Smaller Sheath Research Articles

Tract embolization with gelatin sponge after percutaneous transhepatic portal vein intervention.

Bleeding from the puncture tract after percutaneous transhepatic portal vein intervention can become life-threatening. To date, studies about tract embolization with gelatin sponge after percutaneous transhepatic portal vein intervention are only with small numbers of patients, or non-consecutive or pediatric patients with a relatively small sheath in diameter. To evaluate the safety and efficacy of tract embolization with gelatin sponge strips after percutaneous transhepatic poral vein access. Between September 2017 and February 2024, 100 consecutive patients (61 men, 39 women; mean age = 53 ± 15 years) underwent a total of 105 portal vein interventions using a percutaneous transhepatic approach. Tract embolization for the removal of 6-8 Fr sheath was performed using gelatin sponge strips in all procedures, including 71 portal vein embolization before major hepatectomy, 27 portal balloon venoplasty or stent placement after liver transplantation, and seven other interventions. No bleeding occurred after tract embolization with gelatin sponge strips. Minor portal vein thrombosis was detected in three procedures after liver transplantation and in one procedure for portal vein stenosis caused by essential thrombocytopenia. Thrombosis occurred in the punctured portal vein branch in all procedures. Thrombosis was not clinically relevant in any patient, and it was difficult to differentiate whether thrombosis was caused by sheath placement or the inserted gelatin sponge. Tract embolization with gelatin sponge strips after percutaneous transhepatic portal vein intervention is a safe and feasible method for preventing hemorrhage from the puncture tract.

Intraoperative cell salvage technique in patients undergoing complex endovascular aortic repair

Complex endovascular aortic repair (EVAR) requires the use of multiple small sheath cannulation inside a large sheath. Because the large sheath is not designed for multiple small sheath cannulation, large amounts of blood loss can be encountered in complex EVARs. Cell Saver can be used effectively in complex EVARs using a modified draping technique, allowing for increased cell salvage and autogenous transfusions as needed.

Feasibility of standby ECMO with preset femoral vascular sheaths for high-risk transcatheter aortic valve replacement

Objective Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide temporary circulatory and respiratory support allowing hemodynamic stabilization during high-risk transcatheter aortic valve replacement (TAVR). However, the optimal timing of VA-ECMO use in high-risk TAVR remains controversial. We aimed to report our experience using a novel standby ECMO strategy during high-risk TAVR. Methods We retrospectively evaluated consecutive patients who received high-risk TAVR with standby ECMO between March 1,2023 and March 1,2024 at the Beijing Anzhen Hospital. Small, 5F or 6F sheaths were placed in ipsilateral femoral vein and artery before TAVR procedures. The primary outcome of this study was survival to hospital discharge with good neurological recovery defined as cerebral performance category (CPC) 1-2. Results A total of 24 patients undergoing high-risk TAVR with standby ECMO were included. Six (25.0%) of the 24 patients with standby ECMO suffered from cardiogenic shock or cardiac arrest and required emergency VA-ECMO institution. The median (IQR) cannulation time was 8 (6–11) minutes, and the median (IQR) ECMO duration was 35 (24–48) hours. All of the 24 patients underwent successful TAVR procedures and survival to hospital discharge with CPC1-2. Conclusions Standby ECMO with preset femoral vascular sheaths was feasible and effective for refractory cardiogenic shock and cardiac arrest during high-risk TAVR.

