bluuebunny/crossref_metadata_2025 huggingface dataset:
Bidirectional Cavopulmonary Shunt with Accessory Pulmonary Blood Flow
Authors: Goel Pankaj , Murthy Kona Samba , Cherian Kotturathu Mammen
Published: May 2013

Ninety-five patients underwent a bidirectional cavopulmonary shunt between 1995 and 1999. Group 1 (n = 38) had a shunt without an additional source of pulmonary blood flow. Group 2 (n = 57) had a shunt with accessory pulmonary flow. Patients with accessory pulmonary flow were better palliated (82% asymptomatic in group 2 versus 63% in group 1; p = 0.03). Intensive care stay was longer in group 2 (6.9 ± 7.5 days versus 4.6 ± 3.6 days; p = 0.05). There were no differences between the groups in terms of early postoperative oxygen saturation, incidence of pleural effusion, or the need for inotropic support. Leaving an additional source of pulmonary blood flow in selected patients is recommended. These findings are of special significance in developing countries where additional surgery is often unaffordable and a bidirectional cavopulmonary shunt may be the only procedure undertaken.
Pulmonary Blood Distribution after Total Cavopulmonary Connection
Authors: Chu Jun Min , Wu Qing Yu , Wang Wen Ming
Published: May 2013

From July 1998 to December 2000, the distribution of pulmonary blood flow was evaluated in 34 consecutive surviving patients who had been randomly assigned to one of 4 different modes of total cavopulmonary connection. All patients underwent radionuclide lung perfusion imaging with 99mTc-macroaggregated albumin to determine the distribution of blood from the superior and inferior venae cavae and the total pulmonary flow to each lung. The most physiological distribution of blood between the right and left lungs was obtained when the inferior vena cava anastomosis was widened and slightly offset towards the right pulmonary artery in patients without persistent left superior vena cava. This type of anastomosis should also reduce the incidence of arteriovenous malformations in the lung caused by exclusion of hepatic venous return.
Follow-Up on Heart Transplant after Left Ventricular Assist System Bridge
Authors: Fukushima Norihide , Ohtake Shigeaki , Sawa Yoshiki , Nishimura Motonobu , Matsumiya Goro , Takashima Seiji , Hori Masatsugu , Shirakura Ryota , Matsuda Hikaru
Published: May 2013

The first heart transplantation permitted under the new organ transplantation law was carried out in a 47-year-old man in the dilated phase of hypertrophic cardiomyopathy. He had been on a Novacor left ventricular assist system for the previous 4 months. The posttransplant course was uneventful and he returned to work 9 months later. After 2 years of follow-up, he was in good condition and enjoyed a normal quality of life and regular work.
Repeat Tricuspid and Mitral Valve Replacement for Enterococcal Endocarditis
Authors: Hamanaka Yoshiharu , Mitsui Norimasa , Hirai Shinji
Published: May 2013

A man who underwent tricuspid and mitral valve replacement with bioprostheses at 45 years of age required a second double valve replacement at 50, a third tricuspid valve replacement for enterococcal endocarditis at 57, and a third mitral valve replacement for relapsing enterococcal endocarditis at the age of 60. Recurrent Enterococcus faecalis prosthetic valve endocarditis was thought to be due to colon polyps causing intermittent infection.
Right Atrial Myxoma Arising from Crista Terminalis in Septuagenarian
Authors: Sajja Lokeswara Rao , Mannam Gopi Chand , Penumatcha Krishnam Raju , Sompalli Sriramulu , Angajala Rajasekhar
Published: May 2013

A right atrial myxoma arising from the crista terminalis was detected during follow-up echocardiography in a 74-year-old man who had undergone coronary artery bypass grafting one year earlier. The myxoma was excised en bloc with a wide cuff of normal atrial wall and the right atrium was reconstructed with autologous pericardium.
On-Pump Catheter-Guided Interruption of Pulmonary Arteriovenous Fistula
Authors: Joshi Raja , Manohar Soman Rema Krishna
Published: May 2013

A 4-year-old girl with a congenital pulmonary arteriovenous fistula underwent selective ligation of the fistulous tract with the aid of a preoperatively placed endovascular catheter and cardiopulmonary bypass.
Use of Streptokinase in Fibrinous Purulent Pericardial Effusion
Authors: Üstünsoy Haşim , Sivrikoz Muammer Cumhur , Topal Metin , Yilmaz Kutluhan , Koçer Bülent
Published: May 2013

A 7-year-old girl presented with fibrinous purulent pericardial effusion secondary to Staphylococcus aureus osteomyelitis. Poor drainage was achieved by pericardiocentesis, but intrapericardial fibrinolytic therapy with streptokinase restored effective drainage and the patient recovered rapidly.
Giant Mediastinal Lipoblastoma
Authors: Ng Calvin SH , Wan Song , Sihoe Alan DL , Arifi Ahmed A , Chan Wing Yee , Lee Tak Wai , Chik Ki Wai , Yim Anthony PC
Published: May 2013

A 3-year-old girl with fever, increasing cough, and nasal discharge for 2 weeks, was found to have a giant mediastinal lipoblastoma. The tumor weighing 556 g was successfully resected.
Pulmonary Parenchymal Abscess: VATS Approach to Diagnosis and Treatment
Authors: Podbielski Francis J , Rodriguez Heron E , Wiesman Irvin M , Brown Andrew M , Quiros Emily D , Ziauddin Mohammed F
Published: May 2013

