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Tiwana J, Kearney KE, Lombardi WL, Azzalini L. Challenges in the diagnosis and management of dry tamponade. Catheter Cardiovasc Interv 2024. [PMID: 39354877 DOI: 10.1002/ccd.31241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 10/03/2024]
Abstract
Dry tamponade is a rare complication of percutaneous coronary intervention. It encompasses a heterogenous pathophysiology and is used to describe hemodynamic compromise secondary to a coronary artery perforation, without free-flowing fluid in the pericardium. Tamponade physiology can result from compressive epicardial, intramyocardial, subepicardial hematomas, or dissecting intramyocardial hematomas. The diagnosis of dry tamponade requires hemodynamic derangement in the context of a compressive hematoma as demonstrated by imaging. Although echocardiography can often help identify dry tamponade, additional studies including right heart catheterization, computed tomography, or cardiac magnetic resonance imaging can inform the exact mechanism and help guide management. This article describes a case of dry tamponade, reviews the existing literature on the topic, and offers expert recommendations on diagnosis and management.
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Affiliation(s)
- Jasleen Tiwana
- Alaska Heart and Vascular Institute, Anchorage, Alaska, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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2
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Masoomi R, Burke CR, Del Cid Fratti J, Azzalini L, Kearney KE, Lombardi W. Left atrial compression syndrome secondary to coronary artery perforation: Pathophysiology, diagnosis, and management strategies. Catheter Cardiovasc Interv 2024. [PMID: 39154249 DOI: 10.1002/ccd.31182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/22/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Abstract
Coronary perforation (CP) poses a significant risk of morbidity and mortality, particularly, in patients with a history of cardiac surgery. The occurrence of loculated pericardial effusion presents distinctive challenges in these postcardiac surgical patients. This study delves into the complexities arising from the formation of loculated pericardial effusions subsequent to CP, with a specific focus on the loculated effusion in the posterior wall leading to left atrial compression syndrome. This analysis is dedicated to elucidating pathophysiology diagnostic and treatment strategies tailored for addressing left atrium compression syndrome, providing invaluable insights into the intricacies of diagnosing, treating, and managing this entity in the postcardiac surgical patient.
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Affiliation(s)
- Reza Masoomi
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Christopher R Burke
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington, USA
| | | | - Lorenzo Azzalini
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kathleen E Kearney
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - William Lombardi
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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3
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Communicating Coronary and Ventricular Pseudoaneurysms Complicating Coronary Artery Perforation. JACC Case Rep 2022; 4:1020-1025. [PMID: 36062057 PMCID: PMC9434650 DOI: 10.1016/j.jaccas.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022]
Abstract
We present the case of a 75-year-old man who experienced rebleeding after surgical treatment of grade III coronary perforation, resulting in intertwined complications including communicating coronary and ventricular pseudoaneurysms. The percutaneous intervention of sealing the rebleeding site with a covered stent implantation managed this rare pseudoaneurysm successfully. (Level of Difficulty: Advanced.)
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4
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Stone JR. Diseases of small and medium-sized blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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5
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Dash D. Coronary chronic total occlusion intervention: A pathophysiological perspective. Indian Heart J 2018; 70:548-555. [PMID: 30170652 PMCID: PMC6116719 DOI: 10.1016/j.ihj.2018.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 12/03/2022] Open
Abstract
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is the last frontier in coronary intervention. PCI of CTO carries multiple advantages, such as significant improvement in symptoms, improvement in abnormal wall motion and left ventricular function and, possibly, increased long-term survival. As of today the procedural success is markedly improved because of technical innovations and is limited to highly experienced operators. To enhance the overall success rate from a worldwide perspective, a thorough understanding of its pathophysiology is critical to further development of newer techniques and technologies. In this review, the author outlines in-depth the evidence that underpins our understanding of CTO pathophysiology and its insight into CTO intervention that incorporates various steps and techniques to cross the lesion.
