bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated Positron-Emission Tomography for Nodal Staging in Lung Cancer
Authors: Lee Hyun Joo , Kim Young Tae , Kang Won Jun , Lee Hyun Ju , Kang Chang Hyun , Kim Joo Hyun
Published: May 2013

As lymph node metastasis is the most important factor determining the surgical outcome of lung cancer, we evaluated the accuracy and clinical usefulness of functional imaging with integrated positron-emission tomography and computed tomography in nodal staging of non-small-cell lung cancer. Between October 2003 and August 2004, 43 newly diagnosed patients underwent curative surgical resection or mediastinoscopic nodal biopsy after chest computed tomography as well as whole-body functional imaging for clinical staging. Based on histopathologic findings in the lymph nodes, we compared the diagnostic usefulness of computed tomography and functional imaging. Twenty-two patients were N0 stage, 6 were N1, 11 were N2, and 4 were N3. Although functional imaging seemed to be superior for evaluation of N2 nodes, there were no significant differences in the sensitivity, specificity, positive-predictive value, negative-predictive value, or accuracy. The situation was similar for N1 nodes, and there were no significant differences except for the false-negative rate. High false-positive and negative-rates for N2 lymph nodes suggest that functional imaging should not replace mediastinoscopy.
Aneurysm of All 3 Sinuses of Valsalva Causing Coronary Insufficiency
Authors: Bhat PS Seetharama , Babu Murali , Gehlot Rajeev , Peer Syed Murfad
Published: May 2013

A 35-year-old woman presented with chest pain and easy fatigability. Transthoracic echocardiography demonstrated an unruptured aneurysm involving all 3 sinuses of Valsalva. Successful surgical repair was undertaken, without the need for aortic valve replacement or coronary artery bypass.
Stomach Pierced by Apical Cuff Late after Removal of Toyobo Assist Device
Authors: Nawata Kan , Kyo Shunei , Ono Minoru , Motomura Noboru , Takamoto Shinichi
Published: May 2013

A 38-year-old woman suffering from dilated cardiomyopathy underwent successful removal of a Toyobo left ventricular assist device after 11 months of support. Four months later, discharge of pus from the skin resulted from the contaminated residual apical cuff. The purulence stopped spontaneously 16 months later, but halitosis then developed. Two weeks later, fever and hematemesis occurred. Emergency surgery revealed gastric perforation by the apical cuff, which was removed under cardiopulmonary bypass.
Robot-Assisted Excision of Ectopic Mediastinal Parathyroid Adenoma
Authors: Chan Alexander PH , Wan Innes YP , Wong Randolph HL , Hsin Michael KY , Underwood Malcolm J
Published: May 2013

Robot-assisted excision of an ectopic parathyroid adenoma in the superior mediastinum was performed in a 57-year-old man. The mass was located by methoxyisobutylisonitrile scan and computed tomography. Identification of the ectopic parathyroid adenoma was facilitated by the 3-dimensional images of the da Vinci robotic system, and resection was achieved using EndoWrist instruments. Robot-assisted excision of parathyroid adenoma located in the relatively inaccessible superior mediastinum proved to be feasible.
Blunt Coronary Injury Presenting as Massive Left-Sided Hemothorax
Authors: Tyson G Hart , Anderson Curtis A , Rodriguez Evelio , Kypson Alan P
Published: May 2013

Hemothorax after blunt trauma results from injury to intrathoracic structures or the chest wall. Tube thoracostomy is the most common mode of treatment; depending on the type of injury, it is frequently the only intervention required. Rarely, blunt cardiac injury can produce hemothorax if a communication exists between the pericardium and pleural space. We describe such a case that highlights the importance of a broad differential diagnosis when treating acutely injured patients.
Hemodynamic Advantages of Right Heart Decompression during Off-Pump Surgery
Authors: Velissaris Theodore , Jonas Max M , Ohri Sunil K
Published: May 2013

Cardiac maneuvering during off-pump coronary artery bypass surgery can compress the right ventricle, causing temporary dysfunction and hemodynamic instability. The hemodynamic impact of a decompression technique comprising right pleurotomy and pericardial release was investigated during cardiac elevation. Intraoperative continuous real-time monitoring of cardiac index and stroke volume index was carried out using the PulseCO system in 12 consecutive patients with normal ventricular function who underwent off-pump coronary artery bypass by a single surgeon. A pulmonary artery catheter was used to monitor pulmonary artery pressure and systemic venous O2 saturation. Hemodynamic changes during vertical displacement of the heart were measured before and after performing a right pleurotomy and pericardial release. Following right heart decompression, stroke volume index, cardiac index, mean arterial pressure, and systemic venous O2 saturation were significantly better preserved during cardiac elevation. This demonstrates that right heart decompression via pleurotomy and pericardial release significantly improves hemodynamic stability during cardiac manipulation. We recommend the use of this procedure in off-pump coronary artery bypass when cardiac tilting is required.
Predifferentiated Adult Stem Cells and Matrices for Cardiac Cell Therapy
Authors: Spadaccio Cristiano , Chachques Emmanuel , Chello Massimo , Covino Elvio , Chachques Juan C , Genovese Jorge
Published: May 2013

