Talia Arif’s Post

74 years-old male patient with history of former smoker and dyslipidemia. CLTI (Rutherford 5). Rest pain and ulcer on left first toe. Angiography revealed severe stenosis of left CFA, severe stenosis of profunda femoral artery, occlusion of the SFA, severe stenosis of popliteal artery, occlusion of both tibial arteries, severe stenosis of TP trunk and the dorsalis pedis artery is reconstituted by collateral circulation through a large anterior malleolar branch of the peroneal artery. Strategy: Retrograde puncture of right CFA and 6 Fr-45 cm sheath placement in the left EIA with up and over technique. Failed first attempt of antegrade recanalization of SFA with the support of a Rubicon 18 and a Command 18 guidewire. Retrograde puncture of distal SFA and failed attempt of retrograde recanalization of SFA with the support of a Rubicon 18 and a Command 18 guidewire. Multiple failed attempts of recanalization after CART and reverse CART techniques. Successfull retrograde recanalization after parallel balloon technique and rendez vous technique. Pre-dilatation of the fem-pop segment with a 7 mm x 120 mm balloon. 6.5 mm x 200 mm Supera stent placement in the fem-pop segment and placement of two 7 mm x 120 mm self-expandable stents in the proximal and mid portions of the SFA. Left CFA angioplasty with a 7 mm x 40 mm balloon. TP trunk angioplasty with a 4 mm x 80 mm balloon. Good flow to the foot and complete resolution of rest pain.  #clti #cli #limbsalvage #peripheralarterydisease #endovascular #clifighters #diabeticfoot #vascularnews #hospital #medicine

Division Interventional Pulmonology Yashoda Hospitals Hyderabad POST INTUBATION TRACHEAL STENOSIS BRONCHOSCOPIC RECANALISATION & SILICON STENT PLACEMENT YouTube link: https://lnkd.in/gB4FDcDf 72 year old male, Known case of COPD, Hypertensive, Diabetic, CAD post PTCA, CVA Was On tracheostomy and decannulated 2 weeks back. Presented with history of noisy breathing and cough. CT showed tracheal stenosis. Stenosis was dilated with electrocautery cuts, CRE balloon, serial rigid tracheoscopes and 15 by 40mm silicon stent was inserted and secured with sutures. #Bronchoscopy #Interventionalpulmonology #WomeninIP

This patient has a history of mitral valve replacement. They developed subacute endocarditis requiring 6 weeks of IV antibiotics. A recent ECHO reveals this. What would you do in this scenario? What heart rhythm would indicate a surgical urgency/emergency? Comment below. #physicianassistant #apacvs2024 #echocardiography #mitralvalvereplacement #mitralvalve #endocarditis #cardiacsurgery #criticalcare #physicianassistantstudent #physicianassociate

#845 Which of the following statements about the transaortic valve Doppler flow tracing shown in the Figure is TRUE? A. The probability of critical aortic stenosis in this patient is very low B. The estimated peak transaortic valvular gradient is 90 to 100 mm Hg C. Aortic insufficiency is severe D. Based on the Doppler findings, premature closure of the mitral valve is likely E. The echocardiogram likely reveals normal left ventricular wall thickness Answer:B The Doppler tracing was obtained across the left ventricular outflow tract of a patient with combined aortic stenosis and aortic insufficiency. The tracing shows a characteristic delayed onset of peak velocity, consistent with significant aortic stenosis. The pressure gradient across the aortic valve can be calculated using the modified Bernoulli equa- tion (pressure gradient = 4 × V2). The peak velocity across the aortic valve of approximately 4.8 m/sec in the figure corresponds to an instantaneous peak systolic gradient of 92 mm Hg. In general, when the aortic flow velocity is >4 m/sec, the probability of critical aortic stenosis is high. In contrast, an aortic flow velocity <3 m/sec is usually associated with only mild aortic stenosis. For aortic flow velocities that are intermediate, echocardiographic calculation of the aortic valve area or additional hemodynamic data are often needed. The diastolic flow on this tracing represents aortic insufficiency. Severe aortic insufficiency is associated with a rapidly declining flow velocity, whereas mild aortic insufficiency demonstrates a gradually declining velocity. In this case, the decline in diastolic velocity is gradual and the degree of aortic insufficiency is likely mild. Premature diastolic closure of the mitral valve may be observed in patients with severe, acute aortic insufficiency owing to the greatly elevated diastolic left ventricular (LV) pressure; it would not be expected in this patient given the mild degree of aortic insufficiency present. Additional findings on the echocardiogram that may help assess the severity of aortic valve disease include measurements of LV size and thickness. In this patient with severe aortic stenosis, one would expect to find concentric LV hypertrophy. #cardilogy #Echocardiography

