bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome of composite arterial Y-grafts in off-pump coronary artery bypass
Authors: Sugimura Yukiharu , Toyama Masaaki , Katoh Masanori , Kotani Mitsuhisa , Kato Yuji , Hisamoto Kazuhiro
Published: May 2013

The efficacy of using composite arterial Y-grafts in off-pump coronary artery bypass has not been established. We assessed graft patency, long-term clinical outcomes, and the indications for composite arterial Y-grafting by reviewing 53 patients who underwent primary isolated elective off-pump coronary artery bypass with composite arterial Y-grafts between January 2002 and December 2008. Coronary angiography or 64-slice multidetector computed tomographic coronary angiography was used to assess graft patency. Follow-up raged from 18 to 97 months. The rates of mortality, graft failure, and recurrence of ischemic heart disease were 0%, 22.6%, and 13.2%, respectively. Only 4 (7.5%) patients required additional procedures (percutaneous coronary interventions or repeat surgery) because of graft failure. A significantly higher rate of graft failure was evident when one end of the composite graft was anastomosed to a 75% stenosed branch of a native coronary artery and the other end to a branch with >90% stenosis. The long-term patency of composite arterial Y-grafts in off-pump coronary artery bypass requires proper judgment of the indications.
A modified approach: chordal transfer together with shortening
Authors: Cagli Kerim , Yalcinkaya Adnan , Lafci Gokhan , Ulas Mahmut Mustafa , Tasoglu Irfan
Published: May 2013

We describe a simple method to repair anterior mitral leaflets with elongated chordae, using chordal shortening and transfer techniques on the same segment. With this method, optimal elongated chordae shortening is determined easily, and shortened chordae are supported by the transferred chordae.
Mitral valve prosthesis implanted in atrial wall over huge calcified annulus
Authors: Gualis Javier , Castaño Mario , Gómez-Plana Jesús , Martin Carlos , Miguel Antonio de , Diego Alejandro de
Published: May 2013

We describe an alternative technique for mitral valve replacement in patients with severe mitral annular calcification, in whom conventional techniques are not feasible. A new annulus that allows supra-annular prosthetic implantation is created.
Late relapse of non-typhoidal salmonella vascular graft infection after 5 years
Authors: Oon Jolene , Ong Catherine WM , Robless Peter A , Fisher Dale A
Published: May 2013

Salmonella bacteremia can be complicated by mycotic aneurysm with the potential for a catastrophic presentation. Treatment involves prompt surgery with debridement, extraanatomic bypass, and prolonged antibiotic therapy. Any relapse tends to occur within the 1st year after surgery. We describe a case of Salmonella enteritidis mycotic aneurysm in a 56-year-old man 5 years after the initial presentation, emphasizing the importance of aggressive initial therapy and long-term surveillance.
Pseudocoarctation of the aorta complicated by thoracic aortic aneurysm
Authors: Kimura Keiichi , Ohtake Hiroshi , Kato Hiroki , Yashiki Noriyoshi , Tomita Shigeyuki , Watanabe Go
Published: May 2013

Pseudocoarctation is a rare anomaly involving kinking or buckling of the aorta without a pressure gradient across the lesion, considered to be a benign entity warranting no specific intervention. An uncommon case of pseudocoarctation associated with aortic aneurysm formation in 21-year-old woman is described. Pathological findings suggested that the etiology was anomalous development of the aorta in association with pseudocoarctation; therefore, careful follow-up of patients affected by pseudocoarctation is mandatory.
Totally endoscopic atrial septal repair using no robotic techniques
Authors: Xiangjun Zeng , Xufa Chen , Liang Tao
Published: May 2013

Standard surgical closure of an atrial septal defect via sternotomy is safe and effective. To avoid sternotomy and improve the cosmetic result, minimally invasive cardiac surgery has emerged as an alternative. Robot-assisted totally endoscopic atrial septal defect repair is convincingly superior, but the robotic system is expensive and complicated. We describe a technique of totally endoscopic closed-chest atrial septal defect closure without the aid of a robotic device. Twenty patients underwent totally endoscopic atrial septal defect repair using no robotic techniques between May 2009 and December 2009. No major intraoperative or postoperative complications were observed. One operation was converted to a conventional sternotomy because bleeding from the aortic root could not be controlled. Closure of an atrial septal defect can be performed safely and effectively via an endoscopic approach using no robotic techniques.
A tip for keeping the surgical sutures in order during bronchoplasty
Authors: Kamiyoshihara Mitsuhiro , Igai Hitoshi , Nagashima Toshiteru
Published: May 2013

We describe a device that we use to keep many surgical sutures in order during bronchoplasty. This device is torus-shaped with slits at regular intervals radially, which encircles the surgical field. We tuck the suture material into the slits in the suture runner. Traditionally, they are controlled by the use of many mosquito forceps. We believe that this device is useful, and that our method is simpler than the traditional method.
Total anomalous pulmonary venous connection beyond infancy
Authors: Reddy Kandakure Pramod , Nagarajan Ramodass , Rani Usha , Prasad Shiva , Chakravarthy Srinivas , Rao Ivatury M , Murthy Kona Samba
Published: May 2013

