bluuebunny/crossref_metadata_2025 huggingface dataset:
Bronchoalveolar Carcinoma Presenting as Malignant Pericardial Effusion
Authors: Iyer Raju S , Agarwal Sanjeev , Vamaraju Bharadwaja , Kola Srinivasu , Bhavanarushi Srinivas , Reddy Kumaraswamy
Published: May 2013

A 35-year-old male underwent emergency pericardiectomy for repeated tamponade. A computed tomography scan of the thorax showed a consolidated lung lesion with pleural effusion. Emergency aspiration removed hemorrhagic pericardial fluid and straw colored pleural effusion. Both fluids tested negative for malignant cells. He later underwent a pneumonectomy after a biopsy revealed carcinoma of the lung. The case is reported to illustrate this rare presentation of bronchoalveolar carcinoma.
Double-Outlet Right Ventricle with Supravalvular Mitral Ring and Parachute Mitral Valve
Authors: İslamoğlu Fatih , Atay Yüksel , Alat İlker , Saribülbül Osman , Alayunt E Alp
Published: May 2013

A 3-year-old female presented with double-outlet right ventricle associated with supravalvular mitral ring, parachute mitral valve, left persistent superior vena cava, and atrial septal defect. The supra-annular mitral valve ring was resected. Only one papillary muscle of the mitral valve could be detected and this was minimally divided to achieve adequate valve opening. An intraventricular tunnel repair technique using a polytetrafluoroethylene patch was carried out to repair the double-outlet right ventricle, which had a subaortic ventricular septal defect. The follow-up results at 2 years are excellent.
Paraplegia Complicating Left Posterolateral Thoracotomy
Authors: Pathare Hemant Pramod , Chitalkar Reshma Ramchandra , Hardikar Ashutosh Avdhoot , Tendolkar Anil Gangadhar
Published: May 2013

A 16-year-old female underwent an emergency posterolateral thoracotomy for construction of a systemic-pulmonary shunt to alleviate a cyanotic spell. She developed paraplegia secondary to intraspinal expansion of oxidized cellulose that had been placed intraoperatively as a hemostat. Surgical decompression of the spinal cord lessened the morbidity.
Mitral Valve Replacement with Bioprosthesis in Age Group Fifty to Sixty-Five Years
Authors: Katircioğlu Salih Fehmi , Yamak Birol , Ulus Tulga , Birincioğlu Levent , Saritaş Ahmet , Taşdemir Oğuz , Bayazit Kemal
Published: May 2013

Between 1982 and 1990, 151 patients aged 50 to 65 years of age underwent isolated mitral valve replacement with a bioprosthesis. Overall hospital mortality was 10.6% (16/151). The total cumulative follow-up period was 527.6 patient-years with a mean of 4.34 ± 2.53 years and a range of 2 months to 10.9 years. During the follow-up period, 27 patients (5.11% per patient-year) developed bioprosthesis dysfunction of whom 26 were reoperated and one was treated medically, 4 patients had thromboembolic complications (0.75% per patient-year), one patient (0.18% per patient-year) had anticoagulant-related bleeding, and two patients (0.37% per patient-year) had a paravalvular leak (one was reoperated). Total valve-related complications were 6.44% per patient-year. Late mortality was 2.65% per patient-year (14/151). Ten-year actuarial survival was 78.5%. Freedom from bioprosthesis dysfunction was 56.6%, from thromboembolic complications 95.8%, and from all complications 49.6%. Our findings of a high rate of bioprosthesis dysfunction as well as a low rate of thromboembolic complications after mitral valve replacement with a bioprosthesis in older patients suggests that the use of bioprostheses should be limited.
Spirometric Changes following Open-Heart Surgery on Rheumatic Mitral Valves
Authors: Chandra Abha , Srivastava Shashi , Dilip Dronamraju
Published: May 2013

Evaluation of pulmonary function by spirometry in adult patients undergoing cardiac surgery is a simple test to assess pulmonary reserve that has important implications in the operative morbidity. Pulmonary function was studied preoperatively, before discharge, and at the 3-month follow-up in 22 randomly selected patients who underwent open-heart surgery for rheumatic mitral valve disease (2 reconstructions, 20 replacements). The mean preoperative cardiothoracic ratio was 0.58. Lung function was found to be impaired preoperatively in all 22 patients and the majority suffered from restrictive lung disease. Better preoperative lung function was seen in nonsmokers, patients with a cardiothoracic ratio of less than 0.50, and those with a normal pulmonary artery pressure. After mitral valve surgery, the mean pulmonary artery pressure was 20.6 ± 2.9 mm Hg, the mean mitral valve pressure gradient was 3.6 ± 2.4 mm Hg, and the mean cardiothoracic ratio was 0.52 ± 0.09. A significant deterioration was seen in the predischarge spirometric values of forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate, flow rate at 25% to 75% of expired vital capacity, and maximum volume ventilation. The deterioration was greater in smokers and those who had prolonged cardiopulmonary bypass (more than 80 minutes). No correlation was found with ventilation because all patients were electively ventilated overnight. There was an overall improvement in spirometric parameters at the 3-month follow-up although the values remained lower than predicted. Spirometry was found to be useful for assessing lung function in patients undergoing mitral valve surgery and we recommended it as a routine test.
Surgical Repair of Complete Atrioventricular Septal Defect
Authors: Uddin Mohammed Jalal , Velimir Stojanovic , Salama Abdul Latif , Othman Babu , Othman Lulu , Haque Enamul , Shuhaiber Hani
Published: May 2013

