RESUMEN
The current state of the literature for a bullet embolization to the heart and/or pulmonary vasculature indicates the occurrence is rare but could increase due to the rise in civilian low-kinetic-energy firearm acquisition and use. We present the case of an older teenage male who sustained a gunshot wound to the left flank. The bullet entered the iliac vein, travelled through the heart and lodged in the pulmonary artery. Successful relocation of the bullet to the internal iliac vein was performed by the interventional radiologist. This article highlights the advancement of interventional radiology as a successful non-invasive endovascular technique for bullet embolus removal.
Asunto(s)
Procedimientos Endovasculares , Migración de Cuerpo Extraño , Arteria Pulmonar , Heridas por Arma de Fuego , Humanos , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía , Masculino , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/lesiones , Arteria Pulmonar/cirugía , Resultado del Tratamiento , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/terapia , Procedimientos Endovasculares/instrumentación , Adolescente , Radiografía Intervencional , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/lesiones , Vena Ilíaca/cirugía , Angiografía por Tomografía Computarizada , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/cirugía , Embolia Pulmonar/terapiaRESUMEN
Pulmonary artery rupture is a rare complication of right heart catheterization characterized by a rapid clinical deterioration and high mortality rate. We present the case of an 89-year-old woman with severe symptomatic aortic stenosis who underwent cardiac catheterization prior to aortic valve replacement. The patient had acute cardiopulmonary deterioration due to pulmonary artery rupture at the time of right heart catheterization, that was successfully sealed by balloon tamponade.
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Estenosis de la Válvula Aórtica , Oclusión con Balón , Enfermedad Iatrogénica , Arteria Pulmonar , Lesiones del Sistema Vascular , Humanos , Femenino , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/lesiones , Arteria Pulmonar/fisiopatología , Arteria Pulmonar/cirugía , Resultado del Tratamiento , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/terapia , Lesiones del Sistema Vascular/cirugía , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Índice de Severidad de la Enfermedad , RoturaRESUMEN
BACKGROUND: Bleeding from the pulmonary artery (PA) can be fatal in video-assisted thoracoscopic surgery (VATS) for lung cancer. We evaluated intraoperative PA injury and assessed precautions for thoracoscopic anatomic pulmonary resection. METHODS: We retrospectively analyzed a total of 1098 patients who underwent radical surgery for lung cancer utilizing complete VATS from January 2010 to December 2021. RESULTS: A total of 16 patients (1.5%) had PA injury during VATS, while hemostasis was performed by conversion to thoracotomy in eight patients (50.0%). Although there was a significantly greater operation time and blood loss for patients in the PA injury group (318.4 vs. 264.9 min, p = 0.001; 550.3 vs. 60.5 g, p ≤ 0.001, respectively), there was no significant different for the chest tube insertion duration and length of postoperative hospital stay (4.9 vs. 7.8 days, p = 0.157; 10.6 vs. 9.9 days, p = 0.136, respectively). There was a significant difference observed for the surgical procedure related to the left upper lobectomy in the PA injury group (43.8 vs. 18.8%, p = 0.012), with the primary causative PA determined to be the left anterior segmental PA (A3 ) (31.3%). CONCLUSIONS: VATS is both feasible and safe for lung cancer treatment provided the surgeon performs appropriate hemostasis, although fatal vascular injury could potentially occur during VATS. Surgeons need to be aware of the pitfalls regarding PA dissection management.
Asunto(s)
Pérdida de Sangre Quirúrgica , Neoplasias Pulmonares , Arteria Pulmonar , Cirugía Torácica Asistida por Video , Humanos , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Neoplasias Pulmonares/cirugía , Arteria Pulmonar/lesiones , Estudios Retrospectivos , Cirugía Torácica Asistida por Video/efectos adversosAsunto(s)
Embolia , Migración de Cuerpo Extraño/diagnóstico , Vena Ilíaca , Arteria Pulmonar , Radiografía Torácica/métodos , Heridas por Arma de Fuego/complicaciones , Toma de Decisiones Clínicas , Embolia/diagnóstico por imagen , Embolia/etiología , Embolia/terapia , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/etiología , Humanos , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/lesiones , Vértebras Lumbares/lesiones , Masculino , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/lesiones , Tomografía Computarizada por Rayos X/métodos , Espera Vigilante/métodos , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/fisiopatologíaRESUMEN
No disponible
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Humanos , Femenino , Anciano , Drenaje/efectos adversos , Arteria Pulmonar/lesiones , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/complicaciones , Lesión Pulmonar/etiología , Tomografía Computarizada por Rayos X/métodosRESUMEN
PURPOSE: The knowledge of variations in the branching patterns of pulmonary artery may have important clinical implications in the field of thoracic surgery. METHODS: At the Department of Thoracic Surgery of Monaldi Hospital in Naples, between January 2017 and December 2019, 569 anatomic pulmonary resections via video-assisted thoracic surgery, including lobectomy and segmentectomy, were performed. RESULTS: Among the 569 thoracoscopic pulmonary resections, 24 variations in the branching patterns of pulmonary artery were identified and documented. Anatomic variations on the left were more frequent than on the right. CONCLUSION: This paper, providing a summary of vascular anomalies identified during major lung resections, could help surgeons avoid intraoperative complications, especially during minimally invasive procedures where the visual field is more restricted than open surgery.
