ABSTRACT
Introducción. La atresia pulmonar con comunicación interventricular es una cardiopatía compleja con una incidencia aproximada de 2% entre todas las cardiopatías congénitas. Se asocia con frecuencia al síndrome de deleción 22q11. Tiene una amplia variabilidad anatómica que es necesario precisar con exactitud para poder establecer un plan médico quirúrgico individualizado. Caso clínico. Se presenta el caso de un paciente de 2 años con atresia pulmonar y comunicación interventricular asociadas a dos grandes colaterales aortopulmonares. Este paciente fue corregido mediante conexión de ventrículo derecho a arteria pulmonar, durante la cual fue posible ligar una de las colaterales; la restante fue embolizada mediante un dispositivo trascateterismo con oclusión total. Conclusiones. El manejo de las arterias colaterales asociadas a atresia pulmonar con comunicación interventricular es complejo pero accesible al tratamiento trascateterismo mediante el implante de dispositivos con mínima morbimortalidad.
Background. Pulmonary atresia with ventricular septal defect (VSD) is a complex heart disease with an incidence of ~2% of all congenital heart diseases. It is frequently associated with 22q11 deletion syndrome. Due to the extensive anatomic variability, it is necessary to accurately establish an individualized surgical/medical plan. Case report. We report the case of a 2-year-old patient with pulmonary atresia and two associated mayor aortopulmonary collateral arteries. This patient underwent right ventricular-pulmonary artery connection at which time it was possible to ligate one of the collaterals. The remaining were embolized by transcatheter device with total occlusion. Conclusions. Management of collateral arteries associated with pulmonary atresia with VSD is complex but is accessible with transcatheter treatment with device implantation with minimal morbidity.
ABSTRACT
Portal hypertension (PH) is defined as pathological increase of hydrostatic pressure in the portal venous system, usually related to liver cirrhosis. Among the uncommon causes of PH is the arteriovenous intra or extrahepatic fistula (AVF) of traumatic, iatrogenic or congenital origin. Clinical history and ultrasound findings of AVF are very important for the diagnosis. From a therapeutic point of view, there are three alternatives: clinical/imaging follow-up, surgical repair and transcutaneous catheter embolization. A report of a clinical case and a review of the literature are presented. Patient with portal hypertension as a result of intra hepatic AVF, successfully treated by transcutaneous catheter embolization. A 54 year-old female patient, and cholecystectomized and with history of breast cancer, presented altered liver function tests several months after gallbladder surgery. Once biliary disease was ruled out, liver biopsy was performed, which was compatible with autoimmune hepatitis. During follow-up, intrahepatic AVF was observed by means of ultrasound. Underlying disease was successfully managed with Prednisone and Azathioprine. Nine years later, she experienced an episode of confusion and disorientation compatible with hepatic encephalopathy (HE) and esophageal varices diagnosed by upper endoscopy. Laboratory tests and imaging did not show progression baseline liver disease. Angiographic procedures confirmed an intra hepatic AVF and selective embolization was carried out. There was clinical remission of HE and esophageal varices. We concluded, that transcutaneous catheter embolization is a valid alternative for the treatment of intra hepatic AVF, which accounted for the successful result for this particular patient.
La hipertensión portal (HP) se define como el aumento patológico de la presión hidrostática en el sistema venoso portal, habitualmente relacionada con cirrosis hepática. Entre las causas infrecuentes de HP está la fístula arterio-venosa (FAV) intra o extrahepática de origen traumáticas, iatrogénicas o congénitas entre otras. En el diagnóstico son importantes los antecedentes clínicos y hallazgos ecográficos que demuestran FAV. Desde el punto de vista terapéutico, existen tres alternativas: seguimiento clínico y de imágenes, reparación quirúrgica y embolización con catéter transcutáneo. Se presenta caso clínico de paciente con (HP) a consecuencia de una FAV intrahepática, tratada satisfactoriamente mediante embolización con catéter transcutáneo y revisión de la literatura pertinente. Se trata de una paciente de 54 años con antecedentes de cáncer mamario y colecistectomía en quien se constatan alteraciones de pruebas hepáticas varios meses con posterioridad a cirugía vesicular. Una vez descartada patología biliar, se realizó biopsia hepática la que fue compatible con hepatitis autoinmune. Durante el seguimiento se pesquisó FAV intrahepática como hallazgo ecográfi co. Su enfermedad de base se trató satisfactoriamente con Prednisona y Azatioprina. Nueve años más tarde, consulta por episodio de confusión y desorientación compatible con encefalopatía hepática (EH) y presencia de várices esofágicas a la endoscopia. Tanto el laboratorio como imágenes no mostraron progresión de enfermedad hepática de base. Es sometida a procedimiento angiográfico, que confirmó FAV intrahepática, procediendo a embolización selectiva. Hubo remisión del cuadro clínico de EH y regresión de las várices esofágicas. Se concluye que la embolización con catéter transcutáneo, es una alternativa válida en el tratamiento de FAV intrahepáticas, terapia que constituyó la solución definitiva del cuadro clínico reportado.
