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1.
Respir Care ; 65(11): 1773-1783, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32759372

RESUMO

The COVID-19 pandemic has profoundly affected health care delivery worldwide. A small yet significant number of patients with respiratory failure will require prolonged mechanical ventilation while recovering from the viral-induced injury. The majority of reports thus far have focused on the epidemiology, clinical factors, and acute care of these patients, with less attention given to the recovery phase and care of those patients requiring extended time on mechanical ventilation. In this paper, we review the procedures and methods to safely care for patients with COVID-19 who require tracheostomy, gastrostomy, weaning from mechanical ventilation, and final decannulation. The guiding principles consist of modifications in the methods of airway care to safely prevent iatrogenesis and to promote safety in patients severely affected by COVID-19, including mitigation of aerosol generation to minimize risk for health care workers.


Assuntos
Infecções por Coronavirus , Remoção de Dispositivo/métodos , Gastrostomia , Controle de Infecções , Pandemias , Pneumonia Viral , Traqueostomia , Desmame do Respirador/métodos , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Cuidados Críticos/normas , Gastrostomia/instrumentação , Gastrostomia/métodos , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/normas , Pneumonia Viral/complicações , Pneumonia Viral/cirurgia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Risco Ajustado , Traqueostomia/instrumentação , Traqueostomia/métodos
2.
J Card Surg ; 35(10): 2866-2868, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720320

RESUMO

BACKGROUND AND AIMS: Fracture and retention of a guidewire after cardiac resynchronization therapy device implantation has not been reported in the literature so far, although it is an uncommon but known complication during cardiac interventions like percutaneous coronary interventions and other cardiac catheterization procedures. METHODS: A 53 years old female patient presented with severe pain over the left arm and shoulder for a period of 1 to 2 days. The patient had a history of dilated cardiomyopathy with severe left ventricular dysfunction and underwent cardiac resynchronization therapy device implant 3 years back with subsequent lead replacement 6 months back due to lead dysfunction. On evaluation, a coronary guidewire which might have fractured and been retained inadvertently during previous surgical procedure, was discovered in her deltoid muscle. Her symptoms were attributed to the guide wire which may have been aggravated by the movements of her arm. Emergency surgical exploration was done and the guidewire was removed. RESULTS AND CONCLUSION: We are reporting a case of unlikely and unusual delayed presentation of retained intervention guide-wire post cardiac resynchronization therapy, which was retrieved from the left deltoid muscle.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/efeitos adversos , Cardiomiopatia Dilatada/terapia , Músculo Deltoide/cirurgia , Remoção de Dispositivo/métodos , Falha de Equipamento , Intervenção Coronária Percutânea/efeitos adversos , Disfunção Ventricular Esquerda/terapia , Cardiomiopatia Dilatada/complicações , Emergências , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
3.
J Card Surg ; 35(8): 2100-2102, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32668088

RESUMO

Transcatheter repair systems are becoming increasingly popular as a potential solution for high-risk and inoperable patients with mitral regurgitation. The cardioband (Edwards Lifesciences, Irvine, California) is a transcatheter direct annuloplasty device, based on the concept of an undersized ring annuloplasty. We report a case of minimally invasive surgical explantation of a failed cardioband device 21 months after its implantation. Intraoperatively, it was found that three anchors of the cardioband device were detached from the posterior annulus at P2. In this report, a "cut and unscrew" technique with some tips and tricks is presented for the removal of the device.


Assuntos
Cateterismo Cardíaco/métodos , Remoção de Dispositivo/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Anuloplastia da Valva Mitral/instrumentação , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Feminino , Humanos
4.
PLoS One ; 15(7): e0236093, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706784

