bluuebunny/crossref_metadata_2025 huggingface dataset:
Right Atrial Thrombus Masquerading as Intracardiac Cyst: A Case Report
Authors: Singh Arvind V , Walsh John T , Birdi Inderpaul S
Published: May 2013

Intracardiac cystic lesions are rare. Hydatid disease, blood cysts and bronchogenic cysts in various chambers of the heart have been reported. Right atrial thrombus presenting as a cystic lesion on echocardiogram has not been reported. We describe a patient with mitral regurgitation in atrial fibrillation with a right atrial cyst, which was found to be a cavitating thrombus.
Right Cervical Aortic Arch with Aberrant Left Subclavian Artery
Authors: Tjang Yanto S , Aramendi José I , Crespo Alejandro , Hamzeh Gadah , Voces Roberto , Rodríguez Miguel A
Published: May 2013

The combination of right cervical aortic arch, aberrant retroesophageal left subclavian artery originating from a Kommerell's diverticulum, and a ligamentum arteriosum, constitutes a rare form of vascular ring. Two patients aged 21 days and 54 years, who were diagnosed by multislice 3-dimensional computed tomography and magnetic resonance imaging, underwent surgical division of a vascular ring. The adult required resection of a Kommerell's aneurysm and subclavian artery reimplantation.
Subcoronary Implantation of a Stentless Valve in Patients with Aortic Aneurysms
Authors: John Alexander , Al-Hariri Basel , Ackemann Juergen , El-Mehsen Mohamed , Roethemeyer Stefan , Warnecke Henning
Published: May 2013

Experience with a new operation for patients with aortic valve disease and aneurysm or dissection of the ascending aorta is described. Twenty-four patients aged 66 87 years were operated on using a subcoronary implantation technique with a stentless aortic valve bioprosthesis and an extension using a vascular tube prosthesis. No major adverse cardiac events were observed in the postoperative period. This operation offers a safe alternative to the technically more demanding procedures of composite bioprosthetic ascending aortic replacement or full root replacement.
Surgery for Sinus of Valsalva Aneurysm: 27-Year Experience with 100 Patients
Authors: Yan Fei , Huo Qiang , Qiao Jun , Murat Vakeli , Ma Song-Feng
Published: May 2013

Sinus of Valsalva aneurysm is a rare anomaly. This study was designed to assess the long-term outcome of surgical repair of sinus of Valsalva aneurysm and factors influencing the prognosis. From August 1980 to August sinus of Valsalva aneurysm repair. Ventricular septal defect (42) and aortic regurgitation (34) were the most frequent coexisting anomalies. An approach via the involved chamber was used in 60 patients, aortotomy in 5, and a combined approach in 35. Either direct (43) or patch (57) closure was used to repair the defect. Aortic valve replacement was required in 14 patients, and 8 needed valvuloplasty. Eighty patients were followed up for 15.6 ± 3.9 years. There were 3 hospital deaths and 2 late deaths. New York Heart Association functional class improved significantly after surgery. Actuarial survival was 94% at 10 years, and 90% at 15 years. Surgical treatment of sinus of Valsalva aneurysm is safe and effective, but late progressive aortic regurgitation is still a risk during long-term follow-up, and early aggressive measures are recommended.
Harmonic Scalpel in Video-Assisted Thoracoscopic Thymic Resections
Authors: Soon Jia-Lin , Agasthian Thirugnanam
Published: May 2013

Video-assisted thoracoscopic thymectomy is safe, but the efficacy of this technique in thymomectomy is unproved. Data of 103 consecutive patients who had thoracoscopic thymectomy and thymomectomy between 1998 and 2006 were retrospectively reviewed. Conventional monopolar diathermy and endoscopic Liga clips were used in the first 50 patients, and the Harmonic Scalpel was employed in the next 53. Only mean tumor size differed between groups (56.6 ± 18.2 vs 40.0 ± 20.8 mm in Harmonic Scalpel group). A similar number of patients had myasthenia gravis in the first group (72%) and Harmonic Scalpel group (83%). There were 49 thymomas (22 in first group, 27 in Harmonic Scalpel group). Of the earlier patients, 2 were re-explored for excessive chest tube drainage, 1 had ipsilateral phrenic nerve injury, and 2 had left phrenic nerves sacrificed intraoperatively due to thymoma invasion, but there was no significant difference in complications between groups. At a mean follow-up of 3.40 ± 2.38 years (range, 0.04–8.52 years), there was 1 thymoma recurrence in the first group. Use of the Harmonic Scalpel in video-assisted thoracoscopic thymic resection is safe and confers some advantages over conventional methods of dissection.
Interpleural Morphine vs Bupivacaine for Postthoracotomy Pain Relief
Authors: Dabir Shideh , Parsa Tahereh , Radpay Badiozaman , Padyab Mojgan
Published: May 2013

This prospective randomized double-blind trial was designed to compare the analgesic effects of interpleural bupivacaine and interpleural morphine for postthoracotomy pain management. Thirty-six American Society of Anesthesiologists class I and II patients undergoing an elective posterolateral thoracotomy were randomly divided into 2 groups of 18 each. Before chest closure, an interpleural catheter was inserted under direct vision. At the end of the operation and every 4 hours thereafter, they received either 0.25% bupivacaine with epinephrine or 0.2 mg·kg−1 morphine sulfate interpleurally for 24 hours. The chest tubes were clamped during injection and for 15 min afterwards. Supplementary doses of intravenous morphine were given on request. The pain severity was evaluated at rest and on coughing before and 30 min after each interpleural injection, using an 11-point visual analog scale. Supplemental analgesic consumption and side effects were recorded. Both interpleural morphine and bupivacaine significantly reduced pain scores 30 min after each injection. However, pain scores and supplementary analgesic requirements were significantly lower in the interpleural morphine group. No serious side effects were detected in either group. Interpleural morphine provides better pain control than interpleural bupivacaine after a posterolateral thoracotomy.
Prognostic Variability in Completely Resected pN1 Non-Small-Cell Lung Cancer
Authors: Gonfiotti Alessandro , Crocetti Emanuele , Lopes Pegna Andrea , Paci Eugenio , Janni Alberto
Published: May 2013

