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Dextrocardia is a very rare congenital malposition, and most cardiologists are not familiar with the radiographic angiograms of this condition. Here, we first report a case of dextrocardia with a chronic total occlusion (CTO) lesion undergoing retrograde percutaneous coronary intervention (PCI). Significant difficulties in lesion interpretation and device manipulation were encountered with the original angiograms. These challenges were not significantly improved until we adopted the double-inversion technique. The procedure was finally accomplished by using the kissing wire technique with a poor angle of attack. Retrograde CTO PCI for patients with dextrocardia is feasible with adequate techniques.
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Angiografía Coronaria , Oclusión Coronaria , Dextrocardia , Intervención Coronaria Percutánea , Humanos , Dextrocardia/complicaciones , Dextrocardia/diagnóstico por imagen , Intervención Coronaria Percutánea/métodos , Oclusión Coronaria/cirugía , Oclusión Coronaria/diagnóstico , Oclusión Coronaria/complicaciones , Masculino , Enfermedad Crónica , Anciano , Persona de Mediana EdadRESUMEN
An 85-year-old female with situs inversus totalis presented with right hemiplegia, right facial nerve palsy, eye deviation to the left, and aphasia. Magnetic resonance imaging revealed acute ischemic lesions in the left insular cortex and the frontal lobe. Magnetic resonance angiography revealed an occlusion of the left internal carotid artery. Reversed-image mechanical thrombectomy achieved complete reperfusion in three passes within 54 minutes. Six months post-intervention, the patient could walk indoors independently. Our technique, which replicates the normal arterial anatomy by inversion and angulation, was adapted to situs inversus totalis.
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OBJECTIVE: To demonstrate the feasibility of transoral resection of, even large, combined laryngoceles by endoscopic CO2 laser resection using the inversion technique. METHODS: A retrospective study over a 25-year period of 20 patients with 22 combined laryngoceles. All patients were operated on using the CO2 laser inversion technique. Pre- and postoperative computed tomography (CT)-scans or magnetic resonance (MR) imaging were available in all patients. RESULTS: There were no surgical problems during all procedures. One patient required a tracheotomy pre-operatively due to a compromised airway. All procedures were without intraoperative complications. Postoperatively, there were two complications: one hemorrhage, and one patient developed a granuloma with airway compromise. In two patients, residual disease was detected on postoperative imaging. One of them was re-operated several years later due to the progression of this residual external component of the laryngocele. One patient had a non-significant small internal laryngocele recurrence. The recurrence rate in this series was 2/22 (9.1%). The majority of patients (15/20) could be discharged from the hospital the day after surgery. CONCLUSION: The results of this study show excellent control of combined laryngoceles using the CO2 laser inversion technique, with a short hospital stay and a low rate of complications and recurrence. Even in large combined laryngoceles, CO2 laser excision using the inversion technique should be considered. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:2742-2746, 2023.
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Laringocele , Terapia por Láser , Humanos , Laringocele/cirugía , Dióxido de Carbono , Estudios Retrospectivos , Endoscopía , Terapia por Láser/métodos , Rayos LáserRESUMEN
BACKGROUND AND AIMS: The optimal procedure for reconstructing the dissected aortic stump for acute type A dissection remains controversial. We routinely used the intimal-protected adventitial inversion technique (iPAIT), a modified adventitial inversion technique, to protect the fragile intima by inserting a graft and assessed the safety and efficacy of this technique. METHODS: Between August 2008 and April 2020, 146 consecutive patients with acute type A dissections underwent thoracic aortic surgery in our hospital. Extended total aortic arch replacement was performed in 119 patients (81.5%). Sixty-nine patients underwent treatment for distal aortic anastomosis with the iPAIT. To compare the iPAIT to a historical control, we assessed 69 iPAIT patients and 25 patients who underwent total arch replacement using gelatin-resorcinol-formaldehyde (GRF) glue. RESULTS: Hospital mortality was 2.9% in the iPAIT group and 8.0% in the GRF group. Perioperative characteristics were similar between the two groups. However, postoperative computed tomography revealed that the obliteration rate was significantly higher in the iPAIT group (60/66, 90.9%) than in the GRF group (15/23, 65.2%) (p = .01), not including the patients who had died or developed severe renal dysfunction. The 8-year aortic event-free survival rate in the iPAIT group (81.3%) was significantly higher than that in the GRF group (47.4%). CONCLUSIONS: The use of this technique for acute type A dissections resulted in a low mortality rate and demonstrated promising midterm survival and may accelerate the obliteration of a patent false lumen and prevent late aortic events.
