bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes and Vascular Disease: A New International Trial
Authors: Patel Anushka , Chalmers John , Chaturvedi Vivek , Currie Rochelle , Monaghan Helen , Neal Bruce
Published: May 2013

The prevalence of diabetes is increasing, particularly in developing regions of the world. The social and economic consequences of this disease and its complications are enormous. We discuss the scope and implications of the increasing burden of diabetes and describe the rationale and design of a new international study examining blood pressure lowering and glucose control interventions aimed at reducing the risk of vascular complications in people with type 2 diabetes. This study is the first large-scale randomized trial in diabetes to include participants from both lower- and higher-income regions of the world.
Single-Stage Treatment of Aortic Coarctation and Aortic Valve Disease
Authors: Sun Li Zhong , Luo Xin Jin , Liu Yong Min
Published: May 2013

Surgical management of thoracic aortic coarctation associated with severe aortic valve disease is difficult in most cases. As staged procedures are associated with a higher rate of morbidity and mortality, simultaneous operative management of both lesions is desirable. From 1997 to 2001, 9 patients (8 males and 1 female with a mean age of 30.1 ± 10.4 years) with this condition underwent simultaneous ascending aorta—infrarenal abdominal aorta bypass graft and aortic valve replacement. One patient died from failure of the extracorporeal circulation during the operation. Another patient suffered from partial intestinal obstruction in the early postoperative period but was successfully treated. The underlying pathology was successfully corrected in the 8 surviving patients, whose blood pressure in the upper limbs was reduced while that in the lower limbs rose. Being easier to manage, the single-stage approach with extraanatomic bypass is safe and effective for managing this aortic complication.
Primary Surgical Repair of Ventricular Septal Defect
Authors: Demirag M Kemal , Keçeligil Hasan Tahsin , Kolbakir Fersat
Published: May 2013

Between January 1983 and December 2000, 78 patients underwent primary repair of a ventricular septal defect. There were 42 males (54%) and 36 females (46%) of whom 13 (17%) were under 1 year old, 50 (64%) were aged 1–10 years, 11 (14%) were aged 10–20 years, and 4 (5%) were over 20 years old. The ventricular septal defect was a perimembranous type in 60 patients (77%), subarterial (outlet) type in 10 (13%), and atrioventricular canal (inlet) type in 4 (5%). Operative repair was performed with a patch in all except 2 patients. Early postoperative complications included insignificant aortic regurgitation in 4 patients, persistent complete heart block in 1, and residual shunt in 4. There were 5 early deaths (6.4%) and 1 late death (1.8%) in 56 patients followed up. Early primary closure of ventricular septal defects, usually via a right atriotomy, can be performed with acceptable mortality and morbidity rates.
Accordion-Like Prosthesis for Modified Blalock-Taussig Shunt
Authors: Corno Antonio F , Hurni Michel , Tozzi Piergiorgio , von Segesser Ludwig K
Published: May 2013

From March 1996 to July 2002, 26 consecutive patients, with a mean age of 17.9 months and a mean body weight of 6.6 kg, underwent the modified Blalock-Taussig shunt with a tubular accordion-like prosthesis. In a mean follow-up period (defined as the interval between the shunt procedure and repair or last evaluation) of 10.9 months (range, 1 to 32 months), there were 1 death due to excessive pulmonary blood flow in a neonate with hypoplastic left heart syndrome and 3 reoperations to correct shunt-related problems, 2 of them early and 1 late (to regulate pulmonary blood flow after left ventricular retraining for transposition of the great arteries). There was no occurrence of shunt obstruction or kinking. Other shunt-related early complications, such as bleeding, infection, or serous fluid leakage, did not occur, and no patient needed pulmonary artery reconstruction during surgical repair. Shunt patency was confirmed by Doppler echocardiography in all patients and also by angiography in 73% of the patients. This prospective study confirmed our preliminary results with this prosthesis. The use of this prosthesis is justified for reducing early and late complications potentially associated with the modified Blalock-Taussig shunt, particularly distortion of the pulmonary arteries.
Combined Coronary Artery Bypass Grafting and Abdominal Aortic Aneurysm Repair
Authors: Ohuchi Hiroshi , Kato Masaaki , Asano Haruhiko , Tanabe Hiroaki , Ogiwara Masanori , Imanaka Kazuhito , Gojo Satoshi , Yokote Yuji , Kyo Shunei
Published: May 2013

The purpose of this paper was to assess the results and feasibility of simultaneous coronary artery bypass grafting and abdominal aortic aneurysm repair. Twenty nine patients with a mean age of 65 years underwent simultaneous coronary artery bypass grafting and abdominal aortic aneurysm repair between June 1990 and March 2002. All patients had significant coronary artery disease and were considered as indicated for coronary artery bypass grafting. This was performed first in 28 patients and simultaneously with abdominal aortic aneurysm repair in one, with a mean number of grafts of 2.5, a mean aortic cross-clamp time of 40 minutes, and a mean bypass time of 115 minutes. Eight straight and 21 bifurcated grafts were employed. The total operating time averaged 400 minutes. The median postoperative hospital stay was 18 days. One patient died of stroke and mediastinitis, for a mortality rate of 3.5%. This experience suggests that combined coronary artery bypass grafting and abdominal aortic aneurysm repair is both safe and effective.
One-Stage Repair of Cardiac and Arch Anomalies without Circulatory Arrest
Authors: Murthy Kona Samba , Coelho Robert , Roy Christopher , Kulkarni Snehal , Ninan Benjamin , Cherian Kotturathu Mammen
Published: May 2013

