bluuebunny/crossref_metadata_2025 huggingface dataset:
Histological/Biological Characterization of Decellularized Bovine Jugular Vein
Authors: Li Wu , Liu Wei-Yong , Yi Ding-Hua , Yu Shi-Qiang , Jin Zhen-Xiao
Published: May 2013

Several deficiencies in currently available right ventricular valved conduits make them problematic for use in infants and children. A solution would be to develop a tissue-engineered valved conduit containing autologous cells. A method was devised to produce a decellularized bovine matrix scaffold for developing a tissue-engineered right ventricular valved conduit. Fresh bovine jugular veins were treated with sodium deoxycholate and Triton X-100. The major structural proteins of the fresh and decellularized jugular venous valves and vessel walls were detected by histological methods. Thickness, water absorption rate, water maintenance rate, disruption strength, and extensibility were determined. Circumferential and radial specimens of valves and vessel walls were subjected to tensile testing. Histological analysis showed that no cell fragments were retained within the decellularized matrix scaffold and the major structural proteins had been retained intact. There were no significant differences in thickness, rates of absorption and maintenance of water, disruption strength, and extensibility between the decellularized and fresh veins. It was concluded that this treatment can successfully remove cellular components while maintaining the major structural components and the histological and biological properties of bovine jugular veins.
Middle Cerebral Arterial Blood Flow Velocity and Hemodynamics in Heart Surgery
Authors: Demirci Abid , Ünver Süheyla , Karadeniz Ümit , Çetintaş Yeşim , Kazanci Dilek , Erdemli Özcan
Published: May 2013

The aim of this study was to evaluate the effects of propofol, isoflurane, and sevoflurane on middle cerebral arterial blood flow velocity during open heart surgery, and the relationship between these effects and hemodynamic parameters. Fifty-two patients undergoing coronary artery bypass on cardiopulmonary bypass were divided randomly into 3 groups: the first group received 100 μg·kg−1·min−1 propofol, the other groups received one minimum alveolar concentration of sevoflurane or isoflurane for anesthesia maintenance. Middle cerebral arterial blood flow velocities were measured by transcranial Doppler, and hemodynamics were measured by the thermodilution technique. Middle cerebral arterial blood flow velocities decreased significantly after administration of isoflurane and propofol, but there was no significant difference between the groups. After weaning from cardiopulmonary bypass, cerebral blood flow increased and came close to the value after induction in all groups. The pulsatility index and resistivity index increased significantly only after the propofol infusion, but there was no significant difference between the groups.
Radial Artery Graft Use and Off-Pump Coronary Artery Bypass Surgery Outcome
Authors: Gurbuz Ahmet T , Findik Orhan , Cui Haiyan , Aytac Aydin
Published: May 2013

Radial artery is commonly used as a conduit for surgical revascularization. There is scarce data on the effect of radial artery use on outcome following off-pump coronary artery bypass. We prospectively evaluated 591 patients undergoing off-pump coronary artery bypass. Radial artery grafts were used in 398 of these patients (mean age, 67.6 ± 10.4 years; mean follow-up, 37.7 ± 13.4 months). Symptom recurrence (angina, congestive heart failure), adverse cardiac events (myocardial infarction, coronary re-intervention, sudden cardiac death), and overall mortality were recorded. Multivariate Cox regression analysis was used to evaluate predictors of endpoints. Patients with and without radial artery grafts were similar with respect to preoperative risk factors. Recurrent angina developed in 29 patients, congestive heart failure in 5, and myocardial infarction in 9. Coronary arteriography was performed in 27 patients, and 23 underwent re-intervention. Radial artery graft was an independent predictor of increased symptom recurrence and adverse cardiac events. Patients with radial artery grafts also had a tendency towards more angina recurrence, coronary re-intervention, and sudden cardiac death.
Oral Sildenafil to Control Pulmonary Hypertension after Congenital Heart Surgery
Authors: Peiravian Farah , Amirghofran Ahmad A , Borzouee Mohammad , Ajami Gholam H , Sabri Mohammad R , Kolaee Sara
Published: May 2013

This study investigates the role of oral sildenafil in decreasing pulmonary pressure after congenital heart surgery. Between September 2002 and September 2004, among a group of postoperative children with large septal defects, moderate to severe pulmonary hypertension [pulmonary artery (PA) to aortic (Ao) pressure ratio of 0.76 ± 0.17] and systemic desaturation (Ao Sat = 0.89 ± 0.11), oral sildenafil (0.3 mg·kg−1, every 3 hours) was administered for a period of 24–48 hours (sildenafil group). These patients were compared to a group of 22 children with similar pathologies who did not receive sildenafil (control group). Postoperative PA pressure (28.61 ± 7.80 vs 39.40 ± 10.80 mm Hg) and PA/Ao pressure (0.28 ± 0.08 vs 0.41 ± 0.11) were significantly lower in the sildenafil group ( p = 0.001 and 0.001 respectively). Pulmonary hypertensive crisis was detected in 4 patients in the control group, but none in the sildenafil group ( p = 0.02). There was no significant rise in PA pressure following discontinuation of the drug (26.30 ± 6.66 vs 28.49 ± 10.93 mm Hg, p = 0.366). No significant complications were noticed regarding sildenafil use. Low doses of oral sildenafil appear to be effective and safe to control postoperative PA pressure in children. Absence of rebound pulmonary hypertension, availability, and low cost of the drug are considered as its major advantages.
Deep Pericardial Suture vs Apical Suction for Off-Pump Bypass Grafting
Authors: Ustunsoy Hasim , Kazaz Hakki , Celkan Mehmet A , Kayiran Celalettin , Hayta Rengin , Bayar Ekrem
Published: May 2013