An In-Vitro Comparison of Steady State Leakage Rates through Introducer Sheaths Used for Fenestrated Endovascular Aortic Aneurysm Repair

Objectives– fEVAR involves deploying a covered stent into the aorta followed by multiple visceral stents through fenestrations in the main body of graft. The most commonly used large sheaths for cannulation of visceral vessels are the Gore DrySeal Flex, Cook Performer Check-Flo and Medtronic Sentrant. None of these sheaths were designed for the insertion of multiple sheaths, and so a slow but steady leakage of blood occurs during the procedure. The aim of this paper is to assess in an in vitro setting which large bore sheath has the best valve for use when multiple smaller sheaths are inserted through it. MethodsThree large bore introducer sheaths (LBIS) were used for this study, The Gore DrySeal Flex LBIS, Medtronic Sentrant LBIS and Cook Performer Check-Flo LBIS. A test rig was constructed, made of an 18-litre fluid reservoir mounted vertically and receiving a constant supply of water from a domestic water supply which flowed into the reservoir and out of an overflow. The reservoir was connected to the LBIS by a vertical plastic pipe with an internal diameter of 40mm and an isolation valve. The LBIS was connected to the isolation valve by inserting the LBIS up a flexible silicone tube connected to the isolation valve. The LBIS was subject to a constant column/pressure of water and fluid leakage from the LBIS was collected in a plastic pot/tray placed underneath the LBIS. The leakage rates through each LBIS were determined for the following smaller diameter sheath combinations inserted through the valve, one 6 French Sheath, two 6 French Sheaths, two 6 French Sheaths and one 7 French Sheath. This was done to closely mimic a fEVAR procedure in vitro. The procedure was to insert different sheath combinations through the non-return valves in the LBIS and measure the volume of fluid that leaked through the valves. The leaked fluid was weighed, and the weight was converted to volume using the density of water (1g/ml). ResultsThe average (mean) leakage rates for each LBIS and each sheath combination showed that leakage rates when only one sheath was inserted were very low. For all three LBIS’s tested, the leakage rates increased dramatically when multiple sheaths were inserted. The Medtronic LBIS leaked the most, followed by Cook, followed by Gore. For the Cook LBIS, the leakage rates exhibited with 2 x 6 French sheaths were approx. 106 times greater than those for the Gore LBIS and five times greater for the 2 x 6 French + 1 x 7 French sheath combination. A similar comparison for the Medtronic LBIS vs the Gore LBIS yields factors of 132 and 8. ConclusionsLeakage rates increase significantly when multiple sheaths are inserted and the Gore LBIS demonstrates significantly lower leakage than both the Cook and Medtronic during procedures that require simultaneous, multiple insertions of smaller sheaths. Although the Gore Dryseal has by far the lowest leakage rate when three small diameter sheaths are inserted (just under 1ml/s), depending on the duration of the procedure this could still result in significant blood loss.

Ureteral Stricture Outcomes Using Small Ureteral Access Sheath During Retrograde Intrarenal Surgery

Ureteral Stricture Outcomes Using Small Ureteral Access Sheath During Retrograde Intrarenal Surgery

Acute Carpal Tunnel Syndrome from Horseshoe Abscess

Case: A 53-year-old man presented with a puncture wound to his right thumb, resulting in a horseshoe abscess, its infectious clinical picture muddled by dense paresthesias from the ensuing acute carpal tunnel syndrome. He was treated with irrigation and debridement of the thumb and small finger flexor tendon sheaths, carpal tunnel release, and bootlacing and dermal substitute application to the proximal forearm with eventual split-thickness skin grafting. Conclusion: Although a horseshoe abscess resulting in acute carpal tunnel syndrome is a rare entity unquantified in the literature, the treating orthopaedic surgeon should be aware of its association and initiate appropriate treatment accordingly.

The "Woggle" Technique for Venous Access Site Management: An Old Technique for a New Need.

