Acute myocardial infarction secondary to COVID-19 infection: A case report and review of the literature

BackgroundThrombotic complications of COVID-19 infection have become increasingly apparent as the disease has infected a growing number of individuals. Although less common than upper respiratory symptoms, thrombotic complications are not infrequent and may result in severe and long-term sequelae. Common thrombotic complications include pulmonary embolism, cerebral infarction, or venous thromboembolism; less commonly seen are acute myocardial injury, renal artery thrombosis, and mesenteric ischemia. Several case reports and case series have described acute myocardial injury in patients with COVID-19 characterized by elevations in serum biomarkers.Case reportHere, we report the first case to our knowledge of a patient with acute coronary syndrome confirmed on catheter angiography and cardiac MRI. This patient was found to additionally have a left ventricular thrombus and ultimately suffered an acute cerebral infarction. Recognition of thrombotic complications in the setting of COVID-19 infection is essential for initiating appropriate therapy.ConclusionsIn acute myocardial injury, given the different treatment strategies for myocarditis versus acute myocardial infarction secondary to coronary artery thrombus, imaging can play a key role in clinical decision making for patients.     

CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

The aim of this study was to analyze the technical results, the extraosseous cement leakages, and the complications in our first 500 vertebroplasty procedures. Patients with osteoporotic vertebral compression fractures or osteolytic lesions caused by malignant tumors were treated with CT-guided vertebroplasty. The technical results were documented with CT, and the extraosseous cement leakages and periinterventional clinical complications were analyzed as well as secondary fractures during follow-up. Since 2002, 500 vertebroplasty procedures have been performed on 251 patients (82 male, 169 female, age 71.5 ± 9.8 years) suffering from osteoporotic compression fractures (n = 217) and/or malignant tumour infiltration (n = 34). The number of vertebrae treated per patient was 1.96 ± 1.29 (range 1–10); the numbers of interventions per patient and interventions per vertebra were 1.33 ± 0.75 (range 1–6) and 1.01 ± 0.10, respectively. The amount of PMMA cement was 4.5 ± 1.9 ml and decreased during the 5-year period of investigation. The procedure-related 30-day mortality was 0.4% (1 of 251 patients) due to pulmonary embolism in this case. The procedure-related morbidity was 2.8% (7/251), including one acute coronary syndrome beginning 12 h after the procedure and one missing patellar reflex in a patients with a cement leak near the neuroformen because of osteolytic destruction of the respective pedicle. Additionally, one patient developed a medullary conus syndrome after a fall during the night after vertebroplasty, two patients reached an inadequate depth of conscious sedation, and two cases had additional fractures (one pedicle fracture, one rib fracture). The overall CT-based cement leak rate was 55.4% and included leakages predominantly into intervertebral disc spaces (25.2%), epidural vein plexus (16.0%), through the posterior wall (2.6%), into the neuroforamen (1.6%), into paravertebral vessels (7.2%), and combinations of these and others. During follow-up (15.2 ± 13.4 months) the secondary fracture rate was 17.1%, including comparable numbers for vertebrae at adjacent and distant levels. The presence of intradiscal cement leaks was not associated with increased adjacent fracture rates. CT-guided vertebroplasty is safe and effective for treatment of vertebral compression fractures. CT-fluoroscopy provides an excellent control of the posterior vertebral wall. The number of cement leakages alone is not directly associated with clinical complications. However, even small volumes of pulmonary PMMA embolism might be responsible for the fatal outcome in cases with underlying cardiopulmonary insufficiency.     

