bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitral Valve Repair on the Beating Perfused Heart
Authors: Savitt Michael A , Singh Taranpreet , Gao Guangqiang , Ahmed Aftab
Published: May 2013

It is difficult to assess the success of mitral valve repair in the arrested heart. Various techniques have been described. Transesophageal echocardiogram (TEE) provides excellent two-dimensional evaluation of the repair, but three-dimensional anatomic characteristics are limited. We describe a simple technique for performing mitral valve repair on the beating heart. This allows accurate evaluation of valvular competence and three-dimensional anatomic characteristics prior to closure of the atriotomy.
Pathobiology of Idiopathic Ascending Aortic Aneurysms
Authors: Kirsch EW Matthias , Radu N Costin , Allaire Eric , Loisance Daniel Y
Published: May 2013

The majority of ascending aortic aneurysms cannot be related to any specific etiology and should be qualified as idiopathic. The pathobiology of ascending aortic aneurysms remains incompletely understood. Data from direct study are still scarce and often limited because of patient heterogenicity. Currently available information suggests that destructive remodeling of the aortic wall, inflammation and angiogenesis, biomechanical wall stress, and molecular genetics are relevant mechanisms of idiopathic ascending aortic aneurysm formation and progression. Further understanding of these mechanisms will likely provide novel diagnostic, prognostic, and therapeutical tools for the clinician.
Hydatid Cyst of the Right Atrium: A Rare Presentation
Authors: Tandon Shekhar , Darbari Anshuman
Published: May 2013

Hydatid cyst of the heart is an uncommon lesion. Reported is the case of a 24-year-old female patient admitted with a history of chest pain and hemoptysis, and a mass lesion in the right atrium. Investigations and intraoperative intervention revealed the mass to be a hydatid cyst located in the right atrium, along with hydatid cysts of the liver and both lungs. The right atrial mass was successfully removed under cardiopulmonary bypass.
Transbronchial Localization of Small Pulmonary Lesions for Thoracoscopic Resection
Authors: Mawatari Tohru , Watanabe Atsushi , Ohsawa Hisayoshi , Abe Tomio , Yamada Gen
Published: May 2013

The localization of small lung masses at thoracoscopic operation is very difficult. A 67-year-old female with tiny pulmonary metastases of renal cell carcinoma primary was successfully treated by pulmonary thoracoscopic resection after transbronchial localization using a dye.
Active Cerebral Perfusion during Carotid Endarterectomy
Authors: Imanaka Kazuhito , Kato Masaaki , Ogiwara Masanori , Kyo Shunei
Published: May 2013

A patient with critical stenoses in the bilateral internal carotid arteries (ICA) required multivessel coronary revascularization. The diameter of the left ICA was far greater than the right, which strongly suggested that the cerebral circulation was highly dependent on the left. During left ICA endarterectomy, active cerebral perfusion of 300 mL·min−1 at 23°C using an extracorporeal circulation was employed through the ICA under repair. Subsequently, coronary bypass was performed on-pump with the heart beating. The postoperative course was very good.
Papillary Fibroblastoma of Tricuspid Valve with Pulmonary Embolization
Authors: Mastroroberto Pasquale , Olivito Silvio , Onorati Francesco , di Virgilio Antonio , Merola Salvatore , Renzulli Attilio
Published: May 2013

A 53-year-old man was diagnosed with a papillary fibroelastoma of the tricuspid valve with pulmonary embolization and associated coronary artery disease. He underwent excision of the tumor and coronary bypass grafting. Due to potential embolization, it is recommended that all such fibroelastomas be excised.
Mitral Valve Papillary Fibroelastoma: Surgical Considerations
Authors: Novaro Gian M , Cabrales Rafael E , Boyd W Douglas
Published: May 2013

Cardiac papillary fibroelastomas are uncommon primary cardiac tumors. Due to their infrequent occurrence, an appropriate management strategy has been difficult to define. We report a 51-year-old female with a papillary fibroelastoma of the mitral valve diagnosed during a source of embolism evaluation, where the association between symptoms and the tumor were equivocal. The mitral valve papillary fibroelastoma was electively surgically excised, based on the proposed guidelines that allow for identification of patients at greatest risk of embolic events. We review the evaluation and selection of those patients who might benefit from surgical therapy even in the absence of symptoms.
Post-Pleuropneumonectomy Herniation of Liver Mimicking Major Pulmonary Embolism
Authors: Huwer Hanno , Winning Johannes , Isringhaus Helmut , Kalweit Gerhard
Published: May 2013

Following right-sided pneumonectomy and hemidiaphragm resection in a 58-year-old man with epithelioid mesothelioma, acute respiratory insufficiency and life-threatening circulatory collapse developed after a forced Valsalva maneuver. Major pulmonary embolism was diagnosed on clinical grounds, however computed tomography revealed herniation of the liver into the right hemithorax.
Transfusion Related Acute Lung Injury in Cardiac Surgery
Authors: Kalkat Maninder S , Dandekar Uday , Jegannath Vijay , Levine Adrian
Published: May 2013

Transfusion related acute lung injury (TRALI) is an uncommon complication following administration of blood products. It is often difficult to differentiate from other commoner causes of cardio-respiratory instability. However, prompt diagnosis and management is associated with favorable outcome.
Cannulation and Cardiopulmonary Bypass Produce Selective Brain Lesions in Pigs
Authors: Tóth Zsolt , Györimolnár Iván , Ábrahám Hajnalka , Hevesi Ákos
Published: May 2013