Between January 1988 and March 1996, 40 patients underwent repair of complete atrioventricular septal defect with a two-patch technique and routine atrioventricular valve cleft closure. The mean age of the patients was 10.8 ± 6.9 months and the mean weight was 6.6 ± 2.6 kg. Twenty-three had Down's syndrome and 13 had coexisting cardiac anomalies. Preoperative angiography and echocardiography revealed mild atrioventricular valve regurgitation in 22 patients, moderate regurgitation in 16, and severe regurgitation in the other 2. The mortality was 12.5% (4 early and 1 late deaths). The major cause of death was pulmonary hypertensive crisis. Reoperation was necessary in 3 patients; 2 had atrioventricular valve annuloplasty and one had prosthetic valve replacement. All 3 survived reoperation. Echocardiography at a mean of 32 ± 20 months postoperatively showed mild left atrioventricular valve regurgitation in 32 patients and moderate regurgitation in 3. Management of postoperative pulmonary hypertensive crisis and repair of complete atrioventricular septal defect before the development of high pulmonary vascular resistance may reduce the mortality of this surgical procedure.
Catecholamine Cardiomyopathy: An Autopsy Study
Authors: Ratnakar Kamaraju Suguna , Sundaram Challa , Rajasekhar Angajala , Gayathri Krishnamoorthy , Prayag Aruna K , Jaishankar Sadasiva , Raju Bhoopathiraju Soma
Published: May 2013

Pheochromocytoma, an uncommon intra-abdominal tumor of the sympathetic nervous system, is associated with episodic hypertension. Cardiac complications infrequently occur as the principal presenting symptoms and may account for the morbidity and mortality. The role of catecholamines, mainly noradrenaline, in ventricular hypertrophy and cardiac dysfunction is well documented. This report documents two autopsy cases, one of adrenal pheochromocytoma and the other of extra-adrenal pheochromocytoma, with manifestations primarily of cardiac etiology. The changes described indicate catecholamine cardiomyopathy.
Total Resection of Interatrial Septal Echinococcosis
Authors: Bolourian Ali Asghar
Published: May 2013

Echocardiography indicated a myxoma in the right atrium of a 19-year-old male who suffered an episode of syncope. At surgery, a mass containing hydatid cysts was found in the interatrial septum. The patient underwent en bloc resection of the cysts and patch closure of the defect in the interatrial septum. Transient atrioventricular dissociation was observed for 12 hours postoperatively. Subsequent radiography revealed very two small cysts in the lungs, which were treated with albendazol. The patient made a good recovery with no recurrence during the short-term follow-up.
Minimally Invasive Valve Replacement: Surgical Disasters Might Also be Expected
Authors: Mestres Carlos-A , Cassinello Norberto , Fuentes Manuel
Published: May 2013

Minimally invasive cardiac surgery is rapidly gaining popularity. Diminishing surgical trauma by using smaller incisions seems to achieve the goal of a shorter length of hospital stay with reduced cost, better cosmetic results, and overall patient satisfaction. Therefore, a number of advantages can be anticipated, especially in selected patients. However, surgical complications might also be expected. The case of a 54-year-old male suffering intraoperative aortic dissection due to femoral artery cannulation illustrates the fact that we must be very careful when introducing any modification to the usual clinical practice.
Reserpine-Induced Complete Heart Block
Authors: Singh Mandeep , Agarwala Manoj Kumar , Juneja Rajnish
Published: May 2013

Reserpine is an adrenergic neuron blocking agent that acts by depleting the stores of catecholamines. Its use as an antihypertensive has declined recently because of frequent undesirable side-effects. The side-effects are primarily extracardiac and occur at high dosages. Cardiovascular side-effects are rare and include a decrease in atrioventricular conduction, potentiation of digitalis toxicity, and possible precipitation of ventricular ectopics. We report a case of reseprine-induced complete heart block requiring a temporary pacemaker for a few days.
Post-Banding Pulmonary Artery Pseudoaneurysm
Authors: Cheung David LC , Au Wing Kuk , Chiu Wing Hung , Chui Shui Wah , Lee Wai Tsun
Published: May 2013

Following pulmonary artery banding and left subclavian aortoplasty, a neonate developed a staphylococcal wound infection and a pseudoaneurysm of the pulmonary artery. She died of uncontrolled sepsis.
Minimally Invasive Vein Harvest for Coronary Artery Bypass Surgery
Authors: Li Chiu Yang , Lai Shiau Ting , Yu Tarng Jenn , Wang Jih Shiuan
Published: May 2013

Between October 1996 and August 1997, 56 endoscopic vein harvests were performed with video monitoring. Incisions of 2 to 3 cm in length were made at the groin and above or below the knee. The harvested veins were used for coronary artery bypass grafting. The complication rate was 1.8%. The average hospital stay for patients undergoing the endoscopic procedure was 7.2 days. All incisions had healed well at the 12-week follow-up. Endoscopic saphenous vein harvest provides a minimally invasive alternative to the open procedure. It gives a good cosmetic result, promotes early ambulation, and may reduce postoperative pain.
Repair of Thoracic Aortic Aneurysm and Dissection Using Deep-Hypothermic Circulatory Arrest
Authors: Manapat Adrian E , Garcia Jorge M , Barril Joseph B , Lopez Gary A , Talavera Diomedes A
Published: May 2013

