bluuebunny/crossref_metadata_2025 huggingface dataset:
Choice of conduit for coronary artery bypass grafting in poor ventricles
Authors: Attaran Saina , Shaw Matthew , Saleh Hesham Z , Pullan Mark D , Fabri Brian M
Published: May 2013

Background: advantages in the use of arterial grafts for coronary artery revascularizations have been reported previously.

Objectives: we aimed to compare the outcome and survival rates of different conduits in patients with poor ventricular function (ejection fraction <30%).

Methods: in a 10-year period, 979 patients with an ejection fraction <30%, who underwent isolated first-time coronary artery bypass grafting, were divided into in 3 groups: (A) total arterial grafts ( n = 257), (B) total vein grafts ( n = 76), and (C) left internal mammary artery and vein grafts ( n = 610). Multivariate logistic regression was used to assess the effect of graft type on mortality, while adjusting for patient and disease characteristics. Hospital mortality and 5-year survival rates were compared among the groups.

Results: hospital mortality was 8.9% for group A, 11.8% for group B, and 5.7% for group C. Mortality at 5 years was 27.2% for group A, 42.3% for group B, and 28.7% for group C. After risk adjustment, hospital mortality and mid- and long-term mortality showed no significant differences among the groups.

Conclusions: patients with poor ventricular function have a high mortality rate in both the short- and long-term with any type of conduit. Mortality rates with total arterial grafts and vein plus arterial grafts were comparable before and after risk adjustment.
Cardiac surgery in cases of myeloproliferative neoplasm: risk factor for stroke
Authors: Sommer Sebastian-Patrick , Wagner Christoph , Sommer Stefanie , Krannich Jens-Holger , Aleksic Ivan , Schimmer Christoph , Schuster Christoph , Leyh Rainer G
Published: May 2013

Objectives: a history of myeloproliferative neoplasms is considered to increase the risks in cardiac surgery. In patients with myeloproliferative neoplasms, increased rates of perioperative infections and thromboembolic complications are suspected, but studies analyzing the impact of myeloproliferative neoplasms on results after cardiac surgery are lacking.

Methods: 13 patients with the diagnosis of myeloproliferative neoplasm underwent cardiac surgery. These patients were matched to 36 controls. Matching criteria consisted of sex, age, diagnosis, and comorbidities. Patients were analyzed regarding laboratory parameters, blood transfusion demands, morbidity, and mortality.

Results: compared to controls, patients with myeloproliferative neoplasms demonstrated a significantly lower body-mass index ( p < 0.01), creatinine ( p = 0.024), prothrombin time ( p = 0.001), and urea level ( p = 0.012). The perioperative leukocyte response ( p = 0.03) was ameliorated, and platelet counts ( p < 0.02) increased. Patients with myeloproliferative neoplasms had a reduced need for erythrocyte concentrates (54% vs. 86%, p = 0.047) but increased need for plasma and thrombocytes (15% vs. 0%, p = 0.07). Patients with myeloproliferative neoplasms had a significantly increased incidence of thromboembolic events compared to controls (31% vs. 3%, p = 0.014). Hospital mortality remained at zero, but mid-term survival was lower in patients with myeloproliferative neoplasms ( p = 0.078).

Conclusions: myeloproliferative neoplasm as a concomitant diagnosis increases the risk of thromboembolic complications during cardiac surgery. Plasma and platelet substitutions have to be administered, although strokes were not associated with hemostatic treatment.
Endovascular repair of intrathoracic ruptured Kommerell’s diverticulum
Authors: Yamashiro Satoshi , Nagano Takaaki , Kuniyoshi Yukio , Kise Yuya , Maeda Tatsuya , Arakaki Ryoko
Published: May 2013

A right-sided aortic arch associated with an aberrant subclavian artery is a rare anomaly. Regardless, this condition is clinically relevant because mortality is associated with rupture, morbidity results from compression of mediastinal structures, and the surgery is complex. We describe the successful surgical repair of this vascular anomaly by totally debranching the neck vessels and placing an endovascular stent-graft to exclude the ruptured Kommerell’s diverticulum.
Surgery in thoracic actinomycosis
Authors: Boudaya Mohamed Sadok , Smadhi Hanène , Marghli Adel , Mouna Mlika , Charmiti Fatma , Ismail Olfa , Kilani Tarek
Published: May 2013

Background: diagnosis and treatment of thoracic actinomycosis is difficult. In most cases, surgery is performed to rule out lung cancer or to control severe symptoms such as hemoptysis.

Methods: 6 patients with a mean age of 42 years underwent pulmonary resection and were given a pathologic diagnosis of thoracic actinomycosis at our institution between 2003 and 2010. We reviewed preoperative clinical characteristics, computed tomography findings, surgical indication, postoperative clinical course and outcome.

Results: All patients were symptomatic. One patient had a history of cervical actinomycosis. The mean interval between radiographic identification of the abnormality and surgical intervention was 8 months (range, 4–17 months). Radiographic findings in all cases included a mass-like appearance, simulating lung malignancy or chronic suppuration. The various histological and bacteriological examinations had failed to make the diagnosis. Thoracic actinomycosis was confirmed after thoracic surgery. All patients received penicillin-based antibiotic treatment for at least 2 to 3 months. Good clinical results were observed in 5 patients. In one patient, we noted recurrence of actinomycosis after 10 months; it was a multidrug-resistant form.