Hemodynamic changes during heart luxation and stabilization are major problems in off-pump coronary artery bypass surgery. The hemodynamic effects of an apical suction device were compared with those of the classic posterior pericardial suture in 45 patients with multivessel coronary disease undergoing off-pump coronary artery bypass. Mean age was 63.78 ± 8.11 years; 31 patients were male and 14 were female. Transesophageal Doppler echocardiography was used for hemodynamic monitoring. All hemodynamic parameters were significantly better when the apical suction device was used to position the heart for anastomoses on the posterior descending and circumflex arteries.
Off-Pump Resection of Aorto-Saphenous Vein Graft Pseudoaneurysm
Authors: Bittar Mohamad N , Duncan Andrew J
Published: May 2013

Pseudoaneurysms of saphenous vein grafts are rare. We present the case of a 58-year-old man who presented with recurrent angina nine years following quadruple coronary artery bypass graft surgery in 1983. He was found to have an aneurysm arising from the ascending aorta. The patient underwent off-pump aorto-saphenous vein pseudoaneurysm resection and redo coronary artery bypass grafts.
Distal Carotid Perfusion in Combined Carotid Endarterectomy and OP-CABG
Authors: Rao Parachuri V , Hosabettu Praveen K , Dhaded Sanjay , Mathew Avery , Punnen Julius , Kanchi Muralidhar
Published: May 2013

An alternative method of maintaining carotid perfusion during combined carotid endarterectomy and off-pump coronary artery bypass grafting involves insertion of a cannula in the ascending aorta after a median sternotomy. This cannula is connected to a perfusion cannula, the distal end of which is inserted into the carotid artery beyond the carotid arteriotomy. This technique of aortico-carotid shunting and carotid perfusion was utilized in nine patients who underwent successful combined carotid endarterectomy and off-pump coronary artery bypass grafting.
Pulmonary Hypertension Alters Natural History of Anomalous Left Coronary Artery
Authors: Akbari Jayesh , Theodore Sanjay , Krishnamanohar Soman R , Neelakandhan Kurur S
Published: May 2013

A girl who was diagnosed at 8 months old with anomalous left coronary artery from the pulmonary artery and was subsequently lost to follow-up, presented at the age of 11 years with congestive heart failure and severe mitral regurgitation with supra-systemic pulmonary artery pressure. With progressive mitral regurgitation, coronary steal is reduced by the rising pulmonary artery pressure, and patients present late with severe valvular cardiomyopathy.
Revascularization and Mitral Valve Replacement in a Patient with Porcelain Aorta
Authors: Charokopos Nicholas , Antonitsis Polychronis , Rouska Efthymia , Toumbouras Michalis
Published: May 2013

In cases of severe atherosclerosis of the ascending aorta, alterations in the standard surgical technique are mandatory. We report mitral valve replacement and coronary artery bypass grafting in a patient with a severely atherosclerotic aorta. Cardiopulmonary bypass was conducted via an arterial cannula in the femoral artery and two single venous cannulas. Coronary artery bypass grafting was performed using bilateral internal thoracic arteries with beating heart in normothermia. The mitral valve was replaced with a mechanical prosthesis during hypothermic fibrillatory arrest.
Intra-aortic Filtration is Effective in Collecting Hazardous Materials
Authors: Mestres Carlos-A , Bernabeu Eduardo , Fernández Claudio , Colli Andrea , Josa Miguel
Published: May 2013

Neurological complications after cardiac operations are mostly due to particle embolization. This case illustrates the embolic potential of any material. A 77-year-old lady underwent re-operation for homograft aortic regurgitation and mitral valve replacement. Intra-aortic filtration was used. After cardiopulmonary bypass the filter was found to have captured a pledget from a suture used to secure the mitral replacement device.
Near-Infrared Spectroscopy Monitoring of Brain Oxygen in Infant Cardiac Surgery
Authors: Huang Ji-Hong , Su Zhao-Kang , Wang Shun-Min
Published: May 2013

The use of near-infrared spectroscopy for monitoring cerebral oxygenation during different types of cardiopulmonary bypass was evaluated in 24 patients aged 5 to 13 months. They underwent open-heart surgery under cardiopulmonary bypass with moderate hypothermia, deep hypothermia with low flow, or deep hypothermia with circulatory arrest. Near-infrared spectroscopy data were compared with electroencephalography and biochemical indicators (neuron-specific enolase, lactate). Near-infrared spectroscopy data showed no correlation with biochemical indicators in patients undergoing cardiopulmonary bypass with moderate hypothermia or deep hypothermia with low flow. In the deep hypothermia with circulatory arrest group, the oxygenated hemoglobin signal declined to a nadir during circulatory arrest. The period from reaching the nadir until reperfusion and the minimum values of oxygenated hemoglobin correlated closely with increases in neuron-specific enolase and lactate. All patients with an oxygenated hemoglobin-signal nadir time < 35 min were free from behavioral evidence of brain injury. The oxygenated hemoglobin-signal nadir time may be useful in predicting the safe duration of circulatory arrest.
Omental Transposition: The Final Solution for Major Sternal Wound Infection
Authors: Athanassiadi Kalliopi , Theakos Nick , Benakis Georgios , Kakaris Stamatis , Skottis Ion
Published: May 2013

