bluuebunny/crossref_metadata_2025 huggingface dataset:
Alveolar Capillary Dysplasia with Congenital Misalignment of Pulmonary Vessels
Authors: Sihoe Alan DL , Lee Alex TH , To Ka-Fai , Thung Kin-Hoi , Lee Tak-Wai , Yim Anthony PC
Published: May 2013

Alveolar capillary dysplasia with misalignment of pulmonary vessels is an uncommon congenital cause of persistent pulmonary hypertension of the newborn. It is universally fatal, and diagnosis is entirely dependent upon surgical lung biopsy. We present a case of alveolar capillary dysplasia with misalignment of pulmonary vessels occurring in a full-term neonate, emphasizing that early involvement of the thoracic surgeon for a histological diagnosis allows expensive and ineffective treatments to be avoided.
Thoracic-Abdominal Approach in Primary Pulmonary Synovial Sarcoma
Authors: Zonta Sandro , Lovisetto Federico , Morbini Patrizia , Cobianchi Lorenzo , Nazari Stefano
Published: May 2013

We report a case of primary synovial sarcoma of the lung. The patient was a 32-year-old male who presented with a mass in the right hemithorax invading the peritoneal cavity. The neoplasm was resected through a thoracic-abdominal approach. The patient is doing well 21 months after surgery. Within the last decade thoracic localizations of synovial sarcoma are an emerging histopathological entity thanks to the molecular analysis of the SYT-SSX fusion gene transcript.
Late Pulmonary Valve Implantation after Repair of Tetralogy of Fallot
Authors: Yin Shengli , Salazar Jorge , Nolke Lars , Azakie Anthony , Karl Tom R
Published: May 2013

Ten cases of elective late pulmonary valve implantation after repair of tetralogy of Fallot were reviewed. The interval after initial repair ranged from 1.5 to 43 years (mean, 20.0 ± 12.3 years). There was no hospital mortality or late death during a mean follow-up of 12.5 months. Preoperatively, 9 patients were in New York Heart Association functional class III–IV; after pulmonary valve implantation, all 10 patients were in class I–II (average improvement, 1.7 classes). Left ventricular ejection fraction improved significantly (from 62.1% ± 4.7% to 70.2% ± 4.9%), as did fractional shortening (from 34.0% ± 5.0% to 40.0% ± 4.2%). Right ventricular diameter decreased significantly (from 32.3 ± 7.5 to 24.4 ± 5.4 mm). QRS duration decreased significantly (155.2 ± 27.1 vs. 140.0 ± 21.2 msec), but there was no significant difference in QT interval (460.9 ± 29.6 vs. 451.9 ± 50.6 msec). Hospital stay was 4–7 days. One patient had preoperative ventricular fibrillation requiring resuscitation and an implantable cardiac defibrillator; another needed a defibrillator at the time of pulmonary valve implantation, because of ventricular arrhythmias. It was concluded that late pulmonary valve implantation after tetralogy of Fallot repair had significant benefits and carried low operative risk.
Aortic Valve Replacement with Toronto SPV in Elderly Patients: 10-Year Results
Authors: Tamim Muhammed , Bové Thierry , Van Belleghem Yves , Caes Frank , François Katrien , Van Nooten Guido J
Published: May 2013

A retrospective assessment of clinical and echocardiographic variables was performed in 145 patients who received a Toronto SPV aortic valve replacement. The majority (90%) of these elderly patients (mean age, 75.5 ± 7.4 years) were preoperatively in New York Heart Association class III–IV. Operative mortality was 4.8%. Follow-up was complete up to 10 years and revealed few valve-related complications: thromboembolism (7), bleeding (4), and prosthesis dysfunction necessitating reoperation (3). Late mortality was cardiac-related in 11.7% and noncardiac-related in 17.2%. Actuarial survival was 83% at 5 years and 63% at 8 years. Echocardiography showed low transvalvular gradients (peak, 17.5 ± 7.5 mm Hg; mean, 9.2 ± 4.2 mm Hg) resulting in a significant reduction in left ventricular mass index during the first 3 years. Independent of the transprosthetic gradient, left ventricular mass index tended to increase again beyond the 5th year, which correlated positively with the presence of arterial hypertension in this older population. The Toronto SPV bioprosthesis offers an aortic valve substitute with excellent long-term hemodynamics, resulting in significant early left ventricular mass regression. Considering the limitations of this selected elderly population, the clinical outcome and survival up to 10 years are encouraging, with few observed valve-related events.
Rearrangement of T-Cell Receptor Beta and Gamma Genes in Thymoma
Authors: Nakajima Jun , Matsumoto Jun , Takeuchi Eriho , Fukami Takeshi , Takamoto Shinichi
Published: May 2013

To investigate the differentiation stage of tumor-infiltrating lymphocytes in thymoma tissue, we performed Southern blot analysis of T-cell receptor beta and gamma genes in thymomas resected from 19 patients. At the same time, we conducted flow cytometric analysis of T-cell surface markers and examined the clinicopathological features of the thymomas. We found that the incidence of T-cell receptor gamma gene rearrangement was significantly higher in Masaoka stage I thymomas (11 of 12 cases) than in stage II or III invasive thymomas (3 of 7 cases). Moreover, gamma gene rearrangement was observed in all 10 type AB and B1 thymoma specimens and in 4 of 6 type B2 thymoma specimens. The 2 specimens of type B3 thymomas, which were classified as stage III, showed neither gamma nor beta gene arrangement and were single-positive for CD4 or CD8. Six thymoma specimens that showed beta gene rearrangement expressed both CD4 and CD8. In conclusion, thymomas have the capability of T-lineage cell differentiation, except for a subset of invasive thymomas with malignant characteristics.
Renin-Angiotensin System Polymorphisms and Coronary Artery Surgery Patients
Authors: Ozisik Kanat , Misirlioglu Muge , Ulus Tulga A , Tuncer Serdar , Emir Mustafa , Katircioglu Fehmi
Published: May 2013