Lung abscesses are usually treated with antibiotic regimens and postural drainage. Treatment failure necessitates transbronchial drainage with radiographically guided or open procedures. A patient with a lung abscess remained febrile despite a 2-week course of antibiotics and 3 unsuccessful percutaneous drainage attempts. Video-assisted thoracoscopic exploration localized the abscess and facilitated endoscopic unroofing and debridement of the cavity. Thoracoscopic drainage techniques offer a reliable and expedient option for refractory lung abscesses when compared to standard therapy alone.
Endothelial Cell Adhesion Molecules and Cardiopulmonary Bypass
Authors: Vallely Michael P , Bannon Paul G , Hughes Clifford F , Kritharides Leonard
Published: May 2013

Endothelial cell activation and the cell surface expression of adhesion molecules are considered to be crucial steps in the systemic inflammatory response to cardiopulmonary bypass. Endothelial cell adhesion molecules mediate the process of leukocyte adhesion to the endothelium and their subsequent transmigration and degranulation in the subendothelial tissues. The levels of soluble endothelial adhesion molecules in plasma have been used to draw conclusions regarding the cell surface expression of these molecules; the limitations of such studies are discussed. Inhibition of cell adhesion molecules may prevent the inflammatory condition caused by cardiopulmonary bypass and reperfusion injury. Further studies are needed to define the role of endothelial cell adhesion molecules in this inflammatory response.
Cardiac Myxoma and Myxosarcoma: Clinical Experience and Immunohistochemistry
Authors: Liu Sha , Wang Zhe , Chen An Qing , Zhou Guang Hua , Jiang Zhen Bin , Xiao Ming Di
Published: May 2013

From January 1978 to February 1999, 120 patients (42 males and 78 females) with cardiac myxoma (115) or myxosarcoma (5) underwent surgical excision or biopsy. There were 5 early postoperative deaths (mortality, 4.2%). Seventy-three survivors were followed up for 0.75 to 20.25 years (mean, 9.42 years); they comprised 4 myxosarcoma patients who all had recurrence or metastasis, and 69 myxoma patients who had no evidence of recurrence or metastasis. Neither familial myxoma nor Carney complex was found. The 5 cases of myxosarcoma and 18 randomly selected cases of myxoma were evaluated for proliferative activity, metastatic potential, and oncogene products by immunohistochemistry. The expression of p53 and Bcl-2 was similar in both groups. Overexpression of proliferating cell nuclear antigen and low expression of nm23 in myxosarcoma are consistent with the high rate of recurrence and metastasis of this tumor. Surgical resection of sporadic myxoma is a safe and effective treatment with satisfactory early and long-term results. However, the prognosis of myxosarcoma is still disappointing. Regular echocardiography and chest radiography or computed tomography are necessary for early detection of recurrence or metastasis of myxosarcoma.
Outcome of Cardiac and Thoracic Aortic Operation in Patients over 80 Years Old
Authors: Kawachi Yoshito , Nakashima Atuhiro , Toshima Yoshihiro , Kimura Satosi , Arinaga Kouichi
Published: May 2013

A retrospective analysis was performed to determine the early outcome of cardiac and thoracic aortic surgery in patients over 80 years old. Between 1994 and 2000, 41 octogenarians (mean age, 82.6 ± 2.5 years) underwent coronary artery bypass grafting (25), valve surgery (8), thoracic aortic aneurysm repair (7), or combined valve and bypass surgery (1). Overall hospital mortality was 9.8%. Mortality rates for specific procedures were 12% for coronary bypass, 0% for valve surgery, and 14% for thoracic aortic aneurysm repair. Major postoperative complications affected 27% of patients and included severe low cardiac output, respiratory failure, and acute renal failure, with a low incidence of perioperative stroke (2.4%). Cardiac and thoracic aortic operations can be performed with acceptable mortality and morbidity when appropriately applied in selected octogenarians.
Transfusion for Coagulopathy after Heart Surgery: Efficacy of Laboratory Studies
Authors: Hall Timothy S , Skoultchi Alan J
Published: May 2013

Limited information exists regarding transfusions specifically for coagulopathy following cardiac surgery and the value of pre- and postoperative coagulation tests. Procedures (86% coronary bypass, 7.5% valve, and 6.5% combined valve and bypass) on 478 patients were reviewed; 101 patients (21%) were transfused for postoperative coagulopathy. Compared to those not transfused, patients with coagulopathy were significantly older and smaller, and they had more combined valve procedures, emergency operations, and preoperative heparin treatment as well as longer crossclamp and bypass times. Three preoperative tests showed significant differences in the coagulopathy group: activated clotting time, partial thromboplastin time, and antithrombin-III level. Four postoperative tests showed significant differences between the groups: prothrombin time, partial thromboplastin time, fibrinogen level, and fibrin split products at 10 dilutions. Patient characteristics and pre- and postoperative testing can identify patients at high risk of transfusion specifically related to coagulopathy.
Tissue Engineering of an Auto-Xenograft Pulmonary Heart Valve
Authors: Dohmen Pascal M , Ozaki Shigeyuki , Verbeken Erik , Yperman Jessa , Flameng Willem , Konertz Wolfgang F
Published: May 2013

To improve the durability of stentless valves without losing their excellent hemodynamic function, a new-generation auto-xenograft was developed and evaluated. A piece of vein was harvested from 3 juvenile sheep 6 weeks before implantation of the valve. Endothelial cells from the vein material were cultivated and used to reendothelialize a decellularized porcine pulmonary valve. The tissue-engineered valve was implanted into the right ventricular outflow tract of the juvenile sheep. It was explanted after 100 days and assessed macroscopically as well as by x-ray, light microscopy (hematoxylin and eosin staining and von Kossa staining), and scanning electron microscopy. Calcium content of the cusps was determined quantitatively by atomic absorption spectrometry. The sheep implanted with the valve recovered quickly without any problems during the observation period. X-ray examination of the 3 explanted valves showed no cusp calcification, which was confirmed by histological study. Atomic absorption spectrometry showed low tissue calcium content. A clinical safety and feasibility trial with an allograft valve prepared the same way showed excellent short-term results in 6 patients.
Total Cavopulmonary Connection with Extraatrial Tunnel
Authors: Zhang Ren Fu , Gong Han Dong , Zhu Hong Yu , Hou Ming Xiao , Li Xin Min , Wang Jun , Song Heng Chang , Zhang Nan Bin , Tan Li Li
Published: May 2013

