Although Central Venous Catheter (CVC) placement is a relatively simple procedure but its insertion and maintenance are associated with significant risks. Malposition (defined as any CVC tip position outside the superior vena cava) may be associated with catheter insertion and may require immediate intervention. It may result in complications like haemothorax, pleural effusions, pneumothorax, sepsis, thrombosis and cardiac tamponade. This case report presents timely detection of the complication after placement of CVC. Everyone should be aware of the complications and monitor consistently appropriate position of catheter tips.
Introduction: Tuberculous pericarditis continues to be a leading cause of chronic constrictive pericarditis (CCP) in developing countries. Echocardiography plays a key role in the assessment and diagnosis. Methods: Twelve patients who underwent pericardiectomy for CCP in last 18 months of the study period were subjected to clinical and New York Heart Association (NYHA) functional class assessment along with comprehensive echocardiographic evaluation. The data were compared with their preprocedural status. Results: Significant reduction was noted in the incidence of inferior vena cava (IVC) congestion(P < 0.001) and mean left atrial (LA) size from 43.75 ± 4.43 mm to 31.58 ± 3.03 mm (P < 0.001), post pericardiectomy.Respiratory variation of 34.17 ± 8.76 % in the mitral E velocity was significantly reduced to 17 ± 3.69 % (P < 0.001) after surgery. Similarly, respiratory variation in tricuspid E velocities showed significant reduction from 62.17 ± 13.16 % to 32.58 ± 4.7 % (P < 0.001).Prior to pericardiectomy, medial e’ and lateral e’ mitral annular velocities was 15.5±1.24 cm/sec and13.08 ± 1.08 cm/sec, respectively. Following surgery, the medial e’ and lateral e’ was 12.5±1.17 cm/sec(P = 0.001) and 15.42±1.83 (P = 0.004), respectively. Conclusion: Echocardiography provides useful insight in pericardial constriction hemodynamics and worthwhile effects of pericardiectomy.
Background: Carotid Body tumours (CBTs) are rare neuroendocrine tumours. Due to their proximity to vital structures including major vessels and cranial nerves, Surgical excision requires meticulous dissection and any injury to major vessels requires prompt repair. This study aimed to review our experience with the surgical management of Carotid Body Tumours. A Methods: retrospective study was performed on 20 patients who underwent excision of carotid body tumours at Vardhaman Mahavir Medical college and Safdarjung hospital, New Delhi between January 2003 to June 2022. Demographic data describing the presentation, preoperative and intraoperative details, and postoperative complications reported were tabulated and descriptive statistical analysis was done A total of 20 Results: patients were operated on. Complete resection was possible in all the patients. Vascular injury occurred in only 2 patients which were repaired promptly. Cranial nerve injury was reported in only 1 patient which resolved on follow-up. There was no incidence of stroke or recurrence. Conclusions: Periadventitial Excision is the treatment of choice for carotid body tumours and is a safe and effective procedure with minimal intraoperative and postoperative complications.
