Cannula Tip Research Articles

Avoidance of Coronary Sinus Injury During Retrograde Cardioplegia

Coronary sinus injury is a rare but critical complication of retrograde cardioplegia. Even after detection, successful repair with a pericardial patch is not always attained. Malalignment of the infusion cannula relative to the coronary sinus is likely to be partially responsible for the injury. Monitoring the location of the cannula tip can help prevent injury. Transesophageal echocardiography can indicate the vascular structure within which the cannula is located. This finding may be useful in preventing injury to the coronary sinus or middle cardiac vein.

Fat Grafting with Tissue Liquefaction Technology as an Adjunct to Breast Reconstruction.

BackgroundTissue liquefaction technology (TLT) delivers warmed saline from the liposuction cannula tip at low pressure pulses to disaggregate adipocytes. This technology differs significantly from that used in other liposuction devices including water jet-assisted liposuction. Here we introduce our early experience with this technology in the setting of fat transfer for revision breast reconstruction.MethodsA retrospective chart review of 136 consecutive patients who underwent fat harvest with TLT and subsequent transfer into 237 breast reconstructions was conducted at a single institution. This two-surgeon series examined donor and recipient site complication rates over a median follow-up of 143 days [87–233].ResultsThe overall complication rate was 28.7 %, of which the majority (22.1 %) was fat necrosis at the recipient site as documented by any clinical, imaging, or pathologic evidence. The abdomen served as the donor site for half of the cases. Donor site complications were limited to widespread ecchymosis of the donor site notable in 10.4 % of cases. Twenty-five percent of patients had received postmastectomy radiotherapy prior to fat transfer. Prior to revision with fat transfer, implant-based breast reconstruction was used in 75.5 % of cases, and autologous flaps in the remainder. Fat transfer was combined with other reconstructive procedures 94.1 % of the time.ConclusionsTLT can be used to harvest adipocytes for fat transfer with donor site morbidity and recipient site complications comparable to other modalities. The efficiency and quality of harvested fat makes this technology appealing for wide spread adoption during fat transfer.Level of Evidence IVThis journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The direct aortic cannulation for acute type A aortic dissection.

This article describes the surgical techniques demonstrated in our video, “The Direct Aortic Cannulation for Acute type A Aortic Dissection”. Acute type A aortic dissection is a life-threatening condition requiring emergency operation. The choice of arterial cannulation sites to institute cardiopulmonary bypass is still a topic of controversy. Central cannulation directly through the ascending aorta has been reported (1,2). It has a theoretical advantage of not changing the natural antegrade blood flow, and in doing so avoiding intraoperative malperfusion. We believe that accurate positioning of the tip of an arterial cannula is best achieved with epiaortic echo guidance. We use the Seldinger method through the non-dissected part of the aortic wall in most cases, usually via the left side of the ascending aorta. In the current video presentation (Video 1), only the small posterior aspect was not dissected. The case was also complicated by intermittent myocardial ischemia, bicuspid aortic valve and significantly dilated ascending aorta. Video 1 The direct aortic cannulation for acute type A aortic dissection. Here we describe in detail our surgical technique for direct aortic cannulation by the Seldinger method with epiaortic guidance.

Transoral endoscopic nasopharyngectomy with a flexible next-generation robotic surgical system.

To determine the feasibility of transoral endoscopic nasopharyngectomy without division of the soft plate using a flexible, next-generation robotic surgical system. Preclinical anatomic study using four human cadavers. Transoral resection of the nasopharyngeal wall with en-bloc resection of the cartilaginous Eustachian tube and dissection of the parapharyngeal fat space. The first flexible robotic surgical system has recently been described. We performed a series of laboratory experiments to determine whether this flexible system could be used to perform transoral robotic nasopharyngectomy. This novel system allowed docking of the patient-side cart at the side of the operating table. The cannula tip was placed approximately 12 cm from the edge of the retractor pointing superiorly toward the nasopharynx (NP). Retraction of the soft palate anteriorly and tonsillar pillars laterally with stay sutures expanded the velopharyngeal inlet, providing adequate space to deploy all four instruments (three surgical instruments and a camera) into the NP for dissection. All instruments could be deployed into the NP, without collision or restriction of joint movement in this cadaver model. Using this position and docking location, the new flexible surgical robot provided sufficient access, reach, and visualization to complete robotic nasopharyngectomy with en-bloc resection of the cartilaginous Eustachian tube. This feasibility study showed that transoral endoscopic nasopharyngectomy could be performed without compromising the integrity of the soft palate using a novel flexible robotic surgical system. N/A. Laryngoscope, 126:2257-2262, 2016.