Hii everyone #snsinstitution #snsdesignthinking #snsdesignthinkers #pulmonaryembolism clot in one of the blood vessels in your lung. This happens when a clot in another part of your body (often your leg or arm) moves through your veins to your lung. A PE restricts blood flow to your lungs, lowers oxygen levels in your lungs and increases blood pressure in your pulmonary arteries. This condition is a medical emergency. Without quick treatment, a pulmonary embolism can cause heart or lung damage and even death. About 33% of people with a pulmonary embolism die before they get a diagnosis and treatment. Pulmonary embolism symptoms may include: Sudden shortness of breath — whether you’ve been active or at rest. Fast breathing. Wheezing. What causes a pulmonary embolism? Pulmonary embolism causes include: Blood collecting or “pooling” in a certain part of your body (usually an arm or leg). Blood usually pools after long periods of inactivity, like after surgery, bed rest or a long flight or plane ride. Injury to a vein, like from a fracture or surgery (especially in your pelvis, hip, knee or leg). Another medical condition, like cardiovascular disease (including congestive heart failure, atrial fibrillation, heart attack or stroke).

It’s not yet a rule of thumb, but a new “thumb test” may be able to detect your risk for a potential aortic aneurysm, according to Medical Xpress. An aneurysm is a ballooned segment of an artery, which are the vessels that supply oxygenated blood to your body tissues. “Aneurysms may cause no problems, but if they grow larger, they can weaken, burst and bleed. This is bad enough in most arteries, but imagine if the artery involved were the biggest in your body?” Aortic aneurysms can develop slowly, often symptom-less, so that you don’t know they are evolving. This simple thumb/palm test can tell you within seconds where you stand. https://ow.ly/LyI750RQQbV #aorticaneurysm #thumbpalmtest #heart #medicaltest #thumbtest

Tricuspid regurgitation (TR) is a common finding in fetus. TR represents the abnormal backflow of blood into the right atrium during right ventricular contraction due to valvular leakage. Think about; 1) Abnormal Tricuspid Valve (Ebstein, Tricuspid Valve dysplasia) 2) Elevated right ventricular pressure (for example pulmonary valve stenosis) 3) Aneuploidy (especially with extra markers) 4) Transient insufficiency of tricuspid valve in fetal life (benign) Technique: The pulsed Doppler gate (sample volume of 2-3 mm) should be placed perpendicular across the tricuspid valve in the four-chamber view with the angle of insonation <20°. These are the informations that you can find anywhere but you should educate your eyes to see the abnormal colour dance of the heart. As you can see in the video below, the blue(because it is away from probe) jet flow starts from the tricuspid valve level and touchs the right atrium wall. When you recognised it, you should put the pulsed Doppler gate on your tricuspid valve as described above. Most of the TRs are benign if it is mild and isolated but it may be associated with aneuploidy and with both cardiac and extracardiac defects.

A flow diverter is not always the only option. A 64-year-old female presented with swallowing difficulty with solid foods, on evaluation of which a giant left petro-cervical internal carotid artery aneurysm, was diagnosed. The balloon occlusion test was done under local anesthesia with hypotension provocation, which showed good crossflow across anterior and posterior communicating arteries without any neurodeficit during on-table examination. Under TIVA and balloon inflation, parent vessel occlusion was attempted with large micro coils; however, residual flow was noted post-coil placement, which was dealt with 1ml 80% glue injection. Final angiography runs showed complete occlusion of the parent vessel with good crossflow across anterior and posterior communicating arteries. The patient was discharged in the next two days without any neuro deficit with the advice of 4 weeks of steroids and antiplatelet therapy.

"An LVAD is a kind of artificial heart pump. It is used to treat people with severe heart failure and is sometimes given to people on the waiting list for a heart transplant. Normally, the left ventricle, one of your heart’s four chambers, pumps blood into your aorta (the large artery leaving the heart) and around your body. In the event that someone has severe heart failure, the heart is too weak to pump enough blood around the body. Some patients being considered for a heart transplant may need to have an LVAD implanted if they are unlikely to survive until a suitable donor heart becomes available. The device helps the failing heart and aims to restore normal blood flow." (copied from British Heart Foundation) Today we had implanted LVAD to a patient with severe heart failure and cardiomyopathy, EF=15% aside PAH up to 70mmHg (MR, TR), and it is 11th in a row. Another chance to restore quality of life, after drastic terminal heart failure. Thanks to our coleagues from Abbott for another lifesaving HeartMate 3... Photo in comments #lvad #rvad #bivad #circulatorysuppory #abbott #heartmate3 #cardiovascular #cardiacanesthesia #icu

Learning from your own outcomes. Pulmonary vein reconnection remains the most common reason for re-ablation after a first pulmonary vein isolation. This non-randomized comparison of re-ablation procedures at the UHZ also suggests that reconnections after cryo-balloon ablations were easier to close than reconnections after RF-based ablations. But read for yourself https://lnkd.in/exPVcvti