Stem cell therapy is a major field of research worldwide, with increasing clinical application, especially in cardiovascular pathology. However, the best stem cell source and type with optimal safety for functional engraftment remains unclear. An intermediate cardiac precommitted phenotype expressing some of the key proteins of a mature cardiomyocyte would permit better integration into the cardiac environment. The predifferentiated cells would receive signals from the environment, thus achieving gradual and complete differentiation. In cell transplantation, survival and engraftment within the environment of the ischemic myocardium represents a challenge for all types of cells, regardless of their state of differentiation. An alternative strategy is to embed cells in a 3-dimensional structure replicating the extracellular matrix, which is crucial for full tissue restoration and prevention of ventricular remodeling. The clinical translation of cell therapy requires avoidance of potentially harmful drugs and cytokines, and rapid off-the-shelf availability of cells. The combination of predifferentiated cells with a functionalized scaffold, locally releasing molecules tailored to promote in-situ completion of differentiation and improve homing, survival, and function, could be an exciting approach that might circumvent the potential undesired effects of growth factor administration and improve tissue restoration.
Tender Inflammatory Infrarenal Aortic Aneurysm Simulating Acute Rupture
Authors: Pang Yin Chun , Chan YC , Ting AC , Cheng SW
Published: May 2013

Even with multislice computed tomography, it may be difficult to differentiate contained ruptured or leaking atherosclerotic aneurysm from a tender inflammatory aneurysm. The decision for early intervention is based on clinical judgment. We describe successful open graft repair of a tender inflammatory infrarenal abdominal aortic aneurysm simulating acute rupture in a 63-year-old man.
Lower Ministernotomy and Fast Tracking for Atrial Septal Defect
Authors: Karthekeyan Baskar Ranjith , Vakamudi Mahesh , Thangavelu Periyasamy , Sulaiman Sajith , Sundar Ayya Syama , Kumar Siva Muthu
Published: May 2013

We report our experience with a 3–5-cm lower ministernotomy incision for closure of atrial septal defect in 53 patients. Fibrillatory arrest was used in 19 patients, and crossclamping with cardioplegia in 33. One patient had to be converted from fibrillatory arrest to crossclamping with cardioplegic arrest. The mean bypass time was 39.6 ± 13.1 min, arrest time was 9.9 ± 4.5 min, and crossclamp time was 20.7 ± 8.69 min. All patients recovered without adverse events. They were fast tracked to recovery and extubated after 63.4 ± 9.2 min. The mean intensive care unit stay was 1.07 ± 0.33 days, and hospital stay was 3.07 ± 0.38 days. The ministernotomy approach was used successfully in 51 patients; in the other 2, it had to be converted to a full sternotomy because of technical difficulties. Our experience confirms that this technique offers satisfactory cosmetic results, stable sternal reconstruction, good surgical exposure, minimal interference with respiratory mechanics, and minimal pain, allowing extubation in the operating room and a speedy recovery.
Improvement of Tricuspid Regurgitation after Pulmonary Thromboendarterectomy
Authors: Ishida Keiichi , Masuda Masahisa , Imamaki Mizuho , Katsumata Masayoshi , Maruyama Takuto , Miyazaki Masaru
Published: May 2013

Chronic thromboembolic pulmonary hypertension causes right ventricular dilation with various degrees of tricuspid regurgitation, leading to right heart failure. Pulmonary thromboendarterectomy can substantially improve pulmonary hemodynamics and right ventricular dilation. The aim of this study was to determine whether the reduction of tricuspid regurgitation persists during follow-up. We studied 26 patients undergoing pulmonary thromboendarterectomy without repair of tricuspid regurgitation; 24 were followed up for 7 to 59 months after surgery (mean, 33 months). Echocardiographic and right heart catheterization data were obtained before and early after surgery. Severity of tricuspid regurgitation and tricuspid pressure gradient were evaluated at follow-up. Two patients died early after surgery, but none died during follow-up. Pulmonary thromboendarterectomy substantially improved pulmonary hemodynamics and right ventricular dilation. Tricuspid regurgitation graded severe in 5 patients and moderate in another 5, improved to trivial or mild postoperatively. The decreases in tricuspid pressure gradient and regurgitation early after surgery persisted during follow-up.
Pericardial Tamponade after Superior Vena Cava Stent: Are Nitinol Stents Safe?
Authors: Khalid Imran , Omari Mohammad , Khalid Tabindeh J , Castillo Eduardo , Khandelwal Akshay , Kattoo Ron
Published: May 2013

Placement of a single new-generation nitinol stent resulted in acute pericardial tamponade in a 70-year-old man with superior vena cava syndrome.
Procedure-Related Myonecrosis after Bare and Drug-Eluting Stent Implantation
Authors: Lee Chi-Hang , Tse Hung-Fat , Tai Bee-Choo , Chen Zhaojin , Chan Mark Y , Tan Huay-Cheem
Published: May 2013

We sought to compare the incidence of myonecrosis after elective implantation of bare metal stents with that of drug-eluting stents. The data of stable patients who were treated with stenting in a single native coronary artery were analyzed retrospectively. The stents used were bare metal in 119, sirolimus-eluting (Cypher Select Plus) in 119 patients, paclitaxel-eluting (Taxus Liberté) in 120, zotarolimus-eluting (Endeavor Sprint) in 122, and everolimus-eluting (Xience V) in 72. Endpoints included post-procedural myonecrosis (any elevation of creatine kinase-MB), myocardial infarction (creatine kinase-MB > 3 times the upper limit of normal), and large myocardial infarction (creatine kinase-MB > 5 times the upper limit of normal). The incidences of myonecrosis (16.7%–18.9%), myocardial infarction (3.3%–8.4%), and large myocardial infarction (1.7%–5.6%) were not significantly different among stent types. At the 30-day follow-up, there were 2 deaths in patients who had Taxus Liberté stents, one death each in those with Xience V and bare metal stents, and no cases of stroke or target vessel revascularization. In this study, bare metal stents and the 4 drug-eluting stents were associated with similar low incidences of myonecrosis, myocardial infarction, and large myocardial infarction.
Outcome of Blunt Diaphragmatic Rupture. Analysis of 44 Cases
Authors: Gwely Noureldin Noaman
Published: May 2013

