bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying Paraplegia Risk Associated with Thoracic Endografting
Authors: Preventza Ourania , Wheatley Grayson H , Williams James , Ramaiah Venkatesh , Rodriguez-Lopez Julio , Diethrich Edward B
Published: May 2013

Endografting, like open surgical repair of the thoracic aorta, can be complicated by paraplegia. We reviewed our thoracic endografting experience regarding the incidence and treatment of spinal cord neurologic events. Between February 2000 and July 2008, 346 patients underwent endoluminal grafting of the descending thoracic aorta. Indications for intervention included atherosclerotic aneurysms (45.9%), acute and chronic dissections (31.5%), miscellaneous lesions (13.6%), and penetrating aortic ulcers (8.9%). Ten women and 4 men (4.0%), with a mean age of 71.3 years, developed either paraparesis (1.7%) or paraplegia (2.3%). Nine (64.3%) of these patients had an aneurysm, 4 (28.6%) had acute or chronic type B aortic dissection, and 1 (7.1%) had a penetrating aortic ulcer; 3 (21.4%) of them had previously undergone open abdominal aortic aneurysm repair, and 13 (92.9%) required coverage of more than 20 cm of the aorta. Cerebrospinal fluid drainage was instituted in 7/8 paraplegic patients. Eight (57.1%) of the 14 patients recovered fully, 2 (14.3%) experienced partial recovery, and 4 (28.6%) had significant neurological deficits. Paraplegia following thoracic endografting appears to be associated with female sex, longsegment coverage of the thoracic aorta, and aneurysmal disease.
Positron-Emission Tomography for Lung Cancer in a Tuberculosis-Endemic Region
Authors: Sit Alva KY , Sihoe Alan DL , Suen Wai Sing , Cheng Lik Cheung
Published: May 2013

A potential limitation of integrated positron-emission tomography and computed tomography in non-small-cell lung cancer may be false-positive results due to granulomatous disease. This retrospective study examined the accuracy of this imaging modality for mediastinal nodal staging of non-small-cell lung cancer in Hong Kong where tuberculosis remains endemic. There were 249 lymph node stations evaluated in 107 patients, of whom 38 (36%) had active tuberculosis or evidence of previous tuberculosis. Imaging results were compared with histological findings. The sensitivity, specificity, and accuracy of integrated imaging for mediastinal nodal staging were 52%, 86%, and 80%, respectively; the overall positive-predictive value for mediastinal nodal metastasis was 46%, and the overall negative-predictive value was 89%. The positive-predictive value for mediastinal nodal metastasis was 39% in patients with tuberculosis and 50% in controls; the negative-predictive value was high in both groups (92% and 87%). The likelihood ratio for true positives was 6.47 in patients with tuberculosis vs. 10.97 in controls. This suggests that the reliability of positron-emission/computed tomography may be substantially poorer in patients with tuberculosis. Histological confirmation should be considered mandatory in patients with suspected metastasis on integrated imaging.
Repair of Left Ventricular Pseudoaneurysms
Authors: Fedakar Ali , Bugra Onursal , Onk Alper , Mataraci Ilker , Eren Ercan , Zeybek Rahmi
Published: May 2013

The outcomes of 3 different methods of repair of left ventricular pseudoaneurysm after myocardial infarction were analyzed retrospectively. The operations were carried out in 22 patients between 1985 and 2008. Repair procedures included primary closure with Teflon-pledgeted sutures, and Dacron or pericardial patches. Overall hospital mortality was 27.3% (2 patients had primary closure, 3 had a Dacron patch, and 1 had a pericardial patch). Mean postoperative bleeding was 885 mL (range, 200-4,800 mL). Mean preoperative and postoperative ejection fractions were 40% (30%–47%) and 48% (30%–65%), respectively. The overall incidence of arrhythmia was 36.4% (8 patients). The incidence of arrhythmia was lowest in the pericardial patch group, but this was not statistically significant. No significant differences in postoperative ejection fraction or hemorrhage were found among the study groups. Mean survival was 61.9 ± 41.4 months in the 16 hospital survivors. Although the 3 techniques gave similar results, repair with an autologous pericardial patch may offer an advantage in terms of less postoperative arrhythmias.
Fracture of Epicardial Resynchronization Lead Caused by Deceleration Injury
Authors: Fernández-González Angel L , García Bengochea José B , Cortes Laíño Joaquín , Martínez Monzonis Amparo , Veiras del Río Sonia , Alvarez Escudero Julian
Published: May 2013

A 50-year-old man with heart failure, systolic dysfunction, and abnormal septal motion underwent ventricular resynchronization. Postoperative clinical and echocardiographic improvement was observed. Several months later, he complained of worsening functional class after a traffic accident. Pacing lead fracture was diagnosed. After replacing the lead, improvement of clinical condition and ventricular parameters was achieved. The role of seat belts in causing dysfunction of pacemakers and resynchronization devices after deceleration injury is discussed.
Comparison of Cryoprecipitate with Commercial Fibrinogen in Bullectomy
Authors: Nakanishi Kozo
Published: May 2013