Subject(s)
Humans , Female , Middle Aged , Embolization, Therapeutic/methods , Arteriovenous Fistula/diagnosis , Arteriovenous Fistula/therapy , Hypertension, Portal/etiology , Arteriovenous Fistula/complications , Hepatitis, Autoimmune , Hypertension, Portal/therapyABSTRACT
Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present in the absence of specific underlying pathology or trauma and is typically associated with anticoagulation therapy. We report a case of a 74-year-old female patient with a cerebral infarction related to atrial fibrillation who developed a spontaneous lumbar arterial hemorrhage complicating heparin therapy. The diagnosis was suggested by a computed tomography scan and confirmed by angiography. She was treated successfully with transcatheter embolization.
Subject(s)
Aged , Female , Humans , Anticoagulants/adverse effects , Embolization, Therapeutic , Hemorrhage/etiology , Heparin/adverse effects , Lumbar Vertebrae/blood supply , Retroperitoneal Space , Therapeutics , Tomography, X-Ray ComputedABSTRACT
We report the findings of a patient with an asymptomatic Arc of Buhler (AOB) aneurysm, which was successfully treated by transcatheter coil embolization. An abdominal CT and angiography revealed an intact pancreaticoduodenal artery arcade (PDAA) and an anomalous communication between the SMA and celiac axis, termed an AOB. An aneurysm was observed at the origin of the AOB and treated with a transcatheter embolization using coils. A follow-up CT imaging confirmed the total occlusion of the aneurysm with a patent PDAA. The successful results of this treatment suggest that the endovascular therapy of an AOB aneurysm with a celiac axis occlusion and an intact PDAA is feasible and safe.
Subject(s)
Adult , Humans , Male , Aneurysm/diagnostic imaging , Angiography , Celiac Artery/abnormalities , Embolization, Therapeutic , Mesenteric Artery, Superior/abnormalities , Tomography, X-Ray ComputedABSTRACT
Objective To explore the treatment and efficiency of high blood flow vascular malformations of oral maxillofacial region with super-selective arterial embolization. Methods 18 cases underwent angiography of the head and neck before treatment and then followed by super-selective catheterization with microcatheter to embolize the feeding vessels of the vascular malformations with PVA. 8 cases underwent surgical excision within 72 hours after the embolization and the other 10 cases passed through the arterial radical emboliztion treatment. Results Technical success ratio reached 100% with no complications causing skin necrosis or incorrect arterial embolization else where in the skull. All 8 cases undergone preoperative embolization showed obviously less bleeding, easier removal of the mass and reduction of operation time. 10 cases with radical arterial embolization manifested reduction of swelling and improvement of organ function within 1 to 24 months after the procedure. 5 patients were cured with only once operation, 4 cases with twice operation and 1 with the thrice. Conclusions Aterial embolization is a safe and effective method in the treatment of high blood flow vascular malformations of oral maxillofacial region.
ABSTRACT
Endoscopy has been the method of choice for the initial diagnosis and treatment of gastrointestinal bleeding. However, in the case of difficult localization or endoscopic failure, angiographic or surgical alternative may be recommended. The role of angiography has been emphasized recently to control upper GI bleeding. We experienced a case with deep ulcer displaying exposed vessel along the duodenal bulb, which imposed serious rebleeding risk. Although, active bleeding was controlled by the epinephrine injections in that patient, rebleeding risk was still high. So the patient underwent emergency angiography with embolization of the pancreaticoduodenal artery and gastroduodenal artery using multiple microcoils. Follow-up endoscopic examinations showed a coil protruding into the lumen from the ulcer bed, and the exposed coil at the ulcer base was completely by the regenerated epithelium three months later. Here in, we describe the rare case of a endodcopically exposed coil after embolization for bleeding duodenal ulcer which is the first case ever reported in Korea.
Subject(s)
Humans , Angiography , Arteries , Diagnosis , Duodenal Ulcer , Emergencies , Endoscopy , Epinephrine , Epithelium , Follow-Up Studies , Hemorrhage , Korea , UlcerABSTRACT
Fistula between coronary artery and pulmonary artery is a type of coronary artery anomalies. It can cause atypical chest pain and fatigue, angina pectoris, endocarditis, finally myocardial steal can result in heart failure and myocardial infarction. But only 0.1-0.2% of coronary angiographic studies reveal the communications between coronary artery and other spaces. (heart chamber, pulmonary artery etc.) It is frequently congenital, but acquired types are increasing because chest and heart manipulations such as opertion of tetralogy of Fallot, endomyocardial biopsy, radiation therapy, or penetrating blunt trauma are increasing. There are reports about repair of fistula using thrombogenic tips, coil embolization and surgical intervention. We report a connection between coronary artery and pulmonary artery in 79 years old female. She was 30 pack-years smoker and suffered from dyspnea several years with chronic obstructive pulmonary disease. She presented with atypical chest pain and palpitation after admission. Electrocardiography showed ST-T wave abnormality. Emergency coronary angiography and chest CT scan revealed coronary-pulmonary artery fistula. Transcatheter embolization was performed and she was relieved from discomforts.
