Haemostasis of a right ventricle-gunshot wound using a novel haemostatic vacuum device.
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ABSTRACT:
SUBMITTER: Porcu P
PROVIDER: S-EPMC3397729 | biostudies-literature | 2012 Aug
REPOSITORIES: biostudies-literature
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Project description:BackgroundGunshot wounds (GSWs) often result in neuropraxia or a mixed injury pattern rather than direct nerve transection. There is still debate between early and delayed intervention for the optimal treatment of intact nerves following GSWs. Early intervention may prevent the formation of dense scar tissue, and delayed intervention allows for the zone of injury to be fully demarcated for optimal treatment planning. Here, we present the case of a 29-year-old male who underwent exploration of the right common peroneal nerve after a GSW.Case descriptionA 29-year-old male presented for evaluation of a GSW to the right lower extremity at the level of the fibular head he sustained 2 months prior. Following his injury, he was immediately evaluated in the emergency department and offered supportive care. He reported paresthesias in the right lower extremity and a right-sided foot drop. Computed tomography demonstrated a bullet fragment in the distal right lower extremity, and ultrasound revealed a partial thickness injury in the right peroneal nerve. Exploration of the right common peroneal nerve and bullet fragment was recommended. The bullet fragment was removed from the distal right lower extremity in one piece. Following this, the right common peroneal nerve was decompressed proximally to distally, with scar tissue encountered distally. Postoperatively, the patient did well, ambulating shortly after surgery, and at 3 weeks postoperative, he was ambulating without difficulty.ConclusionClinical judgment and risk-benefit analysis of each patient must be made individually to determine the most optimal treatment method following GSWs.
| S-EPMC10858762 | biostudies-literature
Project description:The diagnosis and management of injuries of the heart or the great vessels continues to be a major surgical challenge in the past and now. This case study introduces the conservative management of a patient who developed a venous bullet embolus after being shot in the lower extremities. In this case report, we aim to review some of the literature on bullet emboli and to raise awareness of its existence. It was concluded that for bullets left in the limbs, bullet position in relation with peripheral vessels should be evaluated carefully to treat and avoid the bullets moving along with the bloodstream.
| S-EPMC5386942 | biostudies-literature
Project description:Gunshots embolizing to the heart is a rare occurrence. We report a case of percutaneous retrieval of a gunshot bullet from the right ventricle (RV) cavity of a 40-year-old lady. To the best of our knowledge, this is the first case to be reported with a right supraclavicular inlet of the bullet and successful percutaneous retrieval using a snare from the RV cavity. A 40-year-old female patient was referred to our cardiac centre from a general hospital with a gunshot injury 8 days prior. On arrival, she was haemodynamically stable, there was an inlet wound at the right supraclavicular area. Transthoracic echocardiography revealed the bullet in the RV cavity. Under conscious sedation, right femoral vein access succeeded to retrieve the shot from the RV to the groin. The bullet slipped out and resnared from the right internal iliac vein and came out safely from the right femoral vein through the 24-Fr sheath. The vein was closed using a figure of 8 suture. The patient discharged home after 2 days. Bullet emboli to the heart are rare, endovascular retrieval of a bullet from the right ventricular cavity is feasible and relatively safe; however, more research is required. Echocardiography during the procedure is strongly recommended to early detect any complications. Accurate use of available tools such as X-ray, echocardiography, computed tomography, and fluoroscopy is a must for precise diagnosis.
| S-EPMC6601199 | biostudies-literature
Project description: Not available
| S-EPMC4707444 | biostudies-literature
Project description:BackgroundA systemic right ventricle (RV) after atrial switch in transposition of the great arteries (TGA) or congenitally corrected TGA (ccTGA) often results in advanced heart failure in adulthood.Case summaryFour patients with INTERMACS Class III underwent durable ventricular assist device (VAD) implantation for a systemic RV. Two patients were diagnosed with ccTGA and underwent tricuspid valve replacement, and two were diagnosed with TGA in childhood and underwent Mustard repair. The two patients with ccTGA received an EVAHEART (Sun Medical, Nagano, Japan) and HeartMate 3 (Abbott Laboratories, Abbott Park, IL, USA) at the age of 56 years and 34 years, respectively. Of the patients with TGA, one received a Heartmate II at age 40 years, and one received a HeartMate 3 at age 40 years. All patients were weaned from cardiopulmonary bypass without subpulmonic VAD support and transferred to the intensive care unit with optimum VAD support. No in-hospital deaths, cerebrovascular accidents, or other major complications occurred. The post-VAD right heart catheter study showed a remarkable reduction in pulmonary capillary wedge pressure in all patients.DiscussionThe indications for and surgical technique of durable VAD implantation for a systemic RV after atrial switch of TGA or ccTGA have not been fully established. A durable VAD, including the HeartMate 3, was successfully implanted in four such patients in this study. Pre-operative three-dimensional computed tomography images and intraoperative transoesophageal echocardiography guidance helped to determine the positions of the inflow and pump.
