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1.
J Cardiothorac Surg ; 19(1): 380, 2024 Jun 26.
Article in English | MEDLINE | ID: mdl-38926882

ABSTRACT

Intra-cardiac thrombosis is a potentially devastating complication of extracorporeal membrane oxygenation (ECMO) mechanical circulatory support. We present here a patient who suffered complete thrombosis of a fresh mitral prosthesis and left atrium in the setting of ECMO with aortic insufficiency who was treated with repeat valve replacement and thrombectomy. To our knowledge, she is the only patient in the reported literature to have survived this complication.


Subject(s)
Bioprosthesis , Extracorporeal Membrane Oxygenation , Heart Atria , Heart Valve Prosthesis , Mitral Valve , Thrombosis , Female , Humans , Bioprosthesis/adverse effects , Extracorporeal Membrane Oxygenation/methods , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Mitral Valve/surgery , Thrombectomy/methods , Thrombosis/etiology , Thrombosis/surgery , Aged
2.
Artif Organs ; 46(8): 1659-1668, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35191553

ABSTRACT

In a multicenter, retrospective analysis of 435 patients with refractory COVID-19 placed on V-V ECMO, cannulation by a single, dual-lumen catheter with directed outflow to the pulmonary artery was associated with lower inpatient mortality.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , COVID-19/therapy , Catheterization/methods , Catheters , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/methods , Humans , Retrospective Studies
3.
J Thorac Cardiovasc Surg ; 163(6): 2107-2116.e6, 2022 06.
Article in English | MEDLINE | ID: mdl-34112505

ABSTRACT

OBJECTIVE: To determine characteristics, outcomes, and clinical factors associated with death in patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) support. METHODS: A multicenter, retrospective cohort study was conducted. The cohort consisted of adult patients (18 years of age and older) requiring ECMO in the period from March 1, 2020, to September 30, 2020. The primary outcome was in-hospital mortality after ECMO initiation assessed with a time to event analysis at 90 days. Multivariable Cox proportional regression was used to determine factors associated with in-hospital mortality. RESULTS: Overall, 292 patients from 17 centers comprised the study cohort. Patients were 49 (interquartile range, 39-57) years old and 81 (28%) were female. At the end of the follow-up period, 19 (6%) patients were still receiving ECMO, 25 (9%) were discontinued from ECMO but remained hospitalized, 135 (46%) were discharged or transferred alive, and 113 (39%) died during the hospitalization. The cumulative in-hospital mortality at 90 days was 42% (95% confidence interval [CI], 36%-47%). Factors associated with in-hospital mortality were age (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.06-1.61 per 10 years), renal dysfunction measured according to serum creatinine level (aHR, 1.21; 95% CI, 1.01-1.45), and cardiopulmonary resuscitation before ECMO placement (aHR, 1.87; 95% CI, 1.01-3.46). CONCLUSIONS: In patients with severe COVID-19 necessitating ECMO support, in-hospital mortality occurred in fewer than half of the cases. ECMO might serve as a viable modality for terminally ill patients with refractory COVID-19.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Respiratory Distress Syndrome , Adolescent , Adult , COVID-19/therapy , Child , Extracorporeal Membrane Oxygenation/adverse effects , Female , Hospital Mortality , Humans , Male , Middle Aged , Retrospective Studies
4.
J Card Surg ; 35(11): 3183-3190, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32790006

ABSTRACT

IMPORTANCE: Cardiac tamponade requiring emergent intervention is a possible complication of coronavirus disease 2019 (COVID-19) infection. Favorable clinical outcomes are possible if timely management and drainage are performed unless ventricular failure develops. OBSERVATION: Cardiac tamponade in COVID-19, based on the limited reported cases, seems to be more common among middle-aged men with observed complications in black and ethnic minorities. Prognosis is worse amongst patients with concomitant ventricular failure. DESIGN AND METHODS: This is a case series of three COVID-19 patients complicated by cardiac tamponade, requiring surgical intervention at a single institution in New York. INTERVENTION: Pericardial window, Pericardiocentesis. OUTCOME: One patient had recurrence of cardiac tamponade with hemorrhagic component but fully recovered and was discharged home. Two patients developed cardiac tamponade with concomitant biventricular failure, resulting in death. CONCLUSION AND RELEVANCE: Cardiac tamponade with possible concomitant biventricular failure can develop in COVID-19 patients; incidence seems to be highest at the point of marked inflammatory response. Concomitant ventricular failure seems to be a predictor of poor prognosis.


