bluuebunny/crossref_metadata_2025 huggingface dataset:
Interposition of aortic valve leaflets for reinforcement of Bentall proximal anastomosis
Authors: Mohite Prashant N , Ahmad Tanveer , Prabhu Sudesh V , Thingnam Shyam K
Published: May 2013

Bleeding from the proximal suture line is not uncommon after composite graft anastomosis in the Bentall procedure. The passage of valve sutures through the aortic valve leaflets interposed between the pledgets and the cuff of the composite valved conduit strengthens the repair.
Thoracic surgery mortality and morbidity in a university hospital
Authors: Suksompong Sirilak , Thamtanavit Sarawut , von Bormann Benno , Thongcharoen Punnaruk
Published: May 2013

This study was undertaken to determine the mortality and morbidity of lung resection surgery in the 2,415-bed Siriraj University Hospital, Thailand, and compare them to rates in similar facilities (benchmarking). Demographic and clinical data as well as perioperative outcome variables of patients who underwent elective thoracic surgery from January 2006 to May 2010 were reviewed retrospectively. There were 558 cases of lung resection. Mortality was 0.9% and perioperative morbidity was 8.2%. Univariate analysis identified age >75 years, history of pulmonary disease, preoperative rehabilitation consultation, and operative time >2 h as predictors of mortality and morbidity. With less statistical power, hypertension, cancer, peripheral vascular disease, and thoracotomy also contributed to perioperative outcome. Comparisons with data from the current literature place our results in the range of good quality. Following benchmarking criteria, perioperative outcomes after lung resection surgery in our hospital are good. To further improve quality, we will pay special attention to patients with advanced age and history of pulmonary disease.
Teicoplanin-induced neutropenic sepsis mimicking endocarditis
Authors: Booth Karen , Parissis Haralambos
Published: May 2013

Teicoplanin is a less toxic replacement for vancomycin in most situations where resistant organisms are encountered, and is therefore the drug of choice. As a commonly used drug in cardiac surgery, we treated a case of presumptive endocarditis with teicoplanin that caused neutropenic sepsis, unmasked on withdrawal of treatment.
Double-line closure of anterior postinfarction ventricular septal perforation
Authors: Hamamoto Masaki , Futagami Daisuke
Published: May 2013

We describe a modified patch closure technique for repairing subacute anterior ventricular septal perforation. Through a left ventriculotomy, a larger double-layered planar patch is secured with double suture lines to close the defect and cover the ventricular septum. This modification is simple and easy, and may help to avoid a residual shunt.
Simple and safe graft insertion in the elephant trunk technique
Authors: Ishikawa Noboru , Omoto Tadashi , Miyauchi Tadamasa , Oi Masaya , Fukuzumi Masomi , Tedoriya Takeo
Published: May 2013

The elephant trunk technique is a well-established procedure, but aortic wall injury or aneurysmal rupture may occur if the graft is forcibly pushed to insert it into the distal aorta. We have developed simple and safe insertion technique using a syringe.
An unusual case of pleural empyema in a tsunami survivor
Authors: Ota Hideki , Kawai Hideki
Published: May 2013

A 74-year-old man who survived the tsunami after the Great East Japan Earthquake, was admitted to our department because of respiratory distress. He developed aspiration pneumonia and pleural empyema of the right thorax. Decortication was performed by video-assisted thoracoscopic surgery. An unsuspected aspirated pine tree branch and pulmonary pleural fistula were discovered. The branch was removed, the pleural fistula was opened for drainage of the intrapulmonary abscess, and the patient made a good recovery.
Acute type A aortic dissection complicated by persistent left superior vena cava
Authors: Matsuno Yukihiro , Ishida Narihiro , Fukumoto Yukiomi , Shimabukuro Katsuya , Takemura Hirofumi
Published: May 2013

Acute type A aortic dissection in a patient with persistent with left superior vena cava is a very rare condition. There are some technical problems encountered during cardiovascular surgery in such a patient. We describe successful repair of acute type A aortic dissection complicated persistent with left superior vena cava, and the technical difficulties encountered during surgery.
Malignant transformation of bronchogenic cyst revealed by 99mTc-MIBI-SPECT
Authors: Fiorelli Alfonso , Rambaldi Pierfrancesco , Accardo Marina , Santini Mario
Published: May 2013

Adenocarcinoma arising from a mediastinal cyst was detected by exercise technetium-99m hexakis-2-methoxyisobutylisonitrile 99mTc-MIBI scintigraphy in a 65-year-old woman with known coronary disease. This guided further investigations and resection of the tumor which stained positive for P-glycoprotein. Three years earlier, myocardial scintigraphy was negative, probably due to down-expression of P-glycoprotein because the cells were in the early stages of carcinogenesis. After completing malignant transformation, the high P-glycoprotein expression resulted in MIBI uptake on the second myocardial scintigraphy.
Surgical treatment of an interatrial septal paraganglioma
Authors: Aki Akira , Okada Kimiaki , Furuya Hidekazu , Shimura Shinichirou , Cho Yasunori , Ueda Toshihiko
Published: May 2013

A 39-year-old man presented with chest pain. Chest radiography and echocardiography indicated a possible cardiac tumor. Echocardiography, computed tomography, and magnetic resonance imaging revealed a tumor in the interatrial septum. The patient underwent tumor resection under cardiopulmonary bypass. A paraganglioma was diagnosed on the basis of histopathological findings.
A clinical-angiographic risk scoring system for coronary artery anomalies
Authors: Rigatelli Gianluca , Rigatelli Alberto , Cominato Sandra , Panin Stefano , Nghia Nguyen Thuong , Faggian Giuseppe
Published: May 2013

