Introdução: Foramen ovale patente (FOP)
ocorre em até 25% dos adultos saudáveis.
Pode favorecer embolização paradoxal,
enxaqueca e insuficiência respiratória (IR).
Apresenta-se caso de IR e ortodeoxia por
shunt direito-esquerdo via FOP sem
evidência prévia de aumento da pressão
intra-auricular direita. Encerramento do
FOP resolveu eficazmente IR.
Caso clínico: Homem, 52 anos. Mieloma
múltiplo IgA/k diagnosticado um ano antes.
Internado por IR hipoxémica grave com
ortodeoxia e má resposta à oxigenoterapia,
após colocação de cateter venoso central
(CVC) na subclávia direita. Referia
parestesias e alterações visuais
inespecíficas, após manipulações do CVC.
Características da IR sugeriam shunt entre
circulação pulmonar e sistémica. Sem
evidência clínica ou imagiológica de shunt
transtorácico com contraste: shunt direito-
-esquerdo. Ecocardiograma transesofágico:
FOP. Cateterismo cardíaco (após resolução
espontânea da IR): sem shunt. Uma semana
depois recorreu IR grave, que resolveu (bem
como queixas neurológicas) com
encerramento do FOP.
Discussão: IR por shunt intra-cardíaco sem
aumento da pressão nas cavidades direitas é
de difícil interpretação hemodinâmica.
Raros relatos (em adultos) associam esta
entidade a anomalias anatómicas...
This research aimed to analyze the properties and typologies of a biotechnology sector network with regard to their relationships, attributes and performance in research and production of innovations. For this purpose, it had as its empirical field the Northeast Biotechnology Network, using patent reports produced by the network as a data source. In order to track the relationship networks between members, groups, institutions and projects, social networking analysis tools were used, making it possible to construct relationship matrices between the laboratories and companies and, lastly, researchers. In total, 117 researchers were identified, distributed among 18 research centers and 47 laboratories or companies. Their projects are distributed across three main areas: agriculture, industrial and health, the latter being the strongest of the three with more patents produced and more institutions involved in research. The weak density presented by the network, at all analysis levels, strengthens the necessity for integration strategies. Also, it indicates the possibility for new relationships between agents that are still isolated. However, it does not diminish its importance for economic development in the region in which it operates.
A 5-year-old girl was referred to our institution for closure of a silent patent ductus arteriosus. Cardiac catheterization revealed a tiny-to-small patent ductus arteriosus of the elongated, conical type (Type E). Coil occlusion was performed with a Gianturco coil, 0.035-4 cm-3 mm. A follow-up echocardiogram showed a very small residual ductal shunt and a moderate-sized thrombus at the aortic end of the ductus arteriosus. The patient remained asymptomatic. (Tex Heart Inst J 2002;29:210–2)
The patient with a patent, infected vascular graft presents a dilemma to the surgeon, who must decide whether revascularization is necessary in addition to removal of the infected graft. When a graft infection points superficially or requires drainage, the graft may be well enough exposed to provide easy access. A technique to determine preoperatively the need for revascularization in two patients with patent, exposed grafts is discussed. Following therapeutic anticoagulation, the exposed grafts were occluded with a screw clamp. Within 1 hour, one patient developed ischemic rest pain, associated with a fall in ankle blood pressure to < 60 mm Hg. Consequently, the patient underwent excision of the infected graft and revascularization with another extraanatomic bypass graft. The second patient, who had moderate intermittent claudication, tolerated clamping of the graft without ischemic symptoms at rest. Revascularization was performed through noninfected tissue, with the knowledge that the graft could be removed if necessary, without causing ischemic rest pain. This technique helps to determine preoperatively whether patients with exposed, infected grafts require revascularization as well as graft excision.
