A & A case reports
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Case Reports
Needle Migration to the Heart: An Unusual Association of Hemodialysis and Cardiovascular Morbidity.
In this report, we present a unique complication of hemodialysis: the hemodialysis access needle was lost into an arteriovenous fistula. The event went unnoticed for several months. ⋯ Loss of the needle was likely unrecognized because of the use of a retracting safety cannula that conceals the needle within a sheath after removal. This case highlights a rare and potentially serious complication of hemodialysis access, demonstrates a possible hazard of retracting safety needles, and reviews the management of foreign bodies that have migrated into the heart.
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Case Reports
Atrioventricular Sequential Pacing for Hypertrophic Cardiomyopathy During Liver Transplantation.
Hypertrophic cardiomyopathy is a myocardial disorder that carries an increased risk of morbidity and mortality during liver transplantation. We describe the use of atrioventricular sequential pacing, placed preoperatively, to assist with intraoperative management of a patient with severe refractory hypertrophic cardiomyopathy undergoing orthotopic piggyback liver transplantation. We discuss the pathogenesis and treatment of this infrequent but serious comorbidity.
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A 43-year-old woman with a history of the Cushing syndrome secondary to adrenocortical carcinoma presented to the operating room for right adrenalectomy, hepatectomy, nephrectomy, and inferior vena cava (IVC) thrombectomy. Initial intraoperative transesophageal echocardiogram (TEE) confirmed the presence of an IVC tumor below the hepatic veins. ⋯ The remainder of the procedure finalized uneventfully. The case highlights the importance of TEE monitoring for noncardiac surgery with thrombotic involvement of the IVC.
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Case Reports
Methylene Blue for Vasoplegia When on Cardiopulmonary Bypass During Double-Lung Transplantation.
Vasoplegia syndrome, characterized by hypotension refractory to fluid resuscitation or high-dose vasopressors, low systemic vascular resistance, and normal-to-increased cardiac index, is associated with increased morbidity and mortality after cardiothoracic surgery. Methylene blue inhibits inducible nitric oxide synthase and guanylyl cyclase, and has been used to treat vasoplegia during cardiopulmonary bypass. However, because methylene blue is associated with increased pulmonary vascular resistance, its use in patients undergoing lung transplantion has been limited. Herein, we report the use of methylene blue to treat refractory vasoplegia during cardiopulmonary bypass in a patient undergoing double-lung transplantation.
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Mechanical valve thrombosis is a severe complication of valve replacement associated with significant patient morbidity and mortality. The main factors that predispose patients to thrombus formation include endothelial injury or dysfunction, hypercoagulability, and hemodynamic changes. ⋯ Early diagnosis of thrombus could prevent adverse patient outcomes. We describe the use of transesophageal echocardiography in the diagnosis of acute thrombus in a patient with a recently replaced single atrioventricular valve.