From October 1989 to September 1997, 14 patients underwent repair of a thoracic aortic aneurysm or dissection using deep-hypothermic circulatory arrest. There were 10 males and 4 females with a mean age of 58 years (range, 43 to 82 years). The diagnoses included one ascending aortic aneurysm, one ascending aortic and arch aneurysm, 2 aortic arch and descending aortic aneurysms, 4 descending aortic aneurysms, 2 chronic aortic dissections of type A and 4 of type B. The involved aortic segment was replaced with a woven Dacron tube graft in 11 patients and repaired with a patch of woven Dacron in the other 3. Concomitant procedures were coronary artery bypass grafting in 2 cases; one aortic valve replacement, and one wedge resection of the left-upper lobe of the lung. A median sternotomy approach was used in 6 patients of whom 5 had right atrial-femoral artery bypass and 1 had right atrial-ascending aortic bypass. In addition to sternotomy, one patient had a left anterolateral thoracotomy. Seven patients had a left posterolateral thoracotomy with femorofemoral bypass. The mean circulatory arrest time was 35 minutes (range, 13 to 59 minutes). The lowest perfusion temperature ranged from 7°C to 16°C. Retrograde cerebral perfusion was used in 5 patients. There was one operative death from massive bleeding. Early complications included stroke in 2 patients, vocal cord paralysis in one, prolonged ventilatory support in one, reoperation for bleeding in one, and pleural effusion in 3 patients. There were 2 late deaths and the 11 surviving patients (78%) have been followed up for a mean period of 18 months. Deep-hypothermic circulatory arrest was found to be a useful technique in the repair of aortic aneurysm and dissection. We consider retrograde cerebral perfusion to be safe and easily performed. It probably decreased the incidence of stroke in patients with involvement of the aortic arch.
Discordant Limb-Lead and Precordial-Lead QRS Voltages in Inferior Myocardial Infarction
Authors: Luen James Yip Wei , Lim Yean Teng , Tan Huay Cheem , Chia Boon Lock
Published: May 2013

A 70-year-old man with acute inferolateral and posterior myocardial infarction presented with congestive heart failure. The 12-lead electrocardiogram showed a discordant pattern consisting of very low limb-lead QRS voltages and tall R waves in leads V2 and V3.
Angina Pectoris Due to Severe Muscular Bridge in Hypertrophic Cardiomyopathy
Authors: Topcuoĝlu M Şah , Usal Ayhan , Kayhan Cem , Pekedis Aladdin , Tokcan Acar , Bozkurt Abdi , Kanadasi Mehmet , Ulus Tümer
Published: May 2013

We report the case of a 39-year-old male with hypertrophic cardiomyopathy who complained of angina pectoris. The patient was treated with a beta blocker and a calcium antagonist without effect. Myocardial scintigraphy revealed anterior ischemia. Cardiac catheterization and ventriculography revealed severe systolic narrowing of the left anterior descending coronary artery and no significant pressure gradient across the left ventricular outflow tract. Myotomy was performed on a muscular bridge over the left anterior descending coronary artery and the patient's angina was relieved. In young patients with hypertrophic cardiomyopathy who develop angina refractory to medical therapy, a coexisting muscular bridge should be sought.
Aneurysm of Right Cervical Aortic Arch with Abnormal Branching Pattern
Authors: Shrivastava Sandeep , Shrivastava Shipra , Neelakandhan Kurur Sankaran
Published: May 2013

We report a rare case of congenital saccular aneurysm of the right cervical aortic arch in a 16-year-old girl. There were no branches arising from the aortic arch but 3 branches arose from the ascending aorta: the left innominate artery, the right common carotid artery, and the right subclavian artery. The aneurysm was successfully repaired with a plasma-preclotted woven Dacron interposition graft during profound hypothermic cardiopulmonary bypass without total circulatory arrest.
Extracardiac Unruptured Sinus of Valsalva Aneurysm Presenting with Aortic Incompetence
Authors: Discigil Berent , Boga Mehmet , Gürcün Ugur , Soydas Cahide , Yüksel Münevver
Published: May 2013

We report a case of extracardiac unruptured aneurysm of the noncoronary sinus of Valsalva presenting with massive aortic regurgitation and high fever. The preoperative evaluation, echocardiographic and cardiac catheterization findings, and surgical management of this rare condition are discussed.
Balloon Dilatation of Membranous Obstruction of the Inferior Vena Cava
Authors: Pathare Hemant Pramod , Biniwale Reshma Manoj
Published: May 2013

Membranous obstruction of the inferior vena cava is a rare congenital anomaly that results in the primary type of Budd-Chiari syndrome. We describe the case of an 8-year-old boy initially diagnosed with intrahepatic portal hypertension, who underwent percutaneous transluminal balloon dilatation of an inferior vena cava membrane located in the suprahepatic inferior vena cava, which resulted in successful palliation of his symptoms.
Recent Advances in Echocardiography of Aortic Disorders
Authors: Kanojia Ajay , Kasliwal Ravi R
Published: May 2013

Pathological processes affecting the thoracic aorta are a source of significant morbidity and mortality. It is not surprising therefore that many imaging modalities have evolved for comprehensive assessment of this vital structure. Currently available techniques include chest radiography, computed tomography, magnetic resonance imaging, echocardiography, and aortography. Compared with other modalities, echocardiography is the most attractive because of its advantages of speed, portability, immediate availability of results, and low cost. With recent advances in echocardiographic instrumentation, technology, and newer approaches such as multiplane transesophageal echocardiography it has evolved as the most promising imaging technique for diagnosis of aortic disorders, providing comprehensive information of the site and extent of aortic pathology and associated complications.
In Vitro Self-Training in the Surgical Technique of Aortic Valve Repair and Reconstruction
Authors: Luo Hong He , Choo Suk Jung , Oury James H , Duran Carlos MG
Published: May 2013