Sternal osteomyelitis after median sternotomy for cardiac surgery is associated with considerable morbidity and mortality. The ideal reconstruction after sternal debridement is still debated. From 2000 to 2004, we treated 15 patients for sternal osteomyelitis (type IIIB, IVA, IVB) after median sternotomy for cardiac surgery. Total or partial resection of the sternum and extensive debridement were performed in all cases. The defect was covered by omental transposition. In 11 cases, a single-stage operation took place, and a two-stage procedure was employed in 4. All patients had antibiotics postoperatively. There were 3 (20%) deaths due to cardiac failure. Hospital stay ranged from 21 to 45 days. Transient paradoxical movement of the anterior chest wall disappeared within one month. No recurrence was observed during 6 to 24 months of follow-up. Radical debridement along with omental flap transposition provides definitive control of the infection in cases of failure of other semi-conservative or surgical interventions. Prognosis depends on the general condition of the patient.
Mitral Valve Repair for Extended Commissural Prolapse Involving Complex Prolapse
Authors: Morimoto Hironobu , Tsuchiya Koji , Nakajima Masato , Akashi Okihiko , Kato Kaori
Published: May 2013

We reviewed our experience of mitral valve repair techniques for extended commissural prolapse involving complex prolapse of either or both leaflets, due to chordal rupture or elongation. Between June 1991 and January 2005, 21 of 210 patients who underwent mitral valve repair for mitral regurgitation had extended commissural prolapse involving either or both of the anterior and posterior leaflets. There were 17 (81%) patients with degenerative and 4 (19%) with infective endocarditis. The distribution of diseased mitral commissural lesions was: posteromedial commissure in 14 (67%) patients, anterolateral in 6 (29%), and bilateral in 1 (5%). Reconstructive techniques included leaflet folding plasty in 10, resection-suture in 6, the sliding technique in 2, commissuroplasty in 2, and chordal shortening in 1. There were no perioperative deaths; postoperative mitral regurgitation was none or trivial in 19 patients and mild in 2. The mean follow-up period was 54 months (range, 2–155 months), and no patient required re-operation. There was one late death from a noncardiac cause at 103 months. Mitral valve repair for extended commissural prolapse is satisfactory. We consider leaflet folding plasty and its modification to be effective in patients who require extensive leaflet resection in the commissural area.
Interleukin-4 C-590T Polymorphism Has No Role in Coronary Artery Bypass Surgery
Authors: Bittar Mohamad N , Khasati Noman H , Deiraniya Abdul K , Yonan Nizar
Published: May 2013

Interleukin-4 exerts anti-inflammatory effects through decreased macrophage production of tumor necrosis factor-α and interleukin-1ß. We investigated genetic predisposition in the interleukin-4 response to coronary revascularization and studied the association between C-590T polymorphism, interleukin-4 levels, and outcome of surgery. DNA was obtained from 96 consecutive patients undergoing elective coronary revascularization. Patients were genotyped for interleukin-4 C-590T polymorphism using a sequence-specific primer polymerase chain reaction. Interleukin-4 levels were measured using an enzyme-linked immunosorbent assay in serum samples taken 3 hr postoperatively. The frequency of interleukin-4 C-590T genotypes CC, CT, and TT was 33.3%, 27.1%, and 39.6%, respectively. Patients with the TT genotype had significantly higher circulating levels of interleukin-4 (3.4 ± 4.6 pg·mL−1) postoperatively compared to CC (2.5 ± 0.1 pg·mL−1) and CT (2.7 ± 0.5 pg·mL−1) genotypes. Interleukin-4 C-590T polymorphism is the main determinant of postoperative interleukin-4 levels. The TT genotype is the highest producer of interleukin-4. Neither the genotype nor the serum levels seem to play any role in recovery from coronary artery bypass surgery.
Definitive Management of Advanced Empyema by Two-Window Video-Assisted Surgery
Authors: Drain Andrew J , Ferguson Jonathon I , Sayeed Rana , Wilkinson Sharon , Ritchie Andy
Published: May 2013

We describe how 2-window video-assisted thoracoscopic decortication and lung mobilization can provide definitive management of stage III empyema. This technique was used in 52 patients with stage III empyema. None required additional ports or a thoracotomy. Three patients (6%) needed computed tomography-guided drainage of persistent large loculi, but none required further surgery. Chest radiographs at 6 weeks after surgery confirmed full lung expansion and resolution of pleural collection in the other 49 patients (94%).
High-Risk Repair of Ascending Aortic Aneurysm Due to Giant Cell Aortitis
Authors: Atluri Pavan , Woo Y Joseph
Published: May 2013

Giant cell arteritis increases the risk of developing a thoracic aortic aneurysm. Thoracic aortic aneurysm repair in octogenarians carries a profound increase in postoperative morbidity and mortality. We report the successful repair of an ascending aortic aneurysm in an 83-year-old woman with a history of treatment for temporal arteritis and pathologic evidence of giant cell aortitis.
Mitral Valve Repair in Infants and Children
Authors: Shetty Devi P , John Colin N , Rao Shekar , Puthenveetil Sankaran J , Raj R Benedict
Published: May 2013

A number of children are born with myxomatous deformity of the mitral valve, causing mitral regurgitation. Traditional techniques of repair may be daunting in these children because apart from their small size, their valves appear grossly deformed and the tissues are friable. Techniques to circumvent these problems and ensure a predictable and satisfactory outcome are described.
Modified Sandwich Technique for Acute Aortic Dissection
Authors: Ohata Toshihiro , Miyamoto Yuji , Mitsuno Masataka , Yamamura Mitsuhiro , Tanaka Hiroe , Ryomoto Masaaki
Published: May 2013

We describe a new method for aortic anastomosis in the repair of acute type A aortic dissection. The anastomosis site is prepared with the adventitial inversion technique, which converts a dissected aorta into a conduit lined with tough adventitia. The end is reinforced with felt strip outside and anastomosed with interrupted everting mattress and running sutures, resulting in complete hemostasis. This modified sandwich technique will likely be useful for the surgical treatment of acute aortic dissection.
Stanford Type A Aortic Dissection with Child B Liver Cirrhosis
Authors: Matsukuma Seiji , Yamaguchi Hiroshi , Hamawaki Masayoshi
Published: May 2013