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Aneurisma de la Aorta Torácica , Disección Aórtica , Enfermedad Aguda , Anastomosis Quirúrgica/métodos , Disección Aórtica/etiología , Aorta/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/etiología , Grosor Intima-Media Carotídeo , Humanos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
OBJECTIVES: The adventitial inversion technique is used widely for aortic reconstruction for acute type A aortic dissection, as it easily controls the bleeding at anastomotic sites and closes the patent false lumen. However, this technique for arch vessel reconstruction has not been previously reported. Therefore, we applied the adventitial inversion technique for dissected arch vessel reconstruction to close the patent false lumen. METHODS: Among 57 consecutive patients who underwent emergency surgical treatment for acute type A aortic dissection from July 2006 to July 2012, the adventitial inversion technique for the dissected arch vessels was performed in 26 patients (42 arch vessel stumps). The patency and morphologic change of the false lumen of the arch vessels were evaluated using contrast-enhanced computed tomography. RESULTS: Overall, 2 hospital deaths were recorded, and the hospital mortality rate was 4%. No postoperative cerebral strokes and reoperations due to bleeding occurred. Follow-up by contrast-enhanced computed tomography was completed in 24 patients (37 stumps) with a mean duration of 99 ± 35 months. The postoperative closure rate of the false lumen after adventitial inversion was 86%, which was higher than when adventitial inversion was not used. No adverse events including stroke occurred during follow-up period. CONCLUSIONS: This technique facilitates the closure of the false lumen of dissected arch vessels and might improve clinical outcomes.
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Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Adventicia/diagnóstico por imagen , Adventicia/cirugía , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/etiología , Disección Aórtica/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Mortalidad Hospitalaria , Humanos , Estudios Retrospectivos , Stents , Resultado del TratamientoRESUMEN
This study describes a method for the modification of polyurethane small-diameter (5 mm) vascular prostheses obtained with the phase inversion method. The modification process involves two steps: the introduction of a linker (acrylic acid) and a peptide (REDV and YIGSR). FTIR and XPS analysis confirmed the process of chemical modification. The obtained prostheses had a porosity of approx. 60%, Young's Modulus in the range of 9-11 MPa, and a water contact angle around 40°. Endothelial (EC) and smooth muscle (SMC) cell co-culture showed that the surfaces modified with peptides increase the adhesion of ECs. At the same time, SMCs adhesion was low both on unmodified and peptide-modified surfaces. Analysis of blood-materials interaction showed high hemocompatibility of obtained materials. The whole blood clotting time assay showed differences in the amount of free hemoglobin present in blood contacted with different materials. It can be concluded that the peptide coating increased the hemocompatibility of the surface by increasing ECs adhesion and, at the same time, decreasing platelet adhesion. When comparing both types of peptide coatings, more promising results were obtained for the surfaces coated with the YISGR than REDV-coated prostheses.
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Materiales Biocompatibles/química , Materiales Biocompatibles/farmacología , Prótesis Vascular , Poliuretanos/química , Poliuretanos/farmacología , Animales , Materiales Biocompatibles/síntesis química , Coagulación Sanguínea/efectos de los fármacos , Línea Celular , Supervivencia Celular/efectos de los fármacos , Técnicas de Cocultivo , Células Endoteliales de la Vena Umbilical Humana/citología , Células Endoteliales de la Vena Umbilical Humana/efectos de los fármacos , Humanos , Ensayo de Materiales , Fenómenos Mecánicos , Ratones , Microscopía Electrónica de Rastreo , Miocitos del Músculo Liso/citología , Miocitos del Músculo Liso/efectos de los fármacos , Adhesividad Plaquetaria/efectos de los fármacos , Poliuretanos/síntesis química , Porosidad , Propiedades de SuperficieRESUMEN
Situs inversus totalis with dextrocardia is a rare congenital occurrence. Risk of coronary atherosclerosis and acute myocardial infarction in this subset is similar to that in the general population. Diagnosing myocardial injury in time, and executing primary percutaneous coronary intervention (PCI) successfully in these patients is challenging given that physicians are rarely attuned to recognizing the electrocardiographic changes of acute coronary syndromes in this anatomy and interventional cardiologists are not routinely accustomed to working with the angiographic projections in this unique subset. Here, we describe electrocardiogram identification and an approach to primary PCI in one such patient. We have also attempted to simplify and refine primary PCI in this subset by introducing postero-anterior projection single inversion technique for suitable lesions in suitable vessels in this unique subset.
