bluuebunny/crossref_metadata_2025 huggingface dataset:
Control of Persistent Inferior Vena Caval Bleeding
Authors: Shah Bhupesh D , Shah Deena , Calla Sakuntala , Shah Mehul , Shah Varsha
Published: May 2013

A technique to control inferior vena caval bleeding by clockwise rotation of the inferior vena cava after skeletization, is described. This gave excellent hemostatic control and the inferior vena cava was stitched in this position. On follow-up, there was no evidence of compromised inferior vena caval drainage.
Blalock-Taussig Shunt Using Fresh Saphenous Vein Homograft
Authors: Okur Faik Fevzi , Tavli Vedide , Kayhan Bekir , Kirman Mustafa , Atalay Cenk Sinan , Tekdoğan Mehmet
Published: May 2013

The occurrence of life-threatening early and late complications following the use of expanded polytetrafluoroethylene grafts for modified Blalock-Taussig shunts prompted the application of saphenous vein homografts instead. In 21 patients with cyanotic congenital heart disease, fresh saphenous vein homografts were used for Blalock-Taussig shunts from February 1998. The veins were obtained from blood-group matched patients undergoing coronary bypass grafting in the next operating room. There was no early or late mortality. Clinical and echocardiographic studies showed that all shunts were patent and functioning well at an average follow-up of 11 months. This simple homograft technique has no ischemic time and requires no chemical or antibiotic contact.
Absorbable and Nonabsorbable Sutures for Tracheal Anastomoses in Dogs
Authors: Elbeyli Levent , Kepekci Yalçin
Published: May 2013

Tracheal anastomosis was performed in 3 groups of 6 mongrel dogs each (mean age, 4 months; mean weight, 7 kg) to compare synthetic sutures. The interrupted technique was used for all anastomoses and they were evaluated by rigid bronchoscopy in the 3rd postoperative week. While suture absorption was observed in the Vicryl group, it was not visible in the Ethibond and polydioxanone groups. Dogs were sacrificed between 26 and 76 days (mean, 44 days) postoperatively. No stenosis was observed in any group. Histological evaluation of the epithelium showed a statistically significant difference in epithelization between Vicryl and Ethibond, and between polydioxanone and Ethibond. There was no difference between Vicryl and polydioxanone. These results suggest that absorbable suture material is superior for tension-free anastomoses.
Brucella Endocarditis Treated by Surgical and Medical Combination
Authors: Kaya Bülent , Sirlak Mustafa , Özkan Mehmet , Eryilmaz Sadik , Akalin Hakki
Published: May 2013

A 40-year-old man developed brucella endocarditis. Brucella melitensis was isolated from blood cultures. Echocardiography revealed flail mitral valve with ruptured chordae. Mitral valve replacement was performed and the infection was cured with tetracycline and rifampin given for 3 months after surgery.
Cerebral Circulation via Right Vertebral Artery in Takayasu's Arteritis
Authors: Topcuoğlu Mehmet Şah , Yaliniz Hafize , Tokcan Acar , Bozdemir Hacer , Sarica Yakup
Published: May 2013

A 42-year-old woman had left fronto-orbital aching and amaurosis for 6 months. Fluorescein angiography of the left eye showed vasculitis. Aortography revealed total occlusion of both subclavian arteries, both carotid arteries, and the left vertebral artery, with serious narrowing of the abdominal aorta. The right vertebral artery was spared. Blood flow in the middle and anterior cerebral arteries was normal in spin-echo and phase-contrast magnetic resonance studies. Immuno-histochemical findings indicated Takayasu's arteritis.
Giant Blood Cyst of the Mitral Valve
Authors: Sharma Sanjeev , Strauss Richard , Swanson Jeffrey S
Published: May 2013

A 68-year-old man underwent coronary angiography for postinfarction angina, which revealed right coronary artery stenosis and a mass in the left ventricle. Transesophageal echocardiography showed a large blood cyst originating from the anterior papillary muscle of the mitral valve. Coronary artery bypass grafting was performed and the cyst was successfully excised.
Spontaneous Regression of Ostial Coronary Artery Lesion
Authors: Pillay Devan , Hamid Zainal Abidin Abdul
Published: May 2013

A 47-year-old man with a positive exercise test underwent coronary angiography that showed 90% ostial left anterior descending coronary artery stenosis. The patient opted for medical therapy and included a Chinese herbal remedy that contained Ganoderma lucidum. After 2.5 years, angiography showed spontaneous regression of his coronary artery lesion.
Pseudoaneurysms of the Profunda Femoris Artery
Authors: Yavuz Şenol , Selimoğlu Özer , Göncü Mehmet Tugrul , Özdemir İbrahim Ayhan
Published: May 2013

Three cases of pseudoaneurysm of the profunda femoris artery as a late complication of various traumas, were confirmed by femoral arteriography. Successful surgical repair was performed. Angiography is recommended for accurate diagnosis.
Acute Type A Aortic Dissection. Influence of Early Management on Results
Authors: El-Bishry Ahmad , Al-Khaja Najib , Krebber Hans , El Fiki Mohamed , Aziz Mohamed Abdel , Enein Hosam Aboul , Saeed Mohamed , Sallam Ismail
Published: May 2013