To determine the predictors of outcome after blunt diaphragmatic rupture, the records of 44 patients aged 15–70 years (84.1% male) who underwent diaphragm repair between 1998 and 2007 were reviewed. There were 38 (86.4%) cases of acute diaphragmatic rupture and 6 (13.6%) of post-traumatic diaphragmatic hernia. The injury was left-sided in 30 (68.2%) patients, right-sided in 12 (27.3%), and bilateral in 2 (4.5%). The diagnosis of acute diaphragmatic rupture was made preoperatively in 28 (73.7%) patients and intraoperatively in 10 (26.3%). Repair was carried out through a thoracotomy in 31 cases, laparotomy in 4, and thoracolaparotomy in 3. The mortality rate after diaphragmatic rupture was 13.2% (5/38). The 33 survivors had a significantly younger mean age (37 vs. 57 years) and lower incidences of multiple injuries (36.4% vs. 100%) and shock (24.2% vs. 100%). Repair of diaphragmatic hernia was performed through a thoracotomy in all cases, with no mortality. It was concluded that age, associated severe multiple injuries, and clinical status were predictors of mortality after blunt diaphragmatic rupture.
Radial Incision for Ventricular Septal Defect with Membranous Septal Aneurysm
Authors: Tateishi Atsushi , Kawada Masaaki , Takeuchi Mamoru , Taga Naoyuki , Otsuka Yoji , Kataoka Koichi
Published: May 2013

Surgical exposure and accurate closure of a ventricular septal defect with a membranous septal aneurysm beneath the septal tricuspid leaflet carries a risk of tricuspid valve dehiscence and conduction disturbances when the septal leaflet is detached along the tricuspid annulus. To avoid these problems, we use a radial incision to expose and close perimembranous ventricular septal defects. We reviewed recent cases to determine the risks and benefits of this technique. From January 2005 through September 2008, 30 patients underwent closure of a perimembranous ventricular septal defect through a right atrial approach at our institution. The operation included radial incision of the membranous septal aneurysm to improve visualization of the perimembranous ventricular septal defect in 9 patients. There was no perioperative or late death. The operative and postoperative courses were uneventful in all cases. A residual leak was detected in only one patient. No patient had more than mild postoperative tricuspid valve insufficiency, none underwent reoperation, and no new arrhythmia or conduction disturbance was detected during follow-up. The radial incision for closure of a ventricular septal defect with a membranous septal aneurysm provides satisfactory exposure of the defect through the right atriotomy, for safe and accurate closure.
Clinical Outcome of Video-Assisted Thymectomy for Myasthenia Gravis and Thymoma
Authors: Agasthian Thirugnanam , Lin Soon Jia
Published: May 2013

We reviewed our experience of video-assisted thoracoscopic thymectomy for myasthenia gravis and thymomas in 119 patients, aged 12–83 years, who were treated between 1998 and 2007. Disease severity was graded using the Osserman classification. To prevent rupture of the tumor capsule and tumor seeding, thymomas were resected using a modified no-touch technique. Thymoma diameters were 10–90 mm (mean, 50 mm). There were no operative deaths, 12 (10%) patients had complications, and 87 (73.1%) improved by 1 or more Osserman grades postoperatively. After follow-up of 1.9–10 years (mean, 4.9 years), 74 (62%) patients remained asymptomatic, with 21% in complete stable remission. Using multivariate regression analysis, there were no statistical differences in median pre- and postoperative Osserman grades with regards to age, sex, duration of symptoms, and presence of thymoma. Video-assisted thoracoscopic thymectomy for myasthenia gravis and selected thymomas can achieve long-term clinical outcomes comparable to those of standard approaches.
Pericardial Monocusp for Pulmonary Valve Reconstruction: A New Technique
Authors: Pande Shantanu , Agarwal Surendra K , Majumdar Gauranga , Chandra Bipin , Tewari Prabhat , Kumar Sudeep
Published: May 2013

Enhancing the pulmonary annulus renders the pulmonary valve incompetent in cases of tetralogy of Fallot. A pressure-loaded right ventricle may change to a volume-loaded ventricle, which may dilate and eventually dysfunction. This study evaluated a new technique of fashioning a monocusp valve from untreated autologous pericardium suspended on a transannular patch. It was assessed in 40 children undergoing complete repair of tetralogy of Fallot between January 2005 and December 2007. 24 patients had a transannular patch alone (group A) and 16 received a transannular patch with the autologous pericardial monocusp valve (group B). All patients were followed up for 1 year with transthoracic echocardiography to determine pulmonary insufficiency. There was no significant difference in cardiopulmonary bypass or aortic crossclamp times, postoperative chest tube drainage, duration of inotropic usage, intensive care unit or hospital stay between groups. Univariate analysis showed significantly lower grades of pulmonary insufficiency in group B. This technique for creating an autologous pericardial monocusp valve is an inexpensive, simple, and reliable procedure that effectively reduces pulmonary insufficiency at the 1-year follow-up.
Double-Outlet Right Ventricle with Extremely Rare Conotruncal Morphology
Authors: Naito Yuji , Kurosawa Hiromi , Hiramatsu Takeshi , Sakamoto Takahiko , Sughimoto Koichi , Yamazaki Kenji
Published: May 2013

