bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe Hemolysis after Implantation of a Rashkind Occluder in a Large Ductus
Authors: Ho Jonathan KS , Yim Anthony PC , Lee Janet FY , Tse Lawrence KK , Mak Gary YK , Low John , Sanderson John
Published: May 2013

We report an unusual case of severe mechanical hemolysis after implantation of a 17-mm Rashkind patent ductus arteriosus occluder in a young adult female with a large ductus. The device failed with conservative management, including implantation of a second occluder, and surgery was required to close the ductus. This occluder may not be suitable for closure of a large patent ductus arteriosus.
Instantaneous Subaortic Obstruction after Closure of Aortopulmonary Shunt
Authors: van Son Jacques AM , Falk Volkmar , Mohr Friedrich W
Published: May 2013

We report the case of a young child with tricuspid atresia, discordant ventriculoarterial connection, rudimentary right ventricle, and mildly restrictive bulboventricular foramen. Intraoperative temporary snaring of the modified Blalock-Taussig shunt resulted in a dramatic volume reduction of the left ventricle, a decrease in bulboventricular foramen size, and an instantaneous increase in the gradient across the latter from 15 mm Hg before occlusion of the shunt to 44 mm Hg. A modified Damus-Stancel-Kaye procedure resulted in early relief of the aortic outflow obstruction; in addition, a bidirectional cavopulmonary anastomosis was constructed. The use of intraoperative echocardiography is recommended to monitor subaortic obstruction in procedures that unload volume in univentricular hearts with discordant ventriculoarterial connection.
Hepatorenal Bypass for Renovascular Hypertension
Authors: Thakore Vijaysinh , Unnikrishnan Madathipattu , Neelakandhan Kurur Sankaran
Published: May 2013

An alternative source of arterial inflow is sometimes necessary for renal revascularization when aortorenal endarterectomy or bypass are inappropriate due to a diseased aorta. We report the case of a 29-year-old male who underwent hepatorenal bypass for renovascular hypertension and chronic renal insufficiency. Hepatorenal revascularization was performed by interposing reversed saphenous vein between the common hepatic artery and the right renal artery. Postoperatively, both renal and hepatic functions were normal and the hypertension was reduced.
Effect of Aortic Cross-Clamp Time on Myocardial Infarction after Coronary Bypass Surgery
Authors: Øvrum Eivind , Abdelnoor Michel , Forfang Kolbjørn
Published: May 2013

Univariate and multivariate statistical analyses were applied to 1200 consecutive patients undergoing first-time myocardial revascularization. Forty-three patients (3.6%) developed evidence of myocardial infarction as judged by serial electrocardiograms and release of enzymes. Out of 23 preoperative and intraoperative potential risk factors for perioperative myocardial infarction, multivariate regression analysis revealed that duration of aortic cross-clamping was a powerful continuous variable risk factor. The relative risk increased twofold at 44 minutes compared to 17 minutes, approached three times the risk at 53 minutes, and reached more than six times the risk after 84 minutes of aortic cross-clamping. Two other independent predictors for perioperative myocardial infarction were identified: the presence of preoperative arterial hypertension and significant (> 75%) left main coronary artery stenosis. Left ventricular impairment, gender, age, severity of angina, and the number of distal anastomoses were not identified as risk factors for perioperative myocardial infarction. Our data indicate that the incidence of perioperative myocardial infarction may be reduced by consistent efforts to minimize aortic cross-clamp time without compromising the adequacy of myocardial revascularization.
Surgical Treatment of Primary Cardiac Tumors
Authors: Jiu Gu Chun , Ke Bao Wei , Xun Guo Bin , Hong Yuan , Yi Xiu Zhong
Published: May 2013

During a 16-year period from 1980 to 1996, 101 patients with primary cardiac tumors underwent surgery at the 1st Affiliated Hospital of China Medical University, which represented 2.44% of 4142 open-heart surgical cases during this period. Most tumors were benign; 94 were myxomas, 2 were fibromas, and 1 was a hemangioma. Three myxomas were in the right atrium and 91 were in the left atrium. The 4 malignant tumors comprised 2 mesothelioma, 1 histiocytoma, and 1 right atrial malignant myxoma. All benign tumors were completely excised with 4.95% mortality. Only 1 malignant tumor was completely excised. In our experience, the long-term result of surgical treatment of benign cardiac tumors is excellent, whereas the prognosis for patients with malignant cardiac tumors is very poor. The incidence of malignant tumors was lower than in other studies.
Surgery for Pulmonary Mycosis
Authors: Di Busroh Ismid , Mallapasi M Nurolim , Hakim Tarmizi
Published: May 2013

We reviewed 739 cases of surgery for pulmonary infection between 1970 and 1990 at the Persahabatan Hospital, Jakarta. In 32 cases (13.61%) surgery was performed for pulmonary mycosis. There were 20 males and 12 females; the majority were between 31 and 50 years of age and all were symptomatic. Primary mycosis infection was found in only 1 case (3%) with a diagnosis of coccidioidomycosis; the other 31 patients had aspergillosis secondary to tuberculosis. Pneumonectomy was performed in 2 cases (6%), lobectomy in 28 cases (88%), and cavernoplasty in 2 cases (6%). Four operations were performed on an emergency basis, 15 were regarded as semi-emergencies, and 13 were carried out electively. Postoperative complications consisted of 2 cases of bronchopleural fistula, one of which was self-healing and the other needed a muscle plombage. There was 1 death (mortality 3%) from septic shock 3 weeks after the operation. The low mortality and morbidity support a surgical approach to the treatment of pulmonary mycosis in symptomatic patients.
Management of Aortic Intramural Hematoma
Authors: Posacioğlu Hakan , Atay Yüksel , Çetindağ Bülent , Yağdi Tahir , Ertürk Ümit , Büket Suat
Published: May 2013

