bluuebunny/crossref_metadata_2025 huggingface dataset:
Correction of Traumatic Tricuspid Insufficiency Using the Double Orifice Technique
Authors: Luo Guo-Hua , Ma Wei-Guo , Sun Han-Song , Xu Jian-Ping , Sun Li-Zhong , Hu Sheng-Shou
Published: May 2013

Traumatic tricuspid insufficiency is an uncommon clinical condition and surgical procedures vary. In this paper we report our experience in treating traumatic tricuspid insufficiency using the double orifice technique. From January 2000 to September 2003, 10 patients with traumatic tricuspid regurgitation were admitted to our hospital, 5 of whom were corrected using the double orifice technique. There were 4 males and 1 female with ages ranging from 31 to 52 years. Preoperative transthoracic echocardiography (TTE) detected severe tricuspid regurgitation in 4 patients and moderate tricuspid regurgitation in 1 patient. At surgery, tear of the tricuspid anterior papillary muscle was found in 2 cases and anterior chordal rupture in 3 cases. The valves were successfully repaired using the double orifice technique in combination with ring annuloplasty. There was no repeat operation, no operative complications or deaths. Before discharge, TTE detected normal tricuspid valve function in 2 cases and tiny regurgitation in 3 cases. After a follow up of 8 to 36 months, TTE demonstrated normal valve function in 1 patient and tiny regurgitation in 4 patients. The double orifice technique appears to be a simple but effective method of repairing traumatic tricuspid incompetence. Satisfactory clinical outcomes can be produced in carefully selected patients.
Clinical and Electrophysiologic Profile of Brugada Syndrome in Iranian Patients
Authors: Haghjoo Majid , Arya Arash , Emkanjoo Zahra , Sadr-Ameli Mohammad Ali
Published: May 2013

Clinical and electrophysiologic characteristics of 20 patients (15 males; mean age, 42 ± 9 years) with Brugada syndrome were studied. Electrocardiographic abnormalities (spontaneous in 6 and provoked in 14) were recognized in 5 symptomatic and 15 asymptomatic patients. Mean PR (188 ± 18 vs. 184 ± 24 ms) and QT (362 ± 34 vs. 382 ± 28 ms) intervals and ST-segment elevation (2.28 ± 0.42 vs. 2.70 ± 0.77 mm) were similar in both groups. The PR interval was slightly longer in males than females (191 ± 21 vs.168 ± 18 ms, p = 0.042), but ST-segment elevation (2.70 ± 0.78 vs. 2.24 ± 0.26 mm) was similar. The HV interval was longer in males than females (57 ± 4 vs. 50 ± 4 ms, p = 0.047). Ventricular arrhythmias were induced in 40% of asymptomatic patients. There was no significant difference in age, sex, PR interval, ST-segment elevation, or HV interval between inducible and non-inducible patients. A defibrillator was implanted in 8 patients. During 16 ± 2 months of follow-up, one symptomatic patient had appropriate device therapy. None of the asymptomatic and non-inducible patients experienced a cardiac event. Electrophysiologic data have no role in predicting inducibility in programmed stimulation.
Ablation of Atrial Fibrillation Using Microwave Energy — Early Experience
Authors: Kabbani Sami S , Murad Ghassan , Jamil Hisham , Sabbagh Ammar , Hamzeh Khaled
Published: May 2013

Between Dec 12, 2002 and Aug 22, 2004, 84 operative patients with chronic atrial fibrillation (AF) were subjected to AF ablation with microwave energy. Of these, 49 patients were female; their ages ranged between 20 and 72 years (mean, 43.1 years). Most patients suffered from mitral disease, accompanied in over one third of cases with tricuspid insufficiency. Thirteen patients had aortic valve disease, mostly with mitral involvement. Three patients had coronary artery disease, three had atrial septal defect and one had a left atrial (LA) myxoma. Seventy-two patients underwent endocardial ablation and 12 patients underwent epicardial ablation. Operative mortality was 4 (4.8%), and there were no major untoward postoperative events. Fifty seven patients (71.3%) had their AF converted to sinus rhythm immediately after surgery. Amiodarone or sotalol was used in all postoperative patients for 6 months, except in 8 who had bradycardia. Electrical defibrillation was utilized in cases of atrial flutter or persistent AF. Seventy patients were followed for at least 6 months. In total, 52 of them (74.3%) are still in sinus rhythm. We believe microwave ablation is a satisfactory and safe method of AF ablation, and because it is brief, it can be added to surgical procedures without undue risk to the patient.
A New Surgical Techique for Adenoid Cystic Carcinoma Involving Tracheal Carina
Authors: Sayar Adnan , Metin Muzaffer , Solak Okan , Turna Akif , Alzafer Süha , Ece Turan
Published: May 2013

Reported is the successful treatment of a 24-year-old male with adenocystic carcinoma involving the tracheal carina, in which the tumor extended along the right main bronchus across the orifice of the right upper lobe. The patient underwent a carinal resection plus right upper lobectomy and reconstruction of the carina, resulting in neither anastomotic complication nor recurrence of disease during 28 months of follow-up.
Unruptured Sinus of Valsalva Aneurysms Manifesting as Complete Heart Block
Authors: Rajashekar Durgaprasad , Subramanyam Gangapatnam , Panchamukheswar Rao , Praveen Maddirala , Guruprasad Sonuguri
Published: May 2013

We present a patient with bilateral unruptured sinus of Valsalva aneurysms involving both the left and right coronary sinuses. The large left sinus aneurysm protruded into the left atrium and the right sinus aneurysm extended into the interventricular septum, producing a transient complete heart block.
Intensive Care Unit Readmission after Elective Coronary Artery Bypass Grafting
Authors: Alex Joseph , Shah Rajesh , Griffin Steven C , Cale Alexander RJ , Cowen Michael E , Guvendik Levent
Published: May 2013