One hundred and six patients were operated upon for acute type A aortic dissection in 7 years between February 1992 and May 1999. There were 102 males and 4 females, aged 18 to 83 years with a mean of 59 ± 14 years. All patients underwent surgery within 14 hours of diagnosis. The ascending aorta was replaced with a Dacron graft in 103 patients; in the other 3 cases, the repair extended to the aortic arch. The aortic valve was preserved by resuspension in all except 4 patients, 3 of whom had Marfan's syndrome. There were 9 (8.5%) deaths, all due to respiratory and multiorgan failure. Nine patients (8.5%) needed hemodialysis; only one of these required permanent dialysis. Ten patients (9.4%) had transient neurological disorders, 2 others (1.9%) suffered permanent hemiplegia. Three patients (2.8%) underwent reoperation for bleeding. Tracheostomy for prolonged respiratory assistance was required in 6 patients (5.7%), of whom 1 died from respiratory failure. Early surgical intervention could be performed with low morbidity and mortality.
Aortopulmonary Window Repair: 15-Year Surgical Experience
Authors: Aizaz Khawar , Al Qethamy Howaida , Al Jubair Khalid , Al Faraidi Yahya , Al Fagih Mohammed R
Published: May 2013

Aortopulmonary window is an uncommon anomaly. Early surgery is recommended before permanent pulmonary vascular changes develop. Results were reviewed in 18 patients who underwent aortopulmonary window repair between January 1985 and December 1999. A transaortic approach was employed in 12, a transpulmonary approach was used in 3, the pulmonary artery flap technique was performed in 2, and an aortopulmonary window was simply ligated in 1 patient. Concomitant repair of all associated anomalies was carried out, except in 2 patients who had interrupted aortic arch repaired 6 days before aortopulmonary window repair. There was no hospital mortality. During a mean follow-up of 43 months (range, 6 to 144 months), there was no late death and all patients were in New York Heart Association functional class I, except 3 who required reoperation: 2 had pulmonary artery confluence stenosis 5 to 10 years after aortopulmonary window repair; and 1 required transfer of the right coronary artery from the pulmonary artery to the aorta 28 months after aortopulmonary window repair. Surgical repair of aortopulmonary window, even when associated with other cardiac anomalies, carries a low risk. Early surgical treatment achieved excellent immediate and long-term results.
Second Chinese National Registry of Catheter Ablation of Tachyarrhythmia
Authors: Hu Da Yi
Published: May 2013

The Chinese national registry of radiofrequency catheter ablation of tachyarrhythmias included data from 134 hospitals over 3 years from January 1995. Ablation was used in 24,343 patients, with 97% success, 3.1% recurrence, 0.95% complications, and 0.02% mortality overall. Accessory pathway ablation was performed in 15,617 patients (64.2%) with atrioventricular reciprocating tachycardia (97% success, 2.8% recurrence, 1% complications). The 6,746 patients (27.7%) with atrioventricular nodal reentrant tachycardia underwent slow pathway ablation (98% success, 2.7% recurrence, 1% complications). Focal ablation in the right or left ventricle was attempted in 1,025 patients (4.2%) with idiopathic or organic ventricular tachycardia (87% success, 6.8% recurrence, 0.5% complications). The 419 patients with atrial tachycardia underwent atrial focal ablation (84% success, 9.9% recurrence, 0% complications). Focal or linear ablation of the isthmus was conducted in 366 patients with atrial flutter (89% success, 10% recurrence, 1.1% complications). Atrioventricular junction ablation was used for rate control in 170 patients with atrial fibrillation (99% success). Multiple atrial linear ablations for rhythm control were 56% successful. Success rates and incidence of complications depended on the type of tachyarrhythmia, and remained constant over the 3 years. Further improvements in technique are needed to improve success rates and decrease the incidence of complications.
Ventriculoarterial Connection for Coronary-Pulmonary Artery Fistula
Authors: Lee Hyun Sung , Park Young Hwan , Cho Bum Koo
Published: May 2013

One-stage ventriculoarterial connection for correction of a coronary artery-to-main pulmonary artery fistula, and transfer of 2 major aortopulmonary collateral arteries from the descending aorta to the right pulmonary artery were successfully accomplished in a 4-month-old boy with pulmonary atresia and a ventricular septal defect.
Severe Mechanical Hemolysis after Complete Occlusion of Arterial Duct
Authors: Aydoğan Ümrah , Tansel Türkan
Published: May 2013

Streptokinase was administered for femoral artery thrombosis in a 14-month-old girl after complete occlusion of an arterial duct with a Jackson coil. Hemoglobinuria started after femoral artery patency was achieved. Ductal shunting was unimpeded 35 hours after cessation of streptokinase. The problem was resolved by implantation of a second coil.
Routine Use of the Radial Artery for Coronary Artery Revascularization
Authors: Meharwal Zile Singh , Trehan Naresh
Published: May 2013

Between January 1997 and December 2000, a total of 4,000 patients underwent myocardial revascularization using the radial artery as one of the conduits. The mean age of the patients was 54 ± 7 years, and 92.8% of them were male. Of these patients, 31% had a left ventricular ejection fraction below 40% and 22.8% underwent urgent operation. A total of 4,225 distal anastomoses were performed using the radial artery. The average number of grafts was 3.3 ± 0.5. The hospital mortality rate was 0.8%. Low cardiac output, inotropic support, perioperative myocardial infarction, reoperation for bleeding, atrial fibrillation, and sternal infection occurred in 1.8%, 2.8%, 1.2%, 1.2%, 16.8%, and 1.2% of the patients, respectively. None of the patients had major ischemia of the hand. The incidence of local hand wound complications was 0.7% (wound infection, 0.4%; wound dehiscence without infection, 0.1%; and hematoma, 0.2%). The average length of stay in the intensive care unit was 20 ± 7 hours and in the hospital was 6 ± 2 days. Postoperative angiography, performed in 106 patients at a mean interval of 18 months, showed that 92.4% of radial artery, 96.2% of internal mammary artery, and 76.2% of saphenous vein grafts were patent.
Play Safe: Band the Late Presenting Complete Atrioventricular Canal
Authors: Al Qethamy Howaida O , Aboelnazar Saber , Aizaz Khawar , Al Faraidi Yahya
Published: May 2013

