bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic thoracobiliary (pleurobiliary and bronchobiliary) fistula
Authors: Andrade-Alegre Rafael , Ruiz-Valdes Maylin
Published: May 2013

Background: Traumatic thoracobiliary fistula is a rare but serious complication. A series of thoracobiliary fistulas secondary to penetrating trauma and analysis of trends in management are presented.

Methods: We retrospectively reviewed all patients with traumatic thoracobiliary fistula, treated from April 2008 to February 2010. There were 5 patients: 4 suffered gunshot wounds and 1 was stabbed. The mean injury severity score was 22.

Results: Initial treatment was insertion of a chest tube in all cases. One patient underwent damage-control surgery and hepatic packing, and 3 were managed with laparotomy, a perihepatic closed drain, and suture of the diaphragm. Two patients developed bronchobiliary fistulas and 3 had pleurobiliary fistulas. Diagnostic procedures involved determination of bilirubin in pleural effusion, computed tomography, magnetic resonance cholangiography, hepatobiliary iminodiacetic scans, and endoscopic retrograde cholangiography. Definitive treatment included sphincterotomy and stenting in 4 cases, pulmonary decortication in 5, fistulectomy in 2, hepatic suture in 2, perihepatic closed drain placement in 4, and suture of the diaphragm in 4.

Conclusions: Traumatic thoracobiliary fistulas are complex lesions. A multidisciplinary approach is required for a timely and successful outcome. Endoscopic retrograde cholangiography is very useful as the initial procedure to confirm the diagnosis and also for treatment.
Thoracoscopic surgery for non-small-cell lung cancer: elderly vs. octogenarians
Authors: Srisomboon Chaisit , Koizumi Kiyoshi , Haraguchi Shuji , Mikami Iwao , Iijima Yoshihito , Shimizu Kazuo
Published: May 2013

Background: Octogenarians are rarely referred for surgical treatment of lung cancer owing to the morbidity and mortality of pulmonary resection, their frailty, and limited lifespan. We reviewed the results of thoracoscopic surgery, performed completely under the monitor, for treatment of primary non-small-cell lung cancer in octogenarians, and compared them with those in elderly patients.

Patients and methods: Between September 25, 2002 and August 25, 2011, a retrospective database of 24 octogenarians and 70 elderly patients (age range, 75–79 years) who underwent thoracoscopic surgery for treatment of primary non-small-cell lung cancer were reviewed. Demographic, histopathologic, preoperative, perioperative, postoperative, outcome variables, and survival were assessed.

Results: In the octogenarian group, 29% had postoperative respiratory complications, 4% had postoperative cardiac complications, operative mortality was 4%, the recurrence rate was 8%, and the postsurgical 5-year survival rate was 74%. In the elderly group, 25% had postoperative respiratory complications, 6% had postoperative cardiac complications, operative mortality was 3%, the recurrence rate was 6%, and the postsurgical 5-year survival rate was 80%.

Conclusions: Thoracoscopic surgery for treatment of primary non-small-cell lung cancer can be performed with similar postoperative complication rates, operative mortality, and survival in octogenarians when compared to elderly patients.
Minimizing single-port access in video-assisted wedge resection, with a hookwire
Authors: Ng Calvin SH , Hui Joyce WY , Wong Randolph HL
Published: May 2013

Single-port video-assisted thoracic surgery lung resection is increasing in popularity. In selected cases, the incision length of single-port video-assisted thoracic lung wedge resection can be minimized by preoperative strategic positioning of a percutaneous hookwire to allow intraoperative traction of the lung nodule to facilitate endostapler wedge resection, thereby substituting the sponge-holding forceps for lung retraction during the procedure.
A Clinical Study of Isolated Aortic Valve Replacement: A Univariate Analysis of Risk Factors
Authors: Sung Kim Wook , Ryul Lee Jeong , Bong Kim Ki , Whan Sung Sook , Hyuk Ahn , Jin Kim Yong , Hurn Chae , Hyun Kim Joo , Ryang Rho Joon , Whan Kim Chong , Phill Suh Kyung , Kyun Lee Young
Published: May 2013

Between 1979 and 1990, 190 patients underwent isolated aortic valve replacement at Seoul National University Hospital in Korea. There were 11 (5.8%) in-hospital deaths. Univariate analysis identified advanced age (p = 0.026), preoperative serum GOT or GPT greater than 40IU/1 (p < 0.001, p = 0.003), NYHA Class III or IV (p = 0.029), preoperative mean pulmonary arterial pressure greater than 19 mmHg (p = 0.019), reoperation for aortic valve replacement (p = 0.035), second or third open heart surgery (p < 0.001), and use of mechanical valve (p = 0.008) as variables associated with increased in-hospital risk. Follow-up documented survival rates of 98.1% and 96.4% and event-free survival rates of 95.7% and 81.6% at 3 and 7 postoperative years, respectively. NYHA Class III or IV (p = 0.009), preoperative serum total bilirubin level greater than 1.2 mg/dl (p = 0.009), reoperation for aortic valve replacement (p = 0.03), second or third open heart surgery (p = 0.002), and use of mechanical valve were associated with decreased late survival and event-free survival.
Thrombolytic Therapy in Acute Myocardial Infarction: A Review with Current Recommendations
Authors: White Roger L.
Published: May 2013

