Percutaneous coronary intervention for distal coronary graft anastomosis le-sions: a case series

BACKGROUND

Management of coronary artery graft failure, especially at the site of a recent distal anastomosis, is a challenging clinical situation, and literature data are scarce.

CASE SERIES

We present a case series of patients with coronary artery bypass graft failure up to six months after surgical revascularization, who were treated with percutaneous coronary intervention at the site of distal graft anastomosis through the graft or the native vessel.

CONCLUSIONS

Percutaneous coronary intervention at distal graft anastomotic lesions is challenging, it can be performed from either the graft or the native vessel, and the angiographic result may not always be optimal. HIPPOKRATIA 2019, 23(2): 87-91.

Impact of Post-Exodontia Bleeding in Cardiovascular Patients: A New Classification Proposal

Background:

Exodontia (dental extraction), being the most frequent minor surgical procedure in the general population, inevitably involves a large number of patients on antithrombotic medication. Current experience shows that there is a degree of confusion in managing these patients.

Description:

Post-exodontia bleeding, a natural consequence of every dental extraction with no or minor clinical significance in the vast majority of cases, often appears to be of major concern to both patients and healthcare practitioners (dentists or physicians), either because of the alarming nature of oral bleeding itself or because of the distorted perception about its importance. These concerns are enhanced by the lack of a universal standardized definition of post-exodontia bleeding and by the fact that all currently available post-exodontia bleeding definitions bear intrinsic limitations and tend to overestimate its clinical significance.

Conclusion:

In order to overcome the aforementioned issues, this article presents an overview of post-extraction bleeding and proposes a classification, based on the well-recognized Bleeding Academic Research Consortium (BARC) bleeding definition, aiming at reducing heterogeneity in this field.

Ipsilateral radial and ulnar artery cannulation during the same coronary catheterization procedure

BACKGROUND

Switching to femoral after a failed radial approach carries an increased risk of bleeding complications since the femoral artery puncture is performed in patients already anticoagulated. Moreover, dedicated radial operators find it more and more difficult to use the femoral approach, and ulnar artery cannulation provides them with the opportunity to further reduce its use. Our objective was to evaluate the feasibility and safety of ipsilateral radial and ulnar artery cannulation during the same coronary catheterization procedure.

METHODS

We performed a retrospective analysis of all cardiac catheterizations, from January 2015 until June 2016, with initial radial approach and conversion to ipsilateral ulnar approach. Patients with sheath insertion both in radial and ipsilateral ulnar arteries were further evaluated.

RESULTS

Four thousand one hundred and two procedures were performed during the study period, and 3,876 (94.5 %) of them were performed initially through a radial approach. Radial and ipsilateral ulnar catheterization was accomplished in nine patients, resulting in successful catheterization and procedure completion, without any serious complications recorded.

CONCLUSIONS

Ipsilateral radial and ulnar artery catheterization proved to be feasible and safe, without any serious complications. Hippokratia 2016, 20(3): 249-251.

Bleomycin cardiotoxicity during chemotherapy for an ovarian germ cell tumor

INTRODUCTION

Platinum-based chemotherapeutic regimens, including BEP (bleomycin, etoposide, cisplatin) represent the standard of care, first line therapy in non-epithelial ovarian tumours. Cardiovascular toxicity is a rare adverse effect of bleomycin.

CASE REPORT

A 41-year-old woman with ovarian granulosa tumor, treated with first line BEP chemotherapy experienced chest discomfort rapidly progressing to severe precordial pain during bleomycin infusion. The infusion was stopped and electrocardiographic changes indicative of myocardial ischemia were revealed. Anti-anginal and anti-thrombotic treatment was introduced. Cardiac enzymes were not elevated and echocardiographic findings showed no wall motion abnormalities. Twenty four hours after the episode the elctrocardiographic changes insisted and chemotherapy was decided to be continued, excluding bleomycin, with no symptom recurrence.

DISCUSSION

Cardiovascular complications pose a rare but potential fatal adverse effect of BEP chemotherapy and should be carefully addressed, especially in patients with additional cardiovascular risk factors. Physicians dealing with bleomycin-based therapies may find this knowledge useful for a more comprehensive evaluation of chest pain syndromes in those patients.

Fleshy palmaris longus muscle - a cadaveric finding and its clinical significance: a case report

INTRODUCTION

Palmaris longus variations may include complete agenesis, variation in the location and form of the fleshy portion, aberrancy in attachment, duplication or triplication, accessory tendinous slips, replacing elements of similar form or position. Description of case: An anomalous palmaris longus muscle was found in the right upper extremity of a 63 year-old male cadaver. The muscle was totally fleshy without a long insertion tendon. Its origin was normal, the belly was rather broad and long, fusiform at the upper half and unipennate at the lower half of the forearm, and it was toggled into a short and thick tendon. At its insertion the tendon was split forming a second thinner tendon. The thick tendon was inserted into the flexor retinaculum and the thinner one into the palmar aponeurosis. The muscle compressed the median nerve although no related symptoms were reported on the cadaver's medical history.

DISCUSSION

This variation is of clinical importance because it may cause carpal tunnel syndrome or difficulties in image interpretation by radiologists. In addition the palmaris longus muscle is an anatomical landmark for operations at the forearm and wrist and its tendon can be used as a graft.

A bicarotid trunk in association with an aberrant right subclavian artery. Report of two cases, clinical impact, and review of the literature

A combination of an aberrant right subclavian artery (ARSA) and a bicarotid trunk (BCT) appears in up to 2.5% of the population. The aim of this study is to report the higher total and male incidence of this variation in the literature and to summarise its clinical impact, providing useful knowledge to anatomists, radiologists, cardiologists, and vascular and thoracic surgeons in order to avoid diagnostic pitfalls and therapeutic complications. A total of 72 (43 female and 29 male) Greek Caucasian formalin-embalmed cadavers were studied. The international literature was reviewed along with the dissection archives of the Department of Anatomy from 1986 to 2009. Two male cadavers were found to have an ARSA combined with a BCT (incidence: total 2.78%, males 6.9%, females 0%). Both aortic arches consisted of three branches: (1) the BCT, (2) the left subclavian artery, and (3) the ARSA. The common carotids followed a normal route to the neck; the ARSA passed between the trachea and the oesophagus in the first case and behind the oesophagus in the second case, and was accompanied by a non-recurrent laryngeal nerve. In the second cadaver the ARSA formed a sharp angle (kinking/buckling) on its route to the right arm. The ARSA is associated with several congenital cardiovascular anomalies and some chromosomal and other syndromes. It is occasionaly responsible for causing dysphagia, dyspnoea, or acute ischaemia to the right upper limb, and it may present as a superior mediastinal mass in cases of aneurysm formation.