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When the shaft breaks: managing a cath lab nightmare
Publication . Oliveira, Catarina; Azaredo Raposo, Miguel; Marques da Costa, José; Pinto, Fausto J.; Silva Marques, João
Objective: We describe the case of a 57-year-old male patient with anterior ST-segment elevation myocardial infarction in cardiogenic shock. Coronary angiography revealed severe left main (LM) and triple-vessel disease, and the patient was refused for surgery due to lack of distal grafting landing zone. A shaft fracture occurred during LM percutaneous coronary intervention, leaving the fractured stent hanging in the aorta. This case highlights the successful retrieval of the fractured stent shaft using a snare technique.Key steps include coronary protection and bailout fixing with a stent in LM artery and use of snare technique to retrieve the shaft from the aorta. Potential pitfalls: Operators should avoid pulling the system when stent entrapment occurs. Take-home messages: Bailout access through the Impella sheath can be used in complication management. When stent entrapment occurs, use balloon trapping instead of pulling the entire system and protect coronary arteries with guidewires before proceeding with shaft extraction.
Enhancing diagnostic precision: intracardiac echocardiography-guided endomyocardial biopsy for complex right atrial mass
Publication . Gregório, Catarina; Vilela, Marta; Oliveira, Catarina; Pinto, Fausto J.
An 80-year-old woman with a history of B-cell non-Hodgkin lymphoma presented to the emergency department with exertional dyspnea and lower limb edema. A transthoracic echocardiogram revealed a large extracardiac mass invading the right atrium. A diagnostic transcatheter endomyocardial biopsy guided by intracardiac echocardiography was performed. This case highlights the role of intracardiac echocardiography in enabling unusual endomyocardial biopsy targeting, allowing for correct positioning of the bioptome, adding to the procedure's safety and precision, mainly when performed on atrial masses.
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Fundação para a Ciência e a Tecnologia
Programa de financiamento
Concurso de avaliação no âmbito do Programa Plurianual de Financiamento de Unidades de I&D (2017/2018) - Financiamento Base
Número da atribuição
UIDB/00306/2020