Whether cardiopulmonary bypass alone or together with manipulation of the aorta produces neurologic complications remains controversial. Using a pig model, the immediate effects of aortic cannulation and cardiopulmonary bypass on neural injury in different brain regions were investigated in 3 experimental groups: non-operated controls; operated controls with aortic cannulation without cardiopulmonary bypass; and operated animals undergoing cardiopulmonary bypass. Immunohistochemistry using a monoclonal antibody against calretinin was used to show possible ischemic damage in the hippocampal formation which is one of the most vulnerable regions to ischemia. Both cannulation of the aorta alone and cardiopulmonary bypass resulted in numerous argyrophilic neurons in discrete regions of the prefrontal and cerebellar cortex. Decreased calretinin immunoreaction and a reduced number of calretinin-positive neurons were observed following aortic cannulation or cardiopulmonary bypass compared to the non-operated controls. This suggests that both cannulation of the aorta alone and cardiopulmonary bypass affect a selected population of neurons. Therefore, off-pump, aorta no-touch technique may prevent neurologic complications.
Coincident Atrioventricular Nodal Reentrant and Idiopathic Ventricular Tachycardia
Authors: Kazemi Babak , Arya Arash , Haghjoo Majid , Sadr-Ameli Mohammad A
Published: May 2013

Double tachycardia appears to be relatively rare. Our single-center experience of coincident typical atrioventricular nodal reentrant and idiopathic ventricular tachycardia was reviewed. Between September 2003 and February 2005, 40 patients with idiopathic ventricular tachycardia underwent catheter ablation for right ventricular outflow tract tachycardia in 20, left ventricular outflow tract tachycardia in 2, and left ventricular septal tachycardia in 18. In 5 patients (2 men and 3 women, aged 27–49 years) there was a combination of typical atrioventricular nodal reentrant tachycardia and idiopathic ventricular tachycardia. They had no structural heart disease. The presenting arrhythmia was supraventricular in one and ventricular in 4. There was no case of inducibility of one arrhythmia by the other (tachycardia-induced tachycardia), but an interaction was observed in one tachycardia in which inducibility was seen only after ablation of the other arrhythmia. Radiofrequency ablation of either arrhythmia did not prevent induction of the other.
Mid-Term Results of Ross Procedure: Our Limited Experience
Authors: Wang Rong , Farnsworth Alan , Albrecht Helmi
Published: May 2013

From February 1995 to February 2005, 30 patients underwent the Ross procedure with the root replacement technique. There were 20 males (66.7%) and 10 females (33.3%), aged 13 to 49 years. The diagnosis was aortic stenosis in 12 patients (40%), aortic regurgitation in 10 (33%), mixed stenosis and regurgitation in 6 (20%), prosthetic endocarditis with an aortic root abscess in 1 (3.3%), and a perivalvular leak in 1 (3.3%). There was no early or late death. Six patients (20%) suffered 7 significant operative complications. Over a median follow-up of 65 months (range, 4–114 months), there were 3 re-operations for autograft failure and 2 for homograft failure. No patient experienced a cerebrovascular accident, and all but one were free from endocarditis. Freedom from autograft failure was 94.1% ± 5.7% at 5 years and 79.5% ± 10.7% at 8 years, while freedom from homograft failure was 96.6% ± 3.4% at 5 years and 88.5% ± 8.3% at 8 years. Our midterm results show that good early and late survival can be obtained in young patients with aortic valve disease. Re-exploration for bleeding and late autograft failure are the main concerns of this challenging operation, especially early in the surgeon's learning-curve.
Electrocardiographic Changes after Coronary Artery Surgery
Authors: Cagli Kerim , Ozbakir Cemal , Ergun Kumral , Bakuy Vedat , Circi Renda , Circi Pinar
Published: May 2013

The electrocardiographic changes early after uncomplicated coronary artery bypass with complete revascularization were examined preoperatively and on the 1st and 3rd postoperative days in 53 patients. Heart rate, PR index, corrected PR interval, corrected P dispersion, corrected duration of QRS complex, corrected QT dispersion, corrected QT interval, rhythm, QRS axis, ST-segment changes, and blocks were determined. Changes in new parameters obtained by different combinations of R, S, and T waves were also studied. On the 1st postoperative day, atrial fibrillation was significantly less prevalent, right bundle branch block increased significantly, and QRS axis was significantly more positive but returned to baseline on the 3rd postoperative day. Postoperative heart rate and PR index were significantly higher than preoperative values. In the postoperative period, corrected PR interval was significantly lower, corrected QRS complex duration was significantly shorter, corrected QT interval was significantly longer, and corrected QT dispersion showed a significant increase on the 1st postoperative day. This study defines electrocardiographic changes in uncomplicated patients with complete revascularization. Any deviations from these findings may alert us to the need for further evaluation of an undesired event.
Ascending Aortic Aneurysm Resection: 15 Years’ Experience
Authors: Meharwal Zile S , Khanna Surendra N , Choudhary Abhay , Mishra Manisha , Mehta Yatin , Trehan Naresh
Published: May 2013

