Successful occluder removal and reocclusion of an atrial septal defect after occluder immigration to aortic arch: a case report.

BACKGROUND: Atrial septal defect (ASD) is a common congenital heart disease, and currently, transcatheter intervention is the most common clinical treatment method. However, certain complications still occur during the percutaneous process, among which occluder loss and displacement are rare but serious complication. Although the probability of occluder loss and displacement is low, severe cases can endanger life. CASE PRESENTATION: Here, we report the case of a patient who underwent ASD closure in which the occluder fell off into the aortic arch, the detached occluder was recovered through catheter intervention, and the patient underwent ASD closure again. CONCLUSIONS: In this case report, we highlight that although percutaneous closure of an ASD is regarded as a routine procedure, clinicians should remember the possibility of complications, especially occluder loss and displacement. Therefore, interventionist should carefully evaluate the situation before intervention closure, establish standardized interventional treatment procedures, and provide timely treatment follow-up.

Predictors of early removal of intragastric balloon due to intolerance: Insights from a multiethnic Asian cohort.

Introduction: Intolerance frequently limits the use of intragastric balloons (IGBs) in the treatment of obesity. This includes refractory nausea, vomiting and abdominal discomfort. Our study aims to identify predictors of balloon intolerance and early removal, which will help to guide patient selection for this intervention and peri-procedure care. Method: We conducted a retrospective cohort study of 54 consecutive patients who underwent IGB insertion from July 2017 to July 2022 in a single tertiary institution in Singapore. Forty-seven (87.0%) patients completed therapy, while 7 patients (13.0%) had early removal of the balloon due to intolerance. Characteristics of both groups were compared. Results: Multivariate analysis revealed significant associations between early balloon removal and both depression (P=0.012) and anxiety (P=0.001) after adjusting for age, sex, ethnicity, height, nulliparity, balloon type and volume. Univariate analysis revealed that anxiety was the main risk factor (P=0.004, odds ratio 9.111, 95% confidence interval 1.624-51.124), while depression was no longer a significant predictor. Conclusion: Identifying predictors of balloon intolerance and early removal can enhance patient selection and improve peri-procedural care. In patients with a history of depression or anxiety, it is important to ensure adequate counselling and preparation prior to balloon insertion.

Percutaneous femoral venoarterial ECMO decannulation at the bedside using the Manta vascular closure device.

A case of peripheral venoarterial extracorporeal membrane oxygenation decannulation using the Teleflex Manta vascular closure device is presented.

Snare device retrieval of occluder embolized in patent foramen ovale closure: A case report.

RATIONALE: Transcatheter interventional closure therapy is the main treatment method for patent foramen ovale (PFO). However, occluder abscission is a serious complication in PFO interventional therapy. Thus, timely and effective management of the occluder detachment is crucial for improving patient prognosis. PATIENT CONCERNS: A 52-year-old female patient was admitted to the Department of Neurology mainly due to "right upper limb weakness for two days, which aggravated for eight hours." The patient had no history of any other diseases. DIAGNOSES: The patient was diagnosed with an atrial septal defect (foramen ovale type) and cerebral infarction. INTERVENTIONS AND OUTCOMES: The occluder abscission was successfully removed after several attempts with the help of the snare device. LESSONS: When the PFO occlusion device is detached, interventional treatment would lead to minimal trauma, fast postoperative recovery, and a definite therapeutic effect. Based on mastering the indications and standardizing the operational process, this is a safe and effective minimally invasive treatment method.

Disintegration of Multiple Parts of a Bone Transport Nail During Planned Removal: A Case Report.

CASE: A 34-year-old man with a distal tibia bone defect was treated with an intramedullary bone transport nail (Precice Bone Transport System, NuVasive). During planned removal after successful treatment, 7 separate subcomponents of the nail became disconnected and had to be separately removed using specialized instrumentation. This occurred despite adherence to the manufacturer's recommended technique for nail removal and in the absence of clinical or radiographic evidence of implant failure. CONCLUSION: When planning for implant removal, surgeons should be aware of potential intraoperative disconnection of subcomponents of this magnetic bone transport nail and ensure that equipment for retrieval (e.g., very long endoscopy forceps) is available.

Complications resulting from an intragastric balloon in a patient without follow-up and monitoring.

The intragastric balloon (IGB) is recognised as a minimally invasive intervention for the treatment of obesity. Here, we detail a rare and life-threatening complication stemming from this procedure. A female patient in her 40s, who had an IGB in situ for 14 months, presented at the emergency department with septic shock characterised by abdominal guarding and emesis. These symptoms were a direct result of IGB-induced bowel obstruction. We emphasise that the patient missed the recommended 6-month removal window, which in our opinion is the decisive cause leading to deflated balloon migration and subsequent complications. In the course of managing multiple critical events, the patient required multiple operations related to the bowel obstruction, numerous nutritional and psychological challenges. Currently, the patient is living with short bowel syndrome, secondary to the chronic intestinal failure, necessitating the administration of parenteral nutrition 6 days per week.

