Prevalence of Fracture and Fragment Embolization of Bard Retrievable Vena Cava Filters and Clinical Implications Including Cardiac Perforation and TamponadeBACKGROUND: Vena cava filters represent an alternative treatment option for patients with contraindications to anticoagulation, or they might serve as adjunctive treatment for continued emboli despite anticoagulation. The fracture of a filter strut with subsequent end-organ embolization is a rarely reported but potentially life-threatening occurrence. METHODS: We sought to determine the prevalence of fracture and embolization of the Bard Recovery (first generation) and the Bard G2 (second generation) vena cava filters. A retrospective, single-center, cross-sectional study was conducted by evaluating all patients who received either a Bard Recovery or Bard G2 filter from April 2004 until January 2009. A total of 189 patients had undergone implantation: 1 pregnant woman and 35 patients who died were excluded from our study. In addition, 10 patients who had the filter removed were also excluded. Ultimately, 80 patients participated in the trial. Subjects underwent fluoroscopy to assess the filter's integrity. Embolized struts were localized by fluoroscopy. Echocardiography and cardiac computed tomography were performed in patients with fragment embolization to the heart. RESULTS: Thirteen of 80 patients had at least 1 strut fracture (16%). At least 1 strut in 7 of the 28 Bard Recovery filters fractured and embolized (25%). In 5 of these 7 cases, patients had at least 1 fragment embolize to the heart (71%). Three patients experienced life-threatening symptoms of ventricular tachycardia and/or tamponade, including 1 patient who experienced sudden death at home. Six of 52 Bard G2 filters fractured (12%). In 2 of these 6 cases, the patients had asymptomatic end-organ fragment embolization. CONCLUSION: The Bard Recovery and Bard G2 filters had high prevalences of fracture and embolization, with potentially life-threatening sequelae.
Valve Disease Associated with Ergot Alkaloid Use: Echocardiographic and Pathologic CorrelationsBrief Reports1 July 1992Valve Disease Associated with Ergot Alkaloid Use: Echocardiographic and Pathologic CorrelationsMargaret M. Redfield, MD, Walter J. Nicholson, MD, William D. Edwards, MD, A. Jamil Tajik, MDMargaret M. Redfield, MD, Walter J. Nicholson, MD, William D. Edwards, MD, A. Jamil Tajik, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-117-1-50 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptErgot alkaloid preparations such as ergotamine (Cafergot, Sandoz, East Hanover, New Jersey) and methysergide (Sansert, Sandoz) are used to treat migraine headache. Characteristic histologic changes are seen in patients with methysergide-induced valvular disease (primarily mitral and aortic regurgitation) (1, 2). Recently, ergotamine-induced valvular disease was documented pathologically (3). We report the echocardiographic and pathologic features of five patients with valvular disease associated with long-term ingestion of ergot alkaloids.PatientsCase HistoriesAll patients were using ergot alkaloid preparations for treatment of headache. Patients were initially identified because gross pathologic findings were thought to be unusually severe for rheumatic disease. The...References1. BanaMacNealLeCompteShahGraham DPPYJ. Cardiac murmurs and endocardial fibrosis associated with methysergide therapy. Am Heart J. 1974;88:640-55. CrossrefMedlineGoogle Scholar2. Misch K. Development of heart valve lesions during methysergide therapy. Br Med J. 1974;2:365-6. CrossrefMedlineGoogle Scholar3. HauckEdwardsDanielsonMullanyBresnahan AWGCD. Mitral and aortic valve disease associated with ergotamine therapy for migraine: report of two cases and review of literature. Arch Pathol Lab Med. 1990;114:62-4. MedlineGoogle Scholar4. MunroeAllenCox DPA. Mitral regurgitation occurring during methysergide (Sansert) therapy. Can Med Assoc J. 1969;101:62-5. MedlineGoogle Scholar5. MasonBillinghamFriedman JMJ. Methysergide-induced heart disease: a case of multivalvular and myocardial fibrosis. Circulation. 1977;56:889-90. CrossrefMedlineGoogle Scholar6. Spierings E. Cardiac murmurs indicative of aortic valve disease with chronic and excessive intake of ergotamine. Headache. 1988;28:278-9. CrossrefMedlineGoogle Scholar7. SeilerJenzerKàcl KHJ. Verlauf eines Falles von Ergotismus mit Femoralarterienverschlüssen und Mitralinsuffizienz. Vasa. 1973;2:366-71. MedlineGoogle Scholar8. Graham J. Cardiac and pulmonary fibrosis during methysergide therapy for headache. Am J Med Sci. 1967;254:1-12. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and Cardiac Diagnostics Associates, York, Pennsylvania. For current author addresses, see end of text. 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Clinical studies of styrene workers: initial findings.William V Lorimer, Ruth Lilis, W. J. Nicholson et al.|Environmental Health Perspectives|1976 Styrene monomer is a high volume chemical used chiefly in production of polystyrene. A clinical survey of 493 production workers was undertaken at the oldest and largest monomer production, polymerization, and extrusion facility in the U.S. Relative exposure durations and levels were obtained from occupational histories. Significant differences between the high and low exposure groups were found with regard to history of acute prenarcotic symptoms, acute lower respiratory symptoms, prevalence of FEV 1/FV less than 75 per cent, and elevated GCTP. Other liver function tests, chest x-ray, FVC less than 80 per cent, and hematological parameters showed no distinct pattern. A concomitant mortality study has been mounted and is in progress.