bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Angiotensin-Converting Enzyme Inhibition Can Cause Severe Post CPB Vasodilation – Current UK Opinion
Authors: Devbhandari Mohan P , Balasubramanian Sendhil K , Codispoti Max , Nzewi Onyekwelu C , Prasad Sai U
Published: May 2013

Preoperative use of angiotensin-converting enzyme inhibitors in cardiac surgery patients is thought to cause extreme vasodilatation in post cardiopulmonary bypass period. Opinions are divided as to whether it is beneficial or not to stop it prior to operation. A national survey in the UK was carried out on this issue. Questionnaires were sent to 167 currently practicing UK cardiac surgeons, out of which 105 (62%) replied back. Their responses were analyzed. Among the surgeons who replied to the questionnaires, the majority (63%) were of the opinion that the use of angiotensin-converting enzyme inhibitors leads to vasodilatation resulting in increased usage of fluids, inotropes and vasoconstrictors. However, there was no agreement on the issue of stopping it prior to surgery. Forty one (39%) felt it was beneficial to stop the angiotensin-converting enzyme inhibitors prior to surgery whereas 40 (38%) of them thought it was harmful to stop it. Twenty one (20%) were of the opinion that it made no difference. 39% of respondents practiced stopping the drug prior to planned operation. This national survey revealed differences in management of patients on angiotensin-converting enzyme inhibitors undergoing cardiac surgery. Recommendations from available literature are equally varied, highlighting the need for multicenter randomized trials to address this clinical problem.
Simplified Antegrade Cerebral Perfusion and Myocardial Protection during Stage I Norwood Procedure
Authors: Vricella Luca A , Samankatiwat Piya , de Leval Marc R , Tsang Victor T , Vouhé Pascal R
Published: May 2013

Several important modifications have been introduced in the intraoperative management of neonates with hypoplastic left heart syndrome during first-stage palliation. Among these, utilization of selective antegrade cerebral perfusion and interposition of a conduit between the right ventricle and pulmonary artery are currently favored by many centers. We briefly describe our current approach to the modified stage I Norwood procedure.
Comparative Study of the L-Hydro Process and Glutaraldehyde Preservation
Authors: Nina Vinicius JS , Pomerantzeff Pablo MA , Casagrande Ivan SJ , Cheung David T , Brandão Carlos MA , Oliveira Sérgio A
Published: May 2013

Commercial bioprosthetic heart valves are commonly preserved in glutaraldehyde and are cytotoxic to host cells, preventing spontaneous endothelialization. The aim of this study was to demonstrate the potential for in vivo endothelialization of bioprostheses treated by the L-Hydro process which consists of mild extraction of antigenic substances and incorporation of antiinflammatory and antithrombotic agents. Seven stented porcine heart valves treated by the L-Hydro process and 3 glutaraldehyde-fixed porcine heart valves were implanted in the mitral position in juvenile sheep. The valves were evaluated by echocardiography, angiography, histology, and histochemistry. No hemodynamic differences were observed, but scanning and transmission electron microscopy showed nearly complete coverage by endothelial cells of all leaflets in the L-Hydro-treated valves after 5 months of implantation. The endothelial cells were in direct contact with the underlying collagen and expressed von Willebrand-related antigens. The surfaces of the glutaraldehyde-treated valves were covered by fibrin, macrophages, calcium, and thrombotic material; only sparse endothelial cells were observed and contact with the underlying tissue was incomplete. These data indicate that L-Hydro-treated porcine valves are capable of inducing spontaneous endothelialization.
Omentoplasty in Treatment of Early Bronchopleural Fistulas after Pneumonectomy
Authors: Chichevatov Dmitry , Gorshenev Alexander
Published: May 2013

This study was undertaken to assess the efficacy of omentoplasty in 12 cases of bronchopleural fistula after pneumonectomy. All fistulas formed within 16 days after the primary operation (median, 7 days). In 10 cases, omentoplasty was performed within 10 hours of diagnosis; the other 2 cases were treated at 28 and 31 hours. The greater omentum was mobilized through a laparotomy and secured tightly around the bronchial stump using original principles of fixation. After omentoplasty, dehiscence of the bronchial stump was observed in 5 (42%) patients, but owing to reinforcement with greater omentum, recurrence of the fistula was observed in only one case. In 3 patients, recurrence of pleural empyema did not lead to the return of the bronchopleural fistula. Hospital mortality was 8.3% (one patient). In patients without bronchopleural fistula recurrence, the median postoperative hospital stay was 31 days. Early omentoplasty for bronchopleural fistula after pneumonectomy is an effective procedure that eliminates purulent bronchopleural complications completely within the shortest possible period of time.
Cellular Cardiomyoplasty for Myocardial Regeneration
Authors: Chachques Juan C , Salanson-Lajos Corinne , Lajos Paul , Shafy Abdel , Alshamry Adel , Carpentier Alain
Published: May 2013

The evolving challenge of managing patients with congestive heart failure is the need to develop new therapeutic strategies. The cellular, molecular, and genetic approaches investigated aim to reinforce the weak, failing heart muscle while restoring its functional potential. This approach is principally cellular therapy (i.e. cellular cardiomyoplasty), the preferred therapeutic choice because of its clinical applicability and regenerative capacity. Different stem cells: bone marrow cells, skeletal and smooth muscle cells, vascular endothelial cells, mesothelial cells, adipose tissue stroma cells, dental stem cells, and embryonic and fetal cells, have been proposed for regenerative medicine and biology. Stem cell mobilization with G-CSF cytokine was also proposed as a single therapy for myocardial infarction. We investigated the association of cell therapy with electrostimulation (dynamic cellular cardiomyoplasty), the use of autologous human serum for cell cultures, and a new catheter for simultaneous infarct detection and cell delivery. Our team conducted cell-based myogenic and angiogenic clinical trials for chronic ischemic heart disease. Cellular cardiomyoplasty constitutes a new approach for myocardial regeneration; the ultimate goal is to avoid the progression of ventricular remodeling and heart failure for patients presenting with ischemic and non-ischemic cardiomyopathies.
Mid-Term Experience with Valved Bovine Jugular Vein Conduits
Authors: Pawelec-Wojtalik Malgorzata , Mrówczyński Wojciech , Wodziński Andrzej , Wojtalik Michal , Henschke Jacek , Sharma Girish K
Published: May 2013