Between September 1989 and June 2004, 148 consecutive patients underwent ascending aortic replacement for aneurysm or dissection. There were 130 males (88%) and 18 females (12%). Their mean age was 46.20 ± 13.36 years. Fifty-seven patients (39%) were treated for type 1 and type 2 aortic dissection, and 91 (61%) for ascending aortic aneurysm. The Bentall procedure was performed in 81 patients (55%), the Cabrol procedure in 7 (5%), separate ascending aortic replacement and aortic valve replacement or repair was carried out in 24 (16%), and ascending aortic replacement only in 36 (24%). Hospital mortality was 4.05% (6 deaths). On univariate analysis, left ventricular ejection fraction ≤ 30%, emergency surgery, contained rupture, concomitant coronary artery bypass grafting, and age ≥ 65 years were risk factors for early mortality. However, on multivariate analysis, ejection fraction ≤ 30% and contained rupture were the only factors significantly associated with early mortality. The long-term survival rates were 87.2% ± 3.7% at 5 years, 78.0% ± 5.6% at 10 years, and 60.9% ± 9.9% at 15 years. Ascending aortic resection for aneurysm or dissection can be performed with low mortality and morbidity.
Using Cone and Plate(let) Analyzer to Predict Bleeding in Cardiac Surgery
Authors: Gerrah Rabin , Brill Alex , Tshori Sagi , Lubetsky Aharon , Merin Gideon , Varon David
Published: May 2013

The cone and plate(let) analyzer is an established method for assessing platelet function. It evaluates adherence of platelets on an extracellular matrix, expressed as a percentage of surface coverage and the average size of the aggregates. The purpose of this study was to determine the applicability of the cone and plate(let) analyzer in monitoring platelet function and predicting postoperative bleeding. The relationship between postoperative bleeding, perioperative platelet function, and other parameters was studied. A significant decrease in surface coverage was detected upon establishment of cardiopulmonary bypass (from 6.9% ± 3.9% to 4.7% ± 1.7%) with a return to preoperative values at the end of surgery. Preoperative average size and surface coverage were the only parameters that significantly and linearly correlated with postoperative bleeding. Patients with an aggregate average size < 20 μm2 had a significantly higher incidence of severe bleeding (> 965 mL) than those with a size > 20 μm2 (44% vs. 0%), and a higher mean blood loss (908 ± 322 mL vs. 337 ± 78 mL). Similar results were obtained for surface coverage < 5%, indicating the predictive value of these parameters. Preoperative platelet function as evaluated by the cone and plate(let) analyzer is an independent risk factor determining postoperative bleeding.
An Alternative for Descending Thoracic Aortic Aneurysm Repair
Authors: Okada Kenji , Sueda Taijiro , Orihashi Kazumasa , Tanaka Nobuhiro , Nakanishi Kazuyoshi , Ochi Mitsuo
Published: May 2013

A simple technique termed “clamp test and spinal cord-plegia” for descending thoracic aortic aneurysm surgery is described. The clamp test is a passive method of creating ischemic conditions, whereas spinal cord-plegia is an active method of decreasing metabolism. This technique is a practical test that double-checks for critical feeding arteries and seems to have an excellent spinal cord-preserving effect.
Re-operation for Tetralogy of Fallot with Single Right Coronary Artery
Authors: Nagashima Mitsugi , Sato Harumitsu , Hohjo Yosihisa , Okamoto Yoshiki , Miura Takashi , Tomino Tetsuo
Published: May 2013

A 7-year-old girl with tetralogy of Fallot in association with a single right coronary artery, was successfully re-operated on for right ventricular outflow tract obstruction. To identify the course of the abnormal coronary arteries during the re-operation, a probe was directly inserted into the coronary arteries after aortotomy. Ventriculotomy was successfully performed under the guide of the probe, without damaging the coronary arteries. Double outflow technique was applied for the relief of the right ventricular outflow tract obstruction.
Role and Outcome of Surgery for Pulmonary Tuberculosis
Authors: Olcmen Aysun , Gunluoglu Mehmet Z , Demir Adalet , Akin Hasan , Kara Hasan V , Dincer Seyyit I
Published: May 2013

The need and outcome of surgical intervention in patients with pulmonary tuberculosis were assessed retrospectively. Between 1993 and 2003, 72 major surgical procedures were performed in 57 patients with pulmonary tuberculosis. There were 44 males and 13 females with a mean age of 34 years. Indications for surgery were: trapped lung in 18 (31.6%), multidrug-resistant tuberculosis in 10 (17.5%), aspergilloma in 10 (17.5%), destroyed lung in 5 (8.8%), massive hemoptysis in 4 (7%), bronchopleural fistula in 3 (5.3%), persistent cavity in 2 (3.5%), and undiagnosed nodule in 5 (8.8%) patients. The most common procedure was lobectomy (31.9%). Other procedures included decortication, wedge resection, pneumonectomy, segmentectomy, and myoplasty. There were 28 complications in 18 patients, including prolonged air leak in 12 (21.1%), residual space in 7 (12.3%), empyema in 5 (8.8%), hematoma in 2 (3.5%), chylothorax and bronchopleural fistula in 1 (1.8%) each. There was no operative death, but one patient died from sepsis late in the follow-up period (mortality, 1.8%). As morbidity and mortality rates are acceptable, surgical intervention can be considered safe and effective in patients with pulmonary tuberculosis.
Outcome of Single Ventricle and Total Anomalous Pulmonary Venous Connection
Authors: Sachdev Manvinder S , Jena Pradyumna K , Kurup Renu P , Varghese Roy , Kumar R Suresh , Coelho Robert
Published: May 2013

Management of patients with single-ventricle physiology is significantly affected by anomalies of pulmonary venous return at all stages, whether primary palliation, bidirectional Glenn shunt, or completion of Fontan circulation. We treated 25 patients with pulmonary venous anomalies and single ventricle by staged palliation, from June 1996 to May 2005. Visceral heterotaxy with atrial isomerism was present in 19 of them. Primary palliation with a systemic-to-pulmonary artery shunt was undertaken in 15 patients. There were 5 early deaths, of which 4 were due to obstruction of pulmonary venous return. A bidirectional Glenn shunt was constructed in 17 patients including 10 who had it as a primary palliative procedure. There were 7 early deaths after the bidirectional Glenn procedure; only one was due to pulmonary venous obstruction. Five patients attained completion of the Fontan procedure. There was one early death after the Fontan operation. Anomalous pulmonary venous return can significantly complicate the management of patients with single ventricle, with an impact on survival in early infancy. Palliation with the aim of instituting extracardiac conduit Fontan circulation allows greater latitude and more streamlined management.
Evaluation of the Spatial Resolution with 1.5–4 Tesla in a Stenosis Model
Authors: Wittlinger Thomas , Martinovic Ivo , Moritz Anton , Romanzetti Sandro
Published: May 2013

