Assuntos
Falso Aneurisma/complicações , Embolização Terapêutica/métodos , Hemorragia/terapia , Hipotensão/etiologia , Artéria Torácica Interna , Marca-Passo Artificial/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Angiografia , Hemorragia/complicações , Hemorragia/diagnóstico , Humanos , Hipotensão/diagnóstico , Masculino , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
Perclose Closure Device (Abbott-Vascular) was attempted for femoral artery (FA) access site closure by an experienced operator. The device was felt to snap as it was pushed through the previously scarred skin and subcutaneous tissue. Perclose had broken into two pieces with the proximal portion outside the body and the distal portion embolizing to lie in the FA to distal aorta. The left FA was accessed through 8F sheath and 4-8mm Basket snare passed through a 6F multipurpose guiding catheter. The tip of the broken Perclose was caught with the snare and pulled out. The Perclose has a distal flexible sheath that is overmolded directly onto the proximal rigid guide. This junction of sheath and guide may be a weak point. Accidental pressure applied at this weak point in any Perclose device during deployment can cause breakage. Awareness of this rare complication is important for safety.
Assuntos
Cateterismo Cardíaco/efeitos adversos , Remoção de Dispositivo , Artéria Femoral , Técnicas Hemostáticas/instrumentação , Idoso , Falha de Equipamento , Humanos , MasculinoAssuntos
Cateterismo Cardíaco/efeitos adversos , Catéteres , Seio Coronário/patologia , Vasos Coronários/patologia , Ventrículos do Coração/diagnóstico por imagem , Idoso , Cateterismo Cardíaco/instrumentação , Angiografia Coronária/efeitos adversos , Angiografia Coronária/instrumentação , Feminino , Humanos , Pressão , Artéria RadialAssuntos
Dissecção Aórtica/diagnóstico , Dor no Peito/diagnóstico , Aneurisma Coronário/diagnóstico , Adulto , Dissecção Aórtica/complicações , Dissecção Aórtica/terapia , Cateterismo Cardíaco , Dor no Peito/etiologia , Aneurisma Coronário/complicações , Aneurisma Coronário/terapia , Diagnóstico Diferencial , Feminino , HumanosRESUMO
A patient with minimal coronary artery disease presented in cardiogenic shock when her previously undiagnosed hypothyroid state was complicated by an episode of AV nodal re-entrant tachycardia. She did not respond to multiple pressors, and recovered dramatically after starting thyroid supplementation. Hypothyroidism caused her lack of responsiveness to pressors and perpetuated her hypotension and increased filling pressures long after she reverted to a sinus rhythm. Our case dramatically demonstrates the severe lack of physiologic reserve that can be associated with hypothyroidism.
Assuntos
Hipotireoidismo/complicações , Choque Cardiogênico/etiologia , Idoso , Feminino , HumanosRESUMO
A 93-year-old woman with a history of hypertension was noted to have a mass in the left atrium prolapsing partially through the mitral valve on a routine surface echocardiogram in 2002. A transesophageal echocardiogram was then performed revealing an irregular mass with an appearance of protruding fronds of tissue. The echogenicity of the mass was inhomogeneous with some areas of punctate calcification, and the mass was attached to the interatrial septum. The echocardiographic appearance of the mass was almost pathognomic of atrial myxoma, and this is the oldest patient yet to have been diagnosed with a probable myxoma. The patient did not want surgical removal of the mass. She is still asymptomatic at the age of 95 years.