From June 1999 to January 2004, 43 children underwent implantation of a valved bovine jugular vein conduit and correction of complex congenital heart defects. Median age was 1.98 years (range, 11 days – 13.3 years). There were 7 early deaths (16.3%) unrelated to conduit failure or thrombosis. Median follow-up of 36 survivors was 24 months (range, 1–48 months, quartile range, 12–48 months), total follow-up was 78 patient-years. There were 3 late deaths (8.3%) due to infection, pulmonary thromboembolism, and sudden cardiac arrest after re-operation to repair a right ventricular outflow tract aneurysm. There were 2 conduit explantations due to dysfunction and suspected endocarditis. Three patients underwent balloon dilatation of distal stenoses. The mean peak gradient through the pulmonary anastomosis was 15 mm Hg (range, 3–42 mm Hg) among patients free from re-intervention. No severe valve regurgitation was observed. Freedom from re-intervention was 72% at 48 months. This conduit remains a good alternative to homografts. Causes of distal stenosis must be clarified, guidelines for prophylactic anticoagulation must be created, and the role of percutaneous balloon dilatation established.
Value of Wedge Resection for Lung Cancer in Poor Cardiopulmonary Status Patients
Authors: Mahesh Balakrishnan , Forrester-Wood Christopher , Amer Khalid , Ascione Raimondo
Published: May 2013

The strategic management of primary lung cancer in patients with poor cardiopulmonary status is still controversial. The aim of this study was to ascertain the early and late results of wide-margin wedge resection with curative intent in this group of patients. Between January 1995 and January 2002, 24 patients (13 males; mean age, 69.96 years) with baseline poor cardiopulmonary status underwent wide-margin wedge resection of preoperatively diagnosed primary lung cancer. All patients suffered from chronic obstructive pulmonary disease and 9 (37.5%) also had symptomatic ischemic heart disease. Eight patients were in New York Heart Association class III and 12 were in class IV. There were no post-operative deaths. Complications included chest infection in 3, surgical emphysema with prolonged air leak in 1, and atrial fibrillation in 6. Overall 7-year survival was 23.3%. Three patients with ischemic heart disease suffered late non-cancer-related death due to myocardial infarction at 48, 60, and 60 months postoperatively. Cancer-free 5-year survival was 54.3%, with 7/24 (29%) late recurrences. Our study suggests that wide-margin wedge resection is a valuable surgical option for primary lung cancer in patients with poor cardiopulmonary status.
Hydatid Cyst in the Wall of the Ascending Aorta
Authors: Aydin Naz B , Celik Seden , Suzer Asuman , Coruh Turkan , Okay Tamer , Gercekoglu Hakan
Published: May 2013

Hydatid disease rarely involves the aortic wall. We report a case of hydatidosis involving the ascending aorta and the left atrium. The patient underwent replacement of the ascending aorta with a prosthetic Dacron graft and left atrial cystectomy. At the 6-month follow-up, she was leading a normal life.
Off-Pump Coronary Endarterectomy in High-Risk Patients
Authors: Nurozler Feza , Kutlu Tolga , Küçük Güngör , Ökten Candan
Published: May 2013

The outcome of off-pump endarterectomy in patients with diffuse coronary artery disease and increased risk factors for cardiopulmonary bypass was reviewed. Thirty-eight procedures were carried out in 32 patients (21 men and 11 women) aged 59 to 78 years (mean, 69 years). Mean left ventricular ejection fraction was 38.6% (range, 24% – 55%). The number of grafts per patient was 2.6. The left internal mammary artery was used in 29 patients (91%). Endarterectomy was performed on the right coronary artery and its branches (18), the left anterior descending artery (15), diagonal branch (2), and the circumflex system (3). Overall operative mortality was 3.1%. Perioperative myocardial infarction occurred in 6.2%. Follow-up was complete in 30 patients (94%). The mean follow-up period was 14 ± 3.3 months. Late survival was 93%. Freedom from cardiac events that required hospital re-admission was 89%. Freedom from angioplasty of the endarterectomized vessel was 96%. These findings indicate that off-pump endarterectomy can be performed with good results in patients with diffuse coronary artery disease.
Imaging of Calcified Coronary Arteries with Multislice Computed Tomography
Authors: Wittlinger Thomas , Martinovic Ivo , Moosdorf Rainer , Moritz Anton
Published: May 2013

Reliable noninvasive detection of coronary artery disease is a prime goal in clinical cardiology. The aim of this study was to investigate the accuracy of multislice computed tomography in detecting coronary artery disease in correlation to the calcium score. Fifty patients with 61 stenoses > 50% and 41 occlusions underwent multislice computed tomography and conventional coronary angiography. Calcium scoring was calculated for the total coronary artery territory and patients were divided into 3 groups based on this score. Multislice computed tomography visualized 89% (365/500) of all coronary segments. The sensitivity and specificity for detection of stenoses > 50% or occlusion was 47%–92%, and 97%–100% for the calcium score. Forty of 500 segments were underestimated by multislice computed tomography, of which 39 were in the group with a calcium score > 400. Multislice computed tomography allows noninvasive angiographic evaluation of coronary artery disease with high diagnostic accuracy. However, the method strongly depends on the degree of vascular calcification and underestimates the degree of stenosis according to the calcium score. This new technology holds promise for noninvasive risk assessment in patients with known or suspected coronary artery disease.
Repair of a Giant Left Ventricular Pseudoaneurysm in a Jehovah's Witness
Authors: O'Flynn Elizabeth , Purkayastha Sanjay , Athanasiou Thanos , Casula Roberto
Published: May 2013

