Texas Heart Institute journal
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Review Case Reports
Embolization of patent foramen ovale closure devices: incidence, role of imaging in identification, potential causes, and management.
Transcatheter patent foramen ovale (PFO) closure is an alternative to antiplatelet or anticoagulative therapy in patients with cryptogenic stroke, and it is associated with a small incidence of periprocedural sequelae. Because embolization of PFO closure devices is a very rare procedural complication, data on its frequency, causes, and management are sparse. We sought to review the medical literature and the cases of PFO closure-device embolization at our institution with the aim of identifying likely problems and reporting potential solutions. ⋯ In both patients, device embolization was identified in a timely fashion, the embolized device was safely retrieved, and the PFO was percutaneously closed with success. The incidence of PFO closure-device embolization is very low. The cases described here underscore the importance of imaging in the identification of morphologic predispositions to closure-device malpositioning, in the recognition of impending embolization, and in the timely management of embolization.
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Case Reports
Surgical approach to aortic valve replacement after previous bilateral internal thoracic artery grafting.
The authors present a manubrium-sparing sternotomy technique for aortic valve replacement in patients who have undergone previous myocardial revascularization with both internal thoracic arteries. They have found that preoperative 64-multislice computed tomographic imaging facilitates surgical planning by delineating the course of patent grafts and, in particular, the relationship between the sternum and the right internal thoracic artery graft. A manubrium-sparing sternotomy can in such instances avoid injury to the right internal thoracic artery graft during both resternotomy and adhesion dissection, thus reducing surgical risk and operative time.
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May-Thurner syndrome, also called iliac vein compression syndrome, is a rare cause of left iliac deep vein thrombosis, which arises from pulsatile compression of the left common iliac vein by the right common iliac artery. The resultant endothelial damage and intraluminal spur formation can lead to iliac deep vein thrombosis and sudden-onset left-lower-extremity edema and pain. Patients typically present with May-Thurner syndrome in their 2nd to 4th decades of life. ⋯ Magnetic resonance venography of the pelvic veins yielded a definitive diagnosis of May-Thurner syndrome. Catheter-directed thrombolysis and intravenous stent placement resolved her symptoms, and she was discharged from the hospital on anticoagulative therapy. A year later, she had no residual pain or edema, and the affected veins were patent with normal phasic flow and normal responses to compression and augmentation.
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We used 3-dimensional computed tomographic images to create a disease-based transesophageal echocardiographic simulation system for complex congenital heart defects. We enrolled 7 pediatric patients with complex congenital heart defects in this proof-of-concept study. Preoperative computed tomographic images and intraoperative transesophageal echocardiographic images were acquired for all patients. ⋯ The ability of 3-dimensional computed tomography to yield the spatial and temporal congruence of transesophageal echocardiography in selected planes was also good to excellent. We found that 3-dimensional computed tomographic images can simulate the process of transesophageal echocardiography in acquiring the echocardiographic image clearly. This imaging method has the potential to be applied successfully to a disease-based transesophageal echocardiographic simulation system.