Since it was first described in the early 1990s, magnetic resonance coronary angiography has evolved into a promising noninvasive modality for imaging the coronary arteries. The aim of this study was to evaluate the detection accuracy and spatial resolution of vascular stenosis in contrast-enhanced 3-dimensional magnetic resonance angiography on a flow phantom. The examinations were performed with 1.5, 3, and 4 T whole-body imaging systems. For imaging at 4 T, we used a gradient-echo-multi-slice sequence. The system was flushed with gadopentetate dimeglumine contrast medium at flow rates of 40 and 60 mL·min−1. The accurate detection of in vitro stenoses was possible in segments of 0.4 mm in diameter at 4 T. The best results were obtained at a flow velocity of 40 mL·min−1 and a contrast medium concentration of 0.2 mmol·L−1. Contrast-enhanced high-field 3-dimensional magnetic resonance imaging provided a highly accurate evaluation of the degree of stenosis in this model. Exact evaluation of vessel diameters < 0.4 mm was not possible, even with 4 T. In vivo studies are necessary to overcome the current limitations in the visualization of small distal vessel segments.
Kinking of the Atrioventricular Plane during the Cardiac Cycle
Authors: Goetz Wolfgang A , Lansac Emmanuel , Lim Hou-Sen , Stevens Scott A , Weber Patricia A , Duran Carlos MG
Published: May 2013

Systolic descent of the atrioventricular plane toward the relatively stationary left ventricular apex is well described. As the atrioventricular plane includes two separate valvular units, systolic atrioventricular plane displacement should not be homogenous. In 6 sheep, sonomicrometric crystals were implanted at the base of the right coronary sinus, anterolateral and posteromedial fibrous trigones, posterior mitral annulus, left ventricular apex, and the tips of the anterior and posterior mitral leaflets. The aortomitral angle was calculated and related to simultaneous left ventricular and aortic pressures and mitral valve movement. The aortomitral angle was largest at end diastole (150.73° ± 15.48°). During isovolumic contraction, it narrowed rapidly to 144.90° ± 16.64°, followed by a slower narrowing during ejection until it reached its smallest angle at end systole (139.66° ± 16.78°). During isovolumic relaxation, the aortomitral angle increased to 143.66° ± 16.02° at the beginning of diastole. During the first third of diastole, it narrowed again to 141° ± 16.24° before re-expanding to maximum at end diastole. During systole, the atrioventricular plane descended non-homogeneously toward the apex, with kinking at the hinge between the aortic and mitral annulus plane. This deformation of the atrioventricular plane has relevance in valve surgery.
Operative Treatment of Sternal Fractures
Authors: Al-Qudah Abdullah
Published: May 2013

Four patients with displaced sternal fractures complained of intractable pain following road traffic accidents. They all had bone deformities, but only one had associated traumatic injuries. All patients underwent operative reduction and fixation of the fractured sternum using a T-shaped compression-tension stainless steel plate and screws. Pain relief was often dramatic and all patients progressed to sternal union. None required reoperation. No infections occurred. Two plates have subsequently been removed. On follow-up, all patients had excellent results. Sternal plating, which is based on the tension-band principle, is an effective treatment for displaced sternal fractures.
Intrapulmonary Channel for One-Stage Correction of Aortic Arch Obstruction
Authors: Lai Yong-Qiang , Zhou Qi-Wen , Wei Hua , Zhang Chun , Zhang Zhao-Guang
Published: May 2013

There are several methods of surgical repair of aortic coarctation or interruption; the optimal technique is still controversial. The purpose of this study was to assess a new surgical method: intrapulmonary channel for one-stage repair of aortic coarctation or interruption associated with intracardiac anomalies. Between 1993 and 1995, 4 patients with aortic coarctation or interruption and intracardiac anomalies received one-stage surgical correction. Their ages ranged from 5 to 26 years (mean, 16 years). The aortic arch lesions were preductal coarctation in 2, and type B interruption in 2. Coexisting anomalies consisted of patent ductus arteriosus in 4, ventricular septal defect in 3, and aortopulmonary window in 1. An intrapulmonary channel was constructed in all patients, and co-existing anomalies were corrected simultaneously. There was no hospital death or late mortality. A cerebral complication occurred in one patient because of air embolism. Mean follow-up was 9.5 years (range, 8.5–11.5 years). There was no evidence of recoarctation or late aneurysm formation. For selected patients with aortic coarctation or interruption and intracardiac anomalies, an intrapulmonary channel might be an option for one-stage correction.
Thoracoscopic Surgery for Pulmonary Arteriovenous Malformation
Authors: Nakajima Jun , Takamoto Shinichi , Takeuchi Eriho , Fukami Takeshi , Sano Atsushi
Published: May 2013

