Continuous Supplemental Oxygen Research Articles

An unexpected life-threatening persistent oxygen desaturation in a child after extubation.

Ureteroscopic nephrolithotripsy is now being preferred over percutaneous nephrolithotomy for removal of kidney stones in children. Here, in this report, we have discussed persistent oxygen desaturation immediately after extubation in a two-year-old child who underwent Ho-YAG (holmium-yttrium-aluminium garnet) laser ureteroscopic nephrolithotripsy. The child developed bilateral pleural effusion after nephrolithotripsy and required continuous oxygen supplementation to maintain oxygen saturation above 95%, followed by ultrasound-guided thoracentesis.

Case Report: Scrub Typhus manifesting as Acute Respiratory Distress Syndrome (ARDS) with corresponding radiological findings

Background Scrub typhus is a life-threatening infectious disease endemic in the Asia-Pacific region. It typically presents with nonspecific symptoms such as fever, headache, and myalgia, making early diagnosis challenging. Acute Respiratory Distress Syndrome (ARDS) is a severe pulmonary condition characterized by acute-onset hypoxemia, bilateral lung infiltrates on radiology, and increased pulmonary capillary permeability. Case Presentation An 18-year-old female student in central India presented with a seven-day history of recurrent fever, chills, dry cough, and severe shortness of breath, escalating to Modified Medical Research Council dyspnea grade III-IV. After unsuccessful local clinic treatment, a chest radiograph revealed bilateral pneumonia. On admission, she displayed tachycardia, tachypnea, hypotension, and hypoxia requiring non-invasive ventilation (NIV). Computed tomography confirmed scrub typhus-associated pneumonia, and serological testing was positive for scrub typhus. She was diagnosed with moderate ARDS and began treatment. Symptomatic improvement was seen in the ICU, and she was discharged on day 10 with radiological and clinical resolution. Management and Outcomes She received intravenous doxycycline and oral azithromycin for scrub typhus and any potential concurrent lung infection. In the ICU, she required continuous NIV and supplemental oxygen, with significant symptomatic improvement, evidenced by reduced tachypnoea and oxygen requirements after 72 hours. She was weaned off NIV and monitored for an additional four days. After satisfactory oxygen saturation on room air, she was discharged on the tenth day. High-resolution CT scan demonstrated resolution of ground glass opacities and consolidation. Sequential chest radiographs exhibited gradual reduction in bilateral alveolar infiltrates over time, in parallel with clinical improvement. Laboratory findings, including reduced CRP and D-dimer values, and a normal hemogram on discharge indicated a resolution of leukopenia. Conclusion This case underscores the importance of early recognition and intervention in scrub typhus-associated ARDS and highlights the utility of timely diagnostic imaging in monitoring the progress of the disease.

Non-invasive ventilation treatment for patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) affects the lives of millions of patients worldwide. Patients with advanced COPD may require non-invasive ventilation (NIV) to support the resultant deficiencies of the respiratory system. The purpose of this study was to evaluate the effects of varying the continuous positive airway pressure (CPAP) and oxygen supplementation components of NIV on simulated COPD patients by using an established and detailed model of the human respiratory system. The model used in the study simulates features of advanced COPD including the effects on the changes in ventilation control, increases in respiratory dead space and airway resistance, and the acid-base shifts in the blood seen in these patients over time. The results of the study have been compared with and found to be in general agreement with available clinical data. Our results demonstrate that under non-emergency conditions, low levels of oxygen supplementation combined with low levels of CPAP therapy seem to improve hypoxemia and hypercapnia in the model, whereas prolonged high-level CPAP and moderate-to-high levels of oxygen supplementation do not. The authors conclude that such modelling may be useful to help guide beneficial interventions for COPD patients using NIV.