Introduction: Whether pericardial closure should be done or not is still a debated topic. While many studies favour pericardial closure after cardiac surgery, many are still not in favour of the same. Objective : Objective of this study was to analyse the changes induced by pericardial closure on the haemodynamic of the patient using easily measurable variables. Methods : Data of 30 patients were analysed of which 14 underwent mitral valve replacement, 10 underwent coronary artery bypass grafting and 6 underwent double valve replacement. Results: There was statistically significant change in cardiac output (p<0.01), central venous pressure (p<0.05) and left ventricular end diastolic diameter (p<0.01) after pericardial closure. Clinically the pericardial closure was well tolerated. Conclusion: Despite exhaustive experience, the topic of closing pericardium is still debated. Our study shows that clinically pericardial closure is well tolerated and in return it also safeguards the risks associated with re-do operations
Objective : To assess the early results of surgical and endovascular intervention in peripheral arterial disease Materials and methods : Retrospectively, we analysed the early results of treatment of lower extremity arterial diseases, managed at our institute. Depending up on the lesion characters and the distal run-off as evident from imaging, patients underwent either surgical or endovascular intervention for their disease. Over a period of one-year form July 2018 to July 2019, twenty-two patients were managed in total. Nine of them underwent surgical bypass for either aortoiliac or femoro-popliteal lesions. Another thirteen patients underwent endovascular intervention for lesions at aorto-iliac, femoro-popliteal and “Below the Knee” lesions. Procedure related morbidity, procedural success rate, postoperative pain score, hospital stay, flow patency and symptomatic improvement at follow-up at three and six months were analysed. Results: The results were optimistic with ischemic ulcers showing signs of healing, patients symptomatically better with improved walking distance and relieved of rest pain. Due to a smaller study population, limited study time and the study itself being a non- randomised one, no intragroup comparisons were made. The procedural success was 100% for each group, no periprocedural morbidity. The hospital stay was 9 days for surgical aorto bifemoral bypass patients, 5.8 days for femoropopliteal patients. For those who underwent endovascular intervention, average hospital stay was 3.4, 2.5 and 3 days respectively for the aorto-iliac, femoropopliteal and “Below the Knee” level groups. The average pain score was 6.3 and 5.8 for surgical aortobifemoral bypass and femoropopliteal bypass. Pain scores for the endovascular intervention group was 4.4, 3.2 and 4.7 respectively for the aortoiliac, femoropopliteal and “Below the Knee” level groups. The improvement in the Rutherford gradings at six months were Aorto bifemoral Bypass (4.6 to 3.6), Femoro-popliteal (4.1 to 2.6) in the surgical group and Aortiliac (4.4 to 3.4), Femoropopliteal (4.2 to 2) and no change in the score for the “Below the Knee” group. At six-month follow-up, Doppler interrogation revealed a triphasic flow pattern in surgical and endovascular bypasses involving the aortoiliac and femoropopliteal segments. The doppler interrogation for the “Below the Knee” lesions at six-month follow-up was biphasic (n=3) to monophasic (n=1). Conclusion: Surgical bypass and endovascular intervention either as an independent treatment modality or in combination as a Hybrid procedure looks promising in the management of LEAD. Surgical bypass is no doubt morbid, but early results are satisfactory in terms of patency rates and clinical improvement. The early six months results of endovascular intervention, are particularly encouraging in the femoropopliteal segment with poor distal run off. The results are inconsistent for the “Below the Knee” segment disease. TASC II- A and B lesions are addressed by endovascular interventions, whereas TASC II- C and D lesions are addressed by surgical bypass. Multidisciplinary individualised treatment approach should be adopted in deciding which treatment to be provided for a particular patient based on clinical, imaging findings and institutional protocols
Background: Dearth of expertise to manage vascular trauma spiraled with delay in diagnosis and referral to tertiary care centers continue to plague a developing nation like India. The brachial artery is the commonest artery to be injured in extremity following trauma. Although the patients present late, revascularization to salvage the limb and to maintain its function is advocated. This retrospective study was done to evaluate the management and outcomes of brachial artery revascularization in patients with delayed presentation of traumatic brachial artery injury.Methods: Twenty-six patients of traumatic brachial artery injury who met the inclusion criteria during 1-year study period (August 2019 to July 2020) were included. Patients with iatrogenic vascular injury, severe vascular injury associated with massive orthopaedic neuromuscular injury (i.e., crush injury), mottled upper limb and injury to neck, chest, abdomen, lower limbs or any pseudoaneurysm were excluded. Data were analysed.Results: Amongst 26 patients studied, 24 (92.30%) patients had complete transection of the artery. Of these, 19 (79.16%) had primary repair in the form of end-to-end anastomosis and 7 (29.16%) underwent reverse interposition saphenous vein grafting. Two patients with partial laceration of brachial artery underwent primary (lateral) repair. Associated fracture of humerus was managed with internal fixation following revascularization. Four cases underwent end to end repair of median nerve. Majority, 22 (84.61%) had good functional outcome and 4 (15.38%) had satisfactory functional results. Limb salvage rates was 100%.Conclusions: Revascularization beyond warm ischemia time is still desirable to prevent limb loss. Traumatic neurological injury affects the functional outcome.
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