The frequencies of angiotensin-converting enzyme gene insertion/deletion, angiotensinogen-M253T, and angiotensin II type 1 receptor-A1166C polymorphisms were analyzed in 105 patients undergoing coronary artery bypass grafting (group 1) and a control group of 105 non-cardiac patients (group 2). Blood samples were obtained for biochemical analyses and DNA extraction. Genotyping was performed by polymerase-chain-reaction-based restriction analysis. According to the angiotensin-converting enzyme gene insertion/deletion polymorphism, 36.3% of patients in group 1 and 30.7% in group 2 were homozygous for the DD allele. This difference was not statistically significant. Angiotensin II type 1 receptor-A1166C genotype polymorphism was also not significantly different between the groups. The results showed the angiotensinogen-M235T polymorphism to be heterogenous. The MM homozygote frequency was significantly higher in controls (72.3%), whereas 80% of the TT homozygote frequency was in the surgical group ( p = 0.001). These results show that although there were no significant differences in angiotensin-converting enzyme gene insertion/deletion and angiotensin II type 1 receptor-A1166C genotype polymorphisms between the groups, angiotensinogen-M235T polymorphism of TT homozygote frequency was significantly associated with patients undergoing coronary artery bypass surgery.
Acute Myocardial Infarction in the First Trimester of Pregnancy
Authors: Salam Amar M
Published: May 2013

Acute myocardial infarction rarely occurs in women during pregnancy. However, when it does occur, it usually carries a high risk of maternal and perinatal mortality. There is a lack of awareness that this condition can occur in pregnancy since coronary artery disease is uncommon in women of childbearing age. In this report, a 43-year-old lady with acute anterior myocardial infarction in her eighth week of pregnancy is presented. The challenges involved in diagnosing this condition in pregnancy are briefly discussed.
Myocardial Ischemia after Cabrol Operation
Authors: Çetin Gürkan , Özkara Ahmet , Tireli Emin , Köner Özge , Süzer Kaya
Published: May 2013

A 33-year-old woman who had undergone a Cabrol-type aortic root replacement for acute aortic dissection during labor 27 months ago was admitted with chest pain. Electron-beam tomography and coronary angiography showed stenosis at the level of the anastomosis. Urgent coronary revascularization was performed using bilateral internal mammary artery grafts. Although graft occlusion after the Cabrol procedure is an infrequent complication, it should be considered during follow-up.
Early Results of Anatomic Repair in a Subgroup of Corrected Transposition
Authors: Subtaweesin Thaworn , Sriyoschati Somchai
Published: May 2013

The atrial switch operation with the Rastelli procedure is becoming popular for treatment of the subgroup of corrected transposition of the great arteries with ventricular septal defect and pulmonary obstruction. This technique eliminates the problem of short- and long-term right ventricular failure, and decreases the incidence of iatrogenic atrioventricular heart block. Between April 2001 and November 2002, this technique was used in 3 patients aged 5 to 7 years. Two had a Senning operation and one had a Mustard operation. There was no operative death. The first patient needed re-operation to close the sternum. The last patient was re-explored for bleeding. All patients were in New York Heart Association functional class I at their last follow-up. The atrial switch plus Rastelli procedure is feasible in this subgroup of corrected transposition, but longer follow-up is necessary to determine whether this approach is indeed warranted.
Conservative Management of Postsurgical Chylothorax with Octreotide
Authors: Gómez-Caro Abel A , Diez Moradiellos Francisco J , Marrón Carmen F , Cabrero Larrú Emilio J , de Nicolás Martín José L
Published: May 2013

Postsurgical chylothorax after lung resection has an important associated rate of morbidity and mortality, and a large proportion of cases require re-exploration. The most desirable and least aggressive option is conservative treatment. The use of octreotide seems to be associated with a higher rate of resolution without the need for surgical intervention. We present 4 cases in which this drug showed excellent efficacy and minimal adverse effects in the resolution of postsurgical chylothorax.
Concomitant Aortoaxillary Bypass and Coronary Artery Bypass Grafting
Authors: Inoue Takehiro , Saga Toshihiko
Published: May 2013

The optimal revascularization strategy for patients with subclavian and coronary artery disease has not been established. This study assessed the mid-term clinical outcome of concomitant aortoaxillary bypass and coronary artery bypass grafting in 5 patients. A ring-reinforced polytetrafluoroethylene graft was attached to the ascending aorta and led to the proximal segment of the axillary artery via the pleural cavity. Patients were followed up for 2–10 years (mean, 5.4 ± 3.4 years). Postoperative aortography and angiography demonstrated patent aortoaxillary and coronary bypass grafts in the short-term follow-up of all patients. Two patients with Takayasu aortitis needed re-operations for recurrent angina and annuloaortic dilatation. Another patient required removal of the aortoaxillary bypass graft because of infection, and subsequently underwent a left femoroaxillary bypass one year after the original procedure. Subclavian steal phenomenon did not occur. Aortoaxillary bypass with coronary artery bypass may be an effective option for patients with co-existing subclavian and coronary artery disease.
Effect of Chordal Preservation on Left Ventricular Function
Authors: Muthialu Nagarajan , Varma Shashi K , Ramanathan Sundar , Padmanabhan Chandrasekar , Rao K Madhusudana , Srinivasan Muralidharan
Published: May 2013