We report 6 consecutive cases of pulmonary arteriovenous malformation in the periphery of the lung, which were treated successfully by thoracoscopy. Pulmonary wedge resection was performed with a linear cutting stapler to divide the feeding artery, drainage vein, and aneurysmal lesion of the arteriovenous malformation. Operative time ranged from 30 to 95 min (mean, 50 min). Bleeding was minimal in all cases. No major surgery-related complications were observed. Postoperative hospital stay was limited to one week except for one patient who had experienced a brain infarction preoperatively, caused by migration of an embolization coil. Histological examination confirmed that the arteriovenous malformation foci were completely removed. Pulmonary wedge resection through thoracoscopy is feasible as an alternative treatment for arteriovenous malformation located in the periphery of the lung parenchyma when pulmonary embolization therapy is difficult or unsuccessful.
Longitudinal Reinforcement for Treatment of Sternal Dehiscence
Authors: Totaro Pasquale , Degno Nello , Argano Vincenzo
Published: May 2013

Re-fixation of the sternum after sternal dehiscence is still a problem following cardiac surgery. An original technique that allows reinforcement against various causes of dehiscence is described. The technique consists of 3 additional overlapping longitudinal wires set on both sides of the sternum. Over 2 years, this technique was applied in 34 patients, with complete sternal re-fixation in all, and no signs of recurrence on follow-up.
Surgical Repair for Entire Inferior Vena Cava Occlusion in Budd-Chiari Syndrome
Authors: Rikitake Kazuhisa , Itoh Tsuyoshi , Natsuaki Masafumi , Katayama Yuji , Ohtsubo Satoshi , Kataoka Hiroumi
Published: May 2013

Successful repair of thrombotic occlusion of the entire inferior vena cava, including the iliac and hepatic veins, was performed on a 51-year-old man with Budd-Chiari syndrome associated with severe liver dysfunction.
Mycotic Aortic Aneurysm following Treatment of Pyogenic Vertebral Osteomyelitis
Authors: Woo Siu-Bon , Cheng Lik-Cheung , Wong Wing-Cheung
Published: May 2013

Mycotic aortic aneurysm is a surgical emergency. However, its bizarre presentations could delay the golden hour of surgical reconstruction which is the mainstay of treatment. We report a case of mycotic aneurysm of the aortic arch which developed in the postoperative period after surgical treatment of pyogenic vertebral osteomyelitis at the lower thoracic level.
Totally Endoscopic Coronary Artery Bypass Surgery
Authors: Mishra Yugal K , Wasir Harpreet , Sharma Krishan K , Mehta Yatin , Trehan Naresh
Published: May 2013

Robotically enhanced surgery is a fast-developing technique that allows totally endoscopic cardiac surgery on both the beating and arrested heart. Between December 2002 and May 2005, 13 patients underwent totally endoscopic coronary bypass using the da Vinci system; 11 operations were on a beating heart and 2 on arrested hearts. The mean time for internal mammary artery mobilization was 42 min. The time for left internal mammary artery-to-left anterior descending artery anastomosis was 20–36 min for totally endoscopic cases. In one patient, the right internal mammary artery was anastomosed to the diagonal artery. No patient required conversion to a median sternotomy. Mean intensive care unit stay was 1.2 days and mean hospital stay was 4.5 days. There was no hospital mortality. All 13 patients had coronary angiography at 3-month intervals, which showed 100% patency in 12 patients while one had 50% anastomotic narrowing for which coronary angioplasty was performed. Using robotic technology, completely endoscopic anastomosis is possible in patients with single-vessel disease. Use of robotics is now extended to achieve complete myocardial revascularization by harvesting both internal mammary arteries in addition to making a small thoracotomy for direct anastomosis.
Late Re-operation for Aortic and Mitral Starr-Edwards Ball Valve Prostheses
Authors: Aoyagi Shigeaki , Fukunaga Shuji , Arinaga Koichi , Yokokura Yoshinori , Yokokura Hiroko , Egawa Noriko
Published: May 2013

Starr-Edwards ball valves removed more than 15 years after implantation were retrospectively investigated macroscopically. Eight patients required re-operation. Valve models used in the initial operations were a non-cloth-covered valve in 2 patients and a cloth-covered valve in 6. Two patients had replacement of an aortic ball valve (model 1260 and model 2320) and 6 underwent mitral valve replacement (model 6120 in one, model 6320 in 5). The mean time to re-operation was 23.0 ± 4.8 years after implantation. Cloth wear causing significant hemolysis was observed in all cloth-covered valves, regardless of valve position. Autologous tissue growth was noted on the orifice ring and struts in both aortic and mitral prostheses. Thrombus formation was not found in any of the valves. Ball variance in silicone rubber balls was mild in the non-cloth-covered valves, even in the aortic position. The most significant problem with the cloth-covered ball valve was cloth wear. Cloth wear should always be considered when 15 years or more have passed since valve implantation. Significant hemolysis, elevation of lactate dehydrogenase values, and echocardiographic detection of transvalvular regurgitation are diagnostic of cloth wear, and are indications for replacement of a cloth-covered ball valve.
Asymptomatic Solitary Mediastinal Cystic Lymphangioma: A Rare Entity
Authors: Misthos Panagiotis , Sepsas Evangelos , Kokotsakis Ioannis , Skottis Ion
Published: May 2013

Solitary mediastinal cystic lymphangioma is an extremely rare tumor-like abnormality of the lymphatic system, of congenital origin. From 1996 to 2003, 4 cases of solitary mediastinal cystic lymphangioma were managed in our department. The clinicopathologic characteristics were recorded and analyzed. The incidence proved to be 1.2% among all cases of mediastinal masses admitted to our department. All patients were asymptomatic, they shared common radiologic features, and all were managed by radical surgical excision. No recurrence or mortality were noted during follow-up ranging from 2 to 7 years. Complete excision of this benign entity has an excellent prognosis.
Effect of pH Management on Brain Perfusion during Retrograde Cerebral Perfusion
Authors: Yang Yanmin , Li Zhijun , Yang Luojia , Jackson Michael , Turner Allan , Ye Jian
Published: May 2013