We used the Tuscan Cancer Registry archives to retrieve records of 2,896 patients with a histological diagnosis of lung tumor from January 1996 to December 2000. Of 2,410 patients with non-small-cell lung cancer, 767 (31.8%) underwent complete resection. The following variables were analyzed for their influence on survival in the 157 patients with pathologic N1 status: sex, age, cell type, pathologic tumor status, number and level of involved lymph nodes, tumor grade, and type of surgery. Overall 5-year survival rates were 43.9% for 417 patients with pN0 disease, 10.8% for 176 with pN2 disease, and 31.6% for those with pN1 disease. In pN1 disease, the overall 5-year survival rates for patients with hilar and non-hilar lymph node involvement were 27.4% and 39.6%, respectively. Univariate analysis demonstrated that pathological T status and level of N1 involvement weresignificant prognostic factors. Cox proportional hazards analysis indicated that hilar lymph node involvement was an independent prognostic factor. N1 lymph node status was identified as an independent prognostic factor in a combination of subgroups with different prognoses.
Surgical Palliation for Taussig-Bing Anomaly with Multiple Lesions
Authors: Agematsu Kota , Aoki Mitsuru , Naito Yuji , Fujiwara Tadashi
Published: May 2013

A successful surgical palliative procedure, consisting of an arterial switch operation, pulmonary artery banding, and arch repair, was performed in a neonate with Taussig-Bing anomaly and aortic arch interruption, subaortic stenosis, and multiple muscular ventricular septal defects. Such anatomical complexity made treatment difficult. This palliative procedure allows future biventricular repair.
Two Easy Ways to Ensure Safe Sternotomy and Sternal Closure
Authors: De Cicco Giuseppe , Fucci Carlo , Lorusso Roberto
Published: May 2013

Appropriate sternotomy and sternal closure are the most important factors in mechanical stability of the sternum and prevention of several postoperative complications. Easy techniques for identifying the sternal midline to facilitate opening and for obtaining reinforced closure are described. These techniques require minimal additional time. They are particularly indicated in patients at risk of sternotomy-related complications, and helpful to young surgeons in training.
Mature Cardiac Myocyte Hamartoma in the Right Atrium
Authors: Movahedi Namvar , Boroumand Mohammad Ali , Anvari Maryam Sotoudeh , Yazdanifard Parin
Published: May 2013

During coronary artery bypass grafting in a 58-year-old man, a mass was discovered incidentally in the right atrium, measuring 1.5 × 1 × 0.5 cm. It was composed of disorganized hypertrophic mature cardiac myocytes, and associated with focal fibrosis, mature adipocytes, and mild lymphocytic infiltration in peripheral areas, indicative of cardiac hamartoma. This type of hamartoma has been rarely reported as an isolated mass in the right atrium.
Minimally Invasive Thoracoscope-Assisted Heller Myotomy for Achalasia
Authors: Ma Nan , Zhong Hong , Ye Chuanzhong , Shan Genfa , Zhang Fuxian , Mei Ju
Published: May 2013

Forty-five patients (20 men and 25 women) with a median age of 46.5 years, who were diagnosed with esophageal achalasia by clinical history, esophagoscopy, and barium esophagogram, underwent thoracoscope-assisted Heller myotomy with a minimal incision. Esophageal pressure and pH were monitored. Two patients were excluded because of mucosal perforation during the operation, requiring conversion to an open procedure. There was no postoperative esophageal leakage or hospital death. All patients resumed a normal diet as soon as gastrointestinal function recovered, and their symptoms disappeared completely. The mean operative time was 1.2 hours (range, 0.5–3.8 hours). After 2.1 years of follow-up, the outcome was rated excellent in 33 (77%) patients, good in 7 (16%), and fair in 3 (7%). Esophageal dilation was required in 3 patients because of relapsing dysphagia within 3 months after the operation. Four (9%) patients had some regurgitation but no further surgical or medical treatment was needed. Esophageal pressure and pH correlated with the clinical manifestations. Our modified Heller myotomy with the assistance of thoracoscopy is effective for achalasia.
Renal Outcome Following On- and Off-Pump Coronary Artery Bypass Graft Surgery
Authors: Ooi Joanna SM , Abdul Rahman Mohd R , Shah Shamsul A , Dimon Mohd Z
Published: May 2013

A prospective study was carried out to compare the outcomes of patients with preexisting non-dialysis-dependent renal dysfunction who underwent coronary artery bypass grafting with or without cardiopulmonary bypass. Elective off-pump coronary artery bypass was performed in 29 patients with renal dysfunction. Their results were compared with those of a similar group of 35 patients who underwent the conventional on-pump coronary artery grafting. There was a significant deterioration in creatinine clearance in the on-pump group on days 1, 2, and 4 after surgery, while creatinine clearance in the off-pump group remained close to the baseline level. Both groups had improved to the preoperative creatinine clearance values on follow-up at 4 weeks. It was concluded that off-pump surgery provided better renal protection than the conventional on-pump technique in patients with preexisting non-dialysis-dependent renal dysfunction.
Mitral Valve Replacement in Calcified Annulus Following Ring Annuloplasty
Authors: Messer Simon , Saxena Pankaj , Mickelburgh Marcia , Jalali Homayoun , Konstantinov Igor E
Published: May 2013