| S-EPMC7891278 | biostudies-literature
Project description:Mechanical circulatory support devices are used to offer short-term support for patients with cardiogenic shock. However, these devices are not without complications, and the risk and management of each must be closely considered. We discuss an infrequent complication of the percutaneous right heart pump and review complications reported to the U.S. Food and Drug Administration. (Level of Difficulty: Intermediate.) Central Illustration
| S-EPMC9350931 | biostudies-literature
Project description:Systemic right ventricular failure is a common finding in patients with transposition of the great arteries. Some of these patients require ventricular assist device implantation. We describe the feasibility of HeartMate 3 [Abbott, Illinois, United States] implantation in a patient with transposition of the great arteries, high human leukocyte antigen sensitization, and severe pectus excavatum using a two-stage approach.Learning objectives1.To notice the challenges faced while implanting HeartMate 3 [Abbott, Illinois, United States] in patients with congenital heart disease and anatomical limitations.2.To understand that despite the difficulties, HeartMate 3 implantation is possible, worthwhile, and sometimes the only choice in a patient with end-stage heart failure and congenital heart disease.
| S-EPMC9352421 | biostudies-literature
Project description:We introduce an implantable intracardiac soft robotic right ventricular ejection device (RVED) for dynamic approximation of the right ventricular (RV) free wall and the interventricular septum (IVS) in synchrony with the cardiac cycle to augment blood ejection in right heart failure (RHF). The RVED is designed for safe and effective intracardiac operation and consists of an anchoring system deployed across the IVS, an RV free wall anchor, and a pneumatic artificial muscle linear actuator that spans the RV chamber between the two anchors. Using a ventricular simulator and a custom controller, we characterized ventricular volume ejection, linear approximation against different loads and the effect of varying device actuation periods on volume ejection. The RVED was then tested in vivo in adult pigs (n = 5). First, we successfully deployed the device into the beating heart under 3D echocardiography guidance (n = 4). Next, we performed a feasibility study to evaluate the device's ability to augment RV ejection in an experimental model of RHF (n = 1). RVED actuation augmented RV ejection during RHF; while further chronic animal studies will provide details about the efficacy of this support device. These results demonstrate successful design and implementation of the RVED and its deployment into the beating heart. This soft robotic ejection device has potential to serve as a rapidly deployable system for mechanical circulatory assistance in RHF.
| S-EPMC5937685 | biostudies-literature
Project description:Level of Evidence: Level V, expert opinion.
| S-EPMC8696864 | biostudies-literature
Project description:Purpose of reviewRight ventricular (RV) function is an important determinant of morbidity and mortality in patients with pulmonary arterial hypertension (PAH). Although substantial progress has been made in understanding the development of RV failure in the last decennia, this has not yet resulted in the development of RV selective therapies. In this review, we will discuss the current status on the treatment of RV failure and potential novel therapeutic strategies that are currently being investigated in clinical trials.Recent findingsIncreased afterload results in elevated wall tension. Consequences of increased wall tension include autonomic disbalance, metabolic shift and inflammation, negatively affecting RV contractility. Compromised RV systolic function and low cardiac output activate renin-angiotensin aldosterone system, which leads to fluid retention and further increase in RV wall tension. This vicious circle can be interrupted by directly targeting the determinants of RV wall tension; preload and afterload by PAH-medications and diuretics, but is also possibly by restoring neurohormonal and metabolic disbalance, and inhibiting maladaptive inflammation. A variety of RV selective drugs are currently being studied in clinical trials.SummaryNowadays, afterload reduction is still the cornerstone in treatment of PAH. New treatments targeting important pathobiological determinants of RV failure directly are emerging.
| S-EPMC6693931 | biostudies-literature