bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac hydatid disease: literature review
Authors: Abhishek Vijayakumar , Avinash Vijayakumar
Published: May 2013

Hydatid disease is endemic to various regions of the world, with an incidence of 0.4 per 100,000 persons. Isolated cardiac involvement is rare and occurs in only 0.02%–2% of cases. As the majority of cases are asymptomatic, can present catastrophically, and lead to high mortality, it has become increasingly important to identify the disease in an early stage and treat it with surgical excision. This review aims to familiarize the readers with the varied presentations, early diagnosis, and management of cardiac hydatid disease.
Mitroflow Pericardial Bioprosthesis: Experience to Seven Years
Authors: Jamieson W.R. Eric , Gerein Alfred N.
Published: May 2013

Between 1983 and 1987, the Mitroflow pericardial prosthesis was implanted in 99 patients, ranging in age from 28 to 94 years (mean 62.8 years). Early mortality was 6.1% (6 patients), and late mortality was 4.8% per patient-year (22 patients). Total cumulative follow-up was 458 patient-years (mean 4.6 years). At 7 years, patient survival was 62% for aortic valve replacement and 63% for mitral valve replacement. The overall rate of valve-related complications was 7.4% per patient-year (34 events): thromboembolism, 2.8%; antithromboembolic-relatedhemorrhage, 1.1%; prosthetic valve endocarditis, 0.7%; non-structural dysfunction, 0.7%; and structural valve deterioration, 2.8%. At 7 years, freedom from thromboembolism was 80.3%, and freedom from prosthetic valve endocarditis was 95.5%. At 5 and 7 years, freedom from structural valve deterioration was 93.4% and 69.7%, respectively. At 5 years, freedom from structural valve deterioration was 97.3% for aortic valve replacement (AVR), 86.6% for mitral valve replacement (MVR), and 100% for multiple valve replacement (MR). At 7 years, freedom from structural valve replacement was 84.6% and 61.3% for AVR and MVR, respectively. At 7 years, overall freedom from reoperation was 68.2%; from valve-related mortality, 81.4%; from valve-related residual morbidity, 97.4%; and from treatment failure (valve-related mortality and residual morbidity), 79.0%. At 7 years, the Mitroflow pericardial bioprosthesis has provided satisfactory clinical performance, especially in the aortic position, with an acceptable freedom from structural valve deterioration.
Arterial Switch for Repair of Simple and Complex Transposition of Great Arteries in a New Unit
Authors: He Luo Hong , Neng Lee Chuen , Tee Tan Tiong , Wei Sim Kwang , Nabuchi Akihiro , Jie Zhang Ming
Published: May 2013

Between January 1987 and October 1992, 11 neonates and 2 infants (12 males and 1 female) underwent arterial switch operation (ASO). There were 9 simple transpositions of great arteries (TGA), 3 TGA with ventricular septal defect (VSD), and 1 double outlet of right ventricle (Taussig-Bing) with TGA. There were 12 cases of patent ductus arteriosus (PDA) and 6 cases of atrial septal defect (ASD). Nine patients had Yacoub type A coronary pattern, 3 had type B, and 1 had type D. The neonates' mean age was 15.5 days (one 120 days old and one 22 months old). The average body weight of the neonates was 4.2 kg. The Lecompte maneuver was performed on all patients. The average bypass time was 187.8 min, and mean aortic cross-clamp time was 76.2 min, with a mean circulatory arrest time of 10 min in 6 cases. Early hospital mortality was 15.4% (2 deaths)—1 patient died during operation from myocardial infarction, and another died postoperatively from poor heart function. All survivors experienced early postoperative heart failure and needed temporary inotropic support. One patient was lost to follow-up. The other 10 patients were free from any cardiac symptoms at follow-up, with good left ventricular function. Mild to moderate aortic regurgitation and stenosis and the same in the pulmonary valve were seen on echocardiogram. Seventeen months after ASO, 1 patient required reoperation for severe postoperative pulmonary stenosis. We concluded that ASO can be performed with an acceptable mortality rate in a new unit with no previous experience of such surgery.
Use of Glutaraldehyde Solution in Treatment of Acute Descending Aortic Dissection
Authors: Fit Chen Ying , Hwa Chou Shah , Chun Yu Yu , Jen Cheng Yu
Published: May 2013

Based on technical simplicity and safety, we report a promising method for toughening and strengthening the aortic wall through direct application of 25% glutaraldehyde solution in the same manner described in 1989 by Vasseur and Hammond for treating patients with acute ascending aortic dissection. We have used this technique successfully in a patient with acute descending aortic dissection.
Percutaneous Cardiopulmonary Bypass for Cardiogenic Shock
Authors: Meharwal Zile Singh , Sharma Vijay Kumar , Kohli Vijay Mohan , Mishra Anil , Seth Ashok , Trehan Naresh
Published: May 2013

Percutaneous cardiopulmonary bypass was performed in 9 patients who developed cardiogenic shock. Of these patients, 5 were postoperative patients who developed cardiogenic shock on the day of operation. In 3 of these patients, intraaortic balloon pump was used in addition to percutaneous cardiopulmonary bypass. Two patients required percutaneous cardiopulmonary bypass in the cardiac catheterization laboratory for cardiogenic shock during angioplasty, and 2 other patients developed cardiogenic shock secondary to acute anterior wall myocardial infarction. Cardiopulmonary bypass was initiated with 18F femoral arterial and venous cannulae. Flow rates between 2.5 and 4.5 l/min and a mean blood pressure equal to or greater than 60mmHg were achieved. Of 5 postoperative patients, 3 survived and 2 died. Two patients who crashed during angioplasty were managed with emergency coronary artery bypass grafting, and both survived. Of 2 patients who developed cardiogenic shock following acute anterior wall myocardial infarction, 1 survived and 1 died. The surviving 6 patients were followed up for a mean period of 8 months. Five patients were in New York Heart Association Functional Class I, and 1 patient was in Class II.
Curative Therapy for Supraventricular Arrhythmia with Radiofrequency Catheter Ablation—Comparison with Surgical Therapy
Authors: Teo Wee Siong , Kam Ruth , Tan Arthur , Wong James , Kiat Ong Kim
Published: May 2013