This study was undertaken to determine the effects of different pH management strategies during retrograde cerebral perfusion on the relationship between retrograde perfusion pressure and brain tissue perfusion. Six pigs were subjected to an alpha-stat strategy and another 6 to a pH-stat strategy during hypothermic (15°C) retrograde cerebral perfusion at perfusion pressures of 10 to 70 mm Hg, in increments of 10 mm Hg every 20 min. Regional cerebral blood flow was significantly higher in the pH-stat group than in the alpha-stat group. The cerebral blood flow peaked at perfusion pressures of 40–50 mm Hg (18.6% ± 10.8% in the pH-stat group vs. 3.6% ± 1.2% in the alpha-stat group). In both groups, the intracranial pressure remained below the critical level of 25 mm Hg, even at a retrograde perfusion pressure of 70 mm Hg. Cerebral lactate production was higher in the alpha-stat group than the pH-stat group during retrograde cerebral perfusion at pressures of 10–30 mm Hg. Compared to the alpha-stat strategy, the pH-stat strategy significantly improved brain tissue perfusion. With an open inferior vena cava, the optimal perfusion pressure seems to be 40–50 mm Hg.
Minor Infection Encouraged by Steroid Administration during Cardiac Surgery
Authors: Sano Tetsuro , Morita Shigeki , Masuda Munetaka , Yasui Hisataka
Published: May 2013

The aim of this study was to investigate whether steroid administration would increase the risk of postoperative infection. Sixty adults who underwent elective cardiac surgery under cardiopulmonary bypass were prospectively randomized into two groups. Thirty-one patients received hydrocortisone (50 mg·kg−1) before and after cardiopulmonary bypass, the other 29 served as controls. Various hemodynamic and pulmonary measurements were obtained perioperatively, and the white blood cell counts and levels of C-reactive protein were checked up to the 14th postoperative day. Steroid administration did not have any favorable effects during the perioperative period. Re-administration of antibiotics was needed in 7 patients (22.6%) after the 7th postoperative day in the steroid group, and in 3 (10.3%) in the control group. The peak white cell counts and C-reactive protein levels after the 7th postoperative day were significantly higher in the steroid group. Steroid administration offered no clinical benefit to patients undergoing cardiac surgery with cardiopulmonary bypass, and it may encourage minor infections in the late postoperative period.
Tracheo-innominate Artery Fistula in Children with High-Lying Innominate Artery
Authors: Chittithavorn Voravit , Rergkliang Chareonkiat , Chetpaophan Apirak , Vasinanukorn Prasert
Published: May 2013

Tracheo-innominate artery fistula (TIF) is an uncommon but frequently fatal complication of tracheostomy. Significant airway hemorrhage usually occurs after premonitory bleeding. When massive bleeding occurs, immediate control of arterial bleeding, control of the airway and subsequent definite treatment are the principles for saving lives. Without prompt surgical intervention, the outcome of this complication is grave. Physicians should maintain a high index of suspicion of TIF in any patient with a recent tracheostomy and subsequent tracheal hemorrhage.
Disseminated Intravascular Coagulopathy Caused by Intracardiac Mesothelioma
Authors: Jin Tao , Wang Hai-Yong , Ni Yi-Ming
Published: May 2013

We report a case of intracardiac mesothelioma complicated by chronic disseminated intravascular coagulopathy in a 50-year-old woman. Her symptoms were completely relieved by emergency resection of the tumor. Primary resection of the intracardiac mesothelioma is adequate treatment for this complicated surgical problem.
Late Presentation of Congenital Bochdalek Hernia: A Case Report
Authors: Mishra Pankaj K , Shackcloth Michael , Andrew Elizabeth , Page Richard D
Published: May 2013

A 23-year-old man presented with a long history of dyspnea and wheezing thought to be due to asthma. Abnormal appearance of the left hemithorax was an incidental finding on a chest X-Ray. On further investigations he was found to have congenital Bochdalek hernia which was repaired surgically. All his respiratory symptoms resolved and he was able to discontinue treatment for asthma. We want to emphasise that late presentations can be misleading even to an astute clinician.
Plasma Troponin Levels after Cardiac Surgery vs after Myocardial Infarction
Authors: Abramov Dan , Abu-Tailakh Muhammad , Frieger Michael , Ganiel Amir , Tuvbin David , Wolak Arik
Published: May 2013

Raised plasma troponin, a diagnostic marker for myocardial infarction, usually occurs after cardiac surgery, leading to difficulties in diagnosing postoperative myocardial infarction. To ascertain whether the same processes influence troponin elevation in both conditions, a literature search was performed for plasma troponin elimination curves after myocardial infarction, myocardial infarction with reperfusion, and cardiac surgery. From 70 studies, 11 curves using the Stratus immunoassay kit were analyzed: 5 post-cardiac surgery (412 patients), 2 after myocardial infarction with reperfusion (169 patients), and 4 after myocardial infarction (640 patients). For each group, a new plot was formulated from the mean troponin level at each time interval. While the up-slope of the cardiac surgery curve was much steeper than that of myocardial infarction, resembling that of myocardial infarction with reperfusion, its down-slope was significantly more gentle than that of both other groups (−0.91 vs −5.31, t = 3.47, df = 8, p < 0.01). This suggests that postoperative troponin elevation involves enhanced cell permeability as seen after ischemia reperfusion rather than permanent cellular damage. The gentler down-slope may point to surgery-induced impaired troponin removal from the circulation. Due to the different mechanisms proposed, implications from post-myocardial infarction troponin levels may not be conferred on post-cardiac surgery patients.
Treatment Methods for Spinal Cord Injury Caused by Acute Type B Aortic Dissection
Authors: Fujisawa Yasuaki , Morishita Kiyofumi , Fukada Johji , Kawaharada Nobuyoshi , Hachiro Yoshikazu , Abe Tomio
Published: May 2013