Most patients with total anomalous pulmonary venous connection are operated on in infancy, with low mortality and morbidity, but in developing countries, we still encounter patients beyond infancy. We describe our experience in 26 patients aged 1–16 years (mean, 5.01 years), with total anomalous pulmonary venous connection, who underwent correction between June 2007 and December 2009. Eleven patients were > 5-years old. Transthoracic echocardiography was diagnostic in all cases. Mean intensive care unit stay was 2.3 ± 0.87 days, and hospital stay was 9.23 ± 2.34 days. There were no early deaths and no major postoperative complications. Follow-up ranged from 10–40 months. Pulmonary artery pressure, as judged by echocardiography, reduced significantly in all patients. Repair of total anomalous pulmonary venous connection beyond infancy can be carried out safely with acceptable results.
Update on the mitral pulmonary autograft
Authors: Kabbani Sami S , Sabbagh Nada A , Kudsi Abir Y , Nabhani Fawzi , Jamil Hisham
Published: May 2013

Between July 1997 and August 2004, 92 patients with irreparable mitral valves underwent replacement with a pulmonary autograft. This report brings the follow-up data of these patients up to date. Eighty-eight patients had a successful Ross II operation; 4 were lost to follow-up. The mean follow-up period was 94 months. Transesophageal echocardiography revealed a successful outcome in all 88 patients immediately after the operation. Operative mortality was 4.6%, and late mortality definitely related to the operation was 12.5%. At a mean follow-up of 94 months, freedom from structural valve deterioration (significant mitral stenosis and/or regurgitation) was 93.4%, freedom from reoperation was 92.0%, and freedom from all causes of death was 82.9%. Two autografts were explanted because of endocarditis. Two patients developed significant pulmonary stenosis, one of whom underwent operative repair. These data compare favorably with those of mitral valve replacement using modern bioprostheses. This procedure remains an option for the relatively young patient when life-long anticoagulation is contraindicated or impractical. It is also an option to consider in infants with complex irreparable mitral valve disease.
Streptokinase for malignant pleural effusions: a randomized controlled study
Authors: Okur Erdal , Baysungur Volkan , Tezel Cagatay , Ergene Gokhan , Okur Hacer Kuzu , Halezeroglu Semih
Published: May 2013

Effective palliative treatment in malignant pleural effusion can only be carried out when the lung is fully expanded after drainage of effusion. We investigated the efficacy of intrapleural fibrinolytics for lysing fibrin deposits and improving lung reexpansion in patients with malignant pleural effusion. We randomly allocated 47 patients with malignant pleural effusion into 2 groups: a fibrinolytic group of 24 were given 3 cycles of 250,000 U intrapleural streptokinase; the control group of 23 received pleural drainage only. Pleurodesis with 5 mg of talc slurry was performed in all patients who had lung reexpansion after drainage. Patient characteristics, pleural drainage, lung expansion assessed by chest radiography, and pleurodesis outcomes were compared between the 2 groups. Patient characteristics were similar in both groups. Lung reexpansion was adequate for performing talc pleurodesis in 96% of patients in the fibrinolytic group and 74% in the control group. In the fibrinolytic group, the mean volume of daily pleural drainage before streptokinase administration was 425 mL, and it increased significantly to 737 mL after streptokinase infusion. Intrapleural administration of streptokinase is advisable for patients with malignant pleural effusion.
Nanofiber-reinforced biological conduit in cardiac surgery: preliminary report
Authors: Guhathakurta Soma , Galla Satish , Ramesh Balasundari , Venugopal Jayarama Reddy , Ramakrishna Seeram , Cherian Kotturathu Mammen
Published: May 2013

Several options are available for right ventricular outflow tract reconstruction, including commercially available bovine jugular vein and cryo-preserved homografts. Homograft non-availability and the problems of commercially available conduits led us to develop indigenously processed bovine jugular vein conduits with competent valves. They were made completely acellular and strengthened by non-conventional cross-linking without disturbing the extracellular matrix, which improved the luminal surface characteristics for hemocompatibility. Biocompatibility in vitro and in vivo, along with thermal stability, matrix stability, and mechanical strength have been evaluated. Sixty-nine patients received these conduits for right ventricular outflow tract reconstruction. Seven conduits dilated and 4 required replacement. To counteract dilatation, biodegradable polymeric nanofibers in various combinations and in isolation (collagen, polycaprolactone, polylactic acid) were characterized and used to reinforce the conduit circumferentially. Physical validation by mechanical testing, scanning electron microscopy, and in-vitro cytotoxicity was conducted. Thermal stability, spectroscopy studies of the polymer, and preclinical studies of the coated bovine jugular vein in animals are in progress. The feasibility studies have been completed, and the final polymer selection depends on evaluation of the functional superiority of the coated bovine jugular vein.
An unusual case of left chest stab wound
Authors: Zebele Carlo , Gianoli Monica , Elenbaas Ted , Brink Peter RG , Van Zundert André AJ
Published: May 2013

A 72-year-old man was admitted with one blade of a huge pair of shears in his left thorax. His hemodynamics deteriorated due to life-threatening vascular lesions. An urgent thoracotomy revealed several injuries to the intercostal vessels and left apical inferior lung lobe. The blade tip was stuck in the posterior chest wall, 2 cm adjacent to the descending aorta. The blade was removed, the lung was sutured, and the patient made a good recovery.
Aortoesophageal fistula after thoracic stent grafting
Authors: Albors José , Ángel Bahamonde José , Manuel Sanchis Juan , Boix Ricardo , Palmero Julio
Published: May 2013