Prospective data of 3,120 consecutive patients who had elective coronary artery bypass were analyzed to identify patient profile, cost, outcome and predictors of those readmitted to the intensive care unit. Group A ( n = 3,002) had a single intensive care unit admission and group B ( n = 118) were readmitted within 30 days after surgery. Parsonnet score, EuroSCORE, age, body mass index, chronic obstructive airway disease, peripheral vascular disease, renal dysfunction, unstable angina, congestive cardiac failure, and poor left ventricular function were higher in group B. Bypass and crossclamp times were longer, and the prevalence of inotropic and balloon pump support, arrhythmias, myocardial infarction, re-exploration, blood loss and transfusion, cerebrovascular accident, wound infection, sternal dehiscence, and multisystem failure were higher in group B. Despite a 4-fold increase in cost of care, the mortality rate (32.4%) of patients readmitted to intensive care was 23-times higher than routine patients (1.4%). Crossclamp time > 80 min, Parsonnet score > 10, EuroSCORE > 9, sternal dehiscence, ventricular arrhythmias, and renal failure predicted readmission.
Surgery for Non-Small Cell Carcinoma in Geriatric Patients: 15-Year Experience
Authors: Sirbu Horia , Schreiner Waldemar , Dalichau Harald , Busch Thomas
Published: May 2013

The purpose of this study was to determine the clinical patterns, short- and long-term survival in elderly patients after surgery for non-small cell lung carcinoma. The 273 patients aged over 70 years who underwent curative resection from 1986 to 2001 were retrospectively assessed. Mean age was 73.2 ± 3.1 years, (11% were > 80 years). The mean follow-up was 31 months. Standard procedures were used: 151 lobectomies, 49 bilateral lobectomies, 42 pneumonectomies, 9 sleeve resections, and 22 wedge resections. The 30-day mortality was 5.4%. Multivariate analysis showed that extended procedures, male sex, and age were predictors of mortality. Overall survival rates at 5, 10, and 15 years were 35.6%, 10.5%, and 2.5%, respectively. Advanced disease stage, low forced expiratory volume in 1 second, and previous cardiac disease were independent predictors that adversely influenced survival. Geriatric patients with non-small cell lung carcinoma can undergo resection safely with acceptable long-term survival. Lobectomy is the procedure of choice, extended resections should only be carried out in highly selected patients. Careful attention to preoperative clinical staging is important as the elderly beyond the early stage of disease fare poorly. Surgery is justified for the treatment of stage I–II lung cancer.
Low-Dose Anticoagulation in Chinese Patients with Mechanical Heart Valves
Authors: Zhou Xin-Min , Zhuang Wei , Hu Jian-Guo , Li Jian-Min , Yu Jie-Feng , Jiang Ling
Published: May 2013

The aim of this study was to provide guidelines for optimal anticoagulation in Chinese patients after mechanical heart valve replacement. A Carbomedics valve was implanted in 178 patients between July 2000 and July 2003. During follow-up, 22 bleeding events and 1 thromboembolic complication occurred. The linearized rates of bleeding and thromboembolism were 5.83% and 0.26% per patient-year, respectively. The linearized mortality rate was 0.79% per patient-year. The final mean international normalized ratio (INR) was 1.68 ± 0.38, however there was a significant variation between the early and late periods of follow-up. For Chinese patients with mechanical heart valves, bleeding was the major complication rather than thromboembolism. Low-dose anticoagulation (international normalized ratio 1.4–2.0) could markedly decrease bleeding and effectively prevent thromboembolism. As the INR was most unstable in the first postoperative month, re-examination of patients in this period is critical.
Effect of Prolonged Intensive Care Stay on Survival following Coronary Surgery
Authors: Ghotkar Sanjay V , Grayson Antony D , Dihmis Walid C
Published: May 2013

The aim of the study was to examine midterm survival in patients who required prolonged recovery in the intensive care unit. The 5,186 consecutive patients who underwent isolated coronary surgery between April 1997 and March 2002 were retrospectively analyzed. Patients were classified as having prolonged (> 3 days) or normal (≤ 3 days) stay in the intensive care unit. Patient records were matched to the National Health Service Strategic Tracing Service which records all-cause mortality in the UK. Case-mix was controlled for by constructing a propensity score from core patient characteristics, which was included along with the comparison variable in a multivariable analysis of outcome. Prolonged intensive care unit stay was recorded in 475 (9.16%) patients. Mortality was 9.14% during the study period with a total follow-up of 19,618 patient-years (mean, 3.8 years). Adjusted 5-year survival was 78.0% for prolonged intensive care unit stay vs. 90.7% for normal stay, with an adjusted hazard ratio for midterm mortality of 2.6 ( p < 0.001). Midterm mortality was significantly higher in patients with a prolonged intensive care unit stay following coronary bypass.
All Internal Thoracic Artery Composite Graft Revascularization
Authors: Izumoto Hiroshi , Ishihara Kazuaki , Kawase Tetsunori , Nakajima Takayuki , Satoh Hiroshi , Kawazoe Kohei
Published: May 2013

The aim of this study was to determine the most efficient design of composite grafts and clarify the technical feasibility rate of composite grafting using internal thoracic artery exclusively in patients undergoing triple-vessel revascularization. Retrospective analysis of 104 consecutive patients was carried out. An in situ left internal thoracic artery graft for the left anterior descending artery area, with attachment of the right internal thoracic artery to the side of the left internal thoracic artery to revascularize the circumflex and right coronary vessels, was the most efficient graft design. The technical feasibility rate was 80% (83/104 patients). The mean number of distal anastomoses for the entire group was 3.8 ± 0.8 per patient. Intraoperative left internal thoracic artery flow rate was 91.6 ± 37.8 mL·min−1. With more experience, it is thought that the technical feasibility rate could be increased.
Site-Specific Detection of Bleeder Using Transesophageal Echocardiography
Authors: Wasir Harpreet , Mittal Sanjay , Mishra Yugal , Mehta Yatin , Trehan Naresh
Published: May 2013

