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2.
J Cardiothorac Surg ; 14(1): 28, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717747

RESUMO

BACKGROUND: Isolated right atrial rupture (IRAR) from blunt chest trauma is rare. There are no physical exam findings and non-invasive testing specific to the condition, which result in diagnostic delays and poor outcomes. We present a case of IRAR along with a systematic review of similar cases in the literature. CASE REPORT: A 23-year-old male presented following a motor vehicle accident (MVA). He was bradycardic and hypotensive during transportation; and required intubation. There were contusions along the right chest wall with clear breath sounds, and no jugular venous distension, muffled heart sounds. Hemodynamic status progressively worsened, ultimately leading to his death. However, no external sources of bleeding or evidence of cardiac tamponade was found. METHODS: A search of PubMed, Ovid, and the Cochrane Library using: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Articles were included if they were original articles describing cases of IRAR. RESULTS: Forty-five reports comprising seventy-five (n = 75) cases of IRAR. CONCLUSION: IRAR most commonly occurs following MVAs as the result of blunt chest trauma. Rupture occurs at four distinct sites and is most commonly at the right atrial appendage. IRAR is a diagnostic challenge and requires a high index of suspicion, as patients' hemodynamics can rapidly deteriorate. The presentations vary depending on multiple factors including rupture size, pericardial integrity, and concomitant injuries. Cardiac tamponade may have a protective effect by prompting the search for a bleeding source. A pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are favourable with timely recognition and prompt surgical intervention.


Assuntos
Apêndice Atrial/lesões , Traumatismos Cardíacos/diagnóstico , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Evolução Fatal , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Adulto Jovem
3.
Ann Thorac Surg ; 107(1): e71-e73, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30240767

RESUMO

The left atrial appendage (LAA) is a major site of clot formation in atrial fibrillation. Stand-alone thoracoscopic LAA complete closure can decrease stroke risk and may be an alternative to life-long oral anticoagulation. This report describes a technique for totally thoracoscopic LAA exclusion with an epicardial clip device. This approach provides a safe and likely more effective alternative to LAA management than other endocardial devices.


Assuntos
Apêndice Atrial/cirurgia , Toracoscopia/métodos , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/lesões , Fibrilação Atrial/complicações , Angiografia por Tomografia Computadorizada , Humanos , Complicações Intraoperatórias/cirurgia , Pericardiectomia/métodos , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
4.
J Invasive Cardiol ; 30(11): E126-E127, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30373956

RESUMO

Left atrial appendage (LAA) perforation is a possible complication not only after release of the closure device, but also during the diagnostic phase due to sheath positioning in the LAA. We present an 83-year-old woman with permanent atrial fibrillation and high thromboembolic and bleeding risk who was admitted for elective percutaneous LAA closure. During angiographic study, she suddenly became hypotensive. Heart perforation with leakage of contrast in the pericardial space was evident and imaging confirmed cardiac tamponade. Rapid release of the closure device and pericardial evacuation allowed the operators to successfully manage the cardiac tamponade and avoid a surgical option.


Assuntos
Apêndice Atrial/lesões , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/efeitos adversos , Tamponamento Cardíaco/etiologia , Traumatismos Cardíacos/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Idoso de 80 Anos ou mais , Angiografia , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico , Transfusão de Sangue Autóloga/métodos , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/terapia , Ecocardiografia Transesofagiana , Feminino , Traumatismos Cardíacos/complicações , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/terapia , Humanos , Pericardiocentese , Fatores de Tempo
6.
Asian Cardiovasc Thorac Ann ; 26(5): 343-346, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29719981

RESUMO

Background Percutaneous device closure of an ostium secundum atrial septal defect is associated with excellent outcomes and cosmetic results but at the cost of occasional serious and sometimes fatal complications as well as lifelong follow-up. Surgical intervention is required in cases of device-related complications, which carries a slightly higher risk compared to primary closure of an atrial septal defect. We present a surgical perspective of device closure of atrial septal defect. Methods Our database was searched over 4 years for complications related to percutaneous device closure of atrial septal defect, which required surgical retrieval of the device and closure of the defect. We identified 14 cases that required surgical intervention. Results The median age of the 14 patients was 18 years (range 4-58 years). The size of the defect ranged from 15 to 40 mm (median 30 mm). Device embolization into any part of the cardiovascular system ( n = 8) was the most common complication, followed by malalignment of the device ( n = 5). One patient had left atrial appendage perforation causing pericardial effusion and cardiac tamponade, and underwent surgical repair. The other 13 patients underwent removal of the device and atrial septal defect closure. One patient developed severe mitral regurgitation requiring mitral valve replacement. There was no mortality. Conclusion Although the incidence of device-related complications may be small, they carry a high risk of death or long-term morbidity, even with a small atrial septal defect, unlike primary surgical closure of isolated atrial septal defect.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Remoção de Dispositivo/métodos , Migração de Corpo Estranho/cirurgia , Comunicação Interatrial/terapia , Insuficiência da Valva Mitral/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Adolescente , Adulto , Apêndice Atrial/lesões , Apêndice Atrial/cirurgia , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Criança , Pré-Escolar , Bases de Dados Factuais , Remoção de Dispositivo/efeitos adversos , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Asian Cardiovasc Thorac Ann ; 22(5): 598-600, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24585276

