Alexander Smekal

Early Sheath Removal After Coronary Artery Interventions with Use of a Suture-Mediated Closure Device: Clinical Outcome and Results of Doppler US Evaluation

PURPOSE To evaluate the safety and efficacy of a suture-mediated closure device by comparing clinical outcomes of its use to those of manual compression and by using Doppler ultrasound (US) examination. MATERIALS AND METHODS One hundred patients were randomized to treatment with either suture-mediated closure (n = 50) or manual compression (n = 50) after percutaneous transluminal coronary angioplasty (PTCA). The 50 patients randomized to receive suture-based treatment were allowed to get out of bed 4 hours after the procedure, whereas bed rest was required for 1 day in the patients treated with manual compression. All patients underwent clinical and US examination before getting out of bed and before discharge from the hospital. RESULTS Forty-seven of 50 patients randomized to undergo suture-mediated closure were ambulatory the day of intervention, in 6.2 hours +/- 4.7 (mean +/- SE) after undergoing PTCA. The results of the US examination for these patients demonstrated the absence of bleeding complications after getting out of bed. All patients treated with use of manual compression were ambulatory the following day, 18.3 hours +/- 2.2 after undergoing PTCA. There was no difference in the occurrence of vascular complications between the two groups. CONCLUSION Suture-based closure is a safe and effective method of achieving immediate hemostasis and shorter bed rest without increasing the risk of bleeding complications in PTCA procedures.

Spiral-CT angiography to assess feasibility of endovascular aneurysm repair in patients with ruptured aortoiliac aneurysm

BACKGROUND To evaluate spiral computed tomography (SCT) angiography for assessment of feasibility of endovascular aneurysm repair (EVAR) in patients with ruptured aortoiliac aneurysm (AAA). PATIENTS AND METHODS 24 patients (mean age 74 years; range, 69 to 82 years) with suspicion of ruptured AAA and stable hemodynamics were preoperatively examined by using a SCT scanner in the emergency room. SCT angiography was performed from the suprarenal aorta to the femoral bifurcation after a fixed injection delay time of 30 seconds. After that a venous phase SCT scan, beginning at the last image position and ending at the upper thoracic aperture, was performed. RESULTS The mean acquisition time of the SCT scan was 80 seconds (range 70 to 100 seconds), the mean overall procedure time, including image reconstruction, 5 minutes (range, 4 to 6 minutes). 2D images were directly evaluated during CT data acquisition, and 3D image reconstructions within 10 minutes (range, 8 to 11 minutes) after the SCT scan. AAA rupture was assessed in 14/24 patients (58%): in 10/14 patients (71%) rupture was contained to the retroperitoneum, and in 4/14 patients (29%) intraperitoneal rupture was observed. Successful EVAR was performed in 6/14 patients (43%) with ruptured AAA, and in 8/10 patients (80%) without ruptured AAA. Open surgery was exclusively performed in 6/24 patients (25%) with inappropriate anatomy for EVAR and in 4/24 patients (17%) with intraperitoneal rupture. CONCLUSIONS Spiral computed tomography angiography is a reliable technique to assess feasibility of endovascular aneurysm repair in patients with ruptured aortic aneurysm. However, it can only be recommended for patients with stable hemodynamics, despite of the short acquisition time.Background: To evaluate spiral computed tomography (SCT) angiography for assessment of feasibility of endovascular aneurysm repair (EVAR) in patients with ruptured aortoiliac aneurysm (AAA). Patients and methods: 24 patients (mean age 74 years; range, 69 to 82 years) with suspicion of ruptured AAA and stable hemodynamics were preoperatively examined by using a SCT scanner in the emergency room. SCT angiography was performed from the suprarenal aorta to the femoral bifurcation after a fixed injection delay time of 30 seconds. After that a venous phase SCT scan, beginning at the last image position and ending at the upper thoracic aperture, was performed. Results: The mean acquisition time of the SCT scan was 80 seconds (range 70 to 100 seconds), the mean overall procedure time, including image reconstruction, 5 minutes (range, 4 to 6 minutes). 2D images were directly evaluated during CT data acquisition, and 3D image reconstructions within 10 minutes (range, 8 to 11 minutes) after the SCT scan. AAA rupture...

Endotracheal neurofibroma in neurofibromatosis type 1: an unusual manifestation

Tracheal involvement is an extremely rare manifestation in patients with neurofibromatosis type 1 (NF-1). We present a 33-year-old women with NF-1 suffering from progressive dyspnea. Multislice spiral CT revealed a neurofibroma located within the trachea with intratracheal extension. To our knowledge, this is the first report of an intratracheal neurofibroma which has been documented by CT. This indicates that multislice spiral CT allows accurate demonstration of localization and extent of this rare manifestation of neurofibromas.