Between 1999 and 2002, 23 patients underwent single-stage complete repair of cardiac anomalies and aortic arch obstruction, without circulatory arrest. Median age was 1.2 years. Intracardiac defects included ventricular septal defect in 9, double-outlet right ventricle in 6, d-transposition of the great arteries and ventricular septal defect in 2, subaortic obstruction in 3, and atrial septal defect in 3. Fourteen patients had coarctation of the aorta, 6 had coarctation with hypoplastic aortic arch, and 3 had interrupted aortic arch. Simple techniques were employed such as cannulation of the ascending aorta near the innominate artery and maintaining cerebral and myocardial perfusion. After correction of arch obstruction, intracardiac repair was undertaken. The mean cardiopulmonary bypass time was 169 min, aortic crossclamp time was 51 min, and arch repair took 16 min. There was no operative mortality or neurological deficit. In follow-up of 1–43 months, no patient had residual coarctation. This simplified technique avoids additional procedures, reduces ischemic time, and prevents problems related to circulatory arrest.
Angioscopic Appearance and Histopathology of Coronary Artery Thrombi
Authors: Ohba Takayoshi , Hata Noritake , Ohaki Yoshiharu
Published: May 2013

A 70-year-old woman presented with acute coronary syndrome. Coronary angiography documented occlusion of the left circumflex coronary artery, and coronary angioscopy showed large red thrombi at the site of occlusion. These thrombi were aspirated using a RESCUE thrombectomy catheter, after which coronary flow was reestablished. Histological examination of the aspirated thrombi revealed platelets, irregularly intermingled erythrocytes, and a large number of leukocytes (mainly neutrophils); tissue resembling vascular endothelium also was present.
Atresia of Coronary Sinus Ostium with Coronary Venous Flow to Left Atrium
Authors: Bozbuğa Nilgün , Balkanay Mehmet , Taş Serpil , Erentug Vedat , Yakut Cevat
Published: May 2013

The rare cardiac anomaly of atresia of the coronary sinus ostium with a large communication between the coronary sinus and the left atrium was discovered during a mitral valve replacement operation in a 44-year-old woman.
Early Repolarization Pattern Occurring with the Wolff-Parkinson-White Syndrome
Authors: Poh Kian Keong , Low Adrian , Tan Huay Cheem , Chia Boon Lock
Published: May 2013

A 35-year-old male presented with the combined ECG abnormality of the early repolarization pattern and the Wolff-Parkinson-White syndrome. This has not been previously reported.
Posttraumatic Intrapancreatic Aortosplenic Fistula Causing Portal Hypertension
Authors: Estrada Òscar , Mestres Carlos-A , López-Boado Miguel-A , Salmerón Juan A , Visa José , García-Valdecasas Juan-Carlos
Published: May 2013

Arterioportal fistulas are uncommon. The case of a patient with massive uncontrollable esophageal variceal bleeding is presented. Reversible portal hypertension was caused by a posttraumatic giant intrapancreatic aortosplenic fistula. Percutaneous closure was unsuccessful, and pancreatectomy was performed to control the bleeding. The case is discussed and the literature on this exceptional cause of portal hypertension is reviewed.
Thymectomy for Myasthenia Gravis: 12-Year Experience
Authors: Singh Rana S , Behera Sukanta K , Saji Radhakrishnan , Dhaliwal Rajinder S
Published: May 2013

Thymectomy has been shown to be effective in the treatment of myasthenia gravis. The logical goal of operation is the complete removal of the thymus, but there is no consensus on the selection criteria of patients for surgery and the choice of surgical approach. We retrospectively reviewed 56 patients with myasthenia gravis who had been treated surgically by transsternal radical thymectomy between January 1990 and March 2002. The patients were symptomatically grouped according to the modified Osserman clinical classification. There was 1 hospital death, and 53 patients had been followed up for between 1 month and 12 years. Improvement after thymectomy was observed in 1 of 4 patients (25%) in Osserman group I, 25 of 34 patients (74%) in Osserman group IIA, and 16 of 18 patients (89%) in combined Osserman groups IIB and IIC. Transsternal radical thymectomy is an effective therapy for myasthenia gravis. Sustained improvement is achievable in female patients with moderate to severe symptoms and in patients with thymic hyperplasia.
Beneficial Effect of Aspirin on Renal Function Post-Cardiopulmonary Bypass
Authors: Gerrah Rabin , Izhar Uzi
Published: May 2013

Urine thromboxane, plasma creatinine, and creatinine clearance were determined perioperatively in 20 patients undergoing coronary bypass surgery. Ten patients took aspirin until the day of surgery, and 10 discontinued aspirin at least one week before surgery. A significant increase in urine thromboxane following establishment of cardiopulmonary bypass was observed only in the control group. Plasma creatinine increased in the control group on the 1st postoperative day (from 81.9 ± 13.2 to 97.6 ± 13.2 μmol·L−1, p = 0.02) and decreased next day to the preoperative level (82.7 ± 9 μmol·L−1, p = 0.03). In the aspirin group, creatinine remained unchanged on the 1st postoperative day (89.4 ± 14.2 vs. 87.2 ± 7.7 μmol·L−1, p = 0.6), and increased significantly on the 2nd day (101.4 ± 8.5 μmol·L−1, p = 0.01). The aspirin group had higher creatinine levels ( p < 0.0001) and lower creatinine clearance (60.2 ± 16.5 vs. 82 ± 25.7 mL·min−1, p < 0.0001) than the control group on the 2nd postoperative day. A significant positive correlation was seen between urine thromboxane and creatinine on day 2 in both groups (r = 0.6). Aspirin administrated before coronary surgery may have a beneficial effect on renal function, probably mediated by its antiplatelet activity and thromboxane inhibition.
Polyurethane Grafts: A Viable Alternative for Dialysis Arteriovenous Access?
Authors: Peng Chan Wearn , Tan Seck Guan
Published: May 2013