Radiofrequency catheter ablation is a newly introduced technique that does not require open heart surgery and is designed for curing patients with arrhythmia. We present our experience with this technique in 223 patients, with recurrent supraventricular tachycardia due to accessory pathways associated with the Wolff-Parkinson-White syndrome or AV nodal reentrant tachycardia. Of the patients, 119 underwent radiofrequency ablation of accessory pathways, while 101 underwent AV nodal modification. Two patients underwent both AV nodal modification and accessory pathway ablation during the same session. One patient had AV nodal ablation. Mean age was 39.4 ± 14.1 years (13–73 years). There were 108 males and 115 females. Except for 1 patient, all had significant symptoms. Radiofrequency ablation performed during the first session was successful in 215 patients (96.4%). With repeat ablation, 218 (97.8%) of the patients were successfully ablated. When compared with surgery, the efficacy is similar; however, radiofrequency ablation is less costly and results in less morbidity. Radiofrequency catheter ablation is highly efficacious and is the treatment of choice in patients who are at risk for sudden death or have failed drug therapy. It should also be offered as an alternative to lifelong drug therapy.
Congenital Left Atrial Aneurysm
Authors: Trehan Naresh , Meharwal Zile Singh , Sharma Vijay Kumar
Published: May 2013

A 13–year-old boy, who presented with a 4-year history of breathlessness and palpitation, was admitted with atrial fibrillation. Left atrial aneurysm was diagnosed with echocardiography and angiography. After excision of the aneurysm, the patient became asymptomatic and was in normal sinus rhythm.
Persistent Left Superior Vena Cava Draining into the Left Atrium
Authors: Haneda Kiyoshi , Sato Naoshi , Ohmi Mikio , Tofiikuji Motohisa , Nakame Takahiko , Sato Kaori , Mohri Hitoshi
Published: May 2013

An 8-year-old male presented with persistent left superior vena cava draining into the left atrium, hemizygous continuation, double outlet right ventricle, cor triatriatum, and visceroatrial discordance. After correction of the double outlet right ventricle and cor triatriatum at the age of 5, he developed mild cyanosis due to a persistent left superior vena cava draining into the left atrium. At the age of 8, an intraatrial tunnel was successfully constructed with bovine pericardium to reroute the abnormal systemic venous flow.
New Trends in Aortic Valve Surgery: A critical Review of Standard Prosthesis v. Stentless Replacement and Repair
Authors: Duran Carlos MG , Gometza Begonia , Khouqeer Fareed , Al-Sanei Ali , Al-Halees Zohair
Published: May 2013

Different alternatives for the surgical treatment of aortic valve disease have been recently introduced. All consecutive patients who underwent aortic valve surgery between July 1988 and March 1994 were reviewed. There were 674 patients with a mean age of 32.4 years, mean preoperative functional class of 2.82, and rheumatic etiology in 59% of the cases. The patients were divided into 3 groups: Group I. standard aortic valve replacement with biological and mechanical prosthesis ( n = 313); Group II. stentless aortic valve replacement using homograft, pulmonary autograft and reconstruction with pericardium ( n = 145); and Group HI. aortic valve repair ( n = 216). The hospital mortality was 6.07% for the standard, 0.68% for the stentless, and 3.70% for the repair. Total follow-up was 1,304.75 patient years with a mean of 21.93 months. The actuarial survival at 66 months excluding hospital mortality was 85.24 ± 4.59% in the standard replacement, 92.63 ± 4.03% in the stentless, and 91.20 ± 3.02% in the repair group. The highest incidence of reoperation corresponded to the repair group with an actuarial freedom from reoperation of 74.26 ±7.03%, v. 92.52 ±4.52% in the standard and 85.11 ± 6.71% in the stentless group. There were no thromboembolic events in the isolated aortic valve survivors in both the stentless and repair groups and 1.28% patient years in the standard. We conclude that both the stentless aortic valve replacement and the aortic repair represent a good alternative v. standard replacement, especially for those young rheumatic patients in which anticoagulation and durability of the prosthesis is still a problem.
Aortic Valve Repair: Techniques and Results
Authors: Kumar A. Sampath , Gundane Prasanth
Published: May 2013

Twenty-two patients underwent aortic valve repair for rheumatic aortic regurgitation (AR) from April 1991 to August 1993. Six patients were female. Thirteen patients required mitral valve repair and 3 patients underwent mitral valve replacement. One patient required tricuspid valve repair in addition to aortic and mitral valve reconstruction.

