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Acute Pulmonary Embolism Caused by Abdominal Pannus Retraction in an Awake Patient in the Operating Room: A Case Report. A A Pract 2022; 16:e01559. [DOI: 10.1213/xaa.0000000000001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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2
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Stombaugh DK, Daubenspeck D, Chaney MA, Lu S, Fitzsimons MG, Gerlach RM. Percutaneous Vacuum-Assisted Thrombectomy for Right Atrial Mass. J Cardiothorac Vasc Anesth 2021; 36:3392-3402. [DOI: 10.1053/j.jvca.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 11/11/2022]
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Akhtar YN, Walker WA, Shakur U, Smith G, Husnain SS, Adigun SF. Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users. Catheter Cardiovasc Interv 2021; 97:1290-1295. [PMID: 33645916 DOI: 10.1002/ccd.29584] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/22/2021] [Accepted: 02/14/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A retrospective case series of a percutaneous approach to debulk tricuspid valve endocarditis (TVE) using an 8 French mechanical aspiration system in patients with a history of intravenous drug use (IVDU) was reported. IVDU associated TVE is increasing in the United States and is associated with high mortality despite early surgical debridement. Patients with advanced disease, shock, and respiratory failure may not be candidates for surgical debridement or replacement. These patients have recurrent events despite medical therapy METHODS: About 25 patients with IVDU associated TVE with persistent bacteremia confirmed by repeat blood cultures after 72 hr of sensitivity directed antibiotics and presence of pulmonary emboli confirmed by computed tomographic (CT) scan, who had undergone percutaneous aspiration were included. Patients were all deemed high risk for surgical debridement by a CT surgeon and evaluated by an infectious disease consultant. Procedures were performed under moderate sedation with intracardiac echo and a steerable guide with a CAT8 Penumbra aspiration catheter. RESULTS There were no intraprocedural deaths or complications. About 36% had septic shock on presentation. Survival of index hospitalization was 88%. Repeat blood cultures showed no growth on all surviving patients. Readmission rate was 4% (n = 1) at 1 month. About 40% (n = 2) patients with septic shock survived at 1 month compared with 100% survival (n = 20) in those without shock. Presence of septic shock was associated with reduced survival at 1 month (p < .01). CONCLUSION Percutaneous mechanical aspiration with an 8 Fr system is a feasible, minimally invasive alternative to surgical debulking. Mortality remains high in those presenting with septic shock. Further studies are needed to evaluate long-term outcomes.
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Affiliation(s)
- Yasir N Akhtar
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
| | - William A Walker
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
| | - Umar Shakur
- Sturdy Memorial Hospital, Attleboro, Massachusetts, US
| | - Gary Smith
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
| | - Syed S Husnain
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
| | - Shade F Adigun
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
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Bangalore S, Alviar CL, Vlahakis S, Keller N. Tricuspid valve vegetation debulking using the AngioVac system. Catheter Cardiovasc Interv 2021; 98:E475-E477. [PMID: 33565679 DOI: 10.1002/ccd.29519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
Tricuspid valve endocarditis with recurrent septic pulmonary emboli is an indication for surgery. We present the case of a 36-year old man with tricuspid valve endocarditis and septic pulmonary emboli with percutaneous extraction of the vegetation. We discuss the nuances of such an approach and the need for more evidence in the management of these complex patients.
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Affiliation(s)
- Sripal Bangalore
- Grossman School of Medicine, New York University, New York, New York
| | - Carlos L Alviar
- Grossman School of Medicine, New York University, New York, New York
| | - Susan Vlahakis
- Grossman School of Medicine, New York University, New York, New York
| | - Norma Keller
- Grossman School of Medicine, New York University, New York, New York
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Anfinogenova ND, Vasiltseva OY, Vrublevsky AV, Vorozhtsova IN, Popov SV, Smorgon AV, Mochula OV, Ussov WY. Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review. Semin Thromb Hemost 2020; 46:895-907. [PMID: 33368111 DOI: 10.1055/s-0040-1718399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.
