Dehiscence of an Infected Composite Ascending Graft with Systolic Extrinsic Compression
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ABSTRACT:
SUBMITTER: Lick S
PROVIDER: S-EPMC7481838 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
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Project description:BackgroundAortic conduit pseudoaneurysms are rare complications of surgical aortic root replacements. These complications are typically treated with a redo-sternotomy, but these surgeries carry high mortality rates, and patients may not always be good surgical candidates. There have been a few reported cases where aortic pseudoaneurysms have been successfully treated percutaneously with both short- and long-term success. We describe a case were a sub-annular aortic root pseudoaneurysm was closed using an Amplatzer Vascular Plug 2 device.Case summaryA 68-year-old man was admitted to the hospital 6 weeks after surgical aortic valve and aortic root replacement undergone for prosthetic valve endocarditis. On computed tomography, he was found to have a large fluid collection with extravasation into a false lumen located on the right side of the ascending aorta. Diagnostic catheterization confirmed flow into the pseudoaneurysm cavity from a sub-annular location. This defect was then closed using an Amplatzer Vascular Plug 2 device, with no residual flow or concern for re-opening at 8 months follow-up.DiscussionThis case presents the first documented use of an Amplatzer Vascular Plug 2 to close an aortic root pseudoaneurysm in the sub-annular location. Heart team discussion is crucial in determining whether surgical or percutaneous treatment management should be performed. This case highlights a novel treatment method for sub-annular aortic root pseudoaneurysms which can be considered an alternative to surgery and potentially life-saving for high-risk patients.
| S-EPMC10716677 | biostudies-literature
Project description:BackgroundSplit thickness skin graft (STSG) is a routine reconstructive manoeuvre, particularly after excision of cutaneous lower limb malignancies. While surgical technique is well established, evidence supporting the postoperative management of these grafts is less robust. Compression therapy after the index procedure may be an important adjunct for graft take and minimizing complications, particularly in patients susceptible to oedema from a concurrent lymph node procedure.MethodsAn initial PubMed literature search was performed using the terms "split thickness skin graft", "compression" and "oedema" yielding no results, hence a broader search was performed combining the terms "compression", "pressure" and "split thickness skin graft" providing 383 results. One hundred articles remained for abstract review after an initial screen.ResultsThe literature on compression therapy to promote split thickness graft take is modest, with only 12 articles described (12/100, 12.0%). Even then, none of these were in the setting of grafting after oncological resection. Many of the articles promote negative pressure wound therapy (NPWT) as an established adjunct to promote graft take (80/100, 80.0%).ConclusionsThere is limited demonstrated efficacy of postoperative compression therapy for lower limb STSG let alone in patients with an ancillary lymph node procedure. Further large-scale trials ideally in a prospective fashion are warranted to validate this as a simple, widely available and cost-effective adjunct to STSG in this particularly susceptible population of reconstructive patients.
| S-EPMC10005980 | biostudies-literature
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| S-EPMC8129039 | biostudies-literature
Project description:BackgroundMyocardial ischemia occurs in the setting of inadequate or complete cessation of blood supply to the myocardium. While atherosclerosis is the most common cause; other causes have been identified. Rare cases can be caused by extrinsic compression of the coronaries by a dilated pulmonary artery (PA) or by mechanical obstruction from nearby chest tubes or drains. We present two cases of myocardial ischemia-driven malignant arrhythmia leading to cardiac arrest caused by obstruction of the coronary blood flow from external compression.Case descriptionIn the first case, venous bypass graft compression from a chest tube postoperatively was noted and in the second case left main coronary artery (LMCA) compression from a dilated PA secondary to pulmonary artery hypertension (PAH) was seen. Diagnosis of these two cases was made via emergent coronary angiogram and intravascular ultrasound (IVUS) and treated by placing a drug eluting stent (DES) in LMCA compression and by adjusting the chest tube and placing a DES in the venous bypass graft with the restoration of flow. We also review the available literature regarding the incidence, diagnosis, and management of this rare entity.ConclusionsOverall, extrinsic compression of the coronaries is rare, therefore clinicians need to be aware of this infrequent process, to allow for appropriate diagnosis, management, and to prevent excess morbidity and mortality from this rare complication.
