bluuebunny/crossref_metadata_2025 huggingface dataset:
Restoration of the thoracic aorta in Type A dissection with hybrid prothesis
Authors: Hoffman Andras , Parker Jack ATC , Raweh Ayman , Autschbach Rüdiger
Published: May 2013

Following successful repair of Type A dissection, late morbidity and mortality depend on the progression of residual chronic Type B dissection. To avoid the development of late aneurysms of the descending thoracic aorta, a persistent aortic false lumen around the stent-graft can be prevented by remodeling the thoracic aorta. Ten consecutive patients (mean age: 56 years) with acute Type A dissection underwent a “frozen elephant trunk operation” with the E-vita hybrid prothesis, under deep hypothermic circulatory arrest, between October 2009 and April 2010. The thoracic aorta was restored to its original size. Computed tomography was used to size the aortic diameter. All patients survived and were routinely discharged. Postoperative computed tomography showed no remaining false lumen and no distal organ ischemia in any patient. No new neurological complication was recorded. Two patients suffered postoperative pulmonary arterial embolism; one underwent embolectomy. Restoration of the thoracic aorta is a safe procedure to close the false lumen during the primary operation for acute Type A dissection. However, the diameter of the stent should reflect the overall aortic size, independent of the diameter of the true lumen.
Randomized controlled trial of bilateral intrapleural block in cardiac surgery
Authors: Mansouri Mojtaba , Bageri Keivan , Noormohammadi Esmaiel , Mirmohammadsadegi Mohsen , Mirdehgan Abolgasem , Ahangaran Atefeh Gholami
Published: May 2013

The aim of this study was to determine the efficacy of bilateral intrapleural block with bupivacaine as a preemptive analgesic for postoperative pain in coronary artery bypass graft surgery. In a double-blind prospective clinical trial, 70 patients were randomly divided into a bupivacaine group (20 mL bupivacaine 0.25% and 0.5 mL adrenaline 1/200,000 each side) and a control group (20.5 mL normal saline each side). Evaluation of the severity of pain was performed using the visual analog scale at 12 and 24 h after entering the intensive care unit and again during chest tube removal. Pain scores at 12 and 24 h after intensive care unit admission were significantly lower in the bupivacaine group. There were no side-effects related to intrapleural block, such as pneumothorax or emphysema. In coronary artery bypass graft candidates, preemptive analgesia with bilateral intrapleural block using bupivacaine provided relatively less painful conditions during the first 24 h after surgery, but it did not improve the clinical outcome.
Levosimendan vs. intra-aortic balloon pump in high-risk cardiac surgery
Authors: Lomivorotov Vladimir V , Cherniavskiy Alexander M , Boboshko Vladimir A , Kornilov Igor A , Lomivorotov Vladimir N , Karaskov Alexander M
Published: May 2013

The purpose of our study was to compare the efficiency of levosimendan and preventive intra-aortic balloon pump in high-risk cardiac patients (left ventricular ejection fraction <35%) operated under cardiopulmonary bypass. In 20 patients, intra-aortic balloon pump was started 16–18 h before surgery; another 20 had a levosimendan infusion starting after induction of anesthesia with an initial bolus of 12 µg·kg−1 for 10 min, followed by 0.1 µg·kg−1·min−1 for 24 h. Postoperative complications, hemodynamics, and markers of cardiac damage were analyzed. In the levosimendan group, cardiac index was significantly higher 5 min after cardiopulmonary bypass, at the end of the operation, 2 and 4 h after perfusion, compared to the intra-aortic balloon pump group. The level of troponin I in the levosimendan group was significantly lower at 6 h after the operation. Intensive care unit stay was significantly shorter in the levosimendan group. It was concluded that the use of levosimendan in high-risk cardiac patients is as effective as intra-aortic balloon pump, in terms of maintaining stable hemodynamic during and after operations under cardiopulmonary bypass. The lower level of troponin I at 6 h postoperatively suggests cardioprotective properties of levosimendan, but requires further investigation.
Significance of mitral valve repair for active-phase infective endocarditis
Authors: Omoto Tadashi , Tedoriya Takeo , Oi Masaya , Nagai Naoko , Miyauchi Tadamasa , Ishikawa Noboru
Published: May 2013

Mitral valve repair is preferred to replacement in infective endocarditis, but in the active phase, it often requires extensive debridement of infected tissue and complex reconstruction. We investigated 22 consecutive native mitral valve operations during active-phase infective endocarditis. The time from initiation of medical treatment to operation was 16.8 ± 16.4 days. Mitral valve repair was performed in 15 (68.2%) patients, using prosthetic annuloplasty in 14, an autologous pericardial patch in 11, and artificial chordal replacement in 9. Hospital mortality was 9.1% (2 patients), due to subarachnoid hemorrhage and pneumonia. One patient died 26 months after valve replacement due to congestive heart failure. The postoperative left ventricular end-diastolic dimension was significantly smaller (45.7 ± 5.6 vs. 53.3 ± 10.2 mm) and ejection fraction was significantly higher (57.0% ± 14.7% vs. 40.1% ± 8.2%) in patients who underwent valve repair compared to those who had valve replacement. Mitral regurgitation requiring reoperation occurred in 3 patients during follow-up. Mitral valve repair is feasible in active-phase infective endocarditis, and results in improved regression of left ventricular dimensions compared to valve replacement. However, complex mitral valve repair with extensive leaflet resection may not have long-term durability.
Epithelioid malignant mesothelioma presenting with features of esophageal tumor
Authors: Khalil Mohammed W , Campbell Anne Patricia , Cowen Michael Edward
Published: May 2013