RESUMO

A 42-year-old man sustained blunt thoracic trauma after a motor vehicle accident. He underwent an urgent operation. Operative findings included a large hematoma, a 4-cm tear in the left atrial appendage, and a long pleuropericardial rupture along the right phrenic nerve. We repaired the left atrial appendage without cardiopulmonary bypass, and closed the pericardial defect primarily. The patient recovered fully and was discharged on the 6th postoperative day.


Assuntos
Apêndice Atrial/lesões , Traumatismos Cardíacos/etiologia , Hérnia/etiologia , Ferimentos não Penetrantes/etiologia , Acidentes de Trânsito , Adulto , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Hérnia/diagnóstico por imagem , Herniorrafia , Humanos , Masculino , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
10.
11.
Catheter Cardiovasc Interv ; 83(2): 305-7, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23674434

RESUMO

A 76-year-old male patient was admitted for percutaneous left atrial appendage (LAA) closure because of chronic atrial fibrillation and a history of gastrointestinal bleeding under oral anticoagulation. The procedure was complicated by perforation of the LAA with the lobe of the closure device being placed in the pericardial space. Keeping access to the pericardial space with the delivery sheath, the LAA closure device was replaced by an atrial septal defect closure device to seal the perforation. Then the initial LAA closure device was reimplanted in a correct position. Needle pericardiocentesis was required but the subsequent course was uneventful.


Assuntos
Fibrilação Atrial/terapia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Traumatismos Cardíacos/terapia , Dispositivo para Oclusão Septal , Apêndice Atrial/lesões , Fibrilação Atrial/diagnóstico , Desenho de Equipamento , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Pericardiocentese , Radiografia Intervencionista , Resultado do Tratamento
12.
J Invasive Cardiol ; 24(11): E289-93, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23117323

RESUMO

We report an 88-year-old male with coronary artery disease, previously placed left main coronary artery drug-eluting stent, and atrial fibrillation unable to tolerate anticoagulation with warfarin in addition to dual antiplatelet therapy who underwent percutaneous catheter-based ligation of the left atrial appendage. During the procedure, left atrial appendage perforation occurred with resultant pericardial effusion. The novel LARIAT suture delivery system (SentreHEART) allowed immediate and definitive management of this complication and effective ligation of the left atrial appendage. Prospective studies are needed to determine whether this is a safe and effective method for thromboembolism prophylaxis in patients with atrial fibrillation, but its novel design incorporates an immediate resolution to the most-feared complication of catheter-based left atrial appendage manipulation while effectively excluding the left atrial appendage via suture ligation.


Assuntos
Apêndice Atrial/lesões , Apêndice Atrial/cirurgia , Cateteres Cardíacos , Intervenção Coronária Percutânea/métodos , Técnicas de Sutura , Suturas , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Stents Farmacológicos , Humanos , Ligadura , Masculino , Intervenção Coronária Percutânea/instrumentação , Tromboembolia/prevenção & controle , Resultado do Tratamento
13.
Tex Heart Inst J ; 39(4): 579-81, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22949784

RESUMO

Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.


Assuntos
Acidentes de Trânsito , Procedimentos Cirúrgicos Cardíacos , Traumatismos Cardíacos/cirurgia , Ferimentos não Penetrantes/cirurgia , Algoritmos , Apêndice Atrial/lesões , Apêndice Atrial/cirurgia , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Ecocardiografia , Feminino , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Esternotomia , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/fisiopatologia , Adulto Jovem
15.
Europace ; 14(2): 297, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22266846

RESUMO

A 66-year-old man was implanted with a pacemaker. Seven years after implantation he was admitted due to cardiogenic cerebral embolism and warfarin therapy was introduced. After that, he suffered recurrent pericardial effusion for unexplained reasons. An exploratory thoracotomy revealed that the screw of the atrial lead had penetrated through the right auricular appendage wall.