RESUMO

INTRODUCTION: Surgical and percutaneous tracheostomy remains a commonly performed procedure in the intensive care unit (ICU). Given the unique patient population in the Middle East we decided to perform a review of the procedures performed in our hospital over a two-year period. METHODS: Single centre, retrospective observational study. All tracheostomies performed between January 2016 and January 2018 were included in the study. The primary outcome was the rate of tracheostomy complications. Multivariate logistic regression analysis was used to identify the independent factors associated with complications and decannulations. RESULTS: One hundred sixty-four patients were included in the study. Percutaneous tracheostomy was performed in 99 patients (60.4%). Complications occurred in thirty-eight patients (23%). Higher Left ventricular ejection fraction (OR = 0.94, 95%CI: [0.898-0.985]) and percutaneous tracheostomy (OR = 0.107, 95%CI: [0.029-0.401]) were associated with lower complications. Good Eastern Cooperative Oncology Group (ECOG) performance status (OR = 4.1, 95%CI: [1.3-13.3]) and downsized tracheostomy tube (OR = 6.5, 95%CI: [2.0-21.0]) were associated with successful decannulations. Successful decannulation was associated with lower hospital mortality when compated to those who could not be decannulated (3.2% vs 33.3% p < 0.0001). CONCLUSION: In our older population with high comorbidities, percutaneous tracheostomies were associated with less complications than surgical tracheostomies. Patients with poor premorbid functional status and those who could not have their tracheostomy tube sucessfuly downsized were less likely to be decannulated, and had a higher mortality. This data enables physicians to inform the families of the added risks involved with tracheostomy in this patient group.


Assuntos
Remoção de Dispositivo/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Traqueostomia/efeitos adversos , Desmame do Respirador/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Prognóstico , Estudos Retrospectivos
5.
J Card Surg ; 35(7): 1642-1643, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32484974

RESUMO

BACKGROUND AND AIM: Complications of inferior vena cava filters are relatively common, and they vary according to different filter types and designs. We aim to present a case of penetrated inferior vena cava filter into the liver. METHODS: Case report. RESULTS: A 42-year old man with thrombophilia (prothrombin gene mutation) required the insertion of an inferior vena cava filter because of recurrent gastrointestinal bleeding associated with oral anticoagulation. However, it penetrated through the retro-hepatic vena cava into the liver, being manifested by constant, blunt abdominal pain. Endovascular retrieval was considered of extreme risk, though a surgical approach was performed under cardiopulmonary bypass with deep hypothermic circulatory arrest. The patient has recovered uneventfully with complete symptom relief. CONCLUSIONS: In symptomatic penetrated vena cava filters in which endovascular retrieval is not feasible, a surgical approach with appropriate planning is a safe and effective treatment.


Assuntos
Parada Circulatória Induzida por Hipotermia Profunda/métodos , Remoção de Dispositivo/métodos , Fígado/lesões , Fígado/cirurgia , Falha de Prótese , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/cirurgia , Adulto , Ponte Cardiopulmonar , Procedimentos Endovasculares/métodos , Humanos , Fígado/irrigação sanguínea , Masculino , Resultado do Tratamento
6.
Isr Med Assoc J ; 22(5): 315-319, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32378825

RESUMO

BACKGROUND: Buried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported, and the treatment of this condition is still unclear. OBJECTIVES: To evaluate the Seldinger technique for treatment of early BBS after PEG insertion. METHODS: We report two cases of early BBS in two consecutive patients who underwent PEG insertion to maintain oral intake. The first patient was an 83-year-old woman showing Alzheimer type dementia, while the other one was a 76-year-old man who presented with maxillary cancer and treated with radiotherapy followed by left maxillectomy. Post-surgery, he developed progressive difficulty of swallowing due to mouth deformation and treatment related nerve toxicity. The first patient presented with fever and purulent discharge from the gastrostomy insertion site, without ability to rotate or slide the tube through the stoma 10 days after the PEG insertion. The man was admitted to the hospital 5 days following PEG insertion due to a fever of 38°C and peritubal swelling with purulent discharge. In addition, the tube could not rotate or slide through the stoma. RESULTS: Buried bumper syndrome was demonstrated by computed tomography scan. Gastroscopy and gastrostomy tube replacement was performed successfully according to the Seldinger technique (replacement over guidewire) in both cases. Correct intragastric tube positioning was demonstrated radiographically before resuming tube feeding. The two patients were discharged in good physical condition several days later. CONCLUSIONS: External replacement over guide wire should be considered in such cases.