Fibrin glues are widely used for various pulmonary operations, but commercially produced glues are made of heterogeneous fibrinogen that has infection risks. We used autologous cryoprecipitate and evaluated its clinical value as a fibrin sealant instead of the commercially available glue. One hundred patients who underwent thoracoscopic bullectomy for primary spontaneous pneumothorax were studied. The apical visceral pleura was covered with an absorbable mesh and a fibrin glue. Autologous cryoprecipitate glue was used in 30 patients (group A), and commercially produced fibrinogen was used in 70 (group B). The mean duration of postoperative chest drainage was 1.9 days in group A and 1.5 days in group B. The cumulative 2-year postoperative recurrence rate was 3.4% in group A and 6.5% in group B. There were no differences in clinical results after surgery for primary spontaneous pneumothorax, using either autologous cryoprecipitate or commercially produced fibrinogen. The production autologous cryoprecipitate was easy and low-cost. We propose that autologous cryoprecipitates be used in operations for primary spontaneous pneumothorax.
3f Prosthesis Aortic Cusp Replacement: Implantation Technique and Early Results
Authors: Pillai Ravi , Ratnatunga Chandana , Soon Jia Lin , Kattach Hassan , Khalil Amina , Jin Xu Yu
Published: May 2013

Stentless aortic bioprostheses have been successfully used for over a decade. The 3f bioprosthesis is a new equine pericardial stentless valve, unique in its tubular design, preserving the native aortic sinuses post-implant. Forty-six consecutive aortic valve replacements with the 3f bioprosthesis were performed between June 2003 and January 2005. The patients were prospectively assessed and echocardiography was performed at 6 months, 12 months, and annually thereafter. The median follow-up was 2.1 ± 0.9 years. There was one early and 4 late deaths; none were valve-related. The 2-year mean transvalvular gradient was 8.8 ± 3.8 mm Hg, the mean echocardiographic aortic regurgitation grade was 0.4 ± 0.7 (grade 1 being trivial). Echocardiographic sizing of the aortic annulus before surgery accurately predicted prosthesis size. The 3f bioprosthesis is easy to implant. Early clinical results are favorable, with hemodynamic profiles consistent with those of other stentless prostheses. Longer follow-up is required to confirm its durability.
Midterm Evaluation of Hemodynamics of the Top Hat Supraannular Aortic Valve
Authors: Aagaard Jan , Nissen Henrik , Geha Alexander S
Published: May 2013

The CarboMedics Top Hat supraannular aortic valve provides an orifice-to-annulus ratio of 1:1 in most patients, and enhances patient outcomes. This study compared the midterm echocardiographic parameters of 52 patients undergoing aortic valve replacement with a Top Hat valve with those in other studies of Top Hat or CarboMedics intraannular valves. Echocardiography was performed 6–48 months after surgery with Top Hat sizes 21-27. Parameters evaluated included mean gradient, peak gradient, effective orifice area, and effective orifice area index. Preoperative and postoperative echocardiographic measurements were compared in 38 patients with aortic valve stenosis. Hemodynamic data were comparable to those of other studies, but the Top Hat prosthesis implanted was significantly larger (by a mean of 3.29 mm) than the valve size indicated using an intraannular valve sizer in 48 patients. Mean effective orifice area improved significantly from 0.73 cm2 preoperatively to 2.04 cm2 postoperatively. In patients with preoperative aortic valve stenosis, postoperative mean peak gradient was significantly reduced. The larger orifice-to-annulus ratio of the Top Hat valve improved hemodynamic parameters assessed by echocardiography up to 4 years postoperatively, with a lower transvalvular gradient, hence decreased left ventricular workload.
64-Slice Computed Tomography of Bovine Internal Mammary Artery Coronary Grafts
Authors: Colli Andrea , Budillon Alessandro Maria , Cademartiri Filippo , Palumbo Alessandro , Maffei Erica , Gherli Tiziano
Published: May 2013

In cases where conventional aortocoronary grafts cannot be used, No-React bovine internal mammary artery is a possible alternative. The aim of this study was to assess the patency and clinical performance of bovine internal mammary artery as a coronary bypass conduit, using 64-slice computed tomography coronary angiography. Eleven patients (mean age, 68.2 ± 5.9 years) received 11 bovine grafts between 2002 and 2006. Eight of these patients were alive after a mean follow-up of 29.4 ± 16.3 months. Their mean additive EuroSCORE was 6.5 ± 3.2. The mean number of distal anastomoses was 2.5 ± 0.5. Six grafts were anastomosed to the right coronary artery, 2 to the left anterior descending artery, and 3 to the circumflex artery. All 11 bovine grafts were found to be occluded after 14.1 ± 3.6 months. This demonstrates very poor results with the bovine coronary graft, thus we do not recommend its use, and we suggest considering an hybrid approach in selected cases.
Extracorporeal Membrane Oxygenation for Children with Fulminant Myocarditis
Authors: Mani Anna , Shankar Sriram , Tan Teng Hong , Wong Keng Yean
Published: May 2013

The purpose of this study was to evaluate the outcomes of children requiring extracorporeal membrane oxygenation for acute myocarditis. The hospital records of 8 patients who underwent membrane oxygenation for myocarditis from January 2002 to October 2008 were reviewed. Ages ranged from 3 to 12 years (median, 6 years). Duration of membrane oxygenation ranged from 89–502 h. Two patients who collapsed and required cardiac massage prior to membrane oxygenation did not survive. Five (62.5%) patients were discharged well, but one developed dilated cardiomyopathy and died 18 months later. One child had severe mitral regurgitation after weaning from membrane oxygenation, and underwent successful mitral valve repair. Another patient had no cardiac contractility for the initial 2 weeks, but regained good cardiac function after 21 days of support. She was weaned off membrane oxygenation and discharged home well. Complications included left hemiparesis in one patient and left hemothorax in 2. Recovery of cardiac function and a good outcome can be anticipated in children with acute myocarditis requiring membrane oxygenation. Initiation of membrane oxygenation before cardiovascular collapse increases the likelihood of survival.
Bidirectional Cavopulmonary Shunt with Additional Pulmonary Blood Flow
Authors: Suzuki Yasuyuki , Yamauchi Sanae , Daitoku Kazuyuki , Fukui Kozo , Fukuda Ikuo
Published: May 2013

