bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of Perioperative Blood Glucose Management in Cardiac Surgical Patients
Authors: Shine Timothy SJ , Uchikado Mihoko , Crawford Claudia C , Murray Michael J
Published: May 2013

Tight blood glucose control has become a therapeutic goal for anesthetic management of patients undergoing cardiovascular surgery. We discuss the evidence for a link between blood glucose levels and rates of morbidity and mortality in cardiac surgical patients in the intensive care unit. Hyperglycemia per se has been associated with higher rates of deep wound infection, neurologic, renal, and cardiac complications following surgery, as well as longer intensive care unit stay. We review the specifics of glucose management in patients undergoing cardiac surgery and hypothermic cardiopulmonary bypass, including the role that insulin may play in regulating blood glucose levels intraoperatively and the relationship between insulin and outcome.
Acute Fatal Post-CABG Low Dose Amiodarone Lung Toxicity
Authors: Argyriou Mihalis , Hountis Panagiotis , Antonopoulos Nicolaos , Mathioudaki Maria
Published: May 2013

Amiodarone is one of the commonly used anti-arrhythmic agents with well-recognized chronic pulmonary toxicity. We present our experience of a patient with a fatal outcome after coronary artery bypass grafting and a short course of amiodarone treatment with a low total cumulative dose for the treatment of postoperative atrial fibrillation. Necropsy revealed diffuse pulmonary damage due to acute amiodarone lung toxicity.
Combined Coronary Artery Re-Operation and Pulmonary Resection for Hemoptysis
Authors: Abe Tomonobu , Kajiyama Makoto , Ohara Keiji , Asaoka Mineo , Toyama Masashi , Kobayashi Atsukata
Published: May 2013

We present a 59-year-old woman who underwent combined pulmonary resection for bronchiectasis with massive, recurrent hemoptysis and redo coronary artery bypass. She had previously been hospitalized four times for massive hemoptysis. She had also undergone coronary artery bypass and had symptomatic severe graft disease. We performed simultaneous right middle lobectomy and redo triple bypass. At surgery, lobectomy was performed before heparinization, then redo bypass was performed using on-pump cardiopulmonary bypass. The postoperative course was uneventful.
Neonatal Blalock-Taussig Shunt: Technical Aspects and Postoperative Management
Authors: Swain Sunil K , Dharmapuram Anil K , Reddy Pramod , Ramdoss Nagarajan , Raghavan Sreekanth S , Kona Samba M
Published: May 2013

A systemic-pulmonary artery shunt in neonates with decreased pulmonary blood flow is technically demanding. We describe our surgical technique, postoperative management, and results in 19 neonates who underwent a modified Blalock-Taussig shunt between April 2003 and March 2006. Prostaglandin infusion was required in 8 patients who were critically cyanosed, and 5 were on inotropic support preoperatively. A 3.5 or 4.0-mm polytetrafluoroethylene graft was anastomosed with 8/0 polypropylene suture. Postoperatively, systemic pressure was kept slightly higher than normal, and heparin was started early. One patient required revision of the shunt, and one was reexplored for bleeding. There were 2 hospital deaths (mortality, 11%) in patients with preoperative hemodynamic instability. The mean follow-up period was 12 months, with no late postoperative shunt blockage or death. Meticulous surgical technique and judicious use of heparin and inotropic agents improved the outcome and reduced the incidence of shunt blockage and reexploration for bleeding.
Off-Pump Coronary Artery Bypass Grafting in Left Ventricular Dysfunction
Authors: Masoumi Masoumali , Saidi Mohammad R , Rostami Farhanaz , Sepahi Helen , Roushani Daem
Published: May 2013

Between August 2004 and May 2006, 124 patients undergoing coronary artery bypass grafting with ejection fractions ≤ 35% were randomly assigned to off-pump or conventional procedures. Preoperative characteristics were the same in both groups, except for age and degree of mitral regurgitation. Off-pump coronary artery grafting was carried out using a tissue stabilizer and a single-suture technique; conventional coronary bypass employed cardiopulmonary bypass, moderate hypothermia, and antegrade-retrograde cold blood cardioplegic arrest. There were significantly fewer vessels grafted (3.09 ± 0.41) in the off-pump group than in those who had a conventional procedure (3.42 ± 0.86). The rates of mortality, morbidity, balloon pump support, inotropic usage, gastrointestinal bleeding, renal dysfunction, reintubation, as well as intensive care and hospital stay, were significantly lower in the off-pump group. The incidence of perioperative myocardial infarction did not differ significantly between groups. The results of this study indicate that beating-heart coronary bypass is safe and effective in patients with left ventricular dysfunction.
Coronary Artery Fistulas in Pulmonary Atresia and Ventricular Septal Defect
Authors: Collison Sathiakar P , Dagar Kulbhushan S , Kaushal Sunil K , Radhakrishanan Sitaraman , Shrivastava Savitri , Iyer Krishna S
Published: May 2013

Pulmonary atresia with ventricular septal defect is an anomaly with highly variable anatomy. Rarely, a coronary artery-to-pulmonary artery fistula may contribute to pulmonary blood flow. Since 1996, we have treated 4 patients with coronary-pulmonary fistula associated with pulmonary atresia and ventricular septal defect. Two fistulas originated from the left coronary, one from the right coronary, and one from a right-sided solitary coronary system. All terminated in the main pulmonary artery, which was adequate in all cases. The fistulas were managed by direct internal closure. Total intracardiac repair was then accomplished in all patients at the same sitting. There was one death. In children with favorable anatomy, direct closure of the fistula from the pulmonary artery is adequate and allows single-stage intracardiac repair.
Is Treatment of Acute Type A Aortic Dissection in Septuagenarians Justifiable?
Authors: Shrestha Malakh , Khaladj Nawid , Haverich Axel , Hagl Christian
Published: May 2013