Assuntos
Nutrição Enteral/instrumentação , Gastrostomia/instrumentação , Complicações Pós-Operatórias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/métodos , Feminino , Humanos , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Retratamento , Fatores de Tempo
7.
Medicine (Baltimore) ; 99(20): e19935, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443293

RESUMO

INTRODUCTION: The removal of bent intramedullary (IM) nail can become a challenge. Therefore, various methods have been reported for the extraction of nails after femoral refracture. We want to share our successful treatment. PATIENT CONCERNS: Case 1. A 44-year-old man was admitted to our clinic after falling while playing soccer. He complained severe right thigh pain with a visible deformity of the femur. His medical history revealed a right femoral shaft fracture caused in a traffic accident which had been treated with intramedullary nailing. Case 2. A 27-year-old man, who had suffered a right femur fracture after a motorcycle accident and been treated with an IM nail, presented after falling down the stairs. He had severe right thigh pain without any open wound or neurologic deficit. DIAGNOSIS: Case 1. Plain radiographs revealed a refracture of the right femoral shaft and a bent IM nail. The initial varus deformity of the nail was 60.1° in the coronal plane. Case 2. The valgus deformity of the nail was 16.1° with an apex-posterior angulation of 34.8° in the sagittal image of plain radiographs. INTERVENTIONS: Case 1. Initial manual reduction was tried in emergency room. Then, under general anesthesia closed reduction of the fracture and bent IM nail was done. After closed reduction, the nail was straightened and extracted smoothly. Case 2. Closed manipulation was attempted initially. But no difference in the deformity was achieved. Therefore, via skin incision, the bent nail was progressively sectioned with high-speed cutting burr until the nail could be straightened. OUTCOMES: Case 1. The patient was mobilized with partial-weight bearing assisted with a crutch on postoperative day two. One year after surgery, the fracture union was complete and the patient was pain-free. Case 2. Six months after surgery, the fracture union was complete with sufficient callus formation around the fracture site. CONCLUSION: There is no gold standard method to remove a bent IM nail. However, since manual reduction to straighten the bent nail causes minimal soft tissue damage, it should be considered first. If it fails, other methods should be attempted, progressing from the minimally invasive technique to more invasive methods.


Assuntos
Pinos Ortopédicos/efeitos adversos , Remoção de Dispositivo/métodos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Complicações Pós-Operatórias/cirurgia , Adulto , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Recidiva
8.
Artigo em Inglês | MEDLINE | ID: mdl-32459076

RESUMO

As the number of young and relatively low-risk patients undergoing transcatheter aortic valve implantation increases, the number who will require open heart surgery months or years later will also increase. Only a few cases of late transcatheter heart valve explantation (without root replacement) have been reported in the literature, and this rare procedure can be surgically very challenging. In this video tutorial we present the case of a patient with a valve-in-valve subacute thrombosis, and we describe the surgical technique for valve explantation.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica , Remoção de Dispositivo/métodos , Reoperação/métodos , Trombose , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Trombose/etiologia , Trombose/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
9.
J Card Surg ; 35(7): 1664-1668, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32383229

RESUMO

INTRODUCTION: In adult congenital patients with transposition of the great arteries originally treated with the Mustard (atrial switch) procedure, the most common reason for re-intervention is baffle stenosis. This may be exacerbated by permanent transvenous pacemaker lead placement across the baffle. CASE REPORT: A 47-year-old female status post Mustard procedure performed at 15 months old presented with a high-grade stenosis of the superior vena cava (SVC) baffle from the SVC to the left atrium, with a nonfunctional permanent pacemaker lead passing through the baffle. A mechanical rotating dilator sheath was used for attempted lead extraction, relieving the baffle stenosis almost completely as a secondary effect, before the placement of a 10 × 27 mm Visipro balloon-expandable stent in the SVC baffle. CONCLUSIONS: Use of the mechanical rotating dilator sheath is an evolving treatment strategy in adult congenital heart disease to minimize the risk of bleeding, trauma to surrounding structures, and death. Its ability to fully alleviate baffle stenosis even when full lead extraction is not feasible or is associated with significant procedural risk, further demonstrates its expanded role in this patient population. A multidisciplinary approach and great diligence must be employed to avoid potential complications.


