ABSTRACT
Left ventricular free wall rupture can be a catastrophic problem. Although small lacerations can be managed with various techniques of primary closure, larger and more complex defects can be difficult to treat. We present and discuss 2 cases of chronic, complex ventricular pseudoaneurysms managed successfully with long-term mechanical support.
Subject(s)
Aneurysm, False/surgery , Heart Aneurysm/surgery , Heart Rupture/surgery , Heart Valve Prosthesis Implantation , Heart-Assist Devices , Mitral Valve Insufficiency/surgery , Myocardial Infarction/complications , Postoperative Complications/surgery , Ventricular Dysfunction, Left/surgery , Adult , Aortic Dissection/diagnosis , Aortic Dissection/surgery , Aneurysm, False/diagnosis , Aortic Valve Insufficiency/surgery , Cardiac Output, Low/diagnosis , Cardiac Output, Low/surgery , Echocardiography , Heart Aneurysm/diagnosis , Heart Failure/diagnosis , Heart Failure/surgery , Heart Rupture/diagnosis , Heart Transplantation , Humans , Long-Term Care , Magnetic Resonance Imaging , Male , Postoperative Complications/diagnosis , Reoperation , Ventricular Dysfunction, Left/diagnosisABSTRACT
BACKGROUND: Standard cavography is performed with iodinated contrast material with plain film or digital subtraction technique. However, preplacement imaging may change final inferior vena cava filter (IVC) placement in 11 to 26% of patients. This study will examine the use and reliability of incidental spiral computed abdominal tomography (CAT) scans for the placement of IVC filters. METHODS: Over a 25-month period, CAT scan data were prospectively collected on patients at high risk for pulmonary embolism (PE) or with PE that required an IVC filter. CAT scans were then evaluated specifically for vena cava anatomy and relationship to renal veins and lumbar spine. IVC filters were then placed before cavography under fluoroscopy (performed only to confirm accurate placement) based on the static relationship of the renal veins/IVC and spine. RESULTS: One hundred twenty-two patients had IVC filters placed. In the last 78 eligible patients, CAT scan placement was verified with post deployment cavography. IVC filters were deployed an average of 3.25 mm below the lowest renal vein with no veins misidentified. No strut malposition was noted on post deployment cavography. 12.1% had findings by CAT scan that altered some aspect of IVC filter placement. CONCLUSIONS: Admission or same hospital stay spiral CAT scan can provide enough anatomic detail to safely guide placement of an IVC filter. IVC filters can be deployed at bedside without contrast cavography if the preplacement CAT scan is adequate.