We report the successful surgical management of a giant chronic left ventricular pseudoaneurysm that developed after an inferior myocardial infarction in a 71-year-old female Jehovah's Witness. The case presented a highly risky challenge to the surgeon because of the faith's stance of refusing blood transfusion.
Mycotic Aneurysm of the Right Coronary Artery
Authors: Omoto Tadashi , Saito Kiyoshi , Kashima Toshitaka , Kume Masato , Hosaka Shigeru , Kimura Sosuke
Published: May 2013

Mycotic embolism in patients with infective endocarditis is not uncommon, however, mycotic aneurysm of a coronary artery is very rare. We report the case of a 62-year-old woman with mitral valve endocarditis complicated by mycotic aneurysm of the right coronary artery. Mitral valve replacement and resection of the mycotic aneurysm with coronary artery bypass were performed.
Valve Repair with Maze Procedure in Acromegaly
Authors: Takeda Koji , Kobayashi Junjiro , Nakajima Hiroyuki , Ishibashi-Ueda Hatsue , Kitamura Soichiro
Published: May 2013

Acromegaly is characterized by a hypersecretion of growth hormone and is frequently associated with valvular abnormality and arrhythmia. The increased morbidity and mortality is primarily caused by stroke and cardiovascular disease. Therefore, valve reconstruction and sinus rhythm recovery will be particularly beneficial. We report herein the successful surgical treatment of two patients with combined valvular insufficiency and chronic atrial fibrillation in the setting of acromegaly.
Aortobronchial Fistula: The Hidden Connection
Authors: Falode Tunde , Alphonso Nelson , Austin Conal , Anderson David
Published: May 2013

A 67-year-old man presented with hemoptysis following 2 previous operations on the descending thoracic aorta. Preoperative investigations and surgical exploration failed to demonstrate an aortobronchial fistula. It was subsequently detected at autopsy after the patient succumbed to a massive bout of hemoptysis.
Apicoaortic Valved Conduit for a Patient with Porcelain Aorta
Authors: Miyatake Tsukasa , Murashita Toshifumi , Oyama Noriko , Yamada Satoshi , Komuro Kaoru , Yasuda Keishu
Published: May 2013

A 69-year-old woman had severe aortic stenosis with a circumferentially calcified aorta from the ascending aorta to the aortic arch, and moderately impaired left ventricular function. Implantation of an apicoaortic valved conduit was performed as aortic clamping was not feasible. The early results were excellent.
Treatment of Right Heart Failure with a New Microaxial Blood Pump
Authors: Christiansen Stefan , Dohmen Guido , Autschbach Rüdiger
Published: May 2013

Isolated postcardiotomy right ventricular failure is rare but associated with a high mortality. Therefore, new developments reducing this mortality are necessary. We report our first successful clinical use of a new paracardiac right ventricular microaxial blood pump which was developed for postcardiotomy right heart failure.
Early Failure of Surgical Angioplasty with Tissue Glue: A Word of Caution
Authors: Malik Asif , Oc Mehmet , Doukas George , Alexiou Christos , Spyt Tomas J
Published: May 2013

A 43-year-old woman with critical stenosis of the left main stem was managed with saphenous vein angioplasty using BioGlue. She developed severe myocardial ischemia postoperatively, probably due to external compression exerted on the patch by the adhesive material, and required emergency coronary artery bypass grafting.
Pneumatic Pump Reduces Leg Wound Complications in Cardiac Patients
Authors: Ho Cally K L , Sun Man Ping , Au Timmy W K , Chiu Clement S W
Published: May 2013

Leg wound complications at the site of vein harvest for coronary artery bypass graft, although infrequent, cause significant morbidity. Pneumatic pressure therapy is valuable in venous and lymphatic diseases, but its usefulness after leg vein harvest has not been determined. A prospective randomized controlled trial was conducted on 200 patients, half of whom had sequential pneumatic leg pump therapy postoperatively. Wound healing, extent of lower limb edema, patient satisfaction, and the financial implications of pneumatic pressure therapy were assessed. In the study group, 71 patients had satisfactory wound healing vs. 23 in the control group. The leg wound infection rate in the study group was 3% vs. 15% in the control group ( p = 0.003). Lower limb edema was significantly reduced in the study group in the early postoperative period ( p < 0.05), and the mean postoperative length of hospital stay was reduced by 2.6 days in patients given pneumatic pressure therapy ( p = 0.003). The sequential pneumatic leg pump is an effective, inexpensive, and convenient device that reduces leg wound complications after coronary artery bypass grafting.
Primary Pulmonary Amyloidosis Due to Low-Grade B Cell Lymphoma
Authors: Georghiou Georgios P , Boikov Olga , Vidne Bernardo A , Saute Milton
Published: May 2013

Pulmonary involvement is not an infrequent complication of systemic amyloidosis, although affected patients rarely have significant pulmonary symptoms. In contrast, localized (primary) pulmonary amyloidosis is rare. We report a case of pulmonary low-grade B cell lymphoma with amyloid production, causing localized pulmonary amyloidosis.
Novel Technique for Proximal Anastomosis of Vein Graft to Right Coronary Artery
Authors: Bhaskar Jayapadman , Sharma Ashok K
Published: May 2013

