Subsequent Tamponade Research Articles

Предварительные результаты хирургического лечения пациентов с регматогенной отслойкой сетчатки с разрывами в нижних отделах

Retinal regmatogenic detachment is a serious disease that causes complete irreversible blindness in the absence of operative treatment [1]. Despite the use of the latest technology, the risk of relapse of regmatogenic detachment with lower breaks in the conditions of tamponade of the real cavity with silicone oil is 10–25 % of cases, and after extrusion silicone oil — up to 34 % due to the preservation of the space between the retina surface and the lower meniscus of the silicone bubble, increasing the risk of progression of proliferative vitreoretinopathy [2, 3]. At present, in cases of pronounced proliferative vitreoretinopathy, where there is no intraoperative retinal attachment, a high risk of immediate retinal detachment, breaks in the lower quadrants, the tamponade of choice is the perfluorinated compound [4]. Purpose. To assess the effectiveness of short-term tamponade of the vitreal cavity by perfluorinated compound in patients with retinal regmatogenic detachment when localizing a tear in the lower retina. Material and methods. Analysis of treatment of 30 patients (30 eyes) with diagnosis of the primary regmatogenic retinal detachment with proliferative vitreoretinopathy C type 1–3 with macular zone capture has been performed, with the localization of rupture in the lower retina. All the patients were divided into two groups depending on the vitreal tamponade. I group (n = 14): vitreoretinal surgery was performed at the first stage with a 14 days twist tamponade of the perfluorinated compound cavity, and perfluorinated compound removal with subsequent tamponade of the gas-air mixture (C2F6) was performed at the second stage combined with facoemulsification and implantation of intraocular lens. II group (n = 16): the first step was vitreoretinal surgery with silicone oil tamponade 1300, the second step was silicone oil removal with a tamponade of the vitreal cavity with balanced saline solution. The observations were at least 6 months after perfluorinated compound or silicone oil removal. Results. According to our study, short-term perfluorinated compound tamponade was found to be more effective than silicone oil tamponade in patients with retinal detachment with lower lacerations, only 37.5 % of relapses were detected in group II. Conclusion: The effectiveness of the use of short-term tamponade of the vitreal cavity of perfluorinated compound in the treatment of patients with retinal detachment with lower retinal ruptures is confirmed by the results of the study. This method makes it possible to improve the anatomical and functional results of vitreoretinal surgery in this category of patients, reducing the risk of postoperative complications. Keywords: rhegmatogenous retinal detachment, tamponade of the vitreal cavity, perfluorinated compound

P87: Fracture Of A Dual Lumen Protekduo Cannula With Ventricular Perforation And Tamponade In A Recovery COVID-19 Patient

Background: In the absence of formal registry data anecdotal reports of cannula complications provide the only mechanism of risk assessment in the extended use of short term mechanical circulatory support devices. We report an unrecognized cannula fracture with perforation of the right ventricular apex and subsequent tamponade at the time of de-cannulation. Methods and Results: Patient is a 38 yo AAF with a history of asthma diagnosed with COVID 19 (nasal PCR) and admitted to an OSH with hypoxia (O2 sat 70%) and progressive dyspnea on exertion requiring HFNC and subsequent deployment of a right internal jugular 29 Fr Protek-DUO double lumen cannula with in-line oxygenator for venovenous ECMO respiratory support. After 36 days of VV ECMO support and mechanical ventilation, the patient was transferred with a diagnosis of COVID ARDS for transplant evaluation. Fourteen days post-transfer the patient was ambulatory and no longer required mechanical ventilation. No flow related issues were noted during the entire period of ECMO support (flow 2.8 to 3.4 L/min, delta P 20 mmHg or less, single oxygenator exchange on ECMO day 38). On ECMO day 67 the patients CxR was clear (Figure 1) and the RIJ cannula was removed without complication. Approximately two minutes after cannula removal the patient became unresponsive with tachycardia and hypotension (SBP 60 mmHg) which initially responded to volume resuscitation. With progressive loss of systolic blood pressure chest compressions were started with complete hemodynamic collapse. A transthoracic ECHO suggested tamponade and the chest was opened at the bedside demonstrating a chronic appearing hematoma with blood extravasation at the apex of the right ventricle (Figure 2). Bleeding was controlled with a single prolene stitch. Subsequent examination of the cannula demonstrated a fracture in the wire reinforced cannula at the point where the catheter transitioned from the apical RV into the RVOT (Figure 3). Conclusion: Given the progressive pulmonary hypertension frequently seen with prolonged COVID ECMO support, the RA to PA dual-lumen cannula has proven an effective MCS strategy (1) with survival advantage when compared to standard VV ECMO support (2). The Protek-DUO cannula was not designed for prolonged ambulatory MCS (> 60 days). Given the recent report of a seemingly identical cannula fracture event (3), clinicians should be aware of the potential for cannula fracture over time. Literature Cited (1) Mustafa AK, et al. (2020) ECMO for patients with COVID-19 in severe respiratory failure. JAMA Surg 155(10):990-992. (2) Saeed O, et al (2022) Outcomes by cannulation method for venovenous ECMO during COVID-19: a multicenter retrospective study. 46(8):1659-1668. doi: 10.1111/aor.14213. (3) Odish MF, et al (2022) Fracture right atrial-pulmonary artery cannula (Protek-DUO) in a 164-day extracorporeal membrane oxygenation bridge to lung transplant. doi: 10.1097/MAT.0000000000001879. Online ahead of print.