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Affiliation(s)
- Debabrata Dash
- Thumbay Hospital, Ajman, United Arab Emirates; Beijing Tiantan Hospital, Beijing, China.
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6
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Divanji P, Shunk K. Complications of chronic total occlusion percutaneous coronary intervention: Subepicardial hematoma. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:553-557. [PMID: 29331435 DOI: 10.1016/j.carrev.2017.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
A 67-year-old man with coronary artery disease and previous coronary underwent successful Guideliner reverse CART percutaneous coronary intervention of a chronic total occlusion of the right coronary artery. He later developed evidence of myocardial ischemia, and imaging, including angiogram, echocardiogram, and cardiac computed tomography revealing active dye extravasation from the previously normal RV marginal branches, in addition to a large subepicardial hematoma. Despite these dramatic findings, the patient remained hemodynamically stable and pain-free, with resolving ECG changes. Thus, with close clinical observation, the patient did not undergo pericardiocentesis or other invasive procedures, and was discharged home safely. This review evaluates the complications of CTO-PCI, with a focus on subepicardial hematomas, discussing diagnosis and management of this highly morbid complication.
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Affiliation(s)
- Punag Divanji
- Division of Cardiology, University of California, San Francisco, VA Medical Center, San Francisco, CA, United States.
| | - Kendrick Shunk
- Division of Cardiology, University of California, San Francisco, VA Medical Center, San Francisco, CA, United States
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7
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Guo R, Yang L. The successful use of autologous skin in management of guidewire-induced distal coronary perforation. Clin Case Rep 2017; 5:1018-1021. [PMID: 28588859 PMCID: PMC5458019 DOI: 10.1002/ccr3.966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 03/14/2017] [Accepted: 03/19/2017] [Indexed: 11/24/2022] Open
Abstract
The successful use of autologous skin to management may provide a useful and widely applicable method for dealing with the troublesome complication of guidewire‐induced coronary perforation.
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Affiliation(s)
- Ruiwei Guo
- Department of Cardiology Kunming General Hospital of Chengdu Military Command Kunming Yunnan China
| | - Lixia Yang
- Department of Cardiology Kunming General Hospital of Chengdu Military Command Kunming Yunnan China
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Grieshaber P, Nef H, Böning A, Niemann B. Myocardial Ischemia Caused by Subepicardial Hematoma. Thorac Cardiovasc Surg Rep 2017; 6:e5-e9. [PMID: 28352501 PMCID: PMC5367147 DOI: 10.1055/s-0037-1601315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Bleeding from bypass anastomosis leakage occurs early after coronary
artery bypass grafting. Later, once the anastomosis is covered by intima, spontaneous
bleeding is unlikely. Case Description A 63-year-old male patient developed a pseudoaneurysm-like,
subepicardial late-term bleeding resulting in a hematoma that compromised coronary
artery flow by increasing extracoronary pressure. This resulted in severe angina
pectoris (Canadian Cardiovascular Society IV) and myocardial ischemia within the
affected area. After surgical removal of the hematoma and repair of the anastomosis, the
patient's symptoms disappeared and no signs of myocardial ischemia were present. Conclusion Surgical removal is an efficient therapy for subepicardial hematoma
inducing myocardial ischemia.
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Affiliation(s)
- Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, University Hospital of Giessen, Giessen, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
| | - Bernd Niemann
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
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Senarslan O, Tamci NB, Kantarci UH, Eyuboglu M, Senarslan DA. Left ventricular haematoma mimicking lateral wall myocardial infarction secondary to percutaneous coronary intervention. Cardiovasc J Afr 2016; 28:e9-e11. [PMID: 27834983 PMCID: PMC5661151 DOI: 10.5830/cvja-2016-090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 10/16/2016] [Indexed: 11/29/2022] Open
Abstract
Dissecting intra-myocardial haematoma is a rare disease and a potentially fatal complication after cardiac surgery. Patients with previous heart surgery have more risk for dissecting intra-myocardial haematoma after percutaneous coronary intervention. Management of this issue is challenging. We describe a rare case of a 63-year-old woman with a left ventricular wall-dissecting intra-myocardial haematoma, which developed 30 minutes after percutaneous coronary intervention. The patient was treated conservatively, with a successful outcome.