We present a patient with persistent severe hemolysis following mitral valve repair which resolved after valve replacement with bioprosthesis. The posterior portion of the annuloplasty ring was retained due to severe calcifications of the posterior mitral valve annulus. All chordae were preserved to avoid disruption of the mitral annulus.
Surgical Anatomy of Atrioventricular Septal Defect
Authors: Adachi Iki , Uemura Hideki , McCarthy Karen P , Ho Siew Yen
Published: May 2013

This review aims to describe the anatomic spectrum of hearts classified with the collective term atrioventricular septal defect. Despite their anatomical variety, hearts with the stigmata of atrioventricular septal defect share the characteristic feature of a common atrioventricular junction guarded by a 5-leaflet valve. The lack of normal atrioventricular septation makes the aorta un-wedged, resulting in an elongated outlet length on the left ventricular surface (known as inlet-outlet disproportion). The major determinant of anatomic variations is the relationship of the bridging leaflets to the septal structures. This important relationship determines not only the level of intracardiac shunting (interatrial only, interventricular only, or both) but also the propensity for left ventricular outflow tract obstruction. Furthermore, the location of the atrioventricular node, which is posteroinferiorly displaced from the tip of the triangle of Koch, is also affected by this relationship. Understanding the cardiac anatomy in this malformation is an absolute prerequisite for successful surgery, and should be facilitated by recognizing the fundamental nature of the morphology.
Pulmonary Protection During Cardiac Surgery: Systematic Literature Review
Authors: Carvalho Enisa MF , Gabriel Edmo A , Salerno Tomas A
Published: May 2013

Ischemia-reperfusion injury occurs during heart surgery in which cardiopulmonary bypass is used. Current knowledge of the factors contributing to postoperative pulmonary dysfunction and the measures to avoid it are reviewed.
Graft Replacement for Massive Mobile Embolic Source in Brachiocephalic Artery
Authors: Oishi Yasuhisa , Hirahara Nana , Takaseya Toru , Kawara Takemi , Yasaka Masahiro , Morita Shigeki
Published: May 2013

A 76-year-old woman presented with multiple brain infarctions in the right middle cerebral artery and vertebral artery area. Carotid sonography revealed a large mobile pedunculated mass in the brachiocephalic artery, which showed rapid growth despite treatment with heparin and aspirin. Graft replacement of the brachiocephalic artery was performed under selective cerebral perfusion with deep hypothermia. Histology of the resected specimen revealed aortic atherosclerotic plaque.
Folic Acid-Based Intervention in Non-ST Elevation Acute Coronary Syndromes
Authors: Imasa Marcelo Severino B , Gomez Neil T , Nevado Jose B
Published: May 2013

Homocysteinemia is a risk factor for cardiovascular diseases. Folic acid combined with vitamins B6 and B12 is effective in lowering homocysteine levels. This randomized placebo-controlled study was designed to determine the effect of a folic acid-based supplement on secondary prevention of clinical events in non-ST-segment elevation acute coronary syndromes. The study comprised 240 patients with either unstable angina or non-ST-elevation myocardial infarction in the previous 2 weeks who were randomized to a folate group ( n = 116) or a placebo group ( n = 124). The folate group received 1 mg folic acid, 400 μg vitamin B12, and 10 mg vitamin B6 daily. Clinical outcomes within 6 months were assessed. The composite endpoint of death, nonfatal acute coronary syndrome, and serious re-hospitalization was significantly higher in the folate group; serious re-hospitalization alone was significantly higher in this group. Advanced age and diabetes increased susceptibility to the composite outcome. Folic acid-based supplementation is not beneficial and may even be harmful in the secondary prevention of cardiovascular events in patients with unstable angina and non-ST-elevation myocardial infarction. Further studies on the safety of such supplements are suggested. Controlled Clinical Trials Registry no. ISRCTN30249553.
Massive Cerebral Air Embolism after Bronchoscopy and Central Line Manipulation
Authors: Seeburger Joerg , Borger Michael A , Merk Denis R , Doll Susanne , Bittner Hartmuth B , Mohr Friedrich W
Published: May 2013

A 50-year-old woman who underwent double-lung transplantation suffered a massive cerebral air embolism with severe neurological impairment and temporary hemodynamic deterioration after surveillance bronchoscopy and central line removal. We hypothesize that this was due to microscopic pulmonary parenchymal injury during bronchoscopy as well as air entrainment during removal of the central venous line, with subsequent transpulmonary passage into the cerebral vessels.
Outcomes of Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation
Authors: Sajja Lokeswara R , Mannam Gopichand , Dandu Bhaskara R S , Pathuri Satyendranath , Sompalli Sriramulu , Anjaneyulu AV
Published: May 2013

Mitral regurgitation is a frequent complication of ischemic heart disease. A retrospective study was performed on 127 patients with significant ischemic mitral regurgitation (regurgitant jet area ≥6.0 cm2 and/or vena contracta width ≥0.70 cm) who underwent elective mitral valve repair between January 2001 and October 2007. Concomitant myocardial revascularization was carried out in all except one patient, and left ventricular restoration in 8. All patients had ring annuloplasty, with release of posterior mitral leaflet tethering in 21, leaflet resection in 7, chordal transfer in 3, and chordal shortening in 2. There were 4 (3.1%) hospital deaths. Two patients underwent successful mitral valve replacement for repair failure in the immediate postoperative period, and one had an unsuccessful valve replacement at 3 months. During a mean follow-up of 19.65 ± 13.21 months in 121 patients, 111 had trivial or no residual regurgitation, and 10 had mild regurgitation. Mitral valve repair for chronic ischemic mitral regurgitation is a reproducible technique with satisfactory early and mid-term outcomes and freedom from valve-related complications.
Exercise Tolerance in Extracardiac Total Cavopulmonary Connection
Authors: Yin Zongtao , Wang Cengwei , Zhu Hongyu , Zhang Renfu , Wang Huishan , Li Xinmin
Published: May 2013