This study was undertaken to analyze the risk of mortality and neurological complications after treatment of acute type A aortic dissection in septuagenarians. From 1996 through 2002, 24 patients > 70 years underwent surgery for acute type A aortic dissection. Their median age was 75 years (range, 71–82 years), and 15 were male. Eleven (46%) had previous neurological events, 22% presented with hemodynamic instability and aortic rupture was found in 7%. Ten had hypothermic circulatory arrest alone, 3 had it in combination with retrograde cerebral perfusion and 11 had selective antegrade cerebral perfusion as an adjunct. The overall survival rate was 71% (17/24). Temporary neurological dysfunction was found in 3 (12.5%), and permanent neurological dysfunction in 9 (37.5%), leading to death in 3. Comparison of mortality rates and neurological outcome showed a marked tendency towards better outcome in patients who had hypothermic circulatory arrest and selective antegrade cerebral perfusion. Surgery for aortic dissections in the elderly can be performed with acceptable mortality, but there is a high rate of neurological complications. Despite the small number of patients, selective antegrade cerebral perfusion seemed to reduce the incidence of neurological events.
Replacement of Right Coronary Leaflet with Bovine Pericardium
Authors: Tao Liang , Zeng Xiang-Jun
Published: May 2013

Bovine pericardium was used to replace the right coronary leaflet to manage aortic insufficiency resulting from ventricular septal defect in 6 patients aged 15 to 34 years. Aortic insufficiency was severe in 5 patients and moderate in one. In all patients, the ventricular septal defect was repaired before aortic valvuloplasty. They were followed up for 5 to 6 months. No mortality was observed. Three patients had relief of aortic insufficiency, 2 had mild residual aortic insufficiency, and one had minor insufficiency not requiring re-operation. Replacement of the right coronary leaflet with bovine pericardium is a promising technique for young patients. The short-term outcomes are encouraging, but longer follow-up is required to assess the durability and function of bovine pericardium in the aortic position.
Surgical Closure of Adult Patent Ductus Arteriosus Using a Pursestring Suture
Authors: Inaba Hirotaka , Higuchi Kazuhiko , Koseni Kenji , Osawa Hiroshi , Kinoshita Osamu
Published: May 2013

A 52-year-old woman with patent ductus arteriosus underwent transpulmonary surgical closure through a median sternotomy. The procedure was performed under cardiopulmonary bypass with normothermia and a beating heart, using transductal balloon occlusion and a pursestring suture around the orifice of the ductus. The use of a pursestring suture allowed minimization of the risk of balloon breakage, obviated the need for profound hypothermia and circulatory arrest, and greatly increased the technical facility of the procedure.
Clear-Cut Complete Rupture of Origin of Right Main Bronchus
Authors: Mihos Petros T , Potaris Konstantinos , Gakidis Ioannis , Myrianthefs Pavlos M , Baltopoulos George J
Published: May 2013

Complete rupture of the main bronchus after blunt thoracic trauma is rare. Most patients with blunt traumatic injury to the trachea or bronchus die before arriving at hospital. A 26-year-old man with complete right main bronchus rupture was successfully treated by urgent surgical intervention and postoperative fiberoptic bronchoscopy for bronchial toilet.
Right Coronary Artery Translocation in Tetralogy of Fallot
Authors: Luo Wan-Jun , Huang Ri-Mao , Tang Yong , Li Bei
Published: May 2013

We describe a simple and cost-effective technique to repair anomalous origin of the right coronary artery from the left coronary artery in tetralogy of Fallot. The proximal right coronary artery is re-implanted into the aorta after it is mobilized and transected. This technique avoids the use of conduits in infants or adults with tetralogy of Fallot and anomalous right coronary arteries, and maintains the growth potential of the translocated native coronary artery.
Vettath's Blower and Blower/Mister — A Simple Device for OPCAB Surgery
Authors: Vettath Murali P , Vellachamy Kannan A , Talya Rameshwara , Thazhakuni Ismail , Moothencheri Jayaprakash , Thomas Jiji
Published: May 2013

Since the advent of off-pump coronary artery bypass surgery, a blower/mister has been routinely used in cardiac operation theatres. In our setup, in an attempt to reduce the cost of coronary artery bypass grafting by performing off-pump coronary artery bypass, reusable materials have been routinely used.
Conduit from Hypoplastic Right Ventricle to Pulmonary Artery in Tricuspid Atresia
Authors: Amanullah Muhammad M , Hasan Asif , Kirk Richard
Published: May 2013

Tricuspid atresia with transposition of the great arteries produces single ventricle physiology. Ultimate goals of neonatal palliative operations are to provide optimum anatomic and physiologic conditions for a Fontan procedure. A modification of the Norwood procedure is reported, with an aorto-pulmonary anatomosis, utilizing the hypoplastic right ventricle as the pulmonary outflow conduit, avoiding a left ventriculotomy and preserving its function with excellent recovery. We believe this technique has not been previously published in the English literature.
Coronary Heart Disease Service Framework for Revascularization in Pakistan
Authors: Elahi Maqsood M , Khan Jawad S
Published: May 2013

