
Vol 9 (4) ◽  
Author(s):  
Rehman HU, MBBS, FRCPC ◽  
Kambo J, MD
Keyword(s):  
Complete Blood Count ◽  
Vital Signs ◽  
Liver Function Tests ◽  
Left Hand ◽  
Lower Base ◽  
Associated Symptoms ◽  
Chest Auscultation ◽  
History Of ◽  
Artery Disease ◽  
The Right

A 72-year-old woman presented with a one-week history of fever, non-productive cough, and three unwitnessed syncopal episodes, with no other associated symptoms. She had poor recollection of the episodes, but denied urinary/fecal incontinence, tongue biting, numbness, parasthesias, or weakness. Her medical history was significant for hypertension, dyslipidemia, leg ulcers, psoriasis, stress incontinence, and gastroesophageal reflux disease. She did not have diabetes, coronary artery disease, or peripheral vascular disease. Her medications included Atorvastatin, Enalapril, Hydrochlorothiazide, Lansoprazole, and Calcium. She did not smoke or drink. On examination, her vital signs were stable and she was afebrile. Chest auscultation revealed crackles in the right lower base. She developed an erythematous, lacy sharply demarcated rash on her left hand that lasted for 3–4 hours after her blood pressure was taken on the same arm (Figures 1 and 2). Blood tests were unremarkable and included glucose, complete blood count, electrolytes, urea, creatinine, liver function tests, and coagulation studies.

Successful endovascular extraction of newer generation Angio-Seal collagen plug and anchor after acute embolization

Vascular ◽  
2013 ◽  
Vol 22 (3) ◽  
pp. 214-217 ◽  
Author(s):  
Nidal Abi Rafeh ◽  
Faisal B Saiful ◽  
Georges Khoueiry ◽  
Mohammad Zgheib ◽  
Salman Arain
Keyword(s):  
Coronary Bypass ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Closure Device ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Vascular Laboratory ◽  
History Of ◽  
Drug Eluting ◽  
The Right

A 75-year-old woman with past medical history of coronary bypass, atrial fibrillation, mitral valve repair undergoes percutaneous coronary intervention of left circumflex artery with a drug eluting stent. An Angio-Seal vascular closure device was used post procedure to obtain hemostasis. Shortly after deployment, frank bleeding was observed necessitating manual compression at the arteriotomy site. After hemostasis was achieved, the right lower extremity was found to be pale, bluish with feeble pulses. Doppler ultrasound was emergently performed revealing decreased blood flow after mid superficial femoral artery (SFA) and an echo lucent object lodged luminally in the SFA. Patient was urgently taken to the vascular laboratory where an Angio-Seal device, including the collagen plug and anchor, was successfully removed endovascularly patient made full recovery and was discharged home the following day.

scholarly journals A Rare Cause of Supraventricular Ectopic Beats and Angina in a Young Patient

2018 ◽  
Vol 4 (2) ◽  
pp. 106-109
Author(s):  
Monica Jurcău ◽  
Mariana Floria ◽  
Bogdan Mazilu ◽  
Anca Ouatu ◽  
Daniela Maria Tanase
Keyword(s):  
Coronary Artery ◽  
Stress Test ◽  
Young Patients ◽  
Physical Exertion ◽  
Diagnostic Techniques ◽  
History Of ◽  
Ectopic Beats ◽  
Artery Disease ◽  
One Year ◽  
The Right

Abstract Introduction: We present the case of a young man with multiple atherosclerotic risk factors and a rare cause of angina and supraventricular ectopic beats. Case presentation: A 35-year-old man with one-year history of stable angina pectoris and supraventricular ectopic beats, without any medication, presented to the emergency room complaining of anterior chest pain that occurs at moderate physical exertion. The rest electrocardiogram, transthoracic echocardiography, and chest X-ray were normal; the exertion stress test was also normal, except for supraventricular ectopic beats (trigeminal rhythm). Due to the intermediate pre-test probability of coronary artery disease, he was evaluated using coronary computed tomography angiography. An anomalous origin of the right coronary artery from the left coronary sinus, with an inter-arterial course and without any atheroma plaques, was observed. During hospitalization the evolution was stable, without complications. The patient was further referred to a cardiac surgery clinic to evaluate the possibility of surgical treatment of this anomaly. Conclusions: Coronary artery anomalies are very rare; however, they present multiple implications in current practice. The most severe complication of this condition is represented by sudden death in young patients due to malignant ventricular arrhythmias. Imaging diagnostic techniques allow for a rapid, noninvasive diagnosis of this rare cause of angina.