Evaluation of Ascending Aortic Atherosclerosis with 16-Multidetector Computed Tomography Is Useful before Total Endoscopic Coronary Bypass Surgery

BACKGROUND The purpose of this study was to investigate the assessment of ascending aortic atherosclerosis with 16-multidetector computed tomography (16-MDCT) angiography prior to total endoscopic coronary artery bypass (TECAB) surgery. METHODS Forty-five patients were examined with electrocardiogram-gated, 16-MDCT angiography. The presence of atherosclerosis at the ascending aorta was graduated as severe (>50% of circumference) or as mild (<50% of circumference). Ascending aortic plaque composition was evaluated based on CT densities expressed as Hounsfield units (HU). TECABs using the Da Vinci telemanipulator were performed either on the arrested heart (n = 39) with an intra-aortic cardiopulmonary bypass (CPB) perfusion device or on the beating heart (n = 6) in patients with severe atherosclerosis. RESULTS The presence of mild atherosclerosis at the ascending aorta (11/39) was associated with intra-aortic CPB perfusion device-related difficulties such as intra-aortic balloon migration (BM) or balloon rupture (P = .007) in arrested heart TECABs. The CT density of atherosclerotic plaque in patients with BM was mean 58 HU +/- 51 standard deviation (SD), suggesting noncalcifying plaque. In patients without BM, CT density of plaque was mean 526 HU +/- 306 SD corresponding to calcifying plaque (P < .001). Balloon rupture occurred in 2 patients who had calcifying plaque at the ascending aorta. CONCLUSION Evaluation of ascending aortic atherosclerosis with 16-MDCT angiography is useful prior to TECAB surgery. Even mild atherosclerosis of the ascending aorta is associated with intraoperative difficulties regarding the remote-access perfusion system that is used for arrested heart TECAB surgery.

High-Resolution 16-MDCT Evaluation of Radial Artery for Potential Use as Coronary Artery Bypass Graft: A Feasibility Study

OBJECTIVE The objective of our study was to assess the feasibility of using 16-MDCT angiography for the preoperative assessment of the radial and ulnar arteries and the palmar arches in patients scheduled for radial artery harvesting for coronary artery bypass graft (CABG) surgery. CONCLUSION Sixteen-MDCT angiography shows promise for the noninvasive preoperative assessment of the radial artery as a CABG donor site.

Does Preoperative Multislice Computed Tomography Predict Operative Times in Total Endoscopic Coronary Artery Bypass Grafting

OBJECTIVE Multislice computed tomography (MSCT) is currently discussed as a potential tool for procedure planning in endoscopic heart surgery. We aimed to assess the influence of various thoracic measurements on operative times in arrested heart totally endoscopic coronary artery bypass grafting (AHTECAB). METHODS 34 patients (aged 59 years, 71% male) scheduled for AHTECAB were examined prospectively with ECG-gated 16-channel MSCT angiography of coronary arteries and internal mammary arteries. All AHTECABs were single LIMA to LAD bypass operations using the Da Vinci telemanipulator and the ESTECH remote access perfusion system. RESULTS The LIMA-LAD distances were: I (at origin of the first diagonal branch) 4.3 cm (2.5-6.0), II (aortic valve level) 3.7 cm (1.1-6.4), III (mitral valve level) 2.9 cm (0.7-5.0), and IV (basis cordis) 2.3 cm (0.6-4.3). The anterioposterior thoracic diameter was 12.4 cm (8.9-15.6), and the transverse diameter was 24.9 cm (21.1-26.8). LIMA-LAD distances I (P = .025, r = .396) and III (P = .042, r = .356) significantly correlated with the anastomotic time. Increased rotation of the heart to the left was associated with a decreased cardiopulmonary bypass time (p = .016, r = -.451). CONCLUSION These data suggest that MSCT has the potential to predict operative times in robotic AHTECAB.

Prolapsing Atrial Myxoma Dynamic Visualization With Multislice Computed Tomography

An 80-year-old woman had a history of increasing dyspnea with a sensation of thoracic pressure. Transthoracic echocardiography demonstrated a mobile hyperechoic mass located in the left atrium (Figure 1A) and prolapsing into the left ventricle (Figure 2A). A moderate obstruction of the mitral valve was observed. The mass was suspicious for a cardiac tumor, although an additional thrombus formation could not be excluded. Accordingly, a contrast-enhanced, ECG-gated, 16-row helical CT scan (Sensation 16, Siemens) demonstrated a hypodense mass based on …An 80-year-old woman had a history of increasing dyspnea with a sensation of thoracic pressure. Transthoracic echocardiography demonstrated a mobile hyperechoic mass located in the left atrium (Figure 1A) and prolapsing into the left ventricle (Figure 2A). A moderate obstruction of the mitral valve was observed. The mass was suspicious for a cardiac tumor, although an additional thrombus formation could not be excluded. Accordingly, a contrast-enhanced, ECG-gated, 16-row helical CT scan (Sensation 16, Siemens) demonstrated a hypodense mass based on …