Chordopapillary apparatus preservation was compared with valve-excising mitral valve replacement in a retrospective analysis of 360 patients, of whom 98 had total or partial chordal preservation and 262 had the conventional operation. No significant differences were seen in age, sex, pathology, crossclamp or cardiopulmonary bypass times between the 3 groups. Left ventricular fractional shortening decreased significantly in patients whose valves had been excised completely, whereas it remained unchanged in patients with either partial or total chordal conservation. There was a survival benefit for patients undergoing leaflet preservation (92% vs. 80% for conventional excision at 5 years; p = 0.001). Chordal preservation during valve replacement for mitral valve disease improves survival, enhances functional status, preserves left ventricular geometry and function, and improves overall cardiac performance. Preservation of the posterior leaflet alone offers excellent results that are comparable to those of patients with total chordal preservation.
Mixed Venous-Arterial CO2 Tension Gradient after Cardiopulmonary Bypass
Authors: Takami Yoshiyuki , Masumoto Hiroshi
Published: May 2013

Significant venous hypercarbia has been reported in septic shock and circulatory failure. Cardiopulmonary bypass also impairs systemic and pulmonary blood perfusion. The objective of this study was to determine the clinical significance of the increased venous-arterial CO2 tension gradient resulting from venous hypercarbia after cardiopulmonary bypass. On arrival in the intensive care unit, venous and arterial CO2 tensions were measured in the radial and pulmonary arteries in 140 consecutive patients who had undergone coronary ( n = 79), valve ( n = 34), aortic ( n = 20), and other ( n = 7) surgery under cardiopulmonary bypass. The mean venous-arterial CO2 tension gradient was 5.0 ± 3.3 mm Hg (range, 7.7 to 15.7 mm Hg). By linear regression analysis, the factors that significantly correlated with venous-arterial CO2 tension gradient were bypass duration, aortic crossclamp time, initial arterial lactate level, transpulmonary arteriovenous lactate difference, arterial bicarbonate level, base excess, cardiac index, mixed venous O2 saturation, O2 delivery, O2 consumption, and the peak value of creatine kinase. The venous-arterial CO2 tension gradient may reflect impaired perfusion and anaerobic metabolism induced by cardiopulmonary bypass and could be a simple and useful indicator for patient management after surgery under cardiopulmonary bypass.
A Very Rare Entity: Catamenial Pneumothorax
Authors: Poyraz A Serhan , Kilic Dalokay , Hatipoglu Ahmet , Demirhan Beyhan A
Published: May 2013

Catamenial pneumothorax, a variant of spontaneous pneumothorax occurs exclusively in women of menstrual age. Catamenial pneumothorax is associated with a high rate of recurrence. The etiology and pathogenesis is enigmatic. We describe the case of a 42-year-old woman with right-sided catamenial pneumothorax recurring four times, caused by ectopic endometriosis in the pleural layers which was confirmed histopathologically. Surgical treatment should be accomplished during menstruation for optimal visualization of pleurodiaphragmatic endometriosis.
Comparison of Antihypertensives after Coronary Artery Surgery
Authors: Toraman Fevzi , Karabulut Hasan , Goksel Onur , Evrenkaya Serdar , Tarcan Sumer , Alhan Cem
Published: May 2013

Hypertension following coronary artery bypass grafting is a common problem that may result in postoperative myocardial infraction or bleeding, Hemodynamic effects were compared in 45 hypertensive coronary bypass patients randomized to receive either diltiazem, nitroglycerin, or sodium nitroprusside. Diltiazem was administered as an intravenous bolus of 0.3 mg·kg−1 within 5 min, followed by infusion of 0.1–0.8 mg·kg−1·h−1 in group 1. Nitroglycerin was infused at a rate of 1–3 μg·kg·h−1 in group 2, and sodium nitroprusside was given at a rate of 1–3 μg·kg−1·min−1 in group 3. Hemodynamic measurements were carried out before infusion (T1) and at 30 min (T2), 2 h (T3), and 12 h (T4) after initiation of treatment in the intensive care unit. Mean arterial pressure decreased significantly in all groups. There were no differences among groups at T1 and T2. At T3, heart rate in group 2 was significantly higher than group 1. At T3 and T4, the double product was highest in group 3 (group 1 vs. 3, p < 0.001). These results suggest that the hemodynamic effects of the 3 drugs are similar within the first 30 min. However, after 30 min, diltiazem affords better myocardial performance and more effective control of hypertension.
Long-Term Pulmonary Function after Lobectomy for Primary Lung Cancer
Authors: Funakoshi Yasunobu , Takeda Shin-Ichi , Sawabata Noriyoshi , Okumura Yoshitomo , Maeda Hajime
Published: May 2013

The aim of this study was to investigate the factors affecting long-term postoperative pulmonary function with a view to increasing the application of combined resection, bronchoplasty, and induction therapy. Results in 80 patients who underwent lobectomy for primary lung cancer were analyzed. Predicted postoperative pulmonary function was calculated using the formula: postoperative predicted function = preoperative function × [1 − (b − n) /(42 − n)], where n and b are the numbers of obstructed segments and total segments, respectively, in the resected lobe. Spirometry was performed serially on the preoperative day, and at 3, 6, 12, 18, and 24 months postoperatively. The difference between the predicted postoperative pulmonary function and the function measured at 12 months postoperatively was calculated, and clinical and therapeutic variables were analyzed. Univariate analysis revealed that the difference in vital capacity was significantly related to surgical approach, bronchoplasty, and induction therapy, while the difference in forced expiratory volume in one second (FEV1) correlated with surgical approach and induction therapy. Multiple regression analysis showed induction therapy to be the sole factor related to the differences in both vital capacity and FEV1. Lung resection after induction therapy may cause an additional loss of pulmonary function in the late phase.
Nosocomial Infections and Balloon Counterpulsation: Risk Factors and Outcome
Authors: Pawar Mandakini , Mehta Yatin , Ansari Abdul , Nair Rajeev , Trehan Naresh
Published: May 2013