A Technical Modification for Establishing Selective Antegrade Cerebral Perfusion during Pulmonary Endarterectomy

Pulmonary endarterectomy (PEA) due to chronic thromboembolic pulmonary hypertension (CTEPH) is mainly performed in deep hypothermic circulatory arrest without additional cerebroprotective means. A 49-year-old man was treated by PEA for CTEPH by using selective antegrade cerebral perfusion by advancing the tip of the systemic perfusion cannula into the brachiocephalic trunk. The postoperative course was uneventful.

Ozone Treatment for Chronic Anal Fistula: It Is Not Promising.

The aim of this study is to assess the effect of ozone gas in the treatment of anorectal fistulae. The tip of a 20G intravenous cannula was inserted from the fistula orifice. Medical ozone was introduced into the fistula. A total of 10 sessions of ozone gas insufflation was performed on alternate days. Treatment was considered to be successful if fistula discharge ceased and the outer fistula orifice closed; however, if discharge was continued or outer fistula orifice was open, the treatment considered to be failed. A total of 12 adult patients were included in the study. The fistula was closed in three patients (25%), in nine patients (75%) without closure. In one patient who had fistula closure, the fistula recurred after 2months. Patients did not express any discomfort during ozone insufflation. There were no side effects or complications due to ozone insufflation. The success rate of ozone insufflation in anorectal fistulae closure is low.

Artifactual aortic dissection as a result of post-mortem CT angiography

Abstract An 82-year-old woman who died unexpectedly at home was admitted to our institute for investigation into her cause of death. Extensive subarachnoid hemorrhage was identified on the admission post-mortem computed tomography (PMCT) scan. Subsequent post-mortem computed tomography angiography (PMCTA) utilizing embalming principles and equipment identified leak of contrast from the right middle cerebral artery indicative of ruptured aneurysm and this was confirmed at autopsy. Unexpectedly after autopsy, PMCTA review revealed a large intimal flap indicative of apparent extensive aortic dissection arising from the tip of the infusion cannula in the left femoral artery to the ascending aorta, rupturing into the pericardial sac. This was not in keeping with the admission PMCT and was not detected at autopsy, although aortic atherosclerosis was present. This finding mirrors a similar artifact recently described in the literature secondary to embalming. In this case, it appeared to be an artifact of the PMCTA technique due to mechanical disruption of the arterial wall at the point of cannulation with flow of contrast solution into both true lumen and aortic wall creating a false lumen. With increasing use of post-mortem imaging to assist in medico-legal death investigations, it is imperative that practitioners be aware of and take into consideration the post-mortem changes and artifacts that can be caused by and detected on such imaging. In addition, it is important that all cases undergoing PMCTA have a preliminary PMCT for comparison and that all imaging findings are presented to the pathologist prior to autopsy for correlation at dissection.

Inverted Internal Limiting Membrane Flap For Large Traumatic Macular Holes

The aim of the study was to assess the role of inverted internal limiting membrane flap as a treatment option for large traumatic macular holes.This is a prospective noncomparative study in which 12 eyes with large traumatic macular holes (basal diameter of 1300-2800 μm) since 3 to 6 months were subjected to standard 23-gauge vitrectomy with removal of the posterior hyaloid, brilliant blue G (BBG)-assisted internal limiting membrane peeling in a circular fashion keeping it attached to the edge of the hole to create a flap. At the end of the surgery, air fluid exchange was done with inversion of the internal limiting membrane flap inside the macular hole using the soft tipped cannula and sulfur hexafluoride 20% as tamponade. The main follow-up measures are the best corrected visual acuity and the optical coherence tomography for 6 to 9 months.All the included eyes had a closed hole from the first week postoperative and along the follow-up period (6-9 months). The best corrected visual acuity improved from 20/2000 to 20/200 with a median of 20/400 preoperatively to 20/400 to 20/50 with a median of 20/100 at the end of follow-up period.Inverted internal limiting membrane flap is a good adjuvant to standard vitrectomy in the management of large traumatic macular holes that led to the 100% closure rate and improvement of best corrected visual acuity.