成都地区军队干部内科常见慢性病及死亡原因调查

目的调查成都地区军队干部内科常见主要慢性病逐年患病率和病死率,为制定部队干部的健康保健计划提供科学依据。方法从我院保健科提取2006-2009年成都地区军队干部体检资料,统计分析主要内科疾病患病情况和同期住院的病死率和死亡原因构成情况。结果内科常见慢性病排序依次为高血压,慢性支气管炎、冠心病、脂肪肝、糖尿病、慢阻肺、脑梗塞、恶性肿瘤、痛风、急性心肌梗死10种疾病;2006-2009年总病死率分别为3．01％、3．62％、7．87％、7．29％。住院死亡的前5位疾病为恶性肿瘤、呼吸系统疾病、冠心病、脑梗塞、糖尿病。恶性肿瘤中主要为肺癌、消化系统肿瘤。结论成都地区军队干部内科常见慢性病主要是心脑血管病、呼吸系统疾病和代谢病,主要的死亡原因是恶性肿瘤、呼吸系统疾病和心脑血管病。     

Methodology and results of intravenous thrombolysis in acute myocardial infarction

For the vast majority of patients with acute myocardial infarction, intravenous thrombolysis is at present the only therapeutic approach aimed at early reperfusion of the ischemic myocardium. Rapid recanalization of the infarct-related coronary artery is achieved in at least 50–60% of the patients by short-term high-dose infusions of streptokinase or urokinase with a low risk of bleeding. A substantial reduction of infarct size, however, can be expected in only a minority of patients, mostly in those who are treated very early. The effects of intravenous thrombolysis on early and late mortality from acute myocardial infarction are still equivocal; more conclusive data may be expected from ongoing randomized trials.     

Sudden cardiovascular death associated with sexual activity

In recent discussions about potency-enhancing drugs such as sildenafil, health hazards associated with sexual activity have attracted increasing attention (1). In a medicolegal postmortem study performed in the Center of Legal Medicine at the University Hospital in Frank furt/Main over a 33-year period (1972–2004), about 32,000 forensic autopsies revealed 68 (0.22%) natural deaths occurring during sexual activity. Except for 5 women (7.4%; average age 39.8 years), in most cases, men were involved (92.6%; average age 59.1 years). The most frequent cause of death was myocardial infarction (n=28; 41.2%). In three cases, pericardial tamponade accompanied by myomalacia were observed. In 20 patients (29.4%), coronary artery disease (CAD) without signs of acute myocardial infarction (MI) was diagnosed. The medical history of 19 of the deceased indicated previous MI. There were seven cerebral hemorrhages (10.3%). The annual incidence of sudden cardiovascular death during sexual activity is estimated to be 1.9 per 1000 autopsies for men and 0.16 per 1000 autopsies for women (1). It is necessary to inform patients with CAD about prodromes and risk in relation to any form of physical and/or emotional stress. This study was presented at the Sixth International Symposium in Advanced Legal Medicine (ISALM), Hamburg, Germany, September 2006.     

TUNEL: a useful screening method in sudden cardiac death

The primary objective of this study was to investigate if detection of apoptosis in the heart can be used to diagnose early myocardial ischaemia. The material consisted of myocardial tissue from autopsy cases: 10 cases with occlusive, thrombotic coronary artery disease and acute myocardial infarction, 10 cases of sudden cardiac death without coronary artery disease (CAD) and 8 controls without cardiovascular disease and with known causes of death. Necrotic changes in the myocardium were detected with hematoxylin-erythrosin-saffron, Mallory’s PTAH stain and with antibodies against complement 9. Apoptotic nuclei were visualised with two different kits using the terminal deoxynucleotidyl transferase-mediated desoxyuridinetriphosphate nick end-labeling (TUNEL) method on histological sections. In the patients with CAD, early myocardial infarction was found in one defined area of the ventricular wall; apoptotic myocyte nuclei were observed not in the necrotic lesions, but evenly spread usually without a gradient, all over the myocardium with a mean number per high power field of 29% (range 3–56%) of the total number of myocyte nuclei. In the sudden cardiac deaths without CAD, necrosis was scarce and distributed both focally and irregularly in both the left and right ventricular walls. With few exceptions, the percentage of apoptotic myocyte nuclei exceeded 20% in all sections (mean 24%, range 0–68%). No difference was seen between patients with CAD and those without CAD (p > 0.05). With the TUNEL method, positively stained nuclei were seen very early and extensively all over the myocardium. It is not certain that they represent true apoptosis induced by ischemia, but TUNEL appears to be a useful screening method in cases where sudden cardiac death is suspected. Received: 20 March 2001 / Accepted: 26 June 2001     