Conclusion: diagnosis of actinomycosis can be problematic because of difficulty in isolating actinomyces. In these cases, surgery is very helpful.
Aorto-left ventricular tunnel: uncommon site of origin and management
Authors: Furtado Arul Dominic , Peer Syed Murfad , Bhat Seetharama , Mahimarangaiah Jayaranganath
Published: May 2013

Cases of aorto-ventricular tunnel involving the right ventricle and more commonly, the left ventricle have been described. The site of origin is located above the right coronary cusp and occasionally, the left. We describe an aorto-left ventricular tunnel in a 16-year-old girl, with aneurysmal expansion into the right ventricular outflow tract. Its aortic origin was above the commissure of the right and noncoronary cusps of the aortic valve.
High-sensitive C-reactive protein predicts outcome after coronary artery bypass
Authors: Wang Jianyang , Zheng Zhe , Yang Limeng , Zhang Lu , Fan Hongguang , Hu Shengshou
Published: May 2013

Background: Elevated high-sensitive C-reactive protein is a powerful independent predictor of cardiovascular events. However, there are scant data on its impact on midterm or long-term outcomes of coronary artery bypass grafting.

Method: We analyzed data of 2863 patients who underwent coronary artery bypass in 2006–2007. Early endpoints were hospital mortality and major morbidity. Midterm endpoints were overall mortality, major adverse cardiovascular events, and heart failure.

Results: During hospital stay, 26 patients died and 288 suffered major morbidity. After 3.6 years of follow-up, 56 patients had died, 105 had major adverse cardiovascular events, and 70 developed heart failure. Multivariate analysis revealed every 1 mg·L−1 increase of high-sensitive C-reactive protein was associated with increased odds ratio for early mortality (odds ratio = 2.50, p = 0.002), major morbidity (odds ratio = 1.38, p = 0.02), and hazard ratio for midterm mortality (hazard ratio = 1.68, p = 0.03), major adverse cardiovascular events (hazard ratio = 1.48, p = 0.04), and heart failure (hazard ratio = 1.88, p = 0.01). Preoperative high-sensitive C-reactive protein > 2.5 mg·L−1 predicted higher risks of early (hazard ratio = 2.69, p = 0.02) and midterm mortality (hazard ratio = 1.92, p = 0.02), major morbidity (hazard ratio = 1.46, p = 0.004), major adverse cardiovascular events (hazard ratio = 2.06, p < 0.001), and heart failure (hazard ratio = 1.71, p = 0.03).

Conclusions: Elevated high-sensitive C-reactive protein (>2.5 mg·L−1) predicts poor early and midterm outcomes after coronary artery bypass.
Mitral stenosis after IMR ETlogix ring annuloplasty for ischemic regurgitation
Authors: Martín Carlos-Esteban , Castaño Mario , Gomez-Plana Jesús , Gualis Javier , Comendador Jose Manuel M , Iglesias Ignacio
Published: May 2013

Objectives: Ring annuloplasty combined with coronary artery bypass grafting is the standard approach for treatment of patients with ischemic mitral regurgitation. We evaluated mitral valve hemodynamic performance and recurrence of mitral regurgitation after ring annuloplasty.

Patients and methods: 40 consecutive patients (mean age, 70 ± 8 years) with chronic ischemic mitral regurgitation grade ≥2+ received annuloplasty with an IMR ETlogix ring. During follow-up (25.9 ± 15.5 months), 84% of surviving patients underwent exercise stress echocardiography to assess recurrence of mitral regurgitation and differences between rest and exercise mitral valve hemodynamic performance.

Results: Hospital mortality was 10%. During follow-up, we found no significant differences between left ventricular ejection fraction or end-diastolic and end-systolic diameters pre- and postoperatively (41% vs. 45%, 59 vs. 56 mm, and 49 vs. 46 mm, respectively), but there was a significant increase in mitral mean gradient with exercise (3.3 ± 1.2 vs. 7.8 ± 4 mm Hg, p < 0.001). Two patients had mitral regurgitation ≥grade III–IV.

Conclusions: Mitral annuloplasty with the IMR ETlogix ring provides effective correction of chronic ischemic mitral regurgitation, but this technique may induce functional mitral stenosis.
Is a cell saver necessary in off-pump coronary artery bypass surgery?
Authors: Tan Nguyen Luong , Corbineau Hervé , Phu Bui Duc , Verhoye Jean-Philippe
Published: May 2013

Background: Off-pump coronary artery bypass surgery should have a significantly lower risk of postoperated bleeding than on-pump surgery. However, the use of a cell saver has been considered necessary, with significant additional cost incurred. Can we consider performing off-pump coronary artery bypass surgery without a cell saver?

Patients and methods: A prospective observational study was performed in 68 consecutive patients operated on for 2- or 3-vessel coronary lesions by the off-pump technique.

Results: The mean number of distal anastomoses was 2.7 ± 0.7. Both internal thoracic arteries were used in 45 patients, and sequential revascularization was performed in 27, with 140 (77.8%) arterial grafts. Cell savers were used in 21 (30.9%) patients. In these 21 patients, the mean volume retransfused after treatment was 315 ± 177 mL. Postoperatively, 11 (16.2%) patients were transfused with packed red blood cells, with a mean volume of 636 ± 234 mL per patient. The 2 factors identified as associated with a higher risk of autotransfusion were female sex and a lower preoperative hemoglobin.