Transesophageal echocardiography continues to be an indispensable postoperative diagnostic tool for cardiac surgical patients. Transesophageal echocardiography was carried out postoperatively in 30 consecutive hypotensive patients with low cardiac output who had undergone coronary bypass surgery. In 19 of these patients, a cause of low cardiac output requiring surgical intervention was excluded, and they were managed conservatively. In 11 patients, a surgical cause of low cardiac output was indicated: diffuse bleeding from no particular site in 5, and from a specific site in 6. They underwent urgent re-operation, and the echocardiography findings were confirmed on the operating table. Not only is transesophageal echocardiography important in diagnosis, but it is also highly specific in locating the site of bleeding.
Traumatic Giant Pseudoaneurysm of Innominate Artery
Authors: Dhaliwal Rajinder S , Luthra Suvtesh , Goyal Sameer , Behra Sukant , Krishna Rama , Ba Kanchan
Published: May 2013

A 20-year-old man developed a giant pseudoaneurysm of the innominate artery 5 months after blunt chest trauma, causing severe respiratory distress and superior vena cava compression symptoms. The patient was managed with hypothermia and low flow cardiopulmonary bypass resulting in a successful outcome.
Coronary Artery Bypass Surgery in a Patient with a Functional Single Lung
Authors: Yazicioglu Levent , Aral Atilla , Uymaz Ozge , Akalin Hakki
Published: May 2013

Destructed lung and pneumonectomy are associated with anatomic and physiologic changes that may interfere with the conduct of subsequent open heart surgery. Here we report a case of an autopneumonectomized patient who required open heart surgery. The preoperative, intraoperative and postoperative management of this patient was unique. Open heart procedures on patients with a single lung can be performed with acceptable operative mortality and morbidity.
Saphenous Vein Patch Plasty to Correct Saphenous Graft and Aortotomy Mismatch
Authors: Dandekar Uday , Kalkat Maninder S , Ridley Paul
Published: May 2013

Mismatch of aortotomy and saphenous vein graft size occasionally occurs and can compromise the contour of the anastomosis thereby jeopardising its patency. We describe an alternative technique of saphenous vein patch plasty to overcome this complication by giving a more desirable hooded contour to the anastomosis. This results in improved graft patency, hemostasis and clinical outcome.
Modulation of Systemic Inflammatory Response after Cardiac Surgery
Authors: Raja Shahzad G , Dreyfus Gilles D
Published: May 2013

Cardiac surgery and cardiopulmonary bypass initiate a systemic inflammatory response largely determined by blood contact with foreign surfaces and the activation of complement. It is generally accepted that cardiopulmonary bypass initiates a whole-body inflammatory reaction. The magnitude of this inflammatory reaction varies, but the persistence of any degree of inflammation may be considered potentially harmful to the cardiac patient. The development of strategies to control the inflammatory response following cardiac surgery is currently the focus of considerable research efforts. Diverse techniques including maintenance of hemodynamic stability, minimization of exposure to cardiopulmonary bypass circuitry, and pharmacologic and immunomodulatory agents have been examined in clinical studies. This article briefly reviews the current concepts of the systemic inflammatory response following cardiac surgery, and the various therapeutic strategies being used to modulate this response.
Cor Triatriatum: Operative Results in 20 Patients
Authors: Al Qethamy Howaida O , Aboelnazar Saber , Al Faraidi Yahya , Al Jubair Khalid , Gadura Mohamed , Fagih Mohamed
Published: May 2013

Cor triatriatum is an uncommon cardiac anomaly occurring in 0.1% of children with congenital heart disease. We reviewed our results from 20 patients presenting with cor triatriatum in the last 20 years (from March 1983 to August 2002). Mean age at repair was 20 months (1 – 132 months). During a mean follow-up period of 31 months (2 – 156 months) there were no deaths. All patients were in sinus rhythm except one patient who needed pacemaker insertion one week after repair. A total of 14 patients were asymptomatic and 6 were in New York Heart Association Class I. Cor triatriatum is amenable to surgical repair with excellent results when diagnosed early, and when not associated with other severe cardiac anomalies.
Ascending Aorta or Arch Surgery: Is Previous Cardiac Surgery a Risk Factor?
Authors: Narayan Pradeep , Rogers Chris A , Caputo Massimo , Angelini Gianni D , Bryan Alan J
Published: May 2013

Surgery on the ascending aorta ± arch is a challenge. The risks involved in such operations after previous cardiac surgery were assessed in elective and emergency settings in a single institution. Over a 10-year period, 29 patients underwent replacement of the ascending aorta ± arch following previous cardiac surgery. In 12 patients (41.4%), the procedure was carried out on an emergency basis. Thirteen had previous replacement of the ascending aorta and 16 had previous valve replacement with or without coronary artery bypass; 4 patients were undergoing a 3rd cardiac operation. Concomitant procedures included coronary artery bypass in 2, arch replacement in 4, and descending aortic replacement in one. The overall in-hospital mortality was 13.8% (4/29) vs. 12.4% (33/267) in primary procedures. Mortality in elective repeat surgery was 5.9% (1/17) vs. 25% (3/12) in emergency re-operations. The incidences of permanent stroke (3.4%) and renal failure (3.4%) were similar to first-time operations. Elective re-operation for ascending aorta ± arch repair can be accomplished with acceptable mortality and morbidity. Outcomes in emergency cases carry a higher early mortality but still conform to contemporary expectations and are similar to emergency first-time aortic surgery.
Femoral Artery Cannulation in Stanford Type a Aortic Dissection Operations
Authors: Hou Xiao-Tong , Sun Yan-Qing , Zhang Hong-Jia , Zheng Si-Hong , Liu Yu-Yong , Wang Jian-Gang
Published: May 2013