PS-R02-3: MASSIVE TUBERCULOUS PERICARDIAL EFFUSION WITHOUT CARDIAC TAMPONADE OR MEDIASTINAL LYMPHADENOPATHY IN AN 88 YEAR OLD MALE: A CASE REPORT

Tuberculosis, although endemic in Asia does not commonly affect the heart and would usually present as constrictive pericarditis. Pericardial involvement heralds an unfavorable prognosis and remains a challenge to clinicians. Cardiac tamponade is common in patients with massive pericardial effusions. In the Philippines, it is the second most common cause of cardiac tamponade as documented in the five-year CAPTIVE Heart Study. Mediastinal lymphadenopathy occurs in all cases and denotes lymphatic spread to the pericardium. We present a rare case of an elderly patient presenting with two month history of dyspnea without fever, weight loss, or chest pain. Echocardiography revealed thickened pericardium with fibrinous strands and massive pericardial effusion of 91 mm without tamponade physiology. CT scan revealed absence of mediastinal or hilar lymphadenopathy. Sputum gene xpert was positive. Anti-tuberculosis regimen was started. Patient also then underwent anterolateral thoracotomy, pleuropericardial window with biopsy. Histopathology revealed chronic inflammatory cells, peripherally located granulomas composed of epitheloid cells and Langhans giant cells confirming tuberculosis as the cause of the pericardial effusion. Large pericardial effusion of more than 20 mm is a predictor to the development of hemodynamic instability and subsequent tamponade. In comparison to 2D Echocardiography findings of the patient with a pericardial effusion measurement of 91 mm, still no tamponade physiology was noted even if the effusion existed for more than a month. Mortality is high even in the absence of cardiac tamponade. Mediastinal lymphadenopathy does not occur in all cases of tuberculous pericardial effusion but is still a possibility as seen in the case. The threshold of chronic massive pericardial effusion in developing into tamponade may be higher than previously noted as documented in the case.

Кондиционированная аутологичная плазма (ACP) в лечении больших макулярных разрывов