Many centers across the country have used collaborative techniques to identify problems and come up with innovative solutions. Excellent improvements have been made in every aspect of the patient's journey through the cardiac surgery services, such as decreased length of stay, reduced clinical variation and costs, and improved outcome. We looked at how the cardiac surgical team at our center is helping to improve services for patients undergoing coronary revascularization. Improvements are not just focused on waiting lists or operating rooms but reflect the wider experience of patients and their families.
Left Ventricular-Right Atrial Communication Complicated by Aortic Regurgitation
Authors: Okamura Toru , Nagase Yuzo , Mitsui Fujio , Shibairi Masao
Published: May 2013

We report a case of left ventricular-right atrial communication complicated by aortic valve incompetence in a 29-year-old man. The patient had a history of heart murmur during childhood. There were no clinical signs of infection. We performed plication of the aortic valve and patch closure of the left ventricular-right atrial communication under cardiopulmonary bypass. The patient improved immediately after the operation.
Differentiation of Ischemic and Dilated Cardiomyopathy on Electrocardiograms
Authors: Aghasadeghi Kamran , Aslani Amir
Published: May 2013

Differentiating coronary artery disease with left ventricular dysfunction from dilated cardiomyopathy is important prognostically and therapeutically. To provide a diagnostic algorithm to distinguish these conditions using a standard 12-lead electrocardiogram, all 105 patients with left ventricular ejection fraction < 50% who underwent angiography between January 2004 and December 2006 were studied prospectively. Coronary artery disease was defined as ≥ 50% stenosis of the left main coronary artery or ≥ 70% stenosis of 1 or more of the 3 major epicardial arteries. Normal coronary angiography findings with left ventricular ejection fraction < 50% was defined as dilated cardiomyopathy. The most specific finding for differentiation of these diseases was pathologic Q waves in lead II, aVF, V3 or V4. The most sensitive parameter was a ratio ≥ 5 of R-wave amplitudes in lead V6 and lead III (94% sensitive). The 12-lead electrocardiogram provides a useful noninvasive method for differentiation of dilated cardiomyopathy from coronary artery disease with left ventricular systolic dysfunction.
Valvuloplasty in the Treatment of Rheumatic Tricuspid Disease
Authors: Pande Shantanu , Agarwal Surendra K , Majumdar Gauranga , Kapoor Aditya , Kale Niraj , Kundu Anirban
Published: May 2013

Organic involvement of the tricuspid valve is uncommon. Valve repair is preferred over replacement as it results in a low gradient across the valve and obviates the risk of prosthesis-related complications. From October 2002 to October 2004, 37 patients who required tricuspid valve repair for organic involvement were included in this study. They were divided into 2 groups depending on the surgical procedure for valve repair: 20 patients in group 1 had tricuspid commissurotomy and De Vega annuloplasty; 17 in group 2 had tricuspid commissurotomy only. There were significant reductions in peak and mean tricuspid gradients and right ventricular systolic pressure in both groups. Annular shortening was similar in both groups (median, 23% in group 1, 21% in group 2), but the ratio of the tricuspid regurgitation jet area to right atrial area was greater in group 2 (median, 0.40 in group 2, 0.19 in group 1). There was no postoperative death. We recommend supporting the tricuspid annulus with annuloplasty in patients with organic tricuspid valve disease and no dilatation of the annulus, if annular shortening is < 30%.
Abscess of Residual Lobe after Pulmonary Resection for Lung Cancer
Authors: Ligabue Tommaso , Voltolini Luca , Ghiribelli Claudia , Luzzi Luca , Rapicetta Cristian , Gotti Giuseppe
Published: May 2013

Abscess of the residual lobe after lobectomy is a rare but potentially lethal complication. Between January 1975 and December 2006, 1,460 patients underwent elective pulmonary lobectomy for non-small-cell lung cancer at our institution. Abscess of the residual lung parenchyma occurred in 5 (0.3%) cases (4 bilobectomies and 1 lobectomy). Postoperative chest radiography showed incomplete expansion and consolidation of residual lung parenchyma. Flexible bronchoscopy revealed persistent bronchial occlusion from purulent secretions and/or bronchial collapse. Computed tomography in 3 patients demonstrated lung abscess foci. Surgical treatment included completion right pneumonectomy in 3 patients and a middle lobectomy in one. Complications after repeat thoracotomy comprised contralateral pneumonia and sepsis in 1 patient. Residual lobar abscess after lobectomy should be suspected in patients presenting with fever, leukocytosis, bronchial obstruction and lung consolidation despite antibiotic therapy, physiotherapy and bronchoscopy. Computed tomography is mandatory for early diagnosis. Surgical resection of the affected lobe is recommended.
Management of Malignant Pleural Effusion Associated with Trapped Lung Syndrome
Authors: Qureshi Rizwan A , Collinson Sandra L , Powell Roy J , Froeschle Peter O , Berrisford Richard G
Published: May 2013

Management of recurrent malignant pleural effusion associated with trapped lung syndrome remains problematic. An alternative treatment using a pleural catheter has been advocated. Between August 1999 and August 2002, 127 patients underwent thoracoscopy for malignant pleural effusion. Of these, 52 (41%) with trapped lung were managed by insertion of a pleural catheter. Mean age was 66 years (range, 42–89 years). The most frequent diagnosis was breast cancer. Spontaneous pleurodesis (drainage < 10 mL) occurred in 25 (48%) patients whose catheter was removed after 30 to 255 days (mean, 93.8 days). Symptomatic relief was achieved in 49 (94%) patients. Mean dyspnea score improved significantly from 3.0 to 1.9. Complications comprised catheter blockage, surgical emphysema, cellulitis, and loculated effusion in 2 patients each. Mean length of hospital stay was 3 days (range, 1–16 days). Median survival was 126 days (range, 10–175 days). We conclude that long-term placement of a pleural catheter provides effective palliation for malignant pleural effusion associated with trapped lung syndrome.
Endoscopic vs Conventional Vein Harvesting: A Prospective Analysis
Authors: Vaidyanathan Karthik R , Sankar Madhu N , Cherian Kotturathu M
Published: May 2013