Polyurethane grafts, promoted for their self-sealing properties and low complication rates, were recently introduced for hemodialysis access. We review our experience with this graft material to determine its complication and patency rates. Between January 1995 and December 1999, 118 patients, 75 female and 43 male, with a mean age of 51 years, had a total of 163 polyurethane arteriovenous grafts inserted. The grafts were mostly 6 mm in diameter (69.3%), placed in a loop configuration (91.4%) in the forearm (49.7%). The median follow-up period was 12 months. The grafts were first cannulated for hemodialysis at a median time of 19 days after implantation, with 12% used within 3 days. Thrombosis and infection were the most common complications at rates of 32.7% and 30.0%, respectively. Infection was the most common cause of graft loss (61.5%). These complications were amenable to salvage intervention. The 1-year primary and secondary patency rates were 73% and 86%, respectively; the 3-year secondary patency rate, 72%. The 1-year serviceability rate was 64%. With satisfactory patency rates and the advantage of its self-sealing properties permitting early cannulation, polyurethane grafts provide a viable alternative for hemodialysis access. Early recognition and appropriate management of complications can prolong graft survival.
Surgical Repair of a Distal Arch Aneurysm with a Stent-Graft
Authors: Higuchi Kazuhiko , Koseni Kenzi , Hisaki Motoyuki , Kotsuka Yutaka , Takamoto Shinichi
Published: May 2013

This study evaluates the effectiveness and potential complications of stent-grafting for the treatment of distal arch aneurysms using profound hypothermia and circulatory arrest with retrograde cerebral perfusion. Between December 1998 and December 2001, 9 consecutive patients with a distal arch aneurysm (6 men and 3 women, mean age 71 years) underwent surgical repair using a stent-graft. Profound hypothermic circulatory arrest and retrograde cerebral perfusion were performed in all patients. Endovascular leakage was screened postoperatively using three-dimensional computerized tomography. The mean follow-up period was 27.4 months. Thirty day mortality was 0%. One patient died 3 months after stent-grafting due to proximal leakage into her aneurysm. The mean postoperative extubation period was 2.1 days. No patients suffered cerebral infarction or paraplegia. Although preliminary outcomes using this technique were good, endovascular leakage is a concern. We suggest that, if major proximal leakage is recognized postoperatively, re-intervention should be performed as soon as possible. Endovascular stent-grafting appears to be a good alternative treatment for distal arch aneurysms, although longer follow-up is necessary to more comprehensively evaluate this procedure.
Cardiac Anomalies in Turner Syndrome
Authors: Angeli Emanuela , Pacini Davide , Napoli Gabriella , Bartolomeo Roberto Di , Fattori Rossella , Pierangeli Angelo
Published: May 2013

This is the case of a 30-year-old woman with Turner Syndrome, with Mosaicism, exhibiting a bicuspid aortic valve with aortic stenosis, ascending aortic dilatation, pseudocoarctation of the aorta, left superior vena cava and lusoria subclavian artery. The successful surgical procedure consisted of the replacement of the aortic root and ascending aorta with a composite valved graft.
Repair of Ascending Aortic Aneurysm in a Patient with Fibrosarcoma over Sternum
Authors: Dayioglu Enver , Kalko Yusuf , Basaran Murat , Onursal Ertan
Published: May 2013

The combination of an ascending aortic aneurysm and suprasternal soft tissue tumor is rarely reported in the literature. This case involves a 62-year-old man diagnosed with an ascending aortic aneurysm and a fibrosarcoma over the sternum that was successfully treated by surgery. The patient underwent an aortic replacement operation with a Dacron graft and a muscle flap transposition procedure to cover the defect over the sternum.
Chylothorax following Coronary Bypass Grafting: Treatment by Talc Pleurodesis
Authors: Abid Qamar , Millner Russel W
Published: May 2013

Chylothorax after myocardial revascularization is a rare but serious complication. There is as yet no definitive treatment. We report a case in which chylothorax was diagnosed on the 3rd postoperative day. Conservative management with dietary restriction to medium-chain triglyceride led to reduction of chyle leakage from 300 to 400 mL/day to 50 to 60 mL/day 3 days later. However, the leak persisted until talc pleurodesis was performed.
Ascending Aorta-Abdominal Aorta Bypass for Takayasu's Arteritis
Authors: Ahn Hyuk , Hwang Ho Young
Published: May 2013

Three patients with type III Takayasu's arteritis were referred to us because of the upper extremity hypertension and vascular claudication of the lower extremities. They underwent extra-anatomic ascending aorta-abdominal aorta bypass with vascular graft under a median sternotomy and a splitted midline laparotomy incision without cardiopulmonary bypass. The postoperative course was uneventful. Upper extremity hypertension and vascular claudication were completely resolved.
Endoscopic-Assisted Atraumatic Coronary Artery Bypass
Authors: Vassiliades Thomas A
Published: May 2013

Minimally invasive operations designed to graft the left anterior descending coronary artery with the left internal mammary artery are either traumatic to the chest wall or technically difficult and expensive. This report describes a novel procedure that is less traumatic and simpler.
Suprahepatic Approach for Peritoneal Dialysis in Neonatal Cardiac Surgery
Authors: Kumar Dharmapuram Anil , Cartmill Timothy Boyd , Rao Ivatury Mrutyunjaya
Published: May 2013