Primary repair of complete atrioventricular canal in patients who present beyond one year of age carries a high mortality. Between January 1995 and February 2000, 16 patients aged 8 to 24 months (mean, 14.5 months) received pulmonary artery banding at presentation and underwent total correction at 24 to 96 months old (mean, 41.9 months). There was one hospital death (mortality, 6.25%). During a mean follow-up of 10.2 months (range, 6 to 28 months), there was no late death, 13 of the 15 survivors (87%) were in New York Heart Association functional class I, and 2 (13%) were in class III. In patients with complete atrioventricular canal who present late with severe reactive pulmonary hypertension, banding followed by complete repair reduces the risk associated with primary repair.
Esophageal Perforation Caused by a Blister-Wrapped Tablet
Authors: Gupta Narendar Mohan , Gupta Vikas , Gupta Rajesh , Sudhakar Vuluchala
Published: May 2013

An 84-year-old man was diagnosed with esophageal perforation following ingestion of a blister-wrapped tablet. His condition improved after 2 weeks of conservative treatment using antibiotics and high-protein enteral nutrition.
Is Hyperamylasemia after Cardiac Surgery Due to Cardiopulmonary Bypass?
Authors: Wan Song , Arifi Ahmed A , Chan Carmen SY , Ng Calvin SH , Wan Innes YP , Lee Tak Wai , Yim Anthony PC
Published: May 2013

Although hyperamylasemia has been reported in a large proportion of patients undergoing cardiac surgery with cardiopulmonary bypass, its clinical significance and pathogenetic mechanisms remain poorly understood. The study was designed to investigate whether avoidance of cardiopulmonary bypass would limit amylase elevation. Serum levels of amylase and lipase were measured preoperatively as well as 24 and 48 hours postoperatively in 58 patients undergoing elective coronary artery bypass grafting. Three surgical approaches were used: cardiopulmonary bypass (n = 32) and off-pump through a median sternotomy (n = 14) or a left minithoracotomy (n = 12). There was no hospital mortality or postoperative abdominal complications. Transient hyperamylasemia occurred in 14 patients: 7 (22%), 5 (36%), and 2 (17%) in the respective groups. The increase in amylase levels was similar among the groups. However, no lipase elevation was detected in any patient. There was no clear correlation between hyperamylasemia and increased creatinine levels. Perioperative plasma calcium levels were normal in patients who had hyperamylasemia. Our results indicate that hyperamylasemia after bypass surgery is not related to the use of cardiopulmonary bypass or the mode of surgical access.
Intramural Cardiac Myxoma in Left Ventricular Wall: An Unusual Location
Authors: Rendón Felipe , Agosti Julio , Llorente Alberto , Rodrigo David , Montes Kepa
Published: May 2013

A 27-year-old asymptomatic woman was investigated for an abnormal finding in the cardiac contour on routine chest radiography. Echocardiography revealed a heterogeneous mass in the anterolateral left ventricular wall. Excision of the tumor disclosed an absence of communication between the residual cavity and the left ventricular endocardium. Histological features of the tumor indicated an intramural myxoma.
Goldenhar's Syndrome
Authors: Özdemir Özcan , Arda Kemal , Turhan Hasan , Tosun Özgür
Published: May 2013

A 12-year-old male was admitted with postaxial polydactyly on the right hand, congenital heart disease, vertebral anomaly, and facial asymmetry. Investigations confirmed the diagnosis of a congenital disease, Goldenhar's syndrome, with the rare associations of polydactyly and probable autosomal dominant inheritance.
Experimental Coronary Artery Occlusion: Relevance to Off-Pump Cardiac Surgery
Authors: Hsi Charles , Cuenoud Henri , Soller Babs R , Kim Hun , Favreau Janice , Vander Salm Thomas J , Moran John M
Published: May 2013

Mechanical coronary artery occlusion is required for minimally invasive direct coronary artery bypass and off-pump coronary artery bypass surgery. It is important that the method of occlusion be minimally traumatic. Chronic effects of these methods have never been studied. Temporary occlusion of coronaries utilizing suture snare, silastic loop snare, and bulldog clamp was carried out in 12 Yucatan pigs. Three animals each were sacrificed acutely and at 3, 6, and 12 months. The area of occlusion of each vessel was examined by light microscopy and the degree of damage recorded. In the animals sacrificed acutely, there was more damage using the suture snare than with the other 2 methods, but there was minimal damage at longer intervals. There was slight damage acutely and chronically with the bulldog technique. No damage was seen acutely with the silastic loop technique, but some late damage was found. The techniques of coronary artery dissection and occlusion used for minimally invasive and off-pump bypass surgery may contribute to early postoperative graft occlusion.
Mitral Annular Reconstruction
Authors: Yoshikai Masaru , Ito Tsuyoshi , Murayama Junichi , Kamohara Keiji
Published: May 2013

Mitral annular reconstruction using a pericardial patch was performed in 3 cases of atrioventricular disruption. This technique may be useful for atrioventricular disruption in cases of active endocarditis, redo valve replacement, left ventricular rupture after mitral valve replacement, and annular calcification.
False Aneurysm Due to Suture Loosening after Aortic Arch Replacement
Authors: Tanaka Keita , Makuuchi Haruo , Naruse Yoshihiro , Kobayashi Toshiya , Hayashi Ichiro , Takayama Takehiko , Namifusa Yusuke
Published: May 2013