Aortoesophageal fistula after thoracic stent grafting is rare and usually fatal. A 66-year-old woman developed an aortoesophageal fistula 1 month after endovascular stent grafting of the thoracic aorta for a complicated type B dissection. She had a fatal episode of massive bleeding before she could be treated. The limited treatment options are discussed.
Association between body mass index and outcome of coronary artery bypass
Authors: Harvey Ryan , Haluska Brian , Mundy Julie , Wood Annabel , Griffin Rayleene , Shah Pallav
Published: May 2013

Studies have shown disparate findings regarding body mass index and outcomes after coronary artery bypass. We analyzed body mass index and other clinical variables that might predict morbidity and mortality after primary isolated coronary artery bypass. Data on 4,425 patients (79% men) were reviewed retrospectively. They were classified as underweight (1.6%), normal weight (65%), obese (32%), and morbidly obese (1.4%) according to body mass index < 20, 20–29, 30–39, and > 40 kgċm−2, respectively. Multiple logistic regression was used for correlates of 30-day outcome. Cox regression was used for predictors of late outcome in underweight and morbidly obese patients. There were 45 (1%) deaths and 234 (5%) cases of morbidity within 30 days. Independent correlates of 30-day morbidity were smoking, logistic EuroSCORE, blood and blood product transfusions. Correlates of 30-day mortality were logistic EuroSCORE and blood transfusion. The only independent predictor of late death in underweight and morbidly obese patients was preoperative arrhythmia. Body mass index was not a predictor of 30-day morbidity or mortality. The 1-, 3-, and 7-year survival rates were not significantly different between underweight and morbidly obese patients. Body mass index did not affect short-term outcomes after primary coronary artery bypass grafting.
Coronary pseudoaneurysm in a non-polymer drug-eluting stent: a rare entity
Authors: Kapoor Aditya , Batra Aditya , Kumar Sudeep , Pandey Shantanu , Agarwal SK , Sinha Nakul
Published: May 2013

Coronary pseudoaneurysms following implantation of drug-eluting stents, although rare, are not unknown. Nearly all such cases have been reported in patients with sirolimus or paclitaxel polymer-based stents. We describe a case of coronary pseudoaneurysm developing with a non-polymer-based drug-eluting stent in a 50-year-old man who was successfully managed by coronary artery bypass grafting.
Ruptured sinus of Valsalva aneurysm: 10-year Indian surgical experience
Authors: Menon Sabarinath , Kottayil Brijesh , Panicker Varghese , Pillai Vivek , Karunakaran Jaykumar
Published: May 2013

Sinus of Valsalva aneurysm is a rare anomaly with a higher incidence in Eastern than Western populations. Recent improvements in diagnostic techniques have resulted in more patients undergoing surgical repair. Uncorrected, the intracardiac shunts and frequently associated cardiac lesions cause a preventable deterioration in heart function. We retrospectively analyzed the data of 33 patients who underwent repair of ruptured sinus of Valsalva aneurysm from May 2000 to January 2010. The aneurysms originated from the right coronary sinus in 24 patients and from the noncoronary sinus in 9, and ruptured into the right ventricle in 21, right atrium in 10, and left ventricle in 2. Operative procedures included simple plication (1), patch repair (32), and aortic valve replacement (10). There were 3 early deaths. The 30 survivors were followed up for 5.4 ± 2.6 years; all had an improvement in functional class, with superior results in those with no aortic regurgitation. Surgical treatment of ruptured sinus of Valsalva aneurysm has an acceptably low operative risk and good long-term symptom-freedom survival. An early aggressive approach is recommended to prevent worsening symptoms and more extensive disease.
Ruptured aneurysm of coronary artery-to-pulmonary artery fistula
Authors: Kazuno Kei , Akasaka Nobuyuki , Kiyokawa Keiko , Sasajima Tadahiro
Published: May 2013

A 69-year-old lady was discovered unconscious. Computed tomography showed pericardial effusion and a coronary artery aneurysm of 25 mm in diameter in front of the main pulmonary artery. Emergency surgery revealed a coronary-pulmonary artery fistula and coronary aneurysm surrounded by a large hematoma. The inflow and outflow of the fistula were closed, and no cardioplegic leakage was noted. Postoperative angiography showed residual fistulas that were successfully closed by transcatheter embolization.
Ruptured saphenous vein graft aneurysm after aortocoronary bypass grafting
Authors: Satsu Takuma , Onoe Masahiko , Miyashita Naoya
Published: May 2013

Computed tomography demonstrated a giant saphenous vein graft aneurysm that compressed the right atrium of a 72-year-old woman 20 years after undergoing coronary artery bypass grafting. Angiography revealed contrast medium leakage in the mid-portion of the graft aneurysm. Aneurysmectomy was performed without repeat grafting. Postoperative myocardial scintigraphy demonstrated no significant myocardial ischemia. The ischemic effect of non-revascularization should be considered preoperatively because of the difficulties with repeat grafting.
Adenocarcinoma in pulmonary sequestration
Authors: Lawal Lukman , Mikroulis Dimitrios , Eleftheriadis Savvas , Karros Panagiotis , Bougioukas Ioannis , Bougioukas Georgios
Published: May 2013

A 67-year-old male smoker presented with hemoptysis and recurrent pneumonia. Chest computed tomography showed an emphysematous cyst and air-fluid level cavities in the left lower lobe. A left lower lobectomy was performed. The intraoperative finding was intralobar sequestration. Histopathology revealed adenocarcinoma within the sequestrated lobe. Only 8 cases of lung cancer and sequestration have been reported since 1963.
Aneurysm of sinus of Valsalva: uncommon presentation
Authors: Elumalai Raja Saravanan , Vaidyanathan Kirthivasan , Nainar Madhu Sankar , Balasubramaniam Govini , George Susan
Published: May 2013

