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Sample records for cardiac tamponade due

  1. Cardiac tamponade (image)

    MedlinePlus

    Cardiac tamponade is a condition involving compression of the heart caused by blood or fluid accumulation in the space ... they cannot adequately fill or pump blood. Cardiac tamponade is an emergency condition that requires hospitalization.

  2. Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma.

    PubMed

    Liang, Huai-min; Chen, Qiu-lin; Zhang, Er-yong; Hu, Jia

    2016-04-01

    Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62%. Delayed cardiac tamponade is a rare phenomenon that appears days or weeks after injury. Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.

  3. Cardiac Tamponade Revisited

    PubMed Central

    Ariyarajah, Vignendra; Spodick, David H.

    2007-01-01

    Cardiac tamponade is a life-threatening clinical syndrome that requires timely diagnosis. Herein, we present an instructive case of a patient who had cardiac tamponade. The condition went undiagnosed and resulted in the patient's death because almost all of the pathognomonic clinical findings of tamponade were unrecognized or not manifest. To better prepare health care professionals for similar challenges, we discuss the symptoms and clinical signs typical of cardiac tamponade, review the medical literature, and highlight current investigative methods that enable quick, efficient diagnosis and treatment. PMID:17948086

  4. Cardiac tamponade due to bleeding as a potential lethal complication after surgery for esophageal cancer.

    PubMed

    Ito, Shuhei; Morita, Masaru; Nanbara, Sho; Nakaji, Yu; Ando, Koji; Hiyoshi, Yukiharu; Okamoto, Tatsuro; Saeki, Hiroshi; Oki, Eiji; Kawanaka, Hirofumi; Tanoue, Yoshihisa; Maehara, Yoshihiko

    2015-01-01

    Cardiac tamponade, due to bleeding in the pericardial space after esophagectomy for esophageal cancer, is an extremely rare complication and may be associated with sudden hemodynamic instability that can lead to death unless there is prompt diagnosis and appropriate treatment. A 76-year-old man underwent sub-total esophagectomy via a cervico-right thoracoabdominal approach and reconstruction with a gastric tube through the retrosternal route. On postoperative day 4, the patient developed hypotension due to cardiac tamponade caused by bleeding into the pericardial space and he had a decreased level of consciousness. Pericardial resection and open drainage via a minimal left anterior thoracotomy was performed that resulted in hemodynamic improvement followed by an uneventful recovery. Cardiac tamponade due to postoperative bleeding, which is a rare but life-threatening complication, should be considered as a cause of hemodynamic instability in the early postoperative period after esophagectomy. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  5. Pyogenic Pericarditis and Cardiac Tamponade Due to Streptococcus anginosus in a Combat Theater

    PubMed Central

    Tripp, Michael S.; Franzos, Tracy; Wallace, Scott C.; Drinkwine, Benjamin J.; Villines, Todd C.

    2017-01-01

    Abstract Streptococcus anginosus group pericarditis is rare. A 24-year-old male soldier presented for care at a military clinic in Afghanistan with shock and cardiac tamponade requiring emergent pericardial drainage and aeromedical evacuation. We review the patient’s case, the need for serial pericardial drainage, and the available literature on this disorder. PMID:28470013

  6. Paradoxical hypertension with cardiac tamponade.

    PubMed

    Argulian, Edgar; Herzog, Eyal; Halpern, Dan G; Messerli, Franz H

    2012-10-01

    Subacute (medical) tamponade develops over a period of days or even weeks. Previous studies have shown that subacute tamponade is uncommonly associated with hypotension. On the contrary, many of those patients are indeed hypertensive at initial presentation. We sought to determine the prevalence and predictors of hypertensive cardiac tamponade and hemodynamic response to pericardial effusion drainage. We conducted a retrospective study of patients who underwent pericardial effusion drainage for subacute pericardial tamponade. Diagnosis of pericardial tamponade was established by the treating physician based on clinical data and supportive echocardiographic findings. Patients were defined as hypertensive if initial systolic blood pressure (BP) was ≥140 mm Hg. Thirty patients with subacute tamponade who underwent pericardial effusion drainage were included in the analysis. Eight patients (27%) were hypertensive with a mean systolic BP of 167 compared to 116 mm Hg in 22 nonhypertensive patients. Hypertensive patients with tamponade were more likely to have advanced renal disease (63% vs 14%, p <0.05) and pre-existing hypertension (88% vs 46, p <0.05) and less likely to have systemic malignancy (0 vs 41%, p <0.05). Systolic BP decreased significantly in patients with hypertensive tamponade after pericardial effusion drainage. Those results are consistent with previous studies with an estimated prevalence of hypertensive tamponade from 27% to 43%. In conclusion, a hypertensive response was observed in approximately 1/3 of patients with subacute pericardial tamponade. Relief of cardiac tamponade commonly resulted in a decrease in BP.

  7. Cardiac tamponade due to low-volume effusive constrictive pericarditis in a patient with uncontrolled type II autoimmune polyglandular syndrome.

    PubMed

    Palmer, William C; Kurklinsky, Andrew; Lane, Gary; Ussavarungsi, Kamonpun; Blackshear, Joseph L

    2014-03-01

    Type II autoimmune polyglandular syndrome (APS), a relatively common endocrine disorder, includes primary adrenal insufficiency coupled with type 1 diabetes mellitus and/or autoimmune primary hypothyroidism. Autoimmune serositis, an associated disease, may present as symptomatic pericardial effusion. We present a case of a 54-year old male with APS who developed pericarditis leading to cardiac tamponade with a subacute loculated effusion. After urgent pericardiocentesis intrapericardial pressure dropped to 0, while central venous pressures remain elevated, consistent with acute effusive constrictive pericarditis. Contrast computerized tomography confirmed increased pericardial contrast enhancement. The patient recovered after prolonged inotropic support and glucocorticoid administration. He re-accumulated the effusion 16 days later, requiring repeat pericardiocentesis. Effusive-constrictive pericarditis, an uncommon pericardial syndrome, is characterized by simultaneous pericardial inflammation and tamponade. Prior cases of APS associated with cardiac tamponade despite low volumes of effusion have been reported, albeit without good demonstration of hemodynamic findings. We report a case of APS with recurrent pericardial effusion due to pericarditis and marked hypotension with comprehensive clinical and hemodynamic assessment. These patients may require aggressive support with pericardiocentesis, inotropes, and hormone replacement therapy. They should be followed closely for recurrent tamponade.

  8. [Morgagni hernia causing cardiac tamponade].

    PubMed

    S Breinig; Paranon, S; Le Mandat, A; Galinier, P; Dulac, Y; Acar, P

    2010-10-01

    Morgagni hernia is a rare malformation (3% of diaphragmatic hernias). This hernia is usually asymptomatic in children. We report on a case revealed by an unusual complication. Severe cyanosis was due to right-to-left atrial shunt through the foramen ovale assessed by 2D echocardiography. Diagnosis of the Morgagni hernia was made with CT scan. The intrathoracic liver compressed the right chambers of the heart causing tamponade. Cardiac compression was reversed after surgery and replacement of the liver in the abdomen. Six months after the surgery, the infant was symptom-free with normal size right chambers of the heart.

  9. Cardiac Perforation and Tamponade During Transjugular Intrahepatic Portosystemic Shunt Placement

    SciTech Connect

    McCowan, Timothy C.; Hummel, Michael M.; Schmucker, Tracey; Goertzen, Timothy C.; Culp, William C.; Habbe, Thomas G.

    2000-07-15

    A patient developed acute severe hemodynamic compromise during a transjugular intrahepatic portosystemic shunt (TIPS) procedure for intractable ascites. Rapid clinical and radiographic evaluation of the patient disclosed pericardial blood and cardiac tamponade as the cause, probably due to right heart perforation from guidewire and catheter manipulation. The tamponade was successfully treated percutaneously, and the patient survived. Cardiac tamponade should be considered in the differential diagnosis of patients who develop hypotension during TIPS placement.

  10. Two cases of delayed cardiac tamponade due to pericarditis after pulmonary vein (PV) isolation for atrial fibrillation.

    PubMed

    Torihashi, Sadayoshi; Shiraishi, Hirokazu; Hamaoka, Tetsuro; Imai, Mikimasa; Kuroyanagi, Akira; Nakanishi, Naohiko; Nakamura, Takeshi; Yamano, Tetsuhiro; Matsumuro, Akiyoshi; Shirayama, Takeshi

    2015-01-01

    Catheter ablation is an established treatment for atrial fibrillation (AF). The incidence of major complications related to the procedure is reported to be 4.5%, and delayed cardiac tamponade (DCT) is a rare, although recently recognized, complication. However, the mechanisms underlying the development of DCT remain unclear. We herein report the cases of two men, both 49 years of age, who developed cardiac tamponade requiring pericardiocentesis a few weeks after undergoing pulmonary vein isolation for persistent AF. Physicians should explain to the patient the potential for DCT as a complication prior to performing catheter ablation and provide careful follow-up for at least a few weeks after the session.

  11. [Cardiac tamponade as the first symptom of lung cancer].

    PubMed

    Gromadziński, Leszek; Przelaskowski, Piotr; Januszko-Giergielewicz, Beata; Górny, Jerzy; Stankiewicz, Aleksander; Każarnowicz, Andrzej; Pruszczyk, Piotr

    2013-01-01

    Pericardial effusion is a relatively common clinical problem. It is, however, rarely the first symptom of cancer. Cardiac tamponade testifies to an advanced stage of cancer and is a negative prognostic factor. This paper presents a patient in whom cardiac tamponade was the first symptom of lung cancer. A 63-year-old male, habitual smoker, was admitted to hospital due to progressive symptoms of exertional dyspnoea lasting for a few days and chest pain. Echocardiographic examination revealed a large amount of fluid in the pericardium with echocardiographic signs of a life-threatening cardiac tamponade. The patient underwent pericardial puncture and additional imaging examinations. Lung adenocarcinoma was recognized as the underlying disease. Due to the recurrence of the life-threatening cardiac tamponade, video-assisted thoracoscopic pericardial fenestration was performed and systemic chemotherapy was introduced with good results.

  12. Cardiac tamponade presenting as refractory asthma.

    PubMed

    Rosen, Sasha

    2013-01-01

    Asthma has numerous etiologies, and successful treatment requires a proper diagnosis. Changes in weather and exposure to dust can make treatment of asthma difficult. This case exemplifies a diagnostic dilemma associated with bronchospasm; bronchospasm can have an occult cardiac etiology. Diagnosis can be particularly challenging in rural sub-Saharan Africa during the Harmattan, when winds are blowing sands from the Sahara into nearby villages, especially when radiographs are not available. This case is that of a 40-year-old female Ghanaian woman with a lifelong history of asthma. Although she has often had exacerbations of bronchospasm during the dusty Harmattan season, her bronchospasm was now refractory to usual treatments. X-rays were not available at the clinic in the rural city of Tamale, Ghana, and bedside ultrasound was utilized. She was found to have cardiac tamponade with secondary "cardiac asthma." After 750 cc of fluid was aspirated during a bedside pericardiocentesis, her bronchospasm immediately resolved. The cardiac effusion was due to previously unknown renal failure from hyper-tension. The patient was referred for dialysis and 1 year later was well without any recurrence of significant cardiac effusions. Healthcare providers should be wary of atypical non-pulmonary etiologies of bronchospasm, especially in cases where there is an inadequate response to usual treatment. Bedside ultrasound has great utility for the diagnosis of cardiac tamponade.

  13. [A case of cardiac tamponade due to malignant pericarditis with lung adenocarcinoma, effectively treated with pericardial drainage and pemetrexed plus cisplatin chemotherapy].

    PubMed

    Yoshida, Kazufumi; Teramoto, Shinji

    2015-01-01

    A 68-year-old man was diagnosed with non small cell lung cancer in May 2013. Although the patient was negative for EGFR mutation, he wished to undergo treatment with gefitinib and erlotinib as first-line therapy. However, one year later, he was admitted to our hospital because of cardiac tamponade due to malignant pericarditis. He received pericardial drainage, after which his condition was stabilized. He was diagnosed with lung adenocarcinoma by cytology of pericardial effusion and treated with pemetrexed plus cisplatin as second-line therapy. Thereafter, the malignant effusion was decreased and the primary lesion was regressed. He received six courses of chemotherapy, however, brain metastases and bone metastases appeared. The brain metastases were controlled with gamma knife radiosurgery and he received carboptatin-paclitaxel plus bevacizumab as third-line therapy. The patient is currently receiving chemotherapy without any recurrence of malignant pericarditis or cardiac tamponade.

  14. Cardiac tamponade - unusual clinical manifestation of undiagnosed malignant neoplasm.

    PubMed

    Perek, B; Tomaszewska, I; Stefaniak, S; Katynska, I; Jemielity, M

    2016-01-01

    Cardiac tamponade may be the first or predominant symptom of some pathologies but its etiology is not uncommonly unknown on admission to hospital. The purpose of this study was to evaluate the predominant causes of cardiac tamponade in previously healthy patients treated emergently in a single cardiac surgical center. The study involved 81 patients with the mean age of 58.1±16.0 years who underwent emergent subxyphoid pericardiotomy due to cardiac tamponade. Pericardial effusion was analyzed macro- and microscopically. Examinations done in the cardiac surgical department revealed pericarditis secondary to infection (n=17) or autoimmunologic processes (n=2) and malignancy in 18 patients (predominantly of the lungs (n=11)). Pericardial effusion obtained from patients with viral and autoimmunologic-induced pericarditis was straw-color and odorless while with bacterial infections dark yellow, iridescent and usually malodorous. Additional workup in the regional hospitals enabled to reveal malignant tumors in 29 patients, leukemia or lymphoma in 5 subjects. In all but one of the neoplastic cases, pericardial fluid was turbid and dark red or plummy. In 10 patients etiology of tamponade remained unknown. In conclusion, cardiac tamponade in previously healthy patients may be occasionally the predominant symptom of cancer, especially of the lungs. Macroscopic intraoperative appearance of pericardial fluid may be helpful in identification of causative condition of cardiac tamponade.

  15. Cause and Long-Term Outcome of Cardiac Tamponade.

    PubMed

    Sánchez-Enrique, Cristina; Nuñez-Gil, Iván J; Viana-Tejedor, Ana; De Agustín, Alberto; Vivas, David; Palacios-Rubio, Julián; Vilchez, Jean Paul; Cecconi, Alberto; Macaya, Carlos; Fernández-Ortiz, Antonio

    2016-02-15

    Cardiac tamponade is a life-threatening condition, whose current specific cause and outcome are unknown. Our purpose was to analyze it. We performed a retrospective observational study with prospective follow-up data including 136 consecutive patients admitted with diagnosis of cardiac tamponade, from 2003 to 2013. We thoroughly recorded variables as clinical features, drainage/pericardiocentesis, fluid characteristics, and long-term events (new cardiac tamponade ± death). The median age was 65 ± 17 years (55% men). In the baseline characteristics, 70% were no smokers, 12% were on anticoagulation, and 13 had suffered a previous myocardial infarction. In the preceding month, 15 patients had undergone a cardiac catheterization, 5 cardiac surgery, and 5 pacemaker insertion. Fever was observed in 16% of patients and 21% displayed other inflammatory symptoms. In 81% of patients, pericardiocentesis was needed. The fluid was hemorrhagic or a transudate in the majority, with positive cytology in 15% and bacteria in 3.7%. Main causes were malignancy (32%), infection (24%), idiopathic (16%), iatrogenic (15%), postmyocardial infarction (7%), uremic (4%), and other causes (2%). After a maximum follow-up of 10.4 years, cardiac tamponade recurred in 10% of the cases (62% in the neoplastic group) and the 48% of patients died (89% in the neoplastic cohort). In conclusion, most cardiac tamponades are due to malignancy, having this specific cause a poorer outcome, probably as a manifestation of an advanced disease. The rest of causes, after an aggressive intensive management, have a good prognosis, especially the iatrogenic.

  16. Giant Purulent Pericarditis with Cardiac Tamponade Due to Streptococcus intermedius Rapidly Progressing to Constriction.

    PubMed

    Tigen, Elif T; Sari, Ibrahim; Ak, Koray; Sert, Sena; Tigen, Kursat; Korten, Volkan

    2015-08-01

    Purulent pericardial effusion, although rare, is a life-threatening condition usually produced by the extension of a nearby bacterial infection locus or by blood dissemination in the immune-suppressed subjects or in the course of cardiothoracic surgery. Because clinical features of purulent pericardial effusion are often nonspecific, it can cause delay in diagnosis. Therefore, a high index of suspicion is required for timely diagnosis and management. Herein, we describe a case of giant purulent pericardial effusion due to Streptococcus intermedius with the history of bronchiectasis and pneumonia, which was successfully treated with pericardiocentesis via parasternal approach, appropriate antibiotics, and pericardiectomy.

  17. A severe penetrating cardiac injury in the absence of cardiac tamponade.

    PubMed

    Connelly, Tara M; Kolcow, Walenty; Veerasingam, Dave; DaCosta, Mark

    2016-10-26

    Penetrating cardiac injury is rare and frequently not survivable. Significant haemorrhage resulting in cardiac tamponade commonly ensues. Such cardiac tamponade is a clear clinical, radiological and sonographic indicator of significant underlying injury. In the absence of cardiac tamponade, diagnosis can be more challenging. In this case of a 26-year old sailor stabbed at sea, a significant pericardial effusion and cardiac tamponade did not occur despite an injury transversing the pericardium. Instead, the pericardial haemorrhage drained into the left pleural cavity resulting in a haemothorax. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion, a concomitant cerebrovascular event and a long delay from injury to appropriate medical treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate a primary chordae of the anterior mitral leaflet.

  18. Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest.

    PubMed

    Xing, Jingjun; Li, Shangxun; Zhang, Lin; Yang, Yi; Duan, Yijie; Li, Wenhe; Zhou, Yiwu

    2015-01-01

    Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients.

  19. Cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy.

    PubMed

    Goldstein, James A

    2004-09-01

    The pericardium envelopes the cardiac chambers and under physiological conditions exerts subtle functions, including mechanical effects that enhance normal ventricular interactions that contribute to balancing left and right cardiac outputs. Because the pericardium is non-compliant, conditions that cause intrapericardial crowding elevate intrapericardial pressure, which may be the mediator of adverse cardiac compressive effects. Elevated intrapericardial pressure may result from primary disease of the pericardium itself (tamponade or constriction) or from abrupt chamber dilatation (eg, right ventricular infarction). Regardless of the mechanism leading to increased intrapericardial pressure, the resultant pericardial constraint exerts adverse effects on cardiac filling and output. Constriction and restrictive cardiomyopathy share common pathophysiological and clinical features; their differentiation can be quite challenging. This review will consider the physiology of the normal pericardium and its dynamic interactions with the heart and review in detail the pathophysiology and clinical manifestations of cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy.

  20. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign.

    PubMed

    Dwivedi, Sankalp; Siddiqui, Fayez; Patel, Milan; Cardozo, Shaun

    2016-01-01

    Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.

  1. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign

    PubMed Central

    Patel, Milan

    2016-01-01

    Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization. PMID:27597903

  2. Chylopericardium presenting as cardiac tamponade secondary to mediastinal lymphangioma.

    PubMed

    Alsmady, M M; Aladaileh, M A; Al-Zaben, K; Saleem, M M; Alimoglu, O

    2016-11-01

    Mediastinal lymphangioma is a rare entity and chylopericardium is a rare form of pericardial effusion. We report a case of acute chylous cardiac tamponade due to a cervicomediastinal lymphangioma in a one-year-old boy. A chest x-ray revealed marked cardiac enlargement and echocardiography showed massive pericardial effusion. Emergency surgery was performed whereby a pericardial window was created, followed by excision of the lymphangioma.

  3. A Case of Primary Bacterial Pericarditis with Recurrent Cardiac Tamponade.

    PubMed

    Yoshizane, Takashi; Yamamoto, Takeshi; Hayashi, Hiroshi; Kitamura, Mitsunobu; Miyachi, Hideki; Hosokawa, Yusuke; Akutsu, Koichi; Shimizu, Wataru

    2017-01-01

    Cardiac tamponade is an important and potentially lethal complication of acute pericarditis. However, recurrence of cardiac tamponade is rare when it is treated appropriately. We present a 49-year-old man with bacterial pericarditis and recurrent cardiac tamponade, which was caused by the rupture of an upper part of the left atrium (LA). According to the autopsy findings, bacteremia from Staphylococcus aureus developed on a substrate of poorly controlled diabetes mellitus and spread to the pericardium via the blood. Subsequently, tissue necrosis developed from the pulmonary trunk and aorta to the LA, leading to recurrence of cardiac rupture and cardiac tamponade.

  4. Emergency room thoracotomy for acute traumatic cardiac tamponade caused by a blunt cardiac injury: A case report.

    PubMed

    Ishida, Kenichiro; Kinoshita, Yoshihiro; Iwasa, Nobutaka; Nakae, Masaro; Sakaki, Masayuki; Ieki, Yohei; Takahashi, Kyosuke; Shimahara, Yumiko; Sogabe, Taku; Shimono, Keiichiro; Noborio, Mitsuhiro; Sadamitsu, Daikai

    2017-01-01

    Traumatic blunt cardiac injuries have a high mortality rate, and prompt diagnosis and treatment can be lifesaving in cardiac tamponade. A 62-year-old man was transferred to the emergency department after a motor vehicle accident. He was hemodynamically unstable. A focused assessment with sonography in trauma (FAST) showed pericardial fluid with right ventricular collapse consistent with cardiac tamponade in the subxiphoid view. He collapsed despite a subxiphoid pericardiotomy. Owing to the ongoing hemodynamic instability, we performed a left anterolateral thoracotomy. Direct incision of the pericardium showed blood and clots within the pericardial space, indicating hemopericardium. The heart stroke and hemodynamic status recovered on removing the clot. Although the physical findings of cardiac tamponade are not always apparent in life-threatening acute cardiac tamponade after blunt trauma, FAST is a reliable tool for diagnosing and following cardiac tamponade. A median sternotomy is a standard approach for evaluating cardiac injury in hemodynamically stable patients with or without cardiopulmonary bypass. However, a left anterior thoracotomy was the fastest, simplest life-saving procedure considering the need for open-chest cardiac massage given our patient's life-threatening condition. A prompt diagnosis using FAST and treatment can be lifesaving in traumatic acute cardiac tamponade. A pericardiotomy via a thoracotomy is mandatory for lifesaving cardiac decompression in acute traumatic cardiac tamponade in cases of ineffective drainage due to clot formation within the pericardial space. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  5. Spontaneous Coronary Artery Dissection with Cardiac Tamponade.

    PubMed

    Goh, Anne C H; Lundstrom, Robert J

    2015-10-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.

  6. Cardiac Tamponade as Initial Presentation of Hodgkin Lymphoma

    PubMed Central

    Hajra, Adrija; Bandyopadhyay, Dhrubajyoti; Layek, Manas; Mukhopadhyay, Sabyasachi

    2015-01-01

    Cardiac involvement in malignant lymphoma is one of the least investigated subjects. Pericardial effusion is rarely symptomatic in patients of Hodgkin lymphoma (HL). Few case reports are available in the literature. There are case reports of diagnosed HL patients presenting with pericardial effusion. HL patients who present with recurrent episodes of pericardial effusion have also been reported. Pericardial effusion has also been reported in cases of non HL. However, pericardial effusion leading to cardiac tamponade as an initial presentation of HL is extremely rare. Very few such cases are there in the literature. Here, we present a case of a 26-year-old male patient who presented with cardiac tamponade and in due course was found to be a case of classical type of HL. This case is interesting because of its presentation. PMID:26900491

  7. Echocardiographic approach to cardiac tamponade in critically ill patients.

    PubMed

    McCanny, Peter; Colreavy, Frances

    2016-12-24

    Cardiac tamponade should be considered in a critically ill patient in whom the cause of haemodynamic shock is unclear. When considering tamponade, transthoracic echocardiography plays an essential role and is the initial investigation of choice. Diagnostic sensitivity of transthoracic echocardiography is dependent on image quality, and in some cases a transoesophageal approach may be required to confirm the diagnosis. Knowledge of the pathophysiology and echocardiographic features of cardiac tamponade are essential for the practicing Intensivist. This review presents an approach to the recognition, diagnosis, and treatment of cardiac tamponade in critically ill patients.

  8. A case of cardiac tamponade due to an isolated abscess in the ascending aorta of a pregnant woman with a history of intravenous substance abuse.

    PubMed

    Shattuck, Brandy; Livingstone, John

    2017-06-01

    We describe the case of a 23-year-old white female, 10-12 weeks pregnant, with a history of intravenous drug use and a recently diagnosed pneumonia, who was found deceased in her bed after a night of sleep. Although postmortem serum toxicology tested positive for alprazolam, tetrahydrocannabinol, and morphine, the ultimate cause of death was determined to be cardiac tamponade secondary to an isolated abscess in the ascending aorta. The patient had several risk factors for aortic rupture and cardiac tamponade including intravenous drug use, pneumonia, and pregnancy. However, an autopsy of the patient showed an isolated abscess of the ascending aorta without evidence of infective endocarditis, coronary artery rupture, aortic aneurysm, or aortic dissection making this an unusual case of cardiac tamponade. The aim of this case report is to encourage providers to obtain a tissue culture of any aortic abscesses so that the organisms involved can be identified. The identification of such organisms may help guide antimicrobial treatment in similar presentations in the future.

  9. Attention! Cardiac tamponade may be caused by underlying Castleman's disease.

    PubMed

    Atay, Hilmi; Kelkitli, Engin; Okuyucu, Muhammed; Yildiz, Levent; Turgut, Mehmet

    2015-05-01

    Castleman's disease is a rarely observed lymphoproliferative disease. In the literature, various signs and symptoms of the disease have been reported; one of these is secondary cardiac tamponade. We describe the case of a 41-year-old man who developed cardiac tamponade during examination, and who was later diagnosed with Castleman's disease, based on his lymph node biopsies.

  10. Subcapsular liver hematoma causing cardiac tamponade in HELLP syndrome.

    PubMed

    Kinthala, S; Fakoory, M; Greaves, T; Kandamaran, L; Thomas, H; Moe, S

    2012-07-01

    HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome is an obstetric complication with heterogeneous presentation, multisystem involvement and variable prognosis, but which usually resolves after delivery. We report a case of HELLP syndrome with subcapsular hematoma of the liver causing extrapericardial cardiac tamponade. The subcapsular hematoma and cardiac tamponade were managed conservatively.

  11. Cardiac tamponade as a presenting manifestation of severe hypothyroidism.

    PubMed

    Butala, Ashvin; Chaudhari, Shilpa; Sacerdote, Alan

    2013-02-05

    We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.

  12. Cardiac tamponade as initial presenting feature of primary hypothyroidism in the ED.

    PubMed

    Ekka, Meera; Ali, Imran; Aggarwal, Praveen; Jamshed, Nayer

    2014-06-01

    Pericardial effusion is commonly detected in patients with severe hypothyroidism and is typically mild; rarely, it may lead to cardiac tamponade. Cardiac tamponade with myxedema coma as initial presenting feature of previously unrecognized hypothyroidism is rare. This case highlights that previously undiagnosed hypothyroidism can manifest as myxedema coma with shock due to pericardial tamponade particularly in winters because a cold environment can precipitate myxedema.We report an undiagnosed case of primary hypothyroidism who presented to the emergency department for the first time with both cardiac tamponade and myxedema coma. This combination of cardiac tamponade and myxedema coma as the presenting features of primary hypothyroidism has rarely been reported in the literature. The patient was effectively managed with echocardiography-guided pericardiocentesis, levothyroxine, and external rewarming. Cardiac tamponade and myxedema coma as presenting features of previously unrecognized primary hypothyroidism are extremely rare. Urgent bedside echocardiography with pericardiocentesis along with thyroxine therapy is the treatment of choice. It is important to include hypothyroidism as the differential diagnosis in patients with cardiac tamponade and altered level of consciousness especially in winter months.

  13. Role of echocardiography in the treatment of cardiac tamponade.

    PubMed

    Chandraratna, P A N; Mohar, Dilbahar S; Sidarous, Peter F

    2014-08-01

    Accumulation of fluid within the pericardial sac results in elevation of intrapericardial pressure with consequent cardiac compression or tamponade. Cardiac tamponade is a life-threatening condition which requires urgent evacuation of pericardial effusion (PE). Current pericardial evacuation techniques and approaches are varied. Echocardiography provides valuable insights into identifying patients who are suitable candidates and further facilitates pericardiocentesis by improving guidance techniques. Several previous publications have provided excellent reviews of the pathophysiology of cardiac tamponade. We review the clinical presentation and role of echocardiography for diagnosis of tamponade. We focus on medical and surgical approaches for the removal of PE. Moreover, as the clinical and hemodynamic consequences of PE depend on the volume and the rate of accumulation of PE, we review the various scenarios of "small" PE resulting in cardiac tamponade.

  14. Cardiac tamponade, an unusual complication of acute pancreatitis.

    PubMed

    Veron Esquivel, Daniel; Aello, Gerardo; Batiz, Fernando; Fernandez Barrera, Alejandro

    2016-03-11

    A 41-year-old Hispanic man was admitted to our hospital with the diagnosis of acute pancreatitis due to hypertriglyceridemia. During his stay, he developed sudden haemodynamic instability and clinical presentation suggestive of cardiac tamponade. A transthoracic echocardiogram confirmed the diagnosis. Echocardiography-guided pericardiocentesis was performed with immediate haemodynamic improvement. The patient's condition underwent favourable evolution. The pancreatitis was resolved and a control transthoracic echocardiography was performed showing no pericardial effusion. The pathophysiology of this rare entity is unknown. Early diagnosis and treatment are crucial. Although pericardiocentesis is the treatment of choice, there have been a few reports of medical treatment with encouraging results. Although the association of acute pancreatitis and tamponade are anecdotal in literature, medics should be aware of this association in order to perform prompt diagnosis.

  15. Cough induced syncope: A hint to cardiac tamponade diagnosis

    PubMed Central

    Ramirez, Roberto; Lasam, Glenmore

    2017-01-01

    We report a case of a 75-year-old male with history of lung adenocarcinoma who presented with shortness of breath and frequent episodes of cough-induced syncope. A large pericardial effusion was found on echocardiogram suggestive of cardiac tamponade. Pericardiocentesis was done which improved the dyspnea and eventually resolved the syncope. There are only two other cases reported in the literature with cough-induced syncope in the setting of pericardial effusion or cardiac tamponade. Our clinical vignette also highlights the importance of pulsus paradoxus identification in patients with cough induced syncope to rule out cardiac tamponade since this is the most sensitive physical finding for its diagnosis. PMID:28603595

  16. Cough induced syncope: A hint to cardiac tamponade diagnosis.

    PubMed

    Ramirez, Roberto; Lasam, Glenmore

    2017-05-26

    We report a case of a 75-year-old male with history of lung adenocarcinoma who presented with shortness of breath and frequent episodes of cough-induced syncope. A large pericardial effusion was found on echocardiogram suggestive of cardiac tamponade. Pericardiocentesis was done which improved the dyspnea and eventually resolved the syncope. There are only two other cases reported in the literature with cough-induced syncope in the setting of pericardial effusion or cardiac tamponade. Our clinical vignette also highlights the importance of pulsus paradoxus identification in patients with cough induced syncope to rule out cardiac tamponade since this is the most sensitive physical finding for its diagnosis.

  17. Cardiac tamponade masquerading as gastritis: a case report.

    PubMed

    Ahmed, Abuzaid; Harsha, Tella Sri; Hamza, Tantoush; Allen, Ameri; Mohamed, Elkhashab

    2014-07-30

    Pericardial effusion and cardiac tamponade can develop in patients with virtually any condition that affects the pericardium. A high index of suspicion with proper diagnostic scheme can lessen the concomitant morbidity and mortality. Although cardiac tamponade mimics many medical conditions, internists and primary care physicians should be aware of the physiological and clinical aspects of the disease spectrum. A 31-year-old Caucasian man, with no significant past medical history, presented to our emergency room with acute upper abdominal heaviness of 2 hours' duration after drinking excessive amounts of alcohol in a short period of time (binge drinking). The coexistence of recent alcohol binge drinking and nonspecific abdominal complaints usually presume a diagnosis of gastritis in our daily encounters in the absence of hepatic, biliary or pancreatic derangements. We present a case in which the presenting abdominal pain turned out to be related to cardiac tamponade. Cardiac tamponade is a sort of cardiogenic shock and is a medical emergency. Clinicians should understand the cardiac tamponade physiology, especially in cases without large pericardial effusion, and correlate the signs of clinical tamponade together with the echocardiographic findings. Drainage of cardiac tamponade is life-saving. A high index of suspicion with proper diagnostic arcades lessens the concomitant morbidity and mortality.

  18. An unusual case of cardiac tamponade: ruptured subaortic diverticulum.

    PubMed

    Salemi, Arash; Lee, Ben; Ivascu, Natalia; Webber, Geoffrey; Paul, Subroto

    2010-05-01

    Cardiac diverticula are rare congenital anomalies found as outpouchings from various chambers of the heart. We present a case of a diverticulum arising from the membranous septum with free rupture into the pericardial space and tamponade.

  19. Rapid progression to cardiac tamponade in Erdheim-Chester disease despite treatment with interferon alpha.

    PubMed

    Nakhleh, Afif; Slobodin, Gleb; Elias, Nizar; Bejar, Jacob; Odeh, Majed

    2016-07-01

    Erdheim-Chester disease (ECD) is a rare form of non-Langerhans histiocytosis with heterogeneous clinical manifestations. The most common presentation is bone pains typically involving the long bones. Approximately 75% of the patients develop extraskeletal involvement. Cardiac involvement is seen in up to 45% of the patients, and although, pericardial involvement is the most common cardiac pathology of this rare disease, cardiac tamponade due to ECD has been very rarely reported. We describe a case of a patient found to have ECD with multi-organ involvement and small pericardial effusion, which progressed to cardiac tamponade despite treatment with interferon alpha.

  20. Acute pericarditis with cardiac tamponade induced by pacemaker implantation.

    PubMed

    Shingaki, Masami; Kobayashi, Yutaka; Suzuki, Haruo

    2015-11-01

    An 87-year-old woman was diagnosed with third-degree atrioventricular block and underwent pacemaker implantation. On postoperative day 12, she experienced cardiac tamponade that was suspected on computed tomography to be caused by lead perforation; therefore, we performed open-heart surgery. However, we could not identify a perforation site on the heart, and drained a 400-mL exudative pericardial effusion. Subsequently, we diagnosed the pericardial effusion as due to pericarditis induced by pacemaker implantation. It is sometimes difficult to distinguish pericarditis from pacemaker lead perforation, so both should be included in the differential diagnosis.

  1. Cardiac tamponade caused by migration of a swallowed sewing needle.

    PubMed

    Vesna, Djokić; Tatjana, Atanasijević; Slobodan, Savić; Slobodan, Nikolić

    2004-01-28

    The case of a 20-year-old female prisoner who died due to cardiac tamponade caused by a swallowed sewing needle migration is reported. According to the autopsy report and complete analysis of medical records, the migration of the swallowed needle was reconstructed: from esophagus and stomach, through diaphragm and pericardium up to the left heart ventricle, where the needle was found at the autopsy. The case is very interesting and unique: there has been no similar case described in medical literature so far.

  2. Invasive hemodynamics of constrictive pericarditis, restrictive cardiomyopathy, and cardiac tamponade.

    PubMed

    Sorajja, Paul

    2011-05-01

    Cardiac catheterization historically has been the principal diagnostic modality for the evaluation of constrictive pericarditis, restrictive cardiomyopathy, and cardiac tamponade. In many instances, the hemodynamic consequences of these disorders can be accurately delineated with non-invasive methods. However, cardiac catheterization should be considered when there is a discrepancy between the clinical and non-invasive imaging data, and particularly may be required for the evaluation of patients with complex hemodynamic disorders. This report describes the methods and clinical utility of invasive hemodynamic catheterization for the evaluation of constriction, restriction, and cardiac tamponade.

  3. Cardiac tamponade as a complication of parenteral nutrition.

    PubMed

    Garcia, Diego Paim Carvalho; Neto, Clarissa Santos; Hubner, Pablo Nelson Valle; Furtado, Thiago de Almeida; Petroianu, Andy; Alberti, Luiz Ronaldo

    2015-01-01

    Complications arising from the use of central venous catheters are numerous, but cardiac tamponade is a complication well defined, very rare and often fatal. The mortality rate is 47-77% in the literature. We report a case of successful diagnosis and treatment of cardiac tamponade by parenteral nutrition in a 31-year-old female. There are only few cases of cardiac tamponade reported in the world literature since 1958. The true incidence is unclear and the most cases occur in children. Despite the rarity of this condition, it has a high mortality rate. The clinical findings are pain and discomfort in the epigastrium and chest region, nausea, dyspnea, tachycardia, distended jugular veins, paradoxical pulse, hypotension, electrocardiographic tracing signals with low voltage and enlargement of cardiac area. The immediate diagnosis and the treatment of cardiac tamponade are capital for patient survival. Cardiac tamponade should be suspected among patients with sudden onset of shock in use of parenteral nutrition, and therefore immediately treated. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Cardiac tamponade as a complication of parenteral nutrition

    PubMed Central

    Garcia, Diego Paim Carvalho; Neto, Clarissa Santos; Hubner, Pablo Nelson Valle; Furtado, Thiago de Almeida; Petroianu, Andy; Alberti, Luiz Ronaldo

    2015-01-01

    Introduction Complications arising from the use of central venous catheters are numerous, but cardiac tamponade is a complication well defined, very rare and often fatal. The mortality rate is 47–77% in the literature. Presentation of case We report a case of successful diagnosis and treatment of cardiac tamponade by parenteral nutrition in a 31-year-old female. Discussion There are only few cases of cardiac tamponade reported in the world literature since 1958. The true incidence is unclear and the most cases occur in children. Despite the rarity of this condition, it has a high mortality rate. The clinical findings are pain and discomfort in the epigastrium and chest region, nausea, dyspnea, tachycardia, distended jugular veins, paradoxical pulse, hypotension, electrocardiographic tracing signals with low voltage and enlargement of cardiac area. The immediate diagnosis and the treatment of cardiac tamponade are capital for patient survival. Conclusion Cardiac tamponade should be suspected among patients with sudden onset of shock in use of parenteral nutrition, and therefore immediately treated. PMID:25681814

  5. Cardiac tamponade as an initial manifestation of systemic lupus erythematosus.

    PubMed

    Carrion, Diego M; Carrion, Andres F

    2012-06-12

    Clinical manifestations of pericardial disease may precede other signs and symptoms associated with systemic lupus erythematosus. Although pericardial effusion is one of the most common cardiac problems in patients with systemic lupus erythematosus, haemodynamically significant effusions manifesting as cardiac tamponade are rare and require prompt diagnosis and treatment.

  6. Optimal fluid amount for haemodynamic benefit in cardiac tamponade.

    PubMed

    Singh, Vikas; Dwivedi, Sudhanshu K; Chandra, Sharad; Sanguri, Ritesh; Sethi, Rishi; Puri, Aniket; Narain, Varun S; Saran, Ram K

    2014-06-01

    The present study was undertaken to assess the effect of volume expansion on cardiac haemodynamics in patients with cardiac tamponade and to ascertain an optimum amount of fluid that can produce the maximum benefit in tamponade patients. In patients of tamponade, interim measures may occasionally be needed when facilities for pericardial fluid drainage are not immediately available. Intravascular volume expansion is the most commonly advocated measure but with limited scientific data. Patients ≥16 years of age with large circumferential pericardial effusion and showing echocardiographic evidence of cardiac tamponade were included. Haemodynamically unstable patients, those with structural heart diseases, pregnant females, and those undergoing haemodialysis were excluded. The various haemodynamic parameters were measured using Edwards Life Sciences Vigilance II monitor, Swan Ganz CCO catheter, intrapericardial access, and arterial access at baseline and after each 250 ml fluid over 5 min (total 1000 ml in 20 min). The entire fluid was drained at the end of the procedure. A total of 28 patients constituted the study group, all of whom exhibited an improvement in haemodynamic parameters (systolic blood pressure, cardiac output) and a rise of the intracardiac pressures with volume expansion. Significant (p<0.05 ) increase in systolic and diastolic blood pressure, cardiac output, and cardiac index occurred up to 250-500 ml bracket; above which the significance was lost. A higher resting heart rate, a lower SBP at presentation, a higher initial intrapericardial pressure, and a lower cardiac index were the statistically significant predictors of a >15% increase in cardiac index. Rapid infusion of as little as 250 ml intravenous normal saline may improve the cardiac haemodynamics in a significant proportion of tamponade patients.

  7. Cardiac tamponade caused by central venous catheter in two newborns.

    PubMed

    Monteiro, Andrey José; Canale, Leonardo Secchin; Barbosa, Rodrigo; Méier, Milton

    2008-01-01

    Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.

  8. Conventional Coronary Angiography Induced Takotsubo Cardiomyopathy Complicated with Cardiac Tamponade

    PubMed Central

    Kang, Min Gyu; Kim, Kye-Hwan; Koh, Jin-Sin; Jeong, Young-Hoon; Hwang, Jin-Yong

    2017-01-01

    Takotsubo cardiomyopathy (TCM) is a transient left ventricular dysfunction that typically occurs after emotional or physical stress. TCM has a benign prognosis and serious complications are uncommon. However, though very rarely reported, cardiac tamponade has occurred on some occasions. We hereby report the case of a 70-year-old woman who underwent coronary angiography with an ergonovine provocation test to evaluate recurrent chest pain and was readmitted 7 days later presenting with TCM, followed by left ventricular outflow tract obstruction and cardiac tamponade.

  9. Cardiac tamponade presenting as early manifestation in dengue fever.

    PubMed

    Bendwal, Suresh; Malviya, Kavita; Jatav, O P; Malviya, Kapil

    2014-03-01

    Dengue fever (DF) is an outbreak prone viral disease transmitted by aedes mosquitoes. It is often associated with evidence of plasma leakage due to increased vascular permeability manifested by pleural effusion, ascites, hypoproteinaemia and pericardial effusion. Cases of small pericardial effusion have been reported in association with dengue fever, largely with dengue haemorrhagic fever (DHF) during epidemic outbreaks. Dengue may rarely present with cardiac tamponade as early manifestation and urgent pericardiocentesis is life saving. A 34 year old male presented with low grade fever, headache, myalgia and breathlessness. Echocardiography revealed large pericardial effusion with right ventricular diagnostic collapse requiring urgent drainage. Subsequently patient improved. Dengue serology (both IgM and IgG) was reported as markedly elevated supporting a diagnosis of classic dengue fever.

  10. Cardiac tamponade as initial presentation in systemic lupus erythematosus.

    PubMed

    Jawaid, Ambreen; Almas, Aysha

    2014-05-01

    Systemic Lupus Erythematosus (SLE) is one of the many diseases known as 'the great imitators' because it can have diverse presentations and so is misunderstood for other illnesses. This case illustrates a 19 years old girl with SLE who presented as cardiac tamponade which is a rare feature of lupus pericarditis requiring medical and surgical treatment. Even after pericardiocentesis and steroid therapy there was a re-accumulation of the pericardial fluid resulting in cardiac tamponade which led to pericardial window formation. This case draws attention to the need to consider the diagnosis of tamponade in patients with connective tissue disease and dyspnea or hemodynamic compromise. It also outlines the treatment options available so that surgical referral, if needed, can be done timely for this rare but life threatening manifestation of SLE.

  11. Cardiac tamponade: an initial presentation of SLE

    PubMed Central

    Cheng, Wilson; Balachandar, Ramya; Mistry, Paresh

    2013-01-01

    A 45-year-old woman presented with dyspnoea, chest pain, orthopnoea and bilateral leg oedema. On admission, she was found to have nephrotic syndrome and global pericardial effusion with impending tamponade for which pericardiocentesis was performed. The diagnosis of systemic lupus erythematosus was made based on the clinical and biochemical findings. She was also started on dialysis and immunosuppressants for lupus nephritis. PMID:23868025

  12. A new scoring system for the triage of cardiac tamponade.

    PubMed

    Imazio, Massimo; Adler, Yehuda; Ristić, Arsen D; Charron, Philippe

    2015-03-01

    Prompt recognition of cardiac tamponade is critical since the underlying hemodynamic disorder can lead to death if not resolved by percutaneous or surgical drainage of the pericardium. Nevertheless, the management of cardiac tamponade can be challenging because of the lack of the validated criteria for the risk stratification that should guide clinicians in the decision-making process. The Working Group on Myocardial and Pericardial Diseases issued this position statement in order to reply to specific questions: Which patients need immediate drainage of the pericardial effusion?; Is echocardiography sufficient for guidance of pericardiocentesis or should patient be taken to the cardiac catheterization laboratory?; Who should be transferred to specialized/tertiary institution or surgical service?; What type of medical support is necessary during transportation? Current European guidelines published in 2004 do not cover these issues and no additional guidelines are available from major medical and cardiology societies.

  13. Case report and literature review: cardiac tamponade as a complication of pericardial extramedullary hematopoiesis.

    PubMed

    Mahadevan, Navin R; Morgan, Elizabeth A; Mitchell, Richard N

    2016-01-01

    Pericardial effusion can cause cardiac tamponade physiology with resultant cardiogenic shock and death. Myelofibrosis, the replacement of marrow cavity by fibrous connective tissue, is a secondary complication of a group of disorders known as myeloproliferative neoplasms, which are clonal processes characterized by abnormal proliferative growth of one or more hematopoietic lineages. One consequence of myelofibrosis is the development of hematopoiesis at other anatomic sites, most commonly the spleen and liver, a phenomenon known as extramedullary hematopoiesis (EMH). Herein we report a case of a man who died from pericardial tamponade due to a subacute pericardial effusion secondary to EMH in the pericardium in the setting of myelofibrosis. This case highlights an unusual etiology for pericardial effusion and tamponade that should be considered in cases of myelofibrosis and stimulates a discussion regarding the mechanisms and anatomic distribution of EMH.

  14. Dasatinib Induced Cardiac Tamponade-A Rare Association

    PubMed Central

    Wattal, Sushant; Rao, Mugula Sudhakar; Chandra, GS Naveen; Shetty, K Ranjan

    2017-01-01

    Drug induced cardiac tamponade is rare. Therapy for imatinib resistant Chronic Myeloid Leukaemia (CML) is an emerging challenge in clinical haematology. For such cases treatment with second line tyrosine kinase inhibitors like dasatinib has resulted in improved outcomes. Dasatinib is a second line BCR-ABL tyrosine kinase inhibitor used in the treatment of Imatinib resistant or Imatinib intolerant CML. Dasatinib has been reported to cause severe pericardial effusions in 1% of all patients in clinical studies. We report here a case of Dasatinib induced cardiac tamponade in whom all other causes of pericardial effusion were excluded and whose clinical symptoms as well as effusion showed no recurrence one month after the drug was stopped.

  15. Role of a 12-lead electrocardiogram in the diagnosis of cardiac tamponade as diagnosed by transthoracic echocardiography in patients with malignant pericardial effusion.

    PubMed

    Argula, Rahul G; Negi, Smita I; Banchs, Jose; Yusuf, Syed Wamique

    2015-03-01

    Few studies have looked at the utility of the 12-lead electrocardiogram (ECG) in diagnosing cardiac tamponade in malignant pericardial effusion (PE). The aim of this study was to determine the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of 12-lead ECG in diagnosing cardiac tamponade in PE. Abnormalities on a 12 lead ECG can be used to diagnose or exclude cardiac tamponade in patients with malignant PE. Using echocardiography as the gold standard for diagnosis of cardiac tamponade, we determined the Se, Sp, PPV, and NPV for individual and combinations of the 3 ECG abnormalities (low-voltage complexes, electrical alternans, and sinus tachycardia). For PEs of all sizes, the Se, Sp, PPV, and NPV for detecting cardiac tamponade were: low-voltage complexes (56%, 74%, 81%, 46%), electrical alternans (23%, 98%, 95%, 39%), and sinus tachycardia (76%, 60%, 79%, 56%), respectively. Presence of all 3 and any of the 3 ECG abnormalities had a Se, Sp, PPV, and NPV of 8%, 100%, 100%, 36% and 89%, 47%, 77%, 69%, respectively, for cardiac tamponade. The odds ratios for cardiac tamponade in PE were 3.7 (95% confidence interval [CI]: 1.65-8.30) for low-voltage complexes, 12.3 (95% CI: 1.58-95.17) for electrical alternans, and 4.9 (95% CI: 2.22-10.80) for sinus tachycardia. Presence of any of 3 ECG abnormalities had an odds ratio of 7.3 (95% CI: 2.9-18.1) for cardiac tamponade. In malignant PE, combination of ECG abnormalities can supplement clinical examination in the diagnosis of echocardiographic cardiac tamponade. Due to its low NPV, 12-lead ECG cannot be used as a screening tool to exclude cardiac tamponade with malignant PE. © 2015 Wiley Periodicals, Inc.

  16. Clinical and cytological correlations in pericardial effusions with cardiac tamponade.

    PubMed

    Petcu, D P; Petcu, C; Popescu, Carmen Florina; Bătăiosu, C; Alexandru, D

    2009-01-01

    We studied 27 patients diagnosed with pericardial effusion with cardiac tamponade on which pericardiocentesis was performed. The purpose of the study was to evaluate the benefits and limits of the cytological examination of the pericardial liquid in the etiological diagnosis and the treatment of patients with cardiac tamponade. The pericardial liquid taken was examined macroscopically, biochemically (content of proteins, glucose, cholesterol, and LDH), cytologically (MGG stained smears from pericardial liquid) and bacteriologically. The obtained results were compared to the clinical data, the laboratory and paraclinical tests, to differentiate the cause and therapeutically procedure. The cardiac tamponade remitted after pericardiocentesis in all patients. The pericardial liquid was exudate (Ligth criteria) in 82% of all patients. The cytological examination of the pericardial liquid showed malignant smear in 40.74% of the patients, smear of the TBC specific inflammation type in 7.40% patients, smear of non-specific inflammation type in 25.94% of patients, reactive type smear in 25.9% of patients.

  17. Echocardiographic Evaluation of Pericardial Effusion and Cardiac Tamponade

    PubMed Central

    Pérez-Casares, Alejandro; Cesar, Sergi; Brunet-Garcia, Laia; Sanchez-de-Toledo, Joan

    2017-01-01

    Pericardial effusion (PEff) is defined by an increase in the physiological amount of fluid within the pericardial space. It can appear following different medical conditions, mainly related to inflammation and cardiac surgery. Cardiac tamponade is a critical condition that occurs after sudden and/or excessive accumulation of fluid in the pericardial space that restricts appropriate filling of the cardiac chambers disturbing normal hemodynamics and ultimately causing hypotension and cardiac arrest. It is, therefore, a life-threatening condition that must be diagnosed as soon as possible for correct treatment and management. Echocardiographic evaluation of PEff is paramount for timely and appropriate diagnosis and management. A structured echocardiographic approach including two-dimensional, M-mode, and Doppler echocardiographic evaluation assessing (i) quantity and quality of pericardial fluid, (ii) collapse of cardiac chambers, (iii) respiratory variation of the ventricular diameters, (iv) inferior vena cava collapsibility, and (v) flow patterns in atrioventricular valves should give the bedside clinician the necessary information to appropriately manage PEff. Here, we review these key echocardiographic signs that will ensure an appropriate assessment of a patient with PEff and/or cardiac tamponade. PMID:28484689

  18. Cardiac tamponade as an initial presentation for systemic lupus erythematosus.

    PubMed

    Li, William; Frohwein, Thomas; Ong, Kenneth

    2017-08-01

    Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease which follows a relapsing and remitting course that can manifest in any organ system. While classic manifestations consist of arthralgia, myalgia, frank arthritis, a malar rash and renal failure to name a few, cardiac tamponade, however, is a far less common and far more dangerous presentation. We highlight the case of a 61year-old male with complaints of acute onset shortness of breath and generalized body aches associated with a fever and chills in the ER. A bedside echocardiogram revealed a significant pericardial effusion concerning for pericardial tamponade. An emergent pericardiocentesis performed drained 800mL of serosanguinous fluid. While denying a history of any rash, photosensitivity, oral ulcers, or seizures, his physical examination did reveal metacarpal phalangeal joint swelling along with noted pulsus paradoxus of 15-200mmHg. Subsequent lab work revealed ANA titer of 1:630 and anti-DS DNA antibody level of 256IU/mL consistent with SLE. This case highlights cardiac tamponade as a rare but life-threatening presentation for SLE and raises the need to keep it in the differential when assessing patients presenting with pertinent exam findings. Published by Elsevier Inc.

  19. Cardiac tamponade as an independent condition affecting the relationship between the plasma B-type natriuretic peptide levels and cardiac function.

    PubMed

    Minai, Kosuke; Komukai, Kimiaki; Arase, Satoshi; Nagoshi, Tomohisa; Matsuo, Seiichiro; Ogawa, Kazuo; Kayama, Yosuke; Inada, Keiichi; Tanigawa, Shin-Ichi; Takemoto, Tomoyuki; Sekiyama, Hiroshi; Date, Taro; Ogawa, Takayuki; Taniguchi, Ikuo; Yoshimura, Michihiro

    2013-07-01

    Plasma B-type natriuretic peptide (BNP) is finely regulated by the cardiac function and several extracardiac factors. Therefore, the relationship between the plasma BNP levels and the severity of heart failure sometimes seems inconsistent. The purpose of the present study was to investigate the plasma BNP levels in patients with cardiac tamponade and their changes after pericardial drainage. This study included 14 patients with cardiac tamponade who underwent pericardiocentesis. The cardiac tamponade was due to malignant diseases in 13 patients and uremia in 1 patient. The plasma BNP levels were measured before and 24-48 h after drainage. Although the patients reported severe symptoms of heart failure, their plasma BNP levels were only 71.2 ± 11.1 pg/ml before drainage. After appropriate drainage, the plasma BNP levels increased to 186.0 ± 22.5 pg/ml, which was significantly higher than that before drainage (P = 0.0002). In patients with cardiac tamponade, the plasma BNP levels were low, probably because of impaired ventricular stretching, and the levels significantly increased in response to the primary condition after drainage. This study demonstrates an additional condition that affects the relationship between the plasma BNP levels and cardiac function. If inconsistency is seen in the relationship between the plasma BNP levels and clinical signs of heart failure, the presence of cardiac tamponade should therefore be considered.

  20. Using a human cardiovascular-respiratory model to characterize cardiac tamponade and pulsus paradoxus

    PubMed Central

    Ramachandran, Deepa; Luo, Chuan; Ma, Tony S; Clark, John W

    2009-01-01

    competition for fixed filling space. We find that simulating active septal contraction is important in modeling ventricular interaction. The model predicts increased arterio-venous CO2 due to hypoperfusion, and we explore implications of respiratory pattern in tamponade. Conclusion Our modeling study of cardiac tamponade dissects the roles played by septal motion, atrioventricular and right-left ventricular interactions, pulmonary blood pooling, and the depth of respiration. The study fully describes the physiological basis of pulsus paradoxus. Our detailed analysis provides biophysically-based insights helpful for future experimental and clinical study of cardiac tamponade and related pericardial diseases. PMID:19656411

  1. Hashimoto thyroiditis with an unusual presentation of cardiac tamponade in Noonan syndrome.

    PubMed

    Lee, Mi Ji; Kim, Byung Young; Ma, Jae Sook; Choi, Young Earl; Kim, Young Ok; Cho, Hwa Jin; Kim, Chan Jong

    2016-11-01

    Noonan syndrome is an autosomal dominant, multisystem disorder. Autoimmune thyroiditis with hypothyroidism is an infrequent feature in patients with Noonan syndrome. A 16-year-old boy was admitted because of chest discomfort and dyspnea; an echocardiogram revealed pericardial effusion. Additional investigations led to a diagnosis of severe hypothyroidism due to Hashimoto thyroiditis. The patient was treated with L-thyroxine at 0.15 mg daily. However, during admission, he developed symptoms of cardiac tamponade. Closed pericardiostomy was performed, after which the patient's chest discomfort improved, and his vital signs stabilized. Herein, we report a case of an adolescent with Noonan syndrome, who was diagnosed with Hashimoto thyroiditis with an unusual presentation of cardiac tamponade.

  2. Disseminated pneumococcal infection with pericarditis and cardiac tamponade: report of one case.

    PubMed

    Foo, Ning-Hui; Chen, Chun-Ta; Chow, Julie Chi

    2005-01-01

    A 1-year-5-months-old female who had cough, rhinorrhea and prolonged fever for 19 days was admitted to the intensive care unit due to exertional dyspnea. She was intubated promptly in virtue of hypotension and cyanosis. The physical examination demonstrated diminished breathing sound over the right lung and distant heart sound; echocardiogram showed cardiac tamponade. Further X ray study showed right hydropneumothorax and cardiomegaly. Pericardiocentesis and chest thoracostomy were performed, and subsequently all the cultures showed growth of Streptococcus pneumoniae. Antibiotics therapy was started promptly after admission. Further investigation indicated osteomyelitis of the right ilium, so that surgical debridement was done. The patient was discharged 54 days later with complete recovery. After following up for 18 months, no restrictive heart disease developed. Purulent pericarditis with cardiac tamponade is an extremely rare complication of pneumococcal infection.

  3. Hashimoto thyroiditis with an unusual presentation of cardiac tamponade in Noonan syndrome

    PubMed Central

    Lee, Mi Ji; Kim, Byung Young; Ma, Jae Sook; Choi, Young Earl; Kim, Young Ok; Kim, Chan Jong

    2016-01-01

    Noonan syndrome is an autosomal dominant, multisystem disorder. Autoimmune thyroiditis with hypothyroidism is an infrequent feature in patients with Noonan syndrome. A 16-year-old boy was admitted because of chest discomfort and dyspnea; an echocardiogram revealed pericardial effusion. Additional investigations led to a diagnosis of severe hypothyroidism due to Hashimoto thyroiditis. The patient was treated with L-thyroxine at 0.15 mg daily. However, during admission, he developed symptoms of cardiac tamponade. Closed pericardiostomy was performed, after which the patient's chest discomfort improved, and his vital signs stabilized. Herein, we report a case of an adolescent with Noonan syndrome, who was diagnosed with Hashimoto thyroiditis with an unusual presentation of cardiac tamponade. PMID:28018461

  4. Pneumopericardium Leading to Cardiac Tamponade in a Patient with Lung Cancer.

    PubMed

    Al-Taweel, Ahmad; Ayub, Adil; Huang, Chyun-Yin; Rehmani, Sadiq; Al-Ayoubi, Adnan; Bhora, Faiz Y

    2016-12-01

    Pneumopericardium resulting in cardiac tamponade in patients with lung cancer is not documented. We report a case of squamous cell carcinoma of the lung complicated by pneumopericardium and subsequent cardiac tamponade. The patient underwent an urgent pericardial window with rapid improvement in symptoms. We discuss the possible pathogenesis and treatment options for this rare condition.

  5. Early and long-term outcomes of pericardiotomy in the treatment of primary cardiac tamponade

    PubMed Central

    Tomaszewska, Iga; Stefaniak, Sebastian; Bartczak, Agnieszka; Jemielity, Marek

    2015-01-01

    Introduction Cardiac tamponade is a life-threatening clinical entity that requires emergent treatment. A variety of therapeutic methods have been applied. The purpose of this retrospective analysis was to study the efficacy of emergent surgical pericardiotomy in both the relief of cardiac tamponade and in the prevention of recurrence of pericardial effusion. Material and methods This study involved 90 consecutive patients (58 males and 32 females) with a mean age of 57.4 ± 14.1 years, who underwent emergent pericardiotomy in the years 2006 to 2011 due to symptomatic primary cardiac tamponade. At the end of the follow-up period all living subjects had control echocardiographic examination. Survival analysis was performed with the use of the Kaplan-Meier method. Results The mean duration time of surgery was 14.2 ± 4.5 minutes. All patients survived surgery but one died during in-hospital stay. During the post-discharge follow-up period (median 49 months) 32 patients died for any reason. One-year and four-year probability of survival was 0.68 ± 0.05 and 0.64 ± 0.05, respectively. Malignancy diagnosis was associated with significant negative impact on survival. One-year and four-year probability of survival was 0.56 ± 0.06 and 0.53 ± 0.06 for cancer patients while it was 0.93 ± 0.05 and 0.89 ± 0.06 for the others, respectively. In two cases, only cancer patients, re-intervention due to effusion recurrence was necessary. Conclusions Pericardiotomy, although invasive, is a safe method to relieve cardiac tamponade. It is also very efficient in the prevention of recurrence of pericardial effusion, even in cancer patients. PMID:26702272

  6. Autopsy imaging for cardiac tamponade in a Thoroughbred foal.

    PubMed

    Yamada, Kazutaka; Sato, Fumio; Horiuchi, Noriyuki; Higuchi, Tohru; Kobayashi, Yoshiyasu; Sasaki, Naoki; Nambo, Yasuo

    2016-01-01

    Autopsy imaging (Ai), postmortem imaging before necropsy, is used in human forensic medicine. Ai was performed using computed tomography (CT) for a 1-month-old Thoroughbred foal cadaver found in a pasture. CT revealed pericardial effusion, collapse of the aorta, bleeding in the lung lobe, gas in the ventricles and liver parenchyma, and distension of the digestive tract. Rupture in the left auricle was confirmed by necropsy; however, it was not depicted on CT. Therefore, Ai and conventional necropsy are considered to complement each other. The cause of death was determined to be traumatic cardiac tamponade. In conclusion, Ai is an additional option for determining cause of death.

  7. Autopsy imaging for cardiac tamponade in a Thoroughbred foal

    PubMed Central

    YAMADA, Kazutaka; SATO, Fumio; HORIUCHI, Noriyuki; HIGUCHI, Tohru; KOBAYASHI, Yoshiyasu; SASAKI, Naoki; NAMBO, Yasuo

    2016-01-01

    ABSTRACT Autopsy imaging (Ai), postmortem imaging before necropsy, is used in human forensic medicine. Ai was performed using computed tomography (CT) for a 1-month-old Thoroughbred foal cadaver found in a pasture. CT revealed pericardial effusion, collapse of the aorta, bleeding in the lung lobe, gas in the ventricles and liver parenchyma, and distension of the digestive tract. Rupture in the left auricle was confirmed by necropsy; however, it was not depicted on CT. Therefore, Ai and conventional necropsy are considered to complement each other. The cause of death was determined to be traumatic cardiac tamponade. In conclusion, Ai is an additional option for determining cause of death. PMID:27703406

  8. Factors affecting survival in pediatric cardiac tamponade caused by central venous catheters.

    PubMed

    Kayashima, Kenji

    2015-12-01

    Pediatric central venous catheter (CVC) placement is useful but associated with complications such as cardiac tamponade. We aimed to identify risk factors for death in cardiac tamponade. Published articles on pediatric CVC-associated cardiac tamponade were obtained by searching PubMed and Google and retrospectively reviewed to analyze risk factors for death. Factors examined for their effect on mortality risk included patient age, weight, CVC size, days from CVC insertion to tamponade occurrence, substances administered, insertion site, treatment, CVC material, and initial CVC tip position. Of 110 patients reported in 62 articles, 69 survived and 41 died. Among survivors, 55 of 69 patients were treated; among deaths, only 7 of 38 (OR 537.9, 95% CI 29.3-9,877, p < 0.0001). Multiple regression analysis in 44 cases showed that treatment (p < 0.0001) and initial CVC tip position (p = 0.020) were independent predictive factors related to improved cardiac tamponade survival. Past studies have mainly discussed how to avoid pediatric cardiac tamponade; by contrast, the present study focused on how to avoid deaths. The findings of this review suggest that cardiac tamponade survival is better when tamponade is detected early and treated promptly and might be affected by initial CVC tip position.

  9. Cardiac tamponade and severe pericardial effusion in systemic sclerosis: report of nine patients and review of the literature.

    PubMed

    Fernández Morales, Alejandro; Iniesta, Nerea; Fernández-Codina, Andreu; Vaz de Cunha, Joana; Pérez Romero, Teresa; Hurtado García, Robert; Simeón-Aznar, Carmen Pilar; Fonollosa, Vicent; Cervera, Ricard; Espinosa, Gerard

    2016-12-10

    To describe the clinical characteristics, treatment and outcome of patients with systemic sclerosis (SSc) developing severe pericardial effusion or cardiac tamponade. SSc patients with severe pericardial effusion or cardiac tamponade from three Spanish hospitals were collected. In addition, a computer-assisted (PubMed, MEDLINE) search of the literature to identify all cases of cardiac tamponade or severe pericardial effusion associated with SSc reported in English, French and Spanish from 1987 through September 2015 was performed. We included 40 patients (nine cases from the Spanish hospitals and 31 cases from the literature review). Most patients (87%) were female with a mean age at pericardial involvement of 49.3 ± 15.2 years (range: 18-80 years), and 22 (55%) patients had the diffuse cutaneous subtype. Twenty-five (63%) patients presented with cardiac tamponade and the remaining 15 (37%) as severe or massive pericardial effusion. Pericardial involvement was previous or simultaneous to SSc diagnosis in 13 (32.5%) cases. In most cases (88.9%) pericardial fluid analysis disclosed an exudate. Half the patients received steroids and 35% needed surgical treatment. Five (12.5%) patients died due to cardiac tamponade, three of them during the acute phase and the remaining two, 2 and 9 months later, respectively. Although cardiac tamponade or severe pericardial effusion is an infrequent complication in SSc patients, it can be the first manifestation of disease associated with the diffuse cutaneous subset. No specific treatment for this complication is known. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  10. Management of acute cardiac tamponade by subxiphoid pericardiotomy.

    PubMed

    Alcan, K E; Zabetakis, P M; Marino, N D; Franzone, A J; Michelis, M F; Bruno, M S

    1982-02-26

    Eighteen patients with cardiac tamponade were treated by subxiphoid pericardiotomy performed with the patients under local anesthesia. This group included 9 cases of uremic pericarditis (50%), 5 cases of metastatic cancer (28%), 2 cases of trauma (11%), 1 case of tuberculosis (5.5%), and 1 case of unknown cause. Immediate relief from acute cardiac tamponade was obtained in all 18 cases with only minor and self-limiting postoperative complications, including transient supraventricular arrhythmias (five cases) and fever (five cases). There were no deaths related to either the operative procedure or reaccumulation of the pericardial effusion. The drainage period averaged 9.6 days (range, three to 28 days). Pericardial biopsy was performed in 15 of 18 cases. We conclude that subxiphoid pericardiotomy is a safe and effective method for the management of pericardial effusion of diverse causes. The ability to perform this technique safely using local anesthesia and the capacity to obtain a biopsy specimen under direct visualization make this technique superior to both needle pericardiocentesis and pericardiectomy in the acutely ill patient.

  11. Non-septicemic melioidosis presenting as cardiac tamponade.

    PubMed

    Chung, Hsing-Chun; Lee, Ching-Tai; Lai, Chung-Hsu; Huang, Chun-Kai; Lin, Jiun-Nong; Liang, Shiou-Haur; Lin, Hsi-Hsun

    2008-09-01

    Melioidosis is endemic in Taiwan. It is caused by infection with Burkholderia pseudomallei. A prolonged course of oral eradication therapy to avoid relapse after an intensive intravenous therapy is recommended to treat melioidosis. Melioidosis with cardiac involvement is rare and is often combined with septicemia, for which the mortality rate is 20-60%. The initial clinical presentations of melioidosis mimic Mycobacterium tuberculosis infection, which is the most common etiology of bacterial pericarditis in Taiwan. We present a case of non-septicemic melioidosis that presented as non-suppurative cardiac tamponade and left subcarinal lymphadenopathy. Underlying diseases included hepatitis B-related liver cirrhosis and hepatocellular carcinoma. The patient was successfully treated with 2 weeks of intravenous ceftazidime and 12 weeks of oral doxycycline, trimethoprim-sulfamethoxazole, and amoxicillin/clavulanate. Melioidosis-related pericarditis should be considered in the differential diagnoses of bacterial pericarditis in Taiwan.

  12. Delayed cardiac tamponade after open heart surgery - is supplemental CT imaging reasonable?

    PubMed

    Floerchinger, Bernhard; Camboni, Daniele; Schopka, Simon; Kolat, Philipp; Hilker, Michael; Schmid, Christof

    2013-06-24

    Cardiac tamponade is a severe complication after open heart surgery. Diagnostic imaging is challenging in postoperative patients, especially if tamponade develops with subacute symptoms. Hypothesizing that delayed tamponade after open heart surgery is not sufficiently detected by transthoracic echocardiography, in this study CT scans were used as standard reference and were compared with transthoracic echocardiography imaging in patients with suspected cardiac tamponade. Twenty-five patients after open heart surgery were enrolled in this analysis. In case of suspected cardiac tamponade patients underwent both echocardiography and CT imaging. Using CT as standard of reference sensitivity, specificity, positive and negative predictive values of ultrasound imaging in detecting pericardial effusion/hematoma were analyzed. Clinical appearance of tamponade, need for re-intervention as well as patient outcome were monitored. In 12 cases (44%) tamponade necessitated surgical re-intervention. Most common symptoms were deterioration of hemodynamic status and dyspnea. Sensitivity, specificity, positive and negative predictive values of echocardiography were 75%, 64%, 75%, and 64% for detecting pericardial effusion, and 33%, 83%, 50, and 71% for pericardial hematoma, respectively. In-hospital mortality of the re-intervention group was 50%. Diagnostic accuracy of transthoracic echocardiography is limited in patients after open heart surgery. Suplemental CT imaging provides rapid diagnostic reliability in patients with delayed cardiac tamponade.