Coronary artery air embolism: a potentially fatal complication of CT-guided percutaneous lung biopsy

CT-guided transthoracic lung biopsy is becoming a widely accepted procedure for the diagnosis of pulmonary lesions. The rate of severe complications following such a procedure has been reported. Of these complications, air embolism is the most likely to be fatal. We report a case of right coronary air embolism resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of the lung. The patient died from underlying malignant disease 4 months later.Coronary artery air embolism, a condition with a high mortality rate, mostly results from the iatrogenic introduction of gas bubbles into the bloodstream. Direct injection of air or gas into major arterial vessels during cardiac catheterisation or interventional radiological angiography has been reported; however, it also is a rare complication of CT-guided percutaneous transthoracic biopsy of the lung. In the literature, 19 possible causes for air embolism are listed [1]. Of these, two are generally accepted as the most probable causes: communication of the ambient air with a pulmonary vein via the biopsy needle, or development of a bronchial-venous fistula at the needle tract or site of the core sample. We report a case of air embolism in the aorta and right coronary artery resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of lung.     

Incremental prognostic value of <Superscript>99m</Superscript>Tc-tetrofosmin myocardial SPECT after percutaneous coronary intervention

Objective  Percutaneous transluminal coronary angioplasty is a well-established therapeutic method in selected patients with coronary artery disease. The aim of this study was to assess the incremental prognostic value of technetium-99m (^99mTc)-tetrofosmin myocardial gated-single- photon emission computed tomography (SPECT) in asymptomatic patients after coronary artery stenting. Methods  A total of 246 consecutive patients (aged 55.5 ± 8.2 years, 182 men) participated in the study with a median follow-up of 9.5 years (interquartile ra 5.8–10.5 years). All patients underwent exercise gated-SPECT myocardial imaging within 5–7 months. Myocardial scintigrams were performed using 99mTctetrofosmin, and were evaluated calculating the summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) indexes. Cardiovascular death and non-fatal myocardial infarction were considered as hard cardiac events, and late revascularization (>3 months after myocardial SPECT) procedures as soft events. Receiver-operating characteristic (ROC) analysis was used to test the prognostic ability of SSS and SDS for cardiac events. Cox proportional hazards models were used to evaluate the incremental value of SPECT variables. Results  Cardiac death occurred in 12 (4.9%) patients and non-fatal myocardial infarction in 20 (8.1%) patients. In addition, 60 (24.4%) patients underwent a late revascularization procedure. Using ROC analysis the optimal cut-offs of SSS (AUC = 0.94; 95% CI 0.92–0.97) and SDS (AUC = 0. 76; 95% CI 0.70–0.82) for the prediction of cardiac events were 10 and 1.7, respectively. Multiple Cox regression analyses revealed that SSS > 10 (HR = 24.2; 95% CI 7.44–78.79) and SDS > 1.7 (HR = 2.72; 95% CI 1.23–6.00) provided incremental prognostic value over clinical and exercise test data for the composite end points of any cardiac event. Conclusions   ^99mTc-tetrofosmin myocardial gated- SPECT, performed 6 months post-percutaneous coronary intervention (PCI), provides incremental prognostic information for the prediction of cardiac events in asymptomatic patients after PCI.     