There are some controversies regarding the usefulness of leaving additional pulmonary blood flow when establishing a bidirectional cavopulmonary shunt. From April 2002 to September 2008, 13 patients (mean age, 24 ± 16 months) underwent a bidirectional cavopulmonary shunt procedure with fine adjustment of additional pulmonary blood flow, as an intermediate step before the Fontan operation. There were no hospital deaths. Modified Blalock-Taussig shunts were left during the bidirectional cavopulmonary shunt operation in 7 patients, and pulmonary bands were tightened in 4. The main pulmonary artery with a previous pulmonary band was left open in one case. Oxygen saturation increased from 74.5% ± 7.4% to 84.6% ± 1.9% after the operation, cardiothoracic ratio decreased from 55.9% ± 6.1% to 53.2% ± 3.4%, Left ventricular end-diastolic pressure decreased from 11.0 ± 2.6 to 7.8 ± 3.0 mm Hg, and mean pulmonary arterial pressure from 14.7 ± 7.5 to 10.2 ± 3.1 mm Hg. Pulmonary artery index did not change significantly. In our experience, additional pulmonary blood flow with adjustment in each patient at the time of shunt construction was an excellent temporary palliation prior to the Fontan operation.
Surgery for Papillary Fibroelastoma with Uncommon Location in Left Ventricle
Authors: Domenech Alberto , Pérez de Arenaza Diego , García Rivello Hernán , Patrucco Liliana , Bracco Daniel
Published: May 2013

Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is uncommon. A 59-year-old woman with 2 previous strokes presented with a tumor in the left ventricular apex. The patient underwent tumor resection through a left ventriculotomy. The histopathologic diagnosis was papillary fibroelastoma.
Repair of Ventricular Septal Perforation after Inferior Myocardial Infarction
Authors: Yamamoto Nobuyuki , Ohara Kuniyoshi , Nie Masaki , Torii Shinzo , Inoue Nobuyuki , Miyaji Kagami
Published: May 2013

Various techniques have been used for repair of ventricular septal perforation complicating inferior myocardial infarction, but no standard method has been established. An effective technique for closing ventricular septal perforation using double patches via a right atrial approach is described. In our experience, no residual shunt was observed after repair using this procedure.
Oxygen Pulse as a Predictor of Cardiopulmonary Events in Lung Resection
Authors: Campione Andrea , Terzi Alberto , Bobbio Marco , Rosso Gian Luca , Scardovi Angela Beatrice , Feola Mauro
Published: May 2013

Traditional algorithms suggest a stepwise approach to the functional evaluation of candidates for lung resection. A cardiopulmonary exercise test is incorporated as a supplementary test for patients with borderline pulmonary predicted values, and sometimes as a first screening test for cardiac risk evaluation. To assess the predictive weight of exercise tests in noncardiac thoracic surgery, we retrospectively analyzed 99 patients (80 males) aged 67.8 ± 8.1 years who underwent lung resection after a cardiopulmonary exercise test. During basal spirometry, the mean predicted forced expiratory volume in the first second was 69.9% ± 18.6%, and predicted carbon monoxide diffusing capacity was 71.6% ± 20.5%. Peak oxygen consumption was 11.1 ± 3.2 mL·kg−1·min−1, oxygen pulse was 9 ± 2.8 mL·beat−1, and minute ventilation/CO2 output was 45.2 ± 7.7. Mean hospital stay was 10.4 days, and intensive care unit stay was 0.3 days. Postoperative complications occurred in 20 (20%) patients. On multivariate analysis, body mass index, a high level of exercise achieved during the cardiopulmonary exercise test, lower heart rate at peak exercise, and oxygen pulse correlated significantly with better postoperative outcome. Cardiopulmonary exercise tests are helpful for stratifying patients undergoing thoracic surgery. Perioperative complications seem to be strongly related to left ventricular function and physical performance.
Mesothelial Cells vs. Skeletal Myoblasts for Myocardial Infarction
Authors: Bourahla Belahouel , Shafy Abdel , Meilhac Olivier , Elmadbouh Ibrahim , Michel Jean-Baptiste , Chachques Juan C
Published: May 2013

Cell transplantation for the regeneration of ischemic myocardium is limited by poor graft viability and low cell retention. Omental flaps in association with growth factors and cell sheets have recently been used to increase the vascularization of ischemic hearts. This experimental study was undertaken to evaluate the hemodynamic evolution and histological modifications of infarcted myocardium treated with mesothelial cells, and to compare the results with those of hearts treated with skeletal myoblasts. Myocardial infarction was created by surgical ligature of 2 coronary branches in 34 sheep; 6 died immediately due to ventricular fibrillation. Mesothelial cells were isolated from greater omentum, and myoblasts from skeletal muscle. After expanding the cells for 3 weeks, infarcted areas were treated with culture medium (control group), mesothelial cells, or myoblasts. After 3 months, echocardiographic studies showed significant limitation of ventricular dilatation and improved ejection fractions in both cell-treated groups compared to the controls. In the mesothelial cell group, histological studies showed significantly more angiogenesis and arteriogenesis than in the control and skeletal myoblast groups. Mesothelial cells might be useful for biological revascularization in patients with ischemic heart disease.
Clamp-and-Sew Technique for Traumatic Injuries of the Aorta: 20-Year Experience
Authors: Bhaskar Jayapadman , Foo Jonathan , Sharma Ashok Kumar
Published: May 2013