Cardiopulmonary adaptation during exercise was compared in patients with an extracardiac total cavopulmonary connection and controls with biventricular repair of Fallot's tetralogy. Heart rate, blood pressure, respiratory frequency, and transcutaneous oxygen saturation increased with treadmill exercise intensity below grade 3 in patients who had undergone extracardiac total cavopulmonary connection. When exercise intensity exceeded grade 4, blood pressure and oxygen saturation decreased continuously, respiratory rate kept increasing, and heart rate showed no significant change. In cases of fenestrated cavopulmonary connection, heart rate peaked at grade 5 exercise intensity, and blood pressure at grade 4; but both peaked at grade 3 in nonfenestrated patients. During all exercise testing, fenestrated patients had a higher respiratory rate but lower oxygen saturation than those without fenestration. Exercise tolerance was below normal after a cavopulmonary connection, but patients still adapted to exercise below grade 3 with appropriate increases in heart rate and respiratory rate. Due to insufficient right heart systems, patients with a cavopulmonary connection showed obvious exercise limitation at exercise intensity grade 3 or more. Total exclusion of the right heart system may also have adverse effects on the sinoatrial node, leading to impaired heart rate regulation.
Left Anterior Descending Coronary Aneurysm
Authors: Lloyd Julie-Ann S , Weiss Eric S , Vricella Luca A
Published: May 2013

A 19-year-old man presented with gradual onset of retrosternal chest pain and hemodynamic instability. Echocardiography and computed tomography showed substantial anterior and posterior pericardial effusion with tamponade. At surgery, a 3-cm ruptured aneurysm of the left anterior descending coronary artery was identified. It was successfully bypassed using a saphenous vein graft anastomosed to the ascending aorta.
Clinical Determinants of ckit-Positive Cardiac Cell Yield in Coronary Disease
Authors: Rani Koippallil G Aghila , Jayakumar Karunakaran , Sarma P Sankara , Kartha Chandrasekharan C
Published: May 2013

Recent animal studies and clinical trials have reported the scope of heart-resident ckit-positive stem cells in regenerating infarcted myocardium. The determinants of successful isolation of such cells are unknown. The objective of this study was to determine the influence of risk factors for coronary artery disease and disease severity on the successful isolation of ckit-positive cells from right atrial tissue of patients with coronary artery disease. The findings suggest that coronary artery disease and cardiac remodeling in chronic ischemia may not affect the yield of ckit-positive cells from atrial tissue, but a significant negative correlation between the age of the patient and the number of migrated ckit-positive cells was observed. This suggests that in older patients, stem cell isolation from cardiac biopsies may not succeed, and such cells may not be available for cell therapy.
Radial Artery Jump Graft from Anterior to Posterior Descending Coronary Artery
Authors: Taggart David P , Balacumaraswami Lognathen , Venkatapathy Ajit
Published: May 2013

A novel technique to achieve total arterial grafting, using a radial artery jump graft from the anterior descending coronary artery to the posterior descending artery, was employed in a preliminary series of 10 patients. All radial artery grafts were patent. This was confirmed using the SPY intraoperative fluorescence imaging system. There were no postoperative complications in any patient, and all were discharged uneventfully.
Short- and Long-Term Results of Lung Resection for Cancer in Octogenarians
Authors: Voltolini Luca , Rapicetta Cristian , Ligabue Tommaso , Luzzi Luca , Scala Valerio , Gotti Giuseppe
Published: May 2013

To analyze short- and long-term results of surgery in octogenarians, we reviewed data of 96 consecutive patients aged 80 years or more who were operated on for non-small-cell lung carcinoma from 1990 to 2005. Risk factors for complications, perioperative mortality, and long-term survival were assessed by univariate and multivariate analysis. Major complications developed in 17 (17.7%) patients, leading to death in 9 (9.4%) of them. Resection of more than 1 lobe, cardiorespiratory comorbidity, PaO2 < 75 mm Hg, and CO diffusion capacity <60% were predictive of major complications; extended resection was also predictive of 30-day mortality. The overall 5-year survival rate was 38%, with a significant difference between stage I/II and stage III. In multivariate analysis only pathological stage was related to long-term survival. Surgery is feasible for octogenarians, and even patients in stage II can achieve remarkable survival.
Repair of Narrowed Coronary Sinus without Connecting Left Superior Vena Cava
Authors: Miyamoto Takashi , Doi Yoshio , Ikeda Kentaro , Kobayashi Tohru , Kobayashi Tomio
Published: May 2013

We successfully repaired a markedly narrowed coronary sinus without connecting a left superior vena cava in a 3-year-old boy with an atrial septal defect.
Self-Retaining Pledgeted Suture as Retractor for Mitral Procedure
Authors: Ng Choi-Keung , Benedikt Peter , Schwarz Christian , Hartl Peter
Published: May 2013

A simple reliable maneuver to optimize exposure of the left atrium for mitral valve operations is described. It offers more space to mobilize the valvular structure, facilitating complicated reconstruction in the posteromedial commisural area.
Cellular Cardiomyoplasty: What Have We Learned?
Authors: Kao Race L , Browder William , Li Chuanfu
Published: May 2013