Conclusions: The use of a cell saver in off-pump surgery is useless in most cases. Careful surgical hemostasis is essential to limit hypovolemia.
Cardiac and pulmonary dysfunction in asymptomatic beta-thalassanemia major
Authors: Noori Noor Mohammad , Keshavarz Kambiz , Shahriar Mosaeib
Published: May 2013

This study assessed cardiac and pulmonary dysfunction in 26 asymptomatic patients with beta-thalassemia major. This investigation was a case-controlled study considering 10–20-year-old patients with beta-thalassemia major and no cardiac or pulmonary symptoms. Healthy individuals matched for age and sex were used as controls. At 48–72 h after blood transfusion, the patients underwent echocardiography and spirometry by a cardiologist and a pulmonologist. The results were compared to those of the control group. The right and left myocardial performance index, preejection period/ejection time ratio, ejection fraction, acceleration time, isovolumic contraction time, and bilateral isovolumic relaxation times in the study group demonstrated significant differences from the data of the controls. Right deceleration time was significantly different between the 2 groups. Myocardial performance index, peak early velocity of the right heart, and peak atrial velocity-to-peak early velocity ratio of the right side by Doppler tissue imaging were also significantly different between the 2 groups. Spirometry showed a significant difference in forced expiratory volume in 1 s/forced vital capacity between groups. Based on spirometry, pulmonary involvement in the patients was 77% restrictive. These findings show that systolic and diastolic dysfunction of the heart and pulmonary disturbances are unavoidable in patients with beta-thalassemia major.
Thymoma hyalinized by steroid therapy in myasthenia gravis
Authors: Yoshida Yukihiro , Ueda Ryuta , Murakawa Tomohiro , Ota Satoshi , Nakajima Jun
Published: May 2013

We encountered a 72-year-old woman with myasthenia gravis and thymoma who received glucocorticoid therapy for respiratory failure before undergoing thymectomy. After the antiacetylcholine receptor antibody titer was normalized, and the thymoma shrunk with prednisolone, the patient was free from symptoms. On pathological examination, the majority of the thymoma (type B2) had been hyalinized. Preoperative steroid therapy was effective in stabilizing myasthenia gravis and in inducing apoptosis of both epithelial and lymphocytic components of the thymoma.
Primary inferior vena cava leiomyosarcoma: reconstruction is not mandatory
Authors: Rodríguez-Caulo Emiliano A , Velázquez Carlos , Ramírez Bella , Barquero José M
Published: May 2013

Computed tomography in an 81-year-old woman revealed obstruction of the inferior vena cava by a large primary vascular leiomyosarcoma, and involvement of the right renal vein. She underwent successful en-bloc resection of the tumor, right kidney, hepatic segments IV and VI, and inferior vena cava, without caval reconstruction. A renal vein-to-remaining infrahepatic inferior vena cava saphenous vein graft bypass was performed for left renal venous drainage. The need for vascular reconstruction is not always mandatory.
Homograft use in patient with tetralogy of Fallot and absent pulmonary valve
Authors: Takeuchi Koh , Masuzawa Akihiro , Kobayashi Jotaro , Tsuchiya Keiji , Ono Minoru
Published: May 2013

A neonate with tetralogy of Fallot and absent pulmonary valve presented with respiratory distress due to airway obstruction after birth. He was placed on mechanical respiration. At 28-days old, he underwent pulmonary artery reduction and pulmonary homograft insertion. Ventricular septal defect patch closure was performed under cardiopulmonary bypass. His postoperative course was complicated by prolonged mechanical ventilatory support because of tracheomalacia. After 1 year of follow-up, he was in good condition without pulmonary regurgitation.
Intralobar pulmonary sequestration associated with bronchogenic cyst in adult
Authors: Traibi Akram , Strauss Christiane , Validire Pierre , Gossot Dominique
Published: May 2013

Pulmonary sequestration and mediastinal bronchogenic cysts are rare but well known to thoracic surgeons. However, their association is exceptional. We report such a case in a young adult. The common origin of these 2 malformations is discussed.
Isolated left ventricular collapse in rheumatic heart disease with tamponade
Authors: Garg Naveen , Moorthy Nagaraja
Published: May 2013

Echocardiography in a 23-year-old woman with chronic rheumatic heart disease revealed severe mitral and tricuspid stenosis, severe tricuspid regurgitation with severe pulmonary hypertension, and mild-to-moderate pericardial effusion that resulted in cardiac tamponade with isolated left ventricular collapse. The left ventricle became the victim as this was the only low pressure chamber. This report emphasizes the role of echocardiography in the diagnosis and early recognition of atypical clinical and hemodynamic manifestations of cardiac tamponade.
An alternative method for endoaortic clamping in atherosclerotic aorta
Authors: Alvarez Jose Rubio , Quiroga Juan Sierra
Published: May 2013

To decrease the risk of traumatic injury or dissection of the aorta in patients with diffuse atherosclerotic disease or calcification of the ascending aorta, we have devised a simple method that uses an Embol-X aortic cannula with a Fogarty occlusion catheter.
Pulmonary artery aneurysm with dissection and hemopericardium
Authors: Tiwari Nikhil , Ganguly Gautam , Garg Anurag , Nagi Gagandeep Singh , Hasnain Shahbaz , Dikshit Vikas
Published: May 2013

Pulmonary artery aneurysm presenting with dissection and hemopericardium is extremely rare, and we came across one such case in our center. The patient was a 22-year-old man who presented with dyspnoea, tachypnoea, and pallor. On evaluation, he was found to have a leaking pulmonary artery aneurysm with dissection and hemopericardium, and a patent ductus arteriosus. He underwent pericardiocentesis followed by successful closure of the ductus, aneurysmectomy, and reconstruction of the pulmonary artery.
Anomalous origin of the left main coronary artery. Surgical management
Authors: Desgué Julien , Cuttone Fabio , Babatasi Gerard , Labombarda Fabien , Massetti Massimo
Published: May 2013

A 53-year-old man, with no medical history, presented with acute coronary syndrome. Coronary angiography revealed a common right ostium giving rise to both the right coronary artery and the left main coronary artery. The left interior mammary artery was used as a single bypass graft to the left anterior descending coronary artery. The patient was asymptomatic on follow-up.
Surgical repair of aortico-left ventricular tunnel: report of two cases
Authors: Shiraishi Shuichi , Takahashi Masashi , Watanabe Maya , Tsuchida Masanori
Published: May 2013

