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Cureus Mar 2024Lung needle biopsy can cause air to enter the vessels due to the traffic between the vessels and the trachea. Hyperbaric oxygen therapy (HBOT) according to the U.S. Navy...
Lung needle biopsy can cause air to enter the vessels due to the traffic between the vessels and the trachea. Hyperbaric oxygen therapy (HBOT) according to the U.S. Navy Treatment Table (USNTT) 6 or 6A protocol is used for arterial gas embolism (AGE). However, no treatment or HBOT protocol for asymptomatic intra-arterial air has been established. Here we report two cases of asymptomatic intra-arterial air during lung needle biopsy that were preventively treated with HBOT according to the USNTT 5 protocol. In case 1, a 72-year-old man with malignant lymphoma in remission underwent computed tomography (CT)-guided lung needle biopsy of a nodule in his right lung. During the biopsy, the patient developed a cough, followed by chest pain and dyspnea. Chest CT revealed a right pneumothorax and air in the left ventricle and aorta. The patient did not present with symptoms suggestive of AGE. After thoracic drainage, 4.5 hours after onset, the patient underwent HBOT according to the USNTT 5 protocol. After one session in the hyperbaric chamber, follow-up whole-body CT showed disappearance of intravascular air. In case 2, a 69-year-old man with chronic obstructive pulmonary disease underwent CT-guided lung needle biopsy of a nodule in his right lung. Post-examination CT showed intravascular air in the aorta, pulmonary artery and vein, and left ventricle. However, the patient had no symptoms. One hour after onset, the patient underwent HBOT according to the USNTT 5 protocol. A whole-body CT the next day confirmed the disappearance of intravascular air. Both patients were discharged without sequelae. HBOT is an effective treatment to flush out intra-arterial air and inhibit the expression of adhesion molecules. Asymptomatic intra-arterial air may be adequately treated with HBOT according to a short protocol such as USNTT 5.
PubMed: 38449913
DOI: 10.7759/cureus.55665 -
Journal of Cardiovascular... Apr 2024Cryoablation therapy for pulmonary vein isolation (PVI) to treat paroxysmal atrial fibrillation (PAF) is well established. A novel 28 mm cryoballoon system designed to... (Clinical Trial)
Clinical Trial
INTRODUCTION
Cryoablation therapy for pulmonary vein isolation (PVI) to treat paroxysmal atrial fibrillation (PAF) is well established. A novel 28 mm cryoballoon system designed to operate under low pressure to safely reach a lower nadir temperature and maintain constant balloon size during cooling has not been prospectively studied in a large patient population for safety and efficacy. The FROZEN AF (NCT04133168) trial was an international multicenter, open-label, prospective, single-arm study on the safety and performance of a novel cryoballoon system for treatment of PAF.
METHODS AND RESULTS
The study enrolled patients at 44 sites in 10 countries across North America, Europe, and Asia. Subjects were indicated for PVI treatment of PAF and had failed or were intolerant of one or more antiarrhythmic drugs. Procedural outcomes were defined based on the 2017 HRS consensus statement. Follow-up was performed at 7 days, 3, 6, and 12 months. Data are reported as mean ± SD or median (IQR). PVI was performed with a 28 mm cryoballoon in 325 drug refractory PAF patients. Complete PVI was achieved in 95.7% of patients. In cryoablation lesions longer than 60 s, 60.1% of PV isolations required only a single cryoballoon application. Procedure related complications included: phrenic nerve palsy [temporary 4 (1.2%), persistent 0 (0.0%)], cardiac tamponade/perforation 2 (0.6%), and air embolism 1 (0.3%). Freedom from documented atrial arrhythmia recurrence at 12 months was 79.9% (AF 82.7%, AFL 96.5%, AT 98.1%), antiarrhythmic drugs (AAD) were continued or re-initiated in 26.8% of patients after the 3-month blanking period. Additionally, an extension arm enrolled 50 pts for treatment with 28/31 mm variable size cryoballoon. A single temporary PNP occurred in this group, which resolved before discharge. Freedom from documented recurrence at 12 months in these pts was 82.0%.
CONCLUSIONS
This novel cryoballoon may facilitate PVI to treat PAF, providing more options to address the variety of anatomies present in patients with PAF. This cryoballoon system proved to be safe and effective for treatment of patients with drug refractory or drug intolerant PAF.
Topics: Humans; Anti-Arrhythmia Agents; Atrial Fibrillation; Catheter Ablation; Cryosurgery; Heart Injuries; Prospective Studies; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 38448797
DOI: 10.1111/jce.16220 -
Wiener Klinische Wochenschrift Mar 2024
PubMed: 38446261
DOI: 10.1007/s00508-024-02337-1 -
Frontiers in Physiology 2024Intrapulmonary air-filled cavities, e.g., bullae, blebs, and cysts, are believed to contribute topulmonary barotrauma (PBT) and arterial gas embolism (AGE) in divers....