Assuntos
Apêndice Atrial/lesões , Eletrodos Implantados/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Derrame Pericárdico/etiologia , Derrame Pericárdico/prevenção & controle , Varfarina/efeitos adversos , Ferimentos Penetrantes/etiologia , Idoso , Anticoagulantes/administração & dosagem , Humanos , Masculino , Recidiva , Resultado do Tratamento
16.
Europace ; 13(6): 901-2, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21296773

RESUMO

A 74-year-old man with chronic atrial fibrillation underwent ablation under conscious sedation. After sheath removal from the left atrium, the patient flexed his thighs, resulting in a 'foetal position' developing tamponade due to an right atrial (RA) appendage perforation from sheath migration. This illustrates the importance of close monitoring during sedation weaning, recommending removal of all sheaths prior to sedation withdrawal.


Assuntos
Apêndice Atrial/lesões , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Átrios do Coração/lesões , Traumatismos Cardíacos/etiologia , Idoso , Apêndice Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Sedação Consciente , Remoção de Dispositivo , Átrios do Coração/cirurgia , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Erros Médicos , Restrição Física , Resultado do Tratamento
17.
Heart Rhythm ; 7(2): 173-80, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20129293

RESUMO

BACKGROUND: Left atrial appendage (LAA) isolation is rare and may be associated with impaired transport function and thromboembolism. OBJECTIVE: The purpose of this study was to determine the mechanisms of inadvertent isolation of the LAA during atrial fibrillation (AF) ablation. METHODS: This study consisted of 11 patients (ejection fraction 0.43 +/- 0.18, left atrial diameter 51 +/- 8 mm) with persistent AF who had LAA conduction block during a procedure for AF (n = 8) or atrial tachycardia (AT) (n = 3). RESULTS: LAA conduction block occurred during ablation at the Bachmann bundle region in 6 patients, mitral isthmus in 3, LAA base in 2, and coronary sinus in 1. The mean distance from the ablation site to the LAA base was 5.0 +/- 1.9 cm. LAA isolation was transient in all 6 patients in whom LAA conduction was monitored and was permanent in the 4 patients in whom conduction was not monitored during energy delivery. The remaining patient was noted to have LAA isolation during a redo procedure before any ablation. Nine of (82%) the 11 patients have remained arrhythmia-free without antiarrhythmic drugs at mean follow-up of 6 +/- 7 months, and all have continued taking warfarin. CONCLUSION: Electrical isolation of the LAA may occur during ablation of persistent AF and AT even when the ablation site is remote from the LAA. This likely is due to disruption of the Bachmann bundle and its leftward extension, which courses along the anterior left atrium and bifurcates to surround the LAA. Monitoring of LAA conduction during ablation of persistent AF or AT is important in avoiding permanent LAA isolation.


Assuntos
Apêndice Atrial/lesões , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Fibrilação Atrial/fisiopatologia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Eur J Cardiothorac Surg ; 34(5): 1118-9, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18823789

RESUMO

Blunt traumatic cardiac rupture is associated with a high mortality rate. Motor vehicle accidents account for most cardiac ruptures, but crush injury is relatively rare. We describe a case of a 77-year-old man who had the left atrial 'basal' appendage ruptured through blunt trauma due to a fall. He was surgically treated and recovered without complication.


Assuntos
Apêndice Atrial/lesões , Traumatismos Cardíacos/cirurgia , Ferimentos não Penetrantes/cirurgia , Acidentes por Quedas , Idoso , Apêndice Atrial/cirurgia , Traumatismos Cardíacos/complicações , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Resultado do Tratamento , Ultrassonografia
20.
Injury ; 39(9): 1089-92, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18675979

RESUMO

Improvements in pre-hospital care and the development of integrated Trauma Systems have streamlined access for the severely injured to sophisticated, specialist Trauma Centre reception and resuscitation. We describe the initial care of a survivor of combined ruptures of the left ventricle and left atrium secondary to blunt injury. This case emphasises the contribution of such a Trauma System in achieving a favourable outcome for a severely injured trauma patient with injuries previously considered non-survivable.


Assuntos
Traumatismos Cardíacos/cirurgia , Lesão Pulmonar/cirurgia , Toracotomia/métodos , Ferimentos não Penetrantes/cirurgia , Apêndice Atrial/lesões , Serviços Médicos de Emergência , Átrios do Coração/lesões , Átrios do Coração/cirurgia , Ventrículos do Coração/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Ressuscitação/métodos , Ruptura/cirurgia , Resultado do Tratamento
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