Intramural aortic hematoma is a life-threatening disease and all patients with intramural hematoma of the ascending aorta should be treated by surgery on an emergency basis. Conversely, uncomplicated descending aortic hematoma may not require surgical treatment, especially if the pain and expansion of the hematoma can be controlled with antihypertensive therapy. However, further studies are needed to define the treatment. Towards this goal we report the clinical features and treatment of two recent cases of intramural aortic hematoma.
Nonsurgical Retrieval of Ruptured, Fractured Intra-Aortic Balloon Catheter
Authors: Premchand Rajendra Kumar , Chakravarthi Padmanabhan Tirumalai Nallan , Allam Vasanth Kumar , Sadasivan Jaishankar , Rao Damera Seshagiri
Published: May 2013

The possibility of rupture of an intra-aortic balloon has been theorized since its introduction and confirmed by recent reports. Few incidents of fracture of an intra-aortic balloon catheter have been reported and in most of these cases the entrapped balloons were removed surgically. We report the successful nonsurgical removal of a ruptured, fractured intra-aortic balloon catheter.
Calcified Sinus of Valsalva Aneurysm Eroding into the Interventricular Septum
Authors: Bapat Vinayak Nilkanth , Shahani Rohit Bhojo , Tendolkar Anil Gangadhar
Published: May 2013

A 12-year-old male patient with complete heart block was diagnosed by cardiac catheterization to have an unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum. Aortic regurgitation was absent and he underwent permanent pacemaker implantation. Three years later, he was readmitted with severe aortic regurgitation and left ventricular failure. The pacemaker was replaced and the patient underwent successful patch closure of the aneurysm and aortic valve replacement. The mode of presentation, noninvasive methods of evaluation, and surgical management of this rare cardiac pathology are discussed.
Tricuspid Valve Repair in Corrected Transposition with Situs Inversus
Authors: Atay Yüksel , İslamoğlu Fatih , Alat İlker , Alayunt E Alp
Published: May 2013

A 31-year-old female presented with tricuspid valve insufficiency, atrial septal defect, pulmonary valve stenosis, and corrected transposition of the great arteries with situs inversus. She underwent successful ring annuloplasty of the tricuspid valve, pericardial patch repair of the atrial septal defect, pulmonary commissurotomy, and correction of poststenotic pulmonary artery dilatation.
Performance by Age Groups in Biological and Mechanical Cardiac Valve Replacement
Authors: Fradet Guy J , Jamieson WR Eric , Miyagishima Robert T , Munro A Ian
Published: May 2013

A group of 1195 patients who received biological valve prostheses (mean age 57.3 years, range 8 to 85 years) and a group of 1345 patients who received mechanical heart valves (mean age 56.1 years, range 13 to 91 years) were analyzed for complications by age group (less than or equal to 54 years, 55 to 65 years, and over 65 years). The freedom from thromboembolism and anticoagulant-related hemorrhage at 8 years after aortic valve replacement was significantly higher in patients who received a biological prosthesis in all age groups. The freedom from thromboembolism and anticoagulant-related hemorrhage at 8 years after mitral valve replacement was significantly higher in patients who received a biological prosthesis in the age groups less than or equal to 54 years and over 65 years. The freedom from all valve-related complications at 5 and 8 years after aortic or mitral valve replacement showed the same trend of greater freedom from complications in biological prostheses patients compared with mechanical prostheses in most age groups. However, freedom from valve-related reoperation, mortality, and residual morbidity for aortic and mitral valve replacement for all age groups was not significantly different. These results show that biological prostheses can be considered for patients aged 55 years and older. The prostheses by age group or position at 8 years were not differentiated by valve-related reoperation, mortality, and residual morbidity. t 8 years there is a demonstrated price to pay for a presumed increase in longevity for patients with mechanical valves in the aortic position, reflected by an increase in thromboembolism and anticoagulant-related hemorrhage in all age groups.
Early Experience with Homograft Valve Banking
Authors: Choudhary Shiv Kumar , Srivastava Sushant , Chander Horisk , Sharma Rajesh , Venugopal Panangipalli , Dogra Tirath Das , Kumar Arkalgud Sampath
Published: May 2013

Homograft cardiac valves have been shown to have several advantages over conventional prosthetic valves. From October 1993 through November 1996, 273 homografts (262 valved and 11 non-valved) were used in various procedures at the All India Institute of Medical Sciences, New Delhi, India. The recommendations of the American Association of Tissue Banks were followed for procurement, harvesting, and storage of the valves. One hundred and ninety-six hearts were procured yielding a total of 439 homograft valves; 192 were pulmonary homografts, 187 were aortic homografts, and 60 were mitral homografts. Eighty-five homografts were used in the Ross procedure, 64 were used in homograft replacement of the aortic valve, 28 were used in replacement of the mitral valve, 85 were used in various operations for heart disease as valved conduits, and 11 homografts were used as either non-valved conduits or for patch repair. One hundred and thirty-five homografts (31%) were discarded for various reasons. Our early experience of valve banking is discussed.
Clinical Significance of Isolated Coronary Bridges
Authors: Qing Goo Chang , Shan Du Luo , Su Yang Ting , Biao Zhu Long
Published: May 2013