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Affiliation(s)
- Nina D Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Oksana Y Vasiltseva
- Unit of Aorta and Coronary Artery Surgery, E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russia
| | - Alexander V Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Irina N Vorozhtsova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Andrey V Smorgon
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Olga V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Wladimir Y Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
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Arora H, Kumar PA. Case Series of Vacuum-Assisted Thrombectomy: An Acceptable Trade-Off in Evidence-Based Methodology? J Cardiothorac Vasc Anesth 2020; 35:1046-1048. [PMID: 33234466 DOI: 10.1053/j.jvca.2020.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Harendra Arora
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Lu SY, Dalia AA, Lang M, Fitzsimons MG. Perioperative Outcomes of Thrombectomy Patients Using Venovenous Bypass and Suction Filtration With General Anesthesia. J Cardiothorac Vasc Anesth 2020; 35:1040-1045. [PMID: 33051147 DOI: 10.1053/j.jvca.2020.09.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/23/2020] [Accepted: 09/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE AngioVac (Angiodynamics, Latham, NY) is a novel drainage system that offers a less-invasive approach compared with open surgical thromboembolectomy to remove intracardiac and intravascular thrombotic and embolic material. For this study, the authors' single-center experience with patients undergoing thromboembolectomy using the AngioVac system was reviewed retrospectively to evaluate anesthetic management and postoperative complications. DESIGN Retrospective, observational study. SETTING Single institution, quaternary care hospital. PARTICIPANTS The study comprised 20 consecutive patients whose treatment included the AngioVac between January 2016 and November 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty patients underwent AngioVac suction filtration. The mean age was 56 years, and women comprised 35% of the patient cohort. Indications for AngioVac suction filtration included deep venous thrombosis involving the inferior vena cava (n = 12 [60%]), right atrial mass/thrombus (n = 11 [55%]), right ventricular mass/thrombus (n = 3 [15%]), and pulmonary embolism(n = 2 [10%]). All patients required vasopressor support, and nine patients (45%) required blood transfusion during the procedure. There was no intraoperative death or cardiac arrest associated with the procedure. The 30-day mortality was zero, and in-hospital mortality was 5% (1/20). Significant postoperative complications occurred in 11/20 patients (55%). Postoperative left ventricular dysfunction (36% v 0%; p < 0.05), preoperative shock requiring vasopressors (36% v 0%; p < 0.05), postoperative blood transfusion (100% v 56%; p < 0.05), and having undergone recent surgery (64% v 11%; p < 0.05) were associated with increased odds of experiencing postoperative complications. CONCLUSIONS The rate of intraoperative complication during AngioVac suction filtration is low, but vasopressors and blood transfusions often are required. Patients at increased risk of developing postoperative complications potentially can be identified as having undergone recent surgery, experiencing preoperative shock requiring vasopressors or postoperative left ventricular dysfunction, and requiring postoperative blood transfusion.
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Affiliation(s)
- Shu Y Lu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Adam A Dalia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
| | - Maximilian Lang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Michael G Fitzsimons
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
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Chen T, Mordehai E, Sodha N, Kolodziejczak M, Savio C, Maslow A. Anesthetic Considerations for Percutaneous and Open Right Atrial Thrombectomy in a Hemoglobin SC Patient. J Cardiothorac Vasc Anesth 2020; 35:1161-1166. [PMID: 32807600 DOI: 10.1053/j.jvca.2020.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Tzonghuei Chen
- Department of Anesthesiology, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Eveline Mordehai
- Department of Anesthesiology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Neel Sodha
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Christopher Savio
- Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, RI
| | - Andrew Maslow
- Department of Anesthesiology, Warren Alpert Medical School of Brown University, Providence, RI
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Boisen ML, Iyer MH. Transesophageal Echocardiography Diagnosis of Tricuspid Valve Injury During AngioVac Percutaneous Pulmonary Embolectomy. CASE (PHILADELPHIA, PA.) 2018; 2:181-185. [PMID: 30370379 PMCID: PMC6200684 DOI: 10.1016/j.case.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Imaging evidence of right ventricular dysfunction predicts risk in pulmonary embolism. Catheter techniques are an alternative to systemic lysis or surgical embolectomy. Catheter embolectomy may be enhanced by transesophageal echocardiographic imaging.
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Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University-Wexner Medical Center, Columbus, Ohio
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Gold AK, Patel PA, Lane-Fall M, Gutsche JT, Lauter D, Zhou E, Guelaff E, MacKay EJ, Weiss SJ, Baranov DJ, Valentine EA, Feinman JW, Augoustides JG. Cardiovascular Collapse During Liver Transplantation-Echocardiographic-Guided Hemodynamic Rescue and Perioperative Management. J Cardiothorac Vasc Anesth 2018. [PMID: 29525193 DOI: 10.1053/j.jvca.2018.01.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew K Gold
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Meghan Lane-Fall
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Derek Lauter
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Zhou
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric Guelaff
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily J MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dimitri J Baranov
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth A Valentine
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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