FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2004243604> ?p ?o ?g. }

• W2004243604 endingPage "1418" @default.
• W2004243604 startingPage "1416" @default.
• W2004243604 abstract "A 57-yr-old man (weight, 61 kg; height, 158 cm) with a history of hypertension and smoking was scheduled for aortic valve replacement to treat severe aortic stenosis. Echocardiography revealed an aortic valve area of 0.6 cm2 and a mean pressure gradient of 66 mm Hg across the stenotic aortic valve. Left ventricular hypertrophy was evident with normal systolic function and impaired diastolic function indicated by an abnormal relaxation pattern. After anesthetic induction and tracheal intubation, a 5-MHz multiplane transesophageal echocardiography (TEE) probe (Agilent Technologies, Andover, MA) was inserted into the esophagus. A 7.5F pulmonary artery catheter (PAC) (Edward Lifesciences LLC, Irvine, CA) was then inserted through an 8.5F percutaneous sheath introducer (Argon Medical Devices, Athens, TX) positioned in the right internal jugular vein. A normal pulmonary artery wedge pressure tracing was obtained at a depth of 50 cm, and the position of the catheter tip in the right main pulmonary artery was confirmed by TEE. No difficulties or immediate complications were associated with PAC insertion, and TEE of the right atrium, right ventricle, and pulmonary artery revealed no obvious abnormalities. Two vena cava cannulae (DLP69328, 28F cannula for inferior vena cava [IVC]; Medtronic, Minneapolis, MN) were inserted into the right atrium for cardiopulmonary bypass (CPB). After aortic valve replacement, the patient was uneventfully separated from CPB, and the 2 vena cava cannulae were easily removed. About 1 h after separation from CPB, there was a change in the waveform of the PAC suggestive of catheter wedging. The PAC tip was thought to be located too deeply; the anesthesiologist encountered resistance while attempting to gently withdraw the PAC by pulling with mild force and the catheter did not move. Therefore, TEE was interrogated to determine the cause of the resistance. A midesophageal bicaval view, with the multiplane angle at 85° and a field depth of 12 cm, revealed an area of relatively high brightness resembling an echogenic spot on the PAC, which was accompanied by acoustic shadowing and was fixed in the IVC cannulation site (Fig. 1). Gentle traction on the PAC produced invagination of the IVC cannulation site (Fig. 1) (Video 1; see Supplemental Digital Content 1, https://links.lww.com/AA/A37, transesophageal echocardiography showing entrapment of a pulmonary artery catheter [PAC]. Midesophageal bicaval view shows PAC entrapment. An area of relatively high brightness, resembling an echogenic spot, is visible on the PAC [circle], accompanied by acoustic shadowing [triangles]. Traction on the PAC produced invagination of the right atrial wall [arrow] with the echogenic spot and acoustic shadowing. The right atrial wall resembles “tenting” following the manual traction. RA, right atrium; LA, left atrium; SVC, superior vena cava; IVC, inferior vena cava; PAC, pulmonary artery catheter.) After we indicated that the PAC might be entrapped at the IVC cannulation site, the surgeon palpated the PAC in the right atrium. A slight pull on the catheter stretched and also pulled the purse string suture at the IVC cannulation site, which confirmed PAC entrapment. A new 2–0 Nespolen purse-string suture was placed around the original stitch, which was excised, and the catheter was released from the suture site without complications. The catheter was then withdrawn without difficulty to determine whether it had been perforated with the needle. The catheter appeared normal, demonstrating that the PAC was not perforated, but merely encircled by the suture. The patient was transferred to the intensive care unit and had an uneventful recovery.Figure 1.: Transesophageal echocardiography showing entrapment of a pulmonary artery catheter (PAC). Midesophageal bicaval view shows PAC entrapment after slight withdrawal. The PAC is fixed in the inferior vena cava cannulation site of the right atrial wall. In the same area, an area of relatively high brightness, resembling an echogenic spot, is visible on the PAC (circle), accompanied by acoustic shadowing (triangles). Traction on the PAC produced invagination of the right atrial wall, resembling “tenting” of the atrial wall (arrow). RA = right atrium; LA = left atrium; SVC = superior vena cava; IVC = inferior vena cava.DISCUSSION Placement of a PAC for hemodynamic monitoring during cardiac surgery is associated with various complications, one of which is entrapment of the catheter.1 PACs have become entrapped at various locations, such as the cannulation site on the IVC,2–4 the right atriotomy suture line,1,4 the pulmonary artery vent site,4–7 and the right ventricular papillary muscle.1 The mechanisms of catheter entrapment involve a suture encircling or perforating the catheter and knotting of the catheter around cardiac structures (such as the tricuspid apparatus) or around the catheter itself.1,7 In this case, with the aid of TEE, we made an intraoperative diagnosis of PAC entrapment because of encircling by the purse-string suture at the IVC cannulation site. Exact localization of the entrapment site with TEE led to safe surgical removal of the entrapment. TEE and fluoroscopy are imaging techniques that can be used to confirm the location of an entrapped catheter. However, TEE might be superior to fluoroscopy for intraoperative diagnosis, especially with an open sternotomy, because it is readily available to cardiac anesthesiologists. Other advantages of TEE as a diagnostic modality are that the right atrium, right ventricle, right ventricular outflow tract, and pulmonary artery can be simply and clearly visualized. A few reports have described TEE as a useful tool for diagnosing PAC entrapment at the site of atrial purse-string sutures,2 in the right atrial wall at the site of suturing of the incision for retrograde cardioplegia solution infusion,3 and the pulmonary artery vent suture site.5 Because entrapment can occur at different sites, corresponding to specific scanning planes (Table 1), a combination of different scanning planes would be required to define the entrapment site when the exact site is difficult to confirm.Table 1: Possible Site of Pulmonary Artery Catheter (PAC) Entrapment and Possible Scanning Planes Corresponding to Each SiteIn this case, the PAC was entrapped at the IVC cannulation site, at the anterior part of the right atrium near the IVC. Therefore, a midesophageal bicaval view was appropriate for confirming the entrapment site; this view also revealed the portion of the catheter in the right atrium that was fixed on the IVC cannulation site. This appeared on TEE images as a relatively high brightness portion, similar to an echogenic spot, with acoustic shadowing beyond it (Fig. 1), and was confirmed by palpation by the surgeon. Furthermore, gentle traction on the PAC produced invagination of the IVC cannulation site, with the echogenic spot with acoustic shadowing also moving with manual traction, resembling “tenting” of the atrial wall. (Fig. 1) (Video 1; see Supplemental Digital Content 1, https://links.lww.com/AA/A37, transesophageal echocardiography showing entrapment of a pulmonary artery catheter [PAC].) It is necessary to distinguish an entrapped catheter from artifacts such as a side lobe artifact from the catheter or confounding anatomical structures such as the crista terminalis or an elongated Eustachian valve. However, the precise image of the catheter as described above, together with movement of the atrial wall with the echogenic spot with manual traction, the movement being unrelated to the cardiac cycle, facilitated an accurate diagnosis. Our experience in this case suggests that it is important to check PAC mobility by the application of gentle traction on the catheter, before sternal closure. If resistance is encountered, then TEE evaluation should be performed to locate an entrapped PAC before closing the chest. Entrapping suture images, depicted as an echogenic spot with acoustic shadowing on the PAC, and invagination of the tissue wall at the entrapment site with manual traction, resembling “tenting” in the appropriate TEE view, are likely to localize the entrapment site of the PAC." @default.
• W2004243604 created "2016-06-24" @default.
• W2004243604 creator A5011013472 @default.
• W2004243604 creator A5021162166 @default.
• W2004243604 creator A5039731223 @default.
• W2004243604 creator A5055719826 @default.
• W2004243604 creator A5057681787 @default.
• W2004243604 creator A5060552958 @default.
• W2004243604 creator A5090750541 @default.
• W2004243604 date "2009-11-01" @default.
• W2004243604 modified "2023-10-16" @default.