Background. Macular tear (MR) is a disease that leads to a significant decrease in visual acuity, central scotoma and metamorphopsia, which significantly affects patients' quality of life. For several decades a lot of techniques of MR treatment have been implemented, but modern vitreoretinal surgery is still searching for treatment methods allowing to achieve maximal anatomic and functional results, so the study of application of autologous conditioned plasma (ACP) in MR treatment today is of particular interest. Purpose. Retrospective comparative analysis of surgical treatment of idiopathic MR using ACP. Material and methods. The research was carried out on the basis of Microsurgical ophthalmic center of high-technology medical care of Voronezh Regional Clinical Ophthalmologic Hospital. A total of 82 eyes with idiopathic MR were operated on. Two groups of patients were studied. The first group of patients (41 eyes) underwent surgical treatment: microinvasive three-port 25G-vitreoectomy with membranopilling removal of posterior hyaloid membrane to the extreme periphery and internal border membrane in the central retinal region within the vascular arcades with subsequent tamponade of vitreal cavity with air, intravitreal to macular zone in layers dosed with autologous conditioned plasma until the appearance of visual film. To obtain autologous conditioned plasma, 15 ml of a patient's venous blood was collected immediately before surgery in a patented dual-circuit Arthrex ACP syringe (Germany), which was then centrifuged for 5 minutes at a speed of 1500 rpm. Surgical treatment was performed on the Constellation Vision System using a Topcon Offiss OMS-800 microscope. The second group (41 eyes) underwent microinvasive three-port 25G-vitreoectomy with membranopilling removal of posterior hyaloid membrane to the extreme periphery and inner border membrane in the central retinal region within the vascular arcades followed by vitreal cavity tamponade with air. The results of treatment were assessed on the 7th day. All patients underwent full ophthalmological examination according to the existing standards, which included: visometry, perimetry, biomicroscopy, biomicrophthalmoscopy, B-scanning, optical coherence tomography of the macular area for morphometric evaluation of macular rupture on Optovue RTVue 100. Results. The results of the treatment were assessed on the 7th day. MR closure according to OCT data was observed in 97 % of cases in the first group, in the second group anatomical integrity of the macular area was restored in 90 % of cases. The MRR before and after surgery in the group with ACP was 0.149 ± 0.029 to 0.229 ± 0.025. The MCOZ before and after surgery in the control group was 0.161 ± 0.031 to 0.175 ± 0.027. According to the results of ACP D.G. Arsyutov, in 57 % of cases there was a complete blocking of MR in the early postoperative period, in the distant postoperative period a completely blocked rupture was found in 43 %. Conclusions. The results obtained confirm the effectiveness of ACP for the treatment of large idiopathic macular ruptures. The use of plasma in the treatment of MR allows to achieve high anatomical and functional results in the postoperative period. Keywords: macular rupture, autologous conditioned plasma

High take-off of coronary arteries contributing to lethal myocardial ischemia: report of two cases

Abstract Introduction/Objective High take-off coronary arteries (HTO) are defined by coronary ostia arising above the sinotubular junction (STJ). Although asymptomatic in most individuals, there is increasing evidence that HTO is a risk factor for sudden cardiac death. Here we present two patients where HTO contributed to death. Methods/Case Report Patient A was a 52 year old morbidly obese male with atypical chest pain, new inferior ST elevations and troponinemia. Multiple coronary angiographies did not reveal any stenosis, but 3 stents were placed in the RCA due to concern for vasospasm. 3 days later the patient died. Autopsy revealed cardiac tamponade and non- atherosclerotic ischemic heart disease with remote apical LV scar and diffuse patchy interstitial fibrosis in the myocardium, which could be attributed to HTO of the RCA 0.5 cm above the STJ and early intramuscular courses of both coronaries. Multiple angiographies likely caused iatrogenic coronary injury and subsequent tamponade. Patient B was a healthy 33 year old female at 34 weeks gestation, who developed anaphylaxis during IV iron infusion for severe iron deficiency anemia. She was transferred to the OR for emergent C-section. Minutes after delivery she died. Autopsy revealed HTO, with coronary ostia being 0.4 cm and 0.7 cm above the STJ, respectively and acute angle take-off of LCA. No atherosclerosis was noted. The inability to increase myocardial perfusion through the coronary arteries during a high stress situation due to pregnancy, iron deficiency anemia and anaphylaxis likely contributed to lethal myocardial ischemia. Results (if a Case Study enter NA) NA Conclusion HTO and other coronary artery anomalies (CAAs) should be considered in cases of cryptogenic acute and chronic myocardial ischemia. Hemodynamic characterization of HTO, including those < 1 cm above the STJ in presence and absence of other CAAs may help better understand their pathophysiologic significance. Antemortem diagnosis requires high clinical suspicion and appropriate surgical intervention could be life-saving.

