Bullet embolus from a pulmonary vein to the right axillary artery

A case of bullet embolus from a pulmonary vein to the right axillary artery is reported. Though bullet embolization is unusual, it should be considered in any patient who has sustained a gunshot wound and does not have an exit wound, and whose plain films demonstrate a bullet far from the suspected path of the projectile.     

Inadvertant atrial fixation of a Swan-Ganz catheter by suture and a method for its percutaneous removal

A patient with type I dissection of the thoracic aorta inadvertently had a Swan-Ganz catheter sutured to the right atrium during surgical repair of the dissection. A method for its removal using percutaneous passage of a No. 15 scalpel blade is described. The hazards of Swan-Ganz catheters are explored, and the changing roles of nonsurgical interventional procedures are discussed.     

Prevention of embolization of a catheter fragment to the lower extremity by compression of the femoral artery

Distal embolization of a catheter fragment into the lower leg during attempted retrieval was prevented by compression of the common femoral artery to retain the fragment above the inguinal ligament, where it was retrieved successfully. This maneuver should be employed when it is suspected that a fragment may dislodge or is difficult to grasp. This will prevent embolization occurring distally, where surgical retrieval will most likely be required.     

Angiographic demonstration of tumor vascularity in left atrial myxoma: A case report

We describe a 63-year-old woman with a large sessile left atrial myxoma and coexisting mitral valve stenosis and regurgitation. The diagnosis of a left atrial tumor was confirmed by echocardiography and coronary angiography. This case reveals the rare finding of tumor vascularity originating from both the right coronary artery and left circumflex artery.     

Percutaneous retrieval of a retained Jackson-Pratt drain fragment

A retained intraabdominal Jackson-Pratt drain fragment was percutaneously retrieved using an inflated angioplasty balloon that had been maneuvered inside of the drain lumen over a hydrophilic-coated steerable guidewire.     

Comparison of Two Foreign Body Retrieval Devices with Adjustable Loops in a Swine Model

The purpose of the study was to compare two similar foreign body retrieval devices, the Texan™ (TX) and the Texan LONGhorn™ (TX-LG), in a swine model. Both devices feature a ≤30-mm adjustable loop. Capture times and total procedure times for retrieving foreign bodies from the infrarenal aorta, inferior vena cava, and stomach were compared. All attempts with both devices (TX, n = 15; TX-LG, n = 14) were successful. Foreign bodies in the vasculature were captured quickly using both devices (mean ± SD, 88 ± 106 sec for TX vs 67 ± 42 sec for TX-LG) with no significant difference between them. The TX-LG, however, allowed significantly better capture times than the TX in the stomach (p = 0.022), Overall, capture times for the TX-LG were significantly better than for the TX (p = 0.029). There was no significant difference between the total procedure times in any anatomic region. TX-LG performed significantly better than the TX in the stomach and therefore overall. The better torque control and maneuverability of TX-LG resulted in better performance in large anatomic spaces.     

经胸超声心动图在左冠状动脉异常起源于肺动脉的诊断及随访中的应用

目的:探讨经胸超声心动图(TTE)在左冠状动脉异常起源于肺动脉(ALCAPA)的诊断及随访中的应用价值.方法:收集18例ALCAPA患儿的临床资料,分析TTE的诊断符合率及典型征象,随访6个月后,分析术前及术后左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)及二尖瓣反流情况.结果:18例中,TTE正确诊断1...     

Coilon removal

Successful percutaneous removal of a “coilon” (spring coil with compressed Ivalon plug) is described. A large 18 French Teflon dilator was used for retrieval because of the danger of stripping off the attached Ivalon plug at the time of extraction through the puncture site.     

