bluuebunny/crossref_metadata_2025 huggingface dataset:
The Recent Exchange Rate Fluctuations
Authors: Mandal Kumarjit
Published: May 2013

The recent exchange rate fluctuations in India have been a matter of concern for the policymakers and general public. The current exchange rate regime in India, known as managed float, has evolved through a long process of searching for an appropriate policy regime for India. Since exchange rates are relative prices of two currencies it is generally affected by the relative productivity differential and real wage rates in the long-run. However, the bubbles arising out of speculation plays a major role in determining the exchange rates in the short-run. The present scenario about the exchange rate fluctuations in India has been caused to a large extent by the deteriorating current account balance and the adverse expectations associated with it. However, the question of intervention by the government in the exchange rate market should be decided on the basis of the impact of such exchange rate fluctuations on the real effective exchange rate and the possible effects on the employment situation in the country.
Low-Dose Warfarin in Patients with Carbomedics Heart Valve Prostheses
Authors: Andersen Per V , Aagaard Jan
Published: May 2013

All patients who received a Carbomedics heart valve prosthesis were assessed retrospectively by interview regarding thromboembolic, hemorrhagic, or other valve-related events. In cases of such events, the patient's practitioner or cardiologist was interviewed. Hospital records were reviewed in cases of hospital admission. Included in the study were patients who had isolated replacement of the aortic or mitral valve in whom it was possible to collect all International Normalized Ratio values from discharge through follow-up. There were 148 patients with isolated aortic valve replacement and 56 with isolated mitral valve replacement. Bleeding events were 3 times more frequent than thromboembolic events. Based on our results we will apply an International Normalized Ratio between 2 and 2.5 for patients with a Carbomedics heart valve prosthesis in aortic position and ratios between 2.5 and 3 for those with a mitral valve prosthesis.
Dosage of Epsilon-Aminocaproic Acid to Reduce Postoperative Blood Loss
Authors: Chauhan Sandeep , Bisoi Akshay Kumar , Rao Beeraka Heramba , Rao M Sanjeeva , Saxena Nita , Venugopal Panangipalli
Published: May 2013

Postoperative blood loss, blood and blood-product requirements, and complications were compared for 3 commonly used doses of epsilon-aminocaproic acid in 150 patients undergoing first-time coronary artery bypass surgery. The patients were randomly assigned to one of 4 groups. Group 1 (n = 30) served as a control, group 2 (n = 30) received a single dose of 150 mg·kg−1 of epsilon-aminocaproic acid after anesthetic induction, group 3 (n = 30) received a loading dose of 150 mg·kg−1 followed by infusion of 1 g·h−1 for 6 hours, and group 4 (n = 60) received doses of 150 mg·kg−1 at induction, on bypass, and after protamine. No patients, including those who had endarterectomies, experienced any complications attributable to epsilon-aminocaproic acid administration. All patients who received epsilon-aminocaproic acid had significantly less bleeding compared to controls. Groups 3 and 4 had the least blood loss and packed-cell requirements.
Surgical Treatment of Coronary Artery Fistula
Authors: Gu Chun Jiu , Zhang Zhi Wei , Yan De Min , Gu Tian Xiang , Yuan Yi Hua , Xiu Zong Yi
Published: May 2013

Six patients with coronary artery fistula were treated surgically between October 1977 and November 1998. The clinical manifestations, diagnostic criteria, indications for operation, and surgical techniques were evaluated. One patient died from ventricular fibrillation on the 2nd postoperative day. The outcome for the other 5 patients was good; symptoms and heart murmurs disappeared and all are alive and well after 10 to 21 years of follow-up. It was concluded that analysis of clinical data can confirm the diagnosis and this condition can be treated satisfactorily by suitable surgery.
Two-Coronary Repair for Anomalous Left Coronary Artery from Pulmonary Artery
Authors: Talwar Sachin , Bhan Anil , Sharma Rajesh , Choudhary Shiv Kumar , Airan Balram , Saxena Anita , Kothari Shyam Sunder , Juneja Rajnish , Venugopal Panangipalli
Published: May 2013

Between January 1989 and December 1998, 13 patients (7 males) aged 3 months to 32 years, underwent surgery for anomalous left coronary artery from the pulmonary artery. Eight presented with congestive cardiac failure and all had evidence of left ventricular dysfunction. One patient had associated tetralogy of Fallot. Preoperative diagnosis was established by echocardiography and cineangiography. Nine patients underwent Takeuchi repair and 4 had direct implantation of the anomalous artery into the aorta. There were 2 postoperative deaths due to low cardiac output. In survivors, serial echocardiograms demonstrated significant improvement in left ventricular function 3 months to 10 years after surgery. Postoperative angiograms in 4 patients showed a patent aortocoronary tunnel in 3 who underwent Takeuchi repair and a patent aortocoronary anastomosis in one who had direct implantation of the anomalous artery into the aorta. It was concluded that early establishment of a two-coronary system gave gratifying short-term and long-term results.
Electron-Beam Computed Tomography for Symptomatic Coronary Disease
Authors: Kuin Bernard Kwok Wing , Lim Yean Teng , Quek Swee Tian , Ann Lenny Tan Kheng
Published: May 2013

Forty-two symptomatic patients underwent both electron-beam computed tomo-graphic calcium scoring and coronary angiography. Correlation between coronary artery calcium score and angiographic coronary disease showed a high specificity (90%) but low sensitivity (50%). The low negative predictive value of 36% suggests that electron-beam computed tomography is not useful in symptomatic patients.
Spontaneous Dissection of Left Main Coronary Artery: Surgical Management
Authors: Sajja Lokeswara Rao , Farooqi Afroz , Yarlagadda Ramesh Babu , Mastan Saheb Shaik , Pothineni Ramesh Babu
Published: May 2013

