bluuebunny/crossref_metadata_2025 huggingface dataset:
Restenosis after Percutaneous Balloon Mitral Valvuloplasty in Patients with Previous Surgery
Authors: Won Ha Jong , Hewn Shim Won , Chung Namsik , Soo Jang Yang , Wook Lim Sang , Kwan June , Hyung Lee Moon , Yun Cho Seung , Soon Kim Sung
Published: May 2013

To identify the risk factors of restenosis after balloon mitral valvuloplasty in patients with mitral restenosis after surgical valvotomy, we obtained 30.4 ± 13.0 months (range 6 to 53 months) follow-up data in 19 patients with restenosis after surgical valvotomy in whom balloon valvuloplasty was successfully performed since April 1988. There were 10 females and 9 males with a mean age of 42.7 ± 8.7 years (range 28 to 59 years). Eleven patients were in atrial fibrillation. Restenosis occurred in 8 patients (42%) during follow-up. The median value for restenosis by Kaplan-Meier survival analysis was 40 months. Restenosis by univariate analysis correlated with smaller valve area after the procedure and shortness of the interval from previous surgical valvotomy to restenosis. The independent predictors of restenosis identified by Cox proportional hazard analysis were mitral valve area after valvuloplasty (p = 0.0013) and echo-score (p = 0.0244). There was a significantly increased risk of restenosis inpatients with a post-valvuloplasty mitral valve area of less than 1.6 cm2 compared with those who had a greater mitral valve area. Patients with echo-scores greater than 8 were not significantly less likely to develop restenosis than those with echo-scores of less than 8.
Aortic Valve Repair: Initial Experience from Central Chest Hospital
Authors: Chotivatanapong Taweesak , Chaiseri Pradistchai , Charupatanapongse Ugrit , Petchyungtong Promporn
Published: May 2013

From September 1994 to September 1995, 24 patients underwent aortic valve repair in our hospital. It was successful in 21 cases and failed in the other 3 patients. There were 13 males and 8 females. The age range was between 20 and 60 years with a mean age of 35.6 years. Follow-up was complete in all patients. The mean follow-up time was 6.2 months, ranging from 3 weeks to 13 months. Aortic valve lesions in these patients were caused by rheumatic disease (17), endocarditis (2), congenital (1), and degenerative (1) conditions. The most common anatomic lesions were cusp thickening, cusp retraction, commissural fusion, and calcification. Most of the patients had other procedures along with aortic valve repair, including mitral valve repair (13), mitral valve replacement (3), tricuspid annuloplasty (2), and tricuspid repair (1). The most common surgical procedures were subcommissural annuloplasty, commissurotomy, cusp thinning, and free-edge unrolling. Cusp extension, using autologous pericardium was performed in 3 cases. Almost all of the patients needed multiple procedures (mean 3.4 procedures per patient). There was no hospital mortality nor valve-related complication in our series. No patient had a thromboembolic problem. Postoperative echocardiography showed an improvement in the mean aortic valve area and the pressure gradient across the aortic valve in patients with stenosis, and a decrease in the severity of aortic regurgitation in those with regurgitant lesions. We concluded that early results of aortic valve repair were encouraging and may be a good alternative treatment, especially in certain groups of patients.
Left Atrial Myxoma: Surgical Experience of Eighty Cases
Authors: Wu Zhao Xi , Yen Zheng You , Ming Wang Zhan , Zhen Zhang Rong
Published: May 2013

Eighty cases of left atrial myxoma were operated upon between January 1980 and May 1994. The ages, the course of disease, symptoms, and signs were very variable among the patients in this series. Echocardiography gave the definitive diagnosis, providing confirmation in all cases. Early surgery is imperative once diagnosis is confirmed. In cases were the patient was in poor condition, treatment was deferred for up to 2 weeks in order to optimize the patient for the surgery.
Patch Repair of Left Main Coronary Artery Using Autologous Pericardium in a Young Female
Authors: Hayashi Jun-Ichi , Eguchi Shoji , Ohzeki Hajime , Sugawara Masaaki , Hiratsuka Masahide , Hirahara Hiroyuki , Horikawa Kozo , Okada Yoshinobu
Published: May 2013

Successful patch repair of the left main coronary artery was performed using fresh autologous pericardium in a 19-year-old female without evidence of aortitis. Early and late postoperative studies revealed good patency of the left main coronary artery, and the patient is free of symptoms. Patch repair may be the best option for isolated left main coronary artery disease, especially in young patients.
Catheter Embedded in Right Ventricular Trabeculations
Authors: Min Yuan Shi , Qiang Guo Jia , Oh Teik E
Published: May 2013

In an attempt to obtain perioperative hemodynamic information on a 4-year-old girl with congenital heart disease, a thermodilution catheter was inserted via the right subclavian vein. However, it failed to float into the pulmonary artery. Attempts to free the catheter were unsuccessful and a ventriculotomy was performed. The catheter was found to be embedded in a crack due to trabeculations in the thickened right ventricle. This case highlights one of the difficulties that may be encountered during catheterization of patients with complex abnormalities of cardiac anatomy.
Huge Solitary Aneurysm in Left Main Coronary Artery with Arteriovenous Fistula
Authors: Horii Taiko , Suma Hisayoshi
Published: May 2013

A 72-year-old female was found to have a huge solitary coronary artery aneurysm in the left main coronary artery, with an associated coronary artery fistula draining into the right atrium through the coronary sinus. She underwent resection and repair of the aneurysm successfully.
Primary Left Atrial Myxofibrosarcoma: Highly Malignant Cardiac Tumor
Authors: Yi Li Jiun , Yue Lin Fang , Long Chen Chi , Hsun Chu Shu , Pin Lien Wen
Published: May 2013