Prognostic significance of ischemic electrocardiographic changes during vasodilator stress testing in patients with normal SPECT images

BACKGROUND: Patients with ischemic electrocardiographic (ECG) findings during exercise stress testing but normal perfusion images generally have a low risk of cardiac death or myocardial infarction (<1% per year). During vasodilator stress testing, however, the prognostic significance of the combination of normal perfusion images and ischemic ECG changes is unknown. METHODS AND RESULTS: Among 5526 patients who underwent vasodilator stress single photon emission computed tomography (SPECT), 49 (0.9%) had normal images but ischemic ECG changes. A unique feature of this population was that 43 (88%) were women with a mean age of 67 +/- 10 years. Ischemic ECG changes occurred at a mean heart rate of 101 +/- 15 beats per minute and persisted for 6.8 +/- 4.7 minutes after termination of drug infusion. During follow-up of 28 +/- 20 months, cardiac death occurred in 2 patients and nonfatal myocardial infarction in 4 patients. The rate of cardiac death or nonfatal myocardial infarction was 4% at 1 year, 10% at 2 years, and 14% at 3 years. Of the 12 patients who underwent coronary angiography or autopsy during follow-up, 11 had multivessel coronary artery disease, indicating that these patients likely had false-negative SPECT image results. Eight patients required coronary revascularization. CONCLUSIONS: The finding of ischemic ECG changes with normal SPECT images during vasodilator infusion is uncommon, occurs primarily in older women, and is associated with a higher subsequent cardiac event rate than is customarily associated with normal images.     

Prognostic value of stress 99mTc-tetrofosmin myocardial perfusion imaging in predicting all-cause mortality: a 6-year follow-up study

Purpose The aim of this study was to ascertain whether stress myocardial perfusion imaging can independently predict long-term mortality.Methods We studied 1,386 patients with known or suspected coronary artery disease by means of stress ^99mTc-tetrofosmin myocardial perfusion tomography. The end point during follow-up was death from any cause. Mortality rates were compared with that in a reference population using calculated age- and gender-specific data in the general population.Results Mean age was 60±11 years. There were 608 (44%) women. Perfusion abnormalities were fixed in 416 (30%) patients and reversible in 445 (32%) patients. During a mean follow-up of 6±1.9 years, 290 (21%) patients died. The annual mortality was 1.7% in patients with normal perfusion and 5.2% in patients with abnormal perfusion. Patients with multivessel distribution of perfusion abnormalities had the highest annual mortality (6.2%). The annual mortality in the reference population was 3.2%. In a multivariate analysis model, predictors of death were age [risk ratio (RR)=1.06, 95% CI 1.04–1.07], male gender (RR=2, CI 1.6–2.6), history of heart failure (RR=2.3, CI 1.8–3.1), diabetes mellitus (RR=2.1, CI 1.6–2.7), smoking (RR=1.8, CI 1.4–2.3), reversible perfusion defects (RR=1.8, CI 1.4–2.5) and fixed perfusion defects (RR=1.7, CI 1.3–2.1).Conclusion Myocardial perfusion abnormalities on stress ^99mTc-tetrofosmin tomography are independently associated with long-term risk of death. The extent of perfusion abnormalities is a major determinant of mortality. The presence of normal perfusion is associated with a lower mortality compared with the general population.     

Complications of selective percutaneous transfemoral coronary arteriography.

A total of 1,250 selective coronary arteriographic procedures were performed by the percutaneous transfemoral technique. There were no deaths. Local complications included delayed hemorrhage in 14 patients, peripheral emboli in 2, and thrombosis in 1. Cerebral complications included fibrin or air emboli in 3 and dislodgement of a mural thrombus by the catheter in 1. Cardiac complications included ventricular fibrillation in 11, myocardial infarction in 3, and profound hypotension in 1. With routine use of a transparent manifold and removal of the guide wire distal to the arch vessels, no cerebral emboli or myocardial infarctions have occurred in the last 500 examinations.     