Indication Specific Cannula Treatment

Blunt-tip cannulas have been developed for the use with dermal fillers. They can help to improve the way dermal fillers are injected as they do –generally spoken- enable for a less traumatic injection of the material as well as a very aesthetically appealing result. There is a lot of discussion on whether to use a blunt tip cannula or a hypodermic needle generally. Obviously, there is no one way to inject fillers: any injection equipment –and this does relate to cannulas and needles, too- should be used individually and in an indication-specific way. The objective of this article is to give some guidelines on why and how the use of cannulas does make sense.

Physical Factors Affecting Outflow Facility Measurements in Mice.

Mice are commonly used to study conventional outflow physiology. This study examined how physical factors (hydration, temperature, and anterior chamber [AC] deepening) influence ocular perfusion measurements in mice. Outflow facility (C) and pressure-independent outflow (Fu) were assessed by multilevel constant pressure perfusion of enucleated eyes from C57BL/6 mice. To examine the effect of hydration, seven eyes were perfused at room temperature, either immersed to the limbus in saline and covered with wet tissue paper or exposed to room air. Temperature effects were examined in 12 eyes immersed in saline at 20 °C or 35 °C. Anterior chamber deepening was examined in 10 eyes with the cannula tip placed in the anterior versus posterior chamber (PC). Posterior bowing of the iris (AC deepening) was visualized by three-dimensional histology in perfusion-fixed C57BL/6 eyes and by spectral-domain optical coherence tomography in living CD1 mice. Exposure to room air did not significantly affect C, but led to a nonzero Fu that was significantly reduced upon immersion in saline. Increasing temperature from 20 °C to 35 °C increased C by 2.5-fold, more than could be explained by viscosity changes alone (1.4-fold). Perfusion via the AC, but not the PC, led to posterior iris bowing and increased outflow. Insufficient hydration contributes to the appearance of pressure-independent outflow in enucleated mouse eyes. Despite the large lens, AC deepening may artifactually increase outflow in mice. Temperature-dependent metabolic processes appear to influence conventional outflow regulation. Physical factors should be carefully controlled in any outflow studies involving mice.

Isolation and Culture of Mesenchymal Stem Cells From Rabbit Scapular Subcutaneous Adipose Tissue and Their Ability to Differentiate Into Osteoblasts

Background: The objectives of this study were to separate and culture mesenchymal stem cells (MSCs) from adipose tissue, examine the expression of surface markers on these cells, and determine their ability to differentiate into osteoblasts in normal medium. Objectives: The objectives of this study were to separate and culture mesenchymal stem cells (MSCs) from adipose tissue, examine the expression of surface markers on these cells, and determine their ability to differentiate into osteoblasts in normal medium. Materials and Methods: Sterile adipose tissue was obtained from the scapular subcutaneous adipose tissue of two rabbits (average weight, 2.8 kg) for cultivation and differentiation by either liposuction with a blunt hallow tip cannula or by direct surgery. The morphology, differentiation, and expression of mesenchymal-specific surface markers of rabbit, such as CD90, CD45, CD73, CD44, and CD105, were examined in cells from the third passage by flow cytometry. The MSCs from adipose tissue were stained with a lentivirus genome for cell tracking. The differentiation of MSCs into osteoblasts was investigated using a specific histological stain, Alizarin red. Results: The identity of adipose tissue cells was confirmed by oil-red O staining and examination under an optical microscope at both the initial stage and after differentiation into mesenchymal cells. The results demonstrated that cells derived from adipose tissue differentiated into mesenchymal cells. The nature of the mesenchymal cells was confirmed by the expression of specific surface markers, including CD90, CD45, CD44, CD73, and CD105, by flow cytometry. Finally, Alizarin red staining confirmed the differentiation of MSCs into osteoblasts. Conclusions: Based on our findings, we conclude that the separation and reproduction of adipose tissue cells is an appropriate method for purification of MSCs in animal studies. Regarding the histomorphometric and flow cytometry analysis results, we demonstrated the different future.

A flexible, single-arm robotic surgical system for transoral resection of the tonsil and lateral pharyngeal wall: Next-generation robotic head and neck surgery.