We describe a case of false aneurysm due to loosening of the anastomotic sutures 5 years after graft replacement for subacute type A aortic dissection. Leakage from the graft was controlled by tightening the suture slack indicating that suture loosening was the cause of the aneurysm. The mechanism was probably the progressive thinning of the edematous swollen aortic wall over the years causing the sutures to loosen.
Cardiac Operation with Associated Pulmonary Resection: A Word of Caution
Authors: Ng Calvin SH , Arifi Ahmed A , Wan Song , Lee Tak Wai , Yim Anthony PC
Published: May 2013

Pulmonary tuberculosis reactivation is an unusual cause of respiratory failure after cardiac surgery. Fulminating tuberculosis was reactivated in a 50-year-old man after combined coronary artery bypass grafting and pulmonary resection on cardiopulmonary bypass. Clinicians should be aware of the immunosuppressive effects associated with cardiopulmonary bypass, and the consequent potential for tuberculosis reactivation.
Freestyle Xenograft Implantation Technique for Reducing Aortic Insufficiency
Authors: Arifi Ahmed A , Wan Song , Nashef Samer , Ng Calvin SH , Wan Innes YP , Yim Anthony PC
Published: May 2013

The Freestyle aortic xenograft has been shown to be safe and effective for aortic valve replacement. However, implantation is often complicated by aortic valve insufficiency, which could lead to premature valve failure. We describe an implantation technique that can potentially prevent aortic insufficiency.
Gastrointestinal Complications after Transperitoneal Abdominal Aortic Surgery
Authors: Alpagut Ufuk , Kalko Yusuf , Dayioglu Enver
Published: May 2013

A major gastrointestinal complication after transperitoneal aortic surgery, though unusual, may be disastrous. We determined retrospectively the risk factors, associated events, and outcomes of gastrointestinal complications that developed after transperitoneal aortic revascularization to treat aneurysmal or occlusive disease over a 10-year period. Among 750 patients reviewed, gastrointestinal complications developed postoperatively in 65 of them (8.6%), including paralytic ileus in 35 patients, gastrointestinal bleeding and mechanical ileus in 6 patients each, colonic necrosis in 2, ischemic colitis and diarrhea in 10, acute cholecystitis in 2, ascites in 1, as well as aortoduodenal fistula, which developed about 2 months postoperatively in 3 patients. Five of the patients died of multiorgan failure. Mean stay in the intensive care unit was 3 days, and hospital stay ranged from 15 to 60 days. No risk factors were identified for the occurrence of gastrointestinal complications. These results show that gastrointestinal complications after transperitoneal aortic surgery prolong hospital stay and may have serious consequences.
Modified Circuit for Retrograde Cerebral Perfusion
Authors: Bhan Anil , Chaudhary Shiv Kumar , Sharma Rajesh , Hote Milind , Gupta Rajeev , Venugopal Panangipalli
Published: May 2013

A modified circuit for delivery of retrograde cerebral perfusion during ascending aortic or aortic arch surgery is described. The technique was applied in 15 patients who showed good postoperative recovery.
Left Ventricular Volume Reduction Surgery in the Middle East
Authors: Kabbani Sami S , Izzat Mohammad Bashar , Jamil Hisham , Akasheh Bassam , Hanania Daoud , Raffa Hassan
Published: May 2013

Heart transplantation is not yet socially acceptable in the Middle East, and left ventricular assist facilities are not generally available in this region. Therefore, left ventricular volume reduction surgery was attempted in 41 patients with end-stage heart failure (33 males; median age, 36.3 years) in 4 Middle Eastern tertiary referral centers between February 1996 and January 2001. Heart failure was due to idiopathic cardiomyopathy in 21 patients, ischemia in 11, rheumatic valvular disease in 8, and viral myocarditis in 1. Associated procedures were aortic valve replacement in 5 patients, mitral valve repair in 25, mitral valve replacement in 7, tricuspid valve repair in 6, and coronary bypass grafting in 8. Hospital mortality was 31.7%. Five patients were lost to follow-up. The survival rate of hospital survivors at 18 months was 65.2%. Three of the surviving patients did not benefit from the operation. Although our results were somewhat disappointing, this operation remains an option for surgeons working in developing areas of the world. It is hoped that better patient selection and new techniques of left ventricular volume reduction that avoid resection of viable muscle will further improve the outcome of this operation.
Myocardial Laser Coagulation for Free Wall Rupture following Acute Infarction
Authors: Mizutani Tetsuo , Suzuki Hitoshi , Tanaka Jin
Published: May 2013

A 73-year-old woman was diagnosed with ventricular free wall rupture following acute myocardial infarction. The lesion was repaired with laser coagulation, fibrinogen-thrombin glue application, and patch reinforcement. Five years after surgery, the patient was in New York Heart Association class I.
Surgical Extraction of Infected Pacemaker Leads after Cardiac Surgery
Authors: Nouraei Seyed Mahmoud , Bexton Rodney S , Hasan Asif
Published: May 2013

Surgical extraction of permanent pacemaker leads is performed when noninvasive extraction is felt to be unsafe or has been unsuccessfully attempted. Surgical extraction in patients with previous cardiac surgery presents a particular challenge as resternotomy is hazardous and the presence of surgical adhesions makes video-assisted approaches difficult. We report 2 cases of successful deployment of a surgical technique using femorofemoral cardiopulmonary bypass and right anterior thoracotomy for removal of pacemaker leads.
Rejection and Indirect Revascularization of Glycerin-Preserved Tracheal Implant
Authors: Saueressig Maurício G , Moreschi Alexandre H , Barbosa Gilberto V , Edelweiss Maria IA , de Souza Felipe H , Savegnago Fabrício L , de Macedo Neto Amarílio V
Published: May 2013