Results of treatment of patients with midfacial fractures

Background. Fractures of the bones of the facial skeleton, in particular the midface area, are one of the most frequent reasons for patients to apply to maxillofacial inpatient care, not only in Ukraine but also abroad. Along with more modern treatment technologies (osteosynthesis using titanium miniplates and minigrid for fixation bone fragments), methods of repositioning of fragments with subsequent tamponade of the maxillary sinus with iodoform tampon and without tamponade and fixation of fragments are used. A certain group of patients is treated conservatively, which is associated with their reluctance to undergo surgery, minimal displacement of fragments or minimal cosmetic and functional impairments. The purpose of the study. Comparative evaluation of the results of treatment of patients with fractures of the midface area by repositioning the fragments of the zygomatic-orbital complex without fixating the fragments and their subsequent fixation by tamponade of the maxillary sinus with iodoform tampon. Object and methods of research. The comparison was made of the results of treatment of 70 patients with fractures of the midface area, among which 13 patients were treated by the method of repositioning fragments of the zygomatic-orbital complex (ZOC) without fixation and without maxillary sinus tamponade, 29 patients underwent repositioning of ZOC fragments with subsequent fixation of fragments with iodoform tampon – the tamponade of the maxillary sinus was performed on the affected side. For comparison, the results of conservative treatment of 28 patients with fractures of the midface area were used. Results. It was found that the reliable (χ2=11.43; p<0.05) majority of patients (64%) sought treatment within 0-3 days after injury. 83-89% of patients who underwent repositioning of the fragments had fresh small-fragment fractures. The reliable (χ2=11.43; p<0.05) majority of them simultaneously had 3-4 sites of bone fractures of the midfacearea, hemosinus of varying degrees and paresthesia in the infraorbital area. In the majority of patients who underwent repositioning of bone fragments with and without tamponade (85% and 93%, respectively), the final displacements ranged from 3.1 to 6 mm. In patients treated conservatively, in most cases (93%) the displacements were greater than 3.1 mm, which remained after treatment. Conclusion. In the majority of patients treated with the studied methods, in the long term, the displacement of bone fragments remained, which had functional and cosmetic consequences. In all studied groups, a certain cosmetic effect was achieved over time, as evidenced by a reliable (χ2=160.9; p=0.00000) decrease in the indicator by the visual analogue scale .

Subacute Cardiac Tamponade in a Patient with Malignancy

We hereby present a 57-year-old woman with a history of asthma and hypertension who presented to the emergency department with shortness of breath, syncope and loss of consciousness. Patient complained of decreased appetite, constipation and 20lbs weight loss over one month. Patient denied fever, chills, chest pain, nausea, vomiting, headache, pain or swelling in lower extremity, trauma, hemoptysis. Vitals at presentation: temperature 99.8 F, pulse 124 bpm, BP 135/93 mm Hg, respiratory rate 18 pm, oxygen saturation 96% on room air. Non-contrast CT scan of the brain was unremarkable. Cervical spine CT did not show any acute bony fracture or subluxation or central canal stenosis. Chest xray showed right upper lung infiltrate and very small right pleural effusion. Chest CT showed: small pulmonary emboli involving right lower lobe and left upper lobe sub segmental pulmonary arteries, large pericardial effusion, right upper lobe ground glass pulmonary infiltrates, right upper lobe pulmonary mass with multiple bilateral pulmonary nodules concerning for metastatic process, small right-sided pleural effusion, bilateral hilar and mediastinal lymphadenopathy concerning for metastatic disease, multiple ill-defined hepatic lesions. EKG showed sinus tachycardia without electrical alternans. Echocardiogram showed: left ventricular ejection fraction 50- 55%, grade 1 diastolic dysfunction consistent with impaired relaxation and normal filling pressures. There is a large circumferential pericardial effusion and right ventricular diastolic collapse suggesting tamponade physiology evident on echocardiogram. Pericardiocentesis was done, about 700 cc of fluid was removed and the patient’s symptoms improved. This patient had pericardial effusion most likely due to malignancy. Pericardial fluid buildup and subsequent tamponade in a malignancy is usually subacute. In malignancy, fluid accumulates slowly, pericardium stretches with time allowing ample fluid to be accumulated vs in an acute tamponade as there is very rapid, large pericardial effusion, pericardium does not have time to stretch and may present with more alarming signs and symptoms. Sub-acute tamponade as is seen in malignancy presents with less alarming signs and symptoms and might be missed. Patients with subacute tamponade may be asymptomatic or complain of fatigability, chest discomfort, dyspnea caused by decreased cardiac output and increased filling pressures.