Biosynthesis of Gamma-Aminobutyric Acid by Engineered Clostridium tyrobutyricum Co-Overexpressing Glutamate Decarboxylase and Class I Heat Shock Protein

Gamma-aminobutyric acid (GABA) is a major inhibitory neurotransmitter in the mammalian central nervous system that has a significant beneficial effect on human health. Traditional microbial GABA synthesis requires continuous oxygen supplementation. Here, a new anaerobic platform for GABA production was established with engineered C. tyrobutyricum ATCC 25755, which is considered an ideal anaerobic microbial-cell factory for bioproduction. Glutamate decarboxylase (GAD) and Class I heat-shock proteins were screened and overexpressed, generating an excellent Ct-pMAG strain for monosodium-glutamate (MSG) tolerance and GABA production, with a GABA titer of 14.26 g/L in serum bottles with the mixed substrate of glucose and MSG. Fed-batch fermentation was carried out in a 5 L bioreactor, achieving 35.57 g/L and 122.34 g/L final titers of GABA by applying the pH-free strategy and the pH-control strategy, respectively using MSG. Finally, a two-stage strategy (growth stage and bioconversion stage) was applied using glutamate acid (L-Glu) and glucose as the substrate, obtaining a 400.32 g/L final titer of GABA with a productivity of 36.39 g/L/h. Overall, this study provides an anaerobic-fermentation platform for high-level bio-GABA production.

Understanding patient experience of chronic cough in interstitial lung disease

Chronic cough is a common symptom in patients with interstitial lung disease (ILD), negatively contributing to health-related quality of life. Despite this, there is limited information and understanding on the experience of this group of patients with chronic cough. This study aimed to explore the symptom experiences for chronic cough in patients with ILD to identify its characteristics and impacts. A qualitative study using semi-structured telephone interviews was undertaken in 16 adults with a diagnosis of ILD of any type and severity. Patients were recruited from a quaternary referral centre in Melbourne, Australia. Interviews were transcribed verbatim and coded by two researchers using thematic analysis. Patients (age range: 39-87 years, forced vital capacity: 53-107% predicted and diffusing capacity of the lung for carbon monoxide: 28-89% predicted) experienced a spectrum of cough severity and characteristics, including both dry and productive coughs. The impact of chronic cough included physical symptoms, social and emotional difficulties, and interference with work and vocational participation. Management strategies used to relieve cough included mucolytics, opiates, throat lozenges, warm drinks, pacing, breath control, relaxation exercises, movement, continuous positive airways pressure and supplemental oxygen. Patients expressed a need for further information and education regarding chronic cough, including its triggers and management. This study highlights the experience and significance of chronic cough in patients with ILD. The nature and severity of chronic cough in patients with ILD appears to be more heterogeneous than previously described, with physical, social and emotional impacts contributing to symptom burden.

Abstract 13199: Transcatheter Valve Implantation in Reversed Potts Shunt in Pulmonary Arterial Hypertension: Keeping the Shunt Reversed

Case description: 19-year-old female with idiopathic PAH diagnosed at the age of 4 with surgical valved reversed Potts shunt (rPS), from the left pulmonary artery (LPA) to the descending aorta (DsAo), at the age of 16. In her case, the valved rPS was fashioned using a 10 mm Fusion graft (Getinge ® , Getinge, Sweden), and a 12 mm valved Contegra conduit (Medtronic ® , MN, USA) that was trimmed at a shorter length than the graft and positioned in the middle of it, leaving the distal edges of the graft intact at the smaller diameter. She presented in 2021 with decompensated right-sided heart failure requiring continuous oxygen supplementation and pressor and ionotropic support. Investigation: Echocardiography showed normal LV size and function, severe RV dilation and dysfunction with RVSP of 102 mmHg (SBP: 119 mmHg). New bidirectional flow across the valve within the rPS was noted. Management: Patient taken to the cardiac catheterization lab for valve implantation within the rPS. Her RA pressure was 11, RV 90/16, PA 90/45 (64) with a simultaneous aortic pressure of 90/56 (71), PCWP of 14, PA saturation of 60%, AsAo saturation of 84%, and DsAo saturation of 84%. Angiography showed bidirectional shunting and an incompetent deteriorated rPS valve. We modified the 18mm Ensemble ® transcatheter valve delivery system to fit a 20 mm Melody ® (Medtronic, MN, USA) valve, by removing the 18 mm balloon and using a15 mm balloon instead, maintaining the external sheath of the delivery system. Once the valve was crimped onto the balloon, we advanced it with the tip of the balloon slightly inflated over a stiff wire. After valve deployment, angiography demonstrated resolution of left to right shunting. Post valve deployment, her hemodynamics were stable as prior except for a drop in her PA saturation to 49%, and DsAo saturation to 80%. Discussion: rPS is designed to offload the RV in severe PAH. The bovine jugular valve in this case prevented left to right flow across rPS and thus pulmonary overcirculation, functioning as it was originally intended: a valved unidirectional rPS. This valve, while originally intended to be deployed to 18-22 mm in diameter in the pulmonary position, can be functional at diameters as narrow as 12-16 mm.