Myocardial bridging of a coronary artery has been noted in 0.5% to 1.6% of arteriograms but the clinical significance is controversial. We reviewed retrospectively 761 consecutive coronary arteriograms performed in the Chinese PLA General Hospital from 1986 to 1996. Myocardial bridging of a coronary artery was noted in 12 cases (1.5%), located exclusively in the left anterior descending coronary artery and isolated without fixed coronary artery stenosis. The bridges ranged in length from 10 to 50mm (mean 24 mm) and were classified as grade 1 (8% of cases), grade 2 (25%) and grade 3 (67%). All patients were hospitalized because of angina. Eight (67%) of the 12 patients suffered from anterioapical dyskinesia including 2 who had acute myocardial infarction with a left ventricular aneurysm. Three patients (25%) with a small posterior descending coronary artery died. In our view, when there is a hyperdominant left anterior descending coronary artery with a small posterior descending artery and a myocardial bridge, the patient appears to be in jeopardy and myocardial bridging can no longer be considered a benign coronary anomaly, especially when there is grade 3 narrowing of the left anterior descending coronary artery during systole.
Successful Bridge to Heart Transplantation in a Patient with Ebstein's Anomaly
Authors: Hachida Mitsuhiro , Minami Kazutomo , Koerner Michael , Morshuis Michael , Koertke Heinrich , Koerfer Reiner
Published: May 2013

A 52-year-old female was diagnosed with Ebstein's anomaly and an associated atrial septal defect. She underwent closure of the atrial septal defect and tricuspid valve replacement. Severe left ventricular failure was found after discontinuation of cardiopulmonary bypass, thus biventricular mechanical support was established. Four days later the patient underwent successful heart transplantation and was discharged without any complications.
Medium-Term Result of Domino Heart-Lung Transplantation
Authors: Atthapaisalsarudee Suree , Sakornpant Pantpis , Tanamai Supreecha , Saengchote Surapoj , Kojaranjit Vichao , Lertpradit Pattanasak , Chaiyodsilp Sant , Warinsirikul Wiwat
Published: May 2013

We report the medium-term result of the first domino heart-lung transplantation successfully performed in South East Asia. In January 1990, a 45-year-old female who was in severe respiratory distress and required continuous oxygen therapy for end-stage pulmonary fibrosis received the heart and lungs from a 21-year-old male with brain death due to head injury. The recipient's heart was transplanted to a 31-year-old male who was in severe congestive cardiac failure from cardiomyopathy. The heart-lung donor had blood group O and the other patients had blood group A. Both recipients are in good health 7 years after the surgery.
Petrified Cardiac Myxoma Mimicking Atrial Thrombus with Focal Segmental Glomerulosclerosis
Authors: Kakkar Nandita , Vasishta Rakesh Kumar , Banerjee Ashru Kumar , Sapru Rajinder Prashad , Sud Kamal
Published: May 2013

An uncommon histologic variant of cardiac myxoma masquerading as a mural thrombus is described. The association of focal segmental glomerulosclerosis with cardiac myxoma may be coincidental and further studies of renal pathology in cases of cardiac myxoma are indicated.
Extra-Anatomical Bypass between Ascending Aorta and Abdominal Aorta
Authors: Bartoccioni Sandro , Mercati Ugo , Massini Carlo , Fiaschini Paolo , Di Manici Gino , Fedeli Corrado , Di Lazzaro Davide , Possati Gian Federico
Published: May 2013

We present two cases successfully operated on at our institution using the technique of ascending aorta-abdominal aorta bypass. The first patient was a 60-year-old female with a large partially thrombosed aortic aneurysm between the origin of the left subclavian artery and the celiac axis. The second was a 55-year-old female who had coarctation of the aorta, aortic valve stenosis, and three-vessel coronary artery disease. A one-stage operation was performed to correct all three pathologies. Extra-anatomical aortic bypass was found to be the most suitable surgical technique in both patients although for different reasons.
Thrombolytic Therapy in Acute Myocardial Infarction Part II: 1997 Update
Authors: White Roger L
Published: May 2013

Thrombolytic therapy has become an established treatment for acute myocardial infarction. Streptokinase was first demonstrated in 1988 to reduce mortality rates. In 1993, tissue plasminogen activator was shown to have a slight superiority over streptokinase in reducing mortality rates (approximately 1%). Reteplase is a second generation thrombolytic agent that is given in two bolus injections intravenously over 30 minutes. Studies demonstrated slightly better and more rapid improvement in myocardial perfusion with reteplase compared to tissue plasminogen activator. However, recent studies showed 30-day mortality rates in patients treated with reteplase were similar as those treated with tissue plasminogen activator. The use of angioplasty, aspirin, beta blockers, angiotensin converting enzyme inhibitors, and lipid lowering agents also contribute to the reduction of mortality from acute myocardial infarction.
Femoral Bypass with Left Thoracotomy for Submitral Left Ventricular Aneurysm
Authors: Manohar Soman Rema Krishna , Rathod Ramesh Chandra , Tharakan Jagan Mohan
Published: May 2013

A simplified technique for repair of submitral left ventricular aneurysm is presented. Since the patient had no mitral regurgitation the aneurysm was approached through a left thoracotomy with femorofemoral bypass and the repair was technically simple.
Minimally Invasive Coronary Artery Bypass as a Salvage Procedure
Authors: Malhotra Rajneesh , Mishra Yugal , Maheshwari Pankaj , Mehta Yatin , Trehan Naresh
Published: May 2013

A 58-year-old male patient undergoing for coronary reoperative surgery had hemodynamic instability associated with intractable ventricular fibrillation after induction of anesthesia before starting the surgery. Minimally invasive coronary artery bypass surgery with left internal mammary artery-to-left anterior descending coronary artery anastomosis under percutaneous left femoral artery-to-left femoral vein cardiopulmonary bypass was employed successfully as a life saving measure.
Intraoperative Dissection of Aorta and Successful Repair
Authors: Sankar Nainar Madhu , Lai Kevin , Harrison Kenneth , Klineberg Peter , Hanna William Meldrum
Published: May 2013

A 67-year-old female undergoing coronary artery bypass grafting developed dissection of the ascending aorta during decannulation. It was diagnosed by intraoperative transesophageal echocardiography and she underwent a successful repair.
First Open-Heart Surgery in Alport Syndrome
Authors: Al Ebrahim Khalid , Tahir Mohammed , Shafei Hussein
Published: May 2013

