bluuebunny/crossref_metadata_2025 huggingface dataset:
Arterial Complications following Cardiac Catheterization in Children Less than 10 kg
Authors: Bulbul Ziad R , Galal Mohammed Omar , Mahmoud Elsayed , Narden Bettina , Solymar Laszlo , Chaudhary Mohammad Ashraf , Al Halees Zohair Y
Published: May 2013

We sought to determine if a higher dose of heparin would reduce arterial complications in patients weighing 10 kg or less undergoing cardiac catheterization to investigate congenital heart disease. Sixty patients were given either 100 (group A) or 150 (group B) IU·kg−1 of heparin in a double-blinded randomized manner. Initial arterial access was established using a 4F cannula in all patients. Mean activated clotting time measured 20 minutes following heparin administration was significantly lower in group A than in group B (199 versus 251 seconds). Only 3 out of 60 patients (5%) required treatment for loss of femoral pulse. The age, weight, activated clotting time, length of catheterization procedure, time taken to establish arterial access, and the duration of arterial cannulation were comparable between the groups. Weight under 4 kg, age under 1 month, and cannula size larger than 4F were identified as independent risk factors for the development of arterial complications. Arterial access using a 4F cannula is a safe procedure in children weighing 10 kg or less. The incidence of significant arterial complications is low, and they do not appear to be preventable by a higher dose of heparin.
Robotically Controlled Video-Assisted Port-Access Mitral Valve Surgery
Authors: Trehan Naresh , Mishra Yugal K , Sharma Mitesh , Bazaz Surinder , Mehta Yatin , Sharma Krishan Kant , Shrivastava Sameer
Published: May 2013

From 1997 to 2000, 221 patients underwent mitral valve surgery through a mini-thoracotomy, using a port-access endovascular cardiopulmonary bypass system in 38 and a transthoracic clamp in 183. In 120 patients, exposure of the mitral valve was facilitated by an endoscope attached to a voice-controlled robotic arm (AESOP 3000). The mitral valve was repaired in 26 patients and replaced in 195; 24 were redo cases. Operating time was 3.5 ± 1.2 hours, aortic crossclamp time was 58 ± 16 minutes, intensive care unit stay was 22 ± 7 hours, and hospital stay was 6.4 ± 1.2 days. Median postoperative blood loss was 332 ± 104 mL. There was 1 hospital death. On follow-up at 16.4 ± 12.2 months, there was no late death or reoperation. New York Heart Association functional class improved from 2.6 ± 0.5 to 1.4 ± 0.8. Use of video and robotic assistance minimized incision length and allowed visualization of the whole mitral valve apparatus. The transthoracic clamp facilitated aortic crossclamping and injection of cardioplegia. These findings indicate that the procedure is safe and effective and suggest advantages over conventional surgery in terms of cost, cosmesis, blood loss, postoperative discomfort, intensive care unit and hospital stay.
Acute Thrombotic Obstruction of Mitral Valve Prosthesis: Low Protein C Level
Authors: Ohata Toshihiro , Sakakibara Tetsuo , Takano Hiroshi , Ishizaka Toru
Published: May 2013

A 51-year-old female underwent redo mitral valve replacement with a pericardial bioprosthesis because of acute thrombotic obstruction of a mechanical valve, in spite of adequate anticoagulation with warfarin. Her protein C level was 24% of the normal value and protein S was reduced to 54% of normal.
Isolated Idiopathic Pulmonary Artery Aneurysm
Authors: Agarwal Saket , Chowdhury Ujjwal Kumar , Saxena Anita , Ray Ruma , Sharma Sanjeev , Airan Balram
Published: May 2013

Aneurysm formation of the main pulmonary artery is rare. Its natural history is not well understood and there are no clear guidelines on optimal treatment. A 20-year-old woman with a huge saccular aneurysm of the main pulmonary artery, underwent repair with a pericardial patch and concomitant reconstruction of the pulmonary valve. The patient was doing well on follow-up at 6 months; echocardiography revealed a good repair with mild to moderate pulmonary regurgitation.
Mediastinal Myelolipoma
Authors: Gao Bing , Sugimura Hiroshi , Sugimura Shuichiro , Hattori Yoshinobu , Iriyama Tadashi , Kano Hideki
Published: May 2013

Myelolipoma is a rare tumor, and a mediastinal location is extremely unusual. The main pathologic feature is the coexistence of mature adipose tissue and bone marrow cells; the presence of megakaryocytes is essential for diagnosis. The successful removal of a mediastinal myelolipoma in a 59-year-old man is described.
Bronchial Artery Dissection and Fatal Hemothorax following Pneumonectomy
Authors: Tang Augustine TM , Velissaris Theodore J , Tsang Geoffrey , Roche William
Published: May 2013

A 59-year-old man died suddenly and unexpectedly two days after an uncomplicated pneumonectomy for bronchogenic adenocarcinoma. In addition to a distal pulmonary thromboembolism found at postmortem, there was significant hemorrhaging into the pneumonectomy space, which was associated with rupture of a dissecting aneurysm in the calcified bronchial artery stump. The pathology and surgical implications of bronchial artery disease are discussed.
A Technique Facilitating Muscle-Sparing Thoracotomy
Authors: Akçali Yiğit , Demir Hasan , Tezcan Bekir
Published: May 2013

The muscle-sparing thoracotomy technique preserves the latissimus dorsi and serratus anterior muscles and provides excellent exposure for most thoracic and mediastinal operations. It also reduces postoperative pain and complications, and preserves pulmonary function. The technique has been developed further to facilitate subcutaneous dissection by insufflation of air from a syringe connected to a large-bore needle via a 3-way tap.
Coronary Artery Bypass in Patients with Severe Left Ventricular Dysfunction
Authors: Dilip Dronamraju , Rao Mangu H , Chandra Abha , Rao M Sanjeeva , Rajasekhar Durgaprasad , Prasad Sribhasyam Venkateswara , Mohan Alladi
Published: May 2013

