bluuebunny/crossref_metadata_2025 huggingface dataset:
Carotid Intima-Media Thickness and Coronary Artery Disease: An Indian Perspective
Authors: Hansa Gupta , Bhargava Kartikeya , Bansal Manish , Tandon Sharad , Kasliwal Ravi R
Published: May 2013

To determine whether carotid intima-media thickness is associated with coronary artery disease and cardiovascular risk factors in the Indian population, carotid intima-media thickness was measured using high-resolution B-mode ultrasonography in 101 patients with coronary artery disease and 140 control subjects. Carotid intima-media thickness was measured at 3 predefined sites on each side. The maximum carotid intima-media thickness was significantly higher in the coronary disease group compared to the controls (1.02 vs. 0.80 mm). The average intima-media thickness was also significantly higher in the coronary disease group (0.82 vs. 0.67 mm). On multivariate logistic regression analysis, carotid intima-media thickness was the only factor found to be an independent predictor of coronary artery disease. There was a significant association between risk factor count and the average and maximum intima-media thickness values in the combined study population. These results indicate that raised values of average and maximum carotid intima-media thickness are significantly associated with the presence of coronary artery disease and this association is independent of the presence of other conventional cardiovascular risk factors.
Staphylococcus Aureus Pancarditis Complicated by a Left Ventricular Pseudoaneurysm
Authors: Arifi Ahmed A , Koehler Alwin , Hwong Thomas MT , Wan Song , Wan Innes YP , Yim Anthony PC
Published: May 2013

Acute septic pancarditis is a life threatening but fortunately rare condition. We report a case of this condition in a young 20-year-old female patient with an early complication of mitral valve destruction and a late complication of a left ventricular pseudoaneurysm formation.
Dose Comparison of Tranexamic Acid in Pediatric Cardiac Surgery
Authors: Chauhan Sandeep , Bisoi Akshay , Kumar Neeraj , Mittal Dinesh , Kale Shailaja , Kiran Usha , Venugopal Panangipalli
Published: May 2013

To compare different doses of tranexamic acid, 150 consecutive children with congenital cyanotic heart disease were randomly assigned to one of 5 groups of 30 each. Group A served as a control. Group B received 50 mg·kg−1 of tranexamic acid at induction of anesthesia. Group C received 10 mg·kg−1 at induction followed by an infusion of 1 mg·kg−1·h−1. Group D had 10 mg·kg−1 at induction, 10 mg·kg−1 on bypass, and 10 mg·kg−1 after protamine. Group E had 20 mg·kg−1 at induction and again after protamine. The control group had the longest sternal closure time, the greatest blood loss in the first 24 hours, and the highest requirements for blood and blood products. Among the 4 groups given tranexamic acid, group D (triple dose) had the best results, followed by group E (double dose). Group B (single dose) had the worst results among the groups receiving tranexamic acid.
Aortic Valve Replacement with the Medtronic Freestyle Stentless Bioprosthesis
Authors: John Alexander , Glauner Christoph , Manoutcheri Mohammad Ali , Ziaukas Virgilijus , Mahesh Gummiah Muniputtana , Warnecke Henning
Published: May 2013

During a five-year period from 1996 to 2000, the Medtronic Freestyle stentless bioprosthesis was implanted in 310 patients of advanced age. Age at operation ranged from 60 to 90 years (mean, 76 ± 4 years). 191 patients were female and 119 male. All implants were done by the modified subcoronary method using our own modification which enabled an improved adaptation of the porcine aortic root to the human anatomy. Two sinuses were scalloped and the third left intact. Additional coronary bypass grafts were necessary in 129 (39%) patients and mitral valve procedures in 23 (7%). Mean perfusion time was 109 ± 12 minutes and crossclamp time 87 ± 8 minutes. 16 (5%) patients died perioperatively. Another 17 (5.7%) patients died during a 1 to 5.6 year follow-up (mean, 2.9 years). There was only one valve related death due to infection of the valve. In spite of the advanced age, 95% of the survivors were free from cardiac symptoms and continued to live an active and fruitful life. The biological nature of the valve and the low gradients are perhaps reasons for the good results. The long-term results are expected to be good.
Mitral Valve Repair with Aortic Valve Replacement in Rheumatic Heart Disease
Authors: Ho Huynh-Quang Tri , Nguyen Van-Phan , Phan Kim-Phuong , Pham Nguyen-Vinh
Published: May 2013

From 1992 to 2001, 609 patients with rheumatic heart disease underwent aortic valve replacement with either mitral valve repair ( n = 201) or mitral valve replacement ( n = 408). Follow-up extended to 10 years. Thirty-day mortality was 1.4% for mitral valve repair and 0.7% for mitral valve replacement ( p = 0.4). Survival at 9 years was 96.5 ± 1.4% after mitral valve repair and 89.7 ± 7.8% after mitral valve replacement ( p = 0.73). Freedom from major bleeding at 9 years was 94.8 ± 2.4% after mitral valve repair and 81 ± 7.2% after mitral valve replacement ( p = 0.03). Freedom from other valve-related complications and from mitral valve re-operation was similar for the two groups. This study showed that in patients with rheumatic heart disease the results of mitral valve repair with aortic valve replacement were comparable to those of double valve replacement. Major bleeding was less frequent after mitral valve repair with aortic valve replacement. Therefore, whenever feasible, mitral valve repair should be attempted in patients with rheumatic heart disease who need concomitant aortic valve replacement.
Multiple Purpose Simulator Using a Natural Porcine Mitral Valve
Authors: Arita Makoto , Tono Sumihiro , Kasegawa Hitoshi , Umezu Mitsuo
Published: May 2013