Minimally invasive vein harvesting is associated with better leg wound healing and a lower incidence of wound infections. We analyzed our experience in 2 prospectively enrolled groups of non-randomized patients undergoing elective coronary artery bypass grafting. Group 1 was 81 patients who had endoscopic vein harvesting; group 2 was 80 who had conventional open vein harvesting. The time taken for endoscopic harvest (skin incision to skin closure) was significantly less than that for open harvest (51.07 vs 75.94 min). The number of cases to reach a plateau on the learning curve for endoscopic vein harvest was 20 for 2 lengths of vein and 35 for 3 lengths of vein. Significantly more suture repairs per vein were required in group 1 (1.32) than group 2 (0.38). The incidence of wound infection was 1.2% in group 1 vs 8.8% in group 2. Endoscopic vein harvesting is not difficult to learn and it should be preferred over open vein harvest, given its benefits in wound healing.
Intramyocardial Angiogenic Cell Precursor Injection for Cardiomyopathy
Authors: Arom Kitipan V , Ruengsakulrach Permyos , Jotisakulratana Vibul
Published: May 2013

Stem cell therapy for heart failure is a rapidly progressing field. The objective of this study was to assess the safety, and short-term results of thoracoscopic direct injection of angiogenic cell precursors into patients with endstage cardiomyopathy. Cells were obtained from the patient's own blood, avoiding immunological concerns. The number of cells prior to injection was 29.1 ± 18.9 ×106. Forty-one patients with cardiomyopathy (mean age, 58.5 ± 14.3 years) underwent stem cell injection; 21 had dilated cardiomyopathy and 20 had ischemic cardiomyopathy. Overall ejection fraction improved significantly by 4.8% ± 7.5% at 149 ± 98 days postoperatively. It increased from 25.9% ± 8.6% to 28.7% ± 9.8% in dilated cardiomyopathy, and from 26.6% ± 5.8% to 33.6% ± 7.8% in ischemic cardiomyopathy. New York Heart Association functional class was significantly better at 2 months in both groups. It was concluded that thoracoscopic intramyocardial angiogenic cell precursor injection is feasible and safe in patients with cardiomyopathy. The early results are good, and phase II trials are in progress.
Late Presentation of Cor Triatriatum with Persistent Levoatrial Cardinal Vein
Authors: Feltri Cristiana , Crawley Cinzia , Peart Ian , Pozzi Marco , Corno Antonio F
Published: May 2013

An asymptomatic 10-year-old boy presented with reduced exercise tolerance and an echocardiographic diagnosis of cor triatriatum. Transthoracic and transesophageal echocardiography failed to reveal the persistent levoatrial cardinal vein discovered at surgery. In patients with late presentation of cor triatriatum with severe mitral inflow obstruction and a small patent foramen ovale, an alternative communication between the posterior collecting chamber and the systemic venous circulation should be sought with alternative imaging techniques.
Angiosarcoma Presenting as Syncope
Authors: Nayar Sushma , Nayar Pradeep G , Cherian KM
Published: May 2013

A 31-year-old lady presented with anemia and syncope. Echocardiography revealed massive pericardial effusion with a right atrial mass. Transesophageal echocardiography, computed tomography and magnetic resonance imaging scans confirmed presence of a right atrial mass. Histopathology revealed a high grade angiosarcoma. Complete resection was done and the patient was referred to an oncology unit for further management. After three months the patient had extensive metastasis and succumbed to the disease. This case report highlights the clinical presentation, rapid and aggressive course of cardiac angiosarcomas.
Current Status of Off-Pump Coronary Artery Bypass Surgery
Authors: Raja Shahzad G , Dreyfus Gilles D
Published: May 2013

The expanding indications for angioplasty coupled with the successful short and mid-term results of randomized controlled trials of drug-eluting stents have already had an unquestionable impact on the practice of coronary revascularization operations. However, coronary artery bypass grafting remains a major mode of therapy for coronary artery disease. It is likely that surgery will continue to be preferred for more complex subsets and that surgeons will have to continue to maintain good results in patients with more complex problems. Concerns regarding morbidity associated with conventional surgical myocardial revascularization on cardiopulmonary bypass have led to a resurgence of interest in off-pump bypass surgery during the last decade, with the expectation that it would be safer if cardiopulmonary bypass could be avoided. This review summarizes the impact of off-pump bypass surgery in reducing the morbidity and mortality associated with conventional coronary artery bypass on cardiopulmonary bypass by evaluating the current best-available evidence from randomized controlled trials and meta-analyses comparing off-pump surgery with conventional bypass grafting.
Double Outlet Right Ventricle with Anomalous Left Pulmonary Artery
Authors: Bockeria Leo A , Makhachev Osman A , Sobolev Andrey V , Plakhova Viktoria V , Gorbachevsky Sergey V , Zaets Sergey B
Published: May 2013

We describe a rare case of anomalous origin of the left pulmonary artery from the ascending aorta with concomitant double-outlet right ventricle in a 2-year-old boy. He underwent successful 2-stage surgical treatment with transluminal balloon pulmonary valvuloplasty, followed by complete repair. A follow-up examination at 4 years after the operation showed good results.
Effect of Completion of Cardiac Rehabilitation on Heart Rate Recovery
Authors: Soleimani Abbas , Salarifar Mojtaba , Kasaian Seyed E , Sadeghian Saeed , Nejatian Mostafa , Abbasi Ali
Published: May 2013