Decannulation protocol in pediatric patients: case series study.

OBJECTIVE: The aim of this study was to describe the phases of a decannulation protocol and the results from its application in hospitalized children. METHODS: This is a retrospective, observational study. Data were collected from medical records of decannulated patients followed up in a pediatric hospital in Belo Horizonte, Minas Gerais between 2011 and 2021. RESULTS: Among the children followed up in the service (n=526), 23% (n=120) were successfully decannulated. Children aged between 2 months and 16 years, with a mean age of 4 years, 69% of whom were male, were evaluated. About 75% of the patients have tracheostomy due to upper airway obstruction and 60% of these due to acquired subglottic stenosis. At the beginning of the decannulation protocol, 5.5% of the patients had moderate oropharyngeal dysphagia, while 80.4% had normal swallowing. Correction in the upper airway pre-decannulation was performed in 39.5% of the patients, dilation in 63.8%, and endoscopic correction was performed in 55.3%. After performing the decannulation, none of the patients had complications. CONCLUSIONS: The described decannulation protocol is safe, since no complications such as death and need for recannulation happened.

Intrauterine Device Completely Encapsulated by Fibrous Tissue in a Postmenopausal Woman: A Case Report.

A 54-year-old woman, who had been menopausal for over two years and had an Intrauterine Device (IUD) in place for over twenty years, requested a removal of the IUD. The IUD was found to be embedded during the removal process. Under ultrasound guidance, a hysteroscopic examination revealed the embedded IUD and additional uterine cavity content. Hysteroscopic removal of the IUD and the foreign body was performed, and the pathology report indicated fibrous tissue with hyaline degeneration. For postmenopausal women with IUDs, early removal is recommended to minimise complications. Hysteroscopic examination should be the first choice for the rare complication of embedded IUDs covered with fibrous tissue, with hysteroscopic removal as the preferred treatment.

Extraction of lumenless pacing leads from the His bundle and left bundle branch area: outcomes of the high-volume centre.

AIMS: The application of conduction system pacing (CSP) in clinical practice is growing, and the need for lead extraction will also increase. The data on outcomes and safety of CSP lead extraction are limited. The aim of this study was to assess procedural outcomes and safety of CSP lead removal. METHODS AND RESULTS: Forty-seven patients from the EXTRACT Registry with the indication for CSP lead removal were enrolled in the study conducted at the Department of Electrocardiology in Katowice, Poland. Extraction technique, outcomes, safety, and complication were evaluated. Forty-three (91.5%) leads were successfully removed, and 41 (87.2%) were removed with traction only. The dwelling time of 28 extracted leads was longer than 1 year, and the oldest extracted lead was implanted for 89 months. Seven (14.9%) leads were removed from the left bundle branch (LBB) area and 36 from the His bundle (HB). Transient complete atrioventricular block occurred during the procedure in two patients. In 27 out of 31 attempts (87.1%), new CSP leads were implanted: nine (33.3%) HB pacing leads and 18 (66.7%) LBB area pacing leads. CONCLUSION: The CSP lead extraction is safe and feasible with a low complication rate and high rate of CSP lead reimplantation.

Retrieval of Broken Guidewire from the Hip Joint Protruding inside the Pelvic Cavity: A Rare Case Report.

Hardware breakage in the form of guide wire or drill bit is a devastating complication particularly if occurs around hip joint during cephalo-medullary nailing. It should be removed on urgent basis as it can migrate to the pelvic cavity and damages adjacent neuro-vascular bundle and visceral organ immediately as well joint arthritis later on. There are very few cases report available in the literature with retrieval techniques by using disc forceps, pituitary forceps, oversized reamers, arthrotomy with joint dislocation and through ilioinguinal approaches occasionally. We are presenting an interesting and rare case of broken guide wire inside hip joint protruding into the pelvic cavity which got retrieved through lower midline open laparotomy approach.

RésuméLa rupture du matériel sous forme de fil de guidage ou de foret est une complication dévastatrice, en particulier si elle se produit autour de l'articulation de la hanche lors du clouage céphalo-médullaire. Il doit être retiré de toute urgence car il peut migrer vers la cavité pelvienne et endommager immédiatement le faisceau neuro-vasculaire et l'organe viscéral adjacents, ainsi que l'arthrite articulaire plus tard. Il existe très peu de cas rapportés dans la littérature avec des techniques de récupération utilisant des pinces discales, des pinces hypophysaires, des alésoirs surdimensionnés, des arthrotomies avec luxation articulaire et occasionnellement par des approches ilio-inguinales. Nous présentons un cas intéressant et rare de fil guide cassé à l'intérieur de l'articulation de la hanche faisant saillie dans la cavité pelvienne, qui a été récupéré par une approche de laparotomie ouverte sur la ligne médiane inférieure.

Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads-A Single-Center Experience.