Acute distal aortic dissection rarely causes spinal cord ischemia presenting with paraplegia or paraparesis. Spinal cord involvement has poor outcomes, and there is no established effective treatment for this disorder. In this report we describe the acute conservative treatment of two cases of paraplegia/paraparesis due to acute type B aortic dissection. Early reversal of lower-limb dysmobility was achieved.
Thoracoscopic Thymectomy in a Previous Sternotomy
Authors: Vyas Soumil , Agasthian T , Goh Meng Huat , Shankar S
Published: May 2013

A video assisted thoracoscopic surgery (VATS) thymectomy is a viable alternative to conventional open thymectomy in myasthenia gravis (MG). A previous operation in the same anatomical region is generally considered a relative contraindication to any minimally invasive approach in the same area. Few cases of VATS on previously operated chests have been reported. We report a case of a VATS thymectomy in a patient who had undergone two previous sternotomies for cardiac disease.
Acute Fulminant Myocarditis after Diphtheria, Polio, and Tetanus Vaccination
Authors: Wu Shye-Jao , Sun Shen , Li Jiun-Yi , Hu Po-Yuan , Chien Chen-Yen
Published: May 2013

We report an infant case of acute fulminant myocarditis which occurred after administration of a diphtheria, polio, and tetanus vaccination. Fever and dyspnea developed after the vaccination. Extracorporeal membrane oxygenation was used for intractable cardiogenic shock. The patient survived the extracorporeal support, but poor ventricular contractility recurred 2 months later and she died while waiting for heart transplantation.
Pulmonary Oncocytoma: A Rare Case
Authors: Burrah Rajaram , Kini Usha , Correa Marjorie , Srirangapatna Srikrishna
Published: May 2013

Oncocytomas are rare tumors with characteristic histological features of large eosinophilic cells with prominent nucleoli and small round nuclei. They commonly occur in the kidney and salivary glands. Their occurrence in the lungs is very rare; fewer than 6 cases being reported so far in the available world literature. We encountered one such case and present the details of the management and its outcome.
Infective Endocarditis Associated with Sjögren's Syndrome
Authors: Sughimoto Koichi , Nakano Kiyoharu , Gomi Akihiko , Nakatani Hayao , Nakamura Yoshitsugu , Sato Atsuhiko
Published: May 2013

Sjögren's syndrome is one of the major autoimmune diseases, however infective endocarditis associated with Sjögren's syndrome has not previously been reported. A patient with Sjögren's syndrome associated with aortic valve regurgitation due to infective endocarditis, underwent successful aortic valve replacement. Patients with Sjögren's syndrome tend to be at a higher risk of intraoral infections due to diminished secretion of saliva. Particular care must be taken of Sjögren's syndrome patients as they can also be at an increased risk of infective endocarditis.
Antioxidant Attenuates Acute Lung Injury after Cardiopulmonary Bypass in Rats
Authors: Wang Li-Zhong , Li Shi-Tong , Wang Ying-Tian , Wang Zheng-Ping
Published: May 2013

This study tested the effects of the antioxidant pyrrolidine dithiocarbamate on acute lung injury induced by cardiopulmonary bypass in rats. Adult rats were randomly divided into 3 groups of 7 each. The study group was pretreated with pyrrolidine dithiocarbamate before undergoing 60 min of normothermic partial cardiopulmonary bypass, a control group underwent cardiopulmonary bypass only, and a third group underwent a sham operation involving anesthesia and cannulation only. The respiratory index at 60 min after terminating bypass was significantly increased in the study group only. Neutrophil, malondialdehyde, interleukin-8, nuclear factor-κB, and protein levels in bronchoalveolar lavage fluid from the cardiopulmonary bypass group were significantly higher than those in the other two groups, with marked inflammatory changes on lung histopathology. It was concluded that cardiopulmonary bypass can directly induce acute lung injury, and pyrrolidine dithiocarbamate attenuates this injury by inhibiting nuclear factor-κB activity.
Surgical Coronary Revascularization in Severe Left Ventricular Dysfunction
Authors: Chong Chee Fui , Fazuludeen Ali Akbar , Tan Christie , Da Costa Mark , Wong Poo Sing , Lee Chuen Neng
Published: May 2013

Surgical revascularization in patients with coronary artery disease and severe left ventricular dysfunction is a common practice and poses a surgical challenge. From September 2002 to May 2004, 50 patients (47 men and 3 women; mean age, 59 ± 9 years) with a mean preoperative ejection fraction of 19.7% ± 3.2% underwent surgical revascularization. The mean EuroSCORE was 7.2 ± 3.4. Indications for surgery were congestive heart failure in 8 patients (16%), angina in 20 (40%), ventricular arrhythmias in 4 (8%), and critical left main stem disease in 12 (24%). Twenty-two patients (44%) had emergency surgery for critical anatomy and unstable symptoms. The number of grafts per patient was 3.7 ± 0.8. Seventeen patients (34%) required intra-aortic balloon pump support, 16 (32%) needed pacing, and 48 (96%) had inotropic support postoperatively. Morbidity included re-operation for bleeding (2%), acute renal failure (10%), hemodialysis (4%), and fatal multiorgan failure (4%). Postoperative (4.9 ± 3.7 months) 2-dimentional echocardiography was available in 18 patients of whom 11 (61%) showed improved left ventricular function (range, 5% to 45%). Thirty-day hospital mortality was 8%. These data indicate that surgical revascularization can be performed safely with acceptable hospital mortality in high-risk patients with severe left ventricular dysfunction.
The Ross Operation: Clinical Results and Echocardiographic Findings
Authors: Salehi Mehrdad , Sattarzadeh Roya , Soleimani Ali Akbar , Radmehr Hassan , Mirhosseini Jalil , Sanatkar Far Mehdi
Published: May 2013