To evaluate the effects of a cardiac rehabilitation program on heart rate recovery after percutaneous transluminal coronary angioplasty, a historical cohort study was performed on 436 patients of whom 285 were grouped on completion of 5, 10, or 24 training sessions. All 3 groups showed significant improvements in heart rate recovery, peak heart rate during treadmill testing, and end-training heart rate, from baseline to follow-up. Heart rate recovery on follow-up correlated significantly with the number of completed exercise sessions. The number of sessions, baseline ejection fraction, and age were independent predictors of mean post-training heart rate recovery. The cardiac rehabilitation program had a significant effect on peak heart rate and heart rate recovery, regardless of the underlying characteristics of the patients.
Predictors of Emergency Conversion to On-Pump during Off-Pump Coronary Surgery
Authors: Hovakimyan Arman , Manukyan Vilen , Ghazaryan Sarkis , Saghatelyan Merouzhan , Abrahamyan Lusine , Hovaguimian Hagop
Published: May 2013

The purpose of this study was to determine predictors and evaluate outcomes of emergency conversion to cardiopulmonary bypass during planned off-pump coronary artery bypass grafting. From January 2001 to November 2005, of 467 consecutive patients aged ≥ 60 years who underwent off-pump coronary surgery, 17 (3.6%) were converted to cardiopulmonary bypass. Those converted to an on-pump technique had significantly higher rates of postoperative cerebrovascular accident (17.6% vs 1.1%), intraaortic balloon pumping (5.9% vs 0%), and red blood cell transfusion (82.4% vs 57.3%), as well as prolonged intensive care unit stay (52.9% vs 25.2%), ventilation time (25% vs 5.3%) and hospital stay (64.7% vs 31.3%) compared to patients whose operation was completed off-pump. Multivariable logistic regression identified left ventricular ejection and left main stenosis as significantly associated with conversion. The rate of emergency conversion to cardiopulmonary bypass during planned off-pump coronary surgery was acceptable, but patients who required conversion had less favorable early outcomes than those who remained off-pump.
Selection of Monitoring Site and Outcome after Neonatal Coarctation Repair
Authors: Maddali Madan M , Valliattu John , al Delamie Taha , Zacharias Sunny
Published: May 2013

To assess whether simultaneous invasive arterial pressure monitoring of right upper and lower limbs in neonatal aortic coarctation with or without arch hypoplasia has an impact on surgical decision-making and outcome, data of 140 newborns who underwent emergency surgical repair over 15 years were analyzed retrospectively. The 36 who had simultaneous right arm and lower limb arterial pressure monitored intraoperatively were assigned to group 1. The other 104 who had blood pressure monitored invasively at a single site (either upper or lower limb) were allocated to group 2. In group 1, a residual gradient across the repaired segment was detected intraoperatively in 13% of patients, and corrected at the same sitting. In group 2, 6% needed subsequent balloon angioplasty. In all babies with arch hypoplasia in group 1, the proximal aortic cross clamp was readjusted at least once to avoid compromise of carotid blood flow. Simultaneous right upper and lower limb invasive pressure monitoring has an impact on the overall outcome in these sick neonates.
Life-Threatening Vomiting Caused by Large Morgagni Hernia in an Octogenarian
Authors: Türüt Hasan , Demirpolat Gülen , Bülbüloglu Ertan , Yüksel Mürüvvet
Published: May 2013

An 84-year-old woman presented with frequent severe vomiting, dyspnea and generalized muscle weakness associated with diaphragmatic hernia. Her poor general condition and muscle weakness resembling cranial pathology were considered to be due to severe vomiting caused by a Morgagni hernia. An urgent subcostal laparotomy confirmed the diagnosis. The critical role of urgent surgery, even in advanced age, is emphasized.
Extralobar Pulmonary Sequestration in the Hilum
Authors: Chen Chang , Zheng Hui
Published: May 2013

Extralobar pulmonary sequestration usually occurs between the left lower lobe and the diaphragm; occurrence in the hilum has not been reported previously. An unusual case of extralobar pulmonary sequestration, presenting initially as a hilar bronchogenic cyst in a 43-year-old female, is described.
Ascending Aortic Transection: Useful Adjunct in Pulmonary Artery Reconstruction
Authors: Singh Ashutosh , Krishnan Ganapathy S , Agarwal Ravi , Dave Dhiren , Cherian Kotturathu M
Published: May 2013

Pulmonary artery reconstruction is frequently needed during surgery for congenital heart disease. Exposure of the main pulmonary artery and its branches is difficult if they are hypoplastic with a large anteriorly placed aorta. In redo operations, adhesions make this not only technically difficult, but also prone to bleeding. We electively transected the ascending aorta in 36 patients to facilitate pulmonary artery exposure, without complications or significant prolongation of cross clamp time.
Hemodynamic Evaluation of Aortic Regurgitation by Magnetic Resonance Imaging
Authors: Wittlinger Thomas , Dzemali Omer , Bakhtiary Farhad , Moritz Anton , Kleine Peter
Published: May 2013