Subject(s)
COVID-19/complications , Cardiac Tamponade/therapy , Cardiac Tamponade/virology , Drainage , Extracorporeal Membrane Oxygenation , Fatal Outcome , Heart Arrest/etiology , Humans , Male , Middle Aged , Obesity/complications , Pericardial Effusion/therapy , Pericardial Effusion/virology , Pericardiocentesis
5.
Cardiol Res ; 10(2): 114-119, 2019 Apr.
Article in English | MEDLINE | ID: mdl-31019641

ABSTRACT

Penetrating cardiac injuries are highly lethal and carry high mortality rate. Both blunt and penetrating cardiac injuries in patients who survive are known to present with well-known sequelae that often appear days to weeks after the initial insult. In the literature there have been documented cases of cardiac injury induced myocardial infarction, ventricular aneurysms, valvular dysfunction and even fistulous tracts between the coronary vessels and chamber. Although the most commonly injured vessel is the left anterior descending (LAD) coronary artery, traumatic injuries to the left coronary artery result in early death in the majority of cases. We present a unique case of LAD pseudo aneurysm and stenosis presenting as acute coronary syndrome (ACS) months after the initial penetrating cardiac injury successfully managed by stenting. There are only few isolated case reports of coronary artery pseudoaneurysm following penetrating chest trauma published in English literature.

8.
Case Rep Cardiol ; 2017: 9614835, 2017.
Article in English | MEDLINE | ID: mdl-28396805

ABSTRACT

A 49-year-old African American male patient with no past medical history was admitted because of 3 months of difficulty swallowing solid and liquid foods. He had constant retrosternal discomfort and appeared malnourished. The chest radiograph revealed a right sided aortic arch with tracheal deviation to the left. A swallow study confirmed a fixed esophageal narrowing at the level of T6. Contrast enhanced Computed Tomography (CT) angiogram of the chest and neck revealed a mirror image right aortic arch with a left sided cardiac apex and a prominent ductus diverticulum (measuring 1.7 × 1.8 cm). This structure extended posterior to and indented the mid esophagus. A left posterolateral thoracotomy was performed and the ductus diverticulum was resected. A retroesophageal ligamentum arteriosum was found during surgery and divided. This rare combination of congenital anatomical aberrations led to severe dysphagia in our patient. Successful surgical correction in the form of resection of the ductus diverticulum and division of the retroesophageal ligamentum arteriosum led to complete resolution of our patient's symptoms.

10.
Tex Heart Inst J ; 42(2): 181-3, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25873837

ABSTRACT

The fracture of an inferior vena cava filter strut and its migration to the heart is a rare sequela of implanted inferior vena cava filters. Perforation through the right ventricle into the pericardium with resultant cardiopulmonary compromise is even less frequent. We report the case of a 53-year-old man who presented with chest pain and hypotension consequent to cardiac tamponade. A fractured inferior vena cava filter strut had migrated and perforated his right ventricle. The fractured strut was successfully removed by means of cardiac surgery. Inferior vena cava filters should be placed when necessary to minimize the risk of pulmonary embolism, and regular radiologic monitoring should be performed; however, the eventual extraction of retrievable filters should be considered. In addition to discussing the patient's case, we briefly review the relevant medical literature.


Subject(s)
Cardiac Tamponade/etiology , Vena Cava Filters/adverse effects , Abdomen , Chest Pain/etiology , Coronary Angiography , Equipment Failure , Foreign-Body Migration , Heart Ventricles/diagnostic imaging , Heart Ventricles/injuries , Humans , Male , Middle Aged , Pericardium , Stress, Mechanical
11.
Ann Vasc Surg ; 28(8): 1934.e7-1934.e11, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25038316

ABSTRACT

Carotid blowout is a rare fatal complication most commonly observed in head and neck cancer patients, especially after radiation therapy. Traditional surgical approaches carry extremely high morbidity and mortality rates. We present a case of acute hemorrhage from extracranial carotid artery in a 64-year-old man with history of total laryngectomy, tracheostomy, and chemoradiotherapy for laryngeal cancer. Tumor was noted to be encasing and eroding into the internal and common carotid artery with a large soft tissue neck defect. Hemorrhage was successfully controlled employing 3 Viabahn covered stents of increasing diameter in the internal and common carotid artery in an overlapping fashion under local anesthesia. Deployment of tapering overlapped covered stents in common and internal carotid artery may safely be performed to obtain endovascular control of active hemorrhage in a hostile neck.