The objective of the following study was to evaluate antigenicity, malacia and revascularization in glycerin-preserved canine tracheal allografts. Trachea with six cartilage rings (2.4 to 3.1 cm) were distributed in three study groups: autograft (21), allograft (18) and glycerin-preserved (22). We implanted two segments from different groups in the greater omentum of dogs. After 28 days, latex was injected in the canine aorta before the segments were harvested. We evaluated number of sectors with functional vessels, number of vessels dyed in the submucosa, acute arteritis score, incidence of acute rejection, cartilage lesion score, and malacia. The autograft group had a larger number of dyed vessels than the glycerin-preserved group. The autograft group also had a higher average number of quadrants with functional vessels than the allograft group and the glycerin-preserved group. The allograft group had a higher mean score for acute arteritis than the autograft group and more acute rejection than the glycerin-preserved group. The cartilage lesion score did not show any significant difference between groups. Malacia was not observed in any tracheal segment. Overall, the glycerin-preserved tracheal implant had low antigenicity and good rigidity, but showed incomplete revascularization.
Spontaneous Rupture of the Left Subclavian Artery in Neurofibromatosis
Authors: Slisatkorn Worawong , Subtaweesin Thaworn , Laksanabunsong Pansak , Warnnissorn Malee
Published: May 2013

Two patients with neurofibromatosis presented with expanding masses at the left supraclavicular region. Computed tomography (CT) scans revealed vascular masses. The patients underwent surgery and ruptures of the left subclavian artery were found. Both patients were treated by ligation of subclavian artery.
Off-Pump Surgery: A Choice in Unstable Angina
Authors: Kohli Vijay , Goel Mukesh , Sharma Vijay Kumar , Mishra Yugal , Malhotra Rajneesh , Mehta Yatin , Trehan Naresh
Published: May 2013

The benefit and safety of off-pump coronary artery bypass surgery in patients with unstable angina was assessed retrospectively. From February 1996 to October 2001, 5,306 patients underwent multivessel off-pump coronary artery bypass, of whom 920 (17%) had unstable angina. In these 920 patients, ejection fractions ranged from 15% to 70%, 203 (22%) had an ejection fraction of 20%–35%, and 11 (1%) had an ejection fraction < 20%. Triple-vessel disease was present in 625 patients. Preoperative intraaortic balloon pump support was used in 28 patients. Operative approaches included mid sternotomy (86%), lower partial sternotomy (9%), and left anterior thoracotomy (2%). The number of grafts ranged from 1 to 5 with a mean of 2.43 ± 0.86, and 92.3% of patients received a left internal mammary artery graft. Twenty-two patients need intraoperative intraaortic balloon pumping. Ten patients (1%) suffered perioperative myocardial infarction. The mean hospital stay was 7.8 ± 4.3 days. Hospital mortality was 2/920 (0.22%). Intraaortic balloon pumping was helpful in these cases of unstable angina refractory to medical therapy. Off-pump coronary artery surgery was found to be safe and beneficial in these patients.
Lung Function after Deep Hypothermic Cardiopulmonary Bypass in Infants
Authors: Su Zhao Kang , Sun Yong , Yang Yan Min , Zhang Hai Bo , Xu Zhi Wei
Published: May 2013

There is increasing concern about neurologic injury due to deep hypothermia with low flow during repair of complex congenital heart defects in neonates and infants. Twenty infants with ventricular septal defect and pulmonary hypertension were randomly assigned to cardiac repair under deep hypothermia with circulatory arrest or deep hypothermia with low flow. Measurements of static pulmonary compliance, airway resistance, and respiratory index were performed before institution of cardiopulmonary bypass and at 5 minutes and 2 hours after cessation of cardiopulmonary bypass. Both groups had significant pulmonary dysfunction in terms of static pulmonary compliance, airway resistance, and respiratory index. There was greater impairment of pulmonary compliance and respiratory index after deep hypothermia with low flow, and this group required longer intensive care unit stay.
Repair of Tuberculous Aneurysm of Distal Aortic Arch
Authors: Suresh Keshavamurthy , Kurian Vallikapathalil M , Sankar Nainar Madhu , Patel Alpesh , Joseph Peter , Cherian Kotturathu M
Published: May 2013

A 65 year old female patient presented with one episode of massive haemoptysis requiring transfusion and subsequently cough with streaky haemoptysis. Computerized tomographic scan and angiogram revealed aneurysm of the distal aortic arch. She underwent elective repair of the psuedoaneurysm through median sternotomy and the bronchial communication was closed through left thoracotomy. Tubercle bacilli were identified in the contents and excised wall of aortic tissue.
Predicting the Response to Lung Volume Reduction Surgery Using Scintigraphy
Authors: Shigemura Norihisa , Akashi Akinori , Nakagiri Tomoyuki , Ohta Mitsunori , Matsuda Hikaru
Published: May 2013

This study was conducted to evaluate the use of quantitative scintigraphy with a newly designed marker to assess and predict the efficacy of lung volume reduction surgery in treating emphysema. In a series of 50 patients with severe emphysema who underwent the operation, ventilation/perfusion scintigraphy was performed and 2 markers of area ratio and lung uniformity were measured before and 6 months after surgery. The markers were correlated with the results of pulmonary function tests. The histopathological subtype of emphysema was also determined in the resected specimen and related to improvement in the markers. The markers were closely related to improvement in forced expiratory volume in 1 second, with the highest correlation being the marker lung uniformity measured by perfusion scintigraphy. Improvement in this marker was significantly greater in centrilobular than in panlobular emphysema. This quantitative method of scintigraphy could provide an excellent reflection of surgical efficacy as well as predict the surgical outcome. Additionally, it provides a mechanistic explanation for the differential improvement between the histopathological subtypes of emphysema following surgery.
Endovascular Stent-Graft Repair of Aortic Dissection
Authors: Li Xiao-Xi , Wang Sheng-Ming , Chen Wei , Zhuang Wen-Quan , Wu Zhuan-Hong , Chang Guang-Qi , Li Song-Qi , Yang Jian-Yong , Lin Yong-Jie
Published: May 2013