Restoring blood flow, improving perfusion, reducing clinical symptoms, and augmenting ventricular function are the goals after acute myocardial infarction. Other than cardiac transplantation, no standard clinical procedure is available to restore damaged myocardium. Since we first reported cellular cardiomyoplasty in 1989, successful outcomes have been confirmed by experimental and clinical studies, but definitive long-term efficacy requires large-scale placebo-controlled double-blind randomized trials. On meta-analysis, stem cell-treated groups had significantly improved left ventricular ejection fraction, reduced infarct scar size, and decreased left ventricular end-systolic volume. Fewer myocardial infarctions, deaths, readmissions for heart failure, and repeat revascularizations were additional benefits. Encouraging clinical findings have been reported using satellite or bone marrow stem cells, but understanding of the benefit mechanisms demands additional studies. Adult mammalian ventricular myocardium lacks adequate regeneration capability, and cellular cardiomyoplasty offers a new way to overcome this; the poor retention and engraftment rate and high apoptotic rate of the implanted stem cells limit outcomes. The ideal type and number of cells, optimal timing of cell therapy, and ideal cell delivery method depend on determining the beneficial mechanisms. Cellular cardiomyoplasty has progressed rapidly in the last decade. A critical review may help us to better plan the future direction.
Impact of Coronary Disease after Aortic Valve Replacement
Authors: Grünenfelder Jürg , Kilb Iram , Plass Andre , Cominelli Silvano , Zeller Daniela , Genoni Michele
Published: May 2013

Left ventricular dimensions tend to reduce after aortic valve replacement in patients with aortic stenosis. Whether concomitant coronary artery disease has an influence on postoperative ventricular dimensions has not been evaluated. Between 1998 and 2002, 112 patients underwent aortic valve replacement for aortic stenosis; 68 had isolated aortic valve replacement, and 44 had combined coronary artery bypass grafting. Left ventricular dimensions were assessed by echocardiography preoperatively and at 3 and 12 months postoperatively. Transvalvular mean gradient, left ventricular end-diastolic diameter, and left ventricular mass index decreased significantly postoperatively, while left ventricular ejection fraction improved. Preoperative left ventricular dimensions in patients with isolated aortic stenosis were worse than in those with aortic stenosis and coronary artery disease. After aortic valve replacement with coronary artery bypass, left ventricular mass index regression was less than that after valve replacement alone, and there was no improvement in ejection fraction. This suggests that coronary artery disease has a negative impact on postoperative myocardial recovery.
Impact of Gender on Outcome after Coronary Artery Bypass Surgery
Authors: Ennker Ina C , Albert Alexander , Pietrowski Detlef , Bauer Kerstin , Ennker Juergen , Florath Ines
Published: May 2013

Following recent studies concerning the increased risk of coronary artery bypass surgery for women, the impact of sex is still a controversial issue. Between 1996 and 2006, 9,527 men and 3,079 women underwent isolated coronary artery bypass in our institute. To adjust for dissimilarities in preoperative risk profiles, propensity score-based matching was applied. Before adjustment, clinical outcomes in terms of operative mortality, arrhythmias, intensive care unit stay, and maximum creatine kinase-MB levels were significantly different for men and women. After balancing the preoperative characteristics, including height, no significant differences in clinical outcomes were observed. However, there was decreased use of internal mammary artery, less total arterial revascularization, and increasing creatine kinase-MB levels with decreasing height. This study supports the theory that female sex per se does not increase operative risk, but shorter height, which is more common in women, affects the outcome, probably due to technical difficulties in shorter patients with smaller internal mammary arteries and coronary vessels. Thus women may especially benefit from sequential arterial grafting.
Effect on the Brain of Two Techniques of Myocardial Protection
Authors: Stygall Jan , Suvarna Sujeeth , Harrington Jane , Hayward Martin , Walesby Robin K , Newman Stanton P
Published: May 2013

This study compared the occurrence of intraoperative microemboli and postoperative changes in neuropsychological performance in 195 patients undergoing coronary artery bypass grafting who were randomized to intermittent crossclamp fibrillation or cardioplegic arrest. Cerebral microemboli were recorded from cannulation to 15 min after decannulation, using transcranial Doppler in 166 patients. Microemboli in relation to 9 surgical events were also noted. Neuropsychological change scores were obtained by comparing cognitive performance preoperatively with that at 6–8 weeks after surgery. The median number of microemboli detected was 105 (range, 9–1,757) in the fibrillation group, and 110 (range, 1–1,306) in the cardioplegia group, with no significant difference between groups. There was also no significant difference between groups in the generation of microemboli during any of the surgical events. Neuropsychological tests were completed postoperatively by 177 participants, with no significant differences in performance found between the 2 groups. Given the equivalence of the effect of intermittent crossclamp fibrillation and cardioplegic arrest on microemboli and neuropsychology, consideration of which form of myocardial protection to employ should perhaps focus more on which method affords most protection to the heart.
Primary Tuberculous Sternal Osteomyelitis: A Clinical Rarity
Authors: Bhatia Vijay Yashpal , Aggarwal Vinod , Sharma Umesh , Gupta Anubhav
Published: May 2013

Primary tuberculous sternal osteomyelitis is a rare condition, presenting as painful swelling and discharging sinuses over the chest wall. Diagnosis is based on radiological findings and histological examination of debrided infected tissues, with specific cultures for mycobacteria. Two cases were successfully treated by surgical debridement and reconstruction using pectoralis major muscle flaps, followed by antituberculous therapy.
Importance of Strain Imaging in Cardiac Rehabilitation
Authors: Claessens Philip , Meulendijks Jan , Claessens Christophe , Claessens Marc , Claessens Maria , Claessens Jan
Published: May 2013