There was 1 early death and 5 early failures. Of these, 3 were considered unsatisfactory valves for repair and replaced after an attempt at repair. In 2 others, the aortic valve was replaced within a week of initial attempt at repair. There were 2 late failures, 1 of which had aortic valve replacement and another who is awaiting reoperation. Fourteen of 22 patients have been judged to have good results clinically and echocardiographically.
Subacute Left Ventricular Free-Wall and Double Cardiac Rupture: Clinical Features and Surgical Considerations of a Surgically Salvageable Condition
Authors: Bedi Harinder Singh , Sharma Vijay Kumar , Kohli Vijay , Mishra Anil , Jayant Ashok , Trehan Naresh
Published: May 2013

Subacute cardiac rupture after myocardial infarction carries a high mortality. This article describes 4 cases—3 with rupture of the left ventricle and 1 with a combined rupture of the left ventricle and interventricular septum (double rupture). All patients were successfully operated; however, the patient with the double rupture died of a massive cerebrovascular accident on the 8th postoperative day. The importance of early diagnosis and prompt surgical intervention is discussed, along with a review of the literature.
Detection of Björk-Shiley Mitral Valve Dysfunction via Doppler Echocardiography
Authors: Shigenobu Masaharu , Sano Shunji
Published: May 2013

Fifty-eight patients with a Björk-Shiley (B-S) mitral valve were examined to study applicability of Doppler echocardiography in diagnosing and predicting the severity of prosthetic valve dysfunction. The effect of valve replacement on the hemodynamic performance at rest and during bicycle exercise was determined from serial echocardiographic data. The high pressure gradient group in which peak pressure gradients were assumed to be more than 15mmHg at rest, showed negative values of percent change in both stroke volume index (%ΔSVI) and left ventricular end-diastolic volume index (%ΔEDVI). All patients with high pressure gradients had poor exercise response of the left ventricle, whereas most patients with low pressure gradients showed good exercise response. The high pressure gradient group had significantly smaller mitral valve area than did the low pressure group. This suggests that impairment of inflow caused by the artificial valve, namely, prosthetic valve stenosis, is possibly a significant factor causing left ventricular dysfunction—notably a decrease in stroke volume during exercise. Reoperation was performed with good results in 5 of 58 patients because of high pressure gradients across the mitral valve prosthesis caused by tissue overgrowth. We conclude the high pressure gradient group is considered to be a reserved cohort of reoperation and periodical measurement of the pressure gradient via Doppler echocardiography can predict prosthetic valve dysfunction before it deteriorates significantly.
Ideal Position of Central Venous Catheters: Length of Catheter in Relation to Height of Patient
Authors: Muralidhar Kanchi , Acharya Krishna , Dash Prasantha
Published: May 2013

One hundred patients of either sex undergoing elective cardiac operation were divided randomly into 2 groups. In both groups, the right internal jugular vein was cannulated using the Seldinger technique and multilumen central venous catheters. The length of catheter inserted in Group A was height of the patient in centimeters divided by 10, and Group B height in centimeters divided by 12. Ideal catheter tip position could be obtained in 94% of the patients in Group B, but only 36% in Group A ( p < 0.001).
Surgery for Degenerative Mitral Regurgitation Valve Repair v. Valve Replacement with Chordal Preservation
Authors: Shigenobu Masaharu , Sano Shunji
Published: May 2013

This study compares mitral valve repair and mitral valve replacement with chordal preservation for chronic mitral regurgitation due to myxomatous degeneration with special reference to left ventricular function. Twenty-six patients underwent complete preoperative and 2 years later postoperative echocardiography study. Thirteen patients underwent mitral valve replacement associated with preservation of chordae tendineae and papillary muscles, and 13 patients had mitral valve repair. There were no statistically significant differences between the 2 groups for clinical findings, hemodynamic profiles, or left ventricular function compared prior to surgery. After correcting mitral regurgitation, increase in cardiac index was significant for the repair group. Left ventricular end-diastolic volume decreased in both groups. Left ventricular end-systolic volume significantly decreased in the repair group, but remained unchanged in the replacement group. Both ejection fraction and mean left ventricular circumferential fiber shortening velocity (mVcf) decreased in the replacement group, but significantly increased in the repair group 2 years after surgery. These findings suggest valve replacement with chordal preservation shows less improvement in ventricular systolic function late after surgery compared with mitral valve repair.
Reoperations for Aneurysmal Disease of the Ascending Aorta, Aortic Arch, and Descending Aorta: Their Causes and Operative Results
Authors: Aoyagi Shigeaki , Akashi Hidetoshi , Tayama Keiichiro , Hanamoto Yuji , Yamana Kazunari , Oryoji Atsushige , Kosuga Kenichi , Oishi Kiroku
Published: May 2013

Between 1984 and 1993, 20 patients underwent reoperation for the thoracic aorta or ascending aorta and aortic valve. There were 14 male and 6 female patients who ranged in age from 28 to 70 years with a mean of 53.2 years. The mean interval between initial operation and the 2nd operation was 70.4 months. Of the 20 patients, 6 had stigmata of Marfan's syndrome. The primary aortic pathology requiring initial operation was annuloaortic ectasia in 10 patients, aortic valvular disease in 5, aortic dissection in 3, and mega aorta syndrome, aortic aneurysm in multiple segments, or aortic arch aneurysm in 1 each. Cause of reoperation was pseudoaneurysm formation at suture lines in the ascending aorta in 6 patients, new or progressive dilatation in the remaining aortic segment in 5, new or persistent aortic dissection in 4, graft infection in 2, and recurrent aortic arch aneurysm in 1. The remaining 2 patients received a planned two-stage operation for multiple aneurysms or mega aorta syndrome. Six patients died early after reoperation, yielding a hospital mortality rate of 30%; however, 3 of the 6 deaths were related to a compromised preoperative clinical condition and 1 to perioperative contamination. Two operative deaths (10%) were related to operative techniques. Results suggest application of separate grafts for coronary artery reattachment, as in the Cabrol or Piehler techniques, or the aortic button technique for aortic root replacement, may help eliminate pseudoaneurysm formation, which is one of the major complications after operations on the ascending aorta. It is also suggested that early diagnosis and prompt operative treatment for recurrent or residual aneurysmal diseases of the aorta may be essential for successful definitive treatment.
Chylothorax after Operation for Congenital Heart Disease
Authors: Bin Hsu Ron , Hsun Chu Shu , Sh Chiu Ing , Chung Chang I , Hsien Hou Shou
Published: May 2013