Two girls aged 1 and 15 years with heart murmurs were diagnosed with aortico-left ventricular tunnel. In the 1-year-old, the tunnel had an intracardiac aneurysm within the right ventricular outflow tract; both openings were closed The 15-year-old had no aneurysmal dilatation, but she had mild aortic regurgitation; the aortic opening of the tunnel was closed with a patch. Both girls had uneventful postoperative courses with excellent early results.
Mycobacterium massiliense: an emerging pathogen in cardiovascular infections
Authors: Sadanandan Rajesh , Kuriakose Kudakachira Mathew , Ramanarayanan Piravom Venkiteswarier , Philomina Beena
Published: May 2013

We describe 2 cases of Mycobacterium massiliense infection after cardiac surgery. A 68-year-old man developed high-grade fever and sternal wound infection 5 weeks after aortic valve replacement. He was discharged after antibiotic treatment but readmitted with pseudoaneurysm of the aortic root. He succumbed to hemorrhage 2 weeks after reoperation. A 7-year-old boy developed endocarditis after atrial septal defect patch repair, and underwent replacement of the patch. Samples from both patients grew Mycobacterium massiliense.
Mycotic aneurysm of ascending aorta in an infant
Authors: Tachibana Kazutoshi , Takagi Nobuyuki , Kannki Kazushige , Higami Tetsuya
Published: May 2013

Mycotic aneurysm of the ascending aorta is rare in infants. A 12-month-old infant developed a mycotic aneurysm of the ascending aorta secondary to group A streptococcus septicemia. He developed atrioventricular block, and the rapid aneurysm progression under medical therapy prompted us to perform an emergency operation. The aneurysm was successfully repaired using an autologous pericardial patch. He remained well with normal sinus rhythm and was developing normally at the 5-year follow-up.
Monitoring brain oxygen saturation during awake off-pump coronary artery bypass
Authors: Toda Arinobu , Watanabe Go , Matsumoto Isao , Tomita Shigeyuki , Yamaguchi Shojiro , Ohtake Hiroshi
Published: May 2013

Objective: To evaluate the changes in cerebral blood flow during awake off-pump coronary artery bypass grafting and compare with the changes during off-pump coronary artery bypass grafting under general anesthesia, using continuous monitoring of regional cerebral oxygen saturation.

Methods: The study population comprised 3 groups of patients who had undergone off-pump coronary artery bypass grafting with thoracic epidural anesthesia, general anesthesia, or a combination of the two. Regional brain oxygen saturation, determined with a near-infrared oxygen monitor, and mean arterial pressure during surgery were calculated and compared among the 3 groups.

Results: Patients who had undergone awake off-pump coronary artery bypass grafting with thoracic epidural anesthesia had a significantly higher cerebrovascular impairment ratio, and the EuroSCORE was high. No significant differences were observed among the 3 groups in terms of the relationship between mean arterial pressure during surgery and regional brain oxygen saturation. It is suggested that there were no differences in cerebral blood flow and mean arterial pressure changes among the 3 groups.

Conclusions: Awake off-pump coronary artery bypass grafting is a safe surgical technique for patients with history of cerebral infarction or impaired cerebral blood flow. Awake off-pump coronary artery bypass grafting is a less invasive procedure that allows efficient management of intraoperative cerebral blood flow, and can be equally effective as a percutaneous coronary intervention.
Tirofiban-induced acute profound thrombocytopenia after primary angioplasty
Authors: Dursunoglu Dursun , Taşköylü Özgür , Gür Sükrü , Sari İsmail
Published: May 2013

Glycoprotein IIb/IIIa inhibitors are used in the acute coronary syndromes and percutaneous coronary intervention as antiplatelet agents. However, these agents induce thrombocytopenia in approximately 1% to 5% of patients, and may lead to bleeding complications. Abciximab is associated with higher incidence of thrombocytopenia than eptifibatide and tirofiban. We describe a case of acute profound thrombocytopenia due to on tirofiban treatment in a patient who underwent primary angioplasty.
Left ventricular pseudoaneurysm after surgery for infective endocarditis
Authors: Itoda Yoshifumi , Komae Hyoe , Yamamoto Tetsufumi , Takeda Makoto
Published: May 2013

A 46-year-old man had undergone aortic valve replacement for aortic regurgitation due to active infective endocarditis in 2006. He had been followed by transthoracic echocardiography revealing results within normal limits except for a subannular depressed scar. In 2010, a giant left ventricular pseudoaneurysm was detected on three-dimensional computed tomography. We performed surgery for patch closure of the pseudoaneurysm and redo aortic valve replacement.
Postpneumonectomy bronchial stump recurrence and bronchopleural fistula
Authors: Cariati Andrea , Piromalli Elisa , Taviani Mario
Published: May 2013

Objective: To reduce the incidence of postpneumonectomy local recurrence, and to prevent the onset of bronchopleural fistula.

Background: A long bronchial stump with a short tumor-free bronchial margin has been found to be associated with a higher incidence of local recurrence, and with the development of bronchopleural fistula in some cases.

Methods: 134 patients underwent pneumonectomy for non-small-cell lung cancer in 2 institutions. Bronchial stump length was measured intra- and postoperatively.

Results: 30-day postoperative mortality was 2.9%. There were 3 postoperative bronchopleural fistulas after right pneumonectomy (3/61) and one after left pneumonectomy (1/73; p = 0.2; fistula was more frequent in the long-stump group), which were successfully treated with carina sutures in 75% of cases. The overall incidence of local recurrence was strongly related to the presence of tumoral microinvasion in the resection margin (100%).