We retrospectively reviewed the case records of 82 patients with severe left ventricular dysfunction (ejection fraction < 30%) who underwent coronary artery bypass grafting between March 1993 and February 2000. They were aged 28 to 76 years (mean, 60 years), and 66 of them were male. Significant comorbid factors included hypertension (93%), diabetes mellitus (85%), and hypercholesterolemia (49%). The number of grafts used ranged from 1 to 3. The majority of the patients (91%) belonged to the Canadian Cardiovascular Society angina class III. Coronary angiography revealed single-vessel (in 16% of the patients), double-vessel (52%), and triple-vessel disease (32%), and left main stem disease (18%). Seven patients (9%) died within 48 hours after surgery. The mean duration of hospital stay was 7 ± 2 days. The 75 patients who survived were followed up for 3 months to 7 years. At the 1-year follow-up, 61 of the 68 patients (90%) who were alive moved up from angina class III to class I. Our observations suggest that coronary bypass carries an acceptable mortality risk and may offer a better quality of life in patients with poor ventricular function.
Redo Mitral Valve Surgery Using the Port-Access System
Authors: Trehan Naresh , Mishra Yugal K , Mathew Satish G , Sharma Krishna K , Shrivastava Sameer , Mehta Yatin
Published: May 2013

Redo mitral valve surgery is hazardous, hence we explored an alternative approach using a port-access system that avoids reentry. Between October 1997 and December 2000, 32 patients underwent mitral reoperation using the system. All patients had previous cardiac operations. This procedure consisted of a right anterolateral minithoracotomy and femorofemoral cannulation using special port-access instruments and endoaortic clamping in 24 patients or direct transthoracic sliding-rod aortic clamping in 8. The valve disease was of rheumatic etiology in 28 patients and degenerative in 4. The valve was replaced in 31 cases and a paravalvular leak after mitral valve replacement was closed in 1. In 2 cases, the tricuspid valve was repaired along with mitral valve replacement. Mean total operating time was 4.5 ± 1.2 hours, cardiopulmonary bypass time 162 ± 72 minutes, and aortic crossclamp time 62 ± 21 minutes. There was no mortality, and mean stay in the intensive care unit was 22 ± 7 hours and hospital stay 6.4 ± 1.2 days. Postoperative blood transfusion was required in 12 patients. In view of the favorable results, we recommend using the port-access system as a standard approach for mitral reoperation.
Cerebral Metabolism of Nitric Oxide during Retrograde Cerebral Perfusion
Authors: Ueno Katsuhito , Takamoto Shinichi , Miyairi Takeshi , Morota Tetsuro , Shibata Ko , Murakami Arata , Kotsuka Yutaka
Published: May 2013

The aim of this study was to determine whether alpha- or pH-stat protects the brain during deep hypothermic retrograde cerebral perfusion. Fifteen anesthetized dogs on cardiopulmonary bypass were cooled to 18°C under alpha-stat and underwent retrograde cerebral perfusion for 90 minutes under alpha-stat or pH-stat, or underwent antegrade cardiopulmonary bypass under alpha-stat as the control. Cerebral blood flow of the cortex was monitored and serial analyses of blood gases and total nitric oxide oxidation products made. Cerebral blood flow and cerebral metabolic rate for oxygen were significantly higher and plasma levels of nitric oxide oxidation products in the outflow from the brain were significantly lower in retrograde cerebral perfusion under pH-stat than under alpha-stat. This study shows that reduced levels of nitric oxide oxidation products may protect against neuronal damage induced by nitric oxide and that increased cerebral blood flow under pH-stat may lead to a reduction of nitric oxide oxidation products. Under retrograde cerebral perfusion, pH-stat is thus better than alpha-stat for protecting the brain.
Video-Assisted Thoracoscopic Surgery for Congenital Heart Disease
Authors: Yu Shi Qiang , Cai Zhen Jie , Cheng Yun Ge , Duan Da Wei , Xu Xue Zheng , Chen Wen Sheng , Zhou Gen Xu
Published: May 2013

We report our experience with video-assisted thoracoscopy in the surgical closure of heart septal defects. Nine patients, aged 10 to 26 years, underwent operation for closure of an atrial septal defect; and 3, aged 10 to 22 years, for closure of a ventricular septal defect. Three minithoracotomies with a diameter of 2 to 3 cm were made in the fourth intercostal space of the right parasternum and the fourth and seventh intercostal spaces of the right middle axillary line, respectively. Through the openings and guided by a thoracoscope, a catheter was inserted into the superior vena cava, femorofemoral extracorporeal circulation was built, the aorta was crossclamped, and the myocardium was protected by cold cardioplegia. The right atrium was opened, and the defect was exposed with a traction suture. Primary closure of defects was performed successfully in all patients. The duration of aortic crossclamping and extracorporeal circulation ranged from 11 to 56 minutes and from 50 to 168 minutes, respectively. Postoperatively, cardiac murmur disappeared and echocardiograms showed no residual shunt. Repair of heart septal defects can be completely done with the assistance of video-assisted thoracoscopy, offering a new option with minimal incision.
Outcome following Repair of Sinus Venosus Atrial Septal Defects in Children
Authors: Russell Jennifer L , LeBlanc Jacques G , Deagle Margaret L , Potts James E
Published: May 2013