Thrombolytic therapy has clearly become an established therapeutic modality to treat patients with acute myocardial infarction. Since there is no ideal agent at this time, we must evaluate the advantages and disadvantages of current therapy based on major clinical studies. Thrombolysis is the body's natural response to dissolving clots after they have served their purpose. Thrombolytic agents accelerate fibrinolysis by overwhelming the system. There are 4 thrombolytic agents currently available: streptokinase urokinase, anistreplase (APSAC), and rt-PA. Tissue plasminogen activator is a naturally occurring protein that can be created with genetic recombinant technology (rt-PA). It establishes higher patency rates (70–90%) than the other available thrombolytic agents. Recently published results of accelerated rt-PA infusion during acute myocardial infarction demonstrate that the infarct-related artery seems to open more quickly and provide greater blood flow. The use of intravenous heparin as adjunctive therapy along with aspirin seems to maintain patency at comparable levels to streptokinase. Not only is mortality reduced in the accelerated rt-PA group, but complications from myocardial infarction such as arrhythmia and heart failure are significantly reduced. rt-PA remains the drug of choice in the hypotensive patient and, because of potential allergy, in patients with previous exposure to streptokinase. Percutaneous transluminal coronary angioplasty is frequently needed to improve long-term patency and reduce ischemic episodes. Recent studies show that it may provide some advantage over thrombolytic therapy, because the artery can be opened faster, with higher flow rates.
Functional Significance of Collateral Circulation in Patients with Total Coronary Occlusion
Authors: Won Ha Jong , Yun Cho Seung , Soo Jang Yang , Sik Chung Nam , Hewn Shim Won , Soon Kim Sung
Published: May 2013

Functional significance of collateral circulation was evaluated in 125 patients with total coronary occlusion. Patients were classified into 2 groups: group 1, patients without myocardial infarction; and group 2, patients with a first transmural myocardial infarction occurring within 3 months of symptom onset. There was a higher prevalence of well-developed collaterals and multivessel disease in patients without myocardial infarction than in those with myocardial infarction. The left ventricular ejection fraction, left ventricular enddiastolic pressure, and segmental wall motion scores were significantly better in group 1 than group 2. Despite total coronary occlusion, 61% of group 1 had a normal resting electrocardiogram; however, 96% of patients who underwent treadmill tests proved positive. The proportions of well-developed collaterals in 3 groups, divided according to the internal between onset of myocardial infarction and angiography (within 1 day of operation, 2 to 14 days, or 15 days to 3 months), were 13%, 54%, and 60%. There were no significant differences in left ventricular ejection fraction, segmental wall motion score, and left ventricular enddiastolic pressure in myocardial infarction patients with poorly developed collaterals and well-developed collaterals. The degree of collateral development is higher in myocardial infarction with right coronary artery occlusion compared with that of left anterior descending artery occlusion, without regarding the dominancy or length. Collateral circulation can prevent myocardial ischemia and present myocardial function in a significant number of patients without infarction; however, it does not provide protection against exercise-induced myocardial ischemia in the majority of patients from group 1. Although well-developed collaterals are not usually present within 1 day after myocardial infarction, they are generally present after 2 weeks. Collateral vessels in patients with myocardial infarction have no beneficial effects on preserving myocardial function.
Arterial Pressure during Open Cardiac Surgery: Radial vs. Dorsalis Pedis
Authors: Muralidhar Kanchi , Lhilo Sunil , Bakshi Kanti Bhushan , Shetty Devi Prasad
Published: May 2013

Fifty consecutive adult patients undergoing elective coronary artery bypass grafting or valve replacement had their left radial and dorsalis pedis arteries cannulated with 20G arterial cannula during a standard anesthetic induction. Similar pressure monitoring systems were used for both arteries. The left radial and dorsalis pedis pressures were recorded at 10-minute intervals during the prebypass, postbypass, and postoperative periods (up to 6 hours) and statistically analyzed. There were 38 male and 12 female patients, with a mean (SD) age of 50.3 (11.3) years. In the prebypass period, the dorsalis pedis systolic was significantly higher than the left radial systolic pressure; whereas, the mean arterial pressure was similar in both arterial systems. During the postbypass period, systolic and mean pressures in the dorsalis pedis were significantly lower than those in the left radial. The normal prebypass relationship of the dorsalis pedis and left radial was reestablished in the postoperative period at a mean time (SD) of 4.8 (1.2) hours after moving to the intensive care unit.
Perioperative Myocardial Protection with Continuous Infusion of Diltiazem in Coronary Bypass Surgery
Authors: Seitelberger Rainald , Hannes Waltraud
Published: May 2013

In a randomized study 120 patients undergoing elective coronary artery bypass grafting were investigated to evaluate the perioperative antiischemic and antiarrhythmic efficacy of diltiazem. The patients received a continuous, perioperative infusion of either diltiazem 0.1 mg/kg/h, N = 60) or nitroglycerin (control group lpg/kg/min, N = 60) over a period of 24 hours. Perioperative monitoring included hemodynamic measurements and 3-channel Holter monitoring up to 24 hours postoperatively; repeated assessment of 12–lead electrocardiogram; and analysis of ischenlia-specific laboratory parameters (CK-MB and troponin-T). Myocardial function was assessed preoperatively at 1 and 4 hours after cardiopulmonary bypass by transesophageal echocardiography (TEE, short axis view, monoplane 5 MHz faced array transducer). The 2 groups did not differ with respect to preoperative and operative data. Except for a significant reduction in perioperative heart rate by an average of 9 beats/min, diltiazem had no influence on hemodynamic parameters. The antiischemic efficacy of diltiazem led to a reduction of the number (17 ± 9 vs. 25 ± 5, p < 0.05) and duration (69 ± 47 vs. 104 ± 87 min, p < 0.05) of transient ischemic events and a lower incidence of perioperative myocardial infarction (3.3 vs. 6.7%) as compared to the nitroglycerin group. Peak values of CK-MB and troponin-T were significantly lower in the diltiazem group. Patients treated with diltiazem had a lower incidence of perioperative atrial fibrillation (5 vs. 18%, p < 0.05) and lower numbers of ventricular premature beats/hour (10 ± 8 vs. 19 ± 22, p < 0.05). The postoperative increase in myocardial function was more pronounced in the diltiazem group. The perioperative infusion of diltiazem does not adversely affect perioperative hemodynamics and myocardial contractility but provides potent antiischemic and antiarrhythmic protection of patients undergoing coronary artery bypass grafting. Future investigations must focus on the role of diltiazem in the improvement of long-term prognosis after coronary bypass surgery.
Combined Mitral Valve Replacement and Pericardiectomy in a Patient with Mitral Regurgitation and Constrictive Pericarditis
Authors: Sankar Nainar Madhu , Ponoth Premanand , Sivaprakasha Krishna , Jacob John Bapoo Kotail , Bashi Vellayikodath Velayudhan , Cherian Kotturathu Mammen
Published: May 2013