For peritoneal dialysis of neonates after cardiac surgery under cardiopulmonary bypass, a Tenckhoff catheter was inserted via the sternotomy wound and guided suprahepatically into the abdomen. The technique was used in 84 neonates and found to be safe, simple, and reproducible.
Bleeding following Coronary Surgery after Preoperative Low-Molecular-Weight Heparin
Authors: Myhre Ulf , Stenseth Roar , Karevold Asbjørn , Bjella Lise , Lingaas Per Snorre , Olsen Per Olav , Haaverstad Rune , Kirkeby-Garstad Idar , Levang Olaf Walle
Published: May 2013

Low-molecular-weight heparin and acetyl salicylic acid have become an established treatment for unstable angina. A retrospective study on our database of one year was carried out to see what impact preoperative low-molecular-weight heparin versus none had on the postoperative course of 473 patients having coronary surgery exclusively. Apart from the fact that the low-molecular-weight heparin patients had a higher New York Heart Association classification and marginally more grafts, longer bypass and cross-clamp time, the preoperative characteristics and surgery of the two groups were similar. The low-molecular-weight heparin group had twice as many (9.7% versus 4.7%) re-operations for bleeding, 46% versus 26% had blood transfusion and 22.3% versus 12.6% plasma transfusion. The postoperative outcome was otherwise similar. Preoperative treatment of unstable angina with low-molecular-weight heparin carries a definite risk of postoperative bleeding. Although this study did not reveal any serious consequences, bleeding, transfusions and re-operations are associated with infections, wound healing problems and death. The indications and length of treatment with low-molecular-weight heparin in unstable angina patients have to be appropriate and the perioperative management of these patients has to address the bleeding tendency.
The Use of Autologous Pericardium for Complicated Mitral Valve Annulus
Authors: Güden Mustafa , Kazimoğlu Kamran , Sanisoğlu Ýlhan , Sağbaş Ertan , Yaman Reşit , Akpinar Belhhan
Published: May 2013

The study aims to discuss annular repair using the autologous pericardial patch in cases with severe mitral ring calcification and endocarditis during mitral valve replacement. In the study, annular reconstruction was applied, during mitral valve replacement, to 8 patients who had extensive annular calcification or annular destruction due to endocarditis. After annular resection, a two-centimeter wide autologous pericardial patch was sutured continuously to the left ventricular wall close to the posterior annulus. After the valve sutures with pledgets were placed at the back of the pericardial patch, the other edge of the patch was sutured continuously to the left atrial posterior wall. Suturing was complete after the whole annulus was encircled. Thereafter, an appropriately sized mechanical prosthesis valve was used. One patient died postoperatively due to low cardiac output (early mortality 12.5%). Echocardiographical paravalvular leakage was not detected in any of the cases during follow-up. Annular dehiscence and other annular pathologies were also not detected. This reconstructive approach may positively influence mortality and morbidity in cases with complicated mitral pathologies.
Open Fixation in Flail Chest: Review of 64 Patients
Authors: Balci Akin Eraslan , Eren Şevval , Çakir Ömer , Eren M Nesimi
Published: May 2013

The strategy for treatment of flail chest remains controversial. Various alternatives were assessed by reviewing the records of 64 patients treated from 1991 through 2000. Patients were classified according to therapeutic approach: group 1 was 27 patients who underwent open fixation of the fractured ribs, group 2 was 19 patients managed by intermittent positive-pressure ventilation, and group 3 was 18 patients managed mainly by synchronized intermittent mandatory ventilation. Two patients initially treated by ventilation underwent successful open fixation. In group 1, ventilatory support was required in 21 (77.8%) patients postoperatively, the mean duration of ventilation was 3.1 days, mean hospital stay was 18.3 days, morbidity was 11.1% (3/27), and mortality was 11.1%. In groups 2 and 3, the mean time for stabilization of paradoxical chest wall movement was 6.6 days, and mean duration of ventilation was 7.2 days. Mortality was 27.0% (10/37) in patients treated nonsurgically; 21.0% (4/19) in group 2, and 33.3% (6/18) in group 3. In groups 2 and 3, pain control required epidural analgesia in 13 (35.1%) cases, intercostal nerve blockade in 16 (43.2%), and narcotic or nonnarcotic parenteral analgesia in 8 (21.6%). Open fixation is a successful treatment modality for traumatic flail chest.
Interlocking Sternotomy: Initial Experience
Authors: Joshi Raja , Abraham Smartin , Kumar Arkalgud Sampath
Published: May 2013

An interlocking sternotomy using a lazy-S-shaped incision was performed in 91 patients undergoing cardiac surgical procedures (group A). The results were compared with those of 77 patients (group B) who underwent a standard sternotomy by the same surgical team. In group A, the incidence of sternal instability was 2.27% (2/88) versus 8.21% (6/73). No dehiscence or mediastinitis was noted in group A, whereas 6.85% (5/73) in group B had this complication. Analysis of diabetics revealed no sternal complication in group A compared to 50% (3/6) in group B. The interlocking sternotomy significantly reduced the incidence of sternal instability and helped to prevent sternal dehiscence and mediastinitis. Use of this safe, simple, and reproducible technique is strongly recommended, especially in diabetics.
Application of Mechanical Dilatation of the Pyloric Sphincter in Esophagectomy for Esophageal Carcinoma
Authors: Wang Yong-Qing , Ye Wei-Wen , Lu Tao , Zhang Wei-Ming , Xu Yong
Published: May 2013