Spontaneous dissection of a coronary artery is a rare cause of obstructive coronary artery disease and sudden death. We report a case of spontaneous dissection of the left main coronary artery, which manifested as ischemic heart disease and was successfully treated by emergency myocardial revascularization. Prompt diagnosis and surgical revascularization are crucial for survival.
Primary Echinococcosis of the First Rib
Authors: Al-Qudah Abdullah
Published: May 2013

A 24-year-old man was investigated for dyspnea and swelling of the right side of the neck with pain in the right shoulder, which had developed over the previous year. Hydatid cyst of the right first rib was diagnosed by chest radiography and computed tomography. Serology for hydatid disease was negative. The cysts and the first rib were excised via a right thoracotomy. The postoperative course was uneventful. Histology revealed multilocular echinococcal lesions.
Coronary Artery Bypass Grafting without Cardiopulmonary Bypass
Authors: Tezcaner Tevfik , Yorgancioğlu Cem , Çatav Zeki , Moldibi Oğuz , Tokmakoğlu Hilmi , Süzer Kaya , Zorlutuna Yaman
Published: May 2013

Between March 1994 and April 1998, 2869 patients underwent coronary artery bypass grafting at our institution. Of these, 415 (14.5%) with a mean age of 54.4 ± 9.9 years were operated on without cardiopulmonary bypass. Internal thoracic artery was used in 402 cases (97%) and the left anterior descending artery was revascularized in all except 1. Distal anastomoses ranged from 1 to 3, with a mean of 1.45 ± 0.58. Major postoperative complications comprised reoperation because of internal thoracic artery spasm in 1 patient, lower extremity ischemia due to intraaortic balloon pumping in 1 patient, revision for excessive bleeding in 3, and perioperative myocardial infarction in another 3. Hospital mortality was 1.2% (5 deaths). Coronary angiography was performed in 38 patients, 1 to 44 months postoperatively. Examination of 56 distal anastomoses revealed a patency rate of 86.1% for internal thoracic artery grafts and 55% for saphenous vein grafts. It was concluded that coronary bypass surgery without cardiopulmonary bypass gave favorable results in the early postoperative period. However, considering the late graft patency rates, either patient selection or the technique should be reevaluated.
Coronary Artery Bypass Surgery without Cardioplegia: Early Results
Authors: Wong Poo Sing , Vendargon Simon , Lim Choon Gek
Published: May 2013

From November 1996 to April 1999, 348 patients underwent isolated non-cardioplegic coronary artery bypass grafting at a new center. There were 123 (35%) patients aged over 60 years, 48 (14%) were female, 70 (20%) had a left ventricular ejection fraction below 0.3. Coronary artery bypass graft surgery was performed using hypothermic intermittent ischemic fibrillatory arrest of the heart. The left internal mammary artery was used in 97% of cases. Mean grafts per patient was 3.5. Sixty-three patients (18%) underwent 65 coronary endarterectomies. The overall operative mortality rate was 2.3% (8/348). Follow-up was 97% complete. Mean follow-up was 14.9 ± 8 months (range, 1 to 30 months). Freedom from angina was 98.3% at 6 months, 97% at 12 months, and 97% at 24 months. The overall survival was 96.7% at 6 months, 95.8% at 12 months, and 94.4% at 24 months. It was concluded that this method of myocardial protection for isolated coronary artery bypass graft surgery provided excellent operating conditions in this group of patients.
Acute Gastrointestinal Complications after Open Heart Surgery
Authors: Akpinar Belhhan , Săgbaş Ertan , Güden Mustafa , Kemertaş Kubilay , Sönmez Bingür , Bayindir Osman , Demiroğlu Cem'i
Published: May 2013

Retrospective analysis revealed that 24 of 4401 adult patients (0.5%) developed severe gastrointestinal complications after open heart surgery during a 3-year period from January 1995. There were 4 women (17%) and 20 men (83%). Mean age was 61.7 ± 2.02 years. Gastrointestinal bleeding (33.3%), mesenteric ischemia (20.8%), pancreatitis (20.8%), hepatic dysfunction (16.7%), and cholecystitis (16.7%) were the most common complications. Mortality was 41.7% (10 patients). During the same period, mortality in the patients who did not develop gastrointestinal complications was 1.89% (p < 0.0001). Emergency basis, reoperation, combined operations, peripheral vascular disease, diabetes mellitus, chronic lung disease, and impaired left ventricle function were found to be risk factors for the development of postoperative gastrointestinal complications.
Coronary Sinus Injuries following Retrograde Cardioplegia
Authors: Elwatidy Ahmed F
Published: May 2013

A retrograde coronary sinus cardioplegia catheter was used for administration of retrograde cardioplegic solution in 620 of 942 coronary bypass procedures performed over a 3-year period. Coronary sinus injuries were encountered in 4 patients (0.65%).
Bioprostheses and Mechanical Prostheses Predictors of Performance
Authors: Jamieson WR Eric , Germann Eva , Fradet Guy J , Lichtenstein Samuel V , Miyagishima Robert T
Published: May 2013

From 1975 to 1995, 4200 patients had bioprosthetic valve replacements (2240 aortic, 1607 mitral, 353 multiple) and 2038 had mechanical valve replacements (747 aortic, 928 mitral, 363 multiple). Freedom from major thromboembolism or both major thromboembolism and hemorrhage for aortic and mitral valve replacement at 15 years was significantly greater for bioprostheses than mechanical prostheses. Freedom from valve-related mortality and reoperation for both aortic and mitral valve replacements was the same for bioprostheses and mechanical prostheses. Advancing age increased overall mortality (all positions), valve-related mortality (aortic, mitral), major thromboembolism (aortic), thromboembolism and hemorrhage (aortic, mitral) but decreased reoperation (all positions). Coronary artery bypass grafting increased overall mortality (aortic, mitral) but not valve-related mortality, and it decreased reoperation rate (aortic, mitral). Overall mortality was not influenced by valve type in aortic or multiple valve replacement but it was decreased by bioprostheses in mitral valve replacement. Valve type did not influence valve-related mortality (all positions). Mechanical valves decreased reoperation only for aortic valve replacement but they increased major thromboembolism with and without hemorrhage for both aortic and mitral replacements. There is support for bioprostheses in aortic valve replacement and mechanical prostheses in mitral valve replacement but for neither in multiple valve replacements.
Pregnancy with St. Jude Medical Mitral Valve Prosthesis
Authors: Yamak Birol , Emir Mustafa , Ulus Tulga A , Aksöyek Ayşen , Işcan Zafer , Katircioğlu S Fehmi , Taşdemir Oğuz
Published: May 2013

