Endocavitary implantation of a permanent pacemaker in the contralateral side of right pneumonectomy: a case report

The definitive endocardial stimulation is easy to install, allows a stable position of the leads, and a satisfactory stimulation thresholds for a long period. The epicardial approach is reserved for some rare indications including infectious contexts. The endocardial approach has been considered for a 67 years man with a complete AV block and an atrial fibrillation. This patient had undergone a right pneumonectomy 15 years before. A VVIR pacemaker has been implanted successfully by an internal jugular vein approach, and connected to a passively fixed unipolar lead. Because of the right ventricle deformation which made it unrecognizable, even by angiography means, we had to face major difficulties to position the lead. The epicardial approach should be considered even if a direct unique lung controlateral approach is easier than homolateral, because it allows us a quick ventricular access under the view control.     

Stent deployment within a guide catheter aids removal of a fractured buddy wire.

We report a case of fractured buddy wire that was successfully removed by deploying a stent within the guide catheter, trapping the fractured segment of wire between stent and endoluminal surface of the guide catheter. This technique provides an alternative to either percutaneous snare or surgical intervention.     

Retrieval of a subintimal fractured guide wire from the brachial artery following saphenous vein graft stenting

We present a case of a 58‐year‐old woman with diabetes mellitus with a history of angina, coronary artery bypass 24 years previously and who underwent retrieval of a fractured coronary buddy wire from the right brachial artery following attempted coronary intervention to a saphenous vein graft via the right radial route. Attempted removal of the guide wire had caused guide catheter‐induced dissection of the vein graft in addition to a distal stent edge dissection before fracture in the brachial artery. The fractured end of the buddy wire was found to be in the subintimal space and could only be retrieved by advancing the wire into the subclavian artery by means of wrapping its free portion around the guiding catheter. Its fractured end could then be snared into the guiding catheter but could only be withdrawn from behind the stented segment in the vein graft by means of a trap balloon in the guiding catheter. Successful stenting of a guide catheter‐induced dissection and distal stent edge dissection within the vein graft was then performed. This case highlights the hazards of deploying stents over buddy wires and of fractured guide wires in coronary intervention. © 2015 Wiley Periodicals, Inc.     

Loss of the guide wire: a case report.

A case of a lost guide wire extending from the vena cava to the back of the neck after central venous catheterization is presented. A trainee inserted a central venous catheter via the left subclavian vein in a 40-year-old male patient after surgery, but did not notice that a guide wire was completely inserted in the vein. After 6 months, the lost guide wire was seen extending from the saphenous vein through the vena cava, right atrium, right ventricle, pulmonary artery and lung tissue to the back of neck. Although percutaneous catheterization of central veins is a routine technique, it is a procedure requiring advanced surgical skills, expert supervision, and attention to detail in order to prevent adverse effects. The present case is not only a technological problem, but also one of responsibility. The operator must hold onto the guide wire at all times until removal from the vessel, and a supervisor must make sure that trainees are aware of all possible complications.     

Injury to a saphenous vein graft during removal of a temporary epicardial pacing wire electrode.

Removal of a temporary atrial epicardial pacemaker electrode damaged a saphenous vein graft. A new blood clot was removed from the damaged graft. The hole was successfully repaired with a polypropylene suture. Pacing wires should be carefully sited and should be removed only when facilities for urgent operation are available.     

Successful percutaneous stenting of a right gastroepiploic coronary bypass graft using monorail delivery system: a case report.

The right gastroepiploic artery (RGEA) is being successfully used as an arterial conduit in a selected group of patients undergoing coronary artery bypass graft surgery. However, myocardial ischemia may result due to spasm, occlusion, and stenosis of this graft. The anastamosis site at distal right coronary artery (RCA) or posterior descending artery (PDA) is the most common location for stenosis of an in situ gastroepiploic coronary bypass graft. Balloon angioplasty of such stenoses has been reported with optimal short-term results. Stent deployment would decrease the restenosis rate, so that repeat procedures could be minimized for these technically challenging lesions. We describe a case of successful deployment of a stent with monorail delivery system at the anastamotic site stenosis of an in situ gastroepiploic right coronary artery bypass graft. This percutaneous coronary intervention could prevent redo coronary artery bypass graft surgery. Cathet. Cardiovasc. Intervent. 49:197-199, 2000.     

Ascending aorta-supraceliac abdominal aorta bypass: successful removal of an infected graft in the descending thoracic aorta.

An infected graft and a mycotic pseudoaneurysm were successfully resected by employing an ascending aortasupraceliac abdominal aorta bypass graft in a 19-year-old man. He had formerly undergone graft replacement surgery for traumatic aneurysm of the descending thoracic aorta, with the aid of a temporary external bypass graft. After this first operation, the patient had suffered from septicemia due to Psudomonas aeruginosa, which resulted in formation of mycotic pseudoaneurysms at the distal anastomotic site of the prosthetic graft and at both stumps of the formerly employed external bypass graft.     