A simple device for in vitro assessment of aortic surgery on an isolated heart or aortic root specimen is described. This device was designed as a simple tool to provide surgeons with immediate and direct visual feedback on the results of a procedure performed on the aortic valve in an isolated cardiac specimen. The objectives were to assess the duration of learning new aortic surgical procedures and to instill a greater sense of confidence to the surgeon prior to operating on a patient. Free-hand pericardial aortic valve reconstructions were performed on 9 pig hearts and 5 human homografts, which were tested with this device. In the pig, valve reconstruction was tested using the whole heart as well as the isolated aortic root. Detailed qualitative and quantitative assessments of the performance of the reconstructed aortic valve were possible using this device.
Dobutamine Stress Test to Evaluate Different Sizes of Prosthetic Aortic Valves
Authors: Çam Nese , Gerçekoğlu Hakan , Çelik Seden , Gürsürer Metin , Tayyareci Gülşah , Karabulut Hasan , Narin Ahmet , Tezel Tuna , Yiğiter Besim
Published: May 2013

Dobutamine stress testing and Doppler echocardiography were used to assess hemodynamics in 27 patients aged 16 to 54 years with various sizes and types of aortic valve prosthesis. All patients underwent a symptom-limited treadmill exercise test within two days of the dobutamine test. There was no significant difference in ejection fractions and transvalvular gradients at rest and during dobutamine stress between St. Jude Medical, Medtronic-Hall, and Carbomedics valves. Exercise duration did not differ significantly among the different types of valve. When patients were classified by their underlying lesion, those with aortic stenosis and those with aortic insufficiency had similar ejection fractions and transvalvular gradients at rest and during dobutamine stress. The mean and peak transvalvular gradients at rest and during dobutamine stress were significantly different in patients with different valve sizes but the extent of the increase in gradients during stress was not significant. Linear regression analysis revealed that both peak and mean gradients during dobutamine stress could be predicted by the resting gradients. There was a negative correlation between valve size and gradients at rest and during stress, while there was a significant correlation between exercise duration and valve size. Dobutamine stress echocardiography was useful for studying hemodynamics in patients with aortic valve prostheses and the findings show that valvular size was the main determinant of exercise capacity.
Antegrade-Retrograde Cardioplegia for Myocardial Protection during Coronary Artery Bypass Graft Surgery
Authors: Aziz Tarek A Abdel , Al Khaja Najib , Ali Mohamed A , Maklad Ali S , Bassiouny Mohamed F , Turner Murdo , Roberts Donald G
Published: May 2013

This prospective randomized clinical study was designed to assess and compare the use of combined antegrade-retrograde cardioplegia versus antegrade cardioplegia in providing adequate myocardial preservation during coronary artery bypass graft surgery. Fifty patients undergoing elective coronary artery bypass grafting were randomly divided into 2 groups according to the route of cardioplegic delivery: group A (25 patients) received antegrade cold crystalloid cardioplegia; group B (25 patients) received combined antegrade-retrograde cold crystalloid cardioplegia. The groups were compared by clinical and electrocardiographic criteria and biochemical markers of ischemic myocardial damage. There was a highly significant statistical difference between the groups in terms of spontaneous recovery of sinus rhythm (40% of patients in group A versus 96% in group B). The use of direct current shock to restore sinus rhythm was higher in group A (60%) compared with group B (4%). Low cardiac output occurred in 20% of patients in group A and in 16% of patients in group B but this difference was not statistically significant. No bundle-branch block was found in group B whereas the incidence was 8% in group A. Significantly higher levels of biochemical markers of myocardial damage were obtained in group A at 10 minutes, 4 hours, and 12 hours after declamping. These results indicate that combined antegrade-retrograde cardioplegia is superior to antegrade cardioplegia for myocardial protection during coronary artery bypass graft surgery.
Emergency Coronary Artery Bypass Grafting after Failed Angioplasty
Authors: Mavitaş Binali , Ulus A Tulga , Yildiz Ülkü , Yamak Birol , Birincioğlu C Levent , Katircioğlu S Fehmi , Özer Can , Taşdemir Oğuz , Bayazit Kemal
Published: May 2013

Of 602 patients who underwent percutaneous transluminal coronary angioplasty in a 6-year period, 18 required emergency coronary artery bypass grafting within 12 hours of the procedure. The indications for emergency surgery were acute myocardial infarction in 5 patients, coronary artery dissection in 4, ventricular fibrillation in 3, unstable angina pectoris in 2, total coronary occlusion in 3, and cardiogenic shock in 1 patient. All patients were taken to the operating room in a deteriorating hemodynamic state; 4 received vasodilatating agents and another 4 were treated with vasodilators and inotropic agents, intra-aortic balloon pumping was used in 7, an autoperfusion catheter in 1, and 1 other required external cardiac massage. One patient was operated on in the catheterization laboratory. There was 1 death, giving an operative mortality of 5.6%. The internal thoracic artery was used for coronary artery bypass grafting in 7 patients. There were no deaths during the long-term follow-up.
Chest Wall Tumors
Authors: Özuslu B Ali , Genç Onur , Gürkök Sedat , Balkanli Kunter
Published: May 2013

We reviewed 94 consecutive patients who underwent resection of soft tissue or bone tumors of the chest wall between September 1989 and December 1996. There were 3 females and 91 males ranging in age from 12 to 69 years (median, 22.85 years); 16 had a primary malignant tumor, 11 had a metastatic tumor, and 67 had a benign tumor. Sixty-four patients underwent resection of the chest wall skeleton. Overlying soft tissue was resected en bloc in 15 patients. Chest wall defects were not reconstructed with prosthetic material or autogenous grafts because the defects were not large. Soft tissue reconstructive procedures were predominantly muscle transposition. There were no early postoperative complications and the median hospitalization was 14.2 days (range, 6 to 47 days). Follow-up was complete in all patients and ranged from 2 to 36 months (median, 24.5 months). All patients with benign tumors are currently alive. Recurrent chest wall tumors developed in 5 patients and they underwent a second operation. Nine patients died from distant metastases. There were no early or late deaths related to either resection or reconstruction of the chest wall. We conclude that wide or adequate chest wall resection, depending on histopathologic type of tumor, is the key to successful management of chest wall tumors. In general, this procedure can be performed in one operation with a short hospital stay and low operative mortality.
Post-Enteric Mycotic Aneurysm of Abdominal Aorta with Total Disruption
Authors: Suri Rajendar Krishan , Jha Neerod Kumar , Rao Katragadda Lakshmi Narasimha , Singh Mandeep , Chari Pramila
Published: May 2013