A 28-year-old man presented with acute onset of chest pain. Transthoracic echocardiography confirmed an aneurysm of the sinus of Valsalva dissecting into the interventricular septum. During the next 12 h, the aneurysm enlarged to involve the entire interventricular septum, and the patient developed features of cardiac tamponade. He underwent successful surgical repair.
A case of aortoesophageal fistula
Authors: Bakhshandeh Ali Reza , Salehi Mehrdad , Radmehr Hasan , Riahi Gholam Reza
Published: May 2013

Aneurysms of the thoracic aorta can have various manifestations, some of which may simulate esophageal diseases, clinically and radiographically. Aortoesophageal fistula is rare and usually fatal. We report a case of aortoesophageal fistula presenting with progressive dysphagia and intermittent episodes of upper gastrointestinal bleeding.
Ruptured pulmonary artery aneurysm: a surgical emergency
Authors: Puri Deepak , Kaur Harinder Pal , Brar Rahat , Singh Kiran Pal , Sahoo Manoranjan , Mahant Tek Singh
Published: May 2013

Idiopathic pulmonary artery aneurysm rupture was diagnosed in a 79-year-old man who presented with a dry cough. He was considered unlikely to tolerate extensive pulmonary artery reconstruction or lung resection; hence, he was salvaged by timely ligation of the distal pulmonary artery at the origin of the aneurysm.
Simple and quick repair of cardiac rupture due to blunt chest trauma
Authors: Doi Atsuo , Lee Chuen Neng , Leng Sophia Ang Bee , Sorokin Vitaly
Published: May 2013

Atrial rupture following blunt chest trauma carries a high mortality rate. It can be difficult to maintain hemodynamic stability and control massive bleeding due to poor visualization. We describe a case in which bleeding control was obtained simply and effectively using a Satinsky clamp, allowing repair of atrial rupture without the use of cardiopulmonary bypass.
Relapsing infective endocarditis following closure of ventricular septal defect
Authors: Sai Sadahiro , Adachi Osamu , Saiki Yoshikatsu , Konishi Akinobu , Tabayashi Koichi
Published: May 2013

An 8-year-old boy who had undergone Dacron patch closure of a ventricular septal defect 5 years earlier, was admitted with relapsing methicillin-resistant Staphylococcus aureus infective endocarditis and lung abscesses. Echocardiography indicated vegetation attached to the tricuspid valve and the Dacron patch. The infected patch was replaced with glutaraldehyde-treated autologous pericardium. He was discharged uneventfully and has been well for 4 years, without signs of infection.
Right atrial thrombus migrating to the superior vena cava during surgery
Authors: van de Gevel Dennis FD , Soliman Hamad Mohamed A , Schönberger Jacques , van Dantzig Jan-Melle , van Straten Albert HM
Published: May 2013

Free-floating right heart thrombi are extremely mobile structures that carry a very high mortality rate. We describe a case of pulmonary embolism with a free-floating right heart thrombus that migrated to the superior vena cava during the institution of cardiopulmonary bypass.
Coronary surgery in a hemophiliac with continuous factor VIII replacement
Authors: Kypson Alan P , Rodriguez Evelio , Anderson Curtis A
Published: May 2013

In the past, hemophiliacs rarely underwent cardiac surgery because of limited lifespan. As blood transfusions have become safer, hemophiliacs are living longer and becoming more susceptible to diseases that afflict the elderly, such as coronary atherosclerosis. We describe the hematologic management of a patient with hemophilia A who underwent coronary artery bypass surgery.
Aortic root replacement for Valsalva sinus aneurysm with lupus erythematosus
Authors: Hirose Tomoaki , Kameda Yoichi , Yoshikawa Yoshiro , Abe Takehisa , Hayata Yoshihiro , Taniguchi Shigeki
Published: May 2013

A 76-year-old man with systemic lupus erythematosus was found to have an aneurysm of the right sinus of Valsalva. Aortic root replacement with a stentless bioprosthesis, using a full root technique, was successfully performed. The pathological findings of the excised aortic valve were not secondary to atherosclerosis, inflammatory or infectious disease, but seemed to be compatible with those previously reported in a case of systemic lupus erythematosus.
Cardiophrenic angle lymph node metastasis from a fallopian primary tumor
Authors: Eguchi Takashi , Takasuna Keiichiro , Nakayama Ataru , Ueda Noritane , Yoshida Kazuo , Fujiwara Masayuki
Published: May 2013

Isolated cardiophrenic angle node metastases are relatively rare, as are primary fallopian tube carcinomas. We describe a case of a cardiophrenic angle node metastasis from such a tumor, with no peritoneal involvement. A 52-year-old woman, who had been previously diagnosed with fallopian tube carcinoma, was referred with a right cardiophrenic angle mass. A thoracoscopic resection was performed. The pathological diagnosis was lymph node metastasis from the primary lesion.
Giant pseudoaneurysm of the aortic arch and successful surgical repair
Authors: Fatimi Saulat H , Abbas Salma , Hanif Hashim M , Muzaffar Marium
Published: May 2013