  13. Delayed cardiac tamponade after open heart surgery - is supplemental CT imaging reasonable?

    PubMed Central

    2013-01-01

    Background Cardiac tamponade is a severe complication after open heart surgery. Diagnostic imaging is challenging in postoperative patients, especially if tamponade develops with subacute symptoms. Hypothesizing that delayed tamponade after open heart surgery is not sufficiently detected by transthoracic echocardiography, in this study CT scans were used as standard reference and were compared with transthoracic echocardiography imaging in patients with suspected cardiac tamponade. Method Twenty-five patients after open heart surgery were enrolled in this analysis. In case of suspected cardiac tamponade patients underwent both echocardiography and CT imaging. Using CT as standard of reference sensitivity, specificity, positive and negative predictive values of ultrasound imaging in detecting pericardial effusion/hematoma were analyzed. Clinical appearance of tamponade, need for re-intervention as well as patient outcome were monitored. Results In 12 cases (44%) tamponade necessitated surgical re-intervention. Most common symptoms were deterioration of hemodynamic status and dyspnea. Sensitivity, specificity, positive and negative predictive values of echocardiography were 75%, 64%, 75%, and 64% for detecting pericardial effusion, and 33%, 83%, 50, and 71% for pericardial hematoma, respectively. In-hospital mortality of the re-intervention group was 50%. Conclusion Diagnostic accuracy of transthoracic echocardiography is limited in patients after open heart surgery. Suplemental CT imaging provides rapid diagnostic reliability in patients with delayed cardiac tamponade. PMID:23800191

  14. Evaluation of non-surgical causes of cardiac tamponade in children at a cardiac surgery center.

    PubMed

    Ozturk, Erkut; Tanidir, Ibrahim Cansaran; Saygi, Murat; Ergul, Yakup; Guzeltas, Alper; Odemis, Ender

    2014-02-01

    The aim of this study was to examine the causes of cardiac tamponade in children undergoing percutaneous pericardiocentesis. Patients who presented with other complaints but were diagnosed with cardiac tamponade based on clinical and echocardiographic findings between January 2010 and January 2013 were retrospectively investigated. Electrocardiography, telecardiography and transthoracic echocardiography were performed. Pericardiocentesis was performed percutaneously under continuous blood pressure and rhythm monitoring with echocardiography and fluoroscopy. Pericardial fluid was analyzed on hemography and biochemistry. Fourteen patients (six boys, eight girls; median age, 7 years) underwent pericardiocentesis for cardiac tamponade. At presentation, 78% had dyspnea, 56% chest pain, and 49% fever. All had cardiomegaly, and their cardiothoracic index was 0.56-0.72. Also, all patients had sinus tachycardia; 78%, low QRS voltage; 70%, ST-T changes; and 50% QRS alternans. On echocardiography the widest diameter of pericardial effusion was between 12 mm and 36 mm depth around the heart. The pericardial fluid was purulent in one, serohemorrhagic in seven, serofibrinous in two, and serous in four cases. Pericardiocentesis was unsuccessful in two patients, who underwent open surgical drainage, with no complications. Based on pericardial fluid characteristics and additional tests, cardiac tamponade was caused by an infection in five patients, hypothyroidism in two, familial Mediterranean fever in two, malignancy in one, acute rheumatic fever in one, collagen tissue disease (systemic lupus erythematosus) in one, catheter placement-associated damage in one, and idiopathic pulmonary arterial hypertension in one patient. Pericardial effusion and cardiac tamponade in children have varied causes, and early treatment is life saving. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  15. Cardiac tamponade complicating coronary perforation during angioplasty: short-term outcomes and long-term survival.

    PubMed

    Stathopoulos, Ioannis; Kossidas, Konstantinos; Panagopoulos, Georgia; Garratt, Kirk

    2013-10-01

    Cardiac tamponade constitutes the most severe clinical consequence of a coronary perforation (CP) during percutaneous coronary intervention (PCI). We analyzed 23,399 PCIs and identified 73 patients complicated by CP (0.31%), of which 26 developed tamponade (0.11%). Patients were divided into two groups: CP with tamponade (group A) and CP without tamponade (group B). Characteristics and outcomes were compared and a multivariate model was developed to evaluate the independent contribution of tamponade on mortality. All patients with tamponade were treated with pericardiocentesis. Tamponade increased the risk of death by more than 3-fold (odds ratio [OR] = 3.3; 95% confidence interval [CI],1.01-10.6; P=.047) relative to patients with CP but no tamponade. CP with tamponade during non-elective PCI carried a significantly worse long-term prognosis (P=.001) than the same complications during elective PCI. The use of glycoprotein IIb/IIIa inhibitors and bivalirudin did not differ between groups. Polytetrafluoroethylene-covered stents were used similarly between the two groups, while coil embolization was used more often in group A (P=.003). Emergent cardiac surgery was needed in 3 patients (11.5%) in group A versus 1 patient (2.1%) in group B. Tamponade complicating CP during PCI has short- and long-term major adverse effects. In-hospital mortality after tamponade and referral for emergent surgical treatment have decreased. Nonetheless, tamponade in this setting increases risk of death by >3-fold. PCI of complex lesions with an expected increased risk of perforation should be undertaken cautiously among patients with non-elective PCI because of increased early and late risk of death.

  16. [Cardiac tamponade after withdrawal of a peripheral access central catheter].

    PubMed

    García-Galiana, E; Sanchis-Gil, V; Martínez-Navarrete, M Á

    2015-03-01

    Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis.

  17. Cardiac tamponade as a presenting manifestation of Sheehan syndrome.

    PubMed

    Alexander, Varkey; Chattopadhyay, Arijit; Yasin, Khalid; Kurian, Thomas T

    2008-01-01

    We report a 38-year-old Syrian woman who presented with progressive breathlessness, hypotension and circulatory collapse. Echocardiogram revealed a large pericardial effusion with evidence of cardiac tamponade. There was a history of secondary amenorrhoea, loss of axillary and pubic hair following childbirth at 28 years of age. Investigations revealed low levels of gonadotrophins, oestrogen, prolactin and thyrotrophin but normal levels of basal and post-synacthen (ACTH) cortisol. An MRI of the sella showed atrophic changes of the pituitary. She was treated with intravenous fluids, dopamine infusion, intravenous hydrocortisone and thyroxine replacement. The clinical suspicion of Sheehan syndrome facilitated early administration of corticosteroids, adequate thyroxine replacement and rapid resolution of pericardial effusion.

  18. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery.

    PubMed

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

  19. Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes.

    PubMed

    Orbach, Ady; Schliamser, Jorge E; Flugelman, Moshe Y; Zafrir, Barak

    2016-01-01

    Cardiac tamponade is a life-threatening state that complicates various medical conditions. The contemporary interventional era may have led to changes in clinical characteristics, causes and outcomes of cardiac tamponade. We investigated all patients diagnosed with cardiac tamponade, based on clinical and echocardiographic findings, at a single medical center between the years 2000 and 2013. Data on medical history, index hospitalizations, pericardial fluid etiologies, and acute and long-term outcomes were collected. Cardiac tamponade was observed in 83 patients (52% females). Major etiologies included complications of percutaneous cardiac interventions (36%) and malignancies (primarily lung cancer; 23%), infectious/inflammatory causes (15%) and mechanical complications of myocardial infarction (12%). Sixteen (19%) patients died during the index hospitalization. Acute presentation of symptoms and lower quantity of effusion were associated with in-hospital mortality (p = 0.045 and p = 0.007). Tamponade secondary to malignancy was associated with the most substantial increment in post-discharge mortality (from 16% in-hospital to 68% 1-year mortality). During the mean follow-up of 45 months, 39 (45%) patients died. Malignancies, mechanical complications of myocardial infarction and bleeding/coagulation abnormalities were etiologies associated with poor survival (80% mortality during follow-up). Tamponade secondary to complications of percutaneous cardiac interventions or infectious/inflammatory causes were associated with significantly lower mortality (28% and 17%; log rank p < 0.001). In a contemporary cohort, complications of percutaneous cardiac intervention replaced malignant diseases as the leading cause of cardiac tamponade. Nevertheless, these iatrogenic complications were associated with a relatively favorable outcome compared to tamponade induced by complications of myocardial infarction, coagulation abnormalities and malignant diseases.

  20. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

    PubMed Central

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13–30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9–43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention. PMID:27855225

  1. Coronary artery perforation complicated by recurrent cardiac tamponade: a case illustration and review.

    PubMed

    DePersis, Michael; Khan, Safi U; Kaluski, Edo; Lombardi, William

    2017-03-07

    Coronary artery perforation during percutaneous intervention is a rare but potentially life threatening complication. The treatment of coronary perforation can be challenging in view of potential life threatening consequences such as cardiac tamponade or myocardial infarction. Presented is a clinical course of a 69year-old female who developed cardiac tamponade as a result of presumed wire related perforation of the posterolateral branch of the right coronary artery. Her clinical course was further complicated by recurrent tamponade, atrial fibrillation, stress induced cardiomyopathy, heparin induced thrombocytopenia and cardiogenic pulmonary edema. Based on review of the medical literature a treatment algorithm for wire perforation is suggested.

  2. Point-of-Care Diagnosis of Cardiac Tamponade Identified by the Flow Velocity Paradoxus.

    PubMed

    Shyy, William; Knight, Roneesha S; Kornblith, Aaron; Teismann, Nathan A

    2017-05-15

    The presentation of cardiac tamponade is a spectrum from occult to extreme. The clinical history, physical exam, electrocardiogram, and radiographic findings of tamponade have poor sensitivities and even worse specificities. We use a clinical scenario to demonstrate how point-of-care cardiac ultrasound can diagnose impending cardiac tamponade in a clinically stable patient. The ultrasound finding we recommend is the flow velocity paradoxus, in which respiratory variation causes significant changes in transvalvular inflow velocities, which are exaggerated when tamponade is present. The management of a pericardial effusion depends on its physiologic effect, and point-of-care ultrasound directly measures that effect and expedites patient care. © 2017 by the American Institute of Ultrasound in Medicine.

  3. Cardiac tamponade as the initial presentation of malignancy: is it as rare as previously supposed?

    PubMed Central

    Muir, K. W.; Rodger, J. C.

    1994-01-01

    Advanced malignant disease frequently involves the heart and pericardium, and pericardial effusion is a common postmortem finding in such patients. Identification of pericardial effusions in life is uncommon, however, even when symptomatic. Cardiac tamponade occurring as the first presentation of malignancy appears to be uncommon. We present five cases of cardiac tamponade due to undiagnosed malignancy which presented to a general medical unit over 18 months. The availability of echocardiography was an important factor in correct diagnosis, since clinical features were non-specific. Bronchial adenocarcinoma was the cause in three of the five cases. Review of the literature confirms adenocarcinomas of the bronchus as the most common cause of this complication. The majority of cases have presented with large volume, haemorrhagic effusions, and cytology (with or without carcinoembryonic antigen measurement) was diagnostic in most patients. Immediate treatment with subxiphoid pericardiotomy is recommended; the role of balloon catheter pericardiotomy remains to be established. Combined chemotherapy and radiotherapy appears to extend survival, which in some cases may be prolonged. We recommend that early echocardiography should be obtained in all patients presenting with apparent cardiac failure, since early treatment of malignant effusions provides symptomatic relief. Images Figure 1 PMID:7831164

  4. Cardiac tamponade and paroxysmal third-degree atrioventricular block revealing a primary cardiac non-Hodgkin large B-cell lymphoma of the right ventricle: a case report

    PubMed Central

    2011-01-01

    Introduction Primary cardiac lymphoma is rare. Case Presentation We report the case of a 64-year-old non-immunodeficient Caucasian man, with cardiac tamponade and paroxysmal third-degree atrioventricular block. Echocardiography revealed the presence of a large pericardial effusion with signs of tamponade and a right ventricular mass was suspected. Scanner investigations clarified the sites, extension and anatomic details of myocardial and pericardial infiltration. Surgical resection was performed due to the rapid impairment of his cardiac function. Analysis of the pericardial fluid and histology confirmed the diagnosis of non-Hodgkin large B-cell lymphoma. He was treated with chemotherapy. Conclusion The prognosis remains poor for this type of tumor due to delays in diagnosis and the importance of the site of disease. PMID:21892927

  5. Cardiac tamponade as the first clinical sign of gastric adenocarcinoma: a rare condition.

    PubMed

    Arısoy, Arif; Memiç, Kadriye; Karavelioğlu, Yusuf; Sen, Fatma

    2014-06-01

    Cardiac tamponade originating from a primary gastric cancer (GC) is a rare condition. Patients are generally asymptomatic until the disease is advanced. We report a rare patient with cardiac tamponade as the first manifestation of primary GC. A 46-year-old male was admitted with progressive dyspnea. Cardiac tamponade was diagnosed on two-dimensional ultrasonographic echocardiography. Pericardiocentesis yielded 1500 ml of bloody fluid. Pericardial cytologic examination was positive for malignant cells. The patient underwent abdominal computed tomography scan, which showed thickening of the gastric wall and several mesenteric lymph nodes. Endoscopic examination of the stomach disclosed malignant ulcer along the lesser curvature, and the biopsy showed diffuse type adenocarcinoma. Chemotherapy was initiated by the Oncology Department, and he had no pericardial effusion after six courses of systemic chemotherapy. In conclusion, this is a rare condition and difficult to diagnosis early. Thus, physicians should be aware of malignancy of the stomach when patients present with unexplained cardiac manifestations.

  6. Adult-onset Still's disease and cardiac tamponade: a rare association.

    PubMed

    Carrilho-Ferreira, Pedro; Silva, Doroteia; de Jesus Silva, Maria; André, Rui; Varela, Manuel Gato; Diogo, António Nunes

    2015-06-01

    Adult-onset Still's disease is a rare disorder with potentially severe clinical features, including cardiac involvement. This systemic inflammatory disease of unknown origin should be considered in the differential diagnosis of pericarditis, with or without pericardial effusion. Cardiac tamponade is a very rare sequela that requires an invasive approach, such as percutaneous or surgical pericardial drainage, in addition to the usual conservative therapy. The authors describe a case of adult-onset Still's disease rendered more difficult by pericarditis and cardiac tamponade, and they briefly review the literature on this entity.

  7. Adult-Onset Still's Disease and Cardiac Tamponade: A Rare Association

    PubMed Central

    Silva, Doroteia; de Jesus Silva, Maria; André, Rui; Varela, Manuel Gato; Diogo, António Nunes

    2015-01-01

    Adult-onset Still's disease is a rare disorder with potentially severe clinical features, including cardiac involvement. This systemic inflammatory disease of unknown origin should be considered in the differential diagnosis of pericarditis, with or without pericardial effusion. Cardiac tamponade is a very rare sequela that requires an invasive approach, such as percutaneous or surgical pericardial drainage, in addition to the usual conservative therapy. The authors describe a case of adult-onset Still's disease rendered more difficult by pericarditis and cardiac tamponade, and they briefly review the literature on this entity. PMID:26175648

  8. Cardiac tamponade in a neonate: a dreadful condition—need for functional echo

    PubMed Central

    Iyer, Venkatesh Harohalli Aswathanarayana; Sharma, Deepa Mohan; Charki, Siddhu; Mohanty, Pankaj Kumar

    2014-01-01

    Cardiac tamponade is a clinical emergency. Detection of a swinging heart rate is one of the earliest markers of large pericardial effusion, in which the four cardiac chambers are free to float in a phasic manner. We present a case of a preterm baby, one of the twins, who developed sudden onset of deterioration in the form of swinging heart rate, fluctuation in blood pressure and desaturation, requiring emergency intubation and inotropic support. Bedside functional echo was performed, which demonstrated cardiac tamponade; an immediate echocardiography-guided tap was initiated and fluid was aspirated from the pericardial space. PMID:25535228

  9. Delayed right ventricular defibrillation lead perforation presenting as cardiac tamponade and treated surgically.

    PubMed

    Noguchi, Masahiko; Nakai, Toshiko; Kawano, Yuji; Shibayama, Kentaro; Obunai, Kotaro; Tabata, Minoru; Watanabe, Hiroyuki

    2017-04-01

    Right ventricular perforation leading to cardiac tamponade can occur during the chronic phase after cardiac device implantation. Physicians who manage the pacemaker clinic must be alert to the wide range of symptoms and signs that can accompany delayed right ventricular perforation. Surgical rather than percutaneous lead extraction may be prudent.

  10. Case report: cardiac tamponade resembling an acute myocardial infarction as the initial manifestation of metastatic pericardial adenocarcinoma.

    PubMed

    Scheinin, Scott A; Sosa-Herrera, Jose

    2014-01-01

    Pericardial malignancies are uncommon, usually metastatic, linked to terminal oncology patients, and rarely diagnosed premortem. A very small number of patients will develop signs and symptoms of malignant pericardial effusion as initial clinical manifestation of neoplastic disease. Among these patients, a minority will progress to a life-threatening cardiac tamponade. It is exceedingly rare for a cardiac tamponade to be the unveiling clinical manifestation of an unknown malignancy, either primary or metastatic to pericardium. We present the case of a 50-year-old male who was admitted to the emergency department with an acute myocardial infarction diagnosis that turned out to be a cardiac tamponade of unknown etiology. Further studies revealed a metastatic pericardial adenocarcinoma with secondary cardiac tamponade. We encourage considering malignancies metastatic to pericardium as probable etiology for large pericardial effusions and cardiac tamponade of unknown etiology.

  11. Case Report: Cardiac Tamponade Resembling an Acute Myocardial Infarction as the Initial Manifestation of Metastatic Pericardial Adenocarcinoma

    PubMed Central

    2014-01-01

    Pericardial malignancies are uncommon, usually metastatic, linked to terminal oncology patients, and rarely diagnosed premortem. A very small number of patients will develop signs and symptoms of malignant pericardial effusion as initial clinical manifestation of neoplastic disease. Among these patients, a minority will progress to a life-threatening cardiac tamponade. It is exceedingly rare for a cardiac tamponade to be the unveiling clinical manifestation of an unknown malignancy, either primary or metastatic to pericardium. We present the case of a 50-year-old male who was admitted to the emergency department with an acute myocardial infarction diagnosis that turned out to be a cardiac tamponade of unknown etiology. Further studies revealed a metastatic pericardial adenocarcinoma with secondary cardiac tamponade. We encourage considering malignancies metastatic to pericardium as probable etiology for large pericardial effusions and cardiac tamponade of unknown etiology. PMID:25114766

  12. Life-Threatening Cardiac Tamponade Secondary to Chylopericardium Following Orthotopic Heart Transplantation-A Case Report.

    PubMed

    Wierzbicki, Karol; Mazur, Piotr; Węgrzyn, Piotr; Kapelak, Bogusław

    2016-08-23

    Chylopericardium is a rare complication in cardiac surgery, and an extremely rare occurrence in patients following orthotopic heart transplantation (OHT), which, however, can lead to cardiac tamponade. Here we present a case of a 59-year-old man who underwent OHT and suffered from chylopericardium resulting in cardiac tamponade late in the postoperative course, despite the initially uneventful early postoperative period (decreasing blood drainage was observed directly after the procedure, and the drains were safely removed). After the diagnosis of chylopericardium was made, the conservative treatment was initiated, which turned out to be insufficient, and eventually invasive approach for the recurrence of tamponade secondary to chylopericardium was required. We discuss the available therapeutic options for chylopericardium and demonstrate the successful invasive therapeutic approach with use of the absorbable fibrin sealant patch.

  13. Pericardial effusion and cardiac tamponade after ventriculoperitoneal shunt placement: a case report.

    PubMed

    Wiwattanadittakul, Natrujee; Katanyuwong, Kamornwan; Jetjumnong, Chumpon; Sittiwangkul, Rekwan; Makonkawkeyoon, Krit

    2016-10-01

    Insertion of a ventriculoperitoneal shunt is a common neurosurgical procedure in both adult and paediatric patients. It is one of the most important treatments in cases of hydrocephalus; however, there is a wide range of complications: the most common complication being a shunt infection, and examples of rare complications are shunt migrations and cardiac tamponade. Several reports of distal ventriculoperitoneal shunt migration in different sites, including chest, right ventricle, pulmonary artery, bowel and scrotum were published. But pericardial effusion with cardiac tamponade and its relationship to distal ventriculoperitoneal shunt migration into the pericardial sac has never been reported.

  14. Catheter-Malposition-Induced Cardiac Tamponade via Contrast Media Leakage During Computed Tomography Study

    SciTech Connect

    Liang, C.-D. Ko, S.-F.; Huang, C.-F.; Chien, S.J.; Tiao, M.M.

    2005-12-15

    We present a rare case of a central venous catheter-malposition-induced life-threatening cardiac tamponade as a result of computed tomography (CT) with contrast enhancement in an infant with a ventricular septal defect and pulmonary atresia after a modified Blalock-Taussig shunt. The diagnosis was confirmed by chest radiographs and CT study with catheter perforation through the right atrial wall and extravasation of the contrast medium into the pericardium, leading to cardiac tamponade and subsequent circulatory collapse. Two hours after successful cardiopulmonary resuscitation, the patient gradually resumed normal hemodynamic status.

  15. Thoracentesis-reverting cardiac tamponade physiology in a patient with myxedema coma and large pleural effusion

    PubMed Central

    Werlang, Monia E.; Pimentel, Mario R.

    2017-01-01

    A large pleural effusion causing cardiac tamponade physiology and severe hemodynamic compromise is an uncommon event. We report a case of a 53-year-old woman with severe hypothyroidism presenting with myxedema coma and refractory shock. Her hemodynamic status failed to respond to fluid resuscitation and vasopressors. A transthoracic echocardiogram and chest radiograph demonstrated a pericardial fluid accumulation associated with a large left-sided pleural effusion. Thoracostomy tube insertion resulted in prompt improvement of the patient's hemodynamic status. Our finding demonstrates that a large pleural effusion may play an important role in cardiac tamponade physiology. PMID:28670061

  16. Intravenous immunoglobulin in treatment of cardiac tamponade in a patient with systemic lupus erythematosus.

    PubMed

    Grenader, Tal; Shavit, Linda

    2004-12-01

    We describe a 23-year-old female patient with a history of systemic lupus erythematosus and pulmonary hypertension who developed a large pericardial effusion with cardiac tamponade. Invasive interventions such as pericardial window or pericardiectomy were ruled out because of the posterior localization of the effusion and high risk of general anesthesia in a patient with severe pulmonary hypertension. The patient received high-dose steroids intravenously with no response. A 5-day course of intravenous immunoglobulin resulted in gradual decrease of the pericardial effusion and resolution of cardiac tamponade within 2 weeks.

  17. Recurrent pleural effusions and cardiac tamponade as possible manifestations of pseudoprogression associated with nivolumab therapy- a report of two cases.

    PubMed

    Kolla, Bhaskar C; Patel, Manish R

    2016-01-01

    Checkpoint inhibitors are a class of agents that employ host's adaptive immune defenses in fighting cancer. With many new indications and several ongoing clinical trials in a variety of malignancies, the usage of these agents is set to increase significantly. One of the key challenges patients and physicians face while using these drugs is with the appropriate assessment of response to therapy. We are reporting two patients with lung cancer who were treated with nivolumab and experienced rapidly accumulating recurrent pleural effusions requiring multiple thoracenteses (6 and 4 times each for patient 1 and 2 respectively) with in the first few weeks of initiation of therapy and also developed pericardial effusion with cardiac tamponade requiring pericardiocentesis. Both patients had prior history of malignant spread to pleural and pericardial space in their disease course. Therapy was continued in the first patient with spontaneous resolution of effusions after 8 weeks and the disease showed near complete response to treatment on imaging at 16 weeks. Second patient declined to continue further treatment with nivolumab after 3 cycles due to recurrent effusions and cardiac tamponade, although there was some evidence of clinical response at discontinuation. Patients with history of malignant involvement of visceral spaces should be monitored closely for rapidly accumulating effusions and particularly for cardiac tamponade, after initiation of therapy with nivolumab. This presentation could represent pseudoprogression, and continuation of therapy with close monitoring is prudent as long as effusions are manageable and there is no definitive evidence of progression elsewhere.

  18. Malignant Cardiac Tamponade from Non-Small Cell Lung Cancer: Case Series from the Era of Molecular Targeted Therapy

    PubMed Central

    Li, Bob T.; Pearson, Antonia; Pavlakis, Nick; Bell, David; Lee, Adrian; Chan, David; Harden, Michael; Mathur, Manu; Marshman, David; Brady, Peter; Clarke, Stephen

    2014-01-01

    Cardiac tamponade complicating malignant pericardial effusion from non-small cell lung cancer (NSCLC) is generally associated with extremely poor prognosis. With improved systemic chemotherapy and molecular targeted therapy for NSCLC in recent years, the prognosis of such patients and the value of invasive cardiothoracic surgery in this setting have not been adequately examined. We report outcomes from a contemporary case series of eight patients who presented with malignant cardiac tamponade due to NSCLC to an Australian academic medical institution over an 18 months period. Two cases of cardiac tamponade were de novo presentations of NSCLC and six cases were presentations following previous therapy for NSCLC. The median survival was 4.5 months with a range between 9 days to alive beyond 17 months. The two longest survivors are still receiving active therapy at 17 and 15 months after invasive surgical pericardial window respectively. One survivor had a histological subtype of large cell neuroendocrine carcinoma and the other received targeted therapy for epidermal growth factor receptor mutation. These results support the consideration of active surgical palliation to treating this oncological emergency complicating NSCLC, including the use of urgent drainage, surgical creation of pericardial window followed by appropriate systemic therapy in suitably fit patients. PMID:26237019

  19. Acute Primary Pneumococcal Purulent Pericarditis With Cardiac Tamponade: A Case Report and Literature Review.

    PubMed

    Patel, Hiren; Patel, Charmi; Soni, Mrugesh; Patel, Amit; Banda, Venkat

    2015-10-01

    Bacterial pericarditis is a rapidly progressive and highly fatal infection, and is often diagnosed postmortem in half of the cases. Even with drainage and antibiotics, the mortality rate is high. Gram-positive cocci, specifically Streptococcus penumoniae, have been the most common cause of bacterial pericarditis with a preceding primary site of infection. Following the introduction of antibiotics in the 1940s and more recently the pneumococcal conjugate vaccine, the incidence has drastically decreased.We describe an extremely rare case of primary streptococcus pneumoniae purulent pericarditis that presented with cardiac tamponade. The patient was successfully treated with broad-spectrum antibiotics and urgent pericardiocentesis.Due to the high mortality rate with purulent pericarditis, a high index of suspicion is needed when acute pericarditis is suspected for early diagnosis to instate appropriate therapy with antibiotics and drainage.

  20. Microvascular permeability changes might explain cardiac tamponade after alcohol septal ablation for hypertrophic cardiomyopathy.

    PubMed

    Hsu, Jen-Te; Hsiao, Ju-Feng; Chang, Jung-Jung; Chung, Chang-Min; Chang, Shih-Tai; Pan, Kuo-Li

    2014-04-01

    Various sequelae of alcohol septal ablation for hypertrophic obstructive cardiomyopathy have been reported. Of note, some cases of cardiac tamponade after alcohol septal ablation cannot be well explained. We describe the case of a 78-year-old woman with hypertrophic obstructive cardiomyopathy in whom cardiac tamponade developed one hour after alcohol septal ablation, probably unrelated to mechanical trauma. At that time, we noted a substantial difference in the red blood cell-to-white blood cell ratio between the pericardial effusion (1,957.4) and the peripheral blood (728.3). In addition to presenting the patient's case, we speculate that a possible mechanism for acute tamponade--alcohol-induced changes in microvascular permeability--is a reasonable explanation for cases of alcohol septal ablation that are complicated by otherwise-unexplainable massive pericardial effusions.

  1. Improved hyponatremia after pericardial drainage in patients suffering from cardiac tamponade.

    PubMed

    Jong, Bor-Hsin; Wei, Cheng-Chun; Shyu, Kou-Gi

    2016-06-11

    Some case reports showed unexplained hyponatremia in patients with cardiac tamponade. Reversible hyponatremia was observed in these patients who received pericardial drainage. The occurrence rate of hyponatremia in patients of cardiac tamponade is not clearly known. The objective of this study was to identify the relationship between hyponatremia, cardiac tamponade and their underlying diseases. We reviewed the clinical data of patients with cardiac tamponade and receiving pericardial drainage between January 2000 and January 2012 in our hospital. Cardiac tamponade was diagnosed by clinical presentation: hypotension, pulsus paradoxus, and increased jugular vein pressure. We used paired T test to compare the sodium change before and after pericardial drainage. Pearson's chi-square test was used to analyze the relationship of hyponatremia with malignancy and cardiac chamber compression proved by echocardiography. For the 48 patients, the mean pre-drainage sodium level was 129.1 ± 7.1 mEq/L and the mean post-drainage sodium level was 130.4 ± 5.6 mEq/L (p = 0.06). Among the 48 patients, 31 (65 %) had hyponatremia. For the 31 hyponatremia patients, the mean pre-drainage sodium level was 124.8 ± 4.9 mEq/L and the mean post drainage sodium level was 127.5 ± 4.5 mEq/L (p = 0.003). Hyponatremia was significantly associated with malignancy (p = 0.038). There was no significant change of pre-drainage and post-drainage sodium level in patients without malignancy. The post-drainage sodium level in the malignant patients significantly increased from 125.5 ± 8.0 to 129.1 ± 5.5 mEq/L (p = 0.017). The presence of hyponatremia was strongly associated with the cardiac tamponade sign (p < 0.001). After pericardial drainage, the sodium level significantly increased in patients with chamber compression than in patients without compression. Hyponatremia is associated with cardiac tamponade especially for malignant pericardial

  2. Fatal cardiac tamponade as the first manifestation of acute myeloid leukemia.

    PubMed

    Leptidis, John; Aloizos, Stavros; Chlorokostas, Panagiotis; Gourgiotis, Stavros

    2014-10-01

    Acute myeloid leukemia is a hemopoietic myeloid stem cell neoplasm. It is the most common acute leukemia affecting adults,and its incidence increases with age. Acute myeloid leukemia is characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells. As the leukemic cells keep filling the bone marrow, symptoms of the disease started to appear: fatigue, bleeding, increased frequency of infections, and shortness of breath. Cardiac tamponade or pericardial tamponade is an acute medical condition in which the accumulation of pericardial fluid prevents the function of the heart. Signs and symptoms include Beck triad (hypotension, distended neck veins, and muffled heart sounds), paradoxus pulses, tachycardia, tachypnea, and breathlessness. Pericardial effusion and cardiac tamponade are rare and severe complications of leukemia; they often develop during the radiation therapy, chemotherapy, or infections in the course of leukemia. This study sought to assess the fatal cardiac tamponade as the first manifestation of acute myeloid leukemia (AML). We found no reports in the literature linking these 2 clinical entities. Although the patient had no signs or diagnosis of AML previously, this case was remarkable for the rapidly progressive symptoms and the fatal outcome. The pericardial effusion reaccumulated rapidly after its initial drainage; it is a possible explanation that the leukemic cells interfered with cardiac activity or that they decreased their contractility myocytes secreting a toxic essence.

  3. The curious case of a cardiac tamponade in the hypertensive patient presenting as abdominal fullness.

    PubMed

    Li, William; Subedi, Rogin; Madhira, Bhaskara

    2017-01-19

    Cardiac tamponade is a medical emergency consisting of an accumulation of fluid in the pericardial space which is rapidly progressing and fatal. Because cardiac tamponade is ultimately a clinical diagnosis, mindful consideration for atypical presentations is essential for the reduction of mortality in the acute setting. Our patient was a 77year-old female admitted after presenting with general malaise, weakness, somnolence, altered mental status and urinary incontinence found to have CML (chronic myeloid leukemia) on confirmatory bone marrow biopsy after suspicions arose from a leukocytosis of 34,000 cells per mcL with 85% neutrophils and elevated blasts (8%). Initial vital signs revealed mild tachycardia, mild tachypnea and blood pressure elevated to 162/84mm Hg along with a temperature of 38.7°C and oxygen saturation of 96% on 2l by nasal cannula. She received the standard of care for a community acquired pneumonia and was started on treatment with decitabine as further work-up was unremarkable. An abdominal CT performed for abdominal fullness later displayed a large pericardial effusion. Repeat echocardiography exhibited right atrial diastolic collapse, inferior vena cava dilatation (IVC) without inspiratory collapse >50% and the large pericardial effusion consistent with tamponade. The blood pressure remained hypertensive until she suddenly went into cardiac arrest after being intubated for a pericardial window and expired. Our case highlights the need to keep cardiac tamponade as a differential in the hypertensive individual with abdominal complaints as atypical presentations can obscure diagnosis, delay treatment and increase mortality.

  4. Haemopericardium causing cardiac tamponade: a late complication of pectus excavatum repair

    PubMed Central

    Barakat, M J; Morgan, J A

    2004-01-01

    A 24 year old man presented to the emergency department with clinical signs of cardiac tamponade requiring emergency surgery. The cause was a sternal wire from a pectus excavatum repair two years previously that had fractured and migrated through the pericardium causing an epicardial injury and a haemopericardium. PMID:15020540

  5. Cardiac Tamponade Diagnosed by Point-of-Care Ultrasound.

    PubMed

    Smith, Austin T; Watnick, Caroline; Ferre, Robinson M

    2017-02-01

    We present a case involving a 12-year-old boy who presented to the emergency department and was diagnosed with a pericardial effusion with tamponade physiology by point-of-care ultrasound. The diagnosis resulted in prompt treatment and definitive therapy.

  6. Pericardial Tamponade Consequent to a Dynamite Explosion

    PubMed Central

    Ozer, Orhan; Sari, Ibrahim; Davutoglu, Vedat; Yildirim, Cuma

    2009-01-01

    Acute cardiac tamponade is a life-threatening emergency that requires prompt treatment by either percutaneous or surgical pericardiocentesis. It may occur after penetrating or blunt chest trauma. We report a case of pericardial tamponade in the absence of penetrating trauma, due to blast overpressure injury after a dynamite explosion—which has not, to our knowledge, been reported before. Physicians should be aware of the possibility of pericardial tamponade in victims of barotraumatic events such as dynamite or bomb explosions, even in the absence of penetrating trauma. Cardiac tamponade, although life-threatening, is easy to treat when recognized. PMID:19568402

  7. [Cardiac tamponade associated with umbilical venous catheter (UVC) placed in inappropriate position].

    PubMed

    Gálvez-Cancino, Franco; de la Luz Sánchez-Tirado, María

    2015-01-01

    Umbilical venous catheter (UVC) is widely used in neonatal intensive care units. Pericardial effusion is an uncommon but life-threatening complication; and tamponade have been reported in 3% of neonates having such catheters. We present a case of cardiac tamponade as a complication of venous catheter in a neonate. The patient was diagnosed at the appropriate time by echocardiography and the pericardiocentesis was performed, and after removal of the complete pericardial effusion,an improvement of the critical condition was achieved. It is important to document the optimal positioning of UVC before the start of infusions.

  8. Cardiac tamponade: a review of diagnosis and anaesthetic and surgical management illustrated by three case reports.

    PubMed Central

    White, J. B.; Macklin, S.; Studley, J. G.; Marshall, R. D.

    1988-01-01

    Cardiac tamponade is an uncommon problem in a district general hospital. Three patients were admitted to the intensive therapy unit at Northampton General Hospital with tamponade in a 7-week period, each with a different underlying aetiology. Their case histories are presented and the management in the light of these described. The aetiology, physiology, clinical signs and investigations leading to the diagnosis are considered. In the discussion the opportunity is taken to review the recent literature on the subject. Images fig. 1 Fig. 2 PMID:3061355

  9. Giant epicardial cyst presenting as acute cardiac tamponade in a 2-year-old boy.

    PubMed

    Masuoka, Ayumu; Sakurai, Hayato; Shiraishi, Masahisa; Yoshiba, Shigeki; Katogi, Toshiyuki; Suzuki, Takaaki

    2015-09-01

    Cystic structures within the pericardial cavity are rare. They are divided into epicardial and pericardial variants. Pericardial and epicardial cysts rarely cause symptoms. This report describes a case of epicardial cyst with acute cardiac tamponade in a 2-year-old boy with no previous cardiac history who was transferred to our hospital because of hemodynamic instability. Emergency drainage of the pericardial effusion and complete excision of the cyst were performed through a median full sternotomy.

  10. Recurrent Hemorrhagic Pericardial Effusion and Tamponade due to Filariasis Successfully Treated with Ivermectin and Albendazole.

    PubMed

    Sinha, Santosh Kumar; Goel, Amit; Sachan, Mohit; Saraf, Sameer; Verma, Chandra Mohan

    2015-01-01

    Filariasis presenting with pericardial effusion with tamponade is rare. We report a case of a 30-year-old female who was admitted with severe dyspnea and chest pain since 2 days. Echocardiogram showed massive pericardial effusion with tamponade. Pericardial fluid aspiration drained 1.2 L of hemorrhagic fluid. Cytology examination revealed microfilaria of Wuchereria bancrofti. She was treated with diethyl carbamazine and discharged. Six weeks later, she presented again with massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done. Cytology examination revealed microfilaria of W. bancrofti. This time she was treated with ivermectin and albendazole and cured. Hemorrhagic effusion resolved completely. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of recurrent pericardial effusion.

  11. SLE or hypothyroidism: who can triumph in cardiac tamponade?

    PubMed

    Chaudhari, Sameer Sadashiv; Wankhedkar, Kashmira Pramod; Mushiyev, Savi

    2015-03-06

    A 36-year-old Hispanic woman with a history of systemic lupus erythaematosus (SLE) in remission presented with progressive dyspnoea, bilateral leg swelling and increasing fatigue with rapid weight gain over the past few months. Her physical examination showed mildly tender thyromegaly and pericardial rub. Investigations showed new onset marked hypothyroidism as well as an active lupus serology with echocardiogram confirming severe pericardial effusion and a tamponade phenomenon. Urgent pericardiocentesis relieved her acute symptoms, and prompt treatment with thyroxine replacement and immunosuppression for lupus disease was initiated. Pericardial fluid analysis remained negative for any malignancy and/or infection/s. The patient had a gradual and consistent improvement with this treatment. She was discharged and appeared to be clinically stable at subsequent follow-up visits. However, the case remained a diagnostic dilemma over whether the tamponade was being driven by hypothyroidism versus lupus, leaving us with an opportunity to explore further.

  12. SLE or hypothyroidism: who can triumph in cardiac tamponade?

    PubMed Central

    Chaudhari, Sameer Sadashiv; Wankhedkar, Kashmira Pramod; Mushiyev, Savi

    2015-01-01

    A 36-year-old Hispanic woman with a history of systemic lupus erythaematosus (SLE) in remission presented with progressive dyspnoea, bilateral leg swelling and increasing fatigue with rapid weight gain over the past few months. Her physical examination showed mildly tender thyromegaly and pericardial rub. Investigations showed new onset marked hypothyroidism as well as an active lupus serology with echocardiogram confirming severe pericardial effusion and a tamponade phenomenon. Urgent pericardiocentesis relieved her acute symptoms, and prompt treatment with thyroxine replacement and immunosuppression for lupus disease was initiated. Pericardial fluid analysis remained negative for any malignancy and/or infection/s. The patient had a gradual and consistent improvement with this treatment. She was discharged and appeared to be clinically stable at subsequent follow-up visits. However, the case remained a diagnostic dilemma over whether the tamponade was being driven by hypothyroidism versus lupus, leaving us with an opportunity to explore further. PMID:25750217

  13. Pericardial effusion with cardiac tamponade caused by a central venous catheter in a very low birth weight infant.

    PubMed

    Chioukh, Fatma-Zohra; Ameur, Karim Ben; Hmida, Hayet Ben; Monastiri, Kamel

    2016-01-01

    With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. One of the life-threatening complications is pericardial effusion and cardiac tamponade; however, it is potentially reversible when it is caught in time. The authors present a case of cardiac tamponade following umbilical venous catheterisation in a neonate. The patient was diagnosed at the appropriate time by echocardiography and urgent pericardiocentesis proved lifesaving.

  14. Does posterior pericardial window technique prevent pericardial tamponade after cardiac surgery?

    PubMed

    Zhao, Jian; Cheng, Zhaoyun; Quan, Xiaoqiang; Zhao, Ziniu

    2014-04-01

    To investigate the efficacy of the intraoperative posterior pericardial window technique in preventing pericardial tamponade following open heart surgery. Adult patients undergoing coronary and/or valve surgery were randomly divided into a control (traditional) or a pericardial window (PW) technique group. Pre-, intra-, peri- and postoperative clinical data were collected prospectively, including incidence of pericardial tamponade, cardiac arrest, drainage volume, ventilation assistance time and moderate-to-large pericardial effusion. In total, 458 patients were included: 230 controls and 228 in the PW group. The incidence of pericardial tamponade in the PW group was significantly lower than in controls. Cardiac arrest occurred in one patient (0.4%) in the PW group and five (2.2%) controls; this difference was not statistically significant. Moderate-to-large pericardial effusion after drainage extubation and new-onset atrial fibrillation were significantly more common in controls than in the PW group. After stratification by age (≤ 70 versus > 70 years), there was no between-group difference in duration of endotracheal intubation, although in the PW group, after removal of the tracheal cannula, duration of noninvasive positive pressure ventilation was significantly longer in older patients. The pericardial window procedure did not increase the rate or severity of procedure-related complications. This simple technique significantly decreased the incidence of postoperative pericardial tamponade and new-onset atrial fibrillation.

  15. A Rare Case of Cardiac Tamponade Induced by Chronic Rheumatoid Arthritis.

    PubMed

    Yousuf, Tariq; Kramer, Jason; Kopiec, Adam; Bulwa, Zachary; Sanyal, Shuvani; Ziffra, Jeffrey

    2015-09-01

    Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease primarily involving the joint synovium. RA is a systemic disease which has many known extra-articular manifestations. We present a unique case of a patient with long standing RA who presented with a primary complaint of chest and back pain. Echocardiography revealed borderline normal left ventricular function and a large pericardial effusion with the finding of elevated intrapericardial pressure suspicious for cardiac tamponade. Infectious workup was all found to be negative. The presence and elevation of anti-cyclic citrullinated peptide antibody, rheumatoid factor and C-reactive protein (CRP) confirmed the patient was having an active flare-up of RA. It was determined that this flare-up was the cause of the cardiac tamponade. A pericardiocentesis was performed and 850 mL of bloody fluid was drained. The patient remained stable following the pericardiocentesis. At his follow-up visit, repeat echocardiogram showed no signs for pericardial effusion. Although there has been extensive study of RA, there are only a few documented cases noting the occurrence of cardiac tamponade in these patients. Therefore, it is important for the clinician to be aware of and recognize this potentially serious cardiac outcome associated with a common rheumatologic condition.

  16. An unusual case of non-small-cell lung cancer presenting as spontaneous cardiac tamponade.

    PubMed

    Joseph, Sarah; Al-Khalisy, Hassan; Randhawa, Umair; Lazar, John; Peroutka, Kathryn

    2016-04-01

    Hemorrhagic pericardial effusion with associated cardiac tamponade as a de novo sign of malignancy is seen in about 2% of patients.1 Consequently, cardiac tamponade is an oncologic emergency and considered a unique presentation of a malignancy.2 Cancer emergency is defined as an acute condition that is caused directly by the cancer itself or its treatment and requires intervention to avoid death or significant morbidity.3 The mechanism by which cardiac tamponade is classified as a life-threatening emergency stems from its impairment of right ventricular filling, resulting in ventricular diastolic collapse and decreased cardiac output, which can ultimately lead to death.4 We describe the case of a previously healthy woman in her late 40s who was a nonsmoker with no previous risk factors and who presented with a large pericardial effusion and bilateral pulmonary emboli. She was diagnosed with metastatic epidermal growth factor receptor-positive (EGFR-positive) adenocarcinoma of the lung. This case highlights an oncologic emergency as a de novo presentation of malignancy.

  17. Short-term minoxidil use associated with pericardial effusion and cardiac tamponade: an uncommon presentation.

    PubMed

    Pasala, Krishna K; Gujja, Karthik; Prabhu, Hejmadi; Vasavada, Balendu; Konka, Sudarsanam

    2012-11-01

    A 48-year-old man presented with complaints of shortness of breath and lower extremity swelling. His medical history was significant for hypertension on minoxidil and recent intracerebellar hemorrhage. Electrocardiography showed sinus tachycardia with left ventricular hypertrophy, and cardiomegaly was noted in the chest x-ray. The patient was hypertensive and tachypneic on admission. An echocardiogram taken immediately showed a large pericardial effusion with evidence of cardiac tamponade. He underwent immediate pericardiocentesis with drainage of 900 mL of pericardial fluid with significant improvement in the symptoms. Analysis of the pericardial fluid proved to be nondiagnostic. Infectious and rheumatologic causes were ruled out. After an extensive battery of tests, not yielding any diagnostic results, the pericardial effusion was attributed to minoxidil therapy. Closer monitoring is needed to prevent potentially fatal complications such as cardiac tamponade as in our patient.

  18. Late erosion of Amplatzer septal occluder device resulting in cardiac tamponade.

    PubMed

    Tchantchaleishvili, Vakhtang; Melvin, Amber L; Ling, Frederick S; Knight, Peter A

    2014-12-01

    Transcatheter device closure of atrial septal defects (ASDs) is a minimally invasive technique that offers an alternative to conventional surgical repair. There are risks imposed by this technique; however, they compare favourably with risks of surgical closure. Here, we present a case of a 59-year old male with late erosion of an Amplatzer septal occluder device resulting in cardiac tamponade 5 years after device placement. To the best of our knowledge, cardiac tamponade this late after device placement has not yet been reported. Septal occlusion device erosion remains a major issue among the risks imposed by device closure of an ASD. More data are needed to better understand its true causes and possible solutions.

  19. Diastolic heart failure: restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade: clinical and echocardiographic evaluation.

    PubMed

    Asher, Craig R; Klein, Allan L

    2002-01-01

    An understanding of the basic principles of diastolic function is important in order to recognize diseases that may result in diastolic dysfunction and diastolic heart failure. Although uncommon, restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade are among the disorders that may affect primarily diastolic function with preservation of systolic function. Diastolic heart failure may manifest with chronic nonspecific symptoms or may present with acute hemodynamic compromise. Echocardiography plays a vital role in the diagnosis of diastolic dysfunction and differentiation of these disease processes. It also provides a basis for clinical decisions regarding management and surgical referral. This review summarizes the clinical features, pathophysiology, and hemodynamic and echocardiographic signs of restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade.

  20. Application of Percutaneous Cardiopulmonary Support for Cardiac Tamponade Following Blunt Chest Trauma: Two Case Reports

    PubMed Central

    Kim, Seon Hee; Kim, Yeong Dae; Cho, Jeong Su; Lee, Chung Won; Lee, Jong Geun

    2012-01-01

    Since the advent of percutaneous cardiopulmonary support (PCPS), its application has been extended to massively injured patient. Cardiac injury following blunt chest trauma brings out high mortality and morbidity. In our cases, patients had high injury severity score by blunt trauma and presented sudden hemodynamic collapse in emergency room. We quickly detected cardiac tamponade by focused assessment with sonography for trauma and implemented PCPS. As PCPS established, their vital sign restored and then, they were transferred to the operation room (OR) securely. After all injured lesion repaired, PCPS weaned successfully in OR. They were discharged without complication on day 26 and 55, retrospectively. PMID:23130310

  1. Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: experience of a centre without cardiothoracic surgery.

    PubMed

    Cruz, Inês; Stuart, Bruno; Caldeira, Daniel; Morgado, Gonçalo; Gomes, Ana C; Almeida, Ana R; Loureiro, Maria J; João, Isabel; Cotrim, Carlos; Pereira, Hélder

    2015-04-01

    Cardiac tamponade has been reported in 18.7% of patients with acute type A aortic dissection and its presence is associated with worse outcomes. Emergency aortic repair together with intra-operative pericardial drainage is the recommended treatment approach. However, controversy surrounds how to manage patients with haemopericardium and cardiac tamponade who cannot survive until surgery. To describe a case series of patients with critical cardiac tamponade complicating aortic dissection admitted to a hospital without cardiothoracic surgery, and in whom preoperative controlled pericardial drainage was performed. Single centre retrospective study: during a nine-year period, 21 patients with Stanford type A aortic dissection were admitted at our centre; six of them (28.6%) presented clinical and echocardiographic signs of cardiac tamponade (four males; mean age 58±17 years). In this subgroup, controlled pericardiocentesis was safely performed with no major immediate complications and it was effective in five patients, improving haemodynamic instability and allowing transfer to the operating room. Preoperative controlled pericardiocentesis can be lifesaving when managing patients with critical cardiac tamponade (pulseless electrical activity or refractory hypotension) complicating acute type A aortic dissection, namely when cardiac surgery is not immediately available. © The European Society of Cardiology 2014.

  2. [Pericardial Fenestration in a Patient with Myocardial Metastasis and Cardiac Tamponade after Surgery for Esophageal Cancer;Report of a Case].

    PubMed

    Kobayashi, Kensuke; Suto, Yukio; Akashi, Okihiko; Sakata, Yoshihito; Hayama, Yasufumi; Kon, Junichi; Chino, Osamu

    2016-09-01

    We report a case of pericardial fenestration in a patient with myocardial metastasis and cardiac tamponade after surgery for esophageal cancer. A 66-year-old man had been suffering from orthopnea, hypotension and general malaise due to cardiac tamponade and heart failure. Esophagectomy was performed with substernal gastric tube reconstruction for advanced esophageal carcinoma. Nine months after the operation, heart failure developed, and myocardial and pericardial metastasis was subsequently detected. Subxiphoidal pericardiocentesis was abandoned due to the substernal gastric tube, and pericardial fenestration was performed through a small left anterior thoracotomy at the 5th intercostal space. His symptoms were ameliorated immediately and the procedure contributed greatly to maintain his quality of life. Preoperative computed tomography was useful for revealing the anatomical positions of the gastric tube and important vessels.

  3. The preventive role of the posterior pericardial window in the development of late cardiac tamponade following heart valve surgery.

    PubMed

    Uzun, Kemal; Günaydın, Zeki Yuksel; Tataroǧlu, Cenk; Bektaş, Osman

    2016-05-01

    It is reported that creating a window from the posterior pericardium into the left pleural cavity during coronary bypass surgeries reduces postoperative late cardiac tamponades. Although late tamponades are more common after heart valve surgeries, this procedure is not generally performed. The present study investigated whether creating a window has a preventive effect on the formation of late cardiac tamponade after heart valve surgeries. The study was conducted on all patients (n = 262) in whom one or more valves were replaced and who fulfilled the study criteria between January 2010 and October 2014 in one centre. We began to create a posterior pericardial window in all valvular patients from March 2012. One hundred and thirty-five patients operated on before this date (Non-Window Group) and 127 patients after this date (Window Group) were compared for the development of late cardiac tamponade. There were no differences between the groups in terms of preoperative and intraoperative characteristics. Late pericardial tamponade was not observed in any patients from the Window Group, whereas it occurred in 7 (5.2%) patients from the Non-Window Group (P = 0.015). Three patients died in total; all 3 were from the Non-Window Group. One of the mortalities was associated with tamponade. Creating a pericardial window may reduce late cardiac tamponade events/episodes, which may be a fatal complication in valve patients. We recommend performing this procedure by allocating some time during the surgical procedure in order to avoid tamponade. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  4. The preventive role of the posterior pericardial window in the development of late cardiac tamponade following heart valve surgery

    PubMed Central

    Uzun, Kemal; Günaydın, Zeki Yuksel; Tataroǧlu, Cenk; Bektaş, Osman

    2016-01-01

    OBJECTIVES It is reported that creating a window from the posterior pericardium into the left pleural cavity during coronary bypass surgeries reduces postoperative late cardiac tamponades. Although late tamponades are more common after heart valve surgeries, this procedure is not generally performed. The present study investigated whether creating a window has a preventive effect on the formation of late cardiac tamponade after heart valve surgeries. METHODS The study was conducted on all patients (n = 262) in whom one or more valves were replaced and who fulfilled the study criteria between January 2010 and October 2014 in one centre. We began to create a posterior pericardial window in all valvular patients from March 2012. One hundred and thirty-five patients operated on before this date (Non-Window Group) and 127 patients after this date (Window Group) were compared for the development of late cardiac tamponade. RESULTS There were no differences between the groups in terms of preoperative and intraoperative characteristics. Late pericardial tamponade was not observed in any patients from the Window Group, whereas it occurred in 7 (5.2%) patients from the Non-Window Group (P = 0.015). Three patients died in total; all 3 were from the Non-Window Group. One of the mortalities was associated with tamponade. CONCLUSIONS Creating a pericardial window may reduce late cardiac tamponade events/episodes, which may be a fatal complication in valve patients. We recommend performing this procedure by allocating some time during the surgical procedure in order to avoid tamponade. PMID:26819273

  5. Minimally invasive transxiphoid approach for management of pediatric cardiac tamponade – one center's experience

    PubMed Central

    Haponiuk, Ireneusz; Kwasniak, Ewelina; Chojnicki, Maciej; Steffens, Mariusz; Sendrowska, Aneta; Gierat-Haponiuk, Katarzyna; Leszczyńska, Katarzyna; Paczkowski, Konrad; Zielinski, Jacek

    2015-01-01

    Introduction Cardiac tamponade is excessive collection of fluid in the pericardial sac surrounding the heart that leads to restriction of cardiac function and causes critical cardiogenic shock and rapid circulatory depression. Despite the potential variety of different etiologies in the face of a dangerous decrease of cardiac output, the emergency life-saving procedure is surgical pericardial fluid evacuation. Aim To perform a retrospective analysis of clinical data and the results of minimally invasive transxiphoid pediatric cardiac tamponade evacuation procedures performed in a cardiac surgery center. Material and methods We performed a retrospective analysis of all consecutive patients referred for treatment in our department in a period of 6 years (15 patients) who underwent emergency pericardial drainage after an echocardiographically proven diagnosis. The procedure of choice was minimally invasive transxiphoid fluid evacuation with routine pericardial drainage. Retrospective operative data analysis was performed: clinical symptoms, pre-admission and initial emergency diagnostics and interventions, the morphology and total amount of drained pericardial fluid, length of stay, final results, and overall survival rate. We introduced an original pediatric tamponade index (PTI). The PTI was analyzed according to catecholamine support before the drainage and the length of hospital stay after the procedure. Results All patients survived the procedure. No early complications of the presented minimally invasive subxiphoid approach were noted. Mean PTI in patients with intensive catecholamine support before the operation was significantly higher than in patients without it. Conclusions Minimally invasive surgical transxiphoid interventions appear to be a safe and effective method to provide life-saving support with retrieval of the fluid for further laboratory investigations. PMID:25960801

  6. The evaluation of cardiac tamponade risk in patients with pericardial effusion detected by non-gated chest CT.

    PubMed

    Ohta, Yasutoshi; Miyoshi, Fuminori; Kaminou, Toshio; Kaetsu, Yasuhiro; Ogawa, Toshihide

    2016-05-01

    Although pericardial effusion is often identified using non-gated chest computed tomography (CT), findings predictive of cardiac tamponade have not been adequately established. To determine the findings predictive of clinical cardiac tamponade in patients with moderate to large pericardial effusion using non-gated chest CT. We performed a retrospective analysis of 134 patients with moderate to large pericardial effusion who were identified from among 4581 patients who underwent non-gated chest CT. Cardiac structural changes, including right ventricular outflow tract (RVOT), were qualitatively evaluated. The inferior vena cava ratio with hepatic (IVCupp) and renal portions (IVClow) and effusion size were measured. The diagnostic performance of each structural change was calculated, and multivariate analysis was used to determine the predictors of cardiac tamponade. Of the 134 patients (mean age, 70.3 years; 64 men), 37 (28%) had cardiac tamponade. The sensitivity and specificity were 76% and 74% for RVOT compression; 87% and 84% for an IVClow ratio ≥0.77; and 60% and 77% for an effusion size ≥25.5 mm, respectively. Multivariate logistic regression analysis demonstrated that RVOT compression, an IVClow ratio ≥0.77, and an effusion size ≥25.5 mm were independent predictors of cardiac tamponade. The combination of these three CT findings had a sensitivity, specificity, and accuracy of 81%, 95%, and 91%, respectively. In patients with moderate to large pericardial effusion, non-gated chest CT provides additional information for predicting cardiac tamponade. © The Foundation Acta Radiologica 2015.

  7. Bacterial Pericarditis Accompanied by Sudden Cardiac Tamponade After Transbronchial Needle Aspiration Cytology.

    PubMed

    Matsumoto, Takeshi; Otsuka, Kojiro; Imai, Yukihiro; Tomii, Keisuke

    2016-04-01

    A 48-year-old man was referred for an abnormal shadow in his chest x-ray. Transbronchial needle aspiration cytology was performed at the mediastinal necrotic lymph node #7, and he was diagnosed as having small cell carcinoma. Fifteen days after bronchoscopy, sudden cardiac tamponade occurred and pericardial drainage suggested a diagnosis of bacterial pericarditis. He was successfully treated by drainage and administration of antibiotics. Complication of bacterial pericarditis associated with bronchoscopy is rare. However, physicians should watch for the appearance of this condition for up to 3 weeks after bronchoscopy, especially in cases with necrotic lymph nodes.

  8. [Right ventricular perforation and cardiac tamponade caused by a central venous catheter].

    PubMed

    Fukuda, H; Kasuda, H; Shimizu, R

    1993-02-01

    A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. Cardiac tamponade was revealed by rapid opening of the chest. Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.

  9. Delayed cardiac tamponade: A rare but life-threatening complication of catheter ablation.

    PubMed

    Yetter, Elizabeth; Brazg, Jared; Del Valle, Diane; Mulvey, Laura; Dickman, Eitan

    2016-11-17

    Delayed cardiac tamponade (DCT) is a rare and life-threatening complication of catheter ablation performed as a treatment of atrial fibrillation, with few cases described in the medical literature. We present the case of a 57year-old man presenting with DCT 61days following a catheter ablation procedure. To the best of our knowledge, this is the most delayed case of cardiac tamponade (CT) following catheter ablation described in the literature. We also discuss the importance of point of care ultrasound (POCUS) in the diagnosis and treatment of CT. Emergency physicians must maintain a high index of suspicion in making the diagnosis of CT as patients may present with vague symptoms such as neck or back pain, shortness of breath, fatigue, dizziness, or altered mental status, often without chest pain. Common risk factors for CT include cancer, renal failure, pericarditis, cardiac surgery, myocardial rupture, trauma, and retrograde aortic dissection. In addition, although rare, both catheter ablation and use of anticoagulation carry risks of developing CT. A worldwide survey of medical centers performing catheter ablation found CT as a complication in less than 2% of cases [1]. Some proposed mechanisms of DCT include small pericardial hemorrhages following post-procedural anticoagulation or rupture of the sealed ablation-induced left atrial wall [2]. Clinical examination and electrocardiography may be helpful. However, the criterion standard for diagnosing CT is echocardiography [3].

  10. Cardiac tamponade secondary to purulent pericarditis diagnosed with the aid of emergency department ultrasound.

    PubMed

    Gabler, Mackenzie

    2017-08-01

    Purulent pericarditis is a rare but devastating disease process and even when treated, carries a poor prognosis. Cardiac tamponade is the most severe complication of purulent pericarditis and without acute surgical intervention, is often fatal. Diagnosis requires pericardiocentesis; however, early consideration of the disease and its complications in the emergency department (ED) can be life-saving. Here, we present a case of an intravenous drug user who presented with altered mental status and a rectal temperature of 105.4°. While in the ED, the patient acutely decompensated. The ED physician performed bedside cardiac ultrasound that a showed pericardial effusion and right ventricle diastolic collapse concerning for cardiac tamponade. The patient underwent urgent pericardiocentesis which revealed 300 ml of purulent fluid. Both blood and pericardial cultures grew methicillin-sensitive Staphylococcus aureus. Despite a complicated hospital course, with appropriate antibiotic coverage and surgical intervention, the patient was discharged in good neurologic condition. This rare case of purulent pericarditis underscores the utility of bedside ultrasound in the ED and the complicated nature of altered mental status in intravenous drug users. Published by Elsevier Inc.

  11. Cardiac tamponade arising from a venous source following anterograde dissection re-entry coronary angioplasty to a chronic total occlusion.

    PubMed

    Danson, E; Arena, F; Sapontis, J; Ward, M; Bhindi, R

    2016-10-01

    Cardiac tamponade is a rare complication of coronary intervention to chronic total occlusions (CTO PCI). We report a case of persistent bleeding from a venous source following successful anterograde dissection-reentry (ADR) CTO PCI. Pericardiocentesis was performed 1 h post-procedure for tamponade. Persistent bleeding was investigated with contrast transesophageal echocardiography, pericardial manometry and blood analysis. Coronary venography revealed subtle extravasation from a cardiac vein adjacent to the site of luminal re-entry. Coronary venous perforation using ADR CTO PCI has not previously been described; however, the volume of blood loss may be significant and surgical exploration may be appropriate.

  12. Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade.

    PubMed

    Saisho, Chika; Ishii, Hidenobu; Edakuni, Nobutaka; Imamura, Yohei; Tokito, Takaaki; Kinoshita, Takashi; Azuma, Koichi; Yamada, Kazuhiko; Hoshino, Tomoaki

    Primary pericardial malignant mesothelioma is a very rare clinical entity and its prognosis is very poor. We herein report a 67-year-old man who presented with pericardial mesothelioma that was diagnosed 21 months after the onset of cardiac tamponade as the initial manifestation. Despite undergoing pericardiocentesis and surgical pericardial fenestration at the onset of cardiac tamponade, we were unable to make a conclusive diagnosis of mesothelioma based on the cytological and histological findings. This unusual case had a relatively long progression-free period without treatment before the appearance of pleural tumors that showed the histological features of malignant sarcomatoid mesothelioma.

  13. Pericardial effusion with cardiac tamponade caused by a central venous catheter in a very low birth weight infant

    PubMed Central

    Chioukh, Fatma-Zohra; Ameur, Karim Ben; Hmida, Hayet Ben; Monastiri, Kamel

    2016-01-01

    With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. One of the life-threatening complications is pericardial effusion and cardiac tamponade; however, it is potentially reversible when it is caught in time. The authors present a case of cardiac tamponade following umbilical venous catheterisation in a neonate. The patient was diagnosed at the appropriate time by echocardiography and urgent pericardiocentesis proved lifesaving. PMID:28154705

  14. Recurrent Cardiac Tamponade: An Unusual Presentation of Intrahepatic Cholangiocarcinoma

    PubMed Central

    Corral, Juan E.; Arosemena, Leopoldo; Garcia-Buitrago, Monica T.; Madrazo, Beatrice; Martin, Paul

    2016-01-01

    A 48-year-old Egyptian woman presented with 8 months of sharp right upper chest pain and weight loss. She was discovered to have an enlarged cardiac silhouette on chest x-ray, and an echocardiogram revealed a large pericardial effusion with diastolic right atrial collapse. Pericardial window was done, and epithelial membrane antigen-positive neoplastic cells were identified in the pericardial fluid. Computed tomography showed a 6-cm hypermetabolic lesion on the liver segment IV, confirmed on biopsy to be a moderately differentiated adenocarcinoma consistent with intrahepatic cholangiocarcinoma. PMID:27144206

  15. Intrapericardial synthetic glue injection--a last resort effort to salvage recurrent cardiac tamponade secondary to coronary microleak post PCI.

    PubMed

    Goel, Pravin K; Kapoor, Aditya; Batra, Aditya

    2011-12-01

    We report a case of cardiac tamponade caused by a coronary microleak from an unapparent site that was successfully managed by sealing of the pericardial space with intrapericardial injection of sterile synthetic glue which, to the best of our knowledge, is the first report of its kind for post-PCI coronary leaks.

  16. Cardiac tamponade after malignant superior vena cava stenting: Two case reports and brief review of the literature.

    PubMed

    Da Ines, David; Chabrot, Pascal; Motreff, Pascal; Alfidja, Agaïcha; Cassagnes, Lucie; Filaire, Marc; Garcier, Jean-Marc; Boyer, Louis

    2010-04-01

    Percutaneous stenting of the superior vena cava (SVC) is usually recommended as a palliative procedure for malignant SVC obstruction with low reported morbidity. Complications are uncommon and usually of minor consequence. We report two unusual cases of cardiac tamponade following SVC stenting in patients with malignant SVC syndrome. Echocardiography allows rapid diagnosis and guides pericardial drainage in the interventional radiology suite.

  17. Iatrogenic catheter-related cardiac tamponade: a case report of fatal hydropericardium following subcutaneous implantation of a chemotherapeutic injection port.

    PubMed

    Shields, Lisa B E; Hunsaker, Donna M; Hunsaker, John C

    2003-03-01

    The need to obtain dependable access to the vascular system constitutes a significant component in the treatment and management of critically ill patients. Intravenous chemotherapy administered to cancer patients over an extended period of time often results in loss of peripheral vascular access due to vein sclerosis, "exhaustion" or tissue necrosis. Medical investigators have designed and steadily upgraded a variety of devices constructed to improve venous access for long-term utilization. As with the introduction of any foreign object into the body, each of these devices has complications which may be life threatening and occasionally fatal. We present an unusual case of iatrogenic acute hydropericardium and cardiac tamponade caused by the percutaneous infusion of chemotherapeutic fluid via a right subclavian central venous implant system (Port-a-Cath). Failure to implant and monitor the device with a radiograph following placement according to manufacturer's guidelines and accepted standards of medical practice were causally related to an unusual complication, namely, perforation of the right cardiac ventricle by the catheter tip, resulting in sudden and unexpected cardiac death.

  18. Rare Purulent Cardiac Tamponade Caused by Streptococcus Constellatus in a Young Immunocompetent Patient: Case Report and Review of the Literature

    PubMed Central

    Hindi, Zakaria

    2016-01-01

    Patient: Male, 19 Final Diagnosis: Cardiac tamponade Symptoms: Chest pain • shortness of breath Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Purulent pericardial tamponade is a very rare occurrence in the current era of widespread antibiotic use. It is even rarer when caused by Streptococcus constellatus: a microorganism usually classified among the normal flora of the human body. It is occasionally diagnosed with certain predisposing factors. Case Report: We present the third case of Streptococcus constellatus cardiac tamponade reported in the current medical literature, occurring in a previously healthy young man who was initially admitted and treated for possible community-acquired pneumonia. The patient required immediate subxyphoid pericardiocentesis. He was also treated successfully with a lengthy course of both intravenous and oral antibiotics. Two months post-hospitalization, he was confirmed clinically stable with complete resolution of his purulent effusion. We also conducted a review of the literature for all Streptococcus milleri group purulent pericardial infections between 1984 and 2015. Conclusions: Purulent cardiac tamponade caused by Streptococcus constellatus is extremely rare. It can be life threatening, however. Early appropriate diagnosis and therapeutic intervention are critical for a good outcome. PMID:27847383

  19. Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation: results from a worldwide survey in 34 943 atrial fibrillation ablation procedures.

    PubMed

    Michowitz, Yoav; Rahkovich, Michael; Oral, Hakan; Zado, Erica S; Tilz, Roland; John, Silke; Denis, Arnaud; Di Biase, Luigi; Winkle, Roger A; Mikhaylov, Evgeny N; Ruskin, Jeremy N; Yao, Yan; Josephson, Mark E; Tanner, Hildegard; Miller, John M; Champagne, Jean; Della Bella, Paolo; Kumagai, Koichiro; Defaye, Pascal; Luria, David; Lebedev, Dmitry S; Natale, Andrea; Jais, Pierre; Hindricks, Gerhard; Kuck, Karl-Heinz; Marchlinski, Francis E; Morady, Fred; Belhassen, Bernard

    2014-04-01

    Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female sex is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade. A systematic Medline search was used to locate academic electrophysiological centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to sex and their mode of management including any case of related mortality. Nineteen electrophysiological centers provided information on 34 943 ablation procedures involving 25 261 (72%) men. Overall, 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in women and 169 (0.67%) in men (odds ratio, 1.83; P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantially lower risk in high-volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; women tended to develop more tamponades during transseptal catheterization. No sex difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high-volume centers. Three cases of tamponade (1%) culminated in death. Tamponade during AF ablation procedures is relatively rare. Women have an ≈2-fold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high-volume centers. Surgical backup and acute management skills for treating tamponade are important in centers performing AF ablation.

  20. Cardiac tamponade

    MedlinePlus

    ... Possible Complications Complications may include: Heart failure Pulmonary edema Bleeding Shock Death When to Contact a Medical ... Heart attack Heart failure - overview Hypothyroidism Pericarditis Pulmonary edema Radiation therapy Systemic lupus erythematosus Review Date 5/ ...

  1. Endouterine hemostatic square suture vs. Bakri balloon tamponade for intractable hemorrhage due to complete placenta previa.

    PubMed

    Kavak, Salih Burcin; Atilgan, Remzi; Demirel, Ismail; Celik, Ebru; Ilhan, Rasit; Sapmaz, Ekrem

    2013-11-01

    To compare the efficiency of endouterine hemostatic square suture and the Bakri balloon tamponade in the treatment of bleeding due to complete placenta previa (CPP). Thirteen patients with the diagnosis of CPP and intractable bleeding were randomly divided into two groups in a single blind study. Group 1 (n=6) included patients in whom endouterine hemostatic square suture was applied, while group 2 (n=7) included patients in whom Bakri balloon tamponade was applied. The two groups were compared according to the maternal outcomes, the duration of caesarean section, the preoperative and the postoperative hemoglobin and hematocrit (Htc) values, the intraoperative and postoperative blood loss, as well as the newborn characteristics. The duration of operation and the amount of intraoperative bleeding were significantly higher in group 1 (time: 78.3 ± 8.1 vs. 62.8 ± 3.9 min; P<0.05; intraoperative bleeding: 1946 ± 242 vs. 1520 ± 92 mL; P<0.05). The postoperative 24th h Htc values were found to be significantly lower in group 1 than in group 2 (25.6 ± 3.7 vs. 29.5 ± 1.3 g/dL; P<0.05). The postoperative blood loss was higher in group 1 than in group 2. (351 ± 70 vs. 120 ± 56 mL; P<0.05). There are two methods that are effective in preventing bleeding in CPP. However, the Bakri balloon tamponade may be a better alternative due to a shorter operation time and less blood loss.

  2. An unusual presentation of cardiac tamponade associated with Epstein-Barr virus infection.

    PubMed

    Ho, Kai Man Alexander; Mitchell, Sheena C

    2015-05-13

    We present a case of an 80-year-old woman who presented with a dry cough, shortness of breath and general malaise. She had presented 5 days previously with a sore throat, feeling feverish and with non-specific symptoms. Her background included paroxysmal atrial fibrillation and hypertension. She was initially thought to have decompensated heart failure secondary to atrial fibrillation and was initiated on diuretic therapy. However, a transthoracic echocardiogram performed revealed collapse of the right ventricle and a swinging heart, suggestive of cardiac tamponade. The patient underwent therapeutic pericardiocentesis where 700 mL of exudative, blood-stained fluid was drained. Subsequent testing of the pericardial fluid revealed the presence of Epstein-Barr virus DNA. Serial follow-up transthoracic echocardiograms revealed resolution of the pericardial effusion and the patient remained asymptomatic.

  3. [Cardiac tamponade as first manifestation in Mediterranean fever with autosomal dominant form].