Intrathoracic epithelioid mesothelioma commonly presents as a diffuse tumor of the pleura. It rarely occurs as a localized tumor that might be surgically resectable. We report a case of one such localized mesothelioma in a 72-year-old woman, which arose from the wall of the esophagus and had all the presenting features of an esophageal tumor.
Can invasive thymomas be resected by video-assisted thoracoscopic surgery?
Authors: Agasthian Thirugnanam
Published: May 2013

Although video-assisted thoracic surgery can be used for well-encapsulated thymomas, its role in invasive thymomas remains controversial. Between 1998 and 2009, 77 patients aged 22–76 years underwent thymomectomy by video-assisted thoracic surgery. Tumors < 5 cm without major invasion on preoperative computed tomography were selected. There were 13 invasive thymomas (Masaoka stage III and IV). A modified dissection technique was employed to prevent breaching the tumor capsule and risking tumor seedling. Limited resection of the phrenic nerve, pericardium, perithymic fat, and a wedge of lung was performed en bloc with the tumor. The mean duration of surgery was 138 min. Hospital stay was 3.6 days. Eleven patients had associated myasthenia gravis. There was 1 case of wound infection and no operative mortality. The mean size of the thymomas was 34 mm (range, 23–55 mm). All patients had adjuvant radiotherapy. During follow-up of 4.9 years (range, 1–10 years), there was one local recurrence. With the modified video-assisted thoracic surgery technique, selected invasive thymomas detected during surgery can be removed safely without resorting to sternotomy.
Successful management of descending necrotizing mediastinitis
Authors: Wakahara Teppei , Tanaka Yugo , Maniwa Yoshimasa , Nishio Wataru , Yoshimura Masahiro
Published: May 2013

Descending necrotizing mediastinitis is a critical infection and the mortality rate remains high. Early aggressive surgical drainage and antibiotic therapy are essential for treatment. We evaluated the efficiency of transthoracic drainage using a minimally invasive technique in 11 cases of descending necrotizing mediastinitis between May 2002 and March 2008. Weperformed a right-side minithoracotomy with thoracoscopic assistance, and the mediastinum was thoroughly drained. The length of hospitalization ranged from 30 to 117 days. The postoperative course was good in all patients, and the outcome was favorable. All patients were discharged without major complications. We recommend employing a minithoracotomy with thoracoscopic assistance for aggressive treatment of descending necrotizing mediastinitis.
Pulmonary resection after lung transplantation in cystic fibrosis patients
Authors: Souilamas Rédha , Saueressig Mauricio , Boussaud Véronique , Amrein Catherine , Guillemain Romain , Sonett Joshua
Published: May 2013

Pulmonary resection after lung transplantation in end-stage cystic fibrosis presents unique challenges, and scant literature exists to guide physicians. We retrospectively reviewed 78 transplants for cystic fibrosis performed between 2003 and 2008. Fourteen patients underwent posttransplantation pulmonary resection. We analyzed the indications, surgical procedures, outcomes, and survival. Three pneumonectomies, 4 lobectomies, and 11 wedge resections were carried out. We identified 2 groups based on indication: a diagnostic group, and a therapeutic group of patients in whom the indications were septic native lung in 2, allograft infection in 2, lobar torsion in 2, pulmonary infarction in 2, and size mismatch in 4. The mean intensive care unit and hospital stays were 29 and 50 days, respectively. Four (28.57%) patients died during follow-up, including 2 who underwent pneumonectomy; 10 (71.43%) are still alive. Survival was 43.43 ± 8.06 months, and it was not significantly different from that in cystic fibrosis patients who had lung transplantation without pulmonary resection. Pulmonary resection following lung transplantation in cystic fibrosis patients showed acceptable survival and surgical risk, but metachronous pneumonectomy was associated with higher mortality.
Sodium thiopental and mean arterial pressure during cardiopulmonary bypass
Authors: Dabbagh Ali , Rajaei Samira , Ahani Mohammad Reza
Published: May 2013

Sodium thiopental is known to have a number of cardiovascular effects, but injection into the cardiopulmonary bypass reservoir has not been studied. The effect of sodium thiopental on mean arterial blood pressure during cardiopulmonary bypass was assessed in 150 patients undergoing elective coronary artery bypass grafting. Sodium thiopental 3 mg · kg−1 was administered via the cardiopulmonary bypass reservoir. Mean arterial pressure was recorded just before drug administration and at 15-sec intervals up to 120 sec afterwards. Compared to the baseline value, mean arterial pressure was significantly higher at 30, 45, 60, and 75 sec after drug administration, and it was significantly lower at 90, 105, and 120 sec. Sodium thiopental, in addition to its effects on myocardial tissue, acts initially as a potent vasopressor, and shortly after, as a potent vasodilator.
Organ procurement: Spanish transplant procurement management
Authors: Manyalich Martí , Mestres Carlos A , Ballesté Chloë , Páez Gloria , Valero Ricard , Gómez María Paula
Published: May 2013

Transplantation is an accepted therapeutic option to save or improve the quality of life when organ failure occurs or tissue replacements are needed. However, the lack of organs is the major limitation. The deceased organ procurement organization and professionals provide the solution to this international problem. In this review, we identify the elements involved in the organ procurement management process to analyze the possibility of implementation of deceased organ procurement for a transplantation program. While the donation rates are subject to several negative factors including religious, economic, cultural, and legal issues, the existence of well-trained professionals may considerably increase them. Professional training in organ donation along with the establishment of a solid organizational system has been identified as the crucial factor in developing efficient organ donation and transplantation programs.
Simple home-made suction device to aid excision of friable atrial myxoma
Authors: Wong Randolph HL , Wan Innes YP , Ng Calvin SH , Underwood Malcolm J
Published: May 2013