Cardiac surgery using cardiopulmonary bypass in patients with advanced liver cirrhosis has been infrequently performed, and reported to be too risky. Aortic dissection accompanied with liver cirrhosis is extremely rare. A 61-year-old woman who had aortic dissection and Child B liver cirrhosis underwent ascending aorta replacement. Liver protection during cardiopulmonary bypass was successfully accomplished by moderate hypothermia and use of an aortic occlusion balloon to maintain sufficient hepatic blood flow.
Cardiac and Pericardial Echinococcosis: Report of 15 Cases
Authors: Murat Vakeli , Qian Zhongxi , Guo Shuiyuan , Qiao Jun
Published: May 2013

Between 1978 and 2002, 15 patients (mean age, 23.0 ± 8.5 years) with cardiac and pericardial echinococcosis were treated surgically. The cysts were located in the right atrium in 3 patients, on the anterior myocardium in 7, and pericardially in 5. The 3 patients with right atrial cysts were operated on using cardiopulmonary bypass. There were 4 recurrences requiring re-operation after a mean of 12 months. All other patients received mebendazole treatment and exhibited no recurrence during follow-up. One late death due to chronic right heart failure occurred after 10 months of follow-up. The serologic test is an effective method of diagnosis in undeveloped and developing countries.
Does Tranexamic Acid Reduce Blood Loss in Off-Pump Coronary Artery Bypass?
Authors: Mehr-Aein Aflatoon , Sadeghi Mostafa , Madani-civi Manouchehr
Published: May 2013

The hemostatic effect of tranexamic acid on the bleeding tendency and transfusion requirements in patients undergoing off-pump coronary artery bypass surgery was assessed in a prospective randomized double-blind study. Of 66 patients undergoing elective operations, 33 were given tranexamic acid (15 mg·kg−1 before infusion of heparin and 15 mg·kg−1 after protamine infusion), and the other 33 received only saline. Postoperative bleeding, transfusions, complications, hematological variables, and plasma D-dimer levels were recorded. Postoperative blood loss was significantly less in the tranexamic acid group compared to the control group (320 ± 38 vs 480 ± 75 mL). Patients in the tranexamic acid group received significantly less allogeneic blood products (0.46 vs 0.94 units per patient), and they had lower postoperative D-dimer levels. No postoperative thrombotic complications were observed in either group. Although off-pump coronary artery bypass surgery is associated with reduced frequency of hemorrhagic disorders, defective hemostasis still occurs, and tranexamic acid effectively reduces postoperative blood loss and the need for allogeneic blood products.
Influence of Comorbidity on Outcome after Pulmonary Resection in the Elderly
Authors: Beshay Morris , Dorn Patrick , Ris Hans-Beat , Schmid Ralph A
Published: May 2013

The aim of this study was to determine the influence of comorbidity on outcome after pulmonary resection in patients over 75 years old. Three hundred and thirty-three patients with non-small-cell lung cancer operated on between 1998 and 2002 were divided into 3 age groups: < 60 years (group 1), 60–75 years (group 2), > 75 years (group 3). Overall operative mortality was 0.3%; 30-day mortality was 1%. There were more major complications with re-operation in groups 1 and 2, but minor complications occurred significantly more frequently in group 3 (36% vs 16%). Overall mean hospital stay was 12 days, with no significant difference among groups. Three-year survival rates were: 80%, 70%, and 65% in groups 1, 2, and 3, respectively, with no significant difference among groups. Age or the presence of comorbidity should not be considered contraindications for lung resection. With proper patient selection and careful preoperative evaluation, many major complications after pneumonectomy are avoidable.
Blood, Sweat, Toil, and Tears of Surgical Training. Part I: Blood
Authors: Drain Andrew J , Ferguson Jonathon I , Wilkinson Sharon , Nashef Samer AM
Published: May 2013

There may be conflict between the requirements of surgical training and those of the clinical service if training has an impact on clinical outcomes. One area of potential impact is perioperative blood loss. We compared total and 12-hour blood loss after 2,079 consecutive cardiac operations performed over 2 years by trainees and consultants. One- and two-way analyses of variance with EuroSCORE and surgeon status as factors were carried out to evaluate the impact of surgeon status on blood loss. There was no difference in blood loss between consultants and trainees. We also compared the rates between consultants and trainees of patients returning to the operating room due to bleeding. This showed a significant difference, with trainees having a higher rate of investigation for bleeding. Cardiac surgical training can be achieved without an adverse effect on blood loss, but it may be associated with a higher rate of re-intervention for bleeding.
Left Ventricular Aneurysm in Patients with Previous Cardiac Surgery
Authors: Alsaddique Ahmed A , Furnary Anthony P
Published: May 2013

Left ventricular aneurysm in patients who have undergone previous cardiac surgery is infrequently reported. We reviewed the results in all patients treated for left ventricular aneurysm between 1983 and 1995 at St. Vincent Hospital and Medical Center. Of 109 patients undergoing left ventricular aneurysm surgery, 10 had open heart surgery an average of 8.9 years previously. There was no mortality or significant morbidity in those who had previous operations. Functional status improved significantly after surgery. We concluded that surgical treatment of left ventricular aneurysm in patients who had previous open heart surgery can be performed with acceptable risks and leads to functional improvement.
Tranexamic Acid and Primary Coronary Artery Bypass Surgery: A Prospective Study
Authors: Maddali Madan M , Rajakumar Muthukkumar C
Published: May 2013