    PubMed

    Sánchez Ferrer, F; Martinez Villar, M; Fernández Bernal, A; Martín de Lara, I; Paya Elorza, I

    2015-01-01

    Familial Mediterranean fever (FMF) is a hereditary disease characterized by brief, recurring and self-limited episodes of fever and pain with inflammation, of one or several serous (peritoneum, pleura, pericardium, synovial or vaginal tunic of the testicle). Amyloidosis is its more important complication and the principal reason of death in the cases in which it appears. Diagnosis is based on the clinic and is confirmed by genetic tests. The treatment with Colchicine (0,02-0,03 mg/kg/day) prevents the recurrence of FMF attacks and the development of secondary (AA) amyloidosis. We report a case of a 13-year-old child in which FMF was diagnosed after several coincidental episodes with fever, pericarditis and cardiac tamponade. The genetic confirmation showed an autosomal dominant inheritance that is less frecuent than the recesive form, in this disease.

  4. [Cardiac tamponade: a rare complication of central venous catheter - a clinical case report].

    PubMed

    Azevedo, Ana Catarina; Flor de Lima, Isabel; Brito, Vânia; Centeno, Maria João; Fernandes, Antero

    2016-03-22

    The extensive use of central venous catheters (CVC) in a hospital environment leads to increased iatrogenic complications, as more catheters are used enclosed and its maintenance is prolonged. Several complications are known to be related to central venous catheter, of which the uncommon cardiac tamponade (CT), hardly recognized and associated with high mortality. We present a clinical case, with favorable outcome, of a patient who developed a CT 17 days after CVC placement, and try to reflect on the measures that can be taken to reduce its incidence, as well as the therapeutic approaches to practice in the presence of a suspected CT. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  5. [Cardiac tamponade following sternal puncture. Usefulness of ultrasound focussed assessment with sonography for trauma].

    PubMed

    Magaldi, M; Hervías, A; Perelló, L; Fontanals, J

    2014-03-01

    One of the aims of the medical profession is to be able to detect complications in patients during diagnostic tests and treatments. The early diagnosis of these complications can prevent a fatal outcome. The diagnosis is often based on clinical symptoms and supported by complementary tests. Diagnostic tests have been developed in the last few years that are rapid and easy to use, as well as being cost effective and minimally invasive. Focussed assessment with sonography for trauma ultrasound (echo-FAST) was introduced in the 1990s in the field of resuscitation as a test for the rapid detection of intra-abdominal and pericardial fluid in multiple injury patients, but its uses in other cases not involving trauma still raise doubts and controversy. A case is presented of a patient subjected to a sternal puncture for a bone marrow aspirate, who had a complication of a secondary cardiac tamponade, which was diagnosed early using echo-FAST.

  6. Delayed recurrent pericarditis complicated by pericardial effusion and cardiac tamponade in a blunt trauma patient

    PubMed Central

    Khidir, Hazar H.; Bloom, Jordan P.; Hawkins, Alexander T.

    2015-01-01

    A 19-year-old male suffered orthopedic fractures, blunt solid organ injury and pneumopericardium after a fall from 40 feet. With the exception of an external fixation device, he was managed non-operatively and discharged to a rehabilitation unit after 8 days. He was readmitted 4 days later with chest pain and clinical evidence of pericardititis that resolved with the initiation of non-steroidal anti-inflammatory drugs and colchicine. He returned to the rehabilitation hospital, but was readmitted once again for chest pain and hypotension. Echocardiogram revealed cardiac tamponade that required emergent drainage. He tolerated the procedure well and was discharged home from the hospital to continue treatment for his pericarditis. He is doing well at 3 months of follow-up. PMID:25709254

  7. Low-pressure cardiac tamponade masquerading as severe sepsis diagnosed with a bedside ultrasound and as the initial presentation of malignancy.

    PubMed

    Conti, Ricardo Augusto Slaibi; Oppenheim, Ian Mandeville

    2014-01-01

    We report a patient with low-pressure cardiac tamponade masquerading as sepsis and as the initial presentation of malignancy. A quick diagnosis was done by the intensivist performing a bedside ultrasound. The diagnosis of low-pressure cardiac tamponade is a challenge because the classic physical signs of cardiac tamponade can be absent. It is made even more challenging when the vital sign changes and physical examination findings mimic severe sepsis. One of the benefits of a bedside ultrasound in the assessment of a patient with an initial diagnosis of severe sepsis or septic shock is the rapid diagnosis of cardiac tamponade if it is present. A 55-year-old male presented to the emergency department with weakness, cough, and syncope. His examination was notable only for dusky mottling of his cheeks, chest, and neck. Specifically, there was no jugular venous distension or pulsus paradoxus. A chest radiograph showed a right upper lobe infiltrate, whereas his electrocardiogram showed only sinus tachycardia. His white blood cell count and lactic acid were elevated. The sepsis protocol was started and a bedside ultrasound revealed signs of cardiac tamponade. The patient immediately improved after a pericardiocentesis. Analysis of the pericardial biopsy revealed adenocarcinoma, later determined to be from a pulmonary primary source. Because low-pressure cardiac tamponade is life-threatening and difficult to diagnose, evaluation of the pericardium with a bedside ultrasound should be considered in patients with syncope, severe sepsis, or shock.

  8. Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure

    PubMed Central

    Singh, Gurkeerat; Sabath, Bruce

    2016-01-01

    An 84-year-old man with hypertension and a history of deep venous thrombosis (on warfarin) was admitted with shortness of breath presumed to be due to congestive heart failure. Echocardiogram performed the following day showed a low-normal ejection fraction with signs of elevated right-sided pressures but was otherwise normal. He improved with diuretic therapy but after a few days was found to be hypotensive with a concomitant rise in creatinine with decreased urine output. This was felt to be secondary to over-diuresis but he did not respond to small boluses of intravenous fluids as his kidney function continued to worsen and hypotension persisted. He was transferred to the intermediate care unit where a rapid, bedside ultrasound revealed a new, moderate-sized pericardial effusion with tamponade physiology. Pericardiocentesis, with removal of 750 cc of frank blood, led to dramatic improvement in blood pressure, kidney function, and urine output. Here, we demonstrate the utility of point-of-care ultrasound in a community hospital setting where urgent echocardiogram is not routinely available. We also report acute kidney injury due to pericardial tamponade reversed with therapeutic pericardiocentesis. PMID:27124173

  9. Pacemaker stimulus amplitude alteration without loss of capture: an unusual ECG finding in cardiac tamponade from pacemaker lead perforation.

    PubMed

    Suksaranjit, P; Prasidthrathsint, K

    2014-01-01

    A variation in pacemaker stimulus amplitude can represent pacemaker system dysfunction from generator malfunction, lead insulation defect, lead fracture, or artefact of digital signal processing of the electrocardiography recorder. Pacemaker lead perforation into the pericardial space typically results in loss of capture which was not demonstrated in our patient. In summary, we report an unusual ECG finding of pacemaker stimulus amplitude alteration without loss of capture in the setting of cardiac tamponade from pacemaker lead perforation.

  10. Hemodynamic and regional blood flow distribution responses to dextran, hydralazine, isoproterenol and amrinone during experimental cardiac tamponade

    SciTech Connect

    Millard, R.W.; Fowler, N.O.; Gabel, M.

    1983-06-01

    Four different interventions were examined in dogs with cardiac tamponade. Infusion of 216 to 288 ml saline solution into the pericardium reduced cardiac output from 3.5 +/- 0.3 to 1.7 +/- 0.2 liters/min as systemic vascular resistance increased from 4,110 +/- 281 to 6,370 +/- 424 dynes . s . cm-5. Left ventricular epicardial and endocardial blood flows were 178 +/- 13 and 220 +/- 12 ml/min per 100 g, respectively, and decreased to 72 +/- 14 and 78 +/- 11 ml/min per 100 g with tamponade. Reductions of 25 to 65% occurred in visceral and brain blood flows and in a composite brain sample. Cardiac output during tamponade was significantly increased by isoproterenol, 0.5 microgram/kg per min intravenously; hydralazine, 40 mg intravenously; dextran infusion or combined hydralazine and dextran, but not by amrinone. Total systemic vascular resistance was reduced by all interventions. Left ventricular epicardial flow was increased by isoproterenol, hydralazine and the hydralazine-dextran combination. Endocardial flow was increased by amrinone and the combination of hydralazine and dextran. Right ventricular myocardial blood flow increased with all interventions except dextran. Kidney cortical and composite brain blood flows were increased by both dextran alone and by the hydralazine-dextran combinations. Blood flow to small intestine was increased by all interventions as was that to large intestine by all except amrinone and hydralazine. Liver blood flow response was variable. The most pronounced hemodynamic and tissue perfusion improvements during cardiac tamponade were effected by combined vasodilation-blood volume expansion with a hydralazine-dextran combination. Isoproterenol had as dramatic an effect but it was short-lived. Amrinone was the least effective intervention.

  11. Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature.

    PubMed

    Maharaj, Satish S; Chang, Simone M

    2015-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve any organ system, exhibiting great diversity in presentation. Cardiac tamponade as the initial presentation of childhood onset SLE (cSLE) is rare. We report the case of a 10 year old Afro-Caribbean female who presented with complaints of chest pain, shortness of breath and fever over 4 days. Clinical examination strongly suggested cardiac tamponade which was confirmed by investigations and treated with pericardiocentesis. After a thorough investigation, the underlying diagnosis of SLE was confirmed using the Systemic Lupus International Collaborating Clinics (SLICC) criteria and high dose corticosteroid therapy initiated. A review of recent studies shows that common initial presentations of cSLE include constitutional symptoms, renal disease, musculoskeletal and cutaneous involvement. In presenting this case and reviewing the literature we emphasize the importance of cSLE as a differential diagnosis when presented with pericarditis in the presence or absence of cardiac tamponade. In these patients early diagnosis and treatment is desired and in this regard we also discuss the sensitivity of the SLICC criteria in cSLE.

  12. Pericardial tamponade consequent to a dynamite explosion: blast overpressure injury without penetrating trauma.

    PubMed

    Ozer, Orhan; Sari, Ibrahim; Davutoglu, Vedat; Yildirim, Cuma

    2009-01-01

    Acute cardiac tamponade is a life-threatening emergency that requires prompt treatment by either percutaneous or surgical pericardiocentesis. It may occur after penetrating or blunt chest trauma. We report a case of pericardial tamponade in the absence of penetrating trauma, due to blast overpressure injury after a dynamite explosion-which has not, to our knowledge, been reported before. Physicians should be aware of the possibility of pericardial tamponade in victims of barotraumatic events such as dynamite or bomb explosions, even in the absence of penetrating trauma. Cardiac tamponade, although life-threatening, is easy to treat when recognized.

  13. Prolonged Drainage and Intrapericardial Bleomycin Administration for Cardiac Tamponade Secondary to Cancer-Related Pericardial Effusion.

    PubMed

    Numico, Gianmauro; Cristofano, Antonella; Occelli, Marcella; Sicuro, Marco; Mozzicafreddo, Alessandro; Fea, Elena; Colantonio, Ida; Merlano, Marco; Piovano, Pierluigi; Silvestris, Nicola

    2016-04-01

    Malignant pericardial effusion (MPE) is a serious complication of several cancers. The most commonly involved solid tumors are lung and breast cancer. MPE can give rise to the clinical picture of cardiac tamponade, a life threatening condition that needs immediate drainage. While simple pericardiocentesis allows resolution of the symptoms, MPE frequently relapses unless further procedures are performed. Prolonged drainage, talcage with antineoplastic agents, or surgical creation of a pleuro-pericardial window are the most commonly suggested ones. They all result in MPE resolution and high rates of long-term control. Patients suitable for further systemic treatments can have a good prognosis irrespective of the pericardial site of disease. We prospectively enrolled patients with cardiac tamponade treated with prolonged drainage associated with Bleomycin administration. Twenty-two consecutive patients with MPE and associated signs of hemodynamical compromise underwent prolonged drainage and subsequent Bleomycin administration. After injection of 100 mg lidocaine hydrochloride, 10 mg Bleomycin was injected into the pericardial space. The catheter was clumped for 48 h and then reopened. Removal was performed when the drainage volume was <25 mL daily. Twelve patients (54%) achieved complete response and 9 (41%) a partial response. Only 1 (5%) had a treatment failure and underwent a successful surgical procedure. Acute toxicity was of a low degree and occurred in 7 patients (32%). It consisted mainly in thoracic pain and supraventricular arrhythmia. The 1-year pericardial effusion progression-free survival rate was 74.0% (95% confidence interval [CI]: 51.0-97.3). At a median follow-up of 75 months, a pericardial progression was detected in 4 patients (18%). One- and two-year overall survival rates were 33.9% (95% CI: 13.6-54.2) and 14.5% (95% CI: 0.0-29.5), respectively, with lung cancer patients having a shorter survival than breast cancer patients. The worst

  14. Prolonged Drainage and Intrapericardial Bleomycin Administration for Cardiac Tamponade Secondary to Cancer-Related Pericardial Effusion

    PubMed Central

    Numico, Gianmauro; Cristofano, Antonella; Occelli, Marcella; Sicuro, Marco; Mozzicafreddo, Alessandro; Fea, Elena; Colantonio, Ida; Merlano, Marco; Piovano, Pierluigi; Silvestris, Nicola

    2016-01-01

    Abstract Malignant pericardial effusion (MPE) is a serious complication of several cancers. The most commonly involved solid tumors are lung and breast cancer. MPE can give rise to the clinical picture of cardiac tamponade, a life threatening condition that needs immediate drainage. While simple pericardiocentesis allows resolution of the symptoms, MPE frequently relapses unless further procedures are performed. Prolonged drainage, talcage with antineoplastic agents, or surgical creation of a pleuro-pericardial window are the most commonly suggested ones. They all result in MPE resolution and high rates of long-term control. Patients suitable for further systemic treatments can have a good prognosis irrespective of the pericardial site of disease. We prospectively enrolled patients with cardiac tamponade treated with prolonged drainage associated with Bleomycin administration. Twenty-two consecutive patients with MPE and associated signs of hemodynamical compromise underwent prolonged drainage and subsequent Bleomycin administration. After injection of 100 mg lidocaine hydrochloride, 10 mg Bleomycin was injected into the pericardial space. The catheter was clumped for 48 h and then reopened. Removal was performed when the drainage volume was <25 mL daily. Twelve patients (54%) achieved complete response and 9 (41%) a partial response. Only 1 (5%) had a treatment failure and underwent a successful surgical procedure. Acute toxicity was of a low degree and occurred in 7 patients (32%). It consisted mainly in thoracic pain and supraventricular arrhythmia. The 1-year pericardial effusion progression-free survival rate was 74.0% (95% confidence interval [CI]: 51.0–97.3). At a median follow-up of 75 months, a pericardial progression was detected in 4 patients (18%). One- and two-year overall survival rates were 33.9% (95% CI: 13.6–54.2) and 14.5% (95% CI: 0.0–29.5), respectively, with lung cancer patients having a shorter survival than breast cancer patients

  15. Pericardial tamponade with a normal cardiopericardial silhouette due to a penetrating metallic projectile propelled by a lawnmower.

    PubMed

    Esfahani, Shadi Abdar; Yousefzadeh, David K

    2013-01-01

    This report describes a case of pericardial tamponade in a 6-year-old boy due to a penetrating projectile coat hunger wire propelled by a lawnmower. A dismissible dermal injury at the entry point and a normal initial cardiopericardial silhouette are reported. The report issues a new warning to be added to the warnings already listed in lawnmower manuals.

  16. Acute cardiac tamponade: an unusual cause of acute renal failure in a renal transplant recipient.

    PubMed

    Nampoory, Naryanan; Gheith, Osama; Al-Otaibi, Torki; Halim, Medhat; Nair, Prasad; Said, Tarek; Mosaad, Ahmed; Al-Sayed, Zakareya; Alsayed, Ayman; Yagan, Jude

    2015-04-01

    We report a case of slow graft function in a renal transplant recipient caused by uremic acute pericardial effusion with tamponade. Urgent pericardiocentesis was done with an improvement in blood pressure, immediate diuresis, and quick recovery of renal function back to baseline. Pericardial tamponade should be included in consideration of causes of type 1 cardiorenal syndrome in renal transplant recipients.

  17. Rare Purulent Cardiac Tamponade Caused by Streptococcus Constellatus in a Young Immunocompetent Patient: Case Report and Review of the Literature.

    PubMed

    Hindi, Zakaria

    2016-11-16

    BACKGROUND Purulent pericardial tamponade is a very rare occurrence in the current era of widespread antibiotic use. It is even rarer when caused by Streptococcus constellatus: a microorganism usually classified among the normal flora of the human body. It is occasionally diagnosed with certain predisposing factors. CASE REPORT We present the third case of Streptococcus constellatus cardiac tamponade reported in the current medical literature, occurring in a previously healthy young man who was initially admitted and treated for possible community-acquired pneumonia. The patient required immediate subxyphoid pericardiocentesis. He was also treated successfully with a lengthy course of both intravenous and oral antibiotics. Two months post-hospitalization, he was confirmed clinically stable with complete resolution of his purulent effusion. We also conducted a review of the literature for all Streptococcus milleri group purulent pericardial infections between 1984 and 2015. CONCLUSIONS Purulent cardiac tamponade caused by Streptococcus constellatus is extremely rare. It can be life threatening, however. Early appropriate diagnosis and therapeutic intervention are critical for a good outcome.

  18. [Cardiac tamponade in hypothyroidism. Probability of coexisting viral pericarditis--a case report].

    PubMed

    Elikowski, Waldemar; Małek, Małgorzata; Ziemnicka, Katarzyna; Kościański, Andrzej; Kalawski, Ryszard

    2005-06-01

    The authors describe a case of a 50-year-old woman admitted to hospital with clinical symptoms of a cardiac tamponade. Pericardiocentesis was done and 850 ml of fluid were drained during three days. Relatively slow heart rate (82/min before, and 60/min post intervention) and initial laboratory data: marked hipercholesterolemia (8.2 mmol/l) and high CK activity (1830 IU/l) were typical of hypothyroidism. Examination of hormone levels confirmed this suspicion (TSH 162 uIU/ml, fT4 0.11 microg/dl, fT3 0.4 pmol/l). USG image and antithyroid antibodies presence (anti-TPO >3000 U/ml) helped in diagnosing of autoimmune thyroiditis. During substitution therapy with L-thyroxine her clinical status improved systematically. Additionally, an increased raised serum titre of Coxackie B virus antibodies (B3-B5 >1/256) suggested coexisting viral pericarditis. Two months before hospitalization she had symptoms of viral infection. A review of current literature on the subject is presented.

  19. Novel echocardiographic prognostic markers for cardiac tamponade in patients with large malignant pericardial effusions: A paradigm shift from flow to tissue imaging.

    PubMed

    Chalikias, George; Samaras, Antonios; Ziakas, Antonios; Kikas, Petros; Thomaidis, Adina; Drosos, Ioannis; Giannakoulas, George; Karvounis, Haralambos; Konstantinides, Stavros; Tziakas, Dimitrios

    2017-09-01

    With this study, we sought to investigate the prognostic value of echocardiographic tissue imaging markers in predicting tamponade among patients with large malignant pericardial effusion compared to routinely used echocardiographic signs. A total of 96 consecutive patients with large malignant pericardial effusion, not in clinical cardiac tamponade, underwent an echocardiographic examination and were prospectively assessed for 1 month. Clinically evident cardiac tamponade was considered as the study endpoint. The prognostic performance of tricuspid valve annular plane systolic excursion (TAPSE) and peak systolic annular velocity at the lateral margin of the tricuspid valve annulus (STV ) was assessed and compared to routinely used imaging signs. During follow-up, 37 patients (39%) developed clinically evident cardiac tamponade. TAPSE (area under the curve [AUC] 0.958) and STV (AUC 0.948) had excellent predictive accuracy for tamponade. Multivariate analysis showed that TAPSE (Hazard ratio [HR] 3.03; 95% CI 1.60-5.73, P=.001) and STV (HR 1.17; 95% CI 1.05-1.29, P=.005) remained independent significant predictors of cardiac tamponade. Reclassification analysis and decision curve analysis showed additive prognostic value and adjunct clinical benefit of these markers when added to a recently published triage pericardiocentesis score. Echocardiographic tissue imaging markers such as TAPSE and STV are characterized by an excellent prognostic ability for development of cardiac tamponade and better prognostic value compared to routine echocardiographic signs in patients with large malignant pericardial effusion. Incorporating these markers to a recent triage pericardiocentesis score resulted in additional prognostic value and increased clinical benefit. © 2017, Wiley Periodicals, Inc.

  20. Closure of pericardium after open heart surgery. A way to prevent postoperative cardiac tamponade.

    PubMed Central

    Nandi, P; Leung, J S; Cheung, K L

    1976-01-01

    Between July 1968 and December 1975, 821 patients underwent open heart operations. In 596 cases the pericardium was left open and in 225 the pericardium was closed. Forty-one patients in the open pericardium group required reoperation and 23 of these had tamponade. Four patients in the closed pericardium group had reoperation but there was not a single case of tamponade. In most cases that required reoperation the bleeding was from extrapericardial sources. Absence of tamponade in the closed pericardium group can be explained by the fact that blood from extrapericardial sources of bleeding cannot collect round the heart because the pericardium is closed. Thus closure of pericardium helps to prevent tamponade. Reoperations some months or years after the original operation are technically easier and less hazardous if the pericardium has been closed because the closed pericardium prevents the heart from becoming adherent to the back of sternum and also because there are fewer adhesions in the pericardial cavity. PMID:795444

  1. Pericardial tamponade due to haemorrhagic pericardial effusion as a complication of prasugrel: a case report.

    PubMed

    Cader, Fathima Aaysha; Haq, M Maksumul; Nasrin, Sahela; Karim, Md Rezaul

    2016-08-30

    Striking an adequate balance between bleeding risks and prevention of stent thrombosis can be challenging in the setting of percutaneous coronary intervention (PCI) with drug eluting stents (DES) in acute myocardial infarction (MI). This is more pronounced in patients treated with both low molecular weight heparin (LMWH) and dual antiplatelet therapy (DAPT). Prasugrel, a second generation thienopyridine with more potent platelet inhibition capability, is associated with significant bleeding risks. This risk of bleeding is often underestimated when prescribing pharmacological agents such as DAPT and LMWH, designed to reduce ischaemic events following PCI in acute MI. Life-threatening haemorrhagic pericardial and pleural effusions not associated with access site bleeding are a rare example of such bleeding complications. We report a case of a Bangladeshi male who developed cardiac tamponade resulting from haemorrhagic pericardial effusion as well as bilateral pleural effusions, 9 days after PCI with a DES, while on prasugrel and aspirin. He had presented late with inferior ST elevation myocardial infarction (STEMI), and was therefore also given enoxaparin initially. Haemorrhagic pericardial and pleural fluid were drained, and the patient was discharged on DAPT comprising of aspirin and clopidogrel. Following PCI to obtuse marginal, which was done as a staged procedure 6 months later, he was commenced on ticagrelor instead of clopidogrel. He developed no further bleeding complications over 1 year of follow up. Non-access site bleeding such as this, leading to haemorrhagic pericardial and pleural effusions can be rare and life-threatening. Furthermore, patients with acute coronary syndromes (ACS) have marked variation in their risk of major bleeding. Since haemorrhagic complications are associated with mortality, maintaining a balance between the risk of recurrent ischemia and that of bleeding is of paramount importance. The use of validated bleeding risk scores

  2. Air tamponade of the heart

    PubMed Central

    Orłowski, Tadeusz; Iwanowicz, Katarzyna; Snarska, Jadwiga

    2016-01-01

    Pneumopericardium is a rare disease defined as the presence of air or gas in the pericardial sac. Among the etiological factors, the following stand out: chest trauma, barotrauma, air-containing fistulas between the pericardium and the surrounding structures, secondary gas production by microorganisms growing in the pericardial sac, and iatrogenic factors. Until now, spontaneous pneumopericardium has been considered a harmless and temporary state, but a review of clinical cases indicates that the presence of air in the pericardium can lead to cardiac tamponade and life-threatening hemodynamic disturbances. We present the case of an 80-year-old patient with a chronic bronchopericardial fistula, who suffered from a cardiac arrest due to air tamponade of the heart. PMID:27516791

  3. Cardiac Tamponade as a Presenting Manifestation of Infliximab-Induced Lupus in Patient Treated for Crohn’s Disease

    PubMed Central

    Kulairi, Zain; Kam, Michael

    2017-01-01

    Crohn’s disease is characterized by inflammation of the mucosal lining of the gastrointestinal tract. Infliximab is a tumor necrosis factor-α inhibitor that has been associated with increased remission and decreased disease flare-ups. Biological agents such as infliximab have been associated with adverse events. We present a rare case of cardiac tamponade caused by infliximab treatment for Crohn’s disease in a 30-year-old female. She was treated with emergent pericardial window and drainage of pericardial fluid. Infliximab was discontinued, and serositis was treated with steroids. The patient was later successfully rechallenged with vedolizumab. PMID:28138445

  4. Iatrogenic acute cardiac tamponade during percutaneous removal of a fractured peripherally inserted central catheter in a premature neonate.

    PubMed

    Minghui, Zou; Hujun, Cui; Li, Ma; Weidan, Chen; Yanqin, Cui; Xinxin, Chen

    2015-01-01

    Acute cardiac tamponade (ACT) is a life-threatening complication associated with a peripherally inserted central catheter (PICC) in premature neonates. We present a case of ACT in a 4-day-old male infant. On the second admission day, a PICC was inserted. After 2.5 months, chest radiography showed PICC fracture, and its distal portion had migrated into the right pulmonary artery. Percutaneous removal through cardiac catheterization was attempted. However, right ventriculography demonstrated intrapericardial spillage of contrast agents, and iatrogenic ACT was confirmed. Cardiopulmonary resuscitation (CPR) was immediately started with open-chest cardiac massage. Further surgical exploration revealed right atrial appendage perforation. After 25-min CPR, the patient restored spontaneous circulation, and removal of the foreign bodies was performed. The post-operative course was uneventful. PICC fracture is an uncommon complication, but may be life-threatening. Precaution should be taken to avoid ACT during removal of a broken PICC. Once the tamponade is diagnosed, immediate interventions are mandatory.

  5. Cardiac tamponade leading to the diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): a case report and review of the literature.

    PubMed

    Yano, Toshiyuki; Ishimura, Shutaro; Furukawa, Tetsuaki; Koyama, Masayuki; Tanaka, Marenao; Shimoshige, Shinya; Hashimoto, Akiyoshi; Miura, Tetsuji

    2015-11-01

    Eosinophilic granulomatosis with polyangiitis (EGPA), which was previously called Churg-Strauss syndrome, is a necrotizing systemic vasculitis of unknown cause accompanied by prominent eosinophilia. Cardiovascular complications, including eosinophilic myocarditis, are a major cause of mortality in this disorder. Acute pericarditis with slight pericardial effusion is a typical manifestation in EGPA, though hemodynamically significant pericardial effusion has been reported in a few cases. We report a case that initially presented with isolated cardiac tamponade, which was followed by systemic manifestations of EGPA over 3 weeks. Including the present case, previous EGPA cases with cardiac tamponade are reviewed to delineate its clinical characteristics.

  6. Successful use of BT-Cath(®) balloon tamponade in the management of postpartum haemorrhage due to placenta previa.

    PubMed

    Uygur, D; Altun Ensari, T; Ozgu-Erdinc, A S; Dede, H; Erkaya, S; Danisman, A N

    2014-10-01

    To investigate efficacy of the BT-Cath(®) in cases of uncontrollable haemorrhage due to placenta previa. Retrospective study of women treated with the BT-Cath in the event of postpartum haemorrhage (PPH) due to placenta previa, despite optimal management with medical treatment. Between 2011 and 2013, 237 women had placenta previa (0.45%) at the study hospital. This study evaluated 53 women who underwent uterine tamponade with a BT-Cath. Haemostasis was achieved in 45 women (85%), and hysterectomy was required in six women (11%). Two women required repeat laparotomy. The mean duration of balloon tamponade was 9.8h (standard deviation 6.4h). When the relationship between balloon volume and treatment success was evaluated, the area under the receiver operating characteristic curve was 0.803 (95% confidence interval 0.633-0.973; p=0.007) and the optimal cut-off point was 220ml, with sensitivity of 88% and specificity of 71%. The intra-uterine BT-Cath is simple to use, even among clinicians with little experience, and is an effective treatment choice in patients with PPH due to placenta previa when medical treatment is unsuccessful. Minimal inflation of the balloon, a shorter period of intra-uterine balloon tamponade and early deflation of the balloon are recommended. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery—A Report of 100 Patients

    PubMed Central

    Gumrukcuoglu, Hasan Ali; Odabasi, Dolunay; Akdag, Serkan; Ekim, Hasan

    2011-01-01

    Background. Cardiac tamponade (CT) represents a life-threatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. We have reviewed 100 patients with CT at our institution over a five-year period and compared the results of echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis with regard to functional outcomes. Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis). CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and follow-up data were collected. Results. Echo-guided pericardiocentesis was performed in 38 (38%) patients (Group A), primary surgical treatment was preformed in 36 (36%) patients (Group B), and surgical treatment following pericardiocentesis was performed in 26 (26%) patients (Group C). Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp.), followed by tuberculosis (14%). Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A. Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates. PMID:21941665

  8. Acute Cardiac Tamponade in a 58-Year-Old Male with Poststreptococcal Glomerulonephritis

    PubMed Central

    Bottinor, Wendy; Fronk, Daniel; Sadruddin, Salima; Foster, Harriet; Patel, Nilang; Prinz, Andreas; Jovin, Ion S

    2016-01-01

    Pericarditis in conjunction with nephritis is an uncommon clinical scenario with a broad differential diagnosis. We present the case of a 58-year-old male who developed nephritis and pericardial effusion with tamponade physiology. In the following, we discuss the differential diagnosis for concomitant nephritis and pericarditis and discuss the work-up performed on our patient. We also review the epidemiology of postinfectious glomerulonephritis in adults and describe previous cases of Streptococcus pyogenes pericarditis in the literature. PMID:27826373

  9. Diagnosis of cardiac tamponade with transesophageal echocardiography following the induction of anesthesia for suspected testicular torsion.

    PubMed

    McHugh, Stephen M; Wang, Xiao; Sullivan, Erin A

    2015-01-01

    Transesophageal echocardiography (TEE) is a valuable tool for evaluating hemodynamic instability in patients under general anesthesia. We present the case of a 28-year-old man who presented with complaints of testicular pain concerning for testicular torsion. After induction of general anesthesia for scrotal exploration and possible orchiopexy, the patient developed severe and persistent hypotension. Using intraoperative TEE, the diagnosis of pericardial tamponade was made, and an emergent pericardial window was performed.

  10. Acute Cardiac Tamponade in a 58-Year-Old Male with Poststreptococcal Glomerulonephritis.

    PubMed

    Bottinor, Wendy; Fronk, Daniel; Sadruddin, Salima; Foster, Harriet; Patel, Nilang; Prinz, Andreas; Jovin, Ion S

    2016-09-01

    Pericarditis in conjunction with nephritis is an uncommon clinical scenario with a broad differential diagnosis. We present the case of a 58-year-old male who developed nephritis and pericardial effusion with tamponade physiology. In the following, we discuss the differential diagnosis for concomitant nephritis and pericarditis and discuss the work-up performed on our patient. We also review the epidemiology of postinfectious glomerulonephritis in adults and describe previous cases of Streptococcus pyogenes pericarditis in the literature.

  11. Bard Denali inferior vena cava filter fracture and embolization resulting in cardiac tamponade: a device failure analysis.

    PubMed

    Kuo, William T; Robertson, Scott W

    2015-01-01

    A 46-year-old woman underwent inferior vena cava filter placement before bariatric surgery and returned within 6 months for routine removal. She complained of a 1-week history of severe chest pain, and during retrieval, two fractured filter components were identified including one arm in the right ventricle. The filter body and one fragment were successfully retrieved, but the fragment in the right ventricle was refractory to percutaneous retrieval. During open-heart surgery, the fragment was found traversing through the ventricular wall resulting in cardiac tamponade. Electron microscopic fragment analysis revealed high-cycle metal fatigue indicating the filter design failed to withstand this patient's natural inferior vena cava biomechanical motions. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

  12. New development of cardiac tamponade on underlying effusive–constrictive pericarditis: an uncommon initial presentation of scleroderma

    PubMed Central

    Subramanian, Stalin R; Akram, Rakhshanda; Velayati, Arash; Chadow, Hal

    2013-01-01

    A 40-year-old man with a medical history of hypertension was admitted for weight loss, generalised weakness, joint pains and mottling of fingertips. The initial laboratory data revealed microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure. Intravenous steroids were started for possible diagnosis of systemic lupus erythematosus based on admission assessment. Intravenous immunoglobulin and plasmapharesis were subsequently added to the treatment plan to cover thrombotic thrombocytopenic purpura while his autoimmune panel was pending. The echocardiogram study on day 2 revealed cardiac tamponade for which he underwent pericardiocentesis and right heart catheterisation. The atrial waveforms postpericardiocentesis demonstrated effusive–constrictive pericarditis. His clinical condition kept on deteriorating with reaccumulation of pericardial effusion and further complicated by hemoperitoneum and colonic obstruction. He had cardiorespiratory arrest on his fourth admission day and was not revived. Anti-Scl-70 antibody came back positive. Autopsy findings confirmed the presence of fibrinous pericarditis and hemoperitoneum. PMID:23853085

  13. Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis.

    PubMed

    Kanaroglou, Savas; Nair, Vidhya; Fernandes, John R

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), cardiac tamponade and sudden cardiac death that typically affects young women in the postpartum period. Rarely, it can be caused by systemic inflammatory conditions such as sarcoidosis. Sarcoidosis is an inflammatory disease most often affecting the lung and lymph nodes that can sometimes affect the heart. The authors report a case of sudden cardiac death caused by SCAD in the context of undiagnosed and subclinical cardiac sarcoidosis. The decedent was a 47-year-old male with a relatively innocuous past medical history. He was found dead in bed. At autopsy, there was a lethal hemopericardium resulting in cardiac tamponade. Gross examination of the heart revealed dissection of the posterior descending coronary branch of the right coronary artery. Histologically, the coronary artery showed acute and organizing dissection with evidence of vasculitis. A chronic inflammatory infiltrate consisting of lymphocytes, histiocytes, eosinophils and giant cells was seen. Sections of the myocardium showed myocarditis with a nonnecrotizing granuloma. The death was attributed to cardiac tamponade secondary to SCAD in the context of systemic sarcoidosis. The presented case demonstrates two concurrent rare pathologies and highlights the importance of considering SCAD in cases of sudden cardiac death at autopsy. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Cardiac tamponade following liver transplantation after intrapericardial control of the suprahepatic vena cava.

    PubMed

    Xu, Junming; Hong, Johnny C; Busuttil, Ronald W

    2015-03-01

    Transabdominal intrapericardial control of the suprahepatic inferior vena cava (SIVC) is a rather uncommon procedure occasionally required in conjunction with complicated liver transplantation (LT) and hepatobiliary surgery. Experience with this technique is limited. Here we report 6 cases of LT in which transabdominal intrapericardial control of the SIVC was necessary. After institutional review board approval was obtained, a single-center, retrospective review was conducted from January 1991 to December 2013 to identify adult cases (age > 18 years) of LT in which transabdominal intrapericardial isolation of the SIVC was necessary. Among 4102 adult LT cases in the study period, 6 such cases were identified. To gain access to the pericardial space, a 6- to 9-cm vertical incision was made above the SIVC. After reperfusion, the diaphragmatic incision was partially closed and selectively drained. Pericardial tamponade developed in 1 patient, and it necessitated emergent reoperation and widespread drainage. In conclusion, transabdominal intrapericardial isolation of the SIVC is easily achieved without the need for a separate thoracic incision. However, to be effective, the pericardial incision should be only partially closed, and the pericardial sac should be drained liberally. Such patients should be carefully monitored for signs and symptoms of pericardial tamponade, the development of which should prompt an immediate return to the operating room for emergent decompression and widespread drainage.

  15. Cardiac Tamponade Associated with the Presentation of Anaplastic Large Cell Lymphoma in a 2-Year-Old Child

    PubMed Central

    Mira-Perceval Juan, Gema; Alcalá Minagorre, Pedro J.; Huertas Sánchez, Ana M.; Segura Sánchez, Sheila; López Iniesta, Silvia; De León Marrero, Francisco J.; Costa Navarro, Estela; Niveiro de Jaime, María

    2015-01-01

    The anaplastic large cell lymphoma is a rare entity in pediatric patients. We present an unusual case of pericardial involvement, quite uncommon as extranodal presentation of this type of disorder, that provoked a life-risk situation requiring an urgent pericardiocentesis. To our knowledge, this is the first report on a child with pericardial involvement without an associated cardiac mass secondary to anaplastic large cell lymphoma in pediatric age. We report the case of a 21-month-old Caucasian male infant with cardiac tamponade associated with the presentation of anaplastic large cell lymphoma. Initially, the child presented with 24-day prolonged fever syndrome, cutaneous lesions associated with hepatomegaly, inguinal adenopathies, and pneumonia. After a 21-day asymptomatic period, polypnea and tachycardia were detected in a clinical check-up. Chest X-ray revealed a remarkable increase of the cardiothoracic index. The anaplastic large cell lymphoma has a high incidence of extranodal involvement but myocardial or pericardial involvements are rare. For this reason, we recommend a close monitoring of patients with a differential diagnosis of anaplastic large cell lymphoma. PMID:26435869

  16. Cardiac tamponade and para-aortic hematoma post elective surgical myocardial revascularization on a beating heart - a possible complication of the Lima-stitch and sequential venous anastomosis.

    PubMed

    Marcinkiewicz, Anna; Jaszewski, Ryszard; Piestrzeniewicz, Katarzyna; Zwoliński, Radosław

    2014-06-04

    Off-pump coronary artery bypass (OPCAB) surgery can be associated with some intrinsic, but relatively rare complications. A pericardial effusion is a common finding after cardiac surgeries, but the prevalence of a cardiac tamponade does not exceed 2% and is less frequent after myocardial revascularization.Authors believe that in our patient an injury of a nutritional pericardial or descending aorta vessel caused by the Lima stitch resulted in oozing bleeding, which gradually leaded to cardiac tamponade. The bleeding increased after introduction of double antiplatelet therapy and caused life-threatening hemodynamic destabilization. According to our knowledge it is the first report of such a complication after OPCAB. We present a case of a 61-year old man, who underwent elective surgical myocardial revascularization on a beating heart. On the 11th postoperative day the patient was readmitted emergently to the intensive care unit for severe chest pain, dyspnoea and hypotension. Coronary angiographic control showed a patency of the bypass grafts and significant narrowing of circumflex artery, treated with angioplasty and stenting. The symptoms and hemodynamic instability exacerbated. A suspicion of dissection of the ascending aorta and para-aortic hematoma was stated on 16-slice cardiac computed tomography. The patient was referred to the Cardiovascular Surgery Clinic. Transthoracic echocardiography revealed cardiac tamponade. On transesophageal echocardiography there were no signs of the ascending aorta dissection, but a possible lesion of the descending aorta with para-aortic hematoma was visualized. Emergent rethoracotomy and cardiac tamponade decompression were performed. 12 days after intervention the control 64-slice computed tomography showed no lesions of the ascending or descending aorta. On one-year follow-up patient is in a good condition, the left ventricular function is preserved and there is no pathology in thoracic aorta on echocardiography. Mechanical

  17. Pericardial Effusion and Cardiac Tamponade Following Percutaneously Inserted Central Line Insertion in an Extremely Low-birth-weight Baby: Case Report and Successful Management

    PubMed Central

    Desai, Avinash V.; Kumar, Abnish; Shanbhag, Praful; Shah, Forum

    2017-01-01

    Pericardial effusion and cardiac tamponade are rare complications of percutaneously inserted central lines (PICLs), in extremely low-birth-weight babies. This particular complication carries a high degree of mortality, if not suspected and diagnosed. Bedside echocardiography proves not only diagnostic but also can be lifesaving in these conditions. Here, we wish to report such a baby who suddenly deteriorated and showed cardiovascular instability 2 days after the insertion of PICL. Immediate bedside echocardiography helped pick up the effusion which was drained using a subxiphoid percutaneous approach. PMID:28197055

  18. Myopericarditis with predominantly right ventricular involvement with normal B-type natriuretic peptide and cardiac tamponade as the initial manifestation of systemic lupus erythematosus.

    PubMed

    Manautou, Luis; Jerjes-Sanchez, Carlos; Meraz, Manuel; Perez-Garcia, Luis F; Diaz-Cid, Antonio; de la Peña-Almaguer, Erasmo; Avila, Cesar; Sanchez, Luis

    2014-08-01

    A previously healthy young man presented with a 12-hour history of sudden dyspnea and severe chest pain at rest. Initial findings of physical examination, electrocardiogram and chest radiography showed typical pericarditis and clinical instability. Echocardiogram revealed small pericardial effusion with right ventricle dilatation. The patient was admitted in the ICU; a new echocardiogram revealed moderate pericardial effusion and diagnosis of pericarditis complicated with acute cardiac tamponade was established. The patient transiently improved after pericardial window. In the following hours, the diagnosis of myocarditis with predominantly right ventricular involvement (MPRVI) with severe right heart failure was supported by clinical, chest radiography and echocardiogram data, despite normal B-type natriuretic peptide. On day 2, cardiac troponin I detection was observed. By day 3, B-type natriuretic peptide in the range of ventricular dysfunction was identified. Cardiovascular magnetic resonance findings supported the diagnosis of MPRVI. A systematic MEDLINE/PubMed from 1993 to 2013 does not identify any cases of MPRVI related to systemic lupus erythematosus. Simultaneous acute MPRVI with normal B-type natriuretic peptide and acute cardiac tamponade heralding the diagnosis of systemic lupus erythematosus, to the best of our knowledge, has not been previously described.

  19. Hiatal hernia causing extrapericardial tamponade after coronary bypass surgery.

    PubMed

    Papoulidis, Pavlos; Beatty, Jasmine Winter; Dandekar, Uday

    2014-10-01

    Cardiac tamponade is defined as compression of the heart due to accumulation of fluid in the pericardial sac, leading to raised pericardial pressures with haemodynamic compromise. We describe the case of a 76-year old female patient who underwent a routine off-pump coronary artery bypass graft operation and within 48 h developed classic signs of cardiac tamponade. The perioperative echocardiogram and operative findings at re-exploration revealed no clots or fluid collection. A giant hiatus hernia was found to be responsible for the tamponade through extrinsic compression. After insertion of a nasogastric tube and decompression of the stomach, there was a rapid improvement of the clinical picture. The remaining postoperative course was uneventful and the patient was discharged 5 days later, with referral to the general surgeon for further management. We conclude that, in cases of tamponade post-cardiac surgery, extrapericardial pathologies should be considered. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  20. Management and Outcome of Periprocedural Cardiac Perforation and Tamponade with Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Single Medium-Volume Center Experience.

    PubMed

    Mujović, Nebojša; Marinković, Milan; Marković, Nebojša; Kocijančić, Aleksandar; Kovačević, Vladan; Simić, Dragan; Ristić, Arsen; Stanković, Goran; Miličić, Biljana; Putnik, Svetozar; Vujisić-Tešić, Bosiljka; Potpara, Tatjana S

    2016-10-01

    Cardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported. We analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011-2016. Of 1500 RFAs performed in 1352 patients (age 55 years, interquartile range: 41-63), 569 were left-sided procedures (n = 406 with transseptal access). Conventional RFA or irrigated RFA was performed in 40.9% and 59.1% of procedures, respectively. Ablation was performed mostly for atrioventricular nodal reentrant tachycardia (25.4%), atrial fibrillation (AF; 18.5%), atrial flutter (18.4%), accessory pathway (16.5%) or idiopathic ventricular arrhythmia (VA; 12.3%), and rarely for structural VA (2.1%). CT occurred in 12 procedures (0.8%): 10 AF ablations, 1 idiopathic VA and 1 typical atrial flutter ablation. Factors significantly associated with CT were older age, pre-procedural oral anticoagulation, left-sided procedures, transseptal access, AF ablation, irrigated RFA and longer fluoroscopy time (on univariate analysis), and AF ablation (on multivariable analysis). The perforation site was located in the left atrium (n = 7), right atrium (n = 3), or in the left ventricle or coronary sinus (n = 1 each). Upon pericardiocentesis, two patients underwent urgent cardiac surgery because of continued bleeding. There was no fatal outcome. During the follow-up of 19 ± 14 months, eight patients were arrhythmia free. Incidence of RFA-related CT in our medium-volume center was low and significantly associated with AF ablation. The outcome of CT was mostly favorable after pericardiocentesis, but readily accessible cardiothoracic surgery back-up should be mandatory in RFA centers.

  1. [Late tamponade after heart surgery: a dreadful diagnostic pitfall].

    PubMed

    Glock, Y F; Herreros, J; Tejeira, F J

    1983-05-01

    In a series of 250 consecutive open-heart operations, three cases of late cardiac tamponade were noted following the operation. This led the authors to review the literature pertaining to this complication. Ninety-nine cases were collected. The frequency of late tamponade associated with cardiac surgery was 0.62% and was fatal in 16.2% of those cases. The delay before the tamponade appeared varied from 3 days to 3 months (mean 14.5 +/- 7.8 days). The initial clinical picture is insidious and vague, and this constitutes the danger of late cardiac tamponade. The clinical signs are of the respiratory (dyspnea, chest pain), gastrointestinal (anorexia, vomiting) and central nervous (mental confusion, even coma) systems. Pallor with a drop in hematocrit in patients on anticoagulant therapy suggests occult bleeding. A definitive diagnosis depends on catheterization of the right side and on mono- and bidimensional echocardiography. The authors believe that computerized axial tomography represents an interesting noninvasive and reliable examination technique when it can be used during emergency treatment. Pericardial puncture, which is both a diagnostic and therapeutic technique, was useful in one third of the cases; it produced a false-negative result in 12%. The resulting differential diagnoses are pulmonary embolism, myocardial insufficiency and septic shock. Late cardiac tamponade may be produced by one of two mechanisms: hemopericardium due to overdosage of anticoagulants or an exacerbated form of the post-pericardiotomy syndrome. Emergency treatment is always necessary. Pericardiocentesis is a useful diagnostic aid and provides temporary stabilization preoperatively. A wide surgical approach is always indicated. The mortality in untreated patients is 100%. The frequency of immediate relapse or, occasionally, of delayed relapse is estimated to be 11%; relapse may be lethal.

  2. Acute tamponade of the left paracorporeal pump house due to membrane defect in a patient with a Berlin Heart EXCOR biventricular assist device.

    PubMed

    Völz, Sebastian; Holmberg, Michael; Redfors, Bengt; Dellgren, Göran

    2014-10-01

    We report a case of acute tamponade of the left paracorporeal pump house in a patient supported by a Berlin Heart EXCOR biventricular assist device (BiVAD) caused by mechanical defect in the membrane of the arterial chamber. A 36-year old male was admitted for composite graft surgery due to a large aortic regurgitation and consecutive heart failure, decompensated postoperatively and was rescued by with an extracorporeal membrane oxygenation (ECMO) device. He was accepted for heart transplantation, and a BiVAD (Berlin Heart EXCOR) was implanted as bridge-to-transplantation. Two months after discharge, he experienced dyspnoea and received error signals from his BiVAD. Relatives released him from his BiVAD companion driver, connected him to the hand pump and transported him to our institution. On arrival, he was in cardiogenic shock and was stabilized by ECMO. Inspection of the arterial chamber revealed a wear hole and delamination of the diaphragm, which had led to a tamponade by air insufflation into the three-layer membrane. New BiVAD paracorporeal pumps were connected, and the patient was subsequently successfully transplanted. The case depicts the difficulty of diagnosis in this specific patient setting. Despite transparent design of the BiVAD chambers, the development of a chamber tamponade remained undetected until explantation of the system.

  3. A Case of Blunt Traumatic Cardiac Tamponade Successfully Treated by Out-of-hospital Pericardial Drainage in a "Doctor-helicopter" Ambulance Staffed by Skilled Emergency Physicians.

    PubMed

    Otsuka, Hiroyuki; Sato, Toshiki; Morita, Seiji; Nakagawa, Yoshihide; Inokuchi, Sadaki

    2016-03-20

    We report a 55-year-old man who relapsed into a state of shock in an ambulance before arriving at our critical care center after a fall injury. The diagnosis of cardiac tamponade was made by portable ultrasound, and immediate pericardiocentesis and drainage were performed at the heliport. He was then transported immediately to our hospital with continuous drainage and surgery was performed. After surgery, the patient was transferred to the intensive care unit in stable condition. After undergoing rehabilitation, he made a full recovery and was discharged. This case illustrates that such patients can be treated reliably by pericardial drainage performed by skilled emergency physicians in the field by making use of the "doctor-helicopter" ambulance transportation system, followed by emergency surgery in a critical care center.

  4. Extra-pericardial tamponade following Wolf Mini-Maze procedure: a case report.

    PubMed

    Bailey, James P

    2015-11-05

    Extra-pericardial tamponade is a rare life threatening condition that has not previously been reported in association with Wolf Mini-Maze procedures. In this case, atypical presentation of cardiac tamponade caused by postoperative anticoagulation resulted in a second hospitalization, a second surgery, and delayed recovery time. The goal of this case report is to increase awareness about a life threatening complication that can occur following minimally invasive cardiac surgery. A 60 year old male with long standing essential hypertension, who was recently treated for atrial fibrillation utilizing the Wolf Mini-Maze procedure, experienced a postoperative international normalized ratio increase from 3.6 to 5.3 over the course of six days. Fifteen days postoperatively, the patient experienced mild exercise intolerance, his condition rapidly progressed to a constellation of symptoms including severe exercise intolerance, dyspnea, hypotension, and near syncope. A diagnosis of cardiac tamponade was made, and the patient was re-admitted to the hospital. Attempts to reverse his warfarin anticoagulation with fresh frozen plasma and vitamin K were unsuccessful after 24 h. Video-assisted thoracotomy was performed to relieve the tamponade, and during surgery he was diagnosed with extra-pericardial tamponade caused by an extensive hematoma. Complications due to anticoagulation therapy required this re-admission, additional surgery, and delayed recovery. The patient has since recovered completely with no long term morbidities and is asymptomatic three years following initial presentation. This case marks the first time extra-pericardial tamponade has been reported post cardiothoracic intervention in English literature. Many surgical procedures require postoperative anticoagulation; in the past, warfarin has been the standard of care due to its purported reversibility. This case provides an example of the challenge presented when anticoagulating with warfarin, and the reversal of

  5. Sudden perinatal death due to rupture of congenital cardiac diverticulum. Pathological findings and medico-legal investigations in malpractice charge.

    PubMed

    Marchesi, Matteo; Boracchi, Michele; Gentile, Guendalina; Maghin, Francesca; Zoja, Riccardo

    2017-09-01

    Congenital diverticula of the left ventricle, very rare malformations, are determined by an abnormal embryonic development of the ventricular wall and can be isolated or associated to other cardiac anomalies. In most of the cases, these pathologies are not symptomatic and in some patients can be associated to ventricular arrhythmia, cardiac rupture with tamponade and sudden death. Authors are presenting the case of a sudden death in an 8-weeks-old newborn due to rupture of a cardiac congenital diverticulum of the left ventricle, discovered only at the moment of the autopsic examination. The parents of the victim pressed charges against the medical staff that was appointed to the cares, blaming them with malpractice. The missed diagnosis of a cardiac congenital diverticulum of the left ventricle, a rare pathology, reflects the trickiness of the medical management that can lead to medico-legal controversies and, even though such rare conditions must be always taken into consideration when investigating possible dysfunction causing the death, diagnostic difficulties, in the case in exam, justify the missed diagnosis intra-vitam of cardiac ventricular diverticulum. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Cardiac arrest due to baclofen withdrawal syndrome

    PubMed Central

    Cardoso, Ana Luísa; Quintaneiro, Claudio; Seabra, Helena; Teixeira, Carla

    2014-01-01

    A 41-year-old man presented with postcervical traumatic complete quadriparesis under intrathecal baclofen therapy (ITB) for refractory spasticity. Less than 24 h after having his baclofen pump substituted, he develops hyperthermia, seizures, cognitive depression, acute hypoxaemic respiratory failure and cardiovascular instability leading to mechanical ventilation and vasopressor support. He was transferred to an intensive care unit with diagnosis of community-acquired pneumonia leading to septic shock. He evolved with progressive clinical worsening and multisystem organ failure and cardiac arrest in non-shockable rhythm (pulseless electrical activity)—4 min resuscitation with return of spontaneous circulation. Considering the possible diagnosis of baclofen withdrawal syndrome and, in suspicion of ITB delivery disruption, the catheter system was surgically explored and a leaking tubule attachment was found. Despite aggressive cardiovascular, respiratory and renal support therapy, clinical improvement occurred only after restoration of intrathecal drug delivery. He was discharged from the hospital after 56 days, having returned to baseline status. PMID:24827663

  7. [Long-term survival of a breast cancer patient with carcinomatous pleuritis and carcinomatous cardiac tamponade successfully treated by multimodality therapy].

    PubMed

    Tanaka, Yosuke; Tsuboi, Kaori; Yamamoto, Akira; Tsuda, Shoichi; Tsujii, Shigehiro; Yagi, Ken; Kitamura, Tatsuhiko

    2015-04-01

    A 69-year old woman was admitted to our hospital because of dyspnea and pain in her left breast. Computed tomography revealed a massive quantity of left pleural effusion, a tumor in the left breast(5 cm in diameter), left cervical and supraclavicular lymph node metastasis, and a large left axillary metastatic mass. Based on a core needle biopsy, her breast tumor was diagnosed pathologically as scirrhous carcinoma, which was positive for estrogen receptor/progesterone receptor and negative for HER2 using the FISH assay, and left pleural metastasis was diagnosed cytologically. The carcinomatous pleural effusion was successfully controlled using pleural instillations of pirarubicin HCl and OK-432 after pleural drainage. A near clinical complete response was achieved by EC systemic chemotherapy(6 months)followed by endocrine therapy(letrozole), but 3 months later she was diagnosed cytologically with carcinomatous cardiac tamponade. After operative pericardial drainage, intrapericardial instillations of cisplatin and OK-432 successfully prevented re-accumulation of pericardial effusion. Systemic chemotherapy(weekly paclitaxel)for 11 months and endocrine therapy(letrozole)resulted in a clinical complete response. One year and 10 months after pericardial drainage, she underwent surgery(mastectomy and axillary lymph node dissection level II)because of two small tumors in the left breast which were found to be malignant using PET-CT. One tumor(diameter 1.6 cm)was found pathologically to consist of degenerated cancer cells, and another tumor(diameter 2 cm)was diagnosed as recurrent cancer. There was no lymph node metastasis in the axilla except for a single mass(1.4×0.7×0.3 cm), which was composed of extremely degenerative and necrotic non-lymphoid cancerous tissue. Since having the surgery, she has not experienced recurrence on hormone therapy with fulvestrant, and to date she is still alive, 3 years and 5 months since the left pleural metastasis episode.

  8. Motion of the Esophagus Due to Cardiac Motion

    PubMed Central

    Palmer, Jacob; Yang, Jinzhong; Pan, Tinsu; Court, Laurence E.

    2014-01-01

    When imaging studies (e.g. CT) are used to quantify morphological changes in an anatomical structure, it is necessary to understand the extent and source of motion which can give imaging artifacts (e.g. blurring or local distortion). The objective of this study was to assess the magnitude of esophageal motion due to cardiac motion. We used retrospective electrocardiogram-gated contrast-enhanced computed tomography angiography images for this study. The anatomic region from the carina to the bottom of the heart was taken at deep-inspiration breath hold with the patients' arms raised above their shoulders, in a position similar to that used for radiation therapy. The esophagus was delineated on the diastolic phase of cardiac motion, and deformable registration was used to sequentially deform the images in nearest-neighbor phases among the 10 cardiac phases, starting from the diastolic phase. Using the 10 deformation fields generated from the deformable registration, the magnitude of the extreme displacements was then calculated for each voxel, and the mean and maximum displacement was calculated for each computed tomography slice for each patient. The average maximum esophageal displacement due to cardiac motion for all patients was 5.8 mm (standard deviation: 1.6 mm, maximum: 10.0 mm) in the transverse direction. For 21 of 26 patients, the largest esophageal motion was found in the inferior region of the heart; for the other patients, esophageal motion was approximately independent of superior-inferior position. The esophagus motion was larger at cardiac phases where the electrocardiogram R-wave occurs. In conclusion, the magnitude of esophageal motion near the heart due to cardiac motion is similar to that due to other sources of motion, including respiratory motion and intra-fraction motion. A larger cardiac motion will result into larger esophagus motion in a cardiac cycle. PMID:24586540

  9. Motion of the esophagus due to cardiac motion.

    PubMed

    Palmer, Jacob; Yang, Jinzhong; Pan, Tinsu; Court, Laurence E

    2014-01-01

    When imaging studies (e.g. CT) are used to quantify morphological changes in an anatomical structure, it is necessary to understand the extent and source of motion which can give imaging artifacts (e.g. blurring or local distortion). The objective of this study was to assess the magnitude of esophageal motion due to cardiac motion. We used retrospective electrocardiogram-gated contrast-enhanced computed tomography angiography images for this study. The anatomic region from the carina to the bottom of the heart was taken at deep-inspiration breath hold with the patients' arms raised above their shoulders, in a position similar to that used for radiation therapy. The esophagus was delineated on the diastolic phase of cardiac motion, and deformable registration was used to sequentially deform the images in nearest-neighbor phases among the 10 cardiac phases, starting from the diastolic phase. Using the 10 deformation fields generated from the deformable registration, the magnitude of the extreme displacements was then calculated for each voxel, and the mean and maximum displacement was calculated for each computed tomography slice for each patient. The average maximum esophageal displacement due to cardiac motion for all patients was 5.8 mm (standard deviation: 1.6 mm, maximum: 10.0 mm) in the transverse direction. For 21 of 26 patients, the largest esophageal motion was found in the inferior region of the heart; for the other patients, esophageal motion was approximately independent of superior-inferior position. The esophagus motion was larger at cardiac phases where the electrocardiogram R-wave occurs. In conclusion, the magnitude of esophageal motion near the heart due to cardiac motion is similar to that due to other sources of motion, including respiratory motion and intra-fraction motion. A larger cardiac motion will result into larger esophagus motion in a cardiac cycle.

  10. Management of malignant pericardial effusion and tamponade

    SciTech Connect

    Press, O.W.; Livingston, R.

    1987-02-27

    The optimal management of neoplastic cardiac tamponade has been controversial, with ardent proponents of pericardiocentesis (with or without sclerotherapy), surgical decompression, and radiation therapy as primary therapeutic modalities. In the eight years since this oncologic emergency was last reviewed in this journal, several informative therapeutic trials have been reported that warrant a reappraisal of the recommended interventions for this condition.

  11. Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy

    PubMed Central

    Seibel, Ira; Cordini, Dino; Willerding, Gregor; Riechardt, Aline Isabel; Joussen, Antonia Maria

    2014-01-01

    Background Choroidal melanoma is frequently accompanied by an exudative retinal detachment that can persist after proton beam therapy. This study investigates whether vitrectomy without tumor resection improves the clinical outcome. Methods This is a retrospective interventional case series. Twenty patients with choroidal melanoma with exudative retinal detachment involving the macula were treated by vitrectomy, endodrainage, photocoagulation, and silicone oil tamponade after proton beam therapy. Results The mean follow-up was 38.4 months (median 21.5, range 12.0-122.0). The mean time between proton beam therapy and surgery was 4.5 months (range 0.1-9.2). Reattachment was achieved in 95% of the patients after one vitrectomy. One patient was lost to follow-up because enucleation was performed after 45.9 months due to a secondary glaucoma. Mean visual acuity decreased from 1.1 to 1.8 logMAR before vitrectomy and after 4 years, respectively. No patient showed local tumor recurrence. Metastatic disease was present in 1 patient after 15.2 months, and this patient died after 19.2 months. Conclusion Vitrectomy is indicated after therapeutic proton beam irradiation in patients who present with persisting exudative retinal detachment involving the macula and high local or systemic risk factors for hemorrhagic complications, thus excluding endoresection. PMID:27175359

  12. Predictors of moderate-to-severe pericardial effusion, cardiac tamponade, and electromechanical dissociation in patients with ST-elevation myocardial infarction.

    PubMed

    Figueras, Jaume; Barrabés, Jose A; Lidón, Rosa-Maria; Sambola, Antonia; Bañeras, Jordi; Palomares, José Rodriguez; Martí, Gerard; Dorado, David Garcia

    2014-04-15

    Occurrence of moderate-to-severe pericardial effusion (PE; ≥10 mm), cardiac tamponade (CT), and sudden electromechanical dissociation (EMD) was investigated in 4,361 patients with ST-elevation myocardial infarction from 1993 to 2011 in 3 different periods: 1993 to 2000 (n: 1,488); 2001 to 2008 (n: 1,844); and 2009 to 2011 (n: 1,014). Their predictors, including the use of no reperfusion therapy (n: 1,186), thrombolysis (n: 1,607), or primary percutaneous coronary intervention (PPCI, n: 1,562), were also evaluated. Incidence of PE (8.7%, 6.8%, and 5.0%), CT (5.0%, 2.9%, and 1.9%), and EMD (3.7%, 1.7%, and 1.0%), declined over the 3 periods as did mortality (12.0% 8.2%, and 5.9%) with different rates of thrombolytic therapy (52%, 37%, and 14%) and PPCI (7%, 38%, and 76%; all p<0.001). In patients treated without reperfusion therapy, thrombolysis, and PPCI, incidence of PE (12.0%, 5.7%, and 4.3%), CT (6.0%, 3.0%, and 2.2%), and EMD (4.1%, 2.2%, and 0.8%) was different as was mortality (14.4%, 8.3%, and 5.9%; all p<0.001). Independent predictors of PE were lateral infarction (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.57 to 6.49), increasing age (OR 1.05, 95% CI 1.04 to 1.07), number of electrocardiographic leads involved (OR 1.34, 95% CI 1.23 to 1.45), and admission delay (OR 1.01, 95% CI 1.01 to 1.02). Increasing ejection fraction (OR 0.97, 95% CI 0.96 to 0.98), thrombolysis (OR 0.53, 95% CI 0.37 to 0.75), and PPCI (OR 0.35, 95% CI 0.25 to 0.50), however, were protectors (all p<0.001). Lateral infarction, age, number of leads involved, ejection fraction, thrombolytic therapy, and PPCI were also predictors/protectors of CT and EMD. In conclusion, PE, CT, and EMD rates in patients with ST-elevation myocardial infarction have objectively fallen in the last 2 decades, and their predictors are lateral site, increasing age, number of leads involved, and lack of reperfusion therapy. Late hospital admission is also a relevant predictor of PE.

  13. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression

    PubMed Central

    Almehmadi, Fahad; Chandy, Mark; Edwards, Jeremy

    2016-01-01

    Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management. PMID:27651957

  14. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression.

    PubMed

    Almehmadi, Fahad; Chandy, Mark; Connelly, Kim A; Edwards, Jeremy

    2016-01-01

    Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management.

  15. Low-Pressure Pericardial Tamponade: Case Report and Review of the Literature.

    PubMed

    Walsh, Brooks M; Tobias, Lauren A

    2017-04-01

    Focused cardiac ultrasound (FoCUS) is accurate for determining the presence of a pericardial effusion. Using FoCUS to evaluate for pericardial tamponade, however, is more involved. Many experts teach that tamponade is unlikely if the inferior vena cava (IVC) shows respiratory variation and is not distended. A 53-year-old woman presented to the emergency department (ED) with severe orthostatic hypotension, exertional dyspnea, and hypoxia. The evaluation did not reveal an acute cardiopulmonary etiology, but FoCUS demonstrated a pericardial effusion, with several signs consistent with tamponade. The IVC, however, was not distended. She was believed to be hypovolemic, but fluid therapy provided minimal benefit. The patient's condition improved only after aspiration of the effusion. The patient's presentation was likely a "low-pressure" pericardial tamponade. Patients with this subset of tamponade often do not have significant venous congestion, but urgent pericardial aspiration is still indicated. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pericardial tamponade may not manifest with IVC plethora on ultrasound. Patients with low-pressure tamponade do not present with the most florid signs of tamponade, but they nonetheless fulfill diagnostic criteria for tamponade. If a non-plethoric IVC is used to rule out tamponade, the clinician risks delaying comprehensive echocardiography or other tests. Furthermore, the potential for deterioration to frank shock could be discounted, with inappropriate disposition and monitoring. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Short-term intraocular tamponade with perfluorocarbon heavy liquid.

    PubMed

    Drury, Brett; Bourke, Robert D

    2011-05-01

    Inferior retinal detachment pathology can be difficult to manage due to inadequate tamponade with low specific gravity tamponade agents and the propensity for the development of proliferative vitreoretinopathy (PVR). We report the efficacy and adverse effects associated with the use of perfluorocarbon heavy liquid as a short-term tamponade in managing such pathologies. Retrospective analysis of 17 eyes treated with short-term perfluoro-n-octane tamponade for complex inferior retinal pathology, including inferior detachment and PVR. Mean follow-up time was 14 months and mean tamponade duration was 7 days. Reattachment of the retina during the study period was achieved with a single set of operations in 13/17 (76%) eyes, with four eyes requiring a subsequent set of vitreoretinal operations. Postoperative visual acuity (VA) was equal to or better than preoperative VA in 14 (82%) of 17 eyes. Complications arising during the follow-up period included superior redetachment, atrophic macular changes, minor macular haemorrhage, cataract, elevated intraocular pressure, corneal defects, PVR, epiretinal membrane and retained perfluorocarbon heavy liquid. One case of intraocular inflammation occurred >6 months after removal of perfluoro-n-octane tamponade. Short-term perfluoro-n-octane tamponade achieved a stable reattachment rate of 76% when used to manage challenging retinal pathologies.

  17. Feasibility of diagnosis of postcardiotomy tamponade by miniaturized transesophageal echocardiography.

    PubMed

    Hirose, Hitoshi; Gupta, Shreya; Pitcher, Harrison; Miessau, Joseph; Yang, Qiong; Yang, Jenny; Cavarocchi, Nicholas

    2014-07-01

    Pericardial tamponade after cardiac surgery is a critical diagnosis that can be difficult to diagnose using conventional cardiac monitoring. Transesophageal echocardiography can provide comprehensive information to make the diagnosis but is not always available, whereas transthoracic echocardiography has its utility limited because of the body habitus or other surgical effects. New monitoring devices, miniaturized hemodynamic transesophageal echocardiography (hTEE), which allows point of care assessment of cardiac filling and functions, may aid in diagnosis of postcardiotomy tamponade. From May 2011 to July 2013, 21 patients underwent hTEE to rule out pericardial tamponade for clinical suspicion of tamponade after open heart surgery. The hTEE images were reviewed, and the patient outcomes were analyzed. Nine patients showed no evidence of pericardial collection and did not require reexploration. Two patients showed a presence of small hematoma without ventricular compression and also did not undergo exploration. Ten patients were positive for pericardial tamponade (effusion or hematoma with ventricular compression); eight of these cases underwent emergent surgical exploration. Of the two patients who did not undergo immediate reoperation, one was managed by chest tube manipulation and the other patient underwent subsequent surgical exploration after his extensive coagulopathy was corrected by medical treatment. The diagnosis of pericardial tamponade postcardiotomy is feasible using a disposable hTEE based on our limited experience. We avoided unnecessary explorations while concomitantly made prompt diagnosis in emergent situations. The hTEE device was a valuable tool in hemodynamic management in the intensive care unit, allowing rapid evaluations. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Cardiac arrest due to a missed diagnosis of Boerhaave's syndrome.

    PubMed

    Davies, Jennifer; Spitzer, David; Phylactou, Maria; Glasser, Martin

    2016-05-06

    A 91-year-old presented with a rare cause of cardiac arrest. He was initially admitted with severe back pain following vomiting and diagnosed with probable aspiration pneumonia. On day 3 of admission, he was discovered in cardiac arrest and cardiopulmonary resuscitation was started. On intubation, a left-sided pneumothorax and subcutaneous emphysema were noted. Needle decompression showed gastric fluid leaking from the cannula. The patient regained a cardiac output, and a subsequent CT scan confirmed a large pneumomediastinum with air tracking to the neck and chest, and bilateral pneumothoraces. A diagnosis of Boerhaave's syndrome was made. The patient was transferred to the intensive care unit but did not survive. This case demonstrates the importance of looking for and treating the rarer reversible causes of cardiac arrest, and of maintaining a high index of suspicion for Boerhaave's syndrome. Despite its rarity, Boerhaave's syndrome is often misdiagnosed on initial presentation, leading to delayed treatment and poor outcomes.

  19. [Sudden cardiac death due to sarcoidosis. Case report].

    PubMed

    Sejben, István; Som, Zoltán; Cserni, Gábor

    2017-07-01

    Sarcoidosis is a systemic granulomatous disease of unknown aetiology, which is characterized by bilateral hilar lymphadenopathy and pulmonary disease. Clinically detected cardiac involvement occurs in 5% of sarcoid patients, although cardiac manifestations are discovered in 25% of the cases at autopsy. Sarcoid heart disease frequently causes atrioventricular block. The authors present the case of a 44-year-old man with bradycardia. On admission, second degree Mobitz II, then third degree atrioventricular block was diagnosed. Coronarography showed normal coronary arteries. 2.5 years following artificial Biotronik Entovis DR type pacemaker implantation, sudden cardiac death occurred. Autopsy revealed sarcoidosis with cardiac, pulmonary, splenic, renal and lymph node involvement. In case of young or middle-aged patients with atrioventricular block, it is best to search for other causes if the most common coronary origin can be excluded. Orv Hetil. 2017; 158(27): 1067-1070.

  20. Tamponade Relief by Active Clearance of Chest Tubes.

    PubMed

    Vistarini, Nicola; Gabrysz-Forget, Fanny; Beaulieu, Yanick; Perrault, Louis P

    2016-03-01

    Chest tubes are used in every case of cardiac surgery to evacuate shed blood from around the heart and lungs. Chest tubes can become partially or totally occluded, leading to tamponade. The purpose of this article is to discuss a novel method of maintaining chest tube patency in the early recovery after cardiothoracic surgery. The PleuraFlow Active Clearance Technology is a system to prevent chest tube clogging that can be used to help routinely maintain chest tube patency at the bedside in the intensive care unit. A patient exhibited physiologic tamponade that was confirmed by transthoracic echocardiography. The chest tube was successfully reopened by actively clearing the chest tube using Active Clearance Technology, resulting in resolution of the tamponade. The present study reports the case of a patient with massive postoperative pericardial effusion with tamponade, successfully managed by active clearance chest tube. Further studies will help define the role for this technology in routine cardiac surgery. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Fatal cardiac glycoside poisoning due to mistaking foxglove for comfrey.