Atrial myxoma, especially the papillary subtype, is known to be friable and gelatinous. Manipulation of an atrial myxoma during surgery can be very difficult, and not uncommonly results in fragmention and embolization of part of the tumor. The conventional method using a metallic spoon to manipulate the tumor is widely practiced because alternatives are sparse. We describe a novel home-made suction device to aid the excision of friable atrial myxomas.
Computed tomographic angiography in tetralogy of Fallot
Authors: Ashok Kasar Pankajkumar , Ravikumar Radhakrishnan , Varghese Roy , Kotecha Monika , Vimala Jesudian , Kumar Raghavan Nair Suresh
Published: May 2013

Echocardiography is often inadequate for imaging tetralogy of Fallot, prompting cineangiography. This study prospectively evaluated multidetector computed tomographic angiography for preoperative evaluation of tetralogy of Fallot in 112 consecutive patients. Forty-eight had nonconfluent or hypoplastic pulmonary arteries (mean z-score, −2; range, −11.1–0.13) permitting only palliative or no surgery; 64 had adequate pulmonary artery anatomy (mean z-score, 0.59; range,−2.53–3.4) allowing total repair. The surgical data of 50 patients who underwent total correction were compared with transthoracic echocardiography and multidetector computed tomographic angiography findings. Multidetector computed tomographic angiography tended to reveal unsuspected collaterals and coronary abnormalities besides outlining the right ventricular outflow tract and pulmonary artery branches. The branch pulmonary artery diameter z-score was the most important determinant of surgical strategy, with the worst figures being associated with no surgical options or palliative surgery, and the best figures leading to corrective surgery. The mean radiation dose was 3.45 mSv. Multidetector computed tomographic angiography is a powerful supplement to echocardiography in the preoperative evaluation of tetralogy of Fallot.
Aortic valve replacement with smaller valve size
Authors: Sato Manabu , Suenaga Etsuro , Koga Shugo , Kawasaki Hiromitsu
Published: May 2013

The occurrence of prosthesis-patient mismatch after aortic valve replacement with a small valve size was evaluated in 249 patients, focusing on echocardiographic data. Aortic valve pathology included regurgitation in 174 patients and stenosis in 75. Echocardiography was performed in the early and late postoperative periods. A projected effective orifice area index < 0.85 cm2ċm−2 was noted in 56 patients; values ≥ 0.85 cm2ċm−2 were found in 128. Postoperative changes in ejection fraction, left ventricular mass regression, and peak transprosthetic gradient were similar in both groups. Small prostheses (≤ 19 mm) were used in 43 patients who had significantly higher postoperative transprosthetic gradients in both the early and late periods, compared to those with larger prostheses. Our findings show that the occurrence of prosthesis-patient mismatch after aortic valve replacement is rare. Left ventricular mass regression occurred in most patients, with acceptable transprosthetic gradients.
An interrupted technique for difficult distal anastomosis during arch surgery
Authors: Follis Fabrizio , Filippone Gianfranco , Montalbano Giuseppe , Centineo Luigi , Finazzo Mario , Follis Marco
Published: May 2013

During aortic arch replacement, construction of the distal anastomosis represents the crucial step because of the time limit of circulatory arrest. If the aneurysmal neck is located at the level of the 5th thoracic vertebra, it becomes difficult to carry out through a sternotomy approach. We describe a case in which an interrupted suture technique, similar to that used for valve replacement, was employed to maximize the limited exposure and achieve a water-tight anastomosis.
Ectopic hepatocellular carcinomas developed in the chest wall and skull
Authors: Nenekidis Ioannis , Anagnostakou Vania , Paralikas Ioannis , Kokkori Aikaterini , Dedeilias Panagiotis , Zisis Charalambos
Published: May 2013

A 68-year-old man presented with a suppurating mass on his skull and a palpable mass on his right upper thoracic wall. Computed tomography revealed a round mass, 70 mm in diameter, invading the right pleural cavity, and a second tumor infiltrating the skull through the left parietal bone. Both masses were resected simultaneously. Histopathology showed that both tumors were hepatocellular carcinomas.
Catastrophic late mitral bioprosthetic thrombosis
Authors: Jung Hye-Jin , Song Bong Gun , Heo Seung Hye , Kim Kye Yeon , Kim Yong-In
Published: May 2013

Although clinically significant bioprosthetic valve thrombosis is rare, it should be considered a possible cause of valve dysfunction when there is an increasing transvalvular pressure gradient after anticoagulation is terminated. We describe a rare case of bioprosthetic mitral thrombosis in a 77-year-old woman 2 years after valve replacement and a maze procedure.
Coagulase-negative staphylococcus endocarditis: staphylococcus lugdunensis
Authors: Sibal Amul K , Lin Zaw , Jogia Dilesh
Published: May 2013

Staphylococcus lugdunensis is an infrequent cause of native valve endocarditis. A case of triple-valve involvement of Staphylococcus lugdunensis with intracardiac fistula formation in a 47-year-old woman was managed successfully with surgery. The importance of early diagnosis and prompt referral for surgical treatment is highlighted.
Thoracoscopic management of spontaneous pneumothorax due to azygos lobe bullae
Authors: Azoury Fouad M , Sayad Paul
Published: May 2013