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This work presents a method of obtaining cylindrical polymer structures with a given diameter (approx. 5 mm) using the phase inversion technique. As part of the work, the influence of process parameters (polymer hardness, polymer solution concentration, the composition of the non-solvent solution, process time) on the scaffolds' morphology was investigated. Additionally, the influence of the addition of porogen on the scaffold's mechanical properties was analyzed. It has been shown that the use of a 20% polymer solution of medium hardness (ChronoFlex C45D) and carrying out the process for 24 h in 0:100 water/ethanol leads to the achievement of repeatable structures with adequate flexibility. Among the three types of porogens tested (NaCl, hexane, polyvinyl alcohol), the most favorable results were obtained for 10% polyvinyl alcohol (PVA). The addition of PVA increases the range of pore diameters and the value of the mean pore diameter (9.6 ± 3.2 vs. 15.2 ± 6.4) while reducing the elasticity of the structure (Young modulus = 3.6 ± 1.5 MPa vs. 9.7 ± 4.3 MPa).
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In ultrasound tissue harmonic imaging (THI), it is preferred that the bandwidth of the array transducer covers at least the fundamental frequency f0 for transmission and the second harmonic frequency 2f0 for reception. However, it is challenging to develop an array transducer with a broad bandwidth due to the single resonance characteristics of piezoelectric materials. In this study, we present an improved interleaved array transducer suitable for THI and a dedicated transducer fabrication scheme. The proposed array transducer has a novel structure in which conventional elements exhibiting f0 resonant frequency and polarization-inverted elements exhibiting 2f0 resonant frequency are alternately located, and the thicknesses of all piezoelectric elements are identical. The performance of the proposed method was demonstrated by finite element analysis (FEA) simulations and experiments using a fabricated prototype array transducer. Using the proposed technique, f0 and 2f0 frequency ultrasounds can be efficiently transmitted and received, respectively, resulting in a 90% broad bandwidth feature of the transducer. Thus, the proposed technique can be one of the potential ways to implement high resolution THI.
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Transductores , Ultrasonografía , Diseño de Equipo , Análisis de Elementos Finitos , HumanosRESUMEN
BACKGROUND: The reconstruction of a total amputated auricle is aesthetically demanding for otorhinolaryngology surgeons. Although various reattachment methods have been introduced since 1898, only a few have achieved satisfactory aesthetic outcomes. This study aimed to present a successful case of auricular reconstruction using a two-stage inversion technique. CASE PRESENTATION: The patient's left ear was extensively lacerated in a violent event 3 h before admission. The first-stage surgery was performed within 6 h of ischemic time. The amputated segment was prepared and trimmed carefully, and the anterior aspect of the avulsed auricle was directly sutured. The posterior skin of the ear was separated from the cartilage to close the wound. Then, using an inversion maneuver, the cartilage was pushed into a postauricular underlying muscle bed. In the second-stage surgery 27 days after the first procedure, the auricle was released and the normal ear structure was restored using full-thickness skin grafting. During a follow-up of more than 9 years, the patient showed satisfactory postoperative results in terms of cosmetic and functional outcomes of the reattached auricle. The size of his left ear was about 90% of the size of his right ear. CONCLUSIONS: The reconstruction of a total amputated auricle is challenging. The key to surgery lies in the sufficient preservation of the meticulous shape of the cartilage. The microsurgical anastomosis is a good choice only in selected cases. It is believed that the two-stage inversion technique can be a simple alternative to reconstruct the auricle in most situations when it is lacerated and contaminated.