We report an extremely rare case of suprarenal mycotic aneurysm of the abdominal aorta below the origin of the superior mesenteric artery, secondary to Salmonella infection in a 3-year-old boy, which was associated with total disruption of the aortic wall. This case was successfully managed surgically with debridement and interposition of a double velour Dacron graft in the involved segment of aorta. A high degree of suspicion, angiographic evaluation supported by noninvasive investigations, and a planned surgical approach are required for a successful outcome.
Minimally Invasive Ligation of Coronary Artery Fistula
Authors: Kaushal Sunil K , Radhakrishnan Sitaraman , Iyer Krishna S
Published: May 2013

Successful surgical occlusion of a left anterior descending coronary artery-to-right ventricular fistula through a minimally invasive route is described. The fistula was ligated epicardially through a small midline pericardial window created in the xiphisternum without myocardial dissection, cardiac arrest, or cardiopulmonary bypass. Intraoperative transesophageal echocardiography played a crucial role in locating the site of the fistula, thereby allowing a minimally invasive surgical approach and assessment of the adequacy of repair.
Giant Thoracic Aneurysm Associated with Coarctation of the Aorta
Authors: Topcuoğlu Mehmet Şah , Salih Orhan Kemal , Kisacikoğlu Bülent , Kayhan Cem , Ulus Tümer
Published: May 2013

A 39-year-old male with low back pain, fatigue, and nausea of 2 years duration was referred with a suspected mass in the left lung. Computed tomography and magnetic resonance imaging showed a giant aneurysm associated with a coarctation of the descending thoracic aorta. A Dacron tube graft was interposed. Histopathologic examination revealed atherosclerosis of the aneurysmal wall.
Primary Chylopericardium in a Heroin Addict
Authors: Chello Massimo , Mastroroberto Pasquale , Cirillo Francesco , Malta Emanuele
Published: May 2013

We describe a case of primary chylopericardium following acute Staphylococcus aureus endocarditis in a 33-year-old female heroin addict. The patient underwent surgical ligation of the thoracic duct after a low-fat diet failed to control the fluid accumulation. Three months postoperatively, the patient was in a good general condition and no pericardial effusion was observed.
Bloodless Pediatric Cardiac Surgery? Deliverance with Erythropoietin
Authors: Creery W David , Black Michael D , Adatia Ian , McIntyre Brian
Published: May 2013

A 2-year-old 11.6 kg boy with congenital heart disease whose parents refused homologous blood products was treated preoperatively with iron and human recombinant erythropoietin for 6 weeks. Surgical repair was performed without exposure to blood products other than human albumin. Treatment with iron and erythropoietin in combination with post-bypass modified ultrafiltration, minimization of hemodilution, reinfusion of residual pump prime, and diuresis may reduce or avoid the need for blood transfusion in acyanotic children undergoing elective cardiac surgery.
Medical Therapy for Coronary Artery Disease: Primary and Secondary Prevention
Authors: Sudhir Krishnankutty
Published: May 2013

This review examines the various approaches to primary prevention and some aspects of secondary prevention of coronary artery disease. The role of aspirin, beta blockers, exercise, diets, fish intake, vitamin E, and folic acid are discussed. The potential role of chlamydia in atherosclerosis, the protective effect of alcohol consumption, and the benefits of female sex hormones are also examined. An update on lipid-lowering therapy and a summary of recent major clinical trials establishing the use of 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors in primary and secondary prevention of coronary artery disease are provided.
Three-Year Experience with the Ultracor Valve Prosthesis
Authors: Taşdelen Atilay , Ikizler Coşkun , Aşlamaci Sait , Yavari Afshin , Ekici Enver , Arslan Gülnaz
Published: May 2013

From February 1992 to October 1995, 504 patients aged 3 to 69 years (median, 36 years) received 663 Ultracor prostheses (103 aortic, 259 mitral, 12 tricuspid, and 130 multiple). Early mortality was 2.77% with a rate of 3.88% for aortic valve replacement, 3.47% for mitral, 0% for tricuspid, and 0.99% for double valve replacement. Follow-up was 100% (719.5 patient-years) and the overall mortality (early and late deaths) was 3.76% with a rate of 4.85% after aortic valve replacement, 3.85% after mitral valve replacement, 8.33% after tricuspid valve replacement, and 2.97% after double valve replacement. There were no deaths among 29 patients who had triple valve replacement. All patients including 33 children (3.5 to 18 years of age) received sodium warfarin. The linearized risk per patient-year for all embolic events (major and minor) was 0.69%, 1.11%, and 0.69% for aortic, mitral, and multiple valve replacement respectively. When only major events were considered, the linearized risks were 0.27%, 0.13%, and 0% per patient-year respectively. Freedom from major systemic embolism was 99% ± 0.07% after aortic valve replacement, 99% ± 0.07% after mitral valve replacement, and 99% ± 0.06% after multiple valve replacement. Five patients suffered valve thrombosis, 4 of whom definitely received inadequate anticoagulation therapy. Sixteen patients had 25 episodes of anticoagulant-related hemorrhage. No structural failure was recorded and no significant hemolysis was found in the absence of periprosthetic leak. This experience encourages us to continue using the Ultracor prosthesis.
Benefits of Glucose-Insulin-Potassium before Mitral Valve Replacement
Authors: Tünerir Bülent , Aslan Recep , Işiksoy Serap , Çolak Ömer , Beşogul Yavuz , Kural Tugrul
Published: May 2013

