Applying Runthrough Guidewire To Transseptal Puncture Without Iodinated Contrast Agent

Aims: Conventional transseptal puncture(TSP) relies on fluoroscopy and iodinated contrast agent to distinctly position the transseptal needle at the left atrium, however, there exists great challenges in clinic in patients with contrast hypersensitivity or allergy-like reactionsin the procedure. This study aimed to evaluate a novel approach to TSP assisted by Runthrough guidewire and fluoroscopy without use of iodinated contrast agent. Methods: Sixty patients with paroxysmal atrial fibrillation undergone radiofrequency catheter ablation were enrolled from February 2021 to October 2021, and randomised to routine TSP group and Runthrough guidewire assisted group. The two groups were compared regarding the total operative time, length of fluoroscopy exposure, difference of radiation dose in X-ray, and the safety was evaluated in the patients undergone TSP without iodinated contrast agent. Results: There were no differences in baseline demographics or clinical characteristics between the two groups. Although the total procedure time[(1.98±0.29) min vs.(2.11±0.14) min, P<0.04],length of fluoroscopic exposure [(1.83±0.30) vs.(1.98±0.14), P<0.19] and radiation dose in X-ray[(27.83±3.21) uGym2vs.(29.13±1.57) uGym2, P<0.30] were somewhat statistically different between groups, yet the difference was insignificant. No complications, including pericardial tamponade and aortic perforation, occurred in all patients. Conclusion: Iodine-free TSP under the guidance of Runthrough guidewire and fluoroscopy can be a simple, safe, economical and effective approach to TSP, and may be reproduced as a novel option for TSP in patients with contrast hypersensitivity or allergy-like reactions.

Non hemorrhagic pericardial effusion from ibrutinib İn a patient without comorbidities

Introduction The most common kind of leukemia in adults is chronic lymphocytic leukemia (CLL). CLL is treated with ibrutinib. During the course of ibrutinib therapy, bleeding and cardiac arrhythmias may occur. Non-hemorrhagic adverse events are extremely infrequent in individuals using ibrutinib. Case report A 64 year-old man was diagnosed with CLL in June 2016. He was treated with 6 courses of FCR, he stayed in remission for 3 years and then relapsed. He achieved partial remission after two months of therapy with ibrutinib. The patient was admitted to the hospital with fever and shortness of breath. Pericardial tamponade and effusion was diagnosed during his evaluation. Management & outcome Non-hemorrhagic exudative effusion was drained by pericardiocentesis and a pericardial catheter was inserted to drain pericardial effusion. In all pleural and pericardial effusion samples, pathological and flow cytometric examination revealed no atypical malignant cells for malignancy, including CLL. Infections, both bacterial and viral, were also undetectable in the samples, as were rheumatological markers of collagen vascular disease. Ibrutinib therapy was discontinued. The pericardial effusion and tamponade were linked to ibrutinib treatment after evaluating the adverse drug reaction probability scale with a total score of 6. Colchicine was administered to reduce the pericardial effusion. The catheter was removed; pericardial effusion did not reoccur during follow up visits. Discussion Serious adverse events of ibrutinib are seen when treating CLL patients. This group of individuals should be closely monitored for potentially serious complications such as pericardial effusion and cardiac tamponade.

Pericardial Tamponade and Elevated Serum CA-125 Level in Inadequately Treated Hypothyroidism

Cardiac tamponade is a medical emergency and must be managed promptly, and reaching a diagnosis is imperative to prevent recurrence. Herein, we present a case of a young female patient that presented with progressive shortness of breath and abdominal distension and was found to have cardiac tamponade with the finding of elevation of a blood tumor marker, CA-125, in the setting of nonadherence to thyroid replacement therapy. She was managed by surgical pericardial window and abdominal paracentesis, with replacement of thyroid hormones leading to resolution of the tamponade and ascites. CA-125 elevation associated with cardiac tamponade and myxedema ascites due to hypothyroidism is very rare, and we aim to shed light on the importance of having a broad differential when approaching cardiac tamponade and understand the association between CA-125 and hypothyroidism.

Multiple coronary artery perforation following global pericardial tamponade in a patient with prior coronary artery bypass graft surgery: a case report

Background Patients who undergo coronary artery bypass graft surgery rarely develop global pericardial tamponade due to pericardial adhesions. There are no reports of multiple coronary artery perforations following global pericardial tamponade during percutaneous coronary intervention in these patients. Case Summary A 52-year-old male who underwent coronary artery bypass graft surgery developed effort angina pectoris. Coronary angiography demonstrated chronic total occlusion of the first diagonal branch with severe stenosis of the second diagonal branch. Because his chest pain did not improve with medical therapy and ischemia of the left ventricular anterolateral wall was confirmed by myocardial scintigraphy, percutaneous coronary intervention was performed. The second diagonal branch stenosis was passed anterogradely by a 0.014-inch coronary angioplasty guidewire, while the first diagonal branch chronic total occlusion was recanalized by side-branch intravascular ultrasonography-guided parallel wiring. After stent deployment, coronary artery perforation at the distal end of the second diagonal branch was detected via contrast injection. We immediately performed intravascular hemostasis, leading to the disappearance of contrast. However, multiple bleeding sites were visualized by angiography at different sites of coronary arteries, including the circumflex artery. Although intravascular hemostasis is a standard procedure, we could not control rebleeding. Despite intensive care, the patient died. Discussion Increased tissue pressure due to bleeding possibly led to global pericardial tamponade with multiple coronary artery perforations. We report a rare case of a patient with multiple coronary artery perforations during coronary intervention.

Incarcerated intrapericardial diaphragmatic hernia after laparoscopic pericardial window for malignant pericardial effusion

Laparoscopic Pericardial Window (LPW) is a safe, minimally invasive surgical technique for treating pericardial effusion/tamponade. This technique allows adequate decompression and avoids single-lung ventilation and the need for thoracic drainage in severely ill patients; it also provides anatomopathological and microbiological diagnosis leading to treatment measures. An intrapericardial diaphragmatic hernia is among the rarest complications of this procedure. A 85-year-old man, who underwent LPW for pericardial tamponade, presented to the emergency department 12 days post-operative with bowel obstruction; CT scan showed an incarcerated hernia into the pericardial sac. Laparoscopic reduction and hernia repair were performed using a large-pore Mesh to allow further drainage of histologically proven malignant pericardial effusion. Keywords: pericardial tamponade; pericardial window; surgical drainage of pericardial effusion; intra-pericardial diaphragmatic hernia.