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Pabellón Auricular/cirugía , Procedimientos Quirúrgicos Otológicos/métodos , Procedimientos de Cirugía Plástica/métodos , Amputación Traumática/cirugía , Cartílago/trasplante , Pabellón Auricular/lesiones , Humanos , Laceraciones/cirugía , Masculino , Trasplante de Piel , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Partially covered self-expandable metallic stents (PCSEMS), although an effective treatment for anastomotic/staple line leaks and strictures, can be difficult to remove. This study examines the effectiveness of the inversion technique for the removal of PCSEMS in the treatment of leaks and strictures that occurred post-sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). METHODS: Consecutive patients who underwent PCSEMS removal for a leak and/or stricture post-SG or RYGB between July 2013 and December 2016 at the Johns Hopkins Medical Institutions were reviewed. All PCSEMS removals were first attempted via the inversion technique, which involves grasping the distal end of the stent and inverting it through itself. RESULTS: Fourteen patients (four males) underwent PCSEMS removal via the inversion technique for an anastomotic/staple line leak (50%), stricture (29%) or both (21%) post-SG (79%) or RYGB (21%). Technical success (successful removal of the stent) was achieved in one endoscopic session for 13 of the 14 PCSEMS (93%). One PCSEMS required the use of the stent-in-stent technique for removal. The median dwell time was 47 days (range 5-72). A distal partial occlusion developed in five patients (35%) due to tissue overgrowth and one PCSEMS (7%) migrated, necessitating premature removal. Eight patients (57%) experienced clinical success at follow-up, and six patients (43%) required subsequent treatment due to persistence or recurrence of the pathology. CONCLUSIONS: The inversion technique is a safe, effective, and efficient method of removing PCSEMS placed to correct anastomotic/staple line leaks and strictures post-SG and RYGB.
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Fuga Anastomótica/etiología , Fuga Anastomótica/cirugía , Remoción de Dispositivos/métodos , Endoscopía Gastrointestinal , Gastrectomía/efectos adversos , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Stents Metálicos Autoexpandibles , Adulto , Anciano , Constricción Patológica/cirugía , Remoción de Dispositivos/efectos adversos , Endoscopía Gastrointestinal/instrumentación , Endoscopía Gastrointestinal/métodos , Femenino , Gastrectomía/instrumentación , Gastrectomía/métodos , Derivación Gástrica/instrumentación , Derivación Gástrica/métodos , Humanos , Masculino , Persona de Mediana Edad , Reoperación/instrumentación , Reoperación/métodos , Estudios Retrospectivos , Grapado Quirúrgico/efectos adversos , Grapado Quirúrgico/instrumentación , Resultado del TratamientoRESUMEN
The Radiation Assessment Detector (RAD), onboard the Mars Science Laboratory (MSL) rover Curiosity, has been measuring the energetic charged and neutral particles and the radiation dose rate on the surface of Mars since the landing of the rover in August 2012. In contrast to charged particles, neutral particles (neutrons and γ-rays) are measured indirectly: the energy deposition spectra produced by neutral particles are complex convolutions of the incident particle spectra with the detector response functions. An inversion technique has been developed and applied to jointly unfold the deposited energy spectra measured in two scintillators of different types (CsI for high γ detection efficiency, and plastic for neutrons) to obtain the neutron and γ-ray spectra. This result is important for determining the biological impact of the Martian surface radiation contributed by neutrons, which interact with materials differently from the charged particles. These first in-situ measurements on Mars provide (1) an important reference for assessing the radiation-associated health risks for future manned missions to the red planet and (2) an experimental input for validating the particle transport codes used to model the radiation environments within spacecraft or on the surface of planets. Here we present neutral particle spectra as well as the corresponding dose and dose equivalent rates derived from RAD measurement during a period (November 15, 2015 to January 15, 2016) for which the surface particle spectra have been simulated via different transport models.