    PubMed

    Wu, I-Lin; Yu, Jiun-Hao; Lin, Chih-Chuan; Seak, Chen-June; Olson, Kent R; Chen, Hsien-Yi

    2017-08-01

    Accidental ingestion of foxglove (Digitalis purpurea) can cause significant cardiac toxicity. We report a patient who ingested foxglove mistaking it for comfrey and developed refractory ventricular arrhythmias. The patient died despite treatment with digoxin-specific antibody fragments (DSFab) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). A 55-year-old woman presented to the emergency department with nausea, vomiting and generalized weakness eight hours after drinking "comfrey" tea. She had bradycardia (54 beats/min) and hyperkalemia (7.6 mEq/L). Electrocardiogram revealed a first-degree atrioventricular conduction block with premature atrial contractions, followed by polymorphic ventricular tachycardia three hours after arrival. A serum digoxin level was 151.2 ng/mL. The patient developed ventricular fibrillation while waiting for Digibind infusion. Resuscitation was performed and an emergent VA-ECMO was set up. A total of eight vials of Digibind were given over the next 16 hours. She temporarily regained consciousness, but remained hemodynamically unstable and subsequently developed lower limb ischemia and multiple organ failure, and she expired on hospital day seven. A botanist confirmed that the plant was foxglove. The diagnosis of cardiac glycoside plant poisoning can be difficult in the absence of an accurate exposure history. In facilities where DSFab is unavailable or insufficient, early VA-ECMO might be considered in severely cardiotoxic patients unresponsive to conventional therapy.

  2. [Fever, asthenia, myalgia and murmur due to cardiac myxoma].

    PubMed

    Giménez Roca, C; Felipe Villalobos, A; Cambra Lasaosa, F J; Prada Martínez, F; Caffarena Calvar, J M; Jou Muñoz, C

    2013-10-01

    Cardiac tumours are rare, especially in children, and most of them are benign. Myxomas are unusual in children, being more common among adults. They are usually located in the left atrium, with 25% appearing in the right. The clinical signs and symptoms depend mainly on where the tumour is located. A feature of these tumours is that they can be accompanied by constitutional symptoms and laboratory abnormalities. Echocardiography is the study of choice, and a prompt resection is required to prevent serious complications. We present a case of a 10 year-old girl diagnosed with right atrial myxoma who presented with a fever, myalgia, asthenia and laboratory abnormalities. Diagnosis was made by echocardiography, and the early surgical resection of the tumour ran smoothly and showed a good postoperative recovery.

  3. Survival from cardiac arrest due to sushi suffocation

    PubMed Central

    Hifumi, Toru; Kiriu, Nobuaki; Kato, Hiroshi; Koido, Yuichi; Kuroda, Yasuhiro

    2014-01-01

    BACKGROUND: Sushi suffocation is relatively uncommon, and it is an unignorable cause of sudden death; however, no reports on sushi suffocation have been published. METHODS: A 60-year-old man was referred to our hospital for post resuscitative intensive care. He had choked on sushi and collapsed in the dining room of a mental hospital. A nursing assistant summoned a physician who attempted to extract the sushi. External cardiac massage was initiated after 7 minutes had elapsed and followed by endotracheal intubation. Return of spontaneous circulation was achieved after 7 minutes of resuscitation. A bronchoscopy demonstrated a large amount of shari in the trachea and right bronchus, which was removed with alligator forceps and a wire basket. RESULTS: Neurological recovery was evident on day 2 of admission. He was transferred back to the mental hospital with no neurological complications. CONCLUSION: Emergency physicians should consider sushi suffocation, including its clinical features and management. PMID:25215168

  4. Direct transatrial pericardiocentesis for tamponade caused by left atrial perforation after trans-septal puncture.

    PubMed

    Picard, Fabien; Millán, Xavier; de Hemptinne, Quentin; L L'allier, Philippe

    2016-07-07

    Trans-septal puncture is associated with risks of serious complications. We report a case of an obese 52-year-old man with hypertrophic cardiomyopathy who underwent preoperative coronary angiography and cardiac catheterisation complicated by left atrial perforation. We describe a direct transatrial pericardiocentesis approach to treating cardiac tamponade.

  5. Salmonella pericarditis with tamponade in systemic lupus erythematosus.

    PubMed

    Sánchez-Guerrero, J; Alarcón-Segovia, D

    1990-02-01

    Despite the high frequency of both pericardial involvement and of infectious complications in SLE, septic pericarditis is uncommon. We report here a patient with SLE who developed tamponade due to Salmonella infection. Most of the other eight recorded cases of septic pericarditis in SLE were due to Staphylococcus aureus and none has been previously attributed to Gram-negative bacteria.

  6. Acute Cardiac Failure in a Pregnant Woman due to Thyrotoxic Crisis

    PubMed Central

    Okuda, Nao; Onodera, Mutsuo; Tsunano, Yumiko; Nakataki, Emiko; Oto, Jun; Imanaka, Hideaki; Nishimura, Masaji

    2012-01-01

    Introduction. Cardiac failure during pregnancy is usually related to preeclampsia/eclampsia, rarely to hyperthyroidism. While hyperthyroidism can easily lead to hypertensive cardiac failure and may harm the fetus, it is sometimes difficult to distinguish hyperthyroidism from normal pregnancy. Case Presentation. We encountered a case of 41-year-old pregnant woman with hypertensive cardiac failure. Because we initially diagnosed as pre-eclampsia/eclampsia, Caesarian section was performed. However, her symptoms still persisted after delivery. After thyroid function test results taken on the day of admission were obtained on the fourth day, we could diagnose that her cardiac failure was caused by thyrotoxic crisis. Conclusions. Hypertensive cardiac failure due to hyperthyroidism during pregnancy is rare and difficult to diagnose because of similar presentation of normal pregnancy. However, physicians should be aware of the risks posed by hyperthyroidism during pregnancy. PMID:24804110

  7. Pericardial Tamponade in an Adult Suffering from Acute Mumps Infection

    PubMed Central

    Flieger, Robert Rainer; Mankertz, Annette; Yilmaz, Kadir; Roepke, Torsten Kai

    2016-01-01

    Here, we report a case of a 51-year-old man with acute pericardial tamponade requiring emergency pericardiocentesis after he suffered from sore throat, headache, malaise, and sweats for two weeks. Serological analyses revealed increased mumps IgM and IgG indicating an acute mumps infection whereas other bacterial and viral infections were excluded. In addition, MRI revealed atypical swelling of the left submandibular gland. Whereas mumps has become a rare entity in children due to comprehensive vaccination regimens in western civilizations, our case highlights mumps as an important differential diagnosis also in adults, where the virus can induce life-threatening complications such as pericardial tamponade. PMID:27818687

  8. Occurrence of spontaneous and audiogenic seizures following global brain ischaemia due to cardiac arrest.

    PubMed

    Ułamek-Kozioł, Marzena; Kocki, Janusz; Bogucka-Kocka, Anna; Januszewski, Sławomir; Czuczwar, Stanisław J; Pluta, Ryszard

    2015-01-01

    Transient cardiac arrest due to cardiac vessel bundle occlusion was used to produce a rat model of spontaneous and audiogenic seizures. Among the rats, spontaneous seizures were present in 64%, and audiogenic seizures could be evoked in 86%, during two weeks of survival after cardiac arrest, by exposure to a loud sound produced by rattling keys, beginning one day after the post-ischaemic injury. Data from literature suggested a key role for GABA-ergic system widespread dysfunction especially in the hippocampus in post-cardiac arrest onset of audiogenic seizures. Reduced GABA inhibition in the hippocampus seems responsible for audiogenic seizures following cardiac arrest. In summary it may be considered that the occurrence of audiogenic seizures following cardiac arrest is determined not only by a neuronal loss, especially in the hippocampus, but also by a condition of synapse modification by a regenerative phenomenon. Data from our study clearly indicate that global brain ischaemia due to cardiac arrest may induce the susceptibility to spontaneous and audiogenic seizures, but this effect is transient.

  9. [Cardiopulmonary resuscitation in cardiac arrest following trauma].

    PubMed

    Leidel, B A; Kanz, K-G

    2016-11-01

    For decades, survival rates of cardiac arrest following trauma were reported between 0 and 2 %. Since 2005, survival rates have increased with a wide range up to 39 % and good neurological recovery in every second person injured for unknown reasons. Especially in children, high survival rates with good neurologic outcomes are published. Resuscitation following traumatic cardiac arrest differs significantly from nontraumatic causes. Paramount is treatment of reversible causes, which include massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade. Treatment of reversible causes should be simultaneous. Chest compression is inferior following traumatic cardiac arrest and should never delay treatment of reversible causes of the traumatic cardiac arrest. In massive bleeding, bleeding control has priority. Damage control resuscitation with permissive hypotension, aggressive coagulation therapy, and damage control surgery represent the pillars of initial treatment. Cardiac arrest due to hypoxia should be resolved by airway management and ventilation. Tension pneumothorax should be decompressed by finger thoracostomy, pericardial tamponade by resuscitative thoracotomy. In addition, resuscitative thoracotomy allows direct and indirect bleeding control. Untreated impact brain apnea may rapidly lead to cardiac arrest and requires quick opening of the airway and effective oxygenation. Established algorithms for treatment of cardiac arrest following trauma enable a safe, structured, and effective management.

  10. Sudden unexpected death due to severe pulmonary and cardiac sarcoidosis.

    PubMed

    Ginelliová, Alžbeta; Farkaš, Daniel; Farkašová Iannaccone, Silvia; Vyhnálková, Vlasta

    2016-09-01

    In this paper we report the autopsy findings of a 57 year old woman who died unexpectedly at home. She had been complaining of shortness of breath, episodes of dry coughing, and nausea. Her past medical and social history was unremarkable. She had no previous history of any viral or bacterial disease and no history of oncological disorders. Autopsy revealed multiple grayish-white nodular lesions in the pleura and epicardial fat and areas resembling fibrosis on the cut surface of the anterior and posterior wall of the left ventricle and interventricular septum. Histological examination of the lungs and heart revealed multiple well-formed noncaseating epithelioid cell granulomas with multinucleated giant cells. Death was attributed to myocardial ischemia due to vasculitis of intramural coronary artery branches associated with sarcoidosis. Sarcoidosis is a multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas in the affected organs and tissues. The diagnosis of sarcoidosis in this case was established when other causes of granulomatous disease such as tuberculosis, berylliosis, hypersensitivity pneumonitis, and giant cell myocarditis had been reasonably excluded.

  11. Pericardial Tamponade: a Rare Complication of Sternal Bone Marrow Biopsy

    PubMed Central

    Santavy, Petr; Troubil, Martin; Lonsky, Vladimir

    2013-01-01

    Injury of the heart with concomitant pericardial tamponade as a result of sternal bone marrow biopsy is rare. An 80-year-old man was admitted with dehydration and non-specified abdominal pain to the regional hospital. Sternal aspiration biopsy was performed because of anemia and thrombocytopenia. Later on, because of the back pain, general weakness and blood pressure drop, an echocardiography examination was indicated. Pericardial fluid collection was found. Anticipated ascending aortic dissection was excluded on computed tomography scan, but pericardial fluid collection was confirmed. Transfer to our cardiac surgical facility ensued. Limited heart tamponade was affirmed on echocardiography and surgery was immediately indicated. Blood effusion was found in upper mediastinal fat tissue and 300 mL of blood were evacuated from opened pericardial space. Stab wound by sternal biopsy needle at the upper part of ascending aorta was repaired by pledgeted suture. Postoperative course was uneventful. PMID:24179668

  12. Successful use of therapeutic hypothermia after cardiac arrest due to amitriptyline and venlafaxine intoxication.

    PubMed

    Kontio, Terhi; Salo, Ari; Kantola, Teemu; Toivonen, Lauri; Skrifvars, Markus B

    2015-06-01

    The prognosis of out-of-hospital cardiac arrest (OHCA) due to intoxication is dismal. Tricyclic antidepressants (TCAs) are widely used in the treatment of depression, but possess significant cardiotoxicity, and are one of the most common medications used in suicide attempts worldwide. TCA poisoning can cause hypotension, seizures, and cardiac conduction disturbances, which can lead to life-threatening arrhythmia. Current guidelines recommend mild therapeutic hypothermia (TH) for unconscious survivors of OHCA, but hypothermia treatment itself can cause disturbances in cardiac conduction, which could aggravate the effect of TCAs on cardiac conduction. We report the successful use of TH in a 19-year-old woman who was resuscitated from ventricular tachycardia after intentional ingestion of amitriptyline and venlafaxine, a serotonin-norepinephrine reuptake inhibitor. The cardiac arrest was witnessed, but no bystander cardiopulmonary resuscitation (CPR) was performed. The initial rhythm was ventricular tachycardia with no detectable pulse. Three defibrillations, magnesium sulfate, and sodium bicarbonate were given and her trachea was intubated, after which return of spontaneous circulation (ROSC) was achieved in 26 minutes. After ROSC, she had seizures and was sedated with propofol. Out-of-hospital TH was initiated with 1500 mL of cold Ringer's acetate. An infusion of norepinephrine was initiated for low blood pressure. On arrival at the university hospital, she was unconscious and had dilated pupils. She was tachycardic with a body temperature of 33.5°C. She was transferred to the intensive care unit and TH was maintained with invasive cooling. During the TH treatment, she did not experience any serious cardiac arrhythmia, transthoracic echocardiogram was normal, and the electrocardiogram (ECG) returned to normal. The patient was extubated 45 hours after the cardiac arrest. After the extubation, she was alert and cooperative, but slightly delusional. She was

  13. Protective effect of pulmonary hypertension against right-sided tamponade in pericardial effusion.

    PubMed

    Khan, M Usman; Khouzam, Rami N

    2015-01-01

    Patients with pericardial effusion are susceptible to cardiac tamponade. A compressing circumferential pericardial effusion typically results in an equalization of intracardiac and pericardial pressure during diastole and a progressive collapse of the right atrium and ventricle. Pulmonary hypertension that increases the afterload of the right ventricle may result in elevated pressures initially in the right ventricle and subsequently in the right atrium. This may lead to right ventricular hypertrophy and a pathologic structural and functional remodeling of both right heart chambers. Conversely, elevated pressures within the right heart chambers caused by longstanding pulmonary hypertension may resist and protect against tamponade of these chambers in the setting of a coexisting pericardial effusion. In such cases, a sudden reduction in pulmonary arterial pressures may result in tamponade of the right heart chambers.

  14. Incidental Identification of Right Atrial Mass Using Bedside Ultrasound: Cardiac Angiosarcoma

    PubMed Central

    Pourmand, Ali; Boniface, Keith

    2011-01-01

    Background Emergency ultrasound is now used in both community and academic hospitals for rapid diagnosis and treatment of life-threatening conditions. Bedside emergency echocardiography can rapidly identify significant pathology such as pericardial effusions and tamponade, right ventricle dilatation due to pulmonary embolism, and cardiac hypokinesis, and aid in the diagnosis and management of patients in emergency department (ED). Case Report A 41-year-old man presented twice to the ED with history of abdominal pain and was diagnosed with primary cardiac angiosarcoma with point-of-care ultrasound. Conclusion This case is illustrative of how bedside cardiac ultrasound in the ED can dramatically change a patient's hospital course. PMID:22224142

  15. Tamponade by an expanding left ventricular pseudoaneurysm: A unique presentation.

    PubMed

    Mahesh, Balakrishnan; Ong, Ping; Kutty, Ramesh; Abu-Omar, Yasir

    2015-10-01

    Left ventricular free wall rupture secondary to myocardial infarction is an uncommon but catastrophic event requiring emergency surgery. We describe a unique presentation of left ventricular free wall rupture as delayed tamponade caused by a gradually expanding pseudoaneurysm compressing the left atrium, leading to pulmonary congestion that required increasing respiratory support to maintain oxygenation, and necessitated emergency surgery. We discuss the options available to treat pseudoaneurysms due to left ventricular free wall rupture.

  16. [Myopericarditis due to enterovirus in association with rhabdomyolysis and renal failure].

    PubMed

    Cacace Linares, N; Domeniconi, G G; Freire, M C

    2001-01-01

    We present the case of a 49 year old man who was admitted with odynophagia, fever and abdominal pain. Later he developed dyspnea and polymialgias. Pericardial effusion was detected on the echocardiogram. Renal failure and rhabdomyolysis developed worsening the clinical picture. A pericardial surgical drainage was decided due to cardiac tamponade. All samples were negative for bacteria and fungi. The presence of enterovirus in pericardial fluid was confirmed.

  17. Pulmonary Arterial Capacitance Predicts Cardiac Events in Pulmonary Hypertension Due to Left Heart Disease

    PubMed Central

    Sugimoto, Koichi; Yoshihisa, Akiomi; Nakazato, Kazuhiko; Jin, Yuichiro; Suzuki, Satoshi; Yokokawa, Tetsuro; Misaka, Tomofumi; Yamaki, Takayoshi; Kunii, Hiroyuki; Suzuki, Hitoshi; Saitoh, Shu-ichi; Takeishi, Yasuchika

    2016-01-01

    Background Although pulmonary hypertension due to left heart disease (LHD-PH) accounts for the largest proportion of pulmonary hypertension, few reports on the epidemiological analysis of LHD-PH exist. Recently, pulmonary arterial capacitance (PAC) has attracted attention as a possible factor of right ventricular afterload along with pulmonary vascular resistance. We therefore investigated the clinical significance of PAC in LHD-PH. Methods The subject consisted of 252 LHD-PH patients (145 men, mean age 63.4 ± 14.7 years) diagnosed by right heart catheterization. PAC was estimated by the ratio between stroke volume and pulmonary arterial pulse pressure. Patients were classified into four groups according to the PAC (1st quartile was 0.74 to 1.76 ml/mmHg, the 2nd quartile 1.77 to 2.53 ml/mmHg, the 3rd quartile 2.54 to 3.59 ml/mmHg, and the 4th quartile 3.61 to 12.14 ml/mmHg). The end-points were defined as rehospitalization due to worsening heart failure and/or cardiac death. The Cox proportional hazard regression model was used to determine what variables were associated with cardiac events. Results The patients in the 1st quartile had the lowest cardiac index and stroke volume index, and the highest mean pulmonary arterial pressure, mean pulmonary capillary wedge pressure, and pulmonary vascular resistance compared with the 2nd, 3rd, and 4th quartiles. Fifty-four patients experienced cardiac events during the follow-up period (median 943 days). The event-free rate of the 1st quartile was significantly lower than that of the 3rd and 4th quartiles (66.7% vs 82.5% [3rd quartile], P = 0.008; and 92.1% [4th quartile], P < 0.001). The Cox hazard analysis revealed that PAC was significantly associated with cardiac events (HR 0.556, 95% CI 0.424–0.730, P < 0.001). Conclusion PAC is useful in the prediction of cardiac event risk in LHD-PH patients. PMID:27875533

  18. Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient

    PubMed Central

    Lekkham, Rapeepat; Climaco, Antoinette

    2017-01-01

    Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE) bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired. PMID:28316844

  19. Pediatric cardiac arrest due to drowning and other respiratory etiologies: Neurobehavioral outcomes in initially comatose children.

    PubMed

    Slomine, Beth S; Nadkarni, Vinay M; Christensen, James R; Silverstein, Faye S; Telford, Russell; Topjian, Alexis; Koch, Joshua D; Sweney, Jill; Fink, Ericka L; Mathur, Mudit; Holubkov, Richard; Dean, J Michael; Moler, Frank W

    2017-06-01

    To describe the 1-year neurobehavioral outcome of survivors of cardiac arrest secondary to drowning, compared with other respiratory etiologies, in children enrolled in the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) trial. Exploratory analysis of survivors (ages 1-18 years) who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation (ROC). Participants recruited from 27 pediatric intensive care units in North America received targeted temperature management [therapeutic hypothermia (33°C) or therapeutic normothermia (36.8°C)] within 6h of ROC. Neurobehavioral outcomes included 1-year Vineland Adaptive Behavior Scales, Second Edition (VABS-II) total and domain scores and age-appropriate cognitive performance measures (Mullen Scales of Early Learning or Wechsler Abbreviated Scale of Intelligence). Sixty-six children with a respiratory etiology of cardiac arrest survived for 1-year; 60/66 had broadly normal premorbid functioning (VABS-II≥70). Follow up was obtained on 59/60 (30 with drowning etiology). VABS-II composite and domain scores declined significantly from premorbid scores in drowning and non-drowning groups (p<0.001), although declines were less pronounced for the drowning group. Seventy-two percent of children had well below average cognitive functioning at 1-year. Younger age, fewer doses of epinephrine, and drowning etiology were associated with better VABS-II composite scores. Demographic variables and treatment with hypothermia did not influence neurobehavioral outcomes. Risks for poor neurobehavioral outcomes were high for children who were comatose after out-of-hospital cardiac arrest due to respiratory etiologies; survivors of drowning had better outcomes than those with other respiratory etiologies. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Sudden Cardiac Death of a Body Packer Due to Cocaine Cardiotoxicity

    PubMed Central

    Pramanik, Parthasarathi; Vidua, Raghvendra Kumar

    2016-01-01

    This article presents a case of sudden cardiac death due to the effects of cocaine concealed in the body of a male drug smuggler in his 40s, a so-called body packer. A total of 57 body packets filled with cocaine powder were discovered in his body cavities. The detailed autopsy examination, including histopathology and toxicology findings, is discussed with the aim of describing the mechanism of cocaine intoxication in the body packer and an analysis of cocaine-induced cardiotoxicity and sudden death. PMID:27932899

  1. Systemic lupus erythematosus presenting as cardiac tamponade—a case report

    PubMed Central

    Kumar, Mohan Ashok; Sathyamurthy, I.; Jayanthi, K.; Ramakrishnan; Ramasubramanian

    2012-01-01

    Although pericarditis and pericardial effusion (PE) are some of the common manifestations of systemic lupus erythematosus (SLE), the occurrence of cardiac tamponade is quite rare. We present herewith a young girl with cardiac tamponade presenting as initial manifestation of SLE. PMID:22572440

  2. Intrauterine balloon tamponade for the control of postpartum haemorrhage.

    PubMed

    Lohano, Rajni; Haq, Gulfishan; Kazi, Sarah; Sheikh, Saima

    2016-01-01

    To evaluate the effectiveness of balloon temponade in the management of postpartum haemorrhage. The study was conducted at the Dow University of Health Sciences and Civil Hospital Karachi from January to July 18, 2012, and comprised women aged 18-35 years, parity 1-6 and gestational age 31-41 weeks, who developed or were admitted with primary postpartum haemorrhage due to uterine atony in whom medical treatment had failed. SPSS 10 was used to analyse the data. The mean age, parity, gestational age of 139 women was 26.4±4.2 years, 3.4±1.3, 37.81±1.67 respectively. Mean estimated blood loss was 1155.8±350.6 ml, mean systolic blood pressure 90.96±18.1 mmHg, diastolic blood pressure 55±7.5 mmHg and mean pulse was 108.3±10.89 bpm. Balloon tamponade was effective in 126(90.4%) cases. Condom catheter balloon tamponade was an effective means of controlling postpartum haemorrhage. There should be a low threshold for use of balloon tamponade as it is effective, easy to use, easily available, has low complication rate, and an inexpensive modality to manage non-traumatic postpartum haemorrhage, especially in resource-limited settings, and still maintain reproductive ability.

  3. Effect of acute pericardial tamponade on the relative contributions of systolic and diastolic pulmonary venous return: a transesophageal pulsed Doppler study.

    PubMed

    Louie, E K; Hariman, R J; Wang, Y; Hwang, M H; Loeb, H S; Scanlon, P J

    1995-01-01

    The effect of acute pericardial tamponade on pulmonary venous return was assessed by transesophageal pulsed Doppler echocardiography. In 14 open-chest anesthetized dogs peak pulmonary venous flow velocities in systole (VJ) and in diastole (VK) were measured during apnea and atrial pacing while acute tamponade was induced by intrapericardial instillation of 0.9% sodium chloride solution. Before intravascular volume expansion, induction of acute tamponade resulted in a significant decline in VK (43 +/- 17 to 19 +/- 8 cm/sec; p < 0.05) but no change in VJ or the ratio VJ/VK. After intravascular volume expansion, induction of acute tamponade resulted in significant reductions in VJ (43 +/- 9 to 29 +/- 10 cm/sec; p < 0.001) and VK (37 +/- 19 to 15 +/- 11 cm/sec; p < 0.001). The effect was disproportionately greater on VK, however, resulting in a significant increase in VJ/VK (1.51 +/- 0.84 to 2.58 +/- 1.41; p < 0.001). The disproportionate effect of acute tamponade on VK suggests that increased pericardial pressure directly constrains diastolic filling of the left atrium as a conduit to the left ventricle and that it does not decrease the systolic and diastolic phases of pulmonary venous return uniformly. Intravascular volume expansion increases cardiac output before acute tamponade, but during acute tamponade it amplifies the disproportionate impact of increased pericardial pressure on left ventricular diastolic filling as the left ventricle is constrained within the fluid-filled pericardial sac.

  4. Acute Liver Failure Due to Budd-Chiari Syndrome in the Setting of Cardiac Synovial Sarcoma.

    PubMed

    Stine, Jonathan G; Newton, Kelly; Vinayak, Ajeet G

    2015-04-01

    Primary malignant tumors of the heart, specifically cardiac sarcomas, are rare and mainly diagnosed at autopsy. Acute Budd-Chiari syndrome is a recognized cause of acute liver failure and has been associated with several rare cardiac tumors: atrial myxoma, caval rhabdomyosarcoma, and primary cardiac adenocarcinoma. We present the first case of a fatal, highly differentiated cardiac synovial sarcoma that presented as acute liver failure from Budd-Chiari syndrome.

  5. Recurrent pericardial effusion and tamponade in a patient with Erdheim-Chester disease (ECD).

    PubMed

    Mishra, Ajay Kumar; Mani, Sunithi; George, Anu Anna; Sudarsanam, Thambu David

    2015-11-24

    Erdheim-Chester disease (ECD) is a rare xanthogranulomatous disorder characterised by the proliferation of lipid laden histiocytes along with infiltration of various organs of the body. Although commonly presenting with bone pains secondary to bony infiltration, cardiac involvement in the form of periaortic fibrosis and pericardial involvement may be seen in a subgroup of patients. We report a case of ECD presenting as recurrent pericardial effusion along with pericardial tamponade.

  6. Chylopericardium with symptoms of tamponade on the grounds of extensive neck vein thrombosis

    PubMed Central

    Nardini, Marco; Katsogridakis, Emmanuel; Migliore, Marcello; Dunning, Joel

    2017-01-01

    Chylopericardium is a recognized complication of thoracic trauma, surgery or malignancy. Idiopathic or primary presentations, however, are rarely encountered in clinical practice. The severity of its presentation varies from the complete absence of symptoms to cardiac tamponade. We present the case of a 23-year-old woman with chylopericardium and extensive neck vein thrombosis that was managed surgically with a pericardial window. PMID:28122899

  7. T-wave oversensing in implantable cardiac defibrillators is due to technical failure of device sensing.

    PubMed

    Gilliam, F Roosevelt

    2006-05-01

    The expanded indications for the use of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death have increased concerns about inappropriate delivery of therapies. Dual-chamber systems have improved the capacity of ICDs to differentiate ventricular arrhythmias from supraventricular arrhythmias. Still, T-wave oversensing is a major source of inappropriate therapy. It is likely the true incidence of T-wave oversensing is greater than reported as documented events reflect only those stored in a device memory. Reviewing cases of T-wave oversensing that failed noninvasive correction; we found successful resolution resulted from generator replacement. We conclude that T-wave oversensing is due to inadequate signal processing by some ICD generators.

  8. Evidence-based diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism.

    PubMed

    Logan, Jill K; Pantle, Hardin; Huiras, Paul; Bessman, Edward; Bright, Leah

    2014-07-01

    When a previously healthy adult experiences atraumatic cardiac arrest, providers must quickly identify the etiology and implement potentially lifesaving interventions such as advanced cardiac life support. A subset of these patients develop cardiac arrest or periarrest due to pulmonary embolism (PE). For these patients, an early, presumptive diagnosis of PE is critical in this patient population because administration of thrombolytic therapy may significantly improve outcomes. This article reviews thrombolysis as a potential treatment option for patients in cardiac arrest or periarrest due to presumed PE, identifies features associated with a high incidence of PE, evaluates thrombolytic agents, and systemically reviews trials evaluating thrombolytics in cardiac arrest or periarrest. Despite potentially improved outcomes with thrombolytic therapy, this intervention is not without risks. Patients exposed to thrombolytics may experience major bleeding events, with the most devastating complication usually being intracranial hemorrhage. To optimize the risk-benefit ratio of thrombolytics for treatment of cardiac arrest due to PE, the clinician must correctly identify patients with a high likelihood of PE and must also select an appropriate thrombolytic agent and dosing protocol.

  9. Novel heavy tamponade for vitreoretinal surgery.

    PubMed

    Williams, Rachel L; Kearns, Victoria R; Lo, Amy C; Day, Michael; Garvey, Michael J; Krishna, Yamini; Ma, Da; Stappler, Theodor; Wong, David

    2013-11-05

    The aim of this study was to produce a heavy tamponade with a specific gravity greater than 1.06 g/mL that was optically transparent, could be manufactured using simple processing, could be injected using standard clinical equipment, and would have appropriate biocompatibility. Aerosil silica was added to a phenyl trimethicone and mixed via a roller, overhead stirring, and ultrasonics. The refractive index, visible absorbance, and shear viscosity were measured. The injectability of the solutions was evaluated using the Accurus Viscous Fluid Injection system. The tamponade efficiency was assessed using a model eye chamber and compared with that of Densiron 68, Oxane HD, and F6H8. The biocompatibility was evaluated in vitro and in vivo in rabbits. Tamponade agents were produced with specific gravities of 1.10, 1.11, 1.13, and 1.16 g/mL that had good optical clarity. Mixing using overhead stirring was sufficient to produce tamponade agents with shear viscosities in the range 1000 to 5000 mPa·s that were reproducible and stable during storage. The solutions were easier to inject using the Accurus Viscous Fluid Injection system than silicone oil 1000 mPa·s. The 11% silica solution had greater tamponade efficiency than Densiron 68 or Oxane HD. There was no evidence of cytotoxicity in vitro. Silica solution 11% induced cataract earlier than Polydimethylsiloxane 1000 (PDMS 1000). Silica solution 11% and phenyl trimethicone reduced the a-wave value at 1 week after vitrectomy, but recovery was observed at later time points. Silica solution 11% caused inner nuclear layer (INL) nuclei dropdown in inferior retina from 4 weeks postoperation. Polydimethylsiloxane 1000 induced a similar phenomenon in superior retina 12 weeks postoperation. We have produced a heavy tamponade with good clarity that has appropriate shear viscosity, injectibility, enhanced tamponade efficiency, and biocompatibility similar to that of PDMS 1000.

  10. Fulminant mediastinitis due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: atypical presentation and spreading following cardiac surgery.

    PubMed

    Valenzuela, Horacio; Carrascal, Yolanda; Maroto, Laura; Arce, Nuria

    2013-05-01

    Mediastinitis due to Klebsiella pneumoniae, related to thoracic wall contamination after cardiac surgery, has rarely been described. We aim to report a case of fulminant mediastinitis due to extended-spectrum beta-lactamase-producing K. pneumoniae, secondary to a disseminated concomitant pulmonary infection. The patient remained pauci-symptomatic until clinical manifestations of sepsis acutely appeared.

  11. Targeted Temperature Management After Pediatric Cardiac Arrest Due To Drowning: Outcomes and Complications.

    PubMed

    Moler, Frank W; Hutchison, Jamie S; Nadkarni, Vinay M; Silverstein, Faye S; Meert, Kathleen L; Holubkov, Richard; Page, Kent; Slomine, Beth S; Christensen, James R; Dean, J Michael

    2016-08-01

    Performance Category outcomes (≤ 3). In comatose survivors of out-of-hospital pediatric cardiac arrest due to drowning, hypothermia did not result in a statistically significant benefit in survival with good functional outcome or mortality at 1 year, as compared with normothermia. High risk of culture-proven bacterial infection was observed in both groups.

  12. Puerperal uterine inversion managed by the uterine balloon tamponade.

    PubMed

    Thiam, Mariétou; Niang, Mouhamadou Mansour; Gueye, Lamine; Sarr, Fatou Rachel; Dieme, Marie Edouard Faye; Cisse, Mamadou Lamine

    2015-01-01

    The uterine inversion is a rare and severe puerperal complication. Uncontrolled cord traction and uterine expression are the common causes described. We report a case of uterine inversion stage III caused by poor management of the third stage of labor. It was about a 20 years old primigravida referred in our unit for postpartum hemorrhage due to uterine atony. After manual reduction of the uterus, the use of intra uterine balloon tamponade helped to stop the hemorrhage. The uterine inversion is a rare complication that may cause maternal death. The diagnosis is clinical and its management must be immediate to avoid maternal complications.

  13. Long-term heavy silicone oil intraocular tamponade.

    PubMed

    Dooley, Ian J; Duignan, Emma S; Kilmartin, Dara J

    2016-02-01

    Heavy silicone oil tamponade is intended to be temporary, but may occasionally be indefinite in patients who refuse, or are deemed unsuitable for, further surgery. The aim of this study is to compare the outcomes of patients with temporary versus indefinite heavy silicone oil intraocular tamponade. This retrospective, comparative case series identified 75 patients who underwent heavy silicone oil instillation (Oxane HD) over a 6 year period (2006-2012) in one institution. Thirty-nine patients had temporary heavy oil tamponade and 36 patients had indefinite tamponade. The majority (68 %) of patients had a history of previous vitreoretinal surgery prior to oil instillation and 66.7 % had pre-existing proliferative vitreoretinopathy (PVR). The mean final logMAR best corrected visual acuity (BCVA) was significantly better in the temporary tamponade group (1.34 ± 0.66) than the indefinite tamponade group 1.82 ± 0.64 (p = 0.003). Ambulatory BCVA (≥ 4/200) was retained in 76.3 % of temporary tamponade patients versus 54.3 % of indefinite tamponade patients (p = 0.093). Successful retinal reattachment was significantly more likely in temporary tamponade patients (92.3 %) than indefinite tamponade patients (75 %; p = 0.04). Complications in the patients with indefinite heavy silicone oil tamponade included redetachment (38.9 %), corneal pathology (13.8 %), secondary glaucoma (11.1 %) and anterior segment emulsification (8.3 %).While temporary tamponade patients had better outcomes than those with indefinite tamponade, the majority of indefinite tamponade patients still retained ambulatory vision in the affected eye. Indefinite heavy silicone oil tamponade remains a viable option for those who cannot undergo removal of oil surgery.

  14. Role of Tamponade in Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage.

    PubMed

    Balakrishnan, Divya; Jain, Bhavna; Nayaka, Ashraya; Rani, Padmaja Kumari; Mukundaprasad, Vinod; Jalali, Subhadra

    2017-01-01

    To analyze the role of tamponade in vitrectomy for proliferative diabetic retinopathy with vitreous hemorrhage. A retrospective chart analysis of patients who underwent vitrectomy for proliferative diabetic retinopathy (PDR) between 2006 and 2013, with a minimum follow-up of six months, was done. The data collected included age, gender, control of diabetes, pre- and postoperative best-corrected visual acuity (BCVA), retinal detachment, type of tamponade, and recurrence of vitreous hemorrhage (VH). Statistical analysis was done using SPSS software version 2.0 and p values <0.05 were taken as significant. A total of 73 eyes of 73 patients were included. The patients were analyzed in four groups: Group 1: no tamponade; Group 2: air; Group 3: gas; Group 4: silicone oil (SO). Eighteen (24.7%), 18 (24.7%), 15 (20.5%), and 22 (30.1%) patients were in the four groups, respectively. The mean preoperative BCVA in logMAR was 1.61, 1.84, 2.25, and 2.03 and the mean change in BCVAs at six months was -0.98, -0.94, -0.97, and -0.19 in four groups, respectively. Recurrent vitreous hemorrhage was noted in 11.1%, 11.1%, 6.7%, and 9.5% of patients of four groups; it was not statistically significant. The retina remained attached in 100%, 100%, 93%, and 90% of patients in the four groups, respectively, at six months. The use of an intraocular tamponade in eyes with vitreous hemorrhage due to PDR was not found to be superior to no tamponade in reducing recurrent vitreous hemorrhage. Therefore, the use of a tamponade in eyes without retinal break is not beneficial.

  15. Targeted Temperature Management After Pediatric Cardiac Arrest Due To Drowning: Outcomes and Complications

    PubMed Central

    Moler, Frank W.; Hutchison, Jamie S.; Nadkarni, Vinay M.; Silverstein, Faye S.; Meert, Kathleen L.; Holubkov, Richard; Page, Kent; Slomine, Beth S.; Christensen, James R.; Dean, J. Michael

    2016-01-01

    Objective To describe outcomes and complications in the drowning subgroup from the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial. Design Exploratory post hoc cohort analysis Setting Twenty-four PICUs Patients Pediatric drowning cases Interventions Therapeutic hypothermia versus therapeutic normothermia Measurements and Main Results An exploratory study of pediatric drowning from the THAPCA-OH Trial was conducted. Comatose patients >2 days and <18 years were randomized ≤6 hours following return-of-circulation to hypothermia (n=46) or normothermia (n=28). Outcomes assessed included 12-month survival with a Vineland Adaptive Behavior Scale (VABS-II) score ≥70, 1-year survival rate, change in VABS-II score pre-arrest to 12-months, and select safety measures. Seventy-four drowning cases were randomized. In patients with pre-arrest VABS-II ≥70 (n=65), there was no difference in 12-month survival with VABS-II score ≥70 between hypothermia and normothermia groups [29% vs. 17%; relative risk (RR) 1.74; 95% confidence interval (CI) 0.61 to 4.95; p=0.27]. Among all evaluable patients (n=68), the VABS-II score change from baseline to 12-months did not differ (p=0.46) and one-year survival was similar (49%, hypothermia vs. 42%, normothermia; RR 1.16; 95% CI 0.68 to 1.99; p=0.58). Hypothermia was associated with a higher incidence of positive bacterial culture (any blood, urine or respiratory sample) (67% vs. 43%; p=0.04), however, the rate per 100 days at risk did not differ (11.1 vs. 8.4; p=0.46). Cumulative incidence of blood product use, serious arrhythmias and 28-day mortality were not different. Among patients with CPR durations >30 minutes or epinephrine doses >4, none had favorable Pediatric Cerebral Performance Category (PCPC) outcomes (≤3). Conclusions In comatose survivors of out-of-hospital pediatric cardiac arrest due to drowning, hypothermia did not result in a statistically significant benefit in survival with

  16. Cardiac arrest due to drowning--changes over time and factors of importance for survival.

    PubMed

    Claesson, Andreas; Lindqvist, Jonny; Herlitz, Johan

    2014-05-01

    To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival. Retrospectively reported and treated drowning cases reported to the Swedish OHCA registry between 1990 and 2012, n=529. The data were clustered into three seven-year intervals for comparisons of changes over time. There were no changes in age, gender, witnessed status, shockable rhythm or place of OHCA during the time periods. Bystander CPR increased over time, 59% in interval 1992-1998, versus 74% in interval 2006-2012 (p=0.005). There was a decrease in delay between OHCA and calling for the Emergency Medical Service (EMS) over the years, while calling for the EMS to arrival increased in terms of time. Survival to hospital admission appears to have increased over the years (p=0.009), whereas survival to one month did not change significantly over time. In a multivariate analysis, witnessed status, female gender, bystander CPR, place-home and EMS response time were associated with survival to hospital admission. For survival to one month, place, age, shockable rhythm and logarithmised delay from calling for an ambulance to arrival were of significance for survival. In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Emerging Cardiac Imaging Modalities for the Early Detection of Cardiotoxicity due to Anticancer Therapies.

    PubMed

    López-Fernández, Teresa; Thavendiranathan, Paaladinesh

    2017-02-08

    The undeniable advances in the field of oncology have finally led to a decrease in overall cancer-related mortality. However, this population of long-term cancer survivors is now facing a shift toward a substantial increase in cardiovascular morbidity and mortality. Because the development of overt cardiotoxicity can be associated with poor outcomes, preclinical identification of cardiac toxicity is important. This will promote early instauration of treatments to prevent overt heart dysfunction and allow oncologists to continue cancer therapy in an uninterrupted manner. Surveillance strategies for the early detection of cardiac injury include cardiac imaging and biomarkers during treatment. In this review, we outline existing cardiac imaging modalities to detect myocardial changes in patients undergoing cancer treatment and in survivors, and their strengths and limitations.

  18. Pressure-overload cardiac hypertrophy is associated with distinct alternative splicing due to altered expression of splicing factors.

    PubMed

    Kim, Taeyong; Kim, Jin Ock; Oh, Jae Gyun; Hong, Seong-Eui; Kim, Do Han

    2014-01-01

    Chronic pressure-overload cardiac hypertrophy is associated with an increased risk of morbidity/mortality, largely due to maladaptive remodeling and dilatation that progresses to dilated cardiomyopathy. Alternative splicing is an important biological mechanism that generates proteomic complexity and diversity. The recent development of next-generation RNA sequencing has improved our understanding of the qualitative signatures associated with alternative splicing in various biological conditions. However, the role of alternative splicing in cardiac hypertrophy is yet unknown. The present study employed RNA-Seq and a bioinformatic approach to detect the RNA splicing regulatory elements involved in alternative splicing during pressure-overload cardiac hypertrophy. We found GC-rich exonic motifs that regulate intron retention in 5' UTRs and AT-rich exonic motifs that are involved in exclusion of the AT-rich elements that cause mRNA instability in 3' UTRs. We also identified motifs in the intronic regions involved in exon exclusion and inclusion, which predicted splicing factors that bind to these motifs. We found, through Western blotting, that the expression levels of three splicing factors, ESRP1, PTB and SF2/ASF, were significantly altered during cardiac hypertrophy. Collectively, the present results suggest that chronic pressure-overload hypertrophy is closely associated with distinct alternative splicing due to altered expression of splicing factors.

  19. Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade.

    PubMed

    Nakagawa, Eiichiro; Abe, Yukio; Komatsu, Ryushi; Naruko, Takahiko; Itoh, Akira

    2015-10-01

    Cardiac tamponade resulting from perforation of a cardiac chamber is a relatively rare complication of pacemaker implantation. We report the first case of perforation of the right coronary artery related to the implantation of a screw-in atrial pacing lead, presenting as life-threatening cardiac tamponade. We report the case of a 72-year-old woman with complete atrioventricular block and dyspnea on exertion. A permanent pacemaker was implanted with bipolar Medtronic active-fixation leads positioned in the right atrial appendage and at the right ventricular basal septum without any difficulty. Approximately 3.5 h after the procedure, the patient complained of nausea, and the systolic blood pressure decreased to less than 60 mmHg. Echocardiography revealed a large pericardial effusion. Because the effects of pericardiocentesis lasted for less than an hour, the patient underwent a thoracotomy. After evacuation of a massive hemopericardium, bright red blood was seen gushing out from the right coronary artery, which was located on the opposite site of the right atrial appendage where a small portion of the screw tip was observed to be penetrating the atrial wall. The right coronary artery perforation was repaired using autologous pericardium-reinforced 7-0 prolene mattress sutures. Perforation of the right coronary artery is a potential complication and should be part of the differential diagnosis of cardiac tamponade after pacemaker implantation.

  20. Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade

    PubMed Central

    Nakagawa, Eiichiro; Abe, Yukio; Komatsu, Ryushi; Naruko, Takahiko; Itoh, Akira

    2015-01-01

    Cardiac tamponade resulting from perforation of a cardiac chamber is a relatively rare complication of pacemaker implantation. We report the first case of perforation of the right coronary artery related to the implantation of a screw-in atrial pacing lead, presenting as life-threatening cardiac tamponade. We report the case of a 72-year-old woman with complete atrioventricular block and dyspnea on exertion. A permanent pacemaker was implanted with bipolar Medtronic active-fixation leads positioned in the right atrial appendage and at the right ventricular basal septum without any difficulty. Approximately 3.5 h after the procedure, the patient complained of nausea, and the systolic blood pressure decreased to less than 60 mmHg. Echocardiography revealed a large pericardial effusion. Because the effects of pericardiocentesis lasted for less than an hour, the patient underwent a thoracotomy. After evacuation of a massive hemopericardium, bright red blood was seen gushing out from the right coronary artery, which was located on the opposite site of the right atrial appendage where a small portion of the screw tip was observed to be penetrating the atrial wall. The right coronary artery perforation was repaired using autologous pericardium-reinforced 7-0 prolene mattress sutures. Perforation of the right coronary artery is a potential complication and should be part of the differential diagnosis of cardiac tamponade after pacemaker implantation. PMID:26550089

  1. Cardiac failure due to a giant desmoid tumour of the posterior mediastinum.

    PubMed

    Bouchikh, Mohammed; Arame, Alex; Riquet, Marc; Le Pimpec-Barthes, Françoise

    2013-12-01

    We report a rare case of a giant desmoid tumour responsible for cardiac and respiratory failure. Complete removal was decided upon, despite an initial failure in another centre because of symptom severity. In such cases, wide local resection remains the best therapeutic approach, but the risk of local recurrence is high. Literature review confirms the exceptional presentation and the benefit of aggressive surgery.

  2. Implantable Cardiac Defibrillator Pocket Infection Due to a Previously Undescribed Cupriavidus Species▿

    PubMed Central

    Christensen, Joshua B.; Vitko, Nicholas P.; Voskuil, Martin I.; Castillo-Mancilla, Jose R.

    2010-01-01

    The genus Cupriavidus consists of Gram-negative, nonfermenting bacteria most of which are environmental organisms, though some species have been associated with human disease. We report the recovery and identification of an isolate that represents a previously undescribed species of Cupriavidus from an implantable cardiac defibrillator pocket infection. PMID:20427695

  3. Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

    PubMed Central

    2011-01-01

    Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU). Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA) score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52%) of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index < 1.0 L/min/m2 and a positive fluid balance (> 4,683 mL) were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery. PMID:21624108

  4. Vitreon, a short-term vitreoretinal tamponade.

    PubMed Central

    Blinder, K J; Peyman, G A; Desai, U R; Nelson, N C; Alturki, W; Paris, C L

    1992-01-01

    This investigation of the liquid perfluorocarbon, perfluorophenanthrene (Vitreon), establishes its safety and efficacy as a short-term vitreoretinal tamponade. We utilised Vitreon as an intraoperative tool and postoperative vitreoretinal tamponade in 16 patients. Proliferative vitreoretinopathy (PVR) (six), giant retinal tear (four), rhegmatogenous retinal detachment (three), retinal detachment with keratoprosthesis (two), and submacular and vitreous haemorrhage (one) were successfully repaired. Vitreon was left in the eye and removed 5 days to 4 weeks postoperatively. Complications encountered included proliferative PVR (five), limited peripheral retinal detachment (three), macular pucker (two) cataract (three), hypotony (two), excessive fibrin reaction (one), and elevated intraocular pressure (one). At the latest evaluation, all retinas are attached with a follow-up of 1.25 to 12 months (mean 6.8 months). PMID:1420054

  5. Sudden Cardiac Death Due to Deficiency of the Mitochondrial Inorganic Pyrophosphatase PPA2.

    PubMed

    Kennedy, Hannah; Haack, Tobias B; Hartill, Verity; Mataković, Lavinija; Baumgartner, E Regula; Potter, Howard; Mackay, Richard; Alston, Charlotte L; O'Sullivan, Siobhan; McFarland, Robert; Connolly, Grainne; Gannon, Caroline; King, Richard; Mead, Scott; Crozier, Ian; Chan, Wandy; Florkowski, Chris M; Sage, Martin; Höfken, Thomas; Alhaddad, Bader; Kremer, Laura S; Kopajtich, Robert; Feichtinger, René G; Sperl, Wolfgang; Rodenburg, Richard J; Minet, Jean Claude; Dobbie, Angus; Strom, Tim M; Meitinger, Thomas; George, Peter M; Johnson, Colin A; Taylor, Robert W; Prokisch, Holger; Doudney, Kit; Mayr, Johannes A

    2016-09-01

    We have used whole-exome sequencing in ten individuals from four unrelated pedigrees to identify biallelic missense mutations in the nuclear-encoded mitochondrial inorganic pyrophosphatase (PPA2) that are associated with mitochondrial disease. These individuals show a range of severity, indicating that PPA2 mutations may cause a spectrum of mitochondrial disease phenotypes. Severe symptoms include seizures, lactic acidosis, cardiac arrhythmia, and death within days of birth. In the index family, presentation was milder and manifested as cardiac fibrosis and an exquisite sensitivity to alcohol, leading to sudden arrhythmic cardiac death in the second decade of life. Comparison of normal and mutant PPA2-containing mitochondria from fibroblasts showed that the activity of inorganic pyrophosphatase was significantly reduced in affected individuals. Recombinant PPA2 enzymes modeling hypomorphic missense mutations had decreased activity that correlated with disease severity. These findings confirm the pathogenicity of PPA2 mutations and suggest that PPA2 is a cardiomyopathy-associated protein, which has a greater physiological importance in mitochondrial function than previously recognized. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

  6. Cardiac rehabilitation improves coronary endothelial function in patients with heart failure due to dilated cardiomyopathy: A positron emission tomography study.

    PubMed

    Legallois, Damien; Belin, Annette; Nesterov, Sergey V; Milliez, Paul; Parienti, J-J; Knuuti, Juhani; Abbas, Ahmed; Tirel, Olivier; Agostini, Denis; Manrique, Alain

    2016-01-01

    Endothelial dysfunction is common in patients with heart failure and is associated with poor clinical outcome. Cardiac rehabilitation is able to enhance peripheral endothelial function but its impact on coronary vasomotion remains unknown. We aimed to evaluate the effect of cardiac rehabilitation on coronary vasomotion in patients with heart failure. We prospectively enrolled 29 clinically stable heart failure patients from non-ischaemic dilated cardiomyopathy and without coronary risk factors. Myocardial blood flow was quantified using (15)-O water positron emission tomography at rest and during a cold pressor test, before and after 12 weeks of cardiac rehabilitation and optimization of medical therapy. Rest myocardial blood flow was significantly improved after the completion of rehabilitation compared to baseline (1.31 ± 0.38 mL/min/g vs. 1.16 ± 0.41 mL/min/g, p = 0.04). The endothelium-related change in myocardial blood flow from rest to cold pressor test and the percentage of myocardial blood flow increase during the cold pressor test were both significantly improved after cardiac rehabilitation (respectively from -0.03 ± 0.22 mL/min/g to 0.19 ± 0.22 mL/min/g, p < 0.001 and from 101.5 ± 16.5% to 118.3 ± 24.4%, p < 0.001). Left ventricular ejection fraction, plasma levels of brain natriuretic peptide, maximal oxygen consumption and the Minnesota Living with Heart Failure Questionnaire score were also significantly improved. The improvement was not related to uptitration of medical therapy. Coronary endothelial function is altered in patients with heart failure due to non-ischaemic dilated cardiomyopathy. In these patients, cardiac rehabilitation significantly improves coronary vasomotion. © The European Society of Cardiology 2014.

  7. Clinical Usefulness of Bakri Balloon Tamponade in the Treatment of Massive Postpartum Uterine Hemorrhage.

    PubMed

    Nagai, Sayori; Kobayashi, Hiroaki; Nagata, Tomomi; Hiwatashi, Sayuri; Kawamura, Toshihiko; Yokomine, Daisaku; Orita, Yuji; Oki, Toshimichi; Yoshinaga, Mitsuhiro; Douchi, Tsutomu

    2016-01-01

    Intrauterine globe-shaped metreurynter tamponade has been used for some time to treat massive postpartum hemorrhage (PPH). More recently, the Bakri balloon has come into use to treat PPH. It is made of silicon, possesses a drainage lumen, and has a sausage-like spindle shape. The aim of the present study was to investigate the clinical usefulness of Bakri balloon tamponade for massive PPH. Subjects in the present study comprised 5 patients with uterine atony, 3 with placenta previa, and 2 with low-lying placenta. All patients exhibited massive PPH and resistance to conventional hemostatic managements. Bakri balloon tamponade was appliedto these 10 patients. The mean amounts of uterine bleeding (average ± SD) before and after Bakri insertion were2,732 ± 1,397 mL and 380 ± 376 mL, respectively. The median (third-first quartile ranges) volume of salineinflating the balloon was 200 mL (300-150 mL). The median (third-first quartile ranges) indwelling duration of Bakri balloon was 24 hours (24-11 hrs). The overall success rate of Bakri balloon tamponade was 90% (9/10).There were no cases of slipping out or complications regarding balloon placement. Our findings suggest that Bakri balloon tamponade may be applied to the treatment of massive PPH in uterine atony and placenta previa.The Bakri balloon appears to have the following merits: (1) easy insertion into the uterine cavity and low rate of slipping out, (2) proper conformability to the hemorrhagic area due to its spindle shape, (3) ability to monitor blood loss through the drainage lumen even after insertion.

  8. Impaired contractile function due to decreased cardiac myosin binding protein C content in the sarcomere

    PubMed Central

    Cheng, Y.; Wan, X.; McElfresh, T. A.; Chen, X.; Gresham, K. S.; Rosenbaum, D. S.; Chandler, M. P.

    2013-01-01

    Mutations in cardiac myosin binding protein C (MyBP-C) are a common cause of familial hypertrophic cardiomyopathy (FHC). The majority of MyBP-C mutations are expected to reduce MyBP-C expression; however, the consequences of MyBP-C deficiency on the regulation of myofilament function, Ca2+ homeostasis, and in vivo cardiac function are unknown. To elucidate the effects of decreased MyBP-C expression on cardiac function, we employed MyBP-C heterozygous null (MyBP-C+/−) mice presenting decreases in MyBP-C expression (32%) similar to those of FHC patients carrying MyBP-C mutations. The levels of MyBP-C phosphorylation were reduced 53% in MyBP-C+/− hearts compared with wild-type hearts. Skinned myocardium isolated from MyBP-C+/− hearts displayed decreased cross-bridge stiffness at half-maximal Ca2+ activations, increased steady-state force generation, and accelerated rates of cross-bridge recruitment at low Ca2+ activations (<15% and <25% of maximum, respectively). Protein kinase A treatment abolished basal differences in rates of cross-bridge recruitment between MyBP-C+/− and wild-type myocardium. Intact ventricular myocytes from MyBP-C+/− hearts displayed abnormal sarcomere shortening but unchanged Ca2+ transient kinetics. Despite a lack of left ventricular hypertrophy, MyBP-C+/− hearts exhibited elevated end-diastolic pressure and decreased peak rate of LV pressure rise, which was normalized following dobutamine infusion. Furthermore, electrocardiogram recordings in conscious MyBP-C+/− mice revealed prolonged QRS and QT intervals, which are known risk factors for cardiac arrhythmia. Collectively, our data show that reduced MyBP-C expression and phosphorylation in the sarcomere result in myofilament dysfunction, contributing to contractile dysfunction that precedes compensatory adaptations in Ca2+ handling, and chamber remodeling. Perturbations in mechanical and electrical activity in MyBP-C+/− mice could increase their susceptibility to cardiac

  9. Coronary perforation with tamponade successfully managed by retrograde and antegrade coil embolization.

    PubMed

    Boukhris, Marouane; Tomasello, Salvatore Davide; Azzarelli, Salvatore; Elhadj, Zied Ibn; Marzà, Francesco; Galassi, Alfredo Ruggero

    2015-07-01

    In recent years, retrograde approach for chronic total occlusions has rapidly evolved, enabling a higher rate of revascularization success. Compared to septal channels, epicardial collaterals tend to be more tortuous, more difficult to negotiate, and more prone to rupture. Coronary perforation is a rare but potentially life-threatening complication of coronary angioplasty, often leading to emergency cardiac surgery. We report a case of a retrograde chronic total occlusion revascularization through epicardial collaterals, complicated by both retrograde and antegrade coronary perforation with tamponade, and successfully managed by coil embolization.

  10. Late Chronic Tamponade after Intraoperative Right Ventricular Rupture Repair with Mediastinal Fat.

    PubMed

    Gualis, Javier; Castaño, Mario; Rodríguez, Miguel Angel; García, Cristina

    2015-12-01

    Advanced age and female sex are known risk factors for ventricular wall rupture during open-heart procedures. We present the case of an 83-year-old female patient with an intraoperative traumatic right ventricular free wall rupture during an aortic valve replacement procedure. Pledgetted interrupted sutures reinforced with large pieces of mediastinal fat were used for rupture repair. After 6 months, the patient was readmitted with the diagnosis of a retrosternal mediastinal mass and clinical signs of cardiac tamponade that required reoperation.

  11. Penetrating cardiac trauma: analysis of 240 cases from a hospital in Bogota, Colombia.

    PubMed

    Isaza-Restrepo, Andres; Bolívar-Sáenz, Dínimo José; Tarazona-Lara, Marcos; Tovar, José Rafael

    2017-01-01

    Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach.

  12. [Opacification of an intraocular lens: calcification of hydrophilic intraocular lenses after gas tamponade of the anterior chamber].

    PubMed

    Schmidinger, G; Pemp, B; Werner, L

    2013-11-01

    A patient with endothelial dystrophy was treated with Descemet stripping automated endothelial keratoplasty (DSAEK) combined with cataract extraction and implantation of a hydrophilic intraocular lens (IOL, Lentis-L312, Oculentis) but visual acuity dropped from 0.15 logMAR to 0.52 logMAR 18 months later due to calcification of the IOL. With new methods of lamellar corneal transplantation being used more frequently the number of necessary anterior chamber tamponades with air/gas are increasing. In cataract cases in which a gas tamponade and transplantation might be necessary later on (cornea guttata), hydrophilic IOLs should be avoided.

  13. Molecular defects in cardiac myofibrillar proteins due to thyroid hormone imbalance and diabetes.

    PubMed

    Machackova, Jarmila; Barta, Judit; Dhalla, Naranjan S

    2005-12-01

    The heart very often becomes a victim of endocrine abnormalities such as thyroid hormone imbalance and insulin deficiency, which are manifested in a broad spectrum of cardiac dysfunction from mildly compromised function to severe heart failure. These functional changes in the heart are largely independent of alterations in the coronary arteries and instead reside at the level of cardiomyocytes. The status of cardiac function reflects the net of underlying subcellular modifications induced by an increase or decrease in thyroid hormone and insulin plasma levels. Changes in the contractile and regulatory proteins constitute molecular and structural alterations in myofibrillar assembly, called myofibrillar remodeling. These alterations may be adaptive or maladaptive with respect to the functional and metabolic demands on the heart as a consequence of the altered endocrine status in the body. There is a substantial body of information to indicate alterations in myofibrillar proteins including actin, myosin, tropomyosin, troponin, titin, desmin, and myosin-binding protein C in conditions such as hyperthyroidism, hypothyroidism, and diabetes. The present article is focussed on discussion how myofibrillar proteins are altered in response to thyroid hormone imbalance and lack of insulin or its responsiveness, and how their structural and functional changes explain the contractile defects in the heart.

  14. Atlas-based quantification of cardiac remodeling due to myocardial infarction.

    PubMed

    Zhang, Xingyu; Cowan, Brett R; Bluemke, David A; Finn, J Paul; Fonseca, Carissa G; Kadish, Alan H; Lee, Daniel C; Lima, Joao A C; Suinesiaputra, Avan; Young, Alistair A; Medrano-Gracia, Pau

    2014-01-01

    Myocardial infarction leads to changes in the geometry (remodeling) of the left ventricle (LV) of the heart. The degree and type of remodeling provides important diagnostic information for the therapeutic management of ischemic heart disease. In this paper, we present a novel analysis framework for characterizing remodeling after myocardial infarction, using LV shape descriptors derived from atlas-based shape models. Cardiac magnetic resonance images from 300 patients with myocardial infarction and 1991 asymptomatic volunteers were obtained from the Cardiac Atlas Project. Finite element models were customized to the spatio-temporal shape and function of each case using guide-point modeling. Principal component analysis was applied to the shape models to derive modes of shape variation across all cases. A logistic regression analysis was performed to determine the modes of shape variation most associated with myocardial infarction. Goodness of fit results obtained from end-diastolic and end-systolic shapes were compared against the traditional clinical indices of remodeling: end-diastolic volume, end-systolic volume and LV mass. The combination of end-diastolic and end-systolic shape parameter analysis achieved the lowest deviance, Akaike information criterion and Bayesian information criterion, and the highest area under the receiver operating characteristic curve. Therefore, our framework quantitatively characterized remodeling features associated with myocardial infarction, better than current measures. These features enable quantification of the amount of remodeling, the progression of disease over time, and the effect of treatments designed to reverse remodeling effects.

  15. Postmortem genetic testing should be recommended in sudden cardiac death cases due to thoracic aortic dissection.

    PubMed

    Gago-Díaz, Marina; Ramos-Luis, Eva; Zoppis, Silvia; Zorio, Esther; Molina, Pilar; Braza-Boïls, Aitana; Giner, Juan; Sobrino, Beatriz; Amigo, Jorge; Blanco-Verea, Alejandro; Carracedo, Ángel; Brion, María

    2017-04-08

    Acute thoracic aortic dissections and ruptures, the main life-threatening complications of the corresponding aneurysms, are an important cause of sudden cardiac death. Despite the usefulness of the molecular diagnosis of these conditions in the clinical setting, the corresponding forensic field remains largely unexplored. The main goal of this study was to explore and validate a new massive parallel sequencing candidate gene​ assay as a diagnostic tool for acute thoracic aortic dissection autopsy cases. Massive parallel sequencing of 22 thoracic aortic disease candidate genes performed in 17 cases of thoracic aortic dissection using AmpliSeq and Ion Proton technologies. Genetic variants were filtered by location, type, and frequency at the Exome Aggregation Consortium and an internal database and further classified based on the American College of Medical Genetics and Genomics (ACMG) recommendations published in 2015. All prioritized results were confirmed by traditional sequencing. From the total of 10 potentially pathogenic genetic variants identified in 7 out of the 17 initial samples, 2 of them were further classified as pathogenic, 2 as likely pathogenic, 1 as possibly benign, and the remaining 5 as variants of uncertain significance, reaching a molecular autopsy yield of 23%, approximately. This massive parallel sequencing candidate gene approach proved useful for the molecular autopsy of aortic dissection sudden cardiac death cases and should therefore be progressively incorporated into the forensic field, being especially beneficial for the anticipated diagnosis and risk stratification of any other family member at risk of developing the same condition.

  16. Rate-dependent activation failure in isolated cardiac cells and tissue due to Na+ channel block

    PubMed Central

    Spindler, Anthony J.; Paterson, David; Noble, Denis

    2015-01-01

    While it is well established that class-I antiarrhythmics block cardiac sodium channels, the mechanism of action of therapeutic levels of these drugs is not well understood. Using a combination of mathematical modeling and in vitro experiments, we studied the failure of activation of action potentials in single ventricular cells and in tissue caused by Na+ channel block. Our computations of block and unblock of sodium channels by a theoretical class-Ib antiarrhythmic agent predict differences in the concentrations required to cause activation failure in single cells as opposed to multicellular preparations. We tested and confirmed these in silico predictions with in vitro experiments on isolated guinea-pig ventricular cells and papillary muscles stimulated at various rates (2–6.67 Hz) and exposed to various concentrations (5 × 10−6 to 500 × 10−6 mol/l) of lidocaine. The most salient result was that whereas large doses (5 × 10−4 mol/l or higher) of lidocaine were required to inhibit action potentials temporarily in single cells, much lower doses (5 × 10−6 mol/l), i.e., therapeutic levels, were sufficient to have the same effect in papillary muscles: a hundredfold difference. Our experimental results and mathematical analysis indicate that the syncytial nature of cardiac tissue explains the effects of clinically relevant doses of Na+ channel blockers. PMID:26342072

  17. Evidence of a wide spectrum of cardiac involvement due to ACAD9 mutations: Report on nine patients.

    PubMed

    Dewulf, Joseph P; Barrea, Catherine; Vincent, Marie-Françoise; De Laet, Corinne; Van Coster, Rudy; Seneca, Sara; Marie, Sandrine; Nassogne, Marie-Cécile

    2016-07-01

    Acyl-CoA dehydrogenase 9 (ACAD9) is a mitochondrial protein involved in oxidative phosphorylation complex I biogenesis. This protein also exhibits acyl-CoA dehydrogenase (ACAD) activity. ACAD9-mutated patients have been reported to suffer from primarily heart, muscle, liver, and nervous system disorders. ACAD9 mutation is suspected in cases of elevated lactic acid levels combined with complex I deficiency, and confirmed by ACAD9 gene analysis. At least 18 ACAD9-mutated patients have previously been reported, usually displaying severe cardiac involvement. We retrospectively studied nine additional patients from three unrelated families with a wide spectrum of cardiac involvement between the families as well as the patients from the same families. All patients exhibited elevated lactate levels. Deleterious ACAD9 mutations were identified in all patients except one for whom it was not possible to recover DNA. To our knowledge, this is one of the first reports on isolated mild ventricular hypertrophy due to ACAD9 mutation in a family with moderate symptoms during adolescence. This report also confirms that dilated cardiomyopathy may occur in conjunction with ACAD9 mutation and that some patients may respond clinically to riboflavin treatment. Of note, several patients suffered from patent ductus arteriosus (PDA), with one exhibiting a complex congenital heart defect. It is yet unknown whether these cardiac manifestations were related to ACAD9 mutation. In conclusion, this disorder should be suspected in the presence of lactic acidosis, complex I deficiency, and any cardiac involvement, even mild. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Hyperthemia after cardiac surgery due to ascariasis in a child: report of a case.

    PubMed

    Maekawa, Yoshiyuki; Sakamoto, Takahiko; Umezu, Kentaroh; Ohashi, Noburoh; Harada, Yorikazu; Matsui, Hikoroh

    2012-07-01

    Ascaris lumbricoides is the most common parasite affecting humans, especially in countries and regions with lower socio-economic conditions. A 2-year-old female child underwent right pulmonary angioplasty using cardiopulmonary bypass. Serious hyperthermia continued after surgery, and, therefore, a re-exploration of the mediastinum was performed because mediastinitis was suspected. No evidence of wound infection was revealed. Ascaris lumbricoides was subsequently isolated from her stool. The patient had no further hyperthermia throughout her hospitalization and was discharged uneventfully on post-operative day 12. The probable origin of the fever was an A. lumbricoides infection and ascariasis may cause the occurrence of serious hyperthermia during the perioperative period. Ascaris lumbricoides infection may, therefore, cause high-grade fever after cardiac surgery.

  19. Bradycardia during Transradial Cardiac Catheterization due to Catheter Manipulation: Resolved by Catheter Removal

    PubMed Central

    Kumar, Vishesh; Stys, Adam

    2017-01-01

    Purpose. To report the resolution of bradycardia encountered during transradial cardiac catheterization through the catheter pullback technique in two cases. Case Report. A 62-year-old male and an 81-year-old male underwent coronary angiogram to evaluate for coronary artery disease and as a result of positive stress test, respectively. Upon engagement of the FL 3.5 catheter into the ascending aorta through the transradial approach, the first case developed bradycardia with a heart rate of 39 beats per minute. The second case developed profound bradycardia with a heart rate of 25 beats per minute upon insertion of the 5 Fr FL 3.5 catheter near the right brachiocephalic trunk through the right radial access. Conclusion. Bradycardia can be subsided by removal of the catheter during catheter manipulation in patients undergoing transradial coronary angiogram if there is a suspicion of excessive stretching of aortic arch receptors and/or carotid sinus receptors. PMID:28348915

  20. [Retinal tamponade with silicone oil - long term results].

    PubMed

    Jančo, L; Tkáčová Villemová, K; Ondrejková, M; Vida, R; Bartoš, M; Mesárošová, M

    2014-10-01

    The aim of this study is to evaluate the frequency and efficacy of silicone oil (SO) retinal tamponade in various retinal diseases. The incidence of silicone oil tamponade according to individual indications, incidence of complications and duration of tamponade were evaluated in the study. A retrospective study included 510 eyes that were operated on pars plana vitrectomy (PPV) from January 2010 to December 2012. In our group we evaluated 241 men and 189 women, age 4-84 years, mean 62 years . Follow-up period was 12 to 48 months, an average of 27.5 months . We evaluated 253 eyes with diabetic retinopathy, 201 eyes with regmatogenous retinal detachment, 34 eyes with endophthalmitis and 22 eyes after the injury. In 253 diabetic retinopathy eyes (DR) silicone oil tamponade was indicated in 56 eyes (22.1 %). Silicone oil removal was done on 22 eyes (39.3 %), the average length of SO tamponade was 9.7 months. After SO removal BCVA (best corrected visual acuity) 0,1 and worse had 12 eyes (54,6 %), 0,2 - 0,4 had 5 eyes (22,7 %) and 0,5 or better had 5 eyes (22,7 %). Permanent SO tamponade was left in 34 diabetic retinopathy eyes (60.7 %). Secondary glaucoma (SG) was present in 40 eyes (71.5 %). In 201 retinal detachment (RD) eyes silicone oil tamponade was used in 76 eyes (37.8 %). Secondary glaucoma was present in 31 eyes (40.8 %). Silicone oil was successfully removed in 40 eyes (52.6 %), the average length of tamponade was 9.2 months. In this group BCVA 0,1 and worse had 22 eyes (55,0 %), 0,2 - 0,4 had 15 eyes (37,5 %) and 0,5 or better had 3 eyes (7,5 %). 36 eyes (47,4 %) RD eyes had permanent silicone oil tamponade. In a group of 34 eyes with endophthalmitis SO tamponade was used in 16 eyes (47 %). Secondary glaucoma was present in 3 eyes (18.8 %). Silicone oil removal we did in 11 eyes (68.8 %), the average length of SO tamponade was 5.5 months. After SO removal BCVA 0,1 and worse had 3 eyes (27,2 %), 0,2 - 0,4 had 4 eyes (36,4 %) and 0,5 or better had 4 eyes (36

  1. Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation.