Congenital coronary anomalies remain a debated issue. On the basis of a critical review of the literature and our historical series, we propose a simple clinical profile scoring system for congenital coronary anomalies. A review of literature over the past 30 years was performed, searching for a relationship between the worst coronary anomaly presentation and manifestations and the anatomical and functional features. A risk scoring system was created based on these features, and retrospectively applied to our historical series of 140 consecutive patients (52 females; mean age, 60.1 ± 19.3 years; mean follow-up, 60 ± 23 months). Origin from the pulmonary artery, intramural course, intramyocardial course, coronary fistula with a significant pulmonary-to-systemic flow ratio, superimposed coronary artery disease, and associated congenital heart disease were associated with the worst clinical presentation. The risk scoring system gave 2 points to anatomical features and 1 point to the association with clinical and functional characteristics: 3 risk classes were identified: >3, 2–3, and <2 points. The system showed good correlation with presentation and manifestations on follow-up. Although not exhaustive, the proposed scoring system may simplify the clinical evaluation of patients with such abnormalities, being a model for decision making.
Survival after surgical repair of ischemic ventricular septal rupture
Authors: Abu-Omar Yasir , Bhinda Peter , Choong Cliff KC , Nashef Samer AM , Nair Sukumaran
Published: May 2013

Objectives: We reviewed our results and experience over a 14-year period to identify predictors of outcome following surgical repair of postinfarction ventricular septal rupture.

Methods: A retrospective review was carried over a 14-year period. All patients had surgical repair of a postinfarction ventricular septal rupture. Patient demographics, perioperative variables, and survival data were collected. Logistic regression identified independent predictors of 30-day mortality. Multivariate analysis determined the effects of independent risk factors on survival.

Results: Surgery for postinfarction ventricular septal rupture was carried out on 59 patients. The median age was 69 years, and 69% were male. In 54% of patients, the ventricular septal rupture was anterior, and 75% had concomitant coronary artery bypass grafting. Mortality was 39% at 30 days. Age was the most important predictor of 30-day and long-term outcome. Logistic regression analysis identified age, preoperative ventilation, and female sex as significant predictors of 30-day mortality. Cardiogenic shock, preoperative ventilation, and advanced age were associated with reduced medium-term survival. Surprisingly, anterior ventricular septal rupture was associated with reduced long-term survival. Concomitant coronary artery bypass grafting did not influence 30-day or long-term outcome.

Conclusions: Despite advances, the surgical mortality from ventricular septal rupture remains high. Age remains the most important predictor of outcome, and concomitant coronary artery bypass grafting does not appear to have a demonstrable benefit. Interestingly, anterior ventricular septal rupture had poorer long-term outcome than inferior ventricular septal rupture.
A new concept in the sewing rings for mechanical heart valves
Authors: Kurian Mathew V , Umasankar Payanam R , Sabareeswaran Arumugam , Shenoy Sachin J , Subban Vijayakumar , Joseph Mathew K
Published: May 2013

Background: valve-associated complications challenge the quality of life and longevity after heart valve replacement. Inappropriate healing may be a contributing factor.

Objective: to evaluate a new design mechanical heart valve in an animal model.

Methods and results: the new valve was fabricated by substituting the sewing ring with an inbuilt suture ridge and an overlying fabric flap. It improved the effective orifice area. Animal experiments were performed on pigs to compare this valve with standard valve models. The animals were kept on dual antiplatelet drugs. Six of the 8 test animals survived the observation period of 140 days compared to 2 of the 6 controls. Among the test valves, one had thrombosis and 3 had significant tissue hyperplasia, whereas 5 control valves had thrombosis associated with significant tissue hyperplasia. Three test valves had paravalvular defects compared to none in the control group. Histology showed good tissue incorporation of the fabric flap of the test valves, whereas the control valves had tissue infiltration limited to the peripheral fabric layer of the sewing ring.

Conclusion: the new valve has improved effective orifice area, and the animal study showed better survival, good healing, and a lower incidence of thrombosis and tissue hyperplasia.
Aortic valve replacement with biological substitutes in children
Authors: Talwar Sachin , Malankar Dhananjay , Garg Sanket , Choudhary Shiv Kumar , Saxena Anita , Velayoudham Devagourou , Kumar Arkalgud Sampath
Published: May 2013

Background: this study was performed to assess the results of aortic valve replacement in children with biological substitutes including homografts, pulmonary autografts (Ross procedure), and aortic valve reconstruction with autologous pericardium (Duran technique).

Methods: between March 1992 and July 2009, 73 children with aortic valve disease (mean age, 11.8 ± 2.7 years) underwent aortic valve replacement with biological substitutes including homografts, pulmonary autografts, and aortic valve reconstruction with autologous pericardium. Associated procedures were mitral valve repair in 32 and subaortic membrane resection in 3.

Results: early mortality was 1.4% (1 patient). Median follow-up was 94 months. Sixty (83.3%) survivors had insignificant aortic regurgitation. Reoperation was required in 7 (9.6%) patients: for autograft dysfunction alone in 2, autograft failure and failed mitral valve repair in 2, autograft dysfunction with severe pulmonary homograft regurgitation in 1, severe homograft aortic valve regurgitation in 1, and right ventricular outflow tract obstruction in 1. There were 4 (5.4%) late deaths. Actuarial reoperation-free, event-free, and aortic valve dysfunction-free survival were 92.5% ± 4%, 93.4% ± 3.3 %, 94% ± 2.9%, 86.2% ± 4.3%, respectively, at 94 months.