Several closure devices are routinely used for percutaneous arterial access, while a relatively low number is available for the management of large bore venous accesses. The Woggle technique is a modification of the purse-string suture which was introduced several years ago in patients undergoing hemodialysis. A population of 45 patients who underwent transvenous femoral structural heart interventions was retrospectively evaluated. The Woggle technique consists of a purge string suture with a collar to maintain the tension as stable over time and a suture lock to tighten the suture. Sheaths magnitude ranged from 8 French (F) to 14 F. A rapid post-procedural hemostasis was achieved in the whole population, and in 95% of cases, definite hemostasis was obtained after the first single release; the mean time of release was 302 ± 83 min. Although no relevant bleedings were reported, a significant reduction in hemoglobin levels was found in the whole population. This decrement was statistically significant only in the group with sheaths higher than 12 F. A single mild local hematoma was recorded in the group in which smaller sheaths were used. Seventy-two percent of patients were pre-treated with a dual antiplatelet therapy. The Woggle technique has shown to be a simple, effective, and safe approach for the management of large bore venous in percutaneous structural heart interventions.

Successful coronary artery fistula closure using Amplatzer duct occluder II device in a 10-months-old infant

Link of Video Abstract: https://youtu.be/ZYpxn1S7yjwBackground: Coronary artery fistula is a rare entity of cardiovascular anomaly. The etiology is often congenital due to malformation of coronary artery vessels. They are mostly asymptomatic, while some cases may be present with complications such as congestive heart failure, myocardial infarction, or pulmonary hypertension. This case study aims to evaluate the Successful coronary artery fistula closure using Amplatzer duct occluder II device in a 10-months-old infant. Case Presentation: The 10-month-old female infant was present with a coronary artery fistula diagnosed at three months old. The echocardiography revealed a right coronary artery fistula to the right atrium with an ampulla size of 7.29 mm, waist of 3.11 mm, and length of 4.71 mm. The patient underwent cardiac catheterization and coronary artery fistula closure with a transvenous technique approach using Amplatzer duct occluder II. The procedure was successful, and the echocardiography examination found no residual flow from the fistula. This is the first reported case of successful coronary artery fistula closure using the Amplatzer duct occluder II device. Conclusion: Fistula closure using the Amplatzer Duct Occluder II device, in this case, is preferred because it is safe and efficient to use in small infants due to its small sheath delivery catheter caliber.

Radial access for peripheral vascular intervention: the S.M.A.R.T. RADIANZ Vascular Stent System

ABSTRACT Introduction Radial access is the standard of care for nearly all cardiac catheterization procedures. It improves patient satisfaction, reduces the length of stay, and is associated with fewer complications. However, few devices and tools are available for the treatment of peripheral arterial disease via a transradial approach (TRA). The S.M.A.R.T. RADIANZ Vascular Stent System is among the RADIANZ suite of products, which is aimed at expanding the portfolio of devices to treat peripheral arterial disease. Areas Covered In this Expert review, the following areas will be covered: (1) Current Landscape of peripheral vascular intervention (PVI) using TRA (2) Detailed description of the S.M.A.R.T. RADIANZ Vascular Stent System. (3) Ongoing clinical trials to evaluate safety of this approach. (4) Future directions and current regulatory status. Expert Opinion TRA for PVI is a promising approach. It holds the possibility of substantially improving the care of patients with peripheral arterial disease (PAD). Numerous challenges must be overcome to realize the full potential of a radial-to-peripheral (RTP) approach. The length of devices and the small sheath size are the main constraints of this approach. The results of the ongoing RADIANCY trial will demonstrate the safety, in selected patients, of the RADIANZ suite of products.

Fimbribambusa jokowii Widjaja (Poaceae: Bambusoideae), a new scrambling bamboo from Flores, Indonesia

A new bamboo species, quite widely distributed along the border between Sikka and East Flores Districts on Flores, Indonesia, is described and illustrated. It is named in honour of Ir Joko Widodo, the President of Indonesia. The main distinction between this and other Fimbribambusa Widjaja species is the culm sheath auricle, which is long, glabrous and black, the linear sheath blade on the culms, the yellowish base to the leaves, the small leaf sheath auricle and long bristle, and the entire ligule.