We present the case of a patient with chronic constrictive pericarditis and significant mitral regurgitation who successfully underwent combined pericardiectomy and mitral valve replacement. The need for early surgical correction is stressed. Prolonged ventilatory and inotropic support was required in the postoperative period.
A Simplified Technique of Autotransfusion of Shed Mediastinal Blood
Authors: Oswal Dilip , Agrawal Nandkumar , Khandeparkar Jagdish , Joshi Vasant , Magotra Ratna
Published: May 2013

We present a simplified technique for autotransfusion of shed mediastinal blood following open heart surgery. We use a hard-shell cardiotomy reservoir as a collection and infusion device. It is a safe and simple technique applicable in any setup, does not require any sophisticated equipment or trained personnel, and is extremely cost effective.
Gusto Hawaii: A Community Hospital's Experience in an International Randomized Study
Authors: Ashmore Roger C , Pine Maria C , Chen J Roy , Grattan Mark T , Kai Wesley J , Scully Nial M , Shen Edward N , White Roger L
Published: May 2013

Multiple thrombolytic agents are available for treating patients with acute myocardial infarction. The recently completed Global Utilization of Streptokinase and rt-PA for Occluded coronary arteries (GUSTO) study randomized 41,000 patients to 1 of 4 thrombolytic treatment regimens. Straub Clinic and Hospital, a small community hospital in Hawaii, participated in this international clinical trial enrolling a total of 40 patients. Our patient characteristics and use of concomitant therapy were similar to the combined GUSTO, study results. Coronary angiography was performed in 93% of patients postthrombolytic therapy, with a majority of patients having single vessel coronary disease and a patent infarct-related artery. The severity of coronary artery disease at our hospital was similar to the combined GUSTO study results. Percutaneous transluminal coronary angioplasty was performed in 53% of patients and coronary artery bypass surgery in 13% of patients postthrombolytic therapy at our hospital, compared to 15% and 9% in the combined GUSTO study, respectively. The clinical events postthrombolytic therapy at Straub Clinic and Hospital were similar to the combined GUSTO study results, except for a lower incidence of ischemia/reinfarction at our hospital (7.5% v 23.2% respectively).

These data suggest that treatment of acute myocardial infarction with thrombolytic therapy can be administered in a safe and timely manner at a small community hospital.
Cosmetic Approach to Cardiac Surgery
Authors: Kumar Arkalgud Sampath , Rao Pantula Narsimha , Saxena Dilip Kumar
Published: May 2013

We describe our experience in 71 patients operated on between September 1991 and July 1993 for a variety of intracardiac procedures via right thoracotomy incision. The technique provides adequate exposure for mitral, tricuspid, aortic, and atrial septal surgery. The most significant advantage is the cosmetic result, which is highlighted.
Enhanced External Counterpulsation in the Treatment and Rehabilitation of Coronary Patients in Indonesia
Authors: Karim Sjukri , Sani Aulia , Karo-Karo Santoso , Kasim Manoefris , Basha Adnil , Gunadhi Ign , Japaries Willie , Suwita Raymond
Published: May 2013

We report our experience using the new noninvasive treatment for coronary patients called enhanced external counterpulsation (EECP). Thallium-201 stress scintigraphy and treadmill test were done before and after 36 sessions of EECP treatment on 38 coronary patients.

The results showed significant (P < 0.01) improvement in perfusion as well as exercise tolerance in 86.8% and 94.2% of patients, respectively. The symptoms of angina pectoris and functional classes of the patients also showed significant (P < 0.05) improvement. All patients tolerated the treatment without serious complications.

The magnitude and rate of increased exercise tolerance achieved by EECP treatment was greater than those achieved by training after coronary bypass surgery (CABG) or exercise training rehabilitation program for the matched coronary patients reported by others 7 , 8 .

The mean double products (DP) from the treadmill test results of the improved Tl-201 perfusion subgroups decreased significantly (P < 0.001). On the contrary, the DP of the unimproved subgroup increased significantly (P < 0.001). This could mean improvement in efficiency of the heart in the former, that is, more work was done with lower pressure-pulse products.
Hemodynamic Evaluation and Exercise Tolerance Comparison before and after Operation in Closed versus Open Mitral Valvotomy in Pure Mitral Stenosis
Authors: Biu Alex Yip Shing , Hing Chow Wing , Keung Mok Che , Yin Ho Yuk , Cheung David
Published: May 2013