The outcome of surgical repair of sinus venosus atrial septal defect was reviewed retrospectively. The operation was performed on 44 children aged 8 to 163 months, between April 1985 and November 1998. Median cardiopulmonary bypass and aortic crossclamp times were 58 minutes (range, 29 to 141 minutes) and 29 minutes (range, 4 to 67 minutes), respectively. Use of blood products decreased from 4.5 units per patient in the first period (1985 to 1989) to 0.6 units in the last period (1995 to 1998). Median intensive care and hospital stays were 2 days (range, 1 to 12 days) and 6 days (range, 4 to 16 days), respectively. There was 1 early death (2.3%). Complications included reexploration for bleeding in 2 patients (4.5%) and for superior vena cava obstruction in 1 (2.3%), and arrhythmias in 3 (6.8%), which required a pacemaker in one. During follow-up of 15 to 176 months, 83.8% of patients were in sinus rhythm. One required angioplasty for superior vena cava stenosis, hemodynamically insignificant residual shunt was found in 3, and mild superior vena cava stenosis in 3. Repair of sinus venosus atrial septal defect carries a low mortality and morbidity, but long-term follow-up is needed to monitor potential sinus node dysfunction and superior vena cava stenosis.
Limited Right Posterior Thoracotomy Approach to Atrial Septal Defect
Authors: Sunil Gopalraj S , Koshy Sajan , Dhinakar Seetharaman , Shivaprakasha Krishnanaik , Rao Suresh G
Published: May 2013

Experience of atrial septal defect closure via a limited posterior thoracotomy is described. From July 1999 to May 2001, 75 prepubertal girls with a median age of 7 years (range, 3 to 13 years) and a median weight of 18 kg (range, 10 to 46 kg) underwent atrial septal defect closure through a limited right posterior thoracotomy. All but 2 patients had an uneventful postoperative recovery. The median duration of ventilation was 13.3 hours (range, 4 to 24 hours). Median hospital stay was 6 days (range, 6 to 8 days). All patients were followed up for 7 to 32 months (mean, 15 months). The wounds healed well without any restriction of limb movement. The limited posterior thoracotomy gave excellent cosmetic results and can be used as a safe alternative approach for atrial septal defect closure in prepubertal females.
Patch Enlargement of the Posterior Mitral Leaflet in Ischemic Regurgitation
Authors: Rendón Felipe , Aramendi José I , Rodrigo David , Baraldi Christian , Martínez Pablo
Published: May 2013

We discuss our early experience in 2 patients with a patch enlargement technique for treating chronic ischemic mitral regurgitation due to restricted motion of the posterior mitral leaflet. This technique corrects the restricted motion and offers better coaptation without compromising the mitral orifice.
Postinfarction Left Ventricular Free Wall Rupture Repaired Successfully
Authors: Tireli Emin , Kalko Yusuf , Kafali Eylül , Basaran Murat
Published: May 2013

Left ventricular free wall rupture is a well-recognized complication of myocardial infarction and a frequent cause of death. A 49-year-old man was successfully treated for a left ventricular free wall rupture that occurred on the third day after an anterior myocardial infarction. Concomitant myocardial revascularization was performed.
Congenital Cleft of Anterior Tricuspid Leaflet in Adolescent
Authors: Okutan Hüseyin , Yavuz Turhan , Bilgin Selçuk , Düver Harun , Kutsal Ali
Published: May 2013

The diagnostic findings and treatment of an isolated congenital cleft of the anterior leaflet of the tricuspid valve in a 14-year-old boy are described. An atrial septal defect was closed by primary suturing, and the tricuspid valve was successfully reconstructed by De Vega annuloplasty.
Acromegaly: A Rare Manifestation of Bronchial Carcinoid
Authors: Bhansali Anil , Rana S Singh , Bhattacharya Sujit , Muralidharan Rajgopal , Dash Radharaman J , Banerjee Ashru K
Published: May 2013

Bronchial carcinoids usually present with pulmonary symptoms. Neurohumoral manifestations in the form of acromegaly and Cushing's syndrome are rarely encountered. We report a case of bronchial carcinoid with features of acromegaly due to ectopic production of growth hormone-releasing hormone. Surgical resection of the lung lesion resulted in regression of acromegalic features, normalization of growth hormone secretory dynamics, and remarkable diminution of pituitary size seen on magnetic resonance imaging.
Retroesophageal Hematoma Caused by Fish Bone Perforation of the Esophagus
Authors: Jougon Jacques , Minniti Antonio , Moralès Patrick , Laurent François , Velly Jean François
Published: May 2013

A 39-year-old man complained of acute dysphagia and dorsal pain while eating fish. Radiologic and endoscopic studies revealed a retroesophageal mass, which was later shown to be a hematoma.
Preoperative Intraaortic Balloon Pump for Salvage Myocardial Revascularization
Authors: Christenson Jan T
Published: May 2013

The benefit of preoperative intraaortic balloon pumping on hospital and 1-year mortality was assessed in 17 consecutive patients with cardiogenic shock who underwent salvage coronary artery bypass surgery between January 1996 and May 2000. Mean preoperative cardiac index was 1.57 ± 0 23 L.min−1.m−2. Hemodynamic stability was achieved prior to surgery in 14 patients, and mean cardiac index increased to 2.28 ± 0.64 L.min−1.m−2. Hospital mortality was 5.9% (1 patient). Five patients required postoperative intraaortic balloon pumping because of low cardiac output. The duration of intensive care, hospital stay, and the total procedural cost were similar to those reported for high-risk coronary bypass grafting. Cardiac event-free survival was 88.2% (15/17) at 1 year. Intraaortic balloon pumping promises to be an effective therapy for patients in cardiogenic shock who subsequently undergo surgical myocardial revascularization as a salvage procedure.
Coarctation of the Aorta in Neonates and Young Infants: Surgical Experience
Authors: Pantula Narasinga Rao , Kumar Raghavan Nair Suresh , Dharmapuram Anil Kumar , Mohmoud Hassan Mohamed , Chandran Sushil , Dhir Achal Kumar , Saxena Dileep Kumar , Azhagappan Sivan Pillay , Pillai Velayudhan Ramakrishna , Venkitachalam Chokkanathapuram Gopalakrishnan , Fikree Mohamed Amin , Nazer Yousuph Abdul , Cartmill Timothy Boyd , Ivatury Mrutyunjaya Rao
Published: May 2013

A retrospective analysis of repair of aortic coarctation in young infants was conducted. Between April 1997 and December 2000, 21 patients under 4 months of age underwent repair of coarctation. Their mean age and weight were 41 ± 42 days (range, 2 to 120 days) and 3.6 ± 0.7 kg (range, 2.6 to 4.9 kg). The indications for surgery were congestive heart failure and/or shock. Diagnosis was made by 2-dimensional echocardiography with Doppler color flow imaging. Preoperative gradients ranged from 25 to 100 mm Hg. Aortic arch hypoplasia was present in 8 patients; 7 patients also had ventricular septal defect. Wide excision of the coarctation segment with extended end-to-end anastomosis was performed in 20 patients, while 1 required a Gore-Tex interposition graft between the left common carotid artery and the descending aorta. Subclavian angioplasty was performed to augment the anastomosis in 1 patient. There was no early mortality. One patient died 2 months after surgery. Follow-up examination revealed recoarctation in 5 patients (23.8%), all of whom underwent successful balloon dilatation. In conclusion, wider excision of the coarctation with extended end-to-end anastomosis reduces the chances of recoarctation. Percutaneous balloon angioplasty for treating recoarctation is effective in immediately reducing pressure gradients.
Arch-First Technique for Aortic Arch Operation Using Branched Graft
Authors: Tsukui Hiroyuki , Aomi Shigeyuki , Tomioka Hideyuki , Nonoyama Masaki , Koyanagi Hitoshi , Nagasawa Chinami , Nomura Minoru
Published: May 2013

To compare the arch-first technique with conventional aortic arch reconstruction 19 patients were randomly assigned to either procedure. Nine patients underwent the arch-first technique (group A) and 10 underwent the conventional technique (group B). There were no hospital deaths and no significant differences between groups in terms of intraoperative bleeding or the duration of operation cardiopulmonary bypass aortic crossclamping recovery from anesthesia or intensive care. The mean duration of retrograde cerebral perfusion via the superior vena cava was significantly shorter in group A (41.7 ± 10.4 min) than group B (63.9 ± 10 min). Transient neurologic dysfunction was noted in 4 (44%) patients in group A 6 (60%) in group B postoperatively but there was no permanent neurologic dysfunction in either group. The arch-first technique makes it possible to reduce the duration of cerebral ischemia retrograde cerebral perfusion via the superior vena cava reestablish antegrade cerebral perfusion earlier without damaging severely atheromatous arch vessels or conducting retrograde cerebral perfusion via a femoral artery. This technique has the potential to reduce the incidence of neurologic dysfunction.
Comparison of Off-Pump versus Conventional Coronary Revascularization
Authors: Naseri Erdinç , Sevinç Meral
Published: May 2013

Between May 1999 and August 2001, 231 patients underwent off-pump coronary bypass, of whom 171 required revascularization of the anterior vessels of the heart. They were compared with a group matched for age, sex, and risk factors undergoing revascularization of the same group of vessels under cardiopulmonary bypass. Mortality was comparable in both groups but the incidence of cerebrovascular accident, respiratory insufficiency, and renal failure was less in the off-pump group. Postoperative drainage and blood transfusion requirements were significantly less in the off-pump group. Intensive care and hospital stay were shorter in the off-pump patients. A considerable number of patients are potential candidates for off-pump coronary bypass, the only contraindication being technical limitations. Follow-up at 6 to 24 months indicates that off-pump coronary bypass can be performed safely with a decrease in morbidity and more rapid return to normal lifestyle.
Combined Valve Operations with Transection of Ascending Aorta
Authors: Wang Wen Lin , Cai Kai Can , Wang Wu Jun
Published: May 2013

To facilitate combined aortic and mitral valve operations, a new approach was developed. It was employed in 50 patients with both aortic and mitral valve disease. The ascending aorta was transected 1.5 cm above the aortic annulus, and the roof of the left atrium was incised. The damaged valves were replaced or repaired. Both aortic and mitral valves could be exposed satisfactorily by this approach. All patients recovered smoothly after the operation. Complications comprised intraoperative bleeding from the distal end of the ascending aorta in 1 patient and hoarseness in 3 postoperatively. The approach was considered quick and easy for combined valve operations.
Infection Risk Factors in Pediatric Cardiac Surgery
Authors: Mrowczynski Wojciech , Wojtalik Michal , Zawadzka Danuta , Sharma Girish , Henschke Jacek , Bartkowski Rafal , Pawelec-Wojtalik Malgorzata , Wodzinski Andrzej , Westerski Przemyslaw
Published: May 2013

Cardiac operations were preformed in 499 children from January 1998 through December 1999. Their median age was 263 days. A positive culture from blood, bronchoalveolar lavage, wound, or central catheter was obtained in 110 patients (22%). Age, sex, presence of pulmonary hypertension, body surface area, ratio of body surface area to oxygenator surface area, whether heart surgery was open or closed, and the duration of the operation, cardiopulmonary bypass, intubation, and intensive care were analyzed. Patients who developed infections were significantly younger, with smaller body surface areas and disparity with the oxygenator surface area, longer operative and bypass times, extended intubation, and prolonged intensive care. There was a significant correlation between infection and pulmonary hypertension. Sex and type of operation were not predictors of infection.
Caught in the Act: Impending Paradoxical Embolism
Authors: Fabricius Alex M , Krüger Martin , Hanke Michaela , Mohr Friedrich W
Published: May 2013

In a 73-year-old woman admitted with pulmonary embolism, a thrombus wedged across a patent foramen ovale was revealed by transesophageal echocardiography. After systemic anticoagulation, cardiac embolectomy and closure of the atrial septal defect were considered. Before surgery, repeat transesophageal echocardiography revealed only a small patent foramen ovale with no residual thrombus. We assumed dissolution of the thrombus as the patient had no sign of systemic or recurrent pulmonary embolism.
Bidirectional Glenn Shunt for Right Ventricular Endomyocardial Fibrosis
Authors: Mishra Amit , Manohar Soman Rema Krishna , Ramalingam Sankar Kumar , Valiathan Marthandavarma Sankaran
Published: May 2013

A 25-year-old man in New York Heart Association functional class IV with right ventricular endomyocardial fibrosis received a palliative bidirectional Glenn shunt. Despite a stormy postoperative convalescence the bidirectional Glenn shunt provided good long-term palliation.
Acute Descending Aortic Dissection Associated with Coarctation in Adult
Authors: Shin Jae Seung , Sun Kyung , Shim Wan Joo , Kim Kwang Taik , Kim Hyoung Mook
Published: May 2013

A 44-year-old man with congenital aortic coarctation experienced acute dissection that crossed the coarctation and extended to both iliac arteries. The primary entry of the dissection was proximal to the coarctation segment, just below the origin of the left subclavian artery. Surgical procedures involved resection of the diseased segment including the coarctation, and graft interposition.
Adult Presentation of Complete Atrioventricular Septal Defect
Authors: Kown Murray H , Vricella Luca , Salerno Christopher T , Rosenthal David N , Black Michael D
Published: May 2013

Complete atrioventricular septal defect generally presents early in life with symptoms of congestive heart failure. Untreated, patients almost universally develop irreversible pulmonary hypertension. We present an unusual case of a Down's syndrome patient whose septal defect first presented at 20 years of age.
Neuroleptic Malignant Syndrome: Uncommon Postoperative Diagnostic Dilemma
Authors: Bhan Suraj , Kulkarni Vinay , Mehta Yatin , Sharma Krishan Kant , Trehan Naresh , Suri Madan Lal
Published: May 2013

Neuroleptic malignant syndrome occurred in a 71-year-old man on haloperidol therapy for mild depressive dementia. After coronary artery bypass grafting, he developed hyperthermia, elevated creatine kinase without a corresponding rise in the MB-isoenzyme, leukocytosis, raised liver enzymes, urea, and creatinine. His condition responded to bromocriptine therapy.
Acute Right Coronary Artery Embolus after Aortic Valve Surgery
Authors: Abid-Allah Mouhcine , Al Jubair Khalid
Published: May 2013

A 35-year-old man with rheumatic aortic valve regurgitation developed acute right ventricular failure 8 days after valve replacement with a mechanical prosthesis. Angiography showed a right coronary artery embolus. Successful coronary artery bypass grafting was performed on the beating heart.
Multimodality Targeted Approach in Redo Off-Pump Coronary Artery Bypass Surgery
Authors: Mishra Yugal K , Wasir Harpreet , Khanna Surendra N , Shrivastava Sameer , Mehta Yatin , Trehan Naresh
Published: May 2013

Records of 86 patients who underwent off-pump redo coronary revascularization between December 1997 and December 2000, were analyzed. Approaches included median sternotomy (47), anterolateral thoracotomy for left anterior descending artery and diagonal targets (35), posterolateral thoracotomy for the obtuse marginal with proximal anastomosis on descending aorta (3), and a combined subxiphoid-anterior thoracotomy approach (1) for right gastroepiploic artery-to-left anterior descending artery anastomosis. The mean age was 61.82 years. There were 2 (2.3%) operative deaths. Complications included perioperative myocardial infarction in 4 patients and reexploration for bleeding in one. Blood transfusion was required in 12 patients. The mean length of hospital stay was 5 ± 2 days. A multimodality targeted approach for off-pump redo coronary artery bypass offers a less invasive but safer method of myocardial revascularization, with decreased complications, lower blood product requirement, and early hospital discharge.
Single Midline Approach for Permanent Pacemaker Implantation in Children
Authors: Benjacholamas Vichai , Chotivittayatarakorn Piroj , Lertsupchareon Porntep , Muangmingsuk Sunthorn , Khongphatthanayothin Apichai
Published: May 2013

Permanent pacemaker implantation was carried out in 12 children with a mean age of 1.4 years (range, 2 days to 4 years) and a mean weight of 8.6 kg (range, 2.4–13.6 kg), using a single midline approach for placement of both the epicardial lead and the pacemaker generator (intermuscular abdominal implantation). Platinized porous-tipped steroid-eluting epicardial leads were used in all patients. The pacemakers worked well, and there was no early postoperative complication. This technique was found to be rapid, simple, and safe in children, especially neonates and infants.
Arterial Switch Operation in Neonates with Complex Congenital Heart Defects
Authors: Wojtalik Michal , Sharma Girish , Mrowczynski Wojciech , Siwinska Aldona , Henschke Jacek , Bartkowski Rafal , Pawelec-Wojtalik Malgorzata , Piaszczynski Maciej
Published: May 2013

The aim of the study was to analyze short-term results of the arterial switch operation in 29 neonates with simple transposition of the great arteries (group A) and 18 (group B) with complex heart defects: transposition with a ventricular septal defect (10), coarctation of the aorta (5), or Taussig-Bing anomaly (3). The operations were usually performed on the 7th day of life (2nd–30th day), after a Rashkind procedure when necessary. The mean weight was 3,530 ± 780 g, body surface area was 0.219 ± 0.032 m2. Delayed sternal closure was necessary in 7 patients from group A (24%) and 8 from group B (44%) because of hemodynamic instability after weaning from extracorporeal circulation; these neonates had significantly lower body weights and smaller body surface areas. Perioperative mortality was 13.8% (4 patients) in group A and 27.8% (5 patients) in group B. Correction of complex transposition tends to be associated with a higher operative risk than simple transposition, but the difference was not significant.
Coronary Artery Bypass Grafting for Patients with Poor Left Ventricular Function
Authors: Hirose Hitoshi , Amano Atsushi , Takanashi Syuichirou , Takahashi Akihito
Published: May 2013

Patients undergoing isolated first-time elective coronary bypass surgery were classified according to their preoperative ejection fraction: group 1 comprised 131 patients with poor left ventricular function (ejection fraction < 40%); group 2 was 1,496 control patients. The mean number of distal anastomoses was not significantly different in the 2 groups, however, clamp time, pump time, and operative time were longer in group 1. Patient recovery was significantly slower in group 1. Morbidity (14.5% in group 1 versus 7.4% in group 2, p < 0.005) and mortality (2.3% versus 0.1%, p < 0.0001) were higher in group 1. During late follow-up, the 5-year survival rate (70.1% versus 90.5%) and 5-year event-free rate (65.6% versus 81.9%) were significantly inferior in group 1 compared to group 2. The results of bypass surgery in cases of decreased left ventricular function were poor, and such patients need to be carefully followed up.
Risk Factor Analysis of Orthotopic Heart Transplantation
Authors: Omoto Tadashi , Minami Kazutomo , Böthig Dietmar , Schütt Ulrich , Tenderich Gero , Wlost Stephan , Körfer Reiner
Published: May 2013

From March 1989 to December 1999, 1,013 heart transplantations were carried out in this center. Univariate analysis of potential risk factors for early death was followed by stepwise logistic regression to determine independent risk factors. Long-term results were assessed by the Kaplan-Meier method. Multivariate comparisons of long-term results were performed using Cox's proportional hazards model. Early mortality was 8.6%. Actuarial survival was 78.1%, 69.4%, and 53.1% at 1, 5, and 10 years, respectively. Mean total ischemic time was 194 minutes. Independent risk factors of early mortality were female recipient, donor age over 50 years, and ischemic heart disease in the recipient. The precise mechanism of the increased early mortality in female recipients should be studied in the future. Although older donor age was a predictor of early mortality, because of the donor shortage, older hearts should not be excluded from the donor pool. Survival was better in patients with dilative cardiomyopathy than in those with ischemic heart disease.
Risk in Elderly Patients after Stentless versus Stented Aortic Valve Surgery
Authors: Ennker Jürgen , Rosendahl Ulrich , Ennker Ina Carolin , Bauer Stefan , Florath Ines
Published: May 2013

Recent studies suggest that the hemodynamic advantage of stentless bioprostheses over the stented type improves long-term survival after aortic valve replacement, but the more complex and time-consuming implantation technique may increase the risks of operative death and postoperative complications. Between April 1996 and June 2001, 519 patients with a mean age of 76 ± 5 years underwent aortic valve replacement using a stentless (Medtronic Freestyle, n = 277) or stented bioprosthesis (Medtronic Mosaic, n = 242). Multiple logistic regression analysis considering different patient populations revealed no increased risk of operative death, postoperative complications, or neurological impairment after implantation of a stentless bioprosthesis. Survival curves in respect of 367 patients who underwent aortic valve replacement up to September 2000 and were followed up for 3 years were not different ( p = 0.98). As the patients were elderly, improved survival due to implantation of a stentless valve could not be demonstrated within this time span.
Impact of Preoperative Renal Dysfunction on Cardiac Surgery Results
Authors: Abramov Dan , Tamariz Miguel , Fremes Stephen , Tobe Sheldon , Christakis George , Guru Veena , Goldman Bernard
Published: May 2013

Results of cardiac surgery were analyzed using a database that included plasma creatinine levels in 2,214 patients, of whom 507 had preoperative renal dysfunction (creatinine clearance < 0.9 mL·s−1·m−2). Logistic regression and propensity score analyses found preoperative renal dysfunction to be an independent predictor of morbidity and mortality. Plotting preoperative creatinine clearance against morbidity and mortality revealed an exponential increase in morbidity and mortality when preoperative creatinine clearance was < 0.84 mL·s−1·m−2. Patients were stratified for age, operative procedure, and comorbidity. In all stratified groups, preoperative creatinine clearance < 0.84 mL·s−1·m−2 was associated with similar exponential increases in morbidity and mortality. In patients with preoperative renal dysfunction, elevated plasma creatinine levels persevered for 6 months postoperatively. Dialysis beyond postoperative day 10 was required in < 2% of patients with preoperative plasma creatinine of 160–200 μmol·L−1 and in 5% in those with creatinine > 200 μmol·L−1 ( p < 0.05). Actuarial survival was significantly reduced (< 90% at 18 months postoperatively) in patients with preoperative renal dysfunction.
Stroke in Thoracic Aortic Surgery: Outcome and Risk Factors
Authors: Kawachi Yoshito , Nakashima Atsuhiro , Toshima Yoshihiro , Kosuga Tomokazu , Imasaka Kenichi , Tomoeda Hiroshi
Published: May 2013

The risk factors and the outcome of stroke in thoracic aortic surgery were studied in 127 patients (86 males, 41 females), aged 18 to 84 years (mean, 64 years), operated on between September 1994 and December 2000. There were 29 operations on the ascending aorta, 63 arch, 29 descending, 5 thoracoabdominal, and 1 extraanatomical bypass. Perioperative stroke occurred in 15 patients (12%). The risk factors for stroke were identified as preexisting chronic renal failure and femoral arterial cannulation. Hospital death occurred in 4 of the 15 cases (27%) of stroke and 7 of the 112 cases (6%) without stroke ( p < 0.05). There were 18 late deaths during a mean follow-up period of 3.2 years (range, 1 month to 7.2 years). The 3-year survival rates were 43 ± 14% in the stroke patients and 85 ± 4% in the other patients. Actuarial survival, including during hospitalization, was lower in the stroke patients than in the other patients not only among those 70 years or older but also among all the patients (both p < 0.0001). Stroke occurring in thoracic aortic surgery is thus an important risk factor for early and late mortality, particularly in patients 70 years or older.
Successful Treatment of Accidental Air Embolism in Warm Heart Surgery
Authors: Gomes Walter J , Strisiver David A , Penco Albert JF , Rampersad Kamal , Angelini Gianni D
Published: May 2013

Normothermic cardiopulmonary bypass has recently been proposed as a superior technique for maintaining body metabolism. However, its use remains controversial since the degree of cerebral protection provided might be inferior to that conferred by conventional hypothermic techniques. We report a case of accidental massive air embolism during coronary artery bypass surgery under normothermia, which was successfully managed with induced hypothermia at 20°C and retrograde cerebral perfusion.
Posterior Mediastinal Schwannoma
Authors: Fierro Nicola , D'Ermo Guiseppe , Di Cola Giuseppe , Gallinaro Luca Salvatore , Galassi Giorgio , Galassi Giovanni
Published: May 2013

An exceptional case of neurilemmoma in a 33-year-old asymptomatic man is described. Complete excision of an encapsulated 7.2-cm mass was achieved successfully. Pathological findings were consistent with a diagnosis of schwannoma with areas of sclerosis.
Pulmonary Origin of Circumflex Artery in Aortopulmonary Window
Authors: Mahadevan Chalam , Kareem Shiraz , Jitendra Vikram , Sivakadaksham Natarajan , Kumar MP Naresh
Published: May 2013

An aortopulmonary window associated with an anomalous left circumflex coronary artery arising from the adjoining pulmonary sinus in a 4-kg baby boy was successfully repaired by re-routing with a pericardial patch.
Anomalous Left Coronary Artery: Modified Direct Aortic Implantation
Authors: Kumar Dharmapuram Anil , Rao Pantula Narasinga , Kumar Raghavan Nair Suresh , Nazer Yoosuph Abdul , Rao Ivatury Mrutyunjaya
Published: May 2013

The technique of direct transfer of an anomalous left coronary artery from the pulmonary artery to the aorta was modified. Using part of the lateral and anterior wall of the pulmonary artery as a flap in continuity with the coronary button as part of the transfer, a tension-free anastomosis is possible. This technique was employed in 3 consecutive infants, with good outcome.
Assessment of Coronary Bypass Graft Patency by Electron-Beam Computed Tomography
Authors: Aziz Tarek A Abdel , Kumar Pramod , Bazargani Nooshin , Al-Hato Eman , Al Khaja Najib
Published: May 2013

Twenty-one patients undergoing coronary artery bypass grafting were prospectively evaluated by conventional selective coronary angiography and electron-beam computed tomography. Eighty bypass grafts (60 saphenous vein and 20 left or right internal mammary artery) were evaluated for patency. The sensitivity and specificity of electron-beam computed tomography were 72% and 100%, respectively; positive and negative predictive values were 100% and 92.5%, respectively. Sensitivity and specificity according to coronary region were: left anterior descending artery, 33% and 100%; diagonal artery, 67% and 100%; circumflex artery, 75% and 100%; right coronary artery, 100% and 100%. Electron-beam computed tomography is relatively accurate and a promising tool for noninvasive evaluation of graft patency after coronary artery bypass graft surgery.
Pulmonary Sclerosing Hemangiomas: New Approach in Patients with Low Cancer Risk
Authors: Mahesh Balakrishnan , Sheffield Edward , Forrester-Wood Christopher , Amer Khalid
Published: May 2013

Three cases of sclerosing hemangioma managed differently are described. Thoracic surgeons should raise their awareness of this benign slow-growing tumor in the differential diagnosis of solitary pulmonary nodule. Radiographic evidence of expansion of such a lesion is not conclusive for malignancy, and should not affect its biological behavior. Intraoperative frozen-section histology may prevent unnecessary resection of lung tissue. Extracapsular enucleation is the treatment of choice for sclerosing hemangiomas.
Peroneal Artery Reconstruction via Medial Approach Using Tourniquet Occlusion
Authors: Shindo Shunya , Ogata Koji , Kubota Kenji , Kojima Atsuo , Kobayashi Masahiro , Tada Yusuke
Published: May 2013

As peroneal artery bypass surgery is technically demanding, a simplified medial approach was used in 23 peroneal artery reconstructions in 21 patients between January 1993 and December 2001. The outcomes were reviewed retrospectively. Peroneal artery reconstruction was undertaken through a medial skin incision using tourniquet occlusion and saphenous vein grafts. Graft patency was confirmed by angiography or duplex color imaging. Peroneal bypass was possible through the medial approach in 20 cases; in 1 limb, the target was occluded. During a mean follow-up of 43.9 months, there were 4 graft occlusions. None of the failures was due to a technical error related to the procedure. All of the other patients had relief of their symptoms, including those who presented with disabling claudication. Technical improvements have made peroneal bypass a reasonable choice in below-knee arterial reconstruction. This technique should not be restricted to limb salvage.
Mitral Regurgitation: Comparison between Edge-to-Edge Repair and Valve Replacement
Authors: Raman Jai , Shah Pallav , Seevanayagam Siven , Cheung John , Buxton Brian
Published: May 2013

