[Intracardiac echocardiography-guided device closure of atrial septal defects: our initial experience]. / Intrakardiyak ekokardiyografi esliginde sekundum atriyal septal defekt kapatilmasi: Klinigimizin baslangiç tecrübesi.

OBJECTIVES: Although intracardiac echocardiography (ICE) has long been used for various cardiologic interventions, its utilization has been quite limited in Turkey. We assessed our experience with the use of ICE during transcatheter closure of secundum atrial septal defects (ASD). STUDY DESIGN: Fourteen patients (8 females, 6 males; mean age 34 years; range 15 to 62 years) underwent transcatheter device closure of ASD with ICE guidance. Before the procedure, 13 patients were examined by transesophageal echocardiography (TEE). Intracardiac echocardiography was used to evaluate the interatrial septum, defect size, the relationship of the septal occluder with neighboring structures before its release, and residual shunts after device release. RESULTS: Using short- and long-axis ICE images, the anteroposterior and superoinferior rims of the ASD, coronary sinus, and pulmonary vein openings were successfully visualized in all the patients. Defect diameters measured by ICE were closely correlated with those measured by TEE (97%) and balloon sizing (95%). The defects were closed successfully in 13 patients; the procedure was terminated in one patient due to the prolapse of both discs into the left atrium. There was no procedural complication. One patient experienced gastrointestinal hemorrhage that required blood transfusion two days after the procedure. No residual shunts were observed on follow-up transthoracic echocardiographic examinations one and six months after the procedure. CONCLUSION: Having high image quality and color Doppler features, ICE is quite functional in determining defect size, position of the septal occluder and its relationship with neighboring structures; thus, it is a reliable alternative to TEE which is used routinely in transcatheter closure of ASDs.

Spinal accessory neuropathy associated with deep tissue massage: a case report.

Spinal accessory neuropathy (SAN) causes impaired arm mobility and pain. The spinal accessory nerve is often injured during surgical procedures such as neck dissection for tumor resection or cervical lymph node biopsy. Other traumatic injuries may also occur. SAN causes weakness of the trapezius muscle and, less frequently, of the sternocleidomastoid muscle. The clinical consequence of trapezius muscle weakness includes impaired stability of the scapula leading to upper limb dysfunction and pain. We present a rare and illustrative case of SAN associated with deep tissue massage leading to scapular winging and droopy shoulder as a result of weakness of the trapezius muscle.