A 50-year-old woman presented with fever, cough, shortness of breath, and left-sided chest pain. Computed tomography with contrast showed a pseudoaneurysm occupying the upper half of the left hemithorax. Surgical repair with a Dacron patch was performed after considering the risk of pseudoaneurysmal rupture.
Thoracoscopy-assisted removal of left ventricular thrombus via minithoracotomy
Authors: Kuroki Keiichiro , Murakami Takashi
Published: May 2013

A left ventricular thrombus was successfully removed after broad anterior myocardial infarction in a 58-year-old woman, using video-assisted thoracoscopy via minimally invasive port access. Through a right minithoracotomy, a left ventricular thrombus behind the papillary muscles and trabeculation were completely visualized with the aid of thoracoscopy, and removed without difficulty. This approach seems to be a useful alternative to a left ventriculotomy, avoiding the resultant compromised left ventricular function.
NT-pro-brain natriuretic peptide levels after valve replacement
Authors: Elasfar Abdelfatah A
Published: May 2013

Elevated plasma N-terminal pro-brain natriuretic peptide levels have been demonstrated in patients with chronic valvular disease. To assess whether changes in N-terminal pro-brain natriuretic peptide levels after mitral, aortic, and double-valve replacement reflect changes in heart failure symptoms, a prospective observational nonrandomized study was undertaken in 24 consecutive patients (mean age, 55.3 ± 16.2 years; 58% male) undergoing mitral and/or aortic valve replacement. Mitral valve replacement was carried out in 12 patients, aortic valve replacement in 8, and combined mitral and aortic valve replacement in 4. N-terminal pro-brain natriuretic peptide measurements, echocardiography, and functional class assessment were performed before and 6 months after surgery. A decrease in N-terminal pro-brain natriuretic peptide at 6 months postoperatively was significantly associated with decreased left atrial dimension, left ventricular end-diastolic and end-systolic dimensions, increased ejection fraction, and improvement in functional class. Thus we can hypothesize that measurement of N-terminal pro-brain natriuretic peptide might allow early detection of any clinical deterioration as well as assessment of the long-term outcome in valve replacement patients.
Video-assisted thoracoscopic patent ductus arteriosus closure in 2,000 patients
Authors: Nezafati Mohammad Hassan , Soltani Ghasem , Mottaghi Hassan , Horri Mohsen , Nezafati Pouya
Published: May 2013

Video-assisted thoracoscopic surgery has proved to be a safe and effective method with low complication and high success rates. From 1997 to 2008, 2,000 consecutive patients with patent ductus arteriosus underwent closure of the ductus with 2 titanium clips via a video-assisted thoracoscopic technique. Complete closure was confirmed using our handmade intraesophageal stethoscope. The mean age was 5.2 years, and mean weight was 9.8 kg. One death was reported 1 month after surgery, due to sepsis during hospitalization for chylothorax treatment. The procedure was converted to an emergency thoracotomy in one case, due to ductal wall rupture. There were 4 late residual shunts treated via thoracotomy. We observed transient laryngeal nerve dysfunction in 14 patients. All patients were reassessed by postoperative echocardiography. The mean procedure (skin-to-skin) time was 10 ± 2 min, and hospitalization was 21 h. This study indicates that video-assisted thoracoscopic closure of patent ductus arteriosus is a safe, simple, and cost-effective method with low complication and high success rates. Furthermore, the cosmetic benefits make it appropriate as an out-patient procedure.
Timing of surgical closure of patent ductus arteriosus in preterm neonates?
Authors: Tantraworasin Apichat , Woragidpoonpol Surin , Chuaratanapong Supachai , Sittiwangkul Rekwan , Chittawatanarat Kaweesak
Published: May 2013

A retrospective cohort study was conducted on 115 preterm neonates who underwent patent ductus arteriosus ligation after failure of medical treatment, at Chiang Mai University Hospital between January 2003 and December 2010. Two groups were defined: an early surgery group (39.1%) treated with surgical closure within 21 days, and a late surgery group (60.9%) operated on >21 days after birth. There were significant differences between the 2 groups in terms of weight at surgery, birth weight, duration of intubation, ductal size, and preoperative indomethacin usage. The early surgery group had a longer intensive care unit stay, but differences in postoperative chronic lung disease, ductal size, and surfactant use were not significant. Babies with a low birth weight (<1,500 g) and those with a higher ductal gradient were more susceptible to chronic lung disease, but multivariate analysis showed no difference between early and late surgery patients in either early extubation or chronic lung disease. It was concluded that early patent ductus arteriosus ligation did not show more benefits than late surgery.
Recombinant activated factor VII for hemorrhage after pediatric cardiac surgery
Authors: Singh Sarvesh Pal , Chauhan Sandeep , Choudhary Minati , Vasdev Sumit , Talwar Sachin
Published: May 2013

Postoperative bleeding is a common complication after pediatric cardiac surgery. Use of recombinant activated factor VII for intractable hemorrhage after cardiac, pediatric, and neurosurgery has been shown to decrease postoperative bleeding, but data in children are limited. This retrospective study analyzed 20 children <15 years-old who underwent cardiac surgery and received recombinant activated factor VII for refractory postoperative hemorrhage. All patients underwent mediastinal reexploration before recombinant activated factor VII was administered as a bolus dose over 2–3 min as rescue therapy. If no significant decrease in chest tube drainage was observed, the dose was repeated after an interval of at least 2 h. The median dose of recombinant activated factor VII administered per bleeding episode was 83.33 µg·kg−1 (range, 72.47–87.50 µg·kg−1), and the dose per patient was 154.16 µg·kg−1 (range, 93.06–180.52 µg·kg−1). The median number of doses found to be effective in these children was 1.76. There were significant decreases in mediastinal chest tube drainage and the volume of packed red blood cells, platelet concentrates, and cryoprecipitate administered after recombinant activated factor VII. No complications were observed during the therapy.
Transposition with intact septum diagnosed at nine months: arterial switch?
Authors: d’Udekem Yves , Cheung Michael , Butt Warwick , Shann Frank , Brizard Christian P
Published: May 2013