The relative merits and efficacy of open versus closed mitral valvotomy remains controversial. The purpose of this study was to compare improvement of the hemodynamic parameters and exercise tolerance capacity of the 2 operations in 59 patients with pure mitral stenosis in sinus rhythm. Patients were randomly assigned to 1 of 2 groups: 29 patients in group 1 were operated on with the closed technique and 30 patients in group 2 were operated by the open technique. Preoperatively, the hemodynamic parameters and exercise capacity were similar in the two groups. Cardiac catheterization and exercise treadmill test were performed on all patients before and 3 months after each operation. Hemodynamic parameters as well as exercise tolerance capacity were significantly improved by both open and closed valvotomy ( p < 0.0001). However, postoperatively the improvement in exercise capacity was similar in both groups ( p = NS) and there was no significant difference in hemodynamic parameters in both groups, except for reduction in pulmonary artery pressure and increment in cardiac output. Complication rates were similar in both groups, except for atrial arrhythmias, which were more common in group 2. This study suggested that the closed technique, when performed by experienced surgeons, achieved similar hemodynamic and functional results as the open method. It also has the potential advantage of cost savings in addition to avoiding the complications of cardiopulmonary bypass. It clearly has a place in properly selected patients with mitral stenosis.
Long-Distance Procured Homograft-valved Conduit Replacement for Congenital Heart Disease: Initial Experience with 10 Cases
Authors: Neng Lee Chuen , He Luo Hong , Tan Christie TT , Sim Eugene KW , Jie Zhang Ming , Ong Adrian KY
Published: May 2013

We review our experience from January 1987 to September 1992 with the surgical treatment of complex congenital malformations requiring an extracardiac homograft-valved conduit. There were 10 patients in the series; 7 pulmonary and 3 aortic homografts were implanted. Ages ranged from 1 month to 26 years (mean 7.9). There were 4 cases of hospital mortality, none related to the homograft itself. The major postoperative complication was low cardiac output syndrome. The 6 survivors have been followed between 3 months and 5 years and no dysfunction of the valved homograft, thromboembolism, or hemolysis have been recorded. All the survivors are symptom-free with a good quality of life. The use of homografts is advised in selected cases of right and left ventricular tract reconstruction for congenital heart disease; homografts are easy to handle and offer several technical advantages over prosthetic tissues.
Bidirectional Glenn Shunt for Complex Cyanotic Congenital Heart Disease
Authors: Srivastava Sushant , Iyer Krishna Subramony , Sharma Rajesh , Bhan Anil , Das Bhabananda , Airan Balram , Kothari Shyam Sunder , Saxena Anita , Venugopal Panangipalli
Published: May 2013

The bidirectional Glenn Shunt has been advocated for definitive or staged palliation of patients with a functional single ventricle and decreased pulmonary blood flow who are unsuitable for a Fontan operation. Between April 1990 and July 1994, 86 patients underwent bidirectional Glenn operation at the All India Institute of Medical Sciences in New Delhi. This operation was performed electively in 73 patients (group I), as a take-down for Fontan failure in 10 patients (group II), and to complement a two-ventricle repair in 3 patients in whom the right ventricle or the tricuspid valve was inadequate to handle the entire systemic venous return (group III). Fifty-five other procedures were performed in addition to the cavopulmonary shunt. The mean ICU stay was 2 days. There were 5 early deaths in group I, 6 in group II, and none in group III. Mean oxygen saturation at the time of discharge was 84.2% on room air. Follow-up ranged from 3 to 51 months. The bidirectional Glenn shunt was definitive palliation in 9 patients with azygos or hemiazygos continuation of the inferior vena cava. In the remaining patients, a corrective procedure is planned only if there is evidence of failure of palliation or ideal criteria for the Fontan procedure are met. Only 3 patients from group I have therefore undergone subsequent conversion to a Fontan circulation. The bidirectional Glenn shunt provides excellent relief of cyanosis, does not volume load the heart, and possibly lowers the risk of a subsequent Fontan operation. Timely take-down of a failed Fontan procedure is imperative for successful salvage.
Congenital Esophagobronchial Fistula in an Adult—A Case Report
Authors: Ponoth Premanand , Bashi Vellayikodath Velayudhan , Sankar Nainar Madhu , Cherian Tuttathil John , Cherian Kotturathu Mammen
Published: May 2013

A 58-year-old man presented with cough, mainly while taking food, of recent origin. On investigation this proved to be the result of a fistulous communication between the esophagus and the right lower bronchus. Surgical treatment effected disappearance of the symptoms; and the congenital nature of the fistula was proven histopathologically. A high index of suspicion in all cases of recurrent cough at the time of deglutition is required to recognize this rare entity.
Primary Intracardiac Repair of Double Outlet Right Ventricle and Ventricular Septal Defect without Pulmonary Stenosis
Authors: Prasanna KG Jaya , Iyer Krishna Subramony , Sharma Rajesh , Airan Balram , Rao Ivatury Mrityonjaya , Saxena Anita , Kothari Shyam Sunder , Venugopal Panangipalli
Published: May 2013

From January 1991' to May 1994, 29 patients with double outlet right ventricle with ventricular septal defect, without pulmonary stenosis underwent primary intracardiac repair at the All India Institute of Medical Sciences, New Delhi. Patients were classified into 4 groups based on location of the ventricular septal defect. The ventricular septal defect was subaortic in 11, subpulmonary in 13, doubly committed subarterial in 1, and noncommitted in 4 patients. Surgical treatment consisted of intraventricular routing of the left ventricle to the aorta (17), and the left ventricle to the pulmonary artery followed by an arterial switch operation (12). There were 4 (13.9%) early deaths. Follow-up ranged from 3 months to 3 years (mean, 1.5 years). There was no late mortality. Three patients had residual ventricular septal defect, one of whom has undergone reoperation. One patient has a gradient of 25 mmHg across the left ventricular outflow tract. Double outlet right ventricle with subpulmonic ventricular septal defect was found to be a significant risk factor for early mortality (p = 0.03). The subgroup of double outlet right ventricle with subpulmonic ventricular septal defect who had a combination of single coronary artery and post arterial switch operation was particularly prone to pulmonary hypertensive crisis and hospital death (p = 0.002).
Homograft Aortic Root Replacement for Early Prosthetic Endocarditis
Authors: Kumar Arkalgud Sampath , Rao Pantula Narsimha , Sharma Rajesh , Bhan Anil , Airan Balram , Das Bhabananda , Iyer Krishna Subramony , Trehan Hemant , Venugopal Panangipalli
Published: May 2013