Tranexamic acid was used to reduce postoperative drainage and allogenic blood transfusion requirements in patients undergoing on-pump primary coronary bypass surgery. Over 12 months, 222 patients participated in this prospective, randomized, placebo-controlled, double-blind study conducted at a tertiary center. Half of the patients were randomly allocated to receive tranexamic acid as a bolus (10 mg·kg−1) prior to sternotomy, followed by an infusion (1 mg·kg−1·hr−1) up to the time of starting of protamine. The other 111 patients received a saline bolus and infusion. Postoperative drainage and transfusion requirements were measured in all patients. Markers of graft patency, hemostasis, hemodynamic stability, and fibrinolysis were evaluated. Chest closure time, renal function parameters, allergic reactions, incidence of stroke, re-exploration, and hospital mortality were also noted. Postoperative drainage was significantly less and blood conservation considerably better when tranexamic acid was used. Post-bypass hemostasis was achieved faster, fibrinolysis was less, and there was no evidence of increased incidence of graft occlusion in the group given tranexamic acid.
Multiperforated Atrial Septal Aneurysm and a Single Coronary Artery
Authors: Losanoff Julian E , Richman Bruce W , Jones James W
Published: May 2013

Multiperforated atrial septal aneurysm (ASA) with left-to-right shunt and elevated pulmonary arterial pressure is rare. We present an adult patient with this unusual anomaly combined with a single coronary ostium emerging from the right sinus of Valsalva. The ASA was excised and the defect repaired successfully.
Pulmonary Atresia, VSD in Association with Coronary-Pulmonary Artery Fistula
Authors: Najm Hani K , Jha Neerod K , Godman Michael , Al Mutairi Mansour , Rezk Ahmed I , Momenah Tarek
Published: May 2013

Congenital coronary-pulmonary artery fistula is rare in patients with pulmonary atresia and ventricular septal defect. The nomenclature, physiological, clinical, and surgical implications of these fistulas are yet to be defined. We report a one-year-old child with pulmonary atresia, ventricular septal defect, and a right coronary-pulmonary artery fistula who also had a diminutive, disconnected left pulmonary artery in addition to aortopulmonary collaterals. The patient underwent corrective surgery. However, the fate of diminutive pulmonary arteries is unknown. The literature was reviewed to explore the clinical or surgical implications of such fistulas for improved understanding and management in the future.
Superior Vena Cava Reconstruction with Homograft Conduit under Circulatory Arrest
Authors: Mahesh Balakrishnan , Ratnatunga Chandana
Published: May 2013

Superior vena cava obstruction may be due to benign or malignant causes. This may be treated surgically by using autologous saphenous vein grafts, autologous pericardial patches cut and reconstituted as tubes, expanded polytetrafluoroethylene grafts, or percutaneously by balloon dilatation and stenting procedures. We report a case of superior vena cava obstruction in which the obstructed segment was bypassed using a tube constructed from aortic and pulmonary homograft conduits, under hypothermic circulatory arrest without using jugulo-atrial shunts, leaving the obstructed segment in situ.
Mitral Valve Repair: Is There Still a Place for Suture Annuloplasty?
Authors: Fundarò Pino , Tartara Paolo M , Villa Emmanuel , Fratto Pasquale , Campisi Salvatore , Vitali Ettore O
Published: May 2013

Prosthetic ring annuloplasty is considered the gold standard technique for mitral valve repair, but it has been associated with some drawbacks. Suture annuloplasty is less expensive and may have some physiopathologic advantages. We reviewed the literature to assess clinical results of mitral suture annuloplasty. Thirteen series, each reporting more than 50 patients and published in the last 10 years, were included in the analysis. They comprised 1,648 patients with cumulative follow-up of 5,607 patient-years. Our review suggests that suture annuloplasty is a safe procedure, but a trend toward recurrence of annular dilatation with time was reported. In selected cases, suture annuloplasty is effective, and its mid-term clinical results are encouraging and compare well with those of prosthetic ring repair series. The quality of the results varies according to the particular annuloplasty technique used and to the mitral valve pathology treated. Recent technical modifications have been found to decrease the incidence of repair failure and promise to improve the reproducibility of the procedure. Further investigations are warranted to better assess the long-term results of suture annuloplasty, and to determine whether its theoretical functional advantages translate into a real clinical benefit.
Mediastinal Aortosympathetic Paraganglioma: Report of Two Cases
Authors: Ramos Ricard , Moya Juan , Villalonga Rosa , Morera Ricard , Ferrer Gerardo
Published: May 2013

Thoracic paragangliomas or extra-adrenal pheochromocytomas are uncommon neoplasms that may arise from the extra-adrenal paraganglia. Paragangliomas arising in the anterior mediastinum are most frequent and are related to the base of the heart. Paragangliomas of the posterior mediastinum are most infrequent, and arise from aorticosympathetic paraganglia. We present two cases of posterior mediastinum paraganglioma. Complete tumor resection was done through posterolateral thoracotomy. The diagnosis of aorticosympathectic paraganglioma was established by histologic examination.
Continuous Hemodiafiltration during Cardiopulmonary Bypass in Infants
Authors: Yoshimura Naoki , Oshima Yoshihiro , Yoshida Masahiro , Murakami Hirohisa , Matsuhisa Hironori , Yamaguchi Masahiro
Published: May 2013