We report the first case of open-heart surgery in a patient with Alport syndrome, which refers to the clinical triad of hereditary nephritis, sensory neural deafness, and ocular abnormalities. The conduct of cardiopulmonary bypass, the bleeding tendency, and the precautions taken in a patient with end-stage renal failure are discussed.
Thrombolytic Therapy for Stuck Prosthetic Valves: Phenomenon of Delayed Opening
Authors: Rao Chaganti Venkateswara , Padmanabhan Tirumalai Nallan Chakravarthi , Rao Damera Seshagiri , Rajagopal Prabhala , Jaishankar Sadasivan
Published: May 2013

Thrombolytic therapy for left-sided prosthetic valve occlusion is a viable alternative to surgery. The phenomenon of delayed opening of a bileaflet valve is a peculiar feature of thrombolytic therapy. Of 64 patients who received thrombolytic therapy and presented on 71 occasions, partial success was observed in 28 patients on completion of treatment. Of these 28 patients, delayed opening of the leaflets was observed in 14 (50%) over a period of 3 to 12 months. We suggest that this unique feature of bileaflet valves might delay or avoid reoperation. The need for frequent follow-up of patients with partially successful thrombolytic therapy is emphasized.
Surgical Treatment of Aortoesophageal Fistula
Authors: Gu Chun Jiu , Zhang Zhi Wei , Bao Wei Ke , Yan De Min , Yuan Yi Hua , Xiu Zong Yi
Published: May 2013

Aortoesophageal fistula is an uncommon and lethal clinical condition. We operated on 2 cases of aortoesophageal fistula between 1991 and 1996. The operations were uneventful. However, both patients died from fatal hemorrhage at 7 and 30 days postoperatively, respectively. The management of aortoesophageal fistula is still a challenging problem for cardiac surgeons.
Role of Lymphocyte Subsets in Pathogenesis of Chronic Rheumatic Heart Disease
Authors: Suri Rajendar K , Jha Neerod K , Vohra Harpreet , Manjari Ratna S , Venkateshwaran Rajam , Sharma Madhulika , Thingnam Shyam KS , Ganguly Nirmal K
Published: May 2013

Analyses of lymphocyte subsets using flow cytometry were conducted to determine the significance of these cells in the pathogenesis of chronic rheumatic heart disease. Lymphocytes (B cells, T cells, CD4 cells, CD8 suppressor or cytotoxic T cells, activated T cells, and natural killer cells) were measured in blood and left atrial appendage samples of 30 patients with rheumatic heart disease and 10 patients with acyanotic congenital heart disease. Monoclonal fluorescent-labeled antibodies were used to identify various cells by flow cytometry. There was a significant increase in CD4 cells and activated T cells with a significant decrease in B cells in the left atrial appendage tissue of patients with rheumatic heart disease compared to those in the control group. There was no significant difference between the two groups in the distribution pattern of T lymphocytes in peripheral blood. These changes in rheumatic heart disease reflect an abnormal immunoregulatory mechanism with an ongoing enhanced immunological process continuing into the chronic phase of the disease. In our opinion, this persistent T cell response may lead to fresh damage to the myocardium and deformation of the heart valves.
Surgical Approach to Myocardial Rupture after Acute Myocardial Infarction
Authors: Nwogu Chukwumere E , Moran John M , Becker Richard M , Pezzella A Thomas
Published: May 2013

Rupture of the ventricular wall is a highly lethal complication of acute myocardial infarction that is diagnosed more frequently with the increased use of two-dimensional echocardiography. External patching techniques were used to treat 4 patients with ventricular rupture, thus avoiding resection of necrotic myocardium. Three of the patients survived. One patient developed a large left ventricular pseudoaneurysm requiring reoperation. The other 2 patients had intact repairs on follow-up echocardiogram obtained after 5 weeks and 3 years, respectively. With prompt recognition and treatment, patient survival and excellent short-term results can be achieved.
Profile of Coronary Artery Bypass Surgery in United Arab Emirates: Dubai Hospital Experience
Authors: Sadanandam Rajan , Al Khaja Najib , Aziz Mohd A , Turner Murdo A
Published: May 2013

Although coronary artery bypass surgery has become a common procedure, there were no data available regarding this type of surgery in the United Arab Emirates. Therefore, we undertook this retrospective study of the first 522 consecutive patients undergoing coronary artery bypass graft surgery between October 1992 and July 1997. The mean age was 49.1 years at operation with a 97.1% male predominance. Patients of Asian origin accounted for 75.8%, Arabs 22.4%, and Europeans 1.7%. Chronic stable angina was the most frequent presenting symptom (70.4%) and 62.1% patients had at least one prior myocardial infarction. There was a 44.6% incidence of hypertension and 32.9% of patients were diabetic. Other prominent risk factors were smoking (55.7%), hyperlipidemia (53.9%), and family history of ischemic heart disease (10.7%). Left main coronary artery obstruction was evident in 6.5% of patients. An average of 3.4 grafts per patient were performed using reverse saphenous vein and endarterectomies were needed in 2.2%. The early mortality rate in elective cases was 2.4%. This study suggests that in spite of a high incidence of multiple risk factors, our patients tolerated coronary artery bypass surgery well. Our findings highlight the trend towards more urgent operations and the decreasing age of patients with severe coronary artery disease.
Cannulation of Left Inferior Pulmonary Vein and Distal Thoracic Aorta for Left Heart Bypass
Authors: Nalladaru Zubin , Chen Qiang , Sharma Ashok Kumar
Published: May 2013

We describe a simple safe technique of left heart bypass using cannulation of the posterior aspect of the left inferior pulmonary vein for repair of an aneurysm in the distal aortic arch.
Silk Loop for Ligation of Running Sutures
Authors: Chiu Ing Sh , Lin Shou Fong
Published: May 2013