Conclusions: aortic valve replacement with biological substitutes is associated with acceptable hemodynamics and midterm results.
Aortic valve perforation following transcoronary ablation of septal hypertrophy
Authors: Galeone Antonella , Barreda Eleodoro , Choussat Rémi , Leprince Pascal , Pavie Alain
Published: May 2013

We report the case of a 47-year-old man with hypertrophic obstructive cardiomyopathy who underwent transcoronary ablation of septal hypertrophy and developed severe aortic regurgitation after the procedure. Intra-operatively, we found a wide perforation of the noncoronary cusp, and performed aortic valve replacement.
Sonoclot analysis in children with congenital heart disease
Authors: Chaudhary Vishal , Chauhan Sandeep , Choudhury Minati , Kiran Usha , Talwar Sachin , Kapoor Poonam M
Published: May 2013

Background: This study aimed to compare preoperative baseline Sonoclot variables between acyanotic and cyanotic congenital heart disease patients.

Methods: 100 patients aged from infancy to 9-years were studied. Fifty patients each from the cyanotic and acyanotic groups were studied for sonoclot parameters preoperatively. After inhalational anesthetic induction, blood was collected from the arterial line and analyzed in a Sonoclot analyzer to measure Sonoclot activated coagulation time, clot rate, and platelet function.

Results: Sonoclot activated coagulation time was normal in both groups, but lower in the cyanotic group (127.95 ± 51.4 s) than the acyanotic group (147.85 ± 45.48 s; p = 0.54). Both groups had abnormal clot rates and platelet function. The clot rate was significantly lower in the cyanotic group (19.31 ± 10.68 Uċmin−1) than acyanotic group (24.88 ± 9.23 Uċmin−1; p = 0.009). Platelet function was deranged in 31% of patients (cyanotic, 59%; acyanotic, 8%; p < 0.001). Platelet function was the most severely affected baseline parameter.

Conclusions: Pediatric acyanotic and cyanotic congenital heart disease patients have deranged coagulation parameters as assessed by the Sonoclot analyzer. The abnormality is more marked in cyanotic patients. Platelet function is the most severely affected parameter. These baseline parameters in conjunction with post-bypass parameters for an individual patient will help in the formulation of specific blood component transfusion guidelines.
Remote ischemic preconditioning in percutaneous coronary revascularization: a double-blind randomized controlled clinical trial
Authors: Ghaemian Ali , Nouraei S Mahmoud , Abdollahian Fatemeh , Naghshvar Farshad , Giussani Dino A , Nouraei SA Reza
Published: May 2013

Objective: To assess the impact of pre-procedural remote ischemic preconditioning on the incidence of myocardial complications following percutaneous coronary intervention.

Background: Ischemic preconditioning of a remote vascular territory improves the subsequent ischemic tolerance of distant organs.

Method: The Myocardial Event Reduction with Ischemic Preconditioning Therapy (MERIT) trial recruited 80 consecutive patients undergoing elective angioplasty with drug-eluting stents to receive two 5-min lower limb tourniquet occlusions or an un-inflated tourniquet (controls) 1 h before the procedure. The primary outcome was troponin T level at 24 h. Secondary outcomes were intra-procedural chest pain and ST-segment deviation.

Results: 6 patients in the control group and 2 in the ischemic preconditioning group had pre-procedural raised troponin T ( p = 0.23). This increased to 16 (40%) in the control group and 5 (12.5%) in the study group at 24 h ( p = 0.01). Fewer patients in the study group experienced intra-procedural chest pain (1 vs. 7, p = 0.056). Mean ST-segment deviation time was 13 ± 35 s in the study group and 58 ± 118 s in the control group ( p = 0.02). At a mean follow-up of 11 months, the major adverse cardiac event rate did not differ significantly between the groups.

Conclusion: These data suggest that ischemic preconditioning reduces the absolute risk of post-procedure cardiomyocyte necrosis by 27.5%, and reduces intra-procedural chest pain and ST-segment deviation in patients undergoing percutaneous coronary interventions. We suggest its routine use in percutaneous coronary intervention, although the long-term prognostic impact in this patient group warrants further investigation.
Management and midterm outcomes of post-infarction ventricular septal defect
Authors: Wiemers Paul , Harvey Ryan , Khatun Mohsina , Mundy Julie , Peters Paul , Shah Pallav
Published: May 2013

We assessed midterm outcomes, predictors of mortality, and residual defects after repair of post-infarction ventricular septal defect in 10 patients (mean age, 65.3 years; range, 50–78 years) who were operated on between 2000 and 2008. Mean time from onset of symptoms of myocardial infarction to diagnosis of ventricular septal defect was 3.5 days. Time from diagnosis to surgery ranged from 6 h to 84 days. The defects were located anteriorly in 4 patients and posteriorly in 6. Patch reconstruction of the septum was used in 6 patients and the infarct exclusion technique in 4. Hospital mortality was 60%. The only predictor of mortality was tricuspid valve competence ( p = 0.048). There was no correlation between location of the defect or type of repair and operative mortality. Residual or recurrent ventricular septal defect was noted in 6 patients. Location of the defect and type of repair were not predictors of residual or recurrent defects. Residual ventricular septal defect was not associated with increased short-term mortality or reduction of functional status. Early mortality associated with post-infarction ventricular septal defect repair is significant. Discharged patients continue to have good functional capacity and quality of life, as well as favorable midterm survival.
Successful resection of a huge paraganglioma utilizing cardiopulmonary bypass
Authors: Al-Jehani Yasser , Saleh Waleed , Halees Zohair Al , Ashour Mahmoud
Published: May 2013