The homologous blood prime in cardiopulmonary bypass circuits contributes a significant electrolyte and metabolite load in small infants. The efficacy of hemofiltration and continuous hemodiafiltration of the blood prime in preventing metabolic disturbances in small infants was compared in two groups of 60 patients each. Blood pH, base excess, and calcium concentrations decreased during cardiopulmonary bypass in the hemofiltration group. The acid-base balance was well preserved during cardiopulmonary bypass by continuous hemodiafiltration. This therapeutic strategy may confer an advantage in maintaining more physiological conditions during cardiopulmonary bypass in small infants.
Total Arterial Revascularization and Concomitant Aortic Valve Replacement
Authors: Shrestha Malakh , Khaladj Nawid , Kamiya Hiroyuki , Maringka Michael , Haverich Axel , Hagl Christian
Published: May 2013

The safety of total arterial revascularization with a left internal thoracic artery-radial artery T-graft was evaluated in patients with at least two-vessel coronary artery disease and aortic valve stenosis requiring concomitant aortic valve replacement. From June 2001 to January 2005, 18 patients underwent aortic valve replacement and total arterial revascularization, while 101 had aortic valve replacement and conventional grafting. By matching age, sex, left ventricular ejection fraction, and number of distal anastomoses, 1:2 matched groups were generated: 15 patients with a left internal thoracic-radial artery T-graft, and 30 with left internal thoracic artery and additional vein grafts. Aortic cross clamp and cardiopulmonary bypass times were similar in both groups. There were no significant differences in postoperative data between the groups. Early mortality was 0% in the T-graft group and 2% in those with conventional grafts. Follow-up ranged from 2 to 50 months. Event-free survival was 100% in the T-graft group and 90% in the conventional graft group. Total arterial grafting with a left internal thoracic-radial artery T-graft can be performed in selected patients with aortic valve stenosis requiring simultaneous aortic valve replacement.
Coronary Artery Bypass Surgery with On-Pump Beating-Heart Technique
Authors: Fouda Mohammed
Published: May 2013

To evaluate the results of on-pump beating-heart coronary bypass grafting, a retrospective study was carried out on 106 patients who had this procedure between 2003 and 2006. There were 87 (82%) men and 19 (18%) women, with a mean age of 60.53 ± 11.97 years. Five (5%) patients had unstable angina, 10 (9%) had a recent myocardial infarction, and 16 (15%) had congestive heart failure. The mean ejection fraction was 40.38% ± 11.46%. The mean cardiopulmonary bypass time was 66.81 ± 31.14 min. The median number of grafts per patient was 3. The median intensive care unit stay was 47 hours, and hospital stay was 7 days. There were 4 (3.8%) deaths. The mean Parsonnet score was 12.75 ± 11.27 and the logistic EuroSCORE was 7.06 ± 8.62. This study shows that the on-pump beating-heart technique is a safe and convenient method for coronary artery bypass grafting.
Results of Coronary Bypass and Valve Operations for Mitral Valve Regurgitation
Authors: Sirivella Srikrishna , Gielchinsky Isaac
Published: May 2013

Combined coronary bypass grafting and valve procedures for mitral valve regurgitation result in poor outcomes, but the impact of the etiology of valve regurgitation on operative and long-term outcomes is not well defined. A retrospective analysis of 468 patients who had combined coronary bypass grafting and valve operations for mitral regurgitation showed that 78% had valve repairs and 22% had replacements for ischemic (45%) or degenerative (55%) disease. Predictors of operative mortality were ischemic mitral regurgitation, failure to use the internal mammary artery for grafting, severe coronary disease, acute myocardial infarction, low ejection fraction, advanced heart failure, emergency operation, and mitral valve replacement. The 5-year survival rates for propensity-matched patients with ischemic or degenerative disease were similar (66%). Low ejection fraction (< 35%), advanced age (> 67 years), valve replacement surgery, residual mitral regurgitation, and severe coronary artery disease were predictors of poor long-term outcome. Although the operative outcomes of ischemic mitral regurgitation were poor compared to those of degenerative disease, the long-term survival was similar in both groups of propensity-matched patients. Left ventricular remodeling, an optimal valve procedure without residual mitral regurgitation, and left ventricular function are more important determinants of long-term outcome than the etiology of valve regurgitation.
Urokinase Thrombolysis in Acute-on-Chronic Vascular Occlusion of Lower Limb
Authors: Shrivastava Chandra P , Devgarha Sanjeev
Published: May 2013

Between January 2000 and June 2003, 70 patients (63 men and 7 women) with acute-on-chronic lower limb vascular occlusion underwent thrombolysis with 1 million units of urokinase. Forty-eight patients had unilateral and 22 had bilateral involvement; 9 had gangrenous changes. The mean age was 47 ± 9 years, 73% were smokers, and 13% had diabetes. The definition of a good response was either return of distal pulses or a warm limb and relief of pain at rest. Fifty-three (76%) patients (including 5 with gangrenous changes) had symptomatic improvement with thrombolysis (group 1), and 17 (24%) did not respond (group 2). All 70 patients (including 7 who later required amputation) underwent surgical intervention with a polytetrafluoroethylene interposition graft or arterioplasty. A good response to surgical treatment was found in significantly more patients (49/53, 92%) in group 1 compared to group 2 (7/17, 41%). Claudication distance after 6 months of follow-up improved in a significantly higher percentage of patients in group 1 (85%) than group 2 (38%). Preoperative thrombolysis improved the outcome and predicted the result of arterial surgery.
Stentless Valves Treated by the L-Hydro Process in the Aortic Position in Sheep
Authors: Santos Paulo C , Gerola Luís R , Casagrande Ivan , Buffolo Ênio , Cheung David T
Published: May 2013