A technique for ligating the end of a running polypropylene suture or for securing inadvertent loops is described. This method was used in 700 pediatric cardiac procedures without failure of ligation.
Prosthetic Cardiac Valve Replacement: Management Problems
Authors: Sharma Navneet , Grover Anil , Radotra Bishan Das
Published: May 2013

Altered states of coagulability can be precarious for patients with valvular prostheses. Prosthetic valvular thrombosis can produce devastating hemodynamic changes wherein surgical intervention might be high risk. We describe the cases of 4 patients with prosthetic cardiac valve replacements to highlight some of the problems that might be encountered. The first patient suffered prosthetic valve thrombosis following withdrawal of her anticoagulants during labor. She was treated with urokinase but failed to survive. The second young female suffered two episodes of valvular thrombosis and was successfully treated with streptokinase on the first occasion but succumbed one year later during the second episode. The third patient was an elderly male who suffered an intracerebral hemorrhage as a result of an increase in anticoagulant dosage. He was successfully managed with low molecular weight heparin. In the fourth case, a young female with a prosthetic mitral valve had a favorable clinical outcome in spite of withdrawal of anticoagulants during labor.
Intravenous Diltiazem for Treatment of Supraventricular Tachycardia after Coronary Artery Bypass Surgery
Authors: Birincioğlu C Levent , Ulus A Tulga , Yamak Birol , Katircioğlu S Fehmi , Mavitaş Binali , Taşdemir Oğuz
Published: May 2013

Between 1995 and 1997, 180 patients who had undergone coronary artery bypass grafting were given intravenous diltiazem for conversion of supraventricular tachycardia to sinus rhythm or control of ventricular rhythm in atrial fibrillation. The patients were divided into three groups of 60 each: group 1 required no inotropic support; group 2 had mild inotropic support with dopamine; group 3 had high-dose inotropic support with adrenalin and dopamine. Thirty-eight patients in group 1 (63%), 40 in group 2 (67%), and 32 in group 3 (53%) responded to one or two doses of diltiazem. There was no difference between the groups in terms of the success rate of the treatment (p > 0.05). Additional procedures were needed in 70 patients including cardioversion in 20 (12 in group 1, 8 in group 2). Mean cardiac index was significantly increased and mean pulmonary artery pressure was significantly decreased in all three groups after diltiazem treatment. After the first dose of diltiazem (0.25 mg·kg−1), the mean heart rate decreased from 141.5mg·kg−1 ± 3.8, 136.9 ± 8.5, and 140.2 ± 4.7 to 118.2 ± 5.1, 101.2 ± 6.7, and 105.6 ± 16.8 in groups 1, 2, and 3, respectively. The maximum decrease was seen after 5 minutes. After the second dose of diltiazem (0.35 mg·kg−1), although mean heart rates were not significantly decreased, 45% of group 1, 44% of group 2, and 46% of group 3 patients who did not respond to the first dose of diltiazem, converted to sinus rhythm. In the early postoperative period after coronary artery bypass graft surgery, diltiazem was of benefit in the treatment of supraventricular tachycardia and atrial fibrillation or flutter. This treatment may be especially useful in patients who are in poor hemodynamic condition.
Side-Branch of Internal Mammary Artery Bypass Graft Causing Coronary Steal
Authors: Mastroroberto Pasquale , Chello Massimo , Zofrea Saverio , Ceravolo Roberto , Perticone Francesco
Published: May 2013

A case of coronary steal syndrome caused by a large unligated branch of the left internal mammary artery in a patient who had undergone myocardial revascularization is described. The presence of recurrent angina, a positive exercise stress test, and repeat angiography showing a lateral branch of the mammary artery led to a diagnosis of the coronary steal phenomenon. Surgical ligation of the branch was performed and the patient became symptom-free with a negative exercise stress test.
Balloon Mitral Valvotomy in Pregnant Patient with Anomalous Inferior Vena Cava
Authors: Agarwala Manoj K , Singh Mandeep , Grover Anil , Varma Jagmohan S
Published: May 2013

Successful balloon valvotomy was performed by the Inoue technique in a pregnant lady with severe mitral stenosis and pulmonary edema. Total pelvic and abdominal shielding was used and a transseptal puncture was carried out through the left femoral vein because of an anatomically anomalous course of the inferior vena cava.
No-Touch Method for Off-Pump Coronary Artery Bypass Grafting
Authors: Tünerir Bülent , Aslan Recep , Kural Tuğrul , Beşoğul Yavuz
Published: May 2013

We describe a simple no-touch method of coronary artery bypass grafting that facilitates anastomosis on the beating heart by means of a blower. This technique avoids clamping or occluding the target coronary artery. We successfully performed 22 distal anastomoses in 12 direct off-pump coronary artery bypass operations with no in-hospital mortality or cardiac complications. Two patients underwent a left anterolateral small thoracotomy for single-vessel disease and 10 had a median sternotomy for double-vessel disease. The technique provided a dry operative field and adequate exposure at the moment of suture.
Ten-Year Results with Liotta Porcine Bioprostheses in the Mitral Position
Authors: Yamak Birol , Mavitaş Binali , Saritaş Ahmet , Katircioglu S Fehmi , Ulus A Tulga , Birincioglu Levent , Karagöz Y Haldun , Sener Erol , Taşdemir Oguz , Bayazit Kemal
Published: May 2013