Between April 1997 and February 2000, total cavopulmonary connection with an extraatrial tunnel was used to treat 9 cases of complicated congenital heart disease: single ventricle (4), double-outlet right ventricle (3), mitral atresia (1), and tricuspid atresia (1). There was no mortality. One patient developed bacterial endocarditis and required reoperation after 52 days to replace the tunnel. At follow-up ranging from 11 months to 3 years, 3 patients were in New York Heart Association functional class I, and 6 were in class II. One patient with single ventricle had refractory supraventricular tachycardia after a modified Fontan operation 4 years earlier, which was cured by the total cavopulmonary connection procedure. The essential factors for a good outcome include appropriate surgical indication, avoidance of aortic crossclamping and cardiac arrest, and unobstructed anastomosis between the superior and inferior venae cavae and the pulmonary artery.
Transcatheter Coil Embolization of Coronary Artery Fistula
Authors: Alekyan Bagrat G , Podzolkov Vladimir P , Cárdenas Carina E
Published: May 2013

Between December 1982 and August 2001, coil embolization of coronary artery-to-cardiac chamber fistula was attempted in 15 patients aged 11 months to 44 years (mean, 7.2 ± 2.5 years). The fistulae connected the left anterior descending artery to the right ventricle in 4 patients, the right coronary artery to the right ventricle in 3, the right coronary artery to the right atrium in 3, the circumflex artery to the right ventricle in 2, the circumflex artery to the right atrium in 2, and the right coronary artery to the trunk of the pulmonary artery in 1. Complete fistula occlusion was achieved in 14 patients (93%); one had a residual shunt and underwent repeat embolization one year later, resulting in complete occlusion. There was one early death (7%) in a 4-year-old girl who developed femoral artery thrombosis and acute renal failure. Complications comprised migration of the coil into the pulmonary artery (2), femoral artery thrombosis (2), and perforation of the vessel wall by the guidewire (1) with immediate thrombosis and occlusion of the fistula (no coil was deployed). The 13 survivors with coils were followed up for 0.5 to 13 years; complete occlusion of the fistula was confirmed in all cases.
Situs Inversus and Coronary Artery Disease
Authors: Erdil Nevzat , Çetin Levent , Sener Erol , Demirkiliç Ufuk , Sağ Cemal
Published: May 2013

Situs inversus is a rare condition and there are few reports of myocardial revascularization in such patients. A 56-year-old woman with situs inversus totalis and coronary artery disease underwent successful anastomosis of the right internal mammary artery to the anterior descending coronary artery, and a saphenous vein graft to the right coronary artery.
Multiple Giant Aneurysms of Coronary Arteries
Authors: Sethi Gulshan K , Mullangi Sivaprasad , Goldman Steve
Published: May 2013

Multiple giant aneurysms of the coronary arteries occur extremely rarely and are usually associated with Kawasaki disease in children. A 53-year-old man with multiple giant coronary artery aneurysms was treated successfully by aortocoronary bypass grafting.
Lipoma of the Left Ventricle
Authors: Srinivas Babu Kosuru , Gopalakrishnan Mundayat , Mahadevan Ramachandran , Satyaprasad Velivela
Published: May 2013

A 36-year-old female was admitted with dyspnea on exertion of one year's duration. Echocardiography revealed a tumor arising from interventricular septum with dynamic left ventricular outflow tract obstruction. On cardiopulmonary bypass with cardioplegic arrest, the tumor was approached through a transverse aortotomy, and excised from the interventricular septum through the aortic valve. Postoperative recovery was uneventful and the patient was asymptomatic with no recurrence at follow-up after one year.
Percutaneous Extraction of Entrapped Infective Transvenous Pacing Lead
Authors: Memon Rizwan Aziz , Buckley John , O'Donnell Angus
Published: May 2013

A 57-year-old woman had an entrapped infected transvenous pacing lead successfully removed percutaneously with a Dormier basket under fluoroscopy, thus avoiding a major surgical procedure.
Congenital Pulmonary Lymphangiectasia with Chylothorax
Authors: Lee Seock Yeol , Yang Sung Rin , Lee Kihl Rho
Published: May 2013

A 5-year-old boy with dyspnea was diagnosed through thoracentesis as having chylothorax. After conservative management failed, open thoracotomy was performed. Lung biopsy confirmed the diagnosis of congenital pulmonary lymphangiectasia. Chylothorax was successfully controlled by fibrin glue pleurodesis in this patient.
Unexplained Systemic Hypertension after Closure of Ductus Arteriosus
Authors: Davierwala Piroze , Thakur Nityanand , Babu Packriswamy , Reddy Sreedhar , Kumar Pawan , Menon Raj , Tendolkar Anil G
Published: May 2013

Immediately after surgical closure of a patent ductus arteriosus, a 12-year-old boy developed severe systemic arterial hypertension refractory to medication. The cause of hypertension could not be found, but it came under control 3 weeks postoperatively with a combination of angiotensin-converting enzyme inhibitor and chlorothiazide.
Total Reconstruction of the Mitral Valve with Autopericardium: Anatomical Study
Authors: Gasparyan Vahe C , Galstyan Van S
Published: May 2013

