1/4. Use of the Alfieri edge-to-edge technique to eliminate left ventricular outflow tract obstruction caused by mitral systolic anterior motion.A 68-year-old woman with concentric left ventricular hypertrophy, prosthetic valve endocarditis with aortic root abscess, and sepsis had aortic root replacement with an aortic allograft. On weaning from cardiopulmonary bypass, she had hemodynamic instability caused by systolic anterior motion of the mitral valve, which resulted in a left ventricular outflow tract obstruction; the peak pressure gradient across the left ventricular outflow tract was 130 mm Hg, and there was moderately severe (3 ) mitral regurgitation. After reinstitution of cardiopulmonary bypass, a central Alfieri edge-to-edge stitch was placed between the anterior and posterior leaflets of the mitral valve. This reduced the gradient across the left ventricular outflow tract to 10 mm Hg and eliminated the mitral regurgitation, which enabled successful separation from cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
2/4. ventriculoperitoneal shunt malfunction presenting with pleuritic chest pain.BACKGROUND: Ventriculoperitoneal (VP) shunts are widely used for treating hydrocephalus. These devices are prone to malfunction with up to 70% requiring revision. Shunt infection and obstruction comprise the majority of malfunctions and usually present dramatically. However, rare presentations occur. methods/RESULTS: We report a rare case of VP shunt malfunction presenting with pleuritic chest pain. A 13-year-old girl with a VP shunt placed at birth for congenital hydrocephalus presented on multiple occasions with pleuritic chest pain, cough, and fever. She was diagnosed with an upper respiratory tract infection and discharged home. She returned with respiratory compromise, and chest x-ray depicted the shunt catheter in the pleural space with an associated pleural effusion and infiltrate. The patient fully recovered with intravenous antibiotics, thoracentesis, and placement of a new shunt system. CONCLUSIONS: VP shunt malfunction usually presents with signs and symptoms of increased intracranial pressure and/or infection. However, unusual presentations of malfunction may occur with signs and symptoms which appear unrelated to the shunt. Thus, all patients with VP shunts warrant a comprehensive evaluation.- - - - - - - - - - ranking = 0.2keywords = obstruction (Clic here for more details about this article) |
3/4. Case report: relief of acute obstruction of the Detour subcutaneous pyelovesical bypass.A 36-year-old patient was admitted to the emergency department with complaints of severe flank pain, nausea, vomiting, anuria, and general illness. Five months earlier, we had placed a subcutaneous pyelovesical prosthesis (Detour; Porges) of the ureter for treatment of a chronically dilated upper urinary tract in a solitary right kidney previously treated by double-J stenting. ultrasonography of the right kidney revealed severe hydronephrosis. A percutaneous nephrostomy catheter was placed, and antegrade pyelography showed complete obstruction of the prosthesis. urinalysis and culture demonstrated a candida infection. A systemic antimycotic was administered, and fluid management was started. On the third day, diuresis appeared, and antegrade nephrostomography confirmed patency of the bypass.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
4/4. Superior vena cava occlusion and/or syndrome related to pacemaker leads.Four cases of pacemaker-related SVC obstruction or syndrome are reported. While two of them lacked any symptom suggestive of SVC obstruction, the other two presented with mild symptoms. None of them received any treatment. One died from a cause unrelated to SVC obstruction, while the others presented no change in their clinical status. A review of the literature suggests that neither thrombotic nor fibrotic obstruction in patients with pacemaker leads is strictly related to the number of abandoned leads, the presence of severed leads, or the time elapsing from pacemaker implant. The diagnosis is clinically made and is confirmed by venography. Only one of the reported deaths is attributable to SVC obstruction. The remaining cases from the literature responded to treatment with heparin, thrombolytic agents, angioplasty, or surgery.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |