bluuebunny/crossref_metadata_2025 huggingface dataset:
Left Ventricular Outflow Tract after Kawashima Intraventricular Rerouting
Authors: Iwai Shigemitsu , Ichikawa Hajime , Fukushima Norihide , Sawa Yoshiki
Published: May 2013

Left ventricular outflow tract obstruction is a concern in the long term after Kawashima intraventricular rerouting for Taussig-Bing anomaly. This study assessed the late results and left ventricular outflow tract dimensions after intraventricular rerouting for Taussig-Bing anomaly in 6 children. Age at operation ranged from 8 months to 7 years. The shortest distance from the tricuspid valve to the pulmonary valve ranged from 8 to 18 mm, which was 79%–139% of the normal aortic annulus diameter. All patients survived the operation, but one died of chronic heart failure 4 months after repair. Three patients had no left ventricular outflow tract obstruction 15 to 31 years after repair, and 2 had significant obstruction at 9 and 14 years. One patient underwent successful revision of the intraventricular baffle; the distance between the tricuspid and pulmonary valves was 16 mm (108% of the normal aortic annulus) although it had been 8 mm (79%) at the initial repair. Late results of intraventricular rerouting were considered favorable.
Thymectomy for Myasthenia Gravis: Prognostic Factors in 70 Patients
Authors: Aghajanzadeh Manucher , Khoshrang Hossein , Mohammadzadeh Ali , Roudbari Seyed A , Ghayeghran Amir R
Published: May 2013

Thymectomy has become increasingly accepted as an efficacious procedure for myasthenia gravis, with high rates of complete clinical remission. Predictors of the response to thymectomy for myasthenia gravis vary in the literature. We retrospectively reviewed the clinical records of 70 patients (63% female; mean age, 38 years) diagnosed with myasthenia gravis from August 1993 to August 2004, to determine the factors predicting outcome. Complications occurred in 20%, but there was no hospital mortality. Complete clinical remission was obtained postoperatively in 47%. Our results indicate that patients with less than 1 year's duration of disease have a better prognosis, and Osserman stages I, IIa, and IIb are also associated with higher clinical remission rates. Female patients have a better prognosis than males, and the younger the patient the better the outcome. Thymectomy is indicated for myasthenia gravis as early as possible in the course of the disease.
Results of Isolated Valve Replacement in Hemodialysis Patients
Authors: Kato Wataru , Tajima Kazuyoshi , Terasawa Sachie , Tanaka Keisuke , Usui Akihiko , Ueda Yuichi
Published: May 2013

Frequent bleeding complications and poor long-term results have been reported after valve replacement in hemodialysis patients. We use mainly bileaflet mechanical valves with low-dose warfarin therapy (target international normalized ratio, 1.8–2.0) in such cases. Data of 27 hemodialysis patients undergoing isolated valve replacement from 1993 to 2002 were retrospectively analyzed. Bileaflet mechanical valves were selected in 23 patients and bioprostheses in 4. Those with mechanical valves were treated with mild anticoagulation therapy. There were 3 (11.1%) early deaths due to ischemic colitis, interstitial pneumonia, and ventricular arrhythmia. There were 3 late deaths and 5 bleeding complications during follow-up. The overall survival rate was 85.2% at 3 years and 72.9% at 5 years. The survival rate of patients with mechanical valves was 82.6% at 3 years and 76.7% at 5 years. One patient with a bioprosthesis experienced structural valvular deterioration after 3 years. The results demonstrate an acceptable long-term outcome. A bileaflet mechanical valve managed with mild anticoagulation therapy is a reasonable strategy for hemodialysis patients.
Surgical Experience with Cardiac Echinococcosis
Authors: Kabbani Sami S , Ramadan Ahmed , Kabbani Loay , Sandouk Aref , Nabhani Fawzi , Jamil Hisham
Published: May 2013

Cardiac echinococcosis is a rare affliction of the heart encountered in areas where the tapeworm Echinococcus is endemic. During the 15 years to September 2005, 19 consecutive patients (11 female; mean age, 25.6 ± 12.8 years) with cardiac echinococcosis were operated on at Damascus University. Diagnosis was mainly established by 2D-echocardiography. Twelve patients also had extracardiac hydatidosis. All patients were operated on using cardiopulmonary bypass and cardioplegia. Intact cysts were generally enucleated, ruptured cysts were exteriorized, and interventricular septal cysts were managed by controlled puncture and aspiration. There was no operative mortality. All patients were placed on mebendazole postoperatively for periods appropriate to the extent of their hydatidosis. There were 4 known late deaths due to systemic extension of the disease. Cardiac echinococcus is a serious disease that should be managed surgically without delay. Enucleation of intact cysts under cardiopulmonary bypass and cardiac arrest is our preferred method of excision. Anthelmintic medical treatment is a valuable and necessary adjunct to surgical management.
Atrial Septal Defect with Ascites and Pleural Effusion
Authors: Ho Hee-Hwa , Chau Elaine , Chiu Alex , Kwok On-Hing
Published: May 2013

A case of a lady referred for repair of an atrial septal defect is described. She presented with an insidious onset of recurrent ascites and pleural effusion. Cardiac catheterization showed constrictive physiology. The patient subsequently underwent surgical closure of the atrial septal defect and pericardiectomy
Evaluating the Quality of Trials of Hypothermic Circulatory Arrest Aortic Surgery
Authors: Shuhaiber Jeffrey H
Published: May 2013

The quality of level 1 evidence in reports on deep hypothermic circulatory arrest was assessed, and the confounding factors in surgical management and study design that can prevent meta-analysis formulation were determined. A systematic search of the literature was conducted using categorized nomenclature for randomized controlled trials in adult patients undergoing deep hypothermic circulatory arrest in the last 40 years. Twelve randomized controlled trials (2.3%) were found among 504 publications on deep hypothermic circulatory arrest listed on Medline from 1960; only 4 of them related to adults. One adequately powered study demonstrated reduced blood loss in deep hypothermic circulatory arrest using aprotinin. Three studies comparing retrograde and antegrade perfusion were underpowered. The median CONSORT score was 14 (range, 13–15). There were no consistent measures of similar outcomes (neuropsychometric, neurocognitive). No explanation was provided for the difference in reported ranges of neurological deficits in nonrandomized (5%–70%) and randomized (3%–9%) studies. Existing studies of deep hypothermic circulatory arrest are insufficient and inconsistent in the outcome measured, which explains the lack of a meta-analysis. Neurological injury remains high, and an appropriately powered study of interventions that can optimize cerebral perfusion is necessary.
Two Surgical Cases of Acute Aortic Dissection in Pregnancy with Marfan Syndrome
Authors: Wakiyama Hidetaka , Nasu Michihiro , Fujiwara Hiroshi , Kitamura Aki , Okada Yukikatsu
Published: May 2013

We describe 2 surgical cases of acute aortic type A dissection during pregnancy in women with Marfan syndrome. Both of them underwent emergency aortic root replacement under deep hypothermia; one patient was in her 21st week of pregnancy and the other was treated 1 day after a normal delivery. The patients experienced fair postoperative courses, but intrauterine fetus death was confirmed in the first case.
Minimally Invasive Right Posterior Minithoracotomy for Open-Heart Procedures
Authors: Mohamed Khaled Samir
Published: May 2013

A right posterior minithoracotomy was evaluated in 123 selected patients between November 2002 and August 2006. Their ages ranged from 1.5 to 32 years (mean, 7.8 years) and weights ranged from 12.3 to 61.6 kg (mean, 23.3 kg). Pathology included atrial septal defect in 81 (66%), ventricular septal defect in 16 (13%), and 24 other (mainly valve) defects. All patients had a strictly posterior right minithoracotomy through the 4th or 5th right intercostal space, with a 7–9-cm skin incision. There was no mortality or procedure-related morbidity. The mean cardiopulmonary bypass time was 68 min, ischemic time was 47 min, and 47 (38%) patients were extubated on the operating table. The mean hospital stay was 4.3 days and it was < 5 days in 108 (88%) patients. A cosmetically fine scar was achieved in all patients. The right posterior minithoracotomy is a safe, cosmetically superior, and cost-effective approach for selected open-heart procedures.
Minimal vs Median Sternotomy for Aortic Valve Replacement
Authors: Moustafa Moustafa A , Abdelsamad Ayman A , Zakaria Gamal , Omarah Magdy M
Published: May 2013

The aim of this study was to compare postoperative outcomes in patients undergoing aortic valve replacement through a ministernotomy or conventional sternotomy. Sixty patients were randomized into 2 groups of 30 each: group 1 had a full sternotomy and group 2 had a ministernotomy. Pain was evaluated on a daily basis, pulmonary function tests were performed perioperatively. The skin incision was shorter in group 2 (7.17 vs 24.50 cm in group 1). There was significantly less mediastinal drainage in group 2 (233 vs 590 mL in 24 hours in group 1). Group 1 patients had more blood transfusions and longer ventilation time. In group 1, 96.7% experienced severe pain, whereas 93.3% in group 2 reported minimal pain. Hospital stay was 17.7 days in group 1 and 8.0 days in group 2. The ministernotomy had a cosmetic advantage, less blood loss and transfusion requirement, greater sternal stability, better respiratory function, and earlier extubation and hospital discharge.
Prosthetic Valve Replacement in Adolescents with Rheumatic Heart Disease
Authors: Akhtar Raja P , Abid Abdul R , Zafar Hasnain , Sheikh Saqib S , Cheema Masud A , Khan Jawad S
Published: May 2013

To assess long-term survival and anticoagulant-related complications after mechanical valve replacement in adolescents with rheumatic heart disease, 88 patients aged ≤ 18 years were prospectively followed up for 10 years (404.2 patient-years). There were 58 (65.9%) boys and 30 (34.1%) girls, with a mean age of 15.4 ± 2.1 years. Mitral regurgitation was detected in 39 (44.3%) patients, and both mitral and aortic regurgitation in 15 (17%). Ball valves were inserted in 52 (59.1%) patients, bileaflet valves in 31 (35.2%), and single-disc valves in 5 (5.7%). There were 4 (4.5%) hospital deaths and 11 late deaths. Patient survival at 30 days, 3 months, 1, 5, and 10 years was 95.5%, 93.2%, 87.5%, 82.9%, and 82.9%, respectively. Mechanical valve thrombosis occurred in 4 patients; it was fatal in 3 of them. Three patients died from stroke. Severe hemorrhage required hospital admission in 4 (4.5%) patients. Mechanical valve replacement in adolescents, with careful follow-up and anticoagulation, has acceptable long-term results.
Age Deteriorates Palmar Microcirculation following Radial Artery Harvesting
Authors: Knobloch Karsten , Tomaszek Sandra , Haverich Axel , Vogt Peter M
Published: May 2013

The effect of age as a risk factor for deterioration of palmar microcirculation after radial artery harvesting for coronary revascularization is unknown. In 114 patients aged 61.7 ± 6.7 years undergoing radial artery harvesting, superficial and deep tissue oxygen saturation, postcapillary venous filling, and capillary blood flow were determined using a combined laser Doppler spectrophotometry system 25 ± 5 months after surgery. Superficial and deep oxygen saturation at the harvested thenar eminence decreased with age. In the nondonor hand, oxygen saturation declined in the first and second digits. Postcapillary venous filling pressure in both thenars increased with age. It was concluded that neurological complications do not correlate with age. Palmar tissue oxygen saturation, palmar capillary blood flow, and blood velocity decrease, while postcapillary venous filling pressure significantly increases with age. Radial artery harvesting for coronary revascularization does not compromise palmar microcirculation to the same extent as age. A cut-off value of ≤ 67 years was determined by microcirculatory assessment; beyond this, significant deterioration of palmar microcirculation is more likely to occur.
Anticoagulation for Prosthetic Heart Valves in Pregnancy. Is There an Answer?
Authors: Khamooshi Amir J , Kashfi Fahimeh , Hoseini Saeed , Tabatabaei Mohammad B , Javadpour Hossein , Noohi Fereydoon
Published: May 2013

The aim of this retrospective study was to compare the different anticoagulation regimens used in pregnant women with prosthetic heart valves. We reviewed 196 pregnancies in 110 women from 1974 to 2000. The patients were divided into two groups: group 1 (142 pregnancies) had warfarin throughout pregnancy; and in group 2 (54 pregnancies), warfarin was replaced by subcutaneous heparin during the first trimester and last two weeks of pregnancy. There were no maternal complications in 129 pregnancies in group 1 and 44 in group 2. There were significantly fewer normal births in group 1 (56; 39.4%) compared to group 2 (39; 72.2%). Group 1 had a significantly higher rate of spontaneous abortion (46.5% vs 14.8%), but group 2 had a higher rate of valve thrombosis. In group 1, women with a warfarin requirement < 5 mg had a lower rate of spontaneous abortion. Warfarin is an effective anticoagulant in pregnant women with mechanical valves but it results in significant fetal loss when the dose is > 5 mg. Heparin is a less effective anticoagulant resulting in more maternal complications, but it is more protective of the fetus.
Anticoagulation in Pregnancy with Mechanical Heart Valves: 10-Year Experience
Authors: Akhtar Raja P , Abid Abdul R , Zafar Hasnain , Cheema Masud A , Khan Jawad S
Published: May 2013

Anticoagulation in pregnancy was evaluated in 33 women with a mechanical heart valve prosthesis who had 53 pregnancies between 1994 and 2006. Their mean age at valve operation was 24.4 ± 5.4 years, and 22 (67%) had isolated mitral valve disease. Of these patients, 22 had a single pregnancy, 5 had 2 pregnancies, 3 had 3, and 3 had 4. In 43 pregnancies, the patients took warfarin throughout; in the other 10, heparin was used in the first trimester followed by warfarin until the last 15 days. Mean international normalized ratio and warfarin levels before, during, and after pregnancy were similar. Complications occurred in 3 (6%) women who had thrombosed valves: 2 (20%) in the heparin group and 1 (2%) who had warfarin only. Live births resulted from 37 (70%) pregnancies. There were significantly more abortions in the heparin group (6; 60%) than the warfarin group (8; 19%). Hemorrhage requiring transfusion occurred in 2 (5%) patients in the warfarin group. All live births resulted in healthy babies. It was concluded that anticoagulation with warfarin is safe during pregnancy in women with mechanical heart valves.
Learning Curve of Arch-First Technique Analyzed by Cumulative Sum
Authors: Song Min-Ho , Tokuda Yoshiyuki , Hirai Masaya , Ueda Yuichi
Published: May 2013

This study was undertaken to verify efficacy of the arch-first technique in the light of its learning curve. From April 2002 to September 2005, 10 consecutive elective cases of total arch replacement were retrospectively examined. The learning curve of the arch-first technique was constructed using cumulative sum analysis. There were no operative deaths. The mean deep hypothermic circulatory arrest time was 28.4 ± 13.7 min, the lower body ischemic time was 91.3 ± 35.1 min, aortic cross clamp time was 133.2 ± 18.1 min, cardiopulmonary bypass time was 198.8 ± 21.5 min, and operation time was 383 ± 24 min. The durations of deep hypothermic circulatory arrest, bypass, and operation were under the 90% lower alarm line in all 10 cases. The lower body ischemic time and cardiac arrest time were between the 80% upper and lower alert lines. Cumulative sum analysis of total arch replacement using the arch-first technique showed satisfactory rates of improvement in reconstruction of the 3 arch vessels, cardiopulmonary bypass time, and overall mortality.
Aortic and Mitral Valve Replacement in a Patient with Hemophilia B
Authors: Thankachen Roy , George Biju , Shukla Vinayak , Korula Roy J
Published: May 2013

A 25-year-old man with factor IX deficiency had an aortic and mitral valve replacement using a 2M Starr Edwards valve in the mitral position and a 22 Medtronic valve in the aortic position under cover of factor IX concentrate. The surgical procedure and the immediate postoperative period were uneventful except for a pericardial effusion which required a pericardiostomy. He was anticoagulated with heparin in the immediate postoperative period while the factor IX concentrate was being administered. Oral anticoagulation with acenocoumarol (Acitrom®) was started, maintaining the international normalized ratio between 1.5 and 2. He was doing well at follow-up 9 months later.
Off-Pump Pericardiectomy Using an Ultrasonic Scalpel and a Heart Positioner
Authors: Fukumoto Atsushi , Yamagishi Masaaki , Doi Kiyoshi , Ogawa Mitsugu , Inoue Tomoya , Yaku Hitoshi
Published: May 2013

The surgical treatment of constrictive pericarditis often requires extensive pericardial dissection under cardiopulmonary bypass. We performed a pericardiectomy in a patient with constrictive pericarditis without cardiopulmonary bypass, with assistance of a sternal retractor and a suction heart positioner. The severely calcified pericardium, which adhered tightly to the epicardium, was dissected with an ultrasonic scalpel. The operation was completed without blood transfusion. There was no malignant arrhythmia.
Papillary Fibroelastoma of the Left Ventricle: Report of Two Cases
Authors: Hino Haruaki , Miyairi Takeshi , Kitamura Tadashi , Miura Sumio , Kigawa Ikutaro , Fukuda Sachito
Published: May 2013

Papillary fibroelastoma is a relatively rare cardiac tumor. We report two cases of papillary fibroelastoma. The first case involved a 45-year-old woman who presented with rheumatic valves and three tumors developing from the papillary muscle and left ventricle. The second case involved a 68-year-old man who was asymptomatic and whose tumor was detected incidentally on echocardiogram. Both cases were treated surgically. An additional 71 cases of papillary fibroelastoma reported in the medical literature in Japan are reviewed.
Di(2-Ethylhexyl) Phthalate Exposure during Cardiopulmonary Bypass
Authors: Takahashi Yosuke , Shibata Toshihiko , Sasaki Yasuyuki , Fujii Hiromichi , Bito Yasuyuki , Suehiro Shigefumi
Published: May 2013

Di(2-ethylhexyl) phthalate is an excellent plasticizer for polyvinyl chloride but a known endocrine disrupting chemical. To investigate whether tubing containing no diethylhexyl phthalate reduces the overall extraction of this plasticizer during cardiopulmonary bypass, 16 patients undergoing coronary artery bypass grafting were randomly divided into 2 groups of 8 each. Group A had tubing containing diethylhexyl phthalate in the circuit, and group B had no diethylhexyl phthalate in the tubing. The plasma diethylhexyl phthalate level at the end of cardiopulmonary bypass was significantly increased compared to before anesthesia in both groups (group A: 103 ± 60 to 2,094 ± 1,046 ng·mL−1; group B: 135 ± 60 to 472 ± 141 ng·mL−1), and it was significantly higher in group A than group B. This study demonstrates that using tubing free from diethylhexyl phthalate significantly reduces the release of this agent during cardiopulmonary bypass, which may minimize exposure to diethylhexyl phthalate.
Repair of Aortic Coarctation in Adults: The Fate of Hypertension
Authors: Hashemzadeh Khosro , Hashemzadeh Shahriar , Kakaei Farzad
Published: May 2013

The benefit of coarctation repair on the resolution of systolic hypertension in adults has been questioned. In this retrospective study, hypertension was assessed in 38 adults (22 men, 16 women; mean age, 25.6 ± 6.9 years; range, 16–39 years) who underwent coarctation repair between 1996 and 2006. Thirty patients had preoperative hypertension (mean systolic pressure, 158.3±18.6; range 140–200 mm Hg). At preoperative catheterization, the peak mean systolic gradient across the coarctation was 70.6 ± 21.2 mm Hg (range, 38–120 mm Hg). Operative procedures were resection and end-to-end anastomosis (11 patients), patch aortoplasty (24) and resection with interposition of a Dacron tube graft (3). The patients were followed up for 2–90 months (mean, 37 ± 23 months). Of the 30 patients with preoperative hypertension, 25 (83%) were normotensive at the last follow-up. The mean postoperative systolic blood pressure was significantly lower than the preoperative level. More than half of the patients (58%) were still taking antihypertensive medication. Surgical repair of coarctation of the aorta in adults can lead to regression of systolic hypertension and a decreased requirement for antihypertensive medication.
Preoperative Autologous Blood Donation for Cardiac Surgery in Children
Authors: Hibino Narutoshi , Nagashima Mitsugi , Sato Harumitsu , Hori Takaki , Ishitoya Hitoshi , Tomino Tetsuo
Published: May 2013

Preoperative autologous blood donation has been shown to reduce homologous blood transfusion in cardiac operations, but there have been few reports of its use in children. Of 50 children aged 6 months to 5 years (weight, 6.1–14.8 kg) undergoing primary cardiac surgery for simple anomalies, 23 donated autologous blood before surgery, the other 27 were age and weight-matched controls. Two donations of 10 mL·kg−1 each were collected via the femoral vein under mild general anesthesia 12 ± 5 and 19 ± 7 days preoperatively. No complications related to autologous blood collection were observed. Homologous blood use was significantly less in the group given autologous blood (4.3%) compared to the control group (44.4%). There was no significant difference in hemoglobin levels between groups before, during or after the operation. Preoperative autologous blood donation appears to be safe and effective in reducing homologous transfusions, even in children weighing less than 15 kg.
Long-Term Results of Isolated Tricuspid Valve Replacement
Authors: Tokunaga Shigehiko , Masuda Munetaka , Shiose Akira , Tomita Yukihiro , Morita Shigeki , Tominaga Ryuji
Published: May 2013

The long-term outcome of isolated tricuspid valve replacement is unclear because this procedure is rare and usually performed in combination with replacement of other valves. The results of all 31 isolated tricuspid valve replacements carried out in 23 patients in Kyushu University Hospital between 1975 and 2004 were retrospectively reviewed. A bioprosthesis was used in 27 cases and a mechanical valve in 4. There were 2 operative deaths and 4 late deaths. One patient with a mechanical prosthesis needed redo tricuspid valve replacement due to valve thrombosis 6 months after surgery. The mean cardiothoracic ratio and functional class improved significantly postoperatively. At 15 years after tricuspid valve replacement, actuarial survival was 75.6% and freedom from valve-related events was 84.9%. For bioprostheses, freedom from structural valve deterioration at 5, 10 and 15 years was 95.2%, 95.2% and 85.7%, respectively. The long-term results of tricuspid valve replacement are considered satisfactory, and a bioprosthesis can be recommended due to its good outcome and no need for anticoagulation. We should not wait until the development of endstage cardiac impairment before carrying out tricuspid valve surgery.
Mitral Valve Replacement in Severe Pulmonary Arterial Hypertension
Authors: Mubeen Mohammad , Singh Amrendra K , Agarwal Surendra K , Pillai Jeewan , Kapoor Shalini , Srivastava Ashok K
Published: May 2013

The immediate postoperative hemodynamics in 43 patients with severe pulmonary arterial hypertension who underwent mitral valve replacement between January 2000 and September 2001 were studied prospectively. The mean age was 30.6 years. There was mitral stenosis in 19 (44.1%), mitral regurgitation in 9 (20.9%), and mixed lesions in 15 (34.9%). In 36 patients (83.7%, group 1) pulmonary arterial pressure was sub-systemic, with a mean of 58.1 mm Hg and pulmonary vascular resistance of 743.4 dyne·s·cm−5. Seven patients (16.3%, group 2) had supra-systemic pulmonary arterial pressure of 83.2 mm Hg and pulmonary vascular resistance of 1,529 dyne·s·cm−5. Lung biopsies were taken from the right lower lobe in 24 patients. Operative mortality was 5.5% in group 1 and 28.5% in group 2. After mitral valve replacement, the pulmonary arterial pressure and vascular resistance decreased significantly in group 1. In group 2, pulmonary arterial pressure decreased significantly but pulmonary vascular resistance remained elevated. Pulmonary vascular changes did not progress beyond grade III (Heath-Edwards’ classification). Mitral valve replacement is safe even in the presence of severe pulmonary arterial hypertension as long as pulmonary arterial pressures are below systemic pressures. Lung biopsy did not help in identifying patients with irreversible pulmonary arterial changes.
Endoscopic Radial Artery Harvesting: Patient Satisfaction and Complications
Authors: Nishida Satoru , Kikuchi Yujiro , Watanabe Go , Takata Munehisa , Ito Shigeki , Kawachi Kenji
Published: May 2013

Endoscopic radial artery harvesting was recently introduced to reduce the morbidity associated with conventional open harvesting and improve cosmetic outcomes. From January 2004 through December 2006, 25 radial arteries were harvested endoscopically from 25 patients using the VasoView endoscopic system. Bilateral radial arteries were harvested from 6 patients by both the endoscopic and open techniques, and postoperative patient satisfaction was assessed using a visual analogue scale. Mean harvesting time was 61.9 ± 16.0 min (range, 44–105 min), and mean harvested conduit length was 16.8 ± 2.0 cm (range, 15–19 cm). Objective dorsal thenar numbness remained in 2 patients (8%); none complained of forearm numbness. All patients expressed marked satisfaction with the endoscopic technique and the small incision. Patient satisfaction was significantly higher with the endoscopic technique than with the open technique (visual analogue scale of 9 vs 5). Postoperative angiography revealed occlusion of a graft that had been anastomosed to a small diagonal branch. The overall graft patency was 96.6%. Endoscopic radial artery harvesting can be performed safely with infrequent complications. This method results in excellent patient satisfaction, particularly regarding the cosmetic outcome.
Isolation of ckit-Positive Cardiosphere-Forming Cells from Human Atrial Biopsy
Authors: Rani Koippallil G Aghila , Jayakumar Karunakaran , Srinivas Gopal , Nair Renuka R , Kartha Chandrasekharan C
Published: May 2013

There is increasing interest in developing cell-based therapies to regenerate functional muscle and blood vessels in infarcted dysfunctional myocardium, using stem cells resident in the adult heart. The objective of our study was to identify an easy and cost-effective method for the isolation and expansion of human adult cardiac-resident stem cells. The cells were isolated from right atrial biopsy samples obtained from patients with ischemic heart disease, who were undergoing coronary artery bypass grafting. Two different isolation methods, enzymatic and nonenzymatic, were employed. The cell yield and cluster formation were not significantly different with either of the techniques used for cell isolation. The nonenzymatic method is recommended because of its simplicity and lower cost compared to the enzymatic method.
A Rare Cause of Dissection of Ascending Aorta after Aortic Valve Replacement
Authors: Masuda Zenichi , Murakami Takashi , Shishido Eishun , Kuinose Masahiko
Published: May 2013

We present a 78-year-old man who developed Stanford type A aortic dissection seven years after aortic valve replacement. At the previous operation, the diameter of the ascending aorta was 40 mm. Three years later, computed tomography revealed the diameter to have expanded to 50 mm. Four years later, the patient developed aortic dissection with entry at the ascending aorta, and a graft replacement was performed.
Leiomyosarcoma of the Left Atrium
Authors: Čanádyová Júlia , Šetina Marek , Smetanová Simona , Mokráček Ales
Published: May 2013

A 41-year-old woman underwent successful excision of a leiomyosarcoma of the left atrium. The preferential left atrial location and frequent myxoid appearance of leiomyosarcoma of the heart make it particularly difficult to distinguish preoperatively from atrial myxoma. Early diagnosis and aggressive surgical intervention with chemotherapy may improve the prognosis.
Unforeseen Scenario in Removal of a Tracheobronchial Foreign Body
Authors: Türüt Hasan , Gulhan Erkmen , Tastepe Irfan
Published: May 2013

Tracheobronchial foreign body aspirations occur most commonly in children but under certain circumstances, are seen in adults. Majority of patients can succesfully be managed via bronchoscopy. However, unexpected complications may develop during the removal procedure. We describe an unusual complication encountered during the removal procedure of an inhaled scarf pin in the trachea of a 23-year old woman. Crucial removal procedure is implicated and awareness of this rare complication is emphasized.
Solitary Benign Fibrous Tumors of the Pleura
Authors: Regal Mohamed A , Al Rubaish Abdulla M , Al Ghoneimy Yasser F , Hammad Reda I
Published: May 2013

Solitary benign fibrous tumors of the pleura are very rare. Seven patients (mean age, 52 years) who presented between 1995 and 2005 were studied retrospectively. They had nonspecific chest symptoms and no history of asbestos exposure or smoking. Chest radiography showed a large opacity occupying most of the affected hemithorax, with clear costophrenic angles. Computed tomography of the chest showed a large well-delineated heterogeneous mass directly related to the lateral chest wall. Needle biopsy suggested the benign nature of the lesion. Surgery was performed through a posterolateral thoracotomy. Five tumors arose from visceral pleura, and 2 from parietal pleura. The mean tumor diameter was 7.5 cm (range, 8–14 cm). Complete surgical excision was carried out in all cases. Histopathology and immunohistochemical staining confirmed the benign nature of the tumors. There was no mortality or major complication. The mean follow-up period was 4 years (range, 1–10 years). All patients remained tumor-free during follow-up. Wide local excision, including pulmonary and pleural resection, is recommended as the best therapeutic option.
Fibrin Sealant for Left Ventricular Rupture after Mitral Valve Replacement
Authors: Garcia-Villarreal Ovidio A , Casillas-Covarrubias Luis E
Published: May 2013

Despite safer surgical procedures, left ventricular rupture remains a rare but potentially lethal complication of mitral valve replacement. The use of fibrin sealant has substantially improved the outcome of many difficult bleeding episodes after cardiac surgery. We describe a case of left ventricular rupture successfully treated with fibrin sealant combined with external Teflon-pledgeted sutures.
Hancock Valve Deterioration in Tricuspid Position for Ebstein's Anomaly
Authors: Sughimoto Koichi , Nakano Kiyoharu , Gomi Akihiko , Nakatani Hayao , Nakamura Yoshitsugu , Sato Atsuhiko
Published: May 2013

A 65-year-old woman with a Hancock valve implanted 25 years earlier for Ebstein's anomaly underwent a successful second tricuspid valve replacement with a Mosaic valve because of significant tricuspid regurgitation. At surgery, it was found that the Hancock valve had a cylinder-shaped hole and had lost its entire structure. Tricuspid valve dysfunction may be tolerated for a long time before surgery is contemplated.
Left Heart Pump-Assisted Beating Heart Coronary Surgery in High-Risk Patients
Authors: Pepino Paolo , Oliviero Piermario , Petteruti Francesco , di Tommaso Luigi , Monaco Mario , Stassano Paolo
Published: May 2013

A simple technique of left ventricular assistance, offering the advantages of both cardiopulmonary bypass and off-pump revascularization, was adopted for high-risk patients. It was used in 56 patients with critical left main stenosis and occluded right coronary artery, severely reduced ejection fraction and/or unstable angina. All patients underwent complete and successful myocardial revascularization (3.4 grafts per patient). Weaning from the pump was uncomplicated, and none required conversion to full cardiopulmonary bypass.
Intimal Sarcoma of Aortic Arch Treated with Proton Therapy following Surgery
Authors: Ishigami Naoyuki , Suzuki Kazuchika , Takahashi Tsuyoshi , Neyatani Hiroshi , Bashar Abul Hasan M , Kazui Teruhisa
Published: May 2013

Management of a rare case of intimal sarcoma of the aortic arch is reported, which was diagnosed unexpectedly after total arch replacement for pseudoaneurysm. The prognosis for this condition is poor, with death usually within a few months from diagnosis. The newly developed proton-beam radiation therapy was applied to treat a local recurrence of the sarcoma following surgery. Positron-emission tomography/computed tomography revealed complete remission of the lesion.
Mycotic Pseudoaneurysm of the Ascending Aorta at Site of Aortic Cannulation
Authors: Gabbieri Davide , Dohmen Pascal M , Linneweber Jörg , Lembcke Alexander , von Heymann Christian , Konertz Wolfgang F
Published: May 2013

Reoperation for pseudoaneurysm of the ascending aorta presents a surgical challenge. Instituting femorofemoral bypass and establishing hypothermic circulatory arrest is a well-known strategy, although not free from complications. We report a case of mycotic pseudoaneurysm after coronary artery bypass in a 53-year-old man, at the site of previous aortic cannulation, and review the surgical strategies proposed to manage this pathologic entity.
Bicuspidized Pulmonary Homograft for Truncus Arteriosus Repair
Authors: Benjacholamas Vichai , Namchaisiri Jule , Khongphatthanayothin Apichai , Lertsapcharoen Pornthep
Published: May 2013

Primary repair is preferable to palliation in infants with truncus arteriosus. At our institute, an appropriately small homograft valved conduit is not available for every patient; a bicuspidized pulmonary valve homograft is an alternative. Between December 1996 and August 2005, 24 patients aged 28 days to 21 months with truncus arteriosus underwent primary repair with a homograft valved conduit; bicuspidized homografts were used in 15 of them. In the 18 (75%) patients who survived to hospital discharge, 5-year survival was 94% (75% for tricuspid homografts and 100% for bicuspidized homografts, which was not significantly different). Freedom from reoperation or balloon angioplasty in all 18 survivors was 89% at 5 years. Freedom from reoperation in tricuspid and bicuspidized homograft groups at 5 years was 67% and 100%, respectively; the difference was not statistically significant. Bicuspidized homografts worked as well as tricuspid conduits in the intermediate term. The remodeled homografts showed excellent hemodynamic characteristics and appear to be a reasonable alternative when an appropriate size of valved homograft is unavailable.
Catheter Ablation of Left Atrial Ganglionated Plexi for Atrial Fibrillation
Authors: Pokushalov Evgueny , Turov Alex , Shugayev Pavel , Artyomenko Sergey , Romanov Alex , Shirokova Natalya
Published: May 2013