To describe the application of a novel flexible robotic surgical system to transoral endoscopic head and neck surgery of the tonsillar fossa and lateral oropharyngeal wall. Preclinical anatomic study using three human cadavers. Transoral resection of the lateral oropharyngeal wall with mucosal and muscular resection of the tonsillar fossa. This single-port flexible robotic system could be used to successfully perform transoral resection of this region. The optimal angle to dock the patient-side cart was at a 90-degree angle to the operating room table. The placement of the remote center of the robotic instrument arm was evaluated in three positions. When the cannula tip was placed at 10 to 15 cm, all instruments could be deployed past the first and second joggle joint settings, without collision or restriction of arm movement. Using this position and docking location, all four arms were deployed inside the oral cavity without collision or restriction of movement in all three cadavers. The Da Vinci SP (Intuitive Surgical, Inc., Sunnyvale, CA) provided sufficient access, reach, and visualization in order to complete a transoral lateral oropharyngectomy. The first preclinical feasibility study of a novel, flexible, single-arm robotic surgical system is presented for its use in transoral endoscopic head and neck surgery. N/A.

Bending of a vertical cannula without alarm during insulin pump therapy as a cause of unexpected hyperglycemia: A Japanese issue?

Currently, two types of cannula are available for Medtronic® insulin pump therapy: the vertical Quick-set® cannula (Medtronic plc, Dublin, Ireland) and the 30-degree angle Silhouette® cannula (Medtronic plc). However, it has not been established which cannula should be used in specific patients. Here, we present two Japanese patients with type 1 diabetes who experienced unexpected episodes of hyperglycemia caused by bending of the vertical cannula during insulin pump therapy. Case 1: An 84-year-old Japanese woman (body mass index 18.7 kg/m2) who had fulminant type 1 diabetes caused by drug-induced hypersensitivity syndrome was admitted to Kanazawa University Hospital, Kanazawa, Ishikawa, Japan, because of repeated hyper- and hypoglycemic episodes. Her serum and urinary C-peptide were undetectable. We started a continuous subcutaneous insulin infusion (CSII) for better glycemic control. Initially, she used a 9-mm long Quick-set® cannula with the infusion set. However, she experienced several episodes of unexpected hyperglycemia caused by bending of the cannula tip and agglutination, even after switching to a 6-mm long Quick-set® cannula (Figure​(Figure1).1). Therefore, she switched to a 13-mm long Silhouette® cannula inserted at a 30° angle. Subsequently, she did not experience the hyperglycemic episodes caused by obstruction of the cannula. Figure 1 A bent cannula tip and agglutination (arrow) in a 6-mm long Quick-set® cannula. Case 2: A 57-year-old Japanese man (body mass index 21.3 kg/m2) who had had type 1 diabetes for 7 years was admitted to our hospital for control of brittle diabetes. His blood glucose had increased recently, and he had experienced some hypoglycemic episodes. He started CSII, using a 9-mm long Quick-set® cannula. He experienced some unexpected hyperglycemic episodes, without the insulin pump triggering an alarm, caused by cannula bending, which disappeared after switching to the Silhouette® cannula. The two patients experienced a total of eight episodes of hyperglycemia. Of these, we recognized a bent cannula in six episodes (one with intracannula agglutination), and a normal cannula appearance in two episodes. Insertion failure or extended indwelling of the cannula alone do not explain the cannula problem, because four of the eight hyperglycemic episodes occurred 24–72 h after cannula insertion, unlike previous observations that most catheter problems start on day 31. We speculate that the vertical cannula tip reached the abdominal wall and bent during use because both of our patients were thin (skinfold thickness 8 mm in case 1 and 10 mm in case 2). Although the 6-mm long cannula was shorter than the skinfold thickness in case 1, there is a difference between the real skinfold thickness on insertion and the thickness on computed tomography. The cannula bends only on reaching abdominal muscle. Elderly people find it difficult to insert vertical cannulas, and they might not have inserted the cannulas adequately. In addition, a warning should be issued regarding the absence of a pump alarm, which occurred in one of the eight episodes. We conclude that a bent vertical cannula tip should be considered to be a cause of unexpected hyperglycemic episodes during CSII therapy, especially in relatively slender people with diabetes. A prospective randomized controlled study comparing the outcomes of 9 mm versus 6 mm and vertical versus horizontal cannulas in type 1 diabetic patients with different body mass indexes, body fat percentages and skinfold thicknesses is necessary to prove our hypothesis. Furthermore, the alarm system of the CSII device should be improved, so that it detects early cannula obstruction to prevent unexpected hyperglycemic episodes.