Traumatic aortic injuries are associated with high morbidity and mortality, and the ideal operative approach for surgical management is unclear. We analyzed our results with the open clamp-and-sew technique over a 20-year period. Twenty patients with transected aorta were given interposition grafts; 19 of them had multisystem injuries. Mean aortic crossclamp time was 21.7 min (range, 12–30 min). Postoperative complications included pneumonia in 4 patients, acute renal failure in 1, recurrent laryngeal nerve injury in 2, chylothorax in 1, and sepsis of unknown etiology in one. There was no incidence of operation-related paraplegia. Although there was no 30-day mortality, one patient died after 90 days from diffuse axonal injuries to the brain. In experienced hands, the clamp-and-sew technique is effective and safe for the management of traumatic aortic transection.
Extracardiac Fontan Operation after Late Bidirectional Glenn Shunt
Authors: Ganigara Madhusudan , Prabhu Atul , Varghese Roy , Pavithran Sreeja , Valliatu John , Kumar Raghavan Nair Suresh
Published: May 2013

The outcomes of 33 consecutive extracardiac Fontan operations performed between 1999 and 2008 in patients who mostly had initial Glenn shunts beyond infancy were reviewed. Preoperatively, the median oxygen saturation was 76.2% and mean pulmonary artery pressure was 10.5 mm Hg. The median age was 4.1 years at Glenn shunt procedure and 10 years at Fontan operation. The duration of chest tube drainage was longer in these patients than in series where Glenn shunts were created at a younger age. All patients received warfarin for 1 year, then warfarin and/or aspirin. At follow-up (median, 14 months), there was no significant ventricular dysfunction. Median oxygen saturation at the last follow-up was 92%. All patients in sinus rhythm preoperatively continued in this status. There was no Fontan failure or mortality. All patients were in New York Heart Association class I or II, although objective cardiopulmonary exercise evaluation in 8 patients showed impaired exercise tolerance. Despite a trend towards prolonged pleural effusion, there was no adverse outcome in the short or intermediate term. Long-term follow-up is required to see whether delayed creation of a Glenn shunt is associated with late disadvantages.
Reconstruction of Anterior Descending Artery after Removal of Stents
Authors: Zattera Giuseppe F , Grande Antonino M , Gaeta Roberto , Savasta Marcello , Lentini Salvatore , Viganò Mario
Published: May 2013

A 65-year-old man who had previously undergone multiple stenting on the coronary tree, was referred for urgent surgery. The left anterior descending coronary artery was found to be completely stented from the proximal to the distal portion. Open endarterectomy was required for removal of multiple thrombosed stents and reconstruction of the left anterior descending artery using left internal mammary artery. This highlights the need to spare the distal parts of coronary vessels for future surgery.
Extended Three-Patch Technique for Congenital Supravalvular Aortic Stenosis
Authors: Oka Norihiko , Liava'a Matthew , Saxena Pankaj , d'Udekem Yves , Brizard Christian P , Konstantinov Igor E
Published: May 2013

We describe a modified extended 3-patch surgical procedure to relieve supravalvular aortic stenosis. This simple technique provides effective and lasting enlargement of the ascending aorta in patients with severe congenital supravalvular aortic stenosis.
En-Bloc Free Gastroepiploic Artery Graft Provides a Good Long-Term Patency Rate
Authors: Eda Tadahito , Miyahara Ken , Oshima Hideki , Usui Akihiko , Matsuura Akio , Ueda Yuichi
Published: May 2013

For coronary artery bypass grafting, the use of free gastroepiploic artery is unpopular because of its tendency to vasospasm. We assessed the en-bloc free gastroepiploic artery graft, which has the gastroepiploic vein anastomosed to the right atrial appendage to prevent graft spasm, and compared it to the skeletonized free gastroepiploic artery graft. A retrospective review was conducted in 57 patients who received en-bloc grafts and 29 who had skeletonized grafts. Kaplan-Meier analysis demonstrated the superiority of the en-bloc free gastroepiploic artery graft with an 80-month patency rate of 96.6% compared to 66.7% with skeletonized grafts. We selected 13 cases from each group, using propensity-score matching, and compared the long-term patency rates. Propensity-score matched analysis showed 80-month patency rates of 100% for en-bloc grafts and 60% for skeletonized grafts. Coronary artery bypass using free gastroepiploic artery grafts with venous drainage seems to provide good long-term results.
10-Year Follow-Up of Off-Pump Multivessel Coronary Artery Bypass Grafting
Authors: Raja Shahzad G , Navaratnarajah Manoraj , Kitchlu C Saifuddin , George Shane , Ilsley Charles D , Amrani Mohamed
Published: May 2013

On-pump total arterial grafting is associated with improved long-term outcomes compared to conventional grafting using left internal thoracic artery and saphenous vein grafts, but there are no data to confirm the same for off-pump total arterial grafting. We assessed the impact of off-pump total arterial grafting on medium-term outcomes. From September 1998 to September 2008, 580 consecutive patients who had off-pump multivessel arterial grafting only were compared with a control group of 806 patients undergoing off-pump coronary artery bypass with internal thoracic artery and saphenous vein grafts, performed by the same surgeon. Perioperative data were collected prospectively. Medium-term univariate and risk-adjusted comparisons between the 2 groups were carried out. After adjusting for clinical covariates, total arterial grafting did not emerge as a significant independent predictor of medium-term mortality, readmission to hospital, or the composite outcome of death and readmission. At medium-term follow-up, off-pump total arterial grafting, despite being a safe and effective myocardial revascularization strategy, offered no mortality or morbidity benefits.
Postoperative Revision Surgery for Bleeding in a Tertiary Heart Center
Authors: Mataraci Ilker , Polat Adil , Toker Mehmet Erdem , Tezcan Orhan , Erkin Alper , Kirali Kaan
Published: May 2013