A novel technique for anastomosis of the proximal (aortic) end of the saphenous vein conduit to the right coronary territory is described. This has proved to be an excellent technique that can be performed expeditiously with minimal assistance. It is easily reproducible with consistent results, even for surgeons in the initial stages of their learning curves.
Evaluation of Bioprosthetic Valve for Small Aortic Root in Elderly Patients
Authors: Shiono Noritsugu , Watanabe Yoshinori , Kawasaki Muneyasu , Yokomuro Hiroki , Fujii Takeshirou , Koyama Nobuya
Published: May 2013

The hemodynamics of stentless bioprostheses are superior to those of mechanical valves, especially for patients with a small aortic root. Between March 1999 and July 2001, we implanted 18 Freestyle stentless porcine valves using our technique of repeated division of the space by halving the distance. Seven patients received 19–21-mm valves and 11 received 23–25-mm valves. Clinical data and early and midterm outcomes of both groups were compared. The mean preoperative echocardiography gradient of the small valve group was 84.7 mm Hg, and when discharged from hospital, the mean gradient was 14.8 mm Hg. One operative death was encountered due to arrhythmia. This stentless porcine prosthesis has excellent hemodynamics and can be implanted safely and easily, even in elderly patients with a small aortic root, using our suture technique.
Fast-Track Cardiac Surgery: Application in an Australian Setting
Authors: Gooi Julian , Marasco Silvana , Rowland Michael , Esmore Don , Negri Justin , Pick Adrian
Published: May 2013

In response to the current state of healthcare in Australia, our unit has employed a fast-track policy for low-risk cardiac surgery patients since January 2000. This study was designed to examine the safety and efficacy of this policy. From July 2001 to June 2004, 342 (23%) of 1,488 patients undergoing cardiac surgery were identified preoperatively as suitable for fast-track recovery. There was a significantly shorter median time to extubation (4 hr vs 9 hr), reduced intensive care unit stay (8 hr vs 26 hr), and a lower rate of readmission to the intensive care unit (0.6% vs 4.2%) for those fast tracked compared to the other patients. The fast-track group had a lower incidence of complications and significantly decreased median length of hospital stay (5 vs 7 days). We concluded that this policy accurately identifies the low-risk cardiac surgery patients suitable for less intensive postoperative recovery.
Influence of Fast-Track Recovery after Coronary Artery Bypass in the Elderly
Authors: Charokopos Nicholas , Antonitsis Polychronis , Toumbouras Michalis , Konstantinopoulos John , Rouska Efthymia
Published: May 2013

We retrospectively analyzed 711 consecutive patients who had isolated coronary artery bypass grafting between January 2000 and December 2004; 572 younger patients (< 70 years) were compared with 139 elderly patients (≥ 70 years). A rapid recovery program based on an anesthetic protocol for early extubation was applied to all patients. The overall hospital mortality rate was 3.3% for the younger group and 4.3% for the elderly group. There were no significant differences in rates of hospital mortality and postoperative complications between the two groups. Early extubation was achieved in significantly more younger (71%) compared to elderly (57%) patients. Rapid recovery with discharge before the 5th postoperative day was achieved in 19% of the elderly compared to 48% of the younger patients. Patients in the younger group were discharged from hospital earlier (6.8 ± 0.3 vs 8.0 ± 8.5 days). Application of fast-track treatment in an elderly population appears to be a safe and effective approach if used on a selective basis when criteria for early extubation are met.
Safe Treatment of Post Thoracotomy Seroma
Authors: Durrleman Nicolas , Pryshipov Maksim , Wihlm Jean-Marie , Massard Gilbert
Published: May 2013

Postoperative seroma is a common complication after muscle-sparing lateral thoracotomy. The main cause is considered to be the result of subcutaneous flap mobilization. We present a case of seroma which occurred following a pneumonectomy owing to subcutaneous flooding with pleural fluid, which was successfully treated by subclavian catheter insertion. The technical aspect of the procedure is described.
Easy Technique for Mounting the Heartstring System into the Sheath
Authors: Takemura Hirofumi , Fukumoto Yukiomi , Miyauchi Tadamasa , Shimabukuro Katsuya , Imaizumi Matsuhisa , Ishida Narihiro
Published: May 2013

The Heartstring system was developed to avoid the use of side-biting aortic clamps, but the sealing system sometimes tears. To solve this problem, a string is wound around the coiled seal and pulled gently.
A Rare Complication of Pneumonectomy: Hiatal Hernia Associated with Gastric Volvulus
Authors: Thorpe James AC , Foroulis Christophoros N , Shah Samir
Published: May 2013

A rare case of intrathoracic gastric herniation resulting in intermittent gastric volvulus was observed in a 69-year-old female patient five months after left pneumonectomy for lung cancer. The mechanism of post-pneumonectomy intermittent gastric volvulus and the techniques of surgical repair are discussed.
Valve Repair in Rheumatic Heart Disease in Pediatric Age Group
Authors: Reddy Pramod K , Dharmapuram Anil K , Swain Sunil K , Ramdoss Nagarajan , Raghavan Sreekanth S , Murthy Kona S
Published: May 2013