From 1986 to 1995, 513 young women of childbearing age (11 to 45 years) underwent mitral valve replacement with a bileaflet St. Jude Medical prosthesis. Twenty-one patients became pregnant within 3 years postoperatively. The mean age of these patients at the onset of pregnancy was 27 ± 8 years (range, 16 to 43 years). Follow-up was complete for all pregnant patients. Of 11 who continued to take warfarin during pregnancy, one had a premature delivery, 2 had spontaneous abortions, and 8 had therapeutic abortions. Five patients who ceased oral anticoagulant therapy had normal deliveries but 4 underwent reoperation for valve thrombosis postnatally, with concurrent left hemiplegia in one case. The other 5 patients adhered to an anticoagulation protocol for pregnancy; there were 3 normal deliveries, 1 premature birth, and 1 abortion. There is a high risk of thromboembolism in patients with mechanical heart valves whose anticoagulants are interrupted during pregnancy. We believe that careful supervision can reduce maternal morbidity and mortality.
Subtotal Pericardiectomy via Sternotomy for Constrictive Pericarditis
Authors: Srivastava Ashok K , Ganjoo Anoop K , Misra Bashist , Chaterjee Tapas , Kapoor Aditya , Pandey Chandra Mani
Published: May 2013

Records of 103 patients with constrictive pericarditis who underwent subtotal pericardiectomy from January 1990 to December 1997 were retrospectively analyzed. The etiology of pericardial constriction was unknown in 63, tuberculous in 30, pyogenic in 7, and miscellaneous in 3 patients. Adequate pericardiectomy could be accomplished in 85 (82.5%) patients. Eleven patients (10.68%) died within 30 days of surgery. The 92 survivors were followed up for 47.21 ± 30.7 months; functional status improved in all cases. Of 15 variables examined by univariate logistic regression analysis, preoperative New York Heart Association functional class IV, atrial fibrillation, left atrial size > 40 mm·m−2, mild to moderate mitral regurgitation, tricuspid regurgitation, pericardial calcification, and inadequate pericardiectomy were found to be significant predictors of poor outcome. Adequate pericardiectomy via sternotomy was considered to carry low operative risk and provide excellent improvement in functional capacity.
Management of Parapneumonic Empyema in Children
Authors: Çekirdekçi Ahmet , Köksel Oğuz , Göncü Tuğrul , Burma Oktay , Rahman Ali , Uyar Ihsan Sami , Ayan Erhan , Uysal Ayhan
Published: May 2013

Empyema is a serious complication of bacterial pneumonia in children. Between July 1992 and July 1998, 53 children aged 7 months to 12 years (mean age, 5.5 years) were treated for empyema complicating pneumonia. After diagnostic thoracentesis, closed tube drainage was carried out with appropriate antibiotic therapy and other treatment strategies such as pleural lavage, intrapleural enzymatic debridement, decortication, or pulmonary resection, according to the effectiveness of drainage and clinical status. There was one death from toxic shock. It was concluded that early decortication in the chronic stage of the disease is a safe and effective treatment modality.
Non-Small Cell Lung Cancer with Ipsilateral Intrapulmonary Metastasis
Authors: Kamiyoshihara Mitsuhiro , Kawashima Osamu , Sakata Shuji , Ishikawa Susumu , Morishita Yasuo
Published: May 2013

From 1981 through 1997, lobectomy or pneumonectomy with mediastinal lymph node dissection was performed in 604 patients with non-small cell lung cancer, of whom 42 (7%) were diagnosed as having ipsilateral pulmonary metastasis. There were 23 males and 19 females, the mean age was 66 years. Lobectomy was carried out in 37 cases and pneumonectomy in 5. Postoperative histology identified 29 adenocarcinomas, 11 squamous cell carcinomas, 1 large cell carcinoma, and 1 adenosquamous cell carcinoma. Two cases were classified as pathologic stage I, 1 as stage II, 26 as IIIA, and 13 as IIIB. Blood vessel invasion was present in 33 cases and absent in 2 cases. Five and 10-year survival rates were 34.3% and 17.1%, respectively. Patients with pulmonary metastasis had a poorer prognosis than those without metastasis; there were local recurrences in 6 patients, distant metastases in 9, and 15 deaths. There were no significant differences in recurrence sites between patients with and without pulmonary metastasis. Multivariate analysis showed that lymph node involvement and blood vessel invasion were useful prognostic factors. Ipsilateral pulmonary metastasis in the same lobe was regarded as local invasion for which surgical resection is the optimal treatment.
Role of Pretransplant Arteriography in Diabetic End-Stage Renal Disease
Authors: Garg Naveen , Kapoor Aditya , Umesan Chirammal Valappil , Sharma Raj Kumar , Sinha Nakul
Published: May 2013