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Radiación Cósmica , Marte , Neutrones , Exposición Profesional/análisis , Monitoreo de Radiación/métodos , Astronautas , Humanos , Protección Radiológica , Medición de Riesgo , Factores de TiempoRESUMEN
AIM: A tension-free well vascularized colorectal or coloanal anastomosis is not always possible following rectal or sigmoid resection. The study reports on the short-term and long-term outcome of a modified right colon inversion technique as a means of facilitating a low colorectal or coloanal anastomosis. METHOD: All patients who underwent right colonic inversion, a modified Deloyers' procedure, were identified retrospectively from the prospective database of the Colorectal Department of the Royal Marsden Hospital from October 2008 to December 2013. RESULTS: There were 14 (nine male) patients of median age 58.7 (45-75) years. The main indication was extensive diverticular disease (50%) and previous colonic surgery (21.4%). A defunctioning stoma was performed in 64.3% which was reversed in all within 3-6 months. Three (21.4%) patients developed postoperative complications (Clavien-Dindo 1-2) and none required reoperation. The median duration of follow-up was 11 months. One (7.2%) patient had one bowel movement per day, 10 (71.4%) patients had two bowel movements per day and three (21.4%) patients had three per day. CONCLUSION: The modified right colonic inversion technique is safe and achieves intestinal continuity with a tension-free well vascularized anastomosis. Good function and low morbidity show that the procedure is a credible alternative to ileorectal or ileoanal anastomosis.
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Canal Anal/cirugía , Colon Ascendente/cirugía , Colon Transverso/cirugía , Recto/cirugía , Terapia Recuperativa/métodos , Anciano , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Defecación , Divertículo del Colon/cirugía , Femenino , Guerra del Golfo , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios RetrospectivosRESUMEN
Percutaneous coronary intervention in patients with dextrocardia presents several challenges due to abnormal location of the heart, mirror image pattern of aortic arch and its branches, and abnormal coronary origin and orientation. The challenges involve appropriate choice of vascular access, guiding catheters, engagement technique, acquisition and interpretation of radiological orientation of coronary anatomy, and appropriate radiological angles and views. We report a patient with dextrocardia and situs inversus who presented with acute ST segment elevation myocardial infarction and was successfully treated with trans-radial primary percutaneous coronary intervention using "double inversion technique." We also emphasize that left radial artery approach may be technically preferred to right radial artery approach due to mirror image aortic arch branching pattern.
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Distal anastomosis during total arch replacement (TAR) for thoracic aortic aneurysm (TAA) is often difficult to perform because of the limited surgical view. The most common methods available are direct anastomosis of a 4-branched graft to the distal aorta, or stepwise anastomosis with the elephant trunk procedure. However, the stepwise technique requires graft-to-graft anastomosis, which is often associated with bleeding. In the present study, we developed a new approach, which we have termed the “Branched Graft Inversion technique”, which does not require anastomosis between grafts, and facilitates anastomosis with a view equal to that in the stepwise technique. A 65-year-old man with a diagnosis of saccular-type thoracic aortic aneurysm was admitted. Cardiopulmonary bypass was established by cannulating the ascending aorta and femoral artery via a median sternotomy. We performed distal anastomosis under selective cerebral perfusion during hypothermic circulatory arrest (25°C). An inverted branched graft was inserted into the descending aorta and anastomosed using mattress and running sutures together with outer reinforcement with a Teflon felt strip. The distal end of the inverted branched graft was then extracted, and reconstruction of the neck vessels and proximal anastomosis were performed. Our newly developed Branched Graft Inversion technique was useful during TAR for TAA.
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We treated two cases of Stanford type A acute dissecting aortic aneurysm with the adventitial inversion technique. Both case 1) a 65-year-old woman and 2) a 74-year-old woman underwent emergency operation. After cardiopulmonary bypass was established as usual, the diseased aorta was resected, and the intima was trimmed about 10mm shorter than the transected adventitial line in both proximal and distal ends. After GRF glue was employed, the adventitia was inverted inward over the false-lumen, and then tacked with horizontal continuous mattress sutures using 5-0 polypropylene. The graft was then anastomosed with continuous sutures using 3-0 polypropylene. No bleeding occurred from the anastomosis site in both cases. This method was completed without the use of artificial reinforcement, nevertheless patent anastomosis was possible. This simple method was easily performed and proved to be safe and useful.