The objective of this study was to investigate the effectiveness of additional intraoperative mechanical dilatation of the pyloric sphincter in order to prevent early postoperative gastric retention after esophagectomy using the stomach as substitute for esophageal carcinoma patients. Between October 2001 and May 2002, 32 consecutive esophageal carcinoma patients were treated with esophagectomy combined with additional intraoperative mechanical dilatation of pyloric sphincter (trial group). Another 30 patients underwent esophagectomy without additional intraoperative mechanical dilatation of the pyloric sphincter (control group). Both groups were compared in the following aspects: amount of postoperative GI drainage, time of flatus, intrathoracic gastric fluid retention and other surgical related complications. The amount of GI drainage in the trial group was significantly less than that in the control group ( p < 0.05), and time of anal exsufflation was 1 to 2 days. X-ray demonstrated only 0 to 25% of intrathoracic gastric fluid retention and no related complications such as anastomotic leakage, so the patients in the trial group suffered less gastric reflux. Additional intraoperative mechanical dilatation of the pyloric sphincter in radical esophagectomy can accelerate gastric emptying, the recovery of gastric-intestinal function and obviously decrease the occurrence of early postoperative gastric retention and related complications. This method does have the advantages of ease of performance, confirmed effectiveness and safety. It can be utilized in radical esophagectomy through any approach of thoracotomy.
Multivessel Total Arterial Revascularization via Left Thoracotomy
Authors: Singh Sushil Kumar , Mishra Surya Kumar , Kumar Deepak , Yadave Ram Deo , Sinha Subhash Kumar
Published: May 2013

Off-pump coronary artery bypass grafting is now becoming the preferred method of coronary revascularization. The trend is towards complete revascularization, preferably arterial. We are describing here a method of multivessel, total arterial, complete revascularization via an anterolateral thoracotomy approach in 27 patients. There was an average of 3.2 grafts/patient. Angiograms were performed in 9 patients (33.33 %). There were no operative mortalities. None of the patients required conversion to cardiopulmonary bypass or midsternotomy.
Clinical Implication of Atrial and Brain Natriuretic Peptide in Coronary Artery Bypass Grafting
Authors: Song Min-Ho , Kobayashi Yoshie , Michi Hiroyasu
Published: May 2013

Atrial natriuretic peptide and brain natriuretic peptide are known to be indices for heart failure. Atrial natriuretic peptide and brain natriuretic peptide changes in off-pump and on-pump coronary artery bypass grafting is hypothesized to be correlated to clinical implications of coronary artery bypass grafting. 20 consecutive off-pump and 20 consecutive on-pump coronary artery bypass grafting patients were studied. Perioperative atrial natriuretic peptide and brain natriuretic peptide values were measured and statistically analyzed in terms of 14 factors related to myocardial damage and recovery. Postoperative atrial natriuretic peptide plateaued on the third postoperative day and it decreased gradually down to the preoperative level by one month in the off-pump group. Postoperative brain natriuretic peptide plateaued, showed very slow decrease and it never reached down to the preoperative level. The peak brain natriuretic peptide level was correlated with aortic cross-clamp time, postoperative pleural effusion, and postoperative atrial fibrillation ( p < 0.01). The atrial natriuretic peptide change reflected surgical prevention of ventricular remodeling. Brain natriuretic peptide > 450 μg·mL−1 had strong predictive power for atrial fibrillation and pleural effusion and is a useful marker for management of coronary surgery patients.
Activated Clotting Time during Cardiopulmonary Bypass: Is Repetition Necessary during Open Heart Surgery?
Authors: Neema Praveen Kumar , Sinha Prabhat Kumar , Rathod Ramesh Chandra
Published: May 2013

We evaluated the need of activated clotting time monitoring and efficacy of heparinization protocol in 100 patients undergoing open heart surgery. Patients were anticoagulated with 300 or 400 units·kg−1 heparin, based on their heparin sensitivity assessed at 5 min by activated clotting time. One-third of the initial dose was repeated at 90 min and thereafter hourly until completion of cardiopulmonary bypass. Patients who attained an activated clotting time of > 350 seconds at 5 min were included. Activated clotting time was repeated every 30 min. A time of < 350 seconds or presence of clot in the surgical field/extracorporeal circuit was considered failure of the protocol. Cardiopulmonary bypass was performed using a membrane oxygenator, non-pulsatile flow, hypothermia and crystalloid/blood priming solution. At 5 min, 94 patients had activated clotting time of > 350 seconds, 6 were < 350 seconds. At predetermined time intervals of 30 min, up to 210 min, 406 activated clotting time measurements were above 400 seconds and 40 were between 350 and 400 seconds. No clot was observed in the surgical field or extracorporeal circuit. This anticoagulation protocol ensures adequate anticoagulation during hypothermic cardiopulmonary bypass. With this protocol, only one activated clotting time at 5 min after heparin administration is required and essential; subsequent monitoring is not necessary.
Assessment Based on EuroSCORE of Ministernotomy for Aortic Valve Replacement
Authors: De Smet Jean-Marie , Rondelet Benoît , Jansens Jean-Luc , Antoine Martine , De Cannière Didier , Le Clerc Jean-Louis
Published: May 2013

To assess the advantages of a ministernotomy over a standard sternotomy for aortic valve replacement, 191 patients were classified as low-, medium-, and high-risk by EuroSCORE. A ministernotomy was carried out in 100 patients, and a standard sternotomy was used in 91. Among low-risk patients, those who had a ministernotomy showed a marginal increase in atrial fibrillation. Of the medium-risk patients, those who had a sternotomy had significantly more atrial fibrillation and slightly more general infections. In the high-risk subgroup, significantly more atrial fibrillation was observed in the sternotomy group, and more neurologic events were observed in the ministernotomy group; the difference became nonsignificant when only severe events were considered. There was a significant benefit in terms of rhythm disturbances in medium- and high-risk patients who underwent a ministernotomy compared to those who had a full sternotomy. Mortality, duration of intensive care, and hospital stay were not influenced by the operative method.
Lung Perfusion with Oxygenated Blood during Aortic Clamping Prevents Lung Injury
Authors: Zheng Jing-Hao , Xu Zhi-Wei , Wang Wei , Jiang Zhu-Ming , Yu Xiao-Qing , Su Zhao-Kang , Ding Wen-Xiang
Published: May 2013

