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Neurology in Documentaries
Published in Eelco F. M. Wijdicks, Neurocinema—The Sequel, 2022
Two days before the accident, the documentary shows a night of drinking. Then we see the accident itself, when Kevin attempts a new “cab double cork,” which is a double backflip with a twist. Without bracing himself with his hands, he lands with his face flat on the icy wall. He immediately becomes comatose with a marked orbital hematoma. Witnesses later tell us that he had to be intubated and was “shaking.” Another bystander tells us that his left eye had a “blown pupil.” He is helicoptered out to the neurointensive care unit, where he stays for 26 days. Shown on film is the family receiving notification of the accident—accompanied by a request to grant permission for a ventriculostomy. We get a glimpse of Kevin’s MRI scan, which shows multiple, severe shearing lesions in the hippocampi and lesions peppered throughout the white matter. There is also an extensive intraventricular hemorrhage that likely prompted the ventriculostomy.
Surgical Strategies of Myectomy for Hypertrophic Obstructive Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
V. Rao Parachuri, Sreekar Balasundaram, Ameya Kaskar
At the conclusion of resection the ventriculotomy is closed using a 1 cm wide Teflon (Bard soft), covering the entire length of the incision. Two layers of 3’0’ Prolene with a 26 mm needle is used. A deeper multiple interrupted horizontal mattress suture, followed by a superficial over and over suturing technique is used for secure closure of the ventriculotomy.
Device-Specific Considerations
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Wayne E. Richenbacher, Shawn L. Jensen, Scott D. Niles, James M. Ploessl
The patient is placed on CPB and normothermia maintained. The ventricular apex is elevated and buttressed 2-0 Ethibond sutures placed in a horizontal mattress fashion about the apical dimple.6 The sutures are passed through the sewing ring and tied securing the sewing ring to the epicardial surface of the heart. With the patient in the Trendelenburg position a circular ventriculotomy is created in the left ventricular apex with a coring knife.
Update on shunt closure in neonates and infants
Published in Expert Review of Cardiovascular Therapy, 2021
Karim A. Diab, Younes Boujemline, Ziyad M. Hijazi
Surgical approach to closing VSDs in small infants is not without associated risks. Mortality rates as high as 16% have been reported after left ventriculotomy with a 10% reoperation rate [50]. Some advocate pulmonary artery banding as a better option for infants with significant mVSDs. In a series of 130 patients with isolated mVSDs (61 of whom were less than 1 year of age), mortality rate was 7.7% and 4 patients required permanent pacemakers [51]. Kitagawa et al. [52] also reported a series of 22 infants who underwent closure of mVSDs using a right atriotomy technique with or without left ventriculotomy and the rate of reoperation was 10% for residual VSDs. This highlights that repair of these defects, when clinically indicated, continues to represent a surgical challenge with significant morbidity and mortality particularly for muscular defects. The coarse trabeculations make it difficult to approach muscular defects from the right ventricle, while a left ventricular approach can result in significant left ventricular dysfunction. In addition, the rate of residual defects remains unsatisfactory with a reoperation rate for residual VSDs reported to be as high as 10%, especially in infants [50,52]. Therefore, device closure of these defects through percutaneous or perventricular approaches has become an attractive and feasible alternative to surgery, especially in these young patients [44,45,49,53–62]. To that end and since the first percutaneous device closure was performed by Lock [57], several devices have been used for VSD closure.
Minimally invasive left ventricular assist device implantation: optimizing device design for this approach
Published in Expert Review of Medical Devices, 2020
Anamika Chatterjee, Silvia Mariani, Jasmin S. Hanke, Tong Li, Ali Saad Merzah, Regina Wendl, Axel Haverich, Jan D. Schmitto, Günes Dogan
In a few cases, a pump explantation after LV recovery is indicated. The general surgical procedure and minimally invasive approach for LVAD explantation are similar to that of LVAD exchange. Several explantation strategies for different LVADs have been described in the existing literature. These include ventriculoplasty with removal of the sewing ring or sewing ring preservation and occlusion of the cored ventriculotomy with a dedicated plug [34], each with or without the removal of the outflow graft. The ventriculoplasty procedure is characterized by the absence of postoperative anticoagulation and foreign material but requires mandatory CPB and extensive surgery on left ventricle walls. On the other hand, the mechanical plug is safer, faster, without hindering the option of LVAD re-implantation in case of future cardiac impairment and may reduce intraoperative bleeding risk, as no removal of sewing ring is needed.
An update on diagnostic and prognostic biomarkers for traumatic brain injury
Published in Expert Review of Molecular Diagnostics, 2018
Kevin K. Wang, Zhihui Yang, Tian Zhu, Yuan Shi, Richard Rubenstein, J. Adrian Tyndall, Geoff T. Manley
Severe TBI patients (about 10–15% of all TBI, GCS 3–8) are often managed in neurointensive care units (neuro-ICU) in major hospitals. Monitoring of patient’s brain and systemic status (including intracranial pressure) is critical in enhancing patient’s survival rate and long-term outcome. Here, ventriculostomy procedure is often performed as a means of cranial decompression. Thus, the availability of both blood samples and CSF samples can be obtained for possible ‘real time’ biomarker monitoring. For example, the biomarker load (e.g. biomarker levels over a period time, or area under the curve) for UCH-L1 in both CSF and serum can distinguish injury severity and mortality [35]. Thus, we envision repeated monitoring of TBI biomarker levels over time in a neuro-ICU setting might provide useful and actionable information in the management of patients with severe TBI.