Electrocardiogram Findings Associated With Malignant Pericardial Effusion and Cardiac Tamponade.

Electrocardiogram Findings Associated With Malignant Pericardial Effusion and Cardiac Tamponade.

Surgical treatment of cervical spine tumors involving vertebral artery in children: analysis of small sample siz

To analyze the features of cervical spine tumors involving vertebral artery in pediatric patients. A single center 2-year retrospective cohort includes 7 children with cervical spine tumors involving vertebral artery. Demographic data, duration of diagnostic process, clinical and radiological manifestations, features of surgical treatment, morphology, and postoperative outcomes were studied. We analyzed the features of vascular imaging, pre- and intraoperative manipulations on the vertebral artery. Mean age of patients was 13.3 years, duration of diagnostic process - 13.1 months. Cervicalgia was the most common complaint. Malignant process was found in 2 cases. Preoperative temporary balloon occlusion test and subsequent endovascular embolization of vertebral artery were performed in 1 case, intraoperative ligation - in 1 patient. Injury and subsequent tamponade were noted in another patient. There were not neurological complications associated with arterial occlusion in postoperative period. Our group was compared with the data from 14 manuscripts comprising 21 children with similar cervical spine lesions. The decision making algorithm for surgical treatment of patients with cervical spine tumors involving vertebral artery is proposed.

Diagnostic and treatment of nose bleeding in children with chronic hepatitis B

State of the problem: Nasal bleeding is one of the most common causes of patients seeking emergency otorhinolaryngological care, as well as the most common type of bleeding in medical practice. Frequent causes of nosebleeds are changes in the vascular wall, hemorrhagic diathesis, atherosclerosis, as well as diseases of the blood, kidneys, liver. Purpose of research: To study the clinical course and effectiveness of some methods of treatment of nosebleeds in chronic hepatitis B in children. Materials and methods: We observed 78 children aged 3 to 17 years. The method of examination included a detailed study of complaints and anamnesis of patients, endoscopic examination of the nasal cavity, radiography of the nose and paranasal sinuses. Patients were divided into 2 groups. The first group consisted of 30 patients in whom treatment was carried out by the proposed method (after detachment of the mucous membranes into the nasal passages of the patient, a standard hemostatic sponge swab soaked in solcoseryl Gel was introduced), the second group included 20 patients who received traditional treatment (effect on the bleeding area with vaseline, which was previously applied to the gauze swab). Results: Chronic hepatitis b In children retains its characteristic clinical signs, including subatrophy and dryness of the mucous membranes of the nose, nasal bleeding, adhesions of the nasal cavity, the hepatosplenomegaly and the violation of some biochemical parameters. Nosebleeds on the background of chronic hepatitis B occur with frequent relapses, which contribute to the severe course of chronic hepatitis B and can lead to an unfavorable outcome. Conclusion: Good clinical effect of selective sparing surgical technique: endoscopic submucosal detachment of the nasal septum in the region of the zone of Kisselbach, with subsequent tamponade hemostatic sponge impregnated with ointment “Solcoseryl”.

Orbitozygomatic Craniotomy for Giant Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video.

Giant intracranial aneurysms pose a significant surgical challenge because of the associated difficulty in achieving adequate visualization of the parent artery and aneurysm neck. This patient had an incidentally identified giant anterior communicating artery aneurysm. An orbitozygomatic craniotomy was performed for aneurysm exposure and aneurysmal neck dissection. Aneurysm dome opening and thrombectomy was performed to debulk the aneurysmal mass, which facilitated subsequent aneurysmal neck visualization. Sequential utilization of temporary clips of the bilateral A1 and bilateral A2 vessels reduced hemorrhage during thrombectomy. Multiple permanent clips were applied along the dissected aneurysm neck to permit occlusion. A small fracture of the aneurysm neck was identified, and cotton was applied with subsequent tamponade utilizing a fenestrated clip to maintain hemostasis. Indocyanine green fluoroscopy was used to verify parent and distant vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