Maternal Body Mass Index and Risk of Bronchopulmonary Dysplasia in Extremely Preterm Infants.

We evaluated the relationship between maternal body mass index (BMI) and death or bronchopulmonary dysplasia (BPD). We hypothesized that in extremely low birth weight (ELBW; BW < 1,000 g) infants, the risk of death or BPD would be greater if the maternal BMI deviated further from the ideal BMI of 24. ELBW infants admitted to AdventHealth Neonatal Intensive Care Unit (NICU) between calendar years 2012 and 2017 were included in this retrospective observational study. BPD was defined as continuous supplemental oxygen use at 36 weeks post-menstrual age. There was no association between the deviation of maternal BMI from the ideal of 24 and the composite outcome of death or BPD (6.9 ± 6.7 vs. 7.06 ± 6.6, pp = 0.966). However, there was a lower risk of death with a higher maternal BMI (p = 0.024). BPD was also associated with a higher maternal BMI (p = 0.045). Maternal BMI was not associated with the composite variable of death or BPD in ELBW infants. The lack of association was due to the contrast between high BMI and a lower risk of death and a higher risk for BPD. · Maternal BMI was not associated with the composite outcome of death or BPD.. · Elevated BMI was associated with a higher risk of BPD.. · Elevated BMI was associated with a lower risk of death..

Prediction and influence of comorbid conditions on the degree of severity of acute intestinal infection caused by opportunistic pathogens in elderly and patients against the COVID-19 background

Analysis of comorbid conditions in elderly and senile patients with COVID-19 and acute intestinal infection (AII) caused by representatives of opportunistic flora, conducted on 71 patients of the infectious disease department, including 42 women (59.15%) and 29 (40.85%) men. In patients, acute intestinal infection was caused by enteropathogenic bacilli ‒ 38 (53.52%) patients, bacteria of the genus Pseudomonacea ‒ 10 (14.09%), and St. aureus ‒ 23 (32.39%). The average age of the patients was 71.48±7.53 years. Analysis of comorbid conditions and prediction of disease progression was performed according to the severity of the disease and using the Charlson comorbidity index, the ABCD scoring system, the COVID-19 severity index, and the NEWS questionnaire. It was established that the examined patients have a high propensity for a severe course of diseases with their comorbid burden. A reliable lack of relationship between the comorbidity index and the degree of severity of AKI has been proven. Patients with AII had a low to moderate risk of developing infectious complications and also required continuous supplemental oxygen support and intensive care. According to the results of a survey on the NEWS system, patients who have a constant supply of oxygen have a higher probability of the formation of severe AII (OR=7.50; CI (1.28‒43.84); p=0.02), and a lower probability in relation to the average degree of severity (OR=0.13; CI (0.02‒0.78); p=0.02). Predicting the degree of severity of an acute intestinal infection that has developed against the background of COVID-19 affects the choice of treatment methods, in particular oxygen therapy, accelerates decision-making and the effectiveness of therapy. Keywords: acute intestinal infection, coronavirus disease COVID-19, dysbiosis, comorbid pathology, infectious complications, intestinal microbiocenosis.

Periodic oxygen supplementation drives efficient metabolism for enhancing valuable bioresource production in photosynthetic bacteria wastewater treatment

Periodic oxygen supplementation (A-O) strategy was proposed to improve pollutant removal and enhance bioresource production of photosynthetic bacteria (PSB). The A-O strategy obtained higher COD (91.4%) and NH4+-N (78.6%) removal compared with the non-oxygen supplementation (N-O) strategy, which was similar to the continuous oxygen supplementation (C-O) strategy. A-O strategy achieved the highest biomass concentration of 1338.5 mg/L. Bacteriochlorophyll and carotenoids concentration in the A-O strategy were 24.9–31.1% and 15.1–23.7% higher than those in the other two strategies; coenzyme Q10 concentration and content were 52.5% and 21.3% higher than that in the N-O strategy. The metabolomic analysis showed that the A-O strategy enhanced the tricarboxylic acid cycle after fumaric acid formation and β-alanine metabolism, then caused higher biomass accumulation. The A-O strategy reduced the inhibition of photophosphorylation by oxidative-phosphorylation and maintained both characteristics. Hence, A-O might be an economic strategy for enhancing pollutant removal and bioresource production in PSB-based wastewater treatment.