Between February and September 2003, 136 (5.3%) of 2,558 patients undergoing cardiac surgery were supported with intra-aortic balloon counterpulsation. There were 71 infected (group 1) and 65 noninfected (group 2) patients. Risk factors for nosocomial infections were identified by univariate and multivariate analysis. On univariate analysis, significant risk factors were operation time, balloon pump duration, ventilation hours, duration of central venous catheter placement, amount of blood transfused, left ventricular ejection fraction < 30%, intra- and/or postoperative intra-aortic balloon counterpulsation, surgery under cardiopulmonary bypass, combined procedures, re-exploration, and Acute Physiology And Chronic Health Evaluation (APACHE) II score. On multivariate analysis, ventilation hours and amount of blood transfused were independently associated with group 1. Respiratory tract infections were common in the balloon counterpulsation population (41.1%). Mortality was significantly higher in patients needing balloon pump support (19.9%) compared to controls (1.1%), but it was similar in groups 1 and 2. Recognition of risk factors for postoperative infection in patients undergoing cardiovascular surgical procedures with intra-aortic balloon counterpulsation may help to improve their prognosis and allow more organized surveillance.
Autologous Pericardial Valved Conduit for the Ross Operation
Authors: Chotivatanapong Taweesak , Kasemsarn Choosak , Yosthasurodom Chaiwuth , Chaiseri Pradistchai , Sungkahapong Vibhan , Hengrussamee Kriengkrai
Published: May 2013

The feasibility and function of autologous pericardial valved conduit for right ventricular outflow tract reconstruction in the Ross operation were assessed. Between June 1997 and April 2002, 31 patients underwent this procedure at our institution; one was lost to follow-up. The other 26 males and 4 females were aged 17 to 60 years (mean, 36.6 years). Causes of aortic valve disease were infective endocarditis in 26 and rheumatic valve disease in 4. Mean follow-up was 16.7 months (range, 1–58 months). Preoperatively, 9 patients were in functional class II, 19 in class III, and 2 in class IV. Concomitant procedures included coronary artery bypass (1), mitral valve replacement (6), tricuspid valve replacement (1), and ventricular septal defect closure (1). Mean aortic crossclamp time was 199.4 min. There were 4 (13.3%) hospital deaths and no late death. Mean postoperative functional class was 1.17 with +0.36 aortic regurgitation, a peak gradient of 21.9 mm Hg (range, 6–59 mm Hg) across the conduit, and grade +0.96 pulmonary regurgitation. No conduit-related complication was detected. Use of autologous valved conduit for the Ross operation is feasible. Long-term follow-up is mandatory to assess durability.
Adaptive Cardiac Binding: A New Method for Treatment of Dilated Cardiomyopathy
Authors: Chekanov Valeri , Dumcius Arimantas , Karakozov Pavel
Published: May 2013

Adaptive cardiac binding, a new surgical procedure for advanced heart failure, allows a gradual increase in compression on the dilated heart, with separate loads on the left and right ventricles. A canine model of biventricular heart failure (anastomosis between the carotid artery and jugular vein and doxorubicin administration) was created. Twenty-four dogs were divided into 4 groups: control, adynamic cardiomyoplasty, plastic cardiac binding, and adaptive cardiac binding. In the adaptive cardiac binding group, fluid was added (35, 15, and 10 mL) to each side of the pouch at weeks 1, 2, and 3. Left ventricular ejection fraction was 59% ± 4% before induction of heart failure and 27% ± 2% 6 weeks later. Immediately after the main operation, left ventricular ejection fractions were 35 ± 3% (cardiomyoplasty), 34% ± 4% (plastic cardiac binding), and 35% ± 4% (adaptive cardiac binding). Four weeks later, left ventricular ejection fraction had not changed in the cardiomyoplasty (37% ± 3%) and plastic cardiac binding (32% ± 2%) groups, but significantly increased in the adaptive cardiac binding group (48% ± 5%); it had decreased to 23% ± 4% in controls. Adaptive cardiac binding is a promising new surgical approach for patients with end-stage heart failure.
Pulmonary Sequestration and Surgical Treatment
Authors: Genç Onur , Gürkök Sedat , Dakak Mehmet , Gözübüyük Alper , Özkan Murat , Çaylak Hasan
Published: May 2013

Pulmonary sequestration is nonfunctioning, abnormal pulmonary tissue existing inside or outside the visceral pleura. It is not connected to the tracheobronchial tree. In this study, the results of 8 patients, who were diagnosed with pulmonary sequestration and treated during hospitalization in Gülhane Military Medical Academy between 1996 and 2003, were reported. Sex, age, symptoms, diagnostic approach, operative findings, procedures and postoperative outcomes were reviewed. No postoperative complications were seen. In the long-term follow-up all patients were seen to be asymptomatic. We believe surgical resection is mandatory in order to avoid infection and destruction of the normal pulmonary parenchyma even in asymptomatic cases. Furthermore, when infection occurs, major resection such as lobectomy may be necessary rather than segmentectomy or wedge resection, which involves removal of minimal pulmonary parenchyma.
Low-Prime System Minimizes Transfusions and Hemodilution in Coronary Bypass
Authors: Beholz Sven , Zheng Liling , Rusche Martin , Kessler Michael , Konertz Wolfgang
Published: May 2013

Standard heart-lung machines lead to substantial hemodilution with associated impaired organ function and increased need for blood transfusions. The aim of this study was to evaluate the effect of the new PRECiSe low prime volume system on perioperative myocardial damage, hemodilution, and transfusions. In a case-matched prospective study, 40 patients undergoing coronary artery bypass surgery using PRECiSe were compared with 40 patients on a standard heart-lung machine. In the PRECiSe group, the prime volume was significantly reduced, resulting in less hemodilution and transfusion requirements during and after extracorporeal circulation: only 10% of patients needed transfusions vs. 35% in the control group, with an average transfusion need of 0.16 vs. 1.25 units. There were no significant differences in perioperative cardiac-specific enzymes. The PRECiSe system was considered safe and effective for coronary artery bypass surgery.
Perioperative Circulating Blood Volume and Cardiac Function in Valve Disease
Authors: Tsunooka Nobuo , Hamada Yoshihiro , Takano Shinji , Watanabe Yuji , Imagawa Hiroshi , Kawachi Kanji
Published: May 2013