Valve repair in children is technically demanding but more desirable than valve replacement. From April 2004 to September 2005, 1 boy and 8 girls with rheumatic heart disease, aged 2–13 years (median, 9 years), underwent valve repair for isolated mitral regurgitation in 5, combined mitral and aortic regurgitation in 2, mitral stenosis in 1, and mitral regurgitation associated with atrial septal defect in 1. Chordal shortening in 7, annular plication in 6, commissurotomy in 1, reconstruction of commissural leaflets in 7 were performed for mitral valve disease. Plication and reattachment of the aortic cusps was carried out in 2 patients. Annuloplasty rings were not used. All patients survived the operation, 8 had trivial or mild residual mitral regurgitation, and 1 had trivial aortic regurgitation. Mean left atrial pressure decreased from 14 to 7 mm Hg postoperatively. During follow-up of 3–18 months, all children were asymptomatic and enjoyed normal activity. None required reoperation. In addition to chordal shortening and annular plication, reconstruction of the commissural leaflets is considered the most important aspect of valve repair. It can be achieved without annuloplasty rings, giving good early and midterm results.
Chylous Pericardial Effusion after Aortic Valve Replacement
Authors: Chaloob Salim S , Brown Michael , Stuklis Robert G
Published: May 2013

Chylous pericardial effusion after open-heart surgery is a rare complication. We report a case of chylous pericardial effusion following aortic valve replacement, which presented as cardiac tamponade, and its subsequent management.
Echocardiographic Follow-Up after Implanting 17-mm Regent Mechanical Prostheses
Authors: Casali Giovanni , Luzi Giampaolo , Vicchio Mariano , Lilla della Monica Paola , Minardi Giovanni , Musumeci Francesco
Published: May 2013

The aim of this study was to evaluate midterm echocardiographic results and changes in quality of life after aortic valve replacement with 17-mm St. Jude Medical Regent mechanical prostheses in patients with aortic valve stenosis. The study population was 34 women and 2 men, aged 31–83 years. Echocardiographic follow-up was 100% complete at 4.1 ± 1.8 years. Hospital mortality was 5.6%. Actuarial 5-year survival was 88.5% ± 0.067%. Postoperative echocardiography showed significant regression of left ventricular mass index and significant reductions of peak gradient, mean gradient and mean effective orifice area index. All survivors were interviewed using the 36-item Short Form Health Survey questionnaire. Scores obtained in 7 of the 8 domains of the test were significantly higher than preoperative values. In our experience, implantation of this prosthesis allowed regression of left ventricular mass index and improved the perceived quality of life.
Ventricular Restoration by Linear Endoventricular Patchplasty and Linear Repair
Authors: Parachuri V Rao , Adhyapak Srilakshmi M , Kumar Praveen , Setty Ravindra , Rathod Ravi , Shetty Devi P
Published: May 2013

Surgical ventricular restoration improves cardiac function in patients with large left ventricular aneurysms. Aneurysm repair techniques have evolved to geometric repair by exclusion of the aneurysmal area with a circular patch. But even circular endoventricular patchplasty may result in a less elliptical ventricle. We modified the techniques of both linear and geometric repair. The early and intermediate outcomes in 102 patients with post-infarction left ventricular aneurysm, treated between 2001 and 2004, were analyzed. Concomitant procedures included coronary artery bypass grafting in 73 patients, mitral valve repair in 29, cryoablation in 3, and post-infarction ventricular septal rupture repair in 3. Overall mortality was 12.7%. Left ventricular ejection fraction increased significantly postoperatively, from 31.5% ± 6.5% to 34.2% ± 5.9%. There were significant decreases in end-diastolic volumes from 140.3 ± 38.3 to 100.8 ± 33.5 mL, and end-systolic volumes from 95.1 ± 26.1 to 66.0 ± 21.7 mL. These benefits continued at the 12- to 52-month follow-up. Our modified technique restores a near physiological left ventricular geometry and has a favorable clinical outcome.
Simple and Reliable Distal Anastomosis for Total Aortic Arch Replacement
Authors: Ohkado Akihiko , Tanaka Akiko , Yamada Akitoshi , Inoue Kyozo , Wakita Noboru
Published: May 2013

In total aortic arch replacement, distal aortic anastomosis is often remarkably difficult because of the deep operative field. Once bleeding from the anastomotic area occurs, it is intractable not only because of technical problems but also decreased coagulability due to deep hypothermia and the fragility of the aortic wall. We describe a simple but reliable strategy for distal anastomosis, which is unique with regard to the approach to the anastomotic area and the anastomotic method.
Bilateral Giant Pulmonary Bronchogenic Cysts
Authors: Liu Ligang , Pan Tiecheng , Wei Xiang
Published: May 2013

Bilateral giant tension bronchogenic cysts were detected by computed tomography in a 13-year-old girl who presented with fever and severe cough. One was located in the right upper lobe, the other in the left lower lobe. The cysts, both measuring 10 cm in diameter, were removed in 2 operations 2 months apart.
Self-Expanding Bifurcation Stent for Malignant Esophagotracheobronchial Fistula
Authors: Lindenmann Joerg , Neuboeck Nicole , Anegg Udo , Matzi Veronika , Maier Alfred , Smolle-Juettner Freyja Maria
Published: May 2013

A 60-year-old man with esophageal carcinoma in the upper 3rd underwent palliative treatment including photodynamic therapy, brachytherapy, external beam irradiation, and esophageal stenting. He developed a symptomatic malignant esophagotracheobronchial fistula that could not be closed by telescope-stenting in the esophagus. Implantation of a self-expanding, covered metal, tracheal bifurcation stent by flexible bronchoscopy resulted in immediate closure of the fistula with an uneventful recovery.
A Rare Case of Adult Pulmonary Myofibromatosis
Authors: Wang Shaohua , Huang Hailong , Ruan Zheng , Song Kangsheng
Published: May 2013