Assuntos
Transposição das Grandes Artérias/métodos , Remoção de Dispositivo/instrumentação , Marca-Passo Artificial/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Transposição dos Grandes Vasos/cirurgia , Veia Cava Superior/patologia , Veia Cava Superior/cirurgia , Transposição das Grandes Artérias/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Remoção de Dispositivo/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Stents Metálicos Autoexpansíveis , Resultado do Tratamento
10.
J Card Surg ; 35(7): 1687-1689, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32400072

RESUMO

Device embolization is a rare major complication of atrial septal defect percutaneous closures which requires surgical management if noninvasive retrieval fails. We report a symptomatic delayed embolization of an Amplatzer septal occluder device into the left ventricle outflow tract tangled with the mitral valve, complicated with ventricular arrhythmias and cardiac tamponade during percutaneous retrieval attempt. Emergent surgical treatment was performed, requiring a combined approach through the right atrium and the aorta for surgical removal.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Embolia/etiologia , Embolia/cirurgia , Migração de Corpo Estranho/cirurgia , Ventrículos do Coração , Valva Mitral/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Idoso , Aorta , Arritmias Cardíacas/etiologia , Tamponamento Cardíaco/etiologia , Feminino , Átrios do Coração , Humanos , Resultado do Tratamento
11.
Z Gastroenterol ; 58(7): 664-671, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32380554

RESUMO

Standard therapy for benign stenoses of the biliary tract are coated metal stents or multi-stenting with plastic stents. Uncoated metal stents are not recommended because tissue ingrowth and overgrowth may render them impossible to remove with acceptable risk.We report a patient with chronic calcifying pancreatitis and cholestasis who, after unsuccessful multistenting with a total of 15 stent changes, was implanted with an uncoated metal stent in the common bile duct as second-line therapy. After this stent had been in place for six years and had to be balloon-cleaned 19 times during this time, the indication for removal came up. A fully coated metal stent of the same diameter but 2 cm longer was inserted into the lumen of the uncoated stent. It was left in place for 9 months and cleaned once during this time. Then, via ERCP, both stents were extended in a telescope-like manner, mobilized using a forceps and finally removed from the bile duct. Afterwards, the patient remained symptomless and free from cholestasis.The stent-in-stent technique for removing uncoated stents was first described for the esophagus. Our case shows that it can also be used in the biliary tract and even after an extended period of time.


Assuntos
Colestase/cirurgia , Ducto Colédoco/cirurgia , Remoção de Dispositivo/métodos , Pancreatite/cirurgia , Stents , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Metais
12.
J Cardiothorac Surg ; 15(1): 101, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32423421

RESUMO

BACKGROUND: Fractured catheter as a foreign body in situ is a rare complication after port catheter placement. We report a single center's experience on percutaneous transvenous retrieval of intravascular fractured port catheter and treatment techniques. METHODS: Patients undergoing percutaneous transvenous retrieval of intravascular fractured port catheter from Jan 2010 to Dec 2018 were retrospectively collected. A total of 10 patients (8 females and 2 males) were enrolled in this study. Procedures were performed within 1 day after diagnosis. Two methods of retrieval were considered, direct retrieval by gooseneck snare and guide wire as media to retrieve were used in the procedure. RESULTS: All the fractured catheters in 10 patients were successfully retrieval by 2 methods, direct retrieval by gooseneck snare(n = 6) and guide wire as media of retrieval(n = 4). The time interval between port catheter implantation and discovery of catheter fracture was 36.50 ± 42.99(ranged 1 to 146) days. The operation time was 24.10 ± 8.32(ranged 10 to 36) minutes. No immediate procedure related or 1 month follow-up complications occurred in all the 10 patients. CONCLUSION: Percutaneous transvenous retrieval of intravascular fractured port catheter is a simple and safe procedure, which maybe recommended as the first choice for patients with fractured port catheter in situ.


