bluuebunny/crossref_metadata_2025 huggingface dataset:
Endotracheal Tube Ignition During the Intratracheal Laser Treatment
Authors: Komatsu Teruya , Kaji Reiko , Okazaki Shun , Miyawaki Ikuko , Ishihara Kyousuke , Takahashi Yutaka
Published: May 2013

We experienced the combustion of the endotracheal tube during a bronchoscopic potassium titanyl phosphate laser resection of an intratracheal metastatic tumor. Some preventive precautions have been reported, however, none of them are absolutely perfect. We report the rare occurrence of tracheal tube ignition, preventive measures and treatment strategies for the resultant airway burn.
Operative Timing for Absent Pulmonary Valve with Obstructive Sleep Apnea
Authors: Hayashi Yoshitaka , Barron Garry J , Almeida Aubrey A
Published: May 2013

Congenital absence of the pulmonary valve appears to have a prolonged fate, despite substantial regurgitation, thus the optimal timing of surgical correction remains unclear. A 53-year-old man with isolated pulmonary regurgitation accompanied by obstructive sleep apnea developed progressive heart failure after reopening of the foramen ovale. Closure of the interatrial shunt and pulmonary valve replacement with a 25-mm mechanical prosthesis relieved his refractory left heart failure.
Valve-Sparing Aortic Root Stabilization in Acute Type a Aortic Dissection
Authors: Shrestha Malakh , Khaladj Nawid , Hagl Christian , Haverich Axel
Published: May 2013

Composite replacement is the standard approach for repair of acute type A aortic dissection involving the aortic root. Reimplantation or remodeling procedures have become valve-sparing alternatives. We developed a new and simple technique to stabilize the aortic root. A Dacron graft is attached outside the native aortic cylinder, and incised twice vertically to create openings corresponding to the right and left coronary ostia. Thus the entire graft covers the native aortic root cylinder from the outside, and the native aortic valve and coronary ostia do not need to be reimplanted. From 2002 to 2007, this technique was applied in 14 patients (8 male) with a mean age of 71 years (range, 34-83 years). Four patients died within 30 days; 3 had been hemodynamically unstable with ventilator and inotropic support preoperatively. Echocardiography showed normal function of the preserved aortic valve, without regurgitation, in all patients. This technique is an alternative valve-sparing method for stabilization of the aortic root in patients with acute type A aortic dissection.
Diaphragmatic Fenestrations in Catamenial Pneumothorax: A Management Strategy
Authors: Rafay Mohammad , El-Bawab Hatem , Kurdi Wesam , Kattan Khaled Al
Published: May 2013

Video-assisted thoracoscopic exploration of the right hemithorax in a 37-year-old woman with recurrent catamenial pneumothorax revealed multiple diaphragmatic fenestrations. She underwent successful plication of the diaphragm, with no recurrence of pneumothorax after 4 years of follow-up.
Quality of Life after Mechanical vs. Biological Aortic Valve Replacement
Authors: Aboud Anas , Breuer Martin , Bossert Torsten , Gummert Jan F
Published: May 2013

To assess the quality of life after biological and mechanical aortic valve replacement, data of 136 patients were assessed retrospectively after 2 years of follow-up. Bioprostheses were implanted in 53 patients with a mean age of 74 years, and mechanical prostheses were used in 83 with a mean age of 64 years; there were 47 women and 89 men. Quality of life was evaluated using the Short Form 36-Item Health Survey questionnaire. Physical function scores were significantly better in patients with a mechanical prosthesis. Mental health indices were identical in both groups. Younger patients with mechanical valves and older patients with biological valves had significantly better item scores. In all age groups, men tended to have better scores than women, but a significant difference was noted only in the physical functioning index. The quality of life in patients with mechanical and biological valves was similar at 2 years postoperatively.
Coarctation of Right Aortic Arch with Left Descending Aorta in an Adult
Authors: Hirota Masanori , Ishino Kozo , Kawada Masaaki , Sano Shunji
Published: May 2013

We report an adult case of right aortic arch coarctation with a left descending aorta. Associated anomalies included dextrocardia, situs inversus, polysplenia, bilateral superior vena cava, and absent inferior vena cava with azygos connection. Extensive mobilization of the azygos vein was needed to obtain a good surgical field, including the left descending aorta via a right thoracotomy, and the lesion was anatomically repaired by resection and end-to-end anastomosis.
Hospital Outcome of Coronary Artery Bypass Grafting and Coronary Endarterectomy
Authors: Abid Abdul R , Farogh Ajwad , Naqshband Mumraiz S , Akhtar Raja P , Khan Jawad S
Published: May 2013

To compare hospital mortality and postoperative complications in patients with severe coronary artery disease undergoing coronary artery bypass grafting with or without coronary endarterectomy, 100 consecutive patients were divided into 2 groups of 50 patients each. Group 1 had coronary endarterectomy, and group 2 had no coronary endarterectomy. There were 87 men and 13 women, with a mean age of 54.79 ± 7.8 years; 48% had stable angina. The right coronary artery was endarterectomized in 22 patients, the left anterior descending artery in 21, and the left circumflex in 7. There were no significant differences in outcomes. There was 1 hospital death in each group. Perioperative myocardial infarction occurred in 2 patients in group 1 and 1 in group 2. Endarterectomy is a suitable option to achieve complete revascularization in patients with refractory angina and severe diffuse disease.
Off-Pump Coronary Artery Bypass for Emergency Myocardial Revascularization
Authors: Darwazah Ahmad K , Sham'a Raed AH Abu , Isleem Ismail , Hanbali Basel , Jaber Bashar
Published: May 2013