Suspicious bilateral lung nodes were detected incidentally in a 49-year-old man who had undergone a homograft kidney transplant 6 years earlier. Two nodules were excised by a video-assisted left minithoracotomy. The morphological and immunohistochemical patterns were compatible with a diagnosis of pulmonary myofibromatosis.
Temporary Right Ventricular Support with Impella Recover RD Axial Flow Pump
Authors: Sugiki Hiroshi , Nakashima Kuniki , Vermes Emmanuelle , Loisance Daniel , Kirsch Matthias
Published: May 2013

Post-cardiotomyright ventricular failure is a serious complication that frequently results in adverse outcomes. We reviewed our experience with the Impella Recover RD (Impella Cardiosystems GMbH, Aachen, Germany). From January 2007 to December 2007, 7 patients (5 males, 54 + 7 years old) had this device implanted for temporary support after heart transplantation in 4, after repeat mitral valve replacement in 2, and with a left ventricular assist device in 1. Devices were implanted during initial operation ( n = 5) or shortly thereafter ( n = 2). Six patients underwent implantation without cardiopulmonary bypass. Effective support with pump flows of 4.0-4.5 L · min−1 and adequate unloading (central venous pressure decreased from 15.3 ± 1.4 to 9.4 ± 1.2 mm Hg) was achieved in all patients. Patients were assisted for a mean duration of 4.9 ± 4.5 days. Three patients could be weaned after 7.0 ± 5.6 days of support and underwent device explantation without cardiopulmonary bypass. One of these patients died of recurrent right ventricular failure, 2 remained stable but died later of sepsis. The patient with a left ventricular assist device was switched to an alternative device for prolonged support. Two patients experienced pump dysfunction. Our preliminary experience shows that the Impella Recover RD is an effective device that can be easily implanted and explanted. However, its mechanical reliability needs to be improved.
Off-Pump Coronary Surgery causes Immediate Release of Myocardial Damage Markers
Authors: Karu Inga , Tähepöld Peeter , Sulling Toomas Andres , Alver Margus , Zilmer Mihkel , Starkopf Joel
Published: May 2013

Off-pump coronary surgery does not eliminate the risks of ischemia-reperfusion injury. The main objective of this study was to describe the extent and time course of changes in myocardial metabolism and development of myocardial injury associated with revascularization. Coronary sinus and arterial blood samples for measurement of troponin I, creatine kinase MB, lactate, glutathione, and interleukin-6 were taken from 23 patients prior to grafting, after completion of each anastomosis, and up to the 1st postoperative morning. The results were evaluated together with parameters of cardiac function. Release of lactate, creatinine kinase MB, and troponin I into the coronary sinus was evident after completion of the 1st graft, and increased over time. During the procedure, only trace amounts of oxidized and reduced glutathione were detected in coronary sinus and arterial blood. Significant increases in interleukin-6 were found in coronary sinus samples after 5 and 20 min of reperfusion. Surgical trauma during off-pump coronary surgery is sufficient to activate an inflammatory response in the myocardium, together with unfavorable metabolic conditions to cause myocardial necrosis.
Stem Cell Experiments and Initial Clinical Trial of Cellular Cardiomyoplasty
Authors: Guhathakurta Soma , Subramanyan Usha R , Balasundari Ramesh , Das Chandan K , Madhusankar Nainar , Cherian Kotturathu Mammen
Published: May 2013

Growing myocardial cells from human stem cells and stem cell transplantation to repair injured myocardium are new frontiers in cardiovascular research. The 1st stage of this study was conducted to determine whether transplantation of autologous bone marrow stem cells into infarcted myocardium of sheep could differentiate into beating cardiomyocytes. The 2nd stage was to demonstrate transdifferentiation of human bone marrow mesenchymal stem cells to precursor cardiomyocytes in vitro, using a novel conditioning medium. In the 3rd stage, a clinical trial of stem cell implantation in patients with severe myocardial dysfunction involved injection of peripheral blood-derived endothelial precursor cells in 11 patients and autologous bone marrow mononuclear cells in 29. A marginal improvement in myocardial function was noted at 3 months (mean increase in ejection fraction, 6% ±1%), although it plateaued at 6 months. The trial proved to be safe because there was no procedure-related mortality. There is growing optimism that stem cell therapy may delay heart transplantation.
3-Dimensional Structures to Enhance Cell Therapy and Engineer Contractile Tissue
Authors: Schussler Olivier , Chachques Juan C , Mesana Thierry G , Suuronen Erik J , Lecarpentier Yves , Ruel Marc
Published: May 2013

Experimental studies in animals and recent human clinical trials have revealed the current limitations of cellular transplantation, which include poor cell survival, lack of cell engraftment, and poor differentiation. Evidence in animals suggests that use of a 3-dimensional scaffold may enhance cell therapy and engineer myocardial tissue by improving initial cell retention, survival, differentiation, and integration. Several scaffolds of synthetic or natural origin are under development. Until now, contractility has been demonstrated in vitro only in biological scaffolds prepared from decellularized organs or tissue, or in collagenic porous scaffold obtained by crosslinking collagen fibers. While contractility of a cellularized collagen construct is poor, it can be greatly enhanced by tumor basement membrane extract. Recent advances in biochemistry have shown improved cell-matrix interactions by coupling adhesion molecules to achieve an efficient and safe bioartificial myocardium with no tumoral component. Fixation of adhesion molecules may also be a way to enhance cell homing and/or differentiation to increase local angiogenesis. Whatever the clinically successful combination ultimately proves to be, it is likely that cell therapy will require providing a supportive biochemical, physical, and spatial environment that will allow the cells to optimally differentiate and integrate within the target myocardial tissue.
Beating-Heart Tricuspid Annuloplasty Using the Tailor Flexible Ring
Authors: Izutani Hironori , Nishikawa Dairoku , Kubota Yasuhiko , Kashiyama Noriyuki
Published: May 2013

