Search results for "shunt"
showing 10 items of 114 documents
Budd-Chiari syndrome with portal, splenic, and superior mesenteric vein thrombosis treated with TIPS: who dares wins.
2003
A 20 year old man presented with severe ascites and malnutrition due to Budd-Chiari syndrome (BCS) with portal vein (PV), and splenic and mesenteric vein (SMV) thrombosis in the proximal 3 cm. He had received regular and more frequent paracenteses of up to 17 litres each for eight months. He had a poor BCS prognostic index of 8.41 (table 1). After referral, despite full anticoagulation and diuretic drugs, he deteriorated over three weeks. No thrombophilic disorder was found. View this table: Table 1 Comparison of laboratory and clinical data before and two months after transjugular intrahepatic portosystemic stent shunt (TIPS) He underwent transjugular intrahepatic portosystemic stent shunt…
TIPS for acute and chronic Budd-Chiari syndrome: a single-centre experience.
2003
Abstract Background/Aims : Transjugular intrahepatic portosystemic shunt (TIPS) is a technically challenging but feasible treatment for Budd–Chiari syndrome (BCS). However, information about the outcome, particularly in patients with liver failure, is scarce. We report our experience of TIPS for BCS. Methods : Fifteen patients with BCS underwent TIPS. Eight had hepatic failure and seven underwent TIPS for BCS uncontrolled by medical treatment. Results : Fourteen out of 15 had successful TIPS placement. Out of the eight hepatic failure patients, four died soon after TIPS: one liver rupture, one portal vein rupture, one liver failure and one pulmonary oedema. Another patient had a significant…
Paradoxical embolism through a patent foramen ovale from central venous catheter thrombosis: A potential cause of stroke
2020
Paradoxical embolism refers to a potential condition in which an embolus arising from a venous source crosses into the systemic circulation through a right-to-left cardiac shunt causing an arterial embolism. A 39-year-old woman carrier of a central venous catheter (CVC) without evident risk factors for stroke, developed an acute right homonymous hemianopia during hemodialysis. On neuroimaging, an infarct in the territory of the left posterior cerebral artery was demonstrated. Transesophageal echocardiography revealed a patent foramen ovale (PFO) and a large fluctuating thrombus in the right atrium on the tip of the CVC, thus allowing a diagnosis of ischemic stroke from paradoxical embolism.…
Hypoplasia of the posterior mitral valve leaflet: Don't forget to look beyond the mitral valve.
2020
Hypoplasia of the posterior mitral valve leaflet (PMVL) is a very rare finding in adulthood and can coexist with other congenital heart defects. In this image, a transesophageal echocardiography (TOE) carried out on a 59-year-old woman with a 2-month history of dyspnea revealed a hypoplastic PMVL causing severe mitral regurgitation associated with a secundum-type atrial septal defect (ASD) with left-to-right shunting. This case demonstrates how essential 3-dimensional TOE is for a comprehensive assessment of the mitral valve and to improve the diagnostic accuracy of concomitant congenital heart abnormalities.
Loup-assisted technique to create arterio-venous fistulas in elderly. A single centre experience
2019
AIMS: The radio-cephalic arteriovenous fistula (RCAVF) is the first choice treatment in end-stage renal disease patients. In the last few years, the hemodialysis population has shown a high percentage of elderly patients (> 65 year old) with comorbidities, mainly vascular diseases, which may adversely affect their vascular access success. The aim of this study was to evaluate the effectiveness of a loup-assisted technique to create RCAVFs in over 65 patients. PATIENTS AND METHODS: 98 consecutive patients with renal failure were prospectively observed. The patient were divided in relation to their age (> 65 year old; < 65 year old). In both groups, a microsurgical distal RCAVF was c…
RUPTURE OF AN AORTIC DISSECTION INTO THE RIGHT ATRIUM IN A PATIENT WITH PREVIOUS AORTIC VALVE REPLACEMENT: A CASE REPORT
2005
We report the case of a 73-year-old man with a history of previous aortic valve replacement in 1990 and rupture of an aortic dissection into the right atrium. The patient was admitted to the emergency room because of chest pain, stopped not long after. The electrocardiogram did not show any signs of ischemia and myocardial enzymes were not increased. Transthoracic echocardiography revealed aortic root dilation (maximum diameter 60 mm) extended to the aortic arch, and the presence of a flow from the ascending aorta to the right atrium (evocative of a fistula between the two chambers). The aortic valvular prosthesis function was good. Transesophageal echocardiography confirmed an aorta-right …
Transcervical approach for carotid artery stenting with transitory reversal flow: Case report
2021
Introduction Carotid artery stenting (CAS) has been indicated as an alternative to carotid endarterectomy in high risk patients. Sometimes, an aortic arch can be anatomically unfavourable for CAS. Herein we report our experience in a case of CAS with transcervical approach. Presentation of case A 77-year-old male was referred to our hospital for severe subtotal occlusion of the left internal carotid artery. He had a past medical history of radiation to the head and neck for laryngeal cancer. Previous CT-angiography had shown a type III aortic with bovine arch. CAS via transcervical approach was performed with transitory reversal flow during the placement of RX Spider Filter 6 Fr (Medtronic,…
Bispectral index changes in carotid surgery.
2010
Intraoperative monitoring of cerebral ischemia with shunting during carotid endarterectomy (CEA) remains controversial. Our objective was to evaluate the sensitivity and specificity of BIS changes during carotid clamping in relation to shunted patients in awake CEA.Eighty CEAs under cervical block were included. There were two patient groups: with clinical signs of cerebral ischemia (shunted patients) and without signs of cerebral ischemia (nonshunted patients). Data were based on bispectral index (BIS) values and neurological monitoring at different surgery time points, with special attention paid during carotid clamping. BIS values were compared between shunted and nonshunted patients. Se…
Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement
2021
BackgroundExternal ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%. The purpose of this simulation study is to provide preliminary data about the possibility of increasing the safety of one of the most common life-saving procedures in neurosurgery by testing a new device for EVD placement.MethodsWe used a novel guide for positioning the ventricular catheter (patent RM2014A000376). The trajectory was assessed using 25 anonymized head CT scans. The data sets were used to conduct three-dimensional computer-based and combined navigation and augmented reality-based simulations using pla…
Improving angle stability by switching shunt reactors in mixed overhead cable lines. An Italian 400 kV case study
2019
Stringent environmental constraints make the construction of new transmission overhead lines more and more difficult. Alternatively, today it is possible to use cable lines for high (HV) and extra-high (EHV) voltage systems. The configuration of the so-called mixed lines can create some problems in the operation of the electrical system, both during steady-state and transient conditions. In particular, the system stability is one of the main concerns when analyzing the dynamic response of power systems. In this paper, the study of angular stability of a system containing a mixed line is presented: a specific control logic applied to the shunt reactors of the mixed line is proposed as improv…