Emergency coronary artery bypass is associated with increased operative mortality. The objective of this study was to evaluate the efficiency and safety of off-pump emergency coronary artery bypass, and to compare the outcome with that of the conventional on-pump procedure. Data of 79 patients who underwent emergency isolated coronary artery bypass were reviewed retrospectively; 45 had off-pump coronary bypass and 34 had conventional surgery. In the off-pump group, mean ejection fraction was significantly lower (28% ± 9% vs. 39% ± 10%), and there were fewer grafts per patient (1.8 ± 0.7 vs. 3.2 ± 0.8). Early mortality was higher in the conventional surgery group (14.7% vs. 8.9%), but late mortality was similar in both groups. Patients who had on-pump surgery had lower rates of recurrent angina (16% vs. 34%) and symptoms of heart failure (20% vs. 51%). Re-hospitalization was more common in off-pump patients, but cardiac re-interventions were similar. There was no significant difference in 5-year survival rates. The results of off-pump coronary bypass were better than the preoperative predicted EuroSCORE, thus it was concluded that patients treated on an emergency basis should have an off-pump revascularization procedure.
Expression of Pin1 mRNA in Non-Small-Cell Lung Cancer Patients
Authors: Ai ZhengHua , Zhang WeiXing , Luo WanJun , Huang LingJin , Pan Yi
Published: May 2013

Phosphorylation of proteins on serine or threonine residues preceding proline is a major regulatory mechanism in cell proliferation and transformation, which is catalyzed specifically by Pin1, a peptidylprolyl isomerase. Pin1 is overexpressed in several human cancers. The expression of Pin1 mRNA in the circulation was assessed in 26 patients with non-small-cell lung cancer who underwent surgical resection. They were randomly assigned to a pulmonary artery first ligation group and a pulmonary vein first ligation group. Pin1 mRNA expression in blood samples from patients with lung cancer, controls with benign lung disease, and healthy subjects were determined by a real-time reverse transcriptase polymerase chain reaction. Compared to those with benign lung disease and healthy controls, Pin1 mRNA was overexpressed in patients with non-small-cell lung cancer, and the levels correlated with lymph node-positive disease and tumor stage. Expression of Pin1 mRNA in the distal part of the pulmonary vein was significantly higher than in the proximal part. Postoperative Pin1 mRNA expression was significant lower than preoperative expression. There was no significant difference in Pin1 expression between groups based on pulmonary vessel ligation. These findings suggest that Pin1 might be a useful tumor marker for cancer therapy.
Reduction Aortoplasty for Ascending Aortic Aneurysm: A 14-Year Experience
Authors: Belov Iuri V , Stepanenko Anna B , Gens Andrei P , Savichev Dmitri D , Charchyan Eduard R
Published: May 2013

We present early results and long-term follow-up after reduction aortoplasty with external wrapping of the ascending aorta. From December 1993 to February 2008, 32 consecutive patients who had reduction aortoplasty were compared with 47 consecutive patients who underwent prosthetic graft replacement of the ascending aorta. The groups were similar in baseline characteristics. Patients in the reduction aortoplasty group had significantly shorter aortic crossclamp times (18.78 ± 1.91 vs. 34.04 ± 3.25min) and cardiopulmonary bypass times (30.16 ± 2.36 vs. 60.83 ± 2.05 min), and they received fewer transfusions. There was no significant enlargement of the aortic diameter at the level of the sinus of Valsalva in the reduction aortoplasty group during the follow-up period (from 38.84 ± 3.10 to 39.48 ± 2.72 mm). Reduction aortoplasty with external wrapping of the ascending aorta is a simple and promising surgical method. Our experience shows that this technique is the procedure of choice in patients without aortic dissection and with an appropriately sized sinus of Valsalva.
Sternal Weave in High-Risk Patients to Prevent Noninfective Sternal Dehiscence
Authors: Narang Sumit , Banerjee Amit , Satsangi Deepak K , Geelani Muhammad A
Published: May 2013

Dehiscence of the sternum is a serious and potentially devastating complication. The purpose of this prospective study was to determine whether a prophylactic sternal weave would decreased the incidence of noninfective sternal dehiscence, compared to routine sternal closure, in a high-risk group. Between 2000 and 2007, 200 patients undergoing median sternotomy for cardiac surgery, with one or more risk factors including New York Heart Association functional class III/IV, chronic obstructive pulmonary disease, osteoporosis, obesity, and off-midline sternotomy, were randomly assigned to group A (sternal weave closure, 100 patients) or group B (routine sternal wire closure, 100 patients). No patient in either group with a single risk factor had sternal dehiscence. The incidence of noninfective sternal dehiscence was significantly less in group A than group B in patients with 2 or more risk factors (2.5% vs. 12.5%). Routine sternal closure is sufficient in patients with a single risk factor, whereas a prophylactic sternal weave should be carried out in all patients with 2 or more risk factors, to decrease postoperative morbidity.
Comparative Analysis and Outcomes of Sleeve Resection versus Pneumonectomy
Authors: Parissis Harry , Leotsinidis Michael , Hughes Ann , McGovern Eilish , Luke David , Young Vincent
Published: May 2013