Magnetic resonance imaging was compared with echocardiography and angiography in determining the regurgitant volume in patients with aortic regurgitation. Forty patients were examined at 1.5 T. The regurgitant jet was located using a gradient-echo sequence. Cine measurements were performed to calculate left ventricular function. For flow evaluation, a velocity-encoded breath-hold phase-difference magnetic resonance sequence was used. The degree of aortic regurgitation assessed by magnetic resonance imaging agreed with that of angiography in 28 of 40 (70%) patients, and with the echocardiography result in 80%. Correlation between calculated stroke volume by magnetic resonance cine and flow measurements was very good ( r > 0.9). Magnetic resonance imaging enables quick and reliable quantitative assessment of aortic regurgitant volume, and it might be the optimal technique for multiple follow-up studies and assessment of left ventricular function, leading to better evaluation of disease severity and optimization of the timing of valve surgery.
Esophageal Injuries Due to Aluminum Phosphide Tablet Poisoning in India
Authors: Darbari Anshuman , Tandon Shekhar , Chaudhary Sushant , Bharadwaj Manu , Kumar Ambrish , Singh Gyan P
Published: May 2013

Aluminum phosphide is a lethal systemic poison with 80%–90% mortality. Survivors have taken either a very small amount or the tablet had been exposed to air, rendering it less toxic, but often causing severe esophageal injuries. The presentation and treatment of 11 cases of esophageal injury due to aluminum phosphide are described. Ten patients had esophageal stricture, and 1 had tracheoesophageal fistula with stricture. Endoscopic bougie dilatation was sufficient in 7 patients, and surgical intervention was required in 4 who underwent definitive repair via gastric tube or feeding jejunostomy with a 2nd stage repair planned in 2. There was no mortality but significant morbidity. Mortality and morbidity might be prevented by withdrawing this pesticide from the market, making its sale difficult, or modifying the packaging.
Anomalous Origin of Right Coronary Artery from Left Coronary Sinus
Authors: Hamzeh Gadah , Crespo Alex , Estarán Rafael , Rodríguez Miguel A , Voces Roberto , Aramendi José I
Published: May 2013

Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.
Mammary Artery Patch Reconstruction of Left Anterior Descending Coronary Artery
Authors: Prabhu Anil D , Thazhkuni Ismail E , Rajendran Sunil , Thamaran Ranjish A , Vellachamy Kannan A , Vettath Murali P
Published: May 2013

Most patients with diffuse coronary disease require endarterectomy for revascularization. In view of the high morbidity and mortality associated with coronary endarterectomy, patch angioplasty and reconstruction of the coronary artery was developed. We retrospectively evaluated 104 patients who underwent mammary artery patch angioplasty of the left anterior descending coronary artery. The procedure consisted of laying open the entire diseased segment of the coronary artery and patching it with an in-situ left internal mammary artery onlay patch, without endarterectomy, in an off-pump procedure. One (0.9%) patient died, 2 (1.8%) suffered perioperative myocardial infarction, and an intraaortic balloon pump was used in 2. The mean blood loss was 224 mL. Intensive care unit stay was 2.5 days, and hospital stay was 7.8 days. At 1-year follow-up, most patients were in New York Heart Association functional class I. Follow-up angiography was carried out in 16 patients and showed good patency of all anastomoses. Arterial patch reconstruction of the left anterior descending coronary artery can be performed safely and effectively in an off-pump procedure, with excellent early and intermediate results.
Anomalous Left Coronary Artery from Non-Facing Pulmonary Sinus
Authors: Hirota Masanori , Kawada Masaaki , Ishino Kozo , Sano Shunji
Published: May 2013

A case of anomalous left coronary artery originating from the non-facing pulmonary sinus, located at the most distal position from the aorta, is described. An intrapulmonary tunnel was created without causing undue stenosis or kinking. The Takeuchi procedure is considered to be a useful surgical technique when the origin of the anomalous left coronary artery is far from the aorta.
Simultaneous Bilateral Carotid Endarterectomy under Local Anesthesia
Authors: Portinos Athanassios , Kefaloyannis Emmanuel , Philippakis George , Dountsis Apostolos , Zisis Charalambos , Bellenis Ion
Published: May 2013

A 75-year-old man with bilateral carotid stenosis and severe coronary artery disease underwent successful simultaneous bilateral carotid endarterectomy under local anesthesia. A few days later, coronary artery bypass grafting was performed with no complications.
A Simple Method of Inspection of Proximal Bleeding in Bentall Procedure
Authors: Song Min-Ho , Tokuda Yoshiyuki , Nakayama Tomohiro , Hattori Keisuke
Published: May 2013

A simple method of checking for bleeding from the proximal anastomosis site in Bentall operations is described. After suturing a Carbo-Seal prosthesis to the aortic annulus, using a folding-over technique, the left ventricle is filled with cardioplegic solution through the prosthetic valve, and the heart is massaged to visualize possible leaks at the level of the suture.
Clinical Characteristics and Surgery of Primary Lung Cancer in Younger Patients
Authors: Funakoshi Yasunobu , Takeda Shin-Ichi , Kadota Yoshihisa , Kusu Takashi , Maeda Hajime
Published: May 2013

Controversy exists regarding the clinical characteristics, pathological findings, and prognosis of patients < 50 years of age with primary lung cancer. The medical records of 4,556 patients diagnosed with primary lung cancer between 1980 and 2004 were reviewed; of these, 305 were < 50 years old. Of 1,335 patients who were surgically treated, 122 were < 50 years old. Females were over-represented in the younger group. Younger patients had a significantly higher incidence of adenocarcinoma and large cell carcinoma, and a lower incidence of squamous cell carcinoma. The resectable rate in younger patients was significantly higher. Overall and among surgically treated patients, the survival rates of younger patients with stage 0-I disease were significantly better than those of older patients. Younger patients with early-stage primary lung cancer had a significantly better prognosis than older patients, although survival in the advanced stages was not significantly different.
One-Stage Procedure for Lung and Liver Hydatid Cysts
Authors: Aghajanzadeh Manucher , Safarpoor Fizolah , Amani Hussein , Alavi Ali
Published: May 2013