The aim of this study was to evaluate femoral artery cannulation in Stanford type A aortic dissection operations. Between March 1994 and December 2001, 88 patients with Stanford type A aortic dissection underwent surgery with cardiopulmonary bypass and perfusion through the femoral artery; 31 of them had deep-hypothermic circulatory arrest. False lumen perfusion was detected in 8 patients (9.1%). There were 4 (4.5%) cerebral events: 2 patients had diffuse cerebral injury, with one death; and 2 patients had hemiplegia, with one death. Six patients (8.0%) had delayed incision healing, with local infection in one. There was no lower extremity ischemia associated with femoral artery cannulation. It was concluded that retrograde perfusion through the femoral artery was effective for repair of aortic dissection, with a low risk of those cerebral events associated with a high mortality rate.
Anomalous Origin of Left Coronary Artery from Pulmonary Artery in Adults
Authors: Murala John S. K. , Sankar Madhu N , Agarwal Ravi , Golla Prasad N , Nayar Pradeep G , Cherian Kotturathu M
Published: May 2013

Various techniques have been described for management of anomalous origin of the left coronary artery from the pulmonary artery presenting in adults. Three patients, 1 male and 2 females, aged 27–37 years, underwent transpulmonary pericardial patch closure with concomitant left internal thoracic artery anastomosis to the left anterior descending artery, under standard cardiopulmonary bypass, thus creating a two-coronary system. One patient had concomitant mitral valve repair. All 3 survived the operation. Postoperative angiography in 2 patients revealed good antegrade flow with decreased collaterals in one and competitive inhibition with increased collaterals in the other. This procedure is considered to be the safest and simplest in this subset of patients.
Magnetic Resonance Angiography in Coronary Artery Bypass Grafting
Authors: Ohuchi Shingo , Kawazoe Kohei , Izumoto Hiroshi , Yoshioka Kunihiro
Published: May 2013

An attempt was made to reduce the incidence of perioperative stroke by detecting cerebrovascular disease with preoperative head and neck magnetic resonance angiography and by selecting the coronary artery bypass grafting technique. This strategy was used in 268 patients with ischemic heart disease who had undergone both head and neck magnetic resonance angiography before elective coronary artery bypass in our hospital between May 1997 and April 2001. In patients with significant stenosis or obstruction detected by head and neck magnetic resonance angiography, the findings were evaluated and cerebral blood flow was examined using brain single-photon emission computed tomography. In those with a high risk of cerebrovascular ischemia, off-pump coronary artery bypass was performed to maintain cerebral blood flow. No stroke occurred during surgery, and hemodynamic cerebrovascular ischemia was prevented in all 268 patients. Postoperative stroke occurred in 3 patients (1.1%), but the incidence of perioperative stroke was reduced.
Cardiopulmonary Bypass without Preoperative Exchange Transfusion in Sicklers
Authors: Maddali Madan M , Rajakumar Muthukkumar C , Fahr Jutta , Albahrani Maher J , Amna Mohamed A
Published: May 2013

The effect of hypothermic cardiopulmonary bypass techniques on the sickling process was evaluated in patients with sickle cell hemoglobin. It was presumed that intraoperative hemolysis, as identified by hemoglobinuria, reflected increased sickling. Data of 43 patients with sickle cell traits and 2 with sickle cell disease, who were operated on under cardiopulmonary bypass and cold cardioplegic arrest in a tertiary center from the beginning of 1995 to the end of 2004, were retrospectively analyzed. A mean nasal temperature of 30.8°C ± 2.1°C was achieved. Three patients with sickle cell trait developed intraoperative hemoglobinuria, albeit with normal surrogate values for hemolysis. However, they had significantly lower mean hemoglobin levels during cardiopulmonary bypass compared to those sickle cell patients who did not exhibit hemoglobinuria (hemoglobin, 6.0 ± 0.2 vs. 7.4 ± 0.9 g·dL−1, p < 0.01). Total drainage and blood transfusion requirements in patients with normal and sickle cell hemoglobin were similar. It was concluded that hypothermic cardiopulmonary bypass with cold cardioplegia is safe in sickle cell patients. Maintenance of adequate hemoglobin levels during cardiopulmonary bypass may be important to avoid triggering a sickling process.
A Lethal Complication of Propofol
Authors: Suen Hon Chi , Haake Robert J , Chavez Victor M , Hayat Sultan A
Published: May 2013

High-dose propofol infusion for sedation of patients in the intensive care unit can result in rhabdomyolysis, acute renal failure, metabolic acidosis, hyperkalemia, ventricular arrhythmia, hyperthermia, and death. The death of a patient with such complications after lung biopsy is reported. Until a safer dosage range has been determined, propofol infusion at rates higher than 5 mg·kg−1·h−1 should be discouraged for long-term sedation (> 48 h).
Sewing Needle in the Heart
Authors: Talwar Sachin , Subramaniam K Ganapathy , Subramanian Anandaraja , Kothari Shyam S , Kumar A Sampath
Published: May 2013

An unusual case of a sewing needle in the heart is reported for its rarity. The relevant literature is briefly reviewed.
Wide Sleeve Resection of Lower Trachea through Anterior Approach with Omentopexy
Authors: Yoshino Ichiro , Yamaguchi Masafumi , Kakeji Yoshihiro , Ichinose Yukito , Maehara Yoshihiko
Published: May 2013