A 9-month-old infant presented with transposition of the great arteries and intact ventricular septum. His left ventricle was thin and deconditioned. He underwent an arterial switch operation and was electively supported with a left ventricular assist device for 8 days. He subsequently made a full recovery. Elective use of left ventricular support allows an extension of the age limit for the arterial switch operation.
Extended indications for robotic surgery for posterior mediastinal tumors
Authors: Kajiwara Naohiro , Kakihana Masatoshi , Usuda Jitsuo , Ohira Tatsuo , Kawate Norihiko , Ikeda Norihiko
Published: May 2013

Previously, we evaluated use of the da Vinci Surgical System for anterior and middle mediastinal tumors in clinical cases, focusing on feasibility, safety, and appropriate settings. In this study, we evaluated extending the indications for robotic surgical treatment of posterior mediastinal tumors to include those located adjacent to the upper vertebrae or aorta. Three patients with mediastinal tumors located immediately adjacent to the vertebrae or aorta, underwent resection with the da Vinci Surgical System. All resected tumors were benign histologically. Robotic surgery enabled treatment of tumors located in the posterior mediastinum, which are very difficult to reach, making resection with the conventional video-assisted thoracoscopic surgery technique extremely difficult. All procedures were performed safely, smoothly, and extremely precisely. Crucial to the success of these operations were the appropriate placement and angle of the special da Vinci surgical ports in relation to the target and the patient’s position, which varied according to the tumor location.
Assessment of the standard pediatric unfractionated heparin dosing protocol
Authors: Al Obary Eman E , Al-Jazairi Abdulrazaq S , Zaghloul Iman M , Saleh Mahasen M , Al Musa Abdulrahman S , Al-Halees Zohair
Published: May 2013

Current dosing guidelines for unfractionated heparin therapy in pediatric patients are based on recommendations of only one study that evaluated a weight-based dosing nomogram. To test the hypothesis that adhering to a strict weight-based nomogram yields better therapeutic results in pediatric patients, we prospectively monitored 25 consecutive pediatric patients who received unfractionated heparin based on the nomogram, and compared them to control patients whose treatment did not follow the standard nomogram. The mean time needed to achieve the target activated partial thromboplastin time was significantly shorter in the study group than the control group (18.32 ± 9.98 vs. 43.8 ± 30 h). A higher proportion of the study group reached the target activated partial thromboplastin time at 12, 24, and 36 h, compared to controls: 44% vs. 6%, 72% vs. 28%, 100% vs. 58%, respectively. Within the study group, patients under 1 year of age needed more time to achieve the target activated partial thromboplastin time than those over 1-year old. The performance of the standard dosing nomogram was excellent with regard to early anticoagulation target achievement, without increasing the risk of bleeding. Further studies are warranted to refine this nomogram for pediatric patients who are less than 1-year old.
Beating heart as an alternative for closure of secundum atrial septal defect
Authors: Thapmongkol Siraphop , Sayasathid Jarun , Methrujpanont Jessada , Namchaisiri Jule
Published: May 2013

We repaired secundum atrial septal defect in 135 consecutive patients from February 2003 to December 2010. There were 98 females and 37 males, with a mean age of 22.92 ±17.46 years (range, 3–55 years). To prevent myocardial dysfunction and systemic embolism caused by the conventional technique, the operation was performed with a beating heart under cardiopulmonary bypass in 63 cases, and compared the data retrospectively with cases treated under aortic crossclamping, to determine the safety of the beating-heart technique and to evaluate risk factors for embolism in stroke patients. Patient age and size of defect were similar in both groups. There was no death and no residual shunt in either group. The mean cardiopulmonary bypass time was 36.84 ± 9.8 min in the beating-heart group and 43.13 ± 16.7 min in the crossclamp group. The ejection fraction and the incidence of postoperative arrhythmia were similar in both groups. There were no differences in blood products transfused, intensive care unit stay, hospital stay, or perioperative morbidity. In our experience, the results of the beating-heart technique were not different from the conventional technique.
Adhesion barrier reduces postoperative adhesions after cardiac surgery
Authors: Kaneko Yukihiro , Hirata Yasutaka , Achiwa Ikuya , Morishita Hiroyuki , Soto Hajime , Kobayahsi Jotaro
Published: May 2013

Reoperation in cardiac surgery is associated with increased risk due to surgical adhesions. Application of a bioresorbable material could theoretically reduce adhesions and allow later development of a free dissection plane for cardiac reoperation. Twenty-one patients in whom a bioresorbable hyaluronic acid-carboxymethylcellulose adhesion barrier had been applied in a preceding surgery underwent reoperations, while 23 patients underwent reoperations during the same period without a prior adhesion barrier. Blinded observers graded the tenacity of the adhesions from surgical video recordings of the reoperations. No excessive bleeding requiring wound reexploration, mediastinal infection, or other complication attributable to the adhesion barrier occurred. Multiple regression analysis showed that shorter duration of the preceding surgery, non-use of cardiopulmonary bypass in the preceding surgery, and use of the adhesion barrier were significantly associated with less tenacious surgical adhesions. The use of a bioresorbable material in cardiac surgery reduced postoperative adhesions, facilitated reoperation, and did not promote complications. The use of adhesion barrier is recommended in planned staged procedures and those in which future reoperation is likely.
Nutritional status of patients undergoing chemoradiotherapy for lung cancer
Authors: Shintani Yasushi , Ikeda Naoki , Matsumoto Tomoshige , Kadota Yoshihisa , Okumura Meinoshin , Ohno Yuko , Ohta Mitsunori
Published: May 2013