SHOCK5: Utilization of an RP Flex Impella to support Right Ventricular Dysfunction post Left Ventricular Assist Device Placement

Background: Right ventricular dysfunction (RVD) during Left Ventricular Assist Device (LVAD) placement is associated with increased morbidity and mortality. Right Ventricular Assist Device (RVAD) implantation has been shown to reduce the severity of RVD and can improve overall outcomes. We describe the first use of the RP Flex Impella (Abiomed, Danvers MA) RVAD to support RVD during durable LVAD HeartMate 3 implantation(Abbott, Chicago, IL). Case: A 68 year old female with a history of postpartum cardiomyopathy on home inotropic support for 4 years presented with acute exacerbation of heart failure in the setting of sustained ventricular tachycardia. She was evaluated for LVAD however preoperatively there were concerns for risk of RVD due to pulmonary artery pressure index (PAPI) 1.5 and echocardiogram with moderate right ventricular (RV) dilation and significantly reduced function which had progressed as compared to prior assessments. It was decided during the pre implant meeting to support the RV given borderline parameters despite high dose inotropic support. The RP flex impella was placed via the right internal jugular vein and provided 2.8L support. A sodium bicarbonate purge was utilized instead of heparin due to bleeding concerns. By postoperative day (POD) 1 epinephrine and inhaled nitric oxide were successfully titrated down to facilitate early extubation and systemic heparin was started with a goal PTT 50-60 along with aspirin 81mg. Central venous pressure (CVP) remained 8-12mmHg with PAPI 1.2-1.9 over the next few days. RV function on echo remained mildly reduced and LVAD parameters and hemodynamics were stable. Based on the ability to wean inotropes with stable hemodynamics, formal wean occurred on POD4 with reduction to 1.5L flow. Hemodynamics remained unchanged with CVP 10, PA 30/15, PAPI 1.5. Low dose milrinone remained for RV support and the Impella was removed POD 5 at bedside without complication. Post removal RV dilation and drop in PIs resulted in iNO therapy, which was quickly transitioned to sildenafil. Inotropes were fully weaned off POD 12 and the patient was discharged to acute rehab on POD 16 off inotropes and on sildenafil. Throughout this course, renal function remained within the patient’s normal range and the patient was ambulatory from POD 6. Conclusion: This experience describes the first use of RP flex impella to support RVD during durable LVAD placement. The RP flex impella offers a small, percutaneous option for RV support with ease of use and easy bedside removal due to small sheath size. Early use of the RP flex, preventing further sequelae of RVD allowed for adequate support, bypassing the need for surgical RVAD and thus a shorter recovery than traditionally required. Additionally this case adds to the growing literature of RVAD utilization to improve outcomes in patients with marginal RV function for a successful durable LVAD.

A novel approach to place an adult-size stent to treat coarctation of the aorta using small introducers: "Nijres technique".

Aortic arch stent placement in young children is a medical dilemma. This is attributed to the critical lack of commercially available stents that can be delivered through small sheaths and yet have the potential to be dilated to the adult-size aorta. Here in, we describe an innovative first-in-human technique that allows for overcoming the aforementioned challenges. A Palmaz Genesis XD stent was placed to treat coarctation of the aorta in two young children through small-bore sheaths.

Description of two new species of apple snail (Ampullariidae: Pomacea) from Peruvian Amazonia

Two new species of apple snails are described, Pomacea penai sp. nov. and Pomacea reevei sp. nov. that are used as food resources in Peruvian Amazonia. We used anatomical and conchological features to diagnose these two species. Pomacea penai sp. nov. is characterized by a highly variable shell morphology, spire that is prominent to immersed, apical penis sheath gland covering 1/3 penis sheath and elongated basal gland, prostate broad proximally, reduced stomach septum, green eggs, and commonly inhabits temporary flooded areas, creeks, and oxbow lakes. Pomacea reevei sp. nov. possesses a large shell, ranging from 81-137 mm, grey broad penis sheath, small apical penis sheath gland and the basal gland covering 1/3 penis sheath, tall stomach septum, white eggs, and found in deep lentic water bodies.