A saphenous vein graft aneurysm with fistula development to the right atrium: Surgical management of a rare bypass graft complication

A patient presented late following coronary artery bypass surgery with recurrent angina. Investigations revealed a saphenous vein graft aneurysm, which subsequently formed a fistula with the right atrium. This was managed by surgical excision and repair followed by regraft of the run-off territory. Intraoperatively, the left internal mammary artery, a patent graft to the left anterior descending artery, was isolated from the circulation during aortic cross-clamping by preoperative placement of a percutaneous balloon catheter within this graft. Surgery was successful and the patient was discharged symptom-free one week later.     

Right internal mammary artery graft angioplasty through a right brachial artery approach using a new custom guide catheter: a case report.

Angioplasty of right internal mammary artery grafts may present problems because of the variable origin of the mammary artery and its angulation from the subclavian artery. We report a case of successful angioplasty using a custom designed guide catheter, after failed attempts using conventional guide catheters.     

Percutaneous removal of a fractured right heart catheter from the apex of the right ventricle

A 58-year-old woman underwent right and left heart catheterization for suspected ischaemic heart disease with ventricular tachycardia. During the procedure a Bourassa catheter fractured and lodged at the right ventricular apex. Under general anaesthesia and radiographic screening the fragment was removed using a bronchoscopy biopsy forceps via the jugular vein after other methods had failed. This case highlights the need for familiarity with several techniques for the removal of such fragments.     

Bochdalek hernia in adults. Apropos of a case in the right side

Posterolateral diaphragmatic hernia (Bochdalek's hernia) is an infrequent finding in adult patients. Most of them are asymptomatic. Symptomatic cases present with digestive symptoms. Sometimes the clinical picture is related to the associated congenital malformations and not to the hernia itself. It is more common on the left side and in most of the cases it lacks of hernia sac. Simple radiologic study is the clue for the diagnosis. A case of Bochdalek's hernia in a 85 year-old patient is presented.     

Percutaneous removal of a broken central venous catheter from the right atrium

We report a case of a 32 year-old woman in whom catheter was inserted into a jugular internal vein in order to chronically administer antibiotics intravenously. For the next four years the introducer was kept in place. Due to a persistent cough, the chest X-ray was performed, demonstrating the broken introducer. Since a surgical removal did not succeed, a percutaneous procedure via femoral vein was performed successfully. Our case report draws special attention to the necessity of a regular check-up of patients with intravascular introducers.     

Staged carotid artery stenting and coronary artery bypass graft surgery: initial results from a single center.

The objective of this study was to assess the clinical course of patients undergoing planned percutaneous carotid stenting followed by staged coronary artery bypass grafting (CABG). Coexisting carotid and coronary atherosclerotic disease is relatively common. A combined or staged surgical approach has a composite stroke, myocardial infarction, or death rate of > 10%. We performed a retrospective search of our single-institution database to identify all patients scheduled to undergo staged carotid stenting followed by CABG. Twenty-three such patients (17 males, 6 females) were identified, with 3/23 (13%) requiring bilateral carotid stenting. Most carotid lesions were asymptomatic (18/26; 69.2%) and severe (mean stenosis, 82.9% 6+/- 8.6%). Stents were successfully placed in 26/26 carotid arteries (100%). One stent procedure (1/26; 3.8%) resulted in a minor stroke, but full recovery occurred within 1 week. There were no other peri-stenting complications. Three patents (3/23; 13%), none of whom suffered an adverse event at carotid stenting, elected not to undergo CABG. The mean interval from last carotid stent to CABG was 69.6 6 +/- 39.6 days (range, 8-157 days). Antiplatelet therapy was ceased > 3 days prior to CABG in 10/20 patients (50%), but continued until surgery in the remainder. There were no peri-CABG bleeding or neurological complications, but one myocardial infarction occurred (1/20; 5%). Therefore, of the 20 patients who underwent planned carotid stenting followed by CABG, our overall rate of death, stroke, or myocardial infarction was 10%. However, our rate of death, persistent stroke or myocardial infarction was 5%. Planned carotid stenting followed by staged CABG is a viable method of treatment for patients with coexistent carotid and coronary atherosclerosis.     

Importance of a hydrophilic coronary wire in anatomically challenging transradial access: an extended case series

Anatomic variations during transradial (TR) procedures are relatively common and represent a significant cause of technical failure, even for experienced radial operators. In this study, we present an interesting alternative technique to overcome these anatomical anomalies. A significant amount of TR procedures in various and challenging anatomical conditions were successfully completed with the use of a 0.014″ hydrophilic coronary guidewire.