We describe a standard procedure of tricuspid annuloplasty using the St. Jude Medical Tailor Flexible Ring with a beating-heart technique. This flexible ring is supposed to be more physiological than a rigid ring for reducing mechanical stress on the annulus. To avoid zigzag the flexible ring when tying the sutures, they must be placed at exactly the same distance apart on both the tricuspid annulus and the ring.
Primary pulmonary synovial cell sarcoma: radiological findings and management
Authors: Jindal Tarun , Dutta Roman , Kumar Arvind , Kumar Rakesh , Kumar Narender , Choudhary Shiv Kumar
Published: May 2013

Primary pulmonary synovial cell sarcoma is a rare tumor without specific symptoms, signs, or radiological features. The role of functional imaging has not yet been evaluated, and diagnosis is usually made on histopathological examination. Positron-emission computed tomography findings and surgical resection in a 22-year-old man and a 40-year-old woman are described.
Continuous absorbable suture technique for tracheobronchial sleeve resections
Authors: Chakaramakkil Mathew Jose , Jim Loh Yee , Soon Jia-Lin , Agasthian Thirugnanam
Published: May 2013

From January 2000, we changed from the traditional interrupted suture technique for tracheobronchial sleeve resections to a continuous suture technique with absorbable suture. This retrospective study reviewed our experience in the first 50 consecutive patients operated on between January 2000 and August 2006. The median age was 61 years (range, 30 to 80 years). There were 35 men and 15 women, 49 had malignant disease, and 1 had a benign tumor. Two patients had tracheal resection without removal of lung parenchyma; all others underwent sleeve lobectomy. There was 1 (2%) operative death due to pneumonia, and 8 (16%) postoperative complications including atrial fibrillation, lobar atelectasis, prolonged parenchymal air leak, empyema, paralytic ileus, and chylothorax. There was no anastomotic dehiscence or bronchopleural fistula. None of the patients developed stricture at the anastomotic site when followed up for a mean duration of 18.6 months. The continuous suture technique is easy to perform and the results are comparable with those of the interrupted suture technique. The use of absorbable suture appears to reduce the incidence of stricture at the anastomotic site.
Open vertical vein in non-obstructed supracardiac TAPVC: merits and fate
Authors: Hote Milind Padmakar , Garg Sanket , Choudhury Minati , Raghu Maruti Govindappa
Published: May 2013

Data of 18 patients who underwent surgical repair of non-obstructed supracardiac total anomalous pulmonary venous connection between January 2007 and March 2011 were reviewed. The vertical vein was left patent in all patients as an elective surgical strategy. There was no operative mortality in patients with or without preoperative pulmonary infection, but there were significant differences in postoperative airway pressures, ventilation time, intensive care unit and hospital stay between the 2 groups. None of the patients demonstrated any flow in the vertical vein over a 30-day follow-up period. One patient had a mild anastomotic stricture and pulmonary venous hypoplasia. Operative repair of supracardiac total anomalous pulmonary venous connection can be carried out successfully without ligation of the vertical vein, and this strategy possibly reduces early postoperative morbidity and mortality, with no adverse effects detected in the short to midterm follow-up.
Rupture of abdominal aortic aneurysm with shrinkage after endovascular repair
Authors: Morishita Hiroyuki , Takayama Yutaka , Nagata Rihito , Yokoyama Yuichiro , Yoshimi Fuyo , Nagai Hideo
Published: May 2013

An 85-year-old man, who had undergone endovascular abdominal aortic aneurysm repair 8½ years earlier, was transferred to the emergency department with chest pain and transient loss of consciousness. Computed tomography revealed a ruptured abdominal aortic aneurysm with a stent graft inside. His aneurysm was 62 mm in diameter at the endovascular repair, but 45 mm at the rupture site. He was rescued by emergency aneurysmectomy.
Results of one-hundred and seventy patients after elective Bentall operation
Authors: Verbakel Karin MJ , van Straten Albert HM , Hamad Mohamed A Soliman , Tan Erwin SH , ter Woorst Joost F
Published: May 2013

The aim of this study was to evaluate the short and long-term operative results of patients who underwent a Bentall procedure in a 12-year period. We retrospectively analyzed the data of 170 patients who underwent an elective Bentall procedure between January 1998 and July 2010. All pre- and perioperative variable were entered into a multivariate regression model to identify significant predictors of early and late mortality. The early mortality rate was 11.2% (19/170 patients). Multivariate logistic regression analysis identified prior cardiac operation and cardiopulmonary bypass time as independent risk factors for early mortality, with odds ratios of 5.75 (95% confidence interval: 1.850–17.874; p = 0.003) and 1.011 (95% confidence interval: 1.003–1.019; p = 0.008), respectively. The Kaplan-Meier curve shows an overall survival of 78% ± 4% at 5 years and 66% ± 10% at 10 years. Cox regression analysis revealed no independent risk factors for late mortality. The Bentall procedure is still the procedure of choice for aortic root replacement. Improvements in perioperative management in recent years has improved the early outcome, and in our experience, the late results of this technique were satisfactory.
A 17-year-old with neurofibromatosis and spontaneous coronary artery dissection
Authors: Uyar Ihsan Sami , Uyar Belkız , Okur Faik Fevzi , Akpinar Besir , Abacilar Feyzi , Ates Mehmet
Published: May 2013

A 17-year-old girl with neurofibromatosis type 1 presented with unstable angina. Cardiac catheterization revealed an aneurysm with thrombus in the left anterior descending coronary artery. She was discharged on medical treatment but returned 2 months later with severe chest pains. Angiography revealed an increase in the size of the aneurysm in the left anterior descending coronary artery, with thrombus and dissection. The patient underwent coronary artery bypass surgery. Follow-up after 1 year revealed no problems.
Pulmonary cusp augmentation in repair of tetralogy of Fallot
Authors: Attanawanich Sukasom , Ngodgnamthaweesuk Montein , Kitjanon Narumol , Sitthisombat Chanawit
Published: May 2013

Background: pulmonary insufficiency after transannular patch repair of tetralogy of Fallot is associated with a poorer outcome.