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Affiliation(s)
- Omer Senarslan
- Department of Cardiology, Medifema Hospital, Izmir, Turkey.
| | | | | | - Mehmet Eyuboglu
- Department of Cardiology, Special Izmir Avrupa Medicine Center, Karabaglar, Izmir, Turkey
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10
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Kawaguchi S, Takeuchi T, Hasebe N. Pulmonary artery compression by a localized epicardial hematoma in a patient with idiopathic thrombocytopenic purpura after percutaneous coronary intervention: a case report. BMC Cardiovasc Disord 2016; 16:206. [PMID: 27793101 PMCID: PMC5084387 DOI: 10.1186/s12872-016-0378-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background The most common complication of coronary artery perforation, a rare complication of percutaneous coronary intervention (PCI), is hemopericardium with cardiac tamponade. However, localized extra-coronary bleeding can lead to epicardial hematoma, which is a rare phenomenon. We report the case of an unusual delayed presentation of post-PCI hematoma with unrecognized guidewire perforation. Case presentation A 70-year-old man with idiopathic thrombocytopenic purpura (ITP) and a history of coronary artery bypass grafting (CABG) underwent PCI. A bare metal stent was implanted in left main coronary artery (LMCA) after balloon dilation. The procedure was performed without any complications, and the patient was discharged 5 days later. However, the patient was unexpectedly admitted by ambulance with cardiogenic shock and new-onset chest pain the next day. Echocardiography did not show any wall motion abnormalities, but a large mass on the right ventricle outflow tract was detected. Contrast-enhanced computed tomography showed a hematoma compressing the main pulmonary artery trunk and the right ventricle. The patient developed sudden cardiopulmonary arrest and cardiopulmonary resuscitation was successful. The patient died during emergent surgical removal of the hematoma. Large, dark red clots between the pulmonary artery trunk and aorta were observed. The suspected origin of the epicardial hematoma was blood oozing from the stent site in LMCA. Conclusion This is an unusual case with delayed development of localized hematoma following PCI in the absence of guidewire perforation. Furthermore, this case illustrated the potential of occasional critical complications in patients with impaired blood clotting undergoing PCI.
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Affiliation(s)
- Satoshi Kawaguchi
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Toshiharu Takeuchi
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Naoyuki Hasebe
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
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Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:412-7. [DOI: 10.1016/j.carrev.2016.05.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022]
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Kato R, Ashikaga T, Sakurai K, Ito J, Ogawa T, Tahara T, Yokoyama Y, Satoh Y. Influence of additional ballooning with a dual wire balloon after a rotational atherectomy to expand drug-eluting stent for calcified lesions. Cardiovasc Interv Ther 2012; 27:155-60. [DOI: 10.1007/s12928-012-0102-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 01/25/2012] [Indexed: 11/30/2022]
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14
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Left ventricular perforation and dissecting subepicardial hematoma after catheter ablation for Wolff-Parkinson-White syndrome. Gen Thorac Cardiovasc Surg 2011; 59:280-3. [DOI: 10.1007/s11748-010-0667-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Accepted: 06/29/2010] [Indexed: 10/18/2022]
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Furui M, Ohashi T, Yoshida T, Oka F, Hirai Y, Sakakura R, Kageyama S, Kojima A. Cardiogenic shock without cardiac tamponade caused by a subepicardial hematoma after percutaneous coronary intervention. Gen Thorac Cardiovasc Surg 2011; 59:114-6. [PMID: 21308438 DOI: 10.1007/s11748-010-0628-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 04/01/2010] [Indexed: 11/28/2022]
Abstract
A 73-year-old man complaining of pain on effort was admitted to a hospital for a percutaneous coronary intervention (PCI) because of severe stenosis of the mid right coronary artery. During PCI, a coronary artery was ruptured, and the patient suddenly went into shock. Percutaneous pericardiocentesis was successfully performed, and cardiac tamponade was relieved. Despite the echocardiographic finding of no cardiac tamponade, the patient remained in the shock state. An emergency operation was performed. There was little pericardial effusion, but a large subepicardial and intramyocardial hematoma was present and was being compressed by the pericardium. Pericardial incision and off-pump coronary artery bypass grafting were performed. The patient was discharged on the 12th postoperative day. Decompression of the subepicardial hematoma by pericardiotomy ameliorated the condition of the patient, who was in cardiogenic shock. We thus report a rare case of subepicardial hematoma resulting in shock during PCI in which cardiac tamponade was not observed.