异物创伤性动脉瘤犬模型构建的初步探讨

目的：建立异物创伤性动脉瘤的犬模型,为伴血管损伤软组织异物一站式介入治疗研究提供动物模型。 方法：随机选取2年龄的健康雄性比格犬7只,分为颈动脉瘤造模5只和未造模2只,造模于右侧颈动脉共5支血管为研究组,其左侧颈动脉及未造模2只犬两侧颈动脉共9支血管为对照组。研究组将长约15~20 mm的离断颈静脉剪开、缝合于同侧颈总动脉前璧上,以弯型断针穿破静脉片及动脉前壁,静脉片-动脉壁间腔搏动性充盈且无缝缘渗漏后,断针部分留存于该间腔甚或动脉腔内,逐层缝合手术区域组织。然后,经皮经股动脉插管选择性颈总动脉进行数字减影血管造影（DSA）。对照组颈动脉仅于其旁以缝针经皮扎伤软组织且无明显出血及血肿。术前、术后行颈部CT血管成像（CTA）和数字放射摄影（DR）检查与评估。 结果：研究组5支右侧颈动脉断针创伤性动脉瘤均成功造模,技术成功率100%;DSA清晰显示动脉破口、动脉瘤状动脉突起及断针异物,载瘤动脉局部轻度痉挛及狭窄,创伤性动脉瘤模型的瘤颈宽度为（2.1±1.3）mm,瘤体宽（9.7±1.1）mm,瘤体高（4.2±1.7）mm;CTA不如DSA显示效果佳。对照组9支颈动脉均正常。 结论：采用颈静脉片侧-侧吻合于同侧颈动脉前壁上并以断针穿破静、动脉壁且断针部分留置于其间的技术与方法,成功构建了异物创伤性动脉瘤犬模型。     

Migration of fractured guidewire and its retrieval by endovascular snare catheter: A case report

Central venous catheterization is commonly used in patients undergoing cardiovascular surgery and it is a relatively safe procedure. A 62-year-old woman who underwent emergency mitral valve replacement for infective endocarditis received a central venous catheter after induction of anesthesia. Postoperative chest radiography revealed a wire-like foreign body near the puncture site of the internal jugular vein, which was later retrieved successfully using a snare catheter under fluoroscopy. This report highlights the importance of careful observation of the withdrawn guidewire and dilator and the role of perivascular ultrasound in all cases requiring this procedure.     

Coronary artery dissection secondary to selective coronary angiography

Coronary artery dissection during coronary arteriography is a rare complication. We describe three cases occurred in our laboratory (0.18% of all the procedures). All the invasive procedures were performed with a femoral approach with Judkins catheters by three different surgeons with limited experience; all dissections involved the right coronary artery. Two patients were men with coronary artery disease and the third was a woman who underwent catheterization for mitral valve disease. An inferior acute myocardial infarction occurred in both men and one of them was surgically treated. No ischemia was observed in the female patient with mitral disease. According to previous reports, we believe that the patients at risk for such a complication (adults with diffuse coronary artery disease or young women with valvular disease and normal coronary arteries) must be more carefully considered. Moreover, in these patients soft-tip Judkins catheters should be used during femoral procedures in the right coronary artery.     

Inadvertent embolic obstruction of abdominal aorta from left atrial thrombus after percutaneous mitral valvuloplasty

Inadvertent embolic obstruction of the distal abdominal aorta and left renal artery during a percutaneous mitral valvuloplasty procedure in a patient with mitral stenosis is reported. The embolism was from a left atrial thrombus which was detected by magnetic resonance imaging (MRI) but not by transesophageal echocardiography.     

Transvascular retrieval of an accidentally ejected tip occluder and wire

Accidental ejection of a tip occluder and wire and subsequent damage of the angiographic catheter tip is described as well as retrieval of the wire. A complication of the final removal was intimal tear and thrombus formation close to the puncture site. Successful thrombectomy and vascular repair was performed. No other complication was encountered.     

Omental actinomycosis mimicking a foreign body infection

Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces species. Abdominal actinomycosis is a rare condition and difficult to diagnose before surgery. Here, we report a case of omental actinomycosis mimicking a foreign body infection on computed tomography (CT). A 47-year-old man presenting with abdominal pain had a heterogeneous area comprising a 2-cm long linear radiopaque material with surrounding enhancing soft tissue density lesions and fat infiltrates, measuring 9 × 8 cm in the omentum of the right upper quadrant on CT. We assumed that the linear radiopaque material was a foreign body, such as a fish bone. Laparoscopy-assisted right hemicolectomy and partial omentectomy were performed under radiological suspicion of foreign body infection. Histological examination revealed the omental lesion to be actinomycosis. The patient was treated with antibiotics for 10 weeks, and he recovered well without any complication. Omental actinomycosis mimicking a foreign body infection is rare. The experience and knowledge regarding the variable CT findings of abdominal actinomycosis are useful because it should be differentiated from malignancy and other inflammatory conditions.     