Cardiac rehabilitation improves the subjective condition of the patient; but are there associated structural and functional cardiac adaptations? The study group consisted of 39 patients with an inferior infarction and 21 patients with an anterior infarction, treated by surgical revascularization followed by 4 months of cardiac rehabilitation. Maximal exercise testing and Doppler echocardiography were performed before and after the rehabilitation program. Performance capacity was significantly improved after cardiac rehabilitation, but left ventricular function remained unchanged on Doppler imaging. Only by analyzing the subgroups using strain imaging significant differences were noted after cardiac rehabilitation: patients with an inferior infarction exhibited improved strain values in the anterior wall; those with an anterior infarction had improved strain values in the inferior wall. Strain values in the infarcted regions were worse after cardiac rehabilitation. Strain imaging indicated that cardiac rehabilitation could bring about improvements in cardiac function exclusively in the healthy non-infarcted myocardium, while there were signs of further deterioration of myocardial function in the highly ischemic zones.
Carinoplasty with Telescope Anastomosis for Tuberculous Bronchial Stenosis
Authors: Tanaka Hisaichi , Ohta Mitsunori , Matsumura Akihide , Ikeda Naoki , Kitahara Naoto , Iuchi Keiji
Published: May 2013

A 25-year-old women developed severe stenosis of the right main bronchus after medical treatment for pulmonary tuberculosis in the right upper lobe. She underwent a right upper sleeve lobectomy with partial excision of the right main bronchus and right side of the carina. Reconstruction was performed using telescopic anastomosis between the carina and intermediate bronchus. Her symptoms improved immediately.
Late Presentation of Aortic Root Abscess in Endocarditis with Coronary Ischemia
Authors: Namboodiri Narayanan , Bohora Shomu , Misra Manoranjan , Bijulal Sasidharan , Jayakumar Karunakaran , Tharakan Jaganmohan A
Published: May 2013

Formation of a large aortic root abscess is an infrequent complication of aortic valve endocarditis in adults. Extrinsic compression of the coronary arteries by this abscess is still rarer. Here, we report a case of a 22-year-old male with aortic root abscess, who presented 2 months after the completion of treatment of endocarditis with exertional angina. Coronary angiogram revealed compression of proximal left anterior descending and left circumflex arteries by the abscess. The patient was successfully treated with pericardial patch exclusion of the abscess cavity and coronary artery bypass graft. The presentation of aortic root abscess with myocardial ischemia as a late complication of treated endocarditis has not been reported earlier.
Dual Inferior Venae Cavae with Mitral Stenosis
Authors: Tambe Sandeep P , Sinha Prabhat Kumar , Bhupali Ashok N
Published: May 2013

A 34-year old woman with rheumatic mitral stenosis was found to have complete dual inferior venae cavae with bilateral infrarenal and suprarenal segments, on balloon mitral valvuloplasty. The bilateral, renal, and gonadal veins drained separately on the ipsilateral side. The left inferior vena cava was larger than the right, and the right inferior vena cava had an aneurysmal dilatation near its origin. The left inferior vena cava drained into the superior vena cava-right atrial junction.
Hypothermic Circulatory Arrest: Renal Protection by Atrial Natriuretic Peptide
Authors: Ohno Masahiro , Omoto Tadashi , Fukuzumi Masaomi , Oi Masaya , Ishikawa Noboru , Tedoriya Takeo
Published: May 2013

Moderate hypothermic circulatory arrest with selective cerebral perfusion has been developed for cerebral protection during thoracic aortic surgery. However, visceral organs, particularly the kidneys, suffer greater tissue damage under moderate hypothermic circulatory arrest, and acute renal failure after hypothermic circulatory arrest is an independent risk factor for early and late mortality. This study investigated whether atrial natriuretic peptide could prevent the reduction in renal perfusion and protect renal function after moderate hypothermic circulatory arrest. Twelve pigs cooled to 30°C during cardiopulmonary bypass were randomly assigned to a peptide-treated group of 6 and a control group of 6. Moderate hypothermic circulatory arrest was induced for 60 min. Systemic arterial mean pressure and renal artery flow did not differ between groups during the study. However, renal medullary blood flow increased significantly in the peptide-treated group after hypothermic circulatory arrest. Myeloperoxidase activity was significantly reduced in the medulla of the peptide-treated group. Renal medullary ischemia after hypothermic circulatory arrest was ameliorated by atrial natriuretic peptide which increased medullary blood flow and reduced sodium reabsorption in the medulla. Atrial natriuretic peptide also reduced the release of an inflammatory marker after ischemia in renal tissue.
Eight-Year Experience of Intraoperative Aortic Dissection
Authors: Lin Tzu-Yu , Chen Yih-Sharng , Chiu Kuan-Ming , Hsu Ron-Bin , Yu Hsi-Yu , Wang Ming-Jiuh
Published: May 2013

