Image in Cardiology
Clips on the X-ray: Expect the unexpected
Clips cirúrgicos na radiografia do tórax: o insólito acontece
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array:22 [ "pii" => "S0870255123003943" "issn" => "08702551" "doi" => "10.1016/j.repc.2023.02.015" "estado" => "S300" "fechaPublicacion" => "2024-02-01" "aid" => "2245" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2024;43:95-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S0870255123003906" "issn" => "08702551" "doi" => "10.1016/j.repc.2023.04.015" "estado" => "S300" "fechaPublicacion" => "2024-02-01" "aid" => "2242" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2024;43:91-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "The SAFEST study: The crucial role of primary health care in the diagnosis and management of atrial fibrillation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "91" "paginaFinal" => "93" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Estudo SAFEST – o papel essencial dos Cuidados de Saúde Primários no diagnóstico e abordagem da fibrilhação auricular" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4086 "Ancho" => 2091 "Tamanyo" => 228905 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Geographic distribution of recruitment. Primary care units that have concluded recruitment, in ascending order of number of participants (in green): UCSP (<span class="elsevierStyleItalic">Unidade de Cuidados Saúde Personalizados</span>) Beja, UCSP Trancoso, UCSP Celourico da Beira, USF Salus, UCSP Torre de Moncorvo, UCSP Sines, UCSP Bragança I – Sé, USF (<span class="elsevierStyleItalic">Unidade de Saúde Familiar</span>) Lethes. Study sites not yet activated (in gray): UCSP Mirandela II, UCSP Alfândega da Fé, UCSP Seia, USF Beira Saúde, UCSP Ferreira do Alentejo, UCSP Ourique, UCSP Alcácer do Sal, USF Uadiana.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Gonçalves-Teixeira, Daniel Caldeira, Rui Baptista, Inês Zimbarra Cabrita, Margarida Nogueira, Ricardo Fontes-Carvalho" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Gonçalves-Teixeira" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Caldeira" ] 2 => array:2 [ "nombre" => "Rui" "apellidos" => "Baptista" ] 3 => array:2 [ "nombre" => "Inês" "apellidos" => "Zimbarra Cabrita" ] 4 => array:2 [ "nombre" => "Margarida" "apellidos" => "Nogueira" ] 5 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Fontes-Carvalho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123003906?idApp=UINPBA00004E" "url" => "/08702551/0000004300000002/v1_202402041059/S0870255123003906/v1_202402041059/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Clips on the X-ray: Expect the unexpected" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "95" "paginaFinal" => "96" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rita Justo Pereira, Mariana Lemos, Isabel Sampaio Graça, Graça Nogueira, Rui Anjos" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Rita" "apellidos" => "Justo Pereira" "email" => array:1 [ 0 => "anajustopereira@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mariana" "apellidos" => "Lemos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Isabel" "apellidos" => "Sampaio Graça" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Graça" "apellidos" => "Nogueira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Rui" "apellidos" => "Anjos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Pediatrics, Centro Hospitalar Universitário do Algarve, Faro, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Clips</span> cirúrgicos na radiografia do tórax: o insólito acontece" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 674 "Ancho" => 1340 "Tamanyo" => 126226 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Normal chest X-ray with two vascular clips on the left upper cardiac shadow (arrow); (B) aortic angiography showing the two vascular clips occluding the left subclavian artery 7 mm from its emergence (asterisk). The ductus arteriosus has been occluded with a device (arrowhead).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An asymptomatic five-year-old female was referred due to a heart murmur. Surgical clipping of a patent ductus arteriosus (PDA) had been performed overseas in infancy, but she was subsequently lost to follow-up. The physical exam confirmed a 3/6 continuous murmur in the left subclavicular area and weak left upper extremity pulses. An echocardiogram showed a moderate PDA with continuous left-to-right shunt and mild dilatation of the left heart chambers. Apparently, the ductus arteriosus had not been closed effectively and an elective percutaneous closure was scheduled.</p><p id="par0010" class="elsevierStylePara elsevierViewall">At admission her chest X-ray was normal except for the presence of two surgical clips apical to the cardiac shadow (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). Aortic angiography revealed a PDA and, unexpectedly, two vascular clips occluding the left subclavian artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). Retrograde PDA closure was successfully performed with implantation of an Amplatzer Duct Occluder II. Unfortunately, the clip ligation was considered irreversible. An echocardiogram confirmed ductus closure with no residual leaks. She was discharged home clinically well.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Inadvertent clip placement during surgical PDA closure can cause severe complications including injury to the left recurrent laryngeal or left phrenic nerve<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> and occlusion of the left main bronchus<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2,3</span></a> or left pulmonary artery.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Confirmation of postoperative clip position is therefore imperative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In our case, X-ray analysis raised suspicions of incorrect ligation due to abnormal apical clip position above the aortic knob. Post-procedure angiography (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B) clearly confirmed the difference between the closed PDA and the abnormal clip position.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To our knowledge, this is the first report of an iatrogenic left subclavian artery occlusion following surgical PDA closure. Perfusion of the left arm is maintained via the vertebral artery.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship contribution</span><p id="par0030" class="elsevierStylePara elsevierViewall">All authors participated in article preparation. RJP, ML and RA conceived the present report. GN was the patient's pediatric cardiologist. RA carried out the procedure. RJP wrote the paper with input from all authors. ML, GN and RA revised the article. RA and GN were responsible for final approval. All authors approved the final manuscript.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Informed consent was obtained.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authorship contribution" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-02-12" "fechaAceptado" => "2023-02-23" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 674 "Ancho" => 1340 "Tamanyo" => 126226 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Normal chest X-ray with two vascular clips on the left upper cardiac shadow (arrow); (B) aortic angiography showing the two vascular clips occluding the left subclavian artery 7 mm from its emergence (asterisk). The ductus arteriosus has been occluded with a device (arrowhead).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical closure of patent ductus arteriosus in preterm low birth weight infants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Mandhan" 1 => "S. Brown" 2 => "A. Kukkady" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1747-0803.2008.00241.x" "Revista" => array:6 [ "tituloSerie" => "Congenit Heart Dis" "fecha" => "2009" "volumen" => "4" "paginaInicial" => "34" "paginaFinal" => "37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19207401" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left main bronchus obstruction after patent ductus arteriosus ligation: an unusual complication" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.L. Harris" 1 => "R. Krishnamurthy" 2 => "L.P. 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Abe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40792-018-0471-y" "Revista" => array:5 [ "tituloSerie" => "Surg Case Rep" "fecha" => "2018" "volumen" => "4" "paginaInicial" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29956009" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inadvertent ligation of the left pulmonary artery during intended ductal ligation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Tefera" 1 => "R. Bermudez-Cañete" 2 => "C. van Doorn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13104-015-1467-3" "Revista" => array:5 [ "tituloSerie" => "BMC Res Notes" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "511" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26423273" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004300000002/v1_202402041059/S0870255123003943/v1_202402041059/en/main.assets" "Apartado" => array:4 [ "identificador" => "95133" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Image in Cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004300000002/v1_202402041059/S0870255123003943/v1_202402041059/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123003943?idApp=UINPBA00004E" ]
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