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Affiliation(s)
- Masato Furui
- Cardiovascular Surgery Department, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
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Raja Y, Routledge HC, Doshi SN. A noncompliant, high pressure balloon to manage undilatable coronary lesions. Catheter Cardiovasc Interv 2010; 75:1067-73. [PMID: 20517970 DOI: 10.1002/ccd.22430] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yogesh Raja
- Department of Interventional Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
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Ahn MS, Yoon J, Lee JW, Lee KH, Kim JY, Yoo BS, Lee SH, Choe KH. Effectiveness of the hugging balloon technique in coronary angioplasty for a heavy, encircling, calcified coronary lesion. Korean Circ J 2009; 39:499-501. [PMID: 19997547 PMCID: PMC2790133 DOI: 10.4070/kcj.2009.39.11.499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Revised: 07/23/2009] [Accepted: 08/05/2009] [Indexed: 11/16/2022] Open
Abstract
We report our experience in coronary angioplasty and intravascular ultrasonography (IVUS) on a heavy, encircling, calcified lesion that was not dilated with the use of a cutting balloon and a non-compliant balloon. The angioplasty was successfully performed with a simple and inexpensive hugging balloon technique.
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Affiliation(s)
- Min Soo Ahn
- Department of Cardiology, Pusan National University School of Medicine, Busan, Korea
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Grohmann A, Elgeti T, Eddicks S, Knebel F, Rutsch W, Melzer C, Baumann G, Borges AC. Interventricular septum hematoma during cineventriculography. Cardiovasc Ultrasound 2008; 6:4. [PMID: 18199315 PMCID: PMC2257924 DOI: 10.1186/1476-7120-6-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 01/16/2008] [Indexed: 12/20/2022] Open
Abstract
Background Intraseptal hematoma and subsequent myocardial infarction due to accidental contrast agent deposition complicating diagnostic cineventriculography is a previously undescribed complication of angiography. Case presentation A 61 year old man was admitted at intensive care unit because of unstable angina pectoris 1 hour after coronary angiography. Transthoracic contrast echocardiography showed a non-perfused area in the middle of interventricular septum with an increase of thickening up to 26 mm. Review of cineventriculography revealed contrast enhancement in the interventricular septum after contrast medium injection and a dislocation of the pigtail catheter tip. Follow up by echocardiography and MRI showed, that intramural hematoma has resolved after 6 weeks. After 8 weeks successful stent implantation in LAD was performed and after 6 month the patient had a normal LV-function without ischemic signs or septal thickening demonstrated by stressechocardiography. Conclusion A safe and mobile position of the pigtail catheter during ventriculography in the middle of the LV cavity should be ensured to avoid this potentially life-threatening complication. For assessment and absolute measurement of intramural hematoma contrast-enhanced echocardiography is more feasible than MRI and makes interchangeable results.
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Affiliation(s)
- Andrea Grohmann
- Department of Cardiology and Angiology, Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany.