Between October 2000 and January 2002, 9 consecutive male patients with subacute or chronic aortic dissection underwent stent-graft placement. The indication for surgery was continuous pain or aneurysm development. One patient had a type A dissecting aortic aneurysm with a primary tear in the ascending thoracic aorta; the other 8 had type B dissection. Placement of an endovascular stent-graft was technically successful in 8 patients, and one underwent an open procedure for abdominal aortic fenestration. The entry site was sealed and the false lumen disappeared in 8 cases, and thrombosis of the false lumen was obtained. Rupture of an iliac artery dissecting aneurysm occurred in one patient 2 days after stent-graft placement; abdominal aortic fenestration with prosthetic replacement of the distal abdominal aorta was performed. One patient died of myocardial infarction 3 days after the stent-graft procedure. During a mean follow-up period of 7 months (1–16 months), one patient died of acute myocardial infarction at 11 months. It was concluded on the basis of these short-term results that endovascular repair of aortic dissection is a promising treatment, and abdominal aortic fenestration is a useful adjuvant procedure.
Slide Tracheoplasty for Congenital Tracheal Stenosis with Glottic Stenosis
Authors: Rafay Mohammed A , Hajjar Waseem M , Essa Mohammed A , Mahasin Ziyad Z , Al-Kattan Khaled M
Published: May 2013

A 7-month-old child with respiratory distress was diagnosed to have full-length tracheal stenosis with glottic stenosis. Slide tracheoplasty and anterior cricoid split with stenting for glottic stenosis were successfully performed, and the child has completed 5 years of asymptomatic follow-up. This case widens the scope for slide tracheoplasty, and cricoid split with stenting is a feasible procedure for associated glottic stenosis.
Capillary Leakage in Cardiac Surgery with Cardiopulmonary Bypass
Authors: Hamada Yoshihiro , Kawachi Kanji , Tsunooka Nobuo , Nakamura Yoshitsugu , Takano Shinji , Imagawa Hiroshi
Published: May 2013

Cardiopulmonary bypass causes a systemic inflammatory response, which can lead to capillary leak syndrome. In 15 adults undergoing elective cardiac surgery with cardiopulmonary bypass, we determined the volume and peak time of capillary leakage from the measurements of extracellular fluid volume and circulating blood volume taken preoperatively, at various intervals up to 24 hours after surgery, and on the 7th postoperative day. Extracellular fluid volume rose from 15.5 ± 2.7 Lpreoperatively to a peak 4 hours after surgery of 18.3 ± 3.2 L and remained elevated at 24 hours. Circulating blood volume fell from 4.10 ± 0.68 L preoperatively to 3.20 ± 0.58 L at the end of surgery. Fluid administered intraoperatively did not raise the circulating blood volume. Intraoperative fluid balance was positive at 2.62 ± 0.72 L but negative at all time points postoperatively. There was significant postoperative capillary leakage, increasing from 4.7% ± 2.3% of body weight at the end of surgery to a peak 4 hours later of 5.4% ± 2.0% and falling to 2.8% ± 3.3% at 24 hours. This knowledge of the pattern of change in capillary leakage after cardiac surgery with cardiopulmonary bypass might serve as a valuable guide for postoperative management.
A New Technique of Fixing a Costal Coaptation Pin after Resection of Rib Segment
Authors: Tsunezuka Yoshio , Iseki Tomohisa , Sato Hideo , Ishikawa Norihiko , Oda Makoto , Watanabe Go
Published: May 2013

The Poly-L-lactide costal coaptation pin is an effective device in chest wall reconstruction. However, fixation is sometimes incomplete, despite the use of the costal coaptation pin. We report here the use of two suture techniques for the fixation of the incised ribs with costal coaptation and discuss the effectiveness of these procedures. We used the Poly-L-lactide costal coaptation pin in 174 cases of posterolateral thoracotomies with two suture methods. In one method the rib was generally fixed with suture only (L-method, n = 30), and in the H-method pairs of holes were made at the end of the incised ribs for ligating with sutures (H-method, n = 144). The effectiveness of each method was evaluated based on the degree of fixation and lateral shift 24 months postoperatively. Lateral shift was none in 114 (79.2%) cases using the H-method and 18 (60.0%) cases using the L-method. Fixation was good in 131 (91.0%) cases using the H-method but in only 20 (66.7%) cases using the L-method. H-method was significantly more effective than the L-method of costal coaptation. The H-method was very effective for fixing incised ribs and is convenient for use by thoracic surgeons.
One-and-a-Half Ventricle Repair for Right Ventricular Endomyocardial Fibrosis
Authors: Anbarasu Mohanraj , Krishna Manohar Soman R , Titus Thomas , Neelakandhan Kurur S
Published: May 2013

One-and-a-half ventricle repair, consisting of endocardiectomy with tricuspid valve replacement and bidirectional cavopulmonary shunt, was performed on a patient with right ventricular endomyocardial fibrosis and right ventricular outflow tract obstruction. The patient made a smooth recovery. We believe that this repair provides good palliation for a subset of patients with right ventricular endomyocardial fibrosis.
The Prevention of Nerve Injury in Aortic Arch Aneurysmal Surgery
Authors: Kuniyoshi Yukio , Koja Kageharu , Miyagi Kazufumi , Uezu Tooru , Yamashiro Satoshi , Arakaki Katuya
Published: May 2013