Diabetic renal transplant candidates have a high prevalence of obstructive coronary artery disease that is a major cause of morbidity and mortality. This study sought to stratify the risk for renal transplantation by correlating noninvasive tests with arteriographic findings. Fifty-two diabetics (46 males, 6 females) with end-stage renal disease were evaluated noninvasively and by coronary arteriography. The mean age was 46 ± 6 years. Twenty-five patients (48%) had noninvasive evidence of coronary artery disease (angina in 10, old myocardial infarction on electrocardiogram in 6, ST-T changes in 8, regional wall motion abnormality on echocardiography in 8, positive dobutamine echocardiogram in 4, and positive dipyridamole thallium tests in 13). Obstructive coronary artery disease was demonstrated by arteriography in 27 (51.9%). Concordance between noninvasive findings and arteriography was 65.3%. Obstructive coronary disease was present in 66.7% of those with 2 noninvasive indications, in all with more than 2 indications, and in all cases of regional wall motion abnormality. Thus, more than 2 positive noninvasive parameters or wall motion abnormality on an echocardiogram were highly predictive of coronary disease.
Repair of Isolated Atrial Inversion with Venous Return Abnormality
Authors: Birincioğlu Cemal Levent , Tikiz Hakan , Bardakçi Hasmet , Balbay Yücel , Ulus Tulga A , Göksel Siber , Taşdemir Oğuz
Published: May 2013

A 33-year-old woman was found to have atrial inversion (atrioventricular discordance), right-hand ventricular morphology, ventriculoarterial concordance associated with a primum atrial septal defect, and abnormal systemic and pulmonary venous return. The pulmonary veins, inferior vena cava, and left superior vena cava drained into the left-sided morphologically right atrium. Only the right superior vena cava drained into the right-sided morphologically left atrium. Intraatrial baffle repair was performed successfully.
Cardiac and Delayed Renal Transplantation with Same-Donor Allografts
Authors: McKay Glen S , Haydock David A , Bourchier Russell , Ruygrok Peter N , Agnew Trevor M , Coverdale H Arthur , Lund Mayanna , Collins John
Published: May 2013

Three combined heart and delayed kidney transplantations were carried out between 1992 and 1998. The patients received induction therapy with antithymocyte immunoglobulin and were maintained on triple immunosuppressive therapy (cyclosporin, azathioprine, and prednisone). All are currently alive with satisfactory transplanted organ function. The medical histories, clinical course, and outcomes are described. Heart and delayed kidney transplantation with allografts from the same donor appears to be effective treatment for selected patients with end-stage cardiac and renal disease.
Mycotic Aneurysm of Suprarenal Aorta in a 14-Year-Old Boy
Authors: Akgün Serdar , Civelek Ali , Akalin Figen
Published: May 2013

An extremely rare case of suprarenal mycotic aortic aneurysm of the abdominal aorta, secondary to tuberculous infection in a 14-year-old boy is reported. He required a Dacron graft implantation with visceral arterial reimplantation on an emergency basis. The patient died in the early postoperative period because of bleeding due to disseminated intravascular coagulation.
Surgical Management of Eventration of Diaphragm in an Elderly Patient
Authors: Sajja Lokeswara Rao , Farooqi Afroz , Yarlagadda Ramesh Babu , Shaik Mastan Saheb
Published: May 2013

A 70-year-old woman with eventration of the left dome of the diaphragm, presented with features of acute respiratory distress. She was successfully treated by emergency plication of the diaphragm. Computed tomography of the chest was useful for diagnosis.
Combined Medical and Surgical Treatment for Pulmonary Mucormycosis
Authors: Mawatari Tohru , Nakamura Masanori , Koshino Tokuo , Kusajima Katsuyuki , Abe Tomio , Tsunematsu Kazunori , Sugawara Hiroyuki , Takeya Isao
Published: May 2013

A 40-year-old woman with primary pulmonary mucormycosis was successfully treated with combination therapy involving administration of amphotericin B and surgery.
Aortic Valve Replacement with Continuous Suture
Authors: Agarwal Ravi , Sankar Nainar Madhu , Rajan Sethurathnam , Singh Rajarathinam Karnan Kalyan , Cherian Kotturathu Mammen
Published: May 2013

A continuous suture technique for aortic valve replacement is described. The technique was used in 462 patients who underwent aortic valve replacement. Hospital mortality was 6.9%. Mild paravalvular leak was seen in 3% and 0.6% needed reoperation for significant paravalvular leak. This continuous suture technique is quick and effective, associated with few postoperative complications, and recommended for patients in developing countries.
Closed Mitral Commissurotomy Utilizing Right Thoracotomy Approach
Authors: De Dang Hanh , Pezzella A Thomas
Published: May 2013

Right thoracotomy provides an alternative approach for commissurotomy in selected cases of mitral valve disease. From 1970 through 1985, over 300 patients underwent closed mitral commissurotomy by this approach, with satisfactory early results.
ACE Inhibition versus Angiotensin-II Antagonism in Heart Failure
Authors: Kumar Surendra , Maurya Dharm Raj , Chandra Mahesh
Published: May 2013

Heart failure is becoming increasingly frequent. Once diagnosed, 5-year survival is less than 50% and a substantial percentage of patients (25% to 50%) die suddenly. Angiotensin-converting enzyme inhibitors are the only agents shown to reduce mortality in heart failure. All angiotensin-converting enzyme inhibitors appear to have similar clinical benefits in heart failure. Therapy should be started with a low dose and titrated up to the target dosage in major trials. Although angiotensin-I receptor antagonists provide more complete inhibition of angiotensin-II effects, they have not been found to be superior to long-acting angiotensin-converting enzyme inhibitors in reducing morbidity and mortality in heart failure. Therefore, in current clinical practice, angiotensin-II antagonists should be used as an alternative to angiotensin-converting enzyme inhibitors when the latter are not tolerated. The combined use of angiotensin-converting enzyme inhibitors and angiotensin-II antagonists is not currently recommended in the treatment of heart failure.
Coronary Artery Bypass Grafting in Left Ventricular Dysfunction
Authors: Md-Maksumul Haq , Mullasari Ajit Sankaradas , Murali Renuka , Paul Eldho , Cherian Kotturathu Mammen
Published: May 2013