The Liotta porcine bioprosthesis is a third generation bioprosthesis with a very low profile supraannular configuration with low-pressure glutaraldehyde-fixed tissue. Between May 1986 and December 1990, 670 patients underwent isolated mitral valve replacement with Liotta porcine bioprosthesis. There were 403 (60%) females and 267 (40%) males; the mean age was 39.03 ± 4.57 years (range, 16 to 75 years). The predominant lesion was combined mitral stenosis and mitral insufficiency in 46% of the patients. The operative mortality rate was 5.9% and the most frequent cause of the mortality was low cardiac output. Total follow-up was 3193.5 patient-years. The average follow-up period was 6.1 ± 2.5 years (range, 1 to 10 years). During the late period, 44 patients (1.4% per patient-year) died. The long-term survival estimate at 10 years was 84.8% ± 2.7%. Structural valve deterioration developed in 198 patients (6.2% per patient-year). Actuarial estimates of freedom from structural valve deterioration at 5 and 10 years were 87.6% ± 1.5% and 28.5% ± 4.5% and it was unrelated to sex or age. Most patients (88%) who developed bioprosthesis dysfunction underwent repeat valve replacement. The period between the implantation and development of structural valve deterioration was 5.9 ± 1.8 years for female patients and 6.2 ± 1.8 years for males (no statistically significant difference). We concluded from the early and high rates of structural valve deterioration in this young age group that the Liotta porcine bioprosthesis has limited long-term durability for mitral valve replacement.
Heparin Dosing and Postoperative Blood Loss in Patients Taking Aspirin
Authors: Chauhan Sandeep , Ghosh Tushar Kanti , Srivastava Sushant , Sahu Manoj , Mohanty Smriti Ranjan , Mathur Alok , Saxena Nita , Venugopal Panangipalli
Published: May 2013

A large number of patients scheduled to undergo elective coronary artery bypass grafting continue to take aspirin along with other antianginal medication up to the day of surgery. Patients taking aspirin preoperatively are known to bleed more in the postoperative period than those not taking aspirin. This study was undertaken to determine whether the method of heparin administration (protocol-based bolus dose versus an individualized dose) affected postoperative blood loss or requirements of blood and blood products in patients taking aspirin preoperatively. In this prospective study, 300 consecutive patients taking aspirin prior to coronary artery bypass graft surgery were randomly assigned to receive heparin either as a protocol-based bolus of 400 IU·kg−1 (group A) or according to a dose-response curve to obtain an activated coagulation time of 500 seconds on cardiopulmonarybypass (group B). Group B required significantly less heparin (mean 275 IU·kg−1)and less protamine than group A. Postoperative blood loss, requirement of blood and blood products, and time spent on hemostasis in group B was significantly less at 24 hours than group A. We concluded that individualized dosing of heparin using a dose-response curve is preferable to a protocol-based bolus heparin dose in patients taking preoperative aspirin.
Aortic Valve Replacement without Annular Enlargement in Patients with Small Aortic Roots
Authors: Vijayanagar Raghavendra , Chan Gary , Musunuru Rao , Sastry Narendra , Siegman Ira , Rattehalli Narayana , Cortelli Michael
Published: May 2013

Use of small prostheses for aortic valve replacement eliminates the need for annular enlargement but may impair symptomatic resolution and long-term patient survival. We reviewed our experience with 105 consecutive patients who had isolated aortic valve replacement with small mechanical prostheses or bioprostheses (14 to 21 mm) without concurrent annular enlargement between August 1976 and November 1992. The mean age was 72 ± 10 years and 82% of patients were female. Valvular disease was primarily aortic stenosis in 61%, aortic regurgitation in 7%, and mixed aortic disease was present in 32% of patients. Mean preoperative ejection fraction was 64% ± 17% and the aortic valve area was 0.5 ± 0.2 cm2. Prior to surgery, 82% of patients were in New York Heart Association functional class III or IV. The mean duration of follow-up was 8.1 years. There were 7 early and 14 late deaths giving an overall survival of 80% and a 10-year Kaplan-Meier survival rate of 77%. Five patients developed thromboembolic complications (transient stroke) and 2 required repeat aortic valve replacement due to prosthetic valve endocarditis. Doppler echocardiography or cardiac catheterization was performed in 15 patients postoperatively but peak systolic gradient exceeded 50 mm Hg in only one individual with a 21-mm porcine valve. All surviving patients were in functional class I or II. We conclude that aortic valve replacement with small prostheses is associated with excellent long-term patient survival, improvement in clinical symptoms, and a low incidence of complications.
Blunt Thoracic Trauma: Analysis of 1730 Patients
Authors: Kahraman Cemal , Taşdemir Kutay , Akçali Yiĝit , Oĝuzkaya Fahri , Emiroĝullari Naci , Bilgin Mehmet
Published: May 2013

Between 1978 and 1997, 1730 patients with blunt thoracic trauma were treated in our department. There were 450 females and 1280 males. The mean age was 34.3 years ranging from 2 months to 80 years. The most frequent causes of trauma were motor vehicle accidents in 1438 patients and occupational accidents in 232. Injury to multiple intrathoracic structures was noted in 986 (57%) cases. There were associated injuries to the abdomen (13.76%), the head (23.35%), and the skeletal system (22.6%). Eighty-nine percent of the blunt thoracic traumas did not require open thoracotomy but immediate use of lifesaving measures such as closed tube thoracostomy for hemothorax or pneumothorax was necessary in 1543 cases. A laparotomy was carried out in 238 patients. The most common blunt thoracic traumas requiring immediate thoracotomy were massive hemothorax (33 cases), cardiac tamponade (2 cases), and massive tracheobronchial air leak (24 cases). Surgical intervention was necessary in 22 patients with diaphragmatic rupture and in 5 patients with isolated sternal fractures. During the posttraumatic period, adult respiratory distress syndrome occurred in 71 patients, pleural thickening in 29, and pleural empyema in 21 patients. The most common causes of morbidity were atelectasis (10.06%) and pneumonia (5.32%). The mean hospital time for all patients was 15 days and the mortality rate was 5.61%.
Minimally Invasive Excision of Left Atrial Appendage Hemangioma via Hemisternotomy
Authors: Wing Robert Tam Kien , Smith Christopher , Wright-Smith Guy , Almeida Aubrey A , Davidson Malcolm
Published: May 2013

