1/19. Inverse paradoxical embolism in a patient on chronic hemodialysis with aortic bacterial endocarditis.We present a 45-year-old patient on chronic hemodialysis who suffered aortic endocarditis by staphylococcus haemolyticus after bacteremia associated with a venous catheter, which was used temporarily during the maturing phase of a Cimino-Brescia arteriovenous fistula in the left forearm. Three weeks after starting antibiotic therapy, the patient suffered a septic pulmonary embolism. The catheter had been removed 4 weeks before the embolism. thrombophlebitis of lower limbs, infection or thrombosis of the vascular access, and the involvement of right-sided cardiac structures were all discarded. We assumed that the pulmonary episode was probably a consequence of the paradoxical passage of embolic material, detached from the aortic valve, from arterial to venous circulation through the arteriovenous fistula.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/19. Paradoxical embolism in a boy with cystic fibrosis and a stroke.An 11 year old boy with cystic fibrosis suffered a stroke, producing right sided weakness. Four years previously a totally implantable venous access device (Port-a-Cath) had been inserted. magnetic resonance angiography revealed a filling defect in the left middle cerebral artery. Transoesophageal echocardiography demonstrated a thrombus attached to the tip of the Port-a-Cath and also the presence of a patent foramen ovale. After an initial period of anticoagulation the defect was closed using a septal occlusion device introduced via a cardiac catheter. The boy's neurological signs completely resolved and he remains free from further thromboembolic episodes. Whilst pulmonary embolism has been described before in relation to a totally implantable venous access device, this is believed to be the first description of a paradoxical embolism in relation to such a device.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
3/19. Transcranial Doppler of a paradoxical brain embolism associated with a pulmonary arteriovenous fistula.We herein report the case of a patient who had paradoxical brain embolism owing to a pulmonary arteriovenous fistula (PAVF) who was diagnosed as having a right-to-left shunt by transcranial Doppler (TCD) with saline contrast medium. TCD with saline contrast medium failed to detect any high-intensity transient signals immediately after catheter embolization of the PAVF. Thus, TCD with saline contrast medium was useful for identifying the presence of a right-to-left shunt and for confirming that the shunt had been obliterated after endovascular treatment.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
4/19. Paradoxical emboli after central venous catheter removal.central venous catheters are widely used in intensive medicine to provide blood product, nutritional and antibiotic support. A 45-year-old man with an unsuspected patent foramen ovale underwent a bone marrow allograft for poor-risk acute lymphoblastic leukaemia. His venous line was removed because of probable infection, and he simultaneously sustained a myocardial infarct and a cerebrovascular accident. He made a good recovery from both, but subsequently died of relapsed disease. Appropriate pre-transplant screening investigations are discussed, and the differential diagnosis of this complication in the bone marrow transplant setting.- - - - - - - - - - ranking = 2.5keywords = catheter (Clic here for more details about this article) |
5/19. Intra-atrial thrombus after surgical closure of patent foramen ovale.Patent foramen ovale (PFO) represents a potential path for paradoxical embolism and is associated with cryptogenic stroke. It has been suggested that because a PFO represents a repairable lesion (by surgical or transcatheter methods), repair may be the optimal treatment to prevent recurrent stroke. This report describes a patient with recurrent neurologic and peripheral embolic events, which occurred approximately 6 months after the surgical closure of a PFO. The diagnosis of an intra-atrial thrombus with a small residual PFO was made by subsequent transesophageal echocardiography. Thrombus formation at the closure site needs to be considered in a patient with recurrent embolic events after closure of a PFO.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