Of 30 consecutive patients undergoing mitral valve replacement, 15 were randomly assigned to receive pretreatment with glucose-insulin-potassium, while the other 15 received the same volume of normal saline. The characteristics of both groups were similar and all patients were in New York Heart Association functional class III or IV. Papillary muscle samples were obtained at the time of surgery and analyzed for glycogen both biochemically and histochemically. The clinical course was monitored closely during the first 24 hours after surgery. The treated patients had significantly higher glycogen levels (mean, 43 ± 13.54 μmol·g−1) in their heart muscle samples compared to the controls (mean, 22 ± 10.39 μmol·g−1). The treated patients required less pharmacological inotropic support and they had fewer ventricular arrhythmias and more favorable cardiac output and systemic vascular resistance. However, there was no difference in postoperative pulmonary capillary wedge pressure or mortality between the 2 groups. It was concluded that pretreatment with glucose-insulin-potassium had a significant myocardial protective effect in patients in advanced functional class undergoing mitral valve replacement.
Closed Mitral Valvotomy versus Balloon Valvuloplasty: A Comparison of 100 Cases
Authors: Iyer Raju S , Jain Rajnish , Padmanabhan Manoj , Chandra Abha , Agarwal Sanjeev , Sekhar Raja , Dronamraju Dilip
Published: May 2013

From January 1995 to December 1996, 50 patients with mitral stenosis underwent surgical valvotomy and another 50 had balloon mitral valvuloplasty. Balloon valvuloplasty was performed by the Inoue technique and surgical closed mitral valvotomy was carried out through a standard anterolateral thoracotomy with transventricular repeated Tubbs or finger dilatation. Functional status, left atrial mean transmitral gradient, mitral valve area, and left atrial size were recorded. No significant difference was found between the values of these parameters in the 2 groups of patients at the end of the study.
Clinical Results of Retrograde Cerebral Perfusion in Treatment of Aortic Disease
Authors: Çalkavur Tanzer , Atay Yüksel , Yağdi Tahir , Çikirikçoğlu Mustafa , Can Levent , Gürcün Uğur , Özbaran Mustafa , Bilkay Önol , Büket Suat
Published: May 2013

Between 1993 and 1998, 106 adults underwent ascending aorta or aortic arch operations using deep-hypothermic circulatory arrest and retrograde cerebral perfusion via the superior vena cava. Aortic lesions were acute type I dissection in 44 (41.5%), chronic type I dissection in 12 (11.3%), acute type II dissection in 6 (5.7%), chronic type II dissection in 9 (8.5%), ascending aorta or aortic arch aneurysms in 34 (32.1%), and an aneurysm of the sinus of Valsalva with aortic arch aneurysm in 1 (0.9%). The overall neurologic dysfunction rate was 6.6%. Early mortality was 18.8%. By multivariate analysis, circulatory arrest longer than 60 minutes and chronic renal failure were significant predictors of neurological dysfunction. Female gender, preoperative hemodynamic instability, circulatory arrest longer than 60 minutes, preoperative neurological dysfunction, and preoperative organ malperfusion were significant predictors of early mortality. We concluded that retrograde cerebral perfusion minimized neurological complications by preventing debris and air emboli and by providing adequate metabolic support in patients who needed circulatory arrest for surgical treatment of aortic pathology.
Minimally Invasive Approach for Left Atrial Myxoma
Authors: Ravikumar Edwin , Kumar Rajiv , Babu Birudugadda Raju , Thomas Sara , Chandy Sunil Thomas
Published: May 2013

A 32-year-old female with left atrial myxoma who was in New York Heart Association functional class IV, underwent a minimally invasive excision of the tumor through a right parasternal approach. Early follow-up demonstrated that this technique was effective and had the benefits of low cost, rapid recovery, decreased hospital stay, and a good cosmetic result.
Pseudoaneurysms of Bilateral Popliteal Arteries following Infective Endocarditis
Authors: Özerkan Filiz , Ceyhan Ceyhun , Ertürk Ümit , Atay Yüksel , Yüksel Münevver
Published: May 2013

A rare complication of infective endocarditis is pseudoaneurysm of the arterial wall. Aneurysms arise either from occlusion of vessels by septic emboli with secondary arteritis and vessel wall destruction or from bacteremic seeding of the vessel wall through the vasa vasorum. This paper reports on what the authors believe to be the first case of endocarditis presenting as pseudoaneurysm of the bilateral popliteal arteries.
Percutaneous Closure of Aortopulmonary Collateral for Postoperative Hemoptysis
Authors: Cherian Vijit Koshy , Gupta Arun Kumar , Manohar Soman Rema Krishna
Published: May 2013

A 30-year-old male with tetralogy of Fallot presented with a history of hemoptysis. He had a major aortopulmonary collateral artery that could not be interrupted during corrective surgery due to technical problems. Postoperative recovery was complicated by congestive heart failure. Embolization of the aortopulmonary collateral artery was planned but he developed massive hemoptysis and emergency transcatheter occlusion was performed, which successfully controlled both hemoptysis and congestive heart failure.
Effects on the Endocrine System of Pulsatile and Nonpulsatile Perfusion in Heart Surgery
Authors: Silistreli Erdem , Çatalyürek Hüdai , Sariosmanoğlu Nejat , Açikel Ünal , Hazan Eyüp , Oto Öztekin
Published: May 2013