Concomitant pulmonary and liver hydatid cysts occur in 4% 25% of patients with echinococcosis. To evaluate the safety of a single-stage operation, experience with this procedure between 1992 and 2005 was reviewed. Of 152 patients who underwent surgery for pulmonary hydatid cyst, 30 had an additional hepatic cyst that was located on the upper dome of the liver in all cases. Pulmonary cysts were excised first via a posterolateral thoracotomy. After phrenotomy, the hepatic hydatid cyst was evacuated without capitonnage, and a Folly catheter was left in the cavity. Postoperative complications in the 30 patients with cysts in both locations included empyema in 2, bronchopleural fistula in 1, excessive biliary discharge in 3 and hemorrhage in 1. Hepatic hydatid cysts recurred in 2 patients. There was no hospital death. A single-stage posterolateral thoracotomy for extraction of pulmonary and liver hydatid cyst is an effective and safe surgical technique with few complications.
Verapamil and Nitroglycerin Improves the Patency Rate of Radial Artery Grafts
Authors: Yoshizaki Tomoya , Tabuchi Noriyuki , Toyama Masaaki
Published: May 2013

The best way to prevent spasm of the radial artery is still under investigation. We retrospectively compared the effectiveness of topical verapamil-nitroglycerin with papaverine in preventing graft spasm in 215 patients who underwent isolated conventional coronary artery bypass using a radial artery. Postoperative angiographic data were successfully collected in 116 patients. Perioperative radial artery graft spasm was observed in 2 patients in the papaverine group and 1 in the verapamil-nitroglycerin group; this difference was not considered significant. Complete or functional occlusion was detected by postoperative angiography in 13 grafts (10 in the papaverine group and 3 in the verapamil-nitroglycerin group). Multivariate regression analysis revealed that topical papaverine and grafting to the right coronary artery significantly increased the rate of occlusion of radial artery grafts. Although further studies are needed, our data support the view that topical verapamil-nitroglycerin reduces the incidence of radial artery graft occlusion.
Pure Yolk-Sac Tumor of the Lung
Authors: Basoglu Ahmet , Sengul Aysen T , Buyukkarabacak Yasemin B , Yetim Tulin D , Yildiz Levent
Published: May 2013

Primary germ cell tumors of the chest often localize in the anterior mediastinal compartment. Such tumors originating from lungs and pleura are rare. Chest tomography revealed a mass in the middle lobe of the right lung in a 25-year-old man. A middle lobe medial segmentectomy was performed, and chemotherapy was applied postoperatively.
Mechanical Circulatory Support: A Clinical Reality
Authors: Loisance Daniel
Published: May 2013

Mechanical circulatory support is becoming an alternative therapeutic option for patients in cardiogenic shock or advanced cardiac failure who cannot be improved by maximal medical therapy. More than 30 years of engineering development and clinical research have led to a level of efficacy and reliability of ventricular assist devices, which allows promotion of this approach for the most difficult patients. Uses include a gaining-time strategy as a bridge to cardiac transplantation or recovery of native cardiac function, as well as permanent support with the device. The large variety of devices permits every cardiac surgical unit, even those not used to cardiac transplantation, to propose this option to the patient. Recent experience with small silent implantable pumps suggests that the pioneering period of mechanical circulatory support is probably over, and the time has come for precise prospective trials to optimize both patient selection and the timing for utilization. In countries where cardiac transplantation has not developed, there is now an easily accessible technique for management of patients with cardiac failure.
Congenital Quadricuspid Aortic Valve Associated with Severe Regurgitation
Authors: Kawanishi Yujiro , Tanaka Hiroshi , Nakagiri Keitaro , Yamashita Teruo , Okada Kenji , Okita Yutaka
Published: May 2013

A 56-year-old man was referred because of severe aortic regurgitation. He had a quadricuspid aortic valve with a small accessory cusp between the right coronary and noncoronary cusps. The ostium of the right coronary artery was deviated toward the accessory cusp commissure. Aortic valve replacement was performed with a bioprosthesis. The resected cusps showed fibrotic thickening with calcification and fenestration.
A Rare Cause of Dyspnea in Adult: A Right Bochdalek's Hernia-Containing Colon
Authors: Terzi Alberto , Tedeschi Umberto , Lonardoni Alessandro , Furia Simone , Benato Cristiano , Calabrò Francesco
Published: May 2013

Symptomatic cases of Bochdalek's hernia (BH) are uncommon in adults; symptoms arise only due to complications. Most of symptomatic cases are related to a left-sided hernia. Right colon herniation in adults has never been reported. We present a case of a 70-year-old woman with right BH-containing colon. The patient was successfully treated by combined laparoscopic and thoracoscopic approach.
Fibrin Glue Administration to Support Bronchial Stump Line
Authors: Gursoy Soner , Yapucu Murat U , Ucvet Ahmet , Yazgan Serkan , Basok Oktay , Ermete Sulun
Published: May 2013