Calcification of glutaraldehyde-treated bioprosthetic heart valves is a major cause of long-term failure. We studied porcine aortic valves treated by the L-Hydro process and implanted into 14 juvenile sheep (group 1). Another 10 sheep were implanted with glutaraldehyde-treated porcine bioprostheses (group 2). The animals were sacrificed after 150 days and the explanted valves were analyzed for calcification. Hemodynamic measurements by echocardiography and angiography were carried out prior to sacrifice. Macroscopic analysis showed calcification and loss of mobility of the leaflets in all group 2 implants and in one group 1 implant. Light microscopy showed foci of calcification in all group 2 implants and in 3 valves from group 1. A significant reduction in the level of calcification was found in porcine bioprostheses treated by the L-Hydro process and implanted into the juvenile sheep model.
Best Site on Right Ventricle for Open-Chest Biventricular Pacing
Authors: Luzi Giampaolo , Montalto Andrea , Polizzi Vincenzo , D'Alessandro Cesare C , Vicchio Mariano , Musumeci Francesco
Published: May 2013

Cardiac resynchronization therapy is effective in patients with a low ejection fraction and left bundle branch block, but 20%–30% do not respond despite selection of the optimal site for pacing on the left ventricle. We investigated whether optimizing the site for placement of the pacing lead on the right ventricle could further improve left ventricular function during cardiac resynchronization in 19 patients (mean age, 63 ± 5 years) undergoing coronary artery bypass with post-ischemic dilated myocardiopathy (ejection fraction, 25.8% ± 2%) and left bundle branch block. The hemodynamic response to pacing was tested with the right ventricular lead positioned at the interventricular septum, atrioventricular junction, acute margin, and the pulmonary trunk. Biventricular stimulation improved left ventricular function. When the right ventricular lead was sited at the interventricular septum, a significant improvement in all hemodynamic parameters compared to the other sites was obtained. Biventricular pacing is important to optimize cardiac resynchronization. Although further studies are needed to confirm these findings, accurate lead placement is recommended for cardiac resynchronization therapy in patients with poor cardiac function and left bundle branch block.
Congenital Pulmonary Vein Stenosis with Anomalous Pulmonary Venous Connection
Authors: Takabayashi Shin , Shimpo Hideto , Yokoyama Kazuto , Kajimoto Masaki , Onoda Koji
Published: May 2013

An 11-month-old boy with congenital pulmonary vein stenosis, partial anomalous pulmonary venous connection, and ventricular septal defect is described. Angiocardiography demonstrated stenosis between the right upper pulmonary vein and high superior vena cava and obstruction of the right lower pulmonary vein. For pulmonary vein stenosis, we performed transverse sutured plasty for the right upper pulmonary vein, followed by right lower lobectomy. In some patients, combined management for pulmonary vein stenosis is effective.
Device Occlusion of Fontan Fenestration—an Economical Alternative
Authors: Sekar Rajasekaran Prem , Cherian Kotturathu M
Published: May 2013

Fenestrating the Fontan circuit during total cavopulmonary anastomosis is commonly performed to reduce postoperative mortality and morbidity. The resulting systemic desaturation may progressively increase leading to symptoms. We report the case of a symptomatic eight year old, whose Fontan circuit fenestration was closed using a patent ductus arteriosus occluder. The marked improvement in the patient's clinical status immediately and after 3 months confirms this device to be a safe, and economically better alternative to the atrial septal defect occluder.
Chylothorax following Cardiac Surgery Caused by Unusual Lymphatic Anatomy
Authors: Narayan Pradeep , Rahaman Natasha , Molnar Thomas F , Caputo Massimo
Published: May 2013

Chylothorax due to injury to the thoracic duct and lymphatic channels during left internal thoracic artery harvest is well described. However, high volume leakage of chyle due to disruption of aberrant thymic collateral lymphatic channel in the anterior mediastinum has not been described previously. We describe such a case which was managed by early surgical exploration, ligation of the aberrant duct, and insertion of a pleuro-peritoneal shunt.
Primary Hydatid Cyst of the Posterior Mediastinum
Authors: Kabiri El Hassane , Zidane Abdelfettah , Atoini Fouad , Arsalane Adil , Bellamari Hicham
Published: May 2013

Hydatid cystic disease is still a health problem in Morocco. Mediastinal localization is very rare. We report the case of a 24-year-old man who presented with right chest pain and dyspnea. Chest X-Ray and computed tomography showed a mediastinal mass. The diagnosis was confirmed perioperatively by macroscopic and histologic investigations. Resection of the cyst was performed, and a small part intimately adherent to the inferior vena cava and oesophagus was left in place. There were no complications or recurrence.
Left Ventricular Hypertrophy and Remodeling after Aortic Valve Replacement
Authors: Iyem Hikmet , Sekuri Cevat , Tavli Mine , Büket Suat
Published: May 2013

Left ventricular geometric remodeling and regression of hypertrophy were assessed after aortic valve replacement with a mechanical prosthesis in 37 patients with aortic stenosis and 39 with aortic insufficiency, aged 54.2 ± 14.3 and 52.6 ± 16.6 years, respectively. The follow-up period was 2 years. In patients with aortic insufficiency, ejection fraction increased from 54.4 ± 3.5 preoperatively to 59.6 ± 3.4 after 6 months and 61.7 ± 2.7 after 2 years. In patients with aortic stenosis, ejection fraction increased from 56.6 ± 5.1 preoperatively to 63.9 ± 4.4 after 6 months and 71.7 ± 4.1 after 2 years. Geometric remodeling, regression of hypertrophy, and increased ejection fraction of the left ventricle were similar in both groups at 6 months after surgery, but after 2 years of follow-up, greater improvement was found in patients who had undergone valve replacement for aortic stenosis.
Glutamine Improves Myocardial Function following Ischemia-Reperfusion Injury
Authors: Bolotin Gil , Raman Jai , Williams Ursula , Bacha Emile , Kocherginsky Masha , Jeevanandam Valluvan
Published: May 2013