The effects of cardiopulmonary bypass on the endocrine system were investigated in 10 patients who had pulsatile perfusion and in another 10 who had nonpulsatile perfusion during coronary bypass or valve replacement surgery. Measurements were made of thyroid-stimulating hormone, free and total triiodothyronine, free and total tetraiodothyronine, adrenocorticotropic hormone, cortisol, aldosterone, growth hormone, insulin, and glucose at 5 fixed time intervals up to 24 hours postoperatively. In the perfusion period, free and total triiodothyronine levels were less depressed in the pulsatile group. The mean level of growth hormone was significantly higher in the pulsatile group after 60 minutes of perfusion. The mean levels of insulin and glucose were significantly lower in the pulsatile group after 60 minutes of perfusion. Other changes were not statistically significant. We concluded that pulsatile perfusion was of benefit in stabilizing glucose and some hormone levels.
Late Effect of Mechanical Mitral Valve Diameter on Left Ventricular Function
Authors: Kestelli Mert , Zeybek Rahmi , Önem Gökhan , Tonguç Ece , Baltalarli Ahmet , Postaci Nursen , Demir Riza , Sagban Mansur
Published: May 2013

During left ventricular ejection, the minor (transverse) axis of the inner wall shortens by 27% to 37%, while the major axis shortens by 9%. Therefore, shortening of the minor axis accounts for 85% to 90% of the stroke volume and the mitral annulus area alters to assist left ventricular contraction. Mitral valve prostheses with large diameters are preferred but these may lead to systolic malfunction by restricting minor-axis shortening. We studied echocardiographic data of patients who has received mechanical mitral valves with the same inner diameter and opening angle but with different outer diameters (29 mm or 31 mm). Although there was no difference preoperatively in ejection fractions in the two groups, the postoperative ejection fraction was significantly higher in patients with the smaller valve. This finding indicates that mitral valve replacement with a prosthesis of large external diameter caused a deterioration in left ventricular function.
Right Anterolateral Thoracotomy for Repair of Atrial Septal Defects in Young Female Patients
Authors: Pasha Tayyab , Cheema Masud Ahmad
Published: May 2013

We performed a right anterolateral thoracotomy for atrial septal defect closure in young female patients to achieve a good cosmetic result. From December 1995 to June 1997, 25 female patients with a mean age of 10 ± 3 years (range, 4 to 22 years) underwent repair of atrial septal defects that comprised 24 ostium secundum and one sinus venosus. The length of the incision varied from 10 to 14 cm. The ascending aorta was used for arterial cannulation except in 2 cases where the external iliac artery was cannulated. Repairs were performed under crystalloid cardioplegia except in 2 patients where fibrillation was employed. In 5 patients, autologous glutaraldehyde-treated pericardial patch closure was used and the defects were closed directly in the other 20. All patients underwent echocardiography in the intensive care unit and 3 months after the repair. There was no operative or late mortality and no morbidity related to the thoracotomy approach. We concluded that a right anterolateral thoracotomy incision is a safe and effective alternative to a median sternotomy for repair of atrial septal defects and it provided a superior cosmetic result in these young female patients.
Cardiac Sarcomas: Is Tumor Debulking Justifiable Therapy?
Authors: Biniwale Reshma Manoj , Pathare Hemant Pramod , Aggrawal Nandkumar , Tendolkar Anil Gangadhar , Deshpande Jaya , Sivaraman Amoo
Published: May 2013

During a 15-year period from 1982 to 1997, 4 cases out of approximately 12,000 open-heart operations were performed at our institute for malignant cardiac tumors. Three of these tumors were angiosarcomas and one was a high-grade spindle-cell sarcoma. The prognosis for all 4 patients was uniformly poor in spite of maximal tumor debulking and postoperative chemotherapy.
Cardiac Rupture Due to Mitral Valve Endocarditis
Authors: Ismeno Gennaro , Renzulli Attilio , Bellitti Renato , Covino Franco E , De Feo Marisa , Cotrufo Maurizio
Published: May 2013

A 66-year-old lady with a history of mitral valve endocarditis and recent onset of low-output syndrome, underwent successful emergency surgery for myocardial rupture with hemopericardium. Visualization of the abscess cavity was not possible with transthoracic echocardiography and a definitive diagnosis was made by transesophageal echocardiography. Diagnostic and therapeutic aspects of mitral valve abscess are reviewed.
Anomalous Systemic and Pulmonary Venous Connections to Coronary Sinus
Authors: Manohar Soman Rema Krishna , Tharakan Jagan Mohan
Published: May 2013

A 3-year-old female child presented with total anomalous pulmonary venous connection to the coronary sinus coexisting with a persistent left superior vena cava. During the surgical correction, since there was no innominate vein, the left superior vena cava required diversion to avoid systemic desaturation. This was achieved by end-to-side left superior vena cava-to-left pulmonary artery anastomosis that was technically easier than transposing it to the right atrium.
An Alternative Technique for the Repair of Left Ventricular Aneurysm
Authors: Saga Toshihiko , Miyamoto Takashi
Published: May 2013

We describe a technique to repair a left ventricular aneurysm involving the ventricular septum. This technique can reconstruct the ventricular septum as well as the left ventricular free wall, preventing disturbances of the ventricular architecture. The technique also provides the opportunity to revascularize the ventricular septum.
A Simple and Safe Technique of Exposing Coronary Arteries
Authors: Guhathakurta Soma , Deacon Henry Alfred , Sharma Ashok Kumar
Published: May 2013

A gauze sling technique using two long thick gauze strips to rotate the heart on its longitudinal axis is described. This gives excellent exposure to the inferior and posterolateral wall of the heart. Any coronary system can be exposed easily by manoeuvring the free ends of the tapes for anchorage without requiring an assistant to hold the heart.
Minimally Invasive Saphenous Vein Harvest for Coronary Bypass Surgery
Authors: Eid Hossam Eldin , Al Khaja Najib
Published: May 2013