Assuntos
Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/métodos , Corpos Estranhos/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Falha de Prótese , Estudos Retrospectivos , Resultado do Tratamento
13.
J Cardiothorac Surg ; 15(1): 103, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32430008

RESUMO

BACKGROUND: The Swan-Ganz catheter plays an important role in gaining understanding of cardiac pathophysiology and in the hemodynamic monitoring of critically ill patients. Difficult removal of the Swan-Ganz catheter is a rare but serious complication. CASE PRESENTATION: This case presents the difficult removal of a Swan-Ganz catheter in a 28-year-old female patient after cardiac surgery. Fluoroscopy and chest X-ray revealed that a portion of the Swan-Ganz catheter was coiled on the central venous catheter at the level of the superior vena cava. Under X-ray guidance, the central venous catheter was first removed, and then the Swan-Ganz catheter was successfully withdrawn through the percutaneous introducer sheath. CONCLUSIONS: This case report provides an unreported reason for difficult removal and describes a successful solution. This report suggests that X-ray examinations may be necessary before removing the Swan-Ganz catheter.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cateterismo de Swan-Ganz/efeitos adversos , Cateteres Venosos Centrais , Remoção de Dispositivo/métodos , Veia Cava Superior/cirurgia , Adulto , Feminino , Fluoroscopia , Hemodinâmica , Humanos , Radiografia , Veia Cava Superior/diagnóstico por imagem , Raios X
14.
Artigo em Inglês | MEDLINE | ID: mdl-32349262

RESUMO

BACKGROUND: Optimal care of patients treated with a central tunneled catheter (CTC) as vascular access for hemodialysis requires a number of procedures. One of them is CTC removal, usually carried out using mostly the cut-down method (CDM) and the traction method (TM). The procedure seems to be simple and safe; however, occasionally, serious complications may occur. To eliminate the risk of such events, we have introduced a modified cut-down method (MCDM). METHODS: The study included the analysis of retrospective results of 143 CTC removal procedures, 76 of which were performed using the standard cut-down method (CDM), and in 67 cases, the modified cut-down method (MCDM) was applied. RESULTS: As minor side effects occurred in patients treated with both methods with comparable frequency, serious complications were observed only in the CDM patients group. CONCLUSIONS: In our opinion, the new MCDM procedure is the simplest and safest method of CTC removal.


Assuntos
Cateterismo Venoso Central , Cateteres de Demora , Remoção de Dispositivo , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento
16.
Pediatr Surg Int ; 36(6): 679-685, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32342179

RESUMO

PURPOSE: The treatment of MH entails surgical repair either by open abdominal or thoracic approaches or by minimal invasive surgery. The aim of this study is to evaluate the surgical and clinical outcomes of children who underwent laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique. METHODS: This retrospective study includes pediatric patients who underwent surgery for MH between January 2015 and February 2019. The patients' demographic data, symptoms, operative findings and technique and postoperative outcomes were recorded. RESULTS: A total of 17 children with MH were treated. There were 13 boys (76.5%) and four (23.5%) girls. Six patients had trisomy 21 (37%). The mean operation time was 40 min (25-90 min). The hernia sac was removed in all patients and there was no need for prosthetic patch in any of the children. Mean time to start feeding was 10 h (6-24 h). The mean hospitalization time was 2 days (1-5 days). There were no complications intraoperatively or postoperatively. The mean follow-up time was 24 months (6-40). No recurrence occurred during the follow-up time. CONCLUSION: Laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique is a preferable method with excellent outcomes and short hospitalization and feeding time postoperatively. This technique may be performed easily and safely without requiring any additional experience other than basic laparoscopy skills.


Assuntos
Remoção de Dispositivo/métodos , Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Técnicas de Sutura , Suturas , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Duração da Cirurgia , Período Pós-Operatório , Recidiva , Estudos Retrospectivos
17.
Spine Deform ; 8(4): 809-817, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32170660