A 22-year-old man presented with recurrent right-sided spontaneous pneumothorax caused by rupture of azygos lobe bullae. Surgical management was successfully completed using a video-assisted thoracoscopic approach. Resection of the bullae harboring azygos lobe and subsequent pleurodesis were performed, sparing the meso-azygos and azygos vein.
Fenestration closure in a calcified ventricular septal defect patch
Authors: Raja Shahzad G , Atamanyuk Iryna , Pandey Ragini B , Kostolny Martin
Published: May 2013

Ventricular septal defect closure with a fenestrated patch is a recognized rescue maneuver to decrease the risk of right ventricular failure after complete repair in patients with pulmonary atresia. If the fenestration needs surgical closure, severe calcification of the patch may make it extremely difficult. We describe the closure of such a defect in a 6-year-old boy, using a double Dacron patch sandwich.
Simplified closure of ministernotomy using thermoreactive sternal clips
Authors: Grapow Martin TR , Rüter Florian , Melly Ludovic , Winkler Bernhard , Eckstein Friedrich S , Matt Peter
Published: May 2013

An increasing number of aortic valve replacements are performed through a ministernotomy. Due to the small incision and partial fixation of the caudal sternum, the traditional wire closure can be complicated and even harmful to the surrounding tissue. In such cases, we recommend the use of nitinol clips for sternal closure. This technique, which we have used in 48 patients, is simple, safe, and fast, and results in excellent outcomes.
Fracture-dislocation of humeral head with intrathoracic displacement
Authors: Salhiyyah Kareem , Potter David , Sarkar Pradip K
Published: May 2013

Intrathoracic displacement of fractured head of the humerus is a very rare injury. We describe a case of such injury in a 48-old-year lady who presented after a simple fall. She required chest drainage and a thoracotomy to remove the head of the humerus. She subsequently had shoulder hemiarthroplasty with a good outcome.
Effect of right ventricular pacing site on QRS Width
Authors: Nakamura Hiroaki , Mine Takanao , Kanemori Tetsuzo , Ohyanagi Mitsumasa , Masuyama Tohru
Published: May 2013

To assess the effect of various right ventricular pacing sites on QRS duration, we enrolled 50 patients (mean age, 64 ± 13 years; 36 men); 16 had bradycardia and 34 had tachycardia. The right ventricle was arbitrarily divided into 5 sections: high and low right ventricular outflow tract, mid septum, low septum, and apex. Right ventricular pacing was performed using an electrode catheter at each of the 5 sites. QRS duration was 162 ± 20 ms during high right ventricular outflow tract pacing, 143 ± 17 ms during low right ventricular outflow tract pacing, 151 ± 20 ms during mid-septal pacing, 163 ± 16 ms during low-septal pacing, and 167 ± 18 ms during apical pacing. Paced QRS duration was shorter during low right ventricular outflow tract and mid-septal pacing compared to apical pacing in 34 patients. There was a difference of 10 ms or less in the paced QRS duration between these pacing sites in the other 16 patients. QRS duration was shortest when the septum was paced in the right ventricle. However, QRS duration was similar during pacing in the septum and the apex in 32% of patients.
Cardiobacterium hominis prosthetic valve endocarditis: an infrequent infection
Authors: Pousios Dimitrios , Gao Fangfei , Tsang Geoff M
Published: May 2013

A case of prosthetic aortic valve endocarditis due to Cardiobacterium hominis in a 67-year-old woman is described. The diagnosis was confirmed by a positive blood culture and echocardiographic detection of aortic valve vegetations. The patient underwent replacement of the valve with a homograft, and received antibiotics postoperatively. She remained well after 12 months.
Descending necrotizing mediastinitis and thoracic cellulitis due to varicella
Authors: Dajer-Fadel Walid L , Borrego-Borrego Rafael , Flores-Calderon Octavio , Ibarra-Perez Carlos
Published: May 2013

A 22-year-old man with varicella had associated cervical enlargement, right upper thoracic anterior and suprascapular cellulitis, and mediastinitis. A tracheostomy, right posterolateral thoracotomy, cervicotomy, and upper thoracic fasciotomy were performed 14 h after admission, draining purulent exudates from all sites. The patient was discharged on postoperative day 22.
Phosphodiesterase-5 inhibitor and rat lung ischemia-reperfusion injury
Authors: Liu Zhiyong , Fang Lei
Published: May 2013

To explore the protective effect of the phosphodiesterase-5 inhibitor, sildenafil, on lung ischemia-reperfusion injury, 30 rats were randomly divided into 3 groups of 10: a sham-operated group A, a lung ischemia-reperfusion injury group B, and a sildenafil preconditioned group C. A 0.1% sildenafil solution was administrated orally 2 h before establishing an in-vivo lung ischemia-reperfusion model in group C; 0.9% normal saline solution was used in the controls. The lung wet-to-dry ratio, malondialdehyde content, myeloperoxidase and nitric oxide synthase activity in groups B and C were significant higher than those in group A, while the partial pressure of oxygen in arterial blood and cyclic guanosine-3′,5′-monophosphate content in groups B and C were significant lower than those in group A. Compared to group B, lung wet/dry ratio, malondialdehyde content, myeloperoxidase and nitric oxide synthase activity in group C were significantly lower, while arterial O2 and cyclic guanosine-3′,5′-monophosphate content in group C were significantly higher. The expected histological and cytological changes were significantly alleviated in group C. Oral preconditioning with sildenafil prevented rat lung ischemia-reperfusion injury and improved pulmonary function. The mechanisms of this effect might be prevention of cyclic guanosine monophosphate degradation and inhibition of nitric oxide synthase activity.
Tunneling technique for anatomical positioning of aortoaxillary bypass graft
Authors: Mohite Prashant N , Kotkar Kunal D , Popov Aron F , Thingnam Shyam K
Published: May 2013