The management of chylothorax after operations for congenital heart diseases was reviewed retrospectively. Between 1986 and 1993, 5 cases were identified. During 1993, a total of 317 operations were performed for congenital heart disease and 3 patients developed chylothorax, with an incidence of 0.95%. Conservative treatment with dietary modification and chest tube drainage was successful in abolishing chylous leakage in 4 out of 5 cases. Re-exploration with oversewing the leaking lymphaticus was performed in 1 case after 2 weeks conservative treatment. The mean duration of treatment was 25.4 days (range 3–44 days). Hypoalbuminemia complicated 1 case and there was no mortality. There was no correlation between the initial drainage amount and the duration or severity of chylothorax. Venous hypertension (>10mmHg), present in 4 out of 5 cases, may be associated with the development of postoperative chylothorax and high-dose diuretic therapy may be beneficial in these patients.
Chylothorax after Coronary Artery Bypass Surgery
Authors: Horowitz Michael D. , Rader Loralee A.
Published: May 2013

We report the case of a 73-year-old woman who developed a left chylothorax subsequent to surgical myocardial revascularization using the left internal mammary artery. This complication was successfully managed with thoracostomy tube drainage, chemical pleurodesis, and dietary manipulation. We review the literature regarding chylothorax after coronary artery bypass surgery and discuss the etiology and management of this rare complication.
Pseudoaneurysm of the Left Ventricle: Diagnosis and Treatment
Authors: John Thekkekara Alexander , Mahesh Gummiah Muniputtaha , Rao Rathna Nanjunda , Ramesh Saligram Srinivasaiah
Published: May 2013

A 62-year-old man suffered an anterior wall infarction and subsequent rupture of the myocardium and pseudoaneurysm formation. Correct diagnosis was made followed by immediate surgery using patch closure of the defect. The patient's recovery was uneventful.
Some Recent Controversies in Intensive Care
Authors: McArthur Colin J
Published: May 2013

The ability of dopamine to reverse oliguria has led to its ubiquitous renal protective use in patients at risk of acute renal failure. However, this diuresis is due primarily to inhibition of distal tubular sodium reabsorption and not renal vasodilation. Recent controlled clinical studies have been unable to demonstrate a renal protective effect independent of changes in cardiac output.

Selective decontamination of the digestive tract (SDD) has the appealing theoretical ability to minimize upper gastrointestinal colonization with gram-negative bacteria and fungi, and subsequently reduce nosocomial infection and mortality. Such modification of flora does occur, but the initial studies showing a reduction in lower respiratory tract infections have not been supported by recent large double-blind randomized controlled trials. A reduction in mortality or length of stay of general intensive care patients given SDD has never been demonstrated, and it remains an experimental therapy with possible application for some patient subgroups.

Upper gastrointestinal hemorrhage (UGH) in the critically ill is associated with prolonged ventilatory support and coagulopathy, but clinically important bleeding is now uncommon. Prophylaxis with agents that increase gastric pH is effective in reducing UGH, but may be associated with a higher incidence of nosocomial pneumonia than occurs with alternatives such as sucralfate. Prophylaxis does not alter mortality, and it is now controversial which patients, if any, should routinely receive such treatment.
Surgical Closure of Patent Ductus Arteriosus in Infants Weighing Less than 2.5kg
Authors: Boonkasem Somboon , Pongpanich Boonchob , Tejavei Anant
Published: May 2013

Persistent heart failure is a major problem in low birth weight infants with patent ductus arteriosus (PDA). There is a considerable incidence of renal insufficiency and reopening of the ductus after pharmacologic closure. Surgical closure of symptomatic PDA should therefore be indicated to avoid morbidity or mortality from heart failure and renal failure.

Between March 1990 and December 1993 there were 33 low birth weight infants who underwent surgical closure of PDA, ranging in age from 5 to 90 days (mean = 25) with 15 males and 18 females (M:F = 1:1.2). The patients were classified into 3 groups: group 1 (< 1000gm) 11 cases, group 2 (1000-1499gm) 10 cases, group 3 (1500-2499gm) 12 cases. The indications for surgical closure of PDA included: persistent heart failure in 28, renal insufficiency in 20, reopening of the ductus after pharmacologic closure in 16 and growth failure in 1.

The early mortality was 6% (2/33). Both of them were in group 1: one from necrotizing enterocolitis (NEC), and one from cytomegalovirus (CMV) infection on the 6th and 20th postoperative day respectively.

Late death occurred twice: the first case in group 1 from sepsis 35 days postoperatively, and the second in group 2 from pneumonia 3 months after surgery. The causes of late mortality in both cases were not related to surgery.