We describe a case of refractory hypoxemia secondary to a patent foramen ovale immediately after orthotopic heart transplantation in a 60-year-old woman. The patent foramen ovale was successfully closed with a septal occlusion device, with resolution of the hypoxemia. To our knowledge, transcatheter closure of a patent foramen ovale in an adult patient with refractory hypoxemia during the immediate post-transplant period has not previously been reported.
Untreated patent ductus arteriosus carries a higher risk in adults than in children, especially when the defect is large (>4.0 mm in diameter), short, or friable. Therefore, various technical precautions have been suggested for application during surgical closure of a patent ductus arteriosus in an adult. We report the case of a 47-year-old woman with a patent ductus arteriosus who underwent transpulmonary surgical closure of the ductus under hypothermic total circulatory arrest. We discuss the technique in light of the current English-language medical literature.
Fatal haemopericardium in a 27 year old pregnant woman was caused by rupture of a dissecting aneurysm of the pulmonary artery. She had an uncorrected patent ductus arteriosus and severe pulmonary hypertension. The wall of the pulmonary artery showed atherosclerosis and cystic medionecrosis.
Recent reports have documented an association between patent foramen ovale and obstructive sleep apnea. We report on a 51-year-old man with obstructive sleep apnea and recent stroke who was enrolled in a clinic trial evaluating the efficacy of closure of patent foramen ovale following ischemic stroke. He was randomly assigned to device closure. There was subjective dramatic improvement in sleep-apnea symptoms and objective improvement in polysomnographic testing after device implantation. Aside from a drop in apneas and hypopneas from 181 and 8 on the first polysomnogram to 19 and 0 on the second, there was no significant weight loss nor were there other significant changes in sleep parameters or medications. He stopped using continuous positive airway pressure 2 months after implantation and has had no recurrent sleep complaints during 18 months of follow-up. Further studies evaluating the relationship among patent foramen ovale, sleep apnea, and device implantation are warranted.
Transcatheter closure of secundum atrial septal defect (ASD) and patent foramen ovale (PFO) is now widely accepted as an alternative to surgical closure. With currently available devices and techniques, approximately 80-90% of secundum ASDs and all PFOs can be closed percutaneously. While many devices are available, the use of any particular device is dictated largely by individual defect anatomy, device availability, long-term considerations, approval status (US Food and Drug Administration approval versus CE mark), and physician preference.
After cardiac operations, careful management substantially reduces the risks of negative complications during or after the removal of temporary epicardial pacing wires. Herein, we report the case of a 58-year-old man who, 4 days after undergoing aortic root replacement, developed pericardial tamponade after the removal of temporary epicardial pacing wires. Consequent to the tamponade, a right-to-left shunt developed through a previously undiagnosed patent foramen ovale. The patient underwent emergency surgery to repair myocardium that had ruptured due to the removal of the wires, and he recovered uneventfully.
Postoperative hypoxemia can be a challenging diagnostic and management dilemma for the clinician. We present here a case of postoperative hypoxemia following laparoscopic gastric bypass surgery secondary to presumed pulmonary embolism complicated with a patent foramen ovale. The diagnostic pitfalls associated with a negative spiral computed tomography scan and the impact of coexisting medical conditions aggravating the pulmonary dysfunction are reviewed.
Herein, we describe late complications after the transcatheter device closure of a patent foramen ovale in a patient with migraine headaches. The clinical presentation included acute neurologic symptoms and new-onset atrial fibrillation. A mass on the left atrial side of the occluder was surgically removed. Histologic results showed an inflammatory lesion that consisted predominantly of lymphocytes, plasma cells, and macrophages. Despite complete surgical closure and the termination of atrial fibrillation, the patient continued to experience neurologic events.
We describe the case of a large patent ductus arteriosus in a 52-year old man, which was deemed unsuitable for coil occlusion or Amplatzer duct occluder. His ductus was successfully closed using Talent prostheses (Medtronic AVE, Santa Rosa, CA, USA). The postoperative course was uneventful.