A technique for anatomical positioning of a synthetic aortoaxillary bypass tube graft is described. A tunnel is created with the help of a Roberts clamp and intercostal tube drain. There is no need to open the pleura because the graft is tunneled parallel to the subclavian vessels outside the chest cavity.
Severe bronchoconstriction due to sarcoid-like reaction to lung cancer
Authors: Tao Hiroyuki , Yamamoto Hiromasa , Matsuda Eisuke , Sano Fumiho , Okabe Kazunori , Sugi Kazurou
Published: May 2013

Chest radiography in a 59-year-old woman with recurrent pneumonia showed infiltrates in her left upper lung field. Fiberoptic bronchoscopy and chest computed tomography revealed severe constriction in the upper bronchus and a nodule in the left upper lobe. After lobectomy, adenocarcinoma was confirmed, with multiple non-caseating granulomas in the lung parenchyma and lymph nodes. Bronchial constriction was thought to be due to a sarcoid-like reaction secondary to lung cancer, leading to granuloma formation.
Upregulation of APE/ref-1 in recurrence stage I, non small cell lung cancer
Authors: Kang Min-Woong , Kang Shin Kwang , Choi Songyi , Lee Choong Sik , Jeon Byeong Hwa , Lim Seung Pyung
Published: May 2013

Lung cancer, the leading cause of cancer-related death, still lacks reliable biomarkers. Apurinic/apyrimidinic endonuclease 1/Ref-1 is a multifunctional protein involved in the base excision repair of DNA damaged by oxidative stress or alkylating compounds, as well as in the regulation of multiple transcription factors. To validate apurinic/apyrimidinic endonuclease 1/Ref-1 as a biomarker for prediction of lung cancer recurrence, we studied 42 patients who received curative resection and mediastinal lymph node dissection for stage I non-small-cell lung cancer. They were divided into 2 groups based on recurrence, and compared by immunohistochemistry staining of paraffin-embedded tissues and Western blot analysis. Immunohistochemical staining showed a significant difference between the cytoplasm and nucleus in patients who had a recurrence compared to those with nonrecurrent adenocarcinoma. In Western blot analysis, the recurrent adenocarcinoma group showed increased expression of apurinic/apyrimidinic endonuclease 1/Ref-1 in cytoplasm, nucleus, and in total. This indicates that apurinic/apyrimidinic endonuclease 1/Ref-1 is unregulated in recurrent stage I adenocarcinoma. For clinical application as a prognostic marker for non-small-cell lung cancer, further investigation into the role of apurinic/apyrimidinic endonuclease 1/Ref-1 in carcinogenesis is needed in an expanded prospective study.
Framingham risk-based survival of non-small-cell lung cancer
Authors: Poullis Michael , McShane James , Shaw Matthew , Page Richard , Shackcloth Michael , Mediratta Neeraj
Published: May 2013

This study was undertaken to determine whether the Framingham cardiovascular risk prediction model can identify patients who will have reduced 5-year survival after resection for primary lung cancer. The Framingham risk model for predicting cardiovascular death rates in a 5-year period was calculated for 1,981 patients undergoing resection for non-small-cell lung cancer. Receiver operator curve analysis was performed to determine a cutoff with regard to Framingham risk, and this was utilized to construct Kaplan-Meier survival curves for stages I, II, and III. Cox regression analysis was used to determine factors significantly affecting long-term survival. The Framingham risk model predicted that 0.015% to 26.7 % (mean, 5.2%) of our patients would die over a 5-year period. Univariate analysis revealed the Framingham score as being significant for stages I and II, but not III. Cox regression analysis demonstrated age, body mass index, pneumonectomy, stage I, stage III, stage IV, and Framingham score were all significant determinants of 5-year survival. Framingham-based cardiovascular risk prediction in patients undergoing resection for non-small-cell lung cancer stages I and II defined a group with significantly worse 5-year survival.
Thymoma and myasthenia gravis: clinical aspects and prognosis
Authors: Vachlas Konstantinos , Zisis Charalambos , Rontogianni Dimitra , Tavernarakis Antonios , Psevdi Argini , Bellenis Ion
Published: May 2013

Myasthenia gravis is present in a significant proportion of patients with thymoma. We investigated particular features of the clinical behavior of thymoma and its relationship to myasthenia in a retrospective study of 79 patients who underwent thymectomy for thymoma during the last 20 years. The presence of myasthenia gravis, Masaoka stage, World Health Organization histotype, myasthenia response, and survival were analyzed. The mean age of the patients was 56.1 ±12.4 years, and 39 had myasthenia gravis. A significantly higher proportion of patients with myasthenia was found in B2 and B3 histotypes compared to A, AB, and B1. Among myasthenic patients, 33.3% had no response, 50% had a partial response, and 16.7% achieved complete remission. During the follow-up period, 16 (21.1%) patients died. Mean survival was 4.8 ± 1.4 years for patients with no myasthenia response, whereas those with a partial or complete myasthenia response had significantly better survival.
Clinical outcomes of open heart surgery in patients with atopic dermatitis
Authors: Fukunaga Naoto , Yuzaki Mitsuru , Shomura Yu , Fujiwara Hiroshi , Nasu Michihiro , Okada Yukikatsu
Published: May 2013