We describe an extremely rare form of double-outlet right ventricle in a 1-year-old boy who had 1-malposition of the great arteries with the definitive conotruncal features of false Taussig-Bing heart. Extraordinary conotruncal morphology raised several surgical options, however, the definitive anatomical repair was achieved by an arterial switch operation with a baffle from a ventricular septal defect to the pulmonary artery.
Blood Pressure Variability in Patients with Diabetes Mellitus
Authors: Mokhtar Rafidah Hanim , Ayob Azizi , Noor Noriah Mohd
Published: May 2013

Reduced arterial compliance in patients with diabetes mellitus has been shown in several studies, but it has not been significantly associated with either atherosclerosis or vessel wall thickness. Blood pressure variability is still poorly explored in diabetic patients. The aim of this study was to compare blood pressure variability and arterial compliance in patients with type 2 diabetes mellitus and controls matched for sex, age, and weight. Arterial compliance was measured and noninvasive 24-h ambulatory blood pressure monitoring was performed in 18 diabetic patients and 18 controls. There was significantly higher 24-h systolic blood pressure variability (17.7 ± 6.8 vs. 14.6 ± 2.6 mm Hg), diastolic blood pressure variability (15.6 ± 7.1 vs. 11.4 ± 3.1 mm Hg), and mean arterial blood pressure variability (14.8 ± 7.0 vs. 11.1 ± 2.9) in diabetic patients. Systolic, diastolic, and mean arterial blood pressure variability was significantly higher during daytime but not night time in diabetic patients compared to controls. Diabetic patients also had significantly reduced small artery compliance, but no differences in large artery compliance, cardiac output, or systemic vascular resistance. The findings suggest that hyperglycemia may affect the compliance of the vascular system, resulting in high blood pressure fluctuations.
Role of Vacuum in Methicillin-Resistant Deep Sternal Wound Infection
Authors: De Feo Marisa , Vicchio Mariano , Nappi Gianantonio , Cotrufo Maurizio
Published: May 2013

Between January 2002 and January 2009, 39 patients with post-cardiotomy staphylococcal deep sternal wound infection were treated primarily by a vacuum-assisted closure method (group A). Results were compared with those of 30 patients with staphylococcal deep sternal wound infection who received closed mediastinal irrigation with antibiotics (group B). The prevalence of methicillin-resistance was similarly high in both groups (64.1% in A, 56.7% in B). One group B patient died during treatment. The median healing time was significantly shorter at 13 days in group A (mean, 13.5 ± 3.2 days) compared to 18 days (mean, 21.2 ± 16.4 days) in group B. Deep sternal wound infection did not recur after vacuum treatment, while 7 (24%) patients in group B suffered a recurrence. Hospital stay was significantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days). The significantly shorter healing time with vacuum-assisted closure was confirmed in both methicillin-sensitive (12 vs. 17 days) and methicillin-resistant infections (14 vs. 21 days). Hospital stay remained significantly shorter in group A (35 vs. 46 days) when only methicillin-resistant deep sternal wound infection was considered.
Sternotomy Approach for Modified Blalock-Taussig Shunt: Is it a Safe Option?
Authors: Kandakure Pramod Reddy , Dharmapuram Anil Kumar , Ramadoss Nagarajan , Babu Vivek , Rao Ivatury Mrityunjaya , Murthy Kona Samba
Published: May 2013

Central aorta-pulmonary artery shunts have fallen into disfavor because of shunt thrombosis and congestive heart failure, and a modified Blalock-Taussig shunt via thoracotomy can lead to pulmonary artery hypoplasia and distortion. We reviewed the outcomes of a modified Blalock-Taussig shunt by a sternotomy approach in 20 infants from July 2007 to October 2009. Their mean age was 5.79 months, and median weight was 5.4 kg. A 4-mm graft was placed in 11 patients, a 5-mm graft in 8, and a 3.5-mm graft in 1. There was no incidence of sepsis, seroma, or phrenic nerve palsy. There was one hospital death. The mean hospital stay was 10.4 ± 4.3 days (range, 8–15 days). The mean oxygen saturation at discharge was 89% (range, 81%–93%). The sternotomy approach is technically easier to perform, cosmetically preferable, and probably hemodynamically superior. Correction of branch pulmonary stenosis is easily incorporated into this procedure. The theoretical disadvantage of this method is a potential technical difficulty with sternal reentry for subsequent procedures.
Partial Resection of Mitral Leaflets during Mitral Valve Replacement
Authors: Kuralay Erkan
Published: May 2013

Usually, after mitral leaflet tissue is resected, artificial chordae are used to obtain papillary muscle-to-mitral annulus continuity so as to preserve left ventricular performance. A modified technique that does not require resection of the posterior mitral leaflet and permits implantation of an adequate size of prosthesis is described.
Prosthetic Valve Endocarditis in a Multicenter Registry of Chinese Patients
Authors: Hee-Hwa Ho , Chung-Wah Siu , Kai-Hang Yiu , Hung-Fat Tse , Wing-Hung Chui , Wing-Hing Chow
Published: May 2013