| S-EPMC10789896 | biostudies-literature
Project description: Not available
| S-EPMC10501472 | biostudies-literature
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| S-EPMC3263234 | biostudies-literature
Project description:Graphical abstract Highlights • Mycotic aneurysm of the aortic sinus is a rare complication of aortic valve endocarditis.• Mycotic aneurysm of left sinus causing LM compression and circumflex occlusion is shown.• We present TTE and TEE approaches to making the diagnosis of this complex lesion.• Sketches of complications of aortic valve endocarditis are presented.
| S-EPMC9270671 | biostudies-literature
Project description:A left main coronary artery (LMCA) stenosis due to extrinsic compression by mediastinal tumor is a rare finding. In this case reports, we present a 63-year-old woman, who was transferred to the emergency department with chief complains of persistent chest and back pain. An electrocardiogram revealed diffuse ST-segment depression (elevation in lead aVR). Contrast-enhanced computed tomography (CT) showed a huge cystic mass above the left atrium. After the CT examination, she was temporarily in shock. Compression of the LMCA was evident on the CT angiography and a diagnosis of acute myocardial infarction due to compression of the LMCA by a tumor was made. An emergent resection of the tumor was performed. Histopathological assessment of the resected cyst revealed that it was a schwannoma. She made an uneventful postoperative recovery. A follow-up 3-dimensional CT scan performed after the operation confirmed no evidence of LMCA compression.
| S-EPMC7815471 | biostudies-literature
Project description:BackgroundGuidelines recommend targeting decongestion in management of decompensated HF, with lower extremity edema often serving as the clinical target. LECW are seldom used in the acute setting, with a paucity of data on efficacy in HF, despite serving as a cornerstone of chronic lymphedema management.Primary objectiveStudy the efficacy and safety of LECW in acute decompensated HF.MethodsOpen-label, randomized, parallel-group clinical trial.Primary outcomesDays on intravenous (IV) diuretic therapy, total hospital length of stay (LOS), and 30-day all-cause readmission.Results32 patients were enrolled, with 29 patients completing the study. Enrollment was suspended due to the COVID-19 pandemic. Overall LOS was shorter in the intervention group (3.5 vs 6 days, p = 0.05), with no significant difference in total days on IV diuresis or 30-day readmission rate with use of LECW. Fewer patients required continuous diuretic infusion after treatment with LECW (0 vs 7 patients, p = 0.027). The intervention group scored significantly better on the MLWHF (55.5 vs 65, p = 0.021), including both the physical and emotional dimension scores. No adverse events were reported with use of LECW, including a significantly lower incidence of AKI (1 vs 13 patients, p = 0.005).ConclusionThe use of LECW resulted in reduced hospital LOS compared to standard therapy, with no difference in days of IV diuresis administration or 30-day readmission. Treatment with LECW also resulted in less continuous IV diuretic therapy, fewer incidence of AKI, and improved quality of life. Trends toward less escalation of diuresis, and greater reduction in edema were also observed.
| S-EPMC10432693 | biostudies-literature
Project description:To evaluate direct versus indirect monocyte chemoattractant protein (MCP)-1/CCR2 signaling and to identify the cellular producers and effectors for MCP-1 during neointimal hyperplasia (NIH) development in vein grafts.Genomic analysis revealed an overrepresentation of 13 inflammatory pathways in wild-type vein grafts compared with CCR2 knockout vein grafts. Further investigation with various vein graft-host combinations of MCP-1- and CCR2-deficient mice was used to modify the genotype of cells both inside (graft-intrinsic group) and outside (graft-extrinsic group) the vein wall. CCR2 deficiency inhibited NIH only when present in cells extrinsic to the graft wall, and MCP-1 deficiency required its effectiveness in cells both intrinsic and extrinsic to the graft wall to suppress NIH. Deletion of either MCP-1 or CCR2 was equally effective in inhibiting NIH. CCR2 deficiency in the predominant neointimal cell population had no impact on NIH. Direct MCP-1 stimulation of primary neointimal smooth muscle cells had minimal influence on cell proliferation and matrix turnover, confirming an indirect mechanism of action.MCP-1/CCR2 axis accelerates NIH via its signaling in graft-extrinsic cells, particularly circulating inflammatory cells, with cells both intrinsic and extrinsic to the graft wall being critical MCP-1 producers. These findings underscore the importance of systemic treatment for anti-MCP-1/CCR2 therapies.
| S-EPMC3468948 | biostudies-literature