We describe a minimally invasive excision of left atrial appendage hemangioma. This was performed via a hemisternotomy under cardiopulmonary bypass and cardioplegic arrest. The surgical excision was complete and the patient made a normal postoperative recovery.
Primary Pulmonary Paraganglioma
Authors: Silistreli Erdem , Acikel Unal , Oto Oztekin , Catalyurek Hudai , Sariosmanoglu Nejat , Narin Cuneyt , Sagol Ozgul , Kargi Aydanur , Ucan Eyup Sabri
Published: May 2013

A 2-cm nodular mass was detected by thoracic computed tomography in the peripheral region of the right middle lobe of the lung in a 60-year-old female with a 5-year history of cough and respiratory distress. The resected tumor was diagnosed as a primary paraganglioma on pathologic examination.
Brucella Endocarditis Affecting the Mitral Valve
Authors: Andaç M Halit , Ceyran Hakan , Kunt Alper S , Aşik Ramazan , Mercan Hasan
Published: May 2013

Brucellosis is still prevalent in Mediterranean and Middle East countries and Brucella endocarditis is a rare and often fatal complication. We describe a case of Brucella endocarditis in a 23-year-old male who required mitral valve replacement after successful antibacterial treatment.
Retrograde Cerebral Perfusion for Aortic Arch Surgery in Octogenarians
Authors: Ogino Hitoshi , Ueda Yuichi , Sugita Takaaki , Sakakibara Yutaka , Matsuyama Katsuhiko , Matsubayashi Keiji , Nomoto Takuya
Published: May 2013

We reviewed our surgical management of aortic arch aneurysms in 11 octogenarians. Seven operations (63.6%) were performed on an emergency basis for ruptured atherosclerotic aneurysm in 5 cases and for acute dissection in 2. Deep-hypothermic circulatory arrest, continuous retrograde cerebral perfusion, and open aortic anastomosis were employed routinely for brain protection during aortic arch replacement. There was one intraoperative death due to hemorrhage. One survivor died of bowel necrosis 47 days postoperatively and another suffered sudden death 5 months postoperatively. Both of these patients had been treated for a ruptured aneurysm and had suffered from postoperative neurological deficit. There were 2 late deaths due to unrelated events: subarachnoid hemorrhage and hepatic failure. The surgical outcomes were considered satisfactory, except in emergency cases of ruptured aneurysm where there was a high mortality and neurological morbidity. It is recommended that arch aneurysms at risk of rupture should be repaired electively before rupture, even in octogenarians, using deep-hypothermic circulatory arrest, continuous retrograde cerebral perfusion, and open aortic anastomosis.
Surgery for Combined Rheumatic Valve and Coronary Artery Disease
Authors: Yamak Birol , Ulus A Tulga , Katircioğlu S Fehmi , Mavitaş Binali , Saritaş Ahmet , Taşdemir Oğuz , Bayazit Kemal
Published: May 2013

Between 1986 and 1996, 147 patients underwent valve replacement combined with coronary artery bypass grafting. The mitral valve was replaced in 104 patients, the aortic valve in 34, and both mitral and aortic valves were replaced in 9. One hundred and twenty-two (83%) were male with a mean age of 56 ± 5 years (range, 38 to 77 years). The mean age for female patients was 57.9 ± 5 years (range, 38 to 70 years). All of the patients had rheumatic valve disease. Preoperatively, 68% were in New York Heart Association functional class III or IV and 32% were in class II. A total of 252 distal anastomoses were performed (mean, 1.71 per patient) in these patients of whom 48.9% had single-vessel disease, 45% had two-vessel or three-vessel disease, and 6.1% had left main coronary artery disease. The hospital mortality rate was 10.2%. Three patients died during the follow-up period and the overall actuarial survival rate at 10 years was 96.6% ± 1.9%. Operations that combine both valve replacement and coronary artery bypass are performed more frequently because perioperative risk has decreased through more effective myocardial protection. If untreated, both coronary artery disease and significant valve disease may reduce patient survival.
Maximum Exercise after Aortic Valve Replacement with Pulmonary Autograft
Authors: Doty Donald B , Flores Jean H , Yanowitz Frank G , Oury James H
Published: May 2013

Patients describe excellent exercise tolerance after aortic valve replacement with a pulmonary autograft (Ross procedure) but objective data regarding exercise ability has not been available. This report describes testing of maximum exercise performance at least one year after operation. Four athletic males underwent aortic valve replacement with a pulmonary autograft. Exercise to exhaustion was performed on a bicycle ergometer. Measurements of oxygen consumption and echocardiography were carried out. High levels of work energy were achieved (230 to 331 watts). Oxygen consumption increased from a range of 1.7 to 5.1 mL·kg−1·min−1 at rest to 33 to 45.1 mL·kg−1·min−1 at peak exercise. Pressure gradients over the left ventricular outflow tract were calculated by echocardiography as 10 to 14 mm Hg after maximum exercise. These data indicate that high levels of exercise and excellent hemodynamic performance can be achieved after the Ross procedure allowing unrestricted aerobic athletic activities.
Critical Pulmonary Stenosis in Infants and Neonates in the Era of Interventional Cardiology
Authors: Bilkis Abdul Aziz , Alwi Mazeni , Hasri Samion , Haifa Abdul Latif , Geetha Kandhavel , Law Hafiz IA
Published: May 2013