In a case of aortic arch aneurysm associated with adhesion to the surrounding structures, we devised an operative technique to avoid nerve injury during the surgical procedure. By preserving the adventitial layer of the aortic arch aneurysm to which the phrenic and recurrent nerves were attached, injury to the nerves was avoided, and the aneurysmectomy was completed with the distal anastomosis being performed intraluminally.
An Unusual Foreign Body of the Esophagus
Authors: Metin ER
Published: May 2013

Foreign bodies in the esophagus can result in serious complications depending on the size and shape of the ingested body. This report presents an unusual esophageal foreign body (endotracheal tube) caused by a physican who was inexperienced in endotracheal intubation during the treatment of generalized convulsive status epilepticus. When the patient was transferred to our hospital, rigid esophagoscopy was used to extract the endotracheal tube. There were no complications.
Patency and Venous Pressure of Arteriovenous Fistulas for Hemodialysis
Authors: Korkut A Kubilay , Hokenek Faruk , Kalko Yusuf , Sirin Gokce , Tireli Emin , Onursal Ertan
Published: May 2013

The early patency of arteriovenous fistulas created for hemodialysis is affected by various factors, including venous stenosis. We conducted a study to investigate the effect of venous stenosis on early patency by examining perioperative arterial and venous pressures of the fistula. Among the 15 patients selected for the study, 11 had snuff-box fistulas, 3 Brescia-Cimino, and 1 brachial. A thrill was palpable over the anastomosis in 10 patients and absent in 5 patients. In terms of venous pressure, the patients with a thrill had a mean systolic pressure of 35.8 mm Hg and systolic-diastolic pressure gradient of 3.4 mm Hg. In the patients without a thrill, the values were 102.6 mm Hg and 42.8 mm Hg, respectively. In conclusion, patients with venous obstruction in the fistula had a much higher venous pressure than those with a patent fistula. If venous stenosis is suspected, measurement of fistula pressures may be useful for determining the early patency of arteriovenous fistulas.
Mitral Valve Repair for Ischemic Mitral Regurgitation in Dilated Cardiomyopathy
Authors: Kohli Vijay , Wasir Harpreet , Mittal Sanjay , Karlekar Anil , Mehta Yatin , Trehan Naresh
Published: May 2013

Ischemic mitral regurgitation contributes to poor survival in patients with heart failure. The intermediate-term outcome of mitral reconstruction in 15 patients who had ischemic dilated cardiomyopathy with mitral regurgitation requiring surgical intervention was studied. They underwent mitral valve repair along with coronary artery bypass surgery. The mitral valve coaptation depth was considered an important parameter in deciding on repair. Ages ranged from 43 to 72 years. Left ventricular ejection fractions were 15–38% (mean, 26.5% ± 4.3%). The operative technique in all 15 patients was posterior annuloplasty using Dacron felt. At a mean follow-up of 4.6 ± 1.2 months (1–8 months), postoperative transesophageal echocardiography revealed mild mitral regurgitation in 2 patients and none in 13. There was a significant improvement in New York Heart Association functional class from 3.9 ± 1.1 to 1.9 ± 0.3. Mitral valve repair by posterior felt annuloplasty provides favorable results in the intermediate-term in selected patients with ischemic cardiomyopathy and severe left ventricular dysfunction.
Aortic Coarctation Repair with Patch Graft Aortoplasty and Severe Hemoptysis
Authors: Santo Kirkpatrick , Bryan Alan J , Ascione Raimondo
Published: May 2013

This report describes the successful treatment of a confirmed case of hemoptysis from a false aneurysm at the site of a previous coarctation repair. Professionals involved in the clinical care of patients that have undergone previous coarctation repair with patch graft aortoplasty, should be aware of the late risk of false aneurysm occurrence. Periodically screening patients with magnetic resonance imaging to prevent potentially fatal complications is recommended.
Arch Reconstruction without Circulatory Arrest in Neonates
Authors: Takeda Yuko , Asou Toshihide , Yamamoto Nobuyuki , Ohara Kuniyoshi , Yoshimura Hirokuni , Okamoto Hirotsugu
Published: May 2013

Between May 2000 and December 2002, 10 neonates underwent arch reconstruction without circulatory arrest. Age at surgery ranged from 1 to 18 days, and body weight ranged from 1.62 to 3.38 kg. The diagnosis was interrupted aortic arch in 4, hypoplastic left heart syndrome in 3, and coarctation complex in 3. A 3 mm polytetrafluoroethylene graft was anastomosed to the innominate artery, and the brain was perfused via this graft while the aortic arch was reconstructed. Regional cerebral oxygen saturation and the right and left radial artery pressures were monitored. There were 2 deaths: one because of low cardiac output syndrome after a Norwood operation; another from multiple organ failure due to preoperatively undetected congenital biliary atresia. Regional cerebral oxygen saturation was kept constant at over 40% during regional cerebral perfusion. There were no neurologic sequelae observed postoperatively. It was concluded that the regional cerebral perfusion technique can be safely applied during neonatal aortic arch reconstruction, and deep hypothermic circulatory arrest should be avoided.
Secondary Rupture of Aorta following the Surgical Management of Aortoesophageal Fistula
Authors: Jin Tao , Yu Guo-Wei , Ma Liang
Published: May 2013

A patient suffering from an aortoesophageal fistula (AEF) caused by a fish bone, was treated in our institute in 2000. The operation was successful and the patient had an uneventful early postoperative course. However, the patient died of frank hematemesis on the 6th postoperative day due to secondary rupture of the aorta. The lessons learnt and surgical efforts to manage AEF caused by an esophageal foreign body are discussed.
Correlation of Modified Allen Test with Doppler Ultrasonography
Authors: Cagli Kerim , Uzun Alper , Emir Mustafa , Bakuy Vedat , Ulas Mahmut , Sener Erol
Published: May 2013