Aortic dissection is a rare but devastating complication of cardiac operations. The purpose of this investigation was to assess the occurrence of aortic dissection during elective cardiac operations and the usefulness of intraoperative transesophageal echocardiography for the diagnosis and management of this complication. Data of consecutive adult patients undergoing elective cardiac surgery with transesophageal echocardiographic monitoring during an 8-year period were studied retrospectively. Aortic dissection was identified in 7 (0.13%) of 5,247 patients, and diagnosed immediately by transesophageal echocardiography in 5 of them; 2 were diagnosed later by transesophageal echocardiography. All aortic dissections were type A and they occurred after completion of the primary procedure. Two patients treated conservatively died within 5 days. Four of the 5 patients who underwent immediate reoperation survived with serious postoperative complications. Transesophageal echocardiography should be carried out when there is a risk of aortic dissection during cardiac operations, especially in the posterior wall of the ascending aorta, to avoid missing the diagnosis and delaying treatment.
Coronary Artery Bypass in a Patient with Single Anomalous Right Coronary Artery
Authors: Saxena Pankaj , Shehatha Jaffar , Konstantinov Igor E
Published: May 2013

The true incidence of coronary artery anomalies in the general population is unknown. Rarely, atherosclerotic coronary artery disease can be associated with single coronary artery. We describe coronary artery bypass surgery in a 57-year-old man with this association.
Surgery for Bronchogenic Cysts: Always Easy?
Authors: Granato Felice , Voltolini Luca , Ghiribelli Claudia , Luzzi Luca , Tenconi Sara , Gotti Giuseppe
Published: May 2013

A few cases of major complications after surgery for bronchogenic cyst have been reported. The purpose of this study was to analyze the complicated and unusual cases among 30 consecutive patients with bronchogenic cysts treated surgically at our institution between 1975 and 2007. There were 3 cases of mediastinal bronchogenic cyst characterized by significant surgical complications or very unusual pathological findings. The operations were performed through a thoracotomy in 25 patients, and by video-assisted thoracoscopic surgery in 5. Two patients suffered iatrogenic injury of the contralateral main bronchus during excision of a mediastinal cyst; in one of them, late development of foreign body granuloma was related to migration towards the bronchial wall of cyanoacrylate used to reinforce suturing of the bronchial tear. Histological examination of one resected specimen showed a large-cell anaplastic carcinoma arising from the wall of a mediastinal bronchogenic cyst. Bronchogenic cysts should be excised before they become symptomatic or infected, which leads to more difficult surgery and complications. The small risk of developing malignancy within a bronchogenic cyst also justifies early intervention.
Intraoperative Continuous Venovenous Hemofiltration during Coronary Surgery
Authors: Roscitano Antonino , Benedetto Umberto , Goracci Massimo , Capuano Fabio , Lucani Remo , Sinatra Riccardo
Published: May 2013

Postoperative continuous venovenous hemofiltration decreases acute renal failure in patients with moderate renal dysfunction undergoing coronary artery bypass grafting, but it prolongs intensive care unit stay. We developed a simple method to connect a hemofiltration machine to the cardiopulmonary bypass system. To evaluate the benefit of intraoperative hemofiltration, 124 consecutive patients (mean age, 67 ± 6 years) with moderate renal dysfunction were studied. Surgery was preformed between January 2005 and May 2007. On-pump coronary artery bypass with hemofiltration was carried out in 40 patients (group A), 44 had on-pump coronary artery bypass without hemofiltration (group B), and 40 had off-pump coronary artery bypass (group C). Postoperative acute renal failure was defined as either renal failure requiring dialysis or ≥50% decline from the baseline glomerular filtration rate but not requiring dialysis. The 3 groups had similar demographic data and preoperative renal function. After adjusting for covariates and propensity scores, multivariate analysis showed that intraoperative hemofiltration and off-pump surgery protected postoperative renal function. Independent risk factors for postoperative renal dysfunction were age >70 years, left ventricular ejection fraction <35%, and the preoperative glomerular filtration rate.
Repair of Aortic Coarctation in an Adult by Direct Aortoplasty
Authors: Charokopos Nicholas , Artemiou Panagiotis , Antonitsis Polychronis , Rouska Efthymia , Stinios Ioannis
Published: May 2013

Various techniques have been proposed for surgical correction of aortic coarctation in adults. We describe direct aortoplasty repair in a 28-year-old woman with native coarctation. Four-year follow-up with magnetic resonance angiography confirmed a good result. This is a safe and effective technique that provides enlargement of the aortic lumen by avoiding extensive anastomotic suture lines or interposition of prosthetic graft material.
Post-Sternotomy Hemorrhage due to Left Internal Thoracic Artery Pseudoaneurysm
Authors: Yamashiro Satoshi , Kuniyoshi Yukio , Arakaki Katsuya , Inafuku Hitoshi , Morishima Yuji , Kise Yuya
Published: May 2013

We describe a case of pseudoaneurysm of the internal thoracic artery, which was probably caused by infection. Four weeks after aortic valve replacement and coronary artery bypass surgery, an 84-year-old woman suddenly developed painful sternal instability and hypotension, with active hemorrhage from a left parasternal swelling. Selective arteriography revealed a pseudoaneurysm of the left internal thoracic artery. It was surgically excised, and the patient recovered uneventfully.
Video-Assisted Thoracic Surgery Excision of Mediastinal Hemangioma
Authors: Chan Alexander PH , Randolph HL Wong , Wan Innes YP , Hsin Michael KY , Malcolm J Underwood , Yim Anthony PC
Published: May 2013

A 62-year-old woman with a middle mediastinal hemangioma was successfully treated using a video-assisted thoracic surgery approach facilitated by segmental rib resection, despite an initial radiological study that showed encasement by the surrounding great vessels. Pathological examination confirmed a cavernous hemangioma. This approach offers potential resection in difficult cases of mediastinal tumor.
Hyperhomocysteinemia-Induced Myocardial Injury after Coronary Artery Bypass
Authors: Thiengburanatham Sanya
Published: May 2013