Between September 1992 and February 1998, 22 consecutive patients aged 4 to 90 days with critical valvular pulmonary stenosis underwent percutaneous transluminal balloon valvuloplasty. Sixteen were cyanosed and 7 required prostaglandin infusion. The pulmonary valve was successfully crossed in all patients. Progressive dilatation was used to attain a final balloon to valve ratio between 1.2 and 1.4. Mean right ventricular systolic pressure dropped from 109 ± 26 to 34 ± 1 mm Hg. Oxygen saturation increased from 84% ± 8% to 98% ± 2%. There were 5 complications including 1 death due to valvular damage, 1 hemopericardium requiring drainage and transfusion, significant blood loss during cannulation in 2 cases, and a fractured guidewire that was retrieved in another. Repeat valvuloplasty was performed in 2 patients. Two patients required surgery; one had a dysplastic pulmonary valve with persistent pulmonary stenosis and the other had a hypoplastic right ventricle. Of the 20 patients who had valvuloplasty alone, 17 (85%) remained well with a mean peak systolic Doppler gradient of 30 ± 26 mm Hg and no pulmonary regurgitation. We concluded that valvuloplasty is likely to be the only procedure necessary for the majority of infants and neonates with critical pulmonary stenosis. However, surgery is required in cases of dysplastic pulmonary valve or hypoplastic right ventricle.
Postpneumonectomy Bronchopleural Fistula Formation and Surgical Management
Authors: Açikel Ünal , Silistreli Erdem , Özelsancak Nilgün , Karabay Özalp , Uçan Eyüp Sabri , Hazan Eyüp , Oto Öztekin
Published: May 2013

Bronchopleural fistulas and empyema are the most challenging problems after lung resection. We reviewed 4 cases of successful surgical treatment of postpneumonectomy bronchopleural fistulas. Three of the patients had empyema. Primary suturing and pleural decortication were performed in one patient, decortication and fistula repair with additional omentopexy were carried out in the other 3 patients. Recurrence in one patient was successfully treated by thoracoplasty; the others have had no recurrence on follow-up. We recommend aggressive surgical intervention as the most effective treatment for bronchopleural fistula and empyema after pulmonary resection.
Thymolipoma of Anterior Mediastinum
Authors: Thingnam Shyam Kumar Singh , Puri Deepak , Jha Neerod Kumar , Vasishta Rakesh Kumar , Suri Rajendar Krishan
Published: May 2013

Thymolipoma is a very rare benign anterior mediastinal tumour. Most patients are asymptomatic but a few may present with clinical symptoms attributable to its huge size or less frequently, with myasthenia gravis. We report a case of huge thymolipoma occupying almost two thirds of the thorax in a 25-year-old female, which caused collapse of the lower lobe of the left lung simulating cardiomegaly on a chest skiagram. The tumor was successfully removed en bloc through a median sternotomy combined with an extended left anterolateral thoracotomy. There was no clinical or radiological evidence of residual tumor at the 1-year follow-up.
Myocardial Ischemia after Coronary Bypass: Comparison of Trimetazidine and Diltiazem
Authors: Kuralay Erkan , Demirkiliç Ufuk , Özal Ertuğrul , Uzun Mehmet , Tatar Harun
Published: May 2013

The aim of this prospective randomized study was to evaluate the effect of trimetazidine and diltiazem on persistent myocardial ischemia, mostly silent myocardial ischemia, after coronary artery bypass graft surgery. Sixty patients were divided into three groups of 20 each and followed up for 12 months. Patients in all 3 groups received acetylsalicylic acid 100 mg per day, those in group 1 also had trimetazidine 60 mg per day, and those in group 2 had diltiazem 90 mg per day. Each patient had coronary angiography during the first 3 weeks after surgery, 24-hour ambulatory monitoring every month, and cardiac scintigraphy at 3 weeks, 6 months, and 12 months. Ischemic episodes had resolved at 27 weeks in group 1, at 35 weeks in group 2 and at 51 weeks in group 3 (p < 0.05). Perfusion defects had resolved in the trimetazidine group at 6 months. At 12 months, perfusion defects had resolved in the diltiazem group but not in the group receiving only acetylsalicylic acid (p < 0.05). At these doses, trimetazidine and diltiazem were effective in decreasing silent myocardial ischemia following coronary artery bypass grafting. Trimetazidine appeared to be superior to diltiazem at 6 months on 24-hour ambulatory electrocardiogram monitoring and myocardial scintigraphy.
Double-Outlet Right Ventricle Coexisting with Double-Chambered Right Ventricle
Authors: Agarwala Manoj K , Singh Mandeep , Grover Anil , Varma Jagmohan S , Pathak Vijay
Published: May 2013

Of 60 consecutive patients with double-chambered right ventricle studied prospectively during a 42-month period, 7 had coexisting double-outlet right ventricle. There were 5 males and 2 females aged 4 to 20 years old. The clinical profile was similar to that of patients with tetralogy of Fallot. Echocardiography is recommended for the diagnosis of this condition.
Influence of Associated Defects and Type of Surgery in Neonatal Aortic Coarctation
Authors: Jelly Ali , Galal Mohammed Omar , Al Fadley Fadel , de Moor Michael , Al Halees Zohair
Published: May 2013

We reviewed our 12-year experience of surgical treatment for aortic coarctation in 86 neonates. Twenty-three patients had simple coarctation, 38 had an associated large ventricular septal defect, and 25 had complex intracardiac defects. The surgical techniques included subclavian flap angioplasty in 54 (63%), combined resection with end-to-end anastomosis augmented by a subclavian flap in 22 (26%), resection with extended end-to-end anastomosis in 7 (8%), and patch aortoplasty in 3 (3%). Five patients required additional transverse aortic arch augmentation. Hospital mortality was 14% (12/86) and was not related to the type of repair but associated pathology increased the operative risk. Late mortality was 11% (8/74) within one year of repair. Recoarctation developed in 5 patients (7%) within one year. No recoarctation was observed in the group repaired by end-to-end anastomosis augmented by a subclavian flap (p = 0.04).