The 29 survivors are doing reasonably well during follow-up period.
Early and Late Results after Correction of Ventricular Septal Defect with down Syndrome
Authors: Yokoyama Hitoshi , Haneda Kiyoshi , Satoh Naoshi , Ohmi Mikio , Miura Makoto , Mohri Hitoshi
Published: May 2013

We retrospectively reviewed our 20-year experience of patients with ventricular septal defect(VSD) and Down syndrome (DS) to evaluate operative mortality, morbidity, long-term survival, and quality of life after correction of VSD. Between 1971 and 1991, VSD was corrected on 32 patients with DS, 12 male and 20 female, with an average age of 1.9 years. Operative mortality was 3.1% (1/32). Few postoperative complications developed including transient cardiac arrhythmias and low cardiac output. All survivors were free from reoperation with an average follow-up period of 6.8 years. Actuarial survival at 20 years was 97.9%. As many as 93% of the survivors were in New York Heart Association functional class I. Average pulmonary artery pressure in the long-term period was significantly less than preoperative value. Although simple daily activities such as having meals and dressing themselves were performed satisfactorily by more than 90% of the survivors, only 26% of them were able to converse with full understanding. These data suggest the presence of DS does not present a disadvantage for correction of VSD, which may be followed by excellent survival and functional class in spite of limited social activity.
Modified Fontan Procedure with the Simultaneous Bidirectional Cavopulmonary Shunt
Authors: Jin Kim Yong , Gook Jun Tae , Ryul Lee Jeong , Ryang Rho Joon , Phill Suh Kyung
Published: May 2013

We reviewed our experience of 56 patients from 1989 to 1992 who underwent a modified Fontan procedure and a bidirectional cavopulmonary shunt simultaneously. There were 39 male and 17 female patients and their weight ranged from 6.54 to 29kg (mean weight 13.58 ± 3.96kg). Patient age ranged from 16 to 135 months (mean age 42.8 ± 3.7 months). Diagnoses included single ventricle in 29, tricuspid atresia in 11, double outlet of right ventricle in 10, hypoplastic left heart syndrome in 4, and pulmonary atresia with intact ventricular septum in 2 patients. The techniques of inferior vena cava to pulmonary artery (IVC-PA) connection were anastomosis of proximal superior vena cava (SVC) to pulmonary artery (PA) in 27 (group 1), direct atriopulmonary anastomosis with roof formation in 29 patients (group 2). There were significant differences in postoperative 1-hour right atrial (RA) pressure and period of chest tube drainage between group 1 and group 2. The early mortality was 12.5% (7/56), and 2 late deaths (4.1%) occurred with a mean follow-up period of 22.4 months. Risk factors for the late postoperative arrhythmia were immediate postoperative arrhythmia and prolonged pleuro-pericardial effusion. Direct connection of the remaining proximal SVC to PA with the bidirectional cavopulmonary shunt may have less pleuro-pericardial effusion and late arrhythmia than atriopulmonary anastomosis.
Thermocoagulation with Hot Air in Thoracic Surgery
Authors: Sandermann Jes , Aagaard Jan , Nielsen Preben Lovgreen
Published: May 2013

Thermocoagulation with hot air is a new hemostatic procedure. During pulmonary surgery oozing blood and air leaking can be controlled by sweeping a high velocity air stream of about 420°C Cover a pulmonary surface stripped of visceral pleura. The hot air thermocoagulator can also control oozing of blood from the epicardium.
Surgical Treatment of Primary Cardiac Tumors—Experience with 45 Patients
Authors: Yi Lin Jue , Hsun Chu Shu , Teh Lee Yuan , Shen Wang Shoei , Yue Lin Fang , Her Tsai Chang , Jan Huang Por , Zu Tseng Yung , Pin Lien Wen
Published: May 2013

Primary cardiac tumors are very rare and the majority of them are histologically benign and surgically curable. During a 30-year period from 1963 to January 1993, 45 cases of primary cardiac tumors were surgically excised at the National Taiwan University Hospital, representing 0.52% of 8,695 open heart surgical cases during the same period.

In this series, 42 cases (94%) were benign tumors; 39 (88%) were myxoma (30 female, 9 male), and 32 (82%) originated in the left atrium. None were discovered in the left ventricle. In all but the first 6 cases, tumors in patients with myxoma in the left atrium were successfully excised by the transseptal approach. There were 3 patients with rare benign tumors: intracardiac goiter, rhabdomyoma, and hemangioma respectively. The intracardiac goiter was completely excised with no ectopic thyroid tissue after operation and the other 2 received palliative resection. The latter 2 patients suffered no recurrence. Rhabdomyosarcoma, leiomyosarcoma and malignant lymphoma were noted in one patient each, all of whom died of low cardiac output in the early postoperative course. In our experience, the majority of primary cardiac tumors were benign and located in the left atrium. The long-term result of surgical treatment of benign cardiac tumors is excellent, even incases of incomplete resection, while the results from surgical treatment of malignant tumors is poor.
Intracoronary Stents for Management of Coronary Dissection after Balloon Angioplasty
Authors: Yun Cho Seung , Heum Shim Won , Won Ha Jong , Hoon Park Si , Soo Kim Han , Wook Lim Sang , Soo Jang Yang , Chung Namsik , Soon Kim Sung
Published: May 2013

Dissection after percutaneous transluminal coronary angioplasty (PTCA) is a risk factor for acute or subacute vessel closure. Intracoronary stenting was developed to avoid these complications by pressing the intimal and medial flaps against the vessel wall, thus reducing the risk of acute thrombosis. From March 1993 through December 1993, PTCA was performed in 252 patients and implantation into the coronary arteries of a total of 33 stents was attempted in 32 patients with dissection after PTCA. Indications for stent implantation were acute closure in 6 (18.2%), threatened closure in 6 (18.2%), and suboptimal result in 21 (63.6%). Thirty-one stents were successfully deployed in 30 patients (94%), and stenting resulted in an immediate angiographic improvement in diameter stenosis from 87% before stenting to 18% after stenting by caliper estimation. Emergency coronary artery bypass graft surgery was required in 1 patient (3%). A non-Q wave myocardial infarction occurred in 1 patient (3%). Other complications included hematoma of the arterial access site requiring blood transfusion in 4 patients (12.5%) and hemopericardium in 1 patient (3%). Our initial experience with the flexible coil stent indicates it is efficacious for dissections that are threatening or causing coronary closure after angioplasty; however, the long-term outcome in all groups of patients who received coronary stents is unknown.
Acute Posttraumatic Rupture of the Thoracic Aorta: An Eleven-Year Experience
Authors: French Bruce G , Incoll Ian , Hushes Clifford F
Published: May 2013