Background and Objectives: The number of cardiac pacemakers being used has increased in recent decades, and this increase has led to a rise in device-related complications, requiring percutaneous device extraction. Our aim was to present our single-center clinical experience in percutaneous lead extractions. Materials and Methods: We analyzed an observational retrospective cohort study of 93 patients for the transvenous removal of a total of 163 endocardial leads. We evaluated the device details, indications, lead characteristics, extraction methods, complications, reimplantation procedure, follow-up data, effectiveness, and safety. Results: Patients' mean age was 68.6 ± 11.6 years. Lead extraction indications were pocket infection in 33 (35.5%), lead dysfunction in 33 (35.5%), and system upgrade in 21 (23%) cases, and lead endocarditis in 6 (6%) cases. The duration from implantation to extraction time was a detected median of 43 (24-87) months. The most common retracted lead type was the RV defibrillator lead (62%), and the lead fixation type was active for one hundred (61%) patients. A new device was inserted in 74 (80%) patients, and the device type was most commonly a CRT-D (61%). Patients were followed up at a median of 17 (8-36) months, and 18 patients (19%) died at follow-up. Complete procedural success was obtained in 78 (84%) patients, and clinical procedural success was obtained in 83 (89%) patients. Procedural failure was detected in 15 (16%) patients. Major and minor complications were detected in 10 (11%) and 6 (6.5%) patients, respectively. The most common minor complication was pocket hematoma. Conclusions: Our experience suggests that transvenous lead extraction has a high success rate with an acceptable risk of procedural complications. The simple manual traction method has a high rate of procedural success, despite a high dwell time of the lead.

Evolut transcatheter aortic valve replacement explant and aortic root repair with an annular patch in the setting of endocarditis.

As a consequence of the growing number of implanted transcatheter aortic valve prostheses, the increasing incidence of early and late complications of biological valves requires in several cases surgical explantation of the transcatheter valve and subsequent aortic root or surgical aortic valve replacement. In this video tutorial, we show how to avoid aortic root damage in the surgical explantation of a transcatheter aortic valve bioprosthesis in a patient with a dysfunctional transcatheter aortic valve prosthesis affected by endocarditis 15 months after implantation. The infected prosthesis and all foreign materials, concomitant to the calcified native valve, were excised en bloc in preparation for the extensive debridement of infected tissue in the abscess cavity. The defect on the aortic annulus was reconstructed using a pericardial patch, followed by a surgical valve implant.

Forgotten Biliary Plastic Stents: Complications, Management, and Clinical Outcomes.

Background and Objectives: Endoscopic biliary plastic stenting is a safe and effective temporary therapeutic modality used in various benign biliary disorders. Long-term indwelling stents for more than one year without retrieval are termed "forgotten biliary stents". In clinical practice, the forgotten stents are underestimated and the majority of data were obtained from case reports. The aim of this study was to determine the forgotten-biliary-plastic-stent-related complications, their management, and the patients' clinical outcomes. Materials and Methods: This retrospective study was performed at three hospitals during the period from January 2021 to December 2023. In total, 577 patients with biliary plastic stents-inserted for a variety of benign biliary conditions-were included. They were divided into two groups, as follows: group 1 included 527 patients who had biliary stents removed within 3 months, and group 2 included 50 patients with biliary stents retrieved after one year of their deployment. The stent-related complications (e.g., acute cholangitis, stent clogging, distal stent migration, new common bile duct (CBD) stone formation, and proximal stent migration) and the endoscopic management success rate were evaluated. Results: Irretrievable CBD stones were the main indication for biliary plastic stenting in both groups. The stent-related complications, number of endoscopic sessions, and hospital admissions were significantly higher in the patients with forgotten biliary stents than those with stent removal within 3 months. All the study patients were successfully managed endoscopically with uneventful outcomes. Conclusions: Based on this retrospective study, non-adherence to the endoscopists' instructions is the main reason for retained biliary stents for more than one year. The patients with forgotten stents had significantly higher complication rates, a higher number of endoscopic sessions, and a higher number of hospital admissions than those with stents that were retrieved in the scheduled time. All patients were managed endoscopically with a technical success rate of 100%, and with no complication-related mortality.

Navigating the complexities of a forgotten double J stent.

Double-J (DJ) stents are most commonly used urological tools these days. Serious complications may occur when stents are left in place for longer duration. We present a case of a woman in her 40s with a forgotten DJ stent for 4 years, leading to complications such as encrustations, bladder and renal stone formation. The patient underwent a comprehensive endourological approach, including endoscopic cystolithotomy and left-sided percutaneous nephrolithotomy. The case highlights the importance of timely stent removal to prevent complications such as encrustations and stone formation. Patient education and counselling are crucial to avoid poor compliance and the associated risks of forgotten stents. This case underscores the significance of a multidisciplinary approach and emphasises the need for proactive measures to prevent such complications, including the implementation of a stent placement registry.