The effect of irrigation rate on intrarenal pressure in an ex vivo porcine kidney model-preliminary study with different flexible ureteroscopes and ureteral access sheaths.

Ureteral access sheath (UAS) and irrigation are used in flexible ureteroscopy (fURS). Both conventional UAS (cUAS) and vacuum-assisted UAS (vaUAS) are currently available. Irrigation increases the intrarenal pressure (IRP). Our objectives were to study the effects of various irrigation rates on IRP using different sizes of fURS in different sizes and functions of UAS. Ten freshly harvested porcine kidneys served as the study subjects. 11/13F and 12/14F cUAS and vaUAS with 2.8mm and 3.2mm fURS were experimented on in various scope/sheath combinations. 6F pressure monitor catheters were placed into upper, middle, and lower calyces. IRPs were recorded under different irrigation rates in cUAS and vaUAS, with either 150 or 300mmHg aspiration pressures, and with air vent either open or closed. 12/14F cUAS with 2.8mm fURS could maintain IRPs below 35mmHg with irrigation rates up to 200cc/min. With 3.2mm fURS, the rate dropped to 110-120cc/min. With 12/14F vaUAS and vent closed, the IRP remained less than 5mmHg at 200cc/min irrigation for both fURS. For 11/13F cUAS, the < 35mmHg threshold for 2.8mm fURS was 80-90cc/min; for 3.2mm fURS, it was 30-40cc/min. For 11/13F vaUAS with vent closed, IRPs remained < 5mmHg at 200cc/min irrigation for both scopes. Both 12F cUAS and vaUAS can be used safely with 2.8mm fURS up to 200cc/min irrigation. With either a smaller sheath or a larger scope, vaUAS with vent closed can maintain IRP in a safe range up 200cc/min irrigation. vaUAS with vent open performed marginally better than cUAS.

Predictive factors affecting morcellation efficiency in holmium laser enucleation of the prostate.

To determine the factors affecting morcellation efficiency in holmium laser enucleation of the prostate (HoLEP) surgery. Patients who underwent HoLEP surgery by a single surgeon between 2018 and 2022 were included in the study. Our primary outcome of interest in this study was morcellation efficiency. The effect of preoperative and perioperative variables on morcellation efficiency was evaluated with linear regression analysis. A total of 410 patients were included in the study. The mean morcellation efficiency was 6.95±1.70 g/min. Univariable and multivariable linear regression analysis was performed to identify factors affecting morcellation efficiency. Presence of the "beach ball" effect (small, round prostatic tissue fragments that are fibrotic and difficult to morcellate), the learning curve, resectoscope sheath type, prostate-specific antigen (PSA) density, morcellated tissue weight, and the presence of prostate calcification were found to be independent predictive factors (β=-1.107, 95% CI: -1.59 to -0.55, p<0.001; β=-0.514, 95% CI: -0.85 to -0.17, p=0.003; β=-0.394, 95% CI: -0.65 to -0.13, p=0.003; β=-0.302, 95% CI: -0.59 to -0.09, p=0.043; β=0.062, 95% CI: 0.05 to 0.06, p<0.001; β=-0.329, 95% CI: -0.55 to -0.10, p=0.004; respectively). This study reports that presence of the beach ball effect, the learning curve, small resectoscope sheath, PSA density, and presence of prostate calcification negatively affect morcellation efficiency. On the contrary, morcellated tissue weight has a linear relationship with morcellation efficiency.