    PubMed

    Weaver, W D; Fahrenbruch, C E; Johnson, D D; Hallstrom, A P; Cobb, L A; Copass, M K

    1990-12-01

    One hundred ninety-nine patients with out-of-hospital cardiac arrest persisted in ventricular fibrillation after the first defibrillation attempt and were then randomly assigned to receive either epinephrine or lidocaine before the next two shocks. The resulting electrocardiographic rhythms and outcomes for each group of patients were compared for each group and also compared with results during the prior 2 years, a period when similar patients primarily received sodium bicarbonate as initial adjunctive therapy. Asystole occurred after defibrillation with threefold frequency after repeated injection of lidocaine (15 of 59, 25%) compared with patients treated with epinephrine (four of 55, 7%) (p less than 0.02). There was no difference in the proportion of patients resuscitated after treatment with either lidocaine or epinephrine (51 of 106, 48% vs. 50 of 93, 54%) and in the proportion surviving (18, 19% vs. 21, 20%), respectively. Resuscitation (64% vs. 50%, p less than 0.005) but not survival rates (24% vs. 20%) were higher during the prior 2-year period in which initial adjunctive drug treatment for persistent ventricular fibrillation primarily consisted of a continuous infusion of sodium bicarbonate. The negative effect of lidocaine or epinephrine treatment was explained in part by their influence on delaying subsequent defibrillation attempts. Survival rates were highest (30%) in a subset of patients who received no drug therapy between shocks. We conclude that currently recommended doses of epinephrine and lidocaine are not useful for improving outcome in patients who persist in ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case.

    PubMed

    Finsterer, Josef; Stöllberger, Claudia

    2014-06-01

    Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.

  3. Image reconstruction in higher dimensions: myocardial perfusion imaging of tracer dynamics with cardiac motion due to deformation and respiration

    DOE PAGES

    Shrestha, Uttam M.; Seo, Youngho; Botvinick, Elias H.; ...

    2015-10-09

    Myocardial perfusion imaging (MPI) using slow rotating large field of view cameras requires spatiotemporal reconstruction of dynamically acquired data to capture the time variation of the radiotracer concentration. In vivo, MPI contains additional degrees of freedom involving unavoidable motion of the heart due to quasiperiodic beating and the effects of respiration, which can severely degrade the quality of the images. This work develops a technique for a single photon emission computed tomography (SPECT) that reconstructs the distribution of the radiotracer concentration in the myocardium using a tensor product of different sets of basis functions that approximately describe the spatiotemporal variationmore » of the radiotracer concentration and the motion of the heart. In this study the temporal B-spline basis functions are chosen to reflect the dynamics of the radiotracer, while the intrinsic deformation and the extrinsic motion of the heart are described by a product of a discrete set of Gaussian basis functions. Reconstruction results are presented showing the dynamics of the tracer in the myocardium as it deforms due to cardiac beating, and is displaced due to respiratory motion. We find these results are compared with the conventional 4D-spatiotemporal reconstruction method that models only the temporal changes of the tracer activity. The higher dimensional reconstruction method proposed here improves bias, yet the signal-to-noise ratio (SNR) decreases slightly due to redistribution of the counts over the cardiac-respiratory gates. Finally, there is a trade-off between the number of gates and the number of projections per gate to achieve high contrast images.« less

  4. Image Reconstruction in Higher Dimensions: Myocardial Perfusion Imaging of Tracer Dynamics with Cardiac Motion Due to Deformation and Respiration

    PubMed Central

    Shrestha, Uttam M.; Seo, Youngho; Botvinick, Elias H.; Gullberg, Grant T.

    2015-01-01

    Myocardial perfusion imaging (MPI) using slow rotating large field of view cameras requires spatiotemporal reconstruction of dynamically acquired data to capture the time variation of the radiotracer concentration. In vivo, MPI contains additional degrees of freedom involving unavoidable motion of the heart due to quasiperiodic beating and the effects of respiration, which can severely degrade the quality of the images. This work develops a technique for a single photon emission computed tomography (SPECT) that reconstructs the distribution of the radiotracer concentration in the myocardium using a tensor product of different sets of basis functions that approximately describe the spatiotemporal variation of the radiotracer concentration and the motion of the heart. In this study the temporal B-spline basis functions are chosen to reflect the dynamics of the radiotracer, while the intrinsic deformation and the extrinsic motion of the heart are described by a product of a discrete set of Gaussian basis functions. Reconstruction results are presented showing the dynamics of the tracer in the myocardium as it deforms due to cardiac beating, and is displaced due to respiratory motion. These results are compared with the conventional 4D-spatiotemporal reconstruction method that models only the temporal changes of the tracer activity. The higher dimensional reconstruction method proposed here improves bias, yet the signal-to-noise ratio (SNR) decreases due to redistribution of the counts over the cardiac-respiratory gates. However, there is a trade-off between the number of gates and the number of projections per gate to achieve high contrast images. PMID:26450115

  5. Image reconstruction in higher dimensions: myocardial perfusion imaging of tracer dynamics with cardiac motion due to deformation and respiration

    SciTech Connect

    Shrestha, Uttam M.; Seo, Youngho; Botvinick, Elias H.; Gullberg, Grant T.

    2015-10-09

    Myocardial perfusion imaging (MPI) using slow rotating large field of view cameras requires spatiotemporal reconstruction of dynamically acquired data to capture the time variation of the radiotracer concentration. In vivo, MPI contains additional degrees of freedom involving unavoidable motion of the heart due to quasiperiodic beating and the effects of respiration, which can severely degrade the quality of the images. This work develops a technique for a single photon emission computed tomography (SPECT) that reconstructs the distribution of the radiotracer concentration in the myocardium using a tensor product of different sets of basis functions that approximately describe the spatiotemporal variation of the radiotracer concentration and the motion of the heart. In this study the temporal B-spline basis functions are chosen to reflect the dynamics of the radiotracer, while the intrinsic deformation and the extrinsic motion of the heart are described by a product of a discrete set of Gaussian basis functions. Reconstruction results are presented showing the dynamics of the tracer in the myocardium as it deforms due to cardiac beating, and is displaced due to respiratory motion. We find these results are compared with the conventional 4D-spatiotemporal reconstruction method that models only the temporal changes of the tracer activity. The higher dimensional reconstruction method proposed here improves bias, yet the signal-to-noise ratio (SNR) decreases slightly due to redistribution of the counts over the cardiac-respiratory gates. Additionally, there is a trade-off between the number of gates and the number of projections per gate to achieve high contrast images.

  6. Maternal outcomes after uterine balloon tamponade for postpartum hemorrhage.

    PubMed

    Martin, Emmanuelle; Legendre, Guillaume; Bouet, Pierre-Emmanuel; Cheve, Marie-Therese; Multon, Olivier; Sentilhes, Loïc

    2015-04-01

    To evaluate maternal outcomes following uterine balloon tamponade in the management of postpartum hemorrhage. Retrospective case-series. Two French hospitals, a level 3 university referral center and a level 2 private hospital. All women who underwent balloon tamponade treatment for primary postpartum hemorrhage. Uterine tamponade was used after standard treatment of postpartum hemorrhage had failed. The study population was divided into two groups, successful cases where the bleeding stopped after the balloon tamponade, and failures requiring subsequent surgery or embolization. Success rates. Uterine tamponade was used in 49 women: 30 (61%) after vaginal delivery and 19 (39%) after cesarean section. Uterine atony was the main cause of hemorrhage (86%). The overall success rate was 65%. Of 17 failures, surgery was required in 16 cases, including hysterectomy in 11, and uterine artery embolization in one case. Demographic and obstetric characteristics did not differ significantly between the success and failure groups. No complications were directly attributed to the balloon tamponade in the postpartum period. Two women had a subsequent full-term pregnancy without recurrence of postpartum hemorrhage. Balloon tamponade is an effective, safe and readily available method for treating primary postpartum hemorrhage and could reduce the need for invasive procedures. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  7. Drones may be used to save lives in out of hospital cardiac arrest due to drowning.

    PubMed

    Claesson, A; Svensson, L; Nordberg, P; Ringh, M; Rosenqvist, M; Djarv, T; Samuelsson, J; Hernborg, O; Dahlbom, P; Jansson, A; Hollenberg, J

    2017-05-01

    Drowning leading to out-of-hospital cardiac arrest (OHCA) and death is a major public health concern. Submersion with duration of less than 10min is associated with favorable neurological outcome and nearby bystanders play a considerable role in rescue and resuscitation. Drones can provide a visual overview of an accident scene, their potential as lifesaving tools in drowning has not been evaluated. The aim of this simulation study was to evaluate the efficiency of a drone for providing earlier location of a submerged possible drowning victim in comparison with standard procedure. This randomized simulation study used a submerged manikin placed in a shallow (<2m) 100×100-m area at Tylösand beach, Sweden. A search party of 14 surf-lifeguards (control) was compared to a drone transmitting video to a tablet (intervention). Time from start to contact with the manikin was the primary endpoint. Twenty searches were performed in total, 10 for each group. The median time from start to contact with the manikin was 4:34min (IQR 2:56-7:48) for the search party (control) and 0:47min (IQR 0:38-0:58) for the drone-system (intervention) respectively (p<0.001). The median time saved by using the drone was 3:38min (IQR 2:02-6:38). A drone transmitting live video to a tablet is feasible, time saving in comparison to traditional search parties and may be used for providing earlier location of submerged victims at a beach. Drone search can possibly contribute to earlier onset of CPR in drowning victims. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Polydimethyl Siloxane as an Internal Tamponade for Vitreoretinal Surgery.

    PubMed

    Hussain, Rumana N; Myneni, Jayavani; Stappler, Theodor; Wong, David

    2017-01-01

    To report the efficacy and safety of polydimethyl siloxane (Siluron Xtra®) as an internal tamponade. Audit and adverse event screening of procedures (March 2014-2015). Patients who had undergone vitreoretinal procedures with Siluron Xtra® tamponade were retrospectively analysed with respect to anatomical outcome, visual outcomes, and perioperative complications, in particular intraocular pressure. all patients who had undergone Siluron Xtra® tamponade. No cases were excluded; however, there were no paediatric or pregnant patients within this cohort. All vitreoretinal cases were included, including retinal detachments, but also trauma, endophthalmitis, and intraocular foreign bodies. Twenty-eight patients had polydimethyl siloxane as an intraocular tamponade; 24 retinal detachments (83% complicated by proliferative vitreoretinopathy ≥grade C), 12 had previous failed surgery, and 4 had procedures for intraocular lymphoma, endophthalmitis, or trauma. Follow-up was 14-20 months, and mean duration of tamponade was 6.8 months (3-12 months). Anatomical success was 79% after polydimethyl siloxane injection, 58% 3 months following removal (14/24), 5 remain with long-term tamponade, and 5 with redetachment under tamponade required further intervention. Five required topical anti-glaucomatous agents, and 1 following trauma required glaucoma surgery. Cataract developed in 3/6 phakic patients, and visible emulsification occurred in a single patient. Polydimethyl siloxane seems to be an acceptable alternative tamponade agent for the management of complex retinal detachments with comparable anatomical success and comparable rates of raised intraocular pressure to other low-viscosity silicone oil agents, but more importantly, with a lower rate of emulsified oil-related complications, which is important particularly for cases requiring long-term tamponade. © 2017 S. Karger AG, Basel.

  9. Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm

    PubMed Central

    Eisele, Tom; Nunninger, Peter; Münz, Benedikt

    2017-01-01

    Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV) in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred. PMID:28409033

  10. Cardiac resynchronization therapy in patients with challenging anatomy due to venous anomalies or adult congenital heart disease.

    PubMed

    Niazi, Imran; Dhala, Anwer; Choudhuri, Indrajit; Sra, Jasbir; Akhtar, Masood; Tajik, Abdul Jamil

    2014-09-01

    Cardiac resynchronization therapy (CRT) has proven salutary effects in patients with congestive heart failure, systolic dysfunction, and electromechanical dyssynchrony in the setting of ischemic, nonischemic, and congenital cardiomyopathy. While CRT device implants have become routine in the adult ischemic or nonischemic cardiomyopathy populations, patients with congenital heart disease offer special challenges due to unusual anatomic variations. A comprehensive assessment of anatomic abnormalities is essential prior to implant. In addition, implant techniques and equipment must be tailored to the expected anatomy. A flexible approach is necessary-implant may require equipment and techniques adapted from vascular intervention. This article describes our approach to CRT implant in patients with congenital heart disease, and is illustrated by reports of several cases. ©2014 Wiley Periodicals, Inc.

  11. [Circulatory failure due to severe cardiac arrhythmia as a result of hyperkalemia in a very low birth weight infant].

    PubMed

    Apitz, C; Wirbelauer, J

    2006-01-01

    Hyperkalemia is frequently seen during the first days of life in premature infants with a gestational age at birth less than 28 weeks. Normally, these high concentrations of potassium are well tolerated of the premature infants. In a few cases hyperkalemia leads to life-threatening cardiac arrhythmias. We report about a 800 grams weighing preterm infant born after 26 + 4 gestational weeks. 24 hours after birth the infant developed 2 : 1 atrioventricular block due to hyperkalemia with a heart rate about 75 bpm. The bradycardia continued about 45 minutes in spite of immediate therapy concomitant by circulatory failure that resulted in an intraventricular hemorrhage of grade III with periventricular intraparenchymal lesions. The case report demonstrates the variations of the electrocardiogram that can be found in preterm infants with hyperkalemia and their potential risks. Therapy of symptomatic hyperkalemia is not able to interrupt early a life-threatening circulatory failure in any case.

  12. Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

    PubMed

    Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

    2015-01-01

    The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20-1200 mL) in the balloon failure group and 60 mL (5-500 mL) in the balloon success group (p<0.01). Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

  13. Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients

    PubMed Central

    Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

    2015-01-01

    Purpose The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. Methods We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Results Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01). Conclusion Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance. PMID:26263014

  14. Pupillary Abnormalities in Descemet Membrane Endothelial Keratoplasty After Nearly Full Tamponade.

    PubMed

    Arnalich-Montiel, Francisco; Pérez-Sarriegui, Ane; Lauzirika, Gorka; Porrua, Laura; Hernández-Verdejo, José Luis

    2017-03-01

    To describe the incidence, risk factors, and management of pupillary abnormalities after anterior chamber (AC) full air or gas tamponade in Descemet membrane endothelial keratoplasty (DMEK) without pupillary block. In this retrospective case series, clinical records of 25 patients (32 eyes) who underwent DMEK were reviewed for pupillary abnormalities and iris morphology. All patients had nearly full intracameral tamponade with air or 20% SF6 at the end of surgery without default air release postoperatively. Pupillary abnormalities ranging from mild ovalization to mid-mydriasis were seen in 56% of the cases. These abnormalities were not related to morphometric changes in the iris volume, or in the iris dilator or iris sphincter muscle, but were probably due to posterior synechiae. Combining DMEK and cataract surgery increases by 5-fold the odds of developing this complication. Surgical revision of the posterior surface of the iris and synechiolysis reversed these pupillary abnormalities. Nonischemic pupillary abnormalities can be seen in patients with DMEK using a nearly full air/gas tamponade in the AC after surgery despite patent iridectomy especially when combined with cataract surgery. Ensuring complete mydriasis in the immediate postoperative period and a free-floating bubble in the AC above the inferior pupillary margin may reduce its incidence.

  15. Length-dependent changes in contractile dynamics are blunted due to cardiac myosin binding protein-C ablation

    PubMed Central

    Mamidi, Ranganath; Gresham, Kenneth S.; Stelzer, Julian E.

    2014-01-01

    Enhanced cardiac contractile function with increased sarcomere length (SL) is, in part, mediated by a decrease in the radial distance between myosin heads and actin. The radial disposition of myosin heads relative to actin is modulated by cardiac myosin binding protein-C (cMyBP-C), suggesting that cMyBP-C contributes to the length-dependent activation (LDA) in the myocardium. However, the precise roles of cMyBP-C in modulating cardiac LDA are unclear. To determine the impact of cMyBP-C on LDA, we measured isometric force, myofilament Ca2+-sensitivity (pCa50) and length-dependent changes in kinetic parameters of cross-bridge (XB) relaxation (krel), and recruitment (kdf) due to rapid stretch, as well as the rate of force redevelopment (ktr) in response to a large slack-restretch maneuver in skinned ventricular multicellular preparations isolated from the hearts of wild-type (WT) and cMyBP-C knockout (KO) mice, at SL's 1.9 μm or 2.1 μm. Our results show that maximal force was not significantly different between KO and WT preparations but length-dependent increase in pCa50 was attenuated in the KO preparations. pCa50 was not significantly different between WT and KO preparations at long SL (5.82 ± 0.02 in WT vs. 5.87 ± 0.02 in KO), whereas pCa50 was significantly different between WT and KO preparations at short SL (5.71 ± 0.02 in WT vs. 5.80 ± 0.01 in KO; p < 0.05). The ktr, measured at half-maximal Ca2+-activation, was significantly accelerated at short SL in WT preparations (8.74 ± 0.56 s−1 at 1.9 μm vs. 5.71 ± 0.40 s−1 at 2.1 μm, p < 0.05). Furthermore, krel and kdf were accelerated by 32% and 50%, respectively at short SL in WT preparations. In contrast, ktr was not altered by changes in SL in KO preparations (8.03 ± 0.54 s−1 at 1.9 μm vs. 8.90 ± 0.37 s−1 at 2.1 μm). Similarly, KO preparations did not exhibit length-dependent changes in krel and kdf. Collectively, our data implicate cMyBP-C as an important regulator of LDA via its impact on

  16. Cardiac advanced life support-surgical guideline: overview and implementation.

    PubMed

    Herrmann, Cheryl

    2014-01-01

    Cardiac arrest in the immediate postoperative recovery period in a patient who underwent cardiac surgery is typically related to reversible causes-tamponade, bleeding, ventricular arrhythmias, or heart blocks associated with conduction problems. When treated promptly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. The Cardiac Advanced Life Support-Surgical (CALS-S) guideline provides a standardized algorithm approach to resuscitation of patients who experience cardiac arrest after cardiac surgery. The purpose of this article is to discuss the CALS-S guideline and how to implement it.

  17. A case of drug-induced lupus erythematosus secondary to trimethoprim/sulfamethoxazole presenting with pleural effusions and pericardial tamponade.

    PubMed

    Jose, A; Cramer, A K; Davar, K; Gutierrez, G

    2017-03-01

    We report a case of drug-induced lupus erythematosus (DILE) secondary to trimethoprim/sulfamethoxazole (TMP/SMX) in a patient with underlying inflammatory bowel disease (IBD). The initial presentation was with febrile pleural and pericardial effusions followed by cardiac tamponade. The patient was treated with a short course of corticosteroids with complete resolution of symptoms. To our knowledge this is the first reported case of TMP/SMX-induced DILE presenting with life-threatening serositis. When confronted with sterile exudative effusions, clinicians should strongly consider non-infectious etiologies.

  18. Pediatric cardiac emergencies.

    PubMed

    Lee, C; Mason, L J

    2001-06-01

    Successful management of pediatric cardiac emergencies requires an accurate diagnosis to institute an appropriate plan of therapy. The diagnosis, however, is not always straightforward, as evidenced by the nonspecific clinical picture that can be presented by congenital heart defects. Entertaining the possibility of a cardiac problem in neonates with pulmonary symptoms unresponsive to standard therapies is crucial for successful management of patients with congenital heart disease. In addition to ventilatory support, prostaglandin E1 infusions or emergency interventional cardiac catheterization is often a life-saving initial measure in patients with acutely decompensated congenital cardiac lesions that require a patent ductus arteriosus for survival. Pericardial tamponade is associated with various acquired and iatrogenic causes. Emergent pericardiocentesis is mandatory when cardiovascular compromise occurs. The goal of anesthetic management is to maintain cardiac output. With the increasing use of central venous catheters in neonatal ICUs and the high mortality rate for central venous catheter-related cardiac tamponade, the diagnosis must be considered in any patient with a central venous catheter in situ who acutely develops unexplained hypotension, bradycardia, and diminished pulses. Arrhythmias also can cause hemodynamic instability in infants and children. Supraventricular tachycardia is by far the most common emergently presenting arrhythmia in the pediatric population. Unstable patients require immediate intravenous adenosine or synchronized cardioversion. Complete heart block is rare, but it can lead to congestive heart failure and occasionally to cardiovascular collapse and sudden death. Emergency treatment of complete heart block includes pharmacologic support and temporary or permanent pacemaker placement as indicated. In infants, congestive heart failure usually is related to congenital heart disease, whereas in older children, it tends to be secondary

  19. Nivolumab-Induced Pericardial Tamponade: A Case Report and Discussion.

    PubMed

    Kushnir, Igal; Wolf, Ido

    2017-01-01

    Nivolumab, a programmed death 1 (PD1) inhibitor, belongs to a family of drugs known as immune checkpoint inhibitors that share a similar toxicity profile, which includes rash, pruritus, colitis, hepatitis, pneumonitis and thyroid dysfunction. Nivolumab has a proven efficacy in the treatment of malignant melanoma, non-small cell lung cancer and renal cell carcinoma. We present the case of a 67-year-old male patient with metastatic squamous cell carcinoma of the lung who suffered from a massive pericardial effusion secondary to treatment with nivolumab, which he began in June 2015. After five cycles the patient was hospitalized due to acute respiratory failure requiring mechanical ventilation. An echocardiogram revealed a massive pericardial effusion with tamponade. After pericardiocentesis and corticosteroid treatment, the patient's condition improved rapidly. A CT scan revealed a response of the tumor. Although anti-PD1 treatment is usually regarded as less toxic than chemotherapy, a wide spectrum of life-threatening immune-related side effects may still occur and clinical vigilance is required.

  20. Exacerbated cardiac fibrosis induced by β-adrenergic activation in old mice due to decreased AMPK activity.

    PubMed

    Wang, Jingjing; Song, Yao; Li, Hao; Shen, Qiang; Shen, Jing; An, Xiangbo; Wu, Jimin; Zhang, Jianshu; Wu, Yunong; Xiao, Han; Zhang, Youyi

    2016-11-01

    Senescent hearts exhibit defective responses to β-adrenergic receptor (β-AR) over-activation upon stress, leading to more severe pathological cardiac remodelling. However, the underlying mechanisms remain unclear. Here, we investigated the role of adenosine monophosphate-activated protein kinase (AMPK) in protecting against ageing-associated cardiac remodelling in mice upon β-AR over-activation. 10-week-old (young) and 18-month-old (old) mice were subcutaneously injected with the β-AR agonist isoproterenol (ISO; 5 mg/kg). More extensive cardiac fibrosis was found in old mice upon ISO exposure than in young mice. Meanwhile, ISO treatment decreased AMPK activity and increased β-arrestin 1, but not β-arrestin 2, expression, and the effects of ISO on AMPK and β-arrestin 1 were greater in old mice than in young mice. Similarly, young AMPKα2-knockout (KO) mice showed more extensive cardiac fibrosis upon ISO exposure than that was observed in age-matched wild-type (WT) littermates. The extent of cardiac fibrosis in WT old mice was similar to that in young KO mice. Additionally, AMPK activities were decreased and β-arrestin 1 expression increased in KO mice. In contrast, the AMPK activator metformin decreased β-arrestin 1 expression and attenuated cardiac fibrosis in both young and old mice upon ISO exposure. In conclusion, more severe cardiac fibrosis is induced by ISO in old mice than in young mice. A decrease in AMPK activity, which further increases β-arrestin 1 expression, is the central mechanism underlying the ageing-related cardiac fibrosis induced by ISO. The AMPK activator metformin is a promising therapeutic agent for treating ageing-related cardiac remodelling upon β-AR over-activation.

  1. Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade.

    PubMed

    Purwosunu, Yuditiya; Sarkoen, Widyastuti; Arulkumaran, Sabaratnam; Segnitz, Jan

    2016-07-01

    Postpartum hemorrhage is the leading cause of maternal mortality worldwide. Vacuum-induced uterine tamponade is a possible alternative approach to balloon tamponade systems for the treatment of postpartum hemorrhage resulting from atony. In a prospective proof-of-concept investigation of 10 women with vaginal deliveries in a hospital setting who failed first-line therapies for postpartum hemorrhage, tamponade was used. Vacuum-induced uterine tamponade was created through a device inserted transvaginally into the uterine cavity. An occlusion balloon built into the device shaft was inflated at the level of the external cervical os to create a uterine seal. Negative pressure was created by attaching a self-contained, mobile, electrically powered, pressure-regulated vacuum pump with a sterile graduated canister. In all 10 cases, the suction created an immediate seal at the cervical os, 50-250 mL of residual blood was evacuated from the uterine cavity, the uterus collapsed and regained tone within minutes, and hemorrhaging was controlled. The device remained in place for a minimum of 1 hour and up to 6.5 hours in one case while vaginal and perineal lacerations were easily repaired. This preliminary investigation suggests that a device designed to create vacuum-induced uterine tamponade may be a reasonable alternative to other devices used to treat atonic postpartum hemorrhage.

  2. Hemopericardium with tamponade following rivaroxaban administration and its attenuation by CYP3A4 inhibitors

    PubMed Central

    Menendez, Denisse

    2016-01-01

    Novel oral anticoagulants including the factor Xa inhibitor rivaroxaban are important alternatives to warfarin for the prevention of thromboembolic stroke in patients with nonvalvular atrial fibrillation. The pharmacology and metabolism of these agents differ from those of the vitamin K antagonists used over the decades preceding their introduction. We present a case of spontaneous hemopericardium and cardiac tamponade following administration of rivaroxaban. A review of the patient's medications revealed a total of seven agents known to be metabolized through cytochrome P450 3A4 (CYP3A4), the major pathway for rivaroxaban metabolism. While most physicians are familiar with recommendations to monitor renal function in patients prescribed rivaroxaban, we suspect that many fail to evaluate possible interactions with other agents having CYP3A4 inhibitory or inducer activity. PMID:27695181

  3. Guidewire-induced coronary artery perforation and tamponade during PCI: in-hospital outcomes and impact on long-term survival.

    PubMed

    Stathopoulos, Ioannis; Panagopoulos, Georgia; Kossidas, Konstantinos; Jimenez, Marcelo; Garratt, Kirk

    2014-08-01

    Guidewire-induced coronary perforation (CP) rate is reported to have increased. We analyzed 23,399 PCIs and identified 73 patients complicated by CP, of which 31 were guidewire induced. Patients were divided into two groups: group A (guidewire-induced CP) and group B (non-guidewire induced CP). Characteristics and outcomes were compared and a multivariate model was developed to evaluate the independent contribution of guidewire-induced CP on mortality. Group A patients had more PCIs on CTO lesions (P=.001). Group A showed a trend for higher tamponade (P=.08). Delayed tamponade occurred only in group A (P<.001). Polytetrafluoroethylene stents were used more often in group B (P<.01). In-hospital mortality was similar between groups (3.2% vs. 7.1%; P=NS). Emergent cardiac surgery was needed in 5.5% of all CP patients and was similar between groups. Group A had a trend for better survival (hazard ratio [HR], 0.37; 95% CI, 0.12-1.10; P=.07). Tamponade conferred a 3-fold increase in the long-term probability of death (HR, 2.95; 95% CI, 1.07-8.13; P=.04). Guidewire-induced CP during elective PCI had the best survival (HR, 0.31; 95% CI, 0.11-0.87; P=.03). Guidewire-induced CP rate is low. In-hospital mortality was similar for patients with guidewire-induced and non-guidewire induced perforations. Presentation of tamponade was occasionally delayed and associated with increased early and late death. Percutaneous coronary intervention of lesions with an expected increased risk of CP should be undertaken with consideration of the short- and long-term risk, particularly during non-elective PCI since tamponade in this setting increased the risk of late death by nearly 3-fold.

  4. Intrauterine tamponade balloon use in the treatment of uterine inversion.

    PubMed

    Haeri, Sina; Rais, Sheliza; Monks, Brian

    2015-01-06

    Uterine inversion is a rare but life-threatening obstetrical emergency that occurs when the fundus of the uterus prolapses through the cervix, hence turning the uterus inside out. In this case report, we present our experience using an intrauterine tamponade balloon for management of uterine inversion, and a review of the literature. The utility of an intrauterine tamponade balloon in cases of uterine inversion, especially when maternal medical conditions preclude the use of uterotonics, or reinversion is observed should be kept in mind.

  5. Tamponade in the surgical management of retinal detachment.

    PubMed

    Vaziri, Kamyar; Schwartz, Stephen G; Kishor, Krishna S; Flynn, Harry W

    2016-01-01

    Despite treatment advances, rhegmatogenous retinal detachment (RD) can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors.

  6. Tamponade in the surgical management of retinal detachment

    PubMed Central

    Vaziri, Kamyar; Schwartz, Stephen G; Kishor, Krishna S; Flynn, Harry W

    2016-01-01

    Despite treatment advances, rhegmatogenous retinal detachment (RD) can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors. PMID:27041988

  7. Uterine balloon tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage: a randomised controlled trial in Benin and Mali.

    PubMed

    Dumont, Alexandre; Bodin, Cécile; Hounkpatin, Benjamin; Popowski, Thomas; Traoré, Mamadou; Perrin, René; Rozenberg, Patrick

    2017-09-01

    To assess the effectiveness of low-cost uterine tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage (PPH) in low-resource settings. Randomised controlled trial. Seven healthcare facilities in Cotonou, Benin and Bamako, Mali. Women delivering vaginally who had clinically diagnosed PPH that was suspected to be due to uterine atony, who were unresponsive to oxytocin and who needed additional uterotonics. Women were randomly assigned to receive uterine balloon tamponade with a condom-catheter device or no tamponade; both groups were also given intrarectal or sublingual misoprostol. Proportion of women with invasive surgery or who died before hospital discharge. The proportion of primary composite outcome did not differ significantly between the tamponade arm (16%; 9/57) and the standard second line treatment arm (7%; 4/59): relative risk 2.33 (95% CI 0.76 to 7.14, p=0.238). A significantly increased proportion of women with tamponade and misoprostol versus misoprostol alone had total blood loss more than 1000 mL: relative risk 1.52 (95% CI 1.15 to 2.00, p=0.01). Case fatality rate was higher in the tamponade group (10%; 6/57) than in the control group (2%; 1/59) (p=0.059). ISRCT Registry Number 01202389; Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta.

    PubMed

    Zeng, Chanjuan; Yang, Mengyuan; Ding, Yiling; Yu, Ling; Deng, Wen; Hu, Yu; Gong, Xiujuan

    2017-09-01

    femoral artery thrombosis directly related to IAABC placement and recovered after conservative treatment. There was no maternal or neonatal death in this study. Prophylactic insertion of IAABC alone or combined with Bakri tamponade should be safe and effective in controlling intraoperative bleeding due to placenta increta, thus hysterectomy could be avoided. It seems to be less beneficial to women with placenta percreta. Bakri tamponade can be a good choice in the management of placenta increta/percreta before more aggressive surgeries.

  9. Carnitine Palmitoyltransferase-1b (CPT1b) Deficiency Aggravates Pressure-Overload-Induced Cardiac Hypertrophy due to Lipotoxicity

    PubMed Central

    He, Lan; Kim, Teayoun; Long, Qinqiang; Liu, Jian; Wang, Peiyong; Zhou, Yiqun; Ding, Yishu; Prasain, Jeevan; Wood, Philip A.; Yang, Qinglin

    2012-01-01

    Background Carnitine palmitoyltransferase 1(CPT1) is a rate-limiting step of mitochondrial β-oxidation by controlling the mitochondrial uptake of long-chain acyl-CoAs. The muscle isoform, CPT1b, is the predominant isoform expressed in the heart. It has been suggested that inhibiting CPT-1 activity by specific CPT-1 inhibitors exerts protective effects against cardiac hypertrophy and heart failure. However, clinical and animal studies have shown mixed results, thereby posting concerns on the safety of this class of drugs. Preclinical studies using genetically modified animal models should provide a better understanding of targeting CPT1 in order to evaluate it as a safe and effective therapeutic approach. Methods and Results Heterozygous CPT1b knockout mice (CPT1b+/−) were subjected to transverse aorta constriction (TAC)-induced pressure-overload. These mice showed overtly normal cardiac structure/function under the basal condition. Under a severe pressure-overload condition induced by two weeks of transverse aorta constriction (TAC), CPT1b+/− mice were susceptible to premature death with congestive heart failure. Under a milder pressure-overload condition, CPT1b+/− mice exhibited exacerbated cardiac hypertrophy and remodeling compared with that in wild-type littermates. There were more pronounced impairments of cardiac contraction with greater eccentric cardiac hypertrophy in CPT1b+/− than in controlled mice. Moreover, the CPT1b+/− heart exhibited exacerbated mitochondrial abnormalities and myocardial lipid accumulation with elevated triglycerides and ceramide content, leading to greater cardiomyocytes apoptosis. Conclusions We conclude that CPT1b deficiency can cause lipotoxicity in the heart under pathological stress, leading to exacerbation of cardiac pathology. Therefore, caution should be applied in the clinical use of CPT-1 inhibitors. PMID:22932257

  10. Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment

    PubMed Central

    Gui, Jun-Min; Jia, Li; Liu, Lei; Liu, Jian-Di

    2013-01-01

    AIM To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). METHODS A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three-port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow-up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure(IOP) were recorded and analyzed. RESULTS Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow-up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye. CONCLUSION Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony. PMID:23826529

  11. Moderate patient-prosthesis mismatch predicts cardiac events and advanced functional class in young and middle-aged patients undergoing surgery due to severe aortic stenosis.

    PubMed

    Hernandez-Vaquero, Daniel; Garcia, Jose M; Diaz, Rocio; Calvo, David; Khalpey, Zain; Hernández, Ernesto; Rodriguez, Víctor; Morís, César; Llosa, Juan C

    2014-03-01

    The clinical impact of patient-prosthesis mismatch (PPM) on outcomes in young and middle-aged patients undergoing surgery for aortic valve replacement (AVR) remains unknown. Our objective was to examine the mid-term impact of PPM on overall mortality, quality of life, and cardiac events in this population. All patients younger than 70 years of age undergoing isolated AVR from October 2005 to October 2011 were analyzed. PPM was defined as the indexed effective orifice area ≤ 0.85 cm(2) /m(2) . We studied the impact of PPM on mid-term overall mortality, cardiac events, and New York Heart Association functional class using an analysis stratified for propensity score. Cardiac events were defined as cardiac death, sudden death, hospital readmission due to angina, syncope or heart failure or reoperation on aortic prosthesis. Two hundred and ninety-three patients were included in the study, of whom 81 (27.61%) had some degree of PPM. PPM had no impact on mid-term overall mortality (HR=1.45; 95% CI=0.65-3.22; p=0.36), although it had a negative impact on cardiac events (HR=11.52; 95% CI=5.25-25.24; p<0.001) and functional class (RR=7.55; 95% CI=2.59-22.03; p<0.001). Moderate PPM appears to be a strong and independent predictor of cardiac events and advanced functional class in young and middle-aged patients undergoing AVR for severe stenosis. However, it is possible that it has no impact on overall mortality. © 2013 Wiley Periodicals, Inc.

  12. Effects of endurance exercise training on heart rate variability and susceptibility to sudden cardiac death: protection is not due to enhanced cardiac vagal regulation.

    PubMed

    Billman, George E; Kukielka, Monica

    2006-03-01

    Low heart rate variability (HRV) is associated with an increased susceptibility to ventricular fibrillation (VF). Exercise training can increase HRV (an index of cardiac vagal regulation) and could, thereby, decrease the risk for VF. To test this hypothesis, a 2-min coronary occlusion was made during the last min of a 18-min submaximal exercise test in dogs with healed myocardial infarctions; 20 had VF (susceptible), and 13 did not (resistant). The dogs then received either a 10-wk exercise program (susceptible, n=9; resistant, n=8) or an equivalent sedentary period (susceptible, n=11; resistant, n=5). HRV was evaluated at rest, during exercise, and during a 2-min occlusion at rest and before and after the 10-wk period. Pretraining, the occlusion provoked significantly (P<0.01) greater increases in HR (susceptible, 54.9+/-8.3 vs. resistant, 25.0+/-6.1 beats/min) and greater reductions in HRV (susceptible, -6.3+/-0.3 vs. resistant, -2.8+/-0.8 ln ms2) in the susceptible dogs compared with the resistant animals. Similar response differences between susceptible and resistant dogs were noted during submaximal exercise. Training significantly reduced the HR and HRV responses to the occlusion (HR, 17.9+/-11.5 beats/min; HRV, -1.2+/-0.8, ln ms2) in the susceptible dogs; similar response reductions were noted during exercise. In contrast, these variables were not altered in the sedentary susceptible dogs. Posttraining, VF could no longer be induced in the susceptible dogs, whereas four sedentary susceptible dogs died during the 10-wk control period, and the remaining seven animals still had VF when tested. Atropine decreased HRV but only induced VF in one of eight trained susceptible dogs. Thus exercise training increased cardiac vagal activity, which was not solely responsible for the training-induced VF protection.

  13. Heavy silicone oil: a "novel" intraocular tamponade agent.

    PubMed

    Cazabon, Sunildath; Hillier, Roxane J; Wong, David

    2011-06-01

    Advances in vitreoretinal surgery have greatly increased the anatomical re-attachment rate in cases with proliferative vitreoretinopathy. Intraocular tamponade agents have been in use by vitreoretinal surgeons for nearly a century. The effectiveness of an internal agent relies on its ability to make contact with the internal surface of the vitreous cavity. In the short term, this is controlled by the agent's specific gravity and interfacial tensions. In the long term, the viscosity of the material is critical to maintaining its integrity and thus reducing dispersion. The commonly used tamponade agents such as perfluoropropane (C3F8), sulfur hexafluoride (SF6), and silicone oil are "lighter than water" hence, float upward in the aqueous. A consequence of this is that in the upright position the superior retina is very well supported, leaving the inferior retina less well so. More recently, there has been interest in the development of "heavier than water" long-term tamponade agents that sink in the eye. Heavy silicone oil is a transparent, homogenous solution of two substances used as a single tamponade agent with improved properties and a specific gravity greater than water. Densiron (one of the two available heavy silicone oil's) is a mixture of perfluorohexyloctane (F6H8, with a specific gravity of 1.35 g/ml and viscosity of 2.5 mPas), and conventional silicone oil (specific gravity of 0.97 g/ml and viscosity of 5700 mPas depending on the molecular weight). The specific gravity of Densiron is 1.06 g/ml and the viscosity is 1400 mPas, making it a novel heavier-than-water, long-term internal tamponade agent, which means that in the upright position it sinks and provides support for the inferior retina.

  14. Refractive shift of silicone oil tamponade in pseudophakic eye.

    PubMed

    Fang, Wei; Li, Jiuke; Jin, Xiaohong; Zhai, Jing; Dai, Yuanmin; Li, Yumin

    2016-08-16

    Refraction change of silicone oil (SO) tamponade in phakic and aphakic eye has been studied thoroughly; however, it is rarely studied in pseudophakic eye. In this paper we aimed to deduce a theoretical formula predicting refractive shift of silicone oil tamponade in pseudophakic eye and compared it with clinical findings. A theoretical formula was deduced through strict geometric optical principles under the Helmholtz Schematic eye model. Pre/postoperative refractive status of patients who previously underwent phacoemulsification, intraocular lens (IOL) implant, vitrectomy, SO tamponade and required SO extraction was studied. Twenty-six patients (27 eyes, 13 males and 13 females) were studied. Refractive error of SO-off was -1.88 ± 2.73D, and of SO-in was 2.02 ± 3.90. Refractive shift of SO tamponade was -3.90 ± 1.74D. Refractive shift was significantly associated with refractive power of IOL (r = -0.7903, p < 0.0001, Pearson correlation test) and anterior chamber distance (ACD, r = 0.3840, p = 0.0480, Pearson correlation test). Theoretical refractive shift was -4.10 ± 1.51D, and there was no significant difference between the theoretical and the clinical refractive shift (p = 0.3329, Paired T test). Refractive shift of SO tamponade in pseudophakic eye correlates with refractive power of implanted IOL and ACD, and strong correlation between theoretical formula and clinical findings was detected.

  15. Cardiac manifestations of parasitic diseases.

    PubMed

    Nunes, Maria Carmo P; Guimarães Júnior, Milton Henriques; Diamantino, Adriana Costa; Gelape, Claudio Leo; Ferrari, Teresa Cristina Abreu

    2017-05-01

    The heart may be affected directly or indirectly by a variety of protozoa and helminths. This involvement may manifest in different ways, but the syndromes resulting from impairment of the myocardium and pericardium are the most frequent. The myocardium may be invaded by parasites that trigger local inflammatory response with subsequent myocarditis or cardiomyopathy, as occurs in Chagas disease, African trypanosomiasis, toxoplasmosis, trichinellosis and infection with free-living amoebae. In amoebiasis and echinococcosis, the pericardium is the structure most frequently involved with consequent pericardial effusion, acute pericarditis, cardiac tamponade or constrictive pericarditis. Chronic hypereosinophilia due to helminth infections, especially filarial infections, has been associated with the development of tropical endomyocardial fibrosis, a severe form of restrictive cardiomyopathy. Schistosomiasis-associated lung vasculature involvement may cause pulmonary hypertension (PH) and cor pulmonale Tropical pulmonary eosinophilia, which is characterised by progressive interstitial fibrosis and restrictive lung disease, may lead to PH and its consequences may occur in the course of filarial infections. Intracardiac rupture of an Echinococcus cyst can cause membrane or secondary cysts embolisation to the lungs or organs supplied by the systemic circulation. Although unusual causes of cardiac disease outside the endemic areas, heart involvement by parasites should be considered in the differential diagnosis especially of myocardial and/or pericardial diseases of unknown aetiology in both immunocompetent and immunocompromised individuals. In this review, we updated and summarised the current knowledge on the major heart diseases caused by protozoan and metazoan parasites, which either involve the heart directly or otherwise influence the heart adversely. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

  16. Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients

    PubMed Central

    2012-01-01

    Background Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via mini-thoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. Methods Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. Results Forty-eight patients (64.7% male), with a mean age of 55.20 ± 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P <0.001 and P <0.004, respectively). Overall median survival was 10.41 ± 1.79 months. One- and 2-year survival rates were 45 ± 7% and 18 ± 5%, respectively. Conclusion Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival. PMID:22742716

  17. Perfluoro-n-octane as a temporary intraocular tamponade in a staged approach to manage complex retinal detachments

    PubMed Central

    Barthelmes, Daniel; Chandra, Jay

    2015-01-01

    Purpose To evaluate outcomes in patients with complex retinal detachments (RD) with proliferative vitreoretinopathy (PVR) requiring retinectomy using a staged approach utilizing perfluoro-n-octane (PFO) as a short-term postoperative intraocular tamponade. Methods Retrospective analysis. Patients who underwent 23G pars plana vitrectomy for the management of complicated RD where PFO was used as a primary temporary intraocular tamponade. Only eyes with PVR in rhegmatogenous RD or eyes with penetrating injuries or globe ruptures (ocular trauma) and subsequent RD with PVR were included. Analysis of 17 eyes of 17 consecutive patients with a minimum follow-up of 12 months during a period of 5 years. The primary outcome measure was the reattachment rate after at least 12 months of follow-up after the PFO removal. Secondary outcome measures were changes in visual acuity, complications due to PFO use, and necessity for further surgeries. Results Eight eyes with prior penetrating injuries or globe rupture and nine eyes with rhegmatogenous pathology were included. All eyes had PFO as temporary tamponade for 14 days (median), which was replaced by silicon oil. Sixteen eyes (94%) had complete and one eye partial reattachment. No redetachments occurred. All eyes retained or improved visual acuity. On average, only 2.5 procedures, including silicon oil removal, were performed. Two eyes had long-term intraocular pressure of 5 mmHg and no eye had intraocular pressure of ≥21 mmHg. No long-term inflammation was observed. Conclusion PFO seems to be beneficial in a staged approach to repair complex detachments when used as short-term tamponade. A median period of 14 days allowed for both sufficient retinal support plus a reduction in side effects seen in long-term endotamponades. PMID:25784785

  18. Incidence of arteriovenous fistula closure due to high-output cardiac failure in kidney-transplanted patients.

    PubMed

    Schier, Tabea; Göbel, Georg; Bösmüller, Claudia; Gruber, Ingrid; Tiefenthaler, Martin

    2013-01-01

    Some hemodialysis patients develop arteriovenous (AV) fistulas with high flows. This volume overload can result in high-output cardiac failure. To date, predisposing access flow rates are unknown. A retrospective study of all kidney-transplant recipients at the Medical University of Innsbruck (MUI) from 2005 to 2010 included 797 patients with the following criteria: previous hemodialysis with a native AV fistula or a graft, sufficient function of the kidney transplant up to the time of the data analysis, and follow-up care at the MUI. Twenty-nine of the 113 patients (25.7%) needed an AV fistula closure, mostly because of symptoms of cardiac failure. The mean shunt flow in the intervention group was 2197.2 mL/min, whereas the mean shunt flow in the non-intervention group was only 850.9 mL/min. Shunt closures were most frequently made in patients with upper-arm shunts (41.7%). The necessity of shunt closure is not a rarity. Patients who underwent an AV fistula ligature had high access flows with about 2200 mL/min. As the symptoms of cardiac failure greatly improved after shunt closure, patients with high access flow may benefit from such an intervention. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Recombinant activated factor VII in the management of life-threatening bleeding in cardiac surgery.

    PubMed

    Hyllner, Monica; Houltz, Erik; Jeppsson, Anders

    2005-08-01

    Massive perioperative bleeding is a potential complication of cardiac surgery, and may persist despite conventional interventions. RFVIIa is being increasingly used as additional therapy, and the aim of the present study was to describe our experience with rFVIIa in the management of life-threatening bleeding in adult cardiac surgery. Retrospective chart review of 24 patients undergoing a variety of cardiac procedures was performed at Sahlgrenska University Hospital between January and August 2004. The patients developed life-threatening bleeding during or after surgery despite conventional medical therapy and transfusion of blood products, and received rFVIIa as additional therapy. RFVIIa was administered as a median bolus dose of 60 microg/kg. Nineteen patients received one dose of rFVIIa; the bleeding stopped or decreased in 18 of them. Five patients received repeated doses of rFVIIa. Fifteen patients were reexplored due to massive postoperative bleeding or cardiac tamponade and a surgical source of bleeding was identified in six of these patients. A statistically significant reduction in chest drain losses after administration of rFVIIa was demonstrated. No adverse reactions were noted. RFVIIa was successfully used as an additional therapy both during and after cardiac surgery, when bleeding was refractory to conventional methods. Bleeding stopped eventually in all patients and none of the patients exsanguinated.

  20. A concealed atriopleural fistula resulting from a cardiac stab wound.

    PubMed

    Arnáiz-García, María Elena; Arnáiz, Javier; Pontón, Alejandro; Pulitani, Ivana; González-Santos, Jose María; Arévalo-Abascal, Adolfo; Bueno-Codoñer, María E; Arnáiz-García, Ana María

    2014-09-01

    A young male presented with a right parasternal stab wound. The chest radiography was normal and transthoracic echocardiography ruled out pericardial tamponade. He remained hemodynamically stable until three hours later when signs of progressive anemia were observed. Chest computed tomography showed massive right-sided hemothorax. The patient underwent surgery, which revealed an active bleeding atriopleural fistula connecting the right atrium and draining into the right pleura resulting from the negative pressure generated during respiration. This mechanism prevented cardiac tamponade and maintained initial hemodynamically stability.

  1. Management of postpartum hemorrhage with intrauterine balloon tamponade using a condom catheter in an Egyptian setting.

    PubMed

    Kandeel, Mohamed; Sanad, Zakaria; Ellakwa, Hamed; El Halaby, Alaa; Rezk, Mohamed; Saif, Ibrahim

    2016-12-01

    To evaluate uterine balloon tamponade using a condom catheter for the management of early postpartum hemorrhage (PPH). In a prospective observational study at Menoufia University Hospital, Shebin Elkom, Egypt, women with early PPH were enrolled between May 2011 and September 2012. Uterine balloon tamponade with a condom catheter was applied in women who were unresponsive to uterotonics and bimanual compression; patients with successful catheter placement were included in analyses. The primary outcome was successful control (reduction or cessation) of bleeding. A condom catheter was successfully placed for 50 of the 151 women enrolled. The overall success rate of the procedure was 96% (48/50). The condom catheter was successful in all 28 cases of atonic PPH after vaginal or cesarean delivery. It successfully controlled PPH due placental site bleeding in 20 (91%) of 22 patients with placenta previa and a well-contracted uterus. Condom balloon catheter was found to effectively control PPH. The procedure is simple, inexpensive, and safe, and can preserve reproductive capacity, as well as saving the life of the mother. ClinicalTrials.gov:NCT02672891. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Endovascular Stenting under Cardiac and Cerebral Protection for Subclavian Steal after Coronary Artery Bypass Grafting Due to Right Subclavian Artery Origin Stenosis.

    PubMed

    Sakamoto, Shigeyuki; Kiura, Yoshihiro; Okazaki, Takahito; Ichinose, Nobuhiko; Kurisu, Kaoru

    2015-03-01

    Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications.

  3. Video-assisted pericardial fenestration for effusions after cardiac surgery.

    PubMed

    Georghiou, Georgios P; Porat, Eyal; Fuks, Avi; Vidne, Bernardo A; Saute, Milton

    2009-10-01

    Delayed-onset pericardial effusion following cardiac surgery can give rise to significant morbidity due to its presentation as well as management by traditional surgical techniques. An institutional experience of a video-assisted thoracoscopic technique to create a pericardial window, with the advantages of a minimally invasive approach combined with excellent visualization in such patients, was reviewed. A retrospective analysis was conducted on all patients undergoing video-assisted thoracoscopic for delayed pericardial effusion after cardiac surgery from January 2001 to January 2006 at our center. Seven patients with echocardiographically diagnosed delayed tamponade underwent video-assisted thoracoscopy; 5 were receiving anticoagulants after valve replacement, and 2 had undergone heart transplantation. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operative time was 45 min. There were no complications of the thoracoscopic technique. Video-assisted thoracoscopic creation of a pericardial window is safe and effective treatment for loculated pericardial effusions secondary to cardiac surgery.

  4. Changes in cardiac function after pedicle subtraction osteotomy in patients with a kyphosis due to ankylosing spondylitis.

    PubMed

    Fu, J; Song, K; Zhang, Y G; Zheng, G Q; Zhang, G Y; Liu, C; Wang, Y

    2015-10-01

    Cardiac disease in patients with ankylosing spondylitis (AS) has previously been studied but not in patients with a kyphosis or in those who have undergone an operation to correct it. The aim of this study was to measure the post-operative changes in cardiac function of patients with an AS kyphosis after pedicle subtraction osteotomy (PSO). The original cohort consisted of 39 patients (33 men, six women). Of these, four patients (two men, two women) were lost to follow-up leaving 35 patients (31 men, four women) to study. The mean age of the remaining patients was 37.4 years (22.3 to 47.8) and their mean duration of AS was 17.0 years (4.6 to 26.4). Echocardiographic measurements, resting heart rate (RHR), physical function score (PFS), and full-length standing spinal radiographs were obtained before surgery and at the two-year follow-up. The mean pre-operative RHR was 80.2 bpm (60.6 to 112.3) which dropped to a mean of 73.7 bpm (60.7 to 90.6) at the two-year follow-up (p = 0.0000). Of 15 patients with normal ventricular function pre-operatively, two developed mild left ventricular diastolic dysfunction (LVDD) at the two-year follow-up. Of 20 patients with mild LVDD pre-operatively only five had this post-operatively. Overall, 15 patients had normal LV diastolic function before their operation and 28 patients had normal LV function at the two-year follow-up. The clinical improvement was 15 out of 20 (75.0%): cardiac function in patients with AS whose kyphosis was treated by PSO was significantly improved. ©2015 The British Editorial Society of Bone & Joint Surgery.

  5. Variability of hemodynamic responses to acute digitalization in chronic cardiac failure due to cardiomyopathy and coronary artery disease.

    PubMed

    Cohn, K; Selzer, A; Kersh, E S; Karpman, L S; Goldschlager, N

    1975-04-01

    Eight patients with chronic congestive heart failure (four with cardiomyopathy and four with ischemic heart disease) underwent hemodynamic studies during acute administration of digoxin, given intravenously in two 0-5 mg doses 2 hours apart. Observations were made before administration of digitalis (control period) and serially therafter for 4 hours after the first dose. Resting mean cardiac index and pulmonary arterial wedge pressure were as follows: 2.0 liters/min per m2 and 23 mm Hg (control period); 2.1 and 24 (at 1 hour); 2.0 and 23 (at 2 hours); 2.7 and 19 (at 3 hours); and 2.3 and 20 (at 4 hours). Exercise responses of mean cardiac index and pulmonary arterial wedge pressure in five patients were: 3.1 liters/min per m2 and 36 mm Hg (control period); 3.2 and 33 (at 1 hour); 3.2 and 28 (at 2 hours); 3.1 and 27 (at.3 hours); and 3.4 and 31 (at 4 hours). The pulmonary arterial wedge pressure remained elevated during exercise in all cases. Arrhythmias were seen in five patients after administration of 0.5 mg of digoxin. Hemodynamic improvement at 4 hours involving both reduced filling pressure and increased blood flow was observed in only two patients at rest and in one additional patient during exercise. Acute deterioration of cardiac function (elevated pulmonary arterial wedge pressure of decreased cardiac index) occurred 30 minutes after administration of digoxin in four patients, concomitantly with increased systemic resistance. In six patients, a peak hemodynamic effect appeared 1 to 1 1/2 hours after administration of digoxin, with partial or total loss of initial benefit by 2 and 4 hours. In previously performed studies observations have seldom exceeded 1 hour; the results of this 4 hour study suggest that, in patients with cardiomyopathy or coronary artery disease and chronic congestive heart failure, acute digitalization does not necessarily lead to consistent, marked or lasting hemodynamic improvement. Thus, current concepts of the use of digitalis is

  6. Atlas-based analysis of cardiac shape and function: correction of regional shape bias due to imaging protocol for population studies.

    PubMed

    Medrano-Gracia, Pau; Cowan, Brett R; Bluemke, David A; Finn, J Paul; Kadish, Alan H; Lee, Daniel C; Lima, Joao A C; Suinesiaputra, Avan; Young, Alistair A

    2013-09-13

    Cardiovascular imaging studies generate a wealth of data which is typically used only for individual study endpoints. By pooling data from multiple sources, quantitative comparisons can be made of regional wall motion abnormalities between different cohorts, enabling reuse of valuable data. Atlas-based analysis provides precise quantification of shape and motion differences between disease groups and normal subjects. However, subtle shape differences may arise due to differences in imaging protocol between studies. A mathematical model describing regional wall motion and shape was used to establish a coordinate system registered to the cardiac anatomy. The atlas was applied to data contributed to the Cardiac Atlas Project from two independent studies which used different imaging protocols: steady state free precession (SSFP) and gradient recalled echo (GRE) cardiovascular magnetic resonance (CMR). Shape bias due to imaging protocol was corrected using an atlas-based transformation which was generated from a set of 46 volunteers who were imaged with both protocols. Shape bias between GRE and SSFP was regionally variable, and was effectively removed using the atlas-based transformation. Global mass and volume bias was also corrected by this method. Regional shape differences between cohorts were more statistically significant after removing regional artifacts due to imaging protocol bias. Bias arising from imaging protocol can be both global and regional in nature, and is effectively corrected using an atlas-based transformation, enabling direct comparison of regional wall motion abnormalities between cohorts acquired in separate studies.

  7. Off-pump coronary artery bypass grafting for a left main lesion due to cardiac allograft vasculopathy in Japan: first report of a case.

    PubMed

    Fujita, Tomoyuki; Kobayashi, Junjiro; Hata, Hiroki; Murata, Yoshihiro; Seguchi, Osamu; Yanase, Masanobu; Shimahara, Yusuke; Sato, Shunsuke; Nakatani, Takeshi

    2014-10-01

    Cardiac allograft vasculopathy (CAV) is a major cause of mortality after transplantation. We treated a 44-year-old female with off-pump coronary artery bypass grafting (OPCAB) 4 years after heart transplantation. Annual examinations, including coronary angiography and intravenous ultrasound (IVUS), revealed a severe lesion in the left main trunk. The left internal mammary artery was successfully anastomosed to the left anterior descending artery in an off-pump manner. To ensure that patients have a good long-term outcome after heart transplantation, routine examinations, including IVUS, are crucial, because of the nature of CAV. OPCAB is a good option for a left main trunk lesion due to CAV.

  8. Cardiac arrest due to ventricular fibrillation in a 23-year-old woman with broken heart syndrome.

    PubMed

    Del Buono, Marco Giuseppe; O'Quinn, Michael P; Garcia, Paulo; Gerszten, Enrique; Roberts, Charlotte; Moeller, F Gerald; Abbate, Antonio

    Broken heart syndrome, also known as takotsubo cardiomyopathy, is a syndrome characterized by a transient regional systolic dysfunction of the left ventricle associated to a psychological stress. We herein describe a case of a 23-year-old female habitual marijuana user who was resuscitated after cardiac arrest and then diagnosed with midventricular stress cardiomyopathy complicated by subendocardial hemorrhage. We discuss this unique pathological finding, the incidence of arrhythmias in this syndrome, and the possible relation with chronic cannabis and tobacco use. Unfortunately, the patient did not survive, but had she survived, the management of the patient for secondary prevention would have been challenging considering the risk of recurrence with this disease. Copyright © 2017. Published by Elsevier Inc.

  9. Stimulation of the cardiac myocyte Na+-K+ pump due to reversal of its constitutive oxidative inhibition.

    PubMed

    Chia, Karin K M; Liu, Chia-Chi; Hamilton, Elisha J; Garcia, Alvaro; Fry, Natasha A; Hannam, William; Figtree, Gemma A; Rasmussen, Helge H

    2015-08-15

    Protein kinase C can activate NADPH oxidase and induce glutathionylation of the β1-Na(+)-K(+) pump subunit, inhibiting activity of the catalytic α-subunit. To examine if signaling of nitric oxide-induced soluble guanylyl cyclase (sGC)/cGMP/protein kinase G can cause Na(+)-K(+) pump stimulation by counteracting PKC/NADPH oxidase-dependent inhibition, cardiac myocytes were exposed to ANG II to activate NADPH oxidase and inhibit Na(+)-K(+) pump current (Ip). Coexposure to 3-(5'-hydroxymethyl-2'-furyl)-1-benzylindazole (YC-1) to stimulate sGC prevented the decrease of Ip. Prevention of the decrease was abolished by inhibition of protein phosphatases (PP) 2A but not by inhibition of PP1, and it was reproduced by an activator of PP2A. Consistent with a reciprocal relationship between β1-Na(+)-K(+) pump subunit glutathionylation and pump activity, YC-1 decreased ANG II-induced β1-subunit glutathionylation. The decrease induced by YC-1 was abolished by a PP2A inhibitor. YC-1 decreased phosphorylation of the cytosolic p47(phox) NADPH oxidase subunit and its coimmunoprecipitation with the membranous p22(phox) subunit, and it decreased O2 (·-)-sensitive dihydroethidium fluorescence of myocytes. Addition of recombinant PP2A to myocyte lysate decreased phosphorylation of p47(phox) indicating the subunit could be a substrate for PP2A. The effects of YC-1 to decrease coimmunoprecipitation of p22(phox) and p47(phox) NADPH oxidase subunits and decrease β1-Na(+)-K(+) pump subunit glutathionylation were reproduced by activation of nitric oxide-dependent receptor signaling. We conclude that sGC activation in cardiac myocytes causes a PP2A-dependent decrease in NADPH oxidase activity and a decrease in β1 pump subunit glutathionylation. This could account for pump stimulation with neurohormonal oxidative stress expected in vivo. Copyright © 2015 the American Physiological Society.

  10. Stimulation of the cardiac myocyte Na+-K+ pump due to reversal of its constitutive oxidative inhibition

    PubMed Central

    Chia, Karin K. M.; Liu, Chia-Chi; Hamilton, Elisha J.; Garcia, Alvaro; Fry, Natasha A.; Hannam, William; Figtree, Gemma A.

    2015-01-01

    Protein kinase C can activate NADPH oxidase and induce glutathionylation of the β1-Na+-K+ pump subunit, inhibiting activity of the catalytic α-subunit. To examine if signaling of nitric oxide-induced soluble guanylyl cyclase (sGC)/cGMP/protein kinase G can cause Na+-K+ pump stimulation by counteracting PKC/NADPH oxidase-dependent inhibition, cardiac myocytes were exposed to ANG II to activate NADPH oxidase and inhibit Na+-K+ pump current (Ip). Coexposure to 3-(5′-hydroxymethyl-2′-furyl)-1-benzylindazole (YC-1) to stimulate sGC prevented the decrease of Ip. Prevention of the decrease was abolished by inhibition of protein phosphatases (PP) 2A but not by inhibition of PP1, and it was reproduced by an activator of PP2A. Consistent with a reciprocal relationship between β1-Na+-K+ pump subunit glutathionylation and pump activity, YC-1 decreased ANG II-induced β1-subunit glutathionylation. The decrease induced by YC-1 was abolished by a PP2A inhibitor. YC-1 decreased phosphorylation of the cytosolic p47phox NADPH oxidase subunit and its coimmunoprecipitation with the membranous p22phox subunit, and it decreased O2·−-sensitive dihydroethidium fluorescence of myocytes. Addition of recombinant PP2A to myocyte lysate decreased phosphorylation of p47phox indicating the subunit could be a substrate for PP2A. The effects of YC-1 to decrease coimmunoprecipitation of p22phox and p47phox NADPH oxidase subunits and decrease β1-Na+-K+ pump subunit glutathionylation were reproduced by activation of nitric oxide-dependent receptor signaling. We conclude that sGC activation in cardiac myocytes causes a PP2A-dependent decrease in NADPH oxidase activity and a decrease in β1 pump subunit glutathionylation. This could account for pump stimulation with neurohormonal oxidative stress expected in vivo. PMID:26084308

  11. Under Pressure: Intraluminal Filling Pressures of Postpartum Hemorrhage Tamponade Balloons

    PubMed Central

    Antony, Kathleen M.; Racusin, Diana A.; Belfort, Michael A.; Dildy, Gary A.

    2017-01-01

    Objective Uterine tamponade by fluid-filled balloons is now an accepted method of controlling postpartum hemorrhage. Available tamponade balloons vary in design and material, which affects the filling attributes and volume at which they rupture. We aimed to characterize the filling capacity and pressure-volume relationship of various tamponade balloons. Study Design Balloons were filled with water ex vivo. Intraluminal pressure was measured incrementally (every 10 mL for the Foley balloons and every 50 mL for all other balloons). Balloons were filled until they ruptured or until 5,000 mL was reached. Results The Foley balloons had higher intraluminal pressures than the larger-volume balloons. The intraluminal pressure of the Sengstaken-Blakemore tube (gastric balloon) was initially high, but it decreased until shortly before rupture occurred. The Bakri intraluminal pressure steadily increased until rupture occurred at 2,850 mL. The condom catheter, BT-Cath, and ebb all had low intraluminal pressures. Both the BT-Cath and the ebb remained unruptured at 5,000 mL. Conclusion In the setting of acute hemorrhage, expeditious management is critical. Balloons that have a low intraluminal pressure-volume ratio may fill more rapidly, more easily, and to greater volumes. We found that the BT-Cath, the ebb, and the condom catheter all had low intraluminal pressures throughout filling. PMID:28497006

  12. Under Pressure: Intraluminal Filling Pressures of Postpartum Hemorrhage Tamponade Balloons.

    PubMed

    Antony, Kathleen M; Racusin, Diana A; Belfort, Michael A; Dildy, Gary A

    2017-04-01

    Objective Uterine tamponade by fluid-filled balloons is now an accepted method of controlling postpartum hemorrhage. Available tamponade balloons vary in design and material, which affects the filling attributes and volume at which they rupture. We aimed to characterize the filling capacity and pressure-volume relationship of various tamponade balloons. Study Design Balloons were filled with water ex vivo. Intraluminal pressure was measured incrementally (every 10 mL for the Foley balloons and every 50 mL for all other balloons). Balloons were filled until they ruptured or until 5,000 mL was reached. Results The Foley balloons had higher intraluminal pressures than the larger-volume balloons. The intraluminal pressure of the Sengstaken-Blakemore tube (gastric balloon) was initially high, but it decreased until shortly before rupture occurred. The Bakri intraluminal pressure steadily increased until rupture occurred at 2,850 mL. The condom catheter, BT-Cath, and ebb all had low intraluminal pressures. Both the BT-Cath and the ebb remained unruptured at 5,000 mL. Conclusion In the setting of acute hemorrhage, expeditious management is critical. Balloons that have a low intraluminal pressure-volume ratio may fill more rapidly, more easily, and to greater volumes. We found that the BT-Cath, the ebb, and the condom catheter all had low intraluminal pressures throughout filling.

  13. Exploring the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to apparent life threatening events.

    PubMed

    Meert, Kathleen; Telford, Russell; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Dean, J Michael; Moler, Frank W

    2016-12-01

    To explore the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to an apparent life threatening event (ALTE) recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest Out-of-Hospital trial. Fifty-four infants (48h to <1year of age) with ALTE who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation were included. Infants were randomised to therapeutic hypothermia (33°C) (n=26) or therapeutic normothermia (36.8°C) (n=28) within six hours of return of circulation. Outcomes included 12-month survival with Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) score ≥70, 12-month survival, change in VABS-II score from pre-arrest to 12 months post-arrest, and select safety measures. Amongst infants with pre-arrest VABS-II ≥70 (n=52), there was no difference in 12-month survival with VABS-II ≥70 between therapeutic hypothermia and therapeutic normothermia groups (2/25 (8.0%) vs. 1/27 (3.7%); relative risk 2.16; 95% confidence interval 0.21-22.38, p=0.60). Amongst all evaluable infants (n=53), the change in VABS-II score from pre-arrest to 12 months post-arrest did not differ (p=0.078) between therapeutic hypothermia and therapeutic normothermia groups, nor did 12-month survival (5/26 (19.2%) vs. 1/27 (3.7%); relative risk 5.19; 95% confidence interval 0.65-41.50, p=0.10). Mortality was high amongst infants that were comatose after out-of-hospital cardiac arrest due to ALTE in both therapeutic hypothermia and therapeutic normothermia treated groups. Functional status was markedly reduced among survivors. (ClinicalTrials.gov, NCT00878644). Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Silicone oil tamponade to seal macular holes without position restrictions.

    PubMed

    Goldbaum, M H; McCuen, B W; Hanneken, A M; Burgess, S K; Chen, H H

    1998-11-01

    The authors performed a study to determine the effectiveness and safety of silicone oil as a substitute for gas to fill the vitreous cavity to treat macular holes. Multicenter, nonrandomized, interventional trial. Thirty-seven consecutive patients chose vitrectomy with silicone tamponade instead of gas to treat 40 eyes with stage-2 to stage-4 idiopathic age-related macular holes. Stage-2 holes constituted 40% of the holes, and stage-3 and stage-4 holes made up 60%. All eyes were treated with vitrectomy, manual detachment of the posterior vitreous face (not done for stage-4 holes), autologous serum instillation, and silicone fill of the vitreous cavity. After insertion of the oil, the patients resumed normal activity with no restriction of head or eye position except to avoid faceup position. The oil was removed after approximately 6 weeks. The authors considered the seal of the macular hole and the preoperative and postoperative logarithm of the minimum angle of resolution (logMAR) visions the most significant measures for comparison to other studies. Eighty percent of all holes and 86% of holes not treated previously were sealed with a single silicone tamponade of the vitreous cavity. The logMAR value of visual acuity improved an average of 0.26 (2.6 lines) to 0.61 (20/81) for all eyes and 0.34 (3.4 lines) to 0.52 (20/66) when the macular hole sealed. Completeness of fill of the vitreous cavity with silicone affected seal of the macular hole. Three of eight eyes in which open holes developed after oil removal had less than 90% fill of the vitreous cavity by silicone. Sixty-nine percent of lenses increased opacity one grade or were removed after silicone tamponade. There were no significant adverse effects arising from silicone tamponade. Silicone oil tamponade of macular holes is effective and safe. Silicone may be optimal for the treatment of macular holes in persons who must travel, who cannot maintain facedown positioning, or who have monocular vision. The most

  15. Recurrent Muscle Weakness with Rhabdomyolysis, Metabolic Crises, and Cardiac Arrhythmia Due to Bi-allelic TANGO2 Mutations

    PubMed Central

    Lalani, Seema R.; Liu, Pengfei; Rosenfeld, Jill A.; Watkin, Levi B.; Chiang, Theodore; Leduc, Magalie S.; Zhu, Wenmiao; Ding, Yan; Pan, Shujuan; Vetrini, Francesco; Miyake, Christina Y.; Shinawi, Marwan; Gambin, Tomasz; Eldomery, Mohammad K.; Akdemir, Zeynep Hande Coban; Emrick, Lisa; Wilnai, Yael; Schelley, Susan; Koenig, Mary Kay; Memon, Nada; Farach, Laura S.; Coe, Bradley P.; Azamian, Mahshid; Hernandez, Patricia; Zapata, Gladys; Jhangiani, Shalini N.; Muzny, Donna M.; Lotze, Timothy; Clark, Gary; Wilfong, Angus; Northrup, Hope; Adesina, Adekunle; Bacino, Carlos A.; Scaglia, Fernando; Bonnen, Penelope E.; Crosson, Jane; Duis, Jessica; Maegawa, Gustavo H.B.; Coman, David; Inwood, Anita; McGill, Jim; Boerwinkle, Eric; Graham, Brett; Beaudet, Art; Eng, Christine M.; Hanchard, Neil A.; Xia, Fan; Orange, Jordan S.; Gibbs, Richard A.; Lupski, James R.; Yang, Yaping

    2016-01-01

    The underlying genetic etiology of rhabdomyolysis remains elusive in a significant fraction of individuals presenting with recurrent metabolic crises and muscle weakness. Using exome sequencing, we identified bi-allelic mutations in TANGO2 encoding transport and Golgi organization 2 homolog (Drosophila) in 12 subjects with episodic rhabdomyolysis, hypoglycemia, hyperammonemia, and susceptibility to life-threatening cardiac tachyarrhythmias. A recurrent homozygous c.460G>A (p.Gly154Arg) mutation was found in four unrelated individuals of Hispanic/Latino origin, and a homozygous ∼34 kb deletion affecting exons 3–9 was observed in two families of European ancestry. One individual of mixed Hispanic/European descent was found to be compound heterozygous for c.460G>A (p.Gly154Arg) and the deletion of exons 3–9. Additionally, a homozygous exons 4–6 deletion was identified in a consanguineous Middle Eastern Arab family. No homozygotes have been reported for these changes in control databases. Fibroblasts derived from a subject with the recurrent c.460G>A (p.Gly154Arg) mutation showed evidence of increased endoplasmic reticulum stress and a reduction in Golgi volume density in comparison to control. Our results show that the c.460G>A (p.Gly154Arg) mutation and the exons 3–9 heterozygous deletion in TANGO2 are recurrent pathogenic alleles present in the Latino/Hispanic and European populations, respectively, causing considerable morbidity in the homozygotes in these populations. PMID:26805781

  16. Pediatric Fulminant Leptospirosis Complicated by Pericardial Tamponade, Macrophage Activation Syndrome and Sclerosing Cholangitis

    PubMed Central

    Yeşilbaş, Osman; Kıhtır, Hasan Serdar; Yıldırım, Hamdi Murat; Hatipoğlu, Nevin; Şevketoğlu, Esra

    2016-01-01

    Background: Leptospirosis is a zoonotic infectious disease caused by pathogenic spirochetes of the genus Leptospira. Although it is usually asymptomatic and self-limited, severe potentially fatal illness accompanied by multi-organ failure may occur. Case Report: Here we report an unusual case of severe leptospirosis successfully treated with continuous venovenous hemofiltration (CVVHF) and therapeutic plasma exchange (TPE). The patient presented with pericardial tamponade, renal failure and macrophage activation syndrome, and later suffered prolonged jaundice and sclerosing cholangitis during hospitalization in the pediatric intensive care unit (PICU). To the best of our knowledge, sclerosing cholangitis due to leptospirosis has not been reported in the literature. Conclusion: Leptospirosis should be kept in mind in the differential diagnosis of sepsis and septic shock with fever, thrombocytopenia, jaundice and renal failure. TPE and CVVHF should start early after the diagnosis of leptospirosis with multiorgan failure. PMID:27761292

  17. A case of tricuspid valve endocarditis due to Cardiobacterium hominis which emphasizes the shift between the poverty of clinical symptoms and the severity of cardiac damages.