A 54-year-old woman was diagnosed with a large paraganglioma in the left paraaortic area, extending into the aortopulmonary window and up to a right-sided superior vena cava. The tumor was treated with repeated embolizations that failed to reduce its size. Complete surgical excision was achieved utilizing cardiopulmonary bypass. The patient made a full recovery.
Primary cardiac neuroendocrine carcinoma and minimally invasive cardiac surgery
Authors: Carmona Paula , Lázaro Jessica , Llagunes José , Cánovas Sergio
Published: May 2013

Diagnosis of cardiac neoplasm has become more feasible with the use of echocardiography, but imaging is sometimes not enough to establish a diagnosis, and a biopsy is required to determine the diagnosis and treatment. Transesophageal echocardiography-directed biopsies via a minithoracotomy revealed an extremely rare primary cardiac tumor, a poorly differentiated neuroendocrine carcinoma, in the left atrium of a 54-year-old man who presented with syncope and hypotension.
Radiopaque foreign body inhalations
Authors: Sersar Sameh Ibrahim
Published: May 2013

Background: The most frequent cause of accidental household death in children under 6 years of age is inhalation of a foreign body. Delayed management is blamed for death. The absence of a recognizable penetration syndrome complicates and delays not only the diagnosis but also the treatment of foreign body inhalation.

Objective: This report aimed to highlight the problem of radiopaque foreign body inhalation and analyze part of our experience in the treatment of such cases.

Methods: A multicenter experience in the management of radiopaque inhaled foreign bodies in 3 centers in Egypt and Saudi Arabia was reviewed retrospectively, including old and new techniques to remove the foreign body. The study included data from 136 cases.

Results: The majority of patients were female (91.17%). The mean age was 12 years. More than one-third of the inhaled foreign bodies were found on the left side. A positive history of chocking was reported in more than 95%. Almost 87% presented in the first 24 h after inhalation.

Conclusion: Early rigid bronchoscopic extraction of inhaled radiopaque foreign bodies can be achieved with acceptable results. Video-assisted bronchoscopic removal of an inhaled foreign body may be safer.
Detection of ALK fusion in lung cancer using fluorescence in situ hybridization
Authors: Kobayashi Masashi , Sonobe Makoto , Takahashi Tsuyoshi , Yoshizawa Akihiko , Kikuchi Ryutaro , Date Hiroshi
Published: May 2013

Objective: To develop an easy-to-use technique for EML4-ALK detection and establish the effective selection of candidates for screening.

Background: We previously reported clinicopathological findings of patients with lung cancer harboring the EML4-ALK fusion gene. Anaplastic lymphoma kinase inhibitors have therapeutic effects in lung cancer patients with EML4-ALK, accounting for merely 1%–5% of lung cancers.

Methods: We investigated EML4-ALK in tumors from 581 patients. EML4-ALK was detected by a reverse transcription polymerase-chain reaction and by the newly established criteria and algorithm using a fluorescence in situ hybridization method. To establish an algorithm to restrict candidates chosen for ALK fusion gene detection, clinicopathological findings as well as EGFR, ERBB2, and KRAS mutations were analyzed.

Results: 8 (1.3%) tumors had EML4-ALK, EGFR, KRAS, and ERBB2 mutations, which were mutually exclusive and were detected in 191 (32.8%), 56 (9.6%), and 11 (1.8%) tumors, respectively. We screened 581 patients with tumors and another 27 who were nonsmokers or mild smokers (<20 packs per year) lacking EGFR, KRAS, and ERBB2 mutations and who had adenocarcinomas exhibiting an acinar component with moderate or poor differentiation. Of the 27 patients, 8 (29.6%) had EML4-ALK.

Conclusions: We propose criteria for selecting candidates for efficient detection of the fusion gene.
A case of aneurysm and kinking of the extracranial internal carotid artery
Authors: Benedetto Filippo , Massara Mafalda , Lentini Salvatore , Spinelli Francesco
Published: May 2013

Aneurysms of the extracranial internal carotid arteries are rare. They may provoke symptoms of adjacent neurovascular structure compression, cerebral embolization, or rupture. An 81-year-old woman was found to have a saccular aneurysm of 2.2 cm in diameter in the left internal carotid with concomitant kinking. She underwent resection of the aneurysm and the kinked arterial area, followed by end-to-end anastomosis of the internal carotid artery.
Gastric tube reconstruction of esophagus for esophageal and stomach carcinomas
Authors: Kwon Ji Suk , Kim Jae Bum , Cho Kwang Bum , Kim Eun Soo , Park Kyung Sik , Park Chang Kwon
Published: May 2013

Synchronous carcinomas of the esophagus and other organs are relatively uncommon. A 65-year old man with synchronous carcinomas of the esophagus and stomach underwent esophageal reconstruction using a gastric tube following endoscopic submucosal dissection.
Left main coronary artery stenosis secondary to severe pulmonary artery dilation
Authors: Napoleone Carlo Pace , Angeli Emanuela , Oppido Guido , Turci Simone , Gargiulo Gaetano
Published: May 2013

A 45-year-old lady with dyspnea and occasional precordial chest pain was diagnosed with a huge sinus venosus atrial septal defect and partial anomalous pulmonary venous return. Preoperative coronary angiography disclosed severe main stem stenosis, considered secondary to compression by the dilated pulmonary trunk. Atrial septal defect closure and pulmonary artery reduction plasty were performed. The left main coronary artery appeared completely patent. The postoperative course was uneventful, and the patient was asymptomatic on follow-up.
Malignant fibrous histiocytoma originating from right ventricular outflow tract
Authors: Tamenishi Akinori , Matsumura Yasumoto , Okamoto Hiroshi
Published: May 2013