Atopic dermatitis is a skin condition often complicated by colonization with Staphylococcus aureus, which increases the risk of infective endocarditis, skin cellulitis and osteomyelitis. Positive cultures for Staphylococcus aureus are obtained from 70% to 80% of wounds in patients with mediastinitis. Thus sternotomy carries increased risk of mediastinitis in patients with atopic dermatitis. We retrospectively reviewed 25 patients with atopic dermatitis who underwent cardiac surgery via a median sternotomy or thoracotomy from January 1997 to September 2010 at our institution. Postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus was found in 3 patients who had a median sternotomy. They were ultimately discharged in good condition. No mediastinitis occurred in patients undergoing thoracotomy. Mediastinitis may occur due to direct exposure of the bone marrow to methicillin-resistant Staphylococcus aureus in patients with atopic dermatitis whose skin is colonized with such bacteria. Thoracotomy may be a better surgical approach in patients with atopic dermatitis who require thoracic surgery.
Factor VII for excessive bleeding following congenital heart disease surgery
Authors: Changlani Deepak Kishinchand , Devendaran Vimalarani , Murmu Udaya Charan , Ganesan Selvakumar , Varghese Roy , Kumar Raghavannair Suresh
Published: May 2013

Recombinant activated factor VII may be effective in patients with severe bleeding following congenital heart disease surgery requiring cardiopulmonary bypass. From August 2009 through June 2011, 13 patients (median age, 5 months) were given recombinant activated factor VII for severe bleeding after open heart surgery, preventing sternal closure 2 h after completion of cardiopulmonary bypass, or chest tube drainage >10 mLċ kg−1ċh−1 for 2 h. The median dose was 75 µgċ kg−1. The response was positive if postoperative bleeding decreased, permitting sternal closure in the operating room, or if there was > 50% decrease in chest tube drainage. The 3 patients who received factor VIIa in the operating room had successful sternal closure within 1 h. Of the 10 patients who received factor VIIa in the intensive care unit, drainage decreased to < 50% in 1 h in 6 cases, and a second dose was required in 4. None required surgical reexploration. There were 4 deaths, none was related to bleeding. Nine patients were discharged (median hospital stay, 29 days) and were doing well after 3 months. There were no thrombotic complications. Recombinant activated factor VII may be an effective rescue therapy for severe postoperative hemorrhage.
Early outcomes of chordal reconstruction for posterior mitral leaflet prolapse
Authors: Nishigawa Kosaku , Takiuchi Hiroki , Hiroshi Yoji Kubo , Kubo  , Masaki Hisao , Tanemoto Kazuo
Published: May 2013

We retrospectively reviewed 16 patients (7 men and 9 women, aged 36 to 77 years) who underwent mitral valve repair with chordal reconstruction for isolated posterior mitral leaflet prolapse. Preoperative echocardiography demonstrated moderate mitral regurgitation in 1, and severe regurgitation in 15. We routinely used expanded polytetrafluoroethylene sutures as artificial chords, and ring annuloplasty was performed in all cases (mean ring size, 30 ± 2 mm). After implanting the ring, the length of the artificial chords was adjusted repeatedly using saline solution. Early postoperative echocardiography at 7.1 ± 1.1 days after surgery showed mitral regurgitation grades reduced to none or trivial in 15/16 patients. One required reoperation for recurrent mitral regurgitation 1.5 years after surgery. In the other patients, intermediate-term echocardiography at 9.1 ± 10.1 months after surgery demonstrated that residual mitral regurgitation was less than mild. We concluded that chordal reconstruction is an effective and highly reproducible procedure for the repair of isolated posterior mitral leaflet prolapse. Artificial chords for the posterior mitral leaflet should not be too long, to avoid systolic anterior motion or recurrent mitral regurgitation after surgery.
Surgical treatment for tracheobronchial carcinoid tumors: a 16-year experience
Authors: Dewan Ravindra K , Kesieme Emeka B , Ramchandani Radhakrishna
Published: May 2013

We conducted a 16-year retrospective review of 31 cases of tracheobronchial carcinoid tumors treated in our institution between 1995 and 2011, to determine their characteristic features and outcome of management. There were 12 men and 19 women. The most common presenting symptoms were cough and hemoptysis (71%) with a mean duration of 4 years. Preoperative bronchoscopy confirmed the diagnosis in 80% of patients. Right-sided tumors accounted for 60% of cases. Most tumors arose from the mainstem bronchi. Histologic analysis revealed typical carcinoids in 28 cases and atypical carcinoids in 3. Surgical treatment was mainly radical resection (pneumonectomy in 19 patients). A parenchymal-preserving surgery (sleeve resection of left main bronchus and end-to-end anastomosis) was only possible in 2 cases. Mediastinal lymph nodes were involved in 30% of cases. Most patients had widespread extraluminal extension. Follow-up revealed recurrence in one patient. No deaths were recorded, and complications were mainly atelectasis and air leak. Radical resection remains the mainstay of surgical management of bronchial carcinoids in cases of late presentation with destroyed and bronchiectatic distal pulmonary parenchyma. Parenchymal-preserving surgery should only be carried out when indicated.
Short crossclamp heart transplantation: a modified technique
Authors: Bakhshandeh Ali Reza , Salehi Mehrdad , Radmehr Hasan , Ezzat Aso Ibrahim , Riahi Gholam Ali
Published: May 2013

