Pregled bibliografske jedinice broj: 1001392
Left internal mammary artery puncture as a complication of subxyphoid pericardiocentesis
Left internal mammary artery puncture as a complication of subxyphoid pericardiocentesis // European Heart Journal: Acute Cardiovascular Care ( 2015 ) 4 (Supplement 5)
Beč, Austrija, 2015. str. 299-299 (poster, međunarodna recenzija, sažetak, stručni)
CROSBI ID: 1001392 Za ispravke kontaktirajte CROSBI podršku putem web obrasca
Naslov
Left internal mammary artery puncture as a complication of subxyphoid pericardiocentesis
Autori
Babić, Zdravko ; Pavlov, Marin ; Bulj, Nikola ; Kalousek, Vladimir ; Gabrić, Ivo Darko ; Planinc, Danijel
Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni
Izvornik
European Heart Journal: Acute Cardiovascular Care ( 2015 ) 4 (Supplement 5)
/ - , 2015, 299-299
Skup
Acute Cardiovascular Care 2015
Mjesto i datum
Beč, Austrija, 17.10.2015. - 19.10.2015
Vrsta sudjelovanja
Poster
Vrsta recenzije
Međunarodna recenzija
Ključne riječi
perikardiocenteza ; LIMA ; intevencijsko liječenje
(pericardiocentesis ; LIMA ; interventional treatment)
Sažetak
Pericardiocentesis is considered aggressive but relatively safe procedure, especially when performed under echocardiographic guidance. Unintentional left internal mammary artery (LIMA) puncture is known complication of anterior parasternal pericardiocentesis, while it is extremely rare in subxyphoid approach. The authors experienced the later and present such case. 59-years old female was presented to tertiary Clinic due to large pericardial effusion unresponsive to medical therapy. She complained of fatigue, exertional dyspnea, and pitting edema on extremities. Physical examination revealed alert, moderately obese female with picnic constitution. She was normotensive, but tachycardic, tachypnoic, with distended jugular veins, diminished lung sounds and pleural effusion bilaterally, moderate hepatomegaly, ascites and crural pitting edema. Echocardiography showed circumferential pericardial effusion with largest amount of effusion located inferoposteriorly (45 mm), while apically and parasternally effusion measured 10 mm, with signs of threatening tamponade. Due to poor cooperability, small amount of effusion anteriorly, and operator experience, a subxyphoid approach was chosen, however without success in obtaining effusion. One hour after procedure, arterial hypotension and swelling of left m. rectus abdominis (mRA) was observed. Hemoglobin level decreased from 136 to 84 g/L. Computed tomography revealed active blood extravasation from distal LIMA to mRA hematoma spreading through whole of the muscle. Endovascular treatment was chosen over surgery due to coagulopathy and hemodynamic instability. Through left radial approach LIMA was accessed, over the microcatheter ethylene vinyl alcohol copolymer Onyx (Covidien) was administered with successful embolization of LIMA proximal to the lesion. Postprocedural period was complicated with hemodynamic instability, paralytic ileus and acute renal failure. With cardiac surgeon in back-up, an echo-guided apical pericardiocentesis was performed with immediate evacuation of 500 ml of effusion. With corticosteroid and other supportive therapy patient recovered well, mRA hematoma regressed completely, Meigs-like syndrome seems to be the most probable etiology of effusions. Although rare in subxyphoid approach, LIMA puncture during pericardiocentesis is a possible complication, especially in picnic patients with ascites and hepatomegaly. Apical approach with echocardiographic guidance is recommended for avoiding it. Urgent diagnosis and treatment of such patients is needed.
Izvorni jezik
Engleski
Znanstvena područja
Kliničke medicinske znanosti
POVEZANOST RADA
Ustanove:
KBC "Sestre Milosrdnice"
Profili:
Zdravko Babić
(autor)
Marin Pavlov
(autor)
Vladimir Kalousek
(autor)
Ivo Darko Gabrić
(autor)
Danijel Planinc
(autor)
Nikola Bulj
(autor)