Impaired nutrition is an important predictor of perioperative complications in lung cancer patients, and preoperative chemoradiotherapy increases the risk of such complications. The goal of this study was to assess the effect of an immune-enhancing diet on nutritional status in patients undergoing lung resection after chemoradiotherapy. We compared the preoperative nutritional status in 15 patients with lung cancer undergoing lung resection without chemoradiotherapy and 15 who had chemoradiotherapy. Body mass index and lymphocyte counts were lower in patients who had chemoradiotherapy. Although there was no difference in the rate of postoperative morbidity between groups, the chemoradiotherapy patients were more likely to have severe complications postoperatively. After chemoradiotherapy in 12 patients, 6 received oral Impact for 5 days, and 6 had a conventional diet before surgery. Oral intake of Impact for 5 days before surgery modified the decrease in transferrin and lymphocytes after the operation. Preoperative immunonutrition may improve the perioperative nutritional status after induction chemoradiotherapy in patients undergoing lung cancer surgery, and reduce the severity of postoperative complications. These potential benefits need to be confirmed in a randomized controlled trial.
Analysis of open heart surgery in patients with liver cirrhosis
Authors: Sugimura Yukiharu , Toyama Masaaki , Katoh Masanori , Kato Yuji , Hisamoto Kazuhiro
Published: May 2013

Open heart surgery in patients with liver cirrhosis is considered to be very risky, but the predictors of poor outcomes in such cases have not been established. We report the perioperative results of open heart surgery in patients with liver cirrhosis in our hospital. We reviewed the results of 13 cases in 12 patients with liver cirrhosis who underwent open heart surgery between January 2001 and December 2010. The Child-Turcotte-Pugh classification, the model for end-stage liver disease score, EuroSCORE, and perioperative data were used to identify risk factors for morbidity and mortality retrospectively. Ten patients had postoperative complications. Significant differences in morbidity were evident for Child-Turcotte-Pugh class, cardiopulmonary bypass time, and crossclamp time. Two patients died of liver failure, one at 40 days and the other at 2 years after surgery. Statistically significant differences in liver-related mortality were evident in the model for end-stage liver disease scores and serum cholinesterase levels. We concluded that a high Child-Turcotte-Pugh class was associated with increased morbidity. Cardiopulmonary bypass and crossclamp times were also related to high morbidity, while high model for end-stage liver disease scores and low serum cholinesterase levels predicted liver-related mortality.
Repair of total anomalous pulmonary venous return to the coronary sinus
Authors: Garg Pankaj , Talwar Sachin , Rajashekar Palleti , Saxena Anita , Airan Balram
Published: May 2013

An alternative technique for channeling the pulmonary venous return towards the left atrium in patients with total anomalous pulmonary venous return to the coronary sinus is described. The advantages of this technique, which avoids the use of patch material and prevents arrhythmias, are discussed.
Mitral approach in prosthetic endocarditis with calcified annulus and abscess
Authors: Carrascal Yolanda , Valenzuela Horacio , Fernández Mireia , Arce Nuria
Published: May 2013

Abscess resection and prosthesis reimplantation is the only effective treatment for mitral prosthesis endocarditis with extensive annular abscess, but it has high morbidity and mortality when associated with severe mitral annular calcification in the atrial and ventricular walls. We describe a technique that allows repair of the abscess cavity, reconstruction of the annulus, and implantation of a new mitral prosthesis when there is severe adjacent myocardial calcification, so decreasing the reoperation risk.
Successful repair of bicuspid aortic valve with two raphae
Authors: Yamasaki Manabu , Watanabe Sunao , Abe Kohei , Kawazoe Kohei
Published: May 2013

We describe the case of a 17-year-old boy with bicuspid aortic valve with two raphae, for whom subvalvular circular annuloplasty and adjustable cusp suspension procedures successfully terminated severe regurgitation.
Mesenteric artery fenestration for type B dissection with visceral ischemia
Authors: Saitoh Yuhei , Ohmori Hiroshi , Hari Yoko , Setozaki Shuji , Harada Hisao , Soeda Takeshi
Published: May 2013

We describe a successful case of direct superior mesenteric artery fenestration for an acute type B dissection complicated by bowel necrosis in a 68-year-old man. At 11 days after the onset, computed tomography showed superior mesenteric artery obstruction. We fenestrated and connected the true lumen to the false lumen of the superior mesenteric artery, and performed thrombectomy in both lumens. A bowel resection was carried out immediately. The patient was discharged uneventfully after recovery.
Doehle-Heller aortitis: speed of decision is what saves life
Authors: Ayapati Dharma R , Patnaik Amar N , Barik Ramachandra , Kumari N Rama , Gulati Amarpal S
Published: May 2013

