Removal of a Metallic Stent after 9 Years of Placement That Caused Tracheal Stenosis: A Rare Case Report

Introduction

Metallic stents are widely used to prevent airway obstruction for tracheal stenosis caused by malignant diseases. Although their efficacy has been recognized, there is no established evidence surrounding their long-term safety. We report a case of airway stenosis caused by a metallic tracheal stent. Removal of the stent to secure the airway was difficult and extremely complicated.

Case Presentation

A 50-year-old male suffering from dyspnea caused by malignant lymphoma (diffuse large B-cell lymphoma) of the thyroid gland was treated with a metallic tracheal stent. After remission of the lymphoma, stenosis of the stent lumen developed gradually, and the patient complained of dyspnea. Tracheostomy could not be performed due to the metallic stent. Since the patient was unable to intubate, the stent was removed under general anesthesia with partial percutaneous cardiopulmonary support 9 years after the stent placement.

Conclusion

Otolaryngologists should be aware of the possibility of severe stenosis following the long-term placement of a metallic tracheal stent.

Left main coronary malperfusion from acute non-communicating aortic dissection

A 64-year-old man was admitted with sudden back and chest pain. He had undergone aortic valve replacement 5 years earlier. Enhanced computed tomography showed acute type A non-communicating aortic dissection. He was initially treated with supportive medical therapy. Since he was restless, he was placed on a respirator. He went into sudden shock 6 h after onset. Percutaneous cardiopulmonary support was administered, and coronary arteriography showed progression of the dissection to the left main trunk. Percutaneous coronary intervention was performed. He recovered from shock and then underwent ascending aorta replacement. He was discharged from hospital without any major complications.

Fulminant myocarditis in a patient with severe coronary artery disease

A 55-year-old man complaining of fever and exertional dyspnea was admitted for coronary angiography to differentiate between fulminant myocarditis and acute coronary syndrome. He had been treated for 17 years for angina pectoris. His electrocardiogram demonstrated ST segment changes in almost all leads. Cardiac catheterization demonstrated severe stenosis in the left descending artery, the diagonal branch, and the right coronary artery. Ultrasonography, however, revealed diffuse hypokinesis of the left ventricle and edematous wall thickening, suggesting fulminant myocarditis. This is the first report in which a patient with fulminant myocarditis with severe coronary artery disease was successfully treated with mechanical cardiopulmonary support, intensive pharmacological therapy, and staged coronary intervention procedures. Complicated coronary artery disease may delay the diagnosis of myocarditis and worsen the clinical outcome. Patients having fulminant myocarditis with coronary artery disease need careful diagnosis, and percutaneous cardiopulmonary support should be considered in the early clinical stage. <Learning objective: Complicated coronary artery disease may delay the diagnosis of myocarditis and worsen the clinical outcome. It is considered safe to use percutaneous cardiopulmonary support for such patients in the early clinical stage. The present case was rescued with mechanical support in the acute phase of fulminant myocarditis and elective coronary angioplasty in the recovery phase.>.

Various morphologies of bidirectional ventricular tachycardia caused by aconite "Torikabuto" poisoning

A 43-year-old man presented with nausea. The patient developed ventricular fibrillation (VF), which was refractory to antiarrhythmic drugs and defibrillation. A coronary angiogram showed no coronary artery stenosis. We recorded various fatal arrhythmias, including bidirectional ventricular tachycardia (BVT). The presence of multiple types of BVTs that were refractory to drugs such as adenosine triphosphate, isoproterenol, verapamil, propranolol, and pilsicainide, and easily recurred after defibrillation indicated aconite poisoning. After persisting for 24 h, VF spontaneously resolved and sinus rhythm was restored. Laboratory data revealed lethal concentrations of aconitine. To the best of our knowledge, this is the first report of aconite poisoning-induced BVTs manifesting with multiple morphologies on 12-lead electrocardiogram. The arrhythmogenic effects of aconitine are well recognized. In addition to causing VT and VF, aconitine also can cause BVT. Aconitine can lead to delayed afterdepolarization which has an important role in triggering and maintaining BVT. However, in this case, the concentration of aconitine was high enough to render these drugs ineffective. Prompt application of percutaneous cardio-pulmonary support, which was continued until the aconitine was metabolized, proved successful in this case and should be considered as a management approach in cases of severe aconite poisoning.

A case of fulminant myocarditis associated with novel N1H1 influenza successfully treated by percutaneous cardiopulmonary support system

We report a case of fulminant myocarditis associated with N1H1 influenza virus infection. N1H1 was confirmed by a polymerase chain reaction assay and she was treated with oseltamivir phosphate. She was admitted to the hospital because of respiratory distress, however, echocardiography revealed severely depressed wall motion followed by refractory ventricular fibrillation. Extracorporeal circulation by emergent percutaneous cardiopulmonary support system was required to maintain hemodynamic stability. Cardiac function was spontaneously and gradually restored within a week. Findings from biopsy samples taken on day 1 and day 23 were consistent with acute myocarditis.