Objective: to compare the results of 2 techniques of transannular patch repair.

Methods: 93 patients with tetralogy of Fallot and hypoplasia of the right ventricular outflow tract underwent repair between 1990 and 2004 by 2 different techniques. Their ages ranged from 6 months to 12 years. The conventional transannular patch repair was used in 38 patients and 55 had transannular patch repair with pulmonary cusp augmentation.

Results: mortality rates were 13.16% after conventional transannular patch repair and 0% after transannular patch repair with pulmonary cusp augmentation. Follow-up periods were 13–18 years (mean, 15.7 ± 1.64 years) and 5–14 years (mean, 10.8 ± 2.07 years), respectively. The early and midterm results demonstrated significantly more pulmonary insufficiency in the conventional repair group. Transannular patch repair with pulmonary cusp augmentation had longer bypass and operative times, but it was associated with a lower operative mortality than conventional repair. The long-term results showed differences in pulmonary insufficiency, cardiothoracic ratio, and rate of reoperation for pulmonary valve replacement.

Conclusion: reconstruction of the native pulmonary valve accompanied by pulmonary cusp augmentation can reduce postoperative pulmonary insufficiency and has a more favorable long-term outcome.
Descending necrotizing mediastinitis associated with spinal cord abscess
Authors: Dajer-Fadel Walid Leonardo , Borrego-Borrego Rafael , Flores-Calderón Octavio , Argüero-Sánchez Rubén , Navarro-Reynoso Francisco Pascual , Ibarra-Pérez Carlos
Published: May 2013

A 58-year-old man with a history of Ludwig’s angina was admitted with a spinal cord abscess at the level of C2-T1 and associated osteomyelitic destruction of vertebral bodies, spinal cord compression, and secondary quadriparesis, followed by descending mediastinitis. A right posterolateral thoracotomy and a cervicotomy drained purulent exudates. A tracheostomy was performed, and the patient was discharged after 84 days.
Sternal traction: simple technique to prevent tamponade/compression of the heart
Authors: Kandakure Pramod Reddy , Ramodass Nagarajan , Rani Usha , Chakravarthy Srinivas , Rao Ivatury Mrutunjay , Kona Samba Murthy
Published: May 2013

Routine closure of the sternum after cardiovascular surgery sometimes causes severe cardiac depression because of tamponade, leading to cardiogenic shock. We describe a full-thickness chest wall traction suture taken parasternally and tied to an intravenous fluid stand. Upward (outward) traction is applied to the anterior chest while the sternum is primarily closed, which allows physiologic improvement equivalent to delayed sternal closure. It is a safe and easily reproducible technique.
The Use of Aprotinin in Pediatric Cardiac Surgery
Authors: Huiming Huang , Wenxiang Ding , Zhaokang Su , Dinfang Cao , Deming Zhu , Haibo Zhang
Published: May 2013

From April 1990 to December 1992, we used aprotinin in 80 pediatric cases undergoing cardiac surgery. Most patients had moderate to severe tetralogy of Fallot and other complex cyanotic diseases, and 12 cases were reoperated. One-half to one-third of the recommended dose was adopted, and 3 different patterns of administration were compared. All procedures achieved good results with less postoperative bleeding. We suggest the simplest procedure—adding 1 bolus dose of aprotinin to the pump prime—as the method of choice.
Coronary Artery Bypass Surgery in Asia–1992
Authors: Neng Lee Chuen
Published: May 2013

A review of coronary artery bypass surgery in 1992 was conducted by surveying the countries in Asia. The result of the survey is presented. Of the 12 countries that have replied to the survey, the number of coronary artery bypass operations per million of population varied widely, ranging from 390 cases per million to 0.08 cases per million. With certain exceptions, there is a rough correlation between the number of cases done and the infant mortality rate, doctor population ratio, and the per capita gross national product. An additional 7 countries are known not to perform coronary artery bypass surgery at the moment. The overall trend of the past 5 to 10 years is a steady increase in the number of bypass operations done in Asia. The factors influencing these numbers are complex and involve not only the availability of facilities and manpower, the economic situation in each country, prevalence of the disease, and demographics, but also the opportunities for training surgeons and the treatment philosophy of the medical community. It is expected that in the next decade there will be a substantial increase in the level or rates of coronary artery bypass surgery throughout Asia.
Video-Assisted Thoracoscopy Yonsei University Experience
Authors: Yun Lee Doo , Kyoon Kim Hae , Chae Paik Hyo
Published: May 2013

Video-assisted thoracoscopy (VAT) is a new modality that allows visualization and access to the intrathoracic organs without performing posterolateral thoracotomy incision. Recent advancements in endoscopic equipment and surgical techniques have expanded the applications of VAT in thoracic surgery. We performed 171 VAT cases, which previously would have been performed through thoracotomy incisions in 116 patients. The operations performed included 3 wedge resections of the pulmonary nodule, 14 pleural or lung biopsies, 1 pericardial window formation, 93 sympathectomies, 40 bullectomies and pleurodeses, 16 biopsies or excisions of mediastinal mass, and 4 lobectomies. Patients who received operation by VAT seemed to have much less postoperative pain and lower complication rates allowing early recovery and shorter hospitalization.