Circulating blood volume is important in managing fluid balance and cardiac function after surgery under cardiopulmonary bypass. Appropriate management differs among the valve disorders, but perioperative blood volume has not yet been considered. From February 2001 to March 2003, perioperative blood volume, fluid balance, cardiac index, and left ventricular stroke work index were measured in 31 patients: 10 with aortic stenosis, 9 with aortic regurgitation, 3 with mitral stenosis, and 9 with mitral regurgitation. All immediate postoperative blood volume measurements were less than preoperative values, and gradually returned to baseline. At all time points, blood volume in patients with aortic or mitral regurgitation was high, whereas it was low in those with stenosis, especially mitral stenosis. Fluid balance was positive in all patients. Postoperatively, there was a positive correlation between cardiac index and blood volume in all groups. The left ventricular stroke work index in the mitral regurgitation group was significantly higher than other groups, the aortic stenosis group was slightly lower, the mitral stenosis and mitral regurgitation groups were higher than the baseline, and the aortic regurgitation group was essentially unchanged. Thus, it is necessary to consider blood volume perioperatively in different valvular diseases to manage water balance.
Left Ventricular Rupture after Mitral Valve Replacement: A Report of 13 Cases
Authors: Zhang Huai-Jun , Ma Wei-Guo , Xu Jian-Ping , Hu Sheng-Shou , Zhu Xiao-Dong
Published: May 2013

Left ventricular rupture after mitral valve replacement is a rare but lethal complication. Between 1995 and 2003, left ventricular rupture occurred in 13 of 5,449 patients who underwent mitral valve replacement, with an incidence of 0.24%. There were 4 immediate ruptures and 9 delayed ruptures. Urgent repair of the rupture was performed under cardiopulmonary bypass in 11 cases. All mitral prostheses were explanted. External repair alone was performed in one patient. External repair combined with internal repair was performed in 10 patients. Two patients died of cardiac tamponade and failure of cardiac resuscitation. Of the 11 patients who had a re-operation, 6 died in hospital and 5 survived. The mortality was 61.5% (8/13). At a mean follow-up of 4 years, 2 patients were in New York Heart Association functional class II and 3 were in class III. Proper diseased valve removal, decalcification, and prosthesis selection could minimize the incidence of left ventricular rupture. Immediate diagnosis and urgent surgical intervention are crucial for successful repair.
Long-Term Results of Triple-Valve Procedure
Authors: Sakamoto Yoshimasa , Hashimoto Kazuhiro , Okuyama Hiroshi , Ishii Shinichi , Inoue Takahiro , Kinouchi Katsushi
Published: May 2013

Triple-valve procedures are associated with high early and late mortality. We reviewed our experience in 25 patients who underwent combined mitral and aortic valve replacement with tricuspid valve repair or replacement between 1979 and 2004. The mean follow-up was 7.8 years (range, 10 days to 24.5 years). The mean age at operation was 52 years (range, 31 to 72 years). Four patients underwent triple-valve replacement and 21 had double-valve replacement and tricuspid annuloplasty. Perioperative mortality was 20% and late mortality was 24%. Cumulative survival, calculated taking perioperative mortality into account, was 71% ± 10% at 10 years and 36% ± 15% at 15 years after surgery. Only 1 of 20 perioperative survivors required re-operation for prosthetic valve dysfunction. Double-valve replacement with tricuspid annuloplasty offers satisfactory long-term survival with freedom from thromboembolism and re-operation.
Above-Knee Vein Harvest for Coronary Revascularization Increases ASEPSIS Score
Authors: Akowuah Enoch , Shrivastava Vivek , Ponniah Alan , Jamnadas Binal , Chilton Gary , Cooper Graham
Published: May 2013

The long saphenous vein may be harvested from the thigh or the lower leg, depending on the operating surgeon's preference. This prospective study compared the incidence of altered wound healing between these two sites in 175 patients undergoing routine coronary artery bypass grafting over a 3-month period. The patients were divided into 3 groups. In group A, the vein harvest site was restricted to above the upper border of the patella. Group B included harvest sites that started at the ankle but extended above the level of the upper border of the patella. In group C, the vein harvest site was restricted to below the upper border of the patella. The wounds were assessed daily using the ASEPSIS scoring system. In group A, significantly more patients (24%) had an ASEPSIS score > 10, compared to group B (3%) and group C (2%). The mean ASEPSIS score was significantly lower in group C than groups A or B, 1.5 ± 2.4 vs. 6.5 ± 3.2 or 3.7 ± 1.7, respectively. The ASEPSIS score is reduced when vein harvest is restricted to below the level of the knee.
New Anastomosis Assist Devices for Coronary Artery Bypass Grafting
Authors: Shimamura Yoshiei , Takemura Takahiro , Agematsu Kouta
Published: May 2013

Two new graft holders and an anastomosis assist mirror, designed for coronary artery bypass grafting, are described. The graft holders are pinching devices with sponges inside to prevent graft injury. The anastomosis assist mirror is a small circular mirror designed to show a reflective view of the lateral or posterior wall of the heart. Together they can provide secure stabilization of the graft and an excellent view of the anastomotic site.
Late Entrapment of Ball and Cage Valve in Mitral Position
Authors: Akbari Jayesh G , Varma Praveen K , Gadhinglajkar Shrinivas V , Neelakandhan Kurur S
Published: May 2013

