English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

A male patient with a bicuspid aortic valve associated with severe aortic stenosis and a dilated aortic root underwent a Bentall procedure. Apart from the aortic pathology, no other abnormalities were detected by a preoperative transesophageal echocardiography (TEE) examination. After an otherwise uncomplicated surgical procedure, the patient’s heart was deaired using standard maneuvers, including manual cardiac agitation and conventional aspiration of the aortic root vent and left ventricular vent inserted during the operation via the superior pulmonary vein. After the de-airing, a hypoechoic structure suggestive of atrial thrombus was seen in the left atrium (LA) using TEE (Figure A). The surgeon was informed of the unusual finding, and on direct visual inspection of the heart, it was confirmed that the left atrial appendage (LAA) had become intussuscepted and inverted inside the LA. Weaning from cardiopulmonary bypass (CPB) was attempted in order to re-establish normal LA pressures and thus revert the appendage to its normal position. Nevertheless, this attempt was unsuccessful, and application of a Valsalva maneuver also failed. Accordingly, during a brief return to CPB, the tip of the LAA was grasped with Russian tissue forceps and reverted to its normal anatomic position, which was confirmed with a repeat TEE examination (Figure B).

Inverted left atrial appendage: a complication of de-airing during cardiac surgery