To compare the outcome of sleeve resection or complex sleeve resection versus (Vs) pneumonectomy for lung cancer in a single unit. Between 1998 and 2006, 664 lung resections were carried out. There were 129 (19.4%) pneumonectomies and 79 (11.9%) sleeve resections; Twenty one patients (26.5%) underwent a complex sleeve resection. Operative mortality for the sleeve resections (SR) was 2.5% and for the pneumonectomies 8.53%. Overall 5-year survival after SR was 46.8% and after pneumonectomy 37.1%. The survival curves for the 2 procedures after adjusting for risk factors are different. The area under the curve is higher for the SR (Hazard ratio 1.78 C.I.: 0,92-3,46). The 5-year survival for early stages favors SR. The survival for the complex SR was not influenced by the complexity of the procedure but from the TNM stage of each individual case. Multivariate analysis of risk factors affecting survival after surgery showed: male sex Hazard ratio (HR) 1.19, 0.63–2.27(95%CI), Age >63 1.38(HR), 0.78–2.48, Pneumonectomy 1.78(HR), 0.92–3.46 and stage III 4.44(HR), 1.94–10.16(95% CI). For comparative stages survival appears to be better after sleeves, moreover male sex, sleeve resection, age younger that 63 and early TNM stage are positive predictors for survival.
Extraanatomic Bypass and Coronary Artery Grafting for Coral Reef Aorta
Authors: Sugimoto Takaki , Omura Noriko , Kitade Takashi
Published: May 2013

A 63-year-old man complained of abdominal angina and intermittent claudication. Multidimensional angiography showed focal calcified obstruction of the suprarenal aorta, occlusion of the right external iliac artery, and in-stent restenosis in the right coronary artery. Extraanatomic bypass was performed from the ascending aorta to the left external iliac and right femoral arteries, using an 8-mm bifurcated graft, with concomitant off-pump coronary artery grafting. The patient's digestive symptoms and leg claudication disappeared.
Pericardial Adhesions Simulating Myocardial Bridging
Authors: Khan Shahid M , Hassan Walid , Sanei Aly Al , Al-Halees Zohair Y
Published: May 2013

A 48-year-old man with aortic valve disease was diagnosed to have myocardial bridging on preoperative coronary angiography. During surgical exploration, only pericardial adhesions were found, with a normal epicardial coronary course.
Complete Lobar Torsion Simulating Hemorrhagic Shock after Left Upper Lobectomy
Authors: Chen Chang , Duan Liang
Published: May 2013

Lung torsion is a rare but serious complication after thoracic operations. We describe an unusual case of left lobar torsion after video-assisted thoracoscopic upper lobectomy. The profound symptom was impending hemorrhagic shock, which masqueraded as postoperative bleeding. The differentials between these 2 entities and treatment options for lung torsion are discussed.
Eosinophilic Granuloma of the Lung and Rib
Authors: Podbielski Francis J , Worley Todd A , Korn Jason M , Connolly Mark M
Published: May 2013

Langerhans-cell histiocytosis is characterized by abnormal proliferation of Langerhans cells, and frequently associated with cigarette smoking. A 24-year-old man who underwent excisional biopsy of a pulmonary nodule and segmental rib resection was found to have the eosinophilic granuloma variation of Langerhans-cell histiocytosis.
Management of Lobar Torsion following Lung Transplantation
Authors: Souilamas Redha , Couchon Sophie , Hernigou Anne , Guillemain Romain , Boussaud Véronique , Sonnett Joshua
Published: May 2013

We report 4 cases of acute lobar torsion in patients who had undergone bilateral lung transplantation. Bronchoscopy showed complete obstruction in only 2 of them. Torsion was confirmed by computed tomography in coronal minimal and maximal intensity projections with reconstruction. At operation, 1 detorsion and 3 lobectomies were carried out. Early diagnosis and rapid surgical intervention can save the affected lobe.
Long-Term Survival of Uhl's Anomaly with Total Cavopulmonary Conversion
Authors: Takizawa Koki , Suzuki Shoji , Honda Yoshihiro , Kaga Shigeaki , Inoue Hidenori , Matsumoto Masahiko
Published: May 2013

We report a long-term survivor with Uhl's anomaly who underwent one and a half ventricle repair combined with a partial right ventriculectomy in infancy, followed by successful total cavopulmonary conversion with right ventricular exclusion 5 years later. The combination of total cavopulmonary connection and right ventricular exclusion could be the optimal surgical option for a critically ill infant with Uhl's anomaly.
Middle Lobectomy after Pneumonectomy
Authors: Quiroga Jorge , Prim José María G , Moldes Milagros , Ledo Ramiro
Published: May 2013

A 59-year-old man underwent a successful middle lobectomy to treat metastasis from a pulmonary adenocarcinoma resected previously by left pneumonectomy.
Squamous Cell Carcinoma of the Lung in Association with Sarcoidosis
Authors: Tatebe Shoh , Oka Kuniyuki , Toda Joe , Watanabe Maya , Shinonaga Mayumi , Kuraoka Setsuo
Published: May 2013

A 76-year-old man who was known to have sarcoidosis, developed a lung tumor. He had previously undergone cardiac and abdominal vascular surgery, at which sarcoidosis was confirmed by lymph node biopsy. A right lower lobectomy was carried out. Postoperative pathology showed limited disease, but cancer recurred 1 year later. Issues regarding the combination of sarcoidosis and a malignant tumor are discussed.
Emergency Surgical Embolectomy for Pulmonary Emboli after Failed Thrombolysis
Authors: Chu Sharon HL , Andrews David , Watanabe Yuki
Published: May 2013

A 34-year-old man presented in cardiogenic shock secondary to massive pulmonary embolism. Surgical embolectomy was performed after failed thrombolysis. Intraoperatively, a right atrial lesion and pulmonary emboli were removed. Histopathology revealed myxoma complicated by pulmonary emboli. The patient made a good recovery. This case suggests that surgical embolectomy should be considered as first-line treatment for all patients with acute massive pulmonary embolism, and not reserved for those with severe hemodynamic compromise or failed conservative management.
Is Age over 70 Years a Risk Factor for Pneumonectomy?
Authors: Annessi Valerio , Paci Massimiliano , Ricchetti Tommaso , Ferrari Guglielmo , Formisano Debora , Sgarbi Giorgio
Published: May 2013