A 70-year-old man presented with right heart failure due to obstruction of the right ventricular outflow tract by a large tumor mass. The tumor was surgically resected as much as possible. Neither chemotherapy nor radiotherapy was given. The patient died of local recurrence and multiple lung metastases 6 months after surgery. The prognosis of this very rare primary cardiac tumor is generally poor.
Minimal access aortic valve replacement using minimal extracorporeal circuit
Authors: Rajakaruna Chanaka , Webb Gerry , Bennett Mark , Lloyd Clinton
Published: May 2013

A minimal extracorporeal circuit has been shown to decrease the transfusion rate, cardiac and neurological damage in coronary surgery. We describe in detail a technique for minimal-access aortic valve replacement using a minimal extracorporeal circuit, and provide surgical and perfusion tips to maintain antegrade perfusion and a clear surgical field.
Pacemaker lead erosion simulating “Loch Ness Monster”: conservative management
Authors: Garg Naveen , Moorthy Nagaraja
Published: May 2013

The majority of pacemaker pocket or lead erosions are due to either mechanical erosion by the bulky pulse generator or secondary to pacemaker pocket infection. We describe an unusual case of delayed pacemaker lead erosion causing extrusion of a portion of the pacing lead, with separate entry and exit points, with the gap filled with new skin formation, simulating the “Loch Ness Monster”, which was successfully managed conservatively by surgical reinsertion.
Local administration of tranexamic acid in off-pump coronary artery bypass
Authors: Aoki Masakazu , Okawa Yasuhide , Goto Yoshihiro , Ogawa Shinji , Baba Hiroshi
Published: May 2013

Purpose: We administered tranexamic acid locally to patients undergoing off-pump coronary artery bypass, to investigate the hemostatic effects and safety.

Patients and methods: The subjects were 100 consecutive patients who underwent off-pump coronary artery bypass between July 2009 and January 2011. We assigned 50 patients in the early phase, in which tranexamic acid was not employed, to group N, and 50 in the late phase, in which tranexamic acid was employed, to group T. In group T, 10 mL of a solution containing 1 g of tranexamic acid in was sprayed into the pericardial cavity and mediastinum before the sternum was closed. We compared the volume of postoperative blood loss, blood transfusion volume, and complications between the 2 groups.

Results: The volume of blood loss in 24 h after intensive care unit admission was 492 mL in group N and 303 mL in group T ( p < 0.0001); the decrease in blood loss in the group receiving tranexamic acid was approximately 40%. There was no significant difference in the blood transfusion volumes. There were no side effects of tranexamic acid.

Conclusion: In patients undergoing off-pump coronary artery bypass, local administration of tranexamic acid may decrease the volume of postoperative blood loss. The local administration method is simple, inexpensive, and safe.
Six-year survival of a patient with pulmonary artery angiosarcoma
Authors: Chaubey Sanjay , Benson Charlotte , Khan Habib , Monaghan Mark , Shah Ajay M , Judson Ian , Wendler Olaf
Published: May 2013

Angiosarcomas of the pulmonary artery are rare and carry a very poor prognosis. We describe the case of a patient with pulmonary artery angiosarcoma who underwent radical resection followed by chemotherapy and was alive after 6 years of follow-up. Our case demonstrates that a multidisciplinary approach including cardiac diagnostics, radical surgery, and effective adjuvant chemoradiotherapy can improve outcome.
Saccular ascending aortic aneurysm arising within localized chronic dissection
Authors: Carter Jacob J , Peters Paul , Shah Pallav
Published: May 2013

An asymptomatic saccular ascending aortic aneurysm was diagnosed during workup for renal transplantation in a 39-year-old man. At operation, the aneurysm was noted to arise from within a localized and healed dissection, and was managed by ascending aortic replacement and sinotubular junction refashioning.
Primary pulmonary adenoid cystic carcinoma: report of two cases
Authors: Kurul Ismail C , Demiroz S Mustafa , Celik Ali , Tuluce Kerim , Aytekin Ilknur , Sayan Muhammet , Tastepe Abdullah Irfan
Published: May 2013

A 51-year-old man with adenoid cystic carcinoma in the main stem bronchus was treated by a left lower lobectomy. A 44-year-old man with adenoid cystic carcinoma in the peripheral small bronchi underwent a right sleeve upper lobectomy with tracheobronchoplasty and neo-carina reconstruction; because of positive tumor margins, radiotherapy was administered postoperatively. Both patients were alive without any signs of tumor after 30 and 24 months of follow-up, respectively.
Oxidative stress and liver monooxygenase function after heart valve surgery
Authors: Nepomniashchikh Valery A , Lomivorotov Vladimir V , Deryagin Michael N , Lomivorotov Vladimir N , Kniazkova Lyubov G , Fominskiy Evgeniy V , Novikov Maxim A
Published: May 2013

Background and objectives: this prospective study was carried out to evaluate oxidative stress and liver monooxygenase function after cardiac surgery in patients with acquired valvular heart disease.

Methods: 97 patients were studied. Oxidative stress was quantified with malondialdehyde, coupled trienes, hepatocuprein, and catalase activity. Liver monooxygenase function was evaluated with antipyrine pharmacokinetics. For statistical analyses, the Dunnett test and Pearson’s correlation coefficient were used.

Results: on the 1st–2nd postoperative days, high lipid peroxidation activation (malondialdehyde: 9.6 ± 2.7 vs. 6.9 ± 2.0 nmol·mL−1, p < 0.05) and a significant decrease in liver monooxygenase function (antipyrine clearance: 18.3 ± 11.1 vs. 39.0 ± 18.9 mL·kg−1·h−1, p < 0.05) were revealed. On the 3rd–4th and 11th–12th postoperative days, the intensity of oxidative stress decreased and monooxygenase function returned to baseline (antipyrine clearance: 45.6 ± 17.9 vs. 39.0 ± 18.9 mL·kg−1·h−1). The analysis showed a negative relationship between oxidative stress and liver monooxygenase function.