CARDIAC TAMPONADE CONCEALED UNDER LARGE PLEURAL EFFUSION

Pericardial effusions and subsequent tamponade are not infrequent complications of thoracic malignancies. Pericardial window is a more permanent solution for malignant effusions yet depending on the approach can be associated with recurrent effusions. A 32 year old man with untreated Hodgkin's

Left Ventricular Aneurysm in a Four-Year-Old Child

We describe spontaneous rupture of a congenital left ventricular (LV) aneurysm with subsequent tamponade and cardiac arrest in a 4-year-old male with staphylococcal septicemia. Emergency resuscitation, thoracotomy, and oversewing were successfully undertaken in the pediatric intensive care unit. There was complete cardiovascular recovery without adverse neurodevelopmental sequelae. This article details the difficulties in determining the etiology of ventricular aneurysms but highlights the importance of attempting to do so, particularly in distinguishing between congenital and acquired forms. Congenital aneurysms are usually a stable pathology; mycotic aneurysms are not and should be managed emergently, as survival after rupture is rare.

Supporting the early use of echocardiography in blunt chest trauma

This case reports a very unusual mechanism of cardiac rupture following an episode of multiple blunt chest trauma. The patient, a professional jockey, was trampled by horses, and although shocked on hospital admission, he did not present with signs and symptoms that were consistent with cardiogenic shock. This case highlights the difficult and subjective nature of clinical examination in emergency situations when dealing with cases of acute cardiac tamponade. It further emphasises the lack of sensitivity of traditional trauma imaging and investigative approaches such as the standard anteroposterior chest X-ray and electrocardiogram. The diagnosis of acute cardiac tamponade was not made until tertiary-care-centre arrival, when ultrasound technology in the form of bedside echocardiography was used, facilitating emergency surgery to repair a ruptured left ventricle. It is hoped that the sharing of this case will alert fellow clinicians to this uncommon but possible mechanism of cardiac rupture and subsequent tamponade, encourage the early use of echocardiography at the bedside in hypotensive blunt chest trauma cases and reinforce the principles of the Advanced Trauma Life Support course in treating trauma victims.

Idiopathic Thoracic Spinal Cord Herniation: Retrospective Analysis Supporting a Mechanism of Diskogenic Dural Injury and Subsequent Tamponade: Fig 1.

tSCH in the absence of spinal trauma or surgery is a rare disorder for which numerous mechanisms have been proposed. Here, we have conducted an analysis of images in all published reports of idiopathic tSCH and identified evidence supporting a pathogenesis in which anterior dural erosion at thoracic levels generates a CSF leak that pushes adjacent spinal tissue to tamponade the dural defect, causing progressive myelopathy. Additionally, we describe a case of tSCH in which postural headache was a significant symptom before myelopathy. This finding suggests that tSCH pathogenesis may be related to spontaneous intracranial hypotension. Published imaging from all available prior case reports in the scientific literature was reviewed to determine whether tSCH occurred at the disk or bone level. The presence of EDF, HNP, or an osteophyte in the spinal canal was determined from review of published images. Additionally, 3 previously unreported cases from the teaching files of our department were assessed by using these criteria. In greater than two-thirds (47 of 67) of identified cases with published images, tSCH occurred at a disk level. When assessment was possible, EDF, HNP, and osteophytes were present in 26.8%, 30.7%, and 26.2% of cases, respectively. Overall, 52.3% of cases with published images demonstrated evidence of these abnormalities. Our analysis of published imaging indicates that tSCH occurs preferentially at spinal levels and with imaging findings consistent with dural injury that support the proposed etiology of this disorder.

Spontaneous chylous cardiac tamponade: a case report

BackgroundChylous cardiac tamponade is a rare condition with little known cause.Case presentationA case of an otherwise healthy woman who admitted with dyspnea and palpitations is presented. She had a history of a painful flexion-hyperextension of the spine. Diagnostic evaluation proved a chylous pericardial effusion with a disruption of the anterior longitudinal spinal ligament. Video-assisted thoracic surgery with mass supradiaphragmatic ligation of the thoracic duct and pericardial window formation was carried out successfully and resulted in the complete cure of the patient's condition.ConclusionChylous pericardial effusion and subsequent tamponade is a rare entity. Endoscopic surgery is offering a safe and effective treatment.