Early prosthetic aortic valve endocarditis was managed by aortic root replacement using fresh antibiotic sterilized pulmonary or aortic homografts. A report of 3 consecutive cases with a brief review of literature is presented.
Experience with Bilateral Internal Mammary Artery Grafts for Myocardial Revascularization in Asian Patients
Authors: Das Sarajit Kumar , Sankar Nainar Madhu , Satyaprasad Velivela , Bashi Vellayikodath Velayudhan , Cherian Kotturathu Mammen
Published: May 2013

Bilateral internal mammary artery grafts were used for direct myocardial revascularisation in 72 patients from August 1988 to January 1994. Twenty-five of them had diffuse coronary artery disease. The coronary arteries were small in the majority of patients and 10 patients needed endarterectomy. Two patients died in the hospital. Fifty-nine patients were followed up and the mean time of follow-up was 25 months. One patient died during the follow-up period and another patient developed inferior wall myocardial infarction. Three patients are on antianginal medications and the rest are doing well.
Rrepair of Total Anomalous Pulmonary Venous Connection through Right Thoracotomy
Authors: Kumar Arkalgud Sampath , Dharmapuram Anil Kumar , Girotra Samir , Das Bhabananda
Published: May 2013

During right thoracotomy for closure of a secundum atrial septal defect, it was discovered that the patient had supracardiac total anomalous pulmonary venous connection. Repair of this lesion was completed through the same incision without difficulty or sequelae and is described here.
Heart and Heart-Lung Transplantation: An Update
Authors: Yuh David D , Robbins Robert C , Reitz Bruce A
Published: May 2013

Heart and heart-lung transplantation have been established as effective treatments for a wide variety of end-stage cardiopulmonary diseases. Recent years have seen refinements in surgical techniques for cardiopulmonary replacement as well as the selection and postoperative care of thoracic transplant recipients. Despite substantial clinical progress, however, significant problems remain, particularly donor organ shortage, graft rejection, opportunistic infection, and limited organ preservation techniques. Basic and clinical research are currently addressing these problems. In this brief review, we provide an update of our experiences with heart and heart-lung transplantation in the West (particularly at Stanford University), an outline of the active issues in the field, and some thoughts about the development of thoracic transplantation in Asia.
Cardiac Tumors: Surgical Experience in Thirty-Nine Cases
Authors: Suri Rajendar Krishan , Kanwar Raghuvir Singh , Singh Harjinder , Dhaliwal Rajinder Singh , Rana Sandeep Singh , Thingnam Shyam Kumar Singh , Sarwal Virender , Jha Neerod Kumar , Gujral Jagtaran Singh
Published: May 2013

Over a period of 18 years, 39 cases of cardiac tumors were operated upon in the Department of Cardiothoracic Surgery at the Postgraduate Institute of Medical Education and Research, Chandigarh. These included 34 (87%) patients with benign tumors and 5 (13%) patients with primary malignant tumors. All the benign tumors were myxomas, of which 31 (91.2%) were in the left atrium and 3 (8.8%) in right atrium. Primary malignant tumors comprised 2 rhabdomyosarcomas, 1 angiosarcoma, 1 lymphoma and 1 case of pleomorphic malignant fibrous histiocytoma. The diagnosis was established by echocardiography, angiocardiography and computed tomography. In one case the diagnosis was made at autopsy. All myxomas, except tricuspid valve myxoma, were removed completely through right atrial or biatrial approach with the use of cardiopulmonary bypass. Four cases of primary malignant tumors were non-resectable. Near total resection of a malignant fibrous histiocytoma arising from the right middle pulmonary vein and left atrial junction was achieved. There were 2 operative deaths (5.1 %). The follow-up ranged from 3 months to 10 years with a mean of 5.7 years. There was 1 recurrence (2.9%) in the benign group. In the malignant group, 3 cases (60%) died within 5 to 8 months of surgery due to further local and metastatic spread of the tumor. The case of malignant fibrous histiocytoma was treated with postoperative radiotherapy to the right mediastinum and is doing well at follow-up 3 months after surgery.
Surgical Experience with Doty's Repair for Supravalvular Aortic Stenosis
Authors: Airan Balram , Kaushal Sunil K , Bhan Anil , Venugopal Panangipalli
Published: May 2013

The surgical treatment of severe supravalvular aortic stenosis by conventional, asymmetrical, one point patch aortoplasty across the narrowed area has been associated with a substantial incidence of residual stenosis and reoperations. Almost symmetrical relief of such stenosis was achieved with Doty's extended aortoplasty in 5 patients in whom left ventricular aortic gradient was reduced from 60–170 nun Hg to 0–25 mm Hg. This technique of inserting an inverted V-shaped gusset across the stenosed segment into the right coronary sinus and non-coronary sinus, restores the aortic root geometry, provides more predictable relief of aortic obstruction and also improves aortic valve function. Associated procedures involved relief of coarctation of aorta and innominate artery stenosis in 1 case and repair of aortic valve and mitral valve in another case.
Primary Cardiac Hydatid Cyst
Authors: Yilmaz Ahmet T , Arslan Mehmet , Göktepe Mehmet , Demirkilic Ufuk , Kuralay Erkan , Özal Ertuğrul , Tatar Harun , Öztürk Ömer Y
Published: May 2013