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19
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Garvin R, Reifsnyder T. Cutting balloon angioplasty of autogenous infrainguinal bypasses: Short-term safety and efficacy. J Vasc Surg 2007; 46:724-30. [PMID: 17764872 DOI: 10.1016/j.jvs.2007.05.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 02/15/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE This study evaluated the safety and efficacy of cutting balloon angioplasty in the treatment of infrainguinal vein bypass graft stenosis. METHODS Data from a prospective database, supplemented by chart review, were obtained on all patients who underwent cutting balloon angioplasty of lower extremity vein bypass grafts at a single institution during a 4-year period. Noninvasive duplex ultrasound imaging of grafts, along with measurement of ankle-brachial indices and digital pressures, was performed on all patients before and after treatment with the cutting balloon. Efficacy of cutting balloon angioplasty and procedural complications were analyzed. Data from noninvasive vascular testing were compared using the two-tailed paired Student t test. Patency rates were calculated using the Kaplan-Meier method. Differences in patency rates were compared using the log-rank test. RESULTS From July 2002 to February 2006, 109 cutting balloon angioplasties were performed on 70 bypasses in 61 patients. There were 12 complications in 109 procedures (11%), only one of which required immediate operative intervention. Initial technical success was 96%. Noninvasive vascular testing indicators significantly improved immediately after intervention: peak systolic graft velocity decreased from 360 +/- 158 cm/s to 143 +/- 67 cm/s (P < .001), ankle-brachial index improved from 0.55 +/- 0.3 to 0.85 +/- 0.2 (P < .001), and digital pressure increased from 31 +/- 30 mm Hg to 62 +/- 32 mm Hg (P < .001). Patency rates at 6 months according to the Kaplan-Meier method were primary patency, 48% (95% confidence interval [CI], 0.36 to 0.60); assisted primary patency, 72% (95% CI, 0.61 to 0.83); and secondary patency, 99% (95% CI, 0.97 to 1.00). At 6 months, cumulative limb salvage was 94% (95% CI, 0.89 to 1.00). CONCLUSIONS Cutting balloon angioplasty of infrainguinal vein bypass graft stenosis is technically feasible but is associated with a relatively high complication rate and a relatively low short-term patency rate.
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Affiliation(s)
- Robert Garvin
- The Department of Surgery, Division of Vascular Surgery, Western Pennsylvania Hospital, Pittsburgh, PA 15224, USA.
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20
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Satler LF. Successful nonsurgical treatment of left main stem perforation by sacrifice of the LAD. Catheter Cardiovasc Interv 2007; 69:850-1. [PMID: 17390324 DOI: 10.1002/ccd.20993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lowell F Satler
- Division of Cardiology, Washington Hospital Center, Washington, DC
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21
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Dixit M, Gan M, Pradeep KK, Dubey A, Sabade S, Mahapatra R. Dissecting Sub-Epicardial Haematoma: A Rare Complication with the Use of Octopus™ Suction Mechanical Stabiliser. Heart Lung Circ 2007; 16:118-9. [PMID: 17317313 DOI: 10.1016/j.hlc.2006.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 09/27/2006] [Accepted: 10/01/2006] [Indexed: 11/24/2022]
Abstract
Mechanical heart stabilisers are the most important method of anastomotic field immobilisation in off pump coronary artery bypass (OPCAB) surgery. The new generations of stabilisers are small, versatile and relatively free of complications. We report a patient who developed a dissecting sub-epicardial haematoma following OPCAB using the OCTOPUS 3.0 (Medtronic Inc., Minneapolis, USA) suction stabiliser, which manifested as myocardial ischaemia two hours after surgery. It is a rare but potentially lethal complication that has only once before been reported in literature.
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Affiliation(s)
- Mahadev Dixit
- Department of Cardiothoracic Surgery, JN Medical College and KLES Hospital and MRC, Belgaum, Karnataka, India
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