Percutaneous treatment of patent foramen ovale with a septal closure device has become a common procedure, but it is associated with various complications. Migration of the device is uncommon, and migration through the aortic valve into the aorta is rare. Managing the migration of a patent foramen ovale occluder can be challenging; it usually requires surgical retrieval of the foreign body. We report a rare case in which a patient experienced migration of a large patent foramen ovale closure device to the descending aorta. Rarer still was its successful percutaneous management.
We present the case of a 45-year old female operated on for minimally invasive closure of patent foramen ovale, who suffered in the postoperative course of the Budd–Chiari syndrome caused by the thrombotic occlusion of the inferior vena cava. Medical treatment with oral anticoagulants and heparin was promptly established, avoiding a further increase of the thrombus that completely disappeared 3 months later.
Surgery for complex pulmonary aspergilloma is known to be technically challenging, often for indurated hilar structures and obliterated pleural space. We report a case of left pneumonectomy for pulmonary aspergilloma with a history of patent ductus arteriosus ligation via anterolateral thoracotomy and aortopexy via median sternotomy and pericardiotomy. Left pneumonectomy was successfully accomplished by devising a surgical approach and procedures for transection of the left main pulmonary artery.
Transcatheter patent foramen ovale (PFO) closure is an alternative to antiplatelet or anticoagulative therapy in patients with cryptogenic stroke, and it is associated with a small incidence of periprocedural sequelae. Because embolization of PFO closure devices is a very rare procedural complication, data on its frequency, causes, and management are sparse. We sought to review the medical literature and the cases of PFO closure-device embolization at our institution with the aim of identifying likely problems and reporting potential solutions. Out of 310 adult patients who underwent transcatheter PFO closure from June 2002 through April 2011, there were 2 cases (0.6%) of PFO closure-device embolization. In both patients, hypermobile septum primum and thick septum secundum were present. In one patient, failure to use a sizing balloon might have resulted in an underestimation of the PFO's size. In both patients, device embolization was identified in a timely fashion, the embolized device was safely retrieved, and the PFO was percutaneously closed with success.
Percutaneous closure of patent arterial ducts with the Amplatzer Ductal Occluder has become an effective and widely accepted alternative to surgical management. Although rarely, the occluder can be dislodged after an initially successful deployment, and with catastrophic consequences. We describe such a case in a 12-month-old girl who underwent transcatheter closure of a patent arterial duct. After device deployment, the occluder embolized in the patient's descending thoracic aorta, and severe spinal cord ischemic injury resulted. To our knowledge, ours is the first report of this complication after the deployment of an Amplatzer Ductal Occluder. We discuss pathophysiologic mechanisms that could expose patients to the risk of device dislodgment, and we review the relevant medical literature.
We describe the case of a large pseudoaneurysm after transcatheter closure of patent ductus arteriosus in a 42-year old male who developed back pain and dyspnoea 6 months subsequent to the first procedure. The patient's pseudoaneurysm was successfully treated using Talent prostheses (Medtronic AVE, Santa Rosa, CA, USA), though the postoperative course was without incident.
This paper reports results of a network theory approach to the study of the
United States patent system. We model the patent citation network as a discrete
time, discrete space stochastic dynamic system. From data on more than 2
million patents and their citations, we extract an attractiveness function,
$A(k,l)$, which determines the likelihood that a patent will be cited. $A(k,l)$
is approximately separable into a product of a function $A_k(k)$ and a function
$A_l(l)$, where $k$ is the number of citations already received (in-degree) and
$l$ is the age measured in patent number units. $A_l(l)$ displays a peak at low
$l$ and a long power law tail, suggesting that some patented technologies have
very long-term effects. $A_k(k)$ exhibits super-linear preferential attachment.
The preferential attachment exponent has been increasing since 1991, suggesting
that patent citations are increasingly concentrated on a relatively small
number of patents. The overall average probability that a new patent will be
cited by a given patent has increased slightly during the same period. We
discuss some possible implications of our results for patent policy.; Comment: 8 pages, 5 figures