An 11-year experience with 17 acute traumatic ruptures of the thoracic aorta is reviewed. Superior mediastinal widening on initial chest X-ray (CXR) was present in 15 patients. In 2 patients the mediastinum on CXR was initially normal but became wider with regular subsequent films. The diagnosis was made by aortography in 16 patients. All ruptures involved the aortic isthmus although one extended into the distal aortic arch. Emergency aortic repair was performed in all cases. Two had direct suture repair, 1 had a Dacron® patch, and the others required interposition tube grafts. Techniques used to enhance repair varied from a simple cross-clamp without heparinization to total cardiopulmonary bypass, deep hypothermia, and circulatory arrest. Four patients underwent surgery for other conditions prior to aortic repair (2 craniotomies, 2 laparotomies). There was 1 postoperative death and 2 cases of permanent paraparesis, both of which had been documented preoperatively. Aortography is a reliable diagnostic investigation in this condition. Repair should be performed in a center equipped with cardiopulmonary bypass. Surgical priority over the aortic repair should be given only to intracranial hemorrhage or selected cases of intraabdominal bleeding. Paraplegia can result from the injury as well as being associated with the aortic repair.
Right Gastroepiploic Artery in Myocardial Revascularization: Portuguese Experience
Authors: Roquette José , Ouininha Jorge , Castelão Nelson , Robalo Filipe , Melo Duarte Serra e , Miranda Luís Coutinho , Ferreira Rui , da Silva Manuel Nogueira , Bento Rui
Published: May 2013

Excellent results obtained with the use of the internal mammary artery in myocardial revascularization led us to complement its use with other arterial conduits, and the right gastroepiploic artery (RGEA) emerged as a valid alternative, allowing the expansion of total arterial revascularization. From July 1988 until September 1994 we utilized the RGEA in 101 patients with ages between 30 and 71 years (mean 54 9.43). The RGEA was used to bypass the posterior descending artery in 90 patients and for the marginal branches of the circumflex in 11. Exclusive arterial revascularization was possible in 92% of the cases with a mean of 2.7 bypasses per patient. There were 4 (4%) cases of death, and 3 instances of perioperative myocardial infarction. Angiographic control of the RGEA performed in 46 patients showed a patency of 87%. In conclusion, the RGEA was predominantly used to revascularize the inferior wall of the myocardium as a complement to the internal mammary artery. Its use occurred without significant morbidity and mortality, and postoperative angiographic visualization of these arterial conduits allowed us to expect good mid-and long-term patency.
Simplified Shunt for Carotid Artery Surgery
Authors: Neema Praveen Kumar , Neelakandhan Kurur Sankaran , Mohandas Kottilil , Waikar Hemant Digambar , Potti Ganapati
Published: May 2013

Use of intraluminal shunts is an established method for augmenting cerebral blood flow during carotid artery surgery. However, many undesirable complications such as embolization of atheromatous plaque and scuffing of the intima have been described after their use. We describe a simplified shunt, which provides sufficient cerebral blood flow and is devoid of the various known complications.
Pyothorax Caused by Anaerobic Organisms
Authors: Haneda Kiyoshi , Kagami Yoshitoshi , Katakura Tsunenori , Sugawara Hiraku , Makabe Michio
Published: May 2013

Pyothorax was caused by anaerobic organisms including Actinomyces viscosus, anaerobic streptococcus species, and Bacteroides species in a 67-year-old man. Despite administration of antibiotics and continuous irrigation of the abscess cavity with a povidone iodine solution, the pyothorax was complicated by pneumonia and the patient died of sepsis caused by methicillin-resistant Staphylococcus aureus on the 44th hospital day. This case is the 10th report of thoracic Actinomyces viscosus infection in English literature.
Ascending Aorta to Femoral Bypass with Cryopreserved Vascular Homografts
Authors: Mestres Carlos-A , Cartaña Ramón , Castella Manuel , Mulet Jaime , Pomar José L
Published: May 2013

Homograft vascular replacement is almost as old as vascular surgery itself. Gross and Dubost are credited as the first authors who clinically attempted vascular reconstruction using biological tissue of human origin. The advent of synthetic vascular prostheses together with the complexity of logistics in procuring, preserving, and storing vascular homografts made the routine use of vascular homografts impractical. Cryopreservation techniques have strongly influenced the use of biological tissue. The tireless work of a few authors has enabled us to better understand the behavior of homograft tissues in cardiovascular surgery. Homograft replacement of the aortic and pulmonary valves is now a recognized way to treat a number of conditions of the aortic root and the right ventricular outflow tract. Renewed interest in the use of cryopreserved homografts in cardiac surgery has led us to expand our own indications for their use. As our Cryopreservation Unit is fully operative, we also have vascular homografts available for implantation. Here we describe the extended use of vascular homografts in extraanatomic aortic bifurcation bypass in a patient with previous multiple vascular operations. To use the ascending aorta as the inflow source in cardiovascular reconstruction has been previously described; however, it has not been popular among surgeons. Robicsek termed this type of bypass graft “very long” aortic grafts, and we recently had the chance to use fully biological tissue of human origin for this type of reconstruction.
Myocardial Revascularization with Multiple Arterial Grafts
Authors: Calafiore Antonio Maria , Di Giammarco Gabriele , Teodori Giovanni , Mall Shree Prakash , Vitolla Giuseppe , Fino Carlo
Published: May 2013