Effects of intracoronary administration of contrast materials on left ventricular function in the presence of severe coronary artery stenosis

The effects of intracoronary administration of contrast materials on regional and global left ventricular (LV) function were assessed in anesthetized dogs with segmental myocardial ischemia produced by critical stenosis of the circumflex coronary artery. Effects caused by sodium meglumine diatrizoate (R76), sodium meglumine calcium metrizoate (ISO), and metrizamide were evaluated. In the nonischemic state R76 produced an early (0–10 seconds) decrease in LV contractility followed by a late (10–20 seconds) positive inotropic effect. In the presence of regional ischemia there was prolongation of the negative inotropic effect. ISO produced only positive inotropic effects without significant differences between responses in the nonischemic and ischemic states. Metrizamide produced almost no alterations in LV function. Recipient of U.S. Public Health Service Research Career Development Award Grand #1KO4HL00201 from the National Heart and Lung Institute     

男女急性心肌梗死患者临床特点及经皮冠状动脉介入治疗的对比研究

目的：探讨男女急性心肌梗死患者临床特点及经皮冠状动脉介入治疗的对比研究。方法：选择本院2005-09～2011-06因急性心肌梗死进行经皮冠状动脉介入治疗患者417例,男234例,女183例,统计临床表现、冠状动脉病变累及支数、急诊PCI成功率,住院病死率。结果：急性心肌梗死的2种临床类型分布在男性与女性差异无统计学意义,以ST段抬高心肌梗死为主。冠状动脉造影男性与女性均以3支病变为主（63．0％7 vs 0．6％,P=0．160）,单支病变差异无统计学意义。男性双支病变明显多于女性（24．3％ vs 13．7％,P=0．016）,差异有统计学意义。累及部位、手术成功率和院内病死率差异无统计学意义（P〉0．05）。结论：急性心肌梗死发生率高,通过探讨男女急性心肌梗死患者临床特点及经皮冠状动脉介入治疗的异同,有助于男女急性心肌梗死的发现、诊断及治疗,有助于其心血管并发症的预防。     

Long-term results of the Simon nitinol inferior vena cava filter

The aim of this study was to evaluate the clinical efficacy, mechanical stability, and safety of the Simon nitinol inferior vena cava filter (SNF). The SNF was inserted in 114 consecutive patients at two institutions for prophylaxis of pulmonary embolism (PE). Clinical follow-up data were obtained retrospectively on all patients, and 38 patients underwent a dedicated radiologic follow-up protocol consisting of abdominal radiography, Doppler sonography, and CT. There was no immediate complication following filter insertion. Fifty patients died, on average, 5.6 (1–23) months after filter insertion, and 64 patients were alive, on average, 27 (3–62) months after filter insertion. Recurrent pulmonary embolism was documented in 5 patients (4.4 %) but originated distal to the filter in 1 patient. Deep venous thrombosis (DVT) was documented in 5.3 %, thrombosis at the access site in 3.5 %, and thrombosis of the inferior vena cava in 3.5 %. The rate of thromboembolic complications was similar in patients who did receive long-term anticoagulation and in those who did not. Radiologic follow-up showed no filter migration after, on average, 32 (5–62) months. A CT examination showed that struts of the SNF had penetrated the vena cava in 95 %, and were in contact with adjacent organs in 76 %; however, there were no clinical symptoms attributable to the filter. Filters were in an eccentric position in 63 % and partial filter disruption was found in 16 %; however, this did not affect filter function. The rate of recurrent pulmonary embolism after insertion of the SNF is 2.4 % per patient per year. Regardless of long-term anticoagulation, the rate of caval thrombosis is acceptably low. Except for occasional access-site thrombosis, no other filter-related morbidity was observed. Received 12 May 1997; Revision received 12 August 1997; Accepted 13 August 1997     

Systemic air embolism after percutaneous transthorasic needle biopsy of the lung

Computed tomography (CT)-guided percutaneous transthoracic biopsy of the lung is a well-established diagnostic technique, but it can pose complications to the patients. Air embolism is one of the rarest but potentially fetal complications of this procedure. The authors report a fetal case of systemic and massive air embolism to the coronary and cerebral arteries after the performance of lung biopsy. Careful reviewing of the obtained CT images during the procedure may avoid a missing systemic air embolism and can immediately provide an adequate therapy also in asymptomatic patients. This extremely rare complication is an inevitable event and may happen in spite of appropriate experience and meticulous care.     