The lengthening of life expectancy has led to more surgical procedures in elderly patients. The aim of this work was to determine whether age >70 years is a risk factor for pneumonectomy. All cases of pneumonectomy from January 1999 to December 2006 were retrospectively reviewed. The 40 patients aged > 70 years were compared with a group of 70 patients aged 40-68 years matched for sex, physical status, respiratory function, side of pneumonectomy, and pathologic stage. Postoperatively, significantly more older patients had atrial fibrillation (24% vs. 5.6%). There was a low incidence of respiratory complications in both groups, and reduced respiratory function did not increase respiratory morbidity. Thirty-day mortality was not significantly different (2.5% in older vs. 1.4% in younger patients), but long-term mortality rates evaluated at December 31, 2007 were 50% for those aged <70 years (35 patients) and 72.5% for the older group. Although age is a risk factor for morbidity and mortality in pneumonectomy, the risk is acceptable.
Leaflet Suspension and Subvalvular Annuloplasty in Aortic Valve Prolapse
Authors: Izumoto Hiroshi , Kawazoe Kohei , Oka Takanori , Ishibashi Kazuyuki , Yamamoto Hiroshi , Yamamoto Fumio
Published: May 2013

We have utilized the combined techniques of subvalvular annuloplasty and leaflet suspension since 1999 to repair prolapsing aortic valves. We reviewed our short-term results to assess perioperative echocardiographic changes and repair durability. Nineteen patients (15 men and 4 women; mean age, 60.7 years) underwent this operation between July 1999 and June 2002. All were interviewed to establish their latest functional status, reoperation and survival rates. After a mean follow-up of 40.1 months, all patients were alive and in New York Heart Association functional class I. The echocardiographic grade of aortic regurgitation decreased from 3.2 preoperatively to 1.6 at follow-up. Left ventricular end-diastolic dimension shortened significantly from 6.2 to 5.2 cm. Left ventricular end-systolic dimension decreased from 4.1 to 3.3 cm. Annulus size was also significantly less at 2.2 cm from 2.5 cm preoperatively. At 48 months, freedom from reoperation was 88.9% ± 7.4%. The follow-up was 100% complete. Repair of a prolapsing aortic valve with leaflet suspension and subvalvular annuloplasty is a good procedure and the short-term results are satisfying.
Can Chest Trauma Patients Provide Breath Sample with Lion SD-400 Alcometer?
Authors: Rathinam Sridhar , Luke David , Nanjaiah Prakash , Kalkat Maninder S , Steyn Richard S
Published: May 2013

Various investigators have addressed the minimum lung function required to activate breathalyzers, and the impact of comorbid respiratory illness. We postulated that subjects with significant chest trauma may have difficulty in providing an adequate breathalyzer sample. A prospective self-controlled study of 20 patients who underwent thoracotomy was conducted between August 2005 and December 2005, using a Lion Alcometer SD-400. The mean age of the patients was 69.3 years (range, 37–83 years). Preoperatively, their mean forced expiratory volume was 1.97 L (range, 1.19–2.46 L), and peak expiratory flow rate was 240 L min−1 (range, 126-520 L min−1). Postoperatively, mean forced expiratory volume was 1.14 L (range, 0.34–2.2 L) and peak expiratory flow rate was 179 L min−1 (range, 36-492 L min−1). These decreases were highly significant. All patients activated the breathalyzer device preoperatively, but only 2 (10%) could activate it postoperatively. Extrapolating this to patients with chest injury, most may find it impossible to activate breathalyzers.
Mycotic Ascending Aortic Pseudoaneurysm at Aortic Cannulation Site
Authors: Şirin Gökçe , Yilmaz Ŏuz , Demirsoy Ergun , Alan Servet , Soybir Nerime , Sönmez Bingür
Published: May 2013

Mycotic aneurysm of the aorta is a rare but highly fatal complication of coronary bypass surgery. A 49-year-old man developed mycotic pseudoaneurysm in the ascending aorta after coronary bypass in another hospital. Computed tomography showed the pseudoaneurysm originated from the previous aortic cannulation site. The defect was successfully repaired with pericardial-pledgeted sutures.
Biointegration and Growth of Porcine Valved Pulmonary Conduits in a Sheep Model
Authors: Furlanetto Gláucio , Passerino Carlos H , Siegel Rolland , Chueng David T , Levitsky Sidney , Casagrande Ivan S J
Published: May 2013

As there is currently no suitable valved pulmonary conduit for small children, porcine conduits treated by the L-Hydro process were implanted into 9 newborn lambs to investigate growth potential. Of the 8 survivors, 7 were kept alive for 12 months after implantation. The diameter of the conduit and gradient across the valve were evaluated at surgery and at 3 and 9 months postoperatively using bidirectional echocardiographic and angiographic methods. After sacrifice, histological and radiological analyses were performed. The mean weight of the animals was 4.2 ± 1.1 kg at implantation and 43.1 ± 6.2 kg at sacrifice. There was a significant increase in mean valve area from 139.9 ± 18.0 mm2 at implantation to 443.5 ± 89.2 mm2 at 12 months. Pre-sacrifice angiography showed no transvalvular gradient, and radiographic analysis did not reveal significant conduit wall or leaflet calcification in any of the animals. Histological examination of the grafts demonstrated total integration, with native-like intact valve leaflets. Thus functional evaluation, echocardiography, and histology demonstrated growth of the grafts with completely endothelialized and apparently normal pulmonary valve leaflets without calcification.
Impact of Video-Assisted Thoracoscopic Major Lung Resection on Immune Function
Authors: Ng Calvin SH , Wan Innes YP , Yim Anthony PC
Published: May 2013