Hyperhomocysteinemia and other major cardiovascular risk factors are associated with increased vascular oxidative stress. To access the effects preoperative plasma homocysteine levels and other atherosclerotic risk factors on myocardial ischemiareperfusion injury after conventional coronary artery bypass, 213 patients with normal renal function were enrolled prospectively. Cardiac troponin T was measured postoperatively to determine myocardial injury. There was a significant relationship between hyperhomocysteinemia and postoperative peak troponin T. This was more marked in patients without major atherosclerotic risk factors than in those who had at least one risk factor. Moreover, among current cigarette smokers, those with the highest preoperative plasma homocysteine levels had the lowest postoperative troponin T levels. From multivariate linear regression analysis, the predictors of high postoperative troponin T were hyperhomocysteinemia, hypertension, and aortic crossclamp time, but the presence of major atherosclerotic risk factors paradoxically modified the effects of hyperhomocysteinemia on postoperative myocardial ischemia-reperfusion injury.
The Forgotten Driving Forces in Right Heart Failure: New Concept and Device
Authors: Nour Sayed , Wu Guifu , Zhensheng Zheng , Chachques Juan C , Carpentier Alain , Payen Didier
Published: May 2013

Background: Right heart failure is a frequent hemodynamic disturbance in pediatric cardiac patients. Besides inotropic and chronotropic drugs, fluid administration and inhaled nitric oxide, right ventricular mechanical assistance remains difficult to perform. A circulatory assist device adapted for the right heart biophysics and physiology might be more efficient. Materials and Methods: We are developing a prototype of a non-invasive cardiac assist device (CAD) for neonates and pediatrics. It is based on a pulsatile suit device covering and affecting all territories of the right heart circuit. It will be tested in a neonatal animal model of right ventricular (RV) failure. Experimental models will be matched and compared with control and sham groups. Expected results would be immediate hemodynamic improvement due to synchronized diastolic reduction of stagnant venous capacitance, increasing preload and contractility. On long term, increased shear stress with changing intrathoracic pressure in a phasic way would improve and remodel the pulmonary circulation. Future studies will be focused on: hemodynamic, biochemistry, endothelium function test, and angiogenesis.

Comments: A non-invasive CAD guarantees better hemodynamics and endothelial function preservation with low morbidity and mortality. This is a physiological approach, cost-effective method, and particularly interesting in neonates and pediatrics with RV failure.
Prevention of Venous Thromboembolism in Thoracic and Cardiovascular Surgery
Authors: Egawa Noriko , Hiromatsu Shinichi , Shintani Yusuke , Kanaya Kurando , Fukunaga Shuji , Aoyagi Shigeaki
Published: May 2013

Venous thromboembolism is the most preventable illness among patients in hospital. We prepared guidelines for the prophylaxis of venous thromboembolism, based on previous experience of perioperative risk factors. The aim of this study was to evaluate the effectiveness of these guidelines. All 1,467 patients who underwent surgery for thoracic or cardiovascular disease between April 2002 and July 2004, before the prophylactic guidelines were implemented, were assigned to group A. Another 1,389 patients who had surgery between August 2004 and December 2006, after the guidelines had been implemented, formed group B. The incidences of venous thromboembolism perioperatively in the 2 groups were compared. Six (0.4%) patients in group A developed deep vein thrombosis or pulmonary embolism, whereas no patient in group B experienced thromboembolism. The difference between groups was significant, so we consider our guidelines for venous thromboembolism prevention in the perioperative period to be clinically useful.
Figure-of-Eight vs. Interrupted Sternal Wire Closure of Median Sternotomy
Authors: Ramzisham Abdul-Rahman Mohd , Raflis Awang Ruzairee , Khairulasri Mohd Ghani , Min Joanna Ooi Su , Fikri Abdullah Mohd , Zamrin Mohd Dimon
Published: May 2013

Sternal dehiscence is a rare but devastating complication following median sternotomy for cardiac surgery. The optimal technique for sternal closure is unclear. We conducted this prospective randomized trial to compare the incidence of sternal dehiscence after figure-of-8 and simple interrupted suturing in patients undergoing coronary artery bypass grafting. Between January 2007 and June 2008, 98 patients had figure-of-8 suturing and 97 had interrupted sutures. The mean age of the patients was 60.9 ± 7.6 years. The overall sternal dehiscence rate was 8%; 7 cases in the in figure-of-8 group and 9 in the interrupted group. Thirteen patients had no wound infection and healed with conservative treatment. Only 3 patients had sternal dehiscence with infection: 2 with simple interrupted closure and 1 with figure-of-8 sternal closure. There was no significant difference in rates of sternal dehiscence between the 2 groups. It was concluded that figure-of-8 sternal suturing is equally effective as simple interrupted suturing in preventing sternal dehiscence.
Risk Factors for Mediastinitis and Endocarditis after Cardiac Surgery
Authors: Gualis Javier , Flórez Santiago , Tamayo Eduardo , Álvarez Francisco Javier , Castrodeza Javier , Castaño Mario
Published: May 2013

A prospective open-cohort study was performed in 838 adults undergoing coronary revascularization or valve surgery to define the risk factors for development of surgical site infections. Patients diagnosed with mediastinitis or endocarditis during follow-up were compared with patients with no such infection. After 1 year of follow-up, 22 (2.6%) patients had developed mediastinitis or endocarditis. No preoperative or intraoperative variables were identified as risk factors. By multivariate analysis of postoperative variables, respiratory insufficiency, microorganisms in blood cultures, and intensive care unit stay were independent risk factors for the development of these complications. The type of antibiotic prophylaxis had no influence on the incidence of organ or space infections after cardiac surgery.