    PubMed

    Molet, Lucie; Revest, Matthieu; Fournet, Maxime; Donal, Erwan; Bonnaure-Mallet, Martine; Minet, Jacques; Le Bars, Hervé

    2016-12-01

    Infectious endocarditis due to Cardiobacterium hominis is an uncommon event, accounting for less than 2% of all cases of infectious endocarditis. The infection of the tricuspid valve as it is reported here is extremely rare. We report the case of a tricuspid endocarditis due to Cardiobacterium hominis in a 56 year-old man who was admitted to hospital with pelvic and scapular pain. The diagnosis was established through positive blood cultures and echographic detection of a large tricuspid vegetation. Despite efficient antibiotic therapy, valve replacement was required. The clinical course of Cardiobacterium endocarditis is usually subacute, and the diagnosis may therefore be delayed. This case emphasizes the shift between the poverty of clinical symptoms and severity of cardiac damages, what we could call the Cardiobacterium paradox.

  18. Cardiac catheterization

    MedlinePlus

    Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization; CAD - cardiac catheterization; Coronary artery disease - cardiac catheterization; Heart valve - cardiac catheterization; Heart failure - ...

  19. Hemorrhagic Pericardial Effusion with Tamponade: A Rare Adverse Effect of Infliximab—Case Report and Literature Review

    PubMed Central

    Lather, Henry D.

    2016-01-01

    Introduction. Antitumor necrosis factor (TNF) alpha agents are commonly used biologic therapies for a wide variety of rheumatic and inflammatory diseases. Here, we present a case of hemorrhagic pericarditis as a consequence of infliximab and review the literature on pericardial complications stemming from this drug class. Methods. For the literature review, search terms using versions of antitumor necrosis factor alpha AND pericardial effusion OR pericarditis OR pleuropericarditis OR cardiac tamponade were used. Results. Pericarditis is a rare but serious complication of anti-TNF based therapy, and hemorrhagic fluid is even more rare, with only one additional case reported. It is likely that this complication was secondary to a robust immune response to very high titer anti-infliximab antibodies. Providers should be aware that this complication can occur and that abnormal elevations in procalcitonin may accompany this unusual finding. PMID:27822400

  20. Successful use of a Bakri Tamponade Balloon in the treatment of puerperal uterine inversion during caesarean section.

    PubMed

    Vivanti, A J; Furet, E; Nizard, J

    2016-04-23

    Acute puerperal inversion of the uterus is a rare life-threatening obstetric emergency, especially during caesarean section. We present the case of a 30-year-old patient with acute puerperal inversion of the uterus that occurred during placental removal. After a quick reversion of the uterus, an immediate postpartum haemorrhage (PPH) due to massive uterine atony was observed. This atony impacted the whole uterus, with a very thin uterine myometrium. The use of a Bakri Tamponade Balloon use allowed treating extreme uterine atony, immediately stop haemorrhage, and prevent a possible risk of immediate recurrence.

  1. Echocardiography of isolated subacute left heart tamponade in a patient with cor pulmonale and circumferential pericardial effusion.

    PubMed

    Mars, Tomaz; Mikolavcic, Helena; Salobir, Barbara; Podbregar, Matej

    2010-07-14

    Patients with advanced idiopathic pulmonary artery hypertension have often a chronic pericardial effusion. It is the result of increased transudation and impaired re-absorption due to elevated venous pressure. These patients have pre-existent symptoms and signs of chronic right heart failure. High degree of suspicion is required to detect of development of an atypical form of tamponade with isolated compression of left heart chambers as shown in present case report. Transthoracic echocardiography provides a rapid access to the correct diagnosis, a prompt relief of symptoms following the ultrasound guided pericardiocentesis and important diagnostic tool for regular follow up of patients thereafter as shown in our case report.

  2. Cardiac Surgery in Patients Infected with Human Immunodeficiency Virus

    PubMed Central

    Abad, Cipriano; Cárdenes, Miguel Angel; Jiménez, Pedro Conrado; Armas, Mario-Vicente; Betancor, Pedro

    2000-01-01

    From January 1991 through December 1999, 5 consecutive patients who were infected with human immunodeficiency virus presented in need of cardiac surgery. All were men; the median age was 44 years. Two of them presented with mitral and aortic infectious valve endocarditis, 1 with tricuspid endocarditis, 1 with prosthetic valve endocarditis, and 1 with pericarditis and pericardial tamponade. Under cardiopulmonary bypass, the 4 patients with endocarditis underwent these procedures: mitral and aortic valve replacement (2), tricuspid valve replacement (1), and aortic valve replacement (reoperation) and concomitant repair of a mycotic ascending aortic aneurysm (1). In the patient who had pericardial effusion, subxifoid pericardiostomy and drainage were performed, and a pericardial window was created. There was no intraoperative mortality. The patient with pericardial effusion died 8 days after surgery; he was in septic shock and had multiple organ failure. Two deaths occurred at 2 and 63 months, due to hemoptysis and sudden death, respectively. The 2 patients who underwent double valve replacement are alive and in good condition after a median follow-up of 71 months. Cardiac surgery is indicated in selected patients infected by the human immunodeficiency virus. These patients are frequently drug abusers or homosexual. Valvular endocarditis is the most common finding. Hospital morbidity and mortality rates are higher than usual in this group of patients. PMID:11198308

  3. Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy

    PubMed Central

    Schwartz, Stephen G; Flynn, Harry W; Lee, Wen-Hsiang; Wang, Xue

    2014-01-01

    Background Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery to restore normal anatomy and to stabilize or improve vision. PVR usually occurs in association with recurrent RD (that is, after initial retinal re-attachment surgery) but occasionally may be associated with primary RD. Either way, a tamponade agent (gas or silicone oil) is needed during surgery to reduce the rate of postoperative recurrent RD. Objectives The objective of this review was to assess the relative safety and effectiveness of various tamponade agents used with surgery for retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR). Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 June 2013. Selection criteria We included randomized controlled trials (RCTs) of participants undergoing surgery for RD associated with PVR that compared various tamponade agents. Data collection and analysis Two review authors screened the search results independently. We used the standard methodological procedures expected by The Cochrane Collaboration. PMID:24532038

  4. Some Physicochemical Remarks on Spontaneous Emulsification of Vitreal Tamponades

    PubMed Central

    dell'Omo, Roberto; Zeppa, Lucio; Bufalo, Gennaro; Cardone, Michele; Romano, Mario; Ambrosone, Luigi

    2014-01-01

    The importance of gravitational instability in determining the emulsification of vitreal tamponades is discussed. Theoretical results and numerical simulations indicate that the spontaneous formation of water-silicon oil is a rare event and that the very low concentration of surface active agents cannot justify the systematic formation of emulsions. The gravitational instabilities seem to play the main role. Our theoretical results seem in agreement with the experimental evidences; furthermore they indicate a future research line for the improvement of endotamponades. Indeed, the use of biodegradable antifoam may avoid the formation of bubbles and delay the formation of emulsions. PMID:25133159

  5. Cardiac Cephalgia

    PubMed Central

    Wassef, Nancy; Ali, Ali Turab; Katsanevaki, Alexia-Zacharoula; Nishtar, Salman

    2014-01-01

    Although most of the patients presenting with ischemic heart disease have chest pains, there are other rare presenting symptoms like cardiac cephalgia. In this report, we present a case of acute coronary syndrome with an only presentation of exertional headache. It was postulated as acute presentation of coronary artery disease, due to previous history of similar presentation associated with some chest pains with previous left coronary artery stenting. We present an unusual case with cardiac cephalgia in a young patient under the age of 50 which was not reported at that age before. There are four suggested mechanisms for this cardiac presentation. PMID:28352454

  6. Effect of routine rapid insertion of Bakri balloon tamponade on reducing hemorrhage from placenta previa during and after cesarean section.

    PubMed

    Soyama, Hiroaki; Miyamoto, Morikazu; Sasa, Hidenori; Ishibashi, Hiroki; Yoshida, Masashi; Nakatsuka, Masaya; Takano, Masashi; Furuya, Kenichi

    2017-06-24

    To evaluate the effectiveness of routine rapid insertion of a Bakri balloon during cesarean section for placenta previa based on a retrospective control study. Women with singleton pregnancies who underwent cesarean section for placenta previa at our institution between 2003 and 2016 were enrolled. Between 2015 and 2016, women who routinely underwent balloon tamponade during cesarean section were defined as the balloon group. Between 2003 and 2014, women who underwent no hemostatic procedures except balloon tamponade were defined as the non-balloon group. The clinical outcomes of the two groups were retrospectively analyzed. Of the 266 women with placenta previa, 50 were in the balloon group and 216 were in the non-balloon group. The bleeding amounts were significantly smaller in the balloon group than in the non-balloon group: intraoperative bleeding (991 vs. 1250 g, p < 0.01), postoperative bleeding (62 vs. 150 g, p < 0.01), and total bleeding (1066 vs. 1451 g, p < 0.01). Furthermore, the mean surgical duration was shorter in the balloon group than the non-balloon group (30 vs. 50 min, p < 0.01). In the balloon group, five patients suffered from increasing hemorrhage due to prolapse of the balloon from the uterus after the operation, but the hemorrhage was controlled by balloon re-insertion without additional hemostatic procedures. This study demonstrated that the routine rapid insertion of Bakri balloon tamponade during cesarean section significantly decreased intra- and postoperative hemorrhage and shortened the surgical duration in women with placenta previa.

  7. Impact of uterine balloon tamponade on the use of invasive procedures in severe postpartum hemorrhage.

    PubMed

    Gauchotte, Emilie; De La Torre, Manuela; Perdriolle-Galet, Estelle; Lamy, Catherine; Gauchotte, Guillaume; Morel, Olivier

    2017-07-01

    The aim of this study was to assess the impact of tamponade when uterotonic agents fail, on the need for surgery or interventional radiology. All women who received sulprostone for postpartum hemorrhage were retrospectively compared over two periods [December 2008 to December 2010 without use of tamponade (period 1) and June 2011 to June 2013 with use of tamponade (period 2)] in the case of sulprostone failure (STROBE compliant retrospective cohort study). During period 2, interventional radiology or surgery was used only in the case of tamponade failure. 165 women were included (74 for period 1, 91 for period 2). The rate of interventional radiology or surgery significantly decreased from period 1 (21 of 74 women, 28.4%) to period 2 (six of 91 women, 6.6%, p = 0.0003). The rate of assumed failure of uterotonic agents was higher for period 2: 22 of 74 women (29.7%) during period 1, and 41 of 91 (45.1%, p = 0.0439) during period 2. The success rate of tamponade was 92.1% (35 of 38 women). Although the efficacy of tamponade should be viewed in the light of its widespread use, our findings confirm that tamponade significantly reduces the need for interventional radiology or surgery for postpartum hemorrhage treatment. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  8. Retrospective comparisons of vitrectomy with and without air tamponade to repair lamellar macular hole.

    PubMed

    Sato, Tatsuhiko; Emi, Kazuyuki; Bando, Hajime; Ikeda, Toshihide

    2015-01-01

    To investigate the surgical outcomes of vitrectomy with to that without air tamponade in eyes with a lamellar macular hole. The medical records of 23 eyes that underwent 25-gauge vitrectomy with air tamponade and 18 eyes that underwent 25-gauge vitrectomy alone were reviewed. The pre- and postoperative best corrected visual acuities (BCVAs) in logarithm of the minimum angle resolution units were 0.26 ± 0.27 and 0.12 ± 0.15 in eyes with tamponade and 0.35 ± 0.30 and 0.14 ± 0.23 in eyes without tamponade. There were no significant differences in BCVAs between the two groups both pre- and postoperatively. Postoperative BCVA was significantly improved in eyes with tamponade (P = .023) and without tamponade (P < .001). None of the cases developed a full-thickness macular hole postoperatively. These results suggest that air tamponade may not be required during vitrectomy to achieve good BCVA and anatomic closure in eyes with a lamellar macular hole. Copyright 2015, SLACK Incorporated.

  9. [Vitreous Substitute in Retinal Detachment Surgery - Why We Need a New Tamponade Strategy].

    PubMed

    Szurman, Peter

    2017-09-01

    Pars plana vitrectomy combined with an endotamponade is the most important concept in retinal detachment surgery. Numerous advances in techniques and tamponade materials have been made, but the general problems of retinal detachment surgery are still unsolved: The primary success rate is not adequate, and there is no adequate strategy to address proliferative vitreoretinopathy, multiple retinal breaks or persistent hypotony. The story of tamponades is full of myths and misunderstandings. A critical review shows that tamponades have only a minor role in the history of retinal detachment surgery. One might assume that the value of tamponades is overestimated. This may be because the underlying concept is limited: All available tamponades are hydrophobic, so they act by buoyant force and surface tension. This narrow focus on the hydraulic function allows only one tamponade vector and makes complete filling of the vitreous body space impossible. The hydrophobic character of the materials has fundamental disadvantages that tend to increase the risk of new breaks or PVR formation. Thus, a critical revaluation of the value of current tamponades is necessary. One solution might be to develop hydrogels as vitreous body substitute. Such a hydrophilic vitreous body substitute fits the natural and complex function of a juvenile, healthy vitreous much better than gas or silicone oil. Georg Thieme Verlag KG Stuttgart · New York.

  10. Dosimetric perturbations due to an implanted cardiac pacemaker in MammoSite{sup Registered-Sign} treatment

    SciTech Connect

    Sung, Wonmo; Kim, Siyong; Kim, Jung-in; Lee, Jae-gi; Shin, Young-Joo; Jung, Jae-Yong; Ye, Sung-Joon

    2012-10-15

    Purpose: To investigate dose perturbations for pacemaker-implanted patients in partial breast irradiation using high dose rate (HDR) balloon brachytherapy. Methods: Monte Carlo (MC) simulations were performed to calculate dose distributions involving a pacemaker in Ir-192 HDR balloon brachytherapy. Dose perturbations by varying balloon-to-pacemaker distances (BPD = 50 or 100 mm) and concentrations of iodine contrast medium (2.5%, 5.0%, 7.5%, and 10.0% by volume) in the balloon were investigated for separate parts of the pacemaker (i.e., battery and substrate). Relative measurements using an ion-chamber were also performed to confirm MC results. Results: The MC and measured results in homogeneous media without a pacemaker agreed with published data within 2% from the balloon surface to 100 mm BPD. Further their dose distributions with a pacemaker were in a comparable agreement. The MC results showed that doses over the battery were increased by a factor of 3, compared to doses without a pacemaker. However, there was no significant dose perturbation in the middle of substrate but up to 70% dose increase in the substrate interface with the titanium capsule. The attenuation by iodine contrast medium lessened doses delivered to the pacemaker by up to 9%. Conclusions: Due to inhomogeneity of pacemaker and contrast medium as well as low-energy photons in Ir-192 HDR balloon brachytherapy, the actual dose received in a pacemaker is different from the homogeneous medium-based dose and the external beam-based dose. Therefore, the dose perturbations should be considered for pacemaker-implanted patients when evaluating a safe clinical distance between the balloon and pacemaker.

  11. Incidence, presentation and risk factors of late postoperative pericardial effusions requiring invasive treatment after cardiac surgery.

    PubMed

    Khan, Niina K; Järvelä, Kati M; Loisa, Eetu L; Sutinen, Jaakko A; Laurikka, Jari O; Khan, Jahangir A

    2017-06-01

    Occurrence and risk factors of late postoperative pericardial effusions requiring invasive treatment, i.e. pretamponade and tamponade, following cardiac surgery are incompletely described in current literature. The purpose of this study was to define the incidence and presentation of late pretamponade and tamponade as well as to outline significant predisposing factors. A cohort of 1356 consecutive cardiac surgery patients treated in a tertiary academic centre between January 2013 and December 2014 was followed up for 6 months after surgery. Pericardial effusion was considered late when presenting after the 7th postoperative day. The incidence, timing and risk factors, as well as symptoms and clinical findings associated with late pretamponade and tamponade in patients surviving at least 7 days was analysed. Of 1308 patients included in the analysis, 81 (6.2%) underwent invasive treatment for late postoperative pericardial effusion, 27 (2.1%) for pretamponade and 54 (4.1%) for tamponade, respectively, with a median delay of 11 (range 8-87) days after the primary operation. Haemodynamic instability was present in 34.6%, signs of cardiac chamber compression in 54.3% and subjective symptoms, mostly dyspnoea, in 56.8% of patients, respectively. Treated patients were younger, had lower EuroSCORE-II rating, less coronary disease, better cardiac function, higher preoperative haemoglobin values and had mostly undergone elective surgery involving cardiac valves. In multivariable analysis, independent risk factors were single valve surgery and high preoperative haemoglobin level, whereas age 60-69 years was associated with lower risk. Younger, generally healthier patients undergoing valve surgery are at greatest risk for developing late tamponade or pretamponade.

  12. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes.

    PubMed

    Einerson, Brett D; Son, Moeun; Schneider, Patrick; Fields, Ian; Miller, Emily S

    2017-03-01

    Intrauterine balloon tamponade is an effective treatment for postpartum hemorrhage when first-line treatments fail. The optimal duration of intrauterine balloon tamponade for management of postpartum hemorrhage is unclear. The objective of the study was to determine whether intrauterine balloon tamponade removal >12 hours of duration is associated with postpartum hemorrhage-related clinical outcomes. This was a retrospective cohort study of women with postpartum hemorrhage from 2007 through 2014 who underwent intrauterine balloon tamponade. We excluded failures of intrauterine balloon tamponade (intrauterine balloon expulsion with duration <2 hours or if hysterectomy was required prior to planned intrauterine balloon removal). Patients who underwent intrauterine balloon tamponade for 2-12 hours were compared with those who underwent intrauterine balloon tamponade for >12 hours. Examined postpartum hemorrhage-related clinical outcomes included estimated blood loss after intrauterine balloon tamponade placement, blood product transfusion, use of adjuvant measures to control postpartum hemorrhage after intrauterine balloon tamponade (either uterine artery embolization or hysterectomy), and maternal intensive care unit admission. Secondary outcomes examined included postpartum fever and hospital length of stay. Multivariable logistic regression models were used to control for confounding variables. Of 274 eligible women, 206 (75%) underwent intrauterine balloon tamponade for >12 hours and 68 (25%) underwent intrauterine balloon tamponade for 2-12 hours. The median estimated blood loss after intrauterine balloon tamponade placement (190 vs 143 mL, P = .116) as well as the frequencies of blood product transfusion (62.1% vs 51.5%, P = .120), transfusion of ≥4 U of packed red blood cells (17.0% vs 14.7%, P = .659), uterine artery embolization (15.1% vs 16.2%, P = .823), hysterectomy (0.0% vs 1.5%, P = .248), and intensive care unit admission (8.7% vs 7.4%, P

  13. Cardiac cachexia.

    PubMed

    Anker, Stefan D; Steinborn, Wolfram; Strassburg, Sabine

    2004-01-01

    Chronic heart failure (CHF) remains an important and increasing public health care problem. It is a complex syndrome affecting many body systems. Body wasting (i.e., cardiac cachexia) has long been recognised as a serious complication of CHF. Cardiac cachexia is associated with poor prognosis, independently of functional disease severity, age, and measures of exercise capacity and cardiac function. Patients with cardiac cachexia suffer from a general loss of fat tissue, lean tissue, and bone tissue. Cachectic CHF patients are weaker and fatigue earlier, which is due to both reduced skeletal muscle mass and impaired muscle quality. The pathophysiologic alterations leading to cardiac cachexia remain unclear, but there is increasing evidence that metabolic, neurohormonal and immune abnormalities may play an important role. Cachectic CHF patients show raised plasma levels of epinephrine, norepinephrine, and cortisol, and they show high plasma renin activity and increased plasma aldosterone level. Several studies have also shown that cardiac cachexia is linked to raised plasma levels of tumour necrosis factor alpha and other inflammatory cytokines. The degree of body wasting is strongly correlated with neurohormonal and immune abnormalities. The available evidence suggests that cardiac cachexia is a multifactorial neuroendocrine and metabolic disorder with a poor prognosis. A complex imbalance of different body systems may cause the development of body wasting.

  14. Technical note: rapid, large-volume resuscitation at resuscitative thoracotomy by intra-cardiac catheterization

    PubMed Central

    Cawich, Shamir O; Naraynsingh, Vijay

    2016-01-01

    An emergency thoracotomy may be life-saving by achieving four goals: (i) releasing cardiac tamponade, (ii) controlling haemorrhage, (iii) allowing access for internal cardiac massage and (iv) clamping the descending aorta to isolate circulation to the upper torso in damage control surgery. We theorize that a new goal should be achieving rapid, large-volume fluid resuscitation and we describe a technique to achieve this. PMID:27887010

  15. Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction.

    PubMed

    Bednar, Frantisek; Kroupa, Josef; Ondrakova, Martina; Osmancik, Pavel; Kopa, Milos; Motovska, Zuzana

    2016-05-01

    Survivors after cardiac arrest (CA) due to AMI undergo PCI and then receive dual antiplatelet therapy. Mild therapeutic hypothermia (MTH) is recommended for unconscious patients after CA to improve neurological outcomes. MTH can attenuate the effectiveness of P2Y12 inhibitors by reducing gastrointestinal absorption and metabolic activation. The combined effect of these conditions on the efficacy of P2Y12 inhibitors is unknown. We compared the antiplatelet efficacies of new P2Y12 inhibitors in AMI patients after CA treated with MTH. Forty patients after CA for AMI treated with MTH and received one P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) were enrolled in a prospective observational single-center study. Platelet inhibition was measured by VASP (PRI) on days 1, 2, and 3 after drug administration. In-hospital clinical data and 1-year survival data were obtained. The proportion of patients with ineffective platelet inhibition (PRI > 50 %, high on-treatment platelet reactivity) for clopidogrel, prasugrel, and ticagrelor was 77 vs. 19 vs. 1 % on day 1; 77 vs. 17 vs. 0 % on day 2; and 85 vs. 6 vs. 0 % on day 3 (P < 0.001). The platelet inhibition was significantly worse in clopidogrel group than in prasugrel or ticagrelor group. Prasugrel and ticagrelor are very effective for platelet inhibition in patients treated with MTH after CA due to AMI, but clopidogrel is not. Using prasugrel or ticagrelor seems to be a more suitable option in this high-risk group of acute patients.

  16. Management of postpartum haemorrhage with uterine balloon tamponade: The way forward.

    PubMed

    Marasinghe, Jeevan P; Du Plessis, Jacobus; Epitawela, Dinesh; Umstad, Mark P

    2015-08-01

    Uterine balloon tamponade has rapidly gained popularity in the management of postpartum haemorrhage. It is a conservative method often utilised before embarking on advanced surgical interventions. The mechanism of action, complications and long-term outcomes are discussed.

  17. Condom Tamponade in the Management of Primary Postpartum Haemorrhage: A Report of three cases in Ghana.

    PubMed

    Maya, Ernest T; Buntugu, Kennedy A; Aki, Lovelace; Srofenyoh, Emmanuel K

    2015-09-01

    Postpartum haemorrhage is one of the major causes of maternal mortality worldwide. The leading cause of primary postpartum haemorrhage is uterine atony and active management of the third stage of labour with oxytocin is recommended for preventing primary postpartum haemorrhage. Parenteral oxytocin is also the drug of choice for medical management of postpartum haemorrhage secondary to uterine atony. Condom uterine balloon tamponade is .a low cost technique that can be used as a second-line option for treatment. We report retrospectively three cases of primary PPH secondary to uterine atony which were managed successfully with condom tamponade. Condom tamponade is effective in managing post partum haemorrhage secondary to uterine atony and we advocate for the training of all skilled attendants on how to insert the condom tamponade.

  18. Angiosarcoma of the right atrium presenting as syncope and hemorrhagic pericardial tamponade.

    PubMed

    Sams, V G; Tsapenko, A; Kravitz, J N; Gaines, T E

    2012-01-01

    Angiosarcoma of the heart is a rare malignancy that can present in many ways. It is an important diagnosis to consider in patients presenting with otherwise unexplained tamponade-type symptoms. Here we present a case of a young male who presented with hemorrhagic tamponade and underwent resection of a large angiosarcoma of the right atrium. In this case, we describe the rare presentation of angiosarcoma with its diagnostic approaches, hospital course, clinical management, and discussion.

  19. Tamponade or Filling Effect: Changes of Forces in Myopic Eyes

    PubMed Central

    Morescalchi, Francesco; Romano, Mario R.

    2014-01-01

    Myopia is the most common ocular abnormality. Its high and growing prevalence has contributed to a recent surge in surgical interest in the disorder, since retinal detachment in eyes with high myopia differs from that in emmetropic eyes or eyes with low myopia. The myopic eye, because of its specific anatomy, poses special challenges that need to be overcome to ensure the appropriate use of vitreous substitutes. However, intraocular tamponades have shown great potential for revolutionizing retinal detachment surgery and vitreomacular surgery in general in myopic eyes. We provide an updated review of the clinical use of vitreous substitutes in the myopic eye, paying particular attention to analyzing the ideal function of endotamponade agents and comparing the effects of these agents on the physical and biological properties of the eye. PMID:25101290

  20. Neonatal multiorgan failure due to ACAD9 mutation and complex I deficiency with mitochondrial hyperplasia in liver, cardiac myocytes, skeletal muscle, and renal tubules.

    PubMed

    Leslie, Nancy; Wang, Xinjian; Peng, Yanyan; Valencia, C Alexander; Khuchua, Zaza; Hata, Jessica; Witte, David; Huang, Taosheng; Bove, Kevin E

    2016-03-01

    Complex I deficiency causes Leigh syndrome, fatal infant lactic acidosis, and neonatal cardiomyopathy. Mutations in more than 100 nuclear DNA and mitochondrial DNA genes miscode for complex I subunits or assembly factors. ACAD9 is an acyl-CoA dehydrogenase with a novel function in assembly of complex I; biallelic mutations cause progressive encephalomyopathy, recurrent Reye syndrome, and fatal cardiomyopathy. We describe the first autopsy in fatal neonatal lethal lactic acidosis due to mutations in ACAD9 that reduced complex I activity. We identified mitochondrial hyperplasia in cardiac myocytes, diaphragm muscle, and liver and renal tubules in formalin-fixed, paraffin-embedded tissue using immunohistochemistry for mitochondrial antigens. Whole-exome sequencing revealed compound heterozygous variants in the ACAD9 gene: c.187G>T (p.E63*) and c.941T>C (p.L314P). The nonsense mutation causes late infantile lethality; the missense variant is novel. Autopsy-derived fibroblasts had reduced complex I activity (53% of control) with normal activity in complexes II to IV, similar to reported cases of ACAD9 deficiency.

  1. Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy.

    PubMed

    Schwartz, Stephen G; Flynn, Harry W; Lee, Wen-Hsiang; Wang, Xue

    2014-02-14

    Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery to restore normal anatomy and to stabilize or improve vision. PVR usually occurs in association with recurrent RD (that is, after initial retinal re-attachment surgery) but occasionally may be associated with primary RD. Either way, a tamponade agent (gas or silicone oil) is needed during surgery to reduce the rate of postoperative recurrent RD. The objective of this review was to assess the relative safety and effectiveness of various tamponade agents used with surgery for retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR). We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 June 2013. We included randomized controlled trials (RCTs) of participants undergoing surgery for RD associated with PVR that compared various tamponade agents. Two review authors screened the search results independently. We used the standard methodological procedures expected by The Cochrane Collaboration. The review included 516 participants from three RCTs. One study was conducted in the USA and consisted of two trials: the first trial randomized 151 adults to receive either silicone oil or sulfur hexafluoride (SF6) gas tamponades; and the second trial randomized 271 adults to receive either

  2. Heart Failure Due to Age-Related Cardiac Amyloid Disease Associated With Wild-Type Transthyretin: A Prospective, Observational Cohort Study

    PubMed Central

    Connors, Lawreen H.; Sam, Flora; Skinner, Martha; Salinaro, Francesco; Sun, Fangui; Ruberg, Frederick L.; Berk, John L.; Seldin, David C.

    2015-01-01

    Background Heart failure due to wild-type transthyretin amyloidosis (ATTRwt) is an under-appreciated cause of morbidity and mortality in the aging population. The aims of this study were to examine features of disease and characterize outcomes in a large ATTRwt cohort. Methods and Results Over 20 years, 121 patients with ATTRwt were enrolled in a prospective observational study. Median age at enrollment was 75.6 years (range, 62.6–87.8); 97% of patients were Caucasian. The median survival, measured from biopsy diagnosis, was 46.69 months (95% CI, 41.95–56.77); 78% of deaths were due to cardiac causes. By Kaplan-Meier analysis, 5-year survival was 35.7% (95% CI, 25–46). Impaired functional capacity (mean VO2 max of 13.5 mL/kg/min) and atrial fibrillation (67%) were common clinical features. Multivariate predictors of reduced survival were elevated serum brain natriuretic peptide (BNP, 482 ± 337 pg/mL) and uric acid (8.2 ± 2.6 mg/dL), decreased left ventricular ejection fraction (LVEF, 50% median ranging 10-70%), and increased relative wall thickness (RWT, 0.75 ± 0.19). Conclusions In this series of patients with biopsy-proven ATTRwt amyloidosis, poor functional capacity and atrial arrhythmias were common clinical features. Elevated BNP and uric acid, decreased LVEF, and increased RWT were associated with limited survival of only 35.7% at 5 years for the group as a whole. These data establish the natural history of ATTRwt, provide statistical basis for the design of future interventional clinical trials, and highlight the need for more sensitive diagnostic tests and disease-specific treatments for this disease. PMID:26660282

  3. The fertility sparing management of postpartum hemorrhage: A series of 47 cases of Bakri balloon tamponade.

    PubMed

    Alkış, İsmet; Karaman, Erbil; Han, Agahan; Ark, Hasan Cemal; Büyükkaya, Betül

    2015-06-01

    To evaluate the success rate of Bakri balloon tamponade (BBT) for managing postpartum hemorrhage (PPH), intractable to conservative medical treatment, as a fertility sparing intervention. We evaluated 47 women treated with BBT who had severe postpartum hemorrhage and uncontrollable bleeding due to failed treatment with uterotonic agents. The main outcome measure was successful management and preservation of the uterus. Forty-seven women were identified for BBT treatment due to severe PPH. BBT was used to successfully manage hemorrhage in 43 patients, and there was no need for hysterectomy. Four patients required an additional surgical procedure. Of the four failures, a subtotal hysterectomy was performed in two patients, and the other two patients underwent a total hysterectomy. The overall success rate was 91.4%, which was comparable to rates reported earlier. The main cause of PPH was uterine atony (43%). Uterine preservation is an important issue when managing PPH. BBT is an effective, easy to use, and safe procedure for massive PPH that can minimize recourse to hysterectomy after failed medical treatment. Copyright © 2015. Published by Elsevier B.V.

  4. Long term result of silicone oil versus gas tamponade in the treatment of traumatic macular holes

    PubMed Central

    Ghoraba, Hammouda H; Ellakwa, Amin F; Ghali, Ali A

    2012-01-01

    Purpose To compare the effectiveness of pars plana vitrectomy (PPV) with either silicone oil or gas tamponade for the treatment of traumatic macular holes. Methods A retrospective comparative study included 22 patients who were operated on by PPV for repair of traumatic macular holes with either silicone oil tamponade (nine patients) or perfluoropropane (C3F8) gas tamponade (13 patients). Results Twenty-two cases were reviewed to assess the anatomical and visual outcomes of surgery with silicone oil tamponade in nine cases (40.9%) vs 14% C3F8 gas tamponade in 13 cases (59.1%). The age of the silicone oil-treated patients ranged from 10 to 40 years (mean 27.4 ± 11.3 years), while that of the gas-treated patients ranged from 19 to 35 years (mean 26.54 ± 5.68 years). Female patients accounted for 33.3% of the silicone oil group and 30.77% of the gas-treated group. The minimal follow-up time for the silicone oil-treated group was 13 months, with a maximum of 18 months after silicone oil removal. The minimal follow-up time for the gas-treated group was 12 months and the maximum was 24 months. The rate of hole closure after the primary operation with oil tamponade was significantly lower than that with gas tamponade (66.67% vs 92.3%; P = 0.022). With re-operations, the final rate of hole closure was higher in the gas group (100%) than in the silicone oil group (77.8%). The final postoperative decimal visual acuity for the gas group was significantly better than for the oil group (0.433 vs 0.245; P = 0.047). Conclusions C3F8 gas was a more effective tamponade than silicone oil in achieving initial closure of traumatic macular holes. Eyes receiving an oil tamponade required significantly more re-operations to achieve hole closure than did eyes undergoing a gas tamponade. Final visual acuity was better for gas-treated eyes than for silicone oil-treated eyes. PMID:22259236

  5. Efficacy of Vitrectomy Combined with Subretinal rtPA Injection with Gas or Air Tamponade.

    PubMed

    Waizel, M; Todorova, M G; Rickmann, A; Blanke, B R; Szurman, P

    2017-01-31

    Background Functional and anatomical outcome after vitrectomy with rtPA combined with gas or air tamponade. Patients and methods Retrospective analysis of pseudophakic patients treated with subretinal rtPA and gas or air tamponade. The primary endpoint was displacement of haemorrhage six months after surgery. The secondary endpoints were visual acuity (BCVA), haemorrhage diameter (MHD) and central macular thickness (CMT), as measured by SD-OCT. Results 53 of 85 eyes were pseudophakic. 27 of these eyes were treated with air tamponade and 26 with gas tamponade. For patients with air tamponade, the mean BCVA improved from 20/530 to 20/355 (p = 0.01). MHD and CMT decreased from 6386 ± 2281 µm to 3805 ± 2397 µm (p < 0.001) and 895 ± 592 µm to 532 ± 386 µm (p < 0.001), respectively. For patients with gas tamponade, the mean BCVA improved only slightly, from 20/471 to 20/394 (p = 0.17). MHD and CMT exhibited statistically significant decreases from 6759 ± 1773 µm to 3525 ± 1548 µm (p < 0.001) and 1089 ± 587 µm to 537 ± 251 µm (p < 0.001), respectively. Conclusions Vitrectomy with subretinal rtPA injection has strong functional and anatomical effects on submacular haemorrhages with both gas and air tamponade.

  6. 23-gauge vitrectomy and silicone oil tamponade with and without phacoemulsification in rhegmatogenous retinal detachment.

    PubMed

    Ozkan, Seyhan Sonar; Citirik, Mehmet; Beyazyildiz, Emrullah; Beyazyildiz, Ozlem

    2015-01-01

    The aim of this study is to assess clinical outcomes of 23-gauge vitrectomy and silicone oil (SO) tamponade combined with and without phacoemulsification (PE) in rhegmatogenous retinal detachment (RRD). The study included forty eyes of 40 patients that underwent 23-gauge vitrectomy and SO tamponade combined with and without PE. Twenty eyes of 20 cases, of whom underwent 23-gauge vitrectomy and SO tamponade combined with PE were allocated to the group 1. Likewise, 20 eyes of 20 cases that underwent 23-gauge vitrectomy and SO tamponade alone were allocated to the group 2. Best corrected visual acuity (BCVA) between two groups was compared. There was no significant difference in BCVA between the two groups during the 6 months (P = 0.3). Recurrent retinal detachments were observed in 2 cases (10%) in both groups. There was no statistically significant difference between two groups as a point of recurrent retinal detachments (P = 1). We have found higher rates of post-vitrectomy cataract progression (45%) in the eyes with RRD who underwent 23-gauge vitrectomy and SO tamponade. Combined vitrectomy and PE is safe and effective for the patients with RRD.

  7. Serum fibrinogen levels could be an index of successful use of balloon tamponade in postpartum hemorrhage.

    PubMed

    Nakashima, Ayaka; Ogita, Kazuhide; Chita, Masaya; Yokoi, Takeshi

    2017-02-28

    The object of our study was to determine whether serum fibrinogen levels could be used to predict the success rates of balloon tamponade and decrease the use of invasive methods. This retrospective study, conducted at Rinku General Medical Center, was aimed to identify factors associated with high success rates in balloon tamponade. Forty-six patients with postpartum hemorrhage (PPH), non-responsive to uterotonics and treated with balloon tamponade between April 2008 and March 2015, were included. Forty-six women were included, of which 34 underwent vaginal delivery and 12 underwent cesarean delivery. There were no complications from balloon tamponade and its success rate was 73.3%. Seven women required additional procedures: One used gauze packing, three used uterine artery embolization, and five underwent peripartum hysterectomy. The cut-off line of serum fibrinogen level was 172.5 mg/dL (P=0.002) with its 77.4% sensitivity and 66.7% specificity. We recommend measuring serum fibrinogen level for predicting whether the balloon tamponade can be used successfully or not.

  8. Macular Effects of Silicone Oil Tamponade: Optical Coherence Tomography Findings During and After Silicone Oil Removal.

    PubMed

    Lo, Danielle M; Flaxel, Christina J; Fawzi, Amani A

    2017-01-01

    To investigate retinal morphologic changes during silicone oil tamponade and after its removal using spectral domain OCT (SD-OCT) imaging. Retrospective review of 12 patients who underwent silicone oil tamponade for repair of retinal detachments. Macular OCT scans and volumetric thickness maps were examined qualitatively and quantitatively. Volumetric OCT revealed two distinct patterns during silicone oil: macular thickening (Group A) and macular thinning (Group B). In Group A, mean foveal thickness (507 ± 169 µm vs. 407 ± 163 µm, p = 0.003) and mean macular volume (11.6 ± 2.4 mm(3) vs. 9.9 ± 1.5 mm(3)) were significantly increased during tamponade compared to post-oil removal. Group B had significantly decreased mean foveal thickness (210 ± 38 µm vs. 276 ± 58 µm, p = 0.009) and macular volume (7.3 ± 1.8 mm(3) vs. 8.4 ± 1.8 mm(3)) during tamponade. Importantly, resolution of macular changes occurred without further intervention and was associated with improved visual acuity in both groups. Our series suggests that when faced with unexplained macular edema or macular thinning during tamponade, silicone oil removal alone can achieve resolution of these structural changes.

  9. Implantable cardioverter defibrillator and survival after out-of-hospital cardiac arrest due to acute myocardial infarction in Denmark in the years 2001-2012, a nationwide study.

    PubMed

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Lassen, Jens F; Køber, Lars; Torp-Pedersen, Christian; Hansen, Steen M; Lippert, Freddy; Kragholm, Kristian; Christensen, Erika F; Hassager, Christian

    2017-03-01

    The purpose of this study was to describe the implantation of implantable cardioverter defibrillator after out-of-hospital cardiac arrest caused by myocardial infarction in Denmark 2001-2012 and subsequent survival. The Danish Cardiac Arrest Registry was used to identify patients ⩾18 years surviving to discharge without prior implantable cardioverter defibrillator. Information on cardioverter defibrillator implantation was obtained from the National Patient Registry. We identified 974 myocardial infarction-out-of-hospital cardiac arrest patients surviving to hospital discharge, 130 of these patients (13%) had a cardioverter defibrillator implanted early (⩽40 days post-out-of-hospital cardiac arrest), 58 patients (6%) had late implantable cardioverter defibrillator (41-365 days post-out-of-hospital cardiac arrest). Odds of implantable cardioverter defibrillator implantation within one year were higher in patients receiving cardiopulmonary resuscitation (odds ratio (OR)CPR: 1.99, confidence interval (CI): 1.23-3.22, p=0.01), and Charlson Comorbidity Index level 1, (ORCCI1: 2.10, CI:1.25-3.49, p<0.01). Odds of a late implantable cardioverter defibrillator was higher in patients undergoing percutaneous coronary intervention (PCI) (ORPCI: 3.67, CI: 1.35-9.97, p=0. 01). An early, but not late implantable cardioverter defibrillator was associated with increased survival (event time ratioEarly ICD: 1.45, CI: 1.11-1.90, p=0.01). Chronic heart failure, higher age groups, Charlson Comorbidity Index levels 1 to ⩾3 and male sex were associated with lower survival. Highest income was associated with higher survival. Cardioverter defibrillator implantation rates in patients surviving an myocardial infarction-out-of-hospital cardiac arrest increased from 14% to 19% over the period. Of the total patient population, 13% had implantation earlier than recommended by guidelines, presumably as primary prevention of sudden cardiac death. Acute PCI and arrest later in the study

  10. [Role of intraocular tamponade in treatment of complications of proliferative diabetic retinopathy].

    PubMed

    Nawrocki, J; Dziegielewski, K; Pikulski, Z

    1993-01-01

    The authors presented results of pars plana vitrectomy performed in 80 eyes of 70 patients with proliferative diabetic retinopathy. Endo-tamponade with silicone oil was applied in cases complicated by intraocular haemorrhages and tractional or rhegmatogenous retinal detachment. A complete attachment of the retina was achieved in 70 eyes, in 5 a limited area of flat retinal detachment persisted and in 5 the results were negative. The functional results were evaluated in two groups: 1) 26 eyes in which silicone oil was not used or was removed after several months, 2) with permanent silicone oil tamponade. Statistically significant better visual acuity was achieved in the first group. The authors concluded that for better results vitrectomy should be performed in less advanced stages of proliferative diabetic retinopathy, in which permanent silicone oil tamponade is not necessary.

  11. CHOROIDAL THICKNESS CHANGES AFTER VITRECTOMY WITH SILICONE OIL TAMPONADE FOR PROLIFERATIVE VITREORETINOPATHY RETINAL DETACHMENT.

    PubMed

    Odrobina, Dominik; Gołębiewska, Joanna; Maroszyńska, Iwona

    2016-12-28

    To access the potential effect of vitrectomy and silicone oil tamponade on the choroid. Eighteen patients (18 eyes) who had undergone pars plana vitrectomy with 1,000-cSt silicone oil tamponade for proliferative vitreoretinopathy retinal detachment were included in this retrospective study. All patients underwent ophthalmologic examinations before treatment and 1 week and 1, 3, and 6 months after vitrectomy with silicone oil tamponade. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (Spectralis; Heidelberg Engineering) in a horizontal and vertical section beneath the fovea. Choroidal thickness statistically significantly decreased till 3 months after pars plana vitrectomy with silicone oil tamponade: under the center of the fovea (P = 0.014) and in the temporal (P = 0.029), superior (P = 0.046), and inferior areas, determined at 1,500 μm from the center of the fovea (P = 0.030). After 6 months, the desired effect in the form of a decrease in the choroidal thickness was even more prominent, both under the center of the fovea (P < 0.001) and in the nasal (P < 0.001), temporal (P < 0.001), superior (P < 0.001), and inferior areas at 1,500 μm from the center of the fovea (P < 0.001). Choroidal thickness is reduced in eyes receiving silicone oil intraocular tamponade. Silicone oil tamponade may have an impact on the structure and proper functioning of the choroid. The measurements of the choroidal thickness by optical coherence tomography might be a very good tool to detect early changes in choroidal thickness and impact the decision when to remove silicone oil.

  12. Use of Condom Tamponade to Manage Massive Obstetric Hemorrhage at a Tertiary Center in Rajasthan.

    PubMed

    Hasabe, Rakesh; Gupta, Kumud; Rathode, Pallavi

    2016-10-01

    Conventionally postpartum hemorrhage (PPH) has been defined as blood loss of more than 500 ml following vaginal delivery and 1000 ml following a cesarean section [Pritchard et al. in Am J Obstet Gynecol 84(10):1271-1282, (1962)]. Another definition labels PPH as any blood loss which causes a 10 % drop in hematocrit [Combs et al. in Obstet Gynecol 77:69-76, (1991)] or which threatens the hemodynamic stability of the patient and necessitates blood transfusion [Prendiville et al. in Cochrane Database Syst Rev 2:CD000007, (2000)]. The purpose of this study was to evaluate the effectiveness of condom tamponade in the management of massive obstetric hemorrhage. To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive PPH. This prospective study was done in the Obstetrics and Gynecology Department of NIMS Medical College and Hospital, Jaipur, between December 2013 and February 2015. With aseptic precautions, a sterile rubber catheter fitted with a condom was introduced into the uterus. The condom was inflated with 250-500 ml normal saline according to need. Vaginal bleeding was observed, and further inflation was stopped when bleeding ceased. In all but 2 (94.44 %) the cases, postpartum bleeding was stopped within 10 min of creation of tamponade. On an average, 350 ml of normal saline was required to create adequate tamponade to stop the bleeding. Use of condom tamponade can effectively help in reducing both maternal morbidity and mortality associated with PPH. Our study encourages use of condom tamponade which is efficient, cost-effective, easily available and requires lesser skills as compared to the traditional surgical procedures.

  13. Elastic stability of silicone ferrofluid internal tamponade (SFIT) in retinal detachment surgery

    NASA Astrophysics Data System (ADS)

    Voltairas, P. A.; Fotiadis, D. I.; Massalas, C. V.

    2001-01-01

    It has been argued that silicone ferrofluid internal tamponade (SFIT) can provide (360°) tamponade of the retina in retinal detachment surgery. Provided that the produced SFIT is biocompatible, exact knowledge is needed of its elastic stability in the magnetic field produced by the semi-solid magnetic silicon band (MSB) used as a scleral buckle. We propose a quantitative, phenomenological model to estimate the critical magnetic field produced by the MSB that 'closes' retinal tears and results in the reattachment of the retina. The magnetic 'deformation' of SFIT is modeled in accordance with the deformation of a ferrofluid droplet in an external magnetic field.

  14. Hospital-level balloon tamponade use is associated with increased mortality for all patients presenting with acute variceal haemorrhage.

    PubMed

    Tapper, Elliot B; Ezaz, Ghideon; Patwardhan, Vilas; Mellinger, Jessica; Bonder, Alan; Curry, Michael; Saini, Sameer D

    2017-08-24

    Balloon tamponade (BT) can bridge patients to salvage therapy for uncontrollable acute variceal haemorrhage (AVH). However, data are limited regarding the reasons for, rate of and outcomes associated with Balloon tamponade use. First, we performed an single-centre cohort study of all patients (N = 139) with oesophageal acute variceal haemorrhage from 01/2009 to 10/2015. Associations between Balloon tamponade use and adherence to four quality metrics (endoscopy within 12 hours, band-ligation, pre-endoscopy antibiotics and octreotide) were evaluated. Second, we analysed the National Inpatient Sample (2005-2011) to determine the association between in-hospital mortality for patients and their hospital's Balloon tamponade-utilization to acute variceal haemorrhage volume ratio. In the national cohort, 5.5% of 140 521 acute variceal haemorrhage admissions required Balloon tamponade utilization. Adjusting for patient- and hospital-level confounders, the rate of Balloon tamponade use per acute variceal haemorrhage managed at any given hospital was associated with increased mortality for all-comers with acute variceal haemorrhage. Compared to the lowest tertile, acute variceal haemorrhage admissions in the highest Balloon tamponade utilizers were associated with increased mortality of (OR1.17 95%CI (1.01-1.37). In the single-centre cohort, 14 (10.1%) patients required Balloon tamponade. Balloon tamponade utilization was significantly associated with alcohol abuse (50.4% vs 21.4%, P = .04), hepatocellular carcinoma (35.7% vs 8.8%, P = .01), higher median model for end-stage liver disease (MELD) score (26.3vs15.5, P = .002) and active bleeding during endoscopy (64.3% vs 27.5%, P = .01). Failure to provide all quality metrics was associated with a higher model for end-stage liver disease-adjusted risk of Balloon tamponade use: OR 16.7 95% CI(4.17-100.0, P < .0001). Balloon tamponade use is associated with severity of bleeding but may also implicate deficits in

  15. Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report

    PubMed Central

    Kim, Su Ryun; Kim, Seon Ju

    2016-01-01

    Pseudohypoxic brain swelling (PHBS) is known to be an uncommon event that may occur during and following an uneventful brain surgery, when negative suction drainage is used. The cerebrospinal fluid loss related to suction drainage can evoke intracranial hypotension that progress to PHBS. The main presentations of PHBS are sudden unexpected circulatory collapses, such as severe bradycardia, hypotension, cardiac arrest, consciousness deterioration and diffuse brain swelling as seen with brain computerized tomography (CT). We present a stuporous 22-year-old patient who underwent cranioplasty under general anesthesia. The entire course of the general anesthesia and operation progressed favorably. However, the time of scalp suture completion, sudden bradycardia and hypotension occurred, followed by cardiac arrest immediately after initiation of subgaleal and epidural suction drainage. After successful resuscitation, the comatose patient was transferred to the neurosurgical intensive care unit and PHBS was confirmed using brain CT. PMID:27274378

  16. Combination of veno-arterial extracorporeal membrane oxygenation and hypothermia for out-of-hospital cardiac arrest due to Taxus intoxication.

    PubMed

    Thooft, Aurélie; Goubella, Ahmed; Fagnoul, David; Taccone, Fabio S; Brimioulle, Serge; Vincent, Jean-Louis; De Backer, Daniel

    2014-11-01

    A young woman presented with cardiac arrest following ingestion of yew tree leaves of the Taxus baccata species. The toxin in yew tree leaves has negative inotropic and dromotropic effects. The patient had a cardiac rhythm that alternated between pulseless electrical activity with a prolonged QRS interval and ventricular fibrillation. When standard resuscitation therapy including digoxin immune Fab was ineffective, a combination of extracorporeal membrane oxygenation (ECMO) and hypothermia was initiated. The total duration of low flow/no flow was 82 minutes prior to the initiation of ECMO. After 36 hours of ECMO (including 12 hours of electrical asystole), the patient's electrocardiogram had normalized and the left ventricular ejection fraction was 50%. At this time, dobutamine and the ECMO were stopped. The patient had a full neurologic recovery and was discharged from the intensive care unit after 5 days and from the hospital 1 week later.

  17. Blunt Cardiac Rupture: A Diagnostic Challenge

    PubMed Central

    Kumar, Vineet; Dharap, Satish Balkrishna

    2016-01-01

    Blunt Cardiac Rupture (BCR) is a life threatening injury. Majority of patients do not reach the hospital and in those who reach the emergency department, timely diagnosis and treatment is a challenge. The case is about a patient with multiple blunt injuries who presented in shock. Cardiac tamponade was suspected on clinical grounds and on evidence of mediastinal widening on radiograph. In the absence of songography, the diagnosis was confirmed by subxiphoid pericardial window. Emergency thoracotomy revealed a right atrial appendage rupture which was surgically corrected. The patient also underwent splenectomy for grade IV splenic injury. Liver injury, pubic diastasis and tibial spine avulsion fracture was managed conservatively. He recovered well. Systematic observance of trauma resuscitation guidelines can help salvage patients with life threatening complex injuries even in the absence of specialized imaging investigations. PMID:28050441

  18. Controlled Cardiac Computed Tomography

    PubMed Central

    Wang, Chenglin; Liu, Ying; Wang, Ge

    2006-01-01

    Cardiac computed tomography (CT) has been a hot topic for years because of the clinical importance of cardiac diseases and the rapid evolution of CT systems. In this paper, we propose a novel strategy for controlled cardiac CT that may effectively reduce image artifacts due to cardiac and respiratory motions. Our approach is radically different from existing ones and is based on controlling the X-ray source rotation velocity and powering status in reference to the cardiac motion. We theoretically show that by such a control-based intervention the data acquisition process can be optimized for cardiac CT in the cases of periodic and quasiperiodic cardiac motions. Specifically, we formulate the corresponding coordination/control schemes for either exact or approximate matches between the ideal and actual source positions, and report representative simulation results that support our analytic findings. PMID:23165017

  19. Calmodulin 2 Mutation N98S Is Associated with Unexplained Cardiac Arrest in Infants Due to Low Clinical Penetrance Electrical Disorders

    PubMed Central

    Jiménez-Jáimez, Juan; Palomino Doza, Julián; Ortega, Ángeles; Macías-Ruiz, Rosa; Perin, Francesca; Rodríguez-Vázquez del Rey, M. Mar; Ortiz-Genga, Martín; Monserrat, Lorenzo; Barriales-Villa, Roberto; Blanca, Enrique; Álvarez, Miguel; Tercedor, Luis

    2016-01-01

    Background Calmodulin 1, 2 and 3 (CALM) mutations have been found to cause cardiac arrest in children at a very early age. The underlying aetiology described is long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT) and idiopathic ventricular fibrillation (IVF). Little phenotypical data about CALM2 mutations is available. Objectives The aim of this paper is to describe the clinical manifestations of the Asn98Ser mutation in CALM2 in two unrelated children in southern Spain with apparently unexplained cardiac arrest/death. Methods Two unrelated children aged 4 and 7, who were born to healthy parents, were studied. Both presented with sudden cardiac arrest. The first was resuscitated after a VF episode, and the second died suddenly. In both cases the baseline QTc interval was within normal limits. Peripheral blood DNA was available to perform targeted gene sequencing. Results The surviving 4-year-old girl had a positive epinephrine test for LQTS, and polymorphic ventricular ectopic beats were seen on a previous 24-hour Holter recording from the deceased 7-year-old boy, suggestive of a possible underlying CPVT phenotype. A p.Asn98Ser mutation in CALM2 was detected in both cases. This affected a highly conserved across species residue, and the location in the protein was adjacent to critical calcium binding loops in the calmodulin carboxyl-terminal domain, predicting a high pathogenic effect. Conclusions Human calmodulin 2 mutation p.Asn98Ser is associated with sudden cardiac death in childhood with a variable clinical penetrance. Our results provide new phenotypical information about clinical behaviour of this mutation. PMID:27100291

  20. Spontaneous Right Coronary Artery Rupture and Acute Cardiac Tamponade in Behçet's Disease.

    PubMed

    Keskin, Muhammed; Bozbay, Mehmet; Kayacıoğlu, İlyas; Koçoğulları, Cevdet; Bozbay, Ayfer Yıldız; Hayıroğlu, Mert İlker; Gürkan, Ufuk; Eren, Mehmet

    2016-11-01

    Coronary involvement in Behçet's disease is extremely rare and it can bring devastating consequences when it occurs. In this report, we present a 29-year-old male patient with Behçet's disease who developed rapidly changing and progressive coronary artery involvements under medical treatment.

  1. A Therapeutic Wireless Capsule for Treatment of Gastrointestinal Haemorrhage by Balloon Tamponade Effect.

    PubMed

    Leung, Billy H K; Poon, Carmen C Y; Zhang, Ruikai; Zheng, Y L; Chan, C K W; Chiu, Philip W Y; Lau, James Y W; Sung, Joseph J Y

    2016-07-13

    Wireless capsule endoscope (WCE) is a revolutionary approach to diagnose small bowel pathologies. Currently available WCEs are mostly passive devices with image capturing function only, while on-going efforts have been placed on robotizing WCEs or to enhance them with therapeutic functions. In this paper, the authors present a novel inflatable WCE for haemostasis in the gastrointestinal tracts by balloon tamponade effect.

  2. Exclusive Use of Air as Gas Tamponade in Rhegmatogenous Retinal Detachment

    PubMed Central

    Pak, Kang Yeun; Lee, Seok Jae; Kwon, Han Jo; Lee, Ji Eun

    2017-01-01

    Purpose To investigate outcomes of vitrectomy for rhegmatogenous retinal detachment (RRD) using air exclusively as the gas tamponade. Methods This retrospective, interventional, consecutive case series involved reviewing medical records of patients that underwent vitrectomy and gas tamponade for RRD between January 2013 and December 2015. Patients whose eyes were treated exclusively with air tamponade since July 2014 were assigned to the air group, while those treated with heterogeneous gas agents before June 2014 were assigned to the control group. The primary outcome was the primary reattachment rate. Best-corrected visual acuity (BCVA) and duration to detect redetachments were assigned as the secondary outcomes. Results The air group and the control group included 71 and 72 eyes, respectively. The primary reattachment rate was 94.4% in the air group and there was no significant difference with 94.4% in the control group (p = 0.951). BCVA was significantly better in the air group at 1 month (p = 0.021) but not at 3 months postoperatively (p = 0.561). Redetachments were recognized earlier in the air group (9.3 ± 0.5 days) compared with those in the control group (21.3 ± 7.4 days) (p = 0.041). Conclusions In cases of simple RRD with sufficient removal of subretinal fluid, air could be considered for use as gas tamponade. This trial is registered with KCT0002358. PMID:28785481

  3. Refractive predictability in eyes with intraocular gas tamponade - results of a prospective controlled clinical trial.

    PubMed

    Wagenfeld, Lars; Hermsdorf, Kristin; Stemplewitz, Birthe; Druchkiv, Vasyl; Frings, Andreas

    2017-01-01

    To determine the postoperative refractive error in eyes with intraocular gas tamponade in combined phacovitrectomy using a Z-haptic intraocular lens (IOL). This prospective non-randomized case-control study compared patients with combined phacovitrectomy with or without intraocular gas tamponade to cataract surgery-only. The main outcome measure was the IOL power prediction error (PE). Secondary outcome measures were spherical equivalent, anterior chamber depth (ACD), and axial length. Thirty-four patients with epiretinal membranes and 18 patients with cataract only were enrolled. There were no statistically significant (P>0.05) differences of IOL power PE or postoperative ACDs (P=0.952-1.00). Nevertheless, IOL power PE indicated a myopic shift in cases with phacovitrectomy independent of gas tamponade (P=1.00). No statistically significant between-group differences between secondary outcome measures were observed. A myopic shift after phacovitrectomy seems to be independent of the use of intraocular gas tamponade. When using a Z-haptic IOL, aiming for slight residual hyperopia (+0.50 D) is suggested in patients having phacovitrectomy.

  4. Short-Term Vitreoretinal Tamponade with Heavy Liquid Following Surgery for Giant Retinal Tear.

    PubMed

    Eiger-Moscovich, Maya; Gershoni, Assaf; Axer-Siegel, Ruth; Weinberger, Dov; Ehrlich, Rita

    2017-07-01

    To study the efficacy and outcomes of short-term postoperative vitreoretinal tamponade with perfluorocarbon heavy liquid in patients with giant retinal tear. The study group consisted of 13 consecutive patients (13 eyes) who presented with giant retinal tear at a tertiary medical center in 2011-2015 and were treated with vitrectomy followed by short-term tamponade with perfluorocarbon heavy liquid. A minimum of 3 months' follow-up was required for inclusion. The medical charts were retrospectively reviewed for patient demographics, procedural specifics, anatomical attachment rates, pre- and postoperative visual acuity, and postoperative complications. The duration of perfluorocarbon tamponade ranged from 6 to 13 days (mean ± SD 10 ± 2 days). Follow-up time ranged from 3 to 44 months (mean ± SD 11 ± 11 months). Retinal reattachment was achieved intraoperatively in all patients. Repeated detachment with proliferative vitreoretinopathy occurred in one patient (8%), who underwent repeated vitrectomies. At the last follow-up visit, the retina was attached in all patients. Best-corrected visual acuity improved postoperatively compared with preoperatively in all three patients with macula-off retinal detachment (100%) and was equal to or better than the initial best-corrected visual acuity in 6 (60%) of the 10 patients with macula-on retinal detachment. Complications included increased intraocular pressure, cataract, and cystoid macular edema. Perfluorocarbon heavy liquid is a safe and effective material for short-term vitreoretinal tamponade following vitrectomy for giant retinal tear.

  5. The Changes of Retinal Saturation after Long-Term Tamponade with Silicone Oil

    PubMed Central

    Lou, Bingsheng; Yuan, Zhaohui; He, Liwen; Lin, Lixia; Gao, Qianying; Lin, Xiaofeng

    2015-01-01

    Purpose. To evaluate the effects of long-term tamponade with silicone oil on retinal saturation. Methods. A total of 49 eyes that received tamponade with silicone oil were included. The patients were divided into 3 groups (3–6 months, 6–9 months, and >9 months) according to the duration of silicone oil tamponade. Retinal oximetry was performed using the Oxymap system before and 2 months after silicone oil removal. Results. The mean retinal oxygen saturation before silicone oil removal was 107% ± 12% in the arterioles and 60% ± 10% in the venules, with an overall arteriovenous difference (AVD) of 47% ± 14%. The AVD in the >9-month group was significantly higher than that in the 3–6-month group (54% ± 16% versus 44% ± 11%, P = 0.042). After silicone oil removal, the AVD in the >9-month group was significantly decreased (45% ± 9% versus 54% ± 16%, P = 0.009); additionally, the arterioles were significantly wider than before surgery (10.8 ± 0.7 pixels versus 10.4 ± 0.9 pixels, P = 0.015). Conclusions. The tamponade with silicone oil for more than 9 months will cause the alterations of retinal saturation and the narrowing of retinal arterioles, which may further interfere with the oxygen metabolism in the retina. PMID:26557694

  6. Universal definition of perioperative bleeding in adult cardiac surgery.

    PubMed

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J; Sellke, Frank W; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-05-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and quantify bleeding and to facilitate future investigation into this difficult clinical problem. The multidisciplinary International Initiative on Haemostasis Management in Cardiac Surgery identified a common definition of perioperative bleeding as an unmet need. The functionality and usefulness of the UDPB for clinical research was then tested using a large single-center, nonselected, cardiac surgical database. A multistaged definition for perioperative bleeding was created based on easily measured clinical end points, including total blood loss from chest tubes within 12 hours, allogeneic blood products transfused, surgical reexploration including cardiac tamponade, delayed sternal closure, and the need for salvage treatment. Depending on these components, bleeding is graded as insignificant, mild, moderate, severe, or massive. When applied to an established cardiac surgery dataset, the UDPB provided insight into the incidence and outcome of bleeding after cardiac surgery. The proposed UDPB in adult cardiac surgery provides a precise classification of bleeding that is useful in everyday practice as well as in clinical research. Once fully validated, the UDPB may be useful as an institutional quality measure and serve as an important end point in future cardiac surgical research. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  7. [Bakri balloon tamponade for severe post-partum haemorrhage: efficiency and fertility outcomes].

    PubMed

    Alouini, S; Bedouet, L; Ramos, A; Ceccaldi, C; Evrard, M L; Khadre, K

    2015-02-01

    To evaluate efficiency of Bakri balloon tamponade (BB) to stop severe post-partum haemorrhage (PPH) and fertility outcomes. Retrospective study including all patients who underwent Bakri balloon tamponade for severe PPH between January 2009 and December 2013. The objectives were to stop PPH by BB and to evaluate the fertility after Bakri balloon tamponade. Sixty-one women had a Bakri balloon inserted in utero for severe PPH. The PPH was stopped in 55 patients out of 61 (88%). The reasons of severe PPH were uterine atony in 44 cases (72%), placental retention in 10 cases, placenta praevia in 3 cases, and cervical or vaginal tears in 4 cases. In one third of cases, the pregnancy was complicated by diabetes, placenta praevia, hypertensive troubles. A cesarean section or an instrumental delivery was performed for one third of patients. The mean duration of the Bakri balloon insertion was of 7 hours [5-9] and the mean filling of the balloon was of 350 ml [205-450]. The mean blood loss was of 1600 [1200-2250]. Sixty-three percent of patients (n=38) received red blood cells transfusion. The BB was efficient after a vaginal delivery or after a caesarean section and in all cases of placenta praevia. In 6 cases, the BB was inefficient and uterine embolisation or a surgical procedure was performed to stop PPH. Nine women underwent a new pregnancy after the insertion of Bakri balloon for severe PPH and 3 delivered healthy newborns. Bakri balloon tamponade is a minimally invasive intrauterine device efficient to stop severe post-partum haemorrhage. New pregnancies and deliveries are possible after tamponade by Bakri balloon. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  8. Cardiac Rehabilitation After Acute Myocardial Infarction Resuscitated From Cardiac Arrest

    PubMed Central

    Kim, Chul; Choi, Hee Eun; Kang, Seong Hoon

    2014-01-01

    Objective To examine the safety and effectiveness of cardiac rehabilitation on patients resuscitated from cardiac arrest due to acute myocardial infarction. Methods The study included 23 subjects, including 8 with history of cardiac arrest and 15 without history of cardiac arrest. Both groups underwent initial graded exercise test (GXT) and subsequent cardiac rehabilitation for 6 weeks. After 6 weeks, both groups received follow-up GXT. Results Statistically significant (p<0.05) increase of VO2peak and maximal MVO2 but significant (p<0.05) decrease of submaximal MVO2 and resting heart rate were observed in both groups after 6 weeks of cardiac rehabilitation. An increasing trend of maximal heart rates was observed in both groups. However, the increase was not statistically significant (p>0.05). There was no statistically significant change of resting heart rate, maximal heart rate, maximal MVO2, or submaximal MVO2 in both groups after cardiac rehabilitation. Fatal cardiac complications, such as abnormal ECG, cardiac arrest, death or myocardial infarction, were not observed. All subjects finished the cardiac rehabilitation program. Conclusion Improvement was observed in the exercise capacity of patients after aerobic exercise throughout the cardiac rehabilitation program. Therefore, cardiac rehabilitation can be safely administered for high-risk patients with history of cardiac arrest. Similar improvement in exercise capacity can be expected in patients without cardiac arrest experience. PMID:25566479

  9. Shear and Extensional Rheometry of PDMS Tamponade Agents Used in Vitroretinal Surgery

    NASA Astrophysics Data System (ADS)

    Day, Michael; Blanchard, Rowan-Louise; English, Rob; Dobbie, Tom; Williams, Rachel; Garvey, Michael; Wong, David

    2008-07-01

    The emulsification of low molar mass silicone oil (PDMS)-based tamponade agents used in the treatment of complex retinal detachments is a significant clinical problem leading to the patient suffering impairment of vision whilst the tamponade is in place. This is particularly the case in temporal postoperative applications where the tamponade can remain in the ocular cavity for several months. The majority of clinicians prefer to use a PDMS fluid of kinematic viscosity 1000 cS, which offers ease of manual injection. Work is progressing towards the development of tamponades with a reduced tendency to emulsify, through specific tailoring of rheology and interfacial properties. Greater knowledge of the mechanism of intraocular emulsification is being elucidated and has led to the development of `polymer modified' tamponades with enhanced performance. Such materials are formulated by the addition of a high molecular weight PDMS to the base PDMS fluid. Measurement of the shear viscosity at moderate shear rates is useful in predicting performance during manual injection into the eye. However, the determination of the behaviour in both shear and extension at high strain rates is useful in predicting resistance to intraocular emulsification and in informing future modeling studies. Initial experiments focused on rotational rheometry (shear) and capillary breakup rheometry (CaBER—extension). A range of polymer modified tamponades were characterised—based on PDMS base oils from 100-5000 cS and containing up to 30% by weight PDMS of molecular weight varying in the range 100-800 kDa. Even though the volume occupancy of the polymeric additive ranged from dilute to significantly interpenetrated, a linear response was observed in each case. However, subsequent experiments using capillary rheometry lead to the observation of non-linear behaviour and significant differences in the type of response. Systems with enhanced high strain rate tensile viscosities gave improved

  10. Long-term outcome of highly myopic foveoschisis treated by vitrectomy with or without gas tamponade.

    PubMed

    Yun, Li-Na; Xing, Yi-Qiao

    2017-01-01

    To evaluate the long-term safety and efficacy of vitrectomy and internal limiting membrane (ILM) peeling with or without gas tamponade for highly myopic foveoschisis. We performed an open-label, observer-blinded clinical trial of 85 patients with myopic foveoschisis between 2000 and 2012. Patients were randomly allocated to one of two groups, those who received vitrectomy and ILM peeling without gas tamponade (no-gas group) or those who with gas tamponade (gas group) and follow up at least 5y. Visual acuity of gas group improved from 0.82±0.33 to 0.79±0.73 in 6mo, improved to 0.71±0.67 in 1y and within this range in the following 4y. Visual acuity of no-gas group improved from 0.81±0.46 to 0.78±0.66 in 6mo, improved to 0.70±0.65 in 1y. The finial visual acuity of two groups were significantly increased compared with the baseline (P<0.05). The visual acuity was improved in 35 of 40 eyes (87.5%) in gas group and 29 of 33 eyes (87.9%) in no-gas group, while there were no significant differences between gas group and no-gas group in the visual acuity. The foveoschisis on optical coherence tomography (OCT) completely resolved in 5 of 40 eyes in 1mo, 14 eyes in 6mo and 40 eyes in 1y in the gas group. While the foveoschisis completely resolved in 4 of 33 eyes in 1mo, 10 eyes in 6mo and 33 eyes in 1y in the no-gas group. Vitrectomy and ILM peeling without gas tamponade appears to be as effective in the treatment of myopic foveoschisis as vitrectomy and ILM with gas tamponade. However, eyes treated with no-gas tamponade showed more rapid resolution of myopic foveoschisis.

  11. Emerging acute Chagas disease in Amazonian Brazil: case reports with serious cardiac involvement.

    PubMed

    Pinto, Ana Yecê das Neves; Valente, Sebastião Aldo da Silva; Valente, Vera da Costa

    2004-12-01

    Four cases of serious cardiac attacks by autochthonous Trypanosoma cruzi infection from the Brazilian Amazon are reported; three of them occurred in micro-epidemic episodes. The manifestations included sudden fever, myalgia, dyspnea and signs of heart failure. Diagnosis was confirmed by specific exams, especially QBC (Quantitative Buffy Coat) and natural xenodiagnosis. Despite treatment with benznidazol, three patients died with serious myocarditis, renal failure and cardiac tamponade. The authors call attention to the emergence of this disease and reveal a previously unknown pathogenicity of T. cruzi strains in this area, added to a non-usual transmission form.