To evaluate the protective effect of continuous pulmonary perfusion with oxygenated blood during aortic crossclamping, 12 mixed-breed piglets (7–12 kg) were placed on cardiopulmonary bypass for 130 minutes. An experiment group of 6 (group E) had continuous pulmonary perfusion with oxygenated blood during cardiopulmonary bypass, while the other 6 served as controls (group C). Pulmonary function was measured at the beginning and end of cardiopulmonary bypass and one hour later. Histology was compared before and after cardiopulmonary bypass. Pulmonary function after cardiopulmonary bypass was significantly better in group E than group C. There was preservation of the normal pulmonary parenchyma in group E, whereas group C had marked intra-alveolar edema and abundant intra-alveolar neutrophils. Anoxia of lung tissue during aortic crossclamping on cardiopulmonary bypass is probably the major factor in lung injury. Continuous pulmonary perfusion was effective in preventing lung injury during aortic crossclamping.
Limiting Pericardial Adhesions after Coronary Artery Bypass: Experimental Study
Authors: Saha Kamalas , McEwan Winston , Frizelle Frank A , Singh Harsh
Published: May 2013

Retrosternal pericardial adhesion formation constitutes a major hazard during re-do coronary artery surgery. To determine whether an onlay parietal pleural flap over the internal thoracic artery bed would reduce pericardial adhesions after coronary artery grafting, 16 sheep underwent a median sternotomy and both internal thoracic arteries were harvested. On the randomly selected study side, a dissected pleural flap was used to cover the internal thoracic artery bed, the opposite side was left uncovered as a control. Half of the sheep were sacrificed at a median of 102 days (range, 93–109 days), the remainder at a median of 176 days (range, 165–183 days). Two independent observers blinded to the initial operation scored the degree of postoperative adhesions. There was a significant decrease in adhesion formation on the study side covered by the mobilized pleural flap, compared to the control side. There were no increases in pulmonary morbidity or sternotomy wound problems from raising the lateral pleural flap. This simple technique appears to be an effective method of preventing adhesion formation following coronary artery bypass grafting utilizing the internal thoracic artery.
Elective Video-Assisted Thoracoscopic Lung Biopsy for Interstitial Lung Disease
Authors: Yamaguchi Masafumi , Yoshino Ichiro , Suemitsu Ryuichi , Osoegawa Atsushi , Kameyama Toshifumi , Tagawa Tetsuzo , Fukuyama Seiichi , Maehara Yoshihiko
Published: May 2013

Lung biopsy is often required for the definitive subtype classification of interstitial lung disease. The video-assisted thoracoscopic approach has been advocated as an alternative to standard open lung biopsy because it is less invasive; however, whether it makes a positive contribution to treatment strategy remains contentious. We investigated the safety and efficacy of the video-assisted approach in a retrospective review of 30 consecutive patients who underwent the procedure in an elective setting after being diagnosed with interstitial lung disease by chest radiography and computed tomography. The mean age of the patients was 56.7 years. The preoperative vital capacity and forced expiratory volume in 1 second were 80.0% and 83.6%, respectively. There was no operative mortality, but 2 cases of respiratory failure and 1 of prolonged air leak occurred. The diagnostic yield was 100%, and treatment was changed in 57% of the cases as a result of the histological diagnosis. The rate of treatment change was higher for patients with nonspecific interstitial pneumonia than for those with idiopathic pulmonary fibrosis. We conclude that video-assisted biopsy is effective in the subtyping of interstitial lung disease and is a safe procedure when performed electively at the early stage of the disease.
Extensive Thoracoabdominal Aortic Aneurysm Repair Using Deep Hypothermic Bypass and Circulatory Arrest
Authors: Nishi Hiroyuki , Miyamoto Satoru , Minamimura Hirokazu , Ishikawa Takumi , Kato Yasuyuki , Arimoto Hideki , Ohue Kensuke , Shimizu Yoshihiro
Published: May 2013

We sought to evaluate the safety and usefulness of deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest for extensive thoracoabdominal aortic aneurysms. Between March 1994 and December 2002, 17 patients with Crawford type I and II were reviewed retrospectively. The patients were divided into two groups: group H (hypothermic circulatory arrest, n = 8) and group N (normothermic cardiopulmonary bypass, n = 9). In group H, in-hospital mortality was 12.5%, and that in group N was 11.1%. Operation times were similar between the two groups though the cardiopulmonary bypass time was significantly shorter in group N than in group H ( p < 0.05). Postoperative paraplegia occurred in 1 patient of group N. Postoperative renal dysfunction occurred in none of group H except in 1 preoperative dialysis case, whilst it occurred in 6 patients of group N. Postoperative creatinine levels were significantly higher in group N than in group H. Three cases in group H required tracheostomy. Our experience with hypothermic cardiopulmonary bypass and circulatory arrest for diffuse type thoracoabdominal aortic aneurysm confirms the safety and efficacy of this technique. Although respiratory complications remain a problem, the technique is considered to be effective for renal protection.
Fungal Endocarditis: An Autopsy Study
Authors: Challa Sundaram , Prayaga Aruna Kumari , Vemu Laxmi , Sadasivan Jaishankar , Jagarlapudi Murali Krishna Murthy , Digumarti Raghunadharao , Prabhala Rajagopal
Published: May 2013