The feasibility of using modified Allen tests to evaluate arterial circulation in the forearm for possible radial artery grafting, and the correlation of these tests with Doppler ultrasonography, were examined. The hand circulation of 50 patients scheduled for coronary artery bypass grafting was assessed by plethysmography, pulse oximetry, and pencil Doppler, as well as Doppler ultrasonography. Flow, velocity, and diameter of the radial, ulnar, and snuffbox arteries were recorded, and radiological screening indices were evaluated to establish a standard set of criteria. The results of modified Allen tests by plethysmography and pulse oximetry demonstrated the dominance of the ulnar artery. The indices of flow × diameter and velocity × diameter, obtained from Doppler ultrasound measurements, confirmed the dominance of the ulnar artery. When compression was applied to the arteries sequentially, significant alterations were found. The arterial circulation in the forearm can be safely evaluated by the modified Allen tests with plethysmography, pulse oximetry, and pencil Doppler, as these results correlated with Doppler ultrasound.
Preventive Diaphragm Plasty after Pneumonectomy on Account of Lung Cancer
Authors: Chichevatov Dmitry , Gorshenev Alexander , Sinev Eugeny
Published: May 2013

Experience is presented of 53 cases of diaphragm plasty of the bronchial stump, tracheobronchial anastomosis, pericardium, and esophagus wall after extended pneumonectomy on account of lung cancer. A pedicled diaphragm flap was used to prevent bronchopleural fistula in 53 patients, as well as heart dislocation after wide resection of the pericardium in 26, and esophagopleural fistula after resection of the muscle coat of the esophagus in 2. In all cases, there was a high risk of these complications. Dehiscence of the bronchial stump or tracheobronchial anastomosis occurred in 9 patients, but due to diaphragm plasty, a bronchopleural fistula formed in only 3. Restoration of the pericardium and the esophageal muscle coat was successful in all cases. Overall morbidity was 22.6%, 30-day mortality was 7.5%, hospital mortality was 11.3%. Causes of death were fulminant pneumonia of the single lung, cerebral hemorrhage, pulmonary embolism, heart failure, early tumor progression, and sepsis, in one case each. The results were compared with those in 49 patients who underwent other methods of bronchial stump or tracheobronchial anastomosis reinforcement. The analysis revealed that the diaphragm flap was highly efficacious as a multipurpose plastic material.
Off-Pump Revascularization for Significant Left Ventricular Dysfunction
Authors: Woo Y Joseph , Grand Todd J , Liao George P , Panlilio Corinna M
Published: May 2013

Left ventricular dysfunction is a predictor of perioperative morbidity and mortality in on-pump coronary artery bypass grafting. Obligatory global myocardial ischemia and injury induced during crossclamping as well as adverse systemic effects of cardiopulmonary bypass may induce a disproportionately greater overall physiologic insult in patients with poor ventricular function. All patients undergoing nonemergency off-pump coronary artery bypass by a single surgeon during an 18-month period were retrospectively analyzed. Two groups with preoperative ejection fraction classified as poor (10%–35%; n = 31) or normal (55%–80%; n = 60) were compared. The mean ejection fractions were 26% ± 1% and 63% ± 1% respectively, p < 0.000001. In those with significant left ventricular dysfunction, there were 2.8 ± 0.1 grafts per patient, time to extubation was 8.4 ± 1.2 hours, and discharge was after 4.9 ± 0.6 days. These results were statistically equivalent to those in the group with normal left ventricular function. There was no intraaortic balloon pump insertion or mortality in either group. This technique provides an effective means of safely revascularizing patients with significant left ventricular dysfunction, and it may provide a valuable alternative approach in patients with ischemic cardiomyopathy.
Impact of Modified Ultrafiltration on Morbidity after Pediatric Cardiac Surgery
Authors: Raja Shahzad G , Yousufuddin Shaik , Rasool Faisal , Nubi Ayo , Danton Mark , Pollock James
Published: May 2013

Cardiopulmonary bypass is a double-edged sword. Without it, corrective cardiac surgery would not be possible in the majority of children with congenital heart disease. However, much of the perioperative morbidity that occurs after cardiac surgery can be attributed to a large extent to pathophysiologic processes engendered by extracorporeal circulation. One of the challenges that has confronted pediatric cardiac surgeons has been to minimize the consequences of cardiopulmonary bypass. Ultrafiltration is a strategy that has been used for many years in an effort to attenuate the effects of hemodilution that occur when small children undergo surgery with cardiopulmonary bypass. Over the past several years, a modified technique of ultrafiltration, commonly known as modified ultrafiltration, has been used with increasing enthusiasm. Multiple studies have been undertaken to assess the effects of modified ultrafiltration on organ function and postoperative morbidity following repair of congenital heart defects. This review attempts to evaluate current available scientific evidence on the impact of modified ultrafiltration on organ function and morbidity after pediatric cardiac surgery.
Cardiac Tamponade Due to Spontaneous Rupture of Large Coronary Artery Aneurysm
Authors: Kimura Satoshi , Miyamoto Kazuyuki , Ueno Yasutaka
Published: May 2013

A 70-year-old woman admitted with chest pain went into shock due to cardiac tamponade; 1000 mL of blood was drained from her pericardium. Enhanced computed tomography showed massive pericardial effusion and a coronary artery aneurysm in front of the main pulmonary artery. Coronary angiography revealed a coronary artery-pulmonary artery fistula and 3 giant saccular coronary artery aneurysms. Emergency surgical repair was successful.