6/19. Paradoxical cerebral air embolism after removal of a central venous catheter: case report.Paradoxical cerebral air embolization through a residual tract after the removal of a central venous catheter is a serious complication of central venous cannulation. air embolisms resulting from residual catheter tracts in general patients and in single lung transplant patients have been reported. The generally accepted mechanism of this complication is failure of a spontaneous collapse or thrombotic obliteration of a well-formed catheter tract. It may be related to the duration of catheter insertion, the patient's nutritional status, the diameter of the indwelling catheter, the upright position of the patient, deep inspiration or coughing, and improper wound dressing and catheter removal. Cardiovascular collapse, pulmonary or neurologic sequelae, and even death, are commonly noted in patients with air embolism. In this article, we report on cerebral air embolization as a complication with the removal with a central venous catheter in a patient with bullous emphysema. A high degree of suspicion and a prompt diagnosis are required for successful application of established therapy. Simple prophylactic procedures and constant awareness of the unusual mechanism of air embolism remain the best treatment.- - - - - - - - - - ranking = 5.5keywords = catheter (Clic here for more details about this article) |
7/19. Right hemidiaphragmatic elevation with a right-to-left interatrial shunt through a patent foramen ovale: a case report and literature review.A right-to-left shunt (RLS) is an uncommon complication of a patent foramen ovale (PFO) that may cause hypoxemia from venous admixture and ischemic complications from paradoxic embolization. This report presents the third described patient whose RLS through a PFO and profound hypoxemia developed in association with right hemidiaphragm dysfunction (but without a pressure gradient driving the right-to-left flow). In addition to extending the available experience with this unusual clinical event, we report on the successful closure of the PFO by a catheter-deployed double-umbrella device, after the positioning of which the patient's oxygenation normalized.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
8/19. Paradoxical air embolism from patent foramen ovale in scoliosis surgery.STUDY DESIGN: A case was reported in which paradoxical air embolism arose from the patent foramen ovale in scoliosis surgery. OBJECTIVES: To present a case of suspected paradoxical air embolism after scoliosis surgery. SUMMARY OF BACKGROUND DATA: Embolic accident during scoliosis surgery may be caused by air, thrombus, or fat. There is growing attention on patent foramen ovale involved in paradoxical embolism. The devastating consequences are caused by multiple artery occlusions. methods: Details of a recent documented neurologic complication (paraplegia, weakness of right arm, and blurry vision) after scoliosis surgery have been analyzed in medical publications. RESULTS: The surgical procedure was not imputed. The causative role of epidural catheter for analgesia was considered, but it is likely that a paradoxical embolism occurred in this case, based on the multifocal (cerebral and spinal) neurologic dysfunction, the evidence of cerebral ischemia (on computed tomography), and the presence of a patent foramen ovale (on postoperative transesophageal echocardiography). Although no intraoperative embolism detection was available, air embolism was highly suspected because there was no absolute argument to exclude cruor or fatty embolism. CONCLUSIONS: It is critical to detect a patent foramen ovale before surgery and cerebral embolization intraoperatively. This might permit ascertainment of the etiologic diagnosis in case of a complication in surgery for scoliosis.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
9/19. Combined percutaneous pulmonary valvuloplasty and patent foramen ovale closure in an adult with recurrent transient ischemic attacks.We report the case of a 60-year-old man with a history of recurrent transient ischemic attacks, effort syncope, cyanosis, erythrocytosis and a systolic murmur. echocardiography and catheterization showed severe pulmonary stenosis and a patent foramen ovale with a right-to-left shunt. The patient was submitted to combined percutaneous pulmonary valvuloplasty and patent foramen ovale closure using the Amplatzer device.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
10/19. Temporary IVC filtration before patent foramen ovale closure in a patient with paradoxic embolism.pulmonary embolism (PE) and associated acute peripheral ischemia suggest the diagnosis of paradoxic embolism. The most common intracardiac defect associated with paradoxic emboli is a patent foramen ovale (PFO). Therapeutic options include anticoagulation, thrombolysis, inferior vena cava (IVC) filtration, and closure of the intracardiac defect. The authors discuss the diagnosis and treatment of a young female athlete who presented with massive PE complicated by a paradoxic embolus to the right subclavian artery. Systemic and catheter-directed thrombolysis, IVC filtration, and percutaneous closure of a PFO were performed in an effort to return the patient to the level of competitiveness she desired.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
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