An in vitro pulsatile simulator with a porcine mitral valve was developed in order to simulate physiologic and diseased mitral valve conditions. Evaluation of these conditions was conducted from a hydrodynamic and annulus behavior point of view. We found it possible to simulate mild “mitral valve prolapse” and to obtain quantitative data related to the condition. The diseased condition produced a 40% greater regurgitant volume than that observed under the normal condition ( p < 0.0001). Regarding the leakage volume, the diseased condition exhibited about 2.6 times more leakage than the normal condition. The mitral valve simulator proposed in this study is considered fairly stable with respect to both hemodynamics and the behavior of the annulus, and it is an adequate simulator for modeling various types of normal and diseased mitral valve conditions.
Bicaval Anastomosis Reduces Tricuspid Regurgitation after Heart Transplantation
Authors: Park Kook-Yang , Park Chul-Hyun , Chun Yang-Bin , Shin Mi-Seung , Lee Kyung-Chun
Published: May 2013

The standard surgical technique utilizing two atrial cuff anastomoses has been used in the majority of transplant centers until recently when bicaval anastomoses was introduced. The purpose of this study was to compare the prevalence of tricuspid regurgitation after the bicaval and standard techniques of anastomosis. Heart transplantation was performed in 43 patients at our institution from April 1994 to December 2003: 15 by the standard technique (group A) and 28 by the bicaval technique (group B). No differences in pre-transplant diagnosis, donor age, immunosuppression, rejection treatment, or graft ischemic time were evident between the two groups. The prevalence of tricuspid regurgitation (≥ moderate) was higher after the standard technique (36.4% vs. 10.5%; p < 0.05). Survival rates at 1 and 3 years in group A were 87% and 55%, and 86% and 78% in group B, with a significant difference in the 3-year mortality. The bicaval anastomosis technique was found to be associated with a lower incidence of tricuspid regurgitation during the late postoperative period, and should be preferred for heart transplantation.
Endobronchial Lipomatous Hamartoma
Authors: Kurkcuoglu Ibrahim C , Demircan Sedat , Kurul Ismail C , Demirag Funda
Published: May 2013

Pulmonary hamartomas are the most common benign neoplasm of the lung, occurring in the parenchyma or sometimes within the bronchi. Reported is a case of a 64-year-old male patient with an endobronchial tumor. Sleeve left upper lobectomy was performed and histhopathological examination revealed multiple growths of endobronchial hamartomatous foci. This report demonstrates that endobronchial hamartomas may develop from multiple foci.
Aortic Regurgitation with Ventricular Septal Defect in the Young
Authors: Rathore Kaushalendra Singh
Published: May 2013

This study was carried out to assess the outcome in patients who had aortic valve replacement compared to those who underwent aortic valve repair for aortic regurgitation associated with a ventricular septal defect. Of 300 patients undergoing ventricular septal defect closure between May 1990 and December 2003, 36 (12%) had moderate to severe aortic regurgitation; 7 underwent concomitant aortic valve repair and 29 had aortic valve replacement. The mean age of these 36 patients was 17.72 ± 6.84 years, and 69% were male. Follow-up was 8.20 ± 4.97 years in the valve replacement group and 4.1 ± 0.8 years in the valve repair group. The freedom from re-operation after valve repair was 76% after 4 years. After one year of follow-up in 35 patients, 27 were in New York Heart Association class I (77%) and 8 were in class II (23%). After 8 years, 12/21 (57%) patients were in class I, 5 (24%) in class II, and 2 (10%) in class III. Of 22 patients who had a dilated left ventricle, 15 regained normal left ventricular function and volume. Valve repair is preferred, but increasing age makes valve replacement a better alternative.
Managing Sternal Osteomyelitis with Antibiotic Bead Implantation
Authors: Chiu Kuan-Ming , Lin Tzu-Yu , Chu Shu-Hsun , Lu Cheng-Wei
Published: May 2013

Early, aggressive debridement followed by closure with muscle flaps is thought to improve the resolution of deep sternal wound infection that occurs after sternotomy. However, persistently discharging sternal osteomyelitis remains difficult to resolve. We successfully treated 2 patients who developed deep sternal wound infection after cardiac surgery by combining one-stage debridement with implantation of gentamicin beads to fill up the evacuated bone marrow space. This approach provides a simple and effective solution for sternal osteomyelitis.
Experimental Study of Effect of Fontan Circuit on Pulmonary Microcirculation
Authors: Yin Zongtao , Wang Zengwei , Zhu Hongyu , Zhang Renfu , Wang Huishan , Li Xinmin
Published: May 2013

Pulsatile pulmonary blood flow plays an important role in regulating shear-stress-mediated release of endothelium-derived nitric oxide and endothelin-1, and it reduces pulmonary vascular resistance by passive capillary recruitment. The aim of this study was to demonstrate changes in pulmonary capillary structure and endothelial function induced by the chronic nonpulsatile flow of the Fontan circulation. A canine model with nonpulsatile flow in the right lung was established, and sacrificed 3 months later. Compared to the left lung, wall thickness of the pulmonary arterioles was thinner, endothelin-1 expression was weaker, endothelial nitric oxide synthase activity was stronger, and there was a good correlation between the histomorphometric and immunohistochemical findings. These data indicate that long-term nonpulsatile flow can lead to endothelial dysfunction, which may be involved in distention and vascular structure remodeling due to the increase in pulmonary vascular resistance; but it also can lead to increased patency of the arteriovenous shunt, which might be at least partly involved in pulmonary arteriovenous fistula development and exercise limitation after the Fontan operation.
Desmoid Tumors of the Chest Wall
Authors: Zisis Charalambos , Dountsis Apostolos , Nikolaides Athanasios , Dahabreh Jubrail
Published: May 2013