We analyzed cases of re-exploration for bleeding after 19,680 open heart operations performed between January 1995 and January 2009 to determine the risk factors for mortality and morbidity. Half of the 282 patients reexplored had nonsurgical causes of bleeding. The patients were grouped according to the timing of reoperation, early reexploration being on the day of the operation. Mortality, total morbidity, and the need for transfusion of any blood product were compared between the early and late reexploration groups. Most patients (77.7%) were reexplored early. Overall mortality was 8.5% (24 patients). Mortality, total morbidity, renal, gastrointestinal, neurologic and infectious complications, and low cardiac output differed significantly between the 2 groups. Significant predictors of mortality were old age, female sex, left ventricular dysfunction, noncoronary operations, and delayed reoperation. Predictors of morbidity were old age, preoperative dialysis, tobacco use, chronic lung disease, and delayed reoperation. No factors were found to be associated with the need for transfusion.
Global Aspects of Cardiothoracic Surgery with Focus on Developing Countries
Authors: Pezzella A Thomas
Published: May 2013

The incidence and prevalence of cardiothoracic disease continue to increase globally, especially in emerging economies and developing countries. Cardiothoracic surgery is also growing despite limited access, availability of surgical centers, political and cost issues. The increase in atherosclerotic coronary artery disease, rheumatic heart disease, congenital heart disease, trauma, and thoracic malignancies is a more urgent problem than realized in these emerging economies and developing countries, or low- and middle-income countries. A determined focus and cooperation between the preventive and curative elements of care is warranted. This represents a paradigm shift to develop a consensus that fosters a multi-integrated disease-specific approach that includes prevention, promotion, diagnosis, treatment, and rehabilitation. In addition, the concept or acceptance of surgery as a necessary component of public health policy is critical to improving overall global healthcare.
Congenital Right Pulmonary Artery-to-Left Atrial Fistula
Authors: Liu Ligang , Wei Xiang , Pan Tiecheng
Published: May 2013

A 23-year-old man presented with cyanosis since birth. Precordial echocardiography failed to detect any structural heart abnormality except for enlarged left atrium. Pulmonary angiography revealed a type I right pulmonary artery-to-left atrial fistula. Simple ligation of the fistula without cardiopulmonary bypass was performed successfully, and the cyanosis disappeared postoperatively.
Critical Stenosis of Pulmonary Homograft Induced by Surgicel in Ross Procedure
Authors: Teis Albert , Cámara María-Luisa , Ferrer Elena , Romero-Ferrer Bernardo
Published: May 2013

Surgicel is bio-absorbable cellulose used to control bleeding. A 52-year-old woman with severe aortic valve regurgitation and aortic dilatation underwent the Ross procedure and ascending aortic replacement. After 48 h, she suffered severe hypotension and hypoxemia. Arteriography revealed stenosis of the pulmonary homograft, which required urgent re-intervention. Extrinsic compression of the posterior wall of the homograft due to Surgicel was found.
Absence of Calcium Channel α1C-Subunit Mutation in Human Atrial Fibrillation
Authors: Soon Jia-Lin , Ping Liao , Chua Yeow-Leng , Soong Tuck-Wah , Yoong-Kong Kenny Sin
Published: May 2013

L-type voltage-gated calcium channel mutation or phenotypical variation resulting from alternative splicing has been associated with sudden arrhythmogenic death and heart failure. Changes in calcium current density, protein and mRNA expression have been associated with atrial fibrillation. We studied human atrium harvested from 16 cardiac surgery patients (coronary bypass and/or valve procedures) for mutation of Cav1.2 α1C (the main pore-forming subunit of L-type voltage-gated calcium channel) for an association with atrial fibrillation. Seven patients had persistent atrial fibrillation and one was resuscitated from ventricular arrhythmia. Clinical data were collected and prospectively updated for the development of arrhythmia. Four (25%) patients had new-onset postoperative paroxysmal atrial fibrillation. DNA from all atrial specimens was amplified, extracted, and sequenced. The α1C-subunit mutation was absent in all specimens obtained from all patients, regardless of heart rhythm. This suggests that atrial fibrillation is not associated with loss-of-function mutation of the main pore-forming subunit of the L-type voltage-gated calcium channel.
Revisiting the Prone Position in Video-Assisted Thoracoscopic Surgery
Authors: Agasthian Thirugnanam
Published: May 2013

The fully prone position, once used in surgery for chronic inflammatory lung diseases, has become obsolete. In the last 2 years, a modified semiprone position was used for video-assisted thoracoscopic surgery in 358 patients undergoing lobectomy with mediastinal complete lymphadenectomy The ports were placed with the patient in the lateral decubitus position. The patient was rotated 45–60 degrees towards the surgeon, giving enhanced exposure of the posterior mediastinum, esophagus, subcarinal and paratracheal spaces, due to displacement of the lung under gravity away from the operative field. This position is safe, well-tolerated, and allows more ergonomic and anatomical placement of the ports.
Successful Surgical Repair of Complete Sternal Cleft in an Adult
Authors: Jabbad Husain , Shehata Rajab , Al-Ebrahim Khaled
Published: May 2013

We describe direct repair of congenital complete sternal cleft in a 35-year-old woman, using titanium plates fixed by pre-drilled screws to the manubrium and costal cartilages. This provided excellent protective and cosmetic results.
Warm Pediatric Cardiac Surgery: European Experience
Authors: Durandy Yves
Published: May 2013