Mitral valve repair has several advantages over prosthetic valve replacement. A new technique of total reconstruction of the mitral valve with autologous pericardium is described. The native mitral valve leaflets and chordae were excised from 10 human cadaver hearts, in the same way as for prosthetic valve replacement. The dimensions of the physiologically normal mitral valve were used to calculate the parameters for tailoring a corresponding new valve. Autologous pericardium was fixed in 0.625% glutaraldehyde solution for 10 minutes. The calculated parameters of the mitral valve were marked on the pericardium. The new valve was fashioned and inserted in the native valve position. Hydraulic probes showed good competence in all 10 reconstructed mitral valves. This method might be a good alternative to prosthetic valve replacement.
Management of Sternal Fractures: 239 Cases
Authors: Potaris Konstantinos , Gakidis John , Mihos Peter , Voutsinas Valsamakis , Deligeorgis Anastasios , Petsinis Vasilios
Published: May 2013

A review of the management of 239 patients with sternal fractures in a busy trauma center between October 1989 and May 2000 was undertaken to determine the incidence, significance, morbidity, and mortality of this injury. There were 140 men and 99 women with a mean age of 50.3 years (range, 15 to 93 years). Sternal fractures accounted for 8% of admissions for thoracic trauma. The causes were motor vehicle collisions in 215 patients (90%) and falls or direct blows in 24 (10%). Only 64 of 204 car accident patients (31%), 28 men and 36 women, were restrained by seat belts. Complications developed in 13 patients (5.4%). Mortality rate was 0.8%. Mean length of stay in the ward was 6.4 days (range, 1 to 32 days). Four patients (1.7%) underwent surgery. The results show that isolated sternal fractures have low associated morbidity and mortality. Admission is justified for the management of pain and treatment of cardiac complications and concomitant injuries.
Thymoma Associated with Pure Red-Cell Aplasia: Clinical Features and Prognosis
Authors: Murakawa Tomohiro , Nakajima Jun , Sato Hajime , Tanaka Makoto , Takamoto Shinichi , Fukayama Masashi
Published: May 2013

As information on the clinical features and prognosis of thymoma complicated by pure red-cell aplasia is limited, follow-up data on thymoma patients who had a thymectomy between 1954 and 1999 were analyzed retrospectively. Six of 166 cases were complicated by pure red-cell aplasia. In 3 of these, the pure red-cell aplasia appeared after surgical intervention. Remission was observed in 2 patients who underwent extended thymectomy. The other 4 patients subsequently died from pure red-cell aplasia. The outcome in patients with pure red-cell aplasia was poorer than that in the entire group of patients with thymoma and in those with thymoma complicated by myasthenia gravis. The possible onset of pure red-cell aplasia after thymectomy should be kept in mind during follow-up.
Right Heart Assist during Beating Bypass for Severe Left Ventricular Dysfunction
Authors: Matsumiya Goro , Ohtake Shigeaki , Kagisaki Koji , Takahashi Toshiki , Sawa Yoshiki , Matsuda Hikaru
Published: May 2013

Three patients with triple-vessel disease and severe left ventricular dysfunction underwent successful revascularization on a beating heart, using a right ventricular assist system. Heparin-coated circuits with a centrifugal pump provided 2.5 to 3.5 L·min−1 of flow to maintain good hemodynamics and enable easy access to the posterior vessels during vertical displacement of the heart.
Coronary Bypass Surgery in Patient with Malaria
Authors: Balkanay Mehmet , Mansuroğlu Denyan , Kirali Kaan , Ömeroğlu Suat Nail , Yakut Cevat
Published: May 2013

A 65-year-old man with unstable angina pectoris developed malaria prior to coronary artery bypass grafting. After 3 weeks on antimalarial therapy, left internal mammary artery-toleft anterior descending artery anastomosis was performed on the beating heart to avoid the effects of cardiopulmonary bypass. There was no complication in the early postoperative period.
“Y” Graft Bypass for Bilateral Coronary Ostial Aortoarteritis
Authors: Singh Sushil K , Kumar Deepak , Yadave Ram D , Khanna Asha R , Sinha Subhash K
Published: May 2013

A case of bilateral coronary ostial aortoarteritis, which presented with angina pectoris, is reported. Emergency total arterial revascularization was performed using the bilateral mammary artery and radial artery, and the radial artery was hanged “Y” on the left internal mammary artery. The patient was discharged on low-dose steroid. He was asymptomatic at 1-year follow-up.
Carotid Body Tumors
Authors: Aydoğan Hakki , Orhan Gökçen , Aykut-Aka Serap , Albeyoğlu Şebnem , Yücel Okan , Sargin Murat , Göksel Onur , Filizcan Ugür , Eren E Ergin
Published: May 2013

Carotid body paragangliomas were diagnosed by Doppler ultrasound, carotid artery angiography, and cranial computed tomography in a 35-year-old man with a mass in the neck and hearing loss, and in a 42-year-old man with headache, syncope, and a mass in the neck. They underwent successful surgical excision.
Giant Aneurysm of Renal Artery: Surgical Management
Authors: Sajja Lokeswara Rao , Benjaram Sitaram Reddy , Sahariah Sarbeswar , Devaraj Vijay Kumar
Published: May 2013

Giant aneurysm of the renal artery is rare even though renal artery aneurysms are diagnosed more often since the introduction of abdominal ultrasonography and selective renal arteriography. A 52-year-old man with an aneurysm of the left renal artery measuring 16 × 13 × 10 cm presented with features of an expanding aneurysm. He underwent resection of the aneurysm and a left nephrectomy.
Gas Gangrene in Patient with Atherosclerosis Obliterans
Authors: Niimi Masanori , Ikeda Yosifumi , Kan Shigenao , Takami Hiroshi
Published: May 2013