Postoperative mortality and morbidity were assessed in 75 patients with left ventricular dysfunction (ejection fraction < 35%) undergoing coronary artery bypass surgery between January 1995 and February 1999. The operative mortality was 10.7%. A rise in creatine kinase-MB isoenzyme, respiratory infection, ventricular arrhythmias, and hypotension were the most frequent complications. Of 25 variables evaluated by bivariate analysis, use of intraaortic balloon pump support, duration of intensive care stay, episodes of hypotension, low cardiac output, and deterioration of renal and liver function were associated with increased mortality. Morbidity, defined as postoperative hospital stay > 14 days, correlated with higher preoperative dyspnea class, longer cardiopulmonary bypass time, postoperative wound infection, pleural effusion, increased serum creatinine, perioperative intraaortic balloon pump support, and stroke. Postoperative low cardiac output with consequent renal failure, liver failure, and ultimately multiorgan failure, was the most important cause of mortality.
Continuous Selective Cold Perfusion in Thoracoabdominal Aneurysm Repair
Authors: Ohuchi Hiroshi , Ueda Keisuke , Kyo Shunei , Yokote Yuji , Tanabe Hiroaki , Hojo Hiroshi , Neya Kazuo , Omoto Ryozo
Published: May 2013

Fifteen patients with a mean age of 57 ± 17 years underwent thoracoabdominal aortic aneurysm repair under continuous selective blood perfusion of the intercostal and visceral arteries. Three aneurysms were Crawford type I, 6 were type II, and 6 were type III. Surgery was performed on an emergency basis in 5 cases. All operations were carried out using distal perfusion with mild hypothermia (> 32°C) in 13 cases and deep hypothermia (< 20°C) in 2 cases when a proximal clamp was undesirable. During aortic replacement, the intercostal arteries between the eighth thoracic and first lumbar vertebrae and the visceral arteries were reconstructed separately with a prosthetic graft under selective cold blood perfusion (22°C to 26°C). Flow was maintained above 100 mL·min−1. The durations of operation, selective intercostal and visceral perfusion, and distal perfusion were 9 ± 2 hours, 70 ± 35 minutes, and 170 ± 80 minutes, respectively. There was one operative death (mortality, 6.7%) due to respiratory failure and one case of delayed paraparesis. There was no paraplegia, acute hepatorenal failure, or bowel ischemia postoperatively. This experience suggests that continuous selective cold blood spinal and visceral perfusion during thoracoabdominal aneurysm repair can provide adequate organ protection.
Significance of Right Internal Thoracic Artery as Proximal Anastomotic Site
Authors: Hirata Nobuaki , Ohtake Shigeaki , Sawa Yoshiki , Takahashi Toshiki , Yoshitatsu Masao , Matsuda Hikaru
Published: May 2013

The efficacy of the right internal thoracic artery as the proximal anastomosis site in patients with a severely atherosclerotic ascending aorta was evaluated. Coronary artery bypass grafting was performed in 5 patients in whom the right internal thoracic artery was selected as the proximal anastomotic site. The graft flow in the right internal thoracic artery plus saphenous vein or radial artery graft was 52 ± 34 mL·min−1 (range, 30 to 111 mL·min−1). The right internal thoracic artery was found to supply adequate graft flow even to the sequential graft, in each patient. The right internal thoracic artery should be kept in mind when it is difficult to determine the best site for a proximal anastomosis in patients with severe atherosclerosis of the ascending aorta.
Rheumatic Mitral Valve Annuloplasty with Polytetrafluoroethylene Ring
Authors: Akhtar Raja P , Cheema Masud Ahmad
Published: May 2013

Mitral valve annuloplasty was performed using a supporting strip or ring of polytetrafluoroethylene cut from a vascular graft. From October 1995 to September 1997, this material was used in 42 patients (mean age, 17.5 ± 5.9 years) with rheumatic mitral valve disease. The technique was found to be useful, easy, safe, cost effective, and it preserved the physiological function of the mitral valve annulus.
Coronary Arteriovenous Fistulas
Authors: Çimen Serdar , Kaplan Mehmet , Gerçekoğlu Hakan , Ketenci Bülend , Özay Batuhan , Bilgen Fuat , Demirtaş M Murat
Published: May 2013

Between 1988 and 1998, 7 patients with coronary arteriovenous fistulas were treated surgically. Indications for surgery were congestive heart failure and marked left-to-right shunt in association with ischemic heart disease. Long-term follow-up (mean, 99 ± 37 months) was complete and mainly uneventful. Coronary arterio-venous fistulas can be successfully managed by surgery and patients should be treated without delay because complications of an untreated fistula may increase the complexity of the operation.
Surgical Management of Infective Endocarditis
Authors: Sin Yoong Kong , Tan Yong Seng , Shankar Sriram , Chua Yeow Leng
Published: May 2013

Despite advances in diagnostic and pharmaceutical therapy, a significant subset of patients with infective endocarditis require surgical intervention. Details of 44 consecutive patients operated upon for infective endocarditis from December 1990 to January 1996 were analyzed retrospectively. Patient characteristics, presentation, risk factors and microbiological epidemiology are described. The mitral valve was most commonly affected. Nearly 70% of patients had an underlying cardiac abnormality. Early mortality was 11%. Streptococcus was most frequently isolated (40% of cases), Staphylococcus aureus was found in 28% of patients and it was associated with significantly higher mortality. Prosthetic valve endocarditis accounted for 14% of cases and it was associated with significantly earlier intervention as well as a high mortality. Overall survival at 5 years was 84% with an event-free survival of 79%. Surgical intervention when valve failure develops or medical therapy is unsuccessful, is lifesaving and can be associated with acceptable morbidity and mortality. Patients with Staphylococcus aureus infection and those with prosthetic valve endocarditis require aggressive therapy including early referral for surgery.
Primary Neoplasm of the Chest Wall: Surgical Management
Authors: Chowdhury Sowrangshu Kumar , Subbarao Kasturi Satya Venkata Kumara , Nachiappan Muthuraman , Agrawal Karoon
Published: May 2013