Cardiopulmonary bypass - complication of the tip of the aortic cannula

Aim We wish to share a unique occurrence of disconnection of the aortic cannula tip from the rest of the cannula while still on bypass.

"Dual Guidance"? - parallel combination of ultrasound-guidance and nerve stimulation - Contra

Sonography is a highly user-dependent technology. It presupposes a considerable degree of sonoanatomic and sonographic knowledge and requires good practical skills of the examiner. Sonography allows the identification of the puncture target, observes the needle feed and assesses the spread pattern of the local anesthetic in real time. Peripheral electrical nerve stimulation (PNS) cannot offer these advantages to the same degree, but may allow nerve localization under difficult sonographic conditions. The combination of the two locating techniques is complex in its practical implementation. Partially, the use of one location technique is made even more difficult by the combination with the second. PNS in parallel to sonography serves primarily as a warning technology in the case of an invisible cannula tip. It should not be construed as a compensation technique for the lack of sonographic skills or knowledge. However, PNS may be helpful in the sense of a bridging technology as long as the user is aware of its limitations.

Novel Straight Type Aortic Cannula with Spiral Flow Inducing Design

Aortic cannula is one of major factors leading to adverse events such as thrombosis and atherosclerosis development during open heart surgery. This is due to oxygenated blood outflow with high velocity jet from heart lung machine when exiting the cannula tip into ascending aorta. It was discovered, and validated by several researchers that blood flow out of the left ventricle into the aorta is spiral in nature. In this study, a novel design in which internal profile of the cannula was made to induce spiral flow were tested by way of numerical simulation, and compared against existing commercial cannula. Three designs were tested, which differed in number of groove employed. Among the cannula model designs, cannula design with 4 grooves yielded the lowest value of maximum wall shear stress at testing tube with 3.778 Pa and highest value of area weighted helicity density at 40 mm from cannula tips with 11.829 m/s2. Overall, spiral cannula models were showed highly potential in inducing spiral flow, and also the effect on blood hemolysis is acceptable.

The modified liposuction-curettage cannula for the treatment of secondary axillary bromhidrosis with subcutaneous scarring.

The modified liposuction-curettage cannula for the treatment of secondary axillary bromhidrosis with subcutaneous scarring.

Radiofrequency ablation near the bone-muscle interface alters soft tissue lesion dimensions.

Radiofrequency (RF) lesions are safe and effective in the treatment of spine pain; however, models developed to study factors affecting lesion dimensions have been performed in homogeneous media that may not accurately simulate human anatomy and electrophysiology. We present a novel ex vivo porcine model for performing RF lesion studies and report the influence of bone on projection of RF ablation lesions into soft tissue. Radiofrequency lesions were performed in porcine rib specimens using monopolar 18-gauge, 10-mm straight active tip cannula, with a lesion temperature of 80°C for 150 seconds. Ten lesions were performed in pure porcine muscle tissue and abutting porcine rib bone with surrounding muscle. Lesions were exposed with dissection and measured with digital calipers. Maximal effective lesion radius approximately doubled against the bone compared with the pure muscle group (mean, 5.65 mm [95% CI, 5.43-5.87 mm] vs 2.68 mm [95% CI, 2.55-2.81 mm], P < .0001), although this was seen only in a vertical direction and not horizontally. In addition, the prelesion and postlesion impedance of the bone-muscle interface was consistently higher than the muscle-only interface (mean, 165.6 Ohm [95% CI, 146.6-184.6 Ohm] vs 137.8 Ohm [95% CI, 135.5-140.1 Ohm], P = 0.004; 144.3 Ohm [95% CI, 134.3-154.3 Ohm] vs 124.3 Ohm [95% CI, 119.3-129.3 Ohm], P = 0.001). Other dimensions and estimated volume were not significantly different. Bone adjacent to RF lesions alters the surrounding electrophysiological environment causing RF lesions to project further perpendicularly from the needle axis, vertically to bone, than previously expected. This phenomenon should be considered in the future modeling and clinical practice of RF.

