Project description:A 57-year-old woman presented with effort angina. A coronary angiogram revealed critical 2-vessel disease, for which she subsequently underwent percutaneous coronary intervention. During angioplasty, a coronary guidewire-inadvertently passed into the right ventricle through the septal branches of the posterior descending coronary artery-caused a coronary artery-to-right ventricular fistula. This fistula was successfully closed percutaneously by coil embolization. To our knowledge, this is the first report of a case in which a coronary artery-to-right ventricular fistula caused by a guidewire was managed successfully by coil embolization.
Project description:Although directional coronary atherectomy (DCA) is designed to effectively reduce plaque volume by debulking in patients with ischemic heart disease, excision of fibroatheroma has potential to cause distal embolization and periprocedural myocardial infarction. The patients had intravascular ultrasound-derived attenuated plaques in the culprit lesions. A DCA catheter was inserted over a filter-based embolic protection device. After DCA, filter no-reflow phenomenon occurred, and embolized debris was retrieved by the filter device. We describe the novel use of a filter-based embolic protection device during intravascular imaging-guided DCA, particularly in patients at high risk of distal embolization. <Learning objective: The presence of intravascular ultrasound-derived attenuated plaques is at increased risk of distal embolization of debris and periprocedural myocardial infarction during directional atherectomy. A filter-based embolic protection device is available during intracoronary imaging-guided directional coronary atherectomy, particularly in patients at high risk of distal embolization.>.
Project description:Distal femur stem cortical perforation is a rare but potentially catastrophic complication during total hip arthroplasty. If unrecognized, it can lead to transverse fracture of the femur while the patient is ambulating. If an uncemented femur stem was used, previous literature unanimously agrees that revision surgery should be performed. We report a case of uncemented distal femur stem cortical perforation that was treated nonsurgically successfully with protected weight-bearing for 6 weeks. Our patient had previous osteotomy surgeries of the proximal femur with a residual deformity which increased her risk for distal femur stem cortical perforation. At 40-month follow-up, she was asymptomatic, ambulated with normal gait, and was able to perform deep squats. The discussion involves avoiding, recognizing, and managing distal femur stem cortical perforation.
Project description:Fractional flow reserve (FFR) is increasingly used to guide myocardial revascularisation. However, supporting evidence regarding its use originates from studies that have enrolled mainly patients with stable angina, while patients with acute coronary syndromes (ACS) have not been included. Notably, multifactorial microvascular dysfunction and an increased sympathetic tone in patients with ACS may lead to blunted response to adenosine and false-negative results of FFR due to submaximal hyperaemia. This may raise the possibility of deferring treatment of stenosis that instead would have needed dilatation, thus leaving a residual risk of preventable cardiac events. In this literature review, we aim at summarising laboratory and clinical investigations concerning the use of FFR in culprit and non-culprit lesions in ACS. Furthermore, we will report recent data on instantaneous wave-free ratio, an adenosine-free index of functional stenosis severity, in stable coronary artery disease and in patients with ACS.
Project description:We present the case of a 75-year-old man who experienced rebleeding after surgical treatment of grade III coronary perforation, resulting in intertwined complications including communicating coronary and ventricular pseudoaneurysms. The percutaneous intervention of sealing the rebleeding site with a covered stent implantation managed this rare pseudoaneurysm successfully. (Level of Difficulty: Advanced.).
Project description:We have described subcutaneous encapsulated fat necrosis, which is benign, usually asymptomatic and underreported. Images have only been published on two earlier occasions, in which the necrotic nodules appear "pearly" than the cloudy yellow surface in present case. The presented image may help future surgeons to establish the diagnosis peroperatively.
Project description:Quantification of ammonia in whole blood has applications in the diagnosis and management of many hepatic diseases, including cirrhosis and rare urea cycle disorders, amounting to more than 5 million patients in the United States. Current techniques for ammonia measurement suffer from limited range, poor resolution, false positives or large, complex sensor set-ups. Here we demonstrate a technique utilizing inexpensive reagents and simple methods for quantifying ammonia in 100 μL of whole blood. The sensor comprises a modified form of the indophenol reaction, which resists sources of destructive interference in blood, in conjunction with a cation-exchange membrane. The presented sensing scheme is selective against other amine containing molecules such as amino acids and has a shelf life of at least 50 days. Additionally, the resulting system has high sensitivity and allows for the accurate reliable quantification of ammonia in whole human blood samples at a minimum range of 25 to 500 μM, which is clinically for rare hyperammonemic disorders and liver disease. Furthermore, concentrations of 50 and 100 μM ammonia could be reliably discerned with p = 0.0001.