Chest wall desmoid tumors (DT) are rare pathologic entities with microscopic features similar to, or undistinguishable from, fibromas or fibrosarcomas. From 1996 to 2001, four patients with DT were surgically managed in our department. Their ages ranged from 27 years to 43 years (mean 32.25 years, median 29.5 years). A resection of the lesion was performed with negative margins of 4 cm around the tumor (wide resection). A reconstruction of the chest wall was also performed with polytetrafluoroethylene (PTFE) in 2 patients and methylmethacrolate with Marlex mesh in 1 patient. One patient had a recurrence 15 months later, and was admitted for complementary resection, and remains disease-free for 5 years. The rest 3 patients are disease-free for 6 months to 5 years. Resection must include all adjacent, overlying and underlying musculature as well as soft tissues and any spare skin from the procedure should be used. Prognosis after a wide resection is good.
Classic Konno-Rastan Procedure: Indications and Results in the Current Era
Authors: Tabatabaie Mohammad B , Ghavidel Alireza A , Yousefnia Mohammad A , Hoseini Saeed , Javadpour Seyed H , Raesi Kamal
Published: May 2013

Diffuse or unresectable subaortic stenosis is difficult to treat and needs aggressive resection to effectively relieve the obstruction. Anterior aortoventriculoplasty, known as the Konno-Rastan procedure, has been shown to effectively tackle the problems encountered in diffuse subaortic stenosis. A retrospective study was carried out on patients who had undergone a Konno-Rastan procedure at our institution from March 1997 to November 2003. There were 26 patients (16 males and 10 females). The mean age at operation was 12.8 ± 7 years. The mean follow-up period was 30.4 ± 14.5 months. Only mechanical valves were used in this group of patients. The overall 30-day mortality was 11.5% (3 patients). The mean preoperative peak systolic gradient decreased significantly from 91.3 ± 39.3 to 28.1 ± 17.7 mm Hg. Four patients developed permanent complete heart block and 2 had a residual ventricular septal defect in late follow-up. The classic Konno-Rastan procedure using a mechanical valve can be performed with acceptable morbidity and mortality in this difficult group of patients.
Pacing in Preterm with Hydrops Fetalis Due to Congenital Complete Heart Block
Authors: Khositseth Anant , Samankatiwat Piya , Withurawanit Wichaya , Khowsathit Pongsak
Published: May 2013

Hydrops fetalis due to congenital complete heart block (CCHB) is a rare condition. The outcome of the preterm fetus with hydrops fetalis due to CCHB is poor, and is frequently associated with significant morbidity and mortality. The management of this condition is difficult. We report our experience in a hydropic preterm using staged pacing by applying left ventricular epicardial pacing with a temporary pacemaker and subsequently, left ventricular epicardial pacing with a permanent pacemaker.
Composite Y-Graft for Syphilitic Ostial Stenosis in Left Main Coronary Artery
Authors: Tanaka Keita , Takeda Makoto , Nagayama Kazuhiro
Published: May 2013

Coronary ostial stenosis is one of the cardiac manifestations of tertiary syphilis and should be perceived as a disorder of the aorta. A 45-year-old man with no coronary risk factors except smoking developed severe isolated ostial stenosis in the left main coronary artery. He underwent emergency bypass surgery using the bilateral internal thoracic arteries as a composite Y-graft, and recovered uneventfully.
Diaphragmatic Laceration, Partial Liver Herniation and Catamenial Pneumothorax
Authors: Bobbio Antonio , Carbognani Paolo , Ampollini Luca , Rusca Michele
Published: May 2013

Catamenial pneumothorax is a recurrent pneumothorax temporally associated with menstruation. Pathogenesis remains debated however pleural endometriosis or diaphragmatic abnormalities are almost always present. We report the case of a 35-year-old woman with recurrent right catamenial pneumothorax. At thoracoscopy a large laceration of the diaphragm with partial intrathoracic liver herniation was seen. Treatment involved repair of the diaphragmatic lacerations, and pleurodesis. This report shows that large diaphragmatic defects may be observed in patients with catamenial pneumothorax.
Adjusting Oxygen Fraction to Avoid Hyperoxemia during Cardiopulmonary Bypass
Authors: Toraman Fevzi , Evrenkaya Serdar , Senay Sahin , Karabulut Hasan , Alhan Cem
Published: May 2013

Although an adverse influence of hyperoxemia during cardiopulmonary bypass is well documented, there is a wide range of oxygen settings during cardiopulmonary bypass, based mostly on trial and error. The aim of this study was to determine the optimal inspired oxygen fraction during cardiopulmonary bypass. Ninety patients undergoing isolated coronary artery bypass operations were randomly allocated to one of 3 groups of 30 each. In group 1, cardiopulmonary bypass was started with an inspired oxygen fraction of 0.40, increased to 0.60 during rewarming. These settings were 0.40 and 0.50 in group 2, and 0.35 and 0.45 in group 3. Samples for blood gas analysis were collected at defined time periods during the operation. PaO2 was significantly higher in groups 1 and 2 compared to group 3. All patients in group 1 and 88% of patients in group 2 suffered at least one episode of hyperoxemia during cardiopulmonary bypass, compared to 30% of patients in group 3. The differences were significant, and we concluded that to avoid hyperoxemia, inspired oxygen fraction should be kept at 0.35 during cardiopulmonary bypass and increased to 0.45 during rewarming.
Spontaneous Hemothorax and Neurofibromatosis: A Review of a Lethal Combination
Authors: Fedoruk Lynn M , English John , Fradet Guy J
Published: May 2013