  12. Cardiac catheterization - discharge

    MedlinePlus

    Catheterization - cardiac - discharge; Heart catheterization - discharge: Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization discharge; CAD - cardiac catheterization discharge; Coronary artery disease - cardiac catheterization ...

  13. Unsuccessful vitrectomy without gas tamponade for macular retinal detachment and retinoschisis without optic disc pit.

    PubMed

    Hotta, Kazuki

    2004-01-01

    The mechanism of subretinal fluid accumulation in optic disc pit maculopathy is unknown. A 67-year-old Japanese woman complaining of blurred vision in her right eye presented with a best-corrected visual acuity of 20/200. Slit-lamp biomicroscopy and optical coherence tomography examination showed maculopathy typically associated with optic disc pits, except that the patient had no optic disc pit. Long-acting gas tamponade was required to achieve reattachment of the retina and retinoschisis after initial failure of surgery using surgically induced vitreous detachment without either fluid-air exchange or gas injection. Vitreous traction may not have played a major role in introducing fluid into the submacular space in this case. Gas tamponade may be indispensable to achieve surgical success. This may also pertain to some cases of optic nerve pits.

  14. Cardiac arrhythmia and late-onset muscle weakness caused by a myofibrillar myopathy with unusual histopathological features due to a novel missense mutation in FLNC.

    PubMed

    Avila-Smirnow, D; Gueneau, L; Batonnet-Pichon, S; Delort, F; Bécane, H-M; Claeys, K; Beuvin, M; Goudeau, B; Jais, J-P; Nelson, I; Richard, P; Ben Yaou, R; Romero, N B; Wahbi, K; Mathis, S; Voit, T; Furst, D; van der Ven, P; Gil, R; Vicart, P; Fardeau, M; Bonne, G; Behin, A

    2016-10-01

    Myofibrillar myopathies (MFM) are mostly adult-onset diseases characterized by progressive morphological alterations of the muscle fibers beginning in the Z-disk and the presence of protein aggregates in the sarcoplasm. They are mostly caused by mutations in different genes that encode Z-disk proteins, including DES, CRYAB, LDB3, MYOT, FLNC and BAG3. A large family of French origin, presenting an autosomal dominant pattern, characterized by cardiac arrhythmia associated to late-onset muscle weakness, was evaluated to clarify clinical, morphological and genetic diagnosis. Muscle weakness began during adult life (over 30 years of age), and had a proximal distribution. Histology showed clear signs of a myofibrillar myopathy, but with unusual, large inclusions. Subsequently, genetic testing was performed in MFM genes available for screening at the time of clinical/histological diagnosis, and desmin (DES), αB-crystallin (CRYAB), myotilin (MYOT) and ZASP (LDB3), were excluded. LMNA gene screening found the p.R296C variant which did not co-segregate with the disease. Genome wide scan revealed linkage to 7q.32, containing the FLNC gene. FLNC direct sequencing revealed a heterozygous c.3646T>A p.Tyr1216Asn change, co-segregating with the disease, in a highly conserved amino acid of the protein. Normal filamin C levels were detected by Western-blot analysis in patient muscle biopsies and expression of the mutant protein in NIH3T3 showed filamin C aggregates. This is an original FLNC mutation in a MFM family with an atypical clinical and histopathological presentation, given the presence of significantly focal lesions and prominent sarcoplasmic masses in muscle biopsies and the constant heart involvement preceding significantly the onset of the myopathy. Though a rare etiology, FLNC gene should not be excluded in early-onset arrhythmia, even in the absence of myopathy, which occurs later in the disease course.

  15. Fatality after cardiac arrest in thyrotoxic periodic paralysis due to profound hypokalemia resulting from intravenous glucose administration and inadequate potassium replacement.

    PubMed

    Chen, Dan Yun; Schneider, Peter F; Zhang, Xiang Song; He, Zhi Min; Chen, Tang Hua

    2012-09-01

    Thyrotoxic periodic paralysis (TPP) is a variant of periodic paralysis (PP) that occurs in patients with underlying mutations in genes for cation channels, if they develop thyrotoxicosis. It is disabling, and fatalities sometimes occur. Here, we present a patient with TPP who developed hypokalemic paralysis that was probably aggravated by the administration of a carbohydrate, probably contributing to, if not causing, a fatal outcome. A 30-year-old Chinese patient received (131)I treatment for Graves' disease (GD) in our hospital. Three days later in the middle of the night, he developed aggravating paralytic symptoms after a heavy evening meal. The next morning, he was seen in a small clinic and was treated with 1250 mL 5% glucose containing 25 mL 10% potassium chloride (KCl). By early afternoon, he had not improved and was transferred to a city hospital, arriving with grade I muscle strength and severed facial and bulbar paralysis that was shortly followed by cardiac arrest with failure of resuscitation. Shortly before he died, his serum K(+) was 1.15 mEq/L (normal=3.5-5). We postulate that severe hypokalemia developed in our patient in part in response to the high intravenous glucose load that he received. We advocate caution against using intravenous glucose solutions for potassium administration in patients with TPP and recommend a review of guidelines suggesting this form of treatment. In rural settings with limited resources, we favor oral potassium, not to exceed 100 mEq per day, and transfer to a modern medical facility in settings where muscle weakness is developing in patients with TPP.

  16. Effectiveness of prehospital Magill forceps use for out-of-hospital cardiac arrest due to foreign body airway obstruction in Osaka City.

    PubMed

    Sakai, Tomohiko; Kitamura, Tetsuhisa; Iwami, Taku; Nishiyama, Chika; Tanigawa-Sugihara, Kayo; Hayashida, Sumito; Nishiuchi, Tatsuya; Kajino, Kentaro; Irisawa, Taro; Shiozaki, Tadahiko; Ogura, Hiroshi; Tasaki, Osamu; Kuwagata, Yasuyuki; Hiraide, Atsushi; Shimazu, Takeshi

    2014-09-04

    Although foreign body airway obstruction (FBAO) accounts for many preventable unintentional accidents, little is known about the epidemiology of FBAO patients and the effect of forceps use on those patients. This study aimed to assess characteristics of FBAO patients transported to hospitals by emergency medical service (EMS) personnel, and to verify the relationship between prehospital Magill forceps use and outcomes among out-of-hospital cardiac arrests (OHCA) patients with FBAO. We retrospectively reviewed ambulance records of all patients who suffered FBAO, and were treated by EMS in Osaka City from 2000 through 2007, and assessed the characteristics of those patients. We also performed a multivariate logistic-regression analysis to assess factors associated with neurologically favorable survival among bystander-witnessed OHCA patients with FBAO in larynx or pharynx. A total of 2,354 patients suffered from FBAO during the study period. There was a bimodal distribution by age among infants and old adults. Among them, 466 (19.8%) had an OHCA when EMS arrived at the scene, and 344 were witnessed by bystanders. In the multivariate analysis, Magill forceps use for OHCA with FBAO in larynx or pharynx was an independent predictor of neurologically favorable survival (16.4% [24/146] in the Magill forceps use group versus 4.3% [4/94] in the non-use group; adjusted odds ratio, 3.96 [95% confidence interval, 1.21-13.00], p = 0.023). From this large registry in Osaka, we revealed that prehospital Magill forceps use was associated with the improved outcome of bystander-witnessed OHCA patients with FBAO.

  17. Retrograde guidewire fracture complicated with pericardial tamponade in chronic total occlusive coronary lesion.

    PubMed

    Park, Sang-Ho; Rha, Seung-Woon; Her, Keun

    2015-10-01

    Along with various coronary devices progress, there is a now growing trend to percutaneous coronary intervention for chronic total occlusion (CTO). However, the risk of guidewire fracture rate might be increased in complex lesion such as tortuous, calcific lesion or retrograde route. We report a case of successful surgical removal of fractured and entrapped guidewire in a septal channel during retrograde CTO intervention in a patient complicated with pericardial tamponade by delayed penetration of broken guidewire into pericardium.

  18. Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK).

    PubMed

    Botsford, Benjamin; Vedana, Gustavo; Cope, Leslie; Yiu, Samuel C; Jun, Albert S

    2016-01-01

    To compare the effect of 20% sulfur hexafluoride (SF6) with that of air on graft detachment rates for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK). Forty-two eyes of patients who underwent DMEK by a single surgeon (A.S.J.) at Wilmer Eye Institute between January 2012 and 2014 were identified; 21 received air for intraocular tamponade and the next consecutive 21 received SF6. The main outcome measure was the graft detachment rate; univariate and multivariate analyses were performed. The graft detachment rate was 67% in the air group and 19% in the SF6 group (p<0.05). No complete graft detachments occurred, and all partial detachments underwent intervention with injection of intraocular air. The percentages of eyes with 20/25 or better vision were not different between the groups (67% vs. 71%). Univariate analysis showed significantly higher detachment rates with air tamponade (OR, 8.50; p<0.005) and larger donor graft size (OR, 14.96; p<0.05). Multivariate analysis with gas but not graft size included showed that gas was an independent statistically significant predictor of outcome (OR, 6.65; p<0.05). When graft size was included as a covariate, gas was no longer a statistically significant predictor of detachment but maintained OR of 7.81 (p=0.063) similar to the results of univariate and multivariate analyses without graft size. In comparison with air, graft detachment rates for intraocular tamponade in DMEK were significantly reduced by 20% SF6.

  19. Rebubbling in Descemet Membrane Endothelial Keratoplasty: Influence of Pressure and Duration of the Intracameral Air Tamponade.

    PubMed

    Pilger, Daniel; Wilkemeyer, Ina; Schroeter, Jan; Maier, Anna-Karina B; Torun, Necip

    2017-06-01

    To explore the impact of intracameral air tamponade pressure and duration on graft attachment and rebubbling rates. A prospective, interventional, nonrandomized study. setting: Department of Ophthalmology, Charité - Universitätsmedizin Berlin. One hundred seventeen patients who underwent Descemet membrane endothelial keratoplasty (DMEK). Intraocular pressure (IOP) at the end of the surgery, immediately after filling the anterior chamber with air, categorized into low (<10 mm Hg), normal (10-20 mm Hg), and high (>20 mm Hg), and the time until partial removal of the air. Rebubbling rates and endothelial cell density over a 3-month follow-up period analyzed by a multivariable Cox regression model and an analysis of covariance model. Thirty-two patients required a rebubbling (27% [95% CI 19%-35%]). Nine patients required more than 1 rebubbling (7% [95% CI 3%-12%]). Compared with normal IOP, lower (HR 8.98 [95% CI 1.07-75.41]) and higher IOP (HR 10.63 [95% CI 1.44-78.27]) increased the risk of requiring a rebubbling (P = .006). Independent of the IOP, an air tamponade duration beyond 2 hours reduced the risk of rebubbling (HR 0.36 [95% CI 0.18-0.71, P = .003]). One month after surgery, the mean endothelial cell loss was 13% (95% CI 2%-25%) and 23% (95% CI 17%-29%) in the group with air tamponade duration of below and above 2 hours, respectively (P = .126). At 3 months after surgery, it was 31% (95% CI 17%-42%) and 42% (95% CI 32%-52%) in the respective groups (P = .229). A postsurgical air tamponade of at least 2 hours with an IOP within the physiological range could help to reduce rebubbling rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Trans-tamponade optical coherence tomography: postoperative imaging in gas-filled eyes.

    PubMed

    Ehlers, Justis P; Yuan, Alex; Kaiser, Peter K; Dhoot, Dilsher; Sears, Jonathan E; Martin, Daniel F; Singh, Rishi P; Srivastava, Sunil K

    2013-06-01

    To investigate the feasibility of trans-tamponade optical coherence tomography and evaluate factors contributing to image quality and acquisition success. Retrospective case series of eyes receiving Postoperative Day 1 optical coherence tomography imaging after vitrectomy and gas tamponade. The quality of the scans was graded by three independent expert readers. Clinical and surgical variables were recorded and correlated with scan quality. Eighty eyes were included in the study. An image quality classification scheme was developed (0-4, 0 = no image and 4 = comparable quality to trans-fluid optical coherence tomography). In 51 scans (64%), visualization of the inner retina and retinal pigment epithelium was achieved (Grades 2-4) but with variable image quality of the retinal layers. Twenty-nine scans (36%) achieved visualization of all retinal layers (Grades 3-4). Only 9 scans (11%) were of comparable quality to fluid-filled eyes (Grade 4). Pseudophakia (P = 0.0001), shorter operative times (P = 0.007), and macular surgery (P = 0.002) correlated with scan quality. An optimum scan protocol was developed to facilitate maximum quality images. Successful trans-tamponade optical coherence tomography through gas on Postoperative Day 1 is possible but significant variability exists in scan quality.

  1. Simulation Models of Misclassification Error for Single Thresholds of High-Sensitivity Cardiac Troponin I Due to Assay Bias and Imprecision.

    PubMed

    Lyon, Andrew W; Kavsak, Peter A; Lyon, Oliver A S; Worster, Andrew; Lyon, Martha E

    2017-02-01

    Clinical outcome studies for cardiac troponins (cTn) are expensive and difficult to design owing to variation in patients, in the assays, and in the incidence of different types of myocardial infarction (MI). To overcome these difficulties, simulation models were used to estimate the rate of misclassification error for MI and risk prediction resulting from assay bias and imprecision. Finite mixture analysis of Abbott high-sensitivity cTnI (hs-cTnI) results at time 0 h in patients presenting early with acute coronary syndrome (ACS) symptoms to the emergency department (ED) [n = 145, Reducing the Time Interval for Identifying New Guideline (RING) study] allowed derivation of a simulation data set (n = 10000). hs-cTnI concentrations were modified by addition of bias or imprecision error. The percentage of all 10000 modified hs-cTnI results that were misclassified for MI at thresholds of 2, 5, 26.2, and 52 ng/L was determined by Monte Carlo simulation. Analyses were replicated with an all-comer emergency department (ED) population (n = 1137) ROMI (Optimum Troponin Cutoffs for ACS in the ED) study. In the RING study, simulation at 26.2-ng/L (99th percentile) and 52-ng/L thresholds were affected by both bias ±2 ng/L and imprecision (10%-20%) and had misclassification rates of 0.4% to 0.6%. Simulations at the 2-ng/L and 5-ng/L thresholds were only affected by bias. Misclassification rates at bias of ±1 ng/L were 10% for the 2-ng/L threshold, and 5% for the 5-ng/L threshold. Simulation models predicted that hs-cTnI results are seldom misclassified (<1% of patients) when interpretative thresholds are near or exceed the overall 99th percentile. However, simulation models also predicted that low hs-cTnI results, as recommended in guidelines, are prone to misclassification of 5%-10% of patients. © 2016 American Association for Clinical Chemistry.

  2. Internal limiting membrane peeling and gas tamponade for myopic foveoschisis: a systematic review and meta-analysis.

    PubMed

    Meng, Bo; Zhao, Lu; Yin, Yi; Li, Hongyang; Wang, Xiaolei; Yang, Xiufen; You, Ran; Wang, Jialin; Zhang, Youjing; Wang, Hui; Du, Ran; Wang, Ningli; Zhan, Siyan; Wang, Yanling

    2017-09-08

    Myopic foveoschisis (MF) is among the leading causes of visual loss in high myopia. However, it remains controversial whether internal limiting membrane (ILM) peeling or gas tamponade is necessary treatment option for MF. PubMed, EMBASE, CBM, CNKI, WANFANG DATA and VIP databases were systematically reviewed. Outcome indicators were myopic foveoschisis resolution rate, visual acuity improvement and postoperative complications. Nine studies that included 239 eyes were selected. The proportion of resolution of foveoschisis was higher in ILM peeling group than non-ILM peeling group (OR = 2.15, 95% CI: 1.06-4.35; P = 0.03). The proportion of postoperative complications was higher in Tamponade group than non-Tamponade group (OR = 10.81, 95% CI: 1.26-93.02; P = 0.03). However, the proportion of visual acuity improvement (OR = 1.63, 95% CI: 0.56-4.80; P = 0.37) between ILM peeling group and non-ILM peeling group and the proportion of resolution of foveoschisis (OR = 1.80, 95% CI: 0.76-4.28; P = 0.18) between Tamponade group and non-Tamponade group were similar. Vitrectomy with internal limiting membrane peeling could contribute to better resolution of myopic foveoschisis than non-peeling, however it does not significantly influence the proportion of visual acuity improvement and postoperative complications. Vitrectomy with gas tamponade is associated with more complications than non-tamponade and does not significantly influence the proportion of visual acuity improvement and resolution of myopic foveoschisis.

  3. Cardiac Hegemony of Senescence

    PubMed Central

    Siddiqi, Sailay; Sussman, Mark A.

    2013-01-01

    Cardiac senescence and age-related disease development have gained general attention and recognition in the past decades due to increased accessibility and quality of health care. The advancement in global civilization is complementary to concerns regarding population aging and development of chronic degenerative diseases. Cardiac degeneration has been rigorously studied. The molecular mechanisms of cardiac senescence are on multiple cellular levels and hold a multilayer complexity level, thereby hampering development of unambiguous treatment protocols. In particular, the synergistic exchange of the senescence phenotype through a senescence secretome between myocytes and stem cells appears complicated and is of great future therapeutic value. The current review article will highlight hallmarks of senescence, cardiac myocyte and stem cell senescence, and the mutual exchange of senescent secretome. Future cardiac cell therapy approaches require a comprehensive understanding of myocardial senescence to improve therapeutic efficiency as well as efficacy. PMID:24349878

  4. The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery.

    PubMed

    2017-03-01

    The Society of Thoracic Surgeons Task Force on Resuscitation After Cardiac Surgery provides this professional society perspective on resuscitation in patients who arrest after cardiac surgery. This document was created using a multimodal methodology for evidence generation and includes information from existing guidelines, from the International Liaison Committee on Resuscitation, from our own structured literature reviews on issues particular to cardiac surgery, and from an international survey on resuscitation hosted by CTSNet. In gathering evidence for this consensus paper, searches were conducted using the MEDLINE keywords "cardiac surgery," "resuscitation," "guideline," "thoracic surgery," "cardiac arrest," and "cardiac massage." Weight was given to clinical studies in humans, although some case studies, mannequin simulations of potential protocols, and animal models were also considered. Consensus was reached using a modified Delphi method consisting of two rounds of voting until 75% agreement on appropriate wording and strength of the opinions was reached. The Society of Thoracic Surgeons Workforce on Critical Care was enlisted in this process to provide a wider variety of experiences and backgrounds in an effort to reinforce the opinions provided. We start with the premise that external massage is ineffective for an arrest due to tamponade or hypovolemia (bleeding), and therefore these subsets of patients will receive inadequate cerebral perfusion during cardiac arrest in the absence of resternotomy. Because these two situations are common causes for an arrest after cardiac surgery, the inability to provide effective external cardiopulmonary resuscitation highlights the importance of early emergency resternotomy within 5 minutes. In addition, because internal massage is more effective than external massage, it should be used preferentially if other quickly reversible causes are not found. We present a protocol for the cardiac arrest situation that

  5. Endovascular Repair Using Suture-Mediated Closure Devices and Balloon Tamponade following Inadvertent Subclavian Artery Catheterization with Large-Caliber Hemodialysis Catheter.

    PubMed

    Park, Taek Kyu; Yang, Jeong Hoon; Choi, Seung-Hyuk

    2016-07-01

    Accidental subclavian artery cannulation is an uncommon but potentially serious complication of central venous catheterization. Removal of a catheter inadvertently placed in the subclavian artery can lead to substantial bleeding, as achieving hemostasis in this area through manual compression presents considerable difficulty. Additionally, surgical treatment might be unsuitable for high-risk patients due to comorbidities. Here, we report a case of an inadvertently-inserted 11.5-French hemodialysis catheter in the subclavian artery during internal jugular venous catheterization. We performed percutaneous closure of the subclavian artery using three 6-French Perclose Proglide® devices with a balloon tamponade in the proximal part of the subclavian artery. Closure was completed without embolic neurological complications.

  6. Post-vitrectomy observation of Coat's disease associated with exudative retinal detachment, successfully treated with long-term silicone oil tamponade.

    PubMed

    Ogata, Masafumi; Suzuki, Takahiro; Nakagawa, Yoshihiro; Hayakawa, Kenji; Kawai, Kenji

    2014-03-20

    Treating Coat's disease with exudative retinal detachment remains a challenge, since vitreous surgery is frequently accompanied by serious complications such as secondary glaucoma. A 25-year-old woman with Coat's disease of the right eye had cystic exudative retinal detachment along the naso-inferior vessels at the peripheral retina, due to 5-o'clock telangiectasia. Right visual acuity was finger counting. This patient underwent vitrectomy simultaneously with cataract surgery, completed with silicone oil replacement, with thorough drainage of subretinal exudates through the artificial break. Although the complication of secondary glaucoma developed as a result of using silicone oil, approximately three years after the operation, this condition was ameliorated by removing the silicone oil. Thus, blindness was prevented in this patient. Long-term tamponade with silicone oil facilitates performing vitreous surgery in this patient suffering from Coat's disease associated from exudative retinal detachment.

  7. Effect of air and sulfur hexafluoride (SF6) tamponade on visual acuity after epiretinal membrane surgery: a pilot study.

    PubMed

    Chabot, Guillaume; Bourgault, Serge; Cinq-Mars, Benoit; Tourville, Éric; Caissie, Mathieu

    2017-06-01

    The aim of this study was to compare visual acuity improvement after epiretinal membrane (ERM) surgery using air and sulfur hexafluoride (SF6) tamponade. Secondary objectives were to evaluate Visual Function Questionnaire (VFQ) scores and central retinal thickness (CRT) changes. This was a prospective, randomized study. Thirty-two patients were prospectively randomized, 19 to the air group and 13 to the SF6 group. This study has enrolled patients with ERM from clinical practice of 4 vitreoretinal surgeons. Preoperative and postoperative data included best-corrected visual acuity (BCVA) with the use of the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, VFQ scores, CRT, and cataract staging. Pars plana vitrectomy with ERM peeling was performed on all patients, either with partial air tamponade or with complete SF6 tamponade. Mean BCVA improved by 0.07 logMAR (3.5 ETDRS letters) in the air group and by 0.09 logMAR (4.5 ETDRS letters) in the SF6 group (p = 0.58). There was no statistically significant difference between the groups with regard to BCVA, VFQ scores, and CRT. The groups had similar rates of cataract progression and adverse events. ERM peeling with partial air tamponade or with complete SF6 tamponade have similar outcomes in terms of BCVA, VFQ scores, CRT, cataract development, and adverse events. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  8. Non-ischemic perfusion defects due to delayed arrival of contrast material on stress perfusion cardiac magnetic resonance imaging after coronary artery bypass graft surgery.

    PubMed

    Kim, Yeo Koon; Park, Eun-Ah; Park, Sang Joon; Cheon, Gi Jeong; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung

    2014-01-01

    Herein we report about the adenosine stress perfusion MR imaging findings of a 50-year-old man who exhibited two different perfusion defects resulting from two different mechanisms after a coronary artery bypass surgery. An invasive coronary angiography confirmed that one perfusion defect at the mid-anterior wall resulted from an ischemia due to graft stenosis. However, no stenosis was detected on the graft responsible for the mid-inferior wall showing the other perfusion defect. It was assumed that the perfusion defect at the mid-inferior wall resulted from delayed perfusion owing to the long pathway of the bypass graft. The semiquantitative analysis of corrected signal-time curves supported our speculation, demonstrating that the rest-to-stress ratio index of the maximal slope of the myocardial territory in question was similar to those of normal myocardium, whereas that of myocardium with the stenotic graft showed a typical ischemic pattern. A delayed perfusion during long graft pathway in a post-bypass graft patient can mimick a true perfusion defect on myocardial stress MR imaging. Radiologists should be aware of this knowledge to avoid misinterpretation of graft and myocardial status in post bypass surgery patients.

  9. Factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

    PubMed

    Takashina, Hirotsugu; Watanabe, Akira; Mitooka, Katsuya; Tsuneoka, Hiroshi

    2014-01-01

    The purpose of this study was to investigate factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy. This study was a retrospective review of 84 patients (84 eyes) who underwent 23-gauge transconjunctival sutureless vitrectomy under gas tamponade by a single surgeon. At the end of surgery, the sclerotomy was massaged to promote self-sealing. Factors influencing massage time were examined using multiple regression analysis. Independent variables were age, surgical time, vitreous incarceration, intraocular manipulation, and axial length. Significant factors were intraocular manipulation and vitreous incarceration in the examination of all sclerotomies, age only in the examination of infusion sites, and vitreous incarceration only in the examination of manipulation sites. In sclerotomy performed with gas tamponade using 23-gauge transconjunctival sutureless vitrectomy, intraocular manipulation influenced self-sealing of sclerotomy the most, followed by vitreous incarceration, and then age.

  10. Factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy

    PubMed Central

    Takashina, Hirotsugu; Watanabe, Akira; Mitooka, Katsuya; Tsuneoka, Hiroshi

    2014-01-01

    Background The purpose of this study was to investigate factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy. Methods This study was a retrospective review of 84 patients (84 eyes) who underwent 23-gauge transconjunctival sutureless vitrectomy under gas tamponade by a single surgeon. At the end of surgery, the sclerotomy was massaged to promote self-sealing. Factors influencing massage time were examined using multiple regression analysis. Independent variables were age, surgical time, vitreous incarceration, intraocular manipulation, and axial length. Results Significant factors were intraocular manipulation and vitreous incarceration in the examination of all sclerotomies, age only in the examination of infusion sites, and vitreous incarceration only in the examination of manipulation sites. Conclusion In sclerotomy performed with gas tamponade using 23-gauge transconjunctival sutureless vitrectomy, intraocular manipulation influenced self-sealing of sclerotomy the most, followed by vitreous incarceration, and then age. PMID:25336910

  11. Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A multicenter randomized, controlled trial.

    PubMed

    Escorsell, Àngels; Pavel, Oana; Cárdenas, Andrés; Morillas, Rosa; Llop, Elba; Villanueva, Càndid; Garcia-Pagán, Juan C; Bosch, Jaime

    2016-06-01

    Balloon tamponade is recommended only as a "bridge" to definitive therapy in patients with cirrhosis and massive or refractory esophageal variceal bleeding (EVB), but is frequently associated with rebleeding and severe complications. Preliminary, noncontrolled data suggest that a self-expandable, esophageal covered metal stent (SX-ELLA Danis; Ella-CS, Hradec Kralove, Czech Republic) may be an effective and safer alternative to balloon tamponade. We conducted a randomized, controlled trial aimed at comparing esophageal stent versus balloon tamponade in patients with cirrhosis and EVB refractory to medical and endoscopic treatment. Primary endpoint was success of therapy, defined as survival at day 15 with control of bleeding and without serious adverse events (SAEs). Twenty-eight patients were randomized to Sengstaken-Blakemore tube (n = 15) or SX-ELLA Danis stent (n = 13). Patients were comparable in severity of liver failure, active bleeding at endoscopy, and initial therapy. Success of therapy was more frequent in the esophageal stent than in balloon tamponade group (66% vs. 20%; P = 0.025). Moreover, control of bleeding was higher (85% vs. 47%; P = 0.037) and transfusional requirements (2 vs 6 PRBC; P = 0.08) and SAEs lower (15% vs. 47%; P = 0.077) in the esophageal stent group. TIPS was used more frequently in the tamponade group (4 vs. 10; P = 0.12). There were no significant differences in 6-week survival (54% vs. 40%; P = 0.46). Esophageal stents have greater efficacy with less SAEs than balloon tamponade in the control of EVB in treatment failures. Our findings favor the use of esophageal stents in patients with EVB uncontrolled with medical and endoscopic treatment. (Hepatology 2016;63:1957-1967). © 2015 by the American Association for the Study of Liver Diseases.

  12. Intraocular fluid dynamics and retinal shear stress after vitrectomy and gas tamponade.

    PubMed

    Angunawela, Romesh I; Azarbadegan, Ali; Aylward, G William; Eames, Ian

    2011-09-01

    To evaluate fluid dynamics and fluid shear stress on the retinal wall in a model eye after vitrectomy and gas tamponade in relation to saccadic eye movements and sudden head movements and to correlate the results with gas fill fraction (GF). Methods. Analyses was undertaken using high-resolution computational fluid dynamic software. The fluid volume within the eye was discretized using 6 × 10(5) elements and solved with a volume-of-fluid The eye was abstracted to a sphere. Vertical and horizontal saccades and sudden rectilinear displacement of the head were examined. GF was varied from 20% to 80% of the eye height filled with gas. Maximum shear stress during horizontal and vertical saccades was 1.0 Pa (Pascal) and 2.5 Pa, respectively, and was dependent on GF. Rapid rectilinear acceleration of the head caused a maximum shear stress of 16 Pa, largely independent of GF. Fluid sloshing within the eye decayed within 0.1 second. Stresses were maximum at the contact line and equator of the eye and were parallel to the direction of motion. This study predicts that saccadic eye movements and normal head movements after vitrectomy and gas tamponade generate only small fluid shear stresses on the retina that are below published norms for retinal adhesion strength. Sudden, jerking head movements generate fluid shear forces similar to retinal adhesion strength that localize to the area of gas-fluid interface. Fluid sloshing occurs after movement, but rapidly decays on cessation of movement. These results suggest that restrictive posturing after vitrectomy and gas tamponade may be unnecessary. Patients should avoid sudden head movements.

  13. [Silicone oil tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy].

    PubMed

    Kowalski, M; Nawrocki, J; Dziegielewski, K; Pikulski, Z; Bogorodzki, B; Bielecka-Kowalska, A

    1997-01-01

    This paper presents early and later stage of the treatment of 93 eyes (89 patients) with retinal detachment in the course of PVR. All patients were treated in our department between February 1992 and February 1994. Standard port pars plana vitrectomy was performed in all cases related earlier with sclear buckling procedure without success. One week, 6, 12, 24 months after surgery good anatomical results were achieved respectively in: 82%, 80%, 78%. One week, 6, 12, 24 months after surgery good functional results were achieved respectively in: 74%, 67%, 58%. Vitrectomy with silicone oil tamponade is method of choice in the treatment of retinal detachment in the course of PVR.

  14. Outcome of 20-gauge transconjunctival cannulated sutureless vitrectomy using silicone oil or air tamponade

    PubMed Central

    Mohamed, Ahmed Abdel Alim; Abdrabbo, Mohamed

    2013-01-01

    Background The purpose of this study was to assess the outcome of pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system with air or silicone oil tamponade in cases of retinal detachment of different etiologies. Methods A prospective study was performed in 60 eyes from consecutive 60 patients who underwent 20-gauge transconjunctival cannulated sutureless vitrectomy (30 eyes with air tamponade and 30 eyes with silicone oil tamponade), with the inclusion of a further 30 patients who underwent conventional 20-gauge vitrectomy and served as a control group. The main outcome measures were intraocular pressure, wound leakage, and comfort score. Results Preoperative intraocular pressure increased from 17.67 ± 5.6 mmHg preoperatively to 18.78 ± 6.1 mmHg on the first postoperative day in group A and decreased from 16.97 ± 4.9 mmHg to 15.88 ± 5.3 mmHg in group B. These changes were not statistically significant (P > 0.05). The comfort score ranged from 1 to 5 (1 = very bad, 2 = bad, 3 = good, 4 = very good, and 5 = excellent), with a mean of 4.4 ± 0.94 in group A and 4.35 ± 0.99 in group B on the first postoperative day, and no significant difference in scores between the groups at any follow-up visit. There was intraoperative wound leakage in two cases (6.7%) in group A which required suturing and one case (3.3%) in group B, but the difference was not statistically significant (P > 0.05). There was no wound leakage at follow-up in either group. No cases of hypotony, endophthalmitis, or unsealed sclerotomies were noted. Conclusion Pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system combines the advantages of smaller-gauge vitrectomy systems with the economic advantage of not needing to purchase any additional handheld instruments. It can be used with both air and silicone oil tamponade in most cases of retinal detachment. PMID:23450243

  15. Outcome of 20-gauge transconjunctival cannulated sutureless vitrectomy using silicone oil or air tamponade.

    PubMed

    Mohamed, Ahmed Abdel Alim; Abdrabbo, Mohamed

    2013-01-01

    The purpose of this study was to assess the outcome of pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system with air or silicone oil tamponade in cases of retinal detachment of different etiologies. A prospective study was performed in 60 eyes from consecutive 60 patients who underwent 20-gauge transconjunctival cannulated sutureless vitrectomy (30 eyes with air tamponade and 30 eyes with silicone oil tamponade), with the inclusion of a further 30 patients who underwent conventional 20-gauge vitrectomy and served as a control group. The main outcome measures were intraocular pressure, wound leakage, and comfort score. Preoperative intraocular pressure increased from 17.67 ± 5.6 mmHg preoperatively to 18.78 ± 6.1 mmHg on the first postoperative day in group A and decreased from 16.97 ± 4.9 mmHg to 15.88 ± 5.3 mmHg in group B. These changes were not statistically significant (P > 0.05). The comfort score ranged from 1 to 5 (1 = very bad, 2 = bad, 3 = good, 4 = very good, and 5 = excellent), with a mean of 4.4 ± 0.94 in group A and 4.35 ± 0.99 in group B on the first postoperative day, and no significant difference in scores between the groups at any follow-up visit. There was intraoperative wound leakage in two cases (6.7%) in group A which required suturing and one case (3.3%) in group B, but the difference was not statistically significant (P > 0.05). There was no wound leakage at follow-up in either group. No cases of hypotony, endophthalmitis, or unsealed sclerotomies were noted. Pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system combines the advantages of smaller-gauge vitrectomy systems with the economic advantage of not needing to purchase any additional handheld instruments. It can be used with both air and silicone oil tamponade in most cases of retinal detachment.

  16. Right Ventricular Migration of a Recovery IVC Filter's Fractured Wire with Subsequent Pericardial Tamponade

    SciTech Connect

    Saeed, Imran Garcia, Mark; McNicholas, Kathleen

    2006-08-15

    A Recovery filter (C.R. Bard, Tempe, AZ, USA) is a device for pulmonary embolism prophylaxis. There have been few case reports involving the migration of this particular filter or of a broken wire migrating to the heart. We report a case of right ventricular migration of a fractured wire from this filter in a patient who subsequently developed pericardial tamponade and required open heart surgery to extract the fractured wire. We discuss the current US Food and Drug Administration (FDA)-approved nonpermanent inferior vena cava filters and their reported complications. These complications can be life-threatening and may require immediate surgical intervention.

  17. Cardiac Sarcoidosis.

    PubMed

    Birnie, David; Ha, Andrew C T; Gula, Lorne J; Chakrabarti, Santabhanu; Beanlands, Rob S B; Nery, Pablo

    2015-12-01

    Studies suggest clinically manifest cardiac involvement occurs in 5% of patients with pulmonary/systemic sarcoidosis. The principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. Data indicate that an 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic (clinically silent) cardiac involvement. An international guideline for the diagnosis and management of CS recommends that patients be screened for cardiac involvement. Most studies suggest a benign prognosis for patients with clinically silent CS. Immunosuppression therapy is advocated for clinically manifest CS. Device therapy, with implantable cardioverter defibrillators, is recommended for some patients.

  18. Diagnostic accuracy retrospectively of electrocardiographic findings and cancer history for tamponade in patients determined to have pericardial effusion by transthoracic echocardiogram.

    PubMed

    Mathur, Atish Pratap; Saini, Abhimanyu; Lucas, Brian P; AlYousef, Tareq; Margeta, Bosko; Mba, Benjamin

    2013-04-01

    Unexpected pericardial effusions are often found by frontline providers who perform computed tomography. To study the hypothesis that electrocardiographic findings and whether cancer is known or suspected importantly change the likelihood of tamponade for such providers, all unique patients with moderate or large pericardial effusions determined by transthoracic echocardiography during a 6-year period were retrospectively identified. Electrocardiograms were evaluated by blinded investigators for electrical alternans (total and QRS), low voltage (limb leads only, precordial leads only, and both), and tachycardia (>100 QRS complexes/min). Medical records were reviewed to determine whether cancer was known or suspected and whether tamponade was diagnosed. Tamponade was present in 66 patients (27% of 241) with moderate or large pericardial effusions. No tachycardia lowered the odds of tamponade the most (likelihood ratio 0.4, 95% confidence interval 0.3 to 0.6) but by a degree less than any single diagnostic element increased it when present. The combined presence of all 3 electrocardiographic findings and cancer increased the odds of tamponade 63-fold (likelihood ratio 63, 95% confidence interval 33 to 150), whereas their combined absence decreased the odds only fivefold (likelihood ratio 0.2, 95% confidence interval 0.2 to 0.3). In conclusion, electrocardiography findings and cancer rule in tamponade better than they rule it out. Combining these diagnostic elements improves their discriminatory power but not sufficiently enough to rule out tamponade in patients with moderate or large pericardial effusions.

  19. Mechanisms of sudden cardiac death.

    PubMed

    McElwee, Samuel K; Velasco, Alejandro; Doppalapudi, Harish

    2016-12-01

    Sudden cardiac death (SCD) continues to be a major public health problem and is thought to account for almost half of all cardiac deaths. Cardiac arrest and SCD are most commonly due to ventricular arrhythmias. Most patients who suffer cardiac arrest have underlying structural heart disease, with coronary artery disease (CAD) being the most common. In the setting of CAD, ventricular arrhythmias can result due to acute ischemia in the absence of preexisting myocardial scarring or in the presence of established scar from prior infarction without clinically significant ischemia. LV systolic dysfunction is an important predictor of risk for SCD in ischemic heart disease and in most nonischemic disorders, although other factors such as ventricular hypertrophy also play a role. Cardiac arrest and SCD can also occur due to primary electrical disorders in the absence of major structural abnormalities.

  20. Development of emulsification resistant heavier-than-water tamponades using high molecular weight silicone oil polymers.

    PubMed

    Caramoy, Albert; Kearns, Victoria R; Chan, Yau Kei; Hagedorn, Nadine; Poole, Robert J; Wong, David; Fauser, Sascha; Kugler, Wilfried; Kirchhof, Bernd; Williams, Rachel L

    2015-08-01

    Developing new blends of heavier-than-water silicone oil tamponade agents containing high molecular weight polydimethylsiloxane polymer for use in vitreoretinal surgery. The viscoelastic properties of heavier-than-water silicone oil blends (30.5% F6H8 + 69.5% polydimethylsiloxane) containing high molecular weight polymer additive at increasing concentrations were measured using a controlled-stress rheometer (TA Instruments Rheolyst AR 1000 N). Emulsification of the blends was induced using a sonication device and a pluronic surfactant as a strong emulsifier. The percentage emulsion area was photographed and measured using ImageJ software. In a second in vitro emulsification assessment, silicone oil blends were dispersed using a high shear homogenizer and the oil-in-water droplets were counted using a coulter counter particle analyser. The addition of the high molecular weight polymer increased shear viscosity and viscoelasticity of the oil blends, which were measureable and to some extent predictable. The in vitro emulsification models produced contradictory results. This demonstrates the difficulty of designing and using in vitro models to evaluate the emulsification tendency of tamponade agents in vivo. Addition of a high molecular weight polymer to heavy silicone oil can increase the viscoelasticity. These findings might contribute to the development of emulsification resistant heavy silicone oils. © The Author(s) 2015.

  1. IOP measurement in silicone oil tamponade eyes by Corvis ST tonometer, Goldmann applanation tonometry and non-contact tonometry.

    PubMed

    Zhang, Yang; Zheng, Lin; Bian, Ailing; Zhou, Qi

    2017-04-25

    To compare the postoperative intraocular pressure (IOP) of eyes following pars plana vitrectomy (PPV) combined with intravitreal silicone oil (SO) tamponade by Corneal Visualization Scheimpflug Technology (CST), Goldmann applanation tonometry (GAT) and non-contact tonometry (NCT). Thirty-eight participants who had undergone PPV combined with SO tamponade to treat vitreoretinal diseases were enrolled. Postoperative IOP measurements were obtained using CST, NCT and GAT. Inter-device agreement was assessed by Bland-Altman analysis. The correlation coefficient was used to describe the potential postoperative factors affecting the postoperative IOP differences between each device. Bland-Altman analysis revealed the bias between CST and GAT, between CST and NCT, and between GAT and NCT to be -0.2, 2.1 and 2.4 mmHg, respectively. CST and GAT correlated well with each other. NCT values were lower than those of GAT and CST (all p < 0.05), whereas CST values did not differ from the GAT readings. Central corneal thickness, corneal biomechanical properties and age showed significant correlation with the differences of CST-NCT and GAT-NCT. In SO tamponade eyes, NCT obtains lower IOP than other tonometry techniques, and CST is highly consistent with GAT. CST offers an optional non-contact method for measuring postoperative IOP in SO tamponade eyes.

  2. Cardiac arrest

    MedlinePlus

    ... or low levels can cause cardiac arrest. Severe physical stress. Anything that causes a severe stress on your body can lead to cardiac arrest. This can include trauma, electrical shock, or major blood loss. Recreational drugs. Using certain drugs, such as cocaine ...

  3. Cardiac metastases

    PubMed Central

    Bussani, R; De‐Giorgio, F; Abbate, A; Silvestri, F

    2007-01-01

    Tumours metastatic to the heart (cardiac metastases) are among the least known and highly debated issues in oncology, and few systematic studies are devoted to this topic. Although primary cardiac tumours are extremely uncommon (various postmortem studies report rates between 0.001% and 0.28%), secondary tumours are not, and at least in theory, the heart can be metastasised by any malignant neoplasm able to spread to distant sites. In general, cardiac metastases are considered to be rare; however, when sought for, the incidence seems to be not as low as expected, ranging from 2.3% and 18.3%. Although no malignant tumours are known that diffuse preferentially to the heart, some do involve the heart more often than others—for example, melanoma and mediastinal primary tumours. This paper attempts to review the pathophysiology of cardiac metastatic disease, epidemiology and clinical presentation of cardiac metastases, and pathological characterisation of the lesions. PMID:17098886

  4. Comparison of results of Bakri balloon tamponade and caesarean hysterectomy in management of placenta accreta and increta: a retrospective study.

    PubMed

    Pala, Şehmus; Atilgan, Remzi; Başpınar, Melike; Kavak, Ebru Çelik; Yavuzkır, Şeyda; Akyol, Alparslan; Kavak, Burçin

    2017-09-14

    The aim of this study was to compare the postoperative results of the patients who were treated with Bakri balloon tamponade or hysterectomy for placenta accreta and increta. Patients who were diagnosed with placenta accreta or increta preoperatively and intraoperatively and treated with Bakri balloon tamponade (Group 1) or caesarean hysterectomy (Group 2) were compared in regards to the postoperative results. Among the 36 patients diagnosed with placenta accreta or increta, 19 patients were treated with Bakri balloon tamponade while 17 cases were treated with hysterectomy. Intraoperative blood loss amount was 1794 ± 725 ml in G1, which was lower than that in G2 (2694 ± 893 ml). Blood transfusion amount was 2.7 ± 2.6 units in G1, lower than that in G2 (5.7 ± 2.4 units), too. Operation time was 64.5 ± 29 min and 140 ± 51 min in G1 and G2, respectively, showing significant differences between two groups. The success rate of Bakri balloon was determined as 84.21%. In conclusion, cases with placenta accreta/increta, with predicted placental detachment who are willing to preserve fertility, application of uterine balloon tamponade devices before the hysterectomy is encouraging with its advantages compared with the hysterectomy. Impact statement What is already known on this subject: Invasive placental anomalies are the most common indication of postpartum hysterectomy. Recently, uterine balloon tamponade was also included in the treatment modalities of postpartum haemorrhage.This study aimed to compare the postoperative results of UBT or hysterectomy for patients with placenta accreta and increta. What the results of this study add: In this study, the total amount of blood loss was higher in the caesarean hysterectomy group when compared with the Bakri balloon tamponade group. The mean transfusion requirement, mean operation time and hospitalisation period was significantly longer in the caesarean hysterectomy group. The success

  5. Influence of silicone oil tamponade on self-sealing sclerotomy using 25-gauge transconjunctival sutureless vitrectomy: a retrospective comparative study.

    PubMed

    Takashina, Hirotsugu; Watanabe, Akira; Tsuneoka, Hiroshi

    2015-12-01

    Characteristic complications have been reported for transconjunctival sutureless vitrectomy, such as postoperative sclerotomy leakage and postoperative hypotony. Particular attention to sclerotomy closure is required in cases of silicone oil tamponade, because postoperative supplementation of silicone oil implies reoperation, whereas postoperative supplement of gas is comparatively easy. This study investigated sclerotomy closure in cases of silicone oil tamponade using 25-gauge transconjunctival sutureless vitrectomy. We enrolled 19 consecutive eyes with silicone oil injection (Group A, self-sealing sclerotomies, n = 10) (Group B, sutured sclerotomies, n = 9) and 10 eyes with silicone oil removal (Group C, self-sealing sclerotomies) using 25-gauge TSV. Postoperative intraocular pressure was compared between Groups A and B, and between Groups A and C using repeated-measures analysis of variance (ANOVA), one-way factorial ANOVA, and the Tukey-Kramer test. No significant differences in age or axial length were seen among groups, but surgical time differed significantly between Group C and the other groups. Mean duration of silicone oil tamponade was 3.2 ± 1.4 months in Group C, and no sclerotomies in Group A or C required suture placement. Postoperative silicone oil leakage to the subconjunctival space was not encountered in Group A. No cases showed postoperative hypotony (defined as intraocular pressure <5 mmHg). Significant differences in intraocular pressure within the same postoperative period were not identified between Groups A and B. Conversely, significant differences in intraocular pressure within the same postoperative period were identified at postoperative days 1 and 2, although not at postoperative week 1 or postoperative month 1 between Groups A and C. The procedure for sclerotomy closure seems to have little influence on postoperative intraocular pressure in eyes with silicone oil tamponade using 25-gauge transconjunctival sutureless vitrectomy

  6. Prenatal cardiac ultrasound finding in congenital disorder of glycosylation type 1a.

    PubMed

    Malhotra, A; Pateman, A; Chalmers, R; Coman, D; Menahem, S

    2009-01-01

    We present the antenatal cardiac findings in an infant in whom a postnatal diagnosis of congenital disorder of glycosylation type Ia (CDG-Ia) was confirmed. The antenatal findings at 34 weeks' gestation included biventricular cardiac hypertrophy with pericardial effusion, multiple skeletal anomalies and cerebral ventricular dilatation. A severe CDG-Ia multisystem clinical phenotype evolved in the postnatal period, with the infant succumbing at 3.5 weeks of age secondary to a large pericardial effusion with tamponade. A literature review suggests that this is the first case of cardiac manifestations of CDG-Ia observed antenatally. We would also like to suggest that CDG-Ia should be considered and if possible prenatal diagnosis performed in cases with hypertrophic cardiomyopathy, and/or pericardial effusion. (c) 2009 S. Karger AG, Basel.

  7. Cardiac rhabdomyosarcoma

    PubMed Central

    Chlumský, Jaromír; Holá, Dana; Hlaváček, Karel; Michal, Michal; Švec, Alexander; Špatenka, Jaroslav; Dušek, Jan

    2001-01-01

    Cardiac sarcoma is a very rare neoplasm and is difficult to diagnose. The case of a 51-year-old man with a left atrial tumour, locally recurrent three months after its surgical removal, is presented. Computed tomography showed metastatic spread to the lung parenchyma. On revised histology, the mass extirpated was a sarcoma. Because of the metastatic spread, further therapy was symptomatic only; the patient died 15 months after the first manifestation of his problems. Immunohistochemical staining confirmed cardiac rhabdomyosarcoma with metastatic spread to the lungs. Difficulty in diagnosing and treating cardiac tumours is discussed. PMID:20428274

  8. Cardiac Lymphoma.

    PubMed

    Jeudy, Jean; Burke, Allen P; Frazier, Aletta Ann

    2016-07-01

    Lymphoma of the heart and pericardium may develop in up to 25% of patients with disseminated nodal disease, but primary cardiac lymphoma is rare. The majority are diffuse large B-cell lymphomas, which arise in immunocompetent older individuals, men twice as often as women. Subsets are found in immunocompromised patients, including those with HIV-AIDS or allograft recipients. Cardiac lymphomas tend to arise in the wall of the right heart, especially right atrium, with contiguous infiltration of epicardium and pericardium. Pericardial implants and effusions are common. The disease is often multifocal in the heart, but cardiac valves are usually spared. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Cardiac failure in very long chain acyl-CoA dehydrogenase deficiency requiring extracorporeal membrane oxygenation (ECMO) treatment: A case report and review of the literature.

    PubMed

    Katz, Sharon; Landau, Yuval; Pode-Shakked, Ben; Pessach, Itai M; Rubinshtein, Marina; Anikster, Yair; Salem, Yishay; Paret, Gideon

    2017-03-01

    Fatty acid oxidation (FAO) defects often present with multi-system involvement, including several life-threatening cardiac manifestations, such as cardiomyopathy, pericardial effusion and arrhythmias. We report herein a fatal case of cardiac dysfunction and rapid-onset tamponade following an acute illness in a neonate with molecularly proven very long chain acyl-CoA dehydrogenase (VLCAD) deficiency (harboring the known del799_802 mutation), requiring 15 days of extracorporeal membrane oxygenation (ECMO) treatment. As data regarding the use of ECMO in FAO defects in general, and VLCAD in particular, are scarce, we review the literature and discuss insights from in vitro models and several successful reported cases.

  10. Cardiac Rehabilitation

    MedlinePlus

    ... surgery, coronary artery bypass grafting, or percutaneous coronary intervention. Cardiac rehab involves adopting heart-healthy lifestyle changes to address risk factors for cardiovascular disease. To help you adopt lifestyle changes, this program ...

  11. Cardiac Rehabilitation

    MedlinePlus

    ... eating a heart-healthy diet, keeping a healthy weight and quitting smoking. The goals of cardiac rehabilitation include establishing an individualized plan to help you regain strength, preventing your condition from worsening, reducing your ...

  12. Nuclear cardiac

    SciTech Connect

    Slutsky, R.; Ashburn, W.L.

    1982-01-01

    The relationship between nuclear medicine and cardiology has continued to produce a surfeit of interesting, illuminating, and important reports involving the analysis of cardiac function, perfusion, and metabolism. To simplify the presentation, this review is broken down into three major subheadings: analysis of myocardial perfusion; imaging of the recent myocardial infarction; and the evaluation of myocardial function. There appears to be an increasingly important relationship between cardiology, particularly cardiac physiology, and nuclear imaging techniques. (KRM)

  13. Cardiac cameras.

    PubMed

    Travin, Mark I

    2011-05-01

    Cardiac imaging with radiotracers plays an important role in patient evaluation, and the development of suitable imaging instruments has been crucial. While initially performed with the rectilinear scanner that slowly transmitted, in a row-by-row fashion, cardiac count distributions onto various printing media, the Anger scintillation camera allowed electronic determination of tracer energies and of the distribution of radioactive counts in 2D space. Increased sophistication of cardiac cameras and development of powerful computers to analyze, display, and quantify data has been essential to making radionuclide cardiac imaging a key component of the cardiac work-up. Newer processing algorithms and solid state cameras, fundamentally different from the Anger camera, show promise to provide higher counting efficiency and resolution, leading to better image quality, more patient comfort and potentially lower radiation exposure. While the focus has been on myocardial perfusion imaging with single-photon emission computed tomography, increased use of positron emission tomography is broadening the field to include molecular imaging of the myocardium and of the coronary vasculature. Further advances may require integrating cardiac nuclear cameras with other imaging devices, ie, hybrid imaging cameras. The goal is to image the heart and its physiological processes as accurately as possible, to prevent and cure disease processes.

  14. [The importance of silicone oil removal in prophylaxis of the late complications of internal tamponade].

    PubMed

    Wesołek-Czernik, A; Nawrocki, J; Pikulski, Z; Bogorodzki, B

    1998-01-01

    To present the functional and anatomical results after silicone oil removal. Covers 32 patients (34 eyes), age 29-77 years. Silicone oil removal was performed between February 1993 and December 1994. The indication for silicone oil tamponade was: PDVR (17/34), rhegmatogenous retinal detachment (12/34), trauma (4/34) and vitreous haemorrhage (1/34). The conditions of silicone oil removal were complete retinal attachment within at least 3 months, visual acuity not worse than 1/50, no proliferations, laser photocoagulation of peripheral retina. In postoperative period retina was attached in 30 cases (88%). Retinal detachment was observed in 4 cases (12%). Visual acuity remains unchanged in 27 cases. We found that silicone oil removal leads in the majority of eyes to a stabilisation of visual acuity and reduces the progress of silicone oil-related complications.

  15. Cardiac Sarcoidosis Diagnosed by Incidental Lymph Node Biopsy.

    PubMed

    Matsuda, Jun; Fujiu, Katsuhito; Roh, Solji; Tajima, Miyu; Maki, Hisataka; Kojima, Toshiya; Ushiku, Tetsuo; Nawata, Kan; Takeda, Norihiko; Watanabe, Masafumi; Akazawa, Hiroshi; Komuro, Issei

    2017-02-07

    Cardiac involvement in systemic sarcoidosis sometimes provokes life-threatening ventricular tachyarrhythmia. Steroid administration is one of the fundamental anti-arrhythmia therapies. For an indication of steroid therapy, a definitive diagnosis of sarcoidosis is required.(1)) However, cases that are clearly suspected of cardiac sarcoidosis based on their clinical courses sometimes do not meet the current diagnostic criteria and result in the loss of an appropriate opportunity to perform steroid therapy.Here we report a case that was diagnosed as sarcoidosis by incidental biopsy of an inguinal lymph node during cardiac resuscitation for cardiac tamponade.(2)) While the inguinal lymph node was not swollen on computed tomography, a specimen obtained from an incidental biopsy during the exposure of a femoral vessel for the establishment of extracorporeal cardio-pulmonary resuscitation showed a non-caseating granuloma.This findings suggest a non-swelling lymph node biopsy might be an alternative strategy for the diagnosis for sarcoidosis if other standard strategies do not result in a diagnosis of sarcoidosis.

  16. A new heavy internal tamponade in vitreoretinal surgery: an in vitro study.

    PubMed

    Tognetto, D; Lepori, L; Lapasin, R; Minutola, D; Sanguinetti, G; Michelone, L; Fanni, D; Ravalico, G

    2008-08-01

    AimTo study the solubility of perfluorohexyloctane (F6H8) in silicone oil (polydimethylsiloxane (PDMS) 1000) and to measure the viscosity and the specific gravity of the mixture obtained (heavy silicone oil or HSO tamponade) to define the ideal ratio of these components.MethodsThe solubility diagram of the mixture was obtained with the turbidimetric method, indicating the miscibility of F6H8 and silicone oil 1000 at all the useful temperatures. The viscosity was measured in steady shear conditions by using a controlled stress rheometer (Haake RS150) and a double cone/plate (DC 60/4) system, both at 25 and 37 degrees C for different volume per cent compositions of the mixture. The specific gravity was measured at 37 degrees C using a digital densimeter.ResultsA mixture of F6H8 30 v% and PDMS 70 v% was found to be transparent and stable at all the useful temperatures. By combining these proportions of the two substances, a resultant density of 1.06 g/cm(3) was obtained. The viscosity of the 30% F6H8 mixture was 203 mPa.s at 25 degrees C and 163 mPa.s at 37 degrees C respectively.ConclusionsThe ideal F6H8 and silicone oil mixture can be obtained combining 30% of F6H8 with 70% of silicone oil 1000. This mixture seems to have rheological properties useful for its use as an alternative intraocular heavy tamponade.Eye (2008) 22, 1082-1088; doi:10.1038/eye.2008.144; published online 6 June 2008.

  17. Getting to the heart of hypopituitarism.

    PubMed

    Martin-Grace, Julie; Ahmed, Mohamed; Mulvihill, Niall; Feeney, Eoin R; Crowley, Rachel K

    2017-04-01

    A 53-year-old woman was diagnosed with hypopituitarism following an acute presentation with cardiac tamponade and hyponatraemia, having recently been investigated for a pericardial effusion. Secondary hypothyroidism is a rare cause of pericardial effusion and tamponade, but an important differential to consider. Management requires appropriate hormone replacement and, critically, a low threshold for commencing stress dose steroids. Clinical signs classically associated with cardiac tamponade are frequently absent in cases of tamponade due to primary and secondary hypothyroidism, and the relatively volume deplete state of secondary hypoadrenalism in hypopituitarism may further mask an evolving tamponade, as the rise in right atrial pressure is less marked even in the presence of large effusion. Our case demonstrates the importance of a high index of suspicion for cardiac tamponade in this patient cohort, even in the absence of clinical signs, and for measuring both thyroid-stimulating hormone and thyroxine levels when evaluating a pericardial effusion.

  18. [Treatment of cardiac stab wounds. A thirty-one-year experience].

    PubMed

    Mihalache, St; Adăscăliţei, P D

    2005-01-01

    Penetrating cardiac wounds represent a dramatically pathology of the general surgery because of their clinical presentation and outcome. The cardiorrhaphy with the three successive times, carried out with maximum rapidity is the only safe and efficient surgical technique which leads to hemostasis and healing. The aim of this study was to evaluate our results and experience of penetrating cardiac injuries treated at the Clinic of Surgical Emergencies from Iaşi. 20 patients, 17 men and 3 women, of mean age 34 years (range 18-51), with stab wounds, underwent cardiorrhaphy between 1974 and 2004. The clinical aspects were: "white injured" (hemorrhagic shock) in 3 patients, "blue injured" (cardiac tamponade) in 8 patients, both being implied with some patients, one of the aspects being predominant. 9 patients (45%) had only cardiac injuries and 11 (55%) had other associated injuries. There were 7 intraoperative cardiac arrests and 2 postoperative pulmonary complications. In 16 cases the outcome of patients with cardiac stab wounds was favourable. We recorded 4 deaths. Mortality results from the wounds of the right auricle. The high rate of survival (80%) proves that a penetrating cardiac injury with a heavy prognosis may be turned into a relative traumatism harmless for those patients who will remain alive until they arrive in hospital.

  19. Blunt Traumatic Cardiac Rupture: Single-Institution Experiences over 14 Years

    PubMed Central

    Yun, Jeong Hee; Byun, Joung Hun; Kim, Sung Hwan; Moon, Sung Ho; Park, Hyun Oh; Hwang, Sang Won; Kim, Yong Hwan

    2016-01-01

    Background Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase–myocardial band (CK-MB) levels (p=0.042) and platelet counts (p= 0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. Conclusion We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient’s life. PMID:27965920

  20. Late Cardiac Rupture after Amplatzer Septal Occluder Implantation.

    PubMed

    Arnaz, Ahmet; Turkekul, Yasemin; Yalcinbas, Yusuf; Saygili, Arda; Sarioglu, Tayyar

    2016-12-01

    Transcatheter device implantation has become an attractive alternative to surgery in the closure of atrial septal defects in selected patients. However, it can lead to early and late sequelae, some of them life threatening. For example, 79 days before her admission to our emergency department with sudden-onset respiratory distress and respiratory arrest (leading to cardiac tamponade and rupture), a 22-year-old woman had undergone percutaneous closure of an atrial septal defect. We describe the damage and its treatment. Although the adverse effects of transcatheter device implantation are rare, physicians should know that these events can be life threatening. Further data are needed to prevent such sequelae and to design new devices. It is of utmost importance that patients and their family members be informed both of possible sequelae and of life-saving interventions to be administered at early diagnosis.

  1. Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

    PubMed Central

    Turkekul, Yasemin; Yalcinbas, Yusuf; Saygili, Arda; Sarioglu, Tayyar

    2016-01-01

    Transcatheter device implantation has become an attractive alternative to surgery in the closure of atrial septal defects in selected patients. However, it can lead to early and late sequelae, some of them life threatening. For example, 79 days before her admission to our emergency department with sudden-onset respiratory distress and respiratory arrest (leading to cardiac tamponade and rupture), a 22-year-old woman had undergone percutaneous closure of an atrial septal defect. We describe the damage and its treatment. Although the adverse effects of transcatheter device implantation are rare, physicians should know that these events can be life threatening. Further data are needed to prevent such sequelae and to design new devices. It is of utmost importance that patients and their family members be informed both of possible sequelae and of life-saving interventions to be administered at early diagnosis. PMID:28100979

  2. Successful management of pelvic bleeding after caesarean hysterectomy by means of Foley catheter-condom balloon tamponade

    PubMed Central

    Atilgan, Remzi; Aslan, Kubat; Can, Behzat; Sapmaz, Ekrem

    2014-01-01

    In this case report, we describe a 28-year-old woman with multipar gestation who developed postcaesarean atonia and severe pelvic haemorrhage which continued in spite of peripartum hysterectomy. A balloon tamponade tool was formed with Foley catheter and a condom, and was inserted into the pelvis through the vaginal cuff. The tampon was inflated up to 2200 mL and the pelvic tamponade was applied and bleeding was controlled. On the patient's incapability of urination, the volume of condom was decreased to 1800 mL and urination was achieved. seventy-two h postoperatively the Foley catheter-condom was removed through an abdominal incision. Pelvic bleeding ceased. After monitoring for a week, no postoperative fever, infection, pelvic abscess and haematoma were observed. Use of Foley catheter-condom as a pelvis pressure tampon tool may be a simple and effective method which can be easily used to control pelvic bleeding. PMID:24827667

  3. Successful management of pelvic bleeding after caesarean hysterectomy by means of Foley catheter-condom balloon tamponade.

    PubMed

    Atilgan, Remzi; Aslan, Kubat; Can, Behzat; Sapmaz, Ekrem

    2014-05-14

    In this case report, we describe a 28-year-old woman with multipar gestation who developed postcaesarean atonia and severe pelvic haemorrhage which continued in spite of peripartum hysterectomy. A balloon tamponade tool was formed with Foley catheter and a condom, and was inserted into the pelvis through the vaginal cuff. The tampon was inflated up to 2200 mL and the pelvic tamponade was applied and bleeding was controlled. On the patient's incapability of urination, the volume of condom was decreased to 1800 mL and urination was achieved. seventy-two h postoperatively the Foley catheter-condom was removed through an abdominal incision. Pelvic bleeding ceased. After monitoring for a week, no postoperative fever, infection, pelvic abscess and haematoma were observed. Use of Foley catheter-condom as a pelvis pressure tampon tool may be a simple and effective method which can be easily used to control pelvic bleeding. 2014 BMJ Publishing Group Ltd.

  4. Examination of Self-Sealing Sclerotomy for Vitrectomized Eye under Gas Tamponade in 23-Gauge Transconjunctival Sutureless Vitrectomy.

    PubMed

    Takashina, Hirotsugu; Watanabe, Akira; Mitooka, Katsuya; Tsuneoka, Hiroshi

    2016-01-01

    To investigate whether a previous history of vitrectomy affects sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy. This study retrospectively reviewed two groups, a vitrectomized group (seven consecutive cases) and an initial vitrectomy group (82 consecutive cases), who underwent 23-gauge transconjunctival sutureless vitrectomy at Jikei University School of Medicine Daisan Hospital in Tokyo. Factors affecting sclerotomy self-sealing were examined using multiple regression analysis. The criterion variable was massage time, and independent variables were age, surgical time, axial length, vitreous incarceration, history of vitrectomy, preoperative intraocular pressure (IOP), and postoperative IOP. Age (F = 10.4) was the only significant factor. History of vitrectomy was not a significant factor (F = 0.06). Previous history of vitrectomy does not affect sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

  5. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    PubMed Central

    Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; de Paola, Angelo Amato Vincenzo; Carvalho, Antonio Carlos Camargo; Campos, Orlando

    2014-01-01

    Background Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy. PMID:25590933

  6. Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study.

    PubMed

    Revert, M; Cottenet, J; Raynal, P; Cibot, E; Quantin, C; Rozenberg, P

    2017-07-01

    To evaluate the effectiveness of intrauterine balloon tamponade (IUBT) for management of severe postpartum haemorrhage (PPH). To identify the factors predicting IUBT failure. Prospective cohort study. Ten maternity units in a perinatal network. Women treated by IUBT from July 2010 to March 2013. The global IUBT success rate was expressed as the number of women with severe PPH who were successfully treated by IUBT divided by the total number treated by IUBT. IUBT failure was defined as the need for arterial embolisation or surgery. Logistic regression analysis was used to estimate factors predicting IUBT failure. Global IUBT success rate. Factors associated with IUBT failure. Intrauterine balloon tamponade was attempted in 226 women: 171 after vaginal delivery (VD) (75.7%) and 55 during or after caesarean delivery (CD) (24.3%). The global success rate was 83.2% (188/226) and was significantly higher after VD (152/171, 88.9%) than CD (36/55, 65.5%, P < 0.01). The percentage of CD was significantly higher in the failure group (50.0 versus 19.1%, P < 0.01), as was mean (SD) estimated blood loss before IUBT: 1508 ± 675 ml versus 1064 ± 476, P < 0.01. Coagulopathy was significantly more frequent in the failure group (50.0% versus 17.2%, P < 0.01). CD [Odds ratio (OR) 3.5; 95% CI 1.6-7.6], estimated blood loss before IUBT (OR 3.2; 95% CI 1.5-6.8) and coagulopathy (OR 5.6; 95% CI 2.5-13.0) were predictive of IUBT failure. Intrauterine balloon tamponade is an effective method for treating severe PPH. Early balloon deployment before the development of coagulopathy increases its success rate. Intrauterine balloon tamponade is effective for achieving haemostasis in intractable postpartum haemorrhages. © 2016 Royal College of Obstetricians and Gynaecologists.

  7. Cardiac Rehabilitation

    MedlinePlus

    ... your risk of future heart problems, and to improve your health and quality of life. Cardiac rehabilitation programs increase ... exercise routine at home or at a local gym. You may also continue to ... health concerns. Education about nutrition, lifestyle and weight loss ...

  8. Cardiac complications after laparoscopic large hiatal hernia repair. Is it related with staple fixation of the mesh? -Report of three cases

    PubMed Central

    Fernandez, Maria del Carmen; Diaz, María; López, Fernando; Martí-Obiol, Roberto; Ortega, J.

    2015-01-01

    Introduction Laparoscopic Nissen operation with mesh reinforcement remains being the most popular operation for large hiatal hernia repair. Complications related to mesh placement have been widely described. Cardiac complications are rare, but have a fatal outcome if they are misdiagnosed. Presentation of cases We sought to outline our institutional experience of three patients who developed cardiac complications following a laparoscopic Nissen operation for large hiatal hernia repair. Discussion Laparoscopic hiatoplasty and Nissen fundoplication are safe and effective procedures for the hiatal hernia repair, but they are not exempt from complications. Fixation technique and material used must be taken into account. We have conducted a review of the literature on complications related to these procedures. Conclusion In the differential diagnosis of hemodynamic instability after laparoscopic hiatal hernia repair, cardiac tamponade and other cardiac complications should be considered. PMID:26635954

  9. Hepato-cardiac disorders

    PubMed Central

    Fouad, Yasser Mahrous; Yehia, Reem

    2014-01-01

    Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato-cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. Differential diagnoses of liver injury are extremely important in a cardiologist’s clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic congestive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplantation may lead to the improvement of all cardiac changes and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases PMID:24653793

  10. Self-inflicted Cardiac Injury with Nail Gun Without Hemodynamic Compromise: A Case Report

    PubMed Central

    Ho, Simon; Feranec, Nicholas

    2017-01-01

    Pneumatically powered nail guns have been used in construction since 1959. Penetrating injuries to the heart with nail guns have a wide range of presentations from asymptomatic to cardiac tamponade and exsanguination. Mortality related to cardiac nail gun injuries is similar to knife injuries, estimated at 25%. Surgical exploration is the treatment of choice. We describe a case of self-inflicted nail gun injury to the chest without hemodynamic compromise in a 51-year-old man. Computed tomography (CT) imaging confirmed nail penetrating the right ventricle, with the tip adjacent to but not violating the abdominal aorta. The patient was successfully treated with thoracotomy and foreign body removal. PMID:28191375

  11. Cardiac involvement in DRESS syndrome.

    PubMed

    Thongsri, Tomon; Chularojanamontri, Leena; Pichler, Werner J

    2017-03-01

    Cardiac involvement in drug rash with eosinophilia and systemic symptoms (DRESS) syndrome varies considerably between 4% and 21%. Here we present our case and review literatures for its diagnosis and management. An algorithm for diagnosis of cardiac involvement in DRESS syndrome is proposed in this article. Data regarding DRESS-associated myocarditis and eosinophilic myocarditis were gather primarily from MEDLINE database. DRESS syndrome is a hypersensitivity reaction which is due to massive T cell stimulation resulting in cytotoxicity and eosinophil activation and recruitment. It is characterized by fever, morbilliform rash, and various systemic symptoms, in particular hepatitis. Hypersensitivity myocarditis (acute eosinophilic myocarditis) which is typically related to a drug reaction can lead to acute necrotizing eosinophilic myocarditis, cardiac thrombosis and fibrotic stage. Cardiac symptoms range from no symptoms to cardiogenic shock. Diagnosis is based on history, clinical findings, cardiac biomarkers and cardiac imaging techniques. Endomyocardial biopsy is done in a minority of patients for definite diagnosis. If suspected, drug discontinuation and suppression of immune reactions are the first therapies. Corticosteroids are the cornerstone of systemic treatments and should be initiated at the time of diagnosis of DRESS syndrome. Additional therapy and ventricular assist devices could be considered in refractory cases. According to its high morbidity and mortality, patients with DRESS syndrome should be carefully monitored or screened for cardiac involvement. Multidisciplinary care is important for a successful treatment outcome.