Conclusion: patients undergoing surgery for acquired valvular heart disease have considerable oxidative stress and a decrease in liver monooxygenase function on the 1st–2nd postoperative days. Activation of lipid peroxidation is one of the main reasons for suppression of microsomal monooxygenases activity. A slowdown of liver microsomal oxidation might change the pharmacokinetic response of patients under drug therapy.
Arch replacement using antegrade selective cerebral perfusion for shaggy aorta
Authors: Takagi Yasushi , Ando Motomi , Akita Kiyotoshi , Ishida Michiko , Kaneko Kan , Sato Masato
Published: May 2013

Background: Embolic stroke during arch replacement is a serious concern in patients with shaggy aorta.

Objective: To evaluate shaggy aorta in patients who received total aortic arch replacement with antegrade selective cerebral perfusion utilizing axillary perfusion.

Method: Between January 2005 and December 2010, 63 patients underwent preoperative contrast-enhanced computed tomography scanning of the aorta to evaluate atheromatous plaque. We analyzed operative data to investigate which factors were associated with outcomes and survival.

Results: Shaggy aorta was found in 34 (54%) patients. There were 3 (5%) cases in the ascending aorta, 26 (41%) in the aortic arch, and 19 (30%) in the descending aorta. Operative mortality occurred in 1 (2%) patient. Although stroke occurred in 2 (3%) shaggy aorta patients, shaggy aorta was not associated with an increased likelihood of stroke ( p = 0.4951). Survival was significantly lower in patients with shaggy descending aorta ( p = 0.0411) and in patients >75-years old ( p = 0.0200); these traits were identified as independent risk factors for late death ( p = 0.0368 and p = 0.0100, respectively).

Conclusion: We concluded that our perfusion technique protects patients with shaggy aorta against embolism, and that the survival is lower in patients with shaggy descending aorta.
Aorta-to-right ventricular outflow tract fistula with coronary cusp prolapse
Authors: Tiwari Kaushal K , Salvati Alessandro C , di Summa Michele , Barbieri Andrea , Portella Gina , Strada Gino
Published: May 2013

We describe a rare case of aorta-to-right ventricular fistula in a 20-year-old man who presented with signs and symptoms of congestive heart failure. He was successfully treated by closing the fistula with a Dacron patch from the aortic side. At follow-up, he was asymptomatic with no left-to-right shunt.
Central vein stenosis in an Asian hemodialysis population
Authors: Thwaites Stephen E , Robless Peter A
Published: May 2013

Objective and background: Central vein stenosis occurs commonly after instrumentation of the major thoracic veins. We aimed to investigate factors that contributed to this condition in an Asian hemodialysis population, and the results of intervention.

Patients and methods: Hemodialysis patients diagnosed with central vein stenosis between January 2003 and December 2008, were identified from the records of the National University Hospital, Singapore. Eligible controls had a minimum of 2 years of hemodialysis via an arteriovenous fistula and/or central venous catheter, without clinical or radiological evidence of central vein stenosis.

Results: Central vein stenosis was diagnosed in 108 patients. The most common presenting features were arm swelling (32%) and failed hemodialysis catheter insertion (28%). The median frequency of permanent hemodialysis catheter insertion in those who subsequently developed venous stenosis (1.44 per patient per year) was 4 times that of controls (0.36 per patient per year; p < 0.001). Ischemic heart disease ( p = 0.03) and in certain patients, arteriovenous fistula surgery were associated with the development of central vein stenosis; whereas line sepsis, diabetes, and hypertension were not. Central vein angioplasty was attempted in 53 patients; the primary patency was 52% at 1 year.

Conclusion: Central vein stenosis is associated with a higher frequency of hemodialysis catheter insertion and access surgery. Efforts to decrease permanent hemodialysis catheter use should reduce the incidence of central vein stenosis.
Nonobstructive mechanical prosthetic valve thrombosis with acute stroke
Authors: Panduranga Prashanth , Al-Delamie Taha , Al-Mukhaini Mohammed
Published: May 2013

Nonobstructive prosthetic valve thrombosis occurs more frequently during the early postoperative period due to increased thrombogenicity precipitated by inadequate anticoagulation. There is currently no consensus in the management of prosthetic valve thrombosis. We describe a patient with acute stroke secondary to nonobstructive prosthetic valve thrombosis that was due to inadequate anticoagulation. He was managed with intravenous anticoagulation with no resolution of the thrombus. Subsequently, he underwent successful surgical thrombectomy without valve replacement.
Anatomical characteristics of the thoracic aortic arch in an Asian population
Authors: Chiu Peixuan , Lee Heow Pueh , Venkatesh Sudhakar K , Ho Pei
Published: May 2013

Background: Endovascular repair of the aortic arch is often unsatisfactory due to poor stent-vessel conformity and inadequate landing zones.

Objective: To study the anatomical characteristics of the aortic arch and provide basic information for the development of arch-specific endovascular devices.

Materials and methods: Three-dimensional models were reconstructed in Mimics (image segmentation software) from computed tomography aortograms of 120 elderly Asian patients, by manual segmentation. The centerline of each Three-dimensional aortic model was calculated using a repulsive force field method. Measurements of the aorta and supra-aortic branches were analyzed using Patran (finite-element software). A three-dimensional statistical aortic arch model was built using principal component analysis.