Video-assisted thoracoscopic major lung resection for early stage non-small-cell lung carcinoma has been associated with less postoperative pain, better preserved pulmonary function, shorter hospital stay, and enhanced tolerance of adjuvant chemotherapy compared to thoracotomy. Initial concerns regarding safety, oncological clearance, and cost effectiveness were unfounded. Several recent trials have reported improved long-term survival in patients with early stage non-small-cell lung carcinoma undergoing video-assisted thoracoscopic major lung resection, compared to the open technique, although there are inconsistencies. Interestingly, the immune status and autologous tumor killing ability of lung cancer patients have previously been associated with long-term survival. Video-assisted thoracoscopic lung resection results in an attenuated postoperative inflammatory response, but more importantly, it better preserves postoperative immune function. Circulating natural killer and T-cell numbers, T-cell oxidative activity, and levels of immunochemokines such as insulin growth factor binding protein-3 are higher after video-assisted thoracoscopic surgery than after thoracotomy. Recently, interest has developed in the role of the angiogenesis factor, vascular endothelial growth factor, after cancer surgery. Whether differences in immunological and biochemical mediators contribute towards improved long-term survival following video-assisted thoracoscopic major lung resection for cancer remains to be confirmed.
Repairing of Infarcted Myocardium Using a Novel Cell Patch Therapy
Authors: Yokomuro Hiroki , Ichikawa Yukio , Shiono Noritsugu , Kajiwara Hirokazu
Published: May 2013

A 54-year-old man underwent left anterior descending artery bypass grafting with cell patch therapy for myocardial infarction. We applied a novel approach to replicating the infarcted myocardium by anchoring polyglycolic acid felt seeded with autologous peripheral blood mononuclear cells in front of the infarcted area. The cell patch remained fixed to the myocardium for 1 month, and the infarcted myocardium was reperfused.
Intramyocardial Angiogenic Cell Precursors in Nonischemic Dilated Cardiomyopathy
Authors: Arom Kitipan V , Ruengsakulrach Permyos , Belkin Michael , Tiensuwan Montip
Published: May 2013

To determine the efficacy of intramyocardial injection of angiogenic cell precursors in nonischemic dilated cardiomyopathy, 35 patients with nonischemic dilated cardiomyopathy underwent injections of angiogenic cell precursors into the left ventricle (cell group). Seventeen patients with nonischemic dilated cardiomyopathy were matched from the heart failure database to form a control group that was treated medically. Angiogenic cell precursors were obtained from autologous blood, cultured in vitro, and injected into all free-wall areas of the left ventricle in the cell group. After these injections, New York Heart Association functional class improved significantly by 1.1 ± 0.7 classes at 284.7 ± 136.2 days, and left ventricular ejection fraction improved in 71.4% of patients (25/35); the mean increase in left ventricular ejection fraction was 4.4% ± 10.6% at 192.7 ± 135.1 days. Improved quality of life was demonstrated by better physical function, role-physical, general health, and vitality domains in a short-form health survey at the 3-month follow-up. In the control group, there were no significant improvements in left ventricular ejection fraction or New York Heart Association class which increased by 0.6 ± 0.8 classes. It was concluded that intramyocardial angiogenic cell precursor injection is probably effective in the treatment of nonischemic dilated cardiomyopathy.

Disclosures and Freedom of Investigation

Professor Michael Belkin is an advisory board member, a minor shareholder, and receives a consulting fee from TheraVitae Co. Ltd. However, the authors had full control of the study, methods used, outcome measurements, data analysis, and production of the written report.
Bispectral Index-Monitored Anesthesia Technique for Transsternal Thymectomy
Authors: Maddali Madan Mohan , Matreja Prakash Veru , Zachariah Mamie
Published: May 2013

To evaluate the role of bispectral index monitoring as an adjunct to balanced anesthesia in patients with myasthenia gravis undergoing transsternal thymectomy without the use of neuromuscular blocking agents, 10 patients were enrolled into this prospective observational study. After oral midazolam premedication, general anesthesia was induced with fentanyl, propofol, and sevoflurane. Tracheal intubation was performed without neuromuscular blocking agents. During maintenance, continuous monitoring of physiological and bispectral index parameters was used to titrate the doses of remifentanil, propofol, and sevoflurane. Sevoflurane concentration and propofol doses were adjusted to achieve bispectral index values in the high 30s to low 40 s. Propofol was discontinued when the sternum was approximated. Remifentanil infusion was stopped on subcutaneous tissue closure, and sevoflurane was switched off when nearing completion of skin closure. Tracheal extubation was performed when extubation criteria were met. On extubation, bispectral index levels were above 90. The median time from extubation to discontinuation of propofol was 28 ± 4 min, that of remifentanil was 21 ± 4 min, and it was 9 ± 5 min for sevoflurane. Bispectral index monitoring provided excellent hemodynamic control during surgery, and allowed early problem-free tracheal extubation.
Aortic Relocation for Transposition Complex with Aortic Arch Obstruction
Authors: Tateishi Atsushi , Kawada Masaaki , Morita Hideki , Kasahara Shingo , Sano Shunji
Published: May 2013

We describe successful primary repair of 2 cases of transposition complex with aortic arch obstruction. A new aortic arch was reconstructed by direct anastomosis between the well-mobilized ascending aorta and the descending aorta. The neoaortic root with transferred coronary arteries was subsequently anastomosed to the undersurface of this new aortic arch. This technique deals with the significant size discrepancy between the 2 great arteries, and anomalous coronary artery patterns.
Type A Aortic Dissection, Right-Sided Aortic Arch, and Thoracic Aortic Aneurysm
Authors: Hori Daijiro , Tanaka Masashi , Yamaguchi Atsushi , Adachi Hideo
Published: May 2013

