We present a case of root abscess with aorta to right atrium fistula due to vancomycin-intermediate Staphylococcus aureus (VISA) after limb amputation and cardiac surgery. Patient underwent redo ...aortic valve replacement, patch repair of aorta to right atrial fistula, and tricuspid valve repair with a ring. Fistula formation is a rare complication of prosthetic valve endocarditis (PVE). This is the first case to discuss aortocavitary fistula (ACF) formation due to VISA. Transesophageal echocardiogram (TEE) is the preferred imaging modality to diagnose ACF.
Highlights • Nonbacterial thrombotic endocarditis (NBTE) is a rare complication of cancer. • NBTE may precede the diagnosis of an occult gynecologic malignancy. • Malignancy - induced NBTE must be ...considered in patients with unprovoked venous thromboembolism. • The most effective treatment is anticoagulation and treatment of the underlying cancer.
A STENTLESS APPROACH TO STEMI Sultanik, Elliot; Shlofmitz, Evan; Gabaud, Maranatha ...
Journal of the American College of Cardiology,
03/2020, Letnik:
75, Številka:
11
Journal Article
Right heart catheterizations (RHC) remains the gold standard for pulmonary hypertension (PH) diagnosis, and a key component to heart failure (HF) risk assessment and in advanced heart failure ...planning. Many patients with HF and PH require anticoagulation (AC) which cannot be safely held without enoxaparin bridging, due to mechanical heart valves, left ventricular assist devices (LVAD), or chronic thromboembolic pulmonary hypertension (CTEPH). While it is increasingly common to perform RHC without interruption of warfarin AC, no studies have analyzed complication rates in this population. RHC in patients on AC with elevated INR does not lead to more frequent adverse events.
We performed a retrospective analysis of patients over 18 years old with PH and/or HF who underwent RHC at the University of Maryland Medical Center during 2013 calendar year to determine the complication rate and assess for potential pre-procedural predictors of complications. Those with heart transplants undergoing surveillance endomyocardial biopsy were excluded.
A total of 270 right heart catheterizations were reviewed . There were 41 heart transplants that were excluded. Of the remaining 229 cases, 163 (71%) patients had heart failure—110 (48%) with reduced ejection fraction. There were 170 (74%) patients with pulmonary hypertension and 9 patients with an LVAD. Of these cases, 80 (34%) had an INR >1.5 with 27 (12%) having an INR >2 . There were 62 (78%) patients on warfarin. The most common indication for AC was atrial fibrillation/flutter—37 (60%)—with 8 (13%) requiring AC for cardiac thrombus, 7 (11%) for pulmonary embolism/deep vein thrombosis, 4 (6%) for valvular pathology, and 3 (5%) for LVAD. A majority of cases, 179 (78%) gained access via the right internal jugular vein. Micro-puncture kit was used 3 cases. There were no reported cases of hematoma, major bleeding (hemoglobin drop >2gm/dL), pulmonary hemorrhage, or cardiac tamponade. Two patients reported site discomfort—neither had an elevated INR.
RHC can be safely performed in patients with an elevated INR. In light of a growing population of LVAD's, and increasing awareness of CTEPH, a growing population of patients with advanced cardiopulmonary disease requires uninterrupted AC. If confirmed on a larger patient population, these findings would improve patient comfort and significantly reduce health care costs by eliminating the need for enoxaparin bridging or hospital admission for intravenous unfractionated heparin.
Objective
Surgical pulmonary embolectomy has gained increasing popularity over the past decade with multiple series reporting excellent outcomes in the treatment of submassive pulmonary embolism. ...However, a significant barrier to the broader adoption of surgical pulmonary embolectomy remains the large incision and long recovery after a full sternotomy. We report the safety and efficacy of using a minimally invasive approach to surgical pulmonary embolectomy.
Methods
All consecutive patients undergoing surgical pulmonary embolectomy for a submassive pulmonary embolism (2015–2017) were reviewed. Patients were stratified as conventional or minimally invasive. The minimally invasive approach included a 5- to 7-cm skin incision with upper hemisternotomy to the third intercostal space. The primary outcomes were in-hospital and 90-day survival.
Results
Thirty patients (conventional = 20, minimally invasive = 10) were identified. Operative time was similar between the two groups, but cardiopulmonary bypass time was significantly longer in the minimally invasive group (58 vs 94 minutes, P = 0.04). While ventilator time and intensive care unit length of stay were similar between groups, hospital length of stay was 4.5 days shorter in the minimally invasive group, and there was a trend toward less blood product use. In-hospital and 90-day survival was 100%. Within the minimally invasive cohort, median right ventricular dysfunction at discharge was none-mild and no patient experienced postoperative renal failure, deep sternal wound infection, sepsis, or stroke.
Conclusions
Minimally invasive surgical pulmonary embolectomy appears to be a feasible approach in the treatment of patients with a submassive pulmonary embolism. A larger, prospective analysis comparing this modality with conventional surgical pulmonary embolectomy may be warranted.
Objective
Surgical pulmonary embolectomy has gained increasing popularity over the past decade with multiple series reporting excellent outcomes in the treatment of submassive pulmonary embolism. ...However, a significant barrier to the broader adoption of surgical pulmonary embolectomy remains the large incision and long recovery after a full sternotomy. We report the safety and efficacy of using a minimally invasive approach to surgical pulmonary embolectomy.
Methods
All consecutive patients undergoing surgical pulmonary embolectomy for a submassive pulmonary embolism (2015–2017) were reviewed. Patients were stratified as conventional or minimally invasive. The minimally invasive approach included a 5- to 7-cm skin incision with upper hemisternotomy to the third intercostal space. The primary outcomes were in-hospital and 90-day survival.
Results
Thirty patients (conventional = 20, minimally invasive = 10) were identified. Operative time was similar between the two groups, but cardiopulmonary bypass time was significantly longer in the minimally invasive group (58 vs 94 minutes, P = 0.04). While ventilator time and intensive care unit length of stay were similar between groups, hospital length of stay was 4.5 days shorter in the minimally invasive group, and there was a trend toward less blood product use. In-hospital and 90-day survival was 100%. Within the minimally invasive cohort, median right ventricular dysfunction at discharge was none-mild and no patient experienced postoperative renal failure, deep sternal wound infection, sepsis, or stroke.
Conclusions
Minimally invasive surgical pulmonary embolectomy appears to be a feasible approach in the treatment of patients with a submassive pulmonary embolism. A larger, prospective analysis comparing this modality with conventional surgical pulmonary embolectomy may be warranted.
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