Subject(s)
Carotid Artery Diseases/therapy , Carotid Artery, Internal/radiation effects , Endovascular Procedures/instrumentation , Hemorrhage/therapy , Laryngeal Neoplasms/radiotherapy , Radiation Injuries/therapy , Stents , Acute Disease , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/etiology , Carotid Artery, Internal/diagnostic imaging , Hemorrhage/diagnosis , Hemorrhage/etiology , Humans , Male , Middle Aged , Prosthesis Design , Radiation Injuries/diagnosis , Radiation Injuries/etiology , Radiotherapy/adverse effects , Tomography, X-Ray Computed , Treatment Outcome
12.
Case Rep Crit Care ; 2014: 634953, 2014.
Article in English | MEDLINE | ID: mdl-24829838

ABSTRACT

Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.

13.
Case Rep Crit Care ; 2014: 689539, 2014.
Article in English | MEDLINE | ID: mdl-24829839

ABSTRACT

Bullet embolism within the gastrointestinal system is extremely rare. Such bullet injuries are infrequently covered in the general literature, but the surgeon should be aware of the phenomenon. Smaller caliber bullets are more common in civilian gunshot wound (GSW) events. These bullets are able to tumble through the gastrointestinal tract and cause perforation of the intestinal lumen which is small enough to be easily missed. Bullets retained in the abdominal cavity should not be dismissed as fixed and should be carefully monitored to ensure that they do not embolize within the bowel and cause occult lesions during their migration. We present a unique case wherein a bullet caused a minute perforation in the small bowel, before migrating to the distal colon, which resulted in late presentation of sepsis secondary to peritonitis.

14.
Case Rep Anesthesiol ; 2014: 190172, 2014.
Article in English | MEDLINE | ID: mdl-24592335

ABSTRACT

Mediastinal hematoma is a rare complication following insertion of a central venous catheter with only few cases reported in the English literature. We report a case of a 71-year-old female who was admitted for elective chemoport placement. USG guided right internal jugular access was attempted using the Seldinger technique. Resistance was met while threading the guidewire. USG showed a chronic clot burden in the RIJ. A microvascular access was established under fluoroscopic guidance. Rest of the procedure was completed without any further issues. Following extubation, the patient complained of right-sided chest pain radiating to the back. Chest X-ray revealed a contained white out in the right upper lung field. She became hemodynamically unstable. Repeated X-ray showed progression of the hematoma. Median Sternotomy showed posterior mediastinal hematoma tracking into right pleural cavity. Active bleeding from the puncture site at RIJ-SCL junction was repaired. Patient had an uneventful recovery. Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case. A possible explanation of our complication may be attributed to the forced manipulation of the dilator or guidewire against resistance. Clavicle and sternum offer bony protection to the underlying vital venous structures and injuries often need sternotomy with or without neck extension. Division of the clavicle and disarticulation of the sternoclavicular joint may be required for optimum exposure. Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance. Chest X-ray showed to be routinely done to detect any complication early.

15.
Case Rep Emerg Med ; 2013: 198617, 2013.
Article in English | MEDLINE | ID: mdl-23662217

ABSTRACT

Bullet embolism is a well-known but relatively uncommon complication of gunshot injuries. Their rarity and the potential lack of early symptoms lead to delays in diagnosis and often in inadequate early management that can potentially result in the loss of a limb or life. We present an interesting case in which a small caliber bullet to the upper anterior abdomen penetrated the thoracic aorta and traveled to the right popliteal artery embolizing the vessel. The exploratory laparotomy failed to locate neither the bullet nor the trajectory resulting in sudden deterioration and eventual death 5 hours into the postoperative period.

17.
Am J Med Sci ; 341(6): 512-3, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21613938

ABSTRACT

Late prosthetic valve endocarditis is usually caused by streptococci, staphylococci, gram-negative bacilli and candida. The authors report the first case of prosthetic valve endocarditis caused by Gemella sanguinis. The patient's risk factors for the development of Gemella endocarditis were the persistent severe dental caries and the presence of prosthetic valves. The patient required surgical replacement of the infected valve but had a good outcome with preservation of cardiac and valvular function. Evaluation and treatment of the persistent dental infection before initial valvular surgery may have prevented secondary infection of the prosthetic valve.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Endocarditis/etiology , Endocarditis/therapy , Gemella , Gram-Positive Bacterial Infections/etiology , Heart Valve Prosthesis/adverse effects , Adult , Amoxicillin , Ceftriaxone/therapeutic use , Dental Caries/complications , Drug Administration Schedule , Echocardiography , Endocarditis/diagnosis , Endocarditis/drug therapy , Endocarditis/microbiology , Endocarditis/surgery , Female , Gemella/isolation & purification , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/microbiology , Humans , Transplantation, Homologous , Treatment Outcome
18.
Interact Cardiovasc Thorac Surg ; 7(4): 591-4, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18469011