We present a case report of spontaneous hemothorax associated with neurofibromatosis. On review of the literature, a significant mortality rate of 36% is revealed in addition to a surgical mortality of 33%. Treatment options are reviewed and potential management strategies are discussed.
Leukocytosis Caused by Tropical Splenomegaly during Cardiopulmonary Bypass
Authors: Tewari Prabhat , Mittal Pramod , Singh Shiv B
Published: May 2013

We describe two patients undergoing cardiac surgery under cardiopulmonary bypass with concomitant enlarged tropical spleen. Volume overload and leukocytosis occurred during pump management. In the first patient this resulted in acute lung injury, but in the second case methods to reduce the impact of leukocytosis were taken, resulting in a normal postoperative course.
Long Intraaortic Balloon Treatment Time Leads to More Vascular Complications
Authors: Christenson Jan T , Sierra Jorge , Romand Jacques-André , Licker Marc , Kalangos Afksendyios
Published: May 2013

Intraaortic balloon counterpulsation is an established and efficient therapy. Limb ischemia is the most common complication. The impact of treatment duration on balloon-related complications was analyzed retrospectively in 135 patients who underwent balloon counterpulsation between 1998 and 2004. Thirty high-risk coronary patients required preoperative intraaortic balloon therapy, 41 were in preoperative cardiogenic shock, and 64 needed support for difficulties in weaning from cardiopulmonary bypass. No balloon-related mortality occurred. The overall balloon-related complication rate was 20/135 (14.8%); 18 had limb ischemia, of whom 6 (4.4%) required vascular interventions. Intraaortic balloon treatment time was significantly longer in patients who developed limb ischemia (99.8 ± 54.1 h) compared to those who did not (34.4 ± 30.4 h). Preoperative therapy had short treatment times and few complications. Intraaortic balloon pumping provides effective circulatory support with a low complication rate. A clear relationship was established between duration of treatment and balloon-related complications. Independent risk factors for balloon-related complications were long treatment time, acute myocardial infarction, age over 65 years, and ejection fraction less than 0.30.
Endovascular Treatment of Gastroduodenal Artery Aneurysm
Authors: Chong Weng Wah Roland , Tan Seck Guan , Htoo Maung Myint Austin
Published: May 2013

Gastroduodenal artery aneurysms are rare. Common causes include blunt trauma, pancreatitis, infection, autoimmune disorders, vascular intervention and surgery. We report 2 patients with gastroduodenal artery aneurysms, the first being an idiopathic true aneurysm and the next, a pseudoaneurysm resulting from pancreatitis. Diagnoses were made by computed tomography scans with successful embolization of both patients. Treatment of gastroduodenal artery aneurysms includes surgery, endovascular techniques or observation. Embolization is a feasible option for gastroduodenal artery aneurysms and pseudoaneurysms.
Potential Role of Adipocytokine Leptin in Acute Coronary Syndrome
Authors: Dubey Laxman , Zeng He-Song , Wang Hong-Jie , Liu Ren-Yan
Published: May 2013

By activating immune cells or a direct action on the vascular wall, leptin may affect the initiation and progression of atherosclerosis. We investigated whether plasma leptin concentration is associated with coronary artery disease, with particular focus on the relationship between plasma leptin and the development of an acute coronary syndrome. Plasma leptin, interleukin-6 and high-sensitivity C-reactive protein were measured in 34 patients with acute coronary syndrome and 21 with stable angina. Their results were compared with those of 21 normal controls. Plasma leptin levels were significantly higher in the acute coronary syndrome group (13.36 ± 5.02 ng·mL−1) compared to the stable angina group (8.97 ± 4.06 ng·mL−1) or normal controls (5.14 ± 2.75 ng·mL−1). Interleukin-6 and high-sensitivity C-reactive protein were also higher in the acute coronary syndrome group, and leptin correlated positively with interleukin-6 and high-sensitivity C-reactive protein. These findings suggest that plasma leptin levels may be a useful marker of systemic inflammation, and measurement of plasma leptin may be helpful in assessing the risk of developing coronary heart disease.
Easy Technique for Placing Anchoring Sutures for Aortic Root Reimplantation
Authors: Ogino Hitoshi , Minatoya Kenji , Matsuda Hitoshi , Sasaki Hiroaki
Published: May 2013

In the aortic valve-sparing reimplantation technique, insertion of the anchoring sutures beneath the valve is a crucial but difficult step because the spared aortic cusps obscure the field of view. We present a novel and easy method of placing these anchoring stitches with good exposure of the subvalvular tissue.
Management of Extremity Vascular Trauma: Jammu Experience
Authors: Kohli Arvind , Singh Gurjit
Published: May 2013

Experience in 111 patients treated for extremity vascular trauma between 1995 and 2004 is described. Only 40 (36%) patients presented within 6 hours of sustaining the injury. Penetrating injuries due to stabbing and gunshots were the causes in 65 patients, and blunt trauma in 46. There were associated bone fractures in 73 patients. The brachial artery was the most commonly injured upper limb vessel, whereas the femoral vessels were most often damaged in the lower limb. Surgical procedures consisted of end-to-end anastomosis in 50 patients, an interposition graft in 32, lateral arteriorrhaphy in 14, ligation in 6 and venous patch plasty in 5. Concomitant artery and vein repair was carried out in 12 patients, 6 underwent embolectomy and fasciotomy was performed in 16. Three (2.7%) patients died postoperatively. Good blood flow was obtained after repair in 69 (62%) patients, 29 (26%) had collateral compensation, 5 underwent primary amputation and 5 required secondary amputation. Most vascular injuries due to limb trauma can be managed successfully unless associated with severe damage to bones, nerves or soft tissues.
Entry Closure and Aortic Tailoring for Chronic Type B Aortic Dissection
Authors: Matsuyama Katsuhiko , Narita Yuji , Usui Akihiko , Akita Toshiaki , Oshima Hideki , Ueda Yuichi
Published: May 2013