Intrapulmonary air-filled cavities, e.g., bullae, blebs, and cysts, are believed to contribute topulmonary barotrauma (PBT) and arterial gas embolism (AGE) in divers. However, literature is unclear about the prevalence of bullae in healthy adults, ranging from 2.3-33.8%. While this could in part be explained due to increasing quality of radiologic imaging, such as computed tomography (CT) scans, other methodological factors may also affect these findings. This study aims to ascertain the prevalence of bullae in young and healthy adults. This single-center cross-sectional observational study re-assessed the CT scans of adults (aged 18-40) performed for a clinical suspicion for pulmonary embolism, from 1 January 2016 to 1 March 2020. Presence of bullae was recorded in an electronic database. Chi-square and Fisher exact tests were used for statistical analyses. Additionally, a multivariate logistic regression analysis was performed to study the independent predictive value of identified risk factors. A total of 1,014 cases were identified, of which 836 could be included. Distribution amongst age groups (18-25, 26-30, 31-35, and 36-40) was almost equally, however, 75% of the population was female. Of the male proportion, 41% smoked, compared to 27% in females. In 7.2% (95% CI 5.6-9.1) bullae were identified. The prevalence increased with increasing age ( < 0.001), with odd ratios up to 5.347 (95% CI 2.164-13.213, < 0.001) in the oldest age group. Males and smokers had higher odds ratios for bullae of 2.460 (95% CI 1.144-4.208; = 0.001) and 3.406 (95% CI 1.878-6.157, < 0.001), respectively. Similar results were seen in the multivariate logistic regression analysis, where age, male sex and smoking were all statistically significant independent risk factors for bullae. Bullae were seen in 7.2% of a healthy population up to 40 years old. Increasing age, smoking, and being male were identified as statistically significant risk factors, both in independent and in multivariate logistic regression analyses. Our observations may warrant a re-evaluation of the contribution of bullae to PBT and AGE, as the latter two occur very rarely and bullae appear to be more frequently present than earlier assumed.
PubMed: 38420621
DOI: 10.3389/fphys.2024.1349229 -
The Journal of Invasive Cardiology Apr 2024A 52-year-old man with a history of percutaneous coronary intervention (PCI) in the left anterior descending (LAD) coronary artery was admitted for a facilitated PCI...
A 52-year-old man with a history of percutaneous coronary intervention (PCI) in the left anterior descending (LAD) coronary artery was admitted for a facilitated PCI following an anterior ST-elevation myocardial infarction treated with thrombolysis at a nearby clinic.
Topics: Male; Humans; Middle Aged; Percutaneous Coronary Intervention; Embolism, Air; Embolism; Thrombectomy; Coronary Artery Disease; Catheters; Coronary Angiography; Treatment Outcome
PubMed: 38412441
DOI: 10.25270/jic/23.00259 -
The Journal of Invasive Cardiology Apr 2024Percutaneous closure of a patent foramen ovale (PFO) for the prevention of recurrent paradoxical thromboembolic events has been shown to be safe and effective in...
OBJECTIVES
Percutaneous closure of a patent foramen ovale (PFO) for the prevention of recurrent paradoxical thromboembolic events has been shown to be safe and effective in randomized controlled trials. However, it remains uncertain if differences in the structure and design of the occluder devices impact the outcomes. The aim of this study was to compare results of percutaneous PFO closure using 2 widely used double-disc occluders.
METHODS
Consecutive patients who underwent percutaneous PFO closure with the Abbott Amplatzer occluder (APO) or the Occlutech Figulla-Flex-II occluder (OPO) at the Heart Center Lucerne between February 2017 and December 2022 were included in a registry. The primary endpoint was effective closure of the PFO, defined as a residual shunt grade 0 or 1, assessed by contrast echocardiogram at 6-month follow-up. Secondary endpoints included procedural efficacy/safety and major adverse cardiovascular events during the hospital stay and at 6-month follow-up.
RESULTS
One hundred ninety-three consecutive patients (mean age 51.7 ± 12.5 years; 39% women; Risk of Paradoxical Embolism (RoPE) score = 7, IQR = 6-8) underwent percutaneous PFO closure with the APO (120 patients, 62.2%) or the OPO (73 patients, 37.8%). Main indications for closure were crypotogenic stroke in 168 patients (87.1%) and peripheral embolism in 13 patients (6.7%). At baseline, right-to-left shunt (RLS) greater than or equal to grade 2 was present in 189 patients (97.9%). Immediate procedural success was 99.5%. In 1 patient, an air embolism occurred during positioning of the APO occluder with transient chest pain and electrocardiogram changes, but without further sequelae to the patient. At 6-month follow-up, effective closure was achieved in 185 patients (95.8%; APO: 96.6% vs OPO: 94.5%, P = .30). Rates of atrial fibrillation and recurrent thromboembolic events were 4.2 and 0.5%, respectively.
CONCLUSIONS
PFO closure is safe and effective when performed with either the self-expanding Abbott Amplatzer or Occlutech Figulla Flex II PFO occluder.
Topics: Humans; Female; Adult; Middle Aged; Male; Foramen Ovale, Patent; Treatment Outcome; Echocardiography; Stroke; Septal Occluder Device; Thromboembolism; Cardiac Catheterization
PubMed: 38412438
DOI: 10.25270/jic/23.00291 -
Medicina Intensiva Feb 2024
PubMed: 38388221
DOI: 10.1016/j.medine.2024.01.006 -
Journal of Neuroradiology = Journal de... May 2024
Re: Cerebral arterial air emboli on immediate post-endovascular treatment CT are associated with poor short- and long-term clinical outcomes in acute ischaemic stroke patients.
Topics: Humans; Embolism, Air; Ischemic Stroke; Endovascular Procedures; Tomography, X-Ray Computed; Treatment Outcome; Intracranial Embolism
PubMed: 38382803
DOI: 10.1016/j.neurad.2024.02.005