Prolongation of the ischemic time in heart transplantation adversely affects the performance of the donor heart. We compared the impact of ischemic time in 30 patients who had the conventional bicaval method with declamping just after the last anastomosis (group A) and 28 who had a modified short crossclamp technique with declamping after left atrial stump, aorta, and inferior vena caval anastomosis (group B). In the operating room, 4 (13.3%) group A patients need one inotropic and 26 (86.6%) need 2 or more; one (3.3%) needed intraaortic balloon pumping. In group B, one inotropic was used in 7 (25%) patients, 4 (14.2%) need 2 or more, and 17 (60.7%) needed no inotropic. Mean crossclamp time was 80.5 ± 4.7 min in group A and 62.4 ± 5.8 min in group B. Weaning from bypass was faster in group B. Transesophageal echocardiography at the end of the operation showed more complete de-airing in group B. There were no significant differences in intensive care unit stay or the incidence of postoperative neurologic complications between the 2 groups. Easier separation from bypass, even without a hot shot, and better echocardiographic systolic parameters postoperatively are the advantages of this modified technique.
Descending mediastinitis
Authors: Vural Fikret S , Girdwood Robert W , Patel Atulkumar R , Zigiriadis Elias
Published: May 2013

We studied 13 patients with mediastinal abscesses caused by oropharyngeal infections, who presented between April 2007 and June 2011. All patients were operated on after maxillofacial and ear, nose and throat surgeons had treated the primary source and drained all collections in the neck. Thoracic surgery was performed in the same session. Anterior mediastinal collections were drained via a small mediastinotomy. Posterior collections were approached via a thoracotomy. Chest computed tomography was essential to delineate the extent of disease. A thoracotomy approach was used in 7 patients; 2 of them required an anterior mediastinotomy on the opposite side. The others had an anterior mediastinotomy which was bilateral in 2 cases. After repeat computed tomography, 5 patients were operated on for suspected new loculations; tissue edema had caused false imaging in 3 of them. There was no mortality. Early after eradication of the source and pathways to the mediastinum, gravity drainage of mediastinal abscesses, and good antibiotic cover, with repeat computed tomography after 3 days, was an effective approach in this highly fatal disease.
Preoperative intra-aortic balloon pump in high-risk coronary bypass grafting
Authors: Litton Edward , Delaney Anthony
Published: May 2013

Prophylactic intra-aortic balloon pumping prior to coronary artery bypass grafting is employed variably despite some evidence to support its use. The aim of this study was to describe the characteristics, preoperative balloon pump utilization, and outcomes of high-risk patients undergoing coronary artery bypass. The study cohort included all patients in the Australian National Cardiac Surgery Database over an 8 year period. The primary outcome was 30-day mortality adjusted for preoperative illness severity. Coronary artery bypass was performed in 18,662 patients including 2,348 (12.6%) identified as high-risk. Of these high-risk patients, 359 (15.3%) received a balloon pump preoperatively. For high-risk patients, 30-day mortality was significantly higher in those with a preoperative balloon pump than in those who did not receive a preoperative balloon pump (15.3% vs. 4.9%). After adjusting for preoperative illness severity, there was no significant association between preoperative balloon pumping and 30-day mortality. High-risk patients represent a significant proportion of those undergoing coronary artery bypass grafting. Despite their increased risk of postoperative mortality, only a small minority currently receive a preoperative balloon pump. After adjusting for illness severity, there was no significant association between preoperative balloon pumping and 30-day mortality, although we could not rule out a 20% reduction in mortality.
Repair of acute type A aortic dissection: results in 100 patients
Authors: Vohra Hunaid A , Modi Amit , Barlow Clifford W , Ohri Sunil K , Livesey Steve A , Tsang Geoffrey MK
Published: May 2013

To determine short- and long-term outcomes after repair of type A aortic dissection, we reviewed data of 100 consecutive patients (64 men; mean age, 63 ± 12.2 years) who underwent acute type A aortic dissection repair between January 2000 and June 2008. They were divided into group A, open anastomosis (circulatory arrest; n = 59) and group B, closed anastomosis (no circulatory arrest; n = 41). Aortic valve re-suspension or replacement was performed in 77 patients, aortic root replacement in 29, and aortic arch procedures in 31. The median follow-up was 2.8 years (range, 0–8.6 years). The 30-day mortality was 14%; 16.9% in group A and 9.8% in group B. None of the 23 variables analyzed to determine predictors of death or stroke was significant on multivariate analysis. Postoperatively, there was no difference between the 2 groups with respect to stroke, sepsis, renal failure, multiorgan failure, or reoperation. Overall actuarial survival at 1, 3, 5, and 8 years was not significantly different between the 2 groups. Considerable morbidity is still associated with repair of type A aortic dissection, despite a significant improvement in mortality.
Coronary artery bypass: predictors of 30-day operative mortality in Jordanians
Authors: AlWaqfi Nizar , Khader Yousef , Ibrahim Khaled
Published: May 2013

To determine the risk factors and rate of 30-day operative mortality among Jordanian patients undergoing isolated coronary artery bypass surgery, we reviewed the records (January, 2005 to July, 2009) of 1,046 consecutive patients. Demographic and perioperative data were analyzed by univariate and multivariate analysis. The 30-day operative mortality rate was 5.9%. Significant independent predictors of death were age >65 years, female sex, heart failure, ejection fraction ≤35%, prolonged inotropic support, mechanical ventilation >12 h, postoperative pneumonia, and postoperative stroke. The 30-day operative mortality rate was comparable to that reported in other countries.
Detection of perioperative myocardial infarction with ischemia-modified albumin
Authors: Dong Shi-Yong , Wang Xue-Jing , Xiao Feng , Wang Jin , Li Yi-Fan , Li Yan
Published: May 2013