scholarly journals P1496 Congenital anomalous origin of the left coronary system

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Ahmad ◽  
I Ahmed ◽  
R Jibran ◽  
C Raimondo
Keyword(s):  
Coronary Angiography ◽  
Systolic Function ◽  
Coronary Vessels ◽  
Coronary Bypass ◽  
Anomalous Origin ◽  
History Of ◽  
Coronary Cusp ◽  
Normal Ecgs ◽  
The Right ◽  
Right Coronary Cusp

Abstract A 62 year old gentleman presented with a history of recurrent central chest pains radiating to the left arm and jaw lasting up to 15-20 minutes and relieved with GTN. He had numerous admissions to hospital over a period of three years with negative Troponins and normal ECGs. There were several cardiovascular risk factors including obesity, diabetes, hypertension and dyslipidaemia. He also had a family history of ischaemic heart disease, with his mother and brother having heart attacks in their 60s. He was referred for outpatient investigations on multiple occasions but did not attend. This lead to a delay in a formal diagnosis until we eventually convinced him to undergo invasive diagnostic coronary angiography in June 2018. Prior to this, an Echocardiogram was done and showed reasonably preserved cardiac systolic function. Coronary angiography demonstrated unique anatomical distribution of the three main coronary vessels, with an anomalous origin of the left main system (LMS) and left sided arteries arising from the right coronary cusp. The right coronary artery stemmed from its natural position and was the dominant vessel. Hence, all the coronary arteries arose from the same cusp. The LMS was anomalous and hypoplastic; an exceedingly rare occurrence of less than 0.03%. These unusual findings were then confirmed on CT Coronary Angiogram. Although a surgical opinion was sought, the decision was a non-operative approach in view of no significant obstructive lesions and given the technical difficulties of undertaking coronary bypass. Viability imaging and ischaemia testing were then pursued with nuclear modalities. Ultimately, it was proven that the lesions did not show any significant reversible ischaemia and so a continued aggressive secondary prevention strategy was adopted. The patient is stable and doing well on optimal medical therapy. Abstract P1496 Figure. LMS Arising From Right Coronary Cusp

Abstract 12750: Atrial Tissue MicroRNAs 411-5p, 21-5p, 409-3p and 320a Are Associated With Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Menhel Kinno ◽  
Nada Esa ◽  
Raghava S Velagaleti ◽  
Amir Y Shaikh ◽  
Honghuang Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Remodeling ◽  
Tissue Samples ◽  
Elective Cardiac Surgery ◽  
Atrial Tissue ◽  
Prior Literature ◽  
History Of ◽  
Artery Disease ◽  
The Right ◽  
Age And Sex