Although graft replacement for chronic type B dissection is the standard operation, this operation is invasive to some extent, and the mortality and morbidity remain high. We describe a simple and less invasive technique using initial entry closure and aortic tailoring of the dissected lumen.
Arterial Switch Operation: Troponin T Does Not Predict Ventilation Requirements
Authors: Maddali Madan M , Valliattu John , al Delamie Taha , Zacharias Sunny , Ahmed Ahmed R , Ganguly Shyam S
Published: May 2013

The aim of this study was to assess whether postoperative cardiac troponin T levels could predict ventilation requirements in infants undergoing the arterial switch operation. Cardiac troponin T was measured 6 hours after aortic cross clamping and prior to tracheal extubation in 20 consecutive patients; 10 had simple and 10 had complex (with ventricular septal defect) transposition of the great arteries. The mean plasma troponin T level prior to extubation did not differ significantly in patients who were re-intubated and those who were successfully extubated. The initial cardiac troponin T levels in the complex defect group was significantly higher than in the simple transposition group. There was no correlation between initial cardiac troponin T levels and the duration of mechanical ventilation. There was no difference in mean duration of ventilation between the 2 groups. It was concluded that the postoperative cardiac troponin T level is not a predictor of successful extubation or prolonged artificial ventilation in this subset.
Correction of Anomalous Drainage of Right Superior Vena Cava to Left Atrium
Authors: Sajja Lokeswara R , Koneti Nageswara R , Mannam Gopichand , Sundaram M Kalyana
Published: May 2013

A 2-year-old boy with cyanosis was found to have normal situs and looping with anomalous drainage of a right-sided superior vena cava to the left atrium, and intact interatrial septum in association with anomalous drainage of the left pulmonary veins to the right superior vena cava. He underwent successful surgical repair of this rare congenital malformation.
Vacuum-Assisted Closure for Mediastinitis after Pediatric Cardiac Surgery
Authors: Hiramatsu Takeshi , Okamura Yoshitaka , Komori Shigeru , Nishimura Yoshiharu , Suzuki Hiroyuki , Takeuchi Takashi
Published: May 2013

Two children, aged 1 and 14 years with methicillin-resistant Staphylococcus aureus mediastinitis after pediatric open-heart surgery, were fitted with a vacuum-assisted closure system. Complete healing was achieved in both cases, and primary wound closure could be carried out without an omental flap after 6 and 16 days.
Can 64-Row Computed Tomography Replace Angiography after Coronary Bypass?
Authors: Doi Hirosato , Koshima Ryuji , Suzuki Masato , Takahashi Ken , Yokoyama Hiroichi , Yoshida Naoya
Published: May 2013

Multi-detector (64-row) computed tomography has become an alternative to coronary angiography to diagnose graft occlusion and stenosis after coronary artery bypass. We compared the power of evaluation of multi-detector computed tomography with that of conventional coronary angiography in 60 patients who underwent coronary artery bypass with 135 grafts and 210 graft anastomoses. The diagnostic power of multi-detector computed tomography for graft occlusion was: 100% (2/2) sensitivity, 98.5% (131/133) specificity, 50% (2/4) positive predictive value, and 100% (133/133) negative predictive value; there were no significant differences in rates of occlusion among the different types of graft. The diagnostic power of multi-detector computed tomography for stenosis of the graft anastomosis was: 100% (2/2) sensitivity, 95.1% (194/204) specificity, 16.6% (2/12) positive predictive value, and 100% (194/194) negative predictive value, with no significant differences among grafts. Multi-detector computed tomography permits evaluation of bypass grafts and is much less invasive for the patients.
Chronic Contained Rupture of Abdominal Aortic Aneurysm
Authors: Yokomuro Hiroki , Ichikawa Yukio , Kajiwara Hirokazu
Published: May 2013

Computed tomography in a 74-year-old man with intermittent claudication revealed an abdominal aortic aneurysm, retroperitoneal hematoma, vertebral erosion, and total aortic occlusion. Surgery was delayed for 9 months after definitive diagnosis of contained rupture of the aortic aneurysm to allow treatment for ischemic heart disease and cardiac failure. After interposing a Y-shaped woven Dacron graft, the intermittent claudication was alleviated. The postoperative course was uneventful.
Effect of Central Venous Pressure on Spinal Cord Oxygenation
Authors: Ulus A Tulga , Hellberg Anders , Ulus Fatma , Karacagil Sadettin
Published: May 2013

To analyze the effect of central venous pressure on cerebrospinal fluid oxygen tension and intrathecal pressure, multiparameter sensors were introduced into the intrathecal space for continuous monitoring of cerebrospinal fluid PO2, PCO2, and intrathecal pressure in 15 pigs. After 20 min of aortic clamping, hypervolemia was established for 20 min, followed by normovolemia. The animals were divided into 3 groups: in group 1, cerebrospinal fluid PO2 = 0% at some time during crossclamping; in group 2, cerebrospinal fluid PO2 was <50%; and in group 3, cerebrospinal fluid PO2 remained ≥50%. Mean decreases in cerebrospinal fluid PO2 during the initial 20 min of crossclamping were 82%, 57%, and 15% in groups 1, 2, and 3, respectively. Following induction of hypervolemia, central venous and cerebrospinal fluid pressures increased simultaneously; this caused a significant decrease in cerebrospinal fluid PO2 in group 2 only. In this model, aortic clamping did not increase cerebrospinal fluid pressure if central venous pressure was not elevated. The detrimental effect of elevated intrathecal pressure on cerebrospinal fluid oxygenation was seen only in animals with an intermediate degree of spinal cord ischemia. This might have important implications for the prevention of paraplegia during thoracoabdominal aortic replacement.
Current Trends in Extended Lymph Node Dissection for Esophageal Carcinoma
Authors: Fang Wen-Tao , Chen Wen-Hu
Published: May 2013