Results: The mean diameters of the ascending and descending aorta, and the origins of the innominate, left common carotid, and left subclavian artery were 39.4 ± 6.7, 34.5 ± 7.9, 18.0 ± 3.8, 12.6 ± 2.7, and 14.1 ± 2.5 mm, respectively. The length of the ascending aorta, innominate to left common carotid artery, and left common carotid to left subclavian artery were 62.6 ± 11.4, 12.0 ± 5.6, and 18.7 ± 5.6 mm along the centerline. The mean angle of curvature was 103.8 ± 25 degrees. Principal component analysis of the three-dimensional centerlines derived 3 main modes of variation, which account for 61% of the overall shape range.

Conclusion: Aortic arch anatomical information from an elderly Asian population can be useful for the development of future endovascular devices.
Minimally invasive pectus excavatum repair: migration of bar and ossification
Authors: De Giacomo Tiziano , Diso Daniele , Francioni Federico , Anile Marco , Venuta Federico
Published: May 2013

Minimally invasive repair of pectus excavatum is an effective treatment option, with satisfactory results. Nevertheless, complications may occur during bar removal. We describe the case of a 16-year-old boy operated on for pectus excavatum with the Nuss procedure, who developed bar migration into the rib, with ossification, making its removal very difficult.
Chronic tension empyema
Authors: Sano Atsushi , Murakawa Tomohiro , Nakajima Jun
Published: May 2013

A 60-year-old man who had suffered from chronic left tuberculous empyema for 25 years, was diagnosed with chronic tension empyema based on enlargement of the empyema cavity. To prevent compression of the heart and left lung, we removed the empyema capsule. This procedure relieved the compression of the left lung, and the patient’s lung function improved.
Right-sided low grade myxofibrosarcoma of the heart in an adult
Authors: Gupta Pallav , Jain Manoj
Published: May 2013

Myxofibrosarcomas are rare cardiac neoplasms that usually involve the left atrium and present as unicentric or multicentric tumor masses. They can arise from both myocardial and valvular tissue, and can be locally aggressive or show distant metastasis. We describe an unusual case of myxofibrosarcoma involving both the right atrium and ventricle in a 30-year-old man, which was surgically resected. After 12 months of follow-up, there was no recurrence or metastasis.
Pericardial fluid and serum biomarkers equally predict ventricular dysfunction
Authors: Amjad Sofia , Sami Shahid A , Basir Muhammad Nageeb , Hameed Kamran , Fujita Masatoshi , Ahmad Hakeemuddin Razi
Published: May 2013

Background: serum level of amino-terminal pro-B-type natriuretic peptide, a cardiac hormone produced by the heart, is elevated in patients with left ventricular dysfunction. The purpose of this study was to compare the abilities of serum and pericardial fluid levels of amino-terminal pro-B-type natriuretic peptide to detect the left ventricular systolic dysfunction determined by echocardiography.

Methods: 50 patients undergoing coronary artery bypass grafting were included in this study. Left ventricular systolic function was assessed using echocardiography before coronary artery bypass grafting. The samples of serum and pericardial fluid were collected during surgery, and amino-terminal pro-B-type natriuretic peptide levels were assessed by an electrochemiluminescence immunoassay. The log value of amino-terminal pro-B-type natriuretic peptide concentrations was calculated.

Results: the pericardial fluid levels of log amino-terminal pro-B-type natriuretic peptide were significantly elevated compared to the serum levels in patients with impaired left ventricular systolic function. Both serum and pericardial fluid levels of log amino-terminal pro-B-type natriuretic peptide correlated significantly with left ventricular ejection fraction and end-diastolic and end-systolic volume indices. Furthermore, a paired comparison of receiver operating characteristic curves showed a similar performance of amino-terminal pro-B-type natriuretic peptide levels both in serum and pericardial fluid to discriminate left ventricular systolic dysfunction.

Conclusion: serum amino-terminal pro-B-type natriuretic peptide levels have comparable diagnostic value for left ventricular systolic dysfunction with its pericardial fluid levels in patients undergoing CABG.
Aspergillus pacemaker lead endocarditis
Authors: Pillai Jeewan , Mubeen Mohammad , Chaudhari Amit , Dalmia Basant
Published: May 2013

A 47-year-old man who had a pacemaker implanted 2 years earlier, recently developed a fever and had been on antibiotics for 2 months. He presented with pulmonary emboli, and underwent lead extraction and emboli removal. Histopathology demonstrated Aspergillus. Amphotericin B was continued postoperatively. This rare case of pacemaker lead endocarditis suggests that vigorous medical and surgical intervention can be curative.
Surgical outcome of congenital heart disease in Down’s syndrome
Authors: Lal Praveen S , Chavan Bhushan , Devendran Vimala Rani , Varghese Roy , Murmu Uday Charan , Kumar Raghavannair Suresh
Published: May 2013

Background and objective: only a few studies have compared surgical outcomes in children with and without Down’s syndrome. The purpose of this study was to investigate the surgical outcome in children with Down’s syndrome and congenital heart disease and to compare it with that in age- and sex-matched non-Down controls.

Patients and methods: the charts of 32 consecutive Down’s syndrome patients who underwent surgery for congenital heart disease in a single center from January 2006 to May 2010, were compared with the data of 32 age- and sex-matched non-Down controls, focusing on comparative echocardiographic details, surgical outcome, and intensive care unit data. The data were compared using the 2-group t test. The children were followed up for a median period of 48 months.

Results: the most common cardiac lesion in the study group was ventricular septal defect (41%) followed by atrioventricular septal defect (28%). Ventilation and intensive care unit stay were significantly longer in Down’s syndrome children, with a trend towards more respiratory complications. At a median follow-up of 48 months, there were no cardiac events or mortality in the study group. Simple lesions were more common than atrioventricular septal defect in Down’s syndrome.