Clostridia are the main cause of nontraumatic spontaneous gas gangrene. Poor blood flow due to arterial occlusion exacerbates the anaerobic condition. Fulminant gas gangrene in a 54-year-old man with atherosclerosis obliterans was treated by revascularization of the iliac artery using endarterectomy, and his gangrenous lower leg was amputated. However, he died from renal failure.
St. Jude Medical Valve in Pulmonary Position: Anticoagulation and Thrombosis
Authors: Nurozler Feza , Bradley Scott M
Published: May 2013

Between 1979 and 1985, 5 patients underwent pulmonary valve replacement with a St. Jude Medical valve. During follow-up ranging from 30 months to 18 years, there were 6 episodes of valve thrombosis in 4 patients. Three episodes were treated by thrombolysis. Reoperation was necessary in 3 patients. Although the St. Jude Medical valve in the pulmonary position can occasionally function long-term without anticoagulation, these cases show the high risk of thrombosis and need for anticoagulation.
Successful Repair of Ascending Aortic Aneurysm Due to Takayasu's Arteritis
Authors: Tireli Emin , Korkut A Kubilay , Kafali Eylül , Basaran Murat
Published: May 2013

A 2-year-old girl with Takayasu's arteritis and an ascending aortic aneurysm underwent successful graft replacement. Although aneurysms of the great vessels are rarely encountered, this disease should be considered in the differential diagnosis of ascending aortic aneurysms in children.
Primary Lymphoepithelioma-Like Carcinoma of Lung
Authors: Jha Neerod Kumar , Thomson Bruce McKenzie , Meredith David , Stubberfield John
Published: May 2013

A 57-year-old Caucasian woman presented with nonproductive cough. Computed tomography revealed a peripheral solid mass in the upper lobe of the left lung. She underwent thoracotomy and upper lobectomy. Histology of the excised tumor demonstrated lymphoepithelioma-like carcinoma of the lung, with no associated Epstein-Barr virus activity. Being a rare entity and mostly seen in Asians, very few cases have been described previously.
Surgical Steps toward Complete Revascularization in Off-Pump Coronary Bypass
Authors: Arom Kit V , Emery Robert W , Flavin Thomas F , Kshettry Vibhu R , Janey Patricia
Published: May 2013

Surgical techniques aimed at complete myocardial revascularization without the use of cardiopulmonary bypass are described. Between January 1998 and June 2000, coronary artery bypass was performed in 3,003 patients; an off-pump technique was used in 676 and cardiopulmonary bypass was employed in 2,327. Patient characteristics, demography, and preoperative risk factors of the two groups were compared retrospectively, and differences in operative variables and postoperative outcomes were analyzed. Using a commercially available suction stabilization device and the surgical and anesthetic techniques described herein, off-pump coronary revascularization was accomplished with results comparable to the on-pump approach.
Effects of Intravenous Triiodothyronine during Coronary Artery Bypass Surgery
Authors: Güden Mustafa , Akpinar Belhhan , Sagğbaş Ertan , Sanisoğlu İlhan , Cakali Emine , Bayindir Osman
Published: May 2013

A prospective randomized and double-blind study was performed to evaluate whether perioperative triiodothyronine administration has any effect on cardiovascular performance after coronary artery bypass surgery. Sixty patients were assigned to 2 groups of 30 each. When crossclamping ended, group A received an intravenous bolus of triiodothyronine, followed by infusion for 6 hours. Group B received a placebo. Serum triiodothyronine levels and hemo-dynamic parameters were serially measured. Mean postoperative cardiac index was slightly, but not significantly, higher in group A, whereas systemic vascular resistance was significantly lower in group A. Compared with preoperative values, serum triiodothyronine levels dropped significantly in group B at the end of cardiopulmonary bypass and remained low 12 hours postoperatively, while levels rose significantly in group A. No significant differences were detected between the groups in the incidence of arrhythmia, the need for inotropic support, intensive care unit stay, mortality, and morbidity. Perioperative administration of triiodothyronine increased cardiac output slightly and decreased systemic vascular resistance, but it had no effect on operative outcome. Routine use after coronary surgery is thus not recommended.
Two-Stage Arterial Switch Operation: Is Late Ever Too Late?
Authors: Al Qethamy Howaida O , Aizaz Khawar , Aboelnazar Saber AR , Hijab Samina , Al Faraidi Yahya
Published: May 2013

Results of the two-stage arterial switch operation in 49 patients with transposition of the great arteries, performed between January 1995 and September 2000, were reviewed retrospectively. Twenty-one patients had a ventricular septal defect. Anatomical correction was carried out 21.89 ± 9.86 months after pulmonary artery banding, with or without a modified Blalock-Taussig shunt. Hospital mortality was 8% (4 patients). During follow-up of 30.12 ± 14.38 months, there was 1 late death and 1 patient required reoperation for pseudoaneurysm of the ascending aorta. Actuarial survival and freedom from reoperation at 5 years were 90% and 97%, respectively. Late anatomic correction (> 6 months) after the preliminary procedure can be performed with an acceptable mortality and morbidity, but undue delay may lead to left ventricular dysfunction, arrhythmias, and new aortic valve regurgitation or subaortic stenosis.
Evaluation of Tc-99m Tetrofosmin Scan for Coronary Artery Disease Diagnosis
Authors: Chammas Elie , Yatim Ahmad , Hage Chadi , Sokhn Kozhaya , Tarcha Walid , Ghanem Georges
Published: May 2013