Myocardial ischemia-reperfusion injury is common during cardiac procedures. Glutamine may protect the myocardium by preserving metabolic substrates. Glutamine (0.52 g·kg−1) or Ringer's lactate solution (control group) was administered intraperitoneally to 63 Sprague-Dawley rats at 4 or 18 hours prior to experimental ischemia and reperfusion. The hearts were excised and perfused on an isolated working heart model, exposed to global ischemia for 15 min and reperfusion for 1 hour. Left atrial pressure, mean aortic pressure, cardiac flow, coronary flow, and aortic output were measured 15 min before ischemia and every 15 min during reperfusion. There was significantly better cardiac output in the glutamine pretreated groups. Pretreatment at 4 hours before the experiment was superior to pretreatment at 18 hours, with better maintenance of cardiac output and coronary flow. The enhanced protective effect of pretreatment at 4 hours highlights the importance of timing, and suggests a potential clinical benefit.
Surgical Experience of Coarctation of the Aorta in Infants and Young Children
Authors: Zheng Jing-Hao , Liu Jin-Fen , Xu Zhi-Wei , Su Zhao-Kang , Ding Wen-Xiang
Published: May 2013

We evaluated the effectiveness of surgical treatment for coarctation of the aorta in infants and young children, based on our experience over 7 years. From March 1999 to December 2005, 168 cases of coarctation of the aorta in patients aged 21 days to 3 years were treated by end-to-end, extended end-to-end, or extended end-to-side ascending aorta and aortic arch anastomosis. The mortality rate was 0.6%. In 138 (82%) patients, the pressure in the lower extremity was higher than in the upper extremity. During 6–24 months of follow-up, hoarseness appeared in 6 patients. Echocardiography revealed stenosis of the end-to-end anastomosis in only 2 patients. We suggest that the best option for surgical treatment of coarctation of the aorta with associated cardiac malformations is a one-stage procedure using a median sternotomy approach. It is better to perform extended end-to-end anastomosis or anastomosis between the distal descending aorta and the left wall of the ascending aorta, or to extend this anastomosis to the transverse arch.
Novel Method of Thoracoscopic Surgery for Giant Bulla without Residual Cavity
Authors: Utsumi Tomoki , Akashi Akinori , Funaki Soichiro
Published: May 2013

A giant bulla is generally resected by thoracoscopic surgery. Resection using an automated stapling device is popular, however, a number of cartridges may be consumed and a cavity is sometimes left remaining, especially when resecting wide-based lesions. To establish a thoracoscopic surgical procedure that results in no residual cavity, we developed a method in which the roof of the bulla is resected first, followed by resection of the pulmonary parenchyma, including the base of the bulla, using a stapling device. Exposure of the base by first removing the roof facilitates determination of the resection line. Between 2003 and 2005, the procedure was attempted in 6 patients, which included one bilateral case. Conversion to a minithoracotomy was required in one patient because of bulla thickening. The operating time ranged from 80 to 150 min (median, 135 min) in the other 6 cases. Postoperative chest drainage ranged from 2 to 13 days (median, 3 days), and postoperative hospital stay was 5 to 18 days (median, 6 days). No adverse events occurred. We found this procedure to be simple and useful for complete resection of giant bullae.
Perforation of a Substernal Interposed Ileocolon Caused by Right Thoracic Herniation
Authors: Kok Va-Kei
Published: May 2013

Perforation of a retrosternal interposed ileocolon is rare. We present a case of perforation of the interposed colon on the ninth postoperative day, which subsequently herniated to the right pleural space. We suggest that the dilated haustral trapping and the associated “waterfall” effect may have resulted in incarceration of the colon. Careful dissection of the pleura in order to create a retrosternal tunnel, and the use of a suitable length of an esophageal substitute could prevent this complication.
Aortic Root Replacement in Behçet Disease
Authors: Yoshikawa Kazuhiro , Hori Hidetsugu , Fukunaga Shuji , Tayama Eiki , Aoyagi Shigeaki
Published: May 2013

The patient presented with a history of recurrent aphthous stomatitis, genital ulceration, and a family history of positive for collagen disease. Echocardiography and retrograde aortography revealed aneurysm formation of the sinus of Valsalva, and dilatation of the aortic valve annulus with severe aortic regurgitation. On diagnosis of an aneurysm of the sinus of Valsalva and aortic regurgitation associated with Behçet's disease, aortic root replacement with the modified Bentall technique was successfully performed.
Tracheomalacia in a Patient with Unilateral Pulmonary and Renal Agenesis
Authors: Fatimi Saulat , Sheikh Sadaf , Shah Zaman , Fatimi Sonia
Published: May 2013

We report the case of an eight-month-old boy with tracheomalacia secondary to impingement by the right pulmonary artery, together with congenital agenesis of the left lung and the left kidney. Aortopexy and right pulmonary artery-pexy were successful in improving lung function by more than 100%, and the patient remained free of complications in the long term.
Safe Innominate Artery Cannulation for Cardiopulmonary Bypass in Neonates
Authors: Corno Antonio F , Pozzi Marco
Published: May 2013

To reduce the neurological complications of deep hypothermic circulatory arrest, continuous cerebral perfusion was introduced, either by direct innominate artery cannulation or by a tubular prosthesis. This second option, used in our clinical experience, has been extended to applications other than aortic arch reconstruction, to facilitate cardiopulmonary bypass in small neonates (< 3.0 kg) with complex congenital heart defects, and to facilitate postoperative extracorporeal membrane oxygenation.