A previously healthy 78-year-old woman presented with severe chest pain. Computed tomography revealed a right-sided aortic arch with an aberrant left subclavian artery originating from Kommerell's diverticulum, a thoracic aortic aneurysm, and Stanford type A acute aortic dissection. Successful emergency repair of the ascending aorta, total arch, and descending aorta were performed through a median sternotomy only.
Postoperative Pericardial Effusion and Posterior Pericardiotomy: Related?
Authors: Bakhshandeh Ali Reza , Salehi Mehrdad , Radmehr Hasan , Sattarzadeh Roya , Nasr Ahmad Reza , Sadeghpour Amir Hossein
Published: May 2013

Large pericardial effusions develop in 30% of patients after cardiac surgery, and reach their maximum size after 10 days, with tamponade in 1%. The aim of this prospective randomized case-controlled study was to assess the effectiveness of a posterior pericardiotomy in preventing early and late (>30 days) development of pericardial effusion. Between April 2005 and May 2006, 410 patients with a mean age of 68.4 ± 9.2 years undergoing coronary artery bypass grafting alone or combined with valve surgery were divided into 2 groups of 205 each. In the pericardiotomy group, a 4-cm longitudinal incision was made parallel and posterior to the phrenic nerve. Echocardiography was performed at discharge and 15 and 30 days after the operation. At 15 and 30 days postoperatively, 90.2% and 97% of patients in the pericardiotomy group were free of effusion; while none in the control group were free of effusion. A posterior pericardiotomy is easy to perform and seems to be a safe and effective means of preventing postoperative effusion and its adverse consequences.
Safety of Mild Hypothermic Circulatory Arrest with Selective Cerebral Perfusion
Authors: Toyama Masashi , Matsumura Yasumoto , Tamenishi Akinori , Okamoto Hiroshi
Published: May 2013

Although hypothermic circulatory arrest with antegrade selective cerebral perfusion is used for cerebral protection, optimal perfusion characteristics are still unclear. Between May 2006 and March 2008, 26 patients (mean age, 68.9 years; 14 males) underwent thoracic aortic repair with mild hypothermic circulatory arrest (34.3°C ±1.9°C) and antegrade selective cerebral perfusion (30°C) for various indications including 16 acute type A aortic dissections. Mean cerebral perfusion rate was 21.1 ± 4.3mL kg−1 min−1. Non-elective operations were carried out in 16 (61.5%) cases. Operative procedures were ascending aortic replacement in 16 patients, hemiarch replacement in 4, and total arch replacement in 6. Cardiopulmonary bypass time was 209 ± 61 min, cardiac ischemic time was 141 ± 45 min, cerebral perfusion time was 81 ± 67 min, and lower body circulatory arrest time was 65 ± 22 min. Mean rectal temperature drifted to 30.6°C ± 1.3°C. There was 1 (3.8%) hospital death due to rupture of a residual descending thoracic aneurysm. One patient needed reexploration for bleeding, and 2 (7.7%) suffered permanent neurologic dysfunction. No postoperative spinal cord dysfunction was observed. Mild hypothermic circulatory arrest with antegrade selective cerebral perfusion could be performed safely in our patient population.
Autologous Ring vs. Flexible Prosthetic Ring for Ischemic Mitral Regurgitation
Authors: Bakhshandeh Ali Reza , Salehi Mehrdad , Radmehr Hasan , Nasr Ahmad Reza , Rahmanian Mehrzad , Sharifi Khosro
Published: May 2013

Ring annuloplasty is the most common strategy for correction of ischemic mitral regurgitation. When a commercial prosthesis is unavailable or too expensive, an autogenous annuloplasty ring can be handmade by the surgeon. The aim of this study was to compare short-term results of mitral valve repair with autologous annuloplasty rings and the SJM Tailor flexible prosthesis. Between March 2004 and April 2006, 100 patients undergoing coronary artery bypass grafting and mitral ring annuloplasty for ischemic regurgitation were randomly assigned to either type of prosthesis. Transesophageal and transthoracic echocardiography showed no significant differences between these techniques in terms of immediate success of the repair and its durability at 3, 6, and 9 months postoperatively. Autogenous rings are easy to make, cost-effective, and always available. Our short-term results suggest that they may be an acceptable alternative to a commercially produced prosthesis for patients with ischemic mitral regurgitation.
Distal Aortopulmonary Window: A Morphological Variation
Authors: Chaudhari Milind , Hasan Asif
Published: May 2013

Several variations in the morphology of aortopulmonary window have been documented. We describe a unique variation of a large aortopulmonary window, and its successful surgical correction.
Coronary Artery Graft Dilatation Aided by Multidetector Computed Tomography
Authors: Song Bong Gun , Choi Jin Ho , Choi Seung Min , Park Ji Han , Park Yong Hwan , Choe Yeon Hyeon
Published: May 2013

Coronary angiography is the standard method of follow-up for patients with coronary artery bypass grafts, but it is an invasive and costly procedure that is not risk-free. Recently, 64-slice multidetector computed tomography has allowed reliable visualization of coronary artery grafts and their anastomotic status, with high spatial resolution. We describe a successful case of percutaneous coronary intervention for occluded coronary artery bypass grafts with the aid of multidetector computed tomography.
Video-Assisted Pericardial Fenestration for Effusions after Cardiac Surgery
Authors: Georghiou Georgios P , Porat Eyal , Fuks Avi , Vidne Bernardo A , Saute Milton
Published: May 2013