We report the case of a 41-year-old male presenting with acute heart failure due to myxofibrosarcoma of the left atrium. Total resection was performed, followed by 4 courses of postoperative chemotherapy. Recurrence of the tumor was found 14 months later and resection was repeated with local irradiation and chemotherapy. Unfortunately, this failed to halt the spread of the malignancy and the patient died of brain metastasis. We conclude that cardiac myxofibrosarcoma is rare and highly malignant. Adjuvant chemotherapy and radiotherapy seemed ineffective in this case.
Minimally Invasive Coronary Artery Bypass Surgery
Authors: Sim Eugene KW , Landreneau Rodney , Goh Peter MY , Chew Christopher , Lin Ng Wai , Xian Chan Wan
Published: May 2013

A potentially more effective means of surgical treatment for single vessel coronary artery disease has evolved with the development of a minimally invasive technique for surgical myocardial revascularization. We describe the case of a 43-year-old male with a history of proximal left anterior descending coronary artery stenosis. He underwent angioplasty for recurrence of the stenosis and consented to minimally invasive coronary artery bypass grafting. This technique greatly reduces the postoperative morbidity and minimizes complications of the surgery. The technique is probably a more definitive treatment than angioplasty or medical strategies.
Continuous Monitoring of Mixed Venous Oxygen Saturation in a Pediatric Cardiac Surgical Patient
Authors: Je Ko Wen , Sh Chiu Ing , Chung Chang , Hsun Chu Shu
Published: May 2013

By inserting a 4-French Opticath catheter into the pulmonary artery through the right atrium and right ventricle during cardiac surgery in a 2-year-old boy, we could continuously monitor blood pressure and mixed venous oxygen saturation in the pulmonary artery. Because mixed venous oxygen saturation reflects instantly the balance between oxygen supply and demand, continuous monitoring can detect subtle changes in cardiopulmonary function immediately. We found this technique to be simple, safe, and effective, and considered the measurement of mixed venous oxygen saturation to be a reliable indicator of cardiopulmonary stability with the potential to replace many of the other tests currently employed to monitor the critical care of small cardiac surgical patients.
Doppler Hemodynamics of CarboMedics Prosthetic Valves in Aortic Position at Rest and Exercise
Authors: Shimada Ichiro , Okabayashi Hitoshi , Nishina Takeshi , Minatoya Kenji , Soga Yoshiharu , Matsubayashi Keiichi , Kamikawa Yuji , Tanabe Atsushi , Kanai Yasuki , Miyamoto A-Tadaomi
Published: May 2013

To evaluate the size adequacy of CarboMedics prosthetic heart valves, Doppler pressure gradients after aortic valve replacement were determined at rest and immediately after exercise in 83 patients, at a mean time of 18.8 days after aortic valve replacement with CarboMedics prosthetic heart valves (31 standard and 52 R-series). There were 54 males and 29 females, average age 55 years; 12 had pure aortic stenosis, 47 had aortic regurgitation, and 24 had combined lesions. Exercise significantly increased (p < 0.01) the peak velocity (from 2.50 to 2.88 m/sec), the peak pressure gradient (from 25.9 to 34.6 mm Hg), and the mean pressure gradient (from 13.9 to 18.4 mm Hg). Significant differences were observed even in patients with seemingly large valve sizes. Significant correlation (p < 0.0001) was observed between pressure gradients at rest and immediately after exercise, as well as between pressure gradients and theoretical performance index. A theoretical performance index larger than 1.0 cm2/m2 was needed to obtain a postexercise Doppler peak pressure gradient of less than 60 mm Hg early after aortic valve replacement using either the Carbomedics standard or R-series prosthetic heart valves.
Six-Year Experience with CarboMedics Prosthetic Heart Valves
Authors: Ping Zhu , Cui Long Guo , Xue Li Zhong , Sheng Feng Shu , Hua Meng , Sheng Yan Yu , Jian Tong , Chi Wan Lei
Published: May 2013

Between July 1989 and July 1995, 89 CarboMedics prosthetic heart valves were implanted in 70 patients (38 males, 32 females) ranging in age from 13 to 54 years (mean 33 years). Forty-one of these patients underwent mitral valve replacement, 10 had aortic valve replacement, and 19 had double aortic and mitral valve replacement. Early mortality was 4.9%, 0%, and 15.8% respectively in these groups. Mean follow-up time was 3.4 years and was 95.4% complete (3 lost). There were 5 late deaths (7.7%); 1 in the mitral group, 1 in the aortic group, and 3 who had double valve replacements. Three of these late deaths were considered valve-related. The 5-year actuarial survival rates, hospital mortality excluded, were 97% for mitral, 88% for aortic, and 88% for double valve replacement. Preoperatively, 80% of the patients were in New York Heart Association functional class III or IV, whereas postoperatively, 99.5% of the patients were in class I or II. No structural failures were observed. There was 1 case of systemic embolism and 1 case of valve thrombosis, neither of these patients were taking anticoagulants. Hemorrhage was the most frequent complication; 1 of 4 events was fatal. A less intensive warfarin regimen and improvement in hepatic function may reduce hemorrhagic risk while maintaining thromboembolic protection. On the basis of this experience, the CarboMedics prosthetic heart valve appears to be an excellent mechanical prosthesis for cardiac valve replacement, in terms of hemodynamic performance and low thrombogenicity, in patients receiving anticoagulants.
Echocardiographic Study of Residual Shunt after Hemoclip Closure of Patent Ductus Arteriosus in Neonates
Authors: Khowsathit Pongsak , Boonkasem Somboon , Pongpanich Boonchob
Published: May 2013