Conclusion: To prevent postpneumonectomy bronchial stump complications, it might be useful to use carina closure instead of bronchial closure. Carina closure can reduce local recurrence, significantly reduce the fistulization rate, and eliminate the stump diverticulum. Reduction of the length of the bronchial stump can be achieved using a TA Roticulator linear stapler.
Aneurysm following ligation of patent ductus arteriosus: myth or reality?
Authors: Malhotra Amber , Gupta Shyam , Kaushal Ram Prasad , Sharma Praveen , Moolchand Songra
Published: May 2013

Complications following ligation of a patent ductus arteriosus are rare and require careful evaluation. We report one case that highlights the clinical course and operative management of this unusual but significant postoperative complication.
Does use of cell saver decrease the inflammatory response in cardiac surgery?
Authors: Prieto Maria A , Guash Sara , Mendez Jose C , Munoz Cecilia , Planas Antonio , Reyes Guillermo
Published: May 2013

Background: The role of a cell-saver device in the inflammatory response to cardiac surgery has not been well documented. We hypothesized that the use of a cell saver may reduce proinflammatory cytokine concentrations in patients undergoing cardiac surgery.

Methods: 57 patients presenting for first-time nonemergency cardiac surgery were prospectively randomized to control or cell salvage groups. Blood samples for inflammatory marker assays were collected from the arterial line on induction of anesthesia, at the end of cardiopulmonary bypass, 1 h after surgery, and 24 h after surgery. Plasma proinflammatory cytokines were analyzed using a sandwich solid-phase enzyme-linked immunosorbent assay.

Results: The highest cytokine levels were observed 1 h after surgery. When comparing serum interleukin levels in both patient groups during the different perioperative periods, we found a higher interleukin-8 concentration 24 h after the procedure, and higher concentrations of the p40 subunit of interleukin-12 at 1 h and 24 h postoperatively. The concentrations of interleukin-6 and p40 were greater in blood stored by the cardiotomy suction system than in blood processed by the cell saver ( p = 0.01 in both cases). The interleukin-8 concentration was higher in the blood processed by the cell saver ( p = 0.03). No significant differences were observed in interleukin-1 and interferon gamma levels in blood from both systems. Clinical outcomes were similar in both groups.

Conclusions: Our results suggest that cell salvage in low-risk patients undergoing their first elective cardiac procedure does not decrease the inflammatory response after surgery.
Video-assisted mediastinoscopic resection of ectopic parathyroid adenoma
Authors: Yutaka Yojiro , Omasa Mitsugu , Shikuma Kei , Taki Toshihiko
Published: May 2013

Hyperparathyroidism can induce fatal complications in long-term hemodialysis patients. Approximately 20% of patients with hyperparathyroidism have ectopic mediastinal parathyroid glands, and the locations of 2% require a median sternotomy or thoracotomy. A 68-year-old man with an ectopic parathyroid gland in the thymus, underwent total resection via a video-assisted mediastinoscopic approach, which provides a less invasive surgical approach.
Coronary surgery in patients with low ejection fraction: mid-term results
Authors: Ergüneş Kazim , Yurekli Ismail , Lafcı Banu , Gokalp Orhan , Akyuz Muhammed , Yetkin Ufuk , Yilik Levent , Gurbuz Ali
Published: May 2013

Background: The aim of this study was to investigate the effect of preoperative low ejection fraction (≤30%) on postoperative morbidity and mortality in patients undergoing isolated on-pump coronary artery bypass grafting. We also investigated the effect of pre- and perioperative factors on survival.

Methods: Between January 2002 and December 2009, 103 (6.2%) patients with an ejection fraction ≤30% and 1554 (93.8%) with an ejection fraction >30% underwent coronary artery bypass grafting.

Results: In multivariate logistic regression analysis, cardiopulmonary bypass time, operation time, prolonged inotropic support, and intensive care unit stay were independent predictors of mortality in patients with low ejection fraction. Intensive care unit and hospital stays were significantly longer in these patients, and the postoperative mortality rate was significantly higher. Advanced age (≥70 years) influenced mortality during the follow-up of patients with low ejection fraction. Midterm survival was significantly reduced in patients with ejection fraction ≤30%. Smoking, prolonged inotropic support, and prolonged ventilatory support were independent predictors of midterm survival in patients with ejection fraction ≤30%.

Conclusion: On-pump coronary artery bypass grafting can be performed in patients with ejection fraction ≤30%, with reasonable mortality and morbidity rates.
Intrapericardial bronchogenic cyst found incidentally during open heart surgery
Authors: Antoniou Athanasios , Filias Vasilios , Mourtzis Nikolaos , Economidou Stella , Schortsanitis Panagiotis , Panagiotou Matthew
Published: May 2013

Bronchogenic cysts are embryological remnants occurring as developmental abnormalities of the primary foregut. The most common locations of these cysts are the mediastinum, lung parenchyma, and inferior pulmonary ligament. An intrapericardial location is an extremely rare finding. We describe the case of a 76-year-old man with aortic valve stenosis and coronary artery disease, in whom an intrapericardial bronchogenic cyst was found incidentally during the open heart procedure.
Congenital complete heart block in Klippel-Feil syndrome
Authors: Elumalai Raja Saravanan , Nainar Madhu Sankar , Vaidyanathan Kirthivasan , Somasundaram Ganesh , Balasubramaniam Govini
Published: May 2013

A 36-year-old man with a short neck, low hairline, and mild kyphoscoliosis, presented with history of syncope. Chest radiography revealed a diaphragmatic hernia. Computed tomography demonstrated fusion of C2–C6 vertebral bodies, Electrocardiography indicated complete heart block. Ultrasonography showed a right pelvic kidney. He was diagnosed with Klippel-Feil syndrome and underwent permanent pacemaker implantation and corrective surgery for the congenital diaphragmatic hernia.
Prognostic factors in malignant pleural mesothelioma: role of talc pleurodesis
Authors: Al-Alao Bassel Suffian , Parissis Haralabos , Rychlik Igor J , Graham Alastair , McGuigan Jim
Published: May 2013

Objective: To examine baseline characteristics associated with survival in patients with malignant pleural mesothelioma.