Prognostic value of myocardial salvage achieved by reperfusion therapy in patients with acute myocardial infarction.

Myocardial salvage assessed by (99m)Tc-sestamibi scintigraphy is a marker of myocardial tissue reperfusion in patients with acute myocardial infarction. The prognostic value of myocardial salvage index in patients with acute myocardial infarction after reperfusion therapy has not, however, been investigated. METHODS: We analyzed 765 patients with acute myocardial infarction randomized to treatment by coronary stenting (383 patients), primary coronary angioplasty (251 patients), or thrombolysis (131 patients) in the setting of 3 randomized trials. Initial (before reperfusion therapy) and follow-up (7-14 d after reperfusion therapy) scintigraphic examinations were performed to assess the initial perfusion defect, final infarct size, and salvage index. Patients were categorized into 2 groups defined by the median salvage index (0.5): the group with salvage index < 0.5 (374 patients) and the group with salvage index >or= 0.5 (391 patients). The primary endpoint of the study was mortality at 6 mo after the index event. RESULTS: Six-month mortality was 5.1% (19 deaths) in the group with salvage index < 0.5, compared with 1.0% (4 deaths) in the group with salvage index >or= 0.5 (odds ratio, 5.1; 95% confidence interval, 1.9-13.3; P = 0.001). Salvage index (median [25th, 75th percentiles] was significantly smaller in nonsurvivors than in survivors (0.19 [0.05, 0.37] vs. 0.50 [0.26, 0.80], P = 0.0004). The Cox proportional hazards model showed that myocardial salvage index (P = 0.0007), initial perfusion defect (P = 0.0007), and age (P = 0.04) were independently associated with 6-mo mortality. CONCLUSION: Myocardial salvage achieved by reperfusion therapy predicts mortality in patients with acute myocardial infarction. Our findings support the use of salvage index as a surrogate of mortality in clinical trials designed to test the efficacy of reperfusion therapies among patients with acute myocardial infarction.     

Dobutamine stress thallium-201 single-photon emission tomography versus echocardiography for evaluation of the extent and location of coronary artery disease late after myocardial infarction

Dobutamine stress echocardiography and thallium-201 myocardial perfusion scintigraphy are clinically useful methods for the evaluation of coronary artery disease (CAD). However, the relative merits of these imaging modalities in the evaluation of the extent of CAD after myocardial infarction have not been well studied. The aim of this study was to compare the accuracy of dobutamine stress echocardiography and simultaneous ²⁰¹Tl single-photon emission tomography (SPET) imaging for the diagnosis and localization of CAD late after acute myocardial infarction. Dobutamine (up to 40 μg kg^–1 min^–1)-atropine (up to 1 mg) stress echocardiography in conjunction with stress-reinjection ²⁰¹Tl SPET was performed for the evaluation of myocardial ischaemia in 90 patients with previous myocardial infarction who underwent coronary angiography. Significant CAD was predicted on bases of myocardial ischemia (new or worsening wall motion abnormalities on echocardiography and reversible perfusion defects on ²⁰¹Tl SPET). Significant CAD (≥ 50% luminal diameter stenosis) was detected in 73 (81%) patients. The sensitivity, specificity and accuracy of echocardiography in detecting remote ischaemia for the diagnosis of remote CAD (present in 53 patients) were, respectively, 79% (CI 70%–88%), 85% (CI 77%–93%) and 81% (CI 73%–90%), while the corresponding figures for ²⁰¹Tl SPET were 75% (CI 66%–85%), 78% (CI 69%–87%) and 76% (CI 67%–86%) respectively (P = NS vs echocardiography). The sensitivity, specificity and accuracy of echocardiography in detecting peri-infarction ischaemia for the diagnosis of infarct-related artery stenosis (present in 70 patients) were, rspectively, 77% (CI 68%–86%), 85% (CI 78%–92%) and 79% (CI 70%–87%) while the corresponding figures for ²⁰¹Tl SPET were 73% (CI 64%–82%), 85% (CI 78%–92%) and 76% (CI 67%–84%) respectively (P = NS vs echocardiography). The agreement between the two methods for the diagnosis of peri-infarction and remote ischaemia was 70% (kappa = 0.37) and 80% (kappa = 0.59) respectively. It is concluded that dobutamine stress echocardiography and ²⁰¹Tl SPET have comparable accuracy for the diagnosis of infarct related and remote CAD in patients with previous myocardial infarction. The agreement between the methods is higher for the diagnosis of remote CAD than for that of peri-infarction ischaemia. Received 17 October 1998 and in revised form 5 January 1999     