Radiofrequency ablation of pulmonary vein ostia does not provide complete and long-term elimination of atrial fibrillation. Combining this procedure with local radiofrequency application on sites with strong vagal reflexes results in partial parasympathetic denervation and increases the antiarrhythmic effect. A novel catheter-ablation technique to modify ganglionated plexi in the left atrium was assessed in 58 patients (mean age, 52.1 ± 1.9 years, 67% male) with drug-refractory atrial fibrillation, which was chronic in 21 (36%; mean duration, 14.3 ± 2.9 months; range, 5–39 months). The mean left atrial volume was 93.1 ± 6.1 mL. The patients underwent ablation of 4 areas of ganglionated plexi in the left atrium, with no circumferential ablation of the pulmonary veins; atrial fibrillation ceased immediately in 94.1% of them. Transient vagal bradycardia was seen in 93% of patients. For 7.2 ± 0.4 months after the procedure, 86.2% of them were free from arrhythmias, and no antiarrhythmic drugs were administered. Ganglionated plexi ablation is an efficient treatment for atrial fibrillation.
Gender Influence on Hospital Mortality after Coronary Artery Bypass Surgery
Authors: Mandegar Mohammad H , Marzban Mehrab , Lebaschi Amir H , Ghaboussi Pouya , Alamooti Ali RA , Ardalan Ali
Published: May 2013

There is still controversy about the influence of gender on hospital mortality after coronary artery bypass grafting. We analyzed various risk factors in 1,258 patients undergoing isolated on-pump coronary artery bypass, of whom 19 (1.5%) died in hospital. There were 937 men (74.5%) and 321 women (25.5%). Compared to men, women were older with a higher mean body mass index, twice as many were hypertensive and diabetic, and they had higher serum cholesterol and triglycerides. Men smoked more, had lower ejection fractions, more myocardial infarctions and poorer functional status. Female sex, congestive heart failure, low ejection fraction, diabetes, previous percutaneous interventions and chronic lung disease were more prevalent among the patients who died. These factors were used to form a logistic regression model in which sex did not have an independent influence on hospital mortality. The difference between men and women can be explained by differences in risk factor profile.
Fracture Embolization of an Edwards-Duromedics Valve with Asymmetrical Closure
Authors: Yamazaki Kazuhiro , Nishimura Kazunobu , Iwakura Atsushi , Uehara Kyokun , Okada Tatsuji , Sugita Takaaki
Published: May 2013

We report a case of sudden leaflet fracture of an Edwards-Duromedics mitral valve 17-years after its implantation. The patient had a history of an asymmetrical motion of the valve, five months earlier. A computed tomography scan showed two fragments that had embolized to the right brachiocephalic artery and left common iliac artery. An emergency mitral replacement surgery was successfully performed. Asymmetrical closure of the valve leaflet may have contributed to valve fracture.
Repair of Anomalous Left Coronary Artery from the Right Pulmonary Artery
Authors: Modi Paul , Chen Qiang , Murphy Tim , Pawade Ash
Published: May 2013

Surgical correction of anomalous left coronary artery from the right pulmonary artery is achieved by either direct implantation of the left coronary artery into the aorta or creation of a conduit between the two. We modified a technique originally described by Tashiro for the main pulmonary artery, by using a circumferential section of right pulmonary artery wall to create a conduit with a side-to-side anastomosis onto the aorta.
Cardioprotection with Volatile Anesthetics in Cardiac Surgery
Authors: Lorsomradee Suraphong , Cromheecke Stefanie , Lorsomradee Sratwadee , De Hert Stefan G
Published: May 2013

Myocardial ischemia during the perioperative period is a major cause of morbidity and mortality after surgery. Experimental data indicate that clinical concentrations of volatile anesthetics protect the myocardium from ischemia and reperfusion injury, as shown by decreased infarct size and more rapid postoperative recovery of contractile function. These anesthetics may also mediate protective effects in other organs, such as the brain and kidney. A number of recent reports have indicated that these experimentally observed protective effects might also be present in the clinical setting. Implementation of such cardioprotection during surgery may provide an additional tool in the treatment and prevention of ischemic cardiac dysfunction in the perioperative period. This review discusses the clinical studies that have focused on the potential cardioprotective effects of volatile anesthetic agents.
Cavernous Hemangioma of The Rib: A Case Report
Authors: Ceberut Kadri , Aksoy Yaşar Metin , Savaş Fikriye , Müslehiddinoğlu Ahmet
Published: May 2013

Cavernous hemangioma of the bone is an uncommon benign vascular tumor, generally occurring in the spine or skull but extremely rare in the rib. We report the case cavernous hemangioma of the rib treated by surgical resection after CT and MR findings.
Abdominal Aortic Aneurysm Associated with Horseshoe Kidney
Authors: Kawanishi Yujiro , Tanaka Hiroshi , Nakagiri Keitaro , Yamashita Teruo , Okada Kenji , Okita Yutaka
Published: May 2013

The optimal approach to abdominal aortic aneurysm with horseshoe kidney is still debated. We describe a successful abdominal aortic aneurysm repair through a left retroperitoneal approach in a 77-year-old woman with a horseshoe kidney.
Reversal of Myocardial Dysfunction Due to Brain Injury
Authors: Wippermann Jens , Bennink Gerardus , Wittwer Thorsten , Madershahian Navid , Ortmann Christian , Wahlers Thorsten
Published: May 2013

Severe myocardial dysfunction after blunt head injury is a rare but potentially lethal complication. We describe remarkable myocardial recovery after severe hemodynamic deterioration in a young man with brain injury, due to extracorporeal membrane oxygenation support. Because of the severity of brain damage, the patient succumbed after diagnosis of brain death. Postmortem histopathological examination of the heart showed severe myocardial necrosis.
Cardiac Troponin T in Acute Coronary Syndrome with Renal Insufficiency
Authors: Chew Huck Chin
Published: May 2013