Conclusion: children with Down’s syndrome can be operated on with negligible mortality and good functional outcome, but with a higher surgical morbidity.
Effect of landiolol hydrochloride after off-pump coronary artery bypass
Authors: Maisawa Kazuma , Yamazaki Kenji , Ishitoya Hiroshi , Shimamura Yoshiei
Published: May 2013

Objectives: many studies have shown that oral beta blockers reduce the incidence of atrial fibrillation after coronary artery bypass. The goal of this study was to determine whether landiolol, an intravenous beta blocker, reduces the incidence of atrial fibrillation after off-pump coronary artery bypass.

Methods: 39 consecutive patients were given landiolol after coronary artery bypass, and 20 who were not given landiolol served as a control group. Landiolol was intravenously administered at 1 µgċkg−1ċmin−1 in the intensive care unit.

Results: the mean dose of landiolol was 2.3 ± 1.2 1 µgċkg−1ċmin−1. The incidence of atrial fibrillation during intensive care unit stay was significantly lower in the landiolol group compared to the control group: 2.6% (1/39) vs. 20% (4/20). Heart rate after landiolol administration was significantly lower than that before administration, whereas landiolol had no effect on blood pressure. C-reactive protein and creatine kinase levels 7 days after surgery were significantly lower in the landiolol group.

Conclusion: continuous administration of landiolol at a low dose after off-pump coronary artery bypass reduced the incidence of atrial fibrillation.
Body mass index—predictor of outcome after coronary artery bypass grafting
Authors: Shahabuddin Syed , Perveen Shazia , Furnaz Shumaila , Fatimi Saulat , Sami Shahid , Sharif Hasanat
Published: May 2013

Objective: Increased body mass index has been associated with increased postoperative morbidity. We studied the effect of body mass index in our population, using a modified scale suggested by the World Health Organization.

Methods: From January 2006 to December 2008, 1019 patients undergoing first-time isolated elective coronary artery bypass grafting were selected from our cardiac surgery database. Data were analyzed by univariate and multivariate analyses.

Results: Of the 1019 elective coronary artery bypass patients, 168 (15.8%) had a normal body mass index (18.5–22.9 kg·m−2) and 894 (84.2%) had a high body mass index (≥23.0 kg·m−2). There were 921 (86.7%) patients with 3-vessel disease, and 1012 (95.3%) had internal mammary artery grafts. The 30-day mortality was 0.8%. Multivariate analysis revealed age, hospital stay, perfusion time, and renal failure were significantly associated with hospital complications. High body mass index was not significantly associated with morbidity or mortality. The model had an adequate fit at p = 0.708 by the Hosmer and Lemeshow test.

Conclusion: Increased body mass index alone is not a predictor of increased mortality and morbidity. In fact, these outcomes were associated with advanced age, hospital stay, perfusion time, and renal failure.
How to distinguish an active air leak from a pleural space effect
Authors: Marasco Rita Daniela , Giudice Gabriella , Lequaglie Cosimo
Published: May 2013

Aim: We aimed to distinguish a pleural space effect from an active air leak, using a digital chest drain system that provided continuous air flow and pleural pressure checks.

Methods: between March 2010 and October 2011, we employed 144 digital drains for 138 thoracic surgical procedures.

Results: We observed 18 (12.5%) active air leaks, among which 4 (2.8%) were prolonged air leaks characterized by high differential pleural pressure due to increased mean expiratory pressure (>1 cm H2O; p < 0.0001), and 3 (2.1%) late air leaks, all long-lasting ( p < 0.0001), predicted by pressure curve divergence before the air flow appearance. We also reported 25 (17.4%) pleural space effects characterized by a high differential pleural pressure, but mainly due to a lower mean inspiratory pressure (<20 cm H2O; p < 0.0001), and especially related to surgical pleurodesis procedures ( p < 0.0003) and wide lung resections ( p < 0.0002); there was no increasing pneumothorax after provocative clamping.

Conclusions: A digital chest drain system, ensuring continuous air flow and pleural pressure measurement, could clearly identify a pleural space effect, avoiding the frequent misinterpretation of an active air leak, and allowing safe removal of the chest tube at the right time.
Evaluation of plethysmography for diagnosis of postintubation tracheal stenosis
Authors: Jamaati Hamid Reza , Shadmehr Mohammad Behgam , Aloosh Oldouz , Radmand Golnar , Mohajerani Seyed Amir , Hashemian Seyed Mohammadreza
Published: May 2013

Objectives: Post-intubation tracheal stenosis is a serious disease caused by cuff pressure during tracheal intubation. The reported prevalence of post-intubation tracheal stenosis is 10%–22% in intubated patients. Invasive diagnostic methods based on fiberoptic or rigid bronchoscopy are suggested for initial assessment and treatment. This study aimed to evaluate plethysmography as an alternative diagnostic tool for post-intubation tracheal stenosis. We also assessed the relationship between plethysmography and bronchoscopy findings in patients with post-intubation tracheal stenosis.

Methods: The sample included 30 patients who were admitted to our intensive care unit or surgical ward during the course of a year, and diagnosed with post-intubation tracheal stenosis. All patients underwent plethysmography and rigid bronchoscopy. The relationship between the plethysmography and bronchoscopy findings was examined.

Results: Stricture intensity had the strongest correlation with upper airway resistance ( p = 0.001). The relationship of length of stricture to forced expiratory volume in 1 s and maximum expiratory flow 50 and 75 was significant in univariate analysis, and to reserve volume and total lung capacity in multivariate analysis.

Conclusion: Significant relationships were found between plethysmography variables and rigid bronchoscopy findings in patients with post-intubation tracheal stenosis, and some formulas were developed to give an alternative estimate of stricture severity, without bronchoscopy.