A 61-year-old man with tracheal adenoid cystic carcinoma (case 1) and a 28-year-old woman with benign tracheal stenosis (case 2) were treated with sleeve resection of the lower trachea through a median sternotomy and prophylactic omental wrapping. The resected tracheas were 4.5 cm (case 1) and 4.0 cm (case 2) in length. Both patients had an uneventful course after surgery despite postoperative irradiation in case 1 and preoperative infection with methicillin-resistant Staphylococcus aureus in case 2.
Primary Epithelioid Angiosarcoma of the Lung Presenting as Pulmonary Hemorrhage
Authors: Ozcelik Cemal , Onat Serdar , Yaldiz Mehmet , Ozcelik Zerrin
Published: May 2013

Pulmonary angiosarcomas are usually secondary tumors, and only a few primary cases have been reported. We report a unique case of epithelioid angiosarcoma presenting as a solitary mass in the right upper lobe with pulmonary hemorrhage. Because of its epithelioid histology, this tumor may resemble a carcinoma or a variety of vascular lesions with epithelioid endothelial cells. Therefore, the diagnosis of epithelioid angiosarcoma should be based on immunohistochemical staining.
Spontaneous Cervical Emphysema and Pneumomediastinum in an 18-year-old Woman
Authors: Madershahian Navid , Meyn Michael , Strauch Justus T , Wahlers Thorsten
Published: May 2013

Pneumomediastinum or mediastinal emphysema is a known complication of traumatic injury or disease whereas spontaneous pneumomediastinum remains a rare clinical entity. We present the case of a young woman with a diagnosis of spontaneous pneumomediastinum combined with cervical emphysema without any precipitating factors or disease.
Outcome of Pediatric Empyema Thoracis Managed by Tube Thoracostomy
Authors: Rodriguez Maria Lorena Corazon V , Catalan Gisel T
Published: May 2013

The proper management of empyema thoracis in children continues to be a source of debate. This study assessed the clinical profile and outcome of patients managed by tube thoracostomy. Chart review was performed in 31 patients managed from January 1989 to December 2003. Outcome measures were duration and outcome of thoracostomy, number of days to radiologic lung re-expansion, length of hospitalization, and microbiologic flora involved. The mean age was 9 years (male/female, 2:1) and the most commonly affected group were those aged 1 year and below. Staphylococcus aureus was the most frequent infecting organism. A few (6%) achieved lung re-expansion 1 week postoperatively, but 64% did not achieve full lung re-expansion even after 3 weeks. Most (71%) of the thoracostomies were converted to open drainage. Half (52%) of the patients were hospitalized for at least 5 weeks. There were 3 recurrences and 3 deaths, 2 of which were most likely associated with empyema. Empyema managed by tube thoracostomy alone showed evidence of delayed lung re-expansion, prolonged drainage and hospitalization, and unfavorable outcome.
Determinants of Morbidity and Intensive Care Unit Stay after Coronary Surgery
Authors: Abrahamyan Lusine , Demirchyan Anahit , Thompson Michael E , Hovaguimian Hrair
Published: May 2013

The study evaluated rates and determinants of hospital morbidity, serious morbid events, and prolonged intensive care unit stay associated with isolated coronary artery bypass. The medical records of 391 patients undergoing isolated coronary artery bypass at our center during 2003 were reviewed. The observed crude hospital mortality rate was 2.05%, similar to the EuroSCORE predicted mortality rate of 2.34%. Arrhythmia was the most frequent postoperative complication (17.6%). The serious hospital morbidity rate was 5.9%. The final logistic regression model of serious morbid events identified the following predictors: drug allergy, diabetes, and EuroSCORE. Prolonged intensive care unit stay (≥ 3 days) was observed in 9.5% of patients. Multivariable logistic regression analysis revealed age, preoperative rhythm disturbances, previous cardiac operation, and hypertension as independent predictors of prolonged intensive care unit stay. The rates of hospital mortality, morbidity, and prolonged intensive care unit stay were comparable to those of other major international cardiac surgery centers. These data can be used as a benchmark for further self- and peer-assessment quality improvement activities.
Continuous Suture Technique for Freedom Stentless Valve: Reduced Crossclamp Time
Authors: Beholz Sven , Dushe Simon , Konertz Wolfgang
Published: May 2013

The Pericarbon Freedom stentless valve has shown excellent hemodynamics. A continuous suture technique at the inflow site may reduce cardiopulmonary bypass and crossclamp times and affect postoperative hemodynamics. In a prospective case-matched study, interrupted and continuous suture line techniques were used in 68 and 71 patients, respectively. Isolated valve replacement was performed in 70.4% of the continuous suture group and 67.6% of the interrupted suture group. Hemodynamic data were obtained by echocardiography (mean and peak gradients, regurgitation) at discharge and after 1 year. Overall mortality was 5.0% and due to non-valve-related causes. Bypass and crossclamp times were shorter by 22.4 and 20.6 min, respectively, in the continuous suture group. The suture technique at the inflow site did not result in significant differences in the mean (11.8 ± 6.3 vs. 12.5 ± 6.2 mm Hg) or peak gradients (21.0 ± 9.6 vs. 22.0 ± 10.9 mm Hg), or degree of regurgitation. Follow-up showed a further decrease in the gradients.
Prognostic Factors for Disease-Free Survival in pT2N0 Non-Small Cell Lung Cancer
Authors: Park Inkyu , Chung Kyung Young , Kim Kil Dong , Kim Dae Joon
Published: May 2013