ABSTRACT

Indications regarding surgical pulmonary embolectomy for treatment of submassive/massive acute pulmonary embolism remain controversial. An institutional experience with pulmonary embolectomy for acute pulmonary embolism (APE) was reviewed. A retrospective analysis of all patients undergoing pulmonary embolectomy for APE from September 2004 to January 2007 was conducted. Demographic data, clinical presentation and outcomes were analyzed. Fifteen patients underwent surgery for APE over a period of 27 months [average age 59.6 (range 35-89) years, (seven male, eight female)]. Six (40%) patients were admitted with known APE and nine patients exhibited post admission APE (seven - after surgical procedures, two - after cerebrovascular accident). Clinical presentation included dyspnea (86.67%), hemodynamic instability requiring continuous vasopressor support (40%), echocardiographic evidence of right ventricular dilatation (80%). Ten patients undergoing early/expedient embolectomy all survived while delayed surgery in the other five patients (>24 h) was associated with 60% mortality. Expanding indications for early surgical pulmonary embolectomy has stemmed from reliable echocardiographic identification of right ventricular compromise and recognition of these findings as harbingers of subsequent hemodynamic embarrassment. Our series underscores the benefit of early consideration and performance of pulmonary embolectomy in these critically ill patients.


Subject(s)
Embolectomy , Pulmonary Artery/surgery , Pulmonary Embolism/surgery , Acute Disease , Adult , Aged , Aged, 80 and over , Dilatation, Pathologic , Dyspnea/etiology , Dyspnea/surgery , Echocardiography, Transesophageal , Female , Hemodynamics , Humans , Male , Middle Aged , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/mortality , Retrospective Studies , Time Factors , Treatment Outcome , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/surgery
19.
Ann Thorac Surg ; 83(5): 1897-9, 2007 May.
Article in English | MEDLINE | ID: mdl-17462432

ABSTRACT

We report the case of a patient who had an intubation-related tracheal injury who we treated by deployment of a covered tracheal stent. This approach may be preferable to other alternatives in patients with a prohibitive risk of mortality with surgical repair or in an injury with sequelae not suitable for conservative management.


Subject(s)
Intubation, Intratracheal/adverse effects , Trachea/injuries , Trachea/surgery , Tracheal Diseases/surgery , Aged , Bronchoscopy , Female , Humans , Iatrogenic Disease , Rupture , Stents , Tracheal Diseases/etiology
20.
Angiology ; 57(4): 464-77, 2006.
Article in English | MEDLINE | ID: mdl-17022383

ABSTRACT

Left main coronary artery disease carries a poor prognosis. The etiology of isolated and significant left main coronary artery (ILMCA) disease is not well understood. Studies so far were limited by small numbers. The authors identified 46 patients with ILMCA disease from their database over 10 years (group I) and compared them with 83 consecutive patients undergoing catheterization (group II). They also compared patients with ostial vs distal ILMCA disease. Group I represented 0.1% of catheterization patients. The demographic profile and atherosclerotic risk factor profile of the 2 groups as well as ostial and distal ILMCA disease were compared. This is the largest study of ILMCA disease. Risk factors for atherosclerosis were commonly seen. Nonatherosclerotic causes of ILMCA disease were not seen. This study suggests coronary atherosclerosis as the predominant cause of ILMCA disease. ILMCA disease is more common in women. Diabetes is more commonly associated with distal ILMCA lesion. There is a trend suggesting that ostial ILMCA lesion is more common in smokers and women.


Subject(s)
Atherosclerosis/complications , Coronary Angiography , Coronary Artery Disease/etiology , Diabetes Complications/etiology , Hemodynamics , Smoking/adverse effects , Aged , Cardiac Catheterization , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/physiopathology , Diabetes Complications/diagnostic imaging , Diabetes Complications/physiopathology , Exercise Test , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Sex Factors
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