Elevated End-Tidal Carbon Monoxide Concentration in Children with Sickle Cell Anemia

Background: Carbon monoxide (CO) produced during oxygen-dependent cleavage of porphyrin ring of heme is excreted in exhaled breath. The catabolism of heme is increased when red blood cells are destroyed at an accelerated rate. Thus, quantifying CO in exhaled breath could serve as an indicator of hemolysis. However, the requirement for forced breath sample has limited the measurement of exhaled CO in young children.Objective: To assess end-tidal CO concentration (ETCOc) in children with sickle cell anemia (SCA).Design/Methods: ETCOc was measured using the CoSense ETCO Monitor (Capnia Inc. Palo Alto, CA). Children between 5-14 years with SCA (Hb SS) who were not on chronic transfusions were eligible. Healthy children served as age-matched controls. Children with exposure to second-hand smoke, acute respiratory infection or symptomatic asthma were excluded. End-tidal breath samples were collected by placing the tip of a nasal cannula 5 mm into the nares. Up to 3 measurements were taken for each subject and the highest ETCOc value was used for analysis. (ClinicalTrials.gov: NCT01848691)Results: The mean (range) age of 16 children with SCA and 16 controls was 9.7 years (5-14 years) and 9.9 years (5-14 years), respectively. The mean (± s.d.) ETCOc for SCA was 4.85 ± 2.24 ppm versus 0.96 ± 0.54 ppm for control group (p<0.001). The ETCOc in the control group ranged from 0.2 to 2.3 ppm, but was ≤1.2 ppm in 14/16, which is suggested as the upper limit of normal for healthy children. In the SCA group, the ETCOc range was 1.8 to 9.7 ppm, with values ≥2.4 ppm in 15/16 subjects. A threshold ETCOc value of >2.1 ppm provided both sensitivity and specificity equal to 93.8% (69.8-99.8%) for distinguishing SCA from healthy children. Children with SCA who had higher absolute reticulocyte count also demonstrated higher ETCOc (r=0.62, p=0.011). Patients with severe anemia (hemoglobin <8 g/dL) had a higher mean ETCOc (5.43 ppm) than the rest (4.40 ppm) but the difference was not significant. ETCOc level tended to increase with age in SCA (r=0.45, p=0.08).Conclusions: Carbon monoxide in exhaled breath can be measured in young children in the clinic using a portable monitor. ETCOc may be a valuable tool for non-invasive monitoring of the severity of hemolysis in SCA. The mean ETCOc was 5-fold higher in SCA compared with controls, with little overlap seen between the groups. This suggests a potential use for ETCOc as a point-of-care screening test for SCA in children. [Display omitted] [Display omitted] DisclosuresLal:Capnia, Inc: Research Funding. Yen:Capnia, Inc. : Employment. Bhatnagar:Capnia, Inc: Employment.

Abstract 19192: Utility of Cardiac Computed Tomography in Detecting Malposition of Left Ventricular Assist Devices Associated With Pump Thrombosis

Introduction: Pump thrombosis is a potentially life-threatening event that currently presents a diagnostic challenge. We therefore sought to explore the diagnostic utility and the association of measured cardiac computed tomography (CT) parameters in patients with LVAD malfunction due to pump thrombosis. Methods: From 2009 to 2013, 150 patients underwent placement of Heart Mate II continuous flow pump at our institution. Of these 52 patients, underwent cardiac CT with contrast either as part of a prospective protocol or for suspected malfunction. 14 patients had pump thrombosis per the INTERMACS criteria and the remaining were used as controls. Rigorous linear and area measurements for the inflow and outflow tracts of LVADs were performed. Results: The mean age of the population was 55 ± 11, 36 were male, and 28 had ischemic cardiomyopathy. Results are shown in table 1. For inflow cannula, measurement of axial area shown in figure 1, was significantly higher in the pump thrombosis group compared to the control group 31±16 cm2 vs 20 ± 12 cm2 (p=.02). Although, the difference in the acute angle for the inflow cannula relative to the perpendicular axis between the midpoint of the mitral annulus and tip of inflow cannulas was not significantly different between the two groups, there was a trend towards greater angulation in the pump thrombosis group (60 ± 6 vs 53 ± 15) and there was a positive correlation between both measurements r=0.513, p-value= 0.003. Conclusions: Area in the axial view of the ventricle at the site of the inflow cannula tip may be a surrogate for off axis placement of the cannula. This area may be helpful in predicting pump thrombosis in patients.