Residual shunt was determined by postoperative echocardiogram after hemoclip closure of patent ductus arteriosus in 22 neonates, and compared with the findings in 15 neonates who had conventional ligation of the ductus between January 1992 and December 1994. There were no significant postoperative complications related to the surgery. The study showed no residual shunt across the ductus by color and pulsed wave Doppler echocardiography in either group, with the exception of one patient who required a second hemoclip operation. We conclude that the method of closure with a hemoclip is safe and effective.
Inferior Vena Caval Bullet Embolism
Authors: Suri Rajendar K , Jha Neerod K , Sarwal Virendar , Behera Arunanshu , Attri Ashok , Singh Shrawan Kumar , Katariya Rabinder Nath
Published: May 2013

We report a case of bullet penetration into the left iliac vein, with embolus into the inferior vena cava and migration up to the junction of the inferior vena cava and the right atrium. The bullet was subsequently extracted through laparotomy from the infrarenal segment of the inferior vena cava, just above its bifurcation.
Bilateral Partial Anomalous Pulmonary Venous Connection with Intact Atrial Septum
Authors: Corno Antonio F
Published: May 2013

Bilateral partial anomalous pulmonary venous connection is a very rare malformation; its association with intact atrial septum is even more unusual. This report concerns a 5-year-old girl with this condition who underwent successful surgical repair.
A Quarter Century Experience with Mitral Valve Replacement
Authors: John Stanley , John Colin , Saha Kamales , Velaikodeth Bashi Velayudhan , Ravikumar Edwin
Published: May 2013

Between January 1967 and August 1994 Starr-Edwards (Baxter Healthcare Corporation, Santa Ana, CA, USA) ball valve prostheses (model 6120) were implanted in 1129 patients whose ages ranged from 9 to 65 years (mean 29.5 ± 11.08 years). One hundred and ninety-three patients had a concomitant tricuspid valve repair and 36 underwent closure of an atrial septal defect. A closed mitral valvotomy had been carried out previously in 15%. The hospital (30-day) mortality rate was 10.9% (123/1129), which declined to 6.9% (32/461) in the last decade. The patients were administered warfarin to counter thrombogenesis and were regularly monitored with prothrombin time values. Over the last 10 years, aspirin was used as the sole anticoagulant in a cohort of 63 patients. Follow-up was achieved in 87% of cases; the follow-up period ranged from 1 to 25 years with a total follow-up of 8579.69 patient-years. Late death occurred in 132 patients. Anticoagulant-related hemorrhage occurred at a rate of 0.31 per 100 patient-years. Prosthetic valve endocarditis occurred at a linearized rate of 0.05 per 100 patient-years. The incidence of thromboembolic events was 0.5 per 100 patient-years. There was no incidence of structural valve dysfunction or prosthetic valve thrombosis. Forty young women subsequently delivered 47 healthy children. The long-term overall survival rate was 76.1% ± 3.17% at 20 years and 70.4% ± 4.31% at 25 years. These results confirm the long-term durability and superior thromboresistance of the Starr-Edwards ball valve. We conclude that this prosthesis is the device of choice for patients undergoing mitral valve replacement in Third World countries.
Thymomas
Authors: Saha Sibu P , Rogers Anthony G , Earle Gary F , Nachbauer Craig , Baker Mary
Published: May 2013

Neoplasms of the thymus gland (thymomas) represent up to 20% of primary mediastinal tumors and are the most common tumors in the anterior mediastinum. In this report we present our experience with thymoma in 28 patients. Surgical resection was the primary method of treatment and excellent results were obtained in the majority of our patients. There was one surgical death within this series. Although surgical resection has been identified as the treatment of choice, prognosis is dependent on tumor staging. Radiotherapy is recognized as beneficial in the treatment of stages II to IV. The role of chemotherapy, however, has not been determined conclusively in the treatment of thymoma.
Blood Conservation in Open-Heart Surgery
Authors: Bisoi Akshay Kumar , Shrivastava Sushant , Tripathy Puneeta , Tandon Rakesh , Kale Shailaja , Kumar Lokendra , Kumar Arkalgud Sampath
Published: May 2013

At the All India Institute of Medical Sciences, in a 6-week period between October and November 1995, 57 patients with preoperative hemoglobin levels of more than 10 g/100mL were included in a blood conservation protocol. Autologous blood trans-fusion, total body hemodilution to a minimum hematocrit of 20%, and retransfusion of pump blood, along with meticulous intraoperative hemostasis, were performed. Forty-eight, patients (84%) did not require transfusion of homologous blood or blood products. The remaining 9 patients (including 2 who underwent reoperation, 2 who had reexploration, and 2 with preoperative renal failure) received blood or blood products when their hemoglobin fell below 8 g/100mL. No patient had postoperative hemodynamic instability or delayed recovery. All patients were discharged on oral hematinics. Blood conservation techniques are safe and easy to implement. When used in combination, they provide satisfactory results, avoid transfusion-related problems, and conserve blood supplies.
Repair of the Mitral Valve Anterior Leaflet: Early Results
Authors: Chotivatanapong Taweesak , Chaiseri Pradistchai , Leelataweewud Udom , Petchyungthong Promporn
Published: May 2013