From September 1997 to January 1998, minimally invasive harvesting of the long saphenous vein was carried out on 30 randomly selected patients undergoing coronary artery bypass grafting. Two to 4 small skin incisions were made for subcutaneous dissection of the vein. The mean ratio of skin incision length to conduit length was 0.29 ± 0.01. The mean time for conduit preparation was 55 ± 2.6 minutes. Mean hospital stay was 9.2 ± 0.2 days. Morbidity in these patients was significantly lower than that of a control group of 100 patients who underwent the conventional open technique. The method was simple and effective in providing good quality venous conduits at low cost with improved patient satisfaction.
Anoxia-Reoxygenation in Cultured Endothelial Cells: Effects of Fructose Diphosphate and Captopril
Authors: Yu Shi Qiang , Liu Wei Yong , Wang Gang , Ren Yu Shen
Published: May 2013

Cultured rat aortic endothelial cells were morphologically and immunologically characterized before incubation under anoxic conditions for 120 minutes. Cell samples were reoxygenated for 10, 30, and 60 minutes as a model of anoxia-reperfusion injury. The effects of anoxia-reoxygenation were evaluated by measurements of membrane microviscosity, intracellular Ca2+ content, release of 51Cr, and uptake of trypan blue. Membrane microviscosity decreased from 2.03 ± 0.17 poise before anoxia to 1.72 ± 0.22 poise after 120 minutes of anoxia, with a further decrease to 1.54 ± 0.29 poise after 60 minutes of reoxygenation. Release of 51Cr correlated negatively with the decrease in membrane microviscosity and rose from 7.14% ± 0.4% to 12.16% ± 2.79% after anoxia and to 27.17% ± 2.59% after 60 minutes of reoxygenation. Intracellular Ca2+ content and uptake of trypan blue showed no noticeable change during anoxia but they increased significantly during reoxygenation. Addition of fructose-1,6-diphosphate to the anoxic incubation medium partly prevented the change in microviscosity and significantly reduced the release of 51Cr and the uptake of Ca2+ and trypan blue. Captopril exerted similar but less potent effects to those of fructose-1,6-diphosphate.
Electromechanical Effects of Protamine and Verapamil in Rat Papillary Muscle
Authors: Topcuoğlu M Şah , Iteğin Mustafa , Loğoğlu Gülay , Günay İsmail , Tokcan Acar , Ulus Tümer
Published: May 2013

The electromechanical effects of protamine sulfate and the calcium channel blocker verapamil on rat cardiac and skeletal muscles were studied using isolated left ventricular papillary muscle and phrenic nerve-hemidiaphragm preparations. Protamine produced significant decreases in isometric force in the cardiac tissue and contracture developed at concentrations of 40 and 80 mg·L−1. Isometric force also decreased significantly with verapamil at concentrations of 0.757 and 7.57 mg·L−1. Both drugs caused significant decreases in the contractile force of hemidiaphragm muscle when the tissue was stimulated indirectly. Protamine and verapamil caused the resting membrane potential and the amplitude of the action potential to decrease in cardiac tissue and overshoot failed to develop with 80 mg·L−1 of protamine or 7.57 mg·L−1 of verapamil. These bioelectrical changes developed in a dose-dependent manner. It was concluded that protamine had a similar effect to that of calcium channel blockers and it may act through a reduction of cellular calcium. This effect on cardiac tissue may be mediated through the sarcolemmal ion pumps or channels, leading to changes in calcium homeostasis.
Closure of Residual Shunts after Fontan Operation with Amplatzer Occluder
Authors: Amin Zahid , Rocchini Albert P , Wax David F
Published: May 2013

The fenestrated Fontan operation is commonly performed at several centers to decrease postoperative morbidity. Ultimately, the fenestrations are closed to avoid desaturation and embolism. Closure is safely accomplished in the operating room or in the catheterization laboratory with a device. We report our experience with the Amplatzer septal occluder that was successfully used to close residual shunts and fenestrations in two patients.
Aortobifemoral Bypass Surgery Using Mini-Laparotomy Technique
Authors: Açikel Ünal , Karabay Özalp , Silistreli Erdem , Turan Akin , Sariosmanoğlu Nejat , Oto Öztekin
Published: May 2013

We describe 4 cases of aortobifemoral bypass performed using a mini-laparotomy incision (6 to 8 cm) between January 1997 and February 1998. Revascularization of the lower extremities was carried out successfully without the need to enlarge the incision. The mean aortic cross-clamp time was 12.7 ± 3.4 minutes and the mean duration of the operation was 93.7 ± 30.9 minutes. In all cases, bowel sounds appeared at 2 to 8 hours postoperatively and oral nutrition was started after 24 hours. The mean hospital stay was 4.7 days. With the advantages of short operation time, optimal aortic exposure, easy and safe aortic cross-clamping, limited postoperative pain and scar tissue, early mobilization and resumption of intestinal functions, and short hospitalization, we believe that the mini-laparotomy technique is safe and effective for aortobifemoral bypass operations.
Tracheal Adenoid Cystic Carcinoma Mimicking Bronchial Asthma
Authors: Akçali Yiğit , Oğuzkaya Fahri , Kahraman Cemal , Hasdiraz Leyla
Published: May 2013

Adenoid cystic carcinomas are rare tracheal tumors that can mimic bronchial asthma. We describe the characteristics of 2 patients with adenoid cystic carcinoma who presented with symptoms suggestive of bronchial asthma of 2 years duration. Biopsy specimens revealed that the lesions were adenoid cystic carcinoma of the trachea. Both patients underwent collar incision and median sternotomy, the tumors were resected, and the tracheas were reconstructed primarily. Postoperative radiotherapy was given. Their postoperative clinical courses were uneventful and no local recurrences were seen at the 1-year follow-up.