RESUMEN
Cardiopulmonary resuscitation (CPR) is essential for the survival of cardiac arrest patients, but it can cause severe traumatic complications. In the catheterization laboratory, various physical constraints complicate the appropriate performance of CPR. However, we are not aware of reports of CPR complications in this setting. Here, we report a case of coronary artery perforation (CAP) caused by manual CPR in the catheterization laboratory. The patient, a 68-year-old woman, initially underwent successful percutaneous coronary intervention (PCI) for unstable angina. Back in the ward, the patient experienced acute stent thrombosis, which resulted in cardiac arrest, and another PCI was performed under ongoing manual CPR. Although revascularization was successful, sudden CAP occurred, leading to cardiac tamponade. Despite extensive treatment efforts, the patient died 18 hours later.Initially, the compression site of CPR was on the midline of the sternum; however, the compression site shifted to the left, to just above the left anterior descending artery, by the time that CAP was detected via angiography. This corresponded to the area where rib fractures were observed upon computed tomography, suggesting the possibility of traumatic CAP due to manual CPR. The physical constraints in the catheterization laboratory can lead to an inappropriate CPR technique and severe traumatic complications.
Asunto(s)
Reanimación Cardiopulmonar , Vasos Coronarios , Intervención Coronaria Percutánea , Humanos , Anciano , Femenino , Reanimación Cardiopulmonar/efectos adversos , Reanimación Cardiopulmonar/métodos , Vasos Coronarios/lesiones , Vasos Coronarios/diagnóstico por imagen , Intervención Coronaria Percutánea/efectos adversos , Resultado Fatal , Paro Cardíaco/etiología , Paro Cardíaco/terapia , Angiografía Coronaria , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/métodos , Angina Inestable/terapia , Angina Inestable/etiología , Taponamiento Cardíaco/etiologíaRESUMEN
Papillary fibroelastoma (PFE) is a benign tumor that arises mostly from left-sided valves. PFE can cause stroke, and surgical resection may be needed. Lambl's excrescence (LE) is a filiform valvular lesion and is considered a possible cause of stroke. A 79-year-old man with light-headedness and left-sided hemiparesis was diagnosed with stroke. Transesophageal echocardiography (TEE) revealed a round-shaped mobile mass in the left ventricular outflow tract (LVOT), which was considered the cause of the stroke. Surgical resection was performed transaortically, and during surgery, a mass was incidentally detected on the noncoronary cusp (NCC), which was also resected followed by aortic valve replacement. Pathology confirmed that the mass in the LVOT was a PFE and that the filiform mass on the NCC was LE. We herein report a rare case of PFE in the LVOT and coexisting LE on the NCC. A careful examination via TEE helps to identify other possible causes of stroke hidden behind the obvious cause.
Asunto(s)
Fibroelastoma Papilar Cardíaco , Neoplasias Cardíacas , Enfermedades de las Válvulas Cardíacas , Accidente Cerebrovascular , Masculino , Humanos , Anciano , Enfermedades de las Válvulas Cardíacas/complicaciones , Fibroelastoma Papilar Cardíaco/complicaciones , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Válvula Aórtica/patología , Accidente Cerebrovascular/complicaciones , Ecocardiografía Transesofágica , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/diagnóstico por imagenRESUMEN
BACKGROUND: Real-time monitoring of generator impedance drop is not considered in CLOSE protocol pulmonary vein (PV) isolation (PVI) in patients with atrial fibrillation (AF). We verified whether additional information of impedance drop could minimize ablation index required for PVI using modified CLOSE protocol (target ablation indexâ¯≥â¯500 on anterior wall and ≥400 on posterior wall along with inter-lesion distance of 3-6â¯mm and maximum power of 35â¯W) without any adverse effect of procedural data and efficacy. METHODS: Sixty consecutive Japanese AF patients [paroxysmal AF: 43 (72â¯%) patients] underwent first-time PVI with modified CLOSE protocol with real-time monitoring of impedance drop (impedance-guided modified CLOSE protocol). Ablation tags were colored according to impedance drop and ablation was immediately terminated before reaching target ablation index if impedance drop of ≥10â¯Ω was confirmed. Ablation index needed for PVI, first-pass PVI rate, other procedural data, and atrial tachyarrhythmia recurrence were evaluated. RESULTS: Mean ablation index and impedance drop on anterior and posterior walls were 437.6⯱â¯43.5â¯Ω and 10.2⯱â¯2.6â¯Ω and 393.3⯱â¯27.4â¯Ω and 9.3⯱â¯2.2â¯Ω, respectively. First-pass PVI per PV pair was accomplished in 90/120 (75â¯%). No complications occurred. PV gaps after first-pass ablation were locationally most often found on right posterior wall than on the other parts (pâ¯<â¯0.001). There were no differences in mean contact force, impedance drop, and ablation index between walls with and without PV gaps after first-pass PV ablation. During a mean follow-up of 24⯱â¯9â¯months, survival from atrial tachyarrhythmia recurrence was 51/60 (85â¯%) patients. CONCLUSIONS: Using additional generator impedance drop information may be useful to minimize radiofrequency current application to accomplish PVI with modified CLOSE protocol while maintaining efficacy and safety in Japanese AF population.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Humanos , Venas Pulmonares/cirugía , Impedancia Eléctrica , Resultado del Tratamiento , Ablación por Catéter/métodos , Recurrencia , TaquicardiaRESUMEN
Contact dermatitis is a severe complication of cardiac-device implantation that may be observed in patients with metal allergies. Some studies have suggested that wrapping cardiac devices with expanded polytetrafluoroethylene (ePTFE) sheets is effective in preventing contact dermatitis. Most of these studies involved pacemakers, whereas those on implantable cardioverter-defibrillators (ICDs) are rare. Herein, we report a method for the successful implantation of an ICD wrapped with an ePTFE sheet in a patient with metal allergy. The metal part of the ICD generator was tightly wrapped with an ePTFE sheet, which was sewn with ePTFE sutures approximating the edges of the generator. After the wrapping procedure, the patient entered the operating room, and the generator and an ePTFE-coated dual-coil shock lead were implanted via a standard procedure. The shock impedance in the coil-to-can vector was high immediately after the implantation, but it reduced to less than half of its initial value over a period of two weeks post-surgery. The patient did not develop any new skin problems during the 20-month follow-up. This is a method for successfully preventing contact dermatitis; however, attention to the associated high risk of infection is required. Learning objective: Wrapping an implantable cardioverter-defibrillator with an expanded polytetrafluoroethylene sheet was effective in preventing contact dermatitis after implantation. The shock impedance in the coil-to-can vector was high immediately after implantation but reduced to approximately half of its initial value with time.