1/57. Thromboembolism originated from the pulmonary artery stump after Fontan operation.Cerebral thromboembolism is a rare but serious complication after Fontan operation. This is the report of a patient who underwent a successful intracardiac thrombectomy for cerebral thromboembolism after Fontan operation. A 2-year-old girl was referred to us with the diagnosis of tricuspid atresia without pulmonary stenosis, normally related great arteries, and a ventricular septal defect. Although she underwent a successful Fontan operation and division of the main pulmonary artery, she developed a cerebrovascular event at 3 weeks after the operation. echocardiography demonstrated a large thrombus within the residue of the main pulmonary artery, and suggested that the thrombus had migrated into the systemic circulation by way of the ventricular septal defect. At 2 weeks after the cerebrovascular event, she underwent thrombectomy and excision of the pulmonary valve. Although she has developed slight left-sided hemiparesis, she is leading a normal life at 1 year after the operation.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/57. Ultrasound detection of microembolic signals in hemodialysis accesses.Microembolic signals (MES) detected by ultrasound, thought to be of gaseous or solid origin, have been described with decompression illness and in the intracranial and cardiopulmonary circulation. We describe the first reported cases of MES occurring in hemodialysis accesses. Two hemodialysis patients, one with a synthetic graft and one with an arteriovenous fistula, showed MES during a dialysis session detected by duplex ultrasound. We postulate that these MES represent cavitation bubbles developing from turbulent blood flow around the venous needle in the access. However, other potential causes exist, including air introduced into the circulation from the dialysis circuit or microemboli arising from thrombus or atheroma.- - - - - - - - - - ranking = 2keywords = circulation (Clic here for more details about this article) |
3/57. Successful intracranial thrombolysis for cerebral thromboembolic complications resulting from cardiovascular diagnostic and interventional procedures.We report successful local thrombolysis to treat intracranial ischemic complications of angioplasty with stenting of a high-grade carotid artery stenosis, angioplasty with thrombolysis of an occluded venous graft, and routine coronary angiography. Intracranial complications occurring during cardiovascular diagnostic or interventional procedures can be reversed with prompt management via rescue thrombolysis. These events should not be viewed as irreversible complications, and the opportunity for intracranial thrombolysis should be available wherever cardiovascular interventional procedures are performed. The ability to quickly recognize and remedy complications occurring during these procedures is another step in the continued advancement of neuroendovascular therapy.- - - - - - - - - - ranking = 4.0745379421481keywords = coronary (Clic here for more details about this article) |
4/57. Continued lodging of retinal emboli in a patient with internal carotid artery and ophthalmic artery occlusions.Internal carotid artery or ophthalmic artery occlusions are devastating ophthalmological events which lead to severe impairment of vision. A case of multiple branch retinal artery occlusions in a 63-year-old male with internal carotid artery and ophthalmic artery occlusions on brain angiography is presented. Emboli lodging in branches of the retinal arteries were bright, glistening, yellow or orange in appearance. Such a distinctive ophthalmoscopic appearance led to the diagnosis of cholesterol emboli. fluorescein and indocyanine green angiography disclosed delayed filling of the retinal vessels and choroid, and showed multiple hypofluorescence distal to the vessels in which the emboli were lodged. At the time of initial examination, the number of emboli lodged in retinal arteries was estimated at more than 20. As time passed, a few of the previous emboli disappeared and new emboli appeared in other sites on fundus examination. We think that the lodging of new emboli in other sites is due to the continued break-up of atheromatous tissue through the collateral circulation associated with the occlusion of the internal carotid and ophthalmic arteries.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
5/57. Undergoing cardiopulmonary bypass using enoxaparin only during a cardiac transplantation procedure.The use of enoxaparin as a replacement drug to standard heparin, for anticoagulation during extracorporeal circulation, in patients with heparin-induced thrombocytopenia, is still very limited. enoxaparin significantly reduces thrombin formation and activity during cardiopulmonary bypass. The prolonged circulating rate, slow elimination rate and non-total reversion of enoxaparin by protamine can induce important postoperative bleeding. We are describing the first case of cardiac transplantation where enoxaparin was used as a replacement drug to standard heparin.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