  12. Cardiac emergencies.

    PubMed

    Barata, Isabel Araujo

    2013-08-01

    The diagnosis and management of pediatric cardiac emergencies can be challenging and complicated. Early presentations are usually the result of ductal-dependent lesions and appear with cyanosis and shock. Later presentations are the result of volume overload or pump failure and present with signs of congestive heart failure. Acquired diseases also present as congestive heart failure or arrhythmias. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Cardiac lipoma

    PubMed Central

    Ismail, Imtiaz; Al-Khafaji, Khalid; Mutyala, Monica; Aggarwal, Saurabh; Cotter, William; Hakim, Hosam; Khosla, Sandeep; Arora, Rohit

    2015-01-01

    Lipomas of the heart are encapsulated tumors that are composed primarily of mature fat cells. Cardiac lipomas can originate either from subendocardium (approximately 50%), subpericardium (25%), or from the myocardium (25%) and may be located more frequently in left ventricle or right atrium. We report a 74-year-old female who presented with dyspnea on exertion and was found to have 5×5 cm mass occupying most of the right atrium on a transesophageal echocardiogram. PMID:26486106

  14. Intraocular gas dynamics after 20-gauge and 23-gauge vitrectomy with sulfur hexafluoride gas tamponade.

    PubMed

    Kusuhara, Sentaro; Ooto, Sotaro; Kimura, Daisaku; Itoi, Kyoko; Mukuno, Hirokazu; Miyamoto, Noriko; Akimoto, Masayuki; Takagi, Hitoshi

    2011-02-01

    The purpose of this study was to evaluate the intraocular gas dynamics after 23-gauge transconjunctival sutureless vitrectomy (TSV) as compared with 20-gauge pars plana vitrectomy (PPV). A consecutive series of 290 eyes that experienced 20-gauge or 23-gauge vitrectomy with 25% sulfur hexafluoride (SF6) gas tamponade were retrospectively reviewed. Intraocular gas bubble size on postoperative Day 1 and Gas50, the interval to dissipate to a 50% gas fill, were evaluated. The mean intraocular bubble size on postoperative Day 1 was 92.0 ± 8.3% in the 20-gauge PPV cases and 83.8 ± 13.7% in the 23-gauge TSV cases (P < 0.001). The mean Gas50 was 8.6 ± 1.6 days in the 20-gauge PPV cases and 6.6 ± 2.2 days in the 23-gauge TSV cases (P < 0.001). Thorough peripheral vitrectomy and 23-gauge TSV were significantly associated with Gas50 ≤ 4 days (odds ratio, 4.62 and 16.8; P = 0.036 and P = 0.007, respectively). Among thoroughly vitrectomized eyes, 13 eyes treated with 23-gauge PPV with intraoperative suture placement at the sclerotomy sites had gas longevity comparative to those with 20-gauge PPV. Eyes treated with 23-gauge TSV tend to have earlier gas disappearance or incomplete gas fill. Intraoperative suture placement would be a solution.

  15. Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya.

    PubMed

    Natarajan, Abirami; Alaska Pendleton, Anna; Nelson, Brett D; Ahn, Roy; Oguttu, Monica; Dulo, Lidu; Eckardt, Melody J; Burke, Thomas F

    2016-11-01

    To understand healthcare providers' experiences with improvised uterine balloon tamponade (UBT) for the management of uncontrolled postpartum hemorrhage (PPH). In a qualitative descriptive study, in-depth semi-structured interviews were conducted between November 2014 and June 2015 among Kenyan healthcare providers who had previous experience with improvising a UBT device. Interviews were conducted, audio-recorded, and transcribed. Overall, 29 healthcare providers (14 nurse-midwifes, 7 medical officers, 7 obstetricians, and 1 clinical officer) were interviewed. Providers perceived improvised UBT as valuable for managing uncontrolled PPH. Reported benefits included effectiveness in arresting hemorrhage and averting hysterectomy, and ease of use by providers of all levels of training. Providers used various materials to construct an improvised UBT. Challenges to improvising UBT-e.g. searching for materials during an emergency, procuring male condoms, and inserting fluid via a small syringe-were reported to lead to delays in care. Providers described their introduction to improvised UBT through both formal and informal sources. There was universal enthusiasm for widespread standardized training. Improvised UBT seems to be a valuable second-line treatment for uncontrolled PPH that can be used by providers of all levels. UBT might be optimized by integrating a standard package across the health system. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  17. Cardiac optogenetics.

    PubMed

    Entcheva, Emilia

    2013-05-01

    Optogenetics is an emerging technology for optical interrogation and control of biological function with high specificity and high spatiotemporal resolution. Mammalian cells and tissues can be sensitized to respond to light by a relatively simple and well-tolerated genetic modification using microbial opsins (light-gated ion channels and pumps). These can achieve fast and specific excitatory or inhibitory response, offering distinct advantages over traditional pharmacological or electrical means of perturbation. Since the first demonstrations of utility in mammalian cells (neurons) in 2005, optogenetics has spurred immense research activity and has inspired numerous applications for dissection of neural circuitry and understanding of brain function in health and disease, applications ranging from in vitro to work in behaving animals. Only recently (since 2010), the field has extended to cardiac applications with less than a dozen publications to date. In consideration of the early phase of work on cardiac optogenetics and the impact of the technique in understanding another excitable tissue, the brain, this review is largely a perspective of possibilities in the heart. It covers the basic principles of operation of light-sensitive ion channels and pumps, the available tools and ongoing efforts in optimizing them, overview of neuroscience use, as well as cardiac-specific questions of implementation and ideas for best use of this emerging technology in the heart.

  18. Cardiac optogenetics

    PubMed Central

    2013-01-01

    Optogenetics is an emerging technology for optical interrogation and control of biological function with high specificity and high spatiotemporal resolution. Mammalian cells and tissues can be sensitized to respond to light by a relatively simple and well-tolerated genetic modification using microbial opsins (light-gated ion channels and pumps). These can achieve fast and specific excitatory or inhibitory response, offering distinct advantages over traditional pharmacological or electrical means of perturbation. Since the first demonstrations of utility in mammalian cells (neurons) in 2005, optogenetics has spurred immense research activity and has inspired numerous applications for dissection of neural circuitry and understanding of brain function in health and disease, applications ranging from in vitro to work in behaving animals. Only recently (since 2010), the field has extended to cardiac applications with less than a dozen publications to date. In consideration of the early phase of work on cardiac optogenetics and the impact of the technique in understanding another excitable tissue, the brain, this review is largely a perspective of possibilities in the heart. It covers the basic principles of operation of light-sensitive ion channels and pumps, the available tools and ongoing efforts in optimizing them, overview of neuroscience use, as well as cardiac-specific questions of implementation and ideas for best use of this emerging technology in the heart. PMID:23457014

  19. Investigation following resuscitated cardiac arrest.

    PubMed

    Skinner, Jonathan R

    2013-01-01

    Roughly two thirds of resuscitated cardiac arrests in children and youth are due to inherited heart diseases. The most commonly implicated are the cardiac ion channelopathies long QT syndrome, CPVT (catecholaminergic polymorphic ventricular tachycardia) and Brugada syndrome. Diagnosis is pivotal to further management of the child if he/she survives, and also to other family members who may be at risk. Thorough investigation of the cardiac arrest survivor is essential to either identify or exclude inherited heart disease. If standard cardiac investigation does not reveal a diagnosis, pharmacological provocation tests are needed to unmask electrocardiographic signs of disease, even if, due to severe brain injury, it is planned ultimately to allow a natural death. Examples are the ajmaline/flecainide challenge for Brugada syndrome and epinephrine for CPVT. A supportive, informative and sympathetic approach to the family is essential. An arrhythmia specialist and a cardiac genetic service should be involved early, with storage of DNA and cardiac/genetic investigation of the family. This review proposes a diagnostic algorithm-based approach to the investigation of this increasingly common clinical scenario.

  20. Dynamics of the Macular Hole-Silicone Oil Tamponade Interface with Patient Positioning as Imaged by Spectral Domain Optical Coherence Tomography

    PubMed Central

    Oster, Stephen F.; Mojana, Francesca; Bartsch, Dirk-Uwe G.; Goldbaum, Michael; Freeman, William R.

    2010-01-01

    Purpose To evaluate with spectral domain optical coherence tomography (SD-OCT) the relationship between the retina and overlying silicone oil tamponade after macular hole surgery, and to evaluate how this relationship changes with patient positioning. Patients and Methods Retrospective consecutive case series of 10 eyes from 9 patients who underwent macular hole surgery with silicone oil tamponade and subsequent SD-OCT scans. Four of the included eyes were also imaged with patients in face-down posture to determine if the silicone-retina apposition changes with prone positioning. Finally, a single patient was additionally scanned in the lateral and supine positions. Results The posterior surface of the silicone oil bubble was well visualized in all 10 eyes. In the majority of eyes (7/10) the oil tamponade bridged across the macular hole creating a pre-foveal fluid space, but in 3 eyes the silicone oil filled the macular hole and was seen in touch with the underlying foveal depression or retinal pigment epithelium. In 75% of eyes (3/4) the silicone oil-retinal approximation did not vary with face-down position. Supine positioning clearly floated the silicone tamponade anteriorly and off of the retinal surface. Conclusions Silicone oil tamponade can either bridge across macular holes, or in a novel finding, can fill the underlying foveal depression or macular hole space. Generally, the oil position is stable between face-forward and prone SD-OCT images, suggesting that either of these patient positions allows waterproofing of the underlying macular hole. Finally, our images confirm that supine positioning should be avoided post-operatively as it leads to loss of oil-retinal tamponade. PMID:20531144

  1. PARS PLANA VITRECTOMY AND WIDE INTERNAL LIMITING MEMBRANE PEELING WITH PERFLUOROPROPANE TAMPONADE FOR HIGHLY MYOPIC FOVEOSCHISIS-ASSOCIATED MACULAR HOLE.

    PubMed

    Zhang, Zhaotian; Wei, Yantao; Jiang, Xintong; Zhang, Shaochong

    2017-02-01

    To evaluate the outcomes of pars plana vitrectomy and wide internal limiting membrane peeling with perfluoropropane tamponade (C3F8) for highly myopic foveoschisis-associated macular hole. Prospective consecutive cases with highly myopic foveoschisis-associated macular hole were recruited. All the patients underwent pars plana vitrectomy and indocyanine green-aided internal limiting membrane peeling, the range of internal limiting membrane peeling was broadened beyond the vascular arcades and to the nasal side of the optic disc. With tamponade of 16% C3F8, all the patients kept a face-down position postoperatively. The main outcomes were best-corrected visual acuity and primary anatomical success rate. There were 25 patients (25 eyes) included, with a mean age of 54.8 ± 7.2 years. The mean follow-up duration was 14.2 ± 3.9 months. The mean preoperative logarithm of the minimum angle of resolution best-corrected visual acuity (Snellen equivalent) was 1.489 ± 0.558 (20/617). The mean postoperative logarithm of the minimum angle of resolution best-corrected visual acuity at the final follow-up was 0.882 ± 0.522 (20/152), the difference being statistically significant with the preoperative one (P < 0.001). At the final follow-up, 17 eyes (68.0%) had vision improvement, and the primary anatomical success rate was 84.0% (21/25). Pars plana vitrectomy and wide internal limiting membrane peeling with C3F8 tamponade is effective and safe to achieve a high anatomical success rate of highly myopic foveoschisis-associated macular hole closure and regain visual function.

  2. About Cardiac Arrest

    MedlinePlus

    ... Thromboembolism Aortic Aneurysm More About Cardiac Arrest Updated:Mar 10,2017 What is cardiac arrest? Cardiac arrest is the abrupt loss of heart function in a person who may or may not have diagnosed heart ...

  3. Seasonal variations of cardiac output in rats.

    PubMed

    Back, G; Strubelt, O

    1975-11-15

    Cardiac output of rats shows seasonal variations with low values in spring and summer and high ones in autumn and winter. The stroke volume was much more implicated in these changes than the heart rate. The seasonal changes of cardiac output are probably due to changes of thyroid function.

  4. Evaluation of the functional results after different techniques for treatment of retinal detachment due to macular holes.

    PubMed

    Rashed, O; Sheta, S

    1989-01-01

    A total of 50 eyes with retinal detachment due to macular holes were treated in the period from July 1986 to December 1987. In all, 10 eyes underwent pneumatic retinopexy using plain room air. A total of 30 eyes were treated by pars plana vitrectomy, followed by fluid/air exchange, with no treatment of the macular break; in 9 of these the detachment recurred, reflattening of the retina by air tamponade followed by laser photo-coagulation. The other 10 eyes underwent pars plana vitrectomy followed by silicone oil tamponading because of proliferative vitreoretinopathy (PVR). This paper compares the functional results for each group. The parameters used included visual acuity, color vision and visual fields.

  5. Extramedullary Cardiac Multiple Myeloma-A Case Report and Contemporary Review of the Literature.

    PubMed

    Coakley, Maria; Yeneneh, Beeletsega; Rosenthal, Allison; Fonseca, Rafael; Mookadam, Farouk

    2016-05-01

    Multiple myeloma (MM) is characterized by a clonal proliferation of plasma cells. Although the bone marrow is the usual site of involvement, extramedullary plasmacytomas (EMPs) also occur, affecting any tissue. Cardiac and pericardial involvement, although described, have been rare occurrences. We present the case of a 61-year-old female patient 47 days after autologous stem cell transplant for MM who developed cardiac tamponade owing to extramedullary recurrence of myeloma, pulmonary embolism, and takotsubo cardiomyopathy. We performed a review of the published studies of all cases of MM presenting at diagnosis or relapse with cardiac or pericardial involvement in the past 25 years. Including our patient, 34 patients with plasmacytoma involving cardiac or pericardial structures were identified from the literature search. Approximately equal numbers of patients were male and female (42% and 57%, respectively). The mean age was 62 years. Primary plasmacytomas accounted for 12% of the cases. A history of MM, EMP, or monoclonal gammopathy of uncertain significance was noted in two thirds of the cases (66.6%). Treatment included chemotherapy and/or high-dose corticosteroids in 81.1% of cases and 27% underwent radiation therapy. The reporting of all cases to date has focused on unusual findings, rather than treatment approaches or new therapeutic strategies that might benefit patients. We suggest the formation of a database of all cases of cardiac and pericardial EMPs, with a focus on predictive disease variables, standardized staging, outcomes, and survival, to ensure that patients are optimally treated in the modern era.

  6. Sudden cardiac arrest during pregnancy: a rare complication of acquired maternal diaphragmatic hernia.

    PubMed

    Jacobs, R; Honore, P M; Hosseinpour, N; Nieboer, K; Spapen, H D

    2012-01-01

    Acute cardiac arrest during pregnancy is a rare but devastating event. Major causes are haemorrhagic, septic or anaphylactic shock, trauma, pulmonary or amniotic fluid embolism, and congenital or acquired cardiac disease. We present a case of massive intrathoracic migration of viscera through a left diaphragmatic hernia in a pregnant multipara, causing acute obstructive shock and cardiac arrest. Complications of intrathoracic herniation occur when the intruding viscera cause left lung and cardiac compression or mediastinal "tamponade" with decreased venous return. Intrathoracic strangulation of viscera is also common and may cause ischaemia, gangrene and eventual perforation. Sudden cardiac arrest as first sign of left diaphragmatic rupture during pregnancy, however, has rarely been described. In contrast with our patient, this catastrophic event is mostly seen in nulli- and primipara with a known congenital left diaphragmatic defect. Management of a diaphragmatic hernia depends on the clinical presentation and the period of gestation during which it is detected. Despite prolonged resuscitation with more than 1 hour of chest compressions, our patient recovered completely.

  7. Sudden cardiac death – Historical perspectives

    PubMed Central

    Abhilash, S.P.; Namboodiri, Narayanan

    2014-01-01

    Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. It is believed to be involved in nearly a quarter of human deaths, with ventricular fibrillation being the most common mechanism. It is estimated that more than 7 million lives per year are lost to SCD worldwide. Historical perspectives of SCD are analyzed with a brief description on how the developments in the management of sudden cardiac arrest evolved over time. PMID:24568828

  8. Outcomes in variceal hemorrhage following the use of a balloon tamponade device

    PubMed Central

    Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J.; Sanchez, Leon D.; Wolfe, Richard E.; Chase, Maureen; Donnino, Michael W.; Cocchi, Michael N.

    2017-01-01

    Background Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. Methods In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. Results 34 patients with a BTD were identified. Median age was 57.5 (IQR 47–63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p < 0.01). One complication, an esophageal perforation, was identified and managed conservatively. Conclusion In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. PMID:28460805

  9. Outcomes in variceal hemorrhage following the use of a balloon tamponade device.

    PubMed

    Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J; Sanchez, Leon D; Wolfe, Richard E; Chase, Maureen; Donnino, Michael W; Cocchi, Michael N

    2017-10-01

    Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. 34 patients with a BTD were identified. Median age was 57.5 (IQR 47-63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p<0.01). One complication, an esophageal perforation, was identified and managed conservatively. In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Physiological and pathological cardiac hypertrophy.

    PubMed

    Shimizu, Ippei; Minamino, Tohru

    2016-08-01

    The heart must continuously pump blood to supply the body with oxygen and nutrients. To maintain the high energy consumption required by this role, the heart is equipped with multiple complex biological systems that allow adaptation to changes of systemic demand. The processes of growth (hypertrophy), angiogenesis, and metabolic plasticity are critically involved in maintenance of cardiac homeostasis. Cardiac hypertrophy is classified as physiological when it is associated with normal cardiac function or as pathological when associated with cardiac dysfunction. Physiological hypertrophy of the heart occurs in response to normal growth of children or during pregnancy, as well as in athletes. In contrast, pathological hypertrophy is induced by factors such as prolonged and abnormal hemodynamic stress, due to hypertension, myocardial infarction etc. Pathological hypertrophy is associated with fibrosis, capillary rarefaction, increased production of pro-inflammatory cytokines, and cellular dysfunction (impairment of signaling, suppression of autophagy, and abnormal cardiomyocyte/non-cardiomyocyte interactions), as well as undesirable epigenetic changes, with these complex responses leading to maladaptive cardiac remodeling and heart failure. This review describes the key molecules and cellular responses involved in physiological/pathological cardiac hypertrophy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. The syndrome of cardiac cachexia.

    PubMed

    Anker, Stefan D; Sharma, Rakesh

    2002-09-01

    Cachexia, i.e. body wasting, has long been recognised as a serious complication of chronic illness. The occurrence of wasting in chronic heart failure (CHF) has been known for many centuries, but it has not been investigated extensively until recently. Cardiac cachexia is a common complication of CHF which is associated with poor prognosis, independently of functional disease severity, age, measures of exercise capacity, and left ventricular ejection fraction. Patients with cardiac cachexia suffer from generalised loss of lean tissue, fat tissue, as well as bone tissue. Cachectic CHF patients are weaker and fatigue earlier. This is due to both reduced skeletal muscle mass and impaired skeletal muscle quality. Concerning the pathophysiology of cardiac cachexia, there is increasing evidence that neurohormonal and immune abnormalities may play a crucial role. Cachectic CHF patients have raised plasma levels of norepinephrine, epinephrine, and cortisol, and they show high plasma renin activity and increased plasma aldosterone levels. A number of studies have also shown that cardiac cachexia is linked to raised plasma levels of inflammatory cytokines, such as tumor necrosis factor alpha. The available evidence suggests that cardiac cachexia is a multifactorial neuroendocrine and metabolic disorder with a poor prognosis. A complex imbalance of different body systems, termed catabolic/anabolic imbalance, is likely to be responsible for the development of the wasting process. It is hoped that a better understanding of the pathophysiological mechanisms involved in cardiac cachexia will lead to novel therapeutic strategies in the (near) future.

  12. Modulation of the cardiac membrane-bound cyclic nucleotide phosphodiesterase: inhibition due to a contamination of TLC purified S-adenosyl-L-(methyl-/sup 3/H) methionine by Zn/sup + +/ ions

    SciTech Connect

    Dubois, M.; Prigent, A.F.; Nemoz, G.; Fougier, S.; Pacheco, H.

    1985-07-29

    Cardiac membranes pretreated with S-Adenosyl-L-(methyl-/sup 3/H) methionine((/sup 3/H) SAM) purified on TLC silica gel 60 F/sub 254/ plates exhibited a marked decrease in cyclic AMP and cyclic GMP phosphodiesterase activity. However, this inhibition did not appear when membranes were incubated with either (/sup 14/C) SAM or unlabelled SAM. The authors showed that, during the TLC purification of (/sup 3/H) SAM, which involved an acidic elution step, minute amounts of the fluorescent indicator F/sub 254/ (Zn sulfur) were eluted. The contaminating Zn/sup + +/ ions strongly inhibited cyclic nucleotide phosphodiesterase activity and phospholipid methylation with I/sub 50/ values in micromolar range. 17 references, 4 figures, 2 tables.

  13. Single ventricle cardiac defect.

    PubMed

    Eren, Bulent; Turkmen, Nursel; Turkmen, Nurset; Fedakar, Recep; Senel, Berna; Cetin, Volkan; Cetin, Volkn

    2010-05-01

    Single ventricle heart is defined as a rare cardiac abnormality with a single ventricle chamber involving diverse functional and physiological defects. Our case is of a ten month-old baby boy who died shortly after admission to the hospital due to vomiting and diarrhoea. Autopsy findings revealed cyanosis of finger nails and ears. Internal examination revealed; large heart, weighing 60 grams, single ventricle, without a septum and upper membranous part. Single ventricle is a rare pathology, hence, this paper aims to discuss this case from a medico-legal point of view.

  14. Influence of cirrhosis in cardiac surgery outcomes

    PubMed Central

    Lopez-Delgado, Juan C; Esteve, Francisco; Javierre, Casimiro; Ventura, Josep L; Mañez, Rafael; Farrero, Elisabet; Torrado, Herminia; Rodríguez-Castro, David; Carrio, Maria L

    2015-01-01

    Liver cirrhosis has evolved an important risk factor for cardiac surgery due to the higher morbidity and mortality that these patients may suffer compared with general cardiac surgery population. The presence of contributing factors for a poor outcome, such as coagulopathy, a poor nutritional status, an adaptive immune dysfunction, a degree of cirrhotic cardiomyopathy, and a degree of renal and pulmonary dysfunction, have to be taken into account for surgical evaluation when cardiac surgery is needed, together with the degree of liver disease and its primary complications. The associated pathophysiological characteristics that liver cirrhosis represents have a great influence in the development of complications during cardiac surgery and the postoperative course. Despite the population of cirrhotic patients who are referred for cardiac surgery is small and recommendations come from small series, since liver cirrhotic patients have increased their chance of survival in the last 20 years due to the advances in their medical care, which includes liver transplantation, they have been increasingly considered for cardiac surgery. Indeed, there is an expected rise of cirrhotic patients within the cardiac surgical population due to the increasing rates of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, especially in western countries. In consequence, a more specific approach is needed in the assessment of care of these patients if we want to improve their management. In this article, we review the pathophysiology and outcome prediction of cirrhotic patients who underwent cardiac surgery. PMID:25914775

  15. Safety of medium-chain triglycerides used as an intraocular tamponading agent in an experimental vitrectomy model rabbit.

    PubMed

    Auriol, Sylvain; Mahieu, Laurence; Brousset, Pierre; Malecaze, François; Mathis, Véronique

    2013-01-01

    To evaluate safety of medium-chain triglycerides used as a possible intraocular tamponading agent. A 20-gauge pars plana vitrectomy was performed in the right eye of 28 rabbits. An ophthalmologic examination was performed every week until rabbits were killed. At days 7, 30, 60, and 90, rabbits were killed and the treated eyes were examined macroscopically and prepared for histologic examination. Principal outcome was retinal toxicity evaluated by light and electron microscopy, and secondary outcomes were the presence of medium-chain triglyceride emulsification, inflammatory reactions, and the development of cataract. Histologic examination did not reveal any retinal toxicity. Two cases of moderate emulsification were observed, but in these cases, emulsification was caused by the perioperative injection of the agent and did not increase during the postoperative period. We noted 13 cases of inflammatory reaction in vitreous cavity and no case of inflammatory reaction in anterior chamber. Two eyes developed cataract as a result of perioperative trauma to the lens with the vitreous cutter and not secondary to the presence of medium-chain triglycerides in the vitreous cavity. Medium-chain triglycerides did not induce morphologic evidence of retinal toxicity. The results suggest that medium-chain triglycerides could be a promising alternative intraocular tamponading agent for the treatment of retinal detachments.

  16. Ultrasound-guided serial transabdominal cardiac biopsies in cats.

    PubMed

    van Essen, Vivian J; Uilenreef, Joost J; Szatmári, Viktor; Veldhuis Kroeze, Edwin J B; Kuiper, Raoul V; Rothuizen, Jan; de Bruin, Alain

    2012-03-01

    A percutaneous/transdiaphragmatic core needle biopsy technique was developed in cats to obtain serial biopsies from different locations of the left ventricle, through which morphological and molecular changes within the same individual can be studied to unravel the mechanisms of feline cardiomyopathies. Transmural left ventricular myocardial samples were obtained from 29 anesthetized, healthy, adult cats with ultrasound guidance. An 18G automatic biopsy needle was inserted between the last left rib and the sternum through the diaphragm into the thorax. Biopsies were obtained from the left ventricular wall. In five cats, three single biopsies were taken with 4-week intervals. Autopsy was performed on six cats, of which three cats had serial biopsies. In total, 87 biopsies were obtained without long-term effects on cardiac function or structure. The biopsies caused transient single ventricular premature complexes and mild pericardial effusion without tamponade. Necropsy revealed a minimal amount of fibrous connective tissue in the diaphragm and the heart without any significant microscopic lesions in the adjacent muscle tissue. The high quality biopsy material was suitable for morphological and molecular studies. This minimally invasive, ultrasound-guided cardiac biopsy technique thus allows for the safe collection of serial biopsies to study feline cardiomyopathies in an experimental setting.

  17. Magnetic resonance imaging in the evaluation of congestive cardiac failure.

    PubMed

    Rajiah, Prabhakar

    2012-07-01

    Congestive cardiac failure is the end-result of various cardiac disorders, and is a major contributor to morbidity, mortality, and financial burden throughout the world. Due to advances in the knowledge of the disease and scanner technology, magnetic resonance imaging (MRI) is playing an increasingly important role in the evaluation of cardiac failure, including in establishing diagnosis, problem solving, risk stratification, and monitoring of therapy. This review discusses and illustrates the role of MRI in the assessment of congestive cardiac failure.

  18. [Technical Note: Subclavian artery misplacement of a 12F Shaldon catheter: percutaneous repair with a local closure device under temporary balloon tamponade].

    PubMed

    Wildberger, J E; Katoh, M; Fussen, R; Günther, R W

    2006-06-01

    A case of subsequent percutaneous repair using a local closure device with a collagen block (VasoSeal(R)) and temporary balloon tamponade after inadvertent subclavian artery misplacement of a 12F Shaldon catheter is reported. Balloon occlusion safely prevented displacement of collagen into the vascular lumen by occluding the 12F entry site. Furthermore, collagen-induced coagulation was facilitated.

  19. The Effects of Radiofrequency or Cryothermal Ablation on Biomechanical Properties of Isolated Human or Swine Cardiac Tissues.

    PubMed

    Quallich, Stephen G; Kriege, Kevin E; Iaizzo, Paul A

    2016-01-01

    Changes in cardiac tissue properties following the application of various ablation modalities may lead to the development of an array of associated complications. The application of either radio frequency (RF) or cryothermal ablations will alter the biomechanical properties of various cardiac tissues in a differential manner; in some cases, this may be attributable to increased incidences of cardiac tamponade, pulmonary vein stenosis, and/or atrial-esophageal fistula. Thus, a greater understanding of the underlying changes in tissue properties induced by ablative therapies will ultimately promote safer and more efficacious procedures. The effects of applied RF or cryothermal energies on the biomechanical properties of the pulmonary vein, left atrial, or right atrial samples ([Formula: see text]) were examined from fresh excised porcine ([Formula: see text]) and donated human tissue ([Formula: see text]). RF ablations were found to reduce the tensile strength of the porcine cardiac specimens ([Formula: see text]), and a similar trend was noted for human samples. Cryoablations did not have a significant impact on the tissue properties compared with the untreated tissue specimens. Locational and species differences were also observed in this experimental paradigm ([Formula: see text]. Incorporating these findings into cardiac device design and computational modeling should aid to reduce the risks of complications associated with tissue property changes resulting from cardiac ablative procedures.

  20. A randomized trial of early versus delayed mediastinal drain removal after cardiac surgery using silastic and conventional tubes

    PubMed Central

    Moss, Emmanuel; Miller, Corey S.; Jensen, Henrik; Basmadjian, Arsène; Bouchard, Denis; Carrier, Michel; Perrault, Louis P.; Cartier, Raymond; Pellerin, Michel; Demers, Philippe

    2013-01-01

    OBJECTIVES Mediastinal drainage following cardiac surgery with traditional large-bore plastic tubes can be painful and cumbersome. This study was designed to determine whether prolonged drainage (5 days) with a silastic tube decreased the incidence of significant pericardial effusion and tamponade following aortic or valvular surgery. METHODS One hundred and fifty patients undergoing valvular or aortic surgery in a tertiary cardiac surgery institution were randomized to receive a conventional mediastinal tube plus a silastic Blake drain (n = 75), or two conventional tubes (n = 75). Conventional drains were removed on postoperative day (POD) 1, while Blake drains were removed on POD 5. The primary end-point was the combined incidence of significant pericardial effusion (≥15 mm) or tamponade through POD 5. Secondary end-points included total mediastinal drainage, postoperative atrial fibrillation (AF) and pain. RESULTS Analysis was performed for 67 patients in the Blake group and 73 in the conventional group. There was no difference between the two groups in the combined end-point of significant effusion or tamponade (7.4 vs 8.3%, P = 0.74), or in the incidence of AF (47 vs 46%, P = 0.89). Mean 24-h drainage was greater in the Blake group than in the conventional group (749 ± 444 ml vs 645 ± 618 ml, P < 0.01). Overall incidence of significant pericardial effusion at 30 days was 12.1% (n = 17), with 5% (n = 7) requiring drainage. The Blake group had a numerically lower incidence of effusion requiring drainage at POD 30 (3.0 vs 6.8%, P = 0.44). Postoperative pain was similar between groups. CONCLUSIONS In patients undergoing ascending aortic or valvular surgery, prolonged drainage with silastic tubes is safe and does not increase postoperative pain. There was no difference between the Blake and conventional drains with regard to significant pericardial effusion or tamponade in this cohort; however, this conclusion is limited by the low overall incidence of the

  1. Systemic therapy for cardiac sarcomas.

    PubMed

    Ravi, Vinod; Benjamin, Robert S

    2010-01-01

    Cardiac sarcomas create 2 risks: local problems and metastatic disease. Most frequently, the histologies are angiosarcoma and high-grade pleomorphic unclassified sarcoma (formerly called MFH or malignant fibrous histiocytoma). There is also a clinical-pathological entity without distinctive histological features of tumors that originate in the pulmonary artery and are referred to as pulmonary artery sarcomas or intimal sarcomas of the pulmonary artery. Conventional wisdom indicates that soft-tissue sarcomas are poorly responsive to chemotherapy. Luckily, that is not the case. Attempts to concentrate on the local problem only with therapies up to and including cardiac transplantation have been unsuccessful due to the high rate of fatal metastatic disease.

  2. Usefulness of cardiac resynchronisation therapy devices and implantable cardioverter defibrillators in the treatment of heart failure due to severe systolic dysfunction: systematic review of clinical trials and network meta-analysis

    PubMed Central

    García García, M A; Rosero Arenas, M A; Ruiz Granell, R; Chorro Gascó, F J; Martínez Cornejo, A

    2016-01-01

    Aim To assess the effectiveness of cardiac resynchronisation therapy (CRT), implantable cardioverter defibrillator (ICD) therapy, and the combination of these devices (CRT+ICD) in adult patients with left ventricular dysfunction and symptomatic heart failure. Methods A comprehensive systematic review of randomised clinical trials was conducted. Several electronic databases (PubMed, Embase, Ovid, Cochrane, ClinicalTrials.gov) were reviewed. The mortality rates between treatments were compared. A network was established comparing the various options, and direct, indirect and mixed comparisons were made using multivariate meta-regression. The degree of clinical and statistical homogeneity was assessed. Results 43 trials involving 13 017 patients were reviewed. Resynchronisation therapy, defibrillators, and combined devices (CRT+ICD) are clearly beneficial compared to optimal medical treatment, showing clear benefit in all of these cases. In a theoretical order of efficiency, the first option is combined therapy (CRT+ICD), the second is CRT, and the third is defibrillator implantation (ICD). Given the observational nature of these comparisons, and the importance of the overlapping CIs, we cannot state that the combined option (CRT+ICD) offers superior survival benefit compared to the other two options. Conclusions The combined option of CRT+ICD seems to be better than the option of CRT alone, although no clear improvement in survival was found for the combined option. It would be advisable to perform a direct comparative study of these two options. PMID:27326223

  3. One-year outcome after Descemet membrane endothelial keratoplasty (DMEK) comparing sulfur hexafluoride (SF6) 20% versus 100% air for anterior chamber tamponade.

    PubMed

    Schaub, Friederike; Enders, Philip; Snijders, Katharina; Schrittenlocher, Silvia; Siebelmann, Sebastian; Heindl, Ludwig M; Bachmann, Björn O; Cursiefen, Claus

    2017-07-01

    To investigate 1-year clinical outcome and complication rates following Descemet membrane endothelial keratoplasty (DMEK) with sulfur hexafluoride 20% (SF620%) anterior chamber tamponade compared with conventionally used 100% air for primary graft attachment during DMEK surgery. Records of 1112 consecutive DMEKs were reviewed retrospectively and grouped by anterior chamber tamponade used during DMEK surgery (SF620% vs 100% air). Outcome measures included intraocular pressure (IOP), best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD) and central corneal thickness (CCT) at 1, 3, 6 and 12 months after DMEK surgery. Complication rates were assessed, including intraoperative and postoperative complications, and graft detachment rate requiring rebubbling. A total of 854 cases were included in this study. In 105 cases (12.3%), DMEK was performed with SF620%, and in 749 cases (87.7%) 100% air was used for anterior chamber tamponade. Outcome results for IOP, BSCVA, ECD and CCT at all follow-up time points were comparable for both anterior chamber tamponade groups without statistical significant differences (p≥0.05), but graft detachment rate requiring rebubbling was significantly lower in the SF620% group (p<0.001). Whereas SF620% anterior chamber tamponade does not seem to negatively affect the clinical outcome of DMEK surgery within the first postoperative year, use of SF620% significantly reduces the rate of rebubblings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Cardiac manifestations in Behcet's disease

    PubMed Central

    Demirelli, Selami; Degirmenci, Husnu; Inci, Sinan; Arisoy, Arif

    2015-01-01

    Summary Behcet's disease (BD) is a chronic inflammatory disorder, with vasculitis underlying the pathophysiology of its multisystemic effects. Venous pathology and thrombotic complications are hallmarks of BD. However, it has been increasingly recognised that cardiac involvement and arterial complications are also important aspects of the course of the disease. Cardiac lesions include pericarditis, endocarditis, intracardiac thrombosis, myocardial infarction, endomyocardial fibrosis, and myocardial aneurysm. Treatment of cardiovascular involvement in BD is largely empirical, and is aimed towards suppressing the vasculitis. The most challenging aspect seems to be the treatment of arterial aneurysms and thromboses due to the associated risk of bleeding. When the prognosis of cardiac involvement in BD is not good, recovery can be achieved through oral anticoagulation, immunosuppressive therapy, and colchicine use. In this review, we summarise the cardiovascular involvement, different manifestations, and treatment of BD. PMID:25984424

  5. Cardiac xenotransplantation.

    PubMed

    DiSesa, V J

    1997-12-01

    Heart failure is an important medical and public health problem. Although medical therapy is effective for many people, the only definitive therapy is heart transplantation, which is limited severely by the number of donors. Mechanical devices presently are used as "bridges" to transplantation. Their widespread use may solve the donor shortage problem, but at present, mechanical devices are limited by problems related to blood clotting, power supply, and foreign body infection. Cardiac xenotransplantation using animal donors is a potential biologic solution to the donor organ shortage. The immune response, consisting of hyperacute rejection, acute vascular rejection, and cellular rejection, currently prevents clinical xenotransplantation. Advances in the solution of these problems have been made using conventional immunosuppressive drugs and newer agents whose use is based on an understanding of important steps in xenoimmunity. The most exciting approaches use tools of molecular biology to create genetically engineered donors and to induce states of donor and recipient bone marrow chimerism and tolerance in xenogeneic organ recipients. The successful future strategy may use a combination of a genetically engineered donor and a chimeric recipient with or without nonspecific immunosuppressive drugs.

  6. Weekend versus weekday hospital admission and outcomes during hospitalization for patients due to worsening heart failure: a report from Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD).

    PubMed

    Hamaguchi, Sanae; Kinugawa, Shintaro; Tsuchihashi-Makaya, Miyuki; Goto, Daisuke; Tsutsui, Hiroyuki

    2014-05-01

    The day of the week of admission may influence the length of stay and in-hospital death. However, the association between the admission day of the week and in-hospital outcomes has been inconsistent in heart failure (HF) patients among studies reported from Western countries. We thus analyzed this association in HF patients encountered in routine clinical practice in Japan. We studied the characteristics and in-hospital treatment in 1620 patients hospitalized with worsening HF by using the database of the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Patients were divided into two groups according to weekday (n = 1355; 83.6%) or weekend admission (n = 265; 16.4%). The mean age was 70.7 years and 59.4% were male. Etiology was ischemic in 34.0%, and mean left ventricular ejection fraction was 42.5%. Patients admitted on the weekend were significantly older and had more comorbidities, and more severe symptoms and signs of HF on admission. Length of stay was comparable between weekend and weekday admission (35.2 ± 47.0 days vs 33.6 ± 32.0 days, P = 0.591). Crude in-hospital mortality did not differ between patients admitted on the weekend and weekdays (7.5% vs 5.2%, P = 0.136). Even after adjustment for covariates in multivariable modeling with patients admitted on weekday as the reference, in-hospital death was comparable between patients admitted on the weekend and weekdays (adjusted odds ratio 1.125, 95% confidence interval 0.631-2.004, P = 0.691). Among patients hospitalized for worsening HF, admission day of the week did not affect in-hospital death and length of stay.

  7. Sudden cardiac death: A reappraisal.

    PubMed

    Steinberg, Christian; Laksman, Zachary W M; Krahn, Andrew D

    2016-11-01

    Sudden cardiac death (SCD) is still among the leading causes of death in women and men, accounting for over 50% of all fatal cardiovascular events in the United States. Two arrhythmia mechanisms of SCD can be distinguished as follows: shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia) and non-shockable rhythms including asystole or pulseless electrical activity. The overall prognosis of cardiac arrest due to shockable rhythms is significantly better. While the majority of SCDs is attributed to coronary artery disease or other structural heart disease, no obvious cause can be identified in 5% of all events, and those events are labeled as sudden unexplained deaths (SUD). Those unexplained events are typically caused by rare hereditary electrical disorders or arrhythmogenic cardiomyopathies. A systematic approach to the diagnosis of cardiac arrest followed by tailored therapy based on etiology has emerged in the last 10-15 years, with significant changes of medical practice and risk management of cardiac arrest victims. The aim of this review is to summarize our contemporary understanding of SCD/SUD in adults and to discuss current concepts of management and secondary prevention in cardiac arrest victims. A full discussion of the topic of primary prevention of SCD is beyond the scope of this article.

  8. [Cardiac surgery in the elderly].

    PubMed

    Wiegmann, B; Ismail, I; Haverich, A

    2017-02-01

    Due to the increasing demographic changes and the fact that cardiovascular diseases are still the leading cause of death, the mean chronological age of patients undergoing cardiac surgery is steadily increasing. In 2015, 14.8% of these patients were aged 80 years and older. This meta-analysis reviewed if and under what circumstances elderly patients benefit from cardiac surgical procedures without running the risk of limitations in the quality of life and high rates of morbidity and mortality. Generally, the chronological age was not a risk factor for higher perioperative and postoperative morbidity and mortality but the biological age was the critical factor, in particular the associated comorbidities of patients and the timing of the surgical procedure in the course of the disease. The result is that elective operations resulted in a better outcome than operations in a symptomatic or decompensated stage of a disease. Compared to patients receiving conventional medicinal therapy, elderly patients undergoing cardiac surgery had an improved life expectancy. A significant increase in the quality of life could also be identified and was ultimately comparable to those of younger patients after cardiac surgery; therefore, elderly patients even those over 80 years old benefit in all aspects of cardiac surgery, as long as individually adapted operative techniques are considered.

  9. Role of diclofenac in the prevention of postpericardiotomy syndrome after cardiac surgery

    PubMed Central

    Sevuk, Utkan; Baysal, Erkan; Altindag, Rojhat; Yaylak, Baris; Adiyaman, Mehmet Sahin; Ay, Nurettin; Alp, Vahhac; Beyazit, Unal

    2015-01-01

    Objective Postpericardiotomy syndrome (PPS), which is thought to be related to autoimmune phenomena, represents a common postoperative complication in cardiac surgery. Late pericardial effusions after cardiac surgery are usually related to PPS and can progress to cardiac tamponade. Preventive measures can reduce postoperative morbidity and mortality related to PPS. In a previous study, diclofenac was suggested to ameliorate autoimmune diseases. The aim of this study was to determine whether postoperative use of diclofenac is effective in preventing early PPS after cardiac surgery. Methods A total of 100 patients who were administered oral diclofenac for postoperative analgesia after cardiac surgery and until hospital discharge were included in this retrospective study. As well, 100 patients undergoing cardiac surgery who were not administered nonsteroidal anti-inflammatory drugs were included as the control group. The existence and severity of pericardial effusion were determined by echocardiography. The existence and severity of pleural effusion were determined by chest X-ray. Results PPS incidence was significantly lower in patients who received diclofenac (20% vs 43%) (P<0.001). Patients given diclofenac had a significantly lower incidence of pericardial effusion (15% vs 30%) (P=0.01). Although not statistically significant, pericardial and pleural effusion was more severe in the control group than in the diclofenac group. The mean duration of diclofenac treatment was 5.11±0.47 days in patients with PPS and 5.27±0.61 days in patients who did not have PPS (P=0.07). Logistic regression analysis demonstrated that diclofenac administration (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.18–0.65, P=0.001) was independently associated with PPS occurrence. Conclusion Postoperative administration of diclofenac may have a protective role against the development of PPS after cardiac surgery. PMID:26170687

  10. [Cardiac Mechanics Evaluated by Speckle Tracking Echocardiography.

    PubMed

    Abduch, Maria Cristina Donadio; Alencar, Adriano Mesquita; Mathias Jr, Wilson; Vieira, Marcelo Luiz de Campos

    2014-03-25

    Natural myocardial markers, or speckles, originated from constructive and destructive interference of ultrasound in the tissues may provide early diagnosis of myocardial changes and be used in the prediction of some cardiac events. Due to its relatively temporal stability, speckles can be tracked by dedicated software along the cardiac cycle, enabling the analysis of the systolic and diastolic function. They are identified by either conventional 2D grey scale and by 3D echo, conferring independence of the insonation angle, thus allowing assessment of cardiac mechanics in the three spatial planes: longitudinal, circumferential, and radial. The purposes of the present paper are: to discuss the role and the meaning of cardiac strain obtained by speckle tracking during the evaluation of cardiac physiology and to discuss clinical applications of this novel echocardiographic technology.

  11. Cardiac mechanics evaluated by speckle tracking echocardiography.

    PubMed

    Abduch, Maria Cristina Donadio; Alencar, Adriano Mesquita; Mathias, Wilson; Vieira, Marcelo Luiz de Campos

    2014-04-01

    Natural myocardial markers, or speckles, originated from constructive and destructive interference of ultrasound in the tissues may provide early diagnosis of myocardial changes and be used in the prediction of some cardiac events. Due to its relatively temporal stability, speckles can be tracked by dedicated software along the cardiac cycle, enabling the analysis of the systolic and diastolic function. They are identified by either conventional 2D grey scale and by 3D echo, conferring independence of the insonation angle, thus allowing assessment of cardiac mechanics in the three spatial planes: longitudinal, circumferential, and radial. The purposes of the present paper are: to discuss the role and the meaning of cardiac strain obtained by speckle tracking during the evaluation of cardiac physiology and to discuss clinical applications of this novel echocardiographic technology.

  12. Cardiac Mechanics Evaluated by Speckle Tracking Echocardiography

    PubMed Central

    Abduch, Maria Cristina Donadio; Alencar, Adriano Mesquita; Mathias, Wilson; Vieira, Marcelo Luiz de Campos

    2014-01-01

    Natural myocardial markers, or speckles, originated from constructive and destructive interference of ultrasound in the tissues may provide early diagnosis of myocardial changes and be used in the prediction of some cardiac events. Due to its relatively temporal stability, speckles can be tracked by dedicated software along the cardiac cycle, enabling the analysis of the systolic and diastolic function. They are identified by either conventional 2D grey scale and by 3D echo, conferring independence of the insonation angle, thus allowing assessment of cardiac mechanics in the three spatial planes: longitudinal, circumferential, and radial. The purposes of the present paper are: to discuss the role and the meaning of cardiac strain obtained by speckle tracking during the evaluation of cardiac physiology and to discuss clinical applications of this novel echocardiographic technology. PMID:24844877

  13. Dipyridamole cardiac imaging

    SciTech Connect

    Iskandrian, A.S.; Heo, J.; Askenase, A.; Segal, B.L.; Auerbach, N.

    1988-02-01

    Dipyridamole cardiac imaging is a useful alternative technique to exercise stress testing in the evaluation of patients with ischemic heart disease. Intravenous dipyridamole is still in the investigational phase, while oral dipyridamole is widely available. The hemodynamic effects of dipyridamole include an increase in coronary blood flow (due to coronary vasodilation) which is in excess of the increase in myocardial oxygen consumption and cardiac output. The disparity in the increase in coronary blood flow relative to the cardiac output results in an increase in myocardial thallium activity and an increase in the myocardial/background activity ratio. The quality of the thallium images is better or similar to that of exercise thallium images. The optimal dose of intravenous dipyridamole is 0.56 mg/kg, and of the oral dose it is 300 to 400 mg, although higher doses may be necessary in some patients. Analysis of the thallium images has been to a large extent based on visual inspection of the planar images. Delayed images are helpful to establish the nature of the perfusion abnormalities (transient or fixed). The process of redistribution is based on disparate rates of washout from the normal and abnormal zones. The sensitivity and specificity of dipyridamole thallium imaging, whether intravenous or oral, have been shown in a number of studies to be quite adequate and comparable to that achieved during exercise thallium imaging. Dipyridamole two-dimensional echocardiography has also been used in the detection of coronary artery disease; transient (new or worsening of preexisting) wall motion abnormalities have been found to be a specific marker of coronary artery disease. Transmural as well as regional coronary steal phenomena have been postulated as the mechanism for dipyridamole-induced regional wall motion abnormalities. 65 references.

  14. Primary Cardiac Allograft Dysfunction—Validation of a Clinical Definition

    PubMed Central

    Dronavalli, Vamsidhar B.; Rogers, Chris A.; Banner, Nicholas R.

    2015-01-01

    Background Heart transplantation is an established treatment for advanced heart failure. Primary allograft dysfunction (PGD) is reported in up to 40% of transplants and is associated with a poor outcome. Methods As part of Heart Evaluation and Retrieval for Transplantation study, an investigation of the assessment of donor hearts for transplantation, we proposed a clinical definition for cardiac PGD comprising severely impaired systolic function affecting one or both ventricles accompanied by hypotension, low cardiac output, and high filling pressures occurring in the first 72 hours (in the absence of hyper acute rejection and technical surgical factors, such as cardiac tamponade). Here, we examine the prospective application of this definition to 290 heart transplants. We compared the clinical outcome of PGD and non-PGD cases. Results Ninety-four of 290 transplants developed PGD (32.4%). Inotrope use (score) was higher in the PGD group at 24, 48, and 72 hours after transplantation (P < 0.01). In the PGD group, there was a greater requirement for, intra-aortic balloon pump (50% vs 15%, P < 0.01), mechanical support (27% vs 0%, P < 0.01), and renal replacement therapy (61% vs 26%, P < 0.01). Intensive care stay was longer for recipients with PGD (median 14 vs 5 days, P < 0.01) and early mortality was higher (37% vs 4% at 30 days, 42% vs 8% at 1 year, P < 0.01). Conclusions In conclusion, our definition of PGD could be applied in a national multicenter study, and the cases it defined had more frequent complications and higher mortality. PMID:25742423

  15. Cardiac monitoring for cholinesterase inhibitors: a survey.

    PubMed

    Maliepaard, Dirk; MacEwan, Tom

    2009-06-01

    There is no consensus on the monitoring for rare but potentially serious cardiac adverse events associated with cholinesterase inhibitor drugs in the treatment of dementia. Different protocols have been proposed, with and without ECG examination. We surveyed an urban old age psychiatry service to investigate the variables that may influence the implementation of such protocols. Case notes of 45 consecutive patients assessed for dementia were scrutinized, to establish how many underwent an ECG or other cardiac examination prior to drug treatments. Data were collected on demographics, medical conditions and drug treatments. Patient files were searched for indications of investigations and any outcomes. Half of all patients treated with a cholinesterase inhibitor (11/22) had an ECG before treatment. In five cases no pulse or cardiac symptoms were recorded in the absence of an ECG. Medical history, findings on examination, seniority of the clinician, and patient cooperation all may have influenced whether patients had an ECG. In three cases treatment was not prescribed due to concerns over cardiac effects, and with five ECGs new diagnoses were made. A protocol based on pulse monitoring would only have indicated ECGs in two out of 22 cases. Several factors may influence decisions on cardiac monitoring. Fewer ECGs could be done if only pulse and cardiac symptoms were monitored before cholinesterase inhibitor prescription, but new cardiac diagnoses might then be missed. Protocols can be devised to incorporate both cardiac investigation and cholinesterase inhibitor monitoring.

  16. Cardiac Risk Assessment

    MedlinePlus

    ... helpful? Formal name: Cardiac Risk Assessment Related tests: Lipid Profile , VLDL Cholesterol , hs-CRP , Lp(a) Overview | Common ... on Coronary artery disease: Tests and diagnosis .) The lipid profile is the most important blood test for cardiac ...

  17. Cardiac conduction system

    MedlinePlus Videos and Cool Tools

    ... cardiac muscle cells in the walls of the heart that send signals to the heart muscle causing it to contract. The main components ... the cardiac conduction system's electrical activity in the heart.

  18. Cardiac Resynchronization Therapy (CRT)

    MedlinePlus

    ... Venous Thromboembolism Aortic Aneurysm More Cardiac Resynchronization Therapy (CRT) Updated:Apr 24,2015 If you have heart ... may be a candidate for cardiac resynchronization therapy (CRT). What is CRT and how can it help ...

  19. Cardiac metastasis of oral squamous cell carcinoma.

    PubMed

    Pattni, Neeraj; Rennie, Andrew; Hall, Timothy; Norman, Aidan

    2015-09-09

    We present a case of isolated cardiac metastasis of oral squamous cell carcinoma. An 89-year-old woman was due to undergo curative resection of a histologically proven squamous cell carcinoma of the retromolar region. On admission, it was noted that there were ECG changes, and following further investigations, the patient was diagnosed with a cardiac metastasis of her oral malignancy. The presentation, including the diagnostic difficulties, as well as the clinical features of this rare case, are discussed.

  20. Cardiac Med1 deletion promotes early lethality, cardiac remodeling, and transcriptional reprogramming.

    PubMed

    Spitler, Kathryn M; Ponce, Jessica M; Oudit, Gavin Y; Hall, Duane D; Grueter, Chad E

    2017-04-01

    The mediator complex, a multisubunit nuclear complex, plays an integral role in regulating gene expression by acting as a bridge between transcription factors and RNA polymerase II. Genetic deletion of mediator subunit 1 (Med1) results in embryonic lethality, due in large part to impaired cardiac development. We first established that Med1 is dynamically expressed in cardiac development and disease, with marked upregulation of Med1 in both human and murine failing hearts. To determine if Med1 deficiency protects against cardiac stress, we generated two cardiac-specific Med1 knockout mouse models in which Med1 is conditionally deleted (Med1cKO mice) or inducibly deleted in adult mice (Med1cKO-MCM mice). In both models, cardiac deletion of Med1 resulted in early lethality accompanied by pronounced changes in cardiac function, including left ventricular dilation, decreased ejection fraction, and pathological structural remodeling. We next defined how Med1 deficiency alters the cardiac transcriptional profile using RNA-sequencing analysis. Med1cKO mice demonstrated significant dysregulation of genes related to cardiac metabolism, in particular genes that are coordinated by the transcription factors Pgc1α, Pparα, and Errα. Consistent with the roles of these transcription factors in regulation of mitochondrial genes, we observed significant alterations in mitochondrial size, mitochondrial gene expression, complex activity, and electron transport chain expression under Med1 deficiency. Taken together, these data identify Med1 as an important regulator of vital cardiac gene expression and maintenance of normal heart function.NEW & NOTEWORTHY Disruption of transcriptional gene expression is a hallmark of dilated cardiomyopathy; however, its etiology is not well understood. Cardiac-specific deletion of the transcriptional coactivator mediator subunit 1 (Med1) results in dilated cardiomyopathy, decreased cardiac function, and lethality. Med1 deletion disrupted cardiac

  1. External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    PubMed

    Hogan, T S

    2012-10-01

    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient's cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  2. Death Due to Intra-aortic Migration of Kirschner Wire From the Clavicle

    PubMed Central

    Tan, Lei; Sun, Da-Hui; Yu, Tiecheng; Wang, Linxiang; Zhu, Dong; Li, Yan-Hui

    2016-01-01

    Abstract Migration of orthopedic fixation wires into the ascending aorta though a rare occurrence can have devastating consequences. Therefore, prompt recognition, with immediate and cautious retrieval of the implant is paramount in averting these complications. We present a case of a 5-year-old boy with the intra-aortic migration of a K-wire used for the treatment of a right clavicle fracture. He was transferred to us with a history of syncope, chest pain, and shortness of breath 7 days after K-wire placement, which was performed at another hospital. On CT scan, the wire was found to be partially inside the ascending aorta, which was associated with massive hemopericardium and cardiac tamponade. The patient was taken up for emergency surgery for the removal K-wire and for the management of cardiac temponade. However, the patient developed cardiac arrest during the induction of intravenous anesthesia and endotracheal intubation. The K-wire was retrieved from the thorax via thoracotomy. However, the patient died 10 days after the surgery. As the migration of wires and pins during orthopedic surgery can cause potentially fatal complications, these should be used very cautiously, especially for percutaneous treatment of shoulder girdle fractures. The patients with such implants should be followed frequently, both clinically and radiographically. If migration occurs, the patient should be closely monitored for emergent complications and the K-wire should be extracted immediately. PMID:27227938

  3. Cardiac ion channels

    PubMed Central

    Priest, Birgit T; McDermott, Jeff S

    2015-01-01

    Ion channels are critical for all aspects of cardiac function, including rhythmicity and contractility. Consequently, ion channels are key targets for therapeutics aimed at cardiac pathophysiologies such as atrial fibrillation or angina. At the same time, off-target interactions of drugs with cardiac ion channels can be the cause of unwanted side effects. This manuscript aims to review the physiology and pharmacology of key cardiac ion channels. The intent is to highlight recent developments for therapeutic development, as well as elucidate potential mechanisms for drug-induced cardiac side effects, rather than present an in-depth review of each channel subtype. PMID:26556552

  4. Cardiac gated ventilation

    SciTech Connect

    Hanson, C.W. III; Hoffman, E.A.

    1995-12-31

    There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. The authors evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50 msec scan aperture. Multi slice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. The authors observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a non-failing model of the heart.

  5. Hybrid carbon nanotube-polymer scaffolds for cardiac tissue regeneration

    NASA Astrophysics Data System (ADS)

    Ahadian, Samad; Davenport-Huyer, Locke; Smith, Nathaniel; Radisic, Milica

    2017-02-01

    Due to insufficient supply of heart transplants and limited regenerative ability of heart tissues, cardiac tissue engineering has emerged to restore or regenerate the structure and function of native cardiac tissues. Scaffolds play a major role in fabrication of functional cardiac tissues, providing structural support, biodegradation, and cell affinity. However, currently used scaffolds in cardiac tissue regeneration tend to lack adequate electrical conductivity and favorable mechanical properties. In response to these concerns, carbon nanotubes (CNTs) have been used to enhance electrical and mechanical properties of scaffolds in cardiac tissue engineering. Here, we review different hybrid CNT-biomaterial scaffolds, both natural and synthetic, in cardiac tissue regeneration and their fabrication methods. Furthermore, CNT toxicity is also discussed. We further outline future trends in this research area toward using CNTs as a functional nanomaterial in cardiac tissue engineering.

  6. Pars Plana Vitrectomy with Internal Limiting Membrane Peeling in Traumatic Macular Hole: 14% Perfluoropropane (C3F8) versus Silicone Oil Tamponade

    PubMed Central

    Al-Aswad, Mahmoud A.; Saad, Ahmed Abdelwahab; Hamada, Dina; Mahrous, Ashraf

    2017-01-01

    Purpose To evaluate the outcome of 23 G PPV and ILM peeling with 14% C3F8 compared with silicone oil tamponade in cases of TMHs without spontaneous closure. Methods A retrospective comparative study included 33 eyes with TMHs; 7 eyes healed spontaneously, and the remaining 26 eyes have been treated with PPV and ILM peeling. Silicone oil was used as a tamponade for children or adults who refused to adopt face-down position (10 cases). In all other cases (16 cases), 14% C3F8 was used. These cases were followed up for 6 months postoperatively. Results 26 cases (22 males and 4 females) were reviewed, including 10 cases treated with silicone oil and 16 cases treated with 14% C3F8. Patients' age ranged from 9 to 54 years. The success rate was 90% in the silicone-filled (9/10) and 94% in the gas-filled (15/16) eyes. At 6 months, the mean BCVA was 0.3 ± 0.25 in the silicone group and 0.2 ± 0.13 in the gas group (p < 0.05). Conclusions Cases of TMHs should be observed for spontaneous closure. PPV with ILM peeling should be conducted for nonclosing cases. Gas and silicone oil tamponades are equally successful in anatomical and visual outcomes. This trial is registered with CTRI/2017/06/008765. PMID:28811935

  7. The use of topical aqueous suppressants in the prevention of postoperative intraocular pressure elevation following pars plana vitrectomy with long-acting gas tamponade.

    PubMed Central

    Mittra, R A; Pollack, J S; Dev, S; Han, D P; Mieler, W F; Connor, T B

    1998-01-01

    PURPOSE: To determine if topical aqueous suppressant therapy applied after pars plana vitrectomy (PPV) with gas tamponade successfully prevents postoperative elevation of intraocular pressure (IOP). METHODS: A prospective, controlled study was performed on patients who met inclusion criteria and underwent PPV with gas tamponade (SF6 18%-20% or C3F8 12%-16%) over a 1-year period. Treatment eyes received topical aqueous suppressants at the end of surgery. Postoperative IOP checks were performed at 4 to 6 hours, 1 day, and 1 week. RESULTS: Twenty-one control (C) and 20 treatment (T) eyes met the inclusion criteria. The IOP (in mm Hg) measured at 4 to 6 hours (23.05 [C], 14.73 [T] and 1 day (23.24 [C], 17.28 [T]) postoperatively showed a statistically significant difference between the groups (P = .0038) at 4 to 6 hours, and a trend toward significance (P = .057) at 1 day. Eleven control and 3 treatment eyes had an IOP spike above 25 mm Hg at 4 to 6 hours or 1 day postoperatively (P = .02), and 6 control and 1 treatment eye had a postoperative IOP above 30 mm Hg. A pressure rise above 40 mm Hg was seen in 2 control eyes and no treatment eyes. CONCLUSIONS: Use of topical aqueous suppressants following PPV with long-acting gas tamponade is effective in preventing significant postoperative IOP elevation in a majority of cases. PMID:10360287

  8. Cardiac complications of end-stage renal disease.

    PubMed

    Burke, S W; Solomon, A J

    2000-07-01

    Cardiovascular disease is the leading cause of death in patients receiving dialysis. This is attributed in part to the shared risk factors of cardiovascular disease and end-stage renal disease. The risk factors for coronary artery disease include the classic cardiac risk factors of diabetes mellitus, hypertension, dyslipidemia, and smoking. Also in this population, hyperparathyroidism, hypoalbuminemia, hyperhomocysteinemia, elevated levels of apolipoprotein (a), and the type of dialysis membrane may play a role. Management begins with risk factor modification and medical therapy including aspirin, beta blockers, angiotensin converting enzyme (ACE) inhibitors, and lipid-lowering agents. Revascularization is often important, and coronary artery bypass grafting appears to be preferable to percutaneous transluminal coronary angioplasty. This is especially true for those with multivessel disease, impaired left ventricular function, severe symptoms, or ischemia. Congestive heart failure is another common problem in dialysis patients. The management includes correction of underlying abnormalities, optimal dialysis, and medical therapy. Data obtained from the general population indicate obvious benefits from ACE inhibitors and beta blockers, and these agents would be considered the therapies of choice. Erythropoetin is also an essential component of therapy, but the ideal hemoglobin concentration has yet to be determined. Peritoneal dialysis may be helpful in severe cases of heart failure. Pericarditis is seen in less than 10% of dialysis patients and is best diagnosed by clinical examination and echocardiography. Intensive dialysis is often the best initial therapy. Pericardiocentesis is reserved for the setting of pericardial tamponade, but a pericardial window is more definitive.

  9. Rhizomelic chondrodysplasia punctata and cardiac pathology.

    PubMed

    Huffnagel, Irene C; Clur, Sally-Ann B; Bams-Mengerink, Annemieke M; Blom, Nico A; Wanders, Ronald J A; Waterham, Hans R; Poll-The, Bwee Tien

    2013-07-01

    Rhizomelic chondrodysplasia punctata (RCDP) is an autosomal recessive peroxisomal disorder characterised by rhizomelia, contractures, congenital cataracts, facial dysmorphia, severe psychomotor defects and growth retardation. Biochemically, the levels of plasmalogens (major constituents of cellular membranes) are low due to a genetic defect in their biosynthesis. Cardiac muscle contains high concentrations of plasmalogens. Recently cardiac dysfunction was found in a mouse model for RCDP with undetectable plasmalogen levels in all tissues including the heart. This suggests the importance of plasmalogens in normal cardiac development and function. Congenital heart disease (CHD), however, has not been recognised as a major characteristic of RCDP. We aimed to determine the prevalence of CHD found in RCDP patients as well as to describe genetic, biochemical and cardiac correlations. We included 23 patients with genetically proven RCDP. The genetic, biochemical and physical data were evaluated. Echocardiograms were reviewed. Cardiac data were available for 18 patients. 12 (52%) had CHD. All twelve had type 1 RCDP and 11 (92%) had the PEX 7:c.875T>A mutation, of whom seven were homozygous (58%). Plasmalogen levels were significantly lower in the patients with CHD. Cardiac lesions included: septal defects (80% atrial), patent ductus arteriosus, pulmonary artery hypoplasia, tetralogy of Fallot and mitral valve prolapse (mostly older patients). The CHD prevalence among RCDP patients was at least 52%, significantly higher than among the normal population. Plasmalogen levels were significantly lower in patients with CHD. Routine cardiac evaluation should be included in the clinical management of RCDP patients.

  10. Importance of the history in diagnosing cardiac patients.

    PubMed

    Lopez, J F

    1974-03-01

    The importance of a good clinical history has been emphasized by reviewing the most common diagnostic criteria in cardiac patients. Dyspnea of cardiac origin should be differentiated from respiratory disturbances, neuroses, unfitness, etc. Orthopnea, paroxysmal nocturnal dyspnea, cardiac asthma and acute pulmonary edema are manifestations of left ventricular failure. Peripheral edema is most frequently due to circulatory disturbances of the lower extremities. Edema of cardiac origin is bilateral, related to postural changes and associated with cardiomegaly. Hepatic and renal problems are also common causes of edema. Chest pain due to myocardial ischemia (angina pectoris) is characteristic in its location, radiation, onset and relief. It should be differentiated from the many other causes of chest pain (neurosis, pericarditis, myalgia, etc.) by a carefully taken history. Palpitations and syncope are common symptoms of severe cardiac disease. Patients with these complaints should be thoroughly investigated. Syncope of cardiac origin (Stokes-Adams attack) should be differentiated from epileptic seizures.

  11. Stimulating endogenous cardiac repair

    PubMed Central

    Finan, Amanda; Richard, Sylvain

    2015-01-01

    The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration, a combination of these approaches could ameliorate the overall repair process to incorporate the participation of multiple cellular players. PMID:26484341

  12. Cardiac Innervation and Sudden Cardiac Death

    PubMed Central

    Fukuda, Keiichi; Kanazawa, Hideaki; Aizawa, Yoshiyasu; Ardell, Jeffrey L.; Shivkumar, Kalyanam

    2015-01-01

    Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem and higher centers) which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes-hours) and long term (days-years). This important neurovisceral /autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death (SCD). Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extra-cardiac neural remodeling have also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provides a rational mechanistic basis for development of neuraxial therapies for preventing SCD and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention. PMID:26044253

  13. Cardiac innervation and sudden cardiac death.

    PubMed

    Fukuda, Keiichi; Kanazawa, Hideaki; Aizawa, Yoshiyasu; Ardell, Jeffrey L; Shivkumar, Kalyanam

    2015-06-05

    Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy, and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem, and higher centers), which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes to hours), and long term (days to years). This important neurovisceral/autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death. Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extracardiac neural remodeling has also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provide a rational mechanistic basis for the development of neuraxial therapies for preventing sudden cardiac death and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention. © 2015 American Heart Association, Inc.

  14. [Prevalence of supraventricular tachycardia and tachyarrhythmias in resuscitated cardiac arrest].

    PubMed

    Brembilla-Perrot, B; Marcon, O; Blangy, H; Terrier de la Chaise, A; Louis, P; Sadoul, N; Claudon, O; Nippert, M; Popovic, B; Belhakem, H

    2006-01-01

    Supraventricular arrhythmias are considered to be benign when the ventricular rate is slowed and treated by anticoagulants. The aim of this study was to determine the possible influence of these arrhythmias in resuscitated cardiac arrest. Between 1980 and 2002, 151 patients were admitted after a cardiac arrest. Supraventricular arrhythrmias were identified as a possible cause of the cardiac arrest in 21 patients. They underwent echocardiography, exercise stress test, Holter ECG monitoring , coronary angiography and electrophysiological investigation. After these investigations, three patients had a malignant form of the Wolff-Parkinson-White syndrome, two were asymptomatic and, in the third patient, ventricular fibrillation was induced by treatment with diltiazem. In 8 patients, a rapid supraventricular arrhythmia was considered to be the cause of cardiac arrest by cardiogenic shock; 2 patients had hypertrophic cardiomyopathy, 5 had severe dilated cardiomyopathy which regressed in one patient. In ten patients, cardiac arrest due to ventricular tachycardia or fibrillation was provoked by a rapid (> 220 beats/min) supraventricular arrhythmia; two patients had no apparent underlying cardiac pathology. In the others, myocardial ischaemia or acute cardiac failure were considered to be the cause of the cardiac arrest. The authors conclude that rapid supraventricular arrhythmias may cause cardiac arrest either by cardiogenic shock or degenerescence to ventricular tachycardia or fibrillation. Usually, this event occurs in patients with severe cardiac disease but it may occur in subjects without cardiac disease or by an arrhythmia-induced cardiomyopathy.

  15. Cardiac action potential imaging

    NASA Astrophysics Data System (ADS)

    Tian, Qinghai; Lipp, Peter; Kaestner, Lars

    2013-06-01

    Action potentials in cardiac myocytes have durations in the order of magnitude of 100 milliseconds. In biomedical investigations the documentation of the occurrence of action potentials is often not sufficient, but a recording of the shape of an action potential allows a functional estimation of several molecular players. Therefore a temporal resolution of around 500 images per second is compulsory. In the past such measurements have been performed with photometric approaches limiting the measurement to one cell at a time. In contrast, imaging allows reading out several cells at a time with additional spatial information. Recent developments in camera technologies allow the acquisition with the required speed and sensitivity. We performed action potential imaging on isolated adult cardiomyocytes of guinea pigs utilizing the fluorescent membrane potential sensor di-8-ANEPPS and latest electron-multiplication CCD as well as scientific CMOS cameras of several manufacturers. Furthermore, we characterized the signal to noise ratio of action potential signals of varying sets of cameras, dye concentrations and objective lenses. We ensured that di-8-ANEPPS itself did not alter action potentials by avoiding concentrations above 5 μM. Based on these results we can conclude that imaging is a reliable method to read out action potentials. Compared to conventional current-clamp experiments, this optical approach allows a much higher throughput and due to its contact free concept leaving the cell to a much higher degree undisturbed. Action potential imaging based on isolated adult cardiomyocytes can be utilized in pharmacological cardiac safety screens bearing numerous advantages over approaches based on heterologous expression of hERG channels in cell lines.

  16. Acute Effusive Pericarditis due to Horse Chestnut Consumption

    PubMed Central

    Edem, Efe; Kahyaoğlu, Behlül; Çakar, Mehmet Akif

    2016-01-01

    Patient: Male, 32 Final Diagnosis: Pericardial effusion related to the consumption of herbal product Symptoms: Dyspnea Medication: Horse chestnut (Aesculus hippocastanum L) Clinical Procedure: Pericardial and pleural effusions were drained through a pericardiopleural window Specialty: Cardiology Objective: Unusual clinical course Background: There are many well-known causes of pericardial effusion, such as cancer metastasis, bacterial or viral pericarditis, and uremic pericarditis; however, no reports exist in the literature demonstrating a pericardial effusion that led to cardiac tamponade following consumption of an herbal remedy. Case Report: A 32-year-old male patient was referred to our cardiology outpatient clinic with a complaint of dyspnea. The patient’s medical history was unremarkable; however, he had consumed 3 boxes of horse chestnut (Aesculus hippocastanum L) paste over the previous 1.5 months. His chest x-ray examination revealed an enlarged cardiac shadow and bilateral pleural effusion. On transthoracic echocardiographic examination, his ejection fraction was found to be 55% with circumferentially extended pericardial effusion that reached 3.9 cm at its maximal thickness. No growth had been detected in the pericardial and pleural biopsies or blood samples; there was no evidence of an infectious process in the physical examination. Based on this information, we diagnosed pericarditis resulting from the use of herbal remedies. This is the first report to demonstrate that herbal remedy consumption may cause this type of clinical condition. Conclusions: Besides other well-known causes, pericardial effusion related to the consumption of herbal remedies should always be considered when treating patients with pericardial effusion caused by unclear etiologies. PMID:27141926

  17. [Iatrogenic vascular lesions after cardiac catheterization].

    PubMed

    Manuel-Rimbau, E; Lozano, P; Gómez, A; Bethencourt, A; Gómez, F T

    1998-09-01

    The increase in vascular complications after cardiac catheterizations is rising