Between March 1994 and December 1995 a total of 27 cases of mitral valve anterior leaflet repair were undertaken at our institution. Five of the patients were excluded from the study; 3 with predominant mitral stenosis and 2 with atrial septal defect primum type. Of the 22 anterior mitral leaflet repair patients, there were 12 males and 10 females with a mean age of 41.5 years. Follow-up was complete in all patients and ranged from 2 to 22 months with a mean of 8.6 months. Mitral valve disease was attributed to rheumatic disease in the majority of cases (12). Other causes included degenerative (5), endocarditis (2), ischemic (2), and congenital conditions (1). Preoperatively there, were 18 cases of mitral regurgitation, and 4 of mixed mitral stenosis and regurgitation. The most commonly used surgical procedures were prosthetic ring implantation, chordal shortening and chordal transposition. Most of the patients required multiple procedures to accomplish the repair with an average of 3.4 procedures per patient. Neochordal implantation with polytetrafluoroethylene was performed in 4 cases. Reconstruction of the anterior mitral leaflet using autologous glutaraldehyde-treated pericardium was completed in 2 patients who had bacterial endocarditis. There were no hospital deaths nor late mortality in this series. None of the patients required reoperation during the follow-up. The patients' functional status as well as the severity of the mitral regurgitation improved markedly after the operation. We conclude from our study that repair of the mitral valve anterior leaflet is possible in selected patients with good early results.
Translocation of the Right Coronary Artery Orifice for Right Coronary Artery Compression
Authors: Yokoyama Taw , Gifford William A , Katz James R , Carlish Ronald A , Watanabe Masaaki
Published: May 2013

We report two cases of surgery for right coronary artery compression between the ascending aorta and the main pulmonary artery. The first case, a 48-year-old male who developed signs and symptoms of right coronary artery ischemia, was evaluated by computed tomography scan of the chest, cinecardioangiogram, and coronary arteriogram. Anomalous origin of the right coronary artery with compression of the proximal coronary artery was documented and the patient underwent translocation of the right coronary artery orifice to the anterior aspect of the ascending aorta. The postoperative course was uneventful. The second case, a 67-year-old female with calcific aortic stenosis, underwent cinecardioangiogram, and coronary arteriogram. Anomalous origin of the right coronary artery with proximal right coronary artery compression was identified. The symptoms could not be distinguished from her symptomatic calcific aortic stenosis, however, at the time of surgery, significant compression against the proximal right coronary artery was noticed. Translocation of the right coronary artery orifice and aortic valve replacement were performed. This patient's recovery was also uneventful. In view of the excellent results in both cases, we recommend translocation of the right coronary artery orifice to the anterior aspect of the ascending aorta for this type of anomaly.
Traumatic Pseudoaneurysm of the Left Ventricle
Authors: Premchand Rajendra Kumar , Arora Rakesh , Sudhan Rakesh , Allam Vasantha Kumar , Chakravarthi Padmanabhan Tirumalai Nallan , Prabhala Raja Gopal , Sadasivan Jaishankar
Published: May 2013

A pseudoaneurysm of the left ventricle developed in an 11-year-old boy following a trivial blunt trauma to the chest wall. This was detected by echocardiography 3 months after the injury. An echocardiogram performed 2 weeks after the injury demonstrated intact chambers. The false aneurysm resulted from myocardial contusion with subsequent gradual rupture of the left ventricle without coronary artery occlusion. The patient underwent a successful surgical repair. This case demonstrates the need for careful follow-up of all patients sustaining blunt chest trauma.
Rare Type of Mixed Total Anomalous Pulmonary Venous Drainage
Authors: Mulay Anvay V , Ashworth Michael T , Dhasmana Janardan P
Published: May 2013

We describe a rare form of total anomalous pulmonary venous connection in a neonate with major extracardiac congenital abnormalities. The infracardiac communication was hypoplastic, whereas the supracardiac connection had an intrapulmonary course through the left lung. There was an associated atrioventricular septal defect.
Recent Developments in Myocardial Protection: Retrograde Cardioplegia
Authors: Panos Anthony L , Aziz Salim
Published: May 2013

In recent years there has been increasing use of coronary sinus perfusion to deliver cardioplegic solutions during open-heart surgery. This has been aided by advances in coronary sinus catheter design and by easier methods of cannula insertion. Coronary sinus perfusion has been used with both intermittent crystalloid and blood cardioplegia and has recently evolved to include retrograde continuous normothermic blood cardioplegia. Coronary sinus perfusion has several advantages including safety, ease of use (with a single cannula placed out of the operative field), usefulness in patients with significant aortic regurgitation, redo coronary artery bypass graft surgery, and acute myocardial infarction. However, there are continuing concerns about the distribution of retrograde perfusion, preservation of right ventricular function, dislodgment of the coronary sinus catheter (and resulting ischemia during surgery), and damage to the coronary sinus.
Early Results with Bilateral and Single Internal Mammary Artery Grafts. Are They Different?
Authors: Trehan Naresh , Khanna Surendra Nath , Kohli Vijay Mohan , Karlekar Anil , Mishra Yugal , Mishra Anil
Published: May 2013

Between June 1991 and June 1996, 391 patients underwent isolated myocardial revascularization using bilateral internal mammary artery. Three hundred and sixty-five of these patients could be matched retrospectively on the basis of preoperative characteristics with 365 patients operated on during same period who had left internal mammary artery as a single or sequential graft with additional vein grafts. The cardiopulmonary bypass times and aortic cross-clamp times were similar in both groups. There were no statistically significant differences in the two groups in terms of operative mortality (0.55% versus 0.82%), perioperative myocardial infarction (2.46% versus 2.19%), low cardiac output (1.64% versus 1.09%), reexplorations (1.10% versus 1.92%), wound complications (1.10% versus 2.46%), length of stay in the intensive care unit, and total hospital stay. The incidence of respiratory, central nervous system, and renal complications showed no difference between the two groups. Logistic regression analysis showed that the number of internal mammary artery grafts was not a predictor for perioperative complications. If better long-term event-free survival is associated with the use of bilateral internal mammary artery, it should be used wherever possible.
Prognostic Factors for Late Ventricular Arrhythmias after Repair of Tetralogy of Fallot
Authors: Nomura Fumikazu , Ikawa Seiichiro , Kadoba Keishi , Mitsuno Masataka , Sawa Yoshiki , Matsuda Hikaru
Published: May 2013