Extended lymph node dissection helps increase the curativeness of resection, the accuracy of surgical-pathological staging, and the prognosis of thoracic esophageal carcinoma. However, it is also associated with significantly increased surgical morbidity and has noticeable negative effects on the quality of life after surgery. Current trends for selective lymph node dissection based on clinical evidence may be helpful in reducing surgical risks while assuring the completeness of resection.
Scimitar Syndrome: Experience with 6 Patients
Authors: Karthekeyan Ranjith Baskar , Saldanha Richard , Sahadevan M Ranjith , Rao Suresh KG , Vakamudi Mahesh , Rajagopal Balakrishnan K
Published: May 2013

Scimitar syndrome is a rare congenital anomaly characterized by anomalous pulmonary venous drainage to the inferior vena cava, causing a left-to-right shunt. Six patients with scimitar syndrome were diagnosed in our hospital between 2002 and 2008. There were 4 girls and 2 boys; 4 < 5 kg in weight, 2 < 8 kg in weight. Scimitar syndrome was suspected in 5 cases because of dextroversion, and diagnosed by color Doppler echocardiography in all 6 when a scimitar vein was detected entering the inferior vena cava. Computed tomography confirmed the diagnosis in all patients. Two patients had horseshoe lung, 2 had a unilobar right lung, 1 had a hypoplastic right lung, and 1 had a hypoplastic right lower lobe. Three patients had severe pulmonary arterial hypertension, 2 had moderate pulmonary arterial hypertension, and one had normal pulmonary arterial pressure. All patients had lower respiratory tract infections, volume loss of the right lung, a normal or hyperinflated left lung, dextroversion of the heart, and scimitar arteries from the descending aorta. Pneumonectomy was performed in 3 patients, lobectomy in 1, ligation of anomalous vessels in 1, and 1 died before surgery.
Establishment of Rat Model of Cardiopulmonary Bypass in Pulmonary Hypertension
Authors: Liu Hao , Zhang Junwen , Wang Zhongqiu , Dong Guohua , Jing Hua
Published: May 2013

An experimental model of cardiopulmonary bypass in rats with pulmonary hypertension is necessary to understand underlying mechanisms and develop protective strategies. Male Sprague-Dawley rats were randomly divided into a sham group, cardiopulmonary bypass group, pulmonary hypertension group, and pulmonary hypertension with cardiopulmonary bypass group. Both groups with pulmonary hypertension received a subcutaneous injection of monocrotaline 60 mg · kg−1 on day 0. Cardiopulmonary bypass was instituted in one of them 21 days later. The sham and pulmonary hypertension control groups underwent cannulation only. Cardiopulmonary bypass was conducted for 60 min at a flow rate of 100 mL · kg−1 · min−1. Hemodynamic investigations, blood gas analysis, interleukin-6, tumor necrosis factor-α, and survival studies were performed subsequently. Time-dependent increases of serum interleukin-6 and tumor necrosis factor-α were found after cardiopulmonary bypass in both groups. This model allows the study of multiple organ pathophysiological processes after cardiopulmonary bypass in rats with pulmonary hypertension, as well as the evaluation of possible protective strategies.
Deep Hypothermic Arrest for Aortic Valve Replacement in Case of Porcelain Aorta
Authors: Iliopoulos Dimitrios C , Deveja Aris-Rezar , Satratzemis Vasilios , Koudoumas Dimitrios G
Published: May 2013

A 71-year-old man presented with severe aortic stenosis and a heavily calcified aorta. Cardiopulmonary bypass was established with arterial cannula via the distal aortic arch. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were initiated for excision of the ascending aorta. A tube graft was anastomosed to the proximal aortic arch, circulation was reestablished, the aortic valve was replaced with a bioprosthesis, and proximal anastomosis to the sinotubular junction was preformed.
Cervical Mediastinoscopic Lymphadenectomy for Accurate Staging in Lung Cancer
Authors: Bar Ilan , Papiashvilli Michael , Fink Gershon , Sandbank Judith , Stav David
Published: May 2013

Accurate preoperative staging of the mediastinum is important in the treatment of non-small-cell lung cancer. Enlarged mediastinal lymph nodes on chest computed tomography are positive for malignancy on mediastinoscopy in only half of these patients. After negative mediastinoscopy, some positive nodes are found at thoracotomy. The aim of this study was to attempt to remove all lymph nodes accessible by cervical mediastinoscopic lymphadenectomy and reevaluate the same mediastinal stations at thoracotomy for missed lymph nodes. Between 1999 and 2003, 30 patients with operable non-small-cell lung cancer and enlarged mediastinal lymph nodes (>1 cm in diameter on computed tomography) that were negative on cervical mediastinoscopy underwent pulmonary resection with complete lymph node dissection. The total number of lymph nodes dissected in these 30 patients was 329 (143 at mediastinoscopy and 186 at thoracotomy); the mean numbers of nodes dissected were 4.8 at mediastinoscopy and 6.2 at thoracotomy. Ten (6.5%) residual lymph nodes were detected at thoracotomy in mediastinal stations R4, L4, and 7. The low number of missed lymph nodes demonstrates the accuracy of the technique of cervical mediastinoscopic lymphadenectomy.
Solitary Fibrous Tumor of the Pleura: Surgery and Clinical Course in 18 Cases
Authors: Bini Alessandro , Brandolini Jury , Davoli Fabio , Dolci Giampiero , Sellitri Francesco , Stella Franco
Published: May 2013