From October 1991 10 July 1994, 439 patients underwent elective or urgent coronary artery bypass grafting utilizing 2 or more arterial conduits. Age ranged from 28 to 79 years (mean, 62.3 years). Most of the patients had 3-vessel disease (301); the remaining had 2-vessel (120) or 1-vessel (18) disease. A stenosis of the left main trunk greater than or equal to 50% was present in 73 patients; in 16 cases it was a redo operation. The left ventricular ejection fraction ranged from 0.19 to 0.84 (mean, 0.53). We utilized 1110 arterial conduits (430 left internal mammary arteries, 259 right internal mammary arteries, 136 right gastroepiploic arteries, 120 inferior epigastric arteries, 165 radial arteries) together with 113 saphenous veins (2.63 arterial anastomoses per patient, ranging from 2 to 6). In 347 patients (79%) we performed a complete arterial myocardial revascularization with an average of 2.80 anastomoses per patient. Two arterial conduits were used in 245 patients, 3 in 163, 4 in 30, and 5 in 1 patient. The myocardial protection was achieved by means of intermittent antegrade warm blood cardioplegia. The mean cross-clamping time was 47.3 ± 16 minutes (range, 16 to 142 minutes). Five patients (1.1%) died in the postoperative period, none were in the operating theater. The causes of death were cardiac (2), sepsis (1), pneumonia (1) and pancreatic necrosis (1). In 7 patients (1.6%) a perioperative myocardial necrosis occurred without any hemodynamic sequelae. Out of 430 patients alive, 419 (97.4%) are asymptomatic. At the postoperative angiographic control all the arterial grafts explored showed complete patency; the midterm angiography (mean, 14 months) revealed a cumulative patency of 96% (range, 100% for the left internal thoracic artery to 94.1% for the radial artery). We conclude that on the basis of the early results the technique herein described is effective and reproducible, even if long-term follow-up is needed to confirm these data.
Malignant Fibrous Histiocytoma of the Heart: Case Report and Literature Review
Authors: Hoang Huynh Chi , Gangji Diamon , De Smet Jean-Marie , Stefandis Constantin , Le Clerc Jean-Louis
Published: May 2013

A case report of a 57-year-old woman with malignant fibrous histiocytoma of the heart is presented. The clinical presentation was suggestive of a benign atrial myxoma. Careful pathologic study is necessary to differentiate the myxoid variant of malignant fibrous histiocytoma of the heart from the more common benign atrial myxoma. Usually, the evolution of malignant fibrous histiocytoma of the heart is rapidly fatal. Clinical aspects of this patient's case are discussed in conjunction with a review of the available literature.
Ruptured Thoracoabdominal Aortic Aneurysm into the Right Pleural Space
Authors: Aoyagi Shigeoki , Akashi Hidetoshi , Tayama Keiichiro , Higa Yoshiteru , Hiromatsu Shinichi , Hanamoto Yuji , Kai Eizo , Kosuga Kenichi
Published: May 2013

We report on a 71-year-old woman who underwent successful graft replacement for a ruptured thoracoabdominal aortic aneurysm into the right chest. Computed tomographic scans revealed aneurysmal dilatation of the descending thoracic and thoracoabdominal aorta, and a large right posteroinferior hemothorax with a small left extrapleural hematoma. Digital subtraction angiography showed the aortic aneurysm arising 4 cm distal to the origin of the left subclavian artery and extending to just proximal to the origin of the celiac axis. Emergency graft replacement of the thoracoabdominal aortic aneurysm was performed with a partial cardiopulmonary bypass through the femoral artery and vein. Although the patient required respiratory support with a mechanical ventilator for 48 days, she is presently doing well without limit to activities of daily living 12 months after surgery. We suggest that a combination of computed tomographic scans and aortography is useful in making a correct diagnosis of the extent of the aortic aneurysm and in helping to decide surgical procedures and supportive methods.
Surgical Repair of Corrected Transposition of the Great Arteries with Cardiac Anomalies: A Report of Fifty-Three Cases
Authors: Dong Zhu Xiao , Song Sun Han , Yu Wu Qing , Di Xiao Ming , Long Liu Ying
Published: May 2013

Between February 1964 and June 1994, we operated on 53 patients with corrected transposition of the great arteries associated with cardiac anomalies. Their ages ranged from 2.5 to 37 years (mean 15.9 years). There were 36 patients with type SLL and 17 with type IDD. Forty-three patients had ventricular septal defect with pulmonary stenosis, 7 had VSD with pulmonary hypertension and only 3 patients had atrioventricular valve incompetence without ventricular septal defect. Atrial septal defects were found in 13 cases and patent ductus arteriosus in 2. The main operative procedures were closure of ventricular septal defect (49), closure of atrial septal defect (13), resection of pulmonary stenosis (43) and pulmonary annulus enlargement (3). Additional procedures were bypass between the morphological left ventricle and the pulmonary artery using valved external conduit (4), tricuspid valve repair (4), tricuspid valve replacement (4) and one Fontan operation. Nine patients died (17%) within 30 days of operation. The mortality rate decreased from 29.2% to 6.9% after 1988. The main cause of early death was low cardiac output syndrome. The most common perioperative complications were complete heart block (5) and residual tricuspid valve incompetence (4). Forty of the 44 survivors were followed up from 2 months to 5 years. There were 2 late deaths due to tricuspid incompetence. Our surgical experience in the prevention of operative complications are discussed.
Complex Transposition of the Great Arteries with Interrupted Aortic Arch: Modified Great Vessel Reconstruction
Authors: van Son Jacques AM
Published: May 2013