To clarify the prognostic factors for disease-free survival in completely resected pT2N0 non-small cell lung cancer, 81 consecutive patients who were treated between 1998 and 2001 were retrospectively reviewed. Follow-up was complete for all patients and the median follow-up time was 37.5 months. The overall 5-year survival rate was 68.6%, and the 5-year disease-free survival rate was 62.5%. Four factors (age, sex, visceral pleural invasion, and administration of tegafur and uracil) were proposed as prognostic factors for disease-free survival by univariate analysis. In multivariate analysis, visceral pleural invasion by the tumor (hazard ratio = 2.709, 95% confidence interval: 1.085 to 6.765, p = 0.033) and administration of tegafur and uracil (hazard ratio = 0.327, 95% confidence interval: 0.147 to 0.730, p = 0.006) were significant factors. Visceral pleural invasion was a prognostic factor for reduced disease-free survival in completely resected pT2N0 non-small cell lung cancer, and postoperative treatment with tegafur and uracil significantly improved disease-free survival.
Bilateral Axillary Arterial Perfusion in Surgery on Thoracic Aorta
Authors: Kurisu Kazuhiro , Ochiai Yoshie , Hisahara Manabu , Tanaka Kenichiro , Onzuka Tatsushi , Tominaga Ryuji
Published: May 2013

Bilateral axillary arterial cannulation for selective cerebral perfusion might minimize cerebral embolic complications during surgery on the ascending aorta and aortic arch. From March 2002 through February 2004, bilateral axillary arterial perfusion was applied in 12 consecutive patients (mean age, 61.3 years). Operative procedures were total arch replacement in 8 patients, hemiarch replacement in 1, and ascending aorta replacement in 3. Antegrade selective cerebral perfusion was established through vascular grafts anastomosed to the bilateral axillary arteries and a perfusion catheter placed directly into the left carotid artery. Bilateral axillary arterial perfusion through the grafts was successful in all patients. There were no early or late deaths and no incidence of neurologic deficit. There were no complications related to cannulation of the axillary arteries. Bleeding, temporary renal failure, acute respiratory distress syndrome, and graft infection occurred in one patient each; all recovered from these complications. Bilateral axillary arterial perfusion is feasible and effective for brain protection during surgery on the ascending aorta and aortic arch.
Surgical Repair of a Syphilitic Aneurysm of the Distal Arch and Descending Aorta
Authors: Umesue Masayoshi , Durairaj Manoj , Matalanis George , Parsons Sarah
Published: May 2013

Cardiovascular syphilis, which used to be a well-recognized manifestation of tertiary syphilis, has become a rarity. In this report we describe a 47-year-old man presenting with an aneurysm of the distal arch and proximal descending aorta, a somewhat unusual presentation for a syphilitic aneurysm, and discuss the clinical features of cardiovascular syphilis.
A Technical Failure Changes a Y-graft into a C-conduit Causing Steal Syndrome
Authors: Al-Ruzzeh Sharif , Bustami Mahmoud , Athanasiou Thanos , George Shane , Ilsley Charles , Amrani Mohamed
Published: May 2013

Y-grafting is a common coronary grafting technique for performing composite coronary grafts. The outcome and efficacy of this technique have not been studied in detail in the literature. We report a case of an occlusion in the proximal limb of a Y-graft, changing it into a C-shaped conduit and causing a steal syndrome. Our aim is to raise the level of caution when performing this type of composite graft and to suggest how this complication can be managed postoperatively.
Role of Dendritic Cells in Atherosclerosis
Authors: Sharma Ranjit , Li Da-Zhu
Published: May 2013

Atherosclerosis is a lipid-related chronic inflammatory disease in which immune mechanisms play a pivotal role. The lesions are filled with large numbers of immune cells. During the last decade, dendritic cells have been identified in atherosclerotic plaques and are thought to play an important role in atherogenesis. Dendritic cells express major histocompatibility complex I and II, human leukocyte antigen-DR, CD1a, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and co-stimulatory molecule on their surfaces and this explains their unique ability to activate naive T cells. Factors such as oxidized low-density lipoprotein, hypoxia, nicotine, heat shock proteins, and altered nitric oxide synthase activity of the endothelium, all of which cause endothelial dysfunction, have a significant impact on dendritic cell adherence to endothelium and maturation. Mature dendritic cells are capable of presenting antigens to T cells, and activation of T cells leads to release of cytokines, which play an important role in the progression of disease. Drugs such as statins and diltiazem have been shown to protect endothelial function by inhibition of dendritic cell-endothelial cell interaction, and can be applied to delay the progression of cardiovascular diseases.
Tracheobronchial Obstruction as a Result of Mediastinal Mass
Authors: Chao Victor TT , Lim Darren WT , Tao Miriam , Thirugnanam Agasthian , Koong Heng Nung , Lim Chong Hee
Published: May 2013

A 21-year-old woman presented with almost complete extrinsic airway obstruction due to a massive mediastinal tumor. Venovenous extracorporeal membrane oxygenation support for 3 days with concurrent chemotherapy allowed time for tumor shrinkage, ventilation via the endotracheal route, and subsequent successful extubation on the fifth day.
Intracoronary Adenosine Triphosphate for Refractory Coronary Artery Spasm
Authors: Song Min-Ho , Sakurai Koji , Nakayama Tomohiro , Shirakawa Makoto , Hagiwara Hiroaki , Kamiya Haruo
Published: May 2013

A 62-year-old woman underwent aortic valve replacement for aortic stenosis. Her hemodynamics deteriorated with ST-T depression 6 hours postoperatively. Emergency coronary catheterization showed diffuse right coronary artery spasm. The spasm persisted despite intracoronary infusion of nitrates and calcium antagonists. Intracoronary adenosine triphosphate infusion finally resolved the spasm and stabilized the cardiac function.
Total Anomalous Pulmonary Venous Return in an Adult
Authors: Hisagi Motoyuki , Higuchi Kazuhiko , Koseni Kenzi , Inaba Hirotaka
Published: May 2013