From January 1986 to December 1997, 17 patients (12 males and 5 females) aged 13 to 70 years were treated for primary neoplasms of the chest wall. There were 4 cases of fibrous dysplasia, 3 each of chondrosarcoma and Askin's tumor, 2 of plasmacytoma, and 1 each of fibrosarcoma, Ewing's sarcoma, synovial sarcoma, osteosarcoma, and enchondroma. All patients, except the case of Ewing's sarcoma, underwent wide excision or debulking for unresectable tumor, and reconstruction of the chest wall. Preoperative neoadjuvant chemotherapy was given to 1 patient with osteosarcoma, radiotherapy and chemotherapy were given to 2 others. In 8 patients, the skeletal defect was reconstructed with prosthetic material. Soft tissue reconstructive procedures with various myocutaneous flaps were performed in 6 patients. None of the patients required mechanical ventilation postoperatively. There were 2 early deaths. During follow-up of 3 months to 10 years, all patients with benign tumors were free of recurrence, 2 with Askin's tumors and 1 with osteosarcoma died. Prefabricated acrylic ribs are recommended for skeletal support during chest wall reconstruction.
Role of Mediastinoscopy in Intrathoracic Tuberculous Lymphadenitis
Authors: Sayar Adnan , Ölçmen Aysun , Metin Muzaffer , Güleç Hakan , Demir Adalet , Ölçmen Müfid
Published: May 2013

From 1993 to 1998, 19 patients with mediastinal tuberculosis underwent mediastinoscopy without any demonstrable parenchymal lesion and with negative diagnostic bronchoscopy. The mean age was 34.4 years (range, 15 to 67 years) and 10 were male. The most common symptom was cough in 12 patients, 4 were asymptomatic. Computed tomography showed involvement of the right paratracheal nodal station in 8 cases. Multiple biopsies of 3 to 5 mediastinal nodal stations diagnosed tuberculous lymphadenitis in 16 patients; in 5 of these, nonspecific inflammatory nodes were also sampled. In 3 patients who had biopsies of 1 mediastinal nodal station, the diagnosis could not be established. It was concluded that when used effectively, mediastinoscopy was acceptable as a final diagnostic step in patients with mediastinal tuberculous lymphadenitis.
Right Coronary Artery Aneurysm
Authors: Telli Ali , Yağdi Tahir , Çikirikçioğlu Mustafa , Tekdoğan Mehmet
Published: May 2013

A 66-year-old man with an aneurysm of the right coronary artery and stenotic coronary artery disease was successfully treated by lateral aneurysmorrhaphy and coronary artery bypass grafting.
Anterior Mitral Leaflet Myxoma
Authors: Dayal Aruneshwari , Sahni Jeewan Lal , Ahmad Mohammad , Krishna Vinay , Pandey Rama Niwas , Sharma Pramod , Srivastava Pankaj
Published: May 2013

A 19-year-old man was admitted with a 6-month history of palpitations and dyspnea. A sessile myxoma of the anterior mitral valve leaflet was radically excised. Heart block developed postoperatively but the patient converted to normal sinus rhythm spontaneously during follow-up.
Extracardiac Fontan/Kawashima Procedure without Cardiopulmonary Bypass
Authors: Kumar Rajiv , Samuel Susan , Sai K Srinivas , Vakamudi Mahesh , Saldanha Richard , Balakrishnan Komarishi Rajagopalan
Published: May 2013

Two patients with univentricular physiology underwent successful surgical palliation without the use of cardiopulmonary bypass. A 19-year-old girl had an extracardiac Fontan operation and a 4-year-old boy had a Kawashima-type repair with a bilateral bidirectional Glenn procedure.
Hydatid Cyst on Right Ventricular Posterior Wall
Authors: Durgut Kadir , Özergin Ufuk , Özdemir Kurtuluş , Görmüş Niyazi , Yüksek Tahir , Solak Hasan
Published: May 2013

A 14-year-old boy was investigated for unexplained tachycardia and multiple pulmonary emboli demonstrated by computed tomography. A right ventricular hydatid cyst was diagnosed by echocardiography and successfully excised under cardiopulmonary bypass.
Squamous Cell Carcinoma Metastases to Right and Left Heart
Authors: Behranwala Ali Asgar , Sundaramoorthi Thiagarajamurthy , Bhate Sudhir G
Published: May 2013

A 54-year-old man presented with cough, breathlessness, and fatigue. Echocardiography showed multiple masses in the left atrium, right atrium, and left ventricle. The patient underwent emergency surgery with a diagnosis of multicentric myxoma. Postoperative histopathology showed squamous cell carcinoma.
Constrictive Pericarditis: Computed Tomography Findings
Authors: Oto Aytekin , Akinci Devrim , Eryilmaz Muzaffer , Besim Aytekin
Published: May 2013

Computed tomography in 2 patients with constrictive pericarditis and history of tuberculosis showed pericardial thickening and calcification, inferior vena caval dilation, enlarged atria, and small tubular ventricles. Computed tomography accurately differentiated constrictive pericarditis from restrictive cardiomyopathy. Successful pericardiectomy was carried out in both cases.
New Technique of Tricuspid Annuloplasty
Authors: Kestelli Mert , Yilik Levent , Özsöyler İbrahim , Gökdoğan Tayfun , Akdağ Banu , Özbek Cengiz
Published: May 2013

This technique using only 3/0 polypropylene suture, provides reconstruction appropriate to the anatomy and physiopathology of functional tricuspid insufficiency. Problems such as the gliding effect, pannus formation, and infection, should be minimal. The technique was successfully applied in 3 patients.
Endoventricular Left Ventriculoplasty: Overlap Technique for Akinetic Scar
Authors: Sawazaki Masaru , Ito Toshiaki , Yasuura Kenzo , Ogawa Yutaka , Mizutani Shin-Ichi , Ishikawa Hiroshi , Miura Ayuko , Hashizume Ryotaro
Published: May 2013

