RESUMO
Coronary artery to left atrial fistula is rare in patients with mitral stenosis. We report an interesting case of a patient with concomitant mitral valve stenosis and coronary fistulae, originating from the left circumflex artery and drained into the left atrium with two terminal orifices.
Assuntos
Fístula , Hipertensão Pulmonar , Estenose da Valva Mitral , Vasos Coronários/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico por imagem , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/cirurgiaRESUMO
Abstract Coronary artery to left atrial fistula is rare in patients with mitral stenosis. We report an interesting case of a patient with concomitant mitral valve stenosis and coronary fistulae, originating from the left circumflex artery and drained into the left atrium with two terminal orifices.
Assuntos
Humanos , Fístula , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico por imagem , Estenose da Valva Mitral/cirurgia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagemRESUMO
OBJECTIVE: To compare the efficacy of blind axillary vein puncture utilizing the new surface landmarks for the subclavian method. METHODS: This prospective and randomized study was performed at two cardiology medical centers in East China. Five hundred thirty-eight patients indicated to undergo left-sided pacemaker or implantable cardioverter defibrillator implantation were enrolled, 272 patients under the axillary access and 266 patients under the subclavian approach. A new superficial landmark was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. We measured lead placement time and X-ray time from vein puncture until all leads were placed in superior vena cava. Meanwhile, the rate of success of lead placement and the type and incidence of complications were compared between the two groups. RESULTS: There were no significant differences between the two groups in baseline characteristics or number of leads implanted. There were high success rates for both strategies (98.6% [494/501] vs. 98.4% [479/487], P=0.752) and similar complication rates (14% [38/272] vs. 15% [40/266], P=0.702). Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group. CONCLUSION: We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and also allows to get this vein without the guidance of fluoroscopy, contrast, or echography.
Assuntos
Veia Axilar , Veia Axilar/diagnóstico por imagem , Veia Axilar/cirurgia , China , Desfibriladores Implantáveis , Humanos , Estudos Prospectivos , Punções , Veia Cava SuperiorRESUMO
Abstract Objective: To compare the efficacy of blind axillary vein puncture utilizing the new surface landmarks for the subclavian method. Methods: This prospective and randomized study was performed at two cardiology medical centers in East China. Five hundred thirty-eight patients indicated to undergo left-sided pacemaker or implantable cardioverter defibrillator implantation were enrolled, 272 patients under the axillary access and 266 patients under the subclavian approach. A new superficial landmark was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. We measured lead placement time and X-ray time from vein puncture until all leads were placed in superior vena cava. Meanwhile, the rate of success of lead placement and the type and incidence of complications were compared between the two groups. Results: There were no significant differences between the two groups in baseline characteristics or number of leads implanted. There were high success rates for both strategies (98.6% [494/501] vs. 98.4% [479/487], P=0.752) and similar complication rates (14% [38/272] vs. 15% [40/266], P=0.702). Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group. Conclusion: We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and also allows to get this vein without the guidance of fluoroscopy, contrast, or echography.
Assuntos
Humanos , Veia Axilar/cirurgia , Veia Axilar/diagnóstico por imagem , Veia Cava Superior , Punções , China , Estudos Prospectivos , Desfibriladores ImplantáveisRESUMO
The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.
Assuntos
Anastomose Cirúrgica/efeitos adversos , Esôfago/cirurgia , Dilatação Gástrica/etiologia , Infarto Miocárdico de Parede Inferior/etiologia , Estômago/cirurgia , Doença Aguda , Idoso , Benzamidas/uso terapêutico , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/tratamento farmacológico , Estenose Coronária/etiologia , Eletrocardiografia , Esofagectomia/métodos , Esôfago/diagnóstico por imagem , Dilatação Gástrica/diagnóstico por imagem , Dilatação Gástrica/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Gastroparesia/diagnóstico por imagem , Gastroparesia/tratamento farmacológico , Gastroparesia/etiologia , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico , Masculino , Morfolinas/uso terapêutico , Estômago/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Cavidade Torácica/diagnóstico por imagemRESUMO
Abstract The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.