Solitary fibrous tumors of the pleura are very rare neoplasms that can sometimes present with malignant features. Between 1984 and 2007, 18 cases were treated in our institution. There were 7 men and 11 women, with a median age of 56 years (range, 33-77 years). All patients underwent surgical treatment. Except for one case with hemangiopericytic features, all tumors were histologically the fibrous type of pleural mesothelioma. Resections were radical and there were no recurrences. There was no perioperative mortality. The outcome was excellent, and all patients have been followed up continuously. Survival rates at 3, 5, and 10 years were calculated as 86.7%, 75%, and 66.7%. One patient died after 18 months (malignant type of solitary fibrous tumor), and 2 died of unrelated disease after 24 and 53 months. Surgery is the treatment of choice, and careful long-term clinical follow-up is required.
Transannular Pulmonary Enlargement and Bioprostheses for Carcinoid Disease
Authors: Choong Cliff K , Arrowsmith Joseph E , Klein Andrew A , Wells Francis C
Published: May 2013

A diminutive pulmonary artery and right ventricular outflow tract in a 46-year-old woman with a 10-year history of carcinoid syndrome required transannular pulmonary patch enlargement to allow replacement of the pulmonary and tricuspid valves with bioprostheses. The avoidance of anticoagulation permitted further hepatic arterial embolization without an increased risk of bleeding.
Simultaneous Use of Argatroban and Heparin during Cardiopulmonary Bypass
Authors: Okamura Toru , Shin'oka Toshiharu , Ishibashi Nobuyuki , Ishii Hikaru , Kurosawa Hiromi
Published: May 2013

Heparin is the routine anticoagulant for cardiopulmonary bypass, but complications due to heparin are often reported. This study assessed argatroban as an alternative to heparin. Normothermic cardiopulmonary bypass with hemodilution was performed for 2h in 15 dogs (mean weight, 9.8 kg) randomly assigned to 3 groups of 5 each. The controls were given heparin 200 IU·kg−1 before cardiopulmonary bypass; group A had argatroban infused continuously at a rate of 20 μg·kg−1 ·min−1; group H/A had half doses of both heparin (100 IU·kg−1) and argatroban (10 μg·kg−1·min−1). Blood samples were collected at 5 time points during the experiment. Activated clotting time, hemoglobin level, platelet counts, and serum concentrations of fibrinogen, antithrombin III, and thrombin-antithrombin III complex were measured. The platelet count was reduced significantly, and the production of thrombin-antithrombin III complex was inhibited in group H/A. Activated clotting time remained <300 sec at all time points in group A, but it was maintained at approximately 400 sec in group H/A. Fibrinogen and antithrombin III levels were reduced to half in all groups after initiation of cardiopulmonary bypass. The simultaneous use of heparin and argatroban infusion might be useful for cardiopulmonary bypass with hemodilution.
Complications of Angioplasty and Stenting of Cervicocerebral Arteries in Iran
Authors: Ghandehari Kavian , Edraki Keyvan , Karimi Mohammad , Ghorbani Asgar , Haghighi Afshin Borhani , Shabestari Mahmood
Published: May 2013

Angioplasty and stenting of the cervicocerebral arteries is a novel treatment for atherosclerotic stenosis, which has periprocedural complications. Data were collected prospectively from 2007 to 2009 in a multicenter cohort of patients undergoing interventions for cervicocerebral stenosis. Retrospective assessment of the 2003-2006 archives of the same interventionists and a review of their published work is the second part of this national survey. In 592 extracranial internal carotid artery angioplasty and stenting procedures in 581 patients (73% male; mean age, 63.4 ± 7 years), transient ischemic attack, stroke, intracerebral hemorrhage, and death occurred in 1.7%, 1.7%, 0.34%, and 1.52%, respectively. In 114 extracranial vertebral artery angioplasty and stenting procedures in 110 patients (68% male; mean age, 65.3 ± 6 years), transient ischemic attack and stroke each developed in 1 (0.92%) patient, but there was no intracerebral hemorrhage or death. In 70 intracranial angioplasty and stenting procedures in 67 patients (76% male; mean age, 68.5 ± 8 years), transient ischemic attack, stroke, intracerebral hemorrhage, and death were observed in 1.4%, 8.6%, 1.4%, and 2.9%, respectively. The frequency of periprocedural complications in angioplasty and stenting of cervicocerebral arteries by our neurointerventionists was similar to that in developed countries.
Clinical Outcomes of Medical Treatment of Acute Type A Intramural Hematoma
Authors: Sawaki Sadanari , Hirate Yuichi , Ashida Shinichi , Takanohashi Akira , Yagami Kei , Usui Masato
Published: May 2013

A retrospective study was performed in 30 patients who were treated for type A intramural hematoma from 1999 to 2008, of whom 24 were initially treated without surgical intervention. These 24 patients were followed up for 3.3 ± 3.5 years (range, 0 days to 10.0 years). Four hospital deaths occurred (hospital mortality, 16.7%), there were 2 late deaths, and 2 other patients needed an operation during the follow-up period. The event-free survival rate (freedom from death or surgery) at 5 years was significantly lower in patients with maximal aortic diameter ≤48 mm than in those with diameters <48 mm (28.6% ± 17.1% vs. 88.2% ± 7.8%). Maximal aortic diameter ≤48 mm and computed tomography findings of a small intimal defect were significant predictors of rupture or progression of ascending aortic dissection. The outcome of medical treatment for type A intramural hematoma was acceptable during both the early and late periods, but patients with a relatively large aortic diameter or an intimal defect in the ascending aorta have a high probability of adverse outcome, and must be considered for surgery.
An Adult Case of Giant Bronchogenic Cyst Mimicking Tension Pneumothorax
Authors: Yalcinkaya Serhat , Vural A Hakan , Ozal Hasan
Published: May 2013