Safety of short 3-hour recovery and same-day discharge following lower-limb angioplasty in outpatients with intermittent claudication and critical limb ischaemia

To investigate the safety and efficacy of short recovery day-case pathway following lower-limb angioplasty in both intermittent claudication and critical limb ischaemia patients. A retrospective analysis was undertaken of the medical records of consecutive outpatients treated with lower-limb angioplasty over a 1-year period within an interventional radiology (IR) day-case unit in a high-volume vascular centre. Standard post-angioplasty care at York Teaching Hospital is discharge 3 h after puncture site haemostasis without the routine use of closure devices. The rates of successful same-day discharge, procedure success, complications, and re-admissions were calculated with 30-day follow-up. The cohort included 301 patients (57% intermittent claudication and 43% critical limb ischaemia) undergoing 605 angioplasties using access sheath size ranging from 4 to 7 F. Closure devices were used in only 7% of patients. Successful same-day discharge achieved in 98% of patients (294/301), with seven admitted overnight because of complications. Eleven patients (3.6%) were re-admitted within 30 days. Technical success rates were 92%, and 96% when including partially successful interventions, with 4% technical failure. Twelve patients (4%) developed minor complications and four major complications (1%). There were no significant differences in complication rates between small and larger sheath sizes (p>0.05). No procedure-related death was recorded within 30 days. Lower-limb angioplasty can be performed safely as day-case procedure with a short recovery protocol within IR departments for both patients with intermittent claudication (IC) and critical limb ischaemia (CLI). This may significantly increase patient throughput and alleviate pressure on stretched hospital inpatient resources by safely discharging patients on the day of procedure.

In vitro performance of Lifetech IBS Angel™ (iron-based bioresorbable scaffold) stents during overdilation for use in pediatric patients.

The objective of this study was to assess the mechanical performance of the Lifetech IBS Angel stents during overdilation as is often required in pediatric applications; including time of first fracture, foreshortening, and the type of fracturing that occurs. In vitro testing was performed and repeated for each stent three times under physiologic conditions with continuous audiovisual imaging allowing for post-testing evaluations. Assessment of sheath fit was also completed. A total of 47 stents on monorail system were overdilated to complete fracture after passing through either a 4 or 5 French sheath. First strut fracture occurred in 4 and 6 mm stents when they reached greater than 50% overexpansion. Larger stents could achieve at least 30% increased diameter prior to first strut fracture. No fragmentation of any of the stents was seen throughout testing. The IBS Angel has thin struts allowing for a lower profile with increased maneuverability and use with smaller sheaths. Embolization potential of strut fragments was not seen. Increased diameter well beyond design parameters was seen in all with acceptable foreshortening.

Benchtop Evaluation of Miniature Percutaneous Nephrolithotomy Lithotrites

Introduction: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for kidney stones >2 cm. While PCNL has traditionally been performed using 24F to 30F access sheaths, there is a trend toward smaller sheaths and scopes to perform mini-PCNL (mPCNL). We performed benchtop assessment of multiple mPCNL lithotrites. Methods: One 1 cm3, hard Begostone phantom was placed in a cylinder with four 5.5 mm cylindrical openings to simulate the size of a 16.5F mPCNL sheath. Lithotripsy was performed with the 1.5 and 1.9 mm Trilogy, 1.83 mm ShockPulse, or a 200 μm Holmium:YAG (Ho:YAG) laser. Suction was used for the mechanical lithotrites. The Trilogy probes were set at 50% impact, 6 Hz, 80% ultrasound and 10% suction. The ShockPulse was used at high-power setting with low suction. The 1.9 mm Trilogy probe was used with a 15F mini-nephroscope. The 1.83 mm ShockPulse, 1.5 mm Trilogy and laser fiber were used with a 12F mini-nephroscope. The 120 W holmium laser was set at 0.5 J/70 Hz Moses-Distance. Ten independent runs were performed with modality. Time to complete stone clearance was recorded and mass stone clearance rates were calculated. Results: The Trilogy 1.9 mm showed superior stone clearance rate (11.69 ± 3.68 mg/s) vs the ShockPulse (SP) 1.83 mm (6.29 ± 1.37 mg/s, p = 0.003), the laser fiber (4.73 ± 0.61 mg/s, p < 0.0005), and the Trilogy 1.5 mm (6.84 ± 1.21 mg/s). The 200 μm laser fiber was inferior to all mechanical lithotrites. There was no difference between the 1.5 mm Trilogy and the 1.83 mm ShockPulse (p = 0.772). This translates to 3.9, 4.8, and 8.1 minutes less treatment time vs the 1.5 mm Trilogy, SP, and laser, respectively, for a spherical 1.5 cm diameter calcium oxalate monohydrate stone. Conclusion: Among these four commonly used mPCNL lithotripters, the Trilogy 1.9 mm demonstrated superior stone clearance rates in this benchtop model vs the Ho:YAG laser, 1.83 mm SP, and Trilogy 1.5 mm. Future clinical testing is warranted to evaluate the optimal lithotrite for mPCNL.