Experimental myocardial ischemia II: Radiographic contrast media toxicity

The comparative effects of meglumine sodium diatrizoate (MSD), sodium meglumine calcium metrizoate (SMCM), and metrizamide (M) were studied in an isolated canine heart preparation. The parameters observed were coronary blood flow (CBF), myocardial contractile force (MCF), positive and negativedF/dt, and perfusion pressure during normal and ischemic perfusion conditions. MSD had an initial negative inotropic effect but baseline (MCF) returned in 1 min during normal perfusion and 2 min under ischemic conditions. SMCM and M had only a positive inotropic effect under normal perfusion. However, during ischemia, the positive effect of SMCM was followed by a decrease in contractile force. M showed only a positive effect on force during ischemia. Our results indicate that calcium additive may increase the risk of coronary arteriography in patients with severe coronary artery disease. Supported by Grants #1 RO1 HL 21589-01 RAD., HL 19003-03, and the Biomedical Research Support Grant, Beth Israel Hospital Presented in part at the Contrast Material Symposium, Colorado Springs, Colorado, May 26–29, 1979     

Local thrombolytic therapy for superior mesenteric artery embolism: complications and long-term clinical follow-up.

PURPOSE: To evaluate the effectiveness and complications of local intraarterial fibrinolysis in selected patients with superior mesenteric artery (SMA) embolism. MATERIALS AND METHODS: Intraarterial thrombolytic therapy was performed for acute SMA embolism in eight patients. Patients were selected for thrombolytic therapy on the basis of absence of peritoneal signs of intestinal necrosis at physical examination and absent findings of bowel infarction by CT. RESULTS: Clinical success was achieved in five patients and technical success in six. Complications included death due to massive shower emboli from the left ventricle in one patient and extravasation in one patient, who required surgery on the following day. Within one month after thrombolytic therapy, one patient each died of myocardial infarction and cerebral infarction due to emboli, and one patient underwent aorto-SMA bypass surgery due to residual stenosis. In the long-term follow-up period (2-7 years), four patients were still alive, with another embolic episode of a lower limb in one patient. One patient died of an unrelated cause without experiencing another embolic episode. CONCLUSION: Intraarterial fibrinolysis may be a therapeutic alternative in the management of SMA embolism in selected patients in whom an early diagnosis can be made. The long-term results depend on the occurrence of another embolic event.     

Acute Coronary Artery Air Embolism Following CT-Guided Lung Biopsy

CT-guided needle biopsy is a common procedure for obtaining a tissue diagnosis and consequently correctly managing patients. This procedure has many potential complications, ranging from simple pneumothorax or self-limiting hemoptysis to life-threatening pulmonary hemorrhage and air embolism. Though the latter is a rare complication of CT-guided needle biopsy, it has attracted a lot of interest. We report a case of right coronary air embolism resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of the lung.