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โอ้ชาตรี
(2497) ไพฑูรย์ กิตติวรรณ; วงปี่พาทย์คณะบ้านปลายเนิน; ไพฑูรย์ กิตติวรรณ; วงปี่พาทย์คณะบ้านปลายเนิน
RSjournal Vol. 6 No. 2
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RSjournal Vol. 6 No. 1
(2553)
Bioprosthetic Aortic Valve Thrombosis Presenting as Recurrent Inferior Wall STEMI
(2026-03-11) Kittiboonya T.; Leelasithorn S.; Chandavimol M.; Sasiprapha T.; Kongrat S.; Methachittiphan N.; Kittiboonya T.; Mahidol University
Background: Prosthetic aortic valve thrombosis is an extremely rare cause of ST-segment elevation myocardial infarction (STEMI). This case highlights the diagnostic challenge of this clinical entity. Case Summary: A 71-year-old man with bioprosthetic aortic and mitral valve replacement 15 years prior presented with recurrent inferior wall STEMI. Coronary angiography showed no significant stenosis, consistent with myocardial infarction with nonobstructive coronary arteries (MINOCA). Transesophageal echocardiogram revealed a 2-cm mobile thrombus on the right coronary cusp of the prosthetic aortic valve, intermittently occluding the right coronary artery ostium. Discussion: Bioprosthetic valve thrombosis typically occurs early postimplantation; this case is notable for its 15-year latency. It underscores the need to consider valve thrombosis in patients with bioprosthetic valves presenting with embolic phenomena or MINOCA, even long after surgery. Take-Home Messages: Clinicians should maintain a high suspicion for prosthetic valve thrombosis as a cause of MINOCA. Early diagnosis using comprehensive imaging, particularly transesophageal echocardiography, is critical to prevent complications.
Intraureteric Indocyanine Green in Laparoscopic Endometriosis Surgery 10 Steps
(2026-01-01) Panichyawat N.; Duchon M.; Chauvet P.; Bourdel N.; Panichyawat N.; Mahidol University
Objective: To demonstrate a step-by-step technique of intraoperative intraureteric indocyanine green (ICG) administration under cystoscopic guidance to localize intraoperative ureters under near-infrared fluorescence imaging during laparoscopic deep endometriosis surgery. The standardization and description of the surgery in 10 steps are the main objective of this video (Supplemental Video 1). Setting: A university tertiary care hospital. Participant: Patient who was diagnosed with deep endometriosis underwent laparoscopic surgery treatment. The local institutional review board ruled that approval was not required for this video article because the video describes a technique and does not report a clinical case. Intervention: Ten main steps of cystoscopy with intraureteral ICG administration to allow real-time visualization of intraoperative ureters during adhesiolysis and endometriosis resection were described in detail: Step 1: preparing ICG; step 2: preparing ureteric catheter; step 3: preparing instruments for cystoscopy; step 4: cystoscopy; step 5: identifying the ureteric orifices; step 6: inserting ureteric catheter through ureteric orifices; step 7: injecting ICG; step 8: laparoscopic surgery; step 9: intraoperative visualization of ureters; and step 10: deep endometriosis surgery. Conclusion: The use of cystoscopy-guided intraureteric ICG dye instillation and intraoperative ureteric near-infrared fluorescence imaging is a safe and effective tool for visualization of the ureteric position precisely and in real time, making the procedure faster and easier and reducing the intraoperative ureteric complication during laparoscopic deep endometriosis surgery [1-5].