Experiences of Two Centers in Percutaneous Ventricular Septal Defect Closure Using Konar Multifunctional Occluder.

BackgroundTranscatheter closure of perimembraneous ventricular septal defect still poses a challenge due to the adjacent structures of the tricuspid and aortic valves and the risk of atrioventricular block. We report our experience at 2 centers using the KONAR-MF (multifunctional occluder) ventricular septal defect device, which gained its CE mark in May 2018.Methods A retrospective study was carried out on all patients who underwent transcatheter ventricular septal defect closure with the KONAR-MF (multifunctional occluder) ventricular septal defect device at 2 centers.Results A total of 47 patients were identified. The median age and weight of the patients were 25.8 months and 11 kg. The ventricular septal defects that were closed in 5 cases were post-operative hemodynamically significant residual ventricular septal defects. Forty-eight devices were used in the 47 cases. As for the location of the ventricular septal defect, 40/48 (83.33%) ventricular septal defects were perimembranous and 8/48 (16.66%) were muscular. The percutaneous device closure was successful in 46 procedures (95.8%). Device embolization was observed in 2 patients, and a significant residual shunt was observed in 2 cases. In the follow-up, there was no enhancement in the residual shunt in the remaining cases. Temporary atrioventricular block occurred in 2 cases during the procedure and improved after long sheath withdrawal.Conclusion Soft, flexible, and low-profile KONAR-MF (multifunctional occluder) occluders ensure easy and safe implantation, and small sheath sizes allow for their use in small infants. Although near and mid-term follow-ups did not indicate any permanent atrioventricular block, a larger sample of patients and a longer follow-up period is necessary to understand long-term outcomes.

Pseudoplectania africana (Sarcosomataceae, Pezizales), a new species from South Africa

Background: An undescribed species of Pseudoplectania was found during an excursion in Mpumalanga.Objectives: To describe Pseudoplectania africana M.Carbone &amp; Sochorová as a new species and to evaluate presence of crystals as a diagnostic character in Pseudoplectania.Methods: The description was based on standard macro- and microscopical methods. Presence of crystals was tested for in UV light. Phylogeny was inferred using sequencing of the LSU and ITS loci.Results: Pseudoplectania africana is characterised by shortly stipitate to sessile apothecia up to 18 mm broad, richly developed basal tomentum, ascospores with an eccentrically positioned, relatively small sheath, straight, sometimes bifurcate paraphyses, wavy to coiled external hairs and presence of large yellow crystals mainly in the hymenium and ectal excipulum. It was found on a decaying coniferous trunk. The species forms a distinct lineage in the clade with P. tasmanica and P. ericae. All of these three species exhibited presence of the large yellow crystals (sulphur yellow in UV light). No or only small hyaline crystals (whole mount blue in UV light) were found in P. nigrella, P. lignicola, P. episphagnum and P. melaena.Conclusion: The new species represents the first report of Pseudoplectania in South Africa and probably also in the whole of continental Africa. Crystals in hymenium and excipulum appear to be an important trait in Pseudoplectania taxonomy.