Cold pediatric cardiac surgery has been a dogma for 50 years. However, the beneficial effects of cold perfusion are counterbalanced by the drawbacks of hypothermia. Thus, we propose a major paradigm shift from hypothermic surgery to warm perfusion and intermittent warm blood cardioplegia. This approach gives satisfactory results even with prolonged aortic crossclamp times. The major advantages are reduced time to extubation and shorter intensive care unit stay. Warm pediatric surgery is an anecdotal phenomenon no more; over 10,000 procedures have been carried out in Europe. All types of cardiopathy have been treated, including arterial switch, total pulmonary anomalous venous return, interruption of the aortic arch, and hypoplastic left heart syndrome. Once surgeons decide to shift from hypothermia to normothermia, they never decide to shift back to hypothermia. This fact is evidence of the satisfactory clinical outcome obtained with this technique. The technique and the composition of microplegia is identical in all European centers, the only variable factor being the interval between microplegia injections, which varies from 10 to 25 min. We hope that the increasing interest in pediatric warm surgery will hearten new candidates.
Ectopic Congenital Thymic Cyst in the Right Pleural Cavity
Authors: Bruno Vito D , Mariscalco Giovanni , Franzi Francesca , Miceli Antonio , Piffaretti Gabriele , Sala Andrea
Published: May 2013

A 37-year-old man with a huge pleural cyst, presented with symptoms of right heart compression. The mass on the right side of the chest seemed initially to be in connection with the mediastinum. Computed tomography failed to define its relationship with the pericardium, and echocardiography excluded any involvement of the mediastinal structures. The final diagnosis was a congenital thymic cyst exclusively located in the pleural cavity.
A Proposal for Management after Lung Resection, Using a Flexible Silastic Drain
Authors: Kamiyoshihara Mitsuhiro , Nagashima Toshiteru , Ibe Takashi
Published: May 2013

We advocate a technique using a small silastic flexible drain for air leaks after pulmonary resection. Patients undergoing lung resection by video-assisted thoracic surgery were enrolled in this study. The 331 patients consisted of 227 men and 104 women, with a median age of 58 years. The surgical procedures were lobectomy in 145, wedge resection in 177, and segmentectomy in 9. At the end of the operation, a 19F silastic drain under a pressure of −7 cm H2O was inserted. When no air leak was observed, we removed the drain on postoperative day 1. When an air leak was observed, the suction mode was changed to a water seal. The mean duration of chest tube drainage was 1.9 days. The chest tube was removed on postoperative day 1 in 243 (73.4%) patients. Postoperative complications, other than prolonged air leak, occurred in 5 (1.5%) patients. The drain was not effective in 4 (1.2%) patients, and it was replaced with a conventional rigid drain. Management of air leaks using silastic flexible drains is safe and effective after wedge resection. Care should be taken in cases of lobectomy and segmentectomy when a large air leak is anticipated.
Hemodynamics and Outcomes of Aortic Valve Replacement with a 17- or 19-mm Valve
Authors: Okamura Homare , Yamaguchi Atsushi , Noguchi Kenichiro , Naito Kazuhiro , Yuri Koichi , Adachi Hideo
Published: May 2013

When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis-patient mismatch is of concern because it may affect postoperative clinical status. We conducted a retrospective study of outcomes in 65 patients with aortic stenosis requiring valve replacement. Fifty were given a 17-mm or 19-mm St. Jude Regent mechanical valve, and 15 were given a 19-mm Medtronic Mosaic bioprosthesis. Echocardiography was carried out preoperatively, at discharge, and at follow-up. There was 1 (2%) operative death in the Regent group and none in the Mosaic group. There was no valve-related event. Follow-up echocardiography in both groups revealed a significant increase in the mean effective orifice area index, a decrease in the mean left ventricular-aortic pressure gradient, and a decrease in the mean left ventricular mass index. Prosthesis-patient mismatch (effective orifice area index <0.85 cm2 · m−2) existed in 13 (26%) patients in the Regent group and 11 (73%) in the Mosaic group at discharge. All patients improved to New York Heart Association functional class II or better. A small-sized prosthesis may provide satisfactory clinical and hemodynamic results in patients with a small aortic annulus.
Mitral Valve Repair: Past, Present, and Future
Authors: Wong Randolph HL , Lee Alex PW , Ng Calvin SH , Wan Innes YP , Wan Song , Underwood Malcolm J
Published: May 2013

Mitral valve repair is the operation of choice for mitral valve regurgitation, with appropriate selection. Studies have shown that mitral repair is associated with a decrease in both long-term thromboembolic complications and mortality. Since its initial description, various selection criteria and techniques of mitral valve repair have been discussed in the literature. This review serves as a synopsis of the previous achievements, present status, and possible future directions of mitral valve repair, specifically from an Asian perspective. Vast experience has been amassed in understanding mitral valve pathophysiology, and excellent surgical treatments for mitral regurgitation have been developed. With the efforts of pioneers in the field of mitral valve repair, standard surgical treatment strategies have been proven to restore the life-expectancy of patients with degenerative mitral regurgitation to that of the age-adjusted population. Minimally invasive techniques of mitral valve repair further reduce access trauma, and could potentially benefit patients previously excluded from conventional surgery.
Repair of Left Subclavian Artery and Aberrant Right Subclavian Artery Aneurysms
Authors: Nair Kannan R , Vasu Harilal , Jacob Aju , Velayudhan Bashi V
Published: May 2013

Left subclavian artery aneurysm with an aneurysm of the aberrant right subclavian artery is a rare condition with a reported incidence of 0.13% to 1%. We report the successful surgical correction of both conditions in a 34-year-old man.
Left Laterotracheal Retrosternal Goiter with Left Upper Limb Ischemia
Authors: Chafik Aziz , Benjelloun Amine , Bouchentouf Rachid , Mikou Iliass , Ehirchiou Abdelkader
Published: May 2013