A 32-year-old female underwent mitral valve replacement with total chordal preservation (Miki's technique) using 26mm (1M) Starr-Edward prosthesis (SEP) in 1988. The patient was in NYHA class-I until 2001. She progressed to NYHA class-III with paroxysmal nocturnal dyspnoea. Transthoracic echocardiogram showed increased prosthetic valve gradient, and cardiac catheterization confirmed the findings. Intraoperatively, the poppet movement in the cage was found to be restricted due to the preserved subvalvular apparatus entrapping the poppet inside the prosthetic valve cage.
A Surgical Case of Symptomatic Coronary Artery-Pulmonary Artery Fistula
Authors: Saito Aya , Ono Minoru , Motomura Noboru , Hirata Yasutaka , Morota Tetsuro , Takamoto Shinichi
Published: May 2013

We describe a 55-year-old female patient with multiple plexiform coronary artery-pulmonary artery fistulas, who presented with ischemic episodes accompanying an inversion of T wave on an electrocardiogram even though it was a small shunt size. The surgical procedure involved closure of the openings of the fistulas from inside the pulmonary trunk using cardiopulmonary bypass with additional ligations. Postoperative coronary angiogram revealed complete interruption of the coronary artery-pulmonary trunk fistulas resulting in complete resolution of the patient's chest symptoms.
A Pitfall in Ligation of Intrahepatic Shunting after Fontan Type Operation
Authors: Ikeda Akihiko , Hiramatsu Yuji , Horigome Hitoshi , Hori Tetsuo , Noma Mio , Sakakibara Yuzuru
Published: May 2013

An 8-year-old boy experienced progressive cyanosis after a Fontan type operation. Under the guidance of intraoperative color Doppler we performed a transabdominal ligation of the accessory hepatic veins which drained into a common atrium. Reoperation was needed through a median sternotomy to eliminate residual shunting. Although intraoperative Doppler is useful to aid in the ligation of accessory veins while portal hypertension is monitored, intraoperative angiogram serves better to ensure the elimination of intrahepatic shunting in a transabdominal approach.
Post-Pneumonectomy Syndrome in an Adult Presenting with Positional Syncope
Authors: Gebitekin Cengiz , Bayram Ahmet S
Published: May 2013

Post-pneumonectomy syndrome is a rare late complication of pneumonectomy, which is due to extreme mediastinal shift and rotation into the pneumonectomy space. Recurrent syncope following a right pneumonectomy in a 21-year-old woman was treated by insertion of an expandable silicone prosthesis into the pneumonectomy space.
Sternotomy Reconstruction with Omentum Followed by Large Diaphragmatic Hernia
Authors: Vrtik Marian , Cameron David , Edwards Mark G
Published: May 2013

Poststernotomy mediastinitis carries significant morbidity and mortality. Aggressive wound debridement combined with a pedicled omental flap, with or without a pedicled muscle flap, has gained acceptance in the management of difficult sternal wound infections. Two cases of poststernotomy mediastinitis and sternal wound reconstruction with a pedicled omental flap were complicated by a large anterior diaphragmatic hernia containing the large bowel.
Rhesus Positivity and Low High-Density Lipoprotein Cholesterol: A New Link?
Authors: Kanbay Mehmet , Yildirir Aylin , Ulus Taner , Bilgi Muhammet , Kucuk Alparslan , Muderrisoglu Haldun
Published: May 2013

The aim of the study was to investigate the relationship of ABO and Rh blood groups with lipid profile in patients with established multivessel coronary artery disease in a population with low levels of high-density lipoprotein cholesterol. The records of 978 patients with multivessel coronary artery disease, in whom coronary bypass surgery was performed, were investigated. Coronary risk factors including diabetes, hypertension, smoking, and obesity were noted for each patient. Serum lipid profiles: total cholesterol, low-density and high-density lipoprotein cholesterol, and triglyceride levels, were also recorded. The mean age of the patients was 59.3 ± 9.7 years (range, 25–84 years) and 80% were male. The risk factors and lipid profiles of ABO blood types were similar. Rh-negative patients had higher levels of high-density lipoprotein cholesterol (46.9 ± 9.9 vs. 41.6 ± 10.4 mg·dL−1, p = 0.001) and a lower total/high-density lipoprotein cholesterol ratio (4.8 ± 1.3 vs. 5.2 ± 1.6, p = 0.029) compared to Rh-positive patients. The other lipid levels and risk factors had no association with Rh typing. These results indicate a significant association between rhesus positivity and low levels of high-density lipoprotein cholesterol in patients with multivessel coronary artery disease.
Terminal Warm Blood Cardioplegia in Mitral Valve Replacement: Prospective Study
Authors: Rergkliang Chareonkiat , Chetpaophan Apirak , Chittithavorn Voravit , Vasinanukorn Prasert , Chowchuvech Vorapong
Published: May 2013

Terminal warm blood cardioplegia has had a profound impact on cardiac surgery, especially in coronary artery bypass surgery, but there have been few studies on its use in mitral valve replacement. The purpose of this study was to determine whether terminal warm blood cardioplegia offers any advantages in mitral valve replacement. Forty patients with mitral valve disease were prospectively randomized to one of two groups of 20 with different techniques of myocardial protection: group A had cold blood cardioplegia, and group B had cold blood cardioplegia with terminal warm blood cardioplegia. Intraoperative and postoperative variables were used to assess primary outcomes. Postoperative troponin T release was measured as a secondary outcome. Improved spontaneous recovery of sinus rhythm was observed in group B, but the difference was not significant. The maximum doses of inotropics, duration of inotropic support, intensive care unit stay, and postoperative left ventricular ejection fraction were similar in both groups. Troponin T release at 0 and 6 h postoperatively was not different between the two groups. This study did not find any benefit of terminal warm blood cardioplegia in either clinical outcome or troponin T release after mitral valve replacement.
Vasodilator Resistant Lethal Spasm after Uncomplicated Off-Pump Coronary Surgery
Authors: Ueno Tetsuya , Ikeda Kazuyuki , Nakashima Atsushi
Published: May 2013

