Purpose
The pulmonary artery (PA) in patients with pulmonary hypertension (PH) becomes dilated. We analyzed the postoperative changes of the main PA after lung transplantation (LuTx).
Methods
The ...subjects of this retrospective study were 68 LuTx recipients, divided into a PH group (
n
= 36) and a non-PH group (
n
= 32), based on preoperative right heart catheterization findings. The PA diameter was measured on chest computed tomography. We evaluated the correlation between the mean pulmonary arterial pressure (mPAP) and the main PA diameter and compared the main PA diameters before and 3 months after LuTx.
Results
The main PA diameter was significantly correlated with the mPAP (
r
= 0.423,
P
< 0.001). Preoperatively, the mean main PA diameter in the PH group was significantly greater than that in the non-PH group. However, by 3 months after LuTx, the main PA diameter in the PH group had decreased significantly from 32.4 ± 6.7 to 26.9 ± 4.8 mm (
P
< 0.001), while that in the non-PH group had decreased minimally from 28.3 ± 4.9 to 26.4 ± 4.6 mm (
P
< 0.001), resulting in no significant difference in postoperative main PA diameters between the two groups.
Conclusions
The main PA diameter in recipients with PH was enlarged and correlated with the mPAP. The dilated main PA diameter in PH patients decreased shortly after LuTx.
This study aimed to investigate the relationship between changes in patellar height and clinical outcomes at a mean follow-up of 7.7 years (5 to 10) after fixed-bearing posterior-stabilized total ...knee arthroplasty (PS-TKA).
We retrospectively evaluated knee radiographs of 165 knees, which underwent fixed-bearing PS-TKA with patella resurfacing. The incidence of patella baja and changes in patellar height over a minimum of five years of follow-up were determined using Insall-Salvati ratio (ISR) measurement. We examined whether patella baja (ISR < 0.8) at final follow-up affected clinical outcomes, knee joint range of motion (ROM), and Knee Society Score (KSS). We also assessed inter- and intrarater reliability of ISR measurements and focused on the relationship between patellar height reduction beyond measurement error and clinical outcomes.
The ISR gradually decreased over five years after TKA, and finally 33 patients (20.0%) had patella baja. Patella baja at the final follow-up was not related to passive knee ROM or KSS. Interestingly, when we divided into two groups - patella baja and patella normal-alta (ISR ≥ 0.8) - the patella baja group already had a lower patellar height before surgery, compared with the patella normal-alta group. The ISR measurement error in this study was 0.17. Both passive knee flexion and KSS were significantly decreased in the group with a decrease in ISR of ≥ 0.17 at final follow-up.
Patellar height gradually decreased over five years of follow-up after TKA. The reduction in patellar height beyond measurement error following TKA was associated with lower clinical outcomes. Cite this article:
2021;2(12):1075-1081.
A 45-year-old man presented with severe left shoulder pain that was not associated with trauma. Plain radiography with the arm in an elevated position and ultrasonography demonstrated calcium ...deposits at the anterior acromial insertion site of left deltoid muscle. Conservative management could successfully relieve pain. At the 3-year follow-up, the calcification completely disappeared. To the best of our knowledge, calcium deposits at the acromial insertion site of the deltoid have not been reported in the literature. Clinicians who suspect calcific tendinitis but do not observe calcification around the rotator cuff should carefully palpate and examine other sites, such as the deltoid origin, and use ultrasonography or radiography.
Objectives
Although transcatheter aortic valve replacement (TAVR) is an excellent alternative procedure for high-risk patients with severe symptomatic aortic stenosis, it is often associated with ...life-threatening complications. We report on the emergency or elective use of veno-arterial extracorporeal membrane oxygenation (ECMO) to manage these complications.
Methods
Between December 2013 and February 2016, 46 patients underwent TAVR at our institution. Of these, 4 patients required emergency ECMO support and another 3 patients were electively placed on ECMO support at the start of the procedure. The mean age of the ECMO patients was 87.3 ± 3.6 years and all were female. The Society of Thoracic Surgeons-predicted risk of mortality score in these patients was 12.2 ± 6.2%.
Results
TAVR with ECMO was completed through the transapical approach in 6 patients, and the transfemoral approach in 1 patient. The arterial access route for ECMO was the femoral artery in 5, the external iliac artery in 1, and the subclavian artery in 1. Indications for the use of emergency ECMO were hemodynamic instability in 2, cardiogenic shock in 2, while indications for elective ECMO were severe pulmonary hypertension, impaired left ventricular function and a combination of these. There was no 30-day mortality, and the 1-year survival rate was 83.3% with no significant difference compared to patients without ECMO support.
Conclusion
The use of ECMO in very high-risk patients undergoing TAVR may increase safety and contribute to excellent outcomes. Although ECMO support is rarely needed in TAVR, a well-prepared treatment strategy by the heart team is mandatory.
Herein, we report a case of stent angioplasty for a kink in the pulmonary artery (PA) anastomosis soon after living-donor lobar lung transplantation (LDLLT). A 64-year-old man with idiopathic ...pulmonary fibrosis underwent bilateral LDLLT with lung donations from his daughters. After reperfusion, the left PA anastomosis showed a kink, which could not be corrected completely during surgery. Due to the kink in the left PA, and the relatively small donor grafts, the patient required extracorporeal membrane oxygenation) after LDLLT. Approximately 24 hours after reperfusion, stent angioplasty was performed, resulting in the patient being successfully weaned from extracorporeal membrane oxygenation on postoperative day 4.
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