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Variación Anatómica , Complicaciones Intraoperatorias/prevención & control , Neumonectomía/efectos adversos , Arteria Pulmonar/anomalías , Cirugía Torácica Asistida por Video/efectos adversos , Humanos , Complicaciones Intraoperatorias/etiología , Pulmón/irrigación sanguínea , Pulmón/cirugía , Neumonectomía/métodos , Arteria Pulmonar/lesiones , Estudios Retrospectivos , Cirugía Torácica Asistida por Video/métodosRESUMEN
We present a low-cost, simple simulation model of major vascular injury repair for cardiothoracic trainees. This model uses commercially available orthopedic elastic bands to allow repetitive practice of the skills necessary during these rare but critical clinical scenarios. Practicing core skills in the simulation setting will help residents be better prepared when the situation arises.
Asunto(s)
Competencia Clínica , Simulación por Computador , Arteria Pulmonar/cirugía , Entrenamiento Simulado/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/cirugía , Humanos , Internado y Residencia/métodos , Arteria Pulmonar/lesiones , Procedimientos Quirúrgicos Vasculares/educaciónRESUMEN
Pulmonary arterial hypertension (PAH) is associated with elevated pulmonary arterial pressure. PAH prognosis remains poor with a 15% mortality rate within 1 year, even with modern clinical management. Previous clinical studies proposed wall shear stress (WSS) to be an important hemodynamic factor affecting cell mechanotransduction, growth and remodeling, and disease progress in PAH. However, WSS in vivo is typically at most 2.5 Pa and a doubt has been cast whether WSS alone can drive disease progress. Furthermore, our current understanding of PAH pathology largely comes from small animals' studies in which caliber enlargement, a hallmark of PAH in humans, is rarely reported. Therefore, a large-animal experiment on pulmonary arteries (PAs) is needed to validate whether increased pressure can induce enlargement of PAs caliber. In this study, we use an inflation testing device to characterize the mechanical behavior, both nonlinear elastic behavior and irreversible damage of porcine arteries. The parameters of elastic behavior are estimated from the inflation test at a low-pressure range before and after over-pressurization. Then, histological images are qualitatively examined for medial and adventitial layers. This study sheds light on the relevance of pressure-induced damage mechanism in human PAH.
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Presión/efectos adversos , Hipertensión Arterial Pulmonar/fisiopatología , Arteria Pulmonar/lesiones , Animales , Elasticidad , Diseño de Equipo , Modelos Biológicos , Estrés Mecánico , Porcinos , Transductores de PresiónRESUMEN
Autophagy has been greatly implicated in injured endothelial cells during pulmonary arterial hypertension (PAH). ß-arrestin1, a multifunctional cytoplasmic protein, has attracted considerable attention as an essential protective factor in PAH. However, its role in autophagy of injured pulmonary arterial endothelial cells (PAECs) remains to be determined. Here, we investigated the potential effects of ß-arrestin1 on autophagy and apoptosis in human PAECs (hPAECs) under hypoxic stress. Hypoxic stimuli increases autophagy and decreases the level of ß-arrestin1 in hPAECs. Furthermore, pathologic changes, namely increased proliferation, migration, and apoptosis resistance, are observed after hypoxia exposure. These are reversed after ß-arrestin1 overexpression (ß-arrestin1-OV) or treatment with 3-MA, an autophagy inhibitor. Finally, ß-arrestin1 suppresses the increase in autophagy and apoptosis resistance of hypoxic hPAECs. Mechanistically, ß-arrestin1 upregulates the activity of the Akt/mTOR signaling pathway and downregulates the expression of BNIP3 and Nix after hypoxic stress. Collectively, we have demonstrated, for the first time, that ß-arrestin1 reduces excessive autophagy and apoptosis resistance by activating the Akt/mTOR axis in hypoxic hPAECs. This knowledge suggests a promising therapeutic target for PAH.