A 48-year-old woman presented with severe acute heart failure of 7 days duration. Because of her rapidly worsening clinical condition, anatomical diagnosis of aortopulmonary fistula was made by urgent cardiac catheterization, and she successfully underwent immediate surgical closure. Retrospectively, the diagnosis of syphilitic aortitis complicated with aortopulmonary fistula was made by clinical profile, serology, and histopathology.
Biatrial myxomas with Carney complex
Authors: Yamada Yukiko , Sasaki Hideki , Tominaga Takashi , Ishitoya Hiroshi
Published: May 2013

A 30-year-old man presented with chest pain and was diagnosed with biatrial myxomas and pulmonary embolism. He underwent resection of the biatrial myxomas and tumor embolectomy from the pulmonary artery. The histological diagnosis was multiple cardiac myxomas. Further examination showed that this patient also had spotty pigmentations, cutaneous myxomas, and acromegaly. He was diagnosed with Carney complex.
Treatment outcomes for ischemic heart disease in dialysis-dependent patients
Authors: Yeates Alexander , Hawley Carmel , Mundy Julie , Pinto Nigel , Haluska Brian , Shah Pallav
Published: May 2013

Objective: To compare outcomes following intervention in dialysis-dependent patients with ischemic heart disease.

Background: Ischemic heart disease is a major cause of mortality in dialysis-dependent patients. Coronary revascularization and medical modification to relieve symptoms is common, however, there is no clear consensus regarding optimal treatment.

Method: Ninety dialysis-dependent patients with ischemic heart disease were prospectively assessed between 1999 and 2009, with a median follow-up of 24 months; 35 received best medical management, 31 had percutaneous coronary angioplasty and stenting, and 24 had coronary artery bypass grafting.

Results: By multivariate analysis, higher body mass index and lower logistic EuroSCORE were associated with having either procedure compared to medical management. Using the time-to-event Kaplan-Meier method, both stenting and coronary bypass grafting had lower risks of an adverse outcome than best medical management. Mortality was 40/90 (44.4%). Multivariate predictors of mortality were smoking and a logistic EuroSCORE of 7–14. Overall mortality was not different among groups, however, the stent group had a survival advantage at 30-days and 1-year compared to the coronary bypass group. Composite median survival was 52.3 months. SF-36 questionnaires showed quality of life after bypass grafting was significantly better than medical management or stenting. Physical function was better after bypass grafting compared to medical management or stenting.

Conclusion: Dialysis-dependent patients with ischemic heart disease have poor survival despite intervention. Coronary artery bypass achieves fewer composite adverse events and better quality of life than stenting. Symptoms and coronary anatomy should dictate treatment decisions in dialysis-dependent patients.
Modified Lecompte procedure for repair of double-outlet left ventricle
Authors: Truong Nguyen Ly Thinh , Tiep Dang Hanh , Ha Nguyen Thi Thu , Dien Tran Minh , Hoa Pham Huu , Liem Nguyen Thanh
Published: May 2013

A modification of the Lecompte procedure was used successfully for total correction in 2 boys aged 3 and 6 months with double-outlet left ventricle. The operative procedure and short-term results are evaluated.
Aortic pseudoaneurysm due to graft infection after invasive thymoma resection
Authors: Itoda Yoshifumi , Komae Hyoe , Yamamoto Tetsufumi , Takeda Makoto
Published: May 2013

A 69-year-old woman with invasive thymoma underwent chemoradiotherapy followed by surgical resection, including extended thymectomy, right upper lobectomy, and innominate vein and superior vena cava reconstruction with a polytetrafluoroethylene graft. Computed tomography on the 27th postoperative day revealed mediastinitis and right hemothorax; open debridement and evacuation were performed. Vacuum-assisted closure was initiated to heal the median incision. The wound gradually cleared, and the vacuum was terminated on the 150th postoperative day. On the 155th postoperative day, the patient suffered a sudden hemorrhage from the anterior thoracic wall. Computed tomography revealed a ruptured ascending aortic pseudoaneurysm surrounding the graft.
Return to work after coronary artery bypass in patients aged under 50 years
Authors: Pinto Nigel , Shah Pallav , Haluska Brian , Griffin Rayleene , Holliday Julie , Mundy Julie
Published: May 2013

Background: This study was designed to identify factors associated with return to work and quality of life in patients undergoing primary coronary artery bypass at age <50 years.

Methods: 172 patients <50-years old underwent primary coronary artery bypass between January 2000 and December 2006. Predictors of return to work were analysed from variables in a prospectively collected database and on follow-up by the SF-36 questionnaire in 129 (75%) patients.

Results: 136 (79%) patients were working prior to surgery. The educational level was: primary 14.5%, secondary 47%, trade 22%, tertiary 13%, and postgraduate 3%. Type of occupation was blue collar 51%, white collar 41%, pensioner 27%, and unspecfied 8%. The mean follow-up was 86.4 ± 23.4 months. One hundred and twenty-six (69%) patients attended cardiac rehabilitation. Forty (23%) patients experienced recurrence of symptoms; 11 (6%) required reintervention. One hundred and twenty-seven (93%) patients returned to work postoperatively. Univariate predictors of return to work were male sex, blue-collar work, and working prior to surgery. Independent predictors of return to work were working prior to surgery and blue-collar work. Patients who returned to work had significantly higher scores in all 8 domains on the SF36-Questionnaire compared to those who did not return to work.

Conclusions: Preoperative employment and blue collar occupation were associated with a higher rate of return to work after coronary artery bypass in patients of working age. Patients who returned to work had significantly better measured quality of life than those who did not.