Subject(s)
Aged , Female , Humans , Angina Pectoris , Arteries , Biopsy , Chest Pain , Coronary Angiography , Coronary Vessels , Dyspnea , Electrocardiography , Embolization, Therapeutic , Emergencies , Endocarditis , Fatigue , Fistula , Heart , Heart Failure , Myocardial Infarction , Pulmonary Artery , Pulmonary Disease, Chronic Obstructive , Tetralogy of Fallot , Thorax , Tomography, X-Ray ComputedABSTRACT
Common complications of the intestinal tuberculosis are perforation, obstruction, fistulas, and malabsorption. Massive gastrointestinal bleeding is an extremely rare complication of intestinal tuberculosis. Moreover, this may be the first report in the world on transcatheter arterial embolization against the massive bleeding from intestinal tuberculosis patient. We experienced a case of lower gastrointestinal bleeding due to extensive intestinal tuberculosis as massive as vital sign was unstable. Colonoscopy and esophagogastroduodenoscopy did not reveal bleeding focus. Active jejunal bleeding was suspected by technetium99m labelled RBC scintigraphy. Emergency superior mesenteric artery angiography showed active bleeding focus from jejunal branch of artery and transcatheter arterial embolization was tried with microcoil. After embolization, he had no more hematochezia and vital sign became stabilized. On third hospital day, upper endoscopy was done using pediatric colonoscopy and there were multiple circular ulcers on the proximal jejunum but no evidence of mesenteric ischemia. Small bowel tuberculosis should be suspected as a cause of lower gastrointestinal bleeding in case of negative colonoscopy and upper endoscopy. We suggest that the transcatheter embolization could be taken into consideration as a first-line method of treatment for massive bleeding from intestinal tuberculosis before surgical resection.
Subject(s)
Humans , Angiography , Arteries , Colonoscopy , Emergencies , Endoscopy , Endoscopy, Digestive System , Fistula , Gastrointestinal Hemorrhage , Hemorrhage , Ischemia , Jejunum , Mesenteric Artery, Superior , Radionuclide Imaging , Tuberculosis , Ulcer , Vital SignsABSTRACT
Coronary artery perforation is a rare and serious complication in coronary angioplasty. Some patients complicated by coronary perforation may develop cardiac tamponade, which is generally due to massive hemorrhage in the pericardial space between the epicardium and the pericardium. We report a case of coronary artery perforation producing impending tamponade, which was successfully treated by transcatheter embolization of distal circumflex artery using polyvinyl alcohol.
Subject(s)
Humans , Angioplasty , Arteries , Cardiac Tamponade , Coronary Vessels , Hemorrhage , Pericardium , Polyvinyl Alcohol , PolyvinylsABSTRACT
Typhoid fever is still endemic in developing countries and the cause of much morbidity and mortality. Complications such as intestinal hemorrhage, intestinal perforation, hepatitis, pyelonephritis, cholecystitis, osteomyelitis are known to occur. The classical approach to management of intestinal hemorrhage due to typhoid ulceration has been conservative. In, however, the event of massive, persistent and life-threatening hemorrhage not responding to conservative measures, early surgical intervention is life-saving. But surgical intervention is difficult due to multiple bleeding sites and friable distal ileum and colon. These two cases are reported in order to draw attention to the usefulness of mesenteric arteriography and the effectiveness of transcatheter embolization therapy in massive intestinal hemorrhage due to typhoid fever.
Subject(s)
Angiography , Cholecystitis , Colon , Developing Countries , Hemorrhage , Hepatitis , Ileum , Intestinal Perforation , Mortality , Osteomyelitis , Pyelonephritis , Typhoid Fever , UlcerABSTRACT
Congenital coronary artery fistulas are rare congenital heart anomalies. Surgical closure of these fistulas was the therapy of choice till recently. The recent development of a new accurate coil-delivery system has enabled us to embolize the vessels. Percutaneous transcatheter coil embolization is a safe and effective approach to treating coronary artery fistulas and should be considered as the best treatment for coronary artery fistulas. We report the case of 5-year-old girl whose coronary artery fistula was occluded with Gianturco coils successfully.