We report 3 patients with primary cardiac hydatid cysts, all of which were located on the wall of the right ventricle. In one case, an intramyocardial cyst protruded into the right ventricular chamber and in the other 2 cases, cysts protruded into the intrapericardial space. The diagnosis was confirmed by serologic tests, two-dimensional echocardiography, tomographic scanning and cardiac angiography. The patients underwent successful enucleation of the cysts with the aid of cardiopulmonary bypass. There was no morbidity or mortality and late results were satisfactory.
Identification of Paragonimus Westermani in Pulmonary Adenosquamous Carcinoma
Authors: Rue Lai I , Ping Luh Shi , Chie Lee Yung , Kwang Tu Yong , Yu Chou Yuh , Tung Yao Yu
Published: May 2013

A 63-year-old Chinese man complained of a throbbing headache and dizziness for one month. A solitary pulmonary tumor with a single brain metastasis was found. Craniotomy and right upper lobectomy of the lung were performed separately to remove the tumors totally. Pathological studies confirmed the diagnosis of pulmonary adenosquamous carcinoma with brain metastasis. Interestingly, many eggs of Paragonimus westermani were found over the cancerous part of the lung. The association of pulmonary adenosquamous carcinoma with previous paragonimiasis has not been reported previously. The relationship between parasite infestation and subsequent oncogenesis deserves further investigation.
Aorto-Innominate Vein Fistula: A Rare Complication following Open-Heart Surgery
Authors: Sajja Lokeswara Rao , Pinnamaneni Satyanarayana Rao , Narasimha Madhusudan Kandukuri , Reddy Chinna Reddy Naresh Kumar , Reddy Benjavani Sita Ram
Published: May 2013

A case of aorto-innominate vein fistula following open-heart surgery is reported. This was successfully repaired through a redo median sternotomy using partial cardiopulmonary bypass and moderate hypothermia.
Multiplane Transesophageal Echocardiographic Description of a Complete Papillary Muscle Rupture during Acute Myocardial Infarction
Authors: Won Ha Jong , Chung Namsik , Yun Cho Seung , Heum Shim Won , Sik Kang Meyun , Woo Hong Yong , Soon Kim Sung
Published: May 2013

The complete rupture of a papillary muscle is a relatively rare complication of acute myocardial infarction and is generally considered to be rapidly fatal. We describe the multiplane transesophageal echocardiography features of a completely ruptured anterolateral papillary muscle complicating acute non-Q wave lateral myocardial infarction.
Transmyocardial Laser Revascularization: Saudi Experience
Authors: Raffa Hassan , Memon Feroz , Jabbad Hussein , Moinuddin Mohammed , Kayali Mohammed Taher , Langer Jamal , Ramadan Mohammed , Kumar Dillip , Makarem Hani
Published: May 2013

One hundred transmyocardial revascularization procedures were performed between February 1994 and January 1996, using the C02 Heart Laser on 90 patients with stable angina and 10 with unstable angina. This was the sole therapy in 98 cases and utilized in combination with open-heart surgery in 2 others. Most patients (96) had this procedure without having undergone previous coronary artery bypass graft surgery; 66 patients were deemed to have nongraftable vessels, while 34 patients had coronary artery anatomy that was favorable to bypass graft surgery but elected to undergo laser revascularization instead. The majority (86%) were male and ages ranged from 30 to 82 (mean 55) years. At 12 months after the procedure, 92% of patients reported that they were free of angina, while mean exercise tolerance increased from 7 minutes preoperatively to 15 minutes, and metabolic equivalent units rose from 4.8 to 10.2. The average increase in Karnofsky performance score was 51%, and oxygen consumption improved by 93%. The increase in left ventricular ejection fraction was not statistically significant. Most patients resumed work within 18 days of the procedure. Consumption of antianginal medication was reduced to minimal in 83% of the patients at the end of one year. There were 10 deaths in the series, chiefly in patients with extremely low ejection fractions. We conclude that the application of this rapidly evolving procedure as a primary therapy in ungraftable patients, appears to be safe and deserving further study.
Giant Pulmonary Cyst Surgery
Authors: Saha Sibu P , Rogers Anthony G , Earle Gary F , Nachbauer Craig , Baker Mary
Published: May 2013

Giant pulmonary cysts, often developing as a major complication of emphysema, seriously interfere with breathing mechanics. This report describes the results in 35 patients with giant pulmonary cysts who underwent surgical excision. A case report involving a 26-year-old coal miner with bilateral bullous emphysema is also presented.
New Technique for Reinforced Sternal Closure
Authors: Al-Ebrahim Khalid , Shafei Hussein
Published: May 2013

A new technique for reinforced sternal closure is described. The method consists of placing longitudinal in-and-out wires, on each side of the sternum. The 2 longitudinal wires, which lie within the standard transverse wires, are joined and tightened at the upper and lower parts of the sternum after approximation of the transverse wires. This technique was found to be quick, simple and extremely effective.
Negative Outcomes following Video-Assisted Thoracic Surgery
Authors: Yim Anthony PC
Published: May 2013