RESUMO

STUDY DESIGN: Case reports and review of the literature with a proposed management algorithm. OBJECTIVES: To report two cases of a potential vascular complication due to an incorrectly placed pedicle screw (PS) during spine deformity surgery. Relevant literature regarding the management of vascular complications is reviewed, and an evidence-based management algorithm is proposed. Aortic lesions represent a rare but potentially life-threatening complications with spine deformity and revision surgery, significantly increasing the risk. A management algorithm for an aortic lesion in the case of a malpositioned PS has not yet been published. METHODS: Case 1: An 18-year-old female with proximal thoracic spinal non-instrumented fusion underwent a revision corrective procedure due to a progressive right-sided thoracolumbar compensatory curve. However, postoperative computed tomography (CT) performed to evaluate the position of the PS revealed malposition of the left T9 PS, which was abutting the descending aorta with CT angiography excluding the perforation of the aorta. Case 2: A 17-year-old male was scheduled for correction of Lenke 3-C-N adolescent idiopathic scoliosis. Postoperative routine evaluation with low-dose CT revealed a left T9 PS paravertebral malposition, and subsequent CTA demonstrated that the thread of the PS was in contact with the descending thoracic aorta and an unlikely hemodynamically significant vessel injury. RESULTS: Successful removal of both malpositioned PS was performed. In the first case, a cardiovascular surgeon attended the operation if an urgent thoracotomy was needed, and in the second case, additional video-assisted thoracoscopic control of the aorta was performed during PS removal. CONCLUSIONS: Preoperative imaging in spinal surgery is essential to avoid major vascular and other complications when placing PS, especially in thoracic deformities. When a potential major vessel complication emerges, an interdisciplinary approach and an appropriate management algorithm are mandatory to make the best clinical decisions. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Lombares/cirurgia , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Adolescente , Algoritmos , Criança , Remoção de Dispositivo/métodos , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação , Escoliose/congênito , Escoliose/diagnóstico por imagem , Fusão Vertebral/métodos , Cirurgia Assistida por Computador , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Ann Thorac Surg ; 110(4): e307-e309, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32145194

RESUMO

The case provided suggests that an ultrasound-navigated Manta device works well in closing percutaneously the peripheral arterial extracorporeal membrane oxygenation cannulation site. Ultrasonography use during extracorporeal membrane oxygenation decannulation can further diminish the possible device-related technical failures (toggle or collagen protrusion through the vessel wall, toggle stacking into calcifications, or delivery failure of the collagen pad) leading to bleeding and vascular complications. Further studies are needed on this topic.


Assuntos
Cânula , Remoção de Dispositivo/métodos , Oxigenação por Membrana Extracorpórea/instrumentação , Ultrassonografia de Intervenção , Dispositivos de Oclusão Vascular , Humanos , Masculino , Pessoa de Meia-Idade
19.
World Neurosurg ; 138: 360-362, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32200012

RESUMO

BACKGROUND: Retained old cerebrospinal fluid diversion shunt catheters in the neck, chest, or abdominal walls are frequently encountered in patients with lifelong shunt-dependent hydrocephalus who have undergone multiple shunt revisions. Particularly in cases where years and decades go between shunt revisions, the distal catheter portion can get calcified and nearly impossible to remove. Most patients tolerate a retained shunt catheter without problems. In some patients, however, retained catheters can cause pain and discomfort, particularly over the clavicle with head movements. Albeit trivial, we are unaware of innovative solutions to this problem. Here, we describe the use of an endoscopic vein harvest device used in cardiothoracic surgery to completely remove an old, calcified shunt catheter. METHODS: Removal of a calcified ventriculoperitoneal shunt catheter using an endoscopic vein harvesting system was performed in a 32-year-old man with shunt-dependent hydrocephalus from premature birth. At 14 years of age, the patient had his only shunt revision consisting of a new distal catheter being placed adjacent to the old catheter. The patient presented with significant discomfort from the retained original shunt catheter. RESULTS: Using the endoscopic vein harvesting system, the shunt catheter was removed minimally invasively and the patient had complete resolution of his symptomatology. CONCLUSIONS: The endoscopic vein harvesting system used in cardiothoracic surgery is a suitable instrument to remove long segments of a retained ventriculoperitoneal shunt catheter minimally invasively through a small skin incision. To our knowledge, this is the first report of minimally invasive removal of a retained ventriculoperitoneal catheter.


Assuntos
Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/instrumentação , Remoção de Dispositivo/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Derivação Ventriculoperitoneal/efeitos adversos , Adulto , Humanos , Masculino
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