Assuntos
Humanos , Masculino , Idoso , Estômago/cirurgia , Dilatação Gástrica/etiologia , Anastomose Cirúrgica/efeitos adversos , Esôfago/cirurgia , Infarto Miocárdico de Parede Inferior/etiologia , Dilatação Gástrica/tratamento farmacológico , Dilatação Gástrica/diagnóstico por imagem , Benzamidas/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Morfolinas/uso terapêutico , Doença Aguda , Esofagectomia/métodos , Gastroparesia/etiologia , Gastroparesia/tratamento farmacológico , Gastroparesia/diagnóstico por imagem , Estenose Coronária/etiologia , Estenose Coronária/tratamento farmacológico , Estenose Coronária/diagnóstico por imagem , Eletrocardiografia , Esôfago/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/diagnósticoAssuntos
Apêndice Atrial , Fibrilação Atrial , Doença da Válvula Aórtica Bicúspide , Tamponamento Cardíaco , Ablação por Cateter , Amputação Cirúrgica , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/etiologia , Fibrilação Atrial/cirurgia , Doença da Válvula Aórtica Bicúspide/complicações , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cateteres , Humanos , Resultado do TratamentoRESUMO
OBJECTIVE: To summarize the research progress of tibial transverse transport in the treatment of diabetic foot. METHODS: The domestic and foreign literature on the tibial transverse transport for diabetic foot in recent years was summarized, and the advantages and disadvantages of the technique were analyzed. RESULTS: The tibial transverse transport was an innovation based on Ilizarov technique. At present, the treatment of diabetic foot by the tibial transverse transport is in the initial stage and has achieved good results, but there are also problems such as ulcer recurrence and re-fracture. And its biological mechanism to promote tissue regeneration, clinical technical points (such as the selection of incision and bone window size), the technical parameters of postoperative removal program, and the postoperative effectiveness are still in dispute and exploration. More clinical studies and practices are needed in the future to develop a standard protocol for this technique. CONCLUSION: Tibial transverse transport is a hot spot for microcirculation reconstruction of lower extremity. Significant progress has been made in the treatment of diabetic foot, which provides a new direction for limb salvage treatment. However, the technique is not mature, there are still many disputes and difficulties to be further studied clearly.
Assuntos
Diabetes Mellitus , Pé Diabético/cirurgia , Técnica de Ilizarov , Humanos , Salvamento de Membro , Tíbia/cirurgia , Resultado do Tratamento , CicatrizaçãoRESUMO
Abstract Early recognition and rapid and appropriate treatment of cardiac tamponade are mandatory to prevent the irreversible deterioration of cerebral perfusion and other important organs. In this study, cardiac tamponade was induced by inadvertent transseptal puncture, which was managed with pericardial drainage and surgical repair in a patient with symptomatic paroxysmal atrial fibrillation. Epicardial atrial fibrillation ablation and left atrial appendage amputation were also performed at the same time.
Assuntos
Humanos , Fibrilação Atrial/cirurgia , Fibrilação Atrial/etiologia , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/diagnóstico por imagem , Apêndice Atrial/cirurgia , Apêndice Atrial/diagnóstico por imagem , Tamponamento Cardíaco/cirurgia , Resultado do Tratamento , Ablação por Cateter , Cateteres , Amputação CirúrgicaRESUMO
OBJECTIVES: Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED) in China, we herein compare its clinical effects with microendoscopic discectomy (MED) for the treatment of lumbar disc herniation in terms of recurrence and revision rates. METHODS: Six databases, namely, PubMed, EMBASE, Cochrane Library, Ovid, China National Knowledge Infrastructure and Wanfang, were searched by computer. The literature was screened according to inclusion and exclusion criteria, and the quality of the included literature was evaluated. After extracting the data from the papers, Review Manager 5.2 software (Cochrane Collaboration, Oxford, UK) was applied to analyze these data. Finally, sensitivity and publication bias analyses of the results were conducted. RESULTS: A total of 12 studies consisting of 2400 patients were included in this meta-analysis. A comparison of PTED with MED revealed higher postoperative recurrence and postoperative revision rates for PTED (odds ratio [OR] recurrence, 1.60; 95% confidence interval [CI], 1.01 to 2.53; p=0.05 and OR revision, 1.77; 95% CI, 1.18 to 2.64, p=0.006). CONCLUSION: PTED has a number of advantages because it is a minimally invasive surgery, but its recurrence and revision rates are higher than MED. Therefore, MED should not be completely replaced by PTED.