During a median follow-up period of 9 years (ranging from 9 months to 25 years), 24-hour ambulatory electrocardiographic studies were undertaken in 155 patients after repair of tetralogy of Fallot. The patients were divided into two groups. Group A consisted of 76 patients in whom the right ventricular approach was used and group B comprised 79 patients whose repair was through the right atrium. A transannular patch was employed in all patients in group A and in none of the patients in group B. Age at surgery was between 1 and 37 years (median age 4.8 years). During follow-up, 37 patients (48.6%) in group A had significant ventricular arrhythmias (Lown grade 2 or higher) and 13 patients (15.4%) in group B had significant ventricular arrhythmias. A close relationship was observed between age at surgery and Lown grade (R2 = 0.374, p < 0.001) and between follow-up duration and Lown grade (R2 = 0.514, p < 0.001), especially when the two groups were analyzed separately (R2 = 0.502, 0.476, p < 0.001). In contrast, no significant relationship was observed between the ratio of right ventricular to left ventricular pressure and Lown grade or between right ventricular systolic pressure and Lown grade. Discriminant analysis revealed risk factors associated with postoperative ventricular arrhythmias are follow-up duration (partial F = 3.22, p < 0.01), right ventricular to pulmonary artery pressure gradient (partial F = 3.35, p < 0.01), and operative method (partial F = 2.4, p < 0.05). Despite antiarrhythmic therapy, 11 of 22 late postoperative deaths occurred suddenly, presumably from ventricular arrhythmias. In this series of patients, the right atrial and pulmonary artery approach significantly reduced the risk of life-threatening ventricular arrhythmias after repair of tetralogy of Fallot.
Pathology of Severe Mitral Regurgitation following Balloon Valvuloplasty
Authors: Choudhary Shiv Kumar , Bhan Anil , Sharma Rajesh , Airan Balram , Das Bhabhananda , Kumar Arkalgud Sampath , Kaul Upendra , Venugopal Panangipalli
Published: May 2013

This study assessed the mechanism of acute mitral regurgitation following balloon mitral valvuloplasty for the treatment of symptomatic mitral stenosis. We studied 25 patients who required mitral valve replacement for severe mitral regurgitation following balloon mitral valvuloplasty. All the mitral valves studied had features of severe mitral stenosis. Radial tear of the mitral leaflet was responsible for mitral regurgitation in 18 (72%) cases. Of these, 16 involved the anterior mitral leaflet and in 2 cases the posterior mitral leaflet was torn. Three patients (12%) had chordal rupture, whereas in 4 (16%) patients pseudo-orifices were formed. All the excised mitral valves showed significant subvalvular deformity which was underestimated in prevalvuloplasty echocardiography. No other factor was found to be associated with disruption of the valve. Hence, we conclude that cusp deformity and subvalvular pathology are responsible for faulty transmission of forces and improper engagement of the balloon, resulting in disruption of the valvular apparatus. The incidence of severe mitral regurgitation following balloon mitral valvuloplasty might be decreased by appropriate prevalvuloplasty assessment and patient selection.
Cardiac Tumors: Eight-Year Experience
Authors: Kamalakar Kadali Venkata Nagaraja , Jaishankar Sadashivan , Padmanabhan Tirumalai Nallam Chakravarthi , Rao Damera Seshagiri , Sundaram Challa , Prakash Gulla Surya , Kumar Allam Vasantha , Jiwani Pyar Ali Akbar Ali , Rajagopal Prabhala , Rakshak Ayupati Dharma
Published: May 2013

Because of the scarcity of reports of cardiac tumors in Indian patients, we analyzed retrospectively all cases of tumors of the heart from the records of our institute during the period from January 1988 to December 1995. There was a total of 28 patients with cardiac tumors, of which 26 were primary. The majority were myxomas; 20 in the left atrium, 4 in the right atrium, and 1 biatrial. Rhabdomyoma was seen in one patient. There were 2 cases of hepatocellular carcinoma with propagation of the tumor along the inferior vena cava into the right atrium. Salient clinical features, diagnostic modalities, therapeutic interventions, and outcome are discussed.
Effects of Prostacyclin on Hemodynamics after Intestinal Ischemia-Reperfusion
Authors: Katircioğlu S Fehmi , Özgencil Eser , Yamak Birol , Ulus Tulga , Ayaz Selime , Saritaş Zülfikar , Konan Ali , Tuncer Mürüvet , Taşdemir Oğuz , Bayazit Kemal
Published: May 2013

Ten rabbits underwent 30 minutes of superior mesenteric artery occlusion to assess the release of tumor necrosis factor, subcellular damage, and hemodynamic changes after intestinal ischemia-reperfusion injury. Five were treated with prostacyclin 5 ng/kg/min 5 minutes before the arterial occlusion. It was increased to 25 ng/kg/min during occlusion, decreased to 5 ng/kg/min for the first 5 minutes of reperfusion, and then discontinued. A control group of 5 rabbits did not receive any pharmacological agent. Specimens were obtained from the small intestine for electron microscopy after 10 minutes and after 60 minutes of reperfusion, while simultaneous blood samples were collected for measurement of tumor necrosis factor. Minimal changes were seen in tissue from the prostacyclin group but severe mitochondrial damage and vacuolation occurred in the control group. The tumor necrosis factor level was 11.97 ± 3.17 U/mL in the control group and 5.06 ± 2.19 U/mL in the prostacyclin group, one hour after the end of mesenteric occlusion ( p < 0.05). Hemodynamic status, assessed by central venous and arterial pressures, was much more affected in the control group than in the prostacyclin group. Mean arterial pressure was 71 ± 5 mm Hg in the control group, and 91 ± 6 mm Hg in the prostacyclin group ( p < 0.05). Central venous pressure was 5.3 ± 0.9 mm Hg in the control group and 2.3 ± 0.7 mm Hg in the prostacyclin group ( p < 0.05). We conclude that intravenous prostacyclin reduced the severity of reperfusion injury occurring during the early period of reperfusion by inhibiting the release of the toxic mediator tumor necrosis factor, thus decreasing distant organ injury.
Temple Pujari's Lung: A New Pneumoconiosis?
Authors: Iyer Raju S , Dilip Dronamraju , Narayanan Ram , Manoj Padmanabhan , Reddy Kumaraswamy , Naidu Venugopal
Published: May 2013