A 47-year-old man with total anomalous pulmonary venous return met all the conditions necessary for long survival. In particular, his pulmonary vascular resistance was almost normal because of right ventricular outflow tract obstruction. Surgical treatment was performed with a good result.
Coronary Artery Bypass Grafting Using a Bifurcated Internal Thoracic Artery
Authors: Numata Satoshi , Murayama Yuichiro , Sakai Osamu , Koushi Keitaro
Published: May 2013

Coronary artery bypass grafting was performed successfully on a patient by anastomosing the left internal thoracic artery and its pericardiacophrenic branch to the obtuse marginal and the posterior descending coronary artery, respectively, to form a Y graft. Preoperative angiography of the internal thoracic artery had revealed the presence of an unusually large pericardiacophrenic branch almost the size of the main trunk, which allowed us to plan for bifurcated artery grafting.
Stent-graft for Recurrent Melioidosis Mycotic Aortic Aneurysm
Authors: Lee Ser Y , Sin Yoong K , Kurup Asok , Agasthian Thirugnanam , Caleb Michael G
Published: May 2013

Melioidosis is a tropical disease caused by Burkholderia pseudomallei and is prevalent in South East Asia and Northern Australia. It can infect any organ system and is potentially deadly. Melioidosis causing a mycotic aneurysm of the aorta is rare. We present a patient with a melioidosis mycotic aneurysm of the descending aorta presenting with fever and right pleural effusion, managed successfully with initial Dacron graft repair with staged omental reinforcement, and subsequent endovascular stent grafting of a late anastomotic leak.
Non-Infectious Aortitis: An Important Cause of Severe Aortic Regurgitation
Authors: Chau Elaine MC , Wang Elaine , Chiu Clement SW , Chow Wing-Hing
Published: May 2013

From 1995 to 2004, 13 patients with severe aortic regurgitation due to non-infectious aortitis underwent aortic valve surgery at our center. Twenty-eight operations (18 aortic valve replacements and 10 Bentall procedures including 1 aortic root replacement with a homograft) were performed due to a high incidence of prosthetic valve or valved conduit dehiscence (54%). Steroid therapy reduced the incidence of re-operation for anastomotic dehiscence within one year from 90% to 18%. Strategies to prevent dehiscence of the prosthetic aortic valve, which include institution of immunosuppression, replacement of the diseased aorta, and monitoring inflammatory indices, are discussed.
Optimizing Early Extubation after Coronary Surgery
Authors: Georghiou Georgios P , Stamler Alon , Erez Eldad , Raanani Ehud , Vidne Bernardo A , Kogan Alexander
Published: May 2013

Early extubation after isolated coronary artery bypass surgery was assessed retrospectively in 545 of 779 patients treated by the same surgical team over one year. All underwent extubation within 10 hr of arrival at the cardiothoracic intensive care unit: 343 in < 6 hr and 202 in 6–10 hr. Operative mortality was 2.2%. Group comparisons revealed that patients who had earlier extubation were younger (61 vs. 66 years; p < 0.001), more likely to be male (72.5% vs. 61.3%; p < 0.05), with a shorter aortic crossclamp time (49.2 ± 15.0 vs. 53.3 ± 14.0 min; p < 0.05), cardiopulmonary bypass time (65 ± 18.4 vs. 72.2 ± 19.2 min; p < 0.05), intensive care unit stay (18.8 ± 5.6 vs. 22.4 ± 3.2 hr; p < 0.05) and postoperative hospital stay (5.2 ± 2.2 vs. 6.0 ± 2.4 days; p = 0.01). Extubation < 6 hr after cardiopulmonary bypass may accelerate recovery. The finding of no significant differences in clinical parameters between the groups suggests that efforts to further reduce the time to extubation might be worthwhile.
Management of Malignant Mesothelioma by Decortication and Adjunct Phototherapy
Authors: Clarke Charles P , Knight Simon R , Daniel Freddy J , Seevanayagam Siven
Published: May 2013

Malignant mesothelioma is a relatively rare tumor that originates in the pleural space and almost invariably results from exposure to asbestos. Between September 1989 and December 1999, 100 patients were managed with curative intent using a combination of full decortication, adjunct phototherapy after administration of hematoporphyrin derivative, and strip radiotherapy to any areas where adequate clearance was not obtained. The survival curve was compared to that of 17 matched patients treated by decortication alone. Median survival increased from 250 to 440 days in the combined treatment group.
Clinical Characteristics of Bicuspid Aortic Valves in Surgical Patients
Authors: Ichihara Toshihiko , Fujii Genyo , Sasaki Michio , Kawaguchi Osamu , Ueda Yuichi
Published: May 2013

Of 413 patients undergoing surgery for aortic valve disease, 42 were confirmed to have congenital bicuspid aortic valve. There were 24 males and 18 females, with a mean age of 54.9 ± 14.6 years. The etiology of the surgical indications in patients with bicuspid valves were degeneration, rheumatic disease, and infectious endocarditis. Thirty-two patients had aortic stenosis and 10 had aortic regurgitation. Infective endocarditis was seen mainly in patients ≤50 years of age at the time of surgery, while degenerative aortic stenosis occurred more often in older patients. The annular diameter measured during surgery was significantly narrower in the 42 patients with bicuspid valves compared to 371 patients with tricuspid valves who underwent aortic valve replacement during the same period. It is important to prevent infectious endocarditis in younger patients diagnosed with bicuspid aortic valve, whereas careful attention should be paid to decalcification during surgery in older patients because the vast majority suffer from degenerative aortic stenosis.
Right Ventricular Dysfunction Due to Right Ventricular Outflow Tract Patch
Authors: Ge Jian-Jun , Shi Xue-Gong , Zhou Ru-Yuan , Lin Min , Ge Sheng-Lin , Zhang Shi-Bing
Published: May 2013