Asunto(s)
Autofagia/genética , Hipoxia de la Célula/genética , Células Endoteliales/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Arteria Pulmonar/metabolismo , Serina-Treonina Quinasas TOR/metabolismo , beta-Arrestina 1/metabolismo , Adenina/análogos & derivados , Adenina/farmacología , Apoptosis/efectos de los fármacos , Autofagosomas/metabolismo , Autofagosomas/ultraestructura , Autofagia/efectos de los fármacos , Movimiento Celular/genética , Proliferación Celular/efectos de los fármacos , Proliferación Celular/genética , Células Endoteliales/ultraestructura , Técnicas de Silenciamiento del Gen , Humanos , Proteínas de la Membrana/metabolismo , Microscopía Electrónica de Transmisión , Fosforilación , Proteínas Proto-Oncogénicas/metabolismo , Arteria Pulmonar/lesiones , ARN Interferente Pequeño , Transducción de Señal/genética , Proteínas Supresoras de Tumor/metabolismo , beta-Arrestina 1/genéticaAsunto(s)
Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Arteria Pulmonar/cirugía , Traumatismos Torácicos/cirugía , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/cirugía , Heridas Punzantes/cirugía , Adolescente , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Aorta Torácica/fisiopatología , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/fisiopatología , Puente Cardiopulmonar , Paro Cardíaco Inducido , Humanos , Masculino , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/lesiones , Arteria Pulmonar/fisiopatología , Circulación Pulmonar , Flujo Sanguíneo Regional , Esternotomía , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/fisiopatología , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/fisiopatología , Heridas Punzantes/diagnóstico por imagen , Heridas Punzantes/fisiopatologíaRESUMEN
We describe a female patient who received hybrid catheter intervention and occlusion of the patent ductus arteriosus (PDA) and left atrial appendage (LAA). Four hours after the procedure, pericardial tamponade suddenly occurred. Surgical exploration of the heart found that a fixation hook of the WATCHMAN device, had protruded through the LAA wall and tore the dilated pulmonary artery (PA). This is the first case report to describe PA perforation caused by barbs of the WATCHMAN device, and more attention should be paid to the relationship between the LAA and its adjacent structures before LAA closure.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial/terapia , Cateterismo Cardíaco/efectos adversos , Taponamiento Cardíaco/etiología , Conducto Arterioso Permeable/terapia , Arteria Pulmonar/lesiones , Dispositivo Oclusor Septal/efectos adversos , Lesiones del Sistema Vascular/etiología , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Cateterismo Cardíaco/instrumentación , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/cirugía , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/fisiopatología , Femenino , Técnicas Hemostáticas , Humanos , Persona de Mediana Edad , Diseño de Prótesis , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Reoperación , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugíaAsunto(s)
Angioplastia de Balón , Complicaciones Posoperatorias/cirugía , Arteria Pulmonar/lesiones , Estenosis de Arteria Pulmonar/cirugía , Anciano de 80 o más Años , Angioplastia de Balón/métodos , Constricción , Femenino , Humanos , Enfermedad Iatrogénica , Complicaciones Posoperatorias/etiología , Inducción de Remisión , Estenosis de Arteria Pulmonar/etiología , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Hemoptisis/etiología , Cateterismo de Swan-Ganz/efectos adversos , Embolización Terapéutica/métodos , Cateterismo de Swan-Ganz/instrumentación , Arteria Pulmonar/lesiones , Ecocardiografía , Hemoptisis/diagnóstico por imagen , Angiografía/instrumentaciónAsunto(s)
Tratamiento Conservador , Arteria Pulmonar/lesiones , Rotura/terapia , Heridas no Penetrantes/terapia , Accidentes de Tránsito , Adolescente , Adulto , Anciano , Angiografía por Tomografía Computarizada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Rotura/diagnóstico , Túnica Íntima/lesiones , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