Methods: 122 patients with histologically proven malignant pleural mesothelioma during the period 2000–2010 were studied. Survival was evaluated by the Kaplan-Meier method with the logrank test. Cox regression analysis was used to estimate the hazard ratios for possible prognostic factors.

Results: 105 (86%) patients had complete survival follow-up; 91 died and 14 (13.3%) were alive at the end of the observation period starting from the day of diagnosis. The median survival was 286 days (95% confidence interval: 212–359). Talc pleurodesis was performed in 59 patients, and 17 had surgical interventions (2 chest wall resections, 2 extrapleural pneumonectomies, and 13 decortications). Chemotherapy was used in 41 patients, port-site radiation in 68, and combined therapy in 26. Cox regression analysis identified talc pleurodesis ( p = 0.04), chemotherapy ( p < 0.001), port-site radiation ( p < 0.001), and combined chemotherapy and port-site radiation ( p < 0.006) as favorable prognostic factors after adjusting for age, sex, histologic subtype, smoking, and performance status.

Conclusions: Surgical intervention including decortications and extrapleural pneumonectomy had no effect on survival in this series. Chemotherapy and radiation to port sites independently and in combination were associated with improved overall survival in malignant pleural mesothelioma patients. Talc pleurodesis was an independent determinant of survival, but further studies are warranted.
A rare presentation of Bochdalek’s hernia containing duodenum and pancreas
Authors: Muhammad Magdi IA , Abdelrahman Abdelrahman I
Published: May 2013

Symptomatic cases of Bochdalek’s hernia are uncommon in adults; symptoms arise only due to complications. Most of symptomatic cases are related to a left-sided hernia. We describe the case of a 50-year-old woman with Bochdalek’s hernia containing duodenum and pancreas. The patient was successfully treated by a surgical approach.
Aortic valve-sparing in aortic dissection with transposition of great arteries
Authors: Sharma Rajiv , Cohen Brent , Peters Paul , Shah Pallav
Published: May 2013

Patients with transposition of the great arteries have good survival after surgery, but some have complications ranging from heart failure to valve dysfunction. A 42-year-old woman who underwent surgical correction in childhood, presented with aortic dissection and had a valve-sparing root operation, but died immediately postoperatively. Both aortic dissection and valve-sparing root operations in this setting have not been described before. This case highlights facts to consider in the treatment of this presentation.
Left atrial appendage myxoma masquerading as left atrial appendage thrombus
Authors: Malik Lalitaditya , Borgohain Shyamadeep , Gupta Anubhav , Grover Vijay , Gupta Vijay Kumar
Published: May 2013

Myxomas are the most common benign tumors of the heart. They can arise from any heart chamber, but have rarely been described as originating from the left atrial appendage. We describe a case of left atrial appendage myxoma mimicking a left atrial appendage thrombus, and presenting with microembolization to the coronaries.
Migration of a Kirschner pin from the shoulder to the lung, requiring surgery
Authors: Cameliere Lucie , Rosat Paul , Heyndrickx Maxime , Le Rochais Jean-Philippe , Icard Philippe
Published: May 2013

A 62-year-old woman underwent a reduction of a proximal reduced humeral fracture, which was fixed by 3 Kirschner pins. One year later, the orthopedic surgeon failed to remove one of the wires. The patient was lost to follow-up, and 4 years later, she presented with hemoptysis, revealing migration of the pin to the lung. The pin was removed through a thoracotomy. Migration to the lung is often revealed by hemoptysis or pneumothorax. Close follow-up and early removal of the pins are mandatory.
Giant bronchial artery aneurysm presenting as a right hilar mass
Authors: Tan Ann Kheng , Thirugnanam Agasthian
Published: May 2013

We describe a case of bronchial artery aneurysm presenting as a solitary lung mass (4 × 5 cm) in a 53-year-old man with symptoms of cough for 3 months. The aneurysm was only detected at surgery, and resected by performing a middle lobectomy.
Pulmonary pleomorphic carcinoma with rapid progression
Authors: Shintani Yasushi , Ohta Mitsunori , Iwasaki Teruo , Ikeda Naoki , Tomita Emiko , Kawahara Kunimitsu
Published: May 2013

We describe a case of pleomorphic carcinoma showing a recurrent tumor with massive hemorrhage and myxoid change in the chest wall 2 months after complete resection. Whereas specimens from the initial surgery revealed both adenosquamous carcinoma and sarcomatous elements, the recurrent tumor predominantly consisted of a sarcomatous element. The recurrent tumor had stronger immunoreactivity for mesenchymal markers than the primary tumor, indicating that the sarcomatous element had more malignant potential than the epithelial element.
A misleading cause of pseudo-thymic tumor in ectopic Cushing’s syndrome
Authors: Icard Philippe , Heyndrickx Maxime , Galateau-Salle Françoise , Resnik Yves
Published: May 2013

A 27-year-old man was referred with typical features of severe Cushing’s syndrome. A bilateral adrenalectomy was performed. Three months later, a triangular nodular mediastinal enlargement, evocative of a right anterior thymic tumor, was discovered. Thymectomy was undertaken. Histological examination revealed diffuse thymic hyperplasia with negative immunostaining for adrenocorticotropic hormone. Five years later, a right endobronchial tumor corresponding to a carcinoid tumor was removed.
Relationship of venous blood gas with cervical esophagogastric anastomotic leak
Authors: Mohajeri Gholamraza , Tabatabaei Abas , Hashemi Mozafar , Bistgani Mohammad Moazeni
Published: May 2013

Objective: this study investigated the relationship between various parameters of venous blood gas analysis of gastric fundus veins and cervical esophagogastric anastomotic leaks after transhiatal esophagectomy.