Between 1990 and 2002, 237 hearts were examined at autopsy, including 16 with infective endocarditis; 6 showed fungal endocarditis. The preceding pathology was chronic rheumatic heart disease in 2 patients, one of whom had undergone double valve replacement, 2 patients had been treated for acute lymphoblastic leukemia, and one had protein-energy malnutrition. The underlying cause was unknown in one case. The organisms isolated were Aspergillus in 3 patients, Zygomycota in 1, Candida in 1, and both Candida tropicalis and Aspergillus in 1 patient. Immunosuppressed states are a cause of fungal endocarditis in India, although chronic rheumatic heart disease is the preceding pathology in the majority of patients.
Clinical Application of Bidirectional Glenn Shunt with Off-Pump Technique
Authors: Luo Xin-Jin , Yan Jun , Wu Qing-Yu , Yang Ke-Ming , Xu Jian-Ping , Liu Ying-Long
Published: May 2013

A study was conducted to evaluate the outcomes of the bidirectional Glenn shunt technique performed off-pump. Between April 1999 and April 2001, 36 patients underwent bidirectional Glenn shunt, unilateral in 28 patients and bilateral in 8 patients, without using cardiopulmonary bypass. The patients consisted of 25 males and 11 females with a mean age of 5.7 ± 5.4 years and a mean body surface area of 0.72 ± 0.34 m2. Preoperative percutaneous oxygen saturation was 75% ± 7%, and pulmonary arterial pressure was 14.3 ± 3.6 mmHg. There was no operative mortality. Chylothorax occurred in 1 patient in the early postoperative period. All the other patients were discharged without complications. Mean arterial oxygen saturation at discharge was 92.7% ± 4.0%. This shunt technique is easy to perform and is helpful in the early management of patients with a functionally univentricular heart. However, much remains to be learned about this unusual physiological system.
Human Leukocyte Antigens in Hypertrophic Cardiomyopathy Patients in South India
Authors: Shankarkumar Umapathy , Pitchappan Ramasamy , Pethaperumal Srinivasan
Published: May 2013

Hypertrophic cardiomyopathy is characterized by massive ventricular hypertrophy, reduced diastolic function, and excessive ventricular contraction. The human leukocyte antigens HLA-A, HLA-B, and HLA-DR were studied in 14 hypertrophic cardiomyopathy patients with left ventricular obstruction from South India. They were compared with 81 normal age- and sex-matched individuals from the same ethnic background. The human leucocyte antigens were identified using the standard serological assay with a longer incubation for DR antigens. The odds ratio, frequency, chi-squared value, p-value, etiological fraction, preventive fraction, and haplotype frequency estimates were calculated. The HLA-B51 and HLA-DR2 levels were significantly increased in hypertrophic cardiomyopathy patients compared to controls, whereas HLA-A19, HLA-B7, and HLA-DR4 were decreased when compared to the controls. It was noticed that haplotype B51-DR2-DQ3 was significantly associated with hypertrophic cardiomyopathy patients from South India. Hypertrophic cardiomyopathy may be associated with genes in the human leukocyte antigen region, and immunogenetic factors linked to human leukocyte antigens appear to play a major role in the pathogenesis.
Partial Cardiac Autotransplantation for Reduction of the Left Atrium
Authors: Erdoğan Hasan B , Kirali Kaan , Ömeroğlu Suat N , Göksedef Deniz , Işik Ömer , Yakut Cevat
Published: May 2013

Various surgical procedures have been employed to treat a greatly enlarged left atrium. We review the use of partial cardiac autotransplantation to reduce left atrial volume in 7 patients with rheumatic mitral valve disease and left atrial and ventricular volume in 2 patients with idiopathic dilated cardiomyopathy. There were 5 males and 4 females aged 25 to 62 years. The patients with rheumatic etiology had atrial fibrillation, while those with dilated cardiomyopathy had sinus rhythm. The mitral valve was replaced in 6 patients and reconstructed in 3. Mean aortic cross clamp time in the operations involving isolated left atrial resection was 119 ± 44 min. Mean left atrial volume fell from 331 mL to 92 mL, while mean left atrial diameter decreased from 8.6 cm to 4.7 cm. Sinus rhythm was restored in 5 of the 7 patients who had preoperative atrial fibrillation. There was no operative mortality. The patients with dilated cardiomyopathy died in the postoperative period, one on the 14th day from low cardiac output and the other on the 113th day from multiorgan failure. Partial cardiac autotransplantation can be effective in reducing heart chamber size in selected patients, especially those with giant left atrium.
Hyperkalemic Blood versus Crystalloid Cardioplegia in Longer Clamping Times
Authors: Albert Alexander A , Arnrich Bert , Walter Jörg A , Hassanein Wael M , Rosendahl Ulrich P , Gehle Petra , Schön Frank , Ennker Jürgen
Published: May 2013

The 715 patients who had crystalloid cardioplegia were compared with 5419 who had cold hyperkalemic blood cardioplegia for isolated coronary artery grafting from 1996 through 2001. Creatine kinase-MB was measured preoperatively, at 90 min, and 7 hours after the end of extracorporeal circulation. Correlation of post-bypass creatine kinase-MB release with aortic crossclamp time and other variables in the two cardioplegia groups was made using dichotomous encoding of cardioplegia in a multivariate linear regression model. Creatine kinase-MB levels 90 min after bypass were higher in patients who had crystalloid cardioplegia than in those who had blood cardioplegia. There was a linear relationship between aortic crossclamp time and post-bypass creatine kinase-MB release in both cardioplegia groups. Post-bypass creatine kinase-MB release increased with aortic crossclamp time independently of other factors and significantly more with crystalloid cardioplegia than with blood cardioplegia (the slope of the regression line was 0.230 versus 0.106). Intraaortic balloon pumping was used less frequently in the blood cardioplegia group. There was an advantage with blood cardioplegia for myocardial protection in longer aortic crossclamp times for isolated coronary bypass grafting.
Echocardiographic Evaluation of Internal Mammary Artery Graft Patency
Authors: Song Min-Ho , Ito Mamoru , Toki Sachie , Tanaka Keisuke , Kato Wataru , Iwase Jinichi , Tajima Kazuyoshi
Published: May 2013