Transposition of the great arteries with ventricular septal defect is often associated with anterior malalignment of the conal septum, hypoplasia of the ascending aorta and aortic arch, interrupted aortic arch or coarctation of the aorta, and hyperplasia of the main pulmonary artery. This marked disparity in great vessel size can result in difficulties at and beyond the neo-aorta-to-ascending aorta suture line, such as bleeding, distortion, obstruction, or the use of nonviable patch material. A modified surgical approach is presented in which the ascending aorta is anastomosed to the descending aorta, followed by anastomosis of the neo-aorta to the underside of the newly constructed aortic arch using a native aortic flap. The proposed technique greatly simplifies the reconstruction of the neo-aorta and the interrupted aortic arch, reduces tension on the neo-aorta to neo-aortic arch anastomosis, and preserves growth potential of the latter. This modification can especially be of benefit after radical resection of ductal tissue, particularly in association with interrupted aortic arch type A, with resulting long distance between the ascending and descending aorta.
Evaluating Operative Techniques for Distal Aortic Arch Reconstruction
Authors: Yoshizu Hiroshi , Hatori Nobuo , Haga Yoshiyuki , Shimizu Masafumi , Segawa Daisuke , Tanaka Susumu
Published: May 2013

Twenty-three cases of aortic arch aneurysm, over the past 10 years, were divided into 3 groups of similar age and sex for comparison of operative technique. The aortic arch was reconstructed under normothermic femoral bypass via left posterolateral thoracotomy in 9 patients (group II), under hypothermic circulatory arrest via left posterolateral thoracotomy in 7patients (group II) and under hypothermic circulatory arrest with ascending aorta cannulation and brief retrograde systemic perfusion immediately after finishing reconstruction of the aortic arch via median sternotomy in 7 patients (group III). Surgical mortality in groups I, II and III was 33.3% (3/9), 14.3%(1/7)and14.3%(1/7), respectively. Cerebrovascular complications occurred in 1 of 8 patients (12.5%), excluding an intra-operative death, in group II, and in 4 of 7 cases (57%) in group II, of whom 2 were restored to consciousness. There were no cerebrovascular complications in group III (p< 0.005 v. group II). The patient in group III who died of a lung complication 11 days postoperatively was restored to consciousness. Circulatory arrest time was 30.7 ± 17 and 33 ± 17 minutes in groups II and III, respectively. This study demonstrated that normothermic bypass (group II) resulted in an unsatisfactory surgical outcome, and femoral artery cannulation (group II) caused increased cerebrovascular complications compared with ascending aortic cannulation (group III), suggesting that the retrograde aortic flow, but not circulatory arrest per se, predisposed cerebrovascular morbidity. Vascular embolism by debris could be prevented by normograde perfusion via the ascending aorta and brief retrograde systemic perfusion immediately after finishing reconstruction of the aortic arch.
Coronary Ostial Anastomosis in Aortic Root Replacement
Authors: Ravichandran Pasala S , Floten H Storm , Furnary Anthony P , Gately Hugh L , Hovaguimian Hagop , Swanson Jeffrey , Starr Albert
Published: May 2013

We describe reliable methods for coronary ostial anastomosis in aortic root replacement which are uncomplicated and provide a secure attachment of the coronary ostia.
Severe Hypoxemia after Open-Heart Surgery Due to Respiratory Syncytial Virus Infection
Authors: Ishikawa Susumu , Ohtaki Akio , Sato Yasushi , Takahashi Toru , Kawashima Osamu , Kunimoto Fumio , Morishita Yasuo
Published: May 2013

A 5-year-old male with a ventricular septal defect associated with Down's syndrome, who had a previous history of pulmonary artery banding, underwent intracardiac repair. Severe hypoxemia occurred during the weaning from cardiopulmonary bypass. In postoperative evaluations, a severe intrapulmonary shunt was detected. There was no residual pulmonary stenosis or cardiac failure. Extracorporeal membrane oxygenation and intravenous gamma globulin infusion were attempted for a period of 5 days for the treatment of the hypoxemia. These therapies were not effective and the patient died 10 days after surgery from mediastinitis which occurred on postoperative day 7. Respiratory syncytial virus antibody was detected and lung specimens, which were resected on postoperative day 3, revealed an emphysematous distension of alveolar air space without pulmonary hypertension or pulmonary artery hypoplasia histologically. Respiratory syncytial virus infection in children may be an additional risk in cardiovascular surgery.
Treatment of Dissecting Aortic Root Aneurysm Complicated by Abscess after Valve Replacement
Authors: Saiki Yoshikatsu , Kasegawa Hitoshi , Mannouji Eiichi , Ida Takao , Kawase Mitsuhiko
Published: May 2013

A 41-year-old man with a prosthetic aortic valve developed endocarditis with perivalvular leakage, formation of an abscess, and left ventricular-aortic discontinuity, 16 months after aortic valve replacement. Moreover, he developed a complicated huge dissecting ascending aortic aneurysm with thrombotic occlusion of the right coronary artery. Successful repair of this complicated aortic root lesion was achieved using a composite valved graft and employing coronary bypass grafting.