Background: decreased tissue perfusion is one of the causes of anastomotic leak. There are various methods used to assess gastric conduit perfusion, with different results, and we lack a reliable method.

Method: this descriptive study, performed from March 2008 to October 2010, consisted of 45 patients with esophageal cancer who underwent transhiatal esophagectomy. After gastrolysis, blood samples were taken from a gastric fundus vein and submitted for venous blood gas analysis. The cervical wounds were examined 5 days postoperatively. The patients were divided into 2 groups based on the presence of leakage, and mean values of the venous blood gas analysis were compared.

Results: we observed significant differences in mean pH, PCO2, and O2 saturation between the 2 groups ( p = 0.04, p = 0.03, and p = 0.04, respectively).

Conclusion: venous blood gas analysis of gastric fundus veins appears to be a feasible and fast method for intraoperative assessment of microperfusion in the gastric fundus.
Eleven-year experience in thoracoscopic excision of bronchogenic cyst
Authors: Panchanatheeswaran Karthik , Dutta Roman , Singh Khumallambam Ibomcha , Kumar Arvind
Published: May 2013

Objectives: bronchogenic cysts are uncommon congenital cystic lesions. Most are incidentally detected and require surgical excision for histological diagnosis, symptom relief, and to prevent complications. Video-assisted thoracoscopic resection is preferable in suitable patients. In this study, we reviewed the clinical presentation, diagnosis, and thoracoscopic treatment of bronchogenic cysts.

Methods: from January 2001 to December 2011, 14 patients with bronchogenic cyst underwent thoracoscopic surgery for excision of the cyst. Their mean age was 24 years. Twelve patients were symptomatic (85.71%).

Results: the average maximum diameter of the cysts was 6.7 cm. The most common location of the cyst was the mediastinum ( n = 10, 71.4%). All bronchogenic cysts were completely excised. In 7 cases, the procedure was converted to thoracotomy. The mean hospital stay following thoracoscopic surgery was 4 days. There was no recurrence on follow-up.

Conclusions: thoracoscopic excision of a bronchogenic cyst should be considered the first-line therapeutic option. Proper preoperative case selection can prevent conversion to thoracotomy due to major pleural adhesions. There should be a low threshold for conversion to thoracotomy if complete excision of the cyst is not possible, because this is the main goal of treatment to prevent recurrence.
Mitral valve repair in active infective endocarditis with cerebral infarction
Authors: Okada Kenji , Shirasaka Tomonori , Kano Hiroya , Okita Yutaka
Published: May 2013

A 19-year-old woman, who had a recent extensive cerebral infarction caused by a septic embolization in the left-sided territory of the middle cerebral artery, successfully underwent mitral valve repair for severe mitral regurgitation caused by active infective endocarditis, 24 h after the onset of stroke. Anticoagulation during cardiopulmonary bypass was maintained with low-dose heparin and additional nafamostat mesilate. She had no further aggravation of the brain complication and recovered well with midterm mitral valve durability.
Neonatal tuberculosis and cardiac inflammatory myofibroblastic tumor
Authors: Banque Maria Niña F , Ribu Ramon O , Policarpio Maria Theresa T
Published: May 2013

A 1-month-old neonate was admitted in respiratory distress. Two-dimensional echocardiography and computed tomography scan showed a mass anterior to the left ventricle and right ventricular outflow tract. A biopsy revealed an inflammatory myofibroblastic tumor. A tuberculin test showed an 18-mm diameter induration. Three of the 6 household contacts were also positive for pulmonary tuberculosis. Antituberculosis medication was started. After 1 year, echocardiography and computed tomography scan showed complete resolution of the mass.
Transthoracic intra-aortic balloon pump removal without repeat sternotomy
Authors: Soo Alan W , Parissis Haralabos
Published: May 2013

Transaortic balloon catheter insertion for intra-aortic balloon assistance is a practical alternative to the standard transfemoral cannulation in patients with significant aortoiliac occlusive disease. We describe a technique whereby a transthoracic balloon is removed with the aid of video-assisted thoracoscopy.
Non-sinus rhythm after heart surgery: permanent or not? A simple method can tell
Authors: Xing Quansheng , Wu Qin
Published: May 2013

We introduce a simple method to distinguish permanent from transient non-sinus rhythm immediately after resuscitation in cardiac operations. An ice slush of normal saline is sprayed on the surface of the right atrium around the sinus node. If the arrhythmia is transient, the heart usually regains sinus rhythm; if not, the arrhythmia will most likely be permanent. Although we do not know the mechanism, this technique is easy and has worked well in 162 patients.
Right pulmonary hilar pedicle injury secondary to blunt chest trauma in a child
Authors: Muthialu Nagarajan , Hoskote Aparna , Deshpande Ranjit , Lister Paula
Published: May 2013

Combined tracheobronchial and thoracic vascular injury in children following blunt trauma to the chest is potentially life-threatening and almost certain to be fatal unless managed promptly. We report one such incident where prompt identification and early aggressive surgical management prevented an almost certain fatal outcome in a 5-year-old girl with complete disruption of the right main bronchus just distal to the carina, and a tear in the right pulmonary artery.
Surgical treatment of early stage small cell lung cancer
Authors: Ploenes Till , Osei-Agyemang Thomas , Krohn Alexander , Kayser Gian , Burger Meike , Passlick Bernward
Published: May 2013

Background: Chemotherapy with radiation has to be considered the standard therapy for limited-stage small cell lung cancer but surgical resection is possible in a small subgroup in which it may improve survival. Surgery is not recommended as the standard treatment, but a few small studies have demonstrated a benefit of surgery in highly selected cases of limited-stage small cell lung cancer.