We describe a rare case of retrosternal goiter that developed on the left side of the trachea, squeezing between the trachea and the left supra-aortic vessels, and causing signs of compression and acute left upper limb ischemia in a 35-year-old woman. Her symptoms disappeared after an emergency total thyroidectomy was performed.
Diffusion-weighted magnetic resonance for pulmonary nodules: 1.5 vs. 3 tesla
Authors: Ohba Yasuomi , Nomori Hiroaki , Mori Takeshi , Shiraishi Kenji , Namimoto Tomohiro , Katahira Kazuhiro
Published: May 2013

The usefulness of diffusion-weighted magnetic resonance for assessing malignant pulmonary nodules was examined in 58 patients with 76 (58 malignant, 18 benign) pulmonary nodules (1.0–5.6 cm) who underwent 1.5-Tand 3-Tesla imaging and 18F-fluorodeoxyglucose positron-emission tomography prior to surgery. The sensitivities and specificities of these techniques for discriminating benign and malignant nodules were compared. The apparent diffusion coefficients of the pulmonary nodules on 1.5-T and 3-T imaging correlated significantly. The sensitivities and specificities for discriminating benign and malignant lesions were similar among the 3 imaging techniques: 1.5-T imaging, 0.91 and 0.90; 3-T imaging, 0.88 and 0.94; positron-emission tomography, 0.94 and 0.94. The apparent diffusion coefficient on 1.5-T imaging showed a significant reverse correlation with positron-emission tomography, and the correlation between 3-T imaging and positron-emission tomography was marginally significant. Both 1.5-T and 3-T diffusion-weighted magnetic resonance imaging modalities are equally useful for assessing malignant pulmonary nodules.
Efficacy of a New Oxygenator-Integrated Fat and Leukocyte Removal Device
Authors: Dell'Amore Andrea , Tripodi Alberto , Cavallucci Andrea , Guerrini Franco , Ronchi Barbara , Zanoni Silvia , Lamarra Mauro
Published: May 2013

We evaluated the effectiveness of a new oxygenator-integrated device for removing lipid particles and leukocytes from shed mediastinal blood in 20 patients undergoing elective cardiac surgery under cardiopulmonary bypass. Another 20 patients undergoing cardiac surgery without the device served as controls. After filtration with the RemoveLL device, lipid particles, leukocytes, and fats were significantly reduced compared to preoperative levels. In the control group, blood fats and lipid particles at the end of cardiopulmonary bypass were significantly increased compared to preoperative levels. Leukocyte counts at the end of bypass were significantly lower in patients who had the filtration device compared to the control group. Platelets counts and hematocrit changes were not significantly different between the 2 groups.
Experimental Replacement of Pig Trachea with Novel Bioprosthesis from Harp Seal
Authors: Agathos E Andreas , Tomos Periklis , Lachanas Elias , Gakiopoulou Harikleia , Pantopoulou Alkystis , Perrea Despina
Published: May 2013

Tracheal replacement has been a challenging problem for thoracic surgeons for over half of a century. We evaluated the in-vivo performance of a new tracheal bioprosthesis derived from Harp seal (Phoca groelandica) trachea that was fixed and preserved in 0.625% buffered glutaraldehyde solution for 3 months. Ten young male pigs weighing 27–32 kg (mean, 28.7 kg) underwent replacement of a tracheal segment with this new bioprosthesis. The length of replaced trachea was 1.8–2.4 cm (mean, 2.17 cm), representing 2–3 cartilage rings. All pigs survived the operation uneventfully. No immunosuppression drugs were used. The pigs eventually developed dyspnea and were euthanized on postoperative day 17–39 (mean, 30.8 days). Macroscopic and histological analysis showed an intact bioprosthesis but near-total occlusion of the native trachea by a ring of inflammatory infiltration at the site of distal anastomosis. More experiments involving a different concentration of the preservation agent, different management, and perhaps the use of bioengineering techniques are needed to improve the performance of this novel bioprosthesis.
Extracranial Carotid Artery Aneurysm Due to Behçet's Disease
Authors: Albeyoglu Sebnem , Cinar Bayer , Eren Tunc , Filizcan Ugur , Bayserke Olgar , Aslan Cenk
Published: May 2013

Behçet's disease is a chronic systemic inflammatory disorder associated with recurrent oral and genital ulcers and iritis. Vascular lesions are encountered in 7%–29% of patients, gravely affecting the course of the disease. Extracranial carotid aneurysms due to Behçet's disease are extremely rare. We describe a surgically treated case of Behçet's disease in a 28-year-old man who presented with a rapidly enlarging left common carotid artery aneurysm.
Atrioventricular Nodal Reentrant Tachycardia Treatment Using Novel Potential
Authors: Ardashev Andrey V , Makarenko Alexandr S , Zhelyakov Eugeny G , Shavarov Andrey A
Published: May 2013