Spiral-CT Angiographie vor endovaskulärer Versorgung bei Patienten mit rupturiertem aortoiliakalem Aneurysma

BACKGROUND To evaluate spiral computed tomography (SCT) angiography for assessment of feasibility of endovascular aneurysm repair (EVAR) in patients with ruptured aortoiliac aneurysm (AAA). PATIENTS AND METHODS 24 patients (mean age 74 years; range, 69 to 82 years) with suspicion of ruptured AAA and stable hemodynamics were preoperatively examined by using a SCT scanner in the emergency room. SCT angiography was performed from the suprarenal aorta to the femoral bifurcation after a fixed injection delay time of 30 seconds. After that a venous phase SCT scan, beginning at the last image position and ending at the upper thoracic aperture, was performed. RESULTS The mean acquisition time of the SCT scan was 80 seconds (range 70 to 100 seconds), the mean overall procedure time, including image reconstruction, 5 minutes (range, 4 to 6 minutes). 2D images were directly evaluated during CT data acquisition, and 3D image reconstructions within 10 minutes (range, 8 to 11 minutes) after the SCT scan. AAA rupture was assessed in 14/24 patients (58%): in 10/14 patients (71%) rupture was contained to the retroperitoneum, and in 4/14 patients (29%) intraperitoneal rupture was observed. Successful EVAR was performed in 6/14 patients (43%) with ruptured AAA, and in 8/10 patients (80%) without ruptured AAA. Open surgery was exclusively performed in 6/24 patients (25%) with inappropriate anatomy for EVAR and in 4/24 patients (17%) with intraperitoneal rupture. CONCLUSIONS Spiral computed tomography angiography is a reliable technique to assess feasibility of endovascular aneurysm repair in patients with ruptured aortic aneurysm. However, it can only be recommended for patients with stable hemodynamics, despite of the short acquisition time.Background: To evaluate spiral computed tomography (SCT) angiography for assessment of feasibility of endovascular aneurysm repair (EVAR) in patients with ruptured aortoiliac aneurysm (AAA). Patients and methods: 24 patients (mean age 74 years; range, 69 to 82 years) with suspicion of ruptured AAA and stable hemodynamics were preoperatively examined by using a SCT scanner in the emergency room. SCT angiography was performed from the suprarenal aorta to the femoral bifurcation after a fixed injection delay time of 30 seconds. After that a venous phase SCT scan, beginning at the last image position and ending at the upper thoracic aperture, was performed. Results: The mean acquisition time of the SCT scan was 80 seconds (range 70 to 100 seconds), the mean overall procedure time, including image reconstruction, 5 minutes (range, 4 to 6 minutes). 2D images were directly evaluated during CT data acquisition, and 3D image reconstructions within 10 minutes (range, 8 to 11 minutes) after the SCT scan. AAA rupture...

Multislice Spiral CT Follow-Up of a Patient With Implanted DeBakey Ventricular Assist Device

A 52-year-old patient suffering from an extensive acute myocardial infarction of the left ventricle with a residual ejection fraction of 15% developed a rapidly progressive terminal heart insufficiency with low cardiac output syndrome and severe dyspnea. To bridge the time gap until transplantation, a new type of left ventricular assist device (DeBakey VAD) was implanted. The patient could be extubated 3 hours after surgery and returned to the regular ward on postoperative day 4 after an uncomplicated recovery. The DeBakey VAD is a small (3.5-cm diameter and 76-mm length), axial-flow blood pump with a titanium alloy for total intracorporal implantation (Figure 1⇓),1 which has already been successfully implanted in …

Prolapsing Atrial Myxoma

An 80-year-old woman had a history of increasing dyspnea with a sensation of thoracic pressure. Transthoracic echocardiography demonstrated a mobile hyperechoic mass located in the left atrium (Figure 1A) and prolapsing into the left ventricle (Figure 2A). A moderate obstruction of the mitral valve was observed. The mass was suspicious for a cardiac tumor, although an additional thrombus formation could not be excluded. Accordingly, a contrast-enhanced, ECG-gated, 16-row helical CT scan (Sensation 16, Siemens) demonstrated a hypodense mass based on …An 80-year-old woman had a history of increasing dyspnea with a sensation of thoracic pressure. Transthoracic echocardiography demonstrated a mobile hyperechoic mass located in the left atrium (Figure 1A) and prolapsing into the left ventricle (Figure 2A). A moderate obstruction of the mitral valve was observed. The mass was suspicious for a cardiac tumor, although an additional thrombus formation could not be excluded. Accordingly, a contrast-enhanced, ECG-gated, 16-row helical CT scan (Sensation 16, Siemens) demonstrated a hypodense mass based on …