Bronchopleural fistula is an important cause of mortality and morbidity after pulmonary resection. The use of fibrin glue to reduce the tension and number of sutures in the bronchial stump was assessed in this prospective study of 20 patients between June 2002 and May 2003. They all had a high risk of bronchopleural fistula development because of bronchiectasis, tuberculosis, lung abscess, diabetes mellitus, preoperative neoadjuvant radiotherapy, or residual tumor at the surgical margin. After pulmonary resection, the bronchial stump was closed with separate nonabsorbable sutures supported with fibrin glue. Bronchopleural fistula was observed in only 1 (5%) patient during 6.45 ± 3.09 months of follow-up. There was no postoperative mortality. Closing the bronchial stump with an appropriate technique and supporting it with fibrin glue were considered effective in preventing bronchopleural fistula development after pulmonary resection in high-risk patients.
Experience with Paclitaxel-Eluting Infinnium Coronary Stents
Authors: Ostovan Mohammad A , Mollazadeh Reza , Kojuri Javad , Mirabadi Mohammad
Published: May 2013

To investigate the safety and efficacy of the Infinnium Paclitaxel-eluting stents in the treatment of coronary artery lesions, 196 patients with symptomatic coronary disease who received 202 stents at our center from January 2004 to November 2005 were studied prospectively. The primary study endpoint was the incidence of abnormalities on exercise electrocardiograms or cardiac single-photon emission tomography at 6 months, as a noninvasive index of stent reocclusion. Secondary endpoints were the rates of major adverse cardiac events at 1, 3, 6, 9, and 12 months. Stent deployment was successful in 98% of patients. Cumulative major adverse cardiac event rates at the end of 12 months were: cardiac death 1%, myocardial infarction 5% (Q-wave 2.5%, non-Q-wave 2.5%), and repeat revascularization of the stented lesion 3%. The overall major adverse cardiac event rate was 8.1%. There were 6 (3%) stent thromboses; all occurred late after the procedure. In patients with symptomatic ischemic heart disease, the low-cost Infinnium stent proved both effective and safe, with an acceptably low major adverse cardiac event rate.
Effect of Body Mass Index on Perioperative Complications in Thoracic Surgery
Authors: Suemitsu Ryuichi , Sakoguchi Taro , Morikawa Keiko , Yamaguchi Masafumi , Tanaka Hiroyuki , Takeo Sadanori
Published: May 2013

Obesity is perceived as a risk factor in general thoracic surgery. We conducted a single-center retrospective evaluation of perioperative complications in 822 patients who underwent thoracic surgery between 2000 and 2005. According to body mass index, 82 were underweight (< 18.5 kg·m−2), 568 were normal (18.5–24.9 kg·m−2), 155 were overweight (25.0–29.9 kg·m−2), and 17 were obese (≥30 kg·m−2). A significant increase in preoperative comorbidity (hypertension and ischemic heart disease) was observed with increasing body mass index. There was no significant difference in operation time or length of stay in the operating room, but extubation time was significantly different among the 4 groups. Of the intraoperative complications, alveolar-arterial oxygen difference increased significantly with increasing obesity, and hypoxia was least common in the normal group. Postoperatively, there was more pulmonary leakage in the underweight group and less pneumonia in the normal group. Both the underweight and the obese are at increased risk of perioperative complications and need to be carefully observed and managed intraoperatively and postoperatively.
Off-Pump Coronary Revascularization for Left Main Coronary Artery Stenosis
Authors: Mannam Gopichand , Sajja Lokeswara R , Dandu Satya BR , Pathuri Satyendra N , Saikiran Krishnamurthy VSS , Sompalli Sriramulu
Published: May 2013

Experience of on- and off-pump coronary artery bypass in 379 patients with significant left main coronary artery stenosis was retrospectively reviewed. Beating-heart operations were performed on 219 patients between January 2001 and October 2007. Their results were compared with 160 who underwent revascularization under cardiopulmonary bypass during the same period. All patients had multivessel grafting via a median sternotomy. Both groups were comparable demographically. Off-pump patients received significantly fewer grafts per patient (3.21 ± 0.86 vs 3.74 ± 0.82). The use of moderate or high doses of inotropics (> 5 μ g · kg−1 · min−1) was more frequent in the on-pump group (44% vs 26%). Postoperative blood transfusion requirement was lower in off-pump patients, and fewer of them experienced worsening of preexisting renal insufficiency. There were 2 operative deaths in the on-pump group and 1 in the off-pump group. The off-pump procedure is safe and effective in patients with left main coronary artery disease.
Cardiac Surgery and Sickle Cell Disease
Authors: Al-Ebrahim Khaled E
Published: May 2013

Three patients with homozygous sickle cell disease underwent successful open heart surgery for multivalvular lesions. Details of the surgical technique and the necessary precautions are described. Exchange transfusion was implemented in all cases. Crucial issues in cardiac surgical management to avoid or at least minimize vasoocclusive crisis and associated complications are discussed.
Unusual Venacaval Anomalies in a Patient with Atrial Septal Defect
Authors: Oruganti Sai S , Jariwala Pankaj , Taggarse Amit K , Mishra Ramesh C
Published: May 2013

An unusual systemic venous drainage pattern was found in a 30-year-old man with ostium secundum atrial septal defect and pulmonary stenosis. He had the rare association of absent right superior vena cava, persistent left superior vena cava draining into the coronary sinus, and a left-sided inferior vena cava draining into a left superior vena cava through the hemiazygous vein.
Simple Suture Mitral Annuloplasty with Left Ventriculotomy
Authors: Mandegar Mohammad H , Yousefnia Mohammad A , Roshanali Farideh
Published: May 2013

Surgical treatment of mitral regurgitation, especially when compounded by ventricular aneurysm, remains a challenge. Several procedures have been developed to repair the mitral valve and reduce regurgitation. We describe a technique of intraventricular annuloplasty which is much less time-consuming than mitral valve repair through a left atriotomy. This procedure is considered technically easy and useful.