Radiofrequency ablation of atrioventricular nodal reentrant tachycardia is commonly guided by slow and sharp bipolar potentials of the atrioventricular slow nodal pathway. We optimized the morphology of the guiding potential by unipolar mapping of the slow nodal pathway. We identified a novel unipolar dual-component atrial electrogram at the anterior limb of the coronary sinus ostium. The first component was a positive delta-wave type that corresponded to the isoelectric phase on a bipolar electrogram. The second component had fast biphasic morphology and corresponded to the R wave on a bipolar atrial electrogram. Of 104 consecutive patients with typical atrioventricular nodal reentrant tachycardia, 51 were treated with ablation guided by the novel potential, and 53 underwent ablation using the conventional technique. There was no recurrence of tachycardia in any of these patients. In those treated by the novel potential, there was significantly less radiofrequency power applied and a shorter duration of application than in patients treated by the traditional approach. The novel approach to mapping and ablation of the slow nodal pathway in atrioventricular nodal reentrant tachycardia guided by unipolar recording was safe and effective, and comparable to the traditional technique.
Venoatrial Shunt-Assisted Cavopulmonary Anastomosis
Authors: Kandakure Pramod Reddy , Dharmapuram Anil Kumar , Kale Suresh Babu , Babu Vivek , Ramadoss Nagarajan , Rao Ivatury Mrityunjaya , Murthy Kona Samba
Published: May 2013

The bidirectional Glenn shunt operation is conventionally performed under cardiopulmonary bypass. Between June 2007 and September 2009, 218 consecutive patients underwent off-pump bidirectional Glenn shunt institution for single ventricle with pulmonary stenosis complex. Their mean age was 4.72 ± 1.80 years (range, 4 months to 6 years) and median weight was 10.12 kg (range, 4.1–19 kg). A temporary shunt was created between the innominate vein and the right atrium, with a 3-way connector for de-airing. Fifty-five patients had bilateral cavae. The mean internal jugular venous pressure on clamping the superior vena cava was 24.69 ± 1.81 mm Hg. Continuous end-tidal CO2 and O2 saturation were monitored. Adequate oxygen saturation and blood pressure were maintained by optimizing inotropics, volume, and inspired oxygen. The mean duration of ventilation was 10.17 ± 8.96 h (range, 1–73 h). There were no gross neurological complications. Postoperative pleural effusion developed in 6 (2.75%) patients, and 4 (1.83%) had nodal rhythm. Four (1.83%) patients died in the immediate postoperative period due to low cardiac output syndrome. Venoatrial shunt-assisted bidirectional Glenn shunt surgery can be performed safely by optimizing intraoperative management strategies. It is economical and avoids the deleterious effects cardiopulmonary bypass.
Cardiac surgery in a patient with paroxysmal nocturnal hemoglobinuria
Authors: Chu Sharon HL , Andrews David , Watanabe Yuki
Published: May 2013

A 44-year-old woman who had been diagnosed with paroxysmal nocturnal hemoglobinuria, presented with chest pain. Angiography revealed critical distal left main stenosis and proximal stenoses of the left anterior descending and circumflex arteries. Prophylactic antibiotics, infusion of blood products and mannitol intraoperatively, and antithrombotic therapy postoperatively ensured a good outcome of coronary artery bypass graft surgery under cardiopulmonary bypass.
Intramural esophageal bronchogenic cysts
Authors: Chafik Aziz , Benjelloun Amine , Qassif Hassan , El Fikri Abdelghani , El Barni Rachid , Zrara Ibtissam
Published: May 2013

Bronchogenic cysts are most frequently located in the middle mediastinum near the carina. Esophageal bronchogenic cysts are extremely rare. An intramural esophageal bronchogenic cyst was successfully resected from a 51-year-old man.
Intermittent positive-pressure breathing after lung surgery
Authors: Ludwig Corinna , Angenendt Sebastian , Martins Renato , Mayer Volker , Stoelben Erich
Published: May 2013

Intermittent positive-pressure breathing is thought to avoid atelectasis and improve pulmonary function after major lung resections. Since no clear scientific data was available to confirm this, our objective was to determine whether atelectasis can be avoided and if postoperative lung function is improved. Prospective analysis was carried out in 135 patients operated on between 2007 and 2009; 55 received intermittent positive-pressure breathing. Pre- and postoperative lung function tests were similar in both groups. Pulmonary complications were observed in 19% of patients without intermittent positive-pressure breathing and 27% of those who received this treatment. We were unable to find evidence that additional improvement in postoperative pulmonary function is achieved when adding intermittent positive-pressure breathing to the standard physical therapy.
Salvage resection of a large chemorefractory mediastinal germ cell tumor
Authors: Konstantinov Igor E , Saxena Pankaj , Barrett Trenton L , Venkitachalam Stephanie , Keshavamurthy Suresh , Newman Mark AJ
Published: May 2013

Immature mediastinal teratomas refractory to chemotherapy are very rare and require management by an aggressive surgical approach. We describe resection of a large mediastinal teratoma in a 23-year-old man, with a satisfactory early result.
Late tricuspid surgery: predicting outcome with computed tomography
Authors: Chan Daniel TL , Lam Wendy WM , Tsang Flora HF , Ho Cally KL , Au Timmy WK , Cheng Lik-Cheung
Published: May 2013

Tricuspid regurgitation can progressively worsen years after left-sided heart valve surgery, requiring surgical intervention for which the prognostic factors are unclear. This study aimed to assess the prediction of surgical outcome using right ventricular function obtained from computed tomography. We prospectively enrolled 24 patients who underwent isolated tricuspid repair or replacement from 2005 to 2008. Right ventricular computed tomography was carried out before surgery. The primary endpoint was survival with symptomatic improvement after one year. Twelve patients survived with improvement of at least one New York Heart Association functional class, and 12 died or had no symptomatic improvement. All baseline characteristics, echocardiogram data, and surgical details were similar in both groups. Right ventricular computed tomography parameters including end-systolic volume, indexed end-systolic volume, end-diastolic volume, and indexed end-diastolic volume were significantly different between the two groups. We concluded that right ventricular function assessed by computed tomography can predict the surgical outcome in patients undergoing surgery for isolated late tricuspid regurgitation.