The author reviewed his personal experience with 776 video-assisted thoracoscopic procedures on 526 patients over a 34-month period, with particular attention to perioperative complications and procedure failures. There was one death (mortality rate 0.2%). Nonfatal complications comprised persistent air leaks (13), bleeding (4), wound infection (2), intercostal neuralgia (5), cerebrovascular accident (1), reexpansion pulmonary edema (1), deep vein thrombosis (1), prolonged ventilatory support (1), and port site recurrence (1), giving rise to an overall nonfatal complication rate of 5.5%. Procedure failures consisted of 4 incidences of recurrence of pneumothorax (out of 213 cases or 1.9%); 2 recurrences of malignant pleural effusion (out of 39 cases or 5.1%); 2 recurrences following resections for stage I lung cancer (out of 32 cases or 6.3%). Proportionally more complications and procedure failures were seen in the first 17 months compared to the following 17 months, in spite of the fact that more technically advanced procedures were performed in the latter period. Careful patient selection and attention to details are essential in optimizing surgical results.
Heart Frequency Modulation: An Emerging Therapeutic Modality in the Failing Heart
Authors: Chandra Mahesh , Gupta Vivek , Agarwal Ajay , Mehrotra Sanjay
Published: May 2013

Understanding of the importance of the role of compensatoty mechanisms in heart failure has been translated into therapeutic options which can improve cardiac function, favorably alter disease progression, and improve survival. Sinus tachycardia in heart failure results from neurohormonal activation, which reduces ventricular filling time and thus further increases atrial pressure and venous congestion. It may also cause myocardial ischemia, leading to progressive ventricular dysfunction. In this review, the role of heart frequency modulators in heart failure is discussed.
Stent Placement for Idiopathic Obstruction of the Inferior Vena Cava
Authors: Agarwal Rajiv , Kaul Upendra , Jain Pradeep , Sharma Sanjeev , Sharma Sanjiv , Wasir Harbans S
Published: May 2013

Ten patients (mean age 36.6 ± 8 years; 5 male) with idiopathic inferior vena cava obstruction underwent balloon angioplasty, followed by placement of a self-expanding stent. Six had total occlusion, 5 had restenosis (including 2 with total occlusion), and I had a suboptimal result after initial dilatation. The mean diameter of the inferior vena cava increased from 1.5 ± 2.1 mm to 14.4 ± 2.7 mm, and the pressure gradient between the vena cava and the right atrium decreased from 15.2 ± 5.0 mm Hg to 1.1 ± 1.5 mm Hg. Follow-up venography after 74 ± 35 days in 6 patients, revealed ho restenosis, with further enlargement of the mean diameter by 5.2 ± 3.1 mm (44 ± 35%) and abolition of pressure gradients. One patient died 6 months after the procedure from acute Budd-Chiari syndrome. Autopsy revealed a widely patent stent with hepatic vein thrombus. Stent implantation is useful in the management of inferior vena cava obstruction with prior restenosis, total occlusion, or suboptimal results of balloon angioplasty.
Single versus Biventricular Repair for Discordant Hearts
Authors: Prasanna KG Jaya , Sharma Rajesh , Iyer Krishna Subramany , Airan Balram , Bhan Anil , Kothari Shyam Sunder , Saxena Anita , Rao Ivatuary Mritunjoy , Venugopal Panangipalli
Published: May 2013

We reviewed our surgical experience, over a 7-year period, of 38 patients with congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis, who were anatomically well-suited for a biventricular repair. Follow-up ranged from 2 to 9 years (mean 5.3 years). One group of patients underwent a univentricular repair; there were 2 early deaths (8%) among the 24 patients who underwent a Fontan-type repair and 5 patients had prolonged pleural effusion. There was no early mortality in the 3 patients who underwent a bidirectional Glenn anastomosis but there was 1 late death. Patients undergoing a biventricular repair comprised 6 who had closure of a ventricular septal defect and pulmonary valvotomy, and 5 who had ventricular septal defect closure and conduit repair. There was 1 early death (9%) and 2 patients developed iatrogenic complete heart block in this group but there was no late mortality. None of these patients had a double switch procedure. With the advent of the double switch procedure, there are now 3 modes of management for these defects. Determining which of these provides the best long-term result is still a matter for debate.
Patients with Restrictive Lung Function for Valve Surgery
Authors: Mehta Yatin , Juneja Rajiv , Ganguli Somnath , Dhole Sunil , Trehan Naresh
Published: May 2013

Severe restrictive lung pathology following long-standing valvular disease is not uncommonly seen in developing countries. Acute restrictive pulmonary conditions, corrective surgery, and the effects of cardiopulmonary bypass add to the preexisting lung pathology. This may lead to a difficult postoperative respiratory management culminating in an inability to wean such a patient from the ventilator. We present the successful respiratory management of 3 frail patients with rheumatic heart disease and severe respiratory lung pathology, who underwent valve replacement surgery.
Modified Repair of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome
Authors: van Son Jacques AM , Falk Volkmar , Mohr Friedrich W
Published: May 2013

A modified technique for the repair of tetralogy of Fallot with absent pulmonary valve syndrome and stenosis at the origin of the lobar or segmental pulmonary artery branches is described. This consists of generous reduction plasty of the redundant anterior and posterior walls of the aneurysmally dilated branches of the pulmonary artery, resection of the main pulmonary artery, pericardial patch augmentation of the stenotic origins of the lobar or segmental pulmonary artery branches, insertion of a valved pulmonary allograft, and closure of the ventricular septal defect. The advantages of this technique, in addition to relief of the left-to-right shunt, consist of complete decompression of the tracheobronchial structures, and restoration of the capacitance of the central pulmonary arteries. This may result in a reduced tendency for postoperative respiratory insufficiency as well as long-term preservation of right ventricular compliance. The technique was successfully performed on 2 critically ill neonates and a 3-month-old infant.
Anomalous Origin of the Left Coronary Artery
Authors: Iyer Raju Subramaniam , Huu Nguyen Khanh , de Levol Marc
Published: May 2013