A temple pujari (priest), who had long exposure to camphor smoke, developed pulmonary fibrosis. Pneumonectomy of the left lung was performed. We feel that more studies of the lung function of priests working in similar conditions are needed to throw more light on this interesting pathology.
Giant Pseudoaneurysm of the Common Carotid Artery Resulting in Stridor
Authors: Bapat Vinayak Nilkanth , Porwal Manish , Agrawal Nandkumar , Tendolkar Anil Gangadhar
Published: May 2013

A 39-year-old male underwent an attempted right internal jugular vein cannulation during which the right common carotid artery was punctured. Three months later, the patient presented with dysphagia and breathlessness. Carotid angiography failed to demonstrate the pseudoaneurysm because of intra-aneurysmal clots but it was partially delinated by a direct puncture arteriogram of the swelling. At surgery a pseudoaneurysm measuring 8 × 6 cm was excised and the carotid artery was repaired with a saphenous vein patch.
Head and Heart: Neuropsychological Reaction and Arterial Line Filtration during Cardiopulmonary Bypass
Authors: Shahani Rohit , Magotra Ratna A , Khandeparkar Jagdish , Pandey Ragini , Pradhan Prakash , Dewoolkar Lalita , Joshi Vasant
Published: May 2013

As part of a prospective study of neuropsychologic reactions after cardiopulmonary bypass and their relation to arterial line filters, 44 patients who underwent elective cardiac operations were randomized into two groups. Group A had a 40-micron nylon screen filter in the arterial line. No arterial filter was used in group B. Neuropsychological examinations of all patients were conducted before and at a mean of 8 days after the operation on a double blind basis by a single trained psychologist. The tests included the Wechsler Memory Scale, the trail-making test, the Hamilton Anxiety Rating Scale, and the Hamilton Rating Scale for Depression. The 2 groups were otherwise similar with respect to preoperative neurologic and intellectual status, anesthetic methods, duration of operation, operative procedures performed, and the time spent in the intensive care unit. Surprisingly, there was a highly significant improvement in all four test scores after surgery. There were no statistically significant differences in the test scores between the two groups but considerable inter-patient performance variability was noted. The arterial line filter did not appear to have an effect on test scores. Routine use of an arterial filter remains questionable.
Pulmonary Histopathology after Cardiopulmonary Bypass with Pall LG6 Leukocyte-Depleting Filter
Authors: Al-Ebrahim Khalid , Abou-Azama Abdel-Moneim , Anwar Farzal , Chopra Saif , Shafei Hussein
Published: May 2013

There is increasing interest in the use of leukocyte-depleting filters to reduce the harmful effects of neutrophils during cardiopulmonary bypass. Pulmonary histopathology was studied in 7 patients before and after cardiopulmonary bypass. The arterial line leukocyte-depleting filter (Pall LG6) was used in 5 cases and the conventional arterial line filter (Pall Autovent) was used in 2 patients. The results showed no significant influence of the leukodepletion filter on pulmonary histopathologic changes associated with cardiopulmonary bypass.
Staged Cardiac and Aortic Aneurysm Surgery Using Ventricular Assist Device
Authors: Matsuwaka Ryousuke , Shimazaki Yasuhisa , Miyamoto Yuji , Masai Takafumi , Shintani Hideo , Yagura Akihiko , Suzuki Ken , Kook Kim Yong , Matsuda Hikaru
Published: May 2013

A two-stage procedure involving coronary artery bypass grafting and aortic valve replacement followed by abdominal aortic aneurysm repair two days later was performed on a 51-year-old man with severely depressed left ventricular function. The patient was supported with a left ventricular assist device as a short-term bridge between the two stages of surgery. This strategy may be a useful alternative to a one-stage operation in high-risk patients.
Staged Surgical Closure of Patent Ductus Venosus
Authors: van Son Jacques AM , Falk Volkmar , Mohr Friedrich W
Published: May 2013

A staged surgical technique to close a patent ductus venosus is presented.
Surgical Correction of Ruptured Aneurysm of the Sinus of Valsalva
Authors: Song Cao , Kun Qiu Zhao , Li Gu Wei , Yuan Chang , Wei Shi , Peng Chen
Published: May 2013

Between January 1983 and December 1996, 108 patients with ruptured aneurysms of the sinus of Valsalva underwent surgical correction in Shanghai Chest Hospital. The aneurysms ruptured into the right ventricle in 91 patients, into the right atrium in 16, and into the left atrium in 1. The aneurysm originated from the right coronary sinus in 82 patients, from the noncoronary sinus in 25, and from the left coronary sinus in 1. Associated intracardiac defects included ventricular septal defect in 52, aortic valve insufficiency in 67, and patent ductus arteriosus in 2. A ruptured aneurysm of the sinus of Valsalva without aortic valve insufficiency was approached via the cardiac chamber into which it ruptured. When the aneurysm was associated with moderate or severe aortic valve insufficiency we preferred the transaortic approach for repair. The aneurysm was excised at its base and repaired with a Dacron patch regardless of the size of the base of the aneurysm. Active surgical management of aortic valve insufficiency was performed at the initial operation using valve suspension in 25 patients with moderate aortic valve insufficiency and replacement with a mechanical valve prosthesis in 6 cases of severe aortic insufficiency. The early mortality was 2.78%. The median follow-up period was 3.9 years. Of the 72 patients who were followed up, 67 are in New. York Heart Association functional class I or II and 5 are in class III or IV due to severe aortic valve insufficiency. Considering the pathoanatomic features and hemodynamic changes associated with ruptured aneurysms of the sinus of Valsalva in Oriental patients, we advocate repairing the defect with a patch in all cases and stress the importance of active surgical management for aortic valve insufficiency at the initial surgical correction.
Single Center Experience of Abiomed BVS 5000 Ventricular Assist Device
Authors: Samuels Louis E , Kaufman Marla S , Morris Rohinton J , Brockman Stanley K
Published: May 2013