A novel ITGA3 homozygous splice mutation in an ILNEB syndrome child with slow progression

Background and aimsILNEB (interstitial lung disease, nephrotic syndrome, epidermolysis bullosa) syndrome is caused by ITGA3 mutations. Demises usually happened at infancy. This study reports a complete ILNEB syndrome child with slow disease progression. Materials and methodsClinical data and related specimens were collected. Genomic DNA was extracted for genetic sequencing. Integrin α3 expression was detected by western blotting and immunofluorescence staining. ResultsThe patient was male. He experienced recurrent rashes shortly after birth. His sparse eyebrows and eyelashes gradually lost. The patient was vulnerable to respiratory infections and had recurrent fever after vaccine immunization after 4 years. He was found with nephrotic syndrome and polycystic renal dysplasia at 8 years and progressed to end-stage renal disease at 12 years. A chest Computed Tomography revealed intestinal lung disease at 8 years. Continuous oxygen supplementation was needed at 13 years. Counts of lymphocyte subsets revealed elevated percentage of double-negative T cells and activated T cells. Next-generation sequencing revealed a novel homozygous splice mutation c.2219 + 4A > Cin ITGA3 that was predicted to be deleterious. The mutation resulted in exon17 skipping with the loss of 80 bp in the mRNA. The aberrant integrin α3 mRNA level was lower compared to the healthy control. Integrin α3 protein was not detected in urine epithelial cells and skin of the patient. ConclusionsWe report a patient harboring a novel ITGA3 homozygous splice mutation who presented with complete ILNEB syndrome but slow disease progression. Immune disorders were suspected.

Secondary polycythemia in chronic obstructive pulmonary disease: prevalence and risk factors

BackgroundSecondary polycythemia is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, the prevalence of polycythemia in COPD and the contributing risk factors for polycythemia in COPD have not been extensively studied.MethodsWe analyzed the presence of secondary polycythemia in current and former smokers with moderate to very severe COPD at the five-year follow-up visit in the observational COPDGene study. We used logistic regression to evaluate the association of polycythemia with age, sex, race, altitude, current smoking status, spirometry, diffusing capacity for carbon monoxide (DLCO), quantitative chest CT measurements (including emphysema, airway wall thickness, and pulmonary artery to aorta diameter ratio), resting hypoxemia, exercise-induced hypoxemia, and long-term oxygen therapy.ResultsIn a total of 1928 COPDGene participants with moderate to very severe COPD, secondary polycythemia was found in 97 (9.2%) male and 31 (3.5%) female participants. In a multivariable logistic model, severe resting hypoxemia (OR 3.50, 95% CI 1.41–8.66), impaired DLCO (OR 1.28 for each 10-percent decrease in DLCO % predicted, CI 1.09–1.49), male sex (OR 3.60, CI 2.20–5.90), non-Hispanic white race (OR 3.33, CI 1.71–6.50), current smoking (OR 2.55, CI 1.49–4.38), and enrollment in the Denver clinical center (OR 4.42, CI 2.38–8.21) were associated with higher risk for polycythemia. In addition, continuous (OR 0.13, CI 0.05–0.35) and nocturnal (OR 0.46, CI 0.21–0.97) supplemental oxygen were associated with lower risk for polycythemia. Results were similar after excluding participants with anemia and participants enrolled at the Denver clinical center.ConclusionsIn a large cohort of individuals with moderate to very severe COPD, male sex, current smoking, enrollment at the Denver clinical center, impaired DLCO, and severe hypoxemia were associated with increased risk for secondary polycythemia. Continuous or nocturnal supplemental oxygen use were associated with decreased risk for polycythemia.

Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at ≥35+0 weeks gestation

ObjectiveTo identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC).DesignProspective cohort study.SettingTwo perinatal centres in Melbourne, Australia.PatientsAt-risk...

Endobronchial blood patch with thrombin injection

Abstract Introduction: Persistent pulmonary air leaks present a challenging clinical problem, often requiring surgical intervention that not all patients can withstand. Patient concerns: An elderly female with severe emphysematous Chronic Obstructive Pulmonary Disease and dependent on continuous home oxygen supplementation developed recurrent pneumothoraces. On evaluation, the patient was considered a poor surgical candidate for Video assisted thoracoscopic surgery, and therefore a less invasive approach to treat the recurrent pneumothoraces was required. Diagnosis: A diagnosis of recurrent right pneumothorax due to Pulmonary-parenchymal fistula (either alveolo-pleural fistula or broncho-pleural fistula) was made Interventions: Due to the fragile overall condition of the patient, the peri-procedure risk of video assisted thoracoscopic surgery was not acceptable. Hence bronchoscopic evaluation with an endobronchial blood patch with thrombin injection was performed using a swan-ganz catheter. Outcomes: The patient had significant reduction in air leak post procedure and achieved complete resolution on day 3. She was successfully discharged home later. Conclusion: In patients with significant comorbidities that preclude standard interventions for persistent pulmonary-pleural fistulas, endobronchial blood patch repair with thrombin injection can be safely performed utilizing a swan-ganz catheter.

Respiratory depression in a neonate born to mother on maximum dose sertraline: a case report

BackgroundMood and anxiety disorders are common in women of childbearing age, especially during the peripartum period. As more women seek medical management for these conditions, there is an increasing need for studies to better examine the effects of exposure to selective serotonin reuptake inhibitors (SSRIs), and other antidepressants, on newborns at the time of delivery.Case presentationWe report the case of a term Caucasian infant born to a 17-year-old white female taking 100 mg of sertraline daily for depression and anxiety who exhibited respiratory depression and hypoxia after an uncomplicated vaginal delivery. The neonate was treated with the use of continuous positive airway pressure (CPAP) and supplemental oxygen and subsequently the symptoms resolved without complication.ConclusionsWe present this case with the suspicion of poor neonatal adjustment syndrome as the possible cause of the respiratory depression and hypoxia in this newborn.

Granulox-The Use of Topical Hemoglobin to Aid Wound Healing: A Literature Review and Case Series From Singapore.

Chronic wounds are an increasing burden on health care globally, and tissue hypoxia is a common issue in such wounds. Granulox (SastoMed GmbH, Georgsmarienhütte, Germany) is designed to provide wound bases with supplemental oxygen through facilitated diffusion and aid the physiological wound-healing process. It is a topical hemoglobin wound spray that is applied after wound cleaning and debridement to ensure continuous oxygen supplementation for up to 72 hours. Compared with other forms of topical oxygen therapy that require portable devices, Granulox is a spray-on application and the patient experience is similar to the use of a conventional dressing. Current clinical evidence suggests that Granulox aids with both wound healing and with symptom relief in chronic wounds, but current literature is limited by small study populations and further larger studies are required.

The effects of continuous vs intermittent oxygen supplementation on repeat sprint cycling performance

The use of handheld cannisters providing supplementary oxygen to use ‘track side’ is becoming popular. The aim of this study was to determine the optimal time to administer oxygen supplementation (O 2 Supp) during a repeat sprint protocol on cycling performance. Ten male recreationally active University students participated. Testing comprised four visits to the laboratory in a counterbalanced design. Each session entailed ten x 15s repeated sprints interspersed with 45s passive recovery, during which the air inspired was either 100% oxygen (H) or normal air, (N), thus the oxygen content inspired during the sprints and/or the recovery periods, determined the four conditions; NH, HN, HH, NN respectively. It was hypothesised that the HH condition would evoke the largest performance improvements. Repeated measures ANOVA were used to examine the difference between conditions in the outcome measures of mean power (W), rate of power decline (%) and blood lactate (mmol·L -1 ). There was no significant effect of O 2 Supp on mean power (W), blood lactate or performance decline (%) ( p > .05), although. the HH condition did result in the lowest levels of lactate accumulation and the shallowest decline in performance. The NH and HN conditions resulted a greater decline in performance than both HH and NN. Continuous O 2 Supp during repeat sprint cycling is more effective on cycling performance, than when it is administered in short repeated bouts. It appears that the rapid changing of oxygen availability may have a detrimental effect on performance. O 2 Supp can be applied to training programmes that have extended (>1min) periods of recovery.