6/57. Solitary focal coronary artery aneurysm in a middle aged male with atypical chest pain.A 52 year old hypertensive Malay man, a smoker who presented with a one month history of mild chest discomfort not related to exertion and had a positive stress test with ST segment depression in the lateral leads. coronary angiography showed stenosis in the right coronary artery and a coronary aneurysm in the proximal segment of his left anterior descending. The aneurysm was situated just distal to a stenotic lesion. The aneurysm is most likely related to atherosclerotic coronary artery disease. The patient was treated with oral nitrates, aspirin, angiotensin converting enzyme inhibitor and warfarin to prevent thromboembolism related to the coronary aneurysm. He remains asymptomatic one year after diagnosis.- - - - - - - - - - ranking = 32.596303537185keywords = coronary (Clic here for more details about this article) |
7/57. Thromboembolus from a ligated left atrial appendage.The left atrial appendage of patients with mitral valve disease is commonly a source of thromboembolus and is often ligated during mitral valve surgery to diminish this risk. However, ligation is often incomplete. We describe a patient with a stroke whose only source of embolus was an incompletely ligated left atrial appendage. Attempts to exclude the left atrial appendage from the arterial circulation by suture ligation may not decrease the risk of thromboemboli and instead may increase such risk.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
8/57. Exercise testing induces fatal thromboembolism from mechanical mitral valve.Thromboembolism is still one of the most important complications of prosthetic heart valves. Embolism to a major coronary branch is rare, but acute proximal occlusions can be fatal, even when the coronary arteries are otherwise normal and intervention is rapid. We report a fatal complication of an exercise test in a patient who had a St. Jude bileaflet mitral valve. After an exercise test, a 42-year-old woman with a mechanical prosthetic valve had a severe hemodynamic collapse with acute ST segment changes. coronary angiography showed a totally occluded left main coronary artery with TIMI grade 0 to 1 flow. Rapid injection of contrast material and the passage of a floppy guidewire through the thrombus restored a TIMI grade 3 flow. Angiography showed no coronary atherosclerostic involvement. Despite successful coronary reperfusion, intra-aortic balloon counterpulsation, and intensive medication, the patient died. This case demonstrates that exercise testing should be applied with great caution in patients with prosthetic valves, and only after a careful evaluation of valve function. We recommend transesophageal echocardiography prior to exercise testing in these patients.- - - - - - - - - - ranking = 20.37268971074keywords = coronary (Clic here for more details about this article) |
9/57. A case of pregnancy with a history of paradoxical brain embolism.brain embolisms in younger persons are rare but are often caused by a paradoxical embolism, the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. A 27-year-old pregnant woman presented with hemiplegia that had been treated with an antiplatelet agent since the occurrence of a paradoxical brain embolism via the pulmonary arteriovenous fistula. A tendency of hypercoagulation is generally observed during pregnancy, so a patient with this condition has a strong risk factor for venous thromboembolism during pregnancy and even more so for arterial thromboembolism under the intense strain of labor, which is much stronger than that of the valsalva maneuver. This case had been controlled well with an antiplatelet agent and an anticoagulant while the levels of coagulation and fibrinolytic factors were monitored and was followed by a successful pregnancy outcome.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
10/57. Arterial embolism to the upper extremity in a patient with factor v Leiden mutation (APC resistance)--a case report and review of the literature.factor v Leiden mutation has emerged as one of the leading abnormalities in inherited blood coagulation disorders, resulting in a markedly increased risk for deep leg vein thrombosis. A 24-year-old woman presented with acute onset of critical ischemia of her left thumb and index finger. Intraarterial angiography revealed an embolus in the distal radial artery and a thrombotic occlusion of the digital artery of the thumb and index finger. Immediate therapy encompassed a selective surgical embolectomy of the distal radial artery followed by a local intraarterial lysis that was continued for 3 days. Additionally, therapeutic anticoagulation and vasodilating drugs (prostaglandin E) were administered. Within 2 days, capillary refill reappeared and the initial loss of sensory function at the tip of the thumb and index finger diminished. A screening test for thrombophilic disorders led to the diagnosis of a heterozygous mutation of factor v (Leiden mutation). Arterial thromboembolic events of factor v Leiden mutation are rare and have to date been described only in the supraaortic and coronary circulation. Therefore, the arterial embolism to the left hand presented in this report constitutes a rarity that could be successfully salvaged by the combined use of a vascular surgical procedure and intensified medical management.- - - - - - - - - - ranking = 5.0745379421481keywords = coronary, circulation (Clic here for more details about this article) |
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