Comparison of Peres' Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters.

BACKGROUND: Central venous catheterization is a vital procedure for volume resuscitation, infusion of drugs, and for central venous pressure monitoring in the perioperative period and intensive care unit (ICU). It is associated with position-related complications like arrhythmia's, thrombosis, tamponade, etc. Several methods are used to calculate the catheter insertion depth so as to prevent these position-related complications. OBJECTIVE: To compare Peres' formula and radiological landmark formula for central venous catheter insertion depth through right internal jugular vein (IJV) by the anterior approach. MATERIALS AND METHODS: A total of 102 patients posted for elective cardiac surgery were selected and divided into two equal groups-Peres' group (group P) and radiological landmark group (group R). Central venous catheterization of right IJV was done under ultrasound (USG) guidance. In group P, central venous catheter insertion depth was calculated as height (cm)/10. In group R, central venous catheter insertion depth was calculated by adding the distances from the puncture point to the right sternoclavicular joint and on chest X-ray the distance from the right sternoclavicular joint to carina. After insertion, the catheter tip position was confirmed using transesophageal echocardiography (TEE) in both the groups. RESULTS: About 49% of the catheters in group P and 74.5% in group R were positioned optimally as confirmed by TEE, which was statistically significant. No complications were observed in both the groups. CONCLUSION: Radiological landmark formula is superior to Peres' formula for measuring optimal depth of insertion of right internal jugular venous catheter. HOW TO CITE THIS ARTICLE: Manudeep AR, Manjula BP, Dinesh Kumar US. Comparison of Peres' Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24(7):527-530.

"Left atrial myxoma - A tumor in transit".

Cardiac myxoma is the most common type of primary cardiac neoplasm. Over 70% of all cardiac myxomas originate from the left atrium (LA) and 18% from the right atrium (RA). Most myxomas present with constitutional, embolic, and obstructive manifestations. We are presenting a case where a part of myxoma got embolized intra-operatively. Using trans-oesophageal echocardiography, we were able to diagnose and image the transit of the tumor from the left ventricle to the left atrium. We removed the embolized tumor from the left atrium and prevented a dreaded complication like stroke, mesenteric ischemia, renal infarct or limb ischemia, which would have resulted in increased morbidity or mortality of the patient.

Left ventricular mass: A tumor or a thrombus diagnostic dilemma.

Left ventricular (LV) mass is a rare condition, of which the most common is thrombus. Echocardiography is a very useful modality of investigation to evaluate the LV mass. We are reporting a case of LV mass presenting with neurological symptom. The diagnosis of this mass was dilemma as the echocardiographic features were favoring tumor as well as thrombi. Mass (a) measuring 3.8 cm × 1.9 cm attached to the left ventricle apex appeared to be pedunculated tumor and mass (b) measuring 2.4 cm × 1.8 cm attached to the chordae of anterior mitral leaflet resembled a thrombus or an embolized tumor entangled in the chordae. A differential diagnosis for the LV mass is thrombus, tumors such as fibroma, and vegetation. Preoperative detection of a thrombus leads to an alteration in surgical steps. A large and mobile thrombus with or without a hemodynamic alteration is an indication for surgical removal to prevent stroke, myocardial infarction, mesenteric ischemia, renal infarction, gangrene of the limbs, and mortality.

Transvalvular mitral regurgitation following mitral valve replacement a diagnostic dilemma.

After mitral valve replacement with a prosthetic valve, the valve should be competent and there should not be any residual prosthetic valve regurgitation. Transvalvular residual prosthetic valve regurgitation are difficult to diagnose and quantify. we are reporting interesting TEE images as a diagnostic dilemma in a case of transvalvular mitral regurgitation following mitral valve replacement secondary to entrapment of sub-valvular apparatus in a Chitra mechanical heart valve.