The feasibility of using transthoracic echocardiography to assess internal mammary artery graft patency and function was examined. Coronary angiography and transthoracic echocardiography was performed in 60 consecutive patients undergoing coronary artery bypass from April 2000 to March 2002. Flow velocity, velocity-time integral, and the ratio of the diastolic fraction of the velocity-time integral to total velocity-time integral were measured by doppler transthoracic echocardiography. A stress test was carried out to detect coronary flow changes by echocardiography. The relationship between the coronary angiogram and the echocardiogram was analyzed. The overall graft patency rate was 98%. The mean diastolic velocity-time integral in patients with patent grafts was 0.64, and it increased up to 0.72 in response to physical stress. The occluded grafts showed diastolic velocity-time integral fractions of less than 0.60 in all grafts. There was a statistical correlation between patency ≥ FitzGibbon grade B and diastolic velocity-time integral > 0.60. The diastolic velocity-time integral recorded by transthoracic echocardiography predicted the patency of internal mammary artery grafts. As echocardiography is noninvasive and accurate, it might be a useful method of verifying arterial graft patency.
Surgical Treatment of Coronary Artery Fistulas: 15 Years' Experience
Authors: Demirkilic Ufuk , Ozal Ertugrul , Bingol Hakan , Cingoz Faruk , Gunay Celalettin , Doganci Suat , Kuralay Erkan , Tatar Harun
Published: May 2013

We report our experience of surgical treatment of coronary artery fistula and focus on the electrocardiographic changes that may be seen postoperatively. Between 1988 and 2003, cardiac operations were carried out on 9,487 patients, of whom 21 had a coronary artery fistula. The mean age of these 21 patients was 36.8 ± 4.9 years. The fistula originated from the right coronary artery in 9 cases and from the left side in 12. The fistulous connection was to the right ventricle in 5 patients, to the right atrium in 6, to the pulmonary artery in 8, and to the coronary sinus in 2. There was no operative mortality. Two patients (10%) had nonspecific electrocardiographic changes during the postoperative period. Repeat coronary angiography revealed normal coronary anatomy in both, and their electrocardiograms normalized within 2 months. Patients suspected to have myocardial ischemia related to the surgical procedure, with ST segment depression or T wave abnormalities on the electrocardiogram, should undergo repeat angiography to eliminate the possibility of coronary artery damage.
Delayed Cardiac Tamponade after Penetrating Thoracic Trauma
Authors: Rendón Felipe , Danés Luis H Gómez , Castro Mario
Published: May 2013

Acute cardiac tamponade is very common after penetrating injuries to the chest. However, delayed cardiac tamponade is a rare phenomenon that may appear several days after injury. This paper presents three cases of delayed cardiac tamponade diagnosed weeks after ice pick wounds to the back. These experiences and a review of the literature on the subject are discussed.
Tricuspid Valve Replacement: Bioprosthetic or Mechanical Valve?
Authors: Solomon Neville A G , Lim Remy C H , Nand Parma , Graham Kenneth J
Published: May 2013

Significant morbidity and mortality is associated with tricuspid valve replacement, and controversy still exists as to the ideal prosthesis in this position. This study aimed to identify the risk factors for low cardiac output and mortality, and whether bioprosthetic or mechanical valves perform better in the tricuspid position. Results of 121 tricuspid valve replacements in 104 patients between January 1966 and December 2002 were reviewed. Most patients were in New York Heart Association functional class III or IV. Perioperative mortality was 19%. On multivariate analysis, age and preoperative jaundice were significant predictors of low cardiac output; age, jaundice, atrial fibrillation, and bypass time were significant predictors of mortality. Mechanical valves were significantly more prone to thromboembolism, whereas bioprostheses suffered structural valve deterioration. There were no significant differences in anticoagulation or bleeding episodes between the two groups, nor in valve-related events, deaths, and long term survival. There was no significant difference in performance so as to recommend one type over the other, but bioprosthetic valves may be more favorable as they fail predictably.
Double Outlet Left Ventricle, Transposition of Great Vessels and Pulmonary Stenosis
Authors: Shanmugam Ganesh , Pollock James , Macarthur Kenneth
Published: May 2013

A 4 year-old boy with double outlet left ventricle, transposition of the great vessels, severe pulmonary and subpulmonary stenosis, and subaortic ventricular septal defect underwent successful surgical intervention. The surgical techniques and management plan for double-outlet left ventricle are reviewed.
Actinomycosis: An Often Forgotten Diagnosis
Authors: Wong Randolph HL , Sihoe Alan DL , Thung KH , Wan Innes YP , Ip Margaret BY , Yim Anthony PC
Published: May 2013

We report a case of actinomycosis presenting as a chest wall mass in a 35 year-old man. Thoracic actinomycosis poses a diagnostic challenge to clinicians not only because it is uncommon and often forgotten, but also because culture of the causative microbes is technically difficult. The classic microscopic appearance of this Gram-positive bacteria associated with surrounding sulfur granules often forms the basis of diagnosis.