Delayed-onset pericardial effusion following cardiac surgery can give rise to significant morbidity due to its presentation as well as management by traditional surgical techniques. An institutional experience of a video-assisted thoracoscopic technique to create a pericardial window, with the advantages of a minimally invasive approach combined with excellent visualization in such patients, was reviewed. A retrospective analysis was conducted on all patients undergoing video-assisted thoracoscopic for delayed pericardial effusion after cardiac surgery from January 2001 to January 2006 at our center. Seven patients with echocardiographically diagnosed delayed tamponade underwent video-assisted thoracoscopy; 5 were receiving anticoagulants after valve replacement, and 2 had undergone heart transplantation. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operative time was 45 min. There were no complications of the thoracoscopic technique. Video-assisted thoracoscopic creation of a pericardial window is safe and effective treatment for loculated pericardial effusions secondary to cardiac surgery.
Endovascular Management of Traumatic Thoracic Aortic Transection
Authors: Asmat Atasha , Tan Lenny , Caleb Michael George , Lee Chuen-Neng , Robless Peter Ashley
Published: May 2013

The conventional treatment of traumatic thoracic aortic transection is open surgical repair but it is associated with high rates of morbidity and mortality, particularly in patients with multiple injuries. We reviewed our experience of endovascular repair of traumatic thoracic aortic transection. Between March 2002 and December 2007, 7 patients (male 6, female 1; mean age 40 years) with multiple injuries secondary to blunt trauma underwent endovascular stenting. One patient required adjunctive surgery to facilitate endovascular stenting. Mean intensive care unit stay was 8.6 days (range, 3–16 days). Arterial access in all patients was obtained by femoral cut-down. The mean operating time was 122 min. Technical success was achieved in all cases. There was no mortality. One patient suffered a right parietal stroke, but none developed procedure-related paralysis. The mean follow-up period was 18.6 months (range, 6–48 months). There was no evidence of endoleak, stent migration, or late pseudoaneurysm formation on follow-up computed tomography. Endovascular stents can be used to treat traumatic thoracic aortic transection, with low rates of morbidity and mortality. Although early and midterm results are promising, the long-term durability of endovascular stenting for traumatic thoracic aortic transection remains unknown.
Surgical Treatment of Left Ventricular Aneurysm
Authors: Coskun Kasim Oguz , Popov Aron Frederik , Coskun Sinan Tolga , Hinz Jose , Schmitto Jan Dieter , Körfer Reiner
Published: May 2013

When a left ventricular aneurysm leads to pulmonary congestive symptoms, aneurysmectomy may provide relief. This retrospective study included 269 patients who underwent aneurysmectomy between 1993 and 2002, by the classic Cooley operation in 164 and by Dor ventriculoplasty in 105. There were no significant differences in early and late survival between groups, although the frequency of extended anteroseptal infarction was higher in patients undergoing the Dor procedure. Postoperative echocardiographic findings showed significant improvements in left ventricular function in both groups, in terms of end-diastolic and end-systolic dimensions and ejection fraction. Left ventricular aneurysmectomy significantly improved the clinical status and hemodynamic parameters of symptomatic patients. The choice of surgical technique depends on the extent of the scar segment, especially the presence of an anteroseptal scarred area. The Dor procedure is more suitable for restoring normal left ventricular geometry in patients with extensive septal infarction.
Beating-Heart Valve Surgery: A Systematic Review
Authors: Salhiyyah Kareem , Taggart David , Taggart David
Published: May 2013

Beating-heart continuous coronary perfusion (BHCCP) has been promoted as an alternative to the technique of cardioplegic arrest in valve surgery. Its potential advantage is the elimination of cardioplegia and the corollary risk of ischemic reperfusion injury. The use of CCP has been recommended especially when performing more complex operations, such as mitral valve repair, and particularly as surgeons become more familiar with beating-heart coronary surgery. We conducted a systematic review to assess the strength of the evidence supporting the efficacy of BHCCP compared to cardioplegia in valve surgery. Thirty nine reports were identified. Of these, only two were randomized control trials. Overall the studies were generally of poor quality and had a low evidence level. In those studies, mortality and major morbidity from BHCCP were within acceptable levels, nevertheless, there was no advantage over cardioplegic arrest. On the other hand there is weak evidence that it may reduce functional and biochemical markers of myocardial injury. In conclusion, BHCCP is an operative strategy in valve surgery with some potential benefits. There is, however a need for a high quality, prospective, randomized control trial to establish the exact role for BHCCP in complex valve surgery.
Impact of Valves in a Biomechanical Heart Model Assisting Failing Hearts
Authors: Guldner Norbert W , Klapproth Peter , Margaritoff Petra RJ , Noel Ralf , Sievers Hans H , Grossherr Martin
Published: May 2013

Experimental valveless muscular blood pumps (biomechanical hearts) in goats can pump more than 1 L·min−1, but due to a high pendulum volume, no significant flow contribution to the circulation is gained. Thus valved and valveless biomechanical hearts were compared for efficacy. Heart failure was induced in 5 adult Bore goats by repeated intracoronary embolization. A valved and balloon-equipped pumping chamber was integrated into the descending aorta, simulating standard biomechanical circulatory support. The valveless biomechanical heart supported a failing heart with a baseline cardiac output of 2,670 ± 710 mL·min−1 by contributing additional flow of 113 ± 37 mL·min−1. The biomechanical heart model incorporating an outlet valve offered an additional 304 ± 126 mL·min−1, and the use of 2 valves significantly enhanced pulmonary blood flow by 1,235 ± 526 mL·min−1. The use of 2 valves in biomechanical hearts seems to be essential to achieve adequate circulatory support. Double-valved biomechanical hearts driven by an appropriate skeletal muscle ventricle may contribute to the therapy of heart failure.
Blunt Traumatic Bronchial Rupture in Patients Younger than 18 Yearsa
Authors: Gwely Noureldin Noaman
Published: May 2013