Introduction: Atrial Fibrillation (AF) is the most common arrhythmia in clinical practice. MicroRNAs (miRs) are small RNAs that play a role in regulating cardiac remodeling and have been implicated in cardiac arrhythmogenesis. However, few studies have examined the association of atrial miR expression to AF. Hypothesis: Changes in miR expression (estimated as fold-difference in the delta cycle threshold compared to global mean) in human atria can be associated with AF. Methods: Thirty-one consecutive patients undergoing elective cardiac surgery were divided into 2 groups: those with history of AF (n=19) and those with no history of AF who stayed in sinus rhythm post-operatively (n=12). Atrial tissue samples were obtained from the right atrium in all but one (left atrium). Based on pilot data and prior literature, the expression of 82 miRs was assessed using high-throughput quantitative reverse-transcriptase polymerase chain reaction. We used logistic regression adjusting for age and sex to detect the associations between levels of atrial miRs and AF. Results: The mean age of the sample was 65 years (±13) and 71% were men. A history of coronary artery disease and heart failure was present in 42% and 36%, respectively. Among AF subjects, the age- and sex- adjusted odds ratios for the expression of miRs 411-5p, 21-5p, 409-3p and 320a were 0.08 (p= 0.02), 0.20 (p=0.02), 0.13 (p= 0.04) and 0.04 (p=0.048), respectively, compared to no AF. The fold-difference in atrial expression of miRs 411-5p, 21-5p, 409-3p and 320a were -0.567, -0.588, -0.375 and -0.427, respectively, in those with AF compared to no AF. Conclusion: In our study, the atrial expression of miRs 411, 21, 409 and 320 was lower in AF patients compared to those with no AF. Notably, these miRs regulate genes involved in atrial fibrosis, apoptosis, and ion channel function. Our findings further implicate miRs as important mediators of pathological atrial remodeling and suggest their usefulness as biomarkers in detecting AF.

scholarly journals Focal superior quadrant haemorrhages in post COVID-19 patient: A target for personalized medicine

2021 ◽  
pp. 112067212110212
Author(s):  
Maria Cristina Savastano ◽  
Carola Culiersi ◽  
Alfonso Savastano ◽  
Gloria Gambini ◽  
Tomaso Caporossi ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Medical Work ◽  
Anomalous Increase ◽  
Retinal Bleeding ◽  
History Of ◽  
Artery Disease ◽  
The Right ◽  
Work Up ◽  
D Dimer ◽  
Care Support

Purpose: To report a case of multiple superior quadrant intraretinal haemorrhages in post-COVID-19 patient. Case description: A 58-year-old male with a history of coronary artery disease and hypertension, presented with multiple superior quadrant intraretinal haemorrhages in the superonasal quadrant of the left eye 1 month after hospitalization for COVID-19. The right eye was normal. During his 10-day stay, he was treated with hydroxychloroquine, lopinavir + ritonavir, ceftriaxone, and his pre-existing antiplatelet therapy. During hospitalization, a complete medical work up showed an anomalous increase in D-dimer. He did not require intensive care support. Conclusions: In this report, we focused on the origin of retinal bleeding in a post COVID-19 patient, likely due to a focal occlusion of a vessel. Considering the nature of SARS-CoV-2 infection, we hypothesize that retinal haemorrhages were caused by a combination of factors including the patient’s antiplatelet therapy and the thrombotic microvascular injury caused by the virus.

scholarly journals Right-Sided Pyriform Sinus Fistula: A Case Report and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Rachel B. Cain ◽  
Peter Kasznica ◽  
William J. Brundage
Keyword(s):  
Case Report ◽  
Fistulous Tract ◽  
Treatment Options ◽  
Surgical Excision ◽  
Pyriform Sinus ◽  
Neck Abscess ◽  
Pyriform Sinus Fistula ◽  
History Of ◽  
Branchial Cleft ◽  
The Right

Objectives. Pyriform sinus fistulae arise from disturbances in the development of the fetal third and fourth branchial pouches and are predominantly found on the left side. We report the rare case of a right-sided pyriform sinus fistula presenting as a lateral neck abscess.Study Design. Case report.Methods. A 24-year-old woman presented with a two-week history of right-sided neck abscess. A fluoroscopic sinogram revealed a fistulous tract extending from the abscess to the apex of the right pyriform sinus. It was determined that the fistula was likely a third or fourth branchial remnant, a rare right-sided finding. Chemocauterization of the fistulous tract with 40% trichloroacetic acid was used to successfully treat the patient.Results. Approximately 93–97% of branchial pouch anomalies are left sided. Treatment options include surgical excision and cauterization.Conclusions. Branchial cleft cyst and pyriform sinus fistula must be considered in the diagnosis of cervical abscess in either side of the neck.

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