We report a case of lethal spasm of non-grafted coronary arteries after an uncomplicated off-pump coronary artery bypass grafting in a patient with no predisposing factors other than smoking. Transcatheter intraluminal injection of several vasodilators failed to relieve the spasm. The patient remained in profound cardiogenic shock due to broad acute myocardial infarction and died of multiple organ failure.
Anastomosis of Small Arteries: Implications for Coronary Artery Grafts in Asians
Authors: El Oakley Reida M , Lee Chuen Neng , Ooi Oon Cheong
Published: May 2013

The internal mammary artery (IMA) in patients with small body surface area, frequently found in the Asian population, is often small and delicate and can be easily damaged during suturing, particularly at the “toe” of the anastomosis. This may lead to less frequent utilization of the IMA as a bypass conduit. We describe a technique for anastomosing a small-caliber IMA to a coronary artery, using the tip of the graft as an autologous buttress to reinforce the toe of the anastomosis.
Video-Assisted Thoracic Surgery for Hemothorax following Coronary Artery Bypass
Authors: Samra Shivpreet S , Samra Navdeep S , Jain Ajeet , Mehta Vipin
Published: May 2013

A 56-year-old man complained of dyspnea and cough 9 days after coronary artery bypass grafting. Chest radiography showed opacity and left lung collapse. Following removal of clots from the pleural cavity by videothoracoscopy, he recovered without further incident. Video-assisted thoracic surgery is a feasible and safe option in the management of early hemothorax.
Mitral-Aortic Intervalvular Pseudoaneurysm with Ventricular Septal Defect
Authors: Yamamoto Shu , Tedoriya Takeo , Masuda Zenichi , Asai Tomohiro , Sano Shunji , Kawada Masaaki
Published: May 2013

A 35-year-old woman was found on echocardiography to have a pseudoaneurysm of the mitral-aortic intervalvular fibrosa, residual ventricular septal defect, and aortic regurgitation. She had undergone surgical closure of a ventricular septal defect at age 7 and was found to have residual shunt several years later. She had been followed nonsurgically and had symptoms of cardiac failure during her 2 pregnancies. The pseudoaneurysm and the septal defect were successfully repaired.
Late Mortality and Morbidity in Elderly Patients with Mechanical Heart Valves
Authors: Sawaki Sadanari , Usui Akihiko , Abe Tomonobu , Yoshikawa Masaharu , Akita Toshiaki , Ueda Yuichi
Published: May 2013

A retrospective study was performed in patients under and over 65 years old implanted with a mechanical valve, to compare late mortality and morbidity. Of 381 patients who underwent mechanical valve replacement at Nagoya University in the 1990s, 357 (11 hospital deaths and 13 lost to follow-up; 96.4% follow-up rate) were followed up for 7.9 ± 3.3 years (2,811 patient-years). They were divided into two groups either side of 65 years of age at operation. The young and elderly patient groups contained 275 and 82 patients, respectively. The survival rate in the young group was 96.1% (95% confidence interval, 93.7%–98.5%) at 5 years and 92.0% (95% confidence interval, 88.3%–95.7%) at 10 years, which was significantly better than 88.0% (95% confidence interval, 80.6%–95.4%) at 5 years and 73.8% (95% confidence interval, 66.2%–85.4%) at 10 years in the elderly group. The two groups did not differ significantly in the incidence of thromboembolic events, bleeding events, endocarditis, or reoperation. We are also encouraged by the fact that mechanical valves are not a risk factor for late mortality or morbidity, even in elderly patients.
15-Year Comparison of Supra-Annular Porcine and PERIMOUNT Aortic Bioprostheses
Authors: Jamieson WR Eric , Germann Eva , Aupart Michel R , Neville Paul H , Marchand Michel A , Fradet Guy J
Published: May 2013

The second-generation Carpentier-Edwards bioprostheses, the supra-annular porcine valve and the PERIMOUNT pericardial valve, have been evaluated longitudinally for several years. This study compared clinical performance over 15 years. Aortic valve replacement was performed with a supra-annular porcine valve in 1,823 patients (group 1) aged 19–89 years (mean, 68.9 ± 10.9 years) and with a PERIMOUNT pericardial bioprosthesis in 1,430 patients (group 2) aged 16–90 years (mean, 69.5 ± 10.4 years). The groups were similar except for concomitant coronary artery bypass in 43% of group 1 and 18% of group 2 ( p < 0.001). Overall survival at 15 years was 29.3% ± 1.5% for group 1 and 35.2% ± 3.1% for group 2 ( p = 0.0009). The actual freedom from valve-related mortality was 88.5% ± 0.9% for group 1 and 84.9% ± 1.7% for group 2. The actual freedom from structural valve deterioration at 15 years was similar overall, and for patients aged > 60 years, between the groups, but was dissimilar (group 2 > group 1) for age ≤ 60 years. The predictors of structural valve deterioration were valve type (group 1 > group 2), sex (male > female), age, and concomitant coronary artery bypass. Both bioprostheses provided satisfactory clinical performance at 15 years after aortic valve replacement.
Left Ventricular Aneurysmectomy: Tailored Scar Excision and Linear Closure
Authors: Kalkat Maninder S , Dandekar Uday , Smallpeice Chris , Parmar Jitender , Satur Chris , Levine Adrian
Published: May 2013