Since 1987 the Abiomed BVS 5000 biventricular support system has been used successfully for circulatory support in a variety of settings. From June 1994 through December 1996, 20 of these devices were implanted in 17 patients at the Allegheny University Hospitals for ventricular support in these circumstances: following coronary artery bypass-grafting; after left ventricular aneurysm repair; after repair of a postinfarction ventricular septal defect; following double valve replacement; as a bridge to transplantation; and for right ventricular support following transplantation in patients with marked pulmonary hypertension. Fourteen devices were placed at the time of the initial cardiac surgery. Three devices were placed postoperatively after the initial cardiotomy. Of the 14 patients with early insertion, 9 (64%) were weaned off support, 8 (57%) died, and 6 (43%) were discharged. The 3 patients who underwent postoperative implantation could not be weaned from the device. This experience indicates that the Abiomed BVS 5000 can be used to preserve life in a variety of cardiac surgical conditions that would otherwise be fatal and more favorable results can be achieved when the device is placed early.
Video-Assisted Thoracoscope Pulmonary Resection
Authors: Prathanee Sompop , Tontisirin Cherdchai , Kuptamond Chusak
Published: May 2013

A retrospective analysis was made of the records of 10 patients who underwent pulmonary resection by video-assisted thoracoscopic surgery between April 1996 and January 1997. Five patients were referred with incidental findings of a lung mass. The other presenting symptoms were hemoptysis, chronic cough, and chest pain. The pulmonary lesions ranged in size from 1 to 5 cm in diameter, mean 3.3 cm. Video-assisted thoracoscope surgery comprised 7 lobectomies, 2 wedge resections, and 1 pneumonectomy. No postoperative complications were detected. Postoperative hospital stay averaged 7.8 days. We recommended using this procedure for pulmonary resection when indicated on selected patients, with an awareness of cost-effectiveness.
Endothelialization of Porcine Aortic Valves Postfixed with L-Glutamic Acid
Authors: Gang Chen , Yong Liu Wei , Qiang Yu Shi
Published: May 2013

Endothelial cells from rat aorta were cultured before seeding onto porcine aortic valve leaflet surfaces. Primary adherence, growth kinetics, and characteristics of the endothelialization were investigated at different time periods. There were 4 experimental groups: (1) preserved with glutaraldehyde alone, (2) non-preserved, (3) presented with glutaraldehyde and L-glutamic acid, and (4) preserved with glutaraldehyde, epoxy chloropropane, and L-glutamic acid. In group 1 there were no cells growing on the leaflet surfaces after 3 days but in groups 2, 3, and 4 there was distinctive cell growth. Immunostaining and morphologic examinations showed that the growing cells comprised mainly endothelial cells with some fibroblasts. The results showed that L-glutamic acid treatment could neutralize the effect of residual free aldehyde in tanned tissue, thereby allowing endothelial cells to grow on the valve leaflet surfaces.
Staged Surgery for Treatment of Three-Channeled Aortic Dissection
Authors: Irie Yoshihito , Yamada Takashi , Imazeki Takao , Murai Noriyuki , Ohshima Nogahisa
Published: May 2013

Dissection of the wall of an aortic dissection results in a three-channeled aorta. This particular entity creates many problems in the diagnosis and surgical treatment. A 42-year-old male with this lesion underwent successful surgical repair. Fenestration of the abdominal aorta below the renal arteries using a Y-graft was undertaken as the first step, without bypass. This was followed by total replacement of the thoracoabdominal aorta. The patient recovered satisfactorily and remains well. The technique of reconstruction of the splanchnic arteries and the artery to the spinal cord is described.
HeartMate Implantable Left Ventricular Assist Device
Authors: Ting Lai Shiau , Hwang Chang Shiao , Jenn Yu Tarng , Che Shih Chun
Published: May 2013

A 19-year-old male with acute myocarditis, cardiogenic shock, and impending multiple organ failure successfully underwent emergency implantation of a HeartMate WOO IP left ventricular assist device. The perioperative course was uneventful and his condition improved. After 14 weeks his cardiac function gradually recovered and heart transplantation was no longer considered necessary. The left ventricular assist device was explanted. Two weeks later the patient suffered a sudden onset of ventricular fibrillation and died in spite of aggressive resuscitation measures. Questions concerning the future use of such assist devices in patients with cardiomyopathy are discussed.
Successful Repair of Delayed Rupture of Left Ventricle after Valve Surgery
Authors: Sankar Nainar Madhu , Subtaweesin Thaworn , Horton Mathew , Farnsworth Alan
Published: May 2013

A 70-year-old female developed rupture of the posterior wall of the left ventricle 72 hours after mitral valve replacement and tricuspid annuloplasty. She presented with hypotension and hemothorax. Endoventricular pericardial patch repair was performed after removal of the prosthesis. Prompt recognition and hemodynamic stability allowed institution of cardiopulmonary bypass and successful repair.
Inflammatory Pseudotumor of the Lung
Authors: Arda Kemal , Özberk Kaan , Altinaş Kayhan , Cumhur Turhan
Published: May 2013