Cardiac troponin levels are frequently elevated in patients with chronic renal failure, hence diagnosis of myocardial necrosis is difficult. The prevalence of elevated serum troponin T was determined and its diagnostic value in acute coronary syndrome was assessed in patients with chronic renal insufficiency. A retrospective cross-sectional analysis was performed in 227 patients with chronic renal insufficiency and a diagnosis of unstable angina, non-ST or ST-segment elevation myocardial infarction. All patients had baseline serum troponin T levels measured at previous visits; the baseline troponin T level was raised in 53.3%. Cardiac troponin T levels did not correlate with creatinine levels, and were not affected by dialysis. Mortality after an acute coronary event was high (46.3%). Because of the elevated baseline cardiac troponin T levels, detection of acute coronary syndrome in patients with chronic renal failure requires evaluation of serial cardiac enzyme measurements and serial 12-lead electrocardiograms. Early and definitive cardiac interventions may contribute towards decreasing the mortality rate in this group of patients.
Predictors of Sinus Rhythm after Radiofrequency Maze and Mitral Valve Surgery
Authors: Chaiyaroj Suchart , Ngarmukos Tachapong , Lertsithichai Panuwat
Published: May 2013

The prevalence and predictors of postoperative sinus rhythm in patients undergoing a radiofrequency ablation maze operation and mitral valve surgery were assessed in 63 patients of whom 54 (86%) were in permanent atrial fibrillation. Operative mortality was 3.17%. At a median follow-up of 18 months, 54 (88.5%) patients were in sinus rhythm and 7 (11.5%) were in atrial fibrillation. The probability of sinus rhythm at 30 months was 92%. Left atrial diameter was the most significant prognostic factor for sinus rhythm on multivariate proportional-hazard regression analysis. The cutoff value of preoperative left atrial diameter for predicting persistent atrial fibrillation at 6 months was 6 cm (100% sensitivity and 73.6% specificity). The radiofrequency ablation maze operation can be performed in addition to mitral surgery with a high rate of successful conversion to sinus rhythm. Preoperative left atrial diameter < 6 cm is an important prognostic factor for sinus rhythm conversion.
Mortality in Open Heart Surgery with Intraaortic Balloon Pump Support
Authors: Karimi Abbasali , Movahedi Namvar , Salehiomran Abbas , Marzban Mehrab , Abbasi Seyed Hesameddin , Yazdanifard Parin
Published: May 2013

Mechanical circulatory assistance is frequently needed to support the failing heart. The aim of this study was to determine perioperative prognostic factors for hospital mortality in patients undergoing open heart surgery who required intraaortic balloon pump support. Between January 2002 and September 2006, 475 patients received an intraaortic balloon pump perioperatively. Hospital mortality was 21.89%. Risk factors for hospital death identified by multivariate logistic regression analysis were peripheral vascular disease, left main coronary artery disease, postoperative renal failure, postoperative cardiac arrest, and prolonged hospital stay. Minor and major intraaortic balloon pump-related complications were not significant in univariate and multivariate analysis; the incidence was 5.05%. It is suggested that the threshold for using balloon pump support is decreased in high-risk patients undergoing cardiac surgery.
Novel Anti-Adhesive Pericardial Substitute for Multistage Cardiac Surgery
Authors: Matsumura Goki , Shin'Oka Toshiharu , Ikada Yoshito , Sakamoto Takahiko , Kurosawa Hiromi
Published: May 2013

Dense adhesions in the retrosternal space make reoperations difficult in the field of cardiovascular surgery. Several substitutes for pericardium have been employed to prevent dense adhesions forming, but they have been unsatisfactory because of peel formation, calcification, and infection. To overcome these drawbacks, a novel biodegradable pericardial substitute was developed from gelatin obtained from specific-pathogen-free porcine skin and a bioabsorbable polyester mesh, which persists while the adhesion reaction occurs in the retrosternal space. A clinical pilot study of this gelatin sheet was carried out in patients scheduled to receive multistage cardiac surgery. From February 2003 to July 2004, the material was used in 5 patients aged 0.4 to 3.0 years. There were no complications related to the gelatin sheet. The effectiveness of the material was evaluated when the sternum was reopened 1.4 ± 0.5 years later. It took 24.5 ± 6.0 min for the resternotomy, and all surgeons who participated in the surgery rated the effectiveness of the gelatin sheet as “good”. This anti-adhesive sheet prevented dense adhesions, suggesting that this material may be useful as a pericardial substitute for multistage pediatric cardiac surgery.
Early Repair of Acquired Tracheoesophageal Fistula
Authors: Yeh Chou-Ming , Chou Chia-Man
Published: May 2013

We report early direct repair of a cuff-related tracheoesophageal fistula in a 30-year-old alcoholic man with diabetic ketoacidosis who fell unconscious and was ventilated via an endotracheal tube. He was successfully weaned from the ventilator 1 week after the operation.
Retrieval of Broken Paravertebral Catheter by Video-Assisted Thoracic Surgery
Authors: Sihoe Alan DL , Das Subid R , Ling Leong-Chow , Cheng Lik-Cheung
Published: May 2013

A paravertebral catheter was placed in a 34-year-old man to provide analgesia after a right upper lobectomy. On removal, the catheter broke within the chest wall. Although bedside exploration and computed tomography scanning failed to locate it, the 13-cm long retained fragment was easily retrieved by video-assisted thoracic surgery, using a single-port technique.
Endovascular Repair of Traumatic Thoracic Aortic Injuries: A Critical Appraisal
Authors: Lin Peter H , Huynh Tam T , Kougias Panagiotis , Wall Mathew J , Coselli Joseph S , Mattox Kenneth L
Published: May 2013

Blunt trauma to the thoracic aorta is life-threatening, with instant fatality in at least 75% of victims. If left untreated, nearly half of those who survive the initial injury will die within the first 24 hours. Surgical repair has been the standard treatment of blunt aortic injury, but immediate operative intervention is frequently difficult due to concomitant injuries. Although endovascular treatment of traumatic aortic disruption is less invasive than conventional repair via thoracotomy, this strategy remains controversial in young patients due to anatomical considerations and device limitations. This article reviews the likely advantages of endovascular interventions for blunt thoracic aortic injuries. Potential limitations and clinical outcomes of this minimally invasive technique are also discussed.