Coronary artery bypass surgery with or without aneurysmectomy is used to treat patients with left ventricular aneurysm. There is debate about patient selection and the appropriate surgical technique. We analyzed the results of 102 consecutive patients who underwent left ventricular aneurysmectomy and reconstruction using a modified linear closure technique between 1992 and 2003. The mean age was 62 years, 81% of the patients were male, and 47% had an ejection fraction < 35%. The locations of the left ventricular aneurysms were anteroapical (75%), apical (21%), and posteroinferior (4%); 23% contained thrombi. Additional procedures included aortic valve replacement in 4, mitral valve repair in 1, and coronary bypass grafting in 98 patients; 3 underwent isolated repair of left ventricular aneurysm. Hospital mortality was 7% and long-term survival was 76% at a mean follow-up of 39 months. Most patients improved symptomatically postoperatively. Left ventricular aneurysm repair with tailored scar excision and a modified closure technique is associated with acceptable mortality and long-term survival.
Landiolol Enhances Effect of Ischemic Preconditioning in Isolated Rabbit Hearts
Authors: Mieno Shigetoshi , Horimoto Hitoshi , Kishida Kenji , Horimoto Sachiko , Sasaki Shinjiro
Published: May 2013

The effect of the ultra-short-acting beta blocker, landiolol, on ischemic preconditioning was examined in isolated rabbit hearts. Ischemic preconditioned hearts received 2 episodes of 5 min each of global ischemia and reperfusion. The left anterior descending coronary artery was occluded for 1 hour and reperfused for 1 hour. Left ventricular end-systolic and end-diastolic pressures and infarct size were measured. Seven control hearts had no drug infused. Four groups of 6 hearts each were pretreated with 1 or 3 μM of landiolol or a combination of 1 or 3 μM landiolol and ischemic preconditioning. A further group of 6 hearts had ischemic preconditioning without landiolol. Ischemic preconditioning significantly reduced left ventricular end-diastolic pressure and infarct size compared to the controls. Landiolol alone did not change left ventricular end-diastolic pressure or infarct size, but landiolol 3 μM and ischemic preconditioning decreased left ventricular end-diastolic pressure more than preconditioning alone. These data suggest that pre-ischemic landiolol infusion may enhance the cardioprotective effect of ischemic preconditioning.
Giant Bronchogenic Cyst Mimicking Tension Pneumothorax
Authors: Demircan Sedat , Kurul I Cüneyt , Tokur Mahmut , Memis Leyla , Okur Ilyas
Published: May 2013

An 18-month-old girl presented with high fever and vomiting. Pneumothorax and a cystic formation in the right hemithorax were found on a chest radiograph. The cyst measuring 10 × 10 × 8 cm was resected by a simple wedge resection. Histology revealed a complicated bronchogenic cyst with abscess formation.
Adult Dysphagia Associated with Type B Double Aortic Arch
Authors: Shanmugam Ganesh , Pollock James
Published: May 2013

Esophageal compression secondary to a double aortic arch is rare in adults due to its propensity to cause severe symptoms in infancy or childhood. We report four adult patients with dysphagia associated with a double aortic arch. Chromosome analysis in one of these patients revealed a balanced translocation between chromosomes 4 and 18 – this has not been previously reported. Surgical division is indicated in all symptomatic patients and provides excellent operative results.
Intraoperative Aortic Dissection in Pediatric Heart Surgery
Authors: Hibino Narutoshi , Harada Yorikazu , Hiramatsu Takeshi , Yasukochi Satoshi , Satomi Gengi
Published: May 2013

Intraoperative aortic dissection occurred in a 3-year-old-boy undergoing repair of an atrial septal defect. Transesophageal echocardiography was useful for the diagnosis, and conservative medical treatment under close observation was feasible in this case which involved a limited intimal tear.
Chylothorax after Aortic Valve Replacement
Authors: Ergenoglu Mehmet U , Sanisoglu Ilhan , Sagbas Ertan , Yaman Resit , Guden Mustafa , Akpinar Belhhan
Published: May 2013

A 71-year-old-man was diagnosed with chylothorax after aortic valve replacement. He was treated with a low-fat diet and pleural drainage with thoracentesis. The pleural effusion completely resolved by the 14th postoperative day.
Restrictive Physiology in Tetralogy of Fallot: Exercise and Arrhythmogenesis
Authors: Rathore Kaushalendra S , Agrawal Surendra K , Kapoor Aditya
Published: May 2013

The effect of right ventricular restrictive physiology on exercise capacity and arrhythmogenesis after correction of tetralogy of Fallot was assessed in 80 patients aged 7.9 ± 3.6 years. Right ventricular restrictive physiology was defined as the presence of an A wave across the pulmonary artery on 2-dimensional echocardiography. At the 6 month follow-up, 52 patients had restrictive physiology (group 1). A transannular patch was used in 36 patients in group 1 (62%) and in 19 (86%) of the 28 patients without restrictive physiology (group 2). Maximum heart rate attained (69% vs. 77%), maximum predicted heart rate (211 ± 12.6 vs. 226 ± 24.2 beats·min−1), and metabolic equivalents (7.6 ± 3.2 vs. 8.1 ± 2.6) were higher in group 2, but not significantly. The chronotropic index was similar in both groups. In group 1, 14% of patients presented with ventricular premature complexes at 6 months. No effect on exercise capacity and arrhythmogenesis could be attributed to restrictive physiology, but both groups had chronotropic incompetence compared to normal children.
Right Hemothorax from Leaking Aortocoronary Vein Graft Giant Aneurysm
Authors: Singh Sushil K , Sharma Ashok K
Published: May 2013

Aneurysm of the saphenous vein aortocoronary bypass graft is a rare but potentially fatal complication of coronary artery bypass grafting (CABG). We report a case of an aneurysm of the saphenous vein aortocoronary bypass graft presented 7 years after redo CABG, with features of right atrial compression and right hemothorax. The patient was successfully treated surgically.