Bronchogenic cysts are usually discovered only incidentally in the adult. A giant bronchogenic cyst in a 19-year-old woman presenting with pain and shortness of breath was mistaken for tension pneumothorax and initially treated with tube thoracostomy. Giant bullae were diagnosed by computed tomography. Bullae resection was undertaken, but the remaining lung tissue required pneumonectomy. Pathologic examination of the specimen confirmed bronchogenic cyst.
Computed Tomography of Aortic Intramural Hematoma and Thrombosed Dissection
Authors: Siriapisith Thanongchai , Wasinrat Jitladda , Slisatkorn Worawong
Published: May 2013

A retrospective study was undertaken to evaluate the appearance of the aortic wall on computed tomography for the purpose of developing criteria for differentiating acute aortic intramural hematoma from thrombosed false lumen seen in aortic dissection. Computed tomography angiography findings of the thoracoabdominal aorta in 23 patients with suspected intramural hematoma and 25 with thrombosed false lumen were reviewed. The more common features of an intramural hematoma were hyperattenuation of the aortic wall, wall thickness less than a quarter of the aortic diameter, intrinsic wall calcification, a lesion extending around the entire aortic circumference, and ulcer-like projections that may be precursors of intramural hematoma. Wall thickness less than a quarter of the aortic diameter, lesion extending around the entire aortic circumference, and ulcer-like projections were the most useful indicators for distinguishing intramural hematoma from the thrombosed false lumen in aortic dissection.
A case of aspergillosis associated with intralobar pulmonary sequestration
Authors: Morikawa Hiromasa , Tanaka Toru , Hamaji Masatsugu , Ueno Yoichiro
Published: May 2013

We present a case of intralobar pulmonary sequestration (IPS) and pulmonary aspergillosis (PA) in a 32-year-old Japanese man. Immunological examination indicated an initial diagnosis of PA and an antifungal agent was administered. Since an abnormal chest shadow persisted, another causative lung disease was suspected to exist. Further inspection revealed the presence of IPS and surgical resection was performed. The symptoms of IPS are usually secondary to pyogenic infection; nevertheless, Aspergillus is a possible causative microorganism.
Ketamine-etomidate for children undergoing cardiac catheterization
Authors: Malik Madhur , Malik Vishwas , Chauhan Sandeep , Dhawan Naresh , Kiran Usha
Published: May 2013

The purpose of this study was to determine the effects of combined low-dose ketamine and etomidate on hemodynamics during cardiac catheterization in children with congenital cardiac shunts. Sixty children undergoing routine diagnostic cardiac catheterization were included: 30 had a right-to-left shunt, and 30 had a left-to-right shunt. Both groups were given a single dose of etomidate 0.3 mg·kg−1 with ketamine 1 mg·kg−1. There were no hemodynamic changes in the group with a right-to-left shunt. In cases of left-to-right shunt, there were significant differences in heart rate, right atrial pressure, mean arterial pressure, mean pulmonary artery pressure, pulmonary artery wedge pressure, and systemic vascular resistance index. Decreases in pulmonary blood flow and pulmonary-systemic shunt ratio were also observed. Further studies are required with dose titration of this anesthetic combination in pediatric patients with congenital heart disease involving a left-to-right shunt.
Aortic root and hemiarch replacement in osteogenesis imperfecta
Authors: Roubelakis Apostolos , Moorjani Narain , Gallagher Patrick , Ohri Sunil K
Published: May 2013

We describe a case of osteogenesis imperfecta in a 52-year-old man who underwent successful repair of aortic root dilatation and aortic valve insufficiency, using a bioprosthetic aortic valve anastomosed to an interposition graft.
Large left atrial thrombus after mitral valve replacement: how to treat?
Authors: Khan Habib , Chaubey Sanjay , Hill Alexander , Fisher Jane , Wendler Olaf
Published: May 2013

An 87-year-old lady, known to have permanent atrial fibrillation, underwent tissue mitral valve replacement at our institution. At the two-year follow-up, echocardiography revealed a large left atrial thrombus attached to the anterolateral wall and the mouth of the left atrial appendage remnant. The patient was treated with warfarin. One year later, the mass had fully resolved, thus avoiding the need for high-risk redo surgery.
Outcome after mitral valve operations with depressed left ventricular function
Authors: Parker Jack ATC , Kennes Lieven N , Ruckert Jeremie , Dahm Manfred , Vahl Christian-Friedrich
Published: May 2013

We retrospectively investigated 42 patients (27 men, 15 women; mean age, 67 years) with severe mitral valve incompetence and endstage cardiomyopathy (ejection fraction <30%) who were operated on between January 2002 and March 2009. Of these, 14 were in New York Heart Association class IV, and 27 were in class III. The etiology was ischemic in 18 patients and idiopathic dilated in 24. Mitral valve repair was performed in 25 patients, and 17 had mitral valve replacement. The mean logistic EuroSCORE was 33.41. The mean follow-up was 44.52 months. There were no perioperative deaths. Three patients died within 30 days postoperatively. Thirty-day mortality was lower than predicted by EuroSCORE (7.14% vs. 33.41%). The median functional class improved from 3 to 2 during follow-up. Ejection fraction improved from 24% to 42% at 6 weeks, then decreased to 33%. The midterm survival rate was 86%, and 81% after 1 and 2 years. Freedom from reoperation at 2 years was 85%; 6 patients needed reoperation for recurrent mitral regurgitation. Despite high operative risk, mitral valve surgery can be performed successfully with acceptably low mortality in patients with endstage cardiomyopathy. Patients experience substantial clinical improvement and a moderate recovery of left ventricular function.