Between November 2001 and September 2004, 80 patients aged 11 to 56 years (mean, 27.6 years) underwent the Ross operation. The mean preoperative New York Heart Association functional class was 2.37 ± 0.72, and the mean ejection fraction was 52.8% ± 16%. Aortic involvement included stenosis in 19 (24%) patients, regurgitation in 22 (28%), and both in 39 (49%). Root replacement was the technique used in all cases. The mean hospital stay was 5 days, and 74 patients (93%) were followed up for 4–48 months. Four-year actuarial survival rate was 96.25%. Postoperative echocardiography revealed no pulmonary autograft insufficiency in 50 patients (63%), trivial to mild insufficiency in 22 (28%), moderate insufficiency in 2 (3%), and severe insufficiency in one (1%). Two patients required autograft re-intervention. Postoperative echocardiography of the pulmonary homograft valve showed severe stenosis (peak gradient > 50 mm Hg) in 2 patients, and moderate stenosis (peak gradient 25–50 mm Hg) in one. The mean postoperative left ventricular ejection fraction was 51.4%. The Ross operation can be considered an elegant alternative to prosthetic valves in the treatment of aortic valve diseases in developing countries.
Effects of Tranexamic Acid and Autotransfusion in Coronary Artery Bypass
Authors: Mehr-Aein Aflatoon , Davoodi Saeed , Madani-Civi Manouchehr
Published: May 2013

The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on postoperative bleeding and the need for allogeneic transfusion. In a prospective randomized study, 200 patients undergoing coronary artery bypass were divided into two groups: 100 patients received 1–2 units of autologous blood after termination of cardiopulmonary bypass; and 100 patients were given tranexamic acid 15 mg·kg−1 before injection of heparin and again before injection of protamine. Postoperative bleeding was significantly lower in the tranexamic acid group (600 mL) than the autotransfusion group (1,100 mL). The percentage of patients transfused in the autotransfusion and tranexamic acid groups was 70% and 65%, respectively. Patients in the autotransfusion group received significantly more whole blood (2.82 vs 1.93 units). Intensive care and hospital stays were shorter in the tranexamic acid group. There was no hospital mortality and no difference in thrombotic complications between groups. Tranexamic acid was more effective than autotransfusion in reducing postoperative blood loss and allogeneic transfusions after coronary bypass.
Postoperative Residual Pleural Spaces: Characteristics and Natural History
Authors: Misthos Panagiotis , Kokotsakis John , Konstantinou Marios , Skottis Ion , Lioulias Achilles
Published: May 2013

This study was conducted in order to re-define the incidence and natural history of postresectional residual pleural spaces (PRS). From 1997 to 2005, 966 patients who were subjected to less than entire lung resections, were followed and any cases of PRS were recorded. The records of these patients were retrospectively analyzed for age, gender, type of resection, side, apical or basal location, size, PRS wall thickness, empyema as well as for bronchopleural fistula occurence, management, and outcome. Postresectional residual pleural spaces outcome was correlated with space characteristics. A total of 92 cases (9.5%) of PRS were documented which developed frequently ( p < 0.001) after upper lobectomies, malignant disease, at an apical location, and on the right side. Unfavorable outcome was strongly correlated with age > 70 years ( p < 0.001), air leak ( p < 0.001), empyema ( p < 0.001), and thickened pleura ( p < 0.001). Good prognosis of PRS was strongly correlated with male gender, apical location, right side, normal pleura thickness, and small size. Postresectional residual pleural spaces of small size without any associated complications should not prolong hospitalization time.
Airway Compression by Major Aortopulmonary Collaterals with 22q11 Deletion
Authors: Kaneko Yukihiro , Yoda Hitoshi , Tsuchiya Keiji
Published: May 2013

Hypoxic choking episodes due to airway obstruction occurred frequently from 4 months of age in a boy with 22q11 deletion, pulmonary atresia, ventricular septal defect, absent central pulmonary artery, tracheobronchomalacia, and an aberrant right tracheal bronchus. The tracheobronchial tree was compressed by a posteriorly displaced ascending aorta and right aortic arch with aberrant left subclavian artery and major aortopulmonary collateral arteries. Single-stage unifocalization and intracardiac repair plus aortopexy at 8 months resulted in resolution of the respiratory distress and heart failure.
Treatment for Intercostal Arterial Aneurysm in Neurofibromatosis Type 1
Authors: Matsumoto Isao , Ohta Yasuhiko , Tsunezuka Yoshio , Tamura Masaya , Oda Makoto , Watanabe Go
Published: May 2013

We report a valuable case in which a spontaneous intercostal arterial aneurysmal rupture associated with neurofibromatosis type 1, and a re-rupture after embolization of the aneurysm were successfully treated by endovascular embolization without surgery. Our case calls for attention as it indicates that recurrent aneurysmal rupture can occur even after an embolization or surgery. It is important to carefully observe the course of the patient by follow-up computed tomography (CT) or angiography in such cases.