Systemic artery to pulmonary artery fistula associated with mitral regurgitation: successful treatment with endovascular embolization

We present the case of a 60-year-old woman with symptomatic mitral regurgitation caused by a left-to-right shunt via anastomoses consisting of microfistulae, most likely of inflammatory origin, between the right subclavian artery and the right pulmonary artery. The three arteries responsible for fistulous formation, including the internal mammary, thyrocervical, and lateral thoracic arteries, were successfully occluded by transcatheter embolization using superabsorbent polymer microsphere (SAP-MS) particles combined with metallic coils. No complications have been identified following treatment with SAP-MS particles. This approach significantly reduced the patient's mitral regurgitation and she has remained asymptomatic for more than 4 years.     

Shotgun pellet embolization to the intracranial internal carotid artery: Report of a case and review of the literature

We report a patient with the angiographic diagnosis of embolization of a shotgun pellet from its presumed left internal carotid artery entry site to the ipsilateral intracranial internal carotid artery. Subsequently, a left middle cerebral artery territory infarct developed. Review of the literature reveals 30 previous reports of intracranial embolization of metallic missile fragments. Observations of patient demographics, foreign body type, embolization patterns, neurologic deficits and presentations, and patient evaluation and therapy are discussed.     

Behcet综合征累及心血管系统的CT诊断

目的 探讨累及心血管系统的Behcet综合征影像特点及其诊断.方法 搜集1995年7月至2007年12月临床诊断为Behcet综合征累及心血管系统患者11例的电子束CT(EBCT)或64层MSCT检查资料,回顾分析其cT影像特点.结果 11例Behcet综合征患者的CT影像表现为:累及主动脉瓣4例(其中2例同时累及二尖瓣),右冠状动脉假性动脉瘤2例(其中1例同时形成右腋动脉假性动脉瘤,3.5年后无诱因出现腹主动脉假性动脉瘤),左锁骨下动脉假性动脉瘤1例(伴腹主动脉下段闭塞),主动脉弓部真性动脉瘤及溃疡1例,主动脉弓部假性动脉瘤1例,主动脉夹层1例,肺动脉栓塞伴房间隔瘤1例.结论 CT作为Behcet综合征诊断及定期随访的检查手段,可明确心血管系统受累情况,根据其病变的影像特点,为选择临床治疗方法提供依据.     

Evaluation of cardiac morphology, function, and perfusion at low radiation dose before mitral valve surgery

A low-dose cardiac CT examination for preoperative assessment of coronary artery disease and mitral valve annulus dimensions in 79-year-old female with mitral valve regurgitation, consisting of a prospectively ECG-triggered high-pitch first-pass perfusion scan under adenosine stress and a sequential scan at rest enabled the diagnosis of occlusion of the right coronary artery and high-grade stenosis of the left circumflex artery, reversible perfusion defects of the inferoseptal and inferolateral walls and a persistent inferior wall perfusion defect associated with inferior wall thinning and akinesia. All findings were confirmed with catheter coronary angiography and cardiac magnetic resonance imaging. Because of the diagnosis of peri-infarct ischemia, the patient underwent aortocoronary bypass grafting in addition to mitral valve reconstruction. CT allowed for comprehensive preoperative assessment of cardiac morphology, function, and perfusion at a low cumulative radiation dose of 4.3 mSv.     

A large intrapericardial cyst presenting as a cardiac abnormality.

A case of mitral regurgitation apparently caused by extrinsic pressure of the large intrapericardial cyst distorting the mitral valve is reported. The initial radiographic appearance of the cyst suggested an atypically enlarged left atrium. The mitral regurgitation subsided after surgical drainage of the cyst. The angiogram showed elevation of the right pulmonary artery and depression of the left atrium.     

经皮肺动脉异物介入取出一例

患者男,9岁,因"原发孔房间隔缺损性先天心脏病"行"原发孔房间隔缺损根治术",在手术结束前关胸拔22 G"下腔静脉插管"时发现其头端脱落,当时手术视野内、外未发现脱落头端,故考虑脱落于心血管内,极有可能进入肺动脉.当时因无法确定脱落位置,故未手术取出.术后患者情况稳定.为了尽快祛除异物,行胸部正位片检查后,发现在左肺中上野锁骨中线第6后肋与第三前肋交叉处可见"齿轮状"阴影.复行多层螺旋CT检查示:左肺上叶前段基底部异物影,与"下腔静脉插管"头端相似,通过重建显示发现异物头端近心(图1).结合手术病史,考虑"肺动脉内异物"的诊断.因手术取出有困难,故考虑先行"经股静脉肺动脉造影"以明确诊断,必要时用介入方法将异物取出.