Doppler tissue imaging analysis was used to examine the relationship between right ventricular function and right ventricular outflow tract damage in 54 patients with repaired tetralogy of Fallot. The patients were divided into three groups: 16 in whom the right ventricular outflow tract was directly sutured (group DS), 23 who had transventricular patch repair (group TVP), and 15 who had transannular patch repair (group TAP). The control group consisted of 16 age-matched patients who underwent patch closure of a ventricular septal defect (group C). The Tei index was obtained from tricuspid and pulmonary Doppler flow velocities. The right ventricular Tei index was significantly greater in groups TVP and TAP than in group DS. Doppler tissue imaging analysis in groups TVP and TAP showed shorter myocardial systolic velocity, diastolic peak velocity, and atrial diastolic peak velocity, lower peak myocardial velocity and acceleration during isovolumic contraction, and prolonged isovolumic relaxation and contraction times compared to groups DS and C. Right ventricular dysfunction is due to the right ventricular outflow tract patch. Thus, the right ventricular outflow tract may be essential for right ventricular ejection and maintenance of right ventricular function.
Surgical Management of Bilateral Bronchiectases: Results in 29 Patients
Authors: Aghajanzadeh Manucher , Sarshad Ali , Amani Hosin , Alavy Ali
Published: May 2013

Bronchiectasis is a major cause of morbidity and mortality in developing countries. Staged bilateral segmental resection of the lungs is performed in selected patients. Our experience of surgical removal of 87 bilateral bronchiectases in 29 patients during an 11-year period was reviewed retrospectively. High-resolution computed tomography was performed preoperatively in all patients to locate the anatomic sites of bronchiectasis. The mortality and morbidity of the surgical procedure, clinical symptoms, age distribution, etiology, bacteriology, and operative procedures were analyzed. There were 22 males (76%) and 7 females (24%), aged 5 to 60 years, with a mean age of 30 years. Complications developed in 11 patients (38%); atelectasia was the most common (14%). There was one hospital death. Clinical symptoms disappeared in 19 (66%) patients, improved in 5 (17%), and were unchanged in 4 (14%). Staged bilateral resection for bronchiectases can be performed at any age with acceptable morbidity and mortality.
Experimental Assessment of the Drainage Capacity of Small Silastic Chest Drains
Authors: Niinami Hiroshi , Tabata Mimiko , Takeuchi Yasuo , Umezu Mitsuo
Published: May 2013

Recently, flexible fluted small silicone drains have been used widely as chest drains after cardiac surgery. Despite the clinical advantages of using smaller silastic chest drains over conventional chest tubes, an experimental comparison of the drainage capacity between these two drain tubes has not yet been performed. The drainage capacity of 19F silicone drains and 28F conventional tubes was tested. In an in vitro study, both tubes were set in a water bath and drained at a pressure of 10 mm Hg. In an in vivo study, the drains were inserted into the hemithorax in 8 adult pigs. Blood was infused at 20 mL·min−1 into both chest cavities and the tubes were drained at 15 cm H2O for 30 min. In the in vitro study, the drainage capacity of the conventional chest tube was 9-times higher than that of the smaller silicone drain (103.8 vs. 11.6 L·hr −1). However, in the in vivo study, there was no difference in drainage capacity between the two different tubes over time. This experiment demonstrated that the smaller silastic chest drain has sufficient drainage capacity, almost identical to the conventional chest tube, in the clinical setting.
Outcome of Glenn Anastomosis for Heterotaxy Syndrome with Single Ventricle
Authors: Koudieh Mohammed , McKenzie E Dean , Fraser Charles D
Published: May 2013

A retrospective study was undertaken of 157 patients who underwent a Glenn anastomosis between January 1996 and May 2001. Of these, 33 had heterotaxy syndrome: 20 males and 13 females, with a mean age of 1.26 ± 2.8 years. Twenty-five had right atrial isomerism and 5 had left isomerism. A common atrioventricular valve was found in 24 patients, 18 had bilateral superior venae cavae, and 18 had anomalous pulmonary venous return. Repair was carried out in 8 patients with anomalous pulmonary venous return, and pulmonary artery augmentation was performed in 11. Compared to the 124 patients who had a Glenn operation for single ventricle without heterotaxy, there were significantly longer durations of mechanical ventilation, intensive care unit stay, and inotropic support, as well as higher mortality in the heterotaxy group. Heterotaxy syndrome with single ventricle still has a high rate of morbidity and mortality. Patients with severe atrioventricular valve regurgitation are at risk of early death. Complete Fontan circulation may not be possible in all patients, and Glenn anastomosis may be their final palliation.
Graft Replacement and Muscle Wrap for Infected Aneurysm of Thoracic Aorta
Authors: Sakaki Masayuki , Takano Hiroshi , Miyamoto Yuji , Sawa Yoshiki , Matsumiya Goro , Matsuda Hikaru
Published: May 2013

A 68-year-old man was admitted with high fever and enlargement of the distal aortic arch on chest radiography. Computed tomography showed a huge proximal descending thoracic aortic aneurysm. Graft replacement of the proximal descending thoracic aorta was performed on an emergency basis, and a pectoralis major muscle flap was wrapped around the graft. Salmonella enteritidis was detected in the resected tissue. The patient recovered well, with no signs of infection.
Combined Minimally Invasive Coronary Bypass Surgery and Left Pulmonary Lobectomy
Authors: Caimmi Philippe-Primo , Di Biasi Pietro
Published: May 2013

Two patients underwent combined heart and lung surgery performed through a limited left anterior thoracotomy. Good exposure of the left pulmonary hilum and the left anterior descending artery was obtained, allowing left upper lobectomy combined with off-pump coronary bypass grafting. This approach avoids potential complications due to sternotomy, staged operations, and cardiopulmonary bypass. These cases show that a limited thoracotomy allows safe and effective combined lung and cardiac surgery in carefully selected patients.