The aim of this study was to evaluate our results of management of bronchial rupture after blunt chest trauma in young patients. Between January 2000 and December 2007, 34 patients aged 6–18-years old were treated for bronchial rupture; 25 presented early and 9 presented late. The 21 (62%) boys and 13 (38%) girls had a mean age of 11.58 ± 2.51 years. Radiography, computed tomography, and rigid bronchoscopy were performed in stable acute cases and late-presenting cases, with rapid bronchoscopy followed by thoracotomy in urgent cases. In the patients who presented early, repair was undertaken through a right thoracotomy in 21 (84%) and via a left thoracotomy in 4 (16%). Direct suturing was carried out in all except 3 patients who needed lobectomy. Reimplantation of the main bronchus after debridement of the edges was possible in 4 (44%) of the chronic cases, and pulmonary resection was required in 5 (56%). Four (11.8%) patients died due to perioperative cardiac arrest and cerebral hypoxia with failure of resuscitation. Meticulous collaboration between the surgeon and anesthetist is important to ensure survival.
Prolonged QT Interval and Coronary Artery Bypass Mortality Due to Heart Failure
Authors: Foroughi Mahnoosh , Yousefi Zohreh Karkhaneh , Tehrani Masood Majidi , Foroutaghe Azam Noori , Ghanavati Arash , Hassantash Seyed-Ahmad
Published: May 2013

QT-interval prolongation has been shown to predict mortality in coronary artery disease and heart failure. To assess the prognostic value of QT interval for death due to low cardiac output after coronary artery bypass grafting, the QT interval was measured in 3 consecutive beats on the preoperative electrocardiogram (leads II and V4)in30 patients who died perioperatively due to heart failure and a control group of 168 randomly matched hospital survivors during the same 3-year period. Mean corrected QT interval was significantly longer in the patients who died compared to the control group (480.7 ± 96.2 vs. 425.4 ± 21 ms). Among the variables evaluated, QT prolongation was the only independent predictor of perioperative death. In patients admitted for coronary artery bypass grafting, QT interval measurement is a simple clinical tool that may identify patients with a greater probability of a troublesome operative course.
Etiopathology and Management Challenges of Blunt Chest Trauma in Nigeria
Authors: Thomas Martins Oluwafemi , Ogunleye Ezekiel O
Published: May 2013

Blunt chest trauma had not been roundly studied in Nigeria. This study was conducted to determine the etiopathological and management challenges of chest trauma in a developing country. In a prospective multicenter hospital-based study of 10-years duration in the city of Lagos, the data of 896 patients were recorded. The male-to-female ratio was 8:1, and the mean age was 27.1 years. The majority of patients (76.9%) were aged 20–39 years. Road traffic accidents caused 98.1% of the injuries. Lung parenchymal injuries occurred in 66% of patients, and cardiac trauma in 0.1%. Isolated chest trauma was found in 85% of patients, and 134 had associated injuries. The incidence of blunt chest trauma could be reduced if the number of road traffic accidents in Nigeria is reduced.
Incidence and Impact of Cardiac Cachexia in Valvular Surgery
Authors: Tepsuwan Thitipong , Schuarattanapong Suphachai , Woragidpoonpol Surin , Kulthawong Supap , Chaiyasri Anong , Nawarawong Weerachai
Published: May 2013

Cardiac cachexia is a wasting feature of advanced heart failure, which is due to several etiologies and associated with a poor prognosis. This study assessed the incidence and impact of cardiac cachexia retrospectively in 353 patients who underwent valve surgery from June 2005 to June 2006. Using 80% of ideal body weight as a cut-off point, 46 (13%) of these patients were considered to have cardiac cachexia. Patients with cachexia were predominantly male with more underlying diseases and a lower body mass index than those without cachexia. The New York Heart Association functional class was significantly worse in patients with cachexia (class III/IV: 54.4% vs. 21.2%) and they had greater incidences of active infective endocarditis (21.7% vs. 5.2%) and tricuspid regurgitation (41.3% vs. 21.8%) compared to those with normal body weight. The cachexia group had significantly longer postoperative hospitalization and more complications (37% vs. 21.5%); perioperative mortality tended to be higher (6.5% vs. 2.3%) although not statistically significant. Cardiac cachexia remains an important problem in patients undergoing valve surgery, which indicates end-staged disease, and contributes to poor perioperative outcomes. Special care and attention are needed in this particular group of patients.
Long-Term Results up to 19 Years of Mitral Balloon Valvuloplasty
Authors: Fawzy Mohamed Eid
Published: May 2013

Clinical and echocardiographic data of 547 consecutive patients (mean age, 31.5 years) undergoing mitral balloon valvuloplasty with follow-up of 1.5–19 years, were analyzed. Immediately after valvuloplasty, mitral valve area increased significantly from 0.92 ± 0.17 to 1.95 ± 0.29 cm2. Restenosis occurred in 169 (31%) patients; it was less common (20%) in those with a mitral echocardiographic score ≤8. Actuarial freedom from restenosis at 10, 15, and 19 years was 78% ± 2%, 52% ± 3%, and 26 ± 4%, respectively, and significantly higher in patients with echocardiographic scores ≤8: 88% ± 2%, 67% ± 4%, and 40% ± 6%, respectively. Event-free survival at 10, 15, and 19 years was 88% ± 2%, 60% ± 4%, and 28% ± 7%, respectively, and significantly higher in patients with echocardiographic scores ≤8: 92% ± 1%, 70% ± 4%, and 42% ± 7%, respectively. Multivariate analysis identified echocardiographic score ≤8 and post-procedure valve area ≤1.8 as predictors of restenosis, and echocardiographic score > 8 and preexisting atrial fibrillation as predictors of combined events. Valvuloplasty provides excellent results in selected patients with mitral stenosis. The long-term outcome can be predicted from the baseline characteristics of the mitral valve.