We evaluated the clinical outcomes of prosthetic valve endocarditis in 2 major tertiary referral centers in Hong Kong. The study population comprised 80 consecutive Chinese patients who fulfilled the modified Duke criteria for prosthetic valve endocarditis from March 2000 to June 2007. The major clinical endpoints analyzed were hospital mortality, need for valve surgery, and relapse of prosthetic endocarditis. The mean age at presentation was 56 ± 13 years, with a slight male preponderance. There were 76 (95%) patients with involvement of a mechanical prosthesis; the majority (69%) had late prosthetic endocarditis. Major hospital complications occurred in 49 (61%) patients. The overall hospital mortality was 28% (22 patients). Thirty-four (42%) patients required valve surgery during index hospitalization, of whom 5 (15%) died due to uncontrolled sepsis. Factors associated with hospital mortality were older age at presentation, Staphylococcus aureus infection, embolic events, severe heart failure, valve surgery, and any major complication. On multivariate analysis, severe heart failure was the only independent predictor of hospital death. Among the 58 hospital survivors followed up for a mean of 48 ± 31 months, 6 (10%) developed late complications related to prosthetic valve endocarditis, with 5 documented cases of relapse.
Bypass Grafts and Cell Transplant in Heart Failure with Low Ejection Fraction
Authors: Rivas-Plata Alfonso , Castillo Jorge , Pariona Marcos , Chunga Ausberto
Published: May 2013

From June 2004 to October 2007, 34 patients with chronic heart failure and low ejection fraction underwent surgical revascularization; 23 received bypass grafting plus transplantation of bone marrow-derived stem cells (study group) and 11 had revascularization only (control group). The stem cells were implanted into nonviable myocardial areas, bypass grafting was performed in viable myocardial areas. In the study group, the ejection fraction increased from the baseline 26.4% ± 4% to 37.3% ± 11.5% after 26 months. In the control group, ejection fraction increased from 29% ± 2% to 31.5% ± 4.3% after 27 months. The improvement in the study group was significantly greater than that in the control group. Functional class improved significantly from 3.2 to 1.2 in the study group vs. 3.0 to 2.3 in the control group. Stem cell transplantation associated with bypass grafting is feasible and safe in patients with chronic heart failure with low ejection fractions, and it improves ventricular systolic function and functional class.
Pleuroperitoneal Shunting for Intractable Cardiogenic Pleural Effusions
Authors: Kato Takayoshi , Umeda Yukio , Azuma Ken-Ichiro , Murakawa Shinji
Published: May 2013

A 72-year-old man underwent post-infarction ventricular septal defect repair. Postoperatively, he required prolonged ventilation and could not be weaned from positive-pressure-assisted ventilation because of intractable bilateral pleural effusions. Conservative therapy was ineffective. After instituting pleuroperitoneal shunting, the patient could be weaned easily from a respirator.
Application of Lobe-Selective Bronchial Blockade against Airway Bleeding
Authors: Murakawa Tomohiro , Ito Nobuko , Fukami Takeshi , Nakajima Jun , Takamoto Shinichi
Published: May 2013

A 48-year-old man underwent resection of a right upper lobe necrotic tumor and part of his chest wall. Lobe-selective bronchial blockade of bleeding from the right upper lobe was achieved by combining a left-side double-lumen endotracheal tube with a bronchial blocker placed at the right intermediate bronchus. The bleeding right upper lobe was isolated, and the other lobes were protected from blood contamination during the lobectomy procedure.
Bronchial Stump Coverage and Postpneumonectomy Bronchopleural Fistula
Authors: Lindner Michael , Hapfelmeier Alexander , Morresi-Hauf Alicia , Schmidt Michael , Hatz Rudolf , Winter Hauke
Published: May 2013

To prevent postpneumonectomy bronchopleural fistula, coverage of the bronchial stump is recommended, especially for patients treated with neoadjuvant and adjuvant chemotherapy or radiochemotherapy. We compared outcomes after proximal pericardial fat pad coverage and coverage with pleura and surrounding tissues, by retrospective analysis of the records of 243 patients. Postpneumonectomy bronchopleural fistula occurred in 7/143 (4.9%) patients who had pericardial fat pad coverage, and in 6/100 (6.0%) treated by pleural covering. Bronchopleural fistula occurred in 11 patients within 21 days, in one after 2 months, and one after 6 months. Univariate analysis of comorbidities and risk factors did not show any significant differences between the groups. Advanced T stage and carcinomatous lymphangiosis at the resection margin were associated with a higher risk of bronchopleural fistula development, independent of the technique. Reinforcement of the bronchial stump by proximal pericardial fat pad coverage appears to be safe and feasible. It is comparable to coverage with pleura and surrounding tissues.
Predictors of Quality of Life in Chinese Patients with Acute Coronary Syndrome
Authors: Ma Wenlin , Hu Dayi , Liu Guanghui , Jiang Jinfa , Zhao Xudong , Ma Yunsheng
Published: May 2013

Predictors of quality of life in Chinese patients with acute coronary syndrome remain unknown. Between January 2006 and March 2009, a prospective cohort study of 782 patients with acute coronary syndrome was carried out, with follow-up 7 months later. Depression and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale. Quality of life was assessed using the 36-Item Short-Form Health Survey. To identify predictors of decreased quality of life, both the physical and mental component summary scores were analyzed using multiple and ordinal logistic regression. In our quality-of-life model, diabetes mellitus was an independent risk factor for a low mental component summary score. Anxiety symptoms and the baseline mental component summary score were significant independent predictors of a low mental component summary score. Acute myocardial infarction was found to be a risk factor for a low physical component summary score. Anxiety symptoms, baseline physical component summary score, and systolic blood pressure on admission were significant independent predictive factors. Among patients with acute coronary syndrome, those with acute myocardial infarction, diabetes, or a low baseline quality of life need more care and effective intervention to improve their quality of life.
Novel Use of the Internal Thoracic Artery Retractor in Transcervical Thymectomy
Authors: Agasthian Thirugnanam , Jim Loh Yee
Published: May 2013

