An 82-year-old man with a secundum atrial septal defect (ASD) underwent transcatheter closure. The patient had a wide area of aortic and superior rim deficiency, with left ventricular diastolic ...dysfunction and moderate mitral regurgitation. These findings suggested the risk of both cardiac erosion and increased left atrial pressure after closure. To avoid cardiac erosion, a GORE® CARDIOFORM ASD (GCA) occluder (W.L. Gore & Associates, Flagstaff, AZ, USA) was considered an appropriate device in this patient. However, the possibility of excessively high left atrial pressure due to complete defect closure was a concern. Thus, we created a 4.5-mm fenestration using a surgical punch in the fabric membrane of a 44-mm GCA. The device was deployed in an appropriate position, and no significant elevation of pulmonary capillary wedge pressure was observed. One month after the closure, marked improvement in clinical symptoms and continuous flow through the fenestration were observed. This novel fenestration technique may contribute to expansion of the indications for transcatheter ASD closure in patients who require a GCA owing to an anatomically high risk of erosion accompanied by left ventricular diastolic dysfunction.
In elderly patients with left ventricular diastolic dysfunction, transcatheter atrial septal defect (ASD) closure is difficult because rapid resolution of an ASD shunt can cause an increase in left atrial pressure. Previous reports described the creation of a fenestration in the closure device. The use of a GORE® CARDIOFORM ASD (GCA) occluder can reduce the erosion risk; however, creating a stable fenestration is difficult. We developed a novel technique to create a stable fenestration in a GCA.
Both autologous costal cartilage (ACC) and alloplastic materials are widely used in rhinoplasty. However, there is controversy regarding which material can offer the ideal outcome and fewer ...complications.
The authors review current literature to evaluate complication and satisfaction rates with different materials used in rhinoplasty.
A comprehensive literature search of articles was conducted in Embase and PubMed published through April 14, 2017. We included only articles that used ACC, silicone, Medpor, Gore-Tex, or a combination of autologous and alloplastic materials in rhinoplasty. The primary outcomes analyzed were complications and postoperative satisfaction. After data extraction, meta-analysis using the random effect model was performed to summarize outcome parameters among different implant types.
Fifty-three articles met inclusion criteria and were included in the meta-analysis. The overall complication rate of ACC was 14%, which was higher than that of other implants. However, ACC was more commonly used in revision rhinoplasty. Medpor was associated with low overall complication rates (6%) and good aesthetic and functional outcomes.
Our analysis of available evidence suggests that ACC is preferred in revision rhinoplasty, which may explain its association with higher complication rates. In primary rhinoplasty, Medpor offered versatility in addition to low complication rates and good aesthetic and function outcomes. But its potential dramatic damage to the nasal tissue made secondary surgery extremely difficult. Our findings were limited by lack of high-quality evidence. Future studies with rigorous study design for head-to-head comparisons and longer follow-up are needed to establish clear guidelines for choosing the appropriate rhinoplasty graft material.
There are various techniques for additional placement of Gore Excluder Iliac Branch Endoprosthesis (IBE; W. L. Gore & Associates, Flagstaff, AZ) for common iliac artery aneurysms following ...endovascular aneurysm repair (EVAR). However, these techniques do not always allow for the placement of approved, dedicated, self-expanding stent grafts (SESGs), such as internal iliac components, for internal iliac artery bridging. Here, we introduce the “U-turn Dryseal sheath technique,” which can successfully place SESGs using only a unilateral femoral approach.
We inserted a modified 16-Fr Gore Dryseal Flex Introducer sheath (Dryseal sheath) and placed an iliac branch component. Then, we inserted a 12-Fr Dryseal sheath (33 cm) into a 16-Fr sheath and created a U-turn shape of the 12-Fr sheath toward the internal iliac artery portion using an ipsilateral U-turn wire. Next, we placed the SESG through the 12-Fr sheath via the shortest route.
We used this technique to perform IBE placement following EVAR in eight cases and successfully placed the SESGs in all cases without any type Ⅰ or Ⅲ endoleaks.
The U-turn Dryseal sheath technique allows the stable additional placement of IBE with approved SESGs for internal iliac artery bridging in selected cases.
To review current literature and experience with Gore-TexⓇ implant extrusion following medialization thyroplasty, as well as to report the unique case of Gore-TexⓇ implant extrusion following ...revision medialization thyroplasty.
Review of existing literature and description of personal experience with unique case of Gore-TexⓇ implant extrusion following revision medialization thyroplasty.
Review of existing literature found no prior reported cases of Gore-TexⓇ implant extrusion following revision medialization thyroplasty. Risk factors for implant extrusion include the pressure of the implant on insertion and the inability to secure the implant. Cases of implant extrusion can be managed operatively via an endoscopic or via an external open approach.
This is the first reported case of Gore-TexⓇ implant extrusion following revision medialization thyroplasty. Careful consideration should be given in revision medialization thyroplasty as additional implant material may cause increased pressure, a risk factor for implant extrusion.
Woe from wit Griboyedov, Aleksandr Sergeyevich; Hulick, Betsy
2020, 2020-04-14
eBook
Alexander Griboedov's Woe from Wit is one of the masterpieces of Russian drama. A verse comedy set in Moscow high society after the Napoleonic wars, it offers sharply drawn characters and clever ...repartee, mixing meticulously crafted banter and biting social critique.
Patent foramen ovale (PFO) is a flaplike opening in the fossa ovalis; between the septum primum and secundum. It is highly prevalent with approximately 25% of the population having a PFO. It is ...usually asymptomatic but can rarely cause paradoxical embolism leading to stroke and/or significant right to left shunting causing hypoxia. The complications of PFO closure with a percutaneous device include embolization, cardiac perforation, and thrombosis. These are all early complications. We describe the case of a patient with a history of PFO closure who had device thrombosis 3 years after implantation. Management includes anticoagulation with warfarin. Repeat cardiac imaging to document the resolution of thrombosis is recommended.
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