Detection of myocardial perfusion abnormalities using Tc-99m tetrofosmin was evaluated for sensitivity and specificity compared to coronary angiography. Between January 1996 and January 1998, exercise stress tests and myocardial scintigraphy were performed in 58 patients, followed by coronary angiography within 2 months. There were 48 males and 10 females, aged 33 to 72 years (mean, 57 years). The sensitivity and specificity of exercise stress tests were 64% and 68%, respectively, while the sensitivity and specificity of Tc-99m tetrofosmin scans were 88% and 75%, respectively, compared to angiography. For Tc-99m tetrofosmin scans, the sensitivity was 78% for the left anterior descending artery, 66% for the left circumflex artery, and 76% for the right coronary artery; specificity was 74% for the left anterior descending artery, 90% for the left circumflex artery, and 75% for the right coronary artery. It was concluded that Tc-99m tetrofosmin allowed high-quality myocardial perfusion imaging with results comparable to those obtained using thallium-201 chloride.
Septic Pulmonary Emboli Caused by a Hemodialysis Catheter
Authors: Abid Qamar , Price Dallas , Stewart Michael J , Kendall Simon
Published: May 2013

We present an unusual complication caused by a dialysis catheter inserted through the internal jugular vein into the central venous system. The 49-year-old male patient developed a right atrial thrombus, which became infected with Staphylococcus aureus, resulting in septic pulmonary embolism and septicemic shock. The thrombus was excised on cardiopulmonary bypass. The patient made an uneventful recovery.
Limb Ischemia Due to Use of Internal Thoracic Artery in Coronary Bypass
Authors: Yapici Fikri , Tuygun Aybanu G , Tarhan Ibrahim A , Yilmaz Mehmet , Tuygun Abdullah K , Yapici Nihan , Özler Azmi
Published: May 2013

Immediately after undergoing coronary bypass grafting using the left internal thoracic artery, a 59-year-old man developed left leg ischemia. Right-to-left femoral artery crossover bypass was performed and the ischemia resolved. A 72-year-old man developed left calf pain 12 days after a similar procedure; peripheral angiography revealed stenosis of the abdominal aorta and distal peripheral arteries, which did not require intervention.
Vascular Echinococcosis
Authors: Kaynak Kamil , Köksal Cengiz , Kazimoğlu Kamuran , Ozbek Cihan
Published: May 2013

Three patients with arterial echinococcosis presented with chronic or acute arterial occlusion. One case diagnosed as Leriche's syndrome was found at surgery to have aortic occlusion caused by hydatid cysts; arterial reconstruction was performed by aortoiliac interposition of a woven Dacron vascular graft. In the other 2 cases presenting with acute femoral or brachial artery occlusion, embolectomy revealed hydatid cysts as the cause of occlusion.
Cardiomyoplasty: First Clinical Case with New Cardiomyostimulator
Authors: Chekanov Valeri S , Sands Duane E , Brown Conville S , Brum Fernando , Arzuaga Pedro , Gava Sebastian , Eugenio Ferdinand P , Melamed Vladimir , Spencer Howard W
Published: May 2013

Dynamic cardiomyoplasty was performed in a patient using a new cardio-myostimulator (LD-PACE II) designed to enable a novel stimulation regimen that utilizes a new range of stimulation options, including cessation during sleep. After treatment, left ventricular ejection fraction improved in 24 months from 15% to 25% and New York Heart Association classification improved from class IV to II.
Plasmacytoma of the Rib in Young Male
Authors: George Sara M , Ratnakar Kamaraju S , Shome Durjoy K , Nair Rajasekharan , Al Ajmi Abdulla
Published: May 2013

Solitary plasmacytoma of the 11th rib with soft tissue extension was seen in a 29-year-old male. Hematological and biochemical profiles did not reveal any systemic involvement. The 12-cm fusiform expansile lesion was excised and subjected to histopathological examination. The sections revealed sheets of plasma cells with focal cortical discontinuity and adjacent soft tissue invasion. This case is unique in view of the age of occurrence and the site of the lesion.
Early Surgical Intervention for Infective Endocarditis
Authors: Zhu Hong Sheng , Yao Pei Yan , Zheng Jia Hao , Pezzella A Thomas
Published: May 2013

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.
Effect of Oral Anticoagulant during Pregnancy with Prosthetic Heart Valve
Authors: Srivastava Ashok K , Gupta Ashok K , Singh Arvind V , Husain Tanveer
Published: May 2013

This retrospective study aimed to evaluate the risks and outcome of oral anticoagulant use during pregnancy in women with prosthetic heart valves. Between December 1989 and November 1998, 192 females of childbearing age underwent heart valve replacement with a mechanical prosthesis. There were 37 pregnancies in 30 patients during follow-up. Pregnancy was terminated on medical grounds in 5 cases, there were 2 (6%) spontaneous abortions, and 1 (3%) premature birth of a normal baby who died 24 hours later due to asphyxia. The other 29 pregnancies (91%) went to full term and the mothers continued taking oral anticoagulants until a week before the expected date of delivery, then switched to heparin. There was no thromboembolism, valve thrombosis, or maternal mortality. Three babies (10%) had a skeletal deformity: nasal hypoplasia in all 3, with cleft pinna in 1. Continuation of oral anticoagulants during pregnancy provided adequate protection against thromboembolism and valve thrombosis, but the risks of fetal abnormalities and premature delivery should be explained to women of childbearing age with a mechanical valve prosthesis.
Tricuspid Valve Detachment for Transatrial Closure of Ventricular Septal Defects
Authors: Koshy Sajan , Sunil Gopalraj Sumangala , Anil Sivadas Radha , Dhinakar Seetharaman , Shivaprakasha Krishnanaik , Rao Suresh Gururaja
Published: May 2013