1481 Synchronous Esophageal and Colon Adenocarcinoma: A Case Report

INTRODUCTION: Synchronous carcinomas in the same patient were first elucidated in the early 1930s. Following this initial recognition, awareness of synchronous carcinomas coupled with advancements in medical technology have made diagnosis of two primary carcinomas from separate sites in the same time interval possible. We present a case of newly diagnosed synchronous primary esophageal and ascending colon adenocarcinomas in a patient presenting with lower gastrointestinal bleed. CASE DESCRIPTION/METHODS: A 74-year-old female with a history of abdominal aortic aneurysm repair on dual-antiplatelet therapy, chronic obstructive pulmonary disease (COPD) on continuous supplemental oxygen at four liters per minute, and tobacco abuse presented with complaints of bright red blood per rectum. Hemoglobin on presentation was 12.5 g/dL, down-trending to 9.0 g/dL the following day. Esophagogastroduodenoscopy (EGD) revealed a nodule in esophageal mucosa, a submucosal lesion in the esophageal body, 30 centimeters from the incisors, and a small hiatal hernia with initial pathology showing high grade dysplasia in Barrett mucosa. There was no active bleeding site and hemoglobin was stable. Patient was discharged with plan for repeat EGD for evaluation of dysplastic Barrett mucosa and complete work up for anemia. Repeat EGD with endoscopic mucosal resection showed Barrett esophagus and a distal esophageal mass at 30 cm. Colonoscopy showed an ascending colon mass. Histopathology with ancillary immunohistochemistry revealed synchronous primary esophageal adenocarcinoma and a second primary ascending colonic adenocarcinoma. The patient was then staged as esophageal adenocarcinoma T2N0 by endoscopic ultrasound with recommendations for esophageal resection and T2N0 colon adenocarcinoma with recommendations for hemicolectomy. Given comorbidities, she was deemed not a candidate for esophagectomy, however successfully underwent elective right hemicolectomy. DISCUSSION: Common synchronous carcinomas within the gastrointestinal tract include colon and appendiceal malignancies, followed by small bowel, gastric, and esophageal carcinomas. Colonic neoplasias (up to 20%) are the most common synchronous cancers in patients with primary gastric cancer; the incidence of esophageal and synchronous colon cancers is unknown, however, highlighting this case's uniqueness. Upon discovering multiple primary malignancies, accurate staging along with immunohistochemical analysis is key to distinguish each primary cancer and determine appropriate therapy.