A case of inflammatory pseudotumor is reported. Inflammatory pseudotumor is a rare pulmonary tumor-like lesion and its pathogenesis remains obscure. Diagnosis of the lesion is usually not difficult on radiologic examinations but it must not be mistaken for a malignant tumor.
Carpentier-Edwards Bioprosthesis: Structural Deterioration by Age Groups
Authors: Jamieson WR Eric , Ling Hilton , Burr Lawrence H , Fradet Guy J , Miyagishima Robert T , Lichtenstein Samuel V , Munro A Ian
Published: May 2013

The Carpentier-Edwards supra-annular porcine bioprosthesis (second generation prosthesis) was implanted in 2438 patients in 2482 operations between 1982 and 1992. The mean age of the population was 64 years with a range from 21 years to 89 years. There were 1334 aortic and 934 mitral valve replacements. The population was divided into five groups: 21 to 40 years (n = 132); 41 to 50 years (n = 189); 51 to 60 years (n = 454); 61 to 70 years (n = 849); and over 70 years (n = 858). There was no difference in sunival by valve position for age groups 21 to 40 years and 41 to 50 years. Sunival within the age groups 51 to 60 years, 61 to 70 years, and over 70 years was greater for patients with aortic compared with mitral and multiple valve replacements. The freedom from structural valve deterioration at 10 years for all age groups was highest for valves in the aortic position. Patients with valves in the mitral position had a higher freedom from structural valve deterioration at 10 years than those who had multiple valve replacement, although not all the differences were significant. There was a lower incidence of structural valve deterioration in the older age groups. We concluded that the use of the Carpentier-Edwards supra-annular porcine bioprosthesis for aortic valve replacement can be extended to patients over 60 years of age, while its use for mitral valve replacement can be extended to those above 70 years of age.
Surgical Treatment for Acute Abdomen after Cardiovascular Operations
Authors: Misawa Yoshio , Fuse Katsuo , Hasegawa Tsuguo , Kato Morito , Kamisawa Osamu
Published: May 2013

We reviewed 1325 cardiovascular surgical cases in our 17-year experience. Seven men and 2 women presented with an acute abdomen between postoperative day 4 and day 26. Intra-abdominal complications included gastroduodenal hemorrhage in 3 men, perforated duodenal ulcer in 1 man, acalculous cholecystitis in 3 patients after 2 to 4 weeks of fasting, intestinal obstruction in 1 woman, and mesenteric artery occlusion in 1 man. Two of these patients (22%) died from subsequent complications and the others recovered after surgical interventions. None of the 633 patients under 50 years old developed an acute abdomen. Complications related to gastroduodenal ulcer were observed only in men. Far advanced heart failure that forced long-term fasting might have been the cause of acalculous cholecystitis. Prompt and appropriate surgical interventions were required to minimize unfavorable consequences.
Twenty-Five Years of Experience with Left Atrial Myxoma
Authors: Mavitaş Binali , Ulus A Tulga , İşcan Zafer , Yamak Birol , Birincioğlu Levent , Saritaş Ahmet , Katircioğlu S Fehmi , Taşdemir Oğuz
Published: May 2013

Forty-four patients with left atrial myxoma were operated at Türkiye Yüksek İhtisas Hospital between 1971 and 1996. There were 31 female and 13 male patients. The myxoma arose from the interatrial septum in 43 patients and from the annulus of the posterior leaflet of the mitral valve in one patient. Preoperatively, all patients had dyspnea or tachycardia. Clinical evidence of systemic embolism was detected in 9 patients. The diagnosis was established by angiocardiography in 6 patients and by echocardiography in 38 patients. All patients were treated surgically under cardiopulmonary bypass and the myxomas were resected with their septal attachments. The septal defects were closed with a patch in 12 patients and primarily in 32 patients.
Chemotherapy and Myocardial Ischemia
Authors: Al-Ahwal Mahmoud Shaheen , Venner Peter
Published: May 2013

Vascular complications associated with antineoplastic agents are being reported with increasing frequency. We report the cases of 4 young patients who developed myocardial ischemia after treatment with cisplatin-based chemotherapy. This suggests that cisplatin-based chemotherapy might cany the risk of acute or delayed serious cardiovascular events, which should be considered when chemotherapy is used as an adjuvant or when there are other known risk factors.
High Prevalence of p53 Gene Mutation in Esophageal Cancer
Authors: Ho Park Jong , Jong Baek Hee , Ill Zo Joe , Tack Lee Choon , Min Kim Chang , Mog Shim Young
Published: May 2013

Tissue samples from 24 patients with esophageal cancer were studied to determine the incidence and clinical implications of alterations of the p53 gene. Allelic deletion of chromosome 17p and mutation of the p53 gene were determined by Southern blot analysis and polymerase chain reaction single-stranded conformation polymorphism. Nucleotide sequence analysis was performed using the direct sequencing method when abnormalities were detected. Eighteen of the 24 cases of esophageal cancer showed either gene deletions or mutations of the p53 gene. Among 15 tumors with p53 gene deletion or mutation, 13 point mutations and 2 frame shifts were identified. The clinical data were also analyzed in relation to genetic alteration of the p53 gene. These results indicate that allelic deletion of 17p 13 and mutation of the p53 gene are frequent and may occur simultaneously in esophageal cancer cells. Such changes might be an important step in the development of esophageal cancer. However, the presence of a p53 gene mutation was not significantly associated with tumor stage, nodal stage, age, or smoking. There was no evidence to suggest that p53 gene mutation could be a prognostic factor in esophageal cancer patients.