Transcervical thymectomy is a standard approach to the thymus and anterior mediastinum, but it is limited by poor exposure of the lower recesses of the anterior mediastinum. A novel technique using the widely available internal thoracic artery sternal retractor and a 30°-video camera allows enhanced exposure of the anterior mediastinum.
Does Aortic Valve Replacement Mitigate the Risk of Preoperative Heart Failure?
Authors: Ngaage Dumbor , Dickson Joanne , Guvendik Levent
Published: May 2013

Congestive heart failure complicating aortic valve disease has been reported to increase the operative mortality associated with aortic valve replacement. To determine whether this adverse effect remains late after aortic valve replacement, we analyzed prospectively collected and survival data of 849 patients who underwent aortic valve replacement between 1999 and 2008. There were 243 (29%) cases of heart failure preoperatively (138 current and 105 prior). Both operative and late mortality rates (up to 10 years) were significantly higher in heart failure patients. Current congestive heart failure caused a 3-fold increase in operative mortality and an 86% increase in late mortality, whereas previous history of heart failure caused a doubling of late mortality. Preoperative heart failure still compromises early and late survival after aortic valve replacement. Surgery should be considered early in patients with aortic valve disease and deferred, when possible, in those with frank heart failure.
Determinants of Social Activity and Work Status after Coronary Bypass Surgery
Authors: Davoodi Saeed , Sheikhvatan Mehrdad , Karimi Abbasali , Ahmadi Seyed Hossein , Sheikhfathollahi Mahmood
Published: May 2013

Despite the occurrence of adverse events after coronary artery bypass, the degree of social integration can be increased following this operation. This study addresses the predictive power of risk factors as well as clinical status in determining long-term social functioning and rate of return to work following isolated bypass surgery. A prospective cohort study was conducted in 178 patients who underwent isolated bypass surgery between 2004 and 2007. Information on work status and social relationships was obtained 1–2 days before surgery and during a mean follow-up of 29.4 ± 1.1 months. The proportion of patients who engaged in social activities at 2, 3, and 4 years of follow-up was 0.3, 0.6, and just over 0.8, respectively, and the proportion who had returned to work at these time points was 0.2, 0.45, and 0.63, respectively. Social activity after surgery was less in patients with left ventricular dysfunction, cerebrovascular disease, and higher New York Heart Association functional class. The rate of return to work was lower for men and for patients with left ventricular dysfunction, diabetes, cerebrovascular disease, and those who were hospitalized for more than 14 days.
Exploring the Role of Cyclosporine in Reducing Homograft Degeneration Post-Ross
Authors: Al-Jazairi Abdulrazaq , Alkortas Delal , Bulbul Zead , Al-Zubairy Sulaiman , Al-Shahid Maie , Al-Halees Zohair
Published: May 2013

The Ross procedure is safe and effective for children with aortic valve disease. Pulmonary homograft degeneration, proposed to be immune-mediated, is a major cause of reoperation. Cyclosporine increased homograft valve survival in animals, but has not been studied in humans. To investigate the efficacy of low-dose cyclosporine in preventing homograft degeneration and complications, a retrospective historical-controlled study was performed on data of all children who underwent Ross procedure and received cyclosporine. The primary endpoint was homograft function at the last follow-up; secondary endpoints were readmission, reoperation, death, and safety. Seventeen patients were matched with 16 controls. At the end of the follow-up period (cyclosporine, 6.7 years; controls, 8 years), homograft stenosis and/or regurgitation were present in half of all patients. Three (18%) patients in the cyclosporine group and 5 (29%) in the control group were readmitted. Surgical intervention due to homograft failure was needed in 1 (6%) cyclosporine patient and 3 (19%) of the controls. Although cyclosporine failed to show a significant difference in signs of homograft degeneration, it might decrease the need for reoperation following the Ross procedure. Larger prospective well-designed studies are required to confirm these findings.
Effect of Cardiopulmonary Bypass on Cancer Prognosis
Authors: Suzuki Shuichi , Usui Akihiko , Yoshida Katsuhiko , Matsuura Akio , Ichihara Toshihiko , Ueda Yuichi
Published: May 2013

Adverse effects of cardiopulmonary bypass on cancer prognosis are expected but have not been confirmed. Seventy-four cancer patients who underwent cardiac surgery before cancer therapy were followed up for 42 ± 37 months; 45 had cardiac surgery with cardiopulmonary bypass. There was no significant difference in cancer recurrence (40.0%) and deaths (26.7%) among patients who had cardiopulmonary bypass and those who underwent off-pump cardiac surgery (27.6% and 24.1%). There were no significant differences in freedom from cancer-related death at 2 and 5 years after cardiac surgery (78.4% and 68.5%) in the cardiopulmonary bypass group compared to the 29 off-pump group (81.8% and 58.3%). Despite some limitations, this study detected no significant adverse effects of cardiopulmonary bypass on cancer prognosis. Although these results do not verify the safety of cardiopulmonary bypass from an oncologic aspect, they suggest it can be applied in cancer patients who require cardiac surgery.
Complication of bovine pericardial buttress: pulmonary pseudotumor
Authors: Suemitsu Ryuichi , Tokito Takaaki , Ichiki Masao , Takeo Sadanori , Momosaki Seiya , Furuya Kiyomi
Published: May 2013

A 38-year-old man reported progressive back pain 4 years after undergoing partial resection of the lung for spontaneous pneumothorax, using staples buttressed with bovine pericardium. Chest computed tomography detected a mass near the staple line. Resection of the mass was performed successfully and the pain was relieved. The excised material was identified as an inflammatory pulmonary pseudotumor caused by the buttressing material.
Predictors of survival after gastrointestinal complications in bypass grafting
Authors: Vohra Hunaid A , Farid Shakil , Bahrami Toufan , Gaer Jullien AR
Published: May 2013