Mitral regurgitation due to bileaflet prolapse and ischemic causes can be difficult to repair. Midterm experience of the Alfieri edge-to-edge repair as an alternative to valve replacement is reported. Twenty-six patients with severe mitral regurgitation underwent the Alfieri repair between January 1998 and December 2000 (group 1); 15 cases were due to bileaflet prolapse and 7 were of ischemic origin. During the same period, valve replacement was performed in 36 patients (group 2), 20 of whom had similar indications. Follow-up was complete to a mean of 15 months (range, 1–28 months). There was no early death in either group. During follow-up, there was no reoperation in group 1, while 2 patients in group 2 required reoperations due to prosthetic valve endocarditis. There were 4 major thromboembolic or bleeding events in group 2, and none in group 1. All patients in group 1 had trivial to mild mitral regurgitation on follow-up echocardiography. The mean mitral valve gradient was significantly higher in group 2 compared to group 1 (7.2 versus 3.2 mm Hg, p = 0.001). The edge-to-edge repair is associated with good early and midterm results. Long-term follow-up is required to evaluate the durability of this technique.
Transesophageal Echocardiography in Hypotensive Post-Coronary Bypass Patients
Authors: Wasir Harpreet , Mehta Yatin , Mishra Yugal K , Shrivastava Sameer , Mittal Sanjay , Trehan Naresh
Published: May 2013

The utility of transesophageal echocardiography in the evaluation of hypotension in the postoperative period after coronary artery bypass was assessed in 126 patients in the intensive care unit. There were 86 men and 40 women, with a mean age of 58.3 years. The indication for transesophageal echocardiography was hypotension refractory to conventional treatment. Valuable diagnostic information was obtained in 103 patients (82%). Based on the echocardiographic findings, 24 patients (19%) underwent urgent surgical intervention. The mean time required to obtain a diagnosis was 9.6 ± 2.8 min. No significant complications were noted. Our experience suggests that transesophageal echocardiography is highly specific in diagnosing the cause of postoperative hypotension, thus preventing unnecessary surgical intervention and facilitating decision making in cardiac surgical emergencies.
Intravascular Ultrasound: Potential Tool to Assess Coronary Anastomosis Quality
Authors: Tozzi Piergiorgio , Corno Antonio F , von Segesser Ludwig K
Published: May 2013

Coronary angiography and Doppler flow measurements are most commonly used to assess the patency of anastomoses in the operating theater. Intravascular ultrasound might be another means of monitoring the surgical procedure during coronary artery bypass. Five sheep underwent off-pump bypass of the left anterior descending coronary artery using the left internal mammary artery. The running suture was evaluated by intraoperative fluoroscopy and a coronary intravascular ultrasound probe inserted into the target artery proximal to the anastomosis. Macroscopic examination of the anastomosis was performed to validate the angiographic and intravascular ultrasound images. The diameter, cross-sectional area, and compliance of each anastomosis were calculated in systole and diastole. All anastomoses were patent without signs of stenosis. In one case, intravascular ultrasound showed an intimal flap, which was confirmed by macroscopic examination. The mean major anastomotic diameter was 4.5 ± 0.5 mm on angiography and 4.0 ± 0.5 mm on intravascular ultrasound. From the ultrasound data, the mean cross-sectional anastomotic area was calculated as 6.21 ± 0.1 mm2 in systole and 5.49 ± 0.1 mm2 in diastole, and these data were used to calculate the cross-sectional anastomosis compliance. Coronary intravascular ultrasound can visualize intima-to-intima apposition and provide reliable calculations of anastomosis compliance.
Tissue-Engineered Heart Valve on Acellular Aortic Valve Scaffold: In-Vivo Study
Authors: Zhao Dong-E , Li Ruo-Bing , Liu Wei-Yong , Wang Gang , Yu Shi-Qiang , Zhang Cheng-Wei , Chen Wen-Sheng , Zhou Geng-Xu
Published: May 2013

The feasibility of constructing a tissue-engineered heart valve on an acellular porcine aortic valve leaflet was evaluated. A detergent and enzymatic extraction process was developed to remove the cellular components from porcine aortic valves. The acellular valve leaflets were seeded for 7 days in vitro with cells from canine arterial wall and endothelial cells. The constructs were implanted into the lumens of 6 canine abdominal aortas to assess the reconstruction of the valve leaflets. It was found that all cellular components had been removed from the porcine aortic valves. The valve leaflets were completely reconstructed at the end of the 10th week in vivo. Scanning electron microscopy showed that the valve leaflets were partially covered with endothelial cells. It was concluded that porcine aortic valves can be decellularized by the detergent and enzymatic extraction process and it is feasible to construct a tissue-engineered heart valve in vivo on an acellular valve scaffold.
Right Intraventricular Hydatid Cyst of the Heart
Authors: Saad Rasheed A , Amer Khalid MA , Migliore Marcello , Aziz Tarek , Azzu Ahmed
Published: May 2013

A 32-year-old woman presented with shortness of breath and palpitations. Echocardiography and contrast-enhanced computed tomography showed a 4 × 5 cm cyst in the apex of the right ventricle. The cyst was excised on cardiopulmonary bypass. The patient made an uneventful recovery. At the one-year follow-up, she was symptom-free and without recurrence. Different clinical aspects of cardiac hydatid cyst and its surgical management are reviewed.
Single Coronary Artery from the Left Sinus with Atherosclerosis
Authors: Asha Mahilmaran , Sriram Rajagopal , Mukundan Seshadri , Abraham Kurudammanil A
Published: May 2013

We report a rare case of a single coronary artery originating from the left sinus of Valsalva with extensive atherosclerosis in a patient presenting with unstable angina. The distal circumflex artery continued the course of the right coronary artery.
Fully Ringed Polytetrafluoroethylene Graft for Vascular Access in Hemodialysis
Authors: Kao Chiung Lun , Chang Jen Ping
Published: May 2013

Polytetrafluoroethylene grafts have become the alternative to arteriovenous fistulas for hemodialysis access. The most frequent complication of prosthetic grafts is thrombotic occlusion, caused especially by hypotension after hemodialysis and excessive compression for hemostasis. We describe a technique using the ringed polytetrafluoroethylene graft for constructing an upper arm curved graft to overcome external compression. It yields favorable results.