Tricuspid leaflet detachment improves visualization and accuracy of closure of ventricular septal defects via the transatrial route. Between July 1998 and March 2001, surgical correction was performed in 296 cases of isolated ventricular septal defect, 215 cases of tetralogy of Fallot, and 16 cases of double-outlet right ventricle. Of these, 132 patients (79 with isolated ventricular septal defect, 49 with tetralogy of Fallot, and 4 with double-outlet right ventricle) underwent transatrial repair with temporary detachment of tricuspid leaflets for ventricular septal defect closure. The septal leaflet was detached in most cases, with anterior or posterior leaflets being detached when indicated. Median duration of intensive care was 3.6 days, and median hospital stay was 7 days. There was no incidence of tricuspid regurgitation attributable to leaflet detachment, as confirmed by postoperative echocardiography. Reoperation was not required for a residual defect or tricuspid regurgitation. The benefits of temporary leaflet detachment for transatrial repair of various difficult defects far outweigh the risk of postoperative tricuspid regurgitation.
Noninvasive Diagnosis of Coronary Artery Fistula after Cardiac Surgery
Authors: Alabdulgader Abdullah A
Published: May 2013

A 5-year-old boy underwent ventricular septal defect closure as well as resection of the muscle bundle of a double-chamber right ventricle and a subaortic membrane. Five days after surgery, echocardiography revealed a left anterior descending artery fistula with 2 sites of entry to the right ventricle. The child was asymptomatic with no murmurs. Echocardiography is an excellent tool for detecting such silent clinical lesions.
Severe Unilateral Pulmonary Vascular Changes in Child with Polysplenia
Authors: Maeda Katsuhide , Yamaki Shigeo , Murakami Arata , Nakajima Jun , Hishi Toshio , Takamoto Shinichi
Published: May 2013

A 12-year-old boy with polysplenia and single ventricle experienced recurrent episodes of pneumonia, hemoptysis, and pulmonary hypertension. Unilateral pulmonary vein obstruction was diagnosed, and a left pneumonectomy was performed. Microscopy of the resected specimen revealed pulmonary veno-occlusive disease in the small pulmonary venules, and old arteritis in the small pulmonary arteries.
Bronchoplasty with Plication of the Proximal Bronchial Membranous Portion
Authors: Kanzaki Masato , Oyama Kunihiro , Nishiuchi Masaki , Ikeda Toyohide , Murasugi Masahide , Onuki Takamasa
Published: May 2013

Bronchoplasty originally designed for patients with inadequate pulmonary function who cannot tolerate pneumonectomy, has recently yielded good results as well as offering an alternative to pneumonectomy. We describe a technique for plication of the proximal bronchial membranous portion when there is significant discrepancy in lumen size between the main and the segmental bronchi to allow precise end-to-end anastomosis. Plication helps prevent postoperative anastomotic stenosis and obstruction.
Simplified Elephant Trunk Graft Technique for Aortic Arch Replacement
Authors: Miyamoto Shinji , Hadama Tetsuo , Anai Hirofumi , Sako Hidenori , Wada Tomoyuki , Eriko Iwata , Hamamoto Hirotsugu
Published: May 2013

We refined the elephant trunk graft to facilitate and reinforce the distal anastomosis in aortic replacement operations. A cuff is created in a single four-branch graft, which is used for the distal anastomosis; the trunk below the cuff is inserted into the distal aortic stump. This method is feasible for repairing extensive aortic aneurysm with a fragile wall and for treating acute aortic dissection where thromboocclusion of the remaining false lumen is desired.
Repair of Total Anomalous Pulmonary Venous Connection in Early Infancy
Authors: Dharmapuram Anil Kumar , Kumar Raghavan Nair Suresh , Rao Pantula Narasinga , Mahmoud Hassan Mohamed , Chandran Sushil , Dhir Achal Kumar , Saxena Dileep Kumar , Azhagappan Sivan Pillay , Pillai Velayudhan Ramakrishna , Venkitachalam Chokkanathapura Gopalakrishnan , Fikree Mohamed Amin , Nazer Yoosuph Abdul , Cartmill Timothy Boyd , Rao Ivatury Mrutyunjaya
Published: May 2013

From May 1995 through October 2001, 19 infants less than 90 days old underwent surgical correction of total anomalous pulmonary venous connection. In 15 babies with isolated total anomalous pulmonary venous connection, there was one operative death. In 4 with complex anomalies, there were 2 operative deaths. The vertical vein was not ligated in 6 cases for various reasons. Two patients died during reoperation for early pulmonary venous obstruction. In the late follow-up, 2 babies required reoperation for late anastomotic stricture; one needed additional balloon dilatation. Of the 14 surviving patients, one had a small residual gradient and infrequent supraventricular tachycardia, the others were asymptomatic and without gradients. Surgical correction of total anomalous pulmonary venous connection can be carried out in early infancy with low mortality and morbidity. However, associated complex cardiac anomalies and small caliber pulmonary arteries and veins carry higher risks. Recurrent pulmonary venous obstruction and diffuse pulmonary vein stenosis are causes of early reoperation and poor surgical outcome.
Does Gender Affect Outcome of Cardiac Surgery in Octogenarians?
Authors: Ghosh Probal , Djordjevic Miladin , Schistek Roland , Baier Reinhard , Unger Felix
Published: May 2013