We assessed the perioperative pattern of serum ischemia-modified albumin and its role as a myocardial ischemia indicator for early detection of perioperative myocardial infarction in patients undergoing off-pump coronary artery bypass grafting. Venous blood samples were collected from 63 consecutive patients before the operation, immediately after the operation, and at 3, 6, 12, and 24 h postoperatively. Serum ischemia-modified albumin levels were analyzed using an albumin cobalt binding test. The patients were divided into 2 groups retrospectively, according to the occurrence of perioperative myocardial infarction. The serum ischemia-modified albumin levels were compared between groups. The levels peaked immediately after the operation, followed by a gradual regression, but remained elevated during the first 24 h in all patients. The occurrence of perioperative myocardial infarction was identified in 10 patients who had significantly higher ischemia-modified albumin levels at 3 h postoperatively and slower regression rates. Perioperative serum ischemia-modified albumin levels might be helpful in predicting perioperative myocardial infarction.
Management of complicated parapneumonic effusion and empyema using different treatment modalities
Authors: Muhammad Magdi Ibrahim Ahmad
Published: May 2013

To evaluate the efficacy of the 3 treatment modalities (intrapleural instillation of streptokinase, video-assisted thoracoscopic surgery, thoracotomy and decortication) in the management of complicated parapneumonic effusion and empyema, a prospective study was conducted between January 2008 and June 2010. The 69 patients (52 men and 17 women, aged 18–50 years) were divided into 3 groups: 20 patients underwent intrapleural administration of streptokinase, 25 underwent video-assisted thoracoscopic surgery, and 24 had thoracotomy and decortication. Perioperative variables, mortality, and procedure success were compared among groups. In all groups, preoperative variables were well matched for age, sex, and clinical stage according to Light’s classification. No allergic or hemorrhagic complication occurred. Operative time was significantly shorter in patients undergoing video-assisted thoracoscopic surgery. There was no intraoperative complication in the 2 surgically treated groups. Length of hospital stay and duration of chest drainage were significantly shorter after video-assisted thoracoscopic surgery. Procedure success was 50% after streptokinase, 92% after video-assisted thoracoscopic surgery, and 100% after thoracotomy and decortication. There was no perioperative mortality in any group. Video-assisted thoracoscopic surgery is a safe and effective treatment modality for complicated parapneumonic effusion and pleural empyema. Earlier intervention with video-assisted thoracoscopic surgery may produce better clinical results.
Risk factors for hospital death after surgery for type A aortic dissection
Authors: Legras Antoine , Bruzzi Matthieu , Nakashima Kuniki , Hillion Marie-Line , Loisance Daniel , Kirsch Matthias
Published: May 2013

This study was undertaken to identify perioperative risk factors for hospital death in patients undergoing surgery for acute type A aortic dissection. Between 2000 and 2009, 101 consecutive patients underwent emergency surgery for acute type A aortic dissection. Four patients died before institution of cardiopulmonary bypass or completion of the procedure. In the remaining 97 (68 men; mean age, 63.4 ± 16.7 years), proximal repair was performed using ascending aortic replacement with valve re-suspension in 52 (53.6%) and composite valve graft replacement in 44 (45.4%). Distal repair required hemi- or total arch replacement in 42 (43.3%) patients. Overall hospital mortality reached 25.8% (25/97 patients). Logistic regression analysis revealed that advanced age, location of an intimal tear in the arch or more distally, and preoperative coronary malperfusion were significant independent risk factors for hospital death. No procedure-related variables were significant risk factors. Current hospital mortality in patients undergoing emergency surgery for acute type A aortic dissection remains high, but seems to be mainly determined by preoperative variables. More aggressive proximal or distal repairs were not associated with increased mortality.
Acute type B aortic dissection and coarctation: open stent-graft elephant trunk
Authors: Sun Hongtao , Qian Xiangyang , Chang Qian
Published: May 2013

We describe a case of acute type B dissection associated with coarctation of the aorta. An intimal tear was located just distal to the coarctation. Aortic dilatation started below the coarctation and extended to the level of the diaphragm. We performed descending aorta replacement from the distal aortic arch to the level of the 9th intercostal arteries, and implanted a stent-graft elephant trunk through a left posterior lateral thoracotomy in the 5th intercostal space off-pump.
Hemophagocytic syndrome complicating lung resection
Authors: Jiwnani Sabita , Karimundackal George , Kulkarni Atul , Pramesh CS
Published: May 2013

A 68-year-old man underwent a left upper lobectomy for squamous cell lung carcinoma. After 15 days, he was readmitted with fever, dyspnea, and a skin rash. Computed tomography showed a pleural effusion, which was drained. He was diagnosed with hemophagocytic syndrome in view of the fever, skin rash, bicytopenia, hypertriglyceridemia, high lactate dehydrogenase, and raised ferritin levels. His clinical condition deteriorated in spite of steroid therapy, and he died on the 23rd postoperative day.
Response to heart failure therapy: Ventricular volume changes vs. shape changes
Authors: Adhyapak Srilakshmi M , Parachuri V Rao
Published: May 2013

The prolate ellipsoid left ventricular geometry is crucial for its unique contraction and relaxation patterns. Perturbations in optimal cardiac function preceding overt heart failure ensue when this ellipsoid shape assumes a more spherical configuration; this is the stage when therapy should be intensified. The dynamic shape changes during the cardiac cycle in valvular regurgitation, when ventricular volumes are within the normal range, have proved that shape changes are clearly dissociated from volume changes in the early stages. In advanced heart failure, several therapeutic interventions to decrease the ventricular equator and hence the volume, have been tried with variable success. However, the ventricular shape may still be spherical, leading to suboptimal function. The aim in any therapy for heart failure should therefore be to achieve near normal left ventricular anatomy and physiology, with shape assessment as the surrogate marker of therapeutic success.