STUCK IN TRANSIT: LOOMING DISASTER IN A PATIENT WITH A PATENT FORAMEN OVALE-ADHERENT THROMBUS

SESSION TITLE: Pulmonary Vascular Disease SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/23/2019 8:45 AM - 9:45 AM INTRODUCTION: The diagnosis of an impending paradoxical embolism, defined as a thrombus adherent to a patent foramen ovale (PFO), is very rare with the first reported case in 1985 [1]. This phenomenon is increasingly diagnosed due to improved availability of echocardiography and advances in imaging technology, although fewer than 200 cases to date have been reported [2,3]. Impending paradoxical embolism carries a high 30-day mortality rate of 18.4-29% [3,4]. CASE PRESENTATION: Our patient is a 64-year-old male with tobacco use, former alcohol and methamphetamine abuse, who presents with 1-month of progressive exertional dyspnea, lower extremity swelling, and 1-week of left-sided pleuritic chest pain. He was tachycardic and tachypneic on admission, with a blood pressure of 111/78 and SpO2 of 89% on room air. Significant laboratory values include a BNP of 1937 (5-99), troponin 0.03 (<0.03), and an EKG showing sinus tachycardia and right axis deviation. Admission transthoracic echocardiogram (TTE) revealed a reduced left ventricular ejection fraction of 20-25% with global hypokinesis, a moderately dilated right ventricle with severely reduced systolic function, elevated estimated pulmonary artery systolic pressure (PASP) of 63-73 mmHg, and a mobile mass in the right atrium (RA). A CT chest angiogram showed extensive chronic/subacute-appearing thrombi involving the main pulmonary arteries with extension into the right and left lower lobe segmental branches, and a 4.6 cm heterogeneous RA mass. A transesophageal echocardiogram showed a 4.1 x 4.5 cm RA mass traversing a newly noted PFO. Lower extremity dopplers showed bilateral deep venous thromboses extending from the iliac to popliteal veins. Coronary angiogram was without significant obstructive coronary artery disease. His treatment included a continuous heparin infusion, oxygen supplementation, and progressive diuresis. The patient was transferred to a tertiary referral center for pulmonary thromboendarterectomy with PFO closure. The removed mass from the pulmonary arteries was consistent with chronic clot and the final pathology of the atrial mass was organizing thrombus. DISCUSSION: Despite the increasing frequency of detection of an impending paradoxical embolism, the diagnosis is still rare and there are no established treatment guidelines. There is a trend towards improved outcomes with surgical endarterectomy over thrombolysis or anticoagulation alone [5]. CONCLUSIONS: Our patient underwent successful endarterectomy without evidence of systemic embolization. At 1-year follow up, he has normal cardiac function and normal PASP by TTE, with no perfusion abnormalities on VQ scan. His hypercoagulable work-up was non-diagnostic, although anticoagulation for life is recommended. Reference #1: 1. U. Nellessen, W. Daniel, G. Matheis, et al.Impending paradoxical embolism from atrial thrombus: correct diagnosis by transeosophageal echocardiography and prevention by surgery. J Am Coll Cardiol, 5 (1985), pp. 1002-1004. Reference #2: 2. Podroužková H, Horváth V, Hlinomaz O, et al. Embolus entrapped in patent foramen ovale: impending paradoxical embolism. The Annals Of Thoracic Surgery. 2014;98(6):e151-e152. https://doi.org/10.1016/j.athoracsur.2014.08.072. Reference #3: 3. Myers P. O., Bounameaux H., Panos A., Lerch R., Kalangos A. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest. 2010;137(1):164–170. https://doi.org/10.1378/chest.09-0961. 4. Shepherd F, White-Stern A, Rahaman O, Kurian D, Simon K. Saddle Pulmonary Embolism with Thrombus in Transit across a Patent Foramen Ovale. Case Rep Cardiol. 2017;2017:6752709. 5. Fauveaua E., Cohen A., Bonnet N., Gacem K., Lardoux H. Surgical or medical treatment for thrombus straddling the patent foramen ovale: Impending paradoxical embolism? Report of four clinical cases and literature review. Archives of Cardiovascular Diseases. 2008;101(10):637–644. https://doi.org/10.1016/j.acvd.2008.08.011. DISCLOSURES: No relevant relationships by Jenifer Lentz, source=Web Response

HEMOPTYSIS IN EISENMENGER SYNDROME-ASSOCIATED PULMONARY ARTERIAL HYPERTENSION (PAH): FORGOT ABOUT BRONCHIAL ARTERY EMBOLIZATION