Mitochondrial dysfunction plays a principal role in hypoxia-induced endothelial injury, which is involved in hypoxic pulmonary hypertension and ischemic cardiovascular diseases. Recent studies have identified mitochondria-associated membranes (MAMs) that modulate mitochondrial function under a variety of pathophysiological conditions such as high-fat diet-mediated insulin resistance, hypoxia reoxygenation-induced myocardial death, and hypoxia-evoked vascular smooth muscle cell proliferation. However, the role of MAMs in hypoxia-induced endothelial injury remains unclear. To explore this further, human umbilical vein endothelial cells and human pulmonary artery endothelial cells were exposed to hypoxia (1% O2 ) for 24 hours. An increase in MAM formation was uncovered by immunoblotting and immunofluorescence. Then, we performed small interfering RNA transfection targeted to MAM constitutive proteins and explored the biological effects. Knockdown of MAM constitutive proteins attenuated hypoxia-induced elevation of mitochondrial Ca2+ and repressed mitochondrial impairment, leading to an increase in mitochondrial membrane potential and ATP production and a decline in reactive oxygen species. Then, we found that MAM disruption mitigated cell apoptosis and promoted cell survival. Next, other protective effects, such as those pertaining to the repression of inflammatory response and the promotion of NO synthesis, were investigated. With the disruption of MAMs under hypoxia, inflammatory molecule expression was repressed, and the eNOS-NO pathway was enhanced. This study demonstrates that the disruption of MAMs might be of therapeutic value for treating endothelial injury under hypoxia, suggesting a novel strategy for preventing hypoxic pulmonary hypertension and ischemic injuries.
Asunto(s)
Células Endoteliales de la Vena Umbilical Humana , Mitocondrias , Membranas Mitocondriales , Arteria Pulmonar , Adenosina Trifosfato/metabolismo , Calcio/metabolismo , Hipoxia de la Célula , Células Endoteliales de la Vena Umbilical Humana/metabolismo , Células Endoteliales de la Vena Umbilical Humana/patología , Humanos , Inflamación/metabolismo , Inflamación/patología , Mitocondrias/metabolismo , Mitocondrias/patología , Membranas Mitocondriales/metabolismo , Membranas Mitocondriales/patología , Óxido Nítrico/metabolismo , Óxido Nítrico Sintasa de Tipo III/metabolismo , Arteria Pulmonar/lesiones , Arteria Pulmonar/metabolismo , Arteria Pulmonar/patologíaRESUMEN
BACKGROUND: Completion lobectomy long after segmentectomy in the same lobe is extremely difficult because of severe adhesions around hilar structures, especially in cases involving video-assisted thoracoscopic surgery (VATS) completion lobectomy. We report and compare the surgical outcomes of patients who underwent VATS or thoracotomy completion lobectomy long after radical segmentectomy for lung cancer. METHODS: We retrospectively evaluated the surgical outcomes of completion lobectomies performed at our institute long after radical segmentectomies for lung cancer in the same lobe. The efficacy and safety of VATS completion lobectomy was compared to that of thoracotomy completion lobectomy. RESULTS: Ten of 228 patients who underwent radical segmentectomy for lung cancer between 2009 and 2018 underwent completion lobectomy at least a month after segmentectomy; five patients underwent VATS completion lobectomy. None of the patients underwent VATS left upper completion lobectomy, and conversion to thoracotomy was required in one patient. There were no significant differences between VATS and thoracotomy completion lobectomies in the median operative times (VATS 295 min, thoracotomy 339 min, p = 0.55), intraoperative blood loss volumes (VATS 350 mL, thoracotomy 500 mL, p = 0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40 months, thoracotomy 48 months, p = 0.55), and number of patients with pulmonary artery injury (VATS 1, thoracotomy 2, p = 0.49). There was no operation-related mortality. CONCLUSIONS: VATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.
Asunto(s)
Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Cirugía Torácica Asistida por Video , Toracotomía , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Neumonectomía/efectos adversos , Arteria Pulmonar/lesiones , Estudios Retrospectivos , Cirugía Torácica Asistida por Video/efectos adversos , Toracotomía/efectos adversos , Resultado del TratamientoRESUMEN
Cardiovascular injuries represent the second most common cause of death among trauma victims in the United States. Motor vehicle collisions account for more than 80% of all blunt thoracic trauma. Given the nonspecific nature and variable severity of presenting symptoms, such as chest pain and shortness of breath, as well as confounding and overlapping clinical presentations in the setting of additional injuries, diagnosis of cardiovascular injuries can be challenging. This article reviews the clinical entities of acute aortic syndrome and pulmonary embolism, their imaging findings, and diagnostic challenges.