Cardiac Tamponade As the Initial Manifestation of Metastatic Adenocarcinoma from the Colon: A Case Report

Metastatic cardiac malignancies mainly come from the lung, breast, and the lymphoreticular system by direct invasion or hematogenous or lymphatic spread. Metastasis from colorectal cancer to the heart or pericardium is seldom reported and only sporadic antemortem cases have been reported. We report an unusual case of malignant pericardial effusion caused by metastatic adenocarcinoma of colon. Malignant pericardial effusion and subsequent tamponade was the earliest manifestation without any other confirmed clinical metastases. Pericardiotomy was performed to relieve the life-threatening cardiac tamponade. We report this rare case and review the literature.

Giant Aneurysm of Left Anterior Descending Coronary Artery Treated by Surgical Off-Pump Therapy

Coronary artery aneurysms may predispose to acute thrombosis, embolisation and myocardial ischaemia or rupture with subsequent tamponade and/or sudden death. The optimal therapy for patients with coronary artery aneurysm is unknown, and controversy persists regarding the use of medical or surgical modalities. There is no doubt that surgical therapy is reserved for cases with large aneurysms or with myocardial ischaemia due to significant associated coronary artery stenoses. We discuss here the surgical management of a case with coronary artery aneurysm and concomitant coronary artery disease. Although the beating heart technique of myocardial revascularisation and repair of coronary artery aneurysm without cardiopulmonary bypass is not suitable for all patients, it should be considered for those high-risk patients who have impaired left ventricular function or who are at high risk for pulmonary or neurological complications.

RISK FACTORS FOR RETENTION OF SUBRETINAL PERFLUOROCARBON LIQUID IN VITREORETINAL SURGERY

To analyze factors that may lead to inadvertent subretinal retention of perfluorocarbon liquid (PFCL) after vitreoretinal surgery and compare surgical outcomes and complications associated with these events. Consecutive retrospective study. The authors retrospectively reviewed the charts of 72 vitreoretinal surgeries using intraoperative PFCL and its removal through fluid-air exchange and subsequent tamponade. Indications for surgery included trauma, retinal detachment, giant retinal tear, and submacular hemorrhage. Most interventions studied had significant amounts of proliferative vitreoretinopathy and were required after failed or complicated previous vitreoretinal surgery. Analysis was focused on the occurrence of subretinal retention of PFCL during different surgical procedures and techniques, indications, anatomic and visual results, and complications. At the last follow-up, the retina was completely attached in 97% of eyes treated with PFCL after 1 or 2 vitrectomies. Subretinal PFCL was found in 8 (11.1%) eyes. There was no statistical difference in the retention rate for perfluorodecalin and perfluoro-n-octane. The factor most significantly associated with subretinal retention of PFCL was the presence and large size of a peripheral retinotomy. All cases of subretinal PFCL had a retinotomy of 120 degrees or larger. The average retinotomy size in these cases was 259 degrees . Subretinal PFCL was found in 40% of eyes with a 360 degrees retinotomy. Small and medium-sized retinal breaks were not associated with PFCL retention. Another surgical procedure that correlated significantly with subretinal PFCL was lack of saline rinse during fluid-air exchange. Only 1 of the 23 eyes that were rinsed had subretinal PFCL, although many had large retinotomies. Subretinal PFCL retention is most likely to occur in eyes with large peripheral retinotomies, especially if 360 degrees . Saline rinse seems to be useful in the prevention of subretinal PFCL. The presence of subretinal PFCL does not seem to affect visual and anatomic success when located outside the macula, at least during an intermediate period of follow-up.

Low cardiac output complicating pericardiectomy for pericardial tamponade

Neoplastic involvement of the pericardium resulting in an effusion and subsequent tamponade is an emergency requiring prompt decompression, generally safely accomplished by subxiphoid pericardiectomy. However, the current case report describes a patient with florid pericardial tamponade who underwent surgical decompression with transient hemodynamic improvement, who then rapidly developed progressive, heart failure and death. This paradoxical response to pericardial decompression, similar to that seen occasionally with pericardiectomy in constrictive pericarditis, may be more frequent than currently appreciated. Its cause may relate to the sudden removal of the chronic external ventricular support from the effusion resulting in ventricular dilatation and failure.