SESSION TITLE: Pulmonary Vascular Disease SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/23/2019 8:45 AM - 9:45 AM INTRODUCTION: Anticoagulation in Eisenmenger syndrome (ES) associated PAH (ES-PAH) presents a clinical challenge, as there is both an increased prevalence of pulmonary artery thrombosis and hemoptysis. We present a case of ES-PAH complicated by hemoptysis and treated successfully with multi-vessel bronchial artery embolization (BAE). CASE PRESENTATION: A 52-year-old female with an atrial septal defect complicated by ES-PAH treated with continuous epoprostenol infusion, ambrisentan, supplemental oxygen, and thrombophilia previously managed with warfarin; presented with a one-week history with multiple episodes of hemoptysis and chest tightness. She reported a similar episode of hemoptysis one-year previously with no specific source of bleeding identified. At the time of her hemoptysis had resolved with discontinuation of warfarin.On this presentation, her vital signs were unremarkable on 3 LPM nasal cannula. Physical examination demonstrated a right ventricular heave, a loud and prominent P2, and a third heart sound. Electrocardiography revealed normal sinus rhythm and bifascicular block (RBBB and LPFB). CT angiography (CTA) of the chest demonstrated dilated bronchial arteries and patchy ground glass opacities within the left upper and lower lobes, consistent with alveolar hemorrhage.Otorhinolaryngology and interventional pulmonology found no discrete bleeding in the upper or lower respiratory tract. After discussion, prophylactic embolization of the dilated right and left bronchial arteries was performed successfully. No further episodes of hemoptysis were reported post embolization. On outpatient follow-up the patient has remain hemoptysis free. DISCUSSION: Eisenmenger physiology results from chronic left-to-right shunting of blood, leading to increased right-sided pressures, and reversal of shunt flow. Patients with ES-PAH are at increased risk of pulmonary artery thrombosis with concurrent increased risk of hemoptysis and pulmonary hemorrhage(1). Thrombo-embolic risks include atrial fibrillation and indwelling central catheters. Hemoptysis is often due to bronchial artery dilatation and/or rupture. The use of anticoagulation in ES-PAH patients is controversial due to balancing risk between thrombosis and hemoptysis, and survival benefits are unclear(2). BAE in PAH patients is more complex than in patients without PAH, due to frequent higher numbers of culprit arteries and increased anatomical/morphological variability(3). However, BAE has been demonstrated to be a safe and reliable intervention for hemoptysis in PAH3. There is no definitive treatment and repeated BAE for reoccurrence is common. CONCLUSIONS: Anticoagulation in ES-PAH should be used conservatively in an individualized approach. Hemoptysis is an uncommon in ES-PAH and may result from bronchial artery dilatation and rupture. We demonstrated the safety of multi-vessel BAE in ES-PAH and encourage its consideration within this cohort. Reference #1: Wan D, Tsui C, Kiess M, et al. Anticoagulation for Thromboembolic Risk Reduction in Adults With Congenital Heart Disease. Canadian Journal of Cardiology 2017; 33: 1597–1603. Reference #2: Sandoval J, Santos LE, Córdova J, et al. Does Anticoagulation in Eisenmenger Syndrome Impact Long-term Survival?: Anticoagulation in Eisenmenger Syndrome. Congenital Heart Disease 2012; 7: 268–276. Reference #3: Rasciti E, Sverzellati N, Silva M, et al. Bronchial artery embolization for the treatment of haemoptysis in pulmonary hypertension. La radiologia medica 2017; 122: 257–264. DISCLOSURES: No relevant relationships by Olayiwola Amoran, source=Web Response no disclosure on file for Christine Archer-Chicko; Advisory Committee Member relationship with Actelion/Janssen Please note: $5001 - $20000 Added 02/07/2019 by Harold Palevsky, source=Web Response, value=Honoraria Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 02/07/2019 by Harold Palevsky, source=Web Response, value=Honoraria DSMB relationship with Eiger Please note: $1001 - $5000 Added 02/07/2019 by Harold Palevsky, source=Web Response, value=Honoraria No relevant relationships by cyrus vahdatpour, source=Web Response

Superaerophilic Wedge-Shaped Channels with Precovered Air Film for Efficient Subaqueous Bubbles/Jet Transportation and Continuous Oxygen Supplementation.

Pumpless and directed gas transportation in aqueous environments has promising application prospects in various domains. So far, researches on gas transportation based on superaerophilic channels are limited to the transportation of fewer bubbles with low transportation velocity. How to enhance the transportation velocity and realize the transportation of a large quantity of bubbles (especially for gas jet) for practical applications remain unclear. Here, a half-open wedge-shaped channel with subaqueous superaerophilicity is fabricated, which demonstrates excellent bubble affinity and can realize the pumpless and directed bubble transportation. It is proposed that a Laplace force is the main driving force during the transportation and the magnitude of the force is influenced by both the wedge angle of the channel and geometric parameters of the bubble whereas the direction of the force is determined by the orientation of the channel. By applying a precovered air film on the subaqueous superaerophilic wedge-shaped channel, bubbles demonstrate a higher transportation velocity. Additionally, the prepared channel shows an outstanding affinity to oxygen jet at high flux, which can be utilized to transport oxygen for continuous subaqueous oxygen supplementation.