Four patients were treated by endoventricular left ventriculoplasty with coronary artery bypass grafting. Three were elective cases and one had acute myocardial infarction. The overlap technique of left ventriculoplasty was employed in the 3 elective cases. An endoventricular circular suture was placed on the perimeter of the scar, the lateral free margin of the incision was sutured to the septum directly, and the margin of the septal side overlapped the anterior wall. In these 3 cases, end-diastolic volume index and end-systolic volume index were decreased and ejection fraction was increased postoperatively. It was concluded that coronary grafting combined with left ventriculoplasty using the overlap method was suitable for patients with ischemic heart disease and an akinetic scar.
Preoperative Cholesterol and Thrombotic Complications after Coronary Bypass
Authors: Christenson Jan T
Published: May 2013

The relationship between preoperative lipid status and postoperative thrombocytosis was evaluated in 130 patients who were grouped according to their preoperative serum cholesterol level: group A, cholesterol ≥ 6.2 mmol·L−1 (n = 40); group B, cholesterol < 6.2 but ≥ 5.2 mmol·L−1 (n = 22); group C, cholesterol < 5.2 but ≥ 4.7 (n = 18); and group D, cholesterol < 4.7 mmol·L−1 (n = 50). Patient demo-graphics, angiography findings, and operative data did not differ between the groups. The incidence of postoperative thrombocytosis (platelet count ≥ 400,000/μL) was 82.5%, 36.4%, 16.7%, and 2.0% for groups A to D, respectively. Patients who developed thrombocytosis had a significantly higher preoperative ratio of total cholesterol to high-density lipoprotein cholesterol than those with normal platelet counts. The incidence of thrombocytosis directly correlated with the preoperative total cholesterol level. A distinct separation point seems to be a total cholesterol level of 4.7 mmol·L−1. Preoperative lipid control with statins is emphasized to avoid postoperative thrombocytosis and thrombotic complications. The total cholesterol/high-density lipoprotein cholesterol ratio seems to be the best indicator of the risk of developing postoperative thrombocytosis.
Early Myocardial Resuscitation via Coronary Sinus Retroperfusion
Authors: Güden Mustafa , Akpinar Belhhan , Bayindir Osman , Sağbaş Ertan , Sanisoğlu İlhan , Demiroğlu Cem'i
Published: May 2013

Between January 1996 and December 1998, 9 patients needed emergency surgical revascularization after percutaneous transluminal coronary angioplasty failure. The mean age of these 6 men and 3 women was 64 ± 4.2 years. Under anesthesia and partial cardiopulmonary bypass, a cardioplegia needle was inserted into the ascending aorta and a retrograde cardioplegia cannula was introduced transatrially into the coronary sinus. Coronary sinus retroperfusion was performed during graft harvesting for revascularization. There was 1 death (11.1%) from multiorgan failure in a patient who had required cardiopulmonary resuscitation preoperatively. There was evidence of new myocardial infarction in 2 patients (22.2%) and the other 7 made a good recovery.
Prosthesis Size in Aortic Valve Replacement: Surgeon-Related Variable
Authors: Choudhary Shiv Kumar , Mathur Alok , Venugopal Panangipalli , Airan Balram , Sharma Rajesh , Bhan Anil , Saxena Anita , Kumar Arkalgud Sampath
Published: May 2013

A retrospective analysis was performed to determine the surgeon's impact on the selection of the size of prosthesis in aortic valve replacement. From January 1993 through December 1997, 748 patients underwent either isolated aortic valve replacement (530) or double valve replacement (218) with bileaflet valves. Depending on the operating surgeon, patients were divided into group A (367) or group B (381). Preoperative, intraoperative, and postoperative variables in both groups were compared. Groups A and B were identical in demographic and clinical profiles. Cardiopulmonary bypass time, ischemic time, and early and late results in both groups were similar. Significantly more patients undergoing isolated aortic valve replacement in group A (169; 67.9%) received a large (≥25 mm) prosthesis compared with group B (69; 24.5%). Compared with group B, a large prosthesis was used in a significantly greater proportion of all patients in group A, irrespective of etiology, predominant aortic valve lesion, and age of the patient. Overall, the operating surgeon was identified as the most important predictor (odds ratio 3.5; p < 0.0001) of use of a large valve.
Modified Blalock-Taussig Shunt in Neonates: Determinants of Immediate Outcome
Authors: Rao M Sanjeeva , Bhan Anil , Talwar Sachin , Sharma Rajesh , Choudhary Shiv Kumar , Airan Balram , Saxena Anita , Kothari Shyam Sunder , Juneja Rajnish , Venugopal Panangipalli
Published: May 2013

Forty-six neonates with various conditions of low pulmonary blood flow received a modified Blalock-Taussig shunt with a polytetrafluoroethylene graft. Ages ranged from 2 to 30 days (mean, 14.1 days). Hospital mortality was 10.9%. Shunt block requiring reoperation occurred in 3 patients. Incremental risk factors for early mortality were found to be restrictive atrial septal defect, univentricular physiology, and postoperative reintervention. It was found that a Blalock-Taussig shunt could be performed in the neonatal period with a predictable outcome. Single-ventricle physiology and restrictive atrial septal defect were the major determinants of outcome in this subgroup.
Surgical Correction of Vascular Ring Anomalies
Authors: Sharma Sanjeev , Dobbs Jeri L , Cobanoglu Adnan
Published: May 2013