The long-term results of cardiac surgery in 212 consecutive octogenarians (116 men, 96 women) were reviewed retrospectively. Preoperative functional status, Euroscore, and the incidences of hypertension and chronic obstructive pulmonary disease were similar in both sexes. Women had more diabetes mellitus (45% versus 25%; p < 0.05) but less renal dysfunction (16% versus 29%; p < 0.05). Men required emergency procedures more frequently ( p < 0.05). Women underwent complete revascularization more often and had more arterial grafts. Hospital mortality was similar (11.5% in women versus 12.9% in men), but women had more complications (76% versus 64%), longer convalescence (24.3 versus 18.5 days), fewer psychiatric disorders (14% versus 23%) and less heart block (9% versus 19%). Men had a slightly better outcome in terms of functional class and Euroqol score during follow-up of up to 114 months. Median survival was longer in women (3.15 versus 2.96 years) but 1-, 3-, and 5-year survival rates and late deaths were similar. Outcomes appear to be equitable for both sexes among octogenarians.
Fate of Stentless Bioprostheses on Right Side of the Heart
Authors: Erek Ersin , Yalcinbas Yusuf Kenan , Salihoglu Ece , Ozturk Nilufer , Arat Sevda , Sarioglu Ayse , Samanli Umit Bilge , Sarioglu Tayyar
Published: May 2013

Newly developed stentless bioprostheses have shown good midterm results in the aortic position, but few data are available on their use at the right side of the heart. Four types of stentless bioprosthesis were used for right-side reconstruction of congenital heart anomalies in 50 patients (3 Baxter-Edwards Prima, 27 Medtronic Freestyle, 14 Cryolife Ross, and 6 Medtronic Contegra). Mean age was 9.03 ± 6.25 years. Serial Doppler echocardiographic studies were performed to evaluate transvalvular pressure gradients. The hospital mortality was 6%. Reoperation was required in 3 patients in the early postoperative period because of left ventricular outflow tract obstruction, endocarditis, or tricuspid insufficiency. Measurements from 34 patients were available for statistical analysis. Clinical follow-up was complete in 43 of the 47 hospital survivors; the mean follow-up period was 16.6 ± 16 months. Four patients died during follow-up; 93% of the survivors have an unrestricted lifestyle. Although peak transvalvular conduit gradients increased in all types of conduit, no reoperation has yet been performed for conduit stenosis. The newly developed stentless bioprostheses may be a useful alternative for right-side reconstruction of congenital heart anomalies.
Conservative Management of Persistent Pleural Effusion Using Somatostatin
Authors: Haneda Kiyoshi , Shoji Yoshimi , Katakura Tsunenori , Abe Shuichiro , Ogata Yuki , Makabe Michio
Published: May 2013

Persistent pleural effusion developed in an 81-year-old man with acute pulmonary edema due to myocardial dysfunction. Daily chest tube drainage was 1,000 to 1,400 mL. Despite total parenteral nutrition and albumin supplementation, drainage did not decrease. However, continuous infusion of a somatostatin analog was effective in controlling the effusion.
Ruptured Mycotic Thoracic Aortic Aneurysm: Lobectomy and Dacron Graft Repair
Authors: Sin Yoong Kong , Chua Yeow Leng
Published: May 2013

A 57-year-old man presenting with hemoptysis and chest pain was diagnosed to have a Staphylococcus aureus mycotic aneurysm of the descending thoracic aorta, which subsequently ruptured into the left lower lobe of the lungs. He underwent successful repair with lung resection and Dacron graft replacement under hypothermic circulatory arrest, followed by long-term antibiotic therapy.
Reinforced Sternal Closure: The Bilateral Straight Longitudinal Wire Technique
Authors: Al Ebrahim Khalid
Published: May 2013

Sternal dehiscence and mediastinitis are among the most severe complications of median sternotomy. A simplified technique of reinforced closure is described. A straight wire is inserted longitudinally on each side of the sternum, placed within the transverse wires when the latter are approximated. Using this technique in 112 patients with a precarious sternum, no cases of sternal dehiscence or mediastinitis have been seen.
Enhanced External Counterpulsation
Authors: Lam Leslie , Mahmood Shahid
Published: May 2013

Enhanced external counterpulsation is a noninvasive technique designed to increase myocardial perfusion and reduce cardiac workload in patients with coronary artery disease. Recent trials have documented beneficial hemodynamic effects. Stress testing and radionuclide imaging have demonstrated improvemements in functional capacity and myocardial perfusion. This procedure may be the therapeutic choice for patients with severe diffuse disease or in whom repeat revascularization is not possible. The relatively low cost of the technique makes it feasible for patients in developing countries.
Total Arterial Revascularization on Beating Heart: Experience in 803 Cases
Authors: Singh Sushil Kumar , Mishra Surya Kumar , Kumar Deepak , Yadave Ram Deo , Agarwal Rajiv , Sinha Subhash Kumar
Published: May 2013

To avoid the deleterious effects of cardiopulmonary bypass, total arterial revascularization was performed on the beating heart, using an Octopus stabilizer, in this prospective study of 803 patients without selection bias. Single-vessel disease was present in 71 (9%) patients, double-vessel disease in 204 (25%), and triple-vessel disease in 528 (66%). An ejection fraction < 30% was found in 127 (16%) cases. Angiography was carried out before discharge in 204 (25%) patients. Grafts included left and right internal mammary arteries and the radial artery. There were 2,661 grafts placed with a mean of 3.31 grafts per patient (range, 1 to 6). Operative mortality was 0.5%. There was no postoperative stroke and few incidences of renal impairment, even in patients with chronic renal failure. Blood transfusion was not required in 558 (69%) patients. Mean hospital stay was 5.6 days. Overall angiographic patency was 98.6%. Total arterial revascularization on the beating heart was found to be safe, effective, and reproducible in almost all patients, with excellent short-term patency rates and minimal morbidity.