Methods: We conducted a retrospective study of 29 patients with limited-stage small cell lung cancer undergoing surgical resection in our department. There were 7 (24%) women and 22 (76%) men with a median age of 62 years (range, 46–82 years). Medical history, histology and survival status were extracted from the medical database of the University Medical Center Freiburg.

Results: The median overall survival was 20.7 months. In 15 patients who received neoadjuvant treatment, the median survival was 89.4 months. Karnofsky performance status and neoadjuvant chemotherapy had a significant influence on median survival ( p < 0.0004).

Conclusions: We concluded that surgical resection can be beneficial in a highly selected group of patients as a part of a multidisciplinary approach. In addition, surgical resection is safe with acceptable mortality and morbidity.
Changes in lung function after surgery for mesothelioma
Authors: Ploenes Till , Osei-Agyemang Thomas , Krohn Alexander , Waller Cornelius F , Duncker-Rohr Viola , Elze Mirjam , Passlick Bernward
Published: May 2013

Background: The effect of pleurectomy/decortication or extrapleural pleuropneumonectomy on pulmonary function has not yet been evaluated. The aim of this study was to determine the parameters of pulmonary function before and after pleurectomy/decortication or extrapleural pleuropneumonectomy.

Methods: We conducted a review of 48 patients with unilateral malignant pleural mesothelioma who underwent pleurectomy/decortication or extrapleural pleuropneumonectomy. Data including medical history, histology, survival, and pre- and postoperative pulmonary function were extracted from the medical database of the University Medical Center Freiburg, or sought by telephone interview with the general practitioner or patients.

Results: 25 patients underwent extrapleural pleuropneumonectomy and 23 had pleurectomy/decortication. Pulmonary function was not significantly reduced in the pleurectomy/decortication group postoperatively. In the extrapleural pleuropneumonectomy group, the median preoperative total lung capacity of 4.8 L (77.7%) differed significantly from the postoperative total lung capacity of 3.5 L (55.3%; p < 0.0006). The median vital capacity was significantly reduced from 2.8 L (77.7%) preoperatively to 1.8 L (47.6%) postoperatively ( p < 0.0002). Other parameters were also highly significantly reduced after extrapleural pleuropneumonectomy.

Conclusions: Pleurectomy/decortication preserved good pulmonary function, whereas extrapleural pleuropneumonectomy significantly reduced pulmonary function, which may lead to dyspnea and influence the quality of life of these patients.
Anterior mediastinal tracheostomy for malignancy: analysis of 12 cases
Authors: Bagheri Reza , Rahim Mohammad Bagher , Majidi Mohammadreza , Tabari Azin , Akhlaghi Saeed , Tabari Azadeh
Published: May 2013

Introduction: Anterior mediastinal tracheostomy is indicated in extensive cervicothoracic malignancy with cervical mediastinal involvement of the trachea. This study was designed to assess the therapeutic outcome of anterior mediastinal tracheostomy.

Methods: From 2001 to 2010, 10 men and 2 women, with a median age of 64.5 years, underwent anterior mediastinal tracheostomy and were followed up for at least for 1 year. Seven patients had stomal recurrence following laryngectomy, 3 had carcinoma of the cervical esophagus, 1 had squamous cell carcinoma of the trachea invading the subglottic larynx, and 1 had adenoid cystic carcinoma of the trachea invading the subglottic larynx. They were evaluated in terms of etiology of the primary lesion, previous treatment, complications, hospital death, and Kaplan-Meier survival estimate.

Results: The tumor was completely resected in all cases. Postoperative complications included atelectasis (3 patients), stomal necrosis (1 patient), and anastomotic leak (1 patient). There were 2 (16.6%) postoperative hospital deaths. The mean duration of follow-up was 23 months, and the mean overall survival time was 25.59 months. Survival was calculated for 3 groups based on primary etiology: stomal recurrence of laryngeal carcinoma (12.85 months), cervical esophageal cancer (28 months), and primary malignancy of the trachea (29 months).

Conclusion: Because of the small number of patients, a definitive conclusion was difficult, but acceptable morbidity, mortality, and relative survival in selected patients, in whom an extensive cervicothoracic operation was performed by an experienced and skilled team of surgeons, demonstrated that anterior mediastinal tracheostomy can be a helpful procedure for patient survival.
External support in preventing vein graft failure
Authors: Hu Jia , Wan Song
Published: May 2013

Saphenous vein remains a widely used conduit in coronary surgery. However, the long-term success of surgical myocardial revascularization is largely limited by the development of neointimal hyperplasia and superimposed atherosclerosis in vein grafts. Although strategies for preventing vein graft failure have been constantly explored, few therapeutic interventions to date have shown sustained benefits in the clinical setting. The application of external support has emerged as a promising strategy for modulating the overall biomechanical responses in venous wall. Nonetheless, clinical translation of this intervention has been formerly challenged, primarily due to several technique limitations. The purpose of the current review is to summarize the possible mechanisms involved in the external support strategy for preventing vein graft failure. Furthermore, several previously tested biomaterials and delivery techniques are also highlighted.