Between 1981 and 1997, 25 patients underwent operations for relief of tracheoesophageal compression due to vascular rings. Seventeen patients (68%) had a double aortic arch, 6 (24%) had a right aortic arch with an anomalous left subclavian artery and ligamentum arteriosum, and 2 (8%) had a left aortic arch with an anomalous right subclavian artery arising from a Kommerell's diverticulum. Preoperative symptoms consisted of stridor and dysphagia. Four patients (16%) were ventilator-dependent prior to surgery. After division of the vascular ring, wide dissection of the superior mediastinal structures was performed to prevent any compression of the trachea or esophagus. There were no early deaths. Ventilatory support was necessary for a mean of 48 ± 8 hours. One patient required reintubation for 24 hours due to persistent left lower lobe atelectasis. During late follow-up, 2 patients (8%) had recurrent pneumonia, and there were 2 deaths. Surgical repair of vascular rings provided excellent early and late results. The index of suspicion of these aortic arch anomalies should increase if an infant or young child presents with a history of recurrent stridor, dysphagia, or respiratory distress that is not easily explained.
High-Resolution Computed Tomography and Survival in Fibrosing Alveolitis
Authors: Alamoudi Omer S , Logan Paul M , Muller Nestor L , Vedal Sverre , Abboud Raja T
Published: May 2013

High-resolution computed tomography findings were reviewed in 32 patients with cryptogenic fibrosing alveolitis and 18 with fibrosing alveolitis associated with connective tissue diseases (other than scleroderma). The percentage of abnormal lung, total ground-glass attenuation, ground-glass attenuation not associated with fibrosis, and fibrosis (reticular pattern and honeycombing) were compared with lung function and survival. In cryptogenic fibrosing alveolitis, 1-year mortality tended to be higher in patients with predominantly fibrotic lesions (39%) compared to mainly ground-glass attenuation (11%). Similar results were obtained in fibrosing alveolitis associated with connective tissue disease (1-year mortality 44% for fibrosis versus 22% for ground-glass attenuation), but the differences were not statistically significant. In cryptogenic fibrosing alveolitis, the extent of abnormal lung on initial computed tomography was 67% ± 20% in survivors at 1 year and 86% ± 8% in nonsurvivors (p < 0.005); this difference was still significant at 4 years. In fibrosing alveolitis associated with connective tissue disease, the degree of lung involvement between survivors and nonsurvivors was different at 1 year only, thus other factors seem to determine survival. Ground-glass attenuation associated with fibrosis adversely affected survival in cryptogenic fibrosing alveolitis, in contrast to isolated ground-glass attenuation.
Amlodipine, Nitric Oxide, and Platelet Aggregation
Authors: Shankar Ravi P , Bhargava Vinod K , Grover Anil , Mazumdar Siddharta , Garg Santosh K
Published: May 2013

This study examined the effect of a single dose of 0.4 mg·kg−1 amlodipine on platelet aggregation with and without the nitric oxide synthase inhibitor, Nw-nitro-L-arginine. Blood samples were collected from rhesus monkeys at 0, 1, 2, and 6 hours after administration of amlodipine. Aggregation in platelet-rich plasma was stimulated by 10 μM adenosine diphosphate, 20 μM epinephrine, or 2 μg·mL−1 collagen. Administration of Nw-nitro-L-arginine alone significantly increased platelet aggregation for up to 2 hours. This effect was antagonized by amlodipine administered 30 minutes after Nw-nitro-L-arginine. The findings suggest that in platelet-rich plasma, the inhibition of platelet aggregation by amlodipine might be mediated by nitric oxide, a potent endogenous inhibitor of aggregation.
Iatrogenic Aortic Dissection Complicating Cardiac Surgery
Authors: Sin Yoong Kong , Shankar Sriram
Published: May 2013

Two consecutive cases of iatrogenic aortic dissection complicating coronary artery bypass surgery were successfully repaired by interposition graft replacement of the ascending aorta. Both patients had an uncomplicated postoperative recovery. Follow-up imaging showed no residual abnormality. Prompt recognition and repair are essential elements in the management of this potentially lethal complication.
Cardiac Hydatid Cyst
Authors: Özbek Cengiz , Özsöyler İbrahim , Arkci Melike Karadag , Göktoğan Tayfun , Tonguc Ece
Published: May 2013

Two women, aged 19 and 20 years, underwent surgery for hydatid cyst at the right side of the heart. In one patient, the cyst was located on the interventricular septum. It was removed and the defect was closed without capitonnage to avoid blockage. The cavity healed spontaneously. In the other patient, the cyst was at the right atrioventricular groove. It was removed without cardiopulmonary bypass. Both patients recovered well.
Diffuse Cardiac Lipomatosis Presenting as Recurrent Pericardial Effusion
Authors: Srivastava Ashok K , Agarwal Anil K , Kapoor Aditya , Tiwari Prabhat , Pandey Rakesh
Published: May 2013

A 48-year-old man undergoing open pericardiotomy for recurrent pericardial effusion was found to have extensive diffuse cardiac lipomatosis. The mode of presentation, preoperative evaluation, and surgical management of this rare condition are described.
Right Ventricular Endocardial Pacing with Tricuspid Valve Replacement
Authors: Ogino Hitoshi , Matsumoto Masahiko , Yoshioka Tatsuya , Sugita Takaaki , Ueda Yuichi
Published: May 2013

A novel technique for simultaneous tricuspid valve replacement and endocardial pacing is described. The technique was applied in a 67-year-old man who had previously undergone coronary artery bypass grafting and subsequent pericardiotomy via a left thoracotomy. He developed congestive heart failure due to tricuspid valve regurgitation as well as impaired left ventricular function with bradycardia. Endocardial pacing was successfully performed in conjunction with tricuspid valve replacement using a bioprosthesis via a right anterolateral thoracotomy.
Early Management of the Postpneumonectomy Space
Authors: Pezzella A Thomas , Conlan A Alan , Carroll Gerald J
Published: May 2013

A contemporary presentation of the methods of early management of the postpneumonectomy space stresses anatomic and physiological principles. The advantages and disadvantages of each method are discussed.