• W2004243604 title "Transesophageal Echocardiography Is Useful for an Intraoperative Diagnosis of Pulmonary Artery Catheter Entrapment" @default.
• W2004243604 cites W2008181930 @default.
• W2004243604 cites W2031728897 @default.
• W2004243604 cites W2057266506 @default.
• W2004243604 cites W2064196387 @default.
• W2004243604 cites W2064961417 @default.
• W2004243604 cites W2125734864 @default.
• W2004243604 cites W4231266681 @default.
• W2004243604 doi "https://doi.org/10.1213/ane.0b013e3181b8b6aa" @default.
• W2004243604 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/19843781" @default.
• W2004243604 hasPublicationYear "2009" @default.
• W2004243604 type Work @default.
• W2004243604 sameAs 2004243604 @default.
• W2004243604 citedByCount "2" @default.
• W2004243604 countsByYear W20042436042012 @default.
• W2004243604 countsByYear W20042436042022 @default.
• W2004243604 crossrefType "journal-article" @default.
• W2004243604 hasAuthorship W2004243604A5011013472 @default.
• W2004243604 hasAuthorship W2004243604A5021162166 @default.
• W2004243604 hasAuthorship W2004243604A5039731223 @default.
• W2004243604 hasAuthorship W2004243604A5055719826 @default.
• W2004243604 hasAuthorship W2004243604A5057681787 @default.
• W2004243604 hasAuthorship W2004243604A5060552958 @default.
• W2004243604 hasAuthorship W2004243604A5090750541 @default.
• W2004243604 hasBestOaLocation W20042436041 @default.
• W2004243604 hasConcept C126838900 @default.
• W2004243604 hasConcept C139940330 @default.
• W2004243604 hasConcept C141071460 @default.
• W2004243604 hasConcept C164705383 @default.
• W2004243604 hasConcept C2776915481 @default.
• W2004243604 hasConcept C2779892169 @default.
• W2004243604 hasConcept C2780940725 @default.
• W2004243604 hasConcept C2781267111 @default.
• W2004243604 hasConcept C71924100 @default.
• W2004243604 hasConcept C84393581 @default.
• W2004243604 hasConceptScore W2004243604C126838900 @default.
• W2004243604 hasConceptScore W2004243604C139940330 @default.
• W2004243604 hasConceptScore W2004243604C141071460 @default.
• W2004243604 hasConceptScore W2004243604C164705383 @default.
• W2004243604 hasConceptScore W2004243604C2776915481 @default.
• W2004243604 hasConceptScore W2004243604C2779892169 @default.
• W2004243604 hasConceptScore W2004243604C2780940725 @default.
• W2004243604 hasConceptScore W2004243604C2781267111 @default.
• W2004243604 hasConceptScore W2004243604C71924100 @default.
• W2004243604 hasConceptScore W2004243604C84393581 @default.
• W2004243604 hasIssue "5" @default.
• W2004243604 hasLocation W20042436041 @default.
• W2004243604 hasLocation W20042436042 @default.
• W2004243604 hasLocation W20042436043 @default.
• W2004243604 hasOpenAccess W2004243604 @default.
• W2004243604 hasPrimaryLocation W20042436041 @default.
• W2004243604 hasRelatedWork W143084923 @default.
• W2004243604 hasRelatedWork W1975324893 @default.
• W2004243604 hasRelatedWork W1988915849 @default.
• W2004243604 hasRelatedWork W2002383425 @default.
• W2004243604 hasRelatedWork W2027591944 @default.
• W2004243604 hasRelatedWork W2075113415 @default.
• W2004243604 hasRelatedWork W2396891337 @default.
• W2004243604 hasRelatedWork W2405075507 @default.
• W2004243604 hasRelatedWork W2966885345 @default.
• W2004243604 hasRelatedWork W60664525 @default.
• W2004243604 hasVolume "109" @default.
• W2004243604 isParatext "false" @default.
• W2004243604 isRetracted "false" @default.
• W2004243604 magId "2004243604" @default.
• W2004243604 workType "article" @default.