A 4-month-old infant with an anomalous left coronary artery underwent a surgical correction in the form of tubular reconstruction of the anomalous coronary artery using a cuff of the main pulmonary artery and creation of a viable two-coronary artery system. Subsequently, mitral valve repair was performed for severe mitral insufficiency, which had not abated after the repair of the anomalous coronary artery. This case demonstrates the difficulties in diagnosing such patients, along with the advantage of creating a viable two-coronary artery system in such sick infants.
Clamshell Incision for Simultaneous Correction of Aortic Coarctation and Intracardiac Defects
Authors: van Son Jacques AM , Diegeler Anno , Mohr Friedrich W
Published: May 2013

A clamshell incision allows simultaneous correction of aortic coarctation and intracardiac defects. This incision combines the benefits of a single incision with those of excellent exposure of the heart and the entire thoracic aorta as well as a superior cosmetic result.
Intrapleural Analgesia before Pleurodesis
Authors: Laub Michael , Aagaard Jan
Published: May 2013

Intrapleural injection of local anesthetics has proved effective in managing pain caused by various conditions. We used this technique prior to pleurodesis and monitored the effect. Twenty consecutive patients suffering from severe unilateral pleural effusion were included. The investigation was performed double blind. Ten patients received bupivacaine intrapleurally and ten patients received sodium chloride prior to pleurodesis with tetracycline. Pain was scored using the visual analog scale before, and at various intervals after the pleurodesis. The patients in the placebo group had high pain scores and needed supplemental morphine injections. The patients in the bupivacaine group had low pain scores and did not need supplemental morphine. We found that intrapleural injection of bupivacaine prior to pleurodesis with tetracycline was effective in abolishing the pain.
Echocardiographic Appearance of Normally Functioning Sorin Bicarbon Valve Prostheses
Authors: Renzulli Attilio , Vitale Nicola , Ismeno Gennaro , Dialetto Giovanni , Paparella Domenico , de Luca Luigi , Cotrufo Maurizio
Published: May 2013

A clinical and echocardiographic study was carried out to evaluate the performance of the Sorin Bicarbon bileaflet valve. From December 1990 to December 1994, 100 patients underwent isolated mitral (64) or aortic (36) valve replacement. There were 39 males and 61 females, with ages ranging from 21 to 73 years (mean 62 ± 9.6 years). Forty-three patients underwent a transthoracic continuous pulsed color Doppler echocardiogram at 3 and 6 months postoperatively. For mitral prostheses, the parameters calculated were valve area, pressure half-time and mean gradient; for aortic prostheses, peak and mean gradients were measured. Results were compared by analysis of variance to those obtained in patients matched for sex, body surface area, cardiac rhythm, site, and size of the prosthesis who had St. Jude Medical or CarboMedics valves implanted. No statistically significant differences were found among the 3 prosthetic heart valves. The operative mortality was 7%; 3 cases of fatal cerebral hemorrhage occurred in the early postoperative period. There was 1 late mortality, 1 case of transient cerebral ischemia, and 1 of gastric bleeding, all occurring inpatients with mitral prostheses. Midterm follow-up was satisfactory, although a larger series is required to confirm these results.
Circular Plication Annuloplasty for Rheumatic Mitral Valve Disease
Authors: Şağban Mansur , Türköz Rıza , Kestelli Mert , Önem Gökhan
Published: May 2013

Fourteen patients with mitral regurgitation and annular dilatation of rheumatic origin underwent surgery at İzmir State Hospital between May 1991 and January 1995. Number 2 polyester suture was attached around the posterior mitral annulus and circular plication was performed by tightening the suture to obtain a competent mitral valve with the largest possible nonstenotic orifice. Preoperatively all the patients had grade 3 or 4 (mean grade 3.41 ± 0.14) mitral regurgitation diagnosed by color Doppler echocardiography. At follow-up (mean follow-up time 35 ± 6.1 months), echocardiography showed 6 patients had grade 1 mitral regurgitation, 6 patients had grade 2, and 2 patients had no regurgitation (mean grade 1.28 ± 0.19). Postoperatively, the mean mitral valve area was found to be 2.74 ± 0.25 cm2 by pressure half-time echocardiography. The mean left ventricular diastolic diameter was 63 ± 2.9 mm preoperatively and 52 ± 1.7 mm postoperatively ( p < 0.05). The mean gradient across the mitral valve was 5.72 ± 0.78 mm Hg. Success (reduction of mitral regurgitation by at least 2 grades) was 86% at the end of the follow-up period. This annuloplasty technique was found to be a quick and effective method of reducing annular dilatation while maintaining annular flexibility.
Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension
Authors: Qing Gao Chang , Garcia Rodolfo Barragan
Published: May 2013

We describe our experience of treating chronic major vessel thromboembolic pulmonary hypertension with pulmonary thromboendarterectomy. Thromboendarterectomy was performed in 15 patients through a median sternotomy incision using extracorporeal circulation and deep hypothermia. Postoperatively mean pulmonary artery pressure, mean pulmonary vascular resistance, and cardiac index were significantly improved (p < 0.001). Four patients died during surgery, mainly from perfusion edema (operative mortality 27%). The 11 surviving patients received long-term anticoagulant therapy and no incidence of thromboembolism has occurred during the follow-up period. All have shown sustained pulmonary hemodynamic improvement; however, there were 2 late deaths from cardiac failure. We conclude that thromboendarterectomy is an effective treatment for chronic major vessel thromboembolic pulmonary hypertension.