Between April 2001 and December 2005, data were collected prospectively from 2,320 consecutive patients who underwent first-time coronary artery bypass. Logistic multiple regression analyses were carried out to determine the independent predictors of gastrointestinal complications and death. There were 65 major gastrointestinal complications identified in 65 (2.8%) patients: paralytic ileus in 15, mesenteric ischemia in 12, upper gastrointestinal hemorrhage in 16, lower gastrointestinal hemorrhage in 8, small bowel obstruction in 5, pseudoobstruction in 5, and others in 4. The 30-day mortality was 21.5% (14 patients). Female sex, preoperative creatinine >200 µmol·L−1, previous gastrointestinal pathology, low cardiac output, readmission to the intensive care unit, postoperative pulmonary complications, arrhythmias, hemofiltration, and reoperation were independent predictors of major gastrointestinal complications. Independent risk factors for death were readmission to the intensive care unit, the need for hemofiltration, reoperation, and ischemic bowel. Careful hemodynamic control and optimization of perioperative organ perfusion are important to minimize the mortality associated with major gastrointestinal complications after coronary artery bypass.
Predictors of success of the modified maze procedure using radiofrequency device
Authors: Minakata Kenji , Yunoki Tomoyuki , Yoshikawa Eiji , Katsu Masatake , Oda Tomoyuki , Ujino Keiji
Published: May 2013

The modified maze procedure using radiofrequency devices has become an increasingly common surgical option for patients with atrial fibrillation. Several lesion sets have been proposed and tested, but it remains unclear which yields the best results. We studied 61 patients who underwent the modified maze procedure using radiofrequency devices from March 2005. The pulmonary veins were isolated separately on both sides, and a connecting lesion was made inferiorly in the early series of 30 patients (group 1). In 31 patients (group 2) treated from May 2007, we added a superior connecting lesion between both pulmonary veins (completing a box lesion), and also performed coronary sinus ablation from the epicardial side, using a monopolar device. At 6 months postoperatively, maintenance of sinus rhythm with and without antiarrhythmic medications was 70% and 63%, respectively in group 1, and 94% and 90% in group 2 (both p < 0.05). Multivariate analysis indicated that the box lesion with coronary sinus ablation was an independent predictor of the maintenance of sinus rhythm at 6 months. These 2 lesions should not be eliminated from the modified maze procedure.
A 25-year experience with Carpentier-Edwards Perimount in the mitral position
Authors: Ayegnon Kouakou Gregoire , Aupart Michel , Bourguignon Thierry , Mirza Alain , May Marc-Antoine , Marchand Michel
Published: May 2013

Data of 401 patients who underwent mitral valve replacement with the Carpentier-Edwards Perimount bioprosthesis between 1984 and 2009 were evaluated. Their mean age was 68.1 ± 10.4 years (range, 22–90 years) and 54.9% were female. The most common etiology was degenerative disease (33.2%) and 62.1% of patients had mitral insufficiency. Follow-up was 3,178 patient-years, and 96.8% complete; the mean follow-up was 8.9 ± 3.1 years. Overall survival at 25 years was 10.2% ± 3%. Late mortality was 2.48% per patient-year, and valve-related deaths occurred at 1.62% per patient-year. The actuarial freedom from reoperation due to structural valve deterioration at 20 years was 24.3% ± 2% for degenerative disease and 15% ± 1.4% for non-degenerative disease. For degenerative valve disease, the freedom from structural valve deterioration at 18-years was 39% ± 1% for recipients <60-years old and 66% ± 2% for those ≥60-years old. Our data confirm the excellent durability and low mortality associated with the Carpentier-Edwards Perimount for mitral valve replacement. The rate of calcification of the valve was unrelated to degenerative valve disease, but our findings suggest that this prothesis gives better results in recipients ≥60-years old than in younger patients.
Evolution in the treatment of mediastinitis: single-center experience
Authors: Feo Marisa De , Vicchio Mariano , Santè Pasquale , Cerasuolo Flavio , Nappi Gianantonio
Published: May 2013

This study aimed to evaluate our 30-year experience in the treatment of deep sternal wound infection after cardiac surgery. Between 1979 and 2009, deep sternal wound infections occurred in 200 of 22,366 (0.89%) patients who underwent sternotomy. The study population was divided into 3 groups. In group A (62 patients; 1979–1994), an initial attempt at conservative antibiotic therapy was the rule, followed by surgery in case of failure. In group B (83 patients; 1995–2002), the treatment was in 3 steps: wound debridement and closed irrigation for 10 days; in case of failure, open dressing with sugar and hyperbaric treatment; delayed healing and negative wound cultures mandated plastic reconstruction. In group C (2002–2009), the treatment was based on early surgical debridement, vacuum application, and reconstruction using pectoralis muscle flap. Hospital mortality in group A was significantly higher than that in groups B and C. Hospital stay, time for normalization of white blood cell count and C reactive protein, and time for defervescence were significantly shorter in group C. In our experience, early surgical debridement and vacuum application followed by plastic reconstruction provided a satisfactory rate of healing and a good survival rate.
Pattern and presentation of blunt chest trauma among different age groups
Authors: Hanafi Moataz , Al-Sarraf Nael , Sharaf Hazem , Abdelaziz Atef
Published: May 2013

We assessed the presentation and mechanisms of blunt chest injuries sustained in different age groups, and the impact on management options. We retrospectively reviewed the records of 486 patients with blunt chest trauma who were treated between 2004 and 2007. They were stratified into 3 age groups: pediatric, adult, and elderly. Clinical data, mechanism of injury, associated injuries, treatment strategies, and mortality were analyzed. The majority of patients were male (86%), and the largest age group was 12–60-years old (79%). Motor vehicle accidents accounted for 93% of cases. Isolated chest injuries were more common than combined injuries (69% vs. 31%). Tube thoracostomy was required in 39% of patients, predominantly in the elderly age group. Combined injuries involved bone fractures (21%), head (5%), and abdominal trauma (5%). Most blunt chest injuries were treated conservatively (95.5%). Open thoracotomy was required in 4.5% for clotted hemothorax (3.7%), empyema (0.6%), and massive air leak (0.2%). Mortality was 1%, predominantly in the adult group (0.8%). Blunt thoracic injuries are a major cause of morbidity and mortality. As the majority of such injuries are related to motor vehicle accidents, preventative strategies should be enforced.
Does preoperative clopidogrel increase bleeding after coronary bypass surgery?
Authors: Dasarathan Charumathi , Vaidyanathan Karthik , Chandrasekaran Deepthi , Cherian Kotturathu Mammen
Published: May 2013

Antiplatelet therapy has been demonstrated to reduce the risk of cardiac events in patients presenting with acute coronary syndrome, yet all effective therapies also increase the risk of bleeding. This study aimed to test the hypothesis that patients undergoing coronary artery bypass grafting, who received clopidogrel within 5 days before surgery, have worse bleeding outcomes and blood transfusion requirements than those who stopped clopidogrel >5 days earlier. We recruited 342 patients who underwent on-pump elective coronary artery bypass grafting between January 2004 and December 2008. Of these, 191 stopped taking clopidogrel >5 days earlier, and 151 stopped ≤5 days before surgery. Postoperative drainage after 8 and 12 h and the total drainage were similar in both groups. There was no significant difference in the amount of blood products used. There was no reexploration in either group. It was concluded that preoperative clopidogrel exposure does not increase the risk of hemostatic reoperation or the requirements for blood and blood product transfusion during and after coronary artery bypass grafting.
Smeloff-Cutter aortic valve endocarditis 31 years after implantation
Authors: Kanki Kazushige , Takagi Nobuyuki , Tachibana Kazutoshi , Mishina Taijiro , Higami Tetsuya
Published: May 2013

A Smeloff-Cutter ball prosthetic valve was replaced in a 56-year-old woman 31 years after implantation. Prosthetic endocarditis developed after endoscopic mucosal resection of colon cancer. The excised aortic ball valve was almost intact, without any thrombus formation.
Pulmonary sclerosing hemangioma: pitfalls in management
Authors: Low Su-Ying , Teo Felicia , Eng Philip , Tan Puay Hoon
Published: May 2013

Pulmonary sclerosing hemangioma is a rare benign tumor for which surgical excision is curative with an excellent prognosis. It often mimics malignancy, making it a diagnostic and management challenge. We reviewed the clinical, radiological, and histopathological characteristics as well as the surgical management of our patients to assess the potential pitfalls in management. All 19 patients who underwent surgical biopsy between January 1999 and December 2009 with a final histopathological diagnosis of pulmonary sclerosing hemangioma were reviewed retrospectively. The median age was 48 years, 89.5% were female, 89.5% were Chinese, and 68.4% were asymptomatic. There were no specific diagnostic radiological characteristics; 1 of 3 patients who underwent combined positron-emission and computed tomography had a false-positive result. Preoperative attempts at establishing a diagnosis were successful in 20% of patients who had invasive procedures. Intraoperative frozen-section evaluation for pulmonary sclerosing hemangioma had an error rate of 25% and a deferred rate of 31%, resulting in nearly half of our patients undergoing unnecessary extensive surgical procedures. We hope to heighten awareness of this diagnosis, thereby increasing the index of suspicion and minimizing errors in diagnosis.
Pneumothorax derived from bronchiolitis obliterans after marrow transplantation
Authors: Yamanaka Sumitaka , Yamamoto Taketsugu , Inui Kenji
Published: May 2013

Long-term survival has become achievable after bone-marrow transplantation, but various pulmonary diseases due to chronic graft-vs.-host disease have been recognized. Particularly, bronchiolitis obliterans is a life-threatening complication with no effective remedy. Bilateral pneumothorax associated with bronchiolitis obliterans is rare, but it requires careful attention. In a 42-year old man with intractable pneumothorax after bone marrow transplantation and surgical procedures, extensive thoracolysis was effective as an acute treatment for this disease.
For what type of constrictive pericarditis is the waffle procedure effective?
Authors: Yamamoto Nobuyuki , Ohara Kuniyoshi , Nie Masaki , Torii Shinzo , Inoue Nobuyuki , Miyaji Kagami
Published: May 2013

The waffle procedure is performed in patients with marked thickening and calcification of the epicardium and no substantial improvement in hemodynamic parameters after pericardiectomy. We retrospectively investigated the efficacy of the waffle procedure in 6 of 11 patients who underwent pericardiectomy. These 6 patients showed no improvement in central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, or cardiac index after pericardiectomy. After the waffle procedure, all hemodynamic parameters improved, and there were no significant differences compared to those of the 5 patients who did not require the waffle procedure